Most people know that too much sodium from foods can increase blood pressure. A new study suggests that people trying to lower their blood pressure should also boost their intake of potassium, which has the opposite effect to sodium.
Researchers found that the ratio of sodium-to-potassium in subjects' urine was a much stronger predictor of cardiovascular disease than sodium or potassium alone.
"There isn't as much focus on potassium, but potassium seems to be effective in lowering blood pressure and the combination of a higher intake of potassium and lower consumption of sodium seems to be more effective than either on its own in reducing the risk of cardiovascular disease," said Dr. Paul Whelton, senior author of the study in the January 2009 issue of the Archives of Internal Medicine. Whelton is an epidemiologist and president and CEO of Loyola University Health System.
Researchers determined average sodium and potassium intake during two phases of a study known as the Trials of Hypertension Prevention. They collected 24-hour urine samples intermittently during an 18-month period in one trial and during a 36-month period in a second trial. The 2,974 study participants initially aged 30-to-54 and with blood pressure readings just under levels considered high, were followed for 10-15 years to see if they would develop cardiovascular disease. Whelton was national chair of the Trials of Hypertension Prevention.
Those with the highest sodium levels in their urine were 20 percent more likely to suffer strokes, heart attacks or other forms of cardiovascular disease compared with their counterparts with the lowest sodium levels. However this link was not strong enough to be considered statistically significant.
By contrast, participants with the highest sodium-to-potassium ratio in urine were 50 percent more likely to experience cardiovascular disease than those with the lowest sodium-to-potassium ratios. This link was statistically significant.
Most previous studies of the relationship between sodium or potassium and cardiovascular disease have had to rely on people's recall or record of what foods they eat to estimate their level of sodium consumption. This is a less precise measure of sodium intake than urine samples. In addition, many have been cross-sectional rather than follow-up studies.
The new study "is a quantum leap in the quality of the data compared to what we have had before," Whelton said.
Whelton was a member of a recent Institute of Medicine panel that set dietary recommendations for salt and potassium. The panel said healthy 19-to-50 year-old adults should consume no more than 2,300 milligrams of sodium per day -- equivalent to one teaspoon of table salt. More than 95 percent of American men and 75 percent of American women in this age range exceed this amount.
To lower blood pressure and blunt the effects of salt, adults should consume 4.7 grams of potassium per day unless they have a clinical condition or medication need that is a contraindication to increased potassium intake. Most American adults aged 31-to-50 consume only about half as much as recommended in the Institute of Medicine report. Changes in diet and physical activity should be under the supervision of a health care professional.
Good potassium sources include fruits, vegetables, dairy foods and fish. Foods that are especially rich in potassium include potatoes and sweet potatoes, fat-free milk and yogurt, tuna, lima beans, bananas, tomato sauce and orange juice. Potassium also is available in supplements.
Whelton is among the nation's top experts on high blood pressure. He has published more than 400 papers on the subject, and has been the principal investigator on more than $100 million of studies funded by the National Institutes of Health.
Co-authors of the Archives study include Nancy Cook (first author), Julie Buring and Dr. Kathryn Rexrode of Brigham and Women's Hospital; Eva Obarzanek and Dr. Jeffrey Cutler of the National Heart, Lung and Blood Institute; Dr. Lawrence Appel of Johns Hopkins University and Shiriki Kumanyika of the University of Pennsylvania.
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Materials provided by Loyola University Health System. Note: Content may be edited for style and length.
DASH diet: Healthy eating to lower your blood pressure
Discover how DASH can help you lower your blood pressure and improve your health.
By Mayo Clinic StaffDASH stands for Dietary Approaches to Stop Hypertension. The DASH diet is a healthy-eating plan designed to help treat or prevent high blood pressure (hypertension).
The DASH diet includes foods that are rich in potassium, calcium and magnesium. These nutrients help control blood pressure. The diet limits foods that are high in sodium, saturated fat and added sugars.
Studies have shown that the DASH diet can lower blood pressure in as little as two weeks. The diet can also lower low-density lipoprotein (LDL or "bad") cholesterol levels in the blood. High blood pressure and high LDL cholesterol levels are two major risk factors for heart disease and stroke.
DASH diet and sodium
The DASH diet is lower in sodium than a typical American diet, which can include a whopping 3,400 milligrams (mg) of sodium or more a day.
The standard DASH diet limits sodium to 2,300 mg a day. It meets the recommendation from the Dietary Guidelines for Americans to keep daily sodium intake to less than 2,300 mg a day. That's roughly the amount of sodium in 1 teaspoon of table salt.
A lower sodium version of DASH restricts sodium to 1,500 mg a day. You can choose the version of the diet that meets your health needs. If you aren't sure what sodium level is right for you, talk to your doctor.
DASH diet: What to eat
The DASH diet is a flexible and balanced eating plan that helps create a heart-healthy eating style for life. It's easy to follow using foods found at your grocery store.
The DASH diet is rich in vegetables, fruits and whole grains. It includes fat-free or low-fat dairy products, fish, poultry, beans and nuts. It limits foods that are high in saturated fat, such as fatty meats and full-fat dairy products.
When following DASH, it is important to choose foods that are:
- Rich in potassium, calcium, magnesium, fiber and protein
- Low in saturated fat
- Low in sodium
DASH diet: Recommended servings
The DASH diet provides daily and weekly nutritional goals. The number of servings you should have depends on your daily calorie needs.
Here's a look at the recommended servings from each food group for a 2,000-calorie-a-day DASH diet:
- Grains: 6 to 8 servings a day. One serving is one slice bread, 1 ounce dry cereal, or 1/2 cup cooked cereal, rice or pasta.
- Vegetables: 4 to 5 servings a day. One serving is 1 cup raw leafy green vegetable, 1/2 cup cut-up raw or cooked vegetables, or 1/2 cup vegetable juice.
- Fruits: 4 to 5 servings a day. One serving is one medium fruit, 1/2 cup fresh, frozen or canned fruit, or 1/2 cup fruit juice.
- Fat-free or low-fat dairy products: 2 to 3 servings a day. One serving is 1 cup milk or yogurt, or 1 1/2 ounces cheese.
- Lean meats, poultry and fish: six 1-ounce servings or fewer a day. One serving is 1 ounce cooked meat, poultry or fish, or 1 egg.
- Nuts, seeds and legumes: 4 to 5 servings a week. One serving is 1/3 cup nuts, 2 tablespoons peanut butter, 2 tablespoons seeds, or 1/2 cup cooked legumes (dried beans or peas).
- Fats and oils: 2 to 3 servings a day. One serving is 1 teaspoon soft margarine, 1 teaspoon vegetable oil, 1 tablespoon mayonnaise or 2 tablespoons salad dressing.
- Sweets and added sugars: 5 servings or fewer a week. One serving is 1 tablespoon sugar, jelly or jam, 1/2 cup sorbet, or 1 cup lemonade.
Take aim at sodium
The foods at the center of the DASH diet are naturally low in sodium. So just by following the DASH diet, you're likely to lower your intake of sodium.
You can further reduce sodium by:
- Using sodium-free spices or flavorings instead of salt
- Not adding salt when cooking rice, pasta or hot cereal
- Choosing plain fresh, frozen or canned vegetables
- Choosing fresh or frozen skinless poultry, fish, and lean cuts of meat
- Reading food labels and choosing low-sodium or no-salt-added options
As you cut back on processed, high-sodium foods, you may notice that food tastes different. It may take time for your palate to adjust. But once it does, you may find you prefer the DASH way of eating.
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June 25, 2021
- DASH eating plan. National Heart, Lung, and Blood Institute. //www.nhlbi.nih.gov/health-topics/dash-eating-plan. Accessed May 6, 2021.
- Chiavaroli L, et al. DASH dietary pattern and cardiometabolic outcomes: An umbrella review of systematic reviews and meta-analyses. Nutrients. 2019; doi:10.3390/nu11020338.
- 2020-2025 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. //www.dietaryguidelines.gov. Accessed May 6, 2021.
- Salt. Centers for Disease Control and Prevention. //www.cdc.gov/salt/index.htm. Accessed May 6, 2021.
- Rakel D, ed. The DASH diet. In: Integrative Medicine. 4th ed. Elsevier; 2018. //www.clinicalkey.com. Accessed April 4, 2019.
- Sodium in your diet: Use the Nutrition Facts label and reduce your intake. U.S. Food and Drug Administration. //www.fda.gov/Food/ResourcesForYou/Consumers/ucm315393.htm. Accessed April 9, 2019.
- Shaking the salt habit. American Heart Association. //www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/shaking-the-salt-habit-to-lower-high-blood-pressure. Accessed May 6, 2021.
- Tips to reduce salt and sodium. National Heart, Lung, and Blood Institute.//www.nhlbi.nih.gov/health-topics/all-publications-and-resources/tips-reduce-salt-sodium. Accessed May 7, 2021.
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