The importance of Sodium in ketogenic or low-carb high-fat diet
Just remember. We had discussed the interest of Sodium together in the chapter on it. In that chapter, we saw that the "standard" diet was already more or less rich in sodium, but it was above all too rich in carbohydrates on the one hand, and loaded with unhealthy foods on the other.
However, once you decide to start eating Blooness, you need to rebalance your macronutrients, and in particular a drastic reduction in (bad) carbohydrates, for the reasons we have already mentioned earlier in this guide.
By reducing carbohydrates, we then tend towards a low-carb high-fat diet, and sometimes ketogenic for some. However, when we switch to a low-carb diet, there is a risk that the body will be severely lacking in sodium. And government recommendations in terms of dosage are likely to be well below the real needs.
General Reminders on Sodium
Sodium is a mineral that is naturally found in small amounts in many foods such as meat, milk, yogurt, some tropical fruits and vegetables such as artichokes, celery, beets and seaweed.
It is also found in baking soda, which is used in bakeries, laboratories and restaurants to raise dough or make cookies. It is also found in salt, which is widely used in the standard Western diet.
Sodium is the most common electrolyte in extracellular fluid and plays a central - yet little-known - role in a number of important body functions.
In particular, it ensures the transmission of nerve impulses to the neurons, in association with potassium. It has an influence on the hormonal level, on the elasticity of the cells, and is also involved in the contraction of muscles, in the regulation of blood pH and the volume of water in the blood and cells.
Salt Conversion > Sodium
A distinction must be made between sodium and salt, so that the dosages are not wrong. Salt is actually sodium combined with chloride, another mineral. This gives sodium chloride, in terms of the name.
Salt is often used to salt dishes and give them more taste, or to improve their preservation.
In terms of distribution, sodium chloride (i.e. salt) contains about 40% sodium. Therefore, 5 grams of salt (about 1 teaspoon) contains about 2 grams of sodium.
Why it is necessary to increase salt intake in a low-carbohydrate diet
A decrease in carbohydrates leads to a decrease in sodium
As explained just before, a large part of sodium intake comes from meat, milk, yoghurts, and processed dishes.
As soon as we decide to reduce carbohydrates, this results in a de facto decrease in the consumption of processed dishes, such as bread, biscuits (which use baking soda), prepared dishes rich in salt in order to improve their preservation over time, etc....
In other words, sodium consumption will decrease, and this must be compensated for so that we do not end up with a deficiency.
The decrease in insulin results in a loss of sodium in the body
When carbohydrate intake is significantly reduced, blood insulin levels drop, resulting in loss of salt in the urine. This is because the kidneys release fluids, which leads to a loss of electrolytes, with sodium in the forefront.
The objective is therefore to prevent sodium deficiency by increasing your intake, ideally with plenty of water, every day. If sodium is not replaced, you will probably develop the unpleasant symptoms of "ketogenic flu", including headaches and fatigue.
What dosage of salt in ketogenic / low carb diet?
Suggested amount of salt in a ketogenic diet:
To accompany ketoadaptation and to be maintained in ketosis in good conditions beyond the transition period, it is suggested to consume about 4,000 to 7,000 milligrams of sodium each day, which corresponds to about 2 to 3 teaspoons of salt, depending on individual needs.
In a low-carb regime, we would be a little lower in terms of dosage.
In terms of choice, prefer real sea salt or pink Himalayan salt to industrial salt.
Finally, it is a good idea to adapt the amount of salt you consume according to your state of health, the temperature, your level of sporting activity, etc. If, for example, you have no contraindications to salt, you eat a healthy diet, based on raw products, low or at least moderate in carbohydrates, and you practice endurance sports in the middle of summer, it is recommended that you increase your salt intake further.
Are there risks associated with consuming more salt?
New voices in the world of nutrition are increasingly speaking out against the popular belief that salt should be kept to a minimum.
Indeed, all research on the effects of sodium has been conducted in people who follow a "standard" Western diet. This means that most of the salt probably comes from processed foods that are high in carbohydrates, not real foods like meats and vegetables with added salt.
Several studies have shown that diets low in carbohydrates and ketogens - without salt restrictions - can help reduce high blood pressure, waist circumference and high blood sugar and insulin levels.
Data on salt are currently far from unanimous. And moreover, the recommendations are evolving and are not the same for all organizations.
To the question of whether or not to reduce your salt intake, the answer is that it would be wise to reduce your salt intake if your diet is "standard", but to increase it drastically if your diet is low in carbohydrates and high in fibre, fat and moderate protein.
Salt consumption and health problems: is it compatible?
Let's look at what the science says about salt, based on known health problems.
Salt and hypertension
For people with high blood pressure, medicine recommends reducing their salt intake. However, here again, studies diverge:
- According to a 2015 study, salt consumption reduces blood pressure by an average of 5 points in the short term, which is a modest reduction, given the deprivation it causes to the body.
- In this 2011 study, salt reduction led to a 3.5% decrease in blood pressure on average, but had adverse effects on the body, leading the authors of the study to conclude that they "do not know whether low-salt diets improve or worsen health outcomes" overall.
- Finally, in a 2006 study, other researchers suggested a review of the overall diet to promote weight loss and reduce insulin resistance, rather than reducing salt. A low-carbohydrate diet could thus be a way forward.
In the case of hypertension, it would therefore be wise to reduce or at least moderate your salt intake.
Salt and heart disease
People with cardiovascular disease are generally advised to reduce their salt intake as part of a "heart healthy diet", but here is what the research has actually shown:
- In the case of atherosclerosis, a heart disease that affects the arteries, a 2018 study did show that a reduction in sodium resulted in better arterial elasticity, but did not address the long-term effects on arterial health.
- Other large studies such as this one from 2018 have shown that low sodium intake was associated with impaired cardiovascular outcomes, likely due to hormonal alterations in aldosterone and adrenaline, which are part of the "adverse effects of sodium reduction".
- With regard to congestive heart failure, it is also recommended to avoid salt, although this practice is not based on any reliable source, according to another study dating from 2018.
Again, the question of whether reduced sodium intake improves health remains unresolved.
Salt and diabetes
When it comes to the consumption of salt, and therefore sodium, and its impact on diabetes, science still does not speak with one voice.
- According to this 2011 observational study, people with type 2 diabetes who consumed the least sodium were at increased risk of premature death from heart disease or other causes compared to those who consumed the most sodium.
- Another observational study conducted in 2011 in people with type 1 diabetes showed that the highest and lowest sodium intakes were associated with an increased risk of premature death and the development of renal failure.
- The results of the experimental studies are mixed: sodium restriction may lead to small improvements in blood pressure and kidney function in people with type 2 diabetes according to this 2018 study, and for people with type 1 diabetes, salt restriction may have adverse effects on kidney health.
- Finally, several studies, including this one dating from 1998, have shown that insufficient salt intake could aggravate insulin resistance in adults with type 2 diabetes or exacerbate a decrease in glucose tolerance in pre-diabetic people.
In other words, these studies show that diabetics with hypertension should avoid very high sodium intakes (more than 6 grams per day). At the same time, a severe sodium restriction in all people with diabetes could do more harm than good.
Salt and renal failure
For people with kidney failure, studies have shown that moderate sodium intake could be adapted.
It is not always easy to find your way around, as the theories relating to food and dietetics diverge so much. Salt and sodium are no exception to this rule. Many theories clash over them.
Nevertheless, the interpretation of the different studies tends to show that in the case of a low-carbohydrate diet, it is in our interest to increase our salt consumption according to the previously recommended dosage, and to moderate it without reducing it to an extreme extent in the context of a standard Western diet.
Obviously, the idea with the Blooness food guide, would be to move towards the first option, i.e. a diet low if not moderate in carbohydrates, and richer in fat and fibre. In other words, the healthier we eat, the more we should get into the habit of adding salt to our salads and dishes, in case we had got into the habit of removing salt from our diet in order to follow the official recommendations for a highly processed diet.
For people suffering from illnesses such as kidney failure or hypertension, diabetes or heart disease, this should obviously be discussed with their doctor, depending on their medical tests and their state of health.