I found this site by accident when I was searching for a new dietary sodium to potassium ratio calculator because the one I had been using was down. It’s not a calculator but I found it pretty interesting. It discusses many of the things already covered in this thread like the Mars study, sodium being stored in the skin, the Yanomami people etc but then seems to have died in around 2016. I’m not sure why…everything is still online but there’s nothing new posted as far as I can tell. Perhaps there’s nothing new to add. Some of it could be quackery and I apologize if so. I don’t feel qualified to judge if everything on the site is correct tbh. Here it is though for anyone curious.

https://highpotassiumfoods.org/

3 Likes

I’m wondering if anyone here currently eating a no added salt diet is also taking dapagliflozin and if so how it is going? Thanks

1 Like

Prevalence of Admission Hyponatremia in Patients With Diabetes Treated With and Without an SGLT2 inhibitor

https://academic.oup.com/jes/article/7/4/bvad011/6998591

“Hyponatremia often reflects a free water excess. Sodium/glucose cotransporter 2 (SGLT2) inhibitors increase free water excretion through glucose-induced osmotic diuresis. In 2 randomized double-blind, placebo-controlled trials in patients with the syndrome of inappropriate antidiuresis (SIAD), we showed that empagliflozin increased plasma sodium concentration more effectively than placebo.”

“The main finding of this cross-sectional study is that hyponatremia prevalence and plasma sodium concentration were the same in patients with T2DM treated with and without SGLT2 inhibitors, irrespective of comorbidities and comedications.”

“Second, the inhibition of SGLT2 increases glucosuria and natriuresis [38]. One could argue that it would increase urinary sodium clearance and worsen hyponatremia. However, hyponatremia is not a side effect of SGLT2 inhibitors, mainly because the pathophysiology of hyponatremia relies more on a relative water excess than an absolute sodium deficit [39]. Interestingly, our data showed no difference in urine sodium concentration and fractional excretion of sodium between patients with SIAD treated with empagliflozin or a placebo [25, 26]. In patients with T2DM, natriuresis seems to be transient as well [40].”

Severe hypernatremia caused by diabetes drug – a case study report

“Irrespective of severity, hypernatremia may be caused by salt (sodium) overload but is most commonly due to water deficit (i.e. dehydration). This recently published case study report highlights severe hypernatremia due to water deficit. In this case water deficit was attributed to the blood-glucose-lowering drug empagliflozin that is used to help normalize the blood glucose concentration of patients with type 2 diabetes.”

1 Like

Thank you kindly for the helpful links Cronos.
I did find one study from 2021 comparing dapagliflozin in high sodium v low sodium participants in the context of DKD fwiw. I’m not qualified to judge the quality of the study but figured I’d share here if anyone has an interest in reading it.

https://www.nature.com/articles/s41598-020-79687-z

I’m not clear what qualifies for LS in their study but I suspect it’s still much higher than I consume.

Not the exact answer you are looking for, but I take dapagliflozin, and, until last week, on many days I’d only consume 1/4 tsp-ish of salt that was used in cooking.

On the days I eat shelf stable products, like RAO’s sauce, it would obviously be a lot higher.

I don’t notice any differences either way, fwiw.

1 Like

That’s actually very, very helpful Beth! Thank you! 1/4 tsp of salt is equivalent to about how much I get from the naturally occurring sodium my no added salt omnivore diet. I’m mostly interested in seeing if it helps me with reactive hypoglycemia as it has others here. If I could fix that issue it would truly be life changing.

1 Like

Dr. Hashmi chimes in on fluid intake, sodium and kidney health. In the notes on the video he lists all the studies he references.

2 Likes

AI gives this summary (by mistake I just submitted the transcript)

Quick-look takeaway

  • Healthy adults usually do best with ~2 – 3 L of total drinking water a day (all beverages counted). That amount aligns with the U.S. National Academies’ Adequate Intake targets once the ±20 % water that comes from food is subtracted.National Academies Press
  • The popular “8 × 8” rule (1.9 L) was never evidence-based; its origin was a mis-read 1945 Food & Nutrition Board statement.PubMed
  • More isn’t better: the kidney can clear only ≈0.8–1 L per hour. Repeatedly drinking well above that (≈8 L + spread over a day) can dilute blood sodium below 135 mmol/L (hyponatraemia) and, in extreme cases, cause seizures or death.PubMed NEJM Evidence
  • Kidney-stone prevention: ensuring ≥2 L of urine output—roughly 2.5 L + fluid intake for most people—cuts stone recurrence risk about 50 %. Every extra 0.5 L you drink lowers risk another ~7 % up to about 3 L/day.PubMed PubMed
  • Existing chronic kidney disease (eGFR < 45 mL/min/1.73 m², “stage 3B” or worse) usually requires individualised restriction to ≤1.5 L/day, sometimes less, to avoid fluid overload.KDIGOPubMed
4 Likes

Thanks @CronosTempi and @John_Hemming. I watched the video and looked in cronometer where I (obsessively :joy:) track everything that enters my mouth and I’m coming in at about 3 liters per day between all beverages and food. My last sodium level on my blood work was 139 so that’s good. I’ll just keep doing what I’m doing. The AI summary is appreciated as well for easy reference!

2 Likes

I started Dapagliflozin one week ago today and I’m taking 1/2 of the lowest dose so 2.5 mg. Sunday night I had a restaurant meal. Normally I gain 2-3 pounds of fluid when I eat out and it takes about 3 days for it to go away. Monday morning I woke up only 1 pound heavier and it was gone by Tuesday morning so it seems to be helpful. This is exactly the effect I was hoping for when I ordered it.

5 Likes

Latest video by Goobie discussing salt and fluids.

2 Likes

Can Dietary Sodium Reduce Gray Hair?

This is not the first video I have found suggesting that many people have too little sodium intake.
Of course, the caveat is that more sodium equals higher blood pressure. I keep my blood pressure under 120 over 70 by consuming more L-citrulline as needed throughout the day. This has additional benefits.
My hair is not as gray or white as it was two decades ago. But I have attributed this to taking rapamycin for several years.
Michael Lustgarten, PhD., also suggests that taking extra sodium on workout days might reduce recovery time.

2 Likes

How much L-citrulline are you taking per day? I m taking just 1 cap 750 mg at night. May be I should take more.

Let’s keep in mind the WHO estimates 1.89 million deaths a year from excess sodium and dietary sodium reduction as one of the most cost effective ways to improve population health.

4 Likes

That is an overly simplistic fact. You might view the video
Some people are more sensitive than others to sodium, which can cause high blood pressure.
The primary cause of death from sodium is high blood pressure.
Over time, this sustained high blood pressure damages the heart, arteries, and other organs. This significantly increases the risk of heart disease, stroke, and kidney disease, which are the leading causes of death worldwide.

1 Like

I currently take anywhere from 4 to 10 grams daily. I monitor my blood pressure and try to keep the systolic between 120 and 110 and the diastolic between 70 and 60. It seems to vary somewhat with what I am eating, hydration, etc. Usually if it is a little high in the morning, I start with 2 grams.
I also take 4 grams around bedtime.

1 Like

It’s not via HBP only that excess sodium causes damage.

2 Likes

And it keeps your BP 120/70 without BP medication? Just L-citrulline?

1 Like

TMI, I know, but I am not busy this morning.

I have been taking metoprolol succinate XL 50 mg and telmisartan for over ten years. They do a good job of keeping my BP below 130, but for whatever reason, my morning blood pressure varies between 110 and 130. So, in light of the many BP discussions on the forum, I am trying to keep it in a narrow range between 110 and 120. Some are trying for even lower, but I don’t like how I feel when it’s below 110. Meta-analyses show reductions of systolic BP of ~4–7 mmHg and diastolic BP of ~2–4 mmHg

I have been taking L-citrulline along with creatine before going to the gym. Gym rats for decades were supplementing with L-arginine, but it turns out that L-citrulline produces more available L-arginine than an L-arginine supplement. "L-citrulline is converted to L-arginine in the kidneys, which is then used to create nitric oxide (NO). NO is a powerful vasodilator. “L-citrulline increases plasma L-arginine for 6–8 hours, whereas oral L-arginine’s effects often peak and fade within 1–2 hours.” “Exercise benefits: Strong evidence.” L-citrulline has fewer gastrointestinal side effects than L-arginine. Some gym rats take the malate form because the malate portion is a Krebs cycle intermediate that may enhance ATP production and delay fatigue. I have tried both, but subjectively I couldn’t tell the difference.

“L-citrulline supplementation increases plasma L-arginine levels, leading to improved endothelial function and vascular health, particularly in populations with compromised nitric oxide bioavailability, such as hypertensive postmenopausal women and obese pregnant women.”

I probably should post this in one of the supplement threads, but here are the benefits of L-citrulline:
Benefits of L-Citrulline Supplementation
Nitric Oxide Production & Vascular Health
Increases plasma L-arginine levels more effectively than direct L-arginine supplementation.
Improves aerobic performance by enhancing muscle oxygenation.
Delays fatigue by reducing ammonia and lactate accumulation during exercise.

Enhances NO-mediated vasodilation, which improves blood flow and reduces vascular resistance.

Dose-Dependent Effect: The blood pressure-lowering effects of L-citrulline are generally dose-dependent. Studies that have shown significant reductions in blood pressure typically used doses of at least 6 grams per day.

Common Dosages
General cardiovascular support: 3–6 g/day
Erectile function: ~1.5–3 g/day.
Exercise performance: 6–8 g
For blood pressure reduction, clinical studies often use 3–6 g/day in divided doses.

(Note: Everyone in the forum has access to AI searches. If you want additional papers and references, you can do your own search, as the list would be too long to post here.)

Effects of L-Citrulline Supplementation on Endothelial Function and Blood Pressure in Hypertensive Postmenopausal Women

4 Likes

That’s true for the general population that eats a lot of processed high salt foods. I think that for outliers, like the people here that are very interested in their health and eat exceptionally healthy diets, too low sodium intake might even be more common than too high. While excessive intake is obviously bad, too low can be harmful too. When sodium is too low that can result in increased Angiotensin II which increases blood pressure and could decrease Klotho levels. Long-term low salt diet increases blood pressure by activation of the renin-angiotensin and sympathetic nervous systems - PubMed

2 Likes