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What's All This Salt About? Hyponatremia - The Endurance Athlete's Silent Killer


Endurance athletes can be sticklers when it comes to what they put down the hatch. They have to be picky because they are pushing their bodies well beyond simple physiology. At times however one can become so driven by goals and the athlete's "mental block" that a simple everyday compound can gradually run low. If this compound runs dangerously low an individual can have some very serious complications. In today's world SALT is considered bad and for good reason.....because it is easy to consume too much of it. Processed food contains extreme amounts of salt for preservation. When one consumers meal after meal of processed food the salt adds up.

Salt is a necessary compound for the human body and in the absence of salt our bodies could not survive. Salt is utilized in the body for blood volume and water balance, controlling pH in the body, helping to conduct nerve impulses, and in turn creating muscle contraction. Chiefly the biggest muscle to demand salt is the heart. The prolonged effort of an endurance athlete is why the presence of salt is so critical for both performance as well as bodily regulation.

Most athletes would agree that when it comes to longer bouts of performance they will need supplementation of fluids and possibly foods before completing the task. Hydration is important for sustained activity to prevent dehydration. Significant dehydration is considered 5-10% of one's body weight.

Signs of Dehydration

  • Most reliable sign of dehydration is loss of body weight after competition. To observe this one should weigh themselves dry and naked both before and after activity.

  • Other signs of significant dehydration include severe thirst, dry mouth, difficulty creating saliva/spitting

  • Clinical signs will include these symptoms (you may observe these symptoms on yourself or friends/family): Rapid heart rate, fall in blood pressure, poor skin turgor (skin that when pinched will not rapidly return to a flat appearance), lightheadedness when standing (if present one should lay down with the legs elevated for 15 minutes), internal temperature greater than 104 degree F

  • Severe dehydration can impair the body's ability to regulate its temperature leading to an altered mental state and raising temperatures. This serious condition can lead to heat stroke. This is an immediate concern and must be combatted with cooling the individual

If the individual has entered into a mental confusion during or after activity medical attention is an absolute. In the event that many of the above mentioned signs are present and there is no immediate medical attention available then first action is to cool the individual. Ice packs are a viable option although are less effective than an ice bath. If using ice packs place them to the head, neck, groin, and armpits. If an ice water bath is available then place an individual in the bath for 5-10 minutes until the athlete begins to shiver.

Understanding Dysnatremias

Surprisingly, many athletes including seasoned veterans can blindly lead themselves into dysnatremia. A dysnatremia is a state of either too much or too little salt in the body. Salt is a valuable electrolyte that is needed during athletic performance. Too much salt in the body (hypernatremia) is rare for endurance athletes because our body will release ADH. This is a hormone that promotes retention of fluid and promotes thirst to prompt an athlete to drink more. Taking in more water will help to regulate excessive salt in the body. While hypernatremia is rare for endurance athletes, the other end of the spectrum is very frequent. Hyponatremia, too little salt, is an easily obtainable condition and is promoted by over drinking fluids, chiefly water during athletic competition/training. Hyponatremia is a condition that needs addressed and can be observed with the following signs.

Signs of Hyponatremia

  • Moderate symptoms include dizziness, fatigue, headaches, nausea, vomiting, confusion, "phantom running" (legs continue to attempt to move when running ceases), bloating (swelling can be observed in fingers around tight fitting rings, watches, wristbands, etc)

  • Severe symptoms include altered mental state (confusion, disorientation, aggressive), coma, seizures, heart arrhythmias, death

  • Clinical signs include: stable heart rate and blood pressure, body temperatures under 103 degree F

  • Moderate to severe states of hyponatremia can encourage heart arrhythmias with signs of syncope (feeling of passing out), shortness of breath, dizziness, heart palpitations, or chest pain during activity but can RESOLVE with recovery. A key take home is the fact that a routine EKG may appear NORMAL in an office but if you are consistently feeling any of these symptoms during physical effort then you need to request a stress test so physiological stress can be seen DURING testing.

So How Much?

As you can see the signs of dehydration versus the signs of hyponatremia are both concerning and can both lead to threatening conditions. Dehydration can be prevented by drinking at the first signs of thirst and drinking just enough to satisfy that thirst. The body can actually continue to provide adequate effort during exercise on less water than most believe. Think about the fact earlier in the article. Significant water loss is 5-10% of your body weight. For a 150 pound individual that is roughly 8-15 pounds of water! Hyponatremia is no laughing matter and can be prevented with routine application of salt supplementation during prolonged activity. Because of so many individualized variables there is no absolute when it comes to salt intake during exercise.

As a general rule of thumb for efforts over one hour, you are going to need more than simply water and should include electrolyte supplementation

When in hot and humid climates you are in higher need for electrolyte supplementation. Nuun and Hammer nutrition supplements are quick and easy methods of delivery for electrolytes. However, if you are on a tight budget you might consider good old fashion table salt. A general guideline is 200-400mg of table salt per hour of activity depending on exertion level. We like to use this remedy for both sugar and salt supplementation during exercise.


Homemade Electrolyte Replenishment Mix

1. Two Parts Water

2. 1/4 Part Orange Juice

3. 1/8 Part Lemon Juice

4. 1/8 teaspoon table salt

5. Honey to taste

This homemade mix contains fluid for hydration, electrolytes for avoiding hyponatremia, and both glucose and fructose for energy supply. Not to mention it is light on the pocketbook. So go out and enjoy being active, perform at a high level, and set some new personal records!

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Total Physical Therapy
3701 A1 Olsen Blvd 
Amarillo, TX
806 467-8181
806 467-8282 fax
Official Physical Therapy Center for the Amarillo Venom, Amarillo Bulls, and FC Amarillo Bombers

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