Professor Bruce Neal is Executive Director of the George Institute for Global Health, Professor of Medicine at the University of New South Wales and Professor of Clinical Epidemiology at Imperial College London. He works in the field of cardiovascular disease with a track record in the conduct of large-scale clinical trials. His work has supported the discovery and implementation of both novel drug therapies and dietary interventions. Professor Neal is the inaugural recipient of the brand new NHMRC Michael Alpers Global Health Award, recognising his Investigator Grant research into achieving global health gains from potassium enriched salt.
The role of salt in causing high blood pressure and ill health has been recognised for decades and there are more than a hundred trials showing the benefits of cutting salt intake for blood pressure. Unfortunately, despite the evidence, the translation of these findings into reduced salt consumption has been a failure.
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The problem is a simple one – humans like the taste of salt.
Sodium, the cation in salt (sodium chloride), is fundamental to cellular functioning, and ever since life emerged from a saline ocean environment, sodium has been in short supply. Terrestrial life is hard wired to seek out and consume sodium wherever it finds it.
The problem for humans is that sodium is now plentiful in the modern diet but our taste for salt remains and consequently, we hugely over consume sodium.
The paleolithic diet of our hominid ancestors provided about 0.5g of sodium a day whereas average global consumption is now 4.0g per day.
Our bodies cannot manage the huge excess sodium, and it causes blood pressure to rise throughout life and greatly increases the risks of strokes, heart attacks and kidney disease, as well as stomach cancer.
We have been strong supporters of global efforts, led by the World Health Organization, to reduce sodium intake. The strategy has focused on trying to get people and the food industry to cut the amount of salt added to food. However, because of our addiction to salt, these efforts have almost entirely failed. A different approach was required, and this is the basis for my current research on salt substitutes.
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Much less talked about than sodium, but equally important to life, is another cation, potassium. By contrast to sodium, potassium was abundant in our ancestor diets, with a paleolithic pattern of food consumption providing about 10g per day. A modern diet provides only about one third of this because we now eat fewer fresh fruits and vegetables. Diets low in potassium also increase the risk of developing elevated blood pressure and multiple cardiovascular diseases.
Potassium enriched salts offer a simple but elegant solution to these anomalies of a modern diet.
By switching out some of the sodium chloride in regular salt (100% sodium chloride) we can jointly decrease sodium intake and increase potassium intake to get additive blood pressure lowering.
Our landmark NHMRC funded Salt Substitute and Stroke Study showed that salt substitute with a 25% potassium chloride and 75% sodium chloride composition can reduce the risks of stroke, major cardiovascular events and premature death.
Acceptance of the switch was highly regarded with more than 90% of people still using the salt substitute after 5 years.
Receiving NHMRC funding, as well as the NHMRC Michael Alpers Global Health Award will enable me to start translating this discovery into health impact.
The very low cost of this salt substitute means that it has excellent potential for implementation, and the dietary form of the intervention offers simplified translation pathways.
Most importantly, the acceptability data shows that switching to potassium enriched salt is feasible in a way that cutting salt intake is not.
I am more excited about this work than anything else I have been involved with because if we can switch the world’s salt supply, we can prevent 3 million deaths and 10 million more non-fatal cases of cardiovascular disease each year.
This is unparalleled potential for something so simple, affordable and feasible. I signed up for medicine 40 years ago because I wanted to do something worthwhile. It has taken a lifetime to figure out, but with this opportunity, a fantastic team and strong global collaborators, we now have that opportunity.
The NHMRC Michael Alpers Global Health Award is named in honour of Emeritus Professor Michael Alpers AO CSM FAA FRS, whose pioneering work in tropical medicine and public health, particularly in Papua New Guinea, has had a lasting global impact. Professor Alpers dedicated his career to understanding and combating major health challenges such as malaria, pneumonia and other infectious diseases in Papua New Guinea. He is renowned for his groundbreaking research on Kuru, a degenerative neurological disease, that affected people in the Okapa District of Eastern Highlands Province.
This new award (in 2026) recognises excellence in global health research and will be given annually to a leading NHMRC funded researcher whose research focus is an area of global health, selected from the highest ranked grant recipients across NHMRC’s grant program.