High blood pressure, also known as hypertension, is a common condition that affects 1 in every 3 adults in the United States. Although hypertension typically has no signs or symptoms, it can lead to serious complications such as heart attack, stroke, heart failure, and kidney failure. In this “Ask the Paleo Nurse” question and answer segment, Katy helps a reader that has high blood pressure sift through recommendations regarding the consumption of salt and the role of potassium in the management of hypertension.
Reader Question about High Blood Pressure, Salt intake, and Potassium:
I have high blood pressure and I’ve been following the Paleo diet for 2.5 years now. Paleo has helped a bit to lower my blood pressure, but I still have to take a blood pressure medication to manage it. I’ve been told that I should follow a low-salt diet in order to keep my blood pressure under control. Is it still okay to use natural sea salt? Also, is it true that foods high in potassium can help to lower blood pressure?
In its unprocessed state, salt is a naturally-occurring mineral compound that consists mostly of sodium chloride and trace amounts of other minerals, such as silicon, phosphorous, and bromine. Although the conventional medical community has long advised patients with hypertension to consume low-salt diets, there is little evidence to support that reducing salt intake results in a clinically significant decrease in blood pressure or decreases the risk of complications of high blood pressure. A report released in 2013 by the Institute of Medicine concluded that the quality of evidence linking salt to poor health outcomes is lacking. A close examination of several randomized trials actually revealed worse health outcomes in those consuming very low salt diets. A Cochrane review conducted in 2011 found that there was no clinically significant impact of dietary salt intake reduction on mortality or complications from cardiovascular disease.
However, not all salt is created equal and there are still good reasons to avoid table salt and the salt found in high amounts in refined foods. Table salt is highly processed and contains a far less diverse mineral composition than that of natural sea salt. Man-made chemicals and preservatives are also added to table salt as anti-caking and free-flowing agents. A nutrient-dense Paleo diet drastically decreases the amount of processed salt consumed by eliminating refined foods and added table salt. If you are following a Paleo diet, it is likely safe, and perhaps even health-promoting, to consume a small amount of natural sea salt for seasoning and flavor—as long as the natural sea salt intake is balanced with other important minerals and nutrients.
Along with sodium, potassium is a mineral that plays a critical role in blood pressure regulation. It’s the balance between sodium and potassium that controls fluid status in the body, thus impacting blood pressure. Rather than the potential effects of consuming too much salt alone, long-term population studies have suggested that it is an imbalance in the ratio of sodium to potassium that contributes to hypertension-related complications. In other words, the problem is not just eating too much salt, but it’s not getting enough potassium to balance the amount of sodium in the diet. Increasing the consumption of foods that are high in potassium can have a beneficial impact on lowering blood pressure. Paleo foods that are naturally high in potassium include beet greens, Swiss chard, sweet potatoes, spinach, avocado, Brussel sprouts, cantaloupe, cabbage asparagus, and carrots. Interesting, all of these foods are higher in potassium than the banana, which is widely known for its potassium content (see this resource for other foods that are high in potassium). As you are taking a blood pressure medication, you should be aware that consuming foods that are high in potassium is contraindicated when taking certain blood pressure medications known as potassium-sparing diuretics. Too much potassium can be life-threatening, so make sure that you talk about your diet and the medication with your health care provider.
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