Hydration, Electrolytes and Living Low Carb with IH or Narcolepsy

Reducing carbohydrates in our diet can have a positive impact on overall health and wellbeing. It may also help improve our ability to manage symptoms of Idiopathic Hypersomnia (IH) and Narcolepsy. Carbohydrates act much like sugar in the body — causing spikes in blood glucose that are followed by dips. Those dips often trigger the familiar afternoon crashes, which are the last thing people with IH or narcolepsy need!

One of the most important things to keep in mind when following a low-carb lifestyle is electrolyte balance. Ketosis has a natural diuretic effect, meaning the body flushes out more water and sodium through the kidneys. To stay well hydrated and avoid symptoms often called “keto flu”, such as headaches, fatigue, nausea, and dizziness, it’s essential to actively replace electrolytes through food, supplements, or electrolyte drinks.

The Importance of Electrolytes When Living Low Carb

Dehydration can cause electrolyte imbalances — and for people living with Idiopathic Hypersomnia (IH) or Narcolepsy, this is especially relevant. Aside from the general need to replenish electrolytes on a low-carb lifestyle, people with IH and narcolepsy can be particularly prone to dehydration for several reasons.

Why We’re More Susceptible to Dehydration

1. Medications Stimulant and wake-promoting medications (including all amphetamine-based drugs and modafinil) can increase urination, leading to dehydration. They can also cause hyper-focus, meaning you might forget to drink water altogether. 👉 Learn more in “Why is my dex not working” 

2. Long Sleep and Neglecting Hydration Needs Extended sleep times, or simply being too tired to care for ourselves properly, can mean hydration slips down the priority list. It’s also easy to assume that every negative symptom we feel is just part of IH or narcolepsy - but sometimes, dehydration plays a bigger role than we realise. The Overlap Between Dehydration and IH/N Symptoms

Dehydration and electrolyte imbalance can cause many symptoms that overlap with IH and narcolepsy, including:

• Headaches, dizziness, or light-headedness

• Cognitive fog (confusion, forgetfulness, difficulty concentrating)

• Fatigue or low energy

• Rapid or irregular heartbeat

• Muscle cramps, spasms, or weakness

• Nausea and vomiting
  

I can (and I know others can too) experience a lot of that with sleep drunkenness, but nausea and vomiting are not directly related to sleep drunkenness. What Helped Me

I have spent years where there have been days where I don’t feel like I shake the ‘sleep drunkenness’ at all. Fortunately, things began to improve after I switched to a low-carb lifestyle with intermittent fasting, making sure I consistently replenish my electrolytes. Fortunately, this has improved somewhat since switching to a low carb lifestyle (and intermittent fasting) which includes making sure I'm regularly replenishing my electrolytes.

Another helpful change has been delaying my first cup of coffee (or tea) by at least 90 minutes after waking. This allows adenosine levels to rise a little, making caffeine more effective at blocking receptors and keeping us alert throughout the day. Also, our body naturally makes cortisol, a hormone that wakes us up. This starts as soon as we open our eyes. By delaying caffeine intake by 90-120 minutes, we allow the body to wake up naturally and produce cortisol without interfering with its natural rhythm. My Morning Routine

I’ve now added a bottle of electrolyte-replenishing water to my morning routine. Read more about my full routine here

I’m still horizontal and half-asleep when I take my first dose of medication in the morning. Then, I continue to sleep for another hour or so before attempting to wake up for the final time. I then start drinking the electrolyte water as soon as I can, even before I am properly up (ie: vertical and out of bed).

It is still extremely difficult for me to wake up but adding the electrolyte water has helped with the morning nausea and headaches. The length of the ‘sleep drunkenness’ has reduced slightly too – provided I keep my fluids and electrolytes up throughout the day and keep my carbs down.

I’m sure the improvement is due to a combination of lifestyle changes I have made to improve my overall health and welbeing*, but electrolyte replenishment has certainly been part of that progress. *Check out my "How can I improve my quality of life?" post here

How Much Water (and Electrolytes) Do You Need?

There is no single amount of water that is right for everyone. Fluid requirements vary according to body size, climate, activity, medication, diet, and health. The aim is to drink regularly during your waking hours, not to force excessive amounts of water.

For people who sleep for long periods, it can be helpful to begin replenishing fluids and electrolytes soon after waking. Drinking large amounts of plain water without replacing electrolytes is not necessarily beneficial and may leave someone following a low-carb diet feeling worse.

The daily ranges recommended by Keto for Beginners Australia for people following a low-carb or ketogenic diet:

• Sodium: 5,000–7,000 mg per day, spaced throughout the day. This refers to sodium from all sources, not the equivalent amount of table salt. Sources may include broth, salted food, electrolyte drinks or added salt.

• Potassium: 1,000–3,500 mg per day. Sources include spinach, broccoli, avocado, pork and reduced-sodium salt containing potassium.

• Magnesium: 300–500 mg per day. Sources include avocado, spinach, nuts and seeds. Magnesium supplements are another option. Magnesium citrate can cause loose stools, while magnesium glycinate, malate or taurate may be better tolerated.
  

IMPORTANT NOTE: These are guidelines for people following a low-carb or ketogenic diet, not general population recommendations. Individual requirements vary. People with kidney disease, heart disease, high blood pressure or conditions or medications that affect fluid and electrolyte balance should seek individual advice before substantially increasing sodium, potassium or magnesium.

The Keto for Beginners Australia website is unfortunately no longer available. However, they continue to operate the Keto for Beginners Australia Facebook group.

The important point is to pay attention to both sides of hydration: water and electrolytes. Drinking more water without replacing the sodium and other electrolytes lost through low-carb eating may leave you feeling worse rather than better.

Final Thoughts

Nothing I do eliminates my IH symptoms completely, but I have identified some things that do make them worst or certainly a lot harder to manage. By identifying these triggers, I have been able to develop effective strategies for managing my symptoms, which have had a noticeable positive impact on my overall wellbeing. Michelle Chadwick Medical disclaimer: This information is provided for general educational purposes and is not a substitute for individual medical or nutritional advice. Dietary, fluid and electrolyte needs vary. Speak with an appropriately qualified healthcare professional before making significant changes, particularly if you have a medical condition or take medication that may affect fluid or electrolyte balance.