National Library of Medicine. So, are the different forms of potassium supplements safe? Here are some things to consider before you add them to your regimen. Potassium supplements can be dangerous for people with certain underlying health conditions, so talk to your doctor before starting a supplement, according to the National Kidney Foundation. These conditions include:. If you do decide to take potassium supplements, your doctor may want to test your blood regularly and perform periodic heart health checks like an electrocardiogram procedure to make sure everything is functioning properly.
Over-the-counter potassium supplements usually contain no more than 99 milligrams of the mineral — well under the daily recommended intake for adults — which makes it difficult to take too much, according to the ODS. But it can happen: Per the Mayo Clinic , some of the less serious side effects of potassium supplements can include:.
And consistently having too much potassium in your blood can cause dangerous side effects. Stop taking your supplement and talk to your doctor immediately if you experience any of these symptoms:. Prescription supplement doses may be higher than 99 milligrams, but you can only take those under the guidance of a doctor who will monitor your potassium levels closely.
Potassium supplements can interact with some medications. According to the National Kidney Foundation, these include:. Nutrition Nutrition Basics Vitamins and Supplements. He specializes in the integration of lifestyle and other complementary modalities, such as acupuncture or massage, with more conventional medicine in a whole person approach to treating a wide variety of conditions, such as chronic pain, gastrointestinal issues, and autoimmune disease.
Perlman is board certified in internal medicine and specializes in both integrative and functional medicine. He received his medical degree from Boston University School of Medicine in Boston, Massachusetts, where he also completed a residency and fellowship in general internal medicine, a preventative medicine residency, and a Master of Public Health.
Prior to joining Mayo Clinic, Dr. Connect on LinkedIn. Amanda Gardner. Amanda Gardner is a freelance health reporter whose stories have appeared in Health. In , she was selected to be the writer-in-residence at the University of Wisconsin School of Medicine and Public Health. She is also a community artist and recipient or partner in five National Endowment for the Arts grants. Types of Supplements Safety.
Talk to your doctor about the best form of potassium supplement for you — and whether or not you really need one. Video of the Day. Should You Take a Potassium Supplement? Taking diuretic drugs Overusing laxatives Having chronic diarrhea or vomiting Not getting enough magnesium Kidney disorders Intestinal blockages Excessive sweating. Types of Potassium Supplements. Dietary supplements In dietary supplements, potassium is often present as potassium chloride, but many other forms—including potassium citrate, phosphate, aspartate, bicarbonate, and gluconate—are also used [ 18 ].
The Supplement Facts panel on a dietary supplement label declares the amount of elemental potassium in the product, not the weight of the entire potassium-containing compound. Some dietary supplements contain potassium iodide in microgram amounts, but this ingredient serves as a form of the mineral iodine, not potassium. Potassium-only supplements are also available, and most contain up to 99 mg potassium. Information on many dietary supplements that contain potassium is available in the Dietary Supplement Label Database from the National Institutes of Health, which contains label information from tens of thousands of dietary supplement products on the market.
First, the FDA has ruled that some oral drug products that contain potassium chloride and provide more than 99 mg potassium are not safe because they have been associated with small-bowel lesions [ 19 ]. Second, the FDA requires some potassium salts containing more than 99 mg potassium per tablet to be labeled with a warning about the reports of small-bowel lesions [ 20 , 21 ].
In accordance with a ruling by Congress, the FDA may not limit the amount of any nutrient, including potassium, in a dietary supplement, except for safety-related reasons [ 22 ]. However, the FDA has not issued a ruling about whether dietary supplements containing more than 99 mg potassium must carry a warning label [ 21 , 23 ].
Only a few studies have examined how well the various forms of potassium in dietary supplements are absorbed. According to an older study, liquid forms of potassium chloride used as drugs to treat conditions such as digitalis intoxication or arrhythmias due to hypokalemia are absorbed within a few hours [ 6 ].
Enteric coated tablet forms of potassium chloride designed to prevent dissolution in the stomach but allow it in the small intestine are not absorbed as rapidly as liquid forms [ 25 ].
Salt substitutes Many salt substitutes contain potassium chloride as a replacement for some or all of the sodium chloride in salt.
The potassium content of these products varies widely, from about mg to 2, mg potassium per teaspoon [ 1 ]. Some people, such as those with kidney disease or who are taking certain medications, should consult their healthcare provider before taking salt substitutes because of the risk of hyperkalemia posed by the high levels of potassium in these products.
Dietary surveys consistently show that people in the United States consume less potassium than recommended, which is why the — Dietary Guidelines for Americans identifies potassium as a "nutrient of public health concern" [ 26 ]. According to data from the — National Health and Nutrition Examination Survey NHANES , the average daily potassium intake from foods is 2, mg for males aged 2—19, and 1, mg for females aged 2—19 [ 27 ].
In adults aged 20 and over, the average daily potassium intake from foods is 3, mg for men and 2, mg for women. Average potassium intakes vary by race. Non-Hispanic blacks aged 20 and older consume an average of 2, mg potassium per day. Average daily intakes are 2, mg for Hispanic whites and 2, mg for non-Hispanic whites [ 27 ]. Use of potassium-containing dietary supplements does not significantly increase total potassium intakes among U.
Insufficient potassium intakes can increase blood pressure, kidney stone risk, bone turnover, urinary calcium excretion, and salt sensitivity meaning that changes in sodium intakes affect blood pressure to a greater than normal extent [ 1 ]. Severe potassium deficiency can cause hypokalemia, serum potassium level less than about 3. Mild hypokalemia is characterized by constipation, fatigue, muscle weakness, and malaise [ 3 ].
Moderate to severe hypokalemia serum potassium level less than about 2. Severe hypokalemia can be life threatening because of its effects on muscle contraction and, hence, cardiac function [ 5 ]. Hypokalemia is rarely caused by low dietary potassium intake alone, but it can result from diarrhea due to potassium losses in the stool. It can also result from vomiting, which produces metabolic alkalosis, leading to potassium losses in the kidneys. Magnesium depletion can contribute to hypokalemia by increasing urinary potassium losses [ 1 , 33 , 34 ].
It can also increase the risk of cardiac arrhythmias by decreasing intracellular potassium concentrations. In people with hypomagnesemia and hypokalemia, both should be treated concurrently [ 7 ]. Potassium inadequacy can occur with intakes that are below the AI but above the amount required to prevent hypokalemia. The following groups are more likely than others to have poor potassium status. People with inflammatory bowel diseases Potassium is secreted within the colon, and this process is normally balanced by absorption [ 35 ].
Inflammatory bowel diseases are also characterized by chronic diarrhea, which can further increase potassium excretion [ 36 ].
People who use certain medications, including diuretics and laxatives Certain diuretics e. Potassium- sparing diuretics, however, do not increase potassium excretion and can actually cause hyperkalemia. Large doses of laxatives and repeated use of enemas can also cause hypokalemia because they increase losses of potassium in stool. People with pica Pica is the persistent eating of non-nutritive substances, such as clay. When consumed, clay binds potassium in the gastrointestinal tract, which can increase potassium excretion and lead to hypokalemia [ 5 , 31 , 32 ].
Cessation of pica combined with potassium supplementation can restore potassium status and resolve symptoms of potassium deficiency. This section focuses on four diseases and disorders in which potassium might be involved: hypertension and stroke; kidney stones; bone health; and blood glucose control and type 2 diabetes. Hypertension and stroke Hypertension, a major risk factor for coronary heart disease and stroke, affects almost a third of Americans [ 2 , 37 ].
According to an extensive body of literature, low potassium intakes increase the risk of hypertension, especially when combined with high sodium intakes [ 16 , ]. Higher potassium intakes, in contrast, may help decrease blood pressure, in part by increasing vasodilation and urinary sodium excretion, which in turn reduces plasma volume [ 1 ]; this effect may be most pronounced in salt-sensitive individuals [ 2 , 3 , 5 , 37 , 41 ].
The Dietary Approaches to Stop Hypertension DASH eating pattern, which emphasizes potassium from fruits, vegetables, and low-fat dairy products, lowers systolic blood pressure by an average of 5.
Results from most clinical trials suggest that potassium supplementation reduces blood pressure. A meta-analysis of 25 randomized controlled trials in 1, participants with hypertension found significant reductions in systolic blood pressure by 4.
The supplements had the greatest effect in patients with hypertension, reducing systolic blood pressure by a mean of 6. Two earlier meta-analyses of 19 trials [ 45 ] and 33 trials [ 46 ] had similar findings. However, a Cochrane review of six of the highest-quality trials found nonsignificant reductions in systolic and diastolic blood pressure with potassium supplementation [ 47 ]. In , the Agency for Healthcare Research and Quality AHRQ published a systematic review of the effects of sodium and potassium intakes on chronic disease outcomes and their risk factors [ 48 ].
The authors concluded that, based on observational studies, the associations between dietary potassium intakes and lower blood pressure in adults were inconsistent.
They also found no evidence for an association between potassium intakes and the risk of hypertension. A similar analysis conducted by the NASEM committee that included 16 trials found that potassium supplements significantly lowered systolic blood pressure by a mean of 6. However, the effects were stronger among studies including participants with hypertension; for studies including only participants without hypertension, the effects were not statistically significant.
Based on 13 randomized controlled trials that primarily enrolled patients with hypertension, the AHRQ review found that the use of potassium-containing salt substitutes in place of sodium chloride significantly reduced systolic blood pressure in adults by a mean of 5.
However, reducing sodium intake decreased both systolic and diastolic blood pressure in adults, and increasing potassium intake via food or supplements did not reduce blood pressure any further.
This finding suggests that at least some of the beneficial effects of potassium salt substitutes on blood pressure may be due to the accompanying reduction in sodium intake, rather than the increase in potassium intake. Higher potassium intakes have been associated with a decreased risk of stroke and possibly other cardiovascular diseases CVDs [ 16 , 49 ].
However, the AHRQ review found inconsistent relationships between potassium intakes and risk of stroke based on 15 observational studies [ 48 ]. Any beneficial effect of potassium on CVD is likely due to its antihypertensive effects.
However, some research shows a benefit even when blood pressure is accounted for. These findings suggest that other mechanisms e. The FDA has approved the following health claim: "Diets containing foods that are a good source of potassium and that are low in sodium may reduce the risk of high blood pressure and stroke" [ 17 ].
Overall, the evidence suggests that consuming more potassium might have a favorable effect on blood pressure and stroke, and it might also help prevent other forms of CVD. However, more research on both dietary and supplemental potassium is needed before firm conclusions can be drawn.
Kidney stones Kidney stones are most common in people aged 40 to 60 [ 52 ]. Stones containing calcium—in the form of calcium oxalate or calcium phosphate—are the most common type of kidney stone. Low potassium intakes impair calcium reabsorption within the kidney, increasing urinary calcium excretion and potentially causing hypercalciuria and kidney stones [ 16 , 37 ].
Low urinary levels of citrate also contribute to kidney stone development. Observational studies show inverse associations between dietary potassium intakes and risk of kidney stones. Some research suggests that supplementation with potassium citrate reduces hypercalciuria as well as the risk of kidney stone formation and growth [ 52 , 55 ]. In a clinical trial of 57 patients with at least two kidney stones either calcium oxalate or calcium oxalate plus calcium phosphate over the previous 2 years and hypocitraturia low urinary citrate levels , supplementation with 30—60 mEq potassium citrate providing 1, to 2, mg potassium for 3 years significantly reduced kidney stone formation compared with placebo [ 55 ].
This study was included in a Cochrane review of seven studies that examined the effects of potassium citrate, potassium-sodium citrate, and potassium-magnesium citrate supplementation on the prevention and treatment of calcium-containing kidney stones in a total of participants, most of whom had calcium oxalate stones [ 52 ].
The potassium citrate salts significantly reduced the risk of new stones and reduced stone size. However, the proposed mechanism involves citrate, not potassium per se; citrate forms complexes with urinary calcium and increases urine pH, inhibiting the formation of calcium oxalate crystals [ 52 , 56 ]. The authors of the AHRQ review [ 48 ] concluded that observational studies suggest an association between higher potassium intakes and lower risk of kidney stones. However, they also found the evidence insufficient to determine whether potassium supplements are effective because only one trial that addressed this question [ 55 ] met their inclusion criteria.
Additional research is needed to fully understand the potential link between dietary and supplemental potassium and the risk of kidney stones.
Bone health Observational studies suggest that increased consumption of potassium from fruits and vegetables is associated with increased bone mineral density [ 57 ]. This evidence, combined with evidence from metabolic studies and a few clinical trials, suggests that dietary potassium may improve bone health. The underlying mechanisms are unclear, but one hypothesis is that potassium helps protect bone through its effect on acid-base balance [ 37 ].
Diets that are high in acid-forming foods, such as meats and cereal grains, contribute to metabolic acidosis and might have an adverse effect on bone. Alkaline components in the form of potassium salts potassium bicarbonate or citrate, but not potassium chloride from food or potassium supplements might counter this effect and help preserve bone tissue.
In the Framingham Heart Study for example, higher potassium intake was associated with significantly greater bone mineral density in elderly men and women [ 58 ]. In another study, the DASH eating pattern significantly reduced biochemical markers of bone turnover [ 59 ]. This eating pattern has a lower acid load than typical Western diets and is also high in calcium and magnesium, in addition to potassium, so any independent contribution of potassium cannot be determined.
Only a few clinical trials have examined the effects of potassium supplements on markers of bone health. Potassium supplementation significantly increased bone mineral density at the lumbar spine and bone microarchitecture compared with placebo. Conversely, a clinical trial in postmenopausal women aged 55—65 years found that supplementation with potassium citrate at either Overall, higher intakes of potassium from diets that emphasize fruits and vegetables might improve bone health.
Although obesity is the primary risk factor for type 2 diabetes, other metabolic factors also play a role. Because potassium is needed for insulin secretion from pancreatic cells, hypokalemia impairs insulin secretion and could lead to glucose intolerance [ 2 ]. This effect has been observed mainly with long-term use of diuretics particularly those containing thiazides or hyperaldosteronism excessive aldosterone production , which both increase urinary potassium losses, but it can occur in healthy individuals as well [ 2 , 10 , 16 , 65 ].
Numerous observational studies of adults have found associations between lower potassium intakes or lower serum or urinary potassium levels and increased rates of fasting glucose, insulin resistance, and type 2 diabetes [ ]. These associations might be stronger in African Americans, who tend to have lower potassium intakes, than in whites [ 68 , 71 ].
For example, one study of 1, adults aged 18—30 years without diabetes found that those with urinary potassium levels in the lowest quintile were more than twice as likely to develop type 2 diabetes over 15 years of follow-up than those in the highest quintile [ 68 ].
Among 4, participants from the same study with potassium intake data, African Americans with lower potassium intakes had a significantly greater risk of type 2 diabetes over 20 years of follow-up than those with higher intakes, but this association was not found in whites. Serum potassium levels were inversely associated with fasting glucose levels in 5, participants aged 45—84 years from the Multi-Ethnic Study of Atherosclerosis, but these levels had no significant association with diabetes risk over 8 years of follow-up [ 70 ].
Although observational studies suggest that potassium status is linked to blood glucose control and type 2 diabetes, this association has not been adequately evaluated in clinical trials. Don't miss your FREE gift. Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health , plus the latest advances in preventative medicine, diet and exercise , pain relief, blood pressure and cholesterol management, and more.
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