Hydration: An essential ingredient while navigating the path to wellness. By Bryan Glick, D.O., M.B.S.

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1 An essential ingredient while navigating the path to wellness. By Bryan Glick, D.O., M.B.S.

2 Have you ever been told to drink eight, 8 oz glasses of water a day? Do you know why? Is this an old wives tail or based in reality? Providing your body with the proper fluids is a low cost therapy with a high return on your investment. Replacing one of your poor health behaviors with a preventative health behavior like staying hydrated will help your body flourish. In 2004 the Food and Nutrition Board released new dietary reference intakes for water. It is recommended that women consume approximately 2.7 liters (91 ounces) of total water -- from all beverages and foods -- each day, and men an average of approximately 3.7 liters (125 ounces daily) of total water. 3 Based off this research and the content of water in the average diet you can see how the 8 x 8 guideline was created. That s 8oz of water 8 times a day. The most important thing to understanding proper hydration is that, like anything in life, it must be balanced. There is a 10% decrease in your mental performance when you feel thirsty. 4 Dehydration impairs exercise performance. The converse is true such that drinking more than you sweat can have deleterious health implications. 1 Water makes up more than half the content of your body. Every cell, tissue and organ in your body needs water to function correctly. For example, your body uses water to maintain its temperature, remove waste and lubricate joints. Water is essential for good health. 2 Besides water, consuming fluid rich foods will help avoid being dehydrated. Basically any fluid you drink throughout the day contains water like milk, juice and even sodas. Watch out for caffeinated beverages as caffeine is a diuretic and that means it makes you lose fluid in urine. Don t you ever wonder why you have to urinate promptly after that morning cup of joe? Many fruits and vegetables contain a high fluid content such as watermelon, citrus fruits and cucumbers.

3 Symptoms of dehydration include: Less urination Dry mouth Sleepiness or fatigue Extreme thirst Headache Confusion Feeling dizzy or lightheaded Dehydration is crucial to recognize and prevent in two specific populations, infants and the elderly. The causes of dehydration may be easily recognizable to some and more subtle to others. Your body produces fluids to maintain balance in the form of sweat, urine, tears, feces, breast milk and even breathing. When the production of these fluids out paces your fluid intake you will be at risk for dehydration. This is why it is so important for a breast feeding mother to drink measured amounts of fluid while breast feeding. Milk production is very important for the newborn child and the factory producing this vital fluid must have the right building blocks and must be hydrated. Another example, breathing, surprises most people because they are uncertain what fluid is from breathing. The answer is that when you breathe at night you are creating water vapor and weighing yourself before bed and in the morning you can detect a 1/4 to 1/2 pound weight loss overnight. That s right, just from breathing. More obvious examples of fluid loss: spending a long time in the heat without proper hydration, acute diarrhea or prolonged vomiting. All of the above will cause significant loss of fluid. Important in deciding how severe the dehydration is whether they can tolerate fluids orally to keep up with the fluid loss. Many times with acute diarrhea you can experience considerable nausea and vomiting which prohibits fluid replenishment. Dehydration is crucial to recognize and prevent in two specific populations, infants and the elderly. In infants, based on their small size and decreased fluid reserve, very small changes in fluid status from vomiting and diarrhea as well as sweating can be seen by a sunken fontanel leading to serious health implications. For the elderly, their kidney function is in decline and may not be drinking enough fluids for a number of reasons. A simple pinch of the skin on their forearm and it doesn t snap back to normal is a clear indication of dehydration. A combination of any multiple factors can result in hospital admission and intravenous fluid replacement for both these populations. Please pay special attention to the young and the old, especially regarding hydration.

4 There are many signs as evidence of adequate hydration. Your urine should be almost clear. Think about it this way, could you urinate in the toilet and NOT flush for your spouse without them noticing? The best part about this is that it means that you are hydrated and saving water at the same time. Avoid being thirsty because if you are thirsty you are already dehydrated. When you are outside in the heat or humidity and you notice that you haven t urinated for some time, probably time for a break and 8oz of water. If you notice your heart rate is increasing but you are not exercising, this a normal physiologic response by your body to make sure what little fluid left in the body is pumped to the rest of the organs and the brain. The only way to get a lower volume of blood to all the organs is by increasing the heart rate and the blood flow. We are made of water. Keep your tank topped off! It seems pretty simple that water is a good thing but as with everything controversy exists and Heinz Valtin, a Dartmouth Medical School physician, disagrees with the 8 x 8 guideline. Valtin reported that there is no supporting evidence to back up the popular recommendation to drink eight 8 oz. glasses of water per day. Valtin thinks that the notion may have started in 1945 when the Food and Nutrition Board of the National Research Council recommended approximately 1 milliliter of water for each calorie of food, which would amount to roughly 2 to 2.5 quarts per day (64 to 80 ounces). In its next sentence the board stated, [M]ost of this quantity is contained in prepared foods. But that last sentence seems to have been missed, so that the recommendation was erroneously interpreted as how much water a person should drink each day. 5 While I understand the basis for this argument, the assertion that you can get proper hydration from prepared foods is a little off base. Can you get proper hydration from food with high water content? The answer is yes. Do most Americans eat a plant based diet and with high water content foods? The answer is No. The problem is that the food highest in water content are not foods that most Americans eat. Americans have transitioned to a grain-based, calorie rich, nutrient poor and most importantly FLUID POOR diet. The mythbusters above while technically correct in their assertions are trying to poke a hole in a theory to prove a point. They aren t saying humans don t need fluid, they are saying that if you eat the right foods and only if you eat the right foods can you get water from your diet. To help patients in my practice feel better their diet needs to be optimized along with their fluid intake, sleep and psyche. I encounter the damage that the typical American is causing to their body with every bite and I rally their support through education, understanding and teamwork to help them reach their

5 goals. Remember, scientific evidence is a fence. What do I mean? I mean that a fence around your yard fences your kids in and the bears out. All good things I agree but I think there must always be a measure of common sense applied to scientific evidence to prevent us from fencing this one tree from that forest. To prevent dehydration you must do the following: Recognize the sypmtoms of dehydration. If you are thirsty it s We are made of water. Keep your tank topped off! Recognize the symptoms of dehydration. If you are thirsty it s too late! Carry a oz reusable glass bottle every day and consume 2-3 bottles a day. It s important to have a visual reminder of your progress throughout the day. Set a goal and achieve it. Choose water over sugared drinks and those with caffeine. You will also lose weight. When you feel hungry drink a glass of water, the fluid will stretch out the stomach and turn down some of those hunger pangs. Drink water consistently. Before, during and after exercise. If you are watching TV, drink at every commercial break. Have a glass at every meal. Always drink water while driving. Although you can get fluid from the right types of foods, if you re like most Americans, you need to follow the 8 x 8 rule. too late! References: 1. Curr Sports Med Rep Jul-Aug;7(4): doi: /JSR.0b013e31817f005f. Hydration recommendations for sport Centers for Disease Control and Prevention. Water: Meeting Your Daily Fluid Needs. Accessed June 3, Food and Nutrition Board released new dietary reference intakes for water Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx 4. Kendrick Fincher Memorial Foundation. Hydration Facts. Accessed June 3, Accessed 6/4/2013.

6 BRYAN GLICK, D.O., M.B.S. Bryan Glick, D.O., M.B.S., owner and the practicing physician of n1health of Scottsdale, serves patients throughout the Scottsdale and greater Phoenix area. As a doctor of Osteopathic Medicine (D.O.), Dr. Glick is trained as a primary care physician who treats the whole person. The focus for osteopathic physicians is preventive health care, with extra training on the musculoskeletal system. Dr. Glick has built his practice on the core belief that his patients deserve the full attention of a family doctor without time constraints and inaccessibility. To practice medicine in this manner, he developed a private medicine practice in Scottsdale formerly known as Grayhawk Personal Physicians. There he provided advanced preventative care utilizing the Bale-Doneen method, a functional approach to the treatment, prevention and reversal of cardiovascular disease. Recently, Dr. Glick partnered with n1health to join a network of like-minded physicians that are singularly focused on individualized patient care. In this way, Dr. Glick is able to see the patient as an inter-connected web of systems that need to be balanced and adjusted, rather than simply dispensing diagnoses and medications to treat singular symptoms or diseases. He utilizes health coaching along with behavioral modification techniques to educate and motivate patients to create their own wellness and improve their quality of life. Dr. Glick received his undergraduate degree at UCLA in Marine Biology and graduated from the Arizona College of Osteopathic Medicine. He completed his residency program locally, at Banner Good Samaritan in family medicine. He has a master s degree in Biomedical Sciences, and has published two articles based on this research. n1health of Scottsdale 7960 E. Thompson Peak Parkway, Suite B-104 Scottsdale, AZ Dr. Glick was nominated by the Arizona Academy of Family Physicians for the Walter Brazie Fellowship Award as the outstanding second-year family medicine resident in Arizona. He is a featured speaker for CardioDx, Vasolabs, and the American Academy of Private Physicians, and serves on the board for Singulex. When he is not seeing patients, Dr. Glick enjoys practicing yoga, cooking, golfing, mountain biking and woodworking. For more information, please visit n1healthscottsdale.com or call us to schedule an appointment at (480)

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