Overcome Weight Gain, Aging & Metabolic Diseases with Dr. Richard Johnson | Dehydration & Obesity

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Do you want to learn the role of dehydration in obesity and aging? Then check out today's episode with Dr. Richard Johnson, professor of medicine, clinician, researcher, and author, back for a round 2 to learn all about metabolic diseases such as diabetes and obesity, salt's detrimental impact including its role with cancer, the link between high salt and high sugar diets, dementia and Alzheimer's, how to monitor dehydration, how to prevent weight gain, and so much more. I'm your host Claudia von Boeselager, here to uncover the groundbreaking strategies, tools, and practices from the world's pioneering experts to help you live at your best and reach your highest potential. And don't forget to please help spread the word by sharing the show with your family, friends, and colleagues. The more people we can help with this message, the better the world will be. So thank you so much for sharing. Please enjoy.

Dr. Richard Johnson, Rick, so wonderful to have you back onto the Longevity and Lifestyle Podcast. Thank you so much for coming back for round 2.

Thank you, Claudia. Really, I'm happy to be back.

Thank you. So last time we were discussing uric acid and your amazing discovery in this space and metabolic conditions that are pushed or that arise out of high uric acid levels. Today I'd like to start with a different angle and talk about dehydration and how it has so many implications also on different diseases that we know. Can you talk a bit more about that?

Absolutely. So as you know from our last meeting, we talked about the fact that there seems to be a biologic switch that animals use to, to protect them from times when there's no food. And one of the things when there's no food, there's often no water. And so a lot of animals, when they hibernate or when they nest, they're living off their fat, but the The fat can also be a source of water. And so what happens is these animals will, like a hibernating bear, will not be drinking water during the hibernation. Rather, they will be getting their water when they break down the fat. And the fat doesn't contain water, but when they, when you burn fat, you produce water. And surprisingly, fat is really another source of water. So it turns out that there are a lot of animals that use fat as a source of water when water is not available, like whales. Even though they live in the sea, they don't drink salt water at all. And so they get most of their water from food, but they also get some water from the fat they have. Maybe one-third of their water comes from the fat that they carry. And so fat becomes important as a source of water. And so this made us wonder if mild dehydration might be less to activate the switch, because if you were just mildly dehydrated, you'd wanna try to store fat to help you in case things get worse. And so we started thinking about that, and one of the first things we did was we looked at people who are overweight, and actually there were a lot of studies that were already out there And surprisingly, many people who are overweight or obese tend to be dehydrated. And there's this one study, there's this wonderful scientist, Dr. Jodi Stuckey, and she has made her career looking at hydration status of people. And she has really made the case that people are underhydrated, that they're not drinking enough water. And one of her findings was that people who are overweight or obese tend to be much more dehydrated than people who are not. And people who are obese, using this one test called a bioimpedance, which is this kind of fancy testing, they can show that if you're obese, you're 12 times more likely to be dehydrated. So it's really, it's really quite striking. And, and there's a hormone associated with dehydration that's produced when people are dehydrated, and it's called vasopressin. And, and the way that hormone works is that it stimulates the kidneys to hold on to water. So it makes your urine really concentrated and dark yellow and putrid and smell bad. And that's because it's taking all the water out and saving it for you and reabsorbing it in your body so that when you're out walking in a very hot environment, your urine will become concentrated because your body's trying to hold on to water. And so this hormone vasopressin has been observed to be high in people who are obese, and this association has been known for about 10 years, and no one really understood it that well. But vasopressin is really high in people with obesity, uh, it's high in people with diabetes, it's high in people with metabolic syndrome. And, and this finding, along with the fact that most people are overweight, has been known. And interestingly, there are now studies that showing that if you are dehydrated or if you have a high vasopressin level, that it increases your risk to become fat. And not only is it associated with being overweight, but it also predicts whether or not you will gain weight. And so there's actually interest in measuring this as a blood test, as a diagnostic to look at your risk for developing obesity and metabolic syndrome. And the test is called copeptin, but it is really a measurement of vasopressin. So there's this association of dehydration with, with obesity, and there is— I bet you, you have a bottle of water right next to you, do you? Maybe not. Sorry.

No, of course. I have tea with fresh lemon.

Oh yes. Yeah. That's wonderful.

I probably over-hydrate, but tell me what your— yeah. So I like the green tea also for focus and—

Oh yeah. Green tea's wonderful, actually.

Yeah. And the fresh lemon as well, not only for vitamin C, but to get me going. Yeah. So I literally have, this is 1 liter and I probably drink between 3 and 5 liters a day. So yeah.

Oh, just wonderful. So that, so here's what's, what, you know, I've I'm a physician and I work at the hospital and I see patients and I'm a kidney doctor. And there's this classic teaching that, you know, that the kidneys do the work for you. And if you get dehydrated, they're gonna concentrate the urine and hold onto water. And this idea that people should be running around drinking a bottle of water every hour or two is considered to be silly by a lot of physicians and like a myth. Oh yeah, yeah. There's this theory that drinking a lot of water can help prevent obesity, but what's the evidence? What's the evidence? And I've heard this a lot, but what's not well known is that people who are dehydrated are at risk for obesity and people who are overweight and obese tend to be dehydrated. So one of the really— so we did a whole bunch of research to try to figure this out. Does— What's the question? Dehydrate, yeah. Is it just a correlation or is it, is there a real causal relationship? So one of the first things we did was we started thinking about it and we realized that dehydration, although animals, when they get dehydrated, usually we think of it as losing, like an animal that has diarrhea or sweating a lot or vomiting where you lose water. And what happens is the salt concentrations in your blood go up because there's less water there. And that would be like a true type of dehydration. You actually lose water and that stimulates thirst, and then we go and drink water. But it's deep— being dehydrated, it's not really a comfortable situation. We don't like to lose water, but you could become mildly dehydrated by and without losing water. And we realized that's what happens when an animal eats salt. So when you, you like, you eat salt, a deer finds a salt lick and licks the salt, its salt concentration goes up in the blood, but it's not losing water, it's just gaining salt. And then what happens, and this has been shown, is that what happens when that happens is you get thirsty, you drink water, and so it's like a way to bring water into the body., and what happens, so we thought to ourselves, could that be a mechanism to drive fat? And we, as we talked about last time, we think that fructose is the driving nutrient that causes obesity, and we think the way most of us get it is from eating sugar and eating high fructose corn syrup, and these added sugars contain fructose, and they're present in soda 70% of the processed foods, and we're eating like 15% of all our food is from sugar. So it is a major source. But what we found is that the body can make fructose too, and the body can make fructose from glucose. So you have to have glucose around to make fructose. And so we found out that high glycemic carbs get converted, like rice and bread, They're basically starch, and when you eat starch, the glucose goes up in the blood, and that triggers the production of fructose. And recently there was just a study published showing that people who are eating carbs like this, that you can generate as much as of fructose in a day as is present in a soft drink. So that's a fair amount of fructose. And so you can produce fructose from carbs. But interestingly, the way that reaction occurs where glucose gets converted to fructose, it's a chemical reaction. And the enzyme that makes that chemical reaction is stimulated by high salt concentrations. It's like its favorite, the most, the easiest way to activate this enzyme is to eat salt. And so we go, oh my God, well, so if people are eating salt, which we have a taste for salt, We like salt. And if this activates this enzyme, then it will convert the carbs we eat into fructose. Even high glycemic carbs do it on their own, but even other carbs, just if you have glucose on board, the salt is going to activate this enzyme. So for the French fries, which have salt, and often they're salted, that would, yeah, that would turn those potatoes into sugar in your body. Wow. So we started looking at this and we go, gosh, there's— so I called my friends who are obesity doctors and also my friends who are high blood pressure doctors. And one of them who is Georgetown said to me, well, we all know that people who are overweight are eating high salt diets. Every time you measure the urine salt and the urinary salt, it's super high. They're all on high salt diets. I thought, wow. And then we started looking at it, and yes, salt intake correlates with stimulating, causing dehydration, raising vasopressin, and it predicts obesity. In fact, there was a study done about 20 years ago where people were put on a high salt diet and they became insulin resistant in 5 days just by increasing the salt in the diet. Really? Yeah, unbelievable. Yeah, maybe it was. It might have been 7 days, but it was like a week.

It was like a week. Nice.

I did 7 days. They were like insulin resistant. That's pretty striking. And then there's a lot of people in Japan who eat a lot of salt and soy sauce and things like that. And so it's been known that in Japan there's a lot of sodium intake. And we found that that salt intake in Japan that the people with higher salt intake were at increased risk for developing obesity, fatty liver, diabetes, and that it was— you could separate it from calorie intake. And one of the— so one of the things is the salt activates the switch, but of course you have to have carbs present because the glucose is converted to fructose. So it also told me that if you're on a low-carb diet Salt probably wouldn't increase your risk for obesity because you don't have enough carbs around to convert it. And likewise, if you're dehydrated, in a setting where you're dehydrated and you don't have food, you're not going to be storing fat. You're going to be breaking down fat because, because you're not activating the switch to make fat. You don't have the glucose around. You need to break down the fat. So that would make sense to me. So we said to ourselves, okay, if this is real, then if I feed salt to a mouse, it should get fat. There were these papers out that said that if you give salt to a mouse, they start eating more. And there's even data in people that if you give salt to people, that they start eating more. But, but no one had really shown if it causes obesity. So my friend Miguel and I, we I said, let's do it, let's do it. So we put these little mice on salt and got excited. And when you put them on sugar, they get fat within a month or two, they're really fat. It takes a month or so before they really start gaining weight, even 6 weeks with them. It isn't immediate, but they do get fat. But with salt, we went and they started eating right away. We could show that they were eating more, but they seemed to be burning more too initially. And they really weren't gaining weight for the first month. And I said to Miguel, I said, maybe our thinking's wrong, maybe it's not the case. The second month came by and they still were pretty skinny, but they were like really hungry. And I go, ah, what's going on? But, and suddenly right around the third month they started like gaining weight and then very rapidly. And before long they were like huge. They were big and they were diabetic and fatty liver, and it was pretty amazing. And when we looked in their livers, they had a a ton of fructose that they were making, even though they weren't eating fructose. And, and then we did the same experiment in a group of animals that could not burn fructose. They could not metabolize fructose, and they were— they stayed skinny even though they ate the same amount of salt. So with that, at that point, we really knew that, that there was another cause of obesity. It isn't just sugar, it's also salt. That these— that it was there to be a way to help animals protect themselves by providing the water for when they need it. And, and that this is why the camel has the hump and, and all this stuff. So it was pretty, it was a pretty cool story. And yeah, so then we said to ourselves, okay, so if this is the case, how does it relate to the vasopressin? And I have always liked this hormone vasopressin. It's like this hormone that people don't totally understand it because it binds to different receptors, right? And one of the receptors is the one in the kidney that causes the kidney to hold onto water. So that's called the V2 receptor. And, but there's all these V1 receptors that no one really knows what they do. And then when you're a doctor, if you're doing research, there's something that No one knows about it. Gets you excited. Say, what does those, what is the function of those receptors? And it, there was some data that it was associated with like stimulating glucose production and things like that, but no one really had a function for it in people. And I was able to get mice that had been genetically engineered so they don't have the V1a receptor, the V1b receptor in my we had a young fellow, Tom Jensen, who started running these experiments where he was giving salt and sugar and so forth to these animals. One of the first things we found out is that, that although salt obviously stimulated vasopressin, it stimulated fructose as well, as we talked about. So salt was stimulating both fructose production, but it was also stimulating vasopressin. But the two were linked because when we blocked the fructose metabolism, we blocked the vasopressin production. So it was, the two were linked. And then when we, what we found is that when we gave sugar to animals, if we gave high fructose corn syrup, their vasopressin levels went up too. And around the same time, a group in Cleveland gave soft drinks to people and found that that raised vasopressin. So now we know that people who are overweight have high vasopressin levels, and the vasopressin is associated both with dehydration, with sugar and salt intake, and with sugar intake. And so they're all kind of there together. And again, we don't know causality. So what Tom did was we gave the sugar to animals that did not have these vasopressin receptors, and lo and behold, if we gave it to one with the V1a receptor, where it was blocked. They actually got fatter. They loved the fructose and they got fatter. But if we gave the fructose to one that didn't have the V1B receptor, suddenly they were totally protected. They didn't get fat at all. They were lean. They, and they loved sugar, so they were eating all this sugar, but they weren't getting fat. And they had turned off the switch, even though the switch was basically turned off in the these guys. So we know now that vasopressin is involved in the switch along with uric acid, and that it's working through a particular receptor. And, and we've now expanded it. There's a hormone— actually, this is like the first hormone that drives obesity. Leptin protects against obesity, but this is a hormone that drives obesity, and it's working through a particular receptor. And it was pretty cool discovery. And so then what we said, okay, if we can hydrate an animal, can we reproduce what people are doing when they're drinking water? And so we gave sugar to animals and we increased their water intake. And the way we did that was because they were taking the sugar in their drinking water, we had to give the water a different way. So we gave, we made the chow, the food and the the little pellets they were eating, we hydrated those pellets so that the gels were, the food was a little bit bigger 'cause it contained water. And they actually loved that food. And they ate the same amount or even they ate the same amount of total chow. And, but they got extra water. And when they got that, we could block obesity and we could even reverse it partially. We could slow weight gain for sure on sugar. But we could reverse the insulin resistance and there was some real benefit. So this, I feel this is one of the luckiest things that we stumbled on. And, and then, yeah, so suddenly I know that this myth, when all these young doctors who are all very athletic and skinny and they come running around with their bottles of water, it's real. And I, who unfortunately was not a great water drinker, have tried to drink more. And the data shows that theoretically we should be drinking enough to have about 3 liters of urine a day. So the normal urine output's like 1 liter a day or maybe 1.5 liters a day, but if you can get your balance up so that you're urinating like 2.5 or 3 liters a day, you should have a real positive effect. And you don't want to go much more than that because that's you can drink too much water and then you can dilute your serum sodium. And that might not be good because it can cause headaches and even seizures if you— so it's possible to become water intoxicated.

What are levels from a practical point of view, Rick? Because I don't know how many people will actually go about— I think so. If you go to the other side of the spectrum.

Yeah, my, my general recommendation is that 6 to 8 glasses of water a day probably is excellent. And I recommend drinking a glass of water before each meal because that will help keep the serum salt down. Because if you drink water before you eat salt, that's going to be better than eating the salt first, activating the switch, and then trying to reverse it. Yeah.

Drinking. Yes, I go ahead.

Yeah. So if you get a meal, what I've been doing now, it takes a little bit of getting accustomed to it, is I begin by asking for a glass of water. And then my personal rule is not to eat a bite of food until I drink a full glass of water, and then I start eating. And then I maybe I have a second glass, and I try to get 6 to 8 glasses of water in a day. Try not to drink right before I go to bed because. I don't want to get up. Yeah. And, and I think that's a very good balance. Like 6 to 8, 8-ounce glasses a day is perfect. Now, there are 3 situations. I'm a doctor. Okay. There's 3 situations where you don't want to drink a lot of water without talking to your personal physician. The first one is if you undergo surgery, especially if you're a woman and especially if it's gynecologic surgery. Some people will get a syndrome where they'll hold on to water really significantly in that first 24-48 hours after surgery, and drinking a lot of water at that time can be life-threatening because you can hold on to the water and get swelling in your brain. Don't drink a lot of water following surgery, just in general. The second one is if you have heart failure or some really big problem with your heart and your holding on to fluid, you may not want to drink a lot of water without talking to your doctor. Sometimes it's good, but oftentimes it's not, so you have to talk to them. Then the third one, which is relevant to all the athletes in the audience, is that marathon running can be associated with holding on to water. It's a rare thing that— there have been deaths in the Boston Marathon where people were drinking too much water and they dropped their sodium and they seize and you can die. Okay. And marathon runners, the rule is drink to thirst. If you're thirsty, drink, but don't overdrink. I believe that the marathon runner's hyponatremia, as they call it, may actually be related to, to drinking a lot of sugary beverages during marathon runs. And I'm putting together a story to test that. But anyway, at this point we don't know the cause, but we do know that drinking a lot of water during a marathon is not recommended. So you should drink to thirst when you're doing severe exercise, very strenuous endurance type exercise, be careful. So those, otherwise, drink 8 glasses of water a day, drink before meals, drink if you're in a bar and there's alcohol and salted chips and pretzels and you feel like you're gonna eat a little bit, drink a glass of water during that time. That will help with the alcohol. It'll help with the salt. And you don't wanna activate that switch.

So useful. And I think also before bed is really good as well to allow the body to detox and rehydrate overnight. I have a question around salt and is every type of salt an issue? No. Where there's like a Himalayan salt that has minerals, there's sea salt, there's different types of salt as well. Has your research looked at the different types of salt?

Yes. Yes. And there's data in animals too. So sodium chloride is, which is what we call salt. That is the one that activates this. Potassium chloride, or sometimes there's light salts where there's, they mix it with sodium and potassium. Potassium. The potassium chloride salts do not activate this. Okay. Okay, but you can, you don't want to eat a lot of potassium salts if you've got kidney disease or something where you can hold on to potassium. But unfortunately, most of the things that we call salt, natural salts and so forth, contain sodium chloride to some extent. I'm not against salt and I'm not against sugar. I just think we need to be aware that they can activate the switch. And so I recommend for healthy living to minimize eating a lot of sugar and to avoid sugary beverages. Really, it'll help. It'll help you a lot. Doesn't mean you can't have sugar cake at a birthday or things like that, but you just have to be aware that it activates the switch. Same thing with salt. Salty food is going to activate this switch. It's a slower activation, it seems, than with sugar. It takes longer. But I think that you have to be careful. And so try not to add salt to food. Try to keep your salt intake down. If you are eating salty food, drink water. Just drink water with it. You can neutralize it. And if you're on a low-carb diet, you probably don't have to worry about salt. Because you're not eating the carbs that are required to convert the glucose to fructose. You should know that when you're on a low-carb diet, your body is making glucose. You would call it gluconeogenesis. So glucose is in your blood, but it's being made from muscle and fat, and you're not producing a lot of it. But when you're eating carbs, you can eat a large amount of glucose. And so that along with salt is a problem.

That's really helpful to understand as well. And I think the key is with that water consumption, obviously barring those three scenarios, just to hydrate the body and to give it the right resources, obviously then cutting down on salt. And again, I think just that education around reading labels and how much salt is actually in pretty much anything. And even in, I was looking once at a packet of chocolate chip cookies and not only the amount of sugar in there, but the amount of salt that they were putting in there to neutralize the sweetness.

It was really— Wow. Wow. That's really interesting. I have a friend who's in the food industry and he's been, he started telling me about how all these foods get injected with salt. And what they do is they inject meats and stuff and it makes the meat look bigger. Like a shrimp looks really bigger because it's been pumped with salt water. And then the truth is that the, it's actually much smaller. And when you put it on the frying pan, all the water comes out, the salt stays. And now you gotta process. Look at, sometimes they'll tell you whether or not it's been injected with things. And salt water is a favorite thing to inject into these shrimp and stuff.

Oh my gosh. Actually really interesting what you were saying because literally a few weeks ago I was at my parents and I was making some shrimp, but I tried to always where possible find the wild-caught shrimp. Now it was still in its shell, but they don't shrink in size. And I was thinking how astoundingly what a difference. And I'm very wary that a lot of the shrimp, even if it says you have to really read the label, but a lot of them are farmed, filled with antibiotics, etc. But yeah, that must be the telltale sign, how much shrimp when you warm it up shrinks or not. Yes.

What's really going on? So it shrivels up in front of you. Okay. Yeah. But processed food, there's so many studies that show that if you can try to reduce your intake of processed food, you can really help. And it's because of the sugar and salt, high fructose corn syrup and all these things, MSG and stuff that's added.

It's horrendous. Exactly. So I think, and with seafood, it's finding that wild caught seafood, and then for meats, right, the grass-fed meat as well. And you can taste the difference. And I think it's moving away from having to have a huge steak every night to actually seeing it as like an exception, like a nice pleasure a few times a week instead. And then rather invest and buy the quality versus the quantity as well, right?

Yeah, grass-fed is really better than grain-fed. And I didn't really talk about this in my book, but it's really true with grass-feeding, you get much more omega-3, and with the grain-fed, you get more omega-6 in the meat. And there's really increasing evidence, and I do talk about this in the book, about how omega-3s are so healthy and omega-6 tends to be pro-inflammatory. And these seed oils that are omega-6 rich, not so good, and they interact with this fructose pathways. So if you give omega-3, you can block some of the effects of sugar, especially on the brain. So if you give sugar, fructose, to an animal, you can actually show that it can impair their ability to get through a maze, and you can reverse that with omega-3. Walnut oil is a flaxseed, and fish that are rich in omega-3— salmon—

that's good. They're really good for you. Rick, what would you say, and I'm just trying to hypothesize here because I know you're also amongst other, the research scientists in you, but I'm looking at like a Venn diagram intersect between salt and sodium chloride specifically, fructose, and all metabolic or many metabolic diseases. Would you almost say that combination is a major driver?

Oh, it's unbelievable. And so one of the strong associations initially was yes, sugar intake salt intake. They're associated with obesity, they're associated with diabetes, metabolic syndrome, fatty liver. This is where the, my research was. Kidney disease and these kind of classic diseases then leading to heart disease and so forth. But what one of the two incredible areas that we started looking at is how the switch and the can also be important in cancer and also how it's important in neurologic disease, especially dementia. The cancer one is really interesting. So there's two forms of energy, really, that can be— two ways ATP can be produced. And one way is from the mitochondria, and they make most of the ATP. It's a lot of it, and but they require oxygen. And then there's a primitive system called glycolysis. It's really an ancient system, and it does not require oxygen, but it just makes a small amount. And cancer cells like glycolysis because they're often in low oxygen environments, because when a cancer cell metastasizes, like from one site to another, it initially doesn't have a blood supply, so it has to create a blood supply. So it lives in a low oxygen state, and so it turns out that cancer cells prefer energy that's produced by glycolysis. Because it doesn't require as much oxygen. So they actually often use glycolysis, and there's an actual name for it. It's called the Warburg effect, and it was discovered in the 1930s that cancer cells tend to live through the Warburg effect. The way the switch works is it tries to reduce— it tries to help an animal survive. And so one of the ways to help you survive is to reduce your oxygen, because what if you're in a burrow or someplace where there's not a lot of oxygen. So the switch can get turned on in a low oxygen state, and what it does is it suppresses the ATP produced by the mitochondria, so it reduces the oxygen need. So there's an animal called the naked mole rat that lives in South Africa, and it lives in burrows where there's low oxygen, and it lives because it makes fructose, and the fructose keeps the the oxygen needs down. So when you give fructose to a tumor cell, they like it because it stimulates this glycolysis. So there were these beautiful papers in Nature showing that high fructose corn syrup can stimulate tumor growth. And there's a lot of data showing that people who are overweight have an increased risk for tumors, and the tumors that they have the increased risk for, like breast, colon, liver, are tumors that like fructose. And we've gone on and shown that the uric acid that's produced by fructose actually plays a role in cancer growth. And we even raised uric acid in cell and showed that it could accelerate tumor growth in animals. So I think the switch is also affecting cancer. It's not like causing cancer, but it's making the cancer grow more rapidly. So another hit to sugar, another hit to fructose. And then the other thing is all these things like high salt diets, high sugar diets, obesity, they're all risk factors for dementia. And Alzheimer's disease, really no one has understood it because it's associated with these things called amyloid and these plaques and these things called tau protein. But when people try to block those things, the benefits aren't so strong. So they're looking for what could be causing those problems, and what they found is that most people with Alzheimer's have a problem metabolizing glucose, and that there seems to be a mitochondrial problem where the mitochondria is suppressed, and there seems to be a kind of a shift towards glycolysis, and there seems to to be an insulin resistance in the brain. And guess what? Fructose does all that. And so guess what? There are now studies showing that fructose levels are high in the brains of Alzheimer's patients. The risk factors are there. There's some studies showing that fructose in the brain can cause the insulin resistance, the mitochondrial problems, and even affect memory of animals. And so I'm beginning to think that Alzheimer's disease another casualty of the switch and that it was meant to be just like it was meant to be good. There was a point where just minimal and transient activation of the switch could help an animal cuz it actually activates things associated with foraging. But these foraging responses involve becoming a little insulin resistant in the brain and things like that. And so that could be a beneficial thing. Acutely, but chronically it might actually be a big problem. And so, so I've been, I say it's, I feel very fortunate, Claudia, because this research led to this. We stumbled onto the switch and then suddenly we realized that the switch is involved in a lot of, lot of disease. And so it gives the opportunity to both by diet, by things, simple things like drinking more water, stimulating mitochondria to grow back with your green tea or with your dark chocolate does it too. There's some nice things that come out of this where we can help people and then also in the long term, you know, big pharma are now going to try to make inhibitors of some of these things. My little group is trying to make inhibitors too. My goal is not to make money, my goal is to help people. That's That's why I became a doctor. And so if we can find ways to block this switch, it would be a great thing for mankind or humankind.

So anyway, yeah. Amazing what you're doing.

Yeah.

And I think it's not just about maybe blocking it, but just for sharing the education and your work around the consequences so people can make lifestyle choices to get to the root cause of— exactly, Nature Wants Us to Be Fats, your wonderful book. And people obviously to read that as well, because If you know what the drivers are and you can adjust your lifestyle accordingly and to realize with salt as well. For example, my mother who has extreme low blood pressure, she's told to eat more salt. And so again, it's almost, how do you, are there cases with low blood pressure where you think it's okay? Or would you say in general salts should be avoided?

That's a really tough thing. So let's just talk about that. What if you have cancer? And you have no appetite and you're losing weight, part of me feels that it's probably more important to get food in you, the kind of food that could help you. It may be that theoretically fructose could possibly lead to more cancer growth, but if you're not eating at all and that you still could eat a piece of chocolate cake, I would give the cake cake. Just to eat— because it's like the balance. We have to look at what the overall goal is. If we really— so if your blood pressure is really low, eating a high salt diet may help with the blood pressure. But yeah, the consequence might be that you might activate the switch and might hold on, might produce a little more fat. But maybe— but if it makes your blood pressure go up so that you feel better and can walk around, it seems like a good The doctor, you have to balance the pros and the cons and the patient should know too. And then you can decide together.

Yeah.

But it was interesting because we had the nurse that was there and she said you could very well be dehydrated, which is the cause of your low blood pressure. And speaking with you now about this as well, it rings true because I think unfortunately my mother suffers with memory loss due to head trauma. So Dr. DelBretta said, went through his tests and analysis and lack of HRT. And she forgets how much she's actually drinking because of the memory loss. And so we have a new system where she can actually measure how much she's actually drunk in the day, because otherwise one forgets. And just to really be on top of getting the right amount of hydration in it and then seeing what the knock-on effects without having to have that extra sugar.

And you can measure, so you can measure the serum sodium The serum's— and everybody probably should know what their serum sodium is. So, because our data shows that if your serum sodium is like 145 or higher, the chances of you developing obesity are higher. And also the chances that you're dehydrated, need more water, are there. Are higher too. So, yeah, but a normal serum sodium is like 138 to 140, 142. So if you're between 138 and 142, 2, that's really normal. And if it's over 142, you should drink more water. And if your mom is dehydrated because she doesn't have enough water, her serum sodium would be over 142. Would be higher than that. She should be drinking more water.

I'm going to be checking that. So Rick, what would be 5 strategies you would recommend, especially we were touching on dehydration point and obviously fructose, but what would be 5 key takeaways for my audience that you would say focus on these just to, and check how you feel afterwards.

Yeah. Okay. Just 5 general recommendations. One is cut, don't drink sugary beverages and read labels for sugar and think about processed food a lot. And so that's number 1. Number 2, try not to eat a lot of salty food and if you can reduce your salt intake, that would be a positive thing. And drink water would be my third recommendation, drink 6 to 8 glasses of water a day, especially drinking water before meals. And a fourth thing might be to exercise 40 minutes to an hour 3 times a week, and that can help stimulate those mitochondria to recover and become healthier. And if you— the way to do it is to walk or jog or be on a bicycle and to exercise to the point where you have a little trouble talking, but you can still communicate, and that will put you in the zone 2, and that will stimulate those mitochondria. So now you're turning off the switch by reducing sugar and salt, and at the same time you're stimulating recovery. You can also stimulate recovery by the mitochondria with green tea, like what you're doing, dark chocolate, so that's another thing. And then the fifth one is the The other major driver of obesity seem to be these high glycemic carbs: bread, rice, potatoes, cereal. These are the main guys. Chips and starchy foods. And really trying to reduce that is going to be very hard, but it's going to be very helpful. So that, those would be my 5 quick recommendations. I do go into much more detail in the book and so forth, but that's what I would suggest.

Yeah. Nature Wants Us to Be Fat, highly recommendable. So well-written and so well-researched. Rick, thank you so much again for coming on today. Such a pleasure, and we'll have to do a round 3 with all your new discoveries that are coming through as well.

Thank you, Claudia. Yeah, thank you so much for bringing me on.

Such a pleasure.

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