To salt or not? (hyperaldosteronism and POTS)

[amy_bman]

I'm a little lost on what I should be doing in terms of both sodium intake and follow-up tests.

It was recommended that I increase my sodium/electrolyte intake to counter my POTS symptoms, so I've been drinking normalyte daily and adding salt to my meals for a few months now. Occassionally getting 500 mL of saline IV is also particularly useful in improving my low blood pressure.
But then the next thing I know, my aldosterone (first time testing) comes back very high (1540 pmol/L [ref. range 118 - 946 pmol/L]), and yet my sodium, potassium, and renin are all normal. As noted, I generally deal with low blood pressure (not high, which is more typical of hyperaldosteronism).
I see conflicting studies as to whether or not reducing sodium will reduce the aldosterone; I don't want to reduce my sodium because it's been helping with the POTS, but I also have enough heart issues as it is and hyperaldosterone (if that's what it is), isn't gentle on the heart.
Has anyone seen anything like this (especially with normal mineral levels)? Are there other tests I should be pursuing before changing my diet?

 

[triffid113]

I can't help you.per se because I have high blood pressure. But when I was younger, I frequently had adrenal exhaustion... in fact, I think it's common in our over caffeinated youth...and I couldn't even think without extra salt. I did never take an aldosterone or blood pressure test at that time. [I used to drink 20 cups of coffee a day to keep going because I was so anemic from eventually diagnosed fibroid tumors].

I got on to point out 2 things: (1) generally low, doesn't cut it. You should measure your blood pressure daily if you have high aldosterone or are playing with salt (2) I wouldn't put much store in mineral lab tests....minerals in the blood are often nit indicative of minerals in the tissues. For instance, copper is an acute phase reacting, so for all kinds of crazy reasons. Including hormone swings, laxative use, cold, OTC medicines...etc, your body pulls copper out of the tissues to put it in the blood. This is why every study you find about copper is all but worthless, unless it's measured by liver biopsy. Magnesium in the blood is not indicative of magnesium in the atria of the heart, either. Even that most basic electrolyte measured for every heart attack patient is not reflective of what needs to be known. So... don't assume that base is covered by a normal lab test. [We haven't even gotten to how labs decide what is 'normal"]

 

[triffid113]

Um, so, also...if you caffeinate, that could be your problem. I got to 50 and could not tolerate caffeine at all anymore without first taking DHEA. It is common to not be able to tolerate caffeine over 50 due to you max out on DHEA hormone at age 30, and by 50 your DHEA: cortisol ratio is severely whacked. Caffeine = liquid stress = Cortisol. So 2 cups coffee, for instance, raise your cortisol 33pct

 

[amy_bman]

Um, so, also...if you caffeinate, that could be your problem. I got to 50 and could not tolerate caffeine at all anymore without first taking DHEA. It is common to not be able to tolerate caffeine over 50 due to you max out on DHEA hormone at age 30, and by 50 your DHEA: cortisol ratio is severely whacked. Caffeine = liquid stress = Cortisol. So 2 cups coffee, for instance, raise your cortisol 33pct

Thanks for your thoughts! I've actually never had coffee in my life and I've fully avoided caffeine for 4-5 years now (except the occasional weak green tea when my stomach is upset). I'm also on a no-refined/processed sugar diet (not Keto), not sure if that's relavent for this test.
You make a good point that I should be measuring my BP daily. I deal with POTS, and I usually only measure it when I'm feeling dizzy, or before and after IV saline, and those times are when it's low (normal after IV). Doing the NASA Lean test, however, it was all over the place (low to high and back again). It'll be good for me to establish my baseline.
Interesting facts about serum mineral tests, thanks again!

 

[triffid113]

oh, gosh. I did read something interesting about POTS recently. You prolly already know it, but if I remember it, I'll pass it on.

 

[triffid113]

Well, the two things I have read about today where I could have run into a reference on POTS were about arginine and it's role in immunity because my blood pressure has been out of control since I had covid and benfotiamine. But I cannot find where I ran across a mention of POTS. But...I will keep POTS on my radar now. And...hm...I have always had momentary dizziness when my head is moved...just thought it was part of being an awkward person. Not for 10 minutes or more as in POTS. Not of serious concern with me...I am more worried about my ACE +/+ gene ruining my heart or kidneys.

 

[triffid113]

Ok, so I found this, which you no doubt know: What are common symptoms of adrenal insufficiency? Most patients report nonspecific symptoms such as weakness, fatigue, and anorexia. Many also complain of gastrointestinal symptoms such as nausea, vomiting, vague abdominal pain, and constipation. Psychiatric symptoms and symptoms of orthostatic hypotension, arthralgias, myalgias, and salt craving are also reported.

So... I wonder if DHEA would help this? I take DHEA, and while I have some dizziness upon head movement, it is not enough to impede anything for me. The other choice is lowering stress/caffeine/cortisol (so maybe try meditation, or...?).

Could be totally something else - no doubt this is only one of many causes of POTS. Sorry I could not find where I ran across it earlier.