Nov 21 2011

Does Drinking Water Prevent Dehydration?

Umm….Yes. Yes it does.

This is one of those stories that immediately makes me think that there must be a deeper issue that the press is missing. Recently the European Food Safety Authority was asked to evaluate and approve the following statement:

“Regular consumption of significant amounts of water can reduce the risk of development of dehydration and of concomitant decrease of performance.”

After three years of investigation the EFSA concluded:

The Panel considers that the proposed claim does not comply with the requirements for a disease risk reduction claim pursuant to Article 14 of Regulation (EC) No 1924/2006

This decision has been immediately and widely criticized as absurd – the EFSA is saying that water does not prevent dehydration. It’s surreal. It’s right out of Brazil (the movie), a dark comedic dystopian totalitarian nightmare. Or perhaps it’s just abject stupidity.

I have a hard time accepting that interpretation at face value. I’m not any kind of legal expert, but it is my understanding from my involvement with legal cases that they can be decided on two grounds – the merits of the case, and the technical legal aspects of the case. For example, a court can find a defendant not guilty because the facts imply that they are actually not guilty of the crime committed, or because of some legal technicality.

Scientists sometimes face these considerations when pseudoscience is confronted in the courtroom. For example with the Dover intelligent design trial – that evolution is correct science and ID pure pseudoscience is a slam dunk. But defenders of science were concerned that the Kitzmiller vs Dover case may have been decided on some technical legal grounds (about interpretation of the law, for example) rather than the scientific merits.

So my first reaction to the EFSA ruling is that it must be the result of some technicality – the people filing the request used the magenta form instead of the goldenrod, or there was some problem with the wording. I can see numerous problems with the proposed wording – it does not identify a target population, it does not define what “significant” amounts of water are, and the bit about performance seems deliberately vague, as if they will try to use approval of this wording in order to slip in some dubious claim about athletic performance from drinking a particular brand of bottled water.

Or perhaps it is something even more legally obscure, such as the lack of standing or applicability of the law. There must be something.

I tracked down the actual decision, here is the abstract:

Following an application from Prof. Dr. Moritz Hagenmeyer and Prof. Dr. Andreas Hahn, submitted pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of Germany, the Panel on Dietetic Products, Nutrition and Allergies was asked to deliver an opinion on the scientific substantiation of a health claim related to water and reduced risk of development of dehydration and of concomitant decrease of performance. The scope of the application was proposed to fall under a health claim referring to disease risk reduction. The food, water, which is the subject of the health claim, is sufficiently characterised. The claimed effect is “regular consumption of significant amounts of water can reduce the risk of development of dehydration and of concomitant decrease of performance”. The target population is assumed to be the general population. The Regulation (EC) No 1924/2006 defines reduction of disease risk claims as claims which state that the consumption of a food “significantly reduces a risk factor in the development of a human disease”. Thus, for reduction of disease risk claims, the beneficial physiological effect results from the reduction of a risk factor for the development of a human disease. The Panel notes that dehydration was identified as the disease by the applicant. Dehydration is a condition of body water depletion. The Panel notes that the proposed risk factors, “water loss in tissues” or “reduced water content in tissues”, are measures of water depletion and thus are measures of the disease. The Panel considers that the proposed claim does not comply with the requirements for a disease risk reduction claim pursuant to Article 14 of Regulation (EC) No 1924/2006

That didn’t help. They did not identify the reason that the proposed claim does not comply with regulations. That’s what I want to know – what is the reason. I read through the entire decision, and they never go into more detail. The paper simply restates information present in the abstract in different formatting and separated out into different sections, but there is no additional information. No reason is ever given.

A Telegraph article does give the only justification for the decision I can find:

Prof Brian Ratcliffe, spokesman for the Nutrition Society, said dehydration was usually caused by a clinical condition and that one could remain adequately hydrated without drinking water. He said: “The EU is saying that this does not reduce the risk of dehydration and that is correct. “This claim is trying to imply that there is something special about bottled water which is not a reasonable claim.”

If this is the reason then it is not some legal technical ruling. They actually think the claim is misleading.  Assuming Professor Ratcliffe’s justification accurately describes the EFSA’s thinking, the decision is absurd, or at least misleading. Dehydration is not usually caused by a clinical condition. It’s usually (in the assumed general population) caused by not drinking enough fluids, most often due to physical activity or hot and/or dry environments. I have become dehydrated many times in my life, always as a consequence of one of the above situations (and one time because I was at high altitude). In every situation drinking water would have done the trick (and eventually treated the dehydration).

It seems what they are saying is that dehydration, when it is a “disease”, is cause by a clinical condition, and drinking water may not work. For example, if someone has terrible diarrhea and is losing significant amounts of water, drinking water will not do the trick. People can die of dysentery even when they drink a lot of water, because they are secreting water through their bowels. You need intravenous hydration to treat severe dysentery, and you need to treat the underlying condition (or at least give IV hydration until it runs its course).

So maybe – maybe – the EFSA decision is the result of the fact that they did not want to allow a blanket statement that could be applied to conditions where the claim is not true, like dysentery. I don’t know, because they did not explain their decision at all in the actual document. They therefore opened themselves up to legitimate ridicule.

My fear is that this sensational event will create a public backlash against regulatory agencies reviewing health claims by product manufacturers. This is a dramatic and emotional case that can have undue influence on what should be a thoughtful and nuanced discussion about the proper role of regulation in health claims. I suspect the anti-regulation crowd will jump all over it.

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24 responses so far

24 Responses to “Does Drinking Water Prevent Dehydration?”

  1. Rikki-Tikki-Tavion 21 Nov 2011 at 8:34 am

    Thankfully, the anti-regulation crowd is a lot less vocal in Europe than it is in America.

    Also, as most of Europe is on a higher latitude than America, I suppose loss of water due to heat is not as common here as it is there.

  2. Bronze Dogon 21 Nov 2011 at 8:38 am

    Heh. I’m not sure what the precise connection is, but this sprang into my mind:

    GLaDOS: “You know, you’re not really breathing air right now. We just take the carbon dioxide, freshen it up a little, and pump it back in.”

  3. jugaon 21 Nov 2011 at 9:28 am

    It is daft to claim that water prevents dehydration. “Dehydration” means lack of water so drinking water obviously prevents it. The claim is misleading because it implies that water on its own is somehow better than tea or cola or or watermelons. You could slap a “prevents dehydration” on any food product that contains water, which is most products and produce. It doesn’t mean any more to say water prevents dehydration than to say it prevents thirst. It does, though, sound a more serious claim because it implies prevention of a medical condition.

  4. Dagdaon 21 Nov 2011 at 9:36 am

    It does seem to be a technicality:
    http://www.efsa.europa.eu/de/supporting/doc/172e.pdf

    Response to comments on the Scientific Opinion of the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) on the scientific substantiation of health claims related to water and reduced risk of development of dehydration and of concomitant decrease of performance pursuant to Article 14 of Regulation (EC) No 1924/20061:

    “For reduction of disease risk claims, the beneficial physiological effect (which the Regulation requires to be shown for the claim to be permitted) is the reduction (or beneficial alteration) of a risk factor for the development of a human disease (not reduction of the risk of disease). However, undersupply with water would not be considered as a risk factor for dehydration (the disease) in this context as the beneficial alteration of the factor (increased consumption of water) is not a beneficial physiological effect as required by the Regulation. “

  5. Acleronon 21 Nov 2011 at 10:06 am

    Drinking water may in fact be dangerous when dehydrated. You may just wash out more salts.

  6. daedalus2uon 21 Nov 2011 at 10:21 am

    Water will only prevent dehydration at a certain dose. Water can prevent dehydration, but one spoonful of water a day won’t prevent dehydration unless the patient (victim) gets sufficient H2O from other sources. My guess is that the goal of the proposed claim is purely marketing (which is what claims are for) and that the claim would be used to falsely imply that a particular brand of bottled water has magical dehydration properties which are superior to the freely available water from the tap and from drinking fountains.

    If this claim was allowed, then homeopaths could sell their magic water as cures for dehydration.

  7. Willibrordon 21 Nov 2011 at 10:25 am

    Martin Robbins over at the Guardian makes a rather sensible argument in support of the ruling:
    http://www.guardian.co.uk/science/the-lay-scientist/2011/nov/18/1

  8. Artur Krolon 21 Nov 2011 at 10:36 am

    I believe the point of the ruling might have been to prevent a “drink our special bottled water instead of your bad tap water” marketing claim.

  9. jaranathon 21 Nov 2011 at 11:03 am

    I think Daedalus2u nails it. I think this is about marketing, and the panel rejected it because they knew, or strongly suspected, it would be used in a highly misleading way. I would bet the applicants aren’t just looking to slap the claim on ordinary bottled water; this would probably have been used with some kind of magic water (it’s clustered!) and may have been used in the vaguest possible fashion to defend general claims that it “prevents disease” and “enhances performance”. That latter is a dead giveaway there’s something fishy here, since you can apply it to anything you do; any physical activity, be it competing or driving or sleeping or thinking, will probably be affected in some way by dehydration. That gives them enormous latitude to say whatever they like and proclaim official government approval.

    Of course, if Steve’s analysis is correct, that means the EFSA stretched the rules into a pretzel to block some woo. That wouldn’t help with the anti-regulation backlash, which I’ve already seen a little of.

  10. jaranathon 21 Nov 2011 at 11:15 am

    Huh. Maybe they’re not selling something after all. Willibrord’s link claims this was some sort of test case run by a couple guys with chips on their shoulders, and the British soft drink industry says they’ve been running a bunch of variations of this claim by the EFSA to find inoffensive wording.

  11. ConspicuousCarlon 21 Nov 2011 at 11:27 am

    Steven Novella said:
    A Telegraph article does give the only justification for the decision I can find:

    ‘Prof Brian Ratcliffe, spokesman for the Nutrition Society,’

    Was that person a member of the committee or something? If so, then I can see why his explanation would reveal the EFSA motives. But…

    That didn’t help. They did not identify the reason that the proposed claim does not comply with regulations.

    It seems pretty clear to me. As they stated in the text you quoted:

    1. Applicant claims product can reduce the “risk” of a condition.

    2. “Regulation (EC) No 1924/2006 defines reduction of disease risk claims as claims which state that the consumption of a food “significantly reduces a risk factor in the development of a human disease”.”

    3. Applicant could not identify a risk factor which is reduced (when asked, they listed what the EFSA considers a measure of the disease itself, not a risk factor).

    They did not include the word “therefore” in their conclusion, but it seems pretty obvious what their logic is.

    I’ll leave it to you to say whether dehydration is a “disease”, whether dehydration is the level of water in tissue or it is the result of low levels, whether dehydration is usually caused by failure to “regularly” drink water (vs. failure to increase water consumption in specific situations), and whether or not any other medical assumptions made are crazy.

    But I don’t see why their reasoning is a mystery. They identified a word in the statement, they identified a law which they say imposes a specific requirement on its use, and they explained why the applicants did not meet that requirement.

    If the EFSA is suspected of making the “risk factor” argument only to avoid revealing their real motivation, then the applicants can re-submit without the word “risk” and see what happens. It sounds like “reduce the risk of ___” rather than “reduce ___ itself” is a weaker and more cautious form of the statement, but the EFSA is saying that the word “risk” has a specific legal meaning.

  12. _rand15_on 21 Nov 2011 at 12:27 pm

    Actually, I think it’s pretty clear. The problem isn’t whether water prevents dehydration, it’s that dehydration doesn’t count as a *disease*. So it’s not a subject that the panel can be rendering judgement on.

    Too bad they couldn’t just say that!

  13. Steven Novellaon 21 Nov 2011 at 12:53 pm

    Carl – you may be right. When I read that it did not seem clear to me that this was the specific reason for the rejection.

    If we assume that the reason for the rejection is that the applicants did not identify a risk factor that water addresses, then the EFSA is taking a narrow technical approach to their decision.

    I guess I don’t know what their process is. Reports said they put together a panel of experts and took three years to look at the issue. Did they really need the applicants to define what the risk factor is – how about, insufficient fluid intake, or excessive fluid loss? In any case it seems like they are more concerned about how to characterize the role of water in preventing and treating dehydration in precise legal language, rather than the underlying relevant scientific health question.

    If that’s the case, they should have been crystal clear about that.

    As a marketing regulation it does not seem very effective either. It seems heavy handed to prevent companies from saying “drink our special water and it will magically treat dehydration better than other fluids” by not allowing them to say that water is good for dehydration.

    In any case, this is a PR disaster for them, and perhaps that was the intent – to break the process by trying to apply it to a basic physiological process (fluid intake). Next they will see if food cures hunger.

  14. Steven Novellaon 21 Nov 2011 at 12:54 pm

    rand15 – I don’t think that’s the case. They could have just said that, but they seemed to accept “dehydration” as a disease.

  15. Dagdaon 21 Nov 2011 at 1:47 pm

    It seems to me that the ESFA statements generally are rather technical pieces. But they actually state in another article that water is important for the maintainance of normal physical and cognitive function.

    “Loss of body water of about 1 % is normally compensated within 24 hours. Without compensation and with further increase of body water loss, physical and cognitive functions are impaired. The Panel concludes that a cause and effect relationship has been established between the dietary intake of water and maintenance of normal physical and cognitive functions. The Panel considers that, in order to obtain the claimed effect, at least 2.0 L of water should be consumed per day. Such amounts can be easily consumed as part of a balanced diet. The target population is the general population.”
    Found here:
    http://www.efsa.europa.eu/de/efsajournal/doc/2075.pdf

  16. kikyoon 21 Nov 2011 at 2:27 pm

    I think that Carl is correct. The part of the decision that addresses their reasoning seems to be: “The Panel notes that the proposed risk factors, “water loss in tissues” or “reduced water content in tissues”, are measures of water depletion and thus are measures of the disease.”

    They seem to be taking issue with the identification of the level of water in body tissues as a risk factor for dehydration, saying that the level of water in the tissues is actually a measure of how dehydrated you are, not how high your risk of dehydration is.

    Therefore, the water doesn’t lower the risk of becoming dehydrated, it lowers the level of dehydration you already have?

    I think you would have to read the entirety of the regulation cited in order to pinpoint the exact language they are referring to in making their decision since they don’t reiterate the requirements of the regulation themselves.

    I’m not surprised this is so confusing. I took a European Union law class in law school and I really struggled with understanding their decisions as compared to U.S. legal decisions.

  17. nalon 21 Nov 2011 at 9:03 pm

    Article 14 states:

    … for reduction of disease risk claims the labeling or, if no such labeling exists, the presentation or advertising shall also bear a statement indicating that the disease to which the claim is referring has multiple risk factors and that altering one of these risk factors may or may not have a beneficial effect.

    Dehydration has multiple risk factors. The requested label did not address these other risk factors.

  18. sonicon 22 Nov 2011 at 1:16 am

    I believe I have the important clause here–
    The statement on which the eminent EU experts ruled claimed that ‘regular consumption of significant amounts of water can reduce the risk of development of dehydration and of concomitant decrease of performance.’

    It turns out that dehydration is a condition of body water depletion. Therefore ‘body water depletion’ isn’t a risk factor for dehydration– rather it is dehydration.

    http://www.efsa.europa.eu/en/supporting/doc/172e.pdf
    “For reduction of disease risk claims, the beneficial physiological effect (which the Regulation requires to be shown for the claim to be permitted) is the reduction (or beneficial alteration) of a risk factor for the development of a human disease (not reduction of the risk of disease). However, undersupply with water would not be considered as a risk factor for dehydration (the disease) in this context as the beneficial alteration of the factor (increased consumption of water) is not a beneficial physiological effect as required by the Regulation.”

    This decision was reached by a committee of 21 people. It took about three years to make.
    As I understand it the question was asked by a couple professors in Germany as a means of demonstrating the malfunctioning regulatory system current in force.
    If that is true, then I would suggest the decision would be more complete with a QED attached to the end.

  19. eiskrystalon 22 Nov 2011 at 4:00 am

    Perhaps it was the “significant amounts” bit. I.e. that drinking more water than necessary is not going to cure ” the disease”. That would be abused in a heartbeat these days.

    This query to them has “evil marketing opportunity” written all over it.

  20. BillyJoe7on 22 Nov 2011 at 5:30 am

    “‘regular consumption of significant amounts of water can reduce the risk of development of dehydration and of concomitant decrease of performance.’”

    This statement is surely in error. It should read:

    “regular consumption of sufficient amounts of water to maintain hydration can reduce the risk of development of dehydration and of concomitant decrease of performance.”

    The last Australian to die on the Kokoda Trail died of water overload, not dehydration. He was so concerned not to get dehydrated that he drank himself to death.

  21. SARAon 23 Nov 2011 at 3:28 am

    Imagine sitting on a board trying to evaluate statements that will be stretched beyond their assumed function by a plethora of corporations.

    Approving the statement seems simple, until you consider it too much. But if you don’t consider it too much, someone is going to use it as a marketing strategy to sell something that is available for free to most of the population they are selling to.

    If you sat on that board and had seen Alt Med twist your statement approval into an endorsement of their particular product, you might want to run in a hole and hide every time some patently obvious statement comes up for review.

    And you might choose to hide behind a technicality and weather a brief storm of ridicule rather than live for years watching your innocent endorsement be abused outside its intended purpose.

    That it would take 3 years and that the people who draft those decisions can’t make simple straightforward explanations for their decisions, is a sin, though.

  22. JurijDon 26 Nov 2011 at 6:35 pm

    “In any case, this is a PR disaster for them, and perhaps that was the intent – to break the process by trying to apply it to a basic physiological process (fluid intake). Next they will see if food cures hunger.”

    Boy, you’re blowing this hugely out of proportion, Steve.

    I have to tell you that EFSA doesn’t much worry about “bad PR”. There is a nice buffer (mostly comprised of simple inertia against change) that prevents short-lived fluctuations in public opinion to have long reaching consequences as to how such a behemoth as the eurocracy functions.

    This is a good thing in my opinion because experts can focus on their work without worrying what some small segment of the population is a-tweet about today…

    Apart from that, the 3 years it took them to address the issue was not spent simply looking at this one case. They are swamped with crackpots wanting to market their loony claims to the public. It simply takes time to wade through them all.

    This case will have absolutely zero influence on how EFSA functions. It’s just one more “quirky” ruling that will be laughed at for a while and then forgotten about.

    Nobody is batty enough to try and sacrifice an excellent system of anti-quack regulation (currently the best in the world imho) on the cross of one obscure (politically motivated) company making some noise selling magic water. If their intent was to “break the system” and this is what they managed to dream up… they’re even more pathetic than I thought.

    The system was set up to regulate specific health claims. For someone to try and abuse it in this manner is simply laughable – namely trying to push through a claim that would obviously be used to promote their special “magic” water. They got a smack-down and quite appropriately so.

    And besides:
    If they REALLY wanted to say that water prevents dehydration they COULD HAVE stated that with absolutely no need for review. It’s that simple.

    As a marketing regulation it does not seem very effective either. It seems heavy handed to prevent companies from saying “drink our special water and it will magically treat dehydration better than other fluids” by not allowing them to say that water is good for dehydration.

    Actually it’s the other way around. As far as marketing regulation it’s EXTREMELY effective. The number of food-related crack-potteries has gone done significantly in the past few years since EFSA is swinging hard at them.

    And as Carl said: they did prevent them from saying water is good for general “dehydration”.

    They prevented them from saying:
    Water REDUCES the risk of dehydration as pertaining to a specific disease state. This actually is not the case apriori as has been stated before.

    A bit of political background to the story:
    http://thedailywh.at/2011/11/20/debunked-hysteria-of-the-day/

  23. ccbowerson 26 Nov 2011 at 11:59 pm

    “I have to tell you that EFSA doesn’t much worry about “bad PR”. There is a nice buffer (mostly comprised of simple inertia against change) that prevents short-lived fluctuations in public opinion to have long reaching consequences as to how such a behemoth as the eurocracy functions.”

    Repeated episodes of bad PR can have quite an impact when these “short-lived fluctuations” combine to becomes a long term reality. I have no clue with regards to EFSA, but your explanation of the buffer seems less robust than it would need to be to not worry about PR.

    As much as I am sympathetic to regulation that prevents quackery, such methods should be (and appear) rational. When they start appearing as illogical as the quackery itself, it resembles the “if you can’t beat ‘em, join ‘em” saying. I am not saying that this is the case, but appearance is reality with PR.

  24. JurijDon 27 Nov 2011 at 1:32 pm

    What you do not realize is that the Telegraph is to EU-reporting what FoxNews is to honest reporting.

    The Telegraph (And the Mail) are two UK-based newspapers with a clear, admitted and unashamed anti-EU agenda. At every level. They like to cater to the lowest common denominator of the British nationalists who revel in such stories (undoubtedly while fox-hunting and toasting to the queen… :D )

    Just take a look at Telegraph’s website every now and then. It’s filled with the most absurd anti-EU propaganda. A day does not go by when they’re not reporting on how the EU is going under, how the Brits need to pull out, and how the eurocrats are stealing their babies.

    The Guardian

    http://www.guardian.co.uk/science/the-lay-scientist/2011/nov/18/1

    on the other hand has a different take on this story.

    It all seems to have been carefully engineered for purely propaganda purposes by the Telegraph or someone behind them.

    Let me reiterate: scarcely anyone on the continent cares what an insignificant propagandist paper in the UK is saying or trying to “prove”. The guys in Brussels don’t give a rats ass, pardon my French, about some bad “PR” for the EU/EFSA that this pathetic stunt seems to have generated among right-winders in the UK.

    I can understand you making much of it because you’re heavily biased towards English-language news. But if you take a look at German, French, or any of the central and eastern European Slavic news outlets, you’ll quickly see that this is a non-issue.

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