This article was originally published in American Fitness Magazine. All rights reserved 2006. Visit American Fitness magazine online by clicking here!

American Fitness magazine is the official publication of the Aerobics and Fitness Association of America, the world's largest fitness educator. Viewed as the leading magazine by fitness professionals and dedicated enthusiasts, American Fitness has pass-along readership in health clubs and corporate wellness settings that tops 100,000 readers. As an industry trendsetter, the magazine is renowned for breaking new ground in reporting health-related fitness research, current trends, advances in equipment and training applications. | If you weigh: | If you are a Female, you may contain: | Suggested Fluid Intake: | In 8 oz. glasses: | | 100 lbs. | 55 lbs of water | 50 fluid oz. | 6 glasses | | 120 lbs. | 66 lbs. of water | 60 fluid oz. | 7 glasses | | 140 lbs. | 77 lbs. of water | 70 fluid oz. | 8 glasses | | 160 lbs. | 88 lbs. of water | 80 fluid oz. | 10 glasses | | 180 lbs. | 99 lbs. of water | 90 fluid oz. | 11 glasses | | 200 lbs. | 110 lbs. of water | 100 fluid oz. | 12 glasses | | 220 lbs. | 121 lbs. of water | 110 fluid oz. | 13 glasses |
| If you weigh: | If you are a Male, you may contain: | Suggested Fluid Intake: | In 8 oz. glasses: | | 100 lbs. | 65 lbs. of water | 50 fluid oz. | 6 glasses | | 120 lbs. | 78 lbs. of water | 60 fluid oz. | 7 glasses | | 140 lbs. | 91 lbs. of water | 70 fluid oz. | 8 glasses | | 160 lbs. | 104 lbs. of water | 80 fluid oz. | 10 glasses | | 180 lbs. | 117 lbs. of water | 90 fluid oz. | 11 glasses | | 200 lbs. | 130 lbs. of water | 100 fluid oz. | 12 glasses | | 220 lbs. | 143 lbs. of water | 110 fluid oz. | 13 glasses |
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While there has been massive marketing campaigns and programs aimed at stemming or reducing dangerous levels of blood alcohol consumption, efforts are now being made to educate professional and laypersons alike concerning the negative effects of drinking too much water - known as hyponatremia, or water intoxication.
The word intoxication is often associated with drinking too much alcohol. This activity reduces the efficiency of the central nervous system resulting in loss of fine motor coordination and muscle tone, i.e. the staggering drunken gait or stupor of overconsumption of alcohol. Blood alcohol levels of 0.10 to 0.125 can lower heart rate, blood pressure and respiration rates, resulting in slower reflex responses, reaction times, impairment of motor coordination, nausea, loss of balance, slurred speech and loss of proper judgment. At blood alcohol levels of 0.25 to 0.30, mental confusion can occur as well as loss of consciousness. Extreme blood alcohol levels of 0.40 and above can result in coma and possible death due to respiratory failure.
Waterbolics 101
Sixty to sixty-five percent of your internal makeup is water. A thin person has a larger percentage of water in their body than those overweight and obese because fat is almost water-free. Women, because of their physiological predisposition (i.e. more body fat), contain less water than men. For example, under normal circumstances, an adult male’s body weight is about 65 percent water, while an adult female’s body weight is about 55 percent water.
Fluid is distributed in the body between the extracellular compartments (fluid in spaces outside cells) and the intracellular compartments (fluid inside cells). Extracellular fluid is also found within blood vessels and fluid surrounding cells.
Water is considered the universal nutrient. We can go without most essential nutrients for days - even weeks and months - but we cannot survive without water for more than a few days. In today’s fitness and health conscious society, healthcare professionals have stressed the importance of proper fluid intake to guard against dehydration (i.e. the loss of water from the body). Severe dehydration can lead to shock - and even death. In scientific terms, a change in fluid concentrations within intracellular and extracellular compartments of cells is the problem. A 10 percent loss of body fluids (four liters) is considered serious, while a 20 percent loss (eight liters) is usually fatal.
Generally, the body loses two to three quarts of water daily from urination, defecation, sweat and water vapor expelled during respiration. Additional losses of water also occur when exercising, taking medications and at times of stress or illness. Fever, diarrhea and vomiting are examples of common ailments that cause further water loss. Soda and caffeinated beverages like coffee and tea have a diuretic effect on the body and also cause further loss of water.
The Other Side of Dehydration
Healthcare professionals have expressed concerns about the rising trend in increased water consumption and the resulting cases of hyponatremia. Hyponatremia is the opposite of dehydration and is often associated with long-distance events like running and cycling. It can be life threatening, so it’s important that professional and amateur athletes, weekend warriors and water-drinking enthusiasts are aware of this condition. Hyponatremia’s associated symptoms mirror that of dehydration and alcohol intoxication to a large degree.
If you, or anyone you know, experience any of the symptoms listed below following physical activity or an athletic event, you should seek medical attention immediately: 1 Apathy 2 Fainting 3 Bloating 4 Headaches 5 Confusion 6 Lightheadedness 7 Cramping 8 Nausea 9 Dizziness 10 Seizures
Paradoxically, some individuals show no symptoms of hyponatremia. Like dehydration, if hyponatremia is left untreated, it can lead to extreme fatigue, coma and death. Overhydration In a study published in Annals of Internal Medicine in May 2000, Dr. J. Carlos Ayus, professor of medicine at Baylor College of Medicine in Houston, Texas, reported that consuming too much water during a marathon caused brain swelling as a result of water intoxication. Ayus found that excess water is absorbed into the blood, causing fluid to build up in the brain. Eventually, fluid accumulates in the lungs, causing the individual to become breathless and nauseated.
When you consume large amounts of water over the course of a few hours or a day, blood plasma (the liquid of blood) increases, diluting the salt content of the blood. If you are involved in strenuous physical activity you also lose salt - one of several very important mineral electrolytes - by sweating. Sodium and potassium maintain a balance of body fluids inside and outside the cell, while regulating blood pressure in the blood vessels. Too much water and excess sweat can dilute the contents of blood. This disrupts the normal balance required for the body to function properly. Sweat loss can vary from 16 ounces to three quarts during each hour of exercise. (Note: Electrolytes are mineral elements whole molecules split into electrically charged particles called ions when completely broken down and dissolved in body fluids [water].
When minerals become electrolytes, they become active and usable in human tissue, causing all cellular structures to become alive by the electricity they produce.
Maintaining Homeostasis
According to Brenda Bigelow-Kemp, associate professor at the Division of Nursing at D’Youville College in Buffalo, N.Y., and Adele Pillitteri, professor at the College of Nursing at Niagara University in New York, water balance in the body depends on the body’s ability to maintain equilibrium when facing disturbances in water intake and output. These researchers remind us that water intake not only occurs when drinking, but also from solid foods and the metabolism (breakdown) of food. In fact, both fat and carbohydrate metabolism release about 100 milliliters of water for each 100 grams consumes. Protein produces about 40 milliliters of fluid for each 100 grams of protein consumed. For those involved in activities like bodybuilding or similar sports where large amounts of food are consumed (e.g. protein), understanding the above ratios is vital in efforts to maintain homeostasis.
Diet, Drugs and Hyponatremia
There is considerable evidence showing poor dietary habits and the consumption of large amounts of beer (i.e. beer potomania) as predisposed factors that can cause hyponatremia (Hettema and Halma, 1999). Hyponatremic symptoms have also been noted after the use of the recreational drug N-methyl-3, 4 methylenedioxylamphetamine, commonly known as ecstasy (Holmes, Banerjee and Alexander, 1999). Water intoxication can also be caused by many medications according to Dr. Sandy Craig, MD, associate program director and clinical instructor at the Department of Emergency Medicine at the University of North Carolina.
Some well-known culprits are: 1 Acetazolamide (glaucoma pills) 2 Carbamazepine (anti-cancer drug) 3 Clofibrate (cholesterol reducer) 4 Cyclophosphamide (anti-cancer drug) 5 Halopenidol (tranquilizer-anti-psychotic) 6 Indomethacin (arthritis-aspirin substitute) 7 Opiates (pain medications) 8 Thiazide Diuretics (reduces water retention) 9 Selective Serotonin Reuptake Inhibitors (depression and mood disorder medication) |
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Ayus found that many individuals suffering from water intoxication had a history of using over-the-counter non-steroidal, anti-inflammatory drugs including aspirin. These drugs actually inhibit the elimination of water from the body. Ayus also noted that data is still unclear as to whether athletes and physically active individuals other than marathoners experience hyponatremia, but says it is highly possible. The key here is to balance fluid intake to offset water loss, especially during physical activities.
Drinking too much water can cause as much harm as not being hydrated enough. This increase of intracellular water concentration can cause water to move out of the blood plasma, ultimately reducing blood volume in the body, which can lead to circulatory shock. It is important to remember that excess water consumption also disrupts the delicate balance of sodium and potassium, which modulate the correct ratio of water within and outside of the cell.
Drink and Eat the Right Stuff
As previously cited, soda, coffee, tea and alcoholic beverages are not viable options to replace fluids. Certain foods like vegetables and fruits are good sources, providing both water and natural sodium to cellular structures. Also, follow the suggested daily water consumption levels as cited within this article.
For those participating in heavy physical activities, the World Health Organization (WHO) also suggest consuming electrolyte drinks to prevent hyponatremia. WHO researchers maintain that the best combination of electrolytes mixed in one liter of water contains: 1) 20 grams of glucose 2) 3.5 grams sodium chloride 3) 2.9 grams trisodium citrate 4) 1.5 grams potassium chloride
A Word of Caution
Stephanie M. Viach, MS, of Wellbridge Health Clubs reminds us that while hyponatremia is a growing concern, it is not yet widespread with everyday exercisers. Because of this, she insists that other fluids shouldn’t be regularly substituted for water. She says being aware of your thirst will help prevent dehydration, as well as decrease the risk of overhydration. Drink fluids during and/or after exercise to replace lost fluids. Incorporating the use of an electrolyte drink (like Gatorade) will also help avoid water intoxication, she says.
Water Requirements
The most generally recognized rule is to drink at least eight glasses of water daily to maintain homeostasis. Mounting data suggest that to calculate daily fluid intake, you should divide your total body weight in half and that number is how many ounces of water you should consume. Climate, humidity, illness and other factors can increase the above listed intake levels.
Conclusions
Hyponatremia is defined as reduced blood sodium concentration. When sodium levels fall below 129 mEq/L per liter of blood, hyponatremia is characterized by fuzzy thinking and reduced brain functions, mirroring the outward signs of alcohol intoxication. In more severe cases of sodium dilution, the individual lapses into unconsciousness and my stop breathing or experience epileptic-like seizures that can lead to possible cardiac arrest. Additionally, this water overload can result in pulmonary edema (overload of fluid in the lungs), leading to respiratory failure. Craig maintains that water intoxication is the most common electrolyte disorder, with an incidence of approximately one percent of hospitalized patients.
To guard against hyponatremia you must balance your fluid intake with a well-balanced nutritional plan and indulge in less alcohol, soda, coffee and tea. Never substitute the above drinks for good clean water, fresh fruits or vegetables. Pay attention to thirst signals and establish definitive daily intakes as previously shown. This will prevent under and overconsumption, which can cause or disrupt the body’s natural chemical balance resulting in fatal consequences.
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References
Medical Economics Company, Physicians Desk Reference 2001, 55th Ed. Montvale: Medical Economics Company, Inc., 2001
Ayus, J.C., Joseph, V. and Arieff, A.I. “Hyponatremia, cerebral edema, and noncardio genic pulmonary edema in marathon runners”, Annals of Internal Medicine, 132 No. 9 (2000): 711-14
Backer, H.D., Shopes, E. and Cullins S.L., et. al., “Exertional heart illness and hyponatremia in hikers”, American Journal of Emergency Medicine, 17 No. 6 (1999): 532-9
Brown, R.G. “Disorders of water and sodium balance”, Postgraduate Medicine, 93 No. 4 (1993): 227-8
Craig, S. “Hyponatremia” www.emedicine.com (accessed Oct. 14, 2003
Engel, C. “Water to total body weight”, Foods Journey, Fruit-Eze Inc., Portland, 2004. www.fruit-eze.com/education/laxative/weight.htm (accessed June 10, 2005)
Fall, P.J. “Hyponetramis and hypernatremia: a systematic approach to causes and their correction”, Postgraduate Medicine, 107 No. 5 (2000): 75-82
Graham, A.W. and Schultz, T.K. EDS. Principles of Addiction Medicine, 2nd Ed. American Society of Addiction Medicine, 1998
Hamilton, H. and Rose, M. EDS. Monitoring Fluid and Electrolytes Precisely (Nursing Skillbook). Horsham: Intermed Communications Inc., 1979
Hettema, M.E. and Halma, C. “Beer drinker’s hyponatremia: a case report”, Netherland Journal of Medicine, 54 No. 3 (1999): 105-7
Holmes, S.B., Banerjee, A.K. and Alexander, W.D. “Hyponatremia and seizures after ecstasy use”, Postgraduate Medical Journal, 75 (1999): 32-3
Kemp, B. and Pillitteri, A. Fundamentals of Nursing; Boston: Little Brown and Co., 1984
Noakes, T.D. “Filled replacement during exercise” Exercise and Sport Sciences Reviews, 23 (1993): 297-330
Martlew, G. Electrolytes: The Spark of Life, Murdock: Nature’s Publishing LTD., 1995
Mayell, H. and Murphy, P. The Bottled Water Craze, www.beachbrowser.com/archives/environment/january-2000/the-bottled-water-craze.htm (Accessed July 2005) McArdle, W.D., Katch, F.I. and Katch, V.L. Exercise Physiology: Energy, Nutrition and Human Performance, 4th Ed. Baltimore: Williams and Wilkins, 1996
Quinn, E. “Exercise and fluid replacement www.sportsmedicine.about.com
Redmon, G.L. Minerals: What Your Body Really Needs and Why, Garden City Park: Avery Publishing Group, 1999
Rose, B.D. Clinical Physiology of Acid-Base and Electrolyte Disorders, 3rd Ed. New York: McGraw Hill, 1989
Rothenberg, R.E., The New American Dictionary and Health Manual, New York: The World Publishing Company, 1962
Silver, S.M., Schroeder, B.M. and Bernstein, P. “Brain adaptation to acute hyponatremia in young rats”, American Journal of Physiology, 276 No. 6 (1999): 1595-9 Smith, N.J. Food For Sport, Palo Alto: Bull Publishing Co., 1976 |
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