by Michael Arnstein

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Hyponatremia is an Epidemic in Sports Today

This is a very important subject to learn about if you are an aspiring ultra runner.

It doesn’t matter what your diet is, whether you are a fast food junk eater, a vegetarian, vegan, a raw foodist, or a fruitarian like me: Keeping proper blood sodium levels in ultra distance running is the going to be one of the most critical challenges in reaching your goals safely and feeling good.

My number one concern in ultra run racing is trying to stay on top of how much sodium I am taking in, whether it’s too much or too little. Hyponatremia is when you have too little blood sodium, and this is extremely dangerous and can result in seizure and even death in a short period of time. Hypernatremia is when you have too much blood sodium, this normally results in bloating, headache, upset stomach. In extreme dehydration sodium intake can be lethal. Here is my simple approach to trying to manage a balance: If conditions are very hot and humid and you are sweating a lot, and you have unlimited access to water, I would suggest taking as much sodium as you need. Error on taking too much, because if you are sweating a lot and have a continuous source of water, your body will very very quickly sweat out any excess sodium that it doesn’t need. I highly recommend SCAPS as the most simple and effective sodium supplementation: In hot humid weather I normally take 4 per hour, or as many as 6 to 8 per hour if I am at maximal effort. One practical issue that comes up when taking in supplemental sodium during hot conditions where you will be sweating a lot is body skin chaffing. Be sure to wash areas with clean fresh water around your body where skin rubs together. Salt is highly abrasive and can very quickly rub your skin raw. Carry petroleum jelly and continue to rinse rubbing skin areas very often. In hot weather conditions I recommend drinking enough water so you are going to the bathroom 1-2 times per hour, not less, not more. If conditions are cold and you are not sweating as much, the best recommendation that I can offer is to keep your water intake at a level so you are going to the bathroom about 1 to maximum 2 times per hour. This will allow your body to flush out excess sodium, but if you are taking 1-3 scaps per hour you’ll still unlikely to run into hypo or hypernatremia issues. Instead of swallowing sodium pills in cool weather conditions, I recommend putting the pills in your water or sprinkling the sodium on the food you are eating — if your tongue likes the taste of the sodium then your body is directly giving you notice it wants and needs more sodium. If your tongue reaction is that the water or food tastes bad then you have enough sodium in your blood. Use your tongue as a major indicator to know your sodium needs in cool weather conditions where you won’t be sweating as much. For me personally: I don’t need any additional sodium supplementation if it is not hot or humid until I’ve been running hard for more than 4 hours. If it’s hot and humid and I am running hard, I will start taking in supplemental sodium within 2 hours of running. If I run out of sodium and start to experience hyponatremia, I immediately slow down and walk or run at a very low intensity until I have access to sodium, if I try to run hard I will pass out and it could be lethal! Common Sense: Practice in training and in various temperature conditions to learn how much or little sodium supplemental intake you need. The biggest challenge ultra runners face is electrolyte/sodium balance. If you are a raw foodist or a fruitarian like me and don’t eat anything with salt on it during your normal training and living days, don’t try to enter into the sport of ultrarunning thinking you can somehow accomplish hard effort exertions for many many hours without additional salt. It’s nothing to be ashamed about, it’s something that you learn more about the more you race and train in various conditions. Please do not take advice from someone who has no practical experience in this sport. This is a potentially lethal health issue. Hyponatremia is far more common and dangerous than hypernatremia. Attempting to take natural sources of high sodium foods like coconut water or celery juice is risky and it’s very hard to manage these things on a practical level in training or racing conditions. I don’t recommend salty fatty foods like cooked junk food potato chips, this should only be taken in extreme conditions when you have no other choices and hyponatremic. If you don’t believe you need additional sodium for ultra distance running, just try to go for a 4 hour run without sodium intake, then try it with sodium intake. Your 4 hour run with sodium will turn into a 3 hour run and you’ll feel fantastic all the way to the end! Be smart, be safe, finish strong!


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