Osteoporosis and Hyponatremia

We’ve been told for decades to avoid salt. Perhaps that made some more sense when Americans were eating a lot of canned goods and food with preservatives. That is no longer the case. Americans have been improving their food choices (although still tons of room for improvement). Avoidance of salt in an otherwise healthy diet is not great advice. We need salt in our diet, and avoidance of salt can lead to hyponatremia.

If you’ve seen marathon runners collapse, it’s because of hyponatremia. Hyponatremia is a state where the concentration of salt in the body is abnormally low. Most are familiar with dehydration and it’s likely more common, however hyponatremia is not talked about quite as much and can be deadly. As discussed in this article, it can cause confusion, nausea, headache, and swelling of the brain which can lead to death if severe enough. Another problem that it has been linked to is osteoporosis. 

Our bones are storage reservoirs for minerals such as calcium, phosphorus, and salt. This is what makes them hard. When our fluids are deficient in a mineral, the bone will release what is needed. This is a constant dynamic process of minerals coming and going. Osteoblasts form bone and osteoclasts break them down. 

Dozens of studies have confirmed that there is a significant association between hyponatremia and osteoporosis, and many of these studies conclude that the likely mechanism is due to bone salts being released to restore balance.

So, unless you have high blood pressure, salt your food to taste. If you have high blood pressure, work on getting that down first. High blood pressure is usually caused by insulin resistance and adopting a low carb diet may improve symptoms. Of course, consult with your physician or a dietician first. 

Electrolytes and Alcohol

The body is pretty good at keeping an electrolyte to water balance, which is important for nerve conduction and muscle contraction. When you drink alcohol, you may notice that your urine turns clear, a sign that this balance has been disturbed. Here is how it works:

Under normal conditions, the kidneys monitor this balance. As they sense you are becoming dehydrated, the kidneys send a signal to the brain. In turn, the pituitary gland releases antidiuretic hormone (ADH) which tells the kidneys to retain water. Then you will dump some of your electrolytes out when you urinate to restore balance, hence the darker urine color. 

Let’s assume you are in a balanced state of water to electrolytes. As you consume alcohol, it has an effect on the brain, and throws this system out of sorts. It inhibits the release of ADH. Without this important signal, the kidneys do not know to hold on to water, and then you release the fluids you consume through your urine, becoming clearer each time. 

Fast forward to the morning. You’ve depleted your water, but the electrolytes have remained. You are in a salty state. The first time you go to the bathroom, it will be darker than normal as the body is now trying to restore balance. This is likely what causes a hangover; the whole system is dialed down like a dimmer switch. You no longer have adequate water or electrolyte levels. Remember, you need this dial turned up for normal function (especially the brain which is a resource hog-likely the source of headaches). What happens next is a bit of a roller coaster ride.

You’ll probably get up and drink a bunch of water, which is a good thing but now puts you in a state of hyponatremia. This is a state where there is too much water compared to how much salt you have. Hyponatremia will cause a feeling of bloating. Wedding ring suddenly tighter, or swelling in the feet? This can be a sign of hyponatremia and is explained in this article. 

Then perhaps you go out for a nice salty breakfast. You’re craving salt because your body is telling you to restore balance. It’s kind of like driving a truck down the highway and hitting a patch of ice; you swerve and drastically cut the wheel, but overcorrect and swerve the other way back and forth until you finally level out. This is the body trying to restore homeostasis, or balance. 

You can accelerate this process by adding some electrolytes with that water in the morning. That’s why gatorade or pedialyte may make you feel better. However, I prefer to skip the sugar and just add some salt to my water, or use an electrolyte package like LMNT.

If you want the video version of this description:

Overhydration

We are all familiar with how important it is to hydrate, and you’ve probably been told by a medical provider that you have to hydrate more. However, there is such a thing as too much. As with everything in the body, it’s all about balance.

The balance, in this case, is all about electrolytes and water. The body is a bioelectric machine and requires the right balance of fluids to conduct signals like nerve impulses that create muscle contraction. When you eat and drink, the body takes what it needs to keep this balance, and then excretes the rest out. You can easily see this after a salty meal when you urinate. That’s the body dumping out the excess salt. Conversely, if you haven’t had enough salt, the body will excrete more water and your urine will be clearer. 

Dehydration has its risks and you won’t live long without water. However, overhydration can be just as deadly. When you gulp down tons of water prior to a sporting event thinking that it’s a good thing, you can develop hyponatremia. That means that you’ve diluted the fluids and now you don’t have enough salt. Under normal circumstances, the body would just eliminate some water and restore balance. However, if you are a distance runner, you likely are not going to stop to pee. Then if you continue to hydrate, you could get yourself into some trouble. 

Water in the body resides both inside a cell (intracellular), and outside the cell (extracellular). The extracellular fluid is primarily in blood plasma, with a small amount residing in the lymph. About ⅔ of the water is in the intracellular fluid and ⅓ in the extracellular fluid. When you are overhydrated, in an attempt to restore electrolyte balance, water will move from the bloodstream into the cells. This will lead to puffy fingers and toes, and even worse, it can cause hydrocephalus. This means swelling in the brain, and it can be deadly. 

There have been many instances of runners collapsing and dying from overhydration, and many more hospitalizations. So how do we know how much water to drink? This is a complicated question and depends on many factors, such as the type of sport, conditioning levels, male vs. female, body weight, sweat rate, environmental heat, etc. There are some symptoms that will clue you into the early signs of hyponatremia. If your wedding ring is feeling tighter, that’s a sign you have too much fluid retention. Other signs include confusion, cramps, vomiting, and headache. If it goes on for too long, one could go into a coma, have seizures, and even die. 

Part of the issue is that we’ve been told how important it is to hydrate, however this may be an overcorrection and there is a history behind it. In the 1900’s, athletes were told not to drink during a sporting event. Then in the 1960’s, gatorade was invented by a physician at the University of Florida that improved performance for their football team. A whole industry was born around rehydration. As humans do, we overcorrected to the point where many athletes are now overhydrating (thanks to Precision Hydration for the history summary). There are lots of recommendations out there for strategies to optimally hydrate, but bearing in mind all the individual differences we have and all the factors that go into fluid balance, there is no one size fits all answer. Precision Hydration is an organization that has a free online test you can take to give you an idea of what you may need and will even give you a hydration plan. Check it out here.