13) TYPE 2 DIABETES SUPPLEMENTS
j) High Water Intake
It is important for any individual with type 2 diabetes to drink a reasonable amount of water. As blood sugar readings climb from 150 to 200 to 300 and above (it is possible to go up to 3,000, a level which generally results in death!), a symptom can appear which is life threatening, so called "hyperosmolar non-ketotic syndrome", where the body becomes very dehydrated because the kidneys are flushing large amounts of glucose containing urine out and not enough water is being ingested to compensate for the water lost. This generally only happens in elderly patients who are very sick with another disease, but it can happen in even relatively young and healthy patients who don't pay attention to their thirst reflex. It can also happen in people who don't know they have type 2 diabetes and who consume a lot of simple carbohydrates at a single meal. If anyone is a type 2 diabetic, they should drink water or diet drinks at least whenever they feel thirsty.
There is no objective research we could find supporting the position that eight large 16 ounce glasses of water per day helps any weight loss diet (there's lots of "expert" speculation and hypotheses but no double blind, multi-center, statistically significant research). The theory behond the eight glasses of water seems to be that the water will fill the stomach and give a feeling of fullness, thereby taking the edge off off hunger pangs. Every weight loss diet in the world seems to take this "drink eight glasses of water" position but it just isn't supported by meaningful research. There isn't even any objective evidence that drinking large amounts of water helps with bowel movements. It seems that water is absorbed so rapidly by the body that it has little real effect, it just doesn't stay in the stomach very long. The stomach needs a low ph (high acidity) to digest food and that is difficult to obtain with a lot of water in the stomach. So the stomach rapidly moves the water out of the stomach.
But there is one piece of objective research showing that reasonable amounts of water helps prevent heart disease. The proposed mechanism is simple, drink a lot of water and supposedly your blood is thinner, preventing blood clots which cause most heart attacks. This benefit from water has only been shown in one study. The results need to be confirmed in other studies.
"The results of the researchers' study, published in the American Journal of Epidemiology (Vol. 155, No.9), show that drinking high amounts of plain water is as important as exercise, diet, or not smoking in preventing coronary heart disease.
"Basically, not drinking enough water can be as harmful to your heart as smoking," warns Jacqueline Chan, DrPH, principle investigator and lead author of the article. The study, "Water, Other Fluids, and Fatal Coronary Heart Disease," indicates that whole-blood viscosity, plasma viscosity, hematocrit, and fibrinogen-which are considered independent risk factors for coronary heart disease-can be elevated by dehydration.
Neither total fluid intake, nor intake of other fluids combined, showed this reduced risk. Instead high intake (five or more glasses a day) of other fluids showed a greatly increased risk of coronary heart disease. Coffee, soda, milk, and caffeinated sodas did not show any statistically significant heart benefits. Most other fluids are considered high energy drinks. The initial effect of these types of fluids is actually to draw water from the blood because they cannot be digested until their concentration is reduced to be similar to that of blood. This causes at least a temporary increase in blood viscosity, thus increasing the risk of blood clots. Water is absorbed immediately, thus hydrating the blood system. Drinking high amounts of water then thins the blood, reducing the risk of blood clotting, which could lead to heart attacks."
Note that it stands to reason that too much water in the blood will have the undesired effect of increasing blood pressure (one way of decreasing blood pressure for an individual to take diuretics, which reduce the amount of water in the blood). The prevailing research seems to be to drink water when you are thirsty. The human body has a mechanism that knows when it needs water. Utilize that mechanism and you typically won't go wrong. Don't force water consumption unless you're exercising in the heat.
For some people, eight large glasses of water a day might actually be far too much, leading to sodium deficiencies and potentially life-threatening water intoxication, caused by kidneys not being able to keep up the intake of liquids. In 2002, a kidney specialist tried, in vain, to find any scientific evidence supporting the eight-glasses-a-day myth. His report, published in the American Journal of Physiology, concluded that this standard health advice was complete and utter bunk that, like many urban legends, stemmed from a tiny grain of truth. Apparently, the dietary guidelines provided by the Food and Nutrition Board of the National Research Council do say that humans need 1 milliliter of water for each calorie of food—adding up to about 10 cups a day. However, the same guidelines also say that we get most of this liquid from the water in solid food. There’s no need to drink more.
Assuming the beneficial effect of reasonable amounts of water on heart health to be real, this only holds true for pure water or diet drinks, fluids that have sugars of any kind in them have exactly the opposite effect. The Harvard study of thousands of nurses found that high glycemic foods (including sugar filled drinks and fruit juices, especially orange juice and drinks with high fructose corn syrup) significantly increase the likelihood of heart disease. Any diabetic needs to avoid sugar filled drinks. Diet drinks made with artificial sweeteners are acceptable. Note that research has shown that people who replace regular sodas with diet sodas lose weight. Research has also shown that individuals with metabolic syndrome X have a craving for lots of sweet drinks, diet or regular. This last point has led some researchers to incorrectly conclude that diet drinks can be a cause of metabolic syndrome X. The Harvard study clearly showed diet drinks to be of benefit in controlling heart disease.
As usual, there has to be a caveat. If you are outside in the heat, drink as much water as you can, especially if you are overweight. Dehydration, heat prostration and heat stroke are real concerns, especially for anyone with type 2 diabetes. The author lives in Arizona and if he is outdoors in the summer he often just pours water down the front and back of his shirt in addition to drinking a lot of water. Age can often interfer with the proper sweating mechanism so older individuals need to be even more careful in hot weather.
Next Chapter: 14) "AS YET UNPROVEN" SUPPLEMENTS
a) Introduction
b) The Good and the Bad
c) Vitamins and Antioxidants
d) Calcium and Dairy Intake
e) Potassium
f) Phytonutrients, Catechins and Flavonoids
g) Cinnamon
h) Herbal Supplements
i) Other "Panaceas"
j) Alcohol and Coffee
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