Dana Learns An Important Lesson Again: Why Sodium Is Important On A Low Carb Diet

Hey, Gang!

I’ve turned in the book, I’m back from the Low Carb Cruise, and I am ready to write, and to make the new CarbSmart into the internet’s most trusted and popular source of low carb information.  I came up with 53 new ideas for articles and columns while sitting in the Charlotte NC airport on the way home!

But first, time to learn an old lesson over again.

Last summer, I wrote about reading Volek and Phinney’s excellent book  The Art and Science of Low Carb Living right around the same time I was having some nebulous symptoms – fatigue, headaches, cramps, brain fog.  I recognized the symptoms of hyponatremia  – salt deficiency – added extra salt to my diet, and rapidly felt better.

You’d think the lesson would stick.  But nooooooo.

As most of you know, since last autumn I’ve been working on 500 Paleo Recipes: Hundreds of Delicious Recipes for Weight Loss and Super Health 500 Paleo Recipes: Hundreds of Delicious Recipes for Weight Loss and Super Health.  Because salt is controversial in paleo circles – some use good salt, some shun it altogether – I’d been keeping the salt in the recipes to the minimum needed to get the flavor I wanted.  Add to that the fact that I was using even fewer packaged foods than usual – no canned tomatoes, no bouillon concentrate, stuff like that – and my salt intake was clearly lower than usual.

By a few weeks before deadline, I was tired, and my shoulders, neck, and head ached.   More than once I woke up in the middle of the night with a splitting headache, or got up with one in the morning. I saw my chiropractor, and chalked the rest up to stress.  Oh, and a few days of getting the wrong dosage of thyroid, an experience that left me barely conscious – I exaggerate only a little.

Finished the book, and had just a couple of days to shop and pack and head off for the cruise.  Got it done, only to catch cold the day after we sailed.  It was easy to attribute even worse fatigue and headache to the stupid virus.

Because I had a scratchy throat, I was sucking down even more tea, hot and iced, than usual, and at night I went through quarts of club soda while socializing.  (Also a little wine, and the occasional shot of tequila.  But I went through a lot of club soda.)

The second night at sea I sat on a stool at the aft deck bar for two hours, chatting with Sarah and Ray, two lovely first-time low carb cruisers.  (Hi, guys!  Hope you’re reading this!)  When I got up, my legs were so swollen they were stiff.  I had mild “pitting edema” on my ankles – that’s when you’re retaining so much water that a fingertip pressed into the tissue leaves a depression.

That was alarming.  I went back to my cabin, lay on the floor, and put my legs up on the bed, letting the fluid drain out of my legs.  I wondered if the problem was largely sitting on a hard-ish stool and letting my legs dangle (I’m a shrimp), but still, the problem seemed a bit severe to be caused so simply.

My legs didn’t swell that badly again, but they still felt stiff and slightly turgid.

I might add to this that the salt shakers on the Carnival Magic were annoying – half of ‘em were clogged, and even the ones that weren’t had too few holes.  I regularly pried the stoppers out of the bottoms to get enough salt to even taste, and I’m sure I didn’t sprinkle as much salt as I would at home.

I managed to have a really good time despite all of this, and despite That Nice Boy I Married coming down with the cold just as I was starting to get over it.  I mean, I was on a Caribbean cruise with 260 of the nicest people you could ever hope to meet.  I’d have had to be comatose to not have fun.

Flash forward to yesterday.  Been home a couple of days, gotten a couple of good nights of sleep.  Pretty much over the cold except for a little residual snottiness.  But I was exhausted and swimmy-headed.  Again, for a couple of days I wrote off my dizziness as the well-known phenomenon of being able to feel the ship moving for a few days after you disembark, but this was more than that.

Suddenly the dime dropped.  I went and reread stuff about hyponatremia, and sure enough, not only can it cause exhaustion, brain fog, light-headedness, and headache, but there’s a particular kind of hyponatremia that can cause swelling of the extremities.  What kind?  Why, the kind accompanied by excessive fluid intake, that’s what kind.  As salt is washed out of the body, and the sodium level in the blood drops lower and lower, osmotic pressure drives the excess fluid into the cells instead, resulting in swelling.  All that extra fluid to keep the hacking cough at bay had exacerbated my already existing salt deficiency.

The splitting headaches that were waking me up?  So long as I was upright, most of the fluid drained from my brain.  When I lay down, it started to accumulate, with the result that my brain swelled.  This is what will eventually cause coma and death in a really bad case of hyponatremia.

I ran to the kitchen and mixed a little can of V8 Spicy Hot with an equal quantity of beef broth, and stirred in a half-teaspoon of good, mined ancient sea bed salt.  Slugged it down.  Within an hour or two, my energy level was better and I was no longer swimmy-headed when I stood up.  Today I heated the mixture, and stirred in a teaspoon of unflavored gelatin, just because I think it’s highly nutritious stuff I should be getting daily.

I feel a lot better.  I’m not increasing my salt levels any more quickly because the stuff I read says that reintroducing salt too quickly can cause a stroke-like condition leaving permanent damage.  That would be, in a word, bad.  But I’ve learned my lesson: Salt is my friend, and I have to be very careful to get enough.

By the way, That Nice Boy I Married has been diagnosed as hyponatremic, too – once when he’d actually fainted.

All of this is a great illustration of a simple point: Sodium is not the problem.  High insulin levels are the problem, because they signal the kidneys to retain sodium.  Stop eating carbs and drop your insulin levels, and all of a sudden your kidneys become very efficient at removing sodium from the bloodstream. Stop eating a bunch of processed food, and your salt intake drops just as your ability to cope with sodium improves.  Indeed, when I was a kid it was not uncommon for water coolers to have a little dispenser of salt tablets attached, in case people felt woozy, especially in the summer time.  Of course, that was before low fat/high carb mania, before everyone was thawing instead of cooking dinner, before we were told butter and eggs were deadly and cold cereal was our healthiest breakfast, back when you could still find 6 ounce bottles of Coca-Cola, and 12 ounce cans were still a fairly “modern” serving size.

So get your salt.  In particular, if you’re unreasonably tired, lightheaded, headache-y – especially if the headache gets worse when you’re lying down – crampy, brain-fogged, go to the kitchen right now, before you read another thing, and consume an extra ½ teaspoon of salt, and resolve to make certain you get a minimum of a gram to two grams of sodium per day.

Remember, for most of human history we knew that too little salt could kill you.  It’s time to remember that ancient wisdom.

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  1. It’s interesting that you say this , “Sodium is not the problem. High insulin levels are the problem, because they signal the kidneys to retain sodium. Stop eating carbs and drop your insulin levels, and all of a sudden your kidneys become very efficient at removing sodium from the bloodstream. Stop eating a bunch of processed food, and your salt intake drops just as your ability to cope with sodium improves.”

    When really getting into my low carbing I was concerned that maybe I was eating too much sodium. You know worried about high blood pressure and all. Even though I wasn’t eating processed foods, I still check the sodium in my foods. I have drastically reduced my salt intake but I still use my garlic salt when I remember ( I realized that I make my scrambled eggs without salt and didn’t know the difference.). But reading this valid point it makes me not so “scared” of salt.

  2. Fascinating Dana! So glad you re-discovered the problem and that you’re feeling better! Thanks for sharing!

  3. I too find that enough sodium is so important, especially when I’m fat fasting (or close to it) – I start just draining out if I’m not taking an extra 1/2 tsp of salt/day. I’ve tried various delivery methods, bouillon makes me gain weight ( I think I’m sensitive to maltodextrin), salt in hot drinks like tea (works, but not really tasty) – now I just put a 1/4 tsp on the back of my tongue and chase it down with a good sized glass of water. Not tasty, but over quick and sure does the trick! Sometimes I think my midafternoon cravings are just low sodium levels – need to remember to take my afternoon dose of salt too! It is hard sometimes to live in this seemingly upside world of low carb, where salt and fat are really good for you, not things to be avoided at all costs.

    • I found 4 pounds of pink Himalayan sea salt at the Goodwill — for $4! It’s in biggish chunks, so I whack it with a hammer, break off bits that are roughly half-teaspoon-sized, and swallow down 2-3 like vitamin pills. 😀

  4. I landed in the ER this past summer with flu-like symptoms (I’m NEVER sick). While there they did a slew of blood tests, one of which was my sodium count. It was 129 on a “normal” range of 136 – 145. Funny thing was, I knew LCers needed to supplement with salt, but never put 2 and 2 together to take that advice myself. I started drinking salty lemonade: a glass of sugar-free lemonade with 1/2 tsp sea salt dissolved in it. For a week I had two or three glasses a day, and was then re-tested (138 this time). That taught me a lesson. Now I drink at least one glass of salty lemonade a day, much more if it’s hot out.

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