Understanding Electrolytes: Supplements 101

Tina: Yes, we're on mostly Instagram and LinkedIn now. Some Facebook.

Oh, threads. Which I see Facebook threads and um, Instagram I feel are similar.

LEAH: Well, not everybody has all of them. Just because you have one doesn't mean you have them all.

Tina: I know I don't.

 I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

LEAH: and I'm Dr Leah Sherman and on the cancer inside

Tina: And we're two naturopathic doctors who practice integrative cancer care 

LEAH: But we're not your doctors

Tina: This is for education entertainment and informational purposes only

LEAH: do not apply any of this information without first speaking to your doctor

Tina: The views and opinions expressed on this podcast by the hosts and their guests are solely their own 

LEAH: Welcome to the cancer pod 

Hello, Tina.

Tina: Hi, Leah

LEAH: We're talking electrolytes today.

Tina: Yeah. And you know, it's one of those terms, I think people all say electrolytes. You need electrolytes. They're familiar with some huge brands of electrolytes out there on the shelves.

LEAH: popular. The, the electrolyte powders and whatnot that you add to your bottle of water. Very popular.

Tina: Yeah. And they're called electrolytes because they literally conduct electric current when they're dissolved in water.

LEAH: Well, that's a fun science experiment,

Tina: Yeah. You can make batteries from these things.

LEAH: and that's what they do in your body.

Tina: Exactly. So just to start this out on a woowoo note.

LEAH: Oh, we like the woowoo, ooh, moment of woo. It's a moment of woo.

Tina: We are electric beings, so right down to our electrolytes, without them, we cannot exist. There's just currents flowing all over us as we speak. It's the only way we can be speaking.

LEAH: It helps our cells to function like so. We have a heart rage and. Brain and nerve. I mean, they're very important

Tina: I would call it the currency. Of all cellular life.

LEAH: currency

Tina: Mm hmm. Get it? Electric current. It is though, and it's, it's, it's a great topic for us to talk about because within cancer care, it's important to quality of life during treatment. And I think there's a lot of confusion around it just in the grand scheme of health.

So we can maybe debunk some myths out there about what people need and.

LEAH: And what time in their treatment what they would need as well like what they need when?

Tina: And then we'll talk about some symptoms of deficiencies as well. So that's important to recognize and get on top of sooner than later.

LEAH: Yeah, so what exactly are they and it's kind of simple. They're minerals

Tina: Mm hmm. This is sodium, potassium, calcium, magnesium, and then we have a couple we don't talk about very much, but very important to the whole system, chloride and phosphate or phosphorus.

LEAH: right, 

Tina: and you'll hear us use the word balance over and over again because they all are interrelated and this all has to do with balancing electrolytes.

More is not better necessarily of any one of them or all of them. It's all about balancing them properly so that the ebb and flow of electrolytes in our heart, in our nerves, in our muscles, in every cell in the body, ebb and flow of potassium and sodium and calcium. Magnesium is essential to life, and it's essential to optimal health.

LEAH: In someone not going through cancer treatment you can Typically get all the electrolytes you need through your diet, unless you're taking certain medications. Cause there are medications that can cause the loss of those minerals, but in somebody not taking those types of medications, all of these are found in food.

Tina: Yeah, I think that's an important point. I don't think anyone needs to run out, buy electrolytes, concentrated liquids or powders, They are losing them or taking medication that warrants it, right? So you're peeing them out or you, um, for whatever reason are nauseous and you're vomiting yeah, you're losing them in a way that's not normal.

LEAH: Yeah. So those products like Gatorade or Powerade that are marketed as

 I'm not a fan. I'm not a fan of people drinking those just because, oh, well, I don't like the taste of water. So I'm going to drink a Gatorade to hydrate. Unless you're an athlete. I don't think those drinks are necessary.

Tina: Yeah. And if you're an athlete, there's better options. Because Gatorade is a lot of sugar, some coloring, and it's not a really a lot of electrolytes for replacement purposes. So, it's not my favorite to recommend to people anyways.

LEAH: And sometimes if people are like, well, I drink it because I don't like the taste of water. Then I tell them just to flavor their water with it.

Tina: Yeah, dilute it down. It's a pretty good shot of glucose, which is why if you do feel better when you drink a Gatorade, it's because You may have been low sugar at that moment. You may have had a low glucose and so you drink Gatorade. You're like, Oh, I feel, I feel the pick me up. Well, yeah, that's just the sugar boost really.

It's not an electrolyte boost necessarily. So I'm not a huge fan of them.

LEAH: And I had patients that would drink the Gatorade zero. So then you're not even getting the sugar.

Tina: Yeah. Let's talk about that. So here's my mystery question.

LEAH: Okay.

Tina: Sodium, which is. Our primary electrolyte, we need sodium, right? We need a good amount of sodium every day, upwards of, you know, two teaspoons. And the average American diet has a lot of sodium added in processed food. But if you don't eat processed food, you need to salt your food to get the sodium in.

That said, sodium is absorbed in the gut alongside glucose. Alongside sugar. So you need sugar to absorb the sodium, which is why you can't drink seawater, you would have diarrhea. 

So I've never understood The lack of sugar in electrolyte formulas, my understanding is you can use the amino acid glycine and that will help, the absorption in the small intestine, but not many formulas include glycine in them. So I'm, I'm baffled a little bit by Formulas that have sodium but lack any sugar at all.

LEAH: I talked to you about this offline. I would often recommend certain electrolyte formulas that had very low levels of electrolytes, patients to add to their water. there was one Ultima is one that we would recommend that was sweetened with stevia.

So it wasn't really as a replenishment

Tina: Mm hmm.

LEAH: of these minerals. It was more a way of getting someone to drink water, get a little bit extra, you know, minerals. I liked that formula because it did have magnesium in it. I kind of liked that as a way of kind of, you know, just getting people to drink more. But yeah, some of those formulas can have super high amounts of sodium. So they're not things you want to drink on a day to day basis.

Tina: Right. Right. Yeah, my thought is when you need electrolytes, you do them with intent and almost like a medicine, right? You get a real formula with enough sodium, potassium, calcium, magnesium, whatever you need. Most of them are high in sodium with good amount of potassium. But you do it because the labs indicate it.

You do it because your sodium or your potassium is low on your labs.

LEAH: The most common, electrolytes or minerals that you would see on labs would be sodium, magnesium, calcium, and potassium, which are found in very few over the counter electrolyte formulas, all four of those together.

 Typically, if someone is found in their labs to have a low level or a high level. Of any of these, um, if it's a high level, there are ways to manage that with medications or hydration.

If it is a low level, then sometimes they withhold fluids. And they replenish them through IVs and, you know, they have those sodium tablets. you know, there, there are different things that can be prescribed, in addition to adding things or taking them out of your diet.

Tina: I want to just clarify for the listener, we say mineral and electrolyte a little bit interchangeably because of the fact that these are all technically mineral. But we're talking about sodium and potassium, so maybe some people don't know that those are also minerals.

LEAH: Oh, that's true. I guess people think of like calcium, magnesium,

Tina: Yeah, I mean you think of iron, zinc, calcium, magnesium.

LEAH: But iron and zinc are not electrolyte.

Tina: No.

LEAH: So what do they do exactly? They help, like, as you mentioned, you know, they help to support every function in the body, supporting, heart rate, rhythm. Balancing bodily fluids, they help with bone health. I mean, if you have too much phosphorus, like when people drink a lot of certain types of soda, you can get elevated phosphorus levels and that can actually decrease the levels of calcium.

Tina: Yes, this is the classic, you know, removing calcium scales with Coca Cola thing.

LEAH: Well, there you go.

Tina: Yeah, you can take calcium scale off of your bathroom and you leave a sticky mess, but the mineral is gone.

LEAH: Yeah, so that can happen in your bones and your teeth as well. Yeah, it can leach the calcium out. It helps with nerve and muscle function, which, you know, you think of mostly, you know, magnesium is relaxing. If you have too high amounts of calcium, you can get, dysregulated heart rate as well as magnesium

Tina: Mm hmm.

LEAH: and potassium and sodium.

Everything affects the heart.

Tina: Symptoms of a low level. of sodium, or potassium, or calcium, or magnesium. They're remarkably similar.

LEAH: Yeah.

Tina: So, confusion, lethargy, muscle weakness, fatigue, irritability.

LEAH: Welcome to cancer treatment. Like that just happens anyway. It's so, it is hard to, um, to tell, uh, dysregulated blood pressure.

Tina: Yes. Yeah. Especially with magnesium and potassium when they are off. Or, even sodium. Yeah, if sodium is high in the bloodstream. You can have too much volume of blood and if it's low you can be dehydrated and literally have a lower blood volume which leads to a lower blood pressure. Yeah, so the the overlap is pretty notable so the best way to know your level is to get a blood lab done that has the numbers on it especially sodium and potassium which fluctuates so quickly.

And then they're on routine labs. Sodium and potassium.

LEAH: Right. So there are the different types of labs that your doctor can order. Um, there's the BMP, which is the basic metabolic panel. The comprehensive metabolic panel, and then there is a panel called the electrolyte panel. And so something like magnesium isn't routinely ordered. Unless someone is receiving a certain treatment where it's known that you can have low magnesium levels, it's probably not going to get checked.

Until you're symptomatic.

Tina: Yeah. And, you know, the other time that there might be a closer look at these electrolytes is if there is anything wrong with someone's kidneys. 

LEAH: I don't, yeah, I kept seeing that when I was doing the review and I was like, I'm not even getting into kidney, because that is so complicated when somebody has either an underlying kidney issue going into treatment, or the treatment itself affects the kidneys. It's just, that adds a whole new dimension.

Tina: Yeah. Yeah. Because the job of your kidneys. When you think about it, you know, there's only a couple exits out your body, big exits, you know, you're still in your urine, you have some sweat, you breathe off some things, but mostly these electrolytes are going to come off in the urine. And so when you have too much, the job of your kidneys is to sense the high level of fill in electrolyte, magnesium, potassium calcium, whatever, and let you pee it out.

And if you need it in your bloodstream, because you have lower levels, the job of the kidney is to restrain that excretion and to keep it in your circulation to get your levels up to normal. So any kidney dysfunction can lead to electrolyte imbalance, and that's a whole other ballgame.It's a whole other story because. We're talking a lot about deficiencies and not having enough, and sometimes kidney dysfunction leads to high levels of some of these, including magnesium or potassium. Um, so you do have to be cognizant of the fact that they can go in either direction, and if you're going to treat it, you need to see your blood levels so you know what you're doing and you're not causing any harm.

LEAH: Okay, let's, um. Let's get away from the kidney talk and when we come back, we're going to talk more about more specific things related to electrolyte repletion and treatment.

Tina: All right.

LEAH: So I guess the. Number one thing that I think of besides specific treatments that a patient is on would be loss of fluids during treatment.

So vomiting and diarrhea can easily create an imbalance of electrolytes, and that would be a good time for repletion.

Tina: Mm hmm. is a major cause, vomiting and diarrhea, especially if it's persistent for, uh, loss of these electrolytes. Mm hmm.

LEAH: And my recommendation, because it is readily available, is usually Pedialyte.

Tina: Mm

LEAH: Because it's a good balance of electrolytes, you can get an unflavored one, and you can also get those Pedialyte Popsicles, which are like Otter Pops, they're Brightly colored in those plastic wrappers and you stick them in your freezer and for patients other than those receiving Oxali platen where you shouldn't do cold things, you know that soon after treatment I think that those are great You can crush them up if you don't have any appetite because you're vomiting You can easily just kind of suck on those flavored electrolyte ice chips. That's my go to Because you can pick it up at your local drugstore That's a lot of people are familiar with it because they have kids and they've used it with their kids when they've had flus or you know viruses that cause them to vomit.

Tina: Yeah, and kind of the flip side of recommending electrolytes when it's serious. In my world, I have had people, when we know they're going to be doing something that's going to. need electrolytes. Like this is a treatment that we're expected to see low sodium or low potassium, that kind of thing. I will have them go maybe online and get some actual oral rehydration salts.

O. R. S. And, um, for quite some time, the only place I could find them was an emergency kits. You know, you have to go to an outdoor store or somewhere where people are hiking and they put these O. R. S. Salts in their E. R. Kits. And they were specifically, you know, if you got Montezuma's revenge and you need to replace electrolytes, they're made for that, actually.

You take the whole packet, you put it in a quart of water. You drink it over 24 hours or more quickly if you're in danger, you know, this is like serious infections though. like cholera. So anyways, those packets can be used in a lesser form. You can dilute it. So just use quarter of a packet in a quart of water and drink that over 24 hours.

The only reason I go to that is they formulated this in such a way that it is highly absorbable and it's exactly the right. Ratios of sodium, potassium and glucose. It's, made to be absorbed to rescue people really. Now you can find those online and on Amazon from a company called TriOral out of, I believe they're out of Florida,

LEAH: Yeah

Tina: but Tri Oral has them.

And it's a company I trust and I've, I buy them by larger boxes now and just. I can hand them out that way.

LEAH: Loss of appetite is another Factor that can play into people having electrolyte issues if people are on certain diets where they are avoiding Salt, or whatever it may be, you know, extreme diets, can contribute as well as malabsorption which can be related to surgery or other things. If people are taking, as I mentioned before, certain medications, diuretics for high blood pressure is one that we think of, corticosteroids. Can cause

Tina: Mm hmm.

LEAH: electrolyte, you know, slash mineral imbalances as well as laxatives because those are moving fluids through you

Tina: . Yeah. And, you know, the corticosteroids, whether it's prednisone or dexamethasone or, or lesser steroids, um, they can lead to some retention of sodium.

LEAH: as certain blood pressure medications can cause you to retain potassium.

Tina: Yeah. And so I feel like we've gone in some circles. And so we're as clear as mud in some ways to the person who's listening to this

LEAH: We're talking about balance.

Tina: balance. you have a handful of different electrolytes. All needing to be in balance with one another and ultimately blood tests are how you're going to diagnose an imbalance.

You're not going to go by symptoms. So what we don't do clinically, I don't have someone come in with fatigue, lack of appetite, maybe some muscle weakness and just assume their electrolytes are off. I would always test that. I would never give someone intentionally higher doses or Those O. R. S. The oral rehydration salt.

I would never prescribe that without knowing this person needs it because the symptoms of high and the symptoms of low, they overlap. they don't tell us enough definitively clinically. So as a listener, don't think that you can take a symptom ology chart and say, Oh, look at that. It looks like I have low sodium.

You need to do the lab work before you go repleting with any electrolyte. I think it's really an important take home message. Yeah. So I suppose the confusion might not be a bad thing cause we don't want to mislead you and make you think that it's so clear cut. You can go by symptoms and carry on.

Yes.

LEAH: Right. Um, you can go by knowing what treatment someone is getting and knowing that they are at an increased risk of having an electrolyte imbalance. so platinum agents, cisplatin, oxaliplatin, carboplatin, those I think of with decreasing electrolytes kind of across the board.

Tina: platinum itself pushes the magnesium, pushes the calcium, pushes them out so that you urinate out more of the electrolytes. So they. do lead to some deficiencies.

LEAH: So for somebody who is receiving a platinum. Um, I may suggest that they take in some sort of electrolyte formula, not like a super high dose one, but just making sure that they are seeing the dietician, eating foods that are mineral rich. And then I might suggest that they take in, you know, just an extra little sprinkle in their drink of something.

Tina: Yeah. And now these people, if they're getting treatment, they're also getting laboratory work

LEAH: Oh, absolutely.

Tina: are using that as part of your information.

LEAH: Yeah. So depending on where I practice, like in Arizona, the med onc would say, Oh, this patient is low on magnesium. Prescribe the magnesium or in Indiana, the MedOnc would just do their own thing. And so at that point it was just more supporting, making sure they were taking it and then kind of going from there.

Tina: Yeah. So for our average listener, who's not a practitioner, their take home point is to go ahead and get your labs and see where your electrolytes land. Are they inside the range? Are they outside the range? And then have that conversation with the doctor, with the nurse, with the nutritionist. If you have one in house at your hospital, but know that if you're fatigued or let's go through this quickly again.

Fatigue, muscle cramps, numbness or tingling, loss of appetite,

LEAH: Irregular heart rate.

Tina: irregular heart rate, nausea, vomiting. I mean, these are, you're right. These are part and parcel with a lot of treatments. Yes. And I think it's really important for Each patient to look at those labs, look at the electrolytes and determine whether they are outside the range, particularly if they're low, because you can with your diet, simple diet measures, you can increase sodium.

You can increase potassium. Um, and it's safe. It's dietary and not all in my experience. Most medical oncologists. Get so used to seeing the electrolytes outside the range. Don't even mention it to the patient. Nothing. Yeah, it should be between, you know, 135 and 145 for your sodium, but you're at 132 or you're at 130.

They don't say anything. It's when you or I look at it finally go, well that explains why you're so weak. You know, your sodium is low. And so, I think it's really important for people to self advocate and look at their own labs 

LEAH: If your MedOnc isn't taking action because of what your labs show, then I would say address it with food. Don't go out and buy a supplement and start taking that. 

Tina: Mm hmm.

LEAH: There are other treatments that can affect certain electrolytes, specifically the alkylating agents, like, um, cyclophosphamide, which is often given for breast cancer treatment, along with adriamycin, that can cause low sodium, can cause low potassium, and ifosfamide can cause low phosphate,

Tina: Mm hmm.

LEAH: And then you have the targeted therapies, the mabs and the nibs.

Tina: Mabs are, yeah, mabs and nibs.

LEAH: uh,

Tina: That means it ends in those three letters, each of those drugs. 

LEAH: so you can have, low sodium, potassium, and magnesium from, from those. I mean, just dysregulations. and then anti androgens. And so the treatments that patients with prostate cancer, receive that can cause low potassium. Some of them can cause low potassium, which I don't often think of. So, And that's on top of all the side effects and so the platinums cause a lot of vomiting and so that's adding to it, you know, yeah, so it's, it's kind of complicated,

Tina: Yeah. And I think, I think sodium is pretty easy for folks to take in. I mean, there's a lot of sodium in our foods. We can salt our foods very easily. I think potassium becomes a little more mysterious. Of course. We can all just go on Google and look at it, but let me just mention some easy ways of getting it, which is if you like it, coconut water is very high in potassium.

 gotta be a fan of coconut water or get a flavored one that you like, but, um,

LEAH: or mix it in a smoothie. It makes a great base for a smoothie. I cannot stand the taste of coconut water. And when I was in treatment, I would just have them do that as my base for the smoothie.

Tina: Okay, and you can hide it in there.

LEAH: Oh, absolutely.

Tina: Yeah, sweet potatoes. Avocado. So if you like avocados or guacamole, 

LEAH: Um, I think most people think bananas, but yeah, I, white potato,

Tina: White potato. Yes. Good old mashed potatoes.

LEAH: yum,

Tina: I know. Right. And you can put whatever else you want in there. It

LEAH: that's a universal favorite right there.

Tina: usually goes down pretty easy. Yeah. And, the nice thing about all these minerals, of course, this doesn't matter if your foods are hot or cold, 

they're not volatile, they don't go escaping in the air like maybe some vitamins might be able to do.

it can be in a soup and you'll still get all of the electrolytes or minerals. 

LEAH: well, let's go into sodium. So one of my favorite repletions for sodium is tomato juice,

Tina: Mm hmm.

LEAH: someone can tolerate it. And then pickles as well. Dill pickles. Mm. Mm. Yeah.

Tina: I always think of soups, too, because soups really inherently have, whether they're homemade or bought, doesn't matter, they inherently have to have a lot of sodium in them just to taste decent.

LEAH: magnesium. I think of, I think of nuts and seeds. Dark leafy greens, nuts and seeds though, 

Tina: Probably that, that, I lean towards that and then, nut butters. So if you're not into chewing them for whatever reason, you can do the nut butters. And that's all sorts of different nuts. It doesn't have to just be peanut butter. There's hazelnut butter, there's almond butter, there's

LEAH: yeah, almonds, super rich in magnesium in terms of like the nut world, pumpkin seeds. You can add those to, again, you can add those to smoothies if you just don't have an appetite, um, throw those in, blend them up, and then you don't have to worry about chewing them.

Tina: Yeah, and if you happen to live somewhere where there are some nuts that are growing in your area, whether it's pecans in the south, or walnuts in the north, you know, wherever you are, then them in season. We have hazelnuts here in Oregon.

The closer you are to the season, the more the beneficial oils will still be intact. So over time, the oils do degrade.

LEAH: Okay, let's talk about specific electrolyte imbalance concerns. More emergent type of situations that can happen as people go through cancer treatment. one that is most common that I think of is elevated levels of calcium.

Tina: Mm hmm. I would say that is always a concern and there are certain conditions where if there's anything that is degrading the bone metastatic disease that involves the bone, it could also be multiple myeloma, very common. Calcium can be actually high. You don't want to be taking in a calcium supplement, certainly.

And

LEAH: And you need to be careful about other supplements you take, like vitamin D. Some people, I, I'm sure you've had this as well, where a patient presents with high levels of calcium 

And when you talk to them, you find out they're taking some outrageous amount of vitamin D because someone told them that when you have cancer, you should take super, super high doses of vitamin D. And then you take that away and it improves.

Tina: I haven't had that happen very often though. I mean, in my world, but that's probably maybe it just a difference of, uh, of patient populations or something. I don't know.

LEAH: Yeah. I mean, it's been a while since I've seen that, but when I was working in Arizona, I definitely I saw that where they had a provider in a different state who told them to take these really high levels of D,

Tina: Mm hmm. And D as in dog. I'm just going to say for the listener, in case it doesn't, it's not clear.

I did have one patient have an astronomical amount of vitamin D. It was actually vitamin D toxicity. It was very serious. Ended up hospitalized. It was because that person bought some remedy, some cancer cure. Um, from South America and apparently in that container of pills was supposed to cure their cancer among the many things they were taking was a mega dose of vitamin D unbeknownst to them.

They didn't know. Um, but their level, instead of being, you know, upper end is depending where you live, upper end might be 60, 80, maybe even a hundred, um, the lab, they had over 800.

LEAH: Oh my God.

Tina: Yeah, it was, it was big. So what happens with that and the true toxicity of that kind of overdose of vitamin D is the calcium imbalance, which can affect heart rhythms and to the point where it can be fatal.

So, yeah, this is the reason we are so cautious is because, you know, there's a few cases out there you're like, Ooh, yeah, that could have ended badly. They did, you know, they hydrated them and stopped the vitamin D and They probably give him magnesium because of all the calcium, but vitamin D's job is to stop you from peeing out the calcium, among other things, you know, absorbing it, yes, but also prevents some of its excretion, which again, you know, these electrolytes are in a fine tuned balance and your kidneys are integral to that balance.

So, be careful of vitamin D if you have conditions that affect the bone, no matter what the, the cancer type is. If it involves the bone, then watch calcium and vitamin D levels.

LEAH: And I would say that with patients that I've worked with who have multiple myeloma, like that's all tightly managed I remember really working with one patient in particular, trying to increase her calcium levels, because you need to have a certain calcium level to even receive certain medications and, you know, certain treatments, I should say, and it was just really hard, um, trying different forms of calcium, trying different dosages of calcium because it is, it's a dance, it's a very, Precarious dance of trying to make sure that in somebody with myeloma that they have the right level of calcium that it's not too high and not too low because if it's too low, then you can't get certain treatment.

Tina: Yeah, yeah, and alongside some of the drugs like the bisphosphonates, calcium is indicated as a supplement, so they give calcium alongside for people with some metastatic, cancers that go to the bone, if they're receiving some of these drugs that build bone, or Maintain bone. Um, yeah, they'll give calcium in those scenarios.

So again, there's no real simple answer to this, except to pay close attention. And I always encourage people to pay close attention to their own stuff because in my world, I have seen more laissez faire medical oncology than I would like to see. You know, the medical oncologist just abnormals, let alone address it.

Yeah. I would say that's eight out of 10 in my experience.

LEAH: Yeah. See, that's and that's not, that's not my world. Um, that's not my experience. I do want to say that people receiving bisphosphonates for osteoporosis, you also need to supplement with calcium, but we did a whole program episode on calcium. And so that's always worth a lesson. We can put a link in our show notes for folks if they have not yet listened to that episode.

Okay. So continuing with, um, electrolyte imbalance concerns, um, I would say tumor lysis syndrome is something that I have not seen. I think it's because patients are given a medication. Allopurinol, preventively. So there's something that when a patient with typically a blood cancer,

Tina: Mm hmm.

LEAH: when they start treatment, they are given allopurinol, which is something that is common outside of the cancer world for gout.

And that is to reduce the risk of this tumor lysis syndrome, which is when the tumor starts to break down

Tina: Yeah. So tumor lysis is exactly what it sounds like. The actual cancer cells break open and the way that our electrolytes are balanced has to do with a certain amount of potassium inside the cell that then gets released and you can have a massive release of the contents are inside the cancer cells all at once.

So tumor lysis syndrome usually is a concern when there is more tumor burden. and this is usually blood dyscrasia. So we're talking leukemias, lymphomas. 

I also think when it's a very high risk, I believe that not only are they closely watched as a patient getting a treatment where tumor lysis syndrome is likely to happen, sometimes it's even inpatient. So they'll get the chemotherapy inpatient. So they can watch them that closely because it's a, it's a severe reaction that if not caught can be

LEAH: So the third kind of emergent electrolyte imbalance, I guess is what we're calling them, um, is S I A D H, which is syndrome of inappropriate antidiuretic hormone. And I've seen that in patients who have lung cancer and it can happen with other cancers too, but lung is the one that it's most common.

Tina: Yeah. And it's, it is basically a hormone being made by the cancer itself. And that hormone goes and informs the kidneys. And that is where the, the issue is you're, you're having them. a release of a hormone that shouldn't be in high levels. So syndrome, inappropriate anti diuretic hormone release.

LEAH: And that causes low sodium levels.

Tina: Right.

LEAH: And these are, I mean, that's typically caught by a medonk as well. I mean, it's, and what's interesting with that is that it's not always symptomatic. So sometimes it's only found on labs, 

Tina: Yeah. And you know, I would say S I A D H is sometimes the presentation for some cancers, meaning people, that's what they notice. They're like, they're weak. They don't feel great. can be a slow onset and you just kind of get used to it. And then there's swelling. And when you notice swelling in your ankles or any gravity dependent area, you know, it would be your backside if you were laying down and.

That swelling doesn't go away. You can end up finding out that your sodium was low

and then they go Why is the sodium so low and then you keep going upstream trying to find the cause of that and you end Up with SIADH as part of the diagnosis, SIADH can happen without cancer But if that is the cause then you then look for cancer and they would do a chest x ray right away because that's the most common Type of cancer that presents with SIADh.

D. H. 

LEAH: Right. Cause it can also happen with different medications and other conditions. So, yeah. So it's not necessarily a cancer, Diagnosis. All right. So let's take another break and we'll come back and we'll kind of offer some tips and tricks and wrap things up.

 All right, Tina, do you have any sort of tips and tricks that you like to offer patients about different mineral supplementation or, um, electrolyte formulas, anything like that?

I know you talked about the ORS tablets.

Tina: Yeah, it usually comes in a powder.

LEAH: Oh, powder.

Tina: Yeah, it comes in a little sachet

LEAH: O R S sachet.

Tina: Um, the only thing I want to stress to people is that Slow and steady wins. So small amounts doesn't matter which one or Several of these however, you're gonna replete electrolytes when you're low slow and steady wins You absorb them better and without as much GI side effects If you take small amounts all day long, rather than taking a big dose all at once.

LEAH: That's why I like to have them add something to their water, sip it. It's often because somebody doesn't like to drink water in the first place. And so flavor it, um, as well as give a little bit of that, mineral repletion. I will caution that there are some trendy formulas out there for electrolytes that have high doses of sodium that may not be for every day.

Consumption. Um, I think they kind of target them to make them kind of trendy and sexy, probably better for people who are doing serious workouts, CrossFit or whatever it is, Peloton, I don't know, whatever people are doing these days, where you're doing a lot of sweating. But if it's a day to day thing, you might not need those higher levels of sodium.

Tina: Yes. And, and what you're talking about is some of these formulas that have like 500 milligrams in one serving.

LEAH: thousand milligrams. Yeah, there's, there's one that is really super popular. different influencers talk about it and it has a thousand milligrams of sodium. That's not really for daily consumption if you're not

losing a lot of fluids through sweat or vomiting or I, yeah, that's not something that I would recommend.

Tina: Well, you know, that brings up a good point. The daily recommendation, the top end of that is 2, 300 milligrams of sodium. And the top end of the potassium is 3, 000 milligrams, and this is adults, I'm just talking about adults here. Um, I would say the average American, and I know this is true, gets more sodium than potassium, but it's actually, for our health, supposed to be flipped.

We're supposed to at least get equal amounts, if anything, slightly more potassium than sodium. Which is kind of mind blowing, because we pay so much attention to sodium in nutrition circles. We drip saline into people, right? Saline is sodium. And potassium is actually one of those things that people just don't get enough of.

And nutrition is one of those things that I just want to become intuitive and like a language for people. Like, I always think of conceptually. I don't like lists. I don't like rote memorization. Sure, we can remember avocados and white potatoes because we already said that. But if you want potassium, look at fruits that grow in tropical regions and on islands.

All of them are high in potassium. So it doesn't matter if it's banana, or it's pineapple, or it's mango, or Wherever you go. And I, I'm kind of fascinated by that because they're surrounded by salt water. So what grows there is to counter the sodium or to balance the sodium is a lot of potassium rich food.

So think tropical fruits and you probably can't go wrong. And then I think of legumes. And then, of course, the potatoes and the avocado I tack on there just because they're so high. And you can eat just a small amount like a. Quarter of an avocado is 300 milligrams.

LEAH: Yeah, I don't recommend that people take potassium supplements. You can buy over the counter potassium supplements unless your doctor tells you to take potassium. I don't recommend it, but definitely those foods, have we talked about avocado where a serving of an avocado is like a quarter or a fifth of an actual avocado fruit?

Which is weird to me because if you're going to eat an avocado, I think of people just like, okay, I think of myself as eating an entire avocado, maybe splitting it. Maybe I'll just cut it down the middle and split it with someone. But yeah, eating one fifth of an avocado is a serving. That is just so weird to me.

Tina: A medium banana has about 300 too. So a quarter of a medium avocado equals one banana. So, I mean, volume wise, you get, you get more punch from the avocado.

LEAH: You can eat a medium banana and add some nut butter.

Tina: Mm hmm.

LEAH: And get a little more. So there are, there are fun ways of, of increasing, mineral rich foods in your diet. One thing that I learned If someone has low vitamin B6 levels, they may have a hard time with absorbing magnesium.

 And so we would recommend that they take a supplement that had vitamin B6. Um, it's not something I would say do the board. But it might be something that, I mean, you can always check with your doctor and see if you're having a hard time maintaining those magnesium levels, um, depending on your, on your treatment.

And it wouldn't be super high doses, but that was just something that I noticed. Could sometimes help. Yeah, so vitamin B6 can be found in some animal products like, um, poultry, some fish, beef liver, fortified foods. 

Tina: it's also in nuts.

LEAH: Yeah, And, legumes like chickpeas.

So if you are experiencing issues with, like I said, if you're experiencing issues with maintaining that magnesium level, um, you can also have what looks like an iron deficiency and it could be on the labs and it could be a B6 deficiency. So that also can warrant a workup for that.

Tina: I guess the only last minute, late breaking item on my mind calcium on labs can be misleading because calcium on your lab will look low if your albumin is low, but may not truly be low. So, there is something called a calcium correction Um, that you can use a little math or you can also order ionic calcium.

 and the reason for this is albumin is the major protein in the bloodstream and calcium binds to it. So when they're measuring your calcium level, if your albumin is low, your calcium will appear low, but the usable calcium in your bloodstream is ionic calcium. It's free. It's not bound to the protein.

So if you order ionic calcium or request ionic calcium, be done. Then you'll get a truer reading of what your calcium level is.

LEAH: I think the kind of take home message from that with regards to labs is just looking at. One level for certain of these electrolytes isn't going to necessarily tell the whole story because somebody can be slightly dehydrated and so it make their calcium level look higher, but it may not actually be a concern.

Um, maybe you just didn't drink a lot of water or you were vomiting or had diarrhea. And so the calcium level will go up. Not astronomically, but it might just be on the higher end of normal and that could look concerning to a person So sometimes it's not just looking at one specific mineral sometimes it's it's a it's a balance because I have had patients ask me well, how come this is Abnormal and they didn't do anything about it.

And you have to kind of explain that it's not necessarily That clear cut. I mean something like magnesium. Yeah, your magnesium is low your magnesium is low

Tina: Yes. And for magnesium to show low on a lab, it has to be pretty darn low.

LEAH: So that's, that's it. That's our, that's our electrolyte talk.

Tina: Yeah. And you know, I feel like we did what the electrolytes do themselves, which is we went back and forth and around and around and we,

LEAH: Well, maybe we could edit it and make it a little clearer. I don't know. Does it seem that disjointed? Sorry if I seem distracted, but I was having corgi issues on my end, which hopefully we, we edited out most of that. But yeah,

Tina: no, I, I'm not, I am not pointing the finger. I think it's an inherently a, a topic that doesn't lend itself to being so clean cut that. Um, it's clear our, our take home message is basically if you have symptoms of electrolyte imbalance, get some labs done. I think that's our take home message.

LEAH: right. I mean treatment itself can cause A lot of those symptoms. And so if you haven't had labs done in a while, yeah, get your labs run, but you typically are run with, you know, at least with, with chemos and immunotherapy and whatnot. I mean, anything that's infused, you're typically getting some labs done just to make sure that you are in balance enough to even receive treatment.

Tina: Absolutely. And my advice is don't trust someone else to give you your interpretation. Look at the numbers yourself. Because In my experience, more often than not, no one is going to bring your attention to it. And maybe it isn't a big deal, but at least you should know and talk to your doctor about it.

Bring it up. Point it out.

LEAH: Ask questions. I think that's the point is ask questions. So I see that the sodium is low. What does this mean?

Tina: Could that have something to do with the fact that I'm sleeping all day?

LEAH: That could also be because cancer treatment, 

Tina: Right.

LEAH: remember to subscribe, follow wherever it is that you are listening to podcasts and share this episode with somebody. That you like, who might be taking some trendy influencer push electrolyte formula. Maybe they don't need it.

Tina: Yeah. And if you can leave us a rating, that would be great. It always helps us out. It helps other people see our value. And yeah, even if it's just clicking the five stars, you don't have to say much.

LEAH: If you want more to say, you can go to our website and on the right side, there is a little tab with a microphone and leave us a message. You can send us an email at thecancerpod at gmail. com. If you have any questions or comments and you can always follow us on social media

Tina: Yes, we're on mostly Instagram and LinkedIn now. Some Facebook.

Oh, threads. Which I see Facebook threads and um, Instagram I feel are similar.

LEAH: Well, not everybody has all of them. Just because you have one doesn't mean you have them all.

Tina: I know I don't.

LEAH: On that note, I'm Dr. Leah Sherman,

Tina: And I'm Dr. Tina Kazer.

LEAH: and this is the Cancer Pod.

Tina: Until next time.

Thanks for listening to the cancer pod. Remember to subscribe, review and rate us wherever you get your podcasts. Follow us on social media for updates, and as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The cancer pod is hosted by me, Dr.

Leah Sherman. And by Dr. Tina Kaczor, music is by Kevin McLeod. See you next time.