Whole Foods magazine

June 2001

Potassium - to - Sodium Ratio Affects Overall Health

Part 2: Imbalance Often Leads to Hypertension.

An interview with Dr. Richard Moore
by Richard A. Passwater, Ph.D.

 

In April, we discussed how modern diets, high in processed foods, cause an imbalance between sodium (salt) and potassium that affects every cell in the body and can lead to more than 10 diseases. We interviewed Herb Boynton, co-author of The Salt Solution (along with Richard D. Moore, M.D., Ph.D., and Mark McCarty), and learned how this potassium-sodium imbalance is the cause of high blood pressure (essential hypertension), the main cause of stroke, and contributes to heart disease, memory decline, osteoporosis, asthma, ulcers, stomach cancer, kidney stones, and cataracts, and possibly be involved with erectile dysfunction and rheumatoid arthritis. Clearly, the best way to get potassium and sodium back into satisfactory balance is to eat whole foods. When you eat whole, unprocessed foods, you are not going to get very much sodium, but you are going to get very large amounts of potassium. For 90 persons out of 100, that would be an immense improvement in their overall diets.

Dr. Richard D. Moore is our guest for this column. He received his medical degree from the Indiana School of Medicine and his doctorate in biophysics from Purdue University. He is professor emeritus, State University of New York at Plattsburgh.

 

Passwater: When people say, "I am not concerned about salt because I am not salt-sensitive" or "I can eat all the potato chips I want, and my blood pressure doesn't change; therefore, salt is no problem for me," are they missing the boat?

Moore: Absolutely. It is not simply a question of blood pressure. People can have normal blood pressure and still have serious metabolic problems that result from this potassium-sodium imbalance. In turn, these metabolic problems can lead to any of more than 10 diseases, including osteoporosis, asthma, kidney disease, kidney stones, mental decline, stomach cancer, ulcers and others.

Passwater: To help people recognize foods and diets that cause potassium/sodium imbalances, you have devised the "K Factor" to simplify the potassium-to-sodium ratio concept. Instead of having to mentally juggle and compare the two large numbers for potassium and sodium levels, the K Factor is one number that is easier to handle for comparisons.

Moore: "K" is the chemical symbol for potassium, derived from the Latin word kalium. The higher the K Factor, the better the food or diet. Soybeans have a K Factor of 340. Corned beef hash has a K Factor of about 0.37. Selecting mostly foods with a high K Factor will allow you to include some foods with poorer K Factors. The K Factor of the total diet is the important number.

Passwater: You recommend that diets have a K Factor of at least four. Why?

Moore: When I looked at all the published data for both potassium and sodium in the diet -- or in the urine which reflects the diet-and then looked at the incidence of hypertension, I could see that, as the K Factor got above one or two, there was significantly less hypertension (high blood pressure). I chose a K Factor of four because of all the diets where there was any significant occurrence of high blood pressure, the K Factor was less than three. Actually a diet with a K Factor of three or above is not bad, but, for practical purposes, I think a K Factor above four is a better goal. Of course, even higher than that would be better in terms of general health. I say this based upon the fact that our ancestors had a K Factor of about 16 to 1 and we evolved having a K Factor something like that.

Passwater: You're saying that modern diets have a poorer K Factor than diets based mostly on whole, unprocessed food?

Moore: Let me give you a very interesting statistic. In 1985, The New England Journal of Medicine published an article titled "Paleolithic Nutrition." The authors, who had credentials as anthropologists specializing in the Paleolithic era, determined that, on average, our caveman forebears got around 11,000 mg of potassium daily and about 700 mg of sodium. This, by the way, is about the same ratio that modern-day hunter / gatherers have. It works out to a dietary K Factor of 15.7.

Today, in the United States, that 11,000 mg has shrunk to 2,500 mg of potassium. Meanwhile, the sodium intake has increased from 700 mg to 4,000 mg. This is a K Factor of 0.6. You would not expect that any animal species, human or otherwise, could live for several million years with a huge potassium intake and rather modest amounts of sodium and then suddenly flip-flop this ratio with impunity. The scientific literature supports our conclusions.

There is absolutely no doubt that the imbalance thereby produced influences at least ten serious diseases and very probably several others. This is why we think The Salt Solution is an extremely important book, and we hope that people will read it. It will enable them to correct this huge dietary error. A daily ration of 2,500 mg of potassium is far too little. And, of course, as virtually everyone should know, 4,000 mg of sodium is at least ten times as much sodium as people need.

Passwater: What about the diets of the remaining "primitive" peoples of today?

Moore: One factor that was a big influence on us in writing our book was the work done by Drs. Dennis Burkitt and Hugh Trowell. They wrote the book Western Diseases and Refined Carbohydrate and Disease, as well as several others. In Western Diseases, Dr. Trowell states, "Ethnic groups who do not add common salt to their food have lifelong low blood pressure; no exception to this generalization has been traced." That really made an impression on me. The Yamomano Indians in Brazil have excellent blood pressure and they also -- hear this! -- get less than 100 mg of sodium daily versus the 4,000 mg that the average person in the United States consumes.

Passwater: At least our readers understand the value of eating whole foods and holding back on their intake of heavily processed foods.

Moore: You've hit on something that I really would like to emphasize; if you take any unprocessed fruit or vegetable, in 99% of all cases, such foods will have 20 to 100 times as much potassium as sodium. Unprocessed foods have a high K Factor, that is, much more potassium than sodium. This is because the sodium-potassium pumps in their cells work to keep potassium in.

If you take foods like meat, fish, fowl, eggs and dairy products, 99% will have at least three, four or five times as much potassium as sodium. The key factor is to eat whole unprocessed foods. If people ate only whole, unprocessed foods and used salt modestly, there would be no problem with potassium-sodium imbalance. Nevertheless, The Salt Solution and The High Blood Pressure Solution list foods that are particularly high in potassium and also list the major sodium villains.

Passwater: Are we engaged in a hopeless battle? As we know, for some reason, people tend to prefer the convenience or the taste of processed foods. It has just gotten out of hand.

Moore: The statistics show that 80% of the calories consumed by Americans today come from processed foods. Most of these processed foods not only have huge amounts of salt added, but in a great many cases, large amounts of potassium have been depleted. Typical of this is polished rice; three-fourths of the potassium in polished rice disappears. It is about the same with wheat. About three-quarters of the potassium is removed from the wheat berry by reducing it to white flour. We have a double whammy here, with huge amounts of salt being added, and, in a great many cases, potassium being removed.

The shame of it is that it is so easy to increase potassium. As I mentioned, just about any whole food that has not been processed is loaded with potassium. This includes bananas, oranges, apples, rutabagas and cabbage. Potatoes are one of the richest sources of this mineral. A big baked potato, for example, will have about twice as much potassium as a banana but a lot of people will add salt to their baked potato in some form or another, and that is counterproductive

Passwater: What about cow's milk?

Moore: Cow's milk has a K Factor of 2.8. It also is true that even though ocean fish live in a high-salt environment, they still have three to five times as much potassium in the flesh as sodium. So don't rule out salmon, tuna, sardines or any marine fish, because they all are quite high in potassium and quite low in sodium. If you eat the canned variety of these fish, however, you have to be careful they are not loaded with salt.

Passwater: Is there a good way to supplement diets to improve the potassium content? How about salt substitutes?

Moore: The Finnish people developed a product that they call "PanSalt," which is known in the United States as Solgar Heart Salt or Cardia Salt. Most people can't tell it from ordinary salt, yet it has far less sodium than ordinary salt. It also has quite a lot of potassium in it. Over in Finland, the results have been utterly remarkable. Substitution of this flavoring alternative has caused an astonishing 60% drop over the past 20 years in premature deaths from stroke and heart disease, and a drop of 10 points in average diastolic (bottom number) blood pressure. I must add that these people are also admonished to eat high potassium foods and keep their sodium consumption down in general. Whatever the reason, there has been an astonishing reduction in both high pressure and stroke in Finland, where consumer acceptance of PanSalt has been so strong that there are now more than 1,000 processed foods seasoned with the product. This is a significant step.

Passwater: Tell us more about this salt substitute and the studies done with it.

Moore: Solgar Heart Salt/Cardia Salt contains 54% less sodium (by volume) than regular table salt and also contains 176 milligrams of potassium and 13 milligrams of magnesium in each quarter-teaspoon serving. An important factor is that it doesn’t taste bitter as many other salt substitutes do that contain potassium. A taste test conducted by Tuft’s University Health & Nutrition Newsletter (May 1997), found "most tasters found Solgar Heart Salt/Cardia Salt more palatable - and more like salt - than the other salt replacers they tried."

We report in The Salt Solution a clinical study of 24 patients being treated for high blood pressure where Solgar Heart Salt/Cardia Salt was substituted for regular salt, in combination with patient education and lifestyle modification, significantly reduced their systolic by pressure by 8.8 points, on average, and their diastolic blood pressure by 7.1 points. The researchers remarked, "The significant decrease in blood pressure was seen in patients who were taking stable doses of antihypertensive medications, despite constant weight and no measurable increase in exercise." (Phillips, 1998)

Another clinical trial that we report involves 233 hypertensive patients who substituted Solgar Heart Salt/Cardia Salt for table salt for six weeks significantly reduced their systolic blood pressure by 4.2 points and their diastolic blood pressure by 2.7 points. The researchers concluded, "Solgar Heart Salt/Cardia Salt tastes like regular salt and provides a practical means to help patients achieve a diet lower in sodium and higher in potassium." (Whelton, 1997)

Still another clinical trial of 30 subjects found that the substitution of Solgar Heart Salt/Cardia Salt for regular table salt significantly lowered systolic pressure by 7.4 points and diastolic pressure by 3.6 points in just five weeks. (Kawasaki and Itoh, 1996)

Passwater: The blood pressure decreases may seem relatively small, but we should keep in mind that these studies are short and that the differences can be significant over the long term. As shown by the Finnish studies, the effect on stroke was quite dramatic.

Moore: Readers of The High Blood Pressure Solution report very dramatic decreases to below 120/80, even if starting the program over 160/110.

Passwater: A health claim recently has been approved that says, more or less, that food labels can mention potassium in relation to stroke.

Moore: It is a big step forward. The Tropicana Orange Juice people are advertising this fact, which is very much to their credit. But it bears emphasizing that this is not true of just orange juice, but is true of almost all whole fruits and vegetables. Most fruits, vegetables and legumes are loaded with potassium, and most of them have very little sodium. The only vegetable that I can think of that has fairly heavy amounts of sodium is celery, and it doesn't have all that much. It still is very favorable in terms of potassium content.

Passwater: Average citizens, if they know about potassium at all, frequently come to this knowledge only after a doctor has prescribed a diuretic (to reduce excess retained water) and then told them to eat bananas to replace the potassium that has gone out with the water. The thinking appears to be that high blood pressure and too much water retention are not a good combination. So let's get rid of the water. But, in the process, minerals such as potassium also are depleted.

Moore: First of all, The Salt Solution is not anti-drug. However, many people can restore their blood pressure to normal limits simply by increasing potassium and by reducing sodium from this ridiculously high 4,000 mg a day to somewhere between 500 and 1,000 mg a day.

Passwater: OK, I believe that we have established the practical benefits illuminated by your findings. Now, let's chat about the details of the work itself, which, in my opinion, is Nobel Prize stuff on a level with the discoveries of the structure of DNA and the Krebs Cycle. You've helped elucidate one of the cell's basic mechanisms, and, along the way, you seem to have proven the connection between potassium-salt balance and blood pressure. What got you started?

Moore: I got into this not because I was interested in any particular disease, but because I was interested in basic physical mechanisms of how the cell works and how the sodium/potassium pump is involved. When I was a graduate student at Purdue's Physics Department in 1958, I decided to work on that mechanism. I had heard Professor Lorin Mullins, head of the Department of Biophysics at the University of Maryland, refer to calculations that indicated that the sodium pump in a resting cell used almost a quarter of all the energy available. Any mechanism that uses that much energy has got to be important. If you looked at the power distribution in a city and you found one operation in the city was using a quarter of all the electricity, you would think it was an awfully important operation.

When I did some of my early studies about the functioning of the sodium/potassium pump, I uncovered some clues that led me to think that insulin might be affecting it. Later, my group-and also that of Dr. Torben Clausen in Denmark-demonstrated that insulin does indeed regulate the sodium/potassium pump. That is pretty well established now. Additionally, with the help of research by Dr. Ken Zierler at Johns Hopkins University, we know that the action of insulin on this pump occurs at concentrations even lower than those required to affect glucose uptake in cells. This is another clue that insulin action on the pump is awfully important.

Then some theoretical analysis suggested that insulin might be raising the pH (measure of acidity or alkalinity) inside cells, thus making the cell interiors more alkaline. We did experiments in that area, and we were the first to show that is indeed the case. People used to think pH inside cells was constant. Before we did the experiments, I made a habit of asking any biologist or biochemist I would meet at a scientific conference-at least three dozen, I would estimate-"Is the pH inside the cell variable or constant?" The answer invariably was that it had to be a constant. "Why," I would ask. "Because every enzyme is affected by pH," they would invariably answer. It is true that every enzyme is affected by pH, and everyone was assuming -- as I had originally -- that the pH in the cell was therefore constant.

Of course, the corollary hypothesis is that there is a pattern to the enzyme pH profile, which is indeed the way it turns out. The pH is not constant, but is a physiological variable. The pH level is involved with regulation of glycolysis, and to some extent, cell division.

Three or four people besides myself had begun working on regulation of pH. Before long, a couple of the others showed that one way to accomplish this regulation is via the sodium/hydrogen exchange pump, whereby sodium leaks back into the cell due to a difference in its energy gradient. Technically, the electrochemical potential -- or free-energy gradient -- provides the energy to move a proton, which is acid or a hydrogen ion (H+) out of the cell.

That was a possible way to explain our observation of insulin-increased pH. So we undertook experiments that confirmed our theory. Those experiments, incidentally, were very gratifying because they were based on a thermodynamic mathematical analysis that makes predictions which we verified, namely, that at a certain calculable value of extracellular sodium, if the sodium is lowered by replacing it with magnesium or sucrose, the sodium/hydrogen exchange pump no longer works. Further, if the sodium is lowered below that point where the insulin stimulated it, it should make the pH more acidic. And that's what actually happens. This is neat: just by changing the sodium outside the cell, you can convert the action of insulin on glycolysis from stimulation to inhibition.

Passwater: In other words, the pH would go down (more acidic) instead of going up (more alkaline), which is what it normally does.

Moore: Indeed, that is the case. Our work was pretty decisive, but the finding has been ignored by most researchers. But a lot of our other findings on insulin and pH haven't been ignored. In fact, there are a lot of researchers following up on this now. What's disappointing is how few of them are referring back to the original papers written by our group.

Parenthetically, we showed this is the way that insulin affects and stimulates glycolosis: if we lowered the sodium outside the cell below this particular value that can be calculated, we found that insulin-instead of stimulating glycolosis-inhibits it. All this without adding any foreign chemicals. This is a pretty convincing conclusion.

In the process, other people with whom I had worked, including my former major professor, showed that besides the sodium/hydrogen exchange pump, there is a sodium/ calcium exchange pump. This sodium/ calcium exchange pump moves three sodium ions into the cell in exchange for one calcium ion going out.

Passwater: Let's remind our readers that calcium ions have a charge of "plus two," whereas potassium ions and sodium ions each have a charge of "plus one."

Moore: Yes, and now this is a stociometric ratio of 3 to 2 in terms of charges and 3 to 1 in terms of ions. This is opposed to the sodium/potassium exchange pump which is not stociometric.

Passwater: For our non-chemist readers, stociometric merely means a constant proportion is involved. Chemists use this term to describe relationships in which the proportion of the elements involved follow the Law of Constant Proportions.

Moore: The sodium/potassium pump does not have a fixed ratio of sodium to potassium ratio, although textbooks find it convenient to say it is a 3 to 2 ratio.

The sodium/calcium exchange is electrically not neutral, so, therefore, the membrane potential affects that. A higher membrane potential will tend to make that pump move calcium out. At each cycle, that pump moves a positive charge in. The other thing that will make it move calcium out is lowering the sodium inside the cell.

About the time all this was worked out, a researcher called me about an article that I had written about a compound that could stimulate the sodium pump. In the paper, I had mentioned that this compound acted like a "super potassium ion." He was interested in that, and I wondered why. It turned out that he was doing experiments on high blood pressure and he, as well as others, had found a substance in the blood of people with high blood pressure that tends to inhibit the sodium potassium pump.

That was when the proverbial light bulb came on in my brain. I realized that if you inhibit the sodium/potassium pump, of course sodium is going to build up inside the cell. Inhibition of the sodium/potassium pump also causes the plasma membrane (the outermost of the cell's "skin") potential to decrease.

Both of these effects are going to affect the sodium calcium exchange pump in a way that will make it work less actively. Therefore, you are also getting an increase of calcium inside the cell. It is possible, in fact, to calculate exactly what the limits of that increase would be. I believe it was Dr. Mordecai Blaustein, head of the Department of Physiology at the university of Maryland, who showed something like a 5% increase in sodium inside the cell. And this, he said, results in about a 150/cr20% increase in calcium in the cell. It is something like that order of magnitude. Drs. Blaustein and Mullins were both at the University of Maryland, and their groups, as well as a group at Cambridge, had worked out this sodium/calcium exchange pump.

So we now know that this mechanism, the sodium/ calcium pump, is very sensitive to a slowdown of the sodium/potassium pump. Therefore, calcium is going up in all the cells of the body, because we know that a decrease in the potassium and an increase in the sodium in people with high blood pressure is occurring in all the cells of the body-not just the arterial wall cells. But, if one thinks for just a moment-as this researcher who called was thinking: the smooth muscle cells around the small arteries or arterioles control blood pressure. Add to this the fact that the trigger for causing muscle contractions is calcium, and it becomes obvious. It was one of those things where two and two were sitting there in front of me and I hadn't bothered to add them together.

What suddenly came to me was the recognition that as calcium goes up in those muscle cells, the muscles are stimulated to contract and constantly constrict the blood vessels. This, of course, raises blood pressure. Dietary sodium can be the cause of the increased calcium in these cells and the resultant constricted blood vessels. Potassium would, of course, stimulate the sodium/potassium pump and, thus, indirectly, through the resulting increase in sodium-calcium exchange, decrease the intracellular calcium and allow the muscles in the blood vessel walls to relax.

It immediately hit me-why would anyone want to use this so-called "super potassium" instead of using potassium itself? After all, the compound that I had reported on as a "super potassium" presented problems. I had reported in the article that this so-called "super potassium" punches holes in cell membranes over time. I wouldn't go near it, It was bound to be extremely toxic.

Of course, potassium ions are natural things and can't be patented. However, new compounds can be patented and used as drugs. So I tried to speak to the people at the Hypertension Society about the benefits of the natural compounds of potassium over the synthetic drugs, but they didn't want to talk with me or any of my group or the other researchers that I mentioned. That's why I wrote my first book with Dr. George D. Webb -- The K Factor: Reversing and Preventing High Blood Pressure without Drugs (Macmillan, 1986) Why deal with possible dangerous drugs when simple natural substances can do better and more safely?

I wanted this information out in the physicians' and public's hands.

The idea for writing The K Factor wasn't mine. The other researchers also were perturbed because no one would listen to the basic truths we were unearthing. Dr. Mullins especially was annoyed because he had had a similar experience. He couldn't get the cardiologists to listen to the thesis that sodium-calcium exchange is involved with the action of digitalis-increased strength of contraction even though the facts were published in the scientific literature. So he wrote a book about it, We knew we weren't going to get the Hypertension Society to pay attention, so we decided to leapfrog them and go directly to the practitioners and public. I also took the message to the radio and TV airwaves.

Initially. I thought that supplemental potassium alone would be enough to lower blood pressure. But, as I got into it further and really thought it out, I could see it is a lot more than that. A low ratio of potassium to sodium may be the cause of high blood pressure, but blood pressure is not the whole problem. It's very much like dealing with a fever that is caused by an infection.

The elevated body temperature, if it gets high enough, can cause damage, but treating the fever without treating the infection is not the total answer. We try to bring this out in The Salt Solution and in The High Blood Pressure Solution. This potassium-sodium imbalance is a big, big health problem. But, it has been hard to get people to pay attention to it, Now, we are finding that physicians who treat stroke patients are becoming interested. It seems that treating strokes is one of the most discouraging things you can do in medicine.

As I indicated, this potassium/ sodium imbalance is present in every cell in the body. We now have very strong evidence-not totally conclusive, but very strong evidence-that this potassium/ sodium imbalance also is a cause of insulin resistance. Furthermore, this potassium/sodium imbalance, which contributes to insulin resistance also is associated with an abnormal metabolism of carbohydrates and fatty acids, and may contribute to causing Type 2 diabetes. I just mentioned that the Hypertension Society people did not want to listen to us. Well, we had the same experience with the Diabetes Society when Dr. Ken Zierler and I tried to show them the link between sodium and insulin resistance.

I predicted in 1986 in The K Factor, that this potassium/sodium imbalance would be causing other disease states and I mentioned it again briefly in my 1993 book, The High Blood Pressure Solution: Natural Prevention and Cure with the K Factor. (Healing Arts Press) Now, The Salt Solution documents the fact that there are indeed quite a few other disease states caused by this potassium/ sodium imbalance. These relationships all have been discovered in the past five to seven years, and my guess is that we will find even more.

Passwater: I understand that you have updated The High Blood Pressure Solution and that the revision is in press now.

Moore: Correct. There are a couple of things worth noting with regard to high blood pressure. One is that vegetarians almost never get high blood pressure. That simple fact should say to people in flashing neon lights that hypertension is obviously something about diet. First, we know, from other lines of evidence, that there is a potassium/ sodium ratio which is extremely high in that kind of diet, and you don't have to be a vegetarian to get that kind of ratio.

What I did was rank diets of various groups of peoples by the ratio of potassium to sodium in the diets. I found that when you have people with diets better than three-to-one potassium over sodium, you don't see any significant incidence of hypertension. When the diets get down to two-to-one, you begin to see a noticeable incidence of hypertension and when they get down below a one-to-one ratio, there is a lot of hypertension. I chose four-to-one to allow for a margin of error. Of course, we evolved on a much higher ratio than that, about 16-to-0ne. Even relatively recently in history, before food processing, except for the peoples using salt to cure things, the ratio was above four-to-one, closer to ten-to-one. Even meat has a ratio of a little over three-to-one. Kosher meat is probably higher because most of the sodium is in the blood, which is eliminated.

The experience in Finland shows what can be accomplished by just going part way -- by using a salt substitute that replaces 28% of the sodium with potassium and another 12% of the sodium with magnesium (a total of 40% of the sodium replaced, and with significant amounts of the "good guys" added). The Finnish experience doesn't come anywhere near a 4 to 1 ratio -- it's not even up to a 1 to 1 ratio -- yet it was enough to reduce strokes and heart attacks by 60% throughout the nation.

The population of Finland is over five million, and this certainly is larger than the number of participants in any of the drug studies. The biggest drug study on hypertension involved only 17,000 people. The fact that this was done in a whole country and they succeeded in getting this salt-substitute used instead of table salt in food processing, in fast food restaurants etc., as well as at home, shows what can be done. It's simply amazing that few in this country seem to be aware of this even though the information was published in 1996.

Passwater: How about the DASH (Dietary Approaches to Stop Hypertension) diet studies?

Moore: The DASH diet is a step in the right direction, but it doesn't go far enough. It is very frustrating to me because it is entirely based on empiricism and "group think." Those responsible for the DASH diet just looked at evidence showing that there is a little bit of help to be derived from potassium, a little bit of help from sodium and so on. They put the DASH diet and clinical studies together without an understanding of the fundamental relationship between sodium and potassium. That is, they didn't understand the very important point that, because of osmotic equilibrium, the sum of the sodium and potassium inside the cell is very close to constant (within about 2%).

Therefore, it is virtually impossible -- not just because of the sodium/potassium exchange pump and all these things in the body which tend to move sodium in one direction and potassium in the other direction, but just because of physical reasons (the laws of physics) -- to lower sodium inside the cell without the involvement of potassium. Potassium has such an important role in the body. You can't lower the sodium without replacing it with potassium. That is the key: there is just no sense in talking about either sodium or potassium alone! This is so awfully important. It is one point that I would love to get across to the medical profession, but up until now most practitioners have failed to get it.

Therefore, the vast majority of those studies that have been done with dietary sodium were very poorly designed, scientifically. They didn't take into account that this is not a one variable situation. There are two variables that must be taken into account together! The two are linked, and you have to look at them together if you are going to see a pattern.

Passwater: Everyone in clinical studies is trained to look at one variable at a time, no wonder that synergistic effects are missed.

Moore: Not in physics-that's where my background is.

Passwater: It's a shame that more biochemists don't know a little about biophysics.

Moore: In medical school, this idea of trying to change one variable at a time has become a religion. But the only way you can do that is with drugs. You can change an intake of a drug, i. e. one variable, but once you look at what is going on inside the body, you discover that everything is interlinked. Thus, it is impossible to change one variable without all the others also shifting.

Passwater: I call that polypharmacy, and it's just too complex for the scientific method that people have been trained to use. All the nutrients seem to have interactions, and you just can't study them individually.

Moore: That's right. Nutritionists are still talking about sodium requirements. It depends on the potassium levels in the diet, too.

Passwater: It goes on and on. We try to get the message across. Eventually, clinical researchers will design clinical studies to look at more than one variable at a time. In the meantime, I guess we'll have to put up with some frustration.

Thank you Dr. Moore for chatting with us about potassium-sodium ratios and hypertension. Next month, we'll be joined by your Salt Solution co-author, Mark McCarty. WF

2001 Whole Foods Magazine and Richard A. Passwater, Ph.D.

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