Q&A 6/28/22 All About Sodium


Podcast Highlights:

00:27 Taking Breaks from Adaptogens

04:26– Serum Sodium Ranges

05:40 – U-Shape curves

08:06– Functional Ranges on blood work

09:28 – The Salt Fix

10:50 – Healthy Sodium ranges

12:01– Low Sodium

13:25– Adrenal Fatigue

15:48 – Orthostatic Hypotension

20:36– Table Salt

24:01 – Aldosterone

25:44 – Hypovolemia

28:41 – Mild Hyponatremia

44:17 Healthy Blood Pressure Ranges for Older People

Transcript from Webinar:

Howdy!  This is Dr. John, back here with another little Q&A this afternoon. This one we’re recording from my office, so we might get some kind of strange noises coming in. People may walk in the door, etc., but I think we’ll get through it just peachy keen. Today I’m going to answer a couple questions.

Kathryn, can you read me the one question that came in?

00:27 Taking Breaks from Adaptogens

Kathryn: “Yes. ‘Would you recommend taking a break from Adaptogens, especially Siberian ginseng and ashwagandha?'”

Dr Nieters: I recommend taking breaks from just about everything. I mean, if it’s not, you know, kind of life or death, don’t take breaks from your Western medications. In terms of supplements, I generally recommend taking breaks. Actually, the tonic or adaptogenic herbs, you don’t need as much of a break and some argue you don’t need any break. There are other categories of herbs that you should definitely take a break. I definitely don’t think you need to take that long a break. It’s an adaptogen, so it’s constantly working to help with your adrenal function, and I personally would not recommend taking that much time off of it. Maybe a couple of weeks, every few months would be what I would be looking at. “Is it something you need right now?” that’s really the important question.  I see less need of that for adaptogens or tonic herbs; the ones that give you energy.

Kathryn:  “So when you say ‘take a break,’ like after taking it for a month, take a break?”

Dr. Nieters: I would say after 2 to 3 months, I would take a couple of weeks off with a lot of vitamins and minerals. I tell people take the weekends off, you know, take it five or six days a week and then take a couple days off.  I find that that works really well.  Any other questions on there? Not at this time.


Okay, I’m gonna go ahead and share my screen with you all we are. Today the question was, “Dr. John, I’m totally confused about salt. I’ve heard from much of my life that salt is deadly. Lately, I’m seeing that many people don’t consume enough salt.” I’m assuming what they mean is that they’re seeing articles rather than actually seeing people who aren’t getting enough salt. That would take a pretty discerning eye, although it is possible.  Let’s talk a little bit about that. Salt is one of the world’s most sought after commodities throughout history. From as far back as we can go, people treasured salt. The word salary comes from sol, for salt.  Many of the Roman legions were paid in salt. That’s where the term “salary” came from. It’s really one of the most sought after commodities, and basically without enough salt, you die. It’s really that simple.

On the other hand, we’ve been taught that the salt shaker is evil incarnate. It is the biggest problem in our culture. So what’s true? Well, like most everything, both things are true. When we’re looking at supplements, vitamins, minerals, and foods, it’s really a matter of looking at the right ranges. I took some of this out of a book that Kathryn and I are writing. We’ve written it somewhat in a question and answer format.  I just pulled the question up and Kathryn said, Hey, let’s talk about sodium. It seems to be an important item for you on labs. And why is it so important for you that patients have the right sodium level?”   I said to her, “Well, you know, it is one of my absolute favorite most important topics to talk about with my patients.” The reason is that there are massive amounts of good, solid, scientifically-proven information about the importance of keeping very narrow ranges of serum sodium. Serum sodium is generally considered to be the liquid part of your blood.

04:26– Serum Sodium Ranges

How much sodium do you have in your bloodstream at any given time that is being measured? Yet medical doctors rarely speak about sodium unless patients are grossly elevated or have grossly low sodium. I mean they really, really have to be low, low before they’re ever talked about or they’re talking to them about blood pressure and tell them to cut their salt, just as a general exclamation. Well, I need to tell you, I read a lot of labs. I probably have 20 sets sitting on my desk right now waiting for people to show up to discuss them.  If I were to ask people, what do you think the most common problems are that I see on lab tests? They might say, “Oh, anemia,” or “Oh, vitamin B12 deficiency.” Or they might say that it’s someone has too many white cells.  None of those are the right answer.  The thing I most see out of range and most easily fixable on lab tests are sodium ranges. It’s very, very common.

05:40 – U-Shape curves

U-shaped or j-shaped curves are the norm in blood chemistry.  In fact, they’re the norm in most things we look at.  How much sleep should you get? Well, if you get too much sleep, you’re liable to die at a higher rate. If you get too little sleep, you’re liable to die at a higher rate. Exercise – if you exercise too much, you will have a higher mortality rate. If you exercise too little, you have a higher mortality rate. So there’s always a sweet spot. It’s like, what is the maximum bang for my buck that I can get? For example, cross-country skiers – great exercise, right? However, in Finland, they went back and took historically the times of the top cross-country ski racers, and then did a matrix with mortality. How long did they live?  They found that the ski racers with the best times died younger.  They were getting too much high-intensity exercise. Again, we see that in many, many things.

There are lots of really well-done research papers and there is definitely a clear U-shaped curve for sodium. If it’s too low, there’s a greater chance of death from stroke, greater chance of death from falls, greater chance of death from bone fractures. With the strokes, you get a particular type that’s much higher. Then certain types of cancers are much higher with low sodium. Now, you don’t get to see any of those ads on television, right? You’re not going to hear doctors saying that much, and it’s unfortunate.

This was a j-shaped curve. This doesn’t come up at the same angle as this side. It’s a little shorter. Here is exercise: moderate exercise, this is the absolute peak of health or the absolute bottom in terms of mortality. If you get too intense, you die faster. If you get too sedentary, you die faster. Here is another j-shaped curve. You are going to see that it’s not equal on both sides, so it has a J shape. 

08:06– Functional Ranges on blood work

For functional ranges and why they’re important, I have a very short video on the balancingpoint.net.  On there, I have a few minute discussion about functional medicine and why I feel it’s so important in terms of lab readings for all healthcare providers to understand functional ranges. That doesn’t mean you have to do functional medicine and do drugs, etc., but the functional medical ranges are very, very exciting because they are so much more accurate and can save lives. When I talk about low, this isn’t the low in the range that you’d see on if you got a report and you have a reference range.  I’m not talking about it being low compared to that, which is really low. Even in the narrower ranges, if it’s a little too low on the functional narrow ranges, it’s still really a problem. On the other hand, high sodium is extremely dangerous. It increases risk for high blood pressure, for heart attack because the blood gets thicker. You’re going to see a lot of issues there. It’s all about balance. 

09:28 – The Salt Fix

There is an interesting book called “The Salt Fix” by James DiNicolantonio.  I am in the process of reading it, actually, and I have gotten some very interesting information. What I found most interesting was the average salt intake in different cultures and the average serum sodium levels in different cultures.  Then also historically, they can go back and analyze teeth of prehistoric people and tell, amongst other things, how much salt they had. Our salt level was much higher in hunters and gatherers than it is now. Serum sodium levels (again, this is the concentration of sodium in the blood) most of it comes into our system as sodium chloride or table salt. Typical table salt is mostly sodium and chloride, and that is certainly our highest concentration of intake of sodium.  LabCorp indicates a reference range 134 to 144. Most of the other major labs are right there, very close to that.

10:50 – Healthy Sodium ranges

Now, my ideal healthy range for sodium, and I didn’t make this up in a vacuum. I mean, there are many people I trust and care about and love their research and they’ve done massive numbers of studies and put the studies together that shows that the healthy range for sodium is actually 139 to 142.  If you get under 137, you start seeing a lot more adverse events. That’s what the research indicates. You know, you can have an opinion. I can have an opinion. You know, Dr. Oz can have an opinion. However, what’s really important is to look at the research and see what it really indicates. When you get over 141 again, you start seeing more adverse events.  So 134 to 144 is a huge range when compared to 139 to 142. That’s a lot different. It is so shockingly apparent that there are huge differences in mortality with those tiny, tiny changes in sodium range. You’re talking less than 1% can make a tremendous difference.

12:01– Low Sodium

Low sodium is the one thing I find in my patients very, very often, and often it will explain the symptoms that my they are having. What I find once a month or less, is I will have a patient that comes and we do a lab test, or maybe they bring a lab from somewhere else, and it shows high sodium. It’s almost literally, almost never. It’s just very rare. I see lots of low sodium levels and people are having symptoms from those levels. Now our culture has become really salt intake conscious and avoidant of it, and I would say almost phobic of salt intake. There is a good reason for that. In many cases, people in the United States have much too high a salt intake. You know, if you’re eating out a lot or if you’re eating processed foods, you are undoubtedly getting too much salt. You’re also undoubtedly getting too much sugar, and that combination is pretty deadly. If you’re eating well, if you’re growing your own vegetables, if you’re going to a farmer’s market, and if you’re cooking your own food, then it’s likely that you can be low in salt intake.

13:25– Adrenal Fatigue

We’ve all now heard of adrenal fatigue, adrenal exhaustion, etc.. And by the way, those are very, very real issues. I’ll touch the edge of them today and talk about them in more detail at another time.  With the rampant, and I mean epidemic levels of adrenal problems, I do several tests in my office for every new patient to see if they have adrenal fatigue problems and the rate is pretty high.  There is a test called “Ragland’s Test.” Doctors generally call it orthostatic hypotension, but I have copies of Dr. Ragland’s papers from the 1920s where he talked about this test for adrenal problems. If you lie down, relax, lay there for a few minutes. Take your blood pressure. Have you stand up for about 2 minutes and take your blood pressure again. Your pressure should go up ten points because you have to have more pressure to get the blood up into your brain.

In patients with adrenal fatigue problems, their blood pressure levels will often drop. In fact, they will drop if they have adrenal insufficiency. I had a gentleman today who, by all other signs, is in good health.  However, when I start to question him, I can see that there are some problems in this area. We did a Ragland test. His blood pressure went down 18 points; so he’s 28 points low. I find most of my chronic fatigue patients are coming in about 35 to 40 total points low, so he’s kind of pushing it a bit. Then when I pointed that out, he really got a little more down and dirty and got into some real issues in his life that he hadn’t communicated before. Anyway, this is a big deal. You’re coupling this consciousness about avoiding salt and the adrenal issues. The adrenals crave salt. In fact, if you have huge salt cravings, the first place to look is to really get a lab test first, but then start thinking about adrenal fatigue and adrenal issues, because the adrenals want a lot of salt. A lot of salt. 

15:48 – Orthostatic Hypotension

What are the symptoms? The one I look for the most and I test for is orthostatic hypotension; hypo, meaning the low. It’s the opposite of high blood pressure, right? It’s a low blood pressure. Orthostatic is talking about standing up. It’s what happens if you go from one position to another and your blood pressure drops. This is dizziness when one stands up. Now there’s an official level that is legally to diagnose orthostatic hypotension, but I will find my patients, get dizzy to a dangerous level well before they hit that level. If they have true orthostatic hypotension from a legal standpoint, they’re in bad shape. Sometimes they get some nausea, some cognitive impairment or problems; they’re not getting enough blood to their brain, fatigue, some anxiety, definitely difficulty concentrating and sometimes some nausea.  Those are a few symptoms.

I am going to tell you a story that illustrates this.  I think a really good story about a patient. Her name isn’t really Sandra, but everything else is accurate. Such a delightful woman.  She came in, and she was really, really upset. I mean, anxious, you know, like, “Oh, my God. Oh, my God. What am I going to do? What I’m going to do?”  She was a type-A personality, spoke really fast, had a rapid heart rate and really hard charging. She’s used to getting things done.  At one point, she was in tears. She said, “I’ve been to several doctors, I’ve been to alternative doctors, and nobody can help me.”  I said, “Well, what’s the major problem?” I mean, this all happened before I even get a chance to start questioning her.

She said, Well, every day when I drive my daughter to school, I get sick, I get nauseous, I get lightheaded, I get motion sickness. I have to pull the car over. And I sit there and sometimes it’s quite a while until I can regain my senses and I can continue to drive her to school. So obviously, she’s very distraught. Her daughter obviously isn’t happy either. So I asked her a couple of what I thought were very reasonable questions. I said, How long has this been going on? She said, Oh, it’s on a couple of months. And she said she’d never had the problem before.  And I looked down and I said, You know, I’m sitting here with your blood tests. And the first thing that I see, because it’s right at the top of the blood test, it’s very close to the top, is that your sodium levels are low and definitely low from a functional standpoint and also your potassium levels are off. But I’m more concerned about the sodium right now. And then I asked at the magic question that nobody had asked or apparently I said, So, Sandra, what do you do before you drive your daughter to school? And she said, Oh, I get on my peloton and I ride.

And I said, You take a casual ride. And she said, Oh my God, no, I’m driven. I get on for one hour and I go as hard and as fast as I can, she said. I’m really competitive. Which I had already pretty much figured out.  So I said, Do you perspire much? And she said, Oh God, you know, I have to put towels down all around the bike because I sweat so much. And I said, Okay, well, I have a fix for your problem. Are you prepared for it? This could require a lot on your part. And she said, I’ll do whatever it takes. I said, okay, it’s going to be really expensive, but I think we can fix it. I want you to take a half a teaspoon of salt. And I told her how to prepare that there’s a solution called so lay half a teaspoon of salt. About an hour before you get on your peloton, I want you to sip electrolytes and salt all through the day.  She had a peloton, she knew where the bike store was. They have really good electrolytes.  I said I want you to sip those through the day. Three weeks she comes back, all of her problems are gone completely. No nausea, no dizziness, no difficulty driving her daughter to school. And none of the problems has returned. Now, she did not exercise quite as intensely for a while, but the problem, the entire issue was solved with about $0.05 a day of good quality salt. I love it, one of the most precious of all minerals. So salt phobias, again, as I mentioned, it’s been one of the most important trade items in history. We’ve become very salt phobic and again, with good reason, but we’ve taken it a little too far. So salt is actually a generic term for a group of chemicals, but here I’m using it to mean sodium chloride, which is common table salt.

20:36– Table Salt

Now, when you buy a commercial table salt, you go to the supermarket and you grab it off the shelves. That has been heated to about 1400 degrees, which dramatically changes the chemistry. It really alters the chemical structure of many of the minerals in there, and most of the minerals are actually removed in good quality sea salt. I’ve heard 88, 89 minerals in there and Himalayan pink salt is good or some other form of real sea salt.  I say real because there are counterfeits on the market. Someone found that a lot of the “Himalayan Sea salt” was coming from a mine in Pakistan, which was a completely different chemical formula with it. So anyway, get real, real good quality salt. Now you can find articles all over the internet. I’ll bet there are a thousand of them about different forms of “salt.” So go ahead and read some. Find out which ones are good. But typically the Himalayan pink salt and the real sea salts are really good.

Okay, now we’re still seeing recommended sodium levels being pushed downward and that you’re recommending is far lower, that lower than the natural intake that humans have used throughout history. Again, that can be determined by teeth and bone samples. And we’re really seeing recommended levels that are functionally too low, too low. And there’s several reasons for that in a really, really, really healthy person that doesn’t have any adrenal fatigue, that is not over exercising, then those lower sodium levels may work.

But if they have any adrenal fatigue problems, if their kidneys are out of balance, if they’re peeing out a lot of sodium, if they’re perspiring a lot, then often those recommendations are too low. Now some people are sodium sensitive. It looks like about 5% of the population is very sodium sensitive. And they have to be careful about their sodium intake. It’ll really spike their blood pressure, but it’s not everybody. So, again, in my practice, I find most people that are sensitive are sensitive on the low end.  To further exacerbate the problem, most of my patients are older, chronically ill, middle age or older, and they generally work pretty intense lifestyles and they’re kind of worn out in a lot of ways. As my dad used to say, been rode hard and put away wet. And so that will create adrenal fatigue. Now that’s a topic that is generally not well understood. There’s some really simplistic things that people say about what adrenal fatigue is and how to treat it, etc. So I’m going to skirt the issue today and then come back to it and do a much deeper dive. So we all know we talk about a lot of the adrenal hormones, which, by the way, 20 years ago almost nobody knew these. We talk about cortisol activates your blood sugar epinephrine, which gets your heart pumping, norepinephrine that gets you ready for emergencies. It pulls the blood out of your center and pumps it into your hands and feet, etc.. And so the general public has a pretty good idea about what those do.

24:01 – Aldosterone

The next one that people are going to find out a lot about and it’s going to get into their lexicon is aldosterone. It’s one of the key adrenal hormones, particularly for what I’m talking about today. It is the primary controller of sodium to potassium ratios. So you eat a bunch of potassium, eat a bunch of sodium. The body is going to monitor that. So if you have too much of one or the other or even both, and send a message to your kidney to pee out more potassium or more sodium or to pee out more of both.

So that you can stay in that equilibrium state as the body’s trying to keep you in the homeostasis, that very, very narrow range. So if you have low aldosterone, that will lead to low sodium because that’s what it does. It controls sodium, potassium ratios. And if aldosterone is too low, you’ll pee out too much sodium. If you pee out too much sodium, that salt won’t attract water into your bloodstream in its high concentration. When that happens, you literally don’t have as much blood when you stand up. You don’t have enough blood to get it up to your brain and you get orthostatic hypotension. This isn’t the only reason someone can get orthostatic hypotension. But in my practice, it’s definitely the number one reason.

25:44 – Hypovolemia

So then you have a condition that’s called hypovolemia. “Hypo” meaning low, “emia” meaning the blood. And “vol” meaning the volume. So you have low volume of blood. This is a very real condition, but it’s almost impossible to test for from a Western standpoint. It essentially have to remove all of someone’s blood. Really not very practical. So when you look at blood values, say a CBC, that’s a complete blood count.

You look at your red cells, you look at your white cells, your hemoglobin, etc.. But notice those are all given in value in terms of values per unit of blood volume. So you take a certain amount of blood and in that certain amount of blood, you have these concentrations of chemicals. Well, if you don’t have as much blood, you could look perfectly normal in the blood count, but below in any of those things also it could throw it over, so you can have values that look too high or look too low. But it’s really because you’re dehydrated. Okay. So, again, you have to look at these things very carefully and not the quick perusal that is often done. Just kind of. Oh, yeah, you look fine. Good. No, you need to have these really looked at. And now this is an advantage that we have with traditional Chinese medicine. They also have it in diabetic medicine, which is that we take pulses. And as soon as you touch a pulse in a couple positions, you will immediately know if someone has hypovolemia.

And so Kathryn, generally and sometimes other people will scribe for me and take notes. And as I’m going through, they’ll see me take the pulse and then look at the patient and say, do you get dizzy when you stand up? And about 90% of the time they say yes. Because you can feel that there’s low blood volume in the pulses. I mean, it’s simple. It’s really simple. And so we then follow those up with a couple of in-office tests of adrenal function. They generally fail those tests. And the one is the right ones, as I mentioned. Another is the paroxysmal pupillary reflex. And then we’ve got a couple of others. But anyway, we’re going to check in the office and then we’ll probably run some labs.

So the point is that you can have low sodium intake or you could have normal sodium intake and low aldosterone, and either way, you’ll have low serum sodium. So it’s not always based on what you’re bringing into your body. Sometimes it’s based on how much you’re getting out of the body. Okay. So here are a couple of studies and I’ll just to kind of reaffirm a lot of these things. And I’ve got tons of these studies. I just grabbed a few.

28:41 – Mild Hyponatremia

Mild hyponatremia, that means low sodium as a risk factor for fractures. And this was a Rotterdam study.

Mild. That’s an interesting one. It was according to medical institution like LabCorp. It wasn’t even hyponatremia. Remember Lab Corp values went down to 134. Here they tracked over 5000 elderly subjects, which kind of irritates me now that I’m 71. Anyway, they track them and they use the definition of hyponatremia of less than 136. Now, I don’t know of any labs other than functional medicine labs that look at that at that higher level. So anyway, they considered it low less than 136 and they were looking at vertebral fractures or fractures of the bones in the spine and indicated an odds ratio of 1.78. What that means is for every one person that had normal sodium. people with low sodium had 1.78 times more fractures. So again, 1 3/4 fractures, which is almost double the risk of falling and fracturing of the bones. Okay. If sodium levels were under 1.36. All cause mortality was also higher and subjects with hyponatremia. They just died at a 20% higher rate during the course of the study. Okay, so that’s pretty dramatic. They weren’t just breaking their bones. They were dying from a lots of other causes. So, again, we’re looking at some very mild sodium problems and it’s causing huge issues.


So I was mentioning orthostatic hypotension, this is really a problem for my patients again. A lot of them are older. Some of them suffer from balance problems. Since they’re older, they almost always get up in the middle of the night, maybe several times to go to the bathroom. They stand up, they get orthostatic hypotension, they get dizzy, they fall down and they fracture a hip. For example, once you go into the hospital with the fractured hip, your odds of leaving alive are pretty low. Also, many of these people fall and actually get skull fractures and die. Now, a lot of them are older and they’re on blood thinners. So you fall and hit your head on blood thinners. That’s a really severe issue. So this issue of orthostatic hypotension needs at least 100 times the attention that it usually gets. Mortality after hip fracture, 21% if they address the fracture, 70% if they don’t with surgery.

And often in older people, they won’t do surgery because their bones are too brittle. And the all cause mortality doubles for older patients after a hip fracture. And this is what my mom died of. When she was she moved in with me, she was on 41 pills. Within a couple of years. We got it down to one. We couldn’t get her off of that one. She was happier and healthier than she’d been in 40 years. She went down to live in a facility in Santa Cruz, and within a year she was back on 41 pills a day. Amongst them were high blood pressure medications, which made her blood pressure too low. She was given things that lowered her sodium levels, which then made her more likely to pass out. She fell down several times, and the last time she fell down, she fractured her hip and she was so frail they really couldn’t do anything with it. And she passed away shortly after that. Unfortunately, that’s way, way, way too common a story. Okay. So if you have elder parents, friends, etc., keep a close eye on them for these things. It’s a real a real issue. Okay. So when we add the increased risk of low sodium. We’re looking at increased risk of falling because of balance issues and pain. And then looking at the over prescription of blood pressure medications. That’s a deadly. I’ve seen many patients who are put on blood pressure medications. Their pressure came down to normal or even low levels, and they were never taken off the medications.

In fact, I had one guy whose daughter and son in law I’d seen for many years. And they brought him in because he was just not making it. He could barely function. He was losing the ability to have conversation. And it was episodic. It wasn’t all the time. So they brought him in. And so I read the doctor’s report and it said when he was in there, his blood pressure was at 77 over 52 that anybody should pass out of that.  If they don’t pass out, they certainly cannot hold an intelligent conversation because they’re not getting any blood to their brain. So I said, you know, very kindly, I recommend you go back to the doctor and point out how low his blood pressure was. So they go in and she goes in and says, you know, I’m a little worried because my dad’s blood pressure is so low and he’s on all these blood pressure medications. And the doctor said, well, how do you know that? And she said, Well, my acupuncture looked at this and said that his blood pressure was too low and the doctor said, Well, acupuncturist, what do they know? They probably don’t even know how to take a blood pressure. And she looked at him and said, this was in your paperwork. You took his blood pressure. So the doctor was nervous. Someone had taken the blood pressure, had seen that it was 77 and still kept him on the low blood pressure medications. Once they changed his medication, his entire life turned around.


Okay. Here’s another study. Hyponatremia falls and bone fractures, a systemic review and meta analysis. Now, a meta analysis is generally the highest form of research or one of them, because you’re taking a whole bunch of studies, a lot of individual studies, and you put them together. And the advantage of that is you get much bigger numbers, right? And you get a balancing a bias probably a little bit, you know, between one study and another where they’re looking at it. The problem, of course, is sometimes you’re almost comparing apples to oranges, but still, the larger the study, the more likely it is to be valid and this was a pretty big study, a meta analysis. So.


Here’s another one. Hyponatremia and the prognosis of acute ischemic stroke. So does low sodium play a role in strokes? And it showed that. So ischemia is a lack of blood flow. So if someone has at a ischemic stroke, it means that there’s some blockage either in the small vessels they’re blocked or someone gets a blood clot, etc., but it stops the blood from getting to where it needs to go. The other type of stroke is hemorrhagic or hemorrhagic. And in that one, a blood vessel breaks typically and you get blood and bleeding in the brain. So, in this study, the conclusion is that there’s a higher mortality rate in these patients even after they have a stroke and are tracked for 12 months after the stroke, and they maintain a higher possibility of an additional stroke. And the mortality was significantly higher.


In this study Frequency of Electrolyte imbalance in patients presenting with acute stroke. Again, stroke, a brain accident, acute meaning sudden onset electrolytes or minerals that are carried in the blood to balance the blood. So you have potassium, calcium, sodium, etc. and these do thousands of functions. I didn’t put magnesium in there. So the outcome here was that the sodium level was significantly lower in the ischemic stroke group as compared to the hemorrhagic stroke group. So if someone came in with a stroke and they immediately took their metabolic panel, they found that the ones who had a skimming stroke had much lower sodium levels not caused by the stroke. Obviously, there was nowhere for the sodium to go at that point. It was obviously correlated.


So anyway, these are very, very important issues. Here’s another one. Evaluation of serum electrolyte levels in patients with anemia. So again, this is a really common in my practice. I get a lot of older patients with anemia who are on blood pressure medications or sometimes on diuretics so that they pee out more water and they pee out more sodium and potassium with that. And so here we’re looking mostly at the iron deficiency anemia, so we can include menstruating women, vegetarians and vegans, etc. In this study, the sodium levels and potassium levels are impacted in patients with anemia. So there should be even closer monitoring of their serum potassium and sodium if they are anemic. So again, you don’t want to look at any of these tests in a vacuum. You’re looking at the matrix. Do they have anemia? Okay, then we need to be more careful with sodium levels, then we need to be more careful with potassium levels. We need to be more careful with magnesium levels. Or if you see that those levels are low, then you’re going to look and go, oh, is the anemia causing that? Okay. So if you’ve been diagnosed with anemia, you need to get your electrolyte levels checked fairly frequently.


Here’s that word again. Mild. Mild hyponatremia, Hypernatremia and incident. Cardiovascular disease and mortality in older men. A population based cohort study. This is one of my favorites because that has some of the best U-shaped shape curves I could find on the Internet. Now, I’m gonna apologize. This is going to be a little bit hard to see, but over here we have sodium levels. Okay? And this is about 139 and this is 143 and this is cardiovascular risk. So you can see once you get under 139 or once you get over 143, you get a big jump in cardiovascular risk. Same thing down here with total mortality risk here. We’re up at 30. Down here we’re around 15. So twice the risk factor if you’re under 136 than it is if you’re 139, twice, twice the risk factor, it’s not a little bit.

And over here, we have the same type, although it’s a little sawtooth. Here, you get the same thing with potassium levels. Too low, deadly too high. Deadly too low. Deadly, too high, deadly. So again, it’s really getting into that sweet spot and staying there. So Aldosterone, we’re going to take another quick look at that because this one so important. And this is, as I mentioned earlier, the major control in controller of sodium to potassium balance. As the blood electrolyte levels are being analyzed, a message is sent out to increase or decrease the release of aldosterone into the bloodstream from the adrenal glands, the very outer level of the adrenal glands, the kidneys then selectively direct more potassium or more sodium to be increased in the urine output. As the aldosterone goes down, sodium goes down. So if your sodium is consistently too low, you want to look and see if there’s an aldosterone problem.

And this is very common in our culture and causes many of the symptoms that are associated with adrenal fatigue. So another reminder, again, I’m going over a couple of these things more than once. So this is a sudden spell or being lightheaded when you change position. Now there’s something called benign positional vertigo which causes spinning, right? You feel like you’re seasick, you get vertigo, nausea, that that whole feeling, that’s a completely different issue. Orthostatic hypotension, it feels when you stand up like the blood or energy or both, just fall out of your brain. It’s like, whoa, there’s nothing there. And the surprise is that’s actually what happens. You actually don’t have enough pressure to get the blood and the energy back up into your brain. So low aldosterone equals low sodium equals low flow and fluid in the blood. In order to balance the sodium equals hypokalemia or low blood volume equals not enough blood getting to the brain quickly when we go from lying down to standing, talk to your Doc, okay? Do not increase your salt intake.

Sorry. It sounds like I’m all for increasing salt intake. No, I’m for monitoring sodium levels and then taking appropriate action after you monitor it. So don’t increase your salt intake without talking to a health practitioner. That could be a nutritionist, could be a natural path. That would be an acupuncturist, chiropractor, doctor, whoever. Certainly, never change your blood pressure medications without speaking to your medical doctor. Usually medical doctors don’t do much explanation or explaining of why they put people on particular blood pressure medications. And sometimes there are very, very good reasons for particular blood pressure medications that may be doing more than just lowering your blood pressure. So never change that without talking to your doctor again. My point is that your sodium should be checked frequently or your parents sodium, whoever you’re taking care of should be checked frequently. Their blood pressure should be checked frequently to make sure the dosage of blood pressure medication is still correct. So sodium or a complete metabolic panel is very inexpensive.

So that’s my recommendation, if you ever test low in sodium 138 or under or even more importantly, if the sodium to potassium ratio is off, you should actually get your blood chemistry done 3 to 4 times a year to make sure that you haven’t fallen back into a state of low sodium. It’s going to be less than $20 for these for this test, for the whole chemistry panel. Actually, if it’s under 135, at any point, you should have your aldosterone tested.


Kathryn: We have a few questions.

Dr Nieters: Good.

44:17 Healthy Blood Pressure Ranges for Older People

Kathryn: One is. Hello, Dr. John. What is the healthy blood pressure range for older people?


Dr Nieters: Oh, my God. That is such an interesting question and so argued. I’m actually getting ready to take a deep dive into that soon and I’ll have better information for you. Traditionally in Europe, they allow much higher blood pressures in elderly people. They would say generally something like and this could vary 90 plus your age. So if you were 60, they said 150 was okay. They’re kind of backing down from that a little bit and going more to the Western ideas. And I think that the the research is more supportive in this case of the Western ideas. So. I’m okay if it goes up a little bit and people that are getting a little older for the reasons I talked about today, but I would not want it over 140. Okay. Then the diastolic is measuring something. That’s the second number, measuring something differently. And I would like that to be under 90. Okay. That’s the very, very upper limit. I would love to see it at 120 over 78, somewhere in that range.


Kathryn: Okay. If a patient’s blood pressure is normal to low after being on antihypertensives for many years, what would be the best approach to stopping the antihypertensive? Will, the blood pressure eventually creep back up.


Dr Nieters: I don’t know. It depends on what was causing the high blood pressure. So some people are very, very reactive to stress hormones. So the adrenal hormones and those people are generally put on beta blockers or if you’re doctors on top of it or something that blocks the uptake of adrenaline. So if you have a really stressful job or stressful life, you go on those drugs, your blood pressure drops down to normal. It may be normal if you get off the drug. You don’t know unless you know, you do some testing with it. But it depends on which there are several different type of blood pressure medications. Category is families and they each do something a little bit different. The prevailing thought that is starting to take over lately is that rather than giving a high dose of one blood pressure medication, a lot of doctors are going to low doses of three or four different medications because that lowers the possibility of side effects from any one of them.

So far, the research looks very promising on that approach. So, yes, it’s possible that your blood pressure could go back to normal. I’ve seen that happen many, many times. There are quite a few devices. I’ll do something on high blood pressure in the next few weeks just because there’s so much to talk about. But there are a lot of devices. There are mats, PEMF mats that can help with blood pressure. There are a variety of natural supplements that can happen with blood pressure. There’s something called a respirator, which is a breathing timing system that’s very effective. There are devices that you can squeeze tightly with your hands and then relax. And it was discovered that by fighter pilots while they’re flying, have enormously high blood pressure, but they have some of the lowest blood pressure when they’re not flying. And one of the reasons it’s not the only reason, but one of them is they are pressed in there at such high G-forces and they’re squeezing everything so tightly that that helps them then learn blood pressure control. It’s very interesting, some very interesting studies on that … Um … What was the question?


Kathryn: Will, the blood pressure eventually creep back up.


Dr Nieters: It could go either way. It could go either way. Sorry. I wish I could give you a better answer than that.


Kathryn: Okay. Another question is what is the source of electrolytes and how do we know if we are low?


Dr Nieters: I hope you have a week. So electrolytes are minerals carried in the bloodstream. They come from our food, right? In pretty much all cases, unless you take a supplement. So, you know, you’re getting magnesium, potassium, calcium, sodium chloride from the foods that you eat. Now, depending on what you eat, you’re going to maybe get enough, maybe not get enough. Magnesium is a real problem. Our intake of dietary magnesium has gone down over 50% in the last 100 years. And many, many, many people are magnesium deficient. So ultimately, it’s coming from our food or from a supplement and the way you that and it’s a very complex question actually because what your medical doctor will do is run a chemistry panel, sometimes called a metabolic panel.  In there it will list potassium, sodium chloride, calcium, sometimes magnesium. And so they’ll look at that to see what your level in the serum of your blood is.

That’s better than nothing, particularly for sodium and potassium. But it doesn’t give you a very good story because for many of these minerals, only 1% to 2% are actually floating around in your serum. Like for calcium, for example, almost all of it is locked up in bone or in other tissue. And so it’s very hard to measure accurately calcium levels. There are a few tests like magnesium. You can do what’s called a red blood cell, magnesium. So that’s going to be more accurate. And there are a few other minerals that you can test that way and see what’s bound to of the red blood cells and or some other things. And those are more accurate. But you would start with just a basic metabolic panel. How much is that? It’s $7. So that’s $7. Usually there’s a $10 blood, the blood draw. But that covers if you get 20 tests, it’s still $10. So it’s $7 for a we do a chem 14. So we’re testing for 14 different chemicals in your blood and it’s less than a dollar a test. That’s why I say this is just an incredible bargain. And if we detect the problem or if we have reason to believe that there is a deeper problem, then we might do one of the red blood cell tests, or we might do an organic acid test, which is a urine test to see what your metabolite levels are. But we would start with a really inexpensive chem 14.

Okay, that’s it.


Kathryn:  And what would be a source of electrolytes?


Dr Nieters: Our food. Typically, most of them you’re going to find in your fruits and vegetables. Some is. Some are in meat. You’re going to get some potassium in, you know, in your meat and some in eggs, etc.. But mostly it’s going to be in your fruits and vegetables. Yeah. Okay. Okay. Hey. All right. We made it in under an hour. That was a lot of stuff to go over. I absolutely hope that it’s helpful. And the takeaway is real simple. Make sure that you look at your blood tests from a functional standpoint and pay attention to low sodium or high sodium in particular.

Okay. Thank you. I’ll be back with you next week. Keep sending the questions in. In the meantime, be happy. Be healthy. Thank you.


Lifesaving Vitamin Slashes Heart Disease Risk by 57%: https://refp.cohlife.org/_vitamin_k/Mercola%20-%20Vitamin%20K%20Lifesaving%20Vitamin%20Slashes%20Heart%20Disease%20Risk%20by%2057%25.r.pdf

What is the MTHFR Gene?: https://www.healthline.com/health/mthfr-gene#_noHeaderPrefixedContent

Association between low density lipoprotein and all cause and cause specific mortality in Denmark: prospective cohort study: https://www.bmj.com/content/371/bmj.m4266/rr-0

Avocado Consumption and Risk of Cardiovascular Disease in US Adults: https://www.ahajournals.org/doi/10.1161/JAHA.121.024014

11 Proven Benefits of Olive Oil: https://www.healthline.com/nutrition/11-proven-benefits-of-olive-oil

Consumption of Olive Oil and Risk of Total and Cause-Specific Mortality Among U.S. Adults: https://www.jacc.org/doi/abs/10.1016/j.jacc.2021.10.041

Dr. John Nieters L.Ac, DAOM, is an acupuncturist, Chinese herbalist, functional medicine, writer, teacher, and leader in the community. In this episode, John talks about his experience with the importance of finding your vision and purpose in life, in order to create the right goals for you.

Disclaimer: Dr. John Nieters received his Doctor of Oriental Medicine and Acupuncture degree from Five Branches. His use of “doctor” or “Dr.” in relation to himself solely refers to that degree. Dr. Nieters is a licensed acupuncturist in California. This video is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Nieters and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. TheBalancingPoint.net, Alameda Acupuncture, and Dr. John Nieters L.Ac, DAOM are not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this video or site.

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