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The Bottom Line on Hydration
Athletes are (mostly) well-informed about the need for optimal hydration. Long ago are the days when skipping water was thought to ‘toughen’ an athlete. It seems most people are well aware of the “eight 8-ounce glasses of water per day” mantra.
Yet, many questions continue to swirl around this topic, especially with our tendencies to overdo what’s good in moderation - yes, even too much water can be a bad thing. We’ve gone from dehydration to overhydration in a few short years, and now our focus is shifting from the effects of too little water to an overabundance of water.
Too much water can become dangerous, quickly. Known as hyponatremia, this is a condition that can sneak up on anyone, from walkers to runners.
What Is Hyponatremia?
Hyponatremia is a condition in which the salt in the bloodstream has been diluted by water. More specifically, the bloodstream has too much water and too little salt in it, typically brought about by drinking too much water, too quickly in healthy people.
Under normal circumstances, the body will regulate the amount of salt in the blood within a very specific range. As one drinks water, the body is able to make adjustments in volume (urination) and maintain an optimal level of sodium in the blood.
However, consuming too much water, too quickly will outpace the body’s ability to regulate bloodstream water content, and the water ‘seeps’ into the surrounding tissues of the body, including the brain.
Very generally, this isn’t a huge deal for most of the organs in the body, however it is for the brain. The brain has very little room inside the skull for swelling. As the brain swells with water, the tissue is pressed against the skull, and the brain can becomes dysfunctional and damaged. Obviously this is not good, but luckily it takes some pretty intense effort on the part of an individual to cause this. At its worst, hyponatremia can lead to death. At the minimum, it can leave one feeling dizzy and nauseous.
While death from hyponatremia is very rare it does occur and should therefore be addressed. While only the most extreme cases are reported, chances are many runners become hyponatremic to some extent, but we only hear about the most extreme incidents.
Who Gets It?
Generally, women who spend approximately four or more hours on the course are the most likely to become hyponatremic. Why? There are a few theories for this. The first is that women are more vigilant about hydration than men, and women are more likely to follow advice from healthcare professionals and coaches. Therefore, women end up consuming more water than men.
Another theory is that women that develop hyponatremia don’t fair as well clinically as men do. You can blame this on the female hormone estrogen, which researchers think limits the brain’s ability to move potassium out of its cells, which is a response to the influx of water into brain cells in hyponatremia. Young women have a 25% greater chance of serious outcomes (brain damage & death) than postmenopausal women, who have much lower levels of estrogen.
However, all of this does not exclusively qualify only younger women who spend 4 hours on the course. Anyone could become hyponatremic, regardless of age and gender or time spent on the course.
What Are The Symptoms?
Initial symptoms include:
Later symptoms include:
These symptoms can be confused with dehydration, and sometimes people are treated for dehydration when in fact they have hyponatremia. The key here is that treatment for dehydration will make someone feel much worse during or after treatment. Ideally, someone who isn’t doing well and experiencing these symptoms would be seen in a health care setting where some simple, yet detailed testing could occur.
How To Avoid Hyponatremia
Follow these tips for safe and effective hydration strategies!
Here's a video covering why you should add electrolytes to your drinking water: