Water, sodium, and potassium

Ten steps to hydrate properly

Do you carry a water bottle around with you everywhere you go? Do you find yourself drinking water not because you are thirsty but out of compulsion? Or maybe because your mouth tends to get dry otherwise? Do you ever find yourself waking up in the middle of the night to go pee? Are you prone to muscle cramps? Do you get dizzy when you stand up? Do you have poor exercise recovery? If any of these things are true, then it is possible that you are actually drinking too much fluid, not too little, and it is possible that you are overloading yourself with too much salt. Here are ten steps to ensure proper hydration.

1) Temporarily stop drinking anything but water

Humans are the only animals on the planet that drink beverages purely for pleasure. We do it for the sweetness, for the aroma, or for the complexity that it adds to a meal. This is great, but the problem in doing so is that it overrides the mechanisms by which we regulate our hydration. Alcohol and caffeinated beverages further complicate matters because they are diuretics. Once you get better in tune with your thirst mechanism, which I will discuss below, and once you get a better feel for what it’s like to be properly hydrated, you can go back to consuming some beverages for pleasure. In the meantime, stick to simple H2O.

2) Temporarily stop drinking at meals

A lot of us drink at meals not because we are thirsty but because it helps us to wash down the food that we are probably eating too fast, or, as mentioned above, because it adds pleasure, or because it’s simply what we do culturally at a meal. But, again, humans are the only animals that do this. You don’t see lions dragging their prey down to the local watering hole so that they can intersperse their meal with a beverage. Animals eat when they are hungry and they drink when they are thirsty. Speaking of which…

3) Only drink when thirsty

This is the most challenging step, as a lot of us have lost the ability to truly follow our thirst. This is because we have chronically dehydrated ourselves with too much water. Wait, dehydrated ourselves with too much water? How is that even possible? The answer is that when you drink fluids despite not being truly thirsty, you temporarily become over-hydrated. Your kidneys respond to this by producing extra urine. The problem with this is that once you stop drinking, your kidneys don’t immediately go back into normal urine production mode. They stay in over-production mode for a while.¹²³⁴ This can set up a vicious cycle of over-hydration followed by dehydration, which will eventually cause all manner of adverse health effects. The first thing you may notice is a dry mouth. In fact, this is the cue that most “waterholics” use to start drinking again. Next, you might start waking up in the middle of the night to go pee. This is because your kidneys are still in over-production mode. Or, you might start noticing things like cold hands and feet, and dizziness upon standing. This can happen as a result of low blood volume. Finally, as chronic excess water consumption washes out your electrolytes, especially sodium,⁵ you may start getting muscle cramps, experiencing brain fog, having poor exercise tolerance, and generally feeling terrible.

The antidote to all this is to get back in touch with what it means to be truly thirsty. I’m not saying you should wait until you are overtly thirsty to drink. Rather, you should wait until the sensation of water hitting the back of your throat is mildly pleasant and mildly satisfying. No more. No less.⁶

4) Drink only until your thirst is quenched

Along the same lines, don’t finish a glass of water just because that is how much you have poured or because that is how much you have been served. Drink slowly, and stop as soon as your thirst is quenched. You don’t need to stay ahead of your thirst, as the campaign ads might suggest. This is only important if you are engaging in some kind of extreme sporting activity or if you happen to find yourself sitting in a sauna. Otherwise, you can rely on your brainstem. Your brainstem has an amazing mechanism whereby it is able to estimate the quantity of water in each gulp that you take, and predict, with incredible accuracy, the effect that it will have on your body once it is absorbed 30-60 minutes later.⁷ You can trust this mechanism.

5) Regulate your sodium intake.

Once you have stopped over-consuming water, you are now ready for the next step, which is to adjust your sodium intake. You want to consume just enough sodium to drive your thirst, such that your resulting 24-hour urine volume is in the normal range, specifically between 800 mL and 2000 mL per day. If you are overweight or metabolically unhealthy, or if you have a recent history of kidney stones, you want to shoot for the upper half of this range, as this will decrease your chances of developing new or worsening kidney disease. Otherwise, you want to shoot for the lower half of this range, since the associated lower sodium intake will lessen your chances of developing hypertension, as discussed below. Yep, I’m talking about peeing in a measuring cup and tracking it. Don’t worry, this too is only temporary. Once you get a feel for proper hydration, you’ll be able to guesstimate. You will also be able to guesstimate based on the corresponding color of your urine. But remember, you must first stop over-consuming water, and then regulate your sodium intake. The order is important.

But what happens if you consume more than just enough sodium? Does chronic excess sodium adversely affect long term health? The answer to the latter question is fiercely debated, but I think the answer is very likely yes, as I will discuss further in the next section. I would also refer you to the following key articles:⁸⁹¹⁰

One last note is that, over time, you will notice that the amount of sodium required to drive your thirst and keep you feeling good will decrease over time, as your sodium conservation improves, and as other mechanisms kick in. This is a good thing.

6) Get enough potassium

Whereas sodium regulates the volume of water in your extracellular fluids, potassium regulates the volume of water inside of your cells. What is the ideal amount of potassium intake per day? Unless you have kidney disease, you should shoot for 3400-4700 mg of potassium per day. This means consuming plant foods like fruit, especially bananas and avocados, as well as legumes, leafy greens, and other vegetables. Lean meat and fish also have a lot of potassium. I have no problem with fatty red meat, but it has less potassium. Grains also have very little potassium. How do you know how much potassium you are getting? Use an app to track the nutritional content of your diet, or use the USDA food database.

Having more potassium than sodium in your diet will likely lessen your chances of developing hypertension. In fact, having a lot more potassium than sodium may be particularly helpful. The Yanomami tribe in South America consume about 6000 mg of potassium per day, mainly in the form of wild bananas, tubers, fish, and small mammals. At the same time, they consume less than 100 mg of sodium per day! Compare that to 2640 mg of potassium and 3400 mg of sodium per day for the average American. The rate of hypertension among the Yanomami is ZERO. By that, I mean nobody gets hypertension, regardless of age.¹¹ Compare that to a hypertension rate of 72% for Americans over the age of 60.¹²

Do we need to go as low in sodium as the Yanomami in order to achieve health benefits? I don’t think so. In fact, I don’t think their extremely low sodium intake is ideal. Research has shown that just maintaining a potassium-to-sodium ratio above 1.25:1 will protect you against cardiovascular events.¹³ However, I recommend an even higher ratio of 3:1, in other words, a sodium content of about 1200-1500 mg per day. I believe this is the ratio that puts the least stress upon the body to maintain homeostasis. My reasoning is as follows:

1. If you take the known mean concentrations of potassium and sodium in human intracellular and extracellular fluid, and if you assume that our total body water is approximately 2/3 intracellular and 1/3 extracellular fluid, and if you do all the math, then the overall ratio of potassium to sodium in our body fluids is 3:1.

2. Human breast milk, interestingly, has the same potassium-to-sodium ratio of 3:1, according to the USDA food database. Obviously, breast milk is all that infants consume, and they thrive on this ratio.

3. Consider wild carnivores. All they eat is meat; meat that likely has a similar potassium-to-sodium ratio as human flesh and blood. In other words, carnivores thrive on this same ratio of 3:1. “But what about salt licks?” you might ask. “I heard that animals will travel for miles to get some extra sodium from salt licks.” Well, the truth is that only herbivores do this, and they do it because their diets have a much higher potassium-to-sodium ratio of about 20:1. The only reason carnivores go to salt licks is to eat herbivores.

“But what about athletes? I know athletes who consume a lot more sodium, and they have normal blood pressure.”

“And what about experts like Dr. James Dinicolantonio, author of The Salt Fix, who recommends much higher amounts of dietary sodium?”

To this I would say that if you are lean and muscular, i.e. if you have a waist-to-height ratio of 0.48 or less, and an ABSI (body shape index) of less than 0.080 if you are male, and less than 0.075 if you are female; and if you are metabolically healthy, i.e. if you have a fasting insulin of 6 mIu/L or less, and a fasting triglyceride level of 70 mg/dL or less; and if your systolic blood pressure is less than 120 mmHg, then it is likely that you can tolerate higher amounts of sodium in your diet, especially if you sweat a lot.¹⁴ However, I disagree that larger amounts are required for good health. Exceptions might include salt wasting nephropathy, which can be caused by a rare congenital defect, head injury, or certain medications. Also, those suffering from oxalate overload anecdotally report a greater need for sodium.

7) Balance your body pH

When your body is too acidic, your adrenal glands will secrete a hormone called aldosterone.¹⁵ Aldosterone assists your kidneys in excreting the excess acid. However, aldosterone also has the effect of decreasing sodium excretion and increasing potassium excretion. Consequently, if you are chronically acidic, such as occurs when you eat too many acidifying foods like lean meat, cheese, eggs, refined sugar, and grains, without balancing them with enough alkalinizing foods like fruits and vegetables (also animal bones!), your body will accumulate too much sodium and lose too much potassium, potentially wrecking the balance you’ve achieved by following the steps listed above.

If you want to test whether or not you are too acidic, buy a pH meter or pH strips. Your urine should be only mildly acidic, with an ideal pH of 6.2-6.9. This will be further discussed in the chapter on acid-base balance.

8) Get water from food

Water from food is absorbed slowly and will not cause the overhydration-dehydration phenomenon described above. You can get a large portion of your daily water needs from food. Fruits and vegetables are about 90% water. Cooked meat is about 65% water. By contrast, most ultra-processed foods contain very little water.

9) Get enough taurine

If you are consuming seafood, offal, or dark poultry meat, or you are eating a lot of meat in general, then you are likely getting enough taurine, a non-protein amino acid found predominantly in these foods. Taurine acts as an osmolyte, meaning that it helps to maintain hydration by regulating the concentrations of various solutes/electrolytes in various body fluids. If you have high blood pressure, it will help lower it.¹⁶¹⁷ It has the added benefit of activating GABA receptors, which can help you to relax.¹⁸ If you are more plant-based you will likely benefit from supplementation. 250 mg twice per day is probably enough. Some experts recommend much higher amounts, but I’m not a big fan of taking any nutritional supplement in an amount that exceeds what might be found in a normal diet, especially supplements that have neurological effects. Buy the pure powder, as it is inexpensive, has very little taste, and mixes well with just about anything. Alternatively, you can use magnesium taurate if you also need magnesium.

10) Make enough antidiuretic hormone

As the name suggests, antidiuretic hormone (a.k.a. ADH, a.k.a. vasopressin) helps to prevent your kidneys from over-producing urine, particularly at night, and thereby reduces your chances of dehydration. The key nutrients to support ADH production and function are copper,¹⁹ vitamin C,²⁰ and vitamin A.²¹ Copper and vitamin C help to make ADH itself, and vitamin C and vitamin A help to make copper’s carrier protein, ceruloplasmin.

BTW, if you are planning on supplementing with both vitamin C and copper, do not take them together, as these supplements can combine with each other and form toxic compounds that can damage your kidneys.²²

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Disclaimer: The above discussion should not be taken as medical advice. Changes to your diet should only be made with your entire health circumstances taken into consideration. For example, taking the above steps may lessen or eliminate your need for blood pressure medications, and failure to adjust them could result in dangerously low blood pressure. Likewise, if you have renal disease or congestive heart failure, or if you have lost electrolytes due to illness, or if you are on medications that can alter the balance of your electrolytes, such as diuretics, you need to discuss any changes to your diet with a healthcare provider.

1. https://clsjournal.ascls.org/content/ascls/29/3/186.full.pdf

2. https://pubmed.ncbi.nlm.nih.gov/29182412/

3. https://pubmed.ncbi.nlm.nih.gov/12876065/

4. https://pubmed.ncbi.nlm.nih.gov/13481895/

5. https://www.ncbi.nlm.nih.gov/books/NBK562251/

6. https://pubmed.ncbi.nlm.nih.gov/24706817/

7. https://pmc.ncbi.nlm.nih.gov/articles/PMC7335596/

8. https://pubmed.ncbi.nlm.nih.gov/24415713/

9. https://pubmed.ncbi.nlm.nih.gov/37445416/

10. https://pubmed.ncbi.nlm.nih.gov/13552935/

11. https://pubmed.ncbi.nlm.nih.gov/1132118/

12. https://pubmed.ncbi.nlm.nih.gov/40085792/

13. https://pubmed.ncbi.nlm.nih.gov/37072769/

14. https://pubmed.ncbi.nlm.nih.gov/23234732/

15. https://pubmed.ncbi.nlm.nih.gov/25377117/

16. https://pubmed.ncbi.nlm.nih.gov/26781281/

17. https://pubmed.ncbi.nlm.nih.gov/39148075/

18. https://pubmed.ncbi.nlm.nih.gov/30892104/

19. https://pubmed.ncbi.nlm.nih.gov/26612352/

20. https://pubmed.ncbi.nlm.nih.gov/26612352/

21. https://pubmed.ncbi.nlm.nih.gov/3655940/

22. https://pubmed.ncbi.nlm.nih.gov/36671529/