A simple 10-step arthritis treatment plan

What are the most important things we can do to stop and reverse the degeneration, and alleviate the stiffness and pain of arthritis? You can be sure that no matter how bad things are, there are many things that will help, and they don’t involve pharmaceuticals.

We looked in some detail at how to treat arthritis in Treating Arthritis I and II, and have at least one of our readers, an artist, Catherine Bath, who has been able to alleviate a great deal of her stiffness and pain, and recover a good amount of mobility and ease of movement by following the various recommendations we made there and throughout this blog.

Here, prompted by a request from a good friend who needs it, we present a simple treatment plan with the most important elements, and just the essential details needed to understand why the interventions are useful, and how to put them into practice right away.

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Illustration of painful, inflamed, arthritic joints. (Image taken from Everyday Health)

1. Hydrate and alkalise

This is the most important point of all. Without it nothing will work, really. Every joint works thanks to the cartilage that allows the bones to move within it without rubbing against one another. Arthritis is always characterised by the degradation of this cartilage and the pain associated with the inflammation caused by the bones not moving properly or rubbing inside the joints. Cartilage is water (85% by weight) held together in a matrix made mostly of collagen, and chronic dehydration is the first cause of cartilage breakdown (details in Your Body’s Many Cries for Water).

Metabolic acids (mostly uric acid) can only be excreted efficiently by the kidneys when there is an excess of both water in which to dilute the acid, and salt to help carry it out in the urine. Without excess water, the kidneys will prioritise retaining as much of it as they can. Without excess salt, the uric acid will be recycled instead of being excreted in order to to maintain the concentration gradient in the medulla of the kidney that ensures its ability to reabsorb as much water as possible. Chronic dehydration and avoidance of salt, coupled with the drinking of acidic liquids and eating of acid-forming foods inevitably leads to chronic acidosis.

To maintain the pH of the blood at 7.365 in spite of the continuous flow of acids into it from the muscles and digestive system, two main coping strategies are available: 1) The body’s main acid buffering mechanism using the reserves of alkalising minerals stored in the bones and teeth to counterbalance the acid load. If you don’t quite understand the implication here, this means erosion of the bones and teeth to put into the blood some of the alkalising calcium, phosphate and magnesium as acid-buffering minerals. 2) The crystallisation of the uric acid to pull it out of circulation, but then storing it into tissues, of which the joints, regrettably for arthritis sufferers, seem to be used preferentially, even though all tissues can be used for this to a certain extent.

The strategy is simple: drink alkaline water (either naturally so, or made to be with pH drops) on an empty stomach, and allow at least 30 minutes before eating. Aim for 3 litres per day. One litre before each meal, drank over a period of one to two hours, is a simple rule of thumb and easy schedule to remember. And aim for 2 full teaspoons of unrefined salt with your meals.

2. Magnesium chloride and sodium bicarbonate baths

Magnesium is at the very top of the list of supplements for anyone in any circumstance. We explored and explained why in Why you should start taking magnesium today.

Transdermal magnesium and bicarbonate therapy is the best way to simultaneously replenish magnesium stores in the cells, while alkalising the tissues directly by transdermal absorption of magnesium and sodium bicarbonate. If you have a bath tub, do this once or twice per week, or more if you can or need it. Add two cups of each magnesium chloride and baking soda, and soak for 45 to 60 minutes.

I also recommend that in addition to this—but crucially if you don’t have a bath—you take magnesium supplements. I take a fat-bound magnesium supplement called L-Threonate. Another alternative is the amino acid-bound supplement called magnesium glycinate (using glycine). Both of these form maximise absorption. Take it with meals.

3. Silicic acid, collagen, hyaluronic acid, and proteolytic enzymes

An essential constituent of hair, skin, and cartilage. Absorption is poor and slow. This means you need to take small amounts every day for long periods of time. Every morning, first thing, with your first glass of water. You will need to do this in cycles of three months on, three month off. I take Silicea, a concentrated water-soluble silicic acid gel by the German brand Huebner.

Collagen and hyaluronic acid will help greatly in rebuilding the damaged cartilage. Look for type II collagen for better absorption. Now Foods has good products at good prices. Also, glucosamine, chondroitin, MSM have all been shown to be useful for joints.

Proteolytic enzymes are responsible for breaking down, building, and repairing tissues. They can be amazing in accelerating a healing process, no matter what it is. Therefore, this is an essential supplement to take in treating arthritis.

4. Vitamin D3 and K2

These are the two vitamins that control and regulate the availability and deposition of calcium. Vitamin D3 makes it available, and vitamin K2 directs it to the bones and teeth.  Lots of vitamin D3 without K2 will lead to calcification with calcium being deposited all over the place in the arteries and soft tissues. Lots of K2 without D3 will lead to a depletion of available calcium in the bloodstream because it will be stored away in the bones and teeth. K2 is also used to decalcify soft tissues by pulling out and redirecting the deposited calcium from the tissues to the bones.

Vitamin D deficiency is universal in the west, and so is vitamin K2 deficiency. Arthritis sufferers need large doses of both for extended periods of time (at least a year). I recommend taking a combo supplement containing both in an optimal ratio, and take as many capsules as needed to bring vitamin D intake to 20 000 – 50 000 IU per day with breakfast and lunch. For years I took DaVinci’s ADK combo, which I think is one of the best. Now I take Life Extension’s D and K combo, without vitamin A, because its presence dampens the activity of vitamin D3. However, vitamin A promotes the healing of tissues. You can take both, alternating between the two.

Another of our readers who had his entire adult life an arthritic wrist that caused him pain and trouble whenever he used his hand for anything at all, followed my suggestion of taking 50 000 IU of vitamin D3 per day, together with the appropriate amount of vitamin K2 to match in the D3 intake, for six months. Within the first month, he found incredible improvement, something he had never been able to achieve using all the methods and drugs that had been proposed to him by MDs. After three months, his wrist was completely healed. He continued for the entire 6 months just to be sure, and now, his painful, debilitating, arthritic wrist that he was living with for more than 20 years, is a thing of past, a bad memory.

5. Vitamin C

Whole food vitamin C is essential for healing and keeping tissues and cells healthy. And there is definitely a difference between whole food C and ascorbic acid. We discussed this in Vitamin C is not vitamin C. This is not specific to arthritis, but everyone with arthritis should be loading up on it. I take The Synergy Company’s Pure Radiance C. You should take at least three capsules, but better 6 capsules per day, split evenly with each meal.

6. Turmeric extract

Turmeric is one of if not the most powerful natural anti-inflammatory. And inflammation is a hallmark of arthritis. You should take an extract that concentrates the curcuminoids, but you should also think of making yourself hot turmeric drinks, adding as much turmeric to your soups and curries as the flavours and combinations of foods will allow. It always needs to be taken with a lot of fat to maximise assimilation.

7. Food

Naturally, you will have guessed that my recommendations for food are the same as always, but even more important in this case when we are trying to bring inflammation as low as possible, and maximise healing:

  • no simple or starchy carbs because they cause inflammation, tissue damage, and metabolic disorder, except for berries once in a while;
  • unlimited unprocessed saturated fats from coconut oil, butter, and animal sources;
  • enough high quality protein from healthy animals including organ meats, especially liver; and
  • as many green veggies as you like, especially leafy like spinach, kale and lettuces, watery like cucumbers, fibrous like celery and broccoli.
  • Avocados are fantastic to eat as often as you want. Walnuts and hazelnuts are excellent health-promoting nuts (either roasted, or raw and soaked, subsequently dehydrated or not).

8. Sunshine, fresh Air, exercise and sauna

Go out in the sun, go for long hike, expose your skin, breath deeply, run up the hills, work your muscles at the gym if you can, go to Pilates and yoga classes, do lots of stretching whenever you can, and go to the sauna when you can. Make sure you stay 15 minutes to get really hot and for the heat to penetrate into the tissues and joints.

9. Iodine

Iodine is the universal medicine. Everyone needs it, and everyone should be supplementing with it. You can read for yourself why in Orthoiodosupplementation. Start at 12.5 mg and work your way up to 50 mg per day. Increment by 12.5 mg each week. Take the supplements on weekdays and give the kidneys a break on weekends. I take Iodoral, and recommend that. Using the generic Lugol’s solution is as good but less convenient.

10. Melatonin and good sleep

Good sleep is absolutely essential for repair and healing. Make sure you get plenty every day. Melatonin has, in addition to its effects in helping you sleep, many other amazingly health-promoting effects that we will explore in another article sometime soon, I hope.

Last words

Are there more supplements you can take? Of course there are. I personally take all of the above and several others. I wanted to stick to the things which I believe most essential. If I were to recommend additional supplements, I would say to take

  • omega-3’s, which are useful for lowering inflammation, as well as tissue healing and repair. I take Life Extension’s Mega EPA/DHA. Don’t take more than the recommended dose. Omega-3’s are very easily oxidised, and should always be taken in very small quantities.
  • Niacin in the form of niacinamide is also a universally useful supplement because it provides molecular building blocks needed by every single cell to produce energy. I take 500-1000 mg/day, but you could take 3000 mg (1000 mg with each meal). Niacin supplements will also do wonders for your mood (see No more bipolar disorder?).
  • Ubiquinol, the active form of Co-enzyme Q10, is also essential in cellular energy. I would recommend at least 50 mg per day, but more (like 100 or even 200 mg) would probably be better.
  • Vitamin B12 is crucially important for health. And the older we get, the more critical it becomes. I get an injection of 5 mg every month, and recommend that for everyone (see B12: your life depends on it).

Keep in mind that the timescale for improvements is long: on the scale of months. If you think that is too slow, ask yourself how old you are, and how long it took to get to the state you’re in. Now, with the answers in mind, remind yourself to be patient. You need to be determined to get better, consistent with your new regimen, and patient. But I assure you that you will get better. And please, keep me posted on your progress.

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Eat your salt, and eat your fat

A couple of months ago, I had just gotten to the locker room at the gym, when a buddy of mine came in. Changing into his workout clothes, looking at himself in the mirror with his shirt off, he said he was tired of this layer of fat over his abs, that he just couldn’t get rid of it no matter how much he tried. He’s a handsome Columbian guy in his mid thirties, super nice, friendly, and easy going, big open smile with nice white teeth. He’s well built, strong, with balanced musculature but … there’s not much definition.

Everyone wants to be cut, of course, and when you’re working out 5 or 6 times a week, like he does, and you can’t get cut, you get frustrated by that. Quite understandable. Meanwhile, I work out typically three times, and I’m “rallado” as he says to me. In english, the term is shredded: so lean that under tension, we see the muscles fibres. In my case, we can see them in every muscle, including the abs. He knew that, obviously, since I’ve been like this ever since we first met a year and a half ago. The only thing that’s changed is that I’ve put on some muscle and use heavier weights in my workouts.

And so, naturally, that was my queue:

– You just need to cut the carbs. The fat is going to melt off on its own in no time. Especially if you are working out the way you do. Just stick to meat and vegetables. Make it simple for yourself. Have eggs and avocados for breakfast, and meat and veggies the rest of the time. If you can skip breakfast, that’s even better: you’ll give your body a longer time to burn fat.

– Alright! I’ll try it!

After our workout, we said goodbye, and he told me he was going to Columbia for a while for his work (he’s part of a several-generation, several-family-member meat business based there, but lives here in Madrid with his wife and young child). He said that even though they always serve so rice, pasta, and potatoes with every meal, he would do his best to stick to the plan of having only meat and veggies. I gave him a good handshake, told him he could do it, and that it was important to be strict for the first month to allow for a good transition to fat-burning.

A few weeks later, he came back. We bumped into each other at the gym again. I was doing chest and back, he had come to do shoulders. He looked noticeably different: his face was smaller, his features more defined, his neck was thinner and more visible, his eyes were whiter and his skin was smoother. He looked 5 years younger! As soon as I saw him, I told him he looked very good, thinner in the face and neck, younger, and clearly healthier. He was happy to hear me say it, of course. He said that many people had told him that he looked younger, and obviously, he could also see it himself when he looked in the mirror. But it’s always nice when someone tells us we look good; it doesn’t happen very often. He had already lost 4 kg.

We saw each other a few more times at the gym like that, working out, but it took a while before he told me that he was feeling weak, that he couldn’t push as much weight as before, that he was often tired, and strangely, often in an angry mood. Naturally, he thought it was because he wasn’t eating carbs. That somehow he was carb-deficient.

– Do you add plenty of salt and fat with your meals meat and veggies?

– No! I don’t! I haven’t added salt to food in years. And I don’t add fat either.

– That’s the problem. You need to start right away. Lots of salt, and lots of fat with your food, whenever you eat.

– What kind of salt, and what kind of fat?

– Unrefined sea salt, organic butter and coconut oil, and olive oil with salads. With every meal. When you go low carb, you not only get rid of accumulated water in your tissues due to the chronic inflammation triggered by carbohydrate exposure (that’s why your face and neck thin out in the first week or two), but you also excrete more salt in the urine. It’s crucial to eat plenty of unrefined salt every day.

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Organic butter and unrefined salt

 

Two days later, when I got to the gym, he was already into his workout, and he was pushing heavy weights on the benchpress, he was walking around with a spring in his step, and he was smiling. I didn’t even need to ask, but I did anyway:

– So, how are things going? Lots of salt and fat?

– Yes! And I feel great! I feel strong, I feel powerful, I’m not tired, and I’m not angry anymore.

– Fantastic! Glad to hear that. And from now on, you’ll always feel like this. No ups and downs, no weakness or lack of energy, no hunger pangs, no mood swings.

Each time we saw each other at the gym in the next weeks, I could tell he was getting more defined. The last time we met, he was again walking around feeling strong and working heavy weights with a smile on his face, and he looked ripped, a lot more defined. And he knew it too. I could tell by the self-confidence.

When we parted, I told him he looked good, that he looked more defined, and more energetic. He was happy: “Thanks a lot for all your advice. It’s really made a huge difference. I feel great, and my abs are starting to show!”

Not eating enough salt and not eating enough fat is a classic mistake that too many people do. We have been brainwashed into thinking we should avoid fats and we should avoid salt. So, when we cut the carbs, we continue to avoid fat and avoid salt. Then, we get tired and weak, and we think it’s because we don’t eat carbs. Totally not! We’re just not getting enough salt and fat.

And so, we have to repeat this, and repeat it over and over again. Eventually, it sinks in. Especially when we feel the difference it makes. Just like it happened in this case with my Columbian buddy at the gym. So, what’s the moral of the story?

You want to feel strong, and energetic? You want to look healthy and young? You want to get ripped with tight 6-pack abs? The formula is simple:

Cut the carbs. Fast intermittently. Drink alkaline water on an empty stomach. Work heavy weights 3 times a week. Eat enough protein. Eat your salt. And eat your fat. Try it. You’ll see. It works like a charm.

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Keto-adaptation for optimal physical performance

A young man I know recently started to play rugby at a higher level, and thus more seriously than he ever has in the past. Being a smart guy, he wants to get his nutrition “on point”, as he writes, in order to perform at his best. He started reading about nutrition on the internet, and found it to be like “a snake oil convention”, which it most certainly is. So, he contacted me to get my opinion on the subject. I’ve been meaning to start writing about training and performance for a while, and balance out all my writings about disease and overcoming disease conditions, and so I thought this would be the perfect opportunity to start.

The first thing that needs to be said is that there are common aspects as well as differences in the way training and nutrition should be optimised for different disciplines and goals. In common to all disciplines, are that we always want to perform at our best, and recover as fast as possible. Those are the basic and most fundamental drivers.

Differences are much greater in number and far wider ranging in kind, but they can include core aspects like the duration of the event: speed and power versus endurance and stamina (think of the 100 meter dash versus the marathon, or the velodrome cyclist versus the Tour de France rider); the kind of effort required: sustained versus bursty (think of rowing versus tennis); the medium and nature of the forces against which we are working: water or air, with an intervening machine or without (think of swimming versus jumping towards the rim to slam dunk the basketball, skying versus bobsledding, wrestling or judo versus Formula 1 racing).

In every case, there are preferred and optimal skills and trained reactions, fitness and body composition, as well as morphology and muscular development. For now, let’s just look at the basics in the sense of what every athlete would want and would benefit from no matter what kind of activity they do: best performance and fastest recovery.

The most fundamental point is mitochondrial energy production

At the root of all activity of the body, and at all levels, is the generation of ATP by mitochondria. This is really the bottom line for everything, because this is what cells use to function and do what is required of them in every instant. Mitochondria, small organelles thought to have migrated into a cellular membrane early in the history of evolution of life on the planet, are present in every cell in different amounts, and are essential for life. They can oxidise or burn any macronutrient—glucose, amino acids, or fat—to produce ATP, but the bulk is derived either from glucose or fat. In the process, they produce byproducts of different kinds and in different amounts based on the nature of macronutrient used for fuel, and on the energy demands. Therefore, for optimal performance with a fixed number of mitochondria, we want:

  1. the maximum efficiency in ATP energy production, and
  2. the minimum amount of metabolically taxing byproducts.

These question of deriving the most amount of ATP in the most efficient way with the least amount of byproducts that ultimately impede physiological function, has been considered in On the origin of cancer cells (1 and 2)To summarise in very few words: fatty acids are the most efficient way to store energy, on a gram-per-gram basis they produce the most ATP when oxidised by the mitochondria in an oxygen-rich environment, and their oxidation result in the least amount of acidic and physiologically costly byproducts. Therefore, the inevitable and obvious conclusion, is that for optimal physical performance, we want maximum metabolic efficiency, and for maximum metabolic efficiency, we need to provide the conditions that allow our cells to use fatty acids as their primary source of fuel.

The key is efficient fat utilisation

Efficient fat utilisation is achieved in three stages, which are really just two, because the second and third blend into one another seamlessly. The first step is making sure cells can use fat as fuel. Because insulin signals cells to store energy, it prevents fat utilisation (lipolysis). Inhibiting lipolysis is one of insulin’s main functions. To allow cells to burn fat, insulin must be low. To lower insulin levels, we must either fast, or restrict carbohydrates (and to a lesser extent protein). In fasting conditions, most people will reach insulin levels low enough to start fat-burning after 12 to 16 hours. With severe carbohydrate and protein restriction, that means getting all or almost all of your calories from fat, the timescale is probably similar.This first step is therefore achieved within 24 to 48 hours.

The second step is basic adaptation to deriving cellular energy needs from fatty acids, those that we eat, and those that are stored within the body’s fat cells (adipocytes). This is achieved over the course of about 4 weeks by maintaining a very low carbohydrate, low to moderate protein, and high fat diet.

The third and last step is full keto-adaptation, achieved within two to four months of consistent carbohydrate restriction. The word keto in the term keto-adaptation refers to the fact that, from the breakdown of fats, the liver manufactures ketones, the one we measure as a marker is usually beta-hydroxybutyrate, used primarily to fuel brain cells that can only use glucose and ketones. This stands in contrast to most other cells that can use fatty acids directly. An exception to this—the only one, as far as I know—are red blood cells that can only use glucose.

A point that needs to be appreciated relates to the potency of insulin to stop fat-burning. As soon as glucose spikes, insulin will spike, and will stop fat-burning. This is particularly important if we are aiming to burn as much fat as possible or become as efficient fat-burners as possible. Consequently, the very worst thing we can do is to have sugar in the morning, just before or just after training. Even a small piece of fruit will do it. This will generally always stop fat burning in its tracks. And not just for a few minutes, but for hours, all the hours necessary for insulin levels to drop back down low enough to allow lipolysis to start again.

Maximally efficient fat utilisation is where an athlete wants to be, because this will ensure that they always use as much fat and as little glucose as possible, maximising endurance potential while minimising production and accumulation of lactic acid in the muscles. The most important benefits this brings are to be able to sustain long hours of exercise without “hitting a wall” from the exhaustion of glycogen stores, and having muscle fibres that can function smoothly unimpeded by the presence of large amounts of lactic acid, something which also significantly accelerates recovery, as very little time is needed to clear out the small amounts that remain in the muscle after the event or training session.

Fat stores are, for practical purposes, inexhaustible. Even in very lean athletes (below 10% body fat), there will be between 5 and 10 kg of fat reserves to draw on during that ironman, that ultra-marathon, or that mountain-bike-around-the-clock event. Each gram of these 5-10 kg provides 9 kcal of fuel. And so, that endurance event lasting 12 hours during which you burn 7500 kcal could be fuelled with just 830 g of body fat. Naturally, this would not happen, because glycogen from the liver and the muscles will always be used in greater or lesser amounts depending on the level of stress (physiological and psychological), and intensity of the exercise. Nonetheless, this is a good illustration of the massive reservoir of fuel we have at our disposal if we train the body to utilise fat efficiently.

montBlanc-ultraMarathon

The Mont Blanc ultra-marathon. All long distance runners should be keto-adapted.

To get to this point, the muscle cells need to be trained to use fat, first at very low intensity to make sure that they can fuel the activity using mostly fat, and then gradually increasing the level of intensity to force adaptation in continuing to burn fat as the primary fuel. Best way to achieved this, is by doing low intensity endurance work in a fasted state. And over time, gradually extending duration and increasing intensity.

Moreover, doing intense, muscularly demanding, resistance training in the fasted state, is beneficial in many additional ways, including the secretion of greater amounts of growth hormone and testosterone for better growth and repair of tissues, as well as more effective fat utilisation, and protein recycling, which involves the breakdown of damaged, scarred, and otherwise unused tissues in order to maintain, feed and rebuild the muscle tissues that are being used. The same mechanisms involved in protein recycling, act to preserve muscles that are active, while facilitating the breakdown of other tissues, and in particular fat stores, that are not.

There are many benefits to training in a fasted state, and doing both low intensity endurance, as well as high intensity resistance training. This is especially true over the long term, as the body becomes increasingly more efficient at fat utilisation, increasingly better at preserving active muscle mass, and increasingly more effective in repairing damaged tissues and cleaning out metabolic wastes. Such conditions are naturally highly favourable for building strong, healthy, lean muscle mass.

Fast recovery requires minimising inflammation

Whenever we do anything physical, some level of micro tears, fractures, and injuries to the muscle and bone tissues take place. The body’s repair mechanisms involve an inflammatory response. Without a healthy inflammatory response, we would not be able to recover from injuries, recover from training, or build bone or muscle mass. In fact, we would not be able to survive. What we want, is a fast and effective inflammatory response to heal, repair, or build whatever needs fixing as quickly as possible. What we do not want is a low-level of chronic inflammation that cripples the body from functioning at its best.

One of the greatest advantages of running on a fat-based metabolism with maximally efficient fat utilisation, is the fact that the muscle cells are fuelled by burning fatty acids without producing lactic acid. This is in stark contrast to a glucose-based metabolism, where most of the energy is derived from burning glucose, and this always produces lactic acid. As intensity increases, the amount of lactic acid produced will depend first on the intensity, and second on the level of keto-adaptation. The better the keto-adaptation, the more fat will be used to fuel the cells at higher levels of intensity. But, no matter what, the keto-adapted individual, and the athlete in particular, will always, and in all circumstances, produce less lactic acid than the one running a glucose-fuelled metabolism.

All acidic metabolic waste products need to be eliminated from the body. This is the role of the kidneys, whose function we have explored in The kidney: evolutionary marvel. For lactic acid that accumulates in the muscles, the first stage is to get it out of the muscle, and this usually takes quite a while. It can take from hours up to several days. The process of clearing it out can be accelerated using massage, stretching, and very low intensity exercise. Alkalising baths are a fantastic therapy for accelerating recovery, and lowering inflammation. Magnesium chloride and sodium bicarbonate baths are therefore an absolute must for the serious athlete. We have detailed the importance, roles and functions of magnesium in Why you should start taking magnesium today, and discussed inflammation and the importance of alkalisation in Treating arthritis (1 and 2). 

In the end, all metabolic acids lead to increased inflammation, and, when they accumulate in joints and tendons, inevitably to injury. Insulin-stimulating carbohydrates also cause inflammation. They trigger hundreds of inflammatory pathways. And so, by eliminating them from our diet, and allowing the metabolism to run on fat, we have done as much as we could ever do with our food to minimise inflammation in the body. This is what an athlete wants for the fastest possible recovery time, with best training performance, and the smallest risk of injury.

The final and most important element for fast recovery and low inflammation is optimal hydration. This is the most important because all of the body’s cleaning mechanisms, and especially the function of the kidneys, depend intimately on water and salt. Drink alkaline water on an empty stomach—at least 3.5 litres per day. Eat plenty of salt with all your food—at least a full teaspoon. The more you sweat, the more water, and the more salt you need. We looked in detail at how much of each is optimal in How much salt, how much water, and our amazing kidneys.

When do we eat?

If we train in a fasted state, the best is to train in the first part of the day, taking advantage of the fact that the fast has already lasted 12 hours or so. We can rather easily extend that further, and train around noon, following about 16 hours of fasting. Either way, we will want to eat between one to two hours after training, allowing a good amount of time to make sure the body is well hydrated, and stress levels have dropped. This will bring us to having our first meal of the day somewhere between 12:00 and 15:00. Different people have different schedules and preferences depending on the rhythm of their work and personal life. There are no hard rules, and things have to remain flexible, as irregularity is also an important part of training the body to be more adaptable. In fact, you should be somewhat irregular with your schedule for just this reason.

We can have only one meal per day, or we can have two, or we can have one big meal and some snacks, or, best of all, we can sometimes have one meal, sometimes two meals, sometimes have snacks, and sometimes not. The main point in training the body for optimal metabolic efficiency, is to be a significant amount of time, somewhere between 12 and 20 hours, without eating, and to train in a fasted state, in conditions of low blood sugar and low insulin levels. We discussed intermittent fasting in The crux of intermittent fasting, concluding that one of the most important points for successful and effective intermittent fasting is that the body be fuelled by fat and not by glucose. As you will have gathered by this point, our context here relies on the fact that the body is keto-adapted, and therefore, fuelled by fat.

What do we eat?

That was the original question my friend wanted answered, and it is, in a way, very simple to answer: we eat only the least contaminated, least processed, and least insulinogenic, the most natural, most nutrient dense, and most digestible.

Least contaminated means minimising our body’s exposure to toxic substances, heavy metals, hormone disruptors, pesticides, herbicides, chemical additives, anything that is toxic in one way or another. Least processed means minimising manufactured foods, of which we don’t need any. Least insulinogenic means minimising foods that stimulate the secretion of insulin from the pancreas, and this means minimising intake of simple sugars and starches, and not over-eating protein which is about half as insulinogenic as carbohydrates.

Most natural echoes least contaminated and least processed, but additionally implies a freshness, a wholesomeness, an absence of adulterations and manipulations. That’s what we want. Most nutrient dense means maximising mineral content, vitamin content, optimising amino and fatty acid profiles, and overall micronutrient content for a given amount of calories. Most digestible means minimising digestive stress, maximising enzyme content and nutrient absorption.

Digestion, the function and health of the digestive system, is essential. Everything from the food we eat is made available and usable—or not—by and through the digestive system. We have written about digestion on many occasions, but most specifically in Understanding digestion, Intensive natural healing, and Why we should drink water before meals.

But in practice, what do we eat? No junk of any kind. No polyunsaturated oils. No sweet things. No starches. Excellent animal foods and excellent plant-based foods: grass-fed, full-fat meats and organ meats like liver; nutrient dense and non-toxic fish like sardines, herring, anchovies, seafood and wild fish (avoid tuna, swordfish and any other large predatory fish, because they contain large amounts of mercury and other heavy metals); fatty nuts and seeds, especially coconut products, but also walnuts, macadamia, almonds, hazelnuts; dark leafy greens, both in salads (mixed baby greens, baby spinach, arugula, lamb’s lettuce, lettuces of all kinds) and steamed (chard, spinach, and anything similar); green vegetables like celery, cucumbers, broccoli, asparagus, and string beens; colourful vegetables like purple cabbage, red and yellow peppers. You can eat pretty much anything you can think of that is not processed, nutrient poor, or highly insulinogenic.

What should you have for breakfast? We already solved that problem! You do not eat breakfast anymore, remember?

What do you have for lunch after training? You’re in a rush or just lazy? Well, make yourself a coconut milk smoothy. You can put some protein powder (whey or plant-based, but never soy!), some superfood powders, some hemp or chia seeds. You prefer it sweet-tasting? Put some raspberries or blueberries, and stevia extract. You prefer it green and salty? Put some spinach and salt. In both cases, you can add avocado whenever you want. You can make it with cacao powder, with vanilla extract, or with almond extract. You can add raw or roasted almond or hazelnut butter, sunflower seed butter or tahini. Anything you want that is wholesome and healthful. You’ll need to experiment to find combinations you like. Start simple with few ingredients, and add things bit by bit to keep on top of the process and the blends of flavours.

If you’re not in a rush, or don’t want to have a smoothie? In this case you eat exactly as described above: healthy, nutrient dense animal and plant-based foods. This can be as simple as a can of sardines with a bag of organic baby greens. And for supper, the same as for lunch, really. The same simple and basic principles apply to everything you eat at all times, with these two additional points to keep in mind:

The first is that because we do not eat for a significant part of the day, and also because we eat either just one or two meals, it is crucial to get enough calories and fat, nutrition and protein. Otherwise, we will quickly find ourselves in calorie deficit, and this means that if we keep it up for a long time, we will first burn through our fat reserves, and then burn through our muscles. As athletes, we definitely do not want this. So, it is very important to get all the calories we need, especially if we train a hard or long hours on a daily basis.

The second is that for good, deep and comfortable, restful and restorative sleep, we shouldn’t go to bed on a full stomach, and most importantly, not on a stomach full of protein. Digestion is energy intensive. In the case of protein, it is also highly thermogenic, which means that it generates heat. Therefore, going to bed after a large protein meal will  lead to a restless, tossing, turning, hot and uncomfortable sleep. For a deep and restful sleep, we want the opposite: little digestive activity, a slow heartbeat, and a low body temperature. This means that large protein meals should be had several hours before bedtime, in the afternoon or early evening, allowing a good three to five hours for full digestion before going to bed. If you can’t avoid eating late at night, then eat light: a salad is perfect. For a snack instead of a light meal, have a couple of tablespoons of almond butter on cucumber slices or with celery sticks, for example. Because sleep is really the most important part of the body’s recovery process, it is imperative to optimise sleep.

Closing thoughts

With all of what we have discussed mind, is it really any surprise that more and more professional athletes are opting for this metabolic advantage? A number of years ago, the tennis champion Novak Djokovic divulged one of his secrets. What was it? It was exactly this. This year, the third time winner of the Tour de France, Chris Froome, also divulged one of his secrets. What was it? It was exactly this. Are you curious, say, about Froome’s standard first meal of the day? Four poached eggs, smoked Alaskan salmon, and steamed spinach. Surprising breakfast? Not in the least. Indeed, an excellent breakfast!

We are seeing more and more runners, swimmers, triathletes, but also power lifters and body builders making the switch. It is to their advantage, and when they themselves feel the difference it makes, they know it to be true, at which point there is no turning back. Obviously! Who in their right mind would give up such a metabolic advantage? I suspect that eventually, this will be the standard.

And it’s not surprising at athletes from various disciplines have made these changes to their diets and lifestyles. What is surprising is that so few have actually done this. The change is low, but there is a clear shift in this direction. This is attested by witnessing training specialists promoting these principles, training athletes in this way, and demonstrating the immense advantages that it brings to them in their performances. Vespa Power discussing fat utilisation on their website is a good example.

Is all this stuff new? Of course not! Medical doctors, nutrition researchers , diabetes and metabolic medicine specialists have been talking about this for many decades. Some pioneers include Atkins, Rosedale, Volek and Phinney. And the tradition has continued and expanded, especially in the last decade.

Is this the whole story? Of course not! It never is. But it covers the basics. I plan to explore different aspects of what we started discussing here. You can read more about all these things on blogs and websites. Here are three I have read: the athletic MD Peter Attia had a good blog with many informative articles (especially in the beginning) about physical performance at different stages of his own keto adaptation process. The professional ironman triathlete Ben Greenfield also has written about his experience going form fuelling his body with glucose to using fat instead. I point to these because they have articles specifically about the process of keto adaptation we describe above as foundational for optimal sports performance, and also because they were both meticulous in quantifying the physiological changes and writing about them.

Marty Kendall has a very good blog on optimising nutrition in the sense that we have discussed here, and have been writing about for five years, starting with our very first post, What to eat: four basic rules. But what Marty has done is to actually quantify the value of foods, using the USDA nutritional database, assigning to each food an insulin index derived from its insulinogenic potential, and a nutrient density score based on its macro and micro nutrient content. The associated Facebook group is a great resource for information on this and related topics.

Now that we’ve reached the end, I hope this was useful, and that I have managed to show that, whatever the reason or motivation, whatever the sport or skill set required, there is really no other option other than this when you are serious about optimal physical performance.

If you enjoy this article, please share it with your friends and help more people.

Intensive natural healing

It is always very difficult to find out what’s wrong, to find out what’s causing our health problems, to find out what is the reason for the stroke or the heart attack we just had, the diabetes or the cancer we were just diagnosed with. It is always very difficult as long as we think of the body in terms of a collection of separate parts pieced together; as long as we think that it is possible for the arteries supplying the brain or the heart to have a pathology that is not shared by every other organ and tissue; as long as we think that it is possible for the pancreas, the prostate or the mammary glands of the breasts to be defective in their function independently of every other cell throughout the body. The moment we see this, we recognise the absurdity of this point of view and the obviousness of the inter-relation of every cell to every other cell, tissue, organ and system.

There is only one whole body mind, and everything that happens to it affects everything else that takes place within it.

Looking at things from this new perspective, there are always only two possible alternatives: healthy or diseased, ranging from one to the other on a continuous scale with every possible point in between along the line. From this perspective, every medical intervention or treatment that is not intended to correct or remedy something acute—to fix a broken bone, to save someone whose kidneys or liver just failed, to stitch up a wound to prevent the loss of too much blood—but instead attempting to address a chronic disease condition—treating heart disease, diabetes, cancer, arthritis, Alzheimer’s, etc—is bound to fail.

The failure comes from the misunderstanding that stems from the misguided premise that views the body as a collection of parts working to specific ends more or less independently of one another. If we are to ever overcome our health problems and thrive throughout a long and happy life, it is this basic premise—this misguided and erroneous premise—that must be thrown out and replaced by the clear understanding that there is only one whole body mind, and that everything in it affects and is affected by everything else.

We are sometimes, maybe most often, faced with a major health issue that is acute because it is an end point to a degenerative disease condition that has been developing over decades throughout our entire life. Stroke and heart attack are good examples. Sometimes, maybe most often, it is these events that shake us up enough to move us into action, and if we have the luck to have been exposed to sensible information, we can have the chance to begin anew and change the course of the rest of our life, steering it towards recovery and optimal health.

When an event of this kind happens—when we have a stroke or heart attack—we must act fast to recover as quickly as possible and reduce as much as we can the possibility of having another one within weeks or months, something that could easily be fatal. The fact is that this is usually quite likely to happen, and it’s therefore important to take it to heart.

How can we take the most important and extreme measures to reverse this course of progressive degeneration and set ourselves on the course to recovery as quickly as we can? What would I suggest should be done with the greatest sense of urgency based on the understanding that it is our life that is at stake? What are the most important and effective ways to help the body heal and repair itself?

Cleanse, detoxify, heal the gut because everything that circulates in the body comes and goes through what circulates in the bloodstream, and everything that circulates in the bloodstream comes and goes through what enters the intestines. It is in the gut that everything about our health starts and ends, where all nutrients are absorbed and most metabolic wastes are discarded. This is why it must be the foundational focus of the healing process.

There is no better way to cleanse, detoxify and heal the gut than to drink fresh green vegetable juices while at the same time getting a series of colonics: the hydro-colon therapy cleans stuff out of the gut, the juice cleanses, alkalises and nourishes the blood and body. Doing these separately is very good. Doing them together is great. Give yourself two weeks—fourteen days—during which to do this. Every day drinking between two and three litres of fresh green vegetable juice, and every other day getting a colonic (on Monday, Wednesday and Friday, for example).

For the juice, you can make it or buy it, but it must be cold pressed in a slow masticating juicer, and it must be free of sugar, i.e., containing only green watery, fibrous and leafy vegetables. Any amount of sugar will fuel the proliferation of pathogenic bacteria and yeasts like candida, and one of the most important aspects of this gut cleansing and healing is the elimination of the candida which undermines the function and health of our gut and our entire organism. In many modern cities there are small cold pressed juiceries where it is possible to buy very good quality all-organic green juice. Doing it at home is less expensive but requires you to do the work. You can also make some yourself and buy some as well (that’s what I tend to do).

In addition to the juicing and hydro-colon therapy, there are three kinds of supplements that should be taken: probiotics (Prescript-Assist is what I take), L-Carnosine (Paradise Herbs is what I take), and enzymes (I’ve used pHi-Zymes by Baseline Nutritionals and Heal-n-soothe by LivingWell). The probiotics replenish and heal the flora, carnosine helps heal the lining of the gut and glycated tissues, and the enzymes promote accelerated repair of damaged cells. They should all be taken three times a day, morning, noon and late afternoon, always on an empty stomach. Take each time one capsule of probiotics and two of L-Carnosine.

To avoid being too hungry, but also to ensure an important intake of the miraculously healing coconut oil, you should have a coconut milk based smoothie, pudding or ice cream: a small glass, two or three times per day. And to make sure you have a good intake of salt and minerals, you should either put unrefined salt in the green juice or eat cucumber and celery sticks with salt, as much as you feel like depending on taste, once mid-morning and once mid-to-late afternoon. Sometimes you may want to drink salty green juice, and sometimes you may prefer to eat salty, crunchy veggies. Just follow your inclination.

(See the work of Dr Norman Walker for more details about the importance of colonics and juicing.)

Enzymes are proteins with specialised functions. They are the things that do stuff in the body. Most of us have heard that enzymes are made in the pancreas and are needed for digestion because they break down the nutrients into their constituents: starches are broken down into glucose by amylase, fats are broken down into glycerol and free fatty acids by lipase, and various proteins are broken down into amino acids by various proteases. These building blocks of foods can then be absorbed from the gut into the bloodstream and carried all over the body to where they are needed. But enzymes also do practically everything else that needs doing, and, in particular, heal and repair damaged cells and tissues.

All raw foods contain enzymes, some more than others. Fresh juices which contain a high concentration of minerals and nutrients, also contain a high concentration of enzymes. Because the more enzymes are available, the better it is for the body to heal and repair itself. Hence, our strategy for recovering from this stroke, heart attack we just had, is to flood the body with enzymes. The fact is that in western countries, most people live on processed junk food that is not only totally devoid of minerals and micronutrients, but also completely dead and devoid of enzymes. If we don’t survive on processed junk food, then we typically hardly ever eat anything raw. Therefore, even if the food we eat is not as bad as processed fast food, it is still cooked, dead and devoid of enzymes.

Eating this way leads to two major problems. The first is that the pancreas is continuously manufacturing enzymes in a desperate attempt to cope with the digestion of cooked and dead food, and over time, like within a few decades, begins to get exhausted and eventually becomes unable to produce any enzymes. It typically also stops being able to produce insulin at the same time, just because it is simply exhausted. The second is that because all enzymes are used for digesting processed and cooked dead foods, there are hardly any enzymes available for anything else that needs doing, healing and repairing.

In our healing programme, to flood the body with enzymes, we—in addition to drinking all this juice loaded with enzymes of all sorts—will supplement with more enzymes. There is no upper limit to the amount we can take, and the more the better. It is really just a matter of what we can afford and are willing to take on a short, medium and long term basis. It is important to start slowly and increase gradually. This is to allow the body to adjust to the presence of more enzymes, but also because they will immediately start their cleanup of the body, breaking down scared and dead tissues that inevitably accumulate over time, as well as both benign and cancerous tumours. The breakdown products are toxic and need to be eliminated quickly. Hence part of the importance of the initial 14 day juice cleanse with intensive hydro-colon therapy.

The amazing thing about enzymes is that they know exactly what to do, what to break down, what to build up, what needs help repairing and what needs help healing. This can be considered a miracle of nature. But it is just life: the self-organised life of living organisms that has been evolving and having its means and methods refining themselves over the 4.5 billion years of evolution on the planet. Self-organised, synergistic and symbiotic co-dependent emergence and evolution. Miraculous and amazing, but from the perspective of an enzyme, a chloroplast or mitochondria, it is utterly simple, obvious and straight forward: adaptation for improved survival.

(See the work of Drs Cichoke and Gonzalez for more on enzyme therapy.)

Iodine is an element that is needed in every cell. According to statistics from the WHO, 97% of the world’s population is iodine deficient. And according to David Brownstein, M.D., a physician who has spent a good portion of his medical career studying iodine, testing for it, and treating his patients’s deficiencies of salt and iodine, the figure is probably closer to 98 or even 99%. In any case, this means that we can conclude that everyone should be supplementing with iodine to ensure the body an appropriate supply.

Iodine is found in the highest concentration in the thyroid gland, mammary glands, and then other glands of the body. For all glands, but especially for the thyroid and breasts, it is simply crucial. Brownstein has treated with total success a large number of women suffering from fibrous cysts or cancerous tumours in the breasts, and a large number of both men and women suffering from thyroid-related dysfunctions using basically only iodine supplementation and dietary modifications (including, most importantly, increased unrefined sea salt intake). He states his belief that most if not all cystic breast disease and cancers, and that most if not all thyroid problems, regardless of whether they are hypo or hyper thyroid dysfunctions, are caused by iodine deficiency, and are always corrected with appropriate supplementation.

One of the reasons why iodine deficiency is so problematic is that because it is so important in its role in every cell, and because it is part of the halogen family of elements (F, Cl, Br, I, At), it is replaced in the cells by other much more abundant but toxic halogens like fluorine, chlorine and bromine. All of these being common industrial chemicals far too abundant in our environment, water and food, and that find their way into the body, slipping into those slots in the cells intended for iodine. It is only by supplementing and providing the body with the adequate amounts it needs, that these other halogens can be gradually replaced by iodine and excreted from the body.

Brownstein recommends using Lugol’s solution, which is sodium iodine and iodide dissolved in water. It is generic and inexpensive, as it has been around for almost 200 years (first made in 1829), and it is a safe and effective way to replenish iodine stores. For most people (as it was for Brownstein himself and for me) it will be necessary to take 50–100 mg per day for about a year. It should be taken in water or juice on an empty stomach. I took it with water for many months before starting to put it in the green juice, in which the taste cannot be detected. I use a 15% solution (18.75 mg per drop) and took between two and four drops per day (37.5–75 mg; two drops at a time, once or twice per day).

After almost a year, I felt two days in a row an immediate surge of energy and light butterflies in the stomach, which I knew were caused by the iodine stimulating the thyroid because I had read about it. Therefore, reacting to it with such sensitivity, I knew that I had finally replenished, after all these months, the iodine stores. Now, I take one drop in my green juice, which sounds like an infinitesimally small amount, but it is important to maintain supplementation because iodine is needed every day by all cells and it is water soluble making it easily excreted with the urine. It has been estimated by iodine researchers that the body needs a minimum of 12.5 mg per day. Therefore it is best to take a little more than that; one drop of 15% solution which provides 18.75 mg. Iodine is of fundamental importance. Supplementation with it is essential, especially in a detoxification and healing programme.

(See Brownstein’s book for more on iodine, and The Guide to Supplementing with Iodine, for additional details about supplementation)

Magnesium and sodium bicarbonate support the cleansing, detoxification and—very importantly—alkalisation of the gut, blood, tissues and organs of the body. The easiest and most effective way to get these into the tissues is to have a 60 minute bath with one cup of nigari flakes and one cup of baking soda. You should do this every other day (Sunday, Tuesday and Thursday, for example) for the first two weeks. This will help pull out accumulated acid, chemical toxins and heavy metals. It is very pleasant and relaxing to lie in a hot bath for an hour reading a book, listening to music or just lying there quietly, adding hot water to maintain a comfortably hot temperature. It is also an essential part of the detoxification programme. After the first two weeks, you can reduce the number of baths to one to two per week.

(See the work of Drs Dean and Sircus for more on magnesium chloride and sodium bicarbonate.)

Eating for rejuvenation and optimal health is a matter of choosing between health and life or sickness and death. After these first two weeks, you will start to eat more solid foods, keeping the juice as the pillar of your new way of nourishing and taking care of the body. In fact, every day the focus of the first half of the day will be to hydrate, cleanse and alkalise by drinking green juice, one litre in two 500 ml portions, at around 9–10 and then 11:30–12:30. Lunch around 14 will be a green smoothie made of avocado and/or coconut milk, together with other green leafy veggies (kale, celery, cucumber, spinach, etc), and coconut water for the liquid part. You can add salt, black pepper and/or cayenne, other spices, superfood powders or extracts, making the smoothie as nutritious and tasty as you can using your resourcefulness to come up with new ideas and recipes.

Having a smoothie of this kind provide lots of enzymes and nutrients, essential oils and excellent fats, together with the naturally occurring fibres but because they are chopped up and blended smooth, they are very easy to digest and thus cause very little digestive stress; this is second to juicing which removes all the fibres for maximum absorption of nutrients and minimum work by the digestive organs.

In the late afternoon, have another green juice if it’s possible. You should drink one to two litres of alkaline water per day, whenever you feel like it. (You can either buy it, making sure the pH is above 8, or you can add alkalising drops to your high quality filtered water. I use Young pHorever’s PuripHy.) Remember that water and juice intake must be balanced with salt in order to hydrate well and not dilute the blood sodium levels and causing the kidneys to excrete more water. We want to drink lots and eat lots of salt in order to super-hydrate. For each litre of water/juice you need about half a teaspoon of salt.

Stop drinking around 18 or so, approximately 45 minutes before dinner: a big leafy green salad of your choice (baby greens, baby spinach, romaine, oak leaf, kale, mixed lettuces and greens) with some nuts and seeds, plenty of cold pressed organic olive oil or some kind of nut or seed butter dressing, and with this big salad, have a small amount of grass fed meat or wild/organically raised fish every other night (one day on, one day off).

That’s it. This is how you should eat for all the months during which you are recovering until you are in perfect health and perfect shape. You can eat like this for the rest of your life. This is more or less what I do. Some variations, will include creamed vegetable soups with coconut milk in the winter (cauliflower, brocoli, celery, spinach), cold soups like gazpacho in the summer, different kinds of salads (celery-fennel, red cabbage, white cabbage, chopped up cucumbers, tomatoes and red peppers in the summer, soaked nut and seed parsley salad, etc), and different lightly steamed vegetables like brocoli, romanesco, cauliflower and green beans. Of course, you are welcome to experiment in this way depending on the season and on personal taste, mood and circumstances.

Supplements that you should take as soon as you start eating, some with lunch and some with dinner, are the following.

With lunch:
(2) Liposomal Magnesium (L-Threonate; Mercola)
(2) Liposomal Vitamin C (Mercola)
(2) Krill oil (Mercola)
(1) Astaxanthin (Nutrex Bioastin 12 mg)
(2) Turmeric extract (Gaia Herbs)
(1) Cinnamon extract (Stop Aging Now)
(1) Tulsi extract (Source Naturals)
(1) Vitamin B12 (Thorne Research Bio-B12)
(2) A-D-K (DaVinci)
(2) Niacinamide (Thorne Research)
(2) Synergy7 (Stop Aging Now)
(2) Zinc (Source Naturals OptiZinc)
(1) Ubiquinol (Mercola)
(1) Huperzine A (Source Naturals)

With dinner:
(2) Liposomal Magnesium (L-Threonate; Mercola)
(2) Liposomal Vitamin C (Mercola)
(2) Turmeric extract (Gaia Herbs)
(1) Cinnamon extract (Stop Aging Now)
(1) Vitamin B12 (Thorne Research Bio-B12)
(1) A-D-K (DaVinci)
(2) Niacinamide (Thorne Research)
(2) Zinc (Source Naturals OptiZinc)
(1) Ubiquinol (Mercola)
(1) Iron bisglycinate (Thorne Research; depending on blood test results)

You will have noticed the obvious absence of some classes of food products that are eaten by most people most of the time: there are no sugars of any kind and no starches, both of which are known to increase the probability of cardiovascular events by their instantaneous triggering of more than 300 inflammatory pathways, all of which cause the blood to thicken and become more viscous; there are also no dairy products, which are highly acidifying and usually the cause of negative immune responses from mild to severe intolerance or allergies; and there are no commercial foods or drinks, all of which should simply be avoided by everyone for their lack of nutrition and chemical toxic loads. These are detrimental to our health in several ways and therefore have no place in a healing programme or in a diet for optimal health and longevity.

You will also have noticed that there is a strong emphasis on green juices and green vegetables, coconut fat from coconut milk, and just enough healthy and clean animal protein and fats to provide the body with everything it needs to thrive. It is perfectly fine to have berries either on their own or with coconut milk, as well as 80-85% organic chocolate once in a while (and not later in the day than about 15). You can have organic green tea in the morning (until about 12), but stop drinking coffee (if you’re a big coffee drinker, you have to do this gradually). The adrenal glands—the very important stress and sex hormone producing glands—in this day and age are almost always overstimulated from our busy and stressful lifestyles, and therefore usually dysfunctional to a greater or lesser extent. They also need to be healed and for this, they need a break.

You should continue the probiotics, L-carnosine, and enzymes as long as necessary to regain total health. You can continue indefinitely. You should continue the iodine supplementation with 50–100 mg per day for a year (might be anywhere between 8 to 12 months), after which you should reduce to one drop of 18.75 mg, and maintain this indefinitely. You should continue all supplements for as long as the healing process continues, and will benefit from taking them to the end of your days, reducing the quantity to once per day instead of twice (dropping the evening supplements with dinner), and remembering that there are only benefits from taking more depending on the circumstances in your life and your body’s needs. Of course there are plenty of other supplements that we can be of benefit, but the ones listed are those that I consider most important.

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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.

glass-of-water

Pure alkaline 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, magnesium deficiency, and calcification.

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.

Sel-gris_prod

Unrefined sea salt from the Atlantic coast – Sel de Guerande.

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.

Water, ageing and disease

Thinning skin, drying hair, wrinkles, brown spots here and there, patches of discolouration. Sagging eye lids, sagging cheeks, sagging skin all over the body. Loss of bone mass, loss of muscle mass. Stiffening joints, stiffening muscles, stiffening tendons and ligaments, stiffening veins and arteries. Weakness, tiredness, aching. Loss of memory, loss of concentration, loss of intellectual capacity, dullness. Metabolic syndrome, diabetes, senility, dementia, Alzheimer’s, arthritis, elevated cholesterol, atherosclerosis, stroke, kidney failure, liver failure, heart failure, cancer.

Are all these symptoms, these conditions, independent from one another? Are they different? Do they arise spontaneously and develop on their own? Do they just fall upon us unpredictably as rain does? Or are they consequences of more basic factors that elude most of us.

If we could ask the late Dr. Batmanghelidj (1931-2004), M.D., about ageing and disease, he would surely say that its primary cause is the cumulative effects of chronic dehydration on the body, and the plethora of consequences that this brings about. This chronic dehydration that only increases in severity with time, gives rise to so many problems.

But independently of anyone’s opinion, it is an observational fact is that when we are born, the body is 90% water, but when we die, it is only 50% water. Doesn’t this tell us something? Doesn’t this tell us that ageing and dying could be considered as a process of gradual dehydration?

The main way in which we provide water to the body is by drinking. And all of the nutrients required to sustain the body come from the foods we eat. Therefore, the digestive system is truly at the root of it all. As I explained in this previous post on the important of water in the digestive system, the direct consequences of not drinking adequately on an empty stomach long enough before eating, are the poor digestion of food, and the damage caused to the lining of the stomach and intestines that eventually lead to ulcers and leaky gut syndrome.

But poor digestion of food means improper break down of protein into amino acids, and the deficiency in the full range of these essential compounds necessary for so many functions in the brain and in every cell of the body. Poor digestion of food means improper break down of fats into their constituent fatty acids that provide not only the primary source of energy, but also the very building blocks of the membrane of every single cell in the body. Poor digestion of food means improper absorption of minerals and the complex molecules we call vitamins, that together with the proteins and fats are used not only in building all the tissues in the body, but also in every single chemical reaction, transport and communication between cells and tissues. Over time, poor digestion and damage to the digestive organs leads to the permanent loss of the ability to absorb certain minerals and vitamins. There is no doubt that this leads to complications that will manifest in various complex ways.

The lack of water in the digestive system leads to a lack of water in the bloodstream. The blood gradually thickens, its volume decreases, and its viscosity increases. This increases the friction between the blood and the walls of the blood vessels, and therefore the resistance in the flow. The heart is now under severe stress as it attempts to pump this thick, viscous, sticky blood to all parts of the body, and through all the vessels from the largest arteries to the narrowest almost microscopic veins. But this intense efforts by the heart also stressed the vessels themselves. Stress on the vessels leads to lesions. Lesions lead to plaques whose purpose is to patch up and heal the damaged tissues. The accumulation of such plaques, whose spontaneous bursting causes strokes, leads to atherosclerosis that eventually leads to heart failure. Pretty grim picture, isn’t it? But far from being complete yet.

The lack of sufficient amounts of water in the bloodstream obviously means that every organ and every cell of the body gradually becomes more and more dehydrated over time. For the cell, water is by far the most important substance, it is the context in which absolutely everything takes place, and on which everything depends. In order to maintain as much of this precious water as is possible, every single cell starts to produce more cholesterol to seal its membrane a well as possible and keep and protect its water. This is why dehydration leads to the appearance of excessive amounts of cholesterol, which in this case is the cell’s essential water preservation mechanism.

The lack of sufficient amounts of water in the bloodstream is particularly detrimental to the articulations. The joints of the body, all those areas where out limbs bend, are a complex assemblage of tissues whose primary component is cartilage. Cartilage is a kind of a simple matrix that holds water. It is the water content of the cartilage that gives it its suppleness and flexibility, allowing it to protect the bones from rubbing against each other in the joints when we move. It is well known that as we age, all of our joints and cartilage dries out, and we develop what we call arthritis. But is this because we are getting older, or is it because we are getting more and more dehydrated with every passing day? Is arthritis a disease of ageing or is it a consequence of chronic dehydration?

The amazing thing is that the only way to bring water to the cartilage in the joints to maintain their flexibility and prevent their degradation is through the porous ends of the bones to which the cartilage is attached. And the only way to bring water to the end of the bone is through its marrow. And the only way to bring water to the marrow is by way of the blood. Therefore, to prevent the gradual dehydration and subsequent breaking down of the cartilage in the joints, the blood must be well hydrated: thin, easy flowing and full of water.

And what does all this mean for the rest of the body? By weight, the muscles are 75% water; the blood is 82% water; the lungs are 90% water; the brain, the primary element of the central nervous system, is 78% water; even the bones are 25% water. So, it’s pretty simple: as dehydration increases over time, all organs, all tissues and all cells suffer, shrink, weaken, and succumb ever more easily to disease, whatever form it may take.

Dr. Batmanghelidj presents a convincing line of arguments linking breathing and lung disorders like asthma and allergies to chronic dehydration, and also believes that the dehydration of brain and nerve cells whose composition is also mostly water, leads to disorders of the central nervous system such as Alzheimer’s disease.

And the skin? Think about any fruit or vegetable that you place on a shelf in the fridge, like an apple, a carrot or a radish, and leave there for a long time. It will gradually soften, then start to wrinkle, and with time continue to soften and wrinkle more and more until it is nothing but a tiny little dry out thing. Moreover, you may also have noticed that if you take a partially dehydrated carrot or radish, for example, cut them and place them in water for a while, they will re-hydrate by refilling all the cells with water, and in so doing become hard and crunchy once again. However, if you wait too long, then no matter how much time you leave them in water, the cells will not re-hydrate. Logically, since our water content is similar to a fruit or vegetable, what happens to the body is probably very similar, and hence gradual the softening, wrinkling, weakening, and overall degradation of the bodymind at the days and years go by.

Obviously, this does not mean that by drinking enough pure water—no other liquids can be substituted for water—to ensure that the bodymind is well hydrated we will not age. Of course not. But at least, we will ensure that ageing and all the consequences associated with ageing are not accelerated by dehydration. The last thing we want is to accelerate our rate of ageing and our susceptibility to disease.

The truth is that for most living beings on Earth, water is life. There is no question about this. We and most terrestrial animals are constituted of about 60-70% water and 30-40% minerals—by mass. But in fact, in terms of the number of molecules in our bodies, we are 99% water! Can we grasp the significance of this? Can we now realise what dire consequences the slightest dehydration can cause to every cell, every tissue, every organ, and every system of the body? It is hard to quantify, but it is huge. And coming back to our initial question: are ageing and disease different? Are they related? What do you think?

Although chronic dehydration is so common that it is generalised, avoiding dehydration is very simple: drink water and unsweetened herbal teas or light green tea. Don’t drink coffee, black tea or alcohol-containing beverages because caffein and alcohol promote the excretion of free water, and therefore cause dehydration. Don’t drink sweet drinks, juices or sodas; these are full of sugar, including large amounts of fructose, that totally disrupt both the hormonal system and the metabolism, promoting hormonal imbalances and insulin resistance. Don’t drink milk; this is a food containing fats, proteins and carbohydrates that trigger all the required digestive processes that further exacerbate the problems associates with chronic dehydration. Just drink pure, clean, filtered water.

At the very least, drink half a litre when you get up in the morning (7:00), half a litre mid-morning (10:30), half a litre 30 minutes before lunch (12:30), half a litre in the late afternoon (16:30), and half a litre 30 minutes before dinner (18:30). Take a pinch of unrefined sea salt on at least some of the occasions when you drink to reach total of about 2 teaspoons over the course of the day, including the salt taken with the meals.