Helpful for some, a low-salt diet is not always safe
You may have heard that you should be avoiding extra salt. That advice has been standard for many decades. The American Heart Association “recommends no more than 2,300 mg a day and an ideal limit of less than 1,500 mg per day for most adults, especially for those with high blood pressure.”
Such a policy may be helpful for many people, but it actually could put some individuals at risk. A few years ago, we heard from a reader who had been avoiding salt conscientiously for years:
“One day, my sodium level dropped to 125 and I started jerking and was near convulsions. After an ambulance ride to the emergency room, I learned how important it is to watch your salt intake. I was told by the hospital doctor to drink less water so as not to lose too much sodium through my urine.
“The ER doctor also told me to eat extra table salt. When my sodium finally reached 134, which is only one point lower than the normal range, I started feeling so much better.”
The ER physician was addressing the emergency of that moment with advice to drink less water. Drinking too little water in hot weather is also dangerous, as it can lead to dehydration. However, getting too much plain water without enough sodium can result in hyponatremia (low sodium), as our reader discovered. Other electrolytes such as potassium and magnesium are also important.
We worry about blanket advice to cut salt intake as much as possible. Although some people are salt sensitive and will see a drop in blood pressure when they get less sodium in their food, others do not react so strongly. Some even develop high blood pressure when they cut salt drastically. Moreover, people with high blood pressure – precisely those urged to avoid salt – often take medicine to control high blood pressure.
Diuretics are frequently the drugs of choice, but thiazide diuretics such as hydrochlorothiazide or furosemide (Lasix) can deplete the body of many minerals, including sodium as well as magnesium and potassium.
Other medications that may create an imbalance in minerals include antiepileptics, SSRI antidepressants and even proton pump inhibitors such as esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec). Some people taking such drugs have experienced hyponatremia (American Journal of Kidney Diseases, May 13, 2008). It is prudent for patients to have their electrolyte balance monitored regularly, especially during hot weather.
Some other people are actually being advised to increase their salt and fluid intake. In the aftermath of COVID-19, many individuals now suffer from long COVID-19. One of the possible complications of this condition is POTS (postural orthostatic tachycardia syndrome).
Those with this mysterious health challenge experience dizziness when standing up quickly. This can sometimes lead to fainting, which can be very dangerous. Other symptoms include rapid heart rate, brain fog, exhaustion and anxiety.
There aren’t many treatments that can relieve POTS. However, some doctors recommend increased salt and fluid intake along with medications that can help control heart rate.
Salt is not our enemy. Without sodium, our bodies do not function. As a result, we endorse the old adage of moderation in all things, including salt.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”