Thirsty for more hydration knowledge? A POTSy perspective

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Good hydration means your body has the right amount of fluid in the right places. A normal body is about 50-60% water, but body parts differ:

  • Blood is typically about 93% water;
  • muscle is about 73% water;
  • fat is about 10% water;
  • lungs are about 83% water;
  • the brain is about 73% water.

Sweating 2% of one’s body weight (e.g., 3 pounds or 6 cups for someone who weighs 150lbs) is known to make athletes lose their physical and mental edge in the heat. Sweating just 1.5% is known to make average people feel sluggish, moody and unable to think clearly.

Most people don’t need to think about hydration too much: They drink when thirsty, eat when hungry and voila…their bodies do the rest.

A POTSy body often isn’t so good at retaining fluids. One common problem involves the kidney hormones aldosterone, angiotensin and renin, which regulate sodium and fluid retention. When not enough fluid stays in the bloodstream, the reduced blood volume (a.k.a. hypovolemia) contributes to many of the POTS symptoms: low blood pressure, dizziness, fatigue, higher heart rate, heat intolerance, and other classic symptoms.

So it’s probably no surprise that POTS patients need exemplary hydration habits. Below are some findings about sneaky dehydrating factors and tricks for boosting hydration. While this research wasn’t done on POTS patients, and may not always apply to our POTSy bodies, it offers some guidance on things we can try in our quest to feel better. (Disclaimer: Check with your doctor before experimenting.)

These things can dehydrate you:

Low-carb diets, because every gram of carbohydrate hangs on to several times its weight in water during the digestion process.

High protein diets, because acidic byproducts of protein digestion are flushed out with lots of water.

Low-sodium diets, because sodium is the most important electrolyte needed for the body to retain water. Drinking large amounts of water without enough sodium can be dangerous.

Diets lacking in fruits and veggies. The body is designed to get lots of moisture and electrolytes from watery plant foods. For example:

  • Lettuce is 96% water,
  • Broccoli is 89% water,
  • Tomato is 95% water,
  • Oatmeal is 84% water,
  • Watermelon is 92% water,
  • Cucumber is 96% water,
  • Zucchini is 95% water,
  • Cantaloupe is 90% water,
  • Blueberries are 85% water.

Alcohol, a strong diuretic.

Vinegar, a strong diuretic.

High altitudes, because faster breathing and dry air makes you exhale more moisture.

Getting too cold. In an effort to warm you, your body moves fluids from extremities to your core, which increases urine output.

Caffeine and caffeine tablets. Caffeine is a mild diuretic and could lead to mild dehydration if it is not accompanied by drinking water.

Some drugs. Laxatives, blood pressure lowering medications and antihistamines are among those that can dehydrate.

Hormonal fluctuations. Because the reproductive hormones estrogen and progesterone also affect blood plasma volume, young women usually have a time of the month when they are mildly dehydrated due to these hormones.

Getting too hot and sweating.

Breastfeeding.

Vomiting.

Diarrhea.

These things can boost hydration:

Chugging a little before sipping. Start your day by drinking 2 cups of water or other fluid, which signals your stomach to empty fluid into your intestines faster. After that your occasional sips will hydrate you faster.

Consuming enough salt and fluids. The 2015 POTS Expert Consensus Statement recommends consuming up to 10-12g salt and 2-3L water per day.

Sports drinks hydrate better than water because the carbs, salt and other electrolytes help your body absorb fluids, rather than passing them straight through to your bladder.

A little protein. Sports drinks that contain a little protein are more hydrating than those without. Every major brand now offers a version with protein. This is not referring to high protein shakes, but recovery drinks that contain a small amount of protein, usually in a carb:protein ratio of about 4:1.

Soaked chia seeds. Chia seeds reportedly powered the Aztecs to battle and the Tarahumara Indians during their regular 50-100 mile runs. This tip comes from the book “Born To Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen” by Christopher McDougall. Soaked chia seeds may promote hydration because they absorb 12 times their weight in water, grow gelatinous, then slowly release their water during the following days, as they pass through your digestive system. Just don’t forget to soak them for at least 2 hours before consuming so that they don’t expand after you eat them. Start by mixing a teaspoon of chia seeds into a cup of your favorite beverage, soak for 2+ hours, and chew them up as you drink. McDougall compares the nutrition of chia seeds to “a smoothie of salmon, spinach and growth hormone,” but don’t worry—they taste like whatever you soak them in. My favorite soaks are soymilk and cinnamon or coconut water.

What about….?

Coffee or tea. Caffeinated beverages have a mild diuretic effect and can also increase heart rate. Check with you doctor whether it’s safe for you to consume caffeine and at what amounts.

Electrolyte powders or tablets, such as Lyte Show, Nuun, Electro-Mix and many others are good to have on hand, especially when away from home. These can be added to water or other fluids to boost hydration. Follow the directions and add extra salt if the mix is salt-free, like Electro-Mix.

DIY sports drink. You can make your own sports drinks by combining water, salt, sugar (or honey, maple syrup, etc.), and lemon or lime juice or other fruits. You can also add powdered electrolytes such as Electro-Mix or Lyte Show, if desired. There are thousands of different recipes available online, but a simple one from Nancy Clark, RD, the world’s most respected sports nutritionist, calls for mixing:

  • 3 ¾ cups cold water
  • ¼ cup pure maple syrup
  • ¼ teaspoon salt

Coconut water. Studies suggest that coconut water hydrates as well as sports drinks, however it was more likely to cause bloating and stomach upset in one study where it was consumed after running on a treadmill for 60 minutes.

Pickle juice has been studied in small quantities (drinking 1mL/kg body weight) with no findings of benefit or harm. It is not recommended to drink more, as some experts worry it could lead to blood mineral imbalances such as hyperkalemia (high potassium).

Carbonated water is reported to be just as hydrating as regular water, for healthy people. However it may suppress thirst and therefore make you drink less water if you aren’t paying attention.

Sugar-free options. Sugar in beverages promotes better hydration, however if you want options without added sugar, some of the more hydrating choices are soup broth, bone broth, miso broth, unsweetened soymilk, rice milk, oat milk, hemp milk, coconut water or cow’s milk. Just make sure to read ingredient labels and avoid carrageenan, if you want to protect your intestines from possible inflammation and distress.

My personal favorite ways to hydrate include veggie broth, bone broth, organic soymilk, watermelon with salt and cocoa powder sprinkled on top, all sorts of MCAS-friendly teas (more on that in a later blog), salty and sweet veggie stir-fry or ratatouille, roasted salty cauliflower or zucchini, soaked chia, berries and cinnamon, and weak decaf coffee with a pinch of salt and coconut or almond milk. I would love to hear about your favorite hydrating concoctions, so please share. Cheers!

By Jill Brook, M.A., Patient & Nutrition Consultant to the Dysautonomia Clinic

Sources:

• Raj SR, Biaggioni I, Yamhure PC, Black BK, Paranjape SY, Byrne DW, Robertson D. Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia syndrome. Circulation. 2005 Apr 5;111(13):1574-82. Epub 2005 Mar 21.

• Mar PL, Raj SR. Neuronal and hormonal perturbations in postural tachycardia syndrome. Front Physiol. 2014 Jun 16;5:220. doi: 10.3389/fphys.2014.00220. eCollection 2014.

• McDougall, C. Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen. New York: Vintage Books; 2009.

• Clark, N. Nancy Clark’s Sports Nutrition Guidebook—5th Edition. Champaign, IL: Sheridan Books; 2014.

• J Int Soc Sports Nutr. 2012 Jan 18;9(1):1. doi: 10.1186/1550-2783-9-1.

• Kalman DS, Feldman S, Krieger DR, Bloomer RJ. Comparison of coconut water and a carbohydrate-electrolyte sport drink on measures of hydration and physical performance in exercise-trained men. J Athl Train. 2009 Sep-Oct;44(5):454-61. doi: 10.4085/1062-6050-44.5.454.

• Gregor, M. Is Caffeinated Tea Dehydrating? NutritionFacts.org website http://nutritionfacts.org/video/is-caffeinated-tea-dehydrating/. Accessed Nov. 26, 2016.

• R Sheldon, BP Grubb, B Olshansky et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm June 2015:12(6); e41–e63.

• Miller, KC, Mack, G, Knight, KL. Electrolyte and Plasma Changes After Ingestion of Pickle Juice, Water, and a Common Carbohydrate-Electrolyte Solution. J Athl Train. 2009 Sep-Oct; 44(5): 454–461. doi: 10.4085/1062-6050-44.5.454.

• Salt and your health, Part I: The sodium connection. Harvard Health Publications, Harvard Medical School website www.health.harvard.edu/newsletter_article/salt-and-your-health. Accessed Dec. 2, 2016.

• Winter dehydration. Human Performance Resource Center, Department of Defense website www.hprc-online.org/blog/Winter-dehydration. Accessed Dec. 2, 2016.

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