Over recent years, a number of new diets have become popular among health conscious individuals. The most popular include: the low carb high fat (LCHF) diet, as well as the ketogenic and carnivore diets. In this video-interview I discuss how diet affects electrolyte balance. Electrolytes, minerals like salt and potassium are essential “cofactors” for enzymes involved in metabolism. They are essential, meaning we cannot make them on our own. We have to ingest them through diet. Each of these new diets differs in available electrolyte cofactors. In addition, each of these new ways of eating modifies how much insulin we use. Insulin holds onto sodium and so as we reduce our insulin need, we also reduce sodium. Since electrolytes affect everything from cell firing to heart rhythm, it is important to consider whether one’s chosen diet provides sufficient quantities of these critical elements.
I have written about the electrolytes salt and potassium on several occasions, see here and here and here. I have also written about how thirst is an indicator of electrolyte balance or imbalance, see here. In the video, we discuss salt thirst from a different perspective, and sodium requirements with different diets. US Dietary Guideline recommends 2300 mg sodium (sodium is 40% of salt) for the general population and 1500 mg sodium for the elderly and those with heart disease. This is in contrast to research showing that such low sodium actually increases mortality. Accordingly, the ideal amount is around 3500-4500 mg sodium a day for all populations. Another study found that 4000 – 6000 mg sodium was ideal for non-hypertensive individuals.
Salt, Edema, Thirst, Insulin, and Hydration
In diets more heavily focused on animal proteins, managing hydration can become difficult without proper electrolyte support. Edema, or swelling, is a common symptom of improper electrolyte balance and dehydration. Because these diets reduce circulating insulin, and as a result also sodium and water levels, the body becomes dehydrated. To conserve water and salt, the body stores it in the tissues, leading to edema. Rather than reducing water and salt, an increase in both is required to prevent edema. Thirst may also follow, but drinking water is often an inappropriate response.
I also cover protein to some extent in this interview. Much is yet to be clarified about the amount of protein that is ideal. I have written about protein before, you will find it here.
I hope you enjoy this video discussion.
Keto & Carnivore: Electrolytes, Water Retention & More
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This article was first published in April 2020.
Dear Angela
I have a problem with edema especially in face. I have tried many combinations of high/low sodium/potassium, different amount of water, low carb, but never had any effects. There are some days that I wake up and edema is completely gone for a day or 2 but I can’t figure out why.
I have seen your answers to commenters to have some salt when waterlogged, and I also seen an interview when you said to have more potassium foods and lower salt intake when edema appears. I would appreciate if you have any insight
Dear Joanna,
Thanks for reaching out. May I ask what foods you are eating?
Most people collect edema as a result of eating carbohydrates. I don’t just mean “sugar” but all forms of carbohydrates, such as bread, pasta, potatoes, rice, peas, beans, fruits, etc., are all sugar for your body. Few people realize that a day of eating the Standard American Diet, containing lots of grains, veggies, and fruits, are full of sugar even not a single piece of sugar is added to them. For example, a slice of sourdough bread, which according the to USDA weighs 139 gr, contains 72.1 gr carbohydrates and that includes 3.06 gr fiber. So if I subtract the fiber to get how much sugar (net carbs) is in that slice of sour bread, it comes to 69.0.4 gr carbohydrates. 4 gr carbohydrates is equal to 1 teaspoon sugar, so 69 gr carbohydrates in that slice of sour bread is 69/4 = 17 teaspoons of sugar!! In a single slice of bread. You cannot taste the sugar because it is in the form of starch, and we don’t have the ability to break starch into individual glucose molecules in our mouth, so the bread doesn’t taste like sugar at all! But it is 17 teaspoons of sugar!
The reason why carbohydrates cause edema is because glucose is taken out of the blood and must be put inside of cells. However, glucose cannot just get inside of the cells. A single glucose molecule has 6 water molecules in it and it requires insulin and/or sodium transport into the cells. Therefore, as glucose enters the cells, water and sodium leave the cell. And the water that leaves the cell will end up as edema.
Taking salt and water with carbohydrates amplifies the effect and you will end up with bigger edema each day. It matters what you eat. Trying low carbs once for a short while is not going to help since the edema may take weeks or months to reduce. You need to be consistent. Most importantly, how you take the salt and potassium matters. When you take salt with your food, the salt is not free. Salt is made from sodium and chloride, which separate in your stomach and form different chemical bonds. If you take salt with water, these two form an electrolyte, which ties both salt and water down and this will increase your blood volume. If you eat salt with your food, it will be absorbed into your cells through your intestines rather than as an electrolyte in your blood. So it matters how that salt gets into your body.
The same with potassium. If you take potassium with your water, it becomes an electrolyte and increase potassium in your blood, except that there is barely any potassium in the blood in humans! So taking a potassium supplement is the worst possible way to take potassium. potassium resides inside the cells and so the way to take potassium is with food, so it absorbs through the intestines into the cells and not into the blood.
There is a definite method to how to do this. I teach this to migraine sufferers in my Facebook migraine group here, feel free to join to learn how to hydrate properly.
Best wishes,
Angela
Hello Angela
Thank you for getting back to me so quickly
I’m eating mostly meat, eggs, cheese, cream, milk, potatoes, rice, pasta. I’d say whole foods without excessive carbs, mostly sat fat.
What you say about glucose kicking out water and salt from the cell makes sense, but what about people who eat very high carb diet and not struggling with edema? Does their water ends up somewhere else than extracellular space?
Thank you
Joanna
Joanna,
Potatoes, rice, and pasta are on the list of foods with the highest starch content. A single medium potato has almost 10 teaspoons of sugar equivalent in starch. A bowl of rice (3.5 oz so less than half a cup) has 20 teaspoons of sugar equivalent, and pasta is flour, just like sourdough, so expect a huge starch load that converts to sugar. You may think you are eating healthy but for you body and your genetics you aren’t.
People are different. There are people who can smoke 3 packs of cigarettes a day and live to be 100 with healthy lungs, but most people will end up sick from that. There are people who can live on eating sugar all day long as well but you are not one of them. We each have our strength and weaknesses. Those people who don’t get edema–or at least they don’t see their edema–may have a higher carbohydrate tolerance and their body has better ionic channel functions or they have better kidney functions. We don’t know how they differ.
It may be interesting to mention that before I turned to low carbs way of eating–over 10 years ago–I never noticed I was full of edema! I also didn’t notice that my husband was full of edema. I thought that was “me” at my norm. I had no idea since edema seems to sneak up on you and if it increases little at the time, you may not notice.
However, when I moved to the low carbohydrate diet and lost all my edema, my husband told me that my ankles were back to what he remembered from my youth. I also recovered from many health conditions I had, so this encouraged him to join me. I have a favorite picture of him in my office that I looked at the other day just as he was in my office and wow!! His face is so different! He had huge edema that we didn’t notice! We notice it now that he no longer has it.
So you can’t really say that those other people don’t get edema. Correct?
I recommend you give low carbs another try and this time for a year and see the changes. Try it. 🙂
Angela
I will give it a go. I guess I’m just scared to lower carbs by much because you need glucose and if you don’t feed it you’ll make it internally but then won’t cortisol be constantly elevated to increase your blood sugar?
Joanna, we all make glucose internally. We cannot not make glucose internally. Our red blood cells need a constant supply of glucose. Unless you have glycogen storage disease, in which case you need to be given glucose every 2 hours, your body is making enough glucose to supply your body’s needs under any and every condition. Annd neither cortisol nor adrenalin have anything to do with glycogen release.
Angela
Dear Angela
Isn’t cortisol and adrenaline elevated to increase blood glucose on a low carb diet?
Thank you Joanna
Dear Joanna,
No, there is no need to elevate cortisol and adrenaline on the LC diet to increase glucose. The only organs that must use glucose in our body are: red blood cells and the retina of the eyes. Everything else either uses free fatty acids as the preferred fuel source or ketones or both or all three. The amount of glucose these organs need is produced by the liver from fat deposits called triglycerides via gluconeogenesis. In this process, the liver removes the glycerol cap of the triple fatty acid molecules. Two glycerol caps create a glucose molecule, so our stored fat can be used as free fatty acids for organs that use fat and the glycerol converted to glycogen for those that use glucose.
Our body is not designed to run on glucose. Most of our organs default to using fat–including our heart and even our muscles! The muscles switch to using glucose only under hard physical work. It is stored for such moments when we have to run away from the lion or fight that lion for our lives. It isn’t meant to be used for everyday tasks. There are millions of people now eating various low carbohydrate diets–including me for the past 10 years–feeling calmer than I have ever been and becoming healthier than I ever recall having been even in my youth.
Both cortisol and adrenaline become increased for everyone in the morning as we wake and then reduce over the course of the day, and this is very much independent from what one eats, but it is not independent of metabolic health. Those with metabolic disease have much more cortisol and adrenaline spikes than those with a healthy metabolic system. In my experiments of the many nutritional forms, I have never felt calmer than when I ate no plants at all: on the carnivore diet. All my nutritional needs were met and the healthiest were all my markers.
I wish you would give it a try but try the correct carnivore. Join my group to learn what the correct carnivore is.
Hugs,
Angela
Dear Angela,
I wrote above about my daughter. She stopped the drug 8 months ago and the edema is still here. She stopped as soon as it appeared. Did the drug damage her is some way? Can her sodium/ potassium channels be damaged? We have seen so many doctors and no one can help her. No one seems to understand how this drug works. She took it for pelvic pain.
Dear Anne,
I have seen 5 comments from you and all refer to the same case, so I just respond to one to simplify things. In one of your posts you also added that she was taking Gabapentin but stopped, and is now supplementing potassium, magnesium, calcium and sodium. So let me help you take this whole thing apart.
Gabapentin:
From Wikipedia: “Gabapentin is a ligand [ligand = connects to] of the α2δ calcium channel subunit.[69][70] α2δ is an auxiliary protein connected to the main α1 subunit (the channel-forming protein) of high voltage activated voltage-dependent calcium channels (L-type, N-type, P/Q type, and R-type).[9] Gabapentin is not a direct channel blocker: it exerts its actions by disrupting the regulatory function of α2δ and its interactions with other proteins. Gabapentin prevents delivery of the calcium channels to the cell membrane, reduces the activation of the channels by the α2δ subunit, decreases signaling leading to neurotransmitters release, and disrupts interactions of α2δ with NMDA receptors, neurexins, and thrombospondins.[9][10][11] Out of the four known isoforms of α2δ protein, gabapentin binds with similar high affinity to two: α2δ-1 and α2δ-2.[70]… Gabapentin is a potent activator of voltage-gated potassium channels KCNQ3 and KCNQ5″
I highlighted some of the sentence parts with bold because those are the problem areas for your daughter both for the edema and also for what she is supplementing, and why there may be some permanent damage.
Basically the bolded sentences mean the following:
1) Gabapentin blocks both L and R type calcium channels. L is associated with the heart and R with the brain in the cortex, hippocampus, striatum, amygdala and interpeduncular nucleus. (here). These calcium channels are responsible for the function of the heart for its beat (L type) and the neurotransmitter release in the brain (R type). As a result, her brain and cardiovascular systems are significantly affected in how they can function.
2) Calcium must enter the neurons to have the neuron release it’s neurotransmitters. Neurons that cannot communicate, degenerate. So this drug degenerated her brain–this doesn’t mean the brain remains degenerated. It may recover over time.
3) Gabapentin activates voltage-gated potassium channels. This is also a problem because of how the brain must have sodium and potassium in a particular ratio (3:2 sodium:potassium) in order to properly function and be able to start action and resting potentials. Neuronal communication starts with sodium rushing into the cells and this initiates action potential–the start of voltage–and once the voltage started, in those areas where the voltage started it is an action potential. When that is started, immediately sodium must leave the cell and potassium must rush into the cell, and this creates the resting potential, which stops the voltage at that particular point in the neuron.
The voltage is going from sodium channel to sodium channel of the neuron (Nodes of Ranvier) as the action potential goes all the way to the end of the neuron. The resting potential follows all the way, in step, with a tiny delay, putting the voltage out. When the voltage reaches the foot of the neuron, that is where the voltage-gated calcium channels come into action, where calcium rushes into the neuron and literally kicks the neurotransmitters into the synaptic cleft, which is the area between neurons. From here the connected neuron can pick the neurotransmitter up and start its own action and resting potential and send the neurotransmitter to the next neuron it is connected to.
So all of these activities are blocked in the brain except for the potassium channels, which are actually enhanced and activated. And this blocks all chance for an action potential. So her brain basically came to a standstill while on Gabapentin.
Now, she stopped Gabapentin 8 months ago, but while she was taking it, neither her heart nor her brain was able to work properly and drugs that inhibit, do so by connecting (ligand as I noted above) to proteins. And that’s very dangerous, because the connection may damage the folding of the particular protein and it may render it damaged for life. We don’t know if any of this happened but can be. In addition, since her heart was also controlled by this drug, and the heart cannot heal very well because it cannot stop or slow down, it changed her vascular behavior.
The edema is associated with her vascular system not functioning the way that it should. Add to this that she is supplementing electrolyte minerals that she shouldn’t. Please read my article on why supplementing with potassium is a very bad idea. Also, supplementing with calcium may be a bad idea, particularly if she isn’t also supplementing with D3, K2, magnesium, and vitamin C, and assuming that she even needs to supplement with calcium. Supplementing with calcium should only be done in small amounts at the time since the body can only absorb 400 mg at once and while calcium is water soluble, in the body it is fat-soluble.
Calcium supplementing also requires a high-protein diet because over 40% of the bones is protein, which creates a scaffolding onto which calcium can adhere to form bone. So if she is not eating a lot of animal products high in protein, protein synthesis is not going to happen very easily and so her ability to place that calcium anywhere useful is questionable.
And finally: being able to take salt as part of her electrolytes requires that she drink enough water for her weight. For females the minimum water a day is 55% of her weight in pounds. So a female weighing 100 lbs would need 55 ounces (7 cups of 8 oz water each) minimum a day. If she drinks less water than this and if she eats a lot of carbohydrates, her body will hold onto water and also salt, hence the edema. It also matters how much sodium she is taking at once.
I would recommend that she join my Facebook migraine group where she can learn how to eat and what to help recover and stop the edema.
I hope this message is helpful for you.
Best wishes,
Angela
Thank you!
Angela,
I sent this to my daughter and she is so upset. Is it possible to have a private consult with you?
Thanks Anne,
I believe your daughter has already joined my migraine group on Facebook. If you need further guidance, please feel free to contact me by email: angela@migraine-book.com.
Best wishes,
Angela
My daughter took a drug called gabapentin and has been struggling with Edema in her hands and feet ever since, painful Edema. She has also recently tried to cut her carbs out and add in a lot more healthy things like eggs meat liver fish etc. Is there anything else she can do to stop the edema.
Dear Anne,
I am very sorry that your daughter is taking Gabapentin. This drugs is a voltage gated calcium channel blocker, which disrupts neuronal communication. In addition, it is a strong activator of voltage-gated potassium channels, meaning it increases fluids leaving cells. So this explains the edema of your daughter. The low carbohydrate diets will not help with edema caused by a drug. To stop the drug-caused edema, she needs to discuss discontinuation of the drug with her doctor.
Since Gabapentin is prescribed for many conditions, including migraines, if migraines are the reason for the medication, there are way better alternatives out there. If she was prescribed this for seizures, she should contact the Charlie Foundation for help. If for migraine or nerve pain, she should join my Facebook group and we can help her learn to prevent migraine and reduce/prevent nerve pain, depending of the cause.
Best wishes,
Angela
These articles are helping me understand so much more. But I still have problems I cannot fix. I am on a carnivore diet and I have tried increasing my salt intake and drinking small amounts of milk. It has helped a little, but I still have problems with minor muscle cramps but mainly lack of power when exercising.
It would be great to hear your thoughts, thank you.
Dear Sammy,
The problems can have a lot to do with you body’s struggle with insulin resistance. Many people have a hard time because additional steps are often necessary and the switch to a new diet is not enough. Please join us in my Facebook migraine group where you will learn how to apply the carnivore diet right.
Best,
Angela
This is such helpful information. I am now on a low carb high fat (LCHF) diet, thanks so much for sharing this.