A few weeks ago, I heard about this as a good idea via a podcast which claimed that getting closer to the potassium recommendations would remove a large part of the problems of high sodium consumption. I switched my salt to 2⁄3 sodium and 1⁄3 potassium a few weeks ago, and until now I didn’t notice negative effects on taste[1].
Given that potassium is not that expensive, my impression was that a public policy of “everyone, potassium is x% part of table salt from now on” would lead to a large chunk of the benefits without people having to change their taste preferences a lot (by both decreasing sodium by x% and increasing potassium consumption correspondingly). This would increase the prize of salt significantly, which should have similar effects to a sodium tax (the prices would still amount to low single-digit cent costs per day even for high salt consumption).
I would be curious about your thoughts on this, given that you have researched this topic a lot more deeply :)
Nonetheless I could still imagine that there are a number of foods with completely excessive amounts of salt for which other interventions would still be a good idea.
I trust the nutritionist enough to be confident that this change is a good idea for me personally, but I did not look up the sources and I might well have misunderstood the effect-size of increasing potassium consumption
Thanks for your interest! You would have seen the discussion of potassium in the section on potential interventions—and I think the TLDR is that it does look good, but does cost money. Hence, we’re pursuing sodium reduction right now; but as we work with our partners doing the actual advocacy reach-out to governments, we’ll definitely get them to raise potassium as an option. Hopefully, in the long term, economies of scale make these more cost-competitive.
That makes a lot of sense—in practice, there are many relevant considerations and other interventions might well be preferable in many contexts.
The expert opinion
[...] though a Chinese RCT does show positive results, and the current evidence is convincing, still more studies are needed, with the magnitude of benefit not as large as you would think.
also sounds as if potassium-enriched salt surely helps to some degree, but probably isn’t a solution by itself. And I get the impression that research in the coming years will probably improve the uncertainties here.
Apart from this, I am a bit surprised that the costs (“perhaps double the price”) would be a problem for richer countries. If I am understanding this right, this should still be obviously worth it as a health expenditure? A very simple estimate might be:
lost expected life due to high blood pressure: ~2 years (scaling the DALY burden to a single person)
expected gains from switching to potassium-enriched salt: ~1/2 year (I am guessing)
The thing is that potassium salt (or mixed sodium/potassium salts) are available in rich country; it’s really just a matter of uptake. Consumers might not know or think much about the health aspects of things; they might not be price sensitivity; and even “double” is an off the cuff estimate by the expert, and it probably depends on country and location (e.g. f I check Walmart’s e-commerce website, Morton’s potassium salt is 10x as expensive as normal salt).
So it goes back to policy, and whether governments should just regulate sodium content even in salt—we didn’t really explore this, given the higher evidence base and cheapness of salt policies.
Consumers might not know or think much about the health aspects of things
This describes me quite well in many of my health choices, and unfortunately this is apparently really common.
potassium salt is 10x as expensive as normal salt
In my case, I also did not find salt that is pre-mixed at a price that makes sense to me—I bought a pharma-grade bag of KCl and mixed it with usual table salt myself[1], which resulted in a net-price that is 3x of the usual sodium salt.
So it goes back to policy, and whether governments should just regulate sodium content even in salt—we didn’t really explore this, given the higher evidence base and cheapness of salt policies.
That sounds very reasonable—I’ll be looking forward to hearing about updates in the future!
I just realized that I could also just follow the links and found a part of the answer
[...] Another expert is more bearish, noting that though a Chinese RCT does show positive results, and the current evidence is convincing, still more studies are needed, with the magnitude of benefit not as large as you would think. That said, because it’s a substitution of sodium for potassium, there’s a double benefit for cardiovascular health; people don’t consume enough potassium, and potassium lowers blood pressure. And while there is a concern that increasing potassium intake across the population can create risk to people with chronic kidney disease, the evidence is that such people tend to suffer from cardiovascular disease anyway – most hypertension sufferers have higher risk of diabetes/obesity etc.
in section 4.1 1) g)
and also
Of huge interest too is potassium substitution; though evidence of that is fairly
new, they think it is a game changer that can accelerate action. They are trying
to figure out the name (e.g. potassium-enriched salts) from a public relations
perspective. Increasing potassium reduces heart disease – it is an effective
strategy. Low sodium salts in general do cost more – perhaps double the price.
Then again, Himalayan salts are similarly twice as expensive, yet people still
buy it – the challenge is getting the message out there, and that it is good for
you (i.e. benefits of potassium); in Australia they are trying to understand the
barriers to scaling up. There is research on how to get potash in a scalable way
– there is a lot of potassium out there, and only a small amount is food grade
(20%), with the rest (80%) used for things like fertilizer.
in section 3.3. Global Salt NGO, point 2.
I am happy to learn that people are working on this :)
And it does make sense that the increased price also creates difficulties for adoption. This certainly isn’t a trivial problem.
Also, I agree that the public relations perspective is important. Here in Germany, there were large health problems due to missing Iodine, which were reduced by fortifying table salt—but even though the necessity for Iodine hasn’t changed, people/products are starting to use the fortified salt less.
Regarding increasing potassium intake:
A few weeks ago, I heard about this as a good idea via a podcast which claimed that getting closer to the potassium recommendations would remove a large part of the problems of high sodium consumption. I switched my salt to 2⁄3 sodium and 1⁄3 potassium a few weeks ago, and until now I didn’t notice negative effects on taste[1].
Given that potassium is not that expensive, my impression was that a public policy of “everyone, potassium is x% part of table salt from now on” would lead to a large chunk of the benefits without people having to change their taste preferences a lot (by both decreasing sodium by x% and increasing potassium consumption correspondingly). This would increase the prize of salt significantly, which should have similar effects to a sodium tax (the prices would still amount to low single-digit cent costs per day even for high salt consumption).
I would be curious about your thoughts on this, given that you have researched this topic a lot more deeply :)
Nonetheless I could still imagine that there are a number of foods with completely excessive amounts of salt for which other interventions would still be a good idea.
I trust the nutritionist enough to be confident that this change is a good idea for me personally, but I did not look up the sources and I might well have misunderstood the effect-size of increasing potassium consumption
Hi Mart,
Thanks for your interest! You would have seen the discussion of potassium in the section on potential interventions—and I think the TLDR is that it does look good, but does cost money. Hence, we’re pursuing sodium reduction right now; but as we work with our partners doing the actual advocacy reach-out to governments, we’ll definitely get them to raise potassium as an option. Hopefully, in the long term, economies of scale make these more cost-competitive.
That makes a lot of sense—in practice, there are many relevant considerations and other interventions might well be preferable in many contexts.
The expert opinion
also sounds as if potassium-enriched salt surely helps to some degree, but probably isn’t a solution by itself. And I get the impression that research in the coming years will probably improve the uncertainties here.
Apart from this, I am a bit surprised that the costs (“perhaps double the price”) would be a problem for richer countries. If I am understanding this right, this should still be obviously worth it as a health expenditure? A very simple estimate might be:
lost expected life due to high blood pressure: ~2 years (scaling the DALY burden to a single person)
expected gains from switching to potassium-enriched salt: ~1/2 year (I am guessing)
expected costs: 80 years * 2⁄3 kg/year * $10/kg = ~$550
resulting cost-effectiveness (assuming 1 year = 1 DALY): $1100 / DALY averted
Of course this isn’t comparable to GiveWell effectiveness, but it is really cheap compared to other health expenses.
The thing is that potassium salt (or mixed sodium/potassium salts) are available in rich country; it’s really just a matter of uptake. Consumers might not know or think much about the health aspects of things; they might not be price sensitivity; and even “double” is an off the cuff estimate by the expert, and it probably depends on country and location (e.g. f I check Walmart’s e-commerce website, Morton’s potassium salt is 10x as expensive as normal salt).
So it goes back to policy, and whether governments should just regulate sodium content even in salt—we didn’t really explore this, given the higher evidence base and cheapness of salt policies.
That makes a lot of sense!
This describes me quite well in many of my health choices, and unfortunately this is apparently really common.
In my case, I also did not find salt that is pre-mixed at a price that makes sense to me—I bought a pharma-grade bag of KCl and mixed it with usual table salt myself[1], which resulted in a net-price that is 3x of the usual sodium salt.
That sounds very reasonable—I’ll be looking forward to hearing about updates in the future!
with the hope that diluting by 1⁄3 will not be too much for the anti-hygroscopic components of the store-bought table salt
Wow thanks I didn’t know about the potassium alternative ( and in as doctor), that’s exciting I might look into it for myself!
Would not be a difficult cost effectiveness analysis to see if this made sense, nice idea.
I just realized that I could also just follow the links and found a part of the answer
in section 4.1 1) g)
and also
in section 3.3. Global Salt NGO, point 2.
I am happy to learn that people are working on this :) And it does make sense that the increased price also creates difficulties for adoption. This certainly isn’t a trivial problem. Also, I agree that the public relations perspective is important. Here in Germany, there were large health problems due to missing Iodine, which were reduced by fortifying table salt—but even though the necessity for Iodine hasn’t changed, people/products are starting to use the fortified salt less.