lesson in salt, water, and advil

Salt, Water, and Advil on your racecourse – or Yes, Yes and NO.

The Average American consumes approximately 3.6 grams of salt daily and current federal guidelines for sodium intake is 2.3 grams per day. The American Heart Association recommends 2 grams. What many folks miss at the cellular level is that both sodium and potassium are the two ions that your body uses every second of the day at the cellular level. While it is relatively simple to get your daily supply of sodium most folks do not get enough Potassium and you need 4.7 grams daily in order to function optimally. Having the optimum ratio of these elements lowers the incidence of cardiovascular disease and allows optimal membrane potential at the cellular level. Bananas, peaches, prunes, apricots, honeydew melon or cantaloupe, and OJ all contain good sources of potassium.

Blood sodium must be maintained at a level of 135mmol/L and this value is typically easy to maintain without any dietary changes. For runners, the complication comes when someone would be running or walking slowly for a long time, while consuming a lot of water. This can create a condition called hyponatremia. While the article Responsible Drinking on the Trail (Dr. M Hoffman, Ultrarunning, March 2010) states that this condition has been responsible for five fatalities in the US and UK they also write that 30% of the runners at 2009 Western States 100 mile run, who participated in the author’s research, were positive for signs of hyponatremia.

For runners, hyponatremia means low salt. We lose salt is sweating and we can (with great effort) dilute the amount of salt that we have in our bodies by consuming large amounts of water. When you have a lot of water and not enough salt in the body, fluids begin to shift in your system and the results can be catastrophic and life threatening. You need not have a complete class in physiology to get a handle on how this works though. If you are sweating a lot, out for a long time, and throwing in the water as you go – then you need to keep your eye open for crucial signs of what is sometimes call ‘water intoxication”.

Dr. Hoffman lists a number of Danger signs: [additions mine] “Your body would not lose the 2% of its weight you would expect on your longest run but would stay the same weight or gain weight during the run. Your body’s water is changing location and you’ll see swelling, [all over], but especially hands, feet, face – [rings and shoes may be tight.] You would see mental status changes as fluid causes brain cells to swell too. [This would look like stumble; mumble, fumble and you would have to look at their other symptoms to ensure you did not think - dehydration. Recall that people call this condition water intoxication because of the mental status changes you see in people.] This person may also feel sick, [feel nausea and be sloshing from all the water they are hauling in their stomach. Urine output would be beyond the “clear, constant and copious” realm that we expect in hydrated folks as the kidneys are now doing all they can to solve a fluid overload condition.] This is an emergency medical condition that requires immediate attention and complications can include kidney failure.” [They need medical intervention and you take them off of water while you get them help.]

NO Pain reliever on race day. I see it all the time and even among folks who should know better but the more I read and listen on this subject the more I feel compelled to advise you to not use pain reliever on race day. Here is a short list of reasons. You need to stay in tune with your body and prophylactic use of pain reliever, particularly NSAID’s, (non-steroidal anti-inflamatories) has been proven DANGEROUS to runners and their bodies. If you are sore the next day you may choose to take OTC pain reliever in standard dosage with water if you and your physician say it’s OK. Running with ibuprofen (Advil), or naproxen (Alleve) in your system may truly hurt you on race day.

By limiting prostaglandins that normalize blood flow you may tax your kidneys. Your basic over-the-counter drugs may seem benign to you, but they do block important biochemical’s called prostaglandins and these do a great number of things in the body – including dilate the blood vessels to your kidney. Remember that your kidneys are something that you need, and rely on, to maintain the electrolyte balance in the body, maintain fluid balances and eliminate wastes. These NSAID’s (by blocking prostaglandins) may increase your blood pressure at a dangerous time to do so – when running – and this could trigger a TIA or CVA (stroke). NSAID’s block the enzyme cyclooxygenase that protects the heart and thus may pose greater risk to the cardiovascular system as well.

Cyclooxygenase helps protect the stomach lining from digestive acids and so when NSAID’s block the enzyme you may experience nausea, cramping, diarrhea or bleeding. Studies indicate that NSAID’s may increase the risk of Hyponatremia or “water intoxication” a problem with electrolyte imbalance.

There is some new research which says that you might take one baby aspirin every day or every other day – see the link at our FB site for the literature on this preventative for everyone to learn more - then ask your DOCTOR.