Copyright: Nancy Clark MS RD CSSD  April 2013

We’ve all heard the stories about marathoners and soldiers who have died due to consuming too much water. Clearly, overhydration can be as dangerous to your health as underhydration. So what does a sweaty athlete need to know about staying adequately hydrated without stomach sloshing? Dr. Timothy Noakes’ book Waterlogged: The Serious Problem of Overhydration in Endurance Sports is an interesting yet controversial resource that addresses that question.

According to Dr. Noakes, the sports drink industry has effectively marketed a positive image (successful athletes) despite having an overhyped product (salted sugar-water). Noakes believes the sports drink industry has brainwashed athletes to overhydrate—and this has created life-threatening problems. For example, between 1983 and 1998, more than 700 cases of exercise-induced hyponatremia (overhydration that leads to low blood sodium, brain swelling, coma, and even death) were documented in the Gatorade-sponsored Ironman Hawaii  Triathlon. The participants had been  encouraged to drink copiously. Did that advice backfire? For the Comrades Marathon, participants were told to drink according to thirst. Race organizers placed aid stations every 5 km (3 miles) and cases of hyponatermia dropped.

The information in Waterlogged challenges the theory drink before you get thirsty. Noakes believes elite athletes who become champions can tolerate significant sweat loss without untolerable thirst. He contends the associated weight lost via sweating enhances performance. Others question if those athletes could run better if better hydrated!

Below are a few droplets of less-controversial hydration information to help you quench your thirst, perform well, and stay out of the medical tent when you are doing extended exercise in hot weather.

• Our bodies can deal with transient underhydration that lasts from 4 to 8 hours. In contrast, chronic dehydration leads to health issues—such as happens when elderly people are trapped in hot apartments during a heatwave.
• Most athletes feel thirsty at about 2% dehydration. At that point, they’ll start looking for water. Ultrarunners can maintain performance at 3% dehydration. (To determine your percent dehydration, weigh yourself naked before and after your workout. A one-pound drop equates to a loss of 16-ounces of sweat; 2% dehydration equates to a 3 pound sweat loss for a 150-lb. person.)
• Thirst is a powerful fluid regulator. Noakes disapproves of the advice to drink before you are thirsty because that can create problems with overhydration. Yet, others contend drinking on a schedule can help endurance athletes maintain proper hydration, as long as they do not aggressively overhydrate but rather replace fluids according to their sweat losses (as learned during training via pre-post exercise weigh-ins).
• Exercise-induced hyponatremia (low blood sodium) occurs when athletes drink excessively during prolonged exercise. It can also occur when even dehydrated endurance athletes lose significant amounts of sodium in sweat. Data from 669 ultramarathoners indicates 15% experienced low blood sodium. Of those, 24% were overhydrated, 36% were dehydrated, and the rest were in fluid balance (but not sodium balance) (1).
• The amount of sodium lost in sweat varies from person to person. Some people are salty sweaters. Athletes accustomed to exercising in the heat retain more sodium than unacclimatized athletes. (Compare the saltiness of your sweat on first hot day of spring vs. in the fall.)
• Athletes lose relatively more water than sodium, so under standard conditions, the blood sodium level can actually increase during exercise (unless you overhydrate). But with abnormally high sodium high losses, such as during an ultramarathon, blood sodium can be low even in a dehydrated athlete. Hence, sodium replacement can be a wise idea.
• The amount of sodium in a sports drink is small—and unable to counter the dilution of body fluids that occurs with over- drinking. The 220 mg of sodium in 16 ounces of Gatorade is far less than ~1000 mg sodium in 16 ounces of sweat loss.
• Noakes says evidence is lacking to prove that athletes who cramp have low serum sodium or are more dehydrated than non-crampers. He suggests muscle cramps are related to fatigue, not sodium deficiency. If sodium deficiency was the problem, wouldn’t the entire body cramp, not just one muscle?
• Exercise-induced muscle cramps occur in muscles that perform repetitive contractions. Athletes who get cramps tend to be those who do high intensity exercise, as well as those who have a history of cramping. Note: Many exercise scientists believe there are two types of muscle cramps: some related to fatigue, others related to sodium imbalance. The science of cramping lacks a clear consensus!
• Stopping exercise to stretch resolves muscles cramping. (Stretching also resolves nocturnal cramps.)
• A 2.5 oz. mouthful of (salty) pickle juice has been shown to alleviate muscle cramping within 90 seconds of drinking the pickle juice. This rapid benefit is unlikely due to changes in blood sodium levels—too quick! Noakes speculates drinking the (acidic) pickle juice triggers a reflex in the throat that lessens or stops the cramps.
• An athlete who collapses after the finish line is most likely experiencing blood pressure changes—not severe dehydration. When exercise stops, the heart stops pumping enough blood to the brain; the athlete collapses. Noakes advises to quickly raise the athlete’s feet and pelvis above the level of their heart. This aids the return of blood to the heart and rapidly corrects the situation—without any IV fluids.

So what’s a sweaty endurance athlete supposed to do during prolonged exercise? Learn your sweat rate and drink accordingly. If fluid in your stomach starts “sloshing”, stop drinking! The body can absorb about 600 to 1,000 ml/hour (women/ men). Adding carbohydrates and sodium to the water enhances fluid absorption as well as palatability and performance. Consuming “real” foods (salty pretzels, pickles, chicken broth, ham-cheese-mustard wrap) during ultra-endurance events can do a fine job of providing needed electrolytes. Just don’t get too aggressive with water or sodium intake—and have fun!

Nancy Clark, MS, RD, CSSD (Board Certified Specialist in Sports Dietetics) counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her Sports Nutrition Guidebook and food guides for new runners, marathoners, and soccer players offer additional information. They are available at www.nancyclarkrd.com. See also sportsnutritionworkshop.com.

Reference:

1. Hoffman M, Hew-Butler T, and Stuempfle K. Exercise-Associated Hyponatremia and Hydration Status in 161-km Ultramarathoners. Med. Sci. Sports Exerc. 45(4):784–791, 2013.

To see more of the finalists for the People’s Choice Award, click here: michiganfitness.org/gfa-peoples-choice-awards

Am I the only soccer player who has ever gained weight doing double workouts?

Why does my boyfriend lose weight when he starts exercising and I don’t?

For all the exercise I do, I should be pencil-thin. Why can’t I simply lose a few pounds?

Clearly, weight loss is not simple and often includes debunking a few myths. Perhaps this article will offer some insights that will lead to success with your weight loss efforts.

Myth: You must exercise in order to lose body fat.

To lose body fat, you must create a calorie deficit. You can create that deficit by:

• exercising, which improves your overall health and fitness, or
• eating fewer calories.

Even injured soccer players can lose fat, despite a lack of exercise. The complaint “I gained weight when I was injured because I couldn’t exercise” could more correctly be stated “I gained weight because I mindlessly overate for comfort and fun.”

Adding on exercise does not equate to losing body fat. In a 16-week study, untrained women (ages 18 to 34) built up to 40 minutes of hard cardio or weight lifting three days a week. They were told to not change their diet, and they saw no changes in body fatness (1). Creating a calorie deficit by eating less food seems to be more effective than simply adding on exercise to try to lose weight.

Athletes who complain they “eat like a bird” but fail to lose body fat may simply be under-reporting their food intake. A survey of female marathoners indicated the fatter runners under-reported their food intake more than the leaner ones. Were they oblivious to how much they actually consumed? (2) Or were they too sedentary in the non-exercise hours of their day?

Myth: If you do double workouts, surely your body fat will melt away.

Wishful thinking. If you are an endurance athlete who complains, “For all the exercise I do, I should be pencil-thin,” take a look at your 24-hour energy expenditure. Do you put most of your energy into exercising, but then tend to be quite sedentary the rest of the day as you recover from your tough workouts? Male endurance athletes who reported a seemingly low calorie intake did less spontaneous activity than their peers in the non-exercise parts of their day (4). You need to keep taking the stairs instead of the elevators, no matter how much you train. Again, you should eat according to your whole day’s activity level, not according to how hard you trained that day.

Myth: The more you exercise, the more fat you will lose.

Often, the more you exercise, the hungrier you get and 1) the more you will eat, or 2) the more you believe you “deserve” to eat for having survived the killer workout. Unfortunately, rewarding yourself with a 600-calorie cinnamon roll can quickly erase in a few minutes the 600-calorie deficit you generated during your workout.

The effects of exercise on weight loss are complex and unclear—and depend on the 24-hour picture. We know among people (ages 56-78) who participated in a vigorous walking program, their daily energy needs remained about the same despite adding an hour of exercise. How could that be? The participants napped more and were 62% less active the rest of their day (3). While you may be younger than the subjects in that study, be sure to pay attention to your whole day’s activity level. One hour of exercise does not compensate for a sedentary lifestyle.

Myth: You should exercise six days a week to lose weight.

Research suggests exercising four times a week might be better for weight control than six times a week. A study with sedentary women (ages 60 to 74) who built up to exercising for 40 minutes of cardio and weights reports those who did four workouts a week burned about 225 additional calories in the other parts of their day because they felt energized. The group that trained six times a week complained the workouts not only took up too much time, but also left them feeling tired and droopy. They burned about 200 fewer calories in the non-exercise parts of their day (5). Yes, they were ages 60 to 74, but the information is true for any age-group.

Myth: Couples who exercise together, lose fat together.

Not always. In a 16-month study looking at exercise for weight loss, the men lost 11.5 pounds and the women maintained weight, even though they did the same amount of exercise (6). In another study, men who did an 18-month marathon training program reported eating about 500 more calories per day and lost about five pounds of fat. The women reported eating only 60 more calories, despite having added on 50 miles per week of running. They lost only two pounds (7).

What’s going on here? Well, a man who adds on exercise will lose more weight than his partner if he’s heftier and thereby burns more calories during the same workout.  But, speaking in terms of evolution, Nature seems protective of women’s role as child bearer, and wants women to maintain adequate body fat for nourishing healthy babies. Hence, women are more energy efficient. Obesity researchers at NY’s Columbia University suggest a pound of weight loss in men equates to a deficit of about 2,500 calories, while women need a 3,500-calorie deficit (8). No wonder women have a tougher time losing weight than do men.

The bottom line

If you are exercising to lose weight, I encourage you to separate exercise and weight. Yes, you should exercise for health, fitness, stress relief, and most importantly, for enjoyment. (After all, the E in exercise stands for enjoyment!) If you exercise primarily to burn off calories, exercise will become punishment for having excess body fat. You’ll eventually quit exercising—and that’s a bad idea. (A better idea is to meet with a local sports dietitian; use the referral network at www.SCANdpg.org.)

Instead of focusing on exercise as the key to fat loss, pay more attention to your calorie intake. Knocking off just 100 calories a day from your evening snacks can theoretically result in 10 pounds a year of fat loss. One less cookie a day seems simpler than hours of sweating…?

Nancy Clark MS RD CSSD (Board Certified Specialist in Sports Dietetics) counsels casual and competitive athletes in her private practice in the Boston-area (617-795-1875). Her Sports Nutrition Guidebook and Food Guide for Soccer offer additional weight management information. The books are available via www.nancyclarkrd.com. See also www.sportsnutritionworkshop.com.

References:

1. Poehlman, E., W. Denino, T. Beckett, K. Kinsman, I. Dionne, R. Dvorak, P. Andes. Effects of endurance and resistance training on total daily energy expenditure in young women: a controlled randomized trial.  J Clin Endocrinol Metab 87(3):1004-9, 2002.
2. Edwards, J, A. Lindeman, A. Mikesky, and J. Stager. Energy balance in highly trained female endurance runners. Med Sci Sports Exer 25:1398-404, 1993.
3. Goran, M. and E. Poehlman. Endurance training does not enhance total energy expenditure in healthy elderly persons. Am J Physiol 263:E950-7, 1992.
4. Thompson, J., M. Manore, J. Skinner, E. Ravussin, M. Spraul. Daily energy expenditure in male endurance athletes with differing energy intakes. Med Sci Sports Exerc 27::347-54, 1995.
5. Hunter, G., C. Bickel, G. Fisher, W. Neumeier, J. McCarthy. Combined Aerobic/Strength Training and Energy Expenditure in Older Women. Med Sci Sports Exerc. 2013 Jan 30. [Epub ahead of print]
6. Donnelly, E., J. Hill, D. Jacobsen, et al. Effects of a 16-month randomized controlled exercise trial on body weight and composition in young, overweight men and women: the Midwest Exercise Trial.  Arch Intern Med 163:1343-50, 2003.
7. Janssen, C., C. Graef, W. Saris. Food intake and body composition in novice athletes during a training period to run a marathon. Int J Sports Med, 10:S17-21,1989.
8. Pietrobelli, A., D. Allison, S. Heshka, et al. Sexual dimorphism in the energy content of weight change.  Int J Obes Relat Metab Disord 26:1339-48, 2002.

Copyright: Nancy Clark MS, RD, CSSD  February 2013

Soccer Ladies without Monthly Menses: A Cause for Concern

Hey ladies, has your monthly “visitor” stopped coming? Some female soccer athletes feel relieved when they no longer get a monthly menstrual period. (Yes! More freedom, less discomfort, no more cramps.) They may believe having no period is a sign they are training hard, like a real athlete. Others believe they have stopped menstruating because they are exercising too much or have too little body fat. No. Many very lean soccer players who exercise hard have regular menses.

Absence of periods (called amenorrhea) can be linked to serious health problems, including loss of calcium from the bones, almost a three times higher incidence of stress fractures today and long-term problems with osteoporosis in the not-too-distant future. If you should want to start a family, amenorrhea interferes with the ability to conceive easily, and can also contribute to future problems with infertility (even though normal menses may have returned).

Amenorrhea is not sport-specific. Sports that emphasize lightness (ballet, running) have the highest prevalence. Up to 44% of these athletes may experience amenorrhea (as compared to 2% to 5% of women in the general population). Soccer players are not immune. The question arises: among a team of female soccer players, why do some of the women experience menstrual problems and others don’t? The answer may relate to nutrition. Woman with amenorrhea commonly under-eat. Their bodies have inadequate fuel to support the menstrual process, to say nothing of nurture a baby. Under famine-like conditions, menstruation can stop to conserve energy.

If you among the estimated 20% of active women who have missed three or more consecutive menstrual periods and are experiencing amenorrhea, please stop rejoicing and go see your gynecologist. Amenorrhea is abnormal. It can be a red flag for body image problems (i.e., claiming to feel fat even when emaciated), an intense fear of gaining weight or becoming fat, and restrictive eating. Amenorrhea is part of The Female Athlete Triad, along with low bone mineral density/stress fractures, and restrictive eating patterns/eating disorders. Amenorrhea can create undesired health issues.

Resolving the problem

If you no longer get regular menstrual periods and feel as though you are struggling to balance food and exercise, please get a nutrition check-up with a sports dietitian as well as a medical check-up with your doctor or gynecologist. To find a sports dietitian in your area, use the Academy of Nutrition and Dietetics referral networks at www.SCANdpg.org or www.eatright.org.

The most important change required to resume menses includes matching your energy intake with your energy output, so you eat enough to support both exercise and normal body functions. Historically, doctors gave the birth control pill to women with amenorrhea; this forced menstrual bleeding. But taking the birth control pill is a “Band-Aid approach” and does not resolve the underlying problem.

You are likely eating too few calories if you are hungry all the time and think about food too much. You can achieve energy balance by exercising a little less (add a rest day) and by eating a little more (add a healthy snack or two). Your goal is to consume about 15 calories per pound of body weight that you do not burn off with exercise. That means, if you weigh 100 pounds, you my need to eat ~1,500 calories to maintain your weight PLUS another 500 to 800 calories to replace the fuel you burned while training. That totals 2,000-2,300 calories for the entire day, a scary amount of food for some women.

Tips for resolving the issue

If eating this much sounds overwhelming to you, the following tips may help you get “back on the healthy track.”

1. Take a vacation from dieting.

If you cannot let go of your compulsion to lose weight, at least be less restrictive. Cut back on your eating by only 100 to 200 calories at the end of the day, not by 500 to 1,000 calories during the active part of your day. Small deficits can result in losing excess body fat and are far more sustainable than the food chaos that accompanies starving-stuffing patterns.

2. Throw away the bathroom scale.

Rather than striving for a certain number on the scale, let your body achieve a natural weight that is in keeping with your genetics.

3. Eat adequate protein.

When you under-eat, your body burns protein for energy. Some of the protein comes from your diet; for example, the protein in your omelet gets used for fuel instead of building and repairing muscle.  Some of the protein comes from your muscles, hence, you experience muscle wasting and that can lead to weaker bones and stress fractures. A 120-pound soccer player should target 60 to 90 g protein per day. If you think your diet might be low in protein, track your food intake at www.supertracker.usda.gov.

4. Eat a calcium-rich food at each meal to help maintain bone density.

Exercise alone is not enough to keep bones strong. Enjoy milk on cereal, low fat cheese on a lunchtime sandwich, a decaf latte in the afternoon, and a yogurt after dinner.

5. Get adequate vitamin D to help with calcium absorption and bone health.

Sunlight on the skin helps make vitamin D. If you do a lot of your training indoors or at night and get very little sunshine, be sure to choose foods fortified with D (milk, some breakfast cereals), fatty fish like salmon, eggs, and mushrooms. In the winter months, you may need to take a vitamin supplement.

6. Eat at least 20% of your calories from (healthful) fat.

While excess calories from fat are easily fattening, a little fat at each meal (15 to 20 g fat per meal, or 45 to 60 g fat per day) is an important part of a sports diet. You won’t “get fat” by eating fat. Your body uses fat to absorb vitamins A, D, E, and K; these vitamins are important for good health. To boost your intake of healthy fats, sprinkle slivered almonds on cereal, snack on a banana spread with peanut butter, enjoy salmon for dinner, drizzle olive oil on steamed veggies, and add avocado to your turkey sandwich.

Is there long-term damage?

Loss of bone density can be irreversible and lead to early osteoporosis. The younger you are, the better your chances of recovery. My advice: nip this problem in the bud now!

Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sports Dietetics) counsels active people at her private practice in Newton, MA (617-795-1875). For more information, read her Sports Nutrition Guidebook and Food Guide for Soccer: Tips and Recipes from the Pros. The books are available at www.nancyclarkrd.com. Also see www.sportsnutritionworkshop.com for online education and  CEUs.

Check out the article and video:

http://www.nlm.nih.gov/medlineplus/videos/news/Winter_Sports_011113-1.html