While this thread is about the risks of too much sodium, due to it raising blood pressure and possibly damaging blood vessel walls and the kidney due to salt level spikes in the blood after high salt intake, I wanted to raise the issue of the risks of low sodium. While high sodium causes long term damage it rarely causes immediate harm, while low sodium can rapidly cause serious complications including dizziness, catatonia (temporary complete paralysis) and is the main cause of slip and fall accidental deaths in the elderly due to nerve conduction being impaired by low sodium levels. In fact total mortality rates rise as salt intake is reduced beyond a certain point in the diet, even though cardiac mortality continues to go down.
My late father was a long-time diabetic and suffered from low sodium, probably caused by his high blood sugar levels above 180 acting as a diuretic, triggering the kidney to dump blood sugar along blood plasma. This also results in dehydration and the normal response of drinking water (without added electrolytes) to compensate results in low blood sodium levels. My father spent his last 2 years with me and my wife (after my stepmother did not want to take care of him) so I got to see first hand the effect of low sodium. He was always dizzy on his feet and forced to spent most of his time lying down, in spite of us adding as much salt as possible to his diet. One morning I found him in bed unable to move with all limbs catatonic (stiff and unable to bend) : I still remember his eyes moving and following me but otherwise he was unable to communicate or move and I can only imagine how that feels. I called 911 who took him to the ER where they ran some tests to rule out other issues, but ended up just treating him with hypertonic (3% NaCL) IV, after which he was back to normal within an hour. We were told his blood sodium level was 128 which caused most nerves to stop conducting signals to his muscles.
Just last year my wife (age 71) 2 weeks after her 3rd scheduled surgery in 10 months (back surgery, rotator cuff repair and knee replacement) suddenly developed dizziness and fell a couple times and was taken to the ER where they ran tons of tests all of which came back negative. Over the next 6 months more tests were run (MRI, CAT, 24-hour heart monitor, 30-day heart monitor etc) all coming back negative. Her sodium levels were on the lower end of normal (around 135) but not actually low, so it wasn’t until a review by a cardiologist that they figured out that she was suffering from orthostatic hypotension (low blood pressure when standing), probably caused by plasma loss from all the bedrest periods after the 3 surgeries. The kidney tries real hard to keep blood sodium levels within range, and when body sodium level drop too low will dump excess water from the blood to bring sodium concentration back in range, but that can cause blood pressure to drop, initially only when standing, eventually at all times. This also means it is really hard to tell from blood measurements if your body’s sodium levels are too low (or too high). The cardiologist said she squeezed my wife’s limbs and could detect no tissue bloating, which is the only way to tell if the body has excess sodium (or is depleted), but I am not sure if there is an easy way to check that yourself. My wife had also lost 20% of body weight over the previous year due to taking Mounjaro, which my wife was really pleased with, but may have made the problem with orthostatic hypotension worse, since weight loss naturally results in blood pressure going down. My wife’s blood pressure meds were reduced AND her diuretic discontinued and she was told to consume at least 32 oz of electrolyte drink per day to raise her plasma volume. The electrolyte recommended (Normalyte) is basically 1/4 teaspoon salt + 1/4 teaspoon Potassium Citrate + 1/2 teaspoon Sodium Citrate + 1 teaspoon dextrose (per 16 oz water), and we add lemon juice + extra sweetener to make it more palatable.
I don’t suffer from orthostic hypotention, but my blood pressure has also steadily fallen as I lost weight over the last 2 years (down from 205lb to 145lb) and have had to reduce my blood pressure medication to keep by BP above 100. During my recent colonoscopy, they had to give me IV saline for 30 minutes before the precedure because my blood pressure was 80/50 (I felt normal and did not experience any dizzness walking into the hospital). I now take 16 oz of the same electrolyte mix every morning : I figure this also covers the bases by providing the citrate for the citrate protocol discussed elsewhere in these pages. Also, I noticed a clear mental sharpening that happens in the hours after I drink the electrolyte mix (in the morning) so the brain clearly seems to benefit from extra sodium as well.
Bottom line : I would recommend first treating high blood pressure with exercise (or massage), weight loss (if needed) and medications and only as a last resort reduce salt intake. There is no benefit of reducing salt intake if you don’t suffer from high blood pressure and no easy way to know how close you are to triggering the serious harm from low sodium levels. I would still avoid consuming high salt foods without plenty of fluids since the temporary high blood sodium spikes will damage blood vessels and the kidney in the long run.
