Water is medicine—but it’s also full of medications

Is water medicine? Metaphorically speaking, yes, and sometimes quite literally.Calgary’s recent catastrophic main water line break and resultant water restrictions certainly got me thinking a lot about water lately.The human body is composed of up to 60% of water. The substance plays a crucial role in human physiology, including gastrointestinal and renal processes, maintenance of body temperature as well as skin and joints, to name a few. It is estimated that we can only live a few days without water. Wilderness guides often refer to the “rule of 3,” which says a person can live for three minutes without air (oxygen), three days without water, and three weeks without food. Dehydration can happen quickly especially in hotter conditions, causing extreme thirst, fatigue and ultimately, organ failure and death. We need water to live.Read: All about drugs: Project cuts levels of pharmaceuticals found in water supplyThe breadth of this topic is as big as life itself. Without water, there would not be life as we know it on Earth. Quoting from a University of Wisconsin museum exhibition, the succinct lines, “Water sustains life on our planet and intersects with all aspects of it. It serves as a constant muse for artists, an endless medium for scientific exploration, and a centerpiece of cultural expression and sacred practices.” I simply cannot say it better than that.We could do a deep dive into human physiology and cell biology, but I'm no expert in this. Likewise, my rudimentary knowledge is inadequate to explore the spiritual world of our First Nations people regarding water and the importance of its stewardship. This crucial discussion needs to occur if we are to sustain the health of our planet for our grandchildren and their grandchildren. Perhaps when I am thirsty for a bit of controversy, I'll wade into the massive business of bottled water, home filtration systems, ionized or alkaline water.More in keeping with my usual writing, how about water in song lyrics? “River of Dreams” by Billy Joel, “Water” by The Who, “Have You Ever Seen the Rain?” by Creedence Clearwater Revival, “The River” by Bruce Springsteen, “Rain” by the Beatles, “(Sitting on the) Dock of the Bay” by Otis Redding to name just a few. While entertaining, I do want to dive a little deeper into this subject. For all the MDs and pharmacists out there, how about . . . water as medicine because it is full of medication! Read: Should considering pollution have a place in prescribing practices?If you live in a city or reasonably sized municipality, the water flowing out your tap is generally clear, clean and safe. It is monitored for contamination by bacteria, viruses, pesticides, various chemicals such as petroleum products, acids and metals. Water quality experts are increasingly concerned about finding traces of prescription and OTC drugs in our water systems. While the effects on humans has not been well elucidated, the deleterious effect on aquatic life is being demonstrated. Research on lakes, rivers and streams are showing chemicals from drugs are present and quantifiable. While large agricultural facilities and pharmaceutical “pill factories” could be cited as a source of this pollution, the consumer is likely the biggest culprit. Our bodies metabolize a fraction of the pills we ingest, the rest being excreted through urine and feces. This goes directly into our waste water and eventually back into our water systems. Medicinal gels, lotions and creams are additional sources of contamination. Another major contributor is our propensity to flush things down the toilet. As we are told to, we get rid of our unused medication (and there are a LOT, as we know). Unfortunately, this is commonly down the drain and not in containers taken back to pharmacies. Medical institutions, most notably nursing homes may be big culprits for discarding pharmaceuticals and personal care products. Sewage treatment plants are not designed to remove all pharmaceutical chemicals from our drinking water. Thankfully a lot of processes used on both the sewage side as well as the water treatment side help degrade and remove a substantial amount of these compounds. Most chemicals found are well below any level that would be therapeutic in humans. Nevertheless American studies starting back in 2007 in a number of states have confirmed consistent and ongoing traces of a multitude of medications that we prescribe on a daily basis. The list of drugs found in our drinking water include: Antibiotics, antidepressantsblood thinnersheart medications (ACE inhibitors, ARBs, calcium-channel blockers, digoxin)hormones (estrogen, progesterone, testosterone)NSAIDs, painkillerscarbamazepinefibratesThis list is certainly not exhaustive and changes with our evolving prescribing habits. Issues with hormonal contamination has likely been most newsworthy. Quoting from an excellent Harvard Health article: “Numerous studies have shown that estrogen and chemicals that behave like it have a feminizing effect on male fish and can alter female-to-male ratios. Sources of estrogen include birth control pills and postmenopausal hormone treatments, as well as the estrogen that women produce naturally and excrete. Intersex fish—creatures with both male and female sex characteristics—have been found in heavily polluted sections of the Potomac River. Studies of fish upstream and downstream of wastewater treatment plants have found more female and intersex fish downstream from the plants, presumably because of the higher estrogen levels in the downstream water”. So how do we keep our medicinal water free of our medicines? Public education, stricter government surveillance and regulation, especially in the food and agriculture sectors, as well as encouragement that we all dispose of our medications properly, are all viable strategies. We can be meticulous of our own clinical practices in regard to management of out-dated drug samples. We can certainly encourage our patients to use their local pharmacies to properly dispose of their unused medications or use formal “drug take back” programs. We may not be able to fully resolve this issue, but hopefully we can do much better at limiting the damage overall. We need to protect our water. Water is life. Dr. Ted Jablonski is a performing artist and writer who has retired his family practice to focus on sexual medicine and transgender health in Southern Alberta with two feet still on the front-line trenches of acute primary care.

Water is medicine—but it’s also full of medications

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