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| Hi - thought Bikram/Hot Yoga people (or very active athletes) might find this of interest. Follows some of what people here have said about sodium levels too.
Maria
New York Times
April 14, 2005
Study Cautions Runners to Limit Their Water Intake
By GINA KOLATA
After years of telling athletes to drink as much liquid as possible to avoid dehydration, some doctors are now saying that drinking too much during intense exercise poses a far greater health risk.
An increasing number of athletes - marathon runners, triathletes and even hikers in the Grand Canyon - are severely diluting their blood by drinking too much water or too many sports drinks, with some falling gravely ill and even dying, the doctors say.
New research on runners in the Boston Marathon, published today in The New England Journal of Medicine, confirms the problem and shows how serious it is.
The research involved 488 runners in the 2002 marathon. The runners gave blood samples before and after the race. While most were fine, 13 percent of them - or 62 - drank so much that they had hyponatremia, or abnormally low blood sodium levels. Three had levels so low that they were in danger of dying.
The runners who developed the problem tended to be slower, taking more than four hours to finish the course. That gave them plenty of time to drink copious amounts of liquid. And drink they did, an average of three liters, or about 13 cups of water or of a sports drink, so much that they actually gained weight during the race.
The risks to athletes from drinking too much liquid have worried doctors and race directors for several years. As more slow runners entered long races, doctors began seeing athletes stumbling into medical tents, nauseated, groggy, barely coherent and with their blood severely diluted. Some died on the spot.
In 2003, U.S.A. Track & Field, the national governing body for track and field, long-distance running and race walking, changed its guidelines to warn against the practice.
Marathon doctors say the new study offers the first documentation of the problem.
"Before this study, we suspected there was a problem," said Dr. Marvin Adner, the medical director of the Boston Marathon, which is next Monday. "But this proves it."
Hyponatremia is entirely preventable, Dr. Adner and others said. During intense exercise the kidneys cannot excrete excess water. As people keep drinking, the extra water moves into their cells, including brain cells. The engorged brain cells, with no room to expand, press against the skull and can compress the brain stem, which controls vital functions like breathing. The result can be fatal.
But the marathon runners were simply following what has long been the conventional advice given to athletes: Avoid dehydration at all costs.
"Drink ahead of your thirst," was the mantra.
Doctors and sports drink companies "made dehydration a medical illness that was to be feared," said Dr. Tim Noakes, a hyponatremia expert at the University of Cape Town.
"Everyone becomes dehydrated when they race," Dr. Noakes said. "But I have not found one death in an athlete from dehydration in a competitive race in the whole history of running. Not one. Not even a case of illness."
On the other hand, he said, he knows of people who have sickened and died from drinking too much.
Hyponatremia can be treated, Dr. Noakes said. A small volume of a highly concentrated salt solution is given intravenously and can save a patient's life by pulling water out of swollen brain cells.
But, he said, doctors and emergency workers often assume that the problem is dehydration and give intravenous fluids, sometimes killing the patient. He and others advise testing the salt concentration of the athlete's blood before treatment.
For their part, runners can estimate how much they should drink by weighing themselves before and after long training runs to see how much they lose - and thus how much water they should replace.
But they can also follow what Dr. Paul D. Thompson calls "a rough rule of thumb."
Dr. Thompson, a cardiologist at Hartford Hospital in Connecticut and a marathon runner, advises runners to drink while they are moving.
"If you stop and drink a couple of cups, you are overdoing it," he said.
Dr. Adner said athletes also should be careful after a race. "Don't start chugging down water," he said.
Instead, he advised runners to wait until they began to urinate, a sign the body is no longer retaining water.
The paper's lead author, Dr. Christopher S. D. Almond, of Children's Hospital, said he first heard of hyponatremia in 2001 when a cyclist drank so much on a ride from New York to Boston that she had a seizure. She eventually recovered.
Dr. Almond and his colleagues decided to investigate how prevalent hyponatremia really was.
Until recently, the condition was all but unheard of because endurance events like marathons and triathlons were populated almost entirely by fast athletes who did not have time to drink too much.
"Elite athletes are not drinking much, and they never have," Dr. Noakes said.
The lead female marathon runner in the Athens Olympics, running in 97-degree heat drank just 30 seconds of the entire race.
In the 2002 Boston Marathon, said Dr. Arthur Siegel, of the Boston Marathon's medical team and the chief of internal medicine at Harvard's McLean Hospital in Belmont, Mass., the hyponatremia problem "hit us like a cannon shot" in 2002.
That year, a 28-year-old woman reached Heartbreak Hill, at Mile 20, after five hours of running and drinking sports drinks. She struggled to the top. Feeling terrible and assuming she was dehydrated, she chugged 16 ounces of the liquid.
"She collapsed within minutes," Dr. Siegel said.
She was later declared brain dead. Her blood sodium level was dangerously low, at 113 micromoles per liter of blood. (Hyponatremia starts at sodium levels below 135 micromoles, when brain swelling can cause confusion and grogginess. Levels below 120 can be fatal.)
No one has died since in the Boston Marathon, but there have been near misses there, with 7 cases of hyponatremia in 2003 and 11 last year, and deaths elsewhere, Dr. Siegel said. He added that those were just the cases among runners who came to medical tents seeking help.
In a letter, also in the journal, doctors describe 14 runners in the 2003 London Marathon with hyponatremia who waited more than four hours on average before going to a hospital. Some were lucid after the race, but none remembered completing it.
That sort of delay worries Dr. Siegel. "The bottom line is, it's a very prevalent problem out there, and crossing the edge from being dazed and confused to having a seizure is very tricky and can happen very, very fast," he said.
Boston Marathon directors want to educate runners not to drink so much, Dr. Siegel said. They also suggest that runners write their weights on their bibs at the start of the race. If they feel ill, they could be weighed again. Anyone who gains weight almost certainly has hyponatremia.
"Instead of waiting until they collapse and then testing their sodium, maybe we can nip it in the bud," Dr. Siegel said.
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Expert Yogi
Posts: 5098
 
Location: Somewhere in the Mountains of Western NC | Thank you Maria, that was an interesting article. I'm sure there will be more studies and data available soon. It reminded me of something that happened to some horses several years ago near my area. They were on this long trip and at the end, the owners let the horses go to a lake to drink water before they had a chance to cool off. Anyway, about 50 horses dropped dead at the water drinking pond. I think they call this fondering (not sure, don't know horse lingo) but you are suppose to let them cool completely before letting them drink water. Anyway, interesting. |
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| I always felt it funny that we started to drink water due to fear of dehydration. Wouldn't are bodies tell us, not our worries. You don't see animals drinking for the hell of it, unless they, like us were put in that position, like the horses. I felt this way about five months ago and stopped the constant water drinking and my kidneys are much happier and I feel stronger. It looks like the water addiction falls into something like a ciggeret addiction. Thanks for the article. |
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| This is pretty silly. The fact is that far more people suffer from dehydration than hyponatremia. The relatively few people that get hyponatremia are usually "bad" endurance athletes and drunks trying to sober up. If you were a properly trained and conditioned athlete, you would be running more and drinking less during the race and rehydrating properly before and after the race. Most seasoned marathoners plan their water breaks and control their H20 intake.
Water is good for you and you should drink a lot of it. Probably more than you already do. You have to drink A WHOLE LOT to get hyponatremia. Most people don't drink near that volume of water unless they are undertaking something like a marathon and are not in proper condition.
Articles like this raise people's fear unnecessarily about something that is relatively safe. I wouldn't be worried about this unless you are bringing gallon jugs of water into your Bikram class and drinking the whole thing during the 90 min class (which wouldn't leave a whole lot of time for practicing yoga would it?)!!!
If you are a marathon runner or triathelete, then take note. If you are a regular JaneYogi, then drink more water.
--On a side note, in most forms of Hatha Yoga, drinking water during the practice is discouraged because it interferes with Tapas, burning rubbish, and prana flow. As far as I know, Bikram is the only Hatha Yoga style, that encourages drinking water during the practice. |
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| good observation, innerline. Our Kidneys get a workout (or beating, depending) with 64 oz of water a day. Depletes the Kidney energy, which speeds up the aging process. Not to mention, fruits and veggies have a high water content. So does tea. One of my "ancient" Chinese professors mumbled under his breath that many Westerners are addicted to water. Strange addiction, huh? Interesting mindset in many Westerners, if a little is good then a lot must be even better, which of course I find myself doing (especially with yoga!). Then there's the issue of the "dangers" of ice water but that's for another thread...
Anyway, great and enlightening article, Maria. Thanks. I love that there's research on this topic. I suppose someone's got to die to get the researchers interested.
Cheers!  fifi |
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Expert Yogi
Posts: 5098
Location: Somewhere in the Mountains of Western NC | YogaGuy, your not going to believe this!! I agree with your response. Of course, too much water taxes the kidneys and plays hell with the bladder.... but so does not getting enough and Americans do NOT get enough of just plain ole' water - not to mention good water is becoming extinct. What they do get enough of is sodas, coffee, sweeaat tea, artificial splenda drinks, you name it. When I was a kid we NEVER had cokes except for an occassional going to the Tasty Freeze and getting a Float - for a treat. I cringe to see school age children and the things they put in their bodies these days - UGH!
BTW, my Bikram practice is much better when I'm drinking less water, and I take only 2 small water breaks after Garudasana and just before Savasana for floor postures. The one before Savasana could be eliminated as I think it interferes with my performance on the floor when I'm in the Bow.
As for the ice in the drinks thread...well, to start this one off. I will say that I don't even own an ice tray. My daughter pierced her ear the other day without my permission. She complained that the only thing she could find to pierce her ear with was 2 frozen blueberries. I told our Chinese Doctor that she will never complain about Acupuncture ever again!!
Edited by Cyndi 2005-04-14 5:54 PM
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| YogaGuy, I think the idea is that everyone should look at their own practice and think about it. I do know of some people who take 2 Bikram classes in a row. Would I? Never. But in their cases, this would seem to be an issue. As is the Teacher Training, where they do do 2 classes a day. I have also seen huge jugs of water in my studio. Now if they are doing a class everyday, like some do and then keep drinking....will it lead to death - of course not. But is it healthy for the kidneys? I don't think you practice Bikram, correct?
Edited by MariaFloresta 2005-04-14 7:40 PM
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| I actually agree with YogaGuy too! 
It seems to me that every time doctors say something is good for you, 10 years later they come out with a study that says it's now bad for you. I'm a little jaded and skeptical of all these reports because of that.
I'm certainly no athlete (unless couch potatoing becomes a sport), but I watch a lot of sports on TV. I'm a huge fan of ice hockey  and I always noticed that rather than drink the water, the players will take in a big mouthful, slosh it around, and then spit it out (gross? yes!). Apparently to keep the mouth hydrated, but not to weigh down the body? I think that a lot of this is instinctual with the kind of athlete that would regularly perform this kind of exertion. Even my non-athletic body tells me that chugging a ton of water makes me feel sloshy and slow.
As for ice in the drinks, that is funny about the blueberries!!! We don't have any ice in the house either. Last fall I smashed my hand under an armoire and had to put a bag of frozen corn on it! Frankly, I've always preferred drinks without ice since I was a kid. I didn't know anything tamping down my digestive fire at the time, I just don't like watery drinks! Waiters still look at me like I'm just some greedy fool trying to get more soda for my $1.09. |
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| MariaFloresta - 2005-04-14 7:18 PM
YogaGuy, I think the idea is that everyone should look at their own practice and think about it. I do know of some people who take 2 Bikram classes in a row. Would I? Never. But in their cases, this would seem to be an issue. As is the Teacher Training, where they do do 2 classes a day. I have also seen huge jugs of water in my studio. Now if they are doing a class everyday, like some do and then keep drinking....will it lead to death - of course not. But is it healthy for the kidneys? I don't think you practice Bikram, correct?
Yes, everyone should look at their own practice, however, people should also use common sense. People that take 2 Bikram classes in a row still have a greater propensity to develop dehydration rather than hyponatremia given the fact that they are in a 110* sweat box. The study said 13% of Marathoners developed hyponatremia, but they don't talk about the other 87%...that's what I'm concerned with. Furthermore, marathon running for most people is a lot more of a challenge than 2 Bikram classes and will probably induce a lot more guzzling.
Whether or not I practice Bikram is neither germain nor relevant to the discussion. I TEACH Yoga, Martial Arts and coach athletes. I've taken Bikram classes, I know what happens there. I know people that did the teacher training. And yet nothing I've heard or seen really points to a palpable threat of hyponatremia. The way my students train and practice, they are in greater danger of dehydration, NOT hyponatremia. As are most of the people I encounter in my day-to-day dealings. As are most people that hang out in a 110* oven for up to 3 hours a day. The last thing I want to do is have one of my students or athletes get dehydrated. They train hard and drink water. If they drink too much they usually puke. If they don't drink enough they don't perform well. It's sort of self-regulating in that way.
Reading an article is one thing but I have trained alongside many world class athletes and haven't run into anyone that drank too much water, but know quite a few that didn't drink enough water and paid the price. On the list of things that are bad for your kidneys, I think water is at the bottom of the list. I'm not saying hyponatremia doesn't happen. It certainly does, but only to a certain small group of people that put themselves in harm's way. Your average yogi is not in terrible danger is all I'm saying.
Yoga is not an endurance sport. People who participate in marathons, triathalons, super marathons and those types of events are the people most commonly afflicted with hyponatremia. They put a LOT of stress on their bodies. They lose water at a fast rate. The body is breaking down and going into a catabolic state. Then they keep pouring water into themselves hoping to cool their systems down. The rapid loss of salts combined with the large intake of water creates a mineral imbalance that combined with the extreme exertion of the sport makes them sick. If your yoga practice sounds like that, then wow! If not, then relax and breathe easy and have a glass of water.
Edited by YogaGuy 2005-04-14 8:28 PM
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Expert Yogi
Posts: 8442
  
| >>Yoga is not an endurance sport. People who participate in marathons, triathalons, super marathons and those types of events are the people most commonly afflicted with hyponatremia.<<<
The voice of reason! I absolutely agree. Now Bikram is a whole other story and I'm sure a little H2O is handy there but in a "normal" class of 90 minutes, the average person would have to be seriously half way to clinical dehydration to need to drink. I find the term "dehydration" to be bandied about rather blythely these days. I had a parent at school tell me her child was dehydrated at the end of the day last summer. I had to restrain myself from freaking out and saying with mock concern "OMG - did you dash into the emergency ward???!!!" I think she meant the kid was really, really thirsty.
Our social circle includes an MD and a nutritionist, both triathletes and marathoners. They argue the dehydration/hyponatremia thing endlessly and they both have good stats, good brains and good personal experience. Phil Donahue (the talk show king before Oprah for you young 'uns) used to say that if educated and intelligent people disagree on a subject, we should probably all agree to disagree and leave it at that.
I do also know that long distance althetes tend to be extremist and tend to want to make their own rules about how to train - many of them either taking good info to extremes or ignoring it completely in favour of how they "feel". Heard that one anywhere before? These are the folks who get themselves in trouble. |
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| YogaGuy, I don't doubt your experience, believe me. This article struck me because last year there was 1 of those real life medical whodunits in the NY Times magazine about a young guy who came in to the emergency room disoriented and delirous. Thought may he had ODed, etc, but turned out he had spent part of the afternoon in a sauna, thought he should drink lots of water and boom. So it can be an issue - common? who am I to know, but I would quote from the article, which was written by specialists in the field.
<<"Everyone becomes dehydrated when they race," Dr. Noakes said. "But I have not found one death in an athlete from dehydration in a competitive race in the whole history of running. Not one. Not even a case of illness."
On the other hand, he said, he knows of people who have sickened and died from drinking too much.>>
I just asked because Bikram is more static, unlike the athletes perhaps that you deal with, but it gives the opportunity for some people to over drink the same way less experienced marathoners or hikers might according to the study. I also thought it interesting that the doctor feels that sport drink companies have been a part of creating this big worry about dehydration....I guess that would not be a surprise. Again, I am not claiming to be an expert, but I do think it is a relevant thing to talk about, since I have often hear teachers in class say keep drinking all day long to the newbies.
Maria
Edited by MariaFloresta 2005-04-15 7:53 AM
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Expert Yogi
Posts: 8442
| Yes, I would say that the sports drink people have contributed their share to the issue, for sure. They show people playing friendly neighbourhood basketball games, sprinting, playing baseball (  - I mean really - NOT an endurance sport!) and things like that in their ads. Come to think of it, American football was the place most people saw their first sports drink being used. Again - not an endurance sport although I'm sure playing a whole game in the heat with all that padding on can dry you out pretty quickly. |
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| Excellent points Maria. The possibility of death is certainly scary enough to make you want to take note of it. It's good to keep in mind that you can overdo anything, even something good like drinking water. I think it's important to remember that hyponatremia is a mineral imbalance. Therefore, you can still drink a lot of water, if you are replenishing those minerals as well. That is pretty simple to do: just eat. Have some fruit and some salted nuts and you'll be able to drink a lot more water. It's billed as drinking too much water, but can also be seen as not eating enough vitamins and minerals.
The problem I have with sports drinks is not that they over emphasize dehydration. Dehydration is a much more common problem that effects many people in their day to day lives and has been shown to inhibit cognitive performance as well as physical performance. Meaning that it will effect the way you work not just the way you play. The problem I have is that they are loaded with lots of sugar which is largely unnecessary.
Pedialite is a much better alternative for refueling your body after a workout or time in the sauna. Much less sugar, better absorption and more minerals.
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| Another thing to remember is that as a society we take a lot of diuretics in the form of caffeine. Coke, coffee, tea, etc. all make you pee a great deal.
Most of us, myself included, can stand to drink less caffeine and drink more water in it's pure form. |
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Expert Yogi
Posts: 5098
Location: Somewhere in the Mountains of Western NC | Like I said Yogaguy, Water is becoming extinct...even children these days barely know what water is. What I think is ridiculous is for parents to say, Jr. won't drink water, I have to dilute it with coke or juice to get him to drink it. That is BS...when my children were small I gave them water and that was the only option they had. Now both my kids drink only water, sodas are very rare and are not kept in my house. Anyway, I think it is a matter of balance and either breaking habits or not starting them. Besides, half of things on the grocery store shelves are totally unneccessary for human survival...unfortunately, humans think its the other way around. Oh well. |
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| Did the Study mention how much water the athletes drank BEFORE the race? |
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| Like most articles in the MSM (main stream media) this one is more sensation than legitmate journalism. Yes, too much water can be problematic, as dehydration can be. Unfortunately, the main point of articles like this is to draw attention to themselves rather to really inform us about something important in an even-handed or thoughtful manner. I see the publishers of such nonsense as computer virus writers merely looking to increase their visibility in order to then be able to increase their profits. One of my students, who also happens to be a medical professional and triathlete, tells me that this meme has been circulating for years. Clearly, a little common sense is all a majority of people need to ensure their personal safety when working out.
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| Often it takes years to compile empirical data. While the study isn't exactly setting the world on fire, it's not completely worthless either. I bet in the future when our great-grandchildren are posting to this website, scientists will have gleaned something useful & important in the "dangers of drinking too much water" study. |
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Expert Yogi
Posts: 5098
Location: Somewhere in the Mountains of Western NC | Wonder if they'll even do one on the Dangers of NOT drinking enough water...course I doubt it since there might not be any *real* water when our great grand children are here. Wonder if they are just trying to scare us now into not drinking it all  , all the earth's water, I mean...you know like there is a water shortage in some places of the world...
Edited by Cyndi 2005-04-15 9:01 PM
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Dangers of too much water
