Potassium Chloride Salt Substitute: Thoughts?

[Ron Put]

A few months ago Dr. Gregger had a short video on potassium chloride salt substitutes that prompted me to get some and experiment. I don't normally use salt at home, although at times I would get cravings and salt my purple Stokes potatoes or pumpkin slices -- I switched to using potassium chloride and used it virtually every day for a month, or more.

I've had a pretty high potassium intake according to Chronometer for the last few years (being vegan and all), but my lab results were generally in the low 4s (mmol/L) and my sodium was generally low.

After the fairly liberal supplementation with potassium chloride, my lab result shot up to 5.3, a bit above normal.

My blood pressure seems to be a bit lower since I started adding potassium, usually in the low 100s / 60s in the morning and low to mid 110s / 70 by early afternoon, when presumably is at its highest.

Interestingly, my Pulse Wave Velocity has dropped to the very low 6 second/meter (today it was 6.2 s/m), while the average over the last year has been 6.9 m/s. PWV measures arterial stiffness and increases with age. It is predictive of CVD.

My 5.3 potassium lab result is hight than normal and while I don't have kidney issues, I am wondering if adding potassium chloride and a total intake to the tune of 7 or 8 grams per day, according to Chronometer, may cause problems.

Al had posted a study a while back that I found interesting, where the man intake was 78 mmil/L which I calculate to be just over 3 grams. I am consuming double that amount currently, if not more:

"Results: 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."

Are others here substituting potassium for salt, or supplementing with potassium. If so, what is your long-term experience?

[IgorF]

I posted here a test on my own 3:1 ratio for potassium/sodium taken from food https://www.crsociety.org/topic/17639-sodium-inflammation-and-joint-pain/?do=findComment&comment=43792

It is important to assess the dumping out and hormones connected, homeostatic regulation makes it impossible to infer something from serum or spot urine measure (except for emergency cases where homeostatic regulation failed and a medical emergency is in place).

Since these things are regulated very fast due to water solubility I could guess that potassium as a supplement should be "masked" with food to not be dumped out by the homeostasis preferentially. I tried to convince my mother to take some potassium citrate (a teaspoon) to see if this will make any difference in her case (hypertensive, on medications) but she does not want to collect the data in a consistent way.

My speculation is that if a person is not already in a bad ratio for decades and is not a holder of a kind of predisposing ancestry then the effect of moving the values will lie in the 130->110 direction for systolic pressure, with majority of ~10 points or something like this. All the connected things also. But, these values make a serious difference in the long run, ultimately crossing the line "die with almost healthy subsystems" / "die with exhausted capacities for some of them".

My own observation for myself in my thirties and excess salt was oscilation around 135/90 and I moved to 90/60-110/75 with current regimen in my forties but I have it now far from most people are willing to do, it is hard to get 10g of potassium with food.

It is thought that in the past our bodies were tuned to have such a ratio and intake so based on this I came to conclusion that our bodies are better at dealing with excess potassium than sodium but it is a kind of thin ice, the body of knowledge on the topic is wide enough to spend a whole life and fail to answer on this))

Also there is a topic of naturally occured radioactive potassium, at high intakes it is definitely undesirable but I have no idea how to cut down the sodium to really low values, so I will not need to get that high with potassium.

There are a lot of other things connected, calcium, the amount of daily water (and its sources) etc. I feel different this summer than a year ago, thus I will probably do another 24h test to see how it looks like now, maybe I will correct my speculations.

Br,

Igor

 

[IgorF]

Yanomamo indians case, believed to illustrate the way it was evolved to work

https://www.ahajournals.org/doi/10.1161/01.CIR.52.1.146

My own case seems confirming the authors' conclusion, I had comparable numbers for aldo and potassium dropout. However I was not on such a minimal sodium intake like yanomamo studied, thus I am dumping out some midrange amounts of sodium also. There is no such data in the study, but in my case I also have a lot of citrate dumping out, this corresponds to potassium out as a homeostatic outcome of the body's way to balance excess potassium according to "Fluid, Electrolyte and Acid-Base Physiology A Problem-Based Approach, Fourth Edition, 2010" textbook.

In the study mentioned controls group in table 4 shows nacl dropout that is probably much worse with novadays engineered foods, I don't know the salt regulations of the seventies, probably they were expected around 9g/day but for those who did not stapled on industry food the real intake was lower then today.

 

And another thing, to add to high potassium planings. Some numbers to take into account, from a textbook "Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple, 2002" (somebody put it here but it will probably disappear after some time https://www.coursehero.com/file/p7223fo3/Tubular-unresponsiveness-to-aldosterone-occurs-with-a-number-of-chronic-renal/ )
 

Quote

 

Excretion is as low as 10 mEq/day during states
of extreme potassium conservation to as high as 10 mEq per kg body weight/
24 hours. The upper limit of potassium excretion is roughly proportional to the
GFR. If the GFR is 100% of normal, the maximum amount of potassium which
can be excreted in one day is roughly 10 mEq per kg body weight. This is about
70 X 10 = 700 mEq in a 70 kg person. If the GFR is reduced to 50% of nor-
mal the maximum amount of potassium that can be excreted in one day falls
to approximately 50% X 700 = 350 mEq. This is a rough approximation of
maximum potassium excretion because compensatory renal potassium secre-
tory mechanisms will increase potassium excretion, and stool potassium losses
also increase as the body defends itself against hyperkalemia. If the GFR is
further reduced to 20% of normal, the maximal potassium excretion would fall
to the range of about 140 mEq/day (20% of 700 mEq/day).
The average diet has about 1 mEq of potassium per kg body weight,
which amounts to about 70 mEq/day in a 70 kg person. For a diet containing
70 mEq/day, the GFR would need to be reduced to approximately 70/700 =
10% of normal before hyperkalemia develops. In fact, the GFR is usually be-

low this level when hyperkalemia develops based upon usual dietary intake.
Hyperkalemia may develop at less profound levels of renal failure if the potas-
sium intake is increased or if there is a hidden potassium load. For example, a
person with a diet high in potassium would develop hyperkalemia with less
impairment of the GFR. Using a rough estimate of maximum potassium ex-
cretion, a patient with a GFR 15% of normal would develop hyperkalemia if
dietary potassium is over the range of 15% X 700 = 105 mEq/day. As men-
tioned above: this is only a rough approximation of maximum potassium ex-
cretion because compensatory renal potassium secretory mechanisms will
increase potassium excretion, and stool potassium losses also increase as the
body defends itself against hyperkalemia.

 

So, doing the radical change with potassium intake towards the paleolythic levels requires to assess own renal state carefully, because serious troubles could happen for those, who already have slight and hard to distinguish impairs in the renal function. IMHO - several ECGs (https://litfl.com/hyperkalaemia-ecg-library/) and offcourse blood pressure measures with a trustworthy devices should be done before transition and to monitor the changes.

Br,

Igor

 

Edited July 22, 2023 by IgorF

[Ron Put]

On 7/22/2023 at 12:11 AM, IgorF said:

Yanomamo indians case

Interesting, I thought the intake of hunter-gatherers was as low as 500 mg of sodium per day, but according to this report the Yanomamo are at 230 mg (I calculate this based on 10 mEq).

My own sodium intake during the last year is around 1150 mg according to Chronometer and plasma values are low according to lab ranges. My blood pressure generally varied from a peak of around 120/70 to 105/60 depending on time of day, and the systolic has dropped to a peak of around 115 since I started using potassium chloride. As I am entering my sixth decade, this seems to confirm that BP does not have to significantly increase with age.

I am watching my kidney values, as my plasma potassium has moved above normal (5.3 mol/L). My BUN is currently at 7 mg/d, creatinine is below normal at 0.65 mg/dL, BUN/creatinine ratio is 11:1, and eGFR is at 108.

The most interesting bit is the drop in Pulse Wave Velocity by about 0.5 second, to about 6.3-6.4 m/s average these days. It appears that higher potassium intake reliable lowers PWV, based on a quick search I did. Here is one study, although it's in close to obese subjects with rather poor PWV values of around 11 m/s, showing significant arterial stiffness, normally seen in those in their 70s:

Effects of Potassium Chloride and Potassium Bicarbonate on Endothelial Function, Cardiovascular Risk Factors, and Bone Turnover in Mild Hypertensives

[IgorF]

Hm, a bit strange, with such eGFR it should be no problem to excrete very big amounts of excess potassium, maybe something is not optimal with the dosage/timing/form. Or maybe it is an effect of a change and will be tuned by the body after some time.

If fruit sources are unwanted for any reasons there could be dietary boosters like few spoons of passata (low calories, could be found very low sodium if desired) and paprika powder (not smoked one, many calories if 30-50g/day but also rich in potassium). Also there is a lot of potassium in spinach/iceberg/napa cabbage, but this requires to eat 300-500g/day of them in total, not a big deal but needs a "mindset". Maybe for traveling supplementing with potassium salts is more convenient but at stable home regimen perhaps it would be better to reach 7-8g/day via diet?

AFAIR dr. Gregger from whom this thread is started is a big proponent of tonns of greens and I think he is correct in that assessment.

Br,

Igor

[Ron Put]

21 hours ago, IgorF said:

Hm, a bit strange, with such eGFR it should be no problem to excrete very big amounts of excess potassium

Yes, I agree. And frankly I am not worried, since my plasma potassium is 5.3 mol/L, with "normal" upper limit at 5.2, and issues arising at 6.2-6.5 mol/L concentrations. I have the potassium chloride in a salt shaker and had been adding it liberally to my starchy foods, like purple Stokes potatoes,

So, I may have been adding 4-5 grams on many days, in addition to my average potassium intake of approximately 5600 mg from diet, according to Chronometer (top 3 foods are tomatoes, squash and lentils). I've tapered it down a bit on the potassium chloride, will probably test again in a month to see if it leveled off. If it does, I will likely continue adding some potassium chloride, mostly because there is significant benefit to arterial flexibility, as measured by PWV.

 

[IgorF]

Just did another 24h test, publishing it as an example, maybe somebody could find it useful.

 

Cronometer data on intake (plants only, no supplementation):

potassium 10,8g, sodium 2,85g, magnesium 0,9g (200%rda), calcium 1,36g, water 4l

 

excretion and serum catione levels

24h urine potassium: 286,80 mmol/24h in the lab's range 25-125

serum potassium: 4,2 mmol/l in the lab's range 3,5-5,5

24h urine sodium: 97,7 mmol/24h in the lab's range 40-220

serum sodum: 142 mmol/l in the lab's range 136-146

24h urine calcium: 5,1 mmol/24h in the lab's range 0-7,5

serum calcium: 2,45 mmol/l in the lab's range 2,2-2,65

24h urine magnesium: 9.7 mmol/24h in the lab's range 3-5

serum magnesium: 0,85 mmol/l in the lab's range 0,73-1,06

 

for anions I only have chloride, no idea if hydrocarbonates are measurable / make sense

24h urine chloride: 152,1 mmol/24h in the lab's range 110-250

serum chloride: 105 mmol/l in the lab's range 101-109

 

The data is consistent with homeostatic expectations.

 

Aktiia's data for that day tends to oscilate around 92-96/62-63 while sitting, 103-106/73 showed while standing/walking and 8x/5x while sleeping. I do not belive these exact figures, I think they should be corrected ~ +10/5 but even with such a correction the values are desirable.

 

I did a ECG a month ago within a similar regimen and my QT interval is 10-11 squares, thus 400-440ms and this is formally better than I had in the past (I described a bit here https://www.crsociety.org/topic/17558-all-my-lab-results-here-alex-k-chen/?do=findComment&comment=44924 ) Taking into account the potassium role in heart mechanics I think it is not only magnesium as doctors often telling us is important for proper heart operations but also enough potassium / efficiency of its mechanics, so it seems I am compensating something genetical with my current intake levels.

 

Br,

Igor

 

Edited August 4, 2023 by IgorF

[IgorF]

Here are some guidelines https://ukkidney.org/sites/renal.org/files/RENAL ASSOCIATION HYPERKALAEMIA GUIDELINE - JULY 2022 V2_0.pdf p.37 is for dietary intervention for mild elevations that have no accute risks.

Many if not most texts are postulating that the idea about the dietary potassium connection to high serum potassium in the abscense of some impairment in excretion is very unlikely. At the same time there are not much details about possible reasons except CKD. Here is a preview of a good source of such reasons, unfortunately table 15-1 is not visible in the preview but the detailed explanation blocks are readable, the list is surprisingly long https://books.google.com/books?id=TypFDQAAQBAJ&pg=PA448&lpg=PA448&dq="TABLE+15-1+CAUSES+OF+HYPERKALEMIA"&source=bl&ots=XbSCqzA20X&sig=ACfU3U2QEZNB9HZKSWKAg_RZDB8g0-tZpg&hl=en&sa=X&ved=2ahUKEwi9kqyflcaAAxVdgv0HHY_3AUwQ6AF6BAgXEAM#v=onepage&q="TABLE 15-1 CAUSES OF HYPERKALEMIA"&f=false

A lot of drugs, including NSAADS could interfere, also sodium and protein undertake could surprisingly cause mild elevation also.

It seems serum electrolites, paired with 24h values plus aldosteron plus renin/renin activity is a starting point to get more information during planning even with good eGFR. Or to increase the intake and keep an eye on repeating serum potassium values weekly for a few times.