Pregnancy toes are really swollen feet and swollen toes. The name stuck in my mind because one of my daughter-in-laws is pregnant and I was sent a photo from her winter vacation in her flip flops in the snow and winter coat—she was not able to put her boots on because of her swollen feet (swollen even in the cold!).
I did not think much about it until she came to visit me yesterday and I noticed the flip flops and her chubby toes. She had “pregnancy toes” again she said. It then suddenly all became clear. I asked her: did you by any chance have any sugar today? And she said “as a matter of fact, yes!”
I reached for my salt pills that I use for my migraines as do all members in my migraine group on Facebook and handed her one. I really should have photographed what happened but I did not think the effect was going to be so fast and so big. Less than 15 minutes after she took the salt pill and a glass of water, her toes went back to normal. We ended up laughing it away. Had she known this, she could have worn her boots in the snow after all!
So what did her pregnancy toes have to do with sugar and salt you may ask? Previously, I quoted from the Harrison’s Manual of Medicine an important paragraph that I repeat here:
…serum Na+ falls by 1.4 mM for every 100-mg/dL increase in glucose, due to glucose-induced H2O efflux from cells. (page 4)
The above means glucose (part of sugar) and sodium (part of salt) are in inverse relationship. As you increase sugar, salt drops and water is sucked out of your cells by sugar like a giant Slurpee machine. The water then collects on the outside of your cells rather than the inside, thereby dehydrating your cells and at the same time make your body swell. Edema is often associated with too much salt, but in fact, it is too much sugar. Being always thirsty is associated with Type 2 Diabetes but it is also associated with not having enough salt in the body since without salt the cells cannot get hydrated.
In light of this fragile balance between sodium and glucose in the blood, are we treating pregnancy edema, gestational diabetes, and other maternity complications, the way we should? Consider that with pre-eclampsia (gestational hypertension), women are told not to eat salt. You can see what happens when we reduce sodium: glucose increases and we also induce an ionic imbalance. This ionic level imbalance is visible (like the swollen toes) and may lead to further complications. There are two problems that we are facing here: first if she does not eat salt, her sodium-potassium pumps cannot work–this may cause migraines and headaches as I often see in my migraine group. Secondly, as you saw the fragile balance between the see-saw action of glucose and sodium, if she stops eating sodium her glucose may increase, causing swelling. This is an interesting theory to ponder – one that merits research.
Sodium and Glucose Work Together
Salt breaks up in the body into sodium and chloride. Sodium attracts water and holds onto it inside the cells. It keeps chloride outside of the cells to ensure proper voltage and electrolyte balance with the aid of potassium. When you eat sugar, the glucose part of it removes the water from the cells via osmotic channels that are too narrow for the sodium ions to exit. Thus, one ends up with a ton of water outside the cells with sodium inside hugging a tiny amount of water. Swelling occurs as the water leaves the cells but remains between cells.
Given the inverse nature of glucose and sodium in the blood, if one is swollen as a result of too much sugar, eating salt will take the water back from sugar and move it back into the cells–as it did for my daughter-in-law’s pregnancy toes. What is important in this information is this:
- If you feel swollen after eating sweets, you need to eat salt and drink a bit of water to reduce your swelling.
- If you have Type 2 Diabetes or are hypoglycemic, eating a salty meal can give you a major sugar crash and land you in the hospital!
- Eating sugar of any quantity will dehydrate your cells and you and make you run to the toilet every 30 minutes.
Because glucose takes water out of the cells, the edema that follows increases extra-cellular water and causes swelling in the body. This extra-cellular water needs to be reabsorbed into the circulation for the kidneys to be eliminated. To be reabsorbed, sodium is necessary since without sodium, the cells cannot operate their voltage gated sodium pumps and so the gates cannot open to grab glucose to take it into the cells and to get the water back into the cells. I think you can already see the contradictions in the logic of reduced salt: the mom-to-be is told to not eat salt, this causes extra-cellular water and swelling, which needs salt to be reabsorbed into her cells for clearance by the kidneys but which she is not allowed to eat. This way ionic level balance is not possible and chain reactions may occur with negative consequences. She may have protein leaching into her urine, extra hard kidney work, and a whole other long chain of complex events may kick in to make pregnancy a rather unpleasant experience risking the health of the fetus.
The amount of extra-cellular water is very hard for the body to get back into circulation without salt and may take days, taxing the kidneys with the volume of water leaving and increasing pressure on the blood vessels from the outside, causing high BP. However, as the volume of water is leaving the body finally, this reduces blood pressure. When a pregnant woman’s blood pressure drops as a result of all that water leaving, the dehydrated blood cells carry less oxygen. This indicates reduced oxygen for both her and the baby.
By telling mothers to reduce salt intake, glucose increases, which increases blood pressure (BP) rather than reduces it. The similar phenomenon happens in gestational diabetes. In gestational diabetes (and gestational hypoglycemia as well) the sugar level is unstable and is either too high or too low, respectively. Should the mother-to-be eat a salty pickle (as cravings always dictate pickles), she may end up in a major sugar crash and in the hospital for immediate treatment.
The balance between sodium and glucose is very fragile and extremely quick changing as you could see on my daughter-in-law’s foot. Interestingly we now also know that salt does not increase blood pressure but sugar does and so a reduced salt diet automatically increases blood pressure because of the glucose and sodium inverse connection and sugar’s dehydrating properties. Reduced salt also increases triglycerides (Graudal, 2011), causing a lot of problems for people with preexisting heart conditions. So by reducing the salt intake of the mothers to be, are we creating diabetic mothers and/or babies? Babies have been born with diabetes 2!
Is it possible that we are giving the wrong advise to pregnant women about salt and sugar? It’s an interesting question to pose and further research is badly needed. Knowing that salt and sugar are in inverse proportion in the blood, one may suggest eating them together. In fact, eating them together is a much better idea than eating sugar alone. It is best to not eat sugar at all but if you must eat sugar, consider eating salt too.
Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Graudal et al., Cochrane Database Syst Rev. 2011 Nov 9; (11).
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Thank you so much for this article, it really satisfied my science mind as to why my pregnancy edema wasn’t resolving with just time. When I’m swollen I am disgusted by water, which would make sense based on your article since I ask my body what it needs, and it doesn’t need that.
I will try the salt and see what happens.
I had a couple tablespoons of chocolate chips yesterday, but avoid all other sugars except grade B maple syrup which doesn’t react with me. Today my feet were still swollen. Hopefully this knowledge will help me conquer my constant battle with water weight that fluctuates mightily!
Thanks for your comment. Indeed, you need salt. But, maple syrup is a sugar. In fact, it is a high fructose syrup, not different from corn syrup–just made from a different source. But chemically there is no difference between sugar no matter where it comes from. Maple syrup is a combination of glucose and fructose, just like any other sugar. The swelling is caused by all things that contain sugar–even foods that aren’t sweet but are high in starch, such as potatoes, rice, quinoa, legumes, grains, etc. Although you cannot taste the sugar in this because they are in starch form, these are all high in sugar. As long as you eat carbohydrates of any kind, you will get edema.
To get rid of edema, you need to get rid of these foods from your diet.
Good Morning. I would like to understand a concept mentioned by you in this text.
As far as I know, water retention is caused by the fact that it is not reabsorbed into the bloodstream and, as a consequence, is largely eliminated through urine. Eating more salt to “hold the water inside the cells” would do just that.
So, I see no point in your proposal to add more salt to combat water retention, but, I would try to understand. Does the relationship between salt and water retention that I described above be wrong?
Thanks David for your question. Yes, there is a bit of misunderstanding there. You are not at fault though, most medical professionals get this backwards–perhaps wrong teaching methods, since it is clear in most textbooks.
What you describe is edema. Edema is water that is unable to be absorbed back into the blood stream and it is also unable to be eliminated without being reabsorbed by the blood. The kidneys filter blood and have no access to extracellular fluids–such as water from extracellular compartments. Those fluids must find their way back into the blood. Salt pulls the water back into the blood.
Adding salt to your water as hydration achieves 2 things.
1) If you have edema, taking only salt–no water, only salt–will pull water back into your blood. This we use frequently in case of a migraine. Migraineurs are extremely carbs intolerant and glucose sensitive, and as you know, carbs convert to glucose. When glucose enters the cells, it removes both water and salt from the cells
(see Harrison’s Manual of Medicine, 18th edition, page 4).
The water expelled by glucose ends up as edema. Migraineurs, and anyone else can, use salt to move water back into the blood to be eliminated.
2) Drinking water and taking salt increases blood volume. Hydration means increased electrolyte and increased blood volume (without increase of red blood cells and other things) is increase of electrolytes. The proper hydration is always with salt.
In California, where training outdoors often means amazingly high temperatures, it is customary to have athletes drink salt-brine pickle juice during and after outdoor training. Salt also prevents or stops cramps. Milk is another top hydrating drink that has yet to catch on in the US but it is used in Australia.
I hope this helps,
Well heres a change of pace
Im a man and had aortic valve replacement surgery and am over weight
Ive repeatedly have noticed that sugar and salt cause my feet to swell and my knees to hurt.
I also notice walking round the block or down stairs helps keep me limber in my joints.
I never really understood why eating sugar swells up my feet as does salt.
I just was laying in bed and my feet was swelled up cuz of large sugar intake and decided to hunt for answers
I immediately got up and got water and half teaspoon of salt
Does this article relate to men as well
The change is fast when i consume salt or sugar or both
Another thing i notice that affect my feel is pop both normal and diet…is that possible.
Im a 4o year old man and am obese but workin on weight loss.
Thanks for your comment. Indeed, the same goes for men and women who are glucose sensitive–and it seems most are. It seems like you are too. However, you are not applying the salt right. After sugar consumption, just take salt and only enough water to get it down–like 1 sip. That is because glucose removes both water and sodium from your cells. So by returning sodium to the cells, the sodium will pull the water back from your edema. So there is no need to drink more water. 🙂 In fact, drinking water after sweets causes worse edema.
In terms of obesity, lots of studies have found that the key component driver of obesity is carbohydrates, in general, not just sugar but all carbohydrates. So read up on some of the articles here on grains, starches (like potatoes, cereals, breads, rice, corn, etc.,) and reduce (or better yet, quit) all of those as well, not just sugar or sweetened foods/beverages. For a glucose sensitive person, all carbohydrates deposit as fat and there is no way out of that other than stopping to eat all sweeteners and starches (grains are starches).
There are many low carbs high fat groups on Facebook that you can join to learn how, or read up on what it means. You should talk to your doctor about its health aspect–though your doctor is not going to be able to help you with nutrition, he/she will be able to assess your health condition with respect to your heart and how a change of diet may affect you.
1 more quick question
I just want to make sure i understand this concept
If i eat sugar eat salt afterwards
If i eat salt eat sugar afterwards
Pills sound better than teaspoons of salt snd sugar….are they available at walmart
Not quite Jerry: eat sugar, eat salt after wards, no water. And then don’t eat sugar anymore…. but if you MUST eat sugar for some odd reason (I mean we don;t get any nutrition out of sugar, it is an addictive drug-like substance–read here), only take salt after and no water. Never take salt before. You will just end up with bigger edema. But really: try to quit sugar if you are trying to lose your obesity. <3
Oh my goodness – so glad I found this! My first pregnancy I worked out consistently and didn’t eat many calories. However, I had a high sugar intake. At 8 months I had “gained” 50 lbs (so so swollen), but didn’t think too much of it because my fit mother had warned me that she had gained 40-45 lbs of water with each pregnancy. Shortly thereafter I was sent to delivery with severe pre-E. Asked multiple docs if it was possible there was a relationship to high sugar intake. The response was “no, you aren’t obese” and “there’s only a relationship to gestational diabetes” which didn’t sit quite right.
This pregnancy, in addition to a daily baby aspirin I decided to implement a low-carb (keto) diet when I had started gaining more rapidly than I wanted. Now with less than a month to go I’ve only gained 17 lbs and the only time I’ve seen swelling is after “cheating” with simple carbs/sugar. I couldn’t think of why that may be until I googled your article. You have a believer in me!! I appreciate hearing the science behind it and it has convinced me to stick to my regimine through delivery. Thank you!
Thanks for the smile you brought to my face! It is truly fascinating how simple explanations and solutions can be. MDs are not trained to see and “discover” unless they work in a research lab (and there they are constrained to research what they are told) so few people know some of these little tricks. 🙂
I was going to ask you about that baby aspirin. Not sure you know that there is an FDA warning on that. I don’t know your health condition–nor do I suggest that you stop–only want to be sure you know that as per the FDA aspirin cannot be used as a first line preventive for heart attack or stroke because it causes more damage than good. And even as a secondary (meaning after one had a heart attack or stroke) it can only be used in combination with something else. In addition it helps women only in preventing further strokes–it does nothing for the heart in women.
Here you can see the FDA letter response to Bayer (makers of Aspirin) and also you find a link there to the FDA’s official announcement.
I hope you will have a healthy and happy baby–I am also on the ketogenic diet and find it the best thing that happened to me! <3
This makes sense to me as well, also quick note, cayenne pepper for preventative and treatment of heart attack and blood pressure issues
This isn’t true. Cayenne pepper contains a substance that can prevent a nerve from swelling (capsaicin) but it does nothing to reduce blood pressure or prevent a heart attack.
There are many different causes of a hypertension and also of a heart attack. We must find the cause before we jump into treating symptoms.
Fantastic analysis! thank you very helpful!
Thank you PS!
Is there a brand of salt pill that you recommend? I’m not finding any over the counter at stores so I’m going to order online.
I actually just use iodized table salt. I do not believe in any conspiracy theory about salt about the purification process being unhealthy since we only use sodium and chloride form and nothing else so no need to decorate it with minerals; we get those from food and we typically eat salt with food. The anti-caking agents in salt are the same as in flour, in cheese, and in just about everything else we eat so not sure what the big fuss is about. The dextrose you find in salt is minuscule and is keeping salt from getting wet–sugar collects water real good, which you have probably seen if you ever bought packaged sugar and in a week after you once opened it, the whole box/bag is one giant sugar piece.
If you are not sensitive to iodine (no Hashimoto’s or Grave’s disease) I recommend you prevent goiter and under-active thyroid by eating iodized salt or if you pick a salt without iodine, supplement your iodine need (150 mcg for a typical woman (gender and age dependent).
Side note: there are many people who choose various salts that are now fashionable. Those are exactly the same salt as far as your body is concerned.
Purified salt has been used for a long time. I have been eating it all my life and though I am senior, I am the only one with no thyroid problem around the females I know, who eat designer salts. I suppose the choice is yours: eat iodized salt for life and stay healthy or end up taking thyroid hormone replacement pills later and for life if you pick the designer salt. I prefer the first option. Also, some salts, such as the Himalayan salts, are full of toxin and radioactive materials that build up in your body as heavy metals and radiation over the years. I by now have met many people hurt from that salt courtesy of my article on it a few months ago.
Don’t fall for the hype, health is more important and think long term and into the future! As for the minerals: eat healthy wholesome nutritious food.
Hope this helps!
Hi Angela, very interesting! As you know, edema is a cardinal sign of thiamine deficiency and salt wasting syndrome is one of the dysautonomias that responds to thiamine. What do you believe to be the connection? The sodium/potassium pump is ATP dependent.
Dear Dr. Lonsdale,
Thank you for your comment. The sodium/potassium pump is ATPase dependent, meaning magnesium must be attached to the ATP to open the pump and the opening itself is also dependent upon the responsible amount of sodium and potassium to exchange places. As you know, the Sodium/potassium pump is responsible for the generation of the action potential, which is the very electrical current that at the end of the neuron, upon activation of the high-voltage-gated calcium channels, calcium rushes in and literally kicks the neurotransmitters out of the cell to the synapse. In other words, nothing works alone. The sodium/potassium channels work based on the activities and participation of many elements, of which each is equally important. In fact, a paper I bumped into of late suggests that thiamine actually blocks potassium in the sodium/potassium pump, see here, and so I question the benefit thiamine may directly have on this pump.
It is widely accepted that thiamine has significant roles elsewhere in the cells, including ATP generation by the mitochondria.
Edema is a symptom of beriberi together with other symptoms–so far as I could find. In other words, edema on its own may or may not have anything to do with thiamine deficiency. In my experience, certain conditions, such as carbohydrate intolerance and thereby glucose sensitivity, have edema as one of their symptoms independent of thiamine levels. And here the connection to edema is simply that glucose entering the cells cause an efflux of sodium and water from those cells (see: page 4, Longo, D. L. et al. Harrison’s Manual of Medicine 18th Edition.(McGraw Hill Medical, 2013)). So, again, I don’t see direct and “simple” explanation by thiamine here.
Salt-wasting is not a common condition, since it can be defined in a variety of ways. The most common definition is hyponatremia, for whatever reason/cause. Depending on the “reason” or “cause”, this may not be even equivalent to true salt-wasting. For example, as you know, I work with thousands of migraineurs, all of whom have never showed hyponatremia in their electrolyte panels of modern tests. However, Campbell, D. A., Tonks, E. M. & Hay, K. M. An Investigation of the Salt and Water Balance in Migraine. British Medical Journal, 1424-1429 (1951) showed, that migraineurs need 50% more salt (their urine contained 50% more sodium than those without migraines). Thus salt-wasting may mean that the person actually would need more salt than they are permitted to consume. An independent paper I bumped into, whose title I now cannot recall, showed that in the mid-20th Century, the electrolyte panels had much higher sodium levels as normal. A very good article explaining sodium in electrolyte is found here. In this context, it is clear that thiamine is not directly associated with salt-wasting, or, at least, it need not be involved at all.
Similarly to salt-wasting, salt sensitivity can also be examined. Salt sensitivity, especially salt-sensitive hypertension, have always been believed to be genetic. However, there have been no such genes found as of yet. And what I found in my migraine groups over the past 6-7 years, and of the 2-3 members who claimed they had salt-sensitive hypertension and so they couldn’t possibly increase salt in their diet, was that these people all stopped having such hypertension soon after they changed their diets to exclude sugar, starches, grains, and vegetable/seed oils, all of which are inflammatory, and their so called “genetic salt sensitivity” vanished. Because salt-sensitive hypertension disappeared by a change of diet from a high carbohydrate to a low or no carbohydrate diet, with no other changes made, not even supplemental, it seems that thiamine was also not participant in those cases.
In conclusion: I see many instances where thiamine deficiency is paramount. Most people I know could/would benefit from supplementing TTFD type thiamine, simply because of modern lifestyle, food, and medicines, all either block thiamine absorption or thiamine is simply not present in the food in great-enough amount. There are very few food items high in thiamine. pork is one of them but with the plant-based diet movement, the last remnants of any nutritional dietary thiamine will come to an end and all people will either have to supplement or suffer the consequences, which may manifest vastly differently from beriberi!