High Serum Sodium Associated with Mortality and Chronic Disease

Roger Seheult, MD of MedCram explains the association between high serum sodium levels and mortality and chronic disease. See all Dr. Seheult's videos at: www.medcram.co...
(This video was recorded on January 16, 2023)
Roger Seheult, MD is the co-founder and lead professor at www.medcram.co...
He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine.
LINKS / REFERENCES:
How to calculate how much water you should drink (University of Missouri) | www.umsystem.e...
Middle-age high normal serum sodium as a risk factor for accelerated biological aging, chronic diseases, and premature mortality (eBio Medicine) | www.thelancet....
Hyponatremia Explained Clearly (MedCram) | www.medcram.co...
BMP / Chem-7 Results Explained Clearly (MedCram) | www.medcram.co...
Woman dies after water-drinking contest (NBC News) | www.nbcnews.co...
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Video Produced by Kyle Allred
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DISCLAIMER:
MedCram medical videos are for medical education and exam preparation, and NOT intended to replace recommendations from your doctor.
#water #serum #sodium

[@Medcram]

Go to medcram.com for more continuing medical education and check out our merchandise on this page. Noteworthy point: eating high amounts of sodium will not generally give you a high serum sodium concentration but instead give you fluid retention and weight gain. This sounds counterintuitive but it is the truth. For more information on sodium metabolism visit our links for courses on sodium.

[@peacepoet1947]

Water seems very heavy on my stomach and if I take medicine with water, I have a difficult time keeping the medication down. I've been limited to drinking whole milk that seems to settle my stomach issues.

[@no_country_for_real_men]

Exceptional lecture. You are the best presenter from conventional medicine world and after my decades of experience in the healthcare industry and personal experience with incompetent MDs regarding many conditions I know you are spot on correct on this subject material. You are a rare true professional.

[@denniskean183]

Sooo... I am 71 years old and work in my garden every spring. This spring I am digging all day, replacing the soil in my gardening beds due to a pesty Monkey grass. I start at 10am and finish at sundown... 8pm. I took 2 hours for lunch and other obligations, so I worked 8 hours of back-breaking hard work of moving soil from one place to another. It is serious digging and loading the trailer and bringing fresh dirt from my compost stash. Also, to make things worse, I do it only on sunny days (80+ degrees) thank Heavens for this wonderful Spring. So, let's calculate this with the above equation. (30 x 90Kilos + 12 x 480 minutes)/1000 = 8.46 Liters of water are required. That would mean 2+ gallons of water per day!??? I drank possibly 2 liters, but I will concede to 3 liters because of a healthy smoothy (no sugar) and other possible liquids. I notice my dehydration when my stool is hard to pass. My stool was not hard enough to qualify. And I have been doing it for days! I have a high regard for you Dr Seheult. I watch many many of your videos. But this simply does not compute. 2+ gallons is not something I have ever downed in one day. I will say, however, that I feel a lot better when I exercise this hard every spring. Kind of brings life into my body. The pains and aches have disappeared. Am I an Alien species or is the formula in need of some diminutive variable, as the workload increases...?

[@Polymathically]

This takes me back to 2017. I'd just started a 2 week trip through Central Europe, but I had a severe kidney stone attack on only the 2nd night in Prague. I'd had quite a few kidney stone before, so I thought I could power through it with water and pain meds. That was a mistake; after 8 hours of increasing agony, I finally gave up and went to a doctor. I had an 11 mm stone and needed emergency surgery to save my kidney. My group left me behind in this creepy, barely furnished hospital. I'll spare you the details of that long story, but I had to abandon my vacation, vowing to myself that I'd never let this happen again. When I got back home, I talked with my doctor and asked for a list of everything I couldn't eat anymore. Turns out it was mostly due to salty foods and lack of hydration. So I changed my diet overnight and doubled my water intake. Started reading labels before buying stuff at the supermarket, too. Never had a kidney stone again, and I'm much healthier than I used to be. Also, I helped take care of my immunocompromised aunt in her final decade. She was barely into her 60s when she died. But she had several medical conditions, like diabetes, obesity, blood clots, skin cancer, weakened organs, pneumonia, and early signs of dementia. I watched her gradually, but noticeably lose her ability to function. What became apparent to me was that her years of poor dieting had caught up with and ravaged her body in the worst ways. One of the conditions she was diagnosed with in her final year was hypernatremia, which is an excessive level of sodium in the blood. She displayed all the symptoms, including brain dysfunction. She hadn't been able to walk for a couple of years, but eventually she could barely even sit up in bed. She'd been having an increasingly difficult time using her phone, and eventually she couldn't even hold it due to muscle weakness and confusion. Same goes with eating and drinking, the latter of which caused her dehydration to get even worse. She just stopped eating and drinking for days at a time, and wouldn't even drink from a straw. Anything that did manage to go down didn't stay for long. Her kidneys, liver, and heart were barely functioning in the final 6 months. I'll spare you the gory details about what her final 3 months were like. By the end, she could barely talk, and was slipping in and out of reality. It was the stuff of nightmares, and I got a front row seat to all of it. It's a _horrible_ way to spend your final years, and I wouldn't wish it on anyone. Take better care of yourselves, folks.

[@yvonne3903]

Thanks for sharing, it's been my New Years resolution every year for about the last 15 to drink more water, I repeat it every year because it's so important.

[@aliciamilam5636]

Stinging nettle dandelion and lemon juice n peels n ginger a help with the stones....mix n add water ..distilled n u should get free from those..lower your uric acid levels..this guys is amazing teacher..

[@firstlight5797]

Ooopo

[@factsoverfiction7826]

😳

[@fredsmith2299]

@@aliciamilam5636 Those are good remedies .... many years ago my mom had kidney stones and went to doctor and they set up surgery for monday am .... It was friday before .... so I made my mom a stone remedy with malic acid and corn silk tea .... and on Monday the surgery was cancelled ....

[@pk464]

This has been part of my nursing practice for a decade. I have actually had to defend my patient education around the importance of water intake.

[@marysmith7765]

I wish this had more views. This is such an important subject, and like all of the channel’s other videos, in regular people language. I had hyponatremia from years of taking a medication, and it was no joke. I am glad they have online charts now because I’m the one who had to point it out to my doctor. Yeah, not my doctor any more.

[@miaash3870]

You and your marvellous channel are blessings to all mankind!

[@barbarahopper3813]

So just a validation - I was hospitized for dehydration but by the time I passed out much damage was done and the docs were concerned that I would even survive. You would think I'd learn but I still find myself going days with only 1-2 glasses of water a day. I've always wondered if there could be physiological or psychological connections to lack of thirst.

[@monnoo8221]

the body is self-organized system, yet engaging lots of positive and negative feedback loops. Such, it is possible to get the body and its main control center, the brain, into a meta-stable state. Yet, that state could be far off from conditions that would help to live a healthy and pain free long life. For instance in chronic rheumatoid disease the body returns to the bad state after each intervention. If you do not drink enough for a long time you educate your body to survive under harsh conditions, as if you would live temporarily in a super arid region. It becomes a set point, silencing all warning signals that would go off under normal conditions. However, if you do not correct that in the long term that comes with a cost: early and miserable dying. The body is essentially an electro-chemical machine. A lot = almost all of the exchange processes that the cells need to maintain, exchange of chemicals and fluids a driven by a little voltage across the walls of the cell, and that voltage is driven by kation pumps, for sodium and potassium. If the voltage is wrong the cell will die quickly. If the sodium is wrong outside the cell, the cell starts working hard to maintain the proper voltage, but can not completely establish the proper voltage, and it is exhausting... Hence you die early

[@mitubogoogle]

Excellent content. The body requires water AND electrolytes to hydrate. Sodium and potassium interact. Don't forget calcium and magnesium...

[@Tony-dz5tw]

Always based on data, relevant to most of us, great presentation, clear recommendations and risk reminders, and that's why I love this channel so much! Thank you!

[@javierlackinger1525]

I have noticed through the years that the results of labwork/bloodwork can change from one week to the next and that no matter what lab was utilized I have had numerous lab results where I submitted multiple orders from different doctors then from the same blood draw the results for the same test (albumin, calcium, potassium) and in this case sodium specifically were different at times by as high as 5. For example I just had a blood draw at a well known Lab and the results for sodium were 139 for one doctor's order and 144 for the other. In the case of this study that would make all the difference. In fact looking back at the results I have saved through the years shows the same pattern. When I called the Lab and spoke with a representative they stated that in some of these tests even for example on a CBC with differential RBC, HCT, etc. there will always be a very small +/- percentage difference in the results so as I stated previously would have made all the difference in this study. Just wondering if this was accounted for, and it very well may have been, but again just wondering?

[@martinwebb1681]

Your blood results can change from one hour to the next, never mind one week to the next.

[@reinerheiner1148]

Like others I would like to know your take on how (exessive) sodium intake affects serum sodium levels and how this translates to the data from this video. Thanks for the video!

[@rogerseheult1312]

intake of sodium does not affect sodium concentration but rather increases volume. Water intake affects sodium concentration.

[@JM-ig4ed]

Excellent presentation. I hope you do a follow-up one for low sodium - which is such a common cause of seniors to be weak and be a fall risk. I get low sodium due to a diuretic I sometimes take because of Pulmonary Hypertension - lowest was 118. Have always wondered at what point it would necessitate a visit to the ER. My own Mom was hospitalized for 3 weeks one time due to low sodium - it does need to come back up slowly. Thanks for all the work you do - so much appreciated.

[@chibbie1993]

The amount of required water intake also varies based on the individual diet in addition to their activity level and health conditions. If someone eats a lot of vegetables and fruits, they do not need to drink as much water as someone who eats much less vegetables and fruits.

[@budawang77]

Excellent presentation. Thanks for giving us a metric version for people outside the US.

[@johnshopkins554]

Love it cause now I can actually break out that formula instead of just saying do it. It's a total knowledge flex. I do have a request for you doc. Could you do a breakdown on the Pfizer and cov shots in general as it pertains to the data out of Taiwan about myocarditis? You've hit a nice middle ground between educating us about the science and a healthy lifestyle. It's brilliant...Thanks.

[@hgbugalou]

I have a water cooler in my office and in my bedroom as well as the normal stuff in the kitchen. I do this just so I have zero reason (can't get to the kitchen cause I am on the phone, lazy, not feeling well, etc) to not get some water. I suggest everyone do this. You don't have to force it down, but just drink it when you are a little thirsty!

[@jeanwonnacott2718]

My hubby has advanced heart failure. One of the reasons I listen to Dr. Sheult.

[@sapelesteve]

Another very interesting discussion and topic Doc! My take away is that as long as one is consuming enough water & not a huge excess of sodium, the homeostatic bodily processes should keep a normal physiological balance in check.

[@bredbeddledehautdesert4561]

The fix for too much sodium is as easy as sweating it out in the sauna.

[@tracysmith245]

we get far too much calcium every day with supplements that the doctors give u i was shocked when i found out about calcium and k2 it just builds up or takes away bones

[@craigphillips6308]

Getting the right amount of potassium is part of the equation as well. If your potassium levels are low (and how many people do you know who are actually getting the recommended 3500 to 4500 milligrams of potassium everyday?), it will affect your blood pressure among many other bodily functions.

[@mnayak9348]

Potassium also help excess salt to balance, start your day with banana and potato patty for breakfast or banana and strawberry shack

[@jakeaurod]

I always found this confusing. Doctors would tell me to make sure I'm drinking enough water, but at the same time, they'd have me on a diuretic. I had a metabolic panel done two weeks ago for a checkup, and Sodium was 141 (without being on a diuretic), but for the preceding three years the numbers have been closer to 135. I did have cardiac troubles 3 years ago, with STEMI and cardiac arrest in late 2019. It seems like all my numbers are finally close to normal. My hemoglobin had also been below normal for the last 3 years and my doctor told me not to donate blood. When I woke up from a coma in the ICU they weighed me and I had gained 25 lbs, presumably of water weight from my last self-weighing at home. I've heard of others gaining lots of water weight in the hospital from cardiac problems, sometimes so much it seeps out through their skin. I had recently celebrated losing 100 lbs and had flabby skin, maybe I did better because I had somewhere for the extra water to go. Anyway, they had me on Spiranolactone, but had to discontinue it after 10 months because I started feeling faint and weak and had low blood pressure.

[@mitubogoogle]

A huge mistake many doctors make is to put patients on low sodium diets instead of increasing the dietary/supplemental potassium, which regulates the sodium levels. Of course we are referring to patients without health issues which prevents that protocol

[@user-zu1ix3yq2w]

The vast majority of people do not meet the daily recommended value of potassium....

[@craigphillips6308]

I totally agree with you. There is no way that the avg. person is getting the standard recommendation of at least 3500 to 4500 milligrams of potassium a day. It seems to me that high sodium intake coupled by a lack of potassium is what causes high blood pressure, so bringing blood pressure to a healthy range is way more about increasing potassium (through supplementation if necessary), rather than limiting sodium.

[@mnayak9348]

Eat 2 banana , boil potatoes , oranges , avocado to start day all very high in potassium

[@athens31415]

@@mnayak9348 Even all of that food you listed is barely 40% of your daily RDA of potassium.

[@philc.9280]

I was always told 6-8 glasses of fluids per day but I'm pretty sure it depends on body weight, size, male or female, etc.

[@martinwebb1681]

Remember also some of that 6-8 glasses already comes from food intake, especially if that food intake is fresh fruit and vegetables that consist mainly of water. For those that eat lots of processed packaged foods however they would probably need to drink more.

[@Portia620]

Truths!!! I’m small now give me a bolus dose of a certain drug and they’re like well that’s too much for you you think when I only weigh 100 pounds are 114 pregnant my normal weights like 90 pounds now I weigh 112, but the same as with water I mean one size fits all information is not healthcare!

[@mnayak9348]

Too much water can dilute salt too so listen to body if thirsty then drink ,

[@sighthound5449]

I nearly died from LOW sodium...hyponatremia is dangerous and so many people don’t know about it....I had seizure and metabolic encephalopathy and a critical care stay. This was all from simple d&v from food poisoning. 😕

[@jimatsydney]

So sorry to hear about your experience. Many people in the running community find out about the dangers of a low salt diet and exercising in hot weather too by having similar experiences. Many people think a low salt diet is healthy. That’s why there is a RDI of 2000mg sodium (or 5000 mg NaCl). As long as you eat plenty of veggies (potassium) your blood pressure is normally fine. It’s the potassium sodium imbalance that causes most hypertension.

[@jimig399]

@@jimatsydney I'm 53...I cycle 30 to 50 miles daily. I take 2-3 days off each month. For the most part I'm chomping at the bit to get out there. I love to ride and I ride good. I've been doing this for 15 years. I have a body that most professional athletes would be envious of. I don't do any supplements, fad diets or special nutrition. I live in southern California near Palm Springs. It's hot here in the summer. I sweat alot. I've had a couple of heat stroke scares but I've learned to stay wet. I soak myself. I drink an electrolyte/collagen powder only in the summer. In the winter I cut this and do water or a mild green tea. Anything else I could or SHOULD be doing to maintain my physical health? I drink less than half of your recommendations based on mins of exercise. I'm 175 and exercise 2 hours daily. I drink less than a liter of water per day. I drink a lot of coffee. Green tea. Whole milk. I eat a lot of watermelon, kiwi, oranges(at least 3 every day)grapes, cantaloupe and honeydew melon. I also eat salads. We are an agricultural community so its always fresh and close by so my meals come with plenty of hydration. My body is lean and strong muscle. When I drink the amount of water your talking about I cramp up and have to piss 4 times a night. I don't like that. But I have been noticing some telltale signs of dehydration in my skin lately. I can't drink the amount of water your talking about given what I do. Could you? Does anyone? Honestly? Also my backpack becomes so encrusted in salt that I have to change it out every other week. I eat as little salt as possible with my food..when I do salt food it's Himalayan sea salt. Appreciate any insight you can provide.

[@jimatsydney]

@@jimig399 Hi JimiG, I am 62 and have run about 10 x 100 km ultra marathons in the last 8 years. I am also a whole plant based vegan. I am more scared of not getting enough salt than too much. Hypertension is very easy to detect by taking your blood pressure. Mine is 120 over 70. Having too little salt is deadly and can creep up on you especially if you sweat. Cramps can be a sign of low salt. Many ultra event organisers warn of over drinking during events and not taking in enough electrolytes. My advice, if you are of normal health, is have the RDI of 1 teaspoon of salt a day and monitor your blood pressure, and of course eat a lot of veggies for the potassium. Many runners recommend taking in 400 mg of salt per hour of exercise but I don’t know of any research to back that up.

[@jimig399]

@@jimatsydney mines 125/65. Normal range. When I said I eat as little salt as possible I mean I'm conscious of the amounts that I ingest. I'm not on any low salt diet to be sure. I know the danger of that where I live. Salt is my friend. I'm not afraid of salt. I sweat a ton of it out so I know it's gotta go back in. But given how salty everything is these days I don't really require any additional salt. I'm sure to use electrolytes in summer because my water intake does go up considerably. Recently I've been worrying about excising in 115 degree weather and the affects on the liver. I'm experiencing naflds for some reason and my doctor warned me to take it easy this summer because there is a recent correlation between hot weather exercise and it's negative affect on the liver. I'm trying to figure it out because the doctors haven't been able to figure it out themselves. Something is off. My skin has changed and my hair and nails. I feel skinny. Don't feel like I'm healing like I usually do. Like I've got toxins lingering that won't flush out. Maybe decreased liver function. I think it could be a parasite tapping my vitamins and making me deficient. I had it once before 25 years ago. Experienced nearly the same symptoms. Doctors won't test for parasites. They roll their eyes. Fuckin pre madonnas. I think I'm gonna do a master cleanse. Last time it took 26 days. The parasites came out on the 26th day. Reset me completely. Cured so many of my ailments. Thanks for your input sir. Happy trails to you. And good health. 👊🙏

[@jimig399]

@@jimatsydney Dead Sea salt spray was a game changer for me when I found it years ago. Stopped worrying about my potassium and magnesium completely after I started using it. Used to cramp up in my hamstrings and calves something fierce after long 70 Mile rides. Haven't had a muscle cramp in years since using it. 🙋

[@jn5912]

Amen, water is life. Thank you doctor.

[@SkepticalCaveman]

I recommend using a mineral salt mix with with a sodium amount below 70%. The salt I use contains 60% sodium, 30% potassium and 10% magnesium. It also contains iodine. Using this mix not only reduces sodium, bit also increase potassium and that mineral is very important for health.

[@hadleybee9710]

Is it REDMONDS?🤔

[@ldean8360]

I use a similar mix.

[@ldean8360]

@@hadleybee9710 The mix I use is called "Smart Salt."

[@elsagrace3893]

Or you could just eat several servings of veg to increase potassium and use less salt. Don’t eat processed or restaurant food. You don’t need extra stuff to be healthier.

[@hadleybee9710]

@@ldean8360 thank you! I never heard of it.

[@Fair-to-Middling]

So, for the eternally debated question, when tallying up one's amount of liquid per day, does drinking a glass of tea/coffee = a glass of water?

[@altkev]

@BeyondHope do some research here and you'll find that while yes caffeine itself can increase urine production, that doesn't mean it dehydrates you when you consider the additional liquid volume of the drink the caffeine is in. Please do research and don't just repeat myths as fact.

[@soapgirl62]

So does this seem normal for people who are obese? I did a hypothetical for someone weighing 250 lbs and getting 30 minutes of exercise and their water intake would be over 17 cups per day. Seems like a lot. Is this correct? And if he were to Increase his exercise by double, he would need over 18 and a half cups?

[@RichRich1955]

A nurse told me to drink equal amount of water to the coffee as well as the water you'd drink. Food has some water too.

[@RichRich1955]

@@soapgirl62 your urine should be mildly yellow. Running clear every time probably means too much.

[@javadivawithdog]

Coffee and tea have benefits as probiotic foods, but more than 3 cups of coffee a day has risks and has less benefit. Tea is more neutral. This should be a separate consideration from water. Still need to drink water in addition to these things, as the video details.

[@eelkeaptroot1393]

Thanks doc! Water is the essence of life!

[@ndzapruder]

THANK YOU SO MUCH for mentioning excess death!

[@reasoningtruth]

Dr. Seheult, thank you again and again and again . . .

[@murraybrockway6540]

Thirst is the best indicator of how much water to drink in most people. I need more water when eating bread and less when eating more low starch vegetables and fruit. I have been following a whole food plant based diet that is usually no salt, no oil, no sugar and that got my blood pressure between 103/65 and 117/75. Recently visited my mom in the retirement home and then ate canned soup for a couple day before I restocked the frig with home cooked low sodium meals. 111/71 with 75 bpm pulse now was 135/65 78 bpm with the soup. Formerly type 2 diabetic. Currently stage 2 kidney failure.

[@rickw4160]

Obviously this wouldn't be an issue if thirst was the best indicator.

[@coopergates9680]

Have you kept an eye on potassium intake? Substantial potassium can be tough on the kidneys

[@murraybrockway6540]

@@coopergates9680 very ironic that I need potassium, but if my kidneys get worse I would need to avoid potassium. I have heard there is a difference between plant based and eating meat in how much or which potassium rich foods needs to be avoided.

[@murraybrockway6540]

@@rickw4160 thirst is the best indicator for most people and the 8 glasses a day does not apply (is too much) if you are eat water rich foods and not enough if working in extreme heat. I once drank 4 quarts of water in an afternoon, but I was laying under a car in the desert sand welding on a new exhaust system with the temperature at 110° to 120° F.. I got the nastiest headache from drinking too much water during a urinary track infection. You should know that many people forget how to walk when recruits are introduced to marching in boot camp, swinging the arm and legs of the same side together.

[@coopergates9680]

If I only drink when I feel thirsty, I get significantly too little. Had minor hypertension and would get headaches when I ate if I had too little water beforehand.

[@deepakhiranandani6488]

Thanks. This is interesting and informative. However, what with drinking beverages, having soupy meals, being a whole food vegan hence plenty of produce I don't think it would be easy for me to measure water intake. I recall reading and perhaps seeing on videos the common sense idea that the best way to judge water intake is to observe the colour of the urine which should be pale yellow or straw coloured, with dark yellow and colourless urine pointing to too little or too much water consumed respectively. Does that seem a good idea to you?

[@r.p.8906]

2.5 liters of pure water per day is a lot but certainly necessary for good health of a 145 lbs person of any age. Necessary, not sufficient i.e other things also contribute to good health but water is absolute necessity. Your video is such a good reminder, thanks!! This reminds me of the story of Prof. Batmanghelidj who studied the metabolism of water for DECADES and published a book in 1992 outside of the US. However, he did this 25 year long study in Stanford, California and big pharma's money, invested in some literature in the US was against its publication in the US. I can only imagine the billions of dollars that this book could liquidate from their profits... Nevertheless the book became a best seller in the world for over 25 years and is now, recently, also available in the US. " Your body many cries for water" . Very profound book. The studies are randomized control trials. The conclusions are scientifique. He passed away in 2004. This man is a real hero of medicine.

[@jasonhsu4711]

I've been on a low sodium diet as a result of avoiding junk foods and restaurant foods due to the pandemic. I do NOT miss the persistent thirst I would sometimes get after eating restaurant food. That thirst was so persistent that it seemed no amount of water could quench it. Given that one can be dehydrated before the sensation of thirst kicks in, that cannot possibly be a good sign. I know from looking up the nutritional information for many restaurants that it's all too easy to consume 2000, 3000, or even 4000+ mg of sodium from one meal, compared to the daily recommended limit of 1500 to 2300 mg. No wonder so many people have excessively high blood pressure and serum sodium levels. How do you avoid these massive sodium overdoses when eating out and when traveling? Out of all the pitfalls of restaurant foods, the sodium bombs are hardest to avoid.

[@AkaiAzul]

Calorie / food tracking apps often also include sodium levels. You can look up food choices before committing to eating there. Like, say everyone wants to eat pizza, look at what options they have and how much you've already eaten today and make good choices from there.

[@jasonhsu4711]

@@AkaiAzul Unfortunately, those apps only cover a few restaurants, mostly big chains. And only a small percentage of restaurants have low sodium meal options.

[@AkaiAzul]

@@jasonhsu4711 Although true, it gives some idea better than none. It can also vary from restaurant to restaurant, chef to chef.

[@kimjohnson3910]

That’s from msg. It makes you very thirsty.

[@justsaying7065]

Where can we find this biological age calculator that uses 15 biomarkers?

[@monnoo8221]

search for "aging ai calculator"

[@PraveenSrJ01]

I need to drink more water 💧 and get more fluids in my system

[@bke07]

Dr, does ingested sodium and carbs affect serum sodium enough to warrant their inclusion in the calculation?

[@candersson7419]

And low serum sodium associated with hypertension. Got to love the in between.

[@reinotsurugi]

This is great but I think to be truly useful, we have to factor the relationship between salt levels and carb intake, insulin spikes, etc. As someone who does keto and fasting, my water retention varies so much depending on the carbs.

[@michalchik]

I haven't watched the whole thing and I apologize if this is covered. But High serum sodium is also a symptom of adequate amounts of other minerals especially potassium but potentially including magnesium and calcium. It's very hard for the kidneys to eliminate extra sodium if there it's not balanced with other minerals. Hypernatremia is associated with insulin resistance as a causal Factor a lot of the negatives here maybe a secondary correlation to all the health factors associated with insulin resistance in hyperinsulinemia

[@knatay1]

Are gas stoves as toxic as major media outlets are making them out to be right now? Your perspective would mean a lot!!!

[@jimig399]

They are. I've known this for years. Are they any worse than cooking and eating all of your meals from an electric skillet with a non stick coating? That's another debate. Seems everything is killing us.

[@dmcentYT]

Very interesting… in 2021 I landed in the hospital with extremely high BP… not overweight I was actually underweight at the time, don’t drink and don’t smoke… no diseases. When I went in it was 240/140 took 10 days to get it normalized around 160/100… anyways… labeled as primary hypertension… I did come away with some kidney damage my creatinine hovers around 1.9 but the rest of my blood work is mostly all within range including my sodium typically comes back at 140… I’m starting to wonder if sodium even had any role in my high BP now.

[@craigphillips6308]

High Blood Pressure has everything to do with your potassium levels. I don't know anyone who gets the recommended 3500 to 4500 milligrams of potassium from their diets alone, which is why I supplement with potassium chloride. Also, when you were in the hospital, if you had an IV, it's interesting to note that it was likely filled with sodium as well as potassium.

[@marcv2648]

Pretty much all food except fresh meat and fresh fruits/vegetables have added salt today. Compare hunter-gatherer and paleolithic sodium to ours. If you only eat food with no added sodium, your sodium levels will be far lower. Our kidneys evolved to retain salt, but they excrete it because our sodium is too high. Over the long term, excreting sodium from the kidneys damages them. Yes some people become dangerously low for specific reasons, but on the whole we're way too high. The US RDI for sodium is about 5-10 times higher than what paleolithic peoples ingested. Studies documenting this can be found on pubmed.

[@raymitchell9736]

I downloaded the paper and was curious to find out, What about potassium? I know there are important functions in the body; as in the sodium-potassium pumps in the body? or the anion gap? looking at the electrolytes and ph... but I didn't see that mentioned in the paper either... The paper's hypothesis was asking the relationship of hydration and aging and sodium was the proxy marker for hydration, but it got me thinking that there's got to be more to this... I wonder if they have the raw data on that but just didn't publish it? I am positive you'd know about this. Secondly, I know a lot of people eat garbage processed foods and not enough veggies so I would assume that the potassium would be low too, associated with those bad lifestyles? Anyway "food" for thought, and as always, thank you Dr. Seheult.

[@dianasong4594]

good one. thank u very much.

[@michelem226]

I've heard different things about hydration that I don't know whether they are true or not. Like not to chug water because it will just go right through you. And, related, to get water from raw fruits and vegetables because it's more likely to be absorbed.

[@Valentine3e]

Excellent, ThankYou ✨🙏🏼✨

[@olyav5819]

Very interesting!

[@probablyadog]

Great video! Just FYI, I don't see a link to merchandise. I'm sure many people would be interested but it's hard to find! (I actually have not found it yet 😁)

[@Medcram]

Should be below our video on KZbin.

[@lisab3338]

I’ve always felt crummy after too much salt. I’m keto and keep reading how I should use salt liberally but I feel better with low sodium. I need to be better about water intake. Thanks for this episode

[@Bob_Adkins]

I don't know if more or less salt, within reason, will change your sodium levels, but I suspect not. A healthy metabolism can keep sodium levels balanced.

[@javadivawithdog]

@@Bob_Adkins chronic excess sodium contributes to kidney stress then disease, contributing to cardiac myodysfunction contributing to portal back up to the liver, all potentially resulting in metabolic challenges that can be evident in just one value, the serum sodium.

[@javadivawithdog]

The keto attitudes that push salt needs further study and a more nuanced understanding.

[@shellderp]

opposite for me and I guess most people since thats the common thing you hear. I exercise though and lose a lot of sodium from that. You really need to measure sodium and dose it correctly for best results

[@mitubogoogle]

You need sodium. Instead of dropping sodium, consider increasing potassium. Keto is great if u get some carbs (brain needs glucose -watch dr Gundry's videos)

[@sirenagarrido3836]

I wrote a while ago about this problem that I have regarding dehydration my sodium is lower than what you are saying I’ve been losing weight 2 lbs per month for more than a year I had COVID twice and if I had symptoms before now after the second one all the symptoms have increased until now I haven’t found any dr that can help me they keep saying that there is help available to long COVID patient but until now I haven’t found no one who do it. I practically have to start learning all I can about all my symptoms and learning how to handle the best I can because if I don’t do it nobody will, is not just my life is the quality of it who are in the middle and is unbelievable that living in a developed country with the best information and treatment you can’t get it because nobody not just don’t believe it but they never even check or recheck my condition about the symptoms I am having but is true

[@bennguyen1313]

Regarding how the higher the concentration of Serum Sodium, the less free water you have.. Despite constantly drinking water, I am constantly thirsty, and have signs of dehydration (headaches, dry skin, constipation).

[@brycefbarnes]

Hey Dr. Seheult, I enjoyed your presentation here. The results you showed were compelling. I am convinced that more water is needed in my diet. However, I do have a few concerns. First the formulas for how much water did not seem scientific at all. based on your formula I am drinking almost 4.5 Liters of water per day. Maybe that is right.. for optimal health, but it also just seems off. I would really like a more thorough explanation of optimal water. Second, Sodium levels must be influenced by many factors not just hydration. Again this marker by itself seems incomplete. I just felt there is more to how the body regulates hydration and sodium. I would like a more thorough exploration of the science behind all these concepts. Thank you, love your channel, always great content!!! Bryce

[@murraybrockway6540]

A remember a severe headache from drinking too much water during a UTI. Lucky I had the sense to stop and go see a doctor for the UTI.

[@tacticalcenter8658]

Let food digest before drinking water. Don't eat another meal before 4-5 hours. Intermittent fasting is idea, 2 meals a day max, ideally 1 if you can build up to that.

[@bludog4657]

Can I ask if anyone knows of alternatives for constant dry mouth? My mom drinks water constantly because she is always saying her mouth and throat feels so dry, thank you

[@CarmenGarcia-bb6lm]

First the experts said drink a lot of water, and others said you don’t need to drink too much water, what is the true, how many glasses of water is normal to drink in one day?

[@atlantic7949]

Stop eating sugar, that’s where the problem is, not salt. Let’s stop this salt blaming game once and for all. We need sodium.

[@Turbotomass]

How does urine color associate with water consumption? What if your drinking your recommended water quantity and your urine is cystal clear? Is that a sign of over hydration? Also waters effect on lowering stomach acid?

[@Indorm]

During a holiday I once followed the recommendation of 2 liters a day and got diarrhoea, felt tired and my skin looked yellowish. Maybe it was too much for my size - 47 kg, height 162 cm, but it took my motivation away, especially as I'm too busy at work to go to the toilet a lot. Also, doesn't the amount of fruit and veggies you eat make a difference?

[@solapowsj25]

Jacksonian and motor seizures arise at 300 mg/dL sugar in diabetic patients with viral infection. This was reported to the National Institute (NIMHANS) by me and changes in management was made by doctors on the pedestal of DocPlexus.

[@solapowsj25]

Refer: Diabetic coma. Relative dehydration in early Dengue viral fever. DSS.

[@MorrisLess]

I guess I should read the study, but it seems to me that people with weaker kidneys are likely to have more sodium in their blood. Weak kidneys are a potential independent cause of mortality. Unless they've corrected for that, it's a big enough confounder to invalidate the study. It's also quite possible that people who consume less sodium take other measures to protect their health. Correlation does not prove causation. The standard advise with respect to water consumption seems to change with the seasons. Until science provides more definitive answers, it makes sense to do what comes naturally: drink water when you're thirsty.

[@retaj00]

How many viewers went to get a glass of water in the middle of this video?

[@sinclair657]

Much appreciated

[@mikemaldanado6015]

I am vegan and eat at least 10 fruits a day. As we all know fruits are mainly water. Does this count towards the total that one should drink? I find it hard to drink 2 liters more water after consuming so much fruit. I am never thirsty, the only time i consume extra water is when i go out for my daily mtb rides. I never get the sensation of being thirsty and urinate a few times a day. If anyone has any advice please let me know. I am not a doctor. I get bloodwork done once a year and my sodium is always the same, 140.

[@likeaboss6421]

Drinking water is life many people do not drink water at all unless it's through a cup of coffee, tea, or some kind of fruit drinks not taking any pure drinking water at all, I know many people like this including many of my friends a few of which haven't drank any pure drinking water for many years

[@CurtisForrester]

I take for granted just how informative and valuable these videos are - until I share them with someone who experiences that medical condition labeled "MB" (Mind Blown). 😂

[@alexandrecouture2462]

Thank you!

[@riceexperiment]

I appreciate translational medicine. Do you have a video on chronotherapy and genome yet?

[@kellyfarrell4971]

But how do obese people who exercise 60 minutes a day and use a sauna for 30 minutes make that calculation? There's no way that much water is healthy? Also, we water soften and filter, then Burkey filter cuz we live in the mountains near mining, and we have very hard water. I wonder if there are some minerals or electrolytes we should be adding to our water to ensure absorption?

[@psychways]

Correlational research like this is a good start. But there could be confounding factors like pre-diabetes, declining kidney function and adrenal problems causing the high sodium, rather than just low fluid intake. Also, there is a difference between fluid intake and water intake. Fluids can also come from food. More than half of your cooked steak is fluid.

[@Medcram]

Those usually cause low Sodium concentration not high.

[@jimatsydney]

Thank you that was very informative. On a population basis Japan and South Korea consume much more sodium than the recommended RDI. According to the World Life expectancy website Japan has a long lived population and the lowest death by hypertension. South Korea has the lowest death rate by heart disease. Has a similar study been done with these populations. Can these populations take in more sodium but maintain a lower blood sodium level? Are these populations better at drinking water? What correlation is there between potassium serum levels and hydration. Or better still sodium potassium serum ratio as an indication of hydration. This seems too simplistic drawing conclusions off one marker of hydration.

[@whbgegs5571]

good questions. additionally, the original "8 glasses of water per day" recommendation was calculated by INCLUDING the water in our foods, such as cooked spinach (lots of water). modern day american diets include a lot of dry, waterless foods vs. cooked vegetables.

[@monnoo8221]

too much\lots of sodium -> depletion of magnesium, potassium, low potassium + glucose -> damaging stiffening blood vessels -> high BP ; too little drinking is very different in its effects from high sodium They have lots of veggies which provide potassium and magnesium, for magnesium they even take it as a specialized ingredient to their cuisine, called kudzu

[@wellnesssecrets2014]

Hydration, elimination are keys to improve ba

[@TheMiczu]

Does the recommend water intake includes food? Apple is apparently over 80% water, so is that like glass or a half of water?

[@littlevoice_11]

People with low body mass and particularly low muscle mass are more at risk of excess water consumption. For example those with anorexia.

[@GenericHandle54321]

Two things come to mind after watching this. First - this study seems to show a correlation for sure, but not so much a causation from what I can understand. Yes, serum sodium levels are higher in people with disease and premature death. Is this because they eat a poor diet that I filled with crappy fast food, chips, and all kinds of processed food? That would cause a higher serum sodium level, but would drinking more water to get that particular number down improve their health situation? Seems like not. Two - sick people often have worse kidney function, which would alter their serum sodium levels. So, with chronic kidney disease or something approaching that, the sodium levels would be higher, right? So again, would drinking more water help? Third - what about sodium and other electrolytes that are lost through sweating? Low sodium can be very bad, too, as mentioned in this video. But if people are sweating and exercising frequently and only hydrating with filtered water, which has all the trace minerals stripped out, can't this lead to problems as well? Just thoughts. Thanks Doc, for all your videos, if you happen to read this. I'm blown away by people that have this much knowledge and can explain it clearly! As an RT I've worked with some Doctors that just impress the heck out of me, and some that leave me curious as to how they made it through med school! You are definitely in my super impressive group!

[@orjanbern4766]

Thanks for your input, your point seems logical. I myself have good experience with dry fasts to ease skin problems.

[@yasmine4754]

Not drinking much on my 12 hour shifts as a nurse, as we are not allowed to have any drinks, not even water, on our workstations, and in nursing there is no time to go to the breakroom periodically to drink water, there's simply no time. 🤯

[@monnoo8221]

those rules should be sued...

[@billallen275]

What are your recommendations for coffee drinkers? Basically, how to account for the diuretic properties of those beverages? Thanks, I'm going to look for the sodium levels in my records. !!

[@BozzleyOfficial]

Dr! Correct me if I’m wrong but, eating more sodium like salt with minerals AND water can keep a steady flow of H2O and sodium so concentrations would stay low correct? This is one of the bases of the “vertical diet” nutrition plan from stan efferding. It’s been especially effective for me as an athlete. Higher intake of sodium and normal intake of water seems to keep blood volume normalized in the muscle cells. Of course the source of sodium is healthy and not processed or fried foods. Don’t you think it’s important to differentiate ingestion of sodium itself and sodium concentration levels? It seems concentrations only go up with water intake being low and not because sodium intake is high. The body doesn’t try to hold onto the sodium if you have a steady intake, correct? The data seems solid but the conclusions are more important to get right for people’s health don’t you think? Edit: To be clear, NaCl is Salt is Sodium… I get that. I specifically talk about pink salt because it is less refined and has minerals along with it (important to note though that it does not contain iodine which is a necessary nutrient). If you’re like me and get most of if not all of your sodium from non iodized salt, then be sure you are still getting iodine from some other source like organic 100% cranberry juice. Sodium intake is not as cut and dry as some people might think after watching this video and plenty of people drink too much water and not enough sodium. Your diet should be tailored to your lifestyle. For example, for someone who does almost daily anaerobic exercise would benefit from more sodium as well as more water. Especially because steady intake of sodium will reduce your body’s necessity to hold onto it, thus most likely decreasing the serum concentration of sodium in the blood. ***Of course anyone should consult a physician before altering their diet in a big/fundamental way.***

[@ohana8535]

Salt is salt. Pink salt just has additions.

[@Bob_Adkins]

Salt is salt. No one benefits from so-called healthy salt except the salt salesman. A few minerals in the salt doesn't change the way it works.

[@sophiophile]

As everyone else has mentioned, 'healthy pink salt' is marketing woo, unfortunately. As you are an athlete, the important thing is to ensure that you are consuming enough electrolytes to replenish what you sweat out. And during endurance activities that usually is easiest achieved with an electrolyte drink, as water alone can cause dangerous hyponatremia in extreme circumstances. Outside of those times, normal sodium intake recommendations are standard to the best of my knowledge.

[@BozzleyOfficial]

@@ohana8535 of course. My point was that getting sodium from salted fried chicken and other processed salty foods is NOT the same as adding something like salt with minerals to your already healthy diet. Sorry if I was unclear.

[@BozzleyOfficial]

@@Bob_Adkins of course. My point was that getting sodium from salted fried chicken and other processed salty foods is NOT the same as adding something like salt with minerals to your already healthy diet. Sorry if I was unclear.

[@j.jwhitty5861]

I never drink water, I should already be dead, anyhow; starting tomorrow I'll drink a litre a day and try and work my way up 🤔

[@markl205]

Dr. Over the last 6 years my sodium has been 138, 138, 137, 140, 138. I am skeptical that I drank exactly the advised amount of water during that time to get a nice group like that. How might homeostasis play a role in adjusting blood sodium to fluid intake?

[@Whrichd]

Does water in food count towards this or this should be purely water that we drink?

[@MrRobertFarr]

I raised my salt intake to try and reduce my consumption of butter .

[@erikaquatsch2190]

Hey, I'm a nurse. I'm not allowed to drink anything in patient care areas. I don't have time to visit the bathroom, anyway. Frequent UTIs.

[@marcv2648]

Quit sugar.

[@johnnyblazey]

Practically, all Earth-life, requires H2O, which has more advantages than us humans, think...cellular speaking of course. All cells need water to stabiiize and overall support cellular structure, as well as electrolytes, for function, reproduction, balance, diluting excess 'by-products', etc. Spring water is great, for natural minerals and diluted water (intake) w/ electrolytes, for replenishment stabilization. Water/ H2O, Liquid Life...I salute this Earth, when I sip this transparent fluid of rejuvenation! I never-not, have water...it's always my companion. *Edit: 'Thank you Earth, for H2O, for all Life!' * Cheers Dr., for an awesome reminder for Life, from Life, for all Life!

[@TheMJT515]

I never drink water. But I'll drink coffee, tea and soda all day long. That's going to change.

[@kathleenking47]

Coffee dehydrates..so does soda

[@monnoo8221]

@@kathleenking47 no, coffee does not dehydrate. Soda kills due to sugar

[@JW4REnvironment]

Very sad that a woman died from drinking too much water at a radio station event! Very scary!

[@per995]

Would your body tell you by thirst to take the needed amount of liquid? I am almost never thirsty and by that don’t drink other than a small glass of milk or juice to my breakfast. Two cups of coffee in the morning and and one in the evening. Coffee drain the balance too so strange that I don’t crave or feel for drinking anything. The good side is that I don’t get lead or other substances/chemicals by excessive intake. May be wise to check the water quality before drowning down more than actually needed? It so interesting to follow your advices on many different things😊

[@inthesunbythebeach]

I know several people who do not have thirst.

[@marcv2648]

Thirst is driven by high sodium levels, so you're probably fine. If you visit an emergency room, the way they diagnose you as dehydrated is if you have a high serum sodium level.

[@per995]

@@marcv2648 I believe I am fine with my low intake due to the demand is low. A Swedish lady professor brought the water intake hysteria up because it gives for many people mostly negative use of time and money. Especially ladies use too much time to visit the toilet by excessive intake. Waste of your time she told an happens to often. Not negative to it, but overrated. Some use a fortune on bottled water, may be a glass of wine could do some good to your circulation and comfort 😬

[@antibull4869]

Barring kidney issues or genuine medical issues… the risk of water intoxication is minimal for the average person. Drink more water. So long as you arent chugging gallons at a time, the risks of dehydration is far more likely than water intoxication.

[@elizabethryan2678]

I filter water and try to avoid plastic bottles, which leach into the water and after a couple of hours you can taste it

[@christined2066]

My sodium and other electrolytes are always on the low side of normal. I have severe acid reflux (Nissen surgery didn’t help) that is only helped by me drinking water. I drink upwards of 1 gallon (4L) a day. I am 50 years old and my BUN always comes back with “L” written beside it. My doctor is not concerned. I have been hospitalized numerous times because if I vomit I can not stop. The last time all my electrolytes were so low I had chest pain and was hospitalized for several days. For me the Nissen surgery was more for the reason, I am not supposed to be able to vomit. Instead of having the Nissen for the reflux. I have still been able to vomit (not supposed to). My question is, should I be seeing a cardiologist to make sure my electrolytes and bio markers are where they should be?

[@inthesunbythebeach]

If I were you, I would see a cardiologist. There is no downside in doing so, except, perhaps, financially.

[@MeatyMondays]

I have been drinking electrolyte powder supplements with my water for a few months now that have 1000 mg of sodium (one of the ones marketed in the low-carb world), and I got my bloodwork done recently. For the first time in my life, my sodium was out of whack (150), and my Chloride was also elevated at 113. Could this be the cause of the elevated sodium and chloride? None of the other lab markers that you mentioned were abnormal.

[@Medcram]

150 is too high. Should repeat it to make sure and followup with whoever ordered the test.

[@MeatyMondays]

@@Medcram Will do, thank you!

[@RavikantRai21490]

I was wondering why so many people are mg deficient? Is there an interplay between calcium and mg?

[@dplj4428]

Do these studies collect data on nutrition? High salt frozen or canned food? Heart meds with diuretic for person mainly is mouth breather.

[@Salmon_Rush_Die]

A rule of thumb: if thirsty, drink. Don't drink soda, sugary drinks, alcohol, tea or coffee to quench thirst. Just water. Eat foods that provide electrolytes: Sodium, Chloride, Magnesium, Calcium, & Potassium.

[@dplj4428]

Dehydration, mouth breather, diuretic heart meds? How can a person find balance?

[@pierrecurie]

@medcram When drinking cold water, a small amount makes me not thirsty anymore. For room temperature water, however, I feel like the more I drink, the thirstier I get. Any idea what's up with that?

[@sheryl3268]

Another common sense way to replenish water loss from exercise is simply to weigh yourself while naked and dry both immediately before and immediately after exercise. That gives you how much you sweat and drinking the equivalent in water is a good estimate. It doesn't account for water use during non-exercise times though, but it does account for differing levels/volumes of sweat based on level of exertion, temperature, humidity, etc. (which the formula does not). I wonder if using the formula with an exercise length of 0 and then adding the value from weighing before & after exercise would be more accurate...

[@coopergates9680]

The exercise also burns carbs and fat though, which leave in the form of CO2 and water vapor, so you'd have to subtract that mass loss

[@sheryl3268]

@@coopergates9680 I'm thinking the weight of the CO2 is negligible, and the water vapor is, well, water lost too. Sweat isn't only water either, however water holds the primary mass of sweat so the estimate still holds IMO.

[@coopergates9680]

@@sheryl3268 That's the point, it's like getting CO2 and water from a wood fire. You can't weigh the vapors, you weigh the coals after it's out and it's a lot less than the starting wood weighed

[@krisbest6405]

I hate water, but put a jug with an easy tap in the fridge, it talks to me,drink me ,drink me, so once a day l do,and its lovely.?.

[@kathrynoneill81]

What about too little of other electrolytes like magnesium (most people) and/or potassium? This could make sodium too prevalent in comparison, as we get SO much sodium in processed foods, it throws off the balance.

[@Rene-uz3eb]

Magnesium stored in the bones is 0.5% dry weight, and is used on demand using the same mechanism as during calcium need (pth hormone). It certainly is crucial for energy production etc, but since it can be freed from the bone, it seems hard to develop a deficiency. Personally I’ve never noticed much of a difference but I do take a supplement anyhow.

[@peterz53]

@68 my blood work is very good and I'm in good physical health, but Dr never mentions chronically low Na and Cl on CBC. After much head scratching on my part I suspect it might be due to my morning routine of waking early and drink two cup of coffee, a cup of tea and a glass of water ib the 3 hours before blood lab opens for draw. So maybe I'm a little over hydrated. MY diet is low sodium in that I don't add salt and don't eat processed foods which are often high in Na. Will be checking my hypothesis next couple of blood tests by changing morning routine.

[@gz625]

Lol are you sure about that water intake? If my weight is 85kg and no exercising I should drink 2.6L of water! Which is pretty huge amount.

[@paulwolf8444]

If you work, work out and sweat or are thirsty, drink. Simple.