7/31/17

Today…
•  Water
Water & Hydration –  Function & Needs

Strategies for •  Dehydration

–  Assessment, Causes, Effects
Optimal •  Hyper-hydration
–  Hyponatremia
Performance •  Dehydration and Exercise
–  Endurance, Strength, Mixed-Sport
•  Strategies!

Water Water
•  Arguably the most essential
nutrient •  Constitutes 60% of body weight
•  Restriction can lead to death in •  Types of body water
days –  Intracellular (inside cells)
•  2/3 of body water
–  Extracellular (outside cells)
•  1/3 of body water
•  Lymph, blood plasma, etc.

1
 7/31/17

Fluid Balance Water & Electrolytes

•  Water shifts freely in and
•  Body temperature regulation
out of the cells
•  Blood volume (plasma)
•  Controlled by electrolyte
–  Cardiovascular function
concentration
•  Sodium, potassium, •  Nerve impulse transmission
chloride, calcium –  Muscle contraction
–  Concentration gradients •  pH Balance
–  “Where ions go, water is
•  Transport of nutrients
sure to follow”
and waste

Fluid Needs
~ 1ml per kcal/day
+ sweat losses
OUTPUT 8L
Sweat
200 mL
Feces
700 mL
Skin & 11.5 L
Lungs 2.5 L

3L

1500 mL
Urine Exercise
Humidity
Normal 500 mL Heat

2

Factors Affecting Hydration
Needs
•  Environmental temperature
and humidity
•  Acclimatization of athlete
•  Altitude
•  Fitness level of athlete
•  Exercise intensity & duration
Thirst
•  GOAL of thirst: maintain osmolality!
–  Key in maintaining cellular fluid balance!!
•  Not reliable for replacing sweat volume
–  Voluntary replacement 40~60%
•  Is 100% necessary?
•  Thirst appears after 1 – 2%
dehydration
–  Performance implications?
•  Children and older populations
7/31/17
Osmolality
•  Concentration of a fluid mixture
•  Human body ~280 – 300mOsm/L
–  Tight regulation of osmolality
•  Decrease (loss of electrolytes or
addition of fluid)
–  DECREASE in thirst
–  INCREASE in urine production
•  Increase (gain electrolytes or loss in
fluid)
–  INCREASE in thirst
–  DECREASE in urine production
Ignoring Thirst?
•  Shortage of water in the body
•  Increased fluid conservation
–  Antidiuretic hormone
•  From the pituitary gland
•  Forces the kidney to conserve water (reduce
urine flow)
–  Aldosterone
•  Responds to the drop in blood pressure
•  Signals the kidney to retain sodium (water)
3
 7/31/17

Dehydration
Def: Abnormal loss of water from Dehydration is roughly quantified by the amount of
the body. body weight lost. One should consider fuel use in
this equation [~100g/hr (0.2lb) – 250g/hr (0.5lb)]…
or should we?
For example
Pre-exercise weight = 70.0 kg
Post-exercise weight = 68.5 kg
Weight Loss = 1.5 kg
How do you know if you are (1.5 / 70 ) x 100 = 2.1 %
dehydrated?

Urine Color Chart

Urine specific gravity < ~1.014 g/mL

Urine osmolality < ~600 mOsmol/kg

Worsening dehydration

4
 7/31/17

How do we get Dehydration v  ↓ Heat dissipation

v  Substrate
is inevitable !!!
dehydrated? utilization
v  ↓ Blood Volume
•  Max. fluid v  ↓ O2 & nutrient
delivery
Not drinking enough absorption v  ↑ Heart rate
= 1.2 L/hr v  ↓ Waste removal
OR
Sweating (losing) too much Ø 3 hours of exercise
could result in a 6 liter
dehydration! (~10%)
Losses =
0.5 to 3 L/hr

For example...... (De)hydration & Health

•  3hr marathon @ 1.5 L/hr sweat
•  No fluid
–  4.5 liter dehydration (10lbs)
–  In 160lb person ~ 6% dehydration
•  Maximal fluid absorption
–  3 x 1.2 L/hr = 3.6 liters
–  = 4.5L lost - 3.6L replaced
–  = 0.9 liter dehydration (2lbs)
–  In 160lb person ~ 1.2% dehydration

*avg. fluid loss following marathon = 2kg

(4.4lbs)
Noakes, http://www.sasma.org.za/?p=136

5
 7/31/17

Core Temperature
Dehydration & Health
Regulation
•  Dehydration (up to 3%)
–  Does not cause over heating
•  Exercise intensity (metabolism)
determines rise in core temperature
–  Athlete will slow down or stop before critical

Costill et. al., 1970

Warning Signs and Symptoms of Heat

Cramps, Heat Exhaustion, and
Heat Related Illness
Heatstroke

6
 7/31/17

Dehydration & Health Hyponatremia

•  Serum Na+ concentrations below the
•  “Over-drinking is not only
normal range (135-145 mmol/L)
unnecessary to maintain
–  Symptoms appear when serum sodium
thermoregulation, but it drops below 130 mmol/L
could also put people at
•  Early symptoms: bloating, puffiness,
risk for hyponatremic
nausea, vomiting, headache
encephalopathy”
•  Later symptoms: confusion,
Dr. Tim Noakes
disorientation, agitation, seizures,
pulmonary edema, coma and death
•  We will SLOW DOWN before
over heating!
How does it happen?

Hyponatremia Hyponatremia
•  How common is it?
–  Western States Endurance Run (CA)
•  Symptomless hyponatremia (plasma Na+ < •  Treatment
135mmol/L) = 30% (n=47)
»  Rogers et al. Clin J Sport Med June 2011 –  Intravenous Na+
–  Swiss studies – ultra distance
•  Swimmers = 13% •  Best to avoid it!!!!
•  Cyclists = 10% –  Do not force yourself to drink
•  Runners = 5% & 8%
•  6% of overall sample water
–  These numbers are SAME for marathon/ –  Choose beverages with some
Ironman
»  Knechtle et al. Clin J Sport Med May 2011
electrolytes
–  Swiss 24-hour Ultra (161km) Run
•  NO reports of hyponatremia (n=15) •  Most sports drinks are adequate!
–  Loss of 2.2kg, serum Na+ remained
unchanged
–  Consumed ~ 0.8L/hr
»  Knechtle et al. Phys Sportmed Dec. 2010

7
 7/31/17

HYPER-hydration! Dehydration & Exercise

•  Is “hyperhydrating” beneficial or
detrimental to exercise?
–  Sodium and glycerol studies
•  Promising results for glycerol in ultra-
distance events
–  Lower heart rate, improved time trial
performances
•  Increase in weight
•  Uncomfortable?

Is Dehydration
Dehydration & Exercise
Detrimental to
Exercise •  Endurance exercise
–  Does lead to compromised
Performance? cardiovascular function (2-3+%)
•  Higher heart rate
IF so, at what point? •  Decreased VO2max

IF so, during what type, duration, –  Decreased time to exhaustion

•  AIS cycling study (~3.5% dehydrated)
and intensity?
•  2.4L 7% carbohydrate drink versus gel
IF so, how do we prevent it? –  120min @ 50% VO2max & 8% grade
–  ↑ heart rate (12bpm)
–  ↓ time to exhaustion (13.8%)
Answer…it DEPENDS!

8
 7/31/17

Blood Volume DEHYDRATION AND PERFORMANCE

Blood volume is essential for all

cardiovascular functions

♥  Oxygen delivery
♥  Nutrient delivery
♥  Waste removal
2% dehydration
♥  Thermoregulation

♥  Blood pressure regulation

♥  Immune function
L.E. Armstrong, D.L. Costill, and W.J. Fink, 1985, "Influence of diuretic-induced
dehydration on competitive running performance," Medicine and Science in Sports
and Exercise 17: 456-461.

DEHYDRATION AND HEAT PERFORMANCE Exercise Capacity &

Dehydration

S.I. Barr, D.L. Costill, and W.J. Fink, 1991, "Fluid replacement during prolonged exercise:
Effects of water, saline or no fluid," Medicine and Science in Sports and Exercise 23:
811-817.

9
 7/31/17

Dehydration & Exercise Dehydration & Exercise

•  Mixed Sport and Motor Skills
–  Penn State study
•  2% dehydration
•  Exercise session followed by high
intensity skill drill (game simulations)
–  Results
•  2% dehydration led to impaired
shooting, and defensive drill times
•  The 6% carbohydrate group had
improved defense drill times
•  Strength
–  Little to no effect during short term
strength activities
–  UConn study
•  5% dehydration increased cortisol
release following a 10min run at 70%
and 85% VO2max
•  Cortisol will lead to greater muscle
catabolism, and fat storage
–  The cortisol to testosterone ratio was
also lower

Dehydration & Exercise Drinks

•  SUMMARY
–  At what point? •  Understanding what ‘sports’ drinks
•  Dehydration (up to 2-3+%) will not lead to heat can and can NOT do for us
related illnesses
–  No need to over-hydrate •  What should the‘ultimate’ sports
•  Endurance performance declines significantly drink do?
at about the 2-3% level
•  Motor skills (mixed-sport) performance •  What should be in the‘ultimate’
declines at around 2%
•  Cortisol release is increased while exercising
sports drink?
at 5% –  Water
–  Intensity & duration? –  Carbohydrates
•  Assuming adequate pre-hydration
–  1 hour could lead to 2%
–  Electrolytes
–  Higher intensity/hotter/more humid = > sweat –  Protein?
–  PREVENTION?

10
 7/31/17

What’s Best ??
•  Not effective (0% CHO, 0 mEq Na)
–  Dilutes blood
–  ↓ thirst
–  ↑ urine

•  Effective (4-8% CHO, 5–25 mEq Na)

–  Maintains blood osmolality
–  ↑ thirst
–  ↓ urine
Gastric –  ↑ Taste (↑ volume)
emptying •  Less effective (12+% CHO, 2-7mEq
research Na)
tells us: –  ↓ gastric emptying
–  ↓ volume
–  ↑ urine

Optimal Characteristics Sports Drinks

Product Grams CHO CHO Sodium mg Calories Sugar Source
8 ounces Concentration
•  Composition: PowerBar Maltodextrin,
–  Energy: 4 – 8% carbs Endurance
21 8.75 240 85 fructose, and
•  Divide grams carbohydrate per serving by ml per dextrose blend
serving Gatorade Sucrose,
14 6 200 56
•  1oz = 30ml Endurance glucose, and
•  For example: 1 serving = 8oz, 14g CHO Formula fructose blend
8*30=240ml Accelerade
15 6 120 80 Contains
14/240 = .06 or 6% protein,
sucrose,
–  Sodium: up to 100mEq (most are ~ 20mEq) fructose, and
–  Osmoality: isotonic (250-300mOsm) maltodextrin

•  Volume: not too much, but – it needs to Cytomax

Performance
13 5 40 52 Maltodextrin,
fructose,
taste GOOD !!! Drink dextrose

•  Temp: cold! PowerAde

15 6 53 57
•  Carbonation: no! Gu20
13 5 120 50 Maltodextrin,
fructose
•  Stimulants….etc…? Clif Shot Brown rice
Electrolyte
19 8 200 80 syrup and
cane juice

11
 7/31/17

Various Beverages How do we OPTIMIZE

our HYDRATION??
•  DRINK!

•  How much?

•  When?

•  What?

RECOMMENDATIONS Pre-Hydration Strategy

•  Environment, duration, and
intensity dependent
–  Assess losses
•  No need to match weight loss
•  Dehydration ≠ hyperthermia
•  Carbohydrates and electrolytes
for longer (1hr+) duration
activities
•  Do not force over-hydration with
water
•  Maintain hydration throughout
the day – water is BEST
•  Pre-event/training
–  Sports drinks are OK (be mindful
of hypoglycemic rebound)
•  16oz. 2hrs prior
•  8oz. within 20min
•  Volume is very individualized
–  GI Tolerance
–  Type of event

12
 7/31/17

Hydration During Exercise Rehydration

•  Goal:
•  Purpose –  To recover lost fluids and electrolytes
–  Minimize losses –  For repeat performance & immune
system function
–  Maintain electrolytes
•  Optimal Rehydration
•  Sweat trials can
–  Composition:
help determine ideal •  Less than 10% CHO
hydration –  ↑ absorption, ↑ energy, ↑ taste
–  Greater than 10%…
•  Water and/or sports •  Up to 100 mEq/L sodium
drinks –  ↑ thirst, ↓ urine
–  Taste?
–  Volume
Photo © Photos.com •  LISTEN to your thirst!

References
Prevalence of exercise-associated hyponatremia in male ultraendurance athletes.Knechtle
B, Gnädinger M, Knechtle P, Imoberdorf R, Kohler G, Ballmer P, Rosemann Senn.
O.Clin J Sport Med. 2011 May;21(3):226-32.

An intervention study of oral versus intravenous hypertonic saline administration in

ultramarathon runners with exercise-associated hyponatremia: a preliminary
randomized trial. Rogers IR, Hook G, Stuempfle KJ, Hoffman MD, Hew-Butler T. Clin J
Sport Med. 2011 May;21(3):200-3. Fluid shift @
onset of
No case of exercise-associated hyponatraemia in top male ultra-endurance exercise!
cyclists: the 'Swiss Cycling Marathon‘ Rüst CA, Knechtle B, Knechtle P,
Rosemann T. Eur J Appl Physiol. 2011 Jun 9.

Wilmore, J., Costill, D. (2008). Physiology of Sport and Exercise (4th Edition). Human
Kinetics Publishing.

Acute & chronic effects

13