4.

1: Vitamins: Vital Dietary Components

Vitamins (vita- means life and -amine means nitrogen containing) are organic compounds
that the body needs in small amounts. Obtained through the diet, vitamins help regulate and
support a variety of processes related to digestion, absorption, metabolism, and body
regulations. As such, vitamins are a vital key to good health. Without vitamins, the body
would not be capable of sustaining the functions necessary for daily activities. Unlike
carbohydrates, proteins, and fats, vitamins yield no energy, but they are very important in the
growth and maintenance of our bodies. There are 13 vitamins that we know to be essential.
Essential vitamins are found in both plant and animal sources, and the majority cannot be
synthesized by the human body. Thus, they must be consumed in the diet. Exceptions to this
include vitamin K and biotin, which are produced by gut flora (bacteria) in the intestine, and
vitamin D, which is synthesized in the skin through sunlight. Two vitamins can be produced
through precursors: Vitamin A can be produced after we consume food containing beta
carotene, and niacin can be produced when we consume foods containing the amino acid
tryptophan.

In order to be considered a vitamin, an organic compound must meet two criteria: First, due
to the inability of our bodies to manufacture the compound, enough of the compound must be
consumed in the diet to maintain health. Second, symptoms of deficiency occur in the
absence of the compound, resulting in declining health. However, health is often restored
when the deficiency is corrected.

It is important to note, during the manufacturing of food, some nutrients are lost. To counter
this, some foods have been enriched or fortified to ensure that Americans consume all the
nutrients they require through their daily intake. Enrichment is the process of taking
nutrients that were lost in the milling or processing of the food and adding them back to the
final product. For example, all grain products are enriched due to the loss that occurs in the
milling process. Fortification is the process of supplementing a product with additional
vitamins that would not normally be in that product. An example is adding calcium and
vitamin D to orange juice or vitamins to cereal.

Vitamins can be classified as either fat soluble or water soluble, a point that will be expanded
below.

Fat-Soluble Vitamins
Fat-soluble vitamins are dependent on dietary fat for absorption. Once absorbed, fat soluble
vitamins are stored within the liver and adipose (fat) tissue. The fat-soluble vitamins are A,
D, E, and K. As they are not easily excreted after storage, excess consumption over time
could lead to toxic levels in the body. The vitamins that have the highest likelihood of
becoming toxic are vitamin A (animal-derived sources only) and vitamin D. On the other
hand, certain diseases, weight loss medications, and laxatives can interfere with fat
absorption and lead to a deficiency of fat-soluble vitamins. The various fat-soluble vitamins
are outlined below.

Vitamin A can be found in two forms: (1) preformed vitamin A (retinol or retinal), which
comes from animal sources, and (2) provitamin A carotenoids, which come from plants and
are considered precursors—pigments found in plant sources that can be later be converted
into vitamin A. Carotenoids, which includes beta-carotene, are found in yellow, orange, and
red vegetables, and many are antioxidants. Antioxidants stop the reactive substances
(oxidants) from potentially causing damage to cells. 

Vitamin A has several functions, but the most widely recognized is its impact on vision.
Retinal, a form of vitamin A, helps the eye adjust from bright to dim light. Without adequate
intake, the eye loses the ability to adjust to light, a condition called night blindness, and it is
an early indicator of a vitamin A deficiency. If the deficiency progresses, the eye loses the
ability to make mucus and keep the eye moist. The abnormal dryness due to vitamin A
deficiency is called xeropthalmia. Left untreated, the result is blindness. Studies suggest the
consumption of fruits and vegetables high in carotenoids may also aid in the treatment of
macular degeneration, the leading cause of vision loss.

In addition to vision, vitamin A is also important for external skin health as well as the health
of the epithelial cells that line the GI tract. These layers of cells act as barriers to bacteria and
provide immunity from infection. Vitamin A is also needed for growth, development, and
reproduction. Lack of vitamin A leads to stunted growth in children and an inability to
reproduce in adults. Disease prevention is another function of vitamin A. Both cancer and
cardiovascular disease may be prevented with a good intake of vitamin A, especially the
carotenoids. However, the method of consumption should be carefully considered. Much of
the scientific community agrees that obtaining a healthy source of vitamin A from foods
provides more benefits than from supplements. Excellent sources of preformed vitamin A
include liver, fish, fish oils, fortified milk, yogurt, and eggs. The provitamin A carotenoids
are found in dark green leafy vegetables, such as spinach and kale, as well as yellow and
orange fruits and vegetables, such as sweet potatoes, cantaloupe, and apricots). The upper
level for vitamin A is 3000 micrograms of preformed vitamin A per day for adults. Levels
above this could lead to toxicity resulting in increased hip fracture, liver toxicity, and fetal
malformations in pregnant women. Notably, high intake of provitamin A carotenoids do not
cause toxic effects. However, one side effect could be yellowing of the palms of the hands or
soles of the feet if a large amount of orange and yellow vegetables is consumed. This will
resolve when carotenoid levels decline.

Vitamin D is not only a vitamin but also a hormone. Vitamin D occurs in two forms,
ergocalciferol (D2), which is a synthetic product used in supplements, and cholecalciferol
(D3), the form made by the human body. Skin cells contain a cholesterol-like substance that
is converted to 7-dehydrocholesterol by the sun. The liver then converts this to 25-
hydroxyvitamin D3, and the kidney finishes converting the inactive form to active vitamin D,
1, 25-dihydroxyvitamin D3. Ten minutes of sun two to three times per week provides 80-
100% of our vitamin D needs. However, people living in northern climates often have limited
exposure to the sun in the winter months or the sun’s rays are too weak to be beneficial.
Dietary intake thus becomes important. Good sources of vitamin D include fatty fish,
fortified cereal, eggs, butter, fortified milk, and yogurt.

The primary function of vitamin D is the regulation of calcium levels and bone metabolism.
In conjunction with parathyroid hormone (PTH), vitamin D regulates absorption of calcium
and phosphorus from the intestine and deposition of calcium in the bones. Vitamin D also is
important for the immune system, skin development, muscle health, and blood pressure
control. A deficiency of vitamin D results in bone problems in both children and adults. In
children, poor mineralization of the bone due to inadequate calcium deposits results in
rickets, a disease often characterized by bow legs (Figure 4.1).

Figure 4.1 Rickets and vitamin D deficiency. Low levels of vitamin D may cause curvature of the femur
(rickets; right image).

In adults, inadequate calcium absorption and deposition in the bones leads to osteomalacia,
which means soft bones. The result is weak bones that break easily, and it is comparable to
rickets in children. As we age, our bones continue to lose calcium and the production of
vitamin D decreases. Osteoporosis occurs as bone mass decreases and bones thin and
become porous (Figure 4.2).
Figure 4.2 Bone densities. As levels of vitamin D and calcium decrease, once dense bones (left) can become
thin and porous (right).

Research suggests low levels of vitamin D have been linked to increased risk of infections,
cancers, autoimmune disease, and cardiovascular disease. Experts recommend that adults
take 1000 IUs of vitamin D daily. Toxicity from vitamin D is usually related to over
supplementation. Symptoms include excess loss of calcium in the urine, weakness, loss of
appetite, confusion, and calcium deposits in the kidney and other organs.

Vitamin E's main function is as an antioxidant, protecting cell membranes from free radicals.
Free radicals can alter a cell’s DNA, damage cell membranes, and increase the risk for
cancer. For this reason, vitamin E is the most widely used supplement. It has been touted as a
love potion, anti-aging potion, and marketed for heart health. Officially known by the
chemical name tocopherol, vitamin E can be classified by the main forms in the body (alpha-
tocopherol) or in plants (gamma-tocopherol). Major sources include; oils, cereals, eggs,
margarines, whole grains, and nuts. While deficiencies are rare, it can lead to cellular
breakdown and hemolysis (breakdown of red blood cells). Pre-term infants, smokers, and
those who suffer from fat malabsorption are at risk for a deficiency. The upper level of alpha-
tocopherol is 1000 mg per day of the supplemental form. Importantly, vitamin E levels above
1000 mg/day could result in toxicity. Toxic levels interfere with vitamin K’s role in clotting
and can lead to hemorrhagic responses.

Vitamin K is primarily involved in the process of coagulation (blood clotting). Vitamin K is

consumed in our diets through oils, plants, fish and meats. The body can also synthesize
small amounts of vitamin K in the intestinal tract, a process that requires intestinal bacteria.
As the intestinal tracts of infants have not established their gut flora, they do not have enough
bacteria for adequate vitamin K synthesis. For this reason and to support proper clotting,
infants are routinely injected with vitamin K shortly after birth. In other instances, a patient
taking the blood thinner Coumadin (often because their blood clots too easily) is often
recommended to limit their vitamin K intake. In addition to blood clotting, vitamin K is also
necessary for proper bone formation and to bind calcium to muscles and kidneys. In the diet,
sources of vitamin K include green leafy vegetables, green beans, soybean and canola oils,
and liver. A Daily Value of 80 micrograms is recommended for adults, and a deficiency is
rare. Those who would be susceptible to a deficiency include infants, older adults with poor
intake, and an individual who has been on antibiotics for an extended period as this often
results in a diminished gut flora. Unlike the other fat-soluble vitamins, vitamin K disappears
from the body within 24 hours, so toxicity is rare.

4.2: Water Soluble Vitamins

Water-soluble vitamins are absorbed into the blood stream and easily dissolve in water. The
water-soluble vitamins include the eight B-complex vitamins and vitamin C. For the majority
of these vitamins, there is limited storage in the body, so they must be consumed on a daily
basis. The likelihood of toxicity is minimal unless consumed in extremely large quantities,
usually through a supplement. Excessive cooking, improper handling, heat, light, and
exposure to air can all destroy vitamins, and this is especially true for those that are water
soluble. Fruits and vegetables should be consumed soon after harvest for the greatest
nutritional value. To best preserve nutrients, store canned goods in a cool place, refrigerate
foods in moisture-proof containers, and blanch vegetables prior to freezing.

As mentioned above, the water-soluble vitamins are comprised of B complex and vitamin C.
There eight B vitamins are thiamin, riboflavin, niacin, pantothenic acid, biotin, vitamin B-6,
folate, and vitamin B-12. Most B vitamins are found in similar foods, and one of their
functions is to act as coenzymes in the metabolism of carbohydrates, protein, and fats.
Coenzymes are small molecules that bind to inactive enzymes and, once bound, cause the
enzyme to become active. As such, if B vitamins (the coenzyme) are lacking, the enzyme
cannot function and deficiency symptoms occur. Typical North American diets are adequate
in B vitamins, and many grains are fortified with these vitamins. Following digestion of foods
containing B vitamins, 50-90% is absorbed in the small intestine. This means that they have a
high bioavailability. Bioavailability is the amount of a vitamin that is absorbed and available
to the body. The combination of high bioavailability and abundance in the diet means there is
little risk for a deficiency in a healthy individual. However, certain populations do have an
increased risk of deficiencies. For instance, alcoholics tend to exhibit decreased absorption
related to the abuse of alcohol, and elderly individuals who have a very poor diet.
Deficiencies are also more common in developing countries.
B Vitamins
Thiamin (vitamin B-1) is a coenzyme for the release of energy from carbohydrates. Thiamin
also works with enzymes to promote the metabolism of glucose—the major source of energy
for the brain and nervous system. In the case of a deficiency, glucose cannot be metabolized,
and symptoms appear, including weakness, loss of appetite, irritability, poor arm and leg
coordination, an enlarged heart, and severe edema. A thiamin deficiency is called
beriberi, which translates to “I can’t I can’t.” Good food sources include pork, legumes,
milk, orange juice, organ meats, and whole and enriched grains. As stated earlier, deficiencies
are rare, but in countries where polished (white) rice is the major staple, beriberi is much
more common. As thiamin is water soluble, toxicity is rare, even with supplementation.

Riboflavin (vitamin B-2) is a coenzyme used during energy metabolism that requires
oxygen. It is necessary for certain vitamin and mineral metabolism, and it is a known
antioxidant. Major sources of this vitamin include enriched grains, meat, eggs, and milk
products. Riboflavin is very sensitive to light, so milk containers are almost always opaque to
prevent degradation. A riboflavin deficiency is known as ariboflavinosis and is rare. Often a
riboflavin deficiency occurs in conjunction with other vitamin deficiencies. As shown in
Figure 4.3, symptoms include glossitis (inflammation of the tongue), cheilosis (cracks
around the mouth), sun sensitivity, and confusion. There is no known toxicity except when
taken in mega doses.

Figure 4.3 Riboflavin deficiency. Low to null levels of riboflavin are often associated with an inflammation of
the tongue (glossitis) and cracked skin around the mouth (cheilosis).

Niacin (vitamin B-3) functions as either nicotinic acid or nicotinamide. Almost all cells use
this coenzyme for the release of energy from carbohydrates, proteins, and fats. Our bodies
can also make niacin from tryptophan, an amino acid. Through this process, we synthesize
approximately 50% of our body needs. Meat, enriched breakfast cereals, poultry, fish, nuts,
and peanuts are good sources. A deficiency in niacin is known as pellagra, which means
"rough skin" (Figure 4.4). The associated symptoms are known as the 4 D’s: dementia,
diarrhea, dermatitis, and (eventually) death. In developed countries, a deficiency is rare,
except in alcoholics and those with a disorder of metabolism.

Figure 4.4 Niacin deficiency. A patient suffering from pellagra is shown. Notice the large patch of rough, dry
skin often associated with the deficiency.

Conversely, a hallmark of excess niacin intake is flushing, related to an increased blood flow
to the skin and headaches. In some cases, large doses of niacin can be useful in the treatment
of high blood cholesterol levels, but it must be used under the supervision of a medical
professional.

Pantothenic acid is a component of coenzyme A or CoA. It is important in fatty acid

production and the release of energy from the energy yielding nutrients. It is found in a wide
variety of foods, including, but not limited to, chicken, pork, fish, egg yolks, yogurt, legumes,
avocados, and sweet potatoes. Occurrences of a deficiency and toxicity are rare.

Biotin aids in the production of glucose and fatty acids, DNA synthesis, and amino acid
metabolism. Food sources include cauliflower, liver, peanuts, cheese, and egg yolks. The egg
white, however, contains a protein called avidin that prevents the absorption of biotin.
Cooking breaks down this protein and allows absorption to occur. Theoretically, a large
intake of raw egg whites could lead to a biotin deficiency. For the majority of the population
a deficiency is rare, as is the occurrence of biotin-associated toxicity.

Pyridoxine is the general name for the B-6 coenzyme, which exists in three chemical forms:
pyridoxine, pyridoxal, and pyridoxamine. While B-6 is needed for carbohydrate, protein, and
fat metabolism, it plays a key role in protein and amino acid (the building blocks of protein)
metabolism. B-6 enables cells to make nonessential amino acids by removing the nitrogen
group from certain amino acids. Additionally, B-6 is important for the synthesis of white
blood cells to support immune function, the synthesis of hemoglobin for red blood cells, and
for neurotransmitter synthesis. As neurotransmitters allow nerve cells to communicate with
each other, a lack of B-6 interferes with this communication and can lead to convulsions. A
deficiency can also decrease hemoglobin production, the oxygen carrying part of the red
blood cell, resulting in microcytic hypochromic anemia: small, oxygen-deficient red blood
cells. Medically B-6 supplements have been used during the first trimester of pregnancy to
treat nausea, but they should only be taken under direction of a physician. B-6 is found in
both animal and plant sources but has a higher bioavailability in animal sources. Megadoses
of B-6 from supplements can cause hand and foot numbness as well as irreversible nerve
damage. Weight lifters have been known to suffer from toxic effects related to overdose of B-
6 in the hopes of increasing their muscle mass.

Folate (folic acid) functions as a coenzyme in DNA synthesis and cell division as well as
metabolizing amino acids and homocysteine. Folate can be found in different forms in food
such as meats, fish, eggs, and milk. A deficiency of folate can lead to a form of anemia called
megaloblastic (macrocytic) anemia, which is characterized by abnormally large red blood
cells. As folate is needed for red blood cell synthesis, when a deficiency occurs, the red blood
cells can grow but the normal process of cell division cannot occur due to an impairment of
proper DNA synthesis (Figure 4.5). The enlarging yet never dividing cells (megaloblasts) fail
to mature, and their ability to carry oxygen through the blood stream declines, resulting in
anemia.

Figure 4.5. Folate deficiency. The inability of RBCs to properly undergo cell division often leads to the
formation of megaloblastic cells (purple cell; right).

In pregnant women, a deficiency of folate can result in neural tube defects. During the first 6
weeks of the pregnancy, the spinal cord and the nerves at the lower end of the brain are
developing. Lack of folate can lead to defects including anencephaly (lack of a brain) or
spina bifida, improper development of the spinal cord where it fails to close completely and
bulges through the back. The result could be paralysis, incontinence, learning disabilities, and
other health concerns. Studies have linked inadequate folate intake with the neural tube
defects. As such, women of child bearing age should take 400 mcg/day of folate.

Folic acid, the synthetic form of folate, is more readily absorbed than folate. In 1998,
fortification of grain products was made mandatory to reduce the risk of spinal defects. It is
added to ready-to-eat breakfast cereals and grains, and naturally occurs as folate in green
leafy vegetables, orange juice, and legumes. In addition to pregnant moms, older adults with
poor intakes and alcoholics are also at risk for deficiency. Symptoms of a deficiency manifest
as depression, mental confusion, poor growth, diarrhea, and altered nerve function. The upper
limit for folate is 1000 micrograms per day, as levels greater than this can result in toxicity
but only from the synthetic form. The major concern is that overconsumption of folate can
mask a vitamin B-12 deficiency.

Vitamin B-12 has a variety of functions. Its major function is to convert the folate coenzyme
to the active form needed for DNA synthesis. It is also important in homocysteine
metabolism and in maintaining the myelin sheaths that insulate neurons.
Unlike the other vitamins where inadequate intake leads to a deficiency, poor absorption
(rather than intake) causes a B-12 deficiency. The digestion of B-12 begins in the stomach
with its acidic environment. For absorption in the small intestine, B-12 binds to the
glycoprotein intrinsic factor. Intrinsic factor is a protein-like compound produced in the
stomach to increase B-12 absorption. However, the body becomes less efficient at absorbing
B-12 over time. Thus, the elderly can be at risk for a deficiency. In a small percentage of the
population, a defect alters the absorption of B-12. A monthly injection or a nasal spray of
vitamin B-12 corrects this deficiency and improves absorption. When a deficiency does
occur, two types of anemia may result: (1) megaloblastic (macrocytic) anemia. As
mentioned above, without adequate B-12, the conversion of folate coenzymes to the active
form to support proper DNA synthesis does not occur. (2) Pernicious anemia: Pernicious
means "leading to death" and is associated with nerve degeneration that can lead to paralysis
and death. The red blood cells resemble those seen in a folate deficiency but are caused by
poor absorption of vitamin B-12. Other symptoms include weakness, back pain, and tingling
in the fingers and toes. Nerve damage can occur slowly, and the deficiency may take several
years to diagnosis; the damage that results is often permanent. Good food sources of vitamin
B-12 are animal products such as meat, organ meats, eggs, and milk. It is also in fortified
breakfast cereals. As previously stated, the elderly can be at risk for a deficiency related to
decreased production of stomach acid and reduced production of intrinsic factor, thus
decreasing the absorption. Additionally, vegans and infants of breastfeeding vegan women
are also susceptible to a deficiency. Vegans who eat no animal products need to eat foods
supplemented with vitamin B-12 as well as take supplements.

Vitamin C (ascorbic acid) is absorbed in the small intestine and is found in all living tissue.
Vitamin C has four major functions: collagen synthesis, antioxidant properties, iron
absorption, and immune function.

Collagen synthesis: Collagen is the main structural protein found in connective tissue, skin,
bones, teeth, tendons, and blood vessels. It is also necessary for wound healing. A deficiency
can decrease collagen synthesis resulting in scurvy. Symptoms include bleeding gums,
weakness, pinpoint hemorrhages, and poor wound healing. In 1747, Dr. James Lind
demonstrated that consumption of citrus fruits by sailors on sea voyages could prevent scurvy
from developing. It is widely held to be the first recorded and controlled clinical trial in
medicine.

Antioxidant activity: Vitamin C acts as a scavenger of free radicals and studies suggest it
may be effective in preventing certain cancers.

Iron absorption is improved when a food source high in iron is eaten with a good source of
vitamin C.

Immunity: Despite popular belief, large quantities of vitamin C does not prevent colds;
however, it may reduce the symptoms. Good sources include citrus fruits, strawberries,
potatoes, broccoli, ready-to-eat cereals, and fortified drinks. In North America, deficiencies
are rare in healthy individuals who consume a variety of fruits and vegetables. However, high
intakes of vitamin C in the form of supplements can actually decrease absorption and may
cause diarrhea.

4.3: Water: An Essential Nutrient

Having discussed the energy yielding nutrients and vitamins, we will now examine the most
important nutrient, water. While we can survive without food for approximately 8 weeks,
humans can only survive a few days without water. Water makes up 50-70% of the human
body, with the total fluid volume in the body being approximately ten gallons. Lean tissue
has high water content, while fat tissue contains 20% water. The higher the percentage of
lean body tissue (muscle mass), the higher the total body water content.

Water is important for many chemical and metabolic reactions to occur and also functions as
a solvent. A solvent is capable of dissolving other substances. The substance that is dissolved
is called a solute. Water can be found inside cell membranes as part of
the intracellular (inside the cell) fluid and is also part of the blood in
the extracellular (outside of the cell) fluid. Ions are minerals that have an electrical charge
and are called electrolytes. Water-soluble ions include: sodium, potassium, chloride,
phosphate, magnesium, and calcium. The concentration of ions inside and outside of cells
dictates where water moves: If blood volume decreases, the water will shift from inside the
cells to the bloodstream to raise the blood volume. The opposite occurs when blood volume is
too high, and the water shifts into the cells from the blood stream. The process of
water moving through a semi permeable membrane from a less concentrated solute area to a
more concentrated solute area is called osmosis. Intracellular water volume relies on
potassium and phosphate concentrations while extracellular volume depends on sodium and
chloride concentrations. In addition to controlling blood volume, water is important for
regulating body temperature, the removal of waste products, lubricating parts, and making
saliva, bile, and amniotic fluid.

Perspiration (sweating) is the body’s mechanism to prevent overheating. When we sweat,

fluid is released through skin pores and evaporates. This process requires energy, which in
turn expends heat from the body and prevents the body temperature from rising. As we
perform physical activity, particularly in hot or humid weather, our body temperature will
rise. The evaporation of sweat regulates and cools our body temperature. Without adequate
fluid intake, our temperature rises and there is a risk of developing heat cramps, heat stroke or
heat exhaustion.

As previously stated, water acts as a solvent, allowing most substances to be dissolved in the
body. Once dissolved, substances can be either transported to cells or removed from the body
as waste. For instance, kidneys normally filter and excrete four cups of urine per day. The
amount of urine produced is influenced by our intake of protein and sodium—when protein is
consumed, nitrogen is metabolized from the amino acids and must be then excreted in the
urine as urea. Conversely, as sodium and protein (replace with fluid) intake increases, so does
urine output. If one is consuming excess salt, the sodium levels in the blood rise above
normal. To maintain homeostasis, the kidneys filter out the sodium and excrete it into the
urine. Where sodium goes, water follows. This results in increased urine production. If
someone were to consume a high amount of salt, but didn’t increase their fluid intake
dehydration would occur. However, salty foods make us thirsty and it is normal to increase
our fluid intake when eating salty foods.

When fluids, protein, and sodium are all restricted, urine output declines. If the amount of
urine excreted falls below two cups per day, the urine becomes very concentrated, and the
risk of kidney stones increases. You can check if you're consuming enough fluids by
examining the color of your urine. Urine should be clear or pale yellow, whereas a dark
yellow color indicates inadequate fluid intake. To maintain body fluids in sufficient amounts,
water balance must be properly maintained. The amount lost through perspiration,
respiration, urine, and feces should be balanced with an adequate intake. Fluids can come
from both food and water (or other beverages). The general recommendation for total fluid
intake for women is 11 cups daily while men should consume 15 cups. Importantly, the
majority of this intake, nine cups for women and 13 cups for men, should come from fluids
alone.

Thirst is feeling, sense, or need to drink generated by the body to ensure adequate fluid
intake. However, a thirst mechanism is not always reliable as it is possible to become
dehydrated prior to recognizing the need to increase your fluid intake. This is especially true
for athletes, someone ill with a fever, infants, children, and the elderly.

Two hormones are responsible for conserving fluids and preventing dehydration when
adequate fluids are not consumed: (1) antidiuretic hormone (ADH) is released by the
pituitary gland and signals the kidney to conserve water. At the same time, as fluid levels fall
in the blood stream, (2) aldosterone is released from the adrenal glands signaling the kidneys
to retain sodium, which leads to further water retention. If a person continues to ignore
symptoms of thirst over time, endurance declines, fatigue sets in, muscles cramp, and the
result could be coma or death. Although water is the best option, most beverages can be used
to replenish water stores including: non-caloric beverages, low fat and skim milk, coffee, and
tea. Alcohol, however, inhibits the action of the antidiuretic hormone and can lead to
dehydration.

While inadequate fluid consumption is common, ill effects can also result from excess water
consumption. An excessively large water intake will dilute the blood electrolytes and
overwhelm the kidneys' ability to secrete fluids. In extreme cases, water toxicity has led to
death.

The U.S. water supply is one of the safest in the world. The Environmental Protection
Agency (EPA) sets standards for our water sources, and under the Safe Water Drinking Act,
all public water supplies are monitored for contaminants. If contaminants are found, the local
water department is responsible to notify the public about the concern and advise them on
steps to take to ensure safe drinking water. However, many people assume that bottled water
is a safer choice, but in many cases, the water is much the same as what comes out of your
tap. The FDA regulates bottled water, and the standards are very similar to those that are used
for tap water, but drinking tap water can often save consumers a lot of money.