I have a friend who does Adventure Racing with his wife. They are otherwise healthy and in their early 40s. Recently after doing combined off-road running and biking work-outs lasting 4 hours or so they both have been experiencing swelling of their hands and feet. More background info: they live in Florida where the temps have been in the 80s but they are both climatized to the weather and in excellent physical condition. Their nutrition for long work-outs has been diluted 1/2 strength gatorade, water, pretzels, powerbars, and fruit. When I think of swelling of the extremities I think of water retention because of excessive sodium intake. I am hesitant to tell him to drink more free water as this may turn him in the opposite direction and lead to a dilutional hyponatremia. I tend to think maybe his choice of nutrition may be the problem. I would appreciate any insight or advice to help direct them further. Thanks in advance.
I get major swelling in my legs after long workouts, or days on my feet. I have talked with many athletes and some of them think im crazy and the others (pro-cyclists and triathletes) know exactly what I am talking about. After a long, hard effort it is common to have swelling throughout your body. I dont know nutritionally how to fix the problem, but I do use medical compression stockings to aid in recovery. I hope that puts them somewhat at ease to know that others experience the same crazy issue!
My legs swell after long workouts. Everything swells when I use Gatorade endurance and it’s not hot out (too much salt). That being said, you can get swelling from hyponatremia as well. It doesn’t seem like the people in questions are using a lot of salt in their workouts, so it’s hard to say.
Jodi
“you can get swelling from hyponatremia as well”
Yes, but where in the onset of symptoms do you expect the swelling to occur. Fortunately for these 2 individuals I am talking about, they are not experiencing the other classic symptoms of hyponatremia (fatigue. weakness, lightheadedness, dizziness, cramps, nausea, vomiting, muscle aches, or headaches).
Thanks Dr. Jodi 
This happens to me when training for IM distance or marathons. My feet swell terribly every night during heavy volume training. I’ve worked with a nutritionist on it and was told to eat more prior to a workout and during the workout. He thinks that it may be a sign of stress on my adrenal system, and that ingesting more might stress my body less, as I didn’t used to eat during training. But the eating hasn’t changed much. I am also now taking salt in long workouts and races longer that a half IM, just to make sure I don’t go hyponatremic. I too put on compression socks when it gets really bad.
My hands also swell on any bike ride longer than 2h. I have a picture from the finish of strongman this year where I look like me – with some giant human’s hands. I think I gained 10 lbs during Kona last year - all on one bottle/hr of fluid.
Sorry I don’t have more help to offer, but it’s certainly not rare. It does seem odd that it’s happening to both of them! I think the first thing I would suggest is that they stop diluting the gatorade and see if that helps. I think for some of us it’s just a fact of life that we will have to endure as endurance athletes.
RR
My hands swell during long runs, especially during the summer. This was especially a problem when i was doing marathon training. I’ve discovered that when i take salt tablets, I don’t have the same problem. I’d suggest that they try a couple of salt tablets every hour and see if that helps.
Happens to me frequently during long workouts, or workouts during hot conditions, or even if I’m going for a forty minute hike along the beach during the summer.
I’ve never really been able to wear my wedding ring while I run or race because the hand puffiness is always there, regardless of nutrition at the time.
I just got back from DC where it was warmer and more humid than SF and my ring was totally wedged on my finger where normally it is very loose.
My feet/ankles also puff up after long runs too. The scales go up for a day or two then drop back down.
clm