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Waiting To Get Thirsty Is To Die Prematurely And Very Painfully

F. Batmanghelidj, M.D. 

     Heinz Valtin, M.D. an emeritus professor at Dartmouth Medical School, has ventured the opinion that there is no scientific merit in drinking 8 x 8-ounce glasses of water a day and not waiting to get thirsty before correcting dehydration. This view, published in the American Journal of Physiology, August 2002, is the very foundation of all that is wrong with modern medicine, which is costing this nation $1.7 trillion a year, rising at the rate of 12 percent every year. Dr. Valtin’s view is as absurd as waiting for the final stages of a killer infection before giving the patient the appropriate antibiotics. His views are based on the erroneous assumption that dry mouth is an accurate sign of dehydration.

     Like the colleagues he says he has consulted, Dr. Valtin does not seem to be aware of an important paradigm shift in medicine. All past views in medicine were based on the wrong assumption that it is the solutes in the body that regulate all functions and that the solvent has no direct role in any of the body’s physiological functions.  In medical schools it is taught that water is only a solvent, a packing material and a means of transport, that water has no metabolic function of its own. I have come across this level of ignorance about the primary physiological role of water at another Ivy League medical school from another eminent professor of physiology who, like Dr. Valtin, researched and taught the water-regulatory mechanisms of the kidney to medical students and doctors.  Only when I asked him what “hydrolysis” is, did the penny drop and he admitted the scientific fact that water is a nutrient and does indeed possess a dominant metabolic role in all physiological functions of the body.

     Dr. Valtin’s emphasis on the water-regulatory role of the kidneys limits his knowledge to the body’s mechanisms of “deficit management” of the water needs of the body. He seems to base his views of thirst management of the body on the vital roles of vasopressin, the antidiuretic hormone, and the renin-angiotensin system, the elements that get engaged in the drought-management programs of the body, when the body has already become dehydrated.  Indeed, he thinks dehydration is a state of the body when it loses 5 percent of its water content; and that one should wait until at some level of such water loss the urge to drink some kind of “fluid” will correct the water deficit in the body. This view might have seemed plausible 25 years ago. Today, it exposes the tragic limitations of knowledge of the human physiology that is available to a prestigious medical school in America.

     In his recently published and widely reported assertions, Dr. Valtin does not take into consideration the fact that water is a nutrient. Its vital “hydrolytic” role would be lost to all the physiological functions that would be affected by its shortage in its osmotically “free state.” Another oversight is the fact that it is the interior of the cells of the body that would become drastically dehydrated. In dehydration, 66 percent of the water loss is from the interior of the cells, 26 percent of the loss is from extracellular fluid volume and only 8 percent of the loss is borne by the blood tissue in the vascular system, which constricts within its network of capillaries and maintains the integrity of the circulation system.

     Philippa M, Wiggin has shown that the mechanism that controls or brings about the effective function of the cation pumps utilizes the energy transforming property of water, the solvent; “The source of energy for cation transport or ATP synthesis lies in increases in chemical potentials with increasing hydration of small cations and polyphosphate anions in the highly structured interfacial aqueous phase of the two phosphorylated intermediates1.”  Waiting to get thirsty, when the body fluids become concentrated before thirst is induced, one loses the energy-generating properties of water in the dehydrated cells of the body. This is a major reason why we should prevent dehydration, rather than wait to correct it. This new understanding of the role of water in cation exchange is enough justification to let the body engage in prudent surplus water management rather than forcing it into drought and deficit water management, which is what Dr. Valtin is recommending people to do.

     In his research on the “conformational change in biological macromolecules,” Ephraim Katchalski-Katzir of the Weizmann Institute of Science has shown that the “proteins and enzymes of the body function more efficiently in solutions of lower viscosity2.” Thus, water loss from the interior of the cells would adversely affect their efficiency of function. This finding alone negates Dr. Valtin’s view that we should let dehydration get established before drinking water. Since it is desirable that all cells of the body should function efficiently within their physiological roles, it would be more prudent to optimally hydrate the body rather than wait for the drought management programs of the body to induce thirst. Furthermore, it is much easier for the body to deal with a slight surplus of water than to suffer from its shortfall and have to ration and allocate water to vital organs at the expense of less vital functions of the body. The outcome of constantly circulating concentrated blood in the vascular system is truly an invitation to catastrophe.   

     The tragedy of waiting to get thirsty hits home when it is realized that the sharpness of thirst perception is gradually lost, as we get older. Phillips and associates have shown that after 24 hours of water deprivation, the elderly still do not recognize they are thirsty: “The important finding is that despite their obvious physiologic need, the elderly subjects were not markedly thirsty3.”  Bruce and associates have shown that, between the ages of 20 to 70, the ratio of water inside the cells to the amount of water outside the cells drastically changes from 1.1 to 0.84.  Undoubtedly this marked change in the intracellular water balance would not take place if the osmotic push and pull of life could favor water diffusion through the cell membranes everywhere in the body—at the rate of 10-3 centimeters per second. Only by relying on the reverse osmotic process of expanding the extracellular water content of the body, so as to filter and inject “load-free” water into vital cells by the actions of vasopressin and the renin-angiotensin-aldosterone systems—when the body physiology is constantly forced to rely on its drought- management programs—could such a drastic change in the water balance of the body result.

     Two other scientific discoveries are disregarded when Dr. Valtin recommends people should wait until they get thirsty before they drink water. One, the initiation of the thirst mechanisms is not triggered by vasopressin and the renin-angiotensin systems—these systems are only involved in water conservation and forced hydration of the cells. Thirst is initiated when the Na+-K+-ATPase pump is inadequately hydrated. It is water that generates voltage gradient by adequately hydrating the pump proteins in the neurotransmission systems of the body1.  This is the reason the brain tissue is 85 percent water5 and cannot endure the level of “thirst-inducing” dehydration that is considered safe in the article published by Dr. Valtin.

     Two, the missing piece of the scientific puzzle in the water- regulatory mechanisms of the body, which has been exposed since 1987, and Dr. Valtin and his colleagues need to know about it, is the coupled activity of the neurotransmitter histamine to the efficiency of the cation exchange; its role in the initiation of the drought- management programs; and its role in the catabolic processes when the body is becoming more and more dehydrated5. Based on the primary water-regulatory functions of histamine, and the active role of water in all physiologic and metabolic functions of the body—as the hydrolytic initiator of all solute functions—the symptoms of thirst are those produced by excess histamine activity and its subordinate mechanisms which get engaged in the drought- management programs of the body. They include asthma, allergies and the major pains of the body, such as heartburn, colitis pain, rheumatoid joint pain, back pain, migraine headaches, fibromyalgic pains, and even anginal pain5, 6. And, since vasopressin and the rennin-angiotensin-aldosterone activity in the body are subordinates to the activation of histamine, their role in raising the blood pressure is a part of the drought-management programs of the body6. Their purpose of forced delivery of water into vital cells demands a greater injection pressure to counteract the direction of osmotic pull of water from inside the cells of the body, when it is dehydrated. 

     From the new perspective of my 22 years of clinical and scientific research into molecular physiology of dehydration, and the peer-reviewed introduction of a paradigm shift in medical science, recognizing histamine as a neurotransmitter in charge of the water regulation of the body, I can safely say the 60 million Americans with hypertension, the 110 million with chronic pains, the 15 million with diabetes, the 17 million with asthma, the 50 millions with allergies, and more, all did exactly as Dr. Valtin recommends. They all waited to get thirsty. Had they realized water is a natural antihistamine5, 7, 8 and a more effective diuretic, these people would have been saved the agony of their health problems.

1- Wiggins PM; A Mechanism of ATP-Driven Cation Pumps;
PP-266-269, Biophysics of Water, Eds. Felix Franks and Sheila F. Mathis, John Wiley and Sons, Ltd.1982

2- Ephraim Katchalski-Katzir: Conformational Changes In Biological Macromolecules; Biorheology, 21, PP. 57-74, 1984.

3- Phillips PA; Rolls BJ; Ledingham JGG; Forsling ML; Morton JJ; Crowe MJ and Wollner L; Reduced Thirst After Water Deprivation In Healthy Elderly Men; The New England Journal of Medicine, PP.753-759, Vol. 311, No. 12, Sept. 20 1985.

4- Bruce A; Anderson M; Arvidsson B and Isacksson B; Body Composition, Predictions of Normal body Potassium, Body Water and Body Fat in Adults on the Basis of Body Height, Body Weight and Age; Scand. J. Clin. Lab. Invest, 40, 461-473, 1980.

5- Batmanghelidj F. M.D. Pain: A Need For Paradigm Change; Anticancer Research, Vol. 7, No. 5 B, PP. 971-990, Sept.- Oct. 1987; full article posted on

6- Batmanghelidj F. M.D. Your Body’s Many Cries for Water; Global Health Solutions, Inc.

7- Batmanghelidj F. M.D. Neurotransmitter Histamine: An Alternative View; Page 37 of the Book of Abstracts; The 3rd Interscience World Conference on Inflammation, Analgesics and Immunomodulators, 1989 Monte-Carlo. The Abstract and the full article are posted on the Website

8- Batmanghelidj F. M.D; ABC of Asthma, Allergies and Lupus; Global Health Solutions, Inc.

For more information on the role of histamine, see the articles on this topic in the science section,, or read my book ABC of Asthma, Allergies and Lupus.                                

F. Batmanghelidj, M.D.

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