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Can drinking too much water cause constipation?

Excessive fluid consumption from all sources leads to a depletion of potassium, and is one of the major causes of constipation and ensuing dependence on fiber.

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Chapter 2. Water Damage

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

Arthur Schopenhauer (1788 - 1860)

The infatuation with fiber brought with it another menace—the pro­verbial eight glasses of water. Everyone and their dog insists that you MUST drink eight glass of water a day for health and beauty. Well, if you follow this advice, you’re assured of disease and prema­ture aging, which is just the opposite of the original intent.

Water Abuse:

They Play With Words, You Pay With Health

Drinking more water does nothing to lower cholesterol, nothing to prevent colon cancer, nothing to make stools “wetter” or softer, and nothing to alleviate constipation. If anything, the more you drink, the worse all of those things are going to get, including fiber depend­ence and constipation. Why, then, does the advice to drink more water invariably accom­pany the advice to eat more fiber? Apparently, because of associa­tive word play: if a hard stool is dry, then water supposedly makes it moist. As it turns out, this is pure fiction, based on observational con­jectures derived from several unrelated facts: Conjecture #1: Because fiber absorbs water (true), it will increase stool moisture. Wrong! Dietary fiber in stools doesn’t retain water any better than other cellular components, except psyllium seeds in laxatives [1] (a mere 5% more). Word play: dry/moist. Conjecture #2: Because fiber is so highly water-absorbent (true), it requires additional water. Wrong for two reasons! First, up to 75% of fiber [2], including insoluble fiber, gets fermented by intesti­nal bacteria and doesn’t require any water. Second, the remaining fi­ber gets all the water it needs from up to seven liters of digestive juices, which are secreted daily inside the alimentary canal. Word play: dry/wet, absorb/water. Conjecture #3: Water is needed to prevent intestinal obstructions from dietary fiber: Wrong! Water, actually, expands the fiber four to five times its original volume and weight [3], and if anything makes obstruction even more likely. Word play: plug/solvent. Conjecture #4: Water is needed to prevent esophageal obstruc­tions with fiber laxatives. True, water is needed to dissolve fiber powder before taking it, but this has nothing to do with regular food, bodily needs, or constipation, only with drug safety. Word play: dumb/and dumber. If you still have your doubts (can’t really blame you), here is a quote from a Journal of American Dietetic Association’s article, enti­tled “Health Implications of Dietary Fiber”: It is a common but erroneous belief that the increased weight [of stool] is due primarily to water. [4] But that’s not all. Too much water (with or without the fiber) causes more problems than you may realize. Besides, you may con­sume too much water even if you ignore the ubiquitous “eight glasses” advice altogether. This happens because our bodies replen­ish water from four principal sources: From drinking water. Tap, well, spring, and mineral are the pri­mary sources of unadulterated water. Its volume is apparent and easily measurable, because that’s what you drink—100% water. From fluids and drinks of all kinds: colas, seltzer, coffee, tea, juices, dairy, wine, beer, milk, soups, sauces, and so forth. The wa­ter content ranges from 85%–99.9%, and most of it is all appa­rent and measurable as well. Water hidden in solid food. Water is the largest single component of most food, ranging from 50%–70% in meats to 75%–96% in fruits and vegetables. This water isn’t apparent until you squeeze it out under the press or in the juicer. Water from metabolic oxidation. Water is formed as the by-product of many biochemical reactions that take place inside the body, and is actively reused. This water is hidden, completely out of view. Hidden water happens to be as real as water from any other source. But because almost no one counts hidden water, the total daily intake may easily go through the roof. Keep reading!

Eight glasses: Fountain of youth or fountain of death?

Though we look rather solid, and feel dry to the touch, anywhere from 41% to 84% of our body weight is represented by water alone. The spread is so wide because of age, fat (adipose tissue), and pro­tein (muscles) content. In general, a frail old person will have the low­est ratio of water content to total body weight, while newborns and infants will have the highest. For adults (19 to 50 years of age) the water content ratio ranges from 43% to 73% for men, and 41% to 60% for women. The water content decreases in overweight people, because adipose tissue contains less water (10%–40%) than does lean tissue (75%). For the same reason—more fat—women’s bo­dies con­tain less water than men’s. (Source: all figures. [5])

Certainly this leading component of body chemistry is extremely important for our health, and indeed, water’s profound deficit may cause death, and death happens rather fast in its absence. But what about an excess of water? Can it cause a “slow death”?

Yes, it can, and it does. But before analyzing the meaning and im­plication of “slow death,” let’s establish a norm. In other words, what’s the average daily water requirement for the average adult?

Since this question is so controversial, let’s quote directly from a well-regarded academic textbook. (The abbreviation ca. means circa, academic speak for “approximately.”) Hold on to your toilet seat: A person weighing 70 kg [155 lbs] requires at least ca. 1,750 ml [59 oz] water per day. Of this amount ca. 650 ml is obtained by drink­ing, ca. 750 ml is the water contained in solid food, and ca. 350 ml is oxidation water. If more than this amount is consumed by a healthy person it is excreted by the kidneys, but in people with heart and kidney disease it may be retained (edema; pp 505, 771f). —Human Physiology; Robert F. Schmidt, Gerhard Thews, 2nd edition As you can see, only 1,400 ml (47 oz), or about six glasses of wa­ter, are required every day from food and drink in almost equal pro­portion. The rest—the hidden oxidation water—is derived from the body’s internal chemistry. Also, please note one crucial point: 1,750 ml is equal to about seven-and-a-half glasses of water. This is where the initial round fig­ure of “eight glasses” (1,890 ml) originally came from. What Human Physiology makes plain is that only 650 ml, or about two-and-a-half glasses of water, “is obtained by drinking.” Not eight, as we have all been told to drink. Here’s another excerpt, this time from The Merck Manual of Diag­nostic and Therapy, which is considered the gold-standard medical reference source and “must have” manual for any physician and re­searcher worth his or her salt. The Merck is even more miserly and specific: ...a daily intake of 700 to 800 ml is needed to match total water losses and remain in water balance... [6] Just 700 to 800 ml, or about three full glasses of water, derived from all food and drink for the entire day. One average-sized Valen­cia orange contains 104 grams of water; one medium-sized tomato 200 grams; one eight-inch cucumber 286 grams. Essentially, two or­anges, one tomato, and one cucumber will provide all of the water you need for the entire day. Nutrients Reference Lookup Find nutrients content: Fiber Protein Fat Cholesterol Carbohydrates Sugars Fiber Water Calories Ash Within the food group: All food groups All food groups American Indian/Alaska Native Foods Baby Foods Baked Products Beef Products Beverages Breakfast Cereals Cereal Grains and Pasta Dairy and Egg Products Fast Foods Fats and Oils Finfish and Shellfish Products Fruits and Fruit Juices Lamb, Veal, and Game Products Legumes and Legume Products Meals, Entrees, and Side Dishes Nut and Seed Products Pork Products Poultry Products Restaurant Foods Sausages and Luncheon Meats Snacks Soups, Sauces, and Gravies Spices and Herbs Sweets Vegetables and Vegetable Products

Show order: Highest to lowest Highest to lowest Lowest to highest

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Hard to believe, right? Then read The Merck Manual on the Inter­net (it’s free), and verify for yourself that the quote above is accurate and taken within the proper context. Print that article, highlight the relevant passage, and show it to your doctors, dieticians, nutrition­ists, parents, partners, colleagues, spouses, or anyone who insists that you must drink eight glasses of water along with all other food and drink. Out of stubbornness some may dismiss my book, but not The Merck. Now let’s do the “eight glasses” math: eight glasses of water times 8 oz per glass equals 64 oz, or 1.89 liters. This amount of water alone is more than the total daily replacement needs for the average adult, by either Human Physiology or The Merck’s criteria. And this is just drinking water we’re talking about. After adding up all of the water from beverages, water concealed in solid food, and water de­rived from invisible metabolic oxidation, you end up getting much, much more than your daily requirement. And this is exactly what most Americans have been doing for sev­eral decades: consuming two to three times more water than they need. At the present time, the average daily water consumption by men in the United States stands at 3.7 liters (125 oz, or almost a gal­lon), and 2.7 liters (91 oz, or 11.5 glasses) by women. [7] And that’s be­fore adding the water from solid food and oxidation.

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So why, despite the obvious facts and common knowledge, do most medical authorities think so very differently and urge people to drink more, and not less?

Water requirements: In Big Brother’s loving care

The reason lies in the approach. While this book relies on aca­demic and medical references, medical authorities in the United States rely on Recommended Dietary Allowances (RDAs), a set of guidelines published by the National Research Council (NRC). The NRC is funded by the United States government, and it is chartered to determine and set the nation’s paternalistic nutritional standards through the Food and Nutrition Board (FNB), its policy-setting arm. The RDAs are best known from the serving tables that appear on all food and supplements labels. The goals behind RDAs were cer­tainly honorable, but some of the results are typical by-products of a government bureaucracy that’s answerable to no one: wrong po­li­cy, bad results, even more wrong policy to justify the results. The very first suggestion to drink eight glasses of water came from the academic figures already cited. Unfortunately, the go­vern­ment’s proxies failed to forcefully remind the scientists and public alike that the “eight glasses” was meant to include all water con­sumed daily—water from beverages, from oxidation, and hidden in solid food. A few decades later, after most Americans started to heed that sug­gestion in earnest, the Food and Nutrition Board surveyed the aver­age water consumption of people in the United States (the already mentioned 3.7 and 2.7 liters for men and women respectively), and presumed that this was the amount all the rest of us must drink. (Source: National Health and Nutrition Examination Survey (NHANES) III [8]; 2004 Dietary Reference Intakes for Water, Potas­sium, Sodium, Chloride, and Sulfate. [9]) What’s wrong with relying on population surveys? Well, for start­ers, surveys don’t take into account a simple fact, that most Ameri­cans have been hooked on the likes of Folgers, Lipton, Tropicana, Coke, and Budweiser. The more you drink these beverages, the more water is required to replace the losses caused by caffeine, sugar, and alcohol, which are all potent diuretics. That’s why water consump­tion in the United States is so high to begin with, even among those who ignore the “eight glasses” advice. Next, for the sake of experiment, you can easily increase water loss by simply having a healthy person drink more water. Even a three-year-old knows that the more you drink, the more you pee, and the more you pee, the more you need to drink. In a nutshell, that’s how the “finest” government-funded scientists arrived at their find­ings and recommendations—by measuring the end result of their ini­tial bad advice to drink eight glasses of water in addition to all food and drinks.

Overhydration: Too much of a good thing?

Now comes the “slow death” part. Can you wash away your health with too much water? According to Human Physiology, yes, you can: Overdosage symptoms. If larger amounts of hypotonic solutions [water with low concentration of mineral salts] are taken within a short time into the body, or large amounts of salt are lost, there can be a transient influx of water into the intracellular space (pp. 771f). The resulting syndrome, called water intoxication, consists of im­paired performance, headache, nausea or convulsions (symp­toms of cerebral edema). Translation into everyday English: long before the body starts twitching uncontrollably, too much water from food and drinks causes edema, fatigue, migraine, and symptoms of digestive di­stress (nausea). But that’s not all. Other side effects happen along the way, princi­pally because of ongoing mineral loss from excessive urination. Here’s a partial list: Constipation. Potassium is a principal electrolyte, responsible for water retention inside human, bacterial, and plant cells. Overhydra­tion causes the gradual loss of potassium through urine. Potassium deficiency, not shortage of water, is the principal reason behind stool dryness. The dry stool causes constipation, because it is hard, abrasive, and difficult to eliminate. Kidney disease. It doesn’t take a medical degree to understand that kidneys pumping two, three, four or five times more water than normal will wear out faster. (The resources of our internal organs was determined by evolution long before Coke, Pepsi, and Bud came on the scene.) Kidney stones in particular are associated with calcium deficiencies that may result from either a deficiency in one’s diet or from loss related to overhydration. Urinary disorders. Urinary infections are a common side effect of overhydration. With too many carbs and too much water in the sys­tem, urine alkalinity drops, acidity goes up, and the bladder and urethra become hospitable to pathogenic bacteria, which have an af­finity for an acidic environment. Elevated glucose in the urine from too many dietary carbohydrates greatly stimulates these infec­tions by providing plentiful feed for pathogens—a warm, dark bladder becomes just as hospitable to bacteria as a sweet-and-sour Petri dish. Digestive disorders. The more you drink right before, during, or within the first few hours after a meal, the more difficult and time-consuming digestion becomes, because it requires correspond­ingly more hydrochloric acid and digestive enzymes to bring their concentration up to the optimal level. [10] The high vo­lume of liquid in the stomach is prone to causing heartburn, which results from the spillage of acidified content into the unprotected esophagus. In­digestion, or delayed digestion (gastroparesis) causes gastritis—an inflammation of the stomach’s mucosa, which may eventually lead to ulcers. Chronic indigestion may also result from a chloride deficiency (hypochloremia), especially when excess water con­sumption is accompanied by reduced or salt-free diets. Degenerative bone disease. A loss of minerals in general, calcium in particular, leads to bone softening—osteomalacia in adults, sco­liosis in young adults, and rickets in children. (Osteoporosis is a bone tissue disease, and not a mineral deficiency condition, as mis­takenly thought by most people, including most medical profes­sionals. [11] A loss of bone tissue—collagen that makes up the bone matrix—leads to bone brittleness, not softness, as from the loss of minerals.) Premature aging.Facial bones determine our overall appearance and create a perception of age that no makeup or plastic surgery can hide. Because of a comparatively low physical load, facial bones experience the fastest loss of bone tissue and minerals. I call this Mick Jagger syndrome, after the characteristic facial appear­ance of this famous performer. This isn’t surprising—hyperactive stage performers perspire profusely, and drink gallons of water on and off the stage. It’s just more apparent on Mr. Jagger’s face be­cause he’s underweight, and has no fat to cover up a profound bone loss. Muscular disorders. Calcium and magnesium are key regulators of muscle contractions. A deficiency of these two minerals is broadly associated with fibromyalgia, fatigue, cramps, tremors, in­voluntary flinching, and many other conditions that affect not just body muscles, but also the eyes, blood vessels, intestines, heart, womb, and all other organs that are controlled by the muscles. Unstable blood pressure. Hypertension and hypotension naturally follow water binges. First, as the volume of blood plasma in­creases from absorbed water, blood pressure rises. As long as the kidneys remain healthy, the excess is quickly removed, along with the minerals. As the minerals become depleted, the volume of plasma goes down in order to maintain its chemical stability, and low blood pressure sets in. Even though low blood pressure isn’t likely to cause heart attack or stroke, it is as dangerous, because it causes dizziness, drowsiness, and disorientation—not the most de­sirable state for driving a car, managing heavy machi­nery, or car­ing for a child. Heart disease. The heart is a muscular organ. Its health and effi­ciency mirrors the rest of the body, and anything that affects the muscles on the outside, impacts the heart on the inside. Over 400,000 Americans die annually from sudden cardiac arrest. Their hearts simply stop beating. Eighty percent of all cardiac arrests re­sult from “electrical dysfunction” [12] of the heart muscles. Lo and be­hold, minerals—calcium, magnesium, sodium, potassium, and chloride—happen to be the major carriers and/or regulators of those electrical signals, and overhydration is the primary cause of their disbalance, be it an excess of potassium and magnesium, or a depletion of calcium and chloride. Not surprisingly, cardiac arrest preceded the demise of Dr. Atkins, who was also an avid advocate for “eight glasses.” He was fitted with a pacemaker to correct “electrical dysfunction,” but died any­way a year later under mysterious circumstances. According to nu­merous press accounts, [13] his autopsy and medical records revealed a history of heart attacks, congestive heart failure, hypertension, and cardiomyopathy—a heart enlargement typical for overweight men who suffer from high blood pressure. If you care to learn what kind of harm mineral deficiencies can cause, please review The Merck’s “Mineral Deficiency And Toxic­i­ty”chapter [14] on the Internet. Once you learn how important these minerals are, and how profound their loss can be on your health, you’ll understand why a blood test—which provides a relative [15] mir­ror of your mineral status—is such an important diagnostic tool. And nothing dilutes blood faster and leaches those important mine­rals out of your body more than too much water does, especially fil­tered, processed, devitalized, soft water that you’re most likely to con­sume from the tap, bottle, or with factory-made refreshments.

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Moderation: Easy said, easy done

Now we’re primed for the key question: what should your total wa­ter intake be? (I didn’t write “how much do you need to drink” on purpose, because water comes from other sources.) First, thirst should be the first indicator that your body needs more water. But be careful here—the more you drink, the thir­stier you be­come. So you need to bring down your water consumption gradu­ally. Second, the guideline to obtain 1.4–1.6 liters of water daily from all sources—water, drink, and food—is a reasonable one (the equivalent of 5 to 7 glasses). The other 400–500 ml will come from oxidation. Finally, we’ve already established that additional water isn’t re­quired to “dilute” fiber or prevent constipation. You already have plenty of water inside the GI tract to keep your stools moist. The kidneys don’t lie. Under normal circumstances, a healthy per­son should urinate no more than three to five times daily, and zero times during the night, while asleep. If you urinate more often, if the urine is colorless or transparent, or there’s a large volume of it, your cumulative water intake is probably too high.

As always, there are exceptions. Keep these important points in mind:

Physical activities. If you are physically active, exercise strenuously, visit a sauna, drench in hot baths, or perspire heavily for other reasons, your wa­ter needs increase in order to compensate for the losses with sweat, urine, and vapors in exhaled air. Medical conditions. If you have kidney disease or diabetes, or experience diarrhea or vomiting, your water needs increase to compensate for losses re­lated to frequent urination, vomit or stool. Age. The thirst reflex may be blunted in the aged and infirm, and their water intake must be closely monitored. Too much water in this situation is as dangerous as too little, because older hearts and kid­neys can’t expel excess water as fast, and may cause life-threaten­ing edema, hypertension, arrhythmia, blood clots, diarrhea, kidney failure, and many other medical emergencies. Environment. High temperatures, high altitudes, and low humi­dity (dry air) lead to rapid water loss through the lungs and skin (the technical term is insensible losses). The rate of water loss in these circumstances may be up to ten times greater than normal. Infants and toddlers require 1.5 times more water than adults for the following reasons: a higher physiological turnover of water, lar­ger skin area relative to body weight, larger percentage of body water, greater need by the kidneys to remove metabolites, and the inability to express thirst. Don’t confuse “inabilityto express” with “ability to sense.” Unlike socially conditioned adults, chil­dren’s instincts are finely tuned to their bodily needs. The role of a parent or guardian is to provide fluids, but never to force children to drink. Obviously, the fluid provided shouldn’t be juices or soft drinks. Fresh non-carbonated mineral water, preferably from a glass bottle, like Evian, Panna, or Vichi, are the best sources of drinking water for a growing child. Adequately breastfed babies don’t require additional water. Pregnancy. Despite what you may have heard from medical profes­sionals, pregnancy doesn’t impose additional water require­ments beyond an additional 30 ml (about 1 oz) per day. [16] Overhy­dration, along with the chronic deficit of electrolytes and mi­nerals often induced by drinking too much water, is one of the reasons so many pregnant women suffer from edema, nausea, anemia, consti­pation, and inevitable bone disorders: osteomalacia (soft bones), os­teoporosis, degenerative arthritis, periodontal disease, cavities, and many others. Lactation. Since up to 86% of breast milk is water, lactating moth­ers must drink an amount of water equal to the amount of milk they produce, or about 750 to 1000 ml (3 to 4 glasses) extra. Inter­estingly, most women add water, but fail to replace all of the essen­tial fats, proteins, minerals, and microelements that they ex­crete with milk. This omission impacts their own health, and com­promises the health of their babies too, because the quality of milk goes down, and the milk volume may run short or disappear alto­gether. The impact of rapid overhydration is comparable to poisoning. Con­suming too much water than is necessary over a long period of time is as bad, except the problems aren’t as immediately obvious as they are after five to ten liters of water are ingested in one sitting. Finally, here are the additional reasons why too much water makes fi­ber dependence more pervasive and constipation worse: Human anatomy. The digestive organs aren’t a straight tube, so none of the water that you drink streams down into your large intes­tine to moisten or flush out feces. Physiology of digestion. All water from food, drinks, saliva, and di­gestive juices—about seven liters daily—gets absorbed back into the bloodstream in the stomach and small intestine (75% to 90%), and the rest gets assimilated in the large intestine. Minimal requirement. Only 1% of all water involved in diges­tion [17]—the sum of all intake and the secretion of saliva and diges­tive juices—is excreted with stool. I repeat, only 1% (about 70 ml, or 2 oz). As you can see, drinking too little water isn’t going to make much immediate difference in the stool’s shape, weight, moisture content, and consistency, while drinking too much will eventually make the stool dry and hard because of potassium depletion. As stools get drier, people begin adding more and more fiber and drinking more and more water, instead of less.

Underhydration: The opposite side of the coin

What’s the difference between dehydration and underhydration? Underhydration is on the opposite side of overhydration, but not yet as self-evident as dehydration. And that’s why it’s as treacherous as overhydration. The subject of water’s role in health and well-being is insepa­rable from certain essential minerals that help maintain the tight water bal­ance inside the body. You can drink plenty, and still be underdehy­drated, or even dehydrated, when those minerals are miss­ing because of an inadequate diet, heavy perspiration, diarrhea, vomiting, kidney disease, and certain medical conditions. Even then, neither underhydration nor dehydration are likely to cause constipation, because so little water is needed to maintain stool moisture. However, the shortage of those minerals and related ailments may and will cause constipation and fiber dependence.

Chapter summary

The dependence on fiber to maintain regular stools is partially a result of chronic overconsumption of water. The volume of water consumed daily doesn’t play any direct role in forming the stool or causing constipation. The recommendation to drink eight glasses of water in addition to food intake is wrong, because it doesn’t take into account the sub­stantial water content of food and water produced by the body’s own metabolism. Actual daily water needs depend on age, weight, health, gender, oc­cupation, climate, diet, and some other factors. It’s individual for each person, and can’t be generalized. Stool dryness and hardness isn’t caused by water deficiency, and can’t be overcome by drinking more water. To overcome dryness, one must restore intestinal flora and mineral balance, primarily po­tassium. Stool weight, mass, and form doesn’t depend on the amount of con­sumed water. At most, normal stool contains under 75 ml of water (per 100 g), about five tablespoons. Excessive fluid consumption from all sources leads to a depletion of potassium, and is one of the major causes of constipation and en­suing dependence on fiber. Overconsumption of water causes a broad range of other condi­tions and diseases related to depletion and deficiencies of essential minerals and microelements, and adds additional stress on cardiovascular, genitourinary, and digestive organs.

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