Drink up!

Are you drinking enough?  I am referring to your daily hydration and not your alcohol consumption!

Are you aware of the effects of not drinking enough?

Do you know what the recommended amount of fluid intake is on a daily basis?

Do you know the value of different types of hydration – especially if you don’t enjoy water?

Hopefully, this blog will give you a bit more insight and maybe, you will decide to make some changes to what you are currently doing.

This blog will focus on hydration for adults.   It excludes those who are pregnant, children or those with specialist hydration needs.

The idea for this blog has come about as I find myself giving the same advice time and time again to my patients – so I thought it would be helpful to put my thoughts ‘down on paper’.

If you have any health conditions that require you to restrict your fluid intake, then you should seek medical advice.

The effects of not drinking enough fluid

• Dry eyes
• Dry less supple skin which is more prone to break down and pressure sores
• Stiff joints
• Dull looking skin
• Kidney stones
• Urinary tract infections (UTI)
• Abdominal bloating
• Constipation
• Reduced focus and concentration
• Reduced blood pressure which can lead to dizziness and falls
• Dehydration
• Headaches
• Dry lips and mouth
• Feeling lethargic/low energy
• Thirsty (if you feel thirsty then you are already dehydrated!)
• Tired

How much should an adult be drinking in a day?

* If a health professional has advised you to limit your fluid intake – then follow their instructions

Otherwise, the general recommendations are:

1.5 – 2 litres of fluid per day.

Equivalent to about 8-10 mugs/glasses. (Hignett; Government “Eatwell Guide”)

Alternatively:

30-35 ml of fluids per kilogram of body weight per day.  

(BDA UK  ‘I’m not drinking enough’; Government UK, Eatwell Guide)

So, if you weigh 63.5 kg (10 st) you should drink 30 ml x 63.5 kg  = 1,905 ml = 1.9 litres

Times when you need to drink a little bit more

There may be times when you need to drink more than the recommended allowance:

• In hot weather, when you are sweating more
• During physical exercise or activity
• If you are vomiting
• If you have diarrhoea
• Feeling unwell with a fever or high temperature
• Poorly controlled diabetes
• Being on medications that make you urinate more - called ‘diuretics’. Note: If you are on diuretics check with your GP as they may require you to restrict your fluid intake.
• Drinking too much caffeine (diuretic effect)
• Drinking alcohol (diuretic)
• Difficulty swallowing and therefore fluid intake is reduced as a consequence (an assessment by a Speech and Language Therapist may be required – speak with your GP)
• When confused (as you may forget to drink)

How to know if you are drinking enough for you

Check the colour of your urine

Check throughout the day. Generally, it should be a light yellow colour (unless you are eating certain foods or taking certain types of medication). You can find colour charts which are freely available online or check out the following link:  Urine Colour Chart

When your urine is dark yellow this indicates it is concentrated and you need to drink more. It will vary throughout the day and usually your first wee of the day will be concentrated because normally you will not be drinking during the night.

If you check it regularly you will get used to seeing what is normal for you.

Smelly urine

Smelly urine may be a sign of a potential UTI.

Concentrated (very yellow) urine can often have a strong smell.

If you are not weeing as much as you normally would

If you are not needing the toilet as often as you normally do you may not be drinking enough.

Conversely, notice if you are weeing more than normal (“frequency”)  This may be because your urine is concentrated. Concentrated urine can stimulate the bladder and causes more frequent toileting – often with small volumes passed.

Water is the healthiest drink

Water is the healthiest choice by far and tap water is free!!

Have it at room temperature, warm or hot – depending on your preference.

Add ginger or a slice of lemon or lime to it if you don’t like the taste of tap water.

Alternatives if you don't like water

You may want to try some of the suggestions below.

If you can, choose water at least some of the time.  You can then top up your fluid consumption from other sources.

Weigh up the advantages and disadvantages of each option.

I have placed these in order of what I see my patient’s drinking and not in order of importance.

Tea and coffee

Tea and coffee contain caffeine

Caffeine is a stimulant. Therefore drinking tea or coffee will have a mild diuretic effect (ie. make you wee a bit more). The effects of caffeine depend on the individual. It may have a greater effect on those that are not used to caffeine.

There are decaffeinated and caffeine-free versions available, if you wish to explore these.

Drink tea and coffee in moderation  

This means 4-5 cups per day max.  (Hignett)

Your sleep may be affected

Some people find that drinking caffeinated tea or coffee during the day affects their sleep at night. It can do this in 2 ways:

1. It can interrupt the quality /depth of  sleep at night

2.  It may cause them to need the toilet during the night.

If this is you, you could try stopping drinking caffeinated tea or coffee after your lunchtime.

Benefits of drinking tea

Drinking 4-5 cups of tea can reduce the risk of cardiovascular disease and type 2 diabetes.  However, the benefits are diminished by adding sugar, honey, syrups, high-fat milk and cream.

Benefits of drinking coffee

Drinking 3-5 cups a day is linked to reduced heart disease; reduced risk of stroke; improves bowel regularity; improved gut microbiome and other benefits (Thomason, 2022).

However, the benefits are diminished by adding sugar, honey syrups, high-fat milk and cream

Fruit juice, smoothies, vegetable juice (including cranberry juice, orange, grapefruit and others)

Benefits of drinking these

They contain vitamins and minerals

Drink in moderation

It is recommended that you do not exceed 150 ml (1 small glass) of a combined total due to ‘free sugars’ content. (Water, drinks and your health - NHS (www.nhs.uk); Hignett;  Government UK Healthy Eating)

'Free sugars'

‘Free sugars’ refer to the release of sugars in a fruit or vegetable when it is blended or juiced. These free sugars can lead to dental decay; increased calorie consumption and other effects.

You don't get the benefits of fibre

When drinking liquid fruits or vegetables, you do not get any of the added benefits from the fibre that would naturally occur if you ate the fruit or vegetable instead of drinking it.

Beware added sugars and sweeteners

Read the labels as some ‘fruit juices’ will have added sugars and artificial sweeteners added.

Grapefruit juice and calcium channel blockers

Warning: Grapefruit juice: Should not be drunk by those on calcium channel blockers (such as nifedipine, diltiazem and verapamil) or statins (consult your GP/Pharmacist before drinking)

Tips to counteract some of the negative effects

You could choose to:

• Add water to dilute your drink
• Drink with your meal (to reduce the effects of tooth decay)
• Drink through a straw (to reduce dental decay)

Squash

This refers to drinks that are watered down.

Check out the sugar content

Be aware that the ‘low sugar' varieties often contain artificial sweeteners. There is controversy around the impact of artificial sweeteners on health.

Tip

If you choose to drink squash then dilute it as much as possible.

Low-sugar carbonated drinks

Whilst low in sugar, these drinks are carbonated and often contain artificial sweeteners.

Carbonation

The process of carbonation results in increased acidity and can be slightly detrimental to tooth enamel compared to non carbonated drinks such as water.

“Sugar-free fizzy drinks are still acidic (because of the carbonation) which can damage your teeth.”13 soft drinks ranked best to worst - Heart Matters - BHF

“….. carbonated drinks are associated with dental erosion due to their acid content, regardless of whether they contain sugar, lower calorie sweeteners or no-calorie sweeteners.” NHS.UK  The truth about sweeteners - NHS (www.nhs.uk)

Artificial sweeteners

The use of artificial sweeteners is controversial regarding its impact on health.  Why Artificial Sweeteners Are Bad for You - Dr Sinatra's Heart MD Institute

So if you choose these, then drink in moderation.

Tips

Lessen the negative effects by:

• Drinking through a straw
• Having with your meal.

Carbonated drinks with added sugar

Leads to dental decay Carbonated (Sparkling) Water: Good or Bad? (healthline.com)

Choose low sugar varieties with caution

Choose the low-sugar varieties if you feel you must have these in your diet. However, note the comments above about ‘Low sugar carbonated drinks’.

Note that the low-sugar varieties, whilst often portrayed as healthier, still come with their own set of problems due to the use of artificial sweeteners and carbon dioxide.

Low-fat milk (skimmed / semi-skimmed / 1% fat )

Milk contains lactose: milk sugar.  This can cause an allergic reaction in some individuals.

The benefits

• Contains calcium
• Contains vitamin D
• Contains protein
• Contains water

All are beneficial to health.

Milk is not a substitute for drinking water

If you are drinking it instead of water you will be consuming a large amount of calories.

Drink in moderation

Drink it in moderation as part of a balanced diet.

Energy drinks

Contain caffeine

These are high in caffeine and therefore have a diuretic effect.

Sugar content is often high

Check the sugar content as it is often high.

Often carbonated

They are often carbonated. See the comments above about carbonated drinks.

Tips

If you must drink them then:

• Drink in moderation
• Drink through a straw
• Have them with your meals to reduce the impact of sugar and carbonation on your teeth.

Instant powdered drinks and hot chocolate:

These are often high in sugar or artificial sweeteners – check the ingredients.

Flavoured milk, milkshakes, condensed milk and milk-based energy or malt drinks

Contain added sugar.

Sports drinks

Often high in sugars.

Tonic water

Contains Quinine

Quinine can interact with certain medications

Quinine has been found to interact with certain medications (digoxin; warfarin etc) and has been linked with irregular heart rhythms 13 soft drinks ranked best to worst - Heart Matters - BHF

The take-home message is:

We can also get some of our hydration from our diet

Eating things like:

• Yoghurt
• Soup
• Fruit
• Vegetable Courgettes
• Cucumber
• Tomatoes
• Melon
• Other

So maybe choose to eat some of these as part of a well-balanced diet.

How to drink more when you’re not used to it

Many people struggle to drink the recommended daily fluid recommendations.   It may be worth trying to form a new habit around increasing your intake so that it naturally fits into your lifestyle.

You may find some of the following tips useful:

• Drink first thing on waking
• Have a full glass of water with your morning medications/vitamins
• Drink 30 minutes before you are due to eat
• Fill a large bottle with water – and sip throughout the day
• Drink a glass of water every time you drink a cup of tea or coffee
• Use a straw if you struggle to drink from an open-top cup/glass
• If you are reliant on others, ask them to leave a drink for you so that you can easily access fluid during the day

I hope you have found something in this blog that you can take away and start doing today.

Comments

If you have any comments I would love to hear from you.  Anything you feel I have omitted to add to the blog?  Something you feel I have mentioned that you don’t agree with and why. I will read these comments, research them and update this blog accordingly.  To comment hit the ‘reply’ when your subscriber email is sent to you.

Disclaimer

I am not a nutritionist or dietician.  The advice and suggestions in this blog are based on my own preferences and my own personal opinions formed through reading.  I have tried to use trusted sources and to give the advantages and disadvantages of each option.  For professional advice, please ask your GP to signpost you to the relevant professional.

Resources:

Joanna Hignett BDA (The association of UK dieticians) ‘The importance of hydration’, Accessed on line 2023

BDA (The Association of UK Dieticians) ‘I’m not drinking enough’ Accessed on line 2023

The Association of UK Dieticians: Food Fact Sheet: Portion sizes Available online- Accessed Mar 2023

Public Health England 'A quick guide to government healthy eating recommendations’ 2018, Accessed on line May 2023

NHS, Water, drinks and your health Accessed May 2023

Healthline:   Carbonated (Sparkling) Water: Good or Bad? (healthline.com), Accessed online May 2023

British Heart Foundation 13 soft drinks ranked best to worst - Heart Matters - BHF Accessed on line April 2023

Heart MD Institute: Why Artificial Sweeteners Are Bad for You -Dr. Sinatra's Heart MD Institute Accessed online April 2023

NHS.UK: The truth about sweeteners - NHS (www.nhs.uk) Accessed online April 2023

YouTube - Kirsten Greene 'Beat the Bloat Masterclass', https://www.youtube.com/watch?v=-u-N1TwNQHg Accessed April 2023

Thomason, C RD, CDCES (2022) ‘What are the health benefits of coffee?” Online: https://joinzoe.com/learn/health-benefits-of-coffee- Accessed April 2023

South Tees Hospitals ‘Urine Colour Chart’ https://www.southtees.nhs.uk/wp-content/uploads/2022/08/Urine-colour-chart.pdfAccessed online April 2023