Much of our time in providing functional medicine care is spent in establishing balance in a patient’s body. Too little or too much of just about anything can be bad for the person sitting across from us. Take salt for example. It has gotten such bad press relating to blood pressure and heart disease that many actually don’t eat enough. This is especially problematic in our dysautonomia or POTS (postural orthostatic tachycardia syndrome) patients. They often need extra salt. But once again, research suggests that too much salt can be bad for you in other ways. This time it pertains to the potential for salt to interfere with T regulatory immune cells and contribute to autoimmunity.
In the bigger picture, we can’t live without salt in different forms existing in our bodies. Sodium salts, potassium salts, magnesium salts, calcium salts, and others are needed for both metabolism and structural functions. Too little or too much of any one of them however can lead to a variety of symptoms and even death. We truly want just enough and not too much, but exactly where is that line? And what happens if we cross the line?
In prior studies, researchers had found the increasing concentrations of salt could inhibit the function or alter the gene expression of a number of different immune cells. The researchers in this study looked at a type of cell called Treg (“T – reg”). They are a subset of T cells originating from thymus tissue in our bodies. T cells serve in the immune system to attack both microbes and tumor cells in different settings. This subset, Treg, help coordinate other immune cells, directing the right immune response at the right targets and preventing excess immune response at the wrong tissues. Other studies of autoimmune diseases indicate that their dysfunction can contribute to autoimmune diseases like multiple sclerosis and lupus.
As with the immune cell types, they found that increasing salt concentrations altered the gene expression of these Treg cells. They traced this alteration and discovered that changes seemed to begin in the mitochondrial of the cells where energy is produced. The change led to a decrease in the production of ATP, our cell’s energy currency. When they compared the gene expression and the cell activities of these cells to Treg’s taken from autoimmune patients, they turned out to be very similar. This does not proved that increased salt intake directly causes autoimmunity but the mechanism discovered here suggests some role in the autoimmune trigger.
Of course, one should be sure that the change in salt concentration in the study conditions were possible in our bodies. If sodium salt concentrations in our real live bodies could never reach the same conditions in the study, this research would be of little interest or help. However, the changes in sodium concentrations were in line with what could occur in the body with increased salt intake. They did not specific how much more salt one would have to take by mouth but hinted that it was not a large amount.
With all this information, one might go home and throw away their saltshaker right now. I would urge a reflective pause. This study did not advocate for complete salt cessation but addressed the concern for high salt intake by a large percentage of our population. If you are reading this article, there is a good chance that you are above average in health knowledge and below the American average for salt intake. For you, step back and look at your health. You may be right on target with salt intake and can sleep well tonight knowing that this study does not apply to you. You may also be one who knows that you need extra salt to keep your blood pressure from dropping when you stand up. Cutting down on salt might leave you tired, woozy and even passed out. Stop, reflect on your salt intake. If you are eating out frequently, you are likely getting more salt that you realize in significant boluses. In that case, lowering the intake may be a good idea.
Helping patient live healthier more abundant lives requires knowledge of research like this to be combined with wisdom and attention to the unique situation of the patient before us. Balance is almost always a key in guiding our patients through dietary choices and lifestyle restoration.
Beatriz F. Côrte-Real, Ibrahim Hamad, Rebeca Arroyo Hornero, Sabrina Geisberger, Joris Roels, Lauren Van Zeebroeck, Aleksandra Dyczko, Marike W. van Gisbergen, Henry Kurniawan, Allon Wagner, Nir Yosef, Susanne N.Y. Weiss, Klaus G. Schmetterer, Agnes Schröder, Luka Krampert, Stefanie Haase, Hendrik Bartolomaeus, Niels Hellings, Yvan Saeys, Ludwig J. Dubois, Dirk Brenner, Stefan Kempa, David A. Hafler, Johannes Stegbauer, Ralf A. Linker, Jonathan Jantsch, Dominik N. Müller, Markus Kleinewietfeld. Sodium perturbs mitochondrial respiration and induces dysfunctional Tregs. Cell Metabolism, 2023; 35 (2): 299 DOI: 10.1016/j.cmet.2023.01.009
Thanks to Science Daily:
Max Delbrück Center for Molecular Medicine in the Helmholtz Association. “Salt cuts off the energy supply to immune regulators.” ScienceDaily. ScienceDaily, 10 February 2023. <www.sciencedaily.com/releases/2023/02/230210145740.htm>.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.