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Worldwide, physical inactivity accounts for more than 10 million years of healthy life lost, but what we eat accounts for nearly 20 times that. As I discuss in my video Fewer Than 1 in 5,000 Meet Sodium and Potassium Recommended Intakes, unhealthy diets shave hundreds of millions of disability-free years off people’s lives every year. What are the worst aspects of our diets? Four out of the five of the deadliest dietary traps involve not eating enough of certain foods—not eating enough whole grains, fruits, nuts, seeds, and vegetables—but our most fatal flaw is getting too much salt. To put things into perspective, our overconsumption of salt is on the order of 15 times deadlier than diets too high in soda.

Our bodies are meant to have a certain balance of sodium and potassium intake, yet many people, including the majority in the United States, get vastly more sodium and far less potassium than the recommended amounts. Indeed, sodium and potassium goals are currently met by less than 0.015 percent of the U.S. population—close to 99.99 percent noncompliance, with only 1 in 6,000 Americans hitting the recommended guidelines.

What’s So Bad About Salt?

Of all the terrible things about our diets, high dietary sodium intake—that is, high salt intake—is the leading risk, estimated to be causing millions of deaths every year mainly through adverse effects on blood pressure and increased risks of stroke, heart attack, and kidney damage. Hypertension, known commonly as high blood pressure, is called the “silent and invisible killer” because it rarely causes symptoms but is one of the most powerful independent predictors of some of our leading causes of death. I discuss this in my video Are Potassium Chloride Salt Substitutes Effective?.

How Much Sodium Is Healthy in a Day?

Our bodies evolved to handle only about 750 milligrams of sodium a day. Nevertheless, the American Heart Association calls for us to stay under 1,500 milligrams, twice that amount. However, we’re consuming more than four times what’s natural, and it’s only getting worse, having increased over the last couple of decades. An eye-opening 98.8 percent of Americans exceed even that elevated 1,500 milligrams threshold.

Daily Potassium Intake

While many of us are consuming too much sodium, we may also be getting too little potassium, a mineral that lowers blood pressure. Less than 2 percent of U.S. adults, for instance, consume the recommended daily minimum intake of potassium based on chronic disease prevention. So, more than 98 percent of Americans may eat potassium-deficient diets. 

This deficiency is even more striking when comparing our current intake with that of our ancestors, who consumed large amounts of dietary potassium. We evolved probably getting more than 10,000 milligrams of potassium a day. The recommendation was to get about half that amount, yet most of us don’t come anywhere close.

Why Are So Many of Us Lacking in Potassium?

We evolved consuming a diet very rich in potassium and low in sodium, but, today, this pattern has been reversed. The flip reflects a shift away from traditional plant-based diets high in potassium and low in sodium towards the standard American diet. I’m talking about a shift away from fruits, greens, roots, and tubers to an eating pattern filled with salty, processed foods stripped of potassium.

Why Do We Need Potassium?

Low potassium intake has been implicated in high blood pressure and cardiovascular disease, and several meta-analyses have confirmed that high potassium intake appears to reduce the risk of stroke. It follows that potassium is now considered a “nutrient of public health concern” because most Americans don’t reach the recommended minimum daily intake.

What Is the Best Substitute for Salt?

Potassium chloride, which is often found in zero-sodium salt substitutes. We know from randomized controlled trials that sodium reduction leads to blood pressure reduction and increasing potassium intake can also lower blood pressure. So should we be “salting” our food with potassium chloride instead of sodium chloride?

What Is Potassium Chloride? Is It a Viable (and Tasty) Salt Substitute?

Potassium chloride is a naturally occurring mineral salt, which is obtained the same way we get regular sodium salt. Since we get too much sodium and not enough potassium, this would seem to make potassium chloride a win-win solution. Consider these examples:

• In a randomized controlled trial, households had just 25 percent of the sodium chloride salt replaced with potassium chloride. At that level, most people either can’t tell the difference or even prefer the salt with the potassium mixed in. The findings? The use of the salt substitute with one-quarter potassium chloride was associated with cutting the risk of developing hypertension in half.
• In another study, five kitchens in a veterans’ retirement home were randomized into two groups for about two and a half years. They either salted their meals with regular salt or, unbeknownst to the cooks and the diners alike, a 50/50 blend of potassium chloride. Those in the half-potassium group cut their risk of dying from cardiovascular disease by about 40 percent and lived up to nearly one year longer. The life expectancy difference at age 70 was equivalent to that which would have naturally occurred in 14 years––meaning that just switching to half potassium salt appeared to effectively make people more than a decade younger when it came to risk of death.

Side Effects of Potassium Chloride?

As I discuss in my video Potassium Chloride Salt Substitute Side Effects, potassium chloride is “generally regarded as safe” by the U.S. Food and Drug Administration. Healthy individuals don’t have to worry about getting too much potassium because their kidneys excrete any excess in urine, but that’s with potassium in food. What about supplements? No adverse effects have been shown for long-term intakes of potassium supplements as high as 3,000 milligrams a day, and blood levels of potassium are maintained in the normal range by healthy kidneys, even when potassium intake is increased to approximately 15,000 milligrams a day. This isn’t surprising, given that we evolved eating so many healthy plant foods, so many fruits and vegetables, rich in potassium.

The normal range for potassium levels in the blood is between 3.5 and 5.0. There are a small number of individuals who may run into problems, primarily those with severely impaired kidney function. That’s why there’s been such a reluctance to push potassium‐based salt substitutes on a population level. Serious issues may arise if your kidneys can’t regulate your potassium. There may be concern if you have known kidney disease, diabetes (diabetes can lead to kidney damage), severe heart failure, or adrenal insufficiency, or if you’re an older adult or on medications that impair potassium excretion. If you aren’t sure if you’re at risk, ask your doctor about getting your kidney function tested.

Conclusion

National and international health organizations have called for warning labels on salt packets and salt shakers, with messages like “too much sodium in the diet causes high blood pressure and increases risk of stomach cancer, stroke, heart disease, and kidney disease. Limit your use.” So, pass (on) the salt shaker and try some potassium chloride instead.

If you like pickleball, get ready to up the ante with padel. We know what you’re thinking: first, how do you pronounce it? And second, is padel the same as pickleball? For starters, it’s pronounced PAD-el, not to be confused with its homophone paddle, which is a different sport. And no, padel isn’t the same as pickleball — but it’s just as fun.

Padel is the fastest-growing racket sport in the world, while pickleball is “only” the fastest-growing sport in the United States, says Julian Wortelboer, executive VP and chief padel officer of Ultra Club Miami, the largest padel club in the world, and co-host of the Padel Smash Academy podcast with Cesar Caceres. Wortelboer’s Ultra Club Miami has 28 courts, and Wortelboer says the club is at capacity for its full operating hours – 7 a.m. to 11 p.m.– more days than not. Padel will be an invitational sport in the Paris Olympics, and a full Olympic sport for the 2028 Olympics held in Los Angeles.

In other words, padel is a big deal, and it’s only getting bigger. Want to get in on the fun? In addition to Wortelboer, PS tapped padel pros Scott Colebourne, former board member of the United States Padel Association and Victor Perez, one of the top ten padel coaches worldwide, for a padel primer, including how to play padel, tips for beginners, and a break down of padel vs. pickleball.

Experts Featured in This Article:

Julien Wortelboer, is the executive VP and chief padel officer of Ultra Club Miami.

Scott Colebourne, is a former board member for the United States Padel Association.

Victor Perez is one of the top ten padel coaches worldwide.

What Is Padel, Exactly?

“Padel is a form of tennis that is easy to play, fun and extremely sociable,” says Perez. Colebourne describes padel as a blend of tennis and squash that involve lots of strategic, fast-paced play. “Padel is typically played in doubles on an enclosed court that’s roughly 25 percent smaller than a tennis court,” he says, and balls can be played off the court’s walls in a similar way to squash.

Where Did Padel Begin?

Padel has a fascinating origin story. The sport began in Mexico in 1969, says Colebourne, when Enrique Corcuera set up the first court in the backyard of his summer house. According to Wortelboer, Corcuera had limited backyard space, so he created a smaller-sized tennis court, enclosed on either side by the walls of his neighbor’s houses, and started playing a version of tennis that allowed playing the ball off the walls.

When he shared the game with two of his high-society friends from Spain and Argentina, they loved it, and quickly brought it home to their respective countries, says Wortelboer. The sport exploded in Argentina and Spain in the early 1980s, and spread to global popularity from there. According to Wortelboer, major growth happened in 2018 and 2019, and now there are 30 million padel players worldwide. Spain is currently hosting the Seniors World Padel Championships, with over 35 countries participating.

How to Play Padel

Padel is played on a court with enclosed walls 20 meters (about 66 feet) long and 10 meters (about 33 feet) wide, which is larger than a squash court, but smaller than a tennis court. The court is completely enclosed by walls, typically made of concrete, glass, or wire mesh, and a net similar to a tennis net divides the court in half, says Perez. Court surfaces vary, but common materials include artificial grass, carpet, or concrete.

Padel is always played in doubles, and uses the same scoring system as tennis, says Wortelboer. Games are typically played to six points and need to be won by two points, says Perez. Like tennis, players serve into the opposite box, with the ball required to bounce once on the floor and a key rule is that the serve must be underhand, says Colebourne. The ball can only bounce on the ground once, says Perez, but it can bounce on the walls more than once. Once the ball is in play, you can play it off the ground or wall.

What Gear Do You Need to Play Padel?

Like tennis, you’ll need the basics: balls and rackets. Padel balls are slightly smaller than tennis balls, and less pressurized, which results in a slower bounce, says Perez. Padel rackets are like tennis rackets but smaller, with a perforated face instead of strings, and a shorter handle for better two-handled play.

Perez also recommends padel shoes, which offer the best traction on the specific court surface, but says that tennis shoes can work in a pinch. And of course, comfortable athletic clothing that you can break a sweat in.

Benefits of Padel

According to Wortelboer, padel can give you more exercise per minute than other racket sports. “When you play 60 minutes of tennis with two intermediate players, you’re only actually exercising and hitting the ball for about 15-17 minutes, because the rallies are so short,” he says. “In contrast, playing the same amount of padel with the same level of players gives you 43 to 48 minutes of that concentrated exercise.” Padel gives you more exercise in the same amount of time, in part because you’re enclosed in a box, so you aren’t wasting your workout time picking up the ball. Depending on the intensity, says Perez, playing an hour of padel can burn up to 700 calories.

According to Colebourne, padel is also easier to learn than tennis, and offers a great cardiovascular workout, improving agility, reflexes, and muscle tone. One study demonstrated that it can improve fitness and body composition in middle-aged women, and a systematic review has shown its benefits for improving physical fitness and overall health. And since padel is played in doubles, Perez adds that it’s also a great way to socialize with friends and meet new people.

Is Padel the Same as Pickleball?

From a structural standpoint, pickleball uses a perforated plastic ball, similar to a wiffle ball, and composite or wooden paddles without strings, says Colebourne. It’s played on a badminton-size court, with a net that’s slightly lower than a tennis net, and the court is not enclosed by walls that you can play off of. In contrast, padel uses a solid racket, rubber ball, and playing the ball off the walls is a key part of the game, he says. Pickleball can also be played as a singles game, adds Perez, whereas padel must be played with a partner.

In addition to the rules, there are differences in gameplay, too. “Padel requires a lot of focus on the force used and knowing how to control the bounce of the ball off the walls to keep the game dynamic,” says Perez.

Wortelboer puts it succinctly (despite the warning that he might piss off diehard pickleball fans!): “Pickleball is a game; padel is a sport.” For pickleball, you have between six and eight easy shots you need to learn, he says. “In padel there are 39 different shots to master, so it’s a little more complex.”

Wortelboer adds that as padel is traditionally played on texturized fake grass, like turf, it can also be lower-impact and safer on your joints.

Padel Tips for Beginners

“Just get onto the court, start hitting a few balls, and you will fall in love with it,” says Wortelboer. In terms of strategy, Colebourne recommends focusing on control, rather than raw power; learning to play the ball off the wall effectively; working on your footwork; and playing with different partners to improve your all-around game.

Perez echoes the above, and also highly recommends practicing volleys as well as communication with your partner. Most importantly, he says, padel is a social sport, so remember to have fun!

Kaley Rohlinger is a freelance writer for POPSUGAR who focuses on health, fitness, food, and lifestyle content. She has a background in the marketing and communications industry and has written for POPSUGAR for over four years.

Scientists have tracked the scope of “PM 2.5” pollution over decades. PM 2.5 is a size of “particulate matter” that is less than 2.5 microns in diameter. But less information was available about its even tinier cousin, described as “submicron” or “PM 1” particulate matter, which is less than 1 micron in diameter. Why does that matter? Because the “little guys” might be the source of worse health effects.

With a study now published in The Lancet Planetary Health, researchers at Washington University in St. Louis have quantified the amount of PM 1 over the United States from the past 25 years.

“This measurement serves as a starting point to understand which pollutants regulators could target to make the most effective health impact,” said Randall Martin, the Raymond R. Tucker Distinguished Professor of energy, environmental and chemical engineering in the McKelvey School of Engineering. “This effort builds upon WashU’s strengths in satellite remote sensing and modeling atmospheric aerosols that were leveraged in this study,” he added.

Chi Li, research assistant professor in Martin’s atmospheric composition analysis group, is the first author of the work. Li said these estimates will enable further investigation into both the health and environmental effects of submicron particles.

Li said the very small particles quantified in this study generally come from direct air emissions, such as the black carbon particles released by diesel engines or the smoke from wildfires. Sometimes PM 1 can also form through secondary processes when sulfur dioxide or nitrogen oxides are spit out through fuel combustion and burning coal.

It makes intuitive sense that smaller particles of air pollution could do more damage to the human body because they are able to slip past the body’s innate defenses. These submicron particles are at least 6 times smaller than blood cells.

Air particles are not always one single thing, but mixtures of other materials stacked together.

The larger sizes of particles are critically more dominated by components that are not easily modifiable like mineral dust, noted Li.

The researchers were able to calculate their submicron estimates based on the known ratios of what makes up PM 2.5 particles, which include seven main components such as sulfate, nitrate and mineral dust.

“Putting the seven species together, we can calculate the total PM 1 concentration over the country,” Li said.

This research sets the stage for further analysis of where, how and why certain types of particles congregate, and how they can affect the environment and human body.

“When EPA first promulgated a fine PM air quality standard in 1997, there was considerable discussion about regulating PM 1 or PM2.5,” said Jay Turner, the James McKelvey Professor of Engineering Education and co-author on the study. “For numerous reasons, including but not limited to the lack of health impacts studies for PM 1 compared to studies for PM 2.5, the latter was chosen. This study provides a comprehensive, nationwide dataset to examine PM1 impacts on health.”

A next step will involve working with epidemiologists to assess the association of PM 1 with health outcomes.

The new dataset revealed another notable fact: pollution regulation does help. Across the contiguous U.S., average PM 1 levels in the air people breathe dropped sharply from 1998 to 2022, thanks to decades of environmental regulations like the Clean Air Act. However, this progress has slowed since 2010, mainly because of rising wildfire activity. Future pollution controls will need to address emerging, non-fossil fuel sources, study authors said.

Other countries like China have a head start tracking nationwide PM 1, but now the U.S. can quickly catch up.

“This dataset offers unprecedented information for the United States about an important pollutant for which few other measurements exist,” Martin said.

Funding from National Institute of Environmental Health Sciences, National Institutes of Health.

By MATTHEW HOLT

If health policy wonks believe anything it’s that primary care is a good thing. In theory we should all have strong relationships with our primary care doctors. They should navigate us around the health system and be arriving on our doorsteps like Marcus Welby MD when needed. Wonks like me believe that if you introduce such a relationship patients will receive preventative care, will get on the right meds and take them, will avoid the emergency room, and have fewer hospital admissions—as well as costing a whole lot less. That’s in large the theory behind HMOs and their latter-day descendants, value-based care and ACOs

Of course there are decent examples of primary care-based systems like the UK NHS or even Kaiser Permanente or the Alaskan Artic Slope Native Health Association. But for most Americans that is fantasy land. Instead, we have a system where primary care is the ugly stepchild. It’s being slowly throttled and picked apart. Even the wealth of Walmart couldn’t make it work.

There are at least 3 types of primary care that have emerged over recent decades. And none of them are really successful in making that “primary care as the lynchpin of population health” idea work.

The first is the primary care doctor purchased by and/or working for the big system. The point of these practices is to make sure that referrals for the expensive stuff go into the correct hospital system. For a long time those primary care doctors have been losing their employers money—Bob Kocher said $150-250k a  year per doctor in the late 2000s. So why are they kept around by the bigger systems? Because the patients that they do admit to the hospital are insanely profitable. Consider this NC system which ended up suing the big hospital system Atrium because they only wanted the referrals. As you might expect the “cost saving” benefits of primary care are tough to find among those systems. (If you have time watch Eric Bricker’s video on Atrium & Troyon/Mecklenberg)

The second is urgent care. Urgent care has replaced primary care in much of America. The number of urgent care centers doubled in the last decade or so. While it has taken some pressure off emergency rooms, Urgent care has replaced primary care because it’s convenient and you can easily get appointments. But it’s not doing population health and care management. And often the urgent care centers are owned either by hospital systems that are using them to generate referrals, or private equity pirates that are trying to boost costs not control them.

Thirdly telehealth, especially attached to pharmacies, has enabled lots of people to get access to medications in a cheaper and more convenient fashion. Of course, this isn’t really complete primary care but HIMS & HERS and their many, many competitors are enabling access to common antibiotics for UTIs, contraceptive pills, and also mental health medications, as well as those boner and baldness pills.

That’s not to say that there haven’t been attempts to build new types of primary care

Oak Street, ChenMed and Iora (now part of One Medical) were built with the idea of bumping up the primary care services given to seniors in Medicare Advantage, with the idea that–like Kaiser and its competitors–they can take financial risk for specialty and hospital care. The theory, as Iora’s founder Rushika Fernandopulle always said, was “double the spending on primary care and reduce overall costs by 30%.” It’s not too clear if they ever got there.

Of course like everything else in American health care Oak Street and Iora were repeats of earlier efforts by Mullikin, Friendly Hills, HealthPartners and many more to manage overall care costs by taking primary care capitated risk. None of these experiments were left alone by the finance bros long enough to see what would have happened if they played out. The stock market of the 1990s and the 2020s are full of graveyards of publicly traded primary care groups that all had very promising starts. Had they been left alone long enough to grow organically it’s possible that we would see a different future. We might even see that future if Included Health, Transcarent and others manage to build out their primary care/telehealth/navigation/Centers of Excellence offering. But it’s going to take a while

Overall, risk-bearing primary care remains a lonely business despite it being the preferred policy wonk solution since Sydney Garfield started taking prepayment from workers on the Grand Coulee Dam in 1933

Of course this being America you can still get excellent primary care, it is just going to cost ya.

Silicon Valley multi-millionaires pay Jordan Shlain’s Private Medical $40k a year plus for white glove service. At the other end of the scale, One Medical collects $80-200 a year from patients paying for access to next day appointments, NPs who actually answer emails and a free telehealth service for urgent care. In between is a whole host of doctors who have opted out of the hassle of billing insurers and are charging between $500 and $5000 a year for concierge care. Then there are a ton of primary care based services using telehealth, home visits and NPs, often combined with onsite clinics at workplaces

Which means that the number of those providing genuine Marcus Welby MD style primary care in the community continues to fall.

And it’s not too hard to figure out why. The average primary doctor makes a whole lot less than their specialty counterparts.

The fees for primary care are low. They’re set that way deliberately by the RUC (the Relative value scale update committee) which is dominated by specialists and essentially sets Medicare fees, which are then followed by most private insurers. So most doctors tend to look at the top end of this chart rather than the bottom they are choosing their residency slots. American health care is expensive because we have too many specialists doing marginally useful care, and too many hospitals (and pharma and device companies) making bank off them. And it’s all related to that chart.

There was a rather odd count by KFF  saying that nearly  50% of American doctors were in primary care, but that counted a whole lot of doctors are “primary care” who don’t deliver traditional primary care. This is of course wrong but it gives a hint for the solution.

There are 340 million Americans. We can give everyone a PCP and put them in a panel of 600 people (as opposed to the 2-3,000 typical PCP panel. That number happens to be what MDVIP and other concierge services offer. That would require 570 thousand PCPs. Which is about 60% of doctors post-residency in America.

So if we converted all those currently licensed PCPs and added NPs, we could give EVERYONE in America concierge style care. Those doctors would be immediately available and help their patients navigate the system.

Its proponents believe that concierge medicine is not only better but also tends to be much cheaper than regular care. MDVIP claims that it saves $2500 per patient  even after paying its doctors more, which is about 20% of health spending.  My contention is that we could give each PCP $2k per patient (or $1.2m per 600 patient panel), of which they could use (my guess) $300-500k to run their practice, and they could keep $700K to pay themselves.

So my proposal is we give everyone really high-end primary care, pay primary care docs really well and save a boatload of money. And apparently we have nearly enough primary care docs to do it. For sure if they were paid $700K a year we’d soon find plenty more of them.

Matthew Holt is the Publisher of THCB