Forget Low Salt: Why Men in Midlife Should Focus on Potassium and Magnesium - PART 8

We’ve touched on potassium and magnesium, but let’s drive home their roles in the salt and blood pressure story, because this is where conventional advice truly missed the mark. You shouldn’t think about sodium alone; consider the sodium-potassium ratio and overall mineral intake instead. These ratios may be more significant than the absolute amounts of sodium.

Potassium – The Salt Antidote:

Potassium can be seen as nature’s blood pressure medicine. It encourages the kidneys to excrete sodium, eases tension in blood vessel walls, and is associated with lower blood pressure. Many studies indicate that low potassium intake is a stronger predictor of hypertension and stroke than high sodium intake.

Historically, our ancestors consumed diets high in potassium (from foraged plants) and low in sodium, whereas modern diets tend to be the opposite (high in sodium, low in potassium)[1][2].

The result is an electrolyte imbalance that our bodies aren’t adapted to. One reason some salt reduction efforts show a benefit is that they inadvertently also increase potassium intake (for example, telling someone to cut back on salty processed snacks often means they start eating more fruits/veggies).     

It might not be the sodium reduction helping so much as the potassium increase from those dietary shifts. The WHO recommends at least 3,510 mg of potassium per day, specifically to counteract the effects of sodium [3].

Yet, how often do you see public service announcements saying “Eat your potassium today!”? Rarely. Functional medicine, in contrast, will frequently assess a patient’s diet and blood potassium levels, and emphasise increasing them (through diet first, and supplements if needed) as part of a natural blood pressure-lowering strategy. If you up your potassium to RDA levels, you might find you have more leeway with salt because the ratio is improved.

Foods rich in potassium include leafy greens, broccoli, avocados, potatoes (especially sweet potatoes), beans, squash, bananas, coconut water, and yogurt.

A 2014 global study found that individuals with the highest potassium intakes had lower blood pressure and a 24% lower risk of stroke compared to those with the lowest intakes[4].

So maybe the advice should have been “Have a banana and some spinach” instead of “Put down the salt shaker”! For midlife men, focusing on potassium is doubly important because it also supports muscle function and heart rhythm.

Adopt a more whole-food diet and possibly use a potassium salt substitute (such as a low-sodium salt with potassium chloride) as some of your seasoning. You can dramatically improve your sodium-potassium balance. The good news: doing so doesn’t involve any suffering; you get to eat healthier food, rather than less of something.

Magnesium: The Blood Vessel Relaxer:

Magnesium is like the calm, soothing mineral that tells everything to “chill out.” It helps blood vessels relax (vasodilation), can prevent abnormal heart rhythms, and is crucial for muscle relaxation. In terms of blood pressure, magnesium has a gentle lowering effect, especially if someone is already deficient. A meta-analysis of trials showed that magnesium supplementation can modestly reduce BP, particularly in those with hypertension or low Mg status.

However, beyond BP, magnesium sufficiency protects against arrhythmias, improves insulin sensitivity, and can even aid in sleep and stress reduction, all factors that indirectly contribute to improved heart health.

The problem is that an estimated ~50% of people in the US don’t meet the RDA for magnesium. Soil depletion and diets low in greens/nuts contribute. If you’re doing everything else right, watching your sugar intake, exercising, and not going overboard on salt, but your blood pressure is still a tad high, magnesium could be the missing piece.

It’s not uncommon for functional medicine practitioners to recommend magnesium glycinate or citrate at bedtime for patients with hypertension, which often yields improvements.

Magnesium also works well with potassium: they often occur together in foods (e.g., leafy greens are rich in both), and magnesium is essential for maintaining a proper potassium balance within cells. In essence, magnesium and potassium are the unsung heroes that mitigate any potential harm from sodium. They deserved equal billing in guidelines, but didn’t get it.

Evidence of Balance Over Blind Restriction:

We have already cited the Framingham Offspring analysis, where higher intakes of Mg and K corresponded to lower heart risk, while lower sodium intake didn’t show a benefit [5].

There’s also the DASH diet (Dietary Approaches to Stop Hypertension) which is often touted, note that DASH is not a low-sodium diet per se, it’s a high-potassium, high-magnesium, high-calcium diet (lots of fruits, veg, low-fat dairy). When people follow DASH, their BP goes down, largely thanks to the surge in potassium and magnesium intake from all the produce and nuts.

Yes, DASH also recommends moderating sodium (to ~2,300 mg), but studies suggest that DASH works even without strict sodium restriction; the minerals do the heavy lifting. Meanwhile, a low-sodium diet without sufficient potassium/magnesium is likely to disappoint. This is why many pure salt-reduction trials showed negligible results: they weren’t fixing the other side of the equation.

Chloride and Other Electrolytes:

Chloride, as mentioned, typically accompanies sodium. However, there are salt substitutes that replace sodium chloride with potassium chloride; these can be useful for individuals who need to reduce their sodium intake due to medical reasons, as they provide chloride and potassium in place of sodium.

Calcium also plays a role in blood pressure (adequate calcium, mainly from diet, is associated with better BP control). But for brevity, potassium and magnesium are the all-stars to focus on alongside sodium.

Practical tip:

If you’re going to increase salt, ensure you’re also meeting your potassium and magnesium targets. Otherwise, you’re only doing one side of the dance. This could be as simple as: along with salting your steak, have a generous portion of steamed spinach (a powerhouse of K & Mg) or a baked potato (the king of potassium) on the side.

Use herbs like parsley (rich in potassium) and nuts or seeds (for magnesium) in your meals. Consider starting the day with a magnesium-rich green smoothie or taking a magnesium supplement at the end of the day if needed. This way, the “Electrolyte Quartet”, sodium, potassium, magnesium, and chloride, stays in harmony.

Men, especially those who often focus on protein and might neglect vegetables, should pay attention here. Balancing your electrolytes will not only help regulate blood pressure, but can also improve exercise recovery, reduce muscle cramps, help your heart pump more efficiently, and even support better moods and sleep.

To put it plainly: don’t fear salt, but do respect your potassium and magnesium. When you get these ratios right, your blood pressure is more likely to stay in check even with a moderate salt intake, and your overall cardiovascular risk will improve. The villain in our modern diet isn’t the salt shaker; it’s the fact that we’ve traded potassium-rich whole foods for sodium-loaded processed junk.

Fix that, and salt can resume its role as a benevolent flavour enhancer and vital nutrient, not a menace.