Got High Blood Pressure? Don't Drop the Salt

The World Health Organization cites hypertension, aka high blood pressure, as the leading risk factor for global disease burden. It's estimated that in the United States alone, more than 50% of adults are either pre-hypertensive or hypertensive. This massive issue is often (rightfully) attributed to dietary factors, and is especially prevalent in Westernized diets characterized by a high intake of processed foods.

For decades, the increased consumption of sodium chloride (“salt”) that typically comes along with the standard Western diet has been viewed as the primary driver of high blood pressure. Indeed, there is significant research to suggest that excess sodium in the bloodstream leads to water retention as the body attempts to dilute the sodium. This retention increases the volume of fluid within our blood vessels, thereby increasing the pressure inside the vessels and making the heart work harder to continue pumping blood.

If you've ever visited your primary care physician and have been diagnosed as hypertensive, or even simply flagged high on a blood pressure reading, you've likely been advised to reduce salt intake. That was probably the only recommendation you were given, possibly coupled with some vague advice on "managing stress". If you were diagnosed hypertensive, these vague recommendations were accompanied by a prescription slip for Lisinopril, Losartan, Furosemide (Lasix), or the like.

Off you went to throw your salt shaker in the garbage, with a life of bland, unseasoned food lying ahead of you. This whole heart health thing sucks eggs (which you also can't eat, because your cholesterol flagged high too).

While there is research to suggest a decrease in sodium intake may help lower blood pressure in individuals who are obese, elderly, or diagnosed hypertensive, the broad recommendation to cut sodium intake for the sake of general cardiovascular health is greatly oversimplified and lacks critical context. 9 times out of 10 this recommendation fails to acknowledge the other essential mineral we must consider in this equation: potassium.

Sodium and potassium both play multiple crucial roles in the body and are intimately tied to one another. In the body, they tend to have an inverse relationship: As one rises the other decreases, and vice-versa.

To put it succinctly, sodium and potassium balance one another. Potassium helps prevent excess accumulation of sodium in the bloodstream by acting as a diuretic, increasing the excretion of both sodium and water via the kidneys (you pee it out).

Ancestrally, the human diet was much higher in fruits and vegetables rich in potassium, and typically contained far less sodium than we consume today. Sodium was an essential but often scarce resource, so we evolved to crave and consume salt whenever we could get our hands on it. Today, most people's diets in the western world are quite the opposite, with a ratio heavily skewed in favor of sodium, with far less potassium.

So when blood pressure becomes an issue and the blame is placed on sodium intake, is it really due to excess sodium? Or is it actually a deficiency in potassium?

A research review out of the University of Southern California's Keck School of Medicine by McDonough, et al. (2017) found that “Decreasing sodium intake is a well-established way to lower blood pressure, but evidence suggests that increasing dietary potassium may have an equally important effect on hypertension.” This review is part of a growing body of evidence that suggests while some people simply are eating way too much salt, many others may just not be getting enough potassium.

Ok, maybe I should get more potassium. But if sodium really does increase the risk of hypertension, why does the title of this article say "Don't Drop the Salt"?

While heavy sodium intake can be an issue, research from Boston University by Moore, et al. (2017) found that low sodium diets were not associated with lower blood pressure. In fact, study participants who consumed less than 2500 mg of sodium per day actually had higher blood pressure than those with moderate sodium consumption. In short, consuming too little sodium may increase the risk of hypertension (and therefore cardiovascular disease) as much as excess consumption.

The key takeaway is that if you're hypertensive or at-risk of developing hypertension, you should be looking at both your sodium intake as well as potassium intake. You may not need to eliminate sodium from your diet and spend the rest of your days choking down plain chicken breast. A better strategy to lower blood pressure may be moderately reducing sodium intake, while increasing potassium.

What foods are high in potassium? There are many to choose from, including but not limited to:

-Avocados (yes, another reason to love them)

-Sweet potatoes

-Mushrooms

-Apricots

-Raisins

-Fish

-Yogurt

The list goes on. While the RDA of potassium in the U.S. is 4700 mg, many people consume less than 3000 mg per day. So while sodium consumption may be a real issue for some, eating more potassium rich foods could be a major help for others in the battle against hypertension.

So please, don't feel like you need to part ways with your salt shaker that's shaped like a fun little chef. He still can have a role in your kitchen. Instead, consider hooking him up with a shapely looking avocado.