High Potassium Foods

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


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.
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.

Exercise And Leanness – Enough To Prevent Hypertension?

There are several factors that can help protect against hypertension. But when the potassium to sodium ratio of your diet is poor, these factors are of little help. Some recent posts (1, 2) discussed how normally protective fruits and vegetables can be made to fail by a poor ratio. Exercise and leanness are usually felt to prevent hypertension. But they too can be undermined by a poor dietary ratio of potassium to sodium.

SheepIran280 Exercise And Leanness   Enough To Prevent Hypertension?An Old Classic

A recent article (3) brought back memories of a classic article (4) from 1981. This spring there was an article (3) concerning hypertension in Yazd. This is an urban center close to a rural area in Iran that had a high incidence of hypertension in a 1981 report.

What was unique about the rural group, the Qash’qai, was that they remained lean and very physically active into old age. Nonetheless they had a high incidence of hypertension, although not as high as the thin, physically active tea garden workers of India (1) discussed a few weeks ago.

Exercise and leanness usually protect against hypertension. They are associated with lower blood pressure. However, if the basic principle of having a high potassium to sodium ratio in your food is not followed, you will still have a strong chance of developing hypertension.

Exercise And Leanness Are Not Enough

In the 1981 report (4) researchers discussed how blood pressure in the Qash’qai went up with age the same as in a typical urban Western society. The Qash’qai however were nomads who remained lean throughout their life, traveling great distances on foot while shepherding their herds of sheep and goats. Even so, they had an incidence of hypertension of over 20%.

The researchers determined the diet of the Qash’qai by a food frequency questionnaire. But they also confirmed the sodium and potassium content of the diet with measurement of urinary potassium and sodium, which correlates well with the dietary content. The urinary ratio was 0.28 in men and 0.31 in women.

Examination of their diet showed they added salt to almost all of their food, either during preparation or at the table. 100% of the subjects ate bread. For many it was all they ate for at least one meal. Approximately half of the nomads ate rice, 37% ate vegetables and only about 28% ate meat, with 17% eating dairy and 17% eggs.

The researchers measured the sodium and potassium content of the bread and rice. They found very high ratios of sodium to potassium in each of their samples. Also they noted that salt was added to almost every dish.

Exercise And Leanness And No Salt

This is in great contrast to the centenarians that we have discussed in the past. In Sicani (5) and in Sardinia there are a great number of centenarians. They also remain physically active in a mountainous region and maintain a normal weight. However, in contrast, they do not add salt to their food.

In the Qash’qai report the researchers correlated blood pressure with age and body weight. They found that body weight did not increase with age as it does in the West, even though blood pressure increased the same as in the West. Leanness and physical activity do not fully protect against the hypertension resulting from a poor ratio diet.

Rural And Urban Diet With Same Ratio

In the more recent report about Yazd (3) it appears that the sodium and potassium in the diet have not changed. This was an urban environment in which the amount of dietary sodium and potassium had remained in the same ratio as in the rural population.

The percentage of hypertension was twice as great in the Yazd participants as it had been in the Qash’qai. In Yazd, 40% of people were hypertensive (with more than half of them previously undiagnosed). In the Qash’qai, hypertension had been present in at least 22% of men and 29% of women. The Yazd study did not report on physical activity or leanness, but urban dwellers are generally less active and less lean than rural nomads.

The Yazd study included more young people than old (as did the Qash’qai study), but did not report blood pressure by age group. This lack of age group information and the 33 years between reports make it difficult to compare the two groups. Nonetheless, the Qash’qai study shows that exercise and leanness are not enough to fully prevent hypertension. Compared to an urban lifestyle, the leanness and physical activity of a rural nomad lifestyle may cut in half the chance of hypertension.

Prevent Hypertension

But a poor potassium sodium ratio will still lead to hypertension for many who exercise and stay lean. The first and most basic way to prevent hypertension and its associated cardiovascular problems is to eat a diet with a high potassium to sodium ratio.

Exercise and maintaining a normal weight can help when the diet is right. With a high ratio diet, normal blood pressure can be maintained into old age, as with many rural indigenous people (6). When the diet is not right, exercise and weight control will help only a little.
1. http://www.highpotassiumfoods.org/potassium-symptoms/vegetarian-hypertension-india

2. http://www.highpotassiumfoods.org/potassium-symptoms/kimchi-pickling-blood-pressure

3. Sodium and potassium intake of urban dwellers: nothing changed in Yazd, Iran. Mirzaei M, Soltaniz M, Namayandeh M, GharahiGhehi N. J Health Popul Nutr. 2014 Mar;32(1):111-7.

4. Blood pressure of Qash’qai pastoral nomads in Iran in relation to culture, diet, and body form. Page LB, Vandevert DE, Nader K, Lubin NK, Page JR. Am J Clin Nutr. 1981 Apr;34(4):527-38.

5. http://www.highpotassiumfoods.org/high-potassium-foods/longevity-sicani

6. http://www.highpotassiumfoods.org/high-potassium-foods/changes-in-diet-leading-to-hypertension

The Potassium Sodium Ratio. Really?

I don’t understand why the potassium sodium ratio is so important. My doctor tells me to reduce my salt and to eat more fruits and vegetables. Isn’t that enough? Depends. What else do you eat? How do you prepare it? How much sodium does it really contain?FruitsVegs280x206 The Potassium Sodium Ratio. Really?

This website has emphasized the potassium sodium ratio in many of its posts. Medical guidelines discuss reducing sodium and talk about eating more fruits and vegetables as a way to reduce hypertension and cardiovascular disease. However the guidelines don’t explain why to eat the fruits and vegetables or what is important about them.

Why Fruits And Vegetables Are Important

Although fruits and vegetables have many admirable qualities, such as fiber, antioxidants, phytochemicals, and polyunsaturated fats, their most important quality is that they have a high potassium to sodium ratio. This has been shown indirectly in many studies. Many studies show that decreasing sodium improves blood pressure. Almost as many studies show that increasing potassium improves blood pressure. But there have been only a few that have directly studied the ratio.

It’s The Ratio

The report (1) that we will be discussing today directly studied the potassium to sodium ratio. It found that the ratio had the strongest fit to cardiovascular disease. The ratio was stronger than sodium by itself or potassium by itself. It found that there was an effect on cardiovascular disease even after statistical adjustments for blood pressure.

How To Go Wrong Eating Fruits And Vegetables

It is important to understand the potassium sodium ratio because just eating vegetables and fruits is not the key to reducing cardiovascular disease. Increasing the potassium to sodium ratio is the key. The last 2 posts showed some societies that eat more fruits and vegetables than the average Western society. Yet these societies have just as much hypertension as a Western society.

The reason is that they add sodium in the form of salt to the vegetables. Kimchi is a pickled vegetable that is the national food of Korea. Korea has just as much hypertension as Western societies. India is composed of 30 to 50% vegetarians and even non-vegetarians eat very little animal food. However their hypertension is the same as any Western society and they have pockets with a much higher percentage of hypertensive people than the average Western society.

I’m Vegan. Why Are My Blood Tests Bad?

I have vegan friends who do not understand why their cardiovascular biomarkers are so poor. They avoid all animal food. However they eat a great deal of processed food made from plants. Many of the processed foods, such as the veggie burgers, cocoa and sugar products, and the vegan pasta, have a poor ratio. Eating too many of the processed veggie foods and not enough vegetables and fruits as they come from the ground will be counterproductive to being a vegan, if being vegan is done for health reasons.

There have been a great many studies of reduced sodium in the diet. There also have been a great many studies of fruits and vegetables, especially vegans versus omnivores. Most of the studies are done with food frequency questionnaires, which are a good first start.

More Rigor Is Needed

However a more rigorous study would involve measuring urinary sodium and potassium and this is rarely done. Usually when it is done, it is only done once. Because of the variability of what people eat, the amount of sodium and potassium on any given day will be highly variable.

The study we are discussing today did multiple measurements over several years. This gives a much better idea of the average sodium and potassium that someone consumes than a single measurement.

The Study

This study (1) actually included participants and data from 2 studies. The first one was 18 months and the second was 3 years in duration. The average number of sodium measurements and of potassium measurements over these periods was 4.8 each. The study included over 2200 participants.

The researchers did a follow-up at approximately 15 years after the first study and 10 years after the second. They examined the number of deaths that were due to cardiovascular disease and the number of nonfatal cardiovascular events.

The result was that there were fewer and fewer cardiovascular deaths and events in participants as the ratio of potassium to sodium got larger and larger. The ratio provided a better fit to the data than did sodium alone or potassium alone. This was even true when they adjusted results for blood pressure.

The Potassium Sodium Ratio Is Basic

Hypertension is a sign of a basic cellular disease. It is very similar to the sign of fever indicating an infection. Fever is not the disease. Hypertension is not the disease. This basic cellular disease is an imbalance of potassium to sodium. It affects every cell in the body, including the heart and blood vessels. The more rigorous the study, the more likely it is to demonstrate the importance of the ratio.
1. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Cook NR, Obarzanek E, Cutler JA, Buring JE, Rexrode KM, Kumanyika SK, Appel LJ, Whelton PK; Trials of Hypertension Prevention Collaborative Research Group. Arch Intern Med. 2009 Jan 12;169(1):32-40. doi: 10.1001/archinternmed.2008.523.

Vegetarian Hypertension In India

We’ve reported on several studies showing vegetarians have a lower incidence of hypertension than consumers of the Western diet. This is because vegetables and fruits have a high potassium to sodium ratio. If you don’t add salt to the vegetables, a vegetarian diet will have a high potassium to sodium ratio. You will be unlikely to develop hypertension. But there are occasional reports of eating more vegetables and fruits leading to hypertension, such as last week’s report from Korea. When you read such a report you need to look deeper.

India Vegetarian Hypertension In IndiaThis week’s post is about two more such reports. The first (1) reports that a non-vegetarian diet is more protective against hypertension than a vegetarian diet. The second (2) reports that  an urban group of Indians (a group associated with more hypertension) ate approximately 50% more fruits and vegetables than a matched rural group (a group associated with less hypertension).

The reports are out of India, which is a country with more vegetarians than any other nation. Estimates are that between 30 and 50% of the total population are vegetarian.

India is involved at present in a large migration of its populace from rural to urban locations. Concurrent with this migration has been an increase in hypertension.

It’s Not Just Migration

But the increase in hypertension has not been due only to the urban transition. In 1949 the prevalence of hypertension in urban populations was only 1.24%. It rose to 36% in 2003 (1). In rural India, the prevalence also rose. It went from 1.99% in 1958 to 21% in 1994 (1). There is something changing in both rural and urban India to account for this rise in both urban and rural hypertension.

Fried Fish Protective?

The first study (1) looked at the diet in urban Malda in eastern India. It concluded that being non-vegetarian protected against hypertension. The non-vegetarians had a lower prevalence of hypertension than vegetarians. The researchers felt fish consumption and the cooking oil used (mustard oil) may be why the non-vegetarians had less hypertension. However the researchers did only a limited investigation of dietary factors and food preparation. They did not consider sodium or potassium content at all.

The second study (2) compared the diet of urban and rural populations from several areas of India. They found that the urban group ate more fruits and vegetables. Like the first study they did not consider the sodium or potassium content of the diet.

Non-vegetarian. Really?

The second study compared vegetarians to non-vegetarians (the group in the first study found to have less hypertension). The non-vegetarians ate only a minimal amount more meat and fish than the vegetarians. The non-vegetarians ate 19 to 28 g of meat daily and approximately 6 g fish daily. This is an average of only 2/3 to 1 oz. of meat a day and an ounce of fish every 4 to 5 days. The non-vegetarians were almost vegetarian.

A more likely reason for urban dwellers to be hypertensive is related to urban lifestyle. Urban lifestyle has been associated with an increased prevalence of hypertension in a large number of studies. These studies have found an association of hypertension with less physical activity and increased weight in urban migrants.

But the most glaring problem with the first and second studies is not looking at the sodium and potassium content of the study subjects’ diets. Multiple studies have shown an increase in sodium intake and a drop in potassium intake when populations move from a rural to an urban location. This is especially important since salt is added to a great many dishes in India. The daily salt consumption varies from 5 grams a day to 30 grams a day among differing populations in India.

Other studies about Indian hypertension have looked at salt intake. A study (3) of sodium in the urine (and thus the diet) of research participants from a state in southern India showed a significant increase of sodium in the hypertensive group compared to the normal pressure group.

Tea Garden Workers

An especially revealing study (4) was done of tea garden workers in northeast India. It showed a much higher prevalence of hypertension than is generally present in India. This is despite the tea garden workers in the study being more physically active and thinner than other Indians, which is opposite the usual findings associated with hypertension.

Hypertension in these tea garden workers showed a prevalence of 61% among the adults. Other studies of tea garden workers, however, put the prevalence in the range of 46%. In either case, this is much more than the average rate in India, which a recent meta-analysis (5) put at approximately 33% of urban and 25% of rural adults.

30 Grams Of Salt A Day

What is unique about the tea garden workers is their high intake of sodium. In one study (6) they were found to consume from 20 to 30 grams of salt a day. This is compared to the average intake by Indians of approximately 10 grams a day.

Just as in Korea, eating more fruits and vegetables will not protect against hypertension when a great deal of sodium is consumed along with the fruits and vegetables. The protective aspect of fruits and vegetables is primarily their high potassium and low sodium content. Other factors such as polyphenols, antioxidants, and polyunsaturated fats may help. But the epidemiological studies and basic science studies of how these factors protect have not yielded the clear picture that the dietary potassium sodium ratio has.


Tables of potassium and sodium content can be found for high potassium fruits here and high potassium vegetables here. Links to tables for other foods can be found by clicking the List of Posts tab at the top of the page.
1. Study of urban community survey in India: growing trend of high prevalence of hypertension in a developing country. Das SK, Sanyal K, Basu A. Int J Med Sci. 2005;2(2):70-78. Epub 2005 Apr 1.

2. Dietary intake and rural-urban migration in India: a cross-sectional study. Bowen L, Ebrahim S, De Stavola B, Ness A, Kinra S, Bharathi AV, Prabhakaran D, Reddy KS. PLoS One. 2011;6(6):e14822. doi: 10.1371/journal.pone.0014822. Epub 2011 Jun 22.

3. Relationship of sodium and magnesium intakes to hypertension proven by 24-hour urianalysis in a South Indian population. Chidambaram N, Sethupathy S, Saravanan N, Mori M, Yamori Y, Garg AK, Chockalingam A. J Clin Hypertens (Greenwich). 2014 Aug;16(8):581-6. doi: 10.1111/jch.12361. Epub 2014 Jun 17.

4. Hypertension and its risk factors in tea garden workers of Assam. Hazarika NC, Biswas D, Narain K, Kalita HC, Mahanta J. Natl Med J India. 2002 Mar-Apr;15(2):63-8.

5. Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. Anchala R, Kannuri NK, Pant H, Khan H, Franco OH, Di Angelantonio E, Prabhakaran D. J Hypertens. 2014 Jun;32(6):1170-7. doi: 10.1097/HJH.0000000000000146.

6. Prevalence of modifiable cardiovascular risk factors among tea garden and general population in Dibrugarh, Assam, India. Mahanta TG, Joshi R, Mahanta BN, Xavier D. J Epidemiol Glob Health. 2013 Sep;3(3):147-56. doi: 10.1016/j.jegh.2013.04.001. Epub 2013 May 25.

Kimchi, Pickling And Blood Pressure

Many of the various health organizations recommend eating more fruits and vegetables. Study after study has shown that those who eat more fruits and vegetables have less cardiovascular disease and hypertension. There are multiple theories bandied about – antioxidants, harm from animal protein, low fat, alkalinity, and even an occasional “I don’t know,” such as offered by the DASH researchers. Which makes this week’s article even more interesting. It reports that one of the places with a higher fruit and vegetable intake than the US has just about as much hypertension and cardiovascular disease as the US.

Korean Study

Kimchi260x195 Kimchi, Pickling And Blood Pressure

Ancient Kimchi

A recent report (1) out of Korea has demonstrated how you can eat a lot of fruits and vegetables and still be hypertensive. Korea has a 27% (29% men, 24% women) prevalence of hypertension despite the average Korean eating a much higher percentage of their diet from fruits and vegetables than the average Westerner.

Kimchi – Pickled Vegetables

The big difference is how they prepare their vegetables. The national dish of Korea is kimchi – pickled vegetables. The vegetable used may vary, but it is highly seasoned. There is a lot of variation in the type and amount of spice and herbs added. But consistently a great amount of salt is added. Kimchi forms a major part of the daily Korean diet.

Kimchi accounted for more than 20% of potassium intake and more than 50% of sodium intake in the study. Rather than the 1.13 ratio that vegetarians typically have, the Koreans in this study averaged a potassium to sodium dietary ratio of 0.72 for males and 0.78 for females. This is about the same as the ratio of a typical Western diet.

Blood Pressure And Kimchi

The researchers found that for men, a poor potassium sodium ratio was strongly correlated with blood pressure. Dividing the participants into 5 groups, the researchers looked at sodium intake, potassium intake, and the sodium to potassium ratio. They also looked at fruit intake, fruit and non-pickled vegetable intake, and kimchies (kimchi) intake. They found a strong correlation with kimchi intake, and an inverse relation with fruit and non-pickled vegetables.

The study did not find any correlation for the women though. However, in contrast to the men, the fruit intake of the women increased as their kimchi intake increased. With the men, fruit intake decreased as kimchi intake increased. So for the women, the potassium sodium ratio may not have varied as much as the researchers estimated.

Problems With Food Frequency Questionnaires

The researchers felt because they used food frequency questionnaires that a more accurate study could be obtained. They plan to use a prospective trial using a more objective measurement of sodium and potassium (such as urinary measurements).

The problems with using a food frequency questionnaire to estimate potassium and sodium intake are that the memory of the participants may be inaccurate, and the estimates of how much sodium is in the food may be considerably inaccurate. Sodium content of kimchi can be off considerably because each individual uses different methods to prepare kimchi. The researchers used a standard estimate (Food Composition Table of Korea) to determine the amount of sodium in the participants’ diet.

Preparation Matters

Nonetheless, this is a study that shows it is not just getting more fruit and vegetables that lowers blood pressure. It also matters how the fruit and vegetables are prepared. Specifically if sodium is added to the vegetables, they will lose much of their ability to lower blood pressure. This is one problem with canned vegetables in the US. Most canned vegetables have salt added as a preservative.

Done right, having plants as the basis of your diet will reduce blood pressure and reduce the possibility of hypertension’s complications. But adding salt to the plants is not the right way to add them to your diet.

And Korea is not alone. As we will see next week, there is another country where they eat more plants than Americans do. In this country, vegetarians have worse blood pressure than non-vegetarians.

Food Tables

To find tables with potassium and sodium content of vegetables and fruit (without added salt), click the links.

1. The relationship of dietary sodium, potassium, fruits, and vegetables intake with blood pressure among Korean adults aged 40 and older. Kim MK, Kim K, Shin MH, Shin DH, Lee YH, Chun BY, Choi BY. Nutr Res Pract. 2014 Aug;8(4):453-62. doi: 10.4162/nrp.2014.8.4.453. Epub 2014 Jul 17.

Three Spice Combinations To Reduce Salt

Here are three spice combinations that have helped to reduce the need for salt for those trying to cut down on salt. It can take 4 weeks for taste buds to adapt to a low sodium diet. During that time these combinations can help provide enough flavor to avoid the flat taste so many notice when salt is missing.

First Spice Combination

spices Three Spice Combinations To Reduce SaltA rub of olive oil, smoked paprika, cherry extract, smokehouse pepper and coffee extract can be used on beef, pork, poultry, or fish to enhance the natural flavor. Of course, be sure the meat was not injected with salt for a longer shelf life at the store. In addition to avoiding sodium, the spices will provide some potassium and monounsaturated fat. You will be enhancing your potassium to sodium ratio, and the olive oil will allow the potassium to do its magic more easily.

Second Spice Combination

Another great combination is olive oil with garlic powder mixed in. If you add some balsamic vinegar, you will be getting the combination that many Italian restaurants serve with their Italian bread. Just be sure that, if you use it on bread, that the bread is low sodium. This combination can be used on multiple other foods also, such as pasta, salads, and veggies.

Third Spice Combination

A marinade rounds out the trio. Combine lime juice, garlic powder, black pepper, smoked paprika, honey and onion powder to add flavor to any meat. Soaking overnight will work it well into the meat.

Of course, you can combine your other favorite flavors or leave out flavors you don’t care for. But these are tried and true.

There you have it. Three great spice combinations to help you as you transition to a diet that will improve your potassium to sodium ratio and eliminate hypertension.

Tables Of Potassium And Sodium In Various Foods

To find a table with the potassium and sodium content of various spices, try this spices link. Click the following links for poultry, beef, pork or fish. Or use the List of Posts tab at the top of the page to find all the different food tables on this site.

MSG Video

Here is a short three-minute video from the American Chemical Society about MSG. They start off with the general reputation of MSG as toxic, poisonous, cancer-causing, headache causing, and energy sucking. The researcher first isolating it found it had a pleasant taste. The video then explains what it does in our mouth to enhance flavor. And it finishes up with the FDA and WHO evaluation that MSG was generally found to be safe.

How The MSG Controversy Started

MSG is a food additive that has become quite controversial. It is been used since the early 1900s to enhance savory flavors. The controversy about it started in 1968 with a letter to the New England Journal of Medicine. The writer described what he called the “Chinese Restaurant Syndrome.” It consisted of numbness at the back of the neck radiating into the arms and back, with a general weakness, and palpitations of the heart. The writer suggested several possibilities and the Journal felt that MSG was the main potential culprit.

MSG stands for monosodium glutamate. It is the sodium salt of glutamic acid. It was first isolated and put into production in the early 1900s. It was found to stimulate the umami receptors on the tongue. Several other salt forms of glutamate were tried for palatability, but the sodium salt was the only one that did not have a strange metallic aftertaste.

The Studies On MSG

There have been multiple anecdotal reports of side effects from the use of MSG. These include headache, flushing, sweating, numbness, tingling and burning, as well as chest pain, nausea and weakness. But small double-blind studies have not shown any consistent side effects. These studies have resulted in the FDA and the WHO considering MSG to be safe for food. Europe, however, limits how much can be used, and which foods it can be used with.

There have been few studies on a long-term basis. In one study it was given to rats in their diet for up to 6 months. The amounts given were extremely high. In these animals there was damage to the retina of the eyes.

Because the studies on MSG have been short-term, it is difficult to tell if there would be long-term effects from its use. However if glutamate is obtained in its natural form as found in natural foods, only small amounts of less than a gram a day are eaten.

However, when eaten in the amounts found as an additive, several grams may be eaten in a sitting. One study (1) was done giving MSG to people with self-identified symptoms to check their response. They became symptomatic more often with MSG than with placebo.

A second study (2) on nerve cells in the laboratory was done with concentrations of MSG similar to what would be obtained after a meal with added MSG. Nerve cell damage was seen.

If you do not use salt, there is little reason to use MSG. But some studies have found that salt intake can be reduced by 30 to 40% when monosodium glutamate is added to food. If you presently are a heavy salt user, MSG may be able to help you cut back on your salt use. A 40% reduction could improve the potassium sodium ratio by about 70%. But if you are sensitive to MSG, you should probably try a different method.

1. The monosodium glutamate symptom complex: assessment in a double-blind, placebo-controlled, randomized study. Yang WH, Drouin MA, Herbert M, Mao Y, Karsh J. J Allergy Clin Immunol. 1997 Jun;99(6 Pt 1):757-62.

2. Deciphering the MSG controversy. Xiong JS1, Branigan D, Li M. Int J Clin Exp Med. 2009 Nov 15;2(4):329-36.

Longevity In Sicani

There are quite a few pockets of longevity throughout the world. The long lived people in these pockets seem to have a number of characteristics in common. A recent article (1) about one such pocket, Sicani, gives interesting insight into some of the factors contributing to longevity.

Sicani Is A Pocket Of Longevity

MontiSicaniMap260x191 Longevity In SicaniSicani is an area in the West of Sicily. It has 4.32 times as many people over 100 years of age as the rest of Italy. The area is mountainous, and the people are physically active throughout their life. They are lacking obesity, are small in stature, and have a normal BMI. Their diet has a Mediterranean nutritional profile.

There are multiple Mediterranean diets. Each region in the Mediterranean has a unique dietary profile. The researchers studied the diet of the people in Sicani to describe their particular Mediterranean profile.

What They Eat In Sicani

Seasonal plant food comprises the bulk of the diet in Sicani. The people eat a variety of fruits, vegetables and legumes when in season throughout the year. They have some dairy every day, and have a small amount of meat. They eat only a small amount of refined carbohydrates, with no white bread, and only a little pasta. The amount of pasta is less than one ounce and contributes only 200 calories a day.

Their main source of carbohydrates and calories comes from fruits, vegetables and legumes. There are no snacks, sweets, or sweet beverages. And their main source of fat is virgin olive oil.

Other Factors

Some of the factors these people have in common with other long lived people are unrelated to diet. These centenarians remain physically active throughout their lives. Their BMI is in the normal range, being mostly between 19 and 27. They do not have any excessive fat on their body. They also do not smoke and they limit the amount of wine that they drink.

What Is The Common Dietary Factor?

However, what the people of Sicani do not have in common with other pockets of longevity are the individual items in their diet. The foods in their diet differ from the foods in the diets of other long lived non-Mediterranean populations. What the diet does have in common with the diet in other pockets of longevity, though, is that it has a high potassium sodium ratio.

Although the article did not directly calculate the amount of potassium and sodium in their diet, the types of foods that the people of Sicani eat would indicate that they have a high ratio diet. They do not eat canned vegetables, but rather eat the vegetables and fruits as they come from the ground. This means their food is not preserved in sodium or salt as is so often the case in more developed areas. They eat few baked goods so they avoid the sodium of baking soda and baking powder.

Fresh fruits and vegetables almost universally have a high potassium sodium ratio. We have discussed here and here about the high ratio in fruits and vegetables respectively, and their functional aspect here.

Most dairy has a ratio over 3, as does most poultry and meat that is not processed. As a group, legumes average an especially high ratio of potassium to sodium. The ratio for red wine is 31.

This is not to say that the high potassium to sodium ratio in their diet is the only factor contributing to their longevity. Their physical activity, absence of excess body fat, abstinence from smoking, limited alcohol intake, and supportive social structure are also factors shared with other pockets of longevity.

A lot of factors have to come together to get you past 100 years of age. And one of the big factors is eating a high ratio diet.  You can find tables of potassium and sodium values in fruits, vegetables and legumes at the links.

1. Centenarians and diet: what they eat in the Western part of Sicily. Vasto S, Rizzo C, Caruso C. Immun Ageing. 2012 Apr 23;9(1):10. doi: 10.1186/1742-4933-9-10.

Eliminate Most Processed Foods To Start A High Potassium Foods Diet

There are many ways to start a diet consisting of high potassium foods. Probably the best and most thorough way to start is by making a list of what you eat now and finding high potassium food substitutes. However there are multiple other easier ways to start. One way that is relatively easy is to eliminate the obviously processed foods. These are the foods that come in boxes, cans, or plastic wrap. Sodium is usually added to prolong shelf life.

CannedFood Eliminate Most Processed Foods To Start A High Potassium Foods Diet

Boxed Foods

What are some of the foods that come in boxes? These include ready-to-eat cereals, chips, crackers, and multiple other dry foods. The processing of these foods inevitably involves adding sodium chloride – salt. With few exceptions these are all high sodium and low potassium foods.

What foods can be substituted for these? The best substitutes are whole foods. For ready-to-eat cereals, whole oats can be substituted. For chips, you can substitute homemade potato chips. By slicing a potato into thin slices and coating with a little bit of olive oil, you can bake the slices to result in a crispy high potassium snack with no added salt.

Substituting whole-grain foods for some of the dry foods can be done with a little creativity. For example, quinoa or another high potassium grain can be substituted in many dishes for most types of pasta. Cooked rice (not instant or polished – they have a poor ratio) has a good potassium sodium ratio, but loses much of its potassium when cooked. Although the ratio is good, the amount of potassium you get is small.

Canned Foods

The majority of canned foods, whether vegetables, fruits, or legumes, will be high in sodium. Substituting the fresh whole variety will markedly shift the potassium sodium ratio. An alternative is to look for canned foods that show 0 mg or a very small amount of sodium on the label. Although most fresh vegetables, fruits, and legumes are high potassium foods, their canned varieties are not.

Plastic Wrap

Many of the foods that are wrapped in plastic are high in sodium. However if a high potassium food in the plastic bag is fresh and simply washed, it should still be a high potassium food. Many vegetables and fruits are now coming wrapped in plastic. Often poultry and fish that are only frozen without other preservatives may come wrapped. But check the amount of sodium on the label. Sometimes they have been injected with salt for additional shelf life.

Low Sodium Alternatives

Because of the emphasis on low-sodium diets, more and more low-sodium alternatives are being found in boxed, canned and plastic wrapped varieties. If the label says there is no sodium, it may be an acceptable high potassium food. However if it simply says reduced sodium or low-sodium, be sure to check the label for the amount of sodium. A reduced sodium teriyaki sauce or soy sauce will still have a great deal of sodium.

High Potassium Foods Breakfast As A Start

In the last post we talked about replacing your usual snacks with nuts. It is an easy way to start a high potassium diet and improve your potassium sodium ratio. But there are many ways to start the high potassium foods diet. Another good way is to replace your present breakfast with a high potassium foods breakfast.
Croissant280x186 High Potassium Foods Breakfast As A Start

Replace Poor Ratio Breakfast Items

Many breakfasts consist of foods with a poor potassium sodium ratio. Sausages, bacon, or other processed meats, ready-to-eat cereals, baked goods such as biscuits, muffins or toast, pancakes and waffles, and cheese omelettes all have a poor ratio.

These breakfasts can be easily replaced with a high potassium foods breakfast. The first consideration is to decide what items in your breakfast have the most sodium and the least potassium. Then replace these foods with high potassium foods. The breakfast items that we mentioned above have a very poor ratio. Replacing these with high potassium foods will improve your ratio for the entire day.

Better Breakfast Meats

Replacing cured ham with uncured ham or grilled poultry will provide a breakfast meat with a good ratio. If you can’t do without sausage, make your own. Commercial sausages have a horrible ratio. The Mayo Clinic has a recipe here for 12 breakfast patties with only 22 mg of sodium per patty. It even has advice on making the patties mild or spicy.

Better Breakfast Cereals

There are a few ready-to-eat cereals that have a high ratio but most are extremely poor. Replacing the ready-to-eat cereal with a high ratio cereal or a hot cereal consisting of rolled oats (old-fashioned oats) is a good way to start. Fruit or nuts or cinnamon can be added for an even higher ratio. Rolled oats have a very high ratio and can provide a lot of potassium in a cup. Other cereals with a high ratio can be found here (for ready to eat) and here (for hot).

Fruit Is A Good Way To Start

Another way to start would be to make a fruit smoothie. Almost any combination of fruit will provide a high ratio breakfast. Thickness of the smoothie can be controlled by adding nonfat milk or yogurt (watch out for added sugar). These will maintain a higher ratio than adding water. Orange juice or orange juice concentrate will increase the ratio even more than dairy. Find tables of high ratio fruit and fruit juice here and here.

Of course you don’t need to make fruit into a smoothie. It can taste great in its natural state. Fruit can be eaten raw as an individual fruit, or cut up and mixed with other fruit. Mixing honey dew melon, cantaloupe, mango, papaya and pineapple in various combinations is very popular.

Skip The Usual Baked Goods

It is important to skip the baked goods such as biscuits, muffins, toast, pancakes, waffles or croissants. These all have very poor ratios in the most common versions. There are “no sodium” alternatives for some of them, but some that call themselves “no salt” or “low sodium” still have more sodium than potassium. Check the label for sodium amount. Replacing the usual butter or jelly condiment with a high potassium alternative such as almond butter, molasses or some types of marmalade can help only a little.

High Potassium Omelette

Eggs by themselves do not have a good ratio, but can be combined with high ratio foods to provide a high ratio breakfast. Adding cheese to make an omelette makes it a very poor ratio breakfast. Almost all cheeses have a poor potassium sodium ratio. However adding vegetables and herbs such as red or green pepper, onion, broccoli, cauliflower, mushrooms, tomatoes and spices can make an egg omelette a high ratio food.

Doing this each day is a great way to begin the switchover to a diet of high potassium foods. To find tables that will give you potassium content of food so you can choose what to eat for breakfast can be found by clicking the List of Posts tab at the top of the page.



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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