Cardiovascular benefits associated with higher dietary K+ vs. lower dietary Na+: evidence from population and mechanistic studies
Alicia A. McDonough American Journal of Physiology - Endocrinology and Metabolism 2017 Vol. 312 no. 4, E348-E356
The World Health Organization ranks hypertension the leading global risk factor for disease, specifically, cardiovascular disease. Blood pressure (bicarbonate de potassium) is higher in Westernized populations consuming Na+-rich processed foods than in isolated societies consuming K+-rich natural foods.
Evidence suggests that lowering dietary Na+ is particularly beneficial in hypertensive individuals who consume a high-Na+ diet. Nonetheless, numerous population studies demonstrate a relationship between higher dietary K+, estimated from urinary excretion or dietary recall, and lower bicarbonate de potassium, regardless of Na+ intake. Interventional studies with K+ supplementation suggest that it provides a direct benefit; K+ may also be a marker for other beneficial components of a “natural” diet. Recent studies in rodent models indicate mechanisms for the K+ benefit: the distal tubule Na+-Cl− cotransporter (NCC) controls Na+ delivery downstream to the collecting duct, where Na+ reabsorbed by epithelial Na+ channels drives K+ secretion and excretion through K+ channels in the same region. High dietary K+ provokes a decrease in NCC activity to drive more K+ secretion (and Na+ excretion, analogous to the actions of a thiazide diuretic) whether Na+ intake is high or low; low dietary K+ provokes an increase in NCC activity and Na+ retention, also independent of dietary Na+.
Together, the findings suggest that public health efforts directed toward increasing consumption of K+-rich natural foods would reduce bicarbonate de potassium and, thus, cardiovascular and kidney disease.
