Why Do Dysautonomia Patients Increase Their Dietary Sodium (Salt) Intake?

For individuals with dysautonomia, one of the most critical factors they need to consider is their sodium intake. If you’ve ever been handed a treatment plan for dysautonomia, there’s a good chance that your doctor has recommended increasing your salt intake to help you manage your symptoms better.

While there’s no argument over the fact that extra sodium helps, this doesn’t explain the why – why is sodium effective in managing dysautonomia? Why is increasing both potassium and sodium one of the most common recommendations for patients?

The Sodium-Glucose Pump

Before you can understand why extra sodium is essential, you must first understand how the sodium-glucose pump works.

Also known as the sodium-glucose symporter and sodium-glucose cotransporters, the sodium-glucose pump is a biological system that describes the method that your body uses to absorb glucose with the help of salt ions.

There are three significant factors that help in this process:

• Electric charges: Sodium is a positive ion with a +1 charge. Our cells use these ions (as well as the ions of other elements, such as potassium and calcium) to generate electricity. These charges are used to ensure that the body is functioning correctly, including the actions of the sodium-glucose pump.
• Concentration gradient: A concentration gradient is relatively simple to understand – it is when the concentration of one element (in this case, sodium) is higher in one area than in others. One of the ways in which our body transports elements is through these gradients – particles flow from an area of higher concentration to that of a lower concentration until there is an even distribution. So, if there’s more sodium outside a cell than inside one, this distribution will slowly even out over time.
• Adenosine triphosphate: More commonly known as ATP, adenosine triphosphate is an organic compound that helps provide energy to your cells. However, it needs glucose to be produced and function properly.

These processes, along with special glucose transporters known as sodium-dependant glucose transporters (SGLTs), help fuel the action of the sodium-glucose pump. Glucose transport is possible without sodium through the action of facilitative glucose transporters. However, these do not supply enough glucose to your major organs, which is why SGLTs are essential.

The sodium-glucose pump is a cycle, and when it reaches the last step, it starts again from the beginning. Here are the steps that make up this process:

• Sodium is usually far more concentrated outside of cells than inside. In fact, the difference is such that there is up to ten times less sodium within cells than there is in their environment. This concentration difference creates an imbalance – a negative electrical charge builds up inside the cell, attracting the positively charged ions from outside to cross the cell wall. Combined with the previously mentioned concentration gradient, the ions move into the cell to balance out the quantities of sodium.
• In simple terms, sodium ions “pull” glucose molecules with them as they cross from the plasma into the cell. However, the cell wall is full of sodium pumps, small “holes” that open and close, forcing sodium outside the cell and resisting the movement of the sodium into the cell. When they do open, glucose molecules can slip into the cell alongside the transport of sodium. They are then converted into ATP.
• To ensure this process keeps happening, there must always be an imbalance of sodium between the cell and the plasma. Aside from resisting the entrance of sodium, cells also use the ATP produced during the process to push sodium outside, allowing the cycle to begin again.

If your blood glucose levels are low, you can experience mood changes, headaches and migraines, hunger (or, counterintuitively, food aversion), rapid heartbeat, and even dizziness and loss of consciousness. However, to get enough glucose to all your organs, your body needs to get enough sodium, as illustrated above.

In a roundabout way, low sodium diets can also lead to the same symptoms that low glucose can. Keep in mind that this relationship only works one way. You don’t need to consume excess glucose to provide your body with enough sodium, as there are several other biological processes your body can use to compensate for low sodium.

Dysautonomia and Sodium

As mentioned above, dysautonomia patients are usually provided with a revised diet plan that includes increasing their sodium intake. However, rarely do these plans explain why this is necessary.

The first thing to understand is that sodium is not the same as salt. The salt that we consume with food is scientifically known as sodium chloride and comprises two elements – sodium and chloride.

It is the sodium part that dysautonomia patients are concerned with. Most table salts are made up of about 40% sodium and 60% chloride.  While it is possible to use this formula to calculate how much more salt you should consume based on your doctor’s recommendations, it’s usually easier to simply ask them what your recommended salt intake should be.

There are numerous reasons why dysautonomia patients should increase their sodium intake, including sodium’s ability to reduce the likelihood of symptoms like brain fog and dizziness, all of which are also commonly associated with dysautonomia. 

Additionally, people with dysautonomia, especially those with POTS, often have low amounts of important hormones, including angiotensin and aldosterone. The reason for this isn’t known. However, what is known is that these hormones not only regulate the volume of blood in your body, they also affect the absorption of sodium. Low volumes of these hormones mean your body absorbs less sodium, which is counteracted by consuming more of it, to begin with.

Potassium and Sodium

Aside from increasing your sodium intake, your doctor will likely recommend an uptick in your potassium intake as well. These two factors are connected – the body is driven to maintain a delicate balance between sodium and potassium levels, and if you don’t increase your consumption of potassium along with that of sodium, there’s a chance that your body will not absorb the excess sodium.

Furthermore, if potassium and sodium are out of balance, your health can be affected. Too much sodium without potassium to balance it out can result in increased blood pressure and a higher risk of heart disease and stroke.

There are numerous foods that are rich in potassium, including avocados and bananas. However, figuring out how to increase both salt and potassium intake through your diet alone can often be challenging.

This is why Klaralyte offers a balance of 250mg of sodium and 50mg of potassium in each capsule. You can increase the intake of both necessary electrolytes without having to make too many changes to your actual diet!

Other Sources:

https://myheart.net/pots-syndrome/diet/

http://www.dysautonomiainternational.org/page.php?ID=44

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390096/ 

https://www.potsuk.org/diet_and_fluids

https://www.medscape.com/viewarticle/949982

https://www.dysautonomiainternational.org/blog/wordpress/pleasepassthesalt/