Thank you (HOW POWERFUL) and thanks to God

 Biblically speaking, giving thanks has less to do with our circumstances and more to do with God Himself. Thanks means to be grateful for or to give gratitude to something or someone. When we talk about giving thanks to God, do you know the ultimate reason we can give thanks? It is tempting to think we must have “things” or perfect circumstances to experience God’s blessings. Do we tend to praise God only when things are good? Paul, in 1 Corinthians 15:57, tells us the main reason we celebrate thanksgiving, and it has nothing to do with how we feel. 

The Meaning of “Thanks Be to God”

For Paul, giving thanks was an action, not a feeling. Sometimes we think we must feel good to give thanks, and often we are good at giving thanks when we are feeling positive. Throughout the Bible, God insists we be thankful in action, no matter how we feel. Listen to these commands:

1 Thessalonians 5:18 - “Give thanks in all circumstances; for this is God’s will for you in Christ Jesus.”

1 Chronicles 16:34 - “Give thanks to the Lord, for he is good; his love endures forever.”

Psalm 35:18 - “I will give you thanks in the great assembly; among the throngs I will praise you.”

Although we might have a myriad reasons to give thanks, ultimately Paul tells us in 1 Corinthians 15:57 to give thanks for this one reason: Victory in Christ! Victory in Christ has nothing to do with our circumstances, but it does affect our heart’s outlook.

Where Is the Command to Give Thanks in the Bible?

The command to give thanks for Christ’s victory is found in the book of 1 Corinthians. Paul is the author, and he was writing to a church in the city of Corinth. This city was filled with false teaching and division. Paul writes a very convicting letter to them. Paul warns against many things wrong in their church, but as he ends his letter he has some amazing encouragement!

Our passage today is found at the end of the letter. In this section, Paul has been talking about the resurrection of Christ. Although we celebrate Christ’s death because it paid the price for our sins, Paul reminds us the resurrection is the key to living a full Christian life! A victorious life is found in the fact that Christ arose! Death is defeated and we no longer have to face the penalty of sin when we believe in Jesus Christ as Savior.

What Is the Meaning behind 1 Corinthians 15:57?

The last section of 1 Corinthians 15 speaks about the mystery of our own resurrection. Paul admits he doesn’t know exactly how this will work, but we can trust God that we will be raised again on the last day. He says, “Then shall come to pass the saying that is written: ‘Death is swallowed up in victory.’ The sting of death is sin, and the power of sin is the law. But thanks be to God, who gives us the victory through our Lord Jesus Christ.” (1 Corinthians 15:55-57)

We might not understand all of this, but we can know the last truth in Paul’s words: “Death is swallowed up in victory” Our victory is found in Christ’s death and resurrection. The power of sin to destroy our souls has been beaten. Christ has overcome! This is reason enough to give thanks. Death does not have the final word. Death was our greatest enemy, but Christ defeated it.

Nothing can separate us from God, not even the last enemy, which is death. God says because of Christ’s resurrection we have hope! Think of the worst thing to ever happen to you. Now let this truth sink into your soul: you are never separated from God! Romans 8:35 says, “Who shall separate us from the love of Christ? Shall trouble or hardship or persecution or famine or nakedness or danger or sword?” The answer is NOTHING!

More Than Just Actions

The Greek word Paul uses for “thanks be” in this verse is “charis.” You might recognize this word as it means “grace” as well. It means “that which affords joy, pleasure, delight, sweetness, charm, and loveliness.” Paul is telling us to give to God our favor. We are to hold God to the highest praise. That is what “give thanks” means. It means there is joy there.

As Christians, we know joy is more than a feeling of happiness. It is a state of the heart. Paul is telling the Christians that God deserves the “thanks.” This is not just an action on our part, but a heart bent. Yes, God commands us to give thanks, but another way to see 1 Corinthians 15:27 is to just recognize that thanks belongs to God.

It is not just the act of giving thanks, but recognizing this “thanks” or “gratitude” already belongs to God. Many other passages in scripture help to show us this as well. These verses remind us our hearts can always give thanks!

“With praise and thanksgiving they sang to the Lord: He is good; his love toward Israel endures forever. And all the people gave a great shout of praise to the Lord, because the foundation of the house of the Lord was laid.” Ezra 3:11

“I will give thanks to you, Lord, with all my heart; I will tell of all your wonderful deeds.” Psalm 9:1

“For from him and through him and for him are all things. To him be the glory forever! Amen.” Romans 11:36

“The Son is the image of the invisible God, the firstborn over all creation.” Colossians 1:15

Why We Need to Give Thanks According to 1 Corinthians 15:57

According to Paul in his letters there are lots of reasons to give thanks. Look at all of the reasons Paul gives us for giving God thanks. As you read these verses, think: what did you do to deserve any of this? How does Christ play a role in these things?

1. We have deliverance from sin! “Thanks be to God, who delivers me through Jesus Christ our Lord!” (Romans 7:25)

2. We have God’s grace! “I always thank my God for you because of his grace given you in Christ Jesus.” (1 Corinthians 1:4)

3. God listens to our requests! “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.” (Philippians 4:6)

4. We share in Christ’s inheritance! “And giving joyful thanks to the Father, who has qualified you to share in the inheritance of his holy people in the kingdom of light.” (Colossians 1:12)

A Prayer of Thanks for Victory

Dear Father God who loves me so, I give you praise! Your glory shines throughout all of creation, but more so in Christ. In Your Son, whom you gave me so freely, is my reason to give you all of the thanks. I am so grateful for Christ and today I spend this moment giving you thanks. Like Paul, I rejoice in the victory in Christ. When my heart is heavy it is hard to give thanks, but you have proven faithful over and over again. I can look over my life and see the hardships, but I can see the good as well. I can see how you’ve worked in my life to give me good things; your love endures forever, and your will for me is to live forever with you in heaven. What victory you have given me!? Not only do I have peace in this life, a promise waiting for me in the future, but also the daily provisions. Thank you, Lord, for Christ. Thank you, Father, for salvation. Thank you, God, for victory! Amen.

Dear friend, as you move through your life you will experience many ups and downs. However, God has not left us alone. Thank you and love you.

https://m.youtube.com/watch?v=nmOqs-KMAwc

This sacred song is another Swedish heritage. There is so much gratitude, warmth of text and a folk-like quality in the music that appeals to any believer. *“Thanks to God!”* is one of the most popular Swedish hymns that found its way into many evangelical hymnals.

August Ludvig Storm was born on October, 1862, in Motala, and converted to Christ in a Salvation Army meeting. He joined the Salvation Army Corps and became one of its leading officers. He wrote this hymn’s text for the Army publication, Stridsropet (The War Cry), on December 5, 1891. The Original Swedish version had four stanzas, with each verse beginning with the word ‘tack’ (thanks,” having a total of thirty-two “thanks” in all.) The gratitude expressed to God ranges from the “dark and dreary fall” to the “pleasant, balmy springtime,” and “pain” as well as “pleasure.”

A.L. Storm suffered a back ailment at the age of 37 that left him crippled for life but he continued to administer his Salvation Army duties until his death. A year before his death, he wrote another poem in which he thanked God for the years of calm as well as pain.

A.L. Storm’s text later appeared in the Swedish Salvation Army songbook with a Welsh tune. It wasn’t until 1910, when J.A. Hultman included the text with his own tune in the publication Solskenssonger, that the hymn became popular, both in Sweden and in the U.S.

We sang this in church today. It’s a great hymn which reminds us to be grateful to our omnipotent God and Provider.

Lyrics: August Ludvig Storm

Music:  John Alfred Hultman

LYRICS:

Thanks, O God, for boundless mercy

From Thy gracious throne above

Thanks for ev’ry need provided

From the fullness of Thy love

Thanks for daily toil and labour

And for rest when shadows fall

Thanks for love of friend and neighbour

And Thy goodness unto all

Thanks for thorns as well as roses

Thanks for weakness and for health

Thanks for clouds as well as sunshine

Thanks for poverty and wealth!

Thanks for pain as well as pleasure

All Thou sendest day by day

And Thy Word our dearest treasure

Shedding light upon our way

Thanks, O God, for home and fireside (family)

Where we share our daily bread

Thanks for hours of sweet communion

When by Thee our souls are fed!

Thanks for grace in time of sorrow

And for joy and peace in Thee

Thanks for hope today, tomorrow

And for all eternity!

歌詞：

 感謝上帝，感謝無限的憐憫

 從你高貴的寶座上

 感謝您提供的所有需求

 從你愛的豐滿

 感謝每天的辛勤勞作

 當陰影落下時休息

 感謝朋友和鄰居的愛

 和你對所有人的恩惠

 感謝荊棘和玫瑰

 感謝虛弱和健康

 感謝雲彩和陽光

 感謝貧窮和財富！

 感謝痛苦和快樂

 所有你每天發送

 你的話語是我們最寶貴的財富

 照亮我們的道路

 感謝上帝，感謝家和爐邊（家庭）

 我們分享日常麵包的地方

 感謝幾個小時的甜蜜交流

 當我們的靈魂被你餵養時！

 感謝悲傷時的恩典

 為了你的喜樂與平安

 感謝今天的希望，明天

 並且永遠！

Gēcí : 

Gănxiè shàngdì , gănxiè wúxiàn de liánmin 

cóng ni gāogui de bãozuò shàng 

gănxiè nín tigõng de suốyÖu xūqiú 

công nỉ ài de fēng măn gănxiè měitian de xinqín láozuò 

däng yinying luòxià shí xiuxi gănxiè péngyou hé línjū de ài 

hé ni dui suŏyou rén de enhui 

gănxiè jīngji hé méigui 

gănxiè xūruò hé jiànkāng gănxiè yúncai hé yángguãng 

gănxiè pínqióng hé cáifu ! Gănxiè tòngkũ hé kuàilè suõyou ní měitiän fäsong 

ni de huàyu shi women zui băogui de cáifù 

zhào liàng women de dàolù 

gănxiè shàngdì , gănxiè jiā hé lú biãn ( jiātíng ) 

women fēnxiăng richáng miànbão dì difāng 

gănxiè ji gè xiǎoshí de tiánmi jiäoliú 

däng women de línghún bèi ni wèiyăng shí ! 

Gănxiè beishāng shí de ēndiăn 

wèile ni de xilè yu píng'an gănxiè jīntiān de xīwàng , míngtiān 

bingqiè yongyuăn !

[THIS IS HOW POWERFUL YOUR WORDS ARE] 

The Lord has given us one of the most powerful devices in the entire universe . The Lord has given us a tongue . With this device , we can destroy a nation , or build the lives of God's creation . Together we will cover six things that you must use your tongue for .

 Number one , be thankful and say so. It is great to feel grateful. I will encourage you, however, to not just feel thankful , but to say so . In the Bible , we see many examples where people sang their praises with a loud voice . God thought it right to keep that in the Bible out of all the millions of events that happened during the journey of the Israelite people . Tell God that you're thankful . We feel too embarrassed to give praises , but Psalms 100 verse four says we should be thankful and say so . 

There is so much to be thankful for , and if you're thinking of one , thank God for the breath in your body . Sometimes we may succumb to murmuring and grumbling . The Book of Exodus shows us God does not like this . You also did not look forward to interacting with someone with a murmuring attitude . After Moses led the Israelites out of Egypt , we see that they grumbled and murmured and complained.

They were unhappy with the manna . They complained about Moses . They wanted to go back to Egypt where they were slaves and forced to work long hours in the unforgiving sun . We can all remember a time in our lives when we prayed and we were so excited about the first time when God blessed you . The house , the baby , the job you were praying for , the spouse you longed for ; they may be the very thing that you're complaining about today . 

 The Israelites cried for salvation in Egypt , and they complained when the blessing came . The Israelites might have thought that their enemies locked them out of the Promised Land . However , it was their attitude that did that . The Book of Numbers chapter 11 makes this very clear . Our flesh wants to drift to the negative , if you do not control it . It is just a natural pattern . We tell our children to say " thank you " a hundred times , as it is not a natural thing to do . You don't have to work very hard to complain about anything , but it takes a lot of self - control to maintain a grateful attitude . Praise God in the wilderness , and He will give you a lot more to be thankful for . If something bothers , worries you , use prayer and thanksgiving . Philippians four verse six says , " Do not be anxious about anything , but in every situation , " by prayer and petition with thanksgiving , present your requests to God . " Complaining opens a door for the devil . We have to learn to thank God in everything . 

Number two , use your words to bless . The words that we speak have tremendous power . Proverbs 18 verse 21 says , " Death and life are in the power of the tongue , and they who indulge in it shall eat the fruit of it , for death or life . " We should place blessings and not curses on ourselves and our children . We need to pay close attention to how we speak about ourselves . Remember Matthew 15 verse 11 : " What goes into someone's mouth does not defile them , but what comes out of their mouth , that is what defiles them . " 

 Number three , encourage , edify , and build others up . Ephesians four verse 29 : " Let no corrupting talk come out of your mouths , but only such as is good for building up , as fits the occasion , that it may give grace to those who hear . " We are to be strong and courageous . Speak encouraging words to fill your brothers and sisters with courage . "Peace , fear not, it is I." You have to know that people are going through valleys that you might not see , as they put on fake smiles . We have to consciously do these things . James chapter 4 verse 11 tells us , " Do not speak evil of one another , brethren . " Pray for God . " Isaiah 50 verse four says , " The servant of God says , " The Lord has given me the tongue of a disciple , " and of one who has taught , " that I should know how to speak a word in season " to him who is weary . " Pray and think about people you already know you're going to be around and ask God to put something in your heart that you can say to them that will build them up . Psalms 19 verse 14 : " Let the words of my mouth and the meditations of my heart be acceptable in your sight , O Lord , my Rock and my Redeemer . " Let your words inspire , just like the moat off the channel . Be a sun when people are gloomy .

Number Four , speak the truth . God's Word is true . The Bible says that God is the truth . In John 14 verse 16 , Jesus answered , " I'm the way and the truth and the life . " The Word of God is truth . John 17 verse 17 says , " Sanctify them by the truth . " Your Word is truth . " However , the Bible tells us who the father of lies is . John eight verse 44 says , " You are of your father , " the devil , and the desires of your father , you want to do . He was a murderer from the beginning and does not stand in the truth , because there is no truth in him (Satan). When he speaks a lie , he speaks from his own resources , and he is a liar and the father of it . " Choose the side of God when you speak . Proverbs six verse 16 says , " These six things doth the Lord hate ; " yea , seven are an abomination unto him : " a proud look , a lying tongue , and hands that shed innocent blood , and a heart that deviseth wicked imaginations , feet that be swift in running to mischief .

a false witness that speaketh lies , and he that soweth discord among brethren . " In this short list of seven things that the Lord hates , two amongst them are lying . 

Number five , speak the Word of God . Are you confused of how to speak back to challenges ? Then I suggest that you do what Jesus did during his temptation . Jesus was filled with the Word . He only spoke what was written inside the Word of God .

We need to read the Word of God for it to be readily available . Jesus was very used to saying these words : " Haven't you read ? " We are to wash our minds with the Word of God . Repeating actions make them stick . Romans 12 verse two : " Do not be conformed to this world , " but be transformed by the renewing of your mind . Then you will be able to discern what is the good , pleasing , and perfect will of God . " 

Renewing is the continuous tense . Read a book of the Bible , and read it again . Get a favorite book in the Bible and read it to get rhema . The Christian faith needs your mind , and you need to fill your mind with the Word of God to speak the Word of God . When you are filled with the Word , you will have the right word when something sparks your attention . It will also give you the ability to properly discern the Word of God .

 Number six , don't talk too much . The Bible tells us , " A fool multiplies words , " Ecclesiastes 10 verse 14 . The Bible also tells us in Proverbs 10 verse 19 , " When words are many , transgression is not lacking . " But whoever restrains his lips is prudent . " There is a time to keep silent and a time to speak . Do you not see it interesting that we only have two eyes ,

two nostrils , two ears , and only one mouth ? The Bible also tells us to be slow to speak . Proverbs 21 verse 23 : " Whoever keeps his mouth and his tongue " keeps himself out of trouble . " When you wake up , bless your day . Say , " This is the day that the Lord has made . I will rejoice and be glad in it . My family is blessed , and we walk in the blessings of Abraham . "I thank you LORD. 

Our words can do severe damage to our relationships , our careers , and to the world around us , but here's the good news : with the help of the God's Spirit , our words can also do great good . 

God can give you the wisdom we need to control our tongues and learn to speak life - giving words that reflect the love of Christ and what His Word says . 

Here are a few tips to help you tame your tongue and reshape your life .

They can also do great good . We pray that you remain blessed today . We pray that the Lord guides your speech , and we pray that you remain blessed .Thank you and Amen 🙏

[這就是你的話有多麼強大]

 主給了我們整個宇宙中最強大的裝置之一。 主給了我們舌頭。 有了這個裝置，我們可以毀滅一個國家，或者建立上帝創造的生命。 我們將一起介紹您必須用舌頭做的六件事。

  第一，要心存感激，這樣說。 感激不盡。 然而，我會鼓勵你，不僅要感恩，還要說出來。 在聖經中，我們看到很多人大聲讚美的例子。 上帝認為在以色列人旅途中發生的數以百萬計的事件中，將其保留在聖經中是正確的。 告訴上帝你很感激。 我們 覺得 太 尷尬 不能 讚美 , 但 詩篇 100 第四 節 說 我們 應該 感恩 並 這麼 說 .

 有 太多 值得 感恩 了 , 如果 你 正在 想 一個 , 感謝 上帝 賜予 你 身體 裡 的 呼吸 . 有時我們可能會屈服於抱怨和抱怨。 出埃及記告訴我們上帝不喜歡這樣。 你也不期待與一個抱怨的態度的人互動。 摩西帶領以色列人出埃及後，我們看到他們發牢騷、埋怨、抱怨。

 他們對嗎哪不滿意。 他們抱怨摩西。 他們想回到埃及，在那裡他們是奴隸，被迫在無情的陽光下長時間工作。 我們都記得我們生命中的某個時刻，當我們祈禱時，我們對上帝第一次祝福你感到非常興奮。 房子，孩子，你祈求的工作，你渴望的配偶； 他們可能正是你今天要抱怨的事情。

  以色列人在埃及為拯救而哭泣，當祝福降臨時他們抱怨。 以色列人可能認為他們的敵人將他們鎖在應許之地之外。 然而，這是他們的態度造成的。 民數記第 11 章非常清楚地說明了這一點。 如果你不控制它，我們的肉體想要漂向負面。 這只是一種自然的模式。 我們告訴我們的孩子說“謝謝”一百次，因為這不是一件自然的事。 你 不必 很 努力 去 抱怨 任何 事情 , 但是 需要 很大 的 自製力 才能 保持 感恩 的 態度 . 在曠野讚美神，他會給你更多值得感恩的。 如果有什麼事情困擾你，讓你擔心，請使用祈禱和感恩。 腓立比書四節六節說，“不要為任何事憂慮，只要在任何情況下，”藉著禱告和祈求，帶著感恩的心，將你的要求呈獻給上帝。 “抱怨為魔鬼打開了一扇門。我們必須學會在每一件事上感謝上帝。

 第二，用你的話來祝福。 我們所說的話具有巨大的力量。 箴言 18 節 21 節說，“生死在舌頭的權下，放縱舌頭的，必吃它的果子，或死或生。” 我們應該祝福自己和孩子，而不是詛咒自己。 我們需要密切注意我們如何談論自己。 記住馬太福音 15 章 11 節：“進人口裡的，不污穢他們；從口裡出來的，就是污穢他們。”

  第三，鼓勵、造就和建立他人。 以弗所書四章29節：“毀謗的話，不可出口，只要合情合理，好造人的話，好叫聽見的人得恩。”我們要剛強勇敢。 說鼓勵的話，讓你的兄弟姐妹充滿勇氣。 “和平，別怕，是我。” 你必須知道人們正在穿過你可能看不到的山谷，因為他們假裝微笑。 我們必須有意識地做這些事情。 雅各書第 4 章第 11 節告訴我們，“弟兄們，不要彼此說壞話。”為上帝祈禱。 ” 以賽亞書 50 第四 節 說 , “ 上帝 的 僕人 說 , “ 主 已 給 我 一個 門徒 的 舌頭 , ” 和 一個 教導 , “ 我 應該 知道 如何 及時 說 話 ” 的 人 很累。 " 祈禱 並 想想 你 已經 認識 的 人 , 你 會 出現 在 並 祈求 上帝 把 一些 東西 放在 你 的 心裡 , 你 可以 對 他們 說 , 從而 建立 他們 . 詩篇 19 詩 14 : " 讓 我 口 中 的 話 和 主啊，我的磐石和我的救贖主，我心中的默想在你眼中是可以接受的。 ” 讓 你 的 話語 鼓舞 , 就像 溝 外 的 護城河 . 做 一個 人 陰暗 的 太陽 .

 第四，說真話。 上帝的話是真實的。 聖經說上帝是真理。 在約翰福音 14 章 16 節中，耶穌回答說：“我就是道路、真理和生命。” 神的話就是真理。 約翰福音 17 章 17 節說，“用真理使他們成聖。”你的話就是真理。 " 然而 , 聖經 告訴 我們 誰 是 謊言 之父 . 約翰 八 節 44 說 , " 你 是 你 父親 的 " 魔鬼 , 你 父親 的 願望 , 你 想要 做 . 他 從 一開始 就是 一個 殺人犯 . 並且不站在真理中，因為他（撒旦）沒有真理。當他說謊時，他是從自己的資源中說出來的，他是說謊者和謊言之父。” 當他選擇上帝的一面時 你說 。 箴言 6 節 16 節 說 : " 這 六 樣 是 耶和華 所恨 的 ; " 是 的 , 七 樣 對 他 來說 是 可憎 的 : " 驕傲 的 樣子 , 說謊 的 舌頭 , 流 無辜人血的手 , 設計惡計的心 , 腳 即 快 於 惡作劇 .

 說謊的假見證人，在弟兄中間散播不和的人。 “在這七件主所憎恨的事情的簡短清單中，其中有兩件是在撒謊。

 第五，說神的話。 您是否對如何應對挑戰感到困惑？ 然後我建議你做耶穌在受試探時所做的事。 耶穌被聖言充滿。 他只說神的話裡面寫的。

 我們需要閱讀上帝的聖言，以便它隨時可用。 耶穌很習慣說這些話：“你沒讀過嗎？”我們要用上帝的話語來洗心。 重複動作使它們粘住。 羅馬書十二章二節：“不要效法這個世界，”只要心意更新而變化。 然後你就能分辨什麼是上帝美好、可喜悅和完美的旨意。 "

 更新是持續時態。 讀一本書，再讀一遍。 在聖經中找到一本最喜歡的書，然後閱讀它以獲得 rhema 。 基督教信仰需要你的思想，你需要用神的話語充滿你的思想，才能說出神的話語。 當你被話語充滿時，當某件事引起你的注意時，你就會有正確的話語。 它也會讓你有能力正確地辨別上帝的話語。

  第六，不要說太多。 聖經告訴我們，“愚昧人多言”，傳道書 10 節 14。 聖經在箴言 10 章 19 節也告訴我們，“話多，過犯也不乏”。 " 沉默 有時 , 說話 有時 . 你 不 覺得 我們 只有 兩隻 眼睛 很 有趣 ,

 兩個鼻孔，兩個耳朵，只有一張嘴？ 聖經也告訴我們說話要慢。 箴言 21 節 23 節 : “ 保守 口 和 舌頭 的 ” 使 自己 免於 患難 . “當你醒來時，祝福你的一天。說，” *這是主創造的一天。 我會為此歡欣鼓舞。 我的家人很幸福，我們行走在亞伯拉罕的祝福中。 “*我感謝你主。

 我們的話會對我們的人際關係、我們的事業和我們周圍的世界造成嚴重的傷害，但這裡有個好消息：在神的靈的幫助下，我們的話語也能帶來很大的好處。

 上帝可以賜給你我們需要的智慧來控制我們的舌頭，並學會說出能反映基督的愛和他的話語所說的話的賦予生命的話語。

 這裡有一些技巧可以幫助您馴服您的舌頭並重塑您的生活。

 他們也可以做得很好。 我們祈禱你今天仍然蒙福。 我們祈禱主引導你的演講，我們祈禱你保持祝福。謝謝你和阿門🙏

Water and the Human Body

 Water is indeed essential for all life on, in, and above the Earth. This is important to you because you are made up mostly of water. Let's learn  what water does for the human body. 

What Does Water do for You?

1. Needed by the brain to manufacture hormones and neurotransmitters 

2. Forms saliva (digestion) 

3. Keeps mucosal membranes moist

4. Regulates body temperature (sweating and respiration)

5. Allows body's cells to grow, reproduce and survive 

6. Acts as a shock absorber for brain and spinal cord 

7. Flushes body waste, mainly in urine 

8. Converts food to components needed for survival - digestion

9. Lubricates joints 

10. Water is the major component of most body parts 

11. Helps deliver oxygen all over the body. The lungs must be moist in order for gas exchange to be possible.

​​​​​​​Water serves a number of essential functions to keep us all going

Think of what you need to survive, really just survive. Food? Water? Air? Facebook? Naturally, I'm going to concentrate on water here. Water is of major importance to all living things; in some organisms, up to 90% of their body weight comes from water. Up to 60% of the human adult body is water.

According to H.H. Mitchell, Journal of Biological Chemistry 158, 

the brain and heart are composed of 73% water, 

and the lungs are about 83% water. 

The skin contains 64% water,

muscles and kidneys are 79%, 

and even the bones are watery: 31%. 

Each day humans must consume a certain amount of water to survive. 32.53 milliliters for each kilogram of the body weight.  

Of course, this varies according to age and gender, and also by where someone lives. Generally, an adult male needs about 3 liters (3.2 quarts) per day while an adult female needs about 2.2 liters (2.3 quarts) per day. All of the water a person needs does not have to come from drinking liquids, as some of this water is contained in the food we eat.

Water serves a number of essential functions to keep us all going normal and painlessly. 

○ A vital nutrient to the life of every cell, acts first as a building material.

○ It regulates our internal body temperature by sweating and respiration

○ The carbohydrates and proteins that our bodies use as food are metabolized and transported by water in the bloodstream;

○ It assists in flushing waste mainly through urination

○ acts as a shock absorber for brain, spinal cord, and fetus

○ forms saliva

○ lubricates joints

According to Dr. Jeffrey Utz, Neuroscience, pediatrics, Allegheny University, different people have different percentages of their bodies made up of water. Babies have the most, being born at about 78%. By one year of age, that amount drops to about 65%. In adult men, about 60% of their bodies are water. However, fat tissue does not have as much water as lean tissue. In adult women, fat makes up more of the body than men, so they have about 55% of their bodies made of water. Thus:

Babies and kids have more water (as a percentage) than adults.Women have less water than men (as a percentage).People with more fatty tissue have less water than people with less fatty tissue (as a percentage).

There just wouldn't be any you, me, or Fido the dog without the existence of an ample liquid water supply on Earth. The unique qualities and properties of water are what make it so important and basic to life. The cells in our bodies are full of water. The excellent ability of water to dissolve so many substances allows our cells to use valuable nutrients, minerals, and chemicals in biological processes.

Physiology, Water Balance

 The fluids of the body are primarily composed of water, which in turn contains a multitude of substances.

 One such group of substances includes electrolytes such as sodium, potassium, magnesium, phosphate, chloride, etc. 

Another group includes metabolites, such as oxygen, carbon dioxide, glucose, urea, etc. 

A third important group of substances contained within the water of our body, which includes proteins, most of which are vital for our existence. Examples of proteins include coagulation factors, immunoglobulins, albumin, and various hormones.

 As the distribution of the fluid in the body and the substances found within is critical for the maintenance of intracellular and extracellular functions pivotal to survival, the body has developed mechanisms to control compartment composition tightly. However, various clinical pathologies can alter the fluid composition and its constituents in the multiple compartments of the human body, which can have deleterious effects on our health and often require intensive interventions to monitor and maintain normal physiological conditions.

 This article will primarily cover the physiologic composition of water in the human body, differentiate the various compartments in the body and their associated volumes and compositions, depict how to measure the different volumes, and delve into the clinical relevance associated with disturbances of the normal physiological conditions.

Cellular 

At a cellular level, the distribution of the various fluid compartments in the body is paramount for the maintenance of health, function, and survival. For the average 70 kg man, 60% of the total body weight is comprised of water, equaling 42L. The body's fluid separates into two main compartments: Intracellular fluid volume (ICFV) and extracellular fluid volume (ECFV). 

• Of the 42L of water found in the body, two-thirds of it is within the intracellular fluid (ICF) space, which equates to 28L. 

• The ECFV is comprised of two spaces: The interstitial fluid volume (ISFV) and the plasma volume (PV). One-third of the total body water is the ECFV, which is equivalent to 14L. Out of the extracellular fluid volume, 75% or 10.5L of the volume is present in the interstitial space, and 25% of that water is in the plasma, which is equivalent to 3.5L. [Mathew J, Sankar P, Varacallo M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Apr 28, 2021. Physiology, Blood Plasma.]

Each space works in unison with each other and has different functions paramount for normal physiological function.

• The intracellular fluid is comprised of at least ten separate minuscule cellular packages. For the sake of simplicity and to make the analysis of the intracellular space viable, the concept of a united intracellular “compartment” has been created as these collections have important unifying similarities such as location, composition, and behavior, which provides practical utility in the study of physiology. [Davids MR, Edoute Y, Jungas RL, Cheema-Dhadli S, Halperin ML. Facilitating an understanding of integrative physiology: emphasis on the composition of body fluid compartments. Can J Physiol Pharmacol. 2002 Sep;80(9):835-50. ]

• The interstitial fluid consists of fluid, which lies in the space between and around bodily tissue. Although technically a “virtual” space, the interstitial fluid bathes all the cells in the body and links between intracellular fluid and the intravascular compartment. ISF contains nutrients, oxygen, waste, chemical messengers, and contains a small amount of protein. The ISF also contains the lymphatic system, which returns protein as well as excess ISF into the circulation. [Wiig H, Swartz MA. Interstitial fluid and lymph formation and transport: physiological regulation and roles in inflammation and cancer. Physiol Rev. 2012 Jul;92(3):1005-60.]

• Plasma is the only fluid compartment that exists as a real fluid collection all in one space. It differs from the interstitial fluid by its higher protein content and its function in transportation. Plasma is a component of blood and is said to be the “interstitial fluid of the blood” as it bathes the suspended red and white cells, which also reside in the blood.

Mechanism

Several principles control the distribution of water between the various fluid compartments. To understand the different principles, it is essential to realize the following: ingestion and excretion of water and electrolytes are under tight regulation to maintain consistent total body water (TBW) and total body osmolarity (TBO). To manage these two parameters, body water will redistribute itself to maintain a steady-state so that the osmolarity of all bodily fluid compartments is identical to total body osmolarity.

Several different factors mediate the redistribution of water between the two ECF compartments: hydrostatic pressure, oncotic pressure, and the osmotic force of the fluid. Combining these two components yields the Starling equation: Jv = Kfc [(Pc - Pi] - n (Op-Oi)].[7] This equation determines the rate of fluid across the capillary membrane (Jv) and takes the difference between the hydrostatic pressures of the capillary fluid (Pc) and the interstitial fluid (Pi), as well as the oncotic pressure of the capillary fluid (Op) and the interstitial fluid (Oi). It also takes into account the osmotic force between the two compartments (n).

Additionally, there is a relationship between the interstitial fluid and intracellular fluid. These two environments very closely influence each other, as the membrane of the cell separates them. Generally, nutrients diffuse into the cell with waste products coming out into the interstitial space. Ions are typically barred from crossing the membrane but can occasionally cross via active transport or under specific conditions. Water can move freely across the membrane and is directed by the osmotic gradient between the two spaces. Changes in the intracellular fluid volume result from alterations in the osmolarity of the ECF but do not respond to isosmotic changes in extracellular volume.[8] However, any flow of water in or out of the cell membrane will have proportional changes in the ECFV. If a disturbance causes ECF osmolarity to increase, water will flow out of the cell and into the extracellular space to balance the osmotic gradient; however, the total body osmolarity will remain higher than what is typical, and the cell will shrink. If a disturbance were to cause a decrease in ECF osmolarity, then water will move from the ECF into the ICF to attain an osmolar equilibrium; however, the total body osmolarity will remain lower than normal, and the cell will swell. Third, were isosmotic fluid to enter the extracellular space, then there would be no net changes in the ICF, and the ECFV will increase.

Related Testing

Much of this information can appear abstract, especially when talking about compartments that are more of a theoretical space. Therefore, it is crucial to have a way to physically measure the volumes of the different compartments. The way to measure the different spaces is by using the indicator-dilution method.[Zierler K. Indicator dilution methods for measuring blood flow, volume, and other properties of biological systems: a brief history and memoir. Ann Biomed Eng. 2000 Aug;28(8):836-48.] 

The theory behind this is that to measure the volume of a specific compartment; one must introduce into the body measurable substances that are distributed uniformly to a compartment of interest. Using this method, individual volumes can be measured directly, and others can be measured by subtracting the volumes of related compartments. This information can then be quantified by using the equation Volume (V) = Amount (substance injected)/Concentration (measured after equilibration).[Henriksen JH, Jensen GB, Larsson HB. A century of indicator dilution technique. Clin Physiol Funct Imaging. 2014 Jan;34(1):1-9] The following compartments can be measured as followed

• Total body water (TBW) - To measure, you have to inject radioactive titrated water or antipyrine. The idea behind this is that water gets uniformly distributed among all the different compartments. So if one can measure the radioactive water, it follows you to determine the TBW.

• Extracellular fluid volume (ECFV) - To measure this volume, labeled inulin, sucrose, mannitol, or sulfate can be injected. These are large molecules and are therefore impermeable to the cell membrane and will only be able to diffuse to the plasma and interstitial spaces.

• Blood volume - Red blood cell volume can be measured with 51Cr-tag RBCs or by using the formula: Calculated Blood volume= Plasma volume X 100/ [100-(0.87 X Hct %)], where 0.87 is the trapping factor.

• Plasma volume (PV) - Can be calculated using radioiodinated serum albumin (RISA) or Evans Blue dye, as they are specific to the plasma space.

• Intracellular fluid volume - Cannot be measured directly but can be calculated by subtracting ECFV by TBW, as the latter two variables are measurable.

• Interstitial fluid volume - Cannot be measured directly but can be calculated by subtracting PV by ECFV, as the latter two variables are measurable.

Clinical Significance

Aside from the significance of the study of water balance has on our physiologic understanding of the human body, the idea behind it is commonly seen in pathology and is presented clinically on a daily basis. Various conditions lead to an imbalance of water in the different compartments of the body; the specific imbalance can show in different ways and can be treated differently as well. The following presents five clinical scenarios where alterations in water balance can present. Each will have an accompanying analysis of ECF volume, ECF osmolarity, ICF volume, and ICF osmolarity.

• Diarrhea - Diarrhea can be caused by a myriad of pathogens, but classically is associated with isosmotic volume contraction.[Kaptein EM, Sreeramoju D, Kaptein JS, Kaptein MJ. A systematic literature search and review of sodium concentrations of body fluids
. Clin Nephrol. 2016 Oct;86(10):203-28.] 

As the fluid lost is isosmotic, there will be no net effect on intracellular fluid, and the only change will be a decrease in ECF volume with osmolarity remaining unchanged.

• Diabetes Insipidus - In this condition, the body is either unable to produce ADH, or the kidneys cannot respond to it, leading to a hyperosmotic volume contraction. In either case, there is a decrease in free water reabsorption from the distal tubules leading to free water loss

[ Lu HA. Diabetes Insipidus. Adv Exp Med Biol. 2017;969:213-225.] In this scenario, the osmolarity of the ECF increases, leading to an inflow of water from the ICF to the ECF, leading to ICF volume constriction. However, this flow of water across the membrane into the ECF compartment is not enough to compensate for the loss of free water; thus, there is constriction of the EFV as well.

 Lastly, as water is lost from the ICF compartment, the osmolarity of the ICF will increase. The same changes would be expected in severe burns, as well as excessive sweating, where there is excessive loss of free water as well.

•  SIADH - Conversely, there is excessive free water retention in SIADH, so the results will be the antithesis of what is seen in diabetes insipidus, leading to hypoosmotic volume expansion. In this condition, there is excess free water reabsorption in the distal tubule of the kidney leading to a decreased osmolarity of the ECF as well as an expansion of the ECFV.[Kortenoeven ML, Fenton RA. Renal aquaporins and water balance disorders. Biochim Biophys Acta. 2014 May;1840(5):1533-49.] . Due to the decrease in ECF osmolarity, water will flow into the ICF compartment leading to an expansion of the ICFV and decreased osmolarity of the intracellular fluid.

• Adrenal Insufficiency - In this case, there is low aldosterone, primarily leading to decreased tubular sodium absorption, resulting in hypoosmotic volume contraction.[Schwartz MJ, Kokko JP. Urinary concentrating defect of adrenal insufficiency. Permissive role of adrenal steroids on the hydroosmotic response across the rabbit cortical collecting tubule. J Clin Invest. 1980 Aug;66(2):234-42. ]. In this case, there are sodium and water loss, leading to decreased ECFV and decreased ECF osmolarity. Due to this decreased osmolarity, water shifts into the intracellular compartment leading to ICFV expansion. Due to the decreased solute reabsorption, there is decreased ICF osmolarity as well.

• Uremia - Often found in kidney failure. BUN can increase. However, an isolated state of increased urea would not cause a shift in the volume of either compartment, nor would it lead to a change in osmolarity. The reason for this is that these changes are only accompanied by the addition or subtraction of free water or the addition or subtraction of an osmotically active particle, meaning a particle that cannot freely cross the cell membrane.[Lopez-Almaraz E, Correa-Rotter R. Dialysis disequilibrium syndrome and other treatment complications of extreme uremia: a rare occurrence yet not vanished. Hemodial Int. 2008 Jul;12(3):301-6.] As urea can freely cross the cell, it is considered to be non-osmotically active and, therefore, would not change osmolarity, thereby not leading to any shift of water balance.  

Water PhysiologyEssentiality, Metabolism, and Health Implications

 However, water is frequently overlooked as a nutrient. 

Virtually all known living systems depend on water for survival. 

Water is the most abundant molecule in the human body that undergoes continuous recycling. Numerous functions have been recognized for body water, including its function as a solvent, as a means to remove metabolic heat, and as a regulator of cell volume and overall function. Tight control mechanisms have evolved for precise control of fluid balance, indicative of its biological importance. However, water is frequently overlooked as a nutrient. This article reviews the basic elements of water physiology in relation to health, placing emphasis on the assessment of water requirements and fluid balance. Current recommendations are also discussed. 

Life on earth has evolved as a consequence of the presence of water. Although some alternative theories have been suggested for the generation of life in nonaqueous environments, virtually all known living systems depend on water for survival. Water has many properties that seem indispensable for the functioning of cells. It is an excellent solvent for ions, required for nerve signaling, enzyme activity, mineralization of organic compounds, and the properties of DNA. It is also a master of weak intermolecular interactions, such as hydrogen bonds, necessary for the protein binding in their substrates, and hydrophobic reactions, necessary for protein structure. The high specific heat of water, in relation to other substances, makes it capable of absorbing or losing heat without a large temperature change, thus protecting living cells from massive temperature changes that could cause cell impairment or even death.

Metabolism 

Absorption

Water movement through the gastrointestinal wall has great significance, not only for the delivery of ingested fluids but also for the digestion of other nutrients and as a defense from pathogens. In fact, there is equilibrium between intestinal water secretion (through the pancreatic juices, bile, gastric secretion, and saliva) and water absorption that should be maintained within narrow limits, because disturbances in this equilibrium result in diarrhea or constipation. Water movement across the intestinal epithelium may occur paracellularly through the tight junctions and transcellularly through cell membranes. Experiments in canine intestinal segments have shown that the potential for water absorption differs among the various parts of the intestine. Specifically, the large intestine has a greater capacity to absorb a hypotonic solution compared with the jejunum or the ileum, whereas a negative net water flux is observed in the duodenum in the presence of a hypotonic solution. However, most of the water entering the intestine is absorbed in the small intestine. From a total of approximately 8 Liters, about 6.5 Liters is absorbed through the small intestine, whereas the absorptive function of the large intestine is limited to about 1.3 Liter. Although water may diffuse to some extent through cellular membranes, the hydrophobic properties of their lipid bilayer do not allow the degree of absorption required. Instead, the greater part of absorbed water is transferred through channel systems, such as the aquaporins. Water movement in the gastrointestinal tract is regulated by osmotic gradients and is linked to ionic movements. Specifically, absorption of water is linked primarily to the movement of sodium ions, whereas secretion is linked to the movement of chloride ions. This linkage to ionic movements is less essential to the large intestine, where absorption of even distilled water may occur.

Distribution of Water in Body Fluid Compartments

The fluid compartments of the human body include the intracellular fluid, accounting for 55% of total body water, and the extracellular fluid compartment. The latter can be further subdivided into the intravascular fluid compartment or plasma (7.5% of total body water), the rapidly equilibrating interstitial fluid and lymph (20%), and some smaller compartments (the slowly equilibrating interstitial fluid of dense connective tissue and cartilage, the inaccessible interstitial fluid in the bones, and the transcellular fluid, which is produced by the secretory cells). 

 Water distribution across the capillary endothelium is controlled by the balance of filtration forces (that tend to move water from the plasma to the interstitial space) and reabsorption forces, as first described by Starling. 

 The main filtration forces are the hydrostatic pressure that is caused by the pumping of the heart and a less potent colloid osmotic pressure of a negligible amount of protein that is trapped in the interstitial space. The major reabsorption pressure is the plasma osmotic pressure that is attributed to the solute molecules in the plasma.

Integrated Regulation of Body Fluid Balance

Water homeostasis is maintained by mechanisms that sense changes in intravascular volume and plasma osmolality.

Changes in the intravascular volume are sensed by peripheral volume and pressure receptors that induce the release of the antidiuretic hormone, arginine vasopressin, from the neurohypophysis. In addition, neuron-like cells, the osmoreceptors, located within the central nervous system, sense changes in plasma osmolality and also trigger antidiuretic hormone release and the induction of thirst.

 A second important humoral factor in body fluid regulation is angiotensin II. This hormone may act directly, by stimulating the release of antidiuretic hormone in the central nervous system, or indirectly, by stimulating aldosterone release, which in turn induces sodium conservation, a subsequent increase in plasma osmolality, and expansion of the extracellular volume. Antidiuretic hormone is the key factor in renal water handling, promoting water reabsorption in the nephron.

 Specifically, antidiuretic hormone binds to its receptor in the basolateral membrane of the principal collecting duct cells, initiating a cascade of reactions that lead to the translocation of the aquaporin 2 water channels from intracellular vesicles to the apical membrane, rendering this membrane permeable to water.

Human Requirements and Recommendations

Human Body Water Content

In healthy adult humans, total body water represents an average of 59% for males and 56% for females, according to body mass. Large variation is observed across and within age groups, with infants having higher values of water content.  These variations may be attributed solely to differences in body composition, because it has been recognized that the hydration status of fat-free body mass is not altered by age or gender. These relatively high amounts of body fluids are continuously recycled, with equilibrium being established when fluid intake matches fluid loss. In fact, a water deficit may occur over the course of a few hours when intake is reduced or losses are increased.

Human Body Water Functions

Body fluids serve a variety of functions in the human body, including a key role in the digestion, absorption and transportation of other nutrients, formation and stability of cell structures, removal of waste products and toxins, as a solvent for biochemical reactions, thermoregulation of the human body, and lubrication of cavities such as joints. Cell physiologists also have discovered new functions of cellular water. Because water is the main constituent of the cells, cellular water and fluxes of water between extracellular and intracellular compartments are the primary factors affecting cell volume, which in turn regulates a wide variety of cellular functions, such as epithelial transport, metabolism, excitation, hormone release, migration, cell proliferation, or even cell death.

Given the numerous biological functions of water, as well as the fact that it is a main constituent of the human body, it is a surprising fact that water is often ignored as a nutrient. Most textbooks consider protein, carbohydrate, and fat as the macronutrients because these nutrients provide energy. However, if we consider the quantities of water and the energy-producing nutrients needed for an average person, it becomes clear that water is the quintessential macronutrient. However, many problems and considerations have arisen in the study of water in terms of human physiology and nutrition.

Defining Water Requirements

Defining the nutritional status of water as a nutrient, usually referred to as fluid balance or hydration status and subsequently fluid needs, is a challenging task. The main reason for this is that there is no reserve of water in the human body, and thus, fluids must be continuously recycled. Ideally, fluid balance may be determined by measuring fluid gain (via nutrition and metabolic water production) and fluid losses (via the urinary system, the respiratory tract, the skin, and the gastrointestinal system) under controlled environmental conditions and over a set, relatively small amount of time. Such studies have yielded fluid needs in the range of 1.6 to 3.2 Liters, depending on the environmental conditions and the physical activity performed by the subjects. More recently, isotope-labeled water has been used to measure body fluid turnover and water needs by following the decline in hydrogen isotope over time. This technique offers the advantage of measuring fluid balance under real conditions of daily living and has produced similar results to those of water balance studies.

Fluid dynamics may vary considerably within the same person over a period of a day, or even a few hours. Therefore, on many occasions, hydration status (ie, the water status of the body at a specific time point) may be of more interest than overall fluid balance. Many markers have been proposed for the assessment of hydration status, including hematologic indices (such as plasma osmolality and sodium concentrations) and urinary indices (ie, urine osmolality, urine color, and specific gravity); the assessment of total body water by bioelectrical impedance; and cardiovascular function measures (such as heart rate, blood pressure, and orthostatic tolerance). These markers may provide a reasonable estimation of a deficiency (dehydration) or an overload (overhydration) of fluid in the body; however. they cannot provide estimates of actual water needs.

Water Deficiency

A general problem in the study of water as a nutrient is that there is a scarcity of studies examining the effect of long-term water deficiency and its complications in the human body. Acute mild dehydration (a 4% change in body weight) provokes unfavorable effects in the cardiovascular function as plasma volume drops. These effects include an increase in stroke volume and a concomitant increase in heart rate, to maintain constant cardiac output.  In the periphery, dehydration decreases skin blood flow and sweating, thus compromising thermoregulation and increasing body core temperature. However, these levels of water deficiency are fixed rapidly by a decrease in body water loss and the stimulation of thirst, 2 mechanisms that will be discussed later.

Long-term effects of water deprivation have not been described in detail. The only experiments describing severe dehydration conditions were performed in 1944. In one of these experiments, involving a 6-day period of water and/or food deprivation in healthy male soldiers, it was found that body fluid loss follows a biphasic manner: during the first 48 hours, the loss of fluid occurred predominantly from the extracellular space and subsequently from the intracellular space, with the net effect being equal for both spaces at the end of the experiment.

 Lassitude was pronounced, and the authors reported that the subjects were "irritable and foolishly argumentative." Ingestion of a hypotonic sodium solution when subjects were already dehydrated resulted in a reduction of water loss, and the same effect was observed when subjects ingested carbohydrates, whereas total fasting increased the negative water balance. These notions highlight the importance of water in retaining internal homeostasis. In the case of salt ingestion, retention of water would be necessary to maintain plasma electrolytes in normal ranges, whereas in the case of carbohydrate ingestion, their protein-sparing effect decreased the need for removal of the nitrogen products of protein break down, as occurred in the case of total fasting.

Another study of water deprivation with balanced energy intake for 3 to 4 days, published at the same time, described decreased efficiency and unhealthy appearance after dehydration, a slight change in voice, sunken and pale face, and cyanosed lips as characteristics of water deprivation that vanished a few hours after restoration of fluid. This study reported that there was practically no increase in the plasma proteins or hematocrit, indicating that the volume of the blood was maintained at the expense of some other fluid compartment. Dehydration led to an increased production of urea, indicating that water deprivation is accompanied by catabolism of body tissues, even if the energy needs are met.

Although a clear picture of human physiology under chronic and severe dehydration has not been obtained, the aforementioned studies indicate that chronic dehydration represents a threat to body homeostasis and health. Numerous later studies, mainly epidemiological in nature, have explored the association between hydration status and health.

 Although not consistent, hydration status and fluid intake have been associated with many chronic diseases, such as urolithiasis, urinary tract infections, bladder and colon cancer, constipation, bronchopulmonary disorders, hypertension, cerebral infarct, fatal coronary heart disease, venous thromboembolism, mitral valve prolapse, diabetic ketoacidosis, dental diseases, gallstones, glaucoma, and dental diseases. This era of science provides continuous, promising research.

The period that is compatible with life, under conditions of full water deprivation, is not known. Some anecdotal cases of accidental incidents, such as the runner Mauro Prosperi, who lost his way in a sandstorm during the Marathon des Sables, have shown that water deprivation may be sustained for more than 9 days, with losses of body water as high as 13 kg. In critically ill, end-point patients, refusal to take rehydration and nutrition has been considered as a method of euthanasia that takes several days to a few weeks until death occurs. This observation is certainly not applicable to healthy humans, because death may not be attributed solely to dehydration; however, it may indicate that life may be sustained for several weeks under full water deprivation in healthy humans.

Toxicity

Most nutrients display toxicity if their intake exceeds a critical threshold that represents the tolerable upper intake level. For water, no such threshold has ever been established, assuming that the functioning kidney removes the excess fluid. However, in some circumstances, massive fluid intake may indeed provoke toxicity. In psychiatric patients, particularly those with schizophrenia, polydipsia (excess intake of fluids) occurs frequently and may lead to dilutional hyponatremia, a condition also known as water intoxication. Although this kind of hyponatremia is usually associated with an inability to excrete water because of kidney and/or antidiuretic hormone disturbances, some patients are reported to drink such a large fluid volume that they exceed the ability of the kidney to excrete water. This kind of hyponatremia leads to brain edema, causing neurological symptoms such as nausea, vomiting, delirium, ataxia, seizures, and coma, which in turn worsen the psychiatric symptoms of these patients. Water intoxication with hyponatremia may appear also in many other clinical conditions accompanied by a primary defect in the renal excretion of free water and a subsequent expansion of extracellular fluid, but these cases are not related to fluid consumption. Based on the dietary intake data from the third National Health and Nutrition Examination Survey (1988-1994), the top 99th percentile of men aged 31 to 50 years was consuming 8.1 L of fluids per day, and 5% of that age group, more than 6.4 L/d. In a recent study, 44 men aged 55 to 75 years increased their water intake by 2 L/d for 2 months, resulting in an improved lower urinary tract function.

 In summary, because hyponatremia is extremely rare, no tolerable upper limit has been set by the Institute of Medicine.

An interesting condition of water intoxication is exertional hyponatremia, occurring in some athletes during long ultraendurance events (>3 hours). This type of water toxicity is associated with a fluid intake during exercise that exceeds fluid losses via the sweat, without a concomitant replacement of sodium lost. Decreased free water clearance from the kidney, because of redistribution of cardiac output to the active muscle and the skin capillary bed, as well as inappropriate secretion of antidiuretic hormone may contribute to this kind of water toxicity. However, no adverse effects have been reported as a result of chronically high intakes of fluids, when intake approximates losses.

Recommendations

The first official and specific guideline for water intake was reported in 1964 by the Food and Nutrition Board of the National Academies of Science of the United States. This report recommended that a reasonable standard for calculating water allowance is 1 mL/kcal of food. In the 1989 recommendations of the same body, it was stated that because of the low risk of water intoxication, water requirements may increase to 1.5 mL/kcal, to cover variations in activity level, sweating, and solute load.

A systematic approach to water requirements appeared only recently, in the latest version of the Dietary Reference Intakes. These recommendations include absolute values (in liters per day) as recommendations, in terms of adequate intake across all age groups, total water intake (a combination of drinking water, beverages, and food), and water intake by drinking water and beverages, assuming that food contributes to water intake by approximately 19% (Table).

 Adequate intakes for water vary from 0.7 L/d of total water in infants to 3.7 and 2.7 L/d in male and female adults, respectively. Special recommendations are provided for pregnancy and breast-feeding. Recently, the European Food Safety Authority prepared a report on water requirements [EFSA Panel Dietetics Products, Nutrition (NDA); Scientific Opinion on Dietary Reference Values for Water. EFSA J. 2010;8(3):1459; available online at www.efsa.europa.eu]. As in the recommendations provided by the National Academies of Science of the United States, the European committee provides adequate intakes for water in terms of absolute values for many age groups; however, the panel considers the requirements of adolescents beyond the age of 14 years, as well as the requirements of the elderly as being the same as those of adults. Proposed intakes for adults were set at 2.5 and 2.0 L/d for males and females, respectively. Interestingly, these values are considerably lower than those proposed for the population of the United States.

Table: 

Dietary Reference Intakes (Adequate Intakes) for Watera

Conclusions

Water is the most abundant and the most frequently recycled element in the human body. Its numerous functions, in combination with the fact that several mechanisms exist for the tight regulation of fluid balance, suggest that water should be considered as the most significant nutrient in human nutrition. Future research in water physiology should focus on the association between fluid balance or intake and disease, at both molecular and epidemiological levels, and the establishment of more effective methodologies to assess fluid balance and water requirements.

Human Body Colors

 

Human Colors—The Rainbow Garden of Pathology: What Gives Normal and Pathologic Tissues Their Color?

Context.—

Colors are important to all living organisms because they are crucial for camouflage and protection, metabolism, sexual behavior, and communication. Human organs obviously have color, but the underlying biologic processes that dictate the specific colors of organs and tissues are not completely understood. A literature search on the determinants of color in human organs yielded scant information.

Objectives.—

To address 2 specific questions: (1) why do human organs have color, and (2) what gives normal and pathologic tissues their distinctive colors?

Data Sources.—

Endogenous colors are the result of complex biochemical reactions that produce biologic pigments: red-brown cytochromes and porphyrins (blood, liver, spleen, kidneys, striated muscle), brown-black melanins (skin, appendages, brain nuclei), dark-brown lipochromes (aging organs), and colors that result from tissue structure (tendons, aponeurosis, muscles). Yellow-orange carotenes that deposit in lipid-rich tissues are only produced by plants and are acquired from the diet. However, there is lack of information about the cause of color in other organs, such as the gray and white matter, neuroendocrine organs, and white tissues (epithelia, soft tissues). Neoplastic tissues usually retain the color of their nonneoplastic counterpart.

Conclusions.—

Most available information on the function of pigments comes from studies in plants, microorganisms, cephalopods, and vertebrates, not humans. Biologic pigments have antioxidant and cytoprotective properties and should be considered as potential future therapies for disease and cancer. We discuss the bioproducts that may be responsible for organ coloration and invite pathologists and pathology residents to look at a “routine grossing day” with a different perspective.

“I want to know one thing. What is color?” —Pablo Picasso

Nature delights us with a great variety of colors that result from the reflection of a particular wavelength of light from an object. Colors are important to all biologic organisms (that is, microorganisms, plants, and animals) because they are crucial for camouflage and protection, metabolism, sexual behavior, and communication. In general, coloration of organisms results from the production of molecules derived from cyclic compounds.

The human body and its organs have colors, that is, the liver is brown, the heart is red, bones are white, and so on. Although this is obvious and established, the reason why organs have a particular color is not completely understood. Pathologists, more than any other physicians, should be aware of the importance in recognizing normal and abnormal gross organ features—color being one of them—that translate into specific pathologic processes. Because cells are microscopic and colorless as single units, they result in a given color only when they accumulate in millions. Unhealthy and/or neoplastic tissues usually retain the color of the cells from which they derive but may also exhibit completely different color characteristics. We performed a literature search related to the biochemical source of coloration in human organs, and to our surprise, scant information is available. Because of this information gap, 2 fundamental questions were asked: why do human organs have color, and what gives normal and pathologic tissues their distinctive colors? The answers to these simple questions are elusive, even with the current revolutionary advances in molecular biology and biochemistry.

The biochemical processes related to pigment production in plants and animals could be an enormous resource to explain the color in human organs. Herein, we attempt to give a biochemical explanation for the basis of the color of human organs that, to our knowledge, is not currently available in the medical literature. None of the authors are experts in the field of biochemistry or chromatics, but all are instinctually interested in understanding more about human biology. We discuss in a simple manner the bioproducts and their physiologic importance that may be responsible for tissue coloration. We invite pathologists and pathology residents to look at a “routine grossing day” with a different perspective.

PRODUCERS OF COLOR IN HEALTHY AND NEOPLASTIC TISSUES

Carotenes and Carotenoids

In 1937, the Nobel Prize in chemistry was awarded to Paul Karrer for the description of the chemical structure of carotenes and vitamin A. Carotenes are unsaturated hydrocarbons chemically derived from isopentenyl pyrophosphate and terpenes, and include α, β, γ, δ, ɛ, and ζ carotenes, lycopenes, and xanthines.1  Carotenes are fat-soluble molecules that can produce all the colors of the visible spectrum (purple, blue, green, yellow, orange, and red) and are synthesized only by plants.2,3  Carrots (Daucus carota var. sativus), tomatoes (Solanum lycopersicum), and beets (Beta vulgaris) are examples of vegetables containing large amounts of orange, red, and purple carotenes, respectively (Figure 1, A). The word carotene derives from the Latin carota (carrot) and lycopene derives from the modern Latin lycopersicum (tomato). Carotenes also give color to leaves and fruits, but the primary green pigment chlorophyll is dominant (Greek chlóros = green). Once a leaf or a fruit ripens or dies, chlorophyll is degraded, and yellow, orange, and/or red carotenes become apparent.4  This is why leaves change color during fall, and why a banana (Musa acuminata) turns yellow when it's ripe. Xanthines (Greek xanthos = yellow) are yellow pigments (zeaxanthin, lutein, canthaxanthin) that give color to several organisms (Figure 1, A). Staphyloxanthin is the pigment that gives Staphylococcus aureus its golden-yellow color, and the second name aureus is Latin for gold (aurum). This pigment is a virulence factor that helps the organism escape death by neutrophils. 

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Context.—

Colors are important to all living organisms because they are crucial for camouflage and protection, metabolism, sexual behavior, and communication. Human organs obviously have color, but the underlying biologic processes that dictate the specific colors of organs and tissues are not completely understood. A literature search on the determinants of color in human organs yielded scant information.

Objectives.—

To address 2 specific questions: (1) why do human organs have color, and (2) what gives normal and pathologic tissues their distinctive colors?

Data Sources.—

Endogenous colors are the result of complex biochemical reactions that produce biologic pigments: red-brown cytochromes and porphyrins (blood, liver, spleen, kidneys, striated muscle), brown-black melanins (skin, appendages, brain nuclei), dark-brown lipochromes (aging organs), and colors that result from tissue structure (tendons, aponeurosis, muscles). Yellow-orange carotenes that deposit in lipid-rich tissues are only produced by plants and are acquired from the diet. However, there is lack of information about the cause of color in other organs, such as the gray and white matter, neuroendocrine organs, and white tissues (epithelia, soft tissues). Neoplastic tissues usually retain the color of their nonneoplastic counterpart.

Conclusions.—

Most available information on the function of pigments comes from studies in plants, microorganisms, cephalopods, and vertebrates, not humans. Biologic pigments have antioxidant and cytoprotective properties and should be considered as potential future therapies for disease and cancer. We discuss the bioproducts that may be responsible for organ coloration and invite pathologists and pathology residents to look at a “routine grossing day” with a different perspective.

“I want to know one thing. What is color?” —Pablo Picasso

Nature delights us with a great variety of colors that result from the reflection of a particular wavelength of light from an object. Colors are important to all biologic organisms (that is, microorganisms, plants, and animals) because they are crucial for camouflage and protection, metabolism, sexual behavior, and communication. In general, coloration of organisms results from the production of molecules derived from cyclic compounds.

The human body and its organs have colors, that is, the liver is brown, the heart is red, bones are white, and so on. Although this is obvious and established, the reason why organs have a particular color is not completely understood. Pathologists, more than any other physicians, should be aware of the importance in recognizing normal and abnormal gross organ features—color being one of them—that translate into specific pathologic processes. Because cells are microscopic and colorless as single units, they result in a given color only when they accumulate in millions. Unhealthy and/or neoplastic tissues usually retain the color of the cells from which they derive but may also exhibit completely different color characteristics. We performed a literature search related to the biochemical source of coloration in human organs, and to our surprise, scant information is available. Because of this information gap, 2 fundamental questions were asked: why do human organs have color, and what gives normal and pathologic tissues their distinctive colors? The answers to these simple questions are elusive, even with the current revolutionary advances in molecular biology and biochemistry.

The biochemical processes related to pigment production in plants and animals could be an enormous resource to explain the color in human organs. Herein, we attempt to give a biochemical explanation for the basis of the color of human organs that, to our knowledge, is not currently available in the medical literature. None of the authors are experts in the field of biochemistry or chromatics, but all are instinctually interested in understanding more about human biology. We discuss in a simple manner the bioproducts and their physiologic importance that may be responsible for tissue coloration. We invite pathologists and pathology residents to look at a “routine grossing day” with a different perspective.

PRODUCERS OF COLOR IN HEALTHY AND NEOPLASTIC TISSUES

Carotenes and Carotenoids

In 1937, the Nobel Prize in chemistry was awarded to Paul Karrer for the description of the chemical structure of carotenes and vitamin A. Carotenes are unsaturated hydrocarbons chemically derived from isopentenyl pyrophosphate and terpenes, and include α, β, γ, δ, ɛ, and ζ carotenes, lycopenes, and xanthines.1  Carotenes are fat-soluble molecules that can produce all the colors of the visible spectrum (purple, blue, green, yellow, orange, and red) and are synthesized only by plants.2,3  Carrots (Daucus carota var. sativus), tomatoes (Solanum lycopersicum), and beets (Beta vulgaris) are examples of vegetables containing large amounts of orange, red, and purple carotenes, respectively (Figure 1, A). The word carotene derives from the Latin carota (carrot) and lycopene derives from the modern Latin lycopersicum (tomato). Carotenes also give color to leaves and fruits, but the primary green pigment chlorophyll is dominant (Greek chlóros = green). Once a leaf or a fruit ripens or dies, chlorophyll is degraded, and yellow, orange, and/or red carotenes become apparent.4  This is why leaves change color during fall, and why a banana (Musa acuminata) turns yellow when it's ripe. Xanthines (Greek xanthos = yellow) are yellow pigments (zeaxanthin, lutein, canthaxanthin) that give color to several organisms (Figure 1, A). Staphyloxanthin is the pigment that gives Staphylococcus aureus its golden-yellow color, and the second name aureus is Latin for gold (aurum). This pigment is a virulence factor that helps the organism escape death by neutrophils.5 

Figure 1.

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A, Carotenes and carotenoids are unsaturated hydrocarbons derived from isopentenyl pyrophosphate and terpenes, which can only be produced by plants, where they are found in high concentrations. There are several carotene variants with a wide diversity of color. Young plants and fruits contain high levels of green chlorophyll that is degraded with age, exposing the color of the more-prevalent carotenes in them (yellow ripened fruit or orange-red leaves in autumn). Animals obtain carotenes from their diet, with each species able to metabolize only certain carotenes and not others. Carotenes are avidly lipophilic and are deposited predominantly in lipid-rich tissues. B, Flamingoes acquire their beautiful, pink-colored plumage from shells and fish they eat. C, Humans can only absorb certain carotenes (yellow, orange) that are present in plants and vegetables. A raw egg is an appropriate example to show how carotenes color cells yellow. The most-abundant carotenes in humans are α-carotene and β-carotene, lycopenes, and xanthines. Lipid-rich human tissues contain high amounts of yellow and orange carotenes, such as breast adipose tissue (D), clear cell renal cell carcinoma (E), submucosal intestinal lipoma (F), atypical lipomatous tumor/well-differentiated liposarcoma (G), schwannoma (H); adrenal cortical adenoma (I); and adrenal gland cortex (J). The 2 uppermost layers of the adrenal cortex are golden yellow (rich in aldosterone and lipids). However, the third layer or zona reticularis, contains high amounts of cytochromes and lipofuscin and is recognized as a thin brown line between the zona fasciculata and the adrenal medulla (gray). Retinol and xanthines are important for the retina (not shown).

Animals are unable to produce carotenes and can only obtain them from their diet. Because carotenes are lipophilic, they associate with lipid-rich tissues. The abundance of certain carotenes in the diet of animals is reflected in the colors of their plumage, fur, or skin. For example, the blue-footed booby (Sula nebouxii) owes its peculiar blue-colored beak and legs to the high amount of blue carotenes present in fish and shellfish native to the Galapagos coast. Similarly, flamingos (Phoenicopterus spp) are born with gray feathers but develop a beautiful pink plumage following the deposit of red carotenes found in the fish and shellfish they eat (Figure 1, B).6  A similar phenomenon can occur in humans. Physicians are familiar with the terms carotenemia (or xanthoderma) and lycopenemia, the yellow-orange skin discoloration that occurs after excessive consumption of carrots, tomatoes, or beets. Each animal species, including humans, metabolizes certain carotenes but not others. Thus, our tissues would not turn blue (fortunately!) even if we were to consume the blue-footed booby's diet. Humans metabolize yellow and orange carotenes but not blue or red ones for unknown reasons. To understand how carotenes give color to a single cell, one can look at a raw egg. The yellow tinge of the egg “white” and the bright yellow-orange yolk color are due to the accumulation of carotenoids and retinol (also a carotene) (Figure 1, C).7 

The α-carotene and β-carotene, lycopenes, and xanthines are the most common carotenes in human tissues.8,9  They are absorbed and deposited in lipid-rich tissues even before we are born (provided from the mother's diet). Hypothetically, the adipose tissue of a human never exposed to carotenes should be white and not bright yellow, but this scenario does not exist because we ingest carotenes every day from our diet. The adrenal glands and testes are the organs with the highest concentration of β-carotene, followed by the liver.9  However, any organ or tissue with high lipid content will absorb carotenes and exhibit a bright-yellow or orange coloring, such as, the first 2 layers of the adrenal gland cortex (zona glomerulosa and fasciculata, rich in aldosterone and lipids), the ovarian corpus luteum, the macula lutea in the eye (rich in lutein and zeaxanthin), organs rich in fat (pancreas, parotid gland), and adipose tissues.10  The neoplastic counterparts of these organs and in general, tumors with high lipid content, such as lipomas, fibrolipomas, well-differentiated liposarcomas, lipoleiomyomas, adrenal cortical adenomas, and carcinomas, such as clear cell renal cell carcinomas, steroid cell tumors, fibrothecomas, and schwannomas are invariably yellow or golden yellow (Figure 1, D through J). Xanthomas and orange palpebral spots are examples of subcutaneous lesions also colored by carotenes.11  Curiously, not all types of lipids are tinged by carotenes. Myelin, the most abundant lipid of the central and peripheral nervous system, remains white despite the amount of carotenes in our body. It is possible that its chemical composition of sphingomyelin, phosphorylcholine, and ceramides somehow prevents carotenes from being deposited, or the minute amounts present are grossly imperceptible.

What are the functions of carotenes in living organisms? In plants, carotenes are crucial for photosynthesis because they transmit light energy to chlorophyll in the chloroplast. They also protect plant tissues from the action of toxic singlet oxygen. In humans, carotenes not only protect cells from the effects of ultraviolet light but also from the toxic effects of reactive oxygen species.9  Therefore, carotenes are potent antioxidants and quenchers of toxic byproducts derived from metabolic reactions. Vitamin A or retinol (which gives the retina some of its color, hence the name) is the best example of a lipid-soluble molecule with diverse functions, including vision, cell turnover of skin and mucosae, bone growth, and immune system homeostasis. There are probably several other functions of carotenes that are unknown.

Cytochromes, the Heme Group, Iron, and Bile Pigments

Pyrroles are heterocyclic aromatic molecules composed of a ring of 4 carbon atoms and one nitrogen atom (C4H5N).1  Assembly of 4 pyrrole rings forms the tetrapyrrole ring protoporphyrin, a precursor of several organic molecules. Addition of a metal atom to the central portion of protoporphyrin results in the formation of an organic prosthetic group. This chemical structure, and more importantly, the type of metal atom attached, gives these compounds their color. Iron bound to protoporphyrin is red-brown like rust (heme groups). In contrast to eggs with white shells, the “rusty” color observed in pink or brown eggshells is due to protoporphyrin deposition (Figure 2, A and B).12,13  In plants, magnesium bound to porphyrins generates the green pigment chlorophyll (Figure 2, C), and in marine arthropods and mollusks, 2 copper atoms bound to porphyrin form hemocyanin (“blue blood”), which acts as an oxygen transporter in these invertebrates. Hemocyanin turns blue when oxygenated (like copper rust) but is colorless/transparent in a deoxygenated state. Cobalt, magnesium, and copper bound to porphyrins are found in such minimal amounts in humans that they do not exert any color effect.