Yes this new salt paradigm is really interesting. It’s great that a YouTuber like Goobie has presented this information to a wider audience. By the way, thank you @AnUser for pointing me to him. He is a nice and very bright guy.
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I found this site by accident when I was searching for a new dietary sodium to potassium ratio calculator because the one I had been using was down. It’s not a calculator but I found it pretty interesting. It discusses many of the things already covered in this thread like the Mars study, sodium being stored in the skin, the Yanomami people etc but then seems to have died in around 2016. I’m not sure why…everything is still online but there’s nothing new posted as far as I can tell. Perhaps there’s nothing new to add. Some of it could be quackery and I apologize if so. I don’t feel qualified to judge if everything on the site is correct tbh. Here it is though for anyone curious.
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I’m wondering if anyone here currently eating a no added salt diet is also taking dapagliflozin and if so how it is going? Thanks
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Prevalence of Admission Hyponatremia in Patients With Diabetes Treated With and Without an SGLT2 inhibitor
https://academic.oup.com/jes/article/7/4/bvad011/6998591
“Hyponatremia often reflects a free water excess. Sodium/glucose cotransporter 2 (SGLT2) inhibitors increase free water excretion through glucose-induced osmotic diuresis. In 2 randomized double-blind, placebo-controlled trials in patients with the syndrome of inappropriate antidiuresis (SIAD), we showed that empagliflozin increased plasma sodium concentration more effectively than placebo.”
“The main finding of this cross-sectional study is that hyponatremia prevalence and plasma sodium concentration were the same in patients with T2DM treated with and without SGLT2 inhibitors, irrespective of comorbidities and comedications.”
“Second, the inhibition of SGLT2 increases glucosuria and natriuresis [38]. One could argue that it would increase urinary sodium clearance and worsen hyponatremia. However, hyponatremia is not a side effect of SGLT2 inhibitors, mainly because the pathophysiology of hyponatremia relies more on a relative water excess than an absolute sodium deficit [39]. Interestingly, our data showed no difference in urine sodium concentration and fractional excretion of sodium between patients with SIAD treated with empagliflozin or a placebo [25, 26]. In patients with T2DM, natriuresis seems to be transient as well [40].”
Severe hypernatremia caused by diabetes drug – a case study report
“Irrespective of severity, hypernatremia may be caused by salt (sodium) overload but is most commonly due to water deficit (i.e. dehydration). This recently published case study report highlights severe hypernatremia due to water deficit. In this case water deficit was attributed to the blood-glucose-lowering drug empagliflozin that is used to help normalize the blood glucose concentration of patients with type 2 diabetes.”
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Thank you kindly for the helpful links Cronos.
I did find one study from 2021 comparing dapagliflozin in high sodium v low sodium participants in the context of DKD fwiw. I’m not qualified to judge the quality of the study but figured I’d share here if anyone has an interest in reading it.
https://www.nature.com/articles/s41598-020-79687-z
I’m not clear what qualifies for LS in their study but I suspect it’s still much higher than I consume.
Not the exact answer you are looking for, but I take dapagliflozin, and, until last week, on many days I’d only consume 1/4 tsp-ish of salt that was used in cooking.
On the days I eat shelf stable products, like RAO’s sauce, it would obviously be a lot higher.
I don’t notice any differences either way, fwiw.
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That’s actually very, very helpful Beth! Thank you! 1/4 tsp of salt is equivalent to about how much I get from the naturally occurring sodium my no added salt omnivore diet. I’m mostly interested in seeing if it helps me with reactive hypoglycemia as it has others here. If I could fix that issue it would truly be life changing.
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Dr. Hashmi chimes in on fluid intake, sodium and kidney health. In the notes on the video he lists all the studies he references.
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AI gives this summary (by mistake I just submitted the transcript)
Quick-look takeaway
- Healthy adults usually do best with ~2 – 3 L of total drinking water a day (all beverages counted). That amount aligns with the U.S. National Academies’ Adequate Intake targets once the ±20 % water that comes from food is subtracted.National Academies Press
- The popular “8 × 8” rule (1.9 L) was never evidence-based; its origin was a mis-read 1945 Food & Nutrition Board statement.PubMed
- More isn’t better: the kidney can clear only ≈0.8–1 L per hour. Repeatedly drinking well above that (≈8 L + spread over a day) can dilute blood sodium below 135 mmol/L (hyponatraemia) and, in extreme cases, cause seizures or death.PubMedNEJM Evidence
- Kidney-stone prevention: ensuring ≥2 L of urine output—roughly 2.5 L + fluid intake for most people—cuts stone recurrence risk about 50 %. Every extra 0.5 L you drink lowers risk another ~7 % up to about 3 L/day.PubMedPubMed
- Existing chronic kidney disease (eGFR < 45 mL/min/1.73 m², “stage 3B” or worse) usually requires individualised restriction to ≤1.5 L/day, sometimes less, to avoid fluid overload.KDIGOPubMed
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Thanks @CronosTempi and @John_Hemming. I watched the video and looked in cronometer where I (obsessively 
) track everything that enters my mouth and I’m coming in at about 3 liters per day between all beverages and food. My last sodium level on my blood work was 139 so that’s good. I’ll just keep doing what I’m doing. The AI summary is appreciated as well for easy reference!
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I started Dapagliflozin one week ago today and I’m taking 1/2 of the lowest dose so 2.5 mg. Sunday night I had a restaurant meal. Normally I gain 2-3 pounds of fluid when I eat out and it takes about 3 days for it to go away. Monday morning I woke up only 1 pound heavier and it was gone by Tuesday morning so it seems to be helpful. This is exactly the effect I was hoping for when I ordered it.
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