Fluid drinking, healthy choices, how much is the right amount, how much is excessive
August 25 2015 by
Ray Sahelian, M.D.

Fluids make up more than 20 percent of calories in the average American's diet. But most Americans only count the calories they get from solid foods.

Trendy coffees, sodas and other sweetened beverages can quickly add extra calories to your diet.

Consume plenty of plain water
If you like juice, don't drink more than 6 ounces per day, making sure it's 100 percent fruit juice.
Avoid highly caffeinated energy drinks, and do not mix them with alcohol.
Choose the smallest drink serving, and always read the nutrition label.
Although articles in magazines and newspapers, along with experts on TV claiming we need to drink more than 8 glasses of water a day, I personally think many people are drinking too much water a day, especially if they live in a cool environment.

Soft drinks and cancer
Soft drinks contain high levels of a carcinogen known as benzene. Diet soft drinks may contain
aspartame and other harmful substances. Are there other fluid options to satisfy our taste buds besides water?

Am J Clin Nutr. 2012. Soft drinks, aspartame, and the risk of cancer and cardiovascular disease.

Healthy Fluids as the Globe Warms
I used to drink bottled water or boil until I bought a high end water purifier. Now, I just drink this purified water and rarely drink bottled water unless I am traveling. I hope more people try this method rather than spending so much money on bottled water. With the price of fuel going higher, the transport of bottled water will raise prices and also contribute to pollution from fuel use and the dumping of these bottles in the trash. Besides water, have you considered what fluids you normally consume? Here are some suggestions:

Healthy fluid alternatives to soft drinks
Fruit juice - there are so many to choose from. Why limit yourself to orange or apple? Try mango, guava, cherry, prune, grape, berries, watermelon and others. Consider diluting the fruit juices in water, and make sure there is no added sugar.

Vegetable juice - you can drink tomato juice in a bottle or can, and also the mixed vegetable juices such as V8. If you live near a health food store, you can get fresh carrot juice, greens, and other fresh mixed vegetable juices. If you have children, offer them vegetables juices rather than sugared drinks and sodas. Vegetable juices are a wonderful, healthy, fluid.

Herbal teas - there are countless herbal teas you can choose from, and make sure the tea you buy is the actual herb rather than artificially flavored regular tea. Have you ever tried licorice tea? It is so sweet. You can buy licorice root from a health food store and soak it in water and then filter it. You can add ice and make it a delicious summer drink. I have at least a dozen different teas on my kitchen counter and I alternate them. Try iced green tea sweetened with stevia.

Lemonade sweetened with - you can have delicious lemonade, sugar and calorie free. Squeeze your own lemons or buy lemon juice from the store, add water and stevia. Health food stores now carry organic lemon and lime juice. Stevia goes very well with lemon juice. I prefer the Stevia Liquid. Another great option is Stevia-drink-lime.

Soy milk, almond milk, rice milk - these are good alternatives to milk. I am not against milk consumption, I just think many people drink too much. One glass a day is plenty. Substitute these other drinks instead. Most of the soy milk in stores has added sugar. You can buy the unsweetened soy milk and add stevia. Or, sometimes I buy the sweetened ones and use a small amount of this soy milk mixed with a larger amount of the unsweetened.

Coffee as fluid - I suggest not more than 2 cups of caffeinated coffee a day, and preferably in the early part of the day. At times, when I am having breakfast at at restaurant, I ask them to pour half the cup with regular coffee, and the other half with decaf. Regular coffee may have more antioxidants, but the caffeine is not that helpful if used in excess.

Fluid alternatives to soft drinks that may not be that much healthier include many sports drinks, energy drinks, and certain enriched drinks since they contain lots of sugar.

Other types of fluids introduced in recent years include water with added vitamins and minerals. I really don't think these are necessarily, it is just a marketing gimmick to charge more for the water.

Importance of Fluid Replacement in athletics

Football players doing twice-daily workouts in hot August weather experience a small but significant loss of body weight, suggesting that they are not replacing fluid lost by sweating during training. Instructing players to drink specific amounts of fluids at specific times outside of practice helps prevent fluid loss. This is very important since illness and death due to heat stroke are a problem for football players, who must practice wearing heavy uniforms and often are required to complete two practices in a single day, particularly in those who live in hot and humid weather such as Florida, Mississippi and Alabama. International Journal of Sports Medicine, April 2006.


Marathoners should drink when thirsty
How much fluid should a marathon runner drink while racing? The answer depends on a variety of factors, but the best approach is to replace fluids in response to thirst. The International Marathon Medical Directors Association (IMMDA) reports there is no "blanket advice" to give to people about how much fluids are needed while exercising. Instead, they write, "Athletes should learn to trust the sensation of thirst, rather than adhere to rigid guidelines that do not allow for the flexibility that is needed in a dynamic race situation." Their statement, published in the Clinical Journal of Sports Medicine, was issued in response to the existing controversy surrounding the optimal amount of fluid that should be consumed by athletes. Athletes should drink when they feel thirsty, as the best way to protect against consuming too much or too little fluids. Clinical Journal of Sports Medicine, July 2006.


Fluid intake of older adults less
Changes in nerve activity as people age may help explain why older adults often drink less in response to thirst than younger people do. The anterior cingulate cortex of the brain responds to thirst. The anterior cingulate cortex that motivates people to drink when thirsty more rapidly turns off in elderly people after they drink a small amount of water. Age-related changes in the nerves supplying the brain may be at work. There may be changes in the "input" from nerves in the mouth, throat and stomach that sense how much water we've consumed. Proceedings of the National Academy of Sciences Online Early Edition, December 17, 2007.