Jul 12, 2012

Salt, With a Side Order of Salt

Salt is very out of fashion these days.  The government tells us that salt is bad.  Most doctors tell us to lower our salt intake.  Eat less salt!  Avoid a high salt diet!  Sir, please step away from the salt shaker before your head explodes!

Salt does not deserve the evil reputation is has been assigned in modern times.  Salt is literally the "salt of life."  Without salt, we would die.  The ancient Romans valued salt, paying soldiers partially with salt - a salarium.  Thus, a man "not worth his salt" is not deserving of his wages for the day.  This is where we derive the word "salary" from.  So when your boss pays your salary, just think, you could be getting some of that in salt!

Salt was not just used as a currency.  It was used to flavor and preserve foods.  The word "salad" comes from the Roman practice of salting leafy green vegetables (delicious by the way!).  Even going back as far as 6000 B.C., ancient communities that were lucky enough to have a salt production facility often prospered and saw a large growth in their population and wealth.  So let's embrace salt and restore it to it's honorable position in the front and center of the spice rack.

Salt is also great for very modern POTSies.  Most POTS patients can benefit from increasing their dietary salt intake.  Before adding substantial amounts of salt to your diet, you should check with your physician, because there are some forms of POTS and other health problems that would make it unwise for you to increase your salt intake.

How much salt should a POTSy get?
I don't have the magic answer on this.  In theory, I would say as much as you need to help regulate your blood pressure and blood volume to a healthy enough level, so that it improves your symptoms, but not so much that is causes other problems for you.

The medical literature on POTS gives a few different suggested ranges, anywhere from 3-10 grams of salt per day.  Keep in mind that sodium is not the same thing as salt.  Each teaspoon of typical table salt contains about 2.3 grams of sodium.  Each gram of salt contains .4 grams of sodium and .6 grams of chloride.  Again, I would encourage you to speak with your doctor about how much sodium you should get in your diet.

While 10 grams a day may seem like a huge quantity of salt, it really isn't that much sodium.  10 grams of average table salt would give you 4 grams of sodium.  Accodring to the US Center for Disease Control, the average American consumes 3.3 grams of sodium per day.  So consuming 4 grams isn't really that much more than the average joe is consuming.  However, if you have POTS, hopefully you are ecting healthier than the average joe, which means less processed junk that contains all of that salt.  So you if you are eating fresh, natural, not-so-processed foods, you will have to put a little effort in to it to get your 4 grams of sodium per day.

Supplements or Salt Shaker?
You can purchase several different types of salt supplements. Nuun tablets and Thermotabs are popular, but really don't contain that much sodium.  Nuun tables have about .36 grams of sodium per tablet and Thermotabs have .18 grams of sodium.  You would have to take a large quantity of these supplements in one day in order to rely on them exclusively for your sodium needs, but that probably wouldn't be a good idea, since they also contain potassium, and you don't want too much of that.

You can also buy Sodium Chloride tablets.  They usually come in 1g tablets.  They can really irritate your stomach, but some people tolerate them without any problem.  Be sure to drink them with plenty of water and take them with food to minimize the risk of stomach irritation.

I prefer to obtain my 4 grams of sodium per day through a good old fashioned salt shaker, and a cupboard full of high salt, healthy foods.

What Type of Salt?
Be cautious about consuming excessive amounts of iodized table salt.  Regular table salt is iodized.  This can lead to iodine-induced hyperthyroidism in some people.  When I was first sick, we knew I had low blood pressure, so my doctor's encouraged me to consume as much salt as I could, to help increase my blood pressure.  I was using iodized table salt.  I developed flushing, hives, itching all over my body and a host of other symptoms - my doctor thought I had mastocytosis or MCAD (Mast Cell Activation Disorder).  But a young resident at Cornell figured out that all of that iodized salt intake was probably causing these symptoms.  Sure enough, when I switched to sea salt, that does not have added iodine, those symptoms disappeared shortly thereafter.

Iodine is an essential nutrient.  It was added to most of the world's salt supply in the 1920s to prevent goiter.  Goiter is an enlargement of the thyroid gland causing by a lack of iodine in the diet.  If you eat a healthy balanced diet, you shouldn't need additional iodine.  Plenty of regular foods, like eggs, spinach and milk, contain iodine.  Sea salt has trace amounts of iodine in it as well, as iodine is naturally occurring in sea water.  Saltwater fish and sea vegetables (kelp, seaweed, nori) are also a good source of iodine.

High Salt Food Ideas:
Take a cue from the ancient Romans and salt your salad.  A good quality olive oil and a heavy dousing of sea salt on top of baby spinach or mixed greens is delicious.

Broth - store bought chicken, beef and vegetable broth usually contain large quantities of sodium.  Many also contain MSG or other chemical additives, but if you have time to make a homemade broth, it is very easy.  And you can make large batches of it at once and freeze individual sized portions.  Then you can add as much salt as you'd like. Broth actually tastes great with ridiculous amounts of salt in it, and if you add too much salt, you can just as some more water to mellow it out.  I am known to enjoy a cup of chicken broth in a mug in the morning, rather than a coffee.

Soy Sauce/Tamari - Tamari is just soy sauce that doesn't have wheat in it (great for gluten free people). Both contain tons of sodium.  Don't limit your soy sauce to just Chinese take out.  Soy sauce is great with steamed veggies, rice, fish, chicken, beef, turkey, gravies and my favorite, with sunny side up eggs and asparagus.

Nachos - I know you are thinking, how are nachos healthy?  Well, the nacho chips themselves are probably the least healthy part of the meal, but they aren't that bad, and they are high in salt.  Top them with black beans, shredded chicken, salsa, tomatoes, black olives, lettuce, cheese and sour cream. Add a little salt to each ingredient as you make the platter.

Cheese - if you can tolerate dairy, cheese is an excellent source of sodium, and adding more salt to cheese can make it taste even better if you don't overdo it.  I love dipping a small wedge of cheddar into coarse sea salt.  The crunchiness of the salt goes well with the creaminess of the cheese.

Pickles - pickles are basically just cucumbers doused in salt and herbs.  Some brands of store bought pickles have preservatives and chemical additives.  Homemade pickles are very easy to make.  There are endless recipes online.  And when you are done marinating your pickles, you can even drink the juice.  Some people like to add a little sugar to it and partially freeze it, like you would for a frozen margarita.

Mashed Potatoes, Baked Potatoes, Baked French Fries or Sweet Potato Fries are a great way to sneak in lots of salt.  I have never had mashed potatoes that tasted too salty.

Eggs hide salt very well too, and I know I promised to keep this list healthy, but we can't talk about eggs without mentioning that bacon has tons of sodium in it and nothing goes better with eggs than bacon (and a prior item, cheese!).

We'd love to know, what are your favorite high salt foods?