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How to Lower Your Sodium-to-Potassium Ratio

The potassium content in greens is one of two ways they can improve artery function within minutes of consumption.

More than a thousand years ago, for the treatment of hypertension, an ancient Persian medical text advised lifestyle interventions, such as avoiding meat and pastries, and recommended eating spinach. A thousand years later, researchers discovered that a single meal containing spinach could indeed reduce blood pressure, thanks to its nitrate content. All green leafy vegetables are packed with nitrate, which our body can use to create nitric oxide that improves the flexibility and function of our arteries. This may be why eating our greens may be one of the most powerful things we can do to reduce our chronic disease risk.

As you can see at 0:54 in my video Lowering Our Sodium-to-Potassium Ratio to Reduce Stroke Risk, just switching from low-nitrate vegetables to high-nitrate vegetables for a week can lower blood pressure by about 4 points, and the higher the blood pressure people started out with, the greater benefit they got. Four points might not sound like a lot, but even a 2-point drop in blood pressure could prevent more than 10,000 fatal strokes every year in the United States.

Potassium-rich foods may also act via a similar mechanism. If we get even just the minimum recommended daily intake of potassium, we might prevent 150,000 strokes every year. Why? Potassium appears to increase the release of nitric oxide. One week of eating two bananas and a large baked potato every day significantly improved arterial function. Even a single high-potassium meal, containing the equivalent of two to three bananas’ worth of potassium, can improve the function of our arteries, whereas a high-sodium meal—that is, a meal with the amount of salt most people eat—can impair arterial function within 30 minutes. While potassium increases nitric oxide release, sodium reduces nitric oxide release. So, the health of our arteries may be determined by our sodium-to-potassium ratio.

As you can see at 2:30 in my video, after two bacon slices’ worth of sodium, our arteries take a significant hit within 30 minutes. However, if you add three bananas’ worth of potassium, you can counteract the effects of the sodium. As I show at 2:48 in my video, when we evolved, we were eating ten times more potassium than sodium. Now, the ratio is reversed, as we consume more sodium than potassium. These kinds of studies “provide additional evidence that increases in dietary potassium should be encouraged,” but what does that mean? We should eat more beans, sweet potatoes, and leafy greens, the latter of which is like giving you a double whammy, as they are high in potassium and nitrates. The recommendation from a thousand years ago to eat spinach is pretty impressive, though bloodletting and abstaining from sex were also encouraged, so we should probably take ancient wisdom with a grain of salt—but our meals should be added-salt free.

Why might abstaining from sex not be the best idea for cardiovascular health? Because the opposite may actually be true. See my video Do Men Who Have More Sex Live Longer?.


What else can we do about stroke risk? Check out:

For more on potassium, see in Potassium and Autoimmune Disease and 98% of American Diets Potassium-Deficient.

Interested in learning more about the dangers of sodium? See:

Sodium isn’t just bad for our arteries. Check out How to Treat Asthma with a Low-Salt Diet and Sodium and Autoimmune Disease: Rubbing Salt in the Wound?.

I further explore the wonders of nitrate-rich vegetables in:

Sweet potatoes are an excellent high-potassium, low-sodium choice, but what’s the best way to prepare them? Check out The Best Way to Cook Sweet Potatoes.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

 

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Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


45 responses to “How to Lower Your Sodium-to-Potassium Ratio

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  1. It is very important and good article. Lots of information about nutrition is there to read, but this information stands out as it covers the most important factor sodium/potassium. Lots of people can benefit by taking care of their health by following the facts given on the subject.

  2. One of my high fat, high dairy, high animal products-eating friends called me crying late last night. She is in such pain. She is the one who also follows Gundry and she may have gallstones and it wasn’t the gallstones that caused her to cry. Well, those, too, but she said, “There is nothing to eat, except oatmeal.”

    I saw Gundry’s image on a supermarket tabloid cover and I hate that he caused people to be afraid of beans and nightshades and so many things.

        1. Laughing, yes, my text still often switches my words a half-second after hitting the send button.

          I have tried so hard to get her to try WFPB. She is Gundry and Keto-oriented.

          My other friend who is successfully losing weight with Keto, called me as she stopped to get bacon and sausage for her breakfast. She said, “I didn’t have time to prepare Keto foods but I stopped at a fast-food place to make sure that I had something healthy to eat.

          I have talked that friend into almost understanding that WFPB is a good diet, but she really has been more successful than I have at losing weight. She did start off 150 pounds higher weight than I did but her losing over 100 pounds has her more convinced than ever that bacon is a health food.

          1. Bacon as a health food is a terrifying thought! Do you follow the breakfast like a king, lunch like a prince & dinner like a pauper strategy? It seemed to help me accelerate a bit. I try to have at least 14 hours fasting overnight. It’s still slow going. Another 4 kilos to go. I’m in France, so lbs are a bit mysterious to me. :) Good luck and hope you overtake your bacon eating friend. Your arteries are thanking you anyway.

  3. I wonder, what if person has low blood pressure ? Could then greens and other potassium rich food be problematic in that regard? What person with constantly low blood pressure should do?
    Thank you!

    1. Hello Marina,

      First I would identify whether or not your low blood pressure is causing symptoms. If not, it may not be an issue at all, but should be discussed with your doctor. As for potassium, I did a literature search and could not find anything with regard to potassium and hypotension (low blood pressure). It seems that it likely is not a concern, but again, should be discussed with your doctor.

      I hope this helps

      1. Hello, Dr Mathew,

        Thank you for your reply! So potassium rich diet that helps to lower blood pressure not necessary decreases it for those individuals who already has low or in normal range BP? Would that be true ?

        Thank you , Marina

        1. Marina, a potassium rich diet should be the norm to achieve 4700mg per day which is the recommended daily intake. Folk with renal issue’s may be under alternative advice from their GP.

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  4. For years I’ve eliminated salt as far as possible and have a fairly good intake of potassium. I only eat salt in wholegrain bread or if we go out for dinner occasionally and the chef’s a bit too free with the seasoning!

    I’ve recently been tracking everything I eat in an app that summarises all the nutrients. Assuming the app is somewhat accurate, I average 400 mg of sodium and 4000 mg of potassium per day. The sodium is less than the maximum amount recommended for a child. My blood pressure is always low and I’m in good health in my 50s, which aligns very well with the recommendations.

    However, is there a level of salt that is too low? The blog just made me look up the impact of salt being too low and I do often get bad headaches, tiredness and muscle problems in spite of a super healthy diet and lifestyle. Could this be linked to lack of salt?

        1. It depends on climate and physical exertion. The more you sweat, the greater the likelihood you will need a higher minimum requirement to replace losses via sweat..

          However, research suggests 500mg of sodium a day is the absolute prudent minimum. That is about 1,250mg of salt per day. So you are definitely under the minimum.

          However, I understand that US authorities advise than an adequate intake (AI) for adults is about 1500 mg of sodium per day; Salt is 39.3% sodium (say 40%) so that is approx 3,750 mg of salt daily. Table 8-10 also gives equivalent figures for children.
          https://www.ncbi.nlm.nih.gov/books/NBK545436/

          You may also find this link below helpful
          https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day

          1. Thanks, this is really helpful and I’ll take it on board. You also commented above about low blood pressure. Mine is generally 90 over 60, which is quite low. It plummeted further whenever I’ve had an anaesthetic and I had to plead for painkillers when I woke up! A little bit more salt shouldn’t hurt me.

            1. 90/60 is classed as ‘ideal’ by that UK website but it is admittedly right on the borderline. Anything under that is considered low.

              But yes a small amount of added salt per day shouldn’t be a problem for you.

    1. Julie44,

      Are you supplementing B-12? (And, Methyl doesn’t always work is what I found out twice and Dr. Greger verified with a study in his webinar.)

      Bad headaches, tiredness, and muscle problems can be symptoms of low B12, too, and you might start with getting a fresh bottle if you have been taking Methyl B12. It is shelf-stable and it loses its effectiveness when exposed to light or heat or if it sat on a shelf for a long period of time.

      1. It’s a very good point. I’m a bit naughty as I do have 2 eggs and a piece of salmon once a week on different days, but still that’s not B12 every day. Everything else is WFPB. Thanks for the reminder. I’ve adopted most of Dr G’s advice, but not yet the B12. :)

    2. I have had hyponatremia twice from insufficient sodium. The first time could have been from drinking too much water before a blood test bur the second was not. I had been feeling fatigued and not recovering from exercise. My sports doctor did a blood test and discovered my sodium was loo low, even though I had eaten a salty restaurant meal before seeing him. I am on a 100% whole plant food diet other than an occasional restaurant meal, and, estimating, ,had been only getting about a max of 400 mg sodium per day. I added some salt and recovered overnight. The days I get about 800-1000 mg sodium per day and recovered overnight.

      I have become skeptical of ultra low sodium diets. Might work for some but has caused me problems.

      1. I do believe that very low salt is not good for a good proportion of population. I do believe it really depends on what kind of chronic condition a person has.
        I did not research articles to support it but it comes clearly from my experience .
        So I am not surprised you improved increasing salt intake.

    3. Julie, yes, there is a too low salt diet. Potassium is wonderful, and most people are low there. But you can be too low in sodium also, especially in the summer.
      I see patients who are using salt levels fine for people in NY apartments because of doctors’ online advice. (Not local docs though! )
      But it’s not ok here in the southwest desert where you perspire a lot because of high temperatures and low humidity. People get headaches, fatigue and start passing out.
      You have to regulate salt usage by weather and local conditions.

      1. Thanks Marilyn. Yes, I live in southwest France and it is generally quite tropical! All the feedback has really helped me, thanks again.

  5. 3 weeks ago I weighed 209.5 lbs (I am 5’7). My BP was 160/110. At 49 years of age, enough was enough. I am now on meds, but I switched immediately to a plant based diet and upped my activity. As of today, I weigh 197lbs, my best BP is 118/84 and I am walking at least 10km per day at a brisk pace. I accept that the meds are helping, but I am convinced that following Dr Greger’s advice is the real ‘game changer’ here. I am looking forward to being trim, fit and hopefully ditching the meds in a couple of months time.

    My cholesterol has normalised (it had been raised for last 7 years). Eating well is not a chore and it certainly doesn’t feel like punishment or a diet. In fact, I am mentally and emotionally better than in many months.

    Thank you Dr Greger for bringing me hope when I thought that all I could look forward to was chronic ill health and early death (or a sudden fatal cardiac event with no warning).

    1. Wow, congratulations. Keep up the good work. Another WFPB doctor you’re going to want to become acquainted with is Dr. John McDougall. He runs 10 day programs out in California where he puts people on a WFPB diet. He says that most people go off their medications during the program so make sure you are under supervision to determine if you need to reduce your meds.

    2. Congrats on your changes. I was too lazy and took the stroke shortcut:( Vegan for 5 years because of the China Study which led to everything else. It is so simple to follow Dr. G’s plan. Best of luck, don’t give up.

    1. There are conditions in which resistant hypertension can be explained by such diseases as Primary Hyperaldosteronism (Conns Syndrome). In this case too much sodium and too little potassium. The hypertension affects the kidneys directly. This condition once considered rare is much more common than we thought. left untreated another organ of the body to be affected like the kidneys is the heart muscle. This is manifested in left ventricular Hypertrophy. Plant-based eating plan helps greatly in achieving >4700mg of K and <1500mg of sodium. Add in beetroot to the greens and even more nitric oxide becomes available to support arterial function. Dr Greger's notion of 'ancient' folk eating a K-rich diet is intriguing as the switch to a high Na diet makes me wonder whther this is one of the keys that unlocks the electrolyte disfunction in Conns.

      1. Wow cool response my creatinine is 115 and eGFR is 61 and borderline aldosterone issues So whilst I need to minimise the effects of salt for obvious reasons trying to go K and Na rich is not advisable considering I want to go WFPB…. total contradictory what the literature is saying

    2. I can only speak for what I have seen in 4 weeks of WFPB. my renal function is ok, but I do have a high urine microalbumin-creatinine ratio. My urine dipstick was negative for protein (12 months ago it was not and I was burying my head in the sand). Although the albumin creatinine ratio is raised, I chatted through the results with my doc today and she said it has vastly improved since a year ago. So, everything headed in right direction and I am convinced that my body is healing itself. My doc says that 12 months ago my total cholesterol was 7.5 mmol/l, it is now 4.5.

      I am now walking 15-20km daily and plan to start light jogging next week. In my 20s and 30s I was very fit, but ate a typical western diet and drank like a fish (was in the Army). It goes to show that you cannot outrun a bad diet, but now I’m eating my way to health and fitness.

      The doc is talking about me needing to be on the blood pressure meds long term in order to protect my kidneys, I want to be living proof of the ability of WFPB to reverse renal damage!

  6. You neglect to mention the high liklihood of being infected with green leafy vegetables including kale. Many statistics are out there; here is one: “Half of all food poisoning in the U.S.is due to contaminated produce (1998-2008, C.D.C.)”–leafy salad greens, the main culprit. Deadliest foods: tainted poultry and meat but green leafy vegetables are definitely no free lunch.

    Laurence

        1. Yeah sure. You’d know of course.
          https://www.cdc.gov/foodsafety/food-poisoning.html

          This is a video about sodium and potassium. Why on earth are you wittering on about food poisoning? Why should a post about sodium and potassium discuss food poisoning?

          Are you some kind of keto/carnivore/low carb/Atkins genius here to set us all straight? I’m at a loss to understand your post otherwise.

  7. Very informative well-written article. I think it is also good to mention that spinach is high in both oxalates and calcium so it may cause kidney stones in people at high risk if intake is not limited. Spinach could interfere with blood-thinning medication because it is high in vitamin K1 content. If you are taking blood-thinning medications like warfarin, you should consult your doctor before taking large amounts of spinach.

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