Thirst and Salt Intake: A Personal Review and Some Suggestions. In: Ramsay DJ, Booth D, editors. Thirst. London: Springer; 1991. pp. 481-501. [DOI: 10.1007/978-1-4471-1817-6_31]

The biopsychology of salt hunger and sodium deficiency

Sodium is a necessary dietary macromineral that tended to be sparsely distributed in mankind's environment in the past. Evolutionary selection pressure shaped physiological mechanisms including hormonal systems and neural circuits that serve to promote sodium ingestion. Sodium deficiency triggers the activation of these hormonal systems and neural circuits to engage motivational processes that elicit a craving for salty substances and a state of reward when salty foods are consumed. Sodium deficiency also appears to be associated with aversive psychological states including anhedonia, impaired cognition, and fatigue. Under certain circumstances the psychological processes that promote salt intake can become powerful enough to cause "salt gluttony," or salt intake far in excess of physiological need. The present review discusses three aspects of the biopsychology of salt hunger and sodium deficiency: (1) the psychological processes that promote salt intake during sodium deficiency, (2) the effects of sodium deficiency on mood and cognition, and (3) the sensitization of sodium appetite as a possible cause of salt gluttony.

Water balance throughout the adult life span in a German population

Mild dehydration, defined as a 1–2 % loss in body mass caused by fluid deficit, is associated with risks of functional impairments and chronic diseases. Whether water requirements change with increasing age remains unclear. Therefore, the aim of the present investigation is to quantify hydration status and its complex determining factors from young to old adulthood to analyse age-related alterations and to provide a reliable database for the derivation of dietary recommendations. Urine samples collected over a 24 h period and dietary records from 1528 German adults (18–88 years; sub-sample of the first National Food Consumption Survey) were used to calculate water intake (beverages, food and metabolic water) and water excretion parameters (non-renal water losses (NRWL), urine volume, obligatory urine volume) and to estimate hydration status (free-water-reserve) and ‘adequate intake (AI)’. Median total water intake (2483 and 2054 ml/d, for men and women, respectively (P < 0·0001)), decreased with increasing age only in males (P = 0·001). Obligatory urine volume increased in both sexes (P < 0·0001) due to decreased renal concentration capacity. The latter was balanced by a decrease of NRWL (P < 0·05), leaving the free-water-reserve and therefore hydration status almost unchanged. Calculated ‘AI’ of total water was the same for young (18–24 years) and elderly ( ≥ 65 years) adults (2910 and 2265 ml/d, for men and women, respectively). The present study is the first population-based examination showing that total water requirements do not change with age although ageing affects several parameters of water metabolism. Reduced sweat loss with increasing age appears to be primarily responsible for this observation.

Increased salt appetite in patients with congenital adrenal hyperplasia 21-hydroxylase deficiency

Salt appetite was investigated in 14 patients with congenital adrenal hyperplasia of the salt-wasting form (SW group), 12 patients with the simple virilized form who are not salt losing, and 18 healthy siblings. Salt appetite was evaluated by questionnaire, preference tests, and dietary analyses. The findings showed that SW who were not therapeutically normalized showed increased salt appetite but no change in sweet preference. Their salt appetite correlated with symptoms of salt wasting, namely, plasma renin activity, plasma K+, and urine Na+ and (inversely) with blood pressure. Sensitivity to the taste of NaCl was not altered. Factor analyses of a larger group confirmed the distinction between salt appetite and sweet preference, but intake of dietary Na+ and sweet carbohydrates and intake of salty and sweet snacks did not reflect distinct salt or sweet preferences. We confirm that putative perinatal dehydration, due to maternal nausea and vomiting during pregnancy, childhood vomiting, and diarrhea with occasional saline infusion, was related to increased salt appetite in adolescence. The findings suggest that salt appetite in humans is determined by interdependent, innate, physiological, and acquired attributes. Salt appetite in SW patients is an adaptive response mediated by the renin-angiotensin system, an innate predisposition to acquire salt preference (in anticipation of both sodium loss and its consequence), and imprinting by perinatal hyponatremic occurrences. Our findings contribute to understanding human salt intake, provide insight into the motivation for salt in patients with congenital adrenal hyperplasia 21-OH deficiency, and may point the way to improvements in therapeutic compliance in these patients.

Ontogeny of urine preference and its relationship to NH4Cl preference and sodium hunger in suckling rat pups

We chart the postnatal ontogeny of urine preference in the suckling rat. Twelve-day-old sucklings, when offered urine, NH4Cl, or NaCl, ingest more urine and NH4Cl than NaCl. When rendered sodium hungry by ivc renin or by sodium depletion, these sucklings prefer urine and NH4Cl to NaCl, dilute urine, or an NaCl and KCl mineral mix equimolar to urine; however, by 18 days of age, urine and NH4Cl are no longer preferred to NaCl. Hence, urine preference in the suckling may be specific and preparatory for the variety of purposes urine preference serves in the adult rat, and it might guide the pup to urinary sodium in the nest. Since preference for urine and NH4Cl covary during postnatal development, the high preference for NH4Cl in midterm sucklings might be because its ammonium flavor is similar to urine.

Palatability: response to nutritional need or need-free stimulation of appetite?

The traditional view of palatability was that it reflected some underlying nutritional deficit and was part of a homeostatically driven motivational system. However, this idea does not fit with the common observation that palatability can lead to short-term overconsumption. Here, we attempt to re-evaluate the basis of palatability, first by reviewing the role of salt-need both in the expression of liking for salty tastes, and paradoxically, in dissociating need from palatability, and second by examining the role of palatability in short-term control of appetite. Despite the clarity of this system in animals, however, most salt (NaCl) intake in man occurs in a need-free state. Similar conclusions can be drawn in relation to the palatability of food in general. Importantly, the neural systems underlying the hedonic system relating to palatability and homeostatic controls of eating are separate, involving distinct brain structures and neurochemicals. If palatability was a component of homeostatic control, reducing need-state should reduce palatability. However, this is not so, and if anything palatability exerts a stronger stimulatory effect on eating when sated, and over-consumption induced by palatability may contribute to obesity. Differential responsivity to palatability may be a component of the obese phenotype, perhaps through sensitisation of the neural structures related to hedonic aspects of eating. Together, these disparate data clearly indicate that palatability is not a simple reflection of need state, but acts to promote intake through a distinct hedonic system, which has inputs from a variety of other systems, including those regulating need. This conclusion leads to the possibility of novel therapies for obesity based on modulation of hedonic rather than homeostatic controls. Potential developments are discussed.

Macronutrient-specific dietary selection in rodents and its neural bases

The only evidence for nutrient selection comes from baseline or treatment effects on nutrient intakes that are qualitatively similar when sensorily contrasting forms of each macronutrient are investigated and/or dietary compositions and strains of rat or mouse are different within or between laboratories. By that criterion the only potential case of a treatment reliably altering macronutrient selection identified in the present review of the literature is d-norfenfluramine, fluoxetine and paraventricular serotonin (5-HT) reducing the intake of dextrin-containing diets at early dark. The only clear example of reverse effects of an agonist and an antagonist on dietary intake was found with serotonergic agents. Claims for catecholaminergic or opioid involvement in protein intake and peptidergic involvement in carbohydrate intake were not substantiated. There remain the issues of which learnt macronutrient-specific postgastric actions and sensory cues from the affected diet rely on the neural pathway(s) on which the drug is acting to alter dietary selection. Until experiments address these questions, the neural bases of nutrient-specific appetites will remain unknown. Drug effects must be consistent across differently textured and flavoured versions of each macronutrient tested.

Salt appetite consequent on sodium depletion in the suckling rat pup

The ontogeny of the behavioral ability to compensate for sodium deficit was studied in the rat. The experiments showed that: 1) Before weaning age, sodium-depleted pups will increase their avidity for 3% NaCl solution; 2) the ability to select and drink a salt solution in response to a sodium deficit continues to evolve between 17-24 days of age, and that pups at these ages will modify their intake of salt and water as do adult rats when rectifying plasma osmolality; 3) The increased appetite for sodium is evident even when depleted preweanlings are dehydrated and provided with solid NaCl tablets to lick, showing that sodium appetite and hydrational status are already dissociated at this age; and finally, 4) sodium depletion first induces an increase in intake of orally infused 3% NaCl solution in 12-day-old pups. The picture of the development of salt appetite in the suckling rat that these findings present is of a precocious competence to meet a challenge to sodium homeostasis. In this respect salt appetite emerges in parallel to the other ingestive behaviors.