It never fails to impress; the number of individuals who seek medical consultation for diagnosis and treatment of mental disorders only to realize that many of them can see significant improvement with good hydration. A reputable estimate puts the portion of adults who don’t drink enough water at 75%.
The loss of higher level cognitive function is often the first thing that is affected when there are imperfections in body wide metabolism. The brain’s executive function centers are highly reliant on good balance, and can be considered the body’s most fragile and sensitive detector of metabolic distances. It would make sense that nature’s most recent and most complex evolutionary add-ons are also the most sensitive to changes in homeostasis.
Therefore, it is important to consider two levels of homeostasis: 1) one associated with good function as determined by the body’s ability to keep the heart beating, and 2), the state associated with proficient function of higher level processes. So often, metabolic states that are called healthy really mean ‘good enough for the heart’, but aren’t good enough for the fragile complexity of the brain’s prefrontal cortex. We can be more general: any system that requires the transmission of information between a greater number of nodes (neurons) is more sensitive to smaller environmental perturbations.
Chronic dehydration is very common and very underrecognized. Despite drinking adequate amounts of water, having no perception of either dry mouth or thirst, or having lightly colored urine, you can still have chronic dehydration. Symptoms like ongoing brain fog, physical anxiety, sleepiness, weakness, and low motivation, blood pressure fluctuations, amongst others are often caused by unrecognized dehydration.
It is challenging to think of a medical issue that isn’t caused or worsened by dehydration. Even conditions that would be worsened by hydrating are only there because of the over zealous response to dehydration.
Chronic dehydration correction cannot be cured with a brief increase in fluid consumption. In general, thoroughly rehydrating the body and addressing the underlying problem causing persistent dehydration may take several weeks to several months.
When things on the cellular level dehydrate, they take on forms that are difficult to undo with simple rehydration. Consider the increased difficulty of rehydrating dried residue on a pot’s surface if not done with timeliness. Water is the medium through which molecules that would normally bind to each other without water can instead come alive and interact. Now imagine essential proteins having a more difficult time unraveling, disassociating from other proteins or other cellular residues to go off and perform other jobs. Imagine the accumulated difficulties from the reduced ability of DNA to fluidly unravel and orchestrate protein synthesis.
Dehydration past a certain point means cell death for many cells. Why? Tardigrades (water bears) can come alive after rehydration. For human cells, there is a tendency for existing carbohydrates to form crystals in dehydration that ultimately contribute to irreversible death likely through the rupture of cell membranes.
Consider that anything which happens in extreme environments is likely also happening in normal environments. What we call “normal” is a description of the averages of various parts of a system. In any system there are fluxes of over and under states in different areas. Little nooks of dehydration, even in a normal environment, can precipitate crystallization of proteins or carbohydrate matter that are difficult to ‘undo’ and go on to physically destroy fragile cell membranes. It would not be far-fetched to consider the process of protein aggregation in Alzheimer’s or other dementia patients to begin with more frequent localized instances of dehydration.
It would also not be far-fetched to consider that thirst perception may be a natural way for life to conserve rare resources for younger individuals. Once we achieve a level of hydration, it would be wise for nature to adjust thirst perception to keep water sharing equitable for the group. So imagine hydration levels as being laminar levels. Once a hydration level is reached, the body adapts to that water level. Often, when more water is available, the body cannot perceive that it is safe to drink the previous rate of water again. Thus, extra water is then kept for younger members.
It is not unreasonable for thirst perception to be nature’s ‘death clock’. In nature, processes that beget themselves have a way of presenting themselves exponentially. Dehydration falls under this category. Dehydration affects the brain in a way that reduces the perception of the need for water, further compounding the situation. It is possible that thirst perception may be nature’s grim clock, despite conscious knowledge of water’s availability.
The connection between thirst and hunger may be that it connects not only to extracting water from food, but also using the processing of food into the body as a way to ‘hold on to water’. But another more insidious explanation could be that the requirements to mobilize intracellular stores of energy are hampered by less available water required for the free mobility of these processes.
Making lifestyle adjustments and continuously drinking enough fluids to maintain sufficient hydration are required to safely and successfully treat chronic dehydration.
It is easy to underestimate the importance of water since it is ubiquitous and widely available for consumers of mental health treatment. It is difficult to recognize something insidious as problematic after we’ve assumed the issue to be resolved. Chronic dehydration may not be bad enough to ever be noticeable, so it can linger and potentially wreak more havoc than a more obvious acute dehydration which alerts us enough to take action.
Self-assessment of our hydration status can be challenging due to a lack of clear and reliable indicators. The symptoms of dehydration can be subtle and easily mistaken for other conditions, making it difficult for individuals to accurately determine their level of hydration. In addition to these difficulties in self-assessment, it is important to note that some populations are at higher risk of dehydration, including advancing age, young children, athletes, and those with certain medical conditions.
A significant note to understand is the difference between chronic and acute dehydration.
Chronic dehydration and acute dehydration refer to different patterns of fluid loss and replenishment. Chronic dehydration is very difficult to assess.
Acute dehydration occurs when there is a rapid loss of fluid from the body, usually due to sweating, diarrhea, vomiting, or excessive urination. This type of dehydration can develop quickly and may be accompanied by symptoms such as thirst, dry mouth, dizziness, and confusion. Acute dehydration is often resolved by drinking fluids and replenishing lost electrolytes.
Chronic dehydration, on the other hand, occurs when there is a long-term inadequate fluid intake that results in a persistent fluid imbalance. Chronic dehydration can develop over time and may be asymptomatic or only cause mild, but persistent, symptoms, such as mental fog.
Thirst should not be relied on as an indicator of dehydration since it is misleading in conditions of chronic dehydration. Thirst can be dampened by factors such as age, medication (stimulant) use, and high levels of physical activity, leading to a false sense of hydration. Furthermore, by the time thirst is perceived, dehydration has likely already set in.
Urine color is often used as a basic indicator of overall hydration status, but this is not always a reliable indicator, as factors such as diet, medications, and hydration history can affect urine color. Moreover, some individuals may not have a noticeable change in urine color even when they are dehydrated.
How is the brain affected?
Even mild dehydration can impair cognitive function, including attention, memory, and mood. Dehydration can also cause headaches and migraines, which can further contribute to cognitive impairment.
Dehydration can cause a reduction in blood volume, which can lead to decreased blood flow to the brain and a drop in brain volume. This can result in reduced oxygen and nutrient supply to the brain, leading to impaired brain function.
Any drop in volume preferentially affects higher level executive functioning. Executive functioning problems (attention, memory issues) is an early sign that there is a metabolic problem in the body.
Neurons rely on adequate hydration to function properly, as they need proper fluid balance to conduct electrical signals and transmit information. The body’s electrical communication is based on ‘electrically active’ water and potentials formed between hydrophobic layers and pores. Medications or other interventions like stimulants may not only temporarily mask but also compound the problem.
In terms of specific effects on neurons, dehydration can cause changes in the function and structure of the neurons. For example, dehydration can cause the expression of stress-related genes in neurons, leading to oxidative stress and cellular damage. Additionally, dehydration can also cause changes in neurotransmitter release and signal transduction, leading to altered neural communication.
What to do?
During the treatment of chronic dehydration, there will be a perception that higher water intake is not being absorbed since urine output will increase. However, it takes time for our body, including the spaces in between our tissues and ourselves, to adjust. Proper fluid intake requires balances in time, amount and ionic supplementation (salt minerals). Too much or too little can both be detrimental.
There isn’t an obvious sign that tells us “yes, you’re finally hydrated”. One thing you can keep track of would be for signs of dehydration to begin improving; feeling more clear, less fatigued, more physically settled. Since one of the first signs of subtle health issues is trouble with complex thought, if that begins to move back to baseline, then we are moving in the right direction.
Merely drinking water may not be enough. However, the first thing you can do is shoot for, and maintain a reasonable intake of fluid volume. For safety, don’t overdo it, and trust that time is on your side. If you have medical conditions that rely on maintaining certain fluid states such as heart failure, or end stage kidney failure, talk to your doctor first.
The recommendation to drink 8-10 8-ounce glasses of water daily may not account for the significant expansion of fluid absorbing foods that have exploded into normalcy in our day to day diet.
The process of controlling the hydration level of processed foods is there to modify taste, and consistency. But, not only do processed foods not contribute to hydration, but likely contribute to dehydration. Frying food, for example, is essentially a process of dehydration. Add to that, fried foods are often salted, compounding the problem.
So a major first step for many may not be merely to increase the level of water intake, but identify foods that contribute to dehydration through water retention and losses in our gastrointestinal tract.
Consider minimizing foods and beverages that cause direct fluid loss. Alcohol is a diuretic that can increase fluid loss and dehydrate the body. Caffeine is also a diuretic that can increase fluid loss, and affect our perception of hydration levels.
Lastly, packaged foods are almost always in dehydrated form and contain unnecessary additives, salt being a common example. These additives, and the dehydrating process, increase fluid retention, leading to a buildup of fluid in the body and worsening dehydration. Sugary drinks, such as soda and sports drinks, can be high in sugar and calories, leading to fluid retention and contributing to dehydration. Sugar pulls water through osmotic action.
Consider, instead, eating hydrating foods, such as low-prepped fruits and vegetables, and smartly-salted soups.