“If you’re going through hell, keep going.”
– Winston Churchill
Fluid Restrictions
If you are a transplant patient then you have likely suffered through a fluid restriction regime. Fluid restrictions and health concerns are physically and mentally draining. At times they can even be distressing. Drinking water is a basic human right. It is life saving. We grow up being told to “drink water”, or “stay hydrated”. Depriving ourselves of fluid goes against our natural instincts. From my own lived experience, adhering to a fluid restriction is a mental and physical struggle. It’s hell. Like Churchill said “If you’re going through hell, keep going.” I say “the only way is through.”
Following a fluid restriction is an important method to manage symptoms and prevent further complications. Such as high blood pressure, swelling, and breathlessness. This guide offers tips to effectively manage fluid intake and reduce discomfort from thirst while sticking to your fluid allowance.
Of course I have researched the topic of fluid restrictions. I have provided further reading if you want to take a deep dive. The reference list at the end of the post will lead you to some great resources. I asked our transplant community for tips and tricks. These have helped them navigate and adhere to grueling fluid restrictions. I hope this post is of use to you!
Firstly let’s quickly recap Fluid Retention. Alternatively, you can see the full post on Fluid Retention here.
Types of Fluid Retention
Fluid retention comes in three main forms. Ascites, Oedema, and Lymphoedema, but what’s the Difference?
Ascites
Fluid build up on the abdomen is called Ascites. Ascites is often associated with liver disease, heart failure, or malignancies. It mainly occurs due to conditions that create an imbalance in fluid production and absorption. This imbalance particularly involves the liver and blood vessels.
Oedema
Oedema refers to fluid accumulation in tissues, typically affecting the extremities. It is seen as swelling in the feet, ankles, and lower legs. Oedema may be caused by various conditions such as chronic heart failure, kidney disease, and venous insufficiency. Lifestyle factors, such as prolonged sitting or high salt intake, can also cause it. Oedema may also be caused by medications, particularly steroids. As we know, Prednisone is often an important anti- rejection medication used after transplant.
Lymphoedema
Lymphoedema is a specific form of oedema caused by lymphatic system dysfunction. This leads to poor drainage and fluid buildup. This condition can result from congenital factors, cancer treatments, infections, or surgeries affecting lymph nodes. Lymphoedema is often seen as swelling of the torso, head, neck and genitals.
Understanding Fluid Restriction
Fluid restriction limits the amount of fluids consumed daily to prevent or reduce fluid retention. Fluids Fluid includes all drinks, and anything that is liquid at room temperature. Foods like ice cream, ice blocks/cubes, custard, yoghurt and sauces.
What is a normal fluid restriction?
A typical fluid restriction is usually between 1,000 to 1,500 millilitres (ml) (1 Litres to 1.5 Litres) per day. However, this depends on individual health needs and the underlying medical condition. This limit is frequently used for managing heart failure, kidney disease, and liver disease. It also helps with certain endocrine or metabolic disorders. These conditions often lead to excess fluid and can lead to symptoms such as swelling, breathlessness, and high blood pressure.
General guidelines:
1,000 to 1,200 ml per day is considered a severe fluid restriction. It is often used in cases of advanced heart failure or kidney disease.
1,500 ml per day is a more moderate restriction, suitable for individuals with moderate risk or those with milder symptoms.
800 ml per day is reserved for patients with end-stage renal failure. It is also for patients with dialysis, congestive cardiac failure, or liver failure with Ascites.
Fluid restriction regimens are normally complemented with diuretics to help shift fluid build up. I discuss diuretics in a few blog posts. I cover several topics such as Fluid Retention, Cardiomyopathy, Hardening Of The Heart, and Understanding Constrictive Pericarditis. Additionally, I discuss Non Anti Rejection Medications After A Heart / Lung Transplant.
Strategies to Reduce Fluid Intake
Track Your Fluid Intake:
Use a measuring cup or jug to track your daily fluid allowance.
Fill a jug each morning with your daily allowance. Pour from it whenever you consume fluids. This allows you to see how much remains.
Avoid “topping up” drinks as it makes tracking difficult.Choose Small Containers:
Drink from small glasses and cups to avoid consuming large amounts at once. Sipping from smaller portions also helps reduce the urge to drink quickly.
Spread Fluids Throughout the Day
Space your fluid intake evenly to avoid running out of allowance too early. Drinking between meals can also help you manage better than drinking with meals.
Tips to Reduce Thirst
Avoid salty and spicy foods that increase thirst, like processed meats, canned soups, and snacks.
Suck on ice cubes, frozen fruit, or lemon slices instead of drinking fluids. Each ice cube or piece counts toward your fluid intake.
Chew gum, brush your teeth, or use a mouthwash to reduce dry mouth sensations.
Count All Liquids
Remember to include foods that contain high water content. Foods like jelly, custard, and porridge contribute to your daily fluid intake and should be accounted for.
Number One Diet Tip: Reduce Salt
Limiting salt intake is a crucial part of managing thirst. Opt for low-sodium foods and avoid adding salt to meals. You may notice within a short time that your taste buds have adapted and you no longer desire salt. These salty foods will just make you more thirsty causing more mental and physical distress. Foods like olives, feta, and pickles. Canned and processed foods, like gravies, cereal, flavoured noodles and potato mixes, soups and vegetables are high in salt. Cheeses, cured meats (e.g. bacon, bologna, hot dogs and sausages), fast foods and frozen foods also may contain a lot of sodium.
At Home
Avoid salt when cooking and experiment with herbs and spices. Using lemon, lime juice, vinegar and low sodium marinades are excellent options.
Select fresh fruits and vegetables, lean meats, eggs, dairy, and whole grains. These are all To manage sodium intake, follow these guidelines:
Read food labels closely. Check sodium content per serving; aim for under 350 mg. Review the ingredient list for salt in the first five ingredients. The more ingredients a food has the more processed the food. Processed foods are more likely to have hidden salt, sugar, fats and artificial additives.
Look closely at the nutritional label. Be aware of serving sizes and daily values for sodium, fat, and cholesterol. As a general rule look at the 100 gm column. Keep total fats, sugars and salt below 10 gm per 100 gm.
Away from home
When dining out, apply the guidelines above. Also, consider asking for meals without added salt or MSG.
A word on Carbs
Simple carbohydrates will not make you thirsty like salty foods will. However, as discussed in the blog post: Fluid Retention they will retain fluid. Carbohydrates like rice, pasta, sugars and honey are stored as glycogen. For each molecule of glycogen we store we also retain 3 molecules of water. Yep, 1 gm of simple sugar means 3 gm of fluid retained somewhere in your body.
Being Strategic means being Mindful
Strategic food choices really do help manage thirst without adding unnecessary fluids to the diet. Mindfulness means being self aware. Being mindful about your fluid intake leads to better success and outcomes.
Transplant Community: Controlling Thirst
There are many advocacy, support groups and social media pages available for transplant patients. As a member of these groups, I asked members to share their tips to control thirst.
Here are the most popular suggestions.
Slowly suck on Zooper Doopers, there is a no-added sugar option. One of these counts as approximately 75 mls of fluid. Lemonade icy poles are also 75 mls and there is a low sugar option. Be aware, for 100 mls there is a sugar content of 20 gms. This is above the recommended guideline of 10 gms of sugar per 100 gms.
Rinse mouth, gargle and spit out all the water, no cheating.
Limit what you pour into a glass. Temptation rises when a drink is already in front of you. Following a fluid restriction is such a mind game.
Freeze watermelon, pineapple, and citrus fruits as they take longer to eat and are more refreshing than room temperature fruit.
Slowly sucking on low sugar mints and hard lollies stimulates saliva. Thus, reducing that dry mouth feeling.
Start the day with minimal fluid intake. This helps when you feel thirsty later in the day. Particularly as the day heats up in hot climates.
One heart transplant recipient learned so much when she consulted with a dietician. Check out What You Need To Know About Hospital Meals And Food Choices. I unpack the benefits of seeing a dietician while in the hospital.
Fluid Restrictions are tough
Fluid Restrictions are a tough burden to deal with when you are already extremely ill. If you do not follow your fluid intake regime then you will feel the consequences. You will have more fluid build up. This can cause ulcers and sores where fluid leaks out through the skin.
You may feel more breathless, fatigued and find it more difficult to sleep when laying flat. Therefore, adhering to your fluid limit is essential. It can improve your symptoms and improve your safety and comfort.
Are you or have you been on a fluid restriction? Do you have strategies that worked for you? Please share them in the form below. Join our community and subscribe.
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References
Australia, H. (2024, November 1). Fluid retention. Healthdirect Australia. https://www.healthdirect.gov.au/fluid-retention
Fluid restriction diet – 800ml. (2020, December 17). Agency for Clinical Innovation. https://aci.health.nsw.gov.au/projects/diet-specifications/adult/fluid/restriction-800ml
Fluid retention (oedema). (n.d.). Better Health Channel. Retrieved November 1, 2024, from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Fluid-retention-oedema
Health, U. (2024, June 30). Diet and congestive heart failure. UCSF Health. https://www.ucsfhealth.org/education/diet-and-congestive-heart-failure
Home. (2018, June 25). Milton Keynes University Hospital. https://www.mkuh.nhs.uk
Queensland Health. (n.d.). Queensland Health. Retrieved November 7, 2024, from https://www.health.qld.gov.auWater retention causes, symptoms, and treatments. (n.d.). Retrieved November 1, 2024, from https://patient.info/news-and-features/what-causes-water-retention
Stickel, S., Gin-Sing, W., Wagenaar, M., & Gibbs, J. S. R. (2019). The practical management of fluid retention in adults with right heart failure due to pulmonary arterial hypertension. European Heart Journal Supplements : Journal of the European Society of Cardiology, 21(Suppl K), K46–K53. https://doi.org/10.1093/eurheartj/suz207
Water retention causes, symptoms, and treatments. (n.d.). Retrieved November 1, 2024, from https://patient.info/news-and-features/what-causes-water-retention