Outlines practices that endurance athletes should follow, variables they should consider, and guidelines they should use to maintain proper fluid balance in. Editorial Reviews. Review. "For sport science devotees at all levels, and those who love to just site App Ad. Look inside this book. Waterlogged: The Serious Problem of Overhydration in Endurance Sports by [Noakes, Timothy]. read so far, much taken from Timothy D Noakes (author of 'Lore of . please ensure that you have in place safety measures for treating EAH, see p of the pdf link Waterlogged The serious problem of overhydration in endurance sports.
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Waterlogged: The Serious Problem of Overhydration in by Tim Noakes Dr. Tim Noakes takes you contained in the technological know-how of athlete hydration for a desirable examine the human body's desire for Download PDF sample. Download & Read Online with Best Experience | File Name: Waterlogged The OVERHYDRATION IN ENDURANCE SPORTS TIM NOAKES manual in PDF. Sports English Edition by raudone.info pdf, site, word, Serious Problem of Overhydration in Endurance Sports by Timothy Noakes.
Does ‘Drink to Thirst’ Hydration Work For Endurance Athletes?
Indeed, the only acceptable medical treatment for acute heat illness is external cooling via ice packs — not the administration of intravenous fluids, as some may believe.
Heat illness, namely heatstroke, is extraordinarily rare in endurance sports, Noakes points out. Heat exhaustion or heat stroke is far more common in shorter running events, in large part because the intense efforts and short durations of these events merge to create temperature increases before the body can self-regulate pace.
In the vast majority of cases, the heat illness quickly resolves with rest and, when necessary, cooling measures. Noakes points out that in most cases of fatal heat illness, there exists an abnormal mechanism of heat build-up — excessive endogenous heat production — whereby the body goes haywire, producing heat, regardless of external temperature or duration of effort.
The high incidence of heat stroke in short distance events — versus virtually none marathons and ultras — also shines light on the lack of connection between hydration and core body temperature. That heat illness is so prevalent in short-lasting events — where very little fluid is lost, yet there is next to no incidence in multi-hour efforts, even with profound water loss — is telling. Sodium Balance and Performance Dogma: We need to supplement with sodium to complete long-distance endurance events.
Science: The body self-regulates blood sodium concentration via several mechanisms, including sodium sparing in sweat and urine.
One of the most persistent beliefs in ultrarunning is that we must ingest sodium for optimal performance, if not survival. Not so, claims Noakes.
He points out several studies, including sodium deprivation studies involving prolonged exercise over several days, that demonstrates that the body will maintain blood sodium levels in a deprivation state. In explaining this phenomenon, Noakes points out our biological mechanisms to preserve sodium in both sweat and urine — pointing out that these studies measured sodium concentrations next to nothing during prolonged exercise and sodium deprivation.
Moreover, blood sodium concentrations stayed within normal ranges — so long as athletes and subjects drank only to thirst. Science: The self-regulation of sodium concentration results in sodium excesses being secreted; salty secretions will cease when sodium balance is achieved. Simply put, the presence of salt deposits on skin and clothing are due to the body ridding of excesses, and when sodium balance is achieved — or if a blood sodium deficit is perceived — the body will conserve it from sweat and urine.
Dogma: Sodium supplementation stops and prevents Exercise-Associated Muscle Cramping EAMC Science: There is no scientific evidence that shows sodium or other electrolyte deficits in those with muscle cramping. This is another interesting dogma that has thrived, pre-dating even Gatorade. Noakes points out many studies that not only fail to show an association, but demonstrate normal — if not mildly elevated — blood sodium concentrations in those with muscle cramps.
Conversely, it is well accepted that those suffering from hyponatremia do not suffer from muscle cramps — the very patient population that would, in theory suffer the most cramping, should a sodium deficit truly cause cramping.
Internal or external temperatures also do not play a role, as EAMC occur in cool conditions including extreme cold water swimmers.
And there may be a reason for that. The current leading theory on muscle cramping is that neuromuscular fatigue — and the loss of inhibitory reflexes — causes excessive muscle activity, resulting in cramping. Moreover, a study has identified those two risk factors for developing cramping: previous cramping experiences, and faster finishing times; not body weight losses or blood sodium levels.
This could explain the greater incidence of cramps amongst Gatorade drinkers: if an athlete perceives protection from drinking it — along with the ergogenic aid of glucose solution — they will run more intensely, possibly resulting in more cramps. Anti-Diuretic Hormone — the Lynch Pin in Hyponatremic Illness and Death Dogma: The frequency and color of my urine will tell me whether or not I am adequately hydrated; I should continue to drink after exercise until I am able to urinate — to ensure optimal hydration and kidney function.
Science: The presence of excessive anti-diuretic hormone during exercises — referred to as Syndrome of Inappropriate ADH SIADH secretion — can cause overt fluid retention and resulting in concentrated or complete lack of urine, despite severe overhydration and hyponatremia. Antidiuretic Hormone ADH is secreted during exercise to conserve water from urine, when the brain determines that blood sodium levels are increasing. When sodium levels are balanced, ADH secretion stops.
This is the principal reason that, for most of us, we urinate less or not at all during prolonged exercise, or that we urinate a lot when well-hydrated.
This condition, referred to as Syndrome of Inappropriate ADH secretion SIADH , causes athletes to retain water beyond physiologically need, despite potentially severe overhydration and hyponatremia. These are the runners that may exhibit symptoms of EAH — swelling, weight gain, impaired performance and brain function — yet report either dark urine or none at all.
Yet this has nothing to do with the integrity of the kidneys; it is the presence of high levels of ADH that result in the body holding onto this water. The presence of SIADH — measured in blood lab tests — has been a common finding in the most severe cases of hyponatremia, including deaths. In short, ADH prevented any passage of urine. To reiterate: there is zero correlation between frequency or color of urination and hydration, or kidney function. ADH controls whether or not the kidney produces urine.
Therefore, runners attempting to ensure hydration or kidney function with copious fluids might be endangering their race, if not their health, if there is excessive ADH in their bloodstream, blocking urine production. Indeed, given that hyponatremia leads to muscles cell lysis explosion due to swelling , one might be endangering his kidneys with excessive drinking during or after endurance events.
The only things we can trust to ensure adequate fluid intake, according to Noakes, is our thirst and, to a lesser extent, the scale. The absence of thirst and an increasing weight either absolute, or relative is evidence that additional fluid is unnecessary and potentially dangerous.
Treatment and Prevention of Exercise-Associated Hyponatremia As dangerous and deadly as EAH can be, the treatment — if initiated promptly and correctly — is quite simple. Notable are studies that found a simple ingestion of the same volume and concentration of sodium solution does not have the same restorative effect. It is not known at this time why simply ingesting sodium is less effective. Either treatment is far cry from what many hyponatremic runners receive — both at medical aid stations and local hospitals, which is typically more fluid, or intravenous solutions with inadequate sodium concentrations — typically 0.
Noakes implores sports medicine officials — and public health officials, alike — to make a thorough and accurate diagnosis of a hospitalized runner before initiating any IV fluids.
See a Problem?
Given this reality, it is even more shocking that a major ultramarathon, at one point, was offering default intravenous solutions, post-race, without any medical justification. According to Noakes and the body of research on hydration and performance, individual differences are too great to make blanket recommendations.
The only gauge for fluid need is thirst; the only symptom of dehydration is thirst. This value is determined from observational studies of hydration, performance, and incidence of hyponatremia. The low range is for slower, lighter runners; the high end for heavier, faster runners. If so, this subjective assessment might be a more nuanced assessment of fluid need. Whether the converse an overt absence of thirst, accompanied by a dissatisfying taste and appeal of fluid indicates fluid satiation or excess, was not addressed by Noakes or his book.
Consumption of roughly 60g of glucose per hour during competition will improve performance. Noakes has separately researched and reviewed studies on glucose supplementation and determined this value for greatest performance and gastrointestinal acceptance.
Values upwards of grams per hour have shown even greater benefit; however, this increasing sugar invites GI disturbance. Supplemental sodium is unnecessary in endurance competition.
This conclusion, based on his work and literature review, will undoubtedly result in controversy in the ultra community. Noakes is careful to point out numerous studies demonstrating that blood sodium levels are maintained in absence of supplementation and outright deprivation, with prolonged exercise over many days. Moreover, he points out the absence of any study that identifies performance benefit from sodium supplementation; in fact, he points out two studies in the past decade that contradict the notion.
For the sports medicine community, he recommends the following: Be very careful to make accurate diagnoses of troubled runners. Runners who come into medical checkpoints, feeling dizzy while standing still on a scale, are more likely to be experiencing Exercise-Associated Postural Hypotension than any other ailment, says Noakes. The simple treatment is to elevate the feet over the heart, wherein recovery is rapid. There is no evidence that postural hypotension is due to dehydration. More important is an accurate diagnosis of the hyponatremic runner.
An athlete exhibiting the signs and symptoms of hyponatremia — weight gain, swelling, nausea and vomiting, headache, muscle cell breakdown, altered consciousness and seizure — must be accurately diagnosed. Administering a mL bolus of 3. Certainly, he is passionate for the sport, being a veteran of the marathon and ultra distance. Personal accounts of death from overhydration are included in Waterlogged, not to sensationalize, but to better understand how something as innocuous as water, and the good intentions to avoid suffering, can result in deadly consequences.
For this reader, given what has been known — yet ignored — about hydration science for so long, justifies the strength of message.
In the very least, hyponatremia can ruin the race day for runners and families. Worse yet, it could end a running career. Or a life. Just as it has always done for ultrarunners. As a result, your blood becomes saltier rather than more dilute as you start to dehydrate. Those rising blood sodium concentrations are a key part of what drives you to become thirsty. So if you drink water only in response to thirst, you should only ever dilute the blood back down to an acceptable level before the cycle repeats itself.
You should never end up badly diluted hyponatremic unless you drink ahead of thirst which would dilute your blood sodium more than necessary or go for hours and hours drinking only water without replacing any salt.
Theory 2: Drinking to thirst is how we evolved, so it must be best for combating dehydration. There is, I believe, a huge difference. The environment that we now enjoy in much of the developed world—specifically in terms of our free and ready access to water and salt—is also very different from that of our ancestors.
And even if you are perfectly aware of your thirst signals as a general rule, the elite athletes we work with are very in touch with their bodies , the demanding and complex nature of competition can make it difficult to find physically and tactically ideal moments to hydrate. Theory 3: Drinking to thirst removes the need for sodium supplementation. Drinking water to thirst is very likely sufficient for short and light activities where sweat losses are low to moderate, but the data is a lot less clear for longer and hotter events , where sweat loss can be considerable over many hours.
It was even copied by many of his competitors, presumably because it worked. More recent research showed that triathletes who were given salt tablets vs. The study also showed that the group taking salts rehydrated more effectively than the control group. This certainly tallies with my own experiences using sodium supplements during long, hot races.
There are lots of scenarios where just drinking water to thirst is sensible, like for basic day-to-day hydration. And for many people training or racing shorter events in cool to moderate conditions, drinking water to thirst will be sufficient most of the time.Were desperate to be fit, slim and trim, yet held back by the very diets and medically prescribed eating plans we hope will help us change.
Other than basic physiological structure, they could sit down to dinner together. The effect of the diet on Bantings health was drastic, nothing short of miraculous in fact, and after he published his now-famous Letter on Corpulence, documenting his weight struggles and subsequent turnaround, the Banting diet and variations thereof were adopted as an effective weight-loss solution by the medical fraternity in both Europe and the USA.
This is central to Banting animal fat does not make you fat you need to eat it. Waterlogged lays out this work dissecting the bad from the good, and presents it to the reader in plain view. She advised that he begin immediate treatment for both conditions and consult a dietician. Overall, Noakes paints a convincing picture that simply drinking water when you feel like it is all you need to perform your best.
Once youve come off carbs, the only reason you should feel the need to snack is if you are not eating a fatty enough meal or large enough breakfast. After all those years in the kitchen, one day someone left the kitchen door open and he bolted to follow his dream of becoming an extreme adventurer.
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