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Q&A, Staying Hydrated

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I feel dehydrated, but it's difficult to drink anything.
I just urinate fluid out anyway. Why bother?
I don't want to drink late, I don't want to pee, but...
I get chills before bed. Could fluid levels be involved with that?

Q. A member wrote us with the observation that she tends to get chills in the evening... after her intake of fluid has waned. She started wearing a robe to save heat and energy and for reducing chills. She asked further if these two phenomena are related....

“Maybe if I drink more water in the evening I won't be so susceptible to chills??” 

A. Elly's response:

Congrats on these insights with new things to try.

While there certainly many other things that could be involved, for our members with CFS or Fibromyalgia or Orthostatic Intolerance (MVPS/Dysautonomia, POTS, NHM), it is very likely the two things are related. Let us consider some of the issues:

Water holds heat. As one dehydrates….  temperature regulation can become much more difficult, with bigger swings. Both body heat and body moisture are lost through sweat,  breathing out, and it goes down the toilet with urine and feces. When dehydrated, we can chill much more easily or faster… or overheat.

Picture boiling two pots of equal amounts of water using the same size and kind of pots on the stove at the same time. Once removed from the stove, they are put on a wooden board to cool. One is left full and the other has 1/4 of the water removed to simulate the dehydration. Which one will cool off faster? The one with less water! Not sure? Try the experiment.

One reason Hot Water Bottles are used is because water holds heat so well. If you are having the chills and cannot get yourself even temporarilty hydrated, holding some warm water bottles near you can help  stabilize body temperature. Some in the group use beds with warmers, electric blankets, and heating pads.... until they swing the other way and get too hot!

Water, and salty mineral / electrolyte water like we have in us in blood and lymph, holds heat and is actually considered a good insulator for many purposes. Without big oceans, the earth’s temperatures would swing much more wildly than they do. Coastal areas have less temperature swings than the mountain land areas because the water takes so much heat in and takes time letting the heat go.

This is one big reason why staying hydrated matters -- to help maintain one's body temperature. This way not as much physical and coping energy has to go to wild temperature swings, chills, overheating and not sweating or over sweating.

Staying hydrated is not just about water, though. In fact, you can dehydrate yourself with too much plain water relative to the electrolytes of sodium, chloride, potassium, calcium, and magnesium. If bodies perhaps weren't in so much pain or fatigue, balancing and maintaining these minerals and others more fluently, but that isn't what is happening. Perhaps that is why we hear so much about people's symptoms feeling more stabilized when they use these nutrients therapeutically.

We've learned a few tidbits:

Calcium (Ca)- helps with falling asleep (as long as not bound with a stimulant)
                (e.g. Calcium citrate could cause waking since citrate stimulates)
                 calcium also can help with anxiety, muscle spasms, cramps, bones

Magnesium (Mg)- helps with muscle relaxation, constipation, staying asleep
                 (avoid  Mg aspartate since aspartate is stimulating)
                  magnesium also can help with anxiety, spasms and cramps

Potassium (K) - helps regulate heart rate, heart rhythms, blood pressure
                 can be stimulating so a time-release prescription can smooth its effects

Sodium (Na) - helps with blood volume, vision clarity, feeling awake

All of these are water soluble and need to be replenished all through out the day. If one is stressed or anxious or worried, there is a tendency for the body to eliminate especially magnesium and potassium through urine than if one remains calm. Sea salt is a way to often get some of each, or using electrolyte drinks or therapeutic supplements, but each person may have to find the amount of water, sodium, potassium, magnesium, calcium per day that suits them.

Small amounts taken frequently are, yes, less convenient, but often far, far more effective. I found I needed to take chelated magnesium in small amounts, no more than 100 mg in one pill) 7 times a day to stabilize me during my worst times. 7 times!

If one is interested in a little more information, in soft tissue mineral analysis to see how one's body is handling these mineral nutrients, see our page for nutritionist Sam Makoul.

My heart rate increases when I am more dehydrated. The heart works harder at moving the blood is has around. Beside the low fluids making me tired, so do all the extra and more intense heart beats. Read more about fast heart rate and blood circulation at our Q&A page about Orthostatic Intolerance. When I find my balance again, I don't need to push as much water and electrolytes, but when I am very symptomatic, I have to pay attention and compensate for what my body can't do on its own.

One laboratory marker for dehydration is a high BUN:Creatinine ratio. Numbers greater than 1:20 can indicate dehydration. As I recall, the highest my ratio was measured was 1:25, and that was during a time when I needed weekly IV fluid replacement because I could not maintain the fluids I was taking in. I was drinking water, I was taking supplements, and I was in the bathroom. It made sense to me to keep up the intake, because for the 20 minutes the water and electrolytes were floating around in me, I did feel better and had confidence I was providing some of nutrition that my heightened state of nervous system activation required.

Great observation by our member about body temperature and staying hydrated! Drinking more water later in the day…. may very well keep one warmer through until bedtime…. especially if it is not cold or ice water (see below). Drinkin more later, even if it means getting up once or twice in the night could help in other ways, and with the hints we gave about using magnesium and calcium to get back to sleep, it could be worth some experimenting.

Thanks for writing in and inspiring this Q&A page. Check our more at our Q&A Index.

- Elly

Other hydration issues .... 

What about drinking ice water? Does that help?

If we drink water that is cold or cooler than us, we have to burn some of our already depleted energy stores by use some body heat to warm it up. Once it is warm, then yes, it will keep us warm awhile - if it didn't chill us too much at first.

Some might wear a robe or extra sweater while drinking cool water because that saves the body heat and they get to enjoy the cold water which may be helping other things like a sore throat.

Note, some dieters use drinking cold water as a way to lose weight. They are counting on the fact that the body will lose heat and thus burn more calories. That’s great if you are healthy, not on the edge of dehydration all the time and not suffering with temperature problems. We can use that tip to do the opposite, to keep our liquid and food intake to be close to room or body temperature to save some energy, energy that can be then applied for other kinds of healing and living. In restaurants, we can order water with no ice, iced tea with no ice, or hot tea with a cup of ice to combine to make it room temperature. Applying our creativity for healing.... what possibilities!

When we are extra tired or extra stressed, these things become more vital, affecting our vitals. When we are doing better, or if we are just feeling rebellious, we can take more chances with ice water or hot drinks, eating foods straight from the fridge or hot food from the oven…., but, let's do it with more consciousness. We are asking our bodies to do more in handling the cold and heat when it might not be up to it. We might not have to do it for ever, but while under extra stress, letting cold food warm up and the hot food cool before we eat or drink it can make a noticeable difference. We can practice accepting with more grace and gratitude the results of our choices and their lessons.

Briefly, what are some other reasons to make the effort to stay hydrated with both water and electrolytes?

- When blood is extra concentrated, when there is less of it, other things that enter blood can be extra concentrated, too, compared to a more hydrated person. Medications can feel like they are at a higher dose,  chemical sensitivity  symtpoms via taste can be more or feel more severe when dehydrated.

- We can feel like we are more stress sensitive, more sensitive to lights, sounds, smells, background noise, more prone to startle, more likely to pull or  jump away if touched. We don't feel as cushioned in many ways, one being while sitting on a hard chair. We can be more sensitive to touching objects that are vibrating, for example a rolling cart with long handle rolling on a less than smooth floor.

- Adequate liquids and are required to sweat and break a fever, generated by the body to eliminate infections. Infections may linger because the body doesn't have what it needs to produce a full and safe immune response. Getting too hot without a way of cooling down might be worse for some than carrying an infection.

What do you do if you hate the taste of water or can't swallow plain water?

- how about adding flavors such as lemon or lime? or some flavored electrolyte drink powder such as Vitalyte?

- some folks don't realize just how bad their tap water tastes. Find a friend with a Reverse osmosis (RO) filter or buy some RO water and compare tests. A simple faucet filter that just removes chlorine such as a Britta or PUR filter can make a difference.

- soft plastic imparts a taste (not to mention estrogen compounds) into water. Bottled water is popular for convenience and style, because it may not have fluoride, because it tastes better than some tap water. However, if you are struggle to drink water, it could still be the taste of plastic. Consider refilling a small glass bottle with cap and carrying that around. Note, too, that putting RO water into soft plastic bottles may introduce even more plastic taste to the water than with other kinds of water.

- add flavored tea, a splash of juice, a tiny pinch of sea salt.

- how about more soups as way of getting both more water and electrolytes?

- there may be important reasons why your mind and body are saying not to drink. A lack of thirst can just be a temporary symptom of an out of balance autonomic nervous system, or it can be the sign of something else. Please consider not putting pressure on yourself. The added stress might dehydrate you further. Remind yourself you are doing the best you can with  the capacity you have today.

(Excessive thirst can also be from dysautonomia or from other conditions such as diabetes.)

Keep making observations to share with your doctor and the support group. Thanks!
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Updated April 20, 2010