Our Definitive Guide to Sodium for Athletes, with Jared Berg 

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We break down the foundational physiology of sodium alongside a groundbreaking paradigm shift in athlete hydration science.

Episode Transcript

[00:00:00] Trevor Connor: Hello and welcome to Fast Doc, your source for the science of endurance performance. I’m your host, Trevor Connor. Here with Chris Case and physiologist Jared Berg. Salt sodium na plus. We call by a lot of names, but the role that this simple ion has played in our diet and culture can’t be underestimated for much of our history.

Nothing was more valuable, hence the expression worth their weight and salt. To this day, salt continues to pervade our culture and food. Go to the supermarket and look at the sodium content of most foods. Sometimes it’ll shock you go into social media and you’ll see that a giant debate is raging over which is healthier, a high or a low sodium diet.

Certainly in sports Nutritions, our drinks and gels are scientifically engineered to give us the sodium we need, at least according to the marketing department. But what is sodium? What important roles does it play in our bodies? And what are the consequences of a high sodium or a low sodium diet? If you think you have all the answers, think again.

Because the science of sodium and our bodies has recently been upended causing clinics and practitioners to rethink their recommendations. Right now, they have more questions than answers. It was believed that sodium was stored in two compartments in our bodies. It was also believed that both sodium and fluid levels in our bodies were completely controlled by our kidneys.

But recently scientists discovered a third compartment. Our skin, it may very well be our largest storage site, and the skin may play as bigger a role as our kidneys, if not bigger, in regulating sodium balance. This has left clinics, labs, and even sports dieticians questioning accepted recommendations, which are all based in just two compartments.

Here to help us navigate this new science along with a general understanding of sodium. As our head physiologist, Jared Berg, he’ll explain what sodium is and all the roles it plays in our bodies. We’ll discuss recommendations for salt intake, both in general and during exercise. Then we’ll explain the recent findings and why it’s upending sodium science.

With that knowledge, we’ll revisit the high versus low sodium debate and discuss which we think is healthiest. Finally, we’ll dive into sodium and sports, including in conversation about how much you need in your beverages, the role of sodium and cramping, and address serious issues like dehydration and hyponatremia.

At our lab, Jared has been doing nutrition counseling for years, and that has often included a sweat analysis to determine sodium losses. As Jared will explain this, new science is making them take a more complex view of what the sodium losses mean. A view that he believes all sports dieticians need to be learning about.

Discovery of this third compartment means that standard sodium recommendations for some athletes could be bad for their health. We’ll explain, so get ready for a salty one. Yeah, I went there and let’s make you fast. So we’re talking about salt, sodium. Sodium. Sodium, sorry. We should say sodium.

[00:02:56] Jared Berg: I suppose.

It can be specific, right?

[00:02:59] Trevor Connor: Yeah. They do get used interchangeably. But when people are talking about salt, they’re talking about sodium chloride.

[00:03:06] Jared Berg: Yeah. And we can talk about other sodium, like sodium citrate and

[00:03:12] Trevor Connor: Yeah. There are other salts.

[00:03:13] Jared Berg: Yeah, there certainly are.

[00:03:15] Trevor Connor: So I was going to start this one with a really bad, but one of my favorite quotes, which is from the movie Idiocracy.

[00:03:24] Chris Case: Mm-hmm. About Brodo,

[00:03:26] Trevor Connor: where it’s in the future and people aren’t so bright. Mm-hmm. And they are watering all their crops with a Brando Brando, is that the name of the drink, bro? Yes. I forgot the name of the drink. And when the guy from the past asked them, what are you doing, they go. It’s what plants crave.

It’s got electrolytes.

[00:03:46] Chris Case: That’s right. It’s like a spoof of Gatorade that they’re pouring on the plants, hoping that, right. That the plants will go

[00:03:52] Trevor Connor: and they’re killing all the crops.

[00:03:53] Chris Case: They’re killing it all. Yes.

[00:03:55] Trevor Connor: And it was kind of a statement, but I kind of like using it today because we talk a lot about electrolytes, we talk a lot about sodium, but there is a ton to this science, to how sodium interacts with the body to what we need to know about it that I think a lot of people don’t know.

So this is our episode on here’s what you need to know about sodium.

[00:04:17] Chris Case: I feel like to some degree, what you’re saying is some people have the mentality of more is better. The more electrolytes I can pump into my body, the more sodium I

[00:04:26] Trevor Connor: get. It’s what our

[00:04:26] Chris Case: bodies crave. It’s what our bodies crave. So just give it to me

[00:04:29] Trevor Connor: and I’m gonna get so much hate mail for this, but I, yeah,

[00:04:33] Jared Berg: yeah.

And I would agree. I will have clients that’ll come to me in more of the wellness space and they’ll be clients with. Blood pressure and sort of high cardiovascular risk and they’re like, Hey, I’m take, I have my LMNT every morning.

[00:04:49] Chris Case: Mm-hmm.

[00:04:49] Jared Berg: I’m like, oh dang, that has a thousand milligrams of sodium right off the start of your day.

And so, yeah, I think there’s a lot of misinformation and amazing marketing in that space right now.

[00:05:01] Trevor Connor: I will tell you from experience, when I started my cycling career and said I am now an athlete, I’m now serious about cycling.

[00:05:08] Chris Case: You started drinking Gatorade?

[00:05:10] Trevor Connor: I literally did. I would sit there. Yeah, exactly.

At my desk working, drinking Gatorade because I’m an athlete. This is what athletes do all the

time.

[00:05:17] Trevor Connor: It’s just for when you’re riding. Mm-hmm.

[00:05:21] Jared Berg: Yes.

[00:05:22] Trevor Connor: So there’s gonna be a lot of really interesting things we’re gonna cover about sodium. There’s a lot of controversies about it.

[00:05:29] Jared Berg: Yeah. I mean, a lot of still unknowns and I feel like, you know, the more even we get into this discussion, the more questions we have.

[00:05:37] Chris Case: Yep. It’s interesting too, in that the similarities between, they’re not the same thing, but there’s such a push. Towards carbohydrates. Gotta have 120 grams per hour to perform or else you’re off the back. You’re just not that you’re living in the seventies if you’re not doing that. And the same thing, it’s like you gotta have more and more sodium, or if you’re not doing that, performance is gonna drop.

And it’s like the pendulum has swung so far to an extreme. And what we’re gonna talk about is why that isn’t necessarily the case.

[00:06:06] Jared Berg: Yeah, I would think that’s gonna be a good

[00:06:08] Trevor Connor: Yeah.

[00:06:08] Jared Berg: Area for us to go into.

[00:06:09] Trevor Connor: And I think we also have to look at just the cultural significance of salt. There’s an expression, not worth their weight and salt, because there was a time when pretty much the most expensive thing you could buy was salt.

And I looked into this, there were some other interesting things I didn’t know about salt, like the Latin word for health and healthy salut.

[00:06:33] Chris Case: Mm-hmm.

[00:06:34] Trevor Connor: Comes from salt. And you know how the French say salute, or we say salute.

[00:06:40] Chris Case: Mm-hmm.

[00:06:40] Trevor Connor: That comes from that term. So when you’re saying salute to somebody, you’re basically saying salt.

[00:06:46] Chris Case: Mm-hmm. ’cause it was such a precious item.

[00:06:49] Trevor Connor: Right. You look at ancient Rome, they had special salt streets just for transporting salt. So salt has had this huge, really important place in our culture for a very long time. And there’s the other one, the word salad also comes from salt.

[00:07:06] Jared Berg: Hmm. Interesting.

[00:07:06] Trevor Connor: Because Romans used to make salads and put a little salt on it because it was bland.

Yeah.

[00:07:12] Jared Berg: We’re getting all historical.

[00:07:13] Trevor Connor: Wow.

[00:07:15] Jared Berg: I mean, it makes sense. I mean it’s, you can take food that feels sort of bland and very ordinary. Mm-hmm. You sprinkle a little salt on what happens. Wow. We have savory,

[00:07:26] Chris Case: should we go to evolutionary biology too? Now that you’re

[00:07:30] Trevor Connor: Oh, I can,

[00:07:31] Chris Case: I know you want to.

[00:07:32] Trevor Connor: Don’t get me started.

[00:07:33] Chris Case: I can. ’cause that’s, that’s more your forte than history.

[00:07:36] Trevor Connor: Well, so here’s the question, and maybe we save this to the end of the episode of we are gonna make the case here that too much sodium is bad for you.

[00:07:47] Chris Case: Mm-hmm.

[00:07:48] Trevor Connor: Yet. The two things that we crave the most are salt and sugar. Why do we crave salt so much?

If too much is bad for us, that’s that’s little thing, right? That we’re gonna save for the end.

[00:08:02] Jared Berg: I was about to like go into that, but we’re not. We’re gonna save it. I was getting excited,

[00:08:05] Trevor Connor: but let’s start, Jared, give us the basics of sodium. What role does it serve in our body? Why do we need it? What

[00:08:11] Jared Berg: is it?

Yeah. So yeah, I mean, that’s a great place to start because we need salt. We can’t survive without it. Right. It is an essential mineral metal, right? Sodium is a metal. Yeah. Sodium is like a chemical battery, right? That powers nerve impulses and it basically allows our muscles to contract. It’s really. Sort of the impetus for making, allowing our body to move.

Mm-hmm. Sort of use our muscles. So it’s like a chemical messenger mm-hmm. Matter way of saying it.

[00:08:41] Trevor Connor: Mm-hmm.

[00:08:41] Jared Berg: It’s specifically active in that sodium potassium pump.

[00:08:45] Trevor Connor: Yeah. A little bit of physiology for anybody who doesn’t know this, you know, when you, you see images that people make on TV of our nerves firing.

Yeah. They show all these little electrical impulse bolts moving down the nerves. That’s actually not how it works.

[00:08:59] Jared Berg: Mm-hmm.

[00:08:59] Trevor Connor: That’s how a fiber or optic cable works. Mm-hmm. And that’s why you can talk to somebody in Europe. Yeah. Because it travels at the speed of light signals don’t move at the speed of light in our nerves.

What happens is, in a normal resting state, our cells have, most of the potassium is inside the cells. Not outside.

[00:09:16] Jared Berg: Yep.

[00:09:17] Trevor Connor: Most of the sodium is outside the cells, not inside. And what happens is you have these transporters that open up, the sodium floods into the nerve cell, the potassium floods.

[00:09:28] Jared Berg: And

[00:09:29] Trevor Connor: that changes the electrical gradient and that ion exchange moves down the nerve cell.

[00:09:35] Jared Berg: It’s like a consistent polarizing repolarization kind of thing.

[00:09:38] Trevor Connor: Right? So, and it’s slow. So

[00:09:40] Chris Case: relatively speaking,

[00:09:41] Trevor Connor: relatively speaking, it actually takes a bit for a signal to get from your brain down to your hands or down to your feet. And that’s why we actually have some automatic responses that happen more in the spinal column because it’s, yeah, don’t, because if you wait for your brain to respond.

Like if somebody throws something at, you wanna get out the way, right? You

[00:10:01] Chris Case: touch a hot object or something like that. Yeah.

[00:10:02] Trevor Connor: It’s not your brain that pulls the hand away. It’s actually lower down ’cause it’s quicker.

[00:10:06] Jared Berg: But if it was a speed of light, maybe you’d touch that hot object quick enough where you wouldn’t actually get a burn.

Right?

[00:10:11] Trevor Connor: Mm-hmm.

[00:10:11] Jared Berg: But because it’s slower, you actually, you know, your tissue tissue’s damaged. I mean specifically sodium causes or muscle fibers to shorten.

[00:10:19] Trevor Connor: Mm-hmm.

[00:10:20] Jared Berg: Right. Causes the sequence events that causes those muscle fibers to contract and shorten and they gotta release, which makes them sort of lengthen.

[00:10:27] Trevor Connor: But this gradient between potassium and sodium is critical in all of our cells. We would not live without that gradient. Keeping the potassium in the cells, the sodium outside. There’s actually a transporter on all of our cells that keeps, maintains that gradient. It’s a sodium potassium cotransporter.

And at rest.

[00:10:47] Jared Berg: Yep.

[00:10:48] Trevor Connor: To give you an idea how important this is at rest, 25% of the energy that we burn.

[00:10:52] Jared Berg: Yeah. Isn’t that crazy?

[00:10:53] Trevor Connor: Just goes into maintaining those transporters.

[00:10:56] Jared Berg: Yeah. Basically a bunch of ATPs are going to making that happen. It’s

[00:11:00] Trevor Connor: interesting. So without sodium, potassium, nothing in our bodies would function.

[00:11:03] Jared Berg: Yeah. Super important. Sodium also functions in sort of maintaining our fluid balance in our bodies. Simple as water follows, solute and sodium is one of those solutes. And so help us sort of maintain plasma volume and then intercellular hydration status. And then it’s also one of the big things that sodium’s gonna do.

It stimulates thirst.

[00:11:24] Trevor Connor: Mm-hmm.

[00:11:25] Jared Berg: Right. And then it also can reduce urine production. Right. So I mean, you think about it, if we’re have a, you know, more sodium in our extracellular fluid, we’re gonna need to hold onto water to maintain that fluid to sodium balance. Which that basically means that we’re not gonna pee that water out.

[00:11:45] Chris Case: Mm-hmm.

[00:11:46] Jared Berg: Right. And then also, sodium’s very important in the absorption of carbs and amino acids and water. Right. And there there’s been, you know, enough studies that says sodium, you know, electrolytes, concentration, specifically sodium in a fluid, allows us to take that fluid in faster. There’s specific amounts and it’s not, you know, typically that high, but that also accelerates a fluid absorption and also carb absorption, like we think about carbs and trying to get more and more carbs in a beverage.

What we sort of peak out at the fastest absorption rate in a fluid, I think it’s like four or 5% carbs with an appropriate amount of sodium.

[00:12:28] Trevor Connor: So sodium plays actually a very important role in the acid-based balance in our systems. And sodium is an acidifier.

[00:12:35] Jared Berg: Yeah.

[00:12:36] Trevor Connor: And potassium actually kind of counters that.

[00:12:40] Jared Berg: Yeah.

[00:12:40] Trevor Connor: Particularly because remember that we have to keep sodium out of the cells.

[00:12:45] Jared Berg: Yeah.

[00:12:46] Trevor Connor: And we use a potassium sodium cotransporter to maintain that gradient. If we have insufficient potassium, then there’s a backup mechanism to get the sodium out of the cells, which is a hydrogen ion.

[00:13:01] Jared Berg: Yeah.

[00:13:02] Trevor Connor: Sodium co-transporter or transports a hydrogen ion with the sodium molecule cell

[00:13:07] Jared Berg: and the hydrogen ion makes us, makes our,

[00:13:09] Trevor Connor: makes our blood

[00:13:10] Jared Berg: acidic

[00:13:10] Trevor Connor: more acidic.

And for any women listening to this who are concerned about osteoporosis, and there’s a lot of cyclists who are also very concerned about osteoporosis, it is actually more a acid base issue. It is an acidifying effect. ’cause what’s the best source of base in our bodies? It’s calcium.

[00:13:28] Jared Berg: Calcium. So you pull the

[00:13:29] Trevor Connor: calcium outta the bones so you leach the calcium out of the bones to bring the pH back up.

So there are now studies, most of the research on calcium and osteoporosis shows either no benefit or limited.

[00:13:42] Jared Berg: Yeah.

[00:13:43] Trevor Connor: They’re now doing studies where they’re taking people who have osteoporosis, putting ’em on a potassium supplement and you’re actually seeing bone regrowth.

[00:13:51] Jared Berg: Yeah, that makes sense. I mean, because I have sort of well under understood that, uh, sort of osteoporotic.

Tendency of a high sodium diet and one of the recommendations is to reduce sodium in your diet if you’re dealing with sort of osteopenia or basically

[00:14:03] Trevor Connor: Yep.

[00:14:04] Jared Berg: Bone health issues. And to here explain sort of in that acid-based balances. I think that’s really kind of hits home.

[00:14:10] Trevor Connor: And to that point, here’s a 2015 study and in doctrine

[00:14:13] Chris Case: endocrine, if you’re, yes, I see a funny

[00:14:16] Jared Berg: face

[00:14:17] Chris Case: Myocin for endocrine.

[00:14:17] Jared Berg: Is that a Canadian for endocrine?

[00:14:18] Trevor Connor: Yes

[00:14:19] Chris Case: it

[00:14:19] Jared Berg: is. Yes it is.

[00:14:19] Chris Case: According to Trevor, not according to other Canadians I’ve spoken with

[00:14:23] Jared Berg: like Indoc. RIN is like a

[00:14:24] Chris Case: indoc. It makes me think of indoctrinate.

[00:14:26] Jared Berg: Yeah, that’s what I feel. It’s sort of, yeah. We’ve had this discussion. Our fans,

[00:14:30] Trevor Connor: out fans a healing and unique person.

That’s right. Tres. Pronunciation of Indoctor.

[00:14:35] Jared Berg: You’re you’re special.

[00:14:36] Trevor Connor: I am. Chris tells me I’m special all the time.

[00:14:40] Jared Berg: He’s special.

[00:14:41] Trevor Connor: Yes. Now we’ve completely lost that train of thought. Title of this study is Association of Urinary Sodium slash Now you got me worried about the pronunciation of every single word.

Creatinine ratio with bone mineral density in postmenopausal women. And the short of this is they are seeing that that excess of sodium is an issue with osteoporosis.

[00:15:01] Chris Case: Mm-hmm.

[00:15:01] Jared Berg: Yeah. Yeah, for sure.

[00:15:03] Trevor Connor: So last thing that we need to explain before we continue on with our conversation is osmotic pressure. And this is really complex.

I’m giving you a simple explanation, but basically it is a way of measuring the concentration of different solutes, like sodium in a fluid. It’s called pressure. Because if you had two containers that. We’re connected and one had a high concentration of sodium or salt, and one had a low concentration of salt.

There’s gonna be pressure to push the salt into the lower concentration fluid until they’re imbalance, and that’s what happens in our body. We try to keep all our fluids at a particular osmotic pressure, and if some fluid has too much sodium in it, there’s gonna be a drive to push the sodium into the other fluids and get it to a certain point.

And the osmotic pressure for sodium in our body fluids is about 295, 300 milli osmo per hg. And I’m sure I’m mispronouncing that I, I always forget what that exact metric is. So that’s really important to understand because it also means that we keep a very particular concentration of sodium in our blood, in our fluids.

If you start. Consuming too much sodium, you’re gonna have to bring fluid in to dilute it, to get it back to that right concentration. Likewise, if you start losing sodium, you’re gonna start urinating out a lot of fluid volume again, get everything back into balance,

[00:16:39] Jared Berg: for sure.

[00:16:40] Trevor Connor: So let’s talk a little bit, let’s forget about sport for a minute.

[00:16:43] Jared Berg: Yep.

[00:16:44] Trevor Connor: Let’s just talk a little bit about sodium needs. And I know there’s a debate here, we’ll get into debate a little later, but what does the science, and from your experience, what are people’s general sodium needs?

[00:16:56] Jared Berg: Yeah. Our needs are between 500 and a thousand milligrams per day for optimal physical functioning.

Right. That’s not that much.

[00:17:04] Chris Case: No. What’s a bag of ruffles? Potato chips contained, do you know?

[00:17:08] Jared Berg: 160 milligrams.

[00:17:10] Chris Case: Okay.

[00:17:10] Jared Berg: So it’s not a lot, but if you have a glass of tomato juice, you’re already at 800. Glass of tomato juice is 800 milligram.

[00:17:17] Chris Case: Who? The glass of tomato juice anymore.

[00:17:19] Jared Berg: Yeah. You’re like a, do you do

[00:17:19] Chris Case: that?

[00:17:20] Jared Berg: You drink more cama, right? Is that, is that your drink? Clam juice with tomato juice. I know

[00:17:25] Chris Case: what it is. That’s, I would never even get

[00:17:28] Jared Berg: near the can. I think they mixed, I think down in Mexico they mix that with Pacifico or, uh,

[00:17:31] Chris Case: wow.

[00:17:32] Jared Berg: Yeah. It’s

[00:17:32] Chris Case: amado.

[00:17:33] Jared Berg: Fancy, fancy cocktail. Yeah.

[00:17:36] Chris Case: Maybe we’ll do an episode on that.

We should at

[00:17:37] Jared Berg: later, at a later

[00:17:38] Chris Case: date

[00:17:39] Jared Berg: in

[00:17:39] Chris Case: terms of sodium.

[00:17:40] Jared Berg: Yeah. So it is, it is pretty easy to get. I mean, yeah, if you have a bag of potato chips yeah, you’re not gonna have too much. But if you actually have some of those, like veggie straws

[00:17:49] Trevor Connor: mm-hmm.

[00:17:49] Jared Berg: That’s 300 milligrams of sodium and, and it’s serving of those,

[00:17:52] Chris Case: that’s a very concentrated amount in a small bag of,

[00:17:55] Jared Berg: yeah.

[00:17:55] Trevor Connor: So I’ll give you some others. So surprisingly the things that got the most sodium in is soy sauce.

[00:18:00] Jared Berg: Soy sauce, yeah.

[00:18:00] Trevor Connor: Mm-hmm. Yeah. 7,000 milligrams per a hundred grams. A bowl of soup can have a thousand milligrams.

[00:18:06] Jared Berg: It can. Exactly. Yeah.

[00:18:07] Trevor Connor: You know, a couple slices of pizza can be your, your daily sodium intake.

[00:18:11] Jared Berg: Daily sodium. You start your day with again, like a element T or whatever you’re gonna, you’re gonna get a thousand milligrams. You’ve already exceeded your needs for optimal physical functioning.

[00:18:19] Trevor Connor: Yep. Deli meats, canned fish.

[00:18:22] Jared Berg: Super high.

[00:18:22] Chris Case: Yeah. Super. Yeah. Any cheeses are gonna have super high amounts.

[00:18:25] Trevor Connor: Salt is, yeah.

So here, uh, quick tangent here. When you’re talking about cheeses, there’s something called a prowl value for foods. This is proximal renal acid load. Basically a measure of how acidifying foods are in our body and what you need to know about cheeses is. Their proud values are the highest by pretty much an order of magnitude.

They are really acidifying food

[00:18:48] Jared Berg: and then o other ones. I mean like pizza sauce.

[00:18:51] Trevor Connor: Yep.

[00:18:51] Jared Berg: Then you can combine pizza sauce with cheese. You have like this sort of sodium balm. Right? So it’s pretty easy to get that above what you need. Again, 500 to a thousand milligrams, half a gram to one gram of sodium.

[00:19:01] Trevor Connor: The other one that surprises people is one of your, your biggest sources of, of sodium is actually bread.

’cause they, they needed to, yeah,

[00:19:08] Jared Berg: yeah, yeah. Because I wouldn’t always think about that. It’s recommended, like for the American Health Association and the FDA, that you, we have a maximum of 2300 milligrams of sodium per day. That’s sort of what’s recommended.

[00:19:20] Trevor Connor: So a standard slice of bread contains about 100 to 200 milligrams of sodium.

[00:19:26] Jared Berg: Yeah. And so if you have, you know, a few pieces of bread or some french toast

[00:19:30] Chris Case: or Yeah, you’re talking about a pizza, that’s the sodium balm because you got the sauce, you got the cheese, and then you’ve got cross everything. Everything about it has salt, a sodium bal of lots of salt.

[00:19:39] Jared Berg: Yeah.

[00:19:39] Chris Case: And then

[00:19:40] Jared Berg: if you add some pepperoni or something

[00:19:41] Chris Case: exactly like, then you’ve got the cured meats on top of it, and then people sprinkle the Parmesan cheese on top of it for another hit.

It’s like unbelievable amounts.

[00:19:50] Trevor Connor: So hitting your

[00:19:51] Chris Case: knees, but you should still eat your pizza every once in a while.

[00:19:53] Jared Berg: Everyone, I mean, we need to get pizza. Yeah. Search that up. Trevor, while you’re there, how much sodium’s in like a couple pieces of like. Domino’s pepperoni pizza.

[00:20:01] Chris Case: Remember back in the days, Trevor, when you used to go for like a seven hour ride and then you’d come home and you’d eat an entire large pizza by yourself because I I,

[00:20:10] Trevor Connor: it’s a high, a huge bomb.

So a single slice of pizza generally contains between 600 to 1200 milligrams of sos

[00:20:16] Jared Berg: single

[00:20:17] Chris Case: slice. And

[00:20:17] Jared Berg: everybody usually eats one slice, right?

[00:20:19] Chris Case: Oh, yeah, of course,

[00:20:19] Trevor Connor: course.

[00:20:20] Jared Berg: Yeah.

[00:20:22] Trevor Connor: So what we’re basically saying is hitting your sodium needs for the day is not a problem.

[00:20:29] Jared Berg: Yeah. You know, in the typical, you know, diet, hopefully we’re not adhering to the sad diet, the standard American diet, but if we were, we get a lot of sodium

[00:20:37] Trevor Connor: where, where does all this sodium go in our bodies Once we ingest it,

[00:20:41] Jared Berg: yes.

[00:20:42] Trevor Connor: Here’s the really cool thing. Yeah. Which is a new science.

[00:20:46] Jared Berg: Yes.

[00:20:46] Trevor Connor: That’s upending everything that we know about sodium

[00:20:49] Jared Berg: and, and it is, and it’s upending. Even like things that, the way I’m. Recommending sodium intake for athletes, like right now on the, on the daily, and I’m making some changes even in the last month.

[00:21:01] Trevor Connor: Mm-hmm. Yep.

[00:21:01] Jared Berg: Yeah.

[00:21:02] Trevor Connor: So the whole understanding of sodium has been this two compartment model for a long time. We believe that all sodium in our body was stored in two compartments.

[00:21:13] Jared Berg: Yeah.

[00:21:14] Trevor Connor: The intervascular compartment. So think basically our blood, we have a lot of sodium in our blood, and then the interstitial compartment, which is all the fluids surrounding our cells.

And really important to understand with both of these compartments, they are bound by that osmotic pressure we were explaining earlier.

[00:21:33] Chris Case: Mm-hmm. Mm-hmm.

[00:21:34] Trevor Connor: So if you start eating a ton of sodium, what happens is then you become thirsty. You need more fluid to maintain the pressure, so you start drinking a bunch of fluid.

Then your kidney, that increases your blood pressure,

[00:21:46] Chris Case: right? Mm-hmm.

[00:21:47] Trevor Connor: That causes your kidneys to start working overtime and they start getting rid of flat fluid. They also start getting rid of the sodium

[00:21:53] Chris Case: to release valve.

[00:21:54] Trevor Connor: And this is how that pressure is maintained. That’s how the sodium is maintained in our bodies.

[00:22:01] Chris Case: Yep.

[00:22:01] Trevor Connor: And so there’s this equation called the Edelman equation that factors in all this and basically allowed doctors, and I think a lot of people in sports also use this to be able to calculate, if you sweat out this amount, if you drink this amount, if you take in this much sodium, here’s exactly what’s gonna happen in your body and how much we expect you to excrete.

So this whole calculation was for them to, when they’re treating somebody

[00:22:29] Chris Case: mm-hmm.

[00:22:29] Trevor Connor: Who might be dehydrated

[00:22:31] Chris Case: Yeah.

[00:22:31] Trevor Connor: Or have hypernatremia to figure out Exactly. Here’s how much you need and what’s gonna happen.

[00:22:36] Jared Berg: Yeah. Or be on dialysis. Yeah.

[00:22:37] Trevor Connor: Right. The issue is this equation has never been right and it’s often been off.

A lot.

[00:22:43] Chris Case: Is that because of the third

[00:22:45] Trevor Connor: compartment?

[00:22:46] Jared Berg: Yeah. And I have a question before we go into the third compartment, which is getting exciting.

[00:22:49] Trevor Connor: Mm-hmm.

[00:22:50] Jared Berg: Is the two compartment syndrome. I feel like one of those compartments that we can we hold most of our sodium is actually, it’s probably the intracellular you’re talking about is our bones.

Right? About 20 to 30% of our sodium is like actually held in our bones.

[00:23:03] Trevor Connor: That’s fair. And that’s actually hasn’t even been covered. So that I’m looking at a diagram that was written up in the study, explained the whole two compartment model. It doesn’t even show bone tissue.

[00:23:13] Jared Berg: Yeah. And then it, like you think about bone, and from what I understand about sodium and bone, it can be sort of accessed pretty readily.

Mm-hmm. If we need it, if our body is in like a low sodium situation, we’re more than happy to release some of that sodium from our bones.

[00:23:30] Trevor Connor: Interestingly, all these studies I read on the two compartment and three compartment model didn’t even talk about the bones.

[00:23:35] Jared Berg: Yeah.

[00:23:35] Trevor Connor: So that’s interesting. Is that, I wonder what that’s considered to be part of

[00:23:39] Jared Berg: Yeah, exactly.

I’m guessing the intracellular compartment, but Yeah.

[00:23:42] Trevor Connor: Yep. But in this two compartment model, the belief was sodium was always maintained at a certain concentration in our body fluids. So if you consume more sodium, you need more fluid or you need to excrete the sodium. And so the belief was our kidneys completely controlled sodium homeostasis and fluid homeostasis.

That was what was believed in the two compartment model, and that’s what this whole Edelman equation was based on, as we said. This formula, it just never added up.

[00:24:14] Chris Case: Yeah,

[00:24:14] Trevor Connor: it hasn’t worked. Right. You know when they do studies on actual people and measure consumption and then measure excretion, they go, the formula doesn’t predict it.

Right. So what’s going on?

[00:24:25] Jared Berg: That makes sense to me the way that you say this and me being in like doing my clinical dietetic rotations and just seeing how much manipulation they’re doing with diuretics and such to try to control fluid balance. It’s not easy to do this and it’s a significant issue on the floors of the hospital.

[00:24:41] Trevor Connor: Just to go on a little bit of tangent here, here’s what’s even more important because of this maintenance and because we always wanna keep our body in a certain homeostasis and because we have to keep salt at a certain concentration in the blood, the belief was ultimately sodium consumption and sodium excretion are gonna match one another.

And so what they have been doing for years and years and years. In research is using what’s called a 24 hour urinary analysis. Looking at the, how much sodium do you excrete in order to assess how much sodium you’re consuming. And what they’re also now seeing is, yeah, that doesn’t hold up either. And so studies that look at, you know, the impact of sodium consumption on heart disease, on various conditions that use these 24 hour urinary analyses were based on a false assumption.

And so you might not actually be having accurate assessment. So they’re using these urinary excretions to say, okay, this is a high sodium consumer, this is a low sodium consumer. And then going, okay, who has more heart disease, for example, over time, but it’s not accurate. Urinary analyses.

[00:25:54] Jared Berg: Yeah.

[00:25:55] Trevor Connor: Or they aren’t necessarily accurately predicting.

Now one study said you have to do this for seven days in a row and then you can get a more accurate analysis. A single 24 hours isn’t good enough. Isn’t,

[00:26:07] Jared Berg: isn’t enough. Yeah.

[00:26:08] Trevor Connor: So I found that really fascinating and it’s something to think about and I think we’re both gonna say this understanding of sodium homeostasis has been flipped on its head so much.

A lot of this is now questions.

[00:26:21] Jared Berg: Oh yeah. I mean, I’m, it just keeps like questions going on in my head. Yeah. Especially with, you know, recommendations that I would be making with athletes based off of a, not a 24 hour analysis, but a single point in time during a workout of how much salt is showing up in a sodium analysis tool in my lab.

You just kind of wonder like, well, how does, how would that different, you know, change over seven days? How would that change with diet manipulation and Yeah. And such. So yeah, it does create more questions than answers. Right now,

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[00:27:54] Trevor Connor: So what has. Upended all this is a fairly recent discovery, which they are calling the third compartment. So we just talked about the two compartment model. They’ve realized there is a third compartment that stores sodium and it is our epithelial cells, primarily the skin.

[00:28:15] Jared Berg: The skin,

[00:28:17] Trevor Connor: and I’m just gonna throw a couple terms out here, but in the skin are these epithelial cells?

Sodium combined is something called, boy, I’m gonna go

[00:28:29] Jared Berg: this. I’m so excited right now.

[00:28:31] Trevor Connor: Glyco salmon, glycans gags.

[00:28:36] Jared Berg: I’m sure that was perfect.

[00:28:37] Trevor Connor: I’m sure it wasn’t really slow. Sure. And here’s what’s important about that. When it binds to these Gs, it basically deactivates the need to maintain osmotic balance.

[00:28:52] Jared Berg: Yeah.

[00:28:53] Trevor Connor: So it becomes osmotically neutral.

[00:28:56] Jared Berg: Yes, that’s important because it’s not gonna, we can have that sodium stored in our skin and it’s not gonna affect our, our blood pressure, our fluid volume.

[00:29:04] Trevor Connor: So we can store a whole bunch of sodium in the skin and you don’t need to suddenly consume a whole ton of fluid to maintain your osmotic pressure.

[00:29:14] Chris Case: And let me guess, some people store more in their skin than others,

[00:29:18] Trevor Connor: so you have a large storage capacity. And yes, depending on your sodium consumption, you can store more or less. And what they’re showing is where they used to believe the kidneys were. What regulated fluid and sodium balance, the skin plays an important role could potentially play an even more important role.

So let’s say you start over consuming fluid and you need more sodium in the blood. It can draw the sodium outta the skin.

[00:29:49] Chris Case: Mm-hmm.

[00:29:50] Trevor Connor: And maintain osmotic pressure.

[00:29:51] Chris Case: Mm-hmm.

[00:29:52] Trevor Connor: Likewise, if you consume too much sodium and your body’s going, I can’t main osmotic pressure, it’s gonna increase thirst, but the skin can draw a whole bunch of that sodium out of the blood and maintain the osmotic pressure and relieve a lot of the demand on the kidneys to keep this balance.

[00:30:10] Jared Berg: And I feel like this is something that maybe we’ll get into a little bit later, but we don’t quite understand. It’s another question, if we have more sodium in our skin, we might or might not start sweating out more sodium. To me that would make sense that we would, it’s right there. Our, our sweat goes right through our skin.

We would show higher sodium concentration in our sweat. Is that known or not?

[00:30:31] Trevor Connor: So I have been waiting for that and there have finally been a couple studies on that. So for example, here’s one. Which is just an abstract, but there’s a couple other studies that cover it. But there’s one called short-term changes in dietary sodium intake, influence, sweat Sodium concentrations, and Muscle Sodium content in Healthy Subjects.

And this study does address that,

[00:30:53] Jared Berg: but it’s addressing actually the skin.

[00:30:55] Trevor Connor: Yeah.

[00:30:55] Jared Berg: Storage and the, and,

[00:30:56] Trevor Connor: yeah.

[00:30:56] Jared Berg: Okay.

[00:30:57] Trevor Connor: And there were a couple other studies that I don’t have in front of me that addressed it, that basically said, yes, if you start storing too much sodium in your skin, you’re gonna start having saltier sweat because having too much sodium in the skin, and we’re gonna cover this

[00:31:14] Jared Berg: Yeah.

[00:31:15] Trevor Connor: Is damaging, it’s associated with cardiovascular disease. Something that’s really interesting that you’re gonna find interesting, Chris, is it correlates a lot with left ventricular hypertrophy. Mm-hmm. Which is something that happens in atrial fibrillation.

[00:31:30] Jared Berg: Mm-hmm.

[00:31:31] Trevor Connor: Most importantly though, is what you see, because now we understand that the skin.

As a major role in maintaining osmotic balance, maintaining blood pressure. When the skin gets overloaded, people start becoming what’s called salt sensitive, meaning that you start consuming more salt, your blood pressure’s gonna really spike.

[00:31:53] Jared Berg: Yeah.

[00:31:53] Trevor Connor: And your body’s ability to better maintain blood pressure is gonna go down.

[00:31:59] Jared Berg: Yeah. That’s not good.

[00:32:00] Trevor Connor: And last one, they’ve also shown excess sodium in the skin. And this is important for us. Cyclists actually breaks down the oxidative stress protective mechanisms in the skin, which, if you’re getting a lot of sun exposure is something that you need.

[00:32:15] Jared Berg: Yeah.

[00:32:15] Trevor Connor: Hmm.

[00:32:16] Jared Berg: Okay. Yeah, that kind of goes into sort of our next segment, right?

Where we talk about the different concerns around higher, low sodium.

[00:32:23] Trevor Connor: Yeah. So I think even before we get there, it’s important to bring up, there’s a big debate right now. Over whether we should be eating a low sodium or a high sodium diet.

[00:32:35] Jared Berg: I mean, there is some recent research out there that has actually, I think it’s that Bram, B-R-A-A-M in his group talks a little bit about the fact that we’ve seen some, you know, I guess the term is paradoxal.

[00:32:50] Trevor Connor: Yes.

[00:32:51] Jared Berg: Like things with, hey, if when somebody has a sodium load for a few days, they’re noticing a decrease in blood pressure that they’re having a hard time explaining. They tried to go into mechanisms, but I didn’t quite get it.

[00:33:03] Trevor Connor: Likewise, they theorize that a low sodium diet could increase blood pressure.

[00:33:07] Jared Berg: Yeah.

[00:33:08] Trevor Connor: But a lot of this debate comes out of, there were two studies and we’ll put these in the show notes so I’m not reading constantly reading titles.

[00:33:15] Jared Berg: Yeah.

[00:33:15] Trevor Connor: But there were two studies in 2014, I forget the journal that one was published in the other was in the New England Journal of Medicine, which is one of the top journals out there.

And these studies showed a U-shape relationship between sodium consumption and heart disease, meaning people that ate a really high sodium diet like 8,000 milligrams a day.

[00:33:36] Jared Berg: Yeah.

[00:33:37] Trevor Connor: Had very high rates of heart disease, but people that ate a low sodium diet,

[00:33:41] Jared Berg: what was low?

[00:33:42] Trevor Connor: So 1500 milligrams and below.

[00:33:44] Jared Berg: Okay.

[00:33:45] Trevor Connor: Also had very high rates of heart disease. This U-shaped relationship showed the lowest rates of heart disease were up around three 4,000 milligrams a day. That’s which is above the RDA. That’s

[00:33:57] Jared Berg: interesting though, because that’s observational study. I’m guessing

[00:34:01] Trevor Connor: it was an epidemiological study. Yeah, it’s correlation, and this is where correlation is really important

[00:34:06] Jared Berg: because they’re talking about the people who are on 1500 die.

Anybody who’s under 1500 milligrams of sodium is gonna be somebody who’s has at risk of heart disease already. So

[00:34:16] Trevor Connor: bingo.

[00:34:16] Jared Berg: Yeah.

[00:34:17] Trevor Connor: So this data was reanalyzed, I think it was 2017 in another study and I’ll, we’ll put that in the show notes as well. But here was the issue. It was a correlational study and they made a big mistake.

They didn’t control for people that already had heart disease in the study. And generally when your doctor diagnoses you with heart disease, the first thing they tell you is low

[00:34:40] Jared Berg: sodium diet.

[00:34:41] Trevor Connor: Get sodium outta your diet. So it wasn’t the low sodium diet that was causing the heart disease.

[00:34:48] Jared Berg: That’s a population.

[00:34:49] Trevor Connor: No, it was the heart disease that was causing the low sodium diet. Yes,

[00:34:52] Jared Berg: exactly. Yeah.

[00:34:54] Trevor Connor: It was the other way around. So this other study I was telling you about, corrected for this, where they removed people that had already had heart disease.

[00:35:01] Jared Berg: Yeah.

[00:35:02] Trevor Connor: And then it was a straight line relationship. The more sodium you consume, the higher the rates of heart disease.

[00:35:06] Jared Berg: That’s, yeah. That’s just an example of like research correcting itself and the body of evidence versus the single study.

[00:35:13] Trevor Connor: But those two studies get quoted a lot. There are a lot of influencers out there saying, A high sodium diet is good for you. Here is the evidence.

[00:35:22] Jared Berg: Yeah.

[00:35:23] Trevor Connor: So what’s your take on this? High sodium, low sodium?

Should we go into both? What are the concerns though with a, a low sodium diet?

[00:35:30] Jared Berg: Yeah, I think we should, so concerns with low sodium diet. First off, let’s just hit on the fact that a low, you know, low sodium diet or being risk of low sodium is very uncommon in daily living circumstances and healthy populations like we’ve talked about.

Mm-hmm. So don’t be, you know, sort of going through your day and wondering, am I getting enough sodium? You really don’t have to think about whether you’re getting enough, but if you were on a super low sodium diet, whether it was prescribed to you by a doctor or you just happened. To be the very few who just don’t get a lot of sodium in their diet.

Yeah. It can actually be tied to high blood pressure. Mm-hmm. Right. Uh, in that, there’s talking about like the, that could be attributed to the, the re and angio tension system and our kidneys that controls fluid balance or low sodium storage in the skin. The inhibition of the nitric oxide reaction process, which basically that’s a gas that’s released in our endothelial cells, in our blood vessel walls that allows our blood vessels to relax that could be inhibited with low sodium.

Yeah. And then just changes. Or in our central nervous control. All those things could be what may be causes our blood pressure to rise if we’re on a super low sodium diet.

[00:36:39] Trevor Connor: And let’s just point out the obvious that we need sodium to survive.

[00:36:43] Jared Berg: Yes.

[00:36:43] Trevor Connor: If you’re sodium, if you get too low in your diet, you will die.

[00:36:47] Jared Berg: Yep.

[00:36:48] Trevor Connor: So make sure you are getting enough.

[00:36:49] Jared Berg: Yes.

[00:36:50] Trevor Connor: One other thing I will bring up that gets cited a lot by the people that promote a high sodium diet is a belief that a low sodium diet causes insulin resistance. And there’s one particular review that they point to a lot. It was a 2016 review called Low Salt Diet and Insulin Resistance.

And there’s this table in it where there are multiple studies, and this is again where you go make sure you read the whole study. Don’t just look at the table.

[00:37:16] Jared Berg: Yeah.

[00:37:16] Trevor Connor: Because when you look at the table, the evidence seems pretty strong where there’s a bunch of studies that show, yeah, they put people on a low salt diet and you saw some insulin resistance reaction.

[00:37:28] Jared Berg: Yeah, but that’s probably the similar as that previous one where you’re having people with cardiovascular cardiometabolic risk.

[00:37:35] Trevor Connor: This was actually different if you dive into it. The studies that showed a correlation with insulin resistance.

[00:37:43] Jared Berg: Yeah.

[00:37:43] Trevor Connor: They were only a, only on a low salt diet for a short period of time.

Okay. Like five days.

[00:37:49] Jared Berg: Oh yeah.

[00:37:50] Trevor Connor: And were often on an extreme low salt diet, like 500 milligrams a day.

[00:37:54] Jared Berg: Oh. Below what we need for optimal, right? Yeah. Function

[00:37:57] Trevor Connor: for almost for survival.

[00:37:58] Jared Berg: Yeah.

[00:37:59] Trevor Connor: They had some studies that were long-term where it was a more like a thousand milligrams or 1200 milligram

[00:38:06] Jared Berg: Yep.

[00:38:06] Trevor Connor: Per day low sodium diet.

And they actually saw improvements in insulin resistance. So this is a review that gets misquoted. And actually, if you go to the conclusions of the review, that’s exactly what they say. Yeah. Is I love that this review gets cited by people who say, oh, salt causes low salt diet causes insulin resistance.

[00:38:27] Jared Berg: Mm-hmm.

[00:38:27] Trevor Connor: The conclusions of this review actually make the case that that’s what it looks like in the research, but it’s not the case.

[00:38:33] Jared Berg: Yeah. So cool.

[00:38:35] Trevor Connor: Yeah.

[00:38:36] Jared Berg: So kind of just to start sort of teasing into like the sodium and exercise, but we’re not gonna totally go into it yet. I know. But in exercise or extreme environments, low sodium can affect our hydration status.

Mm-hmm.

[00:38:48] Jared Berg: It can play some roles in nerve signaling and muscle contraction ’cause we know that sodium is, you know, part of what helps make muscles shorten. And then it can affect your fluid balance and your blood plasma. And we know that if we don’t have good volume of blood plasma, we’re not gonna be able to transport oxygen and substrates through our body.

And that actually can even lower our VO two during exercise. So basically, because of all its functions as the sodium does, it’s associated with dehydration and then cardiovascular risk events and even death. So, you know, obviously. We need to make sure we’re getting enough sodium. How much is enough? We talked about that already.

It’s not a lot. And the other concern with low sodium is hyponatremia. So if you have, if we were to sit here and have a contest, the three of us, and see how much water we could drink

[00:39:37] Trevor Connor: mm-hmm

[00:39:37] Jared Berg: Over the course of a couple hours, even if we’re not exercising, we could put ourselves into sort of at risk of hyponatremia, which basically means that our cells in our body are just gonna overflow with fluid and then could potentially cause like, you know, brain pressure and really some major issues.

[00:39:55] Trevor Connor: I found it interesting that one review that you and I were sharing the effects of sodium intake on health and performance and endurance and alter endurance sports talked about hypernatremia.

[00:40:05] Jared Berg: Yeah.

[00:40:06] Trevor Connor: And said, well, a, if somebody’s gone into a bad state because of hypernatremia absolutely gets salt in their system.

Mm-hmm. Gets salt into their system fast. Yeah. What they said is though the cause of hypot, Hermia has a lot more with to do with over consumption

[00:40:21] Jared Berg: Yes.

[00:40:22] Trevor Connor: Of fluid than how much sodium you take. So they’re saying even if you take sodium, but you’re just pounding the water.

[00:40:29] Jared Berg: Mm-hmm.

[00:40:30] Trevor Connor: The sodium’s just not gonna compensate enough.

It’s really just the over consumption of fluid that causes it.

[00:40:35] Jared Berg: Yeah.

[00:40:36] Trevor Connor: Not the under consumption of sodium.

[00:40:37] Jared Berg: Yeah. And that’s an easy one In exercise, everyone needs to know how much sweat they’re losing per hour in different environmental. Conditions so they know that they’re not gonna be at risk of over or under fluid consumption.

[00:40:49] Trevor Connor: Yep. So let’s talk now about some of the concerns of too high a sodium diet. And we’ve already talked about a couple osteoporosis,

[00:40:59] Jared Berg: blood pressure,

[00:41:00] Trevor Connor: blood pressure, but what are some of the others

[00:41:02] Jared Berg: sort of immune system response,

[00:41:04] Trevor Connor: right? Yeah, this, I get really excited

[00:41:06] Jared Berg: about it. Yeah. Well if you’re excited about it, take it away.

[00:41:08] Trevor Connor: So let’s start with, these were two groundbreaking studies in 2013, both published in Nature, pretty much the highest impact journal out there. One was titled Sodium Chloride Derives Autoimmune Disease by the Induction of Pathogenic TH 17 Cells. The other one is Induction of Pathogenic TH 17 Cells by Inducible Salt Sensing kinase, SGK one.

So let’s break down what this means. I’ve talked on the show of before about TH 17 cells, they’re a highly inflammatory T-cell. The belief is their role is to deal with bacterial infection and important to note that our body uses sodium to also deal with bacterial infection. So that’s actually, we didn’t even talk about that one.

The other reasons that sodium is stored in the skin because it’s a great antimicrobial. Yeah. And they’ve shown that when you have a cut and it gets infected, your body pushes a lot of sodium into the skin. Right around that infection.

[00:42:10] Jared Berg: Yeah. Probably the same reason why we use sodium to store foods like you know, before we had refrigerator.

Exactly. ‘

[00:42:15] Trevor Connor: cause it was protective against bacteria. So not surprising that a cell that is designed to fight bacterial infection has some sort of relation with sodium consumption. The important thing to understand about th 17 cells, well they have an important role. They’re highly damaging. You want them to upregulate, deal with the infection,

[00:42:34] Jared Berg: and then come down

[00:42:35] Trevor Connor: and then down regulate.

Chronic TH 17 elevation, we are discovering more and more precedes so many conditions. Yeah. So it precedes every single autoimmune disease.

[00:42:46] Jared Berg: Yeah.

[00:42:47] Trevor Connor: But they are now also associating it with heart disease. They’re associating it with cancers. And what they’re showing is that sodium upregulates TH 17 and can also down-regulate T regulatory cells, which are the cells that bring down inflammation.

[00:43:04] Jared Berg: Yeah. Yeah. That sounds like that’s sort of like inflammation is a big player in that. Like, I mean, I see like just in that study, endothelial dysfunction.

[00:43:11] Trevor Connor: Yep.

[00:43:12] Jared Berg: Right. Kidney sodium retention, oxidative stress, arterial hypertension, which is gonna be related to that inflammation.

[00:43:19] Trevor Connor: Yep.

[00:43:19] Jared Berg: And then if we do have inflammation on the arterial walls, we know that they’re gonna be more susceptible to building up plaque and Yeah.

So all those things can lead to a event.

[00:43:27] Trevor Connor: Well, so one of the studies, you and I, and again put all this in the show notes that we were looking at, showed that actually. Even blood pressure like we thought blood pressure was just a simple thing of you consume too much sodium.

[00:43:38] Jared Berg: Yeah. Plumbing. Yeah.

[00:43:39] Trevor Connor: Kidneys can’t keep up, so you get too much fluid that increases blood pressure, but now they’re showing actually blood pressure is an inflammatory reaction.

[00:43:47] Jared Berg: Yeah. I mean if it’s inflammatory, it might cause arterial wall stiffness.

[00:43:50] Trevor Connor: Yep.

[00:43:51] Jared Berg: Right. And that’s gonna make it much harder for that blood vessel wall to deal with that increased osmotic pressure from the high sodium too.

[00:43:58] Trevor Connor: Yep. Exactly.

[00:43:59] Jared Berg: Yeah.

[00:44:00] Trevor Connor: So when you hear people talking about, you know, chronic disease nowadays is because we have inflammation, we need to get inflammation down.

Basically what these studies are showing is sodium is a major driver of inflammation and that can have a lot of other effects too. So another one that I’ll bring up, this was a study that I just recently read, oh, came out in 2018, but the title of this study is Dietary Salt, promotes Neurovascular and Cognitive Dysfunction Through a Gut Initiated TH 17 Response.

So, again, showing TH 17 has multiple effects, and this can be a contributor to neurodegeneration, including Alzheimer’s disease. But what was really interesting when I read this study was, the title isn’t, does SALT contribute to cognitive dysfunction? It’s dietary salt promotes neurovascular and cognitive function through the industry.

And they briefly cover this in the introduction. I’m giving you the short version. Mm-hmm. But basically saying, it is so well established in the science that salt contributes to neurodegenerative diseases, that now we’re just looking for the cause.

[00:45:12] Jared Berg: Mm-hmm.

[00:45:13] Trevor Connor: How it does it.

[00:45:14] Jared Berg: Yeah.

[00:45:14] Trevor Connor: Not whether it does it.

[00:45:15] Jared Berg: Yeah.

Yeah.

[00:45:17] Trevor Connor: And there are multiple studies showing that, yeah, high salt consumption actually contributes to neurogeneration as well.

[00:45:23] Jared Berg: We already touched on the sodium, we actually covered it in detail, how sodium can increase our risk of osteoporosis, you know, because of that. Sodium. It competes with calcium for reabsorption in our kidneys, which that will flush calcium out every urine.

And our kidneys will poke calcium directly from our bones to maintain our, um, pH balance in our body.

[00:45:45] Trevor Connor: Yep. And then another one quickly for cardiovascular disease. So as we said, it’s stores sodium in our epithelial cells. So skin is our biggest, but our blood vessels are all aligned with epithelial cells.

And they have this layer around them called the glycocalyx.

[00:46:03] Jared Berg: Mm-hmm. Yep. Very thin, thin layer.

[00:46:07] Trevor Connor: And those GAG that, I’m not gonna try to pronounce it again Chris, but GAG is in the glycocalyx and they’re showing that the glycocalyx also stores salt. And that’s actually very damaging to our vascular system and contributes to heart disease.

So,

[00:46:24] Jared Berg: so

[00:46:25] Trevor Connor: have we made the case for a high salt diet?

[00:46:27] Chris Case: Tell me, would hope not.

[00:46:28] Jared Berg: Oh yeah. I,

[00:46:29] Chris Case: I mean pizza, but everything else.

[00:46:31] Jared Berg: Yeah. We said, yeah. We said keep enjoying your pizza. ’cause how can you not? Pizza’s so good. But

[00:46:37] Trevor Connor: so now when you eat pizza, you know, people joke when they eat something really bad for them, they go, go straight to my belly.

[00:46:43] Chris Case: Mm-hmm.

[00:46:43] Trevor Connor: You go, it’s going straight to my skin.

[00:46:45] Chris Case: It’s going straight to my skin. Yeah. And my heart and my every, like, everything, it’s destroying everything.

[00:46:51] Jared Berg: Yes, yes. You’re wearing pizza on your skin. It’s, uh,

[00:46:56] Trevor Connor: so going back this high salt, low salt diet, do you change at all your recommendations or do you stick with your recommendations for somebody outside of sport?

Outside of sport? Seems like it’s a good recommendation.

[00:47:09] Jared Berg: Yeah, I think the general recommendations even let that the American Health Association and the RDA are giving of staying under 2300 milligrams of sodium. Yeah, per day is, that’s a solid recommendation and no reason you can’t keep it around 1500 or a touch less.

You gotta be just fine. You’re in a, your body’s gonna function well and then, you know, we’ll get into the exercise component later, but the general recommendations, the body of evidence, you’re talking about it for years, what we’re learning in the new research, the fact that we can store sodium in our skin gives us a sort of buffering window, you know, like of like, Hey, if we’re low on sodium, we’re gonna be okay.

Yeah, we have sodium on reserve, right? We have it in our skin, we have it in our bones, and we stored in our extracellular fluid. So

[00:47:54] Chris Case: I think, I can’t imagine there’s too many people out there that are listening that have any risk of being on the low side and they are exercising often. And so the needs might be different, but there’s also not a more is better.

[00:48:13] Jared Berg: Yeah.

[00:48:13] Chris Case: Necessity

[00:48:14] Trevor Connor: here. Let, let, let me give you an example there of Yeah. The challenges we as athletes face because we generally eat more food because we’re exercising.

[00:48:25] Chris Case: Mm-hmm.

[00:48:25] Trevor Connor: So, leading into this podcast, as I was doing the research, I just went, I wonder how much sodium I’m eating because I, as you can probably tell, I don’t believe in a high sodium diet.

Mm-hmm. I believe in a low sodium diet. I agree with your recommendations. And to that point, world Health Organization recommends 1500 milligrams a day. Yeah,

[00:48:43] Jared Berg: yeah.

[00:48:43] Trevor Connor: And I agree with that recommendation. So I really felt, well my sodium’s gotta be pretty good, so I, I got a nutrition tracker. Yeah. And spent the last two weeks tracking my nutrition,

[00:48:55] Jared Berg: great exercise,

[00:48:56] Trevor Connor: and days where I’m doing long rides and eating a lot more food.

I was getting 4,000. Yeah. 4,500 milligrams

[00:49:04] Chris Case: per day. Just simply through the volume of food and because salt is in pretty much everything that we consume nowadays. The volume of sodium specifically went up. Yeah.

[00:49:13] Jared Berg: Went up. But probably wonderfully proportional to your needs based off of what you’re doing.

With exercise,

[00:49:18] Trevor Connor: it was still too much.

[00:49:20] Jared Berg: You think you’re getting too much salt and you probably weren’t excreting much of that sodium outta your Yeah. Sweat. Yeah. So,

[00:49:27] Trevor Connor: but I mean, the point being I was trying to eat a low salt diet.

[00:49:30] Jared Berg: Yeah.

[00:49:32] Trevor Connor: Was shocked when I was seeing,

[00:49:33] Jared Berg: so

[00:49:34] Trevor Connor: look how much I’m actually eating.

[00:49:35] Jared Berg: Yeah.

[00:49:36] Chris Case: Give us a sense of what you were consuming to get to those levels.

[00:49:39] Jared Berg: Yeah. On that wor, on that like long ride day.

[00:49:41] Trevor Connor: Well, this is the thing, it’s generally I’m eating pretty well.

[00:49:44] Chris Case: Sure.

[00:49:45] Trevor Connor: You know, not eating something salty. So like before my ride I might have a smoothie and you know, there’s no added salt to it, but some of these foods will have a little bit of sodium in them.

[00:49:55] Chris Case: Mm-hmm.

[00:49:56] Trevor Connor: When I’m exercising, I might do a sports drink, I’ll have some things, so I know when I’m exercising that there’s gonna be some sodium, and then I was okay with that, but I’m like, it’s fine because the rest of the day I’m not eating a lot of salt. But for example, my long ride this weekend, I stopped at the Boulder Reservoir and there were grilling hamburgers there.

So I said, let’s have a hamburger. And suddenly that hamburger was 1200 milligrams.

[00:50:18] Jared Berg: Mm-hmm. Yeah.

[00:50:19] Trevor Connor: Somewhere around there.

[00:50:20] Jared Berg: Yeah.

[00:50:20] Trevor Connor: But the rest of my foods, none of them, you would go, oh, that’s a salt bomb food.

[00:50:24] Chris Case: Mm-hmm.

[00:50:25] Trevor Connor: But I was eating. Probably 3,500, 4,000 calories and there is sodium in so many foods.

[00:50:32] Jared Berg: Yeah.

[00:50:33] Trevor Connor: It just adds up.

[00:50:34] Chris Case: Mm-hmm.

[00:50:35] Trevor Connor: Like I get this sweet potato, dried sweet potato snack that I eat as my recovery food.

[00:50:41] Jared Berg: Super. Hed sodium, I’m sure

[00:50:42] Trevor Connor: now it’s straight sweet potato, no other ingredients in it. Okay. So I was like, okay, that can’t have any sodium. Look at the package. 150 milligrams.

[00:50:50] Jared Berg: Yeah.

[00:50:50] Chris Case: Per serving. And you had, how many, did you have one, just one serving or, yeah.

[00:50:54] Jared Berg: That’s the same as

[00:50:54] Trevor Connor: serving two servings serving that’s the same as 300 milligrams.

[00:50:57] Jared Berg: Yeah.

[00:50:57] Chris Case: Yeah.

[00:50:57] Jared Berg: Same as potato chips.

[00:50:58] Trevor Connor: I was personally surprised.

[00:51:00] Jared Berg: Yeah.

[00:51:00] Trevor Connor: How much? And so I’ve been experimenting since on getting myself down. So now I am, I’ve been averaging about 1500 milligrams per day and it is bloody tough.

[00:51:11] Jared Berg: Yeah.

[00:51:12] Trevor Connor: I have to be careful about everything I put in my body to keep my sodium consumption down, because sodium is so

[00:51:19] Chris Case: prevalent.

[00:51:20] Trevor Connor: Prevalent in all the foods that we get.

[00:51:23] Chris Case: One question I wanna hit you with, and I think Jared was also thinking of this same thing, is how and why do you say 4,000 is too much?

[00:51:31] Jared Berg: Yeah.

[00:51:32] Trevor Connor: Sodium.

[00:51:32] Chris Case: Yeah.

[00:51:33] Jared Berg: Yeah, that’s what I was going for. Yeah.

[00:51:34] Trevor Connor: Well, everything that we just said,

[00:51:36] Jared Berg: everything we just said,

[00:51:37] Chris Case: right. But in the con, that’s in the context of somebody who’s not exercising.

[00:51:41] Jared Berg: Yeah. So if we went into that, what Chris is saying, if we went into the idea that you’re, for every hour of exercise, you’re probably sweating out one liter of sweat.

So that’s just a safe estimation. And in that sweat you probably have, I would say a thousand milligrams, maybe 800 milligrams of sodium would be like say on like the average to low side. That would be 800 times 4 30, 2 30, 200 milligrams of sodium. You know? And then you have an additional 800. And I think that would seem like that would be like, it wouldn’t be significantly too much based off of your exercise.

[00:52:19] Trevor Connor: And that’s my question is how much does it increase your needs?

[00:52:23] Jared Berg: Yeah.

[00:52:24] Trevor Connor: And you brought up the evolutionary side. They’ve done analysis on a hundred gatherer societies. They were averaging about 1200 to 1500 milligrams per day.

[00:52:33] Jared Berg: Okay.

[00:52:34] Trevor Connor: And they were frequently walk running a marathon a day.

[00:52:37] Jared Berg: Yeah. And out there in the extreme environments too.

[00:52:40] Trevor Connor: Yeah.

[00:52:41] Jared Berg: Yeah.

[00:52:41] Trevor Connor: So does it increase our needs that much And my, based on how I’ve been feeling in the week that I’ve now brought my sodium down.

[00:52:50] Jared Berg: Yeah.

[00:52:50] Trevor Connor: Feeling a lot better.

[00:52:51] Jared Berg: Yeah.

[00:52:51] Chris Case: His skin is radiant.

[00:52:53] Trevor Connor: Yeah. Look how great my skin is.

[00:52:55] Jared Berg: Oh yeah. Glowing.

[00:52:58] Trevor Connor: You know, honestly, I’ve been doing this a week and a half, so to say that I have seen anything dramatic.

I’m not expecting that I’m planning on doing this for five weeks at least, and seeing the effects. So I don’t wanna be premature. I would say the thing I’ve actually seen the most is the difficulty in doing this, and we should have mentioned this before when we were talking about all the sodium content in various foods.

I would say what is most difficult is eating out. Lena loves to eat out. We get together with her daughter and we go out to dinner. So I’ve been kind of going out to dinner probably three nights a week, often have lunch out. And when I started recording these meals, even what I thought were healthy meals, like I went to a place, I had a salad, but they had the nutrition information about their food and the salad was like 900 milligrams of sodium.

So often when I’m going out to dinner, it’s next to impossible to keep my sodium down. So. That’s what I have seen so far of this week and a half of targeting 1500 milligrams. It’s really hard to do, so if anybody out there thinks they are under consuming, you might wanna reconsider that or at least take a look like I did, because you might be surprised.

[00:54:12] Jared Berg: Yeah.

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For more information, go to to fci optics.com. Let’s get back to athlete needs Brings. Yeah. What are the needs? How does it affect things?

[00:55:03] Jared Berg: It brings, yeah, some questions and so traditionally this is what we’ve been doing with the labs that I’ve worked in, both that cu and here in my own practice, is we’re trying to understand how much sodium is being lost per liter of sweat, and then understanding how many liters of sweat somebody.

Is losing per hour, and then we go ahead and make sodium recommendations based off that. Right. And the recommendations we usually do, because we understand that we do store sodium in our body.

[00:55:38] Chris Case: The two compartments.

[00:55:39] Jared Berg: The two compartments, exactly, exactly. We understood that. Right. So the idea was, well, we have some storage, we have some room to play with.

We don’t need to replace all of it. So we would just say, you know what? Let’s replace 70 to 80 or 75 to 85% of your sodium loss. Allow for that storage to

[00:55:58] Chris Case: make

[00:55:58] Jared Berg: up a difference. Make up the difference. Right. Yeah. You don’t need, you know, so that would kind of support your, even that two compartment.

Situation would support your thought of maybe 4,000 is too much. If we just did 70% of that, that would say like, you know what, you only need 600 milligrams of sodium or five 50. Well five 50 times four is 2,400 milligrams of sodium, or 2200 milligrams of sodium. Mm-hmm. Okay. Then you add your daily needs, maybe a thousand on top of that.

That’s really, you should have only had 3,200 and you would’ve been just fine. So your 4,000 you were saying with that math, I would agree was too much. So I think your line of thought makes sense. However, what if we’re analyzing that sodium and you know, in my lab with my sodium analyzer and that number is inflated because we are storing too much sodium in our third compartment.

[00:56:52] Trevor Connor: Mm-hmm.

[00:56:53] Jared Berg: So then my numbers are all skewed.

[00:56:56] Trevor Connor: Well, this is what I was gonna ask you because they’ve, they’ve said in a hospital clinical setting outside of sport. The discovery of this third compartment has completely upended the calculations their, their understanding of, of fluid and sodium homeostasis.

[00:57:11] Jared Berg: Yeah. And so I’m also saying,

[00:57:12] Trevor Connor: so

[00:57:13] Jared Berg: what about it’s doing the same thing in sport?

[00:57:14] Trevor Connor: Yeah.

[00:57:15] Jared Berg: Yeah. If we go into how I analyze sodium, it’s a simple test. We, you know, usually we’re doing it while we’re doing a metabolic test, so you mm-hmm. We have, we’re, you know, analyzing your substrate utilization, your O2 consumption, taking lactates.

Well, while you’re doing that, I put a sodium patch on your back. If you opt in for a sodium, a sweat analysis, and you’re running or biking for, you know, better part of an hour, and then I basically weigh you in before you got on the bike or treadmill, and I weigh you out after to figure out your sweat rate in those lab, in that laboratory environment.

Then I take that sodium patch and I squeeze that sweat out into my analyzer, and that gives me a sodium concentration per liter, milligram per liter of fluid. So that’s how I’m measuring it.

[00:58:03] Trevor Connor: A lot of, I know the recommendations in the sports world are often replaced sweat losses.

[00:58:08] Jared Berg: Yes.

[00:58:08] Trevor Connor: So you’re doing an analysis.

Yes. But yeah. Here’s my question for you, which my guess is none of us have an answer to.

[00:58:15] Jared Berg: Yeah.

[00:58:15] Trevor Connor: Is we talked about people that have too much sodium stored in the skin. Mm-hmm. There is now actually research showing that Yeah, they sweat out more sodium because their body’s trying to get rid of it. Yeah.

Yeah. ’cause they’re getting into a bad state.

[00:58:27] Jared Berg: So I have two athletes right now that have reported symptoms that I feel like are potentially a sign of cellular dehydration. Mm-hmm. Basically, too much sodium and extracellular fluid is causing basically us to pull fluid out of the cell to. Basically like dilute the sodium and the extracellular fluid so the cell is shrinking, right?

And they’re, what they’re reporting is like extreme muscle soreness. Like they’re getting, you know, into like a 70.3 triathlon. They’re getting into, you know, 40 minutes into it, one hour into it, and they’re like, I didn’t expect this. My numbers, my power output isn’t significantly different than what I’m trained to do.

But then the report back, and this is all according to using that initial model based off of the two compartment model that their needs, because they’re sweating three and a half, four pounds an hour, which isn’t uncommon, especially for a bigger athlete, that they were needing 2000 milligrams of sodium per hour.

Well, that’s a lot of sodium. And so if that number that I was getting in my analyzer was reflective too, reflective of the sodium stored in the skin, then I’m getting an inflated number. Then the recommendations are off. So now we’re gonna go back to the drawing board and we’re gonna try less sodium. My thought is in my lab is to take these athletes and be like, you know what?

Let’s try a low sodium diet like Trevor’s doing right now. Let’s try to like cut back on sodium, see how much your sodium concentration changes in your sweat when you are on a lower sodium compared to. The normal where we tested you before and to see how things change and then make recommendations off of that.

So it’s, you know, it tells you how much. Right now we are in a practice stage of this. We are not all knowing.

[01:00:27] Chris Case: It also seems really hard to predict the variability between individuals in terms of how well they might pull in the sodium from their skin or you mentioned the source from Bones as well. Yeah.

And all of these different sources.

How

[01:00:44] Chris Case: do we know, to the point where it makes me wanna ask the question, does anybody need to be drinking high sodium bottles? Given that the standard American diet has all these sources, sodium, sodium in it, which

[01:00:59] Trevor Connor: is my,

[01:01:00] Chris Case: do we need to just have water in our bottles and then rely on our body’s ability to pull from the excess, the storage, these compartments to.

Get what we need during exercises? Or is that too an, you’re not ready to go there yet?

[01:01:15] Jared Berg: I’m not ready to go there yet. I feel like that is a good question. I think we’ll ultimately land somewhere in between.

[01:01:21] Chris Case: Mm-hmm.

[01:01:22] Jared Berg: Like I’m gonna start surveying or interviewing my clients more to see what their diet is like.

Mm-hmm. I’m gonna make some assumptions about how much they might store in their skin. ’cause I need to get closer than just assuming that they’re losing. Yeah. All of

[01:01:35] Chris Case: this is based on a lot of assumptions. It’s even the formulas you’ve been using for years are based on a lot of assu. Like the 75 to 85% is kind of arbitrary

[01:01:43] Jared Berg: or even based off inaccuracies.

[01:01:44] Trevor Connor: Yeah. Most of the, the formulas that you’re getting in the sports world are also probably based on that too. Compartment model understanding. Correct. So all this needs to be adjusted and to give you what we’re just talking about. To give you an example where I go, I don’t have an answer for this.

[01:01:58] Jared Berg: Mm-hmm.

[01:01:59] Trevor Connor: I believe there are probably some people that high have a high concentration of sodium in their sweat because they just sweat out a lot of sodium.

They do need to be replacing their sodium. Mm-hmm. There are other people that their skin is fully loaded.

[01:02:14] Jared Berg: Mm-hmm.

[01:02:15] Trevor Connor: And they have a high concentration of sodium in their sweat. And this is probably the more common scenario. So they have a very high concentration of sodium in their sweat because their body’s in an emergency state trying to get rid of it.

[01:02:26] Jared Berg: Yeah. Trying to pump it

out.

[01:02:27] Trevor Connor: And they need to reduce the sodium they’re consuming or they’re gonna end up in a disease state. How do we know which is which?

[01:02:32] Jared Berg: Mm-hmm.

[01:02:33] Trevor Connor: I don’t have an answer for that.

[01:02:34] Jared Berg: Yeah, it’s tough. It’s a tough conundrum.

[01:02:36] Trevor Connor: So to your point, Chris, I mean I would still in a sports drink, say probably good to have a little bit of sodium in there.

I’m looking at another study, intestinal fluid absorption during exercise, role of sports, drink osmolality and sodium. And what they say is actually for the absorption of fluid. Glucose is more important than the sodium.

[01:02:58] Jared Berg: Yeah,

[01:02:58] Chris Case: I mean, that’s the other thing that comes up is like, okay, if sodium is necessary to exist in the gut to help with fluid absorption, carb absorption, okay, that’s a source of sodium that you might need to spark that process.

Whereas if you have to pull it in from your skin, then it has to get to your gut to help you absorb those carbohydrates. That seems like one of those processes that it’s not gonna meet the demands because it’s gonna take too long, or it’s just not going to be as readily available or something like that.

[01:03:31] Jared Berg: Yeah, I think that’s a very pragmatic approach to that.

[01:03:34] Chris Case: I will say this is non-scientific in every way. I have not put a scoop of any powder in any water bottle for probably the last. Four years.

[01:03:45] Trevor Connor: I don’t really do it much either.

[01:03:47] Chris Case: I’m not racing that much anymore. Yeah. I’m not going like I used to, but I eat fairly well, but I know I don’t make a concerted effort.

Yeah. To reduce my sodium intake. And so I know that the things that I eat have more salt in it than I want. Yeah. Mm-hmm. Yeah. And so I’m like, eh, I don’t need more of it.

[01:04:06] Jared Berg: Yeah.

[01:04:07] Chris Case: In my bottles when I’m riding.

[01:04:09] Jared Berg: Yep. I’m straight.

[01:04:10] Chris Case: It’s just me.

[01:04:10] Jared Berg: I’m the same way. I probably have used a sports beverage, maybe I probably have four scoops in the last.

Like year. Really? Yeah.

[01:04:21] Chris Case: So we’re off. We’re

[01:04:22] Jared Berg: we’re

[01:04:23] Chris Case: all, we’re all, we’re pretty much the same kind of on the same board.

[01:04:25] Jared Berg: If I go for three hours

[01:04:26] Chris Case: Yeah.

[01:04:27] Jared Berg: My sodium’s gonna come from like the dry cereal and nuts that I put in my back pocket and like maybe an energy bar.

[01:04:34] Chris Case: Right. Exactly. I mean, I’m, I’m getting sodium on the bike because I’m consuming food.

Yeah.

[01:04:39] Jared Berg: Yeah.

[01:04:39] Chris Case: I just don’t feel like I need it more in the bottles.

[01:04:42] Trevor Connor: I’ll give you, you know, a personal extreme case scenario. You know, I love that tour of Tobago race, which is a hundred degrees, a hundred percent humidity. It’s miserable.

[01:04:51] Chris Case: Mm-hmm.

[01:04:51] Trevor Connor: Sounds like long race. I always did a mix of. Uh, sports drinks and water bottles.

But if I drank over the course of that race, say 12 bottles, half mm-hmm. Three of them,

[01:05:03] Jared Berg: yeah.

[01:05:03] Trevor Connor: Might have had a mix in it,

[01:05:04] Jared Berg: right? Yeah.

[01:05:05] Trevor Connor: So you’re, you’re getting what’s handed to you, and I never had an issue getting through the race, but here’s the question that everybody’s gonna ask you. So, but what about cramping?

[01:05:13] Jared Berg: Yeah. What about cramping? That’s a tough one. Yeah. Because I’ve had so much success with this advice. Where it is, like you feel like you have a cramp coming on, you take a hit of sodium, whether it’s through a concentrated sports beverage, a salt tablet that cramp pretty good chance it’s gonna release like better than fi, maybe more like 70, 80% chance that it’s gonna release and subside within 30, 40 seconds after taking that salt.

[01:05:44] Chris Case: Wow.

[01:05:44] Jared Berg: And it’s this time and time again with the amateur athlete, novice, all the way to the very, the most elite athletes. I’ve had the one of, one of my pros who just won US national championships last weekend in 70.3. Triathlon was like, asked me like a year ago, he’s like, sodium’s not really gonna help make your cramp go away.

I’m like, let’s try it. It will, it could make your cramp go away within 30 seconds. You can use it like a bandaid. Right? So that’s a hard one to be like, you know what, sodium is not tied to electrolytes, not tied to cramping. Right. And the research hasn’t proven that. However, whenever we’re in the field, we’re late into a race and fatigue is a serious issue.

I’ve always had success with sodium working as a bandaid for that cramp and making the allway go away.

[01:06:31] Trevor Connor: But what about the, you need lots and lots of electrolytes to prevent cramping. ’cause it seems like that’s where the research says there’s just no

[01:06:39] Jared Berg: evidence. Yeah, I, and I think that goes into where the research is suggesting cramps are coming from and they’re coming from the stress.

Exceeds the tolerance.

[01:06:50] Trevor Connor: Yep.

[01:06:51] Jared Berg: Right. You have too much fatigue in your legs for what you’re doing, and then you ask more of it, your muscles fail and so at that point, which is hard to induce in research at that point, sodium may help with the cramping.

[01:07:05] Trevor Connor: So we talked before about hyponatremia. Mm-hmm. What about hypernatremia?

Too much salt.

[01:07:13] Jared Berg: Yeah. So too much salt. So we talked a little bit about that when I gave some of those, my case studies.

[01:07:17] Trevor Connor: Mm-hmm.

[01:07:17] Jared Berg: Right. When these athletes were basically having 2000 milligrams of sodium per hour, which may have been too high because elevated sodium concentration may have been coming from skin that I was analyzing in their sweat.

[01:07:31] Chris Case: Mm-hmm.

[01:07:32] Jared Berg: The other one of the athletes may have sodium concentration, may have been too high because the environment wasn’t as warm as we were expecting for the race. So they were having too much sodium, not enough fluid that may have been pulling fluid from the cell, causing that cellular dehydration, which is really gonna affect exercise output.

So yeah, so too much sodium could lead to dehydration type symptoms, right? Where we’re just, the tissue that’s actively moving doesn’t have enough fluid in it. It could have a lot of the same symptoms as hypo, low sodium. So hypernatremia can, you know, cause dizziness and a lot of like those chills and things that are similar to dehydration and heat stress responses.

And so could be coming from vascular stiffness, poor blood flow, too much blood pressure. The possibilities are endless and the symptoms of hypernatremia, but it’s, you know, definitely not ideal either.

[01:08:26] Trevor Connor: Yeah. And that one review on the performance in sodium raised, the issue that you have hyponatremia, hypernatremia, dehydration, the, you know, hypernatremia and dehydration.

Can go hand in hand, but what they said is the issue is they all look very similar.

[01:08:44] Jared Berg: Yes, yes.

[01:08:45] Trevor Connor: But the treatment is dramatically different.

[01:08:48] Jared Berg: Mm-hmm. Yep.

[01:08:49] Trevor Connor: And how do you know when somebody’s at the end of a sporting event?

[01:08:52] Jared Berg: Yeah.

[01:08:52] Trevor Connor: And they did say one of the things that differentiates hyponatremia is people will throw up.

[01:08:59] Jared Berg: Yeah. I remember reading that also. And that’s very common. I think that we’ll see that.

[01:09:03] Trevor Connor: Yeah. If you see somebody who’s dizzy and looks off at the end of a sporting event

[01:09:09] Jared Berg: mm-hmm.

[01:09:09] Trevor Connor: Don’t immediately assume, oh, they’re dehydrated. Get a medical professional to evaluate them Exactly. And go, they’re dehydrated and start handing them water and they’re suffering from hyponatremia.

[01:09:19] Jared Berg: You’re gonna exacerbate hyponatremia. You’re

[01:09:20] Trevor Connor: gonna make it worse. Yeah.

[01:09:21] Jared Berg: Yes.

[01:09:21] Trevor Connor: Yeah. So bring a medical expert in.

[01:09:23] Jared Berg: Yeah. And then, you know, for hypernatremia, the increase of fluid could help.

[01:09:28] Trevor Connor: Right?

[01:09:28] Jared Berg: Yeah. That you need to have a really good medical doctor to be able to delineate.

[01:09:33] Trevor Connor: Yep.

[01:09:34] Chris Case: I think I wanna get to that.

Earning question that we started with. You laid it out there. We haven’t answered it. I feel like this has something to do with what we’re talking now, which is our natural ability or our understanding or innate sense of what we need. So it goes back to evolutionary biology.

[01:09:54] Trevor Connor: Let me rephrase the question, which is the two things that humans crave the most are salt and sugar.

[01:09:59] Chris Case: Mm-hmm.

[01:10:00] Trevor Connor: And you don’t believe me. Go to the junk food aisle in the grocery store and look at the ingredients. They put a lot of salt, they put a lot of sugar in those foods because it makes people crave ’em. And quick tangent, be really careful about sauces. This is where people get in trouble. Yeah. Because we just covered soy sauce.

Highest concentration of salt of any food. Mm-hmm.

[01:10:20] Chris Case: That sauce.

[01:10:21] Trevor Connor: A lot of people will eat a healthy food, but then dump a bunch of sauces on it that absolutely kill it. Dressings

[01:10:27] Chris Case: too.

[01:10:27] Trevor Connor: Yep.

[01:10:28] Chris Case: Stuff like that.

[01:10:29] Trevor Connor: Yeah. So that’s a side tangent, but point being, the two things we crave the most are salt and sugar, but there’s a ton of evidence, ton of research out there showing too much sugar.

Consumption is very bad for health.

[01:10:40] Chris Case: Mm-hmm.

[01:10:41] Trevor Connor: I hope we’ve made the case, and I’m sure there’s people listening that are really upset about this and go the show notes, I’m gonna put a ton of references in there. Mm-hmm. Only you’d laugh if you looked at my screen and saw how many studies I have here. I only mentioned a few, but we’ll put a ton in there, but have made the case that a high salt diet is also bad for

[01:10:59] Jared Berg: you.

Yes.

[01:11:00] Trevor Connor: So why do we crave these things from an evolutionary standpoint? Why would we crave these things? Too much is bad for us.

[01:11:09] Chris Case: My guess would be that because there were periods of time where none of it was available. So when there was any amount of it, there was signals that said you should get as much as you can now because you might not get this for another six months.

[01:11:22] Trevor Connor: Bingo. We need them to survive.

[01:11:25] Jared Berg: Yeah.

[01:11:25] Trevor Connor: You have to have a certain amount of sodium or you will die. Even people on a ketogenic diet, their body will convert a certain amount of the ketones to glucose ’cause your brain needs glucose to survive.

[01:11:36] Jared Berg: Yep.

[01:11:36] Trevor Connor: These are two things you absolutely need, but you don’t need them in high concentrations.

And during the time that we were evolving, getting too much was never an issue. It was always an issue of finding them.

[01:11:48] Jared Berg: Mm-hmm.

[01:11:48] Trevor Connor: Getting something. So we involved a strong craving so that when we encountered it, we would eat it.

[01:11:55] Chris Case: Yeah. Yeah. There was a scarcity. So the biology said, get it while you can. And now there’s an excessive amount of these things and,

[01:12:05] Trevor Connor: and we never, and the signal is evolved.

The mechanism to shut down.

[01:12:09] Jared Berg: Yeah. Yeah. That crazy

[01:12:10] Trevor Connor: consumption.

[01:12:11] Jared Berg: Yeah. Yeah. That makes sense.

[01:12:12] Trevor Connor: So, you know, that’s the other thing when, when people say, I just keep eating, I get hungry and hungry, and you go, what are you eating? And it’s always loaded with salt and sugar and you go. Because of that mechanism when you actually, so glucose spikes insulin.

[01:12:26] Chris Case: Mm-hmm.

[01:12:27] Trevor Connor: Insulin spikes hunger. Yeah. When you consume a lot of sugar, you get hungrier.

[01:12:31] Chris Case: It’s a deadly cycle.

[01:12:32] Trevor Connor: So these things will actually make you want to eat more. Yeah. Not eat less.

[01:12:36] Jared Berg: So funny, like we’re talking about this and I’m reading the label on this bottle. Right. Full disclosure, I, this is just carrying my coffee and, and

[01:12:44] Chris Case: Oh,

[01:12:44] Jared Berg: it’s not the actual, it’s not, I’m not actually drinking this and I will won’t buy these ever again.

I don’t think. Now

[01:12:50] Chris Case: that you’ve read the

label,

[01:12:51] Jared Berg: we’re talking about sugar and this is a bought house Farms protein plus with almond butter protein smoothie in a bottle here it has 33 grams of sugar.

[01:13:01] Chris Case: Mm-hmm.

[01:13:01] Jared Berg: Listen to the sodium 590 milligrams of sodium. Wow. In a smoothie

[01:13:08] Chris Case: is, that’s one survey

[01:13:09] Jared Berg: that’s almost as much as tomato juice.

[01:13:10] Trevor Connor: Right.

[01:13:11] Jared Berg: Yeah. So that’s gonna desensitize. I’m gonna be like, I’ll drink this. You know, if I actually was drinking this and probably an hour and a half, two hours later I’ll probably have a cell craving.

[01:13:21] Trevor Connor: Yeah.

[01:13:21] Jared Berg: You know, I mean, if there’s chips, I’m like, oh, this tastes good.

[01:13:23] Trevor Connor: Eat

[01:13:23] Jared Berg: more. You know? You know, not that I’m, yeah.

But my mixed nuts have sodium in them.

[01:13:26] Trevor Connor: Mm-hmm. This is one of the simplest things I give people. If you wanna lose weight, cut salty and sugary foods outta your diet with the warning, you’re gonna see a bunch of weight drop in the first couple days. Yeah. Don’t, too excited. Don’t get too excited. That’s just water loss.

’cause you’re not drinking as, you’re not consuming as much sodium, but what you’ll see is your food cravings will go down.

[01:13:45] Jared Berg: I like that. Yeah, that’s great advice.

[01:13:47] Trevor Connor: Well, we fully cover this,

[01:13:49] Jared Berg: you know, we almost did. I know we kind of wanted to talk a little bit about sodium chloride versus sodium citrate.

[01:13:56] Trevor Connor: Absolutely.

[01:13:57] Jared Berg: Do we away, I’ll take it. So sodium chloride, table salt. The understanding is we have enough chloride. Our body and stored in our body. So do we need to supple, you know, like do we need to have sodium chloride in our sports beverage or could we just do well with sodium citrate, which is more just sodium plus a substrate that pairs well with it from my understanding and helps us get that sodium into our system.

And then the citrate has a really couple cool responses. One is citrate is a substrate that drives the citric acid cycle cycle.

[01:14:31] Trevor Connor: I was gonna say, are

[01:14:32] Jared Berg: you gonna uses in

[01:14:32] Trevor Connor: Creb cycle, are you gonna do

[01:14:34] Jared Berg: ci citric? Yeah. I could’ve say kreb cycle. It’s the same thing as citrate acid. Acid cycle acid. Exactly. So citrate, right?

So pretty awesome that we can have something in our sports beverage that also can sort of drive our metabolism. And the other thing that citrate it can be converted into bicarbonate, which is a whole nother discussion. But bicarbonate can

[01:14:58] Trevor Connor: buffer,

[01:14:58] Jared Berg: buffer. The hydrogen ions that are attached to, to lactate.

So it, it helps control our pH balance, keep our pH a little bit higher so we don’t have acidosis while we’re working out and maybe can handle a little more workload.

[01:15:12] Trevor Connor: What I am amazed by is the fact that we just cracked a joke about the kreb cycle, which is the nerdiest thing I think I’ve ever done.

Both laughed.

[01:15:23] Jared Berg: Yeah.

[01:15:24] Trevor Connor: And Chris didn’t say a word.

[01:15:25] Jared Berg: Yeah,

[01:15:25] Trevor Connor: he was probably just shaking his head.

[01:15:28] Jared Berg: You guys are dorks.

[01:15:29] Chris Case: Well, I mean, I knew that when I walked in the door this morning, half this episode, I’ve been sitting back watching you guys giggle about sodium things. So

[01:15:39] Trevor Connor: I was sitting there laughing, going, I am seriously laughing over kreb cycle versus citric acid cycle.

Yeah. I have become everything I hate

[01:15:47] Jared Berg: and nobody else cares.

[01:15:51] Chris Case: Well, it’s time.

[01:15:52] Trevor Connor: Take homes.

[01:15:53] Chris Case: Take homes. Trevor, I wanna go last. You want to go last Jared,

[01:15:56] Trevor Connor: because I have two and I’m hoping one of you will cover one of them. So I only have to do the other.

[01:16:01] Chris Case: Jared, why don’t you go first?

[01:16:02] Jared Berg: I’ll go first. Sure. So I’m in the business of understanding sodium concentrations in sweat.

I offer that as a service sweat analysis tool, even though there’s, we are even disclosing some unknowns about that. But I, I beg the question to, you know, should you understand your sodium concentration, but not just because you want to use it in the field while you’re in a race or you’re in training, but also to understand maybe.

Some of you, you know, high or low sodium concentration is reflective of how you’re storing, what compartments you’re storing sodium in. So it can maybe give you one more understanding above and beyond doing blood work that shows that our sodium stays in a very finite window just ’cause we’re body’s amazing at controlling it.

But it can give you one more point of reference to know how your body is dealing with sodium.

[01:16:53] Chris Case: I think that one of the more interesting, practical things that somebody can do after listening to this episode is do what Trevor did over the last few weeks, which is just pay attention. Yes. And actually, I don’t know how often people do this, but pay attention and do a little math problem and write down some of the total milligrams of sodium you, it doesn’t have to just be sodium.

It could be a lot of things, but just calculate how much you’re actually consuming. ’cause I think it would actually shock. People in terms of their consumption, particularly around sodium.

[01:17:27] Jared Berg: So I want to get Trevor, I wanna put a patch on him. I wanna have him go out for a ride. Mm-hmm. Or, or a run whatever, and then come back, analyze the sodium now that he, and keep on your low sodium diet.

Right now

[01:17:38] Trevor Connor: I’m planning at least five weeks of being misfocused.

[01:17:42] Jared Berg: So let’s do this and let’s see what your sodium concentration is. And then let’s have you just go on a alt pizza and diet and just Yeah, come on. For, for science and those movies. And bought a host a heart

[01:17:54] Trevor Connor: attack For science.

[01:17:55] Jared Berg: For science. So Trevor agrees.

And then we’re gonna, then we’re gonna Anything for science I him say that once. Exactly, exactly. So then we’re gonna see how it changes. And so, yeah. Anyway, it’d be kinda exciting.

[01:18:06] Trevor Connor: It would be interesting. Let’s, let’s,

[01:18:09] Chris Case: interesting. Exciting.

[01:18:10] Trevor Connor: Let, let’s, let’s figure it out as we go. So I did have two, you mostly covered one of them, but I just wanna emphasize how big a change has occurred in our understanding of sodium and fluid homeostasis.

It has upended what scientists thought they fully understood. Now we don’t. And more importantly, it is much more complicated now.

[01:18:38] Jared Berg: Agreed.

[01:18:39] Trevor Connor: So if you’re asking what does it mean, what does that translate into? Recommendations, unfortunately answers right now are, scratch your head. Uh, don’t know.

[01:18:47] Jared Berg: Yeah.

[01:18:47] Trevor Connor: But that’s exciting.

’cause I think over the next 20 years we’re gonna have a much more sophisticated understanding of it. And I’m, I’m looking forward to reading all that research.

[01:18:56] Jared Berg: Very helpful.

[01:18:57] Trevor Connor: My other takeaway, and I know there are people listening to this who are getting really angry with me, but there has been this debate of the low sodium versus high sodium diet, and which is healthy for you.

And it has taken off on social media. High salt diet is good for you, and I hope we have made the case that just isn’t backed up by the science. And I quoted a couple studies, go to our show notes. I’m gonna put like a hundred references. Just study after study showing the effects. I’m even one I didn’t mention that we read for this understanding the two faces of low salt intake, a review that wanted to look at is low sodium diet good or bad for you?

[01:19:39] Chris Case: Mm-hmm.

[01:19:40] Trevor Connor: And basically what they said is there are very few intervention studies on a low sodium diet, but the ones that have been done have generally shown a benefit. And then when they try in this review to make the case for a low sodium diet being bad for you, they go, we don’t have any research. So hypothetically it could be bad for you for these reasons.

[01:20:00] Chris Case: Mm-hmm.

[01:20:01] Trevor Connor: So there just isn’t a lot of evidence of a low sodium diet being bad for you. There is a ton of evidence, particularly those ground baking studies, showing that high salt. Promotes TH 17. There’s just a high salt diet is bad for you, and that’s one of the take homes I hope people get from this.

[01:20:20] Jared Berg: Yeah, I mean, thinking about sodium tied with inflammation, that’s a huge one. Yeah,

[01:20:26] Trevor Connor: that was another episode of Fast Talk. Subscribe to Fast Talk, whoever preferred to find your favorite podcast. Don’t forget, we’re now on YouTube. Give us a like and subscribe there and help us grow our reach. As always, remember that the thoughts and opinions expressed on Fast Talk are those of the individual.

Join us on social media at At Fast Talk Labs for access to our endurance sports content and continuing education. For coaches, head to Fast talk labs.com For physiologist, Jared Berg and Chris Case, I’m Trevor Connor. Thanks for listening.