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February 7, 1996

Chronic Fatigue Syndrome and Neurally Mediated Hypotension-Reply

Author Affiliations

The Johns Hopkins University School of Medicine Baltimore, Md

JAMA. 1996;275(5):360. doi:10.1001/jama.1996.03530290029024

In Reply.  —Dr Beard points to the absence of data to support the common clinical practice of high sodium intake for those with NMH. While he is correct, the same can be said for claims that a low sodium intake is appropriate for everyone. Have any of the large hypertension prevention studies examined fatigue as an adverse outcome of a low sodium diet? Even if mean blood pressure could be lowered by 2.2 mm Hg after a reduction in sodium intake of 2300 mg/d, as predicted by the Intersalt study,1 we would need to know whether individuals felt better or worse as a result of the dietary change. We would predict that those with an increased susceptibility to NMH would fare worse on the recommended low-sodium diets.Dr Baschetti raises the interesting hypothesis that licorice might be more effective than fludrocortisone for patients with CFS. Until results of a