Impact of 3-day high and low dietary sodium intake on sodium status in response to exertional-heat stress: a double-blind randomized control trial

The effect of pre-exercise oral hyperhydration on endurance exercise performance, heart rate, and thermoregulation: a meta-analytical review

This study aimed to determine the effect of pre-exercise hyperhydration on endurance performance (primary outcome), heart rate, thermoregulation, and perceptual responses (secondary outcomes). Six academic databases were searched to February 2023. Only studies reporting differences in hydration between intervention and placebo/control were included. Meta-analysis determined overall effect size (Hedges' g), and meta-regression the influence of independent moderators (ambient temperature, hyperhydration agent, exercise mode, extent of hyperhydration). Overall, 10 publications generating 19 effect estimates for primary outcomes, and 11 publications reporting 48 effect estimates for secondary outcomes, were included. A small-to-moderate improvement in time-to-exhaustion (TTE) (Hedges' g = 0.31, 95% CI: 0.13-0.50, p = 0.001) and time trial (TT) (g = 0.25, 95% CI: 0.002-0.51, p = 0.049) but not total work (TW) tasks (p = 0.120) was found following hyperhydration. No moderating effects were observed. No effect of hyperhydration was found for heart rate following steady state (SS) exercise (p = 0.069) or the performance task (p = 0.072), nor for body temperature post-SS (p = 0.132) or post-performance task (p = 0.349), but meta-regression of sodium versus glycerol showed lower body temperature post-performance task with sodium (g = 0.80, t (5) = 2.65, p = 0.046). No effects were found for perceived exertion or thermal comfort. Study heterogeneity was low, lacking representation of elite and female athletes, and weight-bearing (i.e., running) exercise modalities. These results suggest pre-exercise hyperhydration provides a small-to-moderate benefit to endurance performance in TTE and TT, but not TW performance tasks. While no moderating effects were observed, lack of heterogeneity makes it difficult to generalise these findings.

Personalized Hydration Strategy to Improve Fluid Balance and Intermittent Exercise Performance in the Heat

Sweat rate and electrolyte losses have a large inter-individual variability. A personalized approach to hydration can overcome this issue to meet an individual's needs. This study aimed to investigate the effects of a personalized hydration strategy (PHS) on fluid balance and intermittent exercise performance. Twelve participants conducted 11 laboratory visits including a VO2max test and two 5-day trial arms under normothermic (NOR) or hyperthermic (HYP) environmental conditions. Each arm began with three days of familiarization exercise followed by two random exercise trials with either a PHS or a control (CON). Then, participants crossed over to the second arm for: NOR+PHS, NOR+CON, HYP+PHS, or HYP+CON. The PHS was prescribed according to the participants' fluid and sweat sodium losses. CON drank ad libitum of commercially-available electrolyte solution. Exercise trials consisted of two phases: (1) 45 min constant workload; (2) high-intensity intermittent exercise (HIIT) until exhaustion. Fluids were only provided in phase 1. PHS had a significantly greater fluid intake (HYP+PHS: 831.7 ± 166.4 g; NOR+PHS: 734.2 ± 144.9 g) compared to CON (HYP+CON: 369.8 ± 221.7 g; NOR+CON: 272.3 ± 143.0 g), regardless of environmental conditions (p < 0.001). HYP+CON produced the lowest sweat sodium concentration (56.2 ± 9.0 mmol/L) compared to other trials (p < 0.001). HYP+PHS had a slower elevated thirst perception and a longer HIIT (765 ± 452 s) compared to HYP+CON (548 ± 283 s, p = 0.04). Thus, PHS reinforces fluid intake and successfully optimizes hydration status, regardless of environmental conditions. PHS may be or is an important factor in preventing negative physiological consequences during high-intensity exercise in the heat.

Effect of Personalized Sodium Replacement on Fluid and Sodium Balance and Thermophysiological Strain During and After Ultraendurance Running in the Heat

PURPOSE

To investigate the effect of personalized sweat sodium replacement on drinking behavior, sodium and water balance, and thermophysiological responses during and after ultraendurance running in hot conditions.

METHODS

Nine participants (7 male, 2 female) completed two 5-hour treadmill runs (60% maximum oxygen uptake, 30°C ambient temperature), in a double-blind randomized crossover design, consuming sodium chloride (SODIUM) capsules to replace 100% of previously assessed losses or placebo (PLACEBO). Fluid was consumed ad libitum.

RESULTS

No effect of SODIUM was observed for ad libitum fluid intake or net fluid balance (P > .05). Plasma sodium concentration increased in both trials, but to a greater extent in SODIUM at 2.5 hours (mean [SD]: 4 [4] mmol·L-1 vs 1 [5] mmol·L-1; P < .05) and postexercise (4 [3] mmol·L-1 vs 1 [5] mmol·L-1; P < .05). Plasma volume change was not different between trials (P > .05) but was strongly correlated with sodium balance in SODIUM (r = .880, P < .01). No effect of sodium replacement was observed for heart rate, rectal temperature, thermal comfort, perceived exertion, or physiological strain index. During the 24 hours postexercise, ad libitum fluid intake was greater following SODIUM (2541 [711] mL vs 1998 [727] mL; P = .04), as was urinary sodium excretion (NaCl: 66 [35] mmol, Pl: 21 [12] mmol; P < .01).

CONCLUSIONS

Personalized sweat sodium replacement during ultraendurance running in hot conditions, with ad libitum fluid intake, exacerbated the rise in plasma sodium concentration compared to no sodium replacement but did not substantially influence overall body-water balance or thermophysiological strain. A large sodium deficit incurred during exercise leads to substantial renal sodium conservation postexercise.

Explaining variation in sweat sodium concentration: effect of individual characteristics and exercise, environmental, and dietary factors

This study determined the relative importance of several individual characteristics and dietary, environmental, and exercise factors in determining sweat [Na⁺] during exercise. Data from 1944 sweat tests were compiled for a retrospective analysis. Stepwise multiple regression (P < 0.05 threshold for inclusion) and T values were used to express the relative importance of each factor in a model. Three separate models were developed based on available independent variables: model 1 (1,944 sweat tests from 1,304 subjects); model 2 (subset with energy expenditure: 1,003 sweat tests from 607 subjects); model 3 (subset with energy expenditure, dietary sodium, and V̇o_2max: n = 48). Whole body sweat [Na⁺] was predicted from forearm sweat patches in models 1 and 2 and directly measured using whole body washdown in model 3. There were no significant effects of age group, race/ethnicity, relative humidity, exercise duration, pre-exercise urine specific gravity, exercise fluid balance, or dietary or exercise sodium intake on any model. Significant predictors in model 1 (adjusted r² = 0.17, P < 0.001) were season of the year (warm, T = -6.8), exercise mode (cycling, T = 6.8), sex (male, T = 4.9), whole body sweating rate (T = 4.5), and body mass (T = -3.0). Significant predictors in model 2 (adjusted r² = 0.19, P < 0.001) were season of the year (warm, T = -5.2), energy expenditure (T = 4.7), exercise mode (cycling, T = 3.6), air temperature (T = 3.0), and sex (male, T = 2.7). The only significant predictor in model 3 (r² = 0.23, P < 0.001) was energy expenditure (T = 3.8). In summary, the models accounted for 17%-23% of the variation in whole body sweat [Na⁺] and energy expenditure and season of the year (proxy for heat acclimatization) were the most important factors.NEW & NOTEWORTHY This comprehensive analysis of a large, diverse data set contributes to our overall understanding of the factors that influence whole body sweat [Na⁺]. The main finding was that energy expenditure was directly associated with whole body sweat [Na⁺], potentially via the relation between energy expenditure and whole body sweating rate (WBSR). Warmer months (proxy for heat acclimatization) were associated with lower whole body sweat [Na⁺]. Exercise mode, air temperature, and sex may also have small effects, but other variables (age group, race/ethnicity, fluid balance, sodium intake, relative V̇o_2max) had no association with whole body sweat [Na⁺]. Taken together, the models explained 17%-23% of the variation in whole body sweat [Na⁺].

Assessment of Exercise-Associated Gastrointestinal Perturbations in Research and Practical Settings: Methodological Concerns and Recommendations for Best Practice

Strenuous exercise is synonymous with disturbing gastrointestinal integrity and function, subsequently prompting systemic immune responses and exercise-associated gastrointestinal symptoms, a condition established as "exercise-induced gastrointestinal syndrome." When exercise stress and aligned exacerbation factors (i.e., extrinsic and intrinsic) are of substantial magnitude, these exercise-associated gastrointestinal perturbations can cause performance decrements and health implications of clinical significance. This potentially explains the exponential growth in exploratory, mechanistic, and interventional research in exercise gastroenterology to understand, accurately measure and interpret, and prevent or attenuate the performance debilitating and health consequences of exercise-induced gastrointestinal syndrome. Considering the recent advancement in exercise gastroenterology research, it has been highlighted that published literature in the area is consistently affected by substantial experimental limitations that may affect the accuracy of translating study outcomes into practical application/s and/or design of future research. This perspective methodological review attempts to highlight these concerns and provides guidance to improve the validity, reliability, and robustness of the next generation of exercise gastroenterology research. These methodological concerns include participant screening and description, exertional and exertional heat stress load, dietary control, hydration status, food and fluid provisions, circadian variation, biological sex differences, comprehensive assessment of established markers of exercise-induced gastrointestinal syndrome, validity of gastrointestinal symptoms assessment tool, and data reporting and presentation. Standardized experimental procedures are needed for the accurate interpretation of research findings, avoiding misinterpreted (e.g., pathological relevance of response magnitude) and overstated conclusions (e.g., clinical and practical relevance of intervention research outcomes), which will support more accurate translation into safe practice guidelines.

Fluid Balance and Carbohydrate Intake of Elite Female Soccer Players during Training and Competition

This study examined sweat rate, sweat sodium concentration [Na⁺], and ad-libitum carbohydrate and fluid intakes in elite female soccer players during training (n = 19) and a match (n = 8); eight completed both for comparisons. Body mass (kg) was obtained before and after exercise to calculate sweat rate. The sweat [Na⁺] was determined from absorbent patches on the thigh or back. Sweat rate, percentage body mass change, and sweat [Na⁺] for 19 players during training were 0.47 ± 0.19 L·h⁻¹, +0.19 ± 0.65%, and 28 ± 10 mmol·L⁻¹, respectively. Sweat rate was higher during a match (0.98 ± 0.34 L·h⁻¹) versus training (0.49 ± 0.26 L·h⁻¹, p = 0.007). Body mass losses were greater post-match (−1.12 ± 0.86%) than training (+0.29 ± 0.34%, p = 0.003). Sweat [Na⁺] was similar for training (29 ± 9 mmol·L⁻¹) and a match (35 ± 9 mmol·L⁻¹) (p = 0.215). There were no differences in match versus training carbohydrate intakes (2.0 ± 2.3 g·h⁻¹, 0.9 ± 1.5 g·h⁻¹, respectively, p = 0.219) or fluid intakes (0.71 ± 0.30 L·h⁻¹, 0.53 ± 0.21 L·h⁻¹, respectively, p = 0.114). In conclusion, female soccer players’ sweat rates were higher during a match than during training, and carbohydrate intakes were below recommendations for matches and training.

The impact of exercise modality on exercise-induced gastrointestinal syndrome and associated gastrointestinal symptoms

OBJECTIVES

This study aimed to determine the impact of running and cycling exercise modalities on the magnitude of exercise-induced gastrointestinal syndrome (EIGS) and associated gastrointestinal symptoms (GIS).

DESIGN

Parallel group trial design.

METHODS

Twenty-eight endurance athletes (male n = 14, female n = 14) completed 2 h running at 55 % of maximal oxygen uptake or cycling at 55 % of maximal aerobic power in T_amb 35 °C and 22 % RH. Pre- and post-exercise blood samples were collected and analysed for markers of intestinal epithelial integrity perturbations (i.e., plasma intestinal fatty acid protein (I-FABP), soluble (s)CD14, and lipopolysaccharide binding protein (LBP)) and systemic inflammatory cytokines (i.e., plasma IL-1β, TNFα, IL-10, and IL-1ra). GIS were assessed pre-exercise and every 10 min during exercise.

RESULTS

Exercise-associated Δ for plasma I-FABP (191 and 434 pg‧ml^-1) and LBP (-1228 and 315 ng‧ml^-1) did not differ between running and cycling, respectively; however for sCD14 was higher (p = 0.030) on cycling (116 ng‧ml^-1) vs running (96 ng‧ml^-1). There were no differences in absolute pre- and post-exercise systemic inflammatory cytokine concentration, with large individual variation observed. Exercise-associated plasma TNF-α, (p = 0.041) and IL-10 (p = 0.019) responses were greater in running than cycling, but did not lead to a greater systemic inflammatory response profile (p = 0.305) between running (5.0arb.units) and cycling (-2.5arb.units). Although greater GIS incidence occurred in running (44 %) compared with cycling (25 %), there was no difference between groups for GIS severity.

CONCLUSIONS

When running and cycling exercise is performed with similar duration, intensity, ambient conditions, and with confounder control, the exercise modality does not substantially impact the magnitude of EIGS or associated GIS severity.

Hyponatremia: Is it related to the seasons?

Background

Hyponatremia is a common electrolyte disorder in inpatients related to morbidity and mortality. In this study, we aimed to examine whether there is a relationship between the incidence of hyponatremia and the seasons among the patients hospitalized in our nephrology department.

Methods

The inpatients in our Nephrology Department between 2012 and 2015 were retrospectively analyzed. The patients with serum sodium levels below 135 mmol/L were included in the study. Hyponatremia incidence was calculated as the proportion of inpatients with low sodium levels in a season to the total number of inpatients in the same season.

Results

Out of 1950 inpatients in four years, 509 were found to have hyponatremia (26.1%). The mean serum sodium level of the patients was 129.7±4.7 mmol/L. Hyponatremia incidences in autumn, winter, spring, and summer were found to be 28.7%, 15.4%, 20.4%, and 36.6%, respectively. Upon comparing the incidence of hyponatremia in patients hospitalized in winter and summer seasons, there was a significantly higher incidence of hyponatremia in summer (p<0.001). We found a positive correlation between hyponatremia incidence and temperature (r=0.867, p=0.001). However, there was a negative correlation between hyponatremia incidence and relative humidity (r=-0.735, p=0.001).

Conclusions

The highest hyponatremia incidence was observed in summer in a four-year period. Loss of sodium by perspiration, along with increased temperature and/or excessive hypotonic fluid intake, might contribute to the development of hyponatremia.

Exertional heat stress and sodium balance: Leaders, followers, and adaptations

Exertional heat stress presents a different acute challenge to salt balance compared to at rest. Sodium (Na⁺) and chloride (Cl^-) losses during exercise are overwhelmingly driven by eccrine sweat glands (the "leader"), with minimal urinary excretion. Total salt losses are therefore largely influenced by thermoregulatory need, although adaptations from prior heat exposure or altered dietary intake influences sweat gland ion reabsorption, and therefore sweat Na⁺ ([Na⁺]_sweat) and Cl^- concentrations. The hypotheses that body Na⁺ and Cl^- conservation, or their release from osmotically inactive stores, can occur during the timeframe of a single bout of exertional heat stress, has not been studied to date. The consequences of unreplaced Na⁺ and Cl^- losses during exertional heat stress appear limited primarily to their interactions with water balance. However, the water volume ingested is substantially more influential than salt intake on total body water, plasma volume, osmolality, and thermoregulation during exercise. Acute salt and water loading 1-3 h prior to exercise can induce isosmotic hyperhydration in situations where this is deemed beneficial. During exercise, only scenarios of whole body [Na⁺]_sweat > 75th centile, combined with fluid replacement >80% of losses, are likely to require significant replacement to prevent hyponatremia. Post-exercise, natriuresis resumes as the main regulator of salt losses, with the kidneys (the "follower") working to restore salt balance incurred from any exercise-induced deficit. If such a deficit exceeds usual dietary intake, and rapid restoration of hydration status is desirable, a deliberate increase in salt intake may assist in volume restoration.

Sports Dietitians Australia Position Statement: Nutrition for Exercise in Hot Environments

It is the position of Sports Dietitians Australia (SDA) that exercise in hot and/or humid environments, or with significant clothing and/or equipment that prevents body heat loss (i.e., exertional heat stress), provides significant challenges to an athlete's nutritional status, health, and performance. Exertional heat stress, especially when prolonged, can perturb thermoregulatory, cardiovascular, and gastrointestinal systems. Heat acclimation or acclimatization provides beneficial adaptations and should be undertaken where possible. Athletes should aim to begin exercise euhydrated. Furthermore, preexercise hyperhydration may be desirable in some scenarios and can be achieved through acute sodium or glycerol loading protocols. The assessment of fluid balance during exercise, together with gastrointestinal tolerance to fluid intake, and the appropriateness of thirst responses provide valuable information to inform fluid replacement strategies that should be integrated with event fuel requirements. Such strategies should also consider fluid availability and opportunities to drink, to prevent significant under- or overconsumption during exercise. Postexercise beverage choices can be influenced by the required timeframe for return to euhydration and co-ingestion of meals and snacks. Ingested beverage temperature can influence core temperature, with cold/icy beverages of potential use before and during exertional heat stress, while use of menthol can alter thermal sensation. Practical challenges in supporting athletes in teams and traveling for competition require careful planning. Finally, specific athletic population groups have unique nutritional needs in the context of exertional heat stress (i.e., youth, endurance/ultra-endurance athletes, and para-sport athletes), and specific adjustments to nutrition strategies should be made for these population groups.

Fluid Balance, Sweat Na+ Losses, and Carbohydrate Intake of Elite Male Soccer Players in Response to Low and High Training Intensities in Cool and Hot Environments

Hypohydration increases physiological strain and reduces physical and technical soccer performance, but there are limited data on how fluid balance responses change between different types of sessions in professional players. This study investigated sweat and fluid/carbohydrate intake responses in elite male professional soccer players training at low and high intensities in cool and hot environments. Fluid/sodium (Na⁺) losses and ad-libitum carbohydrate/fluid intake of fourteen elite male soccer players were measured on four occasions: cool (wet bulb globe temperature (WBGT): 15 ± 7 °C, 66 ± 6% relative humidity (RH)) low intensity (rating of perceived exertion (RPE) 2–4, m·min⁻¹ 40–46) (CL); cool high intensity (RPE 6–8, m·min⁻¹ 82–86) (CH); hot (29 ± 1 °C, 52 ± 7% RH) low intensity (HL); hot high intensity (HH). Exercise involved 65 ± 5 min of soccer-specific training. Before and after exercise, players were weighed in minimal clothing. During training, players had ad libitum access to carbohydrate beverages and water. Sweat [Na⁺] (mmol·L⁻¹), which was measured by absorbent patches positioned on the thigh, was no different between conditions, CL: 35 ± 9, CH: 38 ± 8, HL: 34 ± 70.17, HH: 38 ± 8 (p = 0.475). Exercise intensity and environmental condition significantly influenced sweat rates (L·h⁻¹), CL: 0.55 ± 0.20, CH: 0.98 ± 0.21, HL: 0.81 ± 0.17, HH: 1.43 ± 0.23 (p =0.001), and percentage dehydration (p < 0.001). Fluid intake was significantly associated with sweat rate (p = 0.019), with no players experiencing hypohydration > 2% of pre-exercise body mass. Carbohydrate intake varied between players (range 0–38 g·h⁻¹), with no difference between conditions. These descriptive data gathered on elite professional players highlight the variation in the hydration status, sweat rate, sweat Na⁺ losses, and carbohydrate intake in response to training in cool and hot environments and at low and high exercise intensities.

The (in)dependency of blood and sweat sodium, chloride, potassium, ammonia, lactate and glucose concentrations during submaximal exercise

Purpose

To reduce the need for invasive and expensive measures of human biomarkers, sweat is becoming increasingly popular in use as an alternative to blood. Therefore, the (in)dependency of blood and sweat composition has to be explored.

Methods

In an environmental chamber (33 °C, 65% relative humidity; RH), 12 participants completed three subsequent 20-min cycling stages to elicit three different local sweat rates (LSR) while aiming to limit changes in blood composition: at 60% of their maximum heart rate (HR_max), 70% HR_max and 80% HR_max, with 5 min of seated-rest in between. Sweat was collected from the arm and back during each stage and post-exercise. Blood was drawn from a superficial antecubital vein in the middle of each stage. Concentrations of sodium, chloride, potassium, ammonia, lactate and glucose were determined in blood plasma and sweat.

Results

With increasing exercise intensity, LSR, sweat sodium, chloride and glucose concentrations increased (P ≤ 0.026), while simultaneously limited changes in blood composition were elicited for these components (P ≥ 0.093). Sweat potassium, lactate and ammonia concentrations decreased (P ≤ 0.006), while blood potassium decreased (P = 0.003), and blood ammonia and lactate concentrations increased with higher exercise intensities (P = 0.005; P = 0.007, respectively). The vast majority of correlations between blood and sweat parameters were non-significant (P > 0.05), with few exceptions.

Conclusion

The data suggest that sweat composition is at least partly independent of blood composition. This has important consequences when targeting sweat as non-invasive alternative for blood measurements.

Electronic supplementary material

The online version of this article (10.1007/s00421-020-04562-8) contains supplementary material, which is available to authorized users.

Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride

BACKGROUND

Recent cohort studies show that salt intake below 6 g is associated with increased mortality. These findings have not changed public recommendations to lower salt intake below 6 g, which are based on assumed blood pressure (BP) effects and no side-effects.

OBJECTIVES

To assess the effects of sodium reduction on BP, and on potential side-effects (hormones and lipids) SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to April 2018 and a top-up search in March 2020: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. The top-up search articles are recorded under "awaiting assessment."

SELECTION CRITERIA

Studies randomizing persons to low-sodium and high-sodium diets were included if they evaluated at least one of the outcome parameters (BP, renin, aldosterone, noradrenalin, adrenalin, cholesterol, high-density lipoprotein, low-density lipoprotein and triglyceride,.

DATA COLLECTION AND ANALYSIS

Two review authors independently collected data, which were analysed with Review Manager 5.3. Certainty of evidence was assessed using GRADE.

MAIN RESULTS

Since the first review in 2003 the number of included references has increased from 96 to 195 (174 were in white participants). As a previous study found different BP outcomes in black and white study populations, we stratified the BP outcomes by race. The effect of sodium reduction (from 203 to 65 mmol/day) on BP in white participants was as follows: Normal blood pressure: SBP: mean difference (MD) -1.14 mmHg (95% confidence interval (CI): -1.65 to -0.63), 5982 participants, 95 trials; DBP: MD + 0.01 mmHg (95% CI: -0.37 to 0.39), 6276 participants, 96 trials. Hypertension: SBP: MD -5.71 mmHg (95% CI: -6.67 to -4.74), 3998 participants,88 trials; DBP: MD -2.87 mmHg (95% CI: -3.41 to -2.32), 4032 participants, 89 trials (all high-quality evidence). The largest bias contrast across studies was recorded for the detection bias element. A comparison of detection bias low-risk studies versus high/unclear risk studies showed no differences. The effect of sodium reduction (from 195 to 66 mmol/day) on BP in black participants was as follows: Normal blood pressure: SBP: mean difference (MD) -4.02 mmHg (95% CI:-7.37 to -0.68); DBP: MD -2.01 mmHg (95% CI:-4.37, 0.35), 253 participants, 7 trials. Hypertension: SBP: MD -6.64 mmHg (95% CI:-9.00, -4.27); DBP: MD -2.91 mmHg (95% CI:-4.52, -1.30), 398 participants, 8 trials (low-quality evidence). The effect of sodium reduction (from 217 to 103 mmol/day) on BP in Asian participants was as follows: Normal blood pressure: SBP: mean difference (MD) -1.50 mmHg (95% CI: -3.09, 0.10); DBP: MD -1.06 mmHg (95% CI:-2.53 to 0.41), 950 participants, 5 trials. Hypertension: SBP: MD -7.75 mmHg (95% CI:-11.44, -4.07); DBP: MD -2.68 mmHg (95% CI: -4.21 to -1.15), 254 participants, 8 trials (moderate-low-quality evidence).   During sodium reduction renin increased 1.56 ng/mL/hour (95%CI:1.39, 1.73) in 2904 participants (82 trials); aldosterone increased 104 pg/mL (95%CI:88.4,119.7) in 2506 participants (66 trials); noradrenalin increased 62.3 pg/mL: (95%CI: 41.9, 82.8) in 878 participants (35 trials); adrenalin increased 7.55 pg/mL (95%CI: 0.85, 14.26) in 331 participants (15 trials); cholesterol increased 5.19 mg/dL (95%CI:2.1, 8.3) in 917 participants (27 trials); triglyceride increased 7.10 mg/dL (95%CI: 3.1,11.1) in 712 participants (20 trials); LDL tended to increase 2.46 mg/dl (95%CI: -1, 5.9) in 696 participants (18 trials); HDL was unchanged -0.3 mg/dl (95%CI: -1.66,1.05) in 738 participants (20 trials) (All high-quality evidence except the evidence for adrenalin).

AUTHORS' CONCLUSIONS

In white participants, sodium reduction in accordance with the public recommendations resulted in mean arterial pressure (MAP) decrease of about 0.4 mmHg in participants with normal blood pressure and a MAP decrease of about 4 mmHg in participants with hypertension. Weak evidence indicated that these effects may be a little greater in black and Asian participants. The effects of sodium reduction on potential side effects (hormones and lipids) were more consistent than the effect on BP, especially in people with normal BP.

Salt and water balance after sweat loss: A study of Bikram yoga

Bikram yoga is practiced in a room heated to 105°F with 40% humidity for 90 min. During the class a large volume of water and electrolytes are lost in the sweat, specifically, sodium is lost, the main cation of the extracellular fluid. There is little known about the volume of sweat and the amount of sodium lost in sweat during Bikram yoga or the optimum quantity of fluid required to replace these losses. The participants who took part in this small feasibility study were five females with a mean age of 47.4 ± 4.7 years and 2.6 ± 1.6 years of experience at Bikram yoga. The total body weight, water consumed, serum sodium concentration, serum osmolality, and serum aldosterone levels were all measured before and after a Bikram yoga practice. Sweat sodium chloride concentration and osmolality were measured at the end of the practice. The mean estimated sweat loss was 1.54 ± 0.65 L, while the amount of water consumed during Bikram yoga was 0.38 ± 0.22 L. Even though only 25% of the sweat loss was replenished with water intake during the Bikram yoga class, we did not observe a change in serum sodium levels or serum osmolality. The sweat contained 82 ± 16 mmol/L of sodium chloride for an estimated total of 6.8 ± 2.1 g of sodium chloride lost in the sweat. The serum aldosterone increased 3.5-fold from before to after Bikram yoga. There was a decrease in the extracellular body fluid compartment of 9.7%. Sweat loss in Bikram yoga predominately produced a volume depletion rather than the dehydration of body fluids. The sweating-stimulated rise in serum aldosterone levels will lead to increased sodium reabsorption from the kidney tubules and restore the extracellular fluid volume over the next 24 hr.

Physiological mechanisms determining eccrine sweat composition

Purpose

The purpose of this paper is to review the physiological mechanisms determining eccrine sweat composition to assess the utility of sweat as a proxy for blood or as a potential biomarker of human health or nutritional/physiological status.

Methods

This narrative review includes the major sweat electrolytes (sodium, chloride, and potassium), other micronutrients (e.g., calcium, magnesium, iron, copper, zinc, vitamins), metabolites (e.g., glucose, lactate, ammonia, urea, bicarbonate, amino acids, ethanol), and other compounds (e.g., cytokines and cortisol).

Results

Ion membrane transport mechanisms for sodium and chloride are well established, but the mechanisms of secretion and/or reabsorption for most other sweat solutes are still equivocal. Correlations between sweat and blood have not been established for most constituents, with perhaps the exception of ethanol. With respect to sweat diagnostics, it is well accepted that elevated sweat sodium and chloride is a useful screening tool for cystic fibrosis. However, sweat electrolyte concentrations are not predictive of hydration status or sweating rate. Sweat metabolite concentrations are not a reliable biomarker for exercise intensity or other physiological stressors. To date, glucose, cytokine, and cortisol research is too limited to suggest that sweat is a useful surrogate for blood.

Conclusion

Final sweat composition is not only influenced by extracellular solute concentrations, but also mechanisms of secretion and/or reabsorption, sweat flow rate, byproducts of sweat gland metabolism, skin surface contamination, and sebum secretions, among other factors related to methodology. Future research that accounts for these confounding factors is needed to address the existing gaps in the literature.

Electronic supplementary material

The online version of this article (10.1007/s00421-020-04323-7) contains supplementary material, which is available to authorized users.