Glucose in Oral Rehydration Solutions?

[albertspa]

So, up until recently, I've been making my own Oral Rehydration Solutions based on the ORS formulation recommended by the WHO (WHO Oral rehydration salts, 2006) which was also referenced in a study about POTS (Medow 2019) :

Ingredient	Amount per liter of clean water
Glucose	13.5 grams
Sodium chloride	2.6 grams
Potassium chloride	1.5 grams
Trisodium citrate dihydrate	2.9 grams

At the time I replaced the glucose with a sugar-free alternative (to save on the calories), but I recently found out, that glucose was actually essential for the absorption to work well.

 

(e.g. "The gastrointestinal tract relies on sodium-glucose cotransporters (SGLTs), which are carrier proteins in the intestinal cells. Cotransporters help move substances across membranes. Specifically, SGLTs pair together sodium and glucose transport in the small intestine. This allows glucose to increase the absorption of fluids. Additionally, sodium needs glucose in order to be properly absorbed. This is why ORS contains both glucose and sodium." healthline.com - How Oral Solutions Help to Manage Dehydration

"glucose facilitates the absorption of sodium (and hence water) on a 1:1 molar basis in the small intestine" WHO Oral rehydration salts, 2006

"Specifically for oral rehydration salts, they have a very specific osmolality, so the concentration of sodium and glucose is really specific. So if you overdilute them, they won't be absorbed correctly." Dr. Amanda Miller Dysautonomia International Webinar 2022, Dr. Amanda Miller)

 

Now my question is the following:

Since it's also recommended to decrease your carbohydrate intake, how do you guys make it work with the glucose in Oral Rehydration Solutions? (whether it be homemade or brands like Liquid IV, etc.)

[MikeO]

Well some of this may work for most folks but the glucose got to me. first hint was the liquid IV became sicker that a dog. IMO the WHO oral rehydration is for folks that are dehydrated. drink fluids like normal and you won't need to follow this. 

[albertspa]

@MikeO Unfortunately water itself doesn't do it for me and I gotta consume more sodium anyway, since I'm on fludrocortisone. 🫤

But aside from that, increased sodium intake is recommended by virtually all medical literature when it comes to POTS to counteract the hypovolemia and elevated plasma norepinephrine, that contribute to excessive orthostatic tachycardia, by increasing the plasma volume.

What I'm curious about is whether the glucose in ORS (which evidently is required in order to facilitate the absorption of sodium and thus fluids) doesn't compromise the low-carb approach, which is also recommended for POTS management, since glucose is a carbohydrate.

[MikeO]

4 hours ago, albertspa said:

What I'm curious about is whether the glucose in ORS (which evidently is required in order to facilitate the absorption of sodium and thus fluids) doesn't compromise the low-carb approach, which is also recommended for POTS management, since glucose is a carbohydrate.

Good point! I can do the salt uptake albeit i don't have POTS. High salt and potassium broths have worked for me as well but the carbs (glucose) is a no go for me. I am nOH and the increasing of the plasma volume does help. can't even argue this one.

 

[Water Lover]

My understanding is that the recommendation to limit carbs is to prevent the diversion of blood to the digestive system; I wondered whether, given that glucose is a simple carbohydrate that does not have to be broken down (only processed by the liver for storage), it might not cause as much blood diversion as complex carbohydrates. But while I was looking around to see if that was plausible (not a biology whiz!), I found that there is at least one recent study that associates POTS with insulin resistance and suggests that the body’s response to glucose (the release of a specific peptide) may cause the dilation of splanchnic vessels, and thus directly lead to orthostatic symptoms. So it may just all be a matter of tradeoffs in the end.

[MikeO]

9 hours ago, Water Lover said:

I found that there is at least one recent study that associates POTS with insulin resistance and suggests that the body’s response to glucose (the release of a specific peptide) may cause the dilation of splanchnic vessels, and thus directly lead to orthostatic symptoms.

I have read a number of times that folks with POTS and Dysautonomia are thought to have some degree of insulin resistance or even flat out diabetes or some other issues with glucose regulation. i did read thru the study provided and what stands out for me is the postprandial orthostatics associated with being challenged with increased glucose (carbs/simple sugars).

Last summer i did get tagged with postprandial orthostatic hypotension so the recommendation was a low per meal carb diet (6 small meals a day) otherwise i would go through a 4-5 hour episodes of presyncope, palpitations and lower blood pressure and then just magically seem to recover. 

what now started to make me think is when i did a OGTT test (500ml of sugar water) at hr 2 mark i became orthostatic at the lab. even with a half cup of (sugar(y) instant oatmeal) and i would feel the drop in BP's but with a sugar free version of the oatmeal i am ok. so fast forward i have started mealtime insulin and have been able to eat a normal 45-60 carb meal and the orthostatics have almost entirely cleared up after meals.

Sure i will be googling my hypothesis as to whether or not if insulin has a direct affect on the glucose-dependent insulinotropic polypeptide (GIP) 

[MikeO]

Well found one more article (same data) as @Water Loverposted. was surprised the number of references out on the net for the hormone glucose-dependent insulinotropic polypeptide (GIP) 

https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.121.17852?download=true 

[yabu]

I recently (this summer) found Normlyte - which is made for folks with POTs and it's been a game changer (I was diagnosed almost 20 years ago). Just last week I realized it has glucose and asked my Endocrinologist about it and she confirmed that it isn't a concerning amount at all and to not worry. I had also come across the same articles and have been having some insulin weird issues so had been concerned since I take it first thing in the AM. Super recommend it if you haven't tried it yet. Obviously we are all different, but I really trust my Endo and if she says she thinks it's an okay amount of glucose, I'm gonna believe her. 

 

 

 

 

[albertspa]

56 minutes ago, yabu said:

I recently (this summer) found Normlyte - which is made for folks with POTs and it's been a game changer (I was diagnosed almost 20 years ago). Just last week I realized it has glucose and asked my Endocrinologist about it and she confirmed that it isn't a concerning amount at all and to not worry. I had also come across the same articles and have been having some insulin weird issues so had been concerned since I take it first thing in the AM. Super recommend it if you haven't tried it yet. Obviously we are all different, but I really trust my Endo and if she says she thinks it's an okay amount of glucose, I'm gonna believe her. 

 

https://normalyte.com/collections/normalyte-collection (apple is my real fave) 

 

 

Yup, they're basing theirs on the WHO formula. How much do you consume of it? And do you consume it throughout the day or in one sitting? I'm curious cause many studies speak of 5000 - 12 000mg of sodium intake recommended for a POTS patient, while there's only 851mg of sodium per 500ml in one Normalyte solution packet. Do you use salt supplements in addition to the ORS?

[MikeO]

sugar free option would be LMNT

[yabu]

Sugar free WOULD be amazing - I take it only once first thing in the morning and then I make sure to hydrate (100oz a day) and have salt throughout. I'm lucky that in the past few decades I've been able to manage things for the most part. Until it gets humid in the summer, then I'm basically useless and feel horrible. I do think some people take it more than once a day though? 

[Water Lover]

In addition to the NormaLyte already recommended by @yabu, for anyone who isn’t avoiding sugar and doesn’t feel up to mixing your own like @albertspa, I want to mention TriOral ORS—I haven’t seen it get mentioned much in dysautonomia circles, but it’s been the best, most cost-effective option for me. It’s based on the WHO formula. Each packet makes a liter of solution and provides 1695mg of sodium. I generally drink 2L a day, at two separate times—if I’m sitting, typically over the course of an hour or two, but if I go for a walk of even as much as half a mile I’m likely to drink the whole liter while walking. On a day when I’ve sweated a lot or think I really need more salt, I will occasionally go up to 3L. I generally try to drink a liter of plain water in between rounds of TriOral. (My normal total fluid intake is 4.5 to 5L, though higher on those sweaty days.) Anyway, the reason I’m mentioning it is because in the US you can get a box of 100 packets on Amazon for $40, which is a better value than any other brand I’ve found.

I should mention that I use the unflavored, which is part of how I ended up on this brand; I started off using flavored brands (Liquid IV, LMNT), but it’s hard to find a flavored brand that doesn’t include non-sugar sweeteners like stevia or sucralose; I can’t stand the taste of most non-sugar sweeteners, and some seem to irritate my stomach. The unflavored TriOral solution doesn’t taste objectionable: barely sweet, lightly salty. You can tell it’s not plain water, but really it doesn’t taste like much of anything. I hardly notice it and think by now I just associate it with feeling hydrated. I haven’t tried it yet, but I think it would probably make a really nice fruit-infused water (though I expect you would need either to infuse the water and then strain out the fruit before mixing the solution, or else make sure to eat the fruit, because I expect you’d lose sodium otherwise).

Anyway, no good for those of you who need to avoid glucose, but it’s something that works for me and is worth a look if sugar isn’t a particular concern.

[albertspa]

Just bought all the ingredients for the WHO ORS formulation and it doesn't taste sweet at all (nor does it taste salty). Just tastes like thicker water, for anyone who worries that the glucose might affect the taste. It has 75 mmol/L of sodium, meaning ≈1.72 g/L of sodium.

(https://www.ghsupplychain.org/sites/default/files/2019-02/MNCH Commodities-OralRehydration.pdf)