When I first started getting serious about drinking more water, I used a more-is-better approach.
Wow, was I wrong.
I started feeling queasy and disoriented. At first I thought it was because my body just needed to adjust, so I soldiered on.
After doing some research, though, I found out I was actually experiencing water intoxication. I had to change in order to avoid possibly deadly consequences.
Here’s what you need to know to drink smart.
What is Water Intoxication?
Also called water poisoning or hyponatremia (too little salt), this condition is a result of electrolyte or hormonal imbalance.
You may think, like I did, that because our bodies can be made of as much as 60 percent water, drinking too much of it wouldn’t be an issue.
During the early part of the last century, you would have been in good company.
In a 1923 abstract from the Archives of Internal Medicine, Dr Leonard G. Rowntree wrote that “nature has provided adequately against water intoxication [due to] the sensation of satiety following the ingestion of small or moderate quantities…”
Now, almost 100 years later, we know better. The emphasis on being more physically active and drinking more water has us downing more gallons than ever before.
According to statistics from the International Bottled Water Association, the amount of bottled water we consume has grown almost every year for the last 30 years.
Increased water consumption is good, but it does not come without some cautions.
A Discussion About Electrolytes
OK, so we cannot discuss the dangers of drinking too much water without talking about electrolytes. One popular way endurance athletes avoid hyponatremia is by taking electrolyte supplements in the form of sports drinks, gels and capsules.
What Are Electrolytes?
Electrolytes are vital minerals found in our blood and other fluids in our body. They are also referred to as salts, but they include more than the sodium we are familiar with.
This engaging YouTube video from the American Chemical Society explains salts in depth.
Why Does Electrolyte Balance Matter?
Although we only need a relatively tiny amount of them, salts are indispensable in maintaining a healthy blood chemistry balance. Too much or too little of them can lead to serious health complications.
They carry small electrical charges that facilitate 2 important processes in our bodies:
- Controlling the movement of water into and out of our cells
- Triggering nerve impulses
It doesn’t sound like much, but those two categories of action regulate all of our internal pathways and everything we do. Consider these continuous functions that we never even think about:
- lungs breathing
- brain thinking
- heart pumping
- muscles contracting
- kidneys filtering
- GI system digesting
And here’s the kicker: as important as water is, it contains zero electrolytes.
That’s right. Water can carry them, dilute them and be acted upon by them, but regular water does not provide them.
So we have to get them from other sources, usually food and drink.
Potassium is the most predominant salt in your body
Of all the salts, potassium is the most important. It is present on the surface of almost every cell in your body, and 60% of the calories you eat go toward operating the sodium-potassium pumps in your nervous system alone!
A shortage of potassium in your body can lead to impaired muscle and nerve function, symptoms of which include:
- lack of stamina
- heart arrhythmias (when your heart beats too fast or too slow)
- atrial fibrillation (rapid, ineffective fluttering of your heart)
- decreased ability to absorb energy from your food
- Rhabdomyolysis is the breakdown of skeletal muscle tissue due to trauma, electrolyte imbalance or toxins. Its telltale symptom is reddish-brown urine.
Is It Possible to Get Too Many Electrolytes?
Electrolytes from foods are generally not a problem
An excess of most electrolytes is not an issue if you are getting them from whole foods, but salt is the one electrolyte you need to be concerned about consuming too much of.
It’s not news that eating too much salt is linked with high blood pressure, which in turn puts you at risk for cardiovascular events like stroke and heart attack.
The Dietary Approaches to Stop Hypertension (DASH) diet recommends you consume less than 2,300 milligrams of sodium each day. This is a diet designed to prevent or lower high blood pressure without the use of medication.
For comparison, just one teaspoon of table salt (sodium chloride) contains 2,325 milligrams of sodium.
The average daily amount of salt in standard American fare can be 3,400mg or more!
Control your sodium intake.
This can be done by:
- Increasing your fresh and frozen vegetable intake
- Loading up on fresh and frozen fruit instead of processed desserts
- Reducing cheese, canned foods and salty snacks
- Replacing table salt with low- and no-sodium seasoning mixes
Electrolyte supplementation can be overdone
Another way you can get too many electrolytes is by using supplemental drinks, gels, powders and pills.
The main group of people who need these in their arsenal are elite or endurance athletes. That is because the amount of sweat they excrete on a daily basis requires careful replenishment of electrolytes to prevent getting ill.
The danger with supplements, though, is that you can easily throw your system out of balance because of their concentrated nature. To complicate matters further, you can deplete your body’s reserves of one mineral through an overabundant intake of another.
Where Can You Get the Electrolytes You Need?
Most of the electrolytes we need are in the foods we eat, especially fruits and vegetables. Some foods are especially high in one type of salt.
- Magnesium is found in nuts and seeds.
- Potassium can be obtained from fresh produce like sweet potatoes, avocados and bananas.
- Calcium is abundant in green leafy veggies, dairy products and calcium-fortified foods like tofu and soy milk.
- Chloride can be obtained in sufficient amounts from table salt.
- Sodium is concentrated in table salt, cheese and pickled foods.
If you do experience hyponatremia, the clinic or hospital will most likely start you on intravenous electrolyte solutions to help achieve balance again.
What Happens to Your Body When It Gets Too Much Water?
There are 2 main ways an excess of water can hurt you.
When you drink water, it goes through your digestive, urinary and respiratory systems to be either recirculated or excreted as waste. Water in your bloodstream gets absorbed by your body’s cells to facilitate metabolic processes.
When your cells hold on to too much of the water they can burst and become unable to perform vital functions.
Another way imbalance can occur is through excessive urination.
This scenario occurs because of the electrical charges of the mineral atoms.
Some are positively charged, while others are negatively charged. Opposites attract.
As the water containing one type of charge passes over your cells, crucial salts with the opposite charge are drawn from your cells in large amounts. They enter your bloodstream and are excreted from your body with the water, leaving your cells unable to function.
Who is at Risk?
These elite athletes need to drink lots of water because of how much they lose by breathing hard and sweating.
But there is something called Exercise-associated hyponatremia (EAH) that they need to watch out for.
According to this 2018 study reported in the Transactions of the American Clinical and Climatological Association (TACCA), “Symptomatic EAH is uncommon but can be a cause of mortality in otherwise healthy adults and children.”
People on certain medications
- Diuretics (used to eliminate excess water)
- Selective Seratonin Re-uptake Inhibitors (SSRIs–taken for depression and anxiety) A literature review published in the April 2006 issue of The American Journal of Psychiatry reported that 15 out of the 21 psychiatric patients who experienced symptoms of water intoxication were taking psychotropic medication.
- Chlorpropamide (prescribed for Type 2 diabetes)
- Carbamazepine (decreases seizures)
- Some chemotherapies
The first category on the list may be confusing. While hyponatremia can be caused by too much water and not enough electrolytes, it can also be caused by water loss that takes electrolytes with it (see the section on excreted electrolytes above).
Nicotine is one of the drugs that trigger the release of the hormone called anti-diuretic hormone (ADH). This substance is released by the pituitary gland in your brain.
It makes your body hold onto water.
People with schizophrenia and compulsive disorders
Both the mental health conditions and some of the medications used to treat them can lead to problems.
Those suffering from Alzheimer and other dementia
The confusion and forgetfulness associated with these conditions is to blame. Sufferers may have long-term memories of the need for adequate water intake, while their short-term memory doesn’t tell them how much water they’ve consumed.
Type 2 diabetics
One of the classic symptoms of Type 2 diabetes is excessive thirst and frequent urination. This paired with the effects of some medications used to lower blood sugar put diabetics at higher risk of hyponatremia.
People with kidney issues
Renal (kidney) failure makes it nearly impossible for your body to rid itself of toxins and excess fluid.
People who have a rare condition called Syndrome of Inappropriate Antidiuretic Hormone
It keeps the kidneys from excreting excess water. This usually happens to people in the hospital, but it can also be medication-induced (see above).
Brain injury survivors fall into this category due to the resulting hormonal disturbances.
The interruption in skin integrity leaves victims susceptible to infection and excessive fluid loss.
People with eating disorders
Both insufficient food intake and induced vomiting and diarrhea can severely disturb fluid and electrolyte balance.
What Are the Symptoms of Water Poisoning?
While you can be in danger of this condition without experiencing any symptoms, there are some typical indications that you may need to seek medical help:
- Seizures/convulsions in otherwise healthy people
The most serious effects are coma and death.
How Can You Avoid Water Poisoning?
The key is balance. Drink smart by paying attention to how much water you are taking in and making sure you also have electrolyte balance.
The May 2002 issue of Military Medicinepublished guidelines for fluid intake limits after a series of deaths occurred due to hyponatremia. They recommend drinking no more than 1.5 liters of fluid per hour of heavy sweating.
In order to avoid the dangers of electrolyte imbalance, you need to consume enough salt and sugar during long periods of exercise, especially in high heat and humidity.
Can Water Intoxication Symptoms Be Reversed?
Once you have recognized that you may have the symptoms of water intoxication, seek immediate medical help.
The TACCA report mentioned above indicates that “rapid recognition and appropriate treatment with hypertonic [high-concentration] saline are essential to maximizing outcomes and preventing death.”
Water intoxication symptoms concern many people, from athletes to smokers. Being aware of the risks and how to avoid them will help keep you healthy as you stay active.