Electrolytes and heart health: A science-based guide

Written by Robb Wolf (opens in a new tab)

Medically reviewed by Swapna Ghanta, MD (opens in a new tab) and Eliza Savage, MS, RD, CDN (opens in a new tab)

Heart disease — the <a href="https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1" rel="noopener noreferrer" target="_blank">number one killer</a> globally — is insidious. Risk factors often develop slowly over the course of decades, sometimes culminating in a preventable cardiac event.  On the other side of the coin, like any other aspect of well-being, cardiovascular health is a long-term investment.  Modifiable risk factors, or the aspects of health you have control over, are like deposits. The more consistent and thoughtful your investments, in general, the healthier your cardiovascular system. As a health educator, I’ve spoken to countless folks about the lifestyle factors that can negatively or positively impact the heart. One of the most important investments that compounds over time for heart health is diet, and one crucial aspect of the nutrition conversation is electrolytes.  Getting the right amount of sodium, potassium, magnesium, and calcium — not too much, and not too little — can positively influence modifiable risk factors that influence heart disease, including blood pressure, metabolic health, inflammation, and arterial life.  In this article, we’ll: <ul> <li>Dig into how heart disease develops</li> <li>Summarize a few risk factors of heart disease</li> <li>Explore the research on how electrolytes can impact the cardiovascular system </li> </ul> Short on time? Jump to the end for the electrolyte intake targets the latest research points to for optimal health outcomes.  <h2>Heart Disease Risk Factors</h2> Much of the heart health discussion is centered around reducing risk factors for heart disease.  Most heart disease is characterized by the buildup of calcified plaque in the arteries, which can lead to something called atherosclerotic heart disease.  This buildup is usually a slow process, accumulating over a lifetime and often progressing suddenly to heart attack, stroke, or death.  Although the plaques accumulate slowly, certain risk factors can make them pile up faster, ultimately increasing the likelihood of a cardiovascular event. These risk factors include: <ul> <li>Chronic inflammation (which can happen for a number of reasons, including <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC5507106/" rel="noopener noreferrer" target="_blank">overweight and obesity</a>, <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC4888494/" rel="noopener noreferrer" target="_blank">insulin resistance</a>, smoking, and a diet <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10058108/" rel="noopener noreferrer" target="_blank">high in processed foods</a>)</li> <li>Hypertension (high blood pressure)</li> <li>Hypercalcemia (high blood calcium)</li> <li>Smoking</li> <li>Excessive alcohol consumption </li> <li>Lack of physical activity</li> <li>Oxidized or high levels of low-density lipoproteins (LDLs) in the bloodstream</li> </ul> If this looks like a long list, that’s because it is!  To reiterate my first point: Heart health is impacted by a wide variety of inputs, or investments, that can negatively or positively impact the cardiovascular system.  For example, for many of the bullet points above, doing the opposite can support the heart — such as reducing chronic inflammation, eating a whole-food diet, and not smoking.  Not sure about your personal risk? A knowledgeable healthcare provider can evaluate your risk level and help provide guidance on the specific lifestyle changes that could be impactful in your unique situation. With that said, electrolyte consumption is a piece of the metabolic health conversation many folks gloss over or misunderstand.  Let’s take a look at the role of four of these minerals and how they impact the cardiovascular system. <h2>Sodium and Heart Health</h2> Sodium, as I always say, gets a bad rap. But without it, your heart would literally cease to function.  Along with controlling fluid levels in the body, this critical electrolyte aids nerve and muscle function (remember, your heart is a muscle).  Your body needs electrolytes, including sodium, for proper <a href="https://pharmaceutical-journal.com/article/ld/electrolytes-in-cardiology" rel="noopener noreferrer" target="_blank">electrical signaling</a> — and your heart needs said electrical signaling to beat on cue.  <h3>So, why are we told to limit our sodium intake?</h3> Let’s rewind a bit. The U.S. government has recommended salt restriction for nearly 50 years.  The genesis of this advice is largely attributed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2118645/" rel="noopener noreferrer" target="_blank">1960s research</a> by Lewis Dahl, in which he bred a line of rats whose blood pressure was sensitive to salt. How? He fed them the human equivalent of 560 grams of salt per day (not milligrams — remember: 1,000 mg = 1 g).  Visually, 560 g might look like a full standard coffee mug completely filled with salt and weighs around 1.2 pounds—heavier than a loaf of sandwich bread. Saying that it was an unreasonable amount is an understatement.  Much of Dahl’s research has since been <a href="https://academic.oup.com/ije/article/34/5/972/645875" rel="noopener noreferrer" target="_blank">called into question</a> due to unaddressed confounders, a lack of controls, and poor study design.  Regardless, his work spurred a controversy around salt, culminating in the <a href="https://fns-prod.azureedge.net/sites/default/files/dietary_guidelines_for_americans/1980thin.pdf" rel="noopener noreferrer" target="_blank">1980 US Dietary Guidelines</a> advising salt restriction for heart health. So why do governing bodies like the <a href="https://science.drinklmnt.com/electrolytes/the-fdas-misguidance-on-sodium/" rel="noopener noreferrer" target="_blank">FDA</a> and the <a href="https://science.drinklmnt.com/electrolytes/the-whos-misguidance-on-sodium/?" rel="noopener noreferrer" target="_blank">WHO</a> perpetuate this idea? I have a two-part hunch:  <ol> <li>Processed foods contribute <a href="https://pubmed.ncbi.nlm.nih.gov/20430135/" rel="noopener noreferrer" target="_blank">about 70%</a> of the United States population’s sodium intake.</li> <li>People who eat more processed foods are more likely to live sedentary lifestyles. </li> </ol> In other words, sodium isn’t the causative factor. Rather, overeating refined foods (that happen to be high in salt) and avoiding exercise results in poor metabolic health, insulin resistance, diabetes, high blood pressure, obesity, and many other health issues that impair our cardiovascular systems.  It’s easy to point to salt as the scapegoat and call it a day. But if governing bodies want to reduce the occurrence of chronic inflammatory conditions like heart disease, they should stop <a href="https://www.fda.gov/food/nutrition-food-labeling-and-critical-foods/sodium-reduction-food-supply" rel="noopener noreferrer" target="_blank">devoting resources</a> to reducing sodium in processed foods.  Instead, they should disincentivize processed foods themselves and help make whole foods desirable and accessible.  With that rant out of my system, we’ve seen a lot of research since Dahl’s days. So let’s revisit the original question: Is limiting sodium intake good for your heart? <h3>Is salt restriction an effective treatment for high blood pressure?</h3> The relationship between sodium and blood pressure is more complicated than “less is more.” Again, this is why it’s important to consider all of your risk factors and work with a trusted healthcare provider to support your unique situation.  But, to put the sodium/blood pressure relationship in perspective: Yes, eating a lot of salt results in a transient (momentary) increase in blood pressure, because with more sodium, we retain water.  And yes, some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520886/" rel="noopener noreferrer" target="_blank">observational data</a> link salt restriction to lower blood pressure. But these studies do a poor job of decoupling sodium from highly processed foods. Generally, when folks reduce sodium, they tend to shift to a less processed food diet. Not surprisingly, not all the data tell the same story. For instance: Avoiding sodium can also raise blood pressure by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095258/" rel="noopener noreferrer" target="_blank">stimulating</a> sodium-retention hormones like aldosterone. This may explain the <a href="https://faseb.onlinelibrary.wiley.com/doi/abs/10.1096/fasebj.31.1_supplement.446.6" rel="noopener noreferrer" target="_blank">Framingham Offspring Study</a>, which suggests that low-sodium diets lead to higher blood pressure in people without hypertension. Furthermore, the <a href="https://pubmed.ncbi.nlm.nih.gov/3416162/" rel="noopener noreferrer" target="_blank">Intersalt Study</a> showed no link between high blood pressure and salt consumption in 10,000 people across the globe.  And in 2020, a <a href="https://pubmed.ncbi.nlm.nih.gov/33314019/" rel="noopener noreferrer" target="_blank">Cochrane Collaboration Review</a> found that when study participants were put on low-salt diets, they achieved a mere 0.4 mmHg drop in mean arterial pressure for normotensives and about a 4 mmHg drop for people with high blood pressure. What about specific cardiovascular disease (CVD) events? The authors of a <a href="https://jamanetwork.com/journals/jama/fullarticle/1105553" rel="noopener noreferrer" target="_blank">2011 paper</a> published in the Journal of the American Medical Association found that people consuming 4–6 g of daily sodium had fewer heart events (cardiac arrest, strokes, death) than those consuming fewer than 3 g per day (which is still more than current CDC recommendations). It's worth noting that this study focused on individuals with existing cardiovascular disease or diabetes—groups often advised to limit sodium intake.  While it’s probably not helpful to drastically increase sodium for people with existing hypertension or CVD, these results make me question the logic of universal salt restriction. <h3>The real root causes of hypertension</h3> Rather than picking on transient and intermediate factors in hypertension (like sodium intake), let’s talk about the root causes.  I recently listened to an interesting <a href="https://peterattiamd.com/the-relationship-between-salt-blood-pressure/" rel="noopener noreferrer" target="_blank">conversation</a> between longevity expert Dr. Peter Attia and nephrologist (kidney specialist) Dr. Rick Johnson that may shed some light on this topic.  Dr. Johnson makes a strong case that kidney inflammation — likely due to high uric acid levels — increases sodium retention and salt sensitivity, driving hypertension. This suggests that too much salt isn’t the problem. Too much uric acid is (even this is downstream of the likely cause: insulin resistance).  There is a lot to be said on the topic of metabolic health, but all of that is beyond the scope of this article. For now, understand this: If you’re not eating an appropriately portioned whole foods diet, avoiding sugar, exercising, managing stress, and sleeping well, you’re doing yourself a disservice in the blood pressure department — and reducing sodium alone probably won’t help you much. <h2>Potassium and Heart Health</h2> Potassium is a whole lot less controversial mineral than sodium. It’s clear that higher potassium intakes support cardiovascular health — it’s essential for cardiac muscle contraction and maintaining normal heart rhythms.  It also moves nutrients into cells and waste products out of them, helping achieve a healthy metabolism. (And a healthy metabolism, as we know, is essential for a healthy heart.) Here’s some data about potassium and heart health: <ul> <li>Multiple population studies <a href="https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/#" rel="noopener noreferrer" target="_blank">suggest</a> that hypertension risk falls as potassium intake rises.</li> <li>An <a href="https://insight.jci.org/articles/view/94920" rel="noopener noreferrer" target="_blank">animal study</a> associated low potassium intake with a heightened risk of hardened arteries, a known risk factor for CVD. Inversely, adequate potassium intake was linked with lower risk of vascular calcification and aortic stiffness.</li> <li>In a study of nearly 250,000 people over 5–19 years, stroke risk <a href="https://pubmed.ncbi.nlm.nih.gov/21371638/" rel="noopener noreferrer" target="_blank">decreased</a> 21% for every 1.6 g of additional potassium consumed daily.</li> <li>Rats fed more potassium have <a href="https://pubmed.ncbi.nlm.nih.gov/17634402/" rel="noopener noreferrer" target="_blank">less</a> kidney inflammation.</li> <li>A meta-analysis of randomized controlled trials found that potassium supplementation <a href="https://pubmed.ncbi.nlm.nih.gov/28024910/" rel="noopener noreferrer" target="_blank">lowered</a> blood pressure in people with hypertension.</li> </ul> Another point of interest: The modern diet is low in <a href="https://science.drinklmnt.com/electrolytes/foods-high-in-magnesium-and-potassium/" rel="noopener noreferrer" target="_blank">potassium-rich whole foods</a> and high in salty, processed foods.  So, is widespread hypertension due to our collective sodium intake, or is it that we’re eating too much unhealthy food that is also lacking in potassium?  This is not a rhetorical question, and although it takes a bit of time to unpack, I hope you appreciate both the logic and the implications.  Beyond blood pressure, potassium intake is <a href="https://pubmed.ncbi.nlm.nih.gov/27280455/" rel="noopener noreferrer" target="_blank">inversely correlated</a > with diabetes risk — meaning higher intake of this electrolyte reduces diabetes, and vice versa. Metabolic derangement, a cluster of conditions that disturb or disrupt the normal order of the body and metabolic processes of the metabolism, is <a href="https://www.ncbi.nlm.nih.gov/books/NBK513253/" rel="noopener noreferrer" target="_blank">closely linked</a> to heart disease.  But, I think it’s a stretch to say that potassium causes this effect. This whole phenomena is likely due to the generally healthful effects of eating more minimally processed foods.  People on a high-potassium whole foods diet also tend to engage in healthy behaviors — such as exercise — that ultimately improve metabolic health.  My blood sugar stats might look good because I eat plenty of potassium, or maybe because I rarely miss a jiu jitsu session. (I’d spar on an international flight if it was socially acceptable.) It’s probably a bit of both. <h2>Magnesium and Heart Health</h2> Magnesium <a href="https://pubmed.ncbi.nlm.nih.gov/29793664/" rel="noopener noreferrer" target="_blank">influences</a> much of the cardiovascular system, primarily by supporting nerve and muscle function. Its effects include: <ul> <li>Stabilizing heart rhythm</li> <li>Promoting relaxation of cardiac muscles</li> <li>Regulating key processes related to heart health, such as calcification, clotting, and inflammation (as alluded to before)</li> </ul> Inflammation, in general, can advance heart disease.  Excess immune particles in the bloodstream incite an inflammatory cascade that accelerates plaque formation in the arterial walls — and, of course, more arterial plaques increase the risk of heart attack, stroke, and death. But back to <a href="https://science.drinklmnt.com/electrolytes/magnesium/" rel="noopener noreferrer" target="_blank">magnesium</a>.  Magnesium-deficient people — which is about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786912/" rel="noopener noreferrer" target="_blank">30% of the population</a > — have higher levels of inflammation, so optimizing magnesium intake is a reasonable step to support heart health (and health as a whole).  Magnesium supplementation (compared to placebo) has also been shown to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025730/" rel="noopener noreferrer" target="_blank">prevent</a> cardiac arrhythmias, which are a risk factor for cardiovascular disease.  Note: There are many different <a href="https://science.drinklmnt.com/electrolytes/which-magnesium-is-best/" rel="noopener noreferrer" target="_blank">types of magnesium</a >, and learning more about each one’s role in the body can help you choose the right type to focus on. <h2>Calcium and Heart Health</h2> <a href="https://science.drinklmnt.com/electrolytes/calcium/" rel="noopener noreferrer" target="_blank">Calcium</a> plays a key role in helping your blood vessels contract and expand to stabilize your blood pressure. It also plays a role in enzyme and hormone secretion that help your nervous system send messages, supporting overall organ health.  That said, this essential nutrient is best stored in your skeleton, not your arteries.  Calcium in the arteries can be a sign of advanced heart disease, indicating that particles have broken into the inner lining of the blood vessels called the endothelium.  High blood calcium levels (hypercalcemia) cause this calcification, which stiffens and narrows your arteries. A quick route to high blood calcium levels is to consume calcium in great excess. This may explain why calcium supplements (but not dietary calcium) are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121484/" rel="noopener noreferrer" target="_blank">linked</a > to higher CVD risk.  Swallowing a calcium pill causes transient hypercalcemia, but distributing your calcium over several meals does not — so don’t stress about dietary calcium intake. (In fact, foods with <a href="https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/" rel="noopener noreferrer" target="_blank">higher calcium content</a> are often less inflammatory — think leafy greens, legumes, and tofu — which is ideal for preventing CVD.) One last point on calcium: coronary calcium doesn’t always track perfectly with heart disease risk. Many people have heart attacks and strokes with <a href="https://link.springer.com/article/10.1007/s10554-010-9730-0" rel="noopener noreferrer" target="_blank">zero measurable calcification</a>. But all else equal, less coronary calcium is generally a good thing. <h2>Electrolytes: One Part of the Equation</h2> I spend a lot of time pondering how to reduce CVD risk because it affects so many of us, (both of my parents died at the age of 71 from CVD) — and it’s often preventable. Yet as with many aspects of health, there are no “hacks” or one-size-fits-all approaches. Supporting heart health is best approached through a variety of avenues, such as sleep, exercise, diet, and lifestyle. For the electrolyte part of the equation, the available evidence suggests the following ranges can work for many folks: <ul> <li><a href="https://pubmed.ncbi.nlm.nih.gov/22110105/" rel="noopener noreferrer" target="_blank">Sodium</a>: 4–6 g/day</li> <li><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6181280/" rel="noopener noreferrer" target="_blank">Potassium</a>: 3.5–5 g/day</li> <li><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC5786912/" rel="noopener noreferrer" target="_blank">Magnesium</a>: 400–600 mg/day</li> <li><a href="https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/" rel="noopener noreferrer" target="_blank">Calcium</a>: 1 gram/day (from dietary sources rather than supplements)</li> </ul> These ranges can be achieved through a focus on nutrient-dense whole foods — heavy on the plants (with lots of leafy greens), healthy fats (like nuts and avocados), and whole small fish (like sardines) which tick all of the electrolyte boxes.  If you have any underlying health conditions such as hypertension and kidney disease, you may have a different suggested range, so please consult with your doctor prior to any dietary supplementation.  The best part of upping your nutrition density? As you swap out inflammatory processed foods for real, whole foods, your risk for metabolic syndrome goes down — and the odds of a healthy heart goes way up. If you need an electrolyte boost, consider leveraging electrolyte drinks or supplements as needed.  Not sure if you’d benefit from supplementation? Think through how you feel during your daily routines. If you’re dragging during a workout or noticing it takes longer to recover — or maybe your recovery tracking (via tools like Oura ring, Morpheus, or WHOOP) is clocking a higher heart rate and lower <a href="https://trainwithmorpheus.com/topic/intro-to-heart-rate-variability/" rel="noopener noreferrer" target="_blank">Heart Rate Variability</a> than usual when you’re at the gym — supplements may come in handy.  If you’re having a tough time getting quality sleep, especially if it takes you a while to fall asleep at night, then extra electrolytes might be useful. Chronic stress, whether emotional or physical, can also deplete these essential minerals. So if you’re struggling to manage stress in your daily life, adding in electrolytes can help you bounce back. I also recommend tracking your electrolyte intake with an app for a few days. Once you better understand your current diet you can experiment with different ranges, see how you feel, and adjust your regimen to suit your needs. Electrolyte needs are individual, so it may take a little tinkering to find the balance that’s right for you. Bottom line: Don’t forget to look at the broader picture and other lifestyle factors you can address. Your heart and overall health deserve it. <h2>Key Takeaways</h2> <ul> <li>Heart health, like heart disease risk, stems from a variety of factors that accumulate slowly over time. </li> <li>Focusing on modifiable inputs — all the simple tweaks you can make in your everyday life — is essential for reducing your risk of metabolic syndrome and, as a result, cardiovascular disease.</li> <li>Along with prioritizing nutrition, exercise, and sleep, maintaining electrolyte balance is key for supporting healthy cardiovascular function. </li> <li>Each electrolyte — sodium, potassium, magnesium, and calcium — plays a unique role in heart function and general cardiovascular health.</li> <li>Boosting electrolyte intake is one way to help improve your overall well-being while supporting a healthy heart. </li> </ul>