THE JOINT

Your weekly dose of RA wellness

The Nutrition Edition

I Thought I Needed More Coffee

I can make it through an entire day and then realize I haven't had a sip of water.

As a CRNA, dehydration almost becomes part of the job. You can't bring a water bottle into the OR. Bathroom breaks are unpredictable. Most mornings, I drink coffee and get on with my day.

By mid-afternoon, fatigue and brain fog hit like clockwork. My mind runs through the usual suspects. Not enough sleep? Too much coffee? Not enough protein? Am I flaring?

Water rarely crosses my mind.

This happens despite knowing how important hydration is. I simply forget.

That got me wondering.

Maybe I'm not the only one.

So I started digging into the research. Does hydration affect rheumatoid arthritis? How much water do we really need? And how much attention should we pay to all the warnings about microplastics, toxins, hydrogen water, alkaline water, and expensive filtration systems?

Water isn't a cure-all. It won't lower inflammation or treat RA. But chronic, low-grade dehydration may quietly make fatigue, headaches, constipation, dry eyes, brain fog, and even pain harder to live with.

We spend a lot of time thinking about inflammation, supplements, and medications.

Sometimes we forget the basics.

What Water Is Good For

Most people think about hydration only when they feel thirsty.

The problem is that thirst isn't an early warning sign. By the time you're thirsty, mild dehydration may already be present.

Water does much more than quench thirst. It helps maintain blood volume and blood pressure, carries nutrients throughout the body, supports kidney function, regulates temperature, lubricates joints, and keeps tissues like the eyes and mouth moist.

It also affects how you feel.

Even mild dehydration can make fatigue and brain fog more noticeable and make exercise feel harder.

Sound familiar?

None of those symptoms automatically mean you're dehydrated. RA itself, poor sleep, medications, anemia, and countless other factors can cause the same complaints. That's one reason dehydration is easy to miss.

Many of the things I blame on stress, poor sleep, or a flare can show up simply because I haven't been drinking enough.

Hydration and Rheumatoid Arthritis: Is There a Connection?

There isn't good evidence that drinking more water reduces inflammation or treats RA.

But hydration supports several systems that affect how people with RA feel every day.

Joints

Cartilage and synovial fluid rely on water to provide cushioning and lubrication.

Energy

Even mild dehydration can worsen fatigue, headaches, brain fog, and exercise tolerance.

Medications

Methotrexate and NSAIDs rely on healthy kidney function, making adequate hydration important.

Dry mouth

Sjögren's syndrome and certain medications can make dehydration more likely.

Bottom line

Water isn't a treatment for rheumatoid arthritis.

But it supports many of the things we're trying to optimize: energy, movement, recovery, and medication safety.

How Much Water Do You Need?

There isn't one magic number, and anyone who gives you one without caveats is oversimplifying.

The National Academies of Sciences recommends about 12 cups of total fluid per day for women and 15 cups for men. That includes fluid from food, not just beverages.

Your needs increase if you exercise regularly, live in a hot climate, have diarrhea, or take medications that increase fluid losses.

Coffee, tea, milk, soups, fruits, and vegetables all contribute to your daily intake.

The simplest real-world guide?

Look at your urine color.

Pale straw yellow most of the day usually means you're doing fine.

Dark yellow most of the day is a sign you probably need more fluid.

Crystal clear isn't necessary.

What About Microplastics, Toxins, and Premium Water?

Social media can make this feel overwhelming.

Microplastics are everywhere. They're found in our food, our environment, and our water. Researchers are still trying to understand what long-term exposure means for human health.

The important thing to know is this:

You don't need to avoid drinking water because you're worried about microplastics.

The risk of chronic dehydration is much better understood than the potential risks of microplastic exposure.

What about filters?

If you live in an area with known water quality concerns, filtration can help reduce things like lead, PFAS, chlorine, and other contaminants.

Good options include:

• Simple pitcher filters
• Under-sink filters
• Reverse osmosis systems

You don't need a $5,000 wellness setup.

What About Hydrogen Water?

Hydrogen water has received attention for its potential antioxidant effects, but most studies are small and preliminary. There isn't enough evidence to recommend it for rheumatoid arthritis.

What About Alkaline Water?

Alkaline water is heavily marketed, but there is no convincing evidence that it improves inflammation, reduces pain, or changes the course of RA.

Bottom Line

Plain water works just fine.

If a filter gives you peace of mind, use one. If you enjoy sparkling water, drink it. If you prefer tea or water with fruit, that's fine too.

I Hate Water. Now What?

The good news is that hydration doesn't only come from plain water.

Tea, coffee, fruit, vegetables, soups, smoothies, and other beverages all count.

Green tea contains antioxidant compounds that have shown promise in laboratory and animal studies, though it isn't a treatment for RA. Black tea and herbal teas count too.

Coffee counts as well. Despite the old myth, moderate coffee intake doesn't dehydrate regular coffee drinkers.

Foods help more than most people realize. Cucumbers, watermelon, oranges, berries, lettuce, celery, soups, and smoothies all contribute to hydration.

One benefit of an anti-inflammatory eating pattern is that many of these foods naturally support hydration.

Alcohol is the exception. It increases fluid loss and can make dehydration worse, especially in hot weather or after exercise.

We'll talk more about alcohol and methotrexate in a future issue.

Hydration doesn't require carrying around a gallon jug all day. Find ways to make it enjoyable.

A Few Tricks That Make It Easier

• Keep sliced lemons, limes, oranges, or cucumbers ready in the refrigerator.
• Freeze fruit into ice cubes. Strawberries, blueberries, raspberries, mint, and citrus slices turn plain water into something you'll look forward to.
• Buy the pretty tumbler. Use the fancy glass. Add the reusable straw. Make hydration feel inviting.
• Keep water visible. Out of sight usually means out of mind.
• Pair drinking with existing habits. Coffee brewing? Drink a glass. Taking medications? Drink a glass. Sitting down to lunch? Drink a glass.
• Start your day with water before coffee.
• Use sparkling water if plain water bores you.
• Keep infused water ready in the refrigerator.

Hydrating Recipes

If plain water isn't your thing, these recipes are easy ways to boost hydration while adding a little variety to your day.

Build a Water Loop

This week, attach hydration to something you're already doing.

Put a water bottle or glass next to your coffee maker or kettle.

Before your first cup of coffee, drink one glass of water.

Not instead of coffee.

Just before it.

Your body naturally wakes up slightly dehydrated after a night of sleep, and giving it a head start takes less than a minute.

Pay Extra Attention During Methotrexate Week

If you take methotrexate, make hydration part of your routine around dose day and the following day. Adequate fluid intake helps support kidney clearance and gives your body one less thing to manage.

Use a Simple Gauge

You don't need to track every ounce.

Look at your urine color.

Pale straw = you're probably doing fine.

Dark yellow most of the day = drink a little more.

Crystal clear all day isn't necessary.

Before You Go

If you've been chasing fatigue with more coffee, supplements, or willpower, start with the basics.

One glass of water before your morning coffee is a small habit, but small habits repeated daily often have the biggest payoff.

If you found this helpful, forward it to someone living with RA who might need the reminder too.

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