How to Balance Low Sodium and Electrolyte Replacement During Exercise?

[Kokomodo]

There are two nutrition segments who do not communicate much: low sodium diets and electrolyte replacement. I have seen a number of articles about "low sodium backpacking" and "low sodium backpacking meals." There are also many, many articles (likely driven by a lucrative market) on electrolyte replacement during prolonged exercise.

I have recently been diagnosed with cirrhosis and have been advised to maintain a low sodium diet. Because my diet has been an all natural, whole food diet for a number of years, achieving low sodium guidelines is not difficult. I've found that I actually have to supplement with salt to make sure I don't drop below a necessary minimum intake of sodium.

Sodium lost through sweat during endurance exercises - such as backpacking - can be 500 mg per liter of sweat. And, under fairly typical conditions, an adult can lose two to three liters of sweat during an all day trek. This suggests a potential sodium loss of 1,500 mg per day over a metabolic baseline.

The simplest approach to this while backpacking is to adjust the diet to account for the extra electrolyte loss. A perhaps more compartmentalized approach would be to maintain a low sodium diet, and supplement with electrolyte replacement products in accordance with sweat losses and fluid intake.

I'm interested in the thoughts and experiences of other athletes who normally follow a low sodium diet, and those of sports nutritionists who have considered the metabolic dynamics of sudden changes in the baseline intake and loss. For example, a person who's normal sodium intake is 750 mg/day who then engages in a week long backpacking trip where sodium sweat loss may reach 1,500 mg/day.

I'm also interested in the thoughts and experiences of others who have had to compensate a normal low sodium diet with additional electrolytes, including sodium, for daily moderate to intense exercise.

I can provide links to research studies if anyone is interested.

[nash2 Partner]

Hi Koko

To be an endurance athlete you must be a compensated cirrhotic meaning you have a lot of scar tissue but your liver function is still fairly robust. The low sodium is the standard advice given to patients as it helps manage ascites and reduces kidney stress. Assuming that you don't have any salt mediated problems, the key thing is to maintain a healthy blood level of sodium so for you the ultra low sodium is probably detrimental if it limits your ability to exercise. The real question is why are you cirrhotic? Seemingly it is not from the typical reason of having obesity and fatty liver. The fundamental driver may have more influence on your choices than implied by the standard protocol.

Wayne

[Kokomodo in reply to nash2]

Indeed. The root cause is something I continue to emphasize with my medical team. Their immediate concern - when I was diagnosed - was portal vein thrombosis. However, that seems to be resolving nicely through blood thinners and time. I am hopeful that the PVT diagnosis led the radiologist to suspect and "see" cirrhosis in the CT scan. Of course, that may be wishful thinking. I saw the FLF post on the LIVERFASt test and will discuss that with my doctor. My understanding is that a biopsy is considered the definitive test. My doctor's opinion is that the liver scarring has been going on for decades, and the cause will likely never be discovered. Of course, that makes lifestyle changes to address the root cause directly just scattershot guesses. Not great.

I would not describe myself as an endurance athlete. At least, not what probably comes to mind when you hear that term. My weight has varied over the years. I've been obese, I've been lean. But, if I had to guess at an average BMI over the past twenty years I say between 25 and 30. Backpacking is more about acclimation than fitness. However, there have also been plenty of years when my BMI has been comfortably below 25. Nonetheless, unless the PVT counts against me, yes, my cirrhosis is compensated. Every medical person involved has expressed surprise or bafflement. Zero indicators other than the PVT and the radiologist's read of the CT. No elevated blood markers for the last ten years. They just ask me five times if I'm an alcoholic, and then shake their heads and say, "Maybe genetic?"

This website has been a huge help, by the way. The amount of information available to patients from the medical side - my experience - is surprisingly sparse.

[nash2 Partner in reply to Kokomodo]

If you can get it, I'd suggest a Liver MultiScan. Only recently available in the US, developed in England. It is better than a biopsy for most things. LIVERFASt is also fairly new here but is widely available in Europe and Asia. Many US docs haven't caught up with these tools yet so it depends on where you live. Biopsy was all they had for a long time so it was gold standard by default. There is a significant error rate with biopsy though it does provide some data not available any other way.

Portal vein thrombosis is a blood issue which can be unrelated to the liver. From a liver perspective the issue is portal vein pressure caused by scarring. Were you diagnosed by a hepatologist?

[Kokomodo in reply to nash2]

Yes, I was inpatient under the care of the University of Alabama GI center for about a week. My primary physician on the team was/is a hepatologist. Her current hypothesis is that cirrhosis led to slow blood flow in the portal vein...which led to thrombosis. However, I had a CT scan at another hospital ER a few days prior and the radiologist did not note cirrhosis, only the PVT. A CT scan (without IV contrast) in 2018 also has no mention of liver issues. And, as I said, no indicators in the blood work over the last ten years. My primary care physician was perplexed by the diagnosis.

I have a follow up appointment on the 25th with the hepatologist. Are there questions you recommend I ask? Tests I should ask for? My primary care physician also referred me for an appointment at Vanderbilt's GI center in case I need or want a second opinion following the appt. on the 25th.

[Rcjb in reply to Kokomodo]

I had two cat scans/ultrasounds in one day. The first by appointment, the other at the ER since I’d suffered a weird pain in upper right quadrant for days.The first cat scan/ultrasound was “fine,” I was told. The cat scan with contrast done at hospital ER showed cirrhosis and portal hypertension.

An endoscopy has confirmed varices but none that needed banding.

So it seems all CT scans are not equal?

[nash2 Partner]

FibroScan is pretty effective at diagnosing cirrhosis by measuring liver stiffness. Most hepatologists have them now. If you want to look at a basic blood market do your Fib-4 analysis before you go. CT isn't a very good tool for looking at scar tissue.

fattyliverfoundation.org/fi...

absent a liver MultiScan a PDFF is best to measure liver fat

If you have advanced liver disease you probably have an enlarged spleen and commonly an enlarged liver that are noted by CT or ultrasound. You probably have damage associated with the PVT but the question I'd have is what came first.

[Kokomodo in reply to nash2]

Thank you. This is all very helpful. I looked back through blood work (both during the week in the hospital and previous years. My Fib-4 scores are all less than 1.0. I've also considered MELD scores and its variations, although I've heard that the markers influencing MELD can subside after acute inflammation subsides. I'll do some research and talk to my doctor about the tests. Thank you for taking the time to answer/discuss.

[nash2 Partner]

For what it is worth, the probability is that you do not have advanced fibrosis, but you do need to be sure to get a good analysis of your status.

[MINTVCX]

Has your doctor excluded some known diseases that can cause liver fibrosis? I mean Wilson's disease, AIH, hemochromatosis, HCV, HBV to name most common only. Unfortunately there is always an option cryptogenic liver disease which in my opinion is the worst case. No chance for any treatment only avoid possible damaging liver factors such as alcohol and so on.

[Kokomodo in reply to MINTVCX]

MINTVCX, that's a great question. I'll cover that with my hepatolgist at the next appt, as there were some test results not back yet when I last saw her.

All, since we are at this point way off topic for the thread - despite the great discussion - I recommend any further general discussion, or, discussion on diagnosis, uncertainty, tests, etc go under my "Introduction" post.

healthunlocked.com/fatty-li...