Tag Archives: high sodium diet

 

Potassium Rich Vegetables

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The question of how much salt we should eat has become one of the biggest debates in the Paleo communityand it’s a debate that shouldn’t even exist. Some in the community have started to argue that not only is the standard U.S. recommendation to eat less than 2,300mg of sodium per day wrong, but that we should be eating double to triple that amount 

They also argue that as long as it’s sea salt and not table salt, it’s healthy. The problem with that notion is that most of the negative health effects of too much salthigh blood pressure, cardiovascular disease, insulin resistance, and autoimmune diseasehave to do with the same culprit: simple sodium chloride. And sodium chloride is the same whether it comes in the form of coarse pink colored crystals or refined white table salt.  

Ultimately, most of the arguments supporting more salt in our diet are based on unproven theories and research that has been shown to have serious methodological flaws 

A few years ago, we addressed this question of a high-salt diet and the many negative effects it can have on our healthSince this is such an important question, with such a significant impact on our health, that it’s worth revisiting now. So, in this series, we dive further into the question of how much salt humans should consumeMore importantly, in this series we address the other side of the equationpotassium.  

Perhaps one of the most important, and overlooked, aspects of a healthy diet is the sodium:potassium ratio. Our hunter-gatherer ancestors typically ate a ratio between 1:5 and 1:10. The western diet is closer to 1:1 or even 2:1 sodium to potassium. The Paleo Diet® mimics this ancestral ratio. In our series, Mark J. Smith, Ph.D., explains this ratio and why being closer to our hunter-gatherer ancestors is so important. Dr. Marc Bubbs takes it a step further, addressing several recent studies which show that increasing potassium in our diet can mitigate much of thnegative impact of high sodium intake 

In our third article, Trevor Connor, M.S., addresses one of the arguments made to support a high salt dietthe belief that a low-sodium diet causes insulin resistance. Despite that popular claim, most current research shows the exact opposite. 

Finally, if you are convinced that a sodium:potassium ratio closer to our ancestors is important for your health, then you may be wondering how to get more potassium in your diet. It’s simple: eat more fruits and vegetables. In this series we include a potassium-power house of a salad recipe to get you started.


The Sodium/Potassium ratio and Its Importance in Human Health

By Mark J. Smith, PhD

Salt vs Potassium Foods

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When Dr. Loren Cordain first introduced the concept of Paleolithic nutrition, the scientific research illustrated the importance of three critical nutrient ratios: omega-6 to omega-3 fatty acids, calcium to magnesium, and sodium to potassium (Na+/K+). The evidence suggested these three ratios were quite different in a Paleolithic diet when compared to a typical Western diet. Furthermore, the ratios found in a Paleolithic diet were far more beneficial to human health. Smith explains perhaps the most important of these three ratios.

 

The Effects of Salt Substitute on Community-Wide Blood Pressure and Hypertension

By Dr. Marc Bubbs ND, MSc, CISSN, CSCS

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High blood pressure, or hypertension as it’s referred to in medical circles, is the primary or contributing cause to over 400,000 deaths in the U.S. annually and a high-salt diet is a major contributing factor to hypertension. The problem is that in many parts of the country, getting Americans to reduce the salt in their diet is extraordinarily difficult. In this article, Bubbs addresses several recent studies showing that there is an alternative—an increase in the amount of potassium we eat.

 

Does a Low-Salt Diet Cause Insulin Resistance?

By Trevor Connor, M.S. 

Low-Salt Diet Cause Insulin Resistance

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One of the arguments used by members of the Paleo community who support a high-salt diet is that a low-sodium diet causes insulin resistance, which can lead to diabetes. Connor addresses this argument and why the limited research backing it has serious methodological flaws. Once the well conducted studies are identified, the science tells a very different story: a highsalt diet causes insulin resistance. And potassium in the diet can reduce the impact.

 

Recipe: Blueberry and Roasted Beet Kale Salad 

By Lorrie CordainPaleo Recipe Blueberry and Roasted Beet Kale Salad horizontal

What’s the easiest way to improve the sodium:potassium ratio in your diet? Reduce processed foods high in salt and eat a lot more vegetables and fruit. This recipe, straight out of the Real Paleo Diet Cookbook, is packed with a whole lot of both. Plus, it’s quick and easy to prepare. 

 

Low-Salt Diet Cause Insulin Resistance

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[Part Three in Our Series on the Importance of Sodium and Potassium In Our Diet]

Of all the recent developments in the Paleo nutrition world, perhaps the biggest, and most misguided, is the belief that a healthy diet includes copious quantities of salt. Some voices within the Paleosphere not only suggest that the current U.S. dietary recommendation (RDA) to consume less than 2,300 milligrams (mg) of sodium per day is wrong, but in fact, we should be eating as much as three times that recommendation.

In his blog, one popular writer stated, “I feel the data supports an intake between 3,000 and 7,000 milligrams of sodium [per day].” That data is a combination of theories claiming our Paleolithic ancestors consumed high quantities of salt and a few recent studies indicating that a low-salt diet may contribute to cardiovascular disease (CVD) and insulin resistance.

None of that data holds up under scientific scrutiny.

Recently, Dr. Loren Cordain performed an in-depth analysis of the sodium content of all natural foods and showed that it would have been very difficult, if not impossible, for our hunter-gatherer ancestors to have consumed even the RDA of 2,300mg/day, let alone the 7,000mg recommended by some Paleo bloggers. The ethnographic data indicates that consumption was closer to 1,000mg/day in hunter-gatherer societies[1]

 Despite the large body of research suggesting there were low salt levels in historical dietssome still look for ways to claim our Paleolithic ancestors ate in excess of 3,000 mg/day. Two popular theories have developed out of reverse engineering approach to the science, to back into a place where the science confirms what we want to believe. One suggests that hunter-gatherers got that sodium from animal blood. The other is that they followed wild animals to salt licks. While both sound reasonable at firstthey deserve a closer look to see if they hold up under scientific weight.

 An analysis of wild moose blood (a decent analogue to wild animal blood) found that 100 milliliters (ml) of blood contained 63mg of sodium. So, to get 1,000mg of sodium, you would have to drink 1.59 liters. Or, to put it in daily terms, to consume the modern RDA of sodium, you’d have to drink a gallon of blood every dayNow imagine how much blood would be required for every person in a village to get 7,000mg per day. It’s enough to make a vampire jealous.

 Likewise, while the salt lick theory seems reasonable, remember that the Paleolithic era lasted over one million years. Imagine what it would take for every humanoid ancestor to get 3,000 to 7,000mg of sodium per day from salt licks for a million years. This raises the question: Just how many salt licks were there on Earth? More importantly, if they were that pervasive, why isn’t there a single mention of them in any studies of ancient villages or cultures?

 Occam’s Razor states that the simplest answer is usually the correct oneAnd, in this case, the simple answer is clear: The large body of research shows that hunter-gatherer societies consumed around 1,000mg of sodium per day.

 

The New Argument: A Diet Low in Salt is Bad for Us

Other voices in the Paleosphere recommend a high-salt diet based on their claim that a lowsalt diet is bad for our health. This argument was given credence by a series of studies in the early 2010s that showed a J-shaped curve relationship between salt and mortality. This J-shaped relationship indicated that people who consumed large amounts of salt had higher rates of mortality, but so did people who consumed low quantities of salt[2-7]

We wrote a thorough analysis of these studies a few years agoand our points are well summarized in a 2013 meta-analysis led by Graham McGregor and colleagues. The team concluded “these two papers have many methodological flaws, such as measurement error in assessing daily salt intake, confounding factors not controlled for, and reverse causality (that is, the low salt intake is the result rather than the cause of participants’ illness.) [8]

While the J-shaped curve theory of salt consumption hasn’t been holding up in recent research, many proponents of high-salt diets are now arguing that a low-salt diet leads to insulin resistance. Several recent studies, in both rats and humans, have shown that when salt is heavily reduced in the diet, it leads to a reduction in body water which then stimulates the renin-angiotensin-aldosterone system (RAAS). That’s a mouthful, but what’s important is that an activated RAAS inhibits insulin and leads to insulin resistance. [9-14]

Interestingly, howeverone of those studies, published in 2014, lookeat RAAS specifically and concluded that it was “probably not a mediator of increased insulin resistance on a low-salt diet.” [9]

 

The Actual Data: A Low-Salt Diet May Improve Insulin Sensitivity… 

Two meta-analyses written by Niels Graudal and colleagues summarized the existing research on a low-salt diet and insulin resistance and concluded there was a relationship which gave credence to the theory. [15, 16] However, McGregor and colleagues also addressed these conclusions in their 2013 paper[8]

The meta-analysis, however, was flawed from a public health perspective, as they included a large number of short term trials with a large change in salt intakefor example, from 20g/day to less than 1g/day for only four to five daysand such metabolic studies are irrelevant to the current public health recommendations for a modest reduction in salt intake for a long period of time.

A 2016 meta-analysis published in Clinical Nutrition Research addressed the concerns of extreme sodium reduction and short study lengths.[11] The authors divided 25 studies on low-sodium diets and insulin resistance into short-term vs. long-term studies and extreme salt restriction vs. moderate reductions. 

The results are shown in Table 2, copied from the meta-analysis, below:

Low-sodium diets and insulin resistance

Taken from: Oh, H., et al., Low Salt Diet and Insulin Resistance. Clin Nutr Res, 2016. 5(1): p. 1-6.

It is important to note that for the purposes of the analysis, the authors defined “moderate reduction” as 390 to 780mg of sodium per dayin line with the low end of what has been seen in hunter-gatherers diets. Studies with extreme salt-restriction limited consumption to less than 390mg/daybelow the recommended minimum intake. Even the 2014 study looking at RAAS activation on a low-salt diet admitted in their methodology: “10 mmol/day sodium is at the extreme lower end of the physiological range of sodium intake and not practical for long term use.”

In Table 2, studies that concluded a lowsalt diet contributes to insulin resistance were all in the short term column and almost all were in the extreme sodium restriction columnAs the authors point out, the human body will react to any extreme change in the short run. Short-term insulin resistance might simply be a temporary result of a sympathetic stress response and not something that would continue in the long term. 

To further make this point, all the studies that used moderate sodium restriction or were carried out over a long term had either no impact on insulin resistance or, in three cases, improved insulin resistance.

 

A High-Salt Diet May Make Insulin Sensitivity Worse 

A 2018 study in the journal PNAS addressed the question of salt and insulin resistanceHowever, this study was exploring ways in which a high-saltnot a low-saltdiet might cause insulin sensitivity. The study stated that “in contrast to short-term studies, long-term intake of a high-salt diet is associated with increased frequencies of obesity, insulin resistance, nonalcoholic fatty liver disease, and metabolic syndrome.” [17] 

Without diving deep into the mechanism, the authors of the study found that feeding mice a one percent salt solution for 30 weeks increased their natural production of fructose. Fructose is associated with insulin resistance, diabetes, and obesity. 

Another 2018 study written by Zhaofei Wan et. al. looked at how a high-salt diet may contribute to insulin resistance in humans. They found that feeding subjects 18g of salt per day activated NLRP3 inflammasome, which in turn promoted a form of inflammation associated with insulin resistance. [18] 

To be fair, this study was also a oneweek study and the effects may also be a short-term reaction to increased salt consumption. But, even if it is just short term, another interesting discovery of the study was that taking 4.5g/day of potassium along with the added salt seemed to undue many of the inflammatory effects of the high-salt diet. 

 

In Short: The Data Continues to Show That a Healthy Diet is Low in Salt and High in Potassium

Sodium is an essential nutrient; we need it to survive. But wmust be careful not to translate that into a “more is better” approach by pointing to the health benefits of consuming adequate levels of sodium and extrapolating from there. In the case of sodium, more is not better, and a very convincing body of science shows that 7,000mg/day contributes to a slew of health problemsincluding insulin resistance. 

The 2018 study by Wan et. al. focused, for the first eight pages, entirely on inflammatory markers, reactive oxygen species, and the effects of salt on THP-1 monocytes. In short, iyou’re looking for a nerdy read from a bunch of scientists holed up in a lab, this is not one to miss. 

So, it was interesting to see them take a very Paleo turn in the discussion section of their articleThey state: “increasing evidence suggests that compared with prehistoric or primitive humans, modern people with more sodium and less potassium intake are more vulnerable to suffering from CVD.” 

Their final recommendation stated that “potassium is abundant in fresh fruits and vegetables. Therefore, a greater fresh fruit and vegetable consumption and reasonable salt restriction could protect against the occurrence of insulin resistance and CVD.” This squarely coincides with The Paleo Diet. We hope this recommendation begins to persuade more people to reconsider their sodium intake.

 

Read More in Our Series on Sodium and Potassium in the Diet:

References 

  1. Denton, D., Salt intake and high blood pressure in man. Primitive peoples, unacculturated societies: with comparisons, in The Hunger for Salt, An Anthropological, Physiological and Medical Analysis. 1984, Springer-Verlag: New York. p. 556-584.
  2. O’Donnell, M., et al., Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med, 2014. 371(7): p. 612-23.
  3. O’Donnell, M.J., et al., Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA, 2011. 306(20): p. 2229-38.
  4. Pfister, R., et al., Estimated urinary sodium excretion and risk of heart failure in men and women in the EPIC-Norfolk study. Eur J Heart Fail, 2014. 16(4): p. 394-402.
  5. He, F.J., et al., Does reducing salt intake increase cardiovascular mortality? Kidney Int, 2011. 80(7): p. 696-8.
  6. He, F.J. and G.A. MacGregor, Cardiovascular disease: salt and cardiovascular risk. Nat Rev Nephrol, 2012. 8(3): p. 134-6.
  7. Stolarz-Skrzypek, K., et al., Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA, 2011. 305(17): p. 1777-85.
  8. He, F.J., J. Li, and G.A. Macgregor, Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ, 2013. 346: p. f1325.
  9. Garg, R., B. Sun, and J. Williams, Effect of low salt diet on insulin resistance in salt-sensitive versus salt-resistant hypertension. Hypertension, 2014. 64(6): p. 1384-7.
  10. Prada, P.O., et al., Low salt intake modulates insulin signaling, JNK activity and IRS-1ser307 phosphorylation in rat tissues. J Endocrinol, 2005. 185(3): p. 429-37.
  11. Oh, H., et al., Low Salt Diet and Insulin Resistance. Clin Nutr Res, 2016. 5(1): p. 1-6.
  12. Townsend, R.R., S. Kapoor, and C.B. McFadden, Salt intake and insulin sensitivity in healthy human volunteers. Clin Sci (Lond), 2007. 113(3): p. 141-8.
  13. Fliser, D., et al., The effect of dietary salt on insulin sensitivity. Eur J Clin Invest, 1995. 25(1): p. 39-43.
  14. Iwaoka, T., et al., The effect of low and high NaCl diets on oral glucose tolerance. Klin Wochenschr, 1988. 66(16): p. 724-8.
  15. Graudal, N.A., T. Hubeck-Graudal, and G. Jurgens, Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst Rev, 2011(11): p. CD004022.
  16. Graudal, N.A., T. Hubeck-Graudal, and G. Jurgens, Effects of low-sodium diet vs. high-sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride (Cochrane Review). Am J Hypertens, 2012. 25(1): p. 1-15.
  17. Lanaspa, M.A., et al., High salt intake causes leptin resistance and obesity in mice by stimulating endogenous fructose production and metabolism. Proc Natl Acad Sci U S A, 2018. 115(12): p. 3138-3143.
  18. Wan, Z., et al., Involvement of NLRP3 inflammasome in the impacts of sodium and potassium on insulin resistance in normotensive Asians. Br J Nutr, 2018. 119(2): p. 228-237.
Salt vs Potassium Foods

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[Part One in Our Series on the Importance of Sodium and Potassium In Our Diet]

When Dr. Loren Cordain first introduced the concept of Paleolithic nutrition, the scientific research illustrated the importance of three critical nutrient ratios: omega-6 to omega-3 fatty acids, calcium to magnesium, and sodium to potassium (Na+/K+). The evidence suggested these three ratios were quite different in a Paleolithic diet when compared to a typical Western diet. Furthermore, the ratios found in a Paleolithic diet were far more beneficial to human health.

We have written extensively at The Paleo Diet® regarding our concern that the greater Paleo community has, with little scientific support, embraced the notion that it is acceptable to consume sodium quantities above governmental guidelines (for example, through the copious addition of sea salt to many “Paleo Certified” food items).

Paleolithic nutrition often does not align with government guidelines. However, in this instance, there is agreement between The Paleo Diet’s scientific position—natural foods in primitive and current times provide low sodium quantities—and government recommendations for sodium intake.

Why the sodium/potassium ratio is so important

Providing our physiology with foods that match our genetically determined nutritional requirements is one of the main tenets of a Paleolithic diet. Dietary mismatches can result in health concerns.

The Western diet is low in plant foods containing potassium alkali salts (K-base), which our ancestors ate in abundance. Simultaneously, modern diets comprise foods that replace those K-base salts with sodium chloride (NaCl). As a result, in a typical Western diet the ratio of sodium to potassium is often 1-to-1, and many times worse.

As mentioned, the ratio of sodium to potassium is crucial for our health. An increase in dietary sodium increases the sodium/potassium ratio even if recommended levels of potassium are consumed. More often there is insufficient potassium consumption, which compounds the issue by driving the ratio further from our natural ratio of about 1-to-5 to 1-to-10.

Every cell in our body relies on an intricate balance of sodium and potassium. In 1957, scientists discovered what is called the Na+-K+ pump, found in the outer plasma membrane of almost every cell. It is responsible for pumping three sodium ions out of the cell and two potassium ions into the cell. ATP (the energy currency of the human body) is required to perform this exchange. These pumps maintain a higher concentration of sodium extracellularly (outside the cell) and a higher concentration of potassium intracellularly (inside the cell), which is crucial for the physiological processes of all cells in our body. We would die if this high concentration gradient, with sodium outside of the cells and potassium inside of the cells, was not maintained.

An understanding of the importance that sodium and potassium play in cellular function makes clear that a shift away from our genetically determined nutritional requirements can have dire consequences for our health.

Health consequences of a poor sodium/potassium ratio

A diet that is low in potassium and high in sodium increases the net systemic acid load on the body. This then leads to a chronic metabolic acidosis, which has negative effects on the body, including growth retardation in children, decreased muscle and bone mass in adults, and kidney stone formation. Correction of this acidosis can reverse these conditions (1).

Many proponents of decreased animal protein consumption argue that such a diet creates metabolic acidosis. However, previous findings that showed a correlation between hip fracture incidence and animal protein intake in older women were negated by the consumption of plant food (1). Many plant foods are high in potassium.

This finding is supported by a more recent study demonstrating that while dietary acid load is associated with chronic kidney disease (CKD), potassium intake was negatively associated with CKD, and protein intake had no association with CKD (2).

A review of the scientific literature is overwhelmingly supportive of decreasing sodium while simultaneously increasing potassium for improved health benefits. Despite dietary guidelines of the same recommendation, it was determined that less than 0.015 percent of the population met the goals (3). More recent findings demonstrate an improvement from this number, but still show that only about 10 percent of American adults have a Na+/K+ ratio consistent with the WHO guidelines for reduced risk of mortality (4).

A significant body of research supports the association of a high Na+/K+ ratio with an increase in hypertension (5, 6, 7, 8). Furthermore, it has been found that low sodium and high potassium intake reduces blood pressure in hypotensive, normotensive, and hypertensive individuals (9).

A high Na+/K+ ratio has also been related to urinary stone disease (10)—a risk factor for and a predictor of CKD (11, 12). Likewise, an elevated ratio is associated with an increase in obesity (13) and is related to high insulin resistance and low insulin sensitivity (14). It has also been identified as a risk factor for stroke (15, 16, 17), and even all-cause mortality (17, 18).

What this research demonstrates is that the Na+/K+ ratio is an important factor in your health, and strategies for decreasing sodium consumption and increasing potassium consumption are prudent. One way of improving this is through reduced consumption of modern condiments and ultra-processed foods (19). Thankfully you can avoid them with little effort and easily decrease the ratio by following the guidelines and recipes here at The Paleo Diet® website. And don’t worry about including fresh meat in your diet. A very recent study from Ireland showed fresh meats, but not cured and processed meats, are associated with a lower Na+/K+ ratio (20).

 

Read More in Our Series on Sodium and Potassium in the Diet:

References: 

  1. FrassettoL, Morris RC Jr, Sellmeyer DE, Todd K, Sebastian A. Diet, evolution and aging–the pathophysiologic effects of the post-agricultural inversion of the potassium-to-sodium and base-to-chloride ratios in the human diet. Eur J Nutr. 2001 Oct; 40(5): 200-13. Review.
    https://www.ncbi.nlm.nih.gov/pubmed/11842945
  2. Ko BJ, Chang Y, Ryu S, Kim EM, Lee MY, Hyun YY, Lee KB. Dietary acid load and chronic kidney disease in elderly adults: Protein and potassium intake. PLoS One. 2017 Sep 27; 12(9).
    https://www.ncbi.nlm.nih.gov/pubmed/28953915
  3. Drewnowski A, Maillot M, Rehm C.  Reducing the sodium-potassium ratio in the US diet: a challenge for public health. Am J Clin Nutr. 2012 Aug; 96(2):439-44.
    https://www.ncbi.nlm.nih.gov/pubmed/22760562
  4. Bailey RL, Parker EA, Rhodes DG, Goldman JD, Clemens JC, Moshfegh AJ, Thuppal SV, Weaver CM. Estimating Sodium and Potassium Intakes and Their Ratio in the American Diet: Data from the 2011-2012 NHANES. J Nutr. 2015 Apr 1; 146(4): 745-750.
    https://www.ncbi.nlm.nih.gov/pubmed/26962185
  5. Yin L, Deng G, Mente A, Sun Y, Liu X, Zhang X, Wang X, Wang Y, Bo J, Chen H, Liu X, Gao N, Bai X, Rangarajan S, Li W. Association patterns of urinary sodium, potassium, and their ratio with blood pressure across various levels of salt-diet regions in China. Sci Rep. 2018 Apr 30;8(1): 6727.
    https://www.ncbi.nlm.nih.gov/pubmed/29712960
  6. Cunha MR, Cunha AR, Marques BCAA, Mattos SS,D’El-Rei J, França NM, Oigman W, Neves MF. Association of urinary sodium/potassium ratio with structural and functional vascular changes in non‐diabetic hypertensive patients. J Clin Hypertens (Greenwich). 2019 Sep; 21(9): 1360-1369.
    https://www.ncbi.nlm.nih.gov/pubmed/31444860
  7. Sebastian A,CordainL, Frassetto L, Banerjee T, Morris RC. Postulating the Major Environmental Condition Resulting in the Expression of Essential Hypertension and Its Associated Cardiovascular Diseases: Dietary Imprudence in Daily Selection of Foods in Respect of Their Potassium and Sodium Content Resulting in Oxidative Stress-Induced Dysfunction of the Vascular Endothelium, Vascular Smooth Muscle, and Perivascular Tissues. Med Hypotheses. 2018 Oct; 119: 110-119.
    https://www.ncbi.nlm.nih.gov/pubmed/30122481
  8. Zhao X, Zhang Y, Zhang X, Kang Y, Tian X, Wang X, Peng J, Zhu Z, Han Y.Associations of urinary sodium and sodium to potassium ratio with hypertension prevalence and the risk of cardiovascular events in patients with prehypertension.J Clin Hypertens (Greenwich). 2017 Dec; 19(12): 1231-1239.
    https://www.ncbi.nlm.nih.gov/pubmed/29087023
  9. Li Y, Yin L, Peng Y, Liu X, Cao X, Wang Y, Yang P, Li X, Chen Z.The association of blood pressure with estimated urinary sodium, potassium excretion and their ratio in hypertensive, normotensive, and hypotensive Chinese adults. Asia Pac J Clin Nutr. 2020; 29(1): 101-109.
    https://www.ncbi.nlm.nih.gov/pubmed/32229448
  10. Cirillo M,Laurenzi M, Panarelli W, Stamler J. Urinary sodium to potassium ratio and urinary stone disease. Kidney Int. 1994 Oct; 46(4): 1133-9.
    https://www.ncbi.nlm.nih.gov/pubmed/7861708
  11. Koo H, Hwang S, Kim TH, Kang SW, Oh KH,AhnC, Kim YH. The ratio of urinary sodium and potassium and chronic kidney disease progression. Medicine (Baltimore). 2018 Nov; 97(44).
    https://www.ncbi.nlm.nih.gov/pubmed/30383635
  12. Mirmiran P,NazeriP, Bahadoran Z, Khalili-Moghadam S, Azizi F. Dietary Sodium to Potassium Ratio and the Incidence of Chronic Kidney Disease in Adults: A Longitudinal Follow-Up Study. Prev Nutr Food Sci. 2018 Jun; 23(2): 87-93.
    https://www.ncbi.nlm.nih.gov/pubmed/30018885
  13. Jain N,Minhajuddin AT, Neeland IJ, Elsayed EF, Vega GL, Hedayati SS. Association of urinary sodium-to-potassium ratio with obesity in a multiethnic cohort. Am J Clin Nutr. 2014 May; 99(5): 992-8.
    https://www.ncbi.nlm.nih.gov/pubmed/24552753
  14. Park YM,KwockCK, Park S, Eicher-Miller HA, Yang YJ. An association of urinary sodium-potassium ratio with insulin resistance among Korean adults. Nutr Res Pract. 2018 Oct; 12(5): 443-448.
    https://www.ncbi.nlm.nih.gov/pubmed/30323912
  15. Averill MM, Young RL, Wood AC,KurlakEO, Kramer H, Steffen L, McClelland RL, Delaney JA, Drewnowski A. Spot urine sodium-to-potassium ratio is a predictor of stroke: The Multi-Ethnic Study of Atherosclerosis (MESA). Stroke. 2019 Feb; 50(2): 321-327.
    https://www.ncbi.nlm.nih.gov/pubmed/30661503
  16. Willey J, Gardener H, Cespedes S, Cheung YK, Sacco RL, Elkind MSV.Dietary sodium to potassium ratio and risk of stroke in a multi-ethnic urban population: The Northern Manhattan Study.Stroke. 2017 Nov; 48(11): 2979-2983.
    https://www.ncbi.nlm.nih.gov/pubmed/29018136
  17. Okayama A, Okuda N, Miura K, Okamura T, Hayakawa T, Akasaka H, Ohnishi H,SaitohS, Arai Y, Kiyohara Y, Takashima N, Yoshita K, Fujiyoshi A, Zaid M, Ohkubo T, Ueshima H; NIPPON DATA80 Research Group. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study. BMJ Open. 2016 Jul 13; 6(7).
    https://www.ncbi.nlm.nih.gov/pubmed/27412107
  18. Judd SE, Aaron KJ, Letter AJ, Muntner P, Jenny NS, Campbell RC, Kabagambe EK, Levitan EB, Levine DA, Shikany JM, Safford M, Lackland DT. High sodium:potassium intake ratio increases the risk for all-cause mortality: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Nutr Sci. 2013 Apr 23; 2.
    https://www.ncbi.nlm.nih.gov/pubmed/25191561
  19. Oliveira LS, Coelho JS, Siqueira JH, Santana NMT, Pereira TSS, Molina MDCB.Sodium/potassium urinary ratio and consumption of processed condiments andultraprocessed foods. Nutr Hosp. 2019 Mar 7; 36(1): 125-132.
    https://www.ncbi.nlm.nih.gov/pubmed/30834771
  20. Morrissey E, Giltinan M, Kehoe L, Nugent AP, McNulty BA, Flynn A, Walton J. Sodium and Potassium Intakes and Their Ratio in Adults (18–90 y): Findings from the Irish National Adult Nutrition Survey. Nutrients. 2020 Mar 28; 12(4).
    https://www.ncbi.nlm.nih.gov/pubmed/32231006

Do you know what your blood pressure is? The American Heart Association (AHA) encourages everyone to know his or her key markers for heart health, which includes blood pressure. This has become increasingly important in the last few weeks as the American College of Cardiology (ACC) and the AHA, along with nine other health professional organizations and a panel of 21 scientists and health experts, have developed new blood pressure guidelines for the first time since 2003.

The new Blood pressure categories are as follows:

  • Normal: Less than 120/80 mm Hg;
  • Elevated: Systolic between 120-129 and diastolic less than 80;
  • Stage 1: Systolic between 130-139 or diastolic between 80-89;
  • Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
  • Hypertensive crisis: Systolic over 180 and/or diastolic over 120.

The top number of the measurement (systolic) indicates the amount of pressure against artery walls when the heart contracts, while the bottom number (diastolic) refers to the pressure when the heart is resting between beats.

The 2003 guidelines considered Stage 1 hypertension to be equal to or greater than 140/90, whereas now Stage 1 is measured as 130/80 or greater. Those who were previously diagnosed with pre-hypertension are now labeled as having elevated blood pressure.  This change will result in nearly half of the U.S. adult population (about 46 percent) having high blood pressure, with the greatest impact expected among younger people. Additionally, the prevalence of high blood pressure is expected to triple among men under age 45, and double among women under age 45, according to the guideline authors.

 

Why were the guidelines changed?

One reason for this change was that those who were previously diagnosed with pre-hypertension were at double the risk for a heart attack compared to someone with normal blood pressure. The new blood pressure classifications will allow clinicians to offer an earlier intervention, in the hopes of reducing the risks for cardiac events.

The new guidelines remind us that high blood pressure, in general, is not something we should ignore. It’s a major risk factor for heart disease, second perhaps only to smoking. However, most people with high blood pressure don’t even know they have it. The guidelines aim to aid in not only the prevention, but also in the early treatment of hypertension, in order to overcome this public health challenge.

Despite the alarming number of people who will now be labeled hypertensive, almost none of the newly labeled hypertensive people (those with systolic blood pressure between 130 and 140) should be placed on medications., Fortunately, most doctors will consider advising lifestyle changes, especially a low sodium diet and adequate exercise.

The Paleo Diet would be a more logical approach than a low sodium version of the modern diet for anyone seeking to lower high blood pressure or to maintain a healthy blood pressure.

 

Benefits of The Paleo Diet for Healthy Blood Pressure

Although The Paleo Diet is naturally low in sodium, it offers further benefits to achieving a healthy blood pressure. The Paleo Diet is higher in potassium, which has been linked to lower blood pressures. Potassium is also believed to have protective cardiovascular benefits that may be one factor contributing to the rarity of elevated blood pressures among huntergatherer populations.  Swiss chard, spinach, and avocados are examples of potassium rich foods.

The Paleo Diet consists of whole, unprocessed foods and is naturally low in sugar. The rise of modern disease can be linked to the evolution of the modern diet, consisting of heavily processed foods., In addition to the added sodium, processed foods are also preserved and their flavor is enhanced through the addition of refined sugar.  These added sugars, for which there are at least 56 different names , have also been linked to an increase in hypertension. ,    

We encourage you to know your blood pressure number and to follow The Paleo Diet for heart health.

 


References

1. “Understanding Blood Pressure Readings.” American Heart Association, November 2017, http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.Wk02OVQ-fOQ .

2. Whelton, Paul K., et al. “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Journal of the American College of Cardiology (2017): 24430.

3. Chobanian, Aram V., et al. “The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report.” Jama289.19 (2003): 2560-2571.

4. Stamler, Jeremiah, Rose Stamler, and James D. Neaton. “Blood pressure, systolic and diastolic, and cardiovascular risks: US population data.” Archives of internal medicine 153.5 (1993): 598-615.

5. Whelton, Paul K., et al. “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Journal of the American College of Cardiology (2017): 24430.

6. Whelton, Paul K., et al. “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Journal of the American College of Cardiology (2017): 24430.

7.  Collins, Rory, et al. “Blood pressure, stroke, and coronary heart disease: part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context.” The Lancet 335.8693 (1990): 827-838.

8. Go, Alan S., et al. “An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention.” Hypertension63.4 (2014): 878-885.

9. Oliveria, Susan A., et al. “Hypertension knowledge, awareness, and attitudes in a hypertensive population.” Journal of general internal medicine 20.3 (2005): 219-225.

10. Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003;289:2083-93.

11. Diao, Diana, et al. “Pharmacotherapy for mild hypertension.” Sao Paulo Medical Journal 130.6 (2012): 417-418.

12. Jönsson, Tommy, et al. “Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study.” Cardiovascular diabetology 8.1 (2009): 35.

13. Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O’Keefe JH, Brand-Miller J. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005 Feb;81(2):341-54

14. Frassetto, Lynda A., et al. “Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.” European journal of clinical nutrition 63.8 (2009): 947-955.

15. Cordain, Loren, et al. “Origins and evolution of the Western diet: health implications for the 21st century.” The American journal of clinical nutrition 81.2 (2005): 341-354.

16. Lanham-New, Susan A. “The balance of bone health: tipping the scales in favor of potassium-rich, bicarbonate-rich foods.” The Journal of nutrition 138.1 (2008): 172S-177S.

17. Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O’Keefe JH, Brand-Miller J. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005 Feb;81(2):341-54

18. Monteiro, Carlos Augusto, et al. “Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil.” Public health nutrition 14.1 (2010): 5-13.

19. Lustig, Robert H., Laura A. Schmidt, and Claire D. Brindis. “Public health: the toxic truth about sugar.” Nature 482.7383 (2012): 27-29.

20.  “The 56 Different Names for Sugar (Some Are Tricky)” June 3, 2017, https://www.healthline.com/nutrition/56-different-names-for-sugar .

21. Johnson, Richard J., et al. “Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease.” The American journal of clinical nutrition 86.4 (2007): 899-906.

22. Chen, Liwei, et al. “Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure: a prospective study among United States adults.” Circulation 121.22 (2010): 2398-2406.

 

 

 

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