Sunday, July 28, 2013

Salted or unsalted , science behind hyponatremia in endurance racing

I have a huge interest in the science behind endurance racing . I am a gastroenterology Nurse Practitioner, that has been in practice for 10 years , I also have a bachelors degree in exercise science and minor in nutrition . I started realizing I was getting advice from other athletes that prompted a lot if question for myself as  person of science and for one whom practices medicine and needs to give sound advise to my patients and as I take on this extreme sport of Ironman. I will not claim to be an expert but I promise to pull together the most recent data I can on the subject of sodium balance with exercise.

This question interested me because so many athletes were advising the use of sodium tablets during endurance racing to my husband and I  in order to decrease muscle cramping and aid hydration.

Here is what I found from my research and know from pure physiology. My references are medical journals and Up to Date , which is a data base we use in our clinic to keep us up with the latest data in medical practice.

One point to make is , what is muscle cramping??? Is it  due to lack of oxygen  or due to sodium depletion. This may be another subject all together. But the point is there is a very common condition and even a medical acronym already defined for a "stitch in your side". It is called ETAP, or Exercise-related Transient Abdominal Pain. It is caused by shunting of blood away from the arteries feeding diaphragmatic muscles , causing a diaphragmatic ischemia ( or lack of oxygen). It presents as pain all across / or tranversing the top of the abdomen, from under the right ribs to the left ribs , or some variation. It appears it is more prevalent in female athletes and sometimes worse with menstruation. It goes away with rest and rehydration and there doesn't appear to be any permanent damage. It is not from low sodium , but key point , is dehydration. Dehydration is different from sodium or electrolyte in-balance.

So what is hyponatremia in the medical sense . Simply low sodium. Why is it bad? Appropriate sodium levels are necessary for acid base balance, water balance, nerve transmission and muscle contraction. When it is low, it is a lower concentration in the blood, due to dehydration ( from excess exercise),  or vomiting, and  diarrhea. It can be caused by OVERHYDRATION as well. It is rare in healthy individuals with normal kidney function all together.

Next point, Hypernatremia , or excess sodium in the blood in also bad. It can cause permanent neurological damage. Higher then normal sodium can be from too infrequent urination, profuse sweating, or diarrhea or other  medical disorders.

Signs and Symptoms of low sodium can be  change in mentation or confusion , lethargy, nausea, cramping, twitching, and worse case seizures  or coma. The most noticeable symptom for me in practice has been the change in mentation and lethargy. Patients will literally be closing there eyes to sleep while you are trying to talk with them. Pretty extreme. And most of these patients are elderly with poor kidney function , and more than likely on heart medications and diuretics.

Another key point in this discussion about salted verses unsalted. The American College of Sports Medicine tried to put together a task force to come up with a guideline for sodium intake in endurance events and couldn't. Why , because most of us doing these sports, 1. have adequate kidney function to keep this from happening. 2. get enough sodium from our diets alone to keep this from happening, and 3. It cant happen until you become dehydrated. So, there's the answer stay hydrated and it probably wont happen.

Another myth. Most sports drinks with their limited electrolyte's are hypotonic and therefore aren't enough to actually balance an extreme case of hyponatremia. You can drink them. They are good and tasty, and may help in small increments.

Hydration:
DO NOT over hydrate. American College of Sports Medicine, task force on the subject showed that OVER hydration was the number one reason for hyponatremia. They studied Boston Marathon runners, some had a theory to drink as much water as possible during the event , others drank modestly during the event. The ones whom tried to hydrate as much as possible were more apt to be the hyponatremic ones. When one overhydrates and the kidneys are failing to excrete, then the retained fluid may lead to lower sodium levels. Athletes that weighed more across the finish line, were more apt to have low sodium. A sign  to look for is darkening urine.

ACSM is saying that hydration of 500 to 1500 liters of water per hour of exercise with a normal diet with normal sodium levels should keep the majority of athletes healthy.
If you are one that seems to get a lot of symptoms with extreme exercise then I would advise a physical with your Doctor.

In the practice  of medicine I was taught the horse before the zebra. Meaning most things have the simplest explanation, BUT you cannot forget the zebra exists.

My take home message for myself  after all this is :
Eat some potato chips, drink modest amounts of fluids, and as long as I continue to pee every couple hours , its all good. :)


I found an article the link is that talks more on this issue.

http://www.medscape.com/viewarticle/718774








Friday, July 26, 2013

another Tri

Tomorrow morning starts another 32 mile ,triathlon , the Spudman in Burley Idaho . The fastest mile swim   You'll ever do since it is river aided. My husband should love this. I learned from the last tri two weeks ago I needed to work on my outfit this time . My goal is to find the right attire for my body that won't rub without having to rely on glide or lube . Last tri I only got one small rub under my shorts . All the biking and tri shorts I own have this rubbery type material at the bottom of the leg To keep them in place I guess. So this time I'm  going to wear Underarmer garments under my shorts and the Nike  pro tank under my tri singlet suit. I am strategically placing a stick of glide at the t2 for good measure .
For better hydration i got a water bottle  that fits between my tri bars  as well . I am to hydrate during the bike this time . I hope to have  a nice solid race with little issue.
There are 2100 athletes in this event , hopefully this will be a positively controlled chaos race with all these people . Get us ready for ironman CDA. :)


Tuesday, July 23, 2013

My husband is my training partner, how awesome is that!!!!!!

My Husbands very first triathlon. I am so lucky that he has chosen to take on the voyage of becoming Ironman with me. It makes the dedication, the training, so much easier having him by my side through it all. We will hopefully complete Ironman CDA June 29 2014 together. It will be a 8 days after our 4th Anniversary. So , I guess it will be our Anniversary trip. We usually go someplace tropical to scuba and beach it , but I think this will be very cool.

With four kids ages 1, 3, 8, 14, it takes a lot of coordinating. We sometimes have to take turns training, or hire a babysitter for long training days. The grandmas are awesome!!! They help a lot and are very supportive.
We get creative with our training and try to include our family. We just hiked 33 miles in the Sawtooth National Wilderness over three days. Definitely cross training. We went with my husbands parents and another couple. Day 3 was 18 miles with a pack. Now if I can get through that then I know I can get through 26 miles with no pack. And our family was with us.

We also do our swimming while the 8 year old does her swim team practice and the 3 year old gets swim lessons. When the 14 year old isn't busy he watches the baby or we just take turns. I get an hour and he gets an hour. It all works.

Some days we sacrifice sleep, and other times one of us sacrifices dinner.
WE just commit to get our workouts in for the week and help each other with coordinating that.

I know however, that having my husband as a training partner is probably one of the greatest things I could ever wish for. I think it would be a huge and sometimes wearing sacrifice for the spouse of an ironman in training. So god bless the spouses that are just there being supportive, that is awesome too.
I love you Ben!!!!!!!!


Sunday, July 14, 2013

Learning from set backs during a tri. Bike Chain drop, wrong turns, and cramping.....

So , I did my first Olympic Tri of the season. I  have done others but it was years ago. I am now 42 , and I remember at age 32 it was easy, so to speak.

The triathlon I just completed was the YMCA Spudman, in Boise , Idaho. The swim was great. July 13, 2013, the surface water was 75 degree in Lucky Peak Resevior. I didn't wear a wet suit and felt awesome. Most all the swimmers wore wetsuits. I think many people feel it helps with their buoyancy. I have been a swimmer all my life. I prefer swimming in my swim suit. Anyway I was 26th fastest out of 95 participants, so I felt my swim went well.

On to the bike, first vertical climb , I am feeling wonderful. Then auggh. My chain falls off. I think ok quick fix, nope , it got stuck between by frame and the last chain wheel. OMG, I ended up bloodying up my hands , yanking the damn thing out for at least 3-4 minutes, while at least 20 people pass me by. So disheartening, as there goes my lead in the swim.

Then about mile 20/25 I take a wrong turn. There just happen to be a cycling group that looked like they were in my race but weren't and I followed them left when I needed to go right, I figured it out about 30 seconds later, so there was another minute lost and probably 5 more people passed me. Auggg!!

I m so disheartened, as I really wanted to see what my true capability was today.
I hit the run, and my mojo is gone. I now Im dehydrated and so try to guzzle water and take a swig of power gel. My first 1-4 miles I have the worse cramp across my ribs, I have to run, walk , run several times , and it doesn't go away until mile 5. I only hold 9:21 minutes miles when I know Im capable of 8:00 miles . I finish, very disheartened.

What did I learn from today.
1. I probably need a better bike, but for now, the  bike mechanic at Tri Town in Boise Idaho, fixed my bike with a gadget that helps keep your chain from dropping. Cool. I hope it helps. It was actually designed by Kristen Armstrong's husband. She is the Olympic Cyclist from Boise , Idaho.
2. Know the course as well as you can.
3. Better hydration is necessary and probably need to start using salt tablets . I talked to several ironmen post race. They generally take 1-2 tablets every 1-2 hours with their water.
4. When mishaps take place , stay calm and keep your head in the game. There are so many variables in the triathlon, many of which you have no control over to a point. Things may happen, will happen, and you just have to keep on moving.

How to start training for a triathlon.

My background is swimming. I was a competitive swimmer from age 6 to 22. However , I never road biked until after my college years, and did not start running until after my first child was born, at the young age of 27.

To start I think you just make the decision and do it. If you can float, ride a bike, and walk you can do a triathlon.

With everything you should be realistic. Your process should be catered to yourself and your own limitation. You may take  a couple years to feel ready for your first Olympic tri. I started with signing myself up for 5k and 10 k runs and joining a bike club. I was lucky I didn't have to worry about the swim technique , which is 1/2 of the swim .

For those of you whom aren't swimmers the best book out there is

Total Immersion by Terry Laughlin.

For running I think the best book is

CHI Running by Danny Dreyer

and listening to lectures and books  by Jeff Horowitz, a triathlon coach and athlete.

WHAT IS MY MOJO??????????? (motivation)

 It is interesting to me what motivates people to do the things they do, so I ask myself the same question.

My husband asked me the other day to tell him what has possessed me to sign us up for the most grueling endurance test on the planet? He said that at mile 16 of the marathon , I better know why I signed up for this.
Well, .......I have a really long answer  for this.
There are several things that motivate me to reach this GOAL, of Ironman Coeur d 'Alene 2014.
1. I simply want to be an Ironman, and I know, by training for this race , it will require me to be the healthiest I can be physically, and mentally.
2. I want to show my family, my kids , that things that are difficult are attainable.
3. It has always been on my bucket list.
4. Exercise saves me from mental health issues :)
5. I love to swim, I love to ride , and I love the challenge of becoming a better runner.
6. I want to be a better runner.
7. I love the endorphins exercise gives you.
8. I love the excitement of the race, the camaraderie of the entire event of triathlon from the attitude of the fellow racers and volunteers.
9. I like the science behind diet and exercise which is so vital for preparation for endurance events.
10. I want to LIVE my life to its fullest and when I train and race I feel alive.

So yes , Dear husband I have a lot of mojo for committing to this process. I love you , and I am so excited to be in this together.