High Potassium Foods

High potassium foods, low potassium foods and associated potassium symptoms info


Potassium Sodium Ratio Is Main Benefit Of Fruits And Vegetables

Eating more fruits and vegetables is highly recommended by government health agencies. This is usually done without considering how the foods are processed. Multiple studies have shown that those populations that eat more fruits and vegetables have less hypertension and less cardiovascular disease. Multiple studies of been done on various components of fruits and vegetables to try to determine what aspect of them provides these benefits. What is missed in the studies is the very basic, core aspect of most fruits and vegetables that provides these benefits. This is been known for over two decades. Yet it is ignored.

Among the factors studied in fruits and vegetables other than this core are such substances as fiber, polyunsaturated fats, vitamins and polyphenols. These have all been shown to be helpful for cardiovascular health and reduction of hypertension. However, they have not been studied in relation to the potassium sodium ratio to try to determine how much of the benefit of fruits and vegetables comes from the ratio and how much comes from these other constituents. The critical factor for hypertension prevention is this ratio.

The potassium sodium ratio in the diet determines the potassium sodium ratio inside a person’s cells. This ratio inside the cell determines the voltage across all the cell membranes, including the mitochondrial membrane. Multiple studies have shown that accumulation of calcium inside the mitochondrion results in cell death. Calcium gets inside of the mitochondrion much more readily when the potassium inside the cell is too low. When the potassium inside the cell is too low the voltage across the mitochondrial membrane allows calcium inside too quickly. The mitochondrial matrix swells. Molecules that need to react are too far apart to transfer electrons and energy production stops. The cell without energy dies, usually forming scar tissue.

Some of these other substances, such as polyunsaturated fats or polyphenols, change the configuration of various channels across cell membranes, including the mitochondrial membrane, so that there can be a slight increase or decrease in the ability of potassium and calcium to cross the membranes. This is universal among the substances that have been studied to date. There may other ways these substances aid health, but until a systems approach is taken we will never know how important these other ways are.

However, the potassium sodium ratio is critical since it controls the voltage across membranes. This voltage opens and closes some of these cross-membrane channels, and determines how easily various chemical reactions between molecules in the cell can occur. The charge also controls how easily the ligand dependent channels open. These are the channels that open and close depending on what molecules attach.

So it is important that the food we eat in a day provide us with enough potassium and not too much sodium. Otherwise, our cells will not function optimally. The charge inside and outside the cell will not be right. The chemical reactions inside the cell will falter. The cells will die, and inflammation and scarring will follow.

Many types of food processing subtract potassium or add sodium, so fruits and vegetables wind up lacking the potential health benefits of their natural state. Some common examples are boiling and canning. What has not been emphasized by health officials is the proper preparation of fruits and vegetables so they can retain their healthy effects. If they are boiled in salt water, such as often happens with canning or with home cooking, or have multiple additives, fruits and vegetables will not add to health as much as they could.

Kuna Hypertension

Studies of indigenous groups provide insight into how our ancestors ate, but do not represent exactly how our ancestors ate. Even the studies from the 1940s, 50s and 60s have indigenous groups that are only somewhat representative of Paleolithic eating patterns. We discussed the changes that have occurred over the recent decades in the Tarahumara here, and how the changes affected their rate of hypertension. Despite their efforts to retain tradition, the indigenous Kuna of Panama are undergoing similar changes in lifestyle and have yet to see a change in blood pressure.

Eating patterns of modern indigenous groups differ from pre-agricultural man in that even those who are relatively untouched by urban life are farmers rather than hunter-gatherers, with the rare exception. The Kuna are mostly farmers, but even those who have not migrated to the city have had major changes in their eating habits and lifestyle. Yet indigenous Kuna hypertension is rare.

The Indigenous Kuna

The Kuna who still live on the San Blas Islands trade regularly with Colombians for salt and cocoa. In the distant past they did not have access to salt and grew their own cocoa. They now use salt in their meals, and after a devastating destruction of their cocoa plants in the 1950s and 60s use mostly cocoa from Colombia.

So studies even from the period shortly after the crop destruction would show a very different eating pattern in the indigenous Kuna than would have existed prior. Cocoa would have been consumed less until they developed trade with the Colombians. This Colombian cocoa has a different composition than their prior native cocoa plants.

Kuna Cocoa Consumption

Cocoa is a major component of the Kuna diet, being consumed as a beverage 5 times a day. Some recent papers have discussed how flavonoids in the Kuna’s native cocoa plant are in greater concentration than present in other cocoa. There is a dispute about how often this native plant is consumed by the Kuna compared to the Colombian cocoa. If the Colombian plant were consumed most, the flavonoid consumed would be half that from the native plant.

The composition of the two cocoa plants is given in a 2001 paper (1). The Colombian plant has a lower procyanidin content (a flavonoid) but a much higher ratio of potassium to sodium. Some of the later papers by this group of researchers relate that the native plant is the most commonly consumed by the Kuna, although the 2001 paper indicated the Colombian cocoa is most commonly consumed.

A paper by Barnes (2) also indicates that the native plant is consumed less often, being consumed less than once a week. His paper indicates that most of the cocoa consumed is Colombian. This would favor the potassium sodium ratio rather than flavonoids alone as the main factor in cocoa lowering Kuna blood pressure.

The 2001 paper also claims that the sodium consumed by the indigenous Kuna in 1997-1999 is quite high, so that the low blood pressure among the San Blas Islanders is not due to a low sodium intake. They ascribe the low blood pressure to a high flavonoid intake. A number of papers have shown blood pressure lowering effects from flavonoids, including papers showing a potential biological rationale.

Dietary Potassium Sodium Ratio

However, the series of papers by this group does not account for the dietary potassium sodium ratio, although in a 1997 paper (3) they estimate it from urinary sodium and potassium. They discuss potential inaccuracies in the type study they have done. Such potential inaccuracies are inherent in such studies and do not detract from their conclusions. If they continue their study over the years, changes in diet and blood pressure will help to sort out the potential factors that may account for the low rate of hypertension.

Most of the food eaten by the Islanders has a high potassium sodium ratio. Because of this their daily dietary ratio is highly likely to be higher than the typical Western ratio. Two exceptions to the high ratio food are a soup called Tale Masi and a condiment that is used for dipping fish. The study indicates that the fish is eaten in small amounts, so the condiment would not contribute much sodium to the diet. The soup is salted according to individual taste and the samples the researchers measured had approximately twice as much sodium as potassium. The soup is reported to be eaten once daily. These two exceptions may not contribute much sodium to the diet.

The Kuna Diet Is Changing

The amount of sodium the San Blas Islanders consume is growing though. Over the past several years it has grown from 2.6 tsp per day just prior to 1997, to 7 tsp per day in 2006. As the potassium sodium ratio shrinks, the amount of hypertension in a population will grow.

It takes time for hypertension to develop. In Western society, where a dietary ratio of 0.6 is consumed from childhood on, the percentage of hypertensives grows from 7.3% at age 18-39 to 32% at age 40-59 and 65% for those over 60 (4). With the present trend in their potassium sodium ratio, the indigenous Kuna will take a number of years before developing a Western prevalence of hypertension.

Urbanized Kuna Hypertension

The Kuna migrating to the city already show blood pressure changes. The 1997 paper discusses the rise of blood pressure in the Kuna as they become urbanized. In addition to the San Blas Island Kuna, their study includes 2 other groups of Kuna. The study relates the blood pressure and diet of Kuna who moved into Panama City, and of Kuna with an intermediate lifestyle who moved into a community, Kuna-Nega, just outside the city.

The Kuna in the transitional location, Kuna-Nega, have not fully adapted a Western diet and have fewer hypertensives than the Kuna who have become fully Westernized. The fully Westernized Kuna have the same percentage of hypertensives as other Western societies. Thus this aspect of the study agrees with studies of other migratory indigenous groups.

If the dietary potassium sodium ratio in the San Blas Island Kuna continues to shift, it can be expected that the next two decades will show the same percentage of hypertensives in the indigenous group as in the urban Kuna. This happened with the Tarahumara, as discussed here. Increased physical activity, lack of alcohol intake, lack of smoking, and increased flavonoid intake can only postpone the inevitable.

We hope the Kuna will continue to be studied into the future. If there is truly something unique about this group that allows them to escape the fate that a huge body of scientific studies shows to be inevitable, the discovery of the cause of this unique biological difference would be invaluable.
1. Proximate, mineral, and procyanidin content of certain foods and beverages consumed by the Kuna Amerinds of Panama. Chevaux KA, Jackson L, Villar ME, Mundt JA, Commisso JF, Adamson GE, McCullough ML, Schmitz HH, Hollenberg NK. J Food Comp Anal. 2001; 14:553–63.

2. Where Chocolate Begins and Research Methods End: Understanding Kuna Cacao Consumption. Barnes J. Human Organization. 2013; 72(No 3):211-19.

3. Aging, acculturation, salt intake, and hypertension in the Kuna of Panama. Hollenberg NK, Martinez G, McCullough M, Meinking T, Passan D, Preston M, Rivera A, Taplin D, Vicaria-Clement M. Hypertension. 1997 Jan; 29(1 Pt 2):171-6.

4. Hypertension Among Adults in the United States: National Health and Nutrition Examination Survey, 2011–2012. Tatiana Nwankwo, M.S.; Sung Sug (Sarah) Yoon, Ph.D., R.N.; Vicki Burt, Sc.M., R.N.; and Qiuping Gu, M.D., Ph.D. NCHS Data Brief, No. 133, October 2013.

Flavonoids In Cocoa

A recent article (1) discusses how cocoa contributes to heart health. This article is an interesting review, discussing the history as well as the proposed biological actions of cocoa. The biological actions it focuses on are the actions of the flavonoids present in cocoa.

Because it is believed that cocoa acts to induce nitric oxide, the writer first discusses the history of nitroglycerin. She includes its use by Alfred Nobel as an explosive. An interesting twist she relates is his need to take nitroglycerin as a medication later in life for his angina.

The author then discusses how the processing of cocoa affects the flavonoids during the drying, fermentation and roasting phases of processing. What is missing is the discussion of the use of alkali to produce Dutched cocoa, which gives Dutched cocoa an even greater potassium content, as discussed here.

There is a discussion of two populations studied for their cocoa intake. The Kuna of Panama have been studied because of their migration into an urban life. The other group studied was a group of Dutch.

Both studies show a lower blood pressure among cocoa consumers. In the case of the Kuna, those who did not migrate consumed over 5 cups of cocoa daily compared to their urban counterparts who did not consume cocoa. In the case of the Dutch study, the cocoa consumers got 4 gm/da and the lowest group took in no cocoa.

Flavonoids In Cocoa

Without considering other substances present in cocoa, the emphasis then turns to the flavonoids in cocoa. The flavonoids in cocoa are plentiful. Because flavonoids are present in other foods associated with good heart health, flavonoids are the subject of much research today. The four general properties being studied to determine the mechanism of action of flavonoids are: the anti-oxidant properties, the anti-inflammatory properties, the reduction of platelet aggregation, and vascular relaxation.

Anti-oxidant Activity

Many of the studies on anti-oxidant activity of flavonoids were done in the test tube instead of in the cell. Because the test tube measurements of anti-oxidant level have been shown to lack correlation with cellular anti-oxidant activity, these studies are no longer relevant.

The emphasis today is on developing valid cellular anti-oxidant studies. TBARS is emerging as one of the promising cellular anti-oxidant tests. It measures the peroxidation of lipids in the cell. Cocoa liquor polyphenols have been observed to reduce TBARS. But until the cellular tests are developed more, the value of these tests will be difficult to know.

Anti-inflammatory Properties

Effects of flavonoids on inflammation are also in the early stages of study. Flavonol fractions are being tested to determine how they affect cytokine responses. LDL oxidation is also in the early stage of study. LDL, oxidized LDL and apo B were shown to be reduced by flavonols from cocoa.

Platelet Adhesion

Cocoa in laboratory tests was found to reduce platelet adhesion by reducing the activation of a platelet glycoprotein involved in aggregation. When human subjects were fed cocoa for 4 weeks, the cocoa lowered P-selectin in their platelets and reduced aggregation of their platelets.

Vascular Relaxation

Several studies have shown increased vasodilatation from flavonoids. The vasodilatation is believed to be related to an increase in nitric oxide synthase. The result is an increase in nitric oxide (NO), which is an intermediary that activates potassium channels in vascular endothelium and smooth muscle. Activation of these channels is well known to lead to vascular relaxation.

The mechanism of vasodilatation for flavonoids appears similar to the effect of polyunsaturated fats (PUFAs), discussed here. PUFAs also activate potassium channels. In the case of PUFAs the details of their action are known at the molecular level. More details are needed for flavonoids, but a clearer picture is beginning to emerge.

As with PUFAs, flavonoids partially make up for a poorer potassium sodium ratio by allowing activation of potassium channels at a lower level of potassium in the cell. Flavonoids are an excellent adjunct to an adequate potassium sodium ratio, and may have additional healthy effects. Cocoa, along with a number of other foods, is a great source of flavonoids and potassium. If the cocoa is Dutched, it is an even better source of potassium.

1. Cocoa and heart health: a historical review of the science. Pucciarelli DL. Nutrients. 2013 Sep 26;5(10):3854-70. doi: 10.3390/nu5103854.

Western Diet And The Inuits

Eskimo Western Diet And The InuitsThere have been multiple studies done on the various indigenous populations and the relationship of their diet to hypertension and cardiovascular disease. Some of the indigenous groups that have been studied include the Tarahumara, Yanomamo, Cuna, and Inuit. Before these populations’ diets were changed by exposure to the Western diet they had a very low incidence of hypertension.

As they transitioned to a Western life, they developed more hypertension and cardiovascular disease. Of course there are many factors beyond diet involved in Westernization. It is not necessarily the potassium to sodium ratio that caused the increase in hypertension and cardiovascular disease. When they transition to a Western life, indigenous people take on all the habits of Western life. This includes smoking, alcohol consumption, less physical activity, and the Western diet.

The Western diet has a much lower potassium to sodium ratio than any of the traditional indigenous diets. We have discussed how this has led to more hypertension in the Tarahumara and Kenyan Luo indigenous groups as their diet became Westernized.

Effect Of The Western Diet On The Inuits

Studies on the Inuits show a similar result. The Greenland Inuits studied in the 1920s had an almost purely carnivorous diet. In the 1970s, studies of the Inuits’ diet were done to try to discover how they could have such a low incidence of heart disease and hypertension while getting so many calories from meat.

Because such a high percentage of calories came from fats in their diet, the nature of those fats became the focus of subsequent studies. This focus on the polyunsaturated fatty acids (PUFAs) found in the Inuit diet led to many findings about how PUFAs aid cardiovascular health.

How PUFAs bring about favorable effects on blood lipids, inflammation and health were discovered. An example of one such discovery was discussed in the recent post about how DHA aids the potassium channels in the mitochondria. This action by DHA allows better health results from a slightly lower potassium sodium ratio than would be obtained otherwise.

Sadly the potassium to sodium ratio of the Inuit diet was ignored until recently though. Two relatively recent studies of the Inuits show how important the potassium sodium ratio is. The first study (1) was done on Greenland Inuits in 2002. The Inuits staying in Greenland were compared to those migrating to Denmark. The Inuits in Greenland had a more traditional lifestyle and diet.

Those who migrated took on a more modern lifestyle including a Western diet. The Greenland Inuits ate twice as much fish and seal, and half as much fruit and vegetables as the migrant Inuits. Across all age groups the Inuits in Greenland had lower blood pressure than the Inuits migrating to Denmark. Yes – despite eating more meat and fewer fruits and vegetables, the more traditional Inuits had lower blood pressure. And the older the Inuit age group, the bigger the difference between the blood pressure of the Greenland group and the blood pressure of the age matched migrant group.

In the second study (2) this difference in diet between age groups was examined. The older Inuits got approximately twice as many calories as the younger Inuits got from traditional food sources. No Inuits have a purely traditional diet today. In the Inuits studied in the second report a traditional diet comprised only 28% of total calories. For those Inuit men between 20 and 40 years of age, only 15 to 18% of calories came from traditional food. For those between 40 and 60, 29 to 36% came from traditional food.

This second study did something else quite rare for a study of an indigenous group. It measured the amount of potassium and sodium in the diets of the Inuits. In most of the earlier studies of indigenous cultures, the amount of dietary sodium and potassium had to be estimated from the foods eaten.

The Inuits in the second study had days that included more of the traditional diet than other days. Many of the micronutrients and minerals, including potassium and sodium, were studied for both the more traditional days and the more modern days. The potassium to sodium ratio for the more traditional diet was approximately 1.5. The potassium to sodium ratio for the more modern diet was approximately the same as a typical Western diet. It was 0.67.

So although the studies starting in the 1970s led to useful knowledge about PUFAs, the health results from only increasing PUFA are limited. Increasing the potassium sodium ratio is far more important. The early Inuit diet was purely carnivorous. The Inuits trimmed the visible fat from their meat. The remaining meat, although high in PUFAs, more importantly had a high potassium to sodium ratio. The ratio found in the meat of all wild game is above 4.5. This ratio was far more responsible for the early Inuits’ lower blood pressure than the polyunsaturated fat content.

Will The Real Paleo Diet Please Stand Up?

For those who feel the Paleo diet is the healthiest diet, it is difficult to choose which Paleo diet they are referring to. Is it the diet of the early, purely carnivorous Inuit? Or is it the diet of the early Tarahumara, who were mostly vegetarian?

Rather than try to duplicate a diet it is better to determine what aspect of a particular diet is healthy. To duplicate the food practices of unfamiliar cultures is very difficult. Today’s domesticated animals and plants differ in many ways from wild animals and plants. They even differ from domesticated animals and plants of just a century ago.

Tests, Tests And More Tests

But if you can find the crucial factors in the diet of a particular group of people that led to their health, you can duplicate those factors in a modern diet. By testing suspected factors to determine how they work biologically you can develop a model that explains the health effects.

The common factor in indigenous diets was a high potassium to sodium ratio. As shown in these two studies of the Inuits (as well as multiple studies of other indigenous groups), the higher the potassium to sodium ratio, the lower the blood pressure.

Of course, all the studies of indigenous groups only show an association. They do not show causation. Studies such as those we have discussed previously about the cell biology and physiology of potassium and sodium tested the potassium sodium model to show that the potassium sodium ratio is key to determining blood pressure.

It’s Even In Medical Textbooks

Doctors Guyton, Young and their associates demonstrated the basic physiology of how this ratio leads to hypertension in a definitive manner through an extensive body of work. It is so definitive that it is now in the medical physiology book originally authored by Dr. Guyton, now authored by Dr. Hall.

Where Are The Tables?

To find tables of the amounts of potassium and sodium in foods, click on the List of Posts tab at the top of the page. The list of posts page will have the titles of posts listed. Choose the page that has “table” in its title for the food group that you want.

1. Higher blood pressure among Inuit migrants in Denmark than among the Inuit in Greenland. Bjerregaard P1, Jørgensen ME, Lumholt P, Mosgaard L, Borch-Johnsen K; Greenland Population Study. J Epidemiol Community Health. 2002 Apr;56(4):279-84.

2. Arctic indigenous peoples experience the nutrition transition with changing dietary patterns and obesity. Kuhnlein HV1, Receveur O, Soueida R, Egeland GM. J Nutr. 2004 Jun;134(6):1447-53.

DHA And EPA Prevention Of Heart Failure

In the 1970s researchers found that the Greenland Inuits had much less heart disease than Westerners. The researchers examined the Inuits’ diet to try to find out if diet had anything to do with it. The Inuits’ diet had a higher potassium sodium ratio than the usual Western diet. And it had a higher percentage of polyunsaturated fats (PUFAs) from the large amount of fish the Inuits ate. This finding led to more research to determine whether polyunsaturated fats protected against heart disease, and whether omega-3 fats protected better than omega-6 fats.


Two main omega-3 fatty acids were found to be cardioprotective. These were DHA and EPA. They both had similar protective effects on some of the cardiac markers found in blood. For example, DHA and EPA have similar effects on lowering triglycerides in blood tests. Triglycerides are part of the blood tests performed to determine future risk of heart attack. Because of this and other effects that are felt to be cardioprotective, DHA and EPA are often studied together for other possible ways of protecting the heart.

A recent article (1) examined if DHA and EPA protect the heart cells directly. They tried to find out if DHA and EPA protected against heart failure by preventing the death of heart muscle cells that occurs when their mitochondria (the cell power plants) stop working.

DHA And EPA Reduce Inflammation

In this study the researchers gave DHA and EPA together in the diet. They found that the mitochondrial membranes in heart muscle cells replaced arachidonic acid (AA) with DHA and EPA. This is important because AA can cause an inflammatory response when a cell bursts and dies, leading to scar tissue.

Replacing AA with another fat should lead to less inflammation if a cell bursts. In the heart, less inflammation means less scarring and less heart failure.

Which Is Better – DHA Or EPA?

To find out if both DHA and EPA were equal, or if one was better than the other, the researchers fed these two omega-3 fatty acids separately. They gave DHA by itself and EPA by itself. They found that DHA by itself increased both DHA and EPA in the mitochondrial membranes, and lowered arachidonic acid. So DHA by itself should lower inflammation and scarring.

When EPA was given by itself it increased EPA in the mitochondrial membranes, but not DHA. And it did not lower AA as much as DHA did. So EPA was less effective at preventing inflammation and scarring.

The researchers also studied whether DHA and EPA could prevent the heart muscle cell death involved in heart failure. If the cells do not die they won’t release AA. There will be no scarring. And the heart muscle cells will remain alive to continue strengthening the heart.

Heart muscle cell death results from activation of mPTP channels in mitochondrial membranes. DHA by itself hindered the mPTP channel, stopping cell death and subsequent scarring. This should result in less heart failure.

When EPA was given by itself it did not hinder mPTP. The mitochondria swelled and the cells died. Because EPA did not prevent heart cell death, it should not protect against heart failure as much as DHA.

As discussed in a previous posts, DHA appears to protect against heart failure and the early effects of hypertension from a poor potassium sodium ratio. This study showed how DHA does this. The mechanism for this protection appears to be DHA’s action on preventing cell death, and reducing potential inflammation in the heart.

This does not appear to be the case, however, for EPA. EPA does not prevent heart muscle cell death, but does reduce inflammation when heart muscle cells die. It just does not reduce inflammation as much as DHA.

No Ester, Please

DHA needs to be in the form found in fish to provide these effects, though. As discussed here, DHA as an ethyl ester (the form often found in capsules) does not protect against heart disease.

1. Dietary supplementation with docosahexaenoic acid, but not eicosapentaenoic acid, dramatically alters cardiac mitochondrial phospholipid fatty acid composition and prevents permeability transition. Khairallah RJ, Sparagna GC, Khanna N, O’Shea KM, Hecker PA, Kristian T, Fiskum G, Des Rosiers C, Polster BM, Stanley WC. Biochim Biophys Acta. 2010 Aug;1797(8):1555-62. doi: 10.1016/j.bbabio.2010.05.007. Epub 2010 May 21.

How DHA Helps The Heart

We don’t want to give the impression that the only factor in healthy food is the potassium sodium ratio of the food you eat. Other factors play a role. One that is often discussed is the importance of omega-3 fats. DHA is an important omega-3 that improves heart health. But how does it make a difference?

DHAHeart How DHA Helps The HeartWhat Good Are Fats?

Fats have multiple functions in our bodies. In the cell, fats have a structural function, becoming part of both the cell membrane and various intracellular membranes, such as the membrane of mitochondria. Two other functions of fats are 1) to be burned as fuel, and 2) to participate in cell signaling.

The functions are not exclusive however. One fat does not do one function and another fat another function. Each fat is involved in several aspects of cell function at the same time.

Structure and cell signaling are two functions that are often interrelated. When a fat enters the cell and becomes part of a cell membrane or a mitochondrial membrane, it is not just providing structure. It is also affecting cell signaling.

How Structure Affects Cell Signaling

One way a fat that is part of the structure of a membrane may affect cell signaling is by changing the shape of channels that go through the membrane. These channels allow various molecules to pass from one compartment of the cell to another. Different fats in a membrane will cause a channel to be more open or more closed.

DHA is a polyunsaturated omega-3 fat that has a strong effect on health. One of its effects is to make a cell channel known as a BK(Ca) channel open more easily. This channel is one that allows potassium to move from one compartment to another inside the cell to affect cell signaling.

In heart muscle cells the BK(Ca) channels let potassium flow from one area to another depending on the calcium concentration in parts of the cell (1). When the calcium concentration inside the mitochondria gets too high, another channel known as the mPTP channel lets fluid in and the cell dies (2). By letting potassium flow into the mitochondria, the BK(Ca) channel can stop the mPTP channel from killing the heart muscle cell, discussed here.

DHA And Potassium

An important way that DHA protects the heart is by opening the BK(Ca) channel, making it easier for potassium to pass through the channel. This results in less heart muscle cell death, less scarring in the heart, and less heart failure.

You can get more DHA into your cell membranes by getting more DHA in your diet. A recent article (3) showed that consuming more DHA will cause more of the DHA to be deposited in the mitochondrial membranes of heart cells.  The more DHA that is deposited in the mitochondrial membranes, the more BK(Ca) channels will be able to stop the harm done by the mPTP channels.

Stopping the action of the mPTP channels means stopping the cell death, scarring and heart failure resulting from the channels’ activity. So one way DHA improves health is to improve the action of potassium. It would be interesting to know if some of DHA’s other favorable effects are associated with potassium.

Watch The Source Of DHA

However, you must be careful about your source of DHA. DHA in food may differ from DHA in supplements. The two major food sources of DHA are fish and algae. Wild fish are generally better than farmed fish because they are more likely to be eating algae. Algae is where the fish get their DHA.

The studies discussed above used pure DHA. The form sold in fish oil capsules or as DHA capsules may be the ethyl ester form. As pointed out in a previous post, the ethyl ester form of DHA will block the BK(Ca) channel. If the BK(Ca) channel is blocked, mPTP will not be hindered. The heart muscle cells then will be more easily damaged from a low potassium sodium ratio diet. This may account for the seeming failure of fish oil supplements to improve health.

Another aid to stop the cell death from mPTP activity is to have enough potassium inside the cell. By eating foods with more potassium, more potassium is available inside the cell. This means more potassium is available to pass into the mitochondria to stop the action of the mPTP channel and thus stop cell death.

To Find High Potassium Foods

If you are looking for tables with the amount of potassium and sodium in a particular food, go to the List of Posts page. The post entries that have “table” in their name will have a table of foods with their potassium and sodium content.

1. Intracellular BK(Ca) (iBK(Ca)) channels. Singh H1, Stefani E, Toro L. J Physiol. 2012 Dec 1;590(Pt 23):5937-47. doi: 10.1113/jphysiol.2011.215533. Epub 2012 Aug 28.

2. Intracellular calcium overloading and oxidative stress in cardiomyocyte necrosis via a mitochondriocentric signal-transducer-effector pathway. Mazen Shaheen, MD, Yaser Cheema, MD, Atta U Shahbaz, MD, Syamal K Bhattacharya, PhD, and Karl T Weber, MD. Exp Clin Cardiol. 2011 Winter; 16(4): 109–115.

3. Improved mitochondrial function with diet-induced increase in either docosahexaenoic acid or arachidonic acid in membrane phospholipids. Khairallah RJ, Kim J, O’Shea KM, O’Connell KA, Brown BH, Galvao T, Daneault C, Des Rosiers C, Polster BM, Hoppel CL, Stanley WC. PLoS One. 2012;7(3):e34402. doi: 10.1371/journal.pone.0034402. Epub 2012 Mar 30.

Potassium Sodium Ratio Heart Failure

There are many health damaging effects of a poor potassium sodium ratio that occur even before blood pressure begins to rise. Last post we discussed how a poor potassium sodium ratio causes poor diastolic function of the heart even before blood pressure rises. If it goes on long enough, the poor ratio can lead to scarring in the heart.

In the short term this poor diastolic function can be easily corrected by simply getting a favorable potassium sodium ratio. If not corrected, over time this dysfunction becomes more difficult to reverse. Areas of fibrosis (scarring) begin to show up in the heart when examined under the microscope. A series of studies was done to examine the subcellular mechanism that leads to the scarring in the heart seen in heart failure.

Subcellular Look At Heart Failure

These studies were recently reviewed in an article (1) by the researchers who did this series of experiments. In animals experimentally subjected to high salt intake (potassium sodium ratio of 0.53) and high amounts of aldosterone, small foci of necrosis (dead heart cells) begin to form in the heart ventricle within 4 weeks. These areas of dead heart cells form small areas of scar tissue in the heart, much smaller than occurs from a heart attack.

Over time these take up an increasing percentage of the heart. When the percentage is too much, the remaining heart muscle cells cannot pump blood strongly enough. This is known as heart failure.

How A Poor Potassium Sodium Ratio Damages Heart Cells

The researchers studied the mechanism for this at the subcellular level. To summarize their findings, an increased salt intake leads to a shift in the calcium load inside the heart cell. Calcium builds up in the mitochondria causing the mitochondria to function poorly. Because the mitochondria are the power plants of the cell, all the functions performed by the cell cannot keep up and the cell dies.

The researchers found that this calcium buildup also was associated with an increase in free radicals (ROS). Free radicals interfere with the movement of electrons needed by the mitochondria for their work.

A Poor Ratio Messes Up Pores

Ultimately two pores in the mitochondrial membrane begin to function poorly, the mPTP pore and the BK(Ca) pore. The mPTP pore lets in too much fluid. The mitochondria swell and can no longer function.

The BK(Ca) pore is believed to affect the mPTP pore. When it can let potassium into the mitochondria, it can keep the mPTP pore from opening too much. But the BK(Ca) pore opens and closes based on the calcium concentration. Because there is too much calcium in the mitochondria, the BK(Ca) pore cannot hold back the mPTP pore. The mitochondria swell, and then the cell swells and bursts.

Cell Burst Means Scar

When a cell swells and bursts, the cell contents that are released attract inflammatory cells. These inflammatory cells set off a chain reaction that results in scar tissue. These small areas of scarring (fibrosis) eventually get larger and larger, leading to heart failure.

Hypertension can lead to irreversible damage. This discussion demonstrates one example of how this can happen. Similar types of subcellular damage occur to other cells in the body also. This particular example is one of the best detailed series of experiments at showing how this can happen.

It’s Not Just The Pressure

With these studies we begin to get an excellent understanding of how the potassium sodium balance affects the workings inside the cell. The effects of a poor potassium sodium ratio are not limited to simply increasing blood pressure. The effects occur throughout the body, affecting every cell.

As demonstrated in the ventricle of the heart, it is not just the mechanical effects of the pressure in the arteries that is important. The mechanical elevation of blood pressure is just an end result of many disrupted cellular functions. Unless corrected in a timely manner, the cellular damage leads to irreversible changes.

In some earlier experiments the researchers had one set of control animals get a potassium sodium ratio of 1.33. These animals did not develop the scarring in the heart.

How You Can Prevent Heart Failure

If you, like most Americans, have been on a high sodium, low potassium diet for a long time, you can stop these changes and possibly reverse some of them. If you are young, you can prevent them with a high potassium, low sodium diet.

Tables Of High Potassium Foods

To find tables with the potassium and sodium content of foods, use the List of Posts tab and look for post with the food group your food of interest is in.

1. Intracellular calcium overloading and oxidative stress in cardiomyocyte necrosis via a mitochondriocentric signal-transducer-effector pathway. Mazen Shaheen, MD, Yaser Cheema, MD, Atta U Shahbaz, MD, Syamal K Bhattacharya, PhD, and Karl T Weber, MD. Exp Clin Cardiol. 2011 Winter; 16(4): 109–115.

Free Radical Formation In The Heart

High potassium foods have been well documented to protect against hypertension, osteoporosis, and kidney stones. It has also been associated with less cardiovascular disease and other heart problems. It is well known to doctors that a poor potassium level can cause arrhythmias in the heart. However it is not as well known that it can also reduce the heart’s mechanical function. The poor potassium level results in increased free radical formation.

How Does A Poor Potassium Sodium Ratio Cause Heart Problems?

Dr. Young in an editorial (1) from 2006 discusses the implications of the article we discussed in the last post. It has been shown in animals and in humans that too high a level of sodium or too low a level of potassium causes the ventricle to function poorly. This is because the ventricle does not relax as fully or as fast as when potassium and sodium are at a proper level. The result is less filling of the ventricle and less blood that can be pumped through the blood vessels.

In the article discussed in the last post, this decreased function of the ventricle from inadequate potassium was associated with increased free radical (ROS) formation. In 1994 Dr. Young had shown that improved potassium levels reduced free radical levels in the cell.

Free Radical Formation May Be The Cause

In this editorial he ties together the evidence about increased free radical formation being the possible cause of this reduced heart function. He cites several other studies consistent with this theory. One showed that vitamin C (an antioxidant) improved heart diastolic function. Two other studies connected how the free radicals could interfere with calcium movement in cells, thus interfering with the ventricle’s ability to relax and fill with blood.

The worsening of diastolic function is one of the earliest abnormalities in heart function from inadequate potassium. It occurs before there is any abnormality in the systolic (when the heart contracts) function.  This improvement in the diastolic function from potassium occurs even before blood pressure is lowered.

Thus more and more blanks are being filled in on how an improved potassium sodium ratio improves heart function. The question is not whether a high ratio improves heart function. That has been well established. But it is how. It is the mechanisms the cell uses to bring about these improvements. Each study confirms the basic finding that a high potassium to sodium ratio in the diet helps the heart.

Although Dr. Young wrote the editorial in consideration of the use of potassium supplements to improve the potassium level, the potassium level in the body is best improved with high potassium foods.

Tables Of High Potassium Foods

To find tables of high potassium foods, please look under the List of Posts. Look for posts that have “table” in their title.
1. Potassium depletion and diastolic dysfunction. Young DB. Hypertension. 2006 Aug;48(2):201-2. Epub 2006 Jul 3.

High Potassium Sodium Ratio Reduces Free Radicals In The Heart

High potassium foods protect against the effects of hypertension, as shown in many population studies. Although population studies may show the association between health and a high potassium sodium ratio, basic science studies need to confirm that it is the potassium sodium ratio that causes the improvement in health.

Hypertension Is A Sign Of Cellular Disease

It is important to realize that hypertension is not a disease, but a sign of a cellular disease. Correcting the potassium sodium ratio in the foods you eat can reduce the debilitating consequences of hypertension even before your blood pressure comes down. A recent article (1) is one of many that gives clues as to how this happens. It also showed some limits of blood pressure medicines because they may not correct important physiological disturbances, even when they reduce blood pressure.

The study looked at the mechanical function of the heart with different levels of potassium and sodium in the diet, and with a blood pressure lowering medicine, hydralazine. The study showed that even when there is no reduction in blood pressure, the left ventricle of the heart functions better with a better potassium sodium ratio. It functions better by filling with more blood during its relaxation phase, allowing it to be a better pump.

The study also showed that even though the medication reduced blood pressure, there was no improvement in the function of the ventricle. It did not fill or pump any better.

More Potassium Means Less Free Radicals

To find a possible reason for the results, the researchers looked at whether free radicals (ROS) had anything to do with it. The researchers found that the improved function from the dietary potassium was associated with less free radical activity in the heart cells. However, there was no reduction in free radical activity with the medication, even though the blood pressure was lower.

Other studies indicate that free radicals may directly reduce ventricular relaxation by blocking the pump that moves calcium from one compartment in the cell to another. The increase in potassium reduced free radicals in this study, as did vitamin C in another (2).

The researchers concluded that a higher potassium intake will improve ventricular relaxation and function by protecting against free radical activity. This will happen even in the absence of an improvement in blood pressure.

Basic science studies such as these help explain how the population studies have shown big drops in the incidence of heart failure, strokes and other debilitating consequences of hypertension, when there are only relatively small drops in blood pressure through an entire population, such as in Finland and Japan.

To Find Tables Of Potassium In Food

To find tables with the sodium and potassium content of foods, please look at the List of Posts page. It will list foods by food category. To find a specific food, look in the appropriate food category. To find the potassium in broccoli, for example, look in the post with the vegetables table.
1. Protective effect of potassium against the hypertensive cardiac dysfunction: association with reactive oxygen species reduction. Matsui H, Shimosawa T, Uetake Y, Wang H, Ogura S, Kaneko T, Liu J, Ando K, Fujita T. Hypertension. 2006 Aug;48(2):225-31. Epub 2006 Jul 3.

2. Impaired endothelial regulation of ventricular relaxation in cardiac hypertrophy: role of reactive oxygen species and NADPH oxidase. MacCarthy PA, Grieve DJ, Li JM, Dunster C, Kelly FJ, Shah AM. Circulation. 2001 Dec 11;104(24):2967-74.

Mild Hypertension And The Potassium Sodium Ratio

It is well established that foods with a high potassium sodium ratio affect blood pressure, cardiovascular disease, and osteoporosis. Multiple studies have confirmed the effect. But it is difficult to be sure that potassium alone or in combination with other factors is responsible for the effect until the physiological mechanism producing the effect has been worked out. A recent study (1) provides insight into the mechanism in mild hypertension.

For hypertension, the pathophysiological mechanism has been well worked out at the level of the organism, and at the level of the systems of the organism. However, the cellular details involved in hypertension are not fully known.

For some of the other cardiovascular effects and for osteoporosis, details of the effects on human systems, organs, tissues and cells are still lacking. To work out these details, smaller human studies, as well as animal and cell culture studies are being done.

Recent Study Of Mild Hypertension

A recent study involved 42 untreated mildly hypertensive patients and attempted to determine the effects of potassium supplements on the cells that line blood vessels, on the left ventricle of the heart, and on bone turnover. The two supplements studied were potassium chloride and potassium bicarbonate.

They found that potassium in either form helped the blood vessel cells to function better, and the left ventricle of the heart to function better during its resting phase (when blood flows through the lungs back into the heart). Concerning bone turnover, one of the molecules used as a marker of bone loss improved on potassium bicarbonate.

However, they found no change in blood pressure measured in the office. The researchers relate that they only had a 50% chance of showing a blood pressure change. Two possible reasons are the small number of participants in the study and/or the fact that the participants had only mild hypertension. When the potassium sodium ratio is changed, the blood pressure change is not as great in mild hypertensives as it is in those with worse hypertension.

Very helpful is that the researchers reported how much sodium and potassium was consumed by the participants. The daily potassium sodium ratio in the participants was 1.11 before starting the study. This was higher than the average Westerner who usually has a ratio of 0.6 to 0.7. It was raised to 2.00 during the study.

Our Cells Function Better Even Before Blood Pressure Improves

So although the change in potassium sodium ratio was not enough to change the blood pressure, it did change how the heart functioned, and how blood vessel cells and bone cells functioned. This study adds insight into how favorable health effects can occur from changes in the potassium sodium ratio even when there is no change in blood pressure. Changes in the ratio change how the cells in our body function.

So hypertension is not the disease. It is only a sign of disease – a cellular disease. But you can affect the disease even if you only slightly change your potassium sodium ratio. Of course, the more you change it, the more you affect the disease.

To Find Tables Of Potassium And Sodium In Food

For tables with potassium and sodium amounts present in specific foods, look at the List of Posts page to find links to posts containing tables of various food categories.

1. Effects of potassium chloride and potassium bicarbonate on endothelial function, cardiovascular risk factors, and bone turnover in mild hypertensives. He FJ, Marciniak M, Carney C, Markandu ND, Anand V, Fraser WD, Dalton RN, Kaski JC, MacGregor GA. Hypertension. 2010 Mar;55(3):681-8. doi: 10.1161/HYPERTENSIONAHA.109.147488. Epub 2010 Jan 18.



Two excellent books about high potassium foods and blood pressure reduction are available on Amazon. The first is a practical guide to changing your diet to a high potassium foods diet. It is helpful even if you do not have hypertension. The second is a scientific explanation of the diet. It discusses the changes to your body that occur with high potassium foods.

Practical Guide

Scientific Explanation

RSS National Library Of Medicine



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