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staying hydrated

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Improve fatigue, mood, headaches and itchy skin

By David Dunaief, M.D.

Dr. David Dunaief

Brrr! It’s been super cold this winter, and heating systems have been in overdrive. All the dry heat pumping into our homes, offices and cars can have a dehydrating effect on our bodies. Symptoms of dehydration can range from itchy skin and constipation to fatigue, mood changes and headaches. Our dry throats and sinuses can also make us uncomfortable and more susceptible to irritations and viruses. More serious complications of dehydration can include migraines, heart palpitations and heart attacks. 

Let’s look at techniques for improving hydration and reducing the symptoms and consequences of all this dry air.

Improve ambient humidity

Measure the humidity level in your home with a hygrometer and target keeping it between 30 and 50 percent (1). When the temperature outside drops below 10 degrees Fahrenheit, lower this to 25 percent. You can add moisture to the air in several ways. Use cool mist humidifiers, keep the bathroom door open after you shower or bathe, and place bowls of water strategically around your home, including on your stovetop when you cook or on radiators. If you use humidifiers, take care to follow the manufacturer’s care instructions and clean them regularly, so you don’t introduce mold or bacteria into the air.

Reduce headaches and migraines

A review of studies found that those who drank four cups or more of water had significantly fewer hours of migraine pain than those who drank less (2). Headache intensity decreased as well.

Decrease heart palpitations

Heart palpitations are common and are broadly felt as a racing heart rate, skipped beat, pounding sensation or fluttering. Although they are not usually life-threatening, they can make you anxious. Dehydration and exercise contribute to this (3). Palpitations can be prompted when we don’t hydrate before exercising. If you drink one glass of water before exercise and continue to drink during exercise, it will help avoid palpitations.

Lower your heart attack risk

The Adventist Health Study showed that men who drank more water had the least risk of death from heart disease (4). Group one, which drank more than five glasses of water daily, had less risk than group two, which drank more than three. Those in group three, which drank fewer than two glasses per day, saw the lowest benefit, comparatively. For women, there was no difference between groups one and two, although both fared better than group three. The reason for this effect, according to the authors, may relate to blood or plasma viscosity (thickness) and fibrinogen, a substance that helps clots form.

Resolve decreased concentration and fatigue

Mild dehydration resulted in decreased concentration, subdued mood, fatigue and headaches in women in a small study (5). Dehydration was prompted by walking on a treadmill and taking a diuretic (water pill) prior to the exercise. Results were compared to a control group that did not take the diuretic. The authors concluded that adequate hydration was needed, especially during and after exercise.

Consume hydrating foods

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How much water you need to drink depends on your diet, activity levels, environment and other factors. In a review article, researchers analyzed the data, but did not find adequate studies to suggest that eight glasses a day is a magic number (6). It may be too much for some patients.

You can increase your hydration by altering your diet. Diets with a focus on fruits and vegetables increase water consumption (7). As you may know, 95 percent of the weights of many fruits and vegetables are attributed to water. An added benefit is an increased satiety level without eating calorically dense foods.

In a review, it was suggested that caffeinated coffee and tea don’t increase the risk of dehydration, even though caffeine is a mild diuretic (8). With moderate amounts of caffeinated beverages, the liquid in them has a more hydrating effect than its diuretic effect. Remember that salty foods can dehydrate you, including soups, breads and pastries, so try to avoid these.

It is important to stay hydrated to avoid uncomfortable — and sometimes serious — complications. Diet is a great way to ensure that you get the triple effect of high nutrients, increased hydration and sense of feeling satiated without calorie-dense foods. However, don’t go overboard with water consumption, especially if you have congestive heart failure or open-angle glaucoma (9).

References:

(1) epa.gov (2) Handb Clin Neurol. 2010;97:161-72. (3) my.clevelandclinic.org. (4) Am J Epidemiol 2002 May 1; 155:827-33. (5) J. Nutr. February 2012 142: 382-388. (6) AJP – Regu Physiol. 2002;283:R993-R1004. (7) Am J Lifestyle Med. 2011;5(4):316-319. (8) Exerc Sport Sci Rev. 2007;35(3):135-140. (9) Br J Ophthalmol. 2005:89:1298–1301.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Dr. On Chen. Photo from Stony Brook Medicine

Now that temperatures are on the rise and humidity is surging , it is important to protect our hearts from the hazards of the summer sun. On Chen, MD, interventional cardiologist and Director of the CCU and Telemetry Units, Outpatient Cardiology Services and the Lipid Program at Stony Brook Medicine, has some suggestions to help you stay heart-safe all summer long.

People with an existing heart condition need to be careful with warmer temperatures, but even a healthy heart can be put under stress when temperatures climb. Following are tips for helping to make your summer heart-safe:

  1. Hydrate. Adequate hydration is nothing less than your best friend as the summer heat moves in. Drinking plenty of water helps regulate your temperature, helps your heart pump more easily and keeps all your organs functioning properly. Remember to drink before you are thirsty, and avoid alcohol and caffeinated beverages, which can dehydrate the body. And, it is important to know that some common heart medications can make you more vulnerable to high heat and increase your hydration needs. Talk to your doctor about your specific hydration needs.

  2. Staying Cool. If you don’t have access to air conditioning, cold compresses (an ice-pack or ice-water filled bottle) applied to your ‘pulse points’ — the areas where your veins are closest to your skin’s surface, including wrists, neck, temples and armpits — can help you cool down.

  3. Eat Water-Rich Foods. You get about 20 percent of your water from the foods you eat. A hot weather diet that emphasizes cold soups, salads and fruits can both satisfy hunger and provide extra fluid. Strawberries, watermelon, peaches, cucumbers, celery, tomatoes, peppers and spinach, are all fruits and veggies that are 90 percent or more water.

  4. Know Heat Illness Warning Signs. Spending too much time in extreme heat may lead to heat exhaustion and, in turn, heatstroke, two serious heat-related illnesses in which your body can’t control its temperature.

    1. Heat Exhaustion Symptoms: Heavy sweating, nausea or vomiting, muscle cramps, tiredness, dizziness and fainting. Treatment: Move to a cool place, loosen clothing, use cold compresses, sip cool (not cold) water. If symptoms persist, call 911.

    2. Heatstroke (also called Sunstroke) Symptoms: Fever of 104 degrees or more; severe headache; behavioral changes; confusion; hot, red skin; no sweating; rapid heartbeat and loss of consciousness. Treatment: Heatstroke is a life-threatening medical emergency. Call 911 immediately. Quickly move the individual to a cooler place, use cold compresses, do not give anything to drink.

  5. Know Your Numbers. See your doctor to get a careful look at your “numbers,” including your cholesterol and triglyceride levels, your blood pressure and more. Knowing your numbers and your risk factors are an important part of heart health, especially before engaging in warm-weather activities.

  6. Timing is Everything. Avoid being outdoors during the hottest times of the day, when the sun is at its strongest and temps are at their highest. Your cardiovascular system has to work harder on a hot day in an effort to keep your body cool. In fact, for every degree that your body temperature rises, your heart has to pump an additional ten beats per minute. Everyone is at risk in extreme heat, but high temperatures and humidity are particularly stressful for those who already have a weakened heart.

  7. Be Sun Savvy. A sunburn can dehydrate you and impede your body’s ability to cool. If you’re going to be outside during the peak sun of the day, be sure to apply sunscreen 30 minutes before you head out. Reapply every couple of hours.

  8. Dress for Sun-cess. Think loose, light-colored clothing (to help reflect heat) that is made of a lightweight, breathable fabric like cotton. Add well-ventilated shoes, a wide-brimmed hat, shades and sunscreen and you’re good to go.

  9. Pace Yourself. Make your warm weather workouts shorter and slower, aim for morning or evening when the temps and humidity are lower, choose shady pathways and trails or an air-conditioned space. Work with your healthcare team to develop a plan that is best for you.

  10. Listen to your body. If you aren’t used to regular exercise, are over 50, have heart disease or have questions about your heart health, see your doctor before participating in any strenuous outdoor summer activities.

Although anyone can be affected by heat illness, people with heart disease are at greater risk.

For more information, visit www.heart.stonybrookmedicine.edu or call (631) 44-HEART.

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It is important to stay hydrated if you have a history of stone formation. Stock photo
High sodium and hypertension can increase probability

By David Dunaief, M.D.

Kidney stones, or nephrolithiasis, can be asymptomatic (no symptoms at all) or may present with the classic symptoms of blood in the urine and colicky pain. Pain can be intermittent or constant, ranging from dull to extremely painful, described by some as being worse than giving birth, shot or burned. The pain may radiate from the kidneys to the bladder and even to the groin in males, depending on the obstruction (1). 

Lifetime risk of kidney stones is about 19 percent in men and 9 percent in women (2). Once you form one stone, your risk of another within five to seven years is approximately 50 percent.

Stones are usually diagnosed through clinical examination and abdominal x-rays and/or non-contrast CT scans.

Unfortunately, the first line treatment for passing kidney stones – at least small ones – involves supportive care. This means that patients are given pain medications and plenty of fluids until the stone(s) pass. Usually stones that are <4mm pass spontaneously. Location is an important factor as well, with stones closest to the opening of the urethra more likely to pass (3).

The good news is there are lifestyle changes that can reduce the risk of kidney stones. First, it is very important to stay hydrated, drinking plenty of fluids, especially if you have a history of stone formation (4).

Calcium supplementation’s impact

One of the easiest methods is to significantly reduce your intake of calcium supplements, including foods fortified with calcium. There are two types of stones, with calcium oxalate being the dominant one, occurring approximately 80 percent of the time (5). Calcium supplements increase the risk of kidney stones. When physicians started treating women for osteoporosis with calcium supplements, the rate of kidney stones increased by 37 percent (6). 

According to findings from the Nurses’ Health Study, those who consumed highest amount of supplemental calcium were 20 percent more likely to have kidney stones than those who consumed the lowest amount (7). It did not matter whether participants were taking calcium citrate or calcium carbonate supplements.

Interestingly, the same study found that calcium from dietary sources has the opposite effect, decreasing risk. Those participants who consumed the highest amount of dietary calcium had a 35 percent reduction in risk, compared to those who were in the lowest group. Calcium intake should not be too low, for that also increases kidney stone risk. However, the source of calcium is a key to preventing kidney stones. 

Sodium’s effect

It’s important to reduce sodium for many reasons, but this provides one more. Again, in the Nurses’ Health Study, participants who consumed 4.5 g sodium per day had a 30 percent higher risk of kidney stones than those who consumed 1.5 g per day (7). The reason is that increased sodium causes increased urinary excretion of calcium. When there is more calcium going through the kidneys, there is a higher chance of stones.

Animal protein

Animal protein also seems to play a role. In a five-year, randomized clinical trial, men who consumed small amounts of animal protein, approximately two ounces per day, and lower sodium were 51 percent less likely to experience a kidney stone than those who consumed low amounts of calcium (8). These were men who had a history of stone formation. The reason that animal protein may increase the risk of calcium oxalate stones more than vegetable protein is that its higher sulfur content produces more acid, which is neutralized by release of calcium from the bone (9).

Hypertension

Some medical conditions may increase the likelihood of stone formation. For example, in a cross-sectional study (a certain population during a specific period) with Italian men, those with high blood pressure had a two times greater risk of kidney stones than those who had a normal blood pressure (10). Amazingly, it did not matter if the patients were treated for their high blood pressure; the risk remained. This is just one more reason to treat the underlying cause of blood pressure, not the symptoms.

The most productive way to avoid the potentially excruciating experience of kidney stones is to make these relatively simple lifestyle changes. The more changes that you implement, the lower your risk of stones.

References:

(1) emedicine January 1, 2008. (2) kidney.org. (3) J Urol. 2006;175(2):575. (4) J Urol. 1996;155(3):839. (5) N Engl J Med. 2004;350(7):684. (6) Kidney Int 2003;63:1817–23. (7) Ann Intern Med. 1997;126(7):497-504. (8) N Engl J Med. 2002 Jan 10;346(2):77-84. (9) J Clin Endocrinol Metab. 1988;66(1):140. (10) BMJ. 1990;300(6734):1234. 

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.  

 

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