The hydration game

The hydration game

As New York City Mayor Michael Bloomberg continues to capture headlines for his now overturned bill limiting the purchase of sugary sodas (from Gothamist.com three weeks ago: Bloomberg’s soda ban threatens sanctity of pizza parties), even those that criticize the bans agree that the concept behind such legislation has a valid point: Many people are drinking too many calories. So what should we be drinking (and eating) to stay hydrated?

Water is an essential part of our bodies, reminds Joy Winchester, HFS, from the Take Charge Fitness Program, a wellness facility run by Clinton Physical Therapy Center (a Physiquality network member in Tennessee). “Two-thirds of the body is made up of water,” she says. “Our bodies lose water every day when we sweat, breathe and use the bathroom.” This is why it’s so important to hydrate throughout the day, every day. But how much?

How much water should we drink?On those days when we’re rather sedentary and moving around from work to home and the carpool lane, men should take in roughly 125 oz. of water and women 91 oz. from all dietary sources, says Jim Storhok, a physical therapist at PT Specialists, a Physiquality member in Michigan. (Want to calculate your intake specifically for your body? Multiply your weight in pounds by .08; the result is the number of 8-ounce cups of water you should consume.)

About half of that amount should come from your balanced diet, including fruits, vegetables and other solid foods. To get an idea of which fruits and vegetables contain more water than others, look at this chart published by the University of Kentucky’s College of Agriculture. Even dense foods, when eaten raw, contain high quantities of water — apples are 84% water and broccoli is 91% water. Clearly, their nutritional values extend beyond the vitamins and minerals we automatically think of for such foods.

So what about the liquids we should be drinking? The American Journal of Clinical Nutrition published a set of guidelines that created six categories of beverages, with their recommended daily amounts for each category.

  • Level 1: Water — 20-50 oz. a day
    It’s no surprise that plain old water is the most important category in the study, cited for its importance in metabolism and bodily functions, as well as its essential minerals, like calcium, magnesium and fluoride.

  • Drink up to 40 oz. of unsweetened coffee or tea a day.Level 2: Tea and coffee — 0-40 oz. a day
    Before you reach for that venti mocha latte frappuccino, keep in mind that this refers to unsweetened drinks without anything else. The authors caution against high-calorie, high-energy coffee drinks, emphasizing that any additives to the coffee or tea “lower their value in this guidance system.”

  • Level 3: Low-fat and skim milk and soy beverages — 0-16 oz. a day
    Milk, especially fortified milk, is encouraged as a source of vitamin D and high-quality protein, particularly for those under the age of 18.

  • Level 4: Noncalorically sweetened (i.e., “diet”) beverages — 0-32 oz. a day
    The authors state that such diet drinks are preferable to calorically sweetened beverages as they mean the person would be drinking fewer calories, but they do note that the sweetness of such drinks could lead a person to prefer sweeter drinks, making water, tea and coffee a better choice.

  • Level 5: Caloric beverages with some nutrients — Fruit juices, 0-8 oz. a day; Alcohol, 0-2 drinks a day
    While fruit juices contain most of the nutrients of their source fruit, they lack its fiber and other nutrients; citing the U.S. Dietary Guidelines Committee, the study recommends that “no more than 1/3 of the daily intake of fruit be in the form of juices.” With alcohol, the study acknowledges that there are some known benefits from moderate consumption, but points out the myriad risks of going beyond that threshold.

  • Level 6: Calorically sweetened beverages — 0-8 oz. a day
    The authors have no problem pinpointing soft drinks and fruit drinks as a key component of the rise in obesity (and a more recent study adds type 2 diabetes as a risk). Not only do they add calories to one’s diet, they also tend to reduce the intake of more healthy calories.

When choosing what to drink, one should beware of processed drinks that may sound healthy but add a punch to your daily caloric intake. David Zinczenko, author of the popular Eat This, Not That and now Drink This, Not That books, pointed out to the New York Times that flavored bottled waters like Snapple’s Tropical Mango Antioxidant Water may sound healthy, but include 150 calories of sugar. And as mentioned above, coffee drinks from places like Starbucks may help you to get moving in the morning, but even something as simple as a grande 16 oz. caffe mocha will add up to 330 calories.

How much water do you need to stay hydrated? When you’re working out and expending more energy (and sweating out more water), you’ll need to consume more water in order to stay hydrated. Sarah Koszyk, a dietitian, advises the following test to measure just how much additional water you’ll need to consume in order properly hydrate.
  1. Weigh yourself (naked) prior to a regular 45-60 minute workout. Once you weigh yourself, do not consume any fluids or food.
  2. Enjoy your workout. Sweat it out, but don’t consume anything, including fluids.
  3. After the workout, weigh yourself again (naked) and see how much weight you’ve lost.

For every pound of weight lost during the workout, she says, you’ll need to drink an extra 2 cups of water (about 16 to 20 ounces).

Sarah also advises that sports and electrolyte drinks are really only necessary for workouts that last 90 minutes or more. If you’re doing such an intense workout in the heat, you also might want to consider turning that sports drink into a slushie, as it’s been shown to increase your endurance on hot days.

Regardless of how much you have been exercising, you should always be aware of any signs of dehydration. Any time you have dark-colored urine, dry mouth, and muscle cramps, or you’re feeling lightheaded, Joy recommends grabbing a glass of water and hydrating more.

Joy Winchester Joy Winchester, HFS, works at the Take Charge Fitness Program, a wellness facility run by Clinton Physical Therapy Center, a Physiquality network member in Clinton, Tennessee. A certified health fitness specialist, Joy earned her degree in exercise science from the University of Tennessee-Knoxville in 2010.
Jim Storhok Jim Storhok, DPT, ATC, is a physical therapist at PT Specialists, a Physiquality network member in Troy, Michigan. A certified athletic trainer and a member of the National Athletic Trainers Association, he has been in outpatient physical therapy since 2003.
Sarah Koszyk Sarah Koszyk, MA, RD, is a registered dietician and nutrition coach at MV Nutrition and Eating Free, a partner of Physiquality member Presidio Sport & Medicine in San Francisco, California.


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For further information:

Busko, Marlene. Increased dietary sugar drives global rise in diabetes. Medscape, February 27, 2013.

Yakas, Ben. Bloomberg’s soda ban threatens sanctity of pizza parties. Gothamist.com, February 24, 2013.

Koszyk, Sarah. Hydration nation. Presidio Sport & Medicine, February 2012.

Storhok, Jim. Decrease the risk of dehydration during our “fun in the sun” months. PT Specialists, July 2011.

Brody, Jane E. In summer’s heat, watch what you drink. New York Times, June 28, 2010.

Kolata, Gina. To beat the heat, drink a slushie first. New York Times, April 26, 2010.

Popkin, Barry M., Lawrence E. Armstrong, George M. Bray, Benjamin Caballero, Balz Frei and Walter C. Willett. A new proposed guidance system for beverage consumption in the United States. American Journal of Clinical Nutrition, March 2006.

Bastin, Sandra and Kim Henken. Water content of fruits and vegetables. College of Agriculture, University of Kentucky, December 1997.



The material and information contained on this Web site is for information only and is not intended to serve as medical advice or consultation.

Consult your personal physician before beginning any exercise program or self-treatment.