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I have Hyponatremia, what foods should I choose and what should I avoid?

When we think of Hyponatremia, or low sodium we tend to focus on salt. This, as you may know, is actually not typically the correct focal point. You may have heard your provider say “it’s not a salt problem, it’s a water problem.”  

More often than not Hyponatremia is due to SIADH which is a water handling disorder. In brief, SIADH means your body is sending and receiving an inappropriate signal to hold onto water. This is causing a dilution effect to your blood sodium level. Therefore, its not a lack of salt that’s the problem, it’s an excess of water. 

With this information you can easily understand why a fluid restriction makes sense, but as you may be aware, fluid restriction is often not enough to help correct sodium levels. So besides the fluid restriction, what else can I do with my diet to help? 

When it comes to fluid intake we often overlook how much liquid can come from the food we eat. In some situations, this can be as high as 1/3 of our liquid intake but on average it is around 20-25%. With this in mind, we should try to minimize high water content foods to aid in our quest to get out of the low salt brain fog and get back to feeling good again. 

The highest water content foods tend to be fruits and vegetables, however not all are created equal. Some of the highest water content foods to minimize intake are (water content %): 

  • Cucumber and celery (over 95%)
  • Bell peppers cabbage (92-94%)
  • Tomatoes (over 92%) 
  • Lettuces: iceberg, spinach, romaine (over 92%) 
  • Broccoli and Cauliflower (90%)
  • Watermelon and other melons (over 90%)
  • Strawberries (90%)
  • Pineapple (85%) 
  • Yogurt (85%)
  • Zucchini Carrots and Squash (80-95%) 
  • Oranges and Grapefruit (85%) 
  • Grapes (80%) 
  • Potato (80%) 

On the other end of the spectrum foods that are low in water content to include in your diet

  • Oils (0%)
  • Nut butters: peanut, almond (1-2%)
  • Nuts and Seeds (2-4%)
  • Cereals/granola (5%)
  • Dried fruit and meats (15-30%)
  • Pepperoni  (25%)

Lastly, foods that fall in the middle that could be eaten in moderation may include:

  • Cheeses (most 30-40%)
  • Bagel & Breads (30-40%)
  • Biscuits (about 30%) 
  • Chicken, beef, pork (60-70%)
  • Avocado (72%)
  • Eggs (75%)
  • Cottage Cheese full fat (78%)

Now there is another dietary step to consider. Once we are on a good fluid restriction and we’ve minimized high water content foods, the next critical step is to increase our protein intake

For those without SIADH, it’s the liquid intake that controls the urine output as ADH levels can fluctuate freely to enhance water excretion. In patients with SIADH however, the urine concentration is stuck in an elevated level and thus the solute load (mostly protein, urea, salt) determines the urine output. That’s why UreaAide works so well, due to its high solute content (1 scoop of UreaAide is equal to 8000 mg of salt in terms of solute). Protein isn’t quite as robust as UreaAide but it can certainly provide an assist. We typically recommend a higher protein diet with Hyponatremia understanding however, there may be exceptions, such as those with cardiac conditions or kidney disease who should avoid fatty meat or high protein intake. 

What about Greek Yogurt? 

Greek yogurt is an interesting food as it has a higher water content than you think at about 80%, but Greek yogurt is also a good source of protein at 15 grams per serving. So It’s not the worst food to ingest and is often recommended to enhance protein. What may be a better alternative is cottage cheese. Full fat Cottage cheese has a lower water content at about 70% with an impressively higher protein content at 25 grams per serving. One could also add dried fruit and almond slivers to enhance flavor, add additional protein and take advantage of the low water content. Thus concluding, lower water content and higher protein content are the keys to an ideal Hyponatremia food. 

In closing, when we are doing everything we can to improve our sodium levels and get back to feeling our best, it is ideal to take a holistic approach. This includes fluid restriction yes, but also paying attention to the extra water content hiding in our everyday food choices as well as increasing our protein intake to help. Foods like chicken and beef along with cottage cheese, nut butters, dried fruits, nuts, and seeds are all excellent sources of protein without the higher water content.  As always be sure to consult and discuss any changes with your medical provider, as these are general dietary guidelines only.


Water, hydration and health 

PMID 20646222

USDA National Nutrient Database for Standard Reference 

Food Data Central