Electrolytes and Blood Pressure

Nutrition
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After a lifetime of generally low blood pressure readings (110/70ish) I’ve just had two consecutive readings at the Doctor’s office of 140/80 about 4 weeks apart. Dr really isn’t concerned given my general fitness and active lifestyle and basically just said we’d keep an eye on it and asked me not to turn into Homer Simpson overnight or anything.

From reading this thread it seems like no matter what, I should probably start monitoring at home for a while.

But I got thinking about it and the only major thing I’ve changed recently is I started making my own carb drinks and recovery shakes, mostly following advice from various threads on this forum, and in particular the findings of @Dr_Alex_Harrison. All going well and I’ve been thinking it’s probably a good adjustment to try since I often cramp late into longer events, but I know excessive salt intake can raise blood pressure and I’m definitely using way more sodium just now than I was in premade products.

Is the first step just to slash the salt component of my drink mix for weekday 1hr workouts to zero or near-zero? And the same with my recovery shake? Obviously in those situations I’ve got the rest of a normal day’s nutrition to make up for those electrolytes (and, knowing I used to have low BP and sweat a lot, I’ve deliberately habituated to salting my food pretty heavily).

So then I’d just keep my sodium-heavy hydration plan as-is for longer weekend rides or event days where I’m more likely to end up depleted?

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Definitely do some home monitoring, the two doctor’s office readings may or may not be typical. I’ve found that my blood pressure varies quite a lot due to time of day, stress level, coffee intake, and (I believe) diet. The levels can be surprisingly sensitive to how you’re sitting and breathing (for your home testing compare fast vs. slow breathing and feet tense vs. flat on floor). Don’t take a small number of readings as your true blood pressure level.

An example of variability: a few weeks ago I took my blood pressure and got an unusually high value of 135/88, I then did a easy 1 hour trainer ride (Pettit) and remeasured, my new numbers were 110/75.

I’ll leave it to others to discuss optimal sodium intake levels, but my bias would be to add the minimum dose that meets your goals.

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ER doc here, I’d echo the ‘don’t take one reading as your true BP’. Almost every patient I see has a BP that is at least moderately elevated (except the ones who have a reason for low BP, bleeding, sepsis etc) and we rarely get exited about it. This is due to pain, anxiety over being in an ED etc. Your BP is a function of everything going on with your body at the time. As chaugan pointed out stress caffeine etc can all change your BP, so it is really the trend over time that is important. What we tell people is to get their BP rechecked after the acute issue has resolved and it will frequently be normal. It’s also possible that they have some HTN that just hasn’t been diagnosed yet, hence the importance of the recheck.

As far as the salt intake goes, that’s out of my area of expertise but I would generally say that a lower salt diet is generally recommended for HTN. Everyone has a different level of sensitivity to salt, so what is best for you is probably hard to say. I don’t believe there are any tests available to assess that but maybe a PCP or cardiologist could chime in.

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You can always take it daily for 10 days or so; same general time, arm, posture (feet flat on the floor), etc.

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I would reduce my salt intake for a few weeks and see what the results are. I’m not a doctor so there is no medical reasoning behind this. Just what I would try first.

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White Coat Hypertension is a real thing…and home monitoring is meant to address that issue. it is also worth noting that how most Dr’s offices take BP is a horrible procedure. It is usually one of the first things they do once you get into the the exam room. In reality, to get a more accurate BP reading, you should relax for ~5 minutes before taking it. Also, if taken manually, the process is not very reliable either (for a number of reasons).

That said, most people don’t realize that BP is not a static measurement and will fluctuate, sometimes widely. Rest, nutrition, smoking, exercise and a host of other things can affect a single reading. What matters is your readings and their trends over time.

If you need a home unit, hit me up with a DM. We supply many of the consumer BP devices on the market and I’m more than happy to send you one.

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Facts. ^^^

That said, listen to your MD. I am not a medical doctor.

Have you gained any weight since implementing higher fuel intake rates? That’s the number one reason folks tend to end up with blood sugar dysregulation in high-fuel-intake scenarios.

Please help us get the message out that fuel intake needs to be optimized! Not maximized.

I spent a lot of time on forums promoting the fact that we CAN consume very high intake rates. But it’s extremely important to optimize and not just maximize fuel intake in all scenarios. Just increasing it for all training works great in high-fitness folks. But for us mortals, it’s probably better to have it scale. (I wrote some articles for Slowtwitch about this if you’re interested.) Should You Scale Carb Intake Down on Easy Days? - Slowtwitch.com

And yes, definitely, what @Power13 has to say is spot-on. Whether you buy his BP cuff or not… he’s right. While we’re selling things to the OP, I have an app that will help too. :wink: (but seriously you can just reduce your fuel intake for some rides, cut back on sodium a little if you’ve had it really high, watch your weight, eat lots of fiber and healthy food off the bike, train hard, etc etc, and you’ll be just fine.)

Feel free to ask any questions about strategy here. Provide more info about your typical fuel intake rates (carbs, sodium, fluid, anything else) during training too, and I’m happy to point you in the right direction.

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Yeah, my blood pressure after filling out all that paperwork with the same information 6 times is never great.

So, why did I bother filling it out online before I came? Sure, I’ll do it again on the tablet as I check in. Oh, paperwork with all the same questions… OK. Have a seat in this room… so, why did you come in today, do you have a history of… Now the same questions but verbal as they type in my answers.

Let’s take your blood pressure.

It’s high… hummm.

I say OK, take it again—and then it’s already down 30 points.

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Thanks all, and especially Dr. H and @Power13 for offers of further support. Sounds like it will just be a matter of taking regular readings for a bit and backing off sodium where I think there might be room to do so. There will have been a bit of White Coat going on at the last visit only because the previous one yielded a high result - I’m usually fairly unaffected by this (or at least, I’ve never seen a high reading from a medical professional before). [This post ended up being really long with all the requested and relevant info, but for the TL;DR my only real question is the final two paragraphs at the end.]

Would happily buy my cuff from another forum member - I’ll message you, but may be a moot point due to shipping as I’m in UK and suspect you’re in the US.

I was on the Saturday app at launch too @Dr_Alex_Harrison and found it really insightful to see how sodium and carbs scale to the activity requirements, but ultimately didn’t go past the trial period because I was making my own mixes and am in the UK so the days where I really need to get hydration perfect are rare. You may also recall giving some really helpful advice when I previously asked questions about table sugar mixes as part of a self-supported ultra-endurance event, so actually part of my experiment in making my own drink mixes isn’t just about what I can tolerate but also about developing some level of consistency without precise measuring tools. The ultimate goal is to be able to carry scoops rather than scales (or even eyeball measurments in bottles), bring my salt, and buy my sugar on the go (in addition to solid food of course). For now I’m measuring by scoops and only checking against the digital scales maybe once a week or so for reference/calibration.

I’m 37yo, 172cm, and 71kg. Was probably closer to 72kg when I started mixing for myself and have previously raced at 70kg, so I’m actively trying to cut weight (without any real urgency - 68-69kg by June would be ideal but I’m not sacrificing enjoyment of life off the bike to get any lower than 70 really). Just under 4w/kg (dropping that kilo or gaining a few watts would get me there)

Any bottle that has mix in it gets ~90g sugar, ~3-4g himalayan pink salt, and ~3g citric acid. I can take down a bottle an hour at anywhere between 500mL and 710mL if I’m focused on it and can usually supplement with gels if riding outdoors in the cold and unwilling to drink that much fluid (or when trying to make 2x710mL cover a longer ride without a refill). Based on taste and some of my brief observations using the Saturday app I’ll vary the amount of salt a bit depending on ride/conditions (half a teaspoon seems to be about 2g and a rounded teaspoon about 5g, so I’m eyeballing somewhere in the middle depending on perceived requirements).

I do one bottle in my 1hr Tuesday workout and 1-2 bottles in my Thursday workout depending on length/intensity (60-90 mins). 2 bottles plus 2-4 gels for a Saturday ride which is 1hr out, 1hr hard group ride, 1hr back. Sundays are longer days but pretty variable in length and intensity - for a recent 6hr ride I brought 2 bottles, 2 bags of powder to refill bottles, and maybe 6 gels and wished I’d brought 2 more refill bags rather than trying to make the above stretch.
Wednesday 1hr z2 I usually do fasted, primarily with just water, though if I’m feeling dehydrated or a bit run down I’ll drop an SIS vitamin C electrolyte tab in my bottle.

In my recovery shake I’m using <30g sugar, ~30g pea protein isolate, ~4-5g cocoa powder, and ~3-4g sodium citrate (I find the himalayan salt overpowering here). I do that after every ride including the fasted one.

If it weren’t for the fact that I’m trying to train my gut for event days then I’d happily cut the sodium from my weekday mixes entirely. I also know the sodium helps aid absorbtion so might actually be necessary anyway.

But would it be worth cutting sodium from the recovery shake or is the impact on absorbtion going to be significant there too? Or bringing that down to 1g or less? If I could get it low enough to switch to salt then I can eliminate sodium citrate from my ingredients list entirely which would be a bonus…

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Good questions and thought lines. Answers below, mixed with unsolicited advice. Apologies in advance.

  1. Low priority recommendation: Cut down or eliminate sugar in your post-workout recovery shake. Use a banana instead (unless you train again soon). Eat a solid meal soon after.
  2. Cut sodium citrate out of the post-workout shake. Maybe shake in 1/16th tsp (just a short shake) of table salt. That’ll be all you need for sugar absorption purposes, unless you’re super dehydrated, in which case you only need more sodium because you need to be consuming copious water to fix the dehydration.
  3. Sodium doesn’t need to be terribly high to allow for gut training for carb absorption purposes. I’d bet you could cut back your sodium intake by 50% if you wanted, most days, and be okay performance wise.

Did I catch all your questions?

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Just want to clarify that I was just going to send him a unit at no charge. I’m not looking to use this board to sell stuff.

Forum members don’t let other forum members pay retail. :crazy_face:

Unfortunately, he is the UK, so shipping a unit over there doesn’t make sense. I gave him some recommendations on other units, though.

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That’s amazing, thanks - incredibly helpful to get a better sense for what functional minimums might look like so I know to what degree I can experiment with eliminating stuff. Nice tip to bring down carb content in the recovery shake too and replace with solids!

Sounds like I can even approximate what I used to do with premade products and make the first bottle or two at near-zero sodium, then ramp it up to replenishment levels in subsequent mixes if it’s a long ride (SiS sell an electolyte-free version of their Go powder here in the UK which was my previous first-bottle default, but it doesn’t appear to be available in the US - it would make sense if that’s a climate-specific distribution decision)

Sorry if we accidentally drew mods’ attention to @Power13 - it did read like an offer for free but I didn’t want to assume!

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Im a cardiology NP for what it is worth. I thought I would share some of my experiences. In our office based in the US, patients that get their Na intake under control typically have the best BP control aside from medications. This is because lots of food in the US is packed full of Na. I have recorded my own daily Na intake and have found it to be elevated.

We regularly ask people to record BP at home and report back to us. Plenty of times we have been pleasantly surprised with lower numbers.

The tricky part with BP is there is no way to tell without measuring if it is elevated, aside from an extreme. Following up with your MD will be a wise choice.

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Anything you can share broadly? I’m regularly measuring at home and I’d prefer to do it with a device I can have confidence in.

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Oh no issues there…I just wanted to make sure the other forum members didn’t think I was trying to sell product here. :sunglasses:

Where are you located…the US?

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Yes, US. I’d appreciate any recommendations.

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I’m vaguely interested in recommendations too. A month or two ago I looked at Amazon, the Amazon’s Choice is $35 (Omron) and on Amazon the blood pressure monitors range from about $20 to $60. Or something like that. Former subscriber to Consumer Reports, when I did a quick search this review article Best Home Blood Pressure Monitors of 2023 - Consumer Reports came up but I can’t see the recommendations.

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I’ll say for whatever people buy at home and it needs to calibrated correctly (against a hospital grade electronic cuff or experienced person using a manual cuff).

I do tend to disagree that manual readings are no good compare to automatic. I work in healthcare and some cuffs can be way off and need to be corroborated with manual readings with a stethoscope. It’s the gold standard in my opinion.

Wrist cuffs are worthless (also I’m my opinion).

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I agree wrist cuffs are not helpful.

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When done correctly, manual readings are very, very good. Unfortunately, they are rarely done correctly in a doctor’s office. See above examples of why for starters.

This is a common misconception. However, when used properly, wrist units are just as accurate as upper arm units. Please note the qualifier - when used properly. User error plagues the wrist segment, and the units overall suffer from a pooor reputation as a result.

Users will try and wear it like a watch or, most importantly, do not have it held at heart level when taking a measurement, etc.

We are the only supplier to receive a A/A rating for accuracy from the British Hyoertension Society for a wrist unit. (You get an individual grade for both Systolic and Diastolic readings, hence the double letter rating). The BHS is regarded as the leading independent agency for accuracy evaluation. But even grades in the B range indicate devices that are more than sufficient for home use.

Omron makes a great product, but they are also very expensive relative to other units in the market place. Like us, they are also a prime manufacturer, which is critically important. Most other suppliers source from other factories.

I really don’t want to appear to be using the board to sell our stuff, so I am purposely avoiding any mention of the units we supply in the market (we mostly work in private label, but do have some branded business). Please feel free to PM me and I’d be more than happy to discuss options, answer questions and see if I can help you out.

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