Sounds like a new kid on the block question

[Nicole's Mom]

You'd think by now our family would know the answer to this question after all this time. But here I am trying to find out: How much is too much water to drink like when is one drinking so much that there is a danger of washing out the ADH? Sometimes Nicole's drinking seems reasonable and sometimes she gets really thirsty and drinks what seems like an awful lot of water. She does do a high salt regimen but that doesn't change from day to day. It's pretty much measured out exactly. Yet her thirst changes. I can't seem to find a formula for water intake anywhere especially for POTS patients.

Any help would be appreciated.

Thanks

Beverly

[porque]

Hello,

I know that if you drink too much water you can actually wash out your electroytes. So I think it would help if Nicole drank a sports drink like Propel in addition to pleanty of water.

[Nicole's Mom]

Thanks so much porque for your reply. It's certainly something important to think about- electrolytes. Nicole does take prescription potassium (K-dur) from the pharmacy and magnesium and of course the salt. And her last blood test indicated a balance in her electrolytes.

I was wondering about the ADH since that plays a role in retaining the fluids and I know if you drink too much you can wash that out.

Beverly

[porque]

Forgot to mention that I have had an ADH test that came back way low...doc said it was cuz I drink too much...but I only really drink 2 liters a day and honestly have been doing that way before I had autonomic issues. I was a basketball player and always stayed very hydrated. Never seemed to bother my ADH then. Go figure! But to answer your question I think you would have to drink an enourmous amount to wash out ADH...and even then you wont wash out ADH...your pitutary gland senses when you need ADH to be released...more when you are dehydrated and less when you are consuming aduquate liquds. Make sense? How much water does Nicole consume?

[Jersey Girl]

I was told by an autonomic specialist that one should drink 1 gallon of fluids per dayand have frequent salty snacks. I also drink Propel and usually have one (16.9 ou) before I get out of bed (or finish it up soon after getting up) and another bottle mid-morning in addition to my decaffeinated tea with my breakfast. I don't know anything about ADH levels but I also dump fluid continuously throughout the day. Martha

[DancingLight]

beverly,

you are right about the possibility of drinking too much water and washing out the ADH if that is a problem.

i WANT to drink, drink, drink and am always thirsty. but i try to restrict my fluid intake b/c i am on DDAVP and also b/c if i don't, even on the DDAVP i have to pee constantly. if i drink 'too much' i'm up peeing all night.

so, i judge it based not on thirst, but on how often i can tolerate the peeing!

also, i like to drink some of the mineral waters that have sodium and some other electrolytes in them. they seem to satisfy my thirst more after so many years of plain water, water, water.

also, i feel like if i drink too much water i feel worse and if i don't drink enough i feel worse. the amount changes a little based on how hot it is and if i am sweating a lot!

i try to drink no more than 64 ounces a day probably. but i want to drink more!

don't know if this helps at all!

emily

[briarrose]

Make sure you read what's in the blue box below!

http://www.pihealth.com/water.htm

Are You Drinking Too Much Water?

It's been a busy summer. Most of June was filled with planning and hosting Dr. Joel Wallach from American/Canadian Longevity. Dr. Wallach is 'The' Colloidal Mineral Doctor. He was here for 4 nights and we had a turn out of over 650 people...double what we expected!

Dr. Wallach explains that minerals are severely lacking in our soil and consequently our food. They aren't in our water either. This leads me to our topic today. Are you drinking TOO MUCH water?

How many have you read or been told to drink lots of water? If you haven't heard this, you are the exception. How many of you try to drink 6 to 8 glasses a day regardless of your thirst level? This is one of the common misconceptions in the health world that we are constantly inundated with.

I was pleased to see in 'The Province' newspaper today that Karen Gram has written a piece on the pitfalls of overdoing water consumption. She mentions a Boston marathoner, Cynthia Lucero, who collapsed near the end of the race. She had consumed water during the race which diluted her sodium levels and consequently her body could no longer function. Her brain swelled and she died 2 days later in hospital. She also, mentions research done by Dr. Heinz Valtin on water consumption. His very relevant findings are documented in the article below from CNN.com.

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How much water do we really need?

August 20, 2002 Posted: 2:29 AM EDT (0629 GMT)

August 20, 2002 Posted: 2:29 AM EDT (0629 GMT)

WASHINGTON (AP) -- "Drink at least eight glasses of water a day" is an adage some obsessively follow, judging by the people sucking on water bottles at every street corner -- but the need for so much water may be a myth.

Fear that once you're thirsty you're already dehydrated? For many of us, another myth. Caffeinated drinks don't count because they dehydrate? Probably wrong, too.

So says a scientist who undertook an exhaustive hunt for evidence backing all this water advice and came up mostly, well, dry. Now the group that sets the nation's nutrition standards is studying the issue, too, to see if it's time to declare a daily fluid level needed for good health -- and how much leaves you waterlogged.

Until then, "obey your thirst" is good advice, says Dr. Heinz Valtin, professor emeritus at Dartmouth Medical School, whose review of the eight-glass theory appears in this month's American Journal of Physiology.

"It's about time for all the attention," says Pennsylvania State University nutritionist Barbara Rolls, a well-known expert on thirst. "There's so much confusion out there."

Much of it centers on where you should get your daily water.

"There's this conception it can only come out of a bottle," and that's wrong, notes Paula Trumbo of the Institute of Medicine's Food and Nutrition Board, which hopes to decide by March whether to issue the first official water-intake recommendation.

In fact, people absorb much water from the food they eat. Fruits and vegetables are 80 to 95 percent water; meats contain a fair amount; even dry bread and cheese are about 35 percent water, says Rolls. That's in addition to juices, milk and other beverages.

And many of us drink when we don't really need to, spurred by marketing, salty foods and dry environments, Rolls says.

"For most of us, that's not going to matter -- you're just going to need to go to the bathroom more," she says.

But for people with certain medical conditions, chugging too much can be harmful, sometimes fatal, Valtin warns. Even healthy people -- such as teenagers taking the party drug Ecstasy, which induces abnormal thirst -- can occasionally drink too much. So-called water intoxication dilutes sodium in the blood until the body can't function properly.

Conversely, no one disputes that getting enough water is crucial. Indeed, the elderly often have a diminished sensation of thirst and can become dangerously dehydrated without realizing it. People with kidney stones, for example, require lots of water, as does anyone doing strenuous exercise.

But the question remains: How much water does the typical, mostly sedentary American truly need? And what's the origin of the theory, heavily promoted by water sellers and various nutrition groups, that the magic number is at least 64 ounces?

Top of Page

Valtin, who has spent 40 years researching how the body maintains a healthy fluid balance, determined the advice probably stems from muddled interpretation of a 1945 Food and Nutrition Board report. That report said the body needs about 1 milliliter of water for each calorie consumed -- almost 8 cups for a typical 2,000-calorie diet -- but that "most of this quantity is contained in prepared foods."

That language somehow has morphed into "at least" 64 ounces daily, Valtin says. (One Web site's "hydration calculator" even recommends a startling 125 ounces for a 250-pound couch potato.) And aside from the American Dietetic Association's advice, few of the "drink more water" campaigns targeted to consumers mention how much comes from food.

Valtin couldn't find any research proving the average person needs to drink a full 64 ounces of water daily.

Also, contrary to popular opinion, he cites a University of Nebraska study that found coffee, tea and sodas are hydrating for people used to caffeine and thus should count toward their daily fluid total.

Other myths:

That thirst means you're already dehydrated. That can be true of the elderly, and studies of marathon runners and military recruits in training have found that some focus so intently on strenuous exercise that they block thirst sensations until they're in trouble. But Rolls did hourly hydration tests to prove that drinking when thirsty is good advice for the rest of us.

That water blocks dieters' hunger. Studies show water with food can help you feel full faster, but that just drinking water between meals has little effect, Rolls says.

So how much do we need? Until the Institute of Medicine sets a level, "if people obey their thirst and they are producing urine of a normal yellow color, that's a safe sign," Valtin concludes.

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Hi there:

This is just a follow-up on the water email a few days ago.

I had one person protest about the reference to sodas, tea and coffee counting towards our daily fluid consumption. They thought that we advocate drinking these beverages. We don't! Now and then they're okay, but not as a rule. However, if they are consumed, they do count as fluid consumption. Sodas, however, are particularly bad in that they leach the minerals from your body.

This leads to another point the person disagreed with. He thought it was unbelievable that Dr. Wallach would tell people exercise is not good. Let me make this clear. Dr. Wallach says this...

Excessive exercise leaches valuable minerals from our bodies, thus leaving us open to many different illnesses. Exercise is good when done in moderation and when we replace our minerals during and after a workout. He points out that no professional athlete has ever lived past 100 and many die quite young. Why? Mineral deficiencies. They sweat more than the average person. There has been research into this and it has been shown that when all is said and done, a couch potato will outlive a person who works out a great deal.

If they did a study like this and supplemented the active people with highly absorbable minerals and vitamins the end result would probably be quite different. It makes sense to me. Hope this clears up any misconceptions.

So what do you do about rehydration... especially if you are working out or have an occupation which causes you to sweat excessively? Dr. Jack Taunton, UBC professor, sports medicine physician and marathon runner recommends Gatorade.

We, however, would rather recommend a product without chemical preservatives and colours. According to the label of a bottle of Gatorade, it contains water, sucrose, glucose, fructose syrup, citric acid, natural flavors, salt, sodium citrate, mono-potassium phosphate, ester gum, yellow 5, brominated vegetable oils, yellow 6, blue 1, and caramel 1. These ingredients are listed from greatest concentration to the lowest, as are all ingredients on food labels. The majority of these ingredients are just fancy names for something else. Generally, all the ingredients fall into the following categories: water, carbohydrates, salts, and additives.

We feel that the minerals in your body are very important. When you sweat, you lose not only sodium (which is a mineral) but also all other minerals. So why only replace salt? Dr. Wallach?s formulation ?Sports Tech? (American/Canadian Longevity) contains all of the plant-derived minerals in proper ratio for the human being, as well as Vitamins A, C, D3, E, B1, B2, B5, B6, Pantothentic Acid, Calcium, Magnesium, Potassium. It also, contains an amino acid mix of alanine, arginine, aspartic acid, cystine, glutamic acid, glycine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine, threonine, tyrosine and valine. In addition, it contains sea kelp and sea cucumber. It is flavoured and preserved naturally.

If you are not working out, you can still use 'Sports Tech' in lesser concentration. Or simply add a small amount of juice to your glass of water. Don't try and force more water down than seems comfortable. Keep in mind that the other beverages and foods you consume all contain water. Use your thirst level as an indicator.

For more info on how to purchase 'Sports Tech,' please call (604-272-4325) or email our office.

Other hydration-related information.

[Radha]

i only drink salt water, and Dasani purified water enhanced with minerals, since i stopped drinking plain tap water i notice i hold onto my fluids better and dont pee as much or have that urgent feeling like i cant hold it, guess it has to do with an electrolyte imbalance,

radha

[Guest tearose]

Hi Bev, this is a good question and one that I only began to understand recently myself!

I drink water as much as I feel I need. If I begin to feel dizzy I take a packet of electrolyte mix and take that next. I have to go by how I feel. I can't handle too much salt cause of my lymphedema. I have had demonstrated problems in my blood work from drinking too much water. I did experience a lightheadedness just before that bloodwork. Does Nicole feel anything when she is drinking loads of water? Can she feel the difference?

Sorry I can't help more, that's all I have, tearose

[goldicedance]

Hi, Everyone, I'm back from the Mayo, the holidays, and now am beginning to resume life again.

I would suggest that Nicole measure the amount of water she drinks per day (input) and the amount that she urinates (output). These numbers should pretty much balance. That's what I've been told.

Another suggestion is to have the doctor do a 24-hour urine collection and measure all the different things that doctors measure to determine whether her system is in balance.

I hate to be the party pooper but since we are not doctors, I think the best advice we can give is to have a doctor systematically measure the fluid balance, electrolytes, ADH (or whatever) and so forth. I would hate to have Nicole's mom rely on our lay advice when she has such a question on her mind.

Happy New Year to all! May this year bring better health to all of you and your families.

Lois

[briarrose]

I saw this on CNN today

Too much of a good thing?

There are risks in drinking too much fluid during exercise

(AP) -- Bob Irving downed so much water in the Half Ironman competition he made himself sick. During the last phase of the race, he vomited and had to walk most of the 13.1-mile run because his leg muscles cramped up.

Irving had read about the dangers of overdrinking but figured it was all a myth. Now, after his bad experience in 1998, he avoids drinking excessively during long workouts.

Three decades ago, the top warning sounded by race officials was dehydration. Athletes were told to constantly hydrate after several studies found a link between dehydration and a rise in body temperature, which can lead to heat stroke.

But now researchers are taking a second look at the risks of drinking too much fluid during exercise.

Hyponatremia, or water intoxication, was thrust into the spotlight after the back-to-back deaths of two female runners in 2002, including one who ran in the Boston Marathon. In both cases, the women drank excessive amounts of fluids.

Hyponatremia happens when the body's sodium level falls below normal. People lose salt through their sweat, and overdrinking dilutes the sodium in the bloodstream, causing the brain to swell and push against the skull.

Symptoms of hyponatremia include nausea, vomiting, weakness and, in severe cases, seizures, coma and death.

Research has shown that exercise-related hyponatremia happens only during long periods of exertion, lasting four hours or longer, such as in marathons or triathlons, during which athletes are more likely to drink a lot.

How much people should drink during prolonged exercise has touched off a debate among fitness experts.

Experts agree hyponatremia is a serious problem, but some fear hyping the dangers of overdrinking will cause athletes to dehydrate themselves, and lead race officials to curb the number of water stops during long-distance competitions.

Last year, race officials at the Houston Marathon halved the number of water stops after finding an unusually large number of hyponatremic runners at the medical tent in past years.

Although runners were initially upset with the decision, doctors saw fewer hyponatremic cases, said Dr. Joseph Chorley, the marathon's assistant medical director.

One of the leading international voices on hyponatremia is Tim Noakes, a sports science professor at the University of Cape Town in South Africa, who has published scores of articles on the perils of overdrinking.

Noakes' advice is to drink only when thirsty, because the body will instinctively know when it needs water. But critics say his benchmark is impossible to measure.

Studies have shown that hyponatremic victims are more likely to be female and athletes who have slower finishing times, but researchers do not know why.

The American College of Sports Medicine acknowledges that hyponatremia is a concern, but fears that too much emphasis on overhydrating may cause athletes to ignore drinking altogether.

"We shouldn't focus on the problems associated with overdrinking to the exclusion of the problems associated with not drinking enough fluids," said W. Larry Kenney, a professor of physiology and kinesiology at Penn State University and the immediate past president of ACSM.

Last year, Kenney chaired a conference where medical experts reviewed current hydration guidelines. ACSM will publish a paper next spring that gives athletes guidance on how to prevent hyponatremia.

Among the new recommendations will be to drink only when thirsty and to drink as much as you sweat. The way to know whether you drank too much during a long training routine is if your weight afterward is more than it was before your exercise.

Other groups such as the American Running Association recommend that athletes incorporate salty foods like pretzels into their pre-race meal. The International Marathon Medical Directors' Association urges athletes to drink no more than one cup of fluid every 20 minutes during a race.

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Copyright 2005 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

Find this article at:

http://www.cnn.com/2005/HEALTH/diet.fitnes...n.ap/index.html

[Merrill]

RunnerGirl, care to "weigh in" on this issue?

I'm surprised the last article didn't talk about sodium supplementation during marathons or extended workouts ... the problem isn't wholly caused by drinking too much water--it's also caused by losing too much salt!

It seems like a balance is needed, as in most everything. Back to the original question ... I would say that as long as those of us with pots are keeping our electrolytes in balance and taking in plenty of salt along with our 2+ liters of water daily (and here I go by doctors' recommendations as well as the medical literature on pots, limited tho it may be), we shouldn't be doing ourselves any harm by drinking too much. (I make it a point to drink one or two glasses of [powdered] gatorade with 1/4 - 1/2 tsp salt mixed in every day--and I think it really helps to keep things in balance. It's also tasty and makes staying hydrated much easier for me than drinking plain water, which almost never quenches my thirst.)

[Nicole's Mom]

Thank you all so very much for your opinions and support. I really, really value what you all say. It's good to get direction from you and your experience.

Steph, thank you so much for ALL the information. You go so far out of your way to help. Thank you for doing presenting so much information about this topic in your post. I am so grateful. I am going to print down all that you posted ( and every one else's reply) because it is an important issue.

Emily, like you, there are some days where Nicole wants to drink, drink, drink. I think what you said about limiting to one gallon is a good idea. And Jersey girl, you were told the same by your doctor to drink a gallon per day.

Radha, some of what Nicole drinks is salty water. I measure out the recommended amount of salt each day for her and put it in a little container. She puts some of it in her water which she chugs after her meals because of advice on this forum that salt is best absorbed with food. She does the same at night - late night snack to help retain some fluids overnight. She uses Celtic Salt and takes about 5000++ mgs. sodium which is the higher end of the recommended amount. Some she sprinkles the remainder on her food. But she does drink plain water in between. I will look for the Dansani purified water with mineral. Thanks for that tip.

tearose- you asked if Nicole feels any differently depending on the amount of water she drinks. I don't think she does feel any different. It's more like if she's having a flare-y day she drinks more water in response to that because her thirst increases on the flare-y days. If you don't mind me asking- when you say you have had problems demonstrated in your bloodwork from drinking to much- are you referring to lowered ADH or electrolytes or something else?

porque- that is interesting about your ADH - that it is low and you don't drink a ton. I'm still learning about this ADH so I'm wondering - is there something that you can do to raise it? Is there a drug for this? If so would that drug be a vasopressin that some of you take to help pee less?

As far as how much Nicole drinks, we will start measuring it. It's possible - maybe likely that on flare-y days she drink more than a gallon. On better days she is not so thirsty.

Also how does one measure ADH? Is is bloodwork? We are about to receive all of Nicole's records from her POTS doc. I will look to see if he has been measuring it all along. Whenever she sees him- he has her do bloodwork.

Thanks again to all.

Regards,

Beverly

addendum: By the way- Nicole has continued to come along. Slowly . . . but surely. And for those of you who helped with the last two posts- re: beta blocker - how much it helped you and encouraging Nicole to stick it out-in spite of side effects- she did stick it out and now she is up to 1/2 a pill 1x per day. And will soon go to 1/2 pill 2X per day which is what is on her prescription. She is so sensitive to meds and she climbed up from a smidge of a crumb. For her to be at 1/2 of a pill is HUGE. But it is thanks to all of you that she is doing this. And it's thanks to all of you way back who encouraged her to do salt that she is doing it vigilantly. It is such an important thing to do especially if you're taking florinef. Thank you all!! This forum is just so GREAT!!!!

[Guest tearose]

To answer your question of me Beverly,

I was feeling poorly after a virus, and my internist suggested while I was in his office that I drink more water. I wasn't thirsty and he said just try to drink a little. I proceeded to drink about 8 oz of water. He had me proceed directly to the lab for bloodwork. I remember feeling really wierd, like drunk on the way and was glad my husband was with me. When the bloodwork came back he was quite surprised that I had severely depleted sodium levels...I was over hydrated! He said to never do that again and to trust my own instincts. He did support my instincts to drink the kayolectrolyte which is a balance of electrolytes, potassium and sodium, when I feel depleted or am ill.

Does this help?

PS(My urine collection tests never showed any problems.)

take care, tearose

[BuddyLeesWife]

When I hiked, we were instructed to always eat something salty with every drink break to avoid flushing of sodium. The snack of choice was Pringles potato chips since you only had to eat a few.

Hyponatremia: What It Is, How to Prevent It

By Courtenay Schurman, MS, CSCS

What Is It

Hyponatremia refers to a low concentration of sodium in the blood and occurs when athletes sweat profusely and then drink copious amounts of pure water to replenish fluids, without adequately replacing electrolytes. It occurs more frequently during endurance events that last longer than several hours, where athletes attempting to rehydrate over several hours of exertion may end up compounding the problem without realizing it. In a study of 36 athletes during a 3-4 hour triathlon and 64 athletes in a 9-15 hour Ironman race, no athletes were hyponatremic following the shorter race, but 27% were hyponatremic and dehydrated following the Ironman.

How Can You Prevent It?

If you plan to be out for a long day?s bike ride or weekend summer climb, the simplest way to prevent getting hyponatremia is to include diluted electrolyte-containing fluids (widely varied, including such drinks as Gatorade, Gukinaid or Powerade) and take plenty of salty snacks including pretzels, chips, nuts, or trail mix. Since salty snacks are known to increase thirst levels, not only will the snacks help you replenish missed salts, they also will encourage you to drink much more frequently.

Sweat contains roughly 3 grams of salt per liter, and the rate of perspiration during a long, hot climb or race can average .5-1 liter per hour. If you are climbing all weekend to the tune of 10-15 hour days, you can easily lose too much salt. Try to replenish sodium at a rate of about 1 gram per hour, as recommended by Doug Hiller, MD at the Hawaii Ironman (www.rice.edu/~jenky/sports/salt.html). Be aware that trying to get the necessary gram per hour from beverage alone would require that you drink two liters of Gatorade each hour ? certainly impractical for most people out in the mountains unless you can carry Gatorade powder and continue to add it to your filtered water.

Salty Foods to the Rescue

If you have ever wondered why nuts, soups, trail mix, Doritos, pizza, Mexican food (chips and salsa) or other salty foods taste so delicious during or following long endurance outings, it is because your body needs a certain level of sodium to replace that lost through sweating, and it will tell you in no uncertain terms exactly what it needs. If you or a training or climbing team member experience nausea, muscle cramps, slurred speech, confusion, disorientation, or inappropriate behavior, and yet your urine is clear from your abundant hydration efforts, you may need to get some salt rather than still more water. Severe hyponatremia is a true medical emergency and can result in seizure, coma or even

This article was found on www.bodyresults.com

[Nicole's Mom]

tearose,

Thanks for your kind response and for sharing your story about what overhydration can cause. I'm sorry that you had the reaction to the water but I'm glad that you were able to learn of your sodium depletion and your overhydration tendency. Thanks for helping me understand even more about the subject.

Thanks again,

Beverly