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Salt: the Only Mineral you Need to Replace During Exercise

The only mineral that you need to replace during exercise lasting longer than three hours is sodium, found in common table salt. You do not need to take extra potassium, magnesium or any other mineral during exercise.

The definitive studies on minerals and exercise were done during World War II. Dr. James Gamble of Harvard Medical School paid medical students to lie on a raft in his swimming pool, take various amounts of fluids and salt and have blood drawn to measure salt and other mineral levels. He showed that you have to take a lot of salt when you exercise for several hours, particularly in hot weather. For many years after that, every student at Harvard Medical School heard Dr. Gamble give his lectures on minerals and exercise, and today, most serious medical students still read the Gamble lectures published in 1958, since nobody has improved on his research.

Salt but Not Salt Tablets
After Dr. Gamble published his studies, people who worked or exercised in the heat were given salt tablets. Then doctors became concerned because they thought that a person could have his blood pressure raised by taking in too much salt. Some people would vomit from the high concentration of salt from salt pills in their stomachs. However, salt restriction can cause people to suffer heat stroke and dehydration during hot weather exercise. A low-salt diet does not lower high blood pressure for most people. A high-salt diet causes high blood pressure usually only in people with high blood insulin levels: those with protruding bellies, overweight, and high blood sugar levels. Eating salty foods and drinks when you exercise for more than three hours is unlikely to raise blood pressure. Doctors do not recommend salt tablets today because they can burn holes in your stomach and cause nausea and vomiting.

Why You Need Extra Salt During Prolonged Exercise in Hot Weather
If you don’t take salt and fluids during extended exercise in hot weather, you will tire earlier and increase your risk for heat stroke, dehydration and cramps. The rule is that people who are going to exercise vigorously for more than three hours continuously should take some source of salt while they are exercising. Salty drinks taste awful, so it is easier to meet your needs with salted foods. If you plan to exercise for more than a couple hours in hot weather, drink one or two cups of the liquid of your choice each hour and eat a salty food such as salted peanuts, potato chips or any other salty food.

You Need Salt to Feel Thirsty
Not taking in enough salt when you exercise for more than three hours in hot weather can prevent you from retaining the water that you drink. It can also block thirst, so you may not know that you are dehydrated. Thirst is a late sign of dehydration. You lose water during exercise primarily through sweating, and sweat contains a far lower concentration of salt than blood. So during exercise, you lose far more water than salt, causing the concentration of salt in the blood to rise. You will not feel thirsty until the concentration of salt in the blood rises high enough to trip off thirst osmoreceptors in your brain, and it takes a loss of two to four pints of fluid to do that (American Journal of Emergency Medicine, 1999;17(6):532-539).

You Need Salt to Retain the Fluid You Drink While Exercising
In one study, female competitive distance runners took in drinks with different concentrations of salt during a four-hour run (British Journal of Sports Medicine, August 2003). Ninety-two percent of those who took in plain water with no additional salt developed low blood levels of salt.

Taking in fluid without also taking in adequate amounts of salt dilutes the bloodstream so that the concentration of salt in the blood is lower than that in brain cells. This causes fluid to move from the low-salt blood into the high-salt brain, causing the brain to swell, which can cause seizures and death. This is called hyponatremia, the low salt syndrome that can kill. It is usually caused by taking in far too much fluid, rather than from not taking in enough salt.

How Salt Can Improve Performance in Competition
Taking extra salt just prior to competition can help you exercise longer and harder (Medicine and Science in Sports and Exercise, January, 2007; and Clinical Journal of Sport Medicine, January 2007). Fatigue during hot-weather exercise is caused by lack of water, salt, sugar or calories. Of the four, exercisers are most ignorant of their salt needs.

Always replace fluids, salt, sugar, and protein after you exercise in hot weather. Just salting your food to taste should replace the salt you lose through heavy sweating. If your kidneys are normal, you should be able to rid yourself of any excess salt that you may take in.

How to Tell If You Need More Salt
Salt deficiency causes tiredness, lethargy and cramps. It also weakens muscles, causing you to slow down and lose strength. If you suffer any of these symptoms, you can get a blood test for sodium and chloride on the day after a hard workout. Low blood levels of sodium are most likely to occur on the morning after you have replaced fluid lost from heavy exercise. If your blood sodium level is below 135, you are deficient and need to add more salt to your food.

Who Is Most Likely to Suffer from Salt Deficiency?
Vegetarians and people who limit meat are at increased risk for salt deficiency because plants are naturally low in salt. Meat, fish and chicken naturally contain far more salt. Most processed foods are high in salt because manufacturers know that salt makes food taste good and is also a preservative.

The North American diet typically contains up to ten times the minimal daily salt requirement. If you doubled or tripled your salt losses through sweating, you may still not be deficient because you probably take in far more salt than you need.

Does Extra Salt Cause High Blood Pressure and Heart Attacks?
A review of the world’s literature shows that salt restriction does not lower high blood pressure for most people with high blood pressure (Journal of Hypertension. May 2011;29(5):821-828). Eating salty foods and drinks when you exercise for more than three hours is unlikely to raise blood pressure. I found only six long-term follow-up studies of salt intake and heart attacks. Three of the studies suggest that very low salt intake may cause heart attacks.

Exercise Can Prevent a Rise in Blood Pressure with Extra Salt Intake
Excessive intake of salt causes high blood pressure in some, but not all, people. High blood pressure increases risk for heart attacks, strokes, and kidney damage. Many middle-aged people who start an exercise program lose their tendency to develop high blood pressure when they take in extra salt (Journal of Human Hypertension, May 2006). This study shows that many people who develop high blood pressure from a high-salt diet when they are sedentary, will not develop high blood pressure on the same diet when they exercise.

Metabolic Syndrome
People with high blood sugar levels are the ones who are most likely to develop high blood pressure from excess salt intake. A high-salt diet causes high blood pressure most commonly in people who suffer from metabolic syndrome and are pre-diabetic or diabetic (Lancet, March 2, 2009). Metabolic syndrome occurs when cells lose their ability to respond adequately to insulin and blood levels of sugar rise too high. It is caused by:
* eating too much sugar and other refined carbohydrates,
* being overweight,
* not exercising, and
* lacking vitamin D.
Metabolic syndrome is characterized by storing fat primarily in the belly, having a thick neck, high blood triglycerides, low blood good HDL cholesterol, high blood sugar, and eventually liver damage and all the side effects of diabetes. People with metabolic syndrome have a greater rise in blood pressure with increased salt intake and a drop in blood pressure with salt restriction.

Check Your Own Blood Pressure
If you are concerned about your blood pressure, you can buy an inexpensive wrist cuff and check your systolic blood pressure at bedtime. If it is below 120, you probably do not need to worry about salt. If it is above 120, and particularly if you store fat primarily in your belly rather than your hips, your good HDL cholesterol is below 40, your triglycerides are above 150, or you have a blood sugar above 100 two hours after a meal or an HBA1C above 5.9, you probably should restrict salt and definitely should work to correct the causes of metabolic syndrome:
* lack of exercise,
* overweight,
* eating too much red meat,
* taking sugared drinks and foods,
* lack of vitamin D, and
* not eating enough fruits and vegetables.

My Recommendations:
If you do not exercise, you do not sweat very much and you do not need very much salt. Too much salt can increase blood volume which may raise systolic blood pressure. Being fat is the primary cause of elevated diastolic blood pressure. On the other hand, if you exercise vigorously, you sweat tremendously and lose a lot of salt. Without extra salt during prolonged, vigorous exercise, you will not perform at your best, you will not recover from your hard bouts of exercise and you will be more likely to be injured or tired all the time.

October 12th, 2014
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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