Water - Have you had yours today? Whether you are a weekend warrior, elite athlete, child, young adult, or centurion - water is essential for life. About two thirds of the average adult weight is made up of water.¹ It provides the essence of how our cells function. Appropriate water intake allows your system to regulate its body temperature, metabolize body fat, aids in digestion, lubricates joints, cushions organs, transports nutrients, keeps your mind alert and flushes toxins from your body. Water is an essential nutrient to the human body and it performs many important functions for preserving body homeostasis.^2,3 It is impossible to sustain life without it.

If you are thirsty - your body is trying to tell you something. People typically sense they are thirsty after they are actually dehydrated. Thirst centers are activated when you have lost about 2-3% of your body's water; but mental performance, negative moods and physical coordination become impaired prior to this at around 1% loss.^4,5 Ignoring thirst is never a good idea as it suppresses your bodies internal warning system. Dehydration can range from mild to severe and symptoms vary person to person. Some people with mild dehydration may be completely unaware of even being dehydrated. The Mayo Clinic list symptoms for mild to moderate dehydration to include: dry, sticky mouth; sleepiness/tiredness; thirst; decreased urine output; few or no tears when crying; dry skin; headaches; constipation; dizziness or lightheadedness.⁶ Other literature report incidence of mood alteration, coordination deficients, and overall slowed mental capacity or confusion.^{7, 8} In his book Change Your Water, Change Your Life, Dr. Dave Carpenter also adds to the list of symptoms: high blood pressure, high cholesterol, acid-alkaline imbalance, digestive disorders, asthma/allergies, weight gain, skin disorders, joint stiffness/pain, bladder/kidney problems and premature aging.⁸

So why worry about dehydration? Bottom line - it is a HUGE and PREVENTABLE problem in the United States. Indications are that a portion of the U.S. population may be chronically mildly dehydrated.² And according to the Annals of Epidemiology in 2007; U.S. hospital admissions cost $5.5 billion in 2004 to treat dehydration.⁹ So we should worry about getting enough water - the cost are high health wise and financially to us as individuals.

Awareness is the key to prevention. Many factors exist that increase the chance of becoming chronically mildly dehydrated. For example, some people do not like the taste or odor of water; others take in too many natural diuretics (tea, caffeine, some sodas and alcohol); over the counter supplements (diet pills, holistic cleansers); prescribed medications; poor thirst mechanism which increases in the aged population^{10, 11}; increased participation in exercise; global warming (adverse environmental conditions); and some have medical conditions in which they purposefully defer fluid intake in hope to curb their symptoms. Among those who may intentionally minimize fluid intake are those who suffer stress incontinence, painful bladder syndrome (IC), urinary urgency frequency or mixed incontinence.

If any of the symptoms or factors mentioned above ring true for you - it is not too late! Dehydration is reversible! You do not need to leave your system in an overstressed state. For those of you who are restricting fluids intentionally to avoid leakage or sensations of urgency - research findings suggest that women should NOT restrict their fluid intake to prevent incontinence.¹² The study by Townsend et al found no significant risk of incident of urinary leakage and fluid intake. For those of you who relate to this - take comfort that increasing your fluid intake will NOT increase your leakage - so go ahead and drink up and reap the benefits of being properly hydrated! Those of you who just don't get enough water in for whatever reason - know that you have the potential to think clearer, improve your coordination, maintain a better mood, enjoy optimal health and the ability to respond better - through efforts to hydrate your body!

So then - how do you know if you are dehydrated - if you may not be aware? You can do a quick check on your status using Dr. Armstrong's¹³ Urine Color Test for Dehydration HERE. If your sample falls in the color rating of 1, 2, or 3 you are considered to be well hydrated. If you are outside the range and not taking certain foods, medicines or vitamins that can change the color (and odor) of your urine - you will likely need to consider changing your fluid intake.

If you need more fluid - how much is appropriate? The literature is extremely varied with rules and guidelines on the appropriate amount of fluid intake^{2, 14, 15, 16, 17, 18}, and you should always consult with your Physician prior to making any dietary changes, but a good rule of thumb for healthy, sedentary individuals is drinking � ounce per 1 pound of body weight (ie. if you weigh 140 lbs = 70 ounces of fluid/day) 2/3 of which is clear water. Environmental stressors and exercise would require adjustment of this guideline to fluid intake. Ultimately your fluid intake should be viewed with a goal of getting your urine in the Armstrong Urine Color rating of 1, 2 or 3¹⁵...basically pale yellow and without odor.

Wishing you all a Happy New Year - filled with appropriate hydration and optimal health!

REFERENCES:

• Hansen JT, Koeppen, BM (2002). Netter's Atlas of Human Physiology. Teterboro, N.J: Icon Learning Systems.
• Kleiner SM Water: An essential but overlooked nutrient. J. Am. Diet. Assoc. 1999; 99:200-206.
• Thornton SN Thirst and hydration: physiology and consequences of dysfunction. Physiol Behav. 2010 Apr 26: 100 (1): 15-21. Doi: 10.1016/j.physbeh.2010.02.026. Epub 2010 Mar 6.
• Helmenstine, AM (2012) How Much of Your Body Is Water?
• Lamb DR (2002) Hydration, critical to athletic performance. Coach and Athletic Director, 71, 3.
• The Mayo Clinic. Dehydration symptoms. (2013 update) http://www.mayoclinic.com/health/dehydration/DS00561/DSECTION=symptoms
• D'Anci KE; Mahoney CR; Vibhakar A; Kanter JH; Taylor HA. Voluntary dehydration and cognitive performance in trained College Athletes. Perceptual and Motor Skills, 2009, 109, 251-269.
• Carpenter D. Change Your Water Change Your Life. January 1, 2010.
• Kim S (2007) Preventable Hospitalization of Dehydration: Implications of Inadequate Primary Health Care in the United States. Annals of Epidemiology - Sept 2007 Vol 17, Iss 9, Page 736, DOI: 10.1016/j.annepidem.2007.07.043
• Mack, GW. American College of Sports Medicine. http://www.acsm.org/docs/current-comments/dehydrationandaging.pdf
• Kenney WL, Chiu P. Influence of age on thirst and fluid intake. Med Sci Sports Exerc. 2001 Sep; 33(9): 1524-32.
• Townsend MK, Jura YH, Curhan GC, Resnick NM, Grodstein, F. Fluid intake and risk of stress, urgency, and mixed urinary incontinence. Am J Obstet Gynecol. 2011 July; 205 (1): 73.3l-73.e6 doi: 10.1016/j.ajog.2011.02.054.
• Armstrong LE, Soto JA, Hacker FT, Casa DJ, Kavouras SA, Maresh CM (1998). "Urinary indices during dehydration, exercise, and rehydration." Int. J. Sport Nutr. 8: 345-355.
• Noakes TD Drinking guidelines for exercise: what evidence is there that athletes should drink "as much as tolerable", "to replace the weight lost during exercise" or "ad libitium"? J Sports Sci. 2007 May; 25(7):781-96
• Armstrong LE, Herrera Soto JA, Hacker Jr FT, Casa DJ, Kavouras SA, Maresh CM. Urinary Indices During Dehydration, Exercise, and Rehydration. International Journal of Sports Nutrition and Exercise Metabolism. IJSNEM, 8(4), Dec 1998.
• Valtin H. "Drink at least eight glasses of water a day." Really? Is there scientific evidence for "8 � 8"? Am. J. Physiol. Regul. Integr. Comp. Physiol. 2002; 283:R993-R1004.
• Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain JS, Stachenfeld NS. American College of Sports Medicine position stand. Exercise and Fluid replacement. Medicine and Science in Sports and Exercise. 2007, 39(2): 377-390.
• Meinders A.J., Meinders A.E. How much water do we really need to drink? Ned. Tijdschr. Geneeskd. 2010;154:A1757