The 2002 Boston Marathon made runners think twice as to when would be the proper time to grab another cup of water from hydration stations along the route or when to pull one of those bottles stacked up in their belts after one of the runners died of hyponatremia (overhydration and a diluting of blood-sodium levels).
Almost all runners are aware of the importance of dehydration but only few are cautious when it comes to overhydration. Hyponatremia is an electrolyte disturbance (disturbance of the salts in the blood) in which the sodium concentration in the plasma is lower than normal. Long distance runners are the ones who is more at risk because they tend to sweat too much which causes them to take in more water and not enough sodium which is an essential electrolyte that allows water to permeate the cell walls so that water can be redistributed throughout the body, allowing muscles to work and organs to function properly.
The common symptoms of hyponatremia include bloating, a feeling of fullness in your stomach, nausea, incoherence and disorientation. When you begin to have these symptoms, don't think twice and get some help.
So when are you supposed to drink?
The International Marathon Medical Directors Association (IMMDA) released its hydration guidelines and stated that runners should simply drink when thirsty. Their research proved that thirst is the best way to determine if your body needs hydration and its absence simply means the other way around.
There have been some controversy in terms of the accuracy of "thirst" when used to measure your body's fluid needs. For years, runners have been adviced to drink ahead in order to avoid dehaydration. Honestly, I don't think there should even be a controversy regarding this, I agree that thirst is indeed a good sign since it is known to be one of our body's defense mechanism, but drinking ahead is also advisable specially when water stations along the route is not strategically placed since all runners have different needs in terms of when and how much they are supposed to drink. This ususally depends on the runner's body type, weight, pace, height, ang several other factors which makes all athletes unique. The point is, wether you use the feeling of thirst to know when to drink, or take fluids ahead of time, what's more important is you take just the right amount, combined with enough electrolytes and proper nutrition before, during, and after the race.
How would you know if you are thirsty?
Dr. Lewis Maharam of the International Marathon Medical Doctors Association (IMMDA), in an article from runnersworld.com, suggests listening to your instincts. "If you come up on a water station and you're ambivalent about downing a cup, you're not thirsty and you don't need to drink," he says. For instance, having a dry mouth--which can be the result of nerves or heavy breathing--doesn't necessarily mean you're thirsty. "But if you see the water at the station and crave it," says Dr. Maharam, "then you're truly thirsty and should have a drink." Also from the same article, Dr. William O. Roberts of the American College of Sports Medicine (ACSM) said, after fears of hyponatremia have also fueled controversy over how much sodium runners need to replace along with fluids, the need for salt is exaggerated, since the average runner actually loses very little salt during a one- or two-hour run. "As long as you have some salt in your diet, there is probably not a huge need to have salt in your fluids," he says. The IMMDA however still recommends sports drinks than water because it contains both carbohydrates and electrolytes ideal for long runs.
Sources : (I suggest reading further since this topic involves scientific tests/researches and the effects or requirements may vary from one person to another)
http://www.runnersworld.com/marathon/article-new_rules.html
http://www.coolrunning.com/engine/6/6_1/1179.shtml
http://en.wikipedia.org/wiki/Hyponatremia
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