Usually my POTS* is content to take the back stage and let ME/CFS run the show, but recently it has been asserting itself in a rather forceful manner. Sitting on raised chairs, showering and just existing seems to send my blood rushing from my head to my feet, leaving me spending a lot of time on the floor or against my dresser with my legs up to get that pesky blood back where it belongs.
At this point it’s not a huge worry as I can generally manage my POTS with medication and lifestyle changes (unlike ME/CFS, which laughs in the face of intervention). One such lifestyle change is increasing water and salt intake in the form of electrolyte or hydration drinks. POTS patients are advised to increase fluid and salt intake to 2-3L and 3-5g** / day respectively. This decreases tachycardia by increasing blood volume (which is typically low in POTS patients) and thus blood pressure.
I have recently discovered that sports drinks such as Powerade, which I used to chug on a regular basis, are not the best choice for those with dysautonomia or even athletes due to their low electrolyte, high sugar content. So I ordered a variety of hydration drinks and even made my own to compare and find something palatable and salty enough to drink every day. My findings are as follows:
Nuun effervescent tablets are extremely popular within the online dysautonomia community, to the point where POTSies are upcycling their old bottles for craft! I can see why – they are affordable and come in a wide range of flavours (13 currently listed on their website). The tri-berry, lemon-lime and orange I tried were about as pleasant-tasting as what is essentially flavoured salt water can get.
Some flavours contain caffeine, so that’s something to watch out for it if disagrees with you (not uncommon when you’re prone to tachycardia!). Stevia is another problematic ingredient which has a BP-lowering effect. They also take a LONG time to fully dissolve. (Note: I bought Nuun Active from iHerb.com, which seems to have been superseded by Nuun Hydration.)
An Aussie brand, Shotz Nutrition offers sugar-free electrolyte tablets designed to be used by athletes in combination with their energy/protein bars or energy gels. The orange vanilla was pretty tasty (and not in the slightest vanilla-ery), with the lemon flavour allowing the salt flavour to come through more. I was impressed with the next-day post and the fact that they provided an energy gel sample! (Mmmm, samples.) Would order again.
Note: this product contains the artificial sweetener sorbitol, which is a high FODMAP ingredient. Avoid if you are sensitives to polyols – sorbitol.
I really only tried SOS Hydration because they offered free-ish samples (you pay post). I was pleasantly surprised to find their formula is extremely high in sodium and in line with the World Health Organisation’s guidelines for oral rehydration (see below). Along with the usual berry and citrus, it comes in the more interesting flavours of mango and coconut – however, I found the flavours unpleasant and overly sweet (the product contains stevia as well as sugar).
Another downside to this product is that it comes in tiny sachets that dissolve in one cup (250mL) water, which quickly add up. It also makes it very difficult to prepare when I most need them (i.e., when in presyncope). This was my least favourite of the lot.
Note: contains stevia, which has hypotensive effects.
Hydralyte Ready to Drink
I know Hydralyte is designed specifically for dehydration recovery (eg from gastro), but SHIT is this stuff syrupy. I can’t understand why, as it has a low sugar content compared to juices, sports drinks and soft drinks. Anyway, the ready-made formula with a high electrolyte content means it’s handy in a pinch. Available at the chemist or supermarket.
Gastrolyte Ready to Drink
Much of a muchness to Hydralyte. I bought the pop top version, which is more convenient when I’m blacking out and don’t have time to pour a glass. Just don’t buy the strawberry flavour, unless you like the taste of cherry medicine.
Again, available at the chemist or supermarket.
Repalyte is a flavour free glucose electrolyte powder. Much like Hydralyte and Gastrolyte, it is designed to treat and prevent dehydration due to medical causes such as diarrhoea. It has a fairly high sodium content, and would be a good option to those who can’t tolerate additives, flavours etc (such as Ruth, who kindly sent me a sachet to try. Thanks, Ruth!). To someone like me who is used to salty drinks, it didn’t really taste of anything.
You can buy Repalyte in Australia as an OTC or prescription product.
Note: this review was added 10/02/18.
Aqualyte is an Australian brand which produces flavoured electrolyte solutions “for sport and industry”. As the nutritional information of Aqualyte solution is nowhere to be found on their website and their smallest order is a carton of 50 sachets for $64, I followed the suggestion of a fellow POTSie and asked via email to purchase a sample. For $10, I received 10 sachets of my choosing (of orange, berry and lemon/lime flavour).
Given the positive reviews they receive in the dysautonomia community, I was shocked to read the contents of each sachet. The solution is nearly 2/5 sugar, and contains barely any sodium at all! It’s more equivalent to a sports drink than a rehydration solution, and certainly tastes it. I won’t be finishing my samples and can’t recommend this product.
Note: this review was added 10/02/18.
Ah, my faithful standby. I always have a bottle (or 10) of Powerade Zero in the cupboard, as it is just so convenient and tasty. At 22mmol/L, the sodium content isn’t great, but its far better than the regular Powerade Ion4 (12mmol/L). Sugar free, and handy in a pinch.
Note: this review was added 05/11/18.
Homemade rehydration drink
My aim was to create something approximate to the WHO Oral Rehydration Salts, whose composition is below:
The recipe I used is as follows:
1 tsp lite salt (NaCl / KCl)
1/2 tsp Bi Carb soda
6 tsp table sugar (that’s 1.5TB Aus, 2TB everywhere else)
1L tap water***
This is a variation on the formula shared by the WHO and this rehydration site, using a combination of potassium and sodium present in lite salt rather than just sodium which is in regular salt. It was found on a chronic illness forum, though there are versions online referring to it as a WHO recipe (which I can’t confirm).
My drink was certainly tasty, thanks to the sugar content! There are lots of variations on a theme for this drink – you can add less sugar, or none at all, throw in a squeeze of lemon or lime juice for flavour, or dissolve a sachet of cordial. Many just add a pinch of salt or lite salt to water and call it a day.
I’m unsure of the provenance of this recipe, or the overall effect of using lite salt as opposed to the 1 tsp salt in the WHO recipe. For this reason, I can’t totally recommend it, as I don’t know if the electrolytes are in correct balance, or if the sugar content is appropriate. (WHO states that “glucose facilitates the absorption of sodium (and hence water) on a 1:1 molar basis in the small intestine”, but I don’t know if this applies to just those who are experiencing malabsorption due to a dehydrated state, or everyone.)
Coconut water is a popular choice for rehydration due to its electrolyte content. But it only contains trace amounts of sodium, high levels of sugar and too little of other electrolytes to be of much benefit.
Banana Bag oral solution sachets are HUGE in the dysautonomia community right now. They advertise their drink as being equivalent to WHO ORS formula, which it is – so long as you mix 1 sachet in 240mL of water (not even a cup). Like the SOS Rehydration, the sachets add up, this shit isn’t cheap (a 5-pack of sachets – enough for just over 1L – costs $31.83AUD including shipping). I’m not particularly interested in buying something which is essentially a cleverly-marketed version of Gastrolyte for 3x the cost.
I have tried High 5 Zero Electrolyte Tablets in the past and enjoyed the taste – which is probably because they have a low sodium content comparable to regular sports drinks!
|Product||Sodium mmol/L||Sugars g/L||Cost~ $AUD/L|
|WHO ORS (for comparison)||75||13.5|
|Gastrolyte Effervescent Tablets/Sachets||60||16-18||$4.50-5.50|
|Hydralyte Effervescent Electrolyte Tablets||60||16||$5|
|Repalyte Oral Powder Sachets||60||17.8||$4.50|
|SOS Hydration (Powder Tub, Sachets)||59||12||$4.90|
|Hydralyte Sports Powder Tub||50||20||$1.16|
|Hydralyte Ready to Drink/Sachets||45||16||$9.99-5|
|Gastrolyte Ready to Drink (Pop Tops, 1L)||45||15.8||$8.99-10.99|
|Shotz Electrolyte Effervescent Tablet||37||0||$1.75|
|Nuun Active Effervescent Tablet||33||2.1||$1.71|
|Endura Rehydration Low Carb Fuel||22||1.66-3.74||$2.23|
|Endura Rehydration Performance Fuel||22||60||$2.68#|
|High 5 Zero Electrolyte Tablets||15||0||$0.80|
|Aqualyte Solution Sachets||12||37||$2.13|
|Cocobella Coconut Water||9.1||50||$5|
|Ultima Replenisher Electrolyte Powder Tub/Sachet||4.78||0||$0.96-2.15|
~Cost as of 05/11/18. If instructions dictate dissolving in 16 fl oz water (473mL), volume rounded up to 500mL. Cost does not include post which may be necessary in some cases. If multiple volumes of water for mixing solution are suggested, I chose the smallest volume.
^I wonder if this value is so high as table sugar is sucrose, 50/50 glucose and fructose, so 24g assumedly contains 12g glucose.
#It seems like Endura Low Carb Fuel should be more expensive than Performance Fuel as the tub is much smaller (128 vs 800g), but the dose is smaller too (4 vs 25g). The carbohydrate content of Low Carb Fuel varies depending on flavour: coconut lowest, tropical punch highest. The carbohydrate content of Performance Fuel is based upon their 6% carbohydrate content, though the sugars are a combination of fructose and maltodextrin.
The clear winner for me was totally unexpected – homemade electrolyte drink! Most days I just add 1tsp of lite salt to 1L of water. It doesn’t really taste that bad – certainly nothing like the seawater analogue I was expecting – and is much easier to drink on a regular basis than the flavoured, sweetened drinks on the market.
When I want something different, I choose Shotz Electrolyte Tablets for their ease of use and pleasant flavour. And I always have some Hydralyte or Gastrolyte on hand for when I’m in presyncope and need a quick boost.
What are your favourite electrolyte drinks? If you can shed more light on this topic, or correct any misinformation I may have shared, please chime in!
Edited 12:36pm, 27/09/17 to add information regarding stevia’s hypotensive effects. Thanks to Claire for the tip-off.
Updated 05/11/18 with additions of Endura Performance and Low-Carb Fuel, Hydralyte Sports, Ultima Replenisher Electrolyte Powder and Powerade Zero to the table. Cost added. Powerade Zero review added. Differences between Hydralyte Ready To Drink/Sachets and Effervescent Electrolyte Tablets corrected. Read more in this post.
*Postural orthostatic tachycardia syndrome, ie, tachycardia upon standing.
**Yes, that is GRAMS. Don’t try this at home, non-POTS people.
***The Nuun, coconut water, SOS Hydration, Banana Bag, and Gastrolyte tablets/sachets are calculated by me. It’s been a long time since high school chem, so this may be way off!