| Fitness

How To Improve Your Electrolyte And Micronutrient Concentration

By Christopher Walker

In the low metabolism state, holding on to minerals in your body becomes incredibly hard and your tolerance for water is very low.

This is because your minerals get dysregulated during a long-term stress response. The way to fix that is not always clear and straight-forward.

Table Of Contents:

We will get to that in a bit, but we need to set the stage of what exactly minerals are in the first place.

To start, minerals and electrolytes are the exact same thing. Somehow the term “electrolytes” got branded as a positive thing, yet “sodium” or “salt” got branded as negative, even though sodium is the primary electrolyte in all rehydration beverages.

These minerals are called electrolytes because once in your body in their free “ion” forms, they conduct electricity throughout your body, allowing your electrical-based nervous system to work.

In other words, these minerals are what allow your cells to talk to one another and your brain and body to send signals throughout your system.

Because of this, mineral balance in your body is crucial to good health and a rocking metabolism.

The best analogy for this comes from a mentor of mine, Matt Stone, who says that the fluid inside the body is like soup.

If you add the wrong balance of spices, too many spices, or too much water, the soup will not taste right. You need the right blend, not over-concentrated, not under-concentrated.

Specific to over-activation of the stress metabolism, which lowers your energy production and overall metabolic rate, is the fact that the soup, or the minerals in your body, are too diluted, making it harder for your body to function properly.

Read More: The Metabolism Spectrum (Do You Have A Low Metabolism?)

Correcting Ion Balance In And Out Of The Cell:

correcting ion balance in the cell

The fluid in your body exists in one of two places.

Either it is inside of the cells, which we call the “intracellular space”, or it is outside of and in between the cells, which we call the “extracellular space”. Blood volume makes up 20% of this extracellular space.

When your metabolism is low, the minerals in your body as a whole are diluted from increased exposure to the stress hormones. But specifically, the extracellular fluid gets diminished and the intracellular fluid becomes unregulated as fluid moves out of the extracellular space and into the cells.

This happens because fluid follows minerals through the process of osmosis.

Your cells want equal concentration of minerals inside and outside. When one is more concentrated than the other, there is “osmotic pressure”, which is relieved by the movement of water.

In other words, if the inside of the cell gets more concentrated in minerals than the outside of the cells, the water will move into the cell to dilute it to bring the concentration between the outside and inside to balance.

This means the total volume of the extracellular fluid will be reduced, which is exactly what we see in the low metabolism state.

That also means that blood volume is reduced, which means the pressure of the blood inside your blood vessels, veins and arteries drops.

To combat this, the muscles around these long lines of blood constrict to bring the pressure back up, similar to how a small amount of water will shoot through a thin hose at a high pressure, but the same amount of water will trickle out of a thicker, wider hose.

That is why sodium restriction, NOT sodium intake, is associated with hypertension.

The noticeable side effect of this is cold hands and feet. Since there is a lower amount of blood in your body, there is not enough to completely fill your extremities.

This effect is exaggerated when a stress response is activated in the body because the small amount of blood you do have is being directed to the muscles and brain, as discussed earlier.

This is precisely why one of the major symptoms of a low metabolic rate is cold hands and feet.

What Is Messing With The Ion Balance?:

what is messing with the ion balance

But let’s rewind for a minute - why are the inside of cells getting concentrated while the outside of cells is getting diluted?

After all, this is the reason why the fluid is moving out of the extracellular space and into the cell.

The reason has to do with the primary extracellular minerals: sodium and calcium.

When the stress response gets activated, your body releases hormones, such as cortisol and adrenaline, that dump glucose and fat into your blood to be used by the working muscles and brain.

The problem is that these hormones cause a loss of minerals from the body. Since sodium is so important for the extracellular fluid and for neural communication, your body releases a hormone called “aldosterone” as well, which tells the kidneys to keep sodium (and to a lesser extent, calcium) in the body.

Unfortunately, it can only do this at the expense of the other 2 stress minerals, potassium and magnesium.

Potassium and magnesium are the major minerals inside the cell, while sodium and calcium are outside of the cell. Both calcium and magnesium are also found in large quantities in your bone too.

When you lose potassium and magnesium, your cells lose their ability to maintain a strong ion gradient.

I have mentioned this before when talking about CO2 and how it helps to maintain the gradient (which we will get to in a minute). Essentially, this “ion gradient” is just the balance between minerals inside and outside your cells.

When there is a strong concentration of sodium and calcium outside of your cells and a strong concentration of potassium and magnesium inside your cells, it strengthens the cell membrane, making the boundary between inside and outside the cell more definitive.

So when this ion gradient is weakened from a loss or dilution of potassium and magnesium from inside the cell, more sodium and calcium make their way inside.

On top of this, calcium inside the cell decreases aerobic respiration, meaning we are producing less CO2. CO2 is acidic, and when produced in the cell, it will bind the calcium, an alkaline earth metal, and take it out of the cell.

Because there is less CO2, sodium and calcium more easily enter the cell. Again, it is a negative spiral.

In addition, CO2 is needed to deposit calcium into bone, and without it, calcium will leave the bone, enter the bloodstream, and get stored in tissues (called “calcification of tissues”).

Calcium inside the cell is particularly harmful, as it damages the mitochondria and interferes with normal cellular metabolism.

So now we have a situation where potassium and magnesium are depleted and calcium is inside the cell more than normal, which brings increased water with it. This is all because of an overactivation of aldosterone to maintain sodium levels and decreased CO2 production.

In order to bring things back to balance, we need to reduce aldosterone and increase CO2 production.

Eating more sodium helps to accomplish both of those things.

First, by eating more sodium, you shut down the aldosterone response in your body.

Aldosterone is released during stress in order to hold onto sodium, but if you are consuming plenty of sodium, then you can trigger your body to stop releasing aldosterone. In essence, increasing sodium levels will tell your body that it needs to excrete more sodium and not continue to hold onto it.

Because aldosterone gets shut down, your body can maintain normal levels of potassium and magnesium inside the cell and improve the ion gradient.

On top of this, eating more sodium initially causes more of it to absorb into the cell, especially when the ion gradient is still weak.

When sodium levels get too high inside the cell, the sodium-potassium pump gets activated. This is an enzyme in the cell that uses energy to pump sodium out of the cell while pumping potassium into the cell. In order for it to work, it needs to bind 3 sodium molecules inside the cell and 2 potassium molecules outside of the cell.

When aldosterone is high and potassium is depleted, this pump cannot work properly and sodium gets stuck inside the cell, as we have been talking about.

But if you increase sodium intake, it allows your body to hold onto potassium and allows this pump to work.

This fixes the ion gradient and burns ATP, stimulating aerobic respiration, which produces CO2 to remove calcium, like we just mentioned.

Now that the calcium and sodium are outside of the cell while the potassium is inside, the cell can function normally again.

Learn More: The Low Cortisol Lifestyle | UMZU's Guide To Fighting Stress

But Isn’t Sodium Bad For You?:

isn't sodium bad for you?

Now I am sure that you have always been told that high sodium diets cause high blood pressure and contribute to heart disease.

But is this true?

Not in the slightest.

In the history of nutrition, salt became falsely accused of being bad for you and raising blood pressure, even to the point where millions of babies were being harmed from a recommendation made for pregnant mothers to reduce salt intake.

As it turns out, sodium became unfairly demonized because of a misunderstanding about water retention.

In the short-term, changes in sodium levels in your diet will affect water retention. If you increase sodium, water retention goes up. If you decrease sodium, water retention goes down.

Again though, this is only for the day or so after these changes. A steady, high sodium intake does not result in water retention. In fact, it actually helps to reduce water retention as cells do not stay unnecessarily bloated from improper mineral regulation.

But what about blood pressure?

As it turns out, sodium only raises blood pressure a few points initially, but nothing more than that.

But in the long-run, low sodium intake (and high aldosterone) increases blood pressure and hypertension.

Not only that, but this low sodium intake increases insulin resistance, worsens blood lipid profile, increases obesity, increases risk of heart disease, and is generally associated with higher all-cause mortality.

Many studies have shown that sodium restriction activates the stress response in the body, and the fact that aldosterone is a stress hormone should already make this clear.

To make this abundantly clear, eating sodium actively shuts down stress in your body.

On top of this, we can easily look at the fact that hydration beverages all contain a high amount of salt (and sugar to help the absorption and utilization in the body). Sodium is known to be important for rehydrating because you cannot maintain proper hydration without it.

And the final nail in the coffin of low-salt diets should be that in trauma and shock situations, doctors will give patients an IV that contains “hyperosmotic saline solution”, which involves several liters of fluid that is 10% sodium.

To be clear, that is the equivalent of the salt you would get from around 11 medium sized fries from McDonalds (credit to Matt Stone for this tidbit).

They do this because very high doses of sodium are critical for improving survival from severe shock and surgery, due to its cellular stabilizing and stress reducing abilities.

Salt is calming and therapeutic, helping your body shift out of the stress metabolism.

Of course inherent in improving your metabolism is that you are eating plenty of the other minerals as well - potassium, calcium and magnesium.

Without enough potassium, the sodium-potassium pumps cannot work to balance and strengthen the ion gradient.

Eating enough calcium will help prevent calcium from leaching into your bones. Assuming you can keep aldosterone low and the ion gradients strong, calcium will not end up inside of cells.

Eating magnesium is important because it is involved in over 300 enzymes. Not only that, but magnesium is also crucial to the energy production process.

Most ATP, the cellular energy unit, exists primarily bound to magnesium. Without enough magnesium, ATP production can get dysregulated and it will exist in the cell primarily as ADP bound to calcium instead (again, from increased intracellular calcium).

Now, consuming enough of these important minerals is crucial to increasing your metabolic rate, but it is actually only half of the equation.

That is because it is not just about increasing the quantity of the minerals, but more accurately, the concentration of those minerals.

The Epidemic Of Over-Hydration:

overhydration

A common theme in health and fitness is to always try to drink more water.

I know, because I used to be the guy that would carry his water bottle around with him everywhere, sipping throughout the day to make sure I stayed hydrated.

On top of that, I would pee somewhere around 12 (or more) times per day and it was usually completely clear.

It seems that the fear of dehydration has us thinking that more water is always better.

In truth, overhydration is just as bad and FAR more common.

Yes, dehydration is bad, do not get me wrong, but your body’s thirst mechanism will kick in long before you are dehydrated to any significant degree. This thirst signal is not easy to ignore - you will want to drink water like mad.

But overhydration will dilute your blood sodium, causing you to pee more of it out. This will activate the aldosterone response that we need to shut down so badly and cause all of the exact same problems as eating too little sodium.

In nature, no animal sips water all day long and they certainly do not have clear urine. In fact, if they do, a vet is trained to know that something is wrong with the animal if their urine is clear.

Instead, they drink when they are thirsty and only when they are thirsty. This makes perfect sense, since our highly evolved thirst signal will tell us when we need to drink.

Going back to the soup analogy, you do not want to add too much water and dilute the concentration of the spices in the soup.

You want to aim for the right concentration balanced with the right amount of water, which is precisely what our evolution has designed us to do naturally.

Mineral Reconcentration Recommendations:

So now it should be clear that eating more of the stress minerals, especially sodium, while reducing fluid intake, will help with increasing your metabolic rate.

Now the question is, how much?

As a very general guideline:

  • Sodium intake should be at least 4-6 grams dail, but you can go higher if your body is craving it
  • Potassium intake should be around 4-6 grams daily as well, but generally make sure you are eating more sodium than potassium to encourage the extracellular fluid to expand
  • Calcium intake should be 1-2 grams daily in the form of calcium carbonate, if possible
  • Magnesium intake should be anywhere from 400-600 mg per day, split up into 200 mg doses at maximum (due to digestive issues with high amounts all at once)

I recommend supplementing with calcium carbonate and magnesium carbonate (the carbonate can be converted to carbon dioxide in your blood), eating lots of fruits for potassium, and adequately salting your food to get enough sodium.

Remember that while it is important to get all of these minerals, sodium is the most important since it will allow your body to hold onto the other minerals by reducing aldosterone.

The amount of minerals that you are consuming is also related to the amount of fluid you consume: the more fluid that you drink, the more minerals that you need.

The difficult part here is that the amount of fluid you can “tolerate” depends on your current metabolic rate. This can be seen through the following correlation: the hotter your body temperature, the more sweat that you evaporate and the more water that you should consume.

That is why you should focus instead on the amount of fluid that you are peeing out.

In general, aim to pee 4-6 times per day, spaced evenly apart, and never at night. The color should always be a solid yellow. Light yellow or clear means that you are overhydrated or that a stress response is active. Dark orange urine means that you probably need to drink a glass of water.

In general, of course, do your best to listen to your thirst response and go from there. If you are thirsty, drink. If you are not, do not drink anything.

This means you should generally avoid drinking beverages for taste rather than thirst (although some is okay - I drink my Metabolism Coffee everyday, for example). If you have dry mouth, sipping a salty beverage can help, since dry mouth is actually a symptom of low sodium in the blood.

Regardless of your metabolic rate, if you are peeing the amount specified above and drinking to your true thirst, your fluid balance should be fine.

Key Points:

  • Aim to generally consume 4-6 grams of sodium and potassium daily, 1-2 grams of calcium per day, and 400-600 mg of magnesium daily
  • Consume fluid based on true thirst, not dry mouth or taste
  • Aim to pee around 4-6 times per day, evenly spaced apart without any sudden urges, and never during the night
  • Aim to keep your pee a solid yellow color - if it is light yellow or clear, then you are overhydrated; if it is dark orange, then you are dehydrated

If you would like a step by step guide to show how to eat and live in a way that promotes mineral balance and a healthy metabolism then make sure to check out The Thermo Diet Course only inside of UMZUfit!

the thermo diet

Micronutrient Replenishment:

micronutrient replinishment

Finally, the last major step towards increasing your metabolic rate is ensuring optimal intake of micronutrients, the vitamins and minerals necessary for good health.

That is because certain deficiencies in vitamins or minerals can affect hormonal output and the actual process of energy production.

Now, we have already talked about the importance of the stress minerals, sodium, potassium, calcium, and magnesium. Even though these minerals are micronutrients, we will not cover them again here.

The other major micronutrients that you want to make sure that you are getting are the fat soluble vitamins (A, D, E, K, K2), the B vitamins, vitamin C, copper, and choline are the ones most important for metabolism.

Each of these has a wide variety of functions in the body, some of which are critical for metabolism.

For example, vitamin A is used to create steroid hormones. When cholesterol in the blood combines with thyroid hormone and vitamin A, they make pregnenolone. Pregnenolone is the “mother” of all steroid hormones and it can get converted down into hormones like DHEA, progesterone, testosterone, and DHT. These hormones are all very protective for metabolism and enhance long-term health and metabolic rate.

Vitamin D is important for regulating calcium and magnesium, which as we have seen, are crucial for proper cellular functioning, and it acts as a steroid hormone itself, protecting against cancer, diabetes, osteoporosis, heart disease, and many other diseases.

Vitamin E is the principal fat-soluble antioxidant that can halt the fat-based free radical chain reaction that happens and help minimize the lipid peroxidation that happens from eating PUFAs. We discussed earlier how the antioxidant system in the body works by transferring free electrons from vitamin E, to vitamin C, and ultimately glutathione to neutralize the reaction, making vitamin E crucial for this system to work.

Choline is used to export fat from the liver in the form of cholesterol, which is needed for creation of steroid hormones and bile acids.

The B vitamins are used in the actual steps of cellular energy production, acting as oxidizing and reducing agents in the steps of oxidative phosphorylation.

Copper is also used in the aerobic respiration pathway because the critical enzyme, cytochrome oxidase, is copper-dependent.

This is just a sample of the functions of these vitamins and minerals in the body, and being deficient can affect a variety of different pathways that are necessary.

It is important to get enough of these micronutrients each day to avoid becoming deficient.

The Fat-Soluble Vitamins:

fat-soluble vitamins

As we have seen, the fat-soluble vitamins are important for various reasons.

Since they are fat-soluble, however, they are less easily excreted from the body and build up over time as a result.

That means that if you are deficient in any of these, it might take several months of higher dose supplementation to raise the levels back up to the optimal range.

If you supplement with a higher dose, then you can raise levels more quickly.

Of course it is important to not overdo any of them, which can result in toxicity. Most likely, however, you will notice symptoms of toxicity long before they become a problem, but getting blood tests can help you know which ones you might be deficient in.

Personally, I recommend getting slightly more than the RDA for each of these daily.

That means you should look to aim for these amounts:

  • Vitamin A: 1000-3000 IUs (in the active form, not the vegetable form called beta-carotene)
  • Vitamin D: 500-1000 IUs (depending on sunlight exposure)
  • Vitamin E: 500-1000 IUs (more if eating PUFAs, or getting exposure to other free radicals)
  • Vitamin K: 9000 mcg
  • Vitamin K2: 1000 mcg

Now, it is not important to get hung up on exact numbers as it is far too much to track.

Generally, I recommend eating foods that contain these vitamins, possibly supplementing with low doses as a back-up.

Eating beef and veal liver 1-2 times per week can act as an amazing “multi-vitamin/multi-mineral” since it contains large doses of all the nutrients you need for optimal metabolism. Given that we are constantly learning about new vitamins and different forms that these vitamins can exist in, I think this is generally the best route you can take.

However, not everyone likes the taste of liver, so supplementing with liver tabs is a good secondary option.

However, if a blood test reveals that you are deficient or below the optimal range in any of these vitamins, supplementing with the deficient vitamins is your best option to quickly restore levels.

The Water-Soluble Vitamins And Minerals:

water soluble vitamins

For the water-soluble vitamins and minerals, you can take much more than you need for a day since your body can easily excrete what it does not need (this does not mean that you cannot overdose, just that it is much harder and can only be done in an acute sense).

However, this also means that they need to be replenished more frequently as well.

The B-vitamins are all mostly used for energy production, so these are crucial. If you are eating lots of fruits, then you will most likely be getting enough of them. If you want to be sure, take a B-complex vitamin to cover your bases.

The same generally goes for vitamin C, but Linus Pauling has some interesting research on high dose vitamin C for maximizing health, so this is one vitamin you can take more of if you want. Since it plays such a crucial role in our body’s antioxidant system, you want to make sure that you are getting optimal amounts.

One side point here though is to not take so much that you pee out too much water, causing more excretion of the important minerals. If you have ever taken a high dose B-complex supplement and peed yellow for the next few hours, you know what I am talking about.

Doing this too frequently makes it harder to keep your minerals in balance and can activate an aldosterone response to hold onto sodium as your kidneys excrete the extra B-vitamins.

Finally, choline is an incredibly important nutrient for helping the liver convert liver fat into cholesterol, allowing the liver to work better (important for thyroid conversion).

Since we will be eating a high sugar diet, it is important to get enough choline to keep the liver lean. I recommend getting around 1-2 grams of choline per day.

Both liver and egg yolks are rich in choline, so if you are eating a few eggs per day and liver 1-2 times per week, then you will be getting a good bit.

Supplementation is also a solid option that I use, especially since I am not always consistent in eating eggs and/or liver.

Key Points:

  • Make sure to get adequate levels of the fat-soluble vitamins (A, D, E, K, K2), the B-complex vitamins, vitamin C, copper, and choline (along with the main stress minerals, sodium potassium, calcium, and magnesium) in order to ensure your metabolism is running smoothly
  • If you know that you are deficient in a fat-soluble vitamin, you can use higher doses for a short amount of time to quickly raise levels
  • Supplementing with these micronutrients can make things easier and ensure that you are meeting all of your requirements

If you would like a step by step guide to eliminate micronutrient deficiencies and promote a healthy metabolism then make sure to check out The Thermo Diet Course only inside of UMZUfit!

the thermo diet

References

  • Whaley-Connell, Adam, Megan S. Johnson, and James R. Sowers. "Aldosterone: role in the cardiometabolic syndrome and resistant hypertension." Progress in cardiovascular diseases 52.5 (2010): 401-409.
  • Sowers, James R., Adam Whaley-Connell, and Murray Epstein. "Narrative review: the emerging clinical implications of the role of aldosterone in the metabolic syndrome and resistant hypertension." Annals of internal medicine 150.11 (2009): 776-783.
  • Horký, K. "[Aldosterone as an endogenous cardiovascular toxin and the options for its therapeutic management]." Vnitrni lekarstvi 57.12 (2011): 1012-1016.
  • Whipp, G. T., et al. "Regulation of aldosterone in the guinea-pig—effect of oestrus cycle, pregnancy and sodium status." Aust J Exp Biol Med Sci 54.1 (1976): 71-8.
  • Williams, Gordon H. et al. “Studies of the Control of Plasma Aldosterone Concentration in Normal Man: III. RESPONSE TO SODIUM CHLORIDE INFUSION.” Journal of Clinical Investigation 51.10 (1972): 2645–2652. Print.
  • Mrnka, L., et al. "Low-salt diet alters the phospholipid composition of rat colonocytes." Physiological research/Academia Scientiarum Bohemoslovaca 49.2 (1999): 197-205.
  • Leclerc, Marie, Michele G. Brunette, and Denis Couchourel. "Aldosterone enhances renal calcium reabsorption by two types of channels." Kidney international 66.1 (2004): 242-250.
  • Heer, Martina, et al. "Increasing sodium intake from a previous low or high intake affects water, electrolyte and acid–base balance differently." British journal of nutrition 101.09 (2009): 1286-1294.
  • Parrinello, Gaspare, et al. "Long-term effects of dietary sodium intake on cytokines and neurohormonal activation in patients with recently compensated congestive heart failure." Journal of cardiac failure 15.10 (2009): 864-873.
  • Garg, Rajesh, and Gail K. Adler. "Role of mineralocorticoid receptor in insulin resistance." Current Opinion in Endocrinology, Diabetes and Obesity 19.3 (2012): 168-175.
  • Briet, Marie, and Ernesto L. Schiffrin. "The role of aldosterone in the metabolic syndrome." Current hypertension reports 13.2 (2011): 163-172.
  • Tirosh, Amir, Rajesh Garg, and Gail K. Adler. "Mineralocorticoid receptor antagonists and the metabolic syndrome." Current hypertension reports 12.4 (2010): 252-257.
  • Ruppert, M., et al. "Short-term dietary sodium restriction increases serum lipids and insulin in salt-sensitive and salt-resistant normotensive adults." Klinische Wochenschrift 69 (1990): 51-57.
  • Prada, Patrícia Oliveira, et al. "Low salt intake modulates insulin signaling, JNK activity and IRS-1ser307 phosphorylation in rat tissues." Journal of endocrinology 185.3 (2005): 429-437.
  • Garg, Rajesh, et al. "Low-salt diet increases insulin resistance in healthy subjects." Metabolism 60.7 (2011): 965-968.
  • Catanozi, Sérgio, et al. "Dietary sodium chloride restriction enhances aortic wall lipid storage and raises plasma lipid concentration in LDL receptor knockout mice." Journal of lipid research 44.4 (2003): 727-732.
  • Alderman, Michael H., Hillel Cohen, and Shantha Madhavan. "Dietary sodium intake and mortality: the National Health and Nutrition Examination Survey (NHANES I)." The Lancet 351.9105 (1998): 781-785.
  • Cohen, Hillel W., et al. "Sodium intake and mortality in the NHANES II follow-up study." The American journal of medicine 119.3 (2006): 275-e7.
  • DiNicolantonio, James J., et al. "Low sodium versus normal sodium diets in systolic heart failure: systematic review and meta-analysis." Heart (2012): heartjnl-2012.
  • Alderman, Michael H., et al. "Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men." Hypertension 25.6 (1995): 1144-1152.
  • Cohen, Hillel W., Susan M. Hailpern, and Michael H. Alderman. "Sodium intake and mortality follow-up in the Third National Health and Nutrition Examination Survey (NHANES III)." Journal of general internal medicine 23.9 (2008): 1297-1302.
  • Sharma, Arya M., et al. "Effect of dietary salt restriction on urinary serotonin and 5-hydroxyindoleacetic acid excretion in man." Journal of hypertension 11.12 (1993): 1381-1386.
  • GOUGEON, RÉJEANNE, et al. "Effects of Sodium Supplementation during Energy Restriction on Plasma Norepinephrine Levels in Obese Women*." The Journal of Clinical Endocrinology & Metabolism 73.5 (1991): 975-981.
  • Krause, Eric G., et al. "Hydration state controls stress responsiveness and social behavior." The Journal of Neuroscience 31.14 (2011): 5470-5476.
  • Velasco, I. T., et al. "Hyperosmotic NaCl and severe hemorrhagic shock." American Journal of Physiology-Heart and Circulatory Physiology 239.5 (1980): H664-H673.
  • e Silva, M. Rocha, et al. "Hyperosmotic sodium salts reverse severe hemorrhagic shock: other solutes do not." American Journal of Physiology-Heart and Circulatory Physiology 253.4 (1987): H751-H762.
  • Lopes, O. U., et al. "Hyperosmotic NaCl and severe hemorrhagic shock: role of the innervated lung." American Journal of Physiology-Heart and Circulatory Physiology 241.6 (1981): H883-H890.
  • PASCUAL, JORGE MS, et al. "Resuscitation of intraoperative hypovolemia: a comparison of normal saline and hyperosmotic/hyperoncotic solutions in swine." Critical care medicine 20.2 (1992): 200-210.
  • De Felippe, J., et al. "Treatment of refractory hypovolaemic shock by 7· 5% sodium chloride injections." The Lancet 316.8202 (1980): 1002-1004.
  • Dubick, Michael A., and Charles E. Wade. "A review of the efficacy and safety of 7.5% NaCl/6% dextran 70 in experimental animals and in humans." Journal of Trauma and Acute Care Surgery 36.3 (1994): 323-330.
  • e Silva, M. Rocha. "Hypertonic saline resuscitation." Medicina 58 (1998): 393-402.
  • Christ, F., et al. "Hyperosmotic‐hyperoncotic solutions during abdominal aortic aneurysm (AAA) resection." Acta anaesthesiologica scandinavica 41.1 (1997): 62-70.
  • Messmer, K., and U. Kreimeier. "Microcirculatory therapy in shock." Resuscitation 18 (1989): S51-S61.
  • Mazzoni, Michelle C., et al. "Dynamic fluid redistribution in hyperosmotic resuscitation of hypovolemic hemorrhage." The American journal of physiology 255.3 Pt 2 (1988): H629-37.
  • "Hypothyroidism (underactive Thyroid)." Symptoms and Causes. Mayo Clinic Staff, 10 Nov. 2015. Web. 15 Aug. 2016.
  • Juneja, H. S., S. K. Murthy, and J. Ganguly. "The effect of vitamin A deficiency on the biosynthesis of steroid hormones in rats." Biochemical Journal 99.1 (1966): 138.
  • Jayaram, M., S. K. Murthy, and J. Ganguly. "Effect of vitamin A deprivation on the cholesterol side-chain cleavage enzyme activity of testes and ovaries of rats." Biochemical Journal 136.1 (1973): 221-223.
  • Garland, Cedric F., et al. "The role of vitamin D in cancer prevention." American journal of public health 96.2 (2006): 252-261.
  • Pittas, Anastassios G., et al. "The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis." The Journal of Clinical Endocrinology & Metabolism 92.6 (2007): 2017-2029.
  • Amin, Shreyasee, et al. "The role of vitamin D in corticosteroid‐induced osteoporosis: a meta‐analytic approach." Arthritis & Rheumatism 42.8 (1999): 1740-1751.
  • Suleiman, S. Ali, et al. "Lipid peroxidation and human sperm motility: protective role of vitamin E." Journal of andrology 17 (1996): 530-537.
  • Packer, Lester. "Protective role of vitamin E in biological systems." The American journal of clinical nutrition 53.4 (1991): 1050S-1055S.
  • Esterbauer, Herman, et al. "Role of vitamin E in preventing the oxidation of low-density lipoprotein." The American journal of clinical nutrition 53.1 (1991): 314S-321S.
  • Corbin, Karen D., and Steven H. Zeisel. "Choline metabolism provides novel insights into non-alcoholic fatty liver disease and its progression." Current opinion in gastroenterology 28.2 (2012): 159.
  • Depeint, Flore, et al. "Mitochondrial function and toxicity: role of the B vitamin family on mitochondrial energy metabolism." Chemico-biological interactions 163.1 (2006): 94-112.
  • Depeint, Flore, et al. "Mitochondrial function and toxicity: role of B vitamins on the one-carbon transfer pathways." Chemico-biological interactions 163.1 (2006): 113-132.
  • Huskisson, E., S. Maggini, and M. Ruf. "The role of vitamins and minerals in energy metabolism and well-being." Journal of international medical research 35.3 (2007): 277-289.