Hydration - Fluids for Life

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1 Hydration - Fluids for Life Dr. Thea Chumburidze The Coca-Cola Eurasia and Africa Group January 19, 2010

2 Water is essential for every living thing Without water: Flowers wilt Fruit shrivels Lawns turn brown Rivers run dry Farms become deserts People and animals die water is 2 nd to oxygen as essential to life: You can live ~ 4-5 minutes without air You can live ~ 3-7 days without water You can live ~ 3-5 weeks without food

3 Hydration helps to get the most out of life Generally speaking good hydration supports physical endurance mental focus skin and appearance health and well being competitive edge

4 Water and our body: Our body has ~10 trillion water-filled cells that communicate with each other through the water-based intra-cellular fluid that surrounds them Water in Our Bodies Only ~10% of Body s water is found in the bloodstream; 57% is found inside cells.

5 %Total Body Water (TBW): Every body is different Age and gender affect % Total Body Water Newborn (0 to 6 months):64-84% Child (1 to 12 years): 49-75% Men, years: 43-73% Women, years: 41-60% Men, 51+ years: 47-67% Women, 51+ years: 39-57% The more muscle you have, the more water your body needs.

6 Total Body Water in Humans obese NORMAL athletic

7 Fluid Balance Normal Equation hydration ml Food 1000 Drinks 1200 Metabolic euhydration ml Urine 1250 Feces 100 Skin 850 Lungs Balance: 1ml water 1 kcal energy Classified - Internal use

8 WATER LOSS We need to replace water loses every day. You LOSE ~8-10 cups* of water/day: You need to drink: ~13 cups if you are a man ~9 cups if you are a woman Water and other beverages a day to meet your basic daily water needs. (Based on beverages meeting ~80% of your total daily water needs.) Guide: 1L water for every 1kg lost % water Breath Perspiration Body Waste Water lost must be replaced every day. *If you exercise, live in a hot environment, or have a high Na diet, you may lose more. Classified - Internal use

9 Water Loss External Influencers Weather and climate: temperature, humidity Foods Fluid intakes Metabolic production Urine Skin Breathing Faeces Clothing GAIN LOSSES Activity: length, intensity

10 In a hot and humid climate, dehydration risk is higher through perspiration and better hydration control and higher fluid intakes are recommended. Classified - Internal use

11 Classified - Internal use

12 Negative liquid Balance e.g. Hot weather Liquid intake Food 1000 Drinks 1200 Metabolic Liquid extraction Urine 500 Faeces 100 Skin 5000 Lungs Potential Dehidration Classified - Internal use

13 Reduce endurance Impair concentration Cause headaches Increase fatigue Impact your health Dehydration may cause -. 1% dehydration results in thirst and there is a 10% decrease in mental performance when you feel thirsty 2% dehydration reduces your ability to work 4% dehydration results in lethargy, apathy and menta symptoms Long-term effects of being dehydrated include kidney urinary tract infections, constipation, and kidney stone. Kendrick Fincher Memorial Foundation: Heat Illness & Hydration. (

14 PHYSIOLOGYCAL COMPLICATIONS OF FLUIDS DISBALANCE: HYPONATREMIA (water toxicity) Extra liquid intake Liquid extraction Liquid intake Water intoxication The kidneys' max extraction rate is l/hour Body systems Lung failure Heart failure Brain swelling suasions, coma, pulmonery edema) Classified - Internal use Death

15 Urine Color hydrated Need 1 glass drink Need 1 glass drink every 15 min Need 2-3 drinks every 1 hour -Dry mouth, Dehydration Symptoms -Difficulties in breathing, -Headache, - Reduced urination &color change, - Affected coordination, - Dizziness, - Affected mental performance, - Seizures Classified - Internal use

16 Who is at risk for dehydration? Most inactive adults get enough fluid through their normal beverage drinking behavior. However, children, older adults, and adults who work in hot environments or exercise vigorously need to pay attention to their hydration needs. DRI Report for Water & Electrolytes, USA 2004: Although water is thought of as the primary fluid to maintain hydration, fluids in different types of beverages and foods contribute significantly to a person s daily fluid needs. Classified - Internal use

17 (Wyndham ve Strydom, 1969)

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19 When and how much liquid - for athletes (ACSM-2006) When How Much (1 portion/250ml) 2 hours before exercise; min before exercise; 1-2+ every 15 min during exercise; After exercise; 2 glasses for each 1/2kg lost 2 glasses

20 CARBONHYDRATE-ELECTROLİTE SOLUSIONS FOR HYDRATION AFTER SIGNIFCANT FLUID LOSS CAN BE MADE AT HOME 1 package of powdered drink (~80 g) 4.5 glasses of water (1125 ml) ½ tea spoon of salt (1.7 g) = % 6.9 solution is ready.

21 Hydration (Fluid Gain) Metabolic Water represents about 0.3 L/d Water from foods: Historically: 30% of total water intake (0.5 to 1 L/d) Recent publications from different parts of the world report low values: about 0.7 L/d (Kant et al. 2009, Briawan et al., 2009) The rest of the losses has to be compensated by Beverage intake! Water content of foods % Water Most fruits and vegetables 70-85% Cooked pasta and cereals 65-90% Cheese 40-60% Breads 30-45% Fish and seafood 70-80% Beef and other meat 45-65% Nuts and seeds 1-5% Chips and other snacks 1-10% Water content of beverages % Water Water 100% Brewed coffee and tea ~99% Diet soft drinks ~99% Sports drinks ~92-96% Milk ~85% Regular soft drinks ~85% Fruit juice and fruit drinks ~85%

22 How much should people drink? Review on recommended fluid intake from different authorities & associations Recommendations on fluid intake (ml per day) UK The British Dietetic Association (Food Facts) The British Nutrition Foundation France AFSSA France 1500 (PNNS, manger, bouger ) Mexico Instituto Nacional de Salud Publica 2000 Canada & DRI (Adequate Intake for Water) 3000 (male) USA Australia & Nutrient Reference Values for NZ Australia and New Zealand (*) Wordwide WHO 1500 (*) Based on median population intakes in Australia 2200 (female) 2600 (male) 2100 (female) Large discrepancies between existing Recommendations for fluid intake

23 Adequate Intake (AI) DRI Report for Water and Electrolytes, USA 2004 Infants (150ml/kg/day): 0-6 month: 0.7L/day through human milk 7-12 months: 0.8 L/day milk + foods and beverages (formula, juice, water) Children 1-3 years = 1.3 Liter (as total water, 20% food) 4-8 years= 1.7 L Adolescents 9-13 years= 2.4 L males and 2.1 L females years= 3.3 L males and 2.3 L females Adults years: 3.7 L for males, total water (3 L=13 cups as total beverages, including drinking water) 2.7 L for females, total water (3 L=13 cups as total beverages, including drinking water)

24 ILSI NA Hydration Committee

25 Conference on Hydration and Health Promotion November 2006 Washington D.C., USA Scientific Consensus Statement Regarding the Importance of Hydration and Total Water Intake for Health and Disease

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28 Importance of Hydration and Total Water Intake for Health and Disease Water is essential for life The perception of thirst does not always guarantee appropriate total water intake. Foods and beverages contribute varying amounts of water in the diet. Non-caffeinated and caffeinated beverages such as water, milk, tea, coffee, juice, soft drinks and sport drinks contribute to hydration.

29 Misperceptions on Caffeine and Dehydration Statements by dieticians in the USA during the 1990s Caffeinated beverages dehydrate Drink eight glasses of water a day For each caffeinated beverage that you drink, you must drink the same amount of water to compensate for the dehydration due to caffeine

30 Caffeinated Beverages Hydrate too Caffeine per se has a mild diuretic effect However, caffeine does not have a diuretic effect in individuals who normally consume caffeine, as they develop tolerance Our bodies quickly adapt to caffeine to compensate its mild effects Caffeine can have a diuretic effect in caffeine naive people and four / five days of abstinence from caffeine are needed to become naive 1 4 days of caffeine intake are sufficient to develop tolerance So, caffeinated beverages can be just as hydrating as non-caffeinated ones

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32 Caffeine Has No Effect On Hydration Status Eighteen healthy adult males in a counterbalanced, crossover designed study consumed the following beverages in four separate occasions: Water only ( 0 mg caffeine) Water + caffeinated cola (1.4mg/kg bw caffeine) Water + caffeinated diet cola (1.4mg/kg bw caffeine) Water + caffeinated cola + caffeinated diet cola + coffee (3.13mg/kg bw caffeine) Ann Grandjean et al, JACN 5: , 2000

33 Caffeine Has No Effect On Hydration Status No significant different in the effect of various combinations of beverages on hydration status of healthy adult males. Advising people to disregard caffeinated beverages as part of the daily fluid intake is not substantiated by the results of this study. Ann Grandjean et al, JACN 5: , 2000

34 DRI Report for Water & Electrolytes, USA 2004 Hence, unless additional evidence becomes available indicating cumulative total water deficits in individuals with habitual intakes of significant amounts of caffeine, caffeinated beverages appear to contribute to the daily total water intake similar to that contributed by non-caffeinated beverages.

35 Enjoy Hydration Studies, especially in children, show that people are likely to drink more and stay better hydrated if they like the taste of the fluids they drink.

36 Hydration Tips

37 Importance of Hydration and Total Water Intake for Health and Disease It is agreed that scientific evidence links adequate water intake to survival, health promotion, sustained physical performance, maintenance of mental performance, and safety and productivity in the workplace. Some studies even link a proper hydration to less weight gain.

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39 Thank You!