GAVIN GIOVANNONI – JAN 9, 2024
Almost 30 years ago, while doing my PhD on a urine biomarker of inflammation, I noted that urinary concentration of creatinine, a muscle metabolite excreted in the urine, correlated with disability. I soon worked out that people with MS with worse disability (higher EDSS) were more likely to have bladder dysfunction and were dehydrating themselves to manage urinary frequency, urgency and nocturia. As I asked my study subjects to collect daily urine samples, it became clear that these people with MS (pwMS) were not intermittently dehydrating themselves but were doing it chronically.
We published a small letter in the Annals of Neurology on this issue in response to another paper suggesting urine levels of myelin basic protein-like material (uMBPLM) correlated with disability. It was clear to me that all this group were describing was the correlation of dehydration with disability, i.e. higher levels of uMBPLM were simply a marker of urine concentration and not linked to the biology underpinning disability.
This observation was highlighted again with the chronic cerebrospinal venous insufficiency (CCSVI) debacle. It was clear that many people with advanced MS had collapsed central veins because they were dehydrated, and when rehydrated with intravenous fluids, their veins opened spontaneously (see paper 2). I was vindicated as I had hypothesised this was the underlying problem in CCSVI in an earlier blog post (see ‘CCSVI: could dehydration be a possible confounding variable?’ 25-June-2011).
These findings were familiar. Professor Bryan Matthews, a neurologist in Oxford, had described dehydration as a strategy to manage urinary symptoms in the 1960s and highlighted the issue of pwMS dehydrating themselves to manage their bladder problems in his textbook on MS. Therefore, I was interested to read a recent paper from the Southhampton group describing the same findings (see paper 2 below). It is remarkable how the same things in medicine or neurology tend to be rediscovered for people to become aware of them.
I am frustrated that despite highlighting the issue of chronic dehydration in pwMS many times over the years, it is clear that it remains a persistent problem. My message is clear: don’t use dehydration to manage your bladder symptoms. The potential consequences of chronic dehydration should be enough to change your habits.
Chronic dehydration can have a significant impact on your overall health and well-being and can exacerbate many of your MS symptoms. Here are some of the potential effects of chronic dehydration:
1. Impact on Physical Performance: Dehydration can decrease physical endurance, cause muscle cramps, and exacerbate or cause fatigue. This can affect overall physical performance and make everyday tasks more challenging.
2. Cognitive Function: Dehydration has been linked to cognitive impairment, including issues with concentration, alertness, and short-term memory. Prolonged dehydration may even contribute to long-term cognitive decline.
3. Mood and Mental Health: Studies have shown that dehydration can affect mood and contribute to increased feelings of anxiety and irritability. In severe cases, it can even lead to symptoms resembling depression.
4. Kidney Function: Chronic dehydration can put a strain on the kidneys, potentially leading to the formation of kidney stones and urinary tract infections. It can also impair the kidneys’ ability to filter waste from the blood effectively. It also makes you more susceptible to side effects of non-steroidal anti-inflammatory medications.
5. Digestive Problems: Dehydration can lead to constipation and other digestive issues. It may also contribute to an increased risk of developing peptic ulcers and acid reflux.
6. Skin Health: Inadequate hydration can lead to dry, flaky skin and exacerbate conditions such as eczema and psoriasis. Proper hydration is essential for maintaining overall skin health and elasticity.
7. Risk of Heat-Related Illnesses: Dehydration reduces your body’s ability to regulate temperature, increasing the risk of heat exhaustion and heat stroke, particularly in hot and humid conditions. Please remember that pwMS, in particular people with more advanced MS, may already have a problem with thermoregulation, and dehydration will make things worse. Please note this problem is worsened by drugs that affect sweating, e.g. anticholinergics.
A better way of managing urinary symptoms is using a holistic approach, which I have written about many times before on MS-Selfie.
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