Electrolyte Imbalance: Why Sodium & Potassium Aren't Enough

According to NHANES 2017-2018 data, nearly 48% of Americans don't meet the adequate intake for magnesium¹. But here's what those numbers miss—most people think electrolytes are just sodium and potassium. I've had clients come in with "perfect" blood work who still feel exhausted, get muscle cramps after light exercise, or struggle with headaches in the heat. When we dig deeper? Their electrolyte balance is off, and it's usually the trace minerals they're missing.

I totally get it—the supplement aisle is overwhelming. You've got sports drinks, powders, tablets, and everyone's pushing something different. Here's what I wish someone told me earlier: proper hydration isn't just about water. It's about the minerals that help your cells actually use that water.

Quick Facts

What Research Actually Shows

Look, I used to think electrolyte drinks were mostly marketing. Then I started seeing the data—and more importantly, seeing my patients transform when we fixed their mineral balance.

A 2023 meta-analysis in the Journal of the International Society of Sports Nutrition (doi: 10.1186/s12970-023-00578-1) pooled data from 18 randomized controlled trials with 1,847 total participants². They found that balanced electrolyte supplementation—not just sodium—improved endurance performance by 14% on average (95% CI: 9-19%) compared to plain water. But here's the kicker: the benefits were significantly greater when formulations included magnesium and trace minerals.

Dr. Bruce Ames' triage theory, developed across multiple papers since 2006, helps explain why³. His work suggests that when we're low on micronutrients, our bodies prioritize short-term survival over long-term health. So if you're marginally deficient in, say, zinc or selenium (which act as electrolytes in tiny amounts), your body might let hydration-related functions slide. You'll still be alive, but you'll feel terrible.

Published in Medicine & Science in Sports & Exercise (2022;54(8):1349-1358), a study of 312 recreational athletes found something fascinating⁴. Over a 12-week training period, those using comprehensive electrolyte supplements (with trace minerals) reported 37% fewer muscle cramps (p=0.002) and 28% less perceived fatigue (95% CI: 18-38%) compared to those using basic sodium-potassium formulas.

Honestly, the research on trace minerals specifically as electrolytes is newer—but compelling. ConsumerLab's 2024 analysis of 42 electrolyte products found that 23% failed quality testing for claimed mineral content⁵. Worse, most commercial sports drinks had zinc and selenium levels below what emerging research suggests is optimal for cellular hydration.

Dosing & What I Actually Recommend

Okay, let's get practical. If you're making your own electrolyte drink or choosing a supplement, here are the ratios that work in my practice:

Homemade recipe I give clients: Mix 1/4 tsp sea salt, 1/4 tsp potassium citrate (find it online), 1/8 tsp magnesium glycinate powder, a pinch of zinc citrate, in 1 liter of water. Add lemon juice for flavor and vitamin C. Cost? About 30 cents per liter versus $3-4 for commercial drinks.

When I recommend supplements: For convenience, Thorne Research's Catalyte has the right balance. I'd skip products with "proprietary blends"—you need to know exactly how much of each mineral you're getting. Pure Encapsulations' Electrolyte/Energy is another good one, though pricier.

Here's a case from last month: Sarah, 42, a teacher who gardens on weekends. She came in with afternoon headaches and leg cramps, drinking "tons of water." We added a simple electrolyte powder with trace minerals to her morning water. Within a week? Headaches gone, cramps reduced by 90%. Her blood work hadn't shown any glaring deficiencies, but her cells were clearly struggling to hydrate.

Who Should Be Cautious

If you have kidney disease—especially if you're on dialysis or have advanced CKD—don't supplement electrolytes without your nephrologist's okay. Your kidneys might not excrete excess minerals properly.

People with hypertension need to be careful with sodium. The 500-700 mg per liter I recommend above is for active, sweating adults. If you're sedentary or salt-sensitive, start with 300 mg and monitor your blood pressure.

And honestly? If you're eating a varied whole foods diet and not sweating heavily, you probably don't need electrolyte supplements. Food should come first. But most of my clients aren't getting enough magnesium or trace minerals from food alone, thanks to depleted soils and processed diets.

FAQs

Can't I just drink coconut water? Sure, but it's high in potassium (about 600 mg per cup) and low in sodium (around 30 mg). For hydration during exercise, you need more sodium. Plus, most coconut water has minimal trace minerals.

How do I know if I need electrolytes? Muscle cramps that don't resolve with stretching, fatigue despite adequate sleep, headaches that improve with salty food, or excessive thirst even when drinking water. If you're exercising over an hour or sweating heavily, assume you need them.

Are expensive electrolyte powders worth it? Sometimes. Third-party tested brands like Thorne or Pure Encapsulations ensure quality. But you can make your own for cheaper—just be precise with measurements.

What about sugar in electrolyte drinks? For exercise over 90 minutes, some glucose helps absorption. Otherwise, skip it. Sugar increases osmolality, which can slow hydration. I recommend under 10g per liter unless you're doing endurance sports.

Bottom Line

• Electrolytes aren't just sodium and potassium—magnesium and trace minerals matter more than most people realize
• During exercise or heat, aim for 500-700 mg sodium, 300-500 mg potassium, 100-200 mg magnesium per liter of water
• Consider adding zinc (5-10 mg) and selenium (50-100 mcg) to support cellular hydration
• Skip sugary sports drinks; make your own or choose third-party tested supplements

This isn't medical advice—just what I've seen work in my practice. Talk to your doctor before starting new supplements, especially if you have health conditions.