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]