Spring has sprung, the flowers are out, and if you’re not planning and planting your garden, stake out your local farmers’ markets. Of the myriad reasons to do so, chances are extremely high that you need some potassium. 93% of us do, according to the National Health and Nutrition Examination Survey (NHANES). No better way to get it than lots of fresh fruits and veggies. (Or avocado and coconut water — my two favorite sources.)
For you skimmers, I’ll skip to the punchline of this ENL: If we had to pick one single, easy fix for the impending 47,000,000,000,000 US dollar global health care crisis it would be INCREASE FOOD SOURCE POTASSIUM. That’s it. We’d shave 20-30% right off the top of that debt. Done. And there would be a trickle-down effect of a healthy diet beyond that immediate savings, too.
Potassium giveth …
Sodium taketh away…
Tell Me More….
Most famously, potassium works with its little brother sodium in a delicate ratio, getting pumped in and out of cells. It’s a part of the behind-the-scenes battery using energy (ATP) to generate the pulse of life. Thinking, feeling, heart beating, moving, tasting, breathing and on and on. Potassium is one of the most fundamental players in the game. Any activity requires the action potential that potassium generates as it is being pumped around.
For sake of simplicity, I’ll call the sodium/potassium/ATPase pump The Battery of Life.
See the movie: How the Sodium Potassium Pump Works
Historically, potassium was so ubiquitous in the food supply, deficiency through diet was rare. In fact, look at a Daily Recommended Intake (DRI) table for minerals and you won’t see potassium listed! (You don’t see your DRI for oxygen, either.)
But humans have a way of messing with the most fundamental rules of life, don’t we?
If you’re eating processed foods with any regularity, you’re ingesting too much salt and too little potassium. You’re messing with the Battery of Life. Here’s how bad it is: In the US, according to NHANES, we’re ingesting almost 250% of the DRI of sodium (men: 280%, women: 208%) and only 7% of the recommended amount of potassium.
Way too much, way too little, and way too imbalanced.
Humans are the only mammals to negatively flip the intake of sodium and potassium.
What are the ramifications of this flip?
When we were writing the Elements chapter from Laboratory Evaluations in Integrative and Functional Medicine, we came up with a novel idea: Let’s create a table of the association between essential element deficiencies and top causes of death in the US. We found that potassium deficiency was associated with heart disease, cerebrovascular disease (stroke) and essential hypertension. (What we feel as symptoms of deficiency are vague and widespread but could include muscle cramps, fatigue, slower reflexes.)
Potassium deficiency is associated with the top causes of death worldwide, including hypertension, stroke and heart disease.
About 25% of deaths globally are from heart disease and stroke alone, almost 14 million deaths annually. If we were potassium-replete, especially via fruits and veggies, how much could this number be reduced? How much money could be saved? I remember researching the global cost of hypertension and it alone was pegged at 10,000,000,000,000 US dollars annually. Hence my thesis from second paragraph above that potassium repletion through dietary intake could shave 20-30% off the impending 47 trillion US dollar global medical bill.
A note to a small subset of readers: Yeah, I know, correlation isn’t causation. It seems a pretty tight relationship to me, though. Better still: If we get our potassium from foods, that shift alone will improve morbidity and mortality.
So, in summary, increase potassium-containing foods. A lot. Reduce processed foods. A lot. It’s an easy fix to a longer and healthier life and ultimately will save a lot of money.
Part Two: Assessing potassium and sodium status
This April I was honored to be invited to lecture on allergic disease at the annual Orthomolecular Conference in Toronto, Canada (photos below). As with most good conferences, there are usually a couple “practice changers”; that is, ideas so relevant that they move one beyond just intellectual stimulation and into immediate action and change. For me, one of this year’s came from a lecture delivered by Saul Pilar, MD, a clinician from Vancouver, BC.
Dr Pilar’s simple but powerful take-home message? Measure 24-hour urine sodium (Na+) and potassium (K+) levels in yourself and your patients.
Ruling out confounding factors like Na+/K+-altering diseases and medication effects, urine Na+ and K+ reflect what we eat. Your ratio should be in the vicinity of 1:4 sodium to potassium (1500mg/day Na+ and 4700mg/day K+). And if it’s not? Too many processed foods, too little whole foods. Easy measure, easy fix. (Note: Depending on the reference, there is some disagreement around optimal Na+ and K+ intake, but generally speaking, ballpark is 1:3 to 1:5.)
If you’re wincing at the idea of an onerous 24-hour urine collection, a cursory search of the literature reveals that we can probably get away with this “gold standard” measurement in a 12-hour collection. This suggests that an overnight collection is adequate, too. And this test is routinely insurance-covered.
Generally speaking with regard to minerals, we want to see what’s going on inside the cell. This is usually accomplished by a red blood cell mineral assessment. Looking at intracellular potassium is a good thing, no doubt. However, given the gross imbalance in dietary intake in the case of sodium and potassium, the urine test is best.
Serum sodium and potassium are also routinely assessed; but these levels are so tightly regulated by the body, that you’ll rarely see a nutrient-induced abnormality. If K+ is abnormal in serum, evaluation for causes beyond the diet is essential.
91-year-old Prince Phillip is in the house!
And you can get a blurry glimpse of the proof in this photo. (Arrow provided for your viewing convenience.) Prince Phillip, Queen Elizabeth’s hubby, showed up at the Fairmont Royal York Hotel in Toronto, home of this year’s Orthomolecular Conference. Was he secretly hoping to catch some of the Conference? Maybe… he was in the room right next door!
Prince Phillip’s possee in the Royal York.
For all you Royal-ophiles, his full name is His Royal Highness The Prince Philip, Duke of Edinburgh, Earl of Merioneth and Baron Greenwich, KG (Knight of the Garter), KT (Knight of the Thistle), OM (Order of Merit), GBE (Knight Grand Cross of the Order of the British Empire), AC (Companion of the Order of Australia), QSO (Companion of The Queen’s Service Order), PC (Privy Counsellor). And we thought some integrative physicians have lengthy professional designations….
Also at the conference was Dr. Nicolas Gonzalez talking about Dr. John Beard, pictured on the screen. Dr Beard developed the trophoblastic theory of cancer and pioneered the use of pancreatic enzyme therapy. Very interesting.
Dr Lustig presented on sugar toxicity. Great lecture. See his video, “Sugar, the Bitter Truth,” on YouTube.
Hello Dr. Fitzgerald,
Thank you for your great articles on potassium deficiency. You mention a 1:4 ratio of sodium to potassium, at 1500mg/sodium/day and 4700mg/potassium/day approximately. Don’t mean to be nit picky but I want to make sure I understand. That amount of sodium to potassium looks more like a 1:3 ratio in milligrams of daily intake. I realize there’s a range there that you give from different references. Again, I appreciate your generosity with sharing your teaching and knowledge.
Thank you, Larry