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Are You Drinking Too Much Water?

U.S. News & World Report - Health logo U.S. News & World Report - Health 10/12/2017 Anna Medaris Miller

171012_DrinkingWater: Know the general guidelines for fluid intake based on your weight to avoid any side effects of drinking too much water. © (Getty Images) Know the general guidelines for fluid intake based on your weight to avoid any side effects of drinking too much water. Even something natural, necessary and calorie-free has its limits.

Want to lose weight? Drink more water. Dream of better skin? Drink more water. Crave more energy? Drink more water. The liquid, says Jennifer Sommer-Dirks, a registered dietitian and nutrition manager at Eating Recovery Center in Denver, "has been touted as a miracle" substance for years. It's also increasingly visible on store shelves in varieties like coconut, maple and watermelon and in people's hands as either still or sparkling, flavored or plain. "You always see people walking around with these giant gallon water bottles," Sommer-Dirks says. 

Much of water's praises are due: On a most basic level, we need water to live; our cells and fluids are largely made of the stuff. It's necessary to regulate body temperature, keep muscles and joints limber, keep blood flowing to your kidneys and flush out waste. Experts estimate that most people in most conditions couldn't live more than a few days – max, one week – without water.

On a more practical level, advice to "drink more water" serves plenty of Americans well, especially those who could sub it for health-defeating, sugar-laden beverages or who are trying to lose weight, since water can help you eat more slowly and fill up sooner. In fact, says Heather Mangieri, a spokesperson for the Academy of Nutrition and Dietetics, "I can't remember a time that I gave a recommendation to drink less water."

But there are exceptions to the rule. For example, endurance athletes are perhaps best known to be at risk for hyponatremia, or dangerously low sodium levels in the blood, which can be caused by drinking too much water and consuming too few electrolytes during exercise.

At its worst, water intoxication may contribute to rhabdomyolysis (a potentially fatal condition in which muscle tissue breaks down and releases too much byproduct into the bloodstream for the kidneys to filter effectively), cerebral edema, seizures and cardiogenic shock, says Mangieri, a registered dietitian in Pittsburgh and author of "Fueling Young Athletes." "Hyponatremia is a serious condition that can even result in coma and death," she says. One tragic 2015 case report of a Grand Canyon hiker reported just that outcome.

Research also suggests that people with mental health conditions like depression and addictions may be prone to hyponatremia, in part due to their medications, excess water intake and stress levels. People with eating disorders, too, can over-consume water in an effort to suppress hunger or to hide their low weights from health care professionals during weigh-ins, Sommer-Dirks finds.

"In the eating disorder population, we see the extremes – we see people restricting fluid and water because they're scared of water retention [or] they're [drinking excess water] instead of eating," she says.

Even people who appear to be healthy eaters may be taking the "more water" thing too far, finds Chris Sandel, a nutritionist in the U.K. who works largely with people with disordered eating patterns. He often sees clients eating loads of water-dense foods like fruits and vegetables, drinking water-based beverages like hot tea – and guzzling water throughout the day on top of it. 

"In practice, it's much more common that it's happening in day-to-day life, not to the point that someone is dying, but to the point where someone is taking in much more fluids than they need, or much more fluids in comparison to the amount of electrolytes and the amount of food energy they are taking in," he said in a 2016 podcast episode that covered fluid intake and urination.

The problem? "[The cells] are basically looking and saying 'the ratio of these things' are out, and they can't function the way they should; they can't produce energy the way they should," he said. "To remedy the situation, the cells basically just push water out." Cue frequent – once an hour or more – urination.

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Here's how to help determine if you're drinking an appropriate amount of water for you: 

1. Know the general guidelines.

Divide your weight in pounds in half. That's a very general idea of about how many ounces of fluids – juice, non-caffeinated teas and other liquids included – you should be drinking each day, Sommer-Dirks says. Then, adjust. People who live at high altitudes, exercise (and sweat) more and weigh more, for example, typically need to consume more liquids too. "Drink to [quench] thirst," Sommer-Dirks says. "There's no reason to be chugging water if you're not actually thirsty."

2. Consider your electrolyte intake.

"Too much water" is, of course, relative. The right amount for you is not only unique to your own body, environment, diet and activity level, but also to your electrolyte level, Mangieri emphasizes. "It's not simply drinking too much water that's the issue – it's drinking too much water without consuming enough of the electrolytes needed to keep your body in fluid balance," she says. She helps athletes – especially those who are "heavy sweaters," whose sweat tastes salty and leaves white stains – increase their sodium, chlorine and potassium intake rather than decrease their fluid intake.

"If you are participating in activity lasting longer than one hour and sweat a lot," she says, "make sure to replace both fluid and electrolytes lost in that sweat." Sports drinks or water paired with gels or even preceded by a salty snack can do the trick.

3. Know the symptoms. 

On a daily basis, you can assess your hydration by monitoring the color of your urine, which should be light yellow, Sommer-Dirks says. The National Kidney Association says peeing about 6 cups a day is normal (though it's up to you to figure out how to measure that). During lengthy exercise, beware of symptoms like headaches, muscle weakness, twitching, vomiting and confusion, which can precede hyponatremia, Mangieri says. Keep in mind that some of the same symptoms can signal dehydration.

4. Consult the pros.

If you're not sure if you're getting the appropriate balance of liquids and electrolytes, consult a registered dietitian who can help you figure out what works best for your body, Sommer-Dirks recommends. (People with disordered eating patterns should seek someone with expertise in that area – the National Eating Disorder Association and the Eating Recovery Center are good places to start – while athletes could benefit from an expert in sports nutrition.) Fortunately, most people drink a fine amount of water without even thinking about it. "It is hard to unknowingly consume excessive water to the point where it's going to cause harm," Sommer-Dirks says. Cheers – within limits – to that.

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