Much Ado About Aldosterone: Electrolyte Imbalance & Salt Cravings

By James Wilson, DC, ND, PhD

As a reminder, Aldosterone is responsible for maintaining fluid (water) and the concentration of certain minerals (sodium, potassium, magnesium and chloride) in the blood, the interstitial fluid (area between the cells) and inside the cells. Sodium is most dominant in the blood and potassium is most concentrated inside cells. These electrolyte minerals carry minute electrical charges, so even small deviations in ratio or concentration can lead to alterations in the properties of the fluid, the cell membrane and the biochemical reactions within the cell. As reminder, most physiological reactions in the body depend in some way on the flow or concentration of electrolytes.

In times of stress, aldosterone is the major director of these relationships by its influence on sodium and water concentrations. As the concentration of aldosterone rises, the concentration of sodium rises in the blood and interstitial fluid.

  • When aldosterone secretions are normal, potassium, sodium and fluid levels are also normal.
  • When aldosterone is high, sodium is kept high in the fluids circulating in the body.

However, as circulating aldosterone levels fall, sodium is removed from the bloodstream as it passes through the kidneys and is excreted in the urine, taking water along with it. Initially, there is some loss of volume of body fluids, but it does not become severe until circulating sodium level drops to about 50% of its original concentration in body fluids. At this point, even a small loss of sodium begins to have severe consequences.

When the blood’s sodium supply is not replenished by eating salt-containing foods or liquids, sodium and water is pulled from interstitial fluids into the blood to keep levels from getting too low. If too much salt or fluid is pulled from the interstitial fluids, the small amount of sodium in the cells begins to migrate out of the cells into the interstitial fluid. The cell does not keep a great reserve of sodium in order to maintain its 15:1 ratio of potassium to sodium. As the sodium is pulled from the cell, water escapes as well. This leaves the cell dehydrated and sodium deficient. In order to keep the sodium/potassium ratio constant inside the cell, potassium begins to migrate out in small quantities. However, each cell has minimum requirements for the absolute amounts of sodium, potassium and water necessary for its proper function. Cell function suffers when these requirements are not met, even if the proper ratio is maintained.

Rehydration must be approached carefully when electrolyte imbalance exists. Drinking lots of water or liquid without adequate sodium replacement can make people feel worse because it further dilutes the amount of sodium in the blood. Moreover, cells need salt to absorb fluids. When patients are already low on body fluids and electrolytes, direct them to add salt to their water (about 1/4 teaspoon). Sea salt is a better choice than regular table salt because it contains trace amounts of minerals in addition to the sodium.

When aldosterone levels are low and the patient becomes dehydrated and sodium deficient, they may also crave potassium because the body is sending the message that cells are low on potassium as well as sodium and water. However, after consuming only a small amount of potassium containing foods or beverages, patients will probably feel worse because the potassium/sodium ratio will be further disrupted! Tell patients to avoid soft drinks or electrolyte-rich sports drinks because they are high in potassium and low in sodium, which only add to the imbalance. Further, most ‘hydration’ drinks and sodas contain artificial colors, additives, and unhealthy sweeteners. Your patients are much better off having a glass of water with salt in it, or eating something salty with water to help replenish both sodium and fluid volume.

Original blog by Dr. James Wilson can be found here.

Related: Adrenal Health & Fatigue – a Podcast Interview with Dr. James Wilson


Dr James Wilson

James L. Wilson, DC, ND, PhD, received his Ph.D. in Human Nutrition from the University of Arizona, with minors in Immunology, Microbiology, Pharmacology and Toxicology, and research in Cellular Immunology. His doctorates in Chiropractic Medicine and Naturopathic Medicine are from the Canadian Memorial Chiropractic College and the Ontario College of Naturopathic Medicine (CCNM).

As one of the 14 founding members of CCNM, now the largest Naturopathic College in the world, Dr. Wilson has long been on the forefront of alternative medicine. For over twenty-five years, he was in private practice in Canada and the United States. In 1998, Dr. Wilson coined the term ‘adrenal fatigue’ to identify below optimal adrenal function resulting from stress and distinguish it from Addison’s disease.

With a researcher’s grasp of science and a clinician’s understanding of its human impact, Dr. Wilson has helped many physicians understand the physiology behind and treatment of various health conditions. He is acknowledged as an expert on alternative medicine, especially in the area of stress and adrenal function. Dr. Wilson is a respected and sought after lecturer and consultant in the medical and alternative healthcare communities in the United States and abroad.