The Peter Attia Drive - #200 - AMA #33： Hydration—electrolytes, supplements, sports drinks, performance effects, and more

00:00:00.000 Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.

00:00:16.500 I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can

00:00:20.460 access the AMA episodes in full, along with a ton of other membership benefits we've created,

00:00:25.440 or you can learn more now by going to peteratiyahmd.com forward slash subscribe.

00:00:31.140 So without further delay, here's today's sneak peek of the ask me anything episode.

00:00:39.200 Welcome to ask me anything episode 33. I'm joined once again by Nick Stenson. In today's episode,

00:00:45.900 we talk about all things related to hydration. So I've got a lot of questions about hydration

00:00:52.420 and personally, this has become something that's a lot more interesting to me in the past couple

00:00:57.040 of months than it had been previously for reasons I'll explain in the podcast. So we kind of do,

00:01:02.580 I think, a tour de force on this here. We had actually intended to talk about a few other

00:01:05.620 unrelated topics, but we went so long on hydration that we just decided to make this a dedicated

00:01:09.620 episode to that. So we kind of get into where does water live in our body? You got to start

00:01:13.740 from the standpoint of understanding where are the water compartments of our body? And then you have

00:01:17.380 to get into this idea of tonicity. So it gets a little sciency up there, but then once you

00:01:22.320 understand that, and I think it's pretty straightforward to understand everything that

00:01:25.140 we start to talk about makes sense thereafter. So we get into kind of the difference between

00:01:28.700 dehydration and volume depletion, what the health consequences of that are, how we're actually losing

00:01:33.660 water, how much water we need throughout the day, how much water versus salt you're losing when you sweat

00:01:39.080 and how that changes under different conditions. And therefore what your hydration

00:01:43.080 needs look like under different conditions of temperature and exertion. Talk about how dehydration

00:01:48.500 affects performance, what the signs look like of dehydration. And we even get into what happens when

00:01:54.380 you over hydrate. So that's something that is fortunately rare, but unfortunately can be quite

00:01:59.180 catastrophic. And then we kind of get into all of the different ways one can rehydrate. So what's the

00:02:05.840 difference about rehydrating with electrolytes only versus electrolytes plus glucose versus glucose only.

00:02:11.760 We then get into all of the different sports drinks and how they're put together, which ones are based

00:02:17.500 on scientific principles, maybe which ones less. So even getting into kind of the nuance around the

00:02:22.720 optimal ratio of glucose to sodium. So if you're a subscriber and you want to watch the full video of

00:02:28.240 the podcast, you'll be able to see it within the show notes. If you're not a subscriber, you can watch

00:02:32.200 a sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy AMA number 33.

00:02:41.760 One addendum to this podcast, since it was recorded, this AMA was recorded in early January of 2022.

00:02:50.740 At that time, I had no involvement with any company producing any of the hydration products

00:02:57.420 that are discussed here. However, since recording this podcast, I've continued down the rabbit hole

00:03:02.620 of getting deeper and deeper into this. I've become particularly enamored with one of the companies

00:03:07.220 that I mentioned here. And I am now a small investor in that company. That company is

00:03:12.360 Element, L-M-N-T. So understand that while I now have a financial conflict of interest

00:03:18.740 through my investment in Element, I did not have that at the time of this podcast.

00:03:23.620 All right, Nick, we're back for another AMA. This is your second one. So you survived the

00:03:33.940 first one, huh?

00:03:35.040 Yeah, I made it through the first one. So we'll see how this one goes.

00:03:37.720 All right. I don't know. I think we've got some interesting topics for today. What do we

00:03:40.860 have?

00:03:41.560 We have a good amount of questions that came through around hydration, all things that relate

00:03:46.740 to that, which I know is a topic you became a little more interested in, in the recent weeks

00:03:51.800 and months. I'm sure people, even if they haven't heard the stories, might've seen the scars

00:03:56.560 on your face and some podcasts and things like that, which are healing nicely. So why don't

00:04:01.440 you kind of give people a quick rundown of where this interest came from? Not that you

00:04:06.220 weren't interested before, but where this additional focus.

00:04:09.820 Yeah, yeah. It's definitely a renewed interest. Actually, the story you're referring to was from

00:04:14.020 the time of this recording several months ago. It was kind of a perfect storm of things.

00:04:19.120 So I, on a Tuesday, gave a lot of blood, about three units of blood. And on the Thursday,

00:04:29.680 so two days later, hopped on a long flight from here down to Brazil for the F1 race.

00:04:37.000 And of course, anybody who's been on an airplane knows how dry they are and how dehydrated anybody

00:04:41.360 gets on an airplane. On top of that, it was like an overnight flight. So you're basically asleep

00:04:46.280 most of the time anyway. Get to Brazil. It's Friday morning, I think. I woke up in the morning

00:04:52.460 when I was there. So it's between the giving the blood, the being relatively dehydrated,

00:04:58.200 and then just, I naturally have very low blood pressure anyway. And at least once or twice a month

00:05:02.700 when I stand up from bed, I have to take a knee to just not fall. It's not like I never ever lose

00:05:08.700 consciousness or anything, but anyway, you can see where this is going. Got up in the morning

00:05:13.260 and this time completely lost consciousness, have no recollection of how it happened, but just

00:05:18.400 face planted into a table. And the only thing I remember was the sound of my neck cracking and then

00:05:24.420 waking up looking like it was a murder scene in the room. It's funny at the time, I didn't put two

00:05:30.300 and two together. I didn't understand why I could have such a horrible fall and truly lose consciousness.

00:05:36.960 And then of course, after the fact, putting two and two together and realizing actually you were

00:05:42.120 profoundly dehydrated. So that kind of got me thinking, well, how can I mitigate this sort of

00:05:49.960 thing from happening again? And what does it say overall about my hydration status? Is that partly

00:05:55.300 what may contribute to why I sometimes feel lightheaded in the mornings? Yeah. It's kind of funny when you

00:06:00.640 think about it, your biggest injury from racing in F1 came from travel to a race as opposed to in the

00:06:06.460 race car itself. That's right. That is hands down my biggest injury that involves any racing that I've

00:06:12.460 done or observed. Including in a minivan? Yes, definitely. The biggest challenge is just the

00:06:18.960 family screaming at you when you race. Well, you just got to enjoy the ride. They just got to sit back

00:06:23.860 and enjoy where they're headed. Getting into this hydration thing, I think one thing that'd be

00:06:28.720 interesting is oftentimes people, and I've heard this before, your body's 50% water, your body's 70%

00:06:35.100 water, your body's 60% water. You kind of hear over and over, like your body is so much water. And so

00:06:41.620 when you talk about gaining weight, losing weight, you often hear the term water weight.

00:06:46.320 So just stepping back, what does it even mean that our body makes up anywhere from 50 to 70% of water?

00:06:52.400 Do we know what percentage it is? Where is it located? Maybe you lay the groundwork there.

00:06:58.180 This is a bit confusing. First of all, it does change a little bit. So infants have a higher

00:07:02.500 percentage of their total body in water than adults. So I think using 60% is a reasonable number 0.98

00:07:08.700 because that's about where adults are. So what does that mean? You want to divide that into two

00:07:14.720 categories broadly. The first is water that is inside of cells. And the second compartment is water

00:07:22.120 that is outside of cells. So obviously we're made up of trillions of cells. So the water inside of cells

00:07:29.380 is called, not surprisingly, intracellular fluid. And that accounts for two thirds of your water

00:07:36.180 weight. So if we're talking about 60% of your weight is water, then two thirds of that 60% is

00:07:43.020 within the cells themselves, which of course implies that one third of that weight is extracellular fluid

00:07:49.860 or fluid that is outside of cells. Now this is where it gets a little more confusing because that

00:07:55.320 extracellular fluid resides in different places. Now, one of those places is pretty obvious,

00:08:02.380 which is the vasculature. So you take blood out of the vascular system. Obviously water is a non-trivial

00:08:10.240 component of that. And it turns out it's about 25% of the extracellular fluid is the plasma that makes up

00:08:18.700 the blood, right? So blood is made up of cellular contents, clotting factors, things like that.

00:08:24.900 And then of course, plasma. And you'll notice this anytime you spin blood or see blood spun.

00:08:29.880 The tube, it's red, you spin it. And all of a sudden it gets very dark at the bottom. That's

00:08:36.500 like all the cellular contents. Predominantly what you're seeing is of course the platelets and the

00:08:41.120 red blood cells, which dominate everything else. And then you see a clearish yellow fraction,

00:08:46.440 depending on how much lipids are in there. That's the plasma, which is effectively the water. So 25%

00:08:52.480 of the extracellular fluid resides in that space. About two thirds to 60% of the extracellular fluid

00:09:00.980 resides in what's called the interstitial space. So this is the space that is between cells,

00:09:07.120 but not in plasma. This is very complicated. This is a space that is underappreciated.

00:09:12.520 So when you have a cold or you're really, really sick, some people notice they actually might gain

00:09:18.060 weight. And then they might notice that if they're really paying attention in the days after they're

00:09:23.340 starting to get better, not only are they losing weight again, but they're peeing like crazy.

00:09:28.120 That's because of the expansion of that interstitial space. So when we're sick,

00:09:32.740 our blood vessels become very leaky. And the reason for that is important. That's where we have all the

00:09:39.380 white blood cells and immune cells do something called extravasate from the vascular system so that

00:09:44.860 they can go and reach the tissues. But that leaking is what leads to this swelling. A more extreme

00:09:50.480 example of this is somebody in the ICU who's very sick. They almost always look like a puffed up

00:09:55.120 Michelin man. And that's the reason why. So the remaining part of the extracellular fluid basically

00:10:02.680 resides in the digestive tract, the CSF or other small fluid filled areas within epithelial line spaces.

00:10:10.460 So the way you can sort of put a bow on this is about 67% of your total body water is inside cells.

00:10:18.540 About 20% is in the interstitium, this area that exists between everything. And of course that can

00:10:26.300 really expand when you're sick. About 8% is in the vascular system and about 5% or thereabouts

00:10:32.420 is basically everything else, including CSF and things like that.

00:10:36.200 Do those percentages, the overall percent of water and someone's weight, as well as the breakdown of

00:10:43.660 percent, does that change based on body types? Like if someone's lean, if someone has more muscle,

00:10:49.680 if someone has more fat, and maybe even a follow-up is like, does that even matter?

00:10:54.240 If you're 60% compared to 65, it's probably what your baseline is as opposed to where you are compared

00:11:00.720 to someone else. But it does change for sure. So muscle is far higher water content than fat.

00:11:08.440 So fat tissue is about 10% water by weight. We refer to that as being quote unquote anhydrous

00:11:14.780 without water. Muscle is probably 75% water. So right there you can see, you take two individuals,

00:11:22.960 one of them is 12% body fat. The other is 35% body fat. There's absolutely going to be a difference

00:11:31.420 in how much water that person is carrying. The more muscular person has a higher amount of their

00:11:36.960 body weight made up in water. So, I mean, Bob Kaplan, he's probably what, 80, 90% water weight

00:11:42.160 then with all the muscles he's rocking? I think Bob is pure water. Pure water. Just pure water.

00:11:47.820 Who was it, Bruce Lee? Like this is water, just takes it to a new extreme. That's right. Well,

00:11:52.100 this is water, of course, was David Foster Wallace, but I think Bruce Lee was-

00:11:55.560 Oh, move like water. 0.97

00:11:57.200 Yeah. Taking the form of water. Yeah.

00:11:58.980 Yeah. I got my water mixed up. Another term you hear a lot is tonicity when talking about

00:12:05.100 hydration, water levels, things of that nature. I thought it'd be maybe good to just get an idea of

00:12:10.620 what that is. How does that play into everything here?

00:12:13.820 Tonicity basically refers to how the concentration of one solution compares to that of another.

00:12:21.200 And the way we think about this in human physiology is all relative to the concentration of a cell

00:12:29.600 because the cell is the dominant source of water. So if you ask the question, I think red blood cells

00:12:36.420 are the easiest way to see this. If you put a bunch of red blood cells into another fluid,

00:12:43.460 how would the water move between those two? So let's start with the easiest example of this.

00:12:50.960 The easiest example is something that is isotonic. We have a figure that shows this, right, Nick?

00:12:57.440 Do you want to whip that up?

00:12:58.920 I just pulled that figure up so people can see what we're talking about here.

00:13:02.360 Okay. So what you're looking at are a bunch of red blood cells in a solution where the surrounding

00:13:10.260 solution has a different concentration of solutes in it relative to the red blood cell.

00:13:17.660 So in a moment, I'll tell you what the concentration is of the red blood cell, meaning I'll tell you what

00:13:22.220 the concentration, how much solute, i.e. electrolyte is dissolved within that. For the purpose of this

00:13:28.920 discussion, you just want to understand that there's an equilibrium. So if you put those red

00:13:33.660 blood cells into a solution that has the same tonicity as them, there's a total balance between

00:13:40.240 how much fluid goes from the outside solution to the cells and how much goes from the cells to the

00:13:46.100 outside solution. So the red blood cells don't really change in shape at all. Now, what happens

00:13:51.200 if you put the red blood cells into a very concentrated solution? So we would call that hypertonic. So if

00:13:58.240 you did that, you would have a net flow of water from the red blood cells into that solution. Why?

00:14:06.580 Because just like water always rolls downhill, water always moves in the direction of the concentration

00:14:14.360 gradient. There's a natural equilibrium that's always trying to happen where water is trying to

00:14:20.160 equate the concentration across the permeable membrane of the cell. So in a hypertonic solution,

00:14:27.020 the cells would shrivel up as they lose water into the more concentrated surrounding solution.

00:14:33.680 And of course, the opposite is true. If you put water into a hypotonic solution, there's going to

00:14:40.060 be an influx of water into the cells and they'll eventually swell, swell, swell until they actually

00:14:45.220 would rupture. Does that make sense? The difference between hypertonic, hypotonic, and isotonic?

00:14:49.520 This is an important, if we don't get this right, I think a lot of what we talk about today will be

00:14:52.880 harder to follow. Yeah, I think that does make sense. And just as an aside, anyone who's been in

00:14:58.580 a hospital has seen someone getting intravenous fluids, you've probably noticed you never give

00:15:03.400 somebody water intravenously. Even sterile water, you couldn't give that intravenously because it

00:15:09.340 doesn't have any tonicity. So the tonicity of pure water is essentially zero. So if you just infused

00:15:16.340 water into somebody's vascular system, you would rupture all the cells in their body, that would

00:15:21.920 be a really bad thing to do. So when we give IV fluids, we have to give them relatively close

00:15:29.760 to isotonic solutions. They don't have to be always isotonic. They can be a little hypertonic. And

00:15:35.660 that's something that you typically do with people that have head injuries. As you're trying to reduce

00:15:40.340 the swelling in their brains, you're actually trying to suck fluid out. And then you can also give

00:15:45.740 slightly hypotonic solutions, especially if a person already has too many electrolytes on board,

00:15:51.340 their sodium levels are getting too high and things like that. But as a general rule, you're starting

00:15:55.840 from the baseline of giving an isotonic solution, which is 0.9% sodium chloride. And then you can adjust

00:16:02.800 up or down with how much sodium chloride is in there and also how much other minerals ions are in there,

00:16:09.540 along with things like glucose, which contribute to tenacity as well.

00:16:13.180 Got it. Kind of on that realm then, one of the follow-up questions we got was,

00:16:16.840 what are some of the most important solutes for determining the tenacity of blood?

00:16:21.160 Are there certain things that are more important than others? How do you look at that?

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The Peter Attia Drive - March 21, 2022

#200 - AMA #33： Hydration—electrolytes, supplements, sports drinks, performance effects, and more

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