Chapter 4: Water

Chapter 4: Water 104 Water is the essen al 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 ac vi es. Water is so important to the body’s func on and structure that if we do not consume enough, our...

Chapter 4: Water 104 Water is the essen al 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 ac vi es. Water is so important to the body’s func on 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 con nuously lose it, we need to consume a constant supply. Accordingly, our thirst is very sensi ve to reduc ons in the water content of blood and ssues. By the end of this chapter, you will be able to: Explain how the structure of water dictates its func ons. 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 dehydra on. Give an overview of the role of caffeine and alcohol in health. Compare and contrast the Western view of water with an Indigenous perspec ve. A water molecule is composed of two hydrogen atoms a ached to an oxygen atom, giving it the chemical formula H2O. Geometrically, the molecule has a V-shape, due to the respec ve slightly posi ve (δ+), and slightly nega ve (δ–) charges of the hydrogen and oxygen atoms (Figure 4.1). The nega ve charge forms one pole of the molecule, while the posi ve charge forms the other pole. Water is thus a polar molecule. This charge arrangement allows water to be a racted to other water molecules, as well as other molecules that are polar. Polar molecules that are a racted to and dissolve easily in water are hydrophilic, or water loving. Those that are not polar and not a racted to water are hydrophobic, or water ha ng. 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. 105 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 substan ally. 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 characteris c 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 ssues 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 evening out concentra on differences. For instance, the blood carries many charged, polar substances, such as protein. These a ract water and draw it in to the blood from the extracellular space (Figure 4.3). That is one func on of protein: to maintain fluid balance and make sure that water doesn’t build up in the extracellular space. Conversely, blood pressure provides a force that pushes water out of blood and into the extracellular space. 106 Figure 4.3: The exchange of water between the blood and extracellular space. Figure 4.4: The water-based humour provides structure to the eye. Water helps structures maintain their form. For instance, the water within cells gives them the three-dimensional shape necessary for cellular organelle to func on 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 4.5: 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 diges ve tract. For instance, blood can transport oxygen, nutrients and other cellular needs to the ssues while also removing harmful waste products. The water within cells also allows certain material to move around the cell. It also brings the reactants of chemical processes together. Water is a fluid that is always in mo on and so the substances within water are also in mo on. Accordingly, when compa ble reactants are dissolved in water, there is an increased chance of them colliding and undergoing a chemical reac on. 107 As we learned in Chapter 3, hydrolysis reac ons use water to split larger molecules into smaller ones. An example of a hydrolysis reac on 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 addi on of water. Figure 4.7: Water helps protect us from infec ous agents. Within the lymph you will find many immune cells suspended within a watery environment. If an infec ous 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 infec ons (Figure 4.7). 108 Figure 4.8: Synovial fluid is found in sacs between joints, protec ng them from injury. Water can reduce the fric on and damage from movement or trauma that can nega vely affect our ssues. For instance, the water found in synovial fluid helps protect bones that ar culate from scrapping against each other (Figure 4.8). Also, the mucus found lining body ssues, such as the diges ve tract and respiratory system, can help protect these ssues from injuries. Around and within certain parts of the brain and spinal cord is cerebrospinal fluid. This water-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 func on properly. Even a 0.5˚C change in body temperature can nega vely affect body physiology. This presents a challenge, as the temperature of our external environments can change drama cally throughout the day. Also, without a way to regulate temperature, body temperature can increase for other reasons such as increased physical ac vity (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. 109 Swea ng involves the release of watery sweat from our sweat glands. When this sweat evaporates, it cools down our skin and bodies. Swea ng in a humid environment compromises this process, as the air’s high water content does not let sweat evaporate. This leaves us feeling hot, s cky and uncomfortable. During the hot summer months in many Canadian ci es 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 o en 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 regula on physiology (Bouchama et al., 2007). As global temperatures con nue to rise, the incidence of heat illness and heat injury may also increase. Indeed, in the United States, heat waves result in more fatali es than any other extreme weather event (Na onal Weather Service, n.d.). Every day, we lose water through urine, feces and evapora on. 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 byproduct of cellular respira on. All three of these contribute to our daily water needs (Figure 4.10). Figure 4.10: Sources of water. 110 Water homeostasis is one of the body’s main priori es. To this end, there is a ghtly 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 concentra on of dissolved par cles in the blood is high, meaning that the concentra on 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 regula ng 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 contributes to water loss, since water is needed to help these materials pass outward. When blood volume and pressure is low, the kidneys decrease the produc on of urine. Individuals that are deficient in water will no ce that their urine is more darkly coloured, as it contains less water to dilute waste products. Figure 4.11: The kidneys and water balance. 111 Figure 4.12: Urine colour can indicate hydra on levels. Most of us have experienced a degree of dehydra on in our lives. Dehydra on can be caused by not consuming enough water or by an excessive loss of water, poten ally due to swea ng, diarrhea or vomi ng. Mild dehydra on can be uncomfortable; extreme dehydra on can be deadly. Dehydra on is especially dangerous for young children and older adults and measures should be taken to prevent it. Symptoms of dehydra on include increased thirst, dry mouth, headaches, fa gue, dizziness, irritability and dark urine (Figure 4.12). Chronic dehydra on can lead to more severe complica ons, including kidney damage, seizures and hypovolemic shock. Dehydra on 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 infec ons, kidney stones, and in extreme cases can lead to chronic kidney disease and even death (Roncal-Jimenez et al., 2015). Excessive swea ng not only promotes water loss, but important electrolytes can also be lost in this process. Electrolyte imbalance can compromise the body’s electrical ac vity, poten ally promo ng seizures. Those with sodium and other electrolyte disorders are more suscep ble to these dehydra on-induced seizures (Nardone et al., 2016). Dehydra on increases the risk for hypovolemic shock, which occurs when the body loses a lot of blood or extracellular 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 ssues. 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 me the person stays in hypovolemic shock. If untreated, it can be fatal. 112 Water intoxica on, also known as water poisoning, is a poten ally fatal condi on where the content of water in the body is too high with respect to the level of electrolytes. Water intoxica on can occur when an individual consumes excessive amounts of water in a short period of me and does not excrete it through urina on. However, most cases of water intoxica on occur when a significant amount of water is lost due to excessive swea ng, diarrhea or vomi ng. 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 condi on called hyponatremia, or low sodium in the blood. Figure 4.13: The development of hyponatremia. A decrease in the concentra on of sodium and other dissolved par cles nega vely impacts many body funcons. The brain is par cularly suscep ble to hyponatremia, where it can lead to an increase in intracranial pressure. Most symptoms of water intoxica on are accordingly neurological and include headache, confusion, personality changes, irritability and drowsiness. In extreme cases this can lead to malfunc on 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, o en consume electrolyte mixtures in addi on to replenishing water. 113 Box 4.1: Water intoxica on and a fatal radio contest. In 2007, a radio sta on in Sacramento, California held a contest called “Hold your Wee for a Wii” (ABC News, 2009). The premise: the person who could drink the most water without urina ng would win a Nintendo Wii video game console, a hot commodity at the me. One of the contestants, Jennifer Strange, reportedly drank almost eight litres of water in three hours. She died of water intoxica on. The disc jockeys had apparently been made aware before and during the compe on about the poten ally fatal outcome, but they were unphased and even joked about it on air. In 2009, the radio sta on’s parent company was ordered to pay US$16,577,118 in damages to Jennifer’s family. Diure cs are substances that promote water losses through urina on. Certain medica ons act as diure cs, as do certain psychoac ve drugs like caffeine and alcohol. Diure c pills, some mes called water pills, are prescribed for condi ons such as high blood pressure, kidney stones and ssue swelling. They work by promo ng sodium excre on at the kidney, which also promotes water excreon. While they are generally safe, they should only be consumed under the recommenda on 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 diure c. Caffeine is a psychoac ve 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 diuretic, it is typically consumed for its effects on the central nervous system, as it can promote alertness, while reducing fa gue and drowsiness. 114 Caffeine has been studied for its poten al 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 cancers (Grosso et al., 2017). Cau on should be taken in interpre ng these results, as this review looked at coffee and not caffeine specifically. Coffee is believed to have an oxidant and an -inflammatory proper es that perhaps contribute to the observed effects. While is it generally recognized as safe, caffeine has some poten al side effects. The authors of the above study found an increased risk of miscarriage with coffee consump on. The diure c effects of caffeine may also promote kidney problems. Indeed, a large prospec ve epidemiolocal study of more than 16 million people found that caffeine consump on is associated with a higher risk of kidney stones, especially in women (Sun et al., 2019). Figure 4.15: Alcohol is a diure c. Like caffeine, alcohol is a psychoac ve drug found in certain foods and beverages (Figure 4.15). It has diure c properes and can affect hydra on 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 detrimental to health. High alcohol intakes significantly increase the risk of liver cirrhosis and cancers of the liver and diges ve systems (Grønbaek, 2009). Alcohol also increases the risk of neurological deficits such as confusion and demen a. Further, individuals who chronically consume high levels of alcohol are at higher risk for nutri onal deficiencies, as alcohol impairs the absorp on of several micronutrients. Interes ngly, 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; Poikolainen, 1995). The poten al posi ve effect is not fully understood, though it might be linked to alcohol’s ability to reduce the forma on 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 consump on. Higher levels of consump on are associated with a higher risk of all-cause mortality and are not recommended (Boffe a & Garfinkel, 1990; Piano, 2017). The short-term effects of alcohol depend on several factors. For instance, factors that lead to quicker absorp on lead to more pronounced short-term effects. Absorp on is quickest when alcohol is consumed on an empty stomach and when the concentra on of alcohol in the product is 20–30%, as is the case with for fied 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 individuals have lower total blood volume; thus, alcohol is concentrated more quickly. Blood alcohol also tends to concentrate more before menstrua on and during ovula on. 115 Approximately 90% of alcohol is metabolized and Figure 4.16: Alcohol metabolism. eliminated at the liver. The enzymes alcohol dehydrogenase and aldehyde dehydrogenase modify alcohol in a two-step process that leads to the forma on 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 con nue through cellular respira on to create ATP, the body’s energy currency. Acetyl CoA can also be used to synthesize fa y acids, and this extra energy source is stored in fat ssue. However, this is a minor pathway. Certain people have varia ons in their genes that code for the enzymes alcohol dehydrogenase and aldehyde dehydrogenase. These changes can affect the rate of alcohol metabolism. These varia ons may also increase or decrease risk for alcohol dependence. For instance, one gene c varia on of the enzyme aldehyde dehydrogenase leads to slower metabolism and lower risk for dependence. People with this gene c difference o en experience facial redness, nausea, swea ng, dizziness and a racing heartrate due to the buildup of acetaldehyde. These uncomfortable symptoms are believed to be partly responsible for a lower risk for dependence in these popula ons (Chang et al., 2017). Many people experience hangovers several (6+) hours a er drinking – especially a er high levels of consumpon. Symptoms of a hangover vary, but may include vomi ng, redness, decreased a en on, decreased concentra on, stomach pain and disturbed sleep. The causes of hangovers are complex and not fully clear. Proposed reasons for hangovers include acetaldehyde buildup, the direct effect of alcohol on the gastrointes nal 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 fermenta on 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). 116 The treatments for hangovers are also not fully established. Some studies have found that certain products reduce symptoms, while others have not. A systema c review of six randomized control trials found that supplements of the polysaccharide-rich extract Acanthopanax sen cosus, red ginseng, Korean pear juice, KSS formula and A er-Effect are associated with a decrease in hangover symptoms (Pi ler et al., 2005). Conversely, another meta-analysis of randomized control trials found that supplemen ng propranolol, sugars, borage, ar choke and prickly pear had no effect to cure or prevent a hangover (Pi ler et al., 2005). The authors suggested that the best way to avoid hangovers is to moderate or abstain from alcohol consump on. The exact amount of water an individual requires daily depends on various factors, including their sex, ac vity 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 dehydra on: 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 s ll regions of the country where it is not. Unsafe drinking water dispropor onately affects communi es in the north of Canada, many of which are Indigenous. The risk of drinking unsafe water is that it may contain infec ous agents such as bacteria that can make an individual sick. In these situa ons, drinking bo led water or boiling water is recommended. Boiling water kills most infec ous agents and renders water safer to drink, but it does not, however, remove all poten al contaminants or make it clear. While drinking bo led water is an op on 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 communi es, where water is o en seen not only as a vital nutri onal and industrial resource, but also as a living being (Box 4.2). 117 Box 4.2: An Indigenous lens: Water governance. A Western view of water might reason that it is a valuable natural resource important for both industry and human life. However, using an Indigenous ways of knowing perspec ve, water’s importance goes far beyond how humans use it. According to University of Bri sh Columbia law professor Dr. Gordon Chris e, who is of Inupiat/Inuvialuit ancestry and an Aboriginal rights researcher, in the Indigenous tradi on, “Water is ed 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,” (Chris e 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 government gave the Whanganui River legal status and the same legal rights as humans, which was the world’s first legisla on 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 shi in perspecve 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 star ng point. And that is not an an -development, or an -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 fascina ng approach, the best method to restore the quality and importance of water in Canada is s ll being explored. Indeed, the Decolonizing Water Project is aimed at crea ng 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 con nue to nega vely impact water systems around the globe. One example of their work is to engage Indigenous community members in water monitoring. 118 The Yukon River The Indigenous Observa on Network has trained more than 300 Indigenous ci zens to collect water at more than 50 sites along the 3000-km-long Yukon River. A study compared their collec on samples and analysis to those of professional scien sts and found no significant difference in their results (Herman-Mercer et al., 2018). This shows that ci zens can be trained to provide accurate, precise and reliable scien fic data to govern their own water system and help protect its resilience. This is just one example of the many ways community-based research can be used to help restore the quality and sustainability of our most valuable natural resource and “mother life’s blood.” Water is an inorganic macronutrient. It is an essen al nutrient for humans; we cannot live without a con nuous supply of water to the body. While it provides no energy, it has key structural and func onal roles. Since humans do not store water in the body and are constantly losing it, it is impera ve to replenish water in order to meet the body’s needs. This can be done by ea ng foods, most of which contain water, drinking liquids such as juices that contain water, or by drinking clean, safe water itself. Conversely, diure cs 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. 119 Water is an inorganic polar molecule that is a racted 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 func onal roles in the body. Water intoxica on occurs when there is too much water in the body compared to dissolved electrolytes such as sodium. It is rare, but poten ally fatal. Excessive thirst and darkened urine colour are indica ve of dehydra on. Caffeine, alcohol and diure c pills are diure cs, which promote water losses. Indigenous ways of knowing suggest that water is more than a valuable resource we can use. It is a core part of the spiritual and ancestral rela onship of Indigenous people to their land. Look for signs of dehydra on, including thirst and darkened urine colour. When they occur, drinking water can reduce symptoms and complica ons. The AI for water is 2.7 L/day for women and 3.7 L/day for men. 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