Tag Archives: hydration

TT080: Dangerous Hyponatremia After a 70.3 Half Ironman

Colin Pugh had a dangerous case of hyponatremia that could have resulted in death.  Hydration expert Andy Blow joins us to review his case.  In Colin’s words, here is what happened:

“On Aug 14th I did my first Half Ironman (Stealhead – Benton Harbor MI). I ran a pretty decent race and finished in a time of 5hrs 47 mins. After the race I was about a 3 hour drive from home in Milwaukee WI. I was over there on my own as my girlfriend was working that weekend. Based on the fact I couldn’t stand up without cramping I made the decision to hold up in a hotel for the night and make my way home on the Monday morning. I got to the hotel grabbed a shower and then started to become obsessed with the fact that I hadn’t taken a pee all day and started taking on water (a lot of water!). This was quiet the mistake……..

I then remember only a few things. I remember walking across to the gas station to buy more water and being completely out of it in my mind like kind of drunk feeling. Then I went to bed and woke up at 11pm and proceeded to throw up all a lot of that water back up which wasn’t pretty.

I woke up the next day feeling really rough and text my girlfriend to say I’m not driving until I get kicked out of the hotel at Noon. Then the next thing I know is I’m at the breakfast table grabbing breakfast and all packed up and I had no idea how I got there. Then the last thing I remember on Monday morning was getting on to the highway at my intersection in Michigan and then the next recollection I had was waking up in the ICU on Wednesday morning in Chicago………….

What happened? It turns out that I must have had the sub conscious thought to get to the Emergency Room. Because when I crashed my car into a truck I was only 6 blocks away from the University of Illinois Chicago Medical Center in downtown Chicago. But I had managed to drive over 70 miles without remembering a thing and then passed out behind the wheel. When the cops came up on my accident they said they found me having a seizure in the driver’s seat and then proceeded to smash me out of my car and get medical help.

Then I got to the ER by ambulance and my girlfriend was calling my phone. The ER doctor answers the phone and tells her what they think is going on. My girlfriend is actually a doctor herself, she completely gets what the ER doc tells her and starts freaking out and gets in the car and starts driving the 1-2 hrs down to Chicago to be with me.

So what was going on? Typical human blood has 140-145 mol/liter of Sodium in it. Anything less than 120 mol/liter is classed as serve. On my first blood work when I got to the ER it was at 113 mol/liter and that’s why I kept having seizures. I had Hyponatremia where you drink too much tap water and in essence dilute your blood. I was then admitted to the ICU early Monday and over Monday/Tuesday given fluids and monitored closely until I woke up on Wednesday morning very confused. While I was out I wasn’t being very cooperative it seems……..I had to be tied down feet and hands to stop me from beating all the people up which wasn’t great for my girlfriend to see.

After waking up I had no idea what year it was, what had happened, where I had raced, who the president was…….nothing…….and that was very worrying. But I quickly started to get it all back come Thursday and Friday. I was then discharged from the ICU to home on Friday.

Quiet the experience that I need to get follow up appointments to completely figure out if I had a Kidney issue or if I just put myself in trouble by drinking so much water instead of something with electrolytes in it. In the meantime I’m back to work and doing fine, getting my car fixed up and taking it easy for a little while and deferring a few races that I was booked into for the rest of the season.”

TT079: Hydration With Andy Blow (You’ll Definitely Learn Something New)

Former elite triathlete Andy Blow struggled in hot races.  He cramped and had to figure out a solution.  He retired from triathlons in 2006 but that problem led to his post-racing career.  He is the founder of Precision Hydration and has become an expert on hydration.   In addition to Andy Blow Transalpineendurance athletes he’s worked with NBA, NFL, and professional soccer teams.

Regardless of what you already know about hydration, you will learn more during this interview.

Topics discussed:

  • For most people drinking to thirst will work, but many athletes need to follow a plan to make sure they don’t forget to drink.  A range of 16-28 ounces of fluid replacement per hour is adequate in most cases, but some athletes have much higher sweat rates and will require more
  • Over-hydration before a race can negatively affect performance
  • The sodium concentration in your sweat is relatively static over many years and many different conditions
  • Your body reabsorbs some of the sodium lost through sweat before it reaches the skin
  • Caffeinated drinks don’t result in a net fluid loss
  • And way more than I included here

During the interview I didn’t ask Andy specifically how much fluid loss is allowable for half and full Ironman distance races, so I followed up via email and this was his response:

“the data I’ve seen suggests the fastest finishers of those kind of races can lose between 2 and 6% on average (which tallies with personal experience for me). There may be some people who suffer at that kind of level of loss, and others who can tolerate a bit more (e.g. Gebrselassie who lost 10% during some marathons) but my best guess is that around 2-6% is in the zone for most people if they start the event very well hydrated.

I don’t think the length of race matters so much as even in hot Olympic races people can lose considerable amounts of weight – it’s more how quickly you allow the weight loss to occur (i.e. in long races you have to drink more to mitigate the fluid lossses from earlier on).”

Links

PrecisionHydration.com 

Free online sweat test

Precistion Hydration Testing Centers

TT062: Hydration & Heat Prep From a Hot Ironman Lake Placid and Mont-Tremblant

Canadian Allan MacKenzie recently completed Ironman Lake Placid and Ironman Mont-Tremblant in hot conditions.  We talked about that experience and his heat and hydration questions following the race.  I answer his questions from my own knowledge, but I also add George Dallam’s answers.  

George, a guest on episodes 3, 4, and 25,  is a professor at Colorado State University in Pueblo.  He was the first USA Triathlon National Teams coach and he coached Olympic triathlete Hunter Kemper.  His answers were originally in response to my email, and he allowed me to publish his email here.

Each of Allan’s questions is listed below, and George’s answers follow.

  1. For someone who doesn’t have the opportunity to train much outdoors in high temperatures, what are the best ways to be prepared if race day ends up being really hot?

Acclimate – hot tub, sauna, indoors with heater/humidifier, any stationary training as well. It is all about producing a high sweat rate.

Here is the link to George’s two week hot tub protocol –http://triathletetraining.com/heat-acclimation-protocol/

  1.   How long does it take to get acclimatized/prepared to race in warmer than normal temperatures?

Even one session can help and you can probably maximize over as little as 2-3 weeks with daily sessions.

  1.    Other than adding more sodium to my diet, are there other things I can do with my diet to help get better acclimatizes to the heat?

I’m not an advocate of adding more sodium to the diet, just the opposite.  The currently in vogue notion that “salty sweaters” need more sodium ignores the underlying issue.  Salty sweaters are inevitably consuming more sodium than they realize so the body must constantly excrete the excess.  By reducing sodium in the diet your body will improve in its ability to preserve sodium over time..  Further by greatly increasing your sodium intake over normal in a given racing situation you probably increase the risk of heat stroke – sodium reduces our sweating capacity by holding water in the vascular and interstitial spaces.  The best approach to heat tolerance is appropriate acclimation and a low salt diet in my estimation.

  1.     What are your thoughts on using arm coolers and/or knee coolers to help to stay cool during races?

Pre cooling to lower the core temperature prior to a hot race is certainly very useful.  If you can create a cooling effect on the fly that is certainly useful as well.  However, to do so means carrying extra weight in most cases in the form of a cold solution or ice.  The idea that any clothing enhances cooling in comparison to what the bare skin can accomplish during periods of heavy sweating is misleading.  See this review.  http://link.springer.com/article/10.2165/00007256-200333130-00001#page-1 Some fabrics are relatively more cooling than others (cotton versus wool for instance) but all limit cooling to some degree by  inhibiting the evaporative cooling process in some manner. Maximum skin exposure provides the greatest surface area for sweating and the resulting evaporative effect created as air moves past the body.  The thought with white reflective clothing is that you might avoid radiant heat gain, however the loss in evaporative cooling potential offsets that possible effect.   Of course wearing or not wearing clothing must also be considered in the need for limiting UV exposure and for creating both aero and aquadynamics.   Consider, however that shaved body parts are often nearly as aero/aquadynamic as fabrics designed for the purpose and shaving further increases the potential for evaporative heat loss.  Basically in the heat you should wear the minimal clothing necessary or required and it should be white or light colored.

Very likely your arms and legs have sufficiently keratinized  (tanned) through normal training exposure so that you shouldn’t need to cover them with clothing to prevent sun burn – doing so will reduce your evaporative cooling potential.

5.  And what is your opinion on salt tabs?

See above – this is a worst case scenario.

  1.      When I raced Ironman Mont Tremblant (MT) this year I didn’t pee during the bike portion at all.

That is an obvious indication to me that I was dehydrated. I’m don’t think it had a significant effect on my bike, but I feel it adversely effected my run. Usually I have a good gauge on this and am often guilty of drinking too much. What would you recommend to help prevent this from happening again?

Some relative dehydration can actually be beneficial to performance (although less than ideal when it comes to the possibility of thrombus formation) because you are simply lighter.  This might be true up to about 2% loss in body weight – possibly more if you train in those conditions.  The primary key to maintaining hydration is to drink fluids that are isotonic (similar salt concentration to your body fluids)  – this approach maximizes absorption at the gut and reduces the tendency for diuresis during the race (you’d really rather not pee if possible).    I would drink on schedule in small amounts if you want to prevent dehydration based on your typical weight loss (2 cups per pound). Something like traditional Gatorade cut in  half with water gets you there – most conventional “salty” drinks have way more salt than is present in the blood stream.  I would use Tim Noakes advice and drink to thirst if you want to allow for a little normal dehydration.   If you have had a reason to believe that you are at risk for thrombus formation I would take the first option and stay hydrated when training and racing.   You can also pre-hydrate pretty effectively using a glycerol solution if you have great concerns for dehydration.

  1.       I wore a visor in Lake Placid (LP), but opted for a hat during MT (so that I could put ice under my hat to try and stay cool). Which do you recommend for a really hot day?

Ice under the hat is effective on the fly cooling strategy – see above.

  1.       I have fair skin and usually need sunscreen to prevent getting a burn. In LP I applied it in the am before the swim and again in T2. I planned to do the same in MT, but I forgot to do so in T2 and I think this really played a role with my run time. Does a sun burn have a significant effect on my ability to stay hydrated?

Interesting question.   I’m not aware of any direct effect of sunburn and/or sun screens on evaporative cooling potential.  However, a quick search reveals the following studyhttp://search.proquest.com/openview/3ca96ce6df9654a03c18b6e0cb47d8bd/1?pq-origsite=gscholar which suggests no negative effect of wearing sunscreen and a possible type II statistical error – suggesting there may even be a small positive effect through an improved temperature gradient (core to skin temperature differential) which the study failed to find probably due to too few subjects or the fact that the difference were so small.  You might also experiment in training with sunscreens that are more water resistant – Bull Frog comes to mind – so you can avoid reapplication after the swim.

 

TT045: Ironman Arizona Winner & Olympian Brent McMahon

At age 34 Canadian Brent McMahon attempted his first Ironman in Arizona.  Previously, he was a 2004 and 2012 Olympian, and 2014 was going well with four Ironman 70.3 wins.  On the starting line he didn’t have a time goal, nor had he even pondered a finishing time before this race.

He followed a race plan crafted with Lance Watson, his coach of 20 years.  That included a caloric intake of roughly 500 calories per hour on the bike while ignoring his competitors.  When a couple contenders passed him early in the bike he started to ride with them but backed off when he realized it required a greater power output than he planned to ride.

He finished the bike in third after a 4:21 split.  He ran the first half of the marathon in 1:20 and finished with a 2:43 run, giving him a 5 minute margin of victory and a 7:55 final time, the fastest Ironman debut in history.

Despite competing at a level far above most triathletes, his race execution tips are golden and helpful to all triathletes.

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Links

 

 

TT027: Losing The Last 5 Pounds, Sodium, Hydration, Nutrition, Supplements, & More!

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“The best time to lose weight is in the off-season when that restriction is not going to compromise energy levels as much. However, it is feasible to lose weight in the midst of training.”

Author, Athlete, & Dietitian Kim Mueller

Kim is the guest for episode 27.  She is a Registered Dietitian, a board certified specialist in Sports Dietetics, owner of Fuel Factor Nutrition Coaching, co-creator of and staff nutritionist at Infinit Nutrition, author of “The Athletes Guide to Sports Supplements” (Human Kinetics, 2013), and a former All-American Triathlete.  She is currently focusing on running with a goal of  qualifying for the 2016 Olympic Marathon Trials in LA.

Kim is a big proponent of making diet the primary component to health.  We covered a wide range of topics, including weight loss, supplements, hydration, sodium intake, caloric intake, and much more.

On weight loss, Kim advises her clients to use up to 500 calories of their workout expenditure to incur a deficit for healthy fat loss.  For example, if your base caloric need was 2000 calories and your burned 700 calories training, take in 2200 calories.  If you did no training on a specific day then your caloric consumption should match your baseline rate of 2000 calories.

To determine your caloric needs she recommends the Harris Benedict Equation. This can be found online in many places.  Here is one option:

http://www.globalrph.com/harris-benedict-equation.htm

To track your diet her top choice is a pen and paper.  There are many online options including TrainingPeaks.com and MyFoodRecord.com.

The average athlete will lose ½ to 1 liter of fluid her hour with at least moderate exertion.

Kim’s sodium replacement recommendation – 500-700mg per liter of fluid (33 ounces) consumed.

Kim’s website is Fuel-Factor.com

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TT015: Ironman & Long Distance Racing With Gordo Byrn

 

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Eric: “What was your rationale for going so many years without being tested for VO2 Max?”
Gordo: “It doesn’t matter. All you are going to do is give yourself an excuse not to try.  It does not matter.  Your genetics don’t matter. That’s completely my story.”

Gordo 

I interviewed Gordo Byrn, co-author of Going Long, and a seven time sub-9 hour Ironman finisher, including an 8:29 for a second place finish at Ironman Canada.  Gordo also won Ultraman in Hawaii.  

Gordo went from full time finance guy to not-so-fast triathlete to the elite level by doing a LOT of work (understatement).  Gordo hasn’t raced seriously in several years, but he continues to stay fully involved as a coach (EnduranceCorner.com).

Gordo with son Axel in Colorado.

Gordo with son Axel in Colorado.

Most of the interview covered Ironman distance training and racing, but much of our discussion  provides useful information for all types of racing. Here are some of the highlights.

Ironman Cycling Calorie Race Requirements
Race time, size, and the ability to use fat for fuel will all affect calorie requirements for an Ironman. A powermeter will show you kJs (kilojoules) produced during a ride.. As a starting point, Gordo suggests eating ½ of kJ output on the bike.  For a 200 watt ride, that equates to 720 kJs and a 360 calorie requirement/hour.   Continue reading