© 2001 Whole Foods magazine
April 2001Potassium-to-Sodium Ratio Affects Overall Health
Part 1: Innovative Supplements Have Helped Millions
An Interview with Herb Boynton
By Richard A. Passwater, Ph.D.
When most people think of salt and health, they think of blood pressure. Many, if not most people, are not "salt sensitive" meaning that they can eat salted French fries or potato chips and not notice a rise in blood pressure. So they may reason, "If I'm not salt-sensitive, then I don't have to worry about my salt intake. That's for the salt-sensitive people to worry about."
Wrong! Salt intake, particularly the ratio of potassium to sodium in our diet, affects the functioning of every cell in our bodies!
So, even if your blood pressure doesn't rise with increased salt intake, your rate of aging is increasing, your arteries are stiffening, your bones are weakening, your nerve impulses are slowing, your memory is declining, your risk of kidney stones is increasing, your ability to fight against cancer is impaired and the ability to nourish every cell in your body is decreased. There is overwhelming evidence that an excess of dietary salt, coupled with a deficiency in potassium, is perhaps the single largest contributor to health problems in the U. S.
Salt can cause diseases having nothing to do with blood pressure. One could say that, to a large extent, your health depends on the balance of potassium to sodium (salt) in one's body. By improving your potassium-to-sodium balance, you can lower your risk of heart attack, stroke, osteoporosis, asthma, ulcers, stomach cancer, hypertension and other salt-linked killer diseases. The good news is that increasing the amount of potassium in your diet can counterbalance the effects of high salt intakes.
Bringing this information to the public has been a passion of a longtime friend of mine, Herb Boynton. Herb and his colleagues-Richard Moore, M.D., Ph.D., a pioneer in potassium and sodium biochemistry, and Mark McCarty, a health researcher have written a book, The Salt Solution, that should be read by everyone. I repeat-everyone-not just those interested in health, not just those who have high blood pressure, but everyone!
There is no commercial interest in this passion of Herb Boynton. It is just that Herb developed high blood pressure at an early age, and he knew what a devastating effect that could have on his health and longevity. So, as a "labor of love," he has researched the subject for several decades and now, in the book, in this column and in subsequent interviews with his co-authors, we are able to benefit from his experience.
Herb also is a student of the Paleolithic (Stone Age) and present-day primitive diets. One of the many good fortunes of knowing Herb for more than a quarter of a century is that there have been countless times that he has bent my ear about studies of one primitive diet or another and its health benefits. Herb has been a major contributor to the field of applied nutrition, and yet many people today may not know about his contributions, nor the research that he sponsored at various laboratories around the world. Among other accomplishments, as founder of Nutrition 21, Herb developed and introduced the first-ever selenium and chromium supplements. These nutritional products have improved the health of millions of people around the world.
Herb is "retired" now, which means that he may find more time for writing. He was one of the first to write about selenium and other trace elements in nutrition magazines. His vocabulary and elegant style are legendary, and his early (mid-1970s) articles in Let's Live and Bestways were classics. Please join me for a chat with Herb about his important role in the natural products industry, both past and present.
Passwater: Herb, tell us about the origin of Nutrition 21?
Boynton: About 45 years ago I contracted polio. I was young and in peak physical condition; it was the last thing I expected to happen. I wondered how a vital young guy like me could get a terrible disease like that. It triggered an interest in nutrition that persists to this day. That was the primary reason I founded Nutrition 21. The year was 1973, and I was 49 years old. Nutrition 21 was founded to be a nutrition research firm, and thus began a 25-year intensive course in applied nutrition.
Passwater: You attribute your interest in trace elements to your friend Dr. Klaus Schwarz. As you know, I dedicated my 1980 book, Selenium as Food & Medicine, to Klaus. How did your friendship with Klaus come about?
Boynton: In 1972, 1 read a fascinating article in Scientific American entitled "The Elements of Life." It discussed the manner in which Klaus had invented trace element "isolators" which could restrict the dietary content of a trace element. With the aid of these controlled diets and laboratory animals, he had been able to demonstrate the nutritional essentiality for seven or eight elements that formerly were thought to be unimportant or even toxic. These trace elements included selenium, chromium, silicon, vanadium, nickel, tin and others.
This was an utterly remarkable achievement on Dr. Schwarz's part, and in my view he should have received a Nobel Prize. In any case, he was interested in what I was doing, and together we were able to develop an organic selenium product and later an organic chromium product, both of which Nutrition 21 introduced into the marketplace.
Passwater: Why did you choose selenized yeast to be your organic selenium compound?
Boynton: We didn't think that inorganic forms of selenium were good choices nutritionally. We jointly decided to see if we could grow a yeast product. Yeast already is in the food supply, of course, and it normally contains significant amounts of selenium. We thought that we might be able to increase the amount of selenium normally found in yeast.
We contacted Dr. Henry Peppler at Universal Foods Corporation in Milwaukee, and he agreed to run a series of tests to see if that would be possible. The first few tests were failures, but after about five or six months, we were able to grow a yeast that contained approximately 1,000 parts per million of selenium, and it was indeed organic. A large percentage of the organically bound selenium was in the form of selenomethionine, but it also contained several selenium-peptides. We introduced that into the marketplace about 1975. Anyway, it was just in time for your 1975 book Supernutrition: Megavitamin Revolution, which told the public about your research and the health benefits of selenium.
Passwater: Well, our friendship goes back to that time. You introduced yourself to me after one of my lectures, and I had already known about you from your writings. By the way, we have more sophisticated analyses of selenium yeast now. The best that we could determine before was that selenium yeast contained largely selenomethionine, selenocystine and seleno-peptides. Now, thanks to more sophisticated techniques using high performance liquid chromatography-inductively coupled plasma-mass spectrometry (HPLC-ICP-MS). we know that selenomethionine accounts for no more than about 20% of all selenium-containing compounds. Another group of selenium-containing compounds include selenocystine (which 1 used in any earlier research), seleno-methylselenocysteine and selenoethionine. There also is another group of compounds, mostly unidentified al this time, that make up a about 40% to 50% of all the selenium compounds in yeast. These unidentified compounds may include selenophosphates, triphenyl phosphine selenide, diselenides, triselenides and other very interesting organic selenium compounds.
Later, you introduced selenomethionine, but your next innovative product was GTF-Chromium. Before you introduced it, you permitted me to test it on diabetic mice in my laboratory. The effectiveness of GTF-Chromium was readily apparent in the diabetic mice. Diabetic mice fed the RDA of all nutrients including chromium in the form of chromium chloride grew to be obese, pear-shaped, had high blood sugar levels and were short-lived. Diabetic mice fed the same diet, except that an equal amount of chromium as GTF-Chromium replaced the chromium chloride, grew normally, were normal in shape, did not become obese, had normal blood sugar levels and had normal lifespans.
Chromium is a very important supplement and I enjoyed researching with it and writing about it in my 1982 booklet, GTF Chromium (Glucose Tolerance Factor). How did the discovery of GTF chromium come about?
Boynton: Glucose Tolerance Factor (GTF) was the description for the organic form of chromium that helped insulin function to transport the blood sugar glucose through cell membranes. It was Dr. Schwarz's suggestion that we try to do the same thing for chromium that we did for selenium, and grow yeast with more organically bound chromium than normal. We tried to do this at the same time that we were developing selenized yeast, but-where as it took us only a few months to get a successful method of growing selenium yeast-it took us over a year to achieve a chromium yeast with organically bound chromium. GTF-Chromium was introduced into the marketplace about a year or two later than selenium yeast.
Passwater: Much of what has been reported in the scientific literature about GTF is associated with Dr. Walter Mertz. Wasn't Dr. Mertz a colleague of Dr. Schwarz'?
Boynton: This is true. Dr. Schwarz introduced me to Dr. Mertz and I have had intermittent conversations with Dr. Mertz over the years. As you know, these two scientists were mutually responsible for determining the nutritional essentiality of chromium. I last saw Dr. Mertz about two years ago at a chromium symposium in Boston; he is now enjoying a well-deserved retirement.
We were never able to determine the precise chemical constituents of our chromium yeast, and we still haven't. With regard to the chromium yeast, we know that the chromium is organically bound, but we were never able to elucidate the precise formula of that product. Just as you mentioned that other organic selenium compounds have been identified in selenium yeast, I am sure that there are several interesting organic chromium compounds in GTF yeast.
Later, of course, we became aware of Dr. Gary Evans' patent on chromium picolinate, and our initial tests convinced us that this was a better form of chromium than our GTF-chromium yeast. So we licensed the patent for chromium picolinate from the U.S. government.
Passwater: That was another exciting development! I wrote a series of Vitamin Connection columns on chromium picolinate between February and June of 1989. It also became the focus of my 1992 booklet, Chromium Picolinate, and my 1993 book, The Longevity Factor. This nutrient is so important to insulin function. Also, it helps prevent damage to the body that may result from even only slightly elevated blood sugar levels. The things to watch for are glycation and the formation of Advanced Glycosylation End-products (AGEs) .
You sponsored several clinical studies and research with these compounds, particularly chromium picolinate.
Boynton: Yes, we did. The most important of these was the one that we did with Dr. Richard Anderson of the U.S. Department of Agriculture and Dr. Nancy Cheng. This research started about 10 years ago in Beijing. It first was reported at the annual meeting of the American Diabetes Association in San Francisco in June 1996 and was published in 1997 in the journal Diabetes. The paper was titled "Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes." That study was particularly important because it demonstrated that, at both the 200 mcg and 1,000 mcg dosages, chromium picolinate had very impressive salutary effects on the blood sugar levels of nun-insulin-dependent diabetics. Moreover, benefits were observed at both fasting blood levels and levels of glycosylated hemoglobin. We were extremely pleased with the results of that test.
I might say in passing that the reason we did this in China was that no one was willing to use 1,000 mcg of chromium in the United States, despite the fact chromium is remarkably safe even at gigantic dosages. It was an irrational fear. Nevertheless, we were unable to obtain permission to do this test in the U.S. We were very grateful for Dr. Nancy Cheng for making the Beijing hospital available to us.
Passwater: Somewhere between the work on the two chromium supplements, you introduced L-selenomethionine. I believe that all of the human clinical tests with selenium have been with selenium yeast. What was the story behind selenomethionine?
Boynton: In the early 1980s, there was a scare about yeast products. Although brewer's yeast and baker's yeast had long been staples in health food stores, the public was misled into thinking that nutritional yeasts were related to Candida and that people should be on yeast-free diets. The truth is that nutritional yeasts are totally dead cells. There are a few strains of pernicious yeast, but these have live cells. I recall that you wrote about this ungrounded fear in this column a year or so ago. (Author's Note: There were two columns, both appearing under the overall title "Nutritional Yeasts and Yeastophobia," The first was published in June 1999 and featured Dr. Seymour Pomper, and the second, published in July 1999, spotlighted Dr. Jack Sobel.)
Since many people stopped taking their selenium yeast supplements, I didn't want them to miss the health benefits of selenium, so, with time and effort, we developed L-selenomethionine supplements.
Passwater: Why did you become so passionately interested in potassium and sodium?
Boynton: In 1942, before I'd reached 18, I tried to enlist in the Navy. To my great dismay, I flunked the physical; they told me my blood pressure was too high. I did pass the Army physical, which was more lenient, and I spent the next three years in World War II.
Over the ensuing decades, my blood pressure remained high-too high to even qualify for life insurance. The fact that Nutrition 21 was a research firm immersed me in the scientific research on diet and health. One of the most important facts I learned was that correcting my potassium/sodium balance might reduce my blood pressure and my risk of heart disease as well as other diseases.
As a result, I reduced my salt intake. I began by giving up potato chips (which 1 dearly love) and ate more fresh fruits and vegetables. Changes didn't occur overnight, but after a few months, my blood pressure dropped into the normal ranges. Now I'm in my mid-70s, and my blood pressure hovers around 115 over 75-lower than the blood pressure of many adults decades younger. I no longer worry that I might die of a stroke, as my mother, my sister and my favorite aunt did.
I do, however, continue to watch my salt and potassium intake very carefully. It's the smallest of dietary sacrifices, and the rewards are incalculably rich.
Passwater: What you seem to have mastered so well and for so long gives many others immeasurable difficulty. There are countless numbers of people who need help in adjusting their taste to less salt in their food or in easily increasing their potassium intake. Your book addresses both concerns and we'll chat about them later, but your mention of the word "rich" reminds me that salt was once a measure of wealth. In my 1983 book, Trace Elements, Hair Analysis and Nutrition, I point out that salt was once used as payment for goods. In fact, the word salary is derived from this practice. Then there is the phrase "not worth his salt." Salt has been regarded very highly in the past.
Boynton: Salt is more than a seasoning, and salt craving is almost universal. Several countries even have taxed salt. In India, Mahatma Gandhi led a "salt march" in 1930 to protest the British policy of monopolizing the production, sale and taxation of salt. In 18th-century France, where salt was very expensive and heavily taxed, 10,000 people a year were arrested for smuggling salt-and 300 a year were hanged.
Salt is indeed an essential nutrient, and it used to be scarce. For about 99.5% of human history, salt was so scarce that our bodies learned how to hoard it. It used to be that we had far more potassium in our diet than sodium. Paleolithic diets had about 16 times more potassium than sodium, whereas modern "civilized" diets have about 1.6 times more sodium than potassium.
Through the millennia, our- bodies learned how to hang on tenaciously to sodium and squander potassium. Because sodium has been so scarce in diets until modern times, our bodies developed mechanisms to hang onto every morsel of sodium it could. The sodium-potassium pumps in the kidneys are different than those in other tissues and they function to return sodium back into the bloodstream. Now our diets consist largely of processed foods instead of whole foods. Food processors refine foods in such a way as to reduce potassium and then they add salt to satisfy our cravings and taste preferences. The result is that millions of Americans suffer from a silent but deadly deficiency of potassium, while consuming massive amounts of salt. We eat more than a week's worth of salt every day-while eating only two-thirds as much potassium as we should.
Passwater: As far as I am concerned, the most important finding in your book is that an unbalanced, upside-down ratio between potassium and sodium can affect every cell in the body and greatly affect health and longevity. This is not just a blood pressure thing. Please elaborate.
Boynton: Our bodies have trillions of cells, and each and every cell is dependent on the balance between potassium and sodium. These two electrolytes power the cell membranes to move many biochemical compounds in and out of the cells. Potassium and sodium, using energy produced from food "burned" by the cell in the form of adenosine triphosphate (ATP), act as a pump to move compounds through the cell membranes. This is commonly called the "sodium-potassium pump." The sodium-potassium pump is essential to every cell in your body, and it is a component within all cells of almost all animals on earth-even one-celled animals.
Passwater: That's an important point. When students learn about the sodium-potassium pump, they are told of its importance in nerve, muscle, gastric or kidney cells, but few appreciate the fact that the sodium-potassium pump is critical to every cell. In fact, the energy used by all of these tiny sodium-potassium pumps amounts to one-fourth of the calories consumed by people in calorie balance. Our bodies wouldn't spend this much energy on one function unless there was a very important reason. Just what are these pumps doing and why?
Boynton: The pumps actually are proteins in the cell membranes that pull potassium into the cell interiors and push sodium out. Because the pumps move more sodium out than potassium in, they generate a voltage between the inside and the outside of the cell.
Passwater: The passive transport via diffusion would allow the sodium and potassium to equilibrate on both sides of the cell membrane, and thus there would be no electrical charge. However, the active transport of the pump, which requires energy, concentrates potassium inside the sell and sodium outside the cell.
Boynton: Yes, the pump moves three sodium ions out of the cell for every two potassium ions it brings in. Since both sodium and potassium ions have a positive charge of one (valence), the result is that there is a net transfer of positive charges out of the cell.
Passwater: The pumping action against the gradient is brought about by a protein commonly called "sodium, potassium ATPase," which functions by conformational changes that can attract or repel one of the ions or the other. The conformation change by the protein requires energy from ATP But we still haven't explained why building up this charge, a voltage across the cell membrane, is so important.
Boynton: Well, the electrical potential, the voltage, is like a battery and is capable of doing work. This is called the "sodium battery." One of the key things that this sodium battery does is to drive electrical signals along nerves. It also determines the tension and relaxation of muscle cells by its effect on the calcium pump. And cells couldn't make the proteins they need without the amino acids that are transported through the membrane with the help of the sodium battery. It also enables glucose to enter the cell against the gradient and to become fuel for the energy of the cell to perform all of its functions.
Passwater: OK, I think that our readers get the idea that the potassium-to-sodium balance is indeed critical to the functioning of every cell in our bodies. It appears that if the potassium-to-sodium balance is not right, then the sodium battery does not become fully charged and the electrical potential of the cell membrane is diminished. This, at first, has the effect of stiffening the membrane and decreasing the flow of nutrients into the cell. In essence, the membranes function like aged membranes. The body is aging biochemically. If the voltage further decreases, channels and pores in the membrane may malfunction. Eventually, various illnesses develop. We'll talk more about the calcium pump later on when we talk about why an imbalance of potassium and sodium may be more to blame for osteoporosis than a lack of calcium.
Now that we have given a simplified explanation of the sodium-potassium pump and its importance to overall health, we should point out to our readers that one of your co-authors, Richard D. Moore, M.D., Ph.D., is a pioneer in researching the sodium-potassium pump. How and when did you meet Dr. Moore?
Boynton: Dick and I have been friends for about 20 years. He is now professor emeritus of biophysics, State University of New York. His 1986 book, "The K Factor" was the seminal book for the public on the importance of the potassium-to-sodium ratio. He also wrote a second book, The High Blood Pressure Solution, which is similar to The K Factor but uses language that is easier for the average person to understand. Both books, I thought, were excellent, and it bears saying that Dr. Moore probably knows more about potassium-sodium relationships and the sodium-potassium pump and its relation to general health than anybody else. We were extremely fortunate to secure his assistance as a co-author.
Meanwhile, it should be pointed out that our book is not a technical book. We don't dwell on the science of the sodium-potassium pump. Rather, we concentrate on practical aspects and teach readers how easy it is to make the dietary changes that will improve their health.
Passwater: I found the book very clear and reader-friendly, with lots of practical advice. Your other co-author is Mark McCarty, who formerly was your research director at Nutrition 21. How did you meet Mark?
Boynton: When I started Nutrition 21, I hired medical students from the University of California in San Diego to do research for me. There was a succession of five or six very bright kids who helped me out in the early years. I couldn't afford to hire anybody full time. The brightest of them all was Mark. He was a third- year medical student at the time, and he became extremely interested in nutrition, eventually deciding he would rather be a research biochemist than a medical doctor. So we hired him full time, and he has been enormously important to Nutrition 21. Mark is an extremely bright young man.
Passwater: Well, when a Mensa-qualified person like you calls someone else bright, that is saying a lot. So, as I see it, you have blended your experience as both a supplier of nutrients and a patient who had to learn to balance sodium and potassium, Dr. Moore's experience with the sodium-potassium pump and Mark McCarty's medical research experience, and you have written The Salt Solution. What other diseases besides hypertension do you discuss in the book?
Boynton: Initially, we were interested primarily in the high blood pressure/stroke situation, but the more research we did the more it became evident that potassium-sodium imbalance is linked to a number of other diseases, and among these is osteoporosis. In a metaphorical sense, excess salt simply sucks calcium out of the bones. I would say that a high-salt diet probably is a greater hazard for osteoporosis than a low-calcium diet. By merely reducing salt consumption to rational levels, the problem of osteoporosis can be greatly ameliorated.
Passwater: This is due to the effect of the sodium-potassium pump on the calcium pump. Please elaborate a little on the calcium pump.
Boynton: Earlier, we talked about how the sodium-potassium pump uses the energy from food to make a "sodium battery." The calcium pump removes calcium from cell interiors by letting some of the sodium back in. In effect, the sodium is trying to get back into the cell, drawn by the charge differential. Remember, the cell interior has a negative charge that attracts ions such as sodium. The membrane protein, calcium ATPase, could be called the calcium pump. It is like a wheel that loads up three sodium ions on one side and one calcium ion on the other. This "wheel" also is powered by ATP. Since calcium has a charge of plus two (valence), the net effect is that the negative charge on the cell interior is reduced and calcium is removed...
Passwater: ...from the cell. So the imbalance of potassium and sodium results in calcium being forced out of cells. Oops, I seem to have interrupted you. You were discussing other salt-related diseases.
Boynton: We also found a relationship to asthma and clear relationships to gastric cancer, ulcers and, surprisingly, to age-related cognitive memory decline. The data there are very, very impressive. It seems absolutely true that sustained isolated systolic blood pressure is a factor in dementia and in memory decline in older people and, possibly, even in younger people as well.
Passwater: OK, we have introduced all three authors and set the stage. In Part 2, planned for the June issue, we will discuss more specifically the benefits of improving the potassium-to-sodium ratio and the consequences of not doing so. Plus, we will zero in on some easy and practical tricks to improve one's potassium-to-sodium balance. WF© 2001 Whole Foods Magazine and Richard A. Passwater, Ph.D.
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