Hydration and Electrolyte Balance for Optimal Wellness

Hydration

What do you think of when you hear the word hydration? I bet water comes to mind first. Water is vital to our survival and prevents dehydration.

But it’s not just water acting alone to hydrate us. Optimal hydration depends on maintaining balance between water and electrolytes in the body.

So hydration is not just about checking off the cups of water you need to drink each day, but it’s about ensuring you are also consuming the proper amount of electrolytes to go with it.

To understand how water and electrolytes are essential for hydration and other important physiological functions, it helps to know what happens at the cellular level with water, electrolytes, and other nutrients.

Cellular Hydration

If you zoomed in on your hand, you would find that it is made up of tiny cells, which look like tiny, rounded bricks or bubbles packed closely together, each containing a small nucleus at its center.

Cells are the tiny building blocks that make up all the organs in our body, such as the liver and heart, as well as tissues like fat and muscle. In essence, they form the entirety of our being.

And it is inside of our cells where our metabolism occurs, which is our ability to convert nutrients from our food into energy that powers everything from our heart beating, muscle function, brain function, and digestive system, just to name a few.

Our metabolism depends on nutrients moving from our bloodstream into our cells, and water is crucial for this process. Water helps maintain the right balance of fluids and assists in transporting nutrients into our cells, where they support vital functions.

But it’s not just about water that keeps this balance. This is where electrolytes come in.

Electrolytes

Electrolytes are minerals that carry an electric charge. Some have a positive charge, like sodium and potassium, while others have a negative charge, like chloride and bicarbonate.

Our body is roughly made up of 60% of fluid. All body fluids contain electrolytes. Our body maintains homeostasis by ensuring that positively charged electrolytes are balanced with negatively charged electrolytes in every part of the body. This balance keeps the fluids electrically neutral.

(+) Electrolytes:

• Sodium- Fluid balance, nerve function, blood pressure, muscle contraction
• Potassium- Normal cell functions, nerve function, heart rhythm, blood pressure, muscle contraction
• Calcium- Vital for bone and teeth health, muscle contractions, nerve signaling, and blood clotting
• Magnesium- Involved in over 300 biochemical reactions, including muscle and nerve function, blood glucose control, and energy production.

(-) Electrolytes:

• Chloride– Maintains fluid balance, aids digestion as a component of stomach acid (hydrochloric acid), and helps maintain proper blood volume, blood pressure, and pH of body fluids.
• Bicarbonate– Helps maintain the body’s acid-base balance (pH balance) by neutralizing excess acids in the body.
• Protein
• Lower concentrations of organic acids – sulfate and phosphate

Key Organs That Maintain Fluid and Electrolyte Balance

Consuming adequate fluid and electrolytes is crucial for maintaining overall hydration and body balance. Equally important are the organs and systems responsible for absorbing, excreting fluids, and regulating electrolytes at the cellular level. Here’s an introduction to these essential organs and systems responsible for maintaining fluid and electrolyte balance:

Kidneys

The kidneys take the lead, among organs, for maintaining electrolyte balance since they help to filter blood, reabsorbing necessary electrolytes, and excreting excess amounts through urine.

Brain and adrenal glands

The hypothalamus and pituitary glands in the brain detect changes in fluid levels in the body. They trigger our sensation of thirst and signal the adrenal glands to release aldosterone, a hormone that affects the kidneys. Aldosterone helps the kidneys retain sodium and excrete potassium, adjusting our fluid and electrolyte balance accordingly.

Digestive System

Our gastrointestinal tract is vital for both the absorption of water, and nutrients essential for bodily functions. It serves as a primary site where fluids and electrolytes are absorbed into the bloodstream, ensuring hydration and electrolyte balance. Conversely, the GI tract also plays a role in excreting fluids through bowel movements, helping to maintain overall fluid equilibrium in the body.

Parathyroid Glands

The parathyroid glands are small glands located near the thyroid gland in the neck that produce parathyroid hormone (PTH). PTH plays a critical role in regulating calcium and phosphate levels in the body, crucial for electrolyte balance and bone health.

Signs and Symptoms of Hydration, Dehydration, and Electrolyte Imbalance

Signs of Proper Hydration:

• Clear or light-colored urine, like lemonade.
• Regular bowel movements with comfortable elimination.
• Skin appears more smooth and elastic.
• Stable energy levels.

Signs of Dehydration:

• Darker colored urine
• Dry mouth and throat
• Fatigue
• Dizziness
• Headaches
• Muscle cramps – may occur due to insufficient fluid and electrolyte imbalance

Signs and Symptoms of Electrolyte Imbalance:

• Sodium (Hyponatremia or Hypernatremia):
  • Hyponatremia (Low Sodium): Headache, nausea, vomiting, confusion, muscle cramps, seizures, and in severe cases, coma.
  • Hypernatremia (High Sodium): Thirst, restlessness, weakness, swelling in extremities, and in severe cases, confusion, muscle twitching, and seizures.
• Potassium (Hypokalemia or Hyperkalemia):
  • Hypokalemia (Low Potassium): Muscle weakness or cramps, fatigue, constipation, irregular heartbeat, and in severe cases, paralysis or cardiac arrhythmias.
  • Hyperkalemia (High Potassium): Muscle weakness, tingling sensations, nausea, slow or irregular heartbeat, and in severe cases, paralysis or cardiac arrest.
• Calcium (Hypocalcemia or Hypercalcemia):
  • Hypocalcemia (Low Calcium): Muscle cramps, numbness or tingling in fingers and toes, confusion, and in severe cases, seizures.
  • Hypercalcemia (High Calcium): Excessive thirst, frequent urination, abdominal pain, nausea, vomiting, constipation, bone pain, and in severe cases, kidney stones or altered mental status.
• Magnesium (Hypomagnesemia or Hypermagnesemia):
  • Hypomagnesemia (Low Magnesium): Muscle cramps, tremors, irregular heartbeat, fatigue, and in severe cases, seizures or cardiac arrhythmias.
  • Hypermagnesemia (High Magnesium): Nausea, vomiting, weakness, low blood pressure, slow heartbeat, difficulty breathing, and in severe cases, cardiac arrest.

Adrenal Health and Electrolyte Imbalance: The HPA Axis Connection

Chronic stress can create fluid retention and electrolyte imbalance due to the HPA Axis and the Renin-angiotensin aldosterone system (RAAS). Let me simplify…

The HPA Axis stands for Hypothalamic-Pituitary-Adrenal Axis. The hypothalamus and pituitary gland are located in the brain, while the adrenal glands sit atop the kidneys.

The HPA axis manages our body’s stress response. When the brain senses stress, it signals the adrenal glands to release cortisol. This hormone activates our sympathetic nervous system, known as the “fight or flight” response. During this state, our body prioritizes survival functions like increased heart rate, blood pressure, mental alertness, pupil dilation, and elevated blood sugar, while non-essential functions such as digestion and reproductive processes are suppressed.

Ideally, once the stressor diminishes, the body returns to the parasympathetic state to recover. However, in today’s world, many face persistent stress triggers, leading to chronic stress and potential HPA Axis dysfunction.

HPA Axis dysfunction varies among individuals. Initially, cortisol levels may be higher than normal or fluctuate in unusual patterns (e.g., elevated in the evening when it should be low). Over time, prolonged stress can cause the adrenals to become resistant to cortisol signals, resulting in diminished stress response and lower cortisol levels.

HPA axis dysfunction can develop in individuals experiencing chronic stress. While major stressors like divorce, relocation, or trauma such as sexual assault can certainly contribute to this dysfunction, many may underestimate how daily, smaller stressors also play a significant role. These can include commuting, societal beauty standards, managing digital overload, financial pressures, balancing family and career responsibilities, and caregiving for both older parents and children simultaneously.

Aldosterone and Cortisol

Aldosterone is a hormone produced by the adrenal glands that regulates blood pressure by regulating salt and fluid content in the body. Aldosterone is influenced by stress.

The relationship between cortisol and aldosterone is complex and can vary based on physiological conditions and stress levels.

High Cortisol and Fluid Retention

High levels of cortisol can stimulate the release of aldosterone. This can lead to sodium retention and potassium excretion by the kidneys. Fluid retention is one noticeable effect of this.

Cushing’s syndrome is a condition associated with prolonged exposure to excess cortisol. People with HPA axis dysfunction and chronic stress do not typically develop Cushing’s syndrome because the mechanisms and nature of cortisol regulation and release differ between these conditions.

Low Cortisol and salt cravings

Low cortisol levels can result in decreased aldosterone production, which can lead to electrolyte imbalances and issues such as low blood pressure or orthostatic hypotension. Salt cravings often accompany low cortisol levels as the body naturally seeks to maintain electrolyte balance.

Chronic stress can further reduce aldosterone levels, resulting in increased excretion of salt and water, which can lead to dehydration. If you find yourself craving salty foods during periods of stress, it may indicate dehydration.

Addison’s disease, also known as primary adrenal insufficiency, is a rare and chronic condition where the adrenal glands do not produce sufficient amounts of certain hormones, specifically cortisol and aldosterone. Addison’s disease and HPA axis dysfunction differ in their underlying causes, affected glands, hormone levels, and clinical manifestations.

Gut Health and Electrolytes: Understanding Risk Factors for Imbalance

Our gastrointestinal tract plays a central role in how we obtain nutrients from our food through digestion, absorption, but then also eliminating water.

Diarrhea

Diarrhea can be categorized as acute, lasting a few days to a week, or chronic, persisting for four weeks or more. Prolonged episodes of diarrhea increase the risk of dehydration and electrolyte imbalances.

Electrolyte Risks:

• Sodium: Significant loss can lead to dehydration and hyponatremia (low sodium levels), causing fatigue, headache, and in severe cases, seizures.
• Potassium: Loss can result in hypokalemia (low potassium levels), leading to muscle weakness, cramps, and cardiac issues.
• Bicarbonate: Loss of bicarbonate in diarrhea can lead to metabolic acidosis, causing rapid breathing, confusion, and lethargy.

Vomiting

Electrolyte Risks:

• Sodium: Significant loss can lead to hyponatremia (low sodium levels), which can cause confusion, seizures, and muscle cramps.
• Potassium: Loss of potassium can result in hypokalemia (low potassium levels), leading to muscle weakness, cramps, and cardiac arrhythmias.
• Chloride: Loss of stomach acid results in hypochloremia (low chloride levels), which can contribute to metabolic alkalosis.

Nutrient and Electrolyte Malabsorption

Several conditions and lifestyle factors increase the risk of nutrient and electrolyte malabsorption.

Autoimmune Disorders Affecting the Digestive System

Autoimmune conditions related to digestive health involve disorders where the immune system mistakenly attacks the gastrointestinal (GI) tract or components within it.

• Celiac Disease– An autoimmune disorder where ingestion of gluten leads to damage in the small intestine, impairing nutrient and electrolyte absorption.
• Crohn’s Disease – A type of inflammatory bowel disease (IBD) that causes inflammation in different parts of the digestive tract, affecting nutrient and electrolyte absorption.
• Ulcerative Colitis– Another type of IBD that specifically affects the colon and rectum, leading to inflammation and impaired absorption of water and electrolytes.

Chronic Diarrhea

Persistent diarrhea from various causes (infections, IBS, chronic infections) can lead to significant loss of fluids and electrolytes.

Short Bowel Syndrome

A condition that occurs after surgical removal of a significant portion of the small intestine, reducing the surface area available for nutrient and electrolyte absorption.

Pancreatic Insufficiency

Conditions like chronic pancreatitis and cystic fibrosis impair the pancreas’ ability to produce enzymes needed for digestion, leading to malabsorption of nutrients and electrolytes.

Diabetes increases the risk of pancreatic insufficiency due to the chronic metabolic demands on the pancreas, potentially affecting enzyme production and digestion.

Lactose Intolerance

Inability to digest lactose can lead to diarrhea and malabsorption of other nutrients and electrolytes due to intestinal irritation, especially when consuming dairy or lactose-containing foods.

Small Intestinal Bacterial Overgrowth (SIBO)

Small intestinal bacterial overgrowth (SIBO) occurs when there is an abnormal increase in the number or type of bacteria in the small intestine. This overgrowth can interfere with normal digestion and absorption of nutrients and electrolytes.

Alcoholism

Chronic alcohol abuse refers to prolonged and excessive consumption of alcohol over an extended period of time, typically years. This pattern of alcohol use can lead to damage to the lining of the intestines, resulting in malabsorption of nutrients and electrolytes.

Chronic Kidney Disease

Chronic kidney disease (CKD) is a condition characterized by gradual loss of kidney function over time, typically lasting for three months or more. CKD can also impact the balance and absorption of electrolytes in the digestive tract.

Understanding Altered Electrolyte Needs in POTS

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that predominantly affects women and is often challenging to detect, leading to potential underdiagnosis.

Individuals with POTS experience a range of symptoms when standing upright, including lightheadedness, fainting, rapid heartbeat, and overwhelming fatigue. These symptoms can significantly impact daily life, making it difficult to perform routine tasks or maintain normal activities.

Beyond its cardiovascular effects, POTS can also disrupt electrolyte balance and fluid regulation in the body, further complicating its management and treatment.

Altered Electrolyte Needs in POTS:

1. Sodium: Individuals with POTS may have increased sodium needs due to the condition’s impact on blood volume and fluid retention. Sodium helps maintain blood pressure and fluid balance, which can be dysregulated in POTS.
2. Potassium: Electrolyte imbalances, including potassium deficiency (hypokalemia), can occur in POTS due to excessive fluid loss from increased urinary output or gastrointestinal symptoms. Potassium is critical for proper muscle and nerve function, including the heart.
3. Fluid Intake: Adequate fluid intake is essential for managing POTS symptoms, as dehydration can exacerbate symptoms such as dizziness and fatigue. Electrolyte-rich fluids, such as electrolyte solutions, may be recommended to help maintain hydration and electrolyte balance.

Dietary Strategies to Maintain Hydration and Electrolyte Balance

Drink Your Fluid Needs

Calculate Your Daily Fluid Needs

To determine how much fluid you should consume daily, start by estimating based on your body weight. A simple method is to take your weight in pounds and divide it by 2. This gives you an estimate of your daily fluid requirement.

For example, if you weigh 180 lbs, you would need approximately 90 fluid ounces per day to meet your hydration needs.

Replenish Fluids Lost During Exercise

During physical activity, especially in warm temperatures, your body loses fluids through sweat. It’s crucial to replenish these lost fluids to maintain hydration and support optimal performance.

To replace fluids lost during exercise, a practical approach is to weigh yourself before and after exercise. For every ounce of weight lost due to sweating, aim to drink about 16-20 ounces of fluids.

If weighing yourself isn’t feasible or is uncomfortable, a general guideline is to consume fluids regularly during exercise. Aim for about 8-10 ounces every 15 minutes of activity, adjusting based on your sweat rate and the intensity of your workout.

Remember, individual fluid needs can vary based on factors like exercise intensity, climate, and personal sweat rate. Listen to your body and adjust your fluid intake accordingly to stay properly hydrated.

Salt Your Food

If you’ve been avoiding salting your food because you’ve heard salt is “bad” for you, it’s important to reconsider. As I’ve discussed in this article, sodium is a vital electrolyte necessary for maintaining balance in your body. Unnecessarily restricting salt from your diet can actually be harmful.

First, there are specific situations where I might recommend salt restriction:

• Congestive Heart Failure (CHF)
• High Blood Pressure (depending on individual circumstances)
• Fluid retention and edema
• Excess sodium intake

If you frequently eat out or depend on processed foods, you’re probably already meeting your sodium needs due to their high salt content. Rather than adding more salt to your diet, I recommend shifting towards cooking more meals at home. This transition can help counteract potential inflammation and mineral deficiencies, particularly if your current food choices lack fresh fruits and vegetables.

But, if you predominantly cook at home and follow a balanced, whole-foods-based diet — which I advocate for all my clients — you should be salting your food to taste. Sodium is an essential part of a healthy diet.

It’s generally recommended to consume about 1 teaspoon of salt per day, which equates to approximately 2300 mg of sodium. However, some individuals, particularly those with conditions like POTS or HPA Axis dysfunction, may benefit from higher salt intake.

I can help assess your specific sodium needs and determine the optimal amount to support your well-being. Depending on individual health factors, some people may benefit from higher intakes ranging from 3000 to 4000 mg per day.

You might be surprised to learn that salt-sensitive individuals, also known as responders, are those who exhibit a heightened sensitivity to dietary salt intake, often due to genetic factors. For these individuals, higher salt intake is associated with an increased risk of hypertension.

But in contrast, non-responders can safely consume up to 4600 mg of salt without an increased risk of hypertension. Low-salt diets may not always effectively manage blood pressure, particularly for individuals with borderline essential hypertension who do not respond to them.

table salt vs. sea salt

Choosing the right type of salt can seem overwhelming with so many options available. Here’s a breakdown to help you navigate through the choices:

Table Salt:

1. Composition: Table salt is primarily composed of sodium chloride (NaCl), often with additives like anti-caking agents and iodine (iodized salt).
2. Processing: It undergoes heavy processing to remove impurities and minerals, resulting in fine crystals that are uniform in size and shape.
3. Mineral Content: Typically, table salt is stripped of most minerals during processing, except for added iodine (iodized salt). It lacks the natural diversity of minerals found in sea salt.

Sea Salt:

1. Composition: Sea salt is harvested from evaporated seawater and retains trace minerals from its marine origin. It primarily consists of sodium chloride (NaCl) but also contains small amounts of other minerals depending on the source and processing method.
2. Variability: Sea salt can vary widely in mineral content and flavor based on where it’s harvested and how it’s processed. This variability can influence its taste and culinary use.
3. Mineral Content: Sea salt typically contains trace amounts of minerals such as magnesium, calcium, potassium, zinc, and iron. These minerals are present in varying concentrations depending on factors like the source of seawater and the production method.

The Bottom Line:

While sea salt does contain naturally occurring minerals compared to table salt, these amounts are typically small and may not significantly impact overall nutrition. While I appreciate any way to incorporate more minerals into the diet, sea salt isn’t necessarily the most potent source for this purpose.

Sea salt does offer a distinct taste and texture that many prefer in culinary applications.

Table salt, on the other hand, undergoes more processing and may contain higher levels of chloride compared to what naturally occurs in sea salt. This higher chloride content raises concerns about potential health impacts, such as its effect on blood pressure and kidney function.

My Recommendation:

I recommend opting for sea salt when possible, due to its natural origin and additional minerals. However, if accessibility to sea salt is an issue, table salt can still serve as a suitable option.

If you choose to exclusively use sea salt, it’s important to consider how you’ll obtain iodine in your diet. Sea salt typically does not contain added iodine, which is crucial for thyroid health. More on this, below.

Recommended Salt Brands:

Sea salt:

• Pink Himalayan salt is mined from ancient sea salt deposits in the Himalayan Mountains, prized for its rich mineral content and distinctive pink hue. When selecting Pink Himalayan salt, it’s crucial to ensure it is 100% authentic and certified for purity and quality.
  • The Spice Lab
  • Salt Works
• Redmond Real Salt is sourced from an ancient sea bed in Utah and contains a balanced range of minerals, including trace elements. It is unrefined and free from additives.
• Celtic Sea Salt is a brand offering naturally harvested, unprocessed, and pure sea salt.
  • Light Grey Celtic, Fine Ground Celtic, Flower of the Ocean: France
  • Celtic Pink Sea Salt, Fossil River:  Spain
  • Gourmet Kosher: Guatemala
  • Celtic Kosher Coarse and Fine:  Colima, Mexico
  • Makai Pure: Hawaii, USA

The importance of iodine:

Iodine is a vital mineral essential for thyroid function. It is typically added to table salt to prevent deficiencies. If you opt for sea salt, it’s crucial to ensure your diet includes adequate iodine sources or consider supplementation through a multivitamin or specific iodine supplement.

For individuals with thyroid disorders, I strongly advise consulting with a healthcare professional to determine the appropriate iodine intake tailored to your specific needs. While iodine can sometimes improve thyroid symptoms and function, it can also exacerbate conditions in certain cases. Therefore, personalized guidance is recommended to ensure optimal thyroid health.

It’s important to note that iodine deficiency is a common cause hypothyroidism, goiter (enlarged thyroid) and important for viable pregnancies and fetal development.

Iodine-Rich Foods

Seafood: Fish and shellfish are excellent sources of iodine. Incorporate varieties such as cod, tuna, shrimp, and seaweed (such as nori or kelp), which are particularly high in iodine.

Dairy Products: Milk, yogurt, and cheese can contribute to iodine intake.

Some bread, cereals, and other processed foods are fortified with iodine. Check labels to identify products that provide additional iodine.

Sprinkle Kelp Granules into your food:

One effective way to naturally increase iodine in your diet, particularly if you don’t consume much seafood or dairy, is by sprinkling kelp granules into your food. Maine Coast Sea Vegetables offers a convenient option for this. Simply add a shake or two of sea kelp granules when you use salt, or mix them directly into your salt shaker. This simple addition can help ensure you’re getting adequate iodine for thyroid health and overall well-being.

Eat Mineral-Rich Food

Start incorporating more mineral-dense foods into your diet regularly.

If you experience digestive or malabsorption issues, consulting with a health professional like myself, trained in functional medicine and nutrition, can help address the root causes of both your digestive problems and electrolyte imbalances. Together, we can optimize nutrient absorption and address issues such as chronic diarrhea, reduce autoimmune activity, achieve remission of SIBO, and minimize nutrient losses through stool.

Sodium-rich Food sources (less processed)

• Pickled foods like cucumbers and olives
• Salted nuts and seeds
• Cheese, especially feta, cottage cheese, blue cheese, and parm

Potassium- Rich Food Sources

• Bananas
• Potatoes (with skin)
• Sweet potatoes
• Spinach
• Avocados
• Beans (e.g., kidney beans, black beans)
• Lentils
• Tomatoes
• Yogurt
• Salmon

Calcium- Rich Food Sources

• Dairy products (e.g., milk, yogurt, cheese)
• Leafy green vegetables (e.g., kale, spinach, collard greens)
• Sardines and canned salmon with bones)
• Fortified plant milks (e.g., almond milk, soy milk)
• Tofu
• Chia seeds
• Almonds and other nuts (e.g., Brazil nuts)
• Broccoli
• Oranges
• Edamame

Magnesium- Rich Food Sources

• Leafy green vegetables (e.g., spinach, Swiss chard)
• Nuts and seeds (e.g., almonds, pumpkin seeds)
• Whole grains (e.g., brown rice, quinoa, oats)
• Legumes (e.g., beans, lentils)
• Avocados
• Dark chocolate
• Bananas
• Fatty fish (e.g., salmon, mackerel)
• Tofu
• Yogurt

Should you take an electrolyte supplement?

For chronic stressed individuals, electrolyte solutions or supplements can be beneficial. Chronic stress can disrupt electrolyte balance, making supplementation a helpful way to support overall health.

For exercise, the need for electrolyte supplementation varies based on several factors. Prioritizing fluid intake and maintaining hydration comes first. During light to moderate exercise, electrolyte supplementation may not be necessary. However, in cases of prolonged, intense exercise, especially in hot temperatures, electrolyte depletion is more likely, making supplementation more beneficial.

Individuals with low blood pressure may benefit from electrolyte solutions to help maintain fluid balance and support cardiovascular function.

People with Postural Orthostatic Tachycardia Syndrome (POTS) often experience dysregulation in fluid and electrolyte levels. In my experience helping people with POTs, electrolyte supplements usually play a crucial role in managing symptoms and improving overall well-being.

Those with adrenal issues, such as HPA axis dysfunction, may also find electrolyte supplementation helpful. Adrenal health is closely linked to electrolyte balance, and supplementation can aid in supporting adrenal function.

In all cases, it’s crucial to consult with a healthcare provider to assess individual needs and ensure that electrolyte supplementation is suitable and safe for your health condition and circumstances.

As a Registered Dietitian, I am dedicated to guiding you through this process, helping you understand your body’s unique requirements so that you can achieve optimal well-being. Together, we’ll tailor a personalized approach to optimizing hydration, electrolyte balance, and overall vitality, ensuring you feel your best every day.

Download my free electrolyte and hydration guide!

I’ve prepared this comprehensive guide to ensure you have all the essential, actionable information from this article summarized in one place. Inside my guide, you’ll find:

• A shopping list featuring mineral-rich foods, salts, and iodine sources.
• Recommendations for my preferred mineral and electrolyte supplements.
• Recipes for various homemade beverages beyond water, like refreshing fruit and herb infused mocktails!

This guide is designed to support you in enhancing your mineral intake and optimizing your electrolyte balance for improved overall health.

Download your free guide following this link!