Manor Field Blog number 6. Doctor, how much should I drink?

No, I am not getting at those who enjoy wine or gin; I am just talking about straightforward fluids – water, juice and the like. Tea and coffee too.

I could do some research and find the recommended daily amount (I am sure one exists) – that doesn’t really work however as we are all different. (Here is what the NHS says).

What works for one person might either be too little or too much for another.

I used to have a friend whose mum had kidney stones, and, having witnessed the pain she experienced and heeding her advice, he used to drink huge amounts of water.

As with everything in life, too little can be as bad as too much.

The year of my peak-fitness (2003) I ran the Sheffield Marathon – there a guy drank so much he developed a swollen brain. That is too much.

In the hospital we often find people who have too little fluid on-board, this of course is dehydration (medicalised to ‘acute kidney injury’ (AKI) nowadays).

It all has to do with balance.

What you put in and what comes out.

Too much in and not enough out, and, you are overloaded and may end-up like the guy in Sheffield – I am sure he thought he was doing the right thing, as it was a very hot day and he must have been sweating buckets, but over-replacement is as bad as under, and, the fluid has to go somewhere.

Many of my patients have swollen ankles and legs and this in itself is a separate blog; suffice it to say that this is linked too.

So, doctor, how much?

Well, most of us – adults that is, have been drinking for many years, and, if you have made it into your 50’s, 60’s or older and are in reasonable health, you are probably close to the sweet spot.

An indicator sometimes used is the colour of your pee – it should be a little yellow. Yet, this is just a guide.

There are lots of other factors, such as lifestyle and preference. (Beetroots too).

A major contributor to older people in particular restricting their fluid in take is having to go to the loo too many times (the journey with painful knees, getting on and off the toilet and so on).

They restrict what they drink in the belief that this will limit the journeys. This is a false-economy as what often happens is more concentrated pee that irritates the bladder resulting in a need to pee just as much if not more, and, given that it increases the risk of urine infections can make things altogether worse*.

Bacteria tend to thrive in stagnant water; they don’t like it when you flush too much!

This can be a difficult message as it is often complicated by something called continence, a favourite topic of mine that is also for another day.

So, what should you do?

Just carry-on with what you are doing?

For most people this is the best advice; don’t worry and, even if the doctor or nurse advises, ‘drink more,’ we know from studies on human behaviour that this message doesn’t tend to have long-lasting effects.

Sometimes we do specifically tell patients to drink more, particularly those who are taking certain medicines such as anti-inflammatory and blood-pressure treatments as these can wreck havoc with your kidneys if you dehydrate.

Probably the best guide is to monitor what you are doing and what is happening.

If it is very hot (like that bizarre Wednesday the other week; our hottest day?) or if you are poorly and vomiting or have diarrhoea, drink more. All other things being equal just carry on, as they say.

In a later blog I will discuss sick-day rules which is specific advice for a certain group of people using drugs that can be harmful if you are dehydrated (like those for bloods pressure), for now, sit-back, enjoy your tea, coffee or water and I will berate those who you who associated ‘drink’ with alcohol another day!