Episode 13: 2025 WHO Guidelines on Low Sodium Salt Substitutes with Prof. Mary L’Abbé & Prof. Jaime Miranda
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Prof Mary L’Abbé
Professor, University of Toronto
Director, Collaborating Centre on Nutrition Policy for Chronic Disease Prevention
Prof. Jaime Miranda
Professor & Head, School of Public Health, University of Sydney
Senior Editorial Advisor, Global Heart Journal
In this episode of the Global Heart Podcast, host Pablo Perez welcomes Prof. Mary L’Abbé and Prof. Jaime Miranda to unpack the 2025 WHO Guidelines on low-sodium salt substitutes. Prof. L’Abbé offers insights into the evidence, process, and recommendations behind the guideline, while Prof. Miranda discusses the broader implications for population health and sustainable development.
From hypertension and cardiovascular disease to global nutrition policy, this episode explores why salt substitution is being hailed as a potential game changer in public health.
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Key Takeaways:
Evidence Behind the Guidelines
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Blood Pressure Impact: Low-sodium salt substitutes reduce systolic BP by ~4.76 mmHg and diastolic BP by ~2.43 mmHg, with moderate-certainty evidence.
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Cardiovascular Outcomes: Substitution linked to a 30% reduction in coronary events and significant stroke risk reduction.
WHO Recommendation
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Conditional Recommendation: Endorsed for home use in adults only, with caution in those with kidney disease.
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Exclusions: Most studies excluded pregnant women, children, and people with kidney impairment—evidence not generalizable to those groups.
Implementation Challenges
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Equity & Access: Cost, healthcare infrastructure, and lack of kidney screening can hinder implementation in low-resource settings.
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Iodization Concerns: Salt iodization programs may need recalibration when replacing table salt.
Public Health Opportunity
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Prof. Miranda frames salt substitution as a population-level intervention, akin to statins and antiretrovirals.
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“Game Changer”: Calls for responsible rollout with built-in monitoring, citing its potential for broad societal and economic impact.
Beyond Health: Sustainable Development
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Links to SDG 3 (Health), SDG 8 (Workforce Productivity), SDG 13 (Climate), SDG 17 (Partnerships).
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Salt mining and production are not climate-neutral; alternatives may reduce environmental burden.
Research Gaps
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Lack of trials in children, pregnant women, transplant patients, and people with diagnosed CKD.
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Need for operational and supply-side research (e.g. logistics, economic incentives, delivery mechanisms).
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Questions about ideal sodium-potassium formulations remain open.
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Global health research: a shared responsibility
Prof. L’Abbé outlines three key pillars of global cardiovascular research:
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Clinical evidence for primary and secondary prevention
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Basic science on sodium metabolism and kidney interaction
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Public health research on population behavior and cost-effectiveness
Prof. Miranda adds a fourth: Reciprocity—shared learning and collaboration across global contexts.
Stay informed and advocate for change
Explore the full WHO guideline, Global Heart editorial, and related studies: