Drink your Water!

The fundamentals of health are necessary to maintain and sustain health; for human beings they are hydration, oxygenation, nutrition, movement/rest, and emotional connection with others. This article outlines information on the importance of hydration for body function and seeks to provide some simple ways of maintaining a level of hydration for optimal health.

Let me outline a scenario for you: enter a middle-aged man, chronic constipation, dry skin with deep cracking heals, kidney stones, bouts of gout, difficulty with weight loss, daily midday fatigue, stiff joints and a grumpy outlook that results in him having a low mood and frequent bouts of irritation. What is one thing that might be a simple lifestyle change and has potential to improve all of these complaints? Water!

When we aren’t drinking enough water we may not even notice that we are thirsty. Often we confuse thirst for feelings of hunger and we reach for food instead of a glass of water. It appears that some humans do not respond appropriately to the hormonal message of angiotensin II, and while some studies have found that perhaps it is cognitive choices that are modifying the drinking response, there may be more to it. Such factors as “not knowing the benefits of water drinking,” “not liking the taste,” and “the need to urinate frequently” influence a patient’s behaviour in regards to choosing to drink water or not, regardless of what hormonal signals the body might be sending.

One of the critical factors in maintaining healthy weight is maintaining adequate hydration. Indeed any effort to lose weight is thwarted if the body is in a state of hypohydration, it is unable to release fat stores without the fluid required to carry metabolites and messaging molecules throughout the body.

Chronic hypohydration (extracellular hypohydration) is associated with increased levels of the hormone angiotensin II (AngII). Angiotension II is the body’s way of signaling for the feeling of thirst and to therefore seek out and drink some water. However chronically increased levels of AngII is associated with many diseases such as obesity, diabetes, cancer and cardiovascular disease. Proposed mechanisms to explain these effects involve an increase in metabolism due to hydration expanding cell volume.

Water is a transporter of nutrients and substances throughout the body. It is important for temperature regulation, flushing waste metabolites, providing lubrication for joints, facilitating digestion and regulating bowel movements, having full looking skin and improving mental concentration, focus and mood. In fact you may have the following symptoms of hypohydration and have never realized that the cause to these symptoms is insufficient water intake.

Hypohydration induced fatigue

A pair of recent studies found that young people who were dehydrated were much more likely to feel fatigued during moderate exercise and even when sedentary. Unsurprisingly, fatigue is a common symptom of hypohydration and is said to be the number one cause of midday fatigue.

Hypohydration is one of the most common risk factors for kidney stones

In a study looking at the causes of kidney stones in more than 700 patients, chronic hypohydration caused by a variety of factors was believed to be a factor in about 20 percent of the cases. In one five year randomized trial, patients with kidney stones were told to drink more water which resulted in a significant drop in kidney stone recurrence.

Hypohydration is a factor in chronic urinary tract infection (UTI)

Drinking enough water actually cuts the risk of developing a urinary tract infection (UTI) in half. Not only does urinating more often simply prevent the bacteria that cause a UTI from being able to stay long enough to raise havoc but having more dilute less concentrated urine has been associated with fewer numbers of UTIs.

Hypohydration and metabolic disease

The principle signal sent by the body when hypohydrated is an increase in blood angiotension II (AngII). However chronically elevated AngII appears to be involved in several chronic human diseases such as cardiovascular disease, obesity, diabetes, cancer and alzheimer’s disease. These chronic diseases also involve metabolic dysfunctions. In other words, chronic hypohydration may be driving the continuous release of AngII and the subsequent metabolic dysfunction found in the chronic human diseases that is associated with elevated AngII.

Simple ways to check your hydration status:

A great way to measure if you’re getting enough water is to evaluate your urine color and frequency. Urinating every 90 minutes to 2 hours is normal. If your urine is dark amber in colour and you find you are only urinating every 6 hours of longer, then this suggests that you aren’t hydrated enough. If your frequency is every 30 mins and your urine is completely clear you may be drinking too much water or your body isn’t able to be making use of it and it’s going right through you rather than benefiting you.

Another way to get an idea of your hydration level, especially for kids and elderly, is to check your skin turgor, which is your skin’s elasticity. Pinch the skin on the back of your hand for a few seconds and then release. If your skin turgor snaps back quickly into place, you’re probably well hydrated, if it takes time to return to its normal position you may be dehydrated. Other symptoms of hypohydration include dizziness, brain fog and fatigue.

Benefits of drinking enough water:

Helps with weight management and weight loss.

Increased hydration leads to increased weight loss due to a decrease in eating and an overall loss of fat through increased lipolysis (fat break down). The physiological link between increased water consumption and lipolysis is hypothesized that increased hydration leads to an increase in cell volume and from that to an increase in insulin sensitivity.

Supports Metabolic waste elimination

Fluid is necessary for circulation and bringing waste products from the digestive tract, liver and other metabolic processes in the periphery to the location where they can be excreted. This may be through feces, through the kidneys as urine or through the skin as sweat. All three of these emunctories rely on adequate hydration to excrete the waste. Without it waste products will be more likely to remain in the body and contribute to oxidative load, abnormal hormonal metabolites and other imbalance that have negative consequence on health.

Healthy cardiovascular health

Sufficient water intake is necessary to keep the blood viscous and flowing freely through blood vessels. Less water means more highly concentrated blood which may contribute to increased clot formation, inflammation and cholesterol deposition.

When you don’t have enough fluids in your body some signs are obvious, like producing yellow concentrated urine, but others might go unnoticed.

It is important to stay away from processed foods as they not only contain very little water but also contain elevated amounts of sodium (even sweet treats), which will hinder your hydrating efforts. Same goes for coffee which acts as a diurectic and acts against the total amount of water you consume in a day.

The majority of Canadians are drinking 2-3 cups of coffee, tea, alcohol and fluids coming from caloric beverages such as pop and juice. Many of which are actually more dehydrating as they act as diuretics themselves, further increasing the amount of water that is released through the kidneys into the urine.

I’m going to go out on a limb here and guess that you are hypohydrated. 75 % of Americans are chronically dehydrated and a recent survey done by Nestle demonstrated that Canadians are just as often reaching for caloric beverages rather than water as compared to their neighbours south of the boarder. You’ve probably heard that you should be drinking eight glasses of water a day for optimal health and digestion and while that amount sounds doable but have you ever actually stopped to count them?

References:

Survey of 3003 Americans, Nutrition Information Center, New York Hospital-Cornell Medical Center (April 14, 1998).

Ganio, M. S., Armstrong, L. E., Et. Al (2011). Mild hypohydration impairs cognitive performance and mood of men. British journal of Nutrition, 106(10), 1535-1543.

Armstrong, L. E., Et. Al (2012). Mild hypohydration affects mood in healthy young women. The Journal of nutrition, 142(2), 382-388.

McKinley, M. J., & Johnson, A. K. (2004). The physiological regulation of thirst and fluid intake. Physiology, 19(1), 1-6.

Benton, D. (2011). Hypohydration influences mood and cognition: a plausible hypothesis?. Nutrients, 3(5), 555-573.

Borghi, L., Meschi, T., Amato, F., Briganti, A., Novarini, A., & Giannini, A. (1996). Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. The Journal of urology,155(3), 839-843.

Embon, O. M., Rose, G. A., & Rosenbaum, T. (1990). Chronic hypohydration stone disease. British journal of urology, 66(4), 357-362.

Hooton TM, Vecchio M, Iroz A, et al. Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract InfectionsA Randomized Clinical Trial. JAMA Intern Med. Published online October 01, 2018. doi:10.1001/jamainternmed.2018.4204

Thornton SN . Angiotensin, the hypovolaemia hormone, aggravates hypertension, obesity, diabetes and cancer. J Intern Med. 2009 May; 265(5):616-7.

Chronic cellular dehydration in the aged patient. Ritz P, Investigators of the Source Study and of the Human Nutrition Research Centre-Auvergne.

J Gerontol A Biol Sci Med Sci. 2001 Jun; 56(6):M349-52. Increased water intake as a prevention strategy for recurrent urolithiasis: major impact of compliance on cost-effectiveness.

Lotan Y, Buendia Jiménez I, Lenoir-Wijnkoop I, Daudon M, Molinier L, Tack I, Nuijten MJ

J Urol. 2013 Mar; 189(3):935-9. Increased water intake as a prevention strategy for recurrent urolithiasis: major impact of compliance on cost-effectiveness.

Lotan Y, Buendia Jiménez I, Lenoir-Wijnkoop I, Daudon M, Molinier L, Tack I, Nuijten MJ

J Urol. 2013 Mar; 189(3):935-9.