The health risks mentioned below sound more serious than they are in reality. For most people, serious health complications are less common than issues like decreased energy and chronic pain.
In my experience, I need to drink a LOT of water, and I also need to take in a lot of salt. Spiro is a potassium-sparing diuretic, which means it makes you pee a lot and it makes you lose sodium at a high rate. Most people on spiro need extra salt in their diet compared to everyone else. Sodium is really important; without it your body can’t necessarily use what you ingest, including water.
Most people don’t have to ingest extra electrolytes to stay hydrated, however being on spiro means you’re losing salt a little more (but not quite) like an athlete, even without exercise. Because of the extra salt loss, I drink Gatorade whenever I feel especially thirsty. Basically, I drink it until it stops tasting good, and that means I’m fully re-hydrated.
Spironolactone is officially used to control high blood pressure, so if you’re taking high doses of spiro and don’t have a blood pressure problem, you may also have issues with sporadic low blood pressure. Extra salt intake can also help with this. Low blood pressure can cause dizziness, confusion, fainting, weakness, shortness of breath, and heart palpitations.
Since spiro doesn’t flush potassium out of your system, you can end up with excess potassium in proportion to sodium and water. The problem with this is that potassium is used to control muscle contractions, so when potassium gets out of whack, so do your muscles. Excessive amounts of potassium can cause arrhythmia (irregular heartbeat). Dehydration can also cause heart palpitations, as can extremely low blood pressure, so you want to avoid getting all of them combined. A few bananas now and then won’t kill you, but in general it’s a good idea to avoid high-potassium foods just to be on the safe side.
Urinary Tract Concerns
Here’s another potential problem from taking high doses of spiro: Bladder pain. Dehydration increases the chances of developing a UTI (urinary tract infection) and can irritate the bladder. Drinking plenty of water helps flush out bacteria, making sure they can’t flourish.
Soda, coffee, tea, and other drinks have a double-whammy effect of both worsening dehydration and irritating the bladder with their acidity. You don’t have to remove them from your diet entirely, however it’s a good idea to either drink them as little as possible, or also drink lots of water to balance out their effects, along with taking in extra salt. An irritated bladder can worsen frequent urination and can cause constant groin pain. It sucks.
In general, your best bet is to drink lots of water, take in a little more salt than most people do, and minimize your intake of high-potassium foods.
That’s in general. Your mileage may vary. If you eat lots of fast food, canned food, or frozen dinners, you might not need extra salt because those are all high-sodium foods.
Above all, trust your body. If you get a sudden intense craving for salt, water, fruit juice, sports drinks, or any other kind of nutrition, heed the call. (Unless you have a condition such as high blood pressure or diabetes that requires avoiding them.) Our bodies are good at telling us what we need, if we make the effort to listen.