<p><span style="font-weight: 400">The US government has recommended a low sodium diet for about forty years. The message is that reducing sodium intake will reduce our collective risk of heart disease.</span></p><p><span style="font-weight: 400">Recently, the FDA </span><a href="https://nypost.com/2021/10/13/fda-wants-to-radically-reduce-salt-in-nations-food-supply/?utm_campaign=SWS&utm_medium=email&utm_source=mda&utm_content=MDA&_kx=11XtAoBQjC71bTpwUiNq3fM-31GXD6puI0o5U78KPDI%3D.QazHWz" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">reinforced</span></a><span style="font-weight: 400"> this message by asking food companies to drastically reduce salt in the food supply. The goal is to inch the average intake closer to their target of 2.3 grams of sodium per day.</span></p><p><span style="font-weight: 400">If you’ve been following my work, you know how I feel about low sodium recommendations. They’re not only misguided but they can be dangerous for healthy people.</span></p><p><span style="font-weight: 400">They’re misguided because sodium clearly isn’t the villain in the saga of diet-related illness. Why aren’t we talking about the real villains? Why aren’t we talking about the </span><a href="https://drinklmnt.com/blogs/health/how-sugar-is-making-us-sick" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">glut of sugary foods</span></a><span style="font-weight: 400"> and the lack of exercise that permeate modern living?</span></p><p><span style="font-weight: 400">Because sodium is a convenient and easy-to-understand scapegoat. Because the government </span><a href="https://www.nytimes.com/interactive/2019/08/14/magazine/sugar-slave-trade-slavery.html" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">subsidizes</span></a><span style="font-weight: 400"> the sugar industry to the tune of $4 billion per year. Because many don’t want to hear they need to exercise frequently.</span></p><p><span style="font-weight: 400">All are contributing factors. And so sodium gets shunned across the board. That’s where the danger comes in. Unlike sugar, </span><a href="https://drinklmnt.com/blogs/health/is-sodium-good-or-bad-for-you" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">sodium</span></a><span style="font-weight: 400"> is an essential nutrient. When we don’t get enough of it, bad things happen.</span></p><p><span style="font-weight: 400">I’m talking about blood pressure elevations, </span><a href="https://drinklmnt.com/blogs/health/keto-insomnia" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">insomnia</span></a><span style="font-weight: 400">, and bone density issues—not to mention the raft of symptoms that accompany low sodium living. People often blame their headaches, low energy, and </span><a href="https://drinklmnt.com/blogs/health/what-causes-muscle-cramps" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">muscle cramps</span></a><span style="font-weight: 400"> on dehydration, but </span><a href="https://drinklmnt.com/blogs/health/dehydration-causes-and-symptoms" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">dehydration</span></a><span style="font-weight: 400"> seldom occurs in healthy people. No, it’s more frequently sodium deficiency.</span></p><p><span style="font-weight: 400">Most healthy people need more sodium, not less. They feel and perform much better when they bump it up. But powerful forces are imploring us to curtail sodium. Today I’ll be talking about the folly (and health risks) of these recommendations.</span></p><h2><b>Why Sodium Is Vilified</b></h2><p><span style="font-weight: 400">Back in the 1960s, a scientist named Lewis Dahl did some </span><a href="https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC2118645/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">experiments</span></a><span style="font-weight: 400">. In these experiments, he found that injecting rodents with sodium raised their blood pressure.</span></p><p><span style="font-weight: 400">The rodents, to be clear, were a salt-sensitive breed of rats. And they were given a supraphysiological dose of sodium. And they were rats, not humans. Nonetheless, Dahl’s data would become the bedrock of the anti-salt campaign.</span></p><p><span style="font-weight: 400">The other pillar of the anti-salt campaign rests on observational data. And it’s true: in some populations, higher salt intakes are </span><a href="https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4520886/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">linked</span></a><span style="font-weight: 400"> to higher rates of hypertension (high blood pressure) and heart disease.</span></p><p><span style="font-weight: 400">But in others, they’re not. That’s why we look at the WHOLE PICTURE like researchers did in the 1988 </span><a href="https://pubmed.ncbi.nlm.nih.gov/3416162/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">Intersalt Study</span></a><span style="font-weight: 400">. Analyzing over 10,000 people across 48 cultures, they found no correlation between salt intake and high blood pressure incidence.</span></p><p><span style="font-weight: 400">If sodium was the enemy of healthy blood pressure, it would have shown up there. But it didn’t.</span></p><p><span style="font-weight: 400">What about data </span><a href="https://pubmed.ncbi.nlm.nih.gov/25297880/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">linking</span></a><span style="font-weight: 400"> higher salt intakes in the US to heart disease? Remember that correlation doesn’t prove causation. Consider that:</span></p><ul><li style="font-weight: 400"><span style="font-weight: 400">Many of the populations studied were high-risk populations. They’re not a representative sample of society.</span></li><li style="font-weight: 400"><span style="font-weight: 400">Processed foods </span><a href="https://pubmed.ncbi.nlm.nih.gov/19955402/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">tend</span></a><span style="font-weight: 400"> to be high in salt. So the “high salt” group is also primarily the “high processed foods” group.</span></li><li style="font-weight: 400"><span style="font-weight: 400">People who consume a modern diet of salty processed foods and sugary drinks are more likely to be sedentary—and lack of exercise is a </span><a href="https://pubmed.ncbi.nlm.nih.gov/19996993/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">well-established</span></a><span style="font-weight: 400"> heart disease risk factor.</span></li></ul><p><span style="font-weight: 400">These considerations become more persuasive when you ponder the physiological importance of sodium.</span></p><h2><b>What Sodium Does For You</b></h2><p><span style="font-weight: 400">Sodium’s roles in your body can be lumped into two main categories:</span></p><ol><li style="font-weight: 400"><span style="font-weight: 400">Fluid balance</span></li><li style="font-weight: 400"><a href="https://drinklmnt.com/blogs/health/what-electrolytes-do-for-you" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">Sodium-potassium pumps</span></a></li></ol><p><span style="font-weight: 400">Maintaining fluid balance in your tissues is the goal of hydration. You consume water and electrolytes so your blood can flow, your brain can rest in fluid, your body can dispose of waste, your sweat can cool you off, and much more.</span></p><p><span style="font-weight: 400">Specifically, sodium regulates extracellular fluid balance. It helps maintain blood volume so your blood can shuttle nutrients to your tissues.</span></p><p><span style="font-weight: 400">When most people think about </span><a href="https://drinklmnt.com/blogs/health/how-to-stay-hydrated" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">hydration</span></a><span style="font-weight: 400">, they think about drinking water. They forget about electrolytes like sodium, </span><a href="https://drinklmnt.com/blogs/health/potassium-benefits-and-best-sources#:~:text=Potassium%20101,ions)%20generally%20appear%20as%20K%2B." target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">potassium</span></a><span style="font-weight: 400">, and chloride. This neglect of electrolytes explains many hydration-related issues (cramps, fatigue, etc.) in active, sweaty people.</span></p><p><span style="font-weight: 400">Sodium also primes the proteins—called sodium-potassium pumps—that help to power every living cell. These pumps </span><a href="https://pubmed.ncbi.nlm.nih.gov/30725773/#:~:text=The%20Na%2B%20K%2B%20pump%20is,for%20every%20single%20ATP%20consumed." target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">require</span></a><span style="font-weight: 400"> sodium to:</span></p><ul><li style="font-weight: 400"><span style="font-weight: 400">Maintain cellular membrane potential so nerve impulses can fire</span></li><li style="font-weight: 400"><span style="font-weight: 400">Regulate brain activity</span></li><li style="font-weight: 400"><span style="font-weight: 400">Transport glucose and amino acids into cells</span></li><li style="font-weight: 400"><span style="font-weight: 400">Keep cellular fluids in balance</span></li></ul><p><span style="font-weight: 400">Important stuff, you might say. Now let’s see what happens when you’re low on sodium.</span></p><h2><b>What Happens on a Low-Sodium Diet</b></h2><p><span style="font-weight: 400">If you under-consume sodium, it will make your body sad. But it won’t kill you. Why not? Isn’t sodium essential? What about fluid balance and sodium-potassium pumps?</span></p><p><span style="font-weight: 400">All that stuff is critical, and your body knows it. That’s why it has a dynamic sodium-retention system.</span></p><p><span style="font-weight: 400">The first line of this system is a group of hormones including antidiuretic hormone (ADH), aldosterone, renin, angiotensin, and norepinephrine. </span><a href="https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3951800/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">Triggered</span></a><span style="font-weight: 400"> by sodium deficiency, these hormones tell your kidneys to retain sodium.</span></p><p><span style="font-weight: 400">But these hormones have other effects too, like raising blood pressure and increasing the fight or flight response. I’ll elaborate on that soon.</span></p><p><span style="font-weight: 400">How else does your body maintain sodium status on a low sodium diet? It </span><a href="https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6140170/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">pulls sodium</span></a><span style="font-weight: 400"> from your vast sodium reservoir: the skeleton. Good news for sodium levels, bad news for bone density.</span></p><p><span style="font-weight: 400">This explains how your sodium blood test can come back normal on a salt deficient diet. Serum sodium is not an accurate marker of sodium status, folks.</span></p><h2><b>Health Risks of a Low Sodium Diet</b></h2><p><span style="font-weight: 400">Once you understand the sodium-retention system, the health consequences of a low sodium diet make more sense.</span></p><h3><b>#1: Osteoporosis</b></h3><p><span style="font-weight: 400">When you’re light on sodium, your body pulls it from bone. Probably why low sodium intakes are </span><a href="https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6140170/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">linked</span></a><span style="font-weight: 400"> to the brittle bones and increased fracture risk that define osteoporosis, don’t you think?</span></p><p><span style="font-weight: 400">Salty diets are (surprise surprise) often </span><i><span style="font-weight: 400">blamed </span></i><span style="font-weight: 400">for osteoporosis based on unsupported notions about calcium balance disruptions. The </span><a href="https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6140170/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">evidence</span></a><span style="font-weight: 400">, however, pins sugar as the problem more likely for bone health issues.</span></p><h3><b>#2: Elevated blood pressure</b></h3><p><span style="font-weight: 400">Remember aldosterone, renin, angiotensin, and norepinephrine? These hormones </span><a href="https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3951800/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">rise</span></a><span style="font-weight: 400"> on a low-salt diet to help you retain sodium. These hormones also raise blood pressure. Not ideal for heart health.</span></p><p><span style="font-weight: 400">This explains </span><a href="https://faseb.onlinelibrary.wiley.com/doi/abs/10.1096/fasebj.31.1_supplement.446.6" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">data</span></a><span style="font-weight: 400"> from the 2017 Framingham Offspring Study. In the analysis, sodium-restricted diets (under 2.5 grams per day) were actually linked to </span><i><span style="font-weight: 400">higher</span></i><span style="font-weight: 400"> blood pressures in 2,632 men and women.</span></p><p><span style="font-weight: 400">I’m not saying that too much sodium won’t raise blood pressure. It will, at least transiently. But there’s a sweet spot for sodium and most healthy people are short of it.</span></p><h3><b>#3: Elevated cortisol</b></h3><p><span style="font-weight: 400">You’ve probably heard of cortisol. Known as the “stress hormone”, it exerts effects on most human cells.</span></p><p><span style="font-weight: 400">Cortisol is essential for survival. Let’s be clear on that. But in excess, cortisol can </span><a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/adrenal-glands" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">lead to</span></a><span style="font-weight: 400"> undesirable fat storage, bone decomposition, and muscle breakdown.</span></p><p><span style="font-weight: 400">Most people know that chronic stress elevates cortisol, but fewer people know that low sodium </span><a href="https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5575371/pdf/main.pdf" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">can too</span></a><span style="font-weight: 400">. It’s an underappreciated cause of hypercortisolemia.</span></p><h3><b>#4: Hyponatremia</b></h3><p><a href="https://drinklmnt.com/blogs/health/hyponatremia" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">Hyponatremia</span></a><span style="font-weight: 400"> is a medical condition of low serum sodium. The symptoms include headaches, confusion, fatigue, cramps, and—in severe cases—light sensitivity, brain swelling, and death.</span></p><p><span style="font-weight: 400">The main causes of hyponatremia are heart failure, liver disease, kidney failure, diuretic usage, vomiting, diarrhea, cancer, and excess consumption of sodium-free water. These factors are disruptive enough to derail your sodium-maintenance system.</span></p><p><span style="font-weight: 400">Here’s the thing. Low sodium intakes alone won’t cause hyponatremia, but they </span><i><span style="font-weight: 400">will </span></i><span style="font-weight: 400">increase the risk of developing it.</span></p><p><span style="font-weight: 400">Consuming sodium and drinking to thirst are both the preventative and the cure for exercise-associated hyponatremia. (Exercise-associated hyponatremia is the type hyponatremia borne of overhydration.) More than any other reason, this is why athletes </span><a href="https://drinklmnt.com/blogs/health/how-to-hydrate-for-endurance-sports" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">need to stay salty</span></a><span style="font-weight: 400">.</span></p><h3><b>#5: Sodium deficiency symptoms</b></h3><p><span style="font-weight: 400">Poor sodium status can cause a long list of symptoms, all of which are multifactorial. Here are the big ones:</span></p><ul><li><span style="font-weight: bold">Low energy. </span>Between regulating fluid balance and sodium-potassium pumps, sodium has tremendous influence over <a style="font-weight: bold" href="https://drinklmnt.com/blogs/health/do-electrolytes-give-you-energy" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">subjective energy levels</span></a>.</li><li><span style="font-weight: bold">Muscle cramps. </span>The more sodium lost through sweat, the more cramps <a style="font-weight: bold" href="https://pubmed.ncbi.nlm.nih.gov/16521848/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">occur</span></a>.</li><li><span style="font-weight: bold">Headaches. </span>Headaches can have many causes, but low sodium is always worth ruling out.</li><li><span style="font-weight: bold">Insomnia. </span>Sodium retention hormones like norepinephrine are highly stimulating.</li><li><span style="font-weight: bold">Brain fog. </span>If you have difficulty concentrating, you might not be getting enough sodium.</li></ul><h2><b>How Much Sodium Do You Need?</b></h2><p><span style="font-weight: 400">The answer </span><a href="https://drinklmnt.com/blogs/health/electrolyte-imbalance-or-deficiency" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">depends on factors</span></a><span style="font-weight: 400"> like:</span></p><ul><li style="font-weight: 400"><span style="font-weight: 400">How much you sweat (more sweat, higher sodium needs)</span></li><li style="font-weight: 400"><span style="font-weight: 400">Your dietary habits (low-carb diets increase urinary sodium losses)</span></li><li style="font-weight: 400"><span style="font-weight: 400">The state of your metabolism (insulin resistant folks are </span><a href="https://pubmed.ncbi.nlm.nih.gov/9607376/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">more likely</span></a><span style="font-weight: 400"> to be salt-sensitive)</span></li></ul><p><span style="font-weight: 400">For most people, a good starting point is 4–6 grams of sodium per day (that’s about 2 to 3 teaspoons of salt). This recommendation is based on data from a </span><a href="https://pubmed.ncbi.nlm.nih.gov/22110105/" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">2011 JAMA study</span></a><span style="font-weight: 400"> that found 4–6 grams daily was the sweet spot for heart health in high-risk patients.</span></p><p><span style="font-weight: 400">But sweaty low-carb athletes, for example, will need even more. I work with NHL teams, and some of the big guys need many sticks of </span><a href="https://drinklmnt.com/products/lmnt-recharge-electrolyte-drink" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400">LMNT</span></a><span style="font-weight: 400"> to replace sweat losses when they train. (LMNT contains 1 gram of sodium per stick pack.)</span></p><p><span style="font-weight: 400">You’ll have to play around to find what works best for you. For many of us, the optimal dose may be significantly higher than what authorities continue to recommend. The cool part is that if you’re low on sodium, you should feel better within minutes of a good dose. Try sipping electrolyte water the next time you’re training.</span></p>