Now for my personal favorite, SODIUM!!!

Sodium is a vital mineral in the body. Like the other electrolytes, this mineral is involved in many biochemical processes such as muscle contraction and return, fluid balance, active transport, proper bowel function, and nerve activation. Failure to replace it not only lowers the quality and effectiveness of those processes, it may also create a medical emergency. 

Why do we need sodium on a ketogenic diet? 

When we are in ketosis, our body excretes sodium in the normal way, rather than holding onto excess sodium as we do when we burn carbohydrates for energy. This means that a person in ketosis must be more vigilant about intentionally replacing sodium as it’s excreted.

The most common symptoms of being low in sodium are: 

• Swelling or edema
• Nausea
• Headache
• Anxiety, irritability, tremors
• Brain fog, confusion
• Lightheadedness, dizziness
• Extreme thirst (interestingly, this is a symptom of both low sodium AND high sodium in the body)
• Fatigue, lethargy
• Low appetite
• Muscle weakness

Because sodium is also vital to maintaining the proper balance and absorption of water, electrolytes, and other nutrients in your body, if you don’t adequately replace sodium this may also create a situation of dehydration, low magnesium, low potassium, and other nutrient deficiencies. The more pronounced symptoms of low sodium tend to happen in the beginning stages of a ketogenic diet, and together they are commonly called the “keto flu,” but don’t be lulled into a suboptimal level of functioning by not paying attention to this mineral long term. For people who have been in ketosis over the longer term, less pronounced versions of the above list of symptoms could be signs that your body would function better with more sodium.

How to manage suspected low sodium. 

If you are in ketosis and experiencing any of the symptoms listed above, try popping a quarter teaspoon or an eighth teaspoon of salt on your tongue and swallow with a small glass of water. If you’re not feeling better within 20 minutes, you may want to seek medical attention. Some of those symptoms can indicate a serious health condition, especially if they go on for any prolonged period of time, so please seek medical evaluation if you are concerned. If your symptoms resolve with salt, it’s likely that the cause was being low in sodium and it would be advisable to replenish your body stores of sodium by continuing with small doses of salt and water throughout the day.

How much sodium do we need? 

The average person in ketosis should begin with 4 grams sodium per day, which is the equivalent of 2 teaspoons of salt (note, salt is not sodium, but contains sodium), and adjust intake from there, as needed. Some people will do fine on 2 teaspoons, and some might find they need more. The amount of sodium any person in ketosis needs depends heavily on excretion via sweating and urine, blood volume, the amount of water we drink, medications, stress, menopause, and some medical conditions. 

You can use any food tracker to get an idea of how much sodium you get by entering in how much salt you’re getting along with the amounts of salty foods you’re eating. 

People with treatment-resistant insulin resistance might find that they need less than 2 teaspoons until their insulin levels start to lower.

How do I replenish sodium? 

Dietary sodium comes from salt and foods that contain sodium. Foods that are keto friendly and contain higher levels of sodium include olives, bacon, and other cured proteins, anchovies, dill pickles, pickle juice, and many fermented vegetables.

Some people like to use pink Himalayan salt to get their sodium, but I prefer Murray Salt in Australia or Redmond’s Real Salt in the US. It’s great to use a clean source of salt closer to where you live.

Most ketogenic people like to use a combination of salty foods and adding salt to their meals in order to get their sodium for the day. However, if you are one of those people who needs more than 4 grams of sodium per day, you may need to pop some salt on your tongue through the course of the day and swallow it with a small glass of water. Your body will respond best by spreading salt intake through the day rather than taking it all at once or in two or three large doses.

If you’re traveling, you may want to purchase some sodium tablets to bring with you. You could also fill some gelatine capsules with salt. These are another, more convenient way of getting your sodium in. Just be mindful of the dosage and don’t take large doses at one time!