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Hydration: How much do you need?

waterWe have been counseled to drink eight, 8-ounce glasses of water a day (8 x 8) for such a long time that the advice has become unwritten law…and slavishly followed at that. This chant started so long ago that most people have no idea of its origin. At the same time, we are cautioned not to count alcohol and coffee as hydration elements. The science behind the recommendation is so scant that little support can be given to the exhortation, yet the possession of a water bottle is ubiquitous. It is possible that this idea is the result of misinterpretation or misreading of a notion proposed by the Food and Nutrition Board of the National Research Council that recommended one milliliter of water for every calorie consumed. The neglected fact is that there is water in our food. That would surely separate liquid intake from total dietary intake.

Dr. Heinz Valtin, a medical professor at Dartmouth, examined this mantra earlier in this century, and learned, “No scientific studies were found in support of 8 x 8.”  After reviewing surveys of food and fluid intake on thousands of adults of both genders, Dr. Valtin stated that, “…such large amounts (of water) are not needed because the surveyed persons were presumably healthy and certainly not overtly ill.”  He added that most other kinds of beverages, including soft drinks and coffee, contribute to one’s daily need for hydration, continuing that a considerable body of evidence supports the premise that the human body is fully capable of maintaining proper water balance.  But all this must be tempered with the qualifier, “in healthy persons.”  He leaves us with, “…large intakes of fluid, equal to and greater than 8 x 8, are advisable for the treatment or prevention of some diseases and certainly are called for under special circumstances, such as vigorous work and exercise, especially in hot climates.”  In the spirit of open-mindedness, Dr. Valtin asks that readers submit their own findings to him.

Including the 20% supplied by foods, the Institute of Medicine recommends a fluid intake of about 91 ounces a day for women and 125 ounces for men.  Do you know how much water is in your food?  Few of us do. The puzzling thing about this recommendation is the lack of sufficient data available on water metabolism in adults, especially those who are sedentary and living in a temperate environment.  Most of us take in more than that suggested level, when we account for comestibles, although the geriatric populace is apt to take in less of both food and liquid water, partly because of insensitivity to a thirst stimulus and partly because of a waning ability to taste foods and beverages as well as they did in their early years.  It appears that older men drink less than their younger counterparts, but excrete more urine.  Differences in women have shown to be insignificant, but contribute to the notion that, “water turnover is highly variable among individuals…”  (Raman et al. 2004)

Admittedly, older adults are at greater risk for dehydration, but water balance in this population had not been faithfully studied until Purdue University picked up the reins in 2005, and compared/contrasted water intake/output and total balance of fluids in an older population (63-81 y.o.) and a younger one (23-46 y.o.), finding that, in fat-free mass, there is little difference.  The study noted, though, that fat-free mass was lower in the elderly and that fat-free hydration was significantly higher.  Considering that the elderly have less muscle to begin with, this is simple to follow.  (Bossingham. 2005)

Many people complain that, if they increase water intake, they will spend more time in the lavatory.  While this is the case with many of us, there is a limiting factor—time.  The period of time over which a specific amount of water is consumed makes a difference in when the urge to evacuate that water will arise.  The faster you drink that glass of water, the sooner you will need to excrete it.  The longer the glass lasts, the more time there will be prior to evacuation.  “A water diuresis occurs when a large volume of water is ingested rapidly.”  (Shafiee. 2005)   Also note that water mixed with a poorly absorbed sugar (not glucose) will retard absorption and delay excretion.

The kidneys can process almost four gallons of water a day.  Too much water will make you sick because sodium stores will become depleted and electrolyte activity will be sorely jeopardized.  Drinking over a period of time can thwart this threat.  You need not measure urine output to figure out how much fluid to replace.  That is something you can eyeball.  Thirst should not be the barometer by which fluid need is determined.  While there is no absolute proof that we all need 8 x 8, have a glass of water even when you are not thirsty, working in the heat, or running a marathon.  To prevent electrolyte displacement, we might consider electrolyte replacement in at least a couple of our glasses.

References

MAIN ABSTRACT
Am J Physiol Regul Integr Comp Physiol. November 2002; vol. 283 no. 5: R993-R1004
“Drink at least eight glasses of water a day.” Really? Is there scientific evidence for “8 × 8”? Heinz Valtin and (With the Technical Assistance of Sheila A. Gorman)

SUPPORTING ABSTRACTS
Am J Physiol Renal Physiol. 2004 Feb; 286(2):F394-401. Epub 2003 Nov 4.
Water turnover in 458 American adults 40-79 yr of age. Raman A, Schoeller DA, Subar AF, Troiano RP, Schatzkin A, Harris T, Bauer D, Bingham SA, Everhart JE, Newman AB, Tylavsky FA.
Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA.

Am J Clin Nutr. 2005 Jun; 81(6):1342-50.
Water balance, hydration status, and fat-free mass hydration in younger and older adults. Bossingham MJ, Carnell NS, Campbell WW.
Department of Foods and Nutrition, Purdue University, West Lafayette, IN 47907, USA.

Kidney Int. 2005 Feb;67(2):613-21.
Defining conditions that lead to the retention of water: the importance of the arterial sodium concentration. Shafiee MA, Charest AF, Cheema-Dhadli S, Glick DN, Napolova O, Roozbeh J, Semenova E, Sharman A, Halperin ML.

Renal Division, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada.

Am J Physiol Regul Integr Comp Physiol. 2000 Sep;279(3):R966-73.
Effects of time of day, gender, and menstrual cycle phase on the human response to a water load. Claybaugh JR, Sato AK, Crosswhite LK, Hassell LH.

Department of Clinical Investigation, Tripler Army Medical Center, Tripler Army Medical Center, Hawaii 96859 – 5000. [email protected]

Eur J Clin Nutr. 2010 Feb;64(2):115-23. Epub 2009 Sep 2.
Water as an essential nutrient: the physiological basis of hydration. Jéquier E, Constant F.
Department of Physiology, University of Lausanne, Pully, Switzerland. [email protected]

J Am Soc Nephrol 19: 1041-1043, 2008
Just Add Water
Dan Negoianu and Stanley Goldfarb

Renal, Electrolyte, and Hypertension Division, University of Pennsylvania, Philadelphia, Pennsylvania

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Who Needs Electrolytes and Why?

Many people talk about electrolytes but do you have any idea what electrolyte really is? Being among the smallest of chemicals important to a cell’s function, electrolytes are crucial to the manufacturing of energy, the maintenance of membrane stability, the movement of fluids in the body, and a few other jobs, such as contracting a muscle, like the heart.

No Sweat

You know that you’ll taste salt if you lick the back of your hand after jogging or cutting grass on a hot summer day. Sodium is one of sweat’s main ingredients, along with chloride and potassium. All three are carried to the surface of the skin by the water made in sweat glands and the salt stays after the liquid evaporates. The purpose of sweating is regulation of body temperature, which is achieved by the eccrine glands that cover much of the body. An adult can easily sweat two liters an hour (Godek, 2008), up to eight liters a day (Vukasinovic-Vesic, 2015). It’s the evaporation of the water that has the cooling effect. Some animals do not have efficient sweat glands, such as dogs that have to pant to cool down, or hogs that needs to wallow in mud or cool water.

After exercise — or other cause of heavy perspiration — it’s important to restore fluid balance, especially in hot weather when it is easy to get dehydrated. Rehydration occurs only if both water and electrolytes are replaced. The amount of electrolytes lost through sweat varies from person to person. Accurately matching beverage electrolyte intake with loss through sweat is practically impossible. If you are eating at the same time as drinking plain water, this may suffice for rehydration. Otherwise, inclusion of electrolytes is essential.

What Are They and What Do They Do?

In the body, the electrolytes include sodium, potassium, calcium, bicarbonate, magnesium, chloride, and phosphate. Not all are contained — or needed — in an electrolyte replacement beverage. Sodium, the main cation outside the cell, controls total amount of water in the body, regulates blood volume and maintains muscle and nerve function. You need at least 500 mg a day. The suggested upper level is 2300 mg, but most Americans ingest more than 3000. Chloride, also from table salt, is an anion. Found in extracellular fluids, chloride, in the company of sodium, helps to maintain proper fluid balance and pressure of the various fluid compartments.

Potassium is the major cation inside the cell, where its job is to regulate heart beat and blood pressure while balancing the other electrolytes. Because it aids in transmitting nerve impulses, potassium is necessary for muscle contractions, actually the relaxation half of the contraction. Deficiency of potassium is more common than overdose, and may arise from diarrhea or vomiting, with muscle weakness and cramping being symptoms. Intake of potassium is generally much lower than the recommended 4700 mg a day, which is not surprising in light of the deficits in food caused by insulting agricultural practices. Perhaps the most under-appreciated mineral in the nutrient armamentarium is magnesium, not only a constituent of more than three hundred biochemical reactions in the body, but also a role player in the synthesis of both DNA and RNA. As an electrolyte, magnesium supports nerve and muscle function, boosts immunity, monitors heart cadence, stabilizes blood glucose, and promotes healthy bones and teeth. With half the U.S. population deficient, Mg is the orphan nutrient that is able to prevent elevated markers of inflammation (such as CRP), hypertension (It’s called nature’s calcium channel blocker), atherosclerotic vascular disease, migraines, asthma, and colon cancer (Rosanoff, 2012). Supplementation with magnesium is uncertain because absorption is inverse to intake.

Like the others, calcium is involved in muscle contraction and the transmission of nerve messages, but also in blood clotting. Calcium tells sodium to initiate a contraction so that you can pick up a pencil or scratch your nose. In opposition, magnesium tells potassium to let the pencil go or to move your arm back down. Because the heart needs calcium for a strong beat, it will pull the mineral from bone if dietary sufficiency is missing. After calcium, phosphorus — phosphate — is the most abundant mineral in the body. This anion helps to produce energy inside the cell besides being a bone strengthener. It’s a major building block of DNA and the cell membrane. Bicarbonate keeps pH in balance and is important when muscles make lactic acid from work.

Where Can I Get the Electrolytes I Need?

There are scores of electrolyte replacements on the market and entirely too many with sugar or additives. The issue with electrolytes is, in all honesty, that they taste bitter and salty. The fact that sugar is a carbohydrate hinders the processing of a hydration drink because absorption is slowed. That’s what carbohydrates do. Sugar concentrations in many sports drinks are higher than that of body fluid, so will not be readily absorbed. Plain water passes through too fast; carb-laden drinks pass too slowly. Therefore, an electrolyte balanced drink will do the job better and faster. Sodium and potassium, after all, encourage fluid retention and help to reduce urine output.

It is common knowledge that most of us gravitate to sweetness in times of dehydration; saltiness less so. But when you need rehydration, choose the real stuff, BodyBio’s E-lyte and E-lyte Sport, two electrolyte replacements that copy the mineral balance of the body. Elyte may be used as a daily addition to the diet, and is effective to restore homeostasis in times of virus-induced gastrointestinal distress for adults and children, in electrolyte deficit from uncontrolled diabetes and even for restless leg syndrome. When sodium loss is high from exercise, chose Elyte Sport.

References

Coyle EF.
Fluid and fuel intake during exercise.
J Sports Sci. 2004 Jan;22(1):39-55.

Robert W. Kenefick, PhD and Michael N. Sawka, PhD
Hydration at the Work Site
J Am Coll Nutr. October 2007; vol. 26 no. suppl 5: 597S-603S

Meurman JH, Härkönen M, Näveri H, Koskinen J, Torkko H, Rytömaa I, Järvinen V, Turunen R.
Experimental sports drinks with minimal dental erosion effect.
Scand J Dent Res. 1990 Apr;98(2):120-8.

Noble WH, Donovan TE, Geissberger M.
Sports drinks and dental erosion.
J Calif Dent Assoc. 2011 Apr;39(4):233-8.

Sports Med. 2002;32(15):959-71.
Hydration testing of athletes.
Oppliger RA, Bartok C.

Sawka MN, Montain SJ, Latzka WA.
Hydration effects on thermoregulation and performance in the heat.
Comp Biochem Physiol A Mol Integr Physiol. 2001 Apr;128(4):679-90.

Convertino VA, Armstrong LE, Coyle EF, Mack GW, Sawka MN, Senay LC Jr, Sherman WM.
American College of Sports Medicine position stand. Exercise and fluid replacement.
Med Sci Sports Exerc. 1996 Jan;28(1):i-vii.

Rehrer NJ.
Fluid and electrolyte balance in ultra-endurance sport.
Sports Med. 2001;31(10):701-15.

Maughan RJ, Shirreffs SM.
Dehydration and rehydration in competative sport.
Scand J Med Sci Sports. 2010 Oct;20 Suppl 3:40-7

Gal Dubnov-Raza, Yair Lahavb, and Naama W. Constantinic
Non-nutrients in sports nutrition: Fluids, electrolytes, and ergogenic aids
e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism. 6(4); Aug 2011: pp. e217-e222

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Child Athletes Nutrition

children-sportsA child is not a miniature adult. His or her nutrition and hydration needs are not exactly the same, especially in sports participation.  With the growth and availability of sports opportunities, you’d think that related nutrition needs would be a concern. To the contrary, sports nutrition for youngsters receives less attention than it deserves.

“Most children and adolescents who are strongly committed to sports are not concerned about nutrition as it relates to energy balance and obesity,” states a report from a 2004 issue of Nutrition.  The interactions among nutrition, growth, and development deserve attention if a participant expects to achieve optimal performance and to avoid the injuries and problems that stem from nutritional deficiencies.   Daily fluid turnover in adult athletes has received intense study, but that for children and adolescents hasn’t.  That of adults may be two to three liters a day, but in youngsters has only been estimated at half that—and that has been based on sedentary youth.  Although “sweating capacity is typically reported to be lower in children,” there is an increase in sweat rate when adjusted for body surface area.  Besides the energy needed for normal growth and development, children athletes need to accommodate the greater expenditure from physical activity.  That can vary from one sport to another.  (Petrie. 2004).

Besides the fun, kids participate in sports to hone their skills, to experience the excitement of competition, to be part of a team, and to stay in shape, among other reasons.  But they pay little or no attention to fuel and hydration needs.  Parents and coaches, on the other hand, do.  At least they should.  Hectic schedules, availability of foods, limited time and extended days interfere with choices and timing.

Even though the number of kids playing organized sports is on the rise, fitness levels are on the decline, and are much lower than in previous decades.  This partially explains the spate of sports-related injuries.  (Cordelia. 2011).  Targeted intervention strategies include ample hydration and nutrition.  Because of maturation differences, kids need more protein to support growth, more calcium to support bone, and more attention to the prevention of hypohydration.  (Bar-Or. 2001).

Sweat helps to cool the body, and what comes out has to be replaced, otherwise performance suffers and health is at risk.  To prevent the dizziness, fatigue, nausea, and cramps that characterize dehydration, the young athlete should drink one or two cups of water or electrolyte within four hours of an event.  If no urine has been passed, or if urine is bright yellow and minimal, another 1 ½ cups is suggested within two hours of the game.  During the event, try to replace fluids as they are lost to sweat, about a cup every fifteen or twenty minutes if possible.  Plain water will do, but if the event is longer than an hour, use an electrolyte replacement.  Recovery is just as important to a preteen or teen as it is to an adult.  The best way to determine post-exercise hydration needs is to weigh the child to compute weight loss, and to replace fluid at one and a half times the volume lost to sweat.  One ounce of water (sweat) weighs one ounce, so the math is simple.  A kid’s thirst mechanism is not well-developed, so you’ll almost have to force him to drink…but do it.

The nutrients in which young athletes are most deficient include carbohydrates, calcium, vitamin B6, folate and iron, the last being especially important to girls.  Carbohydrate inadequacy leads to shortened glycogen stores and premature fatigue, especially if the game is sixty minutes or longer.  Once glycogen is gone, fat gets mobilized and the child will “bonk.”  The last thing you want is for the young athlete to burn protein for fuel. An active child will need as many as 500 to 1500 more calories a day than his inert peers.

Two to three hours before an event, give your athlete a light, carb-rich meal:  carrot sticks and a piece of cheese; a little pasta; a small sandwich.  Have him exert himself on a slightly empty stomach to avoid cramping, even fatigue.  Chips, cakes or cookies, and candy are out.  The protein your child needs will not build bulk.  That comes with age.  Normal muscle development will require as much as one and a half grams of protein for each kilogram of body weight, but need not be much more than fifteen to twenty percent of daily calorie intake.  Reduce that during the off season. Thirty percent fat in the daily intake will help to supply needed calories.  Reduce that off-season, too, lest you greet Tweedledee one morning.

The matter of iron deficiency is a particular concern for girls, especially after the onset of menarche, which can be a couple of years late for an iron-fisted ball player.  Iron-deficiency anemia is a real threat for female athletes.  Besides affecting performance and recovery, low iron stores impair immune function and may initiate other physiological problems.  Supplementation is not intended to replace food as a source of nutrients, but in the case of iron deficit, it may be recommended.  (Beard. 2000).  There’s no need for your daughter to join the 50% of the world population who are deficient in iron.  (Ahmadi. 2010).  Raw meat probably won’t help, but getting 15 mg a day from supervised supplementation will.

Youngsters are often grossly misinformed about what they need and don’t need.  Their peers and the internet are not always reliable sources of information.  Some young athletes need only a minor tweak to their diets; others need a complete overhaul.  If you feel inadequate, don’t be embarrassed.  There are dietitians and sports nutritionists who can help.

References

Petrie HJ, Stover EA, Horswill CA.
Nutritional concerns for the child and adolescent competitor.
Nutrition. 2004 Jul-Aug;20(7-8):620-31.

Cordelia W Carter, Lyle J Micheli
Training the child athlete: physical fitness, health and injury
Br J Sports Med 2011;45:880-885

Bar-Or O.
Nutritional considerations for the child athlete
Can J Appl Physiol. 2001;26 Suppl:S186-91.

Beard J, Tobin B.
Iron status and exercise.
Am J Clin Nutr. 2000 Aug;72(2 Suppl):594S-7S.

Ahmadi A, Enayatizadeh N, Akbarzadeh M, Asadi S, Tabatabaee SH.
Iron status in female athletes participating in team ball-sports.
Pak J Biol Sci. 2010 Jan 15;13(2):93-6.

Koehler K, Braun H, Achtzehn S, Hildebrand U, Predel HG, Mester J, Schänzer W.
Eur J Appl Physiol. 2011 May 19. [Epub ahead of print]
Iron status in elite young athletes: gender-dependent influences of diet and exercise.

Committee on Sports Medicine and Fitness
AMERICAN ACADEMY OF PEDIATRICS
Intensive Training and Sports Specialization in Young Athletes
Pediatrics Vol. 106 No. 1 July 1, 2000 : pp. 154 -157

Martinez LR, Haymes EM.
Substrate utilization during treadmill running in prepubertal girls and women.
Med Sci Sports Exerc. 1992 Sep;24(9):975-83.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Coconut Water: Is It What It’s Cracked Up To Be?

fresh-coconutWhether or not Robinson Crusoe was sustained by it, coconut water—not coconut milk—has gathered a following among those fitness fans looking for an all-natural alternative to sports drinks. However, it just might not be good enough for all athletes.  The liquid endosperm of young coconuts, coconut water is considered one of the world’s most versatile natural products. To enhance that image, science has found evidence to support the role of coconut water in health and medicinal applications. One of the traditional uses of coconut water is as a growth supplement in plant tissue propagation and culture, but a wider application can be justified by its unique chemical composition of sugars, vitamins, minerals, amino acids and phytohormones. The last category holds a few welcome surprises, since soy genistein has hogged the spotlight for years.

What’s The Big Deal?
Coconut water is the liquid endosperm and is served directly as a beverage to quench thirst, while coconut milk is the product obtained by grating the solid endosperm with or without additional water to get a food ingredient useful in traditional recipes. Coconut water is more than 90% water; the milk about 50% water, but also containing fat and protein (Seow, 1997). Coconut water is a clear isotonic solution plentiful in young coconuts. (Isotonic means that the tonicity, or tension, of a solution is similar to that of a body fluid and exerts basically the same pressure on both sides of a membrane.) As the coconut matures, its chemical composition and liquid volume change. The liquid may exceed half a liter at nine month’s maturity (Jackson, 2004).

Coconut water is touted as being high in potassium, one of the electrolytes essential to muscle function as the body’s predominant intracellular cation. One cup of coconut water (240 gm) carries about 600 mg of potassium, which is a fraction of the Institute of Medicine’s recommended 4700 mg (http://www.iom.edu/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx). Of course, 8 glasses will put you over the top. The concern is that potassium needs to be balanced with sodium, the electrolyte first lost to heavy sweating. This is where coconut water falls short as a sports beverage. Sodium content of one cup of coconut water is about 250 mg, not enough to aid recovery after a hard workout that spent eighteen times that by sweating more than a day’s worth of suggested intake. There’s more sodium in a glass of vegetable juice. If you have an interest in electrolytes’ role in human health — and you should, really — check out this site for a cogent explanation:  http://crampnomore.com/sportshealth/electrolytes-101.html.

What Good Is It, Then?
In an era of anti-aging curiosity, coconut water seems to be able to hold its own.  The vitamin content of coconut water is insignificant, although considerably better than the zero of plain water, but its phytonutrients, cytokinin and its analog kinetin, have demonstrated appreciable impact as anti-senescent agents. Isolated more than half a century ago, cytokinin has a potent biological effect on plant cells and tissues that influence gene expression, cell cycle, chloroplast development and biosynthesis, stimulation of vascular architecture, and delay of senescence. This characteristic was extrapolated to humans and cell membrane lipid peroxidation (Mik, 2011). Against placebo, in a randomized, double-blind, controlled study, a combination of topical cosmetic ingredients that featured kinetin and niacinamide was found to induce a reduction in spots, pores, and wrinkles and to re-establish evenness after eight weeks (Chiu, 2007). Additionally, age-related changes attributed to lipofuscin, an indicator of damage represented as brown pigmentations from oxidized fats, were delayed (Rattan, 1994).

Cytokinin and its analogs were found to induce cell death and to inhibit cell proliferation in diverse cancer cell lines (Vermeulen, 2002), where researchers were surprised to find anti-cancer effects that extended beyond the original discoveries (Voller, 2010). An item of interest is that these studies were conducted outside the United States, but not necessarily where coconuts are native. There is a modicum of protein in a cup of coconut water (less than 2.0 grams), but when part of a more voluminous coconut protein product, it is sufficiently influential to contribute to an increase and a strengthening of the immune cells that are born in bone marrow (Vigila, 2008). All the while, non-malignant cells are left alone, as cytokinin and kinetin are selective in their inhibition of cell proliferation (Dudzik, 2011).

To Use Or Not To Use?
Though not quite as balanced as serious electrolyte replacement beverages, coconut water has a place in health promotion and disease prevention. To some, it is the darling of India’s Ayurvedic medical practice, where the coconut palm is labeled “Kalpavriksha,” the all-giving tree that provides antibacterial, antifungal, antiparasitic, hypoglycemic, immunostimulant and hepatoprotective properties (DebMandal, 2011) (Preetha, 2012).   To overcome coconut water’s sodium shortfall, some formulators add salt and other enhancements to their drink and then market it as a complete sports beverage. There’s a lot more to learn about what’s in the marketplace, since adulteration is common and can ramp up calories from the basic 46 per cup.

Oral rehydration using coconut water following bouts of diarrhea, especially in children, can forestall the need for intravenous therapy in those who are amply nourished prior to the onset of the infirmity. It is contraindicated in cases of dehydration for lack of electrolyte balance (Adams, 1992). The absorption of coconut water is far superior to that of soft drinks, too, which are often used as fluid replacements by those who are unaware of the options (Chavalittamrong, 1982). The problem with this application, however, is the variability of sodium and glucose content of the coconut fluid at various stages in its development (Fagundes, 1993). A legitimate coconut water purveyor will have analyzed his product before packaging, and will put that data on the label.  Coconut water costs about fifteen cents an ounce. A quality electrolyte replacement concentrate, making four gallons of sports beverage, costs about four cents an ounce…and has the right balance of potassium and sodium, the two important players in muscle contraction and relaxation.

References

Adams W, Bratt DE.
Young coconut water for home rehydration in children with mild gastroenteritis.
Trop Geogr Med. 1992 Jan;44(1-2):149-53.


Adolf K Awua, Edna D Doe and Rebecca Agyare
Exploring the influence of sterilisation and storage on some physicochemical properties of coconut (Cocos nucifera L.) water
BMC Research Notes 2011, 4:451


Casati S, Ottria R, Baldoli E, Lopez E, Maier JA, Ciuffreda P.
Effects of cytokinins, cytokinin ribosides and their analogs on the viability of normal and neoplastic human cells.
Anticancer Res. 2011 Oct;31(10):3401-6.


Chavalittamrong B, Pidatcha P, Thavisri U.
Electrolytes, sugar, calories, osmolarity and pH of beverages and coconut water.
Southeast Asian J Trop Med Public Health. 1982 Sep;13(3):427-31.


Chee C. Seow, Choon N. Gwee
Coconut milk: chemistry and technology
International Journal of Food Science & Technology. May 1997; 32(3):  189-201


Chiu PC, Chan CC, Lin HM, Chiu HC.
The clinical anti-aging effects of topical kinetin and niacinamide in Asians: a randomized, double-blind, placebo-controlled, split-face comparative trial.
J Cosmet Dermatol. 2007 Dec;6(4):243-9.


DebMandal M, Mandal S.
Coconut (Cocos nucifera L.: Arecaceae): in health promotion and disease prevention.
Asian Pac J Trop Med. 2011 Mar;4(3):241-7. Epub 2011 Apr 12.


Dudzik P, Dulińska-Litewka J, Wyszko E, Jędrychowska P, Opałka M, Barciszewski J, Laidler P
Effects of kinetin riboside on proliferation and proapoptotic activities in human normal and cancer cell lines.
J Cell Biochem. 2011 Aug;112(8):2115-24.


Fagundes Neto U, Franco L, Tabacow K, Machado NL.
Negative findings for use of coconut water as an oral rehydration solution in childhood diarrhea.
J Am Coll Nutr. 1993 Apr;12(2):190-3.


Institute of Medicine of the National Academies
Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate
Released:February 11, 2004


Jose C. Jackson, Andre Gordon, Gavin Wizzard, Kayanne McCook and Rosa Rolle
Changes in chemical composition of coconut (Cocos nucifera) water during maturation of the fruit
Journal of the Science of Food and Agriculture. Jul 2004; 84(9): 1049-1052


Kende H, Zeevaart J.
The Five “Classical” Plant Hormones.
Plant Cell. 1997 Jul;9(7):1197-1210.


Mik V, Szüčová L, Smehilová M, Zatloukal M, Doležal K, Nisler J, Grúz J, Galuszka P, Strnad M, Spíchal L.
N9-substituted derivatives of kinetin: effective anti-senescence agents.
Phytochemistry. 2011 Jun;72(8):821-31. Epub 2011 Feb 25.


Eze K. Nwangwa and Chukwuemeka P. Aloamaka
Regenerative Effects of Coconut Water and Coconut Milk on the Pancreatic β–Cells and
Cyto Architecture in Alloxan Induced Diabetic Wistar Albino Rats

American Journal of Tropical Medicine & Public Health. 2011; 1(3): 137-146


Preetha PP, Devi VG, Rajamohan T.
Hypoglycemic and antioxidant potential of coconut water in experimental diabetes.
Food Funct. 2012 Jul;3(7):753-7. Epub 2012 Jun 27.


Rattan SI, Clark BF.
Kinetin delays the onset of ageing characteristics in human fibroblasts.
Biochem Biophys Res Commun. 1994 Jun 15;201(2):665-72.


Sandhya VG, Rajamohan T.
Beneficial effects of coconut water feeding on lipid metabolism in cholesterol-fed rats.
J Med Food. 2006 Fall;9(3):400-7.


Vermeulen K, Strnad M, Krystof V, Havlícek L, Van der Aa A, Lenjou M, Nijs G, Rodrigus I, Stockman B, van Onckelen H, Van Bockstaele DR, Berneman ZN.
Antiproliferative effect of plant cytokinin analogues with an inhibitory activity on cyclin-dependent kinases.
Leukemia. 2002 Mar;16(3):299-305.


A. Geo Vigila and X. Baskaran
Immunomodulatory Effect of Coconut Protein on Cyclophosphamide Induced Immune Suppressed Swiss Albino Mice
Ethnobotanical Leaflets 12: 1206-12. 2008.


Vigliar R, Sdepanian VL, Fagundes-Neto U.
Biochemical profile of coconut water from coconut palms planted in an inland region.
J Pediatr (Rio J). 2006 Jul-Aug;82(4):308-12.


Voller J, Zatloukal M, Lenobel R, Dolezal K, Béres T, Krystof V, Spíchal L, Niemann P, Dzubák P, Hajdúch M, Strnad M.
Anticancer activity of natural cytokinins: a structure-activity relationship study.
Phytochemistry. 2010 Aug;71(11-12):1350-9. Epub 2010 Jun 1.


tJean W. H. Yong, Liya Ge, Yan Fei Ng and Swee Ngin Tan
The Chemical Composition and Biological Properties of Coconut (Cocos nucifera L.) Water
Molecules. 2009, 14, 5144-5164

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Keeping Your Electrolytes in Balance

Gym girlWithout electrolytes, physiological stability—called homeostasis—goes haywire and nerve and muscle function are disturbed, body fluid balance is upset, and other critical body workings are interrupted. These tiny particles of metals carry electrical charges and are present in all body fluids, including urine, blood and plasma. Without the proper timing and intensity of electrical impulses, nerve, heart and muscle function suffer, and might even stop in severe instances. If electrolytes are lost, as would happen in extreme exercise or sickness, replenishment is necessary, but in appropriate amounts. Imbalances can have terrible effects, and they can be caused by a deficiency or an excess. In the chemistry jargon, the prefix hypo- means “too little,” and the prefix hyper- means “too much.”

There is a laundry list of conditions that can lead to electrolyte imbalances, including dehydration and over-hydration, diabetic ketoacidosis, cancer, and head injuries like concussions. Kidney disease, though, is at the top of the list because the kidney’s job is to control fluid, electrolyte, and acid-base balance (Claure, 2012). The surest way to deal with electrolytes is through diet or supplementation, using an electrolyte replacement if necessary, as you might when exercising in the hot weather or when participating in endurance events.

We’ll start with sodium, since it’s the most abundant cation (positive ion) in the extracellular fluid (outside the cell). We need sodium to maintain normal blood pressure in addition to sending electrical messages to initiate a muscle contraction. Water will follow salt into the body. Too much salt will increase blood osmolality, meaning, in a way, that blood has more stuff floating in it because there is too little liquid. If that happens you get thirsty, and anti-diuretic hormone tells the kidneys not to let go of water. Opposite that, low osmolality means that the blood is more watery. If too much water is lost from sweat, respiration, urination, or the weather, or if too much salt is taken in, you have hypernatremia and may suffer symptoms such as disorientation, nausea without vomiting, rapid heartbeat, sunken eyes, or trembling. Your cells are drying out and the kidneys are conserving water, so you don’t urinate.

Losing sodium—hyponatremia—can happen when you drink volumes of plain water during a bout of intense exercise, especially in hot weather. Add lethargy and confusion to the hypernatremia symptoms. If sodium falls too low, permanent neurological damage can occur.  People who have been forced to drink water to take a work-related urine drug test have fainted from hyponatremia, and have experienced hypertension and difficulty breathing.

Potassium is the primary cation inside the cell, where its major physiological role is the regulation of muscle and nerve excitability as the director of relaxation immediately following a muscular contraction initiated by sodium. Potassium imbalance is particularly monitored because of its relationship to coronary health and the heart’s ability to change electrical potential. Imbalance may cause arrhythmia. Excess (hyperkalemia) will cause cardiac arrest; deficit (hypokalemia) will irritate cardiac muscle and increase the chance of premature atrial or ventricular contractions, possibly leading to death. Potassium balance leaves little room for error (van der Meer, 1986) (Lindinger, 1995).

Magnesium, like potassium, is also found inside the cell, where it affects muscle function, energy production and carbohydrate and protein metabolism. Kidney disease is a major cause of hypermagnesemia, although taking too many magnesium-bearing antacids can contribute. Too much magnesium will cause lethargy, which is understandable because magnesium is a relaxant (Gold, 1990) (Spivey, 1990). Too little magnesium is common in the critically ill (Dacey, 2001), among whom mortality is high. Similar to hypokalemia, hypomagnesemia may induce cardiac arrhythmia, although milder signs occur before that happens. Muscle weakness, tremors, anorexia and dizziness are the more common. Can’t sleep?  Got leg cramps?  Magnesium may help (Young, 2002, 2009) (Geurrera, 2009) (Allen, 2012).

Although calcium is electrolytic, it seldom appears in electrolyte replacement drinks because most Americans, especially women, supplement at the behest of their doctors. Calcium works with phosphorus in an inverse relationship. When the value of one is high, the other is generally low. Calcium is involved in contraction of cardiac and smooth muscle, but also enhances the clotting mechanism, maintains cell membrane permeability and helps to transmit nerve impulses. You already know about the bones and teeth. Phosphorus also plays a role in bone formation, but is also needed for energy production and for macronutrient metabolism. By buffering hydrogen ions, it helps to maintain acid-base balance, as well. Like calcium, phosphorus needs are easily met without an electrolyte beverage. Deficiency is rare and occurs secondary to other conditions rather than as a result of low dietary intake. High doses of antacids may deplete phosphorus.

If your exercise regimen lasts more than an hour, especially in warm weather, you’re a candidate for electrolyte replacement. Hard games like tennis, cycling and marathon running, and assiduous resistance training call for such a beverage. During these times, you might need to drink a cup of electrolyte replacement every fifteen or twenty minutes to keep a steady pace and to avoid cramps. Thirst is not always the best barometer for gauging electrolyte needs. A beverage with sugar will compromise the bioavailability of minerals. Since sodium is the first electrolyte lost to heavy sweating, it’s a major consideration in repletion, so don’t be alarmed if you see high levels of sodium in your drink. If you’re interested in balancing electrolytes for yourself and the family, which is especially important when the kids get sick, take a look here:
http://crampnomore.com/sportshealth/electrolytes-101.html. There’s an informative bulletin explaining the how and why of electrolytes, the balance of which is no laughing matter.

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*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.