
Whole Health Psychiatry
Water Quality & Hydration
Proper hydration is crucial for optimal bodily functions, including temperature regulation, joint lubrication, infection prevention, nutrient delivery, and organ performance. Even mild dehydration can impair cognitive abilities, mood, and physical performance. Research indicates that a mere 1% decrease in body weight due to fluid loss can lead to a 5% reduction in cognitive function, affecting short-term memory and attention. Rehydration has been shown to alleviate fatigue and improve mental clarity, emphasizing the importance of consistent fluid intake for physical and psychological well-being.
To maintain adequate hydration, experts recommend a daily fluid intake of approximately 2.7 liters (about 11 cups) for women and 3.7 liters (about 16 cups) for men, including fluids from all beverages and foods. Individual needs may vary based on age, activity level, and environmental conditions. Monitoring urine color—aiming for a light straw hue—can be a practical indicator of hydration status.
One of the most well-known and widely referenced books on the importance of hydration is “Your Body’s Many Cries for Water” by Dr. Fereydoon Batmanghelidj. The book emphasizes that chronic dehydration is an often-overlooked cause of many health issues. The body uses “thirst signals”—frequently misinterpreted as hunger, fatigue, or anxiety—to indicate water needs. Dr. Batmanghelidj argues that many common symptoms, including joint pain, headaches, digestive problems, and even depression, may be the body’s way of signaling dehydration rather than a need for medication or food.
On a biological level, water is essential for nearly every cellular process. Each cell depends on adequate hydration to maintain membrane fluidity, optimize nutrient transport, and enable enzymatic reactions for energy production and waste removal. When hydration is lacking, cells become stressed, intracellular pH may become imbalanced, and the efficiency of biochemical processes—such as neurotransmitter synthesis and mitochondrial function—can decline. This cellular stress can manifest as systemic fatigue, mood disruption, cognitive fog, and even increased pain sensitivity.
At the neurochemical level, insufficient water intake may influence hunger and satiety signaling in the hypothalamus, the brain’s regulatory center for thirst and appetite. Because these two signals are processed in closely related regions, dehydration can often be mistaken for hunger—leading to unnecessary food intake and disrupted metabolic regulation. Additionally, hydration affects blood volume and circulation, influencing the delivery of oxygen and nutrients to the brain and other organs. This is why low water intake can contribute to lightheadedness, dizziness, mental sluggishness, anxiety, and low mood. Dr. Batmanghelidj’s work aligns with modern research, highlighting the neuroendocrine and cellular importance of staying hydrated to support physical and mental health.
Concerns have arisen regarding microplastics in bottled water, with studies detecting plastic particles in many samples. These microplastics can originate from the bottles, especially when exposed to heat or stored for extended periods. Potential health risks include inflammation and disruption of hormonal functions. To minimize exposure, it’s advisable to use reusable glass or stainless-steel containers and consume filtered tap water at a minimum, preferably Reverse osmosis (RO) filtered water.
Reverse osmosis is one of the most advanced and effective water filtration methods available, particularly in areas with compromised or uncertain water quality. It works by forcing water under pressure through a semi-permeable membrane that allows only water molecules to pass through while blocking a wide range of contaminants—including heavy metals (like lead and arsenic), nitrates, fluoride, PFAS (per- and polyfluoroalkyl substances), pesticides, bacteria, viruses, and dissolved salts. The purified water is collected for use, while the filtered-out contaminants are flushed away as waste.
What sets RO apart from other filtration systems is its ability to remove up to 99% of dissolved solids and microscopic pollutants, thanks to its membrane’s pore size of just 0.0001 microns—far smaller than what standard carbon or sediment filters can achieve. While carbon filters are effective for improving taste and removing chlorine or odors, they do not address many harmful substances that RO systems can eliminate.
This makes reverse osmosis a gold standard for delivering clean, safe drinking water—vital for vulnerable populations such as children, pregnant women, and individuals with chronic illnesses. Its comprehensive purification capabilities effectively minimize both chemical and biological threats, offering peace of mind and improved health outcomes.
Key Contaminants of Concern
1. Nitrates
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Sources: Nitrates primarily originate from agricultural runoff, including fertilizers and animal waste. In regions like Nebraska, intensive farming practices contribute significantly to nitrate infiltration into groundwater.
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Health Risks: Elevated nitrate levels are associated with methemoglobinemia (“blue baby syndrome”) in infants, thyroid dysfunction, adverse pregnancy outcomes, and certain cancers.
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Prevalence in Nebraska: Approximately 40% of private wells in Nebraska tested over the past two years have nitrate levels exceeding 3 ppm, with about 15% surpassing the EPA’s maximum contaminant level of 10 ppm.
2. PFAS (Per- and Polyfluoroalkyl Substances)
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Sources: PFAS, known as “forever chemicals,” are found in firefighting foams, non-stick cookware, water-repellent fabrics, and more. They enter water supplies through industrial discharge, landfill leachate, and runoff from contaminated sites.
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Health Impacts: Exposure to PFAS is associated with increased risks of kidney and testicular cancers, liver damage, thyroid disease, immune system suppression, and developmental issues in children.
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Presence in Nebraska: As of December 2024, PFAS have been detected above the proposed maximum contaminant levels in three Nebraska community water systems.
3. Other Contaminants
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Additional pollutants of concern in the Midwest include pesticides, herbicides, and heavy metals like arsenic, which can leach into water supplies from agricultural and industrial activities.​​
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Regional Focus: Nebraska
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A recent report highlights that nitrate contamination remains a persistent issue in Nebraska, with levels exceeding health guidelines in many cases.
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The Nebraska Department of Environment and Energy (NDEE) has initiated voluntary PFAS monitoring programs for community water systems, revealing detections above health advisory levels in certain areas.
Research & Evidence Base
Nitrate Exposure:
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Linked to increased risks of colorectal, kidney, and thyroid cancers.
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Associated with adverse pregnancy outcomes and developmental issues in infants.
PFAS Exposure:
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Studies indicate associations with various cancers, liver enzyme alterations, and immune system effects.
EPA & CDC Data:
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The EPA acknowledges the health risks posed by PFAS and is working on establishing enforceable drinking water standards.
Health Implications
Physical Health:
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Nitrates and PFAS are linked to cancers, thyroid dysfunction, liver damage, and reproductive issues.
Neurological and Mental Health:
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Chronic exposure to these contaminants may contribute to cognitive impairments, developmental delays, and behavioral disorders, particularly in children.
Solutions & Recommendations
1. Water Testing:
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Regular private wells and municipal water testing for nitrates and PFAS are essential.
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Utilize certified laboratories or at-home test kits that meet EPA standards.
2. Filtration Systems:
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Reverse Osmosis (RO): Effective in removing nitrates, PFAS, and other contaminants. Look for systems certified by NSF/ANSI standards.
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Activated Carbon Filters Can reduce certain PFAS levels but may be less effective than RO systems.
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Ion Exchange Systems: Useful for removing specific contaminants like nitrates.
3. Community Resources:
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Contact local health departments and the NDEE for information on water quality and assistance programs.
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As of December 2024, the Nebraska Department of Environment and Energy (NDEE) reported that three community water systems in Nebraska had detected per- and polyfluoroalkyl substances (PFAS) levels exceeding the proposed maximum contaminant levels (MCLs) established by the U.S. Environmental Protection Agency (EPA). The specific communities were not named in the publicly available summary.
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For the most current and detailed information regarding PFAS detections in specific Nebraska communities, residents are encouraged to consult the NDEE’s official website or contact their local water utility providers.
Practical Takeaways: Top 5 Tips for Ensuring Safe Water at Home
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Test Water Annually, Especially if relying on a private well.
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Install Certified Filtration Systems: Preferably, RO systems should have NSF/ANSI certification.
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Stay Informed: Keep up-to-date with local water quality reports and advisories.
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Advocate for Clean Water: Support policies and initiatives to reduce water contamination.
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Educate Others: Share information on water safety with your community to promote collective action.
Summary: The Importance of Hydration and What It Really Means
Proper hydration is essential for nearly every biological function—from regulating body temperature and cushioning joints to supporting brain function, energy production, and detoxification. Even mild dehydration (as little as 1% loss of body fluid) can significantly impair mood, memory, attention, and physical performance. Chronic dehydration contributes to fatigue, anxiety, and headaches and can exacerbate chronic conditions like kidney disease, cardiovascular issues, and mental health symptoms.
However, being “hydrated” doesn’t simply mean drinking fluids—it depends on what you’re drinking. Proper hydration occurs when water is absorbed into your cells and supports biological processes. Beverages like plain water, herbal teas, or mineral-rich fluids help hydrate at the cellular level, enabling water to move across cell membranes, regulate intracellular pH, and fuel energy metabolism. In contrast, high-caffeine, high-sugar, or artificially sweetened drinks can act as diuretics or disrupt electrolyte balance, impairing the body’s ability to retain and use water effectively.
At the cellular level, water facilitates enzymatic reactions, nutrient transport, and waste removal. If cells are underhydrated, they become less efficient at making energy (ATP), neurotransmitter production can slow, and inflammation may rise—affecting everything from mood and cognition to immune health. Hydrating fluids and maintaining electrolyte balance are key to optimizing physical and mental wellness.
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