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Potassium

Specific Recommendations:

• Potassium citrate at Amazon.com and potassium citrate at iHerb.com

News & Research:

• Urinary Alkalization - .cystinuria.com - "Human urine can have pH ranging from about 4 (acid) to about 8 (alkaline). When urine pH rises above 7, cystine becomes much more soluble, so achieving a urine pH of 7.5-8 for a good part of the day is desirable ... For most people adequate alkalization does not occur without taking in extra base. It comes in many preparations. Potassium (K) citrate is preferable to sodium citrate preparations because sodium may increase cystine excretion" - See potassium citrate at Amazon.com.
• The James Buchanan Brady Urological - Kidney stone - jhu.edu - "Citrate is a molecule that binds to calcium in the urine, preventing calcium from binding to oxalate or phosphate and forming a stone. If your potassium level is low or normal, your doctor may prescribe potassium citrate supplement. If you have high blood potassium levels, your doctor may prescribe a sodium citrate supplement, such as Bicitra or sodium bicarbonate ... There is some evidence that citrus juices, such as orange juice or lemonade may increase urinary citrate levels, so these fluids would be particularly good for patients with hypocitra"
• Low Calcium, Potassium Key Risk Factors for Kidney Stones - Medscape, 8/1/22 - "A higher calcium diet is associated with a higher urinary pH, and citrate confers an alkali load which helps protect against the formation of calcium oxalate stones. Foods that are high in potassium also contain more fluid, citrate, and phytate, which, again, have been reported to be protective against kidney stones" - See potassium citrate at Amazon.com.
• Low-sodium salt prevents stroke - Science Daily, 8/30/21 - "Participants in intervention villages were given free salt substitute (about 75% sodium chloride and 25% potassium chloride) as a replacement for regular salt and advised to use it for all cooking, seasoning and food preservation. They were also encouraged to use the salt replacement more sparingly than they previously used salt to maximise their sodium reduction. Sufficient salt substitute was provided to cover the needs of the entire household (about 20 g per person per day). Participants in control villages continued their usual habits ... The risk of stroke was reduced with salt substitute compared to regular salt (29.14 versus 33.65 per 1,000 patient-years; rate ratio [RR] 0.86"
• Association Between Dietary Sodium, Potassium Intake and Lung Cancer Risk - Medscape, 4/29/21 - "Appropriate intake of potassium has a protective effect against lung cancer, while high consumption of sodium is associated with an increased risk of lung cancer" - See potassium citrate at Amazon.com.
• A need for bananas? Dietary potassium regulates calcification of arteries - Science Daily, 10/5/17 - "Bananas and avocados -- foods that are rich in potassium -- may help protect against pathogenic vascular calcification, also known as hardening of the arteries" - See potassium citrate at Amazon.com.
• Community-Wide Salt Swap Moves BP Needle, Halves Hypertension - Medscape, 9/2/19 - "Replacing regular high-sodium salt with a substitute containing 75% sodium and 25% potassium reduced overall systolic BP by 1.23 mm Hg (P = .004) and diastolic BP by 0.72 mm Hg (P = .022) from a baseline average of 113/72 mm Hg ... Systolic BP fell by 1.92 mm Hg among residents with hypertension and by 2.17 mm Hg in those aged 60 years and older ... even modest decreases in blood pressure at the population level bring us larger gains ... Previous work has shown that even a 2–mm Hg reduction in systolic BP can lower stroke mortality by 10% and mortality from ischemic heart disease or other vascular causes in middle age by 7%. Recent studies also have linked potassium supplementation with reduced BP ... A random 24-hour urine sampling of 600 participants showed that sodium levels remained unchanged from baseline (3.94 g vs 3.95 g) but that potassium levels increased from 1.97 g to 2.60 g ... "This is very important because when considering population use of salt substitute, the first thing that arises in every discussion is, 'What about the risks of hyperkalemia?' " Neal said. "I think those risks are probably greatly overstated because they probably only apply to a small proportion of the population with severe kidney disease, most of whom would be aware they have severe kidney disease and should also avoid potassium-salt substitutes." - Note:  This was only 25% potassium, Lite Salt is over 50% (290 mg sodium, 350 mg potassium] .  See potassium citrate at Amazon.com.
• Ask Well: Should I Take a Potassium Supplement? - NYTimes, 3/22/16 - "The daily requirement seems particularly difficult to meet by eating potassium rich foods ... The recommended daily intake for adults is 4,700 milligrams, but many Americans fall short because we don’t eat nearly enough fruits and vegetables .. Over-the-counter supplements and multivitamins cannot contain more than 100 milligrams of potassium because the mineral can cause serious side effects in people with kidney disease and may also interact with certain high blood pressure medications and over-the-counter painkillers, as well as laxatives. Since you would have to take a large number of supplements to get a significant amount of potassium, Ms. Angelone said, “It would be better to get potassium naturally.”" - I ignore the experts on this and take 800 mg per day divided up and with meals.  My yearly blood work still shows it a little on the low side.  See potassium citrate at Amazon.com.
• Upping Dietary Potassium May Have Protective Effect in Diabetes - Medscape, 11/24/15 - "The primary end point of the study was the first occurrence of any renal or CV events, which included initiation of renal-replacement therapy for end-stage renal disease and/or the occurrence of myocardial infarction, angina, stroke, peripheral vascular disease, and death from CV causes ... Compared with patients in the lowest quartile of urinary potassium excretion, patients in the third quartile were 44% less likely to reach the primary end point, while those in the fourth, highest quartile of urinary potassium excretion were 67% less likely to reach the primary end point at the end of the study interval"
• Potassium Intake and Stroke Mortality Risks - Medscape, 12/18/14 - "Comparing highest to lowest quartile of potassium intake with multivariate analyses yielded a hazard ratio of 0.90 (95% confidence interval [CI], 0.85-0.95) for all-cause mortality, 0.88 (95% CI, 0.79-0.98) for all stroke, and 0.84 (95% CI, 0.74-0.96) for ischemic stroke"
• Higher Potassium Intake Linked to Reduced Stroke - Medscape, 9/4/14 - "In the WHI study of older women aged 50-79, those without hypertension who had higher levels of potassium had a 27% reduced risk of stroke than women with low potassium levels ... in general, this population was well below the recommended daily allowance of potassium. In the United States, this is 4700 mg. The women in the WHI study had average intake of 2600 mg, which is very similar to average US intakes. Only 2.8% of women met or exceeded the 4700 mg recommended intake ... The World Health Organization recommends a potassium intake of more than 3510 mg per day, which may be easier to achieve, but still only 16% of women in this cohort met this requirement ... A baked potato contains 900 mg of potassium and a banana contains 420 mg"
• Reducing salt and increasing potassium will have major global health benefits - Science Daily, 4/4/13 - "increased potassium intake reduces blood pressure in adults, with no adverse effects on blood lipids, hormone levels or kidney function. Higher potassium intake was linked with a 24% lower risk of stroke in adults and may also have a beneficial effect on blood pressure in children, but more data is needed" - See potassium citrate at Amazon.com.
• Natural therapies: Cardiologists examine alternatives to halt high blood pressure - Science Daily, 8/30/11 - "The shining star among supplements is coenzyme Q10, an enzyme involved in energy production that also acts as an antioxidant. Patients with hypertension tend to have lower levels of the enzyme, and a meta-analysis -- an overarching analysis of past studies -- found that treatment with coenzyme Q10 supplements significantly reduced blood pressure ... Coenzyme Q10 has a pretty profound effect on blood pressure, but whenever research is based on a collection of other data you have to have some skepticism ... potassium helps lower blood pressure, and there is evidence that increasing the amount of potassium we get through the foods we eat could carry some of the same mild benefits as taking supplements" - See ubiquinol products at Amazon.com and potassium citrate at Amazon.com.
• Potassium, Calcium, and Magnesium Intakes and Stroke Risk - Medscape, 8/2/11 - "In conclusion, findings from this prospective cohort study of women suggest that potassium and magnesium intakes are inversely associated with risk of cerebral infarction among women with hypertension. We observed no protective effect of calcium intake on stroke risk"
• Sodium/Potassium Ratio Important for Health - Medscape, 7/12/11 - "During a mean follow-up of 14.8 years, there were a total of 2270 deaths, including 825 cardiovascular deaths and 443 ischemic heart-disease deaths. After multivariable adjustment, higher sodium intake was associated with increased all-cause mortality (HR 1.20 per 1000 mg/day), whereas higher potassium intake was associated with lower mortality risk (HR 0.80 per 1000 mg/day) ... For sodium-potassium ratio, the adjusted hazard ratios comparing the highest quartile with the lowest quartile were 1.46 for all-cause mortality, 1.46 for CVD mortality, and 2.15 for ischemic heart disease (IHD) mortality ... The results show that sodium/potassium ratio of <1 is protective ... One simple way of boosting potassium, she notes, is to replace regular snacks with fruit"
• Boost Potassium Intake to Cut Stroke by 20% - Medscape, 2/28/11 - "Potassium intake may be increased by well-described dietary changes, mainly an increase in fruit and vegetable consumption, as recommended by all guidelines to prevent vascular diseases ... those that are very rich in potassium--including bananas, tomatoes, oranges, apricots, and most legumes--is probably best ... The researchers identified 11 studies on the association between habitual dietary potassium intake and incidence of vascular events over the past 30 years ... In the pooled analysis, a 1.64-g (42 mmol)/day higher potassium intake--which Strazzullo says is equivalent to around three pieces of fruit high in potassium--was associated with a 21% lower risk of stroke (risk ratio 0.79; p=0.0007), with a trend toward lower risk of CHD and total CVD that attained statistical significance after the exclusion of a single cohort (RR 0.93; p=0.03 and RR 0.74; p=0.0037)"
• Serum Potassium May Predict Incident Type 2 Diabetes - Medscape, 10/29/10 - "Serum potassium level was inversely associated with the risk for incident diabetes, based on multivariate analyses. Compared with adults who had a high-normal serum potassium level (5.0 - 5.5 mEq/L), those with serum potassium levels less than 4.0 mEq/L, 4.0 to less than 4.5 mEq/L, and 4.5 to less than 5.0 mEq/L had an adjusted HR of incident diabetes of 1.64 (95% confidence interval [CI], 1.29 - 2.08), 1.64 (95% CI, 1.34 - 2.01), and 1.39 (95% CI, 1.14 - 1.71), respectively"
• Consumption of 'good salt' can reduce population blood pressure levels, research finds - Science Daily, 9/13/10 - "the average potassium intake in 21 countries including the US, China, New Zealand, Germany and the Netherlands varies between 1.7 and 3.7 g a day. This is considerably lower than the 4.7 g a day, which has been recommended based on the positive health effects observed at this level of intake ... A hypothetical increase in the potassium intake to the recommended level would reduce the systolic blood pressure in the populations of these countries by between 1.7 and 3.2 mm Hg ... Earlier studies have shown that salt reduction of 3 g per day in food could reduce blood pressure and prevent 2500 deaths per year due to cardiovascular diseases in the Netherlands. In Western countries, salt consumption can be as high as 9-12 g a day whereas 5 g is the recommended amount according to WHO standards"
• High potassium? Check your antibiotic - Science Daily, 7/1/10
• Risks from low potassium in heart failure patients with chronic kidney disease - Science Daily, 2/22/10 - "In findings reported in January in Circulation: Heart Failure, a journal of the American Heart Association, the researchers say that even a mild decrease in serum potassium level increased the risk of death in this patient group ... Hypokalemia, or low potassium, is common in heart-failure patients and is associated with poor outcomes, as is chronic kidney disease ... Death occurred in 48 percent of the patients with hypokalemia during the 57-month follow-up period, compared with only 36 percent of patients with normal potassium. The vast majority of subjects, 87 percent, had mild hypokalemia"
• Excessive Cola Consumption Can Lead To Super-sized Muscle Problems, Warn Doctors - Science Daily, 5/19/09 - "We are consuming more soft drinks than ever before and a number of health issues have already been identified including tooth problems, bone demineralisation and the development of metabolic syndrome and diabetes ... Evidence is increasing to suggest that excessive cola consumption can also lead to hypokalaemia, in which the blood potassium levels fall, causing an adverse effect on vital muscle functions ... It appears that hypokalaemia can be caused by excessive consumption of three of the most common ingredients in cola drinks – glucose, fructose and caffeine"
• Low-Sodium, High Potassium is Effective in Lowering Blood Pressure - Science Daily, 1/26/09 - "Those with the highest sodium levels in their urine were 20% more likely to suffer strokes, heart attacks, or other forms of cardiovascular disease compared with their counterparts with the lowest sodium levels. However this link was not strong enough to be considered statistically significant ... By contrast, participants with the highest sodium-to-potassium ratio in urine were 50% more likely to experience cardiovascular disease than those with the lowest sodium-to-potassium ratios. This link was statistically significant ... To lower blood pressure and blunt the effects of salt, adults should consume 4.7 grams of potassium per day unless they have a clinical condition or medication need that is a contraindication to increased potassium intake"
• Reducing Salt Intake Isn't The Only Way To Reduce Blood Pressure - Science Daily, 1/26/09 - "A new study suggests that people trying to lower their blood pressure should also boost their intake of potassium, which has the opposite effect to sodium ... To lower blood pressure and blunt the effects of salt, adults should consume 4.7 grams of potassium per day unless they have a clinical condition or medication need that is a contraindication to increased potassium intake"
• Potassium Loss From Blood Pressure Drugs May Explain Higher Risk Of Adult Diabetes - Science Daily, 11/24/08 - "a drop in blood potassium levels caused by diuretics commonly prescribed for high blood pressure could be the reason why people on those drugs are at risk for developing type 2 diabetes"
• Low Potassium Linked To High Blood Pressure - Science Daily, 11/8/08 - "As a risk factor for high blood pressure, low levels of potassium in the diet may be as important as high levels of sodium"
• Potassium citrate supplements linked to thicker bones - Nutra USA, 10/12/06 - "Taking potassium citrate supplements could boost bone mineral density by similar amounts as observed with pharmaceuticals ... At the end of the study, women taking the potassium citrate supplement are reported to have a significant, one per cent increase in BMD in the vertebrae of the lower back (lumbar spine), compared to baseline ... However, the bone mineral density of the lumbar spine of women taking the potassium chloride supplement (none alkaline) was found to have significantly decreased after one year of supplementation, by about one per cent"
• Good News for Salt Lovers - New Hope Natural Media Online, 8/3/06 - "The men who ate from the kitchens using potassium-enriched salt were about 40% less likely to die from cardiovascular disease than the men who ate from the kitchens using regular salt"
• Substituting Salt With a Potassium Salt May Benefit Elderly Veterans - Medscape, 6/14/06 - "subjects in the potassium chloride cohort had a hazard ratio of 0.59 for CVD mortality vs the control group ... Subjects in the potassium chloride group enjoyed an increased average life expectancy of 0.3 to 0.9 years vs the control group ... Dietary potassium chloride was associated with a significant reduction in the cost of inpatient care vs sodium chloride, with subjects in the experimental group incurring an average of $426 less inpatient cost per individual"
• Salt Substitute Significantly Reduces Hypertension Amongst Rural Chinese - Science Daily, 3/14/06 - "Among the 600 individuals studied in rural Northern China, the low-sodium high-potassium salt substitute demonstrated that it could reduce blood pressure to about the same extent as single drug therapy"
• Potassium Supplementation Reduces Blood Pressure - Healthwell Exchange Daily News, 10/30/03 - "59 healthy adults between the ages of 25 and 65 years were randomly assigned to receive 600 mg of potassium chloride three times per day or a placebo for six weeks ... Systolic blood pressure, diastolic blood pressure, and MAP all decreased significantly in those taking potassium (by 7.6 mmHg, 6.5 mmHg, and 7.0 mmHg, respectively), compared with initial measurements. A significant increase in blood pressure was observed in those taking placebo"
• Addition of Low-Dose Potassium to Diet Lowers Blood Pressure - Medscape, 8/19/03 - "KCl was administered as 1 slow-release tablet containing 8 mmol KCL taken 3 times daily with meals. This daily dose of potassium is equivalent to the content of 5 portions of fresh fruits and vegetables. At the end of the 6-week intervention, the 30 subjects who took potassium showed significant decreases in SBP and DBP (7.60 and 6.46 mm Hg, respectively)"
• Remember Sodium? We're Still Getting Too Much - Intelihealth, 3/14/03 - "In the case of osteoporosis, potassium appears to offset calcium losses from excessive sodium ... postmenopausal women with diets high in salt lost higher amounts of bone mineral. Eating potassium-rich foods such as bananas, tomatoes and orange juice helped stem the calcium loss"
• Low Dietary Or Serum Potassium Risk Factor For Stroke - Doctor's Guide, 8/27/02 - "Diuretic users had an increased risk for stroke which was associated with lower serum potassium (relative risk 2.5;P<0.0001). People who did not use diuretics had an increased risk for stroke if they had low dietary potassium intake (relative risk 1.5;P<0.005)"
• Potassium Citrate Thwarts Deleterious Effects of High Sodium Chloride Diet - Doctor's Guide, 10/14/01 - "oral potassium citrate prevents the increased calcium losses and bone turnover caused by a high dietary salt intake"

Abstracts:

• IV Potassium and Magnesium an Acute Treatment for AF? - Medscape, 10/27/22 - "Suppose I cut my finger while slicing bread. I put a Band-Aid on the cut. That doesn't mean I have fixed it, it means I've helped it temporarily. Atrial fibrillation in this paper is very analogous," he said. "The patient may have episodes, goes to the emergency room, you give them medication, and temporarily alleviate the situation so that the patient does not have to be admitted. It's simple, inexpensive, you make the heart rate go back to normal, not permanently, with few side effects, except perhaps for some pain at the injection site, but that doesn't mean you have fixed the AFib permanently. But for someone who has had a first incidence, or doesn't want to stay in the hospital because it's the weekend, yes, you can use this as a Band-Aid,"
• Over-the-counter alkali agents to raise urine pH and citrate excretion: a prospective crossover study in healthy adults - Urology 2022 Jul 14 - "In healthy participants without a history of kidney stones, LithoLyte® and KSPtabsTM are effective over-the-counter alkali supplements, with a similar side effect profile to prescription potassium citrate" - See LithoLyte® at Amazon.com and KSPtabsTM at Amazon.com. Related Study.
  • Potassium Citrate is Better in Reducing Salt and Increasing Urine pH than Oral Intake of Lemonade: A Cross-Over Study - Med Sci Monit. 2018 - "Potassium citrate supplementation improves pH of urine, decreases urine sodium level, and increases the risk of gastric discomfort and oropharyngeal discomfort. Potassium citrate binds with sodium in urine and decreases sodium level in urine, increases pH of urine, and ultimately reduces stone formation" - See potassium citrate at Amazon.com.
• Serum Potassium Levels of 4.5 to Less Than 5.0 mmol/L Are Associated with Better Vascular Function - J Atheroscler Thromb 2021 Dec 23 - "Serum potassium levels of 4.5-＜5.0 mmol/L are associated with better vascular function regardless of the presence or absence of treatment with drugs that could alter serum potassium levels" - Note: That's the higher third of normal. Mine is at 4.5 so maybe I should increase it a little. See potassium citrate at Amazon.com.
• Association between intake of sodium, potassium, sodium-to-potassium ratio, and blood pressure among US adults - Int J Vitam Nutr Res 2021 Dec 22 - "High dietary sodium and low potassium intake is associated with high blood pressure (BP). The current study aimed to determine if the sodium-to-potassium ratio is more strongly associated with low (130-139/80-89 mm Hg) and high (≥140/90 mm Hg) BP thresholds among US adults than either sodium or potassium alone ... The study confirms an inverse association between higher potassium intake and higher BP threshold. The Doses-response analyses showed sodium-to-potassium ratio is a better predictor of BP thresholds than sodium or potassium alone"
• Is there a relationship between dietary sodium and potassium intake and clinical findings of a migraine headache? - Br J Nutr 2021 Aug 11 - "Migraine Headache Index Score (MHIS) ... After controlling for potential confounders, the 24-hour urine Na was positively associated with a longer headache duration (β=0.29; 95% CI: 0.06, 0.53) in the group with the highest urine Na levels as compared to the group with the lowest levels. After adjustments for potential confounders, an increase of 13.05 in the MHIS was observed when the 24-hour urine Na level increased from the first to the third tertile ... Our findings suggested that a higher 24-hour urine Na level was positively associated with a longer duration of migraine headaches and a higher MHIS"
• Potassium chloride-based replacers: modeling effects on sodium and potassium intakes of the US population with cross-sectional data from NHANES 2015-2016 and 2009-2010 - Am J Clin Nutr 2021 Mar 23 - "Sodium intake in the USA exceeds recommendations. The replacement of added sodium chloride (NaCl) with potassium chloride (KCl) provides a potential strategy to reduce sodium intake ... feasible and practical (F&P) replacement of added NaCl with KCl in foods ... The F&P replacement of NaCl with KCl in top-ranking sources of dietary sodium modeled in this study can result in decreased sodium to a level consistent with the short-term intake goal targeted by the FDA of 3000 mg/d, with the mean potassium intake remaining in the range recommended for the apparently healthy population" - See Lite Salt at Amazon.com.
• Serum potassium in chronic kidney disease: prevalence, patient characteristics and clinical outcomes - Intern Med J 2020 Dec 13 - "Hyperkalaemia and hypokalaemia were present in 6.86% and 2.94% of hospital admissions, respectively. In multivariate regression male sex, lower eGFR, diabetes and cardiac failure were associated with higher odds of hyperkalaemia. Thiazide diuretics, loop diuretics, infectious disease and endocrine pathology were associated with higher odds of hypokalaemia. A U-shaped association was noted between potassium and inpatient mortality. Potassium <4.0 mmol/L and ≥ 5.0 mmol/L was associated with increased mortality. Only patients with potassium ≥5.5 mmol/L had increased ICU admission risk" - See potassium citrate at Amazon.com and iHerb.com.
• Potassium intake, skeletal muscle mass, and effect modification by sex: data from the 2008-2011 KNHANES - Nutr J 2020 Aug 29 - "skeletal muscle index (SMI) ... In men, higher potassium intake was associated with lower odds for low muscle mass; the fully adjusted odds ratios (95% confidence intervals) were 0.78 (0.60-1.03), 0.71 (0.54-0.93), 0.68 (0.51-0.90), and 0.71 (0.51-0.98) for the top four quintiles (referenced against the lowest quintile), respectively. However, this association was attenuated in women after adjusting for total energy intake. Higher potassium intakes were also associated with a greater SMI" - See potassium citrate at Amazon.com and potassium citrate at iHerb.com.
• Long-term potassium intake and associated renal and cardiovascular outcomes in the clinical setting -  - "High potassium intake has been suggested to lower the risk for renal and cardiovascular outcome ... We performed a retrospective cohort study in 541 outpatient subjects with an estimated glomerular filtration rate >60 mL/min/1.73 m2 who had sampled a 24-h urine collection between 1998 and 1999, and had at least 1 additional collection during a 17-year follow-up ... Average age of subjects was 47 years. Estimated mean potassium intake was 74 mmol/day and remained similar during follow-up. The highest tertile of estimated potassium intake was associated with a significant 76% reduction in renal outcome, and 73% decrease of cerebrovascular events, while no effect for overall cardiovascular outcome was found. A 20-mmol increase in potassium intake during follow-up was associated with a 24% reduction in renal outcome" - See potassium citrate at Amazon.com and potassium citrate at iHerb.com.
• Association of dietary sodium:potassium ratio with the metabolic syndrome in Chinese adults - Br J Nutr. 2018 Aug 2:1-7 - "higher dietary Na:K ratio significantly increased the risk of the MetS in Chinese adults" - See potassium citrate at Amazon.com.
• Association Between Urinary Sodium and Potassium Excretion and Blood Pressure Among Adults in the United States: National Health and Nutrition Examination Survey, 2014 - Circulation. 2017 Oct 11 - "Higher levels of sodium and lower levels of potassium intake are associated with higher blood pressure ... Hypertension was linearly associated with progressively higher sodium and lower potassium excretion; compared with the lowest quartiles of excretion, the adjusted odds of hypertension for the highest quartiles were 4.22 (95% CI 1.36, 13.15) for sodium, and 0.38 (95% CI 0.17, 0.87) for potassium, respectively"
• Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality - Circulation. 2017 Oct 12 - "Mean potassium at discharge was 4.3±0.48 mEq/L. Hypokalemia (<3.5 mEq/L), normokalemia (3.5 to 5.0 mEq/L), and hyperkalemia (>5 mEq/L) were observed at the index admission in 77 (3.6%), 1965 (90.8%), and 122 (5.6%) patients, respectively. At a median follow-up of 2.8 years (range=0.03-12.8 years), 1090 patients died (50.4%). On a continuous scale, the multivariable-adjusted association of potassium values and mortality revealed a non-linear association (U-shaped) with higher risk at both ends of its distribution (omnibus p-value=0.001). Likewise, the adjusted hazard ratios (HRs) for hypokalemia and hyperkalemia - normokalemia as reference - were 2.35 (95% confidence interval [CI]:1.40-3.93; p=0.001) and 1.55 (95% CI:1.11-2.16; p=0.011), respectively (omnibus p-value=0.0003). Furthermore, dynamic changes in potassium were independently associated with substantial differences in mortality risk. Potassium normalization was independently associated with lower mortality risk" - Note:  Correct me if I'm wrong but the way I read it, you're better off with high (1.55 risk) than low (2.35 risk) but normal is best (referenced 1.00 risk).  They're calling normal as 3.5 to 5.0 mEq/L. - See potassium citrate at Amazon.com.
• Dietary Sodium to Potassium Ratio and Risk of Stroke in a Multiethnic Urban Population: The Northern Manhattan Study - Stroke. 2017 Oct 10 - "In adjusted models, a higher Na:K ratio was associated with increased risk for stroke (hazard ratio, 1.6; 95% confidence interval, 1.2-2.1) and specifically ischemic stroke (hazard ratio, 1.6"
• Serum Potassium Is Positively Associated With Stroke and Mortality in the Large, Population-Based Malmö Preventive Project Cohort - Stroke. 2017 Oct 3 - "Serum potassium, measured in early mid-life, was linearly associated with both incidence of ischemic stroke and intracerebral hemorrhage and all-cause mortality. An interaction with serum sodium implies that factors related to electrolyte balance and incident hypertension may be mediating factors"
• Elevated Admission Potassium Levels and 1-Year and 10-Year Mortality Among Patients With Heart Failure - Am J Med Sci. 2017 Sep;354(3):268-277 - "Among hospitalized patients with HF, admission K > 5.5mEq/L was independently associated with increased short- and long-term mortality, whereas serum K ≥ 5mEq/L but ≤ 5.5mEq/L was not independently associated with worse outcomes"
• Effects of salt loading and potassium supplement on the circadian blood pressure profile in salt-sensitive Chinese patients - Blood Press Monit. 2017 Jun 16 - "Salt-sensitive (SS) patients ... Approximately 49 normotensive and mildly hypertensive Chinese patients received a study protocol of a 3 days of baseline examination, 7 days of a low-salt diet (3 g NaCl/day), 7 days of a high-salt diet (18 g NaCl/day), and 7 days of a high-salt diet with a potassium supplement (18 g NaCl and 4.5 g KCl/day) ... Compared with the high-salt loading period, the night-to-day blood pressure ratio was significantly reversed by potassium supplement in SS patients (systolic 0.91±0.01 vs. 0.96±0.01, P<0.05; diastolic 0.91±0.01 vs. 0.96±0.01, P<0.05)"
• Serum potassium is a predictor of incident diabetes in African Americans with normal aldosterone: the Jackson Heart Study - Am J Clin Nutr. 2016 Dec 14 - "in those with normal aldosterone (<9 ng/dL, n = 1163), participants in the highest 2 potassium quartiles had significantly lower odds of incident diabetes than did those in the lowest potassium quartile [OR (95% CI): 0.61 (0.39, 0.97) and 0.54 (0.33, 0.90), respectively]" - See potassium citrate at Amazon.com.
• Effects of potassium citrate or potassium chloride in patients with combined glucose intolerance: A placebo-controlled pilot study - J Diabetes Complications. 2016 Mar 17 - "11 subjects (7 male, 4 female, ages 47-63 years), 90 meqs of oral KCl or Kcitrate per day for 2 weeks ... only Kcitrate attenuated insulin resistance as assessed by HOMA-IR (insulin resistance, Kcitrate=2.8 (2.5-3.1), placebo=3.2 (2.9-3.5), p<0.03) and only Kcitrate increased quantitative insulin sensitivity check index ... Kcitrate significantly decreased systolic and diastolic 24-hour ambulatory blood pressures (-4.0 (-3 to -5) and -2.7 (-1.9 to -3.5), respectively as compared to placebo, p<0.02) while KCl was without a significant effect" - Note: 90 meqs of potassium citrate is 3510 mg.
• Achieving the Benefits of a High-Potassium, Paleolithic Diet, Without the Toxicity - Mayo Clin Proc. 2016 Mar 3 - "The average US dietary intake of K+ is well below the current recommended nutritional requirements. This deficiency is even more striking when comparing our current intake with that of our ancestors, who consumed large amounts of dietary K+. K+ deficiency has been implicated in many diseases including cardiovascular disease, kidney stones, and osteoporosis. Importantly, dietary supplementation of K+ has favorable effects on reducing blood pressure, decreasing the risk of stroke, improving bone health, and reducing the risk of nephrolithiasis ... There are widely prescribed hypertensive medications that cause hyperkalemia and thus require dietary K+ restriction. We conclude by discussing newly approved drugs capable of binding K+ in the gastrointestinal tract and speculate that this new pharmacology might allow diet liberalization in patients at risk for hyperkalemia, affording them the numerous benefits of a K+-rich diet" - It seems like you should go by what your blood test says, not what medications you're taking.
• Effects of potassium supplementation on markers of osmoregulation and volume regulation: results of a fully controlled dietary intervention study - J Hypertens. 2015 Nov 21 - "Potassium was found to be effective in reducing BP at higher levels of sodium intake, but to have little effect when sodium intake is restricted ... Individuals received capsules containing sodium [3.0 g (130 mmol)/day], potassium [2.8 g (72 mmol)/day], or placebo for three four-week periods ... Increased potassium intake was associated with a significant decrease in 24-h BP (-3.6/-1.6 mmHg)"
• Effects of sodium and potassium supplementation on endothelial function: a fully controlled dietary intervention study - Br J Nutr. 2015 Sep 7 - "High Na and low K intakes have adverse effects on blood pressure, which increases the risk for CVD ... After 1-week run-in, subjects received capsules with supplemental Na (3.0 g/d), supplemental K (2.8 g/d) or placebo, for 4 weeks each, in random order ... flow-mediated dilation (FMD) ... a 4-week increase in Na intake increased endothelin-1, but had no effect on other endothelial or inflammatory markers. Increased K intake had a beneficial effect on FMD and possibly IL-8, without affecting other circulating endothelial or inflammatory biomarkers"
• Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials - J Hypertens. 2015 Jun 2 - "Potassium supplementation resulted in reduction of SBP by 4.7 mmHg [95% confidence interval (CI) 2.4-7.0] and DBP by 3.5 mmHg (95% CI 1.3-5.7) in all patients. The effect was found to be greater in hypertensive patients, with a reduction of SBP by 6.8 mmHg (95% CI 4.3-9.3) and DBP by 4.6 mmHg (95% CI 1.8-7.5)"
• Association between intakes of magnesium, potassium, and calcium and risk of stroke: 2 cohorts of US women and updated meta-analyses - Am J Clin Nutr. 2015 May 6 - "Pooled multivariate RRs of total stroke for women in highest compared with lowest quintiles were 0.87 (95% CI: 0.78, 0.97) for total magnesium, 0.89 (95% CI: 0.80, 0.99) for total potassium, and 0.97 (95% CI: 0.87, 1.09) for total calcium intake. Pooled RRs for women in highest compared with lowest quintiles of a combined mineral diet score were 0.72 (95% CI: 0.65, 0.81) for total stroke, 0.78 (95% CI: 0.66, 0.92) for ischemic stroke, and 0.80 (95% CI: 0.61, 1.04) for hemorrhagic stroke. In the updated meta-analyses of all prospective studies to date, the combined RR of total stroke was 0.87 (95% CI: 0.83, 0.92) for a 100-mg/d increase of magnesium intake, 0.91 (95% CI: 0.88, 0.94) for a 1000-mg/d increase of potassium intake, and 0.98 (95% CI: 0.94, 1.02) for a 300-mg/d increase of calcium intake" - See magnesium supplements at Amazon.com and potassium citrate at Amazon.com.
• The effect of supplementation with alkaline potassium salts on bone metabolism: a meta-analysis - Osteoporos Int. 2015 Jan 9 - "The objective of this study was, therefore, to conduct a meta-analysis to assess the effects of supplemental potassium bicarbonate (KHCO3) and potassium citrate (KCitr) on urinary calcium and acid excretion, markers of bone turnover and bone mineral density (BMD) and to compare their effects with that of potassium chloride (KCl) ... Urinary calcium excretion was lowered by intervention with both KHCO3 (P = 0.04) and KCitr (P = 0.01), as was net acid excretion (NAE) (P = 0.002 for KHCO3 and P = 0.0008 for KCitr). Both salts significantly lowered the bone resorption marker NTX (P < 0.00001). There was no effect on bone formation markers or BMD. KHCO3 and KCitr lowered calcium excretion to a greater extent than did KCl" - [Nutra USA] - Note:  I take 1100 mg of potassium citrate per day with food to raise my acidic urine PH closer to neutral.  You shouldn't take that much with being under the supervision of a doctor though.
• Low serum potassium concentration is a predictor of chronic kidney disease - Int J Clin Pract. 2014 Jun;68(6):700-704 - "When serum potassium concentration was below 4.0 mmol/l at baseline, hazard ratio (95% confidence interval) of developing CKD was 2.65"
• Low serum potassium concentration is a predictor of chronic kidney disease - Int J Clin Pract. 2014 Jun;68(6):700-704 - "When serum potassium concentration was below 4.0 mmol/l at baseline, hazard ratio (95% confidence interval) of developing CKD was 2.65"
• Effect of high potassium diet on endothelial function - Nutr Metab Cardiovasc Dis. 2014 May 2 - "Thirty five healthy men and women (age 32 ± 12 y) successfully completed a randomised cross-over study of 2 × 6 day diets either high or low in potassium. Flow mediated dilatation (FMD) ... Dietary change was achieved by including bananas and potatoes in the high potassium and apples and rice/pasta in the low potassium diet ... Fasting FMD was significantly improved by 0.6% ± 1.5% following the high compared to the low potassium diet"
• Potassium-rich diet and risk of stroke: Updated meta-analysis - Nutr Metab Cardiovasc Dis. 2014 Mar 18 - "Pooled analysis of 14 cohorts (overall 333,250 participants and 10,659 events) showed an inverse and significant association between K intake and risk of stroke (Relative Risk: 0.80; 95% CI: 0.72-0.90). Our results indicated a favorable effect of higher K intake on risk of stroke"
• Lower potassium intake is associated with increased wave reflection in young healthy adults - Nutr J. 2014 Apr 28;13(1):39 - "Thirty-six young healthy adults (21 M, 15 F; 24 +/- 0.6 yrs; systolic BP 117 +/- 2; diastolic BP 63 +/- 1 mmHg) recorded their dietary intake for 3 days and collected their urine for 24 hours on the 3rd day ... These data suggest that lower potassium intakes are associated with greater wave reflection and stiffer arteries in young healthy adults"
• Association of urinary sodium-to-potassium ratio with obesity in a multiethnic cohort - Am J Clin Nutr. 2014 Feb 19 - "2782 participants in the community-dwelling, probability-sampled, multiethnic Dallas Heart Study were analyzed. The primary outcome established a priori was total-body percentage fat (TBPF) measured by dual-energy X-ray absorptiometry ... TBPF increased by 0.75 (95% CI: 0.25, 1.25) and 0.43 (0.15, 0.72), respectively (P = 0.003 for both), for every 3-unit increase in U[Na+]/[K+] ... The ratio of dietary Na+ to K+ intake may be independently associated with TBPF, and this association may be more pronounced in non-African Americans"
• Effects of potassium chloride and potassium bicarbonate in the diet on urinary pH and mineral excretion of adult cats - Br J Nutr. 2013 Nov 14:1-13 - "Low dietary K levels have been associated with increasing renal Ca excretion in humans, indicating a higher risk of calcium oxalate (CaOx) urolith formation. Therefore, the present study aimed to investigate whether dietary K also affects the urine composition of cats ... Fasting urine pH increased with higher dietary K levels (P= 0.022), reaching values of 6.38 (1.00 % KCl) and 7.65 (1.00 % KHCO3) ... In conclusion, the dietary inclusion of KHCO3 instead of KCl as K source could be beneficial for the prevention of CaOx urolith formation in cats, since there is an association between a lower renal Ca excretion and a generally higher urine pH. The utilisation of K is distinctly influenced by the K salt, which may be especially practically relevant when using diets with low K levels" - Note:  I mentioned in the past about yogurt having a pH of about 4.3 and how that might effect urine pH and that potassium supplements might bring that closer to a neutral pH of 7.0.  This study seems to support it.
• Blood Pressure Responses to Dietary Sodium and Potassium Interventions and the Cold Pressor Test: The GenSalt Replication Study in Rural North China - Am J Hypertens. 2013 Sep 4 - "The dietary intervention included a 7-day low sodium (51.3 mmol/day), a 7-day high sodium (307.8 mmol/day), and a 7-day high sodium with potassium supplementation (307.8 mmol sodium and 60 mmol potassium/day) ... Systolic and diastolic BP responses (mean +/- SD (range), mm Hg) were 8.1+/-8.4 (-39.1 to 18.2) and -3.5+/-5.1 (-25.1 to 11.1) to low sodium, 9.1+/-8.4 (-13.3 to 33.1) and 4.0+/-5.4 (-16.0 to 20.7) to high sodium, and -4.6+/-5.8 (-31.8 to 11.6) and -1.9+/-4.3 (-16.9 to 14.2) to potassium supplementation, respectively" - Note:  Put in simpler terms:  Low sodium, systolic increased 8.1, diastolic decreased 3.5.  High sodium, systolic increased 9.1, diastolic increased 4.0.  Sodium with potassium, systolic decreased 4.6, diastolic decreased 1.9.  So the sodium with potassium was better than the low sodium.
• Benefits of potassium intake on metabolic syndrome: The fourth Korean National Health and Nutrition Examination Survey (KNHANES IV) - Atherosclerosis. 2013 Sep;230(1):80-5 - "7542 adults (≥20 years of age) from the fourth Korean National Health and Nutrition Examination Survey (2007-2009), which is a cross-sectional survey of a nationally representative sample of the Korean population. Data were obtained from standardized questionnaires as well as physical and laboratory examination reports ... subjects in the highest quartile of potassium intake had 39% lower odds for metabolic syndrome compared to those in the lowest quartile (adjusted odds ratio [aOR] = 0.61; 95% confidence interval [CI]: 0.42-0.89; p for trend: 0.013). This association was consistent for both sexes. Among the components of metabolic syndrome, potassium intake was inversely related to abdominal obesity and fasting hyperglycemia in multivariate analysis" - See potassium chelate products at iHerb.
• Serum potassium level is associated with metabolic syndrome: A population-based study - Clin Nutr. 2013 Jul 17 - "Evidence has suggested that low serum potassium concentration or low dietary potassium intake can result in many metabolic disorders ... cross-sectional study in 10,341 participants aged 40 years or older ... The prevalence rate of metabolic syndrome was 51.7% in participants with hypokalemia and 37.7% in those with normokalemia. With the reduction of serum potassium quartiles, participants were tended to have higher level of triglycerides and uric acid, lower level of high-density lipoprotein cholesterol (HDL-C), larger waist circumference and more severe insulin resistance. Serum potassium level significantly decreased with the increasing number of metabolic syndrome components. Compared with subjects in the highest quartile of serum potassium level, multivariate adjusted odds ratios for prevalent metabolic syndrome in the lowest quartile was 1.48"
• Salt loading and potassium supplementation: effects on ambulatory arterial stiffness index and endothelin-1 levels in normotensive and mild hypertensive patients - J Clin Hypertens (Greenwich). 2013 Jul;15(7):485-96 - "The authors investigated effects of excessive salt intake and potassium supplementation on ambulatory arterial stiffness index (AASI) and endothelin-1 (ET-1) in salt-sensitive and non-salt-sensitive individuals. AASI and symmetric AASI (s-AASI) were used as indicators of arterial stiffness. Plasma ET-1 levels were used as an index of endothelial function ... After 3 days of baseline investigation, participants were maintained sequentially for 7 days each on diets of low salt (51.3 mmol/d), high salt (307.7 mmol/d), and high salt+potassium (60 mmol/d) ... High-salt intervention significantly increased BP, AASI, s-AASI (all P<.001); potassium supplementation reversed increased plasma ET-1 levels. High-salt-induced changes in BP, s-AASI, and plasma ET-1 were greater in salt-sensitive individuals. Potassium supplementation decreased systolic BP and ET-1 to a significantly greater extent in salt-sensitive vs non-salt-sensitive individuals ... dietary salt and increasing daily potassium improves arterial compliance and ameliorates endothelial dysfunction"
• Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses - BMJ. 2013 Apr 3;346:f1378 - "22 randomised controlled trials (including 1606 participants) reporting blood pressure, blood lipids, catecholamine concentrations, and renal function and 11 cohort studies (127 038 participants) reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease in adults were included in the meta-analyses. Increased potassium intake reduced systolic blood pressure by 3.49 (95% confidence interval 1.82 to 5.15) mm Hg and diastolic blood pressure by 1.96 (0.86 to 3.06) mm Hg in adults, an effect seen in people with hypertension but not in those without hypertension. Systolic blood pressure was reduced by 7.16 (1.91 to 12.41) mm Hg when the higher potassium intake was 90-120 mmol/day, without any dose response ... An inverse statistically significant association was seen between potassium intake and risk of incident stroke (risk ratio 0.76, 0.66 to 0.89). Associations between potassium intake and incident cardiovascular disease (risk ratio 0.88, 0.70 to 1.11) or coronary heart disease (0.96, 0.78 to 1.19) were not statistically significant"
• Low serum potassium level is associated with nonalcoholic fatty liver disease and its related metabolic disorders - Clin Endocrinol (Oxf). 2013 Feb 13 - "Subjects with nonalcoholic fatty liver disease (NAFLD) have a high risk of developing type 2 diabetes and cardiovascular diseases. Low serum potassium concentration or low dietary potassium intake can result in metabolic disorders ... conducted a community-based study in 8592 subjects to investigate the association of serum potassium with the risk of prevalent NAFLD ... The prevalence rate of NAFLD was 30.3% in this population and gradually decreased across serum potassium quartiles. With the reduction of serum potassium level, participants have larger waist circumference (WC) and more severe insulin resistance. The correlations hold also in multivariate linear regression analysis. In logistic regression analysis, compared with subjects in the highest quartile of serum potassium level, the adjusted odds ratios (ORs) in the lowest quartile was 1.33 (95% confidence interval [CI], 1.11 - 1.60) for NAFLD, 1.81 (95 % CI, 1.49 - 2.19) for insulin resistance and 1.58 (95 % CI, 1.30 - 1.93) for central obesity"
• Potassium citrate supplementation results in sustained improvement in calcium balance in older men and women - J Bone Miner Res. 2012 Sep 18 - "The dietary acid load created by the typical Western diet may adversely impact the skeleton by disrupting calcium metabolism ... 52 men and women (mean age 65.2 + 6.2 years) were randomly assigned to potassium citrate 60 mmol, 90 mmol or placebo daily with measurements of bone turnover markers, net acid excretion, and calcium metabolism including intestinal fractional calcium absorption and calcium balance obtained at baseline and six months. At six months, net acid excretion was significantly lower in both treatment groups compared to placebo and negative, meaning subjects' dietary acid was completely neutralized (-11.3 mmol/day, 60 mmol/day; -29.5 mmol/day, 90 mmol/day, P < 0.001 compared to placebo). At 6-months, 24-hour urine calcium was significantly reduced in persons taking potassium citrate 60 mmol (-46 +/- 15.9 mg/day) and 90 mmol (-59 +/- 31.6 mg/day) daily compared with placebo (p < 0.01). Fractional calcium absorption was not changed by potassium citrate supplementation. Net calcium balance was significantly improved in participants taking potassium citrate 90 mmol/day compared to placebo (142 +/- 80 mg/day, 90 mmol vs. -80 +/- 54 mg/day, placebo; p = 0.02). Calcium balance was also improved on potassium citrate 60 mmol/day, but this did not reach statistical significance (p = 0.18). Serum C-telopeptide decreased significantly in both potassium citrate groups compared to placebo (-34.6 +/- 39.1 ng/L, 90 mmol/d, p = 0.05; -71.6 +/- 40.7 ng/L, 60 mmol/day, p = 0.02) while bone specific alkaline phosphatase did not change. Intact parathyroid hormone was significantly decreased in the 90 mmol/day group (p = 0.01). Readily available, safe, and easily administered in an oral form, potassium citrate has the potential to improve skeletal health"
• Acute effect of calcium citrate on serum calcium and cardiovascular function - J Bone Miner Res. 2012 Sep 18 - "In summary, the acute increase in serum calcium following calcium supplement administration is associated with reduced arterial wave reflection and a marker of increased myocardial perfusion. If maintained long-term, these changes would be expected to reduce cardiovascular risk"
• Sodium intake in men and potassium intake in women determine the prevalence of metabolic syndrome in Japanese hypertensive patients: OMEGA Study - Hypertens Res. 2011 Jun 9 - "High sodium intake was significantly related to increased SBP (P=0.0003) and DBP (P=0.0130). Low potassium intake was significantly related to increased SBP (P=0.0057) and DBP (P=0.0005). Low soybean/fish intake was significantly related to increased SBP (P=0.0133). A significantly higher prevalence of MS was found in men in the highest quartile of sodium intake compared with the lower quartiles (P=0.0026) and in women in the lowest quartile of potassium intake compared with the higher quartiles (P=0.0038). A clear relation between dietary habits and blood pressure was found in Japanese hypertensive patients using a patient-administered questionnaire. Sodium and potassium intake affect MS prevalence. Dietary changes are warranted within hypertension treatment strategies"
• The association of serum potassium level with left ventricular mass in patients with primary aldosteronism - Eur J Clin Invest. 2011 Jan 21 - "Primary aldosteronism (PA) is associated a worse cardiovascular outcome than essential hypertension. Hypokalemia, which is one major characteristic of PA, can affect both cardiac structure and function ... the control group (group 1). Thirty-two patients with serum potassium < 3.5 mmol L(-1) were defined as hypokalemia (group 2), and 53 patients with serum potassium ≥ 3.5 mmol L(-1) were defined as normokalemia (group 3) ... Group 2 patients had significant higher systolic and diastolic blood pressure (DBP), log-transformed plasma aldosterone concentration, log-transformed aldosterone-to-renin ratio and lower serum potassium level than groups 1 and 3. In echocardiographic measurement, group 2 patients had higher LV mass index (LVMI) than groups 1 and 3. In multivariate analysis for factors affecting LVMI in PA patients, only serum potassium level (P = 0.001), use of spironolactone (P = 0.004) and DBP (P = 0.005) were independent factors. In the TDI study, both groups 2 and 3 had lower e' and E/e' values than group 1. Conclusions  Serum potassium level is significantly associated with LVMI in PA patients. Compared with essential hypertensive patients, PA patients had a greater impairment of cardiac diastolic function"
• Potassium magnesium supplementation for four weeks improves small distal artery compliance and reduces blood pressure in patients with essential hypertension - Clin Exp Hypertens. 2006 Jul;28(5):489-97 - "magnesium, 70.8 mg/d; potassium, 217.2 mg/d ... On K+ and Mg2+ supplementation, systolic and diastolic BP decreased 7.83 +/- 1.87 mm Hg and 3.67 +/- 1.03 mm Hg"
• The effect of low-dose potassium supplementation on blood pressure in apparently healthy volunteers - Br J Nutr. 2003 Jul;90(1):53-60 - "After 6 weeks of supplementation MAP [mean arterial pressure] was reduced by 7.01 ... mmHg, SBP was reduced by 7.60 ... mmHg and DBP was reduced by 6.46 ... mmHg ... A low daily dietary supplement of K, equivalent to the content of five portions of fresh fruits and vegetables, induced a substantial reduction in MAP, similar in effect to single-drug therapy for hypertension"