Intended for healthcare professionals

CCBYNC Open access

Rapid response to:

Research

Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l772 (Published 13 March 2019) Cite this as: BMJ 2019;364:l772

Rapid Response:

Diets of Low Sodium with High Potassium to Combat Cardiovascular diseases

Thank you to the authors for this thought-provoking and fascinating article. The data of morning fasting urine for 103570 people reveals that the World Health Organization (WHO’s) advice of low sodium intake (<2 g) with high potassium intake (>3.5 g) every day is infrequent, which suggests that moderate sodium intake (3-5 g/day) with high potassium intake is associated with the lowest risk of mortality and cardiovascular diseases[1]. I think the major scientific basis is as follows: the potassium channel is a regulating selectivity filter gating mechanism of drug activation[2]; Excessive sodium consumption is related to cardiovascular diseases; 99.2% of the global adult population from 181 countries have mean sodium intakes > 2 g/day, with reduced dietary sodium in 183 countries[3]. WHO’s target is extremely uncommon that it is similar to a fatal difficulty of sustaining regular consumption, such as nearly 10000 kinds of health products in the Chinese market cannot solve the problem of chronic disease outbreak. Although these important results have had an impact on WHO guidelines, the development of dietary sodium intake (<2 g/day) that meets the WHO guidelines is essential.

I agree that the technology of low sodium intake (<2 g) with high potassium intake (>3.5 g) every day is not the problem, it has much more to do with system change. According to our 40 patents license of Chinese invention, we have developed a Living-Plant Dry Pulverizer, which is used to transform living plant (barley grass) directly into ultrafine powder and nutritious water in 3 minutes below 50 ºC; the cost is only 1/10 of the cost of freeze drying and half of the cost of general processing. Intracellular potassium and extracellular sodium are indispensable elements in life. This device of cell wall breaking will greatly enhance the intake efficacy of intracellular potassium in functional foods. Zeng’s review points out that more than 30 functional ingredients in barley grass exert potent preventive effects in more than 20 chronic diseases, especially major mechanism with rich in GABA, flavonoids, SOD, K-Ca,vitamins and tryptophan[4]. Potassium content (3384 mg/100g) in barley grass is 10.3 times higher than that of sodium, which prevents cardiovascular heart diseases, regulates blood pressure, increases cognition, improves sleep and so on[4]. The average content (1825mg/100g) of potassium in barley grass for 31 cultivars that we bred is 63.8 fold higher than that of sodium when planted in the mountainous red soil; It contains 62 times GABA (327.5 mg/100g) as well as 99 times Ca and 31 times K than that of polished rice[5]. The average content (3183 mg/100g) of potassium in barley grass for 193 RILs that we bred is 7.4 fold higher than that of sodium in crops planted in vegetable fields that often use human urine and feces[6].

Higher potassium intake (fruit, vegetables, nuts) is a marker of healthier food, however low potassium intake with cardiovascular risk reflects lower intake of fruits and vegetables[1]. However fruits, vegetables and whole grains were indispensable among four top diets i.e. DASH (lower blood pressure), Flexitarian (lose weight), MIND (brain health), especially Mediterranean diet (whole grains, fruits, vegetables, beans, herbs, spices, nuts and olive oil) with significant lower cardiovascular disease and mortality. The ten healthiest countries in the world are associated with the Mediterranean diet and island effect, i.e. Spain, Italy, Iceland, Japan, Switzerland, Sweden, Australia, Singapore, Norway, and Israel, which ranks 169 economies according to factors that contribute to overall health from WHO and United Nations Population Division and the World Bank (https://www.untvweb.com/news/spain-is-2019s-healthiest-country-bloomberg/). These diets with high potassium intake are related to the African center of crop origin (Mediterranean, Ethiopia,West and Cental Africa) for Paleohuman’s foods.

Therefore in my opinion, human chronic disease outbreak due to staple foods ranging from ancient brown rice and barley with high potassium intake to modern white rice and wheat white flour with low potassium intake, which are associated with six major dietary structures from early hominids to modern humans[7], especially sustaining major foods + barley grass powder are the most healthy dietary guidelines for modern humans. This guide is conducive to achieving the WHO’s target of of low sodium intake (<2 g) with high potassium intake (>3.5 g) every day.

References
[1] O’Donnell M,et al. BMJ 2019;364:l772
[2] Schewe M, et al. Science 2019; 363 (6429): 875-880
[3] Webb M, et al. BMJ 2017;356:i6699
[4] Zeng YW, et al. Oxid Med Cell Longev 2018;2018:3232080
[5] Zeng YW, et al. http://science.sciencemag.org/content/363/6426/538/tab-e-letters
[6] Zeng YW, et al. Genet Mol Res 2016;15(4): gmr15049103
[7] Zeng YW. http://science.sciencemag.org/content/362/6416/762/tab-e-letters

Competing interests: No competing interests

15 March 2019
Yawen Zeng
Post scientist, Professor, PhD / Functional Food Crop
Biotechnology and Germplasm Resources Institute, Yunnan Academy of Agricultural Sciences /Agricultural Biotechnology Key Laboratory of Yunnan Province/Key Laboratory of the Southwestern Crop Gene Resources and Germplasm Innovation, Ministry of Agriculture, Kunming 650205, China.
Beijing Road No. 2238