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Abstract
This dissertation research investigated hydration strategies, hydration status, perceptions of the water environment, health, and nutrition among Tsimane forager-horticulturalists undergoing lifestyle transitions in the Bolivian Amazon. Globally, 748 million people do not have access to clean drinking water. How humans meet their water needs through diet is critical to understand because it is extremely costly to make genetic changes or physiological adaptations when dealing with environmental constraints, like water scarcity. This dissertation adds to a human adaptation theoretical approach by examining water holistically within the diet and in relation to disease pressures. Specifically, it investigated water intake and hydration status, how different strategies were associated with gastrointestinal illness risk, how intakes and hydration levels compared to industrial populations, and how perception of water insecurity were related to health outcomes following a major flood in two rural Tsimane villages in Beni, Bolivia. It combined ethnographic, nutritional, qualitative, anthropometric, and biomarker data to contribute to literatures on nutritional adaptations, human adaptability, water insecurity, and global climate change by examining human-environment interactions revolving around water use among a population undergoing lifestyle transitions. It demonstrated that hydration strategies that utilize high proportions of food for water are associated with lower risk of GI illness. These hydration strategies appear to serve as nutritional adaptations to minimize exposure to pathogens through lower intake of raw or untreated water. Findings illustrated that Tsimane absolute water intake and intake from foods was significantly higher than international water recommendations. However, it also found that close to 50% of the individuals were dehydrated. Using random-effects regression models, it illustrated that differences in ambient temperature, activity patterns, and lifestyle drive daily rhythms of hydration. An unintended consequence of lifestyle transitions may be an increased vulnerability to dehydration. Finally, it extended the construct of water insecurity to a water rich, flood prone region and illustrated that high water insecurity was associated with an elevated risk of diarrhea for adults and that maternal medium and high water insecurity related to increased risk of dehydration for their children.