How to beat electrolyte imbalances and feel better

Woman with headache with one hand touching her head and another holding a mug of coffee
Key points
  • Electrolytes are electrically charged atoms called ions
  • The key electrolytes are sodium, potassium, magnesium & calcium
  • These electrolytes interact with each other and need to be in balance
  • Don’t try to eat low sodium – aim for high potassium
  • Don’t forget magnesium – it affects:
    • Energy production
    • How sodium and potassium move in and out of your cells
    • How much calcium gets absorbed
    • Numerous other bodily functions
Read the article

The rejuvenating power of salty ramen

A couple years back in July, I ran a 31km race with my friend in Japan. It was HOT and by the 18k mark I felt both wretched and impressed with the sheer volume of salty liquid that seeped from my pores. You’d think my legs would be sore, but my joints hurt the most and I had a huge headache.  I ended up finishing with the worst time in my age group. 
After stumbling from the finish line to where my friend was, he suggested we go and eat ramen. I said that sounded great, provided I could sit down and not actually have to eat any – I had no appetite. However, when I arrived at the restaurant, I felt more inclined to give the food a try. Something about that unhealthy sodium-rich broth along with plenty of pieces of sushi doused in soy sauce rejuvenated me. My bones and my spine slowly stopped feeling like tubes filled with eggshells.

Sounds like electrolytes are pretty important – what exactly are they?

Technically speaking, electrolytes are substances that dissolve in water into differently electrically-charged atoms called ions, and enable water to conduct electricity. However, when discussing how electrolytes behave inside the body, we refer to the ions themselves as “electrolytes”.  

The main electrolytes are sodium, potassium, magnesium and calcium

As the name suggests, electrolytes are needed to generate electricity in the body. To understand just how important they are, let’s look take a look at “resting” brain cells. 
The inside of a brain cell (neuron) is more negatively charged than the outside of the cell, which is positively charged. This is because there are a bunch of positive sodium ions sitting outside the cell, and inside the cell are a bunch of positive potassium ions mixed with negatively-charged proteins, meaning the total charge inside the cell is negative. Thanks to this arrangement of potassium and sodium, the cell is ready for action. 
Whenever your brain detects some external stimulus, such as maple syrup dripping on your hand (for instance), pumps and channels on the surface of the cell are used to allow positive sodium ions to rush into cell to the point that the total charge inside the cell flips to positive. This signals a rapid cascade of events which leads to another neuron being triggered and then another is triggered and so on, until you finally notice the sensation of something touching your hand and turn to your waiter and say “hey, stop pouring maple syrup on my hand!” Long story short, this process in the brain can’t happen without all these ions – these “electrolytes”. 

Electrolytes (ions) are essential for transmitting signals in the brain and body

While it’s unlikely to happen, deplete sodium, potassium, calcium or magnesium enough and you could end up having seizures or becoming comatose. In 1993, A 49 year old woman hiked through the blistering heat of the grand canyon. Her sodium and potassium levels fell so low that her speech was incomprehensible and her hands and legs were in “constant, non-purposeful motion”. With proper treatment she recovered over a couple days. A more common situation is electrolyte disorders caused by use of diuretics. In elderly patients, diuretics can make them dizzy and at risk of falling even the day after being prescribed diuretics.

Despite what we’ve been told, sodium is very important

Salt (sodium chloride) and other salty things like soy sauce of course provide sodium. We’ve been told to eat less salt because it’s thought to lead to hypertension and eventually heart disease. However, sodium is very important. This study from the New England Journal of Medicine found that people getting six times more than the WHO sodium intake recommendation had much lower risk of heart disease or death than the people actually following the guidelines.
Chart showing estimated sodium excretion and risk of death
How in the world could this be? These guidelines have told us to drastically limit our salt intake, but not how important sodium is to our bodies. The heart needs sodium to pump blood throughout our bodies. Sodium is essential for digestion, cell-to-cell communication, bone formation and the prevention of dehydration. 

Sodium is critical to the proper functioning of muscles and nerves

Sodium helps muscles contract and nerve impulses travel to and from organs such as the heart and brain. Sodium also helps the body retain water – particular when water intake and/or exercise is low. When someone doesn’t get enough sodium, their blood volume decreases, which can impair brain and kidney function. Interestingly, the diet we’ve been recommended to follow is a low fat, high carb, low salt diet. However, one of the transporters that gets carbs (glucose) into our cells so we can use them for energy is dependent on sodium. This means that a high-carb low-salt increases the risk of blood sugar levels being too high for too long.

“Keto flu” is usually just low sodium

Many people have learned just how important sodium is thanks to the popularity of the keto diet. Maybe you’ve heard of this “keto flu” – a supposed inevitable consequence of your body adapting to the very low carb keto diet. People feel irritable, have body cramps, muscle pain, headaches, brain fog and nausea. However, as Dr. Stephen Phinney explains, your kidneys rapidly excrete sodium due to the sudden lack of carbs. Carbs have this effect because they cause your body to secrete insulin, which then instructs your kidneys to retain sodium. When you cut carbs, the kidneys start dumping sodium. I guess “the too little sodium flu” isn’t as catchy as “keto flu”!

Potassium – The partner to sodium

Potassium is key to heart and skeletal muscle contraction. However, balance is important. Too little and too much potassium in the blood can have lethal effects on the heart tissue. It’s also important for nerve conduction and kidney function. Remember the “pump” I mentioned on the surface of the neurons? Well, that’s actually the ”sodium-potassium pump”. These pumps are not only a huge part of brain function, but they’re in a lot of very important places like your muscles, kidneys and heart. In fact, roughly one third of all the energy made by your cells is used to power all these sodium-potassium pumps. Sounds like they’re pretty important! As you’ve guessed, you need both sodium and potassium to power all these pumps. There’s also something called the “hydrogen-potassium pump” which is of critical importance in the stomach. Long story short, you can’t digest your food properly without enough potassium.

Calcium – More than just strong bones

While a huge amount of the calcium in our bodies (about 97%) is in our bones, it’s actually calcium that makes our muscles move. For your muscles to contract and relax, calcium has to be pumped in and out of the muscle cell. Understandably, low calcium can lead to muscle cramps. Calcium abnormalities affect the muscles, but also have have profound effects on the brain, your gut function, and kidney function. Typically, less than half of calcium intake is absorbed in the gut, the rest either being excreted or potentially forming kidney stones or being transported to soft tissues where it can harden (calcify). 

Magnesium – A requirement for good energy levels

Feeling low on energy? It might be magnesium. Magnesium activates many enzyme systems, including those involved in energy production. ATP is your body’s energy “currency,” and magnesium has an essential role in the production of ATP. In fact, what people call “ATP” is often actually “Magnesium-ATP.” This is because ATP must be bound to a magnesium ion to be biologically active. As it happens, the true name of the “sodium-potassium pump” mentioned earlier is the “Na+/K+-ATPase” pump. Because this pump involves ATP,  having low magnesium intake can prevent it from working properly. There’s also research to indicate that magnesium may help treat migraines, mild to moderate anxiety and even chronic pain.
You need calcium and magnesium for appropriate management of the contraction and relaxation of muscles. Magnesium affects calcium in such a way that it allows for muscles to relax properly. This is why most “calming” drink powders or supplements will contain some amount of magnesium. In fact, the synthesis of DNA, RNA, and protein are dependent on magnesium. Definitely not an electrolyte you want to skip out on if you want to age healthily!

You don’t need low sodium, you need to balance sodium with more potassium 

You may have noticed that these electrolytes seem to have similar functions and interact with each other. Potassium, calcium and magnesium are important for muscles, but sodium plays a role there too. A 2012 paper describes how too little sodium intake during exercise increased cramps and muscle fatigue and reduced endurance. While it seemed at first that the athletes were simply overtraining, when they increased their sodium intake the overtraining symptoms vanished, even though they were actually working out harder.
As the name of the “sodium-potassium pump” suggests, the way to be healthy isn’t to just outright restrict salt intake, it’s to make sure you have enough potassium relative to sodium. One of the early research papers from 1976 that led to the idea that we should reduce our salt intake to improve our health was titled “High Sodium-Low Potassium Environment and Hypertension.” The key point that never quite made it to the public was that high salt could cause hypertension if it was paired with low potassium in certain people. The graph at the very start of this article illustrates that too little salt is bad news. You need more potassium, not less salt. If you want to be healthy, eat salt to taste and worry about upping your potassium intake. And of course, make sure you have enough magnesium too!

Calcium and magnesium need to be in balance too.

Have you ever heard of a “cal-mag” as in “calcium magnesium” supplement? Those two electrolytes are often provided together for a reason. It’s often said that magnesium is great for sleep, for muscle relaxation and for energy levels, and that is true, but you need to balance it with calcium. A 2013 study looking at 75,000 people found that higher magnesium led to higher mortality risk for both men and women if calcium intake was too low.
The interesting thing about calcium and magnesium is that calcium depends on magnesium to be absorbed properly. If you don’t have enough magnesium, calcium can end up getting into the soft tissues which can lead to arthritis. You need magnesium for proper function of two things: parathyroid hormone (PTH) and vitamin D. In order to regulate and absorb calcium properly, you need the same two things: parathyroid hormone (PTH) and vitamin D! Low magnesium and the resulting dysregulation of calcium can therefore lead to bone loss. Conversely, having too much calcium relative to magnesium can make it harder for both calcium and magnesium to be absorbed. Too high calcium relative to magnesium can also cause inflammation.
Spoon containing salt with salt spilled on the ground

How much of each electrolyte do you need?

Sodium vs potassium
In his book “The Salt Fix”, pharmacologist and researcher Dr. James DiNicolantonio says: “Scientific research suggests that the optimal range for sodium intake is 3 to 6 grams per day (about 1⅓ to 2⅔ teaspoons of salt) for healthy adults”.  That’s about 7.4 to 15 grams of salt per day. He says you should balance that sodium out with at least 3.5 to 4 grams of potassium per day (the FDA recommends 4.7 grams per day). Potassium is lost very quickly, so the “per day” part is very important. In case you need a little more reassurance about salt, a 1981 study from Japan found that people could get up to as much as 6 times as much sodium as potassium and still not get hypertension. Of course, that’s not the recommendation. 
The point is – don’t worry about lowering your salt, worry about upping your intake of potassium–rich foods. 
Calcium vs magnesium 
The general consensus is that calcium intake should be not much higher or lower than twice that of magnesium. Specifically, a 2018 review says that “Research suggests that calcium to magnesium ratios <1.7 and >2.8 can be detrimental, and optimal ratios may be ∼2.0 .” That’s close to the current recommendations of 1000 milligrams of calcium per day and around 400mg of magnesium per day for men and 310mg for women, though that ratio of 2.0 suggests we could stand to get 500mg of magnesium. 

Every body is different

While it’s important to keep the above standard dietary recommendations in mind, there are other factors in your life that will affect how much you actually need to take. For instance, you may need to eat more salt than usual if you’re highly physically active and/or the weather is hot and humid. You may need to take in more magnesium than usual if you’re a regular drinker, because alcohol increases magnesium loss. And you may need to take in more potassium and calcium than usual if your diet is highly acidic, because acid load can cause leaching of potassium and calcium from muscle and bone. You should be extra careful if you’re taking diuretics, have high blood pressure or a kidney condition – set your intake based on professional medical advice if so.
In conclusion
Lessons learned
Since my run in the hot summer of Japan a few years back, I’ve found that:
  • Taking a somewhat disgusting shot of salt before runs lets me run much farther and faster (only two weeks after that 31k race, I ran a 20k by myself without any issues)
  • Supplementing with too much potassium makes my heart pound and makes me anxious (sounds like I’m not the only one – see: “High potassium can cause anxiety-like symptoms”)
  • Supplementing with magnesium does wonders for my sleep and helps my muscles relax
  • If I’m feeling low on energy, I can usually trace it to a neglect of sodium, potassium and/or magnesium
Balance is key
While I’m not saying electrolytes are the fix to every ailment, if you’re not feeling at your best, you might want to double–check if you’re getting enough of them. You should also check that your electrolyte levels are in balance. People often talk about how good this or that nutrient or mineral is, but what is key is the overall balance. People often benefit from taking omega 3 (fish oil pills) because they typically have too much omega 6 – they need to be in balance. Vitamins A and D need to be in balance, zinc and copper need to be in balance and the same is with electrolytes: sodium and potassium as well as magnesium and calcium.

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