electrolytes

Photo of a female lying down on the ground with her hands to her head in discomfort.

Premenstrual Dysphoric Disorder (PMDD) is a health concern best described as a form of severe premenstrual syndrome (PMS). PMDD affects 3-8% of women worldwide but is not well understood or researched.

What are the symptoms?

PMDD symptoms include anger, irritability, depressed mood, anxiety, lack of pleasure, a sense of overwhelm, difficulty concentrating, fatigue, changes in appetite or food cravings, sleep changes, and physical symptoms such as breast tenderness, bloating or headaches.

These symptoms emerge in the luteal phase of the menstrual cycle, one to two weeks before periods commence, and typically subside within a few days of bleeding.

Over 64% of women experience some kind of mood changes a few days before the onset of menstruation. For women with PMDD these changes are more extreme. Despite having normal hormonal fluctuations during the menstrual cycle, women with PMDD experience an abnormal mood response to these fluctuations. Rage, anger, irritability, intolerance to others, anxiety and depression are commonly reported in women with PMDD. Our patients with PMDD sometimes say extreme statements along the lines of ” I get so mad I feel like I want to kill my husband before my period.”

It is suggested these more extreme changes in mood may be attributable to the effect estrogen and progesterone have on the serotonin, GABA and dopamine systems. These can also alter the renin-angiotensin-aldosterone system, which could explain some of the bloating and swelling that occur during the luteal phase.

Conventional intervention typically involves the contraceptive pill, anxiety medications and anti-depressant medications. For some women this relieves problematic symptoms but may also contribute to other side effects which become more of an issue than the PMDD itself. For those women, considering complementary solutions may be a good option. In traditional medicine practice, herbal medicines have been used to manage PMDD. Some of these natural medications support GABA levels, reduce extreme emotions, reduce depression, minimise physical symptoms and promote relaxation.

Other options often included in a herbal prescription such as withania , ginseng and rhodiola are considered serotonergic – i.e. they support level of serotonin in the brain. Nutrients such as vitamin E, vitamin D, zinc, vitamin B6, 5-HTP, calcium or inositol may be prescribed to help support healthy mood, reduce pain and support hormonal balance.

In naturopathic medicine we consider the individual’s unique presentation and symptomatic picture, rather than the diagnosis. Therefore, our treatment plans are also always tailored to the individual and consider their health history and current lifestyle demands. For some women anger is their key concern, while for others their depression is debilitating.

It helps to be realistic about what changes you can expect and appropriate timeframes. To get the best results we recommend an in-depth assessment and consultation for women with PMDD along with regular reviews to allow for modifications and adjustments of formulas and dosages.

Always seek medical care if you think you may have PMDD.

Want to know more? Contact the Athlete Sanctuary and learn how we can help you.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a Master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.athletesanctuary.com.au

 

References
Hantsoo, L., & Payne, J. L. (2023). Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA. Neuroscience and biobehavioral reviews, 149, 105168. doi.org/10.1016/j.neubiorev.2023.105168

Hofmeister, S., & Bodden, S. (2016). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American family physician, 94(3), 236–240.

Kashanian M, Mazinani R, Jalalmanesh S. Pyridoxine (vitamin B6) therapy for premenstrual syndrome. (2007) Int J Gynaecol Obstet;96(1):43-44.

Tartagni, M., Cicinelli, M. V., Tartagni, M. V., Alrasheed, H., Matteo, M., Baldini, D., De Salvia, M., Loverro, G., & Montagnani, M. (2016). Vitamin D Supplementation for Premenstrual Syndrome-Related Mood Disorders in Adolescents with Severe Hypovitaminosis D. Journal of pediatric and adolescent gynecology, 29(4), 357–361. doi.org/10.1016/j.jpag.2015.12.006

Cerqueira, R. O., Frey, B. N., Leclerc, E., & Brietzke, E. (2017). Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Archives of women’s mental health, 20(6), 713–719. doi.org/10.1007/s00737-017-0791-0

Photo of jars of watermelon and orange in glass jars ogf water with straws.

Most athletes consider the balance of electrolytes when thinking about hydration and recovery, especially over endurance events.  But are salt tablets and electrolytes really necessary?

Before we answer this question, let’s recap on electrolytes and the role they perform in the body.

Sodium is the key electrolyte responsible for controlling extracellular fluid balance while potassium controls the fluid within the cells. Potassium also helps with muscle contraction and supports blood pressure. Electrolytes such as potassium can also impact iron absorption. Potassium (along with other nutrients such as zinc and B vitamins) is essential for hydrochloric acid (HCL) production in your stomach. Without adequate HCL a condition known as achlorhydria can develop where your ability to absorb dietary iron and the successful coordination of iron uptake, export, and iron storage as ferritin is reduced.  This can lead to iron deficiency and anaemia as explained in this article.

Magnesium is well known for its role in nerve function, heartbeat regulation, energy metabolism and blood sugar stabilisation. Your muscles, brain and heart rely heavily on magnesium to do their job. As an electrolyte, magnesium sits both inside and outside cells and binds to water and interacts with other electrolytes.   Calcium is well known for its role in bone health, heart and nerve function and less recognised as an electrolyte. Calcium sits within both intracellular and extracellular spaces. Other electrolytes include phosphates, chloride and bicarbonates.

Sodium and chloride are the two electrolytes lost in large quantities through sweat. The losses of these electrolytes are regulated in response to the balance of sodium consumed in the diet and recent sweat and urine losses.

So is the ingestion of electrolytes or salt tablets really necessary to enhance performance? Well yes and no. Confusing hey!

Why you should consider electrolytes.

Research suggests sodium added to drinks before exercise may improve the amount of that fluid retained, rather than lost through urination and potentially reduce the risk of dehydration. Sodium can also improve the flavour of drinks and encourage consumption when consumed during exercise. This could be handy in warmer conditions and when exercising for two or more hours. Sodium during exercise can also reduce the potential risk of developing hyponatraemia. It is suggested sodium can assist with fluid and carbohydrate absorption from the gut.  If you are a heavy sweater with above average sodium loses (>1g/L) identified through sweat testing, then you may benefit from sodium ingestion during exercise if you are exercising for several hours.

The good news is that most sports drinks and gels contain sodium so it is unlikely the majority of athletes will need to take on additional electrolytes in the form of tablets. Ultra runners and ironman participants may be an exception to this rule.

Keep in mind the body has large stores of sodium that are released into the bloodstream as needed so it is unlikely you will ever run out of sodium unless severely dehydrated. The key reason why sodium is included in sports products is to balance out fluid intake and losses and maintain an appropriate osmolality, while improving the taste and increasing the palatability and consumption of the product, rather than preventing an actual sodium deficit.

And what about cramping?

Cramping is caused by multiple factors that can lead to changes in the nerves that control muscle contraction and muscle fatigue. Therefore, it is a little simplistic to suggest a single nutrient such as sodium or magnesium will prevent cramping.  Further scientific research is required to give us clear guidance around cramp prevention. Many athletes do respond well to magnesium and a suitable hydration protocol.

Don’t forget you can also obtain electrolytes through wholefoods nutrition.

  • Sodium is easily found in most processed foods such as crackers, sardines, smoked foods, pickled foods, roasted seeds and nuts, cheeses, table salt and sauces.
  • Magnesium is found in pumpkin seeds, chia seeds, almonds, spinach, cashews, black beans, peanuts, oats, brown rice, and yogurt.
  • Potassium-rich foods include potatoes, sweet potato, dried apricots, and raisins, beans lentils, spinach, broccoli, avocado and bananas.

So before you reach for more artificial sports products consider if this is really necessary and if there are alternative ways you can provide your body with the electrolytes it requires.

Need specific guidance?  We would be delighted to help.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a Master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.https://https://athletesanctuary.com.au/wp-content/uploads/2023/03/normatec-3-lower-body-system-thumb_720x-1.webp.com.au/wp-content/uploads/2020/05/Seed-Cycle-Blends-scaled-1.jpg.com.au

 

References

Miller KC. et al. An Evidence-Based Review of the Pathophysiology, Treatment, and Prevention of Exercise-Associated Muscle Cramps. J Athl Train. 2022; 57(1):5-15.

Lau WY. et al. Water intake after dehydration makes muscles more susceptible to cramp but electrolytes reverse that effect. BMJ Open Sport Exerc Med. 2019; 5(1):e000478.

Maughan RJ. & Shirreffs SM. Muscle Cramping During Exercise: Causes, Solutions, and Questions Remaining. Sports Med.2019; 49(Suppl2):115-124.

cramping

Is cramping cramping your style? In this article, we explain how cramping and hydration go hand in hand and what you can do to avoid issues.

Several factors contribute to cramping. Many athletes have increased their training intensity and volumes but possibly overlooked their nutritional needs to meet their supplementary training requirements.

Go back to the root cause

Dehydration may contribute to cramping in athletes along with imbalances in electrolytes and muscle fatigue.

There are a number of reasons why we may get more dehydrated. In the heat, we lose more sweat and are more prone to dehydration through both sodium and water loss. We also get dehydrated in winter. We often reduce our consumption of salads packed with magnesium-rich leafy vegetables over the cooler months and our natural inclination to drink fluids may also be reduced and our thirst mechanism sluggish over winter.

Coffee, alcohol, and some drugs (such as oral contraceptives) may also accelerate the excretion or reduce the absorption of water and electrolytes such as magnesium and calcium. Not all athletes realize they require 20% more magnesium than a sedentary person.

The adrenal gland churns through sodium, vitamin C, and magnesium when we are stressed. It is pretty rare to find a person who can honestly say they are stress-free, especially in the current environment.

How to stop cramping- a reminder of the basics

Increasing magnesium-rich foods such as spinach, broccoli, squash, peanuts, cashews, almonds, oats, brown rice and cocoa (quality chocolate can be beneficial!) pumpkin seeds, chia seeds, and yogurt may help reduce cramping in athletes. These foods may also ward off more advanced issues linked to magnesium deficiency such as fatigue, immune, bone, or cardiovascular issues.

Most athletes grossly underestimate their daily fluid needs when taking into account fluid losses from training. Endurance athletes are notorious for skipping hydration opportunities during a session (especially long-distance runners) despite large sweat losses. Many athletes are shocked at how many liters of fluid they lose in a single session and ignore the increased risk of nausea, vomiting, diarrhea, and other gastrointestinal problems due to dehydration. However, excessive fluid intake also causes issues such as hyponatremia (low sodium concentration in the blood). Therefore, knowing your sweat rate is the best way to determine how much you should be drinking during and post-exercise.

Calculating your sweat rate can be completed at home by following these simple steps:

1. Weigh yourself just before an intense one-hour session

2. Complete your session and record any fluids you had during the session

3. After your workout towel dry yourself

4. Weigh yourself again in the same clothing you had on for the session

5. The difference between the two weight measurements equates to the fluid lost per hour i.e. 1 liter = 1 kg of fluid lost. If you had fluids during your session deduct this amount i.e. 1kg of minus 200ml of fluid ingested during the run = 800ml of fluid lost.

Companies such as The Sweat Lab provide home-based sweat tests you can order online here

Post exercise rehydration

During recovery, you will continue to lose fluids through sweating and urination. Plan to replace 125-150% of this fluid deficit over the next 2-6 hours.  Sip a small amount of fluids constantly over a few hours rather than sculling large amounts at once.

Make sure your daily total fluid intake includes both your exercise-associated requirements and physiological needs. Although we are led to believe 8 glasses is sufficient as a basic requirement, national health associations are now suggesting that 15.5 cups (3.7 liters) for men and 11.5 cups (2.7 liters) of fluids a day for women is more appropriate for adults living in temperate climates. Typically 20-30% of your hydration needs are obtained through water-containing foods and the remainder through liquids.

Athletes with a limited intake of dietary sodium (strictly whole foods diet) may benefit from adding a small pinch of sea salt to evening meals or drink bottles (except athletes with elevated blood pressure).

In some cases where magnesium depletion is significant, a magnesium supplement and adequate electrolytes may be beneficial. As with all supplements, it is best to speak with a health professional to avoid the pitfalls of self-prescribing such as gastrointestinal issues and interactions. Athletes with a history of iron or zinc deficiency should be mindful of magnesium forms. Magnesium citrate is often found in supplements as it is well absorbed and specific to muscles however long-term use may interfere with the carrier protein (ceruloplasmin) and contribute to future mineral insufficiency.

Five quick tips for boosting your overall fluid intake:

1. Keep a pot of warm herbal tea or lemon and ginger in your workspace and sip continuously

2. Enjoy a cup of bone broth, miso or soup as a snack or with dinner.

3. Increase your fluid through foods. Enjoy more “wet” dishes such as soups, casseroles or Vietnamese style Pho bowls and enjoy snacks with high water content such as cucumbers, watermelon, oranges and apples.

4. Add warming herbs and spices such as cinnamon and turmeric to your favourite smoothies or juices (made with room temperature water or warm milk and fresh fruits instead of frozen).

5. Stick to a hydration plan during training sessions and keep a record of total intake daily in your training app or journal.

About the Author Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.https://https://athletesanctuary.com.au/wp-content/uploads/2023/03/normatec-3-lower-body-system-thumb_720x-1.webp.com.au/wp-content/uploads/2020/05/Seed-Cycle-Blends-scaled-1.jpg.com.au

accurate pathology tests

In this article, we discuss how to obtain accurate pathology tests. Whilst this article is not meant to serve as a diagnostic tool, it may be helpful to better understand what basic pathology tests are useful and how to prepare yourself so you get the most accurate results.

Pathology test results should always be considered in conjunction with symptoms, a thorough physical examination, and discussed during an appointment so that the context and relevance of your results can be determined. One abnormality in pathology tests does not tell much of your health picture, however, patterns of pathology tests can provide a holistic picture of your overall health, your absorption, and digestion of key nutrients and provide warning signs that require further investigation.

WHAT PATHOLOGY TESTS ARE MOST USEFUL?

Your GP or naturopath can arrange pathology tests for you. Exactly which pathology tests you require, will need to be determined by your healthcare practitioner. As a good starting point, I suggest the following tests for my patients:

*Full blood count and hematology- provides a general picture of your immune system, red blood cells and overall health

*Liver function tests (LFTs)- provide some clues as to how your liver is working and if your liver is under stress.

*Electrolytes– including potassium, sodium, and other key electrolytes required for sports performance and optimal health

*Fasting blood glucose- is a general marker that indicates how well your body is modulating your blood sugar. Issues with blood sugar stabilisation may cause symptoms such as sugar cravings, frequent urination, fatigue, and energy drops after meals.

*C- reactive protein (CRP) is an inflammatory marker that is useful when interpreted in conjunction with iron studies. Iron storage may be impacted by states of high inflammation.

*Iron studies- provides information on your iron storage (ferritin), the protein carriers for iron (transferrin), and how effectively your body is saturating these carriers and transporting iron around your body (transferrin saturation).

*Thyroid hormones- TSH, T3 and T4 provide information on how your thyroid is functioning and can be an early warning sign of autoimmunity and nutrient deficiencies such as iodine, selenium, tyrosine and zinc

*Vitamin B12 ( active and inactive) is also suggested for plant-based patients or athletes who infrequently consume red meat.

*If you are prone to mental health issues (especially seasonal sadness/ low mood), autoimmunity, frequent colds, bone health issues, or hormonal imbalances vitamin D, copper and serum zinc may also be useful markers.

Tests may be repeated every few months to ensure a patient is responding to treatment and improving nutrient absorption through targeted nutrition approaches.

How to get the most accurate pathology tests

To get the most out of your pathology tests, it is recommended your prepare appropriately.

DO

  •  fast for 12-16 hours (have dinner and then postpone breakfast until after your blood draw).

AVOID

  • strenuous exercise for a minimum of 24 hours. Ideally, at least 48 hours if possible.  This includes running, cycling, or strength training. Most patients find it easiest to do a blood test the morning after a rest day.
  • obtaining the blood draw when feeling unwell such as with a cold or flu when checking iron studies as infection may influence your test results
  • alcohol or supplements for 24-48 hours prior to your blood tests

We use a number of pathology collection centres across Australia including Clinical Laboratories, Dorevitch, and Nutripath to obtain accurate pathology results. We also refer to functional testing such as mineral testing completed through Interclinical Laboratories.

 

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.https://https://athletesanctuary.com.au/wp-content/uploads/2023/03/normatec-3-lower-body-system-thumb_720x-1.webp.com.au/wp-content/uploads/2020/05/Seed-Cycle-Blends-scaled-1.jpg.com.au