balking at higher salt dose

[heidikk]

My son just turned 6mo and they want him to go from 1/8 t up to 1/4 t per day. I've tried gradually increasing the amount I put into his applesauce/enzymes mixture but he is starting to fight taking his enzymes, coughing, sputtering, spitting, fussing, flopping around so that the stuff ends up everywhere but in his tummy. Is there a better way I should be doing this?

 

[jdickey6]

Hi. I have 2 kids with CF. My first one was diagnosed at 2, so he didn't start adding salt until much later. The 2nd was diagnosed at a few weeks, so everything started sooner. However, the most important thing is getting food in those tummies. So, if the added salt isn't working, I wouldn't add any for a while. Just be sure to keep him hydrated, lots of water, etc..Then start adding a tiny bit of salt to everything. I found the easiest way to add salts was in liquids. Now, my son who is 17 has become accustomed to the added salt in his Gatorade when he plays baseball. Good luck!!

 

[Gorf]

I have always craved it, people cringe when they see me salt my food. I can eat it right out of the salt packet.

 

[heidikk]

lol, Gorf. my husband is the same way. apparently our youngest son is not. I can see that as we add more types and higher amounts of food to his diet, it might be easier just to salt all of them. Right now he's just got the baby spoon sized amount of apple sauce at each feeding plus one 2 - 3 T sized feeding of cereal that I could add it to. He's still getting most of his nutrition from nursing and I do not want to change that.

 

[Beccamom]

I love to drink salt water. Maybe a cup with a soft spout and juice with salt. I wouldn't mix the enzymes and salt so he doesn't not want the enzymes. Maybe baby sweat potatoes with salt.

lol, Gorf. my husband is the same way. apparently our youngest son is not. I can see that as we add more types and higher amounts of food to his diet, it might be easier just to salt all of them. Right now he's just got the baby spoon sized amount of apple sauce at each feeding plus one 2 - 3 T sized feeding of cereal that I could add it to. He's still getting most of his nutrition from nursing and I do not want to change that.

 

[LittleLab4CF]

Sometimes I feel like a living mass spectrometer. The saline shunt from an IV hits like a skunk, but in taste, and that is a minuscule amount of salt. At this point I am outnumbered where the logic of increased amounts of salt for CFers sounds so convincing. The average American is dehydrated. Although younger adults are more conscious of hydration, I have yet to hear a CF specialist recommend drinking a gallon or water daily. As much as I find salt overwhelming, water is even more so. I hate to drink anything but milk.


If the logic of 'you crave what you need' is to be trusted then my wife's craving for ice cream must be essential for the well being of all women. Wait, I think that’s true. How about a craving for alcohol? As a kid in the fifties, salt tablets were a summer thing and we didn't question it. There was a medical reversal on the benefits of salt at a point. I was fairly young when salt tablets suddenly went behind the pharmacy counter so I don't know the story behind it. Salt is essential and salt has aided in the creation of a new epidemic, tantamount to tobacco use of my parent’s generation.

I challenge the idea of our needing more salt than the average person. I also have no more proof for my argument than the ‘you crave what you need’ crowd. For a period, we can inflict all kinds of abuse on the body and get away with it. If you are overloading your body with a chemical through chronic use, a chronic illness awaits. Just like any drug, have your serum levels tested periodically. You are likely to find that the true salt you crave is potassium chloride. Ask any E.R. worker and dehydrated people come in low in potassium more often than sodium chloride. Way above all electrolytes is WATER, people just aren’t paying attention to the amount of water we need. Salt makes you need more water.

I promise to do some due diligence on my opinion that CFers need just the same amount of salt as the average healthy Joe. Anybody gobbling salt needs to gobble some in the waiting room at the doctor’s office and then have blood drawn. Being told by your doctor to increase salt intake over hot months, or eat more salt than normal should be challenged by the same test. I don’t intend for the doctor to gobble a bunch of salt, but have your blood drawn when you are in a typical period when heat and extra salt are being used.

Something in my gut just doesn’t buy increasing salt, especially by a considerable amount. Compare what you are being told to take, or give your child, to Recommended Daily Amounts (RDA). Blood needs to be drawn close to the time extra salt is taken in to understand how high it gets. To be fair, it should be compared to a resting period recommended by your doctor. If salt is a must, so is an amount of water equal in excess to your salt. Your body will work to balance everything but it will not be successful if you deprive it of its universal cleanser.

My first deliberate encounter with salt was about age 7. I was curious about salt. I had wiped a little powder off the salt shaker much younger and it was not appealing. A baby balking at salt seems natural to me. See how formula and such is salted, which isn't much, but anybody who has dared to taste baby food yams understands a baby isn’t wired for salt just yet. As a practical suggestion to give the tyke a little salt on the sly, figure out how to give 1% salt in formula or some liquid. I mean figure out the proper mix, I’m not going to do it here but you have the entire internet to calculate isotonic or near isotonic salt solution. We can’t taste it. I can’t taste it at that concentration. You can deliver this solution in any quantity and do no harm.

LL

 

[heidikk]

cravings aside, you're saying that we should be trying to increase water intake rather than salt intake? I'd be interested in hearing your logic, especially as it relates to the inability in cf patients to transfer salts through the chloride channels. And potassium chloride?? Isn't that what they use for lethal injection?

 

[kosdancer]

I wouldn't worry about it much. My body always does a really good job of telling me how much salt I need. If I've just worked out, or have been in the sun all day, I have to add a lot of salt to my food before my body tells me it tastes salty enough. And then when I've had enough, my body will tell me because whatever I'm eating is suddenly too salty. When your son gets old enough to eat his own food, he should get his own saltshaker so he can figure out how much he needs himself - it's what my parents did and what my doctors always told us to do.

 

[SoyaSauce]

"I promise to do some due diligence on my opinion that CFers need just the same amount of salt as the average healthy Joe"

"Way above all electrolytes is WATER, people just aren’t paying attention to the amount of water we need. Salt makes you need more water."

Electrolytes are mineral compounds needed in the blood, not water.

People with CF sweat out 10x MORE normal amount of salt in sweat then someone with out CF, that's alot of salt!
This is not just exercising or in a hot climate, Just breathing, coughing, living, you are sweating invisibly daily. I assume some CFers with different mutations will have different rates of salt loss, but fact of the mater is, there is abnormal amount of loss somewhere.

If you are chugging downs gallons of water and no salt, you are flushing your self dry, and that's DANGEROUS- water poisoning.. You flush out too much salt and can cause hyponatremia, because there is no salt to open to let water in.

 

[SoyaSauce]

My son just turned 6mo and they want him to go from 1/8 t up to 1/4 t per day. I've tried gradually increasing the amount I put into his applesauce/enzymes mixture but he is starting to fight taking his enzymes, coughing, sputtering, spitting, fussing, flopping around so that the stuff ends up everywhere but in his tummy. Is there a better way I should be doing this?

Why don't you split the salt dose in has applesauce? Little in the morning, afternoon and night,. Try give him salty snacks, little salt crackers or cheese slices sprinkle with salt, provided he can chew it ok. Just make it a little game, add some to his milk/ juice, You eat some salt and let him watch you.

 

[Rebjane]

Another thought is; do you live in a location that is hot and humid where you are sweating alot and excreting salt?

Our family lives in a relatively cold environment. My daughter w/cf was born in the winter and she was exclusively breastfed. I was told to give her her CF liquid vitamin and salt mixed with breastmilk in a bottle. Everytime I tried to give it to her)she was a newborn); she threw it up. I spoke with our nutritionist and I stopped given her the extra salt. I would give to vitamin via a dropper; no vomiting.

What about giving your child; something salty to suck on? What about those pretzel rods; I remember my daughter would suck on those in her high chair lick off all the salt and throw the rest on the floor. Or, a salt bagel? Yum!

BTW; Pretzels are a STAPLE in our household....Rold Gold sticks..Likely go through a bag every 3 days, my daughter with CF eats all of them! Also, after dinner sometimes, she'll take the salt shaker and pour salt in her hand and eat it for dessert. She self regulates; her salt levels have always been fine.

 

[SoyaSauce]

Just to say, I'm a salt freak. It really keeps my hydrated and makes me feel better, believe it or not.

I am very liberal with salt, sprinkle it on everything, pretzels, cheese, anything.

I drink Gatorade when I work out and take a couple salt tablets to. So obviously I lose alot of salt.
I have even added salt to plain water and I can drink it fine, or even Gatorade to!
I really can't drink plain water with out something salty or other wise I feel really bloated and puffy.

In the summers, it not usual for me to have salt crystals on my head and face.

A few salt- loss incidents for CFers to read, before I really knew how I needed salt.

When I was new to working out didn't know any better of my own health , I decided to go for a run on the treadmill, and just bought a PLAIN bottle of water.

Started running, and continued to drink the plain water, Was fine at first, but I soon deteriorated in performance and then eventually stopped. I became so so HOT, my vision was going hazy, felt shaky and lightheaded, muscles started cramping, my heart was racing, and felt really really 'off', my blood pressure was plunging, & I realized in the moment, I needed some SALT and FAST. I went and got some Gatorade and in few minutes once my salt balance went back up I recovered very quickly.

Another incident, was traveling in Mexico, and was very hot stuffy weather out, I had been on a walking/water tour, and I was drinking Gatorade though out and was totally fine, but I had finished my bottle, and thought I'll be ok, as the tour was finishing up. I decided to make a quick stop and have a look outside the bargain shops. After about 20 minutes of that, I needed to walk back about 1.5 mile walk to the cruise ship port in the hot sun, Not even half way back, and I started getting those sinking death salt- gone-empty symptoms, and thought, 'oh s**t,' I at this point only had plain water, but had SALT tablets in my bag. THANK GOD, took them quickly and sat in the shade for a few minutes, within minutes felt fine again and made it back to the ships port.

Moral of the story is , know what salt you need and how much you lose, !

 

[heidikk]

that is what we're doing already, SoyaSauce. He eats about eight times a day. Before each feeding we take one baby spoonful (maybe 1/2 t ish) of applesauce and mix into it 3 creon 6000's and a pinch of salt. That pinch times eight equals his 1/8th teaspoon of salt. Now we're supposed to double that amount of salt. He has no teeth yet at 6 months old, so no crackers or cheese. He gets a little cereal once a day so I can put a bit more in there and he takes two bottles with goat milk and yogurt mixed. I hadn't thought of putting salt in that, but I could probably get away with a pinch and he'd still eat it. He still just nurses for all other meals.

 

[LittleLab4CF]

Soyasause, and anybody else who isn’t convinced too much salt is too much for anybody.

Thanks for reading my post and bringing up the interesting thoughts. This is my first shot at due diligence. It's thin, but give me time.

Chloride ion channels seem to be the issue with regard to salt. CF is far more than transmembrane electrolyte regulation errors in its effect on people but that is the root of the disease. If you want my train of logic behind my concern over too much salt, here we go.

When salt dissolves in water it becomes ionized or separated into a sodium ions and a chloride ions in solution. Since the sodium atom has a charge of one polarity and the chlorine atom has an equal but opposite molecular attraction or valence these charged atoms are called ions. In this case ionization occurs by dissolving salt in water. The property of this solution allows electrical conduction through normally non-conducting pure water and hence, electrolyte. Potassium chloride is another important electrolyte. Once a person has ingested salt and water one or both agents are used to form the primary fluid that makes blood plasma. Your blood plasma is largely a 0.9% NaCl or salt solution. To summarize, sodium ions and chloride (chlorine) ions form by dissolving in water, or the case of arguing ingesting salt, in the blood plasma.

Cystic fibrosis at the cellular-molecular lever is all about ion channels or molecular pores on the membrane of every cell. Chloride ion channels exist just as sodium and potassium ion channels do for various purposes. When our specialized islet cells go to work, assuming we have any left, they have a special K/ATP or potassium channel (if memory serves) that in turn releases or stops the release of insulin. In some cases ion channels control how much chlorine enters the cell through an entry channel and regulated out of the cell through an exit channel. Some ion channels are bi-directional. Ion channels are like specialized molecular pores in the cell membrane that open and close on command by the cell, reacting to its environment and equalizing the electrolyte concentration inside the cells compared to the blood serum level. This reaction should result in proper balance within and exterior to the cells or to be consumed or excreted for the metabolism of each cell plus any added specialty function.

Hopefully with the vocabulary of ions and ion channels made clear as mud their roll in CF can be understood. Cystic fibrosis results in cells that have no chloride channels, too few or poorly functioning chloride ion channels on each epithelial mucous cell. Salt reassembles or remains in an ion solution balance inside each cell. Sodium and chlorine ion uptake channels draw essential components of salt into the cell however ion transport is interfered with by the CFTR gene mutation set. The salt balance is maintained by aquaporins or bi-directional water channels and ion excretion channels to dump excess out of the cell. CF messes with ion transport through the cell membrane so aquaporins do the heavy lifting by moving water in and out of the cell to maintain equilibrium.

CF causes problems with chloride ion channels at the cellular level. The problem may be that the cannels never make it to the cell membrane as in DF508 and the cell membrane gets no chloride ion channels, they may be poor functioning as in G551D or there may be too few channels. In every CF scenario, electrolyte balance is compromised by problems transporting the chloride ion. What benefit is there in trying to overload your body with electrolytes? The cells can’t use salt properly and this is mostly why we end up with desiccated thick, hydrochloric acid rich and salty mucous. It’s a theory with a lot of science behind it.

As much as your body can regulate large amounts, or toxic quantities of salts, ultimately it begins to lose the fight. If you really think you are going to die soon, go for all the salt you can stand. Seriously, if you crave and love it, and you’re dying soon anyway, why protect yourself from heart disease, coronary artery disease and all the fun it brings with it. Imagine a race to go blind from complications of diabetes or high blood pressure, fun!

CFers can be fatalists like anybody else and damn, I crave sugar like you can’t believe and what the hell, my body will eventually chill down to normal. Earlier today I saw a younger man struggling at a curb, trying to decide if it went up or down. I have stood behind my father in law dozens of times quietly describing a six inch drop curb one foot in front of him or such so my guess, although counter-intuitive due to his young age, was macular degeneration a disease of high blood pressure often caused by chronic over use of salts. I realize that most CFers also live life to the hilt and hence my insistence that too much salt is too much salt regardless of whether you have CF or not. Cystic fibrosis is NOT going to protect anybody from the ravages of coronary disease and if by chance you make it past forty, the systems you abuse now are going to become your new added problems. These are diseases brought on by excess sodium. We don't need large amounts of sodium, do we?

I have had heat prostration twice and undoubtedly countless close calls. I do understand the need for added electrolyte concentrations, but within reason. Show me a CFer who actually needs ten times the amount of salt than a non CFer, healthy Joe and I will applaud that person’s actions to prove that a load of salt is quickly excreted in order to maintain the isotonic concentration needed in the body. Although cystic fibrosis’ sweat chloride test came into being when a doctor noticed that a disproportionate number of CF patients came in to the hospital with dehydration during a heat wave. He surmised that the electrolyte concentration in the blood was compromised and tested their skin for large amounts of salt and found it. He later refined it to sweat chloride as the high acid concentration is more central to the test. No doubt, we have highly acidic skin, some good old salt but a lot of HCL or hydrochloric acid. This makes our hands etch metals and deposit salt on everything else we touch. It is also proof positive that in stressed conditions we need salt.

It is equally proof positive that water alone would have been better than nothing in delaying dehydration in those CF patients brought in during a heat wave. In fact, cysters are salty inside and out. As sorry as it is to try and find advantage in having CF or being a CF carrier but indications are that CFers survive dehydrating diseases like cholera better than non CFers because we retain salt much longer than non CFers through intra-cellular concentrations. This doesn’t justify neglecting adequate salt intake. I have advocated a balance between electrolytes and water intake from my first post.

The root problem, as far as continuing to live with defective chloride ion channels is concerned is both salt and water. Salt transports poorly in and out of the cell membrane and therefore the aquaporins keep the cells in electrolytic balance more actively than a person without CF. If you load up on salt the body will use what it needs and excrete the remainder at tremendous cost. That cost is mitigated by lots of water if you must eat salt in excess. Why do doctors want people to limit their salt, generally speaking?

Being born with a disease that has so much promise of an actual cure can’t justify abusing your body in my opinion. These sodium based diseases are silent killers so there goes the 'you crave what you need" argument. I understand cravings and sometimes they are justified. Most times a craving is a craving and if you must eat salt or crunch ice all day then use common sense and have lots of water to go with the excess of salt.

The mention of potassium chloride as a chemical to stop the heart during lethal injection has a counter point to it. By depleting the body of potassium you can also stop the heart so the whole idea is balance. People wouldn’t be posting and boasting about salt if there weren’t some guilty rationalization going on. Low sodium or high sodium will do the same heart stopping job as potassium and is at the heart of my concern as sodium based diseases are as pernicious as chloride based CF. Sodium ions cause potassium release channels to spew along with calcium channels, raising the serum levels of both. Potassium and calcium channels in heart muscle cells cause it to stop dead so regular salt will cause the very same heart attack potassium alone would cause. Look at beef jerky or spicy sausage salt contents and you start getting into potassium chlorides and other nasty salts which, like sodium causes permanent heart and vascular muscle tension called aptly, hypertension.

Any argument taken out of context can be taken anywhere you want,

LL

 

[nmw0615]

LL,

I do agree with you that too much of anything can end up being a bad thing, I have read from multiple sources, that because CFers can sweat as much as 10 times the amount of salt, we may need to increase our salt intake by small amounts. From the National Library of Health and the National Institutes of Health, "People who live in hot climates may need a small amount of extra table salt" (http://www.nlm.nih.gov/medlineplus/ency/article/002437.htm). The Boston Children's Hospital also says, "many children with CF need extra salt in their diets because they lose more salt in their sweat than other children" (http://www.childrenshospital.org/az/Site2934/mainpageS2934P1.html).

To my understanding, we don't need to be chugging salt. I will never say or believe that. However, when we sweat, we do lose more salt than the normal person which can lead to dehydration. If we drink too much water, our bodies will want to balance it out with salt. If we intake too much salt, our bodies will want water to get back to that balance. If you're sweating excessively, like during the hot summer months, putting an extra shake or two of salt on your fries will help keep you safe from low sodium levels as well as dehydration.

 

[rmotion]

Salt is needed for CF people but in a form that is natural. Sodium Chloride ( table salt, salt pills, tv dinner salt) is the chemical ingredient(heated to 1200 degrees and is formed and crystalized and is not good for health.( that is why cardiologists tell the heart patient to watch their salt) that kind of salt is too much in the diet. for cf's we have shunned this in the guise that we need more salt. and we do the problem is that too much is not good like goldilocks. the form of salt that is best is sea salt naturally occurring with all its constituent parts and minerals, it is balanced naturally. Look at marathon runners they take salt pills the entire race. http://www.saltstick.com/products/sscaps/cfeatures.htm. We also need the potassium and magnesium etc. one great drink to hydrate naturally is coconut water. sea salt and coconut water are a daily thing for me.

 

[rmotion]

Now look at this through the CF lens. How do we differ and how do we function similarly. Just because we have CF does not give us the green light to abandon common sense.
[h=2]Salt Science[/h][h=4]Why do many athletes need electrolyte supplementation?[/h]Hyponatremia, a medical condition marked by low blood sodium levels, can lead to nausea, fatigue, cramping, vomiting, weakness, sleepiness, and in rare severe cases, even death.
Five electrolytes in particular play a pivotal role in maintaining normal human muscle function: sodium, potassium, magnesium, calcium, and chloride. A shortage of any of these electrolytes will affect athletic performance through a range a subtle to serious side effects.
Sweat typically has about 1000 mg sodium/liter, a typical sports drink has 440 mg sodium/liter. If, during the course of training, you ingest nothing but sports drinks (or worse, water), you will become hyponatremic at some point. Many sports drinks also do not address any form of supplementation of the other key electrolytes, potentially causing yet further cramping and muscle issues.
A popular and simple solution to electrolyte shortage due to sweating is supplementation using electrolyte capsules.
[h=4]Why do I need more than just sodium? Table salt is easy to find and cheap to add to my drink mix...?[/h]While sodium is the predominant electrolyte lost in sweat, a quartet of other electrolytes (potassium, magnesium, calcium, and chloride) performs crucial roles in muscle contraction, relaxation, and performance. Loss of these electrolytes over time will impair your muscles to function normally. Table salt only contains sodium chloride. Furthermore, adding too much salt to a drink will make it unpalatable and you will be less likely to actually drink it. A capsule delivers the electrolytes you need without tasting bad.
[h=4]If I take salt capsules, where will I get my carbohydrates?[/h]A strategy that has worked for countless pros and age groupers is to separate your electrolytes from your energy sources so that you can customize the dose of each group. This means to obtain electrolyte supplementation through capsules alone, and an energy source through solid or gel foods and/or complex carb drinks (e.g. maltodextrin).
[h=4]A low sodium diet...[/h]Scientific research maintains that the average Western diet is already too high in sodium and would benefit from a reduction in sodium intake. As sodium consumption increases, output in sweat also increases to maintain a healthy level in our body. Your body become acclimatized to this intake, and "needs" more sodium to maintain this level of function. However, athletic performance drives up the loss of sodium through sweat. If your diet already contains a lot of sodium, you'll need to maintain a higher level of sodium in your body to keep homeostasis (balance) and your ability to function under athletic stress. This can be accomplished by higher doses of electrolyte supplementation. If your diet is lower in sodium, you will still lose electrolytes through sweat, but you can maintain your appropriate blood electrolyte level with less supplementation. In many respects, the ideal situation is to live a low-sodium diet and supplement during heavy training and racing as needed. Using SaltStick Caps electrolyte capsules will allow you to do this easily, and to customize your dose based on individual need.
[h=4]What is the science behind SaltStick[SUP]®[/SUP]Caps?[/h]Simple: What is lost in sweat should be replaced by your electrolyte capsules in a quantity and form which your body can absorb. SaltStick[SUP]®[/SUP] Caps have been formulated to provide your body with a balanced electrolyte content in the suggested serving of 1 capsule per 30-60 minutes. Two SaltStick Caps in an hour equate to 430 mg sodium, 126 mg potassium, 22 mg magnesium, and 44 mg calcium per hour: The ideal ratio to keep you moving.
The Math of Salt Loss Slowtwitch Oct 2009
[h=4]Comparison of Electrolyte Content and Cost of Common Electrolyte Supplements[/h]

	Average Sweat	SaltStick® Caps
Electrolyte	per 11oz / 315 mL	per capsule
Sodium (mg)	220	215
Potassium (mg)	63	63
Magnesium (mg)	8	11
Calcium (mg)	16	22

[h=5]From Maughan and Shirreffs, 1998. Fluid and electrolyte loss and replacement in exercise. In Oxford textbook of sports medicine, 2nd Edition. Edited by Harris, Williams, Stanish, and Micheli. New York: Oxford University Press, pp. 97-113[/h][h=4]What is bioavailability and why does it matter?[/h]A nutrient's bioavailability is the proportion of the nutrient that, when ingested, actually gets absorbed by the body. Absorption rate is important because even when a drug is absorbed completely, it may be absorbed too slowly to produce any effect. SaltStick[SUP]®[/SUP] Caps contain water-soluble chelated potassium, calcium and magnesium citrates and gluconates that have high bioavailability and fast absorption rates. Sodium chloride present is also bioavailable and quickly absorbed. This is in contrast to some supplements that use forms of these minerals that have lower bioavailability, are insoluble, or require high stomach acid to digest.
[h=4]More summaries and research on the importance of electrolytes in sports:[/h]

• ELoad Science
• Wes Hobson Performance
• AMAA Sports Med
• Ultra Cycling
• Rice University, Part 1
• Rice University, Part 2

Note: Any exercise program or changes to your diet should be reviewed with your doctor before beginning a program. Individuals with high blood pressure or any medical condition should seek professional advice prior to electrolyte supplementation.
Note: These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.