Salt Craving and Adrenal Insufficency

[Guest guest]

I have had a strong craving for salt for as long as I can remember.

Give me salt any day over sugar and I will be happy. I was talking

with my mom yesterday who has supposedly got MS and she craves salt

like me, preferable to sugar.

It got me wondering and I did a search on Lyme and salt craving.

There was info, but what kept coming up is adrenal fatigue and even

's Disease which is adreanl disfunction to the max.

Salt cravings are usually due to low adelesterone. Remember the

conversations about Benicar and ARBs like Benicar lowering

Adelesterone even further? One of the articles I found said that. I

wonder if salt cravings could be an indicator that you will not do

well on Benicar?

Salt craving can also be an indication of low magnesium, and aren't

most of us low there?

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Your Adrenal HormonesThe adrenals, small glands located above each

kidney, produce a number of importanthormones. The adrenals' inner

medulla produces epinephrine and norepinephrine (adrenaline).Tumors

of the adrenal medulla which produce excess epinephrine and

norepinephrine are calledpheochromocytomas. Deficiencies of the

adrenal medulla that reduce the levels of thesehormones do not give

rise to clinical problems.Adrenals also contain an outer cortex,

which produces hormones such as cortisol, aldosterone,testosterone,

DHEA, DHEAS, androstenedione and estrogens. Cortisol and aldosterone

are twoof the most important hormones the body makes. Excesses or

deficiencies of these hormonesresult in important clinical problems.

Cortisol, a glucocorticoid, is the stress hormone and isinvolved in

weight control, infection fighting, quality of skin and bones, and

heart function. Itslevels are the highest in the morning, and are

increased by stress and severe illness. Too muchcortisol from any

cause leads to Cushing's syndrome; the symptoms and signs of which

includeweight gain, stretch marks, bruising, extra hair growth,

irregular periods in women, loss ofmuscle, trouble sleeping and

emotional problems, such as depression. Too little cortisol is

partof the syndrome called 's disease, often marked by low

energy, joint and abdominalpain, weight loss, diarrhea, fever, and

electrolyte disturbances. If the adrenals are making toolittle

cortisol, the pituitary compensates and makes more of the hormone,

ACTH. If the pituitaryis not working, both ACTH and cortisol levels

may be low. Aldosterone is the salt-retaining hormone and is a

mineralocorticoid. Excess of aldosterone leadsto high blood pressure

and low potassium. Deficiencies of aldosterone are much

lessappreciated than deficiencies of cortisol, and lead to low blood

pressure and high pulse,especially on standing, the desire to eat

salt (salt-craving), dizziness or lightheadedness onstanding, and

palpitations. Severe cases may lead to high potassium and low sodium

in bloodtests. When the adrenal is not making aldosterone, renin, a

kidney hormone, increases. Excessesof cortisol and aldosterone may

occur independently, that is a patient may have only

excessaldosterone, only excess cortisol, or excesses of both.

Similarly, deficiencies of cortisol andaldosterone deficiencies may

be independent.Many patients coming to see Dr. Friedman lately with

symptom of fatigue and often symptomsof salt-craving, " cognitive

fuzziness " , dizziness or lightheadedness on standing, or

palpitationshave low blood levels of aldosterone. He explains the

connection between low aldosterone levelsand fatigue as follows:

with low aldosterone, the kidney loses salt, leading to low blood

volume.This coupled with the idea that the leg veins don't constrict

properly, leads to lower bloodvolume to the brain and fatigue and

other symptoms. These patients often have a drop in theirblood

pressure and an increase in their pulse when standing. They may also

have decreasedblood flow to the brain when measured by SPECT scan.

Aldosterone deficiency may be madeworse if patients restrict their

salt intake.Soon-to-be-published research by Dr. Friedman shows a

few patterns of abnormalities in therenin-aldosterone axis. A little

more than half the patients with fatigue had low blood levels ofboth

renin and aldosterone. This is called hyporeninemic

hypoaldosteronism and is probably due

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to dysfunction of what is called the autonomic nervous system, which

sends messages from thebrain to the kidneys. Other aspects of the

autonomic nervous system have been found to bedeficient in chronic

fatigue syndrome. About one-third of the patients were found to have

lowaldosterone and high renin. This indicates a deficiency in the

aldosterone production in theadrenals themselves, with a

compensatory rise in the renin coming from the kidney.

Thealdosterone defect can either be an isolated problem, or part of

's disease (often early's disease), in which both

cortisol and aldosterone production are diminished. Theremaining

patients (about one-sixth) had both high renin and high aldosterone.

This is likely tobe a compensatory rise in both of these hormones as

a reaction to a low blood volume, mostlikely due to an inability of

the kidney to retain salt.Dr. Friedman recommends treating patients

with an individualized combination of increased saltconsumption, a

synthetic form of aldosterone called Florinef (fludrocortisone), or

Midodrine(proamantine), a drug used to raise blood pressure. Salt is

the most benign of the treatments. Salt tablets can be purchased in

a drug store or a patient can add an extra teaspoon of salt to

theirfood per day. Florinef comes in 0.1 mg pills and Dr. Friedman

usually starts with 1/2 pill in themorning for a week or two and

then goes up to 1 pill in the morning if no side effects occur.

Themain side effects are headache and swelling in legs (edema).

Midodrine comes in 5 mg pills andDr. Friedman usually starts with 5

mg pills in the morning and noon. He may go up to 2 pillsthree times

a dayand sometimes needs to use both Florinef and Midodrine, as well

as extra salt.The side effects of Midodrine include high blood

pressure, itching, goosebumps, numbness andthe feeling of writing on

your skin or scalp. Many of these side effects go away with use

andboth drugs are unlikely to cause long term damage. Most patients

taking Florinef and Midodrine,as well as extra salt report an

improvement in their symptoms of palpitations

anddizziness/lightheadedness on standing, while many report an

improvement in fatigue andcognitive dysfunction. Licorice, available

as a tea from Alvita, may help with mild cases.Dr. Friedman is doing

further research on the renin-aldosterone axis and chronic

fatiguesyndrome (CFS) in a study generously funded by the CFIDS

(Chronic Fatigue and ImmuneDysfunction Syndrome) Association of

America. He is also studying the effect of Viagra onsymptoms of CFS,

with the idea that Viagra may improve blood flow to the brain. For

moreinformation on these studies, please email Dr. Friedman at

mail@...; or toset up an appointment with Dr.

Friedman, please email

atappointments@....