Hydration is one of the most overlooked issues when it comes to nutrition, but it is one of the most important. Humans are mostly made out of water: it ranges from 75% in infants to 55% in the elderly (older people are also the most likely to be dehydrated, maybe their percentage could be increased?🤔)
Think about the Rule of 3’s for human survival: 3 minutes without oxygen, 3 hours in extreme weather without shelter, 3 days without water, 3 weeks without food.
Around 75% of Americans are chronically dehydrated.
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The Dangers of Dehydration
Mild dehydration of 1% leads to:
Increased:
• Fatigue
• Anger
• Confusion
• Malaise/feeling unwell
Symptoms like:
• Headaches
• Nausea
• Dizziness
• A whole host of digestive problems
Mental
Mild dehydration impairs:
• Short-term memory
• Perceptual discrimination (making sense out of a scene or something chaotic)
• Math abilities
• Visual tracking (ability to watch a moving object)
• Hand-eye coordination
• Psychomotor skills (the ability to use tools like cars, keyboards or instruments)
• Decision making
• Motivation
Physical
Mild dehydration impairs:
• Reduced endurance
• Lower aerobic/cardiovascular performance
• Higher risk of heat exhaustion
• Increased perceived effort (workouts feel harder)
• Increased oxidative stress - which leads to increased inflammation and faster aging process
Water Loss
Sleep
We lose between ½ to 1 liter of water per night, which is the main reason we weigh less in the morning. Part of it is lost through vapor in our breath, and part of it is through urine production during the night. If you wake up after a whole night's sleep and don't have to pee, then you are extra dehydrated and at least 32 ounces short.
Note: Sleep deprivation lowers hydration levels even further due to altering vasopressin. The study authors of this article comment that increasing fluids helps to offset a lot of the fatigue experienced by too little sleep. So if you haven’t slept well, or had an extra late night/early morning, make sure to drink extra.
Exercise
Working out, especially in warm weather, dramatically increases water loss. Athletes and people doing manual labor can lose anywhere from 2 to 12 liters (3 gallons!) in a single day depending on the heat and the activity.
How to Stay Hydrated
#1: Don't Go By Thirst!
People usually don’t start to feel thirsty until they are already about 2% dehydrated.
A lot of people, even when they get thirsty, feel it as hunger instead - our bellies often growl when we are dehydrated!
Go by Your Body Weight Instead
The daily range for optimum hydration is ½ to 1 ounce of fluid for every pound of body weight, so a 150 pound person needs 75-150 ounces daily. Aim for the low end to begin, but fluid needs go up with exercise and time spent in the heat.
During exercise, aim for 8 ounces every 15 minutes
This becomes more important the longer an activity goes. Anyone doing extended activities in heat can figure out exactly how much they need by weighing themselves before and after workouts, adding any fluids they consume.
Example: An athlete weighs 150 lbs before a 1 hour workout, drinks 16 oz during workout, and weighs 149 lbs after workout
16 oz = 1 lb
So 1 lb lost plus 1 lb drunk = 2 lbs water = 32 oz needed for the workout
Hydration for Kids
Kids are at a special risk of dehydration, especially during activities. Kids benefit from being reminded/required to drink fluids during physical activities and sports, ideally every 15 minutes.
Hydration for Older Adults
Older adults are the highest risk group for dehydration due to lower thirst mechanisms. Dehydration is a known risk factor for delirium/confusion and orthostatic hypotension (getting dizzy when you stand up) which in combination with the other downsides of dehydration puts older adults at a higher risk for falls. Keep reading for how to drink more even if you’re not very thirsty.
It's usually easier to get kids (and adults) to drink more water if there is flavor in it. Check out the Healthy Drinks List for some ideas. TK
How to Drink Enough Fluids - Even if You Aren't Thirsty
Many people don’t recognize early signs of thirst and will forget to drink water for hours at a time.
One way is to figure out how much water you should be drinking during the day, and set goals, like "Drink 32 ounces by 10 am". You can also set timers to go off to begin getting in the habit of drinking fluids at regular times during the day.
Get in the habit of drinking water 5-10 minutes before eating. Most people's bellies rumble when they are thirsty, and it's better for your digestion anyway. Water on an empty stomach gets absorbed in 5-10 minutes, but water with food slows down the absorption of the water and the digestion of the food, too - which is a recipe for GERD and reflux like symptoms.
Some people simply don't like the taste of water, or get bored after a while with water. The easiest way to fix this is to always keep tasty flavored low sugar drinks around you at all times. My plain-water-loving wife sometimes makes fun of my beverage habits because I sit down to dinner with 2 (sometimes 3) different drinks: plain water and something flavored and/or carbonated.
For more drink ideas, see The Healthy Drinks List. TK
If you're getting up in the middle of the night to pee:
Cut back or cut off fluids 2-3 hours before bedtime if you are worried about getting up in the middle of the night to empty your bladder.
⚠️ If you are thirsty at night or with meals, that means you’re dehydrated!
Drink more water earlier in the day and you won’t be so thirsty before bedtime.
If you're still waking up more than once per night to pee, double check the amount you're peeing.
If it's not very much, talk to your doctor. It can be a warning sign of sleep apnea, insomnia, prostate issues, or an overactive bladder.
If it's a large amount even if you cut off fluids 2-3 hours before bedtime and pee right before bed, talk to your doctor. It could be a warning sign of diabetes or edema = heart, liver, or kidney problems.
If you feel like you're peeing too often:
Normal urination frequency is 7-10 times per day. Any less than 4 spells trouble for your kidneys. That seems like a lot for some people because they're used to being chronically dehydrated. So it may take some time to get used to having to pee more often.
However, if you are running to the restroom more often than that, you're going to want to add electrolytes. ⬇️
If even flavored beverages still feel difficult to drink:
You're going to want to add electrolytes. ⬇️
Electrolytes
What Electrolytes Are
Electrolytes are minerals that carry an electric charge. Why that matters to living creatures is because our muscles and nerves use electricity to move and communicate with each other.
More specific to hydration, electrolytes help us hold on to the appropriate amounts of water and keep all of our moving parts functioning well.
Adding electrolytes makes it easier to drink fluids.
Our blood stream in particular likes to have a specific ratio of electrolytes to water - it doesn't like to get too diluted. This is a major reason why some people struggle drinking plain water, but Gatorade, alkaline water, coffee and other drinks go down more easily.
The 6 main electrolytes
Sodium
Sodium gets a lot of negative press, but we really need sodium to maintain a healthy fluid balance. We need it for heart, liver, and kidney health, as well as proper muscular functioning and blood pressure. A diet that is too LOW sodium is actually more dangerous than a diet that is too high, especially one that is balanced with the other electrolytes below.
The American standard recommendation is 2300 mg per day, the World Health Organization aims for 2000-5000 mg per day for healthy individuals. Individuals experiencing swelling due to water retention may benefit from cutting back to 1500 mg per day. If you have high blood pressure, it’s worth tracking your salt intake (some people really do consume too much, up to 10,000 mg per day) but it’s also worth making sure your intake is balanced with the other electrolytes below.
Potassium
Potassium is one of the most important minerals in the body and plays a counterbalance to sodium. Potassium prevents excess water and sodium retention, and also balances blood pressure: it is suspected that low potassium intake plays a big role in developing hypertension (high blood pressure). Potassium also ensures proper muscle and nerve function, as well as many other protective benefits for the heart, kidneys, and bones.
The Institute of Medicine recommends 4700 mg per day, but average American intake hovers around half that, between 1755 and 2640 mg per day.
Sources: Bananas are famous for it, but that's more due to marketing than a stellar potassium content. Avocados, oranges, tomatoes, leafy greens, and most other fruits and vegetables are excellent sources of potassium. I'm also a big fan of Morton's Lite Salt to boost potassium intake into recommended levels.
Calcium
Most people associate calcium with building strong bones (which is true) but we also need it for muscle and nerve function, to release hormones properly, and regulating blood pressure. Many parts of the country actually have calcium coming out of their taps: most water that is considered “hard water” is naturally rich in calcium and has been tied to health benefits.
Calcium needs vary from 1000 to 2000 mg per day depending on age, activity, and concerns for bone density. The results for calcium supplements are mixed - most often problematic in the case of high dose calcium supplementation and again there is concern for the lack of balance with the other minerals. More moderate calcium supplementation of 500-1000 mg daily, switching to calcium phosphorus blends, or increasing overall dietary calcium intake is better.
Dairy Sources: Cheese, milk (especially ultrafiltered), yogurt (especially greek), and dairy based protein drinks are all quite high in calcium, ranging from 300 mg in milk to over 600 mg in protein drinks.
Non-Dairy Sources: Canned bone-in sardines and salmon have 450-600 mg calcium for a 3 ounce serving, leafy greens, winter squash and cruciferous veggies have 70-270 mg per cup cooked, and there are tons of calcium fortified foods, especially nondairy milk, certain cereals, and orange juice.
A note on calcium rich foods and supplements: calcium blocks absorption of other electrolytes as well as other important minerals like zinc and iron (also some antibiotics!)
Calcium doesn't play well with others, and is best taken alone. Give an hour or 2 between calcium and these items.
Magnesium
Magnesium is a mineral electrolyte that is starting to be recognized for it’s multiple health benefits, one of the most notable being it’s ability to relax muscles and calm anxious minds. Deficiency has been tied to metabolic disorders, heart disorders, pain disorders, and multiple other health problems.
The recommended dose ranges from 320 - 500 mg per day for adults, with needs increasing for people under stress or doing lots of exercise.
Sources: Beans and greens, especially the dark colored ones - black beans are especially high. Nuts, seeds, and bananas have some but not enough: bananas only contain 30-40 mg, even black beans (120 mg per cup) and pumpkin seeds (170 mg per 1/4 cup) topping the charts only have about 30% of our daily needs.
There's growing evidence that these foods don't have as much magnesium as they used to, likely due to modern farming practices that strip the soil and focus on faster growth and higher yields over quality.
Magnesium is the only electrolyte mineral that really needs to be supplemented: my two favorites are Nature Made (cheaper but still good quality) and Garden of Life (higher quality, all natural and sugar free).
Phosphorus
Phosphate (phosphorus) is an electrolyte most people don’t hear about, but it is the other mineral that is incredibly important to bone health and vital to energy production. Bones and teeth contain about 85% of the body’s phosphate, combined with calcium in the form of hydroxyapatite.
The rest is located inside the body’s cells, where it is involved in energy production. Adenosine TriPhosphate (ATP) is the basic currency for energy production inside of a cell, and phosphate is necessary for production, regeneration, and regulation of ATP.
Adults need 700-1000 mg per day, while teenagers, pregnant women, and people at risk for osteoporosis benefit from 1200-1300 mg per day.
Sources: Most protein foods have phosphorus, with dairy, meats, seafood and eggs being especially high. Nuts, seeds, beans, and whole grains are good sources of phosphorus, but may not be as absorbable.
Chloride
Chloride is usually ignored by mainstream sources, but it’s actually one of the most important electrolytes in the blood, required for proper blood volume, blood pressure, and pH of your body fluids.
Fortunately, it's also extremely easy to get in the diet. Table salt is Sodium Chloride and Chloride naturally occurs in most water sources along with many foods, so most people get adequate amounts of it.
Morning Water with Electrolytes
I always encourage people to drink fluids as early in the day as possible.
I promise I will never, ever take away your morning coffee - but I do recommend you drink 12-24 ounces (about a bottle’s worth) of water before you move on to the caffeinated stuff.
My personal favorite is a twist on the more common Hot water with Lemon drink. There’s nothing magical about the lemon except I happen to love lemon and it’s easy on queasy stomachs, so this is a great drink for someone who isn’t interested in cold drinks first thing in the morning. The water can be any temperature but the electrolytes need to be dissolved before adding any ice. Feel free to switch the lemon out for a different citrus or piece of fruit, or leave out entirely.
Rough formula:
Mug of water, hot or room temp
About ⅛ teaspoon Morton’s Lite Salt (which is 50/50 sodium/potassium)
5 - 15 drops of Trace Minerals Drops (rich in magnesium and chloride and tons of different trace minerals)
1 wedge of lemon, lime, grapefruit (optional)
If you don't want to measure it out, don't! Experiment and go by taste.
Premade Workout Electrolyte Drinks
Electrolyte Drinks with minimal sugar
Ultima - contains all 6 electrolytes
Stur Hydration
Nuun Sport
Pedialyte unflavored (bonus: contains zinc which increases intestinal absorption of water)
Mommy’s Bliss Electrolyte Powder unflavored
BodyArmor Lyte
Vitamin Water Zero Sugar
Runners up (artificial sweeteners/colors): Powerade Ultra, Gatorade Zero, Powerade Zero, Propel
Electrolyte Drinks with Carbs for Endurance Athletes
The top choices use clean ingredients, optimal electrolytes, and digestible carbs: Nuun Endurance, Hammer Nutrition Heed, BodyArmor Black, Bolt24
Runner up: Gatorade G2. A much better option than regular Gatorade or Powerade, but contains artificial sweeteners and colors.
Limit: Gatorade, Powerade, and similar. These are too high in sugar for endurance athletes to tolerate and too low in electrolytes to be worth the stomach cramps. Good in a pinch but should probably be watered down or consumed slowly.
Electrolyte Containing Gels for Endurance Athletes
Gu Roctane - Contains extra Amino Acids and sometimes extra caffeine
Gu Classic - tons of flavors to reduce boredom. Gu offers a free recycling program through Terracycle.com
Hammer Gel - Hammer offers bulk jugs and reusable Hammer Flask to reduce waste and lower cost per serving
Clif Shot - the caps remain attached after you open them to reduce litter
Honey Stingers - Gluten Free, for Honey lovers
Electrolyte Capsules - for people that prefer water
Gu Roctane capsules
Salt Stick comes in both capsules and fast chew tabs
Hammer Nutrition Endurolytes Capsules
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