Over Hydrating or Hyponatremia in Endurance Sports

Challenging Beliefs Cover

I just was finally able to read and finish a book, Challenging Beliefs, by Dr. Tim Noakes that was sitting on my desk for over a year.  Sometimes you only get to books like that when the time is right. It is a memoir of Dr. Noakes research, running, and writing career. He is most famous for writing the Lore of Running, the definitive text on running, which is sold in almost any bookstore I have ever been. In Challenging Beliefs, Dr. Noakes talks about the different topics he has studied over the years and one in particular really caught my attention. The idea that you can be over hydrated causing a state in the body called exercise-associated hyponatremia (EAH).  This can not only affect your performance but can possibly lead to death if all the conditions are right. Symptoms of EAH are nausea, vomiting cramps and the water sloshing around in your belly as you run.

It seems to be universally know the dehydration has the potential to damage your performance in endurance sports.  It makes sense. Not enough water in the body and chemical process in the body will not work the way that they should. As you lose water the sodium level in your blood begins to rise which triggers your to become thirsty. That thirst disappears after you have drank enough water and the sodium concentration returns to normal. When this potential problem was recognized there was massive education of the athletes to avoid dehydration.  There was also money to be made by sports drink companies and the advice turned into the dogma that athletes should be constantly drinking to avoid zero percent dehydration or drink before you are thirsty.

Think About Passing That Aid Station If You Are Not Feeling Thirsty

Think About Passing That Aid Station If You Are Not Feeling Thirsty

EAH occurs when an athletes drinks water in such large quantities that it dilutes the amount of sodium in the blood.  Water then moves into the cells increasing their volume. Normally this water would come out in the athletes urine but in some individuals they still secrete hormones that make the body retain the water. The increasing cell volume can put pressure on the brain as it expands making the whole situation worse and even lead to death in extreme cases.  The treatment for these people is to add sodium to their system so the water can begin to move out.

Dr. Noakes first study on the idea of over hydrating in in durance events was in 1985 but it would take until 2003 for USA Track & Field and 2007 for the American College of Sports Medicine to accept his recommendations. More studies through out the years showed consistently that over drinking can lead to EAH and negative effects on performance and the dehydration should not necessarily be so feared. In fact, another study of the 1997 New Zealand Ironman Triathlon, showed those athletes who perform best often are dehydrated to some degree at the end of a long race. Some races even reduced the number of aid stations on longer races noticing a reduction in need for drastic medical attention for the athletes. Challenging Beliefs is fascinating and worth the time to read if you are interested in athletics of any kind.

It still happens that a relatively healthy athlete dies during a marathon from over drinking. At the very least over-hydrating can negatively affect your performance. I wonder how often a person is very disciplined in their training, is in shape for a marathon, only to be sabotaged by drinking large amounts of water days before and then during the race. I have had so many patients well train, fit and ready for a marathon only make it half way through a race and have to pull out.  Maybe I should have told them to avoid over hydrating and it might have made a difference. I also think about the people who have over-trained and stressed there adrenal glands. One of the functions of the adrenal glands is to help regulate electrolyte balance through a hormone called aldosterone. Are these over-trained individuals more susceptible to EAH? It might be one more reason to be mindful over over-training.

Here are Dr. Noakes recommendations on hydration:

  • Be trained and fit enough to race the distance you have signed up for.
  • Drink when your are thirsty which tends to be between 400mls, and no more than 800mls per hour, of water. This could vary with fitness level and conditions.

Pretty simple but some many of the best ideas are.





Fatigue: Iron Deficiency, Folic Acid and B-12

Anemia could be the cause of your fatigue.

Anemia could be the cause of your fatigue.

Fatigue: Iron Deficiency, Folic Acid and B-12

Fatigue is a common complaint that brings people into my office. People complain they cannot make it through the day or can only be half as active as they used to be. Common causes of fatigue are lack of sleep, poor diet, hypothyroid, adrenal insufficiency, chronic infections, food allergies and the classic anemia.  I am going to focus on anemia because though it is often overlooked as the potential root of a patient’s fatigue. We always have to remember the basics when dealing with a patient. A great example came into the office several weeks ago:

A 70 year old female came to the office with 5 months of fatigue that came on slowly. She was forcing herself through the day and working out but felt like she was just getting old. I almost never buy the “getting old” argument. She was having cramping at night in both her calves and pain in the low back and into the left hip especially. Her diet is very good with eating mostly whole foods with only occasional indulgences, although she tended to intermittent digestive issues. She was getting a good amount of sleep each night. She had a history of thyroid issues, but recent blood testing showed no changes. Generally, in this type of patient, I find some type of chronic infection that is causing the immune system to slowly drain a person’s energy as it fights the infection. I could not find any sign.  She did test negatively to wheat and dairy so those foods were restricted. My testing showed stress in her cardiovascular circuits and an inability to make repeated muscle contractions without causing weakness.  This type of testing called aerobic testing, can reveal if there is a problem with the bodies ability to use fat for energy or its ability to deliver oxygen to the cells so the can produce energy. We tested her aerobic ability again after exposing her to nutrients such as iron, folic acid, B12 and chlorophyll. All strengthened her muscles and made her pass the aerobic function muscle testing. Within one week her energy started to return and 2 weeks later she felt much more like herself making it through the day with full energy and even being able to exercise again! Also the nightly calf cramping stopped. Clearly, her circulation was improving.  Why did this happen? We usually find this out as treatment progresses but mostly likely her impaired digestion or food intolerances (which may not be permanent) slowly caused a poor absorption of these nutrients.  Sometimes, straight forward nutrient support for formation of healthy functional red blood cells is all that is need to change a person fatigue for the better.  Muscle testing often can find a problem before it shows up on a blood test which is what happened in this case.

Red blood cells carry oxygen which allows your body to make energy.

Red blood cells carry oxygen which allows      your body to make energy.

If a person’s the ability to produce energy at the cellular level is impaired they can have a lengthy list of symptoms besides fatigue, such as brain fog, confusion, suppressed immune system, systemic body pain or fibromyalgia. Nerve cells, muscle cells, intestinal cells, cardiac cells, immune cells, all need energy to function. Anemia, especially the iron deficiency type, starts to break down the ability of the body to produce energy.  Energy production in the cells is dependent on red blood cells delivering oxygen so that a series of chemical reactions can take place that create energy (ATP) inside the cells(mitochondria).  Anything that is necessary for those reactions to take place or for the delivery of oxygen to happen must be present or it all grinds to a halt.  The most common nutrients are Iron, folic acid, B-12, B-6, B-1, B-2, B-3, B-5, magnesium, manganese, phosphorus, molybdenum, and copper.  Finding the specific nutrients a patient needs through muscle testing can narrow down what that person really needs the most.

What Makes People Like Tennis Star Novak Djokovic Gluten Intolerant

The US open of Tennis is about to start. As world number 1, Novak Djokovic, takes the court one of the great stories in sports will be told again and again. If you are unfamiliar with his story, here it is. Up to 2011 Djokovic was an excellent player, yet he was not considered to be one of the elite tennis stars. Why was this? After all, he won the Australian Open in 2008. Although he was obviously very skilled in every aspect of the game, he had a habit of collapsing in the heat and during long extended matches. Djokovic would blame it on asthma and seasonal allergies. He appeared out of shape to most of his opponents and even television announcers. This accusation was despite Djokovic’s regimented training schedule, which consumed most of his waking hours. Then in 2011 he won 3 Grand Slam tournaments, 10 Titles, and 43 consecutive matches on his way to becoming the world’s number 1 tennis player. He was so dominant that year there are few achievements in the history of sports that can even compare. What does he credit this dramatic turn around to? Are you ready for this? It’s so simple yet so epic. He changed his diet! He simply stopped eating gluten, dairy and reduced his sugar significantly. How did he know what dietary changes he needed to make? Someone used muscle testing on him to figure it out! When his body no longer had to fight through the inflammation created by consuming these foods, he was able to maintain his skills even during the longest matches. The tennis world did not see him coming.

Djokovic’s story is like many others I know. Maybe they do not become the world number one in tennis, but their lives are changed for the better in major ways when they give up foods their bodies are reacting to. Often their chronic symptoms go away and other problems go away as well-the ones they don’t tell me about. Patients often ask why and how did this happen? They say, “I used to be able to eat those foods without any trouble. Why can’t I now?” The answer can often be found in their patient history. I ask, “What was happening in your life around the time that this started?” It usually takes a moment or two of reflection before they say something like, ”I was going through a divorce,” “I was taking care of my terminally ill father,” “My child was in the hospital,” “I was working long hours at a job I hated,” or “I had just had my 3rd baby in 3 years.” You get the idea. A significant life event generally precedes the onset of their chronic symptoms. There is almost always a timeline that fits.

Stress is insidious and it destroys your body slowly. People think they are thriving on stress, but that is never the case. When they think they are ”thriving” they are really adapting. The body will eventually run out of reserves and can no longer adapt. When it does, the person has a health crisis that was sometimes years in the making. Hans Selye, in his classic book The Stress of Life, found that stress causes intestinal ulcers, suppresses the immune system, and increases the size of the adrenal glands (reason you can adapt to stress at all). We know that the cells that line the intestine are connected with something called tight junctions. Tight junctions function to keep out undigested food particles, toxins and microorganisms that naturally live in our gut. Under stress the tight junctions can start to break down allowing food, toxins and microorganisms to cross the intestinal lining. This can happen even before the classic ulcer is present. These cracks in the intestinal linings make the immune system go crazy. The immune system begins to fight this steady stream of invaders. When you have a cold or flu some of the symptoms of fatigue, headache, achiness are simply due to your body’s immune system working so hard. Mobilizing the immune system requires tremendous energy. This is some of why when you are sick you feel so bad. Symptoms are reasonable for the 1-2 weeks a cold might last, but what if you felt like that all the time. Many people do feel like that all the time, and it often it comes from their immune system battling their leaky gut.

Whole books are devoted to the subject of leaky gut, but here are some of the basics that answer our question of “How did this start?” Something causes a disturbance in the gut such as prolonged stress, poor diet, excessive alcohol, antibiotics, toxic chemical exposure, or pathogenic organisms like bacteria or yeasts. The lining of the intestines becomes compromised affecting the immune system as well as the cells that line your intestine directly. These cells called enterocytes, and their finger like projections called microvilli, are where digestion and absorption occurs. Depending on the level of damage to the intestinal lining different enzymes will no longer be produced or work effectively. It could be enzymes specific to lactose (a type of sugar many people cannot digest), dairy protein, gluten, other wheat proteins or starches to name a few. If this goes on for long periods of time the immune system begins to attack more and more strongly. If it goes on long enough, the body can even begin to attack itself. You are one of these people if you have an auto immune disorder, joint pain, thyroid problem, skin problem or any other body issue that goes away when you take specific foods out of your diet. I have seen it time and again as I work with patients to try and reverse this damage to the gut.

Why did the detrimental affects of intestinal damage start with tennis star Novak Djokovic? I am going to speculate wildly here. A patient of mine gave me a book that Djokovic wrote, Serve to Win, where he tells his tennis story and talks about how important diet is to athletic performance. There is a chapter early in the book that talks about a part of his childhood that was horrific. No child should have to endure such trauma. Djokovic grew up in Belgrade, Serbia during the War of Kosovo. He recounts a time when he was running to a bomb shelter when he tripped and was separated from his family in the darkness. When he was on the ground he looked up to see 2 laser-guided bombs blow up a building in front of him. For 78 nights at 8pm, the siren would blow and they would head for the bomb shelter as the city was bombed. “The feeling of helplessness dominated our lives,” he said. One of the worst forms of stress is feeling like you will not be able to control the situation you are in. Imagine that level of stress on a child. Not knowing day to day if he would see his family again. I think this stressful time period in his life may have started the cascade of events that led eventually to his inability to digest gluten and dairy. Of course, there easily could have been other factors involved over the years as well. There could have been compounding events such as the stress of being bombed and taking a round of antibiotics, which could create an imbalance of bacteria in the intestines; both acting together to result in intestinal damage. I do not know for sure, but I bet the start of Djokovic’s problems could be linked to the time after living through airstikes.

If you have chronic health issues think back to when it all started. What was happening in your life before the symptoms began? Using applied kinesiology and muscle testing we can quickly determine if the health problems you may be experiencing are related to your intestines. Knowing if you have to avoid a certain food makes your life easier and healthier. Using targeted herbs, supplements and lifestyle modification we often restore intestinal balance, which reduces he number of foods one needs to avoid. It is worth the effort of changing your diet because often it is the only way you will recover your health.

Finding High Quality Meat and Poultry

The farm

Your diet and the quality of the food you buy can have the single greatest impact on the health of you and you family.  The hardest part can be getting started.  I thought our first real blog post should be to direct people to resources for finding high quality food suppliers in Northern Virginia.

Our patients are always asking “Where do you by your meat?” We buy most of our meats and poultry from Polyface Farm.  Polyface Farm was made famous in Micheal Pollan’s book The Omnivore’s Dilemma. If you have not read this book it is worth your time. It may change the way you see where your food comes from and why, how it is produced, matters. Polyface is located in Swoope, Virginia (about 3 hours away) and makes deliveries to drop off points in Northern Virginia. We just put an order in at and pick up the food  Continue reading

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Dr. Luke Pietrantone
Dr. Michelle Pietrantone