Electrolyte Supplements: Who Needs Them, Who Doesn't and Who Should Be Careful

The short version

• Most people don't need electrolyte supplements. In 2015 to 2016, 86.7% of US adults already ate more sodium than the 2,300 mg a day target (Clarke 2021), and a review of heat and exercise says a normal diet needs no extra electrolytes, except perhaps in the first few days of hot weather (Sawka 2000).
• B Grade B. In two small trials of 8 healthy adults each who sweated off about 2% of body weight in the heat, drinks with sodium stayed in the body better than water or a sodium-free drink, but performance 4 hours later did not improve (Merson 2008; Shirreffs 2007).
• C Grade C. In an observational study of desert ultramarathon runners, sodium pills were not linked to fewer cases of low blood sodium (Lipman 2021).
• C Grade C. In 14 young adults with POTS, 6 days of a high-salt diet expanded blood volume and cut the heart rate rise on standing compared with a very-low-salt diet (Garland 2021). Salt is a standard first step for POTS and low blood pressure on standing, but not for people with high blood pressure, heart failure or kidney disease, and the evidence is weak, so add salt only on your clinician's plan (Snapper 2022).
• Salt, fluids and potassium can be dangerous with high blood pressure, kidney disease, heart failure, lithium, or medicines that raise potassium, such as ACE inhibitors, ARBs, spironolactone and other potassium-sparing diuretics (Huang 2020; Te Dorsthorst 2019; Ambardekar 2009; Norman 1984).

Do you need electrolyte supplements?

Electrolytes are minerals that carry an electrical charge in the body, mainly sodium, potassium, chloride and magnesium. Food supplies plenty of sodium for most people: nearly 9 in 10 US adults eat more than the 2,300 mg daily target (Clarke 2021). Heavy sweaters lose more. Athletes training in hot weather can lose 3,500 to 7,000 mg of sodium a day in sweat, and normal meals and drinks replace it unless you need to recover within 24 hours or have lost more than 5% of your body weight (Shirreffs 2011). So the honest answer for most people is no: electrolyte powders add sodium you probably already have, and some add magnesium and potassium you may not want.

Are electrolyte drinks better than water for exercise?

B Grade B for rehydration after heavy sweating in small trials of healthy adults, not for performance. When 8 men drank fluids after losing about 2% of their body weight in the heat, drinks with more sodium led to less urine, so more fluid stayed in, but cycling to exhaustion 4 hours later was no better (Merson 2008). In another small trial, only a carbohydrate and electrolyte sports drink brought volunteers back to their starting hydration after 4 hours; two mineral waters and a juice spritzer did not (Shirreffs 2007). At rest, in 19 young adults, electrolytes alone did not consistently beat water, while drinks that added carbohydrate or a protein fragment held on to more fluid (Millard-Stafford 2021).

The American College of Sports Medicine says drinks with electrolytes and carbohydrate can beat water during exercise only in certain circumstances, and that sweat rates vary so much that plans should be individual. You can estimate your own sweat loss by weighing yourself before and after exercise (ACSM 2007).

Do salt pills prevent low sodium in endurance events?

C Grade C: sodium pills weren't linked to less low sodium. Exercise-associated hyponatremia means blood sodium falls too low during long exercise. In an observational study of desert ultramarathons with 174 runners tested at the finish, how much sodium people took from supplements was not linked to low blood sodium (below 135 mmol/L) or high blood sodium; runners with low sodium were more often overhydrated than those with high sodium (Lipman 2021). In a 161 km race with 669 finishers tested, 15.1% had low sodium, in both dehydrated and overhydrated runners, and the authors advised against heavy sodium supplementation and drinking beyond thirst (Hoffman 2013). Our electrolytes page links electrolytes with preventing low sodium in the heat; in the one race study that measured it, sodium pills were not linked to less low sodium.

Should you drink electrolytes when you have diarrhea or vomiting?

C Grade C in adults. In 75 adults admitted to hospital with a stomach virus, a sports drink and two oral rehydration solutions improved stools and body weight about equally over 48 hours, though low potassium lingered more often with the sports drink (Rao 2006). For children with diarrhoea, oral rehydration solutions are the tested option; in hospital trials, a reduced-strength (lower osmolarity) version meant fewer children needed a drip than the older standard formula (Kim 2001). For a child, ask your child's doctor or pharmacist which solution to use and how much, and check the warning signs under When to see a doctor.

Does extra salt help POTS or low blood pressure when standing?

C Grade C. POTS (postural orthostatic tachycardia syndrome) means your heart races when you stand, and orthostatic hypotension means your blood pressure drops. Expert advice puts salt and water first, yet a 2022 review called the published evidence of benefit relatively weak (Snapper 2022). In a 6-day crossover study of 14 adults aged 23 to 49 with POTS, eating far more salt expanded blood volume and lowered standing heart rate compared with a very-low-salt diet, though heart rates stayed higher than in healthy people (Garland 2021). A 2025 review of 21 trials (750 patients) found that POTS treatments, salt included, rest on many small trials (Kwok 2025).

For orthostatic hypotension, a 2026 review lists more salt and fluid, a medicine review and compression garments as the basic steps, with midodrine and droxidopa as the only FDA-approved medicines. It also notes that many people with it have high blood pressure when lying down, which makes treatment harder (Moloney 2026). That is why extra salt needs a clinician's plan, not a guess. Extra salt and fluids are not for people with high blood pressure, heart failure or kidney disease, or anyone told to limit salt or fluid. POTS is the most common circulation problem in people with joint hypermobility or Ehlers-Danlos syndrome (Roma 2018); see our Ehlers-Danlos protocol.

Do electrolytes help a hangover or cramps?

• Hangover, grade D (indirect evidence): trials of electrolyte drinks for hangover are lacking. A review of survey data found that drinking water during or after alcohol was linked to only slightly less next-day hangover, and drinking more during a hangover was not linked to feeling better; dehydration and hangover seem to happen together but separately (Mackus 2024).
• Muscle cramps: our leg cramps guide covers electrolytes, pickle juice and magnesium.

What we'd skip

• Daily electrolyte drinks with a normal diet and ordinary activity (Sawka 2000; Clarke 2021).
• Salt pills to prevent low sodium in long races: they weren't linked to fewer cases in runners (Lipman 2021). Drink to thirst (Hoffman 2013).
• Salt tablets for dizziness without a diagnosis: the cause needs checking first, and salt can worsen high blood pressure when lying down (Moloney 2026).
• Potassium supplements or salt substitutes with kidney disease or potassium-raising medicines: case reports describe dangerous potassium levels (Te Dorsthorst 2019).

Safety and interactions: who should be careful with salt and potassium?

• High blood pressure. Sodium matters: in 133 trials (12,197 people), cutting sodium lowered systolic pressure by about 4 mm Hg on average, more in older people and those with higher pressure (Huang 2020). Potassium-based salt substitutes cut strokes in 20,995 people who had had a stroke or were 60 or over with high blood pressure (Neal 2021), but the trials left out people at risk of high potassium (Brand 2022); see our blood pressure guide.
• Kidney disease and potassium-raising medicines. High blood potassium (hyperkalemia) can cause deadly heart rhythms. In a review of 44 cases caused by food or supplements, salt substitutes and supplements were the main cause in people with normal kidneys, and muscle weakness, vomiting and breathlessness were common (Te Dorsthorst 2019). Kidney disease and medicines that block the renin-angiotensin-aldosterone system, such as ACE inhibitors, ARBs, spironolactone and other potassium-sparing diuretics (amiloride, triamterene, eplerenone), cut potassium excretion (Te Dorsthorst 2019); 7.2% of 926 heart failure patients on spironolactone had to stop it because of high potassium or kidney failure (Tamirisa 2004). See our kidneys guide and can I take magnesium with blood pressure medicine?.
• Heart failure. People with heart failure are usually given salt and sometimes fluid limits. In a US registry, not keeping to diet or medicines was the documented reason for 10.3% of heart failure hospital stays, and those patients arrived with more signs of fluid congestion (Ambardekar 2009). Ask your heart team before adding salt or electrolyte drinks.
• Lithium. Losing salt or fluid, as with heavy sweating, diarrhoea or vomiting, cuts lithium clearance and raises the risk of lithium toxicity (Norman 1984), while changes in salt intake shift levels: in 60 people with bipolar disorder, a fixed 1 g of added salt a day kept lithium steadier than advice to avoid added salt (George 2023). Change nothing about salt, fluids or electrolyte drinks without your psychiatrist.
• Medicines that lower sodium. Thiazide diuretics (Filippone 2020) and antidepressants in older adults (Zhang 2026) can cause low blood sodium. The fix is a blood test and your prescriber, not salt pills.
• Magnesium in powders. With kidney disease, magnesium can build up to dangerous levels because the kidneys can't remove the excess (NIH ODS); ask your kidney team first. Upper limit for adults: 350 mg of magnesium a day from supplements, because more can cause diarrhoea; take more only with blood tests or your clinician's advice (NIH ODS; check your stack).
• Pregnancy and children. Ask your midwife or doctor, or your child's doctor, before using electrolyte products.

When to see a doctor

Get emergency care for:

• confusion, a severe headache, repeated vomiting or a seizure during or after a long race or after drinking a lot of water, which can be dangerously low sodium;
• fainting during exercise, or fainting with chest pain or a pounding heart, which can mean a heart rhythm problem;
• muscle weakness, a slow or irregular heartbeat or breathlessness after potassium supplements or salt substitutes, which can be high potassium;
• diarrhea or vomiting with very little or no urine, confusion or fainting, or when you can't keep any fluids down;
• a baby or young child with diarrhea or vomiting who has few wet nappies, is very sleepy or floppy, has sunken eyes, won't drink or has blood in the stool, or any baby under 6 months with these illnesses;
• an older adult with diarrhea or vomiting who becomes confused, dizzy or drowsy;
• shaking, unsteadiness, confusion, vomiting or diarrhea while taking lithium.

See your doctor soon for:

• dizziness or fainting when you stand up, especially if it is new, follows a new medicine or causes falls;
• a racing heart every time you stand;
• a pounding, fast or irregular heartbeat that doesn't settle;
• diarrhea or vomiting that lasts more than a couple of days.

Don't stop a prescribed medicine on your own; ask the prescriber or pharmacist.

FAQ

Do I need to take electrolytes every day? Most people don't. Nearly 9 in 10 US adults already eat more sodium than the daily target, and a normal diet covers electrolyte needs except perhaps in the first few days of hot weather.

Are electrolyte drinks better than water? After heavy sweating, yes for holding on to fluid: in two small trials of healthy adults who sweated off about 2% of body weight, drinks with sodium kept more fluid in than water (grade B), but performance hours later did not improve. For ordinary days and light exercise, water and food are enough for most people.

Can I take electrolytes with high blood pressure? Ask your clinician first. Sodium matters: in 133 trials, cutting it lowered systolic pressure by about 4 mm Hg. If you choose a low-sodium powder, check whether it adds potassium, and avoid added potassium if you have kidney disease or take a potassium-raising medicine.

Can I take electrolytes with lisinopril or spironolactone? Not without your prescriber's OK if the product contains potassium. ACE inhibitors such as lisinopril, ARBs, spironolactone and other potassium-sparing diuretics make the body hold on to potassium, and case reports describe dangerously high levels from supplements and salt substitutes.

Do electrolytes help POTS? Extra salt and fluids are a common first step on a clinician's plan, but not if you have high blood pressure, heart failure or kidney disease. In 14 young adults with POTS, 6 days of a high-salt diet cut the heart rate rise on standing compared with a very-low-salt diet (grade C). Follow your clinician's plan rather than dosing salt yourself.

Do salt tablets prevent low sodium in long races? In an observational study of desert ultramarathon runners, sodium pills were not linked to fewer cases of low blood sodium (grade C). Drinking to thirst, not beyond it, is the safer rule.

Related pages

• Our electrolytes, potassium and magnesium pages
• Conditions and protocols: orthostatic hypotension and its protocol, POTS and its protocol, autonomic dysfunction, dehydration, hypermobility
• Guides: supplements for blood pressure, supplements and your kidneys, supplements for leg cramps
• Check my stack and how we grade

Sources

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