Insights into the well-documented benefits of this essential mineral for health from several double-blind clinical studies, meta-analyses, and personal experiences over the last four decades
Potassium citrate supports kidney health (hypokalemia, nephrolithiasis, nephrocalcinosis), electrolyte balance, bone preservation (sarcopenia), urinary tract function (kidney stones), digestive health (Helicobacter pylori), and cardiometabolic processes (hypertension), benefiting individuals on keto, vegan, and other acidic diets.
This story does not include health advice. It is for information, inspiration, and awareness purposes.
Potassium citrate has been integral to my health regimen for over four decades. In the early 1990s, I systematically investigated its mechanisms, impact, and implications for brain health, neurological function, and cognition. My extensive research culminated in documented findings to enlighten scientists, clinicians, sensible biohackers, and my loved ones.
Potassium is a necessary electrolyte involved in nerve transmission and is fundamental to cognitive processes like memory, learning, and decision-making. I pay great attention to it, along with sodium, magnesium, calcium, and other trace minerals like iodine, lithium, or boron.
My first encounter with potassium citrate started when I adopted a vegan and fruitarian diet in the early 1980s. Interestingly, my caring mentor, a professor of anthropology and medicine, recommended it to me. He later encouraged me to eat animal products like eggs, fish, and organ meat for optimal health, as he firmly believed that our brains evolved with animal products.
Moreover, beyond endorsing a plant-based diet rich in vegetables and fruits, my scholarly mentor expressed concerns about potential toxic accumulation in the body due to excessive plant consumption. Recognizing the importance of addressing potential nutrient deficiencies, such as vitamin B12, carnitine, choline, Omega 3s, and other nutrients we can’t get from plants, he emphasized the necessity of supplementing with potassium citrate to maintain optimal health.
Later, when I transitioned from keto-vegan to a keto-omnivore and keto-carnivore, another seasoned mentor, an emeritus professor, and an MD and PhD specializing in nutritional biochemistry advised me to maintain magnesium and potassium citrate supplementation in my keto diet to prevent dementia in my older years. He stressed their importance in supporting moderate and occasional deep ketosis for therapeutic benefits.
My systematic exploration of this exceptional molecule deepened in the early 2000s when a chance encounter led me beyond English-speaking borders. I had no inkling of the profound revelation awaiting me and was pleasantly surprised, intensifying my research to understand the value of potassium citrate.
An Eye-Opening / Heart-Warming Serendipitious Encounter
In 2001, I was invited to speak at a science and health conference in Poland. My presentation focused on molecules enhancing cognitive function and performance, offering practical insights to medical professionals, nutrition scientists, and sensible biohackers in attendance.
Although the conference was enriching in various aspects, a particular paper presented by medical professionals played a pivotal role in integrating my two decades of knowledge and experience with potassium citrate.
As I listened to the researchers eloquently present their findings in English, adorned with a distinctly Polish accent, I was amazed at this serendipitous and profound journey. The ambiance evoked a sense of nostalgia, reminiscent of a bygone era, yet the revelations within held a timeless significance that captivated my attention.
This exceptional paper, featured in a historical scientific/medical journal titled Przegląd Lekarski (Medical Review), traced its origins to resilient Cracovian physicians, many of whom survived painful Nazi German camps.
Through their work, they documented the grim medical aftermath of internment in concentration camps, including the exploration of posttraumatic stress disorder. I learned that the publication started with 477 scientists and medical professionals who experienced the complex medical, psychological, and social impacts of Nazi persecution.
What struck me was the journal’s extraordinary history — from being nominated for the Nobel Peace Prize twice, in 1993 and 1994, to its long-standing obscurity on the global stage. Despite its significant scientific and medical value, its contents remained inaccessible to many until 2017.
Summary of the Special Paper from Przegląd Lekarski
In summary, these medical/scientific researchers said that potassium citrate has several therapeutic uses, including treating kidney stones, preventing stone formation in patients with kidney cysts, and aiding in treating conditions like distal renal tubular acidosis and renal hypercalciuria.
They mentioned potassium citrate can also prevent kidney complications during glaucoma treatment and as a potassium supplement for hypertension. However, they did not recommend it for use in cases of urinary tract infection, certain types of kidney stones, hyperkalemia, advanced chronic renal failure, peptic ulcer, gastritis, gastrointestinal bleeding, coagulation disorders, varicose veins, or metabolic alkalosis.
Their comprehensive case studies yielded an intriguing finding: 75% of patients achieved a notable one-year remission from stone disease. This positive outcome was attributed to the strategic utilization of potassium citrate, a treatment approach supported by the expertise of physicians and dieticians.
What is Potassium Citrate, and why does it matter?
Potassium citrate is a compound that combines potassium and citric acid, a key component in cellular energy production through the citric acid cycle. When potassium citrate is formed, it plays a pivotal role in regulating the body’s acid-base balance, primarily by increasing urinary pH.
Potassium citrate can prevent kidney stones and acidosis and manage specific kidney conditions. It is generally safe in low doses but not recommended for patients with some health issues like infections or bleeding. While it can cause mild side effects like temporary alkalosis, it can reduce urine calcium and increase calcium phosphate excretion.
Statspearl informs that potassium citrate replacement may be necessary for patients with hypokalemia, nephrolithiasis, or nephrocalcinosis. Underlying conditions should be sought and treated. Most of the bicarbonate is absorbed in the proximal tubule, so distal RTA is relatively easy to correct.
How is it used in both keto and vegan diets?
Potassium citrate is a valuable tool in keto and vegan diets and personalized approaches to nutrition and supplementation to optimize health outcomes. It regulates acid-base balance, supports electrolyte equilibrium, and promotes overall health and well-being.
In keto and vegan diets, there can be shifts in the body’s acid-base balance due to changes in acidic nutrient intake. Keto diets, high in fat and protein, may increase acid production, while vegan diets, rich in plant-based foods, may increase acidic compounds.
Potassium citrate supplementation helps counteract these effects by alkalinizing the urine, reducing the risk of kidney stones, and maintaining better kidney health. Potassium citrate offers several benefits for people following keto or vegan diets.
Firstly, it helps prevent kidney stones, a common risk due to changes in urinary pH and mineral excretion. Secondly, it supports electrolyte balance, essential for overall bodily function, particularly during dietary restrictions or metabolic changes. Additionally, it maintains pH balance, crucial for bone health, urinary tract function, and metabolic processes.
For keto dieters, it neutralizes increased urinary acidity from high protein and fat intake, while for vegans, it offsets the acid load from plant-based foods. Moreover, for plant-based diets it aids in managing oxalate levels, reducing the risk of kidney stone formation by binding with calcium and alkalizing urine.
Insights from Prominent Scientific Studies
In a 1993 randomized control study published in the Journal of Urology assessing potassium citrate’s effectiveness against kidney stone formation, 57 patients with a history of kidney stones and low urinary citrate levels were divided into two groups.
One group took daily doses of potassium citrate for three years, while the other received a placebo. Results showed a significant decrease in new stone formation in the potassium citrate group, with 72% of patients experiencing remission. In contrast, the placebo group saw little change in stone formation rates.
Potassium citrate also increased urinary citrate, pH, and potassium levels. Adverse effects were minimal, leading to only a few patients withdrawing from the study. This study confirmed the efficacy of potassium citrate in preventing new kidney stone formation in individuals with low urinary citrate levels.
This 2009 study, published in the Journal of Urology, aimed to assess the long-term effects of potassium citrate therapy on urinary metabolic profiles and its impact on stone formation rates.
The researchers conducted a retrospective cohort study on patients treated at the Comprehensive Kidney Stone Center between 2000 and 2006. Of 1,480 patients with 24-hour urinary profiles, 503 met the inclusion criteria, remaining on potassium citrate therapy for at least six months.
They observed significant and sustained changes in urinary metabolic profiles, including increased urinary pH and citrate levels, as early as six months after starting therapy. After initiating potassium citrate therapy, the stone formation rate decreased significantly from 1.89 to 0.46 stones per year.
The study reported a 68% remission rate and a remarkable 93% decrease in the stone formation rate. Long-term potassium citrate therapy, lasting up to 14 years, maintained its effectiveness in altering urinary metabolic profiles and reducing stone formation rates, indicating its value in managing recurrent nephrolithiasis.
The dietary acid load from the typical Western diet may negatively affect the skeleton by disrupting calcium metabolism. It has been debated whether neutralizing this acid with alkaline potassium salts, like potassium citrate, leads to lasting improvements in calcium balance.
In this 2012 randomized control trial published in the Journal of Bone and Mineral Research, 52 men and women (mean age 65.2 ± 6.2 years) were randomly assigned to potassium citrate at 60 mmol/d, 90 mmol/d, or placebo daily.
Measurements of bone turnover markers, net acid excretion, and calcium metabolism were taken at baseline and six months. At six months, both potassium citrate groups showed significantly lower net acid excretion than the placebo, indicating complete neutralization of dietary acid.
Urine calcium levels were notably reduced in those taking potassium citrate, with the 90 mmol/d group showing improved calcium balance. Serum C-telopeptide, a bone turnover marker, decreased significantly in both potassium citrate groups compared to placebo, suggesting potential benefits for skeletal health.
Longer-term trials assessing outcomes like bone density and fracture risk are warranted to confirm these findings and establish the role of potassium citrate in improving skeletal health.
This 2021 clinical study, published in the Journal of International Urology and Nephrology, compared the effectiveness of potassium citrate with hydrochlorothiazide in preventing hypercalciuria in patients with calcium oxalate stones.
After becoming stone-free, researchers randomly assigned patients to receive either hydrochlorothiazide (50 mg/day) or potassium citrate (40 mEq/day) for six months. They conducted urine analysis before treatment and measured volume, calcium, oxalate, citrate, sodium, and uric acid levels at three months.
They assessed stone recurrence by imaging at 6 and 12 months. The results from 40 patients in each group showed that both treatments significantly reduced urine calcium levels, with potassium citrate leading to a greater increase in urinary citrate levels compared to hydrochlorothiazide.
At 12 months, fewer patients in the potassium citrate group had stone recurrence compared to the hydrochlorothiazide group. Their conclusion suggests that potassium citrate effectively reduces calcium excretion and increases citrate excretion in patients with calcium oxalate stones and hypercalciuria, making it a viable option for medical prophylaxis.
More importantly, beyond digestive health hypercalciuria, researchers in a 2018 randomized, Double-Blind, Placebo-Controlled clinical study published in MDPI’s Nutrients journal aimed to understand if potassium citrate affects bone remodeling in postmenopausal women with osteopenia.
Forty women were randomly assigned to either receive potassium citrate (30 mEq/day) or a placebo along with calcium carbonate (500 mg/day) and vitamin D (400 IU/day).
They measured various markers of bone health and mineral metabolism at baseline, three months, and six months. Results showed that potassium citrate supplementation significantly reduced bone resorption markers compared to the placebo group, particularly in women with low potassium and citrate levels.
These researchers concluded that their results suggest that potassium citrate may enhance the benefits of calcium and vitamin D in women with osteopenia and acid-base imbalance.
I want to highlight one more use case of potassium citrate from a 2023 randomized control trial published in the Alternative Therapy Health Medicine. Between April 2019 and October 2022, researchers treated 160 patients newly diagnosed with Helicobacter pylori-related chronic atrophic gastritis (CAG) at the facility.
They randomly divided these patients into two groups: one receiving bismuth potassium citrate medication alone and others none. The medication group received bismuth potassium citrate capsules exclusively, while the experimental group received dietary guidance alongside bismuth potassium citrate usage. Before treatment and upon completion, researchers assessed changes in diet scores, symptom severity, and pathology scores.
Following treatment, the experimental group exhibited significantly lower diet scores, symptom severity, and pathology scores than the medication-only group. Their findings highlight the potential of dietary intervention to enhance the therapeutic efficacy of bismuth potassium citrate in managing Helicobacter pylori-related CAG.
Bismuth potassium citrate is a compound that combines bismuth, potassium, and citric acid. It is used in medicine, particularly in treating conditions like chronic atrophic gastritis caused by Helicobacter pylori infection.
Bismuth potassium citrate helps manage such conditions by exerting its antibacterial and anti-inflammatory effects on the stomach lining. When combined with dietary intervention, bismuth potassium citrate may offer more effective treatment outcomes than bismuth potassium citrate alone.
Bismuth compounds have been used for centuries in medicine, particularly in treatments for gastrointestinal issues such as diarrhea and ulcers. As documented by this 2023 NIH book chapter, Bismuth subsalicylate is a medication used to manage and treat gastrointestinal discomfort and traveler’s diarrhea. It is in the salicylates class of drugs.
The book chapter explains the indications, actions, and contraindications of bismuth subsalicylate, a valuable agent in treating and managing gastrointestinal discomfort and traveler’s diarrhea. Bismuth subsalicylate is commonly found in over-the-counter medications for digestive problems. I will cover them in another story.
A 2024 paper in Springer published a clinical trial. It concluded that the safety of oral administration of 120 mg of bismuth potassium citrate formulations to healthy subjects was good.
There are hundreds of remarkable studies on the benefits of potassium citrate, but I don’t want to overwhelm you with too much science in this post. If you are interested in scientific papers, you may start with Pubmed or this literature review by Unbound Medicine, citing exceptional papers.
Conclusions and Takeaways
My journey with potassium citrate has been illuminating, examining over four decades of research, clinical trials, and personal experiences. From my early investigations into its potential for brain health to encountering its invaluable benefits during my transition to vegan and keto diets, potassium citrate has emerged as a cornerstone of health optimization.
Through serendipitous encounters and deep dives into the scientific literature, I have uncovered its multifaceted role in maintaining urinary health, preventing kidney stones, and enhancing bone density.
Researchers worldwide have echoed the significance of potassium citrate in various medical contexts, including oxalate risks/situations for vegans. Studies have consistently shown its effectiveness in reducing urinary calcium levels, increasing citrate excretion, and mitigating the risk of stone formation.
Moreover, potassium citrate supplementation has been linked to improvements in bone turnover markers, suggesting a potential role in preserving skeletal health, particularly in postmenopausal women with osteopenia, which I covered before in a public health story as a critical health condition for the elderly.
The impact of potassium citrate extends beyond kidney health, reaching into digestive disorders such as chronic atrophic gastritis caused by Helicobacter pylori infection.
Combined with dietary intervention, potassium citrate has demonstrated superior efficacy in alleviating symptoms and improving pathological outcomes. These findings highlight potassium citrate's versatility and therapeutic potential, making it a valuable tool for clinicians, scientists, and patients seeking holistic approaches to wellness.
I only use 99 mg as potassium supplements in high doses are very dangerous and not recommended by health experts. After using it for over 40 years, I have never had a side or adverse effects but gained many benefits both in a vegan and ketogenic diet, relieving associated symptoms and preventing undesirable health consequences.
Thank you for reading my perspectives. I wish you a healthy and happy life.
If you found this story helpful, you may also check out my other articles on NewsBreak. As a postdoctoral researcher and executive consultant, I write about important life lessons based on my decades of research and experience in cognitive, metabolic, and mental health.