High Potassium Foods

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

 

Legumes’ Cholesterol Effects

Beans are one of the high potassium foods, but they have other characteristics that may add to their healthful effects also. Fiber is one of the other main components felt to have a healthful effect. A recent study (1) sought to determine if the fiber in legumes could lower three of the main cardiovascular risk factors. The factors are total cholesterol, LDL, and triglycerides. They studied these in both insulin resistant and non-resistant subjects.

Legumes260 Legumes Cholesterol EffectsLegumes Study

This was a small study that included 64 subjects. They studied the group for 2 four-week periods. They divided the main group into two smaller groups, one of which received a diet high in legumes and the other receiving the Healthy American diet. The legumes diet consisted of five different cooked beans with highly fermentable fiber. All meals were in a controlled setting with dietitians measuring any food that was not eaten.

After the first four-week period there was a break from the diets and then the participants switched. Those who had a high legumes diet the first time around were put on the Healthy American diet. And those on the Healthy American diet were switched to the high legumes diet.

The researchers did an exceptionally good job of controlling the diet during the experimental periods. Both groups received almost identical diets. Diets were adjusted so that there was no weight loss in either group or in any participants. The macronutrient breakdown was the same for both groups.

The difference was mainly in the fiber from beans. More than double the amount of fiber was consumed by those on the high legumes diet than those on the Healthy American diet. The researchers substituted beans for a similar type of food such as pasta or rice.

Results

They found that the Healthy American diet reduced the triglycerides more, but the high legumes diet reduced LDL and total cholesterol more in both resistant and non-resistant participants. However the insulin resistant participants had less effect.

As with many of these types of studies, the researchers did not consider the effect of potassium, and also did not study blood pressure or other cardiac markers beyond the three mentioned. It would be likely that those on the high legumes diet had a higher potassium sodium ratio. Beans are among the highest ratio food group. The type of food they were substituted for in the examples given in the study would not have had as good a ratio. In fact they probably would have had a fairly high sodium content.

Nonetheless the study has several strengths. The high control of the diet and calorie count were very important. Weight loss is almost always associated with a lower total cholesterol, LDL and triglyceride level. Because of the control of weight this would not explain the changes. Fiber has been shown in other studies to also have desirable characteristics. And they were able to show that the beans did have an effect on total cholesterol and LDL. This may be because of the increased fiber, although there are other potential explanations such as an increased potassium sodium ratio.

Tables

For tables with the potassium and sodium content of beans and legumes, click here. To find links to tables with potassium and sodium content of other foods, go to the List of Posts tab at the top of the page.
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1. A high legume low glycemic index diet improves serum lipid profiles in men. Zhang Z, Lanza E, Kris-Etherton PM, Colburn NH, Bagshaw D, Rovine MJ, Ulbrecht JS, Bobe G, Chapkin RS, Hartman TJ. Lipids. 2010 Sep;45(9):765-75. doi: 10.1007/s11745-010-3463-7. Epub 2010 Aug 24.

How A Vegetarian Diet Prevents Hypertension

Dietary treatment of hypertension started as early as the first decade of the 20th century. However the importance of potassium in reducing blood pressure was not considered until 1928. That was when Addison did some short-term administrations of potassium as a salt and saw a reduction in blood pressure. There were intermittent studies between then and 1983 that showed blood pressure was lowered with potassium or with certain types of diet, especially vegetarian diets. By 1983 enough physiology was understood that medical papers began to put potassium together with diet to speculate on the role of potassium in the diet.

VegetarianDiet260 How A Vegetarian Diet Prevents HypertensionThe Vegetarian Diet And Potassium

One of the first reports to discuss potassium in the long term diet as a way to prevent hypertension was a 1983 report from Tel Aviv (1). It indicated that potassium in the vegetarian diet was responsible for lowering blood pressure.

There had been a few prior studies showing lower blood pressure in vegetarians than nonvegetarians. But those studies had been done with younger subjects on a vegetarian diet for only a short time. This study used vegetarians who averaged 19 years on a vegetarian diet. The researchers showed only 2% of vegetarians had hypertension compared to 26% in the general population.

The researchers also considered multiple factors other than the vegetarian diet that can influence blood pressure. Family history of hypertension was similar in the vegetarian and nonvegetarian groups. Because vegetarians are more health-conscious than the general population, the researchers considered smoking, coffee, alcohol, exercise and body weight. They did not feel the differences in smoking, coffee, alcohol or exercise could account for the large difference in blood pressure. The average blood pressure was 147/88 in the nonvegetarian group and 126/77 in the vegetarians.

Body weight had been shown to affect blood pressure. The vegetarians were thinner. But when the researchers matched nonvegetarians with vegetarians of the same relative weight, the vegetarians still had lower blood pressure.

Prior studies had emphasized the role of sodium in hypertension, but this study was one of the first to also understand the importance of potassium. The researchers did not do food frequency questionnaires to determine potassium in the diet. Instead they used a more accurate method of determining sodium and potassium intake.

They collected urinary potassium and sodium. They were able to show that vegetarians and nonvegetarians took in approximately the same amount of dietary sodium. But the vegetarians had a much higher intake of potassium. And the researchers showed that blood pressure went down as potassium intake went up.

Early Basic Physiology

The researchers discussed some of the basic physiologic principles then known to be responsible for potassium’s effect on blood pressure. Small increases in blood potassium levels within the normal range cause long-term effects on sodium. These small increases promote sodium and water excretion in the urine, and less retention in body fluids. Increasing potassium in the diet decreases renin activity. This decreases angiotensin II (which increases blood pressure). Potassium causes blood vessels to relax, which lowers blood pressure. The blood vessel relaxation is because of the effect of potassium on the sodium potassium ATPase pump.

Many more basic physiologic effects on blood pressure from potassium and sodium have been determined since then. Knowledge of these effects provide even greater support for the importance of potassium (and especially the potassium sodium ratio) in the diet.

Other Possible Contributors To Health

Of course there are many other potential aspects about a vegetarian diet that also may contribute to health, as discussed here. A vegetarian diet includes plants that are nutrient dense. Their phytochemicals have been shown to affect cellular structure. The polyphenols in plants affect cell membrane structure, change the ion channels in the membranes, and affect cellular function.

In the vegetarian diet, the increased plant consumption contributes a much higher ratio of unsaturated fats (both polyunsaturated and monounsaturated) to saturated fats. A nonvegetarian diet that includes meat from modern animals will have a greater amount of saturated fat than a typical vegetarian diet.

Because of the emphasis that medical studies place on sodium, there has still to this day been relatively little appreciation of the importance of potassium. And there has been even less appreciation of how plants contribute to the potassium sodium ratio of the diet. The contribution of the dietary potassium sodium ratio to blood pressure is rarely considered. The importance of the ratio’s effect on blood pressure and cellular balance is still not understood by many physicians and lay people.

Food Tables

To find tables with the potassium and sodium content of foods, click on the List of Posts tab at the top of the page.
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1. Low blood pressure in vegetarians: the possible role of potassium. Ophir O, Peer G, Gilad J, Blum M, Aviram A. Am J Clin Nutr. 1983 May;37(5):755-62.

Plant Based Diet – What About It?

Many medical publications report the superiority of a plant based diet. Maybe it’s the phytochemicals. Maybe it’s the antioxidants. Maybe it’s the fiber. Maybe it’s magic. There are many possible explanations. But there is one very specific reason that plants reduce hypertension and cardiovascular disease. And that reason is that plants, with few exceptions, have a high potassium sodium ratio.

PlantBasedDietRatio300 Plant Based Diet   What About It?Exceptions

Exceptions often help prove the rule. There have been several population based exceptions to the superiority of a plant based diet. One is a population of carnivores who have as low a prevalence of cardiovascular disease and hypertension as vegetarians. The other is a pair of populations with a plant based diet who have the same prevalence of cardiovascular disease and hypertension as Western omnivores.

The carnivores with a low prevalence of cardiovascular disease are the Inuits (Eskimos). As their diet has shifted to a more Western diet they have developed the same prevalence of cardiovascular disease and hypertension as modern Westerners. Early studies of the Inuits in their traditional setting however were so remarkable that they spawned many subsequent studies centered on polyunsaturated fats.

The potassium sodium ratio of the Inuit diet was mostly ignored until relatively recently. When potassium and sodium were studied, it was found that the traditional Inuit diet had a high potassium sodium ratio. The wild fish and game that comprise the traditional diet provide a high ratio diet. The Inuits who maintained a more traditional diet had a much lower incidence of hypertension than those who had switched to a more Western diet with its low potassium sodium ratio. A more extensive discussion is found in this post.

The Vegetarian Hypertensives

We have discussed two populations eating a plant based diet that have a prevalence of cardiovascular disease and hypertension equivalent to the Western world. You can find a more extensive discussion in posts here and here.

The first population is the Korean population. They eat far more vegetables than found in the typical Western diet. But because the vegetables have a large amount of sodium added, the Koreans have a prevalence of hypertension similar to the Western prevalence. And yes, they suffer the consequences of that increase in hypertension. The number 1 and 2 killers in Korea are stroke and coronary heart disease (1).

The second population eating a plant based diet with a high prevalence of hypertension is the Indian population. An estimated 30 to 50% of India is vegetarian. Yet they have a prevalence of hypertension of 33% in the cities and 25% rurally. One group of Indians, the tea garden workers, have a prevalence of 46 to 61%. Indians add salt to many dishes. Their average salt intake is 10 grams a day. In one study the tea garden workers were found to consume 20 to 30 grams a day.

Most Important Factor In Plant Based Diet

Many of those promoting a plant-only diet are satisfied by simply showing that those eating more plants have a health advantage over omnivores eating a typical Western diet. However it is important to study what it is about plants that gives this advantage. Otherwise those practicing a plant only diet can go wrong and wind up eating the type of diet found in Korea and India.

There are many components of plants that may contribute to a healthy diet. Plants are nutrient dense with a variety of vitamins, minerals and phytochemicals. They are low in saturated fat, with few exceptions. Many are high in fiber and have slowly absorbing carbohydrates.

However, there is one characteristic plants have that is most certain to contribute to health. A high potassium sodium ratio, as found in the great majority of plants, has been shown time and again to improve health. A large number of basic science studies show the mechanism by which the potassium sodium ratio affects cellular function. These studies provide an underpinning unmatched by any of the other potentially healthful components found in plants.
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1. http://www.worldlifeexpectancy.com/south-korea-coronary-heart-disease

Potassium Enriched Salt Study

The convenience of processed foods plays a big role in their popularity. And it is rare that a processed food is also a high potassium food. But some nations have sought to reduce their rate of cardiovascular disease by changing the way their food is processed, resulting in an improved potassium sodium ratio of the food. Finland started a program in the 1970s which has been very successful in reducing its rate of strokes and cardiovascular disease. In Finland they instructed people about how to change their diet, and they convinced the manufacturers of food to change the composition of the salt they used as preservative. The manufacturers used a potassium enriched salt that was lower in sodium and higher in potassium. Read about it here.

Potassium enriched salt v Normal salt260 Potassium Enriched Salt StudyPotassium Enriched Salt Study

Others have looked at changing the composition of the salt used in food also. Studies have been done with salt that has less sodium and more potassium to determine if it results in changes in cardiovascular disease.

In Taiwan, researchers did such a study (1) on 1981 men in veteran retirement homes. One group used normal salt for cooking and at the table. The other group used a combination potassium enriched salt. Half of the combination salt was a salt of potassium and half was a salt of sodium.

The researchers took one month to gradually transition the experimental group to the new potassium enriched salt. This was to allow for the change in taste from the new salt. They did not modify soy sauce or any other potential sources of sodium.

The groups were very similar in composition. The age distribution of each group was similar. Each group was composed of World War II veterans. And both groups had a 40% rate of hypertension at the beginning of the study.

The diet of the two groups was very similar except for the types of salt. The researchers could control the diets because the residents ate their meals at the retirement homes.

Study Results

The researchers were able to confirm the change in potassium and sodium consumption by studying how much of each was excreted. Sodium was reduced by 17% and potassium increased by 76% in the combination salt group. Sodium and potassium remained almost the same in the normal salt group.

The study period lasted 31 months. After 31 months, the researchers saw a big difference in the rate of cardiovascular death between the two groups. In the potassium enriched salt group there were 13 deaths per thousand persons from cardiovascular disease. In the control group that continued to use the normal salt there were 21 deaths per thousand persons from cardiovascular disease. The deaths in the potassium enriched salt group are the dashed line and the normal salt deaths are the solid line in the graph on this page.

The beauty of this study is the uniformity of the participants and of their diet. There are fewer variables requiring statistical manipulations. Many studies have a wider variety of people, lifestyles and diets. These studies require statistical adjustments which may be inadequate.

Food Tables

To find links to tables of the potassium and sodium content of both processed and natural food, use the List of Posts tab at the top of the page.
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1. Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Chang HY, Hu YW, Yue CS, Wen YW, Yeh WT, Hsu LS, Tsai SY, Pan WH. Am J Clin Nutr. 2006 Jun;83(6):1289-96.

Low Sodium Diet Dangers?

Periodically studies are mentioned in the popular press from the medical literature saying you don’t need to reduce the sodium in your diet. They try to convey the idea that you can take in any amount of sodium and it will make no difference to your health. This is based on a relatively small number of studies. And the studies have a lot of problems. In 2012 (1) a study came out analyzing some recent studies supporting the idea that a low sodium diet can be dangerous.

LowSodiumDiet240x411 Low Sodium Diet Dangers?Danger In A Low Sodium Diet

There are two relatively recent studies that claim getting sodium below 1500 to 3000 mg is dangerous and makes you more likely to die. These two studies describe what has become a popular concept concerning the danger of a low sodium diet. They claim there is a J-shaped or U-shaped relationship between sodium intake and serious health problems.

Both studies have serious design problems. The studies were done in patients who were at high risk of stroke, cardiovascular disease (CVD), kidney disease and other disease. The studies determined dietary sodium by collecting a 24 hour urine sample for sodium in the first study, and a single morning spot urine sample for sodium in the second study. Such sampling methods are not as accurate as methods using multiple collections, since day to day intake of sodium varies a lot.

The first study (2) was a 10 year follow-up of over 2800 Finnish adults. The researchers found a J-shaped survival curve in relation to sodium. From their graph, survival improved as daily sodium was lowered until it reached somewhere between 1200 and 1700 mg per day. Survival then worsened at lower sodium levels, implying danger for a low sodium diet.

For 75% of the participants the rate of death from all causes increased proportionally to sodium. For the 25% taking in a lower amount of sodium an uptick in deaths occurred. The researchers did not report separately on cardiovascular events and deaths, or stroke events and deaths.

Problems With First Study

The biggest problem with the study is that it was in high risk patients. This is done in many medical studies so enough adverse events can occur to make the findings significant. This is a valid method for determining how to medically manage high risk patients. It is not valid for studies of prevention. The object of prevention studies is to find what can allow people to avoid becoming a high risk patient.

The participants at the time of entry into the study already had diabetes for a median of 20 years duration. 47% had hypertension, and 30% were spilling albumin (protein) in their urine.

The protein in the urine indicates some degree of kidney disease. The low sodium group had more participants with very poor kidney function. The high sodium group had some participants with kidney disease, but kidney function was better than in the low sodium group.

In this study, as the sodium in the urine (assumed in the proper situation to be proportional to how much is consumed) went down, the function of the participants’ kidneys was worse. This means that many of the participants already had damaged kidneys. The low sodium group had more people with very poor kidney function.

Age 39 – 8% Died In 10 Years!

The mean age of the participants was only 39 at the beginning of the study, and yet 8% of them died and 4.5% developed end stage kidney disease in the following 10 years. This is way more than would occur in this age group.

Certainly this study group cannot be considered representative of a general population. The most likely reason for the worse survival in the low sodium group is that the sickest participants had been put on a low sodium diet. In other words, the high risk of serious illness and death prompted the participants to be on a low sodium diet, either because their doctor put them on it or because they did it themselves.

Reverse Causality

This is called reverse causality. They were not sick because they went on a low sodium diet. They went on a low sodium diet because they were sick (at high risk).

Second Study

Another study in 2011 (3) showed a J-shaped relationship between urinary sodium and the combined outcome of stroke and CVD. The researchers combined non-fatal and fatal heart attacks, stroke and hospitalization for heart failure as an outcome measure. They showed a greater likelihood of these outcomes when sodium consumption was estimated to be less than 3000 mg a day.

One of the problems with this study is that it was a secondary look at a pair of studies designed for entirely different purposes, so that a great deal of needed information was not collected. As with the first study, it had a great many participants who had damage to their organs already. Almost half had already had a previous heart attack, more than 20% had a previous stroke, 40% had diabetes, and 70% had hypertension. Hardly representative of the general public.

The low sodium group had a higher percentage of people with prior heart disease, hypertension, and a sedentary lifestyle. They also had a higher percentage on diuretics (water pills).

A high percentage of this low sodium group was likely to have been put on a low sodium diet because of their health problems. Furthermore, they had distortion of the sodium in their urine because so many were using medications that affect sodium excretion into the urine. Another example of reverse causation.

Be Skeptical

These studies provide good examples of what to look out for when you hear about medical studies that you should be skeptical of. Reverse causation is a common mistake made when there is an association. Very few people can be made to think that evening cooling causes the sun to go down. But many can be fooled by claims of salt consumption below 3000 mg causing cardiovascular death. Only a few people will question the results. Especially when the study is presented by experts.

Food Tables

Find the posts with food tables listed with other posts under the List of Posts tab at the top of the page.
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1. Sodium, blood pressure, and cardiovascular disease: further evidence supporting the American Heart Association sodium reduction recommendations. Whelton PK, Appel LJ, Sacco RL, Anderson CA, Antman EM, Campbell N, Dunbar SB, Frohlich ED, Hall JE, Jessup M, Labarthe DR, MacGregor GA, Sacks FM, Stamler J, Vafiadis DK, Van Horn LV. Circulation. 2012 Dec 11;126(24):2880-9. doi: 10.1161/CIR.0b013e318279acbf. Epub 2012 Nov 2.

2. The association between dietary sodium intake, ESRD, and all-cause mortality in patients with type 1 diabetes. Thomas MC, Moran J, Forsblom C, Harjutsalo V, Thorn L, Ahola A, Waden J, Tolonen N, Saraheimo M, Gordin D, Groop PH; FinnDiane Study Group. Diabetes Care. 2011;34:861– 866.

3. Urinary sodium and potassium excretion and risk of cardiovascular events. O’Donnell MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, Sleight P, Sharma AM, Dans A, Probstfield J, Schmieder R. JAMA. 2011;306:2229–2238.

Sodium Potassium Ratio – Important?

I always love it when two examinations of the identically same data set come to opposite conclusions. It shows how easy it is to go wrong when relying on statistics. In today’s pair of studies, one group of researchers decided that lowering sodium makes no difference in cardiovascular health. The other group found that lowering sodium did improve cardiovascular health. They also gave a good explanation of how the first study slipped up. And they emphasized the importance of the sodium potassium ratio.

Previously we discussed a different pair of contradictory studies that used the same data set here. In that particular case one way of looking at the data set showed vegans did better than non-vegetarians. Another way of dividing the identically same data set gave a different result. It showed that those vegetarians who also ate fish or consumed milk and eggs did better than vegans.

RutherfordQuote280x367 Sodium Potassium Ratio   Important?The Sodium Potassium Ratio

The researchers in today’s pair of studies used the sodium potassium ratio instead of the potassium sodium ratio. The sodium potassium ratio is used more commonly in the medical literature than the potassium sodium ratio. It is simply the inverse of the potassium sodium ratio.

I prefer the potassium sodium ratio because as the number gets larger, you are doing better and better. With the sodium potassium ratio as the number gets larger, you are doing worse and worse. I prefer for a larger number to mean that you are doing better. For most games and sports a larger number is better. An exception is golf. And I am horrible at golf.

The First Study

In 2008 (1), the researchers looked at data in the Third National Health and Nutrition Examination Survey (NHANES III). They included 8699 people over the age of 30 that they recruited between 1988 and 1994 in their study. Based on a single 24 hour dietary recall questionnaire, they divided the people into 4 groups according to their sodium intake.

They then determined how many in each group had died by the year 2000 from cardiovascular disease or from any cause. They concluded that those who took in more sodium had fewer deaths. They did not study potassium at all.

The Second Study

In 2011 (2), a different set of researchers used the same data set (NHANES III), but included 12,267 participants over the age of 20. The researchers also obtained a second 24 hour dietary recall in 8% of the participants. They used this second questionnaire to better estimate sodium and potassium intake in the entire group.

They then looked at the sodium potassium ratio and deaths through 2006. This gave an average follow-up period of 14.8 years. They found the sodium potassium ratio had a significant association with death from cardiovascular death and death from any cause.

They also found an association of sodium with cardiovascular death for people with a normal blood pressure, but a reverse association if they were hypertensive. The researchers concluded that the reason for low sodium seeming to be harmful was that the low sodium group had many hypertensive patients. The hypertensive patients may have been put on a reduced sodium diet. This is commonly done by doctors for their heart patients.

Which Study Is Right?

A commentary after the 2011 study sums up the two studies well (it is after the citations at the same link). It states that the methodology in the 2011 study was superior. The 2011 study also concurs with the basic science of the cell. The sodium potassium ratio is critical to cellular function.

How can you tell which study is right when two contradictory studies are reported? It seems that every week there are news reports with a new contradictory result. Sadly, you need to have a bit of knowledge about the subject. Hill’s criteria are a good place to start.

There are two criteria that are the most important. You should have enormous differences between the test group and the control group. And basic science studies should be consistent with the results.

When you are improving your potassium sodium ratio realize that the importance of the ratio is not based on just a few observational studies. There is a huge underpinning of basic science studies supporting the importance of the potassium sodium ratio to cardiovascular health at the cellular level.

Tables Of Sodium And Potassium In Food

Looking to improve your potassium sodium ratio? Find a listing of tables with the potassium and sodium content of thousands of foods by clicking the List of Posts tab at the top of the page.
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1. Sodium intake and mortality follow-up in the Third National Health and Nutrition Examination Survey (NHANES III). Cohen HW, Hailpern SM, Alderman MH. J Gen Intern Med. 2008 Sep;23(9):1297-302. doi: 10.1007/s11606-008-0645-6. Epub 2008 May 9.

2. Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey. Yang Q, Liu T, Kuklina EV, Flanders WD, Hong Y, Gillespie C, Chang MH, Gwinn M, Dowling N, Khoury MJ, Hu FB. Arch Intern Med. 2011 Jul 11;171(13):1183-91. doi: 10.1001/archinternmed.2011.257.

Potassium Sodium Guidelines

High potassium foods are a great way to reduce blood pressure, combat osteoporosis, and prevent kidney stones. They all have a high ratio of potassium to sodium. However most Americans eat foods loaded with sodium and with little potassium. Such foods have a horrible potassium sodium ratio. Recommendations by medical institutions to get more potassium and less sodium have had little effect. The Institute of Medicine (IOM) has produced potassium sodium guidelines on how much potassium and sodium to get daily. A recent medical publication (1) tried to satisfy the IOM’s guidelines for sodium and potassium using the typical American diet, but could not meet the guidelines using the typical American diet.

NIH280 Potassium Sodium GuidelinesIOM Potassium Sodium Guidelines

The IOM advises getting 4700 mg of potassium daily. They recommend less than 2300 mg of sodium for healthy individuals, and less than 1500 mg for those over 50 years of age or those with cardiovascular risk factors. Using linear programming, the researchers (1) were unable to satisfy both of these criteria simultaneously using the typical American diet.

The researchers tried to maximize sodium reduction to reach the goal amount and found that the potassium goal could not be reached when they did so. They also tried to maximize potassium intake to reach the goal amount and found the sodium goal could not be reached. This was even when they made an assumption of a 10% reduction of sodium in processed food.

Such a result is expected if there is no change in diet. But more than a 10% reduction of sodium in processed food is possible. And other changes in diet make it completely possible to reach both goals of the Institute of Medicine.

Following Potassium Sodium Guidelines Improves Health

And such changes can make remarkable improvements in health. Even fairly small changes in diet can have dramatic health effects. Finland reduced their average citizen’s sodium intake by slightly more than 10%. When Finland reduced the average salt intake from 12.7 g per day to 11.1, they saw a dramatic reduction in deaths from stroke and cardiovascular disease (2). Both fell by over 50%. And the average diastolic blood pressure in Finland fell from 92.8 to 84.2 in men and from 91.8 to 79.6 in women.

In Finland they achieved part of this change by a change in the salt used in processed food. In the 1980s, food manufacturers changed the salt used from sodium chloride to a combination salt of sodium chloride, potassium chloride, magnesium sulfate, and lysine. Other dietary changes included less use of salt at the table and less use in cooking.

How To Meet Guidelines

But an even greater change in blood pressure can be achieved by shifting away from typical American food. Americans today eat a lot of junk food loaded with sodium and no nutritional value. By including more foods that have a high potassium to sodium ratio, the potassium sodium guidelines can be met with relatively minimal change in the diet.

My wife and I exceed the IOM recommended potassium sodium guidelines every day. Many others other have been able to improve their potassium sodium ratio. Dr. Moore had hundreds of readers of his book (the one in the upper left corner of the page) write to him about how they had improved their ratio and had lowered their blood pressure.

The Biggest Hurdle

The biggest hurdle to overcome is the change in the taste of food. American processed food has become more and more salty and sweet. American taste buds are accustomed to excessive salt and sugar.

When you improve the ratio of your diet, your tongue will take about two to four weeks to get used to the taste of less salt. This is probably the greatest hurdle to overcome. However once the taste buds have adjusted, the true flavor of food becomes more intense. No longer do all foods seem to have the same kind of taste.

Books And Tables

To find out how easy it is to change your own diet you can read either of the two books recommended in the upper left-hand corner. They both show ways to obtain a high potassium sodium ratio in your diet. If you want to do it on your own, you can look at the tables that we have throughout this website to find foods that will provide a favorable ratio. The List of Posts tab has a listing of all the tables.
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1. Food pattern modeling shows that the 2010 Dietary Guidelines for sodium and potassium cannot be met simultaneously. Maillot M, Monsivais P, Drewnowski A. Nutr Res. 2013 Mar;33(3):188-94. doi: 10.1016/j.nutres.2013.01.004. Epub 2013 Feb 12.

2. Do changes in cardiovascular risk factors explain changes in mortality from stroke in Finland? Vartiainen E, Sarti C, Tuomilehto J, Kuulasmaa K. BMJ. 1995 Apr 8;310(6984):901-4.

Mediterranean Diet Reduces Inflammation

The established medical community feels there are a few diets that have health value. The two main ones are the DASH diet and the Mediterranean diet. There have been multiple studies showing that the Mediterranean diet results in a better cardiovascular risk profile than the Western diet. A recent study (1) out of Italy examined how the Mediterranean diet affects some of the inflammatory markers in the blood. Other medical studies have shown that increased inflammatory markers in the blood are associated with more cardiovascular risk.

Mediterranean280 Mediterranean Diet Reduces InflammationMediterranean Diet Reduces Inflammation

The researchers commented that the diet of the typical Italian has been changing from a traditional Mediterranean diet to a more Western diet. They studied 131 subjects in southern and central Italy to determine how much adherence to the Mediterranean diet influenced these inflammatory markers. They measured many of the micronutrients that the medical literature has considered antioxidants. This study came out about the time that the traditional measure of antioxidant capacity was found to have little value.

In this study the researchers defined Mediterranean diet based on four criteria: 1. having increased fruits and vegetables 2. having olive oil as the main source of fat 3. having a low meat and dairy intake 4. having a moderate consumption of wine. Of course there are multiple Mediterranean diets that differ according to the specific geographic location. However these criteria do tend to be relatively common to all Mediterranean diets.

They divided their subjects into 3 categories according to a Mediterranean diet score that weighed the diet according to these criteria. They found that the higher the level of adherence to the Mediterranean diet, the better the blood inflammatory markers were. So the Mediterranean diet reduces inflammation. They speculated on the various traditional antioxidants present in the Mediterranean diet, but did not consider potassium and sodium.

Potassium Content

They reported the average potassium content of the participants’ diet. But they did not report the difference in potassium content of those adhering to the Mediterranean diet versus those not adhering. Also they did not report on the sodium content of either diet.

The overall average of potassium intake was quite low. However if they had examined the potassium and sodium content of those adhering to the Mediterranean diet versus those not adhering, they would probably have found a significant difference. The higher fruit and vegetable content of the Mediterranean diet would likely have resulted in a much higher potassium and lower sodium content.

This is one of the problems with these kinds of studies. As reported in this post, potassium was shown to be a strong antioxidant inside of cells over 20 years ago. Other researchers have since confirmed the finding. Yet potassium intake is not examined in studies of inflammation.

Antioxidant Value Of No Value

Other more popular antioxidants are studied because they have shown antioxidant qualities in the test tube. But the test tube antioxidant values (ORAC) have been shown to have no correlation with antioxidant activity in the body. See this post for a discussion about the lack of correlation. What matters is the antioxidant activity inside the cell, not the activity in the test tube.

The problem in Italy is similar to the problem throughout the world. As more and more people move into cities, their diet and lifestyle changes to an urban diet and lifestyle. The change in diet is one that consists of a diet much higher in sodium and lower in potassium. This results in the cells in our body being too imbalanced to eliminate excessive free radicals. This leads to more inflammation, and will lead to more hypertension and cardiovascular disease throughout the world.

Find Tables Of Potassium Content

However by getting more high potassium foods and less sodium you can prevent the damage from a more Western diet. To find the potassium and sodium content of different foods you can click on the List of Posts tab at the top of the page. From there find a link to a table with your food of interest to find the potassium and sodium content.
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1. Mediterranean Diet Effect: an Italian picture. Azzini E, Polito A, Fumagalli A, Intorre F, Venneria E, Durazzo A, Zaccaria M, Ciarapica D, Foddai MS, Mauro B, Raguzzini A, Palomba L, Maiani G. Nutr J. 2011 Nov 16;10:125. doi: 10.1186/1475-2891-10-125.

Optimize Cell Restoration

High potassium foods can protect against a number of diseases. Hypertension is the disease most strongly shown to be prevented by high potassium foods. By getting a proper ratio of potassium to sodium in your food you provide an electrochemical balance within your cells. This balance provides cell restoration quickly so the cell can function optimally. For your cells to function best, potassium and sodium must pass through multiple channels in the membranes of the cell. If these channels do not allow potassium and sodium to pass properly, cell restoration occurs slowly and disease will result. The last post discussed how the malfunction of some genes that produce the proteins of these channels is associated with hypertension. Another way the channels can function poorly depends on the lipids (fats) that the membranes are composed of.

Excessive saturated fat makes the membranes too stiff, so the channels do not open and close as well as they should. Polyunsaturated and monounsaturated fats make the membranes more fluid. They allow the channels to function better, and allow certain cell messages to be transmitted more easily within the cell. The cell does its work better and restores itself better.

PotassiumChannel Optimize Cell Restoration

Potassium Channel

PIP2

One particular lipid of great interest is PIP2. More and more publications are showing how important it is. It is best known for its role in cell signaling, being split into two molecules that are secondary messengers within the cell. A recent publication (1) reviewed another important function of PIP2. Although PIP2 regulates multiple types of ion channels, the review limited its discussion. It only discussed how PIP2 controls a certain small group of potassium channels.

PIP2 binds strongly to a part of these potassium channels that controls their opening and closing. It causes the channel to open or close depending on the difference in electrical charge (voltage) between the inside and outside of the cell. This difference in charge depends on how much sodium and potassium are inside and outside the cell. And how much sodium and potassium are inside and outside depends on how much are in the food you eat.

Cell Restoration

These particular channels are the ones that are involved in cell restoration. They help the cell restore itself to a resting state after the cell has performed its function. For example, these channels allow a nerve cell that has discharged and sent a message somewhere in your body to restore itself. This allows the cell to send another message all over again – many times a second. If the channel opens and closes too slowly, the nerve cell will not restore itself fully and the nerve will not function as well as it could.

Of course, this is true for every cell in the body. All cells use similar channels. The specific cells already shown to be affected by this small subset of channels are heart rhythm cells, nerve cells and cells of the inner ear. So considering all the channels that PIP2 regulates, all cells (heart, lung, liver, kidney, immune, etc.) in the body will not function as well as they could if potassium and sodium were in balance.

This may be a part of the reason polyunsaturated and monounsaturated fat are better for heart and blood vessel health than saturated fat. They increase the fluidity of the cells’ membranes. This allows PIP2 to open and close channels better. Quick restoration of the cell to its resting state means the cell is quickly ready to get back to work again. The cell can perform more work in a given amount of time.

Potassium Sodium Food Tables

How can you be sure your cells are functioning optimally? Get the right ratio of potassium and sodium in your diet. Links to tables with the potassium and sodium content of many foods can be found here.

There is little reason to be concerned about getting enough PIP2. It is made in our bodies from its precursor phosphotidylinositol. Phosphotidylinositol is found widely in a variety of foods. It is a component of lecithin and phytate. Phytate is a less absorbable form than lecithin. However, if you are getting a variety of high potassium foods, you are getting plenty of PIP2 precursor.
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1. PIP2 regulation of KCNQ channels: biophysical and molecular mechanisms for lipid modulation of voltage-dependent gating. Zaydman MA, Cui J. Front Physiol. 2014 May 27;5:195. doi: 10.3389/fphys.2014.00195. eCollection 2014.

Hypertensive Genes And Potassium Sodium

Genetics are involved in hypertension. There are a few conditions that only require the presence of one gene to result in hypertension. These are very rare. Most of the hypertensive genes require multiple factors to result in hypertension. Some of these factors may be multiple other genes. Some may be environmental factors such as food or exercise. A recent review (1) looked at 130 genes that are commonly associated with hypertension.

MaleKaryotype Hypertensive Genes And Potassium SodiumPrimary Hypertension

In the article, the authors refer to hypertension as essential hypertension. This is a term that is still commonly used, but it is an old term that should be abandoned in favor of the term primary hypertension. There is nothing essential about hypertension.

Although somewhat technical, the study is the most up-to-date review concerning genetic and epigenetic changes associated with hypertension. It does not review those hypertensive genes that are monogenic. These are genes that have a change in just one gene causing hypertension. They are extremely rare.

This was a review article that compiled many other articles that were Genome Wide Association Studies (GWAS). Such studies look at thousands of genes at a time to find genes that occur more often in people with a particular disease than people who do not have the disease. In this particular case, they compiled GWA studies that found associations between genes and hypertension.

Hypertensive Genes

The study found that the hypertensive genes had multifactorial inheritance. None of those studied had Mendelian inheritance (like blue eyes, brown eyes). The authors found none of the extremely rare genes leading to monogenic hypertension.

They were able to come up with a list of 130 hypertensive genes. Not all of the genes had known functions. However of those with known functions, a great many involved sodium and potassium, either directly or indirectly.

To see what functions were involved was very interesting. Many of them involved the RAAS pathway. This is the pathway that involves hormones affecting blood pressure. Also many of the genes were those affecting how the kidney handles sodium and potassium. At the cellular level, many genes affected the potassium channels, the sodium channels, and the calcium channels one way or another. And many genes involved enzymes associated with balancing potassium and sodium.

Epigenetic Changes

The authors also considered epigenetic changes. Epigenetic changes are changes in gene expression caused by mechanisms other than changes in the DNA sequence itself. These are changes such as microRNA, methylation of specific genes or changes in histones (proteins associated with DNA).

This is a more recent area of study that is less developed, so there were fewer studies. Nonetheless, the researchers found some epigenetic overlap with genes affecting potassium and sodium balance. And they also found epigenetic changes influencing genes involved with the results of potassium sodium imbalance, such as nitric oxide and fibrosis.

The authors did emphasize that there was much yet to be discovered and there was no clear set of genetic pathways evident yet. Their hope was that knowing the various genes involved would allow for better design of medications to provide a personal level of prescription.

Lifestyle Changes?

They felt that discovering genetic pathways would provide little help in determining lifestyle changes. In their view, the lifestyle recommendations to eat better and exercise more would apply to anyone.

However, their study shows that the most common hypertensive genes are highly involved in controlling potassium and sodium. This throws more weight behind specific recommendations concerning potassium and sodium in the diet. When these types of genetic studies are combined with epidemiological and physiological studies, the importance of the potassium sodium ratio in the diet becomes harder to ignore.

The key to controlling blood pressure is controlling the potassium and sodium balance in your body’s cells. This can be done by controlling how much potassium and sodium you get in your diet.
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1. Elevated blood pressure: Our family’s fault? The genetics of essential hypertension. Natekar A, Olds RL, Lau MW, Min K, Imoto K, Slavin TP. World J Cardiol. 2014 May 26;6(5):327-37. doi: 10.4330/wjc.v6.i5.327.

Archives

Recommended

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

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