Just as physical complaints can have underlying mental or emotional causes, many mental or emotional complaints can have underlying physical causes. Disentangling these complex relationships is among the primary strengths of holistic medicine, and when it comes to mood disorders, the experience of holistic practitioners has uncovered a wide array of physical imbalances which can lie at the root of mood disorders. Dysbiosis, hypothyroidism, and chronic inflammation from any number of underlying causes can all trigger depressive symptoms through purely physical mechanisms and are often neglected as causes due to having too narrow a focus on treating mental health concerns. While not all cases of depression have a somatic basis, simple dehydration can cause many of the same symptoms, and in fact there are associations noted between water intake and depression risk1. A physical need as elementary as water is just the tip of the iceberg when it comes to determining the causes of low mood.
We must acknowledge that mood problems especially should be approached from the biopsychosocial model of illness, because life circumstances and social determinants of health often contribute to psychological symptoms. However, there are certain well-known mood disorders that seem all the more striking because they tend to develop just when things would seem to be going well in a person’s life, and it is for these cases especially that a possible physical cause should be considered. For instance, a very common syndrome of low mood is postpartum depression, all the more remarkable because most people will cite the birth of their children as the best day of their entire lives. Many psychological factors have been explored in an attempt to explain this relatively common phenomenon, for instance the sudden weight of responsibility or the reality of one’s child falling short of idealized expectations, but what is rarely considered is the tremendous fluid loss that accompanies even uncomplicated childbirth.
It is common to lose four to five pounds of fluid and tissue not including the baby, but including blood, amniotic fluid, and perspiration, and many women report substantial weight loss continuing even during the postpartum period. This is not accounting for lactation, which puts a constant strain not only on hydration status, but electrolyte status as well. The importance of electrolyte is stressed for athletes, but rarely for the peri- and postpartum period. It is known that simple dehydration can precipitate low mood, and there is also reason to believe that depletion of electrolytes through excessive fluid loss, especially sodium, may cause persistent depression until these levels can be restored.
Athletes, especially endurance athletes, are another population who often contend with excessive fluid loss and electrolyte loss. The sporting community is now well aware of the dangers of electrolyte depletion, particularly when endurance athletes or people training strenuously in the heat use plain water to replace fluids lost through sweat. This has proven fatal in some cases, due to the effects of sodium depletion combined with overhydration serving to further dilute sodium concentration. It is also interesting that, similar to people who have recently given birth, many athletes will report experiencing mysterious symptoms of low mood shortly after what should be a cause for celebration, winning or in some cases even just completing a tough athletic event after months of preparation.
Terms like post-marathon blues and gold medal syndrome are used to describe this phenomenon, analogous to postpartum depression in that low mood is suffered just when we would expect a person to be the most happy. Normal sweat losses, especially during physical exertion in hot or humid weather, can average one to two liters per hour, and the average completion time for an Ironman triathlon is over ten hours. These athletes must of course hydrate during the race, if they are to have a chance of surviving let alone finishing, but even with electrolyte beverages it is almost impossible to effectively replace the sodium lost during such a race. The amount of sodium lost through sweat varies widely depending on the individual: the range has been estimated between 200 and 2000 mg/liter of sweat, with 800-900 mg/liter being considered average. This means that an individual sweating 2 liters per hour could theoretically lose 40 grams of sodium in the course of a ten-hour triathlon. To replace this would require eating over 800 snack-size bags of salt and vinegar potato chips. Replenishing such a loss of sodium would therefore become a multi-day or perhaps even multi-week endeavor.
Fluid losses of any kind will always result in more than just dehydration. All of the body’s fluids are saline, including blood, sweat, tears, amniotic fluid, urine, and especially the watery portion of loose stools, meaning any excessive fluid loss will deplete precious electrolytes, primarily sodium. The role of the blood sodium level in maintaining a healthy mood is so intimate that the mental state of hyponatremia is symptomatically identical to depression, and can be easily confused with it. There are numerous cases of electrolyte disturbances masquerading as psychological problems, for instance this case report of hyponatremia being misdiagnosed as bipolar disorder. It is therefore possible, in at least some cases, that depression following some large fluid loss like giving birth or running a marathon could in truth be a symptom of hyponatremia, and be corrected over time with electrolyte supplementation.
SYMPTOMS INDICATING LOW ELECTROLYTE LEVELS
One of the main indicators of low electrolytes is low fluid levels in the body. More important than the sheer quantity of electrolytes in the body is their concentration: if the body’s fluids become too dilute, it will disturb neuromuscular transmission and can literally result in death. For this reason, low electrolytes will limit how much fluid the body is able to retain and will cause a host of symptoms similar to ordinary dehydration. The following are some signs that the body’s overall fluid volume has decreased beneath optimum levels:
- frequent lightheadedness or POTS (positional orthostatic tachycardia syndrome)
- decreased stamina, especially when standing or contrasting with expected fitness
- frequent numbness, especially of the extremities: limbs falling “asleep” easily
- loss of appetite
- ringing in the ears (often caused by decreased blood volume)
- dry skin and increased hair shedding (from poor circulation to the skin)
- thirst that can’t be satisfied no matter how much one drinks
- depressed mood
Simple dehydration can be cured by drinking water, but in states of electrolyte depletion drinking water won’t help much in the long term and may even make things worse, by further diluting electrolyte concentration. There are numerous cases of extreme athletes going into cardiac arrest after replacing large volumes of lost sweat with pure water missing electrolytes, leading to potentially fatal hyponatremia.
One reason electrolyte deficiencies can be difficult to identify is our inability to accurately gauge the sufficiency of electrolyte stores. Lab tests don’t assess whole-body electrolyte levels, merely their concentration relative to water. So when patients present with a low electrolyte condition on conventional lab work, this tends to reflect a sudden acute loss or a condition of dysregulation, not a chronic deficiency. In fact, the location of electrolyte stores in the body and the systems of their regulation are in some cases only beginning to be unraveled. There are no lab tests to measure or even estimate whole body sodium and potassium levels, although it is known there are large stores of these minerals in the skin and muscles respectively. As they are drawn upon to maintain a crucial balance in blood and bodily fluids, these stores can be diminished over time, which can have effects of reducing overall blood volume and placing stress on the adrenal glands.
Although there is no good way as yet to determine if someone needs added electrolytes, a high degree of suspicion should be maintained whenever symptoms of fatigue and depression seem to follow an excessive fluid loss. Fortunately, electrolyte supplements are affordable and safe with generally no side effects, though taking high doses of magnesium may cause loose stools. The body is actually much better at eliminating electrolytes than retaining them, so in healthy people there is very little concern over getting too many, and no harm in trying them even if the problem proves to run deeper.
If electrolytes aren’t enough, there are also a few homeopathic remedies that can be used to support patients who experience symptoms after excessive fluid loss. Perhaps the most famous is Cinchona officinalis*, the first remedy Hahnemann proved and famous for restoring the vitality of patients exhausted through loss of blood or other fluids, including perspiration. Closely allied to Cinchona is Natrum Muriaticum*, possibly the most common homeopathic remedy used to treat symptoms of low mood. While symptoms calling for Natrum Muriaticum* are occasionally relieved by sweat, fatigue with unquenchable thirst and craving for salt are more common and speak to this remedy’s ability not to provide sodium, but to help balance its distribution in the body. A third remedy to consider for the after-effects of fluid loss, though needed less commonly, is Veratrum album*. This remedy became famous for treating exhaustion after long bouts of diarrhea, likely related to the excessive fluid losses.
*Claims are based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated.
- Lee JW, Kim Y. Association of plain water intake with self-reported depression and suicidality among Korean adolescents. Epidemiol Health. 2024;46:e2024019. doi: 10.4178/epih.e2024019. Epub 2024 Jan 9. PMID: 38271962; PMCID: PMC11099597. ↩︎
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