Treating arthritis I: super-hydration, alkalisation and magnesium

This is entitled Treating arthritis I, because I want to highlight that it is the first phase of what I think is of the most fundamental importance for people suffering from any form of arthritis. It should really be entitled Treating and preventing any and all disease conditions in everyone I, because these measures are truly fundamental to optimal health in all respects and for everyone throughout life. So even if you don’t have arthritis, you should read on.

This first phase should be viewed as one during which you train yourself to acquire new habits. It is not a treatment per se, but rather a prescription for the basis of a new daily rhythm where hydrating and cleansing the body are of the most fundamental importance. In the end, it is really very easy and very simple. It’s just that we need to get used to it.

Arthritis is a word that means joint (arthro) inflammation (itis). There are tons of different types of arthritis (in the hundreds), but all of them are manifestations of the same thing in different joints and somewhat different ways. And the symptoms: the stiffness, the breakdown of cartilage and other tissues, the ossification or rather calcification, the crippling pain, are all related to the inflammation. But what if there were no inflammation? Would there be no arthritis?

Without inflammation there is no tendonitis where a tendon gets inflamed like in the well known tennis elbow. Without inflammation of the lining of the arteries there is no plaque and no atherosclerosis, and thus no heart disease and no stroke. Without inflammation there is no Multiple Sclerosis (MS), the inflammation of the myelin sheath that covers nerves, and no Crohn’s disease either, inflammation in the gut. We could go on and on like this because inflammation is at the heart of almost every single ailment from which we suffer. The reason is simple: inflammation is the body’s way of responding to injury in our tissues.

We sprain an ankle and it swells up by the inflammation that follows the partial tearing of ligament and tendon: this is essential for bringing plenty of blood carrying all the specialised molecules and nutrients necessary to repair the injured tissues. What is the best course of action? Just rest and allow the ankle to heal. The more we use it, the slower the healing will be, the longer the inflammation will last, and the more we will increase the chances of causing some more serious or even permanent damage to these fragile tissues. Without the body’s inflammatory response mechanisms, healing would be impossible.

In fact, repair and growth would also be impossible; muscle growth would be impossible. The process is rather simple: stress and tear (injury) followed by inflammation and repair or growth. This applies to body builders who develop enormous muscle mass over years of intense daily workouts, but it also applies to a baby’s legs kicking and tiny hands squeezing your index finger tightly. It applies to their learning to hold their head up and pulling themselves to their feet with the edge of the sofa to then take those first few steps. It applies to me, to you and to every animal. So, once again: repair and growth of tissue depends on the body’s inflammatory response mechanisms. In a well-functioning metabolism, this process takes place continuously in a daily cycle regulated by activity during the day and rest during the night: stress, tear and injury to tissues during activity; repair, growth and cleaning during the night.

Difficulties arise when inflammation becomes chronic. Either a low-grade inflammation that we can ignore completely and go about our business until it manifests in the form of a serious health concern, or a sustained,  sub-acute state of inflammation that does indeed make it difficult to go about our business, but that we can nonetheless learn to ignore or cope with hoping that it will eventually disappear. Unfortunately, this is how it is for most of us to a greater or lesser extent, whether we are aware of it or not. If it weren’t the case, there wouldn’t be hundreds of millions of people suffering from arthritis the world over, and atherosclerosis-caused heart attacks and strokes would not be claiming the lives of more than one quarter of the population of industrialised countries.

As an aside, for those of you who are interested in measurements and quantifiable effects, among the best markers of chronic inflammation are C-Reactive Protein (hsCRP) and Interleukin-6 (IL-6). The number of white blood cells relate to immune response, and if elevated mean the body is fighting something. Elevated concentrations of Ferritin and Homocysteine (HcY) are also associated with chronic inflammation much elevated risks of heart attack and stroke. You can easily get a blood test to check those numbers among other important ones (see Blood analysis: important numbers).

So what is it that causes a person to develop arthritis at 50 or even 40 years of age, while another person only begins to have mild signs of it at 80? What is it that causes a teenager to develop the crippling Rheumatoid Arthritis (RA) at 16, while none of her friends do? Why does only 1 in 400 develop Ankylosing Spondylitis (AS) or bamboo spine, characterised by the chronic inflammation of the spine, the ossification and gradual fusion of the vertebrae? Who knows?

But, for example, approximately 90% of AS patients express the HLA-B27 genotype and exhibit the HLA-B27 antigen, which is also expressed by Klebsiella bacteria. Could it be the bacteria that causes the damage and injury to spinal tissues and structure, which then follows by inflammation that over time becomes chronic, and since the bacteria remains and continues its damaging activities, the inflammation continues to grow together with all the awful symptoms? Maybe. The debilitating effects of certain bacteria and viruses such as Epstein Barr or HPV for example, that persist in the bloodstream over years and decades, are well known. And the chronic inflammation that results of the activity of infectious agents such as these is also a well established effect, even claimed by some to be among the primary causes of arterial disease (see Fat and Cholesterol are Good for You in the Bibliography page.

But whether it is AS or arterial disease, MS or tendonitis, what is common to all is inflammation, and what needs to be addressed are the causes of the inflammation, not the inflammation itself, which is what we do with anti-inflammatory medication. The inflammation is the body’s response to the injury. What we need to do is find and stop the process causing damage and injury to our tissues, and once the tissues have healed, the inflammation will disappear of itself.

There are many things that cause injury to our tissues, and we will look at all the most important ones in greater detail in subsequent posts, but it is fundamental to address first order issues first. Among the most fundamental issues of all are therefore those with which we concern ourselves in the first phase of treatment:  super-hydration, alkalisation and magnesium. But the truth is that these fundamental elements are what everyone concerned with optimising their health should actually concern themselves with first, before everything else.

Super-hydration

Chronic dehydration is at the root of so many health problems that it is hard to know where to begin. I’ve written a few posts on the importance of water that you can identify by their title. If you’ve read them and want to know more, you should read Your Body’s Many Cries for Water (see Bibliography). In relation to arthritis, however, water is not only the primary means to reduce inflammation of stressed cells and tissues, but it is also what gives our cartilage suppleness and flexibility.

Cartilage a very simple tissue. It is water, 85% in healthy cartilage, down to 70% or less in compromised cartilage and in most older people, held within a matrix of collagen and other proteins that consists of a single type of cell called chondrocyte. These cells have very special electrical properties that give cartilage its amazing resistance to friction and pressure. Without sufficient water, however, the chondrocytes cannot work correctly, cartilage dries out and breaks down, and calcification grows.

What is totally under-appreciated is that because cartilage does not have a blood supply, nerves or lymphatic system, water makes it into the cartilage through the porous end of the bone to which it is stuck, and the only way water can make it into the bone in order to get to that porous end to which the cartilage is attached is through the blood that makes it into the bone. Since there is, within the body’s functions, a definite hierarchy in water usage in which the digestive system is naturally the first served since it is through it that water enters, even the mildest dehydration can be felt in the function of the most water-sensitive tissues like those of the lungs (90% water) and muscles (85% water), (something any athlete who has drank alcohol the night before a race or even training run or ride will have noticed), it is unfortunately often the cartilage that suffer the most. Dehydration will make it such that the soft conjunctive tissues at the ends of our bones, in every joint, and that allow us to move will not get the water supply they need to remain well hydrated, supple and flexible. This is really the most important point to remember. What is also highly under-appreciated is the vital importance of silica in the form of silicic acid in the growth, maintenance, repair and regeneration of all connective tissues, including and maybe especially bones and cartilage (here is a good article about it). Silicic acid should therefore be included in all arthritis treatment programmes.

How do we super-hydrate? By drinking more, as much as possible on an empty stomach, and balancing water with salt intake. You should read How much salt, how much water, and our amazing kidneys, and make sure you understand the importance of a plentiful intake of water, an adequate intake of salt, and the crucial balance of these for optimal cellular hydration and function. Detailed recommendations are given below.

Alkalisation

Chronic acidosis, some would argue, is not only at the root of innumerable health complaints and problems, but that it actually is the root of all health disorders. The reading of Sick and Tired, The pH Miracle and Alkalise or Die is, I  believe, enough to convince most readers that that premise is in fact true. Not surprisingly though, it is not possible to alkalise bodily tissues without optimal hydration. And so we immediately understand that chronic dehydration is the primary cause of chronic and ever increasing tissue acidosis. Therefore we address both simultaneously, and in fact, cannot do otherwise.

Briefly, what is essential to understand is that healthy cells thrive in an alkaline environment, and indeed require an alkaline environment to thrive. Conversely, pathogens such as moulds, yeasts, fungi, viruses and bacteria thrive in acidic environments. Healthy cells thrive in well oxygenated aerobic environments, whereas pathogens thrive in anaerobic environments deprived of oxygen. Since this is so, we can say, crudely speaking, that if the tissues and inner environment of the body—its terrain—is alkaline, then pathogens cannot take hold nor develop nor evolve nor survive in it. On the other hand, if the body’s terrain is acidic, then they thrive, proliferate, and overtake it, sometimes slowly and gradually, but sometimes quickly and suddenly, causing sickness and disease.

Everything that we eat and drink has an effect that is either alkalising, acidifying or neutral. This is after digestion, and has little to do with taste. All sweet tasting foods or drinks that contain sugars, for instance, are acidifying. I will write quite a lot more about pH and alkalisation in future posts. For now, we are concerned with alkalising through super-hydration, and this involves drinking alkaline water and green drinks. By the end of phase I, drinking your 2 litres of alkaline water and 2 litres of super-alkalizing green juice should be as second nature to you as brushing the teeth before bed.

Magnesium

As I attempted to express and make evident the importance of magnesium for every cell and cellular process in the body in Why you should start taking magnesium today, and thus show that we all need to take plenty of magnesium daily in order to both attain and maintain optimal health, for someone suffering from arthritis it is extremely important, it is crucial. And the reason is very simple: arthritis is characterised by inflammation, stiffening and calcification. They come together, of course, and it is useless to even wonder if one comes before another. Regardless, the best, most effective, most proven treatment or antidote for inflammation, stiffening and calcification is magnesium.

Magnesium, injected directly into the bloodstream, can almost miraculously stop spasms and convulsions of muscle fibres, and release, practically instantaneously, even the most extreme muscular contraction associated with shock, heart attack and stroke. This is used routinely and very effectively in birthing wards and surgery rooms. Magnesium is the only ion that can prevent calcium from entering and flooding a cell, thereby causing it to die, and magnesium is the best at dissolving non-ionic calcium—the one that deposits throughout the body in tissues and arteries, and over bone, cartilage, tendons and ligaments—and allowing all this excess calcium to be excreted: precisely what we must do in treating arthritis.

In addition, magnesium is very effective at chelating (pulling out) both toxic heavy metals like mercury and persistent chemicals that bio-accumulate in blood, brain and other tissues. For too many unfortunately unsuspecting people, heavy metal toxicity is the cause of a plethora of various symptoms, wide-ranging in nature, hard to understand or associate with some known and easily identifiable condition, but that cause them often immense discomfort up to complete disability.

Putting all of this into practice

When you get up in the morning, you go to the bathroom, undress and spray or spread on your legs, arms chest and belly, neck and shoulders, the 20% magnesium chloride solution (4 teaspoons of nigari with 80 ml of water for a total of 20 g in 100 ml of solution). You wash your hands and face well, put your PJs back on, and head to the kitchen to prepare your water and green drinks for the day.

Line up three wide-mouth 1 litre Nalgene bottles. In each one put: 5 drops of alkalising and purifying concentrate (e.g. Dr. Young’s puripHy) and 10 drops of concentrated liquid trace minerals (e.g. Concentrace).

In the first bottle, add 50 ml of the 2% solution of magnesium chloride (made with 4 teaspoons of nigari dissolved in 1 litre of water), 50 ml of aloe vera juice, 20 ml of liquid silicic acid, fill it up with high quality filtered water, shake well to mix, and take your first glass with 1 capsule of Mercola’s Complete Probiotics. You should drink this first litre over the course of about 30 minutes, taking the third or fourth glass with an added 1-2 teaspoons of psyllium husks. (The aloe vera and psyllium husks are to help cleanse the intestines over time.)

In the second and third bottles, add a heaping teaspoon of green juice powder (e.g., Vitamineral Green by HealthForce), 1/2 to 1 teaspoon of fine, grey, unrefined sea salt, 1/4 teaspoon of finely ground Ceylon cinnamon, a heaping mini-spoonful of stevia extract powder and a single drop of either orange, lemon or grapefruit high quality, organic, food-grade essential oil. Shake well. One of them you will drink between about 10:00 and 12:00, the other between 15:30 and 17:30. Shake every time you serve yourself a glass or drink directly from the bottle to stir up the solutes in the water. You should take these two bottles with you to work and/or keep them in the fridge until needed: the drink is really nice when it’s cool.

Now that the magnesium has been absorbed through the skin—this takes around 30 minutes, you can go have a shower to rinse off the slight salty residue that feels like when you let sea water dry on your skin without rinsing it off. You should wait at least 30 minutes after you have finished your first litre of water before you eat anything.

By about 10 or 10:30, depending on when you finished breakfast, you should start to drink your first litre of green drink and continue until about 12:00 or 12:30. Make sure you finish drinking 30-45 minutes before you eat. Wait at least couple of hours after eating. Then start drinking the second litre of green drink by about 15:30 or 16:00 until about 17:30 or 18:00. Again, make sure you stop drinking always at least 30 minutes before eating. Depending on when you eat dinner, you should drink a half litre of plain water 30 minutes before the meal. The general rules for drinking you should follow are: 1) always drink at least 500 ml up to 30 minutes before eating, and 2) do not drink during or within 2 hours after the meal.

Before going to bed, take a small glass of water with 50 ml of 2% magnesium chloride solution. And that’s it for the day. And tomorrow and the next day and the day after that, keeping to this schedule, until it becomes perfectly natural and customary. After four weeks, you should do another blood test and see how the numbers compare to those before starting. In addition, if you are interested in this from the scientific standpoint, or just curious, or both, you should get Doppler imaging of your coronary and cerebral arteries, as well as an MRI of the joints in your body, including the spine, before you start and at then end of every phase. It will also be extremely informative to test and record the pH of at least your first urine every morning; any additional urine pH readings will be very useful and tracing the progress of the gradual de-acidification of your tissues and the days and the weeks progress. And finally, the transdermal magnesium therapy (putting the 20% solution on your skin), should last 6-8 weeks. By that time, you intracellular magnesium stores should have been replenished. We continue taking the 2% solution indefinitely, and use transdermal magnesium once in a while (once or twice per week).

The great advantage of the transdermal magnesium is that almost all of it is absorbed into your tissues and bloodstream. The oral magnesium is absorbed a level between 25 and 50%, and this depends primarily on the amount of magnesium in the blood when you take it. This is why it is very important to take it first thing in the morning when magnesium is at its lowest, and then in the latter half of the afternoon and before bed, those times when concentrations are lowest. You don’t have to worry about too much magnesium because any excess will be excrete in the urine and faeces. You should just worry about not enough: that’s the real problem. Incidentally, the fact that almost all the magnesium that you put on your skin is absorbed underlines the importance of carefully choosing what we put on our skin. Because in the same way, anything we put on it will be absorbed into our system. So putting coconut and almond oil is just as good for our skin and our health, as it is bad to put on creams and lotions with synthetic chemicals and compounds that all make their way into our blood. General rule: if you cannot eat it, don’t put it on your skin. (Please also read my Updated recommendations for magnesium supplementation.)

That’s it for the first phase: mostly drinking a lot more than you used to, with a few special tweaks to what and when you drink. I haven’t mentioned anything about food even though you can obviously know from the rest of the articles on the blog that this will come in time: in the second phase. We first deal with the first order terms, then the second order terms, and after that with the third and fourth order terms. That’s very important to grasp: what has the most and what has the least impact and thus importance.

How much salt, how much water, and our amazing kidneys

Salt, the one we put on food, is composed almost exclusively of sodium chloride (NaCl) that very easily dissolves in water into positively charged sodium (Na+) and negatively charged chloride (Cl-) ions. And there is something very special and unique about these ions: in our blood, Na+ and Cl- are present in the highest concentrations and maintained in the narrowest of ranges. This is very revealing, and means, quite plainly, that sodium and chloride are the most important  extracellular electrolytes. This is a simple fact. Now, forget everything you’ve heard, been told, or read about salt being bad for you, and consider this:

Our blood is made of red blood cells (45%) and white blood cells and platelets (0.7%) floating in blood plasma (54.3%). Blood plasma shuttles nutrients to cells around the body and transports wastes out. It consists of 92% water, 8% specialised mostly transporter proteins, and trace amounts of solutes (things dissolved or floating in it). And although circulating in trace amounts, the solutes—especially sodium—are vital. The concentration of solutes in blood plasma is around 300 mmol/l (don’t worry about the units for now). In the highest concentration of all is sodium at 140 mmol/l. In the second highest concentration of all is chloride at 100 mmol/l. The sum of these is 240 mmol/l. So, from these numbers alone, we see that blood plasma is more or less just salty water.

Don’t you find this amazing? Don’t you find it amazing that nobody has ever told you this straight out in this way? And isn’t it amazing that we have been and continue to be told to avoid eating salt because it is bad for us: that it causes hypertension that predisposes us to heart disease? It really is completely amazing and ridiculous and also rather sad. But misunderstandings of this kind are unfortunately much more common than they should, as you may remember from What about cholesterol and Six eggs per day for six days: cholesterol?, but also from Minerals and bones, calcium and heart attacks and A diabetic’s meal on Air France. As you will understand for yourself in a few moments, the problem is not too much salt; the problem is not enough water:

Hypertension is not caused by excessive salt consumption. It is caused primarily by chronic dehydration and magnesium deficiency.

Taking a look at the other electrolytes, bicarbonate (HCO3-), the primary pH regulator, is the third most highly concentrated molecule in plasma at 20 mmol/l. Potassium (K+) is the fourth at 4-5 mmol/l, then calcium (Ca 2+) and magnesium (Mg 2+) both at about 1 mmol/l. Therefore, the concentration of sodium in the blood is 7 times higher than that of bicarbonate, 40 times higher than that of potassium, and about 140 times higher than that of calcium and magnesium. And as with everything else in our body’s exquisite physiology, there are very good reasons for this:

Every cell in every tissue and in every organ of our body relies on an electrical potential difference between the fluid inside the cell membrane and the fluid outside of it in order to function: produce energy and transport things in and out. This is particularly important in active “electrical” tissues such as muscles and nerves, including neurones, that simply cannot work—cannot contract and relax in the case of muscle fibres, and cannot fire off electrical pulses in the case of nerve fibres and neurones—without a well-maintained and stable potential across the cellular membrane.

This resting potential across the membrane results from the delicate balance of the equilibrium potential and relative permeability through the cellular membrane of the three most important ions: Na+, K+ and Cl-. The potential is maintained by the sodium-potassium pump: a specialised protein structure in the membrane that ensures the concentration of potassium (K+) stays low outside the cell and high inside the cell, and conversely, the concentration of sodium (Na+) stays high outside the cell and low inside. This is the main reason sodium is so important and why it is so carefully monitored and scrupulously reabsorbed by the kidneys, but there are plenty more.

Obviously, this is not an accident. Nothing about the way our body functions is an accident, and no matter how well a particular physiological function or mechanism is understood or not, we can be confident that it is as perfect and finely tuned as it can be because each and every bodily function is the result of adaptations and refinements over billions of years of evolution. This is not a typo: I really did mean to write billions of years. Because every single cell of which we are made has evolved from all of its predecessors as far back as the very first organic molecules that eventually organised in the very first cell: a group of more or less self-organising organelles that developed a symbiotic relationship with one another just because it benefitted them in some way, and found it safer to cluster together behind a fatty membrane through which they could interact with the outside on their own terms.

The aim of every single self-organising entity, from the simplest virus, bacterium or organelle like the mitochondria (our cellular energy-production furnaces), to highly specialised cells in the brain, in the liver or lining a part of the microscopic nephron tubule of one of the millions of these specialised filtering units in our kidneys, to largest groupings of cells in tissues, organs and systems of organs, has always been and always will be the same: survival. Therefore, to understand living systems objectively we have to understand them from the fundamental perspective of the cell itself, the tissue, the organ and the system of organs itself because every adaptation it undergoes is always aimed at improving its own odds of survival. It is very important to keep this in mind and know that everything that happens in a living system always does so in relation to something else and always for good reason, even when we don’t understand the reason, which in itself is also very important to remember.

I use this opportunity to whole-heartedly recommend Lewis Dartnell’s book Life in the universe. Almost every page for me was a delightful discovery of things I was unaware of and found the book truly illuminating.

Coming back to salt, even though we look mostly at sodium and chloride that are the principal constituents of any kind of salt we put on our food, I very strongly recommend always and exclusively using a real salt: any kind of unrefined sea salt (French, cold water, Atlantic salt is particularly clean and rich in trace minerals), Himalayan salt, Smart Salt or Real Salt (the last two are registered trade marks and very rich in trace minerals). On the contrary, I strongly discourage eating chemically manufactured table salt or even refined sea salt, which are not only stripped of trace minerals found in natural, unrefined salts, but contain varying amounts of chemical additives such as whitening agents, for instance.

Now, without regard for polemical disputes, pseudo-scientific discussions and debates, or otherwise unfounded views and opinions about salt, can we answer the simple question: how much salt should we generally eat? I believe we can, but although it may seem so, it is not that simple a question. So let’s first ask a simpler one:

How do we make a solution with the same concentration of sodium and chloride as our blood plasma?

To answer this our approach is simple: use the mean concentrations of sodium and chloride in the blood to calculate how much salt we need to match these such that drinking our salt water solution will neither increase nor decrease their concentration. It might seem a little technical at first, but bear with me, it is in fact quite simple.

This approach is rather well motivated physiologically because the kidneys’ primary function is to maintain blood pressure and concentration of electrolytes—sodium above all others, and each within its typically narrow range of optimal concentration—while excreting metabolic wastes. The kidneys do this by efficiently reabsorbing most of the water and electrolytes from the large volume of blood that goes through them continuously throughout the day and night, getting rid of as much as possible of the metabolic wastes, and carefully adjusting the elimination of ‘excessive’ amounts of water and electrolytes. (You will soon understand why I placed quotation marks around the word excessive.) Let’s start.

You already know that the mean concentration of sodium in the blood is 140 mmol/l. What we haven’t mentioned is that it must be maintained in the range between 135 to 145 mmol/l. You also know that the mean concentration of chloride is 100 mmol/l, and it must be maintained between 95 and 105 mmol/l. The atomic mass of Na is 23, hence one mole (abbreviated mol) is 23 g, and thus one millimole (abbreviated mmol) is 23 mg. The atomic mass of Cl is 35.5, hence one mole is 35.5 g, and therefore one millimole is 35.5 mg. The molecular mass of NaCl is the sum of the atomic masses of Na and Cl, which implies that one mole of NaCl is 58.5 g, and a millimole is 58.5 mg. (A mole is the amount of substance that contains 6×10^23, Avogadro’s number, elementary entities, in this case, atoms. The molar mass is the same as the atomic or molecular mass.)

Multiplying the concentrations in mmol/l by the molar mass in mg/mmol we get the concentration in mg/l. For Na this equals 140 x 23 = 3220 mg/l or 3.22 g/l, and for Cl it is 100 x 35.5 = 3550 mg/l or 3.55 g/l. This is the mean concentration of sodium and chloride there is in our blood. For a small person like me, weighing, say, 56 kg, there are 4 litres of blood that contain a total of 13 g of Na and 14 g of Cl. This is equivalent to about 2 tablespoons of salt.

It is important to note that this is truly quite a lot in comparison to other ions or molecules in our blood. Glucose, for example, which many—probably most people—mistakenly think as the ‘energy of life’, giving it such great importance, is ideally maintained around 80 mg/dl or 0.8 g/l. This is, therefore, also the amount we would need to add to our salt and water solution to make it have, in addition to that of the salt, the same concentration of glucose as that of our blood. And 0.8 g/l for 4 litres of blood makes a total of 3.2 g of glucose in that (my) entire blood supply. This is about 10 times less than the amount of salt!  What does this tell you about their relative importance in our system?

Now, given that Cl (35.5) is heavier than Na (23), NaCl will have a higher mass fraction of Cl: its mass will be 60% chloride (35.5/58.5) and 40% sodium (23/58.5). This just means that 10 g of NaCl or salt has 6 g of Cl and 4 g of Na. So to get 3.22 g of sodium, we need 8 g of sodium chloride, which provides 4.8 g of chloride.

The simple conclusion we draw from this calculation is that dissolving a somewhat heaping teaspoon of salt in one litre of water gives a solution that has the same concentration of sodium as that of our blood (with a little extra chloride).

Does this mean that we should generally drink such a salt and water solution? No, I don’t think so. Are there times when we should? Yes, I believe there are. But say we drink 4 litres per day, 8 g of salt per litre adds up to 32 g of salt just in the water we drink! If we add even half of this amount to our food, we are looking at about 50 g of salt per day! Isn’t this utterly excessive, especially since we are told by the medical authorities to avoid salt as much as possible, with some people today consuming nearly no salt at all? (This article here takes a sobering look at the evidence—actually, the lack thereof—of the claimed benefits of salt reduction.) And more questions arise: What happens when we eat less salt? What happens when we eat more? What happens when we drink less water? What happens when we drink more?

Eating more or less salt. Drinking more or less water.

Remember that the kidneys try very hard to maintain the concentration of solutes in blood plasma—to maintain plasma osmolarity. Also remember that sodium is by far the most important in regulating kidney function, and it is also in the highest concentration. It is nonetheless total osmolarity that the kidneys try to keep constant, and besides sodium, the other important molecule used to monitor and maintain osmolarity by the kidneys is ureathe primary metabolic waste they are trying to eliminate.

As an aside to put things in perspective about the importance of sodium, plasma osmolarity is typically estimated by medical professionals using the sum of twice the concentration of sodium with that of urea and glucose: calculated osmolarity = 2 Na + urea + glucose (all in mmol/l). Since sodium is typically around 140 mmol/l whereas glucose is less than 5 mmol/l and urea about 2.5 mmol/l, it’s obvious that we could just forget about the latter two whose contribution is less than 3% of the total, and look exclusively at sodium concentration (2 Na = 280; glucose + urea = 7.5, so their contribution is 7.5/(280+7.5) = 2.6%).

Eating anything at all, but especially salt or salty foods, raises plasma osmolarity. In response—to maintain constant osmolarity—the kidneys very efficiently reabsorb water and concentrate the urine. Drinking water dilutes the blood and therefore lowers its osmolarity. In response, the kidneys very scrupulously reabsorb solutes and eliminate water, hence diluting the urine.

If we eat nothing and just drink plain water, beyond the body’s minimum water needs, every glass will dilute the blood further and thus cause the kidneys to try to retain more of the sodium while eliminating more of the water. We are drinking quite a lot, but as the day progresses, we are growing more thirsty. We drink more but go to the bathroom more frequently, our urine grows more diluted, and by the end of the day we find ourselves visibly dehydrated, with chapped lips and dry skin. This seems paradoxical in that while drinking water, we are getting increasingly dehydrated. But it is not paradoxical. It is simply the consequence of the kidneys doing their work in trying to maintain constant blood plasma concentrations of sodium (and solutes). For those of you who have fasted on plain water for at least one day, you mostly likely know exactly what I’m talking about. For those who have not, you should try it and experience this first hand for yourselves. Avoiding dehydration in this case is simple: eat salt to match water intake.

If, on the other hand, we do not drink, then the blood gets more and more concentrated, the concentration of sodium and other ions, urea, and everything else for that matter, rises with time, and the kidneys keep trying, harder and harder with time, to maintain the osmolarity constant by retaining as much as they possibly can of the water that is present in the blood. You might think: why not just eliminate some of the solutes to lower their excessively high concentration? But eliminating solutes can only be done through the urine, which means getting rid of water that, in this state of increasing dehydration, is far too precious, and the kidneys therefore try to retain as much of it as possible, hence concentrating the urine as much and for as long as possible to make full use of the scarce amount of water that is available for performing their functions. But here is a crucial point to understand and remember:

In order to reabsorb water, the kidneys rely on a high concentration of solutes—hyperosmolarity—in the interstitial medium through which passes the tubule carrying the filtrate that will eventually be excreted as urine. This is how water can be reabsorbed from the filtrate: the higher the difference in concentration, the more efficient the reabsorption. If there is plenty of excess salt—sodium and chloride ions—then these solutes is what the kidneys prefers to use to drive up and maintain the hyperosmolarity of the interstitial medium, and urea can be excreted freely. If, however, there is a scarcity of sodium and chloride ions, then the kidneys will do everything to reabsorb as much of the precious ions that are in circulation to maintain adequate concentrations of these in the bloodstream, and at the slightest sign of water shortage and dehydration—to ensure the hyperosmolarity of the interstitial medium for maximum water reabsorption—the kidneys will begin to recycle urea, excreting progressively less of it as dehydration increases.

Most of you will have experienced a long day walking around, maybe while on a trip visiting a city, during which you did not drink for several hours. You might have also noticed that you probably didn’t go to the bathroom either, which you may have found unusual compared to the frequency with which you usually go pee when you’re at home or at work. You will have noticed that your mouth was drier and drier as the hours passed, but also that you felt more and more tired, heavy-footed and without energy.  Eventually it struck you just how thirsty you were, or you were finally able to find water to drink, and drank to your heart’s content. As you drank, you might have felt a surge of energy within as little as a minute or two or even immediately following the first few sips. Soon after, you finally did go to the bathroom, and noticed how incredibly dark and strong smelling your urine was. Now you understand what was happening in your kidneys, why you didn’t go pee for these long hours, why your urine was so dark and smelled so strong. However,  the reason why you felt your energy dwindle as the hours passed, and then return when you drank is still unclear.

Water in the blood regulates its volume. And volume in a closed system determines internal pressure. Our circulatory system is a closed system in the sense that there are no holes where blood either goes in or comes out. Yet at the same time it is not a closed system because water enters and leaves the system: it enters the bloodstream through the wall of the intestines, and leaves it through the kidneys and out into the urine. All physiological functions depend intimately on blood pressure: whether it is shooting up through the roof as we face a huge brown bear towering over us and growling at the top of its lungs, and priming us in this extremely stressful fight-or-flight situation for some kind of high-energy reaction in response, or whether it is as low as it can be during our most soothing and restful sleep deep into the night, when the body is repairing and rebuilding itself. And what is the primary regulator of blood pressure? The kidneys.

I will address the details of how the kidneys function and regulate pressure and osmolarity in another post. For now, what is relevant to understand why your energy faded as the hours passed or, more precisely, as the body got progressively more dehydrated, is straight forward:

As water content decreases, blood volume decreases. As the volume decreases, blood pressure drops. And as blood pressure drops, energy levels go down. It’s as simple as that.

It does not help that as soon as the kidneys detect dehydration and drop in pressure, they release hormones to provoke the contraction of the blood vessels in order to counter the pressure drop. This works to a great extent, but since the arteries and veins are constricted, blood flow throughout the body decreases, which in turn contributes significantly to our feeling increasingly heavy-footed and sleepy. With every passing minute, dehydration increases, pressure decreases, blood vessels contract more and our energy level drops further, to the point where we just want to sit down, or even better, lie down, right here on this park bench, and have a long nap.

Interesting, isn’t it? And here again there is nothing strange or paradoxical in this self-regulating mechanism that eventually puts us to sleep as we get increasingly dehydrated. It is simply the consequence of the kidneys doing their work in trying to maintain constant osmolarity and blood pressure. Avoiding dehydration in this case is even simpler: drink water.

If you’ve read this far, you know that both solutions to prevent dehydration are intimately linked: if we don’t drink enough water we get dehydrated, but if we drink too much water without eating salt we also get dehydrated. So let’s now ask another question:

Precisely how much water?

An adult human being needs on average a minimum of 3 litres of water per day to survive for more than a few days (Ref). This depends on climate and level of activity and a bunch of other factors, but in general the range is well established to be between 2 litres in cooler and 5 litres per day in the hottest climates. As suggested from our previous considerations, minimum water intake is also related to salt and food intake. And although this was obvious to me from my own experience of fasting rather regularly between 1 and 3 days at a time, I had not read about it. But as it turns out, the NRC and NAS both (independently) estimated minimum water intake as a function of food intake to be between 1 and 1.5 ml per calorie. For a diet of 2000 calories this would amount to between 2 and 3 litres. But this obviously does not mean that if we don’t eat anything, we don’t need any water! So, what is the very strict minimum amount of water the body needs before physiological functions break down? The short answer is 1.1 litres. For the slightly longer answer, here is a excerpt from page 45 of The Biology of Human Survival:

If obligatory losses are reduced to an absolute minimum and added up, the amounts are 600 milliliters of urine, 400 milliliters of insensible skin loss, and 200 milliliters of respiratory water loss, a total of 1.2 liters. Because maximum urine osmolarity is 1200 milliosmoles/liter, if diet is adjusted to provide the minimum solute excretion per day (about 600 mOsmol), minimum urine output may fall, in theory, to 500 milliliters per day and maitain solute balance. Hence, the absolute minimum water intake amounts to just more than 1 liter (1.1) per day.

(This is also taught in renal physiology lectures such as this one. If you are interested, you will learn a lot from this longer series of 13 segments on urine concentration and dilution here, as well as from this series of 7 segments on the renin-angiotension-aldosterone system here. I found all of them very instructive.)

Keep in mind that 1100 ml of water per day is the very bare minimum for survival, and that there are absolutely no other water losses: basically, you have to be lying, perfectly calm and unmoving at an ideal room temperature where you are neither hot nor cold, not even in the slightest. That’s not particularly realistic unless you’re in a coma. And to show just how extreme it is, let’s see how much of the water the kidneys need to reabsorb to make this happen:

For someone like me weighing 57 kg, the mass of blood is 57*7% = 4 kg. Since the density is almost equal to that of water, 4 kg corresponds to 4 litres. Of this, we know that plasma accounts for a little more than half (54.7%) by volume which makes 2.2 litres, and since plasma is 92% water, the volume of free water in the blood supply is almost exactly half: 2 litres. Blood flow through the kidneys is, on average, around 1.2 l/min. This amounts to more than 1700 litres per day, and means that for 4 litres of blood in the body, every drop of blood goes through the kidneys 425 times in 24 hours, each and every day.

In the kidneys the first step in filtration is the “mechanical”, particle-size-based separation of the blood’s solids from its liquid component. Water makes up half the blood volume, and therefore represents half the flow through the kidneys: 0.6 l or 600 ml/min (850 litres per day). But only 20% of the total flow goes through nephron filtration, which makes 120 ml/min. In the extreme case we are considering, urine output is taken to be 500 ml in 24 hours, equivalent to 20.83 ml/hour or 0.35 ml/min (500 ml/24 h/60 min). Therefore, to achieve this, the kidneys must reabsorb 119.65 ml of the 120 ml flowing through them every minute. This translates to an astounding 99.7% reabsorption efficiency! I’m very skeptical that your average person’s (generally compromised) kidneys could achieve this, but the point was to quantify how extreme this situation at the limit of human survival really is, and as you can see, it is indeed as extreme can be.

Also, keeping in mind that these minimum vital physiological water losses in these circumstances would occur at a more or less uniform rate throughout the day, it would probably be much better to drink a little at regular intervals during our walking hours than to drink everything at once and nothing else during the remaining 24 hours. But what would be the ideal rate at which we should replenish our water in these extreme circumstances?

Assuming the theoretically minimum combined water losses of 1100 ml are lost evenly over the course of the 24 hours, this corresponds to a water loss rate of 0.76 ml/min (1100 ml/24 h/60 min). This is therefore the ideal rate at which to replenishing it. In practice, we may not have an IV system to do this for us, and we will probably be sleeping long nights as our heart rate and blood pressure will have hit rock bottom. Drinking 1100 ml in 11 hours (to work with round numbers) could be done by taking 100 ml, (half a small glass), every hour. This would be the simplest and most reasonable way to maintain solute balance as best we can.

Naturally, with such a minimal water intake, the kidneys are struggling to maintain osmolarity by retaining as much water as possible. Any additional intake of salt (or food) would make things worse in the sense that it would raise the concentration of sodium (and solutes) in the blood whose balance the kidneys will not be able to maintain without additional water. But remember that eating a 200 g cucumber, for example, supplies nearly no calories as it contains virtually no sugar, fat or protein, while proving almost 200 g (ml) of water. And that, conversely, any drink containing caffeine or alcohol will actually dehydrate as those substances are diuretic and cause the excretion of free water.

A somewhat more realistic scenario is one in which we are not eating, but very moderately active at comfortable temperatures. In this case, most experts would agree that the minimum water requirements would be around 2 litres per day. Since we are fasting, these additional water needs are due to greater water losses through evaporation and physiological activity; not to offsetting increased water needs due to food consumption. Consequently, we should ideally drink about 10 glasses of 200 ml, one approximately every hour from 7h to 19h, and we should not eat any salt.

More realistic but still not so common, is that you are doing a 24 hour fast. The purpose of the fast is to give a break to the digestive system, rehydrate bodily tissues, stimulate more fat burning and flush toxins out of the system. Say we drink 4 litres instead of the minimum of 2. In this case we should, in fact, eat some salt in order to ensure good hydration of tissues by supplying plenty of water through a well hydrated bloodstream without diluting the sodium and thus causing the kidneys to excrete more water. And this brings us back to the basic question that set us on this rather long  investigation:

Precisely how much salt?

But you already know the answer to this question: 1 teaspoon per litre in 2 of the 4 litres. Because we don’t drink during the night for about 12 hours, the body inevitably gets dehydrated. Therefore, the best strategy is to start with plain water to rehydrate the concentrated blood and bodily tissues dehydrated from the night, and end with a litre of plain water in preparation for the dry night coming. You should take the equivalent of 1 generous teaspoon of salt with each of the additional litres of water during the day. This will ensure proper hydration of tissues by preventing excessive dilution of blood sodium levels, and maximum urea excretion. Excess sodium, chloride and any other electrolyte will be readily excreted in the urine.

Finally, the far more realistic scenario and, in fact, the one that for most of us is the everyday, is that we are normally active and eating around 2000 calories a day, typically over the course of about 12 hours. In this case we need the basic 2 litres to offset minimum evaporation and physiological losses, and between 2 and 3 litres to offset the 2000 calories. This makes between 4 and 5 litres, 2 of which must be plain water, and 2 or 3 of which must be matched by a good teaspoon of salt per litre that will most naturally, and maybe also preferably, be taken with the food.

Keep in mind that this is the total salt requirements and many prepared foods contain quite a lot already. The hotter or drier the climate, the more water we need. The more we exercise, the more water and the more salt we need. The more we sweat, the more water and the more salt we need. The more stress we experience, the more water and the more salt we need. And in all of these cases, we also need a lot more magnesium.

By the way, it is interesting but not surprising that this conclusion on the amount of salt per day: about 10-15 g, is also the recommendation of the late Dr Batmanghelidj, the “Water doctor”, as well as that of Drs Volek and Phinney, the “Low-Carb doctors” (see References  for details), although the former emphasises the importance of an abundant water intake, while the latter hardly mention it if at all.

So this is it. We know how much water we should generally drink, and we know how much salt we should generally eat:

We should always drink the bare minimum of 2 litres per day. Ideally we should drink 4-5 litres every day. If for some reason we drink 2 litres or less, we should not take any salt (or food for that matter!). If we drink more than 2 litres, we should match each additional litre of water with 1 teaspoon of salt, taking into account the salt contained in the food we eat. It is always better physiologically to drink more than to drink less. And remember that we hydrate most effectively on an empty stomach by drinking 30 minutes before meals.

Minerals and bones, calcium and heart attacks

Asking Robert Thompson, M.D., author of The Calcium Lie, what causes atherosclerosis and heart disease, he would most likely say that it is the accumulation of calcium in the veins and arteries, but also everywhere else in the body, that leads to a hardening of the tissues, and eventually to the complete stiffening of the blood vessels that inevitably leads to heart attack. He might add that this calcification of the body comes from an imbalance in the amount of calcium that is consumed compared with that of all the other essential minerals required for proper bodily function.

He would also be quick to point out that based on a huge database of about one million results of detailed hair mineral analysis, about 90% of the population is deficient in most if not all elements of the spectrum of essential minerals we need for optimal health, while being over-calcified. Dr Thompson would probably also say that a majority of the conditions that lead to disease, no matter what form it takes, are rooted in mineral deficiencies. Naturally, given that all deficiencies grow with time unless something is done to address the problem, how can this fundamental issue not be related to ageing.

Just as the amount of water in our body and cells tends to decrease with age, so do both bone mineral content and density, as well as the specific hormones like calcitonin and parathyroid hormone. Calcitonin helps fix calcium in the bones, and parathyroid hormone removes calcium from bones when it is required for other purposes. Their main roles is to regulate the amount of calcium to fix in our bones, and their delicate balance depends on factors mostly related to diet and nutrition, but we know that it is intimately linked to Vitamin D levels.

We also know that uric acid tends to accumulate in the tissues throughout the body with time, making every soft tissue stiffer and making our every movement more difficult and painful as we get older, and that an acidic environment tends to leach out minerals from the bones. So what causes bone loss: dropping levels of hormones, dropping levels of Vitamin D, increasing levels of uric acid, increasing mineral deficiencies, all of these, other things?

Thompson repeats throughout his book: “bones are not made of calcium, they are made of minerals”. What minerals? Calcium and phosphorus, yes, but also sodium, sulfur, magnesium, potassium, copper, iodine, zinc, iron, boron, and more. Calcium accounts for about 30% of the mineral content of bone, but phosphate (PO4) makes up about 50% of the bone mass. And in fact, what makes bone hard is calcium phosphate Ca3(PO4)2(OH)2, which immediately shows that it is the balance of calcium and phosphorous intake and absorption—mostly regulated by Vitamin D, which is of vital importance for bone strength and rigidity.

However, it is essential to understand that it is the presence and balance of all of the 84 essential minerals found in unrefined sea or rock salt that are required for optimal overall health, which includes the health of our bones. And remember that table salt contains 97.5% sodium chloride and 2.5% chemical additives, whereas unrefined sea salt from the French Atlantic contains 84% sodium chloride, 14% moisture, and 2% trace-minerals (follow the links to see the chemical analysis of Celtic Sea Salt, Himalayan, and a comparison of the two).

Therefore, one of our primary aims when choosing the foods we eat should be to maximise mineral content. Since Nature’s powerhouses of nutrition, the foods with the highest mineral content and nutritional density are seeds, nuts, sea vegetables, and dark green leafy vegetables, in that order, these are the foods that we should strive to eat as much of as we can in order to always provide the body with maximum amount of minerals that we can. Unrefined sea or rock salt should also be eaten liberally for a total of at least 1-2 teaspoons per day with 2-4 litres of water. (And no, salt does not cause hypertension or any other health problems of any kind, and never has.)

Now, maximising our intake of minerals through our eating of mineral-dense foods, how can we ensure maximum absorption of these minerals? Two key elements are Vitamin D, and fats, especially saturated fats.

Vitamin D is so extremely important for so many things that I simply refer you to the non-profit Vitamin D Council web page for long hours of reading on everything related to Vitamin D. I will just quote the following as an extremely short introduction to it:

Vitamin D is not really a vitamin, but one of the oldest prohormones, having been produced by life forms for over 750 million years. Phytoplankton, zooplankton, and most animals that are exposed to sunlight have the capacity to make vitamin D.

In humans, vitamin D is critically important for the development, growth, and maintenance of a healthy body, beginning with gestation in the womb and continuing throughout the lifespan. Vitamin D’s metabolic product, 1,25-dihydroxyvitamin D (calcitriol), is actually a secosteroid hormone that is the key which unlocks binding sites on the human genome. The human genome contains more than 2,700 binding sites for calcitriol; those binding sites are near genes involved in virtually every known major disease of humans.

Vitamin D is one of, if not the most important substance for optimal health. I take between 25000 and 50000 IU per day, which is approximately the amount produced from about 30 minutes of full body exposure to midday sun for a caucasian. But for the purpose of this discussion on minerals and bones, it is enough to know that vitamin D plays an crucial role in regulating how much calcium and phosphorus is absorbed in the intestine and ultimately fixed in the bones.

On fats there is so much to say that it will have to be for another post. You could read The truth about saturated fats by Mary Enig, PhD, on this coconut oil website that has links to many other interesting articles on fats. And remember that coconut oil is by far the best fat to consume, but more on this another time. But once more, the essential thing to remember is that the more fat there is in the intestines, the more minerals (and antioxidants) will be absorbed into the bloodstream.

Now, what is ageing if it is not the gradual decay of the body and its systems. Given that everything in the body is constituted and constructed from the food we eat and water we drink, isn’t it utterly obvious that in order to maintain the bodymind as healthy as possible for as long as possible it is absolutely essential to ensure that it is always perfectly hydrated by drinking plenty of water before meals, maximise the nutrition density and mineral content of the foods we eat, and minimise intake of harmful substances that disrupt or damage the delicate inner workings of this bodymind? I certainly think so.