1. Heat Exposure Stress and Electrolyte Replenishment with elete Electrolytes elete Electrolyte Add-In, a division of Mineral Resources International, Inc. 1990 West 3300 South Ogden, UT 84401 801.731.7040 801.731.7985 – fax www.eletewater.com

2. Overview  Heat Stress Defined  Symptoms of Heat Stress  The Causes of Heat Stress  Limitations of Sports Drinks  Preventing Heat-Related Health Disorders with elete Electrolyte Add-In Limitations of Sports Drinks Limitations of Sports Drinks Advantages of elete Electrolytes Advantages of elete Electrolytes Comparing elete with Other Electrolyte-Replacement Products Comparing elete with Other Electrolyte-Replacement Products  Further Risk-Reduction Strategies

3. What is Heat Stress?  The human body attempts to maintain an internal temperature of 37° Celsius  Hot weather, physical labor, other heat sources can raise the body’s temperature, which the body will attempt to reduce by pumping blood to the skin’s surface.  The body will also try to lower its temperature through sweat, i.e., water and minerals excreted through the skin, which are then evaporated to aid cooling.  The adverse effects of heat stress can range from mild to life- threatening.

4. Symptoms of Heat Stress  During physical labor, a body can lose 1-2 litres of water/hour.  After 2-3 hours of fluid loss, a person can experience the following adverse effects: Loss of energy/endurance Loss of energy/endurance Physical discomfort Physical discomfort Feeling hot Feeling hot Thirsty Thirsty  After 3 hours of exposure: Muscle cramps & fatigue Headaches Physical weakness Loss of dexterity Reduced alertness Nausea Seizures  After 3-6 hours, heat cramps, heat exhaustion sets in. Heat exhaustion leads to heat stroke (an internal body temperature of 40° Celsius or more), which is life-threatening and must be treated by trained medical professionals.

5. Symptoms of Heat Stress  Heat Rash Red, blister-like lesions Red, blister-like lesions Itching Itching  Heat Cramps Excruciating muscle cramps and spasms Excruciating muscle cramps and spasms  Heat Exhaustion Headaches,dizziness, weakness, nausea, vomiting, extreme sweating, dark-colored urine, pale, clammy skin  Heat Stroke Nausea and vomiting, hot, red skin (sunburn), irritability, confusion, seizures, collapse, unresponsive, high body temperature

6. Causes of Heat Stress  Environmental Factors (temperature, direct sun, heat humidity) The more direct sun, the greater the risk The more direct sun, the greater the risk Low or no wind Low or no wind Hot equipment & reflected heat Hot equipment & reflected heat  Workload How much effort is being exerted? How much effort is being exerted?  Clothing Heavy, multiple layers, non- “breatheable,” dark clothing k Heavy, multiple layers, non- “breatheable,” dark clothing k  Personal Risk Factors Drug and alcohol use Drug and alcohol use Existing medical conditions (hypertension, heart conditions, diabetes) Existing medical conditions (hypertension, heart conditions, diabetes) Medications (antihistamines, blood pressure, heart,laxatives, mental health, seizure, thyroid) Medications (antihistamines, blood pressure, heart,laxatives, mental health, seizure, thyroid)

7. The Electrolytes in Sweat  In a six-hour period (under desert conditions), sweat loss (and corresponding electrolyte losses) can measure: Sweat Loss: 3.5 litres Potassium Loss: 23-70mEq Na Loss: 72-244 mEq  During strenuous exertion, magnesium sweat losses can approximate between 10- 25% of the daily loss.

8. The Limitations of Sports Drinks  Sodium is not the only electrolyte lost in sweat. Makers of sports drinks assume sodium (Na) is the only or “main” electrolytes people lose Makers of sports drinks assume sodium (Na) is the only or “main” electrolytes people lose Na is the most consumed mineral in the diet. Therefore, it should come as no surprise it is excreted more than any other electrolyte Na is the most consumed mineral in the diet. Therefore, it should come as no surprise it is excreted more than any other electrolyte Na is typically cheap to add to beverages; while other electrolytes (magnesium and potassium) are more expensive Na is typically cheap to add to beverages; while other electrolytes (magnesium and potassium) are more expensive  Most electrolyte-replacement drinks omit magnesium (Mg), an essential mineral that plays a crucial role in the body 80% of cell ATP (adenosine triphosphate) is complexed with with Mg 80% of cell ATP (adenosine triphosphate) is complexed with with Mg Mg involved in ensuring adequate blood flow to muscle and organs, maintains acid-base balance, normalizes excitation and contraction in nerve and muscle—including cardiac tissue—involved in nerve conduction, muscle contraction, membrane transport, cell division, even the synthesis of DNA and RNA. Mg involved in ensuring adequate blood flow to muscle and organs, maintains acid-base balance, normalizes excitation and contraction in nerve and muscle—including cardiac tissue—involved in nerve conduction, muscle contraction, membrane transport, cell division, even the synthesis of DNA and RNA. Magnesium acts as a “team captain” of the electrolytes; it keeps sodium outside the cell and potassium inside the cell Magnesium acts as a “team captain” of the electrolytes; it keeps sodium outside the cell and potassium inside the cell Magnesium is to the muscle what calcium is to the bones Magnesium is to the muscle what calcium is to the bones Maintaining optimal magnesium balance is crucial. The body does not “acclimatize” to magnesium deficiency. Maintaining optimal magnesium balance is crucial. The body does not “acclimatize” to magnesium deficiency. Magnesium deficiency linked with heart disease, sudden cardiac death, insulin resistance Magnesium deficiency linked with heart disease, sudden cardiac death, insulin resistance Most people don’t consume adequate amounts of magnesium from foods (Green, leafy vegetables are the predominant Mg-rich food source) Most people don’t consume adequate amounts of magnesium from foods (Green, leafy vegetables are the predominant Mg-rich food source)  Most sports drinks are laden with sugar and artificial preservatives. Compared to sweat, they still contain dilute amounts of sodium and potassium. It’s a common misconception that sports drinks can prevent hyponatremia, diluted blood-sodium levels It’s a common misconception that sports drinks can prevent hyponatremia, diluted blood-sodium levels Consumers of sports drinks will consume significant amounts of sugar long before they receive adequate amounts of fluid and electrolytes Consumers of sports drinks will consume significant amounts of sugar long before they receive adequate amounts of fluid and electrolytes It’s not uncommon for people to complain of nausea, GI distress while using sports drinks It’s not uncommon for people to complain of nausea, GI distress while using sports drinks

9. Limitations of Sports Drinks  Many workers and athletes complain of gastrointestinal (GI) upset and nausea using sports drinks. Once this occurs, many will be reluctant to continue to drink a sports drinks in order to stay hydrated, prevent dehydration (vicious circle)  Nausea and GI distress result in decreased productivity  For workers (especially older) who might have specific health considerations (hypertension, diabetes, etc.), sports drinks high in sodium, sugar pose unique challenges to their health  Overconsumption of energy-dense sports drinks can lead to substantial weight gain in workers  In providing sports drinks to its workers, many workers have to be trained on how to overcome problems such as strong distaste of the drinks, mouthfeel (gagging), and GI distress assoc. with these products (e.g., temperature)  Sports drinks (powders) have to be dissolved and mixed according to manufacturer’s guidelines The problems of too dilute vs. too concentrated The problems of too dilute vs. too concentrated Messy Messy Clean up required Clean up required  Sports drinks are linked with accelerated enamel erosion, dental caries, etc.

10. Preventing Heat Stroke  Wear appropriate clothing  Take regular breaks  Recognize the signs of heat stress  Drink water frequently.  Add elete electrolytes to drinking, portable water to replace essential electrolytes that regulate fluid balance

11. Required fluid intake to maintain hydration during work TWL Level 1 (<140 W. m -2 ) sitting, standing, light hand/armwork Level 2 (140-180 W. m -2 ) sitting, standing, heavy armwork, walking with light armwork Level 3 (180-220 W. m -2 ) walking, moderate lifting or pushing Level 4 (>220 W. m -2 ) carrying, climbing, whole body work = 115 >1.2*>1.2*>1.2*>1.2* 116-1501.0-1.2>1.2*>1.2*>1.2* 140-1800.8-1.01.0-1.2>1.2*>1.2* 180-2200.5-0.80.8-1.21.2>1.2* >2200.3-0.50.5-0.80.8-1.01.2 Red indicates extreme thermal stress. Essential maintenance and rescue work only. Orange indicates workload exceeds TWL. Work-rest cycling must be applied Yellow indicates high thermal stress. No worker to work alone Green indicates moderate thermal stress. No accimatised worker to work alone. Blue indicates low thermal stress. Unrestricted self-paced work.

12. What is elete?  elete Electrolyte Add-In is a pure, liquid, electrolyte concentrate, which contains 4 essential electrolytes—magnesium, potassium, sodium, and chloride—to support fluid balance, muscle function, energy production, heat tolerance, nerve conduction, stamina, etc.  elete instantly infuses water with essential electrolytes and, when mixed as directed, adds minimal flavor. elete makes pure electrolyte water that tastes like water.  elete provides the same amount of potassium, an essential mineral, as Gatorade® and Powerade®, but also provides magnesium, which is not typically found in electrolyte- replenishment drinks (sports drinks).  elete is a “must” for individuals, work crews or anyone needed to maintain adequate hydration, energy, and proper muscle function under grueling conditions of heat stress, fluid loss, and exertion.

13. elete Electrolyte Add-In

14. Advantages of elete  Balanced electrolyte profile. Four vs. two  elete contains magnesium, the “team captain” of electrolytes, essential for energy production, muscle function, electrolyte control  When mixed as directed, elete adds minimal flavor to water  Very easy to mix and use.  Clean up is easy. elete will not stain, leave a residue, or contribute to the growth of mold in coolers, hydration packs, canteens, etc.  Very safe, Generally Recognize as Safe, a U.S. Food and Drug designation.  In a published, peer-reviewed clinical study, those who drank plain water, drank 74% more water to achieve the same level of hydration as those who drank water with elete.  Backed by numerous testimonials from athletes (professional and amateur), coaches, trainers, teams, workers  Certified free of all WADA (World Anti-Doping Agency)-banned substances  Manufactured at a GMP (Good Manufacturing Practices)-certified company. Certification provided by NSF International  Tested for potency and purity at in-house quality assurance laboratory and independent, third-party labs

15. Introducing new elete CitriLyte  elete CitriLyte Add-In™ is a liquid, pure electrolyte concentrate that contains four essential electrolytes—sodium, potassium, magnesium, and chloride—plus zinc and citric acid (citric acid participates in the Krebs energy cycle or the citric acid cycle for energy conversion)  CitriLyte is designed to be added to water to make functional electrolyte water for workers. When mixed, it has a slightly tart flavor almost as if you’d added lemon to the water. When more CitriLyte is added, the tart flavor increases to compensate for the stronger electrolytes.  Using elete CitriLyte to make electrolyte water will optimally hydrate workers by replacing fluids and electrolytes lost in sweat and during exertion. CitriLyte will help fight heat stress  CitriLyte is ideal for workers who may be sensitive to flavor or when you’re adding electrolytes to tap water that already has a noticeable taste.

16. elete CitriLyte Add-In  No sugars, calories, carbs, artificial colors, flavors, etc.  Add to water to keep workers optimally hydrated  Will not stain, leave a color or flavor residue in coolers or a sticky mess to clean up  Will not contribute to the growth of mold or bacteria in coolers or bottles  May be used for workers who cannot otherwise tolerate sports drinks (diabetics, those with high blood pressure)  Three year shelf life. Shelf-stable under the most vigorous temperature and environmental conditions  Will not attract pests  Better value compared to name-brand sports punch products  Available in a range of product sizes to suit small and large work teams

17. Advantages of elete for Industrial Applications  Natural, healthy hydration (no added sugar, no artificial ingredients)  Reduce number of heat stress incidents  Provides a better balance of electrolytes lost in sweat (replaces four— not two electrolytes)  The most cost effective solution available GUARANTEED  Flexible sizes from 24.6-ml to 1-gallon  Easy to mix and use  Because of its flexibility, workers can hydrate with water  Won’t cause GI distress  Used with great success by military personnel in medically treating severe cases of heat stress

18. Clinically Proven to Improve Hydration In a peer-reviewed published study (Wild & Env Med, 19, 172-180 (2008), people who drank water alone drank 74% more water than those who drank electrolyte water made with elete.In a peer-reviewed published study (Wild & Env Med, 19, 172-180 (2008), people who drank water alone drank 74% more water than those who drank electrolyte water made with elete. “In summary, the addition of an electrolyte mixture [elete] to plain water was associated with a decrease in overall fluid consumption of the water + electrolyte group by 220 mL  h -1 or 3.3 L  d -1. ” –John S. Cuddy, et al.“In summary, the addition of an electrolyte mixture [elete] to plain water was associated with a decrease in overall fluid consumption of the water + electrolyte group by 220 mL  h -1 or 3.3 L  d -1. ” –John S. Cuddy, et al. Commenting on the study, renowned emergency physician and founding member of the Wilderness Medical Society, Paul S. Auerbach said, “This [study] suggests that supplementing water with electrolytes might reduce the amount of fluid necessary to transport and consume during extended activity. This would minimize excessive weight, which in and of itself might contribute to a lessening of fatigue.”Commenting on the study, renowned emergency physician and founding member of the Wilderness Medical Society, Paul S. Auerbach said, “This [study] suggests that supplementing water with electrolytes might reduce the amount of fluid necessary to transport and consume during extended activity. This would minimize excessive weight, which in and of itself might contribute to a lessening of fatigue.” Auerbach listed elete among his “Top 4 Items of Medical Equipment,” “…I will never travel anywhere that I expect to need to stay hydrated without bringing along elete.”Auerbach listed elete among his “Top 4 Items of Medical Equipment,” “…I will never travel anywhere that I expect to need to stay hydrated without bringing along elete.”

19. Further Risk-Reduction Strategies (Our Recommendations)  Distribute pocket bottles of elete Electrolyte Add-In individually to workers to self-dose electrolytes through the work shift  Train workers on heat stress, heat stroke, and general hydration strategies (both for themselves and co-workers) including when and how much to drink and how they can use elete in their water or beverages, food, etc.  Use the larger, elete refill bottles to mix elete and make electrolyte water in all of the worker hydration stations, water coolers, hydration packs, canteens, etc. available on each job site and to each worker  Designate point personnel who can supply workers with electrolyte water and elete electrolytes at strategic times and locations to ensure workers are receiving enough water and electrolytes  Staff aid stations with water and elete. Encourage workers to lie down, rest, and drink water with elete.