Everything You Need to Know About DEHYDRATION

In January 2007, in Sacramento, California, a radio station held a water drinking contest, “Hold your wee for a Week.” The contest was to see who could drink the most water without urinating. The winner was awarded a Week – for free! One woman drank so much water she died from water intoxication.[1] She drank over 2 gallons of water in about 3 hours, taking second place and winning two concert tickets. Then she got a headache and went home, dying in her bathroom about 2 hours later. A jury awarded her family over 16 million dollars because of the known danger of water intoxication.[2] This unfortunate woman died of low sodium, or hyponatremia, brought on by diluting her blood with so much water that her kidneys couldn’t get rid of it fast enough. This unfortunate woman died of low sodium, or hyponatremia. Her blood was diluted with so much water that her kidneys couldn’t get rid of it fast enough. This woman may have started with low sodium. Perhaps she was on a low sodium diet or was drinking lots of water every day? The winner drank more water than she did but didn’t die due to the differences in the need for water.

How Much Water Should I Drink?

This question is thrown at me many times every day. Let’s look at the literature:

The MAYO CLINIC says:[3]

• About 15.5 cups (3.7 liters) of fluids a day

WEB MD says:[4]

• the Institute of Medicine (IOM) recommends a total of 13 cups (about 3 liters) of fluid each day.

Harvard Newsletter says:[5]

• The daily four-to-six cup rule is for generally healthy people.

Where Do The Recommendations Come From?

Most of the recommendations from medical sources come from an Institute of Medicine[6] survey, which took the average amount of water consumed and used that as a suggestion. In other words, it’s how much water people drink on average – having nothing to do with health.

The very concept of a recommended amount of water for a population is ridiculous for many reasons. Even recommending an amount for a single individual doesn’t take into account the daily fluctuations in need for water. For example,[7]

• Activity level: Increased activity will increase sweating and the need for water.
• Weather: The ambient temperature and humidity will affect how much is lost through sweating and breathing.
• Metabolism: Some have a higher metabolism and sweat more.
• Size: A larger person has a greater need for water.
• Alcohol and caffeine: increase the need for water because they act as diuretics.
• Health: Fever, vomiting, diarrhea of course increase the need for fluids and electrolytes.

People can drink a lot more than the recommended amount and still get dehydrated. The best way to know is to go by symptoms, such as:

• Thirst
• Constipation (hard stool)
• Dizziness, or lightheadedness, especially when standing.
• Dry mouth
• Dry skin and chapped lips
• Fatigue
• Muscle cramps

However, these symptoms are not only from a lack of water. There are two other types of dehydration that can come from drinking too much water.

1. Lack of sodium
2. Lack of potassium

Sodium Dehydration

Sodium is vilified in the press because it is thought to be the cause of hypertension, and thus heart disease and strokes. People are told to avoid salt. Some are on a salt-free diet, while at the same time drinking their recommended 120 ounces of water every day. While the body is usually very good at adjusting to anything we throw at it, over time the low salt can become a problem. I have had several cases where drinking too much water depletes, or dilutes the salt in the body, preventing the proper functioning of the kidneys, muscles, and nervous system.

I had known Angie for many years because she would come into my office periodically for medications, infections, and her many issues with anxiety. She treated her anxiety with alcohol and was mostly continuously inebriated. She came in one day bumping into the doorways and slurring her words. I indicated she had been drinking again, but she protested, holding up a half-empty water bottle, “I-I-I-I haaavn’ had aaaany hooch… I juuuus’ d-d-drink waaterrr!” I didn’t believe her, because of her history, but I had the office staff call 911 to get her to the hospital. The ER doc called me an hour later and told me her alcohol level was ZERO, she had no drugs in her system, but her sodium was very low. She really had been drinking only water! But she drank so much water without eating food that she did not replace her salt. She had water intoxication so bad she could have died! The brain (as well as all the other cells in the body) needs sodium to function, and she didn’t have enough. Low sodium is actually much more dangerous than high sodium, in the short term.

What Does Sodium Do In The Body?

We are told to avoid salt, but salt is essential for function. It has always been important for taste, preserving food. Salt has even been used as money in the past.[8] Roman legionnaires were paid in salt, or salarium, which is the origin of the word, “salary.” Slaves were also traded for salt in Ethiopia in ancient days, leading to the saying, “worth his salt.” Before refrigeration people preserved food with salt. And people who performed heavy manual labor in the sun all day used salt pills to keep up their blood volume. Sweat always releases salt. When I worked in Venezuela as a missionary, I remember wiping my forehead with my hand and feeling gritty. I thought it was dust from the road, but when I looked, there was no dust. I tasted it and found it to be very salty. The sweat was drying on my forehead and making salt crystals – you can sweat out a lot of salt! Few people work hard outdoors in the heat anymore. People who dig with tractors often have air-conditioned cabs! So, perhaps we don’t need as much salt.

However, normal kidneys can handle over 40 grams of sodium every day. That’s the amount of sodium in about 200 slices of bacon! Just to put that into perspective, the American Heart Association recommends no more than 2,300 milligrams of sodium daily.[9] You could eat twenty times that and your kidneys will be able to balance your electrolytes – if you get enough water and potassium.

Sodium is the salt that primarily keeps your blood volume up. If you don’t have enough sodium, the kidneys will get rid of extra water to keep the sodium concentration in a very narrow range. As you eat more sodium, the kidneys will get rid of it to keep the volume normal. This is how the blood volume is regulated. If you have low sodium and the blood volume is low, you could get very ill, including:[10]  

• Nausea and vomiting
• Headache
• Confusion
• Loss of energy, drowsiness and fatigue
• Restlessness and irritability
• Muscle weakness, spasms or cramps
• Palpitations as the heart tries to circulate a smaller amount of blood.
• Dizziness
• Overheated because you cannot sweat
• Seizures
• Coma

The point is, it is dangerous to have low sodium. Your kidneys know how to regulate sodium very well, if you get enough water and potassium.

Potassium Dehydration

According to the NHANES study, most people in the United States are not getting enough potassium.[11] This does not lead to low potassium in the blood, but rather in the cells. The potassium in the blood will remain constant if the kidneys are functioning. Even when the body is depleted significantly, the blood level will remain normal. The lack of potassium is found inside the cells of the body. There is not enough to fill them up, so they shrink down, and take in more sodium. There are many reasons for having low potassium.

1. Diet – lack of potassium in the diet is the most common.
2. Stress – stress hormones block potassium from getting into the cells and cause the kidneys to get rid of potassium.
3. Drugs – many drugs, especially some diuretics, can deplete potassium.
4. Epstein-Barr Virus (EBV) mononucleosis poisons the potassium pump in the cells.
5. Water – drinking too much water depletes potassium from the kidney.

Those who drink too much water continually deplete potassium as well as sodium. While it’s easy to replace sodium, potassium is another story. The body needs about 4,000 mg of potassium daily, and most people get less than 3,000mg. In fact, 98% of Americans do not get even the minimum recommended amount of potassium daily.[12]

Low potassium mostly affects energy. Like the voltage difference in electricity that creates an electrical current to run motors, the potassium difference between the interior of the cell and the blood runs all the motors in your body. When your potassium is low, it’s like your body is running on low voltage, causing: [13]

• Brain fog
• Muscle spasms
• Fatigue
• Digestive issues
• Heart palpitations or atrial fibrillation
• Tiredness, low energy
• Paralysis

Those who drink too much water can get “intracellular dehydration” from low potassium.[14] This is not “hypokalemia” or decreased potassium in the blood, but rather decreased potassium in the cells which is replaced by sodium. As sodium replaces potassium inside the cells, there is less energy. This is why sodium has been wrongly vilified as the culprit – but the problem is really low potassium.

It’s hard to get enough potassium, so most Americans are deficient. Supplements aren’t a lot of help because they supply about 100mg, and you need about 4,000 mg. No, I don’t recommend taking 40 pills per day, since that would eat away your intestinal lining. The best way to get it is by eating food that is not processed. Fruit. Vegetables. Beans. Lentils.

Potassium lowers your risk of stroke, prevents osteoporosis, decreases heart disease, prevents kidney stones, and lowers blood pressure.[15] It is essential to get enough potassium, and not dilute it or cause it to be lost in the kidneys from drinking too much water. Even though it is very common to have low potassium, it is not healthy. Keep your potassium levels up by eating lots of fruit and vegetables.

Dehydration From Lack of Water

When people don’t drink enough water the volume both inside the cell and of the blood is decreased. The sodium concentration goes up in the blood, and the potassium in relatively higher in the cells. Because of the low volume, the kidneys will hold on to water by concentrating the urine as much as possible releasing sodium and potassium. This dehydration can cause many symptoms:

• Thirst
• Dry mouth
• Darker-colored urine
• Dizziness or lightheadedness
• Less frequent urination
• Headache
• Fatigue
• Confusion
• Bad breath
• Dry skin
• Muscle cramps
• Cravings for junk foods

Cravings?! Where does that come from? When you are not making saliva because of dehydration, the body will produce it if you have something really tasty. Those who have dry mouth from dehydration get a burst of saliva if they eat something sweet, for example. Others may crave the salty taste of chips. It is important to recognize when you have a dry mouth, indicating thirst so you can replete your supply of water. Those who eat junk food get some saliva for a few minutes, but end up needing to have more all the time. Some chew gum to stimulate saliva and do not know they are dehydrated.

Wait Until You’re Thirsty!

The best way to stay hydrated is to drink water when you are thirsty, or when you are sweating excessively.[16] Not that you should wait until you have a dry mouth all the time. It’s a matter of getting enough without getting too much. There is plenty of space between not enough and too much. But people often force water down when they aren’t thirsty because even doctors are telling people to “drink more water.” I have seen nurses with their gallon-sized water bottles with marks on them for each hour of the day. They force themselves to drink when they aren’t thirsty and may be depleting their sodium and potassium.

Moreover, the kidneys need you to be dehydrated at times. The concentration gradient of the kidneys, which allows the kidneys to concentrate urine is dependent on how much water and salt is consumed. Going for a day without eating or drinking helps to reset the system so the kidneys have a greater capacity to manage your fluid and electrolytes.

How Much Water Should I Drink?

Now we come back to the real question. But the answer is different for each person. Two people working outdoors together in the heat, doing the same thing, will not necessarily lose the same amount of water in sweating, for example. One may need a quart of water, and the other only need sips. There are so many factors involved in the determination of how much to drink.

• Fruit and vegetables add water your diet, so you drink less.
• Eating more salt requires more water to excrete it so you drink more.
• High thyroid makes you sweat more, so you need more water and sodium.
• Ambient temperature changes your need for water.
• Elevated glucose may cause you to lose water and potassium in the urine.
• Low magnesium causes the kidneys to waste potassium.
• Insulin resistance depletes potassium from the cells, causing intracellular dehydration.

It can be very confusing if you try to figure it out for just the basic electrolytes and water. Balance must be maintained at all times in spite of constantly changing environmental conditions. So, you don’t have to. Your body has mechanisms to keep you hydrated with sufficient water and electrolytes, if you supply them with at least the minimum amount.

PLAN For Hydration:

Sufficient sodium: it’s easy to get enough if you salt your food to taste. It’s hard to get too much – unless you aren’t getting enough potassium (that’s the key).

Sufficient potassium: This is the real issue. Eat plenty of fruit and vegetables, beans, lentils, nuts, and seeds. The ideal is to get about 4,000mg daily. Here are some ideas in descending order with (milligrams of potassium):[17]

• Medium avocado (980)
• Medium baked potato, with skin (925)
• 1 cup of cooked pinto beans (800)
• 1 cup of cooked lentils (710)
• 1 cup of celery juice (630)
• Medium sweet potato, with skin (450)
• 1 cup of Melon (430)
• 1 medium banana (425)
• 1 cup of milk (350)
• 3 ounces of salmon (319)
• Medium mango (325)
• Medium orange (320)
• 1 cup of soy milk (300)
• 1 tablespoon of molasses (295)
• Medium tomato (290)
• ½ cup of mushrooms (280)
• ¼ cup of raisins (270)
• ½ cup of fresh brussels sprouts (250)
• ½ cup of squash (250)
• ½ cup of broccoli (230)
• 3 ounces of beef (224)
• Medium pear (200)
• Medium apple (190)
• 1 cup Pedialyte (186)
• ½ cup of carrots (180)
• 1 cup of watermelon (170)
• ½ cup of strawberries (125)
• ½ cup of cooked rice or pasta (50)
• Most salt substitutes have potassium chloride. (Check the label for amount)

You can see how hard it is to get enough potassium (40 cups of rice!). Moreover, potassium needs to be replaced continuously, not intermittently. Taking a large amount one time only comes out in the urine, even if you are deficient, because the kidney keeps the blood levels constant. It gets into the cells a little at a time. Potassium is one nutrient that needs DAILY replacement.

Sufficient water: Drink water when you’re thirsty. If you get a dry mouth, chapped lips, constipation (hard stool), you may need more water. There isn’t a set amount that is healthy because there are so many factors involved in how much water you need. Be aware of your own body to keep hydrated, don’t wait until you are constipated or have chapped lips.

When you’re “hungry” or craving something sweet, think first about a glass of water. Don’t chew gum or snack on sweet things to get the saliva flowing – just drink a glass of water.

One day per month, take a break – don’t drink or eat anything for 24 hours to restore the salt gradient in your kidneys. It’s going to require you to be a little more in tune with your body, but it will keep you hydrated, and healthy because your kidneys will be able to concentrate urine.

One helpful trick is to drink room temperature water. Cold drinks cool the brain and quench the thirst mechanism before you have had sufficient water to become well hydrated.

What About Electrolyte, or Rehydration, Solutions?

As we see above, the amount of potassium in rehydration solutions, such as Pedialyte, have very little potassium, or even sodium, and come with a lot of sugar and/or artificial sweeteners. These are not a good option for rehydration. Orange juice, for example has about 500mg of potassium per cup, compared to Pedialyte with only 186. Plus, a cup of orange juice has many other nutrients not found in the electrolyte solutions. Apple juice has 300mg per cup… you just can’t beat nature for nutrition!

It’s Actually Easy!

Hydration is not complicated. It’s really just common sense: Drink when you’re thirsty, get enough sodium and get enough potassium. Avoid getting too much of any of them.

 

 

 

 

Sources:

[1] https://www.latimes.com/archives/la-xpm-2007-jan-14-me-water14-story.html

[2] https://abcnews.go.com/GMA/jury-rules-radio-station-jennifer-strange-water-drinking/story?id=8970712

[3] https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256

[4] https://www.webmd.com/diet/how-much-water-to-drink

[5] https://www.health.harvard.edu/staying-healthy/how-much-water-should-you-drink

[6] https://nap.nationalacademies.org/read/10925/chapter/6

[7] https://health.clevelandclinic.org/how-much-water-do-you-need-daily/

[8] https://seasalt.com/history-of-salt

[9] https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day

[10] https://www.mayoclinic.org/diseases-conditions/hyponatremia/symptoms-causes/syc-20373711

[11] https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/

[12] https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/

[13] https://www.livestrong.com/article/537905-can-drinking-too-much-water-cause-low-potassium/

[14] https://www.livestrong.com/article/537905-can-drinking-too-much-water-cause-low-potassium/

[15] https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/

[16] https://www.webmd.com/diet/what-is-too-much-water-intake

[17] https://www.drugs.com/cg/potassium-content-of-foods-list.html