It may be easy to forget, but water is the most important and essential nutrient for the human body.  Good hydration is important for everyone’s health, but it is especially critical for those living with lupus.  What is the relationship between lupus and hydration?  Read on to find out!

• The 30-second Overview
• How can hydration affect lupus?
• How can lupus affect hydration?
• Tips for Staying Hydrated
• The Take Aways!

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The 30-second Overview

Why is hydration especially important for individuals with lupus? There are several reasons:

• Many common symptoms of lupus are made worse by dehydration. These include fatigue, joint pain, muscle aches and skin conditions.
• Proper hydration is vital for healthy kidney function, and since lupus nephritis is a serious concern for those with SLE, staying well-hydrated may help prevent kidney damage.
• Those with lupus are often more sensitive to temperature changes, and adequate hydration increases the body’s ability to regulate temperature.
• Dehydration can also affect the immune system itself – making it more difficult for the body to fight infections.
• Some lupus medications can have side effects that affect the body’s ability to balance fluids – some causing water retention and others increasing dehydration.

This means that those living with lupus need to maintain a healthy water balance.  How?

• Stay hydrated and maintain a healthy diet with the proper electrolytes.
• Avoid hot, dry weather conditions.
• Maintain a healthy exercise schedule, and
• Stick to a healthcare provider’s treatment plan.

Otherwise, worsening symptoms and even organ damage may be the result.  For more details about lupus and hydration, including some of the latest research … keep reading!

How can hydration affect lupus?

Dehydration, according to the Mayo Clinic, is “when you use or lose more fluid than you take in, and when your body doesn’t have enough water and other fluids to carry out its normal functions.”  Dehydration is bad for anyone, but for those living with lupus, it can be particularly damaging and affect quality of life.  Symptoms of dehydration include:

• Thirst, dry mouth and dry eyes;
• Fatigue and sleepiness;
• Dark colored urine and stress on kidneys;
• Headaches and joint pain;
• Dizziness and confusion.

Each of these can add to or even mask similar symptoms caused by SLE.  In order to track and manage lupus triggers and evaluate a person’s disease state accurately, it is important to limit the largely avoidable complications that may be caused by dehydration.

While dehydration does not cause lupus nephritis, it can certainly aggravate it and even increase the risk of tissue damage.  The kidneys need healthy blood in order to work properly, and dehydration not only can affect blood flow and volume, but it can also affect the concentrations of antibodies and electrolytes – to the point that the kidneys are unnecessarily stressed.

Proper hydration is also critical for a healthy mouth and teeth.  It is common for those living with lupus to have mouth sores and to have an increased risk for tooth decay.  So, drink some water after brushing those teeth!

It is widely understood that the gut microbiome can affect and perhaps even trigger lupus in some people.  While more research needs to be done, there is growing evidence that even the pH of drinking water may have an effect the microbiome and some lupus symptoms.  For example, in lab mice with lupus, slightly acidic drinking water reduced lupus symptoms when compared with pH neutral drinking water.

Hydration is even more important for lupus patients who are also suffering from the overlap disease Sjögren’s syndrome, an autoimmune condition that affects the glands that produce mucus, saliva and tears.  A person with Sjögren’s may feel like they are constantly dehydrated requiring hydrating medications, such as lubricating eye drops, and a strictly monitored water intake.

How much water is enough?   The usual recommendation is 8 glasses of water per day.  More specifically, the Mayo Clinic recommends about 11 cups a day for women and 15 cups a day for men, though it also depends upon physical exertion, and body type.  The amount may need to increase in patients who are suffering from nausea or diarrhea, or are pregnant ro breast-feeding.

Adequate hydration would be a good topic to bring up at an upcoming appointment with your healthcare provider!

 

How can lupus affect hydration?

Fluid Retention: Lupus can actually cause fluid retention, and in turn, this can lead to swelling in the legs, ankles and abdomen, tightness in the skin, increased appetite, less frequent urination and sometimes difficulty swallowing.

How does lupus cause fluid retention?

• Inflammation causes localized swelling (edema) and can create systemic electrolyte imbalances.
• Kidney damage can lead to swelling in many parts of the body, in particular the lower extremities.
• Some lupus medications can also cause water retention, such as antimalarial medications, like Plaquenil (hydroxychloroquine), and corticosteroids, like prednisone.

What can be done to help prevent fluid retention?

• Adjusting one’s diet, in particular reducing the intake of salt while increasing vitamin B6, magnesium and potassium.
• Non-steroidal anti-inflammatory medications (NSAIDs) can also help.
• Sometime diuretics, like Lasix or hydrochlorothiazide may be prescribed.

Electrolyte Imbalances:  While lupus is not thought to cause dehydration, it has been associated with water and electrolyte imbalances – in particular low potassium levels (hypokalemia), low sodium levels (hyponatremia) and issues with blood pH.  These are usually detected in normal blood tests, relatively easy to treat and are more often caused by medications than by lupus itself.

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Tips for Staying Hydrated

 So, staying hydrated is very important.  There are many, easy ways to do this, including:

• Simply drinking plain water throughout the day, without additives and in healthy quantities. There are even apps for smart phones and watches that can help keep a person on schedule.
• Drinking other fluids can be helpful, if they are healthy for the individual, such as juices, milk, teas, some sports drinks, Pedialyte and other beverages with electrolytes.
• Avoid excess alcohol, coffee or other beverages that can lead to dehydration.
• Healthy exercising – meaning not overdoing it – and remembering to replace the electrolytes that may be lost by sweat.
• Managing your temperature and dealing with humidity. Stay cool on hot days and even use humidifiers indoors, if necessary, to keep the skin from drying out.

The Take Aways!

 The relationship between lupus and hydration is surprisingly complicated and there is still more to learn. However, it is clear that there are many important reasons for those with lupus to stay  properly hydrated.   It is critical for supporting healthy kidney function, relieving several lupus symptoms, and for helping manage the side effects of certain medications.  Good hydration also prevents the effects of dehydration from masking the symptoms and triggers that can lead to lupus flares and tissue or organ damage.

Staying well-hydrated is definitely achievable, however it takes some diligence, and it needs to be a part of the patient’s overall lupus treatment plan. So, here’s to staying healthy and hydrated!

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References

Islam, M. A., Khandker, S. S., Kotyla, P. J., & Hassan, R. (2020). Immunomodulatory effects of diet and nutrients in systemic lupus erythematosus (SLE): A systematic review. Frontiers in Immunology, 11, 1477. https://doi.org/10.3389/fimmu.2020.01477

Johns Hopkins Lupus Center. (2023, August 25). Treating lupus with immunosuppressive medications. https://www.hopkinslupus.org/lupus-treatment/lupus-medications/immunosuppressive-medications/

Johnson, B. M., Gaudreau, M. C., Al-Gadban, M. M., Gudi, R., & Vasu, C. (2015). Impact of dietary deviation on disease progression and gut microbiome composition in lupus-prone SNF1 mice. Clinical and Experimental Immunology, 181(2), 323–337. https://doi.org/10.1111/cei.12609

Mayo Clinic Staff. (2021, October 14). Hydration: Overview. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086#:~:text=Dehydration%20occurs%20when%20you%20use,carry%20out%20its%20normal%20functions.

Yamany, A., Behiry, M. E., & Ahmed, S. A. (2020). Hyponatremia as an inflammatory marker of lupus activity is a fact or fad: A cross-sectional study. Open Access Rheumatology : Research and Reviews, 12, 29–34. https://doi.org/10.2147/OARRR.S237168

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Author: Greg Dardis, MS

Professor Dardis was the Chair of the Science Department at Marylhurst University and is currently an Assistant Professor at Portland State University.  His focus has been human biology and physiology with an interest in  autoimmunity.  Professor Dardis is also a former President of the Board of Directors of Kaleidoscope Fighting Lupus.

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All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.