Is potassium chloride a win-win by reducing sodium intake and increasing potassium intake?
Of all the bad things about our diet, a high sodium diet—eating too much salt—is the most dangerous. It is estimated to kill millions of people every year, killing mainly because of its adverse effects on blood pressure and the increased risk of stroke, heart disease, and kidney damage. High blood pressure (hypertension) is still called the “silent and invisible killer” because it rarely causes symptoms, but it is one of the strongest independent predictors of some of our leading causes of death.
We started eating a diet high in potassium and low in sodium, but today that pattern has been completely reversed. This shift reflects a shift away from a traditional plant-based diet that is low in potassium and sodium—a shift away from fruits, vegetables, roots, and legumes—and toward processed, salty foods that have been stripped of potassium, which is considered a “nutrient of public health concern” because 98% of the US population does not meet even the minimum recommended daily intake. As I mentioned earlier, a low potassium diet itself is linked to high blood pressure and heart disease. However, few doctors actually consider telling their patients to eat foods rich in potassium, such as fruits and vegetables, to better control blood pressure, although detailed analysis has confirmed that a high potassium diet seems to reduce the risk of stroke.
There is also a reduction in the risk of stroke independent of blood pressure effects, along with other protective effects of potassium, such as reducing the formation of clots, reducing arterial stiffness, and reducing the production of free radicals. A high sodium diet is associated with a 20% risk of premature death, while a high potassium diet is associated with a 20% reduced risk of premature death. Since sodium is found in unhealthy processed foods, while potassium is concentrated in healthy foods like beans and vegetables, could a low-sodium and high-potassium diet be a sign of a healthy diet—meaning more plant foods and less junk? How do we know sodium is cause-and-effect? it’s bad? Because randomized controlled trials show that sodium reduction leads to lower blood pressure, just as randomized controlled trials show that if people are given more 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 available in these zero-sodium salt bars, which you can see below and at 2:28 in my video. Do Potassium Chloride Salt Substitutes Work?.
Potassium chloride is considered a naturally occurring mineral salt, found in the same way as common sodium salt. Since we get too much sodium and not enough potassium, this would seem to make potassium chloride a winning solution.
A healthy plant-based diet can be the best way to increase your potassium intake, especially since fruits and vegetables have all kinds of other good things in them. But now we have 10 studies, including 11 randomized controlled trials, showing that simply substituting potassium chloride for common salt can lead to significant reductions in blood pressure in people with high blood pressure, suggesting that salt substitutes may also help prevent high blood pressure. We know that replacing salt can lower blood pressure, but does it actually reduce the incidence of high blood pressure, and more importantly, disease outcomes such as stroke and death? You never know until you put it to the test.
In a randomized controlled trial, families replaced their salt with a quarter of potassium chloride. At that level, most people couldn’t tell the difference or even chose salt mixed with potassium. But was it really helpful? Consuming even a quarter of a salt substitute was associated with a reduced risk of developing high blood pressure part.
But what about following people to see if there is a change in the risk of dying from heart disease? Five kitchens in a veterans’ retirement home were randomized into two groups for about two and a half years, salting food with either regular salt or, unbeknownst to the cooks and diners, a 50/50 mixture of potassium chloride. Those who are part of the potassium group reduce the risk of dying from heart disease by about 40% and live about a year longer. The difference in life expectancy at age 70 was “the same as what would naturally occur at 14. [years],” which means that just switching to half potassium salt has been shown to effectively reduce people’s risk of death by more than a decade. In a recent large randomized controlled trial in China involving 600 villages and more than 20,000 people over five years, participants received an alternative salt made from a quarter of potassium chloride, or they received only normal stroke salt, but not only normal stroke salt. and reduced the risk of death from all causes combined!
China is an ideal location for this study because up to 75% of people’s sodium intake comes from salt added in the home kitchen or dining room, while most of the sodium in the American diet comes prepackaged in the meat and processed foods we buy, although of course food companies can change them. Why didn’t they? And why haven’t more people embraced these salt supplements if they work so well and don’t taste the same? We can “Realize the Benefits of a High-Potassium, Paleolithic Diet, Without the Toxins,” says the title of a Mayo Clinic review. So, “Is Salt Change Right for Prime Time?” asked the analyst. What about security? There are convincing arguments about the benefits, but what about the risks, such as “salt substitution that could be detrimental to food availability”? Wait, what? We’ll talk about potential negatives next.
Doctor’s Note
This is the second in a three-part series on salt and potassium. If you missed the first video, check it out Mineral Intake Recommendations Only 1 in 6,000 US Adults Meet. We end the series with Are Potassium Chloride Salt Substitutes Safe and Effective?.
I’m talking about randomized controlled trials of sodium in Evidence That Salt Raises Blood Pressure.
