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Potassium

An essential mineral in fruit, vegetables, beans, milk and potatoes, also sold as supplements and in salt substitutes. People take it for blood pressure.

Explained simply · Last reviewed

What it is

Potassium is an essential mineral that is naturally present in many foods and sold as a dietary supplement. ODS, the US Office of Dietary Supplements, says the body needs it for normal cell function, and that it has a strong relationship with sodium. It names many fruits and vegetables, some legumes such as soybeans, and potatoes as excellent sources. It adds that meat, poultry, fish, milk, yogurt and nuts also contain potassium.

More about Potassium

ODS, the US Office of Dietary Supplements, says the body needs it for normal cell function, and that it has a strong relationship with sodium. It names many fruits and vegetables, some legumes such as soybeans, and potatoes as excellent sources. It adds that meat, poultry, fish, milk, yogurt and nuts also contain potassium.

ODS reports that people in the United States consume less potassium than recommended, and that this is why the 2015–2020 Dietary Guidelines for Americans named it a nutrient of public health concern. According to ODS, a large body of research links low potassium intakes with a higher risk of high blood pressure, especially when sodium intake is high.

In supplements, potassium is often present as potassium chloride, according to ODS, though citrate, phosphate, aspartate, bicarbonate and gluconate are also used. Many salt substitutes replace some or all of the sodium chloride in salt with potassium chloride. ODS adds that using potassium supplements does not significantly raise total potassium intake among US adults, probably because most contain only small amounts.

The research below keeps three things apart where its sources do: potassium supplements, potassium eaten in food, and salt substitutes that contain potassium.

Also known as: potassium chloride, potassium citrate, potassium gluconate, potassium salt substitute

At a glance

Safety: known risks, 3 groups who should avoid it or take extra care and 3 documented interactions. See Safety ↓

Claims made about Potassium, and how strong the evidence is for each:

Each rating follows our published rules and the sources cited for it. We don’t add our own medical judgment. How we rate

Safety

Read this before the ratings below.

Risks

  • ODS, the US Office of Dietary Supplements, states that very high amounts of potassium supplements or salt substitutes that contain potassium could exceed the kidney’s capacity to excrete potassium, “causing acute hyperkalemia even in healthy individuals”. ODS describes hyperkalemia as blood potassium above the normal range. It states that severe cases can cause muscle weakness, paralysis, heart palpitations, a burning or prickling sensation in the extremities, and cardiac arrhythmias that could be life threatening.
  • The same authority reports that case reports indicate very large doses of potassium supplements can cause heart abnormalities and death. It states that the US expert committee found these reports did not provide sufficient evidence to set an upper limit, and that there is no evidence that high potassium intakes cause hyperkalemia in adults with normal kidney function.
  • ODS states that potassium supplements can cause minor gastrointestinal side effects. It reports that potassium salts in certain medicines have been associated with small-bowel lesions, causing obstruction, hemorrhage and perforation, and that FDA requires some oral drugs “providing more than 99 mg of potassium” to carry a warning. It adds that FDA has not ruled on whether supplements above that amount must carry a warning label.
  • In a 2015 Cochrane review of citrate salts for kidney stones, more people stopped treatment because of adverse events on citrate than on placebo or no treatment (four trials, 271 people). The main side effects reported were upper gastrointestinal disturbance, such as stomach pain, bloating and nausea, and one rash. For gastrointestinal events themselves, the difference between the groups was not statistically significant, which is too little evidence to show a difference either way.
  • A 2022 Cochrane review of salt substitutes found they probably raise blood potassium slightly in adults (moderate certainty). It found they likely make little to no difference to hyperkalemia (moderate certainty), but every trial excluded people in whom extra potassium is known to be potentially harmful. The reviewers state that this lack of evidence limits conclusions on the safety of salt substitutes in the general population.

Who should avoid it or take extra care

  • People with chronic kidney disease, or who take medicines that impair potassium excretion such as ACE inhibitors or potassium-sparing diuretics: ODS states that in these people even dietary potassium intakes below the Adequate Intake can cause hyperkalemia.
  • People with type 1 diabetes, congestive heart failure, adrenal insufficiency or liver disease: ODS states that hyperkalemia can also occur in these conditions.
  • Anyone at risk of hyperkalemia: ODS advises consulting a physician or registered dietitian about appropriate potassium intakes from all sources, and states that people with kidney disease or who take certain medications should consult their health care provider before using salt substitutes.

Documented interactions

  • ACE inhibitors and angiotensin receptor blockers (for example benazepril/Lotensin, losartan/Cozaar): ODS states that these medicines reduce urinary potassium excretion, which can lead to hyperkalemia, and that experts recommend monitoring potassium status in people taking them, especially with other risk factors such as impaired kidney function. Source [1]
  • Potassium-sparing diuretics (for example amiloride/Midamor, spironolactone/Aldactone): ODS states that these reduce the excretion of potassium in the urine and can cause hyperkalemia, and that experts recommend monitoring potassium status in people taking them. Source [1]
  • Loop and thiazide diuretics (for example furosemide/Lasix, chlorothiazide/Diuril): ODS states that these increase urinary potassium excretion and can lead to low blood potassium (hypokalemia), and that experts recommend monitoring potassium status in people taking them and starting potassium supplementation if warranted. Source [1]

Safety sources: Source [1]Source [2]Source [3]

What the evidence says

Each claim is rated on its own evidence. Ratings follow the scale on our methodology page.

  • Potassium supplements lower blood pressure in adults with high blood pressure Evidence rating: Moderate

    People with high blood pressure take potassium hoping it will bring their readings down.

    A 2013 review of trials, most testing supplements, found lower blood pressure with more potassium in people with high blood pressure, and rated the evidence high to moderate certainty.

    A 2013 review for the World Health Organization included 22 randomized trials in adults comparing more potassium with less. In 20 of them the extra potassium came from supplements alone. Pooling 21 trials, the reviewers found that with more potassium, systolic blood pressure (the top number) was 3.49 mmHg lower, and diastolic 1.96 mmHg lower. In the 16 trials of people with high blood pressure, systolic was 5.32 mmHg lower and diastolic 3.10 mmHg lower. The review gives slightly different trial counts for diastolic pressure in different places.

    In three trials of people without high blood pressure, the difference was not statistically significant. That is too little evidence to show an effect either way. Only three trials lasted more than four months, two of them in people without high blood pressure, and in them the difference was also not significant. The reviewers say some small-study bias may be present, but that “the consistency in results after subgrouping by hypertension status suggests that any such bias did not greatly affect the results or conclusions”.

    The reviewers rated how sure they could be (certainty) as high for resting blood pressure. They rated ambulatory readings, from four trials, moderate; the diastolic one was not significant. A 2020 review of 32 supplement trials, funded by the European Food Safety Authority, also found lower blood pressure overall. Its estimate of the change in blood pressure turned upward at the largest amounts of supplementation, though those estimates were not significant. The authors write that their results “suggest excessive potassium supplementation should be avoided, particularly in specific subgroups”.

    ODS, the US Office of Dietary Supplements, states that results from most clinical trials suggest potassium supplementation reduces blood pressure. It notes that a Cochrane review of six of the highest-quality trials found nonsignificant reductions. It concludes that “the evidence suggests that consuming more potassium might have a favorable effect on blood pressure”, but that more research on dietary and supplemental potassium is needed before firm conclusions can be drawn. This page rates the claim on the lowest certainty for these outcomes, moderate.

    Sources: Source [1]Source [2]Source [3]

  • Higher potassium intake lowers the risk of stroke or heart disease Evidence rating: Limited

    People take potassium hoping it will protect them from stroke and heart disease.

    In a 2013 review of studies that followed people over time, more potassium went with less stroke but not significantly less heart disease; the reviewers rate this low to very low certainty.

    This claim rests on studies that followed people over time (cohort studies) and measured how much potassium they ate. The 2013 review for the World Health Organization notes that all of them compared groups with different potassium intakes from food. They show an association, not that potassium caused the difference, and they are about potassium from food, not supplements.

    The review pooled nine such studies of stroke, and higher potassium intake went with a lower risk. Its summary table gives a risk ratio of 0.79, while its abstract and results give 0.76, which the abstract calls a 24% lower risk. This page reports both. The links with cardiovascular disease overall (four studies) and coronary heart disease (three studies) were not statistically significant. That is too little evidence to show an effect either way.

    The reviewers rated the stroke evidence low certainty in their table and text, though their abstract calls it moderate. They rated cardiovascular disease and coronary heart disease very low. ODS, the US Office of Dietary Supplements, reports that a review by the US Agency for Healthcare Research and Quality found inconsistent links between potassium intake and stroke across 15 observational studies. ODS states that any benefit of potassium for cardiovascular disease is likely due to its effect on blood pressure, though some research shows a benefit even when blood pressure is accounted for.

    ODS concludes that “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 [cardiovascular disease]”, but that more research on dietary and supplemental potassium is needed before firm conclusions can be drawn. This page rates the claim on the lowest certainty, very low.

    Sources: Source [1]Source [2]

  • Using a potassium-enriched salt substitute instead of regular salt lowers blood pressure in adults Evidence rating: Moderate

    People who salt their food switch to a potassium salt substitute hoping it will lower their blood pressure.

    A 2022 Cochrane review found salt substitutes probably lower adults’ blood pressure slightly compared with regular salt, and rated that moderate certainty.

    This claim is about salt substitutes used in place of regular salt, not potassium tablets. A 2022 Cochrane review, funded by the World Health Organization and UK aid, pooled randomized trials in adults. With the substitutes, systolic blood pressure was 4.76 mmHg lower (20 trials, 21,414 people) and diastolic 2.43 mmHg lower (19 trials, 20,830 people). The reviewers rated both moderate certainty, lowered because results differed a lot from trial to trial.

    The review reports that potassium replaced some of the sodium in 23 of its 26 trials, and in its discussion counts 24 trials using some potassium chloride. In the blood pressure analysis, two small trials, with 81 people, tested a substitute with no potassium. Within the pooled results, trials of substitutes containing potassium chloride also showed lower blood pressure. Most trials were in rural or suburban settings, and more than half in low- and middle-income countries.

    This claim is about measured blood pressure. The reviewers add that “evidence is limited for adults without elevated blood pressure”. For other outcomes the review was less sure. Substitutes may make little to no difference to how many people had high blood pressure (one trial, low certainty). The evidence on blood pressure control is very uncertain, and so is the evidence in children (one trial of 92 children).

    ODS, the US Office of Dietary Supplements, reports a review by the US Agency for Healthcare Research and Quality finding that reducing sodium lowered blood pressure, and that adding potassium from food or supplements did not lower it further. ODS says this suggests at least some of the benefit of potassium salt substitutes may come from the reduction in sodium rather than the extra potassium.

    Sources: Source [1]Source [2]

  • Using a potassium-enriched salt substitute instead of regular salt lowers the risk of stroke, acute coronary syndrome or death from cardiovascular disease Evidence rating: Limited

    People switch to a potassium salt substitute hoping it will protect them from stroke and heart disease.

    A 2022 Cochrane review found salt substitutes probably reduce non-fatal stroke, acute coronary syndrome and cardiovascular death slightly, but rated stroke deaths and other events very low certainty.

    A 2022 Cochrane review looked at events in adults who used salt substitutes in place of regular salt. It concluded that substitutes probably reduce non-fatal stroke, non-fatal acute coronary syndrome (sudden reduced blood flow to the heart) and death from cardiovascular disease slightly. It rated each of these moderate certainty. One large trial drove these results, and 73% of its participants had already had a stroke. The reviewers lowered certainty because that trial may not apply to the general population.

    Two of these results reach no difference at the edge of their range. For non-fatal stroke the risk ratio was 0.90, with a 95% confidence interval of 0.80 to 1.01. Analyses limited to trials at low or unclear risk of bias, or to trials randomizing individuals, did not show the benefit. For cardiovascular death the rate ratio was 0.77, with an interval of 0.60 to 1.00. The acute coronary syndrome result came from the one large trial alone (0.70, 0.52 to 0.94).

    For stroke deaths (two trials) and for other cardiovascular events (five trials, 982 people), the reviewers say the evidence is very uncertain (very low certainty). This page rates the claim on the lowest certainty, very low.

    Sources: Source [1]

  • Potassium citrate salts reduce new calcium kidney stones in adults who have had them Evidence rating: Limited

    People who have had kidney stones take potassium citrate hoping to stop new stones forming.

    A 2015 Cochrane review found fewer new stones and more shrinking stones with citrate salts, but judged the trials’ reporting moderate to poor; ODS says more research is needed.

    This claim is about citrate salts taken by adults with calcium-containing kidney stones, not about potassium in food. A 2015 Cochrane review included seven randomized trials, with 477 people, most with calcium oxalate stones. Three tested potassium citrate, three potassium-sodium citrate and one potassium-magnesium citrate, against placebo or no treatment for at least six months. New stones formed less often with citrate (risk ratio 0.26; seven trials, 324 people). Stones were more likely to shrink (four trials, 160 people).

    The reviewers judged the risk of bias generally low, but the quality of reporting moderate to poor, with a high risk of bias from dropouts in two trials. No trial reported a sample size calculation, and the review did not grade certainty. Results for new stones differed a lot between trials, mostly because of one trial that found no difference. The reviewers call for a well-designed, statistically powered multicenter trial.

    ODS, the US Office of Dietary Supplements, states that the proposed mechanism involves citrate, not potassium itself. It reports that a review by the US Agency for Healthcare Research and Quality found observational studies link higher potassium intake with fewer kidney stones. That review found the evidence insufficient to judge potassium supplements, because only one trial met its criteria. ODS says more research is needed. The sources differ, so this page takes the lower rating, limited.

    Sources: Source [1]Source [2]

  • Potassium supplements improve bone density or slow bone loss Evidence rating: Limited

    People take potassium hoping it will keep their bones strong as they age.

    ODS describes a few trials of potassium citrate or bicarbonate with mixed results on bone density and bone turnover, and says more research is needed.

    This page could not read in full a review that pools these trials, so it reports what ODS, the US Office of Dietary Supplements, says. ODS describes four trials of alkaline potassium salts. In 52 healthy adults over 55, potassium citrate for six months reduced calcium lost in urine compared with placebo. In 201 adults aged 65 or older, who also took calcium and vitamin D, two years of potassium citrate increased bone density at the lower spine.

    ODS also describes a trial of potassium bicarbonate in older adults that reduced markers of bone turnover over 84 days. It also describes a two-year trial in 276 women aged 55 to 65 after menopause, which found that potassium citrate did not significantly reduce bone turnover or increase bone density at the hip or spine.

    ODS states that observational studies link potassium from fruits and vegetables with higher bone density. It says diets that emphasize fruits and vegetables might improve bone health, but that more research is needed to tease out potassium’s own contribution. The trials disagree, so this page rates the evidence limited.

    Sources: Source [1]

How and when to take it

What the cited sources say about taking it. Ask your doctor or pharmacist what applies to you.

  • Check the label for elemental potassium

    ODS states that the Supplement Facts panel declares the amount of elemental potassium in the product, not the weight of the whole potassium-containing compound. It adds that potassium iodide, found in some supplements in microgram amounts, serves as a form of iodine, not potassium. Source [1]

  • There is an Adequate Intake, and no upper limit

    ODS reports that the US expert committee found the data insufficient to set an average requirement, so it set Adequate Intakes instead. ODS lists the Adequate Intake as 3,400 mg for men and 2,600 mg for women aged 19 and older, and 2,900 mg during pregnancy and 2,800 mg during breastfeeding at ages 19 to 50. It states that these values do not apply to people whose potassium excretion is impaired by medical conditions, such as kidney disease, or by medicines. It also reports that the committee did not set an upper limit for potassium. Source [1]

  • Talk to a health care provider first if you have kidney disease or take medicines that affect potassium

    ODS states that individuals at risk of high blood potassium should consult a physician or registered dietitian about appropriate potassium intakes from all sources. It says some people, such as those with kidney disease or who take certain medications, should consult their health care provider before using salt substitutes. Source [1]

Which form the evidence used

Supplements are sold in several forms. This is what the sources on this page say about them — which form the research used, and any comparison those sources themselves made. Where they made none, this page does not rank the forms.

  • Potassium chloride, What the sources supportDetails

    ODS, the US Office of Dietary Supplements, states that potassium in supplements is often present as potassium chloride. A 2013 review of blood pressure trials reports that all but three of its supplement trials used potassium chloride, and that it could not compare supplement types. A 2020 review of supplement trials reports that most used potassium chloride. Neither compared forms with each other, so this page cannot say whether one form differs from another. Source [1]Source [2]Source [3]

  • Potassium citrate, What the sources supportDetails

    The cited kidney stone review included trials of potassium citrate, potassium-sodium citrate and potassium-magnesium citrate. Its authors state that which citrate salt is most favorable remains an unanswered question. ODS reports that the trials of potassium supplements for bone it describes used potassium citrate or potassium bicarbonate. Source [1]Source [2]

  • Potassium gluconate, aspartate, phosphate or bicarbonate, Details

    ODS names these among the other forms used in supplements. It states that only a few studies have examined how well the various forms are absorbed, and reports that a 2016 trial found people absorb about 94% of potassium gluconate from supplements, similar to potassium from potatoes. This is about absorption, not about whether potassium helps any of the claims rated below. Source [1]

  • Potassium-enriched salt substitute, What the sources supportDetails

    A 2022 Cochrane review of salt substitutes reports in its summary that 23 of its 26 trials used substitutes in which potassium replaced some of the sodium, and in its discussion that 24 trials replaced some of the sodium chloride with potassium chloride. It reports that the share of sodium chloride replaced ranged from about 3% to 77%. ODS states that the potassium content of salt substitutes varies widely. Source [1]Source [2]

Sources

  1. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses
    BMJ, 2013 · Meta-analysis · Primary source · Certainty: very low
  2. Potassium Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials
    Journal of the American Heart Association, 2020 · Meta-analysis · Primary source
  3. Potassium: Fact Sheet for Health Professionals
    NIH Office of Dietary Supplements, 2022 · Health authority summary · Primary source
  4. Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women
    Cochrane Database of Systematic Reviews, 2022 · Systematic review · Primary source · Certainty: very low
  5. Citrate salts for preventing and treating calcium containing kidney stones in adults
    Cochrane Database of Systematic Reviews, 2015 · Systematic review · Primary source

Page history

Show all 2 changes to this page
  • — Published.
  • — First drafted. Blood pressure with supplements and with salt substitutes rated moderate; stroke and heart disease, salt substitutes and cardiovascular events, kidney stones and bone health rated limited.