Hi Adam,

As we head into the holidays—full of food, family, and a little extra stress—I wanted to share something reassuring and practical about blood pressure and kidney health.

Here’s the question I hear all the time:
“I’ve totally cut out salt! Why is my blood pressure still running high?”

If that’s you, here’s the most important thing to know:
feeling stuck doesn’t mean you’re doing something wrong.
It usually means you’re dealing with a problem that needs a wider lens.

Sodium matters—but it’s not the whole story

Reducing sodium is a fundamental. It’s important. And for many people, it absolutely helps.

But blood pressure doesn’t respond to just one input. (If only it were that simple—we’d all be done by now.)

One scientific paper puts it this way: “An updated Mosaic Theory has been proposed to explain the pathogenesis of hypertension.”

According to this theory, high blood pressure reflects “various combinations of traits and stressors,” including oxidative stress, sympathetic activation, inflammation, genetics, microbiome influences, kidney mechanisms, vascular function—and salt intake.
(You can read the full paper here if you’re curious: https://doi.org/10.1038/s41392-023-01430-7)

Or, in far less science-y terms: blood pressure goes way beyond salt.

This helps explain why so many people feel frustrated—they’re doing everything they’ve been told, but the pieces they haven’t been taught about are still in play.

What often gets missed

When we zoom out, several contributors consistently show up in the research:

Vitamin D deficiency is associated with higher blood pressure
Potassium intake is linked to lower blood pressure. As in MORE potassium is linked to lower blood pressure. If you don’t truly need a potassium restriction, then you should be eating more potassium! (Of note, some people absolutely do need a potassium restriction but not everyone!)
Oxidative stress damages blood vessels and reduces nitric oxide, making it harder for vessels to relax
Low levels of vitamins D, C, B6, B12, and minerals like magnesium and zinc are linked to increased oxidative stress and hypertension. So eating a narrow highly restrictive diet might actually be doing the opposite of what you hope for!

Even how blood pressure is measured can cloud the picture. KDIGO guidelines highlight that “a lack of standardized blood pressure measuring procedures” has made outcomes harder to interpret. (Translation: that rushed cuff reading after sprinting down the hallway may not tell the full story.)

Where sodium still fits (without over-fixating)

Most sodium intake comes from packaged, restaurant, and convenience foods, not the salt added at home.

If you’re cooking mostly fresh foods, modest salting is usually not the main issue—and yes, you still need sodium.

If convenience foods are common, small shifts can help:

Choose fresh or minimally processed foods when possible
Use frozen fruits and veggies without added sauces
Aim for <140 mg sodium per serving on packaged foods
Lean on herbs, spices, citrus, and aromatics for flavor

The real reason people get stuck

Most people don’t need more discipline.
They need more information, better context, and individualized guidance.

The best outcomes come from taking a holistic look—layering fundamentals like sodium reduction together with nutrient status, oxidative stress, kidney signaling, lifestyle, and real-world eating patterns.

That’s exactly where we come in.

At Kidney Nutrition Institute, we don’t just repeat what you already know—we help you explore everything beyond it, so you can finally understand why your body is responding the way it is and what to do next.

If you enjoy this kind of clear, practical, science-based guidance, I have something exciting to share…

We’re building a new group program for CKD called RenAlign, launching in 2026