Huberman Lab - Using Salt to Optimize Mental & Physical Performance

Episode Date: March 14, 2022

I discuss the role of salt (sodium) in the nervous system and the key role that it plays in mental performance, physical performance and health. I explain how the brain senses salt levels in our body ...and how that relates to our feelings of thirst. I cover the physiology of the renal system and the hormones that control sodium and water balance in our body. I also explore how salt interacts with stress and our immune systems and its crucial role in neuron function. Additionally, I examine research findings suggesting that some individuals might benefit from increased intake of sodium and other electrolytes (magnesium and potassium) to enhance mental performance, lessen anxiety, and offset dizziness. Yet, other people may need less sodium. I discuss how you can determine your optimal sodium intake and why sodium intake levels need to be uniquely tailored to an individual’s lifestyle. Finally, I explain how salt creates ‘hidden’ sugars in many processed foods and the problems that can create. Throughout the episode, I explain peer-reviewed findings outlining salt’s essential role in overall health and describe general recommendations and tools anyone can use to find their optimal salt balance and thereby enhance their brain and body’s performance. For the full show notes, visit hubermanlab.com. Thank you to our sponsors AG1 (Athletic Greens): https://athleticgreens.com/huberman LMNT: https://drinklmnt.com/huberman Supplements from Momentous https://www.livemomentous.com/huberman Timestamps (00:00:00) Role of Salt  (00:02:57) Neuropod Cells, Artificial Sweeteners & ‘Hidden’ Cravings  (00:10:36) Sponsors: AG1, Thesis (00:15:06) Salt Regulation  (00:17:13) How the Brain Senses Salt (00:24:15) Salt & Thirst  (00:29:27) Blood Pressure & Thirst  (00:33:47) Kidneys & Urine Regulation (00:39:08) Vasopressin: Roles in Libido & Urination  (00:45:46) How Much Salt Do You Need?  (00:56:45) Should You Increase Your Salt Intake?  (01:02:19) Tools: Determining Your Individual Salt Intake (01:14:02) Iodine, Sea Salt  (01:17:13) Salt: Roles in Stress & Anxiety  (01:24:20) Other Electrolytes: Magnesium & Potassium  (01:27:57) Tools: Effects of Low-carbohydrate Diets & Caffeine  (01:32:28) General Recommendations for Salt Intake  (01:36:34) Perception of Salt & Sugar Taste, Processed Foods  (01:47:13) Role of Sodium in Neuronal Function, Action Potentials  (01:53:13) Dehydration  (01:55:36) What Salt Intake is Best for You?  (02:00:58) Zero-Cost Support, YouTube Feedback, Spotify, Apple Reviews, Sponsors, Supplements, Instagram, Twitter, Neural Network Newsletter  Title Card Photo Credit: Mike Blabac Disclaimer

Transcript
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Starting point is 00:00:00 Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and Ophthalmology at Stanford School of Medicine. Today, we are going to discuss salt also referred to as sodium. Most of us think of salt as something that we put on and in our food. Maybe something to avoid, maybe some of you are actually trying to get more salt, some of you are trying to get less salt. We all seem to associate salt with things like blood pressure, etc. Today we are going to go down a different set of avenues related to salt. We will certainly cover how salt regulates blood pressure.
Starting point is 00:00:40 We are also going to talk about how the brain regulates our appetite for salt or our aversion for salt. We are also going to talk about how our sensing of salty taste actually mediates how much sugar we crave and whether or not we ingest more or less sugar than we actually need. What you're going to learn today is that the so-called salt system, meaning the cells and connections in our brain and body that mediiate salt craving and avoidance, are regulating many, many aspects of our health and our ability to perform in various contexts, things like athletic performance, things like cognitive performance.
Starting point is 00:01:17 We're also going to talk about aging in dementia and avoiding aging in dementia and what role salt and salt avoidance might play in that. We're going to touch on some themes that for some of you might seem controversial. And indeed, if they are controversial, I'll be sure to highlight them as such. I'm going to cover a lot of new data that point to the possibility. I want to emphasize the possibility that for some people, more salt might help them in terms of health, cognitive, and bodily functioning. And for other people, less salt is going to be better.
Starting point is 00:01:47 I'm going to talk about what the various parameters are. I'm going to give you some guidelines that in concert with your physician who you should absolutely talk to before adding or changing anything to your diet or supplementation regime, can help you arrive at a salt intake that's going to optimize your mental, physical health, and performance. So we're going to cover neurobiology. We're going to cover hormone biology. We're going to optimize your mental, physical health, and performance. So we're going to cover neurobiology. We're going to cover hormone biology. We're going to talk about liver function.
Starting point is 00:02:07 We're going to talk about kidney function, and of course, brain function. I'm excited to share this information with you today. I'm certain you're going to come away with a lot of information and actionable items. Before we dive into the topic of today's episode, I want to highlight a really exciting new study. This is a study from Diego Bajor
Starting point is 00:02:25 His lab at Duke University. The Bajor's lab studies interactions between the gut and the brain and has made some incredible discoveries of the so-called neuropod cells. Neuropod cells are neurons, nerve cells that reside in our gut and that detect things like fatty acids, amino acids, and some neuropod cells sense sugar. Previous work from this laboratory has shown that when we ingest sugar, these neuropod cells respond to that sugar and send electrical signals up a little wire that we call an axon through the vagus nerve for those of you that want to know and into the brain and Through subsequent stations of neural processing if vogue the release of dopamine dopamine is a molecule known to promote craving and
Starting point is 00:03:14 Motivation and indeed action and What these neural pod cells that sent sugar are thought to do is to promote seeking and consumption eating of more sugary foods seeking and consumption, eating of more sugary foods. Now, the incredible thing is that it's all subconscious. This is a taste system in the gut that is not available to your conscious awareness. Now, of course, when you ingest sweet foods, you taste them on your mouth too. And so, part of the reason that you crave sweet foods, perhaps, is because they taste good to you. And the other reason is that these neuropod cells are driving a chemical craving below your conscious detection. So there are really two systems.
Starting point is 00:03:50 Your gut is sensing at a subconscious level, what's in it, and sending signals to your brain that work in concert, in parallel with the signals coming from your mouth and your experience of the taste of the food. Now, that alone is incredible, and it's been the subject of many important landmark papers over the last decade or so. You can imagine how the system would be very important
Starting point is 00:04:11 for things like hidden sugars. When nowadays in a lot of processed foods, they're putting hidden sugars. They're putting a lot of things that cause your gut to send signals to your brain that make you crave more of those foods. So for those of you that really love sugar, just understand it's not just about how that sugar tastes. The new study from the Borges lab deserves attention, I believe.
Starting point is 00:04:33 This is a paper published just recently, February 25th this year, 2022, in Nature Neuroscience and Excellent Journal. And the title of the paper is The Preference for sugar over sweetener depends on a gut sensor cell. The borers lab has now discovered a neuro pod cell, meaning a category of neurons, that can distinguish between sweet things in the gut that contain calories, for instance, sugar, and things in the gut that are sweet, but do not contain calories, artificial sweeteners, like aspartame, sucralose, and so forth. There are also, of course, non-artificial non-chaloric sweeteners, like stevia, monk fruit, etc. They did not explore the full gallery of artificial sweeteners. What they did find, however, ought to pertain to all forms of sweet non-chaloric substances.
Starting point is 00:05:25 What they discovered was that there is a signature pattern of signals sent from the gut to the brain when we ingest artificial or non-chaloric sweeteners. This is important because what it says is that at a subconscious level, the gut can distinguish between sweet things that contain calories and sweet things that do not. Now, what the downstream consequences of this sensing is or what they are isn't yet clear. Now I believe everyone should be aware of these kinds of studies for a couple of reasons. First of all, it's important to understand that what you crave, meaning the foods you crave and the drinks you crave, is in part due to your conscious experience of the taste of those things, but also due to biochemical and neural events that start in the body and impinge on your brain and
Starting point is 00:06:11 cause you to seek out certain things even though you might not know why you're seeking out more sugar. You find that you're craving a lot of sugar or you're craving a lot of foods with artificial sweeteners and you don't necessarily know why. Now artificial sweeteners themselves are a somewhat necessarily know why. Now, artificial sweeteners themselves are a somewhat controversial topic. I want to highlight that. Someone's back, I described a study from Yale University
Starting point is 00:06:32 about how one can condition the insulin system. Insulin is involved in mobilizing a blood sugar and so forth in the body, as many of you know. And I described some studies that were done from Yale University School of Medicine, looking at how artificial sweeteners can actually evoke an insulin response under certain conditions.
Starting point is 00:06:52 Now, a couple of key things. I got a little bit of pushback after covering those studies. And I encourage pushback all the time. It's, you know, pushback is one of those things that forces all of us to drill deeper into a topic. I want to be clear. First of all, I am not one to demonize artificial sweeteners. There is evidence in animal models, in animal models, that artificial sweeteners can disrupt the gut microbiome, but those were fairly high doses of artificial sweeteners
Starting point is 00:07:19 and it's unclear if the same thing pertains to humans. Still unclear, I should say, has not been investigated thoroughly. Some people don't like the taste of artificial sweeteners. Some people do. Some people find that they really help them avoid excessive chloric intake. Some people believe, and yet I should emphasize there still isn't evidence that they can adjust the insulin response in all people. I just want to repeat that three times so that people are clear on that fact. What these new data emphasize, however, is that we need to understand how artificial sweeteners are consumed at the level of the gut, or I should say registered at the level of the gut, and how that changes brain function. Because one thing that I'm familiar with and that many people report is that when they
Starting point is 00:07:59 first taste artificial sweeteners, they taste sort of not right to them. They don't like the taste, but over time, they actually start to crave that taste. I've experienced this. I used to drink a lot of diet sodas when I was in graduate school, so it should be aspartame. And I found that I would, I actually needed them. Now maybe it was the caffeine, maybe I just like the sweet taste of the carbonation. We actually have a drive for carbonation, which is a topic of a future episode.
Starting point is 00:08:22 But when I finally quit them for reasons that were independent of any fear of artificial sweeteners, I found that I didn't like the taste. Nowadays, I only occasionally drink a diet soda. I usually do that form on a plane and there's nothing else available to me. So I don't demonize them. I might drink one every once in a while, no big deal.
Starting point is 00:08:41 I also wanna be clear, I consume stevia on a number of different supplements and foods that I consume. Stevia, stevia of course is a plant-based non-chloric sweetener So I myself consume artificial sweeteners many people hate them many people like them and find them useful for their nutrition And in fact to keep their caloric intake in a range that's right for them and many people like myself are curious about them and And many people, like myself, are curious about them and somewhat wary of them and yet continue to consume them in small amounts. I think most people probably fall into that category. I should also mention that many food manufacturers put artificial sweeteners, such as sucralose,
Starting point is 00:09:16 etc., into foods. And it's always been unclear as to why they might want to do that. And yet we know that the sweet taste consumption, even if it doesn't contain calories, can drive more craving of sweet food. So there may be a logic or a strategy to why they do that. Again, a topic for exploration on today's podcast and in future podcasts because where we're headed today is a discussion about how salt and salt sensing, both consciously and unconsciously, can adjust our craving for
Starting point is 00:09:46 other things like sugar and water and so on. So I want to highlight this beautiful work from the Bohres lab. We'll put a link to the study. I want to open this as a chapter for further exploration. I like to think that the listeners of this podcast are looking for answers where we have answers, but are also, I would hope, excited about some of the new and emerging themes in what we call nutritional neurobiology. And indeed, the Bohors lab really stands as one of the premier laboratories out there that's looking at how foods, as consumed in the gut, are modifying our nervous system,
Starting point is 00:10:17 the foods we crave and how we utilize those foods. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Athletic Greens. Athletic Greens is an all-in-one vitamin mineral probiotic drink.
Starting point is 00:10:42 I've been taking Athletic Greens since 2012, so I'm delighted that they're sponsoring the podcast. The reason I started taking athletic greens and the reason I still take athletic greens once or twice a day is that it helps me cover all of my basic nutritional needs. It makes up for any deficiencies that I might have. In addition, it has probiotics, which are vital for microbiome health. I've done a couple of episodes now on the so-called gut microbiome and the ways in which the microbiome interacts with your immune system,
Starting point is 00:11:10 with your brain to regulate mood, and essentially with every biological system relevant to health throughout your brain and body. With athletic greens, I get the vitamins I need, the minerals I need, and the probiotics to support my microbiome. If you'd like to try athletic greens, you can go to atlettagreens.com slash Huberman and claim a special offer.
Starting point is 00:11:28 They'll give you five free travel packs, plus a year supply of vitamin D3K2. There are a ton of data now showing that vitamin D3 is essential for various aspects of our brain and body health, even if we're getting a lot of sunshine. Many of us are still deficient in vitamin D3. And K2 is also important because it regulates things like cardiovascular function, calcium in the body, and so on.
Starting point is 00:11:49 Again, go to athleticgreens.com slash uberman to claim the special offer of the 5 free travel packs and the year supply of vitamin D3 K2. Today's episode is also brought to us by Element. Element is an electrolyte drink that has everything you need and none of the things you don't. That means it has salt, magnesium, and potassium, so-called electrolytes, which are critical for neuronal function, and a lot of other biological functions. As I mentioned on the podcast before, I'm a fan of salt. I believe in ingesting appropriate amounts of salt.
Starting point is 00:12:20 And by appropriate, I mean, depending on what your background blood pressure happens to be, what your activity levels are, how much you sweat, what your cognitive and physical demands are. Today, we're going to talk about how to determine what those needs are. I'm always trying to stay on top of my hydration, and as you'll also learn about today, salt and water intake and hydration are intimately related. With element, I'm sure to get the potassium, the sodium, and the magnesium that I need, and I do that in a great tasting drink.
Starting point is 00:12:49 And as I mentioned before, it has no sugar. If you'd like to try element, you can go to drinkelement.com. That's drinklmnt.com slash huberman to claim a free element sample pack. You only cover the cost of shipping, otherwise it's completely free. Again, that's drink element lmnt.com slash Hubertman, to claim a free sample pack of element. Okay, let's talk about salt. Salt has many, many important functions in the brain and body. For instance, it regulates fluid balance. How much fluid you desire and how much fluid you excrete. It also regulates your desire for salt itself,
Starting point is 00:13:23 meaning your salt appetite. You have a homeostatically driven salt appetite. I'll talk about the mechanisms today and make them all very clear. What that means is that you crave salty things, beverages and foods, when your salt stores are low, and you tend to avoid salty beverages and foods when your salt stores are high. Although that's not always the case. There are circumstances where you will continue to crave salt even though you don't need salt or, indeed, even if you need to eliminate salt from your system.
Starting point is 00:13:56 Salt also regulates your appetite for other nutrients, things like sugar, things like carbohydrates, and today we'll explore all of that. Technically salt is a mineral, and I should mention that when I say salt, I am indeed referring to sodium in most cases, although I will be clear to distinguish salt from sodium, meaning for table salt from sodium. Most people don't realize this, but one gram of table salt contains about 388 milligrams of sodium. So technically, we should be talking about sodium8 milligrams of sodium. So technically, we should be talking about sodium today and not salt.
Starting point is 00:14:28 I will use them interchangeably unless I'm referring to some specific recommendations or ideas about trying to define your ideal salt, aka sodium intake. Okay, so this is important. I think right off the bat, a lot of people get themselves into a place of confusion and potentially even to a place of trouble by thinking that table salt in grams always equates to sodium in grams. And that's simply not the case. Today, we're going to explore the neural mechanisms by which we regulate our salt appetite
Starting point is 00:15:02 and the way that the brain and body interact in the context of salt seeking, salt avoidance, how to determine when we need more salt, when we need less salt. We'll talk about kidney function. We'll get into all of it and we're going to do it very systematically. So let's start in the brain. We all harbor small sets of neurons. We call these sets of neurons, we call these sets of neurons nuclei, meaning little clusters of neurons, that sense the levels of salt in our brain and body. There are a couple brain regions that do this, and these brain regions are very, very special, special because they lack biological fences
Starting point is 00:15:39 around them that other brain areas have. And those fences, or I should say that fence, goes by a particular name, and that name is the blood brain barrier, or BBB. Most substances that are circulating around in your body do not have access to the brain, in particular large molecules, can't just pass into the brain. The brain is a privileged organ in this sense.
Starting point is 00:16:01 There are a couple other organs that are privileged, and that have very strict barriers, very particular fences, if you will. Those other organs include things like the ovaries and testes, and that makes sense for the following reason. First of all, the brain, at least most of the brain, cannot regenerate after injury. You just simply can't replace brain cells after injury. I know people get really excited about neurogenesis, the birth of new neurons. And indeed, neurogenesis has been demonstrated in animal models. And to some extent, it exists in humans in a few places,
Starting point is 00:16:32 for instance, the olfactory bulb, where neurons are responsible for detecting odorants in the environment for smell that is. And in a little subregion of the hippocampus of memory area, there's probably some neurogenesis. But the bulk of really good data out there point to the fact that in humans there's not much turnover of neurons. What that means is that the neurons you're born with are the ones that you're going to
Starting point is 00:16:54 be using most, if not all, of your life. In fact, you're born with many more neurons that you'll have later, and there's a process of naturally occurring cell death called apoptosis that occurs during development. So you actually are born with many more neurons than you have later in life, and that's the reflection of a normal healthy process of nerve cell elimination. So the estimates vary, but anywhere from a third to maybe even a half or even two-thirds of neurons, depending on the brain area, you're just going to die across development, that might sound terrible, but that's actually one on the brain area, you're just gonna die across development. That might sound terrible,
Starting point is 00:17:25 but that's actually one of the ways in which you go from being kind of like a little potato bug flopping around helplessly in your crib to being an organism that can walk and talk and articulate and calculate math or do whatever it is that you do for a living. So, the brain has a set of elements,
Starting point is 00:17:41 these nerve cells and other cells, and it needs to use those for the entire lifespan. So having a BBB, a blood brain barrier around the brain is absolutely critical. The ovaries and testes have a barrier. For we assume the reason that they contain the genetic material by which we can pass on our genes to our offspring progeny, meaning make children and those children will have our genes, or at least half of them, the other half from the partner, of course. If the cells within the ovaries and testes are mutated, well, then you can get mutations in offspring. So that's very costly in the evolutionary sense.
Starting point is 00:18:19 So it makes sense that you would have a barrier from the blood. So if you ingest what's called a mutagen, if you ingest something that can mutate the genes of cells, you can imagine why there would be a premium on not allowing those mutagen to get into the brain, the ovaries of the testes. Okay. So the brain has this BBB, this blood brain barrier around it, which makes it very, very hard for substances to pass into the brain unless those substances are very small or those substances and molecules are critically required for brain function. However, there are a couple of regions in the brain that have a fence around them, but that fence is weaker. It's sort of like going from a really big wall thick electronic 24-hour surveillance fence where nothing can pass through except only the exclusive cargo that's allowed to go through to having a little cyclone fence with a couple holes in it or it's
Starting point is 00:19:11 kind of a picket fence that's falling over and substances can move freely in from the blood circulating in the body into the brain. And it turns out that the areas of the brain that monitor salt balance and other features of what's happening in the body at the level of what we call osmolarity, at the concentration of salt, reside in these little sets of neurons that sit just on the other side of these weak fences. And the most important and famous of these for its sake of today's conversation is one called OVLT. OVLT stands for the organum vasculosum of the lateral terminalis. It is what's called a circumventricular organ.
Starting point is 00:19:52 Why circumventricular? Well, not to bog you down with neuroanatomy, but your brain is a big squishy mass of neurons and other cell types, but it has to be nourished. And through the middle of that brain, there is a tube. There's a hollow that creates spaces, and those spaces are called ventricles. The ventricles are spaces in which cerebral spinal fluid circulates, and it nourishes the brain. It does a number of other things as well.
Starting point is 00:20:19 The circumventricular organs are areas of the brain that are near that circulating fluid. And that circulating fluid has access to the bloodstream and the bloodstream has access to it. And this structure that I'm referring to, OVLT, organ and vasculosum in the lateral terminal is, has neurons that can sense the contents of the blood and to some extent, the cerebral spinal fluid. There are a couple other brain areas that can do this as well. They go also by the name of circumventricular organs,
Starting point is 00:20:49 and I'll talk about the names of some of those other areas. But for today, and I think for sake of most of the discussion, understand that the OVLT is specials. Why? Because it doesn't have this thick barrier fence, which sounds like a bad thing, and yet it's a terrific border detector. The neurons in that region are able to pay attention to what's passing through in the bloodstream and can detect, for instance, if the levels of sodium in the bloodstream are
Starting point is 00:21:16 too low, if the level of blood pressure in the body is too low or too high, and then the OVLT can send signals to other brain areas, and then those other brain areas can do things like release hormones that can go and act on tissues in what we call the periphery in the body, and for instance, have the kidneys secrete more urine to get rid of salt that's excessive salt in the body, or have the kidneys hold on to urine, to hold on to whatever water or fluid that one might need. So before I go any deeper into this pathway, just understand that the OVLT has a very limited barrier. It can detect things in the bloodstream and this incredible area of the brain almost single-handedly sets off the cascades of things that allow you to regulate your salt balance, which turns out to be absolutely
Starting point is 00:22:05 critical, not just for your ability to think and for your neurons to work, but indeed for all of life. If the OVLT doesn't function correctly, you're effectively dead or dead soon. So this is a very important brain region. So let's talk about the function of the OVLT and flesh out some of the other aspects of its circuitry, of its communication with other brain areas and with the body in the context of something that we of its circuitry, of its communication with other brain areas and with the body, in the context of something that we are all familiar with, which is thirst. Have you ever wondered just why you get thirsty? Well, it's because neurons in your OVLT are detecting changes in your bloodstream, which detect global changes within your body, and in response to that, your OVLT sets off certain events within your brain embody
Starting point is 00:22:46 that make you either want to drink more fluid or to stop drinking fluid. There are two main kinds of thirst. The first one is called osmotic thirst, and the second is called hypovolemic thirst. Osmotic thirst has to do with the concentration of salt in your bloodstream. So let's say you ingest something very, very salty. Let's say you ingest a big bag of, you know, confess I don't eat these very often, but I really like those kettle potato chips. They're pretty salty.
Starting point is 00:23:14 I've never actually measured how much sodium is in them. I'm sure the information is there. Every once in a while, I'm particularly interested in doing so. I'll just down a bag of those things. I really like them and they're very salty. But they almost always make me feel thirsty. And the reason is that by eating those, I've ingested a lot of sodium.
Starting point is 00:23:32 Again, not a frequent occurrence for me, but happens every now and again. And I don't have too much shame about that because I think I have a pretty healthy relationship to food and I enjoy them. And I understand that it will drive salt levels up in my bloodstream, and that will cause me to be thirsty. But why?
Starting point is 00:23:51 Why? Because neurons in the OVLT come in two main varieties. One variety senses the osmolarity of the blood that's getting across that weak little fence that we talked about before. And when the osmolarity, meaning the salt concentration in the blood is high, it activates these specific neurons in the OVLT, and by activates, I mean, it causes them to send electrical potentials, literally send electrical signals to other brain areas, and those other brain areas inspire a number of different downstream events.
Starting point is 00:24:24 So what are those other brain areas inspire a number of different downstream events. So what are those other brain areas? Well, the OVLT signals to an area called the superoptic nucleus, the name and why it's called the superoptic nucleus is not necessarily important. It also signals to the so-called periventricular nucleus. Another nucleus that sits near the ventricles and can monitor the qualities, the chemical qualities of the cerebral spinal fluid as well as probably the bloodstream as well. And the consequence of that communication is that a particular hormone is eventually released from the posterior pituitary. Now the pituitary is a gland that sits near the roof of your mouth.
Starting point is 00:25:06 It releases all sorts of things like growth hormone and luteinizing hormone. Luteinizing hormone will stimulate things like estrogen and testosterone production and release from the ovaries and testes and so on. The pituitary has a bunch of different compartments and functions, but what's really between the body and the brain is that the brain is a lot of different parts of the body. The Neurodustin is a lot of different parts of the body, but the Neurodustin is a lot of different parts of the body, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the body, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts
Starting point is 00:25:30 of the brain, but the Neurodustin is a lot of different parts of the body, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the body, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the
Starting point is 00:25:39 brain, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the brain, but the Neurodustin is a lot of different parts of the the brain, but the Neurodustin is a lot of different parts of the brain, neurons aren't talking in one another about what's happening out there. They're not saying, hey, there's, you know, too much salt in the bloodstream. Let's do something about it. All they receive are so-called action-material waves of electricity. The neurons in the super optic nucleus then release their own electrical signals within the pituitary and some of those neurons and nearby neurons are capable of releasing hormones as well as electrical signals. So from the pituitary, there's a hormonal signal that's released called vasopressin. Vasopressin also goes by the name anti-diuretic hormone. And anti-diuretic hormone has the capacity to either restrict the amount of urine that we secrete or when
Starting point is 00:26:26 that system is turned off to increase the amount of urine that we secrete. So there's a complicated set of cascades that's evoked by having high salt concentration in the blood. There's also a complicated set of cascades that are evoked by having low concentrations of sodium in the blood. But the pathway is nonetheless the same. It's OVLT is detecting those osmolarity changes, communicating to the super optically, a super optically is either causing the release of or is releasing vasopressin antideraretic
Starting point is 00:26:59 hormone or that system is shut off so that the antdiuretic hormone is not secreted, which would allow urine to flow more freely. Anti-diuretic means anti-release of urine, and by shutting that off, you are going to cause the release of urine. You're sort of allowing a system to flow, so to speak. The second category of thirst is hypovalemic thirst. Hypovalemic thirst occurs when there's a drop in blood pressure. So the OVLT, as I mentioned before,
Starting point is 00:27:31 consents osmolarity based on the fact that it has these neurons that can detect how much salt is in the bloodstream. But the OVLT also harbors neurons that are of the barrel receptor, mechanoreceptor category. Now, more on barrel receptors and mechanoreceptors later, but barrel receptors are essentially a receptor, meaning a protein that's in a cell that responds to changes in blood pressure. So there are a number of things that can cause decreases in blood pressure.
Starting point is 00:28:06 Some of those include, for instance, if you lose a lot of blood, right, if you're bleeding quite a lot, or in some cases if you vomit quite a lot, or if you have extensive diarrhea or any combination of those, and there are other things that can reduce blood volume, and we will talk about some of those later. But in the classic case of hypzovalemic thirst, one is simply losing blood, and therefore blood pressure goes down. It's very simple to imagine your mind. You have these pipes, which are the arteries, veins, and capillaries.
Starting point is 00:28:37 And when you lose some blood volume, the pressure in those arteries, veins, and capillaries goes down. OVLT has neurons that can sense that reduction in blood pressure because of the presence of barrel receptors in OVLT. There are other elements that also play into the response to what we call hypovalemic thirst. For instance, the kidney will secrete something called renin, renin will activate something called angiotensin II from the lungs of all things, amazing. And angiotensin II itself can act on OVLT, organ and basculosome lateral terminalis, which
Starting point is 00:29:16 in turn will create thirst. So in both cases, the osmolarity sensing system, meaning osmotic thirst and in hypolimic thirst where blood pressure has dropped, the end result is a desire to drink more. And that desire to drink more comes through a variety of pathways that are both direct and indirect include vasopressin and don't include vasopressin. But I think for just sake of general example, and even for those of you that don't have any biology background or physiology background, just understand that there are two main types
Starting point is 00:29:50 of thirst. Both types of thirst, osmotic thirst and hypovolemic thirst, are not just about seeking water, but they also are about seeking salt. In very general terms, salt, aka sodium, can help retain water. Now that doesn't mean that salt always retains water. If you have excessive amounts of salt, will you retain excessive amounts of water? Well, sort of. As it will soon learn, it's all contextual. But for most cases, we can say that by having salt in our system, our brain in our body can function normally, provided the levels of salt are adequate and not too high or too low.
Starting point is 00:30:32 And thirst, while we often think of it as just a way to bring fluid into our body, is designed as a kind of an interreceptive perception. What I mean by that and interoception as many of you know now from listening to this podcast is a paying of attention or a recognition rather, a conscious recognition of the events going on within our body. So when we are thirsty, it's a certain form of interoception. We go, oh, I need something or I crave something. You may not know exactly what you need, but when you're thirsty, you're not just seeking water, you're also seeking to balance your osmolarity, which means you may be seeking salty fluids or foods. In some cases, you'll try to accomplish this by eating,
Starting point is 00:31:17 or it may be that you're trying to avoid, or you will be inspired to avoid salty fluids and foods. But if you want to understand sodium and its roles in the body, you have to understand thirst. And if you want to understand thirst, you have to understand how fluid balance is regulated in the body. That's not surprising at all. But sodium and water work together in order to generate what we call thirst. Sodium water work together in order to either retain water or inspire us to let go of water to urinate. So before we can dive into the specifics around salt
Starting point is 00:31:52 and how to use salt for performance and various recommendations and things to avoid, we need to drill a little bit deeper into this fluid balance mechanism in the body. And for that reason, we have to pay at least a little bit of attention to the kidney. The kidney is an incredible organ. One of the reasons the kidney is so amazing is that it's responsible for both retaining
Starting point is 00:32:13 holding onto or allowing the release of various substances from the body. Substances like glucose or amino acids, urea, uric acid, salt, potassium, magnesium. It's basically a filter, but it's a very, very intelligent filter. I mean, intelligent, meaning it doesn't have its own mind, but the way it works is really beautiful. Basically blood enters the kidney, and it goes through a series of tubes which are arranged into loops. If you want to look more into this, there's the beautiful loop of Henley and other aspects of the kidney design that allow certain substances to be retained and other substances to be released depending on how
Starting point is 00:32:59 concentrated those substances are in the blood. The kidney responds to a number of hormonal signals, including vasopressin, in order to, for instance, antidiuretic hormone, in order to hold on to more fluid, if that's what your brain embody need, and it responds to other hormonal signals as well. So it's a pretty complex organ. Nonetheless, there's a key point, which I already mentioned, that I think most people don't realize. This is actually something that I like to tell kids when I meet them, provided that they're of appropriate age.
Starting point is 00:33:31 I'll say, oftentimes with kids learning I'm a scientist, they'll ask a question about something related to science, and hopefully, for my sake, it's something about neuroscience. But one thing that I'll tell kids, I'll say, you know that you're urine, your pee is actually filtered blood. And occasionally that will really terrify a kid, but that also occasionally really terrifies an adult. But indeed, your urine is filtered blood. They see blood gets into the kidney,
Starting point is 00:33:59 the kidney is gonna filter out certain things, certain things are gonna be allowed to pass through and others are not, okay? So the way the kidney is designed is that about 90% of the stuff that's absorbed from the blood is going to be absorbed early in this series of tubes. Only a small percentage is going to be regulated or worked out as you get into what's called the distal kidney. Distal just means the furthest part away. The proximal is up close, so like your shoulder is proximal to your midline of your body,
Starting point is 00:34:30 and your hand is distal. In biological terms, you hear proximal distal, which just means near or far from. Just to give a really simple example, let's say that you are very low on fluid. You haven't had much to drink in a while, maybe you're walking around on a hot day. Chances are that the neurons in your OVLT will sense the increase in osmolarity, right? The concentration of salt is going to be increased relative to the fluid volume that's circulating. This of course assumes that you haven't excreted a lot of sodium for one reason or another, but that increase in osmolarity is detected by the OVLT. The OVLT is going to signal a bunch of
Starting point is 00:35:10 different cascades through the superoptic nucleus, etc. And then vasopressin is going to be released into the bloodstream and vasopressin. Again, also called anti-diuretic hormone is going to act on the kidney and change the kidney kidneys function in a couple of different ways, some mechanical, some chemical, okay, in order to make sure that your kidney does not release much water, doesn't make you want to urinate, and in fact, even if you would try to urinate, your body is going to tend to hold on to its fluid stores, okay. So very simple straightforward example. We can also give the other example whereby
Starting point is 00:35:47 if you are ingesting a lot, a lot, a lot of water and it's not a particularly hot day and you're not sweating very much, let's assume your salt intake is constant or is low for whatever reason. Well, then the osmolarity, the salt concentration in your blood is going to be lower, your OVLT will detect that
Starting point is 00:36:04 because of these osmosensing neurons, your OVLT will detect that because of these osmosensing neurons in your OVLT. Your OVLT will fail to signal to the super optic nucleus and there will not be the release of azerpressin antidearetic hormone and you can excrete all the water that your body wants to excrete. Meaning you'll be able to urinate, there's no holding on to water at the level of the kidney. Okay, very simple examples, but hopefully it illustrates how events within the blood meaning the concentration of salt relative
Starting point is 00:36:33 the amount of fluid, right? That's what osmolarity is, is detected by the OVLT, the brain then communicates to the pituitary, the pituitary sends a hormone out into the blood and the hormone acts on the kidney to either hold onto or let go of fluid, meaning to prevent you from wanting to urinate or from stimulating you to want to urinate. Very, very simple kind of yes, no type situation here. There's a lot of nuance to this in reality.
Starting point is 00:37:01 There are a lot of other hormones in this pathway, but I think for at least the stage of the discussion, this should be sufficient. Some of you may have noticed that a molecule we've been talking a lot about today, vasopressin, was also mentioned on a previous episode of the Hebrew and Lab podcast, but in a very different context. The molecule I'm referring to is vasopressin, and I mentioned it's a hormone involved in anti-dioresis, meaning preventing urination. It's an anti-diuretic. But we also talked about vasopressin in the context of desire, love, and attachment. We talked about it in the context of monogamy and non-monogamy in a species of animal called
Starting point is 00:37:40 the Prairie Vole. You can check out that episode. I believe Vaisa Pressen and the non-monogamous prairie voles are mentioned in the timestamp, so it should be easy to find. Vaisa Pressen is made at multiple locations in the nervous system, mainly the super optic nucleus, and indeed it's also involved in aspects of sexual behavior and mating. Now, it does that through mechanisms that are distinct from its anti-diuretic effects. In fact, there are people who take vasopressin
Starting point is 00:38:16 as an affradigic. Now, I'm certainly not suggesting people do that, but I have all the confidence in the world that the moment I talk about vasopressin, someone in the comments is going to say, what do you think about vasopressin nasal sprays and this kind of thing? Vaisopressin and indeed oxytocin, another hormone that's involved in pair bonding and various aspects of brain and body function, are available as a nasal sprays that can get up into the
Starting point is 00:38:43 deep recesses of the brain and can impact some of these core, what we call hypothalamic functions, these primitive drives and hypothalamic functions. I would encourage a lot of caution, maybe even extreme caution in recreational use of things like vasopressin and oxytocin, unless you are working with MD and MD, excuse me, and they prescribe it or they really know what they're doing. These are powerful hormones that have a lot of different effects on the brain and body. The way that vasopressin, meaning antidiuretic hormone,
Starting point is 00:39:11 prevents the release of fluid as urine from the body. It's pretty interesting. It acts directly on the kidney. So as I mentioned before, blood flows into the kidney. A number of things are retained in the early part of the kidney, a number of things are retained in the early part of the kidney. Vaiser Pressen acts at a fairly distal, meaning kind of end game part of the loops of tubes through the kidney, and it increases the permeability of those tubes.
Starting point is 00:39:37 In other words, it makes sure that the fluid that would otherwise pass into a collecting duct and then go out to the bladder. Never actually makes it to the bladder. I point this out because what anti-dioretic hormone does is it prevents the bladder from filling it all. It's not as if it locks fluid in the bladder and prevents you from urinating. I think the way I've been describing things up until now, and the way you'll hear about anti-dioretic hormone, it might sound like it kind of locks up the bladder or prevents you from being able to urinate, but you have a full bladder.
Starting point is 00:40:04 That would be very uncomfortable. That's not the way it works. It actually causes the tubes headed towards the bladder from the kidney to become permeable, meaning to allow fluid to go back into the bloodstream into the rest of the body. So that fluid never actually fills the bladder, and so you never feel the urge to urinate. Now, this is an episode about salt. A key thing to understand about the kidney is that the kidney uses sodium in order to conserve water, which has everything to do with the fact that sodium can actually hold water, put differently, water tends to
Starting point is 00:40:38 follow sodium. So where we have sodium, we tend to have water, and sodium when it's concentrated can hold on to water. And that's one of the main ways that the kidney holds on to water in the body. And as we'll soon learn, there is no simple and direct formula to say, for instance, okay, if salt levels are high, a lot of water is retained, and if salt levels are low, a lot of water is retained and salt levels are low, a lot of water is released. On the one hand, that can be true, but it's also the case because these systems are homeostatic,
Starting point is 00:41:11 meaning they're always seeking balance, both within system, within the salt system, and between systems, the salt and water system. It's also the case often, that if we have enough sodium, well then we can secrete sodium and some water will follow. Or if we don't have enough sodium, then yes indeed, because we're not holding on to water, more fluid can be excreted. But if that condition of low sodium lasts long enough, then we start to
Starting point is 00:41:42 retain water because the body recognizes salt is low and water is being excreted and eventually a system will kick in to retain water. So I'd love to give you a simple black and white yes or no answer for low sodium, high sodium, moderate sodium and water balance, but it's all contextual. And when I say contextual, I mean it will depend on blood pressure, hypertension, pre-hypertension, if that's there, maybe normal tension, hormone levels, exercise, et cetera, et cetera. A pretty good example of how complicated this can all be is one that some of you may be familiar with.
Starting point is 00:42:17 It's pretty well known that during certain phases of the menstrual cycle, when estrogen and progesterone and other hormones are fluctuating that water can be retained in the body. It's what's called edema or a swelling sometimes. The common assumption, and indeed, it can be true, that when estrogen levels are high, there's water retention in the body. Also in males, if estrogen levels are high, there can be water retention in the body. This is one of the reasons why athletes and in particular bodybuilders who take anabolic
Starting point is 00:42:48 steroids, like testosterone, which can be converted into estrogens. Sometimes they'll walk around, they look like they were partially inflated, they look like they're going to pop, and it looks like a swelling of the skin, not just because they have large muscles. And that's not always, but often water retention due to testosterone conversion into estrogen. Now that all sounds consistent, right? Estrogen levels fluctuate. In the menstrual cycle, in males where there's an increase in estrogen, there's retention
Starting point is 00:43:12 of water, but actually estrogen acts as a diuretic. So one would think, okay, when estrogen levels go up, there should be a lot of fluid excreted. But I bring up this example to point out that it's a very complicated and dynamic balance between hormones and salt and fluid. You can't draw a one-to-one relationship there. And that turns out to be a very important point, and we can use that not as a way to further complicate things, but as a way to understand under which contexts less sodium intake or more sodium intake can be beneficial. So, that's why I'd like to turn our attention now. So, how much salt do we need?
Starting point is 00:43:49 And what can we trust in terms of trying to guide our ingestion of salt? First of all, I want to be very, very clear that there are a number of people out there that have pre-hypertension or hypertension. You need to know if you have pre-hypertension or hypertension. You need to know if you have pre-hypertension or hypertension. You need to know if you have normal tension, meaning normal blood pressure. Everyone should know their blood pressure is an absolutely crucial measurement
Starting point is 00:44:14 that has a lot of impact on your immediate and long-term health outcomes. It informs a lot about what you should do. Should you be doing more cardiovascular exercise? Should you be ingesting more or less salt? Should you be adjusting any number of different lifestyle factors? So you need to know that.
Starting point is 00:44:30 And without knowing what your blood pressure is, I can't give a one-size-fits-all recommendation. And indeed, I'm not going to give medical recommendations. I'm simply going to spell out what I know about the research, which hopefully will point you in the direction of figuring out what's right for you in terms of salt and indeed fluid intake. There is a school of thought that everybody is consuming too much salt. And I do want to highlight the fact that there are dozens, if not hundreds of quality papers,
Starting point is 00:44:58 that point to the fact that a, quote unquote, high salt diet can be bad for various organs and tissues in the body, including the brain. It just so happens that because fluid balance, both inside and outside of cells is crucial, not just for your heart and for your lungs and for your liver and for all the organs of your body, but also for your brain, that if the salt concentration inside of cells in your brain becomes too high, neurons suffer. They will draw fluid into those cells because water tends to follow salt, as I mentioned before, and those cells can swell.
Starting point is 00:45:41 You can literally get swelling of brain tissue. Conversely, if salt levels are too low inside of cells in any tissue of the body, but in the brain included, then the cells of the body and brain can shrink because water is pulled into the extracellular space away from cells. And indeed, under those conditions, brain function can suffer. And indeed, the overall health of the brain can suffer. So there are many reports out there indicating both in experimental models and to some extent in humans that over-consumption of salt is bad for brain function and longevity. And yet, there is also decent evidence in both animal models and humans that if salt consumption
Starting point is 00:46:28 is too low, then brain health and longevity will suffer, as will other organs and tissues of the body. So like most things in biology, you don't want things too high or too low. Now, I would say that the vast majority of studies out there pointed the fact that a high salt diet is detrimental to brain health and function. Most of the studies have focused on that aspect of salt balance and its consequences on brain function. One critical issue with many of those studies, however, is that the high salt diet is often coupled to other
Starting point is 00:47:06 elements of diet that are also unhealthy, things like excessively high levels of carbohydrates or fats or combinations of carbohydrates and fats. And so, while I know there are many burning questions out there about how much salt one needs if they are on a low carbohydrate diet or if they are fasting or if they are on a vegan diet, there have simply not been many studies that have explored the low, moderate and high salt conditions on a backdrop of very controlled nutrition. And that's probably reflective of the fact that there are not a lot of very well controlled nutrition studies out there. There are some, of course, but it's very hard to get people to adhere to nutritional
Starting point is 00:47:46 plans in a very strict way and to do that for sufficient periods of time that would allow the various health outcomes to occur. Nonetheless, there's some interesting reports that indicate that the amount of salt intake can indeed predict health outcomes or what we call hazardous events, things like cardiovascular events and stroke and so forth. And what's interesting is that indeed a lower, I'm not saying low, right, because I don't believe that you want your diet to be truly low in anything except perhaps poison, but a lower salt diet can reduce the number of these so-called hazardous events, but it's a somewhat of a shallow U-shaped function
Starting point is 00:48:35 such that yes indeed a high salt intake can be very detrimental for your health, both in terms of cardiovascular events, stroke and other deleterious health events. But somewhere in the middle that actually sits quite to the right, meaning higher than what is typically recommended for salt intake, can actually reduce the number of these hazardous events, at least some reports point to that.
Starting point is 00:49:03 And so I want to emphasize what one of those particular reports says. And I also want to be sure to counter it from the perspective of the context that that study was said in. Because again, my goal here is not to give you a strict set of recommendations at all. It's to point you to the literature, try and make that literature as clear as possible, and allow you to evaluate for yourself. And I don't just say that to protect us. I say that to protect you because, indeed, you are responsible for your health and your health choices.
Starting point is 00:49:30 So the paper that I'm referring to is a very interesting one. We, of course, never want to put too much weight on any one report. But this is a paper that was published in 2011 in the Journal of the American Medical Association. The title of the paper is urinary sodium and potassium excretion and a risk of cardiovascular events. We have not talked much about potassium yet, but sodium and potassium tend to work in concert in the brain and body in order to regulate various physiological functions and health.
Starting point is 00:49:59 And we'll talk more about potassium as time goes on. The key plot or set of data in this study, for those of you who want to look it up, we will link to it. And there are a lot of data in here, but is figure one, which is basically evaluating the amount of urinary excretion of sodium, which is a somewhat indirect,
Starting point is 00:50:21 but nonetheless valuable measure of how much sodium people were ingesting. And plotted against that is what they call the hazard ratio. And the hazard ratio points to the composite of cardiovascular death stroke, myocardial infarction, and infarct as an injury, and hospitalization for congestive heart failure. And what it points to is the fact that the hazard ratio is low-ish at sodium excretion of about two grams per day, but then continues to go down
Starting point is 00:50:54 until about 4.5 to five grams per day. That remember, this is sodium excretion. So it's reflective of how much sodium was in the body, which is reflective of how much sodium was ingested. And then the hazard ratio increases fairly dramatically, a very steep slope, heading anywhere from 7 to 8 to 10 and out towards 12 grams of sodium excretion per day. So the simplest way to interpret these data are that at fairly low levels of sodium, meaning at about two grams per day, you run fewer health risks. But the number of risks
Starting point is 00:51:32 continues to decline as you move towards four and five grams per day. And then as you increase your salt intake further, then the risk dramatically increases. So no study is holy nor is any figure in any study or any collection of studies holy. Rather, we always want to look at what the bulk of data in a particular field reveal. Nonetheless, I think the plot that we described, meaning the graph that we described is pretty interesting in light of the 2020 to 2025 dietary recommendations for Americans, which are, which is that people consume no more than 2.3 grams, meaning 2,300 milligrams of sodium per day. That's about a half a teaspoon of salt per day. Now, most people are probably consuming more than that because of the fact that they are ingesting processed foods and processed foods tend to have more salt
Starting point is 00:52:31 than them than non-processed foods. Now, of course, that's not always the case, right? Sea salt is not a processed food in most cases. And there are a lot of unprocessed foods that can be high in sodium, but processed foods in particular tend to have a lot of sodium. You can see this simply by looking at the packaging
Starting point is 00:52:48 of any number of different foods. But if we were to take this number of 2.3 grams, that's the recommended cutoff for ingestion of sodium, it actually falls in a portion of the curve that we were talking about a moment ago, that indeed is associated with low incidence of hazardous outcomes, cardiovascular, vent stroke, etc. But according to that plot, the ingestion of four or five grams of sodium, almost double
Starting point is 00:53:22 or more sodium than is currently recommended, is associated with even lower numbers of hazardous events. So we need to think about this, and we need to explore it in the context of other studies, of course. And we need to evaluate it in terms of this thing that we've been going back to again and again, which is context, right? These recommendations of 2.3 gram per day cutoff is in the context of a landscape where some people do indeed have hypertension or pre-hypertension. The incidence of hypertension has gone up dramatically in the last 100 years and seems to continue
Starting point is 00:54:00 to go up. Whether or not that's because of increased salt intake or whether or not it's because of increased salt intake and other things such as highly processed foods, that isn't clear. Again, pointing to the challenge in doing these epidemiological studies and really parsing what aspects of a change in some health metric is due to, for instance, the ingestion of more sugars versus more salt. So, simply instance, the ingestion of more sugars versus more salts, or simply because of the ingestion of more salts.
Starting point is 00:54:27 It's a complicated, almost barbed wire topic by now, but we can start to pull apart that barbed wire tangle and start to evaluate some of the other people and other conditions that exist out there, maybe, for you, that actually warrant more sodium intake and where more sodium intake might actually be beneficial. So again, I want to be very, very clear that you need to know your blood pressure. If you have high blood pressure or you're pre-high-pretensive, you should be especially cautious
Starting point is 00:54:56 about doing anything that increases your blood pressure. And as always, you want to, of course, talk to your doctor about doing anything that could adjust your health in any direction. But nonetheless, there are some important papers that have been published in recent years. I want to point to one of them in particular. This is a paper that was published in the journal Autonomic Neuroscience, Basic and Clinical because this paper, like several other papers,
Starting point is 00:55:21 asked the question, and indeed they asked the question in the title to review dietary sodium and health, how much is too much for those with orthostatic disorders? Now orthostatic disorders come in a bunch of different varieties, and we're going to talk about those in a moment, but there are a number of people out there that have low blood pressure, right? People that get dizzy when they stand up, people that are feeling chronically fatigued, and in some cases, not all, those groups can actually benefit from increasing their sodium
Starting point is 00:55:49 intake. Several episodes ago on the Hubertman Lab podcast, I gave it what it's just clearly what we call anic data, which is not even really data, it's just anecdotal data of an individual who was always feeling hungry and craving sugar, and based on the fact that they also had low blood pressure, I had them talk to a physician, and they got permission to try a little mini-experiment on themselves. And so they did, and that mini-experiment was, any time they felt like they were craving sugar, or they were feeling a little light-headed and dizzy, rather than reaching for something
Starting point is 00:56:23 with caloric intake, they took a little bit of sea salt, a little pinch of sea salt and put it into some water and drank it or in the case of this individual, they would actually take a little sea salt packet and they would actually just down a sea salt packet. And for them that provided tremendous relief for their dizziness, but that of course was in the context of somewhat abnormally low blood pressure. So I don't think that they are alone in the fact that many people out there suffer from a low blood pressure condition. Many people out there suffer from a high blood pressure condition.
Starting point is 00:56:54 So know your blood pressure and understand that blood pressure in part is regulated by your sodium intake and your sodium balance. Why? Well, because of the osmolarity of blood that we talked about before, where if you have a certain concentration of sodium, meaning sufficient sodium in your bloodstream, that will tend to draw water into the bloodstream, and essentially the pipes that are your capillaries arteries and veins will be full. The blood pressure will get up to your head, whereas some people their blood pressure is
Starting point is 00:57:24 low because the osmolarity of their blood is low. And that can have a number of downstream consequences. I should also mention it can be the consequence itself of challenges or even deficits in kidney function, but all of these organs are working together. So the encouragement here is not necessarily to ingest more sodium, it's to know your blood pressure and to address whether or not an increase in sodium intake would actually benefit your blood pressure in a way that could relieve some of the dizziness and other symptoms of things like orthostatic disorders. But of course, to do that in
Starting point is 00:58:00 a safe context and to never play games with your blood sugar or your blood osmolarity that could set your system down a cascade of negative events. Let's look at what the current recommendations are for people that suffer from orthostatic disorders like orthostatic hypomeaning, too low tension, orthostatic hypotension, postural tachycardia syndrome, sometimes referred to as POTS, POTS, or idiopathic orthostatic tachycardia and syncope, these have the incredibly elaborate names. Those groups are often told to increase their salt intake in order to combat their symptoms. The American Society of Hypertension recommends anywhere from 6,000 to 10,000, these are very high levels.
Starting point is 00:58:44 So this is 6 grams to 10 grams of salt per day. Keeping in mind again that salt is not the same as sodium. So that equates to about 2400 to 4,000 milligrams of sodium per day. Again, if you want to learn more about this and get more of the citations, I'll refer you back to this study on dietary sodium and health, how much is too much for those with orthostatic disorders. We'll put a link to this in the caption show notes. That's not just in the US. The salt recommendations from the Canadian cardiovascular society are 10,000 milligrams of salt per day. Four grams of sodium is what that equates to.
Starting point is 00:59:21 On and on and on, four things like pots for these postural syndromes that result from, or I should say from these syndromes that involve low blood pressure when people stand up or in certain postures. So I point out this paper and I point out these higher salt recommendations to emphasize again that context is vital, right? That people with high blood pressure are going to need certain amounts of salt intake, people with lower blood pressure, and maybe with some of these postural orthostatic syndromes are going to need higher amounts of salt. And for most people out there, you're going to need to evaluate how much salt intake is
Starting point is 01:00:00 going to allow your brain and body to function optimally. And there are some fairly straightforward ways to explore that. And there's some ways to explore that in the context of what you already know about thirst and salt appetite that can make that exploration one in which it's not going to be a constant wandering around in the dark and where you can figure out what's right for you. For most people, a moderate increase in salt intake is not going to be detrimental, provided that you consume enough fluids in particular water. Okay?
Starting point is 01:00:31 Meaning, if you happen to overeat salt a bit, you will get thirsty, you will ingest more water, and you will excrete the excess sodium. There is evidence that the body can store sodium in various organs. That storage of sodium may or may not be a detrimental thing. In general, excess storage of sodium and tissues and organs of the brain and body is not thought to be good for long-term health. So eating much more sodium than you need for long periods of time is indeed bad for you. Earlier I mentioned that salt and your hunger and thirst for salt is homestatically regulated. And indeed, that's the case, much like temperature is homestatically regulated.
Starting point is 01:01:17 What that means is if you pay attention to it, if your salt levels are low, you will tend to crave salt and salty beverages and salty foods. And in most cases, you should probably follow that craving provided those salty beverages and salty foods are not bringing in a lot of other things or anything, ideally, that's bad for you. So I think it's fair to say that whether or not you're vegan, vegetarian, carnivore, omnivore, that we should all try to limit our ingestion of processed foods. My read of the literature is that sure some processed foods are acceptable for us and aren't going to kill us outright, but that for most people in the world eating fewer processed foods is just going to be a good thing to do.
Starting point is 01:02:06 So following your salt hunger and thirst, in most cases, is going to be beneficial, provided that it's in the context of eating healthy, non-processed foods. On whatever backdrop of nutritional and dietary recommendations is right for you, I simply can't tell you what to eat and what not to eat because I acknowledge the fact that some people are vegans because of ethical reasons related to animals or some people are vegans because of, you know, reasons related to the climate and the environment. Other people do it for specific health reasons. Likewise, I know plenty of people that eat meat and avoid vegetables, believe it or not,
Starting point is 01:02:50 and I know people that eat both, and they do this often each, I should say, all citing literature that supports their particular camp and their particular view. It's not a territory I want to get into, but with respect to salt intake and the fact that that salt intake is homestatically regulated, it is the case that if you're craving salt, you probably need it. So for those of you that are sweating excessively, or even if you're in a very hot environment, and you're not exercising and you're just losing, you're losing water and salt from your system, remember also that you can be in a very cold environment, very cold dry environments, often go together,
Starting point is 01:03:29 and you can be losing a lot of fluids from your body, and you will crave fluids and salt even though it's cold, and you're not actually noticeably perspiring. So if you're exercising a lot, if you're a particular cold, dry environment or a particular hot environment, you ought to be ingesting sufficient amounts of salt and fluid. A rule of thumb for exercise-based replenishment of fluid comes from what I, some episodes back, referred to as the Galpin equation. The
Starting point is 01:03:58 Galpin equation, I named it after Andy Galpin, and I think that is the appropriate attribution there. Andy Galpin is an exercise physiologist at Cal State Fullerton, I believe, and he's going to be a podcast guest here on the Heberman Lab podcast. He's an exceptional muscle physiologist. He also lives in the practical realm where he gives recommendations about exercise to expert athletes as well as the everyday person. So the Galpin equation is based on the fact that we lose about one to five pounds of water per hour, which can definitely impact our mental capacity and our physical performance. And the reason that loss of water from our system impacts mental capacity and physical performance has a lot to do with literally the changes in the volume of those cells,
Starting point is 01:04:48 the size of those cells, based on how much sodium is contained in or outside those cells, and something that I've alluded to before on the podcast, and I'll talk about more in a moment, which is that neurons signal to one another by way of electricity through something called the action potential, and that actually requires sodium and potassium and magnesium. So the Galpin equation suggests that we start exercise
Starting point is 01:05:10 hydrated with electrolytes, not just with water. So that means water that has some sodium, potassium, and magnesium. There are simple low cost ways to do that we'll talk about. And the formula for hydration, the so-called galpin equation, is your body weight in pounds divided by 30 equals the ounces of fluid you should drink every 15 minutes. That may turn out to be more fluid than you can comfortably consume during the activity that you're performing.
Starting point is 01:05:42 Now, the galpin equation is mainly designed for exercise, but I think it's actually a very good rule of thumb for any time that you need to engage mental capacity, not just physical performance. Your body weight and pounds divided by 30 equals the, the ounces of fluid you should drink every 15 minutes does not necessarily mean you have to ingest it every 15 minutes on the dot. And I think many activities, physical activities, but also cognitive activities like zoom meetings
Starting point is 01:06:16 or in-person meetings or lecturing or running or cycling are going to make it complicated to ingest the appropriate amount of fluid every 15 minutes on the dot. I'm not going to speak for Andy for Dr. Galpin, but I think he would probably agree that these are averages to shoot for and that unless you're hyper neurotic, the idea is to make sure that you're entering the activity, cognitive or physical, sufficiently hydrated, and that throughout that activity, you're hydrating regularly. And it points to the fact that most people are probably underhydrating, but not just underhydrating from the perspective of not ingesting enough water, that they're probably
Starting point is 01:07:00 not getting enough electrolytes as well, sodium potassium and magnesium. So I've said to somewhat contradictory things. On the one hand, I said, follow your salt appetite. Follow your salt thirst. If you're craving salt, ingest some salt until you stop craving the salt. On the other hand, I've given you this fairly specific recommendation based on the galopin equation that you should ingest your body weight in pounds divided by 30. That's how many ounces of fluid you should drink
Starting point is 01:07:30 every 15 minutes, which I'm guessing for most people is going to be more fluid than they're currently drinking on average. And so how could it be that you can have a recommendation for what's optimal that's different than the amount that you would reflexively drink? And it has to do with the fact that a lot of the hormone systems like vasopressin and antidereratic hormone, other hormones like aldosterone, and a lot of the neural and hormonal signals that govern salt and water balance are fairly slow to kick in. For instance, if you eat a fairly salty meal and you sense that salt, you'll probably meaning you detected and perceive it because the food tastes salty, you'll probably want
Starting point is 01:08:10 to drink a fair amount of fluid with it. Whereas if some of the salt is disguised by other flavors, something that we'll talk about in a few minutes when we talk about the neural representation of things like salty and sweet, well then you might not notice that something salty and then a few minutes or hours after ingesting that meal, you might feel very, very tired. You might even wonder whether or not it's because of some blood sugar effect. Maybe it's a crash in blood sugar you might think,
Starting point is 01:08:37 or something else related to that meal, or maybe you think it's because of some other event in your life, but actually what has happened is you're dehydrated because you didn't recognize that you needed to drink more fluids. So I want to acknowledge the contradiction in the idea that everything is homestatically regulated and therefore you are aware of what you need and the counter argument that you need to follow these strict recommendations.
Starting point is 01:09:02 It's actually going to be somewhere in between. Of course, your body and brain can start to adapt to certain levels of salt intake. There's a now a fairly famous study that was done in Germany, which looked at different phases of salt intake, meaning they had subjects in just either 12 grams of salt per day or 9 grams per day or 6 grams per day for fairly long periods of time. And they collected urine for testing. This was actually a very controlled study.
Starting point is 01:09:32 I'm just going to paraphrase from the National Institutes of Health report on this study because they did a very nice write up of it. And they say that a big surprise of these results is that whatever the level of salt that was consumed, sodium was stored and released from the subject's bodies in fairly regular, weekly and monthly patterns, meaning people tended to adapt to a certain level of salt intake and then it led to a fairly constant amount of salt retention and urine fluid excretion. And that's because of the various hormones like aldosterone, which regulate sodium excretion from the kidney and glucocorticoids, which we'll talk about more in a moment, which help
Starting point is 01:10:13 regulate metabolism. Glucocorticoids are released from the adrenal glands, which ride to top the kidneys. And there's a very close relationship between the stress system, glucocorticoids, and the salt system. So the reason why your salt appetite isn't a perfect readout of how much salt you should ingest, and why it might be helpful to follow some of these formulas like the Galpin equation, especially if you're engaging in exercise, where you're going to be perspiring, of course, is that your body will tend to adapt to a certain amount of salt intake
Starting point is 01:10:45 over time, and then your appetite for salt won't necessarily be the best indication of how much salt you should ingest or avoid. Before I move on, I want to really re-emphasize the fact that inside of the galvan equation, there is that mention of every 15 minutes, and people have come back to me again and again about this saying, I can't drink that much water every 15 minutes. It's too much volume of fluid in my stomach. I can't run with that, et cetera. Remember, these are averages.
Starting point is 01:11:13 So that's what you want to average around a particular activity. These are not strict recommendations where a buzzer goes off in every 15 minutes. You have to chuck that exact amount of electrolyte containing solution. Another key feature of the study that I was referring to before, which incidentally was published in the journal of clinical investigation, is that the body regulates its salt and water balance not just by excreting sodium, but by retaining or releasing water. This is because of the relationship between sodium and water that we were talking about before.
Starting point is 01:11:44 The advantage of this mechanism they state here on paraphrasing is that the long-term maintenance of body fluids is dependent, is not as dependent on external water as once believed, right? What the system probably evolved to do was to adjust to different levels of sodium availability in the environment. And that raises a really key element of salt and its importance in human history and human evolution and human health. We haven't talked too much about this, and there are several very good books about the history of salt. You know, salt was a very valuable and heavily sought after substance throughout much of human history. So much so that there are actually written reports of people being paid for labor in the form of salt. And salt, when it scares, has been quite expensive in certain regions of the world, especially
Starting point is 01:12:37 regions located further away from the sea. And a friend of mine who has deep roots within the culinary community told me about traveling to some somewhat impoverished areas of Europe some years ago and going into homes where in the middle of the kitchen table, there was a fish, a salty fish hanging from a thread above the table and that because of a lack of availability of table salt, the common practice was to take any food that needed some salt for additional flavoring,
Starting point is 01:13:12 and to actually rub that food on this salty fish or just squeeze the fish a bit onto the food substance in order to get salt from it. So, that's a very extreme example. Nowadays, we take salt for granted. And most of the discussion out there is about excess salt. But as I'm pointing out that salt for a long time has been a very sought after commodity
Starting point is 01:13:36 and one that people really cherished for their health. In the episode that I did on metabolism, I talked about the relationship between salt and iodine. If you're interested in iodine and whether or not iodized salt or non-iodized salt is best or required, I'd encourage you to listen to that episode, which was about, again, metabolism. Some people may need more iodine intake. Some people perhaps do not. Some people might even want to ingest things like kelp. Some people might not. So please listen to that episode if you're interested in the iodine aspects of salt, which have direct impact on thyroid hormone and thyroid function, which of course relates to
Starting point is 01:14:11 metabolism. Nowadays, there's a lot of interest in and even a kind of proliferation of what I call fancy salts. So whether or not you should be ingesting sea salts or common, whether or not, common table salt will suffice. In most cases, for what we're discussing here, common table salt is fine, but I should point out that sea salt often contains other minerals,
Starting point is 01:14:34 which can be very useful. And we will do entire episodes on those other minerals. So sea salt can contain dozens or more of minerals, some of which can be quite valuable to our health. Others of which are less important and only need to be consumed in trace amounts. But you're not going to get many minerals if any from common table salt. And that's why, in addition to the pretty colors and perhaps some people report that they actually taste better.
Starting point is 01:15:01 Some of these so-called fancy salts or sea salts, you might want to consume a more advanced form of salt, if you will, although I suppose it's actually the more primitive of a form of salt, if it's actually the one that comes from the ocean. So we've all heard about how excess salt is bad for blood pressure, damage to the heart, the brain, et cetera. I do want to give some voice to situations where too little salt can actually cause problems,
Starting point is 01:15:24 and this has everything to do with the nervous system. to situations where too little salt can actually cause problems. And this has everything to do with the nervous system. So without getting into excessive amounts of detail, the kidneys, as we talked about before, are going to regulate salt and fluid balance. The adrenal glands, which right atop the kidneys are going to make glucocorticoids like aldosterone. And those are going to directly impact things like fluid balance,
Starting point is 01:15:47 and in part they do that by regulating how much craving for intolerance of salty solutions we have. And there's some really nice studies that have looked at so-called adrenalectomies. Now this is an extreme case, and it's typically done in animal models, but it illustrates the role of the adrenals in salt preference. Basically when the glucocorticoid system, meaning the release of these particular hormones from the adrenal glands, is eliminated by adrenalectamine,ectamy means removal, then the threshold for what's considered too salty really shifts.
Starting point is 01:16:27 So typically, when the adrenals are intact, an animal or a human will prefer a mildly salty to moderately salty solution, if given a choice. And at some point, it's so salty that it just feels aversive. Just like taking a gulp of seawater is almost always aversive. I can't think of an instance where it's not aversive. And actually drinking seawater can kill you because of the high osmolarity of seawater. You certainly don't want to drink seawater.
Starting point is 01:16:55 Under conditions where the adrenals are missing, animals and humans will tend to prefer a higher sodium concentration fluid and they will be willing to tolerate ingesting very high concentrations of sodium. Now, that's a very crude experiment and not one that you want to do, I promise you, but I mention it because it illustrates the very direct relationship between the stress system, which is the glucocorticoid system and the salt craving system. direct relationship between the stress system, which is the glucocorticoid system, and the salt craving system. And this actually makes sense.
Starting point is 01:17:29 Earlier as we were talking about hypavilemic thirst, when there's a loss of blood pressure, from usually due to a loss of blood from the body, there's a salt craving in order to bring that blood volume back up because by ingesting salt, you bring fluid into the bloodstream, you're increasing that blood pressure and you can restore the blood that's lost. Now there are many examples where if sodium levels get too low in the bloodstream, either because people are ingesting too little salt or they are ingesting too much water and therefore excreting too much salt, that it can cause stress and anxiety. There's some really nice data that point to the fact that low dietary sodium can actually
Starting point is 01:18:08 exacerbate anxiety in animal models. To some extent, there's evidence for this in humans as well. That should not come as a surprise. The whole basis for a relationship between the adrenal system, these glucocorticoids, things like aldosterone and the craving for sodium, is that the stress system is a generic system designed to deal with various challenges to the organism, to you or to me or to an animal. And those challenges can arrive in many different forms. They can be an infection, it can be famine, it can be lack of water,
Starting point is 01:18:46 and so on. But in general, the stress response is one of elevated heart rate, elevated blood pressure, and an ability to maintain movement and resistance to that challenge. Okay. I've said this before, but I'll emphasize it again. There's this common misperception that stress makes us sick, and indeed, if stress lasts too long, it has a number of negative effects on our health. But more often than not, if we're pushing, pushing, pushing, we're studying or taking care of somebody or traveling like crazy, we don't tend to get sick under those conditions. But as soon as we stop, as soon as we reduce our adrenaline output, as soon as we reduce our glucocorticoid output from our adrenals, then we will get sick.
Starting point is 01:19:30 That's a very common occurrence. And it's because stress actually activates our immune system in the short term. So I'd like to try and dispel this myth that stress actually suppresses the immune system, at least not in the short term. For long term stress, it's a different issue. You don't want long term ongoing stress, especially of several weeks or more. Nonetheless, it makes sense that bringing sodium into the body would be at least one way that we would be wired to counteract or to resist stressors.
Starting point is 01:20:03 Stressors being the things on the outside coming at us so it could be stressful. Relationships, stressful job situation, again, infection and so on. It's clear from a number of studies that if sodium levels are too low, that our ability to meet stress challenges is impaired. Now, that doesn't mean to place your sodium intake cosmically high, but it does point to the fact that if you're feeling anxious, perhaps from low blood pressure, which can also give symptoms of anxiety, as we talked about before, but even if it's independent of low blood pressure, that slightly increasing sodium intake, again, I would encourage people
Starting point is 01:20:42 do this not in the context of processed foods and drinks, but ideally in the form of maybe a little bit of sea salt and water or salty one's food a little bit more, that can stabilize blood pressure and one's ability to lean into stressors and challenges. And I say this because I think that most people assume that adding salt is always bad when in fact that's simply not the case. There are conditions such as when we are under stress challenge, when there is a natural craving for more sodium and that natural craving for more sodium is hardwired into us as a way to meet that challenge.
Starting point is 01:21:18 So it's hard for me to know whether or not people out there, especially the listeners of this podcast are getting too much just enough or too little sodium. So I can't know that. I'm shouting into a tunnel here. You have to decide how much sodium you are ingesting. But I think that there's some, for most people, especially people who are not hypertensive, prehypertensive, there's some wiggle room to explore whether more intake of sodium could actually be beneficial for suppressing some of the
Starting point is 01:21:46 anxiety responses that they might feel under conditions of stress. Again, more studies need to be done. Certainly, more studies in humans need to be done, but the relationship between stress and sodium intake and the fact that additional sodium intake may be beneficial and indeed is naturally stimulated by stress. Shouldn't be necessarily looked at as a pathological event. I know when some people get stressed, they crave salty foods. That's actually a hard-wired biological phenomenon that you see not just in humans, but in
Starting point is 01:22:15 animals because this is a very primitive mechanism whereby your body is preparing to meet any additional challenges and stressors. We can't have a discussion about sodium without having a discussion about the other electrolytes, magnesium and potassium. Magnesium is important enough and an extensive enough topic that we should probably do an entire episode just on magnesium. For purposes of today's discussion, I just will briefly touch on some of the forms of magnesium that we've discussed on the podcast before in different contexts.
Starting point is 01:22:47 One emphasize that many people are probably getting enough magnesium in their diet that they don't need to supplement magnesium. Some people, however, opt to supplement magnesium in ways that can support them. There are many different forms of magnesium and just in very brief passing, I'll just say, that there is some evidence that you can reduce muscle soreness from exercise by ingestion of magnesium malate, M-A-L-A-T-E. I've talked before about magnesium 3-in-8, T-H-R-E-N-O-A-in-8, THRENO-AT, magnesium 3-in-8, for sake of promoting the transition into sleep and for depth of sleep, and perhaps, again, highlighted perhaps,
Starting point is 01:23:32 because right now it's mainly animal studies and ongoing human studies, but the data are not in. Perhaps magnesium 3-in-8 can be used as a way to support cognitive function and longevity. That was discussed in the episode with Dr. Jack Feldman from UCLA. be used as a way to support cognitive function and longevity. That was discussed in the episode with Dr. Jack Feldman from UCLA. Typically, magnesium 3 and 8 is taken 30 to 60 minutes before bedtime in order to encourage sleep. You can go to our neural network newsletter
Starting point is 01:23:56 and look for the one on sleep. And you can see the recommendations, or I should say, the options for that, because again, you should always check with your physician. Those aren't strict across the board recommendations. And then there are other forms of magnesium, magnesium, bisclicinate, which is somewhat of an alternative to 3 and 8, not known to have cognitive enhancing effects, but seems at least on par with magnesium, 3 and 8 in terms of promoting transition into in depth of sleep
Starting point is 01:24:23 and so on. There are other forms of magnesium, magnesium citrate, which as other functions, actually magnesium citrate, is a fairly effective laxative, not known to promote sleep and things of that sort. So a lot of different forms of magnesium, and there's still other forms out there. Many people are not getting enough magnesium, many people are. Okay, so that's magnesium. Anytime we're talking about sodium balance, we have to take into consideration potassium, because the way that the kidney works and the way that sodium balance has regulated both in the
Starting point is 01:24:56 body and the brain, is that sodium and potassium are working in close concert with one another. There are a lot of different recommendations about ratios out there, and they range widely from two to one ratio of potassium to sodium. I've heard it in the other direction too. I've heard a two to one sodium to potassium. The recommendations vary. One of the sponsors of this podcast, for instance, element, which I've talked about in this episode and before, the ratio there is a gram of sodium to 200 milligrams of potassium, 60 milligrams of magnesium. So there they've opted for a
Starting point is 01:25:32 5 to 1 ratio of sodium to potassium. And of course, many people opt to make their own hydration electrolyte formulas. They'll put sea salt into some water, maybe even in just a potassium tablet. It all depends on the context. An important contextual element is your diet. For instance, carbohydrates hold water in the body. Regardless of how much salt and how much fluid you're ingesting, if you're ingesting carbohydrate and you drink fluids, water, some of that fluid is going to be retained in the body. Now, for people that are following low carbohydrate diets, one of the most immediate effects of a low carbohydrate diet is that you're going to excrete more water. And so, under those conditions, you're also going to lose, not just water, but you'll
Starting point is 01:26:13 probably also lose sodium and potassium. And so, some people, many people, in fact, find that when they are on a lower or low carbohydrate diet, then they need to make sure that they're getting enough sodium and enough potassium. And some people do that by taking 99 milligram potassium tablets every time they eat. Some people do that by ingesting more foods that contain potassium. And of course, some people who are on low carbohydrate diets do ingest vegetables, you know, or other forms of food that carry along with them potassium. So it's quite variable from person to person. I mean, you can imagine if carbohydrate holds water,
Starting point is 01:26:52 water and salt balance in potassium go hand in hand and hand, that if you're on a low carbohydrate diet that you might need to adjust your salt intake in potassium, and conversely that if you're on a carbohydrate-rich diet or a moderate carbohydrate diet, then you may need to ingest less sodium and less potassium. In fact, a certain amount of water is probably coming in through the foods you eat as well. I don't say all this to confuse you. Again, I say this because it all depends on the context.
Starting point is 01:27:19 I'll give it yet another context that I think is fairly common nowadays, which is many people are following a pattern of eating that more or less resembles intermittent fasting or at least time restricted feeding. So they're eating between particular feeding windows. And then in the certain parts of the 24 hour cycle, not just sleep, but during certain parts of their waking cycle, they're also actively avoiding food. Banking on, I think, either the possible, I want to say, possible longevity promoting effects of intermittent fasting or and or, I should say, they are banking on the fact that for many people not eating is easier than portion control for certain parts of the day.
Starting point is 01:27:59 So they find it beneficial to limit calories overall to a given amount, depending on what their goals are, by not consuming food for certain periods of the day, but usually during those periods of the day, they're consuming fluids. And oftentimes those fluids include not just water, but caffeine. And caffeine is a diuretic. It actually causes the excretion of fluids from the body in part because it causes the excretion of sodium. All of that to say that if you're somebody who, for instance, eats your first meal around
Starting point is 01:28:29 noon or 1 or 2 p.m. and you're fasting for the early part of the day and you're drinking coffee or tea or ingesting a lot of water, you are going to be excreting sodium along with that water. And so many people, including myself, find that it's useful, especially when I'm drinking caffeine during that so-called fasting or non-food intake part of the of time restricted feeding, that I'm making sure to get enough salt either in the form of something like element, an electrolyte drink, or putting some sea salt into some water, or certainly any time one is ingesting caffeine, replacing some of the lost water by increasing one's water intake.
Starting point is 01:29:10 There are some simple rules of thumb around this that I think can get most people into a place where they're more comfortable and functioning better, which is for every ounce of coffee or tea that you drink, I should say caffeinated coffee or tea that you drink, that you consume one and a half times as much water. So let's say you have an eight ounce coffee, try and drink about, you don't have to be exact, but try and drink about a 12 ounce glass of water, and you might want to put a tiny bit of sodium into that.
Starting point is 01:29:37 By tiny bit, I just mean a tiny pinch of sodium. Because remember, even if we're talking about increasing the amount of sodium intake overall, the total amount of sodium contained in salt is sufficiently high that even just a quarter teaspoon is going to really start to move that number up towards that range that's still within the safe range. But if you keep doing that all day long, you're very quickly going to get into that excessive salt intake range that is deleterious for health.
Starting point is 01:30:04 So again, if you're consuming more caffeine, you're going to be excreting water and salt and potassium. And so you're going to have to find ways to bring water, salt, and potassium back in. Again, this has to be evaluated for each of your own individual situations. If you're exercising, fasted, and you're doing that after drinking caffeine, then before during and certainly after exercise, you're going to want to replenish the fluids and electrolytes that you lost including sodium. So you can imagine how this all starts to become pretty dizzying, and yet it doesn't have
Starting point is 01:30:34 to be dizzying. We can provide some useful ranges that for most people will work. And so let's talk about what those ranges are, and I'm going to point you to a resource that explores what those ranges are in these various contexts of nutrition, exercise, and so on. The resource is a book that was authored by Dr. James Dean Nichol Antonio. He's not a medical doctor. He's a scientist. He's cardiovascular physiology as well. I believe is a doctor of. And the title of the book is the Salt Fix. The Salt Fix is an interesting read because it points to, first of all, the history of salt in society and as it relates to health.
Starting point is 01:31:13 It actually emphasizes some of the major missteps, maybe even pretty drastic errors that have been made in terms of trying to interpret the role that salt has in various diseases and emphasizes some of the ways in which perhaps increasing salt can actually improve health outcomes. And I think it strikes a pretty nice balance between what's commonly known about salt and what I believe ought to be known about salt or at least taken into consideration. You know, the book does provide certain recommendations and I actually reach out to the author.
Starting point is 01:31:50 I've never met him in person or talked to him directly and I asked him outright, I said, how much salt do you recommend people take on average and he gave, of course, the appropriate caveats about pre-hypertension, hypertension, etc. But made a recommendation, which I'll just share with you. If you want to learn more about the support for this recommendation, you can check out his book. The recommendation he made was anywhere from 8 to 12 grams of salt a day, which corresponds to 3.2 to 4.8 grams of sodium. So going back to the current recommendations that we talked about before, 2.3 grams of sodium
Starting point is 01:32:33 per day, this is about 1.5 times to, you know, double the amount of sodium that's currently recommended in most circles. And then what this corresponds to is about one and a half to two teaspoons of salt per day to arrive at that 3.2 to 4.8 grams of sodium. Again, this is the recommendation that was passed along for most people, most conditions, barring specific health issues.
Starting point is 01:33:00 Now what was also interesting is he pointed to a sodium to potassium ratio, which is four grams of potassium, and he also mentioned 400 milligrams of magnesium, and pointed out, and I generally agree here that many people are deficient in magnesium. So again, that was a 3.2 to 4.8 grams of sodium, four grams of potassium. You might think, well, gosh, that's one and a half to two times the current recommendation, but we can go back to that study that was mentioned earlier in the episode, the 2011 study, where I described this sort of j-shaped curve in which when you look at the occurrence
Starting point is 01:33:39 of these negative health events, they were fairly low at low sodium intake. Lower still at slightly higher sodium intake, much in line with the recommendations that are made or that Dr. D. Nickelantonio passed along to me. And then they increased those health risks increased quite substantially as one moves out past, you know, six grams of sodium, seven grams of sodium per day. That's when things really do seem to get hazardous. And really, it makes sense, I think, given the consensus around this to really avoid very high salt intake. So the salt fix describes the rationale behind those recommendations. The salt fix also describes in quite beautiful detail the relationship between
Starting point is 01:34:27 salt intake, potassium intake, and the relationship to the sugar consumption system. I'd like to pick up on this idea of the relationship between salt and sugar because I think that one key aspect of the way that salt can work and can benefit us or can harm us has to do with the way that sodium and sugar are regulated and actually perceived by the brain and how under conditions of certain levels of sodium intake, we might be inspired to seek more sugar or to crave suites more or less. So up until now, we've been talking about salt as a substance and a way to regulate fluid balance and blood volume and so on. We haven't talked a lot about salt as a taste or the taste of things that are salty.
Starting point is 01:35:10 And yet, we know that we have salt receptors, meaning neurons, that fire action potentials, when salty substances are detected, much in the same way that we have sweet detectors and bitter detectors, and we have detectors of mommy, the savory flavor on our tongue. And earlier at the beginning of the episode, I talked about the fact that we have sweet receptors, neurons that respond to the presence of sugar, or even non-chaloric sweet things in the gut, and that signals up to the brain through the vagus nerve, and those signals converge on pathways that relate to dopamine and so on. in the gut and that signals up to the brain through the vagus nerve and those signals converge on pathways that relate to dopamine and so on. Well, we also have salt sensors at various locations throughout our digestive tract,
Starting point is 01:35:53 although that the sensation and the taste of salt actually exerts a very robust effect on certain areas of the brain that can either make us crave more or say it, meaning fulfill our desire for salt. And you can imagine why this would be important. Your brain actually has to register whether or not you're bringing in salt in order to know whether or not you are going to crave salt more or not. And beautiful work that's been done by the soccer lab, ZUKER, soccer lab at Columbia University as well as many other labs,
Starting point is 01:36:25 have used imaging techniques and other techniques, such as molecular biology, to define these so-called parallel pathways, parallel meaning, pathways that represent sweet or the presence of sweet taste in the mouth and gut, parallel pathways, meaning neural circuits that represent the presence of salty taste in the mouth and gut, and so on. And then those go into the brain, move up through brainstem centers and up to the
Starting point is 01:36:49 neocortex. In need where our seat of our conscious perception is to give us a sense and a perception of the components of the foods that we happen to be ingesting. And a sense and a perception of the fluids and the components of those fluids that we happen to be ingesting. Now, parallel pathways, as I'm describing them, are a fundamental feature of every sensory system, not just the taste system, but also the visual system.
Starting point is 01:37:15 We have parallel pathways for perceiving dark objects or just light objects for perceiving red versus green, et cetera. This is a fundamental feature of how we are built and how our nervous system works. And in the Taste system, much like in these other systems, these pathways are indeed parallel, but they converge and they can influence one another. And I think the simplest way to put this is in the context, first of the visual system whereby your ability to detect the color red has everything to do with the fact
Starting point is 01:37:45 that you have neurons in your eye that absorb long wavelengths of light that we call reds, red wavelengths of light, which are longer wavelengths than, say, blue light, which is shorter wavelength, but it is really the comparison of the electrical activity of the neurons that absorb red light with the activity of the neurons that absorb green light, which actually gives you the perception of red. That might seem a little counterintuitive, but indeed it's not. It's actually because something is red and has less greenness that we perceive it as more red than the green.
Starting point is 01:38:20 This is actually the way that your entire nervous system works, is that we aren't really good at evaluating absolute levels of anything in the context of perception. It's only by comparison. And actually there's a fun experiment that you can do. I think you could probably find it easily online. You could also do this experiment at home. You can stare at something that's red or green for that matter for a while. So you make an active decision to not blink and to stare at something that's red.
Starting point is 01:38:48 And then you look away from that thing and you'll actually see a green after image of that red object. Conversely, if you look at something that's green for a while and you stare at it and you look away, you will see the red after image of that thing. Now, the TASystem doesn't have quite the same aftertaste type effect, but nonetheless the pathways, the parallel pathways for salty and the parallel pathways for sweet and bitter
Starting point is 01:39:13 and so on can actually interact. And this has important relevance in the context of food choices and sugar craving. One of the things that's common place nowadays is in many processed foods, there is a business, literally, a business of putting so-called hidden sugars. And these hidden sugars are not always in the form of caloric sugars. They're sometimes in the form of artificial sweeteners into various foods. And you might say, well, why would they put more sugar into a food and then disguise the sugary taste, given that sweet taste often compel people to eat more of these things.
Starting point is 01:39:47 Well, it's a way actually of bypassing some of the homeostatic mechanisms for sweet. Even though we might think that the more sweet stuff, we eat the more sweet stuff, we crave. In general, people have a threshold whereby they say, okay, I've had enough sugary stuff. You can actually experience this if you ever feel like something is really, really sweet. Take a little sip of water with a little bit of lemon juice in it or vinegar, and it will quickly quench that overly sweet sensation or perception. It will disappear almost immediately. There's actually a practice in fancy meals of cleansing the palate through the ingestion of different foods, and that's the same idea that you're cleansing the palate.
Starting point is 01:40:24 You're actually neutralizing the previous taste so then they can bring yet another dish to overindulge you in decadence and so forth. So these sensory systems interact in this way by putting sugars into foods and hiding the sugary taste of those foods. Those foods, even if they contain artificial sweeteners, can activate the sorts of neurons that we talked about at the beginning of the episode, like the neuropod cells,
Starting point is 01:40:50 that will then signal to the brain to release more dopamine and make you crave more of that food. Whereas had you been able to perceive the true sweetness of that food, you might have consumed less, and indeed that's what happens. So these hidden sugars are kind of diabolical. Why am I talking about all of this in the context of an episode on salt? Well, as many of you probably noticed, a lot of foods out there contain a salty sweet
Starting point is 01:41:16 combination, and it is that combination of salty and sweet, which can actually lead you to consume more of the salty, sweet food than you would have. If it had just been sweet or it had just been salty, and that's because both sweet taste and salty taste have a homeostatic balance. So if you ingest something that's very, very salty, pretty soon your appetite for salty foods will be reduced. But if you mask some of that with sweet, well, because of the interactions of these parallel pathways, you somewhat shut down your perception of how much salt you're ingesting, or conversely, by ingesting some salt with sweet foods, you mask some of the sweetness
Starting point is 01:41:57 of the sweet foods that you're tasting, and you will continue to indulge in those foods. So salty, sweet interactions can be very diabolical. They can also be very tasty, but they can be very diabolical in terms of inspiring you to eat more of a particular food than you would otherwise if you were just following your homeostatic salt or your homeostatic sugar balance systems. And the beautiful imaging work that's been done by the Zuckerlab and other labs has actually been able
Starting point is 01:42:23 to reveal how some of this might work by showing, for instance, that a certain ensemble, meaning a certain group of neurons, is activated by a sweet taste and a non-overlapping, distinct set of neurons, just nearby, sitting cheap to gel with those other neurons, would be activated by salty taste and yet others by bitter taste, et cetera, So there's a separate map of these different parallel pathways, but that when foods or fluids are ingested that are both salty and sweet, you get a yet entirely different ensemble of neurons activated.
Starting point is 01:42:56 So your brain, whether or not it's for your visual system or your auditory system or your taste system, has a way of representing the pure form of taste, salty, sweet, bitter, et cetera, and has a way of representing the pure form of taste, salty, sweet, bitter, et cetera, and has a way of representing their combinations. And food manufacturers have exploited this to a large degree. I mention all of this because if you're somebody who's looking to explore either increasing or decreasing your sodium intake for health benefits, for performance benefits. In many ways, it is useful to do that in the context of a fairly pure, meaning, unprocessed
Starting point is 01:43:31 food intake background, whether or not that's keto, carnivore, omnivore, intermittent fasting or what have you. It doesn't really matter. But the closer that foods are to their basic form and taste, meaning not large, combinations of large amounts of ingredients, and certainly avoiding highly processed foods, the more quickly you're going to be able to hone in on your specific salt appetite and salt needs, which as I've pointed out numerous times throughout this episode are going to vary from person to person depending on nutrition, depending on activity, depending on hormone status,
Starting point is 01:44:04 or even portion of your menstrual cycle for that matter. vary from person to person depending on nutrition, depending on activity, depending on hormone status or even portion of your menstrual cycle for that matter. So if you wanna home in on the appropriate amount of sodium for you, yes, blood pressure is going to be an important metric to pay attention to as you go along and the parameters for healthy blood pressure ranges are readily available online. So I'll let you refer to those in order
Starting point is 01:44:22 to determine those for yourself. But in determining whether or not increasing your salt intake might be beneficial for, for instance, for reducing anxiety a bit or for increasing blood pressure to offset some of these postural syndromes where you get dizzy, et cetera, for improving sports performance or cognitive performance, I can only recommend that you do this in a fairly clean context where you're not trying to do this by ingesting a bunch of salty foods or salty sweet foods, et cetera. And indeed, many people find, and it's a review to bit, and some of the data are reviewed in the book, The Salt Fix, that when people increase their salt intake in a backdrop
Starting point is 01:45:01 of relatively unprocessed foods that sugar cravings can indeed be vastly reduced, and that makes sense given the way that these neural pathways for salty and sweet interact. Now thus far, I've already covered quite a lot of material, but I would be completely remiss if I didn't emphasize the crucial role that sodium plays in the way that neurons function. In fact, sodium is one of the key elements that allows neurons to function at all. And that's by way of engaging what we call the action potential. The action potential is the firing of electrical activity by neurons.
Starting point is 01:45:39 Neurons can engage electrical activity in a number of different ways. They have graded potentials, they have gap junctions, there's a whole landscape of different electrophysiologies of neurons that I don't wanna go into just yet, at least not in this episode. But the action potential is the fundamental way in which neurons communicate with one another. There's sometimes called spikes.
Starting point is 01:46:02 It's just kind of nomenclature that neuroscientists use. I'm just going to briefly describe the action potential and the role that sodium plays. And this will involve a little bit of chemistry, but I promise it will be accessible to anyone even if you don't have a chemistry or a physics background or electrophysiology background. Neurons have an inside and an outside, Inside are things like the your genetic material They have a bunch of things floating around in there that allow those cells to function and they tend to have this Wire extending out of them sometimes a very long wire sometimes a short one that we call the axon and at the end of that Wire that axon they release little packets of chemicals that
Starting point is 01:46:48 that axon, they release little packets of chemicals that either cause the next neuron to fire action potentials or prevent the next neuron from firing action potential. So they can vomit out these little packets of chemicals that either inspire or suppress action potentials in other neurons. The way that that whole process occurs is that a given neuron needs to change its electrical activity. So normally neurons are hanging out and they have what we call a negative charge. And the reason they have a negative charge is that the inside of the cell has things floating around in it like potassium, a little bit of sodium, and some stuff like chloride. These are literally just imagine these as little balls of stuff.
Starting point is 01:47:30 And if they have a negative charge on them, then the inside of the cell is going to tend to be more negative. And outside of the cell, it turns out you're going to have a bunch of stuff that's positively charged. And one of the main factors in creating that positive charge is sodium. Sodium carries a positive charge. So you have neurons that you can just imagine
Starting point is 01:47:52 for sake of this discussion. You can just imagine as a sphere with a little wire sticking out of it. You can put a little minus on the inside for negative. You can put a little plus on the outside for positive. And when that neuron is stimulated by another neuron, if the stimulation, the electrical stimulation is sufficiently high, meaning enough little packets of neurotransmitter have been vomited onto its surface at sufficient concentration, what happens is little pores, little spaces, little gaps open up in the
Starting point is 01:48:28 membrane of that cell that separates the inside from the outside. And because it's positive, there's a lot of positive charge outside and there's a lot of negative inside. It's like a boulder running downhill. All the stuff tends to rush downhill. It tries to create even amounts of charge. So it's negative on the inside, positive on the outside. And what happens is sodium rushes into the cell,
Starting point is 01:48:53 carrying a lot of charge into the cell. And as a consequence, the charge of that cell goes from negative, actually very negative, to quite positive. And if it hits a certain threshold of positive charge because of all the sodium ions going into the cell, then it fires what's called an action potential. And it vomits out its own set of chemicals
Starting point is 01:49:15 onto the next neuron. And so it sets off a chain of one neuron and goes from negative positive, vomits out chemicals onto the next one. The next one, the next neuron that binds to receptors or enters the cell and that cell goes from negative to positive charge, vomit's its contents onto the next cell and so on and so forth. Sodium rushing into the cell therefore is the way that the action potential is stimulated.
Starting point is 01:49:43 In other words, sodium is the way that neurons communicate with one another. The neurons don't stay in a positive charge. Otherwise, they would just keep vomiting out their contents. But they need to maintain some of that and they need to go back to preparing to do it the next time, and the next time by resting a bit. And it turns out that the way they restore their charge is by pushing that sodium back out of the cell. There are mechanisms in place to do that, things like that's so called sodium potassium pump. There's a change in the levels of potassium across
Starting point is 01:50:16 the cell membrane and so on and so forth. If you want to look at a demonstration of this, you can just, you know, you can put into a web browser, the, you know, the action potential, you'll find some beautiful descriptions there on YouTube and elsewhere. Maybe some time on Instagram, I'll do a description with a diagram because I realize a number of people are just listening to this. I can't do that here. I won't do that here because I want everyone to be able to get the same amount of material regardless of whether or not they're watching and they're listening to this. But the point I'd like to make, at least as it relates
Starting point is 01:50:46 to this episode on salt, is that having sufficient levels of salt in your system allows your brain to function, allows your nervous system to function at all. Again, this is the most basic aspect of nervous system function. And there are cases where this whole system gets disrupted. And that brings us to the topic of sodium and water balance.
Starting point is 01:51:09 As many of you have probably heard, but hopefully if you haven't, you'll take this message seriously. If you drink too much water, especially in a short amount of time, you can actually kill yourself, right? And we certainly don't want that to happen. If you ingest a lot of water in a very short period of time, something called the hypernatremia, you will excrete a lot of sodium very quickly and your ability to regulate kidney function will be disrupted. But in addition to that, your brain can actually stop functioning. So
Starting point is 01:51:41 people have actually consumed water to excess, especially after sports events and so forth. If that water doesn't contain sufficient electrolytes, you can actually shut down neurons ability to function at all by disrupting this balance of sodium and potassium in the amount of exercelar sodium and neurons ability to signal to one another through action potentials. And I can't emphasize the importance of action potentials enough. They are the way that I can lift my pen right now, they're the way that I can speak, they're the way that you breathe. They literally control all aspects of your nervous system function.
Starting point is 01:52:15 Now, it takes quite a lot of water intake before you excrete enough sodium that your nervous system is going to shut down. And I certainly don't want to give the impression that simply by ingesting more sodium, your neurons will work better, but it absolutely is the case that if you don't ingest enough sodium, that your neurons won't function as well as they could. And that if your sodium levels are made too low, by hemorrhage or by ingesting so much water, fluid, that you excrete excess amounts of sodium, or through any other mechanism that is, then indeed your neurons won't be able to fire action potentials
Starting point is 01:52:51 and your brain and nervous system simply won't work. And that's one of the primary reasons why dehydration leads to confusion and dizziness and lack of coordination. And I've talked about this a bit in the episode on endurance, but there are instances in which competitive athletes have come into the stadium to finish a final lap of a long endurance race and are completely disoriented and actually can't find their way to the finish line. You know, it might sound like kind of a silly, you know, crazy example, but there are examples of people having severe mental issues and physical issues post exercise when that exercise involved a ton
Starting point is 01:53:26 of sweating or hot environments or insufficient ingestion of fluids and electrolytes because included in that electrolyte formula of course is sodium. And as you just learned, sodium is absolutely crucial for neurons to function. So to briefly recap some of what I've talked about today. We talked about how the brain monitors the amount of salt in your brain and body and how that relates to thirst and the drive to consume more fluid and or salty fluids. We also talked a little bit about the hormones that come from the brain and operate at the level of the kidney in order to either retain or allow water to leave your system. We talked a little bit about the function of the kidney itself, a beautiful organ.
Starting point is 01:54:09 We talked about the relationship between salt intake and various health parameters and how a particular range of salt intake might be optimal depending on the context in which that range is being consumed. Meaning, depending on whether or not your hypertensive is being consumed, meaning depending on whether not your hypertensive, prehypertensive or normal tension. We talked about fluid intake and electrolyte intake, so sodium potassium and magnesium in the context of athletic or sports performance, but also in terms of maintaining cognitive function.
Starting point is 01:54:40 We talked about the galpon equation, which you could easily adapt to your body weight and to your circumstances. Of course, adjusting the amount of fluid and electrolyte intake upwards if you're exercising or working in very hot environments, downwards maybe if you're in less hot environments where you're sweating less and so on. We also talked about the relationship between the stress system and the salt craving system and why those two systems interact and why for some people who may suffer a bit from anxiety or under conditions of stress, increasing salt intake provided it's done through healthy means might actually be beneficial. We also talked about conditions in which increasing salt intake might be beneficial for offsetting
Starting point is 01:55:25 low blood pressure and some of these postural syndromes that can lead people to dizziness and so forth. These are things that have to be explored on an individual basis and, of course, have to be explored with the support of your doctor. I mentioned the salt fix, which I think is an interesting read, keeping in mind that a lot of the information in there runs counter to the typical narrative that you hear around salt, but nonetheless has some very interesting points that you might want to consider. And certainly we'll broaden your view of the history of and the applications of salt as
Starting point is 01:55:56 it relates to a great number of health and performance metrics. We also talked about the perception of salt, meaning the perception of salty taste and how the perception of salty taste and the perception of other tastes like sweet can interact with one another to drive things like increased sugar intake when you're not even aware of it. And indeed, how the combination of salty and sweet taste can bias you towards craving more, for instance, processed foods and why that might be a good thing to avoid. And of course, we talked about salt and its critical role in the action potential, the fundamental way in which the nervous system functions at all.
Starting point is 01:56:32 So my hope for you in listening to this episode is that you consider a question. And that question is, what salt intake is best for you? And that you place that question in the context of your fluid intake. You place that in the context of the diet you're following, the amount of caffeine you might be ingesting, and the diuretic effects of caffeine, and crucially that you place that in the context of the electrolytes more generally, meaning sodium, potassium, and magnesium. Someday there will be an online program or an app I imagine where one could put a bunch of different parameters in about
Starting point is 01:57:11 their particular health status, their particular diet, their particular exercise, et cetera. Maybe it would all be run by AI algorithm or something where it would monitor all of that for us. Then it would spit out for us a precise amount of sodium that we should take in each day. Unfortunately, no such tool or device exists right now. And so all of us have to figure out
Starting point is 01:57:34 the appropriate amount of sodium intake for ourselves. And that has to be done in these contextual considerations. Who knows, maybe one of you will design such an app or such a device. I think it would be very useful. If nothing else, today's discussion ought to illuminate the fact that some strict recommendation of salt intake cannot be made universally across the board for everybody. There's just simply no way that could be done. And yet, I think
Starting point is 01:58:03 most of what we've learned about salt in the general discussions around health are that it's this evil substance. Nothing could be further from the truth. It's an incredible substance. Our physiology is dependent on it. Our cognition is dependent on it. Indeed, our mental and physical health and our performance in essentially all aspects of life is dependent on it.
Starting point is 01:58:24 And I hope I've been able to illuminate some of the beautiful ways in which the brain and the bodily organs interact in order to help us regulate this thing that we call sodium balance. And the fact that we have neurons in our brain that are both tuned to the levels of salt in our body. And position in a location in the brain that allows them to detect the levels of salt in our body and to drive the intake of more or less salt and more or less fluid and other electrolytes, really just points to the beauty of the system that we've all evolved, that allows us to interact with our environment and make adjustments according to the context of our daily and ongoing life. If you're learning from and are enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero cost way to support us. In addition, please subscribe to the podcast on Spotify and or Apple. And on Apple, you have the opportunity to leave us up to a five-star review and you can also leave us a comment. The best place to leave us comments, however, is on the YouTube
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Starting point is 02:00:51 and its many incredible influences on our brain and body. And last but certainly not least, thank you for your interest in science. you

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