Chapter 4 - Water.docx

Chapter 4: Water Water is the essential nutrient with the highest daily requirement. We need water for the body’s structure but it is also important as a solvent and in various physiological activities. Water is so important to the body’s function and structure that if we do not consume enough, our...

Chapter 4: Water Water is the essential nutrient with the highest daily requirement. We need water for the body’s structure but it is also important as a solvent and in various physiological activities. Water is so important to the body’s function and structure that if we do not consume enough, our bodies tell us almost immediately to consume more. Since we do not store water in the body and we continuously lose it, we need to consume a constant supply. Accordingly, our thirst is very sensitive to reductions in the water content of blood and tissues. By the end of this chapter, you will be able to: Explain how the structure of water dictates its functions. Outline how we lose and replenish water each day. Describe how water balance is maintained in the body. List the stages and symptoms of water dehydration. Give an overview of the role of caffeine and alcohol in health. Compare and contrast the Western view of water with an Indigenous perspective. A water molecule is composed of two hydrogen atoms attached to an oxygen atom, giving it the chemical for- mula H2O. Geometrically, the molecule has a V-shape, due to the respective slightly positive (δ+), and slightly negative (δ–) charges of the hydrogen and oxygen atoms (Figure 4.1). The negative charge forms one pole of the molecule, while the positive charge forms the other pole. Water is thus a polar molecule. This charge arrangement allows water to be attracted to other water molecules, as well as other molecules that are polar. Polar molecules that are attracted to and dissolve easily in water are hydrophilic, or water loving. Those that are not polar and not attracted to water are hydro- phobic, or water hating. For instance, lipids are nonpolar, and therefore separate themselves from water when the two are combined. Figure 4.1: Water’s polarity allows it to form bonds with other polar molecules. The human body is 60–70% water by weight (Mitchell et al., 1945). Approximately two thirds of this water is found within cells, or intracellularly, and the remainder is found outside of cells, or extracellularly (Figure 4.2). Figure 4.2: Intracellular and extracellular water. Cells have lipid walls, but are comprised mostly of cytoplasm, a gel-like substance that is 80% water. Given that the human body has more than 30 trillion cells (Bianconi et al., 2013), the water in cytoplasm therefore accounts for the majority of the body’s water. In healthy people, the water content of cells does not change substantially. However, the extracellular water content is constantly being used for the body’s needs and must be regularly replenished. Most extracellular water is found within blood. Red blood cells give blood its characteristic colour, however, more than 90% of the volume of blood is water. Extracellular water can also be found around the joints, in the lungs, lining certain tissues and in the lymph. It is further found in the extracellular space around cells. Water can be exchanged between this extracellular space and the blood. Certain factors regulate this exchange and the content of water in the blood versus the extracellular space. Osmosis drives water to move across semi-permeable membranes, like blood capillaries, with the goal of eve- ning out concentration differences. For instance, the blood carries many charged, polar substances, such as protein. These attract water and draw it in to the blood from the extracellular space (Figure 4.3). That is one function of protein: to maintain fluid balance and make sure that water doesn’t build up in the extracellular space. Conversely, blood pres- sure provides a force that pushes water out of blood and into the extracellular space. Figure 4.3: The exchange of water between the blood and extracellular space. Water helps structures maintain their form. For instance, the water within cells gives them the three-di- mensional shape necessary for cellular organelle to function properly. Another example is the water within synovial fluid found in sacs between joints. Not only do these synovial sacs promote joint structure, but they also allow bones to glide by each other more fluidly. The eye also maintains its structure because of the fluid, or humour, found within it (Figure 4.4). Figure 4.4: The water-based humour provides structure to the eye. Figure 4.5: Water dissolves polar substances. Water is the most important biological solvent because of the variety of polar substances it can dissolve (Figure 4.5). This is important for moving things around the body via blood vessels or the digestive tract. For instance, blood can transport oxygen, nutrients and other cellular needs to the tissues while also remov- ing harmful waste products. The water within cells also allows certain material to move around the cell. It also brings the reac- tants of chemical processes together. Water is a fluid that is always in motion and so the substances within water are also in motion. Accordingly, when compatible reactants are dissolved in water, there is an increased chance of them colliding and undergoing a chemical reaction. As we learned in Chapter 3, hydrolysis reactions use water to split larger molecules into smaller ones. An exam- ple of a hydrolysis reaction is the breakdown of the double-sugar maltose into two molecules of single-sugar glucose (Figure 4.6). Figure 4.6: Hydrolysis is the breakdown of larger molecules into smaller ones with the addition of water. Figure 4.7: Water helps protect us from infectious agents. Within the lymph you will find many immune cells suspended within a watery environment. If an infectious agent gets into the body, it can be moved to the lymph, where these immune cells can act on it for removal. Furthermore, mucus, which is mostly water, helps trap and gather pathogens together for removal. This is why doctors advise us to drink plenty of fluids when we have certain infections (Figure 4.7). Figure 4.8: Synovial fluid is found in sacs between joints, protecting them from injury. Water can reduce the friction and damage from movement or trauma that can negatively affect our tissues. For instance, the water found in synovial fluid helps protect bones that articulate from scrapping against each other (Fig- ure 4.8). Also, the mucus found lining body tissues, such as the digestive tract and respiratory system, can help protect these tissues from injuries. Around and within certain parts of the brain and spinal cord is cerebrospinal fluid. This wa- ter-based fluid helps to protect the brain from various forces that could cause damage. The human body’s temperature must be maintained at around 37˚C to function properly. Even a 0.5˚C change in body temperature can negatively affect body physiology. This presents a challenge, as the temperature of our external environments can change dramatically throughout the day. Also, without a way to regulate temperature, body tempera- ture can increase for other reasons such as increased physical activity (Figure 4.9). Our bodies accordingly use two main strategies to maintain internal temperature; both involve water. Figure 4.9: Water helps us regulate body temperature. Sweating involves the release of watery sweat from our sweat glands. When this sweat evaporates, it cools down our skin and bodies. Sweating in a humid environment compromises this process, as the air’s high water content does not let sweat evaporate. This leaves us feeling hot, sticky and uncomfortable. During the hot summer months in many Canadian cities you may accordingly hear the phrase, “It’s not the heat that gets you, it’s the humidity.” When body temperature increases, as is the case during strenuous exercise, the face often becomes redder. This is because the body tries to maintain its temperature by opening blood vessels close to the skin. This allows blood to shunt some of the heat from the body’s core to the skin’s surface. As the skin heats up, this then triggers the sweat response, which can further cool the body. When the body is unable to regulate temperature, heat illness can occur. Symptoms of heat illness can range from minor heat cramping to heatstroke, which can be life-threatening. Heat stroke occurs when the body temperature rises above 40˚C (Bouchama & Knochel, 2002). It is accompanied by neurological symptoms such as delirium, confusion and convulsions and can lead to coma or death. This is more likely to occur in elderly individuals, or those with disease who have compromised temperature regulation physiology (Bouchama et al., 2007). As global temperatures continue to rise, the incidence of heat illness and heat injury may also increase. Indeed, in the United States, heat waves result in more fatalities than any other extreme weather event (National Weather Service, n.d.). Every day, we lose water through urine, feces and evaporation. Since the body does not store water, we must constantly replenish this water. Beverages account for most of the water we take in, though foods also provide water. The plants and animals we eat are made up of cells. When we eat them, we break down their cells and release the water from their cytoplasm. Water is also gained during certain metabolic processes. Recall from Chapter 3 that water is a by- product of cellular respiration. All three of these contribute to our daily water needs (Figure 4.10). Figure 4.10: Sources of water. Water homeostasis is one of the body’s main priorities. To this end, there is a tightly regulated feedback process in place to make sure that water is maintained at desirable levels. When blood volume decreases, two main mechanisms are employed to help maintain water levels. First, our thirst increases. This is due to several body sensors that indicate to the brain that the concentration of dissolved particles in the blood is high, meaning that the concentration of water is low. Thirst is the body’s way of telling us it is deficient in water. The kidneys also play a key role in regulating water levels. They decide what stays in the blood and what is excreted in urine (Figure 4.11). When blood volume is high, excess water is excreted at the kidneys. If there are a lot of waste products for the kidneys to remove, this also contrib- utes to water loss, since water is needed to help these materials pass outward. When blood volume and pressure is low, the kidneys decrease the production of urine. Individuals that are deficient in water will notice that their urine is more darkly coloured, as it contains less water to dilute waste products. Figure 4.11: The kidneys and water balance. Figure 4.12: Urine colour can indicate hydration levels. Most of us have experienced a degree of dehydration in our lives. Dehydration can be caused by not consuming enough water or by an excessive loss of water, potentially due to sweating, diarrhea or vomiting. Mild dehydration can be uncomfortable; extreme dehydration can be deadly. Dehy- dration is especially dangerous for young children and older adults and measures should be taken to prevent it. Symptoms of dehydration include increased thirst, dry mouth, headaches, fatigue, dizziness, irritability and dark urine (Figure 4.12). Chronic dehydration can lead to more severe complications, including kidney damage, seizures and hypovolemic shock. Dehydration puts extra stress on the kidneys, as they do not have enough water to help secrete waste products. This increases the risk of urinary tract infections, kidney stones, and in extreme cases can lead to chronic kidney disease and even death (Roncal-Jimenez et al., 2015). Excessive sweating not only promotes water loss, but important electrolytes can also be lost in this process. Elec- trolyte imbalance can compromise the body’s electrical activity, potentially promoting seizures. Those with sodium and other electrolyte disorders are more susceptible to these dehydration-induced seizures (Nardone et al., 2016). Dehydration increases the risk for hypovolemic shock, which occurs when the body loses a lot of blood or ex- tracellular fluid. Excessively low blood volume can promote a significant drop in blood pressure. Low blood volume and pressure can compromise oxygen and nutrient delivery to the tissues. Symptoms of hypovolemic shock include increased heartrate, low blood pressure, blue skin colour, cool and clammy skin and mental status changes. The symptoms and severity depend on the health of the person and the length of time the person stays in hypovolemic shock. If untreated, it can be fatal. Water intoxication, also known as water poisoning, is a potentially fatal condition where the content of water in the body is too high with respect to the level of electrolytes. Water intoxication can occur when an individual consumes excessive amounts of water in a short period of time and does not excrete it through urination. However, most cases of water intoxication occur when a significant amount of water is lost due to excessive sweating, diarrhea or vomiting. Both water and electrolytes are lost in sweat, diarrhea and vomit. If these losses are replaced by only drinking water, it dilutes the electrolytes in the body (Figure 4.13). This can result in a condition called hyponatremia, or low sodium in the blood. Figure 4.13: The development of hyponatremia. A decrease in the concentration of sodium and other dissolved particles negatively impacts many body func- tions. The brain is particularly susceptible to hyponatremia, where it can lead to an increase in intracranial pressure. Most symptoms of water intoxication are accordingly neurological and include headache, confusion, personality changes, irritability and drowsiness. In extreme cases this can lead to malfunction of the central nervous system and an increased risk for seizures, brain damage, coma and even death (Box 4.1). Extra electrolytes may be necessary in cases of extreme fluid loss. Endurance athletes such as marathon runners, for instance, often consume electrolyte mixtures in addition to replenishing water. Diuretics are substances that promote water losses through urination. Certain medications act as diuretics, as do certain psychoactive drugs like caffeine and alcohol. Diuretic pills, sometimes called water pills, are prescribed for conditions such as high blood pressure, kidney stones and tissue swelling. They work by promoting sodium excretion at the kidney, which also promotes water excre- tion. While they are generally safe, they should only be consumed under the recommendation of a doctor, as they can increase the risk for electrolyte imbalances, headache, dizziness and kidney failure (Smith, 2014). Figure 4.14: Caffeine is a diuretic. Caffeine is a psychoactive drug found in certain foods and beverages. It is a compound found naturally in many seeds, nuts and leaves. Its most well-known source is coffee (Figure 4.14). While caffeine acts as a diuret- ic, it is typically consumed for its effects on the central nervous system, as it can promote alertness, while reduc- ing fatigue and drowsiness. Caffeine has been studied for its potential disease-reducing effects. A review of meta-analyses found that coffee intake probably decreases risk of cardiovascular disease, Parkinson’s disease, type 2 diabetes and certain types of can- cers (Grosso et al., 2017). Caution should be taken in interpreting these results, as this review looked at coffee and not caffeine specifically. Coffee is believed to have antioxidant and anti-inflammatory properties that perhaps contribute to the observed effects. While is it generally recognized as safe, caffeine has some potential side effects. The authors of the above study found an increased risk of miscarriage with coffee consumption. The diuretic effects of caffeine may also promote kidney problems. Indeed, a large prospective epidemiolocal study of more than 16 million people found that caffeine consumption is associated with a higher risk of kidney stones, especially in women (Sun et al., 2019). Figure 4.15: Alcohol is a diuretic. Like caffeine, alcohol is a psychoactive drug found in certain foods and beverages (Figure 4.15). It has diuretic proper- ties and can affect hydration levels if overconsumed. Alcohol also provides energy to the body; each gram provides 7 kcal. Unlike caffeine, the side effects of alcohol use can be det- rimental to health. High alcohol intakes significantly increase the risk of liver cirrhosis and cancers of the liver and digestive systems (Grønbaek, 2009). Alcohol also increases the risk of neurological deficits such as confusion and dementia. Further, individuals who chronically consume high levels of alcohol are at higher risk for nutritional deficiencies, as alcohol impairs the absorption of sev- eral micronutrients. Interestingly, epidemiological evidence suggests that light to moderate drinkers (1–2 servings of alcohol per day) have a lower risk of cardiovascular disease compared to non-drinkers (Corrao et al., 2000; Grønbaek et al., 2000; Poiko- lainen, 1995). The potential positive effect is not fully understood, though it might be linked to alcohol’s ability to reduce the formation of artery-blocking blood clots and increase HDL, the so-called good cholesterol. However, these effects are only seen at light to moderate levels of consumption. Higher levels of consumption are associated with a higher risk of all-cause mortality and are not recommended (Boffetta & Garfinkel, 1990; Piano, 2017). The short-term effects of alcohol depend on several factors. For instance, factors that lead to quicker absorption lead to more pronounced short-term effects. Absorption is quickest when alcohol is consumed on an empty stomach and when the concentration of alcohol in the product is 20–30%, as is the case with fortified wines like sherry (Paton, 2005). Drinks with dissolved carbon dioxide, such as champagne and mixed drinks with pop, are also absorbed more quickly. A person’s blood volume also contributes to how quickly and intensely alcohol’s effects are felt. Women and smaller indi- viduals have lower total blood volume; thus, alcohol is concentrated more quickly. Blood alcohol also tends to concen- trate more before menstruation and during ovulation. Approximately 90% of alcohol is metabolized and eliminated at the liver. The enzymes alcohol dehydroge- nase and aldehyde dehydrogenase modify alcohol in a two-step process that leads to the formation of acetate (Figure 4.16). Acetate can be used to synthesize acetyl CoA. Recall from Chapter 3 that acetyl CoA can enter the citric acid cycle and continue through cellular respiration to create ATP, the body’s energy currency. Acetyl CoA can also be used to synthesize fatty acids, and this extra energy source is stored in fat tissue. However, this is a minor pathway. Certain people have variations in their genes that code for the enzymes alcohol dehydrogenase and alde- hyde dehydrogenase. These changes can affect the rate of alcohol metabolism. These variations may also increase or decrease risk for alcohol dependence. For instance, one genetic variation of the enzyme aldehyde dehydrogenase leads to slower metabolism and lower risk for depen- dence. People with this genetic difference often expe- rience facial redness, nausea, sweating, dizziness and a racing heartrate due to the buildup of acetaldehyde. These uncomfortable symptoms are believed to be partly respon- sible for a lower risk for dependence in these populations (Chang et al., 2017). Figure 4.16: Alcohol metabolism. Many people experience hangovers several (6+) hours after drinking – especially after high levels of consump- tion. Symptoms of a hangover vary, but may include vomiting, tiredness, decreased attention, decreased concentration, stomach pain and disturbed sleep. The causes of hangovers are complex and not fully clear. Proposed reasons for hang- overs include acetaldehyde buildup, the direct effect of alcohol on the gastrointestinal and other systems and alcohol withdrawal. It is also proposed that it is not the alcohol itself that produces hangover symptoms, but the presence of congeners, substances added during the fermentation process. Red wine, whisky, cognac and tequila, which are alcoholic beverages high in congeners, promote hangovers more than those low in congeners, such as rum, vodka or gin (Pawan, 1973). The treatments for hangovers are also not fully established. Some studies have found that certain products reduce symptoms, while others have not. A systematic review of six randomized control trials found that supplements of the polysaccharide-rich extract Acanthopanax senticosus, red ginseng, Korean pear juice, KSS formula and After-Effect are associated with a decrease in hangover symptoms (Pittler et al., 2005). Conversely, another meta-analysis of random- ized control trials found that supplementing propranolol, sugars, borage, artichoke and prickly pear had no effect to cure or prevent a hangover (Pittler et al., 2005). The authors suggested that the best way to avoid hangovers is to moderate or abstain from alcohol consumption. The exact amount of water an individual requires daily depends on various factors, including their sex, activity level and how much they sweat. An RDA for water hasn’t been determined, so an adequate intake (AI) level of 2.7 L/day for women and 3.7 L/day for men is typically used. One way to determine whether water intake is adequate is to look for signs and symptoms of dehydration: thirst, headache and urine that is dark yellow. The best source of water for most people is water itself. While most drinking water in Canada is safe to drink from the tap, there are still regions of the country where it is not. Unsafe drinking water disproportionately affects com- munities in the north of Canada, many of which are Indigenous. The risk of drinking unsafe water is that it may contain infectious agents such as bacteria that can make an individual sick. In these situations, drinking bottled water or boil- ing water is recommended. Boiling water kills most infectious agents and renders water safer to drink, but it does not, however, remove all potential contaminants or make it clear. While drinking bottled water is an option in these cases, it is not always an economically feasible one. Accordingly, there is momentum towards using community-based research and engagement to help restore the quality of water in Indigenous communities, where water is often seen not only as a vital nutritional and industrial resource, but also as a living being (Box 4.2). Box 4.2: An Indigenous lens: Water governance. A Western view of water might reason that it is a valuable nat- ural resource important for both industry and human life. However, using an Indigenous ways of knowing perspective, water’s importance goes far beyond how humans use it. According to University of British Columbia law professor Dr. Gordon Christie, who is of Inupiat/Inuvi- aluit ancestry and an Aboriginal rights researcher, in the Indigenous tradition, “Water is tied to your existence…It’s part of who you are…it is not a soulless thing you just use…but has a life of its own,” (Christie et al., 2018). Indeed, water is fundamental to many Indigenous beliefs and is seen as a life force, a living thing and mother life’s blood. An example of how central water is to Indigenous beliefs is the 140-year long lobbying effort by the Māori tribe in New Zealand to have a river recognized as one of its ancestors. In 2017, the New Zealand govern- ment gave the Whanganui River legal status and the same legal rights as humans, which was the world’s first legislation of this kind. This means that any harm to the river would be looked at in the same way as harming a person or the tribe. Gerare Albert, the main lawyer for the case summarized the importance of this law and shift in perspec- tive as follows: “We can trace our genealogy to the origins of the universe. And therefore, rather than us being masters of the natural world, we are part of it. We want to live like that as our starting point. And that is not an anti-development, or anti-economic use of the river but to begin with the view that it is a living being, and then consider its future from that central belief,” (Roy, 2017). While giving water the same rights as humans is a fascinating approach, the best method to restore the quality and importance of water in Canada is still being explored. Indeed, the Decolonizing Wa- ter Project is aimed at creating a community-based water governance system that is led by Indigenous individuals and rooted in Indigenous law. Their goal is to create a self-sustaining water and environmental monitoring program that will protect water resources around the country (Decolonizing Water, n.d.). They see this project as especially important as climate change and the many water-intensive energy industries continue to negatively impact water systems around the globe. One example of their work is to engage Indigenous community members in water monitoring. Water is an inorganic macronutrient. It is an essential nutrient for humans; we cannot live without a continuous supply of water to the body. While it provides no energy, it has key structural and functional roles. Since humans do not store water in the body and are constantly losing it, it is imperative to replenish water in order to meet the body’s needs. This can be done by eating foods, most of which contain water, drinking liquids such as juices that contain water, or by drinking clean, safe water itself. Conversely, diuretics such as alcohol and caffeine promote water losses. They are not considered foods; they are drugs and accordingly exert their main effects on the brain. Water is an inorganic polar molecule that is attracted to other polar molecules. Foods, liquids and metabolism are sources of water. Water is the main component of cells. Two thirds of the body’s water are found in cells. Water has a diverse range of structural and functional roles in the body. Water intoxication occurs when there is too much water in the body compared to dissolved electrolytes such as sodium. It is rare, but potentially fatal. Excessive thirst and darkened urine colour are indicative of dehydration. Caffeine, alcohol and diuretic pills are diuretics, which promote water losses. 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