Healthcast 634 - Sweating, Electrolytes, and how to Combat Dehydration.

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I learned about electrolytes in medical school as the substances Sodium, Chloride, Potassium, Calcium, Magnesium, and Phosphate we check on a metabolic panel. However, electrolytes are much more than values on a blood test. These minerals are some of the most vital substances needed to keep us alive. Electrolytes can get out of balance in normal daily life and put us at risk of illness and death if we do not replenish them orally along with rehydration with water. Our kidneys and hormones manage electrolyte concentrations as our intake of these substances in our food and drinks replenish electrolytes that are lost in urine, sweat, and bowel movements. We are not conscious of the bodily mechanisms that manage our water balance, urination, keep our blood pressure normal and supply our brain with these vital nutrients to maintain consciousness, and we become symptomatic only when we are severely deprived of them.

In my medical training, I also learned about how illnesses, and medications affect the amount of each electrolyte in our body however what I didn't learn was how important it is for healthy people who exercise in the heat to replace their electrolytes. You don't have to be an NFL football player or play in the NBA to require electrolytes when you exercise. With inadequate electrolytes you can become weak, and confused, lose muscle strength, faint or completely lose consciousness when you are working or playing games in the heat, even if you are drinking water!

To make my point I'll relay a personal experience that you may have experienced as well, while playing a game outside in the heat. I don't play much golf, but I do play in charity golf tournaments. They are generally timed at the height of the summer heat, and they take almost twice as long as a usual round of golf. This scenario sets all the players up for dehydration and a deficiency of electrolytes. For several years in a row, I noticed that I was well hydrated for about 3 hours by drinking 3 or more bottles of water while I played the first 9 holes. By the 10th hole I was becoming physically weak and mentally slow. I felt I should be ok because I was drinking water and staying hydrated. However, I felt like I was playing golf in Jell-O. I continued to drink water because I thought I was dry, and that is what I thought was wrong with me. Not so…instead of feeling refreshed by drinking endless water, I got worse. Two years in a row I didn't finish the 18 holes.

What had I done wrong? I started using my diagnostic brain to figure out what I was missing. Was I sick or was there something wrong with my metabolism? While I was watching a pre-season football, I noticed the Gatorade that the players were guzzling. I had never tried Gatorade because of the amount of sugar in that drink. I pulled up the contents of Gatorade and found that not only did it rehydrate the hot and sweaty players with water and sugar, but it contained all the electrolytes that players lose when they sweat and exercise in the heat! Bingo! I bet that was what I needed to finish the golf tournament….electrolytes!

It turns out that I had been half right by continuing to drink water, however the more water you drink while you are exercising the more your electrolytes are diluted! It is not a reason to hold off drinking water, because dehydration can damage your kidneys and you can get heat stroke, however adding electrolytes is vital to surviving exercise in the heat. The following year I armed myself with many bottles of water and plenty of electrolytes in the form of NUUN. To every third bottle of water, I added NUUN electrolytes tablet…voila! I could play 18 holes in hot weather and sweat for 5 hours without fainting, or losing muscle strength, and quitting!

So how do you know when you are getting dehydrated and low on electrolytes? You pay attention to your symptoms! Like everything else, the symptoms of electrolyte deficiency is somewhat individual. The possible symptoms of electrolyte imbalance, either high or low electrolytes are listed below:

· Dry mouth and thirsty

· Restlessness

· Mental Confusion

· Weakness-overall

· Inability to stand up

· Muscle weakness

· muscle spasms

· Fatigue

· Heart palpitations

· Constipation

· Nausea or vomiting

· Diarrhea

· Slow or irregular heart rate

· Low blood pressure

· Headache

· Difficulty breathing

· Low or high blood pressure

· Fainting (Syncope)

Remember I'm talking about electrolyte imbalance that is associated with sweating, exercise, diarrhea, drinking a lot of water without electrolytes while exercising, but the same symptoms can come from food poisoning and the severe fluid losses that accompany diarrhea and vomiting.

I am not talking about electrolyte imbalance that can be a specifically related to chronic medical illnesses, medical treatments and medications. These imbalances are specific to a particular

electrolyte loss and are not treated with global oral electrolyte replacement, and requires an ER or Urgent Care for rehydration.

You may not think you need electrolytes but if you take diuretics, or if you go outside in the summer and perspire for long periods of time, you are at risk of losing your electrolytes no matter what your age, however, you become more likely to have this problem as you get older.

By the way, one of the most dangerous factors in electrolyte deficiency is alcohol consumption! Drinking alcohol uses up your magnesium and sodium, so if you drink while playing golf on a hot day, you are at high risk of having dangerous electrolyte deficiencies that can end in seizures and death!

Treatment for severe dehydration, and or lack of electrolytes is IV fluids with electrolytes in the ER. IVs with normal saline plus electrolytes will effectively treat dehydration from vomiting and diarrhea as well as from heat related dehydration, low electrolytes.

I don't own any stock in NUUN or Gatorade, and my go-to prevention would be to add electrolytes NUUN SPORT to every 3rd large bottle of water while actively exercising in the heat, or drink Gatorade instead of plain water every 3-4 bottles of water. Gatorade comes in G0 which is without sugar, or G2 has a much lower sugar content. People without diabetes who are actively exercising can drink some sugar while they are exercising, and it does help muscles to function when they are stressed. Those with Insulin resistance or diabetes should use Nuun, Gatorade zero or G2.

As I say all the time—prevention is the best treatment! Be prepared …. with an electrolyte containing treatment to take BEFORE you feel dizzy or weak!

· Drink plenty of water while exercising, especially exercising in the heat, or spending hours in the sun

· Every so often drink something with electrolytes in it (NUUN-Sport or Gatorade products)

· When you start to feel weak, dizzy, muscle fatigue, Stop exercising, rehydrate, and consume salty products if you don't have electrolytes with you, and lie down in a cool place.

· If you have symptoms of severe dehydration, muscle cramps, you stop sweating, and have changes in your ability to think, you should call an ambulance or go to the Urgent care or the ER for IV rehydration and balance electrolytes right away. Do Not drive yourself!

· This condition can be life threatening!

Just a little personal story: My husband (age 71 and I was 67) and our best friends (71 and 60) went to Cinqua Terra in northern Italy to take a famous hike between two of the towns perched high on the cliffs above the Mediterranean between Monterosa and Vernazza. It is beautiful walk and we had been looking forward to it. We were told it was 3.5 miles so we packed 2 large bottles of water each, I took NUUN electrolytes with me just in case, however we thought we would be hiking early in the morning. Then multiple roadblocks occurred to our plan—the ferry we were supposed to take was not running that day, and it took us 2.5 hours to get to the starting point of the hike. We started hiking at 10:30 am and the day was in the high 70s, and we were hiking in the hottest time of day. We were already behind the 8 ball, but we didn't recognize it, and we had had a very early breakfast, so low blood sugar played a part as well.

Our plan was to be finished well before lunch time. You can imagine the rest…we are all great at sweating, especially my husband. John is 6-4 and 240 so his body required more water and electrolytes than the rest of us with normal body indexes. It took us more than 3.5 hours and it was hot and we were going up and down thousands of stairs made for donkeys..they were very high!

You can imagine the rest…we'd finished almost all our water by the halfway mark, and there is no place to get off the trail, or to get help. My husband began to feel weak and developed a headache, and dizziness. He was sweating profusely and couldn't continue after 2/3 of the trail.

I had 1/3 of a bottle of water left and put a whole NUUN tablet in it (which he said tasted nasty)..but he drank it and laid down in the shade for 30 minutes. He rallied enough to get him to Vernazza, but there is no ER there, so he got cool by soaking in the ocean and recovered with water and more NUUN. I was monitoring him, checking his pulse that was thready, and his breathing.

I am not sure what would happen if We hadn't had water and NUUN.

Protect yourself and your family with being prepared for summer exercise.