Like many POTS patients, I eat loads of salt. The 2015 Heart Rhythm Society Expert Consensus Statement recommends 10-12 grams per day because some POTSy bodies don’t properly retain it. I consider this tasty therapy to be the only perk of having POTS. Given that we eat so darn much of this stuff, it makes sense to develop an appreciation for the finer points of salt.
Here are some helpful tips about the only rock we eat:
- Salt and sodium are not exactly the same thing. Salt is technically sodium chloride—NaCl—and it consists of about 40% sodium and 60% chloride. So if your doctor tells you to consume 10,000mg salt per day, that is only 3876mg of sodium.
- Table salt is heat processed and contains at least 97.5% salt by law, plus anti-clumping agents such as sodium silicoaluminate, sodium thiosulfate or others. Natural salts such as Himalayan, Real Salt, or sea salt are not heat processed and do not have additives.
- Sea salt is evaporated sea water, and has trace amounts of numerous minerals and elements. One drawback, however, is that as our oceans get increasingly polluted, so does our sea salt.
- Real Salt is a brand from Utah’s salt flats which contains trace minerals without the recent ocean pollution. Himalayan salt is another natural option. These salt sources are left from ancient sea beds, from when the ocean covered different parts of the earth.
- Dead Sea salt boasts many health claims, but should not be consumed because it contains too much bromide, which can be toxic.
- Iodized salt can be used to get the nutrient iodine if you don’t get enough from other sources, such as seafood, meat, dairy, sea vegetables or cranberries. The US government had iodine added to table salt beginning in 1922 to address an epidemic of goiters from iodine deficiency.
- Kosher salt is not typically kosher. It got that name because its large crystals made it good for removing blood when processing kosher meat. Larger salt crystals can have less sodium per teaspoon, so check the nutrition label.
- In most people, calcium and potassium are excreted along with sodium. If too much sodium is consumed without enough of these other minerals, the body will leach them from its own tissues, reducing bone density and muscle mass. While I haven’t found research on whether this holds for POTS patients, this possibility motivates me to eat nutrient-rich foods whenever possible.
- Eating very salty foods can trigger cravings for sweets…which trigger cravings for more salt…and the vicious cycle is called “tastebud ping pong.” If it’s making you a slave to your cravings, consider using salt pills to replace salty foods.
- Tastebuds adapt. After a few weeks your high-salt diet will taste normal. This could have embarrassing consequences if you make Thanksgiving dinner to your own taste preference, not realizing that your dinner guests are practically gagging. (OK, I know what you’re thinking: “like we’d ever have the energy to make Thanksgiving dinner.” We can hope!)
Some health authorities such as the Berkeley Wellness Letter state that table salt and natural salt are virtually the same nutritionally, and that any differences from heat processing, anti-caking agents, trace minerals or elements are negligible. While I believe them, I personally choose to use a combination of Real Salt, Himalayan salt and other natural salts, knowing that I consume 2-3 times the quantity of average Americans and those extra trace nutrients or additives might actually add up over time.
Finally, if you’re a real connoisseur, you may want to learn about salt’s dramatic history by reading Salt: A World History, by Mark Kurlansky. You won’t be bored: Salt has altered the outcome of wars, built and destroyed empires, and shaped how humankind populated the planet. Helping POTSies feel better is just one of its many colorful accomplishments.
Sheldon RS, Grubb, BP, Olshansky B, Shen W, Calkins H, Brignole M, Raj SR, Krahn AD, Morillo CA, Stewart JM, Sutton R, Sandroni P, Friday KJ, Tessariol Hachul D, Cohen MI, Lau DH, Mayuga KA, Moak JP, Sandhu RK, Kanjwal K. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Hearth Rhythm, Vol12, No 6, June 2015. http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/2015-HRS-Document-on-POTS-IST-VVS
The Scoop on Salt. The Berkeley Wellness Letter website. Accessed Oct. 25, 2016 from http://www.berkeleywellness.com/healthy-eating/nutrition/slideshow/scoop-salt
Raj S. Postural Orthostatic Tachycardia Syndrome (POTS). Circulation 2013; 127: 23. http://circ.ahajournals.org/content/127/23/2336.full
Heaney RP. Role of Dietary Sodium in Osteoporosis, J Am Coll Nutr. 2006; 25(3 Suppl): 271S-276S. https://www.ncbi.nlm.nih.gov/pubmed/16772639
O’Mahony M. Salt taste adaptation: The psychophysical effects of adapting solutions and residual stimuli from prior tastings on the taste of sodium chloride, Perception 1979; 8(4): 441-76. https://www.ncbi.nlm.nih.gov/pubmed/503775
Kurlansky M. Salt: A World History. New York, NY: Penguin Books; 2003.