Are you getting enough sodium? The answer might surprise you

For as long as I can remember, sodium (and salt, by association) has been billed as one of the villains of the standard American diet, leading to elevated blood pressure that can cause heart attacks or strokes. Last year, the FDA even went so far as to lower the recommended daily allowance of sodium—and, according to the American Heart Association, 62% of Americans support such government-led interventions involving the mineral, which is abundant in processed foods.

But believe it or not, a certain subset of wellness fiends may suddenly find themselves deficient in sodium. In the most extreme cases, this can result in a condition known as hyponatremia, which can cause nausea, vomiting, headache, fatigue, irritability, weakness and, in some cases, even seizures and brain swelling.

Those on the ketogenic diet, for example, may find themselves lacking in sodium. That’s because when you cut out carbs, your insulin levels drop—and when insulin is lower, the kidneys release more sodium. This is part of what causes keto flu symptoms, according to Amy E. Chadwick, ND, Licensed Naturopathic Doctor at Four Moons Spa. “As the body shifts into using fats for energy and [enters] a state of ketosis, there can be a temporary increase in urine production and therefore a loss of water and sodium,” she explains. 

Low-carb eaters aren’t the only ones who may need to up their sodium intake. Endurance athletes, according to Akasha Center founder Edison de Mello, MD, are also at risk due to the sodium-depleting potential of breaking a sweat. Exposure factors such as heat can compound this. (Hot yoga practitioners, take note.) And while a deficiency can be caused by dehydration, it can also be caused by drinking too much water. This is a phenomenon seen predominately in distance athletes as well.

Finally, Parsley Health‘s Jeffrey Egler, MD, tells me that he sometimes recommends sodium supplementation for those with low blood pressure. His prescription? Adding sea salt and bone broth to patients’ grocery lists. To this point, Food Coach NYC founder Dana James, MS, notes that you needn’t get your sodium from a bottle. “If you’re not eating processed food, you do want to add sodium to your diet via, for example, a pinch of sea salt in a smoothie, some pink salt in a salad dressing, or black salt over wok-tossed vegetables and a piece of fish.” she says. “If you do that, you shouldn’t need a pill.” Pass the salt.

Whether you’re sodium deficient or not, you may want to consider adding salt to your bath. Oh, and your decor could use a dash, too.