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One salty lady

Friends, I want to share with you the tale of the Great Salt Crisis of 2017. It’s a tale that stretches across time (well, back a few months) and delves into some of the more whimsical peculiarities that my body foists upon me and those that I foist upon it. Shall we?

Super important caveat: I’m not a doctor. I’m not a chemist. I’m not an endocrinologist. This is my experience and is not a prescription for your behaviour, your medication, or your nutrition. There’s no guarantee I’ve correctly understood the body’s chemicals and their actions. Please read this as an interesting story only.

Last year, as keen readers will no doubt remember me mentioning, was a bit of a meds maelstrom for me, as my endocrinologist and I trial-and-errored our way towards a new and better cortisol dose that will serve me more smoothly over the course of the day. We finally settled into a good routine in about August, and I’ve been on that pleasant and steady dosage ever since. Huzzah for good medical care, huzzah for an excellent endocrinologist!

It took me a long time to bounce back from the meds maelstrom. Due to some misunderstandings, I had spent the first half of the year on a very low dose, dragging myself from thing to thing in a grey and pallid state. (My endocrinologist, upon hearing about this: “You must be exhausted!” Me: “…I’ve been very brave.”) I lost a lot of fitness, partly (I presume) because of cortisol’s impact on muscle strength and energy/stamina overall, and partly because I simply couldn’t be stuffed exercising. After restoring myself to a healthy dose, we began the long and surprisingly slow course to regaining strength and energy. My stamina was shot for a really long time, and my recovery from exertion was slow and annoying.

Early this year, I noticed I was really getting tired. And light-headed. In early January, while we were camping with friends, the bend-over-stand-up process by which one secures tent pegs into the ground was as a dizzying and exhilarating roller-coaster ride for me. I had to sit down for a bit. Later, while helping my beloved yoga teacher with her latest round of teacher training, I found not only was the bend-over-stand-up process by which we go through sun salutations and the prasarita paddottonasana series completely head-draining, but the whole day was nothing short of exhausting. Something was up, I realised, and it was probably cortisol-related.

I had a sudden flashback: while preparing to go camping and packing my meds, I realised my Florinef (fludrocortisone: replaces the body’s aldosterone) was getting to the pointy end of its lifespan. I checked the bottle: It expired in December 2016. “Aha!” Cried M and myself, high-fiving. I treated myself to half a tablet from a new, unexpired bottle, presuming that even if it was expired, I was probably getting some good out of the old ones, and shouldn’t take a whole new one. I called my endocrinologist. The conversation went a little like this:

Me: “Bad news and good news: the bad news is I’ve been feeling like crud. The good news is, I figured out why! My Florinef expired!”

She: “Really? Huh, that’s weird…tablets don’t usually go off that quickly. How’s your salt intake?”

Me: “My what? Yeah, fine. Aren’t I clever?”

She: “Well, it sounds like you’ve sorted it out. Good job. Just keep an eye on your salt levels for me, okay? It’s been pretty hot lately. Call me if the symptoms come back.”

The next day I felt awesome. The day after that, it was back to blobsville. I double checked my meds: definitely the unexpired, fresh bottle. And yet? Still no good. Fine, I thought. I’ll give the salt thing a look at. Over a mug of miso, M and I had a chat about what we eat. Since I’m allergic to nightshades (tomatoes, chillies, potatoes, etc. etc.), we don’t buy a lot of pre-made stuff. Most sauces and things like that are out, because they usually have a little bit of chilli or cayenne or paprika or potato starch or whatever. So we make our own—and don’t add much salt. Why would you? You get told from day one that salt is the Literal Devil and you Must Not Eat It. It’s second only to fat in the hierarchy of edible evil.

And then we gave up carbs. Carby foods generally contain a lot of salt, even the homemade stuff. So there’s another source of salt gone. And there’s a LOT of discussion on various low-carb forums and sites regarding the need to up your electrolyte intake when you ditch the carbs: it seems that there’s something about the relationship between carbs, water, and electrolytes that shifts when you drop carbs. Not for everyone, but definitely for me. So in the end, my salt intake was extremely scant. Mostly from cheddar and feta. Turns out you need salt to get by, too. It’s important.

AND THEN we have the confounding factor of Addison’s. One of the many roles of aldosterone is to regulate the body’s salt and keep it optimum. If you lose a lot of salt, such as through exercising when it’s hot, or even just sitting around sweating when it’s hot, the amount of aldosterone you produce increases, in order to reduce the amount of salt you pee out. Only, if your body can’t adjust it—if, for example, your body’s only source of aldosterone is a fixed-dose tablet every morningthere’s no message sent to say ‘hey, hold onto that salt, we’re running low’. To recap: I was losing salt through sweat (hot summer days, and also exercise more generally), I wasn’t replacing it in my diet (low-carb, no nightshades), and I was mysteriously feeling ill. And the reason I felt so awesome that day I had the extra half tablet of Florinef from the unexpired bottle? That mimicked increased aldosterone, which (temporarily) reduced the amount of salt I was wantonly discarding.

M was a champ and whipped up the saltiest dinners he could think of. I drank mug after mug of miso soup (800mg of sodium per mug, I’ll have you know!). Lucky I love miso soup. After a day or two of sudden and astonishing energy, I picked up some salt tablets at the chemist and now they’re a part of my daily supplements. I even keep a bottle in my gym bag, because I get sweaty at the gym and sometimes need a top-up.

So here’s the kicker: I feel better than I have since August. My stamina is bonkers good; my energy levels are higher than ever; and when I get out of bed in the morning, I feel awesome (sorry, I didn’t want to tell you). I don’t know if it’s because I’ve been a bit short of salt since we gave up carbs (in July), or if I’ve finally recovered from the six-month cortisol underdosing—but I suspect it’s the first option. This has been yet another astonishing revelation in the category of Quirks of Bethini’s System.

My endocrinologist is the best. A follow-up conversation:

Me: “You were right. It was the salt.”

She: “Well, the weather has been disgusting. Keep it up: don’t be scared to take more Florinef if you need it, but if your blood pressure stays steady, you can keep taking the salt tabs.”

Enter my new toy: a manual sphygmomanometer (blood pressure checker dealie). It came in teal! In a dinky little case and with a matching teal stethoscope!

Playing with a stethoscope.

Testing my new blood pressure dealie on an unresponsive patient.

Turns out they don’t even check you’re a doctor. Anyone can buy them.

Stay salty, everyone!

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