Sunday, November 25, 2012

Water Intoxication: How Much Water is Too Much

Amid the modern day mantra to maintain hydration, or to "stay ahead of thirst," It is wise to acknowledge that drinking too much water has an ominous side.

It can be fatal.

Water intoxication affects non-elite athletes more commonly although it can happen to anyone who drinks more water than their body can manage. It is an increasingly recognized problem.

Ingesting an enormous quantity of water too quickly over a short time span causes water intoxication or over hydration because the water ingested exceeds the body's ability to metabolize it safely.

The resulting over hydration will cause dilutional hyponatremia; a state of low sodium levels in the body fluids outside the cells.

The effect on the body will be similar to a fresh water drowning.

When sodium levels drop in the fluids outside the cells, water seeps into the cells in an attempt to balance the concentration of salt outside the cells. The cells then swell because of the excess water. In severe cases, cerebral edema and fluid in the lungs manifests. All of which can be lethal, when left untreated.

As the water content of the blood increases, the body cannot excrete the fluids fast enough. The excess water then goes to the bowel, which pulls salt into it from the body diluting the concentration of sodium in the body tissues leading to massive cellular damage effecting muscle, brain, heart liver, and kidney function. When cell death occurs, water intoxication becomes water poisoning.

Among sodium's varied roles, it helps to maintain blood pressure, electrolyte equilibrium, and allows organs, muscles and nerves to work properly.

Healthy adult kidneys are capable of processing 15 liters of water or almost 4 U.S. gallons, per day, if one drinks the water in small quantities spread throughout the entire day.

It is not advisable, however, to drink 15 liters of water daily over a long period.

The United States Department of Agriculture, food and nutrition information center, in general recommends an average daily fluid intake, including liquids from foods and other beverages, of 2.7 liters or 91 ounces for women, and 3.7 liters or 125 ounces for men spread throughout the day.

It is important to realize that the center's recommendation varies more or less with body mass, activity level, heat, humidity, and health status.

In addition, the average healthy person should ingest no more than approximately 240 milliliters, or close to 8 ounces, in roughly an hour giving the body adequate time to absorb use and excrete the water effectively.

People with known health conditions, particularly conditions affecting water balance, should discuss hydration with a doctor specializing in their particular medical concern.

Hyponatremia, in various forms, affects a wide spectrum of people. It includes those with kidney, liver, endocrine, or heart disorders, and the elderly, as well as people with psychological disorders causing a pathological urge to drink water excessively.

It also, however, may affect otherwise healthy marathon runners who drink to excess for fear of dehydration, as well as people training hard such as boot camp soldiers, according to abstracts published by the National Institute of Health.

It was once thought that athletes should drink as much as they could before thirst set in.

That recommendation no longer applies. Excessive water drinking among inadequately trained non-elite athletes has become such a concern among sports doctors that guidelines are rapidly changing.

In marathons, non-elite athletes are more likely to suffer water intoxication than are elite athletes, due to lack of knowledge about their body's unique requirements.

Fluid and electrolyte needs are widely variable based on the athlete's genetics and environmental conditions.

Elite athletes typically know their body's hourly sweat rate and aim to slowly replace the total amount of fluids and electrolytes lost during that time. Generally, weight lost during exercise per hour + fluid consumed during exercise per hour = hourly sweat rate, according to The International Marathon Medical Directors Association.

Complicating matters is that indicators of water intoxication and dehydration are similar. The treatments, however, are vastly different. Furthermore, hyponatremia can kill more quickly than dehydration.

Thus, at marathons, doctors now do an on-the-spot test for blood sodium levels on collapsed runners to differentiate between hyponatremia and dehydration. Giving fluids to someone with hyponatremia could be fatal, but with dehydration it is life saving.

Moreover, in recent years, over hydration has become one of the most common reported causes of serious heat illness in the Grand Canyon.

Some people hiking the canyon drink large amounts of water and do not eat enough food to provide for electrolyte (salt, potassium) replacement and energy, wrote Patrick J. Bird, PhD, a Professor of Exercise and Sport Sciences at the University of Florida, in his 2000 newsletter.

Fears of dehydration has led to a mistaken belief that the safe thing to do is to drink as much and as often as possible, according to Bird.

Fluid requirements are complex and highly individualized. There is wide variability in sweat rates and renal water excretory capacity, depending on environmental conditions, as well as variable influence on the body's arginine vasopressin levels during exercise, as revealed in studies of hikers who developed hyponatremia in the Grand Canyon.

In addition, the peptide Vassopressin, released from the pituitary, also known as anti-diuretic hormone, fluctuates with the body's fluid and electrolyte balance, thereby influencing water excretion or retention.

Thus, blanket universal drinking guidelines are not possible, according to a consensus of 12 experts at The First International Exercise-Associated Hyponatremia Consensus Development Conference, Cape Town, South Africa, 2005

In Marathon runners, studies have shown that the consumption of a carbohydrate/electrolyte-containing sports drink does not protect against the development of hyponatremia from fluid excess, according to the Clinical Journal of the American society of nephrology.

Commercial sports drinks do not contain enough sodium, according to The International Marathon Medical Directors Association.

During the 2002 Boston Marathon, a 28-year-old woman reached Heartbreak Hill, after five hours of running and drinking sports drinks. She struggled to the top. Feeling awful and assuming dehydration, she chugged 16 ounces of liquid.

She collapsed within minutes.

She was brain dead. Her blood sodium level was determined to be dangerously low, according to Dr. Arthur Siegel, of the Boston Marathon's medical team and the chief of internal medicine at Harvard's McLean Hospital.

In February 2005, a Chico State University student, Matthew Carrington, died after being forced to repeatedly drink from a 5-gallon jug and then do calisthenics, during a fraternity hazing.

Carrington was taken to Enloe Medical Center, where his heart stopped. He was pronounced dead from swelling of his brain and lungs caused by water intoxication.

In January 2007, Jennifer Strange, a 28-year-old suburban Sacramento woman died of apparent "water intoxication" after participating in a contest - "Hold Your Wee for a Wii" - sponsored by local radio station 107.9 KDND. Contestants were asked to drink 8-ounce bottles of water every 15 minutes, without urinating.

Witnesses estimated that Strange swallowed about 2 gallons or about 7 liters of water in approximately three hours.

An autopsy, performed days later by Sacramento County assistant coroner Ed Smith, revealed no traces of "life-threatening medical conditions" that would have otherwise explained Strange's sudden death.

During January 2000, a 20-year-old trainee in the Army drank around 12 quarts, or 3 gallons, of water during a 2- to 4-hour period while trying to produce a urine specimen for a drug test.

She experienced fecal incontinence, lost consciousness, became confused, and died from swelling in the brain and lungs as a result of low blood sodium, wrote Colonel John W. Gardner, medical examiner of the Office of the Armed Forces, in Military Medicine, 2002;167:432-434.

Quick expert medical attention can often save a victim's life by reinstating electrolyte balance, if too much tissue destruction has not occurred.

When blood sodium testing confirms hyponatremia, oral electrolyte-containing fluid replacement does not work well.

Fluid and electrolyte replacement is complex. The right type of fluid-replacement fluid is critical. Treatment of dilutional hyponatremia traditionally includes the administration of a small volume of concentrated salt solution intravenously, as well as oxygen, and other supportive measures.

A newer investigational oral drug, Tolvaptan, a vassopressin V2-receptor antagonist, is proving to treat water overload, in acute and chronic hyponatremia faster, and more effectively, than other treatments.

It works, without significant side effects, according to the results of two large studies presented at the American Heart Association's November 2006 sessions, by Mihai Gheorghiade, M.D., a cardiologist and professor of medicine at USA's Northwestern University.

The easy-to-administer oral drug, developed by Otsuka Pharmaceutical, begins to normalize serum sodium within hours. The normalization is sustained during long-term therapy.

Details of the two studies are in the November 16, 2006 issue of the New England Journal of Medicine.

Wednesday, November 7, 2012

9 Super-Healthy, Vegetarian Protein Sources

PHOTO: A variety of beans including lentils and peas are vegetarian protein sources.


June 3, 2012

According to the United Nations, the meat industry produces more greenhouse gases than the world's plane, train, and automobile fleets combined. So if you're looking for a way to please The Lorax and stay well fed, start getting more of your protein from plants and reduce the amount of meat in your diet, especially the factory-farmed meat that's widely available in supermarkets.

It's not just good for the planet, it's healthier for you, too. Harvard scientists recently completed a study finding that eating a single serving of red meat each day increases your risk of early death, and factory-farmed chicken, often touted as a healthier alternative to beef, can be contaminated with e. coli bacteria that can give you urinary tract infections.

The idea that protein only comes from meat is a myth. Nearly all foods contain small amounts of protein, and it's very easy to get your daily protein requirements from beans, grains, nuts, and certain green vegetables, which have less cholesterol and fat than meat and are usually cheaper, to boot. The Centers for Disease Control and Prevention recommends that women get 46 grams (g) of protein each day and that men get 56 g.

Beans and Lentils

Protein Content: beans, 12 to 14 g per cup cooked; lentils, 18 g per cup cooked

Beans and lentils are the cheapest source of protein out there. So whether you prefer kidney, garbanzo, white, black, or pinto beans, "Buy lots of cans of beans, rinse and drain them to remove 40 percent of the sodium, and use them in everything," suggests Dawn Jackson Blatner, author of The Flexitarian Diet: The Mostly Vegetarian Way to Lose Weight, Be Healthier, Prevent Disease, and Add Years to Your Life. "White beans taste delicious in pasta: garbanzo or edamame in stir-fries; black beans and pinto in burritos, tacos, and quesadillas; and lentils or kidney are great in salads and whole grain pita lunches."

To avoid bisphenol A, or BPA, a hormone-disrupting chemical, found in metal canned foods, buy Eden Organics brand (the company uses cans without BPA in their liners), look for frozen beans, or buy dried ones and cook them accordingly.

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Nuts and Seeds

Protein Content: Nuts, 3 to 7 g per 1/3-cup serving, depending on the type (peanuts and pine nuts have the most); Seeds, 2 to 5 g per 1/3-cup serving, depending on type

Almonds, walnuts, pecans, pistachios, cashews, and pine nuts are all good vegetarian protein sources. "Try a sprinkle of chopped nuts on everything from oatmeal to yogurt to salad, and nut-based dressings are healthy and delicious," says Blatner. On the seed side, Blatner recommends pumpkin, sesame, and sunflower. "I particularly like seed butter, such as sunflower seed butter, on toast with an apple for breakfast," she says.

Chia Seeds  

Protein Content: 4 g per ounce

Though the protein content isn't as high as some other vegetarian foods out there, chia seeds pack a huge nutritional punch. For starters, they're an incredible fiber resource with nearly half (11 g) of the amount you need every day in a single ounce. That helps fill you up and eat fewer calories. They also contain 18 percent of your daily calcium requirement, more than triple that of milk, which helps your bones. Chia seeds have no flavor, so you can add a tablespoon to any food you wish to without altering its flavor, and unlike flax, chia seeds don't need to be ground in order for your body to absorb all the nutrients.

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Tofu and Tempeh

Protein Content: Tempeh, 18 g per serving; tofu, 8 g per serving

"I call tofu the veggie white meat, anything chicken can do, tofu can do, too," says Blatner. "Tempeh [a fermented form of tofu] has a fabulous texture and is a great burger stand-in or perfect crumbled in chili or seasoned or broiled into a high-protein crouton on a salad." Look for organic products to avoid genetically modified soy and hexane, a cancer-causing contaminant that has been detected in heavily processed, nonorganic soy products.

If you're not a fan of tofu or tempeh, you can still reap the protein benefits of soy in soy milk (8 g per glass) and edamame (green soybeans, which have 17 g per cup). But do go easy on soy products, as too much can raise estrogen levels and wreak hormonal havoc in both women and men. Aim for one serving of tofu, soy milk or edamame per day.


Protein Content: Seeds, 6 g per ounce; Milk, 2 g per cup

If you're allergic to soy, or just freaked out by its estrogenic activity, hemp products are your next best bet. Sold as a dairy alternative or as seeds, hemp is one of very few plant proteins that supply you with all the essential amino acids, acids your body can't produce on its own to build muscle and create more protein. The fatty acids in hemp seeds and hemp milk also boost your immune system, and the crop itself is highly sustainable, growing as fast as 10 feet in 100 days and naturally requiring very few pesticides.


Protein Content: 6 g per egg

There's a reason the incredible, edible egg is such a popular breakfast choice. The protein in eggs has the highest biological value, a measure of how well it supports your body's protein needs, of any food, including beef. And the yolks contain vitamin B12, deficiencies of which are common in vegetarian diets and can cause attention, mood, and thinking problems while raising blood homocysteine levels, a risk factor for heart disease, dementia, and Alzheimer's.

To get the healthiest eggs, find a local producer whose chicken flocks are small and feed off of grass, bugs, and organic grain; studies have shown that E. coli and salmonella contamination in eggs is directly related to the size of the flock.

Greek Yogurt

Protein Content: 15 to 20 g per 6-ounce serving

All dairy products are good sources of protein. A glass of milk provides you with 8 g, but Greek yogurt is a protein powerhouse, with twice the protein and half the sugar and carbs of regular yogurt. In fact, Greek yogurt contains the same protein as a three-ounce serving of lean meat. Top that with a handful of nuts and you could get half of your daily protein intake at breakfast. Mixing different vegetarian protein sources into your daily routine also insures that you're getting the right mixture of amino acids, which aid in building muscle and regulating your metabolism.


Protein Content: 4 g per avocado

All vegetables contain between 1 and 2 g of protein per cup, but avocados (which are technically fruits) surpass them all. Though 4 g may not sound like much, avocado protein contains all nine essential amino acids, the amino acids your body can't produce on its own to build muscle and create more protein, in addition to heart- and brain-healthy omega-3 fatty acids.

There may even be a reason these fruits are in season during flu season. "Protein not only builds muscle and maintains organ structures, but is also needed to mount prompt, strong immune responses," explains Carol S. Johnston, professor and director of the nutrition program at Arizona State University's College of Nursing and Health Innovation. "You want to have adequate protein intake daily to have amino acids ready for immune protein synthesis at the time of infection."

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Protein Content: 5 to 7 g of protein per cup, cooked

There are grains, and then there are pseudograins. Grains, wheat, barley, rye, brown rice and corn, all contain decent amounts of protein, and globally, wheat provides more plant-based protein than any other food. But intolerance to the gluten in wheat, barley, and rye is on the rise, owing to the increased use of these grains in processed foods. So if you want to go gluten free, look to corn, rice, and pseudograins, foods that are cooked and served like grains but are technically seeds, including quinoa, amaranth, buckwheat, millet, and wild rice. If you stick with corn, replace the standard yellow or white corn products with blue corn, which has 30 percent more protein.

Humanely Raised Beef

Protein Content: between 20 and 25 g per 3-ounce serving, depending on cut

OK, so beef isn't vegetarian, but you don't have to give up meat entirely to get heart-, brain-, and planet-friendly protein. The UN report finding that factory-farming was so bad for the planet also noted that improving animal diets and getting them off of grain was one huge step meat producers could take to counteract global warming. In other words, feeding animals their natural diet of grass and forage is better for our climate than pumping cattle full of corn and soy, which increase "enteric fermentation," or, basically, flatulent cattle that produce methane, a potent greenhouse gas. That diet also produces healthier beef. Grass-fed meats routinely show higher levels of omega-3 fatty acids and other vitamins, as well as lower levels of E. coli, than factory-farmed beef. Shop for grass-fed beef at your local farmer's market, or order it online through U.S. Wellness Meats.