Tuesday, 6 September 2016

Restriction of fluid intake may make you tireder

Mult Scler. 2016 Aug 19. pii: 1352458516663854. [Epub ahead of print]

Fatigue and fluid hydration status in multiple sclerosis: A hypothesis.

Cincotta MC, Engelhard MM, Stankey M, Goldman MD.



Fatigue is a prevalent and functionally disabling symptom for individuals living with multiple sclerosis (MS) which is poorly understood and multifactorial in etiology. Bladder dysfunction is another common MS symptom which limits social engagement and quality of life. To manage bladder issues, individuals with MS tend to limit their fluid intake, which may contribute to a low-hydration (LoH) state and fatigue.


To evaluate the relationship between patient-reported MS fatigue, bladder dysfunction, and hydration status.


We performed a prospective cross-sectional study in 50 women with MS. Participants submitted a random urine sample and completed several fatigue-related surveys. Using a urine specific gravity (USG) threshold of 1.015, we classified MS subjects into two groups: high-hydration (HiH) and LoH states.


LoH status was more common in MS subjects with bladder dysfunction. Statistically significant differences in self-reported Fatigue Performance Scale were observed between HiH and LoH subjects (p = 0.022). USG was significantly correlated with fatigue as measured by the MS Fatigue Severity Scale (FSS) score (r = 0.328, p = 0.020).


Hydration status correlates with self-reported fatigue, with lower fatigue scores found in those with HiH status (USG < 1.015).

Not infrequently, patients tell me that they restrict their fluid intake because of bladder problems. But is this worsening their MS?

Fatigue in MS occurs mainly later in the day, made worse by heat and exertion. And based on the findings of this study fluid hydration state can affect fatigue levels, with higher levels of hydration being protective against MS-related fatigue. Moreover, the effect of even small changes in hydration state in MS may be a scale magnitude higher in MS owing to underlying autonomic issues. It's not surprising then that hot weather can exacerbate fatigue levels in conjunction with a low hydration status.

The skeptical may point out that more severe bladder problems, such as incontinence, is more common in those with more disabling MS who are also less likely reach a toilet with ease, and so is fatigue. But in 2012, a study in young women also found that dehydration impacted adversely on vitality, fatigue, perception of task difficulty, concentration and headache (Armstrong LE et al. Mild dehydration affects mood in healthy young women. J Nutr 2012; 142(2): 382-388)

Therefore, good hydration is a very low risk intervention and easily incorporated into other programs directed at fatigue.


  1. I've generally always not drunk enough water, not good. Reading about dehydration it can cause constipation which can lead to back ache. Increase risk of infection. It can even cause muscle damage.

  2. How can we check we are hydrated enough? Having clear urine after lunchtime? For some reason I thought sugar can turn urine darker?

    1. This is a tricky one. Darker urine is a more concentrated urine and generally means dehydration. A reduction in the volume of urine produced is a late sign and can mean that your kidney function is lowering

  3. "Tireder" must be American English. It's "more tired".

    1. "American English?" We are two nations separated by a common language" after all. Why type "more tired" when "tireder" saves time?

    2. And why bother with the 'u' in colour or behaviour when color and behavior are shorter and easier to spell - right? An why dont we rite like this an yoos numbrs 2 substitoot entire wrds?

      Because it looks ugly, lazy and plain wrong. It can also lead to inaccurate communication. I don't like bad punctuation or grammar either. Just the way I see it - although I know I'm not the only one.

    3. As riveting as this is, it has little relevance to the content of the post. If I have one request, it is, that bloggers keep their comments/queries relevant to the research or knowledge content presented!

    4. Yes, but strange English can make the content harder to read.

    5. Yep I am strange and Engrish and I guess it is hard to read the stuff I rite :-)

      British English is slowly being erased from Science. Many of the UK scientists are currently not native English speakers by origin and Amercian English is becoming dominant in scientific literature.

    6. It depends on which spellcheck is on ones computer, USA or UK. Don't care how you spell as long as you find a cure.

    7. i thought that there was a move away from trolling? instead, there seems to be a move to mob mentality. when a commenter says something researchers disagree with, now there is a group effort at putting down the commenter?

      clearly, i make no effort at worrying about sentence grammar, and most of the time i don't even proof read what i have written. Still, I agree with Anonymous and think she or he has a point. Even if I am too lazy to change my practice.

      Anyway, I guess I will sit back to see if there are more attacks on people who *gasp* think grammar should be part of our communication. I for one don't understand many of the things written here (particularly jokes, I never get those).

      As to a comment about the original post - well I didn't really get the original post. So not drinking water might not be great for MS. Swell. What you gonna about it? Shame people with MS who avoid water in order to attend a social event without a nappy into drinking water? To not piss their pants at work? Good luck with that.

    8. ps. just as one example - i didn't fully understand what was being said in the comment i copied and pasted below. while i live under no illusion that what i hurriedly type out makes any sense, the fact that i believe my and others' hurried writings are often misunderstood does suggest that grammar should be an important part of our communication.

      "MouseDoctorTuesday, September 06, 2016 5:04:00 pm
      I was deleted in response to this post Anon12.50, but you are correct that reporting on Alemtuzumab information leaves something to be desired.

      The recent posts on the occurrence each year of people getting thyroiditis after alemtuzumab is another case about 5% year 1 10% year 2, 20% year 3, 10% year 4, 10% year in fact totalling 59% yet they report only 40% of people got thyroiditis so some people have thyroid disease over two years. So it is not clear when it is occurring

      So even when reporting side effects it is not clear.

      There are many other things that they have have not been reporting or reporting in unusual ways, whilst you have Anon 1:17 you dont need us to comment

      But we cannot
      Conflict of interests are given"

