HOW TO REHYDRATE AND COMBAT THE ILL EFFECTS OF DEHYDRATION

At some point, we have all experienced symptoms of dehydration. By definition, “dehydration” purely means loss of water from the body. However, in reality, it is much more than that.

Here, we discuss the causes and process of dehydration, and how to quickly rehydrate to avoid it.

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Loss of water = loss of electrolytes

Loss of water is always accompanied by a loss of electrolytes, as water within the plasma is enriched with many electrolytes that are constantly in a state of flux. Symptoms of dehydration are experienced due to a loss of both water and electrolytes, and can be mild or severe based on the duration and extent of the dehydrated state. How quickly and efficiently one rehydrates largely determines the severity of these symptoms.

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CAUSES OF DEHYDRATION

In general, dehydration is evident in most individuals as a “normal” phenomenon during or after exercise or after prolonged physical activity, particularly when the weather is warm or humid. Sweating is a protective mechanism whereby loss of water is a way that the body keeps itself cool or prevents itself from overheating. Loss of water through sweat glands is accompanied by a loss of sodium as well. An equivalent loss of sodium and water allows the body to maintain its blood osmolality (or thickness) within a range without big changes that can be detrimental. As the osmolality rises, it stimulates the thirst center in the brain, allowing an individual to rehydrate quickly by consuming water. This drops the osmolality back to normal and the thirst dissipates. Such a cycle of dehydration-thirst-rehydration is a common physiological change that happens within the human body almost every single day. Symptoms of dehydration are, hence, felt periodically, even among individuals in good health. Since exercise-related dehydration is seen commonly, it begs several questions: How to hydrate can we rehydrate quickly? What is an easy way to rehydrate or stay hydrated during exercise in the hot summer months? Can dehydration be prevented?

Below are some common reasons for dehydration:

Exercise

As mentioned above, loss of fluid and electrolytes is universal although it can differ quantitatively in different people. Dehydration can worsen if the individual does not rehydrate quickly as the fluid and electrolyte losses continue. Temperature, humidity, activity and body type all dictate the hydration status of an individual, particularly if they fail to rehydrate quickly for long periods with the right electrolyte mix.

Occupation-related dehydration

Firefighters often face this challenge while working in very hot conditions as they struggle on how to stay hydrated due to a constant loss of fluids due to environmental conditions. Similarly, construction workers or those who spend extended amounts of time outdoors in the summer heat can get dehydrated significantly.

Vomiting and Diarrhea

Which involves fluid and electrolyte losses through gastrointestinal tract. This is a one of the more common “pathological” ways reason to get dehydrated- children with cholera in developing countries used to be so dehydrated, it eventually led to the birth of oral rehydration solution (ORS).

Medications

Medications such as diuretics, which cause intentional fluid losses in certain conditions. Regular use of these medications can lead to more fluid loss than gained and lead to dehydration.

Alcoholism and hangovers

Alcohol is a dehydrating agent and individuals who wake up with hangovers are depleted in water and electrolytes as a general rule. This is frequently the reason why the best drinks recommended to treat a hangover are water enriched with electrolytes including magnesium.

Flu and flu-like conditions

Surprisingly, this is deemed to be the commonest cause of mild-moderate dehydration in young healthy adults. This is one of main reasons physicians often advise these individuals to “push fluids."

In all these conditions, the common theme still is a significant loss of fluid from the body. Initially, this fluid is derived from the blood volume (since almost 60% of the blood is plasma). If the body doesn’t get a fresh supply in time dehydration continues, the fluid from within the cells (intra-cellular fluid) may be lost. Strikingly, almost 50-60% of human body weight is water in liters. An average man weighing 70 kg has about 40 liters of total body water (TBW). Thus, it is quite significant to note that, despite such a large volume of fluid reserve, just a liter of water loss from the body can lead to significant symptoms of dehydration.

SYMPTOMS OF DEHYDRATION

It is interesting to note that symptoms of dehydration differ among individuals largely because of body size and fluid losses, and it depends on how quickly an individual rehydrates to replace the deficit. How to rehydrate fast is the commonest challenge faced by athletes. Do it too late and face the effects of dehydration; do it early and the benefit is minimal.

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common symptoms

Common symptoms of dehydration include fatigue or tiredness, dry mouth, dizziness and a rapid pulse. Dehydration headaches are fairly common in some individuals who get dehydrated quickly. The reason for dehydration headaches is possibly vasodilation, an adaption where the blood vessels dilate to improve circulation around the body due to a loss in the total blood volume. Some scientists believe it is more neurohormonal. That is, dehydration triggers some responses which release beneficial hormones such as aldosterone or vasopressin, although these may lead to headaches in some individuals. This theory is unproven, as a lot of individuals with high levels of these hormones can present with high blood pressure but not always headaches. Loss of sodium could also explain dehydration headaches in others – indeed, some home remedies that involve replacement of salt and water (e.g., soup or vegetable juices) are thought to reduce the symptoms of dehydration headaches.

serious symptoms

If dehydration continues (e.g., in a diarrheal illness), more serious symptoms may develop – these include listlessness or decreased responsiveness, low blood pressure and shock. These severe symptoms are frequently seen in bacterial or viral illnesses during which the fluid and electrolyte losses are severe and cannot be kept up simply by oral liquids. These individuals are frequently in need for hospitalization and aggressive fluid resuscitation via intravenous methods. The fastest way to rehydrate these individuals is to include parenteral fluids such as normal saline or lactated Ringer’s. Such severe conditions also frequently require replacement of other electrolytes such as potassium and magnesium.

other symptoms

Other symptoms of mild-moderate dehydration include muscle cramps and soreness that are particularly seen in endurance athletes after prolonged activity. In athletes, prolonged soreness can impair the ability to perform repetitive tasks. Rehydration with an isotonic electrolyte drink mix (such as MAGNAK®) that is comprised of a balanced proportion of sodium, potassium and magnesium, can help significantly with muscle cramps in these situations by correcting the fluid and electrolyte deficits.

TREATMENT AND PREVENTION OF DEHYDRATION

The best way to avoid dehydration is to stay well hydrated

As simple as it may sound, the best way to avoid dehydration is to stay well hydrated, assuming the access to water and electrolytes is available.

If dehydration ensues, rehydrating quickly with an electrolyte powder that can be rapidly mixed in water is the best alternative. Frequently, it is hard to judge the exact amount of fluid loss to replace quickly, particularly during an ongoing physical activity. Most seasoned athletes will not be able to gauge their fluid or electrolyte losses during endurance activities despite significant prior experience. This is because, even within an individual, the extent of dehydration varies on a given day.

It largely depends on environmental factors, the state of hydration of the athlete at the onset; the fluids used to rehydrate and the duration of the activity. Some athletes use a total loss in body weight (or % of it) before and after exercise as a measure of need for fluid replacement (e.g., if the athlete’s weight drops by 1 Kg after a workout, it would mean a replacement volume of at least 1 liter to maintain a normal hydration status, since 1 Liter of water weighs 1 kg). While this may help in recovery, it is less useful during an actual race where the fluid losses are more dynamic and evolving in real time; and there is rapid change in the fluid status due to loss and rehydration.

Experts agree that the best way to beat symptoms of dehydration is to rehydrate with isotonic fluids. These are liquids that have a roughly similar tonicity or osmolality (or thickness, if loosely termed) as your blood. A packet of MAGNAK® dissolved in 8-12 fl. oz. of water is an example of isotonic fluid that is rich in electrolytes. Fluids that have an osmolality significantly lower than that of blood are hypotonic and are poor in solutes or electrolytes. The normal blood osmolality is around 275-280 mOsm/Kg and can rise up to a level of 295 when a person gets dehydrated. This is the stimulus for the thirst center in the brain that prompts an individual to drink (water usually). Isotonic fluids replace water that is lost in the sweat but also replenish electrolytes. This allows maintenance of the blood electrolyte levels (particularly of sodium) within a normal range after the replacement of water deficit is complete, and is frequently the reason why symptoms such as fatigue and tiredness are lesser in athletes consuming isotonic fluids. Moreover, isotonic fluids lead to a lesser incidence of hyponatremia (low sodium), which is a potentially dangerous condition seen in endurance athletes if they consume too much water without electrolytes. Some athletes are more predisposed to hyponatremia than others.

During exercise-related dehydration, the level of anti-diuretic hormone (ADH) in the blood is high. This conserves water through the kidneys by minimizing its excretion in the urine (this is why the urine is darker in the dehydrated state). If the athlete mainly consumes water, but no salt, the total body water deficit is replaced, but that of sodium is not. Thus, ongoing sodium loss and a high ADH level predominantly lead to a drop in blood sodium levels which can be severe. This creates hyponatremia, a stage that leads to confusion, headaches, nausea and, in severe cases, seizures. The treatment of hyponatremia is hypertonic (or highly concentrated – 3%) saline given intravenously to bring the sodium level in the blood to a higher level. Although treatable, hyponatremia can cause significant distress as well as hospitalization. The best way to rehydrate and prevent hyponatremia is by using an isotonic electrolyte drink mix, such as MAGNAK®, which delivers sufficient quantity of sodium (300 mg per 16 fl. oz. of water) to replace the deficit from sweat.

HOW TO REHYDRATE EFFECTIVELY: SOME USEFUL TIPS

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Choice of Fluid

As the sports drink industry introduces a new electrolyte drink mix every few months, athletes often wonder what the best electrolyte drink is to rehydrate the body after those intense workouts. As mentioned above, there is a general agreement that rehydration with isotonic drinks is recommended. An electrolyte mix that is comprised of salts and some sugar diluted in water keeps the body well hydrated by replacing water as well as electrolytes. Ideally, the electrolyte mix should contain the three vital electrolytes – magnesium, sodium and potassium (as in the MAGNAK® electrolyte mix). Each of these electrolytes affect distinct cellular activities that change muscle dynamics and thus influence performance. Unfortunately, very few electrolyte powders currently available in the market have the correct proportions of electrolytes that can make a clinical difference in muscle function.

Frequency of fluid intake

This may be variable amongst athletes, but in general, the thirst reflex dictates the frequency, and at times also the quantity, of fluid intake. It is usually a good idea to hydrate continuously during an activity or during hot conditions using sips of electrolyte-rich water. A typical regimen would include 6-8 fl oz of solution every 15-20 minutes during a hike. At times, this may need to be increased based on intensity of activity and rate of fluid loss. High intensity training may require twice the amount of fluid replaced in that interval depending upon the weather and electrolyte losses.

Quantity of rehydrating fluids

How to hydrate with the right amount of fluids? Use a rule of thumb to start with. For an average-sized individual (~70 kg of body weight), 1 liter of fluid intake during a mild-moderate activity during cool-warm weather conditions is usually sufficient. However, as the temperature and humidity in the environment rises with the intensity of the activity (imagine a bike ride in the Florida summer), fluid requirements could be as high as 1 liter/hour. Thus, one needs to account for a variety of factors while considering the best way to stay hydrated. In fact, how to rehydrate yourself efficiently is more of an art than an exact science. Some experts recommend front-loading with 8-10 fl oz of an electrolyte drink prior to the beginning of the activity, and proceeding with another 6-8 fl oz every 15-20 minutes as needed. We suggest that every serious athlete should take notes on fluid intake, weight changes before and after an activity; fluids and electrolytes used during the activity, and symptoms developed. This allows fine-tuning of individual requirements and leaves sufficient room for improvement in rehydration practices that can significantly improve performance.

The amount of sugar in rehydration solutions

Sugars increase the osmolality of the solution and delay their absorption from the gut, not to mention it adds flavor to the drink. While some amount of sugar is required as an immediate fuel and also drives sodium absorption through specialized channels, too much sugar (> 10 g/ 8 fl oz serving) can delay the nutrient transport by pulling water into the gut by principle of osmosis. Rehydration can be negatively impacted in this setting. The best way to rehydrate using an electrolyte drink would be to add a lesser amount of sugar or carbohydrates to allow for rapid absorption of water and nutrients into the bloodstream.

Role of Caffeine intake during dehydration

Caffeine can be a natural stimulant that can help “get one off the couch” but has a diuretic effect, which means it stimulates urine output and can make you lose more water. Additionally, caffeine stimulates the heart to pump faster, increasing the heart rate which is already stimulated during exercise due to release of catecholamines. Caffeine during exercise does not enhance performance based on studies and caffeinated drinks are not the best way to rehydrate for athletes.

Utilization of magnesium-rich formulas

One of the critical electrolytes that has been missing in many sports or electrolyte drinks is magnesium. Most Americans do not get enough magnesium in their diet. This subclinical deficiency causes a magnesium-depleted status and predisposes athletes to muscle cramps and soreness. Using a magnesium-rich formula, such as MAGNAK®, in a rehydration mix allows athletes to correct their magnesium-deficient status and reduces cramping. Magnesium has been shown to improve muscle strength and performance in some individuals when supplemented for a 3-month period in a clinical study. We recommend adding magnesium-rich foods and ingredients to your diet along with MAGNAK® electrolyte powder mix on a regular basis for all athletes, unless they suffer from a heart or kidney condition, for which medical supervision may be necessary and certain restrictions may be required.