How to treat low sodium levels in elderly folks

From the desk of
Robb Wolf
ScienceHow to treat low sodium levels in elderly folks

I recently chatted with an LMNT customer about keeping his elderly father hydrated. His dad was using LMNT to prevent leg cramps, a common symptom of sodium deficiency.

The problem wasn’t with his father, but rather with other seniors in his community; friends of his father’s. They drank sugary sports drinks and balked at the idea of bumping up sodium intake for healthier hydration.

In other words, they were:

  1. Consuming too much sugar. (See my blog on how sugar makes us sick).
  2. Consuming too little sodium.

I didn’t survey this community myself, but I would wager they were also consuming too much sodium-free water. When overdone, that practice can cause a dangerous condition of low serum sodium called hyponatremia.

The research suggests that older folks are largely unaware of this problem. In a community of 170 elderly people, over half reported drinking more than six glasses of water per day. And very few, according to the survey, understood the signs, symptoms, and significance of overhydration.

Many overhydration symptoms (aka, low sodium symptoms) mimic the symptoms of dehydration. But when you treat the headaches, muscle cramps, fatigue, and brain fog of low sodium by drinking plain water, it just makes things worse.

This confusing dilemma has killed people. It’s life and death stuff.

To prevent and treat low sodium levels in the elderly, we need to understand—not only how sodium levels fall—but why they fall. That’s why I wrote this article.

Why We Need Sodium

If you put someone in a survival situation, dietary sodium will quickly become a concern. Even if the person consumes calories and fluids, they won’t feel well without a source of salt.

You can see this happening on the hit survivalist TV show, Alone. After a few weeks in the wild, the contestants are invariably sodium depleted—a depletion which at least partly explains their malaise.

My point is that sodium is important. It’s an essential mineral that serves essential functions including:

  • Regulating extracellular fluid balance
  • Priming sodium-potassium pumps
  • Structuring bone
  • Helping cotransport nutrients (like glucose) through the gut

Let’s double click on the first two bullets: fluid balance and sodium-potassium pumps.

Proper fluid balance is the goal of hydration. You want the right amount of fluids (not too much and not too little) to keep blood flowing, skin moist, brain tissue functioning, and your bowels moving.

Sodium helps with that. It helps, for instance, to prevent your brain and limbs from swelling up with water.

Sodium also fuels the sodium-potassium pumps that keep your nervous system functioning. The mechanics of these pumps are complex, but the short explanation is that three ions of sodium must be pumped out of the cell for a nerve impulse to fire. (By the way, these sodium molecules are called ions because they hold an electrical charge—hence the term “electrolyte”).

Low Sodium vs. Dehydration in the Elderly

How do you know if your folks are suffering from low sodium levels? First, look for the symptoms. The symptoms of low sodium include:

  • Headache
  • Fatigue or low energy
  • Muscle cramps
  • Weakness
  • Brain fog
  • Dizziness
  • Confusion
  • Loss of consciousness, seizures, brain damage, or death (in severe cases)

Unfortunately, many of these symptoms (including the severe ones) mimic the symptoms of dehydration. And when you treat low sodium as dehydration, you risk exacerbating the problem. More on that soon.

First, I want to clarify. I’m not saying that dehydration isn’t an issue for elderly folks. Elderly people tend to get dehydrated more than the general population because of mobility issues, diuretics, and problems with the thirst mechanism. It’s not a problem to be taken lightly.

But I believe low sodium is the more dangerous problem. Hyponatremia is more probable when a fear of salt exacerbates an aggressive hydration strategy—as it often does in the lives of the elderly.

The clinical term for low serum sodium levels is hyponatremia, and most older folks aren’t aware of it. It’s not their fault, though. Hydration advice never talks about sodium. It only talks about water.

There’s a poster hanging in some retirement community 10 miles from your house, chiding folks to drink eight glasses of water a day. The residents remember the very same poster from their days in grade school.

But you won’t find a poster celebrating the salt shaker in this Universe. I need to talk to someone about that.

What Causes Low Sodium Levels in the Elderly?

There are several main causes of hyponatremia:

  1. Heart failure
  2. Kidney failure
  3. Liver disease
  4. Cancer
  5. Diuretic usage
  6. Vomiting and diarrhea
  7. Excessive water consumption

Often these causes overlap. For instance, an old man with a failing heart who drinks too much water will likely experience ankle swelling and other low sodium symptoms.

This is why heart failure patients are often put on fluid restricted regimens and prescribed diuretics. They need help clearing excess fluids.

People with dysfunctional kidneys also have problems clearing excess fluids. And when fluid accumulates, sodium levels plummet.

But the most preventable cause of hyponatremia is overhydration. If we can stop that, we can prevent many needless cases of low sodium.

Elite endurance athletes are no exception to the dangers of overhydration. Thanks to the widespread belief that fluids MUST be replaced the moment they’re lost, many athletes over-hydrate with sodium-free fluids throughout the race.

But when they cross the finish line, things can get ugly. Many stumble around like light-sensitive zombies, often slurring their words and sometimes losing consciousness. That’s what hyponatremia can do to you.

So the first pillar of preventing low sodium is to avoid overhydration.

The second pillar, as you might expect, is to get enough sodium. But when you tell folks (especially elderly folks) to get more sodium, they look at you like you’ve just suggested taking a yoga class on a tightrope stretched between two skyscrapers while blindfolded during a hurricane. Then they take another bite of unsalted chicken and briskly change the topic.

Understanding the Fear of Sodium

Most older folks get skittish around the salt shaker. They’ve been told for decades to avoid sodium in the name of heart health.

The anti-salt campaign began in 1980 with the release of the US Dietary Guidelines, a document that warned citizens to avoid “too much sodium”. Nowadays, the recommendation is more specific: we’re told to limit sodium to 2.3 grams per day.

But the science behind this recommendation is old and not especially relevant. It’s based, in part, on research conducted by Lewis Dahl in the 1960s on salt-sensitive rats.

Yes, if you inject salt-sensitive rats with loads of sodium, their blood pressure will spike. But humans aren’t salt-sensitive rats, and—unless treating hyponatremia—we rarely use intravenous saline.

Sodium fears also stem from observational data linking high sodium intakes to high blood pressure. But the data here is mixed and unconvincing. For instance, the INTERSALT study (the granddaddy of sodium and blood pressure epidemiology) found no link between sodium intake and the prevalence of hypertension across 48 global populations.

But surely elderly people with ailing hearts should restrict sodium? Actually, science suggests otherwise.

In 2011, researchers found that sodium restriction in line with government recommendations was linked to HIGHER rates of heart attack and stroke in high-risk patients. The sweet spot for reduced risk was more than double the government limit: about 4–6 grams of sodium per day.

In other words, strict low sodium diets appear to be bad for your heart, not good for it. For the sake of health, vitality, and longevity, we need to overcome our collective fear of sodium.

How To Prevent and Treat Low Sodium Levels

If you or a loved one is suffering from hyponatremia, seek medical attention. They will likely treat it with either IV or oral saline solution. Acute treatment aside, there are two main strategies for preventing low sodium levels in the elderly:

  1. Don’t drink too much plain water
  2. Consume enough salt

The first strategy is to consume adequate fluid. “Adequate” will vary from person to person, so I’m reluctant to give a figure. Instead, the smart approach is to encourage folks to drink to thirst. Not more, not less.

Thirst is a tightly calibrated system for preventing dehydration and its consequences. It’s why healthy people rarely become dehydrated.

Elderly folks, however, face challenges in achieving this goal. For instance, they might have mobility issues that prevent them from walking to the fridge. Conversely, they might be walking to the fridge too much if they think that more water is always healthy.

Older folks are also more likely to have a less-attuned thirst mechanism. In these situations, pay attention to dehydration-specific symptoms like dark urine and limited urinary volume—and work with a medical professional to determine an appropriate daily fluid intake.

The second strategy is to consume enough sodium. Based on the JAMA study I cited earlier, I recommend getting 4–6 grams of sodium (about 2–3 teaspoons of salt) per day.

For some, that may mean doubling or tripling salt consumption. How can we persuade our sodium-fearing folks to get on board?

Beyond sending them this article and occasionally muttering “stay salty” as you pass them the salt shaker, you might introduce your family to LMNT. Each stick of LMNT has a full gram of sodium, 200 mg potassium, 60 mg magnesium, and zero sugar.

And for those that don’t enjoy drinking water in the first place, LMNT can encourage healthy hydration for its taste. Then they’ll be preventing low sodium levels and dehydration simultaneously—without the empty calories of sugary sports drinks.

In other words, they’ll be living healthier lives. What’s more important than that?

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