Dietitian reviews water enhancers’ small print, usefulness

Supermarket shelves and online marketplaces abound with powders and potions that vie for your attention. Loudly colored packets and plastic, formed to fit consumers’ on-the-go lives, pitch this message: “Water can be so much more than it is! More flavorful, more energizing, more restorative!” 

One brand’s in-your-face claim: “We fix water.”

Karen Munger, a registered dietitian and a certified diabetes care and education specialist at UW Medicine, is unimpressed. “For companies who sell these powders and mixes, it’s all about making money,” she said.

In the Pacific Northwest and other places where the quality of tap water is high, most people will do just fine without flavoring agents, she said. Most people who go to the gym for a half-hour of cardio and some weightlifting don’t need rehydration boosters. Most people don’t need the extra jolt of caffeine or other stimulant to perform an activity better. 

For athletes who will sweat for an hour or more, or whose competitive performance would benefit from a brief infusion of power or intensity, consuming a product for rehydration or energy has more rationale, Munger acknowledged. 

Are these products OK to consume? Munger gave a qualified “yes,” pointing to the “Generally Recognized as Safe” designation of the U.S. Food and Drug Administration. She added, however, that an individual can have bad experiences based on their sensitivities to certain ingredients.

“It’s a misconception (to assume that) if it's on the shelf, it's safe,” she said. Some supplements and additives have been in the food supply for so long, however, that the FDA lets manufacturers “just run with it,” she said.

As she examined ingredient lists of a few products, Munger offered a running commentary: 

“We don’t know what the artificial flavor is. The artificial color is Red No. 40 and Blue No. 1. What’s that do to us? We really don’t know. … Artificial sweeteners in here, this one has both aspartame and acesulfame K (potassium). A lot of people don’t tolerate these, in terms of, it gives a headache or stomachache. … This energy drink has erythritol in it, and that's a sugar alcohol. Again, that can give somebody diarrhea.” 

[Editor’s note: A study published Aug. 8 reported finding in a small cohort that erythritol was associated with increased risk of heart attack and stroke.]

Additives also can interfere with medications that someone is taking, she said. “These herbals, especially, create a level of concern. They can have a diuretic effect, which works against hydration.”

Part of Munger’s role is caring for patients who develop painful kidney stones, a condition influenced by insufficient fluid intake. She is adamant that people get enough hydration every day. If a flavoring additive makes someone more likely to drink the water they need, that’s fine, she said. 

“Some people just still don't like (plain water). If I'm adding a powder or a syrup, the benefit is maybe we're actually drinking adequate water. Adequate water is important. It sustains life.”

But even here, her support came with a caveat:  Among ingredients in flavor enhancers, “the ones that we as dieticians worry about is artificial sweeteners. Some folks don’t tolerate them. They can cause headaches, GI upset, gas and bloating.”

At the end of the day, for any individual, these would-be water-enhancement products could be useful, or not, and benign, or not. Think before you drink. 

Download broadcast-ready soundbites and related multimedia with Munger. 

For details about UW Medicine, please visit http://uwmedicine.org/about.