Wednesday, January 27, 2010

The low modern potassium-to-sodium ratio: Big problem or much ado about nothing?

It has been argued that the diets of our Paleolithic ancestors had on average a much higher potassium-to-sodium ratio than modern diets (see, e.g., Cordain, 2002).

This much lower modern ratio is believed by some to be the cause of a number of health problems, including: high blood pressure, stroke, heart disease, memory decline, osteoporosis, asthma, ulcers, stomach cancer, kidney stones, and cataracts.

But, is this really the case?

The potassium-to-sodium ratio in ancient and modern times

According to some estimates, our Paleolithic ancestors’ daily consumption was on average about 11,000 mg of potassium and about 700 mg of sodium (salt). That yields a potassium-to-sodium ratio of about 16. Today’s ratio in industrialized countries is estimated to be around 0.6.

Just for the sake of illustration, let us compare a healthy Paleolithic diet food, walnuts, with a modern industrialized food that many believe to be quite healthy, whole-wheat bread. The table below (click on it to enlarge) compares these two foods in terms of protein, carbohydrate, fat, vitamin, and mineral content.

Walnuts have a potassium-to-sodium ratio of about 205. The whole-wheat bread’s ratio is about 0.5; much lower, and close to the overall ratio estimated for industrialized countries mentioned above.

At the same time, walnuts provide a better nutritional value than whole-wheat bread, including a good amount of omega-3 fatty acids (2.5 g; of α-linolenic acid, or ALA). However, walnuts have a fairly high omega-6 fat content.

Also, many diabetics experience elevated blood glucose levels in response to whole-wheat bread, in spite of its glycemic index being supposedly lower than that of white bread. Walnuts do not seem to cause this type of problem, even though several people are allergic to walnuts (and other tree nuts).

Health effects of the potassium-to-sodium ratio

So, the potassium-to-sodium ratio appears to have been much higher among our Paleolithic ancestors than today. It is important to stress that, even though this is a possibility, we do not know this for sure. Animals go to great lengths to find salt licks, and then consume plenty of sodium in them. Our ancestors could have done that too. Also, we know that sodium deficiency can be deadly to both animals and humans.

As for the many negative health effects of a low potassium-to-sodium ratio in modern humans, we have reasons to be somewhat skeptical. One has to wonder if the studies that are out there do not conflate the effects of this ratio with those of other factors, such as smoking, heavy alcohol consumption, or consumption of industrialized high carb foods (e.g., cereals, pasta, refined sugars).

Another possible confounding factor is potassium deficiency, not the potassium-to-sodium ratio. Potassium deficiency, like other deficiencies of essential minerals, including sodium deficiency, is associated with serious health problems.

If potassium is deficient in one’s diet, it is also likely that the potassium-to-sodium ratio will be low, unless the diet is also equally deficient in sodium.

Let us take a look at a study by Ikeda et al. (1986), which included data from 49 regions in Japan, a country known for high consumption of sodium.

This study found a significant association between the potassium-to-sodium ratio and overall mortality and heart disease, but only among men, and not among women.

One wonders, based on this, whether another uncontrolled factor, or factors, might have biased the results. Examples are smoking and heavy alcohol consumption, which could have been higher among men than women. Another is chronic stress, which could also have been higher among men than women.

The researchers report that they found no association between the potassium-to-sodium ratio and mortality due to diabetes, liver disease, or tuberculosis. This ameliorates the problem somewhat, but does not rule out the biasing effect of other factors.

It would have been better if the researchers had controlled for the combined effect of covariates (such as smoking, alcohol consumption etc.) in their analysis; which they did not.

Moreover, the study found no association between the potassium-to-sodium ratio and blood pressure. This is a red flag, because many of the diseases said to be caused by a low potassium-to-sodium ratio are assumed to be mediated by or at least associated with high blood pressure.

Regarding the possible confounding effect of industrialized high carb foods consumption, it seems that many of these foods have a low potassium-to-sodium ratio, as the example of whole-wheat bread above shows. Thus, some of the health problems assigned to the low potassium-to-sodium ratio may have actually been caused by heavy consumption of industrialized high carb foods.

It is also possible that the problem is with the combination of a low potassium-to-sodium ratio and industrialized high carb foods consumption.

At the time the study was conducted, Japan was somewhat westernized, which is why industrialized high carb foods consumption might have been a factor. The US strongly influenced the Japanese after World War II, as it helped rebuild Japan’s economy.

In conclusion, the jury is still out there regarding whether the low modern potassium-to-sodium ratio is a big problem or much ado about nothing.


Cordain, L. (2002). The Paleo Diet: Lose weight and get healthy by eating the food you were designed to eat. New York, NY: Wiley.

Ikeda, M., Kasahara, M., Koizumi, A., and Watanabe, T. (1986). Correlation of cerebrovascular disease standardized mortality ratios with dietary sodium and the sodium/potassium ratio among the Japanese population. Preventive Medicine, 15(1), 46-59.