Managing Heat Stroke, Heat Exhaustion and Weight Reduction by Drinking Cold Water?

 Managing Heat Stroke and Weight Reduction by Drinking Cold Water?

Recently it was reported in a local newspaper that the temperature in Singapore soars to 40-year high here:

https://www.malaymail.com/news/singapore/2023/05/13/temperature-in-singapore-soars-to-40-year-high/69090

So was it almost the same in Malaysia, Thailand, Loas, India and elsewhere recently where tar on the road in India melted in blistering heat.

https://thewire.in/environment/climate-change-april-2023-heat-wave-india#:~:text=They%20found%20that%20climate%20change,the%20Heat%20Index%20than%20before.

The temperature of the heat wave that struck Singapore was the same as the temperature of the human body at 37 ⁰ C.  This also means that the body heat generated by those living in Singapore hardly can be lost into the air even if they sweat profusely due to the very high humidity normally between 98 – 100 % in the tropics especially if there is no wind, and even if there was, it would have little cooling effect as the air is already saturated with water vapour. It would not be able to pick up more moisture such as sweat from the skin. There would be very little loss of heat or drop in skin or body temperature through the latent heat of evaporation

What would happen if the body temperature rose above 37 degrees Celsius if the extra heat cannot be dissipated into the environment? Generally, this would result in either a heat exhaustion or a heat stroke.  Heat exhaustion happens when your body loses excess amounts of water and salt, typically from sweating. In contrast, a heat stroke is a serious medical emergency that occurs when the body is unable to control its internal temperature.

When I explained this, a friend whose child experienced a heat stroke brought her to see a doctor thinking it was a fever. The doctor prescribed Panadol (paracetamol) for her daughter. When I heard this, I was taken aback by that prescription / treatment.

Let this be very clear to everyone, including doctors, a heat stroke though the body temperature rises above 37 degrees Celsius is not a fever caused by internal trigger factors such as an infection. The body's increase in temperature is brought about by the environment, an external factor beyond the control of the body to control, other than by sweating, regulated by the hypothalamus in the brain.

It must be very clear to everyone including clinicians that giving an antipyretic drug such as paracetamol is contraindicated in heat exhaustion or in an event of the more serious heat stroke. I was very surprised the doctor prescribed paracetamol to bring the “fever” down. This was absolutely the wrong treatment approach.  Never, never give Panadol or any antipyretic drug or NSAIDs to any person whose body temperature is high due to heat stroke. In doing so they are doing the reverse of what the body is trying to do getting rid of the excess heat.  Antipyretic agents (anti fever drugs) shut down the thermoregulatory mechanisms in the hypothalamus. In doing so, the body overheats further instead.  The body is unable to sweat to cool the body.  

In other words, the doctor who gave the paracetamol was actually blocking the body's attempt to physically get rid of the excess heat through sweating in its attempt to radiate out the heat through sweat and the skin. This is not an ordinary fever in that sense caused internally by an infection

What that doctor did by suppressing the so-called "fever" using paracetamol is going against the norm in managing a heat stroke. He was obviously doing the reverse of what the body was attempting to do through sweating.  The increase in body temperature is due to overheating of the body from outside in the environment, and must never, never be suppressed using paracetamol or any antipyretic drug.

It is very unfortunate doctors are very fond of prescribing drugs for almost anything. Their training and mindset are like that, being brainwashed by the pharmaceutical companies all out to promote drugs to doctors literally for every complaint the patient presents.  The patient goes to consult a doctor for a minor complaint. He goes into his consultation room empty handed for medical advice but comes out with several packets of chemical drugs to take home to "cure" his symptoms. This has been going on rampantly as long as I can remember.

The appropriate management for heat stroke is to lower the body temperature physically, not chemically using fever-reducing medications. This is wrong.

The way to get rid of the excess heat physically is, first bring the patient into a shade away from the sun which is most important. Then remove all thick and tight clothing before sponging the body with cool water. Even this is not very effective if the heat stroke is very severe. Sponging the head, neck, arms, armpits, body is not very effective if there is no wind, or if the humidity is 100 % or near saturation as the latent heat of evaporation cannot be affected.

The best approach if possible is to bathe the entire body in running water using lukewarm water from a water heater mixed with cold water initially at a temperature just about 2 degrees (35 degrees Celsius) below body temperature (37 degree Celsius). Let the water run for at least 10 minutes to remove as much body heat as possible since running water is an excellent conductor of heat.

After 10 minute, lower the water temperature slowly till a cold shower. This is because when the body is overheated, the body attempts to get rid of the excess heat by dilating the subcutaneous microcirculation (peripheral circulation) just below the skin. The skin becomes blushed, red and hot as the body attempts to radiate out the heat through the skin through sweating hoping the sweat would evaporate in the wind especially in low humidity. This is a physical therapy that does not require any drug, antipyretic that would strongly be contraindicated if prescribed or used.

If a heat stroke victim is suddenly bathed in ice cold water what happens is, the microcirculation beneath the skin will contract and shut down by reflex response, trapping the heat below the skin and inside deeper within the body. The excess heat can ever get out and radiate into the surrounding and carried away by the extremely cold water. The doctor / nurse/ rescuer needs to lower the temperature of the water slowly by one degree per minute if possible. Then the skin adapts to the gradual change in water temperature and will not shut down its subcutaneous microcirculation. In this way the running water will conduct away the excess body heat very effectively and very rapidly

Never, never use drugs, Panadol or aspirin to block the increase in body temperature. Neither use NSAIDs (nonsteroidal anti-inflammatory drugs). This heat ("fever") is not coming from the body itself that needs to be blocked. It is coming from outside in the environment. It is physical, it is external, and not an internal biochemical response from inside the body. This should never be blocked by any chemical blockers and inhibitors.

How could that doctor give Panadol to treat the so-called "fever" due heat exhaustion and heat stroke? His "prescription" truly amazes me as a doctor myself.  What kind of a "doctor" was he?  

Concomitantly while sponging, or the best way to cool down an overheated body is  by bathing under  cool running water, is to give him a drink of cold water periodically (only if he is conscious) so that cold water in, warm urine out.

This cycles of cold drink in, and warm urine  out, tremendously extract out the heat from inside  Do this in cycles as often as possible

Let's have a look how this works

It requires 4,184 Joules of heat (1 kilocalorie = 1,000 calories) to raise the  temperature of one kilogram (1 litre) of water to 1°C

Hence if you drink one litre of cold water at 15 degrees Celsius,  it will raise the temperature of urine to body temperature at 37 degrees Celsius, a 22 degree difference. This is a lot of heat extracted out internally vs externally through the skin by sponging or by bathing through gradual lowering down the water temperature

For instance, if just one litre of cold water, say at 20 degrees C is drunk, and the output of urine a few hours later is normally at body temperature (37 ⁰ C) the difference in temperature is 17 degrees. Calculated, you are already extracting 17,000 calories (17 kilocalories or 71.4 kilojoules of heat) out from the body.

(1 big Calorie = 1 kilocalorie = 4.2 kJ).

The average daily energy intake from food of an average Malaysian is about 1,800 to 2,300 kilocalories depending on physical activities, age, sex, body weight among other factors. Let us say the average intake of a reference Malaysian male is 2,000 kilocalories.  By drinking I litre of water at 20 degrees C, resulting in a urinary output at 37 degree C, this is already 0.85 % of the heat generated through food in one day.    

This physical therapeutic modality by sponging with a fan switch on, at low humidity or bathing in cool water for 30 minutes is extremely effective in managing heat stroke. It is the opposite of using chemical drugs to suppress the heat from coming out.

In summary, a doctor colleague once asked me if it was possible to drink very cold water to reduce body weight by ‘burning off’ (extracting) extra heat into the urine? This was also asked by many too frequently.

My answer to her, and to all who believe or asked is, a big NO. You can see for yourself in my calculation, drinking a litre of very cold water at 20 ⁰ C, you only managed to drain off 0.85 % of the heat generated by the food we eat daily, and even if we care to drink 4 litres of water for this purpose at a temperature of 10 degrees C, you only manage to get rid of 108,000 calories. This is only 4.7 % of the daily energy intake from food.

The only and only way to reduce weight is to drastically cut down food intake. Even exercise does not help much. For instance, if your body weight is 70 kg, and you decide to lose weight by running for 4 hours for 10 km at a running pace of 24 min per km, you would only burn off 1764 kilocalories (7409 kilojoules) which is only 77 % of the energy from the 2300 kilocalories of food you eat. You might as well not run so hard till you collapse, but instead eat less. It is much safer and easier to eat less.  That is the only way to lose weight. There is no other easy way. Not just eating less reduces weight. It has been shown in over 100 studies since the time of Clive McCay experiment in the 1930's that there is a very strong correlation between caloric restriction and longevity.

 You cannot gain or lose something from nothing. Just eat less, especially caloric-rich foods. That’s the immortal and fixed laws of physics, chemistry, nutrition, medicine, biology, astronomy, evolutionary biology, food science, toxicology, forensic science, literally all sciences we can never run away from. Don’t believe in any “slimming programme”. They don’t work long term.

By drinking 4 litres of water in the belief you would lose weight, you will run into the risk of water intoxication with symptoms of confusion, disorientation, nausea, and vomiting, drowsiness, confusion, double vision, difficulty in breathing, increased in blood pressure, and in rare cases, brain oedema (swelling in the brain) increased in ICP (intracranial pressure) which is fatal.

You can get this from me as gospel truth.

lim ju boo