What if I told you that you may need to take in more salt this week? It’s going to be another hot one so today I’m talking about ways to optimize your hydration level so you can feel your best. Optimal hydration can improve your treatment side effects, mood, physical performance and weight balance. Your fluid and electrolyte needs are unique. Learn about electrolytes and water goals in cancer care below.
There’s more to hydration than drinking 8 cups of water a day. Understanding how much you need to drink and whether it can be helpful to supplement with electrolytes is a key topic in cancer care.
Many of my clients have significantly decreased their processed food intake as well as eating out less often through working together. That means a major drop in salt and sodium intake which is usually a really good thing, but on these hot days you may not be getting enough sodium for optimal hydration.
Why is sodium important? Your body has the ability to absorb fluid in two main ways: passively and actively. To actively absorb water, sodium and glucose (sugar) are needed. When this is activated you can hydrate more completely which is important if you are struggling with dehydration or active outside in this hot weather.
How do you know if you are dehydrated? Cancer treatment is a risk factor for dehydration. That’s why you get IV fluid during chemo. A buildup of medications and chemo increases therapy side effects, so you want to be hydrated enough to flush them out effectively. Mucositis, nausea, vomiting and diarrhea impact fluid intake and output but replacing these fluids can be challenging. Also, inflammation from radiation treatment increases fluid requirements because extra fluid is used to protect and soothe the treated tissue. If you are significantly dehydrated, on exam, your blood pressure may be low. It can also show up as high sodium (Na) or high creatinine in your blood work.
Beyond treatment, dehydration can worsen lingering side effects like peripheral neuropathy, lymphedema, brain fog, fatigue, and decreased mental wellbeing. Other risk factors for dehydration include being a “salty sweater”, not having strong thirst signals, advanced age and following a low carbohydrate diet.
If you are mildly dehydrated, just 2% below your optimal level, you may notice having more difficulty paying attention and feeling calm. I’ve also seen dehydration contributing to the 3pm sticky spot of cravings and tiredness.
The best way to monitor your hydration level throughout the day is by paying attention to your urine colour. You’ll notice in the morning urine is a dark yellow because you haven’t been drinking much through the night typically, and your body is repairing, recovering and creating waste. You should notice your urine getting paler through the morning as you rehydrate. The kidneys are most active for the first half of your awake hours. Support their job of getting rid of that waste by starting your day with non-caffeinated fluid and continue to take in fluids every 1-2 hours. A light straw colour is an indication of good hydration. If your urine is clear it can mean you’re not absorbing the fluid you’re drinking efficiently. This is a time where electrolytes can give you a boost.
Urine Colour Hydration Scale
Electrolytes can increase your body’s ability to absorb fluid from your diet as well as get that fluid into the cells so they can perform optimally. The key ones are sodium and potassium but you may also see magnesium and calcium in some electrolyte and rehydration products. These are all nutrients we can get in adequate amounts from a personalized diet. But there are situations where supplementing with electrolytes can make a big difference. During treatment, if you are having a hard time drinking water or you are struggling with GI (gastrointestinal/digestive) side effects including vomiting, diarrhea, high ostomy output, constipation or dry mouth/mucositis, fluid replacement is vital. Oral rehydration solutions used in severe dehydration contain about 600 mg of sodium per 250mL. For day to day dehydration caused by long activities outdoors or mild/intermittent GI side effects, look for a product or recipe that has at least 300 mg of sodium per cup. You will probably only need 1-3 cups to optimize your water absorption. Potassium, magnesium and calcium supplementation need to be discussed with your health care provider. Cancer can have a big effect your intake of food sources of these electrolytes as well as blood levels and requirements. Supplementing too much with any of these can make side effects worse and possibly result in hospitalization.
What about sugar? Zero calorie electrolyte products are everywhere. To be a true rehydration drink sugar or glucose is needed. Think of these more as a way to boost your fluid intake by giving your water taste. A little bit of sodium can increase thirst and therefore increase your overall fluid intake through the day but it won’t be enough to replace high losses. Speak to your health care team to understand what your requirements are based on your unique situation.
Is 8 cups of water a day really the goal? I’ve seen 8 cups of water a day recommended all over the place. That’s a very general recommendation but often a reasonable target for most people. However, for optimal results it's best to calculate your fluid needs based on your age, weight, body composition, daily environment and activity patterns. I usually find people's needs are higher than 8 cups.
Here are some ways to take action and improve your hydration level this week:
Start the day fresh with a clear glass of water
Find a water bottle you love and carry it with you
Put a visual reminder to have a drink in the place you spend most of your day
Measurements on a water bottle can help you track your progress and get you closer to your goal
Water isn’t the only fluid: herbal tea, 1-2 cups of coffee, sparkling water, milk, nutritional supplements, soup and yogurt count!
Add flavour to keep things interesting: try a slice of lemon or lime, True Lemon crystals, dilute juice 1:5, low calorie electrolyte powders such as Nuun if appropriate for your individualized needs.
Keep a pitcher of water with a known volume in the fridge, infuse it with chopped fruit or herbal tea if desired.
Rose Sun Tea
Rose petals contain polyphenols that have anti-inflammatory activity. It may aid in reducing mucositis pain as well as chemo-induced nausea and vomiting.
Enjoy this slightly sweetened tea chilled on a sunny day.
Ingredients
¼ cup of dried organic rose petals
2-4 tsp of honey, to taste
1.5 L of water
Instructions
In a glass or BPA free pitcher, add dried rose petals, honey, then water.
Cover and place the pitcher in a sunny spot for 4-6 hours. Stir halfway.
Refrigerate or pour over ice through a tea strainer to enjoy!
Homemade-Aid
Make your own sports drink to take with you on an activity lasting more than 2 hours outside such as hiking, golfing, gardening, Dragon Boating or biking
Ingredients
½ cup juice such a grape, cherry, cranberry (if struggling with constipation try apple or pear, if struggling with mouth sensitivity try peach or pear nectar)
3½ cups water
½ tsp salt
DIY Oral Rehydration Solution
To replace high losses, an oral rehydration solution may be recommended. To make your own, use this recipe.
Ingredients
3/8 tsp salt (sodium chloride)
¼ tsp Windsor Salt Free® (potassium chloride)
½ tsp baking soda (sodium bicarbonate)
2 tbsp + 2 tsp sugar
Add tap water to make 1 liter
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