American diet lacking potassium-rich foods

American diet lacking potassium-rich foods

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Salt is also necessary, but most people consume far too much sodium

One of the most popular spices is also one of the most dangerous: salt. We need salt, but not in excess. On the other hand, potassium is beneficial in our diet. However, we have the opposite problem with potassium: It is underconsumed.

More than 90 percent of people consume far too much sodium, with salt being the primary culprit (Am J Clin Nutr. 2012 Sep;96(3):647-57). Sodium is found in foods that don’t even taste salty.

Bread and rolls are the No. 1 offenders, since we eat so much of them. 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, meat dishes, pastas and snack foods. Foods that are processed and those prepared by restaurants are where most of our consumption occurs (

By contrast, only about 2 percent of people get enough potassium from their diets (Am J Clin Nutr. 2012 Sep;96(3):647-57). According to the authors of the study, we would need to consume about eight sweet potatoes or 10 bananas each day to reach appropriate levels.

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 looking at over 12,000 Americans over almost 15 years (Arch Intern Med. 2011;171(13):1183-1191). In addition, both may have significant impacts on blood pressure and cardiovascular disease, while sodium may also impact multiple sclerosis and potentially other autoimmune diseases.

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

There are two recent studies that illustrate the benefits of reducing sodium in high blood pressure and normotensive (normal blood pressure) patients, ultimately preventing cardiovascular disease: heart disease and stroke.

The first study 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 (BMJ. 2013 Apr 3;346:f1325). 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 study was a meta-analysis (a group of studies) that evaluated data from randomized clinical trials, the gold standard of studies. There were 34 trials reviewed with more than 3,200 participants. Salt was reduced from 9-12 grams per day to 5-6 grams per day. These levels were 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 the salt intake, the greater the effect of reducing blood pressure. The authors concluded that these effects on blood pressure will most likely result in a decrease in cardiovascular disease.

In the second study, a meta-analysis of 42 clinical trials, there was a similarly significant reduction in both systolic and diastolic blood pressures (BMJ. 2013 Apr 3;346:f1326). This meta-analysis included adults and children. Both demographics saw a reduction in blood pressure, though the effect, not surprisingly 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.

In an epidemiology modeling study, the researchers projected that either a gradual or instantaneous reduction in sodium would save lives (Hypertension. 2013; 61: 564-570). For instance, a modest 40 percent reduction over 10 years in sodium consumed could prevent 280,000 premature deaths. These are only projections, but in combination with the above studies may be telling.


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 is lacking in enough of this mineral.

In a recent 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 grams 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. If this does not sound like a large reduction, consider that, by comparison, aspirin has been shown to reduce the risk of stroke by 20 percent.

This effect was important: 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.

Multiple sclerosis

There are several recent, very preliminary studies that suggest higher levels of salt may increase the risk of multiple sclerosis.

One study showed that salt seems to increase the levels of interleukin-17-producing CD4 helper T cells(Th17) that are potentially implicated in autoimmune diseases, such as multiple sclerosis (Nature. 2013 Mar 6). The researchers used mice to show feeding them high levels of salt resulted high levels of Th17 cells and, as a result, a severe form of multiple sclerosis.

Lowering sodium intake may have far-reaching benefits, and it is certainly achievable.

Dr. Kirsten Bibbins-Domingo, associate professor of Medicine at UCSF, who is published extensively on heart disease, commented in Jane Brody’s New York Times article dated April 1 that once we lower sodium intake, our taste buds tend to adapt to the change in about six weeks by expecting less salty foods.

We need to reduce our intake and give ourselves a brief period to adapt. We can also improve our odds by increasing our potassium intake, which also has a substantial beneficial effect, striking a better sodium-to-potassium balance.


Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website and/or consult your personal physician.