Low blood sodium

[Outsidethelines]

Morning all, I wonder if any of you kind folks have experience of this/can advise? A routine blood test last week shows my serum sodium is below normal range - normal is 136-145, and mine is 131.

The GP has labelled this ‘satisfactory’ so presumably isn’t planning to talk to me about it at all. But I was wondering if I should be concerned, and if there’s anything I should be doing? I am ridiculously tired all the time, and I wonder if this could be the reason.

Looking online, the advice seems to be to drink less… but I find that staying hydrated is the best way to fend off having an AF attack. I don’t drink loads, certainly compared with my friends and children who seem to have a water bottle permanently on the go.

I eat a home-cooked diet and very little in the way of processed foods, so my diet is probably lower in salt than most people’s. I thought this was a good thing, as I’m on medication for high blood pressure. But maybe I should eat more salt? It’s all very confusing. I suspect it may be a side effect of the drugs they put me on 9 months ago - Felodipine for high BP and Edoxaban anticoagulant.

Has anyone got any experience of this? I’d really appreciate any advice/shared knowledge. I know GPs get hardly any training in nutrition, and anyway they clearly don’t think this warrants a conversation. And I don’t want to be given yet more drugs to take. But I am feeling extremely tired all the time, so I’m wondering if this could be why, and what I can do about it?

[Peony4575]

Am the same but it doesn’t bother me. I have low blood pressure maybe that’s why . The “ normal range” is a bit of an artificial construct and people vary so if the medics aren’t worried try not to

[Outsidethelines in reply to Peony4575]

Thanks Peony. I have high BP though, so it feels like a bit of a balancing act🤔

[secondtry]

You are right to question your tiredness. I would seek advice from a trusted experienced Nutrionist first. GPs have their limitations and seem to no longer consider the whole person and QOL.

[Outsidethelines in reply to secondtry]

Thanks Secondtry, I agree👍

[JOY2THEWORLD49]

Hi

The difference is insignificant. Have another one and next time have a drink of water with

minerals, lemon, pinch salt and pinch glucose.

Its only a guide and will fluctuate.

I am 3 digits off the top of normal. I don't use salt but top soups etc organic chicken without skin which is heavily salted.

Do you sweat - rapid AF makes one sweat.

cherio JOY 75. (NZ)

[Outsidethelines in reply to JOY2THEWORLD49]

Hi Joy, you’re right, I’m probably overthinking things, as usual. No, I don’t sweat a lot, even when exercising, so it’s not that

[Leggylady]

I was called back for a repeat blood test with low sodium - 129. It had been low for at least 12 months. It then dropped to 127 so I was called back again and told to eat more salt the evening before another test. It stayed around the same level and they have now accepted that as my normal. A different GP recently said it wasn’t a concern to him.

We don’t eat much processed food and I had always been cautious about how much salt I added to food. I have also been aware that hydration is important re AF.

I eat more salt now and don’t let it worry me. I’m not overloaded with energy but hadn’t connected the low sodium - there always seems to be another possible reason.

[Outsidethelines]

Thanks Leggy, I think I’ll start adding more salt to my food intake - in moderation. Funnily enough, when I visited my daughter last weekend, she had put out a dish of salted crisps, and found myself wolfing them down. Not normally my thing, so maybe my body knew it needed the salt😅

[John67]

Good morning,

[John67]

Good morning,I have the same problem. My sodium level is consistently 128 to 130 and it has been as low as 125. Each time the doctor has put NFA. I think at 76 and with other health problems my sodium level is less important than my blood pressure and heart rate. Like you I feel tired all the time.

All the best

John

[Outsidethelines in reply to John67]

Thanks John, that’s very interesting😊

[Ppiman]

I have no experience but, because it's a rather critical electrolyte, I would myself insist on having the test repeated after a fortnight or so (whatever your doctor suggests). Low sodium can be caused by many things, often temporary, it seems. Feeling tired is so difficult to diagnose as a symptom. I have insomnia, so at least I know why I feel that way!

Steve

[Outsidethelines in reply to Ppiman]

Thanks Steve😊

[Singwell]

I too often have low sodium. I hydrate well (1.5 litres a day) and do not eat processed foods. When my sodium is low it can trigger either ectopics or AF. We need 6gms salt a day I learned from another forum member! Measure it up and put it in an egg cup to give yourself and idea.

Once I'd learned this I began to use a little salt in cooking and also allow myself more salty foods such as miso and coconut aminos (a soy sauce replacement). Although we're told to reduce salt if our BP is high this only makes a difference in about 15% of people with high BP (info from Dr Tim Spector). It never made any difference to my BP when it was high.

So, like Pipman I take the view that sodium is an essential element for heart health, and I monitor my intake accordingly. Funnily enough, my body lets me know when I need salt - I'll suddenly crave salty foods.

[Ppiman in reply to Singwell]

When I last looked - hard to find this now - much less than 15% were affected by sodium in their diets. For that small number, at the time, I thought how odd that everyone was encouraged to reduce salt (it was removed from all pre-prepared foods, for example). It was an interesting decision. I always assumed, since then, it had been shown that we all are affected, but you post has brought me to wonder.

Much food we buy from supermarkets is now rather bland.

Steve

[Outsidethelines in reply to Ppiman]

That’s so interesting, Steve. I’d literally never heard that before. I’ve always eaten home-cooked food, not processed, but when they told me I had high blood pressure I made a real effort to cut out added salt as much as possible. Maybe I don’t need to after all…

[Ppiman in reply to Outsidethelines]

I think it will be hard to find out as there has been an international effort to remove salt. The studies I saw showed the number of people whose BP went up when they ate salt was rather tiny. That was some years ago. I am only guessing that newer research has conformed the need for low sodium. I shall do another search and report back.

Steve

[Outsidethelines in reply to Ppiman]

👍will be interesting to see what you find out

[Ppiman in reply to Outsidethelines]

From what I have read, it is generally accepted that sodium intake does increase BP and that increases morbidity and death from such as strokes and heart disease. It seems around a third of people are sodium sensitive, maybe more.

However, it’s also clear that far from everyone is affected and, as the quotation from a large study showed that sodium and its relationship with BP is far more complex and unclear. This study looked at changes in BP over a usefully long time, whereas many look over a short time. Also, many studies looked for an increase in BP of 5% and yet it’s stated by AI on Google that a 5% change in BP cannot accurately be measured.

Here is the quotation:

“The researchers found that people with the lowest blood pressure had the highest intake of sodium and potassium, and those with the highest blood pressure had the lowest intake of sodium and potassium.

Similar effects were seen with magnesium and calcium; higher levels were linked to lower blood pressure, and vice versa.

With this study, Moore hopes to play a part in shifting dietary decisions, and refocus “on the importance of increasing intakes of foods rich in potassium, calcium, and magnesium for the purpose of maintaining a healthy blood pressure."

Sugar worse than salt

Never mind salt; research suggests that sugar has a bigger impact on blood pressure. According to findings published in Open Heart, sugar may be more strongly and directly linked to hypertension and the risk of developing cardiovascular problems…”.

All that can be concluded overall is that the health authorities tend all to agree with the WHO that we are healthier with a low sodium diet. I shall look more deeply into the study I quoted from.

Steve

[Autumn_Leaves in reply to Ppiman]

I think the issue with salt is that many people are unknowingly over consuming salt because it is added to so many commonly consumed processed foods, and especially in combination with foods with a high fat intake — savoury snack foods, takeaways etc. I know there’s always a lot of posts that say “well, actually… *I* don’t eat blah blah and I only eat …” etc etc, but this advice to reduce salt isn’t targeted at people who eat their whole foods and whatnot, it’s public health advice aimed at addressing the most common dietary related health concerns, and right now it’s the high sugar/high fat/high salt processed foods. So it’s not salt in isolation, it’s salt as part of an overall dietary pattern that’s common in the population. Sodium/salt is a problem for people with decreased kidney function, which can be related to obesity, diabetes and also age, and these are all increasing in the population too.

I don’t hang on Tim Spector’s every word (though he’s better than a lot of pop nutrition influencers) but I do think it’s true that some people are salt sensitive and others aren’t. I definitely think that sugar is a risk factor for many conditions (also a common food additive) and that added sugars should be kept to a minimum though I don’t think people need to be phobic about whole fruit — also beneficial for BP because of their potassium content.

Like everything else, it’s multifactorial and people need to consider their diet as a whole. If someone has high BP and reducing salt isn’t helping, then it’s worth looking at other aspects of the diet, like fruit and veg intake, fibre consumption, adequate hydration etc. Even stress levels and sleep. I think when people start focusing on one thing, the risk is that they ignore the bigger picture.

[Ppiman in reply to Autumn_Leaves]

That’s interesting about over-consuming. The study I read was a long while back in my days in the pharmaceutical industry and the study seemed then to confirm that very few people were truly sodium sensitive. These days that figure is quoted as up to 30%. Well – what has changed? One thing that ha concerned me is how short term many of the relevant studies are – 6 weeks and looking for minimal BP changes, often done by the individual at home. That’s why I liked the study I quoted from, which looked as data over years. Of course, even with that, other variables and confounding bits and pieces become involved, so to get an even partly right or useful “answer” is difficult or even unlikely. That’s why, I imagine, the truth is as you suggest: the health authorities know that something is causing the current rate of CV illness and high BP, and that is blocking up hospitals and costing a fortune in prescriptions and doctor time, so let’s pick on salt,

sugar and fat and see what happens.

I wonder when the authorities will be able to track if general sodium reduction has been useful? And I suspect we never will know – not least with the chronic nature of the condition, the current vaping obsession, people now adding salt because bought food is tasteless, smoking still going on, obesity at epidemic proportions, and work trends and comfort eating pushing people to snack and all sorts.

I think you have it spot on when you say that most are ignoring the bigger. I guess that is because it is so unpalatable – mush like the saltless food we are now forced to eat! We “simply” need to eat less and exercise more. People en masse would rather play at consumerist versions of doing that, i.e. buy into set-to-fail fad diets, online Joe Wickes, local gym passes or whatever).

Steve

[Autumn_Leaves in reply to Ppiman]

Who does the cooking in your house?! I sincerely hope it’s not your wife with the saltless mush that she’s forcing you to eat! I hope she doesn’t see that! 🤣

At the individual level we can only try and see if salt/less salt makes a difference to our own BP. Just because Tim Spector isn’t sensitive to salt in that way it doesn’t mean that all his fans are the same as him. He mentioned in an interview a while back that he still takes BP medication because of his loss of vision/mini stroke health scare, but medication decisions are between the doctor and the patient and aren’t public property. So perhaps it’s the BP medication that shifts the needle for him as opposed to cutting out salt. He’s not a stupid man. He doesn’t owe anyone his medical records either.

Interesting what you say about people just buying into a solution because of the marketing and the relatable personalities who promote them, whereas achieving meaningful results requires making changes and sustaining those habits in the long term, not just over the weeks and months, but for years.

[Ppiman in reply to Autumn_Leaves]

That made me smile. My wife (as with our nearby daughter in law - how lucky is that these days?) are both excellent cooks and keen on wholesome diets focused on vegetables, fruits, pulses and beans. I was meaning to refer only to shop-bought foods, in particular bread rolls (we have always baked our own loaves).

Steve

[Autumn_Leaves in reply to Ppiman]

You’re a very lucky man in that case! I don’t eat much bread as I have to be careful not to exceed my tolerance limits for wheat fructans. My husband bought some wholewheat baps for himself recently and I tried a bit and thought it was very sweet for what is supposed to be bread. I don’t think that’s a good thing at all. I was very anti sugar in my 20s, as I believed that it was an unnecessary additive that shouldn’t be added to food. Here we are in 2024 and nothing has changed. We have more processed foods and they still have added sugars. I don’t have the drive to be as militant about these things either. 🤷🏻‍♀️

Harvard Health have an article on BP and salt. It seems that there are genetic differences that may account for why some people may be salt sensitive or not. It’s called Dietary salt and blood pressure: A complex connection if you want to Google it, as I don’t think live links are allowed now.

[Ppiman in reply to Autumn_Leaves]

Thanks! I had read a similar article based on the background data. What seems odd is that the rise in BP post sodium is 5%, which other writers say is not accurately measurable (and my own home BP measurements suggest that is true).

I wonder whether sodium sensitive 1/3 of people can really create a measurable rise in their BP simply by eating sodium? And how much sodium should they take to try this - very little indeed by the sounds of it? Where is the evidence for that 30+% - it must have been measured somewhere. It's all quite confusing.

In recent years, we have cut down on salt in our food, but we don't avoid it by any means. The new version of the bread maker we use (a Panasonic) has the same recipe for bread in its recipe booklet as that which we have always used - but now with no salt in it. In the old book, it says that salt is needed to stop the yeast from over-working, confusingly - what stops the yeast from working in the new recipe?

Perhaps we should cut out salt? I really don't know what to think. If I had high BP, I am sure I would do so.

Steve

[Autumn_Leaves in reply to Ppiman]

I think the 30% number comes from the Zoe customer base, so it’s not a representative sample of the entire population anyway. I have my concerns about the Zoe “studies” but suffice to say, whatever the recommendations coming from that business, it’s just standard healthy eating advice based around a plant predominant diet with the addition of some fermented food. The potassium content of a plant based diet would counteract the sodium in the body so it will have lower the BP, at least in theory. It’s never about just one thing eg salt. I came of age in the 80s when the health messaging was to reduce salt, so I didn’t go out of my way to add it but I didn’t deliberately avoid it either.

We have quite an old Panasonic breadmaker. It’s still going strong. The standard loaf takes about 1tsp salt per loaf, which doesn’t taste particularly salty. My own FODMAP friendly porridge bread has sodium bicarbonate and a small amount of salt, about 0.25tsp but overall there’s quite a bit of sodium in it. The recipe is based on a soda bread loaf. When I bought a sourdough loaf from the bakery — an occasional luxury given the price — I found it extremely salty. I’m not mad for sourdough so I’m not joining that club of babying starter cultures. I don’t think there’s a massive advantage over breadmaker loaves. It’s true that sourdough is more easy to digest if you’re FODMAP sensitive as the cultures break down the wheat fructans rather than your gut microbes have to work overtime, so I can scoff quite a bit. I’m not mad for the taste though. Nor do I want extra work to do!

[Outsidethelines]

thanks Singwell. That’s news to me, about salt making a difference in only 15 per cent of people with high BP. Will have to check out what else Tim Spector says about it. Thanks for telling me

[JOY2THEWORLD49 in reply to Outsidethelines]

Hi

Yes, our body usually tells us - like thirsty for a drink etc.

cherio JOY

[Singwell in reply to Outsidethelines]

If you follow the Zoe podcast on YouTube you might find it there. Apparently it was also his own experience as someone who'd had a mini stroke due to high BP.

[Outsidethelines in reply to Singwell]

Wow, I hadn’t heard about his mini stroke either! I’m fairly new to the Zoe podcast, will look this one up😊

[AussieHeart]

Was your potassium level higher as well? My mother has had low blood sodium for the past two years. First they got her to increase her salt intake. That didn’t work. Due to her combo of low sodium and high potassium her dx was Hyponatremia due to SIADH (syndrome of inappropriate antidiuretic hormone). She immediately had to give up bananas/pumpkin and drink fewer liquids. Very strict on how much she could consume per day. No alcohol. There is a drug, Tolvaptan, they can put you on. And they are considering her for that but first you need to restrict water, drink to thirst in Summer, but intake no more than 800mls to 1 litre per day. Your GP should be checking your bloods every 3 months over one year. If you are still below 135 you need to be referred to a nephrologist. My mum was under a nephrologist pretty much from the get-go as she’s 93 and has SVT. They think age is a factor for her but it can be other underlying issues like high BP, which she takes meds for. Her first symptoms were muscle weakness and pain, fatigue and peeing too much at night and not throughout the day. Reducing water intake has helped with night toilet stops. Hope this info helps.

[Outsidethelines in reply to AussieHeart]

Thanks for your story, Aussieheart. My potassium is normal, it’s just sodium that’s low.

[WildIris]

Yeah, me too, low sodium also low chloride, every blood test for several years.

[Outsidethelines in reply to WildIris]

Interesting, Iris. Maybe it’s not uncommon. Who knows?

[Autumn_Leaves]

It’s only very slightly low and it’s nowhere near needing any treatment. Sodium levels fluctuate anyway, and are especially sensitive to hydration levels. These little borderline abnormalities that are only a few points either way are rarely a concern. It’s the longer term trends that matter, not being a few points out on one occasion. Chances are it will revert to the normal range. I’ve been a few points below normal but it’s typically due to water consumption before a blood draw. It’s always been normal when the test is repeated.

[Outsidethelines in reply to Autumn_Leaves]

That’s really interesting. I’ll try and remember not to drink for a few hours before having a blood test in future

[Autumn_Leaves]

Try it and see. Your body knows how to regulate itself.