Dehydration, Temperature Intolerance and Adrenal Fatigue Syndrome – Part 2

By: Michael Lam, MD, MPH


Read Part 1

Adrenal Fatigue Syndrome and Subclinical Fluid Depletion

Aldosterone output is compromised by adrenal weakness; and the more advanced the Adrenal Fatigue Syndrome, the lower the aldosterone level. Without adequate aldosterone to retain sodium, the body loses more water than it retains, resulting in a chronic state of subclinical dehydration.

The more advanced the fatigue, the more evident subclinical dehydration becomes. Common symptoms include chronic low blood pressure, lightheadedness, dizziness, and orthostatic hypotension. Electrolyte balance is not usually a problem early on, but becomes a concern as AFS progresses to late stages, if fluid imbalance is not addressed and reversed properly.

Signs of Fluid Imbalance

Adrenal Fatigue Syndrome can lead to fluid imbalances and many other symptomsAs AFS progresses to later stages, there are telltale signs that our body generates well in advance as notification of its need for fluids. This can takes years and sometimes even decades to develop. Early symptoms to be on the lookout for include: brain fog, increased thirstiness, heartburn, urinary tract infections, dry mouth, reduced skin elasticity, wrinkles, dry skin, darkly colored urine, and constipation. Unfortunately, few are aware of these subtle signals, especially in the early stages of AFS.

Advanced signs of a body hungry for fluid include chronic low blood pressure, postural hypotension, postural tachycardia, dizziness on arising, cardiac arrhythmia, adrenal crashes, lethargy, and heat intolerance. These are more commonly seen in those with AFS at Stage 3 or higher. They only become evident when water depletion or electrolyte imbalance have become chronic. Routine laboratory tests of fluid balance, including sodium, potassium, and creatine clearance, still often continue to report normal values despite these signs of subclinical fluid depletion.

Fluid and Electrolyte Replenishment

The obvious solution to fluid depletion is fluid replacement. For AFS sufferers this must be done with care, as there is the possibility of further disrupting a fragile electrolyte balance. Therefore the proper amount of sodium should be mixed with water to maintain optimal osmolality.

When healthy, our body requires an intake of over two quarts of water (eight glasses of eight ounces each) for normal function. Depending on our diet, about half to one quart each day is provided by the food we eat. The rest of it has to be taken in apart from this. A good rule of thumb is to drink eight glasses of pure water (non-caffeinated drinks) a day in addition to your food.

To achieve optimum hydration for AFS recovery, it is important to bathe the body internally with ample water balanced with electrolytes. About one quart (four glasses of eight ounces each) of pure filtered water per day for every fifty pounds of body weight is the recommended minimum. For the average 150-pound AFS sufferer, this translates to three quarts (12 glasses of 8 ounces each) a day, or fifty percent more than that recommended for routine bodily function. Those exposed to hot environments need substantially more. That is why AFS sufferers should avoid excessive direct sunlight and cut down outdoor activities in hot weather. Furthermore, water intake should increase by one 8-ounce glass for each 25 pounds above ideal body weight.

If you are taking in liquids that act as a diuretic (such as coffee, tea, and certain sodas), you will need more water to compensate for the water loss due to these dehydrating drinks. A good rule of thumb is to drink one extra glass of water for the equivalent amount of each such drink you consume.

The above are general guidelines only. The exact amount varies from person to person and the body’s state of fatigue. Those who are in advanced stages need to be very careful not to drink too much water without making sure that the body’s internal electrolyte balance is well regulated.

Too much water without enough sodium can lead to a state called dilutional hyponatremia. Symptoms can include lethargy, fatigue, and in extreme cases coma. Conversely, too much salt without enough accompanying water can drive up blood pressure, reduce potassium, and trigger abnormal cardiac function. Professional guidance is critical for anyone in a sensitive state of electrolyte dysregulation or that has a history of sodium/potassium imbalances because the body can decompensate quickly.

Practical Hydration Tips

Keeping hydrated is vital when in Adrenal Fatigue SyndromeThose afflicted with AFS are usually in a state of subclinical fluid and salt depletion as well as fragile electrolyte balance. Their fluid requirements are therefore higher than those of a normal healthy individual. The following tips should be considered:

It is good practice to always carry a filled water bottle throughout the day so as never to be out of reach of water. If tolerated, a bit of lemon juice or a few slices of lemon should be mixed in the water. The container should be glass if possible. Those with sensitive gums should consider using a straw when taking in water with lemon.

Make it a habit to drink more fluid than you need. Do not wait until you are thirsty, as thirst itself is a late warning sign of underlying dehydration.

Because sodium depletion is common, many feel energized when their water contains a bit of salt. Sea salt should be mixed with water if tolerated.

Avoid excessive exposure to direct sunlight. For some, this may mean less a few minutes, especially if they are in advanced stages of AFS.

If outdoor exposure is unavoidable, carry an umbrella for shade, or wear protective headwear and clothing. Take frequent hydration breaks. Always have snacks handy to prevent hypoglycemia.

It is important that water intake be consistent and gradual. Drinking too much water too fast can trigger an adrenal crash if there is a sudden dilution of sodium within the body. As mentioned earlier, this is called dilutional hyponatremia. When this happens, fatigue increases and one should seek medical attention. In severe cases, symptoms include stupor and lethargy and hospitalization may be required.

Food and Beverage Alert

Bewared of what your drink and eat while suffering from Adrenal Fatigue SyndromeIt is important to avoid any caffeinated drinks such as tea and coffee as they contain caffeine, a natural diuretic. Fruits such as pineapple, watermelon, cranberry, pear, peach, grapefruit, honeydew, and strawberries should be consumed in moderation because of their high potassium content which acts in opposition to sodium. Lemons also fall in this category, but with AFS, it has the positive attribute of being a pH balancer. The slow release of vitamin C from lemons far outweighs its slight diuretic property and should be used whenever possible. Apples are also an exception because of its tremendous value in providing a steady source of carbohydrates when the body is fatigued.

Green vegetables with high water content should be avoided because they are among the most potent natural diuretics because of their mineral, water, and fiber content. Many are high in potassium and magnesium, both of which act in opposition to sodium. These include celery, cucumber, carrot, eggplant, asparagus, beet, spinach, seaweed, pumpkin, green bean, artichoke, garlic and onion. Cruciferous vegetables should also be avoided as they are rich in sulfur and also have diuretic properties. They include Brussels sprouts, cabbage, and watercress.

Always consult your physician if you are altering your diet to include natural diuretics when you are already taking diuretic medication.

Read Part 1

References

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© Copyright 2016 Michael Lam, M.D. All Rights Reserved.

Keeping hydrated is vital when in Adrenal Fatigue Syndrome




3 Comments

  • Julie Alexander says:

    The article is very helpful. I have advanced AFS. I am drinking 1/2 my body weight in water a day, but waking with extreme dry cotton mouth all night. I am doing a whole foods diet and use the vegetables and some limited fruit ALL of which were highly recommended. If you can’t eat these vegetables, what CAN you eat? Is there a measure of salt that should be added to the drinking water?

    • Dorine Lam RDN says:

      You asked a good question. Salt intake varies with individuals and on how it should be taken. I actually explain more about it in my book on Adrenal Fatigue Syndrome.

  • Charles says:

    I use to always add lemon to my water because I heard it was alkalizing. But then I read one should not add lemon to drinking water because it can contain sugar and minerals that interfere with the hydrating effect of water. So I stopped and I think straight spring water might work better.