Water, Water, Everywhere

Do we need eight glasses of water a day? How about a gallon? Is there a such thing as too much? Find out all about drinking water on keto.

Article by Mandy Pagano | 04 Oct, 2020

Article originally published on Ketovangelist.com on 6/10/16. It has been lightly edited for re-publication.

Water.

It's the source of all life. Around seventy-one percent of the earth's surface is covered with it. There is water vapor in the air around us. The human body is made up of somewhere between fifty and seventy-five percent water, depending on individual size and age. Water is truly one of the most important chemical compounds in existence. We need it not just to live, but in order for the species to exist and continue.

There are a heck of a lot of dietary myths that have been dispelled or discussed on this site, but one big question that probably needs a bit of a glance is thus:

How Much Water Do We Actually Need to Consume to Be Healthy?

Every health and diet "guru" has an opinion on water consumption and, in general, the most common opinion is that more is better. I've read or seen "expert" recommendations ranging from a gallon a day, to advice like drinking until your urine has no color. When it comes to keto, things get even murkier. Various websites and keto acolytes on social media throw out all kinds of recommendations, such as: one hundred fluid ounces a day, minimum, or; two full gallons a day and supplement like crazy, or; drink until you can't stand it anymore, and then have another glass. Yes, I've seriously seen that last one, and no, I will not be naming the culprit.

What Do Health Organizations Say?

Medical experts vary a bit in their recommendations. For example, the Mayo Clinic's recommendations vary quite a lot depending on your own circumstances (are you pregnant, do you live in an extremely hot climate, or are you incredibly physically active?), although they do mention the standard 8x8 line; as in eight glasses of eight fluid ounces each per day. We've all heard that one.

The U. S. National Institutes of Health (NIH) estimates that the average person needs between ninety-one and one hundred twenty-five fluid ounces of water per day. When factoring in that an estimated twenty percent of our daily fluid consumption comes from the foods we eat, the old 8x8 rule doesn't look too far off. The doctors at WebMD, on the other hand, say that the rule of thumb has changed from the good old 8x8 to one-half (1/2) a fluid ounce per pound of body weight per day, adjusting for other factors as needed.

Pretty reasonable so far, right? Or are you confused?

An Anecdote for Your Consideration:

Late last year, I went to the doctor with some very bizarre symptoms. This was my first bout with very serious, constant neuropathy (tingling, pins and needles feelings) in my fingers, hands, and running up my arms, as well as twitches and muscle spasms in my face, lips, and eyelids. My heart was racing and I felt very ill. The tingling in my arms began running up into my chest, and I was terrified I was having a heart attack or stroke so I headed up to the emergency clinic.

They saw me immediately and, after having quite a bit of blood drawn, peeing into cups, and being hooked up to several machines that go PING!, the doctors determined there was absolutely nothing wrong with me. Except for one thing: I was low on potassium in my blood serum. They gave me two horse pills of a potassium supplement and within minutes the symptoms had started tapering off. That evening everything but the tingling in my fingers had diminished to almost nothing.

Being an emergency clinic, and seeing as I avoid going to the doctor unless it's absolutely necessary, we all (doc included) just assumed I was naturally deficient in potassium and needed to up my intake. He was not my primary doctor so the emergency resident wouldn't write me a script for a heavy-duty potassium supplement, but he did recommend that I pick up some of the low-dose potassium they sell over-the-counter, and told me to consume a lot high-potassium foods. I immediately grabbed potassium pills from the local drug store and started buying avocados by the case.

Problem Solved, Right?

The thing is, my symptoms never really went away. They would come and go over the next few months, and after a while they began to intensify once again. I finally broke down and called a general practitioner for an appointment. We went over everything: diet, exercise, family history, and my blood work and urinalysis from the emergency clinic visit. Ultimately, he suspected that I had a disorder of the parathyroid (the nodules that sit atop your thyroid, and play a major role in regulating your electrolytes). He sent me for more testing.

When I came back to the office, I was pretty stunned to find that there was nothing wrong with me, and so was my doctor. All of my hormone levels came back perfect, and so we had to readjust and re-examine everything. During this discussion, I offhandedly mentioned something about how much I drank daily. At this point in my keto journey I was all-in on the idea that, when it came to water, more was always better, and so I was very proud of the fact that I had such a "healthy" level of water consumption. Doc stopped to consider a moment, and then he asked me to detail out exactly how much in the way of fluids (including coffee, tea, etc) I was drinking daily. "I drink around one hundred fifty fluid ounces of water a day," I boasted, "and I also have maybe four or five cups of coffee." (I like coffee, ok?)

My doctor actually jumped out of his chair and started gesticulating at me wildly. "NO, NO, NO!" he shrieked. "That's way too much! You could kill yourself!"

A Watery Wake-Up Call

At this point, I had been keto for about seven or eight months. When I started, I weighed quite a lot, was thirsty all the time, and I probably did need to drink more water. The problem was as I lost weight, I never adjusted my fluid intake down. I kept on drinking water like it was going out of style, always with the mindset that more was better. I didn't even consider my coffee drinking to be at all relevant to my fluid intake because I'd always heard water meant only water. Since I had lost quite a bit of weight (over fifty pounds at that point), instead of hydrating my body I was actually flushing my electrolytes so badly that even supplementation could not make up for the difference.

It took months of weird symptoms and several rounds of testing for my doctor to realize- after an off-hand comment, mind!- that I was drinking dangerous amounts of fluid every day. Over the next month, I worked with my doctor to drastically reduce my fluid intake. He recommended that I have my coffee in the morning as usual, have a glass of water at meals, and then drink only when thirsty. He explained what should have been apparent: our bodies tell us when they need water by making us thirsty. You have no idea how stupid I felt having to sit there and, very sheepishly, take that advice. What sounds so very obvious really isn't when you factor in all the "noise" in which we are inundated on this subject from the health and wellness industry, the media, and even from our peers.

As time went on I began to only drink when I was thirsty, and at my last round of labs my electrolytes are all now at optimal levels in my blood serum without any supplementation. In other words, once I stopped trying to drown myself everything worked itself out naturally.

Why Is This So Important?

Almost every day, we see chatter about electrolytes and water on keto forums (including the Ketogenic Success Facebook group) and websites. Every symptom imaginable is said to be treated by eating pink salt, taking potassium and magnesium, and drinking a boat load of water. Post after post, question after question, people are constantly either boasting about drinking a gallon (or two, or three!) a day or, conversely, are commiserating about how much they hate drinking water and asking how they can doctor it so they can force more down their gullets.

After my water crisis, these conversations and postings frustrate me to no end. It is true that keto is naturally a little diuretic. That means you will excrete more in the way of water and electrolytes than you would on the SAD (Standard American Diet) or any other high-carbohydrate diet. At the same time, going overboard with water in a manic attempt to compensate can cause some very serious damage. While we here at Ketogenic Success usually recommend the current "rule of thumb" the medical community has circulated (one-half fluid ounce per pound of body weight per day), the truth is that you may need more or less than that, and it will depend a lot on your weight and activity level.

What You Need To Know

  1. Drink to thirst
    • When it comes to hydration follow your body's signals, just like you do with food. Where we should eat when we're hungry and fast when we're full, we should also drink when we're thirsty and stop trying to chug down the gallon jug when we're not. Don't forget that your fluids don't come solely from what's in your glass, cup, or bottle, and so there is no hard-and-fast rule as to how much a body needs to drink every day.
  2. Be aware of what can and cannot be safely supplemented
    • You can generally safely take over-the-counter magnesium supplements, as directed on their packaging, but don't try to correct a long-term imbalance on your own. I do not recommend ever trying to supplement potassium. There is a reason they can only sell potassium over-the-counter in incredibly small doses. When it comes to electrolytes, both deficiencies and overdosing can be extremely dangerous, and potassium exists in a quite delicate balance in the body. It is easier than you think to overdo it- especially if you're also on other medications that may affect your body's ability to absorb this mineral- and if you do there are very, very negative health consequences. Always make sure you run any supplements by your doctor and pharmacist to avoid adverse interactions.
  3. There are a multitude of pre-existing conditions that can cause electrolyte imbalances
    • If you think you have an electrolyte imbalance, or are having symptoms of electrolyte deficiency and it isn't helped by eating an avocado or drinking some good quality salty broth, and you're also not floating away on the sea that is your daily water intake, you should consider seeing a doctor to rule out serious medical conditions.

I understand that the number of pro-keto doctors are few. Many practitioners are vehemently against ketogenic lifestyles, or are just baffled by and ignorant of keto (which is often the best case scenario). Yes, that's frustrating. The truth is that not everything that happens to you, symptom-wise, is related to keto, so if you're having serious health issues you need to see a medical professional. You may have to grin and bear it if he or she gives you a hard time about your dietary intake, but at the very least a doctor can help you confirm or rule out any major illness or medical condition that can't be helped by keto alone.

The Bottom Line 

Please listen to your body, not just when it comes to food alone, but for everything you put into it, including water and other fluids. Learning what your body needs by observing and yielding to its signals is a big step on the way to immediate healing and long-term healthy living, and is a major part of what the ketogenic lifestyle is all about.

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