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Less Salt or More Potassium and Fiber?

Analysis by Dr. Joseph Mercola Fact Checked

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Story at-a-glance -

  • Low-salt diets are associated with higher risk of Type 2 diabetes, hypertension, atherosclerotic vascular disease and sudden cardiac death; more importantly to your heart health is maintaining a balanced potassium-to-sodium ratio and eating sufficient amounts of fiber
  • Past generations consumed many more milligrams of sodium per day than currently recommended by the American Heart Association, yet they had lower rates of hypertension and heart disease
  • High-fiber diets also have a significant impact on your heart health as they support the health of your gut microbiome, and those eating a high-fiber diet enjoy a 40 percent lower risk of heart disease, beneficial reductions in blood pressure, improved insulin sensitivity and reduced inflammation, all of which help lower your risk for heart disease
  • It is best to balance your potassium-to-sodium ratio by eating whole foods high in potassium, such as leafy greens, Brussels sprouts, mushrooms and grapefruit, and reducing or eliminating processed foods

The American Heart Association (AHA) recommends limiting your salt consumption to no more than 2,300 milligrams (mg) a day, with an ideal intake of 1,500 mg per day for adults.1 The rationale used says salt in your bloodstream draws in more water, creating greater work for your heart and increasing your blood pressure.2

However, this is an overly simplistic answer to a far more complex condition, as I discuss in the video above with James DiNicolantonio, Pharm.D. As with all vitamins, minerals and chemicals in your body, each affects and is affected by several different systems.

Your sodium balance is at least impacted by magnesium, calcium and potassium, which in turn affect several aspects of your health, including blood pressure, bone density and heart and kidney health. Each time you change the level of one, you impact the levels of others.

Sodium restriction has been the cornerstone of heart failure management, but a paper published by researchers at Rush University Medical Center created significant doubt, as it found restriction was associated with an increase in the risk of heart failure and death.3 In a second, more recent study, researchers found the risk of cardiovascular events decreased as potassium levels increased.4

Salt has been vilified in much the same way as fat. But just as there are healthy fats necessary for optimal health and unhealthy fats that trigger health problems, there are healthy and unhealthy types of salt. However, sodium is only half the ratio required to keep your body healthy.

The second half of the equation is potassium. One study demonstrated a balanced ratio of potassium and sodium was more strongly associated with blood pressure changes than either sodium or potassium individually.5

History of Salt Use in Food

Historically, salt has been widely and regularly used. In centuries past, people consumed over 10 times the amount of salt we do today as it was a primary food preservative. Salt has been an important part of society and interwoven into countless civilizations.6 Salt was so highly valued and production legally restricted, it even became used as a method of trade and currency.

Special salt rations were given to early Roman soldiers, known as "salarium argentum," the forerunner to the English word "salary." It has played a vital part in religious rituals, symbolizing purity. Salt motivated the early American pioneers and denying access to salt was part of the strategy used by Great Britain against American rebels during the American Revolution.

It played a key role during the Civil War and has been subjected to governmental monopoly and special taxes throughout history. In the 1600s, it was estimated the average person in Sweden was eating 100 grams of salt per day. Today, most get 10 grams per day or less; the average American consumes about 3.4 grams.

Despite this dramatic reduction in salt intake, rates of hypertension are far higher now than they were then. The rapid increase in blood pressure did not really begin until the early 1900s when low salt intake was recommended for heart health.

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DASH Diet Did More Than Lower Salt Intake

The DASH diet is a nutrition plan promoted by the National Heart, Lung and Blood Institute7 as a means of preventing and controlling high blood pressure. The acronym stands for Dietary Approaches to Stop Hypertension and emphasizes portion size, reducing processed foods and eating a wide variety of foods.8

There are two versions of the DASH diet. The standard DASH diet allows up to 2,300 mg of sodium per day, while the lower sodium DASH diet allows 1,500 mg of sodium per day. Both versions recommend consuming a lot of fruits, vegetables, low-fat dairy products and whole grains. The plan also strongly recommends limiting sugary beverages and sweets.

Although researchers found blood pressure measurements went down with the DASH diet, they also found that better predictors of heart disease, such as ratios of cholesterol levels, got worse. The INTERSALT study, published in 1997, was a worldwide epidemiological study of over 10,000 people from 52 countries.9

While the overall results of the study found habitual high-salt intake triggered unfavorable high blood pressure, in the video DiNicolantonio points out a flaw in these assumptions. Of the populations included in the study, four were primitive cultures who consumed no salt.

When the researchers removed those four tribal populations and looked at the remaining developed countries, there was a reduction in blood pressure with an increase in salt intake. When those for primitive cultures were included, the results were different.

DiNicolantonio believes this occurred because those primitive tribes ate foods high in potassium, were leaner, exercised and did not drink alcohol or consume sugar. He points out that when salt is reduced, your body becomes insulin resistant as it preserves sodium by increasing insulin. Increasing your insulin level in turn increases inflammation and your risk of heart disease.

A better endpoint for the study would have been some type of cardiovascular mortality, but the researchers instead measured a midpoint — reducing blood pressure measurements — without looking at the whole picture.

Low-Salt Diets Affect Bone Health and Have Surprising Metabolic Effects

DiNicolantonio goes on to point out your body strives to maintain an optimal level of sodium regardless of your intake. Your body uses magnesium and calcium levels to control your sodium level. As your intake declines your body begins to pull sodium from the bone, and at the same time pulls out magnesium and calcium.

So, reducing your salt intake results in your body stripping sodium from elsewhere, significantly impacting your bone health. As bones are stripped of magnesium and calcium, your risk of osteoporosis rises. Magnesium is also one of the most important mineral deficiencies from which you can suffer. Nearly half of the U.S. population consume less than required amounts from food.

Low magnesium intake and blood levels have been associated with Type 2 diabetes, hypertension, atherosclerotic vascular disease and sudden cardiac death.10 There is also evidence suggesting optimal levels of magnesium may mitigate the negative impact of electromagnetic fields (EMF) on human cells through voltage-gated calcium channels.

Research published in BMJ Open Heart calls magnesium deficiency a principal driver of cardiovascular disease and a public health crisis.11 Consuming a low-salt diet only makes magnesium deficiencies worse. In order to conserve sodium, your body will release magnesium and calcium in sweat, reducing your magnesium levels even further.

In 1994, Dr. Jens Titze, a kidney specialist at Vanderbilt University Medical Center, studied the urine output of a crew on the Mir space station and discovered the astronauts complained of being constantly hungry when given higher amounts of salt.12

Follow-up animal testing confirmed that the more salt mice were given, the less water they drank and the more food they required to avoid weight loss. As salt intake increases, the animals produced higher amounts of glucocorticoid hormones, causing an increase in fat and muscle breakdown.

These proteins converted into urea, known to help your body excrete waste through urine. The urea also helps retain water. In other words, a side effect of higher salt consumption is it frees water for your body to use. The process is energy intensive, which is why the animals required more food on a higher salt diet, and why the astronauts complained of hunger.

Impact of Fiber on Your Cardiovascular Health

Most people, Americans in particular, need to eat more fiber. It helps manage your weight, and researchers have discovered short chain fatty acids produced by bacteria feeding on unprocessed plant fiber actually communicate with your DNA and protect against a number of different diseases.

Additionally, unprocessed high-fiber diets reduce your risk of premature death from all causes. An inverse association has been found between fiber intake and the incidence of heart attack.

Research shows those eating a high fiber diet have a 40 percent lower risk of heart disease and it has been associated with beneficial reductions in blood pressure, improved insulin sensitivity and reduced inflammation, all of which help lower your risk for heart disease.

Interestingly, researchers13 discovered a receptor (Olfr78) in your kidneys and in your nose that receives messages from gut bacteria to help regulate your blood pressure. The smell is acetate and propionate, which are produced when fiber is fermented. As reported by Scientific American:14

"The researchers have uncovered a direct, molecular-level explanation of how the microbiome conspires with the kidneys and the blood vessels to manipulate the flow of blood …

[M]ore than 99 percent of the acetate and propionate floating through the bloodstream is released by bacteria as they feed … Bacteria are therefore the only meaningful source of what activates Olfr78 — which, further experiments showed, is involved in the regulation of blood pressure."

Potassium-to-Sodium Balance Key to Normalizing Your Blood Pressure

Potassium works in your body to relax the walls of your arteries, keeping your muscles from cramping and lowering your blood pressure. A reduction in blood pressure with potassium has been associated in studies with a reduced incidence of stroke.15

Other research has found women without high blood pressure who consumed the most potassium had a 21 percent reduced risk of stroke; those who consumed the most were also 12 percent less likely to die during the study period than those who consumed the least.16

A better strategy to promote public health would be to forgo strict sodium restriction and focus on a high-quality diet rich in potassium. An imbalance in your potassium-to-sodium ratio may also contribute to a number of other diseases including memory decline, osteoporosis, cataracts, erectile dysfunction and rheumatoid arthritis.

The easiest way to negatively affect this ratio is by consuming a diet of processed foods, notoriously low in potassium and high in sodium. Potassium is used to maintain proper pH levels and plays an integral role in regulating blood pressure. In fact, as indicated in the PURE study, deficiency in potassium may be more responsible for hypertension than an excess of sodium.17

According to a 1985 article in the New England Journal of Medicine,18 our ancestors ate nearly 11,000 mg of potassium a day and 700 mg of sodium. This is nearly 16 times more potassium than sodium. Comparing this to the standard American diet, potassium consumption averages 2,500 mg with 3,600 mg of sodium.

A study published in the Archives of Internal Medicine19 was one of the first and largest to evaluate the relationship of salt, potassium and heart disease deaths, finding those at greater risk had a combination of too much sodium with too little potassium.

Balance Your Potassium-to-Sodium Ratio With the Right Salt and Fiber

When you're choosing foods to increase your potassium levels, one of the first foods many consider are bananas. One medium banana contains 422 mg of potassium. However, bananas are far from being your only source of potassium and also contain 6 grams of total fructose. So, consider foods20 high in potassium without the added fructose, such as spinach, leafy greens, Brussels sprouts, mushrooms and grapefruit.

From my perspective, the clear answer is to avoid processed salt and use natural salt in moderation. I believe it is hard for a healthy person to overdo natural salt, as it is a nutritional goldmine — provided you pay attention to your sodium-to-potassium ratio.

The beauty of using Himalayan salt is that, in addition to being naturally lower in sodium, it's much higher in potassium compared to other salts — including other natural salt like sea salt or Celtic salt. Additionally, Himalayan salt is far lower in toxic pollutants, such as plastic microparticles, commonly found in processed salt and sea salt.

Remember, aside from the basic differences in nutritional content, it's processing that makes table salt (and the salt used in processed foods) detrimental to your health. What your body needs is natural, unprocessed salt, without added chemicals or pollutants.

Fiber is another important addition to your nutritional plan to reduce your risk of cardiovascular disease. There are two main types of dietary fiber: soluble and insoluble. Ideally, you need both on a regular basis.

Soluble fiber — Soluble fiber, found in cucumbers, blueberries, beans and nuts, dissolves into a gel-like texture, helping to slow down your digestion. This helps you to feel full longer, which can help with weight control.

Likewise, it slows down the rate at which other nutrients are digested, including carbs, so they're not as likely to raise your blood sugar. Some foods rich in soluble fiber also help feed good bacteria in your gut.

Insoluble fiber — Insoluble fiber, found in foods like dark green leafy vegetables, green beans, celery and carrots, does not dissolve and stays basically intact as it moves through your colon. By adding bulk to your stool, it helps food to move through your digestive tract more quickly for healthy elimination.

Insoluble fiber is also sometimes called roughage, a term describing one of its functions. As it moves through your colon, it helps move along food particles tending to adhere to the sides. Food remaining stuck to your colon may cause bloating, pain and constipation, as well as other problems.