As coronavirus continues to make the news, a host of untruths has surrounded the topic. In this Special Feature, we address some of these myths and conspiracy theories.

The novel coronavirus, SARS-CoV-2, has spread from Wuhan, China, to every continent except Antarctica.

The World Health Organization (WHO) changed their classification of the situation from a public health emergency of international concern to a pandemic on March 11, 2020.

The virus has been responsible for tens of millions of infections globally, causing more than a million deaths. The United States has been the most affected country.

As ever, when the word “pandemic” began appearing in headlines, people became fearful — and with fear came misinformation and rumors.

Below, we dissect some of the most common myths currently circulating on social media and beyond.

Stay informed with live updates on the current COVID-19 outbreak 

1. Spraying chlorine or alcohol on the skin kills viruses in the body

Applying alcohol or chlorine to the skin can cause harm, especially if it enters the eyes or mouth. These chemicals can disinfect surfaces, but people should not use them on their bodies.

Also, these products cannot kill viruses inside the body.

2. Only older adults and people with preexisting conditions are at risk of infections and complications

SARS-CoV-2, like other coronaviruses, can transmit to people of any age. However, older adults and individuals with preexisting health conditions, such as diabetes, obesity, or asthma, are more likely to become severely ill.

While people under 40, including children, are less likely to become severely ill with COVID-19, the disease can lead to complications and death in anyone.

3. Children cannot get COVID-19

Anyone, of any age, can develop the infection that causes COVID-19.

So far, most COVID-19 cases have been in adults, but children are not immune. That said, most children who develop COVID-19 have mild symptoms or none at all.

Also, on May 15, 2020, the WHO released a commentary about an inflammatory condition in children and adolescents that may have links with COVID-19.

The condition, called multi-system inflammatory syndrome in children, known as MIS-C, has features similar to Kawasaki disease and toxic shock syndrome.

Scientists currently know little about this condition, but research from May suggests that it is rare, “probably affecting no more than 1 in 1,000 children exposed to SARS-CoV-2.”

4. COVID-19 is just like the flu

Infection with the virus SARS-CoV-2 can cause COVID-19, an illness that can cause flu-like symptoms, such as body aches, a fever, and a cough. Symptoms of either COVID-19 or the flu can be mild, severe, or rarely, fatal. Both illnesses can also cause pneumonia.

However, the overall profile of COVID-19 is more serious. Different countries have reported different mortality rates, and the case fatality rate in the U.S. appears to be around 2.6%.

While scientists are still determining the exact mortality rate based on developing data, it is likely to be many times higher than that of the seasonal flu.

5. Everyone with COVID-19 dies

This is false. As we explain above, COVID-19 is fatal for a small percentage of people who develop the illness.

The WHO have reported that around 80% of people with COVID-19 experience a relatively form of the illness and do not need specialist treatment in a hospital. Mild symptoms may include a fever, a cough, a sore throat, tiredness, and shortness of breath.

Also, many people with the underlying infection experience no symptoms.

6. Cats and dogs spread the coronavirus

There have been several reports of pets developing the infection, including in the U.S. In most cases, the pets became sick after coming into contact with people who had COVID-19.

According to the Centers for Disease Control and Prevention (CDC), “There is no evidence that animals play a significant role in spreading the virus that causes COVID-19.”

Scientists are debating the importance of these cases in animals. For instance, Jonathan Ball, a professor of molecular virology at the University of Nottingham, in the United Kingdom, says:

“We have to differentiate between real infection and just detecting the presence of the virus. I still think it’s questionable how relevant it is to the human outbreak, as most of the global outbreak has been driven by human-to-human transmission.”

7. Face masks always protect against the coronavirus

Healthcare workers use professional face masks that fit tightly to protect themselves from infections.

Disposable and cloth masks can protect against droplets, but neither can protect against aerosolized particles.

The CDC recommend that all people wear cloth face masks in public areas where it is difficult to maintain a 6-foot, or 2-meter, distance from others. This helps slow the spread of the virus.

Even while wearing a mask, it is essential to continue with other precautions, such as not touching the face, physical distancing, and washing the hands frequently.

Surgical masks and N95 respirators provide greater protection, but reserve these for healthcare workers.

8. Hand dryers kill the coronavirus

Hand dryers do not kill SARS-CoV-2. The best way to protect oneself and others from the virus is to wash the hands with soap and water frequently for at least 20 seconds at a time.

When this is not possible, use an alcohol-based hand sanitizer.

9. SARS-CoV-2 is just a mutated form of the common cold virus

Coronaviruses are a large family, and each has spiky proteins on their surface. Some use humans as their primary host and cause the common cold. 

Other coronaviruses, including SARS-CoV-2, primarily infect animals.

Like COVID-19, Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) are caused by coronaviruses. These viruses also initially passed to humans from animals.

10. You have to be with someone for 10 minutes to catch the virus

The longer a person is close to someone with the infection, the likelier the virus is to transmit. However, the virus can pass from person to person in under 10 minutes.

11. Rinsing the nose with saline protects against the coronavirus

There is no evidence that a saline nasal rinse protects against any respiratory infections. 

Some research suggests that a rinse might ease the symptoms of acute upper respiratory tract infections, but scientists have not found that this technique reduces the risk of infection.

12. You can protect yourself by gargling bleach

People should never put bleach in their mouths. Gargling bleach could never benefit a person’s health. 

Bleach is corrosive and can cause serious damage.

13. Antibiotics kill the coronavirus

Antibiotics only kill bacteria. They do not kill viruses.

14. Thermal scanners can diagnose the coronavirus

Thermal scanners can detect whether someone has a fever — which might result from any number of health issues.

Symptoms of COVID-19 can appear 2–14 days after the infection develops. This means that even if a person develops symptoms, they may have a normal temperature for days before a fever begins.

15. Garlic protects against coronaviruses

Some research suggests that garlic may slow the growth of some species of bacteria. COVID-19 results from a virus, not bacteria. 

There is no evidence that garlic can protect people from COVID-19.

16. Parcels from China can spread the coronavirus

From previous research into coronaviruses similar to SARS-CoV-2, including those that cause SARS and MERS, scientists believe that the virus cannot survive on letters or packages for extended periods.

The CDC explain that “Although the virus can survive for a short period on some surfaces, it is unlikely to be spread from domestic or international mail, products, or packaging.”

17. Home remedies can cure and protect against COVID-19

No home remedies can protect against COVID-19. This goes for vitamin C, essential oils, silver colloid, sesame oil, garlic, fish tank cleaner, sage, or water, even when a person sips it every 15 minutes.

The best approach is to wash the hands frequently, for 20 seconds at a time, to use an alcohol-based hand sanitizer, to wear a face covering in public, and to avoid crowded places.

18. You can catch the coronavirus from eating Chinese food in the US

No, you cannot.

19. You can catch the coronavirus from urine and feces

This is likely false, but the jury is currently out. According to Prof. John Edmunds, from the London School of Hygiene & Tropical Medicine, in the U.K.:

“It isn’t a very pleasant thought, but every time you swallow, you swallow mucus from your upper respiratory tract. In fact, this is an important defensive mechanism. This sweeps viruses and bacteria down into our gut where they are denatured in the acid conditions of our stomachs.”

“With modern, very highly sensitive detection mechanisms, we can detect these viruses in feces. Usually, the viruses that we can detect in this way are not infectious to others, as they have been destroyed by our guts.”

However, it is worth noting that some research suggests that viruses similar to SARS-CoV-2 might persist in feces. A research letter in JAMA also concludes that SARS-CoV-2 is present in feces.

20. The virus will die off when temperatures rise

Some viruses, such as cold and flu viruses, spread more easily in colder months. This does not mean that their transmission stops in warmer weather.

As it stands, scientists do not know how temperature changes influence the behavior of SARS-CoV-2.

21. The coronavirus is the deadliest virus known to humans

While SARS-CoV-2 does appear to be more dangerous than influenza viruses, it is not the deadliest virus that people have faced. Others, such as the Ebola virus, have higher mortality rates.

22. Flu and pneumonia vaccines can protect against COVID-19

Because SARS-CoV-2 is distinct from other viruses, no existing vaccines can protect against it.

23. The virus originated in a laboratory in China

There is no evidence to back up this rumor, which has circulated on the internet. As a recent study demonstrates, SARS-CoV-2 is a natural product of evolution.

Some researchers believe that SARS-CoV-2 jumped from pangolins to humans. Others think that it passed to us from bats, like SARS did.

24. The outbreak began because people ate bat soup

While scientists are confident that the virus started in animals, there is no evidence that soup was involved.

25. 5G helps SARS-CoV-2 spread

As the world becomes more connected, some regions are rolling out 5G mobile technology. This has prompted a raft of conspiracy theories.

One of the most recent to emerge is that 5G is responsible for the swift spread of SARS-CoV-2 across the globe. This is a myth.

Some people believe that 5G helps viruses communicate, often citing a paper from 2011. In this study, the authors conclude that bacteria can communicate via electromagnetic signals.

However, experts dispute this theory. In any case, SARS-CoV-2 is a virus, not a bacterium.

Wuhan was one of the first cities to trial 5G in China, which helps explain the origin of some of these theories. However, Beijing, Shanghai, and Guangzhou also rolled out 5G at a similar time.

It is also worth noting that COVID-19 has significantly impacted countries with very little 5G coverage, such as Iran.

26. Drinking alcohol reduces the risk of infection

The WHO have released a response to the series of myths surrounding alcohol and COVID-19. They explain that while alcohol can disinfect the skin, it does not have this effect inside the body.

They continue, “Consuming any alcohol poses health risks, but consuming high-strength ethyl alcohol (ethanol), particularly if it has been adulterated with methanol, can result in severe health consequences, including death.”

Also, in a fact sheet on the subject, they explain that “Alcohol use, especially heavy use, weakens the immune system — and thus reduces the ability to cope with infectious diseases.”

And because alcohol is associated with a number of diseases, it may make people more vulnerable to COVID-19.

27. Injecting or consuming bleach or disinfectant kills the virus

Consuming or injecting disinfectant or bleach does not wipe out viruses in the body, and it can be extremely dangerous.

As Dr. Wayne Carter, an associate professor at the University of Nottingham’s Faculty of Medicine & Health Sciences, in the U.K., explains, “Disinfectants and bleach are strong oxidizing agents, useful to kill bacteria or viruses when they are deposited on surfaces, but these agents should not be ingested or injected. These agents can cause severe tissue burns and blood vessel damage.”

Dr. Penny Ward, a visiting professor of pharmaceutical medicine at King’s College London, in the U.K., notes, “Drinking bleach kills. Injecting bleach kills faster.”

28. You can contract the coronavirus in swimming pools

As the CDC observe, no evidence suggests that SARS-CoV-2 transmits via the water in swimming pools, hot tubs, or water parks. If this water is disinfected with chlorine or bromine, it should inactivate the virus.

Still, the virus can transmit in all the usual ways in these and any other shared spaces. A person contracts a SARS-CoV-2 infection by inhaling respiratory droplets that contain the virus or coming into contact with infected surfaces.

As in other public places, the CDC recommend staying 6 feet, or 2 meters, away from others at pools and water parks and wearing cloth face coverings when not in the water.

People who operate pools should take extra care to clean and disinfect all facilities.

What should we do?

The CDC recommend the following simple ways to reduce the spread of SARS-CoV-2:

• avoiding close contact with people who seem ill or report symptoms
• trying not to touch the eyes, nose, or mouth
• staying home if any symptoms appear
• sneezing into a tissue, then throwing it in the trash, or sneezing into the crook of the elbow
• using standard cleaning sprays and wipes to disinfect frequently touched objects and surfaces
• washing the hands with soap regularly, for at least 20 seconds at a time
• using an alcohol-based hand sanitizer when soap and water are unavailable
• wearing a cloth face covering in stores, pharmacies, and other public settings

High blood pressure is a dangerous condition that can damage your heart. It affects one in three people in the US and 1 billion people worldwide.

If left uncontrolled, high blood pressure raises your risk of heart disease and stroke.

But there’s good news. There are a number of things you can do to lower your blood pressure naturally, even without medication.

Here are 15 natural ways to combat high blood pressure.

1. Walk and exercise regularly

Exercise is one of the best things you can do to lower high blood pressure.

Regular exercise helps make your heart stronger and more efficient at pumping blood, which lowers the pressure in your arteries.

In fact, 150 minutes of moderate exercise, such as walking, or 75 minutes of vigorous exercise, such as running, per week, can help lower blood pressure and improve your heart health.

What’s more, doing even more exercise than this reduces your blood pressure even further, according to the National Walkers’ Health Study.

Bottom line: Walking just 30 minutes a day can help lower your blood pressure. More exercise helps reduce it even further.

2. Reduce your sodium intake

Salt intake is high around the world. In large part, this is due to processed and prepared foods.

For this reason, many public health efforts are aimed at lowering salt in the food industry.

Many studies have linked high salt intake with high blood pressure and heart events, including stroke.

However, more recent research indicates that the relationship between sodium and high blood pressure is less clear.

One reason for this may be genetic differences in how people process sodium. About half of people with high blood pressure and a quarter of people with normal levels seem to have a sensitivity to salt.

If you already have high blood pressure, it’s worth cutting back your sodium intake to see if it makes a difference. Swap out processed foods with fresh ones and try seasoning with herbs and spices rather than salt.

Bottom line: Most guidelines for lowering blood pressure recommend reducing sodium intake. However, that recommendation might make the most sense for people who are salt-sensitive.

3. Drink less alcohol

Drinking alcohol can raise blood pressure. In fact, alcohol is linked to 16% of high blood pressure cases around the world.

While some research has suggested that low-to-moderate amounts of alcohol may protect the heart, those benefits may be offset by adverse effects.

In the U.S., moderate alcohol consumption is defined as no more than one drink a day for women and two for men. If you drink more than that, cut back.

Bottom line: Drinking alcohol in any quantity may raise your blood pressure. Limit your drinking in line with the recommendations.

4. Eat more potassium-rich foods

Potassium is an important mineral.

It helps your body get rid of sodium and eases pressure on your blood vessels.

Modern diets have increased most people’s sodium intake while decreasing potassium intake.

To get a better balance of potassium to sodium in your diet, focus on eating fewer processed foods and more fresh, whole foods.

Foods that are particularly high in potassium include:

• vegetables, especially leafy greens, tomatoes, potatoes, and sweet potatoes
• fruit, including melons, bananas, avocados, oranges, and apricots
• dairy, such as milk and yogurt
• tuna and salmon
• nuts and seeds
• beans

Bottom line: Eating fresh fruits and vegetables, which are rich in potassium, can help lower blood pressure.

5. Cut back on caffeine

If you’ve ever downed a cup of coffee before you’ve had your blood pressure taken, you’ll know that caffeine causes an instant boost.

However, there’s not a lot of evidence to suggest that drinking caffeine regularly can cause a lasting increase.

In fact, people who drink caffeinated coffee and tea tend to have a lower risk of heart disease, including high blood pressure, than those who don’t drink it.

Caffeine may have a stronger effect on people who don’t consume it regularly.

If you suspect you’re caffeine-sensitive, cut back to see if it lowers your blood pressure.

Bottom line: Caffeine can cause a short-term spike in blood pressure, although for many people, it does not cause a lasting increase.

6. Learn to manage stress

Stress is a key driver of high blood pressure.

When you’re chronically stressed, your body is in a constant fight-or-flight mode. On a physical level, that means a faster heart rate and constricted blood vessels.

When you experience stress, you might also be more likely to engage in other behaviors, such as drinking alcohol or eating unhealthful food that can adversely affect blood pressure.

Several studies have explored how reducing stress can help lower blood pressure. Here are two evidence-based tips to try:

• Listen to soothing music: Calming music can help relax your nervous system. Research has shown it’s an effective complement to other blood pressure therapies.
• Work less: Working a lot, and stressful work situations, in general, are linked to high blood pressure.

Bottom line: Chronic stress can contribute to high blood pressure. Finding ways to manage stress can help.

7. Eat dark chocolate or cocoa

Here’s a piece of advice you can really get behind.

While eating massive amounts of dark chocolate probably won’t help your heart, small amounts may.

That’s because dark chocolate and cocoa powder are rich in flavonoids, which are plant compounds that cause blood vessels to dilate.

A review of studies found that flavonoid-rich cocoa improved several markers of heart health over the short term, including lowering blood pressure.

For the strongest effects, use non-alkalized cocoa powder, which is especially high in flavonoids and has no added sugars.

Bottom line: Dark chocolate and cocoa powder contain plant compounds that help relax blood vessels, lowering blood pressure.

8. Lose weight

In people with overweight, losing weight can make a big difference to heart health.

According to a 2016 study, losing 5% of your body mass could significantly lower high blood pressure.

In previous studies, losing 17.64 pounds (8 kilograms) was linked to lowering systolic blood pressure by 8.5 mm Hg and diastolic blood pressure by 6.5 mm Hg.

To put that in perspective, a healthy reading should be less than 120/80 mm Hg.

The effect is even greater when weight loss is paired with exercise.

Losing weight can help your blood vessels do a better job of expanding and contracting, making it easier for the left ventricle of the heart to pump blood.

Bottom line: Losing weight can significantly lower high blood pressure. This effect is even more significant when you exercise.

9. Quit smoking

Among the many reasons to quit smoking is that the habit is a strong risk factor for heart disease.

Every puff of cigarette smoke causes a slight, temporary increase in blood pressure. The chemicals in tobacco are also known to damage blood vessels.

Surprisingly, studies haven’t found a conclusive link between smoking and high blood pressure. Perhaps this is because smokers develop a tolerance over time.

Still, since both smoking and high blood pressure raise the risk of heart disease, quitting smoking can help lessen that risk.

Bottom line: There’s conflicting research about smoking and high blood pressure, but what is clear is that both increase the risk of heart disease.

10. Cut added sugar and refined carbs

There’s a growing body of research showing a link between added sugar and high blood pressure.

In the Framingham Women’s Health Study, women who drank even one soda per day had higher levels than those who drank less than one soda per day.

Another study found that having one less sugar-sweetened beverage per day was linked to lower blood pressure.

And it’s not just sugar — all refined carbs, such as the kind found in white flour — convert rapidly to sugar in your bloodstream and may cause problems.

Some studies have shown that low carb diets may also help reduce blood pressure.

One study on people undergoing statin therapy found that those who went on a 6-week, carb-restricted diet saw a greater improvement in blood pressure and other heart disease markers than people who did not restrict carbs.

Bottom line: Refined carbs, especially sugar, may raise blood pressure. Some studies have shown that low carb diets may help reduce your levels.

11. Eat berries

Berries are full of more than just juicy flavor.

They’re also packed with polyphenols, natural plant compounds that are good for your heart.

Polyphenols can reduce the risk of stroke, heart conditions, and diabetes, as well as improving blood pressure, insulin resistance, and systemic inflammation.

One study assigned people with high blood pressure to a low-polyphenol diet or a high-polyphenol diet containing berries, chocolate, fruits, and vegetables.

Those consuming berries and polyphenol-rich foods experienced improved markers of heart disease risk.

Bottom line: Berries are rich in polyphenols, which can help lower blood pressure and the overall risk of heart disease.

12. Try meditation or deep breathing

While these two behaviors could also fall under “stress reduction techniques,” meditation and deep breathing deserve specific mention.

Both meditation and deep breathing may activate the parasympathetic nervous system. This system is engaged when the body relaxes, slowing the heart rate, and lowering blood pressure.

There’s quite a bit of research in this area, with studies showing that different styles of meditation appear to have benefits for lowering blood pressure.

Deep breathing techniques can also be quite effective.

In one study, participants were asked to either take six deep breaths over the course of 30 seconds or simply sit still for 30 seconds. Those who took breaths lowered their blood pressure more than those who just sat.

Try guided meditation or deep breathing. Here’s a video to get you started.

Bottom line: Both meditation and deep breathing can activate the parasympathetic nervous system, which helps slow your heart rate and lower blood pressure.

13. Eat calcium-rich foods

People with low calcium intake often have high blood pressure.

While calcium supplements haven’t been conclusively shown to lower blood pressure, calcium-rich diets do seem linked to healthful levels.

For most adults, the calcium recommendation is 1,000 milligrams (mg) per day. For women over 50 and men over 70, it’s 1,200 mg per day.

In addition to dairy, you can get calcium from collard greens and other leafy greens, beans, sardines, and tofu. Here is a list of calcium-rich plant-based foods.

Bottom line: Calcium-rich diets are linked to healthy blood pressure levels. You can get calcium through eating dark leafy greens and tofu, as well as dairy.

14. Take natural supplements

Some natural supplements may also help lower blood pressure. Here are some of the main supplements that have evidence behind them:

• Aged garlic extract: Researchers have used aged garlic extract successfully as a stand-alone treatment and along with conventional therapies for lowering blood pressure.
• Berberine: Traditionally used in Ayurvedic and Chinese medicine, berberine may increase nitric oxide production, which helps decrease blood pressure.
• Whey protein: A 2016 study found that whey protein improved blood pressure and blood vessel function in 38 participants.
• Fish oil: Long credited with improving heart health, fish oil may benefit people with high blood pressure the most.
• Hibiscus: Hibiscus flowers make a tasty tea. They’re rich in anthocyanins and polyphenols that are good for your heart and may lower blood pressure.

Bottom line: Researchers have investigated several natural supplements for their ability to lower blood pressure.

15. Eat foods rich in magnesium

Magnesium is an important mineral that helps blood vessels relax.

While magnesium deficiency is pretty rare, many people don’t get enough.

Some studies have suggested that getting too little magnesium is linked with high blood pressure, but evidence from clinical studies has been less clear.

Still, eating a magnesium-rich diet is a recommended way to ward off high blood pressure.

You can incorporate magnesium into your diet by consuming vegetables, dairy products, legumes, chicken, meat, and whole grains.

Bottom line: Magnesium is an essential mineral that helps regulate blood pressure. Find it in whole foods, such as legumes and whole grains.

Take home message

High blood pressure affects a large proportion of the world’s population.

While drugs are one way to treat the condition, there are many other natural techniques, including eating certain foods that can help.

Controlling your blood pressure through the methods in this article may, ultimately, help you lower your risk of heart disease

Endometriosis is an incurable but manageable gynecological condition.

It occurs when endometrial implants, comprised of tissue normally found within the uterus, are present in other areas of the body.

As the tissue continues to thicken, break down, respond to menstrual cycle hormones, and bleed during the menstrual cycle, endometriosis forms deep inside the body.

Scar tissue and adhesions form, and this can cause organ fusion and anatomical changes.

Endometriosis is thought to affect around 11 percent of women in the United States aged between 15 and 44 years.

Fast facts on endometriosis

Here are some key points about endometriosis. More information is in the main article.

• Endometriosis affects between 6 and 10 percent of women of reproductive age worldwide.
• The condition appears to be present in a developing fetus, but estrogen levels during puberty are thought to trigger the symptoms.
• Symptoms are generally present during the reproductive years.
• Most women go undiagnosed, and in the U.S. it can take around 10 years to receive a diagnosis.
• Allergies, asthma, chemical sensitivities, autoimmune diseases, chronic fatigue syndrome, fibromyalgia, breast cancer, and ovarian cancer are linked to women and families with endometriosis.

What is endometriosis?

Endometrial tissue consists of gland, blood cells, and connective tissue. It normally grows in the uterus, to prepare the lining of the womb for ovulation.

Endometrial implants are buildups of endometrial tissue that grow in locations outside the uterus.

When they grow outside the uterus, this is called endometriosis.

They can develop anywhere in the body, but they usually occur in the pelvic area.

They may affect:

• the ovaries
• the fallopian tubes
• the peritoneum
• the lymph nodes

Normally, this tissue is expelled during menstruation, but displaced tissue cannot do this.

This leads to physical symptoms, such as pain. As the lesions grow larger, they can affect bodily functions. For example, the fallopian tubes may be blocked.

The pain and other symptoms can affect different areas of life, including the ability to work, medical care costs, and difficulty maintaining relationships.

Symptoms

Other medical conditions such as pelvic inflammatory disease (PID), ovarian cysts, and irritable bowel syndrome (IBS) can mimic the symptoms of endometriosis.

Symptoms of endometriosis include:

• Severe menstrual cramps, unrelieved with NSAIDS
• Long-term lower-back and pelvic pain
• Periods lasting longer than 7 days
• Heavy menstrual bleeding where the pad or tampon needs changing every 1 to 2 hours
• Bowel and urinary problems including pain, diarrhea, constipation, and bloating
• Bloody stool or urine
• Nausea and vomiting
• Fatigue
• Pain during intercourse
• Spotting or bleeding between periods

Pain is the most common indication of endometriosis, but the severity of the pain does not always correlate with the extent of the disease.

Pain often resolves following menopause, when the body stops producing estrogen production. However, if hormone therapy is used during menopause, symptoms may persist.

Pregnancy may provide temporary relief from symptoms.

Complications

Complications include:

• infertility, which can affect 50 percent of those with the condition.
• increased risk of developing ovarian cancer or endometriosis-associated adenocarcinoma
• ovarian cysts
• inflammation
• scar tissue and adhesion development
• intestinal and bladder complications

It is important to see a health care provider about symptoms, to avoid future complications.

Treatment

Surgery is possible, but it is normally considered only if other treatments are not effective.

Other options include:

Pain medications: Either over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) or prescription drugs for the treatment of painful menses.

Hormones: Treatment may be with hormonal therapies such as hormonal birth control, Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, Medroxyprogesterone (Depo-Provera) or Danazol. Placement of an intrauterine device (IUD) may also be recommended.

Surgery: Initial surgery will seek to remove the areas of endometriosis, but a hysterectomy with removal of both ovaries may be necessary.

Fertility treatment: Pregnancy may be recommended via in-vitro fertilization (IVF).

Managing symptoms at home

Complementary and alternative treatments may include acupuncture, chiropractic, and herbal medicine, but there is little evidence to show that these are effective.

Avoiding caffeine may help to reduce pain, as caffeine can worsen symptoms.

Exercise, such as walking, may reduce pain and slow the progress of the condition by reducing estrogen levels.

It is important to monitor symptoms, because of the long-term complications of endometriosis. Intolerable pain or unexpected bleeding should be reported to a doctor.

Although there is currently no cure for endometriosis, most women are able to relieve the pain of symptoms and will still be able to have children.

Diagnosis

Diagnosis can be challenging because there is no single test for evaluation.

The only way to truly confirm the condition is by undergoing a surgical laparoscopy.

A surgical laparoscopy is a minimally invasive procedure in which a thin, lighted tube with a miniature camera attached, called a laparoscope, is inserted through a small incision in the pelvic area.

A diagnosis can be categorized as follows:

• Stage 1: Lesions are minimal and isolated
• Stage 2: Lesions are mild. There may be several and adhesions are possible.
• Stage 3: Lesions are moderate, deep or superficial with clear adhesions
• Stage 4: Lesions are multiple and severe, both superficial and deep, with prominent adhesions.

It can take many years to receive a diagnosis.

Other possible diagnostic strategies include a pelvic exam, radiologic imaging with ultrasound or magnetic resonance imaging (MRI), and the use of certain medications including birth control or gonadotropin releasing hormone (GnRH) agonists.

Diet

Dietary steps have been suggested for managing the pain and effects of endometriosis.

A 2004 study suggests that a brown seaweed called bladderwrack may have an estrogen-reducing effect in women. This can reduce the growth rate of endometriosis.

One author presented a case study using a diet low in short-chain-fermentable carbohydrates to reduce the symptoms of endometriosis. This diet has been shown to work on IBS and since it is often found with endometriosis, then perhaps the diet would be effective for those with only endometriosis.

More research is needed, but there is little harm in trying this approach.

Dietary choices have also been linked to the development of endometriosis. A study carried out in 2011 suggested that fruit intake increased the risk of endometriosis and a higher total fat intake decreased the risk.

Dairy products were also shown to reduce the risk of endometriosis, although these results were not statistically significant.

Eating yogurt, sauerkraut, and pickles or finding a good source of probiotics may help reduce gastrointestinal symptoms and cause increased digestive activity.

Avoiding caffeine may help to reduce pain, as caffeine can worsen symptoms.

We often hear that we should drink eight 8-ounce glasses of water a day. However, there is some controversy about this figure and what it really means.

Water is an essential nutrient. It is necessary to sustain all forms of life, and humans can only live a few days without it. It is also a healthful drink.

Health authorities and others often encourage people to consume 2 or more liters of water a day, but is this only plain water or does water from other sources count?

Some sources have described these recommendations as a “myth,” and professionals have questioned the guidelines.

Some point to a lack of scientific evidence to support the claims, while others note that promoters of the concept have included a major mineral water producer.

How much plain water do we really need?

Fast facts on water intake

Here are some key points about daily water consumption.

• Foods and fluids, including water, are the main source of water in our bodies.
• The advice to drink eight 8-ounce glasses of water a day is not based on evidence.
• The amount of water we need depends on individual needs and circumstances, including activity and climate.
• The healthy body naturally maintains a well-tuned balance of fluid, and the thirst mechanism tells us when we need more.

Recommended daily water intake

In 1945, the U.S. Food and Nutrition Board advised people to consume 2.5 liters (84.5 fluid ounces (fl oz) of water a day, including fluid from prepared foods.

Today, the Centers for Disease Control and Prevention (CDC) say, “There is no recommendation for how much plain water adults and youth should drink daily.” However, there are recommendations about total fluid intake from all sources.

In 2004, the Institute of Medicine set the amount at around 2.7 liters, or 91 fluid ounces (fl oz) of total water a day for women and an average of around 3.7 liters (125 fl oz) daily for men.

This refers to the total daily fluid intake from all sources, defined as “the amount of water consumed from foods, plain drinking water, and other beverages.”

The U.S. Dietary Guidelines 2015-2020 do not recommend a specific daily water or fluid intake, but they do recommend choosing plain rather than flavored water and juices with added sugar.

There is currently no set upper level for water intake, although excessive quantities have been known to have adverse effects.

In the United Kingdom, the National Health Service (NHS) recommend consuming 6 to 8 glasses a day, or 1.9 liters (almost 34 fl0.oz), including water that is in food. They note this amount is suitable for a temperate climate. In hotter climates, they say, more will be needed.

Recommended intake by age

There is no fixed amount of fluid recommended by age, but some patterns emerge among healthy individuals doing a moderate amount of activity in a temperate climate.

The following shows average water intake for infants and adults:

Age group	Average daily fluid intake
Infants	From 525 ml for a 3.5-kilo newborn to 1,200 ml for an 8-kilo infant per day, as breast or bottled milk
Adults aged 19 to 30 years	Average of 3.7 liters a day for men and 2.7 liters for women, depending on climate, activity, pregnancy status, and health

Infants

The amount of formula or breast milk an infant takes in averages 780 milliliters (ml), or just over 26 fl oz, of breast milk or formula milk each day until the age of around 6 months. Before the age of 6 months, plain water is not recommended.

This ranges from around 525 ml (just under 18 fl oz) a day for 3.5-kilo newborn to 1,200 ml per day (45 fl oz) for an 8-kilo infant at 6 months, or around 150 ml (5 fl oz) per kilo of weight per day.

This is proportionally far more than an adult needs. After infants start consuming solid foods, they need less fluid from breast milk and formula.

Children aged over 12 months

Children should be encouraged to drink water:

• as part of the daily routine, for example, after brushing teeth and before, during and after playtime at school
• when the weather is warm
• as an alternative to sweetened drinks and juices

Juice consumption should be limited to one glass a day.

Parents are advised to keep a pitcher handy to encourage healthful water-drinking habits, and schools should have water fountains or equivalent facilities.

Children who are sick with a fever

For children who are at risk of dehyration, for example, with a fever, the CDC recommend the following:

Age	Amount of fluid needed
Up to 12 months	3 cups
1 to 3 years	4 cups
4 to 8 years	5 cups
6 to 13 years	8 cups
14 years and over	11 to 13 cups for males and 8 to 9 cups for females

If a child is sick with a fever, it is important to seek medical help. A doctor may also advise oral an rehydration solution to ensure an adequate electrolyte balance.

Adults aged 19 to 30 years

The CDC cites figures showing that in 2005-2010 in the U.S., young people were drinking an average of 0.45 liters or 15 fl oz of water on a given day, while adults drank an average of 1.2 liters, or 39 fl oz.

The adequate intakes recommended for total water from all sources each day for most adults between 19 and 30 years of age are:

• 3.7 liters (or about 130 fl oz) for men
• 2.7 liters (about 95 fl oz) for women

One source suggests a man’s requirements might range from 2.5 liters (84.5 fl oz) if sedentary to up to 6 liters (203 fl oz) if active and living in a warm climate.

For women, the requirements will probably be 0.5 to 1 liter (17 to 34 fl oz) lower than those for men because of typically smaller body mass.

However, during pregnancy, women are likely to need an extra 0.3 liters (10 fl oz), and an additional 0.7 to 1.1 liters (23 to 37 fl oz) while breast-feeding.

Older adults

Older adults may be at risk of both dehydration and overhydration, as a result of health conditions, medications, loss of muscle mass, reduction in kidney function, and other factors.

Older adults who are well hydrated have been found to have:

• fewer falls
• less constipation
• in men, a lower risk of bladder cancer

Dehydration has been linked to a higher frequency of:

• urinary tract infections
• confusion
• kidney failure
• slower wound healing

Needs for fluid intake will depend on the individual.

Few studies have looked at fluid input and output in older people, but at least one has concluded that it is not significantly different from that of younger people.

Those caring for older people are encouraged to provide fluids regularly and assist with ambulation, especially if a reduction in mobility makes it harder to visit the bathroom.

Where do the figures come from?

While water is known to be crucial for life and for preventing dehydration, recommendations for intake are based mainly on survey results showing the average amounts that people consume.

Conclusions are based on the assumption that these amounts must be about right for optimal hydration.

There is little evidence showing that specific quantities have a particular effect on health.

It is impossible to define an optimal intake, because these vary greatly according to:

• activity
• environmental conditions
• individual factors
• body mass
• sex and age
• health status, for example, poor kidney function
• medications, such as diuretics
• whether or not a person is pregnant or breast-feeding

Recommendations that a person should drink eight glasses of water a day also fail to take into account the fact that much of our fluid intake comes from food and other drinks.

Sources of water

Water in the body comes not only from drinking water.

Estimations vary, but according to one source:

• around 20 to 30 percent comes from food
• some 60 to 70 percent comes from drinking water and other fluids
• a small percentage, about 10 percent is “metabolic water,” produced by cells during normal cell function

The more active the body is, the more metabolic water is produced.

Some surveys suggest that around 20 percent of water intake comes from foodstuffs and the rest is from fluids. This depends on diet. A higher intake of fresh fruit and vegetables will mean a higher intake of water from foods.

Metabolic water accounts for around 250 to 350 ml (8.4 to 11.8 fl oz) a day.

Water content of foods

Here are some examples of the water content of different foods and fluids:

Water content as a percentage (%)	Food or drink
100%	Water
90-99%	Fat-free milk, tea, coffee, juicy fruits such as strawberries and cantaloupes, vegetables such as lettuce, celery, and spinach
80-89%	Fruit juice, yogurt, fruits such as apples, pears and oranges, vegetables such as carrots, and cooked broccoli
70-79%	Bananas, avocados, baked potatoes, cottage and ricotta cheeses
60-69%	Pasta, beans, and peas, fish such as salmon, chicken breasts, and ice cream
30-39%	Bread, bagels, and cheddar cheese
1-9%	Nuts, chocolate cookies, crackers, cereals
0%	Oils and sugars

Tap or bottled water?

Bottled or tap water are equally effective at hydrating the body. In terms of hydration, studies in the UK have not found any significant difference between drinking the two.

Mineral waters contain different amounts of minerals, depending on where they come from, but this, too is not significant, as most minerals come from other dietary sources.

What about coffee?

Caffeinated drinks are thought to be dehydrating as opposed to hydrating because of a belief that they have a diuretic effect on our water balance.

A number of studies to test how caffeinated fluids affect hydration have shown that tea and coffee are in fact good sources of water and do not lead to dehydration.

One study of 18 healthy male adults found that no significant difference in impact on hydration, measured in body weight, urine and blood tests after a variety of caffeinated, non-caffeinated, caloric, and non-caloric drinks.

“Advising people to disregard caffeinated beverages as part of the daily fluid intake is not substantiated,” say the researchers.

Another concludes that there is “no evidence of dehydration with moderate daily coffee intake.”

Benefits of drinking water

Water is necessary for the body. It:

• regulates temperature
• lubricates the joints and bones
• protects the spinal cord and other sensitive tissues
• removes waste from the body

Short-term benefits

A healthy fluid intake, including water, prevents dehydration.

The short-term symptoms of significant dehydration include:

• unclear thinking
• mood change
• overheating
• feeling thirsty and having a dry mouth
• fatigue
• dizziness
• headache
• dry mouth, eyes, and lips
• urinating less than usual

Overheating can lead to organ damage, coma, and death.

The CDC urge people to make sure they drink enough water before, during, and after physical work, especially if this involves activity in a hot climate. This can help maintain alertness and effectiveness.

In a hot environment, you may need one 8-ounce cup every 15-20 minutes, but not more than 48 ounces in one hour, as this can lead to hyponatremia, a low level of sodium.

Plain water provides hydration without adding calories or jeopardizing dental health. Sports drinks can be useful in moderation, but too many will add unnecessary sugar to the body.

Long-term benefits

Studies suggest that long-term benefits of drinking water might include a lower risk of:

• colorectal cancer and cancers of the urinary system
• heart disease
• urinary tract infections
• kidney stones
• constipation
• high blood pressure
• stroke

However, these possible long-term benefits also depend on a wide variety of other factors.

In addition, study participants with the lower risk of these conditions still drank fewer than eight 8-ounce glasses of water a day.

Weight loss

Drinking water may also help with weight loss, if a person “preloads” with water before a meal. This may help them feel fuller faster during meals. If they choose water over sweetened juice or soda, they consume fewer calories.

In a study where 318 people with obesity or overweight switched from sugary drinks to plain water, an average loss of 2 to 2.5 percent in weight was noted. But this could be easily explained by a decrease in total calories rather than water itself.

Other possible benefits

Other supposed benefits of drinking more water include prevention of:

• migraine
• nosebleeds
• depression
• high blood pressure
• asthma
• dry cough
• dry skin
• acne

However, there is little or no scientific evidence to confirm these claims.

In children, a higher water consumption has been linked to better diets, behavior and overall health.

When is more water needed?

Extra water may be needed when a person:

• is in a hot climate
• is doing physical activity
• has diarrhea or vomiting
• has a fever

These can lead to additional loss of water.

What about a water detox?

There have also been claims that water can “detox” the body.

These claims are not based on scientific facts.

The liver, kidneys, and human body normally break down toxic substances into less harmful ones or expel them from the body through urine. Water does not have a unique role in these processes.

Too much water can lead to hyponatremia, also known as low sodium. Low sodium levels can be life-threatening causing confusion, seizures, coma and death.

Hydration during exercise

During exercise, factors affecting the amount of fluid lost and the need for extra intake include:

• the type and intensity of the activity
• environmental factors, such as climate
• the size and muscle mass of the athlete

Guidance from the American College of Sports Medicine (ACSM), published in 2007, recommends making an individual estimation of the fluid replacement needed by people taking part in exercise, to avoid dehydration.

Larger athletes may require higher fluid intake, for example, compared with smaller, leaner athletes, due to a larger body surface and higher body weight.

The ACSM advises drinking water during activity to prevent:

• dehydration that leads to a fall in body weight of more than 2 percent
• changes in the electrolyte balance

These changes, they say, can lead to reduced performance.

However, a study published in the British Journal of Sports Medicine concludes that a loss of up to 3 percent of water has “no effect” on real-world sports performance.

The conclusions were supported by findings from a cycling time-trial over 25 kilometers in hot conditions of 91.4° Fahrenheit and 40 percent relative humidity.

Results showed no difference in performance, physiological, and perceptual variables between participants who received hydration and those who did not.

The reason for this, say the authors, is “the body’s rapid defense of its plasma and blood volume following dehydration.”

In other words, the body can regulate water balance with high sensitivity.

Authors of a study focusing on runners in the 2002 Boston Marathon, published in the New England Journal of Medicine (NEJM), concluded:

“Because runners vary considerably in size and in rates of perspiration, general recommendations regarding specific volumes of fluids and frequencies of intake are probably unsafe and have been superseded by recommendations favoring thirst or individual perspiration rates as a primary guide.”

A review of 15 studies found that exercise-induced dehydration did not reduce performance. The authors encouraged athletes to “drink according to their thirst.”

Water and dehydration in the human body

Dehydration can be measured in terms of blood and urine osmolality.

Osmolality is an estimation of the osmolar concentration of plasma. It reflects the concentration of particles in a solution.

As regards dehydration:

• high osmolality indicates a greater need for hydration
• low osmolality suggests there are too few particles, specifically sodium and electrolytes, a sign of overhydration

How much water is in the human body?

The main chemical making up the human body is water. It accounts for between 55 percent and 75 percent of the body’s composition, and it varies between individuals.

• in the average young man, between 50 and 70 percent of the body weight is water
• in infants, 75 percent of body weight is water
• in older people, it is 55 percent

Differences of age, sex, and aerobic fitness affect an individual’s ratio of lean to fat body mass and therefore how much water they contain.

Calculating human water needs

The amount of water we need to take in to maintain a healthy balance is decided by how much water we use and lose that must be replaced.

Over the course of 24 hours, healthy resting adults regulate their water balance to within around 0.2 percent of body weight.

In older children and adults, if a person’s body weight falls by 3 percent due to fluid loss, this is considered dehydration. Moderate dehydration is when weight falls by 6 percent, and severe dehydration is when it falls by 9 percent.

It is difficult to measure the amount of water used or lost by the body. Measures taken across groups of people in studies have shown wide variation.

However, if people show symptoms of dehydration, such as confusion or decreased urine output, they need medical attention.

What about dark urine?

There is a popular concept that darker urine means a person is dehydrated, while pale urine shows they are adequately hydrated.

However, it is difficult to assess the significance of urine color precisely. It depends on the time of day, medications, and other health problems.

Tea- or cola-colored urine, particularly after exercise, can indicate serious muscle injury and severe dehydration and requires urgent medical attention.

However, in normal circumstances, urine that is well within the limits of normal osmolality in laboratory tests can appear moderately yellow. This does not indicate that a person is dehydrated.

In addition, other factors such as diet, medications and health conditions can cause individuals to differ in their urine color.

How does the body regulate water?

Without water, there is no life. For this reason, all living organisms have adapted to avoid dehydration.

Humans can only survive for a few days without water. Infants and older people who lose water through illness and do not replace it can experience life-threatening complications.

Most of the time, however, our bodies’ sensitive natural mechanisms maintain appropriate fluid levels, or homeostasis, as long as we continue to consume food and water.

The two main ways the body does this are:

Thirst: This which tells us when we need to take in more fluid.

Urine output: The kidneys regulate any excess or lack of the water we consume by either emptying it into the urinary bladder or holding onto it in the blood plasma.

The body expels 0.5 to 1 liter (around 17 to 34 fl oz) per day in the form of urine.

The kidneys also:

• regulate the balance of electrolytes, such as sodium and potassium, in the body fluids
• receive hormonal signals to conserve or release water into the urine if the brain detects changes in the concentration of the solutes in the blood

The brain also responds to these changes in solutes, known as plasma osmolality. This is one factor that triggers the thirst for water.

Other ways in which water is lost or expelled from the body are:

Breathing: About 250-350 ml (8.5 to 11.8 fl oz) per day exit from the lungs during. exhalation

Feces: Around 100-200 ml (3.4 to 6.8 fl oz) per day passes out of the body in feces.

Sweating: Sedentary loss ranges from around 1,300-3,450 ml (44 to 117 fl oz) a day, but a physically active person can lose 1,550-6,730 ml (52 to 227.5 fl oz) a day

What about ‘8 by 8’?

It is often said that we needed to drink at least eight glasses of water a day, although there is little scientific evidence to support this.

Prof. Heinz Valtin, of Dartmouth Medical School in Hanover, NH, is one expert who has questioned this advice. He suggests it may be not only unnecessary but maybe even harmful.

In an article published in the American Journal of Physiology in 2002, he concludes:

“Not only is there no scientific evidence that we need to drink that much, but the [8 by 8] recommendation could be harmful, both in precipitating potentially dangerous hyponatremia and exposure to pollutants, and also in making many people feel guilty for not drinking enough.”

Prof. Heinz Valtin

The right types of fluid

Recommendations are now more likely to note that water can come from other beverages and from food. However, these should be chosen carefully.

Beverages that are high in fat or sugar or contain alcohol do not benefit health, and plain water is recommended in preference to these.

More than one alcoholic beverage per day in women and more than two alcoholic beverages per day in men on a regular basis can lead to liver inflammation and injury, an increased cancer risk, as well as negatively affecting every system of the body.

Fatty or sweetened drinks increase calories and lack nutritional value.

Processed foods, such as burgers and chips, high fat, and high sugar diets will contain less water than fresh fruits and vegetables.

Nearly all foods contain water, but fresh and healthful ingredients contain the most compared to processed foods, sugars, and fats.

The CDC note with concern that young people who consume high quantities of junk food are also drinking less water and eating less fresh fruit and vegetables. This can lead to further health problems. They are also often drinking highly sweetened beverages rather than water.

A study published by the CDC in 2013 showed that:

• Seven percent of adults said they did not drink any water
• Thirty-six percent said they drank 1 to 3 cups a day
• Thirty-five percent reported drinking 4 to 7 cups
• Twenty-two percent said they drank 8 cups or more

Those who drank the least water were also less likely to pursue other healthful behaviors, such as consuming fresh fruits and vegetables.

Too much water?

Some have raised concerns that consuming too much water could be dangerous.

Not only the amount of fluid in the body but the balance of minerals that is important for maintaining health and life.

Too much water in the body could lead to hyponatremia, or water intoxication, when sodium levels in the blood plasma become too low.

Symptoms include:

• lung congestion
• brain swelling
• headache
• fatigue and lethargy
• confusion
• vomiting
• seizures
• coma
• death

Hyponatremia may be a risk for people who use the recreational drug Ecstasy. This is likely due to a variety of reasons including a change in hormone levels, brain chemistry, body function, kidney function, along with increased sweating and thirst.

People who drink too much water while exercising could also be at risk. In the Boston runners survey, for example, almost 2,000 of the participants were thought likely to have some degree of hyponatremia due to excessive fluid consumption, and 90 may have finished with critical hyponatremia.

Another risk factor is having certain diseases or using some medications. Diabetes, for example, can lead to excessive thirst. Conditions in which the kidneys cannot excrete enough water, too, can result in this type of problem.

However, just as the body can adapt to higher or lower levels of water and can remind us, through thirst, when we need to drink more, scientists believe an internal mechanism also stops most people from drinking too much water.

Takeaway

There are few scientific measures of how much water we need.

Most studies have focused on how much people consume and assumed that this figure matches or exceeds our needs. It does not determine whether a person is efficiently hydrated or not.

The amount of water a person uses and loses varies according to conditions and activities. Heat, activity, and illness, such as diarrhea and vomiting, can lead to dehydration.

Most healthy people in a temperate climate consume sufficient fluid to remain healthy while carrying out their daily activities, and around one fifth to a quarter of this comes from food. Where there is a lack, the body will usually regulate these needs.

Meanwhile, those who work outside or exercise in a hot climate will not be able to get all their water needs from food. They will need additional water.

Perhaps, as Prof. Farrell of Monash University says, “If we just do what our body tells us, we will probably get it right.”

Q:

Should people aim to consume a particular quantity of water each day?

A:

The most recent research supports the theory that thirst is the best guide for determining fluid intake. For the average individual, even in routine physical activity, allow thirst to determine when and how much you drink. 

Those with certain medical conditions, such as kidney disease or heart failure, may need to follow their doctor’s advice regarding daily fluid intake in order to avoid the complications of low sodium levels in their blood.

Judith Marcin, MD

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.