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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Rick on June 11, 2002, at 11:09:37
I have a feeling this may be a silly question, but here goes…
For a chronic but non-infectious and non-serious sinus problem, I’ve been instructed to drink 6-8 glasses of water a day.
Since doing this, I seem to be getting tired and “out of it.” During the day I’m “slower.” Early in the evening I sometimes sit down and feel overwhelmed with fatigue, which never used to happen much.
Could the large amount of water intake somehow either reduce the effectiveness of the 100 mg Provigil I take and/or potentiate sedative effects of the 1 mg Klonopin and/or have sedative effects unrelated to the meds?
Thanks,
Rick
Posted by beardedlady on June 11, 2002, at 11:18:00
In reply to Can increased water intake affect med response?, posted by Rick on June 11, 2002, at 11:09:37
That's a really good question. I drink about 10 glasses a day. Water is supposed to energize you, rather than make you feel sluggish, so your sluggishness may not be water related. It's also supposed to improve your metabolism, which may mean speeding up the absorption of your meds. I am inclined to guess (which is not helpful to you, I'm sure!) that, since health experts recommend everyone drink at least eight glasses a day, it shouldn't affect your meds or flush them out any sooner. It's an amount you should probably be drinking anyway.
Iso? Are you there? We need you!
beardy
Posted by IsoM on June 12, 2002, at 1:19:58
In reply to Can increased water intake affect med response?, posted by Rick on June 11, 2002, at 11:09:37
Sweet of beardedlady to think I can answer this but I'm not too sure. What I wonder about is how much you're peeing out. Has that increased lots with your extra drinking? Are you still eating enough food or is the extra water leaving you too full or bloated feeling? How hot is it where you are, & are you getting enough salt?
I have no idea if the extra water is affecting your meds, though I shouldn't think so. So then I thought, might you be feeling mild water intoxication? Yes, water is good for us but needs really do vary depending on how active we are, how much we eat, & how salty our food is. That amount of water *may* be too much for you. Symptoms of water intoxication include apathy, confusion, headaches, nausea, & fatigue. Does any of that sound right? If your blood pressure is on the low side of normal, the extra water & no extra salt may be making your blood pressure drop lower, giving a tired feeling too.
Posted by beardedlady on June 12, 2002, at 4:45:18
In reply to Re: Can increased water intake affect med response? » Rick, posted by IsoM on June 12, 2002, at 1:19:58
I have low blood pressure and have been drinking extra water (and using extra salt) but have been feeling sluggish lately, too. Thanks for answering a question I didn't know I had!
beardy
Posted by DiscoPuppy on June 12, 2002, at 10:01:06
In reply to Can increased water intake affect med response?, posted by Rick on June 11, 2002, at 11:09:37
Yes, what an excellent question. I drink exactly 128 ounces of water every day. I did hear somewhere that if you are taking vitamin supplements, that drinking a lot of water just flushes it all out without providing any benefit.
I'd like to know if this holds true for medication. I'm on psychostimulants.
-Puppy-
P.S. I haven't really noticed any difference with my energy level, even before I started taking any meds - I've been doing the 128 ounces of water for years now.
> I have a feeling this may be a silly question, but here goes…
>
> For a chronic but non-infectious and non-serious sinus problem, I’ve been instructed to drink 6-8 glasses of water a day.
>
> Since doing this, I seem to be getting tired and “out of it.” During the day I’m “slower.” Early in the evening I sometimes sit down and feel overwhelmed with fatigue, which never used to happen much.
>
> Could the large amount of water intake somehow either reduce the effectiveness of the 100 mg Provigil I take and/or potentiate sedative effects of the 1 mg Klonopin and/or have sedative effects unrelated to the meds?
>
> Thanks,
> Rick
Posted by Mr Beev on June 12, 2002, at 16:08:33
In reply to Can increased water intake affect med response?, posted by Rick on June 11, 2002, at 11:09:37
I have been quite hydrated for years, and have observed only benefits.
But there is an exception: heavy sweating. I regularly go running out of doors on very hot, very humid days. I have read that one may sweat as much as three quarts per hour (!) during such strenuous activity. When I first began this, I would feel awful after each run. Sometimes badly depressed as well. I had thought this was due to the climate - and no doubt it was - in part. On a hunch one day, after a run I mixed in 1/2 teaspoon salt in a liter of water.
I immediately felt much, much better. I hardly tasted the salt. I now do this regularly when I jog in very hot and humid weather. If one stops in a shop that caters to outdoor enthusiasts, and reads the list of ingredients in "emergency hydration powders", one will usually find that sodium choloride (salt) is the main component, followed by potassium. If I am not mistaken, we lose an order of magnitude more salt than potassium in our sweat.
I remember coming across a doctor stating that folks who are well-hydrated need to make sure they get enough salt in their diet. This is rarely a problem for most Americans, since they are said to consume almost three times as much salt they need every day. But more by sheer chance, I am on a very low salt diet. I believe a suggested ratio of adding salt is something like 1/4 tsp. salt per quart of water drunk each day. I do not pay much attention to this, except on days when I run.
Best regards,
Mr Beev
Posted by johnj on June 12, 2002, at 17:53:23
In reply to Re: Can increased water intake affect med response?, posted by Mr Beev on June 12, 2002, at 16:08:33
Hi:
Your message caught my eye because I have a similiar problem. I have tried running, and lifting and I have always hydrated well. I seem to get this side effect, depression, sleep disturbance after a certain number of days, it used to be weeks. I take nortryptline (TCA), lithium, and a benzo. Working out has always helped me but I find myself worse after a certain period of time. What meds do you take, if you don't mind me asking. I too, have a low sodium intake and wonder if this is a thing that sneaks up on me? Any info would be appreciated. Thank you.
Johnj
Posted by Chloe on June 12, 2002, at 19:01:01
In reply to Question for Mr. BEEV, posted by johnj on June 12, 2002, at 17:53:23
> Hi:
>
> Your message caught my eye because I have a similiar problem. I have tried running, and lifting and I have always hydrated well. I seem to get this side effect, depression, sleep disturbance after a certain number of days, it used to be weeks. I take nortryptline (TCA), lithium, and a benzo. Working out has always helped me but I find myself worse after a certain period of time. What meds do you take, if you don't mind me asking. I too, have a low sodium intake and wonder if this is a thing that sneaks up on me? Any info would be appreciated. Thank you.
> JohnjJohn,
If you are taking lithium, you should NOT be on a low salt diet. Lithium is a salt. And if you body is not getting enough salt it will draw up the available Li salt into the blood stream. This can cause you lithium level to go UP, and perhaps make you feel so awful.Especially if you are exercising and taking li, you must have enough table salt and water to keep your fluid level balance. If your body is sodium starved from sweating it all out, I bet your body is gulping up the lithium salt instead. Perhaps you should check into the low salt diet thing, or have your li levels check around the time you start to feel bad after exercise...
Just a suggestion.
Chloe
Posted by beardedlady on June 12, 2002, at 19:11:50
In reply to Re: Can increased water intake affect med response?, posted by Mr Beev on June 12, 2002, at 16:08:33
If you were a couple of years earlier, you could've invented Gatorade! Good idea about the salt. I eat some (bad for you) fat-free pringles before a jog in the heat. When I camp out west, I drink a lot of water and eat Wheat Thins regularly.
beardy : )>
Posted by Rick on June 12, 2002, at 21:06:05
In reply to Re: water -- attention IsoM! » Rick, posted by beardedlady on June 11, 2002, at 11:18:00
>I am inclined to guess (which is not helpful to you, I'm sure!) that, since health experts recommend everyone drink at least eight glasses a day, it shouldn't affect your meds or flush them out any sooner. It's an amount you should probably be drinking anyway.
That's actually a good point. Maybe there are conditions where lower water intake is indicated, but through the years I recall lots of medical advice to drink lots of water -- and not just for the classic dehydrating maladies like cold or flu. And certainly most of the meds I've been prescribed can have drying effects.
Posted by Rick on June 12, 2002, at 21:23:46
In reply to Re: Can increased water intake affect med response? » Rick, posted by IsoM on June 12, 2002, at 1:19:58
>What I wonder about is how much you're peeing out. Has that increased lots with your extra drinking?
Yes. Lots and lots! I've read that the body adjusts to the increased water intake within a few weeks and reduces the frequency of "urgency." But I can't claim to understand how that would work.
>Are you still eating enough food or is the extra water leaving you too full or bloated feeling?
No difference.
>How hot is it where you are, & are you getting enough salt?
Was quite hot the last few days, but I was in an air conditioned setting most of the time. No real change in eating habits, which for me ususally includes a fair amount of salt.
> I have no idea if the extra water is affecting your meds, though I shouldn't think so. So then I thought, might you be feeling mild water intoxication? Yes, water is good for us but needs really do vary depending on how active we are, how much we eat, & how salty our food is. That amount of water *may* be too much for you. Symptoms of water intoxication include apathy, confusion, headaches, nausea, & fatigue. Does any of that sound right?
Well, yes, since I'm *always* confused :). And for me fatigue and sedation tend to go hand in hand (frankly, I've never fully ubderstood the distinction). Likewise, I'm always tend to be more apathetic when I'm tired. Nothing remarkable as far as headache or nasuea.
>If your blood pressure is on the low side of normal, the extra water & no extra salt may be making your blood pressure drop lower, giving a tired feeling too.
I'm not sure about the salt part, but I think you may be onto something with the blood pressure. It has indeed been pretty low, although my heart rate has been rather high.
But, guess what, I didn't feel tired today! Of course, I did drink less water in the afternoon. Oh, and, "by the way" I took a double-dose of Provigil today.
Rick
Posted by johnj on June 12, 2002, at 22:34:36
In reply to Re: Question for Mr. BEEV » johnj, posted by Chloe on June 12, 2002, at 19:01:01
Chloe:
Thanks a ton for the advice, I never thought of that. I always assumed it was the TCA. I will pose this question to my pdoc on Monday. Thanks...this board is great isn't it? Take care and let us know how you are doing.
Johnj
Posted by Chloe on June 13, 2002, at 9:14:02
In reply to Re: (Chloe), posted by johnj on June 12, 2002, at 22:34:36
> Chloe:
> Thanks a ton for the advice, I never thought of that. I always assumed it was the TCA. I will pose this question to my pdoc on Monday. Thanks...this board is great isn't it? Take care and let us know how you are doing.
> JohnjI woke up in the night, realizing that I think I got it backwards. If you exercise and don't have enough table salt in your diet, your body will take the li salt from your blood. Hence *lowering* your lithium level. Good luck on Monday.
Keep up posted
Chloe
PS Anyone feel free to jump in here if I got it turned around...
Posted by Mr Beev on June 13, 2002, at 11:04:40
In reply to Question for Mr. BEEV, posted by johnj on June 12, 2002, at 17:53:23
> Your message caught my eye because I have a similiar problem. I have tried running, and lifting and I have always hydrated well. I seem to get this side effect, depression, sleep disturbance after a certain number of days, it used to be weeks. I take nortryptline (TCA), lithium, and a benzo. Working out has always helped me but I find myself worse after a certain period of time. What meds do you take, if you don't mind me asking. I too, have a low sodium intake and wonder if this is a thing that sneaks up on me? Any info would be appreciated. Thank you.
> JohnjHello Johnj, I do not mind answering your questions at all, though I am not sure how helpful I shall be (sorry if this is a bit prolix)! I, too, had hitherto found that vigorous workouts had always improved my condition however minimally. I never had this problem until I greatly reduced salt intake as well as sports drinks. Just like yourself, after a fortnight or so of running in hot, humid weather, I found myself increasingly depressed and insomniac. I was not on any medication at the time, having successfully recovered from a substantial depressive/anxiety disorder a year and a half before. I asked myself: what was different this spring over the last (when I was also med-free)? The answer: salt intake.
So I conducted an experiment.
At the time, about a month ago, I was in very bad shape mentally - and, as I now suspect, at least in part due to salt loss. After a run, I mixed 0.5 tsp salt in a liter of water and almost instantly felt much better! A half hour later I mixed another 0.5 tsp/liter and felt a curious warmth suffuse my entire body - and I felt almost normal! It appears to be well known that electrolyte imbalance can precipitate depression and other disorders. I believe we sweat out mostly trace amounts of minerals, a little potassium, and a LOT of salt. One tsp of salt after a run is quite a bit, probably a bit much. But I have low blood pressure, exercise regularly, and have a very low sodium diet, so I reasoned it would likley be acceptable.
The bad news is that this "fix" only lasted for a half week or so before a major depressive/anxiety period began, exactly like I suffered two years ago - before I exercised. Now I am taking 150mg Effexor in the morning and 2.5mg Zyprexa in the evening, and am feeling almost well. I drink at least: roughly 1 quart gatorade before every run and 1Q gatorade + 0.5 tsp salt after every run.
I hope this was helpful in some way,
Best wishes,
Mr Beev
Posted by Mr Beev on June 13, 2002, at 11:14:52
In reply to Question for Mr. BEEV, posted by johnj on June 12, 2002, at 17:53:23
My apologies, I forgot to append these links, which you might find helpful:
http://www.fred.net/ultrunr/hydrate.html
http://www.saltinstitute.org/28.htmlThis commercial site has some intriguing data, e.g. not all table salts are created equal:
Posted by Sunnely on June 13, 2002, at 23:29:42
In reply to Re: Lithium, exercise, salt » johnj, posted by Chloe on June 13, 2002, at 9:14:02
Actually, your first response was correct. If you are on lithium, exercising/sweating without replenishing the fluid loss can raise your lithium level even to the point of toxicity. The same thing can happen if you spend some time in a sauna bath.
Increasing your salt intake will lower your lithium level while decreasing it will raise your lithium level.
> > Chloe:
> > Thanks a ton for the advice, I never thought of that. I always assumed it was the TCA. I will pose this question to my pdoc on Monday. Thanks...this board is great isn't it? Take care and let us know how you are doing.
> > Johnj
>
> I woke up in the night, realizing that I think I got it backwards. If you exercise and don't have enough table salt in your diet, your body will take the li salt from your blood. Hence *lowering* your lithium level. Good luck on Monday.
>
> Keep up posted
> Chloe
> PS Anyone feel free to jump in here if I got it turned around...
Posted by johnj on June 14, 2002, at 16:57:55
In reply to Re: Question for Mr. BEEV » johnj, posted by Mr Beev on June 13, 2002, at 11:14:52
Hi,
Thank you very much for the information. I have avoided any salt for quite some time. That might explain why after a certain time has passed that I started to feel crappy. Although, I do know of a few others that have had some bad luck on nortryptline or it's mama drug amitryptline. I will definatley mention that to my doc on Monday.
He will be sick of hearing all my research into this as is my wife(at times). But, I figure to beat an illness you must get to know it.The funny thing is about 9 or 10 days a go I started taking fish oil capsules and I am feeling pretty good. I did raise my benzo dose some, but what I am feeling is not attributed to only the benzo. I was sure most supplements were only a scam, but am rethinking my position on that. I will see how this plays out over the next few weeks. I tried some sam-e, but it just seemed to make me kind of anxious and hurt my sleep. I was suprised since I took a 3 hour nap after work last Tuesday and usually I am too wound up to relax like that. Something is going on that is for sure.
This site is great for people trading experiences and hopefully this will benefit or shorten the path another one of us has to take.
BTW: Do you feel ok now working out and being on effexor? The "quick fix" is really something strange. I would think that might "solve" it, but I will watch my salt and make sure I hydrate correctly when I start back to getting some excercise. Take care
Johnj
Posted by Chloe on June 14, 2002, at 19:37:11
In reply to Re: Lithium, exercise, salt » Chloe, posted by Sunnely on June 13, 2002, at 23:29:42
Hi Sunnely,
Thanks for correcting me on the li/salt thing. I was pretty sure they were inversely proportional...Then, I began thinking about it, and got all confused! :?)BTW, nice to hear from you. Hope you are well.
Chloe
> Actually, your first response was correct. If you are on lithium, exercising/sweating without replenishing the fluid loss can raise your lithium level even to the point of toxicity. The same thing can happen if you spend some time in a sauna bath.
>
> Increasing your salt intake will lower your lithium level while decreasing it will raise your lithium level.
>
> > > Chloe:
> > > Thanks a ton for the advice, I never thought of that. I always assumed it was the TCA. I will pose this question to my pdoc on Monday. Thanks...this board is great isn't it? Take care and let us know how you are doing.
> > > Johnj
> >
> > I woke up in the night, realizing that I think I got it backwards. If you exercise and don't have enough table salt in your diet, your body will take the li salt from your blood. Hence *lowering* your lithium level. Good luck on Monday.
> >
> > Keep up posted
> > Chloe
> > PS Anyone feel free to jump in here if I got it turned around...
Posted by Mr Beev on June 14, 2002, at 19:44:33
In reply to Very interesting and thank you (Mr. BEEV), posted by johnj on June 14, 2002, at 16:57:55
Hello,
> The funny thing is about 9 or 10 days a go I started taking fish oil capsules and I am feeling pretty good.
I am glad this is helping. I too have been taking supplements, for about one month: one tablespoon of flaxseed oil, one 200mg magnesium citrate pill, one 3mg boron pill - three times a day. It has had no observable effect, for better or worse. I shall continue with the program until I use up the supplies. I have never had any success with supplements, but I figure: why not try, I would certainly prefer to be on vitamin pills than on high-power prescription drugs!
> BTW: Do you feel ok now working out and being on effexor? The "quick fix" is really something strange. I would think that might "solve" it, but I will watch my salt and make sure I hydrate correctly when I start back to getting some excercise. Take care
I find that most drugs and all ADs have no effect on my work outs. Soporifics, such as some benzodiazepines or ambien, sometimes leave me too tired to waddle forth in the wee hours. I too hoped the salt "fix" would "take", but alas and woe... I dimly recall reading somewhere that for quite heavy sweating, gatorade and its ilk are insufficient electrolyte replacements.
I have been spooning in that extra 0.5 tsp of sea salt after every brisk run for about a month now, and have felt no ill effects. Indeed, every now and then I feel palpably better after adding the salt. During this last month, I had my blood pressure taken every week, and it actually decreased! For runs of more than one hour, I carry a 20oz water bottle filled with gatorade (no extra salt), which I consume every 20 minutes or so. This helps a lot and provides more energy for that final strech.
A warning on a subject not related to mental health - so far as I know: not all sports drinks are created equal. For example, powdered orange gatorade contains not merely coconut oil - one of the worst - but partially hydrogenated coconut oil, viz. a so-called "transfat". From the research I had done a couple of years ago, it looks like transfats, e.g. those ingredients which begin "partially hydrogenated..." are pure evil, and best avoided. It is not always easy to do in our shrink-wrapped food culture, I admit.
Best regards,
Mr Beev
Posted by johnj on June 14, 2002, at 20:37:24
In reply to Re: Very interesting and thank you (Mr. BEEV) » johnj, posted by Mr Beev on June 14, 2002, at 19:44:33
Hi,
Thanks for the info on running, I might wait a little time before working out again since I was really bad after the last string of workouts.
As far as the fish oil goes here is what I have been reading. I have taken flaxseed meal with yogurt (right nasty actually) and don't really know if I felt anything or not. I did try lecthin a few times and it made me kind of spacey. My brother(superior health in all regards) had the same problem with lecthin. He tries things because he works out a lot. The problem with flaxseed oil is, correct me if I am wrong, is that it can be converted into EPS which is the good thing in omega 3's. The percentage may be from 20 to 30 percent from what I have read.
Here is what I have taken, I bought it from Walmart, 3 one gram capsules is what I started with and it contains 180 mg of EPS, and 120 mg of (DHL?). I have upped that to 4 a day and today will take 5. It may be you just are not taking large enough dose to feel anything. A bottle of 60 was about $3.50 so it is a great deal and is worth the cost. I have seen that 2 grams of EPS is recommended, but alas we all are different. Good luck! I had some salty fries for dinner just for good measure.
Johnj
Posted by Mr Beev on June 15, 2002, at 10:12:29
In reply to Fish Oil (Mr. BEEV), posted by johnj on June 14, 2002, at 20:37:24
Many thanks for the excellent information. I should definitely consider increasing the intake. I admit I am a bit shy of high dosages... I have actually added a salt shaker to my dinner-table ensemble, something I had hitherto thought I would never do.
Salty regards,
Mr Beev
Posted by JohnX2 on June 16, 2002, at 0:09:59
In reply to Can increased water intake affect med response?, posted by Rick on June 11, 2002, at 11:09:37
> I have a feeling this may be a silly question, but here goes…
>
> For a chronic but non-infectious and non-serious sinus problem, I’ve been instructed to drink 6-8 glasses of water a day.
>
> Since doing this, I seem to be getting tired and “out of it.” During the day I’m “slower.” Early in the evening I sometimes sit down and feel overwhelmed with fatigue, which never used to happen much.
>
> Could the large amount of water intake somehow either reduce the effectiveness of the 100 mg Provigil I take and/or potentiate sedative effects of the 1 mg Klonopin and/or have sedative effects unrelated to the meds?
>
> Thanks,
> Rick
Unless the flu is causing the symptom,
sounds a lot like water intoxication/hyponatremia.Need more salt.
This is strange though because 6-8 glasses of water is
by no means a lot of h20?Some medications can cause something called SIADH
(Syndrome of Inappropriate Antidiuretic Hormone).ADH (antidiuretic hormone) is secreted by the pituitary
gland and signals the kidney to recycle water. This will
dilute the concentration of salt (hyponatremia).
Be Well,
John
Posted by JohnX2 on June 16, 2002, at 0:54:00
In reply to Re: (Chloe), posted by johnj on June 12, 2002, at 22:34:36
TCAs can cause SIADH (Syndrome inappropriate antidiaretic hormone secretion) (too much)
this would cause water retention (dense urine) and possibly hyponatremia.Lithium from what I understand blocks the response to ADH,
which could lead to hypernatremia? and dilute urine?what about Lithium + TCA?
Also, its my understanding that when excersizing we lose a lot of Na and
water, and if we rehydrate without Na replacement, then we are put into
a hyponatremia state (feel real crappy).John
This is the end of the thread.
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