Potassium chloride as substitute for salt - a benefit-risk assessment

Updated: see last paragraph.

A protocol was prepared for the project.

The project was postponed pending guidelines for salt substitutes from the World Health Organization, WHO.

Background

Excessive salt intake can, among other things, lead to high blood pressure and cardiovascular disease, so it is important to reduce salt intake in the population. The average salt intake in Norway is approximately 10 grams per day for men, and somewhat lower for women.

The Norwegian Directorate of Health's action plan for salt (2014-2018) aimed to reduce salt in the diet by 15 per cent by 2018 and 30 per cent by 2025. Replacing sodium chloride (salt) partly with potassium chloride has proven to be a good way to reduce salt.

Terms of reference

VKM was to examine the potential health effects from reduced intake of sodium chloride and a correspondingly increased intake of potassium chloride, for all age groups in Norway greater than one year old.

VKM was also to estimate intake of sodium chloride and potassium chloride from the diet where 0 - 30 per cent of sodium chloride is replaced with potassium chloride.

Update as of February 17 2025:

When VKM published the protocol for the project for public consultation, we were contacted by the World Health Organization (WHO), which informed us that they were working on a similar project. To avoid unnecessary duplication of work, VKM put its plans on hold, awaiting the completion of WHO's work.

WHO has now delivered its recommendation on the use of salt substitutes.

WHO recommends the use of potassium chloride as a salt substitute in household salt, but not as salt used in industrial food production. In light of WHO's recommendation, the Directorate of Health has decided that they do not need VKM to continue its assessment of the benefits and risks of using salt substitutes. Therefore, the work at VKM has been concluded.

The knowledge base for WHO's guidelines is published in a comprehensive systematic review. The reference for the knowledge base is: Brand A, Visser ME, Schoonees A, Naude CE. Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children, and pregnant women. Cochrane Database Syst Rev. 2022, Issue 8.