Research & Education

Potassium: The Little Element that Could (significantly reduce the cost of the global medical crisis)


Spring has sprung the flowers are out and if you're not planning and planting your garden stake out your local farmer's markets. Of the myriad reasons to do so chances are extremely high that you need some potassium. 93% of us do according to the National Health and Nutrition Examination Survey (NHANES). No better way to get it than lots of fresh fruits and veggies. (Or avocado and coconut water -- my two favorite sources.)

For you skimmers I'll skip to the punchline of this ENL: If we had to pick one single easy fix for the impending 47000000000000 US dollar global health care crisis it would be INCREASE FOOD SOURCE POTASSIUM. That's it. We'd shave 20-30% right off the top of that debt. Done. And there would be a trickle-down effect of a healthy diet beyond that immediate savings too. 








Potassium giveth ...








Sodium taketh away...

Tell Me More

Most famously potassium works with its little brother sodium in a delicate ratio getting pumped in and out of cells. It's a part of the behind-the-scenes battery using energy (ATP) to generate the pulse of life. Thinking feeling heart beating moving tasting breathing and on and on. Potassium is one of the most fundamental players in the game. Any activity requires the action potential that potassium generates as it is being pumped around.

For sake of simplicity I'll call the sodium/potassium/ATPase pump The Battery of Life.

See the movie: How the Sodium Potassium Pump Works

Historically potassium was so ubiquitous in the food supply deficiency through diet was rare. In fact look at a Daily Recommended Intake (DRI) table for minerals and you won't see potassium listed! (You don’t see your DRI for oxygen either.)

But humans have a way of messing with the most fundamental rules of life don't we?

If you're eating processed foods with any regularity you're ingesting too much salt and too little potassium. You're messing with the Battery of Life. Here's how bad it is: In the US according to NHANES we're ingesting almost 250% of the DRI of sodium (men: 280% women: 208%) and only 7% of the recommended amount of potassium.

Way too much way too little and way too imbalanced.

Humans are the only mammals to negatively flip the intake of sodium and potassium.

What are the ramifications of this flip?

When we were writing the Elements chapter from Laboratory Evaluations in Integrative and Functional Medicine we came up with a novel idea: Let's create a table of the association between essential element deficiencies and top causes of death in the US. We found that potassium deficiency was associated with heart disease cerebrovascular disease (stroke) and essential hypertension. (What we feel as symptoms of deficiency are vague and widespread but could include muscle cramps fatigue slower reflexes.) 

Potassium deficiency is associated with the top causes of death worldwide including hypertension stroke and heart disease.

About 25% of deaths globally are from heart disease and stroke alone almost 14 million deaths annually. If we were potassium-replete especially via fruits and veggies how much could this number be reduced? How much money could be saved? I remember researching the global cost of hypertension and it alone was pegged at 10000000000000 US dollars annually. Hence my thesis from second paragraph above that potassium repletion through dietary intake could shave 20-30% off the impending 47 trillion US dollar global medical bill.

A note to a small subset of readers: Yeah I know correlation isn't causation.  It seems a pretty tight relationship to me though. Better still: If we get our potassium from foods that shift alone will improve morbidity and mortality.

So in summary increase potassium-containing foods. A lot. Reduce processed foods. A lot. It's an easy fix to a longer and healthier life and ultimately will save a lot of money.

Part Two: Assessing potassium and sodium status

This April I was honored to be invited to lecture on allergic disease at the annual Orthomolecular Conference in Toronto Canada (photos below). As with most good conferences there are usually a couple practice changers that is ideas so relevant that they move one beyond just intellectual stimulation and into immediate action and change. For me one of this year's came from a lecture delivered by Saul Pilar MD a clinician from Vancouver BC.

Dr Pilar's simple but powerful take-home message? Measure 24-hour urine sodium (Na+) and potassium (K+) levels in yourself and your patients.

Ruling out confounding factors like Na+/K+-altering diseases and medication effects urine Na+ and K+ reflect what we eat. Your ratio should be in the vicinity of 1:4 sodium to potassium (1500mg/day Na+ and 4700mg/day K+). And if it's not? Too many processed foods too little whole foods. Easy measure easy fix. (Note: Depending on the reference there is some disagreement around optimal Na+ and K+ intake but generally speaking ballpark is 1:3 to 1:5.)

If you're wincing at the idea of an onerous 24-hour urine collection a cursory search of the literature reveals that we can probably get away with this gold standard measurement in a 12-hour collection. This suggests that an overnight collection is adequate too.  And this test is routinely insurance-covered.

Generally speaking with regard to minerals we want to see what's going on inside the cell. This is usually accomplished by a red blood cell mineral assessment. Looking at intracellular potassium is a good thing no doubt. However given the gross imbalance in dietary intake in the case of sodium and potassium the urine test is best.

Serum sodium and potassium are also routinely assessed; but these levels are so tightly regulated by the body that you'll rarely see a nutrient-induced abnormality. If K+ is abnormal in serum evaluation for causes beyond the diet is essential.

91-year-old Prince Phillip is in the house!

And you can get a blurry glimpse of the proof in this photo. (Arrow provided for your viewing convenience.) Prince Phillip Queen Elizabeth's hubby showed up at the Fairmont Royal York Hotel in Toronto home of this year's Orthomolecular Conference. Was he secretly hoping to catch some of the Conference? Maybe... he was in the room right next door!

Prince Phillip's possee in the Royal York.

For all you Royal-ophiles his full name is His Royal Highness The Prince Philip Duke of Edinburgh Earl of Merioneth and Baron Greenwich KG (Knight of the Garter) KT (Knight of the Thistle) OM (Order of Merit) GBE (Knight Grand Cross of the Order of the British Empire) AC (Companion of the Order of Australia) QSO (Companion of The Queen's Service Order) PC (Privy Counsellor). And we thought some integrative physicians have lengthy professional designations….


Also at the conference was Dr. Nicolas Gonzalez talking about Dr. John Beard pictured on the screen. Dr Beard developed the trophoblastic theory of cancer and pioneered the use of pancreatic enzyme therapy. Very interesting.

Dr Lustig presented on sugar toxicity. Great lecture. See his video Sugar the Bitter Truth on YouTube.


by Dr. Kara Fitzgerald



Dr. Fitzgerald received her doctorate of naturopathic medicine from National College of Natural Medicine in Portland Oregon. She completed the first CNME-accredited post-doctorate position in nutritional biochemistry and laboratory science at Metametrix Clinical Laboratory under the direction of Richard Lord Ph.D. Her residency was completed at Progressive Medical Center a large integrative medical practice in Atlanta Georgia. Dr. Fitzgerald is lead author and editor with J. Alexander Bralley Ph.D. of The Metametrix Institute's Case Studies in Integrative and Functional Medicine. She is a contributing author to Laboratory Evaluations for Integrative and Functional Medicine and the Institute for Functional Medicine's updated Textbook for Functional Medicine. She has also published in a number of peer reviewed journals. Dr. Fitzgerald is on faculty and a Curriculum Advisory Committee member at Institute for Functional Medicine. She is an adjunct faculty member at University of Bridgeport in the school of Human Nutrition and a member of The Institute for Therapeutic Discovery. Dr. Fitzgerald regularly lectures internationally for several organizations. Formerly at Advanced Diagnostic Pain Treatment Center at Yale-New Haven she is now in private practice in Sandy Hook Connecticut. She may be reached at or