You know you should drink plenty of water — the message is everywhere. Do you know why? When can you have plenty of water in your body and still be dehydrated? Can you overdo water? And how does it affect health and disease?
Our bodies are approximately 70% water. Water is inside all your cells, surrounding your cells, and in the blood that circulates through your body. Obviously you require plenty of water to live. But you may figure you get plenty of water from your food and from soft drinks, so why focus on drinking water? Maybe you don’t like having to make more bathroom trips, you fear having to get up in the middle of the night, or you just don’t like straight water.
You may also know that salt makes you store more water. You’ve heard that too much salt is bad. This relates directly to hydration, but how does that work?
Knowing more about how water and salt is used in your body may help.
Intracellular and extracellular water
Extracellular water (ECW) is the water that is outside of your individual cells. Water is part of every bodily fluid, and much of it is in your blood. Sufficient water is needed so that these fluids efficiently move electrolytes, transport oxygen and nutrients, and remove waste products. Intracellular water (ICW) is the water inside your cells. This water is vital to the proper operation of the cell: cell metabolism requires that sufficient water transports nutrients and fuel to the various organelles inside the cell.
ICW should be higher than ECW. Excessive ECW generally means inflammation. Physically damaged tissue with local inflammation is normally a temporary condition where the body uses swelling with fluids to dilute toxins and speed healing. Elevated ECW for this reason is normal and will clear. We’re all familiar with the puffiness of a swollen ankle from a sprain — this is an example of water moving into an inflamed area, surrounding the cells but not going into the cells.
Chronic inflammation will keep ECW elevated. When a test shows that ECW is high consistently, that’s likely a sign that inflammation needs to come down.
In contrast, elevation in ICW is usually a good sign. Since water is necessary for cell metabolism, increased water likely means the cells need more water to maintain their activity. So ICW is an indicator of health and activity.
So why does water move into or out of cells, and how do we keep ICW high?
One way road ahead
Cell membranes — the outer layer of cells that separate them from their outside environment — are semi-permeable lipid (fatty acid) membranes. That is, they only allow certain molecules through, including water. Water also goes towards salt concentration: higher salt levels on one side of a semi-permeable membrane will draw water away from the side with low salt levels. If you drink salty water, even though you are taking in water, the salt will draw more water out of your cells, towards the salt. If you drink plenty of pure water, you are maximizing the potential for water to flow into cells, because there will be more salt within the cells than in the pure water.
In health terms, hydration doesn’t mean getting more water simply into your body. It’s about getting water into your cells. That’s the goal. The amount of water is one factor, and salt levels are another.
A Salt and Battery
We think of salt as being sodium chloride — standard table salt. Salt is composed of ions, specifically a positively charged cation and negatively charged anion. The electric charges attract and form a bond between the two, resulting in an electrically neutral salt. The cation is a usually a metal, while the anion is usually a halide (a subgroup of mineral). This means that there are many salts where the metal binds with the mineral. The primary salts for the body involve sodium, potassium, calcium, and magnesium, and often when we talk about getting less sodium or more potassium in your diet, we are talking about salts that involve those elements.
Potassium and sodium interrelate in the body. Both form a +1 cation, which bonds to the -1 anion of chlorine. When bonded, both form salts, having the same pulling effect on water, so having high concentrations of both salts would strongly draw water towards them. The body can’t afford both to be high. Having high levels of sodium, as many of us do, means less capacity for potassium. Yet both are vital to health, so a balanced intake is vital. This is one reason that we are told to watch our salt intake — when we consume too much sodium, we lose potassium in the process. Calcium and magnesium, both forming +2 cations, also tend to compete in the body and require balancing for proper health.
Published in The BMJ (formally known as the British Medical Journal), researchers at the Nutrition Policy and Scientific Advice Unit, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland reviewed data from 22 controlled trials (1606 participants) and 11 cohort studies (127,038 participants) to determine the impact of increased potassium intake. They found a significant reduction in blood pressure on average for those participants with hypertension, but no change for those with normal blood pressure. They also discovered a 24% lowered risk of stroke with the higher potassium intake.
So we need to take in plenty of water, and maintain a good sodium/potassium and calcium/magnesium balance too. We require all the salts in balance, with lots of water available in the body. Then the kidneys, which are remarkable regulators of salts and water, can do their job properly.
Published in The Lancet, researchers at the London Health Sciences Centre and Western University in London, Canada reviewed various studies to determine the impact of water intake on the kidneys. They found that studies agreed that higher water intake reduced probability of producing kidney stones, and lowered chronic kidney disease, but only when plain water was increased. Increased intake of sweetened beverages actually produced negative effects on the kidneys.
Blood tests — do you want to be normal?
Blood tests are extremely useful in revealing your salt management. We usually get a blood test because a doctor wants it, then get a report back saying :everything is normal” or “there are some readings I’m concerned about, but the rest are fine.” Here’s the problem — the doctor is often relying too heavily on “normal” ranges: ranges that come from the overall populace, with people of average health. If your readings are normal, you are in the average range. That’s not so great, considering the average health of people in this country is rather poor. You want new ranges to be your guide, based on vibrant health.
Published in the European Heart Journal, researchers at the National Heart, Lung, and Blood Institute studied 11,814 individuals with no heart issues, diabetes, or obesity issues to connect risk of elevated sodium levels with later development of heart conditions. Their data concluded that for participants age 70 – 90 with blood levels of sodium above 142 milliequivalent per liter (mEq/L) the risks of developing heart conditions rose dramatically: rising to 143mEq/L doubled the risk of harmful heart enlargement, and 54% more risk of heart failure. Younger participants had lower risk, but still at least 39% increased risk of heart failure. And the risk increased 5% for each additional unit of sodium. The normal blood test range for sodium is 135-146 mEq/L — they were still in the normal range. In a typical medical exam, unless their doctors were carefully monitoring the new research, their readings would have passed without comment.
A Salty Tale
In nature, healthy cells in plants will have the right balance of water and salts, so eating unmodified plant-based food will give you a good balance of the salts you need. It’s when we process and modify food and start adding salt to the foods that we risk going out of balance. Vegetables naturally have a good balance because the plant, to be healthy, required that balance and is just passing that along to you. Taking in extra water helps flush the kidneys and dilute salt excesses. Blood tests will reveal your salt balance and risk for disease from excess salt, if you use a healthier scale than the normal ranges.
Drinking more pure water is one of the easiest things we can do for our health.
Dr. Nemec’s Review
Since your body is mostly water it makes common sense to drink a lot of water. As the Lancet article stated, those that consumed more water had less problem with kidney stones and less kidney disease. So water is the second most important nutrient (after oxygen) that your body requires.
The European Heart Journal article is quite interesting. It stated that the risk of heart disease went up 5% for every one unit of sodium. What if we reversed that and went down at the lower end of normal even below low normal? We have been trained that that is the normal range, but what is NORMAL? Could very low or extremely low sodium actually be an indicator of excellent health in very healthy people?
Salt as we think of it is sodium chloride — a positive charge and a negative charge held together. As discussed above we need all the individual ions in the proper amounts and ratios. Does that quantity come mostly from our diet and fluid consumption? Yes and no. Yes, because when you put food and drink in your body, the body is separating what it needs and how much it needs and then disposing of the rest. So if a person eats all salty food, and puts more salt on their food each meal and has normal health and normal blood pressure, is this salt hurting them? Maybe not, because under stress the body, at times, requires more sodium to aid in adrenal function. But if they continue high salt and do not need the extra sodium then the overflow, if it cannot be cleared, will cause significant risk of health problems. What about the person who is the opposite: they never use salt, they think everything tastes too salty and they eat a plant based diet with lots of vegetables and fruit, and they feel great and have perfect blood pressure? These people require no salt because their bodies get all the sodium they require from the plant based diet — because the plant cells themselves have the perfect ratio already, and if they digest and absorb these plants efficiently then they will have exactly what the cells require. So it is not just a quantity but a level of health and stress that will dictate how much sodium your cells will require. As the BMJ article stated, those with high blood pressure came down with potassium added to the diet and those who had normal blood pressure remained normal. This is how a balanced body works. What about the normal level of sodium in the blood — what should that be? That too is a skewed question because the levels of normal are what has been determined on normal people living a normal life, but is that normal life health promoting? If it was then we would see most everyone living into their 80s and 90s with no medication and no dysfunction or disability, either physically or mentally. We have seen patients in extremely excellent health both physically and mentally with extremely low sodium levels so the level is not always accurate. A healthy body and mind requires far less sodium to maintain function than a not healthy body and stressed mind does. That is the bottom line.
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