Intelligent adults know the body requires fluids to perform optimally. It’s a built-in human response to drink when you get thirsty.
However, quenching your thirst does not necessarily mean you are fully hydrated. Because proper rehydration is often ignored, dehydration is the most overlooked cause of gout.
This is a very deep dive into dehydration to point out critical factors that lead to hyperuricemia and gout. If you are already an expert on dehydration levels and symptoms, then click on to section 4 to learn exactly how dehydration causes gout.
1. What is dehydration? Why are electrolytes necessary?
Dehydration is a condition when the body lacks water. It develops not just from losing water, but failing to replenish it.
Bodily functions start to decline due to the loss of water and fluids. The severity of dehydration intensifies the longer the body goes without water.
Why are electrolytes important for hydration?
Fluid loss also means the loss of essential electrolytes; sodium, potassium, magnesium, bicarbonate, and chloride. These special minerals are necessary to adjust fluid balance- how much water is kept or released by the body.
Failure to balance the loss of water and electrolytes leads to dehydration. Remember, plain water does not contain many electrolytes.
Get control of your water and electrolyte balance. Preview popular powders and sugar-free drinks with essential electrolytes.
2. What are the symptoms of dehydration? What are the levels of severity?
A healthy individual can manage about a 4% decrease in total body water without complication. Dehydration is classified as mild, moderate, or severe based on how much body fluid is lost relative to body weight.
Mild dehydration is considered below 5% water loss of body weight
Studies reported water loss as little as 1-2% can impact coordination and memory. Fluid losses of over 2-4% of body weight start to hinder overall physical performance and the ability to lower body temperature.
Moderate dehydration is considered 5-10% water loss of body weight
At this range, all mild symptoms become more apparent. The decline of muscle endurance and strength is evident. A study from 2003 concluded, only an 8% fluid loss can be hazardous and may require medical attention.
Mild to moderate dehydration symptoms are:
- loss of strength
- impaired coordination
- muscle cramps
- high body temperature
- dark-colored urine
- decreased urination
- dry skin
- dry mouth/thirst
- sunken eyes
- poor concentration
- increased irritability
- high or low blood pressure
Severe dehydration is considered above a 10% water loss of body weight
Severe dehydration is a life-threatening condition and requires immediate medical care. Organ or bodily functions begin to fail at this point. Death may occur at 15% or more loss of body water.
Severe dehydration symptoms are:
- continuous muscle twitch
- slurred speech
- rapid heart rate
- heat stroke
Long term dehydration complications are:
3. What causes dehydration? Why are salt, alcohol, and sugar contributing factors?
The body loses water in less obvious ways. The key is to be aware of the lesser known factors to hydrate accordingly.
The most obvious cause of dehydration is excessive sweating. Strenuous physical activities, hot/humid/dry temperatures, and fevers are major factors for perspiration.
Injury and Pre-existing health conditions
Adverse reactions to illness, injury, or disease can drain the body of fluids. Vomiting, diarrhea, and bleeding are commonly overlooked ways the body loses water. Plus, you are prone to dehydration because you don’t feel like eating or drinking when you feel like sh*t.
Dehydration can come as a side effect from certain medications and drugs (recreational included). Certain medications, especially for high blood pressure, heart disorders, and edema, have strong diuretic effects.
A diuretic is any substance that causes your kidneys to make more urine. Diuretics, or water pills, are meant to flush out water and salt (sodium). Consequently, urination increases total water loss. Diuretics can increase your risk of developing gout because water depletion leaves a higher concentration of waste products, like uric acid, in the body.
A variety of illegal substances can also cause unexpected dehydration. These include stimulants such as cocaine, molly/ecstasy (MDNA), and opioids such as heroin or codeine. Although dose dependent, these drugs cause heart rate and body temperature to spike, which leads to profuse sweating.
Surprisingly, there is no scientific evidence linking marijuana to dehydration. You may think so from experiencing “dry mouth”. However, it’s really because THC stops the salivary glands from producing saliva. If you are feeling very thirsty when toking, you are probably already dehydrated.
Older people become more susceptible to dehydration. The ability to conserve water, store fluids, and sense thirst declines with age. Further, the amount of fluid in older people drops to about 45% body weight, compared to 60% in younger people.
During sleep, the body continues to lose water from breathing and sweating. A healthy male may lose about two pounds of fluid during eight hours of sleep. If 83% of the weight lost is water, then the amount of unreplenished water can be over 25 oz. (0.75L) every night!
For more details on why dehydration is one of the causes of gout while asleep, read this post: This Combination Causes Gout During Sleep
How is salt dehydrating?
Salt, which is 40% sodium, induces dehydration. When there is too much sodium in the blood, the body reacts by taking water from other areas of the body. Water is moved into the bloodstream to the dilute the high concentration of sodium.
Consequently, organs, muscles, and joints become short on fluids. Regular bodily functions decline. Excess salt restricts the kidneys from filtering out harmful toxins in the blood.
While a high-sodium diet may be detrimental, you still need some sodium. It is an essential electrolyte along with potassium and chloride, needed to deliver and store water in your cells. An extreme loss of electrolytes can actually increase the risk of dehydration.
How does alcohol dehydrate you?
Alcohol is a natural diuretic that significantly influences dehydration. It blocks the release of the antidiuretic hormone (ADH), or vasopressin, which is needed to tell the body to retain more water. Additionally, alcohol flushes out the electrolytes needed to store water. For this reason, drinking alcohol not only causes water loss, but also prevents replenishing it.
Although it might be tempting to down a few cold cocktails on a hot day, sweating combined with alcohol will dehydrate you quicker than you think.
Above all, alcohol is a double edge sword to people with gout. It not only provokes dehydration that causes gout, but also contains a high amount of purines from brewer’s yeast.
Is caffeine dehydrating?
There is no clear evidence to prove caffeine significantly increases dehydration. Recent studies have supported caffeine to have diuretic properties, but with very weak effects. It will not make you lose more fluid than you consume from coffee or other caffeinated beverages.
How are sugar and artificial sweeteners dehydrating?
Sugar induces dehydration because of its diuretic effects. Water is needed to metabolize and dispose of excess sugar in the body. High blood sugar forces the kidneys to make more urine.
Similar to a high sodium response, the body shifts water out of cells and into the bloodstream to compensate for a high sugar content. Too much sugar directly affects the functions of the kidneys, pancreas, brain, and nervous system. Over time, high blood sugar can lead to several kidney disorders such as the inability to expel uric acid through urine.
Also, artificial sweeteners like high-fructose corn syrup (HFCS), aspartame, sucralose, neotame, and saccharin are highly dehydrating. All contribute to diabetes, inflammation, high triglycerides, and non-alcoholic fatty liver disease.
For people with gout, high-fructose corn syrup is a dangerous gout trigger. As fructose is metabolized, purines are created. The breakdown of purines produces uric acid.
4. How does dehydration cause gout and hyperuricemia? What organs are involved?
Uric acid levels rise with dehydration, primarily because without water the blood becomes more concentrated. The ability to eliminate uric acid depends on urine flow. No water, no urine, and therefore, no uric acid leaves the body.
Three studies directly links dehydration to causes hyperuricemia and gout:
- In a 2017 UK study of 206 gout patients, dehydration was the second most popular cause of gout. Alcohol consumption was first, and high-purine meats were a close third.
- A survey of 535 gout sufferers reported participants who drank over 64 ounces of water a day experienced a 48% reduction in gout attacks.
- Another study linked excessive sweating raised uric acid concentration in the bloodstream. Results supported dehydration reduces uric acid excretion in urine, and increases purine conversion.
What organs are directly involved when dehydration causes gout?
The Liver breaks down purines
A healthy liver performs over 500 functions in the digestive system. Some major roles are detoxifying blood, converting nutrients into energy, eliminating toxins, processing alcohol/drugs, and producing bile.
Dehydration has a negative effect on the liver’s ability to perform these functions. If the liver cannot filter blood properly, excess waste products are left to the kidneys. Furthermore, excessive alcohol consumption is not only very dehydrating, but also damaging to the liver long term. (see section 3)
Pertaining to gout, uric acid comes from the liver where purines are metabolized. Liver dysfunction may cause an overproduction of uric acid, and vice versa.
The Kidneys filter out uric acid
The kidneys are the organs most associated with uric acid and gout. They are also one of the first organs to respond to dehydration. Long term dehydration can lead to a wide rage of kidney disorders.
When the body needs water, the brain sends a thirst response and releases vasopressin or antidiuretic hormone (ADH). Vasopressin makes the kidneys retain water to keep the body hydrated. As a result, more water returns to the bloodstream and less to urine.
A lack of water limits the kidneys from filtering waste products from the blood. Even worse, they are left with all the harmful substances the liver could not breakdown due to dehydration.
The overload of wastes like urea, creatinine, and ammonia compete with uric acid to pass into urine. Hyperuricemia is when a high amount of uric acid remains in the body. This condition can lead to a buildup at a joint and gout symptoms.
Keep in mind, too much salt or sugar dries out the body and impairs kidney function. Long-term complications lead to chronic kidney disease (CKD), kidney stones, and urinary tract infections. All of which can influence the development of chronic gout.
Additionally, dehydration also makes urine more acidic. Studies showed elimination of uric acid decreases when urine acidity increases. This is because uric acid is less soluble, or less absorbable, in highly acidic urine.
The Heart, high blood pressure, and poor circulation influence gout
Since dehydration makes the blood thicker, higher blood pressure is required to maintain circulation. More so, the release of ADH constricts blood vessels.
Thicker blood and narrower blood vessels cause poor circulation and hypertension. Additionally, the synovial fluid between joints decrease due to dehydration and age. Consequently, these overlooked conditions from dehydration influence uric acid buildup and crystallization at joints.
5. Practical hydration tips to avoid gout
The old 8 glasses (64 oz.) of water per day is a reliable reference point, but does not apply for everyone. To stay well hydrated, you need to drink based on your weight, condition, and daily activity level.
Here are practical hydration tips to avoid gout:
- Get used to drinking water. This can be challenging for long-time soda drinkers. Add slices of lemon, orange, pineapple or cucumber for some flavor.
- Limit soda, artificially sweetened juices and alcohol. These drinks are diuretic, dehydrating, gout triggers.
- Keep a designated a water bottle. A 32 oz. or 1L bottle is a good size to keep at your desk or carry around. A clear bottle will remind you how much (or little) you’ve drunk.
- Eat Hydrating Foods. Food also counts for overall water intake, even though it’s difficult to know how much. Berries, kiwis, jackfruit, cantaloupes and mangos have high water content. These fruits also help the kidneys to excrete more uric acid (see section 4).
- Cut down on sweet and salty foods. (see section 3) High sugar and sodium foods dehydrate the body. Almost all mass-produced and processed foods are packed with sodium or artificial sweeteners. High-fructose corn syrup sets up dehydration and uric acid production. Take a minute to read food labels and choose products with less sugar, low sodium and no fructose.
- Chug 12 oz. of water at breakfast. Immediately replenish the fluid lost during sleep (see section 3). Get ahead of dehydration by drinking at least 12 oz. before your busy day begins. This means to drink water in addition to your (if applicable) cup of coffee, juice or cereal. (If you can shotgun a can of beer, you can quickly down the same amount of water!)
- Check urine color. Frequently having dark colored and cloudy urine means there are more waste products than water. In most cases, this is an initial sign of mild dehydration (see section 2). Although color may vary from meals and medications, healthy urine is typically light yellow to amber.
- Add electrolytes naturally. Electrolytes are found in fruits, vegetables, and nuts. They not only improve hydration, but support nerve-muscle function, help produce energy, and maintain acid-base balance. Water does not contain many electrolytes. The drawback of popular sports drinks is their high sugar and calorie content.
Get control of your water and electrolyte balance. Preview popular powders and sugar-free drinks with essential electrolytes.
Dehydration is not just losing water, but also failing to properly replenish it. The lack of water means less urine to flush out uric acid.
Drinking solely when you feel thirsty does not automatically mean you have successfully rehydrated. Not many of us actually know how much, or little, water we drink. The most obvious way to track your water intake is to keep a personal water bottle with you or at your desk.
For us gout sufferers, it’s not just limiting gout-triggering foods. Certain drinks need to be avoided too. Sure, I know beer, spirits and artificially sweetened beverages taste (and feel) soooo much better than water. Unfortunately, those fun drinks set up dehydration and gout.
Looking back, gout struck even when I avoided alcohol and high-purine foods for weeks. Yet another of my many “WTF?! Gout again?!” moments. I was oblivious of how little water I drank compared to soda and high-fructose juice. Another lesson learned the hard way: dehydration causes gout.
Remember to drink more water on those scorching days at the beach or tailgate, especially if you’re downing alcohol. As you may already know, the less dehydrated you are, the less a head-banging hangover (sometimes). Nevertheless, sufficient and consistent rehydration is another pillar to become GOUTPROOF!
- Adult dehydration https://www.ncbi.nlm.nih.gov/books/NBK555956/
- Diseases Caused by Dehydration https://www.intake.health/post/diseases-caused-by-dehydration
- Dehydration https://medlineplus.gov/dehydration.html
- Serum uric acid and acute kidney injury https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512150/
- Chronic recurrent dehydration associated with periodic water intake exacerbates hypertension and promotes renal damage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032121/
- FAQs for Dehydration Causes Gout. https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/water-balance/dehydration
- Can Dehydration Cause High Blood Pressure? What Experts Say https://www.thehealthy.com/high-blood-pressure/can-dehydration-cause-high-blood-pressure/
- Does Drinking Less Water Affect Your Bone and Joints? https://www.healmybones.com/blog/does-drinking-less-water-affects-your-bone-and-joints/
- Public knowledge of dehydration and fluid intake practices: variation by participants’ characteristics https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282244/#CR6
- The Hydration Equation: Update on Water Balance and Cognitive Performance https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207053/
- No Evidence of Dehydration with Moderate Daily Coffee Intake https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886980/
- What happens to your body when you eat too much salt? https://vitalrecord.tamhsc.edu/what-happens-when-you-eat-too-much-salt/
- Rehydration with fructose worsens dehydration-induced renal damage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045876/
- Consequences of Dehydration https://www.europeanhydrationinstitute.org/consequences_of_dehydration/
- Association of acidic urine pH with impaired renal function in primary gout patients
- Fructokinase activity mediates dehydration-gout induced renal injury https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120672/
- Can Dehydration Affect Your Kidneys? https://www.kidney.org/newsletter/can-dehydration-affect-your-kidneys
- Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle
- Electrolyte abnormalities in the alcoholic patient