Should I Be Drinking 8 Glasses of Water a Day?

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Transcript

Chrissy Billau:

Welcome to prescribed listening from the University of Toledo Medical Center. On this podcast, we introduce our experts to get the answers you need and can trust on this episode with University of Toledo Physician and family medicine, Dr. Coral Matus. We dive into some common themes that came out of our last season.

Dr. Benjamin Hart:

Some of it's just people get dehydrated. So not drinking enough fluid over the course of the day.

Chrissy Billau:

Am I getting enough water? And how much do you really need to drink to stay hydrated?

Dr. Ahmed El-Zawahry:

People tell you, you have to drink 8 glasses of water a day.

Chrissy Billau:

Is that too much for your body? Plus, is water the only option to meet your fluid needs for your overall health? Hello, I'm your host, Chrissy Billau. Dr. Matus, thank you for joining me.

Dr. Coral Matus:

My Pleasure.

Chrissy Billau:

Now, I have one quick question on the spot.

Dr. Coral Matus:

Yes.

Chrissy Billau:

Did you listen to the last season at all? And it's okay if you didn't.

Dr. Coral Matus:

No, I have not.

Chrissy Billau:

It's better that you didn't.

Dr. Coral Matus:

Okay, good.

Chrissy Billau:

Because, in the last season we talked about topics like what causes kidney stones and how the amount of water you can drink can have an impact on if you get said kidney stones. We also talked about your gut health and how being hydrated can help you avoid constipation. And depending on how much water you drink, you might need to pee all the time.

Dr. Coral Matus:

Absolutely.

Chrissy Billau:

So I want to start with you with the umbrella question. Why is it so important to be hydrated?

Dr. Coral Matus:

Great question. And I think you've already touched on just a few of the bad things that can happen if we don't stay hydrated. But I guess, let's start with the kind of elementary answer, the bottom level answer, is that our body is a significant portion water, 50 to 70% of our body is water. And so, it's very important that we have enough water in our body for all of the functions. So besides the things that you mentioned about avoiding kidney stones and urinary health and gastrointestinal health, our joints need the water that is involved in the articulation of our joints and just our cells in order to function as best they can. Water is such an important piece of that. And so, not to mention our cardiovascular system needing enough. So every person needs a significant amount of water to make our body function in every way essentially.

Chrissy Billau:

And the big question, is how much water do we need? I mean, there're new studies that come out or over the years the recommendations have changed. So one of the things we talked about last season with our kidney expert was, how much water we should be drinking a day and how drinking eight glasses a day isn't necessarily right for everyone. And I was like, "What? Okay, how do I do this now?" So what do we teach in our curriculum to our medical students at U Toledo?

Dr. Coral Matus:

Great question. And again, I think depending on which system you're looking at and who you talk to, you might get different answers. So kind of the 8 glasses a day I know is one of the standard answers you'll hear. Some of the recommendations even go up to 11 to 15 cups a day. So eight ounce cups a day, which ends up being somewhere about two and a half to three and a half liters if you convert it that way. So the range can be pretty broad. And so in general, I think for young otherwise healthy adults, somewhere between that probably 8 and 10 glasses a day is a good number. The flip side of that is we need to listen to our body. So it's not a one size fits all.

So for example, some of it depends on how active you are. If you're exercising and doing a lot of activities where you're sweating and losing more water, then clearly you're going to need more. If you're pretty sedentary or especially as we talk about older folks, they may need a little less. And in fact there are some dangers of over-drinking. If you tell an 85 year old woman that she needs to drink 10 glasses of water a day, even if she's not thirsty, we can cause some health problems. And so, it's definitely not a one size fits all. But some of it, when I counsel my patients, a lot of it is you need to listen to your body. And so, I try to give them some symptoms of things that might indicate that they're not getting enough water as a guide to how to navigate that.

Chrissy Billau:

Now, why might you get a different answer on this question depending on the provider you're going to?

Dr. Coral Matus:

So I think the answer is, our body has an amazing capacity to handle what we give it. So in general, there probably is a range where again, otherwise healthy young adults can function within a range of probably 5 glasses to 15 glasses and whatever we give it, the body can adapt to that. However, again, in certain circumstances, especially as we get older, our body gets less efficient at, for example, handling too much water. And while my body might function on 5 glasses a day of water, it may not function optimally. So if you have an athlete that wants to function at peak performance than yes, can you get by with 5 glasses a day? Yes. But are you going to be performing at your peak at 5 glasses? Probably not. And so, besides the fact that it's not one size fits all, there probably truly is a range where people can function and do okay.

Chrissy Billau:

How do you know if you are dehydrated? What are some of the signs? Because, I've heard that myth, "If you're not thirsty, you're probably not dehydrated."

Dr. Coral Matus:

Yeah, right. And thirst is a good indicator. I mean certainly thirst is a trigger our body sends us to try to take in more water. But other symptoms that I think definitely people need to be aware of, and we probably all felt this, if you're sitting or laying down or even squatting down and you stand up and you feel a little dizzy, that might be an indicator that your body's not having the volume that it needs. So some of those signs, again, feeling like your heart's racing when you stand up, certainly that can be related. It can be related to deconditioning, but it can also be related to not having enough volume, enough fluid in your body.

A couple other indicators that all tell patients if there are concerned about hydration levels, looking at your urine. So your urine should be a light yellow to a clear color. If your urine is very, very dark yellow, that can be mean that it's more concentrated and maybe you need to drink a little bit more. Other things that I'll use, especially if I have athletes for example, that want to perform optimally, if they are concerned about hydration in general, if you're getting up in the middle of the night to go to the bathroom to urinate once, that's probably a good level. If you can go 10 hours and not pee, maybe you're not hydrating quite enough. So some of those can be indicators to use.

Chrissy Billau:

Is it also being a little bit tired?

Dr. Coral Matus:

Absolutely. Yep, fatigue, lack of energy, those sorts of things. Even again, going back to athletes sometimes not recovering as well, having a lot of muscle cramps when we're using our muscles more, we need the fluid and the water to wash out the waste products that our muscles produce. So increased fatigue, soreness can come from not hydrating enough. So those can be some indicators as well.

Chrissy Billau:

So if you're going to work out, maybe drink a little water before, during and after?

Dr. Coral Matus:

Yes, absolutely.

Chrissy Billau:

All right. Is it normal to be dehydrated once in a while?

Dr. Coral Matus:

Sure. I think probably all of us get in situations where we forget to sip throughout the day or if we have a long day at work. I know I have my mask on a lot of times and I'm definitely a sipper through the day. And so, if I have my mask on and I'm not sipping on water, it certainly can lead to that. But hopefully our bodies give us that signal and at supper we feel a little thirsty or feel like we need to take in a little bit more. And so, rebalance that at some point.

Chrissy Billau:

I love being able to... Your body's giving you the signs like, "Hey, give me fluids, please. Stop what you're doing?"

Dr. Coral Matus:

Yes, absolutely.

Chrissy Billau:

So when is making sure you're hydrated a little more extra important? I mean, whether you're working outside in construction in the heat of summer or working in an office at a desk all day?

Dr. Coral Matus:

So as you allude to certainly more activity, our body sweats, that's how cool our body, keep it at an ambient temperature. So that, sweat is a mechanism that we use, but we need to replace that fluid. Other times that we really think about are especially pregnant in nursing women. So during pregnancy our body volume increases by 50%. So you have about one and a half times as much volume at the end of pregnancy as you do pre pregnancy. So drinking plenty of fluid is really important. Women that are breastfeeding, you think every time the baby breastfeed goes to breast, they're taking fluid from the woman. So she needs to drink when baby drinks.

So those are some special circumstances, but certainly again, anyone who's working outside, sweating, those sorts of things to replace that. And of course anytime we're sick and losing fluids from other reasons, whether it be a gastrointestinal illness or those sorts of things, clearly we need to make sure that we're staying hydrated. And I'll mention, remember, we get some fluids in our food. So even if you're not feeling well and not eating as much, things like greens, spinach, and lettuce has quite a bit of fluid in it. And so, when we talk about that two and a half to three and a half liters of fluid a day, that's not just in a pure water bottle. We get that in other things as well. So if we're not eating as much because we're ill, then we need to make sure we make up for that in other ways.

Chrissy Billau:

I think your examples are interesting, because I think of watermelon right away, because that's an obvious, this is clearly fluid, but the spinach and stuff, not so much.

Dr. Coral Matus:

Yeah.

Chrissy Billau:

How can drinking water contribute to weight loss?

Dr. Coral Matus:

Well, there's a couple ways. So one of the things that we talk to folks about when they come in and say, "I really want to lose weight." One, is sometimes our body can mistake thirst for hunger. So we feel hungry, but if we actually hydrate, if we drink a six or eight ounce glass of water, we get some satiety, some fullness, and then we can eat. And so we may be able to eat a little less volume and still feel full and satisfied, give our stomach a chance to send the message to our brain that, "Yeah, I'm full, I don't need to overeat. "

The other thing is that a huge portion of excess calorie intake for many Americans is sugared drinks. And so, one of the things, if a person comes to me and says, "I want to lose weight." I have three kind of, first let's try these things. And the first one is, don't drink any calories. So think about everything you drink, whether it be juice, soda, even milk. And again, you can argue that maybe a little bit of this and a little bit of that, but in general, we should not drink any calories. So drinking pure water or if you need tea maybe if you need a little flavor, the water additives or just squeeze some lemon in your water, is really a good way to do that. So the more you drink water, the less you're drinking excess calories can be really helpful.

Chrissy Billau:

And [inaudible 00:10:22] when you start working out after you're not, they always [inaudible 00:10:25], "Well it's just the water weight. It's going to slow down real quick here. Don't get too excited."

Dr. Coral Matus:

Yes, absolutely. And the other fallacy that sometimes people think that if I drink more I'm going to retain more water. But really the body has a way of flushing through and getting rid of the water that you're drinking and not storing it in the cells, but keeping it in the intravascular system and being able to get rid of it. So it's actually a good way to get rid of excess water.

Chrissy Billau:

Are there certain diets or foods out there that you should consider if you're struggling to stay hydrated?

Dr. Coral Matus:

So I guess the one that comes to mind when asked that question is, when you take in more protein, typically you need to drink additional water. So when folks that are on low carbohydrate, higher protein diets, typically we recommend that they make sure that they hydrate really well. And that's for a couple of reasons. But partly because most of our proteins don't have a lot of excess water in it. And so, simple carbohydrates and other excess carbohydrates can have more water in them. So if you're eating a higher protein, lower carbohydrate diet, typically we recommend that you make sure that you're hydrating well or maybe get an extra glass or two of water throughout the day.

Chrissy Billau:

Is there a certain time of year that we're likely to be dehydrated? Because, in our research, I thought, "Oh, it's definitely going to be summer when you're all sweaty and disgusting." But we found some information about winter dehydration.

Dr. Coral Matus:

Yes. And the way I explain it to my patients is when you're out in the sun and you're hot and sweaty, you want to come in and have a big glass of lemonade, a big glass of water. But in the winter when you're sitting around, maybe you're sipping on your tea or sipping on your coffee, you don't feel as thirsty just because of that, because you're all cozy up in your sweater in front of the fireplace, so you may not feel the thirst as much because of that. And again, I think a lot of times our fluid intakes tends to be a little less and sometimes warm things with sugar and caffeine in them. And again, remember that not that caffeinated beverages don't have some fluid in them because they do. But caffeine is also a diuretic. It helps us lose excess water. So we have to be a little careful about our balance of caffeine as well.

Chrissy Billau:

Okay. How does water impact bloating?

Dr. Coral Matus:

Great question. So when you say bloating, it makes me think of a few different things. And the first thing that I think about when you say bloating, is just our gastrointestinal health. And I know people think about bloating as just excess fluid retention, but a lot of times it really is more inflammation or even just bulking of our gastrointestinal system. And so, as you alluded to at the beginning, folks that are constipated that have excess retention of intestinal contents can feel more bloated. So again, hydrating adequately helps our transit time through our intestines and helps things move through in a good way, which can decrease bloating as well. So that's, kind of the association that I always make with adequate hydration, with decreasing bloating.

Chrissy Billau:

So you don't need a laxative, you need water.

Dr. Coral Matus:

Yes, you need water. I mean fiber and things as well, but water is a huge piece of that and we see that a lot in certain areas. I travel to Central America and everyone's constipated and you'll ask, "How much water do you drink?" "Oh, at least two or three cups a day." I'm like, "Oh, cups. No, you need two or three bottles a day." So huge, huge issue in those environments.

Chrissy Billau:

For athletes, what should they be doing to prep their hydration for something like a football game or a hike?

Dr. Coral Matus:

Yeah, that's a great question and one that a lot of times people ask. And if athletes wait until they're thirsty, they're going to struggle to perform. And so, typically we'll tell them and really even especially game day, get up in the morning and drink a glass of water before you even get going. And so, pre hydrating really does help. If they go into a game event or a performance event, just like you hydration right in the middle, then they're going to be behind pretty quickly. And so, I would rather an athlete go into an event over hydrated if anything. Really, the problem is, it's hard to over hydrate because as soon as you hydrate more, you're going to pee some of it out. But if you can be on that front leading edge of it, be a little bit over hydrated when you go into the game, then you leave yourself a little leeway for sweating and water losses that you have during the game.

And then that's where, again, sipping a little bit at a time. You take for example, distance runners. If you run a marathon, it's hard. You'd like to say, okay, at the five mile mark I'm going to guzzle eight ounces, but that really doesn't work. Your stomach doesn't tolerate that. And so, sipping a lot of times, we'll say two or three ounces every 15 minutes if you can, is a good way to do that, if you have the capacity to do that. And you'll see football players, basketball players, they'll come off the court or the field and take a sip out of the water bottle. So a little bit at a time just to rehydrate is a great way to do that. And it allows the stomach to be able to absorb and use the fluid the best that it can.

Chrissy Billau:

Yeah, because the body to process all of it takes a lot of work. And that's why when we talk about drinking too much water, you're like overtaxing your organs here. So it's a balance.

Dr. Coral Matus:

Exactly. You're exactly right.

Chrissy Billau:

Are sports drinks the best choice to rehydrate after exercise?

Dr. Coral Matus:

So a lot of that depends on the length of exercise. So again, in general, the body needs water, it needs fluid. So some of some sports drinks have sugar, have carbohydrate, simple sugars that can get in and replenish the body. So if you've been exercising for a long time, so let's go back to the marathon runner. Halfway through a marathon, your glucose stores, your glycogen stores that are in your muscles are probably depleted. And so, having that quick energy to continue to perform or to replenish can be helpful. The other thing though that sports strings have our electrolytes and so as we sweat, we lose sodium and potassium and some of those salts in our body and in our bloodstream.

And so, replenishing those, is good. And a sports drink is a quick way to do that. Typically, we get those salt in our food, so we can also get it by eating a peanut butter and jelly sandwich or a jelly and tuna sandwich or whatever it is. So we can get it through food. But sports drinks are just a quick way to do that. But again, typically when I think about sports drinks, I think about not the typical, I'm going out for a 30 minute run, but it's the probably more hour to 90 minute exercise or longer. So the athletes that are in a three hour game, sports drinks can come into play part way through that to help replenish those electrolytes as well.

Chrissy Billau:

Do you eat jelly and tuna sandwiches?

Dr. Coral Matus:

I typically don't, but it is one of the things that is recommended, a good protein and carbohydrate combination.

Chrissy Billau:

Like strawberry jelly and tuna?

Dr. Coral Matus:

Sure.

Chrissy Billau:

Okay. [inaudible 00:17:18]

Dr. Coral Matus:

I mean it's an alternative to peanut butter and jelly.

Chrissy Billau:

I'm going to try it.

Dr. Coral Matus:

So it's an option.

Chrissy Billau:

Sorry about that. I just had to know I'm going to try it. So in all of these drinks out there, advertising for increased hydration, how legit is it? I mean, what should people be looking for if they're looking for that boost in hydration? Because, everyone wants the edge.

Dr. Coral Matus:

When they talk about increased rapidity of hydration, one of the things that is true is that when you drink water, water is what we call hypotonic, meaning going back to chemistry, the concentration of salutes is below what's natural in our body. So if you take your blood out, it has a certain level of salts in there. And so, anything that's closer to that, to that level of plasma is going to get in quicker, it's easier for your body to take it in. So pure water is what we call hypotonic. It's a little harder for your body to absorb. So if you get something that's more what we call isotonic, so it's about the same concentration of salutes that's what's in your body, it is a little easier for it to absorb. So that's, where the sports drinks and things that have a little bit of sodium, a little bit of potassium in them can get absorbed a little bit more quickly.

But we're still limited by that volume. Your stomach can only take in, it's not like if you guzzle 10 ounces of isotonic solution that it's going to get right in. It's still limited by the surface area of the stomach and what it can absorb. So again, probably a little bit of an edge with some of those sports drinks that have a little bit of those salutes in them, but not so much so that it's going to make a huge difference. And then you have to realize the back end of that is you are getting more salt and sometimes more sugar, and are those things you really want? Now again, for a performance athlete, you bet, if they're an hour and a half into a marathon or triathlon, they need more electrolytes, more energy. But if you're trying to run a half marathon to lose weight, maybe that's not what you want to replace it with. So some of it depends on your performance goals, and your ultimate goals.

Chrissy Billau:

My 30 minute Pilates in the morning does not need them.

Dr. Coral Matus:

Probably not.

Chrissy Billau:

Now on the flip side, what are some effects of over hydration and drinking too much water? I know we alluded to this a little bit, but I'd like to lay this one out.

Dr. Coral Matus:

So besides just again, the performance thing, you're an hour into exercise and you over hydrate and you feel the fullness, the bloating, the sloshing, the uncomfortableness that can happen with that. The thing we really worry about, and again, typically this is in folks as they get a little bit older, the mechanisms within the kidney that regulate hydration, that regulate the bodies, getting rid of excess water can sometimes not be quite as spry as when we're 20 or 30 or 40. And so, we do have cases where folks can over hydrate, and again, this would be maybe a 65 year old, 70 year old who's trying to stay hydrated and they can actually drink so much that it lowers their body sodium, which can be dangerous.

There are also conditions [inaudible 00:20:28] drink excessively for various reasons, medications, side effects, where they feel thirsty all the time. There's something called psychogenic polydipsia where people just think they need to drink all the time in the psychiatric field where people will just drink excessively. And how that manifests then clinically is, like I said, they'll come in with really low sodium levels, sometimes feeling really weak, confused, dizzy, and you'll measure their sodium levels and they're excessively low. And so, those are kind of special conditions, but they certainly can happen.

Chrissy Billau:

So if you're someone who is doing these long sports, you're a genuine athlete, at what point, if you have a soccer player or somebody coming up to you saying, "I'm trying to do the best I can to be healthier. I'm struggling to stay hydrated." What would you say to them?

Dr. Coral Matus:

So as we mentioned, I think it's different for everyone, but if you have an athlete who is struggling during games, so take your example of a soccer player and they say, "Every time I get into the third quarter and I start to have cramps and I start to feel weaker and I feel like I'm not as hydrated as I need to be." I would tell them one, to work with their athletic trainer, the trainer for their team to maybe look for strategies where you can get little hydration bursts during the game. So maybe the athlete's so busy, even when they come over to the sideline, they're into the game and the strategy, and so they're not thinking about hydrating. That's where a teammate or a trainer can be good at saying, "Hey, here you go." Hand you a water bottle. Make sure you're sipping a little bit.

Maybe it's at halftime, you need to make sure that's where maybe some Gatorade comes in or a sports drink of some sort. But again, that pre hydration and even the night before, maybe that athlete needs to say, "Okay, I've got a game tomorrow at 8:00 PM so tonight at 8:00 PM I'm going to start making sure I over hydrate, even if it means getting up to go to the bathroom a couple times tonight. I want to make sure I head into the game with plenty of hydration before I get into that game situation." Sometimes a little bit of trial and error, what works for each athlete is going to be a little bit different, but you can certainly incorporate your healthcare team in that. And a lot of times, like I said, the athletic trainer or the coach can be a big part of that just to remind you that remember last game, we want to be able to play you through the whole fourth quarter, let's make sure we're keeping you hydrated.

Chrissy Billau:

And I wish more people would, and I don't know if this case for you, have that athlete mentality like, my body is incredibly important and I need to be really careful what I put in it.

Dr. Coral Matus:

Yes, absolutely. That's a very good point. And I think a lot of times people come with certain symptoms, and again, I mentioned this before, but it's the headaches, the dizziness, I feel weak, I stand up and I feel dizzy. That's your body telling you something. And so, a lot of times patients come in and they just want it fixed. And when I say, "It sounds like you're dehydrated, I need you to do this and this." And oftentimes they are open to that, but sometimes they want the quick fix, how about a pill to fix that? And really it's really a lifestyle thing that will we'll do the most good.

Chrissy Billau:

Well, Dr. Matus, let's talk about going to the bathroom, about number one. In our last season with our kidney specialist. He talked about how it all depends on how much water you drink. On average, how many times should people be peeing a day?

Dr. Coral Matus:

Wow, that's a little bit of a loaded question. So this really depends on, it does depend on hydration, but it also depends on the capability of your bladder to hold volume. So a typical bladder is going to feel full or you're going to get the sense that you need to go to the bathroom, number one, somewhere between 150 and 200 milliliters, which is there's 30 milliliters in a cup or in an ounce. So we're talking 15 or 20 ounces in your bladder, you're going to start to feel like you need to void.

The typical bladder though, if you're on an airplane, you can't get up and you really have to hold it, you can hold to three, four, sometimes even 500 milliliters if need be. So again, a lot of it depends on that capability too. Again, as women especially get older, we get a little less savvy in controlling our bladder, so we might have to go a little bit more often. But again, if you do the math, a typical person's probably going to urinate five to seven times during the day, maybe once at night. That would be kind of a normal. But again, a lot of that depends on some other factors as well.

Chrissy Billau:

As women, you mentioned when we get older, we become less savvy when we go to the bathroom. Can you talk a little bit more about that?

Dr. Coral Matus:

Sure. So one of the struggles that I think we have as women get older, well, there's a few things that happen. Naturally, the anatomy in our pelvis changes a bit. And so for women, our bladder is kind of in the front, if you think about the pelvis in the front, and then our uterus sits right behind that. But all of those tissues over time tend to head south a little bit and droop a little bit. And especially for women who have had pregnancies and births, interestingly, there's lots of studies looking at, does vaginal birth impact that or what about women who have cesareans? And there's been a whole body of literature looking at that. But regardless, even women who have not been pregnant in the past, we know that those tissues over time droop and don't perform as well as they should. And so, part of the problem with that is the bladder performs best when it's kind of upright. It sits kind of coming straight up toward our belly button.

And so as that droops, it allows urine to kind of collect in that back part there, and we don't empty as well and some of that urine can remain there. And so, women will come in and say, "Gosh, I feel like I go to the bathroom every hour and a half, but I just don't feel like I empty completely." And so in fact, that can be the case. And so, there're some things that we can instruct women in terms of repositioning during voiding, there's something we call double voiding where we have them sit and urinate, try to empty their bladder, stand up, wash their hands, sit back down and see if they can void again, because sometimes just that those few minutes allow the bladder to reclaim its tone a little bit and urinate and void a little bit more.

But this does become a big issue, a lot of times when women are having more urinary symptoms and concentrated urine and urinary tract infections, we'll say, "You just need to drink more." "Well, I don't like to drink because then I have to get up every half hour at night." And so, it becomes this battle of urinary health, you need a certain level of hydration, but it's very uncomfortable to have to get up every half hour at night to go to the bathroom. And so, there are some medications that can help with that. We actually have medications that can help relax the bladder and make it not so contracty at night and so not feel like you have to go so often. But again, every treatment, of course has a side effect. And so we have to kind of balance the plus and minus of that.

Chrissy Billau:

What's interesting is I had a C-section about five years ago, and after that I did start noticing just a little bit of difference, but even more now over time, just as getting older. My family will make fun of me. We have a bathroom downstairs and upstairs, and I'll go to the bathroom downstairs and I'll carry laundry upstairs. I'm like, "Man, I have to go to the bathroom again." I just went. It's nice to know I'm not losing my mind.

Dr. Coral Matus:

You're not losing your mind. The other thing that happens is, again, with those conditions where the bladder can't handle as much volume, women will get a condition called urge incontinence. And so, probably most older women have experienced this at least once, but you come in from outside and you're washing your hands and all of a sudden you have to go and you feel like you almost can't get there in time. And so, we call that urge incontinence. The thing that I tell women about that is the bladder is a muscle, it's a muscle. And I think about it like a water balloon. So if I wanted to carry a water balloon across the yard, if it's super full, it's going to be harder. I'm going to have to work to carry it. If it's less full, it's a little easier to carry it. And so, a lot of times when women struggle with urge incontinence where every urge like, "Oh, I can't make it to the bathroom." Emptying your bladder more frequently is actually helpful.

All of us get busy. You've had this situation, I do it all the time. I'm seeing a patient like, "Oh, I could go to the bathroom. I'll just see one more patient." And so, you kind of put it off until the third or fourth time you get that urge, then it's much harder to handle the volume that's in the bladder. And so, we even do an exercise where we do timed voiding. And so, if women are struggling with urge incontinence, we'll have them do timed voiding. And I'll say, "On a Saturday, just set your alarms and every time it goes off, go to the bathroom." And then you can slowly increase that time that you're holding urine to slowly allow your bladder to be able to hold more and more. Now, do it every two hours and every three hours. And a lot of times you can retrain the bladder a little bit to be a little bit more tolerant of bigger volumes without those symptoms.

Chrissy Billau:

If you are someone who hates the taste of water, what would you recommend to them to increase their water intake? I know my husband uses these MiO water flavors you just squeeze it and that dramatically increased the amount of water.

Dr. Coral Matus:

Absolutely. And that's a great option. There are the water additives, whether they're the liquid or the powder ones. And a lot of times when folks are having trouble with weight loss and they say, "I just don't like water." I'll recommend those things. The other things, it's more, I guess, natural things. So putting cucumbers in your water, putting lemon in your water, even putting berries in your water. And so sure, it is a bit of calories, but if you take a 16 ounce water bottle and throw a few berries in the bottom, the calorie exchange is minimal and it gives just enough flavor to the water to take the edge off. And again, cucumbers are a zero calorie exchange. So just taking that edge off sometimes is enough to convince folks to drink a little bit more.

Chrissy Billau:

And this is the question coming up. It's a two part, that a lot of people, I said, I'm talking to her about this, "This is what you have to ask her." Coffee and darker drinks, Do they count toward your water intake total for the day? And how much is too much when it comes to staying hydrated?

Dr. Coral Matus:

Yeah, that's great question. So caffeinated drinks, and again, not all coffees are equal. I mean, are you talking about the espresso coffee or the really weak Folgers that you put a little bit. So it's kind of hard to make generalizations. But again, in general, the fluid that you take in, even if you drink a big cup of coffee, the fluid that you take in does count as fluid. The problem is the caffeine negates that. So if caffeine is a diuretic, and it'll encourage you to excrete or get rid of more water. So as a general rule, what I tell my patients is, one serving of coffee or one serving of caffeine, which is about an eight ounce cup of normal coffee, not the super dark, packed in, extra heavy or one cup of tea, is usually about 100 to 120 milligrams of caffeine.

So if you look at that as one serving for each of those that you have, you should have a non-caffeinated fluid to kind of balance it out. So it's not that the fluid doesn't count, it's just that it's kind of a wash in terms of the caffeine, getting rid of that. How much is too much in a day? Again, I feel like this is an age old question, is caffeine good for you? There actually are good studies that shows that moderation of caffeine can improve performance, can even prolong life if you believe some of this studies. So probably one to two servings, so up to about 250 milligrams a day can actually be healthy, can be good for you, as long as you rehydrate on the back end or have some balance, in terms of non decaffeinated beverages, on the backend.

Chrissy Billau:

Water bottles. I used to judge people who had the fancy ones, but now I have them too.

Dr. Coral Matus:

You're almost there.

Chrissy Billau:

So a lot of us enjoy that insulated or glass water bottle or have that cabinet filled with the water cups with straws. Is it helpful to invest in these, to drink more water? Is it like a mind game here?

Dr. Coral Matus:

Again, I think in general it is for a few reasons. One, I think just having it there and reminding you we're creatures of habits. So if it's there, it's like, "Okay, I'll sip, I'll sip." Whereas, if it's not there, you're not going to go get something to get the water. I also think it's helpful for those people, as you mentioned, that don't like pure water. So again, for me, I have a water bottle and I take frozen berries, throw a few in the bottom the night before, put it in the fridge and then sip throughout the day.

And so, just that little bit of berry flavor in the water is more attractive to me. And so, I'll drink a little bit more. I've seen the ones that are the huge ones that are the 24 hours worth of water. To me, that's overwhelming. If I think that I have to drink all that today, that would be overwhelming for me. But for some people it works. They have a goal like, "Okay, I'm going to do this today." So I think for some people it works. I think it's a good reminder and can be helpful.

Chrissy Billau:

What are some tips, and I like the one you just gave, but what are some tips you would recommend to people to stay hydrated throughout a day?

Dr. Coral Matus:

So I think anywhere that you're able to have a drinking container, whether it's a water bottle or a mug or whatever it is. I mean, for me, as I'm seeing patients, I have my water bottle back by the computer. And so I try, each time I sit down to look at a patient or document a patient, I try to sip as I'm doing that. So I think part of it is just making it a habit throughout your day, putting it into the course of your day and making it part of that. It takes about 21 days to develop a habit. So if you start to incorporate that into your day, then it just becomes part of what you do. The other thing is thinking about with your meals. And so, if most people eat two to three meals a day, if you try to say, "Okay, I'm going to make sure I get eight ounces of fluid with each meal." That way you're a little ahead of the game.

Chrissy Billau:

And I like your routine. It starts the night before where you put it in with the berries. So it's just a part of your life.

Dr. Coral Matus:

It's part of part what I do.

Chrissy Billau:

At what point should you talk to your doctor about your hydration? When is it concerning?

Dr. Coral Matus:

So one of the things we haven't talked about is how some other... We talked about a couple of medical conditions, but a common one that we see is diabetes. And so, folks that have diabetes, and especially with uncontrolled blood sugars, so blood sugars that are high, one of the ways that the body gets rid of glucose is through the urine. So when your glucose is high, and there's a condition called osmotic diuresis, so the body tries to get rid of sugar, but it's at the expense of volume of fluid.

And so, some of the symptoms that we see with high blood sugars are what we call polyuria, going to the bathroom a lot. Polydipsia, feeling thirsty all the time. And when you're noticing those sorts of things, like I'm always thirsty, or I'm always going to the bathroom, those should be signals that maybe you need to talk to your doctor and make sure that there's not something else causing that. So any big change in symptoms or symptoms that seem a little bit out of proportion to normal, it may not be just because you're not drinking enough or that you're not being able to control that balance. There may be some other underlying factor that we need to address that would be very helpful.

Chrissy Billau:

And I think that's come out in the last season, is how complicated the plumbing is and how it can be a sign of your water intake isn't the problem, but it's a sign that this other thing is.

Dr. Coral Matus:

Absolutely.

Chrissy Billau:

So Dr. Matus, we talk about common themes. What is the most common question you get asked by your patients and what do you tell them?

Dr. Coral Matus:

I think the thing that I get asked most commonly by patients has to do with weight, weight loss, weight maintenance. And so, I would say if there's something that I answer at least two or three times a day when I'm in the office, that's what it is. I've been trying to cut back on my eating. I've been trying to exercise more, but I just can't lose weight. And so, I think it fits really well into this. I already mentioned that when one of the first things I'll ask is, "What do you drink?"And so, a lot of times people don't think of things that they drink as calories. So they think about what they're eating, but they don't think about that two liter of Coke that they drink every day and how many calories that can be. And when you start to really talk to people about an eight ounce can or a normal can, I guess it's 12 ounce of Coke, has about 200 calories in it. And so, if you start to add that up over the course of a week, even if it's one can a day, that's a thousand calories. And so, over the course of two or three weeks, that's a pound just from drinking one can of Coke a day. And so, being able to relate your liquid intake to how that's impacting your weight and your overall health that way can be eye-opening to people.

Chrissy Billau:

I think that's a good experiment too of, okay, stop drinking Coke for a month. [inaudible 00:36:45]. And let's see what happens.

Dr. Coral Matus:

Yes, absolutely. And it can be really encouraging, because typically people think that I'm going to say, "Okay, you have to stop eating everything you like and you can only eat a thousand calories a day." But when you give them something fairly simple, it's not always easy, but it's fairly simple. If you don't change how you're eating, but just replace your Coke with water and let's see what happens. It seems doable. It seems reasonable. And like you said, interesting experiments.

Chrissy Billau:

And motivational, if you see a little bit of positive direction happening.

Dr. Coral Matus:

You bet.

Chrissy Billau:

What have you been working on lately? Everything.

Dr. Coral Matus:

I'm sorry. That was a funny question. So a big part of my position is I oversee the curriculum for the first two years of the medical school. And so, it's a constant moving target. There's just seems like the amount of knowledge that students need to attain in those first two years to be ready to hit the clinical setting, is just doubling. There's actually data, that in 1920, the doubling time of medical information was in the years, it was four to five years. And today doubling time of information is in the hours. And so, it's just the amount of knowledge that folks have to have, not just in medicine in every field, but in the field of medicine it can feel overwhelming to students. So always looking for ways to help them attain information in a more efficient but effective manner. Our learners are constantly changing as well. And so, being able to match those needs with how to make them excellent clinicians is always a constant challenge. And so, I find that kind of invigorating to try new and innovative things to try to help them get to where they need to be.

Chrissy Billau:

Well, and just anything, the technology's changing. What we know about certain diseases in the body, it's all changing. So you can't stay static and teach what you've been teaching 10 years ago.

Dr. Coral Matus:

Nope. Not at all. And that's one of the examples I use with students a lot. Even through the course, I've been in medicine for 25 years, and some of the things the day I graduated medical school that we knew to be true, are false, just wrong. And so, you look back at some of those things, I mean, even talking about some of them now, "How could we ever think that?" And so I'll tell students, "You just wait, something that to be true today, we're going to look back someday and go, Wow, how did we ever think that was true?" So yeah. It's amazing how things morph and change.

Chrissy Billau:

We had one of our cardiovascular surgeons on for the first episode, and I brought up is a glass of wine a night, good for your heart health? And he said, "No." I was like, "Wait a minute. There're antioxidants in here, all these studies?" And he's like, "I know we thought that before, but the more we learn, don't think you're doing anything good for your heart here."

Dr. Coral Matus:

Absolutely.

Chrissy Billau:

"What?"

Dr. Coral Matus:

And a great example of that is, again, when I was in med school, in residency, the big push was for women, as soon as they were close to menopause, we had to get them on estrogen. We thought that it decreased their cardiac risk. And if you could catch them even before menopause, you were doing them huge favors. And now there's a huge study, a multi-center, huge number of people study that shows that actually that isn't true. And so, we reversed course really quickly over the course of a couple years. And so, it's amazing how things swing. Stick around long enough and the pendulum swings at least once or twice.

Chrissy Billau:

So my glass of wine at night will be good for me again in a few years.

Dr. Coral Matus:

It's very possible. Very possible.

Chrissy Billau:

Well, thank you so much for joining us. I had a great time with you.

Dr. Coral Matus:

Thank you. Thanks so much.

Chrissy Billau:

Thanks for listening to Prescribed Listening. If you like this episode, subscribe for more on your favorite podcast platform. See you next week.