“I want to be empowered to do what is best for my own health, and I want you to be empowered to do what is best for your own health.”
As health and fitness professionals it can be hard to find information that is trustworthy. The health and fitness industry is full of misinformation, making it tricky to navigate for gym owners, personal trainers, coaches and our clients. How often do you have a client ask questions about the latest diet and fitness fads?
Exercise alone is not the answer to the health epidemic we are currently facing. Exercise is important, but we can not expect our clients to achieve ongoing results if they don’t take care of the 5 pillars of sustainable health:
Stress Management
Rest and Recovery
Diet
Training
Community
In this blog post, I want to talk about the importance of some very key minerals that are often overlooked on the diet. Optimal health is not achieved by following a diet that is based on calorie intake and macronutrient balance if it fits your macros is not good enough. Yes, we can improve body composition and health markers by following such a diet plan, but we could achieve this and more by correcting nutrient deficiencies and improving hormone balance.
So where do we start? What's the best bang for your buck in terms of optimising nutrient-density in the diet? In the perfect world, an initial client assessment would include functional blood work to determine the individual deficiencies of vitamins and minerals. Building a partnership with a functional medicine practitioner (FMP) of integrative doctor gives us the ability to look under the bonnet and help our clients individualise their nutrition and supplement plan.
Today I want to talk about two very important minerals that you and your clients should pay close attention to, sodium and potassium.
Sodium and potassium are friends who constantly chase each other around. Potassium is often found inside the cells (intracellular fluid), and sodium is often outside the cells (extra-cellular fluid), and together they create the “Sodium-Potassium-Pump” (SPP). The SPP consumes 20-40% of our energy at rest. Making sure the SPP is running optimally can boost both metabolism and health.
There seems to be little correlation between salt intake alone and high blood pressure. In some of the culture’s studied – higher salt consumption seems to suggest longer life expectancy – “…a low-salt diet may actually lead to serious health consequences and higher overall mortality, particularly in conditions like heart disease and diabetes…, a low salt intake is associated with higher mortality from cardiovascular events… the lowest risk of death for sodium excretion [is] between 4 and 5.99 grams per day…
Potassium and sodium attract water, therefore, it makes sense that potassium pulls water into the cells and sodium pulls water out of the cells. When we consume food and drinks that contain water, the water must get from the intestines into the blood before it can enter the cells. Potassium can not do this alone, sodium must first hydrate the blood before potassium can draw fluid into the cells.
TIP: It is far more hydrating to drink a glass of water with a tiny pinch of salt and some potassium-rich lemon or lime juice than to drink a glass of water alone. It’s also wise to drink small amounts of water while eating foods that contain sodium and potassium.
MYTH: There is a common myth that drinking water while eating food can dilute stomach acids and lower nutrient absorption. Most foods contain high amounts of water, especially carbohydrates. Eating foods that contain potassium and sodium can actually increase stomach acids and digestive enzymes.
Minerals that dissolve in water like potassium and sodium are called electrolytes. Other major electrolytes are calcium, magnesium, phosphorus, and bicarbonate (not a mineral). Because electrolytes dissolve in water, loss of water during sweating, vomiting, diarrhoea, or excessive urination can cause deficiencies in electrolytes.
Too much sodium:
Eating a diet high in sodium and low in potassium (a diet high in processed foods) will hydrate the blood, but leave the cells dehydrated. As the volume of water increases in the blood pressure will also start to increase, which in turn can lead to swelling in the hands, legs, feet, face, or virtually any part of your body. This increase the risk of cardiovascular diseases such as heart attacks and stroke.
Consuming adequate potassium can help remove the high levels of sodium in the blood and restore blood pressure to normal levels. To keep blood pressure stable, and to keep the swelling away, salt and potassium need to be kept in balance.
Hyponatremia: Low Blood Sodium
Hyponatremia is the medial label for low sodium levels in the blood. Signs and symptoms of this can include:
Headaches
Nausea
Attention-deficit
Bone loss and fractures
Vomiting
Muscle cramps
Fatigue
Disorientation
Fainting
Seizures
Stroke
Heart attack
Liver failure
Coma
Brain damage
Death
The following can cause Hyponatremia:
Diet low in sodium
Competitive exercise, especially in the heat, thirst can drive us to consume more water than our kidneys can filter and remove. The water accumulates in the blood and dilutes the sodium
Loss od sodium in vomit, sweet, to diarrhea
Kidney disease
Neurological disease
Certain medications like NSAIDs
Hypernatremia: High Blood Sodium
Hypernatremia is the medial label for low sodium levels in the blood. Signs and symptoms of this can include:
Dizziness
Fainting
Low blood pressure
Low urination volume
Lethargy
Irritability
Coma
Brain hemorrhage
Digestion and Absorption of Nutrients
The transportation function of sodium gives it a central role in the digestion and absorption of nutrients. Our stomach makes hydrochloric acid (HCL) to start breaking down food, digesting important vitamins from proteins so they can be absorbed later in the intestines. HCL contains chloride (found in salt), and sodium is used to transport it into the stomach. Thus, both components of salt, chloride and sodium, are key to digestion and absorption. People with low stomach acid (acid reflux is a sign of low stomach acid) should increase their sodium and chloride intake.
The digestive powers of sodium do not stop there. Sodium is used to transport digestive juices and bile acids into the small intestine. The digestive juices contain enzymes that will break down our food. The bile acids will be used to absorb fats, cholesterol, and fat-soluble vitamins (A, D, E, & K).
Sodium is also used to absorb glucose, the main carbohydrate, and most amino acids, which are broken down from proteins that are most abundant in meat, poultry, fish, eggs and beans.
There are many reasons why its important to correct sodium and potassium deficiencies as they can lead to deficiencies in:
Vitamin-C
Pantothenic Acid (vitamin B5)
Biotin (vitamin B7)
Sulphate
Some forms of selenium
Phosphorus
Magnesium
Iodide
Once nutrients are absorbed, sodium is used in the kidneys to prevent them from being peed out and to transport the nutrient to the cells so they can be used.
Sodium is also used in the transportation of other substances, such as hormones, drugs, toxins, and substances that are essential to life. For example, sodium is used to transport creatine, which athletes use for strength and hypertrophy gains. Creatine has also been shown to help with depression, increase stomach acid, maintain healthy skin, heal wounds, increase the swimming power of sperm, and process light inside the eyes.
Nervous System
Salt and potassium are used by neutrons in the cells, mainly in brain cells, to communicate with our sensors and control our movements. Cell singling through neurotransmitters is supported by sodium and potassium found in the nerve and muscle cells. Sodium and potassium are used to clear neurotransmitters to prevent them from having an effect for longer than intended.
A deficiency of sodium and/or potassium in the brain can disrupt the ability of a neutron to send and receive signals, and it could also make neutrons hypersensitive to neurotransmitters that rant being cleared effectively.
Further roles of potassium
Only one enzyme has established a sodium-dependency in humans, the breakdown of collagen. It's thought that this breakdown is required in the replacement of old collagen with new collagen.
Potassium directly affects a number of enzymes that have the following functions:
Decides whether glucose should be broken down for energy or conserved while protein is made into excess glucose to fuel the metabolism.
Burning glucose for energy.
Burning ketones for energy.
DNA repair.
Allows selenium to act as an antioxidant and can activate thyroid hormone, which raises metabolic rate.
Synthesises niacin (vitamin B3) from protein, and activates niacin found in plant food (niacin found in animal protein does not require this).
Prevents the production of unnecessary proteins that would waste energy and activate inappropriate metabolic pathways.
Coordinates gene expression during fasting states to break down unneeded proteins and damaged tissues.
Insufficient potassium can impact metabolism and hurt our ability to protect tissue from damage and repair damage as we age.
Bone and kidney health:
Sodium and potassium balance is essential to support bone health and kidney health. A number of studies have shown high levels of sodium can deplete the levels of calcium in the bones, and potassium has the opposite effect. High levels of calcium in the blood have been linked to kidney stones. The evidence isn’t very strong, but it suggests that sodium and potassium must be balanced to support bone health, kidney health, and blood pressure.
Hypokalemia: Low Blood Potassium
Hypokalemia is the medial label for low potassium levels in the blood. Signs and symptoms of this can include:
Fatigue
Muscle weakness
Muscle cramps
Muscle spasms or twitching
Bloating
Constipation
Abdominal pain
Slow heart rate, heart skipping a beat or flutters, and sometimes failure
The following can cause Hypokalemia:
A low potassium diet
Loss of potassium in vomit, sweat, diarrhoea, or excessive urination
Overuse of laxatives
Anorexia or bulimia
Magnesium deficiency
Excess consumption of black licorice
The use of diuretics
Kidney disease
High levels of aldosterone - a hormone that controls the balance of sodium and potassium
Prolonged fasting, starvation, or underrating, which sucks potassium out of the cells. Especially risky on a low potassium diet like ketosis
Hyperkalemia: High Blood Potassium
Hyperkalemia is the medial label for high potassium levels in the blood. Signs and symptoms of this can include:
Fast heartbeat at rest
Heartbeat skipping or fluttering
Tingling
Numbness
Weakness
The feeling of something crawling on the skin
Can be fatal
The following can cause Hyperkalemia:
Taking 18g of potassium at once
Certain drugs, especially when taking potassium supplements
Low levels of aldosterone - a hormone that controls the balance of sodium and potassium
Damage to the red blood cells or other tissues that cause potassium to spill into the blood
Kidney failure
The ratio is important
There is reason to believe that the sodium to potassium ratio is more important than the absolute amount of either.
Potassium abolishes the rise in blood pressure otherwise caused by high sodium levels
Potassium abolishes the loss of calcium otherwise caused by high sodium levels
Potassium and sodium work together to balance each other
Our ancient hunter-gatherer ancestors lived in an environment where they naturally got more potassium than they needed while trying to get adequate calories. They had to work hard to get enough sodium in their diet. We, therefore, have a tendency to crave salt but not to crave potassium, just like our ancestors.
Today we live in an environment where it's far too easy to get sodium and calories. It's much harder to get potassium. Our cravings can easily push us towards high salt consumption and not enough potassium.
The RDA recommendations for sodium only apply to people who don’t sweat heavily as a result of temperature or high-intensity activity and don’t take into account the need to balance sodium and potassium.
Low levels of sodium can cause fatigue, weakness, dizziness, or diarrhea. Insufficient sodium intakes fail to support digestion, energy metabolism and brain function. It is quite possible that the risk of fatigue, weakness, dizziness, diarrhoea, high blood pressure, and headaches are all lower when sodium intakes are close to the median intake of around 3000mg/d and potassium intakes are between the 4700mg/d, shown to prevent salt-induced rises in blood pressure, and the 11,000mg/d that our distant ancestors are thought to have consumed.
If we can consume potassium within the optimal range, salt food to taste, and limit the consumption of processed foods (high in sodium), we should be able to align sodium and potassium intake with our physiological needs. If you have high blood pressure or any type of swelling that it’s not associated with an injury, try to increase your potassium intake within the optimal ranges. If this fails to reduce blood pressure you might want to cut sodium intake to 1500-2300mg/d.
Food
We have excelled at predicting plant foods that are rich in calories and poor in potassium. Grains are low in potassium compared to tubers like potatoes, legumes (beans, lentils, peas), fruits and vegetables. In the last century, we’ve started refining grains to make out bread whiter, fluffier, and to give it a longer shelf-life. Refining food will lower their nutrient-density. Packaged foods are often high in hidden sodium, 70-80% of sodium in the typical western diet comes from processed foods.
The biggest contributors to sodium intake are the bread and other processed grain products, cheese, processed meats, condiments and sauces, packaged snack foods (crackers, popcorn, pretzels, and chips), and desserts (cakes, cookies, pastries, and pies).
Sodium in processed foods:
Preserves foods and helps beneficial bacteria out-compete bad bacteria
Assed to meat during cooking helps to draw fluid into the meat and make it juicier
Sodium creates a Gell like structure that holds together foods like hot dogs and breakfast sausages.
Sodium is used in baked goods like bread to slow the rising rate of the yeast. It allows the dough to become airy and it acts as a preservative
Sodium enhances or modifies the flavour
Sodium is added to pre-cooked meats as a preservative
Sodium is added to milk to create a whiter colour
Sodium is often added to condiments like salad dressings and sauces to bind fats and water together
One of the major problems with sodium processed food it the fact that it can be hidden from our taste buds, allowing us to consume large amounts by bypassing our natural tastes. Reducing or limiting processed foods can reduce sodium intake by a whopping 70-80%, but banning the salt shaker from your table can only reduce salt by up to 6%.
Sodium intake advice
A Sustainable Diet E-Book
Healthy eating is a lifestyle choice, not a diet.
If you’ve been eating a diet high in processed foods you should start by cutting all processed foods from your diet for 4weeks. If you’ve been eating a low sodium diet you may wish to increase your consumption of natural sodium-rich foods for 3-4weeks. The reason we do this is to reset the salt taste-buds before we advise to eat salt to taste.
We would be wise to limit our consumption of processed foods and add salt to taste. If you start to crave salt, feel free to increase natural sodium-rich foods.
We must aim to seek out more potassium-rich foods and cut back on processed foods.
Sodium in natural foods
All-natural whole foods contain some sodium, but few of them are high enough for us to get our daily requirements.
Potassium-rich food
Fruits generally contain 100-500mg of potassium per 100g, and veggies generally contain 200-1000mg of potassium per 100g. These foods are high in nutrients and low in calories, making them an excellent choice for our health and longevity.
Fat is high in calories and extremely low in potassium. If someone is following a high-fat diet (ketogenic) they must add potassium to their diet.
If you consume a spice heavy diet, the spices may make a meaningful contribution to your potassium intake. Spices like paprika, turmeric, cayenne pepper, chilli powder, cumin, saffron, fennel, anise, celery, caraway seeds, black pepper, ground ginger, garlic powder, dill seeds, cardoon, sage, and most spice contain potassium.
As you can see, sodium and potassium play an essential role in our hydration and digestive health. As health and fitness professionals we need to educate our clients on the importance of both sodium and possession. We need to be aware of symptoms associated with low electrolytes and make sure our clients are consuming adequate amounts of sodium and potassium from nutrient-rich foods. As personal trainers and coaches, we must prioritise gut health and hydration before we consider nutrition and training.