On recommended consumption and supply of potassium and magnesium to the population

Detailed description of the study

Potassium is one of the main cations (positively charged ions) in the human body. The main part of it is located inside cells and only a small part is in the extracellular space, including blood plasma. Potassium supports the electrical activity of cells, participates in the processes of conducting nerve impulses, muscle contraction, regulating water balance and acid-base balance in the blood.

The concentration of potassium in plasma depends on its intake, redistribution, excretion from the body and is regulated by various substances. In this way, a balance is maintained between intra- and extracellular potassium protein in the cell membrane (sheath) - the potassium-sodium pump. Insulin increases the influx of ions into cells, while alpha adrenergic agonists increase their exit from it. Blood pH also affects the level of this cation. With an increase in acidity (acidosis), potassium is released into the plasma, and with a decrease in acidity (alkalosis), there is an influx into the cell.

The macronutrient enters the body with food: meat, fruits and vegetables. A lot of it is found in apricots, prunes, potatoes, and legumes. The daily norm for humans is 4-5 g. Potassium is absorbed mainly in the small intestine and enters the cells. It is filtered in the kidneys and reabsorbed in large quantities - it enters the blood again. The hormone aldosterone, which is produced by the adrenal glands, increases the excretion of macronutrients by the kidneys. Potassium is also excreted through the intestines and sweat glands.

The concentration of potassium in plasma is quite low and even small fluctuations can lead to disturbances in the body. A test for potassium in the blood plasma may show a decrease in its level (hypokalemia). It occurs due to insufficient intake of the macroelement from food, increased excretion in the urine (some kidney diseases), loss of the ion from intestinal contents (vomiting, diarrhea), and increased production of aldosterone. The main symptoms of hypokalemia are associated with impaired neuromuscular conduction. A person experiences fatigue, muscle weakness, decreased muscle tone, and heart rhythm disturbances.

Hyperkalemia occurs due to excess potassium intake into the body, for example, during intensive infusion of potassium-containing drugs. Also, an increase in the level of the cation in plasma can be observed with insufficient excretion by the kidneys and increased release from cells (destruction of red blood cells, disseminated internal coagulation syndrome and other reasons). Symptoms of hyperkalemia: weakness in the legs, muscle paresis, abdominal pain, numbness, heart rhythm disturbances with a decrease in contraction frequency, and in severe cases, cardiac arrest.

A biochemical blood test for potassium allows you to diagnose its excess or deficiency and take timely measures to correct disorders.

Provision of the population with potassium and magnesium

In different countries, the average consumption of potassium is less than 3000 mg/day, and magnesium is 350 mg/day, i.e. lower than recommended by WHO [8]. The average per capita consumption of potassium by the population of the Republic of Sakha (Yakutia) is 2107 mg, and magnesium - 224 mg. In the Sverdlovsk region, insufficient magnesium intake was found in 55% of schoolchildren and 78.8% of industrial workers (with potassium deficiency in 40.4%) [9, 10].

The average potassium intake by adult men in the Stavropol Territory is close to the norm and higher than that of women [11]. Magnesium consumption by persons with cardiovascular diseases (CVD) and obesity in the Moscow region was 326.5 mg, potassium - 3144 mg [12]. Among patients with metabolic syndrome and intestinal dysbiosis, the content of magnesium and potassium in the diet of women is noticeably lower than that of men (304 mg versus 424 mg and 2521 mg versus 3280 mg) [13].

The share of magnesium of aqueous origin in the diets of the population of Primorye is 2.0–7.5%. The use of household water purifiers without a mineralization unit increases the risk of developing magnesium deficiency [14].

Magnesium deficiency occurs in 2.5–15% of cases and is difficult to diagnose because the level in the blood does not reflect the content of intracellular magnesium. The causes of magnesium deficiency are a decrease in its content in food plants, the use of refined and highly processed foods, the presence of chronic diseases, and drug therapy [15].

Hypomagnesemia is diagnosed when the concentration of magnesium in the blood serum is <0.7 mmol/l, with a norm of 0.7–1 mmol/l [16]. In 2117 pregnant women over 18 years of age with clinical manifestations of magnesium deficiency (hypertonicity of the uterus, leg cramps, preeclampsia, neurasthenia), there was a lack of it in the diet in 78.4% of cases, and a reduced level in the blood in 80.9% [17].

Interpretation:

• Rapid infusion of potassium solution, massive hemolysis, severe tissue damage, acute starvation, hyperkinetic activity (epilepsy), malignant hyperpyrexia after anesthesia, acidosis, dehydration, acute renal failure, final stage of chronic renal failure, Addison's disease, hypofunction of the renin-angiotensin-aldosterone system , pseudohypoaldosteronism, other sodium-wasting conditions, after strenuous exercise (especially in people taking beta blockers), shock, severe hemolysis, tissue ischemia.
• Chronic fasting, vomiting, diarrhea, loss through intestinal fistula, intestinal villous adenoma, renal tubular acidosis, renal tubular failure, Fanconi syndrome, primary and secondary aldosteronism, Cushing's syndrome, Bartter's syndrome, osmotic diuresis (eg, with hyperglycemia), alkalosis, with diabetic ketosis during the period of gluconeogenesis; with the administration of ACTH, cortisone or testosterone, cystic fibrosis.

Sample result (PDF)

Additional sources of potassium and magnesium

In the diet of patients with chronic diseases, pregnant women and other groups of the population, specialized food products and biologically active food additives (BAA) containing significant amounts of potassium and magnesium can also be used [12]. Thus, long-term (more than 4 weeks) intake of potassium as part of dietary supplements by 1900 patients with hypertension contributed to a decrease in systolic blood pressure by 4.48 mm Hg. Art., and diastolic - by 2.96 mm Hg. Art. The most pronounced antihypertensive effect was observed with an initially low (<3500 mg/day) level of potassium intake, high sodium intake (≥4 g/day), a high Na/K ratio in the diet, and the absence of antihypertensive therapy [1].

One of the ways to compensate for the deficiency of potassium and magnesium is the preventive use of salt, in which part of the sodium chloride is replaced with potassium and magnesium salts (68% sodium chloride, 27% potassium chloride and 5% magnesium sulfate). This salt is used instead of regular salt for cooking and adding salt to food.

Dried mineralized seaweed Lithothamnium coralloides

and/or
Lithothamnium calcareum
(6.6%) with 30–34% calcium and 2.3–3.3% magnesium, corresponding to 400–600 mg/100 g soluble magnesium.
The edible seaweeds aosa ( Ulva pertusa
), kelp (
Laminaria japonica
) and others contain 400 to 600 mg of magnesium per 100 g. However, its bioavailability from algae is very low (less than 5%) [41].

In practical medicine, salts of inorganic acids (oxide containing 60% magnesium, carbonate - 28.6%, 7-aqueous sulfate - 9.7%, anhydrous sulfate - 20%), organic acids (magnesium citrate with 15 .8% magnesium, lactate - with 11.9%), chelates with amino acids (magnesium aspartate - magnesium complex 4-water contains 6.6% magnesium). When using inorganic magnesium salts, pregnant women often develop side effects: hot flashes, nausea, headache, decreased heart rate associated with incorrect dosage [8]. Therefore, it is preferable to use its chelates or salts with organic acids (magnesium citrate and magnesium lactate) [17]. Water-soluble citrate is one of the safe forms of magnesium, because it takes part in the Krebs cycle.

Along with single preparations containing potassium (potassium chloride, potassium orotate) or magnesium (magnesium lactate dihydrate, magnesium pidolate, magnesium orotate, magnesium sulfate), complex preparations are used that include both macroelements (potassium aspartate + magnesium aspartate: for example, the drug Panangin). Panangin (1 tablet contains potassium aspartate 158 mg and magnesium aspartate 140 mg) has been used for a long time in domestic and world practice, being one of the most studied and effective preparations of potassium and magnesium aspartate. The undoubted advantage of this drug is the combination of potassium and magnesium, which makes it possible to manifest their synergistic effect [42]. This combination is all the more justified since the metabolism of potassium and magnesium is closely related, and clinically significant hypomagnesemia usually develops against the background of hypokalemia. Aspartic acid, which is part of Panangin, is a natural amino acid that promotes the penetration of potassium and magnesium ions into cells, where it is included in metabolism, being part of many proteins, and also plays an important role in the metabolism of nitrogenous substances, transamination reactions and the formation of pyrimidine bases.

Despite the fact that Panangin contains nutritional substances, it is registered as a medicinal product, since its effectiveness has been confirmed in clinical studies. The maximum daily dose of Panangin in the complex treatment of CVD is 9 tablets, which provides an additional supply of 10% potassium and 27% magnesium from their recommended daily intake. For preventive purposes, the drug is used as a source of potassium and magnesium in a smaller dose (1–2 tablets 3 times a day) [42]. The small content of minerals in 1 tablet allows for fractional administration of this drug throughout the day, which increases the absorption of macroelements.

The need to review potassium and magnesium intake standards

Table 1 presents the recommended intake values ​​(RNI) for potassium and magnesium adopted in different countries, which are periodically reviewed and clarified as scientific data accumulates.

Randomized controlled trials conducted in Europe indicate that potassium intake more than 3500 mg/day has a beneficial effect on blood pressure in adults, and less than 3500 mg/day is associated with a higher risk of stroke and other CVD [37, 38]. ].

Taking into account that a daily potassium intake of less than 3500 mg is associated with an increased risk of stroke due to high blood pressure, the draft standards for physiological requirements for energy and nutrients (2020) for the population of the Russian Federation propose increasing the RDA for potassium from 2500 mg to 3500 mg /day

Due to the fact that magnesium deficiency can cause hypocalcemia and hypokalemia, disrupt the interaction with vitamin D [7] and other substances [38], and also taking into account the experience of the USA and France in the draft norms of physiological requirements for energy and nutrients (2020 .) the RDA for magnesium is expected to increase from 400 mg to 420 mg/day.

Biochemical blood test: normal indicators