Too Much Water May Be Deadly for Athletes
By THE ASSOCIATED PRESS

Filed at 11:50 a.m. ET

Runners, hikers, bikers, even soldiers on long maneuvers should think twice before reaching for that water bottle: A study confirms that drinking too much can be dangerous, even deadly, for endurance athletes.

Researchers who studied 488 runners in the 2002 Boston Marathon found that 62, or more than one in eight, had a serious fluid and salt imbalance from drinking too much water or sports drinks. Three of them had extreme imbalances.

One 28-year-old woman died after the race from the condition, called hyponatremia, in which the excess water dilutes the salt level in the body too much.

''More is definitely not better when it comes to fluids, but it's a hard message to get across,'' said Leslie Bonci, director of sports nutrition at Pittsburgh Medical Center.

Endurance athletes have long been warned about getting dehydrated, and many tend to drink more on race day than they do during training.

The study was reported in Thursday's New England Journal of Medicine.

The researchers, led by Dr. Christopher Almond, a cardiologist at Harvard Medical School and Children's Hospital Boston, tested Boston Marathon runners' blood after the race and collected information on their condition, race time and liquid intake.

They found hyponatremia was most serious in runners who gained substantial weight -- 4 1/2 pounds to 11 pounds -- from drinking lots of water along the route. Extremely thin runners also were at high risk. Runners who drank sports drinks, which contain very little salt, were not less likely to develop hyponatremia.

Bonci and Almond said a good way to prevent problems is for athletes to weigh themselves before and after training sessions. If they gain significant weight, they should cut back on water intake until they find the right balance -- long before race day.

The goal is simply to replace water lost to sweating.

Hyponatremia can begin with confusion and lethargy and progress rapidly to twitching, seizures, stupor, coma and death.

Severe cases are believed to have become more common with the growing popularity of endurance sports. In recent years, hyponatremia has killed several amateur marathon runners, as well as competitors in the Marine Corps Marathon.

This year's Boston Marathon will be on Monday.

It is true, but I would be more worried about dehydration. I am not a Dr. but you really, and I mean really, have to try hard to drink too much.

http://www.nycc.org/mb/Thread.aspx?B...900&TP=1&C=(17)

The hyponatremia is caused by the exercise, not drinking the water, in any case the solution is to add salt to the water. Gatorade already contains a fair amount of sodium/potassium.

Actually, follow the Boston Marathon this Monday; I can almost gaurantee that several people will collapse from acute hyponatremia, particularly given the warm temperatures predicted. As you exercise you sweat and lose water as well as electrolytes, particularly sodium. If you replace the sweat losses with plain water, you gradually dilute your salt reserves. This can lead to cramping, nausea and vomitting in mild cases, seizures and death in severe cases. I recall deaths due to hyponatremia in either last years Boston Marathon or the year before... As another responder correctly stated, drinking gatorade helps. Ultraendurance athletes (ironman distance triathletes, for example) will take "salt tablets" to prevent these complications. www.e-caps.com is just one source of these supplements.

Danny

In addition to racing bikes I am a triathlete and we (my training partner and I) were discussing this from articles in Tri magazines about four years ago. Everyone is behind again...like with aerobars!

Me too. I generally lose a pound or two during a long hot ride, despite drinking as much as a liter an hour if it's really hot and sunny. Can't imagine someone gaining 4-11 pounds during an event, but I guess anything is possible.

It can happen easily both ways. You can become hyponatremic from only drinking water. All you have to do is drink enough to dilute your blood sodium levels enough. The exercise + water combination just makes the whole problem worse for some athletes.

A couple of points. CTS just sent an email on the subject to all its clients, which pointed out that the main issue is the sodium balance, not liquid intake. So if you're drinking Gatorade or the equivalent, the issue shouldn't arise; the danger is drinking plain water. Second, the full article in the NY Times, at the risk of sounding "elitist," pointed out that the risk was primarily for marathoners taking over 4 hours, who stopped at water tables to drink. Faster runners "drink on the fly" and its almost impossible to drink too much that way, so the recommendation was to not stop, stand still, and drink, rather drink as you run. Lastly, the issue is less applicable to cyclists who drink from the water bottles they're carrying, because the amount of water is self-limiting. (Again, racers don't really count, since it is hard to find a lot of time during a race to drink, esp. during crits...) By extrapolation, those at risk would be riders on charity-type rides where you can stop frequently and refill bottles or backpack bladders.

Given the crazy to reduce salt intake, it's not all that suprising.

That's an important point that people have to make when giving recommendations to athletes. I think the new dietary guidelines that came out this year do say that athletes may need more than the recommended amounts of sodium in the diet, but I can't remember for sure. I know that I saw it in something that recently came out...mabye it was in the dietary guidelines. In any case, hopefully most athletes will realize this and take it into consideration when planning out nutrition strategy for races.

Did a ride Saturday where the rest stops had Powerbar Endurance packets to mix into the water bottles. Was surprised to find that it tasted much saltier than the Gatorade or Cytomax I normally use. I actually prefer it to sweet and sticky taste, and like the idea of getting more salt on the long rides.

Sunday I mixed a "pinch" of salt into my Gatorade (600 ml bottle), and that seems to taste about the same...I like it and will continue to add the salt now. G'ade has a higher electrolyte "endurance" version out as well now, but haven't tried it yet.

I started using Power Bars "Endurance" mix about 7 months ago and have been very happy with it. Tastes good enough and seems to have a good balance of sodium, carbs etc. Performance recently had it on sale for $13 a can, so I stocked up. Does anyone know where I can get electrolyte tabs from? and how much/how often to use them?

Hey OCRoadie, your in Fountain Valley huh, well i am based out of HB, what club do u ride with, let me know if you ever want to tear up some roads.

email- pingpongsorcerer@earthlink.net

Contrary to views expressed here, drinking regular gatorade or similar will NOT protect you in ultraendurance events. Gatorade was designed for short events of up to a couple of hours, not ultraendurance events.

Gatorade has relatively low sodium, at 120mg/L. As a comparison, the new "endurance" formulation has 800mg/L sodium. That's a pretty major difference.

I use gatorade for long events, but add plenty of salt (a good 3-4 pinches /L), and make sure I eat salty foods if it is a really long event (eg 8hrs+).

Studies I have read suggest that drinking too much has a worse affect on performance than drinking too little, although both are clearly bad.

I buy Gatorade in powder form, so I can obviously mix it how I like