In the JournalsPerspective

Salt consumption may increase lightheadedness

Higher sodium intake was associated with more frequent and severe lightheadedness in patients who followed the Dietary Approaches to Stop Hypertension diet vs. those who followed a typical Western style diet, according to findings recently published in the Journal of Clinical Hypertension.

“Treatments targeting postural lightheadedness include higher sodium intake with a goal of augmenting BP. However, contrary to these recommendations, some observational studies suggest that higher sodium intake may worsen orthostatic hypotension. In fact, there is limited evidence from clinical trials of the effects of higher sodium intake on postural lightheadedness,” Allison W. Peng, BS, of The Johns Hopkins University School of Medicine, and colleagues wrote.

Researchers conducted a secondary analysis of 412 participants of the DASH-Sodium trial who were not on hypertension medication and had an average systolic BP between 120 mm Hg and 159 mm Hg and diastolic BP between 80 mm Hg and 95 mm Hg. Of that total, 208 participants (mean age, 47.4 years) followed the DASH diet. The others consumed a typical Western style diet (mean age, 49.1 years) that had more red meat and sugar items than DASH.

Peng and colleagues found that among those following the DASH diet, high sodium increased lightheadedness (OR = 1.71; 95% CI, 1.01-2.9) and severity of lightheadedness (P = .02), compared with low sodium. Among those who followed the typical Western style diet, high sodium intake had no impact on lightheadedness (OR = 0.77; 95% CI, 0.46–1.29).

In addition, adults 60 years of age and younger whose high vs. low sodium consumption was part of the DASH diet experienced more lightheadedness than those 60 years of age and older (P-interaction = .04). Younger patients with obesity were also more likely to have lightheadedness than those who did not have obesity (P-interaction = .01).

spilled salt 
Higher sodium intake was associated with more frequent and severe lightheadedness in patients who followed the Dietary Approaches to Stop Hypertension diet vs. those who followed a typical Western style diet, according to findings recently published in the Journal of Clinical Hypertension.
Source:Shutterstock

“Greater sodium intake is widely viewed as an intervention for postural symptoms, like lightheadedness. In contrast, our analysis showed that higher sodium intake in the context of the DASH diet actually increased lightheadedness and had a variable effect in subgroups based on age or BMI. Hence, our results serve to caution health practitioners against recommending increased sodium intake as a universal treatment for lightheadedness,” Peng and colleagues wrote.

“Additionally, our results demonstrate an important need for research to understand the role of sodium, and more broadly of diet, on lightheadedness.” – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.

 

Higher sodium intake was associated with more frequent and severe lightheadedness in patients who followed the Dietary Approaches to Stop Hypertension diet vs. those who followed a typical Western style diet, according to findings recently published in the Journal of Clinical Hypertension.

“Treatments targeting postural lightheadedness include higher sodium intake with a goal of augmenting BP. However, contrary to these recommendations, some observational studies suggest that higher sodium intake may worsen orthostatic hypotension. In fact, there is limited evidence from clinical trials of the effects of higher sodium intake on postural lightheadedness,” Allison W. Peng, BS, of The Johns Hopkins University School of Medicine, and colleagues wrote.

Researchers conducted a secondary analysis of 412 participants of the DASH-Sodium trial who were not on hypertension medication and had an average systolic BP between 120 mm Hg and 159 mm Hg and diastolic BP between 80 mm Hg and 95 mm Hg. Of that total, 208 participants (mean age, 47.4 years) followed the DASH diet. The others consumed a typical Western style diet (mean age, 49.1 years) that had more red meat and sugar items than DASH.

Peng and colleagues found that among those following the DASH diet, high sodium increased lightheadedness (OR = 1.71; 95% CI, 1.01-2.9) and severity of lightheadedness (P = .02), compared with low sodium. Among those who followed the typical Western style diet, high sodium intake had no impact on lightheadedness (OR = 0.77; 95% CI, 0.46–1.29).

In addition, adults 60 years of age and younger whose high vs. low sodium consumption was part of the DASH diet experienced more lightheadedness than those 60 years of age and older (P-interaction = .04). Younger patients with obesity were also more likely to have lightheadedness than those who did not have obesity (P-interaction = .01).

spilled salt 
Higher sodium intake was associated with more frequent and severe lightheadedness in patients who followed the Dietary Approaches to Stop Hypertension diet vs. those who followed a typical Western style diet, according to findings recently published in the Journal of Clinical Hypertension.
Source:Shutterstock

“Greater sodium intake is widely viewed as an intervention for postural symptoms, like lightheadedness. In contrast, our analysis showed that higher sodium intake in the context of the DASH diet actually increased lightheadedness and had a variable effect in subgroups based on age or BMI. Hence, our results serve to caution health practitioners against recommending increased sodium intake as a universal treatment for lightheadedness,” Peng and colleagues wrote.

“Additionally, our results demonstrate an important need for research to understand the role of sodium, and more broadly of diet, on lightheadedness.” – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.

 

    Perspective
    Andrew M. Freeman

    Andrew M. Freeman

    Peng et al’s findings should not necessarily challenge the conventional wisdom of saline’s role in treating lightheadedness. The study had some shortcomings that hinder the wide applicability of its results in a clinical setting. These include the unclear nature of how their patient cohort was developed and how the saline impacted the patients’ blood pressure levels. As an example, would the saline have worked in those who actually had orthostatic hypotension?

    Primary care physicians who have patients that experience lightheadedness should check to ensure their patients, particularly the older ones, are not overmedicated. PCPs should also check to see if dizziness or lightheadedness is an adverse event tied to a medication the patient is taking. Patients that experience lightheadedness in the morning can ease their symptoms by sitting up with their feet over the edge of the bed and allowing a few minutes before standing. Patients may also find compression socks/stockings helpful.

    • Andrew M. Freeman, MD
    • Associate professor
      Director of cardiovascular prevention and wellness
      director, clinical cardiology and operations, division of cardiology, department of medicine
      National Jewish Health, Denver

    Disclosures: Freeman reports no relevant financial disclosures.

    Perspective
    Luke Laffin

    Luke Laffin

    Peng and colleagues’ findings are interesting and hypothesis generating, but they lack the granular data and generalizability needed to truly reconsider current recommendations. Most importantly, the initial Dietary Approaches to Stop Hypertension, or DASH, trial did not obtain orthostatic BP measurements which oftentimes leads to lightheadedness so the authors did not have this information. This is also a population that was not taking any BP medications, which of course can worsen symptoms of lightheadedness.

    There are not many clinicians solely recommending increased sodium content to treat lightheadedness, particularly in patients with hypertension. Approaches to addressing lightheadedness are oftentimes multifactorial and include increased fluid intake, adjusting timing of medication administration and compression stockings in orthostatic hypotension is a contributing factor.

    To decide which patients should take higher sodium intake to treat postural lightheadedness, I measure BP sitting and standing at all visits because these findings can have very significant ramifications for lifestyle recommendations and prescribed medications. In those patients with hypertension and large BP drops when moving from a sitting to a standing position, we tend to recommend a little higher sodium content (typically not exceeding 3 g per day) and increased fluid intake. The amount of sodium we recommend is individualized based on severity of BP changes, symptoms and the presence of hypertension.

    Clinicians should recognize the importance of individualizing the discussion of these symptoms. What I find helpful is to determine when symptoms are most significant/severe. Many patients tend to have most of their postural intolerance symptoms in the late morning/early afternoon. This is due to a constellation of factors including a predictable small decrease in BP due to circadian rhythm, a peak effect of BP medications taken in the morning, and venous pooling after being on one’s feet in the morning. I will recommend increasing sodium intake at lunch in many of those cases.

    • Luke Laffin, MD
    • cardiologist, department of preventive cardiology
      clinical specialist in hypertension, Cleveland Clinic

    Disclosures: Laffin reports no relevant financial disclosures.

    Perspective

    While this is an interesting study, it is just one study, and thus, premature for primary care physicians to consider changing clinical guidelines or practice for lightheadedness in elderly patients based on one study’s results.

    Future studies should explore this study’s weaknesses, such as researching the effect that the DASH diet has on lightheadedness in patients with CVD, diabetes and chronic kidney disease. These are all patients who are more at risk for developing lightheadedness. Future studies should also be longer in length, since 4 weeks is not usually long enough to indicate a permanent solution to a medical problem. 

    There are other ways to alleviate lightheadedness that PCPs can recommend to their patients to enable them to get more salt in their diet, such as drinking more water (at least 48 to 64 ounces a day unless the doctor thinks otherwise for a different medical condition) and keeping their alcohol intake to a minimum (preferably no more than one drink a day for women and two drinks a day for men). PCPs can also ask their patients if they are following the DASH diet and if they are, suggest the patient who is prone to lightheadedness to moderately increase their salt intake.     

    • Mary Cochran, RD
    • registered dietician
      The Ohio State University Wexner Medical Center

    Disclosures: Cochran reports no relevant financial disclosures.

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