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Two years in the past, I had a dialog with my physician that continues to be one of many extra unnerving interactions I’ve ever had. After reviewing the outcomes of a routine blood check, she needed to know if I had just lately skilled any of the next: lack of consciousness, dizziness, confusion, or a seizure. No, no, no, and no. Then she needed to know: Did I’ve an altered psychological state? At that time, debatable.
It turned out I had too little sodium in my blood. Because the physician and I talked, the perpetrator grew to become clear: My wholesome way of life was accountable.
I run or go to the gymnasium day by day. I attempt to eat properly. I drink loads of water, particularly after I’m understanding.
Bombarded by public well being warnings concerning the risks of not consuming sufficient, I used to be afraid of dehydration. Add in cultural myths like the 8×8 rule—eight glasses of 8 ounces of water a day—and way of life messaging that consuming extra water will assist me have higher pores and skin, hair, sleep, digestion, you identify it, and I used to be knocking again not less than 3 liters of water every day. That was on high of my morning coffees, a soda right here and there, meals (water stuffed!), and every other drinks I occurred to have. Sure, these issues depend towards water consumption.
Altogether, I used to be getting an excessive amount of water. Approach, method an excessive amount of.
And now I used to be in peril. Within the physique together with water is sodium—a vital electrolyte that helps your physique preserve its fluid stability, preserves nerve and muscle operate, and retains your coronary heart working, amongst different issues. A wholesome sodium stage is anyplace between 135 and 145 millimoles per liter of blood. Sodium is of course present in meals, and individuals who eat a Western weight-reduction plan have a tendency so as to add fairly a bit further to their meals within the type of desk salt too.
However the physique’s delicate stability between water and salt will be quickly thrown out of whack, particularly throughout train. At one finish of the spectrum is dehydration. On the different is overhydration and hyponatremia, a probably life-threatening situation.
Hyponatremia happens when an individual’s blood sodium ranges drop under 135 millimoles per liter of blood. If somebody drinks to extra, they successfully dilute their blood sodium ranges. On the similar time, water begins to leak into their physique’s tissues, inflicting them to swell, explains Tamara Hew-Butler, a Texas-based podiatrist who focuses on treating and finding out runners. In extreme instances, the mind can begin to swell, resulting in a few of hyponatremia’s core signs: confusion, dizziness, the lack to talk correctly, and complications.
I used to be coaching for a half-marathon on the time that I used to be recognized with hyponatremia, and I used to be simply consuming 4 liters of water or sports activities drinks a day. My physician was blunt: I used to be consuming an excessive amount of and never changing the salt I had misplaced in sweat. And whereas I didn’t really feel as if something was flawed with me, if I didn’t change, I’d be placing myself susceptible to far worse than a headache.
“When the sodium stage begins to creep downward, persons are extra more likely to expertise extra extreme signs,” stated Paul Charlton, an emergency medication doctor and an affiliate school member on the College of Colorado. An individual can lose consciousness, have seizures, collapse, vomit, and fall right into a coma. In excessive instances, the mind swells a lot that the mind stem herniates—a rupture that’s deadly. All of this will occur within the house of just some hours. A number of marathon runners and different athletes have died of overhydration in recent times.
Whereas some individuals will be susceptible to low sodium as a result of they take sure medicines or have an underlying well being downside, exercise-associated hyponatremia strikes in any other case wholesome individuals. Plenty of what we all know concerning the situation comes from finding out ultrarunners and different endurance athletes, in addition to the army. There’s some proof to recommend that ladies could also be extra in danger than males, and whereas it’s unclear why, hyponatremia tends to be extra extreme in smaller people purely as a result of it’s simpler for them to overconsume fluids relative to their physique mass, stated Brendon McDermott, a physiologist on the College of Arkansas and a seasoned marathoner.
It is usually unclear how many individuals might expertise hyponatremia, partially as a result of not everybody reveals signs, Charlton stated. Curiously, some research recommend that sure individuals could be low in sodium on a regular basis, whereas others recommend that some individuals won’t be capable to entry their physique’s sodium shops effectively, tending them towards hyponatremia.
What’s abundantly clear, nonetheless, is that when individuals cease consuming to thirst and as a substitute compel themselves to absorb fluids whereas exercising, their physiology can quickly spiral uncontrolled. (Theoretically, you possibly can additionally overhydrate whereas sitting in your automotive and throwing again Stanley cups stuffed with water, however it might be exceedingly tough.)
Throughout train, the descent into hyponatremia will be exacerbated particularly methods, Hew-Butler stated, not least by sweating out salts. However there’s a hormonal side too: Vasopressin, an antidiuretic hormone, ramps up throughout train, and particularly when it’s sizzling.
“Your physique’s like, ‘Oh my God, I’m shedding water. I’m not going to pee it out,’ ” Hew-Butler stated. By suppressing the decision of nature when you’re shedding fluid by way of sweat, the physique is making an attempt to take care of that delicate water-to-salt ratio and hold every little thing working the way in which it ought to, she defined.
In different phrases, the physique begins making an attempt to retain fluid. Importantly, subbing out water for sports activities drinks is just not going to chop it: “It functionally makes little or no distinction when it comes to individuals’s consequence,” Charlton stated. He and different consultants I spoke to all agreed that the majority sports activities drinks needs to be handled as water. (For context, most industrial sports activities drinks include round 10 % of an individual’s really useful day by day sodium—a 20-ounce bottle of Gatorade Thirst Quencher, for instance, has 270 milligrams, or about 11 %, whereas a 12-ounce bottle of Powerade accommodates 240 milligrams of sodium, which is 10 %.) So in the event you begin chugging sports activities drinks or water halfway by way of a run, then you possibly can shortly swell your cells.
“That’s why typically individuals get in additional bother throughout train,” Hew-Butler stated. “They preload and so they hold loading.”
Confoundingly, hyponatremia’s early scientific presentation—dizziness, headache, confusion—seems nearly precisely the identical as that of dehydration or warmth exhaustion. Hyponatremia will be confirmed solely by a blood check, and whereas medical tents at giant sports activities occasions and emergency rooms have the equipment to have the ability to shortly verify individuals’s sodium ranges, your common Jane—me!—won’t notice the true nature of their downside. And that may make issues worse, quick.
In an growing variety of instances, Charlton stated, individuals who don’t match the everyday mould for acute or exercise-associated hyponatremia are being recognized with the situation.
If somebody is out climbing or taking part in in a highschool soccer sport, and even simply doing a little gardening in sizzling climate, they is perhaps tempted to drink lots of water even when they aren’t thirsty in a bid to keep away from dehydration or merely to chill down, he stated, unwittingly endangering themself within the course of.
Charlton recalled the case of a Japanese lady who was acting on an out of doors stage on a sizzling day. She collapsed and had a five-minute seizure after her act. It turned out that, fearful about warmth damage and following public well being steerage to drink a lot of water, she had drunk about 4 liters of liquid throughout her present. When staffers took her blood on the hospital, they discovered that her sodium stage was 117.
“It was not clear initially [that she had hyponatremia] as a result of she didn’t match their profile,” Charlton stated. “She wasn’t an ultrarunner. She wasn’t engaged in common high-stress actions.”
She was merely making an attempt to handle herself. And doing that earlier than you might be thirsty can result in bother.
“You hear rather a lot about, like, thirst is insufficient, and in the event you get thirsty, it’s too late,” Hew-Butler stated. “However thirst is a organic mechanism that’s been conserved for 700 million years,” she added. “It’s not faulty once you train.”
This resonated with me. I had all the time thought that if I felt thirsty throughout train, and particularly in sizzling climate, then I used to be in bother—dehydrated and susceptible to warmth exhaustion. I by no means as soon as thought-about that I won’t really feel thirsty as a result of I had drunk an excessive amount of.
It’s true that dehydration and warmth exhaustion are extra widespread than hyponatremia—a survey of energetic army personnel in 2024 discovered simply 134 instances of exertional hyponatremia, whereas there have been 471 instances of heatstroke and a pair of,380 instances of warmth exhaustion, for instance.
However McDermott, the College of Arkansas physiologist, famous that whereas dehydration alone is unlikely to kill you, in the event you develop hyponatremia and it goes unchecked, then it might quickly be lethal in and of itself. “There needs to be training on hyponatremia, equal to dehydration,” he stated.
He and different consultants I spoke to for this story stated that folks collaborating in sporting occasions needs to be issued steerage on overhydration, and that public well being messaging should be clearer concerning the particular risks of hyponatremia. Hew-Butler recommended that occasions like marathons ought to really restrict their water and sports activities drink stations to discourage overconsumption.
Charlton argues that public well being officers should be cognizant of hyponatremia once they make suggestions for coping with hotter climate (one thing we’ll solely have increasingly more of as a consequence of local weather change). “In all probability, as extra persons are experiencing warmth with local weather change, there may be simply going to be a unique profile of individual that we have now to have a look at these points in,” he stated.
If somebody is suspected of getting hyponatremia—a situation that’s, once more, tough to diagnose—the primary, neatest thing they’ll do is cease consuming water, Hew-Butler stated. In my case, my physician advised me to drink not more than a liter of fluid—water, espresso, soda, no matter—for a number of days so as to convey my sodium ranges again to a wholesome baseline. As an individual accustomed to consuming 3 or 4 liters a day, I discovered that chopping again was laborious.
Extra acute instances require extra intervention: In some situations, docs would possibly inject a bit of very salty saline into an individual’s blood to attempt to convey up their sodium ranges. If the affected person is ready to swallow, they could make them drink 1 / 4 cup of water containing 4 dissolved bouillon cubes—which actually sounds not dangerous. What about salt dietary supplements? There’s mounting proof that sodium dietary supplements like salt tablets aren’t sufficient to stop hyponatremia throughout intense train, though McDermott stated they doubtless wouldn’t harm both.
On the similar time, there may be no single really useful quantity of water that everybody ought to drink whereas understanding, Hew-Butler stated. In actual fact, you possibly can calculate how a lot fluid you lose whereas exercising by weighing your self earlier than and after an hour of your chosen exercise. The distinction signifies the water weight shed by way of sweat. Aside from that, she and the opposite consultants I spoke to for this piece all had the identical suggestions: Drink once you’re thirsty. Cease once you’re not. Eat salt. And if you end up craving salt on a long term, purchase a bag of pretzels or chips.
Have I discovered my lesson? Kind of. I’ve been recognized with hyponatremia greater than as soon as since that first occasion; my physician thinks I’m a type of those that simply run a bit of low on sodium. However I’ve made adjustments. I make a acutely aware effort to note my thirst whereas exercising. After I know I’m going to be sweating rather a lot, I additionally take an electrolyte combine referred to as LMNT, which I order on-line; it accommodates nearly half of my day by day really useful sodium. I additionally really feel totally at liberty with the desk salt. It’s working for me.
And as Hew-Butler advised me, hydration is “an experiment of 1.” One other method to put it: We stay in a world stuffed with big water bottles. We fetishize a simple well being repair. However, significantly in the event you’re an athlete, take heed to your individual thirst cues and simply say no to large hydration.
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