Is it Necessary for Everyone to Drink At Least 2L of Water Every Day?

This is a post that we are writing because many of our patients seem to be negatively affected by this notion. With widespread information in magazines, news, and instructions that were directly given by their physicians, everyone seems to think that they need to drink at least 2L of water per day.  

However, we need to look at this recommendation more closely. First of all, the 2L water recommendation is based on the assumption that one consumes 2000 kcal per day. All the metabolic reactions in our body work in the medium of water; thus, if we consume more calories, we will need more water to allow these reactions to happen efficiently. By the same logic, we can drink less water if we consume fewer calories. Secondly, this water requirement is not just limited to the drinking of actual "water". It includes water in our food such as vegetables and meat, as well as other beverages like juice. According to research, we can consume 800mL - 1L of water from these sources. This means that we only need to drink 1L of "water". This also means we can drink 4 - 5 glasses (assuming each glass is 200 - 250mL) of water per day instead of 8 - 10 glasses that most people think is necessary. Lastly, our kidneys can only filter 1L of water/hour. We do not need to drink excessively at a time since our kidneys cannot filter all of that anyway.

We now need to know what happens when we drink too much water since that often does not get questioned nor gets covered that much in the media. That is because the side effects are not seen to be that serious for most people. The most obvious side effect is frequent urination. If our body does not need it, it will try to expel excess water via urination. You should reflect on whether you are drinking too much water or not if you have ruled out conditions like urinary tract infection, stress incontinence, or prostate enlargement which can cause frequent urination. We have seen patients who reported going to the washroom every 30 - 45 minutes. Such frequent washroom visits not only decrease one's productivity but can also cause discomfort in the genital region for females due to frequent wiping. Normal urinary frequency for healthy adults is 5 - 6 times per day, which calculates to once every 3 - 4 hours. We have also seen patients with taut skin everywhere and pitting upon palpation from water retention. Patients with edema in the lower extremities (knees, ankles, feet) had difficulty exercising. Yet other patients woke up 4 - 6 times a night to pee and so they had poor sleep. Nocturia (night-time urination) is abnormal and can negatively affect the sleep quality and therefore, the individual's energy level and productivity during the day. Healthy individuals should be able to have a continuous 6 - 8 hours of sleep at night without being woken up by the urge to urinate. In cases where one is not drinking too much fluids in the evening yet has to urinate between sleep, it is usually related to Kidney deficiency in Chinese Medicine pathology. While edema in the lower extremities is also related to Kidney as well as Spleen Deficiencies, if edema is in the upper body (face), it is usually due to disturbance in the Lung function.  

While Western Medicine does not mention much other than frequent urination when one consumes more water than is necessary, Chinese Medicine has a different perspective. Any fluid that goes into our body gets processed (transformed) and transported by the Lungs, Spleen, and Kidneys. There are also other organs that work alongside these major 3 organs such as Small Intestine, Bladder, and Triple Energizer to help separate, transform, transport, and excrete fluids. When the body is overwhelmed by the amount of fluid that enters it, the fluid does not get transformed/transported/excreted and starts to accumulate in our body instead. This accumulated fluid is harmful to our body and becomes pathogens like Dampness, Phlegm, or Phlegm-Fluid. Symptoms and signs may vary, but people with these pathogens can exhibit a tendency to swell (edema/water retention), gain weight easily, runny nose, and sputum. 

In addition, Western Medicine also recommends limiting water intake for the following patient groups:

1. Those who have problems with urinating such as Prostate Enlargement and Stress Incontinence patients

2. Those with stomach problems such as Gastritis and Acid Reflux/GERD patients; Water can dilute the digestive enzymes in our stomach and reduce the digestive efficacy

3. Those with reduced cardiovascular function; There is an increased risk of water retention in extremities due to poor circulation. 

4. Those with reduced renal function; There likely is difficulty controlling the urine amount.

5. Those with reduced hepatic function; The liver may fail to produce sufficient proteins which allow fluids to be excreted together via urine.  

It is recommended to drink water this way:

1. Drink water only when you feel thirsty, not as a habit or obligation. Most patients with problems related to fluids tend to drink excessive water for these reasons.

2. It is best to drink room temperature/body temperature or warm water, as cold water is quite harsh for our Spleen and can also negatively affect other organs like the Heart. As a general rule, do not drink cold water or a smoothie first thing in the morning as that will extinguish the rising Yang which continues to grow until mid-day. Strong Yang Qi is necessary for our metabolism and energy. Therefore drinking cold water in the morning will cause you to feel more tired.

3. Do not drink lots of water before & after meals. This will dilute your gastric juice and therefore slow down your digestion.

4. Do not drink lots of fluid for 2 - 3 hours before going to bed. This can cause you to go to the washroom at night and also does not let your organs rest fully as they need to process that fluid. In patients with severe acid reflux, even fluid intake before going to bed can cause an episode. 

5. It is better to drink herbal tea that suits your constitution instead of plain water. We call this "functional water". 

For example, Job's tear (also called coix or pearl barley) and Poria tea is recommended if you have a Damp constitution with a tendency to gain weight, Astragalus and Ginseng tea is recommended if you have a Qi Deficiency constitution with a low energy level, Cinnamon tea is recommended if you have a Yang Deficiency constitution with a tendency to feel cold, Ginger tea is recommended if you have a cold Stomach with a tendency to get diarrhea or abdominal pain when you eat cold food, Onion peel tea is recommended if you have circulatory system disorders such as high blood pressure/high blood cholesterol/high blood sugar, Tangerine peel tea is recommended if you have a tendency for indigestion and bloating or when you have phlegm. There are other teas specific for different constitutions and health conditions but it will be too long to discuss here. As long as you are keener and more diligent, you can drink water that will benefit your body and improve your health.  

Remember, "Too much is as bad as too little / To go beyond is as wrong as to fall short" (過猶不及).