From the legendary Bruce Lee to the Hong Kong-Taiwanese martial artist Jimmy Wang Yu, whose fame preceded Lee’s and who passed away in April of this year, our onscreen martial-arts gods have a way of elevating themselves onto the plane of immortality, seemingly immune to the laws of nature. They can do no wrong. They exist to fend off the bad guys and to return us home safe and sound. We can never imagine them dead even if they might’ve left us a long time ago.
It might come as little surprise then that Bruce Lee’s name is back in the news. But this time, it’s due to a startling new theory proposing the likely cause behind the Enter the Dragon star’s death: too much water.
A research paper published in the Clinical Kidney Journal of the Oxford University Press titled “Who killed Bruce Lee? The hyponatraemia hypothesis” published in March of this year, could perhaps finally lay conspiracy theories surrounding Lee’s untimely death in 1973 at the age of 32 to rest. The paper proposes that the likely cause of death was “cerebral oedema due to hyponatraemia.”
While the cause of Lee’s death, according to autopsy reports, had been determined as cerebral oedema, or an excess accumulation of fluid in the brain that results in swelling, the reasons that led to the disease were unclear.
Expert theories ranged from over-exertion and heat stroke, possibly compounded by an operation that Lee had had a few months prior to have his underarm sweat glands removed, to an allergic reaction to the main ingredient in a painkiller that he was given after complaining of a headache.
“Cerebral oedema” refers to the swelling of the brain caused by a build-up of fluid in the brain, while “hyponatraemia” occurs when the blood sodium level is below normal and the body holds on to too much water.
Translate, you say? Okay. Lee, according to the paper, likely died because his kidneys were unable to excrete excess water for reasons including prescription drugs as well as a history of acute kidney injury and exercise (and not just because he drank too much water).
So, no, he wasn’t killed by the Chinese secret organised crime syndicate, Triad. He wasn’t poisoned by a jealous lover. The Illuminati had no role to play in his death, there wasn’t any family curse at work, and it wasn’t just Lee having had one glass of H2O too many.
But we decided to stay with the questions anyway, surrounding the many headlines that popped up after this study claiming that he died from drinking too much water.
So, is that really possible for even us? How much is too much? Can drinking a lot of water – something we’ve been told to do so much that we hardly even question it – put unnecessary strain on the kidneys that can, in turn, lead to fatal brain swelling? Can one actually die from drinking too much water?
Sanjiv Kumar Sharma, a consultant neurologist at the Max Smart Superspeciality Hospital in New Delhi, India, told VICE that drinking large amounts of water will not result in death, unless there are underlying pathological diseases, or the patient is consuming multiple drugs that affect the brain, the kidneys, and the heart.
“If the patient has renal dysfunction (one or both kidneys no longer function well on their own) and consumes plenty of water, it could cause dilutional hyponatraemia, where water will be retained and the sodium-potassium pump will fail in the body, causing brain swelling and ultimately resulting in death,” he said. “However, if you don’t have any underlying heart or kidney diseases, simply drinking excessive water will not cause significant cerebral oedema (brain swelling) that can lead to death.”
That said, research does show how “water intoxication” that occurs from having too much water in too short a period of time can be fatal. Now, this rarely happens accidentally. From real-life examples, we’ve seen how this has happened in water drinking contests, where the winner was the person who drank the most and waited the most to go to the toilet, or from heavy exercise in which huge amounts of fluids were consumed. This kind of over-hydration upsets the balance of electrolytes, not giving our kidneys enough time to process. Hyponatraemia can be the result of this overhydration or water intoxication — resulting in low sodium levels and potential swelling of the brain.
This is seen in other physically extreme situations too, like in military training. One U.S. Army study found 17 trainees were admitted to hospital over a year for water intoxication while another found that three soldiers had died from it, leading to a recommendation that no more than 1-1.5 litres of water should be consumed per hour of heavy sweating.
But for most of us, who’d hardly ever subject our bodies to such extremes, Sharma also cautions about other factors that can lead to hyponatraemia without such insane levels of water intake involved. He said that patients with brain infections such as meningitis, opioids, and those on painkillers and similar drugs are more vulnerable because in these cases water is retained in the body.
“The swelling of the brain doesn’t only happen due to high water,” he said. “Even a patient with liver dysfunction can have an accumulation of ammonia in the body leading to brain swelling, so there are multiple factors at play.”
Similarly, as in the case of Lee, the study noted that there were other factors at play that might have resulted in the blockage of his kidney tubules, interfering with his urine secretion, including a history of prescription drugs that were diuretics, non-steroidal anti-inflammatory drugs, opioids, antiepileptic drugs, consumption of alcohol, (contested) use of marijuana, chronic low-solute intake, and a past history of acute kidney injury and exercise.
While Bruce Lee’s death due to hyponatraemia is controversially linked to potential usage of marijuana, studies suggest that people consuming MDMA or ecstasy are more prone to it, since these drugs not just have a tendency to raise your body temperature but also can distort your perception of how hydrated you are.
Delhi-based nephrologist Rajesh Goel also said that there are always multiple events that precede death due to excessive water consumption – from the patient experiencing altered states of consciousness due to drug usage, cardiac issues, and drowsiness, to name a few.
“When the sodium is high, the brain sends signals to the body to consume water and vice-versa for when sodium levels are low,” he told VICE. “However, there are various reasons why someone might consume more water such as high sugar levels, dehydration due to heatstroke, excessive water loss from loose motions, and excessive urine volume.
So, what’s the ideal water consumption intake per day, if you don’t have any kidney, brain or heart issues? According to Goel, three litres is usually considered the upper limit for consuming water, but this volume is also dependent on the weather.
One is likely to consume more water in the summers because water is lost due to sweating, and less in the winters because avenues for the body losing water – primarily, sweating – are fewer. “In conditions where the patient has an increased tendency of urine infection or stone formation, we advise them to drink excessive water, but not in all cases.”
The key, then, is to frequently get tested for any underlying disease and be aware of any renal infections that might get complicated later. Goel said that the most common telltale signs related to kidney dysfunction are usually abnormal or frequent urination, vomiting, difficulty in breathing, and overall weakness. As a warning to all the smokers reading this, Goel added that they’re better off first cutting back on cigarettes, as it causes hormonal imbalances, leading to lower blood circulation in the kidneys.
“If you are drinking four litres of water and still feeling thirsty and not passing an [equivalent amount of urine], it’s advisable to get a sodium evaluation,” said Sharma, who is a neurologist. He also cautioned against the consumption of a little salt in order “to balance things out,” which he added, “doesn’t work either.”
However, many doctors also bust the popular eight-glasses-a-day rule. Believe in your thirst, global health expert Rachel C. Vreeman had told VICE earlier. Vreeman is also the director at the Arnhold Institute for Global Health at the Icahn School of Medicine Mount Sinai.
“Your body tells you that you’re thirsty pretty early on,” says Vreeman, who’s researched hydration beliefs and co-authored a book busting medical myths including the eight-glasses maxim. The problem, Vreeman says, is that people have grown so used to arbitrary goals that they have overridden their thirst signal and no longer have a good sense of when they need to drink something. They can get that back, though, by paying closer attention instead of automatically drinking a certain amount of water.
So, in short, like it is with everything in life – from drugs to desires – moderation is the key and so is listening to what your body actually wants, needs, and is good with. Know what works for you and stick to that.