Markers of hydration status

S M Shirreffs

¹School of Sport and Exercise Sciences, Loughborough University, Leicestershire, UK

 

Correspondence: SM Shirreffs, School of Sport and Exercise Sciences, Loughborough University, Leicestershire LE11 3TU, UK. E-mail: s.shirreffs@lboro.ac.uk

Guarantor: SM Shirreffs.

Abstract

Many indices have been investigated to establish their potential as markers of hydration status. Body mass changes, blood indices, urine indices and bioelectrical impedance analysis have been the most widely investigated. The current evidence and opinion tend to favour urine indices, and in particular urine osmolality, as the most promising marker available.

Keywords: hydration status, water balance, euhydration, hypohydration

Hydration status—some definitions

Euhydration is the state or situation of being in water balance. However, although the dictionary definition is an easy one, establishing the physiological definition is not so simple. Hyperhydration is a state of being in positive water balance (a water excess) and hypohydration the state of being in negative water balance (a water deficit). Dehydration is the process of losing water from the body and rehydration the process of gaining body water. Euhydration, however, is not a steady state, but rather is a dynamic state in that we continually lose water from the body and there may be a time delay before replacing it or we may take in a slight excess and then lose this (Greenleaf, 1992).

Water intake and loss

The routes of water loss from the body are the urinary system via the kidney, the respiratory system via the lungs and respiratory tract, via the skin, even when not visibly sweating, and the gastrointestinal system as faeces or vomit. The routes of water gain into the body are gastro intestinally from food and drink consumption and due to metabolic production. Many textbooks, both recent and older, state water gain and loss figures for the average sedentary adult in a moderate environment in the order of 2550 ml (McArdle et al, 1996), 2600 ml (Astrand & Rodahl, 1986) and 2500 ml (Diem, 1962). However, it is interesting to note that the source of this data is never given.

Measurement of total body water

The body water content of an individual can be measured or estimated in a number of ways, but the current consensus is that tracer methodology gives the best measure of total body water. Deuterium oxide (D₂O or ²H₂O) is the most commonly used tracer for this purpose and full details of the methods and protocols, assumptions and limitations are well discussed elsewhere (Schoeller, 1996). Briefly, the tracers are distributed relatively rapidly in the body (in the order of 3–4 h for an oral dose) and correction can be made for exchange with non-aqueous hydrogen. It is estimated that total body water can be measured with a precision and accuracy of 1–2%.

Assessing hydration status

Hydration status has been attempted to be assessed in a variety of situations for a number of years. In 1975, Grant and Kubo divided the tests open to use in a clinical setting into three categories: laboratory tests, objective noninvasive measurements and subjective observations. The laboratory tests were measures of serum osmolality and sodium concentration, blood urea nitrogen, haematocrit and urine osmolality. The objective, noninvasive measurements included body mass, intake and output measurements, stool number and consistency and 'vital signs', for example, temperature, heart rate and respiratory rate. The subjective observations were skin turgor, thirst and mucous membrane moisture. This manuscript concluded that, although the subjective measurements were least reliable, in terms of consistency of measurement between measurers, they were the simplest, fastest and most economical. The laboratory tests were deemed to be the most accurate means to assess a patient's hydration status. Since this manuscript was published, there has been a large amount of research into some of these measurements, observations and tests, and some of the main ones, along with others, are discussed in the rest of this paper.

Body mass

Acute changes in body mass over a short time period can frequently be assumed to be due to body water loss or gain; 1 ml of water has a mass of 1 g (Lentner, 1981) and therefore changes in body mass can be used to quantify water gain or loss. Over a short time period, no other body component will be lost at such a rate, making this assumption possible.

 

Throughout the exercise literature, changes in body mass over a period of exercise have been used as the main method of quantifying body water losses or gains due to sweating and drinking. Indeed, this method is frequently used as the method to which other methods are compared. Respiratory water loss and water exchange due to substrate oxidation are sometimes calculated and used to correct the sweat loss values, but this is not always done (Mitchell et al, 1972). Examples of such types of calculations are shown in Table 1.

 

Table 1. Examples of hydration status calculations

Figure and tables index

Exercise	Pre-exercise Body mass a (kg)	Post-exercise Body mass b (kg)	Total body massloss or gain a (ml or g)	Drinks consumed during exercise b (ml)	Urine excreted during exercise c (ml)	Sweat volume (ml)	Hydration status d (%)
60 min Running	70.00	68.00	-2000	0	200	1800	-2.9
3 h Walking	70.00	70.00	0	500	400	100	0.0
2 h Cycling	70.00	70.20	+200	1000	0	800	+0.3

^a Body mass measured nude with dry skin.
^b Drinks consumed any time between the two body mass measurements.
^c Urine emptied from the bladder any time between the two body mass measurements.
^d +=water gain, -=water loss, 0=no change in water balance.

Blood indices

Collection of a blood sample for subsequent analysis has been both investigated and used as a hydration status marker.

Measurement of haemoglobin concentration and haematocrit has the potential to be used as a marker of hydration status or change in hydration status, provided a reliable baseline can be established. In this regard, standardisation of posture for a time prior to blood collection is necessary to distinguish between postural changes in blood volume, and therefore in haemoglobin concentration and haematocrit, which occur (Harrison, 1985) and change due to water loss or gain.

 

Plasma or serum sodium concentration and osmolality will increase when the water loss inducing dehydration is hypotonic with respect to plasma. An increase in these concentrations would be expected, therefore, in many cases of hypohydration, including water loss by sweat secretion, urine production or diarrhoea. However, in subjects studied by Francesconi et al (1987), who lost more than 3% of their body mass mainly through sweating, no change in haematocrit or serum osmolality was found, although as described below certain urine parameters did show changes. Similar findings to this were reported by Armstrong et al (1994, 1998). This perhaps suggests that plasma volume is defended in an attempt to maintain cardiovascular stability, and so plasma variables will not be affected by hypohydration until a certain degree of body water loss has occurred.

 

Plasma testosterone, adrenaline and cortisol concentrations were reported by Hoffman et al (1994) not to be influenced by hypohydration to the extent of a body mass loss of up to 5.1% induced by exercise in the heat. In contrast, however, plasma noradrenaline concentration did respond to the hydration changes, which means that it may be possible to use this as a marker of hydration status, at least when induced by exercise in the heat.

Urine indices

Collection of a urine sample for subsequent analysis has also been investigated and used as a hydration status marker.

 

Measurement of urine osmolality has recently been an extensively studied parameter as a possible hydration status marker. In studies of fluid restriction, urine osmolality has increased to values greater than 900 mosm/kg for the first urine of the day passed in individuals dehydrated by 1.9% of their body mass, as determined by body mass changes (Shirreffs & Maughan, 1998). Armstrong et al (1994) have determined that measures of urine osmolality can be used interchangeably with urine-specific gravity, opening this as another potential marker.

 

Urine colour is determined by the amount of urochrome present in it (Diem, 1962). [*u·ro·chrome[yóorə krṑm] is a yellow pigment that gives urine its normal color]

 

 

 

 

 

 When large volumes of urine are excreted, the urine is dilute and the solutes are excreted in a large volume. This generally gives the urine a very pale colour. When small volumes of urine are excreted, the urine is concentrated and the solutes are excreted in a small volume. This generally gives the urine a dark colour. Armstrong et al (1998) have investigated the relationship between urine colour and specific gravity and conductivity. Using a scale of eight colours (Armstrong, 2000), it was concluded that a linear relationship existed between urine colour and both specific gravity and osmolality of the urine, and that urine colour could therefore be used in athletic or industrial settings to estimate hydration status when a high precision may not be needed.

 

Urine indices of hydration status perhaps have their limitation in identifying changes in hydration status during periods of rapid body fluid turnover, as in subjects studied who lost approximately 5% of their body mass with, on average, 62 min of exercise in the heat, then rehydrating by replacing this lost fluid (Popowski et al, 2001). In these subjects, in comparison to measures of plasma osmolality which increased and decreased in an almost linear fashion, urine osmolality and specific gravity were found to be less sensitive and demonstrated a delayed response, lagging behind the plasma osmolality changes.

Bioelectrical impedance analysis

Bioelectrical impedance analysis (BIA) has been widely investigated as a tool for assessing body composition. It has the potential to assess hydration status by the determination of body water and its cellular divisions if a multifrequency device is used. In multifrequency BIA, a current is applied at different frequencies and the higher conductivity of water compared to the other compartments is used to determine its volume. The National Institute of Health technology assessment statement (National Institute of Health, 1994) concluded that 'BIA provides a reliable estimate of total body water under most conditions.' It carried on to state that 'BIA values are affected by numerous variables including... hydration status' and that 'Reliable BIA requires standardisation and control of these variables.' Subsequent work in this area has generally highlighted the limitations of the technique. For example, Asselin et al (1998) concluded that with acute dehydration and rehydration of 2–3% of body mass, standard equations failed to predict changes in total body water, as determined by changes in body mass. Saunders et al (1998) reported that small body water changes were reported as body fat changes in an athletic population, and Berneis and Keller (2000) after inducing extracellular volume and tonicity alterations by infusion and drinking concluded that BIA may not be reliable.

Other markers

Hydration status has also been investigated by a number of less commonly investigated parameters. For example, alterations in the response of pulse rate and systolic blood pressure to postural change have been demonstrated in clinical settings of dehydration and rehydration (Johnson et al, 1995). The diameter of the inferior cava vein, measured with the subject lying supine, has been used with patients undergoing peritoneal dialysis (Cheriex et al, 1989).

Conclusions

The body water content of a person is most appropriately determined using tracer methodology with the use of deuterium oxide. The determination of a person's hydration status has received increasing attention over the past 10 years, much of it influenced by body water losses that can occur in a relatively short period of time with physical activity. Blood-borne parameters and urinary markers have been widely studied areas, with a substantial amount of research into the use of BIA also being undertaken. In most cases, acute changes in body mass are used to signify the body water losses or gains to which comparisons are made. However, an arbitrary decision or definition of euhydration must be made before a person is assigned to being in a state of hypohydration or hyperhydration, and this perhaps remains a major issue to be resolved.

 

The choice of hydration status marker will ultimately be determined by the sensitivity and accuracy with which hydration status needs to be established, the technical and time requirements and the expense of the method. However, consideration must also be given to other conditions or complicating factors that may impact on the parameter of measurement.

 

From the studies reviewed above, it seems fair to conclude that urinary measures are more sensitive than the other methods, but they may have a time lag over the short term. It must also be remembered that classification of the state of hypohydration or hyperhydration depends on the physiological definition of euhydration, which is not as simple as giving the dictionary definition.

References

1. Armstrong LE (2000): Performing in Extreme Environments. Champaign: Human Kinetics.
2. Armstrong LE, Soto JA, Hacker Jr FT, Casa DJ, Kavouras SA & Maresh CM (1998): Urinary indices during dehydration, exercise, and rehydration. Int. J. Sport Nutr. 8, 345–355.
3. Armstrong LE, Maresh CM, Castellani JW, Bergeron MF, Kenefick RW, LaGasse KE & Riebe D (1994): Urinary indices of hydration status. Int. J. Sport Nutr. 4, 265–279.
4. Asselin M-C, Kriemler S, Chettle DR, Webber CE, Bar-Or O & McNeill FE (1998): Hydration status assessed by multi-frequency bioimpedance analysis. Appl. Radiat. Isot. 49, 495–497.
5. Astrand PO & Rodahl K (1986): Textbook of Work Physiology. p 619. Singapore: McGraw-Hill International.
6. Berneis K & Keller U (2000): Bioelectrical impedance analysis during acute changes of extracellular osmolality in man. Clin. Nutr. 19, 361–366.
7. Cheriex EC, Leunissen KML, Janssen JHA, Mooy JMV & van Hooff JP (1989): Echography of the inferior vena cava is a simple tool for estimation of 'dry weight' in hemodialysis patients. Nephrol. Dial. Transpl. 4, 563–568.
8. Diem K (1962): Documenta Geigy Scientific Tables. pp 538–539. Manchester: Geigy Pharmaceutical Company Limited.
9. Francesconi RP, Hubbard RW, Szlyk PC, Schnakenberg D, Carlson D, Leva N, Sils I, Hubbard L, Pease V, Young J & Moore D (1987): Urinary and hematological indexes of hydration. J. Appl. Physiol. 62, 1271–1276.
10. Greenleaf JE (1992): Problem: thirst, drinking behaviour, and involuntary dehydration. Med. Sci. Sports Exerc. 24, 645–656. | PubMed | ISI | ChemPort |
11. Harrison MH (1985): Effects of thermal stress and exercise on blood volume in humans. Physiol. Rev. 65, 149–209.
12. Hoffman JR, Maresh CM, Armstrong LE, Gabaree CL, Bergeron MF, Kenefick RW, Castellani JW, Ahlquist LE & Ward A (1994): Effects of hydration state on plasma testosterone, cortisol, and catecholamine concentrations before and during mild exercise at elevated temperature. Eur. J. Appl. Physiol. 69, 294–300.
13. Johnson DR, Douglas D, Hauswald M & Tandberg D (1995): Dehydration and orthostatic vital signs in women with hyperemesis gravidarum. Acad. Emer. Med. 2, 692–697.
14. Lentner C (1981): Geigy scientific tables. 8th Edition. Basle: Ciba-Geigy Limited.
15. McArdle WD, Katch FI & Katch VL (1996): Exercise Physiology: Energy, Nutrition, and Human Performance. p 54. Philadelphia: Lippincott Williams & Wilkins.
16. Mitchell JW, Nadel ER & Stolwijk JAJ (1972): Respiratory weight losses during exercise. J. Appl. Physiol. 32, 474–476. | PubMed | ISI | ChemPort |
17. National Institutes of Health (1994): Bioelectrical impedance analysis in body composition measurement. NIH Technol. Assess. Statement. December 12–14, pp 1–35.
18. Popowski LA, Oppliger RA, Lambert GP, Johnson RF, Johnson AK & Gisolfi CV (2001): Blood and urinary measures of hydration status during progressive acute dehydration. Med. Sci. Sports Exerc. 33, 747–753.
19. Saunders MJ, Blevins JE & Broeder CE (1998): Effects of hydration changes on bioelectrical impedance in endurance trained individuals. Med. Sci. Sports Exerc. 30, 885–892.
20. Schoeller DA (1996): Hydrometry. In Human Body Composition. eds A Roche, S Heymsfield & T Lohman, pp 25–43. Champaign: Human Kinetics.
21. Shirreffs SM & Maughan RJ (1998): Urine osmolality and conductivity as indices of hydration status in athletes in the heat. Med. Sci. Sport Exerc. 30, 1598–1902

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CHAPTER 5 : THE CHEMISTRY OF DEPRESSION

PERCEPTIVE MARKERS OF DEHYDRATION

When the human body becomes dehydrated, the brain can still get water delivered by "raindrops" through the filter system in its cell membranes, but this is not enough to energize it as fully as when the human body is well hydrated. This discrepancy in the rate of water supply to the brain produces a certain number of sensory outcomes that I consider to be thirst perception. They are as follow : 

THIRST PERCEPTIONS

1. Feeling Tired.

2. Feeling Flushed.

3. Feeling Irritable.

4. Feeling Anxious.

5. Feeling Dejected.

6. Feeling Depressed.

7. Feeling Inadequate.

8. Feeling a "Heavy Head".

9. Cravings.

10. Agoraphobia. 

Figure 5-1. This illustration above should help you recognize the earlier stages of depression before it becomes deeply established. Bear in mind that untimely tiredness could be an early marker of depression. When you are too tired to get out of bed first thing in the morning, you are in fact so dehydrated that your brain is refusing to get engaged in your daily routine. Drink up your water on time and do NOT let the problem turn into full-blown depression. 

WHAT IS DEPRESSION ?

 If it is the hot season and you are too preoccupied to water your grass, it will die of "brown grass disease." First the grass wilts ; then patches of it begin to go yellow, and then brown. If these symptoms of dehydrated grass do NOT register in your mind the need to get out the water hose and thoroughly soak the yard, all the grass in your charge will die, prematurely. And if, God forbid, the importance of water as a medication against the browning of grass and foliage is not held in the safekeeping of your brain , you might wonder what specialist could come and save you from having to re-grass your lawn. And, since specialists are by nature hard to come by and expensive, you would have no choice but to listen to their pearls of wisdom, particularly if the occurrence of brown grass disease is thought to be a genetic problem of the grass in your garden. 

You would have no choice but to have the whole area of brown grass dug up and replanted with a different strain of grass.  Since your new grass has to be watered to grow, you come away with the idea that your specialist knows what he's talking about, and totally in the dark that even your old grass needed to be watered regularly to stay green and healthy. 

In its early stages, depression is like the brown grass disease of the brain cells.  It is a direct outcome of NOT DRINKING WATER on a REGULAR BASIS and, worse, of drinking caffeinated beverages in place of water. Caffeine is a  dying agent and dehydrates the human body. Nine trillion brain cells need water all the time. The human brain is 85 percent water and needs every drop of water to perform its most complicated functions.  Depression is much like the wilting stage of brown grass, but sadly, you cannot dig up the brain cells and plant new gene-improved models in their place, at least not yet. You will have to make do with what you have --water it. Drink your water regularly. 

Depression is only a label given to the physiological state of a dehydrated brain that is not able to perform all its sophisticated functions.  Depending on what area of the brain is more affected by dehydration, different subsets of labels have generated for the same basic problem. And because jargon-peddling is the way of "knowledgeable professionals," the simple shortage of water, water deficits, and the material resources it would bring with it to the needs of the brain, has been responsible for the creation of psychiatry as a field among the medical disciplines.  The difference between psychology and psychiatry is in the way the patient is treated. In the one discipline they talk to you out of your concerns, and in the other they medicate you into conformity.

Since you have been initiated into the field of psychiatry by the advertising programs of the drug industry, you likely want to know all about the relationship of water to serotonin and its reuptake inhibitors, and so on, before you can begin to value water as an effective natural medication against depression.

There are 20 amino acids. From these, the human body manufactures different proteins for construction of both body tissues and the active messenger agents that regulate the human body's functions.  The body has the ability to manufacture 10 of these amino acids, but the other 10 cannot be manufactured and must be imported. The 10 amino acids the human body can make are alanine, glycine, proline, serine, cysteine, aspartic acid, glutamic acid, asparagines, glutamine, and tyrosine.  However, at least two of these amino acids -- cysteine and tyrosine -- are derivatives of other essential amino acids that the human body cannot manufacture but must consume. Cysteine is manufactured from methionine, and tyrosine is manufactured from phenylalanine. 

The body can manufactured some histidine , but not enough of it during childhood and old age.  For this reason, histidine should also be considered an essential amino acid. 

The essential amino acids -- listed in the order of their importance for brain function -- are histidine , tryptophan , phenylalanine, methionine , lysine, threonine , valine, arginine, leucine, and isoleucine. 

Histidine gets converted to the neurotransmitter histamine and is responsible for the water regulation and resource management of the human body.  It operates your thirst sensations and regulates the water-rationing programs of the human body.  It is with us from minute one of life when the ovum is fertilized by the sperm, but has not yet divided into two cells. Histamine has to "wet-nurse" the ovum for it to be able to expand in volume and then divine, and divide, until the baby is born -- histamine is there all the time.  In childhood, when the human body is growing, histamine acts as a strong growth factor, much like growth hormone.  The difference is that histamine becomes more and more active as we grow older, while growth hormone activity diminishes very rapidly from the third decade of life. From your 30th birthday onward. 

The tremendous need for the actions of histamine in childhood and old age makes its precursor amino acids, histidine, essential. Many neurological disorders, such as multiple sclerosis, seem to be produced because of histidine metabolism imbalance. Many emotional problems are associated with excess activity of histamine during its water-regulation. 

The more the human body becomes dehydrated, the more histamine activity takes over the physiological functions that were the responsibility of water. If there is not enough water to energize the mineral pumps, or cation pumps, and regulate the balance between sodium (which has to stay outside the cells) and potassium ( which must be forced back in), histamine stimulates the release of energy to jump-start  the protein pumps and bring about osmotic balance in the environment of the cells -- most vitally in the brain. 

Histamine acts as a natural energy manager in the absence of water and shortage of hydroelectric energy. Brain function is not efficient without histamine when the body is short of water.  Nor is it efficient for long if it has to rely only on histamine as a substitute for the functions of water. In essence, this state of inefficient brain physiology, caused by the missing action of water, is what we call depression. 

Histamine is in charge of the ionic balance inside the cells. It forces potassium ions that leak out of the cell wall back into the cell. It releases energy energy for the pumps that handles the process. The trigger mechanism that gets histamine going is a rise in the level of potassium in the environment around the cells. The action of histamine in the body is what preserves life until water becomes available and can perform its natural functions : The use of antihistamine medications, when water itself is a better natural antihistamine, is tantamount to a criminal act. The tricyclic antidepressants, medications, and in fact even the more modern antidepressants , function as very strong antihistamines. 

The essential amino acid tryptophan gets converted into at least four neurotransmitters and hormones : serotonin, tryptamine, indolamine, and melatonin. 
Two enzymes, one unique to serotonin-producing cells and the other distributed more generally in the brain, act on tryptophan in this conversion process.  Nature has selected tryptophan as the most important amino acid for the brain's control of all the sensations and functions of the human body.

Serotonin is the kingpin chemical, needed for many events that silently regulate the human body physiology.  This is why a shortage of the serotonin that should normally be available is one of the hallmarks of depression. It's also why the pharmaceutical industry has produced a number of chemicals that slow down the rate of serotonin's  destruction in the nerve terminals after it is secreted to perform one of the many functions:
1. Serotonin alters the threshold of pain sensation and produces analgesia.
2. Serotonin control production and release of the growth hormone.
3. Serotonin controls the level of blood sugar.
4. Serotonin controls the blood pressure levels of the body -- it has a tendency to lower blood pressure.
5. Serotonin and tryptophan control appetite. You remember I talked about motilin , which is considered a kind of gut serotonin.  It is the hormone that causes the santiety sensation.
6. Serotonin and tryptophan regulate the human body's salt intake, whereas histamine controls the intake of potassium and its insertion into the cells. 
7.Serotonin has a direct effect on calcium movement into the cells and its involvement in neurotransmission.
8. Serotonin release inhibits histamine's release and its action. 
9. Serotonin production by the brain is reduced when the blood levels of three amino acids -- valine, leucine,  and isoleucine -- rise above normal, such as in starvation, dehydration, lack of exercise, and other conditions that affect protein metabolism of the body.
10. Serotonin strengthens the contractile properties of certain muscles. 
11. The serotonin-stimulated nerve system (serotonergic system) is the medium through which analgesics such as morphine and hallucinogenic drugs like LSD register their effects. It is this kind of stimulation of the serotonergic system that becomes addictive when people get hooked on a drug, be it caffeine or cocaine. 

The brain cells that convert tryptophan to serotonin have the ability to make this conversion at the same rate as it arrives.  These cells do not store tryptophan itself, but store serotonin in vesciles and even pass these vesicles on the nerves' transport system down the track to the nerve endings, to be used when the nerve is stimulated. Thus, low serotonin levels in the nerve system -- seem in depression -- are only caused if tryptophan cannot be delivered to the nerve cells. 

You now understand the physiological upheaval that occurs as a result of tryptophan shortage in the brain tissue. After 20-plus years of research into the relationship of water to pain regulation of the body, I have reached a broad understanding of how to avoid  serotonin depletion in the brain and prevent depression.

WATER : NATURE'S ANTI-DEPRESSANT MEDICATION

Directly or indirectly, water maintains an efficient and effective rate of tryptophan flow into the brain tissue for its immediate conversion into serotonin. Here is how :
1. Normally , when the human body gets dehydrated and cannot produce adequate urine to get rid of its toxic waste and the acid buildup in its cells, certain amino acids are sacrificed to neutralize this acid and make the human body more alkaline. The term usually used is antioxidant. Tryptophan, tyrosine, cysteine, methionine, and more are all sacrificed in an attempt to keep the acid-alkali balance of the human body chemistry within the normal range. 
( NOTE: But by making a few simple changes to your diet and lifestyle, you'll not only balance your body's pH, but experience incredible healing results like increased energy, improved immunity, the reduction or elimination of pain, and a powerful return of your body's ability to heal itself. Many who return balance to their body chemistry help avoid heart disease, arthritis, osteoporosis, diabetes, kidney disease, and cancer. 
Imagine that acid and alkaline are two teams in a tug-of-war contest, each one holding the end of a long rope and trying to shift the balance to its side, and you'll get a good sense of what happens every single second in your body. The pH spectrum ranges from 0 to 14, with 7 being neutral, 0 to 6.9 being acidic, and 7.1 to 14 being alkaline. Normal water pH is 7 . Average human blood pH is roughly 7.365. When your pH balance tips toward either the acidic or the alkaline side of the spectrum, you are vulnerable to a variety of health problems. Because of the current eating habits of most people, it is rare for anyone to become excessively alkaline for an ongoing basis. Excessive acidity is much more common, even among health-conscious eaters. Your blood must stay at pH 7.365. If your diet and lifestyle choices consistently acidify the blood, they will deplete alkaline minerals from your bones and muscles, as well as tax the detoxification organs just to maintain the balance, which can result in many harmful health effects. The bulk of your diet should be made up with alkalizing foods, such as leafy greens (dandelion, kale), round vegetables (onions, cabbage), and legumes (edamame, lentils). Remember: it doesn't matter whether a food itself is acidic or alkaline; it is more important how it affects your body. Strive for a diet consisting of at least 70% alkaline-forming foods.)

2. Regularly drinking enough water to create colorless urine -- resulting in the washing of excess acid out of the body -- would automatically conserve these essential amino acids, enabling them to perform their normal roles in the body. Thus adequate urine production, which should occur with water intake -- not through the use of diuretics, caffeinated beverages, or alcoholic drinks -- is a major safeguard against depression. 

3. All elements that need to get into the brain and reach its cells have to be carried on special transporter systems.  These transporter systems are specific to various  elements. Trytophan shares its transporter system with five other amino acids : valine , leucine , isoleucine, phenylalanin, and tyrosine.  The rate at which tryptophan can cross the blood-brain barrier (BBB) depends on the level of those other amino acids that are in circulation.

4. In starvation, dehydration, and lack of exercise, blood vessels of valine,  leucine, and isoleucine increase. This reduces the available transport system for the passage of trytophan across the BBB, thus causing a gradual depletion of the available tryptophan in the brain.  If dehydration and lack of exercise become established trends in the lifestyle of any individual, the serotonin levels in the brain of that person will decrease.

5. Valine, leucine , and isoleucine are energy-laden amino acids that can be used by the brain or the muscle tissues in the human body for their energy needs -- not to manufacture a product, but rather to perform a function.  Exercise enables muscle tissue to mop up these amino acids from the circulation and make an intermediate product that the liver will then complete the process and make sugar for the brain to use. As a result of the muscles' collection of these amino acids from the circulating blood, increased space on transporter system (which exists only in the capillaries that feed the brain ) is made available for the amino acid tryptophan to catch a ride and reach the brain side of the circulation. 

6. In the same way, the rate of tyrosine transfer to the brain side of circulation will increase and cause a buildup of the dopamine levels that complement serotonin activity in the brain for increasing motivation and purpose.  Thus , adequate exercise is an effective way to replenish brain serotonin levels and ward of depression. Yours truly love to walk in the the forest and parks. Keep walking for at least 2 hours everyday, that way, your body’s natural fat burner will work well for the next 24 hours, even during your sleep. 

7. Another role of adequate hydration in boosting the serotonin levels of the brain is too complex to explain here in this blog. Briefly, tryptophan is extremely heat excitable. Water serves the purpose by producing high heat of activation at the cell membranes.  This is most effectively done at the blood-brain barrier (BBB).

The local heat excites tryptophan. It dislodges itself from the transporter protein in the blood, and attaches itself to another transporter system in the wall of the better-hydrated brain capillaries.  The new transporter system in the capillary wall will more efficiently and effectively deliver it to the brain. In the brain, it gets converted to serotonin, melatonin, tryptamine, and indolamine -- the chemicals that regulate entire human body physiology, including your mood and outlook on life. 

With its simple local heat generation, water causes a speedier shift of tryptophan into the brain.  Water also has many other indirect effects that help tryptophan reach into the brain cells. Thus, water is a natural medication against depression. 

To prevent disease, you must prevent dehydration from getting established in the interior of your body's cells. To reverse a disease process, you need additional insight into the metabolic complication associated with prolonged water shortage in the human body. Naturally, there are other treatment pointers that need to be followed. These are fully explained in the last three chapters . 

Having learned about the missing role of water in depression, let us now see some stupendous results.