Healing Foods Pyramid™

waterWater is included in the Healing Foods Pyramid™ as part of a balanced, whole foods, plant-based diet. This Food Pyramid emphasizes foods that nourish the body, sustain energy over time, contain healing qualities and essential nutrients, and support a sustainable environment.

What are the recommended servings of water per day?

In 2004 the Institute of Medicine published the following recommendations for average daily total water intake in healthy individuals:

While many individuals allow thirst to guide their daily water intake, this may lead to inadequate consumption. By the time you experience thirst, your body fluids are already depleted. Furthermore, in individuals who are ill, infants, athletes and those living in hot environments, sense of thirst is not an adequate reflection of water needs.

Why should you drink water?

When is it important to increase your water consumption?

Fluid requirements increase due to exercise, environmental factors, fever, diarrhea, certain illnesses, pregnancy, and other conditions



Short bouts of exercise:
Consume an extra 1.5 to 2.5 cups of water

Intense exercise lasting >1 hour:
During sustained hard exercise, especially in a hot environment, you need at least 2 cups of water before exercising and 1 cup of water every 20 minutes while exercising.

Pregnant women should drink 2.3 liters (about 10 cups) per day

Women who breastfeed should drink 3.1 liters (about 13 cups) per day.



Increase fluid intake under these conditions:

  • Hot or humid climates
  • During/after sun exposure
  • In heated, indoor air
  • In cold weather while wearing insulated clothing
  • At high altitudes

Increase fluid intake when tolerable. Avoid milk, instead consume clear fluids such as: water, tea, juice, or carbonated water when possible.


Increase fluid intake when tolerable. Consume at least the daily recommendation of water and electrolytes throughout the day.

Solution for Rehydration after Sustained Exercise

Research shows that individuals who consume food and water within the two hours after exercise rehydrate better that those who drink water or sports drinks. So enjoy a balanced meal or snack that includes fresh fruit and/or vegetables with a large glass of water for optimal recovery after sustained exercise.

Dietary Sources

Specific Considerations


Too little water can lead to dehydration, a condition that occurs when you do not have enough water in your body to carry out normal functions. Even mild dehydration can make you tired. Signs and symptoms of dehydration include:



Poor skin turgor
Skin tenting on forehead
Decreased urine output
Dark yellow urine
Sunken eyes
Dry mucus membranes

Excessive thirst
Dry mouth
Little or no urination
Muscle weakness


Drinking Too Much Water

Chlorine and Lead

Chlorine and lead are the two most common contaminants in tap and some bottled water. Although it may serve an important role in a public water supply, chlorine is a strong oxidizing agent and may increase the risk of heart disease and certain cancers. Small amounts of lead may be toxic, especially in infants, children, and pregnant women. The following are some ideas to increase the likelihood that your drinking water is safe:


Signs of appropriate water consumption

Ideas to Increase Water Consumption


National Toxicology Program
National Institute of Environmental Health Sciences
Accessed November 15, 2009

Dietary Intake for Water, Salt, and Potassium
National Academies
Accessed July 28, 2009

Mayo Clinic
Accessed July 28, 2009

Nutrition Fact Sheet: Water
Northwestern University
Accessed July 28, 2009

Soda: Does it Increase the Risk of Osteoporosis?
Mayo Clinic
Accessed July 28, 2009

The Wonders of Water
Accessed July 28, 2009

Water: How much should you drink every day?
Mayo Clinic
Accessed July 28, 2009

Water, Water Everywhere. How Much Should You Drink?
American Dietetics Association
Accessed July 28, 2009

Why You Should Drink More Water
University of Iowa Health Care
Accessed July 28, 2009

The Wildcat Way to Wellness: Water is the Liquid of Life
University of Kentucky Cooperative Extension Service
Accessed July 28, 2009

Water and Hydration
University of Arizona
Accessed July 29, 2009

Original Research and Review Articles

Almond C, et al. Hyponatremia among Runners in the Boston Marathon. The New England Journal of Medicine. 2005; 352:1550-1556.

Altieri A, et al. Fluid intake and risk of bladder and other cancers. European Journal of Clinical Nutrition. 2003;57(Suppl 2):S59 -S68.

Armstrong L, Caffeine, Body Fluid-Electrolyte Balance, and Exercise Performance. International Journal of Sport Nutrition and Exercise Metabolism. 2002; 12: 189-206.

Backer, H. Wilderness First Aid: Emergency Care for Remote Locations, Sudbury, 2005, Jones & Bartlett Publishers.

Campbell SM. Hydration Needs Throughout the Lifespan. Journal of the American College of Nutrition. 2007;26(5):585S-587S.

Chalupka S. Tainted Water on Tap: What to tell patients about preventing illness from drinking water. The American Journal of Nursing. 2005;105(11):40 -52.

Gray M, et al. Does fluid intake influence the risk for urinary incontinence, urinary tract infection and bladder cancer? Journal of Wound, Ostomy, and Continence Nursing. 2003;30(3):126 -131.

Lin M, et al. Disorders of water imbalance. Emergency Medicine Clinics of North America. 2005; 23(3):749-70.

Manz F, et al. The importance of good hydration for the prevention of chronic diseases. Nutrition Reviews. 2005;63(6):S2 -S5.

Von Duvillard S, et al. Fluids and Hydration in Prolonged Endurance Performance. Nutrition. 2004; 20: 651-656.

The Healing Foods Pyramid™ was created by the Nutrition Education Team at the University of Michigan Integrative Medicine, Department of Family Medicine in 2005 and updated in 2009.