Water restriction is the key to treating too-low salt levels
BY KEITH ROACH, M.D.
DEAR DR. ROACH: A few years ago, while skiing in Utah, I became violently ill and could barely walk. I called 9-1-1 and was taken to the hospital, where I was diagnosed with hyponatremia. It took a week in the hospital to recover. My internist eventually prescribed 1 gram of salt/sodium a day and to not drink too much water.
Even though I take the gram of salt a day and salt my food, the salt level in my body continues to remain low at 130-135. Sometimes my legs get shaky, which is my body telling me when the salt level is too low, so I take another gram of salt.
Neither my doctor nor any other has ever been able to tell me what causes this problem. I am 87 years old, 5 feet, 7 inches tall and weigh 130 pounds; my blood pressure is normal, with 20 mg Lisinopril, and I am in relatively good health.
If I were in an assisted living facility where they do not serve salt in food, I’d probably be dead.
As there may be others who have this problem who are in assisted living, I would appreciate your thoughts on this. — P.M.
ANSWER: I think the most likely diagnosis is that you have the syndrome of inappropriate anti-diuretic hormone secretion. SIADH can happen in people with any kind of brain injury, with some cancers, lung diseases and due to drugs. However, in older people, it frequently comes on with no clear reason. The diagnosis of SIADH is made by a thorough evaluation. A kidney specialist would be most expert in diagnosing this condition.
Very low sodium levels are extremely dangerous. The body needs to precisely regulate sodium, and very low levels can cause severe and permanent damage, even death.
Although the salt (sodium) level is low in the blood, salt is not the primary problem for the vast majority of people with this disorder: Water is. Your internist’s advice to not drink too much water was absolutely correct, as water restriction is the primary treatment for this condition, something that can be quite challenging for people to follow. Taking salt by mouth may also be necessary, but can never overcome excess water intake. A goal sodium of 130-135 is reasonable for most people.
DEAR DR. ROACH: My son is very overweight (325 pounds) and has poorly controlled diabetes, with an A1C of 9.7%. His doctor says the most recent research shows that bariatric surgery can send Type 2 diabetes into a long-term remission. How can this be? If the diabetes is in remission, does it still damage the body? Will he still need diabetes medication? — G.R.
ANSWER: Bariatric surgery is the most effective treatment for weight loss in people who are severely overweight. Eighty-five percent of people with Type 2 diabetes are overweight, and those who are overweight and have not been able to get good blood sugar control with diet, exercise and medication should be considered for bariatric surgery. Many studies have shown that bariatric surgery is very effective, and lowers the A1C level by 2% to 3.5%. Nearly 80% of people with diabetes achieve remission with surgery (meaning an A1C level below 6% to 6.5% without medications). The complication rate of diabetes is dramatically reduced after achieving near-normal blood sugar levels.
Bariatric surgery isn’t for everyone, but for younger people who have poorly controlled diabetes or other significant obesity-related conditions, it is a very reasonable option. I agree with his doctor that it is an option worth considering.