Chapter 12

Water

Body fluids are liquids within the human body. Body fluids are discussed in terms of their specific
fluid compartment, a location that is largely separate from another compartment by some form of a
physical barrier. The cell membrane of the cell acts like a biological, physical and selective barrier
between the inside and the outside of the cell.

Body Fluid Compartments

Intracellular fluid (ICF) - The compartment includes all fluid enclosed in cells by their cell
membranes.

Extracellular fluid (ECF) - The fluid that surrounds all cells in the body. Extracellular fluid
has two primary constituents:

• Intravascular - The fluid component of the blood (called plasma) inside the blood vessels.
• Interstitial fluid - The fluid that surrounds all cells (in-between spaces around cells of a tissue).

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 Chapter 12 - Water

Importance of Body Fluids

1. Blood plasma carries oxygen and nutrients to each and every cell
2. Facilitates maintenance of blood pressure
3. Lubrication of joints
4. Physical performance
5. Cell function like protein synthesis

The elimination/excretion of water from the body through natural processes like urination, defeca-
tion, perspiration, and exhalation – is for valid physiological reasons. This is the main reason why
water needs to be replaced exogenously. If this exogenous intake falls short in any way, to replace
the fluid expended for the above very important metabolic reasons, for an extended period of time,
then the body faces the danger of dehydration, which proves fatal if not corrected. Even as first grade
school children we were aware that we as humans cannot exist without air (oxygen), water and food.

Exchange of gases, nutrients, water, and wastes between the three fluid compartments of the body

Water is majorly utilized and thus removed from the body for the following physiological functions:

1. Metabolic waste removal - Metabolic wastes inside the body are harmful to the body and hence
it is very important for the normal functioning/physiological reasons; to get rid of these waste
products.

2. Thermoregulation -Thermoregulation is the maintenance of a particular temperature (approx-

imately 37 degree Celsius) of the human body wherein water is utilized to maintain overall
body temperature by dissipating heat. Water is released through glands in the skin, evaporates
off the skin and thus the body is cooled.

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3. Humidification of air exhaled in every breath - When we breathe out, our lungs expel carbon
dioxide back into the air. Our breath also contains moisture. Because our mouth and lungs are
moist, each breath we exhale contains a little bit of water in the form of water vapor.

Most water intake comes through the digestive tract via liquids and food. Fluid intake is defined as
the amount of water consumed from foods, plain drinking water, and other beverages. Body always
maintains homeostasis with relation to its vitals such as the ‘Fluid balance in the body’.

Fluid balance is an aspect of the homeostasis of the organism. It logically figures then,
that our bodies’ cellular, physiological intelligence, will have a mechanism in place to
alert the body well in time to exogenously ingest water. The alert, like all other alerts
the body gets, will logically be expressed via a strong urge to ingest water, arising
through certain sensations caused by the brain (Hypothalamus).

Conventional wisdom with regards to how one should manage staying hydrated, is based on the
obviously false premise that the human body is NOT intelligent and has no mechanism to alert the
body to restore fluid balance. The body apparently risks dehydration if one is not intellectually taught
about the correct quantity to drink on a daily basis for optimum health, regardless of utilisation.

The premise is proven wrong with one simple fact - To maintain life, the human body has intelli-
gence, and does not need intellect. Human intellect is wasted and worse yet misused when theories
are made up about how much water a human should drink on a daily basis to maintain a physio-
logical state. These theories are often made up to mislead people into purchasing things that are
not needed. The human body is intelligent enough to accurately decide that on a minute to minute
basis. Intelligence has no room for error; intellect is what gives us the power to mislead others and
also gives us the crippling handicap of being susceptible to deception and lies, and also always the
possibility of being wrong, or making a mistake in interpretation of data or what is being observed.
It is this handicap that has led billions to drink regardless of thirst. Any water consumed without
thirst is physioLOGICALLY in excess to the body’s needs.

This is carried to an extreme, especially with regards to Human Performance Nutrition advised to
athletes, leading to disastrous consequences of overhydration/water intoxication/sodium dilution/
hyponatremia. If you have not read much about the perils of overhydration, and read tons on dehy-
dration; if you believed that there is no such thing as too much water, it is only because DRINKING
WATER/ORAL REHYDRATION SOLUTIONS are now a BIG commodity, and thus a business worth
hundreds of billions of dollars.

Keeping the body in homeostasis is the job of cellular intelligence and does not fall under the
purview of intellect. Another way of understanding this is to observe dumb animals without intel-
lect; given the availability of water, they cannot get dehydrated as they simply respond to the urge
to drink, we call as thirst.

You can make an intellectual human drink water even when the human is not thirsty, by deceiving
him with a made up theory that one must consume X amount of water a day/X amount of water
every 3-Hours/thirst is a late indicator of dehydration and what have you. Animals are protected
from this misinformation and deception due to their lack of intellect, and thus have complete reli-
ance on cellular intelligence. You cannot force an animal to drink water. All pet owners will agree

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with this fact. From the smartest humans to the humans of least intellect, from the most educated
professors to the illiterate, all get thirsty; all respond to the urge by finding water around them and
drinking till they quench their thirst; all feel thirsty more in summer than in winter; all feel more
thirsty when engaged in physical exertion that raises body temperature enough to cause perspiration.

An illiterate roadside labourer who has never been to school labours away in the harsh sun, and yet
never gets dehydrated; educated people trying to drink a specific amount of water each day by setting
alarms as reminders, are often MALHYDRATED (could be hypo or hyper hydrated). The amount of
water in the organism is regulated by the body maintaining a delicate balance of the concentrations
of electrolytes such as sodium, potassium, chloride. This auto-homeostatic mechanism of cellular
intelligence is a complex interplay of messages between the electrolytes and osmoreceptors, arte-
rial pressure and baroreceptors, hormones, enzymes and the hypothalamus.

We shall term this incredible complexity of human cellular intelligence, as the THIRST MECHANISM.
The thirst mechanism, like all other things in the body, is orchestrated by the nervous system.

Hypothalamus, a small region of the brain; is a very important part of the central
nervous system. It is located at the base of the brain, near the pituitary gland. It
is always the main initiator of producing hormones and regulates emotional and
behavioural patterns too, as we studied in the previous chapter on hormones. In
addition, the hypothalamus controls the body temperature by serving as the body’s
thermostat.

The hypothalamus has the thirst centre which regulates drinking, likewise it has the feeding &
satiety centre. It is considered to be the link between the nervous system and the endocrine system.

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The thirst centre in the hypothalamus governs the urge to drink. Osmoreceptors are sensory recep-
tors in the thirst center of the hypothalamus that monitor the concentration of solutes (osmolarity)
of the blood. Osmoreceptors basically detect changes in plasma osmolarity. A person gets into a
deficit of water, due to the utilisation of the extracellular fluid as the major component of urine,
feces, sweat, and a not so major component of exhaled air (vapour).

Thirst is a sensation created by the hypothalamus that drives all land and air animals to ingest water.
Fish that are found in the sea (salt water), do have some oral consumption of water that they direct
to their digestive systems (Their main hydration happens via osmosis through their skin/scales).

Lets understand the meaning of this word osmosis in detail.

​​Osmosis deals with chemical solutions. Solutions have two parts, a solvent and a solute. When
solute dissolves in a solvent, the end product is called a solution. Salt water is an example of a
solution; salt being the solute, and water as the solvent. When there is a lot of solute compared to
solvent, a solution is said to be concentrated. When there is a small amount of solute compared to
solvent, then a solution is said to be diluted.

So, solute can be defined as a substance that is dissolved in a liquid solvent to create a solution. A
semi-permeable membrane is a barrier that will allow only some molecules to pass through while
blocking the passage of other molecules. A semi-permeable barrier essentially acts as a filter. It can
be made out of synthetic material or can be biological.

Biological cell membranes serve as barriers and gatekeepers. The cell membrane is special because
only water and very small molecules can pass through it.They are semi-permeable, which means
that some molecules can diffuse across the lipid bilayer but others cannot. Small molecules like
water ( H2O) and gases like oxygen and carbon dioxide cross membranes rapidly. On the other hand,
cell membranes restrict diffusion of highly charged molecules, such as ions, and large molecules,
such as sugars and amino acids.

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In biology, this is usually when a solvent such as water flows into or out of a cell depending on the
concentration of a solute such as sodium. Osmosis happens spontaneously and without any energy
on the part of the cell. Imagine a beaker with a semi-permeable membrane separating the two sides
or halves. On both sides of the membrane the water (solvent) level is the same, but there are different
concentrations of a dissolved substance, or solute, that cannot cross the membrane (otherwise the
concentrations on each side would be balanced by the solute crossing the membrane).

The term ‘osmosis’ refers to the movement of solvent molecules through a semiper-
meable membrane from a region where the solute concentration is low to a region
where the solute concentration is high.

If the volume of the solution on both sides of the membrane is the same but the concentrations
of solute are different, then there are different amounts of water, the solvent, on either side of the
membrane. If there is more solute in one area, then there is less water (solvent); if there is less solute
in one area, then there must be more water (solvent).

An obvious question is what makes water (solvent) move at all? The water will move from the B
side of the beaker to the A side of the beaker, as shown in Figure 2; due to the difference in the
concentration gradient of solutes on the either side of the semi-permeable membrane. Water flows
from the side with the lower concentration of solute to the side with higher concentration of solute.
In the below diagram, the solute cannot pass through the selectively permeable membrane, but the
solvent/water can. This diffusion of water through the membrane—osmosis—will continue until
the concentration gradient goes to zero and the level of solution in the side with a higher solute
concentration will go up.

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To summarize, the direction of net solvent flow is always from the side with the lower concentration
of solute to the side with the higher concentration. And this net flow of solvent through a semi-per-
meable membrane is called osmosis (from the greek word osmós, meaning “push”).

Osmolarity describes the total concentration of solutes in a solution. A solution with

a low osmolarity has fewer solute particles per litre of solution, while a solution with
a high osmolarity has more solute particles per litre of solution.

When solutions of different osmolarities are separated by a membrane permeable to water, but not
to solute, water will move from the side with lower osmolarity to the side with higher osmolarity.
Three terms—hyperosmotic, hyposmotic, and isosmotic—are used to describe relative osmolarities
between solutions. For example, when comparing two solutions that have different osmolarities,
the solution with the higher osmolarity is said to be hyperosmotic to the other, and the solution
with lower osmolarity is said to be hyposmotic. If two solutions have the same osmolarity, they are
said to be isosmotic.

Sometimes, we often come across the word ‘osmolality’. Osmolality measures the concentration
of solutes in a fluid by looking at the number of particles per weight (kilogram) of fluid whereas
osmolarity evaluates the number of particles per volume (litre) of fluid. With dilute fluids, they
are essentially the same, but differences will be more noticeable at higher concentrations and care
must be taken when comparing them as the units for osmolality and osmolarity are not the same.
Having explained osmosis and osmolarity in detail; let’s come back to the thirst mechanism. Thirst
is the urge/ basic instinct to drink fluids that is the primary mechanism involved in fluid balance.

In the presence of abundant water sources, it is the only mechanism for fluid balance that is needed.
In case the thirst mechanism works physiologically, and the human being experiences thirst; the
only reason then for the body to succumb to dehydration would be unavailability of water for an
extended period of time.

Thirst mechanism first and foremost kicks in, due to a physiological drop in the level of fluids in
the body, when the extracellular water is used for physiological purposes, and that correspondingly
increases the concentration of certain solutes such as sodium.

Osmoreceptors are sensory receptors in the thirst centre of the hypothalamus that monitor the
concentration of solutes (osmolarity) of the blood. These osmoreceptors are defined functionally as
neurons that are endowed with an intrinsic ability to detect changes in extracellular fluid osmolarity.
Increased osmolarity in the blood acts on osmoreceptors that stimulate the hypothalamus directly.

The water that leaves the body, as urine, exhaled air, or sweat is ultimately extracted from blood
plasma (extracellular fluid). As the blood becomes more concentrated, the thirst response is triggered.
If blood osmolarity increases above its ideal value, the hypothalamus transmits signals that result in
a conscious awareness of thirst. The person normally responds by drinking water. Osmoreceptors
detect changes in plasma osmolarity (that is, the concentration of solutes dissolved in the blood).
When the osmolarity of blood changes, movement of water in and out of the osmoreceptor cells
changes. That is, the osmoreceptor cells expand when the blood plasma is more dilute and contract
with a higher concentration. When the osmoreceptors detect even slightly high plasma osmolarity,

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they send signals to the hypothalamus, and the hypothalamus in turn creates the biological sensa-
tion of thirst and this signalling is quite rapid.

Thirst is not a late indicator of dehydration as is popularly believed. It is physiological

and not something that triggers once the body is pathological.

The innate cellular intelligence of the body, also makes allowances for non-availability of drinking
water over short periods of time, extending to a few days. This is its ‘fail-safe’ mechanism. A fall
back system, that can elongate the period that the body can survive without water. It is obvious that
if the thirst mechanism plays out as it should, and you get physiologically thirsty, you will start
to look for water. If you cannot find water to drink, the water levels in the blood will continue to
fall, increasing osmolarity. At a critical point, the body will initiate emergency measures, to ration
out the existing water, in the body. It will start to use less water for all the functions in which gross
quantities of water are utilised.

The two primary ways in which water is utilized are - metabolic waste removal management (urine),
and thermoregulation (sweat). The body will try and last out as long as possible without water by
lowering urine output and sweat.

This obviously cannot go on indefinitely, thus is not a solution or an alternative to drinking water.
The thirst mechanism keeps playing out and the urge to drink water keeps increasing in its intensity,
to a point where the only thing we are capable of thinking about is WATER.

The ability of the body to ration its water usage in case of non-availability of water in the imme-
diate after-math of feeling thirsty, simply intensifies the need to drink water, so that, we prioritise
finding a water source above all else, and that our probability of finding water increases, as the
body provides more time by using less water before it gets critical to a point where the body is so
incapacitated that it cannot drink water, even if the water is right in front.

The body loses consciousness, and life will slip away, if the body is not rescued and provided fluids
intravenously in a medical facility. The mechanism that the body uses to reduce usage of water,
in a bid to ration it over a longer period in the absence of water is the renin-angiotensin mediated
water rationing mechanism.

The renin–angiotensin mediated water rationing mechanism is a homeostatic pathway that deals
with blood volume as a whole, impacting blood pressure, as well as plasma osmolarity.

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Endocrine Regulation
Endocrine control over the cardiovascular system involves several hormones that interact with the
kidneys in the regulation of blood volume and thus impact urine quantity.

Antidiuretic Hormone (ADH)

1. Antidiuretic Hormone (ADH), also known as Vasopressin, is secreted by the cells in the hypo-
thalamus and transported to the pituitary where it is stored until released upon nervous
stimulation. Antidiuretic hormone, is secreted in response to either increases in plasma osmo-
larity (very sensitive stimulus) or to decreases in plasma volume (less sensitive stimulus).

Interstitial fluid osmolarity increases usually in response to reduced blood volume as water
moves from the interstitial fluid compartment towards the intravascular compartment through
osmosis. ADH signals its target cells in the kidneys to reabsorb more water, thus preventing
the loss of additional fluid in the urine. This will prevent any further decrease in overall fluid
levels and help restrict further loss of blood volume and drop in pressure.

2. Angiotensin II is a powerful vasoconstrictor, increasing blood pressure. It also stimulates the release
of ADH and aldosterone, a hormone produced by the adrenal cortex. Aldosterone increases the reab-
sorption of sodium into the blood by the kidneys. Since water follows sodium, this increases the
reabsorption of water. This in turn stops further decrease in blood volume, while the stimulator of aldo-
sterone release, angiotensin II, constricts blood vessels, thus raising the plummeting blood pressure.

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Angiotensin II also further intensifies the stimulus on the thirst centre in the hypothalamus. At
this point, a human being’s mind is consumed by only one purpose; finding a source of water
and drinking till the thirst is quenched.

Once the thirst is quenched and the stimulus on the thirst center is removed, due to decreased
osmolarity, aldosterone, ADH, and angiotensin II will return to baseline levels, allowing the normal
outflow of urine, as water will follow the sodium that will be let out at a normal rate. The intake of
water will increase blood volume as per normalised fluid balance, and thus, re-dilation of constricted
blood vessels due to receding angiotensin II will be warranted.

Remember, aldosterone led retaining of sodium leading to re-uptake of water from the kidneys; ADH
led scanty urine output, and angiotensin II led constriction of blood vessels, are emergency measures
that the body takes, when post the thirst stimulus, no water is found, for an extended period of time,
and the body actually faces a significant increase in osmolarity, and a significant decrease in blood
volume, leading to a drop in blood pressure. Osmolarity, and blood volume normalise upon intake
of water, and thus the emergency measures are reversed by the body.

The physiological mechanism of maintaining fluid homeostasis is the hypothalamus,

and osmoreceptor led stimulation of the thirst center located in the hypothalamus,
provided by a slight increase in osmolarity. The stimulus causes a sensation of thirst
(strong urge to drink water), leading the human to immediately access available
drinking water and orally ingest the water till the thirst is quenched.

The intake of water by drinking restores the osmotic pressure to normal. There is a delay of tens
of minutes between the ingestion of water and its full absorption into the bloodstream. However,
drinking can quench thirst within seconds, long before the ingested water has had time to alter the
blood volume or osmolality. This is the body’s intelligence preventing us from drinking a quantity
that would most definitely be excessive.

It is the brain that terminates thirst by using sensory cues from the oropharynx to track ongoing
water consumption and then accurately calculates how this water intake will restore fluid balance,
10-30 minutes in the future, after the water has been absorbed.

Without this accuracy of knowing exactly how much fluid will restore fluid balance; instantaneous
reading of the water consumed by the receptors of the oropharynx, instead of waiting for information
from the osmoreceptors & baroreceptors, prevents drowning the body in excess fluid by overdrinking
When the water is unavailable post thirst for the longest time; increase in osmolarity; decrease in
blood volume, is significant enough to threaten pathological conditions such as sharp hypotension,
intracellular water loss, leading to cellular shrinking and dysfunction and hyperthermia, which
are both potentially fatal.

The symptoms arising from the above are muscle cramps, muscle weakness, increased heart palpi-
tations, light-headedness, nausea, vomiting and also extreme decrease in urine output. Confusion
and disorientation occurs as the brain and other body organs receive less blood flow. This is how
the state of dehydration is defined. Finally, if water is still unavailable, it will lead to a comatose
state, multiple organ failure, and eventually death.

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The endocrine mechanism kicks in for survival in the midst of non-availability of drinking water
to avoid the fatal state of dehydration and conserve body fluids.

Most water intake comes through the digestive tract via liquids and food, but roughly 10 percent of
water available to the body is generated at the end of aerobic respiration during cellular metabolism.

Reiterating for emphasis -

Thirst is a natural, physiologically, in-built regulatory mechanism which tells us to drink water/
fluids, as we lose a particular amount of water/fluids, largely in the process of excretion, thermoregu-
lation, and respiration, causing a slight decrease in blood volume and a slight increase in osmolarity.

Water expelled for thermoregulation is the reason why we will get more thirsty and thus drink
more, in the heat of summer (ambient heat), or if we were to be intensely working out (internal
thermogenesis).

Since, the more we work, the faster is our rate of respiration; the higher is the appetite, leading to
more food consumption. Thus metabolic activity will be high, leading to more metabolic waste, due
to increased food digestion metabolising into energy compounds; energy compounds metabolising
into ATP; increased activity leading to increased rate of respiration.

Thus, the more active we are, the more we will urinate to manage the increased metabolic wastes
due to increased metabolic activities; the more vapour we will exhale.Thus, the more active we are,
the more thirsty we will get, and the more we will drink. Conversely, winter will lower the usage of
water by the body for thermoregulation (less sweat), and thus, cause a drop in thirst, leading us to
consume less water. Consequently, less activity will lower the usage of water for metabolic waste
removal (urine), and thus cause a drop in thirst, leading us to consume less water.

Drinking water constantly with the thought of maintaining fluid balance of the body, irrespective
of the activity, food intake, ambient temperature is downright wrong. It is best to rely on the body’s
innate, super accurate intelligence, rather than any inaccurate calculations that we could do using
our intellect.

Let us understand the regulation of body

temperature mechanisms in detail.

Our skin is the largest sense organ and

can detect several types of environmental
changes. The skin detects changes in tempera-
ture through the use of specialized receptors
known as thermoreceptors. These thermo-
receptors are specialized neurons located
inside the skin that function to detect changes
in environmental temperatures to maintain
homeostasis. ​​Thermoreceptors are able to
detect heat and cold and are found throughout
the skin in order to allow sensory reception
throughout the body.

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When the body temperature rises during exercise or while the external environment is too hot; it
is detected by the hypothalamus. This will increase the flow of warm blood into the capillaries
beneath the skin. The higher temperature of the blood stimulates thermoreceptors in the hypothal-
amus to cause dilation of blood vessels in the skin. The heat will radiate from the warm blood in the
capillaries; out into the environment; as a measure to cool down the body. In addition to the above,
there is another mechanism that will kick in which is the sweat mechanism. The skin has 2 layers
which are dermis and epidermis that has a duct going down which is coiled at the bottom known
as the sweat gland. Blood vessels and capillaries are perfused through the sweat gland. Vasodilation
is the temporary increase in the size of the blood vessels and thus further increase in the volume of
the blood flowing. This is the first measure that the body takes and is called peripheral vasodilation.

Once the sweat is on the surface of the body, it will evaporate into the environment. The reason this
works is as the sweat evaporates; the water changes from liquid to a vapor state and to do this; it
requires a lot of energy. This energy is taken from the body as heat energy. To evaporate a relatively
small amount of sweat, a lot of heat from the body is dissipated.

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If the surrounding environment is dry, meaning that there is low humidity; evaporation of sweat
can happen quite quickly and effectively. However, if the environment is humid, our cooling
mechanism will not be working optimally making us feel uncomfortable with too much heat. Our
amazing body can lose water in the form of sweat (as part of thermoregulation) and still maintain
perfectly normal blood pressure. As long as we have the availability of fluids and we are intaking
that; and as long as we are sweating properly, it is possible to maintain thermoregulation even in
quite hot environments.

When we are sweating, we will lose water and salts through our skin. Sweating depletes our tissues
of water and increases the solute concentration in those tissues. As this happens, water diffuses
from our blood into sweat glands and surrounding skin tissues that have become dehydrated
because of the osmotic gradient. Additionally, as water leaves the blood, it is replaced by the water
in other tissues throughout our body that are not dehydrated. If this continues, dehydration spreads
throughout the body.

Now the problem comes when people cannot release sweat which could be because of wearing too
many clothes/ tight fitted clothes or cannot produce sweat because of extreme loss in body fluids
and non-availability of water to drink to replace the loss of body fluids. This could lead to hyper-
thermia simply known as overheating, a condition in which an individual’s body temperature is
elevated beyond normal due to failed thermoregulation. The person’s body produces more heat
than it dissipates.

What if the body becomes too cold or the external environment is too cold? What will the hypo-
thalamus do then? In this case, the first thing that happens is peripheral vasoconstriction. As we
understand, vasoconstriction is the narrowing of the blood vessels that will consequently decrease
the flow of blood to the surface of the skin. Thus, in this process, less heat is going to be lost and
instead will be preserved.

Hence, in winters, there is lesser usage of water by the body for thermoregulation (less sweat), and
thus, cause a drop in thirst, leading us to consume less water.

Physiologically, fluid intake is regulated by thirst. However, fluid intake can also occur, for example,
because of habits and social influence. Thus, purposeful fluid intake has a substantial behavioral
component that interacts with physiological mechanisms. The main stimulus for thirst is an increase
in plasma osmolarity, and we understand that this increase is detected by osmoreceptors that initiate
neural mechanisms resulting in the sensation of thirst.
The intake of fluids is also influenced by its direct availability and can be socially facilitated or
inhibited by the presence of other individuals. Fluid intake which truly could have been driven
through physiological mechanisms, is actually now driven under the social and behavioural influ-
ence, because of which people tend to drink more water than required by the body.

When the blood volume increases because of excessive water intake beyond the physiological
requirement, the hormonal stimuli to decrease the same to normal is triggered via atrial natriuretic
peptide hormone (ANP hormone).

Atrial natriuretic peptide hormone is secreted by cells in the atria of the heart. Atrial natriuretic
peptide (ANP) hormone is secreted when blood volume is high enough to cause extreme stretching
of the cardiac cells. Natriuretic hormones are counter – regulatory to angiotensin II.

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This promotes loss of sodium and water from the kidneys, and suppress renin, aldosterone, and ADH
production and release. All of these actions promote loss of fluid from the body, so blood volume
and body temperature drops. Normal functioning kidneys can beautifully maintain fluid balance
of the body by excreting out excess water in case you drank an excessive amount.

However, can a person possibly drink so much that he becomes overhydrated and becomes intoxi-
cated with water? Yes, that’s the irony as most of the endurance athletes are overhydrating themselves
with the fear of dehydration. Not only athletes, but generally, drinking tons of water these days has
become almost trendy – people do it for better skin, lustrous hair, better metabolism, possibly as a
part of their fad diets, or some sort of water therapy, and so on.

Over hydrating with water while exercising, can lead to a condition commonly called
Exercise Associated Hyponatremia.

While it’s vital to take care of our hydration levels; during our workouts, going overboard can cause
real life threatening damage. Though the risks of dehydration are well understood, let’s look into
the serious health risks associated with drinking too much water while exercising. In ultra-endur-
ance events, such as ultra-marathons and ironman triathlons, the situation becomes somewhat
more complicated. Since the body’s sodium levels determine water content, the continued loss of
sodium in sweat can lead to a progressive loss of fluid reserves. In such ultra-endurance events,
an adequate sodium intake is therefore necessary. However what is commonly seen, these athe-
letes intake plain water without salt, causing dilutional hyponatremia. This excessive water intake
remains the predominant cause of hyponatremia in all endurance events.

When a person steadily consumes water faster than the kidneys can excrete it or when renal func-
tion is poor, the result is overhydration, a state in which excessive body water causes cells to swell.
A decrease in the osmolarity of interstitial fluid, as may occur after drinking a large volume of water,
inhibits secretion of antidiuretic hormone (ADH). Normally, the kidneys then excrete a large volume
of dilute urine, which restores the osmotic pressure of body fluids to normal. As a result, body cells
swell only slightly, and only for a brief period but incase of an athlete, steady consumption of water
can cause exercise induced hyponatremia.

Normally, cells neither shrink or swell because intracellular and interstitial fluids have the same
osmolarity. Changes in the osmolarity of interstitial fluid, however, cause fluid imbalances. An
increase in the osmolarity of interstitial fluid draws water out of cells, and they shrink slightly.

A decrease in the osmolarity of interstitial fluid, by contrast, causes cells to swell. Changes in osmo-
larity most often result from changes in the concentration of sodium.

If the body water and sodium lost during excessive sweating is replaced by drinking plain water,
then body fluids become more dilute. This dilution can cause the sodium concentration of plasma
and then of interstitial fluid to fall below the normal range. When the sodium concentration of inter-
stitial fluid decreases, its osmolarity also falls. The net result is osmosis of water from interstitial
fluid into the cytosol. Water entering the cells causes them to swell.

The cells in the brain may swell to the point where blood flow is interrupted resulting in cerebral
edema. Swollen brain cells may also apply pressure to the brain stem causing central nervous system

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dysfunction. Both cerebral edema and interference with the central nervous system are dangerous
and could result in seizures, brain damage, coma or death.

In the brain, this swelling increases intracranial pressure, which leads to the first observable symp-
toms of water intoxication: confusion, headache, changes in behaviour, irritability, and drowsiness.
These are sometimes followed by difficulty breathing during exertion, muscle weakness & pain,
twitching, or cramping, nausea, vomiting, and a dulled ability to perceive and interpret sensory
information.

Developing hyponatremia during ultra-endurance sports, the first objective symptom is confusion.
However, the assumption must not be that an athlete in this condition is simply dehydrated. While
athletes who are dehydrated will respond rapidly to intravenous fluid administration, this same
course of treatment would prove disastrous, potentially fatal; to an already fluid overloaded individual.
Needless to say, the treatment for both are completely opposite and if instead of administering salt
water, an athlete suffering from hyperhydration is further hydrated with plain water, it would make
the situation worse – outcome could be seizures, coma and death.

The terrifying thing about overhydration symptoms is that they match with the symp-
toms of dehydration.

So, NEVER - EVER drown yourself into gallons of water! If you’re chugging water even when you’re
not thirsty, you are drinking more than your body needs. Also, if your kidneys are not functioning
properly and you are unknowingly drinking in excess quantities, overhydration can lead to dilution
of electrolytes resulting in lingering headaches, nausea, weakness, swollen feet & hands, confusion,
disorientation.

Overhydration is dangerous because it can lead to an imbalance of electrolytes in the body. If you
consume too much water, there may not be enough of these electrolytes in your blood to keep your
body working properly. Thus, drinking water, when you are NOT thirsty at all, is not physioLOGICAL.

The K11 HPN course, as the name suggests, focuses on performance, and definitely not the clinical
aspect of nutrition. The course focuses on optimizing physiological functions for optimal physical
and mental performance. The reason for including a discussion on this most common condition,
commonly called high blood pressure (hypertension), in the chapter on water is actually straight-
forward and logical. The reason is that people with this condition are conventionally told to dras-
tically reduce salt in their diet. This advice is given due to the perception that sodium (the Na+ in
salt) exacerbates hypertension. Some medicos and degree holding dietitians, including registered
dietitians even go to the extent of saying that sodium causes hypertension.

This aversion and the constant refrain that health professionals conventionally have towards salt,
is in stark contrast to human physiology, as it correlates to fluid balance.

Once on correct nutrition, the body does not unnecessarily retain water. Purposeful restriction of
salt is downright detrimental and can potentially cripple you with hyponatremia. To understand this
better, the course syllabus had to include this section on the real cause of hypertension, which defi-
nitely is NOT the extremely essential food additive, we call as salt, or its constituent sodium (Na+).

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While the “war against sodium” is hugely carried out by the mainstream doctors and the conven-
tional clinical dietitians treating hypertensive patients. Majority of the cases of hypertension/high
blood pressure are deemed “idiopathic”.

Merriam – Webster dictionary meaning/ definition of “Idiopathic” is:

• Arising spontaneously or from an obscure or unknown cause.
• Peculiar to the Individual.

There is actually a clear pathway that leads the body from physioLOGICAL arterial pressure to
potentially pathoLOGICAL. If a diabetic individual presents himself/herself with high Blood
Pressure (Very rare to find a Diabetic who also concomitantly does NOT suffer from Hypertension),
it definitely cannot be termed as Idiopathic. This is so, because there is a clear connection between
hyperglycemia and hypertension.

In a healthy state, when we eat salt, the body senses the increased salt and “turns aldosterone off”
so the kidneys excrete salt and water; this ensures normal blood pressure. In the insulin-resistant
state, the body has artificially elevated levels of aldosterone. It is possible that greater aldosterone
levels might result from hyperinsulinemia. A relationship between aldosterone and insulin resis-
tance has been demonstrated in research.

Thus, in the insulin-resistant state, the body has artificially elevated levels of aldosterone. When
such a person eats salt, the kidneys disobey normal physiology by retaining salt, aldosterone not
cutting off. Rather than excreting the salt in urine it is retained in the blood plasma. Over time, this
leads to an accumulation of body water that increases blood volume and raises blood pressure.

Aldosterone signals the kidneys to hold onto sodium and reabsorb it into the blood so that it is not
expelled through urine. Thus, if the adrenal glands release more aldosterone into the blood, the
body will retain more sodium, and where sodium goes, so, too, does water. This increases the plasma
fluid levels, effectively raising the blood volume, and with it, the pressure.

The irony is that doctors just notice the increased serum levels of Sodium, totally ignoring the root
cause of the problem and thereby, guiding their Hypertensive patients to restrict sodium in their diets.
Chronic high intake of sugar; leading to chronically high insulin; leading to aldosterone not cutting
off even after intake of sodium in a meal; leading to the intake of sodium without the normal excre-
tion of sodium from the body, post intake, will adversely affect sodium homeostasis.

What this also means is that sodium restriction works to an extent ONLY in people who suffer hyper-
glycaemia and thus hyperinsulinemia, because their bodies do not naturally shut down aldosterone
and thus do not eliminate sodium well, and instead accumulate it.

Fatty Protein diets will decrease Insulin to normal levels, facilitating sodium excre-
tion by the kidneys, thus causing excess water to follow the sodium. Normalization
of blood pressure and reduction in retained water; are among the most consistent
and predictable effects of correcting your nutrition!

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Even in their case the simple, elegant solution that is 100 times more powerful and the one that
would actually restore a genuinely healthy state, is to restrict SUGAR instead of SALT.
Restriction of sugar (exogenous glucose in all its carbohydrate forms) will first and foremost tackle
and eliminate hyperinsulinemia, which will then make the body responsive enough to the intake of
sodium (mostly from food cooked with ‘salt to taste’) to cut off aldosterone and allow for the appro-
priate quantum of sodium elimination, thus once again restoring sodium homeostasis.

Healthy people who think that having food with less salt or no salt is what healthy food should
be, are actually ruining their health by eliminating one of the most important ingredients of food.

For those who are not yet insulin resistant, and thus not hyperinsulinemic, and thus their bodies
are sensitive enough to sodium intake and thus physiologically shut off aldosterone upon ingestion
of sodium through foods; for them, restriction of sodium as part of a conventional pseudo healthy
diet could lead to hyponatremia.

So, we understand that sodium is a nutrient of prime importance and has a definite role in the
proper functioning of the human body. Lets understand the functions of sodium as an electrolyte,
amongst other important electrolytes like potassium, chloride and bicarbonate. Body fluid contains
electrolytes, chemicals which, when they dissolve in water, produce charged ions. Electrolytes are
minerals, and carry an electric charge.

Electrolytes like sodium, potassium and chloride play an important role in maintaining the water
balance of the human body. Also, if electrolyte levels are too low or too high, cell and organ functions
will get affected, which may be as common as the onset of constipation problems or muscle spasms.

Electrolytes like sodium and chloride happen to be one of the most critical factors responsible for
water retention in the stools. If we don’t consume enough salt, stools get dehydrated even faster
since the large intestines reabsorb sodium chloride from stools. If there is a connection between
water consumption and constipation, it‘s the complete opposite: the more water we consume, the
drier the stool gets because the excess water consumption causes the depletion of sodium chloride.

The main electrolytes include sodium, chloride, potassium, calcium and magnesium. These five
nutritional elements are minerals, and when minerals dissolve in water they separate into positive
and negative ions. For example, when sodium chloride (NaCl) is dissolved in water, it separates into
positive sodium ions and negative chloride ions. Nerve impulse transmission and muscle contrac-
tion / muscle relaxation - as functions for calcium and magnesium are later covered in detail in the
chapter on vitamins and minerals. Another important electrolyte i.e. Bicarbonate helps in main-
taining the acid- base balance.

Sodium and Potassium are the two primary electrolytes in our body, working together
to maintain fluid balance in cells, blood plasma and extracellular fluid.

Electrolytes are present in blood, urine, tissues, and other body fluids. Extracellular fluid has a
high concentration of sodium and low concentration of potassium while intracellular fluid is high
in potassium and low in sodium. Since potassium is a predominant intracellular electrolyte, its
concentration does not drastically reduce in response to sweating hence there is no need to supple-
ment potassium.

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Sodium is dissolved in the blood and plays a crucial role in maintaining blood volume and pres-
sure. Sodium attracts and holds on water. So, the sodium in the blood, helps hold/keep the liquid
portion (plasma fluid) of the blood. Physiologically, blood vessels cannot expand to a large extent;
so any increase in blood volume (due to increase in water or increase in sodium); results in increase
in blood pressure.

Chloride is the predominant ion that carries a negative charge. Chloride is a major contributor to
maintaining the concentration gradient of the ions between the intracellular fluid (ICF) and extra-
cellular fluid (ECF). Chloride functions to balance positively charged ions in the ECF, maintaining
the electrical neutrality of this fluid.

By now, we understand the importance of electrolytes and water for our body. Voluntary restriction
of fluids before their D-day, is normally practiced by bodybuilders who are mostly on incorrect diets.
Voluntary dehydration is a practice followed in weight-category sports such as wrestling, boxing and
bodybuilding where athletes deliberately induce water loss in a week or few days before competition
to reduce body weight so as to qualify for lower weight categories where they face greater chances
of winning against competitors with lower muscle mass and strength.

Body builders also seek extreme water loss to lose all possible subcutaneous water for appearance
of greater muscle definition and vascularity on stage. Except for bodybuilding where performance
on stage is based on aesthetics, voluntary dehydration would actually reduce performance in sports
as it would drop muscle performance during the competition. Voluntary dehydration faces the
same consequences of dehydration, which include not only drop in performance but risk of muscle
cramps and even risk to health and life.

Practices to achieve dehydration may include a pattern of loading and depleting sodium and water
followed a few days before the competition to trick the body’s hormones such as aldosterone and
antidiuretic hormone (ADH) into excreting excessive water in the urine.

• The human body has innate cellular intelligence.

• Allowing thirst to be your guide, is the smartest thing to do.
• Intra workout application can be plain water or salted water (add salt as per taste).

Other practices include; use of strong diuretics along with restricted water intake, thermal-induced
sweating through saunas, and increased exercise-induced sweating. All these techniques pose a
serious risk to performance and health, and when taken to the extreme, have even led to circula-
tory collapse and death.

The human body, like the bodies of all living creatures; has innate cellular intelligence.

If you’re engaging in strenuous physical activity or outside in hot weather, and are sweating profusely,
the utilization of body fluids for sweat production, will cause an increase in osmolarity, and trigger
the thirst mechanism, making you thirstier than usual, and thus urge you to drink more water.

Allowing thirst to be your guide, is the smartest thing to do.

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If you are living in a hot, humid city with a physically taxing job, you obviously need to drink more
water than somebody with an office job in a cooler environment.

The mistake we make is that we doubt the body’s innate cellular intelligence in maintaining fluid
balance. In other words, where you live, what you do, your exercise intensity all govern your fluid
intake which is accurately indicated by your body in the form of an URGE to drink - defined as
THIRST!

During workout nutrition depends on the environmental conditions (climate or temperature

controlled). For example in a conditioned indoor environment like a gymnasium, intra workout
application can be of plain water or salted water (add salt as per taste).

If you are running on the ground in the sun for a longer duration of time and sweating, intra workout
application can be of salt and water. You can add salt as per taste since it cannot be forced and the
body cannot take in more than its requirement.

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