If you have chronic kidney disease or heart failure, or take certain blood pressure medications, you’ll want to read ingredient labels more closely starting in mid-December.
A rule that the Food and Drug Administration recently finalized could put added potassium into foods that never contained it before.
The agency finalized the rule in October in the Federal Register. It amends the “standards of identity,” which are the strict formulas that dictate what a food legally has to contain to carry its name.
For example, a condiment can’t legally be labeled as “mayonnaise” unless it meets the government’s exact recipe for mayonnaise — which, until the new rule, didn’t allow salt substitutes.
The change means manufacturers can swap out some or all of the added salt in 80 everyday foods — including cheese, ketchup and canned tuna.
Why this matters for your medication list
The FDA didn’t name one specific substitute, but potassium chloride came up most often in public comments on the rule. For most people, that’s a non-issue.
But for some people with chronic health conditions, too much potassium can build up in the blood rather than get filtered out. That condition, called hyperkalemia, can cause an irregular heartbeat and, in severe cases, cardiac arrest.
Those at risk include anyone with kidney disease or heart failure. Certain blood pressure and heart medications also raise the risk, according to the National Institutes of Health. These include:
- ACE (angiotensin-converting enzyme) inhibitors, such as benazepril (Lotensin)
- ARBs (angiotensin receptor blockers), such as losartan (Cozaar)
- Potassium-sparing diuretics, such as amiloride (Midamor) and spironolactone (Aldactone)
These drugs reduce the amount of potassium lost in your urine, which can push your levels too high — especially if you also have kidney problems. The NIH notes hyperkalemia can happen in these people even when they eat typical amounts of potassium from food, and it advises they talk to a health care provider before using salt substitutes.
Some folks may not realize they’re at risk. About 9 in 10 adults with chronic kidney disease don’t know they have it, according to the Centers for Disease Control and Prevention. And more than 1 in 5 adults with high blood pressure are estimated to have the disease.
The FDA considered requiring a warning label for foods made with potassium-based substitutes but decided against it.
Its reasoning is that potassium is already listed on the Nutrition Facts panel once a food hits 2% of the daily value, and any substitute has to be named specifically in the ingredient list, not hidden under a generic term like “salt substitute.”
So the information will be there, but it’s on you to check for it.
Foods to closely check
Here’s where the new flexibility for salt substitutes applies:
- Cheese: Cheddar, mozzarella, Swiss, cream cheese, cottage cheese, Parmesan, blue cheese, Colby and more than 30 other cheese standards
- Dairy: Sour cream, cultured milk, eggnog
- Canned vegetables: Green beans, corn, peas, tomatoes, mushrooms
- Condiments: Ketchup, mayonnaise, salad dressing
- Canned fish: Tuna, salmon, shrimp, oysters
- Baked goods and grains: Bread, self-rising flour, macaroni, noodles
- Other staples: Margarine, maple and cane syrup, chocolate
The health reason behind the switch
More than 70% of the sodium in the average American diet comes from processed, packaged and restaurant food, according to the FDA.
Federal dietary guidelines cap sodium at 2,300 milligrams a day for people 14 and older. Eating too much sodium is linked to high blood pressure, a major risk factor for heart disease and stroke.
Manufacturers have already been working toward voluntary sodium targets set in 2021. But for standardized foods, the old recipes left little room to hit those targets without violating the legal definition of the product.
What to expect
The rule takes effect Dec. 14, but reformulating a product takes time, so don’t expect to see changes in the grocery aisles right away.
It’s more likely the rollout will be gradual, one product at a time, as manufacturers decide whether a lower-sodium version is worth making. And since potassium chloride tends to taste bitter or metallic in larger amounts, the FDA expects that will naturally limit how much manufacturers use.
And if you take any of the above-listed medications, ask your doctor whether you should have your blood potassium level checked, especially before you start buying lower-sodium versions of everyday foods.
Regular potassium and kidney blood tests are standard for people on heart or blood pressure medicines, according to MedlinePlus, a service of the National Library of Medicine.
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