Sodium-potassium balance
by David Dunaief
Nov 26, 2019 | 3763 views | 0 0 comments | 467 467 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
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We need sodium in our diets in modest amounts. However, many Americans overconsume it. Meanwhile, potassium, which we also need, is underconsumed.

More than 90 percent of people consume far too much sodium, with salt being the primary culprit. Sodium is found in foods that don’t even taste salty. Bread is the primary offender.

Other foods with substantial amounts of sodium are cold cuts and cured meats, cheeses, pizza (which has both bread and cheese), fresh and processed poultry, soups, pastas and snack foods. Foods that are processed and those prepared by restaurants are where most of our consumption occurs.

By contrast, only about two percent of people get enough potassium from their diets. Why is it important to reduce sodium and increase potassium?

A high sodium-to-potassium ratio increases the risk of cardiovascular disease by 46 percent, according to a study that followed more than 12,000 Americans over almost 15 years.

To improve our overall health, we need to tip the sodium-to-potassium scales, consuming less sodium and more potassium. Let’s look at the evidence.

Reduced sodium

Two studies illustrate the benefits of reducing sodium in high blood pressure and normal blood pressure (normotensive) patients, ultimately preventing cardiovascular disease, including heart disease and stroke.

The first used the prestigious Cochrane review to demonstrate that blood pressure is reduced by a significant mean of −4.18 mm Hg systolic (top number) and −2.06 mm Hg diastolic (bottom number) involving both normotensive and hypertensive participants.

When looking solely at hypertensive patients, the reduction was even greater, with a systolic blood pressure reduction of −5.39 mm Hg and a diastolic blood pressure reduction of −2.82 mm Hg.

This was a meta-analysis that evaluated data from 34 randomized clinical trials with more than 3,200 participants. Salt was reduced from 9 to 12 grams per day to 5 to 6 grams per day and determined using 24-hour urine tests.

The researchers believe there is a direct linear effect with salt reduction. In other words, the more we reduce salt intake, the greater the effect of reducing blood pressure.

In the second study, a meta-analysis of 42 clinical trials that included adults and children, there was a similarly significant reduction in both systolic and diastolic blood pressures. Both demographics saw a reduction in blood pressure, though the effect was greater in adults.

Interestingly, an increase in sodium caused a 24 percent increased risk of stroke incidence but, more importantly, a 63 percent increased risk of stroke mortality. The risk of mortality from heart disease was increased as well, by 32 percent.

Potassium’s positive effects

When we think of blood pressure, sodium comes to mind, but not enough attention is given to potassium. The typical American diet doesn’t contain enough of this mineral.

In a meta-analysis involving 32 studies, results showed that as the amount of potassium was increased, systolic blood pressure decreased significantly. When foods containing 3.5 to 4.7 grams of potassium were consumed, there was an impressive −7.16 mm Hg reduction in systolic blood pressure with high blood pressure patients.

Anything more than this amount of potassium did not have any additional benefit. Increased potassium intake also reduced the risk of stroke by 24 percent.

The reduction in blood pressure was greater with increased potassium consumption than with sodium restriction, although there was no head-to-head comparison done.

The good news is that potassium is easily attainable in the diet. Foods that are potassium-rich include bananas, sweet potatoes, almonds, raisins and green leafy vegetables such as Swiss chard.

Lowering sodium intake may have far-reaching benefits, and it is certainly achievable. We need to reduce our intake and give ourselves a brief period to adapt — it takes about six weeks to retrain our taste buds once we reduce our sodium intake.

We can also improve our odds by increasing our dietary potassium intake, which also has a substantial beneficial effect, striking a better sodium-to-potassium balance.
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