Hydration Blog

Individualisation - the key to optimal hydration?

Friday, June 28, 2013

Individualisation - the key to optimal hydration?

Having come across 2 interesting articles in the mainstream Running and Triathlon press recently we thought it was a good time to put up a post about just why individualisation is so important when looking at hydration.

First up; a great article by TJ Murphy on Triathlete-Europe entitled 'Does Dehydration Improve Performance?'

http://triathlete-europe.competitor.com/2013/06/21/does-dehydration-improve-performance 

In the article TJ highlights the case of legendary triathlete Scott Molina who famously struggled at the Hawaii Ironman as he battled dehydration, hyponatraemia and pacing issues for years that preventing him from winning the event, despite being amongst the favourites to do so.

He also explores the conclusions in Dr Tim Noakes' 2012 book, 'Waterlogged' that suggest most athletes tend to over, rather than under consume fluids during exercise and that this is largely as a result of the marketing hype created by drinks companies keen to drive up sales of their products. 

We think that one of the best things about this article is the fact that it does acknowledge that whilst Dr Noakes is likely to be very correct in his assertions that a lot of athletes do over drink (thanks to the efforts of the industry to encourage this habit), Murphy also points out that for an individual like Molina who reportedly had a sweat rate of up to 3 litres per hour(!) working out what you need in your own circumstances is the key to optimising your own performance. 

As it turned out in the end Molina did some great homework to understand his own physiology better and came up with an individualised approach to fluid intake and pacing that eventually allowed him to go on and win the Ironman in 1988.

The article closes with a fantastic quote suggesting that "Everyone keeps searching for some perfect answer for matching hydration and performance, but perhaps Mucky Sludge [Scott Molina's nickname] blazed the path for us long ago. We each have to figure this out for ourselves."

The other article is on pg 27 of the latest UK Runners World magazine (August 2013) and highlights the case of Ultra marathon runner Sophie Power who drank herself into a dangerously hyponatraemic state in a multi day race. This was despite that fact that she was taking 'electrolyte' tablets that turned out to actually have a very low sodium content. She was lucky to survive the incident due to the quick thinking of the event medical team but others have tragically lost their lives in similar circumstances. 

So what does all this show?

Well, we think that understanding your own hydration needs based on factors including your own sweat rate, sweat sodium concentration, the length, intensity and environmental conditions of your training and races is key to determining what will best work for you. With some intelligent preparation, research and organised trial and error you can find a hydration and electrolyte strategy that will help you to perform at your best and stay healthy. 

In essence it's exactly why we are making sweat testing more widely available to athletes and producing the only multi-strength range of electrolyte drinks in the world - H2Pro Hydrate - so people can tailor their replacement strategies more closely to their own needs. 

Cramping and Electrolyte Loss - what is the link?

Monday, March 18, 2013

We get asked all of the time about whether electrolyte replacement (particularly sodium) can help with athletes who get cramp. It is always frustratingly hard to explain why sometimes electrolyte supplementation can be like a complete miracle cure for cramps in certain people, however for others it does not help much at all....

We believe it is likely to be because although electrolytes are implicated in some instances of muscle cramping, many other factors such as fitness level, fatigue and the type of movement patterns being undertaken can also be the cause.

In terms of our own experience in the field with 1000's of athletes we tend to find that a more tailored approach to sodium replacement (with drinks closely matching sweat composition, taken to thirst) reduces incidences of cramping in those who tend to suffer cramping late on in endurance events or in competitive games/matches/tournaments after prolonged periods of sweating. This effect tends to be magnified in hot weather or when intensity is very high, and is more pronounced in athletes with high sweat sodium concentrations and/or very high sweat rates. We have also noted some anecdotal experiences of athletes who used to suffer with cramps when taking in high volumes of plain water or low sodium fluids (because they were scared of becoming dehydrated) - and these athletes often see a reduction in cramping when they have either reduced total fluid intake to more normal levels or taken in additional electrolytes with fluids (or a combination of the two). 

Results with athletes who cramp at seemingly random times tend to be less positive (when using sodium supplements alone) - however programmes of targeted stretching, sports massage, more progressive training overload and general dietary improvement can be helpful in reducing the likelihood of cramping occurring in these individuals.

Because of all this we thought we'd share a review article that does a very good job of explaining the possible links between cramping/fatigue and sodium depletion - and it is well worth a read if you are interested in finding out more about the topic as a whole.

The reference is: 

Bergeron, Michael F. “Muscle Cramps during Exercise V Is It Fatigue or Electrolyte Deficit?” Current Sports Medicine Reports: Supplement-Sodium Balance and Exercise 7.4 (2008)

And the full article can be read of downloaded from this link



A genetic reason for why some people lose more salt in their sweat than others?

Wednesday, November 21, 2012

A genetic reason for why some people lose more salt in their sweat than others?

We recently came across an interesting study from the USA which offers a very good explanation of why some people are high salt sweaters and others low or normal.  This group in question biopsied the skin of 3 groups of people - those with cystic fibrosis (known to have high levels of sodium and chloride in their sweat), those with high sweat sodium levels but not CF sufferers and those with normal sweat sodium levels.  Those with CF and high salt sweaters had a lower abundance of a protein called cystic fibrosis transmembrane conductance regulator (CFTR).  This protein is responsible for absorption of chloride and sodium in the sweat gland so a lower level means less is absorbed back into the blood and more is excreted out in sweat.  


Ref:

Brown MB.  Low abundance of sweat duct Cl channel CFTR in both healthy and cystic fibrosis athletes with exceptionally salty sweat during exercise.  Am J Physiol Regul Integr Comp Physiol. 2011; 300: R605–R615

More Evidence For Drinking To Thirst, as well as consuming electrolytes, especially if you lose a lot of salt in your sweat....

Wednesday, October 31, 2012

More Evidence For Drinking To Thirst, as well as consuming electrolytes, especially if you lose a lot of salt in your sweat....

Reading Tim Noakes' book "Waterlogged" does make you think hard about whether one should simply respond to their thirst stimulus rather than try to replace lost volume. I generally do agree with this idea (it seems quite a lot of athletes make the mistake of drinking too much pre, during and post exercise) although do disagree with his observation that sweat sodium levels do not very dramatically between humans. There is in fact plenty of evidence that there is a massive variation (infact in a later blog I will describe the genetic basis for the variation that results in lower number abundance of a protein called CFTR).
Just recently while trawling the sea of evidence related to this topic I came across a study done in Georgia, USA in 2011.  The group looked at thirst responses in cystic fibrosis (CF) suffers, non-CF active people with high sweat sodium levels ('salty sweaters') and controls with average sweat sodium levels. After forcefully dehydrating them by 3% of their body weight in a heat chamber they showed that thirst responses were equal across all groups.  They concluded that the thirst mechanism is maintained despite the large variation of sweat sodium losses, blood osmolality and plasma volume between the groups.  They concluded, relevant to our fundamental principle of sweat sodium replacement, that "....sweat Na+ losses observed in SS (non CF but high salt sweaters) and CF provide empirical support for models and recommendations for consuming electrolytes during prolonged exercise to guard against the potential for hyponatremia in salty sweaters..."

So in agreement with Noakes, drink to thirst. No matter what your sweat sodium losses your thirst appetite will be preserved.  But drink what you lose.

Dr Raj Jutley. 

Ref: 
Brown MB et al. High-sweat Na+ in cystic fibrosis and healthy individuals does not diminish thirst during exercise in the heat.  Am J Physiol Regul Integr Comp Physiol. 2011; 301: R1177–R1185

Placebo effect?

Thursday, July 26, 2012

We received the email below from a customer a few days ago and thought it would be a good idea to share his question our response and his subsequent reply online - especially given the amount of interest there has been in sports drinks since the BBC Panorama documentary highlighting the British Medical Journal's latest thinking on sports drinks was aired on July 18th....

We'll follow on with a more in-depth comment on the BMJ article and also on Dr Tim Noakes' book 'Waterlogged' soon. 

Question:

Hi Guys,

I would be interested in your thoughts on the lack of need for hydration products as currently proposed by Tim Noakes. He says there is no need for anything like this. He also says that sweat with high levels of sodium are just because of high intakes of sodium and to cut this out also means that the sodium levels in sweat will in turn drop. I went to the talk at all 3 motion and have been using your products and have got on fine so far but I’m wondering if this is placebo or not?

 

Our response:

Thanks for your email.

It's a very interesting question, one that we're being asked more and more here is our take on it: 

Firstly whilst we have a huge amount of respect for Tim Noakes and his work he has a record of being quite provocative in his approach to certain topics. He likes to challenge exists dogmas and this is both healthy and necessary in science. However, sometimes he adopts quite an extreme position (in this case that sports drinks are completely unnecessary and that the companies that sell them are conning us) partly, I think, to get people to sit up and take notice and this certainly works!

For starters we do agree with his point that listening to thirst is a good idea. Too many people do force fluid down too frequently and suffer as a result and in our advice to athletes we take a similar position. 

However, one of the main points that we'd disagree with in his new book is in the way it dismisses that there is a large variation in sweat sodium losses; saying that they are relatively similar between people and mainly driven by dietary sodium intake. Our own data (which is probably one of the most comprehensive sets available) shows a much wider variance in sweat sodium values (approximately 19mmol/l to 84mmol/l) in well trained athletes than he quotes in the book (around 20-40mmol). 

It's certainly possible that at the extremes when people are taking in huge volumes of sodium, or virtually none at all, the body could respond by losing more or less in sweat but the fact remains that the main mechanism for regulation of sodium is in the kidneys absorbing or excreting more in urine. From the large numbers of people we have tested (some of whom in professional rugby and football teams all eat similarly controlled diets to one another yet still show this wide variation in sweat sodium levels) it is clear there must be something other than just sodium intake dictating sodium loss in sweat and it would appear that this is genetics. 

On a personal level as I explained in the talk at All3Motion one of the biggest drivers for me in getting my own sweat tested many years ago and looking into this topic further was that I had found by trial and error that by taking in lots of sodium in races I a) stopped cramping (as I had done a lot beforehand) and b) generally my performances improved dramatically. The consistent way in which this happened (and from listening to the experiences of other athletes we've tested and talked to over the years) leads us to strongly believe it cannot just be put down to a placebo effect.

Also, although Dr Noakes is very sure in his opinion that sodium loss has absolutely nothing to do with cramping a lot of anecdotal evidence would suggest otherwise. For sure we don't believe it to be the only factor involved but the amount of athletes who have stopped cramping when we've upped their sodium intake in endurance events is significant. Again our own data from sweat tests and questionnaires shows a statistically significant correlation between athletes who report that they cramp regularly and the fact they tend to have higher sweat sodium levels. This may not offer definitive 'proof' of a link but it ties up with enough anecdotal experience to be taken seriously.

As with a lot of topics in science and sports performance if you search hard enough you can definitely come up with a lot of evidence to prove and disprove most theories. Do we agree with Dr Noakes that many of the big sports drink companies have 'hyped' the efficacy of their products in order to sell more of them? Absolutely. Do we think that there is no benefit to be derived from intelligent use of certain supplements (such as sodium) to prevent performance dropping off as the body gets depleted during extended periods of exercise? No. 

Kind regards

Andy

Subsequent reply:

Thanks for the very detailed reply. It’s refreshing to get that sort of detail.

For my experience with your products I have not suffered any cramps this year since I started taking them. 

This year I have run Ultras, 40, 50 and 100 miler and all using your 1000mg product. I found they helped with hydration and absorbtion of food which is something that I think gets little coverage and is vital.

In the Cardiff 50 this year at mile 46, I came across a guy who could not stand, let alone walk due to massive cramping.  He was actually trying to call his wife as he was going to withdraw as he was in so much pain.

Luckily for him I had your tablets freshly prepared from the last aid station and I made sure he drank the majority of my bottle, I left him alone to deal with his pain and carried on hoping that he may be able to stumble the remaining 4 miles.

Well I'll be! He came flying past me about 10 minutes later saying I had saved him and the drink was an elixir of life! This really pleased me but because I was now being beaten by Lazarus I had to step up my game as there was no way I was going to be beaten by someone who was practically DNFing 10 minutes earlier. Needless to say we both finished in just over 8 hours and I did beat him and came 28th. He was all over me with emotion at the finish line and kept telling everyone he could how I had saved him. In fact it was your product that saved him I just happened to have some ready and was willing to share.

I used it on the 100 I finished 2 weeks ago and has no issues at all although my ankle did swell up like crazy due to terrain etc but I finished in 24.08 and beat myself up for ages for not going under 24 hours but I knocked 2 hours 27 off my 85 mile time from 2 years ago and ran 15 miles further and on harder terrain and elevation so that cant be bad! I have also got my mate Max Dillon who came 3rd at Cardiff on to the product and he loves it too and has had no issues.

Regards,



Creative uses of H2Pro Hydrate.....Nutrichef add them to a smoothie...

Friday, May 18, 2012

We thought we'd share this one. 

We hear of people using H2Pro Hydrate tablets in some creative ways from time to time; adding them to carbohydrate drinks to boost the sodium content or mixing them in 50/50 with flat coke and water to create a very effective caffeinated, carb drink for racing. But this is definitely the most sophisticated use we've come across so far. 

What's more it's from a very well respected source in the world of nutrition; Barbara Cox, CEO of Nutrichef (who incidentally you can follow on twitter @NutriBarbara), and she's been adding it to her smoothies....Thanks for the heads up on this Barbara....

H2Pro Smoothies:

Dissolve 1 table in 500mls water

Add 1 banana

Add handful of strawberries and blueberries

1 tbsp Chlorella (sea algae for protein)

1 shot wheatgrass juice (I use live frozen wheatgrass shots)

Whizz all together in the blend and voila….gorgeous!

It sounds like a really good post exercise recovery drink (plenty of carbs from the fruit, fluids and electrolytes from the H2Pro Hydrate and water and some protein) We're going give it a try once we figure out where to get some Chlorella from!





H2Pro Hydrate at the Patrouille Des Glaciers

Thursday, May 10, 2012

The Patrouille Des Glaciers (PDG) is one of the worlds toughest ski mountaineering races. Held every 2 years in the Alps near Zermatt, Switzerland it is an event with military origins and in 2012 a group of British soldiers headed out to take on the challenge - using H2Pro Hydrate to keep their fluids and electrolytes topped up in a very harsh, unforgiving environment. This is what they had to say about their experience:

"Despite having limited time to prepare we used H2Pro during the flight to Switzerland 48hrs prior to the race which undoubtably helped with our basic hydration. During our training day before the race we tested the race concentration to confirm suitability. Not only did the product keep us hydrated during a long and arduous day but I'm convinced it helped us adjust to the altitude and acclimatise quicker. Although the race was stopped due to avalanches I am sure H2Pro mitigated our lack of environmental training and acclimatisation."

Hydration at high altitude can be an issue due to the dryness of the air and sweat losses whilst ski mountaineering can be very high as it requires a lot of clothing to be worn to protect against the elements yet work rates are very high. Having H2Pro Hydrate in the water they were carrying also helped to stop it freezing up in sub zero temperatures.

We will be supporting the British team in 2 years time when they will get a second chance to take on the PDG - hopefully this time without the avalanche risk that cut this years race short. 

Lee Shannahan with his H2Pro Hydrate and the Matterhorn in the background:

The Ultimate Sport Drink? Possibly not.....

Tuesday, April 24, 2012

We were interested to read an announcement that someone in the US has created the "ultimate sports drink" with its own spin on the ideal electrolyte mix


This time, the EX5 drink puts in a much higher level of potassium than seen in most sports drink - in fact 7x higher than Gatorade and almost 9x higher than Powerade.  It's an interesting concept because unlike appropriate sodium supplementation, nowhere in the scientific literature has it ever been demonstrated that potassium supplementation in sports hydration confers any benefit.

What's more, average sweat losses of potassium are 150 mmol/L so it would take around 16 litres of sweat to become potassium deficient and that's not likely to happen in a typical training session or race no matter how hot it is if you're eating a regular diet.  We're not really big believers in this one.......not with a potassium load that high and a sodium load of only 5 mmol/L.  The lowest sodium loss we've tested in over 300 tests done in house on athletes is 19 mmol/L so there is no way EX5 will replace losses of the lowest salt sweater....

Hydration at the Malaysian Grand Prix.....

Tuesday, March 27, 2012

The Malaysian Formula 1 GP is considered to be the toughest race on the F1 calendar with the heat and humidity taking its toll on the drivers and race crew. Not surprisingly, according to a recent press release Lucozade prepared a special race formulation drink specific to the Mclaren drivers Button and Hamilton http://paddocktalk.com/news/html/story-186284.  Helen Cowie, Technical Director, GlaxoSmithKline Research & Development admits that '....drivers can lose up to three kilos in sweat – roughly five per cent of their body weight......' But  as the drivers are restricted to 1 litre of drink in the cockpit it is imperative that every drop contributes to performance.  

Although the article is based upon science and supports the basis of what we do at Precision Hydration, it fails to mention that Button and Hamilton (and for that matter every single F1 driver on the start grid) have sweat sodium losses that are genetically determined and vary upto 8-fold. Getting this sodium content in the drink is important as sodium is what determines retention of water in the body.  Bespoke hydration in motorsport is not exclusive to Lucozade either as at Precision Hydration we've been doing it since 2009.  In fact our very first client was an endurance rally driver from Kenya who would typically almost pass out on Day 2 or 3 in the heat despite drinking litres of water.  He was tested using the Precision Hydration sweat sodium analysis system and found to be a very high sodium sweater.  With drinking water alone he would dilute his blood sodium leading to water intoxication (mild hyponatraemia).  On bespoke sodium replacement drinks he is now extremely competitive. Since his success our regular clients include Tuthills Porsche Team, David Brabham (ex-F1 and Le Mans winner) and Bradley Smith in Moto2 as well as numerous drivers in GT racing and rallying where the cockpit temperatures can be incredibly high. 

Hyponatraemia in marathon running; featured in the Telegraph - comments from Dr Jutley...

Monday, March 26, 2012

Taken from the Telegraph 26th March 2012:


The article reports the dangers of over-drinking which it claims 'can be deadlier than dehydration'.  The article is actually talking about a potentially fatal but little recognised condition called Exercise Associated Hyponatraemia (EAH) or 'water intoxication' where athletes develop low sodium levels in their blood.  This comes about from replacing sweat sodium losses with low sodium drinks or worse still water alone. With EAH water moves into the brain causing swelling. The athlete typically suffers from poor coordination, confusion, vomiting and often collapse. 

A study published only this year by two London universities showed that 12% of London Marathon runners were planning on a drinking strategy that put them at risk of EAH and that only 35% actually understood its cause and effects.

So how do you go about preventing it? Firstly you have to understand who is at risk of developing it and what conditions predispose to it. The table below shows these factors (ref: Rosner and Kirven, CJASN, 2007)
 
Exercise duration >4 h or slow running/exercise pace
Female gender (may be explained by lower body weight)
Low body weight
Excessive drinking (>1.5 L/h) during the event
Pre-exercise overhydration
Abundant availability of drinking fluids at the event
Nonsteroidal anti-inflammatory drugs (not all studies)
Extreme hot or cold environment
 
The other crucial factor (not really mentioned in the Telegraph article) is to appreciate how much sodium you are losing in every litre of sweat. 

You can either have this done at a lab using absorbent patches applied to your body which are then sent off to the lab for analysis once you saturate them with sweat. Alternatively you can have a Precision Hydration sweat analysis done at our centres http://www.myh2pro.com/sweat-testing in UK or Canada and soon in New Zealand. For those unable to take the test we can also estimate what your losses are via a quick questionnaire. 

Call us on +44(0)1273 900277 and we can take you through this over the 'phone. 

The results allow us to recommend which H2Pro Hydrate product should be right for you. From our own work and current published work the average athlete's sweat sodium loss per litre is 920 mg.  Considering that most sports drinks provide far less than this (Hi-5 Zero provides 500mg/litre; Gatorade 450mg/litre; Powerade 225mg/litre for example) you can understand why even drinking these can result in net sodium loss with the risk of developing EAH.  We avoid this problem by supplying drinks with 250, 500, 1000 and 1500 mg of sodium per litre to cater for all athletes so EAH is less of a possibility....


 

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