Q: What is the difference between salt and sodium, and why should POTS patients care?
A: Many POTS patients are confused about whether they should consume extra salt or extra sodium. Even doctors get confused, and one of the top POTS review articles gets them mixed up. But sodium and salt are not the same, and the difference is important when you consume as much as we do! So here’s the important info:
Salt, a.k.a. sodium chloride (NaCl), is made up of about 40% sodium (Na) and 60% chloride (Cl) by weight. The 2015 Expert Consensus Statement on POTS recommends up to 10-12g daily NaCl per day for POTS patients. This is because POTSy kidneys often don’t retain salt properly, apparently due to problems with the angiotensin-renin-aldosterone system. The upshot is that without enough salt we don’t hang on to fluid, and we get dehydrated or hypovolemic.
It’s important to realize that consuming 10g (10,000mg) salt means 4,000mg sodium, which is slightly higher than what the average American consumes, at 3400mg sodium per day. When we get confused and consume 10g sodium instead of 10g salt…that’s 2.5 times the recommended sodium…Yikes!
A second important point is that dietary sodium can appear in different forms, such as;
- MSG (monosodium glutamate or C5H8NO4Na),
- sodium citrate (Na3C6H5O7),
- sodium bicarbonate (baking soda or NaHCO3),
and others. These are not recommended by the POTS Expert Consensus Statement; only good old NaCl salt is recommended. This means that you can’t assume your Chinese takeout food is POTS-friendly just because it contains loads of sodium. You’ll want to check the ingredients, and hope the sodium came from salt (NaCl) and not MSG, for example.
I think the easiest way to get the right kind of salt in the right quantities is to read labels and add table salt to homemade meals and snacks. 10g salt is about 1.7 teaspoons. Cheers!