Tag Archives: Low Sodium

 

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. 

 

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

The high levels of Lactobacillus probiotics found in kimchi can help soothe diarrhea, calm irritable bowel syndrome, and strengthen the lining of the intestines, among other health benefits. The only problem is that typical kimchi recipes are prepared in a salt brine in order to kill harmful bacteria which leads to a high sodium content. Check out our recent article by Lauren Fellows to learn more about kimchi. Here’s a healthy Paleo-friendly kimchi recipe you can enjoy with many of the benefits and without the high sodium content.

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Paleo Low-Sodium Kimchi Recipe

Kimchi In JarThe high levels of Lactobacillus probiotics found in kimchi can help soothe diarrhea, calm irritable bowel syndrome, and strengthen the lining of the intestines, among other health benefits. The only problem is that typical kimchi recipes are prepared in a salt brine in order to kill harmful bacteria which leads to a high sodium content. Check out our recent article by Lauren Fellows to learn more about kimchi. Here’s a Paleo-friendly kimchi recipe you can enjoy with many of the benefits and without the high sodium content. Want to be hardcore and purely Paleo, try this no-salt kimchi recipe instead.

  • Author: The Paleo Diet Team
  • Prep Time: 10 minutes
  • Cook Time: 30 minutes
  • Total Time: 40 minutes
  • Category: Kimchi
  • Cuisine: Korean
Scale

Ingredients

  • lbs. Napa cabbage, coarsely chopped into large pieces, about 2x1 inches
  • 1½ Tbsp. Himalayan salt crystals
  • 2 fresh garlic cloves, minced
  • 1-inch fresh ginger, grated
  • 2 tsp. coconut sugar
  • 4 scallions, cut into 2-inch slices
  • ¼ cup red onion, very thinly sliced
  • ¼ cup apple cider or rice vinegar
  • 2½ Tbsp. cayenne pepper
  • ⅓ cup lemon juice

Instructions

  1. Place the cabbage in a large bowl, add salt, and toss. Set aside to wilt for 45-60 minutes, tossing every 10 minutes or so.
  2. Thoroughly rinse the cabbage under cold running water, then set aside in a colander to drain for 30 minutes, saving the water as it drains.
  3. In the meantime, combine garlic, ginger, and coconut sugar to make a uniform paste. Set the mixture aside for 15 minutes.
  4. Transfer the cabbage back into the large bowl, and add garlic-ginger blend, scallions, cayenne pepper, and onion, and combine well.
  5. Pack the mixture tightly into a 1-quart lidded glass jar, leaving about an inch of space at the top.
  6. Use the reserved water to lightly “rinse” the bowl to capture any remaining seasoning. Add the apple cider or rice vinegar and lemon juice to the bowl, then pour this liquid into the jar.
  7. Screw on the jar lid, and let stand at room temperature (65-70°F) for 2 days. Refrigerate when finished.

Keywords: Low Sodium, paleo, kimchi, fermentation

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