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The Wellness Blueprint: With Dr. Caleb Davis
Welcome to The Wellness Blueprint with Dr. Caleb Davis, where we uncover the secrets to living a long, active, and pain-free life. Hosted by Dr. Caleb Davis, an orthopedic surgeon and fitness enthusiast, this podcast is your ultimate guide to musculoskeletal health, injury prevention, and wellness.
Dr. Davis combines his expertise as a shoulder and elbow specialist with a passion for empowering people to take charge of their health. From deep dives into cutting-edge restorative medicine to practical tips on avoiding surgery and optimizing recovery, The Wellness Blueprint offers valuable insights for anyone seeking to preserve their body and thrive at every stage of life.
Join us each week for professional guidance, fascinating medical discussions, and actionable strategies that help you move better, feel stronger, and stay functional for years to come. Whether you're an athlete, a weekend warrior, or someone looking to age gracefully, The Wellness Blueprint provides the tools to design a healthier you.
The Wellness Blueprint: With Dr. Caleb Davis
Episode 17: Sip Smarter: The Secret to Optimal Hydration
Can you achieve optimal hydration just by drinking more water? Explore the intricacies of fluid balance and electrolytes in our latest episode where we unravel this complex topic. From understanding the delicate dance of intracellular and extracellular fluids to the crucial roles of sodium and potassium, we provide a comprehensive guide to mastering your body's hydration needs. Our discussion highlights the importance of recognizing dehydration and the true benefits of electrolyte supplementation, especially in the wake of intense physical activities.
Discover the fascinating world of magnesium supplements and why not all forms are created equal. We delve into how electrolytes are essential for maintaining nerve signaling, muscle contractions, and heart health. With cautionary tales of excessive water consumption and real-world advice on personalized hydration strategies based on body size and activity levels, we ensure you're equipped with the knowledge to avoid common pitfalls. Our conversation demystifies hydration myths, including the belief that coffee is dehydrating, and offers practical tips for maintaining a balanced electrolyte and fluid intake.
Join us on a captivating journey through the kidneys' critical role in hydration and blood pressure regulation. We explore the interplay between nephrons, hormones, and hydration, offering a fresh perspective on managing sodium intake and the potential of salt alternatives.
This episode is your gateway to understanding the nuances of hydration and maintaining a healthy, balanced approach to well-being.
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Hey everybody and welcome back to the Wellness Blueprint with Dr Caleb Davis. I'm your host, dr Caleb Davis, and I'm joined by my beautiful, talented co-host, nicole Davis.
Speaker 2:Hey everybody.
Speaker 1:Today we are going to discuss a topic that I think on the surface seems very simple, but actually can become very complex very quickly, and that is the topic of hydration. Nicole, what do you know about hydration?
Speaker 2:I know that most Americans don't get enough of it. I also know that human beings are comprised of a large majority of water. I don't know the actual percentage, but without water we will die. You can go without food for a while, but you can't go without water for more than what? Three days, I think, something like that.
Speaker 1:Yeah, I think everyone's different on that, and it also depends on the food that you're eating, because a lot of food is rich in water. But that sums it up Without water, you'll die. End of episode. We're done. Thanks, nicole. Yeah, we'll see you next week. Now, this is one of those buzzwords. You got to hydrate, everyone hydrate. Remember our very first episode, inflammation. I was like, oh, we got to dig into this, because people use that word so much and I don't think they know what it means. Hydration seems like one of those things to me.
Speaker 2:Well, yeah, because when you say hydration, I assume water, but I don't know if you also mean electrolytes.
Speaker 1:Well, if you want to get really technical, it's just talking about water balance in the body, but it's more than just drinking water or not drinking water, which is what I really want to dive into. We'll talk about dehydration and overhydration and some practical tips for staying hydrated correctly and safely and how you might recognize when you're not getting enough fluids, and we'll also talk about some myths and share some surprising facts, like why water alone might not always be the best option in some cases.
Speaker 2:You're talking about supplementing with Diet Coke, right I like. Why water alone might not?
Speaker 1:always be the best option. In some cases, you're talking about supplementing with Diet Coke, right? Right, because a lot of people drink Diet Coke to get hydrated. So grab yourself a glass of water or Diet Coke and have a listen. So hydration isn't just about drinking water. It's far more of an intricate physiological process than that. It's about maintaining the right balance of fluids and electrolytes across two major compartments in your body Intracellular fluid, meaning inside the cells, and extracellular fluid, meaning outside the cells. Nicole, I'm going to break down and really nerd out on this one. So you tell me when I need to stop, because this was part of med school the kidneys and blood pressure and the vascular system. Just I loved it. So you're going to have to stop me if I go too much, okay?
Speaker 2:All right All right.
Speaker 1:So intracellular fluid makes about two thirds of your body's total water. It's critical for enzyme reactions and nutrient transport and maintaining good cellular structure. Then there's extracellular fluid and then you've probably heard of this there's interstitial fluid. That's fluid that surrounds your cells and that facilitates nutrient and waste exchange in and out of cells.
Speaker 2:I only know interstitial fluids, because isn't that the fluid that comes out when you cut yourself?
Speaker 1:Yeah, like if you have a scrape and you have that clear liquid that comes. Yeah that's interstitial fluid.
Speaker 2:Right.
Speaker 1:Yeah, so that's not in the cells and it's also not in the arteries and veins, but it's that third area of fluid. Then there's plasma, and that's what you would think of as just the liquid portion of your blood. Your blood is filled with all sorts of different things, but think of this as the liquid portion, the plasma. And obviously plasma is very important for transporting nutrients, hormones and waste products all over your body. So the question is how does water get from each of these three places? How does it go across and balance? The movement of water from these compartments is governed by osmotic and hydrostatic pressures, your body's way of ensuring proper size and function of the cells In short, osmotic pressures is how water follows balances of sodium and potassium and magnesium and calcium, because there's electronic charges in these particles and water is drawn to it. Sodium is the main way your body is able to balance fluids into different compartments by regulating how much sodium is in your blood.
Speaker 2:Don't they say too much salt's bad for you.
Speaker 1:Well, we'll get into that. But think of it this way Most of the sodium in your body is outside of cells and it pulls water outside of cells. So if you're having a whole lot of plasma volume, meaning volume of fluid inside your arteries and veins, you're going to have, by necessity, a higher blood pressure. Now, that's a little simplified, but that's the basic idea of having too much sodium in your bloodstream. There's a whole lot of nuance to that statement, but that's the idea of talking about too much salt being bad for you, raising your blood pressure. Let's talk briefly about the role of electrolytes. Probably the ones that people are most familiar with are sodium and potassium. I think everyone knows sodium, because where do we find sodium Salt? Right, table salt, simple table salt. A combination of sodium and chloride is what most people consume in table salt. And what do people think about potassium?
Speaker 2:Bananas.
Speaker 1:Right. For some reason, people always think bananas. There's lots of food that has potassium in it, but bananas are a reasonable source of potassium A lot of people talk about. Oh, you're having muscle cramps, take potassium, eat a banana.
Speaker 2:Yeah, my mother said that to me literally like a week ago.
Speaker 1:I mean, it's not bad advice, but in this day and age, a lot of people are just taking a balanced supplemental form of electrolytes if they are feeling muscle cramps or if they've done a lot of vigorous activities. There's also calcium, magnesium and chloride, and these are all some of the most basic electrolytes that you'll find in supplements or things that you might find that you need to balance after losing these in sweat, for example.
Speaker 2:What's interesting, I was literally just reading up on magnesium because I was looking into a supplement for that, and this one supplement I'm looking at has three different kinds the citrate, something else and something else.
Speaker 1:That's all I remember, 3-n-8, glycinate and citrate. I bet Yep. Yeah, do you remember? We had an episode we talked about magnesium?
Speaker 2:In sleep, right? Yeah, thank God, you remember.
Speaker 1:You forget so fast? Do you remember what magnesium citrate does?
Speaker 2:Yeah, that's the one that you know. Yeah, you're going to wake up and you're going to have a little special friend accompany you to the restroom.
Speaker 1:Yeah, so there's sleep magnesium, there's mental acuity, like mental sharpness, and then there's the pooping magnesium. So, yeah, there's different forms of magnesium too, and a lot of that has to do with how it's absorbed from the gut and into your body versus not, so that plays a role too. It always comes back down to poop pretty quickly.
Speaker 2:It does yeah.
Speaker 1:Let's talk about sodium. Sodium predominantly is found outside of the cells and helps regulate extracellular fluid, so it controls in a large way blood pressure because, if you can imagine, you have more fluid in a system, it's going to have higher pressure and the water is drawn to it. Potassium is found primarily inside cells and it's crucial for nerve signaling and muscle contraction. Calcium is also very vital for muscle contractions and nerve transmission and plays a role in blood clotting as well. Magnesium is also very important in stabilizing nerves and muscle function and supports energy production.
Speaker 1:Now, when I talk about stabilizing nerves and important for muscular contraction, that's because there are these very sensitive gradients of an electrolyte on the inside of a cell membrane and on the outside of a cell membrane and those differences in concentrations actually help propagate electrical impulses up and down nerves. That gives us the ability to control our muscles and if those very delicate balances of concentrations of electrolytes across these cell membranes is disrupted, you have loss of nerve function. It's really fascinating. I'm really nerding out in a huge way because I just love this stuff, and this, by the way, includes heart contractions too. If you have imbalances of potassium and calcium and sodium in your heart and magnesium for that matter, you can actually have serious heart problems.
Speaker 2:That was just in that medical episode. We watched last night that show, that new show Pit.
Speaker 1:The.
Speaker 2:Pit. Yeah, it was that instance of that triathlon runner and apparently he had gotten rhabdo or something and so that had stressed his kidneys and so that.
Speaker 1:He wasn't clearing enough potassium.
Speaker 2:Correct, and so that stressed his kidneys and so that he wasn't clearing enough potassium. Correct and so that, yeah you explain it.
Speaker 1:No, no, I don't know the ins and outs of what that was. It was a medical show so I don't know what his levels were. But essentially he had a dangerous arrhythmia of his heart because he had too much potassium that wasn't being cleared correctly. It was probably some sort of imbalance between the cell membranes of the cardiac tissue not allowing proper electrical impulses.
Speaker 2:Right. So he's like this young, healthy 25-year-old guy and they keep having to like shock his heart back into rhythm. So that, yeah, that's definitely interesting to think about.
Speaker 1:So water alone cannot maintain hydration. You know, all of these electrolytes we just talked about is really what shuttles water into the correct place and maintains that very crucial balance. You can actually have too much water. That leads to something called hyponatremia, meaning too low sodium, and it can cause water to rush into cells due to a lack of an osmotic gradient, and that results in cellular swelling. In very extreme cases, this can even lead to cerebral edema, meaning swelling in the brain, which can lead to headaches, seizures and even death. Now, this would be a pretty extreme example. This is not something the average person is going to experience just by drinking too much water. There's usually some sort of medical reason that the body is not able to properly regulate sodium.
Speaker 2:Well, I remember this happening, I don't know, a decade or so ago, probably two decades ago because we're old now but some woman was doing this radio challenge. Do you remember this? Yes, I do, and she like, chugged a gallon of water within a 20-minute period, or something, to win this contest, and I remember the news describing it as her cells exploded.
Speaker 1:Yeah, do you remember that? I do remember the story you're talking about. No-transcript. Do you remember that? I do remember the story you're talking about. Unfortunately, I don't know the details. Wasn't she not allowed to urinate for a certain number of hours?
Speaker 2:I don't recall that part of it, I just remember it being really tragic because she was like a young woman with children or something.
Speaker 1:A gallon of water in a short period of time is hard to believe. That would be fatal, but more than that, sure I think it doesn't depend on the size of the person.
Speaker 2:It would certainly depend on the size of the person, because I'm doing this new year challenge with my fitness coach and based on women's different body sizes, like their weights and their sizes and their activity levels, we've been assigned different values of water that we're supposed to drink every single day. So, for my goal the entire day I'm supposed to drink one gallon of water. But, women who are smaller than me. They don't have to drink that much.
Speaker 1:Yeah, drinking a whole gallon of water in a span of a few minutes could probably lead to some problems. I wouldn't have guessed it would be lethal, but maybe if you're a small woman it could be. I don't actually know that for sure. So we talked about too much water. But you can also lose electrolytes without having too much water. So if you've lost water but your electrolytes remain high, cells shrink as the water gets pulled out of them and this can cause confusion, muscle cramps and circulatory problems because there's not enough water in the cells to maintain cellular function. That would be known as a hypertonic state.
Speaker 2:So what's an example of someone being hypertonic? Like when would you see that?
Speaker 1:You could just excessive amounts of sweating. Even though you are losing some sodium in sweat, you're still losing more water than salt. You could have way extreme overconsumption of salt that the body can't adequately clear if you're also super dehydrated.
Speaker 2:So if you're like sitting in a sauna for an hour when the recommended dosage of sauna times like 20 minutes, right. So you're sitting in a sauna for an hour and you're eating like fast food.
Speaker 1:I guess that could be an example.
Speaker 2:Gotcha, but yeah, for like people like me who do hot yoga I know it always comes back to yoga, caleb, I know, I know, but I make sure to have electrolytes afterwards is.
Speaker 1:That's just because I always sweat so much during class. You should take electrolytes and water at the same time after your hot yoga. However, if you were to just drink water, that'd probably also be beneficial for you, because you are losing electrolytes in your sweat. However, if you notice you don't drink water for a really long time, what does your urine look like?
Speaker 2:It's dark.
Speaker 1:It's dark, that's because your body is trying to pull all of the water back into your body and while it's still excreting electrolytes and other waste products. And then, when you have a lot of water, what does your urine look like?
Speaker 1:It's clear it almost looks like water because it's putting way, way more water into your urine because it says we have too much water, we don't need this much water, so we don't need to send out as many electrolytes. But we do need to send out water, so it's more diluted. So in a sense you certainly can replete your electrolytes after hot yoga, but just drinking water in that case would also be beneficial. But you're losing both. You're just losing water in a higher amount than you are electrolytes Gotcha. That make sense.
Speaker 2:Yes, good explanation.
Speaker 1:So let's talk a little bit about intracellular and extracellular fluid balance, since we've established what that means. Intracellular and extracellular Disruptions of these balances can have severe consequences. We talk about something called volume contraction. In layman's terms we'd call it dehydration. So you can have isotonic dehydration equal loss of water and electrolytes. This would typically be from vomiting or diarrhea, and this reduces extracellular fluid volume but preserves the balance, the overall relationship between water and electrolytes.
Speaker 2:I've heard instances of people getting a stomach flu and them hardly being able to get out of bed, and that's super concerning because then they eventually end up hospitalized, like I remember a young man who's an acquaintance of an acquaintance who died, like two years ago because he had the stomach bug.
Speaker 1:Yeah, yes, and in the older days, in the days of cholera, you basically just died of dehydration because you couldn't keep any fluid. You're just having massive amounts of diarrhea.
Speaker 2:Loving the time of cholera.
Speaker 1:Well, I'm not loving anything about that, but yeah, yeah. Now cholera. The way it really kills you is dehydration, because you're losing all your fluid. One of your colon's main jobs is to absorb all the water out of your food. So you're not sorry to be crass, but pooping water out. It's relatively a dry, drier excrement man. Again right away back to poop.
Speaker 1:This is for you, dad. If there are things at play like cholera that are not allowing your colon to do its job, you're losing all your water through your colon and then vomiting. You're actually losing a large amount of electrolytes from your stomach as well. So you're losing water and electrolytes when you're vomiting excessively. So you'll see a lot of times when children have been vomiting. They have to get saline fluids, which is isotonic, meaning it matches the balance of electrolytes in your blood. So that's isotonic dehydration. There's also hypertonic dehydration, meaning you're losing more water than electrolytes. Sweating again would be an example of this. We touched about that. As usual, nicole's ahead of the game. Diabetes insipidus would be another example of that.
Speaker 2:Wait, what's insipidus?
Speaker 1:Insipidus is diabetes insipidus.
Speaker 2:Isn't there a horror movie called Insipidus?
Speaker 1:Insidious oh okay, you're thinking insidious. This is not anything related to the pancreas. Diabetes insipidus it's a different disease. It's not like diabetes mellitus. When you think of diabetes, that's what you're actually referring to is diabetes mellitus, depending on how you want to pronounce it. This is a totally different disease process. Diabetes insipidus there's a couple of different ways it can happen, but you're having hormonal shifts that your body is not able to maintain water balances. It's a hormonal problem.
Speaker 2:Sounds pretty. It can be. It can be.
Speaker 1:And it can be really difficult to diagnose too. That'd be an example of hypertonic dehydration. Then there's hypotonic, meaning you're losing more electrolytes than you are losing water, and that's often because you're taking diuretic medication.
Speaker 2:So, like bodybuilders, before they go on stage, don't they like, not drink water? They dehydrate themselves.
Speaker 1:Some people use diuretics to try to reduce volume and have that more cut, more defined look and it can lead to serious problems. If you're using recreational diuretics, People can use it to weight cut, you know, for wrestling.
Speaker 1:UFC like all that sort of thing, which I don't think is legal in professional sports. But that would be a technique and if abused it can lead to serious medical side effects. Then there's volume expansion. We talked about volume contraction. There's volume expansion or over about volume contraction. There's volume expansion or over hydration. This is not something I think a lot of americans deal with in general. But let's talk about isotonic over hydration. This would result from getting too much water and electrolytes at the same time. So isotonic over hydration would result from excessive iv fluids. You're matching your salt and your water at the same time, but you're getting way too much of it. And now in this day and age where people are getting recreational IV hydration, you can just go to a spa or something and get a bag of fluids. It's not that hard to imagine that you could do it. Before that was a common, regular thing. That was a lot harder to do.
Speaker 2:Okay, yeah, so that's like people who are trying to recover from their nice drunken escapades.
Speaker 1:That would be one example. I remember I had a horrible case of a stomach bug where I was vomiting a whole lot and I got an IV bag of fluids because I had isotonic loss of volume, all the throwing up. So I was just trying to replace that volume with isotonic fluid. Remember everyone, isotonic means it's matching what your body's chemical balance should be.
Speaker 2:No one's going to remember that.
Speaker 1:Okay.
Speaker 2:Some people might remember it. I'm happy for you that you remember it and it fills you with such joy that's taking a leap out of our friend Sterling's book.
Speaker 1:Then there's hypotonic overhydration and this would be an example of water intoxication. This leads to just excessive water intake, water that does not have electrolytes in it and this can also lead to water entering the cells because you're diluting sodium, so the water exits the blood and into the cells and it can cause swelling. And then there's hypertonic overhydration. This would be from excessive sodium intake and that draws water out of the cells. This is the example we're talking about, where people with high blood pressure problems. If they eat lots and lots of sodium and don't drink enough water to counteract that, the water gets pulled out of the cells and into the bloodstream, causing high increases of blood pressure, which can cause strain on the heart.
Speaker 2:Are you going to do a quiz at the end of this?
Speaker 1:No, no quiz.
Speaker 2:Seems like you're trying.
Speaker 1:No quiz, no, I just really love this physiology. It's so interesting and I think people just think drink water, water, good, drink water, and that's not a bad takeaway. We'd all do better to drink more water than not. But there's much, much more nuance to this. How am I doing so far? You know everything kind of making sense.
Speaker 2:Yeah, I just you know, don't quiz me on it, okay, actually, I feel like I could remember the hyper and hypotonic stuff. Okay, but the ISO and the whatever other one Isotonic.
Speaker 1:Yeah, isotonic.
Speaker 2:Versus isotonic.
Speaker 1:No, there's no ISO. It's just hypo, hyper and ISO. But what's the opposite of isotonic? There's no opposite.
Speaker 2:ISO is just like. But what's the opposite of isotonic?
Speaker 1:There's no opposite. Iso is just like balanced Hyper is too much and hypo is too little.
Speaker 2:Ugh see I have a bit of a reputation when it comes to water and the water bottles I carry around, because I've got those fancy water bottles that'll put in some UV light so it'll help sterilize bacteria that's in there. So, I'm constantly walking around with a water bottle that lights up and then people are like why is that thing lighting?
Speaker 1:up. It's lighting up right now.
Speaker 2:Yeah, I know it's because I moved it yeah, so your water bottle.
Speaker 1:Let me get this straight your water bottle contains a uv light that flashes on your water that it shines into the water yeah, yeah into the bottle and what it does is it sterilizes the bacteria to prevent it from growing further.
Speaker 2:It doesn't actually filter out the bacteria. You'd have to have the filter in there, which I do have, but not right now.
Speaker 1:You have a bunch of dead bacteria in your water.
Speaker 2:Yeah, yeah, yeah. Dead bacteria Yep.
Speaker 1:Yummy.
Speaker 2:It keeps your water bottle from getting extra funky.
Speaker 1:Uh-huh, does your water bottle normally get pretty funky?
Speaker 2:I mean, how often do you clean your water bottle? Normally get pretty funky. I mean, how often do you clean your water bottle, dr Big Guy?
Speaker 1:You only ever do it, because I do it for you, I think magic fairies do all my dishes and wash my water bottles. Yeah, magic fairies, aka your wife. Yeah, my beautiful co-host, nicole. All right, well, I've already nerded out on all these definitions of iso and hypo and hypertonic. Let's talk about the star of the show, the kidney.
Speaker 2:Oh, I thought you were going to say me.
Speaker 1:No, we're co-hosts. This is shared. No, the star of the hydration is the kidney. I just love this topic, so let's go. Let's dive right into the kidneys. So your kidneys are your body's hydration regulators, and they are a key player also in controlling your blood pressure. So here's how it works. The kidneys filter about 50 gallons of blood every single day. They remove waste products and excess electrolytes through tiny structures in the kidney called nephrons, and then essential nutrients and water are resorbed back into the bloodstream. Sodium resorption is tightly controlled by the renin-angiotensin-aldosterone system.
Speaker 2:I don't know what.
Speaker 1:Don't worry, you won't be quizzed on that. Okay, so there's a couple different key hormones at play here. The antidiuretic hormone, which I bet you can guess what that does.
Speaker 2:It makes it so that you aren't getting bloated.
Speaker 1:What's a diuretic?
Speaker 2:Oh, that's the thing that makes you lose volume.
Speaker 1:So what's an antidiuretic.
Speaker 2:It. Oh, that's the thing that makes you lose volume.
Speaker 1:So what's an antidiuretic? It makes you not lose your fluid. Antidiuretic hormone is released when the body detects dehydration and it signals your kidneys to absorb more water. So think about if you have ADH, antidiuretic ADHD, nope, antidiuretic hormone, adh. If you're releasing that in your bloodstream, that means your urine will become Darker, Darker they're at a hormone ADH.
Speaker 2:If you're releasing that in your bloodstream, that means your urine will become Darker, darker.
Speaker 1:I did it, she did it, yes, yes, because you're going to pull water back into your bloodstream and have not so much in your urine, so that's your way of resorbing more water. Okay, aldosterone is another hormone that increases sodium resorption, which indirectly raises your blood pressure. So that draws more sodium back into your blood. It tells your kidneys to bring more sodium back in your blood, which increases vascular volume, increasing your blood pressure. There's also a hormone called atrial natriuretic peptide, or ANP for short, and that's released when blood pressure is too high and ANP promotes sodium excretion and lowers blood volume.
Speaker 2:Okay, I'm going to ask you some layman questions here right. Because I go to the doctor they always test my blood pressure. They tell me one blah, blah, blah, over blah blah and I never know what's good or not. And I guess my question is what is the function of blood pressure? And I know a lot of people are on medication to stabilize their blood pressure but I don't even understand what a general baseline is for a healthy person.
Speaker 1:The average healthy adult. The answer for what's an average healthy blood pressure is 120. Systolic over 80. Diastolic 120 over 80 would be your average healthy blood pressure. In young adults, or even in adults between the ages of 20 and, say, 60, low blood pressure is not typically something that comes up. There are different reasons why people might have low blood pressure. Most people are worried about high blood pressure and there's a number of reasons why this can cause a problem, but the one that I like to think about the most is imagine you have a lot of pressure in a pipe and you're trying to pump water into that pipe, but there's a lot of pressure pushing back on you. Okay, okay, you're going to have to pump harder to pump that water in, right? What's the pump in your body?
Speaker 2:The heart.
Speaker 1:Yeah, so if your heart is having to pump really, really hard and work really, really hard to pump water in that high pressure system, your heart's going to have strain.
Speaker 2:Yeah, okay.
Speaker 1:And that could cause problems for you in a number of different ways. But actually really, really high blood pressure can actually cause end organ damage, meaning damage to your liver, damage to your kidneys, damage to your brain, but that's usually when you're approaching blood pressures of 190 to 200, which we call a hypertensive emergency or hypertensive crisis. That's not something most young adults are going to deal with, but you might see that in in older age groups, depending on different medical conditions. There's a whole list of reasons why chronic high blood pressure can cause you problems. So that's just me scratching the surface.
Speaker 2:Gotcha Okay. So recap that again. Why are you excited about the kidney?
Speaker 1:I just loved endocrinology so much in med school, seeing how all of these hormones affect this one organ that just so crucially affects how you get blood and how the blood pressure is maintained. It's just this intricate web and system where, if you just mess it up just a little bit, you're dead. I just it's such an amazing thing. Now that's no reason for panic, because in healthy organs you can take a lot of punishment from your external environment and your body will adjust and maintain. People talk about pH of the blood and people talk electrolytes of the blood, but all of these systems are in place that can actually balance it out in a number of different environmental factors, including what's happening to your body externally and what you're eating and drinking. It's very good at balancing, but you might notice shifts in the way you feel and the way you have energy and how you sleep, and all that if you're not taking very good care of your body too.
Speaker 2:His eyes did light up and get like really full of joy when he was talking about the kidneys, just so you know.
Speaker 1:Yeah, in med school I had a serious time thinking about maybe being an endocrinologist or doing nephrology, but I realized I wouldn't get to do surgery or work with a power saw or mallet, so orthopedics had to be the answer. Let's talk about some alternatives of salt, since there are some people who have excessive sodium problems. Have you ever seen salt alternatives at the grocery store? I've seen yes. So we've talked about how sodium is this thing that drives vascular volume. They actually make a potassium chloride salt, so it's not as problematic for high blood pressure and it still gives flavor.
Speaker 2:Yeah.
Speaker 1:Salt's not always a bad thing, though. If your doctor's told you to cut back on salt, chances are that you need to be worried about your salt intake if you have high blood pressure issues. But there's actually been some benefits of loading up on salt in a safe way, in the proper context of sports. That can actually lead to increased performance and endurance and sometimes intra-articular fluid volume, meaning more joint fluid around your knees and hips and everything. So you have more cushioning for your joints during excessive athletic performance. So how do we recognize dehydration? Dehydration can be subtle or it can be severe, so we'll talk about some symptoms. Mild dehydration symptoms include typically dry mouth, maybe some mild fatigue. Your urine starts to turn a darker color.
Speaker 2:Your skin probably dries out too right.
Speaker 1:I think that usually comes when it starts to become more severe. So moderate dehydration would be more like. You might actually get dizzy. You might start having a rapid heartbeat. Then you might notice that your skin is dry. Severe dehydration might include confusion. You're fainting. Your face has this sunken appearance. You can have varying degrees. I think probably a lot of people have experienced the moderate dehydration. That's funny. I've seen a lot of memes out there where people are reminding their spouse or their loved one to drink water because they just feel cruddy throughout the day. Have you ever experienced that?
Speaker 2:Oh yeah.
Speaker 1:Yeah, tell me more.
Speaker 2:I used to get headaches fairly frequently, and so you'd always say well, how much water have you had today? So that was always something that you would say years ago. Now I'm actually quite on top of my water game.
Speaker 1:Yeah, you're probably better at drinking water than I am now.
Speaker 1:Well, I don't have to be in multi-hour surgeries all day I have to confess, I get a large portion of my water drinking in later in the day because I try not to drink too much water before surgery for obvious reasons. But I always keep a big bottle of water reusable bottle of water with me in the office so I can take sips between seeing patients in my office. But let's talk about some practical tips for staying hydrated. How much water do you need? As Nicole already pointed out correctly, it varies significantly. In general just broad strokes women are recommended to get about three liters of water per day, which is a little under a gallon, and men are recommended to get around four liters a day, which is around a gallon. Now, if you are more active or more sedentary, or you may be in a drier environment or you're sweating more often, all of these factors might play a role in why you might need more or less water.
Speaker 2:How many ounces are in a liter?
Speaker 1:A liter is 32 ounces.
Speaker 2:Oh, sorry, okay Two liters is roughly 64 ounces, Because yeah, that makes more sense, Because the recommendation I always got growing up was you need to drink eight 8-ounce glasses of water a day, which would amount to 64 ounces, which is two liters.
Speaker 1:That's some good math right there.
Speaker 2:Thank you, I'm pretty proud of that. So that's two liters. But Dr Big Guy is suggesting women. You get three liters. So add an additional four of those eight ounce glasses on top of that.
Speaker 1:If you drink just two liters of water, you'll be better off than a lot of people.
Speaker 2:Yeah, it's sad to say, but it's totally true.
Speaker 1:The level of activity that you're doing is relevant, so I'm not going to give anyone medical advice on this podcast, specifically for how much water you should drink. This is just a broad stroke Three liters for women, four liters for men, just in general. You can take that and adjust that as you need no-transcript limit.
Speaker 2:But it doesn't right. Like in a lot of cases, caffeine, coffee or tea is going to have an adverse effect on your hydration. Is that right?
Speaker 1:I'm glad you brought that up oh, is that the next part? I will get to it now, because you brought it up. But there's actually a myth that if you drink a cup of coffee, it is more dehydrating than if you were to drink nothing. Let's say, an eight ounce cup of regular black coffee. Does that dehydrate you or does it hydrate you?
Speaker 2:Dehydrate.
Speaker 1:No, it doesn't.
Speaker 2:It's all lies.
Speaker 1:Right? Well, the caffeine does act as a mild diuretic, meaning it stimulates you to lose water through your kidneys, but it's not great enough of an effect to lose that eight ounces of water all in one go. The talk of people losing fluid through diuretics like caffeine.
Speaker 1:you need to drink a lot of caffeine for that to happen, which a lot of people do drink a lot of caffeine, but if you're talking about a cup of coffee and it's eight ounces of water in that coffee, you're still getting hydrated from that. Now, it's not ideal. It's not as good as drinking water if you're doing it for hydration but you're not losing eight ounces of fluid because of that small diuretic effect. So that is a common myth and I wanted to share that one.
Speaker 2:I didn't think that you'd lose eight ounces of fluid. It was just I knew that it would have a counteracting effect.
Speaker 1:A very, very small one. Okay so you're still getting overall fluid increase from that coffee.
Speaker 2:I guess the point that I want to make is well, and maybe this isn't the right point, maybe you just need to slap the. I'm a doctor, I know better than you. Thing on me.
Speaker 1:I would never do that.
Speaker 2:Are you kidding? All right, we won't bring that particular thing into this podcast. It's just the idea that if you were going to drink eight-ounce glasses of something throughout the day, but four of those glasses were hot tea or coffee, that's not ideal.
Speaker 1:It wouldn't be as optimal as drinking water.
Speaker 2:I would just recommend to people that they actually count their pure water as water.
Speaker 1:I don't think that's a bad idea. Now I will say that alcohol usually has a higher level of dehydration effect, so that's why I do recommend everyone drink a glass of water between every alcoholic drink that they drink, if they choose to do so, although we are still in dry January, so I'm hoping people are cutting back.
Speaker 2:That's right, people. It's January.
Speaker 1:I'm also hoping people cut back through the rest of the year, but that's for another podcast. I won't keep preaching at you.
Speaker 2:Actually, I learned that January 10th is the National Day of Quitters, because that's when people fall off on their New Year's resolutions.
Speaker 1:Yeah, well, didn't we talk about that in the episode?
Speaker 2:I don't know if we talked about the National Day of Falling Off.
Speaker 1:I guess not the National Day specifically, but we talked about the percentage of people who stop within the first week, basically, of their New Year's resolution. There's this big debate when do you drink electrolyte drinks? If you sweat a whole lot, it's not a problem to replenish with electrolytes. The problem is, if you sweat all this electrolyte, you're losing water and electrolytes. And if you just drink pure water, you're just replacing it with water and you're not replacing those electrolytes you lost in your sweat. When you sweat, your sweat contains electrolytes, although not in a concentrated amount. Now what happens? You've lost a certain amount of fluid from all this excessive sweating, right. So what happens if you just drink a bunch of water?
Speaker 2:now, you are replenishing the water, but not any lost electrolytes.
Speaker 1:Exactly so. That's why I would encourage you to drink electrolytes when you sweat excessively in exercise.
Speaker 2:So is it better to take the electrolytes before, during or after said excessive exercise?
Speaker 1:That really depends. Some people argue for intra consumption, meaning during the activity. I think that probably during especially if you're talking about performance sports like football or baseball or basketball, where you're actively losing and you need to contain really good muscle contraction and performance and coordination, I think it'd probably be good to have it during the activity, especially if it's going to be very drawn out like a several hours game of basketball or football For your yoga. I don't think it's going to be very drawn out like a several hours game of basketball or football For your yoga. I don't think it's going to make a huge difference whether you do it during or after, although you are having to have some coordination and balance for sure. So if you're finding that you're getting dizzy during your yoga, I would definitely encourage you to drink during class Electrolytes, not alcohol. That could get messy.
Speaker 2:Yes, thank you for the distinction.
Speaker 1:So I recommend that people start your day with a glass of water before you drink your coffee, before you partake in anything else.
Speaker 1:Just drink some water to get your GI system going and starting off on a right note, and sip water throughout the day. Your kidneys are constantly regulating your water and your salt content. Just drink it throughout the day. Don't just try to chug all your water at one time, like I do at the end of the night. That's not exactly true, but I could do a whole lot better about drinking throughout the whole day, because you're eating food which you take in electrolytes and you're drinking water throughout the day and you're constantly getting that good balance. So ideally, your urine will be a light, pale yellow throughout the day, meaning you have a good, optimal balance. You don't want it to really be all the way clear either, because that means your body's having to get rid of excessive water because you've had too much. And you can also include foods like cucumbers and watermelon and leafy greens, because those foods actually have a high water content as well and that stuff counts, but most people don't really think about that.
Speaker 1:And let's be honest, most people probably need more water, not less. In general, do you know another way that you can actually lose a fair amount of?
Speaker 2:water from your body other than sweat and urine.
Speaker 1:It's not bleeding, although that does cause dehydration. No, I'm getting at breathing.
Speaker 2:I was thinking diarrhea.
Speaker 1:Well, we already talked about diarrhea. This is the third or fourth time the word diarrhea has been said in this episode, and this is an episode about hydration. Rapid breathing, especially in dry environments or during sleep, can actually cause water loss through evaporation. What are you laughing at, Nicole? You said rapid or during sleep can actually cause water loss through evaporation. What are you laughing at, Nicole?
Speaker 2:I'm just, like you said, rapid breathing during sleep. That's not what I thought, that's not what my brain filled in.
Speaker 1:Tell me where your brain went.
Speaker 2:No, I really can't, I really can't Okay.
Speaker 1:Yeah, okay, all right, moving on. So this is particularly common in individuals who are mouth breathers. I don't mean that as an insult, just people who breathe through their mouth when they're asleep or people who use CPAP machines? I have this problem pretty significantly. I get dry mouth really badly because of my CPAP machine, but I have started using the humidifier application on the machine now to try to help humidify the air so I don't lose so much water when I'm sleeping.
Speaker 2:Gotcha.
Speaker 1:Remember when we were hiking out in the desert and I said we should have like what? Four gallons of water per person. Yeah, I said what? Am I a camel? I was like how can I carry eight gallons of water around while we're doing a?
Speaker 2:20 mile desert hike. Let's be real, because you would be carrying almost all of that water.
Speaker 1:Yeah, water is heavy to carry. Water is very heavy, and I'm the pack mule.
Speaker 2:I mean don't have so many muscles if you don't want to accept your fate.
Speaker 1:What can I say?
Speaker 2:Why is that sexist?
Speaker 1:Getting your husband to carry everything. Aren't you a strong, confident woman?
Speaker 2:I am a strong, mostly confident woman.
Speaker 1:You are very strong and confident and beautiful.
Speaker 2:Well, thank you all. Thanks yeah.
Speaker 1:But yeah, when you're out in the desert, you're losing water through your skin. You're losing water through your skin. You're losing water through your breathing. So these are all factors that can also affect it. Even if you're not sweating all that much. You may not be sweating as much, but the dry environment is leaching that water out of your body too.
Speaker 2:I do have a question about blood loss, because when I go and donate blood which I recommend everybody do when and if they are capable I know that I have a tendency to get a little I don't know. I almost pass out.
Speaker 1:Well, that would be an example of isotonic dehydration, because you're pulling that fluid out of your body as whole blood. So you're not only losing your plasma, but also your hemoglobin and your platelets and everything else in your blood too. But, you're losing isotonic fluid out of your body.
Speaker 2:And I lose it very rapidly. I don't know what that means about my blood in particular, but when they plug me in and they have that blood flow go, it takes two minutes for that bag to fill up.
Speaker 1:Yeah, Just pumping hard.
Speaker 2:Yeah, I guess.
Speaker 1:I don't know, you're a good pumper. I didn't mean anything by that.
Speaker 2:One of the reasons why I like to donate blood is because I get to eat Oreo cookies afterward.
Speaker 1:Really, you'd probably do better by drinking a whole lot of fluids and getting electrolytes they give you sugary water, sugary drinks like apple juice or whatever, yeah. Yeah.
Speaker 2:And it does make you feel better. Oh, yeah, yeah.
Speaker 1:Yeah, it does. It does it helps boost your energy. But that comes in a whole other role, because we're not just talking about sodium and water. We're talking about hemoglobin and the oxygen carrying capacity of your blood, meaning your blood cannot carry as much oxygen now, because how much of hemoglobin has been removed?
Speaker 2:Which is why they don't let you do strenuous activity for 24 hours.
Speaker 1:But really eating a lot of protein, drinking lots of water but also replacing with electrolytes, Because if you just drink pure water, then you're diluting your blood even further in that situation, all things to think about? Hey, let's take a quick break for Fractured Facts.
Speaker 2:Ooh, yeah.
Speaker 1:Welcome back to Fractured Facts. This one is a little bit more out there. Nothing really to do with the episode, but this is something that's been on my mind a lot lately because I get this question all the time.
Speaker 2:Okay, Is it? How much do you bench?
Speaker 1:No, everyone knows I bench a lot, so no one has to ask. This one has to do with MRIs and metal in the body.
Speaker 2:In or on, or both In. I'm talking about in the body, okay, I saw a disturbing reel about this where somebody had something shoved in a place and they didn't know that it had metal in it and then they went into an MRI machine and then apparently it tore up their insides. Real bad.
Speaker 1:Well, for actual facts, it's taken a dark, dark time. Well in my experience.
Speaker 2:People are more often asking me about orthopedic implants.
Speaker 1:So I fix people's bones with metal plates and screws and rods that go inside their bones, and I do knee and shoulder and hip replacements that are made of metal. So the question that always comes up is can you safely go into an MRI machine if you have an ear placement? Let's just say as an example so I get that question all the time from other doctors, sometimes too, that not everyone is sure of it. What do you think?
Speaker 2:I would be concerned knowing what I know.
Speaker 1:Okay. So why is an MRI machine dangerous for metal? What is that?
Speaker 2:I know the MRI stands for magnetic resonance imaging.
Speaker 1:That is so hot. You're so hot right now. That's impressive, thanks yeah.
Speaker 2:Okay, so it's like a giant magnet, basically, and it pulsates or whatever, and it's like taking images and if you have any kind of metal on your body, it will want to bring it to the machine. It'll be drawn to it.
Speaker 1:That's right. So we talk about a property called ferromagnetic metals, so iron, nickel, cobalt. These materials are usually strongly attracted to magnets and in the powerful magnet field of an MRI they can become dangerous projectiles and literally fly across the room. You've probably seen that in medical shows, but it's actually not too far from the truth. Orthopedic implants like titanium rods or screws are not ferromagnetic. This is why they're safe for MRIs. Some of the older types of surgical staples are ferromagnetic and those can be a problem. Oftentimes you talk about people who have shrapnel in their body like metal. Debris from trauma can also have complications from that as well.
Speaker 2:Wasn't that an issue with Iron man too? Didn't he have shrapnel or something that was about to pierce his heart? And so that's why he created that whole thing that like sits in his chest cavity, and as long as it's on it, like won't pierce his heart.
Speaker 1:Yeah, the magnet was like pulling it away. Yeah, I've seen that. That's real. Like it's real, real. No, it's not. I'm sorry, I was just teasing.
Speaker 2:You look so serious.
Speaker 1:I know.
Speaker 2:I couldn't tell.
Speaker 1:Over 95% of orthopedic implants are safe for MRI machines. There are some different types of medical implants that you need to be concerned about, like spinal nerve stimulators or sometimes implantable defibrillators or pacemakers, and sometimes they have to have special equipment used to turn them off so that they're not interfering with the MRI. But in most cases all orthopedic implants in the United States are MRI compatible.
Speaker 2:I guess that leads to our next question, which is do you need to worry about orthopedic implants if you travel abroad and get into some sort of scooter accident or skydiving accident? Well, probably you'd be dead if you got into a skydiving accident, but you know what I mean. Do you need to worry about orthopedic implants internationally?
Speaker 1:It's funny because this actually came up a few days ago. Somebody told me that they had a surgery done in the Philippines and they asked if it was MRI safe. I told them look, I have no idea. I don't know what implant company they use and I don't know the properties of that metal. So we're going to have to do some digging oh interesting, yeah, now it ended up that they were safe, but sometimes you just don't know right.
Speaker 1:I guess the best answer is never assume the other question I get all the time is will my knee replacement or my hip replacement sit off metal detector at the airport.
Speaker 1:And the answer is oftentimes yes. Yes, it will. And we actually design a little card that says hi, my name is blah blah, I have a hip replacement and it's this company and this is the day that I had it. And people carry those around. So just in case, in most situations you see, the knee has a big scar on the front of it. Most people aren't going to give you a hard time. Plus, you roll your pants up. What are you hiding in that leg? So it's not usually a problem for people, but we do design those cards just so people can have them after their joints are replaced and keep it in their wallet. But I've never really heard of it being a huge problem for people.
Speaker 2:Is there like an emergency shut off button for MRIs?
Speaker 1:If they determine that somebody had something that was magnetic?
Speaker 2:yes, there is. So they can shut it off really quickly if they're concerned. Like, how quickly can it destroy you? Let's say somebody had something lodged in their throat that they didn't like. Okay, all right. All right, this is a crazy wesley question, all right. So let's say somebody was proposing to their girlfriend and they, like, hid the engagement ring inside of whatever they were eating, and then the woman ate it without realizing it, and then she was having intestinal issues. So I don't know why they decided to do an mri thing. And then they realized that it's in her intestinal tract while she's in the mri machine and it is like a magnetic or whatever and would that tear through her body?
Speaker 1:Well, only if it's a really cheap ring, because gold is not ferromagnetic. So if this guy's a cheapskate and it's got a bunch of iron and nickel in it, then maybe but would it theoretically burst out of her like alien and alien?
Speaker 1:I think it would take some time to start. I think it would just cause more pain than anything. I don't think it would literally burst out. I think it would take some time to start. I think it would just cause more pain than anything. I don't think it would literally burst out. It also would depend on the strength of the magnet because MRIs come in different strengths In units called Teslas.
Speaker 1:It's a unit of measure, nothing to do with the car named after the scientist, tesla, but the strength of the magnet would matter. I think it might start digging a hole in the stomach, but I don't think it would just rupture forth. That's a lot of tissue to get through, so in theory, though, it could cause some serious damage.
Speaker 2:That's why that reel that I saw was so horrifying.
Speaker 1:I think the density and the surface area of the object would also matter. So if it was a pin, that might come flying out more easily than, say, A larger object. A larger object with higher surface area where that force would be distributed across the stomach lining. You're getting all these crazy hypotheticals, so you're getting this detailed answer.
Speaker 2:Nice.
Speaker 1:We'll have to save that for another Fractured Facts. I'll see if we can find any MRI horror stories. Yeah, I should have come up with that for now, but I don't have it, so we're going to have to move on. Okay, let's get back to the episode. One last thing that I did want to talk about before we wrapped up is high salt consumption. So the American diet is very high in salt.
Speaker 2:Is that the sodium content you see in all the nutrition packets?
Speaker 1:That's right. So the normal recommended amount of sodium is 2,300 milligrams of sodium per day, with really an ideal limit of 1,500 milligram for individuals with high blood pressure, but if you don't have any blood pressure issues, that cap that's recommended is 2,300 milligrams. The average American consumes approximately 3,400 milligrams of sodium daily, which is a huge excess over the recommended value by almost 50%. So I imagine that you've experienced this, but I certainly have, especially when eating, say, boneless wings. The sodium content is just massive and you feel all sorts of sick afterwards, not just sick to your stomach, and you feel like your hands are swelling, you feel bloated, you might feel like you have a headache and you just feel bloated and swollen all over.
Speaker 2:I think I've experienced this when it comes to movie theater popcorn If you get the giant one because it's like refillable or whatever, and then you're just snacking on it the whole time and then you get up and go and get the refill because you paid 10 bucks for it.
Speaker 1:So you might as well get the refill. I don't even want to think what the sodium content is in eating two buckets of popcorn.
Speaker 2:I've been there.
Speaker 1:It's a lot. That would be an example of getting way, way too much salt, and I would say that you can try to counteract that by doing two things. One is taking some more potassium with it, finding a way to supplement potassium.
Speaker 2:So basically shove some bananas in there with the popcorn.
Speaker 1:I would just take a potassium pill I think they sell that in supplemental form and then taking a lot of water with it, because your body's going to need a way to get rid of all that sodium. It's going to try to drive it out through your kidneys. So I do think that's something, especially if we're going to go to, like an all-you-can-eat steak buffet, a restaurant like Texas de Brazil. Drinking lots and lots of water with it can help offset some of those undesirable effects.
Speaker 2:Is that what we call the meat sweats?
Speaker 1:Yeah, but I think there's some more things at play than just the meat sweats. But really a lot of it is quite a bit the sodium content that you're consuming.
Speaker 2:Is that why they provide caramelized bananas? Texas Day, Brazil.
Speaker 1:That's a great question. I do eat a lot of bananas when I go to Texas Day Brazil, and I was already onto something. Lots of water, lots of bananas, lots of steak that's really all you need in life, right?
Speaker 2:Yeah.
Speaker 1:So that pretty much covered everything I want to talk in this episode. Drink lots of water throughout the day. Try to hit three liters to four liters a day, depending on your activity. Remember if you're in a dry environment, you're breathing a lot. During exercise, you may be becoming more dehydrated than you think, even if you're not excessively sweating. Remember, if you are excessively sweating, to supplement with electrolytes a good balance of sodium, potassium, magnesium and calcium can all be helpful.
Speaker 2:Nicole, do you have anything else to add on that summary?
Speaker 1:No, I'm just glad you didn't quiz me on anything. Yeah, no quizzes, no medical jargon. Just remember hydration is so much more than just water intake.
Speaker 2:I remember growing up playing sports outside a lot in the Florida heat and I would always be encouraged to drink Gatorade because it has electrolytes. It does, but you've taught me that there are different forms of electrolytes and there's different tiers of how good they are. So what should people look for when they search for electrolyte packets? Or perhaps the drinks that have built-in electrolytes, like coconut water, touts that it has electrolytes, gatorade and Powerade and all those?
Speaker 1:Coconut water does have electrolytes. I don't know the exact profile of sodium, potassium, magnesium, calcium in coconut water, but it is close to isotonic, meaning matching your body's ideal electrolyte balance. So coconut water is a good, natural, healthy supplement. I just can't stand the taste of it. Personally, I would look for things that are not packed with sugar. That's one of the downsides of Powerade and Gatorade is they have a lot of added sugar to them, so I do try to stay away from those. I have a certain brand that I use that has a good mix of sodium potassium. Try to stay away from those.
Speaker 1:I have a certain brand that I use that has a good mix of sodium, potassium, magnesium and calcium. It also has a little bit of creatine in it as well, which helps bring back water into the muscles for replenishment and can help with performance. So I find that product good In general. There's a lot of good supplements out there. I'm not too worried about the quality of sodium potassium. It's fairly simple. The one you might want to worry about more is magnesium and the way it's taken up in the body, because, as we said before, magnesium citrate is more of a laxative than anything, so you might want to be careful about the type of magnesium that you take.
Speaker 2:But if I add my packet of electrolytes into my coconut water, is that too many electrolytes?
Speaker 1:You might want to offset it with a little bit more water Just plain water after that, just to help take it in, but that really depends on how much electrolytes you've lost.
Speaker 2:How does one know, Dr Big Gay?
Speaker 1:If you've done two hours of yoga and you're swimming in a puddle, chances are you'll need more electrolytes. But no, there's no way I can really tell you exactly how you'll know that. If you're urinating and it's clear all the time, then you might need more electrolytes, but your kidneys do a pretty good job of pulling that balance in.
Speaker 2:Yes, be kind to your kidneys.
Speaker 1:That's right. Just to conclude, hydration is the synergistic maintenance of water and electrolytes across fluid compartments in the body. It's much more complex than just drinking water. However, I will say most people should just focus on getting their three to four liters of water a day, although if you are doing a lot of excessive sweating and noticing that you're having muscle cramps and fatigue and dizziness, you may want to consider supplementing with electrolytes in addition to your water. But both aspects are essential and remember, it's not just about feeling good and not having headaches. It can also affect your nervous system and your cardiovascular health and overall homeostasis. Nicole, thanks for joining me and let's go get some water before bed.
Speaker 2:All right, sounds good.
Speaker 1:So, as we add an ever important, growing list of things to do, no-transcript.
