Six to eight glasses of water ‘still best’

Behind the Headlines

Wednesday July 13 2011

Many newspapers have reported today that “government advice to drink six to eight glasses of water a day is nothing but "thoroughly debunked nonsense" (The Daily Telegraph).

The news stories are based on an opinion piece in the British Medical Journal, in which Dr Margaret McCartney, a GP from Glasgow, discusses the evidence behind the claims that we all need to drink more water to maintain our health. Specifically, the author questions messages that are being publicised by “Hydration for Health”, an initiative sponsored by Danone, the producer of Volvic, Evian and Badoit bottled waters.

Dr McCartney also questions the advice from NHS Choices, that people should try to drink about six to eight glasses of water or other fluids a day to prevent dehydration.

This article, which has not been externally peer reviewed, contains some good points regarding the lack of evidence that there are health benefits to be had from drinking increased amounts of water, or that people are not drinking enough water and should aim to drink more.

However, McCartney’s argument that government advice is ‘thoroughly debunked nonsense’ is flawed. The two studies on which she bases her argument looked at volumes of water much greater than the current UK advice. Both are American studies that refer to research into the ‘8x8’ rule, which promotes drinking at least eight 8-oz glasses of water a day (1.9 litres). This is much more than  the ‘about 6-8 glasses’ (1.2 litres) of fluid a day advocated by the UK government.

Keeping hydrated is important. It is recommended that 6-8 glasses of water or other fluid are consumed everyday to replace normal water loss, rather than to obtain any broader health benefits.

 

Does this article 'debunk' the advice to drink about six to eight glasses?

No. The two studies on which Dr McCartney bases her argument looked at drinking volumes of water greater than the current UK advice.

Dr McCartney cites a 2002 study by Heinz Valtin to support her argument. In that study, Valtin questionned the US advice that people should aim to drink “at least eight 8-oz glasses of water a day”. Importantly, Valtin specifically examines the evidence behind the 8x8 advice, and not whether 6-8 glasses a day is required. In fact, Valtin states “there is a huge difference between “somewhere around 6 to 8 glasses” and “at least eight glasses””.

The second study that McCartney cites is an editorial which says that the “classic recommendation is known as "8 x 8": eight glasses of 8 oz of liquid per day—not including caffeinated and alcoholic beverages”.

Both are American studies which refer to research into the ‘8x8’ rule, in that US citizens should aim to drink at least eight 8-oz glasses of water a day (1.9 litres). This is more water than the 6-8 glasses (1.2 litres) a day advocated in the UK.

 

How much water does NHS Choices advise people to drink?

NHS Choices’ page on Water and drinks says:
Your body needs water or other fluids to work properly and to avoid dehydration. That’s why it's important to drink enough fluids. In climates such as the UK's, we should drink about 1.2 litres (six to eight glasses) of fluid every day to stop us getting dehydrated.  In hotter climates, the body needs more than this. We also get some fluid from the food we eat.

Our Health A-Z article on dehydration has more detailed advice for specific groups.

Links to the headlines

Advice to drink eight glasses of water daily 'nonsense'. The Daily Telegraph, July 13 2011

Drinking too much water 'can be bad for your health': Benefits are a myth. Daily Mail, July 13 2011

Advice to drink more water dismissed as harmful nonsense. The Independent, July 13 2011

Not a drop of proof lots of water is good for you. Daily Express, July 13 2011 

Links to the science

Waterlogged? BMJ 2011; 343:d4280

 

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Comments are personal views. Any information they give has not been checked and may not be accurate.

June H said on 19 July 2011

I have never drank the quota, I drink a glass of warm water (which like my grandma and mum did when they were alive my grandma was 84 when she died and mum was 60 and they never drank 8 glasses a day, as it wasn't known then and they had a lovely complexion I have about 8 cups of other fluid through the day and I have never had any ill effects. I have no plan now or in the future to change the habit of a life time.

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Neil Wilson said on 14 July 2011

The British Medical Journal also dismisses the advice.

"The complete lack of evidence supporting the recommendation to drink six to eight glasses of water a day is exhaustively catalogued in an invited review by Heinz Valtin in the American Journal of Physiology. Furthermore, existing studies suggest that adequate fluid intake is usually met through typical daily consumption of juice, milk, and even caffeinated drinks. In contrast, drinking excess amounts of water can be dangerous, resulting in water intoxication, hyponatraemia, and even death."

http://www.bmj.com/content/335/7633/1288.full

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User317045 said on 14 July 2011

RE: de2 - "I think you are being too protective of the NHS choices web site here"

It is always a problem for Behind the Headlines when science meets NHS advice, as often the NHS advice does not stack up.

So rather than provide the usual objective assessment of the research in question and risk contradicting the sponsors (i.e. the NHS), we are left with an ambiguous or disingenuous article which skirts around the issue - so the claim that we do not "all need to drink more water" is not directly addressed.

And this is a shame because it undermines Behind The Headlines credibility as a trusted source of analysis.

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de2 said on 14 July 2011

I think you are being too protective of the NHS choices web site here. Dr McCartney may have overstated her case but it remains true that there is no reason to suggest that healthy people need to monitor their fluid intake. Physiological mechanisms will cause people to feel thirsty if they need to drink more.

The only exception is in certain classes of unhealthy people, such as elderly people with dementia or those with acute gastroenteritis.

To suggest that the general population needs to measure their fluid intake and aim for a target is as sensible as suggesting they should monitor their breathing and aim for a certain number of breaths per day.

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Analysis by Bazian

Edited by NHS Choices