Hyponatremia Diet Plan: Balancing Sodium and Water Intake

When we think of hyponatremia, or low sodium, we tend to focus on salt. However, hyponatremia is actually not typically a salt problem, but a water problem. More often than not, hyponatremia is due to SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion), which is a water-handling disorder. In brief, SIADH means your body is sending and receiving an inappropriate signal to hold onto water. This is causing a dilution effect to your blood sodium level. Therefore, it's not a lack of salt that's the problem; it's an excess of water. Understanding this concept is crucial when developing a hyponatremia diet plan.

The Role of Fluid Restriction

With the understanding that hyponatremia is often related to excess water retention, a fluid restriction makes sense. However, fluid restriction is often not enough to help correct sodium levels. So besides the fluid restriction, what else can I do with my diet to help?

Minimizing High Water Content Foods

When it comes to fluid intake, we often overlook how much liquid can come from the food we eat. In some situations, this can be as high as 1/3 of our liquid intake, but on average, it is around 20-25%. With this in mind, we should try to minimize high water content foods to aid in our quest to get out of the low salt brain fog and get back to feeling good again.

The highest water content foods tend to be fruits and vegetables, however, not all are created equal. Some of the highest water content foods to minimize intake are:

• Cucumber and celery (over 95%)
• Bell peppers and cabbage (92-94%)
• Tomatoes (over 92%)
• Lettuces: iceberg, spinach, romaine (over 92%)
• Broccoli and Cauliflower (90%)
• Watermelon and other melons (over 90%)
• Strawberries (90%)
• Pineapple (85%)
• Yogurt (85%)
• Zucchini, carrots, and squash (80-95%)
• Oranges and Grapefruit (85%)
• Grapes (80%)
• Potato (80%)

Incorporating Low Water Content Foods

On the other end of the spectrum, foods that are low in water content to include in your diet are:

Read also: The Hoxsey Diet

• Oils (0%)
• Nut butters: peanut, almond (1-2%)
• Nuts and Seeds (2-4%)
• Cereals/granola (5%)
• Dried fruit and meats (15-30%)
• Pepperoni (25%)

Moderate Consumption Foods

Lastly, foods that fall in the middle that could be eaten in moderation may include:

• Cheeses (most 30-40%)
• Bagel & Breads (30-40%)
• Biscuits (about 30%)
• Chicken, beef, pork (60-70%)
• Avocado (72%)
• Eggs (75%)
• Cottage Cheese full fat (78%)

Increasing Protein Intake

Once we are on a good fluid restriction and we’ve minimized high water content foods, the next critical step is to increase our protein intake. For those without SIADH, it’s the liquid intake that controls the urine output as ADH levels can fluctuate freely to enhance water excretion. In patients with SIADH however, the urine concentration is stuck in an elevated level and thus the solute load (mostly protein, urea, salt) determines the urine output. That’s why UreaAide works so well, due to its high solute content (1 scoop of UreaAide is equal to 8000 mg of salt in terms of solute). Protein isn’t quite as robust as UreaAide but it can certainly provide an assist.

We typically recommend a higher protein diet with Hyponatremia understanding however, there may be exceptions, such as those with cardiac conditions or kidney disease who should avoid fatty meat or high protein intake.

Greek Yogurt vs. Cottage Cheese

Greek yogurt is an interesting food as it has a higher water content than you think at about 80%, but Greek yogurt is also a good source of protein at 15 grams per serving. So It’s not the worst food to ingest and is often recommended to enhance protein. What may be a better alternative is cottage cheese. Full fat Cottage cheese has a lower water content at about 70% with an impressively higher protein content at 25 grams per serving. One could also add dried fruit and almond slivers to enhance flavor, add additional protein and take advantage of the low water content.

Navigating Sodium Intake

While the focus of a hyponatremia diet plan is often on water balance, it's still important to be mindful of sodium intake. A main source of sodium is table salt. The average American eats five or more teaspoons of salt each day. This is about 20 times as much as the body needs. In fact, your body needs only 1/4 teaspoon of salt every day.

Read also: Walnut Keto Guide

Sodium is found naturally in foods, but a lot of it is added during processing and preparation. Many foods that do not taste salty may still be high in sodium. Large amounts of sodium can be hidden in canned, processed, and convenience foods. Sodium controls fluid balance in our bodies and maintains blood volume and blood pressure.

Tips for Managing Sodium Intake

• Eliminate salty foods from your diet and reduce the amount of salt used in cooking.
• Choose low sodium foods. Many salt-free or reduced salt products are available. Salt substitutes are sometimes made from potassium, so read the label.
• Be creative and season your foods with spices, herbs, lemon, garlic, ginger, vinegar, and pepper.
• Remove the salt shaker from the table.
• Read ingredient labels to identify foods high in sodium. Items with 400 mg or more of sodium are high in sodium. High sodium food additives include salt, brine, or other items that say sodium, such as monosodium glutamate.
• Eat more home-cooked meals. Foods cooked from scratch are naturally lower in sodium than most instant and boxed mixes.
• Don't use softened water for cooking and drinking since it contains added salt.
• Avoid medications which contain sodium such as Alka Seltzer and Bromo Seltzer.
• For more information; food composition books are available which tell how much sodium is in food. Online sources such as www.calorieking.com also list amounts.

High-Sodium Foods to Watch Out For

Many convenience foods, salty snacks, and processed meats are high in sodium. Swapping these foods for lower sodium alternatives may be beneficial if you have high blood pressure. Table salt, known chemically as sodium chloride, is made up of 40% sodium. It’s estimated that at least half of people with hypertension have blood pressure that’s affected by sodium consumption - meaning they’re salt sensitive. In addition, your risk for salt sensitivity increases with age.

The Reference Daily Intake (RDI) for sodium is 2,300 mg - or about 1 teaspoon of salt. Still, average daily sodium intake in the United States is 3,400 mg - much higher than the recommended upper limit. This mainly comes from packaged and restaurant foods, rather than from overusing your salt shaker. Sodium is added to foods for flavor and as part of some food preservatives and additives.

Here are some foods that tend to be high in sodium:

• Packaged Shrimp: Packaged, plain, frozen shrimp commonly contains added salt for flavor, as well as sodium-rich preservatives. Breaded, fried shrimp is similarly salty. Opt for fresh-caught ones if you can or check a health food store for frozen shrimp without additives.
• Canned Soup: Canned, packaged, and restaurant-prepared soups often pack a lot of sodium, though you can find reduced-sodium options for some canned varieties. The sodium primarily comes from salt, though some soups also contain sodium-rich flavor additives, such as monosodium glutamate (MSG).
• Ham: Ham is high in sodium because salt is used to cure and flavor the meat. Consider using ham only as an occasional condiment in small amounts rather than eating a full serving.
• Instant Pudding: Pudding doesn’t taste salty, but there’s plenty of sodium hiding in instant pudding mix. This sodium is from salt and sodium-containing additives - disodium phosphate and tetrasodium pyrophosphate - used to help thicken instant pudding.
• Cottage Cheese: Cottage cheese is a good source of calcium and an excellent source of protein, but it’s also relatively high in salt. The salt in cottage cheese not only enhances flavor but also contributes to texture and functions as a preservative. Therefore, you generally won’t find low-sodium versions. However, one study found that rinsing cottage cheese under running water for 3 minutes, then draining it, reduces sodium content by 63%.
• Vegetable Juice: Drinking vegetable juice is a simple way to get your veggies, but if you don’t read nutrition labels, you could be drinking a lot of sodium, too. Fortunately, some brands offer low-sodium versions, which means they can have no more than 140 mg of sodium per serving according to FDA rules.
• Salad Dressing: Some of the sodium in salad dressing comes from salt. An even better option is to make your own. Try using extra virgin olive oil and vinegar.
• Pizza: Pizza and other multi-ingredient dishes account for almost half of the sodium Americans consume. Many of the ingredients, such as cheese, sauce, dough, and processed meat, contain significant amounts of sodium, which add up quickly when they’re combined. Instead, limit yourself to one slice and complete your meal with lower-sodium foods, such as a leafy green salad with low-sodium dressing.
• Sandwiches: Sandwiches are another one of the multi-ingredient dishes that account for almost half of the sodium Americans consume. The bread, processed meat, cheese, and condiments often used to make sandwiches all contribute a significant amount of sodium. You can significantly cut back on sodium, by choosing unprocessed sandwich toppings, such as grilled chicken breast with sliced avocado and tomato.
• Packaged Broths and Stocks: Packaged broths and stocks, which are used as the base for soups and stews or to flavor meat and vegetable dishes, are notoriously high in salt. Fortunately, you can easily find reduced-sodium broths and stocks, which have at least 25% less sodium per serving than the regular versions.
• Boxed Potato Dishes: Boxed potato dishes, particularly scalloped potatoes and other cheesy potatoes, pack a lot of salt. Some also contain sodium from MSG and preservatives. Everyone would be better off swapping boxed potatoes for more nutritious starches, such as a baked sweet potato or winter squash.
• Pork Rinds: Crunchy pork rinds (skins) have grown in popularity due to increased interest in the low-carb ketogenic diet. However, though pork rinds are a keto-friendly snack, they’re high in sodium. If you’re craving something crunchy, consider unsalted nuts instead
• Canned Vegetables: Canned vegetables are convenient but pack their share of sodium. Draining and rinsing canned vegetables for a couple of minutes can reduce sodium content by 9-23%, depending on the vegetable. Alternatively, opt for plain, frozen vegetables, which are low in sodium yet convenient.
• Processed Cheeses: Processed cheeses, including pre-sliced American cheese and loaf-like processed cheese like Velveeta, tend to run higher in sodium than natural cheese. Instead, opt for lower-sodium, natural cheeses, such as Swiss or mozzarella.
• Jerky: The portability of jerky and other dried meats makes them a convenient protein source, but salt is used heavily to preserve them and boost flavor. If you’re a jerky fan, look for meat from grass-fed or organically raised animals, as they tend to have simpler ingredient lists and less sodium. But be sure to check the label.
• Tortillas: Tortillas contain ample sodium, mainly from salt and leavening agents, such as baking soda or baking powder. If you like tortillas, opt for whole grain and consider how the sodium count fits into your daily allowance.
• Cold Cuts and Salami: Not only do cold cuts - also referred to as luncheon meats - and salami contain a lot of salt, many are also made with sodium-containing preservatives and other additives. Sliced, fresh meat - such as roast beef or turkey - are healthier options.
• Pretzels: The large salt crystals on top of pretzels are your first clue of their sodium content. You can find unsalted pretzels, but they still shouldn’t be your go-to snack, as they’re usually made with white flour and have minimal nutritional value.
• Pickles: A single 1-ounce (28-gram) dill pickle spear - the kind of pickle that might come alongside a deli sandwich - has around 241 mg of sodium, or 10% of the RDI. The sodium in whole pickles adds up more quickly.
• Hot Dogs and Bratwurst: In packaged foods, a hot dog or bratwurst link averaged 578 mg of sodium, or 25% of the RDI. Still, processed meats are best saved for an occasional treat rather than everyday fare. The World Health Organization (WHO) cautions that eating processed meats increases your risk for certain cancers.
• Tomato Sauce: You may not think to check the sodium in a can of plain tomato sauce or other canned tomato products, but you should. Fortunately, canned tomato products without added salt are widely available.
• Bread, Buns, and Dinner Rolls: Though bread, buns, and dinner rolls generally don’t contain shocking amounts of sodium, it can significantly add up for people who eat several servings per day. Bagels are an especially big sodium contributor, as they tend to run large in size. Choosing smaller portions of bread will help you cut back on sodium, and opting for whole grain versions is healthier.
• Canned Meats: Like other canned foods, canned meats are higher in sodium than their fresh counterparts, though some manufacturers may be gradually reducing sodium. Pass these up for lower-sodium canned options or buy fresh.
• Boxed Meal Helpers: Boxed meal helpers contain pasta or another starch along with powdered sauce and seasonings. You typically just add water and browned ground beef - or sometimes chicken or tuna - then cook it on your stovetop. A much healthier and yet still quick alternative is to make your own stir-fry dish with lean meat or chicken and frozen vegetables.
• Biscuits: This breakfast favorite packs its share of sodium even when it’s not smothered in gravy. The ones you make from frozen or refrigerated dough may be especially high in sodium, so limit biscuits to an occasional treat.
• Macaroni and Cheese: This favorite comfort food is high in sodium, mainly due to the salty cheese sauce. If you want to occasionally eat macaroni and cheese, consider buying a whole grain version and dilute the dish by adding some vegetables, such as broccoli or spinach.
• Frozen Meals: Many frozen meals are high in sodium, some containing at least half of your daily sodium allotment per dish. Check the label of each variety, as sodium can vary widely within a specific product line. The FDA has set a limit of 600 mg of sodium for a frozen meal to qualify as healthy. You can use this number as a reasonable sodium limit when shopping for frozen meals. Still, it’s healthier to make your own meals.
• Baked Beans: Unlike other canned beans, you can’t rinse baked beans with water to wash away some of the salt since you’d be washing away the flavorful sauce as well. Recipes to make baked beans at home may not have any less sodium, but you can modify them to reduce the added salt.
• Sausage and Bacon: Whether in links or patties, sausage averages 415 mg of sodium per 2-ounce (55-gram) serving, or 18% of the RDI. A 1-ounce (28-gram) serving of bacon has 233 mg of sodium, or 10% of the RDI. Turkey bacon can pack just as much sodium, so check the nutrition label. For good health, you should limit your use of these processed meats - regardless of the sodium count.

Read also: Weight Loss with Low-FODMAP

tags: #hyponatremia #diet #plan