Dietary potassium intake and blood pressure: possible beneficial effect of Paleolithic diet.
Main Article Content
Abstract
Potassium is one of the most important elements of human organism. Its main distribution in the intracellular space makes it an essential component of intracellular volume regulation on the other hand extracellular/ intracellular potassium ratio determines the resting membrane potential. This later capability of potassium makes essential the necessity of maintaining extracellular potassium levels in a narrow range limit between 3.5 and 5.5 mEq/L in order to avoid dangerous dysfunction of excitable cells such as myocardium, neuronal cells and muscle cells. Because of asymmetric potassium distribution between intracellular and extracellular space there is a continuous need to excrete the excess of potassium ingested by food in a diurnal basis. The main site of potassium excretion is the distal nephron and it is coupled directly with the amount of sodium and solute delivered to this segment of the nephron. Although the very early segment of distal convoluted tubule has no ability to excrete potassium it is capable to regulate the amount of sodium chloride delivered downstream the nephron and by this way is implicated indirectly in potassium excretion. Newer data suggest that this segment of the nephron responds to increased extracellular levels of potassium by reducing sodium chloride cotransporter activity and so increases sodium delivery to distal nephron for exchange with potassium and leads to kaliuresis as well as natriuresis. It is believed that this mechanism is responsible for the beneficial effect of increased potassium intake in ameliorating hypertension even in cases of increased salt intake. In this review article, under the light of recent discoveries, we try to elucidate the complex underlying mechanisms of increased potassium intake and blood pressure regulation as well as the possible beneficial effect of Paleolithic diet upon hypertension.
Keywords:
potassium intake, extracellular potassium, intracellular chloride, blood pressure
Article Details
How to Cite
KOULOURIDIS, Ioannis; QARI, Maha; KOULOURIDIS, Efstathios.
Dietary potassium intake and blood pressure: possible beneficial effect of Paleolithic diet..
Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4720>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i11.4720.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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32. Terker AS, Zhang Cho, McCormick JA et al. Potassium Modulates Electrolyte Balance and Blood Pressure through Effects on Distal Cell Voltage and Chloride. Cell Metabolism 2015; 21: 39-50.
33. Cuevas CA, Su X-T, Wang M-X et al. Potassium Sensing by Renal Distal Tubules Requires Kir4.1. J Am Soc Nephrol. 2017; 28: 1814-2017.
34. Wang M-X, Cuevas CA, Su X-T et al. Potassium intake modulates the thiazide-sensitive sodium-chloride cotransporter (NCC) via the Kir4.1 potassium channel. Kidney Int. 2018; 93: 893-902.
35. Castaneda-Bueno M, Ellison DH, Gamba G. Molecular mechanisms for the modulation of blood pressure and potassium homeostasis by the distal convoluted tubule. 2022; EMBO Mol Med 14:e14273.
36. Wu A, Wolley MJ, Mayr H et al. Randomized Trial on the effect of Oral Potassium Chloride Supplementation on the Thiazide-Sensitive Sodium Chloride Cotransporter in Healthy Adults. Kidney Int 2023; 8: 1201-1212.
37. Shoda W, Nomura N, Ando F et al. Calcineurin inhibitors block sodium-chloride cotransporter dephosphorylation in response to high potassium intake. Kidney Int. 2017; 91: 402-411.
38. Shoda W, Nomura N, Ando F et al. Sodium-calcium exchanger 1 is the key molecule for urinary potassium excretion against acute hyperkalemia. PLoS ONE 2020; 15(6): e0235360.
39. Shi Y. Serine/Threonine Phosphatases: Mechanism through Structure. Cell 2009; 139(3): 468-484.
40. Carbajal-Contreras H, Gamba G, Castaneda-Bueno M. The serine-threonine protein phosphatases that regulate the thiazide-sensitive NaCl cotransporter. Front. Physiol. 2023; 14: 1100522.
41. Alt KW, Al-Ahmad A, Woelber JP. Nutrition and Health in Human Evolution-Past to Present. Nutrients 2022: 14:3594.
42. Singh A, Singh D (January 25, 2023). The Paleolithic Diet. Cureus 15(1): e34214. DOI 10.7759/cureus.34214.
43. Cordain L, Miller JB, Eaton SB, Mann N, Holt SHA, Speth JD. Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. Am J Clin Nutr. 2000; 71: 682-692.
44. Cordain L, Eaton SB, Sebastian A et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005; 81: 341-354.
45. Kurokawa K, Okuda T. Genetic and Non-Genetic Basis of Essential Hypertension: Maladaptation of Human Civilization to High Salt Intake. Hypertens Res 1998; 21: 67-71.
46. Oliver WJ, Cohen EL, Neel JV. Blood Pressure, Sodium Intake, and Sodium Related Hormones in Yanomano Indians, a “No-salt” Culture. Circulation 1975; 52: 146-151.
47. Adrogue HJ, Madias NE. Sodium and Potassium in the Pathogenesis of Hypertension. N Engl J Med. 2007; 356: 1966-1978.
48. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure: results for 24-hour urinary sodium and potassium excretion. BMJ 1988; 297:319-28.
49. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 2001; 344:3-10.
50. Meneely GR, Ball COT. Experimental Epidemiology of Chronic Sodium Chloride Toxicity and the Protective Effect of Potassium Chloride. Am J Med 1958; 25(5): 713-725.
51. Yang Q, Liu T, Kuklina EV et al. Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2011; 171(13):1183-1191.
52. Murillo-de-Ozores AR, Carbajal-Contreras H, Magana-Avila GR et al. Multiple molecular mechanisms are involved in the activation of the kidney sodium-chloride cotransporter by hypokalemia. Kidney Int. 2022; 102: 1030-1041.
2. Von Bunge G. Ueber die Bedeutung des Kochsalzcs und das Verhalten der Kalisalze im menschlichen organismus. Z Biol. 1873; 9: 104-143.
3. Staruschenko A. Beneficial Effects of High Potassium: Contribution of Renal Basolateral K+ Channels. Hypertension 2018; (71)6: 1015-1022.
4. Batuman V. Salt and hypertension: why is there still a debate? Kidney Int. 2013; S3: 316-320.
5. McCallum L, Lip S. The hidden hand of chloride in hypertension. Pflugers Arch – Eur J Physiol 2015; 467: 595-603.
6. Langford HG. Sodium-Potassium Interaction in Hypertension and Hypertensive Cardiovascular Disease. Hypertension 1991; S I 17(1): I-155 – I-157.
7. Addison WLT. The Use of Sodium Chloride, Potassium Chloride, Sodium Bromide, and Potassium Bromide in Cases of Arterial Hypertension which are Amenable to Potassium Chloride . Can Med Assoc. J. 1928; 18(3): 281-285.
8. Berghoff RS, Geraci AS. The influence of sodium chloride on blood pressure. IMJ 1929; 56: 395-7.
9. Palmer BF, Clegg DJ. Blood pressure lowering and potassium intake. Journal of Human Hypertension 2020; 34: 671-672.
10. Hoorn EJ, de Baaij JHF. Chloride-sensitive signaling turns the potassium switch on. Kidney Int. 2022; 102: 956-958.
11. Konner M, Eaton SB. Paleolithic Nutrition Twenty-Five Years Later. Nutrition in Clinical Practice 2010; 25(6): 594-602.
12. Ghaedi E, Mohammadi M, Mohammadi H et al. Effects of a Paleolithic Diet on Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Advances in Nutrition 2019; 1(4): 634-646.
13. National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for Sodium and Potassium. Washington, DC; the National Academies Press; 2019.
14. Rajendran VM, Sandle GI. Colonic Potassium Absorption and Secretion in Health and Disease. Compr Physiol. 2022; 8(4): 1513-1536.
15. Gumz ML, Rabinowitz L, Wingo CS. An Integral View of Potassium Homeostasis. N Engl J Med. 2015; 373(1): 60-72.
16. McFarlin BE, Chen Y, Priver TS et al. Coordinate adaptations of skeletal muscle and kidney to maintain extracellular [K+] during K+-deficient diet. Am J Physiol Cell Physiol 2020; 319: C757-C770.
17. Preston R, Afshartous D, Rodco R, Alonso AB, Garg D. Evidence for a gastrointestinal – renal kaliuretic signaling axis in humans. Kidney Int. 2015; 88: 1383-1391.
18. Rabelink TJ, Koomans HA, Hene RJ, Dorhout Mees EJ. Early and late adjustment to potassium loading in humans. Kidney Int. 1990; 38: 942-947.
19. Giebisch G. Renal potassium transport: mechanism and regulation. Am J Physiol. 1998; 274: F817-F833.
20. Meneton P, Loffing J, Warnock DC. Sodium and potassium handling by the aldosterone-sensitive distal nephron: the pivotal role of the distal and connecting tubule. Am J Psysiol Renal Physiol 2004; 287: F593-F601.
21. Reilly RF, Ellison DH. Mammalian Distal Tubule: Physiology, Pathophysiology, and Molecular Anatomy. Physiol Rev. 2000; 80(1): 277-313.
22. Pluznick JL, Sansom SC. BK channels in the kidney: role in K+ secretion and localization of molecular components. Am J Physiol Renal Physiol. 2006; 291: F517-F529.
23. Palmer BF. Regulation of Potassium Homeostasis. Clin J Am Soc Nephrol. 2015; 10(8); 1050-1060.
24. Nomura N, Shoda W, Uchida S. Clinical importance of potassium intake and molecular mechanism of potassium regulation. Clin Exp Nephrol 2019; 23(10): 1175-1180.
25. Hoorn EJ, Gritter M, Cuevas CA, Fenton RA. Regulation of the renal NaCl cotransporter and its role in potassium homeostasis. Physiol Rev 2020; 100: 321-356.
26. Xu B-e, English IM, Wilsbacher JL, Stippec S, Goldsmith EJ, Cobb MH. WNK1, a novel mammalian serine/threonine protein kinase lacking the catalytic lysine in subdomain II. J Biol Chem 2000; 275:16795–16801.
27. Wilson FH, Disse-Nicodème S, Choate KA, Ishikawa K, Nelson-Williams C, Desitter I, et al. Human hypertension caused by mutations in WNK kinases. Science 2001; 293 (5532): 1107–1112.
28. Vitari AC, Deak M, Morrice NA, Alessi DR. The WNK1 and WNK4 protein kinases that are mutated in Gordon’s hypertension syndrome phosphorylate and activate SPAK and OSR1 protein kinases. Biochem. J 2005; 391: 17-24.
29. Piala AT, Moon TM, Akella R, He H, Cobb MH, Goldsmith EJ. Chloride sensing by WNK1 involves inhibition of autophosphorylation. Sci. Signal 2014 May 6; 7(324): ra41.
30. Jonniya NA, Sk MF, Kar P. Investigating Phosphorylation-Induced Conformational Changes in WNK1 Kinase by Molecular Dynamics Simulations. ACS Omega 2019; 4: 17404-17416.
31. Penton D, Czogalla J, Wengi A et al. Extracellular K+ rapidly controls NaCl cotransporter phosphorylation in the native distal convoluted tubule by Cl− -dependent and independent mechanisms. J Physiol. 2016; 594 (21): 6319-6331.
32. Terker AS, Zhang Cho, McCormick JA et al. Potassium Modulates Electrolyte Balance and Blood Pressure through Effects on Distal Cell Voltage and Chloride. Cell Metabolism 2015; 21: 39-50.
33. Cuevas CA, Su X-T, Wang M-X et al. Potassium Sensing by Renal Distal Tubules Requires Kir4.1. J Am Soc Nephrol. 2017; 28: 1814-2017.
34. Wang M-X, Cuevas CA, Su X-T et al. Potassium intake modulates the thiazide-sensitive sodium-chloride cotransporter (NCC) via the Kir4.1 potassium channel. Kidney Int. 2018; 93: 893-902.
35. Castaneda-Bueno M, Ellison DH, Gamba G. Molecular mechanisms for the modulation of blood pressure and potassium homeostasis by the distal convoluted tubule. 2022; EMBO Mol Med 14:e14273.
36. Wu A, Wolley MJ, Mayr H et al. Randomized Trial on the effect of Oral Potassium Chloride Supplementation on the Thiazide-Sensitive Sodium Chloride Cotransporter in Healthy Adults. Kidney Int 2023; 8: 1201-1212.
37. Shoda W, Nomura N, Ando F et al. Calcineurin inhibitors block sodium-chloride cotransporter dephosphorylation in response to high potassium intake. Kidney Int. 2017; 91: 402-411.
38. Shoda W, Nomura N, Ando F et al. Sodium-calcium exchanger 1 is the key molecule for urinary potassium excretion against acute hyperkalemia. PLoS ONE 2020; 15(6): e0235360.
39. Shi Y. Serine/Threonine Phosphatases: Mechanism through Structure. Cell 2009; 139(3): 468-484.
40. Carbajal-Contreras H, Gamba G, Castaneda-Bueno M. The serine-threonine protein phosphatases that regulate the thiazide-sensitive NaCl cotransporter. Front. Physiol. 2023; 14: 1100522.
41. Alt KW, Al-Ahmad A, Woelber JP. Nutrition and Health in Human Evolution-Past to Present. Nutrients 2022: 14:3594.
42. Singh A, Singh D (January 25, 2023). The Paleolithic Diet. Cureus 15(1): e34214. DOI 10.7759/cureus.34214.
43. Cordain L, Miller JB, Eaton SB, Mann N, Holt SHA, Speth JD. Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. Am J Clin Nutr. 2000; 71: 682-692.
44. Cordain L, Eaton SB, Sebastian A et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005; 81: 341-354.
45. Kurokawa K, Okuda T. Genetic and Non-Genetic Basis of Essential Hypertension: Maladaptation of Human Civilization to High Salt Intake. Hypertens Res 1998; 21: 67-71.
46. Oliver WJ, Cohen EL, Neel JV. Blood Pressure, Sodium Intake, and Sodium Related Hormones in Yanomano Indians, a “No-salt” Culture. Circulation 1975; 52: 146-151.
47. Adrogue HJ, Madias NE. Sodium and Potassium in the Pathogenesis of Hypertension. N Engl J Med. 2007; 356: 1966-1978.
48. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure: results for 24-hour urinary sodium and potassium excretion. BMJ 1988; 297:319-28.
49. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 2001; 344:3-10.
50. Meneely GR, Ball COT. Experimental Epidemiology of Chronic Sodium Chloride Toxicity and the Protective Effect of Potassium Chloride. Am J Med 1958; 25(5): 713-725.
51. Yang Q, Liu T, Kuklina EV et al. Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2011; 171(13):1183-1191.
52. Murillo-de-Ozores AR, Carbajal-Contreras H, Magana-Avila GR et al. Multiple molecular mechanisms are involved in the activation of the kidney sodium-chloride cotransporter by hypokalemia. Kidney Int. 2022; 102: 1030-1041.