• Brian Bender, PhD

Sodium Potassium Ratio: Discover Your Ideal Number

The sodium potassium ratio is the amount of sodium divided by the amount of potassium, and its measurement in urine is an excellent measure of dietary intake, dietary quality, and chronic disease risk.


In this post, full of scientific references, we’ll explain what a low and high sodium potassium ratio means, what foods have the best sodium potassium ratio, and how to measure your sodium and potassium ratio on a regular basis.


Sodium and Potassium Ratio and Your Dietary Quality


Maintaining high dietary quality, including high amounts of fruits and vegetables and avoiding excessive salt, is the single most important factor for preventing chronic diseases and maintaining good health [1].


To put it into perspective, poor dietary behaviors are responsible for more deaths than any other behavior, including such serious offenders as smoking, air pollution, and drug abuse [2].

So what constitutes a “healthy diet?”


With few exceptions, a healthier diet should be lower in sodium and higher in potassium.

In fact, lowering dietary sodium intake and increasing potassium intake (resulting in a lower sodium potassium ratio) is an integral strategy of national and international public health goals [3–6].


Thus, a diet with high quality produces a low sodium potassium ratio (generally less than the number 1), while a diet with worse quality results in a high sodium potassium ratio (generally greater than the number 1) [9–12].


The urine sodium potassium ratio is even significantly associated with the U.S. News’ top two healthy diets – the DASH Diet [13–19] and the Mediterranean Diet [20].


Why does this ratio trend so well to overall dietary quality?


First, sodium.


Over 70% of our sodium intake is derived from packaged, preprepared, or restaurant foods [21].


Most health experts agree that eating fewer preprocessed snacks and packaged foods, and more whole foods, is better for overall health and dietary quality [3].


This, in part, explains why the urinary sodium potassium ratio correlates significantly to consumption of processed and ultra-processed foods [22,23].


Second, potassium.


Urinary potassium is a marker that significantly correlates with dietary intake of fruits and vegetables [14,24,25], and it correlates significantly with overall dietary quality itself [26,27].


In fact, urinary potassium is correlated to the Healthy Eating Index (HEI), an index developed by the Center for Nutrition Policy and Promotion based on the USDA’s Dietary Guidelines for Americans [28].


An Ideal Sodium Potassium Ratio for Good Health


The best sodium potassium ratio for good health as suggested by major health institutions tend to fall at or below the number 1. In some cases, your ideal sodium potassium ratio may be even lower, in the 0.6 to 0.8 range.


Obesity & Weight Loss


Urinary sodium, potassium, and the sodium potassium ratio trend with obesity and total body fat percentage [29–33].


Not only do they trend together, but the concentrations of these biomarkers are predictors of weight loss [34].


And when it comes to those who lose weight and maintain their weight loss, successful individuals consistently had higher healthier dietary quality and better HEI (correlated to the sodium potassium ratio), and higher potassium intake [35].


Hypertension (High Blood Pressure), Stroke, and Cardiovascular Disease (CVD)


Decreasing dietary sodium intake and increasing dietary potassium intake is proven to help lower blood pressure [36–39].


Not only has urine sodium, potassium, and the urinary sodium potassium ratio been shown to significantly correlate to blood pressure [40–44], but the sodium potassium ratio has been shown to be a superior metric compared to either sodium or potassium, alone [45–47].


The sodium potassium ratio is also a strong predictor of stroke [48] while also being significantly associated with the risk of CVD and all-cause mortality (again, stronger than either sodium or potassium, alone) [49,50].


It may not come as a surprise now that reducing sodium intake and increasing dietary potassium intake is a proven method for reducing the need for anti-hypertensive medications [51–53].


Chronic Kidney Disease (CKD)


CKD, it should be noted, is often an exception to the rule of desiring higher dietary potassium intake. Dysregulation of kidney function can change the way your body handles these minerals.


Nevertheless, sodium reduction is still recommended and the sodium potassium ratio has been shown to be significantly correlated to CKD [54–56]. Furthermore, among those with CKD, these markers trend with increased risk of CVD [57].


Diabetes


We know poor dietary behaviors and obesity are risk factors for developing diabetes.

But again, urinary sodium and potassium have been found to significantly correlate to impaired insulin response [58–61], metabolic syndrome [62], and type II diabetes [63–69].


Mental Health


As more research accumulates on the link between diet and mental health, dietary quality is increasingly linked to depression, dementia, and Alzheimer’s Disease.


The DASH Diet, the Mediterranean Diet, and the MIND Diet were all associated with lower cognitive decline and lower risk of developing Alzheimer’s Disease [70]. Furthermore, these healthy diets are increasingly linked to risk of depression [71–74].


And as the urinary sodium potassium ratio is a marker for adherence to the DASH and Mediterranean Diets, it may not come as a surprise that it has been shown that this ratio is associated with risk of cognitive decline [75] as well as depression [76].


As mental health is only just starting to get the attention it deserves, expect to see more research emerge on this topic in the future.


Liver Cirrhosis & Ascites


The mainstay treatments of patients with cirrhosis and ascites are a low sodium diet (2000 mg/day) and diuretics, yet objectively managing a low-sodium diet is difficult without urine measurements.


In addition to 24-hour urine sodium measurements, researchers have repeatedly shown that spot urine sodium potassium ratio has adequate accuracy for assessment of dietary sodium restriction compared with 24-h urinary sodium in patients with liver cirrhosis and ascites [77–79].


In fact, several national and private guidelines have included the use of spot urine sodium potassium ratio testing to monitor adherence for patients with liver cirrhosis and ascites [80–82].


Finding Foods with the Best Sodium Potassium Ratio


So the sodium potassium ratio is great.


But what foods help maintain a good ratio?


At a high level, it’s fairly straight forward.


Lower your sodium potassium ratio to improve it. That means, you must lower your sodium intake and/or increase your potassium intake.


To lower your sodium intake, the most straightforward advice is to lower your intake of processed and pre-packaged foods, along with fast foods and excessive restaurant meals.


To increase your potassium intake, you can generally observe the advice to eat more fruits and vegetables.


But what about the specifics? How does these foods compare?


We decided to look into this, ourselves.


After analyzing about 600 foods from the USDA Food Database, we ranked each food by its potassium density (potassium/calorie), sodium density, sodium potassium ratio, and color-coded by food group.


As you can see, fruits and vegetables overwhelmingly top the list.


In fact, it’s interesting to see w


here the sodium potassium ratio of 1 falls on this chart.


The separation of what generally constitutes as good sodium potassium ratio (less than 1) and a poor sodium potassium ratio (greater than 1) lies almost perfectly at the intersection of fruits and vegetables (shown in blue, green, and purple) and fast foods (shown in red).



How to Measure My Sodium Potassium Ratio