Hydration – Hip, Hype or Help

Quick Summary

20560263_sIt’s hip to hydrate, there is a lot of hype about powders/potions/pills and whether it really helps is uncertain and can be dangerous if not used (consumed) properly.  For example, there are no studies found that can tell a 120 pound 20% BMI 22 year old female running a high-altitude marathon on a 90 degree 80% humidity day who ate pasta with the past 24 hours and hasn’t slept in 24 hours, what is the best diet regime for the day?  Every person is so completely different and each circumstance (weather, humidity, workout level, etc.) changes dramatically minute-by-minute , so be careful and create your own solution and monitor/track results for optimum performance.

Here are the key findings of the research for high physical activity and hydration or avoiding dehydration:

20451288_s0 – If you don’t feel good, don’t do it.  We put this one as zero as it should be obvious but obviously needs to be said.  If kids/teens are involved take additional care.

1 – Plan ahead – If you are thirsty, its often too late and again stop until your body can adjust.  21466609_sDrinking too much water too fast doesn’t help as the body really can’t absorb it quickly.  Drinking sports drinks/powders with sodium can help but can cause other issues as again, there is only so much the body can do. SEE BELOW.

Since each person has different hydration needs and will vary by region, you should should really make your own solution for pennies rather buy expensive hydration powders.  Here are some ideas for Homemade Summer Thirst Quenchers adding sodium cautiously until you know what you really need.

2 – Know the weather for the day of and be prepared for changes and have a emergency plan bringing layered clothing and hats.

3 – Avoid caffeine and meds before and during, use afterward.  Caffeine and other meds are diuretics which remove water from the body.  Mixing caffeine with sodium is not a good idea either.

22173413_s4 – Have a diet design plan before, during and after.  Each sport or activity has different diets – build fiber strength before then during the day trail mix for hikers, low fiber for runners/bikers and others build a plan for you not just what what athletes are doing.

5 – Stick to the plan, add a reminder/timer alert and  monitor it.

Background Research

As a life-long journalist when I read anything I am skeptical.  Unlike Reagan, “trust and verify,” I believe “untrust and verify.” This article was inspired by our new research initiative into fitness health thought research.   Specifically when I asked a group of executives about “hydration” most new little about what it was much less when they need it and how much. Pills, powders, potions and concoctions run the gamut yet what is the science and common sense behind this industry.

13077997_sFrom the British Medical Journal, “Defining adequate hydration is complex. It is estimated by the synthesis of clinical indicators (such as confusion, tachycardia, blood pressure, and thirst), serum biochemistry (such as urea and creatinine), tissue perfusion markers (such as urine output, lactate levels), and urine specific gravity.”   Much of the promotion for hydration is for fitness exercise, sports and endurance/adventure situations, however, being “thirsty” is something for someone who simply sits all day becoming de-hydrated from high amounts of caffeine.  However, it is a much deeper issue which we will explore here.  From a practical experience having trained thousands of sales people nothing causes more stress than having to give an speech in front of others.  I think the brain can consume more energy than a runner at full pace and have seen speakers sweat like they are literally in an oven.  I explain to students that they need to drink more not less water to stay cool.  They think by starving the body they will stop sweating.  Quite the reverse, the lungs are like air conditioning fans cooling the body and when people are stressed they literally often breathe slower.  I tell them to drink more and breathe more to keep the body cool and they may not sweat at all.  Meanwhile let’s dig into the technical issues surrounding hydration.

Hyponatraemia – Very Low Sodium – Over-correction Health Hazard

When people exercise or are stressed as mentioned above they sweat salt.  This is why many think that replacing fluids with sodium is the answer.  However, be careful, you cannot replace fluids or sodium quickly.  If you loose too much salt the result is hyponatraemia – the condition of very low sodium in the blood.  Sodium is an electrolyte that regulates the amount of fluid in the body.  According to the Mayo Clinic, hyponatremia signs and symptoms may include:

  • Nausea and vomiting
  • Headache
  • Confusion
  • Loss of energy and fatigue
  • Restlessness and irritability
  • Muscle weakness, spasms or cramps
  • Seizures
  • Coma

According to the New England Journal of Medicine, “Nearly 15,000 people ran the Boston marathon in 2002. An estimated 1,900 runners (Note: total sample size was not indicated) were hyponatraemic by the time they crossed the finish line, 90 of them critically hyponatraemic with serum concentrations of sodium below 130 mEq/l.”   A normal sodium level is between 135 and 145 milliequivalents per liter (mEq/L) of sodium. Hyponatremia occurs when the sodium in your blood falls below 135 mEq/L.  You should be asking, how do I know how much sodium I have and how regulate the amount of fluid in my body.  That answer is even more elusive.  From an article in the Lancet, both sides argue either toward hypotonic.  Common practice is still to give hypotonic fluid to meet hydration goals and others are gathering data that argues for a switch to isotonic fluids. Some say adding sodium helps moving fluids into the blood cells (hypertronic) as opposed to when you exercise, fluids are removed hypotonic.  Isotonic is a balanced state such as drinking water.  According to the BMJ citing New England Journal of Medicine, “The researchers weighed competitors before and after the race and used weight gain as a proxy for fluid intake. Their findings confirm what many athletes already know—that drinking too much of anything during competitions can dangerously upset your electrolyte balance.

In the Lancet article called The Fluid Craze, “Common practice is still to give hypotonic fluid to meet hydration goals and others are gathering data that argues for a switch to isotonic fluids.  Common practice is still to give hypotonic fluid to meet hydration goals and others are gathering data that argues for a switch to isotonic fluids.  The perils of overhydration in athletes are now well known.  Athletic associations and the US  military4 now advise against drinking too much fluid, because hyponatraemia was noted in 10–15% of marathon runners.5 Water stations have been cut in half in major marathons.  Correction of hyponatraemia (low sodium) too rapidly causes brain injury.”

Meanwhile back at the BMJ article, “Sports drinks containing electrolytes do not seem to help, probably because most of them are hypotonic. A typical drink contains only 18 mmol of sodium per litre. So what should marathon runners do? The authors suggest a weigh-in before and after lengthy training runs to help them titrate their hydration more precisely.”  Titrate means to measure.  Yet the article fails to mention how an athlete is supposed to titrate themselves.  They noted, “Drinking only water during the race and the use of non-steroidal anti-inflammatory drugs (NSAIDs) were not associated with hyponatraemia.”  Could this mean you really need to understand your body as runners and cyclists have performed well centuries without additives.  In other words, is the placebo at play here?  Additional research by the providers of such products is recommended.

More Analysis

Hydration is just one form of nutrition. Balancing nutrition and fluids is an ultimate goal for practicing good health and wellness.   As the BMJ notes, “Chronic malnutrition is associated with frailty, unintentional weight loss, weakness, immobility, sarcopenia, and poor endurance. Overhydration manifested as pulmonary oedema is a common consequence of excessive intravenous fluids.  Other problems such as acute kidney injury from avoidable dehydration are added to those related to excess fluid administration (pulmonary oedema, post surgical ileus, wound breakdown, etc.” If these are recognized issues, what are the remedies.

37042538_sBMJ noted “the first step is to maximise normal food intake with a balanced mixture of protein, energy, fibre, electrolytes, vitamins, and minerals.”  Yet when they explore the issue further, results were murky at best.  “In studies in postoperative patients there was little correlation between fluid and electrolytes prescription and preoperative weight, serum electrolyte levels, or ongoing fluid losses.” Reinforcing this was this comment “many do not know the normal daily fluid and electrolyte maintenance requirements, or use this knowledge in daily fluid management practice, a suspicion supported by audit data.”  Moreover, these were more clinical conditions not runners in a high-altitude high-temperature road race or the Tour de France race.


BMJ: The British Medical Journal

Nutrition and fluid balance must be taken seriously

Now is the time to take fluid and nutrition seriously, not only within hospitals but also in care homes and the community. Failure to address these essential but often complex issues has profound, often avoidable effects on morbidity and mortality and results in unnecessary costs.

Journal of American Medical Association

Influence of Hydration Level and Body Fluids on Exercise Performance in the Heat

Michael N. Sawka, PhD; Ralph P. Francesconi, PhD; Andrew J. Young, PhD; Kent B. Pandolf, PhD

During exercise in the heat, sweat output often exceeds water intake, resulting in hypohydration, which is defined as a body fluid deficit. This fluid deficit is comprised of water loss from both the intracellular and extracellular fluid compartments. Hypohydration during exercise causes a greater heat storage and reduces endurance in comparison with euhydration levels. The greater heat storage is attributed to a decreased sweating rate (evaporative heat loss) as well as a decreased cutaneous blood flow (dry heat loss). These response decrements have been attributed to both plasma hyperosmolality and a plasma hypovolemia. Subject gender, acclimation state, and aerobic fitness do not alter the increased heat storage when hypohydrated. Hyperhydration, or body fluid excess, does not seem to provide a clear advantage during exercise-heat stress, but will delay the development of hypohydration.  Click here for Journal of American Medical Association article.

From American Journal of Medicine

Hyponatremia is a common clinical problem in hospitalized patients and nursing home residents. It also may occur in healthy athletes after endurance exercise. The majority of patients with hyponatremia are asymptomatic and do not require immediate correction of hyponatremia. Symptomatic hyponatremia is a medical emergency requiring rapid correction to prevent the worsening of brain edema. How fast we should increase the serum sodium levels depends on the onset of hyponatremia and still remains controversial. If the serum sodium levels are corrected too rapidly, patients may develop central pontine myelinolysis, but if they are corrected too slowly, patients may die of brain herniation. We review the epidemiology and mechanisms of hyponatremia, the sensitivity of women to hyponatremic injury, the adaptation and maladaptation of brain cells to hyponatremia and its correction, and the practical ways of managing hyponatremia. Because the majority of hyponatremia is caused by the non-osmotic release of vasopressin, the recent approval of the vasopressin receptor antagonist conivaptan for euvolemic hyponatremia may simplify hyponatremia management. However, physicians should be aware of the risk of rapid correction of hyponatremia, hypotension, and excessive fluid intake.

This article is a work-in-progress.  We would recommend you consider MedsMinders to track your diet, health, wellness and sports activities.  That is, track your hydration before it becomes dehydration.

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