Drinking water: The first commandment of good health

MALAYSIA - As a nation, we are drinkers. We drink to glory all the time - kopi, teh tarik, and what not.

Yet, ironically, the majority of us are not getting our proper dose of fluids despite being told to drink six to eight glasses (1.5 to 2 litres) of water a day. The result: dehydration.

There are a number of causes of dehydration, including heat exposure, prolonged vigorous exercise, vomiting, diarrhoea, kidney disease, and consumption of diuretic medications.

Dehydration can lead to stress, chronic pain, fatigue, weakness, headache, irritability, dizziness, impaired physical performance and many degenerative diseases. It can also be fatal.

Some professions also put employees at risk for dehydration.

Job hazards

Jon Nathan knows what it is like to be overheated and dehydrated. The former full-time mascot and clown used to be in his costume for four hours at a stretch.

"Back then, the older gear had no ventilation, and it would be a sauna in there! The heat depended on the weather. If I had an indoor show, it would be like running five kilometres in the gym. It was worse outdoors and I'd be sweating profusely despite wearing only shorts and a moisture-absorbing singlet or T-shirt inside. As a clown, I had to wear layers and layers of clothes. It was heavy and hot," he recalls.

The fabric for the mascot is usually spongy, made of fibreglass, paperboard, upholstery foam or canvas. There is also a helmet inside the mascot head. To keep the body shape, there are hooks and wires inside.

The newer mascot gear comes with ventilation fans, mini holes with netting or pockets for ice to allow the wearer to cool off.

He says, "For hygiene purposes, it's easier to clean the outfit if it's made from tarpaulin-like fabric on the inside, but that also means the material is non-breathable."

Initially, Jon was excited to be entertaining in full mascot gear, and although his clothes were drenched in sweat, he ignored the discomfort. Not only was it bulky and tiring, his uniform limited his mobility.

"I didn't know what to expect the first few times as I was thrilled to be a mascot. In an event, you're not sure when it's going to end, so I may not have time to drink water. If there is an assistant, it is a bit easier but most companies don't want to pay for two persons."

With two mascots, each one would take a short break every 40 minutes to hydrate and breathe. Otherwise, hydrating himself was furthest from his mind. Because he was young, he paid no attention to the dehydration signs and kept going. If there were 10 shows a month, Jon would easily lose 3kg a month.

"It was probably water loss, but I didn't complain because I had a little bit of weight then. I probably shouldn't be saying this... then all the girls will become mascots just to shed the pounds!" he says, laughing.

Eventually, he realised the perils of the job and guzzled down plenty of fluids during breaks to keep his body temperature down. Those mascot days are over as Jon, 29, has since joined the corporate life and is happy to be working in an air-conditioned environment.

"I did it for three years and decided to grow up, though I'm still not drinking enough water," he admits.

Unlike Jon, who didn't suffer too much from the effects of dehydration, Siti Halimah Daud, 31, an information technology specialist, has been agonising over frequent headaches and lethargy the past two years. She checked her eyesight and consulted various doctors, who diagnosed her as having tension headaches.

"My headache will start in the afternoon and taper off towards the night. In the morning, I'd be fine. I even thought it was sick building syndrome because my office is very dusty," she says.

The headaches worsened every time she was stressed and would cause her to vomit. If the pain were unbearable, she would pop painkillers. One fine day, a colleague pinpointed that she hardly drank water. Siti Halimah's fluid intake was limited to a cup of black coffee in the morning and at lunch.

"I never realised I wasn't drinking water because I was never thirsty. I hardly exercise either," she reveals.

Consciously, she started bringing a tumbler of water to work. Within two weeks, her headaches and fatigue disappeared. The solution for her mild dehydration was really simple, although the doctors missed the underlying cause.

Relieved that she no longer is in pain, Siti Halimah says, "I try to drink at least six glasses of water now. It really does keep the doctor and diseases away!"

Jon and Siti Halimah are not alone in their predicament, as the majority of us are not getting our daily dose of fluids. Last year's study by the Health Ministry showed that less than 35 per cent of Form One, Two and Four students from 50 schools in the country drink the recommended six to eight glasses of plain water a day.

Water is best

According to the president of the Nutrition Society of Malaysia, Dr Tee E Siong, nothing beats drinking plain water, as it is safe and a low-cost way to ensure adequate fluid intake without additional dietary energy.

"The time to drink water should be well spaced out throughout the day, especially for children who play actively. It doesn't matter what age you are, people who sweat a lot or work in hot conditions are prone to dehydration," he says.

For athletes, excessive sweating causes them to lose electrolytes and essential minerals, so consuming isotonic drinks is necessary to replenish the lost fluids.

Prolonged exercise can also lead to dehydration. Restoration of water balance takes time due to the limitation in the rates of uptake and redistribution of fluid in the body.

Feeling thirsty alone is insufficient in restoring water balance, so athletes must drink more. Drinks with low sodium content are ineffective at rehydration, as they will only reduce the stimulus to drink. Eating a small carbohydrate snack in addition to the rehydrating drink, may improve the intestinal uptake of sodium and water.

"If you're not a sportsman, you don't have to down isotonic drinks constantly. You're just sitting down and doing nothing, so you don't need the excessive sodium and minerals in your body," cautions Dr Tee.

Recent research has shown that caffeinated beverages contribute to the body's daily fluid requirements no differently from plain water. Java lovers can rejoice that coffee and tea do not act as a diuretic when consumed in moderate amounts.

Dr Tee says, "The concern is the caffeine content, but drinking three to five cups of coffee or tea a day is okay. Tea has antioxidant properties, which are good for you. You can also include any beverage (except alcohol) or clear soups as part of your water intake, but it shouldn't be sweetened or too savoury. If it's too savoury, it probably has a high salt content and additional calories."

Alcoholic beverages (eg beer and wine) also contribute to energy intake without other nutrients, as one gram of alcohol contains approximately seven kilocalories, almost similar to that contained in fat (nine kcal).

Water therapy

For a while, there was a fad about water therapy, which claims to control diseases and keep the body well-hydrated. Basically, you have to drink 1.5 litres of room temperature water as soon as you get up in the morning and control your water intake during the day.

In fact, even if you do not consume water afterwards, you would have still met the daily requirement.

In addition to giving you glowing skin, it claims to help control constipation in a day, acidity in two days, diabetes in seven days, pulmonary tuberculosis in three months, gastric problems in 10 days and hypertension in four weeks.

Since our body is made up of around 70 per cent water in the form of blood and other liquids, it has to be "cleaned" to have the required levels of density. If we allow the blood to become thicker, the heart has to work harder to filter out wastes and toxins, to collect and distribute nutrients to the various parts of the body, and to have the blood recharged with oxygen from our lungs.

The theory says that since blood is the main tool for curing ailments and restoring health, we need to have an "inner bath" to cleanse the entire system.

Although there is no scientific evidence to prove that this water therapy treatment actually works, it has been found successful by some Japanese medical practitioners in curing many modern ailments. However, drinking too much water can lead to a drop in sodium levels (hyponatremia), which then causes the brain to swell, resulting in brain impairment, and also exposes one to the risk of heart failure.

Dr Tee doesn't subscribe to this practice.

Changing habits

Consultant physician and president of Malaysian Wellness Society, Dr Rajbans Singh, recommends drinking 33ml of water per kilogramme of body weight.

He says, "The main idea is really to flush out your toxins, but for most people, water seems to be very difficult to drink. A normal, healthy person shouldn't get dehydrated and might not even feel thirsty. The best way to know is to check the colour of your urine. If it's dark yellow, then you're probably not getting enough water."

As for the multitude of water types being sold such as alkaline water, reverse osmosis, distilled water, spring water, flavoured water, deionised water, etc, Dr Rajbans says it doesn't make sense drinking these kinds of water as the body systems are designed to adjust themselves.

"Once the alkaline water goes into your stomach, it becomes acidic. It's only in the intestines that the environment is alkaline, so no matter what you put in, the body can neutralise itself. For generations, we've been drinking clean, treated or boiled water, and that is enough," he explains.

Drinking mineral water should not pose a problem, says Dr Rajbans, unless one has kidney, pancreatic or liver issues. Whether water is consumed hot, at room temperature or cold doesn't matter either.

"The Chinese believe that warm water is better for you unless you have a cold. Some people are also more prone to bronchial constriction when they drink cold water. Personally, I tend to cough when I drink cold water. Of course, it's good to take cold water when you're exercising as it brings the body temperature down," he says.

So how do we ensure we get enough fluids? Find a portable water bottle you like and tote it everywhere!

"Our habits must change!" asserts Dr Rajbans. "Keep a glass of water next to you all the time and make sure you drink it. If you're healthy, nothing will happen except that you'll be running to the toilet more often."

If you don't like the bland taste of water, fruit juices are also good alternatives. However, your sugar levels might spike from all that fructose. The recommended dose is to mix 80 per cent of vegetables (preferably green) with 20 per cent of fruits. That way, besides replenishing your fluids, you can also get the added vitamins and nutrients.

Dr Rajbans says there is nothing wrong with drinking the entire recommended amount at one go. Since most people cannot handle so much fluid at a time, then drinking at two- to three-hour intervals should ensure the daily dose is covered, though it's best to consume everything before 6pm so that sleep is not disturbed at night.

"During sleep, the blood supply to the kidneys increases, and it would have to filter out the excess water, so you might have to wake up and go to the toilet."

Sometimes, people mistake thirst for hunger. So instead of grabbing a snack or filling up with unhealthy foods, try drinking a glass of two of water and re-evaluate how you feel.