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From The Desk Of Clarence Bass

"We have found a strong negative...association between intake of water and risk of fatal coronary heart disease and, in contrast, a positive associative between intake of fluids other than water and risk." Jacqueline Chan, DrPH, American Journal of Epidemiology.

The Plain Water Advantage

Looks like our discussion of water has generated interest far and wide, maybe even struck a nerve or two. The second piece on water (# 96) prompted an information-packed email from Jacqueline Chan, DrPH, Adventist Health Studies, School of Public Health, Loma Linda University, Loma Linda, CA, whose 2002 research report "Water, Other Fluids, and Fatal Coronary Heart Disease" appears in the American Journal of Epidemiology (Vol. 155, No. 9:827-833). While Chan agrees with Dr. Valtin that thereís little or no evidence Ė "an absence of information," in her words -- to support the eight-glasses-of-water rule, she'd like to see "some balance" on the web about the "advantages of plain water." She believes itís important for people to understand that relying mostly on "other fluids" may not be wise.

"Thereís research that shows that cancer of the colon and bladder are reduced by water and not other fluids," Chan writes. Lending support to Dr. Kenseyís theory (art. #93), she continues: "My research [cited above] is very clear that water reduces the risk of fatal heart disease in men and women, and that other fluids together, are detrimental." She says that blood viscosity is considered an independent risk factor for heart disease and confirms that it "can be elevated by dehydration."

The Water-Heart Attack Connection

Dr. Chan and her colleagues examined the connections between coronary heart disease and intake of water and other fluids in 8,280 male and 12,017 female participantís in the ongoing Adventist Health Study. Over a 6-year follow-up period, the subjects experienced 246 "coronary heart disease events," 128 in men and 118 in women. "The clearest and most consistent association with fatal heart disease was found with water intake," the researchers reported. Men who consumed five or more glasses of water suffered significantly fewer heart attacks than those that drank two or less (risk ratio 0.46). Among women, the relative risk was slightly less (0.59), but still significant.

."Intake of fluids other than water was associated with increased risk of fatal coronary heart disease," the report stated. Among women who drank five or more servings of fluids other than water compared to two or fewer, the relative risk was a whopping 2.47. (While the percentage difference is striking, keep in mind that the actual numbers are quite small.) "Fluids other than water" included coffee, hot chocolate, black tea, juice (sweetened and unsweetened), fruit drinks, carbonated soft drinks and alcoholic beverages.

Itís easy to understand why drinking more water would thin the blood, make it flow more smoothly and, therefore, reduce the risk of heart attack (especially after reading Dr. Kenseyís book). Plus, the relationship between blood viscosity and risk is consistent with the well-known fact that heart attacks frequently occur early in the morning, when blood is thicker due to water loss during the night.

But why would consumption of fluids other than water increase the risk?

Dr. Chan and her colleagues in their report offer some logical explanations. The first is almost a given: "Caffeinated beverages [such as coffee and tea] are mild diuretics and thus may raise blood viscosity." Actually, this may not have been a major factor in the study, because California Adventists are health conscious and generally donít drink much in the way of caffeinated beverages. Nevertheless, itís something for the rest of us to keep in mind.

Their second rationale is less obvious and may be more important: "High energy drinks such as juices and regular sodas...cause a net movement of fluid from the vascular system into the [gut] resulting in a rapid elevation in blood viscosity after consumption." In other words, blood and fluids are shunted from the veins and arteries to the stomach and intestines to help digest the high concentration of sugar and other nutrients in juices and sodas.

Thatís one more reason to stick with foods which are absorbed more slowly, such as fruit, vegetables and other whole foods.

Iím probably not the only one who paid a little less attention to water consumption after reading Dr. Valtinís article saying thereís no support for the "8 x 8" rule and that any type of fluids will due. Well, Jacky Chanís email and study has me reaching for the water jug Ė and the apples -- again.

How about you?

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