Salt, or sodium, is often considered a dieter’s enemy because salty foods cause the body to retain fluid and gain weight (two pounds for every quart of water retained). While there is a minimum requirement of 1-2 grams sodium per day to maintain normal circulation and kidney function, most Americans eat five times their minimum need — so sodium deficiency is rarely a problem under normal conditions.

An important exception occurs during periods of moderate to severe calorie restriction such as the weight loss program at The Hernried Center. When the body builds up ketone levels to provide an additional fuel source, the ketones have the side effect of making the kidneys lose more sodium. During weight loss at The Hernried Center, therefore, most patients need 2-4 grams of sodium per day. There are exceptions to this rule, such as patients who have high blood pressure or a heart condition requiring the daily use of such medications as diuretics. As a general rule, the following should be taken into account:

• Almost all patients need some additional sodium, such as bouillon, when taking 600 calories or fewer per day.

• The time to begin taking bouillon is at the onset of the diet, unless otherwise instructed.

• Take your first bouillon as soon as possible: at the most, within two hours of awakening each morning. You only “own” the sodium for 4-6 hours, once it is taken. Bouillon taken in the evening does not help you the next day. Take one bouillon early to mid-morning, no more than four hours after rising; many people need an additional dose in the afternoon. Few people need more than three bouillon cubes per day.

• The best form of additional sodium is bouillon: Herb-Ox brand, cubes only, in the regular strength (not low sodium), providing 1 gram sodium per cube. Do not substitute other brands of bouillon without discussing with The Hernried Center medical staff first. If necessary, patients may take a level ½ teaspoon table salt in exchange for each bouillon cube, but bouillon is preferable.

• Continue taking sodium on a daily basis during weight loss until instructed to stop by a Hernried Center medical provider, or until you discontinue the diet (plans will be made for stopping sodium at your re-alimentation appointment with the behavioral educator).

• Do NOT discontinue sodium as the result of a weight change (weight gain of a pound or two) from day to day.

The signs of sodium deficiency are quite variable but usually include at least one of the following:

1. Lightheadedness or dizziness when standing up from a sitting or lying position.

2. A lingering headache occurring at the back part of the head.

3. Dizziness, nausea or marked fatigue occurring during or after exercise in the heat, when sitting in a hot place (such as a hot car, full sun, etc.), or when taking a hot shower; a sudden feeling of fatigue during physical activity before the point at which you should feel fatigued or exhausted.

If you experience any of these symptoms, consuming a bouillon should relieve most of them within 30 minutes. If symptoms persist, call The Hernried Center immediately. If the clinic is closed, the answering service will contact our on-call staff for you.