Dissolving Mysteries Around Electrolytes

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Announcer: 0:00

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Michael Koren: 0:11

Hello, I'm Dr. Michael Koren, the executive editor of MedEvidence. And we're going to do something a little bit different today. For those of you who are fans of our podcasts, you know that we often interview other physicians. But today we're going to have a different type of expert talk to us about something that's a pretty common problem and something that people are super interested in, which is what are the best electrolyte supplements and how do we enhance our athletic performance, either as an elite athlete or as a weekend warrior? So I'm very, very pleased today to have Owen Schott, who is an endurance training coach, works here in Northeast Florida. You've been recommended by lots of people, Owen, for this show. And what I want to do is I want to explore what you do on a day-to-day basis and also how we can help people choose good electrolyte supplements and hydration supplements. So welcome to MedEvidence!

Owen Shott: 1:12

Yeah, thanks for having me.

Dr. Michael Koren: 1:13

And tell us a little bit about yourself. How did you get into this racket of being an endurance training coach?

Owen Shott: 1:17

Oh man, I mean I've been around athletics my whole life, I feel like, and moved to Jacksonville in '99 on a track and field scholarship.

Dr. Michael Koren: 1:25

Really?

Owen Shott: 1:25

All of a sudden, you know, the the wheels just kept running, got into running, cycling, and travhlon. And I think along the way, I just people are like, Man, you're kind of good at this, and started picking up clients along the way.

Dr. Michael Koren: 1:37

Yeah, that's very cool. So, where'd you grow up uh before you came to Jacksonville?

Owen Shott: 1:40

In the Central Florida area, it's called Inverness, Florida.

Dr. Michael Koren: 1:43

Sure. We know it quite well. Yeah. Okay, cool. And so you went to school here in Jacksonville?

Owen Shott: 1:48

Yeah, yeah. I did a little bit of at FSC J and then UNF.

Dr. Michael Koren: 1:52

Very nice. How'd you like it?

Owen Shott: 1:53

It's good. Yeah, yeah. I I got in a little trouble, but you know, I mean, you know, I was young.

Dr. Michael Koren: 1:58

That's what college is for, of course.

Owen Shott: 1:59

Uh yeah, I've grown up a lot.

Dr. Michael Koren: 2:01

Sounds good. This would probably be for another podcast, but I can tell you about some of my college escapades, which which probably will keep quiet for a little while. Yeah, I know for sure. Any event, so now you're a respected member of the community and helping lots of athletes. So tell us about some of the athletes you've helped with with your work as an endurance training coach.

Owen Shott: 2:21

Yeah, I mean, I've I've had athletes all over the board from 12 years old to 82 years old, running, cycling, traff, and anything that's endurance-based, you know, even obstacle course stuff.

Dr. Michael Koren: 2:33

Absolutely.

Owen Shott: 2:33

But yeah, all levels, all abilities, and you've had Olympic trials qualifiers.

Dr. Michael Koren: 2:38

Nice.

Owen Shott: 2:38

Athletes qualify for you know the Kona Iron Man. So and some just trying to set a PR, you know.

Dr. Michael Koren: 2:44

That's beautiful. I love that. I love that. So you feel free to promote yourself during these podcasts. Um, that's part of what you want to do. So we'll put um, we'll let people know how to get in touch with you. So if they want to use your services, they can certainly do that. But I do want to dig into some of the scientific things. Okay. So I'm a cardiologist, as you know, and I get a lot of questions from my patients about what is the best way to hydrate themselves or what type of electrolyte solution do they need. And in my field, we deal with certain problems. Uh, one of the examples is called autonomic dysfunction. We talked a little bit about that earlier, that this is a concept where the back of the brain and the spinal cord have to get the blood pressure and your heart rate going at a level and constantly regulate that without any conscious thought.

Owen Shott: 3:34

Right.

Dr. Michael Koren: 3:34

And some people don't do that that well. So, one of the things that we deal with a lot is autonomic dysfunction. And that's a situation where the back of the brain and the spinal cord are not controlling blood pressure and heart rate quite as well as they should. We call this autonomic because these are parts of the brain that we don't have to think about. They just automatically take care of these problems. Other things are heat regulation, your your body temperature, stuff like that. But these things can go wrong. So, a good example of something, a diagnosis when things are going wrong is called POTS, which stands for postural orthostatic tachycardia syndrome. And that means people change their position and all of a sudden their heart rate races or they drop their blood pressure. And sometimes people people can even pass out because of POTS and autonomic dysfunction. And the supplements that we use are very, very important to correct some of the underlying problems that will make autonomic dysfunction less of a problem for people. So one of the solutions for this is to use electrolyte formulas, and that's what you advise your people to do every day.

Owen Shott: 4:44

Yeah, no, we I think it's super important. I mean, hydration itself is I think it's undervalued, and then explaining to people like what the purpose of electrolytes is to help with the hydration is super key.

Dr. Michael Koren: 4:57

Yeah. So give give me a little insights when you have a client, and you can use different types of client, either you're you're a 12-year-old or you're an 82-year-old or somewhere in between. How do you evaluate that? And then what would be a typical recommendation?

Owen Shott: 5:12

Yeah, I've I've found the best way is to kind of do a little test with them, you know, send them out for say an hour workout way, way beforehand and way after, and then kind of based on a formula, say, okay, hey, this is what we probably need to be taking during or even pre-load, and that kind of sets us up for at least the opportunity not to fail as much, you know. And and what I found is everybody's different, you know, if young people that don't, or not young, but just people that don't sweat as much, you know, versus somebody that does sweat a lot, you know, we find a big difference.

Dr. Michael Koren: 5:47

Okay. Do you ever look at lab tests, like with their potassium level is sodium level, magnesium level? Do you ever do that?

Owen Shott: 5:53

I haven't. No. And I know it's something that's it's evolving right now and it's it's a big deal, and it could be a direction to go in. But yeah, I think that would be something that would probably help out a lot.

Dr. Michael Koren: 6:04

Do you give sort of structured advice like take X amount of this product on this day? Give give me a little bit of a flavor on that.

Owen Shott: 6:12

I think when I originally started, I I did. I think I was very maybe narrow narrow-minded and just said, oh, this is this is the this is the cookie cutter, and this is the way it has to be. And it's like you need this much sodium, this much magnesium, and and so on. And then again, I I've just found it's a lot of trial and error. I mean, for the individual. Like I can recommend one product for a certain athlete. And you know, just even me and his example, I I don't respond well with there's a nutrition product called Made by Hammer. And it just doesn't work with my gut, you know, and I have other people they're like, Oh yeah, we I use Hammer. And I'm like, oh wow, how you know

Dr. Michael Koren: 6:51

you say it doesn't work with your gut, diarrhea? You get diarrhea with it, or

Owen Shott: 6:53

almost just like shuts down, just body doesn't want to, you know, digest. And so again, is there something in there that I don't get along with?

Dr. Michael Koren: 7:01

Okay,

Owen Shott: 7:01

you know, that that could be the case.

Dr. Michael Koren: 7:03

Yeah, the reason I asked that is because some of these supplemental drinks have magnesium in them, a lot of them do, and that can cause diarrhea.

Owen Shott: 7:10

Okay.

Dr. Michael Koren: 7:10

So that'd be one of the possibilities at least.

Owen Shott: 7:13

There you go. That's uh that's interesting.

Dr. Michael Koren: 7:15

So you you produce this chart in front of us, and hopefully everybody that's listening and viewing can get access to it in some way, because I think it's really, really insightful. And it breaks down the hydration supplements into their sodium content, potassium content, magnesium content, and their sugar content. And these are all super important things. So do you want to just give people a little bit of a sense why those are important for your clients?

Owen Shott: 7:44

Yeah, I I mean the easiest way to explain it is you know, electrolytes help induce the water into the cells or into the molecular, you know, and so everybody's like, oh hydration, hydration, hydration. But you know, if it doesn't have electrolytes in it, then it virtually flushes out of your system. And and you could probably go into the science of the ions and the positives and negatives and why they attract and all that stuff. Yeah. And then even we were talking about it

Dr. Michael Koren: 8:11

Yeah, don't ask me to do that because then I'll bore everybody to death. Yeah. But I I will I I'll I'll bring up some medical issues in a second, but I'm really curious to see how you're advising your clients on these things.

Owen Shott: 8:19

Yeah, I you know, I'd I try to keep things really simple for them. And I said, you you know, the the the electrolytes are like the it's like the key to the to the cell. Okay. And they open it up, and guess what? Everything gets to come in. And so it it it's I just it's so important. I mean, uh as you know, the body is made up of so much water, I mean 60%. Absolutely. And then if if we're not actually absorbing it, then what? Right, you know.

Dr. Michael Koren: 8:44

So it's not only you don't you you want to get it more into the cells than just the bloodstream.

Owen Shott: 8:49

Correct.

Dr. Michael Koren: 8:49

And if the cells don't get it, then you're not doing your job.

Owen Shott: 8:52

Correct. Yeah, yeah. What is it? I mean, two-thirds is intracellular, you know.

Dr. Michael Koren: 8:57

Intracellular fluid for sure. Yeah. So anyhow, just for a little bit of a quote, a medical perspective, sodium is very, very important for volume, the volume of our bloodstreams. Plasma volume is the word that we use. And so you need the sodium to enhance the plasma volume, and people who are prone to pass out because they get, quote, dehydrate are often losing sodium one way or another and need more of it.

Owen Shott: 9:22

Right.

Dr. Michael Koren: 9:22

So people that have low blood pressure or feel dizzy or even pass out when they exercise often need more sodium. Potassium is a key electrolyte for cardiac functioning. And if your potassium level gets either too low or too high, your heart gets very unhappy. Uh, potassium levels that are too high can kill somebody. Potassium levels that are too low tend to cause these palpitations, extra beats, arrhythmias. So it's important, particularly in the older athletes, or particularly people that are on medication for their blood pressure or other things, getting that's that potassium level right is super important.

Owen Shott: 9:55

You've found sorry, do you have you found maybe a lack of potassium growing up has could cause something like that? Or do you think it's just, hey, uh, I'm 40 and I stop not taking as much?

Dr. Michael Koren: 10:08

It's an interesting question. I would say that dietary habits could influence that. So if you have dietary habits where you're eating a lot of fresh fruits and vegetables, you're gonna get your potassium. People that may not be so good at that maybe don't get enough of it.

Owen Shott: 10:23

Okay.

Dr. Michael Koren: 10:23

And people develop those habits early in life.

Owen Shott: 10:26

Right.

Dr. Michael Koren: 10:27

So there's probably I I would say it's not necessarily genetic. There are cases where it could be, but I think for most people it's just the dietary habits that we we pick up.

Owen Shott: 10:36

Yeah, it'd be interesting to s find like a scenario where like maybe the the food is rich in that in those those regions.

Dr. Michael Koren: 10:44

Sure.

Owen Shott: 10:45

And see if people, you know-

Dr. Michael Koren: 10:46

-well, there yeah, yeah, and these are things you can easily look up. You can look up the potassium content, you know, the the classic thing is bananas have a lot of potassium.

Owen Shott: 10:53

Right.

Dr. Michael Koren: 10:53

And it's funny because in medicine, we often have to worry about the opposite. So when the kidneys stop functioning, then sometimes you have to limit the amount of potassium.

Owen Shott: 11:02

Right.

Dr. Michael Koren: 11:03

So if uh people that eat a lot of bananas or oranges, for example, could get into trouble if their kidneys aren't working.

Owen Shott: 11:09

Sounds like a fine line.

Dr. Michael Koren: 11:10

Exactly. That's right. So that that's where we get into more of the pathology management probably than what that what you do day to day. Magnesium is super interesting. It's sometimes the forgotten electrolyte, and it's very highly concentrated in cells, as you were pointing out. It's also kind of hard for the body to absorb it. So a lot of people who need magnesium supplements have a hard time because they get cramping in their intestinal cavities and diarrhea and things of that nature because of the side effects of magnesium. So when people get constipated, they use milk of magnesia, which is a magnesium supplement to help them have diarrhea and get rid of the stool. So magnesium is one of those things that we think about a lot in cardiology, and probably uh we don't think enough about it in other areas of medicine. And magnesium is not only important for the muscle function of the different cells, which of course is critical in athletes, but it's also another thing that affects the arrhythmias or the heart rhythm. So for that reason, we are very, very concerned about magnesium levels being correct. And I found it fascinating that these different supplements had markedly different levels of magnesium.

Owen Shott: 12:22

Right.

Dr. Michael Koren: 12:22

And magnesium is another thing that has to be used carefully for people that have kidney problems. Now, if you don't have kidney problems, you can probably take as much magnesium as you want without any adverse effects. But if you have kidney problems, you can actually overdose on magnesium.

Owen Shott: 12:39

And I guess kind of just clarify to the people that are talking and and is when we're talking about magnesium, I I think you you can probably find uh a dollar store magnesium and you can probably find a magnesium that's right, you know, very more effective.

Dr. Michael Koren: 12:54

Exactly. Yeah.

Owen Shott: 12:54

Um, is there a direction you lean or is

Dr. Michael Koren: 12:56

Oh absolutely, yeah. Yes. So that before I give my answer from a medical standpoint, what's your answer from uh a training standpoint? What do you rec do you have a go-to product that you find to be more useful?

Owen Shott: 13:08

I I don't, you know, and I think that's something that I've I've kind of come opened up and I'm trying to figure it out. Um I've I've seen some some stuff, but I I don't have an evidence, you know, where I've said, hey, let me get some of my athletes on this supplement or this product has XYZ in it.

Dr. Michael Koren: 13:24

Okay.

Owen Shott: 13:25

Yeah.

Dr. Michael Koren: 13:25

Yeah. So magnesium, this is getting into your whole discussion about ions, is part of salts. Okay. So if you remember from college chemistry, a salt has a metal and a non-metal element that come together, and magnesium is the metal element of it. And a commonly used magnesium supplement is magnesium oxide, which is pretty good at getting magnesium into the body, but not as good as some other forms of magnesium, like magnesium glycinate, for example.

Owen Shott: 13:53

Yeah, that's the one that's always coming up for me. Yeah. Yeah.

Dr. Michael Koren: 13:56

Or magnesium theanine. I don't know if you're using that at all.

Owen Shott: 13:58

No,

Dr. Michael Koren: 13:58

y So these are other element, other types of magnesium supplements that seem to be better absorbed, and they have slightly different effects. So the theanine, for example, is an amino acid that attaches to magnesium. And people find that it has a calming effect. And there's actually one study showing it can help people sleep.

Owen Shott: 14:16

Oh, wow.

Dr. Michael Koren: 14:17

There are different little elements for how we use these supplements, and to your point, your well made point, Not all supplements are the same.

Owen Shott: 14:25

Okay.

Dr. Michael Koren: 14:25

And then the final category here is sugar, which is energy. So that's the quick pickup energy. I found it fascinating that some of these products either have higher or lower levels of sugar. So again, something that's super important, I would think, based on the needs of the individual.

Owen Shott: 14:44

Yeah, I think it comes down to you know, what is the individual training for, or what is the individual using at that current moment. So if you know, if it was one of my athletes, when we go out for a workout, they're gonna have a set amount of calories or carbohydrates or sugars that they need to get in. And if it's a you know, if they're just sitting around during the day, it's it's probably not the best to be sipping on something sugary, you know.

Dr. Michael Koren: 15:06

Exactly. That's right.

Owen Shott: 15:07

Yeah, I think that's it, there's kind of a combo where you can look at one product and go, okay, yeah, you probably should be drinking this during the day. But you know, when you get on the bike, this one or when you're going out for a run has a little bit more of oomph to it.

Dr. Michael Koren: 15:18

Yeah, so there there are there are five products on this sheet that uh hopefully people will be able to see. We we're not sponsored by any of them, uh, we're just analyzing this. So again, listening at this list in no particular order. We the first one is called LMNT. And I was not familiar with this until you provide this, but when you look at the numbers, this is something that has a very high level of sodium, which should be good for volume replacement, but has zero sugar. So is there a particular type of athlete use this for?

Owen Shott: 15:48

I I get my athletes, this is their their sip-on, you know. I try to recommend, hey, taking one packet a day in conjunction with the water. The sodium is is pretty potent. Like when I do it, I have to fill up a glass, you know, this high.

Dr. Michael Koren: 16:03

Okay.

Owen Shott: 16:03

Because it it's it's you're like, all right, but yeah, that's kind of more of the day sipper, you know.

Dr. Michael Koren: 16:09

Yeah, so the one comment I would make is that with that level of sodium, if you have high blood pressure, that might be a problem.

Owen Shott: 16:17

Yeah,

Dr. Michael Koren: 16:17

it could exacerbate blood pressure by raising it. Okay. And there's a lemonade brand that you say here, that's not what kids sell on the street corner, is it?

Owen Shott: 16:27

No.

Dr. Michael Koren: 16:27

Is it just one that tastes the best? Is it what I'm saying?

Owen Shott: 16:30

Yeah, they they've got a couple different flavors, but I found the lemonade is yeah, definitely one of my favorites.

Dr. Michael Koren: 16:34

And then you have liquid IV as next. And I've had a few patients who have asked me about that. Again, I see it comes in different flavors. So that one has a less sodium, but a decent amount, but pretty high in potassium, no magnesium, and some sugar. So is there any niche for that in your practice?

Owen Shott: 16:53

I I don't necessarily recommend it. I think it was just one of those first things that, you know, popped up and everybody was like, oh, you know, electrolytes. And I I found that, you know, this that's gonna t be about a $43 billion industry electrolytes.

Dr. Michael Koren: 17:07

Wow.

Owen Shott: 17:07

So I think we're kind of sorting through some of this stuff and looking at it. And but, you know, I've heard of it. I think everybody's heard of liquid IV.

Dr. Michael Koren: 17:14

Sure. And then this one has some additional supplemental vitamins. Interestingly, it has B6 and B12, which could be a treatment for people who have vascular inflammation. There's something called homocysteine, which is associated with vascular inflammation that seems to respond to B complex vitamins. But this uh still has a fair amount of sodium, so if you have high blood pressure ratios, it may not be the best. It has a lot of potassium in it, so if your kidneys aren't perfect, that may be a stress on them. It's low in magnesium, which again is a really important electrolyte, so that may not be the best for people that need magnesium replacement and has a little bit of sugar in it. And then moving to the next one, EFS, which is a little bit more balanced across the board. That one looks to have a little bit of everything. So tell me about that one.

Owen Shott: 18:04

Yeah, so when I when I got into sports, this was this was pretty predominant. And I had a a coach recommend it to me, and you know, he kind of broke it all down of the same thing we're kind of talking about now, and he's like, there's just a good balance of it, and it and it's super crucial, obviously, for heart function and hydration and all that. So that's been one of my go-to's for a while for people that are just constantly having cramps or whatever.

Dr. Michael Koren: 18:27

And this is the one that's highest in sugar.

Owen Shott: 18:30

Yeah, yeah. Again, this, you know, if you're out going for a run or on the bike, this isn't your day supper, you know, where you're hanging around the living room.

Dr. Michael Koren: 18:37

So if you're again, for your for your older people that may be more the weekend warrior type, that might be a little bit of an issue because that they tend towards diabetes. That could be something that they may want to avoid.

Owen Shott: 18:50

Yeah, I think as long as you're you're burning it, you know, you should be fine. But yeah, I wouldn't, like I said, be hanging out.

Dr. Michael Koren: 18:56

You might want to pick one for those people that had a little less sugar in it. Yeah, yeah. And then uh next on the list is coconut water. So that is the lowest in sodium, so you're not going to get a lot of volume resuscitation with that. It's also the highest in potassium and sort of in the middle to low on the others. So tell me about that one. Is there a particular niche that you recommend that for?

Owen Shott: 19:19

No, I just threw this one on there just because it, you know, I think it's readily available. You know, if you went to a gas station, you could probably grab it off the shelf or you know, a grocery store, and and I think a lot of people have heard about it for sure.

Dr. Michael Koren: 19:31

Okay. So my concern with something like that would be that high potassium. Now, if you're on a diuretic, for example, a thiazide diuretic, that might be a good thing because you replace uh potassium which is wasted by the thiazide diuretic. But also you've got to be a little bit careful about that. So when I look at this, I'm thinking this could be a good potassium supplement for some of my patients, but certainly not something that's gonna replace volume or not necessarily something that's gonna be particularly helpful if you have a low magnesium level.

Owen Shott: 20:03

Right.

Dr. Michael Koren: 20:03

And then finally you have Skratch as the the one, the last and the list, not the least, but the last.

Owen Shott: 20:10

Yeah.

Dr. Michael Koren: 20:10

And tell me about that one.

Owen Shott: 20:11

Yeah, Skratch is relatively newer to the market and and and it's it's been a handful of years, but their their go-to was at the beginning, was they're just they put good products, you know, the good sodiums, the good magnesiums, the you know, the good stuff in the product. So that way, you know, you're not getting like Gatorade off the shelf or something like that, you know, and that was their big go-to. So I've definitely shifted some of my athletes to this because it it I just like the clean factor of it.

Dr. Michael Koren: 20:39

Okay, interesting. So you mentioned Gatorade, the G-word. Yeah. And how does this compare to Gatorade or Powerade or one of the more widely commercialized brands?

Owen Shott: 20:48

I mean, I think Gatorade when it first started was probably amazing, you know, and and I I saw a you know, a meme on this or something like that, and it showed it had like five ingredients and now it has 35 ingredients, and so you know, that all the diet is and food colors and stuff like that. So uh I mean, again, what are we trying to target? Is it the most healthy thing for you? Probably not, but will it do the job partially, you know?

Dr. Michael Koren: 21:15

I know some of the forms of Gatorade are very high in sugar, and I have to advise my patients to be careful about that, but others are have lower sugar. So again, there's a role for everything.

Owen Shott: 21:25

Yeah, and that's that's the thing, you know. A a young kid, you could do that, but does that put them on a path down the wrong road, you know?

Dr. Michael Koren: 21:32

So but it's also important to read the labels. I think that's one of the really important take-home messages is that when you understand the contributions of sodium, potassium, magnesium, and the sugar, you can come up with a good solution for you based on your individual circumstances.

Owen Shott: 21:46

Right. And that's where I think it's a lot of trial with most athletes because again, they don't respond well or something like that. And it it's great though that you're putting down, like, hey, somebody that has maybe X, Y, Z, I'd kind of maybe not do that one versus this. One or something like that. So cool.

Dr. Michael Koren: 22:02

So this is this has been absolutely fascinating. Any final words for our audience about how they can either approach excellence in in athletic performance or look at hydration and other supplements?

Owen Shott: 22:17

Yeah, I think the biggest takeaway from this is definitely test it out. You know, if you're training for a marathon, an Iron Man, whatever it is, don't try it on day one of the race. You know, let's you know, give yourself an opportunity, you know, handful of weeks out to go, all right, yeah, let me try this product, let me try that product and see how it responds with your system.

Dr. Michael Koren: 22:38

Absolutely. And do you ever encourage people to get blood tests during your analysis or do they do that spontaneously?

Owen Shott: 22:46

I I have had some athletes do it. Again, it's it's a little out of my wheelhouse, but I'm in that market of trying to find somebody that can help help me with that part of it, you know.

Dr. Michael Koren: 22:56

So absolutely. Well, there are plenty of, I think, physicians who have that orientation. And I'm sure after this podcast, you'll have tons of people that reach out to you and trying to work with you to help different athletes, either the weekend warriors or the elite athletes, maximize their performance.

Owen Shott: 23:12

Absolutely.

Dr. Michael Koren: 23:13

Owen and one of the things that I hear from patients is that some supplements are either easier or more difficult to tolerate from a GI standpoint. Is that something you're noticing with your clients?

Owen Shott: 23:26

Yeah, yeah. I mean, definitely. I think it's it's a trial and error, but every individual's a little different. I think with I've seen guys eat a hamburger and go for a 10-mile run. And, you know, me, not I'm not one of those. I have to like slowly wean myself onto stuff. And I found where I used to be able to take, you know, say 40 carbs an hour, now I can take 80 carbs an hour with a mixture of, you know, magnesium and sodium and things like that. But I think the key is also diluting it with water, you know, having the right balance of water as well.

Dr. Michael Koren: 23:57

Absolutely. Magnesium is one of those elements that is very hard for some people to digest. And uh, in fact, the the most common side effect of magnesium supplements is diarrhea. So you may run into that with some of these supplements, particularly the ones that have high levels of magnesium. Because of the fact that everybody's a little bit different, sometimes there's a bit of trial and error with different magnesium salts to see if one is tolerated better than others. Magnesium oxide is the one that's most commonly used across different medical practices and others in the United States, but others may be better tolerated. Magnesium glycinate is one, magnesium theanine is another that anecdotally people tolerate better. And they also tend to have other effects. So, for example, magnesium theanine has been shown to be helpful to help people relax a little bit and maybe help them sleep.

Owen Shott: 24:52

Yeah. Do you think the amount of magnesium per body weight might have anything to do with it?

Dr. Michael Koren: 24:58

A little bit. The dosing, the dosing can be important. So, for example, a standard dose of a magnesium supplement would be something like magnesium oxide, 400 milligrams twice a day. Okay. Some people, that's adequate in terms of absorbing magnesium and getting their blood levels back up. Some people need more than that. Some people develop horrible diarrhea with that much magnesium and have to back down to half of that dose or even less. So there is a little bit of trial and error there in terms of how you dose the magnesium supplements.

Owen Shott: 25:28

Okay.

Dr. Michael Koren: 25:29

Have you seen any problems with people that take in too much of that free sugar too quickly?

Owen Shott: 25:34

100%. Yeah. It's the our industry has gone crazy on sugar right now or carbohydrate intake. Like I think I was telling you, you know, the standard used to be about 40 grams per hour. And now I've heard, you know, professional triathlete taking almost 160 grams an hour. And again, it I don't think it happens overnight, but they've definitely worked to that. But the backside of that is, you know, man, finding bathroom quick.

Dr. Michael Koren: 26:00

Okay. So they get diarrhea with it or?

Owen Shott: 26:02

yeah, absolutely. Or even maybe the gut just stops working and just says, hey, I'm I'm done with this.

Dr. Michael Koren: 26:06

Really?

Owen Shott: 26:07

You know, yeah.

Dr. Michael Koren: 26:07

So people can vomit and and have bad cramps, abdominal cramps.

Owen Shott: 26:11

Yeah. Yeah. And I think if you don't get enough fluids into mixed it in, I it it's a fine line.

Dr. Michael Koren: 26:16

Interesting.

Owen Shott: 26:17

Yeah.

Dr. Michael Koren: 26:17

Owen, as a cardiologist, I see plenty of people that have a condition called atrial fibrillation. And I think sometimes exercise or over exercise can be a contributing factor to that. Have you seen that in some of your clients? Is that an issue that you that you address?

Owen Shott: 26:33

Yeah, especially in cycling, uh it's it's very common and it's kind of scary because they don't really know what's going on and what's happening is you know, they're getting this elevated heart rate and they're not really going hard, and then it stays and and it's going all over. So I've had multiple athletes where they just didn't know what to do and they have to go in and then they're they're doing procedures on them and stuff like that.

Dr. Michael Koren: 26:55

So just a little bit of a tidbit on that is that people that have lower potassium levels and lower magnesium levels are much more prone to develop atrial fibrillation.

Owen Shott: 27:05

Okay.

Dr. Michael Koren: 27:06

So that might be one of the things that you consider when you're recommending one supplement versus another.

Owen Shott: 27:11

Okay. Perfect. Yeah.

Dr. Michael Koren: 27:12

So, Owen, but I have a question for you. Obviously, we've been talking about electrolytes and hydration, but what's the practical difference for people if they're well hydrated or not? Can you give us some examples of that?

Owen Shott: 27:23

Yeah. So there's actually some some pretty good studies out there, even if you're off by 2% uh, you know, from a body functioning, it's like 20% of effort. So, you know, if we're measuring an empower or a pace or whatever, you can be 20% less. So I think there's other things out there that can equate as well, like muscle soreness, joints, cortisol levels going up. I mean, if you think about it, an unhydrated muscle is like what? It's like a piece of beef jerky. It ain't gonna move, right? But a hydrated muscle is like that steak you're getting ready to put on the grill.

Dr. Michael Koren: 27:55

Sure.

Owen Shott: 27:55

So I think that's probably the most important people part that everybody's missing.

Dr. Michael Koren: 28:00

Interesting. Have you can you think of examples? Somebody that was running a six-minute mile and they got to a five-minute mile because of changes in their nutrition and hydration. Is it that big or or give us a little bit of examples of that?

Owen Shott: 28:13

Yeah, I've definitely had multiple athletes drop close to a minute a mile over a marathon.

Dr. Michael Koren: 28:18

Wow.

Owen Shott: 28:19

Which is huge. You know, in a marathon, it's 26 miles. I think there's other things to it, but you know, there's case study, one athlete was just worked on her biomechanics a little bit and then dialed in her hydration and nutrition. And I mean, she had a 26-minute PR, and I was like, I can't even make that up.

Dr. Michael Koren: 28:36

That's crazy. Yeah, cool, for sure. Owen, thank you so much for being part of MedEvidence. And you you've been a delightful person to talk to and also somebody incredibly knowledgeable. So hopefully a lot of people will learn from this conversation. Awesome. Thank you.

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