How do you address hyponatremia in general? Any differently in someone who also has congestive heart failure? I work in the ER and have noticed recently several patients with sodium less than 131 is the only abnormal value. They’re drinking and urinating frequently due to the 8 to 10 glasses of water they’re told to drink and often Lasix prescribed as well. I understand the standard low-salt, no-salt advice and 8 to 10 glasses is a bit dated, but most conventional ER doctors don’t seem to. Oftentimes these patients are there for nausea and weakness, but can’t find anything wrong. We can always test magnesium. I believe it’s simply the low sodium and electrolytes, but we can’t diagnose or advise as an RN. Can you talk about what the latest Functional Medicine thoughts are in treating hyponatremia both with and without congestive heart failure?

Yes. I think you’re probably right in many of those cases. What we might have somebody do is track their sodium intake using the Chronometer app and then we send them the series that Laura Schoenfeld, one of our functional RDs, wrote on salt. We have a whole series of articles, and it’s called “​Shaking Up the Salt Myth​,” and the gist of it is that salt and sodium, like most nutrients, have a U-shaped curve. You don’t want to have too little, you don’t want to have too much. We’ve erred on the side of too little in most cases. What’s amazing is that too little sodium can be a significant risk factor for heart disease, which of course is what we’re trying to prevent by telling people not to eat any salt or sodium.

You can use the Chronometer, maybe send these articles to the RD on staff there, or if you can talk with the doctors about it or get some of the doctors to read it and you can get the patients to monitor their own sodium levels, because you can’t really do that very effectively with serum sodium. It will drop on the extremes of sodium intake, which is what you’re seeing probably but not necessarily with low levels of sodium deficiency. You won’t even see that in the sodium in the blood because it’s so tightly regulated. Testing magnesium can also be helpful in that situation, but it sounds a lot like what you suspect, just oftentimes inadequate sodium intake with too much water, relatively.