In this video, Dr. Seheult of MedCram, discusses how the amount of water you are drinking may be associated with chronic diseases and premature mortality. A recent study out of Lancet discusses how high normal serum sodium levels in middle age persons may be a risk factor for accelerated biological aging, chronic disease and premature mortality. Many people are interested in trying to stay “biologically” younger than their chronological age. It turns out that water may be one of those ways that has an impact on your biological aging.
Water and Sodium
The basis of this study in the Lancet comes from an observation study that noted that mice who have been subjected to life long water restriction had increased mortality and increase in chronic disease. A way to measure how much water intake a individual has is the idea of serum sodium. Sodium is one of the major ions in the body that regulates fluids. It is closely regulated in the body. As water leaves, sodium concentration goes up and vice versa when water comes in. Sodium concentration is a strong surrogate marker for the amount of free water present. The higher the sodium concentration the less free water is available. At times, in chronic diseases, the body is unable to adequately assess how much free water there is and this can lead to low sodium levels.
Is there such a thing as too much water?
Drinking too much water can be dangerous to the body. If you have chronic disease, it is important that you follow up with your physician to determine what is a safe amount of water intake for your particular case. It is a known fact that people can die from water intoxication. Water will always go to areas of highest solute concentration which is known as osmosis. The brain is highly concentrated and if too much water enters the brain it can cause swelling and herniation of the brain. MedCram has a course on hyponatremia as well as explaining the basic metabolic panel that you get on bloodwork ordered by your doctor.
What about not enough water?
The study from Lancet talks about the idea that not drinking enough water can lead to increased diseases and mortality. The study took 15,752 people aged 45-66 and did a follow up for 25 years. They excluded people from the study that had a serum sodium level outside of the normal range ie 135-146 mmol/L, elevated glucose >140 and BMI >35 kg/m2. The number of people after exclusions were applied was 11,255. They looked at biomarkers for aging, assessment of chronic disease, and fasting 12 hour sodium concentrations. For about 95% of the population, sodium levels will fall between 135-146 mmol/L. People with lower sodium often will have issues with heart, liver and/or kidney disease.
Is there an association with disease and high sodium levels?
The question was is there an association with high sodium and disease? The study out of Lancet did substantiate this. It found that people with sodium concentrations higher than 143 mmol/L had a 39% in chronic disease and a 50% increase in the odds that one’s biological age is higher than one’s chronological age. In the ideal world, you want to have a biological age that is younger than your chronological age.
What’s the best sodium level?
The study found that persons with serum sodium concentrations of greater than 144 mmol/L had a 21% increase in premature deaths. Looking at survival curves, the best survival curve was for sodium levels between 137-142 mmol/L. As you went further away from a sodium level of 140 mmol/L on either side, your survival curve went down. It was noted that as the sodium levels went up the hazard ratio also increased for all cause mortality. Additional covariates that contributed were being older, male, black and tobacco use. Some of the additional biomarkers that were used included glucose, cholesterol, hemoglobin A1C, glomerular filtration rate, FEV, systolic blood pressure, urea nitrogen, cystatin-c, B2M. These markers either go up or down as a person ages. This study is not an intervention study but a cohort trial looking at association. This study shows a strong association between low water intake and chronic disease and premature death. The authors stated that individuals with fasting serum sodium levels above 142 mmol/L have increased risk to be biologically older, develop chronic diseases and die at a younger age.
How much water should you drink?
So how much water should a person take in a day? This link can help you determine how much water you should drink either with or without exercise. Again be sure to check with your physician if you have chronic disease as to what an appropriate amount of water is safe for you to drink.
LINKS / REFERENCES:
How to calculate how much water you should drink (University of Missouri) | https://www.umsystem.edu/totalrewards…
Middle-age high normal serum sodium as a risk factor for accelerated biological aging, chronic diseases, and premature mortality (eBio Medicine) | https://www.thelancet.com/action/show…
Hyponatremia Explained Clearly (MedCram) | https://www.medcram.com/courses/hypon…
BMP / Chem-7 Results Explained Clearly (MedCram) | https://www.medcram.com/courses/bmp-c…
Woman dies after water-drinking contest (NBC News) | https://www.nbcnews.com/id/wbna16614865
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