“Stay hydrated” is a common phrase we often share along with “drink more water”. I remember attempting to follow the advice in the Google gym to drink half your body weight in ounces of water. Wow, what a disaster. Have you ever felt thirsty even though drinking a ton of water? Have you ever noticed that responding to that by drinking more water doesn’t change the craving and the water seems to go right through you? In this article I’ll explain why, how to know if you’re hydrated or not, and the best liquids for hydration.

TLDR:

Hydration refers to the total amount of water in your body as well as how much is inside your cells.
Thirst and urine color are your best guides for your hydration status.
Water should be primarily consumed with electrolytes and sugar in order to maximize hydration, not plain water.
Almost everyone with hypertension, especially those using ACE inhibitors, have electrolyte deficiencies and imbalances.
Almost everyone is deficient in potassium leading to a wide range of pathologies including dehydration, edema, hypertension, stroke, kidney stones, and hyperglycemia.
Fruit juices, milk and bone broth are excellent hydrating drinks containing good amounts of electrolytes.

The human body is roughly 60% water and of that, about 35% of it should be outside cells and 65% should be inside cells to be properly hydrated. For five years I tested people’s hydration level with a bioimpedance device (BIA) which can measure total body water (TBW), extracellular water (ECW) and intracellular water (ICW). Out of about 100 people, most of them had low ICW but sufficient TBW and ECW. No matter how much water they drank, it didn’t increase inside the cells. We ran experiments with all different types of water and water processes. A person could drink 24 ounces or 64 ounces of water and it didn’t change ICW. Obviously there are other variables to improving hydration that I later learned.

There are a lot fitness myths floating around about water. One is that you become dehydrated before you become thirsty. Another in the same vein is that if you feel thirsty you’re already dehydrated. A third is that if you’re hungry you’re actually dehydrated. There’s no evidence to support these sentiments. Thirst is your compass for hydration status. If you’re thirsty drink. If not, don’t drink.

Some of this hydration advice can actually be harmful like ‘drink half your body weight in ounces’. Excess water consumption has two negative effects. One is that you can deplete yourself of precious electrolytes that most of us are already deficient in. Secondly, you can suppress your appetite which leads to decreased calorie intake and cortisol-induced starvation responses.

Urine color is another key hydration marker. If your urine is Transparent or Lemonade colored, you’re drinking too much water or not getting enough electrolytes or both. If its dark and strong smelling like Burnt Orange, too little. The sweet spot is right in the middle called Light Beer. BTW, the dark orange color in urine appears when the ratio of urochrome aka urobilin, a pigment produced from the breakdown of hemoglobin, to water is high.

Other common symptoms of dehydration are low urination frequency, dry mouth and tongue, low saliva production, fatigue, and headache among others. However, there are many other causes for these symptoms as well.

To understand how to get optimal ICW, we need to start with understanding electrolytes.

The most important electrolytes for intracellular hydration are sodium, chloride, potassium, and calcium. Electrolyte balance is managed by your kidneys as well as the amount of TBW, ECW and ICW. Any imbalances severe enough, for long enough, put strain on the kidneys.

Imbalances in potassium, sodium and/or calcium will cause frequent urination that is clear or very light colored. This is the case when you feel thirsty and can’t satisfy it by drinking plain water.

A lot of water, sodium, chloride and potassium are lost when sweating. In fact, sweat contains more potassium as a percentage of total minerals than blood.

The National Academies of Sciences, Engineering, and Medicine (NASEM) set the Adequate Intake (AI) for potassium at 3,400 mg per day and 2500 mg for sodium. The American Heart Association recommends 3,500 mg to 5,000 mg of potassium daily for individuals trying to prevent or treat high blood pressure. The Merck Manual sets the standard at 4700 mg. Potassium has the highest Adequate Intake value of any mineral and more than twice the second highest AI of chloride at 2300 mg.

Less than 2% of US adults overall consume the recommended 4700 mg of potassium per day. Pair this with the overconsumption of sodium and you have a good recipe for dehydration, edema, hypertension, stroke, kidney stones and diabetes.

Balancing sodium and potassium intake is fundamental to maintaining healthy blood pressure via the Renin-angiotensin-aldosterone system (RAAS). Excess sodium intake, relative to potassium, leads to increased blood volume and can cause blood vessels to constrict leading to high blood pressure. Potassium promotes sodium excretion through the kidneys and relaxes blood vessel walls, helping to lower blood volume and blood pressure.

ACE inhibitors block the conversion of Angiotensin I to Angiotensin II as well as lower Aldosterone, which in turn retains potassium. These mineral imbalances cause strain on the kidneys which are responsible for managing them. This is why kidney markers (BUN, Creatinine, eGFR) are often examined in cases of hypertension and dosing with ACE inhibitors.

I’ve looked through PubMed and cannot find a single study showing people that have optimal electrolyte balance and hydration status that also have hypertension. It seems they can’t coexist.

The sodium-glucose co-transporter is one of two major ways water enters the cell. This co-transporter requires glucose to transport water. This study showed that “260 water molecules were directly coupled to each sugar molecule transported.” This co-transporter is also called SGLT-1.

The other major way water enters the cell is through aquaporins, which are regulated by calcium concentrations inside and outside the cell.

Drinking large amounts of plain water dilutes electrolytes in the blood, particularly sodium, a condition known as hyponatremia. This sodium dilution can trigger increased urine production to maintain electrolyte balance. Paradoxically, over-watering can cause headache, brain fog and muscle cramps and weakness.

Sports nutritionists at the University of Florida understood all of these mechanics so in 1965 invented Gatorade for the football team. The original recipe contained water, glucose, salt, potassium, phosphate and lemon juice. The team's success in the 1966 season (with a 9-2 record) and their reputation as a strong second-half team contributed to Gatorade's popularity To be clear, I’m not recommending sports drinks like Gatorade for all the garbage in them now. A homemade sports drink recipe with a 1:1 ratio of juice to water with a pinch of salt is far cleaner and provides additional micronutrients.

In the winter, I drink might drink 8 ounces of plain water but 48-64 ounces of other liquids. Typically that includes orange juice, grape juice, pomegranate juice, low-fat milk, bone broth, coffee and herbal tea with the majority being juice.

These liquids provide plenty of sodium and chloride, glucose, water, potassium and calcium. I monitor my thirst, urine color, Cronometer mineral intake and blood labs to maintain mineral status.

One additional thing I noticed was that my pulse rate decreased by 5bpm by increasing potassium.

If you haven’t had much juice historically and want to start increasing it move slowly and choose fruits that have a that have a 1:1 fructose to glucose ratio. The reason for this twofold: glucose can help your small intestine absorb fructose and the GLUT5 transporters that absorb fructose work in a dose-dependent manner. So if you don’t regularly drink juice, then suddenly smash 32 ounces of OJ there will likely be excess fructose you aren’t able to absorb fermenting in your colon causing dysbiosis. Fructose malabsorption causes leaky gut and subsequent endotoxin release. Gut-based endotoxin is a primary cause of mitochondrial dysfunction, systemic inflammation and fatty liver.

It’s worth noting that the alleged healthy sweetener agave syrup contains roughly 85% fructose/15% glucose and high fructose corn syrup (HFCS) is 55% fructose/ 45% glucose. From the standpoint of fructose malabsorption, agave syrup is far worse than HFCS. Cane sugar (sucrose) is 50:50, a perfect balance. In addition, agave syrup is often marketed as a natural alternative even though it undergoes as much processing as HFCS.

Lastly, this study demonstrated that potassium depletion causes impaired insulin secretion in the pancreas leading to glucose intolerance. The authors demonstrated that insulin production decreased by 27% which decreased the amount of sugar metabolized by the same amount. The end result was hyperglycemia.

Fruits that have a 1:1 ratio and high amounts of potassium are oranges, grapes, pomegranates so their juices are perfect for hydration and electrolyte balance. Apricots, prunes, potatoes and acorn squash are excellent potassium sources. Dairy has good potassium and is the calcium staple in a pro-metabolic diet.

Adding a pinch of salt and carbonated mineral water to juice is the great way to hydrate as well. On top of the glucose, potassium, sodium and chloride you’ll get CO2, the body’s endogenous vasodilator. CO2 also converts to bicarbonate, another important electrolyte involved in pH balance.

I often give my kids a 1:1 water/juice drink with a pinch of salt. And remember, sugar is nature’s cortisol suppressant.

To your health,

Jonathan

This is for informational purposes only and should not replace professional medical advice. Consult with your physician or other health care professional if you have any concerns or questions about your health.

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