Salt: The paradoxical philosopher's stone of autonomic medicine

Mij

Mij

Senior Member (Voting Rights)
New paper on Salt: The paradoxical philosopher's stone of autonomic medicine - to expand intravascular volume or to raise blood pressure.

Highlights
  • Salt has profoundly shaped human history, including diet and medicine.
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    Salt improves orthostatic tolerance but also increases risk of hypertension.
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    Although recommended by consensus, randomized controlled studies have not been done.
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    Salt also affects immune function, psychological state, and gut microbiota.
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    Long term treatment of POTS should include blood pressure monitoring.
Abstract
Sodium chloride, or common table salt, for millennia has played a prominent role in human affairs. Salt is also a key molecule for regulating intravascular fluid volume in patients with orthostatic disorders. In this first article of a special issue of the journal focusing on salt and the autonomic nervous system, the historical and physiologic significance of salt is reviewed, highlighting its importance to society and to medicine. The relevance of salt both for civilization and for autonomic physiology penetrates into nearly every aspect of life and health. Replacing salt that has been depleted or administering salt to expand intravascular volume is considered standard treatment for patients with orthostatic hypotension and syndromes of orthostatic intolerance. The potential long term effects of added salt, including effects unrelated to intravascular volume, have been insufficiently studied in patients with autonomic disorders. A salient concern is the potential increased risk of developing hypertension. Underappreciated aspects of salt include its ability to increase anxiety and through nonosmotic mechanisms to contribute to local tissue inflammation. Salt may be either salubrious or detrimental, or possibly both at the same time, depending on the clinical conditions. Reconciling these opposite effects in clinical practice requires weighing benefits against potential risks, assessing what is known alongside what is uncertain, and titrating treatment decisions to the particular needs of each individual patient.

https://www.autonomicneuroscience.com/article/S1566-0702(21)00125-9/fulltext
 
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Mij said:
Salt improves orthostatic tolerance but also increases risk of hypertension.
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This effect has been found to be very overblown in most people, and only applies to those who take a lot more salt than average.

https://www.acsh.org/news/2018/08/10/spoonful-salt-makes-blood-pressure-go-down-13289

Increasing potassium has been found to reduce blood pressure by relaxing arterial walls. It also has an impact on sodium/salt because it causes more sodium to be excreted.

And an n=1 experience of increasing salt intake :

Here is Valerie’s story with high blood pressure on T4 and treatment with a working desiccated thyroid. This can also apply to T4/T3 or just T3.:

“About 9 years ago I was just breaking out of a very dangerous and bad relationship. I had been under extreme stress for the last 4 years and my blood pressure was just going up & up. My doctor said my thyroid was fine (I was on Synthroid 500 mcg) and my labs were “normal”. He said I needed to lose weight (duh) and gave me a restricted salt diet and Atenolol. OK, I cut salt out of everything I ate—none on the table, none to cook with. I stopped eating canned soups and lunch meats. I bought unsalted butter, and soon I became used to eating like that. Yet, my blood pressure continued to climb.

Finally I was on Atenolol, Hydrochlorothiazide, Lopressor, and Triamterene… all for my BP which at this point was 245/138. Yup, I was a stroke waiting for a place to happen! Then I was diagnosed with Congestive Heart Failure. At that point, I was desperate. I was reading alot on the Internet and learning more and more about natural desiccated thyroid, which at the time was the pre-reformulated Armour Thyroid. I found a place to order it online without a prescription, and started on it, raising bit by bit to find the elimination of symptoms.

Then I found a website that explained how low sodium could cause fluid retention in the body. Now THIS was enlightening! This was the opposite of what all these doctors (four at the time) had been telling me. So I started taking 1/2 tsp Celtic Sea Salt twice a day in a shot glass of water. Now I am sure it was mostly the Natural Desiccated Thyroid, but I think the salt did have a part too, as my BP slowly started to come down. When I got to 145/100, I dropped the Lopressor. It stayed there, so next month I dropped the Atenolol. Then I started feeling really alot better! So in about 6 more months, I dropped all BP meds and was at a stable 130/79!!! Quite an improvement I’d say!

No more nosebleeds which I had been having regularly before, and the fluid retention just melted away. Now the tissue damage took longer to heal, and my legs hurt for almost a year after the swelling went away, but heal they did and now I have no signs of the horrible heart condition or Hypertension I once had.
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Source for the above quote: https://stopthethyroidmadness.com/blood-pressure/
 
Arnie Pye said:
This effect has been found to be very overblown in most people, and only applies to those who take a lot more salt than average.
Click to expand...
The JACC paper I mentioned looked specifically at POTS patients that were classified hyperadrenergic, i.e. the ones prone to bouts of upright hypertension.

There were no differences in blood pressure between the low salt diet and the high salt diet (18gm of salt per day!!) there either - but useful improvement shown in other metrics and some trend towards reduced symptom burden too.
 
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I once went to a cardiologist because I was worried I had arrhythmia. I just had extra heartbeats, so that was fine, but he was concerned that my blood pressure was a little low. He told me to make sure I have enough salt in my diet, especially since I don't eat much processed food.

My main health care provider has also talked to me about eating enough salt. Her reason is that it helps support the adrenals, in addition to the other things I do for that. I add a little salt to each glass of water I drink.
 
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