Post by Neversatisfied on May 18, 2007 1:43:25 GMT -5
By Dr. David Ryan, DC
Several times a year while covering lifting events, I have to deal with individuals who have pushed themselves too far. They have dehydrated themselves to the point of lightheadedness and even passing out. The athlete will start to feel lightheaded and may even stumble and fall or worse—get crushed under a heavy lift. The situation can become critical quickly if the proper steps are not taken immediately.
The effects of dehydration are more devastating then most people realize. The use of “over and/or under the counter” supplementation/pharmacological diuretics are widespread in the world of powerlifting/bodybuilding/wrestling/mixed martial arts, and their effects are the most devastating to those particular athletes trying to make weight. In some cases, diuretics have lead to death. Recently, the interest in the UFC has lead to similar problems being noted in those sports.
The problem is the effects of salt and the crossing of the blood brain barrier. You will actually change the pressure inside of your brain when you dehydrate to extreme levels. In short, it makes your brain swell, and that can kill you. Most of the time, you will die of other problems associated with neurological brain dysfunction such as a heart attack or stroke.
The basic competition scenario
You are drinking two gallons of water per day, and you taper quickly so that your kidneys continue to remove as much water from your body as possible. In some cases, you use various supplements or drugs to force the kidneys to lose even more water. The common problem is losing too much water. Then you might feel lightheaded, but instead of drinking water, you reach for the Pedialyte. Once you have ingested a salt solution, your body is still geared to quickly remove the water from the solution, and you are left with the high concentration of salt in your body. This will set off a chemical reaction in your body, and you are left with fluid problems that can be fatal. The high salt concentration will literally pull fluid off of the brain, and that is very dangerous.
Don’t make the mistake of taking in salt solutions. Drinking Gatorade or Pedialyte can actually make your situation worse. Your body has minerals in the bloodstream called electrolytes. The two main types are potassium and sodium, which occur in a 2:1 ratio, respectively. When you drink these solutions containing salt, the body can go into shock because of the ingestion of high levels of electrolytes. Several problems can occur as a direct result of consuming drinks that contain high levels of salt, and these are compounded by the use of other stimulants such as caffeine or ephedrine. Your electrolytes are even more unstable at ages past thirty and/or if you are ill or had recent trauma.
How Pedialyte or Gatorade can make you very ill
Drinking electrolyte solutions when you have signaled to your kidneys to get rid of as much water as possible is simple. You drink the solution and more and more of the salt stays behind as you continue to remove fluids from your body. Eventually, the salt content is so high that it can become imbalanced (potassium to sodium), or the high concentration of salt will suck fluid out of your brain or heart or some other organ that you might need to live.
Dehydration alone is dangerous. You don’t have to just take in salt solutions or electrolyte solutions to be in danger. Not taking in fluids at all will result in dehydration, and that is very dangerous as well.
Two terms you must learn are hypernatremia and hyponatremia. Hypernatremia is due to too little water, too much salt, or a combination thereof. Hyponatremia is due to too much water, not enough salt, or a combination thereof. The point is simple. You have a balance. Go too high or too low, and you die.
The following was taken from an article in the New York Times:
“Dr. Lewis G. Maharam, the medical director for the New York City Marathon and marathons in San Diego, Phoenix, Nashville and Virginia Beach, said this: ‘There are no reported cases of dehydration causing death in the history of world running. But there are plenty of cases of people dying of hyponatremia.’ Although Gatorade officials say that the salt in the drink prevents the over-hydrating of cells, Maharam says that Gatorade, in this case, is no better than water. Last year, one percent of New York's 35,000 runners were hospitalized with hyponatremia.”
How to spot someone who’s dehydrated
Dehydration (also available from WEB MD) can occur when the body loses too much fluid. Symptoms of mild dehydration include:
increased thirst
dry mouth and sticky saliva
reduced urine output with dark yellow urine
Symptoms of moderate dehydration include:
extreme thirst
dry appearance inside the mouth, and the eyes don’t tear
decreased urination or half the number of urinations in 24 hours (usually three or fewer urinations)
urine is dark amber or brown
lightheadedness that is relieved by lying down
irritability or restlessness
arms or legs that feel cool to the touch
rapid heartbeat
Symptoms of severe dehydration (even if only one of them is present) include:
altered behavior such as severe anxiety, confusion, or not being able to stay awake
faintness that isn’t relieved by lying down, or lightheadedness that continues after standing for two minutes
inability to stand or walk
rapid breathing
weak, rapid pulse
cold, clammy skin or hot, dry skin
little or no urination
loss of consciousness
*Be aware that diarrhea over several days can lead to dehydration. Uncontrolled vomiting leads to dehydration. Begin by drinking 8 oz of water at the top of the hour and Pedialyte or Gatorade on the half hour. See a physician if the diarrhea continues longer than 48 hours or immediately if there is any fever associated with a rash.
What to do
If someone faints: Call an ambulance (911) or defer to medical staff. No matter what the athlete tells you, if they regain consciousness, it’s time for a ride in the squad. If you don’t send them, then you are taking on a huge risk. Consider that most people don’t die immediately. It usually takes a day or two.
Do not give them any fluids if they’re passed out. They will choke and likely die on the fluids.
If they are conscious, only give them water. Ice on the back of their neck is a good idea too. Lie the person down on his or her back with the legs and feet elevated. The person should be constantly monitored for several hours by a physician for changes in condition.
Continue to monitor for (A) airway obstructions, (B) breathing, and (C) circulation.
If they stop any of the ABC’s, begin CPR immediately.
If you use an electrolyte drink, dilute it in half with water. Drink at room temperature. Only drink 8 oz per half hour.
At the Arnold Fitness Weekend, Brian Griffin, MD, and Joe Donovan, MD, have been overseeing professional athletes for many years. They closely attend to each professional physique athlete specifically. They do a particularly great job with monitoring bodybuilders with fluid problems. To date, their main concern with the bodybuilders is dehydration.
Effects of dehydration on breathing
The extreme loss of fluid affects your body’s ability to absorb oxygen. You will keep breathing, but you just can’t get enough air. The bigger you are and the more dehydrated you are, the worse this problem becomes. Another major problem which comes from dehydration is nerve misconduction. Nerve impulses will either fire too much or not at all. This can lead to a fatal situation. Each athlete is introduced to our medical staff and informed about what we expect from the competitor. Their safety is our first and only concern.
Intravenous versus ingestion (needle in your arm verses drinking)
Both take approximately the same amount of time to deliver fluids. Sure, the intravenous is a little quicker, but you have a hole in your arm and how clean is it backstage? Given all the effects, the choice is simple. Drink the water, and if you do drink any salt solution, dilute it 50/50 with plain water.
SmartWater
There is a product called SmartWater, which we use at the Arnold and Olympia for the athletes when necessary. It has no sodium in it and has lots of electrolytes to help you recover. The next time you are at the health food store, grab a bottle and remember to drink it after your next competition. I challenge you to see how much better you feel after two days.
Brian F. Griffin, MD, FACEP, DABAPM, DAAPM recommends the following guidelines as well:
“Hydration is really simple. If you’re not urinating fairly clear urine, you are dehydrated. If your eyes sting when a drop of sweat gets in your eyes, you are losing too many electrolytes BECAUSE you have lost too much water. Your body must now shed the electrolytes (that keep you alive). They are getting too concentrated because of the loss of the water in your body's effort to cool itself. Your electrolyte balance is now seriously disrupted, and even with the shedding of electrolytes, you will be at risk. This is the critical period. Rehydrate with an electrolyte-based but diluted drink or bad things will happen. There is no value in the destruction of your muscle, heart muscle included. The muscle that becomes damaged begins to disproportionably break down and release chemicals, some of which are dangerous (i.e. potassium).”
What to do if you’re cramping uncontrollably
Call 911, and start drinking room temperature water immediately.
Main steps to preventing cramping or death
Weigh yourself the morning of the competition and two days before you start to cut water.
You should never lose more than 15 percent of your body weight in one day. If you do, then drink it back, or you are risking dangerous side effects, including death.
Always drink back the amount of weight that you lose. Remember that one gallon of water equals eight pounds.
So if you started the day at 178 lbs and now weigh 174 lbs, that is four pounds or a half gallon of water that you need back. Now let’s say you started at 184 lbs and now weigh 174 lbs. That is ten pounds so over a gallon of water needs replaced. Consider that 184 – 174 = 10 pounds, and that is very close to your 15 percent danger zone.
Be aware of your danger zone and also how much water you need to replace. If you are taking water loss supplements of any kind, you need to track your weight gain closely to maintain the fluid levels in your body.
A good article to read about the subject is written by Steven L Stephanides, MD. He is a staff physician at the Department of Emergency Medicine at Eisenhower Medical Center. To read the article, visit www.emedicine.com/emerg/topic263.htm - target 1
Several times a year while covering lifting events, I have to deal with individuals who have pushed themselves too far. They have dehydrated themselves to the point of lightheadedness and even passing out. The athlete will start to feel lightheaded and may even stumble and fall or worse—get crushed under a heavy lift. The situation can become critical quickly if the proper steps are not taken immediately.
The effects of dehydration are more devastating then most people realize. The use of “over and/or under the counter” supplementation/pharmacological diuretics are widespread in the world of powerlifting/bodybuilding/wrestling/mixed martial arts, and their effects are the most devastating to those particular athletes trying to make weight. In some cases, diuretics have lead to death. Recently, the interest in the UFC has lead to similar problems being noted in those sports.
The problem is the effects of salt and the crossing of the blood brain barrier. You will actually change the pressure inside of your brain when you dehydrate to extreme levels. In short, it makes your brain swell, and that can kill you. Most of the time, you will die of other problems associated with neurological brain dysfunction such as a heart attack or stroke.
The basic competition scenario
You are drinking two gallons of water per day, and you taper quickly so that your kidneys continue to remove as much water from your body as possible. In some cases, you use various supplements or drugs to force the kidneys to lose even more water. The common problem is losing too much water. Then you might feel lightheaded, but instead of drinking water, you reach for the Pedialyte. Once you have ingested a salt solution, your body is still geared to quickly remove the water from the solution, and you are left with the high concentration of salt in your body. This will set off a chemical reaction in your body, and you are left with fluid problems that can be fatal. The high salt concentration will literally pull fluid off of the brain, and that is very dangerous.
Don’t make the mistake of taking in salt solutions. Drinking Gatorade or Pedialyte can actually make your situation worse. Your body has minerals in the bloodstream called electrolytes. The two main types are potassium and sodium, which occur in a 2:1 ratio, respectively. When you drink these solutions containing salt, the body can go into shock because of the ingestion of high levels of electrolytes. Several problems can occur as a direct result of consuming drinks that contain high levels of salt, and these are compounded by the use of other stimulants such as caffeine or ephedrine. Your electrolytes are even more unstable at ages past thirty and/or if you are ill or had recent trauma.
How Pedialyte or Gatorade can make you very ill
Drinking electrolyte solutions when you have signaled to your kidneys to get rid of as much water as possible is simple. You drink the solution and more and more of the salt stays behind as you continue to remove fluids from your body. Eventually, the salt content is so high that it can become imbalanced (potassium to sodium), or the high concentration of salt will suck fluid out of your brain or heart or some other organ that you might need to live.
Dehydration alone is dangerous. You don’t have to just take in salt solutions or electrolyte solutions to be in danger. Not taking in fluids at all will result in dehydration, and that is very dangerous as well.
Two terms you must learn are hypernatremia and hyponatremia. Hypernatremia is due to too little water, too much salt, or a combination thereof. Hyponatremia is due to too much water, not enough salt, or a combination thereof. The point is simple. You have a balance. Go too high or too low, and you die.
The following was taken from an article in the New York Times:
“Dr. Lewis G. Maharam, the medical director for the New York City Marathon and marathons in San Diego, Phoenix, Nashville and Virginia Beach, said this: ‘There are no reported cases of dehydration causing death in the history of world running. But there are plenty of cases of people dying of hyponatremia.’ Although Gatorade officials say that the salt in the drink prevents the over-hydrating of cells, Maharam says that Gatorade, in this case, is no better than water. Last year, one percent of New York's 35,000 runners were hospitalized with hyponatremia.”
How to spot someone who’s dehydrated
Dehydration (also available from WEB MD) can occur when the body loses too much fluid. Symptoms of mild dehydration include:
increased thirst
dry mouth and sticky saliva
reduced urine output with dark yellow urine
Symptoms of moderate dehydration include:
extreme thirst
dry appearance inside the mouth, and the eyes don’t tear
decreased urination or half the number of urinations in 24 hours (usually three or fewer urinations)
urine is dark amber or brown
lightheadedness that is relieved by lying down
irritability or restlessness
arms or legs that feel cool to the touch
rapid heartbeat
Symptoms of severe dehydration (even if only one of them is present) include:
altered behavior such as severe anxiety, confusion, or not being able to stay awake
faintness that isn’t relieved by lying down, or lightheadedness that continues after standing for two minutes
inability to stand or walk
rapid breathing
weak, rapid pulse
cold, clammy skin or hot, dry skin
little or no urination
loss of consciousness
*Be aware that diarrhea over several days can lead to dehydration. Uncontrolled vomiting leads to dehydration. Begin by drinking 8 oz of water at the top of the hour and Pedialyte or Gatorade on the half hour. See a physician if the diarrhea continues longer than 48 hours or immediately if there is any fever associated with a rash.
What to do
If someone faints: Call an ambulance (911) or defer to medical staff. No matter what the athlete tells you, if they regain consciousness, it’s time for a ride in the squad. If you don’t send them, then you are taking on a huge risk. Consider that most people don’t die immediately. It usually takes a day or two.
Do not give them any fluids if they’re passed out. They will choke and likely die on the fluids.
If they are conscious, only give them water. Ice on the back of their neck is a good idea too. Lie the person down on his or her back with the legs and feet elevated. The person should be constantly monitored for several hours by a physician for changes in condition.
Continue to monitor for (A) airway obstructions, (B) breathing, and (C) circulation.
If they stop any of the ABC’s, begin CPR immediately.
If you use an electrolyte drink, dilute it in half with water. Drink at room temperature. Only drink 8 oz per half hour.
At the Arnold Fitness Weekend, Brian Griffin, MD, and Joe Donovan, MD, have been overseeing professional athletes for many years. They closely attend to each professional physique athlete specifically. They do a particularly great job with monitoring bodybuilders with fluid problems. To date, their main concern with the bodybuilders is dehydration.
Effects of dehydration on breathing
The extreme loss of fluid affects your body’s ability to absorb oxygen. You will keep breathing, but you just can’t get enough air. The bigger you are and the more dehydrated you are, the worse this problem becomes. Another major problem which comes from dehydration is nerve misconduction. Nerve impulses will either fire too much or not at all. This can lead to a fatal situation. Each athlete is introduced to our medical staff and informed about what we expect from the competitor. Their safety is our first and only concern.
Intravenous versus ingestion (needle in your arm verses drinking)
Both take approximately the same amount of time to deliver fluids. Sure, the intravenous is a little quicker, but you have a hole in your arm and how clean is it backstage? Given all the effects, the choice is simple. Drink the water, and if you do drink any salt solution, dilute it 50/50 with plain water.
SmartWater
There is a product called SmartWater, which we use at the Arnold and Olympia for the athletes when necessary. It has no sodium in it and has lots of electrolytes to help you recover. The next time you are at the health food store, grab a bottle and remember to drink it after your next competition. I challenge you to see how much better you feel after two days.
Brian F. Griffin, MD, FACEP, DABAPM, DAAPM recommends the following guidelines as well:
“Hydration is really simple. If you’re not urinating fairly clear urine, you are dehydrated. If your eyes sting when a drop of sweat gets in your eyes, you are losing too many electrolytes BECAUSE you have lost too much water. Your body must now shed the electrolytes (that keep you alive). They are getting too concentrated because of the loss of the water in your body's effort to cool itself. Your electrolyte balance is now seriously disrupted, and even with the shedding of electrolytes, you will be at risk. This is the critical period. Rehydrate with an electrolyte-based but diluted drink or bad things will happen. There is no value in the destruction of your muscle, heart muscle included. The muscle that becomes damaged begins to disproportionably break down and release chemicals, some of which are dangerous (i.e. potassium).”
What to do if you’re cramping uncontrollably
Call 911, and start drinking room temperature water immediately.
Main steps to preventing cramping or death
Weigh yourself the morning of the competition and two days before you start to cut water.
You should never lose more than 15 percent of your body weight in one day. If you do, then drink it back, or you are risking dangerous side effects, including death.
Always drink back the amount of weight that you lose. Remember that one gallon of water equals eight pounds.
So if you started the day at 178 lbs and now weigh 174 lbs, that is four pounds or a half gallon of water that you need back. Now let’s say you started at 184 lbs and now weigh 174 lbs. That is ten pounds so over a gallon of water needs replaced. Consider that 184 – 174 = 10 pounds, and that is very close to your 15 percent danger zone.
Be aware of your danger zone and also how much water you need to replace. If you are taking water loss supplements of any kind, you need to track your weight gain closely to maintain the fluid levels in your body.
A good article to read about the subject is written by Steven L Stephanides, MD. He is a staff physician at the Department of Emergency Medicine at Eisenhower Medical Center. To read the article, visit www.emedicine.com/emerg/topic263.htm - target 1
