Hydration and Lupus

Water is vital to good health. What does water do for you, and how do you get enough of it?

We need water, and quite a bit of it: According to the Mayo Clinic, we need approximately 2.7 liters (for women) to 3.7 liters (for men.) This comes out to about 11.5 cups and 15.5 cups respectively, though it’s a good idea to overshoot this measurement a bit. 

Water is a special molecule that is vital for all life on the planet. This is because it is a unique molecule which has properties that enable many chemical reactions to happen. It also is handy for carrying out toxins, protecting and lubricating joints, and cushioning certain tissues and organs. Humans are about 50% – 70% water, and we are constantly taking in and putting out water, in the form of urine and sweat and even just in our breath. It enables chemical reactions needed for life, cools us down, and transports oxygen and other blood products throughout the body. This is because we lose water whenever we go to the bathroom, sweat, and even breathe.

When a person is properly hydrated, everything in the body just works better. The brain is more efficient, and emotions are more stable. Digestion runs a little smoother. People who drink enough water have more energy and, since water provides a sense of fullness in between meals, it can help with weight management by preventing snacking. It lubricates the joints, reducing joint pain and keeps the body cool. Having adequate levels of water also helps with blood pressure and heart health and, because of this, the kidneys are also able to function better. This helps to avoid kidney stones and allows the kidneys to flush out toxins more efficiently. 

Systemic lupus erythematosus effects all organs in the body (and outside of it, in the case of skin) – and so does water. This means that, for people with lupus, all the benefits of staying hydrated can be very welcome.

Lupus and Dehydration

Dehydration is bad for everyone, but people with lupus are especially vulnerable to the symptoms.. Aside from feeling thirsty, there are other signs of dehydration, including:

• Dark colored urine
• Dry mouth
• Dry eyes 
• Fatigue or sleepiness
• Headaches 
• Confusion
• Dizziness or lightheadedness

At serious levels of dehydration, people will produce little to no urine, sweat, or tears. This is very severe and requires extreme treatment. Don’t get to this point.

People with lupus have to keep an eye on their hydration more than most, especially if they have kidney trouble, as in lupus nephritis. And even more so if they also have Sjogren’s syndrome, an autoimmune disease that affects the glands that produce saliva, mucous, and tears. People with Sjogrens syndrome need to drink more water to make up for their decreased production, reduce their symptoms, and avoid dehydration. You can read more about Sjogren’s syndrome here. 

Temperature and air quality can also contribute to dehydration. People with lupus are particularly sensitive to cold weather, hot weather, and humidity, which all effect how the body loses or holds water. Heat causes more water to be lost through sweat and breathing as the body tries to cool itself.  Humid weather such as hot and muggy summer days can lead to overheating, which can trigger flares.

For people with lupus specifically, however, proper hydration can reduce inflammation by encouraging a healthier immune system. Hydration also keeps the kidneys healthy, reducing symptoms and the risk of kidney damage. It also improves mouth and tooth health, which are common issues for people with lupus. You can read more about tooth decay and lupus here. 

People with lupus have to keep an eye on their hydration more than most, especially if they have kidney trouble, as in lupus nephritis. And even more so if they also have Sjogren’s syndrome, an autoimmune disease that affects the glands that produce saliva, mucous, and tears. People with Sjogrens syndrome need to drink more water to make up for their decreased production, reduce their symptoms, and avoid dehydration. You can read more about Sjogren’s syndrome here. 

Temperature and air quality can also contribute to dehydration. People with lupus are particularly sensitive to cold weather, hot weather, and humidity, which all effect how the body loses or holds water. Heat causes more water to be lost through sweat and breathing as the body tries to cool itself.  Humid weather such as hot and muggy summer days can lead to overheating, which can trigger flares.

For people with lupus specifically, however, proper hydration can reduce inflammation by encouraging a healthier immune system. Hydration also keeps the kidneys healthy, reducing symptoms and the risk of kidney damage. It also improves mouth and tooth health, which are common issues for people with lupus. You can read more about tooth decay and lupus here. 

Tips and Tricks to Staying Hydrated

Drinking plain water, without additives, is generally considered to be the best. If there is safe tap water, then that water is just as good as bottled water. Juices, milk, and herbal teas are second best, though lupuswarriors should watch out for sugar intake. Sugar can exacerbate inflammation and is just something to be careful about in general.  Keep a water bottle with you and keep refilling it when it gets low. Because the body takes a while to register that it needs water, you should drink from it regularly, even when not thirsty. A common adage is “drink 8 cups of water per day,” and if that helps you stay hydrated, then go for it. Drink on a schedule if that helps.

If plain or cold water is not working for you, warm water or tea might be what you need. You can also get a lot of water from your food, especially fruits and vegetables. These are mostly water and will also provide electrolytes and other nutrients. Including these in your diet will help with hydration and overall health. Read more about diets and lupus here. Caffeinated beverages, including green tea, do provide some water, though they can cause jitteriness and encourage urination. 

If you have been exercising and sweating a lot, or are having trouble quenching your thirst, then electrolyte-containing beverages such as sports drinks can help. Electrolytes are minerals that are dissolved in the fluids of your body. They are important for many life functions and include sodium, calcium, potassium, chlorine, phosphate, and magnesium. When kept in balance with each other in the body, alongside water, electrolytes keep the organs and bloodstream healthy. The levels in the body are managed by the kidneys and skin, as well as by one’s diet.

Because they help the body hold onto and better use water, electrolytes help quench the sensation of thirst and maintain a healthy level of hydration. However, sports drinks also often contain sugars, salts, and caffeine that you can’t control. These can have negative effects on one’s health, especially for people with lupus.

However, there are easier, healthier, (and cheaper) ways to make an electrolyte-rich beverage. Vinegar diluted in water with a small amount of sugar is a simple recipe that is easily controlled and effective. Other acidic fruits, such as lemons or limes, also provide electrolytes and add flavor to water. These fruit-based options are acidic, however, so lupuswarriors with tooth or GI problems should be careful. However, they also contain vitamin C, which is an antioxidant that plays a large role in how the body heals itself. Read more about vitamin C and lupus here. 

Alcohol is very bad at hydrating. In fact, part of the cause of hangovers is from dehydration! What water it provides is mostly urinated out as the body tries to flush the alcohol from the system. This is why many hangover remedies involve electrolytes – you are quickly rehydrating the body!

Changing one’s environment can help, too: stay cool on hot days and use humidifiers on cool days. Humidifiers can help prevent drying out, which can help avoid dehydration, but that is not the same as a  however, so a humidifier is better than a hot mucky day for people with lupus.

Fluid Retention and Lupus

Many people with lupus have issues with water retention and swelling, particularly in their abdomens, legs, and ankles. When electrolytes are out of balance due to inflammation or kidney damage, then the body starts to retain water to try to maintain a balance. This causes swelling and can be embarrassing and uncomfortable. Water retention can also be caused by antimalarial medications such as Plaquenil, which are often used in lupus. Steroidal medications such as prednisone also cause fluid retention in the body.  

The answer is to drink more water and adjust the diet – in particular focusing on reducing salt and increasing Vitamin B6, magnesium, and potassium intake. The medications may make it difficult for the body to manage its water balance, but remaining hydrated and reducing the electrolytes in the bloodstream makes it less likely to hold onto its water. Non-steroidal anti-inflammatory medications (NSAIDs) can also help with swelling caused by water retention.