As a physician who worked with athletes for thirty years, I can tell you that the most common cause of sodium deficiency is a health-conscious Mom following popular culture health tips. I had so many young athletes come into my practice with not only cramps but heart palpitations as well (the heart is a muscle). I would always turn to the concerned parent and ask, "You aren't giving him salt are you?" and they would always say "Of course not!" I would ask them why, and they would tell me that sodium was evil. Then I would ask them if electrolytes were good for them and they would tell me that they were. Of course, both sodium and potassium are electrolytes and both are necessary. But most people think that only potassium is good for you. Too much potassium alone is very bad if you are sweating a lot. Just like a battery, you must have both positive and negative poles. Potassium is negative and Sodium is positive and they must both be available.
Thank you Dr. That makes so much sense. I have been of the belief that salt is bad, and try and limit it as much as I can. But being out in the sun and exercising 3 to 4 hours a day, and with drinking lots and lots of water, I cramp up really bad.
That's interesting. I've just done an online health check and was "marked down" for frequently adding salt to my food, despite me declaring i do 12h+ cycling per week. On rides with cafe stops i crave savoury foods and struggle if i eat cake instead. I get home and crave salty food. I often feel muscle twinges after long or intense rides, which turn into cramp if i don't keep consuming electrolyte drinks for hours afterwards. I'm only a sample of one, but i can't accept that low salt is good as a blanket recommendation.
Worst cramping I ever had was when I diligently drank tons of water the night before the Triple ByPass. After reviewing much of PH's info and some TrainerRoad pods, I'm nearly certain I "washed" electrolytes out of my system. I know it's completely anecdotal but I'm up for experimenting with my intake. So I'm looking forward to trying PH this summer in the heat!
Im a physiologist and a road cyclist. I've actually published a few papers on the neuromuscular junction. My favorite theory is that alpha motoneurons become hyperexcitable as a result of micro-damage to muscle fibers. As a result of this damage, the muscle fibers release factors that act in a retrograde manner on to the neurons causing them to increase ACh release. This in turn is what causes the cramping at least in some people. Is this true? I don't know. As you say, this is a big gray area.
Thanks Stuart for commenting, you make a great point. We know for sure from our work with athletes that there is a tendency for muscle cramps to occur more frequently in the less trained/conditioned, later into exercise, or when the muscles are put under more stress. All of these factors contribute, or are linked to, the muscle fibers suffering more damage. From a theoretical standpoint, we think that there is a strong argument behind micro-damage being a key factor in some instances of cramp. On the other hand, we also know that there are many athletes for whom replacing more sodium has had a positive effect on their tendency to cramp. Neither of the two explanations is true in all cases and if an athlete is suffering from muscle cramping then it can be worth them exploring all options. Really appreciate you commenting and please get in touch through our website if you've got any follow-up questions or thoughts.
Electrolyte and dehydration is big. Extreme neuromuscular stimulation is another mechanism, like from repetitive over-effort -like you said. But there’s also an energy deficit and oxygen delivery deficit manifesting in lactic acid buildup, and lastly, muscle breakdown manifesting as rhabdomyolysis in the extreme cases.
A great video Andy and quite timely for me. Been running for ages but suffered a massive calf cramp last week which coincided with me going on a low carb diet! Took me three days for my cramp to go fully but ran today with some of the PN 500 sachets in my water. No cramp but I guess I am not truly doing 'low carb' on the diet anymore?
Hi Clive, thanks for your message and great to hear you found our video useful. Please do let us know how you get on with your upcoming runs using PH 500 and how you manage those cramps by emailing hello@precisionhydration.com. One of our team of Sweat Experts will be happy to help you refine your hydration strategy. Many thanks!
Great video. Thanks. I'm a club cyclist and have no medical background at all. Form a pure logic perspective my conclusion was that potentially the low sodium makes the muscles susceptible to cramp and the intense work actually triggers it. So both sets of remedies would be relevant. I rarely cramp on my bike, it is usually 6-10 hours later. I assume that doesn't change your prognosis ?
Hi Simon, Thanks for your comment. It’s a plausible suggestion you make. There are a couple of laboratory studies (Earp et al. (2019) as one example) which have induced cramping by electrical stimulation of a muscle and have observed that when an electrolyte drink is provided to participants the muscles’ are not as susceptible to cramping as compared to when they are given plain water to drink. To be clear, participants still cramp eventually, but at a higher level of electrical stimulation. These sorts of findings do go some way to support what you’re suggesting, that low sodium increases a muscle’s susceptibility to cramp but ultimately some intense loading of the muscle is the trigger. As for your own experience, if you’re cramping after exercise, it may be worth experimenting with mixing up a high-sodium drink like our PH 1500 in the hours after your cycle. We call this reloading. Alternatively, being more proactive with your fluid and sodium replacement before (preloading) and during your ride may also help reduce, or eliminate, your cramping. If you are interested in speaking to a member of our team for more information around personalizing your hydration strategy then please visit our website and book a free one-to-one video consultation (see the link in the footer).
I get my biggest problems with cramp when I am swimming with fins in the pool. I guess that would mostly support the neuromuscular theory since I am not very used to kicking drills, and I have not been sweating very much when it happens. However, I guess that it would be possible that I am already deficient in electrolytes when hitting the pool, so it may be a combination of both? I sometimes get cramp "out of nowhere", e.g. in my sleep. Could that be a sign that I would need more electrolytes on a regular basis?
We would largely agree with your analysis here Karina, most of the time when cramps are caused early on in sessions when doing a movement that's a little alien to you we can pin that mostly on the neuromuscular theory. However, as you've rightly said, if you're jumping in the pool the morning after a tough and sweaty evening workout where you under-drank there could also be a hydration component to the problem. As with most complicated issues in the sports science world, it's often hard to truly pin a problem down to a single cause as there's a lot of compounding over time happening that we're unaware of. As for your evening cramps, if these are usually happening after tough/sweaty workouts in the day/evening then it would be a sensible next step to trial some stronger electrolyte drinks in and around those sessions to see if that prevents them from happening. This might look like preloading or recovering from your session with a PH1500 or drinking either a PH1000 or PH1500 during the session. If doing this stops the cramps you know you're on to something and can do some further refining to get the dose right over time.
There's many more electrolytes than just sodium. Why omit them from your video? There's 4 times more potassium in the body than sodium, and low potassium can affect muscle performance. But you didn't mention the word potassium even once. Seems this video is incomplete information at best, and deceptive misinformation at worst.
You're absolutely right that sodium isn't the only electrolyte. It is however the most prominent electrolyte lost in sweat, and is lost in significantly different quantities from athlete to athlete. The other electrolytes, what we term 'minor', only make up a very small proportion of total losses and are lost in similar amounts by most people. This is why we include them in equal quantities across our range of multi-strength electrolyte drink mixes. We've written about this in a blog titled 'Do you need potassium, magnesium and calcium in your sports drink?' in our Knowledge Hub that you might find interesting.
As a physician who worked with athletes for thirty years, I can tell you that the most common cause of sodium deficiency is a health-conscious Mom following popular culture health tips. I had so many young athletes come into my practice with not only cramps but heart palpitations as well (the heart is a muscle). I would always turn to the concerned parent and ask, "You aren't giving him salt are you?" and they would always say "Of course not!" I would ask them why, and they would tell me that sodium was evil. Then I would ask them if electrolytes were good for them and they would tell me that they were. Of course, both sodium and potassium are electrolytes and both are necessary. But most people think that only potassium is good for you. Too much potassium alone is very bad if you are sweating a lot. Just like a battery, you must have both positive and negative poles. Potassium is negative and Sodium is positive and they must both be available.
Thank you Dr. That makes so much sense. I have been of the belief that salt is bad, and try and limit it as much as I can. But being out in the sun and exercising 3 to 4 hours a day, and with drinking lots and lots of water, I cramp up really bad.
That's interesting. I've just done an online health check and was "marked down" for frequently adding salt to my food, despite me declaring i do 12h+ cycling per week. On rides with cafe stops i crave savoury foods and struggle if i eat cake instead. I get home and crave salty food. I often feel muscle twinges after long or intense rides, which turn into cramp if i don't keep consuming electrolyte drinks for hours afterwards. I'm only a sample of one, but i can't accept that low salt is good as a blanket recommendation.
Worst cramping I ever had was when I diligently drank tons of water the night before the Triple ByPass. After reviewing much of PH's info and some TrainerRoad pods, I'm nearly certain I "washed" electrolytes out of my system. I know it's completely anecdotal but I'm up for experimenting with my intake. So I'm looking forward to trying PH this summer in the heat!
No that’s a known medical thing. Electrolyte dilution and consequent excretion for sure happens, in both athletes and non-athletes
Also read your article, very well written and great for my research, thank you
Made alot of sense. Thanks for sharing your knowledge..
Im a physiologist and a road cyclist. I've actually published a few papers on the neuromuscular junction. My favorite theory is that alpha motoneurons become hyperexcitable as a result of micro-damage to muscle fibers. As a result of this damage, the muscle fibers release factors that act in a retrograde manner on to the neurons causing them to increase ACh release. This in turn is what causes the cramping at least in some people. Is this true? I don't know. As you say, this is a big gray area.
Thanks Stuart for commenting, you make a great point. We know for sure from our work with athletes that there is a tendency for muscle cramps to occur more frequently in the less trained/conditioned, later into exercise, or when the muscles are put under more stress. All of these factors contribute, or are linked to, the muscle fibers suffering more damage. From a theoretical standpoint, we think that there is a strong argument behind micro-damage being a key factor in some instances of cramp. On the other hand, we also know that there are many athletes for whom replacing more sodium has had a positive effect on their tendency to cramp. Neither of the two explanations is true in all cases and if an athlete is suffering from muscle cramping then it can be worth them exploring all options. Really appreciate you commenting and please get in touch through our website if you've got any follow-up questions or thoughts.
Electrolyte and dehydration is big. Extreme neuromuscular stimulation is another mechanism, like from repetitive over-effort -like you said. But there’s also an energy deficit and oxygen delivery deficit manifesting in lactic acid buildup, and lastly, muscle breakdown manifesting as rhabdomyolysis in the extreme cases.
A great video Andy and quite timely for me. Been running for ages but suffered a massive calf cramp last week which coincided with me going on a low carb diet! Took me three days for my cramp to go fully but ran today with some of the PN 500 sachets in my water. No cramp but I guess I am not truly doing 'low carb' on the diet anymore?
Hi Clive, thanks for your message and great to hear you found our video useful. Please do let us know how you get on with your upcoming runs using PH 500 and how you manage those cramps by emailing hello@precisionhydration.com. One of our team of Sweat Experts will be happy to help you refine your hydration strategy.
Many thanks!
Excellent information
Great video. Thanks. I'm a club cyclist and have no medical background at all. Form a pure logic perspective my conclusion was that potentially the low sodium makes the muscles susceptible to cramp and the intense work actually triggers it. So both sets of remedies would be relevant. I rarely cramp on my bike, it is usually 6-10 hours later. I assume that doesn't change your prognosis ?
Hi Simon, Thanks for your comment. It’s a plausible suggestion you make. There are a couple of laboratory studies (Earp et al. (2019) as one example) which have induced cramping by electrical stimulation of a muscle and have observed that when an electrolyte drink is provided to participants the muscles’ are not as susceptible to cramping as compared to when they are given plain water to drink. To be clear, participants still cramp eventually, but at a higher level of electrical stimulation. These sorts of findings do go some way to support what you’re suggesting, that low sodium increases a muscle’s susceptibility to cramp but ultimately some intense loading of the muscle is the trigger.
As for your own experience, if you’re cramping after exercise, it may be worth experimenting with mixing up a high-sodium drink like our PH 1500 in the hours after your cycle. We call this reloading. Alternatively, being more proactive with your fluid and sodium replacement before (preloading) and during your ride may also help reduce, or eliminate, your cramping.
If you are interested in speaking to a member of our team for more information around personalizing your hydration strategy then please visit our website and book a free one-to-one video consultation (see the link in the footer).
I get my biggest problems with cramp when I am swimming with fins in the pool. I guess that would mostly support the neuromuscular theory since I am not very used to kicking drills, and I have not been sweating very much when it happens. However, I guess that it would be possible that I am already deficient in electrolytes when hitting the pool, so it may be a combination of both? I sometimes get cramp "out of nowhere", e.g. in my sleep. Could that be a sign that I would need more electrolytes on a regular basis?
We would largely agree with your analysis here Karina, most of the time when cramps are caused early on in sessions when doing a movement that's a little alien to you we can pin that mostly on the neuromuscular theory. However, as you've rightly said, if you're jumping in the pool the morning after a tough and sweaty evening workout where you under-drank there could also be a hydration component to the problem.
As with most complicated issues in the sports science world, it's often hard to truly pin a problem down to a single cause as there's a lot of compounding over time happening that we're unaware of.
As for your evening cramps, if these are usually happening after tough/sweaty workouts in the day/evening then it would be a sensible next step to trial some stronger electrolyte drinks in and around those sessions to see if that prevents them from happening. This might look like preloading or recovering from your session with a PH1500 or drinking either a PH1000 or PH1500 during the session. If doing this stops the cramps you know you're on to something and can do some further refining to get the dose right over time.
@@precisionfandh thank you very much for your reply!
got a cramp this evening while playing football
There's many more electrolytes than just sodium. Why omit them from your video? There's 4 times more potassium in the body than sodium, and low potassium can affect muscle performance. But you didn't mention the word potassium even once. Seems this video is incomplete information at best, and deceptive misinformation at worst.
You're absolutely right that sodium isn't the only electrolyte. It is however the most prominent electrolyte lost in sweat, and is lost in significantly different quantities from athlete to athlete. The other electrolytes, what we term 'minor', only make up a very small proportion of total losses and are lost in similar amounts by most people. This is why we include them in equal quantities across our range of multi-strength electrolyte drink mixes.
We've written about this in a blog titled 'Do you need potassium, magnesium and calcium in your sports drink?' in our Knowledge Hub that you might find interesting.