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.

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.