Tag Archives: potassium

Low-Salt Diet Cause Insulin Resistance


[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:


  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.


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

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.1

The economic burden of hypertension and cardiovascular disease (CVD), which is a potential consequence of unchecked hypertension, is estimated at over 50 and 300 billion in the U.S., respectively.2 This makes reducing the health and economic burden of hypertension and heart disease a public health priority.

Reducing salt intake has been highlighted as one of the most cost-effective strategies for improving population-wide hypertension and CVD risk.3-5 In fact, a recent meta-analysis, summarizing multiple studies of the effects of reducing salt consumption on hypertension, found reduced blood pressure and cardiovascular events in individuals with high blood pressure.6

The habit of adding salt during cooking and the consumption of processed foods yields the majority of excess sodium intake. Sodium is added to many processed foods to preserve their shelf-life and increase palatability.

Almost 60 percent of Americans’ household food spending is used for ultra-processed food.7 And a growing majority fail to consume adequate vegetables and fruits. It’s easy to see how sodium intake can quickly skyrocket in the general population.

While behavior modification may help alter nutrition choices at an individual level, success in the general population has proven more difficult. Education and other awareness campaigns have not reduced salt intake, generally.8

Ultimately, population-based approaches are appealing because high blood pressure is on the rise most rapidly in low- and middle-income communities (and countries). Again, this is often due to the practice of adding salt during cooking and the high consumption of cheap, processed food stuffs.

If we can’t get people to reduce their salt intake, perhaps it’s time we adopt strategies to offset the intake of salt in our diets.


Salt substitutes and hypertension

Salt substitutes, such as NoSalt and Morton’s Salt Substitute, which is enriched with potassium, provide a novel and effective strategy for reducing blood pressure. In fact, research shows salt substitutes can reduce both systolic (SBP) and diastolic (DBP) blood pressure by approximately 5mmHg and 1.5mmHg, respectively.9-11

Encouragingly, the research suggests this effect is most pronounced in people struggling with hypertension.

Could simply swapping regular salt for a potassium-enriched salt make a significant difference?

Until recently, the effectiveness of population-wide interventions with salt substitutes had been inconclusive.

A recent study published in Nature examined the effect of replacing regular salt—or sodium chloride (NaCl)—in six villages in Peru, with a combination of 75-percent NaCl and 25-percent potassium chloride (KCl) on blood pressure and incidence of hypertension.

What did the scientists uncover? Study participants were 51 percent less likely to develop hypertension during the “intervention period” when taking the potassium-enriched salt, compared to the control period when consuming their normal table salt.12

To confirm the changes, an analysis of urine samples from the subjects showed there was an increase in potassium and “no change” in sodium status of participants.

Researchers also found an average reduction of 1.23mmHg in SBP and 0.72mmHg in DBP in the participants taking the salt substitute compared with controls—even after adjusting for sex, age, years of education, wealth index, and BMI measured at baseline.12

In short, there was a decrease in both systolic and diastolic blood pressure across the entire population, and the largest effect was seen in those with hypertension and in older individuals.


Do Small Improvements in Blood Pressure Really Impact Public Health?

Let’s investigate how much benefit one gains from reducing blood pressure by 1-2 mmHg. A recent meta-analysis of 61 observational studies of blood pressure and vascular disease in adults revealed for every 2mmHg decrease in SBP, stroke mortality and cardiovascular mortality decreased by 10 percent and 7 percent, respectively.

This benefit from lower blood pressure, brought about by reducing sodium in the diet, occurred not only in those with hypertension, but in normotensive individuals as well, down to a systolic blood pressure of 115mmHg.13

This suggests small reductions in blood pressure, at a population level, yield large public health gains.


How To Increase Potassium in Your Diet

These studies demonstrate that while there are clear benefits to reducing sodium in your diet, some of these same benefits can be accomplished by improving your sodium-to-potassium ratio.

Interestingly, increasing potassium intake yields lower blood pressure among individuals with hypertension and in individuals with high salt intake, regardless of whether they lower their sodium levels.15-18

Of course, most Americans don’t achieve the recommended intake and, therefore, do not consume adequate amounts of potassium to offset the effects of high sodium consumption. The high intake of processed foods (and subsequently sodium) creates the perfect storm for poor vascular health and increased risk of heart disease.

So how do you get more potassium? All fruits and vegetables naturally contain a greater ratio of potassium to sodium, unlike the modern hyper-palatable processed foods that line the shelves of convenience and grocery stores. If you’re consuming the recommended five to nine servings of vegetables and fruits per day, you’re likely achieving sufficient potassium levels to meet your needs.

Let’s look at which vegetables, leafy greens, and fruits provide the greatest quantities, so you can be sure to achieve the recommended 4,700mg of daily potassium for adults.

The following is a shortlist of potassium-rich food:14



The current guidelines for doctors treating patients with hypertension emphasize non-pharmacologic treatment, even in patients with low-risk, stage 1 hypertension.19

The use of potassium-enriched salt substitutes is a pragmatic approach for improving blood pressure across the population and, potentially, significantly reducing the incidence of hypertension as well.

Considering that the compliance of clients to anti-hypertensive medications is poor, and that antihypertensive medication is often unavailable or unaffordable in many low- and middle-income communities, practical solutions like potassium-enriched salt substitutes should be explored.20

Of course, education should also be provided on the importance of vegetable and fruit consumption for increasing potassium levels via the diet and reducing the intake of high sodium processed foods.

So, enjoy your next barbecue—with a potassium-enriched salt and a large serving of veggies!


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


  1. CDC, National Center for Health Statistics. Multiple Cause of Death 1999–2015. CDC WONDER online database. http://wonder.cdc.gov/mcd-icd10.html. December 2016. Accessed March 11, 2020.
  2. Constant AF, Geladari EV, Geladari CV. The economic burden of hypertension. Chapter 21. In: Andreadis EA, editor. Hypertension and Cardiovascular Disease. Switzerland: Springer International Publishing; 2016
  3. Wang, G. & Bowman, B. A. Recent economic evaluations of interventions to prevent cardiovascular disease by reducing sodium intake. Curr. Atheroscler. Rep. 15, 349 (2013).
  4. Salt Reduction: Fact Sheet (World Health Organization, 2016); https://www. who.int/news-room/fact-sheets/detail/salt-reduction
  5. Kontis V. et al. Three public health interventions could save 94 million lives in 25 years global impact assessment analysis. Circulation 140, 715–725 (2019).
  6. He, F. J., Li, J. & Macgregor, G. A. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ 346, f1325 (2013).
  7. Baraldi, L.G., Steele, E.M., et al. Consumption of ultra-processed foods and associated sociodemographic factors in the USA between 2007 and 2012: evidence from a nationally representative cross-sectional study. BMJ Open. 2018; (8)03:e020574.
  8. Trieu, K. et al. Review of behaviour change interventions to reduce population salt intake. Int. J. Behav. Nutr. Phys. Act. 14, 17 (2017).
  9. China Salt Substitute Study Collaborative Group. Salt substitution: a low-cost strategy for blood pressure control among rural Chinese. A randomized, controlled trial. J. Hypertens. 25, 2011–2018 (2007).
  10. Geleijnse, J. M., Witteman, J. C., Bak, A. A., den Breeijen, J. H. & Grobbee, D. E. Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypertension. BMJ 309, 436–440 (1994).
  11. Zhou, B. et al. Long-term effects of salt substitution on blood pressure in a rural north Chinese population. J. Hum. Hypertens. 27,427–433 (2013).
  12. Antonio Bernabe-Ortiz, A, Sal y Rosas, V, et al. Víctor G. Sal y Rosas, Ponce-Lucero, G. et al. Effect of salt substitution on community-wide blood pressure and hypertension incidence. Nat Med (2020).
  13. Lewington, S. et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360, 1903–1913 (2002).
  14. Health Link BC. High Potassium Eating. Online Database. Accessed March 11, 2020.
  15. Binia, A., Jaeger, J., Hu, Y., Singh, A. & Zimmermann, D. Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials. J. Hypertens. 33, 1509–1520 (2015).
  16. Mente, A. et al. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study. Lancet 392, 496–506 (2018).
  17. Poorolajal, J. et al. Oral potassium supplementation for management of essential hypertension: a meta-analysis of randomized controlled trials. PLoS ONE 12, e0174967 (2017).
  18. Filippini, T., Violi, F., D’Amico, R. & Vinceti, M. The effect of potassium supplementation on blood pressure in hypertensive subjects: a systematic review and meta-analysis. Int. J. Cardiol. 230, 127–135 (2017).
  19. Whelton, P. 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: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 71, 2199–2269 (2018).
  20. Attaei, M. W. et al. Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet Public Health 2, e411–e419 (2017).


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.



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.




Salt and CancerWhen I was in the middle of my academic career during the mid to late 1990’s (I retired from Colorado State University in December 2013,) I had the great pleasure of corresponding with Birger Jansson, Ph.D. at the University of Texas, M.D. Anderson Cancer Center in Houston, Texas. Dr. Jansson was a Professor in the Department of Biomathematics at the M.D. Anderson Cancer Center and worked as a biomathematician for the National Large Bowel Cancer Project (NLBCP) between 1973 and 1983 when President Nixon launched his war against cancer in the early 1970s. Birger was known internationally for his brilliant mathematical modeling of all types of cancer, but today he is perhaps best known for his epidemiological and review publications demonstrating how a high salt (sodium) diet promotes all types of cancer, whereas a high potassium diet impedes cancer (1-8).

My correspondence with Dr. Jansson came about from my interest in the reported low incidence of all types of cancers in hunter-gatherers (9-17) who were essentially salt free populations. From animal and tissue experiments, I had long suspected that salt added to diet acted as a promoter of various cancers whereas a high potassium intake retarded cancer development. My correspondence with Birger further confirmed the evidence I had compiled.

Almost exactly 20 years ago in May of 1997 (see attached PDF file), Birger sent me his unpublished and unedited book entitled, Sodium: “NO!” Potassium: “Yes!” Sodium increases and potassium decreases cancer risks. This book represented Birger’s scientific work, from 1981 to 1997, documenting the relationship between dietary sodium and potassium (1-8). The data from his book includes hundreds of scientific references from 1) epidemiological studies, 2) animal studies, 3) tissue studies, and a limited number of 4) randomized controlled human trials with various disease endpoints and markers.

Unfortunately, my correspondence with Birger ceased shortly after he sent me his unpublished and unedited book manuscript on May 10, 1997. I only recently discovered that Birger died (May 23, 1998) about a year to the date after our last correspondence at age 77 as a Professor Emeritus at the University of Texas, M.D. Anderson Cancer Center.

I am in a unique position, in that I probably have one of the few copies of Dr. Jansson’s unpublished book in existence. The book runs about 350 pages in length and is comprised of 10 chapters. My copy clearly was produced as a Xeroxed copy of Birger’s hand typed manuscript (one sided, double spaced pages) and spiral bound with plastic. From my correspondence with Birger (May 10, 1997), you can see that he was contemplating publication of his book in the popular literature, but unfortunately it never happened with his untimely death in 1998.

I have always felt a debt to this great scientist, and after consultation with my colleague Anthony Sebastian (M.D.) at the University of California, San Francisco, we concluded that Birger would have been happy to see that his unpublished book was finally made known to the scientific and world communities.

In this blog I have included a single chapter (Chapter II of Birger’s book), entitled “Human Diet Before Modern Times” that I thought would be of interest to the “Paleo Community” and to worldwide scientists as well. Enjoy!


1. Jansson B. Potassium, sodium, and cancer: a review. J Environ Pathol Toxicol Oncol. 1996;15(2-4):65-73

2. Jansson B. Dietary, total body, and intracellular potassium-to-sodium ratios and their influence on cancer. Cancer Detect Prev. 1990;14(5):563-5

3. Jansson B. Intracellular electrolytes and their role in cancer etiology. In Thompson JR, Brown BW, eds. Cancer modeling. New York: Marcel Dekker 1987:1-59.

4. Jansson B. Geographic cancer risk and intracellular potassium/sodium ratios. Cancer Detect Prev. 1986;9(3-4):171-94

5. Jansson B, Jankovic J. Low cancer rates among patients with Parkinson’s disease. Ann Neurol. 1985 May;17(5):505-9

6. Newmark HL, Wargovich MJ, Bruce VR, Boynton AL, Kleine LP, Whitfield JF. Jansson B, Cameron IL. Ions and neoplastic development. In: Mastromarino AJ, Brattain MG, eds. Large bowel cancer. Clinical and basic science research. Cancer Research Monographs, Vol 3, New York: Praeger Publisher 1985:102-129.

7. Jansson B. Geographic mappings of colorectal cancer rates: a retrospect of studies, 1974-1984. Cancer Detect Prev. 1985;8(3):341-8

8. Jansson B. Seneca County, New York: an area with low cancer mortality rates. Cancer. 1981 Dec 1;48(11):2542-6

9. Bulkley JL. Cancer among primitive tribes. Cancer 1927; 4:289-295.

10. Henson, WW. Cancer in Kafirs: suggested cause. Guy’s Hospital Gazette, March 26, 1904, 131-133

11. Hearsey H. The rarity of cancer among the aborigines of British Central Africa. Brit Med J, Dec 1, 1906, 1562-63.

12. Hildes JA, Schaefer O. The changing picture of neoplastic disease in the western and central Canadian Arctic (1950-1980). Can Med Assoc J 1984; 130:25-32.

13. Rabinowitch IM. Clinical and other observations on Canadian Eskimos in the Eastern Arctic. Can Med Assoc J 1936; 34:487-501.

14. Renner W. The spread of cancer among the descendants of the liberated Africans or Creoles of Sierre Leone. Brit Med J, Sept 3, 1910, 587-589.

15. Riveros M. First observation of cancer among the Pampidos (Chulupi) Indians of the Paraguayan Chaco. Int Surg 1970; 53:51-55.

16. Stefansson V. Cancer: Disease of Civilization? Hill and Wang, NY, 1960.

17. Urquhart JA. The most northerly practice in Canada. Can Med Assoc J. 1935;33:193-196.

Pumpkin- The Perfectly Paleo Carb for Athletes! | The Paleo Diet

With all the nonsense we see these days in the media, it would be easy to misunderstand one of the fundamental principles of a real Paleo diet:  it’s a balanced way of eating.

Contrary to popular belief, it is not a regime focused on eating only meat, all day long. In The Paleo Diet,1 Dr. Cordain explains that a true hunter-gatherer diet is comprised of a macronutrient balance as follows: Pro 19-35%, Cho 22-40%, Fat 28-47%

How do you like them apples? And while a crisp, green apple is a great way to sneak some low glycemic fruit2 into the mix, there are some other options we can enjoy in order to fuel for, or recover from our athletic endeavors.

At this time of year, when we’re just about to welcome autumn produce into our kitchens, what better way to do so than by incorporating one of the most seasonally appropriate fall fruits, the pumpkin?3

In addition to tasting great, pumpkin offers a wealth of health benefits:4

  • Improved eyesight, due to its high Vitamin A content.
  • Cancer prevention from its antioxidant profile, according to the National Cancer Institute.
  • And, perhaps most relevant to this article, a cup of cooked pumpkin has more of the refueling nutrient potassium, with 564 milligrams (compare that to a banana, which has 422).

A little extra potassium helps restore the body’s balance of electrolytes after a heavy workout and keeps muscles functioning at their best.  High in potassium and low in sodium, this is but one more piece of evidence to show how well pumpkin fits into the perfect Paleo profile.

But how do you eat it? Buying a can of it off the shelf isn’t exactly the most natural way to go about it. Here’s my favorite way to enjoy pumpkin with an interesting twist- you can use the squash itself as the serving vehicle!


Paleoista's Pumpkin Soup | The Paleo Diet[/one_half]


  • 1 small to medium sized pumpkin
  • 2 tbsp rendered duck fat, plus another tablespoon reserved
  • 1 small yellow onion, chopped
  • 1 cup white mushrooms, chopped
  • 1 lb 100% grass fed chuck, cut into 1” cubes
  • 2 cups chicken or beef broth, plus more depending on desired consistency of soup
  • 1 spring thyme
  • 1 sprig rosemary
  • 1 bay leaf
  • 4 cups baby spinach
  • 2 tbsp freshly snipped chives, for garnish


1. Preheat oven to 350° F.

2. Remove top from pumpkin and set aside.

3. Scoop out seeds, rinse and set aside to dry.

4. Heat duck fat in skillet over medium high.

5. Add onions and mushrooms and sauté until browned roughly 5 – 7 minutes.

6. Remove onions and mushrooms from skillet and brown beef on all sides, roughly 4 -6 minutes.

7. Add veggies back into skillet along with broth.

8. Scrape browned bits off bottom with wooden spatula.
9. Tie herbs together with kitchen twine and place in mixture.

10. Set pumpkin cut side up in Dutch Oven and use reserved fat to rub all over the outside of the rind.

11. Pour mixture into pumpkin, then cover with pumpkin top.

12. Place in oven and cook one hour, stirring halfway through.

13. Remove from oven and stir baby spinach into the mixture, then replace pumpkin top.

14. Let sit roughly five minutes, then serve in bowls, passing chives for garnish.
Enjoy the leftovers tomorrow after a long run or bike ride; soups and stews are even better on the second day!



[1] Cordain, Loren. The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. Hoboken, NJ: Wiley, 2011. Print.

[2] Braverman, Jody. “Are Apples Good for Keeping Blood Sugar Steady?” Healthy Eating. University of Redlands, n.d. Web. 09 Sept. 2015.

[3] Nelson, Jennifer, RD. “Nutrition and Healthy Eating.” Fruit or Vegetable — Do You Know the Difference? The Mayo Clinic, 15 Aug. 2012. Web. 09 Sept. 2015

[4] Klein, Sarah. “8 Impressive Health Benefits of Pumpkin.” The Huffington Post. Th Huffington Post, 5 Oct. 2012. Web

Potassium-Rich Foods in The Paleo Diet

Potassium is essential for normal body function, including muscle formation, the transmission of nerve impulses, and the metabolism of carbohydrates and protein.

In 2005, the Institute of Medicine established an adequate intake (AI) level for potassium of 4,700 mg per day for adults. This AI was calculated based on intake levels found to lower blood pressure, reduce salt sensitivity, and minimize the risk of kidney stones.1 Adequate potassium consumption may also prevent against stroke and osteoporosis.

Several large epidemiological studies, when considered together, suggest that increased potassium consumption can decrease the risk of stroke.2, 3, 4, 5 In cross-sectional studies of premenopausal, perimenopausal, and postmenopausal women, as well as elderly men, increased potassium consumption (from fruits and vegetables) is significantly associated with increased bone mineral density (BMD), suggesting that diets rich in potassium may help prevent osteoporosis.6, 7, 8

From an evolutionary perspective, our modern dietary ratios of potassium to sodium are much lower than those of our distant ancestors. Researchers estimate that people in Western industrialized cultures consume three times more sodium than potassium, whereas primitive man consumed seven times more potassium than sodium.9, 10


The chart shows the potassium (K) and sodium (Na) concentrations of common Paleo foods. As you can see, all of them provide many times more potassium than sodium, with the exception of chicken meat/skin and eggs, which contain potassium and sodium in roughly a 1:1 ratio.

The Paleo Diet, of course, recommends plenty of vegetables, modest amounts of fruit, seeds, and nuts, and no processed foods (which are typically high in sodium and low in potassium). Mushrooms are also an important food group, not only for their immune-boosting properties, but also for their impressive amounts of potassium. So try our fantastic recipe pairing cilantro-enriched guacamole with grilled Portobello mushrooms for a delicious potassium boost.


Serves 2

  • 1 avocado
  • 1 clove garlic, pressed (divided)
  • 2 tbsp lime juice
  • 2 tbsp olive oil
  • 1 bunch cilantro
  • Freshly milled black pepper
  • 2 Portobello mushrooms
  • 2 tbsp balsamic vinegar


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Christopher James Clark, B.B.A.
Nutritional Grail

Christopher James Clark | The Paleo Diet TeamChristopher James Clark, B.B.A. is an award-winning writer, consultant, and chef with specialized knowledge in nutritional science and healing cuisine. He has a Business Administration degree from the University of Michigan and formerly worked as a revenue management analyst for a Fortune 100 company. For the past decade-plus, he has been designing menus, recipes, and food concepts for restaurants and spas, coaching private clients, teaching cooking workshops worldwide, and managing the kitchen for a renowned Greek yoga resort. Clark is the author of the critically acclaimed, award-winning book, Nutritional Grail.

See more recipes!


1. Institute of Medicine of the National Academies of Science. (2005). Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. National Academies Press. Retrieved from //www.nap.edu/openbook.php?isbn=0309091691

2. Ascherio, A, et al. (September 1998). Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation, 98(12). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/9743511?dopt=Abstract

3. Iso, H, et al. (September 1999). Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Circulation, 30(9). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/10471422?dopt=Abstract

4. Fang, G, et al. (July 2000). Dietary potassium intake and stroke mortality. Stroke 31(7). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/10884449?dopt=Abstract

5. Bazzano, LA, et al. (July 2001). Dietary potassium intake and risk of stroke in US men and women: National Health and Nutrition Examination Survey I epidemiologic follow-up study. Stroke 32(7). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/11441188?dopt=Abstract

6. New, SA, et al. (June 1997). Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. American Journal of Clinical Nutrition, 65(6). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/9174480?dopt=Abstract

7. New, SA, et al. (January 2000). Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? American Journal of Clinical Nutrition, 71(1). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/10617959?dopt=Abstract

8. Tucker, KL, et al. (April 1999). Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. American Journal of Clinical Nutrition, 69(4). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/10197575?dopt=Abstract

9. Young, DB, et al. (April 1995). Potassium’s cardiovascular protective mechanisms. The American Journal of Physiology, 268(4 Pt. 2). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/7733391?dopt=Abstract

10. Linus Pauling Institute, Oregon State University. Micronutrient Information Center. Potassium. Retrieved from //lpi.oregonstate.edu/infocenter/minerals/potassium/

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