Optimizing Metabolism

by Ingrid Kohlstadt, MD, MPH, FACN, FACPM

Rocking the Boat and Making a Splash About Hydration

Introduction

At birth we are more than 70% water. Our cells then embark on a lifetime journey from grape to raisin. To some extent we can modify this process with hydration. However, the frequently touted 8×8 rule – drink eight 8 ounce glasses of water a day – may be dangerous.

Danger 1 is assuming that one size fits all. Our needs both for the amount and type of hydration vary considerably among individuals as well as in any one person at a given time.

Danger 2 is complacency. Patients and their doctors are missing out on using a simple and inexpensive way to improve health and save lives. Because hydration helps optimize blood viscosity, reduce periodontal disease which is a marker for heart disease, improve muscle performance including cardiac muscle, and lower blood cholesterol by shifting it into the cell membranes, in this Townsend Letter on cardiovascular disease let’s rock the boat and make a splash.

Colleague Voices

Hydration is complex and vital. When I attended medical school at Johns Hopkins, Dr. Peter Agre was on the faculty. He was awarded the Nobel Prize for discovering aquaporin, the structure which allows water molecules egress across semipermeable membranes. Genetic and environmental influences on aquaporins underscore the variability and complexity of hydration.

Dr. Fereydoon Batmanghelidj (author of Your Body’s Many Cries for Water) and I coauthored a book chapter on water, which gave me the chance to glean from his scholarly work linking hydration to chronic disease processes.

And then there are the sal-ient details. Salts such as magnesium and potassium are concentrated inside the cell where they forestall the grape to raisin transition mentioned earlier. Dr. Mildred Seelig’s work prompted me to become a Fellow of the American College of Nutrition.

As a research biochemist and advocate for healthful dietary fats, Dr. Mary Enig authored Know Your Fats. By coauthoring a book chapter with her on fats, I better understood the importance of healthy cell membranes, which among their many functions, serve as water tanks.

Patient Voices

These aren’t “The dog chewed my water bottle” excuses. Our patients are telling us the straight-out facts about why 8×8 isn’t so easy. More often than we might realize, it is because of medical conditions or the medical interventions that we are recommending. A top 10 list might look like this.

10. This is confusing. I thought I was getting too much water because my doctor prescribed me a water pill and said I was holding water.

The human body’s water tank is found in every cell. The problem isn’t really holding water but a leaky water tank is usually due in part to nutritionally compromised cell membranes and unbalanced salts. First-line nutrition treatment often involves omega-3 fatty acids and no trans fats, less sodium and more magnesium and potassium in the form of fresh fruits and vegetables.

9. Dehydrated? I thought I was doing a great job.

   Look at the print-out from my Tanita (body composition) scale.

As patients succeed in dieting, the body’s muscle-to-fat ratio changes according. Since muscle is more hydrous than fat, the body’s overall water content increases. This is separate from whether they are optimizing their fluid intake each day.

8. I didn’t realize that dehydration is a side effect of my medication.

Since dehydration is but a minor side effect compared with many possible medication risks, it could receive short shrift when one is discussing a patient’s medications. However, since hydration is a common side effect and one that the patient can usually take action to prevent, it would probably be helpful to discuss.

7. Water tastes plain and not so good anymore.

In my clinical experience, this is a common statement among patients with overworked adrenal glands and low mineral stores. I sometimes suggest that they try drinking unflavored Pedialyte and if they think it tastes OK, their bodies probably need it for a short time. The hydration options are broader than most people realize and include: coconut water, low-sodium chicken broth, some herbal teas, lime water sweetened with stevia and for some an added dash of sea-salt, or water accompanied by eating a banana.

6. I cut soda and juice because of the calories, like you said, Doc.

This common comment reminds me of a recent parking meter dilemma. The meter took all my quarters but only registered on average 1 in every 3 coins. By analogy the human brain doesn’t register beverage calories in the same way that it registers food calories, making sodas and juices quite costly for any diet plan. Getting the local water fountains operational or carrying a glass water bottle is not new but the data on how well those work are impressive.

5. The place didn’t have running water but they sure used a lot of ice.

   I couldn’t find anything that wasn’t contaminated with local water.

Ice is definitely an often overlooked source of organisms that cause travelers’ diarrhea. If coconut water straight from the coconut is available you have a solution. Adding iodine tablets is another treatment, but the excess iodine can cause reactions. If the iodized water is later boiled, it further concentrates the mineral.

4. I didn’t realize how much more water my body needed at this high elevation and dry climate.

Acclimating to high elevation makes us breathe more rapidly and water vapor escapes with each breath in a dry climate. Well-cleaned humidifiers and steamy showers can help “breathe” the hydration back.

3. Doc, do you know how those shipwrecked sailors survived on sea water?

I thought they built solar stills. If you have a sail, the sun and a pot of salt water you can collect the vapor that condenses. I found a detailed description in a “still” useful 1950s US Army Desert Survival manual. My patient had another survival strategy from a supposedly nonfiction lost-at-sea story wherein the survivors hydrated with sea water aborally. Hopefully I will never be in a circumstance where I would need to test the validity of this statement. But the concept is that as sea birds can drink salt water because their upper GI tract can excrete salt, the lower end of the human GI tract can also do this to a limited extent.

2. I tried to concentrate my urine since I might need it to treat a man-of-war sting.

Okay, this patient wanted to show off his expedition medicine skills. Urine is a treatment for man-of-war stings and other venomous exposures. Urine contains short-lived metabolites that can work like enzymes in tropical fruits such as pineapple and papaya which are also applied to stings. For the same reason urine has been used in tanning animal hides.

1. If I drank all the water that

   I was supposed to, I would have frostbite.

Cold temperatures lead to vasoconstriction and very soon thereafter, bladder pressure, as any lifeguard could attest. However the candid patient who first warned me about this risk of hydrating worked in Antarctica. There women use a portable urinal device to prevent frostbite. Importantly no one has to look to the ends of the earth for examples. Conditions as common as urinary incontinence and prostate hypertrophy cause patients to choose under-hydrating when the potential discomforts of urination are high.

In Summary

Hopefully, you found something new and exciting to refresh your intellect on the importance of hydration, just the way that a cool glass of water refreshes one physically.

Read more about disease-specific hydration and other topics in the recent book that I have edited, Advancing Medicine with Food and Nutrients. 2nd ed. CRC Press; 2012 (also available as an e-book).

Ingrid Kohlstadt, MD, MPH, FACN, FACPM, is the founder of INGRIDients Inc., where she has edited Advancing Medicine with Food and Nutrients, 2nd edition (CRC Press; December 2012). On the faculty of Johns Hopkins Bloomberg School of Public Health, Dr. Kohlstadt is researching an approach to leverage nutrition more fully in disease prevention.