Sodium, Inflammation and Joint Pain

[Dean Pomerleau]

In my quest to add diversity to the foods I eat, I recently switched from an oatmeal-based morning porridge to making my own 10-grain hot cereal from whole grain kernals that I buy in bulk and coarse-grind myself with my vitamix.

Anyway, in the first batch of this new multigrain cereal I decided to add a little salt to add some flavor. But mistakenly, I added a lot more salt than I'd intended, to the point where my daily serving of hot cereal contained about 1500mg of sodium, more than doubling my usual daily sodium intake. 

Being someone who hates to waste food, particularly food I worked hard to prepare myself, I decided to eat the first 2-week batch despite having much more salt than I'm used to, figuring what harm can it do.

Within a day or two I noticed my weight had gone up by about 1.5 lbs, which is no big deal but nonetheless very unusual for me. But this wasn't too surprising, since I knew salt makes you retain more water to keep the salinity of your blood constant. Predictably, my blood pressure also went up by about 5-8 points. 

But what I wasn't expecting (but maybe should have) was that my knee joints really started aching. It wasn't quite bad enough to interfere with my unusually rigorous exercise regime, but it was close. Almost as bad as when I had Lyme disease.

Now that I've been eating a salt-free batch of the multi-grain cereal for a few days, the knee pain has disappeared, along with the extra weight and higher blood pressure.

Perhaps my body would have adjusted to the higher level of salt intake if I'd given it longer. There is definitely evidence that elevated dietary salt is associated with inflammation and rheumatoid arthritis [1]. Of course high sodium intake (and excretion) may be a marker for a poor quality diet overall - so it might not be the sodium that is causing the RA in [1]. But given this personal experience of increased joint pain while eating a lot of sodium, I'm not willing to continue experimenting.

I recall some people around here have reported joint issues (particularly knee pain) when engaging in exercise and have been surprised at how I can exercise as much as I do and not suffer from joint pain myself. 

In addition to the relatively low-fat, highly anti-inflammatory vegan diet I eat, perhaps part of my good fortune in this regard results from keeping my sodium intake low. Just something to think about if you've experienced joint pain.

--Dean

------------

[1]  PLoS One. 2017 Oct 13;12(10):e0186157. doi: 10.1371/journal.pone.0186157. 

eCollection 2017.

Sodium excretion is higher in patients with rheumatoid arthritis than in matched 
controls.

Marouen S(1), du Cailar G(2), Audo R(1)(3), Lukas C(1), Vial G(4), Tournadre 
A(4), Barrat E(5), Ribstein J(2), Combe B(1)(3), Morel J(1)(3), Daien CI(1)(3).

Author information:
(1)Rheumatology Department, Lapeyronie Hospital and Montpellier University, 
Montpellier, France.
(2)Internal medicine and hypertension, Lapeyronie Hospital and Montpellier 
University, Montpellier, France.
(3)Institute of molecular genetic, UMR5535, CNRS, Montpellier, France.
(4)Rheumatology Department, Gabriel-Montpied Hospital and Clermont-Ferrand 
University, Clermont-Ferrand, France.
(5)Laboratoire LESCUYER, Aytré, France.

OBJECTIVE: It was shown that sodium can promote auto-immunity through the 
activation of the Th17 pathway. We aimed to compare sodium intake in patients 
with rheumatoid arthritis (RA) vs. matched controls.
METHODS: This case-control study included 24 patients with RA at diagnosis and 
24 controls matched by age, gender and body mass index. Sodium intake was 
evaluated by 24-hr urinary sodium excretion.
RESULTS: Sodium excretion was greater for patients with early RA (2,849±1,350 
vs. 2,182±751.7mg/day, p = 0.039) than controls. This difference remained 
significant after adjustment for smoking and the use of anti-hypertensive and 
nonsteroidal anti-inflammatory drugs (p = 0.043). Patients with radiographic 
erosion at the time of diagnosis had a higher sodium excretion than those 
without (p = 0.028).
CONCLUSION: Patients with early RA showed increased sodium excretion which may 
have contributed to autoimmunity.

DOI: 10.1371/journal.pone.0186157
PMCID: PMC5640209
PMID: 29028829 [Indexed for MEDLINE]

Conflict of interest statement: Competing Interests: The authors have declared 
that no competing interests exist. This work was supported by the Passerelle 
grant (Pfizer). This does not alter our adherence to PLOS ONE policies on 
sharing data and materials. The funder had no role in the study design, 
performance, data analysis or decision to publish.

[Todd Allen]

3 hours ago, Dean Pomerleau said:

Being someone who hates to waste food, particularly food I worked hard to prepare myself, I decided to eat the first 2-week batch despite having much more salt than I'm used to, figuring what harm can it do.

Within a day or two I noticed my weight had gone up by about 1.5 lbs, which is no big deal but nonetheless very unusual for me. But this wasn't too surprising, since I knew salt makes you retain more water to keep the salinity of your blood constant. Predictably, my blood pressure also went up by about 5-8 points. 

But what I wasn't expecting (but maybe should have) was that my knee joints really started aching.

Dean, my condolences, that sounds awful.  What do you think is causing salt intolerance, genetics, lifestyle or just simply getting old?

 

[Dean Pomerleau]

20 minutes ago, Todd Allen said:

Dean, my condolences, that sounds awful.  What do you think is causing salt intolerance, genetics, lifestyle or just simply getting old?

I sense a note of sarcasm, but I'll answer anyway. I suspect my body has adapted to a low sodium diet (perhaps by increasing the level of the salt-retaining hormone aldosterone) and as a result holds on to a lot of sodium when I do eat it, increasing my weight and blood pressure. It could be partly genetic though - since my uncle has hypertension which doesn't respond to diet or medication. 

As for the joint pain, I speculate I may notice swelling in the joints, particularly knees, when I'm retaining water because of the large amount of exercise I do.

--Dean

[Ron Put]

5 hours ago, Dean Pomerleau said:

Within a day or two I noticed my weight had gone up by about 1.5 lbs, which is no big deal but nonetheless very unusual for me. But this wasn't too surprising, since I knew salt makes you retain more water to keep the salinity of your blood constant. Predictably, my blood pressure also went up by about 5-8 points. 

But what I wasn't expecting (but maybe should have) was that my knee joints really started aching. It wasn't quite bad enough to interfere with my unusually rigorous exercise regime, but it was close.

As you note, salt causes water retention, an increase in blood volume, and an increase in blood pressure. I remember reading that it virtually impossible for normally functioning people to consume less salt than required, as even whole foods supply plenty of salt without the need for supplementation -- native tribes in Central America without access to salt can get by on 200mg per day just fine, and don't have coronary disease or high blood pressure to boot.

The RA angle is not something I would have thought of, but the study Dean posted makes sense.

[Saul]

On 3/5/2021 at 11:58 AM, Dean Pomerleau said:

In my quest to add diversity to the foods I eat, I recently switched from an oatmeal-based morning porridge to making my own 10-grain hot cereal from whole grain kernals that I buy in bulk and coarse-grind myself with my vitamix.

Anyway, in the first batch of this new multigrain cereal I decided to add a little salt to add some flavor. But mistakenly, I added a lot more salt than I'd intended, to the point where my daily serving of hot cereal contained about 1500mg of sodium, more than doubling my usual daily sodium intake. 

Being someone who hates to waste food, particularly food I worked hard to prepare myself, I decided to eat the first 2-week batch despite having much more salt than I'm used to, figuring what harm can it do.

Within a day or two I noticed my weight had gone up by about 1.5 lbs, which is no big deal but nonetheless very unusual for me. But this wasn't too surprising, since I knew salt makes you retain more water to keep the salinity of your blood constant. Predictably, my blood pressure also went up by about 5-8 points. 

But what I wasn't expecting (but maybe should have) was that my knee joints really started aching. It wasn't quite bad enough to interfere with my unusually rigorous exercise regime, but it was close. Almost as bad as when I had Lyme disease.

Now that I've been eating a salt-free batch of the multi-grain cereal for a few days, the knee pain has disappeared, along with the extra weight and higher blood pressure.

Perhaps my body would have adjusted to the higher level of salt intake if I'd given it longer. There is definitely evidence that elevated dietary salt is associated with inflammation and rheumatoid arthritis [1]. Of course high sodium intake (and excretion) may be a marker for a poor quality diet overall - so it might not be the sodium that is causing the RA in [1]. But given this personal experience of increased joint pain while eating a lot of sodium, I'm not willing to continue experimenting.

I recall some people around here have reported joint issues (particularly knee pain) when engaging in exercise and have been surprised at how I can exercise as much as I do and not suffer from joint pain myself. 

In addition to the relatively low-fat, highly anti-inflammatory vegan diet I eat, perhaps part of my good fortune in this regard results from keeping my sodium intake low. Just something to think about if you've experienced joint pain.

--Dean

------------

[1]  PLoS One. 2017 Oct 13;12(10):e0186157. doi: 10.1371/journal.pone.0186157. 

eCollection 2017.

Sodium excretion is higher in patients with rheumatoid arthritis than in matched 
controls.

Marouen S(1), du Cailar G(2), Audo R(1)(3), Lukas C(1), Vial G(4), Tournadre 
A(4), Barrat E(5), Ribstein J(2), Combe B(1)(3), Morel J(1)(3), Daien CI(1)(3).

Author information:
(1)Rheumatology Department, Lapeyronie Hospital and Montpellier University, 
Montpellier, France.
(2)Internal medicine and hypertension, Lapeyronie Hospital and Montpellier 
University, Montpellier, France.
(3)Institute of molecular genetic, UMR5535, CNRS, Montpellier, France.
(4)Rheumatology Department, Gabriel-Montpied Hospital and Clermont-Ferrand 
University, Clermont-Ferrand, France.
(5)Laboratoire LESCUYER, Aytré, France.

OBJECTIVE: It was shown that sodium can promote auto-immunity through the 
activation of the Th17 pathway. We aimed to compare sodium intake in patients 
with rheumatoid arthritis (RA) vs. matched controls.
METHODS: This case-control study included 24 patients with RA at diagnosis and 
24 controls matched by age, gender and body mass index. Sodium intake was 
evaluated by 24-hr urinary sodium excretion.
RESULTS: Sodium excretion was greater for patients with early RA (2,849±1,350 
vs. 2,182±751.7mg/day, p = 0.039) than controls. This difference remained 
significant after adjustment for smoking and the use of anti-hypertensive and 
nonsteroidal anti-inflammatory drugs (p = 0.043). Patients with radiographic 
erosion at the time of diagnosis had a higher sodium excretion than those 
without (p = 0.028).
CONCLUSION: Patients with early RA showed increased sodium excretion which may 
have contributed to autoimmunity.

DOI: 10.1371/journal.pone.0186157
PMCID: PMC5640209
PMID: 29028829 [Indexed for MEDLINE]

Conflict of interest statement: Competing Interests: The authors have declared 
that no competing interests exist. This work was supported by the Passerelle 
grant (Pfizer). This does not alter our adherence to PLOS ONE policies on 
sharing data and materials. The funder had no role in the study design, 
performance, data analysis or decision to publish.

Hi Dean!

I actually have a salt deficient diet -- my bloodwork always shows low sodium.  I exercise fairly vigorously -- but not as much as you do (I remember how much time you spent working out on the machines at the last CR Society meeting).

I've never had knee pain -- but I do have a joint problem -- I swam ca. 1 mile per day, most days, for over 30 years -- I used my own (lousy) stroke.  As a result, I wrecked both of my rotator cuffs.  My right shoulder has been replaced by reverse shoulder arthroplasty -- so my right shoulder is made of plastic and steel.  But this contraption works fine, letting me write on the blackboard in my in-person classes. 

The surgeon who did the surgery is Dr. Ilya Voloshin, of URMC.  He also takes care of the Buffalo bills.

  --  Saul

 

[Todd Allen]

On 3/5/2021 at 3:38 PM, Dean Pomerleau said:

I sense a note of sarcasm, but I'll answer anyway. I suspect my body has adapted to a low sodium diet (perhaps by increasing the level of the salt-retaining hormone aldosterone)

I suppose in my unspoken gloating that despite or perhaps because of my diet rich in saturated fat and salt I have no hypertension, inflammation or joint pain I came across as sarcastic.  But I had severe salt sensitivity with inflammation, joint pain and many other issues when I ate a HCLF vegan diet.  In my case I think it was a side effect of hyperinsulinemia as documented in this review article:

The Antinatriuretic Effect of Insulin: An Unappreciated Mechanism for Hypertension Associated with Insulin Resistance?

Quote

Conclusions

Excess dietary sodium intake (i.e. >2 g/day) and alterations in sodium handling leading to sodium retention are basic pathophysiologic concepts of primary hypertension. Preliminary evidence on an antinatriuretic effect of insulin has been expanded by accumulating data showing that insulin stimulates renal sodium reabsorption primarily at the distal nephron, an action that is independent of the effects of the hormone on potassium handling. This effect is clearly maintained, and perhaps increased, in individuals with insulin resistance, playing an important role in the development of hypertension and possibly of salt sensitivity in these states. Further, recent evidence suggests that oxidative stress is connected with both insulin resistance/hyperinsulinemia and sodium retention/salt sensitivity, representing a new factor that can potentiate the above associations and their deleterious consequences

And what is even funnier, the author of this article, George Bakris, was the specialist I was sent to for severe hypertension for which my PCP was unable to find any combination of medications to manage my blood pressure a few years after this article was written.  Bakris also failed to manage my blood pressure, he only considered drugs and thought my diet was healthy.  A couple years later about the time I joined this forum, just after a friend my age also with Kennedy's Disease died from a stroke prompting me to fire my docs and find my own answers, I came to suspect the problem was my high carb diet and I changed it.  Now I don't take any meds at all and often a teaspoon of salt with meals and my resting BP is rarely above 100/60.

Edited March 7, 2021 by Todd Allen

[Dean Pomerleau]

Todd,

It is great to hear you have found a way to manage your Kennedys Disease so successfully, while others with KD of similar age are dying from its side effects. But I wonder just how generalizable and healthy your diet and lifestyle practices are long-term for people without your life threatening genetic condition.

--Dean

[Ron Put]

16 hours ago, Todd Allen said:

But I had severe salt sensitivity with inflammation, joint pain and many other issues when I ate a HCLF vegan diet.

Interesting. But I wonder if it may have been sensitivity and an adverse reaction to something in your previous diet, rather than a broad "vegan" and carbs thing. In fact, it is likely, IMO.  Of course, you have found a solution now and it works for you, so that's great.

I am unclear why you consume that "teaspoon of salt."  Is it to add taste, or does your blood pressure drop if you don't consume salt? 100/60 with salt would suggest that without the salt, these numbers might dip lower.

I had come across something about salt and autoimmune responses and Dean's post reminded me of it:

Salty Diet May Help Trigger Multiple Sclerosis, RA

"All three studies help explain, each from a different angle, how "helper" T-cells can drive autoimmune diseases by creating inflammation. Salt seems to cause enzymes to stimulate the creation of the helper T-cells, escalating the immune response.
"We think of helper T-cells as sort of the orchestra leaders, helping the immune system know what the cells should be doing in response to different microbial pathogens," explained Dr. John O'Shea, director of intramural research at the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases, in Bethesda, Md. "The strength of these papers is that they have found another factor that drives [helper T-cell] differentiation -- salt." ...
Hafler pointed out that while salt may be implicated in autoimmune disease, it may also be found to play an important role in boosting the immune system. Part of the reason chicken soup seems to be effective with colds and flu may be that the salt stimulates an infection-fighting response, he said."

Anecdotally, I generally experience salt cravings when I am sick, which I have attributed to dehydration in the past. But perhaps there is more to it. In fact, in the 24 hours after my second shot of Novavax, I felt flu-like symptoms and had a craving for chips :) Ate a whole bag of salty Terra sweet potato chips...

[Todd Allen]

22 hours ago, Ron Put said:

I am unclear why you consume that "teaspoon of salt."  Is it to add taste, or does your blood pressure drop if you don't consume salt? 100/60 with salt would suggest that without the salt, these numbers might dip lower.

I perform better when I have more salt.  I built an infrared sauna in which I do strength training every night before bed.  These sessions are limited by crossing into heat shock typically as my systolic blood pressure drops below 55 which lately occurs when my heart rate sustains over 180 for a couple minutes.  When I don't get enough salt I cross that threshhold more rapidly at lower levels of exertion.

[Dean Pomerleau]

Note - I moved discussion of Todd's high LDL to a new thread on Is High LDL-c Harmless in Otherwise Healthy People?

--Dean

[IgorF]

It could be that a lot of negative effects associated with sodium are rather a lack of "desired" (by the particular body?) balance between sodium and potassium and since it is a kind of homeostatically regulated thing (with all the complications hard to explain) the professional community translates to the outside a simple message - avoid added salt, just because such a message should be simple for it to work en masse and because it is very hard to have it less than biologically required.

I recently for the sake of curiosity did a 24h urine test and got the following:

potassium 276,30 mmol/24h in the lab's range 25-125
sodium 130,39 mmol/24h in the lab's range 40-220
aldosterone 16.6 ug/24h in the lab's range 2.1-18

Cronometer input for these 24h was like:

sodium 2700mg, potassium 10000mg (maybe a slightly more sodium due to hard to evaluate canned spinach and beans but not more that +100mg perhaps)

From the results I assume the body reacted with raising aldosterone to preserve all the sodium possible and drop out all the extra unbalanced potassium. For the normotensive person this perhaps is ok, e.g. https://www.ahajournals.org/doi/10.1161/JAHA.120.018716

(the other possible issue - elevated aldosterone for prolonged period could raise the stress hormones and this could be unwanted but as a non profi I think I have no chances to assess/track it anyhow)

How it could work for a person with already established hypertension and especially with kidney issues - hard to say, but perhaps it will not "just work" so a kind of a balance when an absolute intake and a relative ratio will decrease the requirement to drop the excess of either will be the most desired way to go. A systematic review on ratio could be also a useful source https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224208/

 

Br,

Igor