Well, from that I think it is unlikely that you were suffering from dringking too much and it is not likely that you were severely dehydrated. I guess it is possible your electrolytes were all screwed up if you were drinking water and you needed sodium or you were drinking sodium and you needed water. Hard to know from this data. Perhaps Dr. Noakes or others can give their personal experience from the medical tent as to what this presentation most commonly represents.

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Frank,
An original Ironman and the Inventor of PowerCranks

I was actually drinking from a 2.75Litre Camelbak which I premixed with:
- 4 Nuun's.
- One daily dose of RaceDay Boost ( Hammer Nurtition).

I threw it on for the bike ,as this particular event had few hydration points and I preferred to just stay aero ,for the short bike ( 40km ).

I drank roughly 1.75-2L of this on the bike ,with a separate biddon of INFINiTT (600ml).

I refrain from drinking plain water, so as to not dilute the electrolytes in my body. I will of course drink some "if" I do not have an electrolyte mixture available.

Thanks

Terry

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"You are never too old to set another goal or to dream a new dream" - Les Brown
"Discipline is the bridge between goals and accomplishment" - Jim Rohn

Well, I suspect that if Dr. Noakes shows up again he will be quite critical of your plan since you were not letting thirst be your guide and you preloaded. I would love to hear his evaluation of why you performed so badly though since there is no evidence of EAH.

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Frank,
An original Ironman and the Inventor of PowerCranks

budump !..........................:)

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"You are never too old to set another goal or to dream a new dream" - Les Brown
"Discipline is the bridge between goals and accomplishment" - Jim Rohn

I think your problem is you live in a ridiculously humid country that famously under-reports its acutal temperatures, never mind the humidity-adjusted temperature. <looks around for black helicopters>

Long time no talk. It's been far too hot here of late.

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_____________________________________________________
"Oh man, it's going to take days to kill all these people!" - Jens Voigt

Hey John :)

Yes I have been undercover !

My car thermo reported 40C outside when I returned from 15 mins at H.Village at lunch the day after (y/day).

Hoping there is something I DON'T already know, that I can learn from this thread (regarding my personal high HR problem in this extreme environment and intensity )

Best regards

Terry

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"You are never too old to set another goal or to dream a new dream" - Les Brown
"Discipline is the bridge between goals and accomplishment" - Jim Rohn

Fascinating to the physiologist, and way over everyone else's head. I am an MD and I hard a hard time getting through it. For the athlete, they need to take in salt tablets, drink electrolyte drinks and not only water, and most of all, mark their weight on their bib or write it with marker on their forearm. When they make it to the med tent or ambulance, if their weight is up, then dont give them any normal saline. The only IV they should ever get would be a sodium concentrate at low volume. As far as having a hydration strategy, this can be easily formulated by weighing onself before and after a long work out. This stuff doesnt have to be rocket science, unless you want it to be. It isn't that hard.

But Noakes is saying you don't need to take in salt tablets and you should drink to thirst.

I have come to believe the biggest problem with the debate over drinking to thirst or not it that the two sides of the argument are failing to recognize the affect which training can have on human physiology. I fully believe that we are inherently born with a thirst reflex which as Noakes argues allows us a great ability to self regulate. However I also believe that through training athletes can effectively learn to suppress this reflex to the point they effectively lose it. Lionel Sanders talked about a suppressed reflex in his recent interview (http://www.slowtwitch.com/...l_Sanders__5168.html) and I feel similarly to him. My body has acclimatized to years of distance running training without any mid-workout hydration/nutrient by shutting down thirst and hunger reflexes during intense activity. I will always hit the wall before I physically feel the need to drink and/or eat and that makes it impossible for me to follow Noakes advice.
As far as I am aware experienced athletes are far more likely to suffer from extreme dehydration while it tends to be novice athletes who get into serious trouble with overhydration. The failure to recognize these physiologic differences makes it impossible to declare one side is right and the other is wrong.

shacking wrote:

Fascinating to the physiologist, and way over everyone else's head. I am an MD and I hard a hard time getting through it. For the athlete, they need to take in salt tablets, drink electrolyte drinks and not only water, and most of all, mark their weight on their bib or write it with marker on their forearm. When they make it to the med tent or ambulance, if their weight is up, then dont give them any normal saline. The only IV they should ever get would be a sodium concentrate at low volume. As far as having a hydration strategy, this can be easily formulated by weighing onself before and after a long work out. This stuff doesnt have to be rocket science, unless you want it to be. It isn't that hard.

Weighing athletes is a good idea on paper... but the devil is in the details and execution. The method I've seen in races is basically a poorly controlled 3rd grade science experiment.

• What is the accuracy and precision of the scales being used?
• Are the scales used at weigh in the same as used in the med tent
• Are the scales rated to perform 1000-2000 measurments (and retain accuracy)
• Should the scales be calibrated during the weighing process?
• What type of resolution and accuracy is required to detect a "weight up" situation
• What is the expected rate of false positives/negatives?
• How risky is a false positive?
• Do you pre-weigh people with their street clothes?
• In the med tent do you towel dry people off before weighing them? any clothing taken off during weighing?

For example I was weighed this year at Challenge wanaka. The scale was placed on a rubber mat over grass and obviously not level. Scale was cheap bathroom dial type. Person reading the scale glanced over from their seated position to read the scale, parallax error. I had on jeans, long sleeve t-shirt, glasses, hat, street shoes... just after a lunch meal. I was recorded as 77kg. My home scale (high quality and trusted) recorded me as 67.5kg with my skin suit on 2 days prior to the race measurement. I think you can see what would go wrong with using weight as an indicator.

This stuff doesnt have to be rocket science, unless you want it to be. It isn't that hard.

I agree.

I trained for years and years - long and hard, racing 9 IM races all 9:40 or under. I never ounce really thought long and hard about hydration and nutrition. I just took in what I needed on the fly as I needed it.


I will admit that this was fine tuned over hours and hours and years and years of training. I recall a few minor bonk episode when I first got into 3 hour plus bike rides, but after that, rarely issues in training or racing.


I never cramped. I never consciously took in salt, although Gatorade was a normal and regular drink on long rides, runs and in racing.


I think a BIG part of the problem with this is that too many, are trying too hard to go too long and too hard, too soon. It took me many years of gradually building up distance and pace, to the point of even considering doing an Ironman.

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Steve Fleck @stevefleck | Blog

 Clearly, there is sodium lost in sweat, and it is only pragmatic and logical to make some effort at partial replacement. You are right, it doesn't have to be a salt tablet, it can be an alternate form of electrolyte.
We don't need a PHD to know the value of a scale. Weigh yourself before and after. It is so easy. Try not to dip under 2%. Simple. I dont really care about the ECF, and intracellular sodium. I dont care about evolutionary theory. It makes no pragmatic difference. One simple test will not only measure % dehydration, it will also lead you to a possible diagnosis of hypervolemic hyponatremia. Not complicated science... is it??

One simple way to win a debate is to exaggerate the opposing position, or your own. You are saying there was a 10kg difference in scales, that's 22 lbs. That is not commonplace or what one would typically expect. You make a good point, but you exaggerate the potential for differences. The scale at this point is the only real piece of evidence to guide emergency personell as to whether fluids should be given or not. Even sodium levels can be high or low in a dehydrated state, so even if you could check sodium in the field, it wouldnt help you alot. My guess is that by the time medical personell realize that the patient is actually fluid overloaded rather than dehydrated, it is already too late, and they have jacked them with 3-5 liters of fluid, making their brain swelling worse. I would say you do make an excellent point however, that having accuracy or precision in scales is important. I would say self reporting weight would be more accurate.

I'm curious if the good Dr. changed his views at all during the 5 years that elapsed btwn post 231 and 232.

Call it an single data point or an anecdote but I have not exaggerated the numbers from my experience. It is one example of how inaccurate the weighing system can be if used to determine weight gain during a race. For my case there would be at least 5kg of weight gain during the race that weighing would not have detected.

Bob Loblaw wrote:

I'm curious if the good Dr. changed his views at all during the 5 years that elapsed btwn post 231 and 232.

Doesn't seem like he has.

Exercise-associated hyponatremic encephalopathy and exertional heatstroke in a soldier: High rates of fluid intake during exercise caused rather than prevented a fatal outcome.

http://www.ncbi.nlm.nih.gov/pubmed/25586818

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Two wheels good. Four wheels bad.

wow - brutal abstract:
Abstract Athletes are often advised to drink in order to "fully replace bodyweight losses" in order to prevent exertional heatstroke (EHS) during exercise in the heat. There is little evidence that "dehydration" in the range experienced by athletes adversely affects thermoregulation or is the exclusive cause of EHS. In contrast it is established that excess fluid intake can cause exercise-associated hyponatremia (EAH) sometimes associated with encephalopathy (EAHE). As part of a series of experiments to determine optimal fluid replacement during exercise in the heat, we studied a group of exceptionally well-conditioned and heat-adapted members of the South African National Defence Force. A 20 year old male started a time restricted 50 km route-march in a dry bulb temperature that reached 37.5°C (WBGT of 33.6°C, relative humidity of 85%). Pre-march plasma osmolality, serum [Na(+)] and total body water measures indicated euhydration. Fluid was available ad libitum and isotonic sports drinks at 5 km intervals. Fluid intake and core body temperature (Tc) were recorded throughout while he was tracked by a global positioning system measuring distance travelled, position and speed. Comparing the total fluid intake of the soldier (12930 mL) to the rest of the participants (mean intake of 9 038 mL) up to 40 km, it is evident that his intake was 3892 mL (approximately 300 mL h(-1)) more than the mean for group. At approximately 17h14 the soldier was found lying by himself at the side of the route, 2.24 km from the finish point. He passed away the next day in a medical care facility. This tragic event provides the valuable opportunity to present data on the pacing, temperature regulation and fluid consumption of an exceptional athlete during the development of a fatal case of combined EAHE and EHS. Pacing, fluid intake, Tc and environmental condition data are presented for 5km intervals throughout the march. We propose a novel hypothesis on the possible contribution of EAHE to the development of EHS.

Self-reported weight wouldn't be more accurate. In the endurance community, just as in the general population, you will see a tendency to under-report weight.
As mentioned before, scale accuracy is critical, and with 2000 athletes at the start, often wearing more clothes before the race than after, after often times several days of 'carbo loading' etc. you're likely to not get good data. So indeed the weigh before and after is likely a very poor strategy, with the typical number of athletes seen at big races.

The soldier who died definitely had an "iron will"; pushed himself all the way to death. Don't mean to sound uncaring but he must have been very highly motivated to finish this 50 km march, to the point of pushing himself to literal physical collapse 2.2 km from the finish. Very impressive actually.

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"Anyone can be who they want to be IF they have the HUNGER and the DRIVE."

Monty has told stories here about the early days of Ironman and how they gamed the scale during a weigh in. You just can't trust the athlete to tell the truth.

Cast iron cavity inserts?

Then what you are saying is that when we find an athlete passed out, we should pump him full of IV fluids for 6 hours until a CT scan shows brain swelling? Since we have identified no reliable way to recognize hypervolemic dilutional hyponatremia in the field, since weight is somehow unreliable. Like any data, it is just data, you take it for what it is worth. It is uncorrect to totally dismiss weight as useful data. I totally disagree with you.

It's not what I'm saying, it's what you're wrongfully inferring I am saying. I haven't said either that we need to totally dismiss weight. I don't care if you totally disagree with me. You seem to infer things very fast. Maybe you need to think a bit more carefully.

now you are back pedalling a little, which is appropriate. If you studied scales, their use, with and without clothes, and all these other holes you are poking in the "use the scale" argument, you won't generally find a 22lb difference. Maybe a 5-10 lb difference. No piece of data in any equation is 100% reliable all the time. I am a doctor, I know that. I treat the patient, not the data. The point I want to make is-- the scale is probably the only useful piece of data in the field... we need to use it, albeit with the knowledge of some normal variation and also margin of error. DONT THROW AWAY THE SCALES!! I want to know how many people died in the hospital, who could have been saved if they hadnt been over-aggressively hydrated? That is the real MEAT of this story. And one we may never find out about.

From my recollection, it seems most people run into problems long before they ever reach a hospital. They hit a med tent, and get diagnosed with dehydration, in goes the IV.