Strokes are one of the leading causes of death globally [1].
But when I talk to my patients in the clinic about how to protect themselves from a stroke, they are often surprised by a significant yet overlooked risk factor that’s easy to fix. And they’re even more intrigued when I tell them that it has to do with a mineral deficiency.
Let me explain, and then I’ll show you how to fix it.
Table of Contents
- The Etiology of Strokes
- Potassium, Blood Pressure, and Strokes
- How to Get Enough Potassium
- The Safe Blood Pressure Target
-
References
The Etiology of Strokes
Strokes come in two forms. Ischemic strokes occur when blood flow to the brain is blocked. This blockage is usually caused by plaque that has broken loose or a blood clot. About 87% of strokes are ischemic [2].
Then there are hemorrhagic strokes. This is when a blood vessel in or surrounding your brain breaks open. When this happens, blood leaks out, causing brain tissue to swell. Increased pressure can damage brain cells [2].
Why do strokes happen?
When it comes to ischemic strokes, the key mechanism is atherosclerosis—the build-up of plaque in the arteries. Though the process is complex, it’s basically about the body trying to cope with chronic damage and inflammation in the walls of the arteries. Think of plaque as a bit like a scab over a wound. Plaque can lead to an ischemic stroke when a piece of it breaks free, or when it ruptures, causing a blood clot [2].
In the case of hemorrhagic strokes, one cause can be poorly formed blood vessels in the brain. But another major factor is high blood pressure [2]. It puts pressure on the artery walls, making them more likely to rupture—especially if they are already weakened.
In fact, high blood pressure contributes to ischemic strokes as well. Elevated pressure creates inflammation inside blood vessels, which promotes the build-up of plaque [3].
High blood pressure is the most important controllable risk factor for strokes. An estimated 51% of stroke deaths are linked to it [4].
For example, the Framingham study—a long-running cohort study in Great Britain—found that people with high blood pressure had an incidence of stroke 5 to over 30 times higher than those with lower blood pressure [4].
And a meta-analysis including 61 studies and over 1,000,000 adults found that the risk of dying from stroke doubled for every 20-point rise in blood pressure [5].
Potassium, Blood Pressure, and Strokes
Most of my patients aren’t aware of the profound link between blood pressure and strokes. But here’s the good news: there’s a simple fix that often makes a significant difference—potassium.
Now, that doesn’t mean loading up on potassium pills. I’ll explain how to correct the deficiency shortly. But before considering blood pressure medications, it’s critical to get potassium levels right—because you might not need medication at all.
What happens when potassium intake is low?
One study observed men with normal blood pressure who were divided into two groups. One group consumed a normal daily amount of potassium, and the other consumed very little. The low-potassium group saw significant blood pressure increases within just 9 days [6].
Other studies have looked at what happens when potassium intake is increased. A meta-analysis of 22 randomized controlled trials found that higher potassium intake reduced systolic blood pressure by 3.49 mm Hg on average [7].
When intake reached 3,500 to 4,700 mg, the drop in systolic blood pressure reached an impressive 7.16 mm Hg [7].
That’s a big deal because every 10-point reduction in systolic blood pressure reduces stroke risk by 27% [8].
Potassium and Stroke Risk
A large clinical trial in China evaluated the impact of a salt substitute—a blend of 75% sodium chloride and 25% potassium chloride. It focused on people who had already suffered a stroke to see if it could prevent a second one [9].
This salt substitute did two things:
- Reduced sodium intake (which raises blood pressure).
-
Increased potassium intake (which lowers blood pressure).
After about 5 years, results showed:
-
A 14% lower incidence of recurrent stroke
- A 30% lower incidence of hemorrhagic stroke
- A 21% lower risk of stroke-related death [9]
More broadly, a large meta-analysis found that the lowest risk of stroke occurred with a potassium intake of about 3,500 mg/day—a 33% reduction in stroke risk compared to those consuming only about 1,100 mg [10].
How to Get Enough Potassium
A natural question at this point is: How do I get 3,500 mg of potassium daily?
The best way to approach this is through diet. Potassium-rich foods also tend to contain other important nutrients, bringing broader health benefits.
High-potassium foods:
- Swiss chard: ~960 mg per cup
- Spinach and other leafy greens
- Bananas: ~450 mg for a medium banana
- Nuts and seeds
Personally, I include a small amount of potassium in MicroVitamin to help me hit optimal levels, but you don’t need to take a supplement if your diet includes these foods.
Researchers have even developed a diet specifically to lower blood pressure—the DASH diet (Dietary Approaches to Stop Hypertension). It emphasizes potassium-rich foods.
A meta-analysis found that those who adhered closely to the DASH diet had a 12% lower stroke risk. It was a linear relationship: the better the adherence, the greater the stroke protection [11].
The Safe Blood Pressure Target
Another common question is: What’s a safe blood pressure when it comes to strokes?
Two major studies have completely reshaped our understanding of what’s “safe.” For a long time, doctors considered 140/90 as acceptable. But we now know that even slightly elevated levels can significantly increase risk.
The SPRINT Study
The SPRINT study involved over 9,000 participants and compared two groups:
- One aimed for a systolic BP below 140
-
The other aimed for less than 120
The study was stopped early because the results were so clear. Those aiming for under 120 had:
- A 27% lower risk of heart attack, stroke, or cardiovascular death [12]
- A 25% lower risk of death from any cause [12]
Follow-Up Study in China
Another massive study in China with over 11,000 people, including participants with diabetes and prior strokes, confirmed these results. Lowering systolic BP to below 120:
- Reduced the risk of cardiovascular death and stroke by 12%
- Reduced all-cause mortality by 21% over 3.5 years [13]
Takeaway
The old “normal” of 140 is no longer good enough. Most people should aim for a systolic blood pressure below 120 to truly protect themselves.
References
1. https://pmc.ncbi.nlm.nih.gov/articles/PMC11786524/
2. https://www.nhlbi.nih.gov/health/stroke/causes
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC7733126/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC3838588/
5. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)11911-8/abstract
6. https://www.nejm.org/doi/10.1056/NEJM198905043201804
7. https://www.bmj.com/content/346/bmj.f1378.long
8. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01225-8/fulltext
9. https://jamanetwork.com/journals/jamacardiology/article-abstract/2829790
10. https://www.ahajournals.org/doi/10.1161/jaha.116.004210
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC6160167/
