Water is life, but drinking too much of it can prove fatal
A recent study proposes that actor Bruce Lee, who died in 1973 at the age of 32, suffered from an acute case of water intoxication. This caused his brain to swell and ultimately led to his death. By
The popular belief that eight glasses of water is the right amount to adequately hydrate the average person is a myth, according to Professor Razeen Davids, head of the division of nephrology at Stellenbosch University and Tygerberg Hospital.
“There is no evidence that supports this for healthy people. You should be guided by thirst,” says Davids.
Even though, according to experts, six to eight glasses a day seems to be the recommended amount of fluid the body needs to function, this does not necessarily include only drinking water from a tap. The body extracts water from everything it consumes, whether it’s food or drinks.
There are conditions for which high water intake may be beneficial, says Davids. For example, patients who are prone to developing kidney stones are encouraged to increase their water intake to achieve a urine output of at least two litres a day.
Hyponatraemia: what is it?
Under specific circumstances, drinking too much water may be fatal, as suggested by a study titled “Who Killed Bruce Lee? The Hyponatraemia Hypothesis”, published in the Clinical Kidney Journal in March 2022.
“Bruce Lee brought attention to martial arts in the Western world and popularised the quote ‘Be water, my friend,’” the authors of the study write. “Lee died at the age of 32 years in Hong Kong on 20 July 1973, under mysterious circumstances.
“The cause of death is unknown, although numerous hypotheses have been proposed, from assassination by gangsters to the more recent suggestion in 2018 that he died from heatstroke.
“The necropsy showed cerebral oedema. A prior episode was diagnosed as cerebral oedema two months earlier.
“We now propose, based on an analysis of publicly available information, that the cause of death was cerebral oedema due to hyponatraemia.
“In other words, we propose that the kidney’s inability to excrete excess water killed Bruce Lee.”
In summary, the authors argue that he suffered from an acute case of hyponatraemia, or water intoxication, which led to a fatal case of brain swelling.
Davids explains that acute hyponatraemia develops within 48 hours and is a result of drinking too much water in the presence of something that inhibits the kidneys’ function of excretion.
“Normally, the kidney would just excrete all the water and there would be no problem,” says Davids. “However, various factors, including pain, nausea and many medications, can stimulate the release of antidiuretic hormone, which causes the kidney to inappropriately hold on to water instead of excreting the water load.”
The study finds that Lee was predisposed to water intoxication on the day of his death owing to a number of risk factors. Not only did he have a high fluid intake, but traces of marijuana were found during his autopsy, which allegedly increases thirst and water consumption.
Furthermore, the presence of prescription drugs (diuretics, non-steroidal anti-inflammatory drugs, opioids and anti-epileptic drugs) in his system possibly increased the secretion of antidiuretic hormone, or they impaired his bodily response to the hormone. Subsequently, the increased levels of antidiuretic hormone or lack of response would have inhibited his kidneys from excreting excess fluids. The presence of alcohol, low intake of solid foods and exercise on the day Lee died also increased his vulnerability to acute hyponatraemia.
From water intoxication to brain swelling
Hyponatraemia is further characterised by low sodium concentration in blood plasma or blood serum, according to Davids. The “diluted-down” sodium levels cause water to start “moving into cells”, he adds.
“When the [sodium] level falls, water moves into cells by osmosis and cells are therefore swollen. This is of greatest concern in the brain as the brain is housed within the rigid skull and therefore brain swelling – cerebral oedema – may cause high intracranial pressure, which can be fatal,” Davids explains.
What does this look like? A severe case of acute cerebral oedema resulted in Lee’s brain at his death weighing 1,575g compared with the normal 1,400g.
“One would usually expect serious complications only with severe hyponatraemia,” Davids says. “If hyponatraemia develops slowly over days, brain cells are able to adapt and will not be swollen, even with really low levels of blood sodium.”
The gradual development of less lethal hyponatraemia is known as chronic hyponatraemia, he adds, explaining that acute hyponatraemia is more common among long-distance runners who drink excessively during a race.
Symptoms of severe water intoxication
Symptoms typically include brain dysfunction, such as sluggishness and confusion, and muscle twitching and seizures in severe cases of water intoxication. In extreme cases, unresponsiveness and, eventually, a coma occur prior to possible death.
Lee’s symptoms soon before his death are described as feeling “faint, having a headache, vomiting and impaired moveability”. After lying down to rest, he was found unconscious about two hours later and pronounced dead.
Even though the body comprises 60% water, drinking large amounts at a faster rate than the kidneys can excrete the excess may have lethal consequences.
“Severe hyponatraemia is an emergency. To treat it, doctors slowly increase the level of sodium in the blood with intravenous fluids and sometimes with a diuretic,” writes Dr James L Lewis III in the online MSD Manual Consumer Version.
“Increasing the sodium level too rapidly can result in severe and often permanent brain damage.”
Not too much, not too little
Excess water intake can pose serious threats to health, and a deficiency of water in the body – or dehydration – can also be lethal in severe cases.
Dehydration can be caused by vomiting, diarrhoea, excessive sweating, burns, kidney dysfunction and the use of diuretics, according to Lewis.
Although there is no evidence to suggest a specific amount of fluid intake for everyone, it becomes generally important to increase water intake during warmer temperatures, especially while spending long hours in the sun or working and exercising on hotter days,
he adds.
Benefits of staying hydrated
Water plays a significant role in maintaining the balance between body fluids, which is necessary for optimal digestion, absorption, blood circulation and body temperature. Balanced body fluids can also help to reduce toxins, alleviate pain – from menstrual cramps to headaches – and can improve metabolic rates. Dr Opeyemi Adeyemi recommends drinking hot water upon waking in the morning to improve digestion and reduce constipation. Eating more water-concentrated foods such as fruits and vegetables – especially tomatoes and cucumber – can also help to boost hydration. It is also recommended that one carries around a bottle of water and chooses water over sugary beverages.
And, as Davids notes, “be guided by thirst” and listen to your body carefully.
Even though the body comprises 60% water, drinking large amounts at a faster rate than the kidneys can excrete the excess may have lethal
consequences