Too much water
November 5, 2022 9:16 AM Subscribe
I require over 10L of water per day in order to be capable of any ordinary activity. I also need lots more food, for example often becoming hungry two hours after large meals. Without these, I am extremely lethargic. I have been checked for everything my very smart GP can think of and she is "out of ideas" (more below). What could cause this?
This was me. You were all justifiably concerned and suggested I could have diabetes and the water could be dangerous.
Medical Investigations
I had "very normal" (my GP) blood tests then, and I got checked again recently and have no signs of over-hydration or any other problem in the blood tests. She has no more ideas. She has referred me to a cardiologist (I have a heart murmur, at times orthostatic intolerance, palpitations and occasional arythmias) and neurologist (to check for dysautonomia). No hyperthyroid, no diabetes, no signs of any problem in blood tests.
Symptoms
I lose lots of water overnight (e.g. 6-7 pounds, from empty bladder to empty). I have to start drinking water when I wake up and don't become capable of doing anything until hours later (after e.g. 4-6 litres and a large meal or two, plus time to digest). I will gain around 10 pounds through the day, so I am absorbing much of the water, but also my body is consuming lots of it (I have tried weighing myself before and after using the washroom to confirm this).
The amount and colour of urination is dead normal.
When I haven't had any extra water, I am super tired, my heart rate spikes on standing (orthostatic intolerance), I struggle to do much walking, I get very tired out from any walking or activity, and my brain is foggy.
With enough food and water, I feel somewhat normal, though still a bit tired. When I manage everything perfectly, I can have periods of hours of feeling fairly normal. During these times, the amount of thirst and hunger are normal (i.e. the thirst can be quenched, just with difficulty).
When I've had some extra water but start to fall behind, I have a bad headache and become very tired and weak, and of course thirsty. Sometimes I have weird muscle pains. Sometimes it seems impossible to become hydrated again later in the day (I remain thirsty, headachy and exhausted despite lots of water). I theorize this is related to limits to digestion and the body trying to deal with the food or something.
Without enough food, I also have a headache and am weak and lethargic.
I often feel hungry or thirsty despite having a full stomach.
At all times, my heart rate is about 20 BPM higher than it would normally be. When dehydrated, I can often feel my heart pounding. It's possible I have a separate heart condition, to be investigated by the cardiologist. I have already had an echocardiogram and Holter monitor.
I always have this problem to a significant degree, but some days are worse than others. I ordinarily take Vyvanse for ADHD but I have had to stop, because it makes things far worse. I think this is because it increases metabolism. If I take it, it becomes more impossible to keep up with the food/water.
Difficulty Managing
This whole situation is very hard to manage. It's hard to absorb enough food and water to become capable of doing stuff.
I add electrolytes, and to some, sugar (i.e. gatorade or drink crystals), especially first thing in the morning. This helps.
The food can interfere with the water (I have read water is mostly absorbed in the small intestine and eating food slows stomach emptying). I can only really have 3-4 good hours per day (during which I am still more tired than normal). If I stop drinking water, I will become dehydrated very quickly.
Possible Causes
I think this must result from increased metabolism, but my doctor is very focused on dysautonomia. It is possible there is more than one thing going on.
I do not have diabetes or hyperthyroid, per multiple rounds of blood tests. That is, unless it is possible to have these with normal blood tests.
Questions
So, I have several questions:
1. What could cause these symptoms?
2. What signs and symptoms should I pay attention to when trying to evaluate this?
3. What kinds of specialists and testing would be appropriate for investigating this?
4. Any ideas for better managing the food/water tightrope to maximize energy throughout the day?
Difficulty level: Canadian health care system. That means I need referrals for any specialist, and it takes a long time to see them (cardiologist was 2.5 months, haven't heard from the neurologist yet).
I understand you are not my doctor. What I am looking for here is speculation, and any plausible ideas I will take back to my doctor.
This was me. You were all justifiably concerned and suggested I could have diabetes and the water could be dangerous.
Medical Investigations
I had "very normal" (my GP) blood tests then, and I got checked again recently and have no signs of over-hydration or any other problem in the blood tests. She has no more ideas. She has referred me to a cardiologist (I have a heart murmur, at times orthostatic intolerance, palpitations and occasional arythmias) and neurologist (to check for dysautonomia). No hyperthyroid, no diabetes, no signs of any problem in blood tests.
Symptoms
I lose lots of water overnight (e.g. 6-7 pounds, from empty bladder to empty). I have to start drinking water when I wake up and don't become capable of doing anything until hours later (after e.g. 4-6 litres and a large meal or two, plus time to digest). I will gain around 10 pounds through the day, so I am absorbing much of the water, but also my body is consuming lots of it (I have tried weighing myself before and after using the washroom to confirm this).
The amount and colour of urination is dead normal.
When I haven't had any extra water, I am super tired, my heart rate spikes on standing (orthostatic intolerance), I struggle to do much walking, I get very tired out from any walking or activity, and my brain is foggy.
With enough food and water, I feel somewhat normal, though still a bit tired. When I manage everything perfectly, I can have periods of hours of feeling fairly normal. During these times, the amount of thirst and hunger are normal (i.e. the thirst can be quenched, just with difficulty).
When I've had some extra water but start to fall behind, I have a bad headache and become very tired and weak, and of course thirsty. Sometimes I have weird muscle pains. Sometimes it seems impossible to become hydrated again later in the day (I remain thirsty, headachy and exhausted despite lots of water). I theorize this is related to limits to digestion and the body trying to deal with the food or something.
Without enough food, I also have a headache and am weak and lethargic.
I often feel hungry or thirsty despite having a full stomach.
At all times, my heart rate is about 20 BPM higher than it would normally be. When dehydrated, I can often feel my heart pounding. It's possible I have a separate heart condition, to be investigated by the cardiologist. I have already had an echocardiogram and Holter monitor.
I always have this problem to a significant degree, but some days are worse than others. I ordinarily take Vyvanse for ADHD but I have had to stop, because it makes things far worse. I think this is because it increases metabolism. If I take it, it becomes more impossible to keep up with the food/water.
Difficulty Managing
This whole situation is very hard to manage. It's hard to absorb enough food and water to become capable of doing stuff.
I add electrolytes, and to some, sugar (i.e. gatorade or drink crystals), especially first thing in the morning. This helps.
The food can interfere with the water (I have read water is mostly absorbed in the small intestine and eating food slows stomach emptying). I can only really have 3-4 good hours per day (during which I am still more tired than normal). If I stop drinking water, I will become dehydrated very quickly.
Possible Causes
I think this must result from increased metabolism, but my doctor is very focused on dysautonomia. It is possible there is more than one thing going on.
I do not have diabetes or hyperthyroid, per multiple rounds of blood tests. That is, unless it is possible to have these with normal blood tests.
Questions
So, I have several questions:
1. What could cause these symptoms?
2. What signs and symptoms should I pay attention to when trying to evaluate this?
3. What kinds of specialists and testing would be appropriate for investigating this?
4. Any ideas for better managing the food/water tightrope to maximize energy throughout the day?
Difficulty level: Canadian health care system. That means I need referrals for any specialist, and it takes a long time to see them (cardiologist was 2.5 months, haven't heard from the neurologist yet).
I understand you are not my doctor. What I am looking for here is speculation, and any plausible ideas I will take back to my doctor.
This sounds a lot like Postural Orthostatic Tachycardia Syndrome (POTS).
Do you find that your symptoms improve when you have a lot of salt?
posted by chariot pulled by cassowaries at 9:42 AM on November 5, 2022 [2 favorites]
Do you find that your symptoms improve when you have a lot of salt?
posted by chariot pulled by cassowaries at 9:42 AM on November 5, 2022 [2 favorites]
Response by poster: To polydipsia - the thirst can be quenched and I excrete normal quantities at normal intervals, so I don't think it's akin to the thirst people have with diabetes.
For POTS - I have the symptoms early in the day but not once hydrated. Salt by itself does not do the trick. I've read recommendations to have e.g. three litres of water for POTS, so this does go much beyond that. It also doesn't explain the hunger. So it is possible I have that, but I think there must be something else as well even if so. My doctor has suggested maybe some of the rarer dysautonomias (of which POTS is one), but said normally people with those would have some weird blood test results I don't have.
posted by lookoutbelow at 9:46 AM on November 5, 2022
For POTS - I have the symptoms early in the day but not once hydrated. Salt by itself does not do the trick. I've read recommendations to have e.g. three litres of water for POTS, so this does go much beyond that. It also doesn't explain the hunger. So it is possible I have that, but I think there must be something else as well even if so. My doctor has suggested maybe some of the rarer dysautonomias (of which POTS is one), but said normally people with those would have some weird blood test results I don't have.
posted by lookoutbelow at 9:46 AM on November 5, 2022
I don't know. But I looked up polydipsia on wikipedia, and it says if it's that, zinc might help. You can test this by eating piles of oysters, but zinc is one of those nutrients that has an upper tolerable intake level, so if it seems to be helping, maybe sort that out with your doctor so you don't end up with new imbalances.
posted by aniola at 9:47 AM on November 5, 2022
posted by aniola at 9:47 AM on November 5, 2022
Best answer: This sounds like me. I have dysautonomia. The most important thing for me was increasing my salt intake. Before this, I literally couldn't drink enough water to hydrate. Dysautonomia is associated with dysfunction of sodium-retention hormones. If you just increase water, but don't increase salt, then it doesn't help or only helps very briefly. Do you have to urinate frequently? This happened to me when I drank a lot of water but not much salt, it was basically going straight through me.
I see you are taking some electrolytes, but for context the suggestions for dysautonomia are an extra 5-10g of salt a day. I use Vitassium salt pills, others use Nuun or LiquidIV or Skratch Labs electrolyte drinks but you do need to consume a lot of it. I have also read that you will absorb water much more quickly on an empty stomach, so I make sure to take my salt and drink a bunch of water prior to eating rather than during or after.
I am not certain about the hunger thing but that also happens to me. I just eat small meals throughout the day; this is supposed to be better for dysautonomia related GI issues anyway.
So my general routine is:
- Wake up, take 1mg of salt and drink 16 oz of water
- Eat breakfast
- Eat a salty snack in a few hours
- Take 1mg of salt and drink 16 oz of water
- Eat lunch
- Drink 16oz of electrolyte drink
- Eat a salty snack
- Take 1mg of salt and drink 16oz of water
- Eat dinner
- Drink 16oz of water
I use the Routinery app to make sure I'm doing everything at the right times in the right order. It is difficult to manage but I feel much better and have more energy and fewer headaches when I manage it.
Follow up with the neurologist for sure. While you're waiting you could try playing around with adding more salt to your diet. If you find table salt hurts your stomach, try Vitassium or another buffered salt pill or electrolyte drink (but make sure it has a lot of sodium; Gatorade for example only has 270mg per bottle vs LiquidIV has 500mg). Let your GP know you're doing that so they can keep an eye on blood pressure etc.
posted by brook horse at 9:47 AM on November 5, 2022 [12 favorites]
I see you are taking some electrolytes, but for context the suggestions for dysautonomia are an extra 5-10g of salt a day. I use Vitassium salt pills, others use Nuun or LiquidIV or Skratch Labs electrolyte drinks but you do need to consume a lot of it. I have also read that you will absorb water much more quickly on an empty stomach, so I make sure to take my salt and drink a bunch of water prior to eating rather than during or after.
I am not certain about the hunger thing but that also happens to me. I just eat small meals throughout the day; this is supposed to be better for dysautonomia related GI issues anyway.
So my general routine is:
- Wake up, take 1mg of salt and drink 16 oz of water
- Eat breakfast
- Eat a salty snack in a few hours
- Take 1mg of salt and drink 16 oz of water
- Eat lunch
- Drink 16oz of electrolyte drink
- Eat a salty snack
- Take 1mg of salt and drink 16oz of water
- Eat dinner
- Drink 16oz of water
I use the Routinery app to make sure I'm doing everything at the right times in the right order. It is difficult to manage but I feel much better and have more energy and fewer headaches when I manage it.
Follow up with the neurologist for sure. While you're waiting you could try playing around with adding more salt to your diet. If you find table salt hurts your stomach, try Vitassium or another buffered salt pill or electrolyte drink (but make sure it has a lot of sodium; Gatorade for example only has 270mg per bottle vs LiquidIV has 500mg). Let your GP know you're doing that so they can keep an eye on blood pressure etc.
posted by brook horse at 9:47 AM on November 5, 2022 [12 favorites]
Best answer: You said “The amount and color of urination is dead normal.” That is really, really, really weird if by normal you mean that you pee about as often and about the same amount as most people do — all that water has to be going someplace. This doesn’t lead me to any conclusions, but it might be something for a doctor to think about.
Are you constantly dripping with sweat? Is there anything else strange your body is doing that explains where all that water is going if you’re not peeing it out? You say you lose 6-7 pounds overnight — how?
posted by LizardBreath at 9:51 AM on November 5, 2022 [7 favorites]
Are you constantly dripping with sweat? Is there anything else strange your body is doing that explains where all that water is going if you’re not peeing it out? You say you lose 6-7 pounds overnight — how?
posted by LizardBreath at 9:51 AM on November 5, 2022 [7 favorites]
Posted before I saw your update. The recommendations are 3 liters of water and 5-10g of salt, are you hitting both of those? When I was only drinking extra water and not also taking a bunch of extra salt, I had symptoms similar to yours.
If you do have POTS its likely you have other things as well; dysautonomias tend to come with a range of issues. So it wouldn't explain everything, but it could be one piece of it.
posted by brook horse at 9:56 AM on November 5, 2022 [2 favorites]
If you do have POTS its likely you have other things as well; dysautonomias tend to come with a range of issues. So it wouldn't explain everything, but it could be one piece of it.
posted by brook horse at 9:56 AM on November 5, 2022 [2 favorites]
Ooh, I don't know, but I'm reading for ideas that might apply to myself.
The medication that I take that can cause increased thirst has been reduced, but the thirst hasn't reduced... and I still think it's weird that after years of the med, after Covid, the crazy thirst showed up at the same time as a lot of my other symptoms...
posted by stormyteal at 10:17 AM on November 5, 2022
The medication that I take that can cause increased thirst has been reduced, but the thirst hasn't reduced... and I still think it's weird that after years of the med, after Covid, the crazy thirst showed up at the same time as a lot of my other symptoms...
posted by stormyteal at 10:17 AM on November 5, 2022
POTS can be part of a constellation of issues that come under hyperflexibility and/or Ehlers Danlos so maybe check those out for speculative associations from a non-medical person.
posted by cacao at 10:24 AM on November 5, 2022 [1 favorite]
posted by cacao at 10:24 AM on November 5, 2022 [1 favorite]
Cacao's post prompted me to be more specific; here are some of the issues that tend to hang out around POTS (technical term: co-morbidities):
- Autism (possibly ADHD, I don't know off the top of my head but autism/ADHD overlap enough I would expect it)
- Anxiety/depression
- GI problems
- Sleep issues
- EDS/hypermobility
- Migraines
- Fibromyalgia
So some other things to explore potentially.
posted by brook horse at 10:32 AM on November 5, 2022 [3 favorites]
- Autism (possibly ADHD, I don't know off the top of my head but autism/ADHD overlap enough I would expect it)
- Anxiety/depression
- GI problems
- Sleep issues
- EDS/hypermobility
- Migraines
- Fibromyalgia
So some other things to explore potentially.
posted by brook horse at 10:32 AM on November 5, 2022 [3 favorites]
Response by poster: "That is really, really, really weird if by normal you mean that you pee about as often and about the same amount as most people do — all that water has to be going someplace."
It is really, really, really weird. To amend slightly - if I overshoot the water, it will be a bit extra. But if I have the balance down, it's a normal frequency and amount (or maybe a bit more), notwithstanding e.g. 1L water/hour. So for example, drinking about three litres over four hours, and peeing once at the end, a medium amount.
Based on imprecise weighing, it's for example two litres over two hours, with 1/2 retained, 1/4 mysteriously disappeared (with no sweating), 1/4 excreted. Very imprecise though.
Towards the beginning of the day, I absorb lots and gain weight quickly.
I'm sweating less than normal except during the hydrated period when it's normal.
posted by lookoutbelow at 10:41 AM on November 5, 2022
It is really, really, really weird. To amend slightly - if I overshoot the water, it will be a bit extra. But if I have the balance down, it's a normal frequency and amount (or maybe a bit more), notwithstanding e.g. 1L water/hour. So for example, drinking about three litres over four hours, and peeing once at the end, a medium amount.
Based on imprecise weighing, it's for example two litres over two hours, with 1/2 retained, 1/4 mysteriously disappeared (with no sweating), 1/4 excreted. Very imprecise though.
Towards the beginning of the day, I absorb lots and gain weight quickly.
I'm sweating less than normal except during the hydrated period when it's normal.
posted by lookoutbelow at 10:41 AM on November 5, 2022
Best answer: First thought, did your doctor do an A1C test, and did they do a glucose tolerance test? Without both, I wouldn't be so sure you can rule out diabetes. Even a negative a1c test doesn't rule it out, it just means you have been controlling your blood sugar.
Other thoughts:
What is your weight generally - stable, increasing, decreasing? And is the change in water weight a big proportional change or small? I am roughly 115lbs and I get PMS bloat of 3-4 lbs basically overnight, so if you are a larger human than I am, the swing in water weight might not be so crazy.
Are you in a dry climate where you could be losing more to sweat than you are realizing?
What, if any, physical activities are you engaged in in a given day? I intermittently lift weights because I am terribly bad at consistency, and one thing I have noticed is that when I get back into lifting, I can lift a lot more than I would expect (probably neuromuscular adaption) and then end up just needing a ton of liquid and electrolites - this is most noticeable if I exercise late in the day - overnight, its like all the water has been sucked out of me even if I have hydrated well after and before bed - and conversely, I'll get a bit of edema and wake up with blanket creases in my skin. Pretty sure I'm shunting water to muscles that are pissed for going too hard.
Tends to be less so once my routine is regular, but still happens to a lesser degree or if I go particularly hard.
Do you take any other medications that could be contributing? ADHDer here, take adderall and bupropion, and both tend to dehydrate me/dry me out by morning AND make me want to drink a lot. Bupropion is worse than adderall. When I read you were on vyvanse, that was my first thought. But having stopped it, I'm wondering if you are on anything else.
Also other meds that might be causing this? Even if your doc didn't mention, a lot can have this as a side effect. Any supplements?
Next thought I have is that you have a salt or other electrolite imbalance? Too much or too little. Too little means its going to be demanding more water, and if there isn't enough salt, try peeing out the extra liquid. I know you said you have normal urine output, but that is kind of subjective so its rough to say. And too much salt means your body is going to try and rid itself of excess salt.
An sdrenal pheochromacytoma could fit the bill, but again, would have increased urine output.
All these ideas aside, my horses not zebra thought is diabetes, so make sure your doc has at least done the two tests I mentioned.
posted by [insert clever name here] at 11:32 AM on November 5, 2022 [2 favorites]
Other thoughts:
What is your weight generally - stable, increasing, decreasing? And is the change in water weight a big proportional change or small? I am roughly 115lbs and I get PMS bloat of 3-4 lbs basically overnight, so if you are a larger human than I am, the swing in water weight might not be so crazy.
Are you in a dry climate where you could be losing more to sweat than you are realizing?
What, if any, physical activities are you engaged in in a given day? I intermittently lift weights because I am terribly bad at consistency, and one thing I have noticed is that when I get back into lifting, I can lift a lot more than I would expect (probably neuromuscular adaption) and then end up just needing a ton of liquid and electrolites - this is most noticeable if I exercise late in the day - overnight, its like all the water has been sucked out of me even if I have hydrated well after and before bed - and conversely, I'll get a bit of edema and wake up with blanket creases in my skin. Pretty sure I'm shunting water to muscles that are pissed for going too hard.
Tends to be less so once my routine is regular, but still happens to a lesser degree or if I go particularly hard.
Do you take any other medications that could be contributing? ADHDer here, take adderall and bupropion, and both tend to dehydrate me/dry me out by morning AND make me want to drink a lot. Bupropion is worse than adderall. When I read you were on vyvanse, that was my first thought. But having stopped it, I'm wondering if you are on anything else.
Also other meds that might be causing this? Even if your doc didn't mention, a lot can have this as a side effect. Any supplements?
Next thought I have is that you have a salt or other electrolite imbalance? Too much or too little. Too little means its going to be demanding more water, and if there isn't enough salt, try peeing out the extra liquid. I know you said you have normal urine output, but that is kind of subjective so its rough to say. And too much salt means your body is going to try and rid itself of excess salt.
An sdrenal pheochromacytoma could fit the bill, but again, would have increased urine output.
All these ideas aside, my horses not zebra thought is diabetes, so make sure your doc has at least done the two tests I mentioned.
posted by [insert clever name here] at 11:32 AM on November 5, 2022 [2 favorites]
One of the commenters up above talks about having 5 to 10 mg of salt. I’m pretty sure they are off by 1000x e.g. they should be talking about 5000 to 10000 mg of salt.
I mentioned this, to ask, is there any possibility you are drastically miscalculating your own water intake? When you say 10 L, is this actually measured using a quality measuring container or device? Have you tried measuring your own urine output also?
posted by soylent00FF00 at 11:34 AM on November 5, 2022 [5 favorites]
I mentioned this, to ask, is there any possibility you are drastically miscalculating your own water intake? When you say 10 L, is this actually measured using a quality measuring container or device? Have you tried measuring your own urine output also?
posted by soylent00FF00 at 11:34 AM on November 5, 2022 [5 favorites]
Best answer: You keep saying "normal", but that doesn't help. What's normal to you might be a clue to someone else. So:
Measure your liquid intake of every kind all day. Measure your urine output precisely every time. Record the color (not "normal" -- pick matching RGB code or there's probably some urine-specific chart) and amounts every time and keep a journal. I recommend a spreadsheet because you can do math formulas on it and graph the trend. It would probably be good to measure food mass and stool mass as well. Then you're going to have the information for the doctor to know where it's all going; I'm sure there's different possibilities if you're peeing it out versus sweating it out.
2nding that you may not have gotten the right diabetes tests.
posted by flimflam at 11:47 AM on November 5, 2022 [5 favorites]
Measure your liquid intake of every kind all day. Measure your urine output precisely every time. Record the color (not "normal" -- pick matching RGB code or there's probably some urine-specific chart) and amounts every time and keep a journal. I recommend a spreadsheet because you can do math formulas on it and graph the trend. It would probably be good to measure food mass and stool mass as well. Then you're going to have the information for the doctor to know where it's all going; I'm sure there's different possibilities if you're peeing it out versus sweating it out.
2nding that you may not have gotten the right diabetes tests.
posted by flimflam at 11:47 AM on November 5, 2022 [5 favorites]
Best answer: Addendum: I looked at your posting history and saw that you had covid somewhat recently. I just had round 2 in September, and I've been trying to decide if some of the symptoms I'm experiencing now are covid selequae or something else. I have been feeling weird since getting over covid, but I also have some preexisting health conditions so I don't know what is what.
Heck, I've been feeling off since my first go with covid - BUT I was also dealing with some additional health and environmental concerns, including mold exposure and then tobacco smoke exposure. I feel worse now, but I also have a broken tooth that I'm waiting to get dental care for (yay medicaid) that seems to have an infection flare up and I don't know how long that infection was a slow boil vs symptoms after covid. I have been giving diabetes the stink eye myself though, because of some issues with fatigue, urination, dry mouth (but they all can point to other things).
Anyway, I don't know what might be long covid and what might be something else, but its been on my radar and you might want it o be on your radar. Also diabetes risk is increased after covid, and I'm going to ask my doctor to test a1c and possibly glucose tolerance because the symptoms could check that box too.
Another aside (hello fellow adhd-er), I do have a tendancy to go down the route of looking at medical issues when weird things SEEM to crop up - I think its because in part, adhd - I both notice things that aren't a problem because I can't tune out normal sensations and totally miss things that are a real health issue which I think is related to problems with interoception. That and a general dysregulation of meals, sleep, and responding to thirst and hunger signals means I will feel off and be convinced something is really wrong and then eat a meal and I'm right as rain. Or not realize I only slept 4 hours and thats why I am dying that day, only realizing once I check my apple watch on my phone. That going to bed a little late turned out to be 4 hours later than I meant to.
The flip side is that sometimes I don't know what is wrong but something isn't right and tell myself its nothing, only to find out I have a silent uti or raging tooth infection, (the later of which incidentally I thought was a heart attack).
I only mention, not saying your issue isn't real but that my experience is that as someone with adhd, it can be harder to recognize a real health issue vs one caused by less than perfect habits but also to miss the forest for the trees and think something is fine until its really not.
That being said, another addendum idea brought to you by adhd - how much did the hunger part start once you stopped your vyvanse? You will have rebound hunger from stopping stimulants. And if they are a lot of carbs, you will end up drinking and retaining additional water. I could see a feedback loop where vyvanse is making you drink more, you stop vyvanse, now you are desperately hungry and the food you are eating contains carbs for quick energy because you still have adhd and unmedicated are going to forget to eat until your body is SCREAMING at you, so you're drinking and retaining more water due to increased carbohydrates. Just a wild hypothesis.
posted by [insert clever name here] at 11:58 AM on November 5, 2022 [3 favorites]
Heck, I've been feeling off since my first go with covid - BUT I was also dealing with some additional health and environmental concerns, including mold exposure and then tobacco smoke exposure. I feel worse now, but I also have a broken tooth that I'm waiting to get dental care for (yay medicaid) that seems to have an infection flare up and I don't know how long that infection was a slow boil vs symptoms after covid. I have been giving diabetes the stink eye myself though, because of some issues with fatigue, urination, dry mouth (but they all can point to other things).
Anyway, I don't know what might be long covid and what might be something else, but its been on my radar and you might want it o be on your radar. Also diabetes risk is increased after covid, and I'm going to ask my doctor to test a1c and possibly glucose tolerance because the symptoms could check that box too.
Another aside (hello fellow adhd-er), I do have a tendancy to go down the route of looking at medical issues when weird things SEEM to crop up - I think its because in part, adhd - I both notice things that aren't a problem because I can't tune out normal sensations and totally miss things that are a real health issue which I think is related to problems with interoception. That and a general dysregulation of meals, sleep, and responding to thirst and hunger signals means I will feel off and be convinced something is really wrong and then eat a meal and I'm right as rain. Or not realize I only slept 4 hours and thats why I am dying that day, only realizing once I check my apple watch on my phone. That going to bed a little late turned out to be 4 hours later than I meant to.
The flip side is that sometimes I don't know what is wrong but something isn't right and tell myself its nothing, only to find out I have a silent uti or raging tooth infection, (the later of which incidentally I thought was a heart attack).
I only mention, not saying your issue isn't real but that my experience is that as someone with adhd, it can be harder to recognize a real health issue vs one caused by less than perfect habits but also to miss the forest for the trees and think something is fine until its really not.
That being said, another addendum idea brought to you by adhd - how much did the hunger part start once you stopped your vyvanse? You will have rebound hunger from stopping stimulants. And if they are a lot of carbs, you will end up drinking and retaining additional water. I could see a feedback loop where vyvanse is making you drink more, you stop vyvanse, now you are desperately hungry and the food you are eating contains carbs for quick energy because you still have adhd and unmedicated are going to forget to eat until your body is SCREAMING at you, so you're drinking and retaining more water due to increased carbohydrates. Just a wild hypothesis.
posted by [insert clever name here] at 11:58 AM on November 5, 2022 [3 favorites]
Best answer: 1/4 mysteriously disappeared (with no sweating)
I'm sorry to say that I have absolutely no idea what might be causing your symptoms, and I hope you get to the bottom of it quickly because this sounds extremely difficult to manage.
I can provide some information about the mysterious water disappearance, though; it's via a normal physiologic process called 'insensible water loss' and it happens in every living human body.
Insensible fluid loss is the amount of body fluid lost daily that is not easily measured, from the respiratory system, skin[1], and water in the excreted stool. The exact amount is unmeasurable but [...] characterizes 30 to 50% of all water loss, contingent on the level of water consumed.
If you've ever been camping in a poorly-ventilated tent, you are intimately acquainted with this process because you wake up with all the lost water from exhalation condensed onto the inside of the tent.
[1] Insensible water loss from the skin is different than sweating.
posted by jesourie at 12:18 PM on November 5, 2022 [9 favorites]
I'm sorry to say that I have absolutely no idea what might be causing your symptoms, and I hope you get to the bottom of it quickly because this sounds extremely difficult to manage.
I can provide some information about the mysterious water disappearance, though; it's via a normal physiologic process called 'insensible water loss' and it happens in every living human body.
Insensible fluid loss is the amount of body fluid lost daily that is not easily measured, from the respiratory system, skin[1], and water in the excreted stool. The exact amount is unmeasurable but [...] characterizes 30 to 50% of all water loss, contingent on the level of water consumed.
If you've ever been camping in a poorly-ventilated tent, you are intimately acquainted with this process because you wake up with all the lost water from exhalation condensed onto the inside of the tent.
[1] Insensible water loss from the skin is different than sweating.
posted by jesourie at 12:18 PM on November 5, 2022 [9 favorites]
Sometimes you have to make a fuss with your doctors and demand to be taken seriously, demand more investigation. This is definitely one of those times.
Step 1: Make another appointment with your doctor. Shoot for an appointment about 2 weeks from now.
Step 2: I strongly second flimflam's advice: make an actual spreadsheet detailing your food and water consumption, and also the amount and frequency and exact color of urine. (Pee into a measuring flask as often as you possibly can to measure the amount.) Write short and succinct notes with any other pertinent details for each day of data. Do this for the full two weeks, and bring the spreadsheet to your doctor.
Doctors pay more attention to data than to vague words like "normal". Even if your doctor doesn't, the spreadsheet gives you a basis to argue with them, demand proper healthcare, insist on further investigation. Do not back down. You must advocate for yourself.
posted by MiraK at 12:19 PM on November 5, 2022
Step 1: Make another appointment with your doctor. Shoot for an appointment about 2 weeks from now.
Step 2: I strongly second flimflam's advice: make an actual spreadsheet detailing your food and water consumption, and also the amount and frequency and exact color of urine. (Pee into a measuring flask as often as you possibly can to measure the amount.) Write short and succinct notes with any other pertinent details for each day of data. Do this for the full two weeks, and bring the spreadsheet to your doctor.
Doctors pay more attention to data than to vague words like "normal". Even if your doctor doesn't, the spreadsheet gives you a basis to argue with them, demand proper healthcare, insist on further investigation. Do not back down. You must advocate for yourself.
posted by MiraK at 12:19 PM on November 5, 2022
Response by poster: Yes AC1, no glucose tolerance. Though, my blood glucose two hours post meal (not controlled setting of course) was 4.7 mmol/L. On the four tests I've had since this started, it's been between 3.6 and 5, all about 2 hours post meal.
Weight increased about 20 pounds over three months to the level it used to be when I didn't take Vyvanse and remembered to eat more, now somewhat stable. Probably 1.5 to 2 times my previous food intake.
Weight means that gaining 10 pounds is just over a 5% increase, so it's not proportionately huge.
I will try sometime doing more of a spreadsheet approach to the intake/output when I can. The measuring intake is based on counting the number of refills of my two 1L Nalgenes, while not drinking from anything else. I'm confident of the quantities.
Not a dry climate, limited physical activity going on (I am not capable of much these days). I sometimes suddenly start noticeable sweating after drinking lots of water, but rarely get to this point. Body temperature seems a bit high compared to normal.
The ADHD-related forgetting meals and not noticing bodily needs is definitely real. The hunger is certainly more without the Vyvanse. Possibly more carbs than is good? Not sure how much those can increase thirst though. I think my diet is fairly balanced. My eating now is far more consistent than it used to be. There certainly could be some kind of rebound from not taking the Vyvanse, I think when I did take it I generally didn't eat enough. When I take it now it's like it supercharges the food/water problem. I'm drinking far more water now, though, than I used to when I felt healthy and was taking Vyvanse.
I've been sleeping more and with greater ease - between 9 and 12 hours, though on a day where I slept less but drank and ate right before and after sleeping, I still felt adequately rested. I think the super tired morning enables more sleep that I don't really need.
posted by lookoutbelow at 12:21 PM on November 5, 2022
Weight increased about 20 pounds over three months to the level it used to be when I didn't take Vyvanse and remembered to eat more, now somewhat stable. Probably 1.5 to 2 times my previous food intake.
Weight means that gaining 10 pounds is just over a 5% increase, so it's not proportionately huge.
I will try sometime doing more of a spreadsheet approach to the intake/output when I can. The measuring intake is based on counting the number of refills of my two 1L Nalgenes, while not drinking from anything else. I'm confident of the quantities.
Not a dry climate, limited physical activity going on (I am not capable of much these days). I sometimes suddenly start noticeable sweating after drinking lots of water, but rarely get to this point. Body temperature seems a bit high compared to normal.
The ADHD-related forgetting meals and not noticing bodily needs is definitely real. The hunger is certainly more without the Vyvanse. Possibly more carbs than is good? Not sure how much those can increase thirst though. I think my diet is fairly balanced. My eating now is far more consistent than it used to be. There certainly could be some kind of rebound from not taking the Vyvanse, I think when I did take it I generally didn't eat enough. When I take it now it's like it supercharges the food/water problem. I'm drinking far more water now, though, than I used to when I felt healthy and was taking Vyvanse.
I've been sleeping more and with greater ease - between 9 and 12 hours, though on a day where I slept less but drank and ate right before and after sleeping, I still felt adequately rested. I think the super tired morning enables more sleep that I don't really need.
posted by lookoutbelow at 12:21 PM on November 5, 2022
Response by poster: I do have an appointment in two weeks, I'm not sure what else to ask her to do. I have the two referrals, to cardiologist and neurologist. She said she'd read up on what blood tests to order and ordered those, with normal results. She seems to think the referral to neurologist is the next step. She does seem to believe me and takes things seriously, and is generally very active in referrals and testing.
Aside from the glucose tolerance, which seems like a good idea, what other tests or investigations should I seek out? And any other specialists?
posted by lookoutbelow at 12:25 PM on November 5, 2022
Aside from the glucose tolerance, which seems like a good idea, what other tests or investigations should I seek out? And any other specialists?
posted by lookoutbelow at 12:25 PM on November 5, 2022
Soylent00FF00, thanks. I meant 5-10g, not mg. Used to my my other meds being mg. Coincidentally I hadn’t had my salt yet when I posted that lol.
posted by brook horse at 1:00 PM on November 5, 2022 [3 favorites]
posted by brook horse at 1:00 PM on November 5, 2022 [3 favorites]
The post says you were tested for diabetes - I assume that means diabetes mellitus? Has your doctor also investigated central diabetes insipidus - it refers to vasopressin deficiency that causes extreme thirst.
posted by Mallenroh at 1:16 PM on November 5, 2022 [4 favorites]
posted by Mallenroh at 1:16 PM on November 5, 2022 [4 favorites]
I don't know what you might have, but "normal" is such a tough thing to know sometimes. Before my kidney transplant, I absolutely thought I was producing "normal" urine. But afterwards, it's so much darker (and is actually "normal" colour now); I'd previously subconsciously assumed that the popular depiction in the media (such as it is) was exaggerated for effect.
posted by Superilla at 1:43 PM on November 5, 2022 [1 favorite]
posted by Superilla at 1:43 PM on November 5, 2022 [1 favorite]
I have no suggestions and I'm no expert, but just reading through the comments I saw this: "suggestions for dysautonomia are an extra 5-10mg of salt a day."
I thought the amount of sodium people 'should' typically eat is around 2000 mg a day (or less?) So I would assume that 5-10 mg of salt is well within the typical daily variation and that eating an extra 5-10mg per day wouldn't make a difference. (I know salt and sodium are slightly different things, but 5 mg salt is even less sodium) I would double check this advice with a professional.
posted by never.was.and.never.will.be. at 1:49 PM on November 5, 2022
I thought the amount of sodium people 'should' typically eat is around 2000 mg a day (or less?) So I would assume that 5-10 mg of salt is well within the typical daily variation and that eating an extra 5-10mg per day wouldn't make a difference. (I know salt and sodium are slightly different things, but 5 mg salt is even less sodium) I would double check this advice with a professional.
posted by never.was.and.never.will.be. at 1:49 PM on November 5, 2022
Thanks, it was corrected above--it should be g not mg (brain fog). I'll message a mod and see if they can fix it.
posted by brook horse at 2:06 PM on November 5, 2022
posted by brook horse at 2:06 PM on November 5, 2022
Best answer: I have not read all the advice above, but re: accessing care: I see you're in vancouver. I wish you were in Toronto, but maybe they have something similar there. Women's College Hospital has a place called the "Acute Ambulatory Care Clinic." It's a weird outpatient-inpatient thing. You go in at your appointment time (which is basically the day after you're referred there) and you just stay all day (and all night) as an inpatient and keep coming back til they figure out what's wrong with you. The thing is that though they will "let" you leave after 10 or 20 or 48 or whatever hours, during the time you are there you're an inpatient. You get a hospital bed and hospital food and the whole inpatient treatment which means -- like an inpatient -- you get whatever tests/imagine you need pretty much when a doctor decides you need them, they can call whatever specialists in as consults (like if you were in the hospital and you needed a cardiologist -- a cardiologist would come to your room and check you out that day), etc. etc. They keep you until they either know what's wrong with you or until "well we can't think of anything else to check right now, come back in two days and we'll keep at it."
It's intended exactly for this sort of "you're not so sick you need to be in the hospital but something complex is obviously going on and we need you right here so we can figure out what it is. The other advantage to being in the hospital is that of course they could continuously monitor you -- like instead of drinking they could give you IV fluids and know EXACTLY how much was going in and out when and watch how any tests they do change as it goes in and out.
Ask your doctor if there's anything similar in Vancouver they could send you to.
posted by If only I had a penguin... at 2:51 PM on November 5, 2022 [6 favorites]
It's intended exactly for this sort of "you're not so sick you need to be in the hospital but something complex is obviously going on and we need you right here so we can figure out what it is. The other advantage to being in the hospital is that of course they could continuously monitor you -- like instead of drinking they could give you IV fluids and know EXACTLY how much was going in and out when and watch how any tests they do change as it goes in and out.
Ask your doctor if there's anything similar in Vancouver they could send you to.
posted by If only I had a penguin... at 2:51 PM on November 5, 2022 [6 favorites]
Response by poster: The Acute Ambulatory Care Clinic is interesting, it seems googling the terms does not help much. If anyone is aware of a similar program in BC or any other terms I could search, that would be awesome. Based on the fact that the clinic is presided over by a general internist, I will follow-up on my doctor's potential idea of referring me to one.
If anyone knows of a spreadsheet template for tracking stuff like this, that is something I may try. Or I'll make one.
Thanks to everyone for many interesting ideas. I have been putting off writing this but I knew it would be useful. I will continue experimenting and observing. Before I discovered that drinking this much water helped, I was often incapacitated for days, so on the whole I'm still on an upward path.
posted by lookoutbelow at 4:35 PM on November 5, 2022
If anyone knows of a spreadsheet template for tracking stuff like this, that is something I may try. Or I'll make one.
Thanks to everyone for many interesting ideas. I have been putting off writing this but I knew it would be useful. I will continue experimenting and observing. Before I discovered that drinking this much water helped, I was often incapacitated for days, so on the whole I'm still on an upward path.
posted by lookoutbelow at 4:35 PM on November 5, 2022
Following along the lines as Mallenroh mentioned- your story reminded me of a NY Times Diagnosis column from 2007 (my brain is weird)
That should be the no paywall link, but let me know if its not. But basically it ends up being the other diabetes and is an easy blood test for your Dr.
posted by zara at 5:29 PM on November 5, 2022 [1 favorite]
That should be the no paywall link, but let me know if its not. But basically it ends up being the other diabetes and is an easy blood test for your Dr.
posted by zara at 5:29 PM on November 5, 2022 [1 favorite]
It sounds so much like diabetes.
Thirding the recommendation for a glucose tolerance test. Also, you might ask to have your insulin level checked and use that to calculate your HOMA-IR score:
https://thebloodcode.com/homa-ir-calculator/
You can approximate this using your triglycerides and glucose levels if you have those results from a standard blood panel.
https://www.mdapp.co/tyg-index-calculator-359/
Fasting glucose is actually the last metric to change after the onset of type 2 diabetes but it’s the standard test for it, which means the disease mostly isn’t caught as early on as it could be. A1c can take a long time to show abnormal results too. When you have insulin resistance, or the early stages of type 2 diabetes, your body will pump out a lot more insulin in an effort to keep your blood sugar under control, so you can be sick for a long time before the standard test results start to show discrepancies. The glucose tolerance test and insulin test would be better at revealing any issues with blood sugar in the early stages of diabetes.
So, in addition to the suggestions about salt/electrolytes, you might try going very low carb for a few weeks and see if it makes you feel better at all.
posted by music for skeletons at 5:52 PM on November 5, 2022
Thirding the recommendation for a glucose tolerance test. Also, you might ask to have your insulin level checked and use that to calculate your HOMA-IR score:
https://thebloodcode.com/homa-ir-calculator/
You can approximate this using your triglycerides and glucose levels if you have those results from a standard blood panel.
https://www.mdapp.co/tyg-index-calculator-359/
Fasting glucose is actually the last metric to change after the onset of type 2 diabetes but it’s the standard test for it, which means the disease mostly isn’t caught as early on as it could be. A1c can take a long time to show abnormal results too. When you have insulin resistance, or the early stages of type 2 diabetes, your body will pump out a lot more insulin in an effort to keep your blood sugar under control, so you can be sick for a long time before the standard test results start to show discrepancies. The glucose tolerance test and insulin test would be better at revealing any issues with blood sugar in the early stages of diabetes.
So, in addition to the suggestions about salt/electrolytes, you might try going very low carb for a few weeks and see if it makes you feel better at all.
posted by music for skeletons at 5:52 PM on November 5, 2022
I am not a doctor, certainly not your doctor...
A bunch of issues:
- First, the data you are presenting seems... pretty amazing. I'm not saying it isn't true, but for most people, 10L (about 2.6 gallons) can be fatal and induce water intoxication you say you are drinking more than 10L per day to feel good.
- if you really belive you are drinking 10L or more per day (which you claim) then you are an extreme biological outlier, and you should probably get someone to believe you, as your doctors simply may not. I think you should track your water intake and output and get a witness (friend, guardian, etc.) to attest to this.
- assuming you are drinking that much water... if there's no biological reasons (some very good reasons posted above) psychogenic polydipsia is a thing, and you should consider whether this could be relevant.
- can you intentionally restrict water? What happens if, in a given day, you only eat about 2500 kCal, 2L of water, and 2g to 5g of sodium (in your food).
posted by soylent00FF00 at 6:39 PM on November 5, 2022 [3 favorites]
A bunch of issues:
- First, the data you are presenting seems... pretty amazing. I'm not saying it isn't true, but for most people, 10L (about 2.6 gallons) can be fatal and induce water intoxication you say you are drinking more than 10L per day to feel good.
- if you really belive you are drinking 10L or more per day (which you claim) then you are an extreme biological outlier, and you should probably get someone to believe you, as your doctors simply may not. I think you should track your water intake and output and get a witness (friend, guardian, etc.) to attest to this.
- assuming you are drinking that much water... if there's no biological reasons (some very good reasons posted above) psychogenic polydipsia is a thing, and you should consider whether this could be relevant.
- can you intentionally restrict water? What happens if, in a given day, you only eat about 2500 kCal, 2L of water, and 2g to 5g of sodium (in your food).
posted by soylent00FF00 at 6:39 PM on November 5, 2022 [3 favorites]
Response by poster: When drinking more like 2L of water, I will essentially be very low energy, heart rate spike on standing and little to no tolerance for walking (e.g. 1-2 blocks before resting), brain fog, easily overstimulated (consistent for me with low cognitive energy), tired, weak. I would not feel horribly thirsty - I don't start feeling distinctly thirsty until I start drinking water. I would urinate probably 2-3 times in the day. I'm not as hungry under those conditions either - just lethargic and intolerant to standing and moving around. It's almost like my body stays in a low metabolism state until I start providing more food and water and then it spikes and can't get enough.
I get why people keep suggesting diabetes and polydipsia, but as far as I can tell, these necessarily involve increased urination unrelated to water intake, and/or unquenchable thirst. I am going to ask my doctor for more tests though.
posted by lookoutbelow at 7:09 PM on November 5, 2022
I get why people keep suggesting diabetes and polydipsia, but as far as I can tell, these necessarily involve increased urination unrelated to water intake, and/or unquenchable thirst. I am going to ask my doctor for more tests though.
posted by lookoutbelow at 7:09 PM on November 5, 2022
Have you talked about an endocrinology referral too? It seems so close to diabetes insipidus except for the lack of raging thirst... I feel like it's good to escalate to somebody who could tell if you'd possibly got D.I. overlaid with something else disrupting thirst response, or some rare variant of it.
The neurology consult for dysautonomia also makes sense. If you can do both and get them to talk to each other that would be ideal. Your GP sounds good but if you may have something pretty unusual, time to throw ALL THE SPECIALISTS at it.
+1 to a log of measured intake and urine volume, to have in hand rather than your referrals asking you to come back when you have one.
Wanted to say you've done a great job figuring out what's gotten you this far. I hope you can get more answers and treatment.
posted by away for regrooving at 9:14 PM on November 5, 2022 [2 favorites]
The neurology consult for dysautonomia also makes sense. If you can do both and get them to talk to each other that would be ideal. Your GP sounds good but if you may have something pretty unusual, time to throw ALL THE SPECIALISTS at it.
+1 to a log of measured intake and urine volume, to have in hand rather than your referrals asking you to come back when you have one.
Wanted to say you've done a great job figuring out what's gotten you this far. I hope you can get more answers and treatment.
posted by away for regrooving at 9:14 PM on November 5, 2022 [2 favorites]
(Just to note: DI, diabetes insipidus, is totally unrelated to 'regular' diabetes -- DI doesn't involve glucose or insulin. The name coincidence is purely on pee-related symptoms. Diabetes tests won't detect DI at all.)
posted by away for regrooving at 9:21 PM on November 5, 2022 [2 favorites]
posted by away for regrooving at 9:21 PM on November 5, 2022 [2 favorites]
This sounds like a question for CrowdMed, where you list your symptoms, upload your medical records, and set a reward for anyone who correctly diagnoses your condition. Then "medical detectives" get to work to figure out what's causing your illness.
posted by alex1965 at 6:01 AM on November 6, 2022 [1 favorite]
posted by alex1965 at 6:01 AM on November 6, 2022 [1 favorite]
One last suggestion here before this thread goes away.
I've historically needed to drink great quantities of water (6L+ daily) in order to maintain energy and hydration levels if I am not eating a high-carbohydrate diet. All else is normal. Extensive tests have been run regarding diabetes and thyroid, especially because I will quickly gain weight on a diet with mid to high carbohydrate levels to keep my thirst in check. Those aren't the issue.
Yet, when on a lower carbohydrate diet where I can maintain my weight, I'm prone not only to weakness and loss of energy without excessive hydration, but also cramping - cramping in my legs, abdomen, extremeties. It's like I'm continually dehydrated on a healthy diet no matter how much water I take in, although more is better than less.
A weight loss doctor many years ago prescribed prescription-level potassium hcl supplements for this (in quantities greater than OTC supplements), and they *worked*. Fewer cramps, fewer issues with hydration. The problem is that doctors generally have an issue prescribing potassium supplements without evidence of other issues, but when I've had access to them, honestly, it has been much easier to keep both my weight and hydration levels in check, and felt "normal".
Salt can help, but IMO, a 10 meq potassium supplement has been the thing that can actually level me out and make me "almost normal" without eating or drinking far too much. I recently convinced my doc to start me on them again, blood tests and all, and it's been night and day. You may want to see if that's a possibility.
posted by I EAT TAPAS at 5:06 PM on November 8, 2022 [1 favorite]
I've historically needed to drink great quantities of water (6L+ daily) in order to maintain energy and hydration levels if I am not eating a high-carbohydrate diet. All else is normal. Extensive tests have been run regarding diabetes and thyroid, especially because I will quickly gain weight on a diet with mid to high carbohydrate levels to keep my thirst in check. Those aren't the issue.
Yet, when on a lower carbohydrate diet where I can maintain my weight, I'm prone not only to weakness and loss of energy without excessive hydration, but also cramping - cramping in my legs, abdomen, extremeties. It's like I'm continually dehydrated on a healthy diet no matter how much water I take in, although more is better than less.
A weight loss doctor many years ago prescribed prescription-level potassium hcl supplements for this (in quantities greater than OTC supplements), and they *worked*. Fewer cramps, fewer issues with hydration. The problem is that doctors generally have an issue prescribing potassium supplements without evidence of other issues, but when I've had access to them, honestly, it has been much easier to keep both my weight and hydration levels in check, and felt "normal".
Salt can help, but IMO, a 10 meq potassium supplement has been the thing that can actually level me out and make me "almost normal" without eating or drinking far too much. I recently convinced my doc to start me on them again, blood tests and all, and it's been night and day. You may want to see if that's a possibility.
posted by I EAT TAPAS at 5:06 PM on November 8, 2022 [1 favorite]
To get the potassium, purchase Lo Salt from the supermarket. It's usually 1/3 sodium to 2/3 potassium.
One reason there's so little potassium in supplements etc, is that if they put too much of *salt* in pill form, the concentrated salts will stick to your gut lining, pull water from your cells due to salt osmosis, and then you end up with little ulcers in your gut - whereas it's fine when added to food, or in solution in water.
Either get an electrolyte mix like LMNT, or, make up your own ORS equivalent like I do:
1g / 1/4 teaspoon Lo Salt (usually 2/3 sodium to 1/3 potassium - that works out to between 150mg to 250mg potassium depending on your brand, so get a calculator if you want it exact)
1g / 1/4tsp to half a teaspoon normal or himalayan salt, depending whether you're matching drinks like lmnt or official ORS proportions
Pinch of epsom salt (for the magnesium sulphate - and yes, old lemonade recipes frequently had epsom salt)
In one litre of water.
I put some lemon juice or vinegar in because I prefer the tart flavour.
I also sometimes dilute tomato juice 1/4 to 3/4 water, then calculate the sodium/glucose levels and add sodium & potassium til it's at WHO recommended ORS proportions.
I have no idea why salty orange ors is so popular, tomato juice works much better as a flavour with the salt.
I'm not a Dr, but you're asking mefi, and yeah, that does sound like POTS, and the point of drinking that much (salted) water is that yes, that alleviates the symptoms of POTS so I'm not surprised if you don't have those symptoms after having that much water?
I'd still try to sloooowly decrease the total amount of water each day, because even if you need the salted water in the morning for POTS, people's bodies/kidneys tend to achieve a... steady state kind of in regards to waste.
Like, if you usually drink a bunch of water and don't one day, you will be really dehydrated, because your kidneys will still try to get rid of the same amount of water they usually do in a normal day, for awhile at least.
Meanwhile, someone who doesn't drink as much water as you would absolutely get water intoxication as their kidneys would not be able to pull that amount of water out that quickly.
And so, while there's a bit of an equilibrium, drinking more water still at some times of day and not while you are sleeping, is still a bigger fluctuation and harder for your body to compensate for.
So, try more electrolyte mix, and chug that first 2litres while waking up, then space the rest of the electrolyte mix out and try slightly less overall liquid, or rather -
You should need less liquid because electrolyte mix should hydrate you better, but you're probably in the habit of chugging water by now, so at the very least try to space it out evenly and see if you really do need as much if there is more potassium and salt etc.
posted by Elysum at 10:59 PM on January 3, 2023
One reason there's so little potassium in supplements etc, is that if they put too much of *salt* in pill form, the concentrated salts will stick to your gut lining, pull water from your cells due to salt osmosis, and then you end up with little ulcers in your gut - whereas it's fine when added to food, or in solution in water.
Either get an electrolyte mix like LMNT, or, make up your own ORS equivalent like I do:
1g / 1/4 teaspoon Lo Salt (usually 2/3 sodium to 1/3 potassium - that works out to between 150mg to 250mg potassium depending on your brand, so get a calculator if you want it exact)
1g / 1/4tsp to half a teaspoon normal or himalayan salt, depending whether you're matching drinks like lmnt or official ORS proportions
Pinch of epsom salt (for the magnesium sulphate - and yes, old lemonade recipes frequently had epsom salt)
In one litre of water.
I put some lemon juice or vinegar in because I prefer the tart flavour.
I also sometimes dilute tomato juice 1/4 to 3/4 water, then calculate the sodium/glucose levels and add sodium & potassium til it's at WHO recommended ORS proportions.
I have no idea why salty orange ors is so popular, tomato juice works much better as a flavour with the salt.
I'm not a Dr, but you're asking mefi, and yeah, that does sound like POTS, and the point of drinking that much (salted) water is that yes, that alleviates the symptoms of POTS so I'm not surprised if you don't have those symptoms after having that much water?
I'd still try to sloooowly decrease the total amount of water each day, because even if you need the salted water in the morning for POTS, people's bodies/kidneys tend to achieve a... steady state kind of in regards to waste.
Like, if you usually drink a bunch of water and don't one day, you will be really dehydrated, because your kidneys will still try to get rid of the same amount of water they usually do in a normal day, for awhile at least.
Meanwhile, someone who doesn't drink as much water as you would absolutely get water intoxication as their kidneys would not be able to pull that amount of water out that quickly.
And so, while there's a bit of an equilibrium, drinking more water still at some times of day and not while you are sleeping, is still a bigger fluctuation and harder for your body to compensate for.
So, try more electrolyte mix, and chug that first 2litres while waking up, then space the rest of the electrolyte mix out and try slightly less overall liquid, or rather -
You should need less liquid because electrolyte mix should hydrate you better, but you're probably in the habit of chugging water by now, so at the very least try to space it out evenly and see if you really do need as much if there is more potassium and salt etc.
posted by Elysum at 10:59 PM on January 3, 2023
Also, you mention adding electrolytes and sugar...
What you don't mention is drinking things in the exact proportions of ORS or particularly low-osmolar-oral rehydration solution.
In this post and the last one you ask what makes it easier to absorb water -
You should definitely read up on:
https://en.m.wikipedia.org/wiki/Oral_rehydration_therapy
The whole point of the exact proportions of salts, glucose and water is that it allows your body to more easily absorb water more quickly, because of sodium/glucose transporters in the cell walls, so that you can absorb more of the water while it's still in your small intestines, rather than waiting for it to get to your large intestines
https://en.m.wikipedia.org/wiki/Sodium/glucose_cotransporter_1
That's why ors saves people with diarrhoea from dehydration because they can't absorb it from the large intestines while that's going on, but it's still helpful for rapid hydration in the morning etc.
And y'know, take this with the pinch of salt in which it's given, and the context that you're seeing a Dr and continuing to do so, but that they're not being particularly helpful.
posted by Elysum at 11:22 PM on January 3, 2023
What you don't mention is drinking things in the exact proportions of ORS or particularly low-osmolar-oral rehydration solution.
In this post and the last one you ask what makes it easier to absorb water -
You should definitely read up on:
https://en.m.wikipedia.org/wiki/Oral_rehydration_therapy
The whole point of the exact proportions of salts, glucose and water is that it allows your body to more easily absorb water more quickly, because of sodium/glucose transporters in the cell walls, so that you can absorb more of the water while it's still in your small intestines, rather than waiting for it to get to your large intestines
https://en.m.wikipedia.org/wiki/Sodium/glucose_cotransporter_1
That's why ors saves people with diarrhoea from dehydration because they can't absorb it from the large intestines while that's going on, but it's still helpful for rapid hydration in the morning etc.
And y'know, take this with the pinch of salt in which it's given, and the context that you're seeing a Dr and continuing to do so, but that they're not being particularly helpful.
posted by Elysum at 11:22 PM on January 3, 2023
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posted by carmicha at 9:36 AM on November 5, 2022 [2 favorites]