“Shall we or shall we not? Yes or No? ” asked the lawyer. Was the witness evading the question when he answered, ” Partly yes and partly no? ” Not at all. There are some questions which can neither be truthfully nor satisfactorily answered by one word. Strange to say, many of the magazine articles treating this subject have attempted to answer yes or no for all individuals. About the briefest answer which can be given to the question, Should we take water with meals? would be: seventy per cent of us should; thirty per cent should not or at least not more than eight ounces of all fluids.
To the average person a stomach is just a stomach. He does not realize there is great variation as to size, shape, position, muscular, and secretory powers. No two leaves are alike. It is not strange that stomachs also vary.
An attempt will here be made to develop the treatment of this subject from a scientific stand-point. The first requirement is to state facts on which conclusions may be based.
The gastric juice is well represented in its chemical value by the amount of hydrochloric acid which it contains. If this is greater than average, water drinking with meals may be an advantage ; if less than average, a disadvantage; if average, not harmful.
So much for the secretory factor in the case. Motility is the other important factor. Motility refers to the motor power or the mechanical ability of the stomach to receive food, hold the same within its grasp, mix thoroughly with its own juices, and, at the proper time, pass it on to the duodenum. The size, shape, position, and muscular power of the stomach determine its motility.
The first real information regarding its muscular contractions was obtained by observation of a man who had received a bullet wound in the stomach, leaving a permanent opening through the abdominal wall. Generalization from such a specific instance was a mistake. Our present information on this subject is quite different. Much of this was obtained by means of the X-ray, which affords opportunity to observe stomachs of many kinds normal as well as abnormal. This has helped to answer the question, ” Should we drink water with meals? ” and has given sufficient reasons therefor.
An X-ray classification according to the shape and strength of the stomach is simple and easily understood. First, there is the stomach which is shaped like a steer’s horn, large end uppermost, called the hypertonic stomach (meaning increased tone). Tone refers to muscular power.
Second, there is the stomach with normal tone orthotonic shaped like the letter J.
Third, there is the stomach with less than normal tone (hypotonic) more like a U than a J the left arm reaching half the height of the right.
Fourth, there is the stomach with practically no tone at all atonic shaped still more like the letter U that is, the left arm comes up almost as high as the right.
For X-ray examination, a bowl of oatmeal and bismuth is given. The bismuth casts a shadow, enabling one to observe its movements through the stomach. A stomach of the first type is emptied of such a meal in two or three hours; that of the second, in three or four; the third, in four or five; and the fourth, in five to seven. It is uphill work for the last two types to empty themselves. Since water seeks the lowest level, it is more difficult for such weak stomachs to pass water than solid food into the intestine.
Every one is familiar with the way in which sand is washed ashore by the waves of the ocean. With each wave the sand is brought further and further on the beach, and the water flows back again. Contractions of the stomach act in a similar way. Each wave brings the solid food toward the outlet of the stomach, and it is gradually passed to the duodenum. In the weak stomach, water flows back again and consequently too much fluid always remains.
In the first and second types, the greater part of the water passes through the stomach in less than fifteen minutes; therefore it will not interfere with the meal. Even three to five glasses may be taken at one meal and half an hour later no more will remain than if only one had been taken. The same cannot be said of the last two types, for the solid food remains long in these, and the fluids even longer. Two glasses of water weigh one pound. If one takes four glasses of water or its equivalent, two glasses of water, one cup of coffee, and one plate of soup, he adds to the weight of the stomach contents two pounds (equal to eight small lamb chops). This is greater than the weight of the solid food contained in an ordinary meal. Most of this water remains to the end of the meal, adding to the weight of the stomach contents for quite a while. It so happens that these weak stomachs, just the ones which cannot stand a heavy load, retain it longer than those which could endure it better the strong ones emptying rapidly.
The stomach is a hollow organ. The function of its muscles is not only to mix and pass the food along, but to maintain its shape and prevent undue stretching and dilatation. When the muscles are weak, the elasticity of its walls is lost and, like an old rubber band, it stretches when filled but does not show a tendency to return to normal size when empty. It is correct to say that the normal stomach is, within limits, the size of its contents; that is, after a small meal, it is seen grasping its con-tents closely; after a large meal, it stretches to accommodate the greater bulk. The stomach of poor tone, instead of grasping its contents, is more like a flour sack lifeless and inelastic.
There are a few symptoms by which poor motility and therefore inability to take large amounts of water may be recognized. There is a feeling of fullness, heaviness, and weight, after small amounts of food. Soup so fills one that it takes the appetite away. Large meals cannot be taken without causing distress.
Even in bad cases, eight ounces of fluid is generally allowable at each meal.
The subject should be easily understood after this presentation of the mechanical features of the stomach. To review those with a large amount of gastric juice, of high acidity, may drink with advantage; those with low acidity, may be injured, especially if motility is at the same time impaired. Those with good motility have no reason to avoid water drinking with meals. Those with poor motility should take no more than eight ounces of fluids of all kinds with each meal.
A certain amount of water is a necessity and it should be supplied between meals in sufficient amounts to bring the total quantity for each twenty-four hours up to one and one-half quarts in winter, with a further allowance for unusual exercise and for warm weather.