Low blood pressure & headache after 1-2 hours of endurance exercise

[yodakramer]

@Dr_Alex_Harrison

These kinds of problems are often solvable by better salt and water strategy and implementation. I’m glad you asked, @itchyboii. I hope I can help. My wife and I have both experienced similar, from dramatically different mechanisms. (she’s crazy fit and has hypotensive genetic predisposition… and I’m the opposite of that, relatively speaking)

+1

That’s actually where I started. I worked with the crew at Hammer Nutrition to dial in my fueling/hydration and electrolyte consumption. Generally speaking, it’s a normal-sized sports bottle per hour (~750ml) with about 175kCal with 125mg sodium (single scoop of Endurolyte Extreme powder).

Post-workout, my recovery protocol included Hammer’s Recoverite in about 1L of water.

I also stepped on the scale before a ride and post to get a sense of water loss and paid attention to urine color as an indicator. But I was hovering around 84/50 after a 4-hour Zwift ride that would take a while to get close to 106/59 (talking like 5 hours).

All that data went to my doc before halving my dosage of doxazosin and eventually eliminating metoprolol (I think over a month or two, she had me step it down).

That was back in March. Dialing in hydration/salt/fuel took me about three months so it’s not like an overnight iterative process. I did end up with a nice spreadsheet though!

[Dr_Alex_Harrison]

@yodakramer

That’s actually where I started. I worked with the crew at Hammer Nutrition to dial in my fueling/hydration and electrolyte consumption. Generally speaking, it’s a normal-sized sports bottle per hour (~750ml) with about 175kCal with 125mg sodium (single scoop of Endurolyte Extreme powder).

I think they let you down a wee bit. Sellers of powders and physical products are often overly conservative in the amounts they recommend because the best way to avoid GI distress is to simply under-consume. And the fastest way to lose a customer and all their friends, is to give one of them gut distress during a long event.

I’d close to double what they recommended you for carbs, depending on duration and intensity of the ride, of course. And you could easily triple their recommendations for sodium and still end up a bit short of optimal.

I’m curious, did Hammer give any rationales for their relatively low fuel intake recommendations?

[itchyboii]

Answering all questions and summarizing…

CO2 decaf black tea is supposed to have 2mg of caffeine per cup (source Tea and Caffeine). I am aware that some coffee brands have more caffeine in their decaf than regular coffee.

What’s interesting is if I drink regular green tea it does nothing for my headaches (unless I dissolve more than 3 packets in a single cup), but if I drink even a single cup of decaf black tea (suppose it has 10mg of caffeine) then it helps with the headache. I am drinking very little tea by volume - just 250mL, so it’s not hydration.

Nootropics like piracetam also help reduce the headache - not sure how because they affect dopamine and increase blood flow to the brain.

For training, I consume (in the summer):

• base training: 30-45g of carbs / hour + 300mg sodium in 750mL
• full tilt: 60-80g of carbs / hour + 1080mg of sodium in 1L

In the winter I sweat very little, so carb intake is the same, but sodium is about 1/3 to 1/2 of that taken in the summer.

I use Gatorade Endurance mix and add Gatorlytes to it 300mg + 780mg = 1080mg total sodium per bottle. I was actually doing this to increase athletic performance and so far I have not noticed an effect on the headaches from doing this.

Post ride I mix Syntha-6 protein with 40g Waxy Maize (but not sodium). I will try adding sodium.

Salt tablets during the day make my stomach feel weird, but seem to help with BP. Once the headaches start, effect from salt tablets seems mild.

Given the above my headaches might either have a neurological root cause either triggered or aggravated by BP or maybe both a neurological and a BP component. I have definitely had it with caffeine for recovery and sleep, so I’ll apply all the sodium and hydration advice given here, will add decaf black tea 3 times per day with salt tablets and might go on low piracetam dosage. The stacking effect from these should provide a major relief.

Great responses guys, thank you so much! I’ll see how it goes, guess I’m stuck playing around and seeing what works and doesn’t.

[lildavo87]

This might sound a bit left field, but I struggled with persistent headaches everyday especially in the morning and I read on reddit some where about sleeping positions causing head aches…

I was a stomach/side sleeper and read that sleeping on your back can help. I started sleeping on my back and the headaches disappeared pretty much over night.

Might be worth a shot considering your workouts are often early morning.