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  • Are Potassium Chloride Salt Substitutes Safe and Effective?

    Are Potassium Chloride Salt Substitutes Safe and Effective?

    Healthy kidneys are required for potassium excretion. If you aren’t sure if you’re at risk, ask your doctor about getting your kidney function tested.

    Based on how we evolved, the optimum dietary potassium intake likely greatly exceeds current and even recommended intakes. The problem is we replaced many of the potassium-rich plant foods that used to fill our diets—fruits, vegetables, leafy greens, roots, tubers—with calorie-dense junk heavy with added fats and sugars, and stripped not only of fiber but also potassium.

    In a traditional, mostly plant-based diet, potassium intake is high and sodium intake is low. But now, high blood pressure is the second leading risk factor for death worldwide, killing more than 10 million people each year. Only unhealthy diets rank higher among global risk factors for death, as you can see below and at 0:41 in my video Potassium Chloride Salt Substitute Side Effects.

    We can improve both by eating more whole, healthy plant foods like greens and beans, which are packed with potassium and help lower blood pressure. But since most of us are getting too much sodium along with too little potassium, what about using salt substitutes? Potassium chloride is the most common salt substitute, so you’d be swapping out sodium for potassium.

    And it works. Based on a meta-analysis of more than a dozen randomized controlled trials, replacing sodium chloride with potassium chloride lowers blood pressure. Most of the trials involved swapping out regular salt for substitutes with less than 30% potassium chloride, and they still got results. And at less than 30% potassium chloride, most people can’t even tell the difference between regular salt and the potassium salt. So, it can taste the same yet still lower blood pressure? What’s the catch?

    Potassium chloride is “generally regarded as safe” (GRAS) by the U.S. Food and Drug Administration. The only major concern for healthy people is that if you go 100% sodium-free and use potassium chloride salt substitutes exclusively, you may find it can taste kind of funny, adding a bitter or metallic taste. I’ve found that it depends on what I’m seasoning. Potassium chloride works perfectly well on some dishes and snacks, but I find it makes other foods inedible. When I learned about the sodium science and threw out my salt shaker for good, within a few weeks, my palate totally changed. Everything tasted fine without salt—except pesto. For some reason, pesto without salt didn’t have the same taste that I loved. So, I tried the potassium chloride salt substitute, and it worked perfectly. I couldn’t tell the difference at all! So, I had the best of both worlds. Then, I remembered how, as a kid, I used to put a tiny sprinkle of salt on watermelon like they do in the South to make it even sweeter. I tried it with the potassium salt and almost gagged. The salt substitute is definitely not for everything.

    The reason healthy people don’t have to worry about getting too much potassium is that they just pee out the excess, thanks to the kidneys. But that’s with the potassium in food—what about supplements? No adverse effects have been shown with long-term potassium supplementation at doses as high as 3,000 mg a day. In fact, blood levels of potassium are maintained in the normal range by healthy kidneys even when potassium intake is increased to about 15,000 mg a day. That’s no surprise since we evolved eating so many potassium-rich plant foods that the natural intake of potassium for the human species may have been on the order of 15,000 mg a day.

    Basically, the normal range for potassium levels in the blood is between 3.5 and 5.0 mmol/L; it becomes concerning when it starts creeping up towards 6 mmol/L. But give people potassium supplements—like the salt substitution trials where participants receive an average of about 2,000 daily milligrams—and blood levels only increase by 0.14 mmol/L. So, they might go from 4 to 4.14 mmol/L, not something that would push levels into the danger range.

    Now, there is a limit. Someone with a “massive banana eating habit” could bump their potassium from a normal level to above 6 mmol/L, but this specific case was evidently the result of eating little else besides up to 20 bananas a day for years. Eating 10 pounds of carrots every day is also probably not a good idea. That’s like 75 carrots in one day—only really possible with a juicer, which is what one person attempted as part of a quack cancer cure. What about overdoing salt substitutes?

    A 1940s report focused on lithium poisoning from the use of salt substitutes. Why? Because lithium chloride was used as a salt substitute. Yikes! But what about potassium chloride, which is what’s used today? There is one case where someone committed suicide by taking a little more than a tablespoon of a potassium chloride salt substitute. That doesn’t seem like a lot—just a tablespoon? I mean, how can we keep that on the shelves if only a tablespoon will kill you? Well, even smaller amounts of regular salt, if taken all at once, can kill you, too. In fact, ingesting salt water was evidently a traditional suicide method in ancient China.

    Having said all that, a small number of the population may run into problems, primarily people with severely impaired kidney function. That’s why there’s been such a reluctance to push potassium‐based salt substitutes on a population level. If your kidneys can’t regulate potassium, then it can definitely become a serious issue. We’re talking about folks with known kidney disease, diabetes (since diabetes can lead to kidney damage), severe heart failure, those on medications that impair potassium excretion, older adults, and people with adrenal insufficiency. If you aren’t sure if you’re at risk, ask your doctor about getting your kidney function tested.

    Ironically, potassium is so good at reducing deaths from high blood pressure—even among those with kidney disease—that using potassium chloride salt substitutes would probably still save more lives despite the risk, as you can see below and at 5:45 in my video.

    Traditional dietary recommendations to kidney patients limited the consumption of fruits and vegetables because they were high in potassium. However, this paradigm is changing quickly given the many benefits of a fundamentally plant-based diet. A whole food, plant-based diet may even ameliorate chronic kidney disease. For example, there’s increasing evidence that a whole food, plant-based diet may help slow the progression of chronic kidney disease and delay kidney failure. So, the practice of restricting dietary potassium in kidney patients should really be reserved for patients with documented hyperkalemia, a potassium level of 6 or higher, because the key to halting the progression of chronic kidney disease might in fact lie in the produce aisle.

    Doctor’s Note

    If you are in crisis, you can call the National Suicide Prevention Lifeline 24 hours a day, seven days a week, at 800-273-8255.

    This is the final blog in a three-part series. If you missed the first two, check out The Mineral Intake Recommendations Only 1 in 6,000 U.S. Adults Meet and Are Potassium Chloride Salt Substitutes Worth Trying?.



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  • Are Potassium Chloride Salt Substitutes Worth Trying?

    Are Potassium Chloride Salt Substitutes Worth Trying?

    Is potassium chloride a win-win by decreasing sodium intake and increasing potassium intake?

    Of all the terrible things about our diets, high dietary sodium intake—high salt intake—is the leading risk. It’s estimated to be causing millions of deaths every year, killing mainly through adverse effects on blood pressure and increased risk of stroke, heart attack, and kidney damage. Hypertension (high blood pressure) is still called the “silent and invisible killer” because it rarely causes symptoms, but it’s one of the most powerful independent predictors of some of our leading causes of death.

    We evolved eating a diet very rich in potassium and low in sodium, but today that pattern has been completely reversed. This flip reflects a shift away from traditional plant-based diets high in potassium and low in sodium—a shift away from fruits, greens, roots, and tubers—and a move towards salty processed foods stripped of potassium, which is considered a “nutrient of public health concern” because 98% of the U.S. population doesn’t even reach the recommended minimum daily intake. As I’ve mentioned previously, low potassium intake itself is implicated in high blood pressure and cardiovascular disease. However, few physicians actually consider telling their patients to eat more potassium-rich foods, like fruits and vegetables, to better control blood pressure, even though several meta-analyses have confirmed that high potassium intake appears to reduce stroke risk.

    There is even a reduction in stroke risk independent of blood pressure effects, consistent with other protective effects of potassium, such as reducing clot formation, reducing arterial stiffening, and reducing the generation of free radicals. Higher sodium intake is associated with a 20% increased risk of dying prematurely, while higher potassium intake is associated with a 20% reduced risk of dying prematurely. Since sodium is found in junky processed foods, while potassium is concentrated in healthy foods like beans and greens, could having low sodium intake and high potassium intake just be a marker for a healthier diet—meaning more plant foods and less junk? How do we know sodium is cause-and-effect bad? Because randomized controlled trials show that sodium reduction leads to blood pressure reduction, just like randomized controlled trials show that if people are given extra potassium, their blood pressure can be lowered as well. So, what about using potassium chloride to salt your food, rather than sodium chloride? That’s what’s found in these zero-sodium salt substitutes, which you can see below and at 2:28 in my video Are Potassium Chloride Salt Substitutes Effective?.

    Potassium chloride is considered a naturally occurring mineral salt, obtained in the same way as regular sodium salt. Since we get too much sodium and not enough potassium, this would seem to make potassium chloride a win-win solution.

    Whole healthy plant foods would be the best way to increase potassium intake, especially since fruits and vegetables have all sorts of other good things in them. But we now have 10 studies, comprised of 11 randomized controlled trials, showing that just swapping in some potassium chloride for regular salt can lead to significant reductions in blood pressure in people with hypertension, suggesting that salt substitutes may even help prevent hypertension as well. We know that salt substitutes can lower blood pressure, but does it actually decrease the incidence of hypertension, and more importantly, disease endpoints like stroke and mortality? You don’t know until you put it to the test.

    In a randomized controlled trial, households had their salt replaced with just a quarter potassium chloride. At that level, most people either couldn’t tell the difference or even preferred the salt with the potassium mixed in. But did it actually do any good? The use of even the quarter salt substitute was associated with cutting the risk of developing hypertension in half.

    But what about actually following people out to see if there’s any change in the risk of dying from cardiovascular disease? Five kitchens in a veterans’ retirement home were randomized into two groups for about two and a half years, salting meals with regular salt or, unbeknownst to the cooks and the diners, a 50/50 blend of potassium chloride. Those in the half potassium group cut their risk of dying from cardiovascular disease by about 40% and lived up to nearly a year longer. The life expectancy difference at age 70 was “equivalent to that which would have naturally occurred in 14 [years],” meaning that just switching to half potassium salt appeared to effectively make people more than a decade younger when it came to risk of death. In a recent massive randomized controlled trial in China involving 600 villages and more than 20,000 people over five years, participants received either a salt substitute made of a quarter potassium chloride, or they received regular salt. Not only did the salt substitute reduce strokes, and cardiovascular events in general, but it also reduced the risk of death from all causes put together!

    China is a perfect setting for this study because up to 75% of the population’s sodium intake comes from salt added in the home kitchen or dining room, whereas most sodium in the American diet comes prepackaged in the meat and processed foods we buy, though certainly the food companies could switch over themselves. Why haven’t they? And why haven’t more people embraced these salt substitutes if they work well and can taste just as good? We could be “Achieving the Benefits of a High-Potassium, Paleolithic Diet, Without the Toxicity,” says the title of a Mayo Clinic review. So, “Is Salt Substitution Ready for Prime Time?” a commentary asks. What about safety? There are convincing arguments about the benefits, but what about the risks, like the “inclusion of potentially fatal salt substitutes in the food supply”? Wait, what? We’ll talk about the potential downsides next.

    Doctor’s Note

    This is the second in a three-part series on salt and potassium. If you missed the first video, see The Mineral Intake Recommendations Only 1 in 6,000 U.S. Adults Meet. We finish the series with Are Potassium Chloride Salt Substitutes Safe and Effective?.

    I talk about the randomized controlled trials for sodium in The Evidence That Salt Raises Blood Pressure.

     



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  • Skip the Salt and Shake on Potassium Chloride?

    Skip the Salt and Shake on Potassium Chloride?

    Worldwide, physical inactivity accounts for more than 10 million years of healthy life lost, but what we eat accounts for nearly 20 times that. As I discuss in my video Fewer Than 1 in 5,000 Meet Sodium and Potassium Recommended Intakes, unhealthy diets shave hundreds of millions of disability-free years off people’s lives every year. What are the worst aspects of our diets? Four out of the five of the deadliest dietary traps involve not eating enough of certain foods—not eating enough whole grains, fruits, nuts, seeds, and vegetables—but our most fatal flaw is getting too much salt. To put things into perspective, our overconsumption of salt is on the order of 15 times deadlier than diets too high in soda.

    Our bodies are meant to have a certain balance of sodium and potassium intake, yet many people, including the majority in the United States, get vastly more sodium and far less potassium than the recommended amounts. Indeed, sodium and potassium goals are currently met by less than 0.015 percent of the U.S. population—close to 99.99 percent noncompliance, with only 1 in 6,000 Americans hitting the recommended guidelines.

     

    What’s So Bad About Salt?

    Of all the terrible things about our diets, high dietary sodium intake—that is, high salt intake—is the leading risk, estimated to be causing millions of deaths every year mainly through adverse effects on blood pressure and increased risks of stroke, heart attack, and kidney damage. Hypertension, known commonly as high blood pressure, is called the “silent and invisible killer” because it rarely causes symptoms but is one of the most powerful independent predictors of some of our leading causes of death. I discuss this in my video Are Potassium Chloride Salt Substitutes Effective?.

     

    How Much Sodium Is Healthy in a Day?

    Our bodies evolved to handle only about 750 milligrams of sodium a day. Nevertheless, the American Heart Association calls for us to stay under 1,500 milligrams, twice that amount. However, we’re consuming more than four times what’s natural, and it’s only getting worse, having increased over the last couple of decades. An eye-opening 98.8 percent of Americans exceed even that elevated 1,500 milligrams threshold.

     

    Daily Potassium Intake

    While many of us are consuming too much sodium, we may also be getting too little potassium, a mineral that lowers blood pressure. Less than 2 percent of U.S. adults, for instance, consume the recommended daily minimum intake of potassium based on chronic disease prevention. So, more than 98 percent of Americans may eat potassium-deficient diets. 

    This deficiency is even more striking when comparing our current intake with that of our ancestors, who consumed large amounts of dietary potassium. We evolved probably getting more than 10,000 milligrams of potassium a day. The recommendation was to get about half that amount, yet most of us don’t come anywhere close.

    Table showing recommended and US intake of sodium and potassium

     

    Why Are So Many of Us Lacking in Potassium?

    We evolved consuming a diet very rich in potassium and low in sodium, but, today, this pattern has been reversed. The flip reflects a shift away from traditional plant-based diets high in potassium and low in sodium towards the standard American diet. I’m talking about a shift away from fruits, greens, roots, and tubers to an eating pattern filled with salty, processed foods stripped of potassium.

     

    Why Do We Need Potassium?

    Low potassium intake has been implicated in high blood pressure and cardiovascular disease, and several meta-analyses have confirmed that high potassium intake appears to reduce the risk of stroke. It follows that potassium is now considered a “nutrient of public health concern” because most Americans don’t reach the recommended minimum daily intake.

     

    What Is the Best Substitute for Salt?

    Potassium chloride, which is often found in zero-sodium salt substitutes. We know from randomized controlled trials that sodium reduction leads to blood pressure reduction and increasing potassium intake can also lower blood pressure. So should we be “salting” our food with potassium chloride instead of sodium chloride?

     

    What Is Potassium Chloride? Is It a Viable (and Tasty) Salt Substitute?

    Potassium chloride is a naturally occurring mineral salt, which is obtained the same way we get regular sodium salt. Since we get too much sodium and not enough potassium, this would seem to make potassium chloride a win-win solution. Consider these examples:

    • In a randomized controlled trial, households had just 25 percent of the sodium chloride salt replaced with potassium chloride. At that level, most people either can’t tell the difference or even prefer the salt with the potassium mixed in. The findings? The use of the salt substitute with one-quarter potassium chloride was associated with cutting the risk of developing hypertension in half.
    • In another study, five kitchens in a veterans’ retirement home were randomized into two groups for about two and a half years. They either salted their meals with regular salt or, unbeknownst to the cooks and the diners alike, a 50/50 blend of potassium chloride. Those in the half-potassium group cut their risk of dying from cardiovascular disease by about 40 percent and lived up to nearly one year longer. The life expectancy difference at age 70 was equivalent to that which would have naturally occurred in 14 years––meaning that just switching to half potassium salt appeared to effectively make people more than a decade younger when it came to risk of death.

     

    Side Effects of Potassium Chloride?

    As I discuss in my video Potassium Chloride Salt Substitute Side Effects, potassium chloride is “generally regarded as safe” by the U.S. Food and Drug Administration. Healthy individuals don’t have to worry about getting too much potassium because their kidneys excrete any excess in urine, but that’s with potassium in food. What about supplements? No adverse effects have been shown for long-term intakes of potassium supplements as high as 3,000 milligrams a day, and blood levels of potassium are maintained in the normal range by healthy kidneys, even when potassium intake is increased to approximately 15,000 milligrams a day. This isn’t surprising, given that we evolved eating so many healthy plant foods, so many fruits and vegetables, rich in potassium.

    The normal range for potassium levels in the blood is between 3.5 and 5.0. There are a small number of individuals who may run into problems, primarily those with severely impaired kidney function. That’s why there’s been such a reluctance to push potassium‐based salt substitutes on a population level. Serious issues may arise if your kidneys can’t regulate your potassium. There may be concern if you have known kidney disease, diabetes (diabetes can lead to kidney damage), severe heart failure, or adrenal insufficiency, or if you’re an older adult or on medications that impair potassium excretion. If you aren’t sure if you’re at risk, ask your doctor about getting your kidney function tested.

     

    Conclusion

    National and international health organizations have called for warning labels on salt packets and salt shakers, with messages like “too much sodium in the diet causes high blood pressure and increases risk of stomach cancer, stroke, heart disease, and kidney disease. Limit your use.” So, pass (on) the salt shaker and try some potassium chloride instead.



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  • FDA Wants To Further Reduce Salt Levels In Packaged, Processed Food

    FDA Wants To Further Reduce Salt Levels In Packaged, Processed Food

    The U.S. Food and Drug Administration has announced a milestone in its voluntary sodium reduction program by completing the Phase I target and issuing draft guidance for Phase II. In this next phase, the FDA plans to further reduce sodium levels in packaged and processed food by 20%, to bring the average intake to about 2,750 milligrams per day.

    According to the U.S. Dietary Guidelines, a person should not consume more than 2,300 milligrams of sodium per day, which is about one teaspoon of salt. The FDA launched its sodium reduction program in 2021, setting a 2.5-year target. The goal for Phase I was to lower the average daily sodium intake from 3,400 milligrams to 3,000 milligrams.

    High sodium intake is linked to health issues such as increased blood pressure, a major risk factor for heart disease and stroke. Studies have shown that reducing sodium intake could prevent hundreds of thousands of premature deaths and illnesses. However, to effectively lower sodium consumption, changes need to be made in the food supply itself, as more than 70 percent of sodium comes from processed and prepared foods.

    “Reducing sodium in the food supply has the potential to be one of the most important public health initiatives in a generation. The early successes we’re seeing with sodium level reduction in certain foods is encouraging and indicative of the impact we believe our overall nutrition approach can have on the wellbeing of society,” FDA Deputy Commissioner for Human Foods Jim Jones said in a news release.

    Phase II will continue to target sodium levels in commercially processed, packaged, and prepared foods in the marketplace.

    “In addition to our sodium reduction efforts, the FDA is also actively working on a forthcoming final rule updating the definition of the claim ‘healthy,’ a proposed rule for front-of-package nutrition labeling and exploring ways to reduce added sugars consumption. The FDA’s sodium reduction and other nutrition initiatives are central to a broader, whole-of-government approach to help reduce the burden of diet-related chronic diseases and advance health equity,” Jones added.

    The American Heart Association (AHA) advises limiting sodium intake to no more than 2,300 milligrams per day, with an ideal limit of 1,500 milligrams for those with high blood pressure. They suggest that reducing daily sodium intake by 1,000 milligrams can significantly improve blood pressure and heart health.

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