Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
Atomic number 11, baking soda, elemental sodium, Na, Na+, NaCl, NaHCO3, natrium (Latin), Natrum muriaticum, normal saline, SaltSticks®, sea salt, sodium acetate, sodium ascorbate, sodium benzoate, sodium bicarbonate, sodium chloride, sodium citrate, sodium lactate, sodium phenylacetate, sodium phosphate, table salt, Thermotabs®.
Note: The information in this monograph is based on meta-analyses and systematic reviews of sodium. Various types of sodium are available (in the diet as well as in medications and industrial sources), but sodium chloride is the main salt used as a source of sodium ions. Other sodium salts are generally used for their ion partners. Thus, sodium benzoate, sodium phenylacetate, sodium ascorbate, sodium acetate, sodium bicarbonate, and other sodium salts are not specifically discussed. This monograph does not cover the use of sodium for nasal irrigation; there is a separate monograph available on this topic.
Table salt (sodium chloride; NaCl) is the most common form of dietary sodium. Other sodium salts exist in the diet, including sodium bicarbonate (baking soda; NaHCO3) and sodium acetate. Sodium is necessary for the function of nerves and muscles, as well as for fluid and electrolyte balance.
In adults, the adequate intake (AI) of sodium is 1.5 grams daily, with a tolerable upper limit (UL) of 2.3 grams daily. Most individuals in North America consume sodium at levels much higher than recommended. Many experts believe that increased salt consumption is a risk factor for the development of high blood pressure. Too much sodium may also contribute to heart disease (stroke, heart failure), kidney disease, osteoporosis, and stomach cancer.
Sodium chloride and other sodium-containing salts may be taken by mouth or injected into the veins to correct electrolyte imbalance. Sodium chloride is also used to help some medicines dissolve in water and as a priming agent for hemodialysis. Baking soda may be used to evaluate parathyroid gland function in people with a specific chromosome disorder (22q11.2 deletion). Concentrated sodium chloride solutions may be inhaled by people with cystic fibrosis to reduce lung complications.
Sodium chloride may improve the taste of foods, and it is commonly added to many dishes. However, sodium may increase the risk of high blood pressure in individuals who are genetically susceptible to this condition. Therefore, the 2010 Dietary Guidelines for Americans recommend that people "reduce intake to 1,500mg" among persons at risk for high blood pressure, diabetes, or kidney disease.
Sodium bicarbonate has been used to treat bleeding gums, sore throats, cankers, mouth sores, and heartburn.
Sodium chloride is used to prevent or treat muscle cramps, fatigue, and other symptoms of perspiration caused by the loss of sodium from sweating.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Nutrition (electrolyte imbalance)
Evidence suggests that sodium chloride, sodium acetate, and sodium bicarbonate may be taken by mouth or injected into the veins to treat electrolyte imbalances caused by dehydration, excess sweating, or dangerously high sugar levels (in people with diabetes).
Evidence suggests that sodium bicarbonate may increase exercise performance. However, the positive benefits may be due to bicarbonate, not sodium. Further research is needed before a firm conclusion can be made.
Preliminary evidence suggests that sodium may help treat exercise-induced encephalopathy (brain dysfunction). Marathon runners may have too low concentrations of sodium in their urine, which can lead to brain dysfunction due to excessive fluid intake and decreased urine production. Limited research suggests that 3% sodium chloride solutions may prevent this effect. Additional research is needed before a firm conclusion can be made.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Anesthetic, arthritis, bleeding gums, boils, conjunctivitis, constipation, cystic fibrosis, dental conditions, diagnostic procedure (assessment of renal function, measurement of cardiac output), dialysis (priming agent for hemodialysis), fatigue, food additive, food preservation, growth, heart disease, heartburn, high blood pressure, intestinal problems (cleansing), kidney disorders (nephropathy prevention), lung function, Lyme disease, mouth sores (gargle), muscle soreness, pneumonia, preservative (preservation of cells or skin for transplant), ringworm, sinus problems, sinusitis (nasal rinse), solvent (drug diluent), sore throat (gargle), stomach acid reduction.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
Based on the dietary reference intakes, the adequate intakes for sodium by mouth in adults are as follows: 1.5-2.3 grams daily for males and females aged 9-50 years, 1.3-2.3 grams daily for males and females aged 50-70 years, and 1.2-2.3 grams daily for males and females aged over 70 years.
1-2 liters of 0.45-0.9% sodium chloride has been injected into the vein daily. 3% or 5% sodium chloride injected into the veins at a rate of 100 milliliters per hour has been used, but further details regarding this method are not available at this time. Sodium injected into the veins should only be performed under the advice of a healthcare professional.
For sinus problems, sodium chloride may be added to warm water as part of nasal cleansing therapy or nasal irrigation. A separate Bottom Line monograph is available on this topic.
For sore throats, 0.25-0.5 teaspoons of salt has been dissolved in eight ounces of warm water and gargled.
For clearing lung mucus in people with cystic fibrosis, five milliliters of 7% sodium chloride solution has been inhaled four times daily for two weeks.
Children (under 18 years old)
Based on the dietary reference intakes, the adequate intakes for sodium by mouth in infants and children are as follows: 0.12 grams daily for newborns (0-6 months old), 0.37 grams daily for infants (7-12 months old), 1-1.5 grams daily for children 1-3 years old, 1.2-1.9 grams daily for children 4-8 years old, and 1.5-2.3 grams daily for children aged nine years old and up.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Avoid in people with a known allergy or sensitivity to sodium.
Side Effects and Warnings
Use intravenous sodium under the advice of a healthcare professional. When injecting sodium into the vein, blot clots, brain or nerve complications, damage to kidney tissue, damage to red blood cells, decreased blood pH, elevated sodium levels, fever, fluid leakage into surrounding tissue, fluid overload leading to overhydration or electrolyte dilution, heart complications, infection at the injection site, inflammation or irritation of the vein at the injection site, local pain, low calcium levels, shortness of breath, or swelling may occur.
Use of intravenous sodium chloride requires clinical and laboratory monitoring of fluid balance, electrolyte concentrations, and acid-base balance. Additional electrolyte supplements or other therapy may be required.
Use cautiously in individuals taking agents that affect blood pressure, as sodium may increase blood pressure.
Use cautiously in children or pregnant and lactating women, as safety data is lacking.
Use cautiously at levels above the adequate intake. When taking high doses of sodium by mouth, muscle and bone loss may occur.
Use cautiously in people taking corticosteroids or diuretics.
Use cautiously in people with elevated levels of sodium or fluid in the blood; limited liver, kidney, and/or heart function; sodium retention; urinary tract blockages; or in the elderly.
Avoid sodium during and immediately following surgery.
Avoid sodium preparations containing aluminum, as the aluminum may become toxic.
Avoid injecting sodium containing benzyl alcohol into the veins of infants, as the alcohol may be toxic.
Avoid in combination with bacteriostatic sodium chloride injection in neonates; 3% and 5% injection solutions in increased, normal, or only slightly decreased serum electrolyte concentrations; and Thermoject® 0.9% injection.
Avoid with known allergy/hypersensitivity to sodium.
Pregnancy and Breastfeeding
There is currently a lack of scientific evidence on the use of excess sodium during pregnancy or lactation.
Sodium is likely safe at levels commonly found in the diet in nonsensitive pregnant and lactating individuals.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Sodium may affect blood pressure. Caution is advised in people taking drugs that affect blood pressure.
Sodium may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs in the blood may be affected, and the intended effects may be altered. People taking any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Sodium may also interact with agents that treat heart conditions, corticosteroids, or diuretics.
Interactions with Herbs and Dietary Supplements
Sodium may affect blood pressure. Caution is advised in people taking herbs and supplements that affect blood pressure.
Sodium may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements in the blood may be affected. It may also alter the effects that other herbs or supplements possibly have on the P450 system.
Sodium may also interact with anti-inflammatories, calcium, carrageenan, diuretics, herbs and supplements used to treat heart conditions, and naringenin.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Costill, D. L., Verstappen, F., Kuipers, H., et al. Acid-base balance during repeated bouts of exercise: influence of HCO3. Int.J.Sports Med. 1984;5(5):228-231. View Abstract
Coton, T., Mallaret, C., Coilliot, C., et al. Severe acute ulcerated gastritis induced by salt. Presse Med. 2009;38(3):499-500. View Abstract
Donaldson, S. H., Bennett, W. D., Zeman, K. L., et al. Mucus clearance and lung function in cystic fibrosis with hypertonic saline. N.Engl.J.Med. 1-19-2006;354(3):241-250. View Abstract
Frings-Meuthen, P., Buehlmeier, J., Baecker, N., et al. High sodium chloride intake exacerbates immobilization-induced bone resorption and protein losses. J.Appl.Physiol 2011;111(2):537-542. View Abstract
Horswill, C. A., Costill, D. L., Fink, W. J., et al. Influence of sodium bicarbonate on sprint performance: relationship to dosage. Med.Sci.Sports Exerc. 1988;20(6):566-569. View Abstract
Lindh, A. M., Peyrebrune, M. C., Ingham, S. A., et al. Sodium bicarbonate improves swimming performance. Int.J.Sports Med. 2008;29(6):519-523. View Abstract
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McNaughton, L., Dalton, B., and Palmer, G. Sodium bicarbonate can be used as an ergogenic aid in high-intensity, competitive cycle ergometry of 1 h duration. Eur.J.Appl.Physiol Occup.Physiol 1999;80(1):64-69. View Abstract
Meinders, A. E., Cejka, V., and Robertson, G. L. The antidiuretic action of carbamazepine in man. Clin.Sci.Mol.Med. 1974;47(4):289-299. View Abstract
Merten, G. J., Burgess, W. P., Gray, L. V., et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 5-19-2004;291(19):2328-2334. View Abstract
Nagasaki, K., Iwasaki, Y., Ogawa, Y., et al. Evaluation of parathyroid gland function using sodium bicarbonate infusion test for 22q11.2 deletion syndrome. Horm.Res.Paediatr. 2011;75(1):14-18. View Abstract
Zabala, M., Requena, B., Sanchez-Munoz, C., et al. Effects of sodium bicarbonate ingestion on performance and perceptual responses in a laboratory-simulated BMX cycling qualification series. J.Strength.Cond.Res. 2008;22(5):1645-1653. View Abstract
Zoungas, S., Ninomiya, T., Huxley, R., et al. Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. Ann.Intern.Med. 11-3-2009;151(9):631-638. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017