Dear Fellow Runners and Friends . Important Note To take care while running ( Its more for people like us who are not professional runners ) :- This note i am sending to all for making our future running more and more cheerful and enjoying. This note I am writing for the benefits of all fellow runners who generally miss most of the below points. I am a Full Marathon Runner and Half marthon runner since last two years . Even I have participated in Javadu Hill Trail Marathon. I strongly felt we all should spend some good time understanding the sport of marathon running with all in-depth technicalities. Looks most of us are running with half baked knowledge and informations. I would like to share my experience of 7th Dec 2014 chennai Marthon. I felt this was one of the best marathon organised by Chennai Runners under able leadership of our race director VPS. I finished my Half Martahon confortably at 2 hours 22 minutes . Done proper stretching and taken lots of photograph with fellow team members . Finished by breakfast after 30 minutes of the race. Till that time I was perfectly ok. After 45 minutes of the Run ,I started getting dizziness and slight headache and not able to move . I taken 1hour of rest below a tree and slowly moved toward my house . I was worried ,so I have done detail research over website and spoken to several experts (doctors and experts from abroad ) . Following Points for your information and knowledge :- a) Most of us do the stretching before the start in a hurry , It should be done properly for all muscles with proper timing. I do proper mobilising all muscles then doing stretching( holding 20 seconds each poistion). b) This time my pace was little fast and to compensate my sweating I have taken more hydration at all station. -- Looks taking more liquid is also not suggested . Important is taking balanced electrolyte. I doubt whether we look into this matter seriously . The below document will give some highlight to key points . c) We should minimum walk for 15 to 20 minutes after the half and full marathon before we do stretching . -- In my case we have directly went for stretching which was usually told to us by experts . d) In my case the problem would have happened only due to two reason i) Postural hypotension or ii) Hyponatremia The details are given below -- Please spend some time reading the note carefully . Otherwise like me anybody can get into this problem in future. i) Orthostatic or postural hypotension Runners and athletes who collapsed after marathon develop very low blood pressure only when standing (exercise-associated postural hypertension, or EAPH). This is caused by physiological changes that begin the moment the athlete stops running or walking after exercise and to which dehydration does not contribute. We know this because the moment these collapsed athletes lie flat, or better, with their legs and pelvis elevated above the level of the heart (“head down”), their symptoms instantly disappear.4 Thus, if the symptoms occur in athletes who are not thirsty and can be reversed instantly without fluid ingestion, the condition cannot be due to dehydration. Rather, EAPH must be due to the relocation of a large volume of blood from the veins in the chest and neck (which fill the heart and ensure its proper functioning) to the veins of the lower legs (which lie below the level of the heart) and therefore fill whenever an athlete stands. One of the physiological costs of bipedalism is that it made it more difficult for exercising humans to regulate blood pressure when standing, because more than 60% of the blood in circulation is contained in large veins that are situated below the level of the heart. If this volume increases abruptly at any time, especially on cessation of exercise, it will cause EAPH to develop. Two factors cause this translocation immediately after the exercise terminates. First, the muscles in the calf, the contraction of which empties blood from the leg veins pumping it toward the heart, stop working. As a result, the action of this “second heart” is lost, causing blood to pool in the legs. Second, exercise impairs the bodily responses to any sudden reduction in blood pressure. This response requires the rapid activation of the sympathetic nervous system, which raises the blood pressure by increasing the resistance to blood flow in many organs, including the muscles of the legs. But endurance training reduces the sensitivity of the sympathetic nervous system to respond to such sudden stresses. Those athletes who do not develop EAPH are able to prevent this relocation of blood volume from the center of the body to the legs, which begins the moment exercise terminates, in part because they activate an appropriate response of their sympathetic nervous system the moment they stop exercising. The symptoms of EAPH are caused by this sudden onset of a falling blood pressure, which results in an inadequate blood supply to the brain (cerebral ischemia). The symptoms of cerebral ischemia are dizziness, nausea leading perhaps to vomiting, and a transient loss of consciousness (fainting). These symptoms persist until the blood flow to the brain is restored by an increase in blood pressure. Usually this occurs when the athlete falls to the ground and lies flat, thereby relocating a large volume of blood from the legs (and intestine) back to the center of the body. This sudden return of blood to the heart rapidly improves heart function and restores blood pressure to the appropriate postexercise value (100 to 120/60 to 80 mmHg), which is usually slightly lower than the accepted normal (110 to 140/60 to 90 mmHg) for resting humans who have not recently exercised. The point is that dizziness, fainting, and nausea are the symptoms not of dehydration but of an inadequate blood supply to the brain. “The most common benign cause of collapse is low blood pressure due to blood pooling in the legs after cessation of exercise (as in postural hypotension, heat exhaustion, or syncope). This condition is treated by elevating the feet and pelvis until symptoms improve” B) Overhydration and Hyponatremia Hyponatremia (low blood sodium levels) is one of the most common medical complications in long-distance training and racing and is the cause of a large number of race-related fatalities. The exact mechanism behind hyponatremia is not clear, but it is known to be associated with the over-consumption of hypotonic fluids (like water). It is important to note that hyponatremia can develop from drinking too much fluid before, during, and even after the race. Furthermore, hyponatremia can also develop from over-drinking sports drinks, despite the fact that most contain sodium. Signs and Symptoms of hyponatremia Although the signs and symptoms of hyponatremia have been described as similar to those of dehydration. The only true symptom of dehydration is thirst. Symptoms associated with hyponatremia include: • Disorientation • Confusion • Headache • Muscle weakness • Nausea and vomiting If left untreated or misdiagnosed as dehydration, hyponatremia can progress to seizure, brain swelling, pulmonary edema (fluid buildup in the air sacs of the lungs), comatose, cardiorespiratory arrest, or death. What is hyponatremia and what are its physical effects? Hyponatremia means a reduced blood sodium (salt) concentration. When the sodium level falls below a particular level , it creates, in mild cases, a general clouding of consciousness not unlike the slowing of brain function that occurs in drunkenness. Nausea and vomiting as well as lightheadedness and dizziness are frequently observed with mild cases. The brain swells as the sodium level gets lower which results from the general state of fluid overload. In the most severe cases, the athlete lapses into unconsciousness, develops epileptic-like seizures and may stop breathing or suffer cardiac arrest. Fluid overload of the lungs may produce pulmonary edema that leads to shortness of breath and coughing up blood-stained sputum. In marathon and half-marathon athletes suffering from hyponatremia, I have observed gross swelling of the hands and forearms in runners with serum sodiums of 130. If you can’t get your rings off at the end of the run, your serum sodium may be low. How and why do distance runners get hyponatremia? When you run or walk long distance, blood is shunted to the legs; less blood flow goes to the kidneys. Therefore salt regulatory hormones ADH and AVF inappropriately increase causing the kidney to make the athlete concentrate their urine with salt and retain the free water. Even Gatorade, Poweraide and all Sports Drinks or IV NS will therefore increase free water and lower serum sodium. Giving salt during the run may in fact be protective and it reminds runners about hyponatremia so that they will not overdrink! By drinking too much fluid during prolonged exercise, athletes therefore develop this dangerous condition.. How can marathoners make sure they are getting enough fluids but not so much as to be at risk for hyponatremia? Recent scientific research has shown that drinking only when you are thirsty is the best prevention. If participants are drinking no more that 1 cup (8oz) every 20 minutes while on the course they will have enough fluids. The risk of dehydration, even in the heat, is far less than developing hyponatremia. What should be done for a stricken runner? The best treatment of the hyponatremia of exercise is prevention. After suspected, if mild, doing nothing and stopping drinking for a while is best.. Given time, the body will start to get rid of the fluid excess by increasing urine production. Full correction of hyponatremia requires that the athlete gradually ingest some salt over the next 6 hours. Given the participant 1 salt packet under the tongue is a good start toward their treatment. All patients suspected of having hyponatremia are transported to the hospital with an IV lock or NS at KVO (keep vein open) only so as to have access for meds if seizures develop. Oxygen should be given to provide maximum 02 saturation to a brain that may be undergoing swelling. IV Fluids are not to be given since the kidney will take the salt out, retain the free water and thereby worsen the hyponatremia. Hospital personnel will take a STAT serum sodium and determine treatment based on that level. The physicians may choose to manage the condition by replacing the lost salt with a very concentrated [3 percent] salt solution given intravenously at a very slow rate [less than 50 ml of fluid per hour; they may start with a 100cc bolus]. This hypertonic saline is usually given in a hospital setting with proper monitoring. What should not be done to a runner with hyponatremia? Athletes with an altered level of consciousness should never be given intravenous fluids until it has been determined that the individual is not suffering from hyponatremia. We need more people to understand that the mild levels of dehydration experienced by modern marathoners does not cause loss of consciousness. Giving fluid to hyponatremic athletes will, at best, worsen the condition and delay recovery. At worst, it may produce respiratory and or cardiac arrest as a result of a sudden worsening of the brain swelling. Pain Relievers Recent medical research has shown that non-steroidal anti-inflammatories (NSAIDs) like Advil, Motrin, Aleve, ibuprofen, naproxen, etc. may be harmful to runners’ kidney function if taken within 24 hours of running;These NSAIDs are thought to increase the possibility of hyponatremia while running long distances due to their decreasing blood flow to the kidneys and interfering with a hormone that helps the body retain salt. Therefore it is recommended that on race day (specifically beginning midnight before you run) you do not use anything. Following guidelines found over internet : • Follow the fluid recommendations….drink only when thirsty. • Favor a sports drink that has some sodium in it over water, which has none. • In the days before the race, add salt to your foods (provided that you don’t have high blood pressure or your doctor has restricted your salt intake). • Eat salted pretzels during the last half of the race. • Do the salt! Carry 2 (two) small salt packets with you (steal from your favorite fast food restaurant), and before the race and again during the last half of the race (marathon or half marathon) consume a single packet under your tongue. • After the race, drink a sports drink that has sodium in it and eat some pretzels or a salted bagel. • Stop taking non-steroidal anti-inflammatories 24 hours before your race and do not start again until a minimum of 6 hours after finishing the race. Hyponatremia presents a particularly vexing problem for runners and race medical staff, because many of its symptoms -- throbbing headache, nausea, cramps, and dizziness -- mirror those of dehydration. But the standard treatment for dehydration, pushing fluids by mouth or intravenously, can prompt the brain or the lungs to swell, which can produce seizure, coma and death in a person who is severely hyponatremic. Instead such a person should receive an IV with a concentrated sodium solution, a diuretic medication to speed water loss, and an anti-convulsive medication, in case of seizure.In more moderate cases, he added, doctors should simply restrict fluids and encourage salt consumption and wait for the person to pee off the extra fluid. How Much Water Is Too Much? For many years now, the American College of Sports Medicine (ACSM) has recommended that athletes drink four to eight ounces of fluid every 15 to 20 minutes of running. Furthermore, they warn that greater than a 2% reduction in body weight due to dehydration will impair performance. These recommendations were based on early studies (Wyndham and Strydom) suggesting that the level of dehydration determines the body temperature response to exercise and thus, the development of heat-related illnesses. Heat-related illnesses would not only be detrimental to performance, but could also be dangerous and potential fatal. Thus, guidelines for hydration during exercise stressed the importance of drinking as much as possible, whenever possible, to prevent any instance of dehydration. • The maximum rate at which the intestines can absorb fluid is, on average, about 600 mL (or 20.3 fl oz.) per hour. The kidneys can only excrete fluid at a rate of about 800 mL/hr in males and closer to 600 mL/hr for smaller females. If fluid is ingested above these rates, it will be retained and may cause a number of problems associated with hyponatremia. • Many races feature a particular sports drink or beverages and marathoners often receive the message that they need to drink a lot and drink often to prevent dehydration. While you don’t need to, and shouldn’t, skip the aid stations completely, it is important to go in with a plan. If you find you are gaining weight during your runs, then you are drinking too much and should appropriately reduce your fluid intake. If you are losing weight but not feeling thirsty, it means you don’t need to worry much as long as you start adequately hydrated and replace fluids upon completion. There are clearly opposing views on proper hydration protocols for endurance exercise. Hopefully, this article brought to light the real danger of over-consuming fluids while participating in long races, but I am sure it has also left many confused on what to do about hydration. The take-away message is that it is important for each athlete to know their individual sweat rate and have an individualized hydration plan for a variety of races and seasons. ---------------------------------------------------------------------------------------------------------------------------- Following confusions still not answered and would like experts on marathon running to answer for the benefit of all :- a) How all the below electrolytes are compensated during the Run . The Gatorade -- what we use while running got only sodium . What about other minerals which is required while running . Most of the time the hydration station will be empty for full marathon runners ( which happened to me in Aurovill marathon ) The important element of potassium and other minerals how to compensate. Looks aboard they take electrolyte capsules . Few details given below. How safe they are some experts from chennai runners to tell us. Electrolytes are similar to laundry soap in your washing machine; although soap doesn’t make your washer run, it is necessary to get your clothes clean. Like laundry soap, balanced electrolytes are necessary for your digestive, cardiac, muscular and nervous systems to function well. Electrolytes are sodium (Na+), potassium (K+), calcium (Ca 2+), magnesium, (Mg 2+), chloride (Cl-), phosphate (PO4 2-), bicarbonate (HCO3-), and sulfate (SO4 2-). Sodium, potassium, magnesium and calcium are the four major electrolytes that maintain the body’s fluid balance. As a side note, the + and – symbols mean these minerals are ionic. Their ionic nature gives the electrolytes the ability to carry electrical energy to keep the body’s systems functioning. Why is electrolyte balance important for runners? For a runner, keeping your electrolytes balanced is key for successful training and optimum performance. If your electrolytes are imbalanced, you could potentially compromise the success of your next run because of muscle fatigue or cramping. Along with the more frequent muscle cramps in the legs, stomach cramps or side stitches can also be the result of an electrolyte imbalance. Other electrolyte imbalance symptoms are: muscle spasms, dizziness, fatigue, nausea, constipation, dark urine, decreased urine output, dry mouth and foul breath, dry skin, muscle weakness or stiff and achy joints. Electrolyte balance and cramping While running you lose electrolytes through your sweat, mainly sodium and potassium. Potassium permits the movement of fluids and nutrients across your cells’ membranes, thus allowing them to carry on their metabolic activities such as contacting muscles. Without sufficient potassium, your muscles cells can’t generate the necessary nerve impulses that control muscle contraction. Cramping is the body’s way of letting you know the electrolyte tank is empty and it cannot continue; it’s like a car running out of gas. Even you’ve never experienced cramping, electrolytes need to be replenished after sessions longer than a hour to facilitate optimal recovery. A note on sodium Just because sodium is an electrolyte, don’t assume your daily sodium consumption will replenish your electrolyte loss from your run. First, sodium causes water retention. Consuming sodium alone and not in combination with other electrolytes may cause severe swelling of the hands, feet and ankles. Second, the body monitors electrolyte losses during the run through hormones. After a run, if sodium is consumed in high amounts without other electrolytes to balance, it neutralizes the hormonal system and disrupts the bodies regulation processes. Sodium should be consumed in combination with other electrolytes to assist proper electrolyte balance. Electrolyte Options Now that we understand the function and importance of replenishing your electrolytes, we can discuss the best possible options to replenish quickly and efficiently. Of course, you can always opt for electrolyte drinks like Gatorade and Powerade, but those often contain high amounts of simple sugar. When you’re replenishing electrolytes throughout the day, you don’t want to be consuming high amounts of simple and artificial sugars. It is observed that lots of marathon runners abraod take electrolyte supplements during run ( how safe expert to comment ) a) Hammer Fizz: Calories 10 (per serving)- calcium 100mg, magnesium 50mg, sodium 200mg, postassium 100mg b) Nuun: Calories 3 calcium 13mg, magnesium 23mg, sodium 360mg, potassium 100mg c) Nathan Catalyst: calories 0 calcium 26mg, sodium 135mg, potassium 60mg d) Hammer Endurolytes (1 capsule) calcium 50mg, magnesium 25mg, sodium 40mg, potassium 25mg e) SaltStick Electrolyte Cap calcium 22mg, magnesium 11mg, sodium 215mg, potassium 63mg Request every runnner to get the expert opinion before taking their own way of running . The above content are only for information. It will be great if chennai runners can give in-depth knowledge on this in their next edition of Rundown magazine. a) Proper mobilising and stretching exercise ( proper time ) b) How to take electrolyte -- Balancing all minerals required during run. How much people should take to avoid dehydration and hyponatremia c) The issues runners may face after the run. I have observed most of the medical team available not exposed to issues related to marathon problems . d) When to do the post stretching exercise to avoid Postural hypotension issues . We have entered into running for keeping ourself healthy for long and happy living. Dont you think we all need full clarity from clarity from experts ( qualified ) . Note to Peter -- It will great if you can through some insight to above confusion. Have a great and healthy running Anil Menon
Posted on: Mon, 08 Dec 2014 11:09:02 +0000
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