Today I’m feeling vaguely victorious and vaguely petrified in equal measure. I told you about my diet, right? The one 0where I have to cut out everything but air, acorns and, if I’ve been really good, I might get to sniff the fridge? Well, when I said that diet and exercise wasn’t good for you, I wasn’t kidding. It turns out that the type of diet I’m on is low in salt as well as low sugar, low fat and low flavour.
Now, I started on lithium 2 years ago. I read the little pamphlet that came with it stating what to do with the little white tablets, when to take them, how many to take and what to do if I accidentally start snorting them like cocaine. But after that I kind of forgot about the little pamphlet and got on with my life. So when I started this diet it didn’t occur to me that the odd symptoms I started getting about 2 weeks in were anything more than dietary pains or the effects of a lifetime of living on sugar.
Last week my lips went numb. Just once and just for about ten minutes and I didn’t really think much of it other than ‘that’s odd and I hope that doesn’t happen again’. But it did happen again. And I was tired all the time. Exhausted to my core kind of tired. And then my right hand went numb which, to my dismay, didn’t stop me being able to go to work and type (I mean, what is the POINT of being poisoned slowly if you can’t get a day off out of it?). And my concentration has been awful. All these things I’ve put down to other issues but it turns out that a low salt diet can really affect your lithium levels, raising them to the point where they become toxic. Yet again I ask you, if you suddenly turned radioactive, you’d want a day off work, right?!
Apparently, what happens is your kidneys process both sodium chloride (common table salt) and lithium chloride (not to be confused with table salt. Doesn’t taste nice on your chips… apparently) in the same way. Ie, if you’re dehydrated or don’t have enough salt in your system your kidneys will hold onto what it has got, and invariably that will mean holding on to the lithium too. Your body doesn’t flush these things away in your urine like it normally would and you end up building up a little store. One thing is relatively harmless although again, wouldn’t recommend you put it on your chips after extraction from said kidneys, while the other thing starts to build up to toxic levels. You notice it most when you get the shakes, numb bits of your body, your concentration goes, etc etc. (there’s a much better explanation here: http://bipolarworld.net/Phelps/ph_2005/ph1350.htm).
You’re supposed to speak to your GP before you go on a diet of any kind when taking lithium but this is where things fell down for me. Neither myself, nor the GP or nurse put two and two together and that’s how I’ve ended up with lips like Mick Jagger and no feeling down my right side. Ok, I exaggerate, but I wouldn’t be me if I didn’t.
For those of you in the same position as me (not walking around like one of the undead, just considering dieting is what I mean by that) you might like to read the following guidelines from the National Institutes of Health Clinical Center:
These diet guidelines will help you keep your lithium blood level stable:
• Drink 8 to 10 glasses of water or other liquids every day.
Drinking plenty of fluids is important while you are taking lithium. Not drinking enough liquids may cause lithium levels to rise. You may need even more liquids during hot weather and during exercise when you sweat heavily. To avoid weight gain, select water and other non-caloric beverages.
• Keep your salt intake about the same.
Do not begin a low salt diet without first talking with your doctor or pharmacist. Do not suddenly increase the salt in your diet either. Less salt may cause your lithium level to rise. More salt may cause your lithium level to fall.
Try to keep your intake of these salty foods about the same from day to day: luncheon meats, ham, sausage; canned or processed meats and fish; packaged mixes; most frozen entrees and meals; soups and broths; processed cheeses like American; salted snack foods; soy sauce; smoked foods; olives, pickles; tomato juice; most fast foods; salt, salt containing seasonings and condiments like ketchup and meat sauces.
• Keep your caffeine intake about the same.
Keep amounts of coffee, tea, cola, and other soft drinks with caffeine about the same from day to day. Less caffeine can cause your lithium level to increase; more caffeine can cause your lithium level to decrease.
• Avoid alcoholic beverages.
Check with your doctor or pharmacist about this issue and any questions you have.
• Take lithium with food or milk.
This will reduce possible digestive side effects like nausea, vomiting, diarrhea, and abdominal pain.
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