Every Spring, there is a good amount of news about hyponatremia, or decreased sodium concentration in the body, and most all talk about how to eat and drink before, during, and after training (exercise). As simple as it sometimes sounds, most people get confused by the contradicting information — (Eat more salt?) — Use a higher/lower carbohydrate solution. — Drink more water — Use salt tablets. The list goes on and on. So enough of that. Let’s talk about know to keep your electrolyte balance stable as well as learn the answers to those questions you may have thought of here and there but didn’t get a straight answer to such as – Why do some people sweat out so much salt that their shorts or their bike helmet chin straps turn from black to white? Why do some people crave salt, and others don’t? Why do some people always feel thirsty even though they are constantly drinking water and constantly going to the bathroom? Why do some people get dizzy or lightheaded when they stand up or get out of bed too quickly? Why does my significant other involuntarily twitch or jump as they’re falling asleep? The answers to all these questions are probably not what you’ve been told by a friend or unenlightened doctor. “That is normal. It happens to everybody.” Well, you don’t want to be like everybody else, and in this case, you certainly do not want to be “normal”.
Your body normally excretes sodium and chloride in urine and sweat. When it loses too much, or retains too much, problems arise. The levels of sodium and chloride, (which I will now just refer to as sodium for simplicity), are regulated by aldosterone levels. Aldosterone is secreted by the adrenal glands, which are the small endocrine organs sitting just on top of each kidney. They cause the kidneys to resorb sodium and maintain electrolyte balance in the body. Maintaining electrolyte balance also means maintaining water balance. When aldosterone levels are low, excessive sodium is lost in the urine and sweat. So aldosterone is a major player in how well you will keep sodium and water in your body during a race, or all day long for that matter.
So how do aldosterone levels become diminished? The answer to that is stress. Under stress, especially chronic stress, the adrenal hormones become depleted and no longer function as optimally as they should. Although this is not a pathological response, and therefore not medically recognized, excessive and high stress levels directly fatigue the endocrine glands where our stress hormones, such as cortisol and epinephrine, are produced – the adrenal glands. Hypoadrenia, or a lowered production of adrenal hormones, is a functional problem found in the vast majority of athletes and persons with high stress levels. Yeah, that’s most people living on this planet.
When the adrenal glands are no longer functioning optimally, a person loses excessive amounts of sodium in their sweat and urine. But along with the decreased aldosterone levels, the adrenal glands also slow down on their production of cortisol, the body’s natural anti-inflammatory hormone and the same one used to help balance blood sugar. Many athletes end up needing a shot of cortisone for symptomatic relief of joint or muscle pain. Yet we naturally make this compound in our body, in the necessary amounts, when the adrenals are working well. Decreasing the nutritional, emotional, and physical stresses will take the burden off the adrenal glands allowing them to produce normal amounts of cortisol so inflammation can be dealt with as needed. Decreased cortisol levels are seen in persons with chronic joint and muscle aches, as well as chronic fatigue syndromes.
So onto the “But why?” questions. The hypoadrenic person/athlete has low aldosterone levels and loses too much sodium. Therefore, they crave sodium, especially after prolonged exercise. Their clothes look white, their skin is salty, and the family dog thinks their leg is a giant salt lick. When sodium levels are low, hydration status is low because the cells cannot absorb water. Drinking plain water at this time just ends up sitting in the stomach, sloshing around during a run, unable to be absorbed. This is also the person who may be constantly drinking water and their urine is always clear. Yet they are actually dehydrated. They are not absorbing any of the water; it is just passing right on through. So taking in some sort of electrolyte drink or salt tablets is a good idea at this time, but even better is fixing the problem at the source, the adrenal glands. That means dealing with the stress in life.
The kidneys and adrenal glands play a major role in the regulation of blood pressure. Normally, when a person goes from a lying to sitting position, the blood pressure should slightly rise. From a sitting to standing position, it should rise some more. But with the hypoadrenic individual, the blood pressure actually stays the same or drops during these postural changes, instead of rising like it should. This drop in blood pressure causes dizziness and sometimes a darkened view. When the problem gets worse, and the blood pressure drops too much, a person can black out. That is why you may feel dizzy or lightheaded upon rising. It is not normal, and it is not healthy. It is due to adrenal insufficiency. Next time you have your blood pressure taken, do so in the different positions, there is no rule saying that it has to be done in a sitting position only.
The last point to be made about the adrenal glands involves the electrolyte potassium. The balance between potassium and sodium is extremely important. Sodium mostly lies outside the cell, potassium inside. When excessive sodium levels are lost, potassium levels are at a higher perceived level in the body, due to the imbalance. This imbalance confuses the nervous system and does not allow for proper firing of certain neurons, hence the “jump” or twitch in muscles, usually at night. Heart palpitations, or a “racing heart” that some athletes feel can also be a result of this phenomena. Of course, you should have this checked by a qualified physician if it persists.
Everything just covered is considered normal because it is exhibited in the majority of people, especially athletes. Correcting the problem, the adrenal problem, will not only save you the hassle of trying to figure out the exact fluid ratios, but it will perhaps resolve many nagging health problems. The time it takes to correct the adrenals depends on stress levels, and how long that stress has been present. It may not be something you can do yourself. But you can start by lowering nutritional/chemical stress, which means eliminating caffeine, hydrogenated fats, and refined sugars. Physical stress is lowered by training aerobic more often and using proper technique and posture, when training and at work. Emotional stress is the stress that I just put into your mind because you read this too quickly and are overwhelmed by the information. Seriously though a lot of people deal with chronic emotional stress due to jobs they hate, working with people they don’t like, and family members they no longer have good relationships with. Understanding this will lead to better health, less injuries and illnesses, faster recoveries, and a faster you.
Sharon LeBrun says
I have had severe adrenal fatigue for a number of years and am doing all I can to get well. I have made some progress with supplements, diet and rest but still have a ways to go before I consider myself normal. I am also planning on doing the 2-week carb-free test to see if that helps. I know carbs are an issue (although I don’t eat that much) because I have peripheral neurophathy (non-diabetic) with a lot of burning, tingling and numbness especially at night and my feet react almost immediately to carbs, especially anything refined. I have long been convinced that there is a direct relationship between the adrenal fatigue and the symptoms with my feet because the weaker I am, the worse my feet become. Do you think this is true and can you offer any advice? Thanks
Yes, that is a true connection and good for you for realizing it. Try the 2 Week Test or the FODMAPs Diet.
I went to a health and wellness doc. Found out I had very low adrenal and also thyroid along with a few others. If one gland is off then it causes other glands to go off key. A normal TSH test which a reg. doc gives will not catch thyroid disorder. You body needs to play like a symphony. Get to a health and wellness doc or holistic doc. It’s worth it to find out.
Would spironolactone taken for acne cause hyponatremia when combined with crossfit or exercise on hot days
This article is a revelation to me. I have had frequent urination since I was a kid, but I assumed it had to do with a urinary stricture. However, I had the stricture repaired three months ago and can now pee normally; but the nighttime frequent urination is still a problem (I sometimes go 4-5 times a night). I have had my prostate checked and all is well. The strange thing is, I don’t understand how it could be stress related, because though I have had stressful times in my life I am generally not very stresses and there is no variation in urinary frequency between the stress periods and non-stress periods.
But another thing in the article that hit home for me is that I am an endurance athlete and chronically overtrain, so I’ve always wondered if my sodium/potassium was out of balance, but blood tests have revealed normal levels. I am also prone to severe cramps during exercise, sometimes debilitating. No doctor has even come close to explaining any of this, except to tell me my electrolytes are out of balance (no duh!).
So your explanation of the adrenal function has me paying serious attention. But what the article doesn’t go much into is how to fix it, besides eliminating stress. I am very low stress right now, not currently working and lower level of exercise because it’s my off-season (but still working out moderately five times a week).
So, what should I do? Would love to see you, if I lived there instead of Nevada. What type of clinician should I see here for adrenal function problems?
Thanks much, this is an incredible health resource!
Check out the Sock Doc site – more info there on the adrenals especially under the Training Principles.
Colin, you need MAGNESUIM! Muscle cramps are directly related to magnesium deficiency. Get magnesium tropical transdermal lotion and/or spray and apply directly to the affected cramping muscles after shower daily (directions are on the bottle).
Plus take a good oral magnesium supplement such as Calm magnesium. You have to he sure you’re also taking enough vitamin D3 as well. If you eat dairy and or leafy greens you won’t need calcium too.
Spencer 3561 says
The answer is very simple, sea salt and water or take magnesium supplements. I have suffered from serious leg cramps before and it stopped after I started putting a quarter teaspoon of sea salt to a gallon of water and drinking it daily. Some people can use a 1/2 of a teaspoon to a gallon of water and does fine. See what works for you.
I should mention: I am 45 years old, and have been vegetarian for 25 years. I have chronically eaten way too much wheat, carbs, and sugar, but have stopped eating bread, most wheat products, and many sweets in the last year. I use almond milk instead of soy. Honey is my primary sweetener, trying to cut down on that as well. Mostly I eat veggies (lots of kale), tempeh, quinoa, and recently have added a couple eggs a few times a week (I seem to crave them). Make lots of veggie stews. I take a flax seed supplement for by omega 3s. Anyhow, thought that might be helpful as you view my previous comment.
Chad Grieves says
I rarely cramp during epic training sessions and the past 2 Ironman races I cramped the last 10 miles of the bike and both quads locked up on the run. I was able to push through it but felt terrible. I load with sodium phosphate 4 days prior to the race and use Hammer endurolytes, Perpetuem and Heed ( consume 24-26 oz fluid per hour and consume 280 calories all liquid). I have heard that Cordyceps can cause cramping but was wondering about the Sodium Phosphate and if Apple Cider vinegar messes with my calcium absorption or magnesium levels. I spray with Magnesium oil and put on feet each night so just perplexed. Cramping is a tough one to figure out.
Have been suffering from adrenal fatigue symptoms for several year.I am a runner. Is it possible to recover while continuing to train and race? Pretty sure I know the answer and I don’t like it. My last marathon was ruined by constant lower leg cramping. I also have ALL of the muscle and back symptoms mentioned in your other article. Thanks for any advice.
Check out the Sock Doc site – specifically the Training Principles.
I had an left adrenalectomy 8 years ago secondary to an bening adrenal mass. Since then, I have battled with chronic fatigue, hospitalizations due to critically low potassium and sodium levels, which were causing syncope, bradycardia and hypotension and sever muscle cramping and sometimes chest pain. My chronic fatigue caused me to have to go on medical leave for a short period of time. I am a runner and an avid cyclist. Unfortunately, because of the chronic fatigue, it is hard to sometimes do the things I love. I have gone to several medical doctors, mostly endocrinologist, which have all offered little help. The article talks about all the things not to do and to avoid…but can you please offer more advice on things we should be doing??! I am desperate to feel better. I am in my thirties and can’t bear the thought of feeling this way for the rest of my life! Thank you!
Check out the 4 part series on the adrenal glands on this site.
Alastair Terry says
I suffer from frequent urination – both during the day and at night.
Although I drink lots of water, I still seem to be dehydrated a lot of the time.
When I eat something with a high salt content (such as some soup from a can), my problem seems to get worse. I feel more pressure inside of me, and my urine flow goes extremely fast or even sprays everywhere. It is like my body is trying to reject something quickly.
Do you have any suggestions for me?
Check out the four part adrenal series on this site.
Doc can you please provide a link I can’t find training principles anywhere. You are fantastic thank you for this information.
Hello I have Adreanal Fatigue. I also always feel dehydrated and I drink a lot of water, I have low sodium and blood pressure, I am tired all of the time.
I read your article and I was wondering is there any supplements and the brand names that you recommend for my adreanals.
What type of vitamins would help should I just take adreanal support or other vitamins also? can you please also give me the brand you recomend :) Thank you very much Jeanine
I can’t give specific advice on what you should or should not take.
Dolly Jewell says
Help. I am in extreme pain. I wake up repeatedly with such severe muscle spasms across my hips it’s not funny. I am urinating 30 x a day or more. i feel dehydrated but drink 8 glasses of water a day. My back legs, and feet are killing me. What should I do?
Dr. Stephen Gangemi says
I think you should find a qualified physician to help you. Urinating 30X a day is definitely not normal!
I had a bit of an unexpected situation a few days ago.
I went off to do a half marathon in the desert at night.
Despite drinking water regularly prior to the race (urinated only once) and during the race, I was not absorbing hydration. Half way through the race I began to experience cotton mouth, nausea and discomfort. I walked the remaining half of the race fighting nausea and dizziness. At the finish line I was not well at all, the nausea persisted. I decided to try to vomit and, when I did, huge amounts of fluids came out. Felt immediately better after that. During the following 48 hours I have drank very large quantities of fluids without urinating much.
Some background info.
The prior month I completed a sprint triathlon in an artificial lagoon. I felt good and did not think I over exerted myself. Within 24 hours of completion I came down with severe urinary tract infection both upper and lower.
Went on a 4 day course of Levofloxacin followed by 3 days of Nitrofurantoin. I stopped taking these drugs 2 weeks prior to the half marathon
Any ideas what may have happened that prevented me from hydrating during the half marathon?
Dr. Stephen Gangemi says
The meds could have possibly affected how you absorb water or your adrenal glands could have been so taxed that the electrolyte imbalances prevented good water absorption.
Sandra G. Elden says
Hello, I am 68 am thirsty all the time, day and night and sometime get rid of it within about an hour. I do have a lot of stress in my life taking care of my husband who had a heart attack and stroke 8 years ago. My skin is dry and never used to be, my hair is still on the normal to greasy side. I wonder why my body is not absorbing water? Appreciate any help you can give.
Dr. Stephen Gangemi says
Check out the adrenal gland series on this site – the 4 parts.
I walked the 22 mile north to south rim hike in the Gand Canyon a few years ago in temps over 108 degrees. We had excellent guides with proper water, electrolyte supplements, food… But, I became violently ill due to the fact that my body would not absorb the electrolytes and water. If I drank, I immediately had to urinate. I had just stopped taking antibiotics for strep. Could the antibiotics have been the reason for this? I want to go back (in lower temps) and try it again but my experience was not so great. I’ve never had the issue since that time.
Dr. Stephen Gangemi says
Sure the antibiotics could be a factor along with the altitude and high temps.
thanks for this article. I suffer from migraines a lot &certain literature points towards potassium/sodium and low carb. This actually helps! But how do I know what the right ratio pot/sod is?
Dr. Stephen Gangemi says
Personally I don’t think most migraines are from a mineral imbalance. But if it was, you’d have to try different ratios to see what works best for you.
Hiya not sure if I will get s reply as this post was ages ago but have just seen it . I have low pressure which causes dizziness and occasional headaches . My gp thinks it’s hormonal and migraine related and lack of sleep as I have a severely autistic son who doesn’t sleep and I have no help . I drink loads of water all the time .. what could I add to my water to help as at my wits end . I am still breastfeeding my son so can’t take lots of supplements . I have been referred to a cardiologist but my ecg was fine . It can go away for a few weeks then comes back and my eyes hurt and I I’m scared to even stand up which I have to do as my sons cater. Any suggestions would be amazing . Fingers crossed ????
Dr. Stephen Gangemi says
Hi – check out the article series on adrenal glands; it should help you out!: https://drgangemi.com/health-articles/hormone-health/adrenal_glands/