Bottled Water Reporter

W W W. B O T T L E D W AT E R . O R G

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IN THIS ISSUE Why Consumer How to Talk Choice of Bottled Healthy Hydration Water Is Important With Legislators

What You Need to Know About FSMA's IA Rule

BOTTLED WATER REPORTER | JAN/FEB 2017

THE HEALTHY HYDRATION ISSUE

Why Drink Water?

How Much Water Should You Drink?

Does Drinking Water Affect Your Mood?

A PUBLICATION OF THE INTERNATIONAL BOTTLED WATER ASSOCIATION

VOL. 57 • NO. 1

COLUMNS GOVERNMENT RELATIONS

28 | Making the Political Argument for Healthy Hydration How to discuss the health benefits of water consumption with legislators.

COMMUNICATIONS

30 | Bottled Water’s Popularity Tells an Important—and Healthy—Story Why it’s important that consumers are increasingly choosing bottled water.

TECHNICAL UPDATE

32 | Understanding FSMA’s Intentional Adulteration Rule How the rule aims to prevent intentional adulteration.

CONTENTS TABLE OF CONTENTS

DEPARTMENTS CHAIRWOMAN'S COMMENTARY...........................2

10 | Why Drink Water?

PRESIDENT’S MESSAGE.......................................4

When you ask three hydration experts why people should drink water, what advice do they give? By Harold Goldstein, DrPH; Stavros A. Kavouras, PhD; and Jodi D. Stookey, PhD

CPO QUIZ..........................................................34

14 | How Much Water Should You Drink?

Global recommendations on water intake vary. Where does recent research stand?

By Roselyne Y. Wagner, PhD, and Isabelle Guelinckx, PhD

20 | Drink More Water Each Day to Optimize Mood and Mental Tasks (Part I of II) If you want to optimize your mood and cognitive processes, science shows why you should drink water daily. By Lawrence E. Armstrong, PhD

24 | The National Drinking Water Alliance: Who We Are, What We Do, and Why You Should Care Water is the business of IBWA members, but it’s also the business of the National Drinking Water Alliance. How can we work together to promote water as an essential part of a healthy diet? By Christina Hecht, PhD

WATER NOTES.....................................................6 ADVERTISERS....................................................35 CALENDAR........................................................35 CLASSIFIEDS.....................................................35

CONNECT WITH IBWA

BOTTLED WATER REPORTER, Volume 57, Number 1.

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IBWA IBWA

International Bottled Water Association

CHAIRWOMAN’S COMMENTARY

WE JUST CAN’T LIVE WITHOUT IT! I’ve often said that you can live without many things in your life, but you can’t live without water—bottled or not.

As we pursue our busy daily schedules, having a convenient bottle of water should be a constant for all of us for many reasons. For starts, two-thirds of our bodies are water.

Studies have shown that drinking water can be helpful with losing weight. Drinking water before a meal may allow you to eat less because you feel full from drinking the water. Research has also demonstrated that water may help to lubricate our joints by keeping the cartilage that surrounds our joints healthy.

Many years ago, I attended a talk on a college campus given by a famous comedian.

He lectured the students about not drinking enough water and on how dehydration was robbing them of their ability to remain alert in class and focus on their studies. He referenced studies on college students who were required to concentrate for extended periods of time and, in the absence of drinking water before the task, were found to be unable to maintain their attention spans.

We also know that drinking water helps our bodies with elimination and can help to prevent constipation. Water also helps our kidneys and liver by flushing waste products from our bodies.

While all the above is helpful information, we simply need to remember that drinking water is good for you! Sitting at your office desk during the day, watching your favorite television show in the evening, enjoying a great meal with family and friends, working out in your home or local gym—these are all fantastic opportunities to have a bottled water handy. For me, I keep bottled water in my car for my commute to and from the office in the Atlanta traffic.

International Bottled Water Association OFFICERS Chairwoman Shayron Barnes-Selby, DS Services of America, Inc. Vice Chair Lynn Wachtmann, Maumee Valley Bottlers, Inc. Treasurer Brian Grant, Pure Flo Water Company, Inc. Immediate Past Chairman Joe Bell, Aqua Filter Fresh, Inc.

BOARD OF DIRECTORS Shayron Barnes-Selby, DS Services of America, Inc. Joe Bell, Aqua Filter Fresh, Inc. Charlie Broll, Nestlé Waters North America Philippe Caradec, Danone Waters of America Andy Eaton, Eurofins Eaton Analytical Brian Grant, Pure Flo Water, Inc. Brian Hess, Niagara Bottling LLC Doug Hidding, Blackhawk Molding Co. Scott Hoover, Roaring Spring Bottling Dan Kelly, Polymer Solutions International Greg Nemec, Premium Waters, Inc. Bryan Shinn, WG America Company Robert Smith, Grand Springs Distribution Louis Vittorio, Jr., EarthRes Group, Inc. Lynn Wachtmann, Maumee Valley Bottlers, Inc. William Patrick Young, Absopure Water Co., Inc.

IBWA EXECUTIVE COMMITTEE Chairwoman Shayron Barnes-Selby, DS Services of America, Inc. Joe Bell, Aqua Filter Fresh, Inc. Charlie Broll, Nestlé Waters North America Philippe Caradec, Danone Waters of America Brian Grant, Pure Flo Water Company, Inc. C.R. Hall, Hall’s Culligan Henry R. Hidell, III, Hidell International Scott Hoover, Roaring Spring Bottling Dan Kelly, Polymer Solutions International Ed Merklen, DS Services of America, Inc. Bryan Shinn, WG America Company Lynn Wachtmann, Maumee Valley Bottlers, Inc. William Patrick Young, Absopure Water Co., Inc.

COMMITTEE CHAIRS

I’m raising a bottle of water to drink to your health!

Communications Committee Julia Buchanan, Niagara Bottling, LLC Audrey Krupiak, WG America Company Education Committee Glen Davis, Absopure Water Co., Inc. Douglas R. Hupe, Aqua Filter Fresh Environmental Sustainability Committee Leslie Alstad, Pure Flo Water Company, Inc. Jeff Davis, Blackhawk Molding Co. Government Relations Committee Derieth Sutton, Niagara Bottling, LLC Lynn Wachtmann, Maumee Valley Bottlers, Inc. Membership Committee Marge Eggie, Polymer Solutions International Kelley Goshay, DS Services of America, Inc.

Shayron F. Barnes-Selby

State and Regional Associations Committee Joe Cimino, ChoiceH2O Ross Rosette, H2Oregon

Shayron Barnes-Selby IBWA Chairwoman

Supplier and Convention Committee Brian Grant, Pure Flo Water Company, Inc. Dan Kelly, Polymer Solutions International

We must not overlook the diligent work of IBWA members and staff to get a “drop” of a mention (pun intended) about the importance of water consumption in the 2015-2020 Dietary Guidelines for Americans! IBWA focused on increasing the water messages in the guidelines, and the Dietary Guidelines for Americans now include a recommendation to limit the consumption of sugar-sweetened beverages and drink water.

Also, because of the work of IBWA members and staff, the recommendation—“Drink water instead of sugary drinks"—now appears on the U.S. Department of Agriculture’s MyPlateMyWins graphic. See for yourself at bit.ly/MyPlateMyHydrationWins.

Technical Committee Andy Eaton, Eurofins Eaton Analytical Kevin Mathews, Nestlé Waters North America

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IBWA

International Bottled Water Association

PRESIDENT’S MESSAGE NEW YEAR, NEW CHANCES TO PROMOTE HEALTHY HYDRATION Consumers are increasingly choosing bottled water as their packaged beverage of choice.

But what about those who have yet to be persuaded by the health benefits of drinking water? IBWA staff considered what unanswered questions they might have when putting together this “Healthy Hydration” issue of Bottled Water Reporter.

We begin by answering the most obvious question: “Why Drink Water?" (p.10).

Here, three noted hydration experts offer their opinions on why people should make water their primary beverage. We follow that up with “How Much Water Should You Drink?” (p.14), where Roselyne Y. Wagner, PhD (PMCONSEILS), and Isabelle Guelinckx, PhD (Danone Nutricia Research), review the varying global recommendations on water intake—and discuss where current research stands on the issue. For people who’d like specific examples of how drinking water helps the body, Drinking Water Research Trustee Lawrence E. Armstrong, PhD, illustrates some of the documented health benefits of water consumption in his article, “Drink More Water Each Day to Optimize Mood and Mental Tasks” (p.20).

IBWA is proud of the role we play in helping consumers achieve a healthier lifestyle.

But we know that, if we are going to be successful at promoting healthy hydration for all, we are going to need allies. In “The National Drinking Water Alliance: Who We Are, What We Do, and Why You Should Care” (p.24), Christina Hecht, PhD, a senior policy advisor at the University of California Nutrition Policy Institute, describes the advocacy work of this influential organization—and outlines some of the ways we can work together to help ensure, people, especially children, “drink water first for thirst.”

Our columns continue the discussion on how to promote the benefits of water consumption. We first review ways members can fold healthy hydration information into their conversations with members of Congress in our Government Relations column (p.28).

Next, the Communications column (p.30) emphasizes the importance of recognizing that the shift of moving from carbonated soft drinks to bottled water is consumer driven—and Americans have been increasing their consumption of bottled water for decades. The Technical Update column (p.32) veers our focus to the Food Safety Modernization Act’s (FSMA) Intentional Adulteration Rule and reviews what impact it will have on IBWA bottlers.

A new year introduces new opportunities for IBWA members to work together to ensure consumers, legislators, and the media know the truth about bottled water and healthy hydration. We look forward to working on the issues with you in 2017.

Joe Doss IBWA President 4

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BOTTLED WATER REPORTER is published for: International Bottled Water Association 1700 Diagonal Road, Suite 650 Alexandria, VA 22314-2973.

Tel: 703.683.5213 Fax: 703.683.4074 www.bottledwater.org

IBWA STAFF President Joseph K. Doss jdoss@bottledwater.org Vice President of Education, Science, and Technical Relations Robert R. Hirst bhirst@bottledwater.org Vice President of Communications Vacant Vice President of Government Relations Vacant Director of Conventions, Trade Shows, and Meetings Michele Campbell mcampbell@bottledwater.org Director of Government Relations J.P. Toner jtoner@bottledwater.org Director of Science and Research Al Lear alear@bottledwater.org Manager of Publications and Special Projects Sabrina E. Hicks shicks@bottledwater.org Manager of Member Services Cheryl Bass-Briscoe cbass@bottledwater.org Education and Technical Programs Coordinator Claire Crane ccrane@bottledwater.org Executive Assistant Patrice Ward ibwainfo@bottledwater.org Bottled Water Reporter Layout and Design Rose McLeod rozmack@gmail.com Tel: 315.447.4385 Editor Sabrina E. Hicks shicks@bottledwater.org Advertising Sales Stephanie Schaefer stephanie@bottledwater.org

THANKS TO 2016 DWRF CASINO NIGHT SPONSORS The Drinking Water Research Foundation extends its sincerest thanks to the Sponsors of the 2016 DWRF Casino Night Fundraiser.

PLATINUM PRESENTING SPONSOR Nestlé Waters North America, Inc. GOLD SPONSORS Hogan Lovells Mountain Brook Water MTN Products, Inc. The Water Guy SILVER SPONSORS AQUAQUEEN Bell Sales, Inc. Blackhawk Molding Co., Inc. NSF International B. B. KINGS SOUTHERN CUISINE SPONSOR Mountain Brook Water

BEVERAGE SPONSOR The Water Guy CASINO TABLE SPONSORS AQUAQUEEN Bell Sales, Inc. Blackhawk Molding Co., Inc. PRIZE SPONSOR NSF International TRANSPORTATION SPONSOR Hogan Lovells VENUE SPONSOR MTN Products, Inc.

The Drinking Water Research Foundation (DWRF) would like to thank all of the sponsors that helped its Casino Night Fundraiser be a success.

This wonderful event, held at B.B. Kings in Nashville, Tennessee, on November 8, 2016, could not have happened without the support of DWRF sponsors and guests. All money raised during the 2016 fundraiser will help fund vital research impacting the future of the bottled water industry.

TO LEARN MORE ABOUT DWRF, VISIT WWW.THEFACTSABOUTWATER.ORG. NOV/DEC 2016

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WATER NOTES

SCIENCE

Research Suggests Pregnant Women Should Not Be Concerned About BPA In a Science 2.0 article, Steve Hentges, PhD, with the American Chemistry Council (ACC), analyzes a 2016 study

by French researchers (bit.ly/ FrStudyBPA) on the exposure of pregnant women to more than 100 substances that may be of concern to a developing fetus, including bisphenol A (BPA). The French study found through urine biomonitoring that the majority of women were exposed to BPA, but the study did not address if the exposure levels were safe.

However, the median BPA level reported, .75 micrograms/liter, is comparable to results from a large-scale study of pregnant women in 6

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Canada and biomonitoring studies in the United Sates.

The levels of BPA found in the French study are low when compared to the levels of metals and organic chemicals reported in those studies.

Hentges used both exposure data and health effects discovered via a safety or risk assessment to evaluate the safety of BPA. Health effect information describes what “effects can be caused by exposure” to a particular substance—and “at what exposure level the health effects might occur.”

Exposure information is used to ascertain whether these exposures are above or below critical levels.

The safety risk assessment used was from a group of Greek scientists who released in late 2016 a peer-reviewed scientific assessment on BPA (bit.ly/ GrkStudyBPA) and concluded that “exposure to BPA does not pose any significant threat according to most realistic exposure scenarios.”

Their conclusion is relevant because the Greek study “explicitly included pregnant women.” Their findings are consistent with the conclusions reached by government bodies throughout the world on the safety of BPA. The Greek study calculated a biomonitoring equivalent (BE) based on

the conservative safe intake level for BPA established by the European Food Safety Authority (EFSA).

The BE level represents the estimated concentration of BPA in urine corresponding to BPA at the safe intake level. Applying the BE to the median BPA exposure level in the French study shows the level of exposure is more than 400 times below the BE level. As Hentges notes, that indicates that “not only are the actual French exposure levels safe, but they’re safe with a wide margin of safety.” The Greek scientists also stated “there is no reason for concern based on either individual or aggregate scenarios of BPA exposure.”

Another important aspect of the French study is that the urine was monitored for both “unconjugated” and “total” BPA. Unconjugated BPA is BPA itself. It was found at low levels in only 10 percent of the urine samples. Total BPA is a metabolized form of BPA, and it was found in about 74 percent of the urine samples, confirming this important metabolic process occurred in the French pregnant women. Hentges concludes that “since the metabolite is biologically inactive and rapidly eliminated from the body, BPA is not likely to cause health effects at the low exposure levels measured in the study.”

For more details, read "Should Pregnant Women Be Concerned About BPA?" at bit.ly/Science20BPA.

WATER NOTES CONFERENCE AND TRADE SHOW

IBWA Announces 2016 Award Winners During the 2016 IBWA Annual Business Conference and Trade Show, held November 7-11 in Nashville, Tennessee, the association announced the winners of eight prestigious awards.

IBWA Board Member, and Supplier and Convention Committee Co-Chair, Dan Kelly (Polymer Solutions International) announced winners in the categories of Route Salesperson of the Year, Plant Manager of the Year (2), Supplier of the Year, Product Innovation, Kristin Safran/IBWA Board of Directors’, and Shayron Barnes-Selby/IBWA Advocacy (2) awards during the conference general session, attended by more than 300 IBWA members and conference attendees. “These winners truly represent excellence within the bottled water industry and IBWA’s membership,” said IBWA President Joseph Doss.

For many years, IBWA has held an awards program to recognize the contributions and achievements of bottled water professionals. It is important to IBWA members that the association celebrates and honors these individuals with a ceremony because we know that it takes an incredible and dedicated workforce to produce and deliver bottled water products. IBWA wishes to congratulate all of our 2016 winners and thank the member companies that participated in the 2016 award program.

Shayron Barnes-Selby/IBWA Advocacy Award winners Terry Clark and Phyllis Rokus.

Supplier of the Year Crystal Mountain Products, Inc.’s Robin Householder (right) with Awards Emcee Dan Kelly.

Plant Manager of the Year (Level IV) Brian White (center) with DS Services’ Eric DeVanie (left) and Shayron Barnes-Selby.

Plant Manager of the Year (Level III) Bill Baker (left) with President of Hall’s Culligan Water C.R. Hall.

EdgePage by Edge Analytical Laboratories won IBWA’s inaugural Product Innovation Award. Allen French (right) received the award from Dan Kelly.

Nestlé Waters North America’s Jerry Williams (left) was named IBWA Route Salesperson of the Year, and Kevin Mathews (right) collected the Kristin Safran/IBWA Board of Directors’ Award.

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SOCIAL M EDIA MESSAGING BOARD If you are loo

“Drink water instead of sugary drinks"— now appears on the USDA’s MyPlateMyWins graphic. See for yourself at bit.ly/MyPlateMyHydrationWins.

king for new op portunities to co nnect with educate them about bottled w share any of th ater issues, feel e following on yo free to ur social media sites during Janu and February— ary or be inspired an d write your ow n!

consumers and

New Year, New You! Whatever your New Year's resolutions, make sure you bring your #BottledWater along to stay #healthy and #hydrated in 2017! bit.ly/NewYearNewH2O

But first...water! #H2OfCourse

National Campaigns

www.instagram.com/p/ BOM8CV3gv40/?taken-by=urh2o

January: National Hot Tea Month, New Year's Day (January 1), National Winter Skin Relief Day (January 8) February: American Heart Month, National Children's Dental Health Month, National Pizza Day (February 9), Valentine's Day (February 14) Not feeling thirsty? #Hydration is important no matter what the temperature is outside. Make sure you stay properly #hydrated even during the winter months! bit.ly/WinterH2OHydration

The benefits of drinking #water are endless! We take #BottledWater with us everywhere to keep our bodies #healthy and #hydrated! www.instagram.com/p/ BODPeqpBpMz/?takenby=bottledwatermatters Should Pregnant Women Be Concerned About BPA? Greek scientists have stated that “there is no reason for concern based on either individual or aggregate scenarios of BPA exposure.” That conclusion is consistent with the views of government bodies worldwide.

Weight loss resolution? Drink #bottledwater not diet soda, new study says: bit.ly/NYTwaterbeatssoda4weightloss

The holiday season is officially over and @SelfMagazine has some tips to help you get back on trace after the festivities. We especially like #1: "Swap all other beverages for water!" www.self.com/story/8-sneaky-ways-to-debloatin-just-one-day

Download: bit.ly/WinterH2OHydration

Ways to prevent cavities: Obviously, brush/ floss daily. Next Best Tip? “Drink water or rinse mouth with water after eating.” #NationalChildrensDentalMonth www.pinterest.com/pin/414964553151045877

February is National Heart Month and the American Heart Association is reminding us that “keeping the body hydrated helps the heart more easily pump blood through the blood vessels to the muscles. And, it helps the muscles work efficiently.” Check out more tips from the AHA and stay #hydrated! http://www. heart.org/HEARTORG/HealthyLiving/PhysicalActivity/ FitnessBasics/Staying-Hydrated---Staying-Healthy_ UCM_441180_Article.jsp#.VqeXe4UrK71

Download: bit.ly/HydratedHeart 8

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Have a happy and #hydrated Valentine's Day!!! #hearthealthy with bit.ly/HydratedHeart

www.pinterest.com/pin/414964553150783195

Social Media Tip If you are looking for "post inspiration" for your company's social media platforms, check out IBWA's Facebook, Instagram, Pinterest, Twitter, and YouTube profiles: • www.facebook.com/bottledwatermatters • www.instagram.com/bottledwatermatters • www.pinterest.com/luvbottledwater • www.twitter.com/BottledWaterOrg • www.youtube.com/user/BottledWaterMatters

DYK, proper hydration throughout the winter months is just as important as during the warmer months? bit.ly/WinterH2OHydration

WATER NOTES

ENCOURAGING WATER CONSUMPTION

Drink Up in LA

Last December, the Drink Up Initiative hosted several events in Los Angeles to support its recent campaign focused on encouraging LA citizens to drink more water. Self Help Graphics and Art in East LA, one of Drink Up’s community partners, hosted a successful event.

Other supporters included the American Beverage Association/Aquafina and Dasani, the Alliance for a Healthier Generation, Mayor Eric Garcetti, the LA Department of Water and Power, Polvora Advertising (Drink Up’s LA creative firm), The California Endowment, Brita, Haws, and many others.

The LA Dodgers, LA Dodgers Foundation, and the LA Galaxy sent sports giants from the past and present to help promote the benefits of water consumption, including former Dodger

Former LA Dodger Ron Cey is flanked by current LA Galaxy players AJ DeLaGarza (left) and Rafael Garcia (right).

Ron Cey and current LA Galaxy players Rafael Garcia and AJ DeLaGarza.

Thus far, Drink Up has garnered nearly 6 million impressions combined between TV, blogs/local news, and social media. But, this is only the start

for Drink Up in LA, as planning for more local—and national—events for 2017 are underway! If you’re interested in learning more about Drink Up’s LA campaign, visit h2oclaro.com.

ENVIRONMENTAL STEWARDSHIP

How the Recycling Partnership Works to Increase PET Packaging Recovery In 2016, IBWA joined the Recycling Partnership (TRP) as a funding partner. TRP is an innovative industry collaboration that is focused on systematically and measurably improving curbside recycling in the United States. Working with community and industry partners nationwide, TRP identifies bestin-class operational and technical support and proven community outreach approaches to improve curbside recycling rates. During the 2016 IBWA Annual Business Conference, TRP Director of Corporate Partnerships Jeff Meyers provided an overview of the organization’s recent successful projects.

Meyers discussed how TRP is focused on increasing new PET packaging recovery. Some commonalities among the highest recovery programs are single stream or fully comingled recycling, the use of carts, an automatic service, and local action for recycling. Sixty percent of recyclable PET packaging is found in the home and still remains unrecovered at a loss to companies, governments, recyclers, and the environment. TRP attains measurable change in curbside recycling by partnering with communities to adopt best practices through a “boots on the ground” approach— growing access to recycling, educating consumers, providing

technical assistance, and expanding best practices. TRP is scaling up to drive nationwide change at the city, regional, statewide, and federal level.

This approach has generated results for IBWA and other TRP members. In the past 24 months, TRP has supported 150 communities with $21 million in investments, 390,000 recycling carts, and greater than 2 million households educated on recycling. For example, a citywide conversion to carts in Greenville, South Carolina, resulted in 35,000 family homes converted from bins to carts and 3.2 million pounds of new PET recovered annually.

The Recycling Partnership encourages IBWA members to participate in new city activations and launches scheduled for their areas. To learn more about TRP, visit recyclingpartnership.org.

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COVER STORY

WHY

DRINK WATER?

Bottled Water Reporter asked three hydration experts why people should drink water.

Here’s what they had to say.

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WHAT WE DRINK MATTERS

By Harold Goldstein, DrPH

There’s an old adage that says we all need eight glasses of fluid each day to stay healthy and hydrated. It’s a pretty easy rule of thumb. What we don’t always hear is the importance of what we choose to quench our thirst. Far too many people are drinking water that’s loaded with sugar— better known as sodas, sports drinks, flavored waters, sweet teas, and energy drinks.

The average American drinks 9 teaspoons of added sugar a day, adding up to 30 pounds of sugar a year. That’s far more than the American Heart Association’s recommended total limit of no more than 5 teaspoons of added sugar a day.

What does all that liquid sugar do to our bodies? It’s bad, very bad, leading to type 2 diabetes, heart attacks, and fatty liver disease. Drinking one or two bottles of sugar-sweetened beverages a day increases the risk for getting diabetes by almost 30%—and triples the risk of dying from a heart attack; after six months, daily consumption of these sugary beverages increases liver fat by almost 150%.

"What does liquid sugar do to our bodies? It leads to type 2 diabetes, heart attacks, and fatty liver disease."

Pure, fresh-tasting water is calorie free, provides the hydration that our bodies need, and can even save money. Water is also an essential tool for maintaining body temperature and healthy digestion, cushioning our joints, and protecting our internal organs. Water has even been proven to be a better option than sports drinks to support physical activity in most cases.

Without a doubt, water is the easy choice—and the best choice—for good health.

As a public health advocate, I encourage people to drink water in whatever form that is most convenient and cost-effective for them. Drinking safe, healthy, refreshing water is infinitely healthier than drinking water that’s been loaded with sugar.

Harold Goldstein, DrPH, is the executive director of Public Health Advocates, a California-based nonprofit advocacy organization working to improve health and turn the tide on the nation’s obesity and diabetes epidemics.

And those slick ads published by soda companies seem to say that drinking soda is like opening happiness? They forget to tell you that if you drink all that sugar long enough, you will also have to start buying vials of insulin to treat your newly developed diabetes.

Luckily, a new trend is starting to gain traction. Healthy hydration—with bottled water leading the charge—is helping to make our eight daily beverage servings work for our health, not against it.

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WATER: THE MOST IMPORTANT NUTRIENT How water intake improves health

By Stavros A. Kavouras, PhD, FACSM, FECSS

"Kids that drink more water in school perform better in cognitive tasks."

United States alone, there are more than 29 million patients with diabetes and 85 million with pre-diabetes. How is diabetes related to water intake and hydration? Recent studies indicate that dehydration and low water intake lead to higher levels of anti-diuretic hormone. A higher level of this hormone is associated with development of diabetes, heart disease, and death. High water intake is thought to be associated with better mood and cognitive function. Kids that drink more water in school perform better in cognitive tasks.

Water is the most abundant molecule in the human body accounting for 50-60% of its weight. Nevertheless, water is the most overlooked and under-studied element in Nutrition Science. Did you know that water is not included in the U.S. Department of Agriculture’s “My Plate” nutritional guidelines (choosemyplate.gov)? Water was also not present in neither the 2005 nor the 1992 food guide pyramid. For this reason, water is considered the “Forgotten Nutrient.”

Water intake and hydration are mainly regulated by thirst and the kidneys. When we run low on water, we get thirsty and we drink. When we drink too much, we go to the bathroom more often to eliminate the extra water. What is important to understand is that we do not get thirsty until we are dehydrated.

Then, water intake quickly turns off our body's thirst signal, well before body water is replenished. As a result, many people do not know that they are chronically under-hydrated because they are not thirsty. After all, thirst is a survival instinct, but it is not necessarily a reliable way to gauge optimal hydration for health.

A 2015 study, based on the U.S. National Health and Nutrition Examination Survey, reported that more than 50% of children are under-hydrated. One-in-four do not drink any water, and three-in-four children drink at least one serving of a sugary beverage. What is worrisome is that low water intake is associated with a variety of health outcomes. Specifically, studies have shown that low water intake is linked to the development of kidney stones, urinary tract infections, and chronic kidney disease. Probably more important are the findings in the area of water intake and diabetes. In the Western world, diabetes is one of the first causes of cardiovascular diseases, the number one factor for all-cause mortality. In the 12

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A simple and practical way to assess if you are drinking enough water is your urine color and number of visits to the bathroom.

Light or clear urine color and more than 6-7 visits to the bathroom per day are both good indicators of appropriate hydration.

Stavros A. Kavouras, Phd, FACSM, FECSS, is an associate professor at the University of Arkansas’ Hydration Science Lab. Follow him on Twitter: @DrHydration.

COLLECTIVE IMPACT EFFORTS ARE NEEDED TO CREATE CONDITIONS THAT FAVOR DRINKING WATER EFFECTS

By Jodi D Stookey, PhD

Drinking water can significantly improve public health with support from collective impact efforts. Collective impact efforts are important, perhaps even necessary, for creating conditions that favor drinking water effects. Depending on background conditions, drinking water can have negative, null, or beneficial effects on health. In the case of weight management, for example, drinking water has had 83 null effects on body weight outcomes, out of 115 effects, reported by randomized controlled trials [1]. Background conditions in these trials did not enable drinking water to lower energy intake and/or increase fat oxidation. Conditions in New York City schools, on the other hand, allowed for installation of

WHY DRINK WATER

drinking water stations in cafeterias to significantly reduce the risk of overweight and obesity for millions of children [2].

Conditions that may modify drinking water effects include characteristics of the target population at baseline, normal, or overweight/obese status; ad libitum or restricted diet; amount and types of beverages consumed; and hydration status (concentrated or dilute urine). Under ad-libitum diet conditions, interventions to promote drinking water instead of other beverages (i.e., to increase drinking water in relative terms) have been effective when drinking water replaces all caloric beverages, not only sugar-sweetened beverages. Under restricted diet conditions, interventions to increase drinking water in absolute terms have been effective for overweight or obese individuals, if the volume of drinking water consumed significantly dilutes urine [below 500 millimoles per kilogram (mmol/kg)].

In New York City schools, the baseline prevalence of overweight or obesity was 39%, the children had access to ad-libitum food, and the background availability of caloric beverages was deliberately limited, such that drinking water replaced caloric beverages, beyond only sugar-sweetened beverages. Beginning in 2001, New York City implemented policies to remove soda from school vending machines, replace whole milk with low-fat milk in school meals, and limit available beverages to those with less than 10 calories per 8oz serving. All schools made these changes before 2009-2010, before installation of drinking water stations. After installation of the water stations in 2010-2013, purchases of fat-free chocolate milk decreased significantly [2].

To create and sustain conditions, collective impact partnerships are necessary, such as change in school policy, food supply/vendor contracts, and/or funding streams. Also necessary is the development of consistent intervention messaging in the community, tailored to the population characteristics. Alone, individuals trying to drink water for weight management, or

"Drinking water stations in New York City school cafeterias are associated with significantly reduced risk of overweight and obesity for millions of children." clinicians advising patients to drink water for weight management, do not have the authority or control over communitywide background conditions.

Null effects of effort to drink water for health outcomes disappoint individuals who make the effort, leave at-risk individuals at-risk, breed uncertainty about drinking water effects, and jeopardize community support and sustainability for drinking water efforts.

Industry commitment to, and participation in, collective impact efforts to create optimal conditions for drinking water effects may enable communities, around the world, to benefit from drinking water.

Jodi D Stookey, PhD, is a clinical scientist at the Children’s Hospital Oakland Research Institute.

References 1. Stookey JD. Negative, Null and Beneficial Effects of Drinking Water on Energy Intake, Energy Expenditure, Fat Oxidation and Weight Change in Randomized Trials: A Qualitative Review. Nutrients. 2016 Jan; 8(1): 19. Published online 2016 Jan 2. doi: 10.3390/nu8010019.

2. Schwartz AE, Leardo M, Aneja S, Elbel B. Effect of a School-Based Water Intervention on Child Body Mass Index and Obesity. JAMA Pediatr.

2016 Mar; 170(3): 220–226. doi: 10.1001/ jamapediatrics.2015.3778.

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HOW MUCH WATER SHOULD YOU DRINK DAILY?

By Roselyne Y. Wagner, PhD, and Isabelle Guelinckx, PhD

Global recommendations on water intake vary between health authorities. What is the scientific evidence behind them?

Water is essential for life. Humans can live for weeks without eating but only a few days without drinking. Yet, most people are not aware of the existing daily recommendations for fluid intake. As drinking is so important for health, why aren’t we more aware about how much we need to drink every day?

We Are What We Drink The human body is composed of approximately 60% water, depending on age, sex, and climate conditions [1,2]. Because water is involved in numerous biological functions in the body—such as building materials for cells and fluids, and temperature control—the body tightly regulates the amount of total body water. It is constantly balancing water losses and water gains. Every day, the body loses water through sweat, respiration, fecal losses, and urine, and it also gains water from metabolic reactions, food, and fluids. (See Figure 1 on p.16.)

Metabolic water production is very limited: it represents, on average, only 300ml. The largest gain of water is from dietary intake: it’s estimated that approximately 20% of total water intake comes from food (moisture), and 80% from fluids [2].

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Figure 1. Typical Daily Water Inputs and Losses of a Sedentary Male

Source: Danone Nutricia Research, “Water and Hydration: Physiological Basis in Adults.� H4H Initiative (www.H4Hinitiative.com).

Drinking water and all other beverages (e.g., juices, milk, sweetened/diet/ alcoholic/hot beverages) are considered as fluids and, within this article, the sum of all these fluids will be called total fluid intake. Factors that affect the water balance are the weather and climate, clothing, diet, and length and intensity of physical activity [3,4]. Because the major source of total body water comes from fluids, it is important to consider the amount and the type of fluids you drink.

Total Water Intake Recommendations: A History Lesson The most recent recommendations concerning water intake in America were published 12 years ago [1]. There was limited data on total water intake, total fluid intake, and/or hydration for a healthy individual at population level.

That is surprising, considering the first studies on human hydration were published in 1950s. In the decades following up to 2010, the number of studies increased; however, they were relevant for specific populations only (e.g., firefighters or soldiers exposed to extreme environment conditions) or 16

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specific conditions (e.g., a patient’s management in hospital or physical activity [6,7]. Moreover, because no links with the major health complications of the general population were identified, total water intake and total fluid intake were not priority research areas in nutrition.

Researchers tended to focus on energy intake and nutrients coming from food rather than those from fluids.

Because in 2014 there was insufficient scientific evidence indicating that a certain water intake could reduce the risk of chronic diseases, the Institute of Medicine (IOM) based its guidelines on the median water intake observed in a national survey [1]. Consequently, the reference values for total water intake of adult men and adult women (>19 years) were set at respectively 3.7 liters per day (L/day) and 2.7 L/day [1].

Knowing that foods contribute for 2030%, the more practical guidelines in the United States for adults are that men should drink 3 L/day and women 2.2 L/day [1].

Those reference values were a source of inspiration for others; China, for example, used the IOM recommendations as a reference until 2007.

Until recently, there was limited data on total water intake, total fluid intake, and/or hydration for a healthy individual at population level.

In the late 2000s, researchers begin to be interested by hydration biomarkers; and methods for assessing hydration emerged [3,8]. In 2010, the European Food Safety Authority (EFSA) published the European reference values for total water intake based on a combination of observed intakes, urine osmolality values, and energy intake [2].

It was the first recommendation of water intake that included hydration biomarkers in its calculation. Currently, the EFSA guidelines for total water intake are 2.5L/day for men and 2L/ day for women, meaning that adult men

HOW MUCH WATER

and women should drink respectively 2 L/day and 1.6 L/day. Each European country is encouraged to include and adapt those recommendations into their official national dietary guidelines [2].

Some countries—such as Spain, the United Kingdom and Turkey—have already incorporated the recommendations [9-11]; yet, still national dietary guidelines might benefit from a revision.

For instance, in France the official dietary guidelines are to drink water ad libitum (i.e., without restraint or limit), which could be open to interpretation by the general public [12].

Emerging Science for More Specific Water Recommendations Adapting an international recommendation to one country might be challenging due to the fact that drinking and eating habits of individuals are specific to each culture.

When EFSA reviewed the available data on water/fluid intake in 2010, it observed great discrepancy in mean total fluid intake across countries in Europe [2,13,14]. Ideally, each country should make an accurate assessment of total fluid intake in a sample representative of its population.

Scientists at Danone Nutricia Research wished to address this gap in the scientific literature by building and publishing on the Liq.In7 database.

This database contains information on the drinking habits of populations in 13 countries across three continents: Japan, Indonesia, China, Iran, Turkey, Poland, Germany, United Kingdom, France, Spain, Argentina, Brazil, and Mexico [15-18].

Besides the cultural aspect, another possible explanation for the inter-country differences in mean total fluid intake is the difference in assessment method used in the countries. In nutrition research, the method of assessment is a key point because people can forget, overestimate, or underestimate their dietary intake,

Adapting an international recommendation to one country might be challenging due to the fact that drinking and eating habits of individuals are specific to each culture. and such actions, consequently, affect the accuracy of the data.

The method most widely used for dietary assessment is "24h dietary recall," which requests individuals to remember all food and fluids consumed during the past 24 hours. A second method used to assess dietary intake is a diary or record: individuals record, in real time, over a period of one or more days, what they eat and drink. The data present in the Liq.In database was collected with such a diary covering seven consecutive days.

The Liq.In record had an additional special feature: it was specific for fluids. A comparison of data collected with a 24h dietary recall versus those collected with a seven-day fluid record demonstrated that with a 24h dietary recall, individuals significantly underestimate about 400ml of their fluid intake [19]. This potentially implies that, because the reference values

are based on food surveys and many food surveys use a 24h recall in their national surveys, the reference values for water intake are underestimated.

Because all surveys providing data to the Liq.In database were performed with the same record, the results of the different countries can be compared.

The results of the surveys showed that in the 13 countries, approximately 60% of men drank less than 2 L/day and 40% of women less than 1.6 L/day [17].

However, the proportion of adults with an average fluid intake below the references ranged from 30% in United Kingdom to 71% in Japan, showing again the large difference in drinking habits between the countries [17].

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Figure 2. Indonesia Official Dietary Guidelines (2014) Pedoman Gizi Seimbang

food and beverages to less than 10% of total energy intake [20]. As described in the March/April 2016 issue of Bottled Water Reporter, beverages can contain up to 9 teaspoons of sugar and should be consumed accordingly [21,22]. The Liq.In results showed that 44.5% of adults exceeded the WHO guidelines on sugar solely by fluid intake [18,20].

Application of the Recommendation to the General Population

Kementerian Kesehatan RI | 2014 Source: Ministry of Health of the Republic of Indonesia, “Recommended Nutritional Intake for Indonesian Population.”

The European Commission and the United States have both promoted initiatives to promote healthy hydration.

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of the adults drank, on average, less than 290mL/day of water. In Mexico, Brazil, Argentina, and the United Kingdom, the adults drank more sweet beverages than water [18].

This observation was even more frequently made when investigation the drinking habits of children and adolescents. In some countries, up to 52% of what children and adolescent drink were sugar-sweetened beverages [15]. In 2015, the World Health Organization (WHO) published guidelines on sugar intake for adult and children that recommended reducing the intake of free sugars from

Once the reference values are produced by the health authorities, they then need to be translated into practical, user-friendly tools and tips easily understood and put into action by the general population. Visual representations of the dietary guidelines exist in some countries. For example, the Chinese Pagoda was developed by the Chinese Nutrition Society in 2007, recommending at least 1.2 L of water per day. In 2014, Indonesia published its pyramid recommending at least 8 glasses of water per day [23]. (See Figure 2 at left.) Additional tools can be developed to promote water. For example, in 2016 the science service of the European Commission (EC) published a toolkit to successfully promote healthy hydration at school [24]. The toolkit indicated that effective interventions at school had a multi-component approach combining education, increased water availability, and/or parental involvement. Moreover, the EC highlighted the importance of engaging the right stakeholders, including the private sector (e.g., water and soft drinks suppliers) [24]. Another example of a campaign increasing the awareness of the importance of healthy hydration is the extremely popular U.S. initiative Drink Up, which launched in 2013 to increase water consumption by encouraging Americans to “drink more water more often" [25].

During the last decade, the scientific evidence in the research of fluid intake and hydration assessment increased.

More intake data on specifically fluid intake were published, and the science on hydration biomarkers also started covering the general population. That set the basis for more robust reference values on total water intake in the future.

Ideally, because estimating the amount of food moisture might be difficult for the general population, these values will be translated into recommendation on the amount to drink, as well as on the fluid types to drink. Moreover, given the fact that a relative large proportion of individuals don’t meet the reference values and/or have a relatively high intake of sugar-sweetened beverages, national campaigns promoting the intake of water seem pertinent.

Roselyne Y. Wagner, PhD, is a scientific project manager for PMCONSEILS in France.

Isabelle Guelinckx, PhD, is a fluid intake manager in the Hydration & Health Department, Danone Nutricia Research in Palaiseau, France.

HOW MUCH WATER

The Next Steps for Recommendations

References 1. Institute of Medicine, Food and Nutrition Board, Dietary reference intake for water, potassium, sodium, chloride and sulfate, IOM, Editor. 2004, National Academy Press: Washinghton, DC. 2. EFSA, Panel on Dietetic Products Nutrition and Allergies (NDA): Scientific opinion on dietary references for water, in J 8:1459, EFSA, Editor. 2010.

3. Armstrong, L.E., Assessing hydration status: the elusive gold standard. J Am Coll Nutr, 2007. 26(5 Suppl): p. 575s-584s.

4. B. Benelam, L.W., Hydration and health: a review. Nutrition Bulletin, 2010(35): p. 3-25.

5. Danone Nutricia Research, Water and Hydration : Physiological Basis in Adults. H4H Initiative www.h4hinitiative.com.

6. Leard, S.E. and E.D. Freis, Changes in the volume of the plasma, interstitial and intracellular fluid spaces during hydration and dehydration in normal and edematous subjects. Am J Med, 1949. 7(5): p. 647-54.

7. Gaebelein, C.J. and L.C. Senay, Jr., Influence of exercise type, hydration, and heat on plasma volume shifts in men. J Appl Physiol Respir Environ Exerc Physiol, 1980. 49(1): p. 119-23.

8. Armstrong, L.E., Hydration assessment techniques. Nutr Rev, 2005. 63(6 Pt 2): p. S40-54.

9. Sociedad Española de Dietética y Ciencias de la Alimentación, Rueda de los Alimentos, SEDCA, Editor. 2007.

10. Ministry of Health, Turkey, Dietary guidelines for Turkey, Turkey, Ministry of Health, Editor. 2011.

11. Department of Health, UK Department of Health, Editor. 2000.

12. PNNS, De l’eau sans modération, Programme National Nutrition Santé (PNNS), Editor. 2000.

13. Gandy, J., et al., Recording of fluid, beverage and water intakes at the population level in Europe. Br J Nutr, 2016. 116(4): p. 677-82.

14. Gandy, J., Water intake: validity of population assessment and recommendations. Eur J Nutr, 2015. 54 Suppl (2): p. S11-S16.

15. Iglesia, I., et al., Total fluid intake of children and adolescents: cross-sectional surveys in 13 countries worldwide. Eur J Nutr, 2015. 54 Suppl 2: p. 57-67.

16. Guelinckx, I., et al., Intake of water and beverages of children and adolescents in 13 countries. Eur J Nutr, 2015. 54 Suppl 2: p. 69-79.

17. Ferreira-Pego, C., et al., Total fluid intake and its determinants: crosssectional surveys among adults in 13 countries worldwide. Eur J Nutr, 2015. 54 Suppl 2: p. 35-43.

18. Guelinckx, I., et al., Intake of water and different beverages in adults across 13 countries. Eur J Nutr, 2015. 54 Suppl 2: p. 45-55.

19. S. Bardonoso, R.M., I.Permadhi, N. R. M. Manikam, R. Pohan, I. Guelinckx, Total fluid intake assessed with a 7-day fluid record versus a 24-h dietary recall: a crossover study in Indonesian adolescents and adults. Eur J Nutr, 2015. 54 (Suppl (2)): p. S17-S25.

20. WHO, Guideline: Sugars intake for adults and children. World Health and Organization, Editors. 2015: Geneva.

21. Hicks, S., New U.S. dietary guidelines recommend water consumption.

Bottled Water Reporter. 2016: https://issuu.com/ibwa. p. 20-25.

22. Culora, J., What you should H2Know about healthy hydration. Bottled Water Reporter. 2016: https://issuu.com/ibwa. p. 14-19.

To learn about Danone’s Hydration for Health initiative, visit www.h4hinitiative.com.

23. Ministry of Health of the Republic of Indonesia, Recommended Nutritional Intake for Indonesian Population. 2013, Ministry of Health: Jakarta, Indonesia.

24. S. Storchsdieck genannt Bonsmann, T.M. Mak, S. Caldeira and J. Wollgast, How to promote water intake in schools: a toolkit. J.S.f.p. report, Editor. 2016, European Union.

25. Partnership for a Healthier America. Drink Up. 2013.

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PART I OF II

DRINK MORE WATER EACH DAY TO

Optimize Mood & Mental Tasks

By Lawrence E. Armstrong, PhD

This article represents Part I of a two-part series. It explores the scientific studies that demonstrate the value of drinking water to optimize mood and cognitive processes. Part II, which will be published in the March/April 2017 issue of Bottled Water Reporter, will explore recent studies that link low daily water intake to a number of chronic diseases and will provide simple recommendations to help you maintain an optimal level of hydration.

Most adults recognize that water is essential to health because it supports numerous physiological functions, including vision, circulation, metabolism, excretion of waste products, and regulation of body temperature. However, few people are aware of recent research that has discovered interesting and valuable cognitive benefits of consuming water each day.

water loss in these studies is approximately 1.0-1.5 percent of body weight, which is considered a mild level of dehydration. Studies comparing these dehydrated participants to a group of control subjects (who consumed as much water as they desired, and whenever they desired it, ad libitum) have revealed several interesting effects.

Scientists who study the effects of daily water intake on the human body asked test participants to stop drinking for half a day or longer, then observed the detrimental effects of the resulting dehydration. The amount of

Most adults rarely experience dehydration greater than 3 percent during their daily activities. The sensation of thirst and the finely-tuned actions of the kidneys maintain adult body weight within 1 lb (0.7%), from

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Mood & Mental Tasks

Most adults rarely experience dehydration greater than 3 percent during their daily activities. However, even mild dehydration—that is, 1-2%—can affect mood, energy level, and mental awareness. one day to the next. However, it is likely that most adults experience a 1-2% body weight deficit several times each week because thirst is not sensed until we reach a 1-2% body weight loss.

Therefore, this article focuses on mild dehydration (1-2% loss of weight).

Controlled Laboratory Studies A Connecticut research team has published the findings of two mild dehydration studies (Ganio et al., 2011; Armstrong et al., 2012). The first involved a 12-hour body weight loss of 1.4% in young women and the second, 1.6% in young men. At those levels of mild dehydration, both groups experienced decreases on mental tasks, compared to control days when they were normally hydrated. Women reported headaches, increased task difficulty, and loss of concentration when mildly dehydrated; they also experienced mood changes in the form of reduced vigor and increased fatigue. Men similarly reported increased fatigue, plus greater anxiety.

However, only men experienced poorer performance on computerized mental tasks, during vigilance and visual memory tasks.

One year later, a French research group studied the effects of 24-hour fluid deprivation (FD) versus normal fluid intake, on selected mood and physiological factors (Pross et al., 2013). The

participating 20 healthy young women normally consumed 2.0–2.8 liters per day (L/d) of water. FD resulted in increased sleepiness and fatigue, lower levels of vigor and alertness, with increased confusion. These women also were more confused, less calm, and less happy. Interestingly, these mood changes were time-dependent, with greater impairments during the early afternoon (2:00 – 4:00 p.m.).

This well-controlled investigation confirmed the findings of their initial study involving mild dehydration, which was published one year earlier (Pross, 2012).

Modifying the amount of fluid consumed each day also can alter mood. Pross and colleagues (Pross et al., 2014) evaluated 52 women and men who habitually drank either a low volume (LOW = 1.5 L/d) or a high volume (HIGH = 2.7 L/d).

During three controlled drinking days, the water intake of the 22 participants in the HIGH group was restricted to 1 L/day, whereas the water intake of the 30 LOW group participants was increased to 2.5 L/day. No purposeful dehydration was involved. In the HIGH group, the smaller volume of water resulted in statistically significant decreases of contentedness, calmness, positive emotions, and vigor.

In the LOW group, drinking more water resulted in decreased fatigue, confusion/ bewilderment, and thirst, with a tendency toward less sleepiness.

A 2013 research investigation discovered the effects of drinking water on the reaction time required to perform a simple fine motor task: pushing a button.

(Edmonds et al., 2013). Thirty-eight test participants abstained from drinking any fluid overnight; this resulted in a state of mild dehydration. In the morning, one-half were not given water to drink, and the other half consumed up to 1 L of bottled water, as dictated by thirst. The group that consumed no water had a slower reaction time than the group that drank water. The authors proposed that water consumption released mental resources (i.e., focused attention) that were otherwise occupied with brain processing of the sensations associated with dry mouth and thirst.

Complex tasks also may be negatively influenced by dehydration, as shown in a 2015 study conducted in the United Kingdom (Watson et al., 2015). The aim of this study was to measure the effect of mild dehydration on performance during a prolonged, monotonous driving simulation task. This task consisted of a 2-hour continuous drive in an immobile car with a full-size, interactive, computergenerated road projection of a dull, monotonous four-lane dual highway.

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A U.K. study illustrated that mild dehydration affects the body similarly to sleep deprivation or a blood alcohol level of approximately 0.08%. the lanes), with long, straight sections followed by gradual bends. Drivers were instructed to remain within their lane unless overtaking slow moving vehicles.

During the normal hydration experiment, volunteers were provided with 200 mL of fluid every hour, whereas only 25 mL was made available each hour during the fluid restriction experiment (FR); thus, test subjects lost 1.1 percent of their body weight during FR (mild dehydration).

The magnitude of performance decrement during FR was similar to that observed following sleep deprivation, or the consumption of alcohol resulting in a blood alcohol content of approximately 0.08% (the current UK legal driving limit).

A different experimental approach was taken by a group of investigators in the United States, who observed 120 healthy college-aged women during their normal daily activities (Munoz et al., 2015).

These women drank water in volumes that ranged from less than 1.0 L/d to over 4.5 L/d, as shown in the figure at right.They were subsequently divided into three groups, to allow comparisons to be made: LOW volume (average, 1.5 L/d), MOD volume (2.3 L/d), and HIGH volume (3.1 L/d). Habitual total water intake (foods + fluids) during daily activities distinguished HIGH volume drinkers from the LOW and MOD groups. The entering, baseline mood scores of these women was assessed with the Profile of Mood States Questionnaire, which is widely accepted in psychological research and is sensitive to numerous stressors, including water 22

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restriction. Those who habitually consumed less water each day (see red line in the figure below) reported more tension, depression, confusion, and total mood disturbance (a summary score).

Practical Applications Since 2011, multiple randomized controlled research studies have identified the value of drinking adequate water to optimize mood, vigor, vigilance, visual memory, complex mental task performance, and fine motor reaction time; this included reducing the incidence of headache. However, it is important

to place in perspective the level of dehydration which these studies involved.

All of the above experiments were conducted either in controlled laboratory settings or while healthy men and women went about their usual daily activities (i.e., no planned strenuous exercise sessions).

When fluid was withheld, body weight loss in all studies reached 1-2%, a mild level of dehydration. Because humans do not perceive this level of mild dehydration until they become thirsty (i.e., at 1-2% body weight loss), it is likely that you reach this level of dehydration several times each week, without realizing it.

Daily Water Intake of 120 young women 20

Low Drinkers

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# of Women

Average Intake: 2.3 liters (2.4 quarts)

10

5

0 0.00

1.00

2.00

3.00

4.00

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Water Consumed in All Fluids and Foods (L/24h)

Mood & Mental Tasks

If your goal is to optimize your mood, mental tasks, and processing of information, recent hydration studies provide sound evidence for optimizing your daily water intake.

Therefore, if your goal is to optimize your mood, mental tasks, and processing of information, the aforementioned studies provide sound evidence for optimizing your daily water intake. To reach a minimum of 2.0 liters of total water each day (water + beverages + water in solid foods), remember that 22% of your total daily water intake is consumed as water in solid food; thus, you should drink at least 1.6 L of fluid, in the form of water and beverages.

Indeed, the average volume of fluids consumed by Americans (plain water + moisture in beverages) is 2.7 L/d (men) and 2.2 L/d (women) (Yang & Chun, 2016).

The Harsh Side Effects of Mild Dehydration Recent research has shown that if you are mildly dehydrated—a 1-2% loss of body weight—there can be detrimental effects on your body, such as the following: • headaches • increased confusion/ • mood changes bewilderment • less calm/happy/contentment • decreased alertness • decreased positive emotions • reduced vigor • greater anxiety/tension • increased sleepiness • increased task difficulty and fatigue • loss of concentration

References • Armstrong LE, Ganio MS, Casa DJ, Lee EC, McDermott BP, Klau JF, Jimenez L, Le

Bellego L, Chevillotte E, Lieberman HR. 2012. Mild dehydration affects mood in healthy young women. The Journal of Nutrition. 142(2):382-8.

Lawrence E. Armstrong, PhD, is a professor of Environmental & Exercise Physiology at the University of Connecticut and the director of the Human Performance Laboratory. He presently serves as a trustee of the Drinking Water Research Foundation and as a scientific advisory board member for Danone Waters, France.

• Edmonds CJ, Crombie R, Gardner MR. “Subjective thirst moderates changes in speed

Part II of this series will be published in the March/April 2017 issue of Bottled Water Reporter and will describe how you can check your own hydration status each day, by making a few simple observations.

• Pross N, Demazieres A, Girard N, Barnouin R, Santoro F, Chevillotte E, Klein A, Le Bel-

of responding associated with water consumption.” Online journal. Frontiers in Human Neuroscience 16 July 2013, pg 1-8. Accessed at http://dx.doi.org/10.3389/ fnhum.2013.00363 on 23 Oct 2016.

• Ganio MS, Armstrong LE, Casa DJ, McDermott BP, Lee EC, Yamamoto LM, Marzano S,

Lopez RM, Jimenez L, Le Bellego L, Chevillotte E. 2011. Mild dehydration impairs cognitive performance and mood of men. British Journal of Nutrition 106(10):1535-43.

• Muñoz CX, Johnson EC, McKenzie AL, Guelinckx I, Graverholt G, Casa DJ, Maresh CM,

Armstrong LE. 2015. Habitual total water intake and dimensions of mood in healthy young women. Appetite 92:81-6.

• Pross N. 2012. Effect of a 24-hour fluid deprivation on mood and physiological hydration

markers in women. Nutrition Today 47(4):S35-7.

• Pross, N., Demazières, A., Girard, N., Barnouin, R., Metzger, D., Klein, A., Perrier, E. and

Guelinckx, I., 2014. Effects of changes in water intake on mood of high and low drinkers. PloS one, 9(4), p.e94754.

lego L. 2013. Influence of progressive fluid restriction on mood and physiological markers of dehydration in women. British Journal of Nutrition Jan 28;109(02):313-21.

• Yang, M. and Chun, O.K., 2015. Consumptions of plain water, moisture in foods and bever-

ages, and total water in relation to dietary micronutrient intakes and serum nutrient profiles among US adults. Public Health Nutrition 18(07): 1180-1186.

• Watson, P., Whale, A., Mears, S. A., Reyner, L. A., & Maughan, R. J. 2015. Mild hypohy-

dration increases the frequency of driver errors during a prolonged, monotonous driving task. Physiology & Behavior, 147, 313-318.

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The National Drinking Water Alliance:

Who We Are, What We Do, & Why You Should Care

By Christina Hecht, PhD

Drinking water has been in

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the news a lot recently: healthy hydration and tap water safety are popular topics.

Water is the business of IBWA members—and, in a sense, it’s also the business of the National Drinking Water Alliance (NDWA). A network of organizations and individuals, NDWA is working to ensure that all children in the United States can drink safe water in the places where they live, learn, and play. NDWA is proud to have the International Bottled Water Association as an active ally.

water researchers and advocates with stakeholders from industry, government agencies, and professional organizations, including IBWA. During the convening, a consensus developed for a coordinated network that, working together with a shared mission, would leverage our independent efforts and, thereby, most effectively increase drinking water consumption. Participants agreed that we would focus on children and that the Alliance would promote water “in all its forms”: tap, filtered, and bottled.

NDWA grew out of a national convening, hosted by the Nutrition Policy Institute of the University of California, Division of Agriculture and Natural Resources, in 2015. The meeting brought together drinking

Since then, NDWA has grown to include a wide range of allies across the United States. NDWA is now a collective impact-type effort coordinated by the Nutrition Policy Institute at the University of California, with primary funding from

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the W.K. Kellogg Foundation, which, as described on its website (www.wkkf.org) “works with communities to create conditions for vulnerable children so they can realize their full potential in school, work, and life.”

NDWA allies work through four primary levers—research, policy and advocacy, access, and education and promotion—to build tap water safety and promote consumption of drinking water. Below is a brief status report on drinking water safety, access and promotion, and some of NDWA's activities.

Ensuring and Assuring Tap Water Safety Most tap water in the United States is safe to drink. However, whether from

source water contamination or from lead and copper that can leach into water as it travels from municipal pipes to building taps, there are pockets throughout the United States where tap water may be unsafe. And children’s small bodies are more vulnerable to even small doses of contamination. The NDWA website offers an interactive map where you can view media reports of tap water contamination: www.drinkingwateralliance.org/map.

NDWA allies are among those working at the federal, state, and local levels to ensure tap water safety. Our efforts are paying off in heightened awareness of the need for testing water at the tap and infrastructure improvements. In 2016, we saw the following developments:

provides funds for a grant program to improve access to safe water in schools.

•

Massachusetts earmarked $2.5 million for testing at the tap in schools.

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Oregon’s State Board of Education and Department of Public Health require schools to develop Healthy and Safe Schools Plans. Schools are not required by law to test for lead but they are required to report how they are preventing lead exposure.

•

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New York State became the first in the nation to legislate required testing at the tap in all public schools; testing is already underway.

Rhode Island passed legislation requiring testing at the tap for lead in all public schools and all licensed childcare facilities, public clinics, shelters, foster homes, and treatment centers.

•

Thirty-eight federal bills were introduced that relate to lead in tap water.

•

A U.S. Department of Agriculture (USDA) memo called for all regional offices and state agencies to ensure that children in National School Lunch Program (NSLP) schools and Child and Adult Care Food Program (CACFP) child-care homes and centers have access to safe drinking water at no charge. (To read that memo, visit: www.drinkingwateralliance.org/single-post/2016/07/22/ USDA-memo-issued-to-schools-regardingtap-water-safety.)

Following the American Academy of Pediatrics, Prevention of Childhood Lead Toxicity, recommendation that lead testing resulting in a reading of more than 1 part per billion (ppb) should be immediately remediated, the District of Columbia Department of General Services will move to incorporate a 1 ppb action level for lead tests on drinking water sources in District of Columbia Public Schools (DCPS) and Department of Parks and Recreation (DPR) centers

California Governor Jerry Brown (D) instructed the State Water Resource Control Board to develop a permit amendment requiring all community water systems to offer free testing for lead and copper in every school served by each system. Testing is anticipated to begin in 2017. The state’s budget also

Those efforts not only help to identify unsafe water conditions but also include requirements that schools clearly communicate the safety of their facility’s water to the families they serve. NDWA believes safety goes both ways: ensuring that water in the places where children spend their time is safe (through testing

•

NDWA

NDWA works to ensure that all children in the United States can drink safe water in the places where they live, learn, and play.

•

More About NDWA NDWA offers its allies and the public many great resources, including the following: • serves as a clearinghouse for resources and toolkits for improving drinking water access and providing drinking water education and promotion • maintains an updated bibliography of the peer-reviewed research on drinking water access and consumption (www.drinkingwateralliance. org/research) • tracks legislation, educates decision makers, works to put Water in All Policies • connects partners across sectors and geographies to work together to make water “First for Thirst.”

To learn more about NDWA, visit DrinkingWaterAlliance.org.

at the tap and remediation), and assuring the public (through publicizing testing results) that we know where the problems are and that, in the vast majority of places, tap water is safe.

How Might This Impact IBWA? Schools with unsafe tap water may need to provide students with bottled water at no charge to meet the water provisions in the Healthy, HungerFree Kids Act of 2010 (HHFKA, JAN/FEB 2017

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The Flint Effect Marc Edwards, PhD—who is professor of civil and environmental engineering at Virginia Tech and a recipient of the MacArthur Grant (commonly referred to as the “Genius Grant”)—presented the Drinking Water Research Foundation’s (DWRF) Alan A. Leff Memorial Lecture during the 2016 IBWA Annual Business Conference, held November 7-11 in Nashville, Tennessee.

Dr. Edwards’ presentation, “Understanding the Flint, MI Water Crisis,” not only chronicled discovering and bringing to the public’s attention the high lead levels and legionella issues that were uncovered in Flint but also earlier findings from 2001 of high lead in drinking water in Washington, DC. In Flint, Dr. Edwards led a research team that collaborated with local residents and government officials to address lead, pathogen, and water infrastructure issues caused by a failure to implement corrosion control treatment in the public water system. He summarized the Flint water study team’s efforts, which combined ethics, engineering, citizen science, laboratory experiments, investigative science, and social media, to confirm the high lead levels in Flint’s public water system. The Edwardsled Flint Water Study Team received Virginia Tech’s Alumni Award for Outreach Excellence 2016, and Dr. Edwards was recognized by Fortune and Time magazine as one of the most influential people in 2016.

Dr. Edwards’ presentation will be posted on the DWRF website (www.thefactsaboutwater.org) and YouTube in the near future.

child nutrition reauthorization) unless or until the schools mitigate maximum contaminant levels of lead in their tap water through filtration or longer term strategies.

IBWA supports federal legislation that would establish a $475,000 grant program to help states provide bottled water to schools and child-care facilities when they are faced with contaminated water supplies.

This grant program would be administered by the USDA, and the funds would be available when the president has declared a state of emergency and it is determined that the public water system poses a significant risk to the health of school children.

(Unfortunately, the bill did not pass out of Congress in 2016.)

Access to Drinking Water: Making the Healthy Choice the Easy Choice Too often children lack what we call “effective” access to water: there may 26

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be too few water fountains at school, or they are broken or dirty (or simply unappealing), leading children to be under-hydrated during the school day.

NDWA works to provide evidencebased best practices to build effective access to water in schools and child care, supporting the HHFKA which requires access to potable water at no charge in schools operating the NSLP and all CACFP sites. For more, visit www.drinkingwateralliance.org/access.

Sometimes there is confusion about beverages in the NSLP school meal programs. Milk must be offered in the cafeteria service line; in many schools and almost all high schools, meals are “offer vs. serve.” Children are required to take at least three out of five reimbursable lunch items to make a complete meal. This is necessary for the school to receive NSLP reimbursement from the USDA. Milk is one of those five items that must be offered and is one of the items students

usually select. Water may not be offered in the service line in place of milk. Water is required to be available, at no charge, in the cafeteria or eating area.

NDWA allies currently have several research projects underway on drinking water access in schools, including the following: •

an in-depth look at drinking water access in Seattle-area high schools, funded by Healthy Eating Research (HER), a national program of the Robert Wood Johnson Foundation— the nation’s largest philanthropy foundation dedicated solely to health

•

development of a “photo-evidence” tool to assess quality of water access in schools, funded by HER.

NDWA also currently has an active campaign working to ensure water access in schools. The Healthy, HungerFree Kids Act requires that all schools operating on NSLP also develop a “Local School Wellness Policy.” Those policies must be in place by summer of 2017, and a number of advocacy organizations have been working to inform schools about the requirement and to provide model language. NDWA has helped to promote this campaign and to disseminate model Wellness Policy language for bringing effective access to safe drinking water into schools. For more, visit NDWA’s Take Action campaign: www. drinkingwateralliance.org/actionschools.

What About Bottled Water Sales in Schools?

The new USDA guidelines for sales of “competitive foods” (i.e., foods sold à la carte in schools), called the Smart Snacks guidelines, are now effective in all schools on NSLP. These guidelines prohibit sales of most sugar-sweetened beverages in schools, opening up space in vending machines for plain bottled water. For more information, visit www. fns.usda.gov/healthierschoolday/toolsschools-focusing-smart-snacks.

NDWA

Like IBWA, NDWA has been advocating for the USDA to add a symbol for water to the MyPlate nutrition guide.

Drinking Water Promotion: “Water: First for Thirst” Myriad efforts are underway across the United States to promote water consumption. NDWA wants young families to know that, once infants are ready for the introduction of complementary foods, water is the best choice for a secondary beverage after breast milk or infant formula. With expert panels working to develop recommendations for infant nutrition and feeding practices (and the 2020-2025 Dietary Guidelines for Americans revision expected to expand to include infants and toddlers, from birth to age 2), it is timely to begin to educate and promote healthy hydration from the early years.

The New York City Department of Health just released a series of videos that capture, in children’s own words, why they drink water. In a collaboration between researchers and film-makers, the University of California, San Francisco, developed short videos in English and Spanish entitled “Share the Love, Share the Water.”

In addition, First 5 Santa Clara, out of California, has created “Potter the Otter,” a popular character used in child-care facilities and schools to teach and remind children to drink water. Potter the Otter demonstrates healthy behaviors and serves as a visual reminder for young children

to drink water. Potter the Otter and other such visual cues will be even more important by October 1, 2017, when child-care sites operating on CACFP will be required not only to make water available throughout the day (the current requirement) but also actively to offer it to children regularly, preferably with a visual cue at the same time.

4,000 sticky pads have been distributed

by WIC clinics, child-care sites, the American Federation of Teachers, educators, researchers, and advocates, letting nutrition educators across the country add their own symbol for water to the MyPlate graphic. These and other promotional resources are available at www. drinkingwateralliance.org/education.

Those efforts, and many other community campaigns, are promoting water as the best replacement for sugar-sweetened beverages.

NDWA looks forward to continuing to work with IBWA to advocate for a symbol for water on MyPlate!

IBWA and NDWA: A Great Team

Christina Hecht, PhD, is a senior policy advisor at the University of California Nutrition Policy Institute (npi. ucanr.edu), which formed the National Drinking Water Alliance in 2015 (www.drinkingwateralliance.org). Her primary focus area is healthy beverages, particularly drinking water, the healthy alternative to sugar-sweetened beverages.

She studies drinking water access and consumption, particularly in children, and works with colleagues across the country to promote and advocate for drinking water access and to reduce disparity in access to and consumption of healthy beverages.

Researchers and public health advocates across the country, together with IBWA, have been advocating for the USDA to take the necessary steps to add a symbol for water to the MyPlate nutrition graphic. The 2015-2020 Dietary Guidelines for Americans stressed the importance of reducing consumption of added sugars and suggested that water was an ideal replacement for sugar-sweetened beverages. Water is an essential part of a healthy diet, and NDWA and IBWA believe the nation’s most ubiquitous nutrition guidance should reflect that.

As part of the campaign, NDWA developed a graphic (top-left of page) to print on sticky pads. To date, approximately

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Making the Political Argument for Health Hydration

By J.P. Toner, IBWA Director of Government Relations

During a typical meeting with elected officials and other key decision makers at the national, state, and local levels, it is increasingly difficult to find an opportunity to talk about one of bottled water’s most important positive attributes: healthy hydration. The reason is because other issues—such as recycling, water 28

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use, bisphenol A (BPA), taxes, and adequate funding for the U.S. Food and Drug Administration (FDA)— tend to dominate the discussions. So, how does one work into high-level conversations the benefits of drinking water and the important role bottled water plays in helping Americans become healthier?

Make Health a Priority Most legislators are concerned, on some level, about fiscal matters. No matter the level of government, liberal or conservative, urban or rural, lawmakers are always looking for opportunities to preach about the evils of bloated budgets, crushing deficits, and their impact

GOVERNMENT RELATIONS on average citizens. And it’s no secret that some lawmakers and regulators want to focus on issues that grab headlines. But even beyond that, lawmakers love to provide their constituents (and the media) examples of how they helped save their communities.

Here’s a conversation-starter for bottled water professionals. The cost of health care in the United States is staggering. Whether reporting on Obamacare or Medicaid, the media hardly lets a day go by without covering the overwhelming burden on the U.S. health-care system—and the health crisis in America. But, bottled water can help Americans become healthier, which means we have an amazing opportunity to chime in on health-care discussions with facts about the benefits of water consumption. Recent, important scientific research has shown how the simplest of changes in the average diet—switching from sugar-sweetened beverages to water—can reap huge benefits. It’s vital for bottled water professionals to relate such facts to our lawmakers.

The Swap and Flip Swapping out sugar-sweetened beverages (e.g., soda and juice) with bottled water is a healthy eating decision that can lead to better overall health and weight loss.

With the obesity epidemic in America hobbling the U.S. health-care system, the positive results of drinking more water should not be minimalized. It’s our job to educate legislators and help them understand how adequate water consumption promotes overall health.

We have access to research that’s sure to get the attention of those making important decisions about the future of health care in the United States.

In fact, legislation is being introduced to help steer people toward making healthier beverage choices. At the local level, there are efforts to tax sugar-sweetened beverages. For example, in Berkeley, California, a sugar-sweetened beverage

tax not only showed a 21 percent drop in the consumption of beverages with added sugar but also a 63 percent increase in the consumption of bottled or tap water.

This is a great example of the importance of keeping access to water, in all forms, available to consumers.

Dr. Armstrong’s research received national coverage in Fitness Magazine and on MensHealth.com. (Learn more by reading Dr. Armstrong’s article on p.20 in this issue of BWR: “Drink More Water Each Day to Optimize Mood and Mental Tasks.”)

EDUCATING LEGISLATORS ON HEALTHY HYDRATION IS OUR JOB. When broaching the topic of healthy hydration with lawmakers, you may find that they would rather talk about groundwater use or waste management.

While those are obviously important issues to discuss, if you want to flip the conversation to healthy hydration, ask if they’ve heard about the U.S. Department of Agriculture’s (USDA) latest tweaks to the MyPlateMyWins print materials. (Check them out at bit.ly/ MyPlateMyHydrationWins.) One new recommendation states, “Drink water instead of sugary drinks.” You could note that when national organizations such as USDA, FDA, and the Department of Health and Human Services (HHS) promote healthier eating habits for Americans, they all agree on the benefits of water consumption.

It’s important to relate that, in addition to the physical improvements that regular consumption of water can effect, there are mental benefits too. The research of Lawrence E. Armstrong, PhD, a professor at the University of Connecticut and trustee of the Drinking Water Research Foundation (DWRF), has shown the unique connection between proper hydration and cognitive performance. His data demonstrates how staying regularly and properly hydrated during the day can help people feel less fatigued, less confused, and overall in a better mood.

Lastly, a great way to show the bottled water industry’s support for any and all efforts to promote the consumption of water—whether filtered, bottled, or tap—is IBWA’s involvement with Drink Up (youarewhatyoudrink.org.) This campaign, created by the Partnership for a Healthier America (which works with stakeholders across the public and private sectors) and has Michelle Obama as its honorary chair, is dedicated to encouraging people to “drink more water more often.” That’s a message I think we all can get behind.

MEET YOUR LEGISLATORS The political landscape will be different in 2017, so it is more important than ever for IBWA members get to know their elected officials and educate them about bottled water issues. Visit bottledwatermatters. org and click the "Take Action" tab to learn the names of your current federal, state, and local legislators. Then, take a moment to contact them and let them know you work in their district and you'd like to talk with them about bottled water.

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Bottled Water’s Popularity Tells an Important—and Healthy—Story

By Chris Hogan, former IBWA Vice President of Communications

As you’ve probably heard, bottled water is about to mark a historic milestone: according to Beverage Marketing Corporation (BMC), bottled water will overtake carbonated soft drinks as America’s largest beverage category, by volume, by early 2017. Consumption of bottled water increased by 7.8 percent in 2016, and bottled water sales were up an impressive 8.6 percent, now totaling $15.8 billion (wholesale). This isn’t a 30

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fluke. For decades, consumers have been increasing their bottled water consumption. Here’s some context: in 2005, every American was drinking, on average, 25.4 gallons of bottled water. However, by 2016, that figure had jumped to 39 gallons, an increase of 13.6 gallons.

BMC predicts that demand for bottled water will remain strong in the coming years—and soft drink consumption will continue to wane.

This kind of cultural shift in consumer preference reflects a clear trend of consumers increasingly choosing healthy, convenient, zero-calorie bottled water as their on-the-go beverage.

Beverage of Choice This consumer shift isn’t really surprising. Most of what we drink today comes in a package, and a vast majority

COMMUNICATIONS of consumers see bottled water as a smart beverage choice for when they are thirsty for something healthier than a soft drink. According to a 2015 Harris Poll survey conducted for IBWA, 96 percent of Americans believe that we should be drinking more water. The poll also found that 95 percent of Americans believe that bottled water is a healthier beverage choice than soft drinks, and 92 percent say bottled water should be available wherever other beverages are sold.

Americans backed up those statistics with their wallets, choosing bottled water as the clear winner when selecting a beverage packaged in plastic. Of course, from a business perspective, the industry benefits—increasing sales and record consumption is certainly good news. However, the fact that this shift is consumer-driven is the real news. Make no mistake, while IBWA continues to educate people about other important issues—such as our industry’s long history of environmental stewardship, the need for increased recycling, and the safety of bisphenol A (BPA)—choosing water for healthy hydration is already a reflexive action for growing numbers of Americans.

Convenient and Healthful Consumers value bottled water for many reasons. Its versatility makes bottled water a great choice for consumption any time of day and in just about any setting. It doesn’t need to be kept ice cold (like soft drinks or juice) or warm (like conventional coffee or tea). Also appealing are the various packaging types offered—with bottled water available not only in 3- and 5-gallon bottles used in homes and offices but also various single-serve container sizes sold at retail locations.

According to “Modeling the Effect of Replacing Sugar-Sweetened Beverage Consumption with Water on Energy

Intake, HBI Score, and Obesity Prevalence,” a recent study funded by the Drinking Water Research Foundation (DWRF) and published in the peerreviewed journal Nutrients, losing weight and improving risk factors for chronic diseases may be as easy as drinking a

during emergencies, natural disasters, and other catastrophic events. The lead contamination of Flint, Michigan’s tap water and concerns about public water system problems in other U.S. cities, underscore the importance of having access to safe, drinkable water.

CONSUMERS INCREASINGLY CHOOSE BOTTLED WATER AS THEIR ON-THE-GO BEVERAGE. glass of water instead of a soft drink or other sweetened beverage. Using national nutrition surveillance data, study results found that swapping water for 8 ounces of sweetened beverage every day could save people roughly 100 calories, which is between 15 and 30 percent of adults’ total caloric intake. In fact, results also revealed that 18 percent of calories in adults’ diets come from beverages.

Current public health recommendations limit beverage calories to less than 15 percent of total daily calories.

The State of Things Bottled water companies are proud to play a role in helping consumers achieve a healthier lifestyle, but, sometimes, they play an even more important role: provider of life-saving, safe drinking water when public water systems are compromised. Our industry has always been at the forefront of relief efforts

The bottled water industry has long supported strong, reliable, public water systems. But, when clean tap water is unavailable, the bottled water industry has been, and will always be, there to ensure that people have access to safe, quality, water. Throughout the years, bottled water companies have immediately responded to the need for clean water after disasters, such as hurricanes, earthquakes, tornados, wildfires, and flooding. But, what is not often understood is that, in order to respond so rapidly, bottled water companies must be part of an active, viable industry.

The fact remains that the bottled water industry has a great story tell.

As we prepare for bottled water’s ascendency to the top of America’s beverage preference list, we should bear in mind that in many ways this landmark moment is actually just a new chapter in the exciting history of bottled water.

IBWA WEB POSTERS AVAILABLE Looking for content for your social media platforms? Visit www.bottledwater.org/ bottled-water-visuals and download educational posters you can share with your followers to help them learn about healthy hydration.

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Understanding FSMA’s Intentional Adulteration Rule

By Bob Hirst, IBWA Vice President of Education, Science, and Technical Relations

“Mitigation Strategies to Protect Food Against Intentional Adulteration,” also known as the Intentional Adulteration Rule (“IA Rule”), was published by the U.S. Food and Drug Administration (FDA) as a final rule on May 27, 2016.

IBWA initiated an assessment of the rule to determine its impact on members of the association. Staff quickly found a surprise, and our first thoughts were that FDA had made an error in applying the rule. As you know, IBWA’s Bottled Water Code of Practice has required member bottling facilities to develop and maintain a food defense plan since 2004.

The exemptions in the final rule based on company size triggered a reassessment of that policy by the IBWA Technical Committee and Board of Directors.

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Overview of the Final Rule The FDA Food Safety Modernization Act (FSMA) final rule is aimed at preventing intentional adulteration from acts intended to cause wide-scale harm to public health, including acts of terrorism targeting the food supply. Such acts, while not likely to occur, could cause illness, death, and economic disruption of the food supply absent mitigation strategies.

Rather than targeting specific foods or hazards, this rule requires mitigation (risk-reducing) strategies for processes in certain registered food facilities.

Key Provisions of the Rule FDA has taken an approach similar to the Hazard Analysis Critical

Control Point (HACCP) system, a process adopted by industry for the identification, evaluation, and control of food safety hazards. Each covered facility is required to prepare and implement a food defense plan. This written plan must identify vulnerabilities and actionable process steps, mitigation strategies, and procedures for food defense monitoring, corrective actions, and verification. A reanalysis is required every three years or when certain criteria are met, including mitigation strategies that are determined to be improperly implemented.

The rule and the food defense plan include the following components: Vulnerability assessment. This is the identification of vulnerabilities

TECHNICAL UPDATE and actionable process steps for each type of food manufactured, processed, packed, or held at the food facility. For each point, step, or procedure in the facility’s process, the following elements must be evaluated: • The severity and scale of the potential impact on public health. This would include such considerations as the volume of product, the number of servings, the number of exposures, how fast the food moves through the distribution system, potential agents of concern, and the infectious/lethal dose of each—and the possible number of illnesses and deaths.

• The degree of physical access to the product. Things to be considered would include the presence of such physical barriers as gates, railings, doors, lids, seals, and shields.

• The ability to successfully contaminate the product.

Mitigation strategies. These should be identified and implemented at each actionable process step to provide assurances that vulnerabilities will be minimized or prevented. The mitigation strategies must be tailored to the facility and its procedures.

Mitigation strategy management components. Steps must be taken to ensure the proper implementation of each mitigation strategy. In each of these areas of food defense, the facilities are given more flexibility in the final rule to establish the actions most appropriate to their operation and product.

• Monitoring: establishing and implementing procedures, including the frequency with which they are to be performed, for monitoring the mitigation strategies.

• Corrective actions: the response if mitigation strategies are not properly implemented.

• Verification: verification activities would ensure that monitoring is being

THE IA RULE IS AIMED AT PREVENTING ACTS OF INTENTIONAL ADULTERATION. conducted and appropriate decisions about corrective actions are being made.

Training and recordkeeping.

Facilities must ensure that personnel assigned to the vulnerable areas receive appropriate training, and facilities must maintain records for food defense monitoring, corrective actions, and verification activities.

are required to comply four (4) years after the publication of the final rule.

Other Businesses. Businesses that are not small or very small do not qualify for exemptions. These businesses are required to comply three years after the publication of the final rule.

IBWA will continue to monitor implementation of the IA Rule over the next two-three years.

Compliance Dates FDA is providing the following longer timelines for facilities to comply with the intentional adulteration rule.

Very small businesses. Businesses (including any subsidiaries and affiliates) averaging less than $10,000,000, adjusted for inflation, per year, during the three-year period preceding the applicable calendar year in sales of human food plus the market value of human food manufactured, processed, packed, or held without sale (e.g., held for a fee) are considered very small businesses.

This exempts the majority of IBWA member bottling facilities from complying with almost all of the rule’s provisions, which lead IBWA to reevaluate its long-standing policy on food defense.

Very small businesses are required to comply with modified requirements within five years after the publication of the final rule (i.e., a very small business must, upon request, provide for official review documentation sufficient to show that the facility meets this exemption).

Such documentation must be retained for two (2) years.

Small businesses. If your company employs fewer than 500 persons, you

IBWA'S 2017 PCQI WORKSHOPS IBWA is currently planning its 2017 PCQI workshop schedule, focusing on the following cities: • Orlando, Florida: February 2017 • Dallas/Fort Worth, Texas: March 2017 • Charlotte, North Carolina: April 2017 • Albany/Troy, New York: April/May 2017 • Sacramento, California: May 2017 • Denver, Colorado: May 2017 • South Bend, Indiana: July 2017 All dates are tentative until a hotel has been contracted. As additional information becomes available, IBWA members will be updated via the News Splash e-newsletter and special email announcements. If you have any questions, contact IBWA Vice President of Education, Science, and Technical Relations Bob Hirst: bhirst@bottledwater.org.

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CPO QUIZ

IBWA

certified plant operators (CPOs) are encouraged to complete the following quiz for ½ IBWA continuing education unit (CEU). The questions are derived from material presented in this issue of the Bottled Water Reporter, the IBWA Plant Technical Reference Manual, and the IBWA Bottled Water Code of Practice. Submit this quiz to Claire Crane (ccrane@bottledwater.org / Fax: 703.683.4074), IBWA Education and Technical Program Coordinator, 1700 Diagonal Road, Suite 650, Alexandria, VA 22314. Look for additional quizzes in future issues and earn additional IBWA CEUs! Name______________________________________________________

Company_ _________________________________________________

Address____________________________________________________

City_______________________________________________________

State/Province_ _____________________________________________

ZIP/Postal Code_ ___________________________________________

Check your selection for each question

1|

The new FDA Intentional Adulteration Rule (IA Rule) requires facilities to prepare and maintain a _____.

OO OO OO OO

Food safety plan Facility evacuation plan Food defense plan Health and safety plan

2|

FDA’s approach to a food defense plan is similar to _____.

OO OO OO OO

A food safety plan A HACCP system A SSOP An operations plan

3|

Currently, FDA’s SOQ for lead is 5 ug/l. The current _____ for public drinking water is 15 ug/l.

OO OO OO OO

Maximum contaminant level (MCL) Standard of quality (SOQ) Warning limit Action level

4|

According to the IBWA Code of Practice, water intended for bottling shall not be stored, transported, processed, or bottled through equipment or lines used for milk, other dairy products, non-beverage foods, or any non-food product.

OO True OO False

5|

Determining the ability to successfully contaminate the product is part of a _____.

OO OO OO OO

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6|

The term applied to a delayed health hazard is _____.

OO OO OO OO

Immediate Long-term Chronic Acute

7|

The IA Rule defines a small business as a business that _____.

OO OO OO OO

Employs fewer than 500 people Has annual sales of less than $2 million Is owned by an individual Produces less than 2,000 cases of water per day

8|

A bottled water plant shall be operated under the supervision of a competent person qualified by experience, education, and training to operate and maintain the plant’s facilities.

OO True OO False

9|

These should be identified and implemented at each actionable process step to provide assurances that vulnerabilities will be minimized or prevented. These must also be tailored to the facility and its procedures.

OO OO OO OO

Critical control points Mitigation strategies Hazards Preventive measures

10|

The IBWA Code of Practice requires _____ testing for total coliform in finished product samples.

OO OO OO OO

Weekly Daily Monthly Quarterly

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BWR 2017 IBWA MEDIA

Now Booking 2017 Ad Space for IBWA's Bottled Water Reporter magazine and News Splash e-newsletter.

Contact Stephanie: 817.719.6197 / stephanie@bottledwater.org.

PLANNER

WE'RE NO.1 IN 2017, BOTTLED WATER WILL SOFT DRINKS OUTPACE AS THE NO. BEVERAGE 1 IN THE UNITED PACKAGED STATES. Now is the time to ensure your business is a part of that success—n to plan your ow is the time advertising campaign with Internationa l Bottled Water the Association authoritative , the voice on all issues concerning the bottled water industry.

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CSBWA 9th Annual Convention and Trade Show River City Hotel and Casino St. Louis, MO

MAY 17- 20

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CLASSIFIEDS

ASSISTANT PROJECT MANAGER EarthRes is seeking an Assistant Project Manager in our Philadelphia, PA area office. Qualifications: BS in Biology, Chemistry; 5-7 years of experience in environmental consulting and/or the beverage/bottled water industry; experience with State and Federal water supply regulations is preferred, including source development, permitting and beverage/bottled water manufacturing and compliance. Strong communication and technical writing skills required. Job Duties: assist with management and coordination of staff personnel and project tasks; prepare reports, work plans and permit applications; prepare investigative scopes of work; evaluate site data; work with clients and regulators; assist with wetlands/waters determinations and report preparation. Interested applicants may send or email resumes and contact information to: Human Resources, EarthRes, PO Box 468, Pipersville, PA 18947, careers@earthres.com.

ARE YOU AN IBWA PAC MEMBER? The IBWA Political Action Committee (PAC) is an important and vital component of IBWA’s political advocacy—both in Washington, DC, and in your backyard.

Interested in learning more about the activities and work of the IBWA PAC and how you can support industry efforts?

Contact IBWA Director of Government Relations J.P. Toner: 703.647.4616 or jtoner@bottledwater.org.

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Join Us In the Business of Making the World Healthy!

Contact membership at 703-647-4615 or cbass@bottledwater.org if you have interest in joining!

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