Sodium and potassium intake

Individuals with higher sodium or lower potassium intakes have been increased risk for elevated blood pressure and hypertension.

Studies suggest that the ratio of sodium potassium intake is an important risk factor for hypertension and cardiovascular disease than each factor alone.

Individuals who receive a potassium containing salt substitute rather than typical salt have lower blood pressure, lower rates stroke, lower rates of major cardiovascular events and deaths from any cause.

The Third National Health And Nutrition Examination Survey (NHANES) 1988 to 1994 estimated the usual intakes of sodium and potassium, their ratio, among persons 20 years of age and older for all cause mortality and cardiovascular disease mortality, followed for an average of 14.8 years: there was a significant monotonic association between increasing sodium-potassium ratio and risk for all cause cardiovascular disease or ischemic heart disease mortality (Yang Q et al).

Recommendations should be for a simultaneous reduction in sodium intake and increase in potassium intake.

Sodium is added to many foods, especially processed ones, while potassium is naturally present in most foods.

More than three quarters of sodium in the US diet is added during food processing.

Sodium intake in the form of sodium chloride does not affect everyone in the same way: most normotensive patients have a minimal change in mean arterial blood pressure when they ingest a high salt intake, whereas many with elevated blood pressure have a measurable increase in the blood pressure, by approximately 4 mmHg.
Some patients with hypertension are salt sensitive and they respond to high salt intake with an increase in blood pressure of 10 mmHg or more.

A low sodium-potassium ratio may be a marker for high intake of plant foods and low intake of processed foods.

Cheeses, cooked meats, breads, soups, fast foods, pastries, sugary products tend to have higher sodium-potassium ratios.

Fruits, vegetables, dairy products and hot beverages tend to have a lower sodium-potassium ratio.

Plant-based diet is high in potassium content and low in sodium content.

Food processing typically add sodium and removes potassium reversing the sodium- potassium ratio.

Dietary potassium is encouraged by eating unprocessed, potassium rich fruits and vegetables and is the safest pathway for increasing such intake.

The National Academies of Sciences intake recommendations for sodium and potassium.

Updated sodium adequate intakes are:

110 mg daily for infants 0-6 months

370 mg daily for infants 7-12 months

800 mg daily for children ages 1-3

1000 mg daily for ages 4-8

1200 mg daily for ages 9-13

1500 mg daily for ages 14 and older

Updated potassium adequate Intakes are:

400 mg daily for infants 0-6 months

860 mg daily for infants 7-12 months

2000 mg daily for children ages 1-3

2300 mg daily for ages 4-8

It is recommended that individuals aged 14 years and older should reduce sodium intakes if above 2300 mg per day.

There is moderately strong evidence that potassium supplementation reduces blood pressure, particularly among adults with hypertension.

In a large randomized trial of persons who received a potassium containing salt substitute rather than typical salt had lower blood pressure, lower rates of stroke, major cardiovascular events and deaths from any cause.

High potassium intake not only lowers blood pressure but also strikingly reduces salt sensitivity, in part due to put the effect of potassium on vascular endothelium.

Several studies have shown that both an estimated lower (spot urine), less than 3000 mg per day, and higher, greater than 6000 mg per day of sodium intake is related to increased cardiovascular risk: suggesting coexisting conditions or changes in health status may play in major role in these findings, and that estimating sodium intake levels on spot urine samples is subject to significant error.

Higher sodium and lower potassium intakes, as measured by a multiple 24 hour urine sample, are associated in a dose responsive manner with a higher cardiovascular risk: supporting reducing sodium intake and increasing potassium intake from current levels.

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