Asking people to focus on what you want them to eat more of is often more effective than having them focus on what you want them to eat less of.
Telling people to eat less salt doesn’t seem to be working. Maybe we should focus on getting more potassium instead.
Nutrition Diva is hosted by Monica Reinagel. A transcript is available at Simplecast.
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Hello, I’m Monica Reinagel and you are listening to the Nutrition Diva podcast. Welcome!
The recommended maximum intake for sodium is about 2300 mg a day, which is roughly one teaspoon of table salt. Most Americans eat about 3400 mg per day, and that upsets the people whose job it is to worry about your health. And I’m not just talking about your mother and me. There are whole government agencies that lay awake at night worrying about your sodium intake.
Their main concern is that eating a lot of salt can raise your blood pressure, and that can be quite dangerous. A high-sodium diet doesn’t lead to high blood pressure in everyone, and some people have high blood pressure even when they eat a very low-sodium diet. But public health policy is all about playing the numbers. The government figures that if everyone ate less salt, fewer people would develop high blood pressure, have strokes, and die, and that would be a good thing.
Accordingly, they have spent the last several decades nagging consumers to reduce their sodium intake They’ve also been pestering food manufacturers to reduce the amount of sodium in processed and packaged foods. Now I don’t want to be hasty and jump to any premature conclusions, but the first 50 years of this effort don’t appear to have produced a whole lot of progress.
To be sure, you see a lot more reduced-sodium or no-salt-added options at the grocery store. Unfortunately, consumers apparently don’t find reduced-sodium products very enjoyable. Reducing the salt in canned vegetables or beans does more than change the taste. It also can negatively affect the texture and aroma of foods, and shorten shelf-life.
For this and many other reasons, all but the most diligent and vigilant of consumers continue to exceed sodium recommendations by a wide margin. So, what’s the solution?
When I’m coaching people on health habits or weight management, I often suggest that if something isn’t working, despite multiple or extended attempts, it might make sense to try something different. And seeing as we don’t seem to be making much headway on sodium reduction, it might be more effective to focus on getting people to increase their potassium intake instead.
I was talking about this with Yanni Papanikolaou—he’s done a ton of high-level research into how different dietary patterns are associated with overall diet quality and various health outcomes and he had this to say:
"The American Heart Association has emphasized the heart health benefits linked to meeting daily potassium recommendations. Foods rich in potassium can blunt the effects of sodium and help to control blood pressure, which can ultimately lower your risk of stroke."
The data show that your risk of dying increases by about 20% for every additional 1,000 mg of sodium you consume. At the same time, your risk of death decreases by about 20% for every additional 1,000 mg of potassium you consume. When you take both sodium and potassium into consideration, it turns out that a high potassium intake largely offsets the effects of high sodium intake on mortality risk.
And in my experience, asking people to focus on what you want them to eat more of is often more effective than having them focus on what you want them to eat less of.
In terms of meeting the dietary guidelines for potassium, there’s a lot of room for improvement. The recommended intake is 4,700 mg of potassium a day. The average intake is only about half that much. Even the folks at the very top of the chart—the 90th percentile of intake—are only averagingt about 80% of the recommended amount.
Fruits and vegetables, dairy products, beans and legumes, meat, fish, and poultry all contain potassium. And Dr. Papanikolaou notes an interesting paradox: “People trying to reduce sodium often avoid canned beans, soup, and vegetables due to their sodium content. But many of these are also quite high in potassium.”
He's right. A cup of canned white beans, for example, contains about 600 milligrams of sodium—but about 1200 milligrams of potassium. Similarly, a cup of canned tomatoes contains 300 milligrams of sodium but almost 600 milligrams of potassium. Sure, cooking with dried beans and fresh tomatoes has its advantages. But you cannot beat the convenience, affordability, and shelf-life of canned beans and veggies. And, as Dr. Papanikolaou points out: “These foods, which are often demonized for being high in sodium, could actually help improve the potassium to sodium ratio of our diets, in addition to the other nutrients they contribute.”
The current iteration of the Nutrition Facts label shows you what percentage of the Daily Value of both sodium and potassium a serving of that food contains—so you can take that into account when assessing how it fits into your diet.
Keep in mind, however, that most of the sodium in your diet is going to come from packaged foods (which usually have Nutrition Facts labels) and prepared foods (which often don’t). Potassium, on the other hand, is also found in lots of fresh foods that don’t have Nutrition Facts labels—particularly fruits and vegetables. (Just one more reason to get that five a day.)
And here’s a fun fact: Users of my Nutrition GPA app are seven times more likely to get that recommended five servings of vegetables a day– and 4 times more likely to have a serving a beans. The Nutrition GPA app is free and available in both the Google and Apple app store.
Here’s a cheat sheet with some good dietary sources of potassium.
It might seem that taking potassium supplements would be an answer to improving the potassium-sodium ratio of the diet but I'm not crazy about this solution—for 3 reasons…
Reason #1. Pills don't equal foods. Fresh whole foods contain a wide range of nutrients that work together to promote health. When we take individual nutrients out of foods and put them in pills, we don't always get the same benefits as we do from eating those foods.
Reason #2: Supplements don't impact diet choices. Some of the benefit of eating more broccoli comes from the vitamins in broccoli. The other benefit of eating more broccoli comes from the fact that we end up eating fewer French fries! When we get our nutrients from whole foods rather than supplements, there isn't as much room on the plate for highly processed, nutrient-poor foods.
Reason #3. It's too easy to overdo it with supplements. Although it would be pretty difficult to get too much potassium from whole foods, it's a lot easier to get into trouble with supplements—especially if you have reduced kidney function or are taking certain medications that impair your ability to clear potassium from your blood. If your blood potassium levels get too high, it can cause weakness, arrhythmias, or even cardiac arrest.
Unless your doctor has prescribed potassium supplements to correct a deficiency, I would not recommend taking a potassium supplement, beyond the amount that might be found in a regular multivitamin.
A lot of salt substitutes are made from potassium chloride salt. that be a good way to increase your potassium intake and cut down on sodium at the same time? Perhaps.
A packet of salt substitute contains about 500 mg of potassium, which is about 10% of the DV for potassium. But the salt that we add to our foods during cooking or at the table generally only accounts for about 25% of our sodium intake. So the amount of potassium you’d get from using salt substitute instead might not add up to a whole lot.
Also, be aware that certain high blood pressure medications (specifically, the potassium-sparing diuretics) are among those that can lower your potassium tolerance. If you are on any medication, check with your doctor to be sure that it's safe for you to use a potassium-based salt substitute—and how much it is safe for you to use.
Thoughts, comments, questions? Send them to me at nutrition@quickanddirtytips.com or call the Nutrition Diva listener line at 443-961-6206. and your question could be featured in a future episode!
If you’re looking for more support for healthy weight management, please check out the tools and resources that are at weighless.life, including a free assessment that will help you create a personalized action plan, based on your current strengths and challenges. That’s at weighless.life/quiz
Nutrition Diva is a Quick and Dirty Tips podcast. It's audio-engineered by Nathan Semmes with script editing by Adam Cecil. Thanks also to Morgan Christianson, Holly Hutchings, Davina Tomlin, and Kamryn Lacy.
That's all for this episode. Thanks for listening! I'll see you next week.