Urea has been used for many years and in many countries for the treatment of SIADH/Hyponatremia. Urea is considered a GRAS (generally recognized as safe) product by the FDA1. In fact, an interesting study took place in Belgium in 2012. They looked at 12 patients with chronic SIADH, with an average sodium of 125 meq/L (low). The first year, they were given the new, very expensive, pharmaceutical drug class Vaptans daily. The average Sodium came up to a normal level of 135 meq/L. 1 patient out of the 12 dropped out due to severe thirst. Next, the patients had an 8 day “holiday” without treatment, and as expected the Sodium went back down (pictured above). Over the next 12 months, the SIADH patients were given oral Urea therapy. The patients now on Urea have a similar normal sodium level of 135 meq/L. However, this time there were no dropouts nor any significant adverse events. The authors, therefore concluded that oral Urea was safe, well tolerated and as effective as the Vaptans at a much lower cost.2 This study impacted the current European best practice guidelines which advocate for Urea over Vaptans for SIADH/Hyponatremia.3
Another study, this time out of Italy, looked back from years 2013-2018 on 36 patients with cancer associated SIADH/Hyponatremia. They were treated with Urea, and had an average sodium 1 point lower at 124 meq/L (low). They noted after only 24 hours of treatment, the sodium improved on average by 5 meq/L. Secondarily, the Italian physician scientists discovered over 90% of patients on 60 days of treatment with Urea, achieved a normal sodium level. The authors, therefore concluded oral Urea was safe, effective beginning first day of treatment, and very well tolerated.4
Urea has been used for many years in multiple countries for SIADH/Hyponatremia. Urea has always shown to be safe and effective even when taken for a year or more. Our version of this miraculous medical food is UreaAide which can be found by clicking here KidneyAide.
Links to the FDA, CJASN and Endocrinology studies + European guidelines for Hyponatremia.
There is a misconception in the medical community regarding Hyponatremia (low sodium) and the benefit of salt tablets. Of course it makes sense on the surface, your sodium (salt) level is low so take more salt right? Wrong! I’m sorry but it’s usually not the ideal strategy, especially in SIADH or Hypervolemic hyponatremia, as in heart failure (CHF). Let’s examine CHF first. CHF by name is congestive heart failure which implies correctly, that the patient is congested with salt and fluid. This is why CHF is usually treated with diuretics (medicines that make you pee salt and water). This decongesting process is actually what rids the body of excess fluid that is diluting the sodium level. Patients with CHF are asked to go on a sodium restriction diet to prevent congestion and this, along with diuretics, most often improves the sodium levels. UreaAide may be of benefit here as it will, salt free, draw off the excess fluid.
Now let’s examine SIADH. The Syndrome of Inappropriate Anti-Diuretic Hormone. Again the name gives it away. A syndrome that is inappropriately releasing a hormone, that inhibits (anti) diuresis (fluid excretion via kidneys). I know it sounds complicated, in essence your body is being signaled to hold water too tightly. The urine is dark and concentrated and you are incapable of releasing water well. Water builds up and dilution of your serum sodium occurs, manifesting as a low sodium on labs. The simplest and safest way to combat this is to excrete the excess water. Their is a chemical pharmaceutical, tolvaptan, that inhibits this directly, however the wholesale cost is $360/pill and tolvaptan harbors a risk of liver toxicity as well as overly rapid correction leading to brain swelling. You can combine diuretics such as furosemide, salt tablets and fluid restriction with varying success, but your still consuming a bunch of salt. The best method that is safe, completely salt free and cost effective is with Urea. Urea, an osmotic diuretic, is like taking 7 salt tablets per dose and will draw the water out safely and effectively via osmosis. You will pee the excess water out and increases your serum sodium without any strong drugs or excess salt. UreaAide (the better Urea) happens to taste great, cost less and dissolve rapidly in just 4oz of water. So yes you can, and probably should, come off all those salt tablets, especially if you’ve been diagnosed with SIADH. So ask your doctor if UreaAide may be right for you!
Order UreaAide Here
Hyponatremia, or low sodium, is quite common affecting estimates of 1.7-2.1% of the US population1. There are many causes of Hyponatremia (low serum sodium). For completeness, there are less common causes of Hyponatremia, such as the type associated with hyperglycemia (very high blood sugar) or seen with extremely high lipids or protein levels termed ‘’pseudohyponatremia’. These types are looked at and treated differently then the more common hypotonic Hyponatremia that most patients have.
It’s very important that we recognize something first, nearly all Hyponatremia is caused by the dilution effect of excess water in the blood. This excess water dilutes the sodium level to below 135 meq/L. It’s in this context that we discuss the major causes of Hyponatremia.
Lets start with medications. There are many medications that lead to Hyponatremia, thiazides diuretics being the most common culprits.
Other drugs commonly implicated are antidepressants and anticonvulsants. Street drugs such as ecstasy, bath salts, and amphetamines are also possible causes.
One question that is often brought up is, ‘doctor can I drink too much water?’
Answer, a resounding yes with some caveats.
Its relative to the solute or food you consume. Your kidney can usually do a great job of ridding your body of excess water. Even the great kidneys, however, have their limits. The lowest dilution the kidneys can ever get down to is 50. 50 what you ask? 50 milliosmoles/Liter (mOsm/L). This implies that your kidney needs at least 50 mOsm/L of ‘stuff’ to get rid of that Liter of water you drank. The ‘stuff’ is food like protein (Urea), salt and potassium. The average person eats about 900 mOsm per day. So consider that scenario of 50 osm/L. The implication here is 900 mOsm/50 mOsm/L is 18 liters a day of water one could excrete. That’s over 4 gallons! So if your eating normally you’d have to drink an awful lot to dilute your sodium. This is actually termed psychogenic polydypsia when it happens. On the other hand, if your not eating all that well, say only 250 mOsm/day, then it’s 250/50= 5 liters. Often however, as we age the kidney may only get down to 100 osm dilution. Now 250/100 is only 2.5 liters of water before you start diluting. This type of Hyponatremia is called ‘’tea and toast’ or ‘beer potomania’ (when it’s beer as the main liquid). So yes you can drink too much water even if your kidney is doing it’s very best. Now what if your kidney is getting the wrong signal?
Syndrome of inappropriate ADH secretion or SIADH is just that, inappropriate signal. ADH is anti-diuretic hormone, meaning when it’s around you anti diurese (make less urine). When ADH is on board the kidney holds water very tight and your urine turns darker and more concentrated. Over several days of drinking water and other liquids, your serum sodium will become diluted.
So what causes the ADH to be excreted?
Common triggers for ADH are nausea and pain; that’s why we often see SIADH after surgeries. Other triggers are Lung disease including cancer (especially small cell) and brain diseases such as stroke, bleed, or infection. These SIADH scenarios respond best to UreaAide because the Urea induces a nice osmotic diuresis. The osmotic diuresis will counteract the dilution effect and raise the serum sodium level.
Another cause of low sodium levels are true volume depletion from vomiting and diarrhea. Here your body will also excrete ADH but this time the signal is appropriate. This is termed effective arterial volume depletion. This type of hypovolemic Hyponatremia usually corrects with iv fluids.
Other reasons your sodium could be low include: heart failure, cirrhosis of the liver, hypothyroidism, and adrenal Insufficiency. These tend to be obvious in terms of heart or liver disease, however thyroid or adrenal must be considered and tested for.
As you see their are a lot of scenarios in which the sodium may drop and your doctor will work with you to figure out why. The key is making the correct diagnosis and then recommending the best treatment.
1. Am J Med. 2013 Dec; 126(12): 1127–37.e1.
There is no such thing as asymptomatic Hyponatremia. We were all taught this in medical school and residency, but what are the problems of leaving your serum sodium a little on the low side?
Based on many different studies both observational and randomized ie: SALT-1 and SALT-2, below are 5 of the more common and ominous risks associated with Hyponatremia especially, a Sodium <130 meq/L
1. Increased risk of osteoporosis-bone disease
2. Increased risk of falls and hospitalizations
3. Increased risk of kidney stones
4. Increased risk of confusion/lethargy/weakness
5. Increased risk of mortality-dying
The good news is there is a simple, safe, and effective way to get your sodium back to normal with UreaAide!
Check it out here click the button below
UreaAide works by osmosis. It really is that simple. When you have excess water (SIADH/Hyponatremia) it is that excess water that is diluting your sodium and causing the number to be low. UreaAide works by increasing the osmolarity (concentration) in the urine which will ultimately draw water to flow in the urine out of the body. As this water leaves the body the dilution effect decreases and the sodium rises. It really is that easy.
I’ve often been asked in my years of practicing nephrology, why does it matter if my sodium is low? The short answer is even mild Hyponatremia is linked to several notable negative signs and symptoms. Hyponatremia is associated with an increased death rate, longer hospital stay, falls, Re-admissions to the hospital, osteoporosis (bone disease), and worsening mental state. More severe forms can lead to seizures, coma and even death. Good news is if caught early and treated properly Hyponatremia can be cured, and sodium levels can be maintained in a normal range. UreaAide is one of the safest most effective ways of helping you maintain normal sodium level. A typical dose of 1 scoop twice a day often does the trick, and it tastes good too!
The FDA definition of a medical food is: “a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation."
Medical foods were defined back in 1988 with the FDA orphan drug act amendments. Medical foods are subject to the same safety regulation and labeling requirements of the food, drug and cosmetic act.
Examples of medical foods would be amino acids for the treatment of specific diseases like PKU or enteral tube feeds for those with malabsorption.
Another example of a medical food is UreaAide, a food taken orally, under the supervision of your doctor, meant to treat Hyponatremia ( low serum sodium) and is guideline based. We at KidneyAide are meticulous when it comes to the above FDA regulations and requirements. UreaAide is manufactured and stored in an FDA registered cGMP manufacturing facility and we use only high grade USP Urea. It is critical that you are getting the highest quality medical foods for safety and effectiveness. So as we say UreaAide is safe, effective and guideline based so you can rest assured your sodium is in proper balance naturally.
SIADH (syndrome of inappropriate anti diuretic hormone) is essentially a water problem. For reasons your doctor likely figured out, your body is holding onto liquids too tightly via a hormone messenger to your kidneys (ADH). Usually the reason for this is some sort of stressor, like pain or nausea.
It may also be related to lung diseases, like COPD or brain disturbances, like a mass or a bleed. Sometimes certain cancers can cause SIADH, as well as certain medications, like Thiazide diuretics. With this water retention your sodium becomes diluted and the sodium level drops.
When it is minor, for example in the low 130's, you probably won't feel much different. However, as the sodium dilutes further into the 120's or 110's or even less, you will likely feel symptoms:
These lower numbers are also dangerous as they may predispose to seizures or brain swelling. There are a handful of guideline based therapies for SIADH. These include, fluid restriction, diuretics with salt pills, as well as the pharmaceutical agents Vaptans and of course, Urea.
Urea has a salty brine taste by itself but we were able to come up with a formula in UreaAide that tastes great using natural mint. UreaAide works as an osmotic diuretic which helps your body get rid of the excess water by pulling the water out via the kidney. You should urinate more and begin to bring the sodium level up slowly and safely. Because it is a naturally based product the side effects are typically mild, such as nausea, distaste or loose stool.
UreaAide comes as 2 options:
1. 15 gram premium dose packets, mint flavored
2. 1lb unflavored with dosing scoop, all natural
The usual starting dose is 1 packet, or 1 scoop twice a day. The unflavored UreaAide is less costly but we highly recommend mixing with your favorite powdered beverage, like Gatorade. You can watch video demonstrations here.
In summary, SIADH is a common reason for low sodium or Hyponatremia. It is caused by multiple triggers and can lead to many different symptoms. There are a few treatment options and you should talk to your doctor about which may be best in your particular situation. If your doctor suggests Urea, we hope you choose UreaAide!