In hot weather months, being outdoors for long periods of time or engaging in physical exertion or vigorous exercise means that we are likely losing fluid through sweat. So, when it comes to hydration, it also important to be mindful of electrolyte balance.
 

What are electrolytes?

 
Electrolytes are essential minerals that have an electric charge. They come from the foods we eat and fluids we drink (1). Electrolytes are in the extracellular and intracellular fluid of the human body, like blood, urine, sweat and tissues (2).

These electrolytes (essential minerals) include sodium, chloride, potassium, magnesium, calcium, phosphate and bicarbonate.

Electrolytes are vital for proper nerve and muscle function, maintaining your blood’s pH and for keeping you hydrated.

You lose electrolytes any time you lose fluid; for example, through sweat, urine, vomiting and diarrhea.

Electrolytes play an important role in (3):

    • Hydration. Regulating the fluid levels in your blood plasma and your body.
    • Maintaining acid-base balance of blood. The normal pH range of blood is slightly alkaline, between 7.35 to 7.45.
    • Regulating overall brain, muscle and nerve function.
    • Enabling muscle contraction and movement, including your heartbeat.
    • Transmitting nerve signals from heart, muscle, and nerve cells to other cells.
    • Helping with blood clotting.
    • Building new tissue.

Understanding Electrolyte Balance and Hydration

 With electrolytes, you want to maintain a Goldilocks balance…not too much, not too little…just right.

Electrolyte imbalance symptoms can range from minor to severe and, sometimes, fatal: dizziness, fatigue, nausea, fluid retention, muscle weakness, muscle spasms or twitching, muscle cramps, numbness, elevated blood pressure, headaches, and anxiety (4).

On the severe end of the electrolyte imbalance spectrum, call 911 if you experience symptoms such as chest pain, mental confusion, rapid or irregular heartbeat, seizures or severe muscle weakness (5).
 

What causes an electrolyte imbalance?

    • Excessive sweating, especially during warm weather months, after vigorous, intense and/or prolonged exercise or exertion because essential minerals are lost when you sweat.
    • Vomiting or diarrhea (as can happen with food poisoning or illness).
    • Having certain heart, kidney or liver disorders.
    • Regularly consuming foods that contain little or no nutrients. These include high-sugar foods, refined carbs, packaged / processed foods, take out / restaurant / fast food and convenience foods (e.g., heat and serve meals, frozen dinners, etc.).
    • Taking certain medications, including antibiotics, diuretics, corticosteroids, birth control pills, blood pressure medications, chemotherapy drugs, diuretics and laxatives, all of which can disrupt electrolyte imbalance (6, 7).

Other potential causes of electrolyte imbalances include:

    • Diabetes (8).
    • Thyroid disease, like Hashimoto’s.
    • Adrenal issues, such as adrenal fatigue / adrenal exhaustion (9).
    • Chronic alcohol use, alcoholism and/or alcohol abuse (10, 11)
      *Note: Alcoholism typically results in malnutrition and multiple nutritional deficiencies because of low appetite and/or poor food choices. However, even alcoholics who eat three nutritious meals a day will have an electrolyte imbalance (12).
    • Cancers, such as lung or gastrointestinal (13).
    • Heart issues.
      These include tachycardia (fast heart rate), bradycardia (abnormally slow heart rate), atrial fibrillation, which can present as irregular heartbeat/pulse, fluttering/racing heart and can create blood clots in the heart that lead to stroke (14, 15,16).
    • Kidney problems (17).
    • Eating disorders, such as anorexia and bulimia (18, 19).
      *Note:  Both eating disorders, which typically involve vomiting, lead to malnutrition, resulting in an electrolyte imbalance.

Ways to Prevent an Electrolyte Imbalance

1.  Optimize hydration. Drinking enough water is key to maintaining good health. As a general guideline, drink approximately half your body weight in ounces. (If you are overweight or obese, aim to drink half your ideal body weight in ounces).

From this baseline, you may need to drink more water if: the weather is hot and humid; you’ve been exercising intensely for an hour or more; you are taking multiple medications; and/or if you are consuming caffeinated beverages (coffee, tea, soda) or alcohol, all of which have a diuretic effect.

As a side note…  Although it is uncommon, it is possible to drink too much water. Those at potentially higher risk for water intoxication are endurance athletes or those in military training who may drink too much water in a short period of time after intense physical exertion.

Drinking too much water (too fast) dilutes electrolytes, especially sodium. Sodium is an important electrolyte in maintaining fluid balance and hyponatremia results when sodium levels fall too low. Too much fluid gets into cells and can cause the brain to swell. Headaches, nausea and vomiting are typical first symptoms of excess water consumption. Severe water intoxication can cause serious symptoms, including double vision, difficulties breathing, confusion and increased blood pressure. A study published in the Annals of Pediatric Endocrinology and Metabolism found that water intoxication can occur when a person drinks 3-4 liters of water in a short period of time (20). Overconsumption of water can easily be sidestepped by spacing water intake throughout the day. So, don’t guzzle down a gallon (4.5 liters) of water in, say, an hour or two! Instead, space your water intake over 8 to 12 hours.

2.  Mineralize!  One of the best ways to prevent an electrolyte imbalance is to eat whole, unprocessed foods rich in trace minerals. The typical American diet is, unfortunately, lacking in minerals. Mineral-rich foods include (21):

    • Leafy greens.  Excellent sources of calcium, magnesium and potassium.  Lettuces, Swiss chard, kale, spinach, arugula, dandelion greens, mustard greens, collard greens, broccoli, broccoli rabe.
    • Unprocessed salt, broths, and foods with naturally occurring salt.  Excellent sources of unprocessed sodium.  Celtic sea salt, pink Himalayan sea salt, bone broth, tomato juice, pickles, olives, meats and poultry.
    • Unprocessed salt and salty foods:  Good sources of calcium, magnesium and trace minerals. Also, an excellent source of chloride.  Sea salt, olives, celery.
    • Fish and shellfish.  Fair sources of magnesium, calcium and/or phosphorus.  Salmon, sardines (bone-in), mackerel, haddock, shrimp, mussels.
    • Nuts and seeds.  Good sources of magnesium and/or calcium.  Pumpkin seeds, flax seed, chia seeds, sunflower seeds, almonds, walnuts.
    • Beans and lentils.  Good sources of potassium, magnesium and phosphorus.  Kidney beans, adzuki beans, lima beans, white beans.
    • Starch Carbs.  Good sources of sodium, potassium, phosphorus, calcium, magnesium.  Sweet potato, potato, winter squashes.
    • Fruits.  Good sources of potassium:  Avocado, figs, prunes, apricots, watermelon, banana.  Excellent source of magnesium: Dark chocolate (at least 70%), raw cacao.  Fair source of calcium, magnesium, phosphorus and potassium:  Coconut as a whole fruit and as coconut water.

3.  Use salt….but the right kind. Table salt, like Morton salt, is refined; stripped of minerals; fortified with iodine; contains synthetic chemicals, including aluminate, fluoride and anti-caking agents); and bleached to achieve its “white” color (22). Table salt is apx. 97.5% sodium chloride and 2.5% chemicals–used to help the salt “pour” more easily (23). Processed table salt provide little nutritive value and can easily jack up your blood pressure.On the other hand, natural, unprocessed salts, such as Celtic sea salt (my personal favorite), pink Himalayan sea salt and Redmond’s sea salt provide over 80 different minerals in trace amounts. We actually need sodium derived from natural salt sources to help regulate fluid balance and to prevent electrolyte imbalance (24).

4.  Discuss potential medication side effects with your doctor. Certain medications can create an electrolyte imbalance, including chemotherapy drugs, diuretics, antibiotics and corticosteroids (25, 26).
 

What About “Sports” Drinks Promoting “Electrolyte Balance”?

Athletes who train intensely, for long duration (an hour or more) and/or in the heat, will lose a lot of fluid (through sweat) and need to replenish electrolytes.

Although commercial sports drinks market themselves as the antidote for replacing electrolytes lost through sweat, they are typically loaded with added sugars (e.g., high fructose corn syrup), carbs and artificial food colorings that can trigger allergic reactions and are linked with increased risk of hyperactivity in children (27).  Most sports drinks do not contain enough electrolytes to really help replenish electrolytes lost through long duration exercise or exertion.

Those who lead a mostly sedentary lifestyle with little to no daily movement or who engage in light to moderate exercise will gain zero benefit from drinking commercial “sports” drinks.

Although brands like Gatorade and Powerade also offer “Zero Sugar” options, these contain artificial sweeteners, like acesulfame potassium and/or sucralose (Splenda) in addition to artificial food colorings that produce their distinct neon colors (not found in nature!).  In a 2022 study of 102,865 French adults, ages 18 and older, researchers found that the consumption of artificial sweeteners (e.g., aspartame and acesulfame potassium, a.k.a. acesulfame K) was associated with increased overall cancer risk—compared to those who did not use them (28).

 
How to Hydrate to Support Electrolyte Balance

 
If you plan to spend—or have spent—several hours at the beach, in the water, or outdoors on a hot day, you may want to sip on a DIY electrolyte cocktail (click on link for recipe).  If you’re on the go, it may be easier to carry electrolyte packets that you can mix and stir. These no-sugar, flavored electrolyte packets offer broad spectrum electrolyte support. My favorite, however, is this raw, unflavored electrolyte drink mix—just electrolytes, no other “stuff”. Flavored packets are available, but the amount of electrolytes in each is the same across the board.

One of my favorite ways to support electrolyte balance is to sip on mineral water, a.k.a., sparkling water. Do not confuse mineral water with tonic water, which contains sugar and preservatives, or seltzer water (which is made by carbonating plain water with carbon dioxide)!  My personal favorite brands of mineral water are Pellegrino and Mountain Valley.

Mineral waters contain varying amounts of calcium, magnesium sodium and/or potassium. And the bioavailability of these minerals when drinking mineral water is good (29).  Ideally, buy mineral water in glass bottles as plastic bottles are a source of microplastics and BPA (bisphenol-A), an industrial chemical used in plastics and an endocrine disruptor. Avoid “flavored” sparkling water, which can include artificial sweeteners.

It’s easy enough to flavor mineral water yourself with a fresh squeeze of lemon, lime, fresh herbs or fruit of choice. Personally, I love to add a knob of fresh ginger root (peel it, crush with flat blade of chef’s knife) to a wine glass and pour cold mineral water over it…SO refreshing!

Coconut water is a source of electrolytes. But, again, read the label. Personally, I am not a fan. Store-bought brands of coconut water can vary in the amount sugar (natural or added; can range from 13 to 20 grams sugar); carbohydrates (can range from 11 to 23 grams); and, the amount of electrolytes they contain. Pay attention to whether you are buying 100% coconut water OR coconut water concentrate (think orange juice concentrate in a can) OR “coconut-flavored” water (For example, Bai coconut-flavored water contains caffeine and only potassium).

Homemade green smoothies—packed with mineral rich leafy greens and a minimum of fruit—are another way to hydrate your body with electrolytes. These are some of my favorites:  Creamy Broccoli-Strawberry Smoothie, Banana-Cacao Green Smoothie, Detox Marathon Smoothie, Summer Cleanser Smoothie and Detox Spinach Pear Smoothie.

Happily, there are many ways—starting with your food and water choices—to keep your electrolytes in check!

 

 

Sources:

1, 2 Journal of Intravenous Nursing. 1994 Sep-Oct;17(5):240-7
3, 6  Roswell Park Comprehensive Cancer Center. Electrolytes.
4, 7  Healthline. How to Prevent an Electrolyte Imbalance.
5  Best Practice and Research. Clinical Endocrinology and Metabolism. 2003 Dec;17(4):623-51.
8 World Journal of Clinical Cases. V2(100; 2014 Oct 16.
9 Metabolic Healing. Electrolytes and the Adrenals/
10, 12  The New England Journal of Medicine. 2017; 377:1368-1377
11  Medical News Bulletin. Electrolyte Imbalance in Alcoholics.
13  World Journal of Emergency Medicine. 2013; 4(2): 113-116.
14  American Heart Association.
15  Cedars Sinai.
16  British Heart Foundation.
17  National Kidney Foundation.
18  Annals of Clinical Biochemistry. 2012 Mar;49(Pt 2):132-43.
19  American Family Physician. 2004; 69(6): 1530-1532.
20  Annals of Pediatric Endocrinology & Metabolism. 2013;18(2): 95-98.
21 Healthsomeness.com.
22 Global Healing. The Health Dangers of Table Salt. Jan 24, 2017.
23 Dr. Jockers. Top 10 Health Benefits of Pink Salt.
24 Dr. Jockers. Electrolyte Imbalance. Symptoms and How to Correct.
25 Chemocare. Electrolyte Imbalance
26 Annals of Pharmacotherapy. Drug-Induced Electrolyte Disorders. March 1, 1983.
27  Center for Science in the Public Interest. Artificial colorings
28  PLOS Medicine. Debras C, Chazelas E, Srour B, Druesne-Pecollo N, Esseddik Y, et al. (2022) Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study. PLOS Medicine 19(3): e1003950.
29 Marktl W. Gesundheitliche Bedeutung natürlicher Mineralwässer [Health-related effects of natural mineral waters]. Wien Klin Wochenschr. 2009;121(17-18):544-50.