Perhaps an adequate minor amount of magnesium salt + potassium salt would be better?

I would encourage many, if not most, people to add some potassium salt (often called non-salt salt in the U.S.) to foods as they are prepared, or to the salt shaker.  I agree with Jan that magnesium supplementation might also be useful.  While I believe that most studies looking at mineral levels in populations find them low, the process still needs to be carried out with care.  While the risk of too much potassium is real, so is the great risk of hypokalemia.

High serum potassium (and magnesium) may be seen in patients using ACE-inhibitors. I would (therefore) recommend only a minor supplementation to the general population..

Definitely there should be warnings for those with health issues and on medication.  I think we all agree that we need to keep people from having the severe problems of hypertension (++) and that is why some supplementation should be a useful public health measure.

Vegetables, if not starchy give a lot of K!!

We could recommend (more) vegetables to get (more) potassium and magnesium.  

Vegetables and fruits are great sources for both minerals and vitamins, and they also contain many other compounds which are very healthy for humans.  There is evidence that even having higher levels of fiber in the diet improves the intestinal microbiota which reduces many disorders, including hypertension.  In general, if all of us ate a well balanced plant based whole food diet we would have a greatly lowered rate of chronic diseases.

I completely agree with J Wolff and practiced this strategy for 50 years!

Let me clarify some concepts:

First, in  humans, all foods are anaimal or vegetable cells having large amount of K content (Cell K= 135-140/ liter of cell water, or 94-96 mmol/ liter of cell), and little Na content (5-7 mmol/l cell). Indeed, total body Na is tighly controled, irrespective of salt diet, by effective mechanisms including renal Na excretion, larger with dietary salt intake (>140-280 mmol/l, overnight urine void), very little (0-5 mmol/24 hrs urine) in population without NaCl resources (Australia and South American Indians).

Second, Foods processeed from industry may differs significantly, and worst have not specific information for K and Na per liter of water (Fluids), or per liter of cell or liter of cell water in the others.

In general, K and Na in our foods should not be a major conern in healthy subjects, but precise indications are required for Renal, Cardiac or Endocrine diseases.    

I agree that the administration of small amounts of potassium to sodium chloride would be beneficial and prevent the development of systemic hypertension (SH) in susceptible people, such as those with genetic burden SH or who are already carriers of Metabolic Syndrome.

There is sufficient scientific and experimental evidence of the effect of potassium salts to prevent and in some cases SH treat. I like clinical use it in my patients and about 10 years ago I published an article about it, which annex to this comment.

However it is worth considering the contraindication of this measure in certain endocrine diseases, such as adrenal insufficiency, in patients with SH already taking ACE inhibitors or ARBs that produce hyperkalemia and in patients with chronic renal failure (CRF )

regards

Sincerely

Dr. Jose Luis Garcia Vigil

Article Importancia de sodio y potasio en el síndrome metabólico

Dietary additives to balance even micro elements is a western  culture as most food intake are processed food in present days as a result of lifestyle from industrial revolution and technology and fast life. Nature has its own balance. A bull or an elephant does not need food additives to remain healthy. Rest of us are following that same path but not all. Substantial use of 'natural' food in diet (called organic in modern language and are expensive) takes care of micro displacements. In Tagore,s language 'give me back the forests and take back the cities', is unfortunately not possible. We cannot move backwards but can be aware.

I am sorry if I have anybody by my answer. I try to grow natures food in my backyard and as far as possible not depend entirely on processed food. It was not easy or even possible when I was busy with my profession.

Dr. Gupta, here in the U.S. many companies label their products as 'natural' but it is not a legal definition and so we never are sure what is in the food.  It is generally thought to mean that no man-made products (chemicals) are added, but that is still not a sign of healthy food.  The term 'organic' is much more precise as it is a legal term that is only supposed to be used for food grown without 'artificial' chemicals, without any pesticides, and without hormones (if meat).  

The concept of a "healthy" diet has been mentioned several times, but no one has defined it.  Is there anyone on this planet that currently has a "healthy" diet?  Is the "healthy" diet the same for me as it is for child in Bolivia?  Since the idea of a "healthy" diet is so unclear, and the quality of food that makes up a healthy diet is so variable, I think we need to stop using this as if everyone knows what a healthy diet is, that everyone can obtain a healthy diet, that we all can afford a "healthy" diet, that we can eat enough of the "healthy" foods of this diet, and that our food preparation does not damage or leach many of these "healthy" components.  We as scientists should be much more precise in what we say, and "healthy diet" is simply an imagined idea that no two nutritionists can even agree upon.

Fruit and vegitables should be recommended (also for several other reasons).

Patients on some diuretics (tiazides) may require potassium supplementation (tablets). In contrast, those on ACEIs or antialdosternic drugs is at risk of hyperkaliemia and should avoid supplements. Therefore, potassium salt is not a good idea for the general population. 

First of all, thank you all for contributing, it has been a productive exchange of comments. As far as i can tell, this discussion has established:

1/ potassium supplementation in cooking salt for general population wouldn't be advisable due to possible unwanted consequences in combination with ACEI/ARB consumption which is wide-spread

2/ a 'healthy diet' provides adequate daily potassium, even though nobody can define that diet explicitly?! (even though as Harvard professor and Chair of Human Evolutionary Biology D. Lieberman states in 'The stroy of human body'.  Penguin Books 2013. - pg. 224 : prehistoric man consumed less tha 1 g of sodium and around 7 g of potassium daily, whereas an average American intake is 3.375 g of sodium and 1.328 g of potassium - based on CDC and peer-reviewed literature fully citated) 

*potassium RDA is thought to be around 2 g, even though somewhere even up to 4.5g is mentioned - definitely more than an average American intake

3/ Would it be prudent for people not taking ACEI/ARB to take some potassium supplementation in terms of preventing hypertension and aiming for a more favorable sodium/potassium ratio intake?

4/ Even though with the usage of ACEI/ARB there is a hyperkalemia, is there a general excess of potassium in body or is the body depleted of it - i.e. a iatrogenic kalipenic state is created on an intracellular level further exacerbating the vicious cycle of hypertension pathogenesis- due to renal filtration?

5/ Magenisum was also mentioned, should it be generally more available to entire population, i.e. adding it to cooking salt?

The mass-scale adding of vitamins in food industry and food processing is a well established practice (e.g. folate, b12, vit C, vit D), however it seems minerals and iother ions get neglected. With our growing understanding of pathogenetic process', is it time to consider such large scale public health tactics, but of course with maximum safety and evading possibilites of  acheiving unwanted toxic concentrations? A lot has been done with iodination of salt, why stop only there?

Dr. Toljan - some response to your post:

1/ I disagree and suggest that supplementation for the general population is best, in part to avoid having to put people on the ACEI/ARB poisoning regimen.  And those on it, way too many but still a small part of total population, should receive as part of their treatment education in how to control K intake.

2/ The average diet does NOT provide adequate potassium, as can be seen in the data you use.  The WHO states "Individuals with hypertension, blacks, and middle-aged and older adults. Aim to consume no more than 1,500 mg of sodium per day, and meet the potassium recommendation (4,700 mg/day) with food."  Most people get well above the sodium and well below the potassium that is recommended.

3/ Yes.  If we could get a proper balance of Na and K in our "diet/supplements" maybe we would not need all of these drugs to 'treat' (not cure) hypertension. 

4/ Yes, the drugs may make the situation worse.

5/ I believe that magnesium is also missing because of our really poor diets of mostly processed foods.  So better diets, and some supplementation and we might have less chronic diseases and problems such as migraines.

I beleive it should. ADDing pottassium to cooking will shift Na/K ratio to the favourable range where it will blunt blood pressure raising effect of Na

It appears that a demagogue has entered this question.  Down votes should be for answers that do not add anything to the discussion.  Being so tied to one side of the question that you do not even like counter arguments is both non-scientific, non-academic, as well as showing the person to be of very low character.  We are supposed to be "arguing" and presenting different views on this question.  Not just agreeing with long time practice which favors medication or real understanding of the problems.

I thought that this good question was a good time for discussion on the questions of potassium and supplementation, whether by whole foods or supplements.  As someone has decided that discussion is bad, and obviously is very narrow minded in their consideration of this important issue, I would like to ask that person to please go to these two questions which deal with questions of integrity and truth.  This is a discussion site, not a site for researchers to condemn the views of others.  As I said the down vote is supposed to be for poor quality answers, not for answers which disagree with a very limited and outdated view.

https://www.researchgate.net/post/What_is_Integrity#view=5756872e48954c2b3c092464

https://www.researchgate.net/post/Can_the_truth_be_measured_by_a_majority_of_opinions#view=5756a43696b7e4989b48afee

It seems that in this question we have found an important divide, the view of clinicians (physicians) who are concerned with specific patients vs those of us who take a public health approach and consider what may be best for the larger group of people.  I am attaching below a link to a meta analysis which looked at studies where an oral supplement was taken and their conclusion "Based on this analysis, an increase in potassium intake should be included in the recommendations for a non-pharmacological approach to the control of blood pressure in uncomplicated essential hypertension."  Even the U.S. government has become involved in this debate asking food manufacturers to reduce sodium in their products, and a small side note was they suggested increasing potassium.

A more recent review and metaanalysis of potassium concluded:  "High quality evidence shows that increased potassium intake reduces blood pressure in people with hypertension and has no adverse effect on blood lipid concentrations, catecholamine concentrations, or renal function in adults. Higher potassium intake was associated with a 24% lower risk of stroke (moderate quality evidence). These results suggest that increased potassium intake is potentially beneficial to most people without impaired renal handling of potassium for the prevention and control of elevated blood pressure and stroke."

Obviously, we can still argue over the question, and we should discuss the best ways to do this (dietary vs some supplementation), but in western countries it appears that potassium is needed in higher levels for the best health of the population.

http://www.ncbi.nlm.nih.gov/pubmed/1649867

http://www.ncbi.nlm.nih.gov/pubmed/23558164

Here is a quote based on the NHANES about potassium in the diet (sorry the data is older) "In reality, the average intake of dietary potassium in many countries is relatively lower than recommended. As in a report from the third NHANES 1988–1994 study, estimated mean potassium intakes of adults in the USA ranged from 2900 to 3300 mg in men and 2200 to 2400 mg in women. The NHANES data from 2003 to 2008, revealed that less than 2% of adults and approximately 5% of men in the USA met the recommendations for potassium intake (i.e., at least 4700 mg/day)."  

The link below in an article about potassium and health makes this statement:  "intakes considerably above current levels are needed for optimal health." 

http://www.ncbi.nlm.nih.gov/pubmed/23674806

I do not know whether there is a definite universal amount of potassium additive needed as in the case of Iodine in some countries. Potassium intake may vary due  to dietary  habits eg. from certain fresh fruits or green vegetables. I do not know whether there is any specific quantity advised and regret my ignorance. I do know that sodium loss happens through sweating in hot humid climates but do not know how much.

Please, read my Article in Letter to Editor (BMJ April 2013): “Low Potassium Intake or Impaired Cell Potassium Uptake”. These comments intents to defined dietary K intake (normal or low)  vs inherited defect of low RBC-K uptake in essential hypertension, with no option except for pharmacological approach with Amiloride HCl Dihydrate.

Further, our recent findings that RBCs are the main regulator of dietary K absorption at GI tract (5-15 minutes), confirmed its role on plasma K regulation, renal K excretion (p= - 0.865), myocardial K (ECG) and total body K (TBK) content as measured.

Therefore, body K physiology needs the measurement of plasma K (extracellular K marker) along with those of RBC-K (intracellular K marker), expressed as K in each fraction of body water compartments.    

Excuse the add comments:

If we recognize the role of RBC in body K physiology, we probably amend the clinical concepts of hypokalemia and hiperkalemia, in which all ECG changes are explained by the presence of severe hypocalcemia (≤0.90 mmol/l) in hyperkalemia (≥7.0 mmol/l), probably irrelevant for any cell or myocytes K having ≥135 mmol/l. However, severe hypokalemia with hypocalcemia are closely related to low RBC-K content (p=0.76). In general, normal ECG despite large changes in plasma K, are simply related to normal plasma ionized calcium, instead of the hyperkalemia or hypokalemia.

However, ionized calcium in plasma or other human fluids, as measured by Ion-selective Calcium electrodes (measuring Ca++ activity) are unreliable leading to reductions in testing (Karon BS, Clin Chem. 2016 Jun;62(6):824-30), as compared with Flame Emission Photometer method (Ca++ composition) from our Laboratory. In this scenario, severe ionized hypocalcemia (≤0.90 mmol/l) has been recorded in ≥40% of critical ill patients (acidosis, sepsis, extensive GI surgery, disseminated intravascular coagulation, onset of assisted ventilation, etc), all difficult to restore in few days, despite serial infusion of IV CaCl2 bolus. 

In brief, please measure plasma ionized calcium, as routine test in critical care unit, chronic renal disease, heart failure, large trauma and surgery procedures, post- blood transfusion, pediatric re-hydration, and others decreased ionized calcium. 

Plasma ionized calcium, as routine test in critical care unit, is important. PTH will also reflect a Ca deviation. And PTH may be correlated to hypertension.

Not-starchy veetableshave high Ca and K content. Are you unable to suggest intake of 200 - 300 grams of non-starchy vegetables per meal?

I agree with Mario and should be included in our diets. In any scenario, confirm that plasma K and Ionized calcium along with RBC-K content were restored, the full evidence that K-Ca compartment are functionally normals.

Plasma ionized calcium, as routine test in critical care units, is of course mandatory. But the role of adequate daily intake of magnesium and potassium for public health and to prevent arterial hypertension is another story.    .

Low dietary magnesium is common in the west, and leads to potassium deficiency.

Low dietary magnesium is common and is associated with high blood pressure and diabetes type 2.  

Have no experience with dietary magnesium but I have seen a few cases of Hyponatriemic  Alkalosis in the aged in my country which seems like GB syndrome but get cured by stabilizing acid/base/electrolyte balance.

There are commercial "lower salt" products which per .6 g (or 1/8 tsp.) provides 135 mg. sodium, 88.2 mg. potassium, 8 mg. magnesium, 7.5 mg. lysine and 12 mcg of iodine. As a patient on a low sodium diet I find this one to be the best tasting. However, in general, the public would not accept this flavor very well and experientially this is the best of them. It does work well in low sodium baking, cheese making and some soups. For anyone interested I use "Good Salt" as it is easy to obtain and far superior to potassium chloride salt substitute. 

 Beverly, I searched for 'good salt' and came across a website called nutrasalt and I am assuming this is what you are referring to.

Sorry to be so slow in response. I cannot find nutrisalt. I buy "Good Salt" on Amazon. It originated in Norway. Even with this, I would caution as people with kidney disease and those on high dose and different diuretics are going to have very different requirements for potassium. Few people, including me, count our mineral levels very closely. It just isn't practical in real life. I watch sodium closely but worry somewhat less about potassium and in real world experience it's a pain in the neck! Not to mention the bad taste.