Sodium Intake and Disease: Another Relationship to Consider

Abstract

Sodium (Na+) is crucial for numerous homeostatic processes in the body and, consequentially, its levels are tightly regulated by multiple organ systems. Sodium is acquired from the diet, commonly in the form of NaCl (table salt), and substances that contain sodium taste salty and are innately palatable at concentrations that are advantageous to physiological homeostasis. The importance of sodium homeostasis is reflected by sodium appetite, an “all-hands-on-deck” response involving the brain, multiple peripheral organ systems, and endocrine factors, to increase sodium intake and replenish sodium levels in times of depletion. Visceral sensory information and endocrine signals are integrated by the brain to regulate sodium intake. Dysregulation of the systems involved can lead to sodium overconsumption, which numerous studies have considered causal for the development of diseases, such as hypertension. The purpose here is to consider the inverse—how disease impacts sodium intake, with a focus on stress-related and cardiometabolic diseases. Our proposition is that such diseases contribute to an increase in sodium intake, potentially eliciting a vicious cycle toward disease exacerbation. First, we describe the mechanism(s) that regulate each of these processes independently. Then, we highlight the points of overlap and integration of these processes. We propose that the analogous neural circuitry involved in regulating sodium intake and blood pressure, at least in part, underlies the reciprocal relationship between neural control of these functions. Finally, we conclude with a discussion on how stress-related and cardiometabolic diseases influence these circuitries to alter the consumption of sodium.

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“… 8 , 9 For example, excess sodium intake is correlated with hypertension in humans. 10 Lifestyle changes are the first line of treatment and are one of the key tactics to reduce hypertension, according to clinical recommendations for its management. 11 – 16 Lifestyle modifications such as dietary intake adjustment, increased physical activity level and smoking cessation have been proven effective in controlling blood pressure.…”

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“…This is odd insofar as salt appetite is the root cause of both of these. As Baumer-Harrison and colleagues clearly state, “Understanding salt preference can help guide interventions aimed at reducing sodium intake” [ 3 ].…”

“…Further to the determinants of salt intake, in ‘Sodium intake and disease: another relationship to consider’, Baumer-Harrison, Breza, Sumners, Krause, and de Kloet present an innovative, instructive and very thorough analysis upending the consensual, while yet emphasizing the relationship of salt intake and disease [ 3 ]. They illustrate how a reciprocal neural relationship of stress and cardiometabolic disease alters the consumption of sodium, leading to their astonishing conclusion of a resulting vicious cycle exacerbating disease.…”