7 reasons why you may have an electrolyte imbalance

Salt shaker lying on its side with salt spilled on the ground
Key points
  • The main cause of imbalances is lack of dietary intake – primarily potassium and magnesium
  • Not all food is made equal – modern farming techniques can rob vegetables of precious electrolytes
  • You can be deficient in an electrolyte by having too little relative to another, not just in absolute terms
  • It’s easy to develop electrolyte imbalances through exercise, especially when drinking a lot of water
  • Taking diuretics can potentially cause life-threatening deficiencies in sodium and/or potassium
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Reason 1: You’re not eating enough of the right foods

This is the most likely, but not the only cause of electrolyte imbalances. While most Americans consume enough (often more than enough) sodium, deficiencies in the other electrolytes are common:

  • Potassium: Fewer than 5% have potassium intake above the recommended RDA of 4,700 mg/day
  • Magnesium: Around 50% consume less than the recommended RDA of 310–420 mg/day (in fact, even less than the EAR (Estimated Average Requirement – the amount required to meet the requirement of half the healthy individuals in a given life stage and gender group)
  • Calcium: Around 40% of Americans do not get enough calcium from their diet, with 25% taking a supplement

A basic rule of thumb to get the right amount of each is to avoid foods that are highly processed and/or high in sugar (which promotes sodium retention – see our other blog post here for details), and to focus on eating whole foods, vegetables (particularly leafy greens like kale and spinach), nuts and seeds, and a good amount of protein.

Healthy food selection of fruit, vegetables, nuts, seeds and meat

Reason 2: Your food is less nutritious than you think

What happens when you optimize agricultural practices to make veggies grow quicker, bigger and more pest resistant? You get bigger vegetables of course. You also get less nutritious vegetables. Donald Davis and his team at the University of Texas at Austin published a study in 2004 on how the nutritional status of our vegetables changed from 1950 to 1999. They looked at 43 different vegetables and fruits, and found “reliable declines” in their levels of protein, calcium, phosphorus, iron, vitamin B2 and vitamin C.

Why is this happening? Davis says that we have been successful in breeding new varieties of crops with traits that allow them to grow bigger much faster. However, he says “their ability to manufacture or uptake nutrients has not kept pace with their rapid growth.” Simply put, modern plants have less nutrients per bite. 
Soil depletion is also a major issue. Plants get their electrolytes and nutrients from the soil, but modern agricultural methods strip these nutrients from the soil, leaving the plants deficient. A 2016 paper entitled Magnesium deficiency in plants: An urgent problem says that …Magnesium content in historical cereal seeds have markedly declined over time, and two thirds of people surveyed in developed countries received less than their minimum daily magnesium requirement.” The fact that not all plants are grown equally is reflected in varying nutritional information for the same food items – for instance, whereas the University of Michigan Health System states that 100g of pistachios contains 25% of your DV potassium, the APAC Journal of Clinical Nutrition claims the same potassium content for only 5g of pistachios.
While the more likely cause of an electrolyte imbalance is simply not getting enough, it’s worth trying to find food which has been grown or raised in a healthy and sustainable way.

Reason 3: You’re taking too much of one electrolyte relative to the others

Electrolyte imbalances can be caused by taking too much of one electrolyte compared to another. This impairs absorption or increases losses of the other electrolyte
For instance, calcium is dependent on magnesium to get absorbed from the gut into the body. At the same time, calcium competes with magnesium to be absorbed from the gut. Having too little or too much magnesium can impair calcium absorption, but having too much calcium impairs absorption of both. While 40% of Americans do not get enough calcium from their diet, significantly more do not consume enough magnesium
A second example is sodium and calcium. High sodium intake can cause calcium deficiencies, because sodium takes calcium with it when you pee sodium out. A combination of high sodium, high calcium and low magnesium can lead to osteoporosis over time. This is especially the case when the diet has a high acid load. Additionally, high levels of calcium in the urine can lead to kidney stones – particularly when taking calcium supplements
In conclusion, aim for a moderate intake of sodium and calcium, while focusing above all on getting more magnesium. Avoid calcium supplements unless prescribed by your doctor.

Reason 4: You’re losing too much through exercise and sweating

No doubt you’re aware of how salty your sweat is – do an intense enough workout and it’ll get in your mouth or burn your eyes. So how much sodium do we lose when we sweat? According to a 2008 paperpeople working hard in the heat lost as much as 4.8 – 6g of sodium in a single work shift. That’s the equivalent of 10 to 15 grams of table saltThis is a good example of why your craving for salt isn’t necessarily a sign of your “unvirtuousness.” If you’re mysteriously craving pickles, fries, chips or pretzels, your body may be urging you to replace lost sodium.
You can also lose a bit of extra magnesium in the urine and sweat when exercising. While it’s not nearly as drastic as sodium, exercise can increase your magnesium requirements by around 10 to 20%. 
Calcium and potassium loss from sweating is unlikely to be an issue. In study described in Mineral Requirements for Military Personnel, subjects doubled their daily calcium losses from sweat. However, they were subjected to intense conditions – 100 minutes of exercise a day and sitting in sauna-like chambers for hours at a time – so it’s unlikely you’ll ever need to worry about this. Likewise, this paper says that …most studies report that potassium excretion is not consistently affected by moderate to heavy exercise“.
Athletic young man drinking a bottle of water

Reason 5: You’re drinking too much water, too quickly

Water is an essential nutrient and it’s critical that we get enough of it. At the same time, drinking a lot of water too quickly can dilute the concentration of electrolytes in your blood (in particular, sodium) because the volume of your blood increases faster than your kidneys can compensate for. In extreme cases this can lead to a condition called hyponatremia, which is potentially fatal. An infamous case of this was when a woman died from drinking too much water while participating in Hold Your Wee for a Wii” water drinking contest. 
Even in less extreme cases, over-drinking water can be a serious problem. Athletes, army personnel, and hikers can experience something called hyponatremic encephalopathy“, which essentially means “brain swelling due to low blood sodium”. As it happens, in 2002 a female runner died from this condition due to drinking too much sports drink before the Boston Marathon.
We’re often recommended to take sports drinks to replenish electrolytes like sodium. Yet, as this study suggests, sports drinks may not be enough to prevent exercised-induced low blood sodium. This is dependent on your exercise intensity and duration, and hydration and sodium level starting points. It may also be because if sports drinks did contain enough sodium, they would probably taste awful! Research indicates that you should have about 450mg of sodium per hour during athletic events. But with sports drinks you may have to drink 1-2 liters to get that, as most of them contain only 230mg to 570mg of sodium per liter. While it’s better than drinking pure water, consuming large amounts of these drinks can cause the very problem they’re meant to solve!

In conclusion – by all means hydrate, but take your time to drink. A pleasant side-effect of slower drinking is less time spent on the toilet – a study from Canada showed that when we sip water regularly instead of gulping down larger amounts, urine excretion is around six times lower – the body absorbs more of the water you drink! And if you’re doing intense or prolonged exercise, consider ingesting some extra salt beforehand – roughly a gram per hour. Weight out a gram of salt on a scale – it’s a lot more than you’d think!
Hand holding one gram of salt

Reason 6: You’re drinking too much alcohol

Alcohol can cause electrolyte imbalances in three ways – through increasing fluid loss, increasing electrolyte excretion, and diluting the concentration of electrolytes within the body. While your kidneys work hard to main fluid and electrolyte balance, alcohol disrupts the production of hormones that maintain this balance.
Firstly, alcohol increases how much fluid you pee out. While that fluid does contain some electrolytes, depending on your starting hydration status and how much water is in the alcohol you’ve been drinking, this can cause your blood sodium levels to rise too high, because more fluid is lost relative to the amount of electrolytes peed out. This can result in common hangover symptoms including thirst, muscle weakness, dizziness and lightheadedness. And of course, if you drink really heavily, you’re likely to lose electrolytes from sweating and vomiting.
Secondly, alcohol increases the excretion of certain electrolytes themselves – in particular magnesium, but also calcium and sodium. Significant magnesium depletion in alcoholics is common, but even a single day of alcohol consumption can cause acute magnesium loss. One study found that giving subjects the equivalent of roughly two glasses of wine (30ml of ethanol) increased their urinary excretion of magnesium by 167% on average. The same people also peed out 89% more calcium and 32% more sodium after drinking the alcohol.
Lastly, alcohol consumption can dilute blood sodium levels where the alcohol contains a large volume of water – in short, beer. A pint of beer contains 560 ml of water, but only 14 mg of sodium (0.6% of your RDA). Drink enough beer and you’ll dilute your blood sodium levels, then you’ll lose water through alcohol’s diuretic effect. If you are drinking beer, you might want to help yourself to some salty nuts or pretzels to avoid this one-two punch.

Reason 7: You’re taking diuretics

It’s not uncommon for medications like diuretics to cause electrolyte imbalances. Some people take diuretics because of a medical condition such as hypertension or heart failure, and some take them for aesthetic or athletic reasons such as losing water weight before a photoshoot or a contest weigh-in (an infamous practice with MMA fighters). Either way, diuretics should be used with caution:
  • If you’re taking a loop diuretic, you’ll be at higher risk of high sodium and low potassium
  • If you’re taking a potassium sparing diuretic, you’ll be at higher risk of low sodium and high potassium
  • If you’re taking a thiazide diuretic, you’ll be at higher risk of low sodium and low potassium
If you’re taking a diuretic, please be sure to consult your doctor to avoid potentially life-threatening electrolyte deficiencies or imbalances.
In conclusion
Lessons learned
  • Focus on increasing your intake of potassium and magnesium, rather than sodium or calcium
  • Make a habit of checking your food’s nutritional content where available
  • Consider supplementing with extra salt if you’re drink beer often or are very physically active
  • If you must drink a lot of water, sip it rather than chug
  • Only take diuretics under medical supervision
  • Learn more about hydration in our podcast with Colleen Muñoz, PhD

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