|The fact that many Americans don't get enough of the "non-salt" electrolytes (calcium, magnesium, potassium) is also due to the fact that mineral water is still an exotic beverage in the US.|
Reason enough to take another look at the possible health consequences and ways to fix these deficiencies by increasing the intake of certain foods or supplements.
Instead of tackling them in an alphabetical order, I would like to start with the two in my humble opinion most critical deficiencies - "critical", not necessarily because they entail the worst health consequences, but "critical", because no one appears to care about them:
You will probably think I am exaggerating (and in fact, I am), but if we are talking about America's Heart Disease Burden (CDC), i.e.
|US "Heart Disease Map" (CDC)|
- about 600,000 deaths due to heart disease in the United States every year – that’s 1 in every 4 deaths,
- heart disease being the leading cause of death for both men and women in the US,
- 720,000 heart attacks with 515,000 "first timers" and 205,000 people who had at least one heart attack before, and
- a financial burden of $108.9 billion each year for heart disease and its consequences, alone,
|Table 1: Paleolithic nutriton according to Eaton (2000) - /1/ based on 3000 kcal/d, 35 % animal: 65 % plant subsistence; /2/ average of US men and women according to the Food and Nutrition Board (1989)|
It is of course higher in calcium, in magnesium folate, B1, B2, vitamin A and vitamin E than the current US diet, but those are nutrients everyone thinks about. Copper (10x higher!) and not even in the list Wallace et al. present in their recent paper in the Journal of the American College of Nutrition (Wallace. 2014), potassium (4.2x higher) and manganese (3.8x higher) are micronutrients no one ever talks about.
Urinary potassium excretion vs. food logs: In subjects who are not on diuretics or other medications that would influence the urinary potassium excretion, the urinary potassium excretion is not necessarily a more accurate, but certainly a more reliable and objective measure of an individual's total potassium intake.The FDA in their infinite wisdom even limits the maximal amount of potassium in dietary supplements to 99mg - i.e. ~2% of their own recommended daily allowance and the prescribed potassium intake on the DASH diet (4,700mg/day for adults (18y+, breastfeeding women "may" consume an extra 500mg/day). If we take the potassium intake of the average Cretan iteration of the Mediterranean (according to Kafatos. 2000) diet or the Paleo diet (according to Eaton. 2000) as a reference it would be as a reference that's 1.8% and 0.8%, respectively. That's unquestionably much less than you would need to double the pathetic 2500mg/day of potassium the average American gobbles down with a 3,000kcal/day diet (Eaton. 2000) - bad news, in view of the fact that insufficient potassium intakes are associated with...
- 29% higher all-cause mortality risk in the 1,448 randomly selected healthy subjects in the Rotterdam Study (Geleijnse. 2007)
- 20% increased higher all-cause-mortality risk in the 12,267 participants of the Third National Health and Nutrition Examination Survey Linked Mortality File (1988-2006), a prospective cohort study of a nationally representative sample (Yang. 2011)
- 36% increased CVD risk (stroke, myocardial infarction, coronary revascularization, or CVD mortality) for the subjects with the lowest (vs. highest) urinary potassium excretion in 2,275 adults with prehypertension aged 30 to 54 year (Cook. 2009)
|Table 2: Estimated Usual Intakes of Sodium, Potassium, and Calories and Sodium-Potassium Ratio at Baseline by Sex, NHANES IIII Linked Mortality Filea (Yang. 2011)|
Furthermore, the difference in all-cause mortality risk between participants with low (Q1) intakes and those who approached "paleo" or at least "Mediterranean" potassium intakes was even large: 39% even after full adjustment!
- 38% increased total stroke and ischemic stroke in among 43,738 US men, 40 to 75 years old, without diagnosed cardiovascular diseases or diabetes, who completed a semi-quantitative food frequency questionnaire in 1986 (Ascherio. 1998)
- 50% increased total stroke risk in the 5,600 men and women older than 65 years and free of stroke at enrollment in The Cardiovascular Health Study (Green. 2002)
- 28% increased total stroke risk according to a 2001 (re-)analysis of data from 9805 US men and women who participated in the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-Up Study (Bazzano. 2001)
- significantly lower bone mineral density (BMD) in elderly men and women with per unit differences that were significantly higher than for magnesium (~30%) and total fruit and vegetable intake alone (+400%; cf. Tucker. 1999)
- higher protein loss due to low-grade acidity; just like the bone loss (Dawson-Hughes. 2000) the loss of nitrogen can be countered by potassium bicarbonate supplements (~4-6g per day lead to a 86.4% reduction in urinary nitrogen excretion in postmenopausal women; cf. Frassetto. 1997 | learn more)
|Figure 2: Graphs showing age-adjusted death rates in the US from cerebrovascular accidents, 1968 through 1988, by socioeconomic quintiles, i.e. median income and high school completeion (Modan. 1992)|
|Figure 3: Low carb, low fat, vegetarian, vegan, low glycemic, Mediterranean, balanced and palolithic diets, they may be based on different premises, but the food recommendations are the same (Katz. 2014).|
Being based on a limited amount of refined starches, added sugars, processed foods; limited intake of certain fats and emphasizing whole plant foods, with or without lean meats, fish, poultry, seafood. They are all well capable of providing the RDA 4,700mg/day of potassium so few of the modern convenient food buyers are consuming on a daily basis.
- Ascherio, A., et al. "Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men." Circulation 98.12 (1998): 1198-1204.
- Bazzano, Lydia A., et al. "Dietary potassium intake and risk of stroke in US men and women National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study." Stroke 32.7 (2001): 1473-1480.
- CDC. Heart Disease Fact Sheet. < www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm > visited on March 20, 2014.
- Cook, Nancy R., et al. "Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study." Archives of internal medicine 169.1 (2009): 32-40.
- Dawson-Hughes, Bess, et al. "Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women." Journal of Clinical Endocrinology & Metabolism 94.1 (2009): 96-102.
- Geleijnse, Johanna M., et al. "Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: the Rotterdam Study." European journal of epidemiology 22.11 (2007): 763-770.
- Green, D. M., et al. "Serum potassium level and dietary potassium intake as risk factors for stroke." Neurology 59.3 (2002): 314-320.
- He, Feng J., and Graham A. MacGregor. "Fortnightly review: beneficial effects of potassium." BMJ: British Medical Journal 323.7311 (2001): 497.
- Iso, Hiroyasu, et al. "Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women." Stroke 30.9 (1999): 1772-1779.
- Kafatos, Anthony, et al. "Mediterranean diet of Crete: foods and nutrient content." Journal of the American Dietetic Association 100.12 (2000): 1487-1493.
- Katz, D. L., and S. Meller. "Can We Say What Diet Is Best for Health?." Annual Review of Public Health 35.1 (2014).
- Loftfield, Erikka, et al. "Potassium and fruit and vegetable intakes in relation to social determinants and access to produce in New York City." The American journal of clinical nutrition 98.5 (2013): 1282-1288.
- Modan, Baruch, and Diane K. Wagener. "Some epidemiological aspects of stroke: mortality/morbidity trends, age, sex, race, socioeconomic status." Stroke 23.9 (1992): 1230-1236.
- Wallace, Taylor C., Michael McBurney, and Victor L. Fulgoni III. "Multivitamin/Mineral Supplement Contribution to Micronutrient Intakes in the United States, 2007–2010." Journal of the American College of Nutrition 33.2 (2014): 94-102.
- Yang, Quanhe, et al. "Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey." Archives of internal medicine 171.13 (2011): 1183-1191.