Toto's Take: stop drinking water wrong
the hitchhikers guide to hydration in the Healingvrse
Dear Companions,
This may seem like a technical post, but it encapsulates one of the most important lessons about the body I have learned thus far. After three years of every type of headache under the sun, not to mention strange autonomic symptoms, I’ve learned a thing or two about proper hydration using salt. This may not seem significant relative to all the hundreds of blood tests and functional testing I’ve done, and all the big problems—hormonal, neurological, chronic pain—but finding relief using a simple tactic, using elements off the periodic table, in the face of a trillion-dollar pharmacological industry, gives me a sense of empowerment that is hard to describe.
So, I’ve become a bit of an idealogue on the topic. Like a vegan, but for hydration. Those who come in contact with me can often hear me singing the gospel of salt—spilling salt all over the place, stopping in cafes to get salt in a napkin when I forget my supply, and often walking through the door asking first for salt. And then reaching for half an avocado if I need to counteract high sodium in the blood strand.
These rules are applicable not only to migraines but also to other types of pain, POTS, ME/CFS, Long Covid, athletic pursuits, and any quest for optimal health. As is often the case in the Healingvrse, there is a slew of Huberman-style content promoting the use of salt in water to hydrate, but without clear explanations.
Reasonless health advice is like Teflon.
Furthermore, most people are bombarded with electrolyte options that are garbage. Much of my knowledge comes from a book written by Dr. Angela Stanton and her super active migraine group focusing on hydration and diet (carnivore or low carb) on Facebook. She believes migraines and other neurological conditions stem from sodium imbalances. She’s been testing her methodology across a group of 10,000+ people with not just migraines, but other issues as well.
Today we will focus on rectifying imbalances via hydration. Sodium in food is another issue, but as a general rule try to balance meals with potassium and sodium (1:1) which you can track on Chronometer. For people with migraines or POTS in particular, check out her group. She has helped many achieve symptom elimination without medication, even those sick for years.
This may look like a book report of sorts, but it took a bit of thinking to isolate the most important things to make a difference to one’s understanding such that it might induce a change in drinking behavior.
Actually, writing this post drove me utterly nuts. Enjoy!
I encourage you to DYR. Hydration is unique, and salt needs depend on your body, but even implementing a small piece of this should have you feeling better.
I hope this is a nice start to your salty universe.
Perhaps this post has caught you before you’ve gone over the deep end. With me, I’ve wondered if my illness is a massive dehydration event. Like the people in the Three Body Problem Game.
Retribution. As a kid I drank Snapple to hydrate after intense swim practices. In college I layered in the Gatorades. Law school brought the slide further into hydration hell with things like Diet Cokes. 60+ LBS gained during pregnancy didn’t bring the appropriate increase in water intake, and sometime after the vaccine, my body just croaked.
I remember once I met with Michal Jordan’s agent, David Falk, and told him I didn’t need water after a long train ride to meet him. I’ll never forget how at the end, I embarrassed myself by repeating my full name when shaking his hand goodbye. Study after study shows major cognitive deficits due to dehydration can range from 10% to over 20% even in mild dehydration. For me—once I got sick—I couldn’t do anything at all.
Life is believed to have originated in the ocean. The primordial ocean had a certain balance of salts, primarily sodium chloride, which early life forms adapted to. As organisms evolved, they maintained internal environments that mimicked these conditions. The salt in our cerebrospinal fluid is nearly the same as the salt in the ocean.
If we go back thousands of years when people ate what they hunted, they ate the blood (full of salt) and also the meat itself was full of salt because of the blood vessels and because each cell is in an ocean-level saline environment. Today we hang animals up to let all fluids out and there goes the salt!
Lesson #1: Why Salt to hydrate
It might seem logical that pure water is the best way to combat dehydration, but the body's hydration balance is more complex. Salt is a necessary ingredient to drive real hydration. Here’s why.
Remember learning about osmosis? I can remember where I was sitting in high school (in the back) when I first learned this principle. Water tends to move from areas of low solute concentration to areas of high solute concentration to reach equilibrium, through the principle known as osmosis.
In other words, water goes into areas where there is more “stuff” for it to dilute.
So, when sodium levels are low in the bloodstream, water moves into the surrounding cells and tissues, where there is more “stuff” for it to dilute. but when sodium levels are high in the bloodstream, water gets drawn out of the cell to maintain fluid balance in the bloodstream.
Either extreme can disrupt cell function. Cells need a balanced environment to function properly. When water moves into the cell, it causes it to swell. This reduces blood volume leading to lower blood pressure and reduced perfusion of tissues, which can impair the delivery of oxygen and nutrients to cells. Ultimately that swelling causes a range of symptoms like headaches, edema, cramps and irregular heartbeats. So, I hope this makes clear as to why a little bit of sodium can go a long way!
On the other hand, too much sodium in the bloodstream will cause too much water to flow out of the cells, leading to cellular dehydration and shrinkage, which can impair their function and cause other symptoms. There are a host of issues associated with that but remember: the kidneys are quite efficient at extracting excess sodium from the bloodstream. In normal conditions, it filters the blood five times per hour. Furthermore, if you have too much salt in the bloodstream, you can dilute with potassium by ingesting half an avocado or an unsweetened coconut water.
Lesson #2: Salt Guidelines
Indeed, only a pinch of salt is needed for benefits of proper hydration. Ultimately, the amount of salt you need depends on your water consumption, but the recommended amount in the Healingvrse is:
1/8th teaspoon of salt per 8 oz cup
Start by adding salt to your morning and evening cups of water.
Gradually increase by adding salt to one more cup each day until all cups contain salt.
For those with conditions like POTS, increase salt to a minimum of 1/4 teaspoon per cup of water. Personally, for my level of disfunction with headaches, I tend to take this greater quantity of salt, and certainly in periods of higher stress or dramatic drops in barometric pressure.
Lesson #3: How to calculate your water intake
This is Dr. Staton Staton’s formula. For women and girls: Multiply your weight in pounds by 0.55, then divide by 8 to get your minimum daily water intake in 8 oz glasses. So, A 150-pound woman should drink (150 * 0.55) / 8 = 10.31, rounded up to 11 cups of water per day.
For men and boys: Use a multiplier of 0.75 for lean, muscular individuals, or 0.7 for those with more body fat. So, a 170-pound muscular man should drink (170 * 0.75) / 8 = 15.94, rounded up to 16 cups of water per day. While a 170-pound man with more body fat should drink (170 * 0.70) / 8 = 14.88, rounded up to 15 cups of water per day.
Important Notes
**Drink pure, flat water without flavoring or carbonation. Sparkling water changes the pH of your stomach and should be consumed only occasionally.
**DON’T SIP WATER; drink an entire 8 oz cup at once for better hydration efficiency. Imagine it driving hydration into your actual cells, and all the right areas in your body. CHUG!
**Coffee, broth, soup, milk, and other drinks do not count as water. Only pure water counts toward your daily intake.
I sit in my chair and drink from a salty goblet, like a cavewoman drinking the blood from her hunt.
A note on how glucose effects hydration!
I’m trying not to get into the entire food aspect of Dr. Staton’s protocol, which include things like protein synthesis and proper macros, but the reason Dr. Staton supports a lower carb diet (~50g+) is that large glucose molecules push sodium out of the cells as they enter, causing a greater risk of imbalance. Therefore, even if you are perfectly salting, a high glucose diet can kick you out of balance.
how glucose causes electrolyte imbalance
To summarize a complex process, glucose uses sodium to move around in the body through a process known as sodium-glucose co-transport (SGLTs). These transporters use the energy from the sodium gradient (the difference in sodium concentration inside and outside the cell) to move glucose into the cells. Essentially, as sodium moves into the cell down its concentration gradient, it provides the energy needed to transport glucose into the cell against its concentration gradient. Sodium is then pushed out of the cell as glucose moves in.
And so where do these go?
Depending on how much glucose had to enter the cells, the amount of sodium and water kicked out will either be able to remain in the interstitial space around the cell or it has to move farther out to other cells because of lack of room. It is this time that you can see edema build up. But according to Dr. Staton, this edema is not in the blood either. It is in pockets of cells elsewhere, such as under your eyes or in your ankles. So, when you see that kind of swelling, you are likely experiencing edema.
Lesson #5: Edema types and treatments
Edema is usually represented by swelling of some parts of the body; there are three types for today:
1. Compartmentalized (just fingers and/or toes, or puffy eyes, swollen ankles, for example).
Swollen ankles, swollen finger, toes, and eye puffiness represent edema caused by glucose—it need not be glucose one ate; it may be glucose released as glycogen as a result of stress. Glucose removes sodium and water from that cell no matter where the glucose came from. Those with strong insulin resistance (like in type 2 diabetes) will have greater amount of glycogen release and therefore a bigger edema response.
For this kind, we use a kick of sodium to drive water back into the cells. We take 1/8th teaspoon of salt without water to reduce edema. Excess sodium will be eliminated by the kidneys. This process will result in you urinating colorless, clear urine.
I take a pinch of salt with a sip of H20 to depuff the magic dragon finger.
2. Systemic (gained several pounds/kilos overnight).
Excessive overnight weight gain (2lbs+) can be influenced by the menstrual cycle or ovulation or other fluctuations. Studies suggest that surges in chloride lead to this type of edema. Salt breaks down further into sodium and chloride, so you don’t want extra salt in this scenario.
Instead, consuming potassium-rich foods can be helpful, as potassium helps balance sodium and chloride levels. You may eliminate salt waters for morning and evening, possibly eliminating salt for all waters. If that does not work, reduce water intake.
Around my cycle, I will eliminate salt in waters for a day or two prior and during.
3. Exercise induced edema (mixture of points 1 and 2).
When you are working out, there are several factors to consider: the type of exercise, duration, and what you are eating/drinking during your workout. These all affect the fluid balance in your body.
intense exercise
Walking, jogging, running, or other exercises often cause swollen fingers and toes in migraine sufferers about 30 minutes into the activity. This is less common with weightlifting. The exact mechanism is unclear but involves glycogen release from muscles, which affects sodium and potassium levels.
As mentioned above, glucose entering the cell will displace sodium. At the same time, during intense activity, cells use more sodium for cellular respiration, muscle contractions, and increased heartbeat. Therefore, you may be in need of more sodium if you experience edema afterward.
Start by “salting up” right before your workout since you will need extra sodium for your muscles. Take salt and water prior to your workout and drink saltwater throughout but be frugal—don’t overdo it. After completing your exercise, sit and wait to see if your toes and fingers return to normal within a few minutes. They should if you have done this properly.
endurance exercise
If you had a marathon or similar long endurance event, it may take up to 3 days to recover. You may experience systemic edema caused specifically by glycogen and excess sodium.
To aid recovery, switch tactics, and consume potassium-rich meals, drink unsweetened coconut water for a potassium-rich drink, and avoid salting water.
During exercise, drink salt water before and during to give your muscles the sodium they need for energy. After brief exercise, check if swelling goes down within 10-15 minutes. Recovery may take longer after endurance exercises. Switch to potassium-rich foods and drinks to deal with excess sodium.
Lesson #5: Pressure & Potassium
For those who experiences symptoms when traveling to different altitudes, or before and during storms, they may be reacting to barometric pressure changes.
When barometric pressure drops, there is less external pressure on blood vessels, and thus the volume of blood drops. Increasing sodium levels in the bloodstream, increases the osmotic pressure in the blood vessels, and thus restores balance, and reduces swelling.
Conversely, when barometric pressure rises, the external pressure on blood vessels increases, and thus the volume of blood increases. In this case, additional salt isn't necessary, but if this process happens too quickly and your body is unprepared, you can have some potassium to counteract it.
storms and planes
It’s easy to track weather changes using the 10-day forecast on WUNDERGROUND!
When a storm approaches, pressure often drops. At the beginning of my illness, just a small drop that most people would never notice could cause a major migraine, never mind huge drops and increases. The solution, I learned, was to add extra salting in the days leading up to it, or hours, or at least be mindful of salting properly to stay balanced. Similarly, when you take off in a plane, the pressure gets lower as you go higher, so to prepare you may salt water at the gate. I’m still fearful of taking any kind of plane, but when I do it will be a huge, huge milestone for me given how much I have loved to travel in my life.
As you descend back to earth the barometric pressure rises again, or in cases of big increases due to weather changes, your vessels may constrict under that pressure, and make the blood volume feel relatively higher, so you may lower your blood volume with some potassium to help dilute the sodium in your system.
According to Dr. Staton, potassium is always taken in via food, rather than supplementation. Usually, you will want to eat an amount of food that delivers roughly 300 mg to 400 mg of potassium. This is the amount found in half of a typical sized avocado or a cup of unsweetened coconut water.
Potassium helps counteract the effects of sodium. Potassium can help dilute the effects of sodium causing your body to excrete more sodium, which in turn, assists in lowering blood volume and pressure. This can be particularly helpful when going to lower altitudes.
Lesson #6: Salt Test
Now you’ve mastered the principles, but you still ended up with a migraine or dizziness or another symptom. This means you are out of balance. By reviewing the above principles, you will know if you need more salt or potassium.
However, if you are unclear as to why you are feeling a certain way, Angela recommends a salt test. This involves putting a few grains of salt under your tongue (up to 1/16 tsp), and then waiting 15 minutes.
If improves your symptoms, you need more salt: take 1/8th teaspoon and chug an 8oz cup of water.
If the salt test makes you feel worse, try a potassium-rich food.
If there is neither improvement nor worsening of your prodrome, what will help you is a properly balanced meal, balanced 1:1 in sodium and potassium. Drink as you normally would.
If my salt test makes me feel better, I am in need of salt. I take a 1/8tsp of salt and chug an 8 oz glass of water.
If salt does not work, I eat half an avocado for potassium.
The salt test is a beautiful example of using intuition and mindfulness to learn about your body. There are many rules here, but each body is unique. Eventually you will get the hang of what you need.
If you are stuck at Lesson #6, then it means you likely have a headache or migraine disorder and should seriously consider Angela’s group. My post here is just a teaser.
salt tablets
Health by Principles is Angela’s recommended salt tablets if you want to simplify or if taking salt plain makes you nauseous. There are a number of reasons why salt can you make you feel sick if you take it alone, but when taken with water I prefer it straight up. For those with thyroid issues, you may need to stay away from the iodine in salt, as I do.
As mentioned, if you interested in full healing, Dr. Staton’s group has a much broader system involving strict food guidelines alongside more detailed hydration principles.
With much love from the Healingvrse,
Rebecca
Thank you for a clear and compelling presentation.
Very interesting and insightful. Well researched. Thank you.