Salt in Diet

[andrew j]

... Thanks for the interesting post, Eric.

I have talked to my Dr. about the amount of salt I eat - and the blood test he ordered showed that I was actually low in sodium!
I can't understand that.

Apparently I have low thyroid.
I think my thyroid was damaged by interferon (which I was on back in 1998).

As with a lot of things when it comes to diet and nutrition (hopefully not trying to teach grandma how to suck eggs?!) it helps if you can measure what you're already doing.
That in itself can help reduce consumption?

... It looks to me as if I'm only consuming about 2,000 mg (2 grams) - rather than the 3 - 4,000 mg I thought I was consuming (and probably was, a while back!).

I'm quite good at reducing consumption.
That's how I quit smoking.

It's important for me to keep my blood and vascular system healthy.
I have significantly reduced blood flow in one of my legs, after the femoral / iliac artery had to be tied off after an operation went wrong last year.

[Mugwump]

Andrew it was an HCV antibody induced reaction that caused my immune system to attack my thyroid and this went on for years before I was finally diagnosed with HCV in 1993. So although it is possible that interferon might have influenced your immune system and caused it to more aggressively attack the thyroid gland, most likely for years you too had a slow immune reaction that created a non specific Graves disease like syndrome the same as what happened to me.

HCV antibodies are a real PITA and are the culprit in many of the extra-hepatic manifestations of chronic HCV infection. It is very hard to generalize how they will effect individuals and it seems some people develop no thyroid issues or other noticeable effects from long term HCV infection whereas others go on to be racked by the effects of reactions to HCV antibodies.

As far as the levels of salt are concerned it is important to consider when testing is done because if you hydrate normally then salt levels will not be as great an issue. Studies have shown that the aging population that have the biggest problems with overconsumption of salts also tend not to hydrate adequately.

In long term care facilities the dietary teaching includes how to reduce the risks of normal salt intake with a balance of hydration. During the hot months we are taught to watch for the beginning signs of dehydration which can occur quite suddenly especially in seniors who have compromised renal functions.

All that said, the extra consumption of salt and other minerals when you are in a situation that requires extra hydration is something which we quite often over look. So you can just as easily become over hydrated and mineral deprived as parched if you do not pay attention to consumption.

What I will say about cirrhosis is that as it progresses it becomes more and more difficult to find a mineral balance and it becomes absolutely necessary to neither over hydrate or over consume minerals. Essentially our fluid and mineral metabolism slowly weakens to the point where eventually either the kidneys fail or the respiratory system causes a heart failure. I have know far too many good people who have died from HCV caused cirrhosis in this way.

So my key to getting over HCV caused cirrhosis once cured has become a slow careful climb back up the hill to some stability in life. Along with not considering myself to be a "liver patient"  but paying careful attention to all aspects of what is required to get over a close brush with death.

Cheers and Happy New Year
Eric

[Lynn K]

Causes for low sodium levels from the Mayo Clinic note liver disease is a cause. People with liver cirrhosis are recommended to restrict sodium to less than 1200mg/day especially if you are having symptoms like edema or ascities. Salt is present in many foods we eat especially if you dine out or eat processed foods so read labels.

http://www.mayoclinic.org/diseases-conditions/hyponatremia/basics/causes/con-20031445

"Heart, kidney and liver problems. Congestive heart failure and certain diseases affecting the kidneys or liver can cause fluids to accumulate in your body, which dilutes the sodium in your body, lowering the overall level"

[andrew j]

I wondered about the state of my liver.
The [last] fibroscan I had done was in 2013 (my most recent gastro. was worryingly off-hand about the need for another one!) - although when I was in hosp. last year a person from the liver unit came down and did a manual examination of my abdomen - sort-of tapping all over it.
She reckoned it was OK.
I think I was F2 - F3 in 2013 (and I had moderate scarring when I had a liver biopsy done in 1996 - 97).

I think my timeframe must be similar to yours, Eric (and maybe yours, too, Lynn?).
(Contracted likely mid-1970's, and Dx in 1996).
I cleared (SVR 12) in early Sept.

It's interesting what you say, Eric, about  Hep C causing the thyroid problems, rather than the interferon.

(... and yes - I probably 'run' at the speed of an older person, now that my leg doesn't work so well!) ...

The only salt I eat is added (raw sea-salt) .
I really don't eat bought or processed food at all.
I drink plenty of water, so hydration should  be OK.
My abdomen is a bit distended, though (I put it down to moving less, now).
Maybe I should have another check-up with my Dr.?

Having said all that - I feel pretty-damn good!

Happy New Year, you guys!

[elias]

As far as the levels of salt are concerned it is important to consider when testing is done because if you hydrate normally then salt levels will not be as great an issue. Studies have shown that the aging population that have the biggest problems with overconsumption of salts also tend not to hydrate adequately.

In long term care facilities the dietary teaching includes how to reduce the risks of normal salt intake with a balance of hydration.

Thanks, Eric.

Not sure if the above means that if you're increasing fluids in your diet, you can add more salt with little harm?

Also: if Na+  blood levels are persistently low, does that give you more leeway in salt intake? Mine hover at almost below normal. No thyroid problems AFAIK

I'm supposed to keep salt intake in check on account of a small kidney stone i had last summer. It's one of about 20+ other restrictions. In addition to recommendation to restrict salt on account of liver damage I'm reading here.. So I'd like not to over-restrict...Restricting salt intake is among the harder  ones..If I don't need to restrict it too much, I'd rather not..  I'd appreciate clarification of above, when you have a chance

I'm F3 and hoping to lower that some after HCV clears

Happy  New Year all!!!
 

[Lynn K]

Liver disease lowers na in blood. People with advanced liver disease need to reduce salt to pass than 1200 mg/ day

So if the cause of low na in blood is liver disease that is not a reason to increase sodium intake in fact quite the reverse.

If you have cirrhosis you should discuss sodium intake with your doctor or a dietician who is knowledgeable in a proper diet for those with ESLD (end stage liver disease) cirrhosis is ESLD.

I became infected with hep c in 1978. Diagnosed with hep c in 1989. Diagnosed with liver biopsy with early cirrhosis in Jan 2008.

[Mugwump]

Thanks, Eric.

Not sure if the above means that if you're increasing fluids in your diet, you can add more salt with little harm?

Also: if Na+  blood levels are persistently low, does that give you more leeway in salt intake? Mine hover at almost below normal. No thyroid problems AFAIK

I'm supposed to keep salt intake in check on account of a small kidney stone i had last summer. It's one of about 20+ other restrictions. In addition to recommendation to restrict salt on account of liver damage I'm reading here.. So I'd like not to over-restrict...Restricting salt intake is among the harder  ones..If I don't need to restrict it too much, I'd rather not..  I'd appreciate clarification of above, when you have a chance

I'm F3 and hoping to lower that some after HCV clears

Happy  New Year all!!!
 

As Lynn stated cirrhosis means that you must decrease salt intake somehow. Obviously if you do not have cirrhosis then the way in which you balance hydration and salts is normal.

For me it reached the point where any exercise was starting to make my urine darken markedly. Since being cured this aspect of cirrhosis has eased off to a point where I can work hard physically for long periods of time again. So there is hope for those of us who have compensated cirrhosis but we still have to pay careful attention to our dietary habits more so than those who have not reached ESLD.

Hope this clears up what I was saying.

Cheers
Eric

[Sergey]

In my understanding, main reason for salt restriction due to cirrhosis is possibility of worsening of ascites/edema. If patient have never had ascites or edema, then salt restriction is not needed. For example, with my beginning cirrhosis without ascites salt restriction is not needed. But, if it will progress to ascites - then salt restriction will be recommended (because salt will cause water retention).

SODIUM RESTRICTION

A negative sodium balance can be obtained by reducing dietary salt intake in approximately 10–20% of cirrhotic patients with ascites, particularly in those presenting with their first episode of ascites [[16], [17]]. There are no controlled clinical trials comparing restricted versus unrestricted sodium intake and the results of clinical trials in which different regimens of restricted sodium intake were compared are controversial [[17], [18]]. Nevertheless, it is the current opinion that dietary salt intake should be moderately restricted (approximately 80–120 mmol of sodium per day). A more severe reduction in dietary sodium content is considered unnecessary and even potentially detrimental since it may impair nutritional status. There are no data to support the prophylactic use of salt restriction in patients who have never had ascites. Fluid intake should be restricted only in patients with dilutional hyponatremia.

http://www.easl.eu/research/our-contributions/clinical-practice-guidelines/detail/management-of-ascites-spontaneous-bacterial-peritonitis-and-hepatorenal-syndrome-in-cirrhosis/report/2

Best wishes and Happy New Year to all!!!
Sergey

[Lynn K]

Yes salt restriction is the first measure to combat ascities and edema however the American diet frequently has too much sodium I believe the recommendation for healthy people is 2400 mg/ day but sodium is hidden in a lot of foods especially processed or when eating at restaurants. And edema and ascities are associated with cirrhosis but not lower levels of damage like F3

[Mugwump]

Thanks for that tidbit Sergey.
Especially what this line says;

Nevertheless, it is the current opinion that dietary salt intake should be moderately restricted (approximately 80–120 mmol of sodium per day). A more severe reduction in dietary sodium content is considered unnecessary and even potentially detrimental since it may impair nutritional status.

Again if you are in a situation where you have possible dehydration it is just as important to not forget that the overconsumption of water without a balance of mineral intake can be just as dangerous especially if you have compromised liver functions.

In 2012 I spent a long hot day rowing hard on a lake searching for rainbows feeding on hatching chironomid and drank large amounts of water without having anything to eat. The result was I almost fainted and fell out of my pontoon boat. But back then that is the way that I wanted to go out.

I had heard about the possibility of new treatments on the horizon but thought that I would not live long enough to see them. They came along faster than I expected...
So for me DAA treatment was a life saver to say the least.

Two years later I was out rowing on the same pond when a thunderstorm came over the hill with a valley caused waterspout that  almost lifted my boat out of the water! There was lightning and wind like a biblical event, trees falling and then hail that drove me off the pond! A minor inconvenience as later that day I had some stellar fishing. When I got off the pond and down into Kamloops my wife called to tell me that my doctor had set up a consultation about going the new DAA treatments. So something told me that quite possibly my time on this earth had not quite expired yet.    

The other side of the coin is now I have to pay much more careful attention to how I deal with having a liver and renal system that could more easily start to leak if I abuse it too much. Ever since being diagnosed as F4 cirrhotic in 2011 I have made an effort to reduce my daily sodium consumption and perhaps this has helped me to avoid ascites and edema and thereby helped me to overcome the most dangerous aspect of having ESLD. 

[Lynn K]

I personally think the most dangerous complication of cirrhosis is portal hypertension caused esophageal varicies. If you haven't had an upper endoscopy you could potentially have enlarged esophageal varicies which you would not feel and be totally unaware of having them. They can suddenly burst and we cirrhotics can potentially have a life threatening bleeding event. So while ascities if severe can cause the development of SPBspontaneous bacterial peritonitis at least you are aware you have ascities you can't miss having them as in severe cases the patient may be bloated enough to appear pregnant. But without having an upper EGD you would not know about having serious varicies. Then of course there is hepatic encephalopathy which if untreated can lead to coma and death as well. Or basically cirrhosis is a terrible way to die...

[elias]

Thanks, Eric

I think that cleared it up for me. Was told by GI I do not have cirrhosis.

Only dr who told me to limit salt was internist treating my kidney stone. Long list of do's and dont's to prevent possible recurrence of that. I've been wondering how much of those were really needed n how much just lumped in there for good measure. So when I read discussion here about salt and liver health, I raised issue if blood Na+ is low, if that's still needed. If i switch to diet of mostly vegetables, as I plan to, decreasing salt much would make it unpalatable. So I'd only do that if really needed and to the extent needed.

 My Na+ isn't too low, just on the low side of the normal range. Which in a sense means  means half of people in normal range are low in Na+ ..and the other half are high.

[Lynn K]

That is why there is a range but as you are in normal range you are normal. Even If you are barely out of normal range on probably any test either just barely above or barely below like a point or 2 my doctors have told me is often not clinically significant.