Hydration: The Key to Exercise Success

Last Editorial Review: 6/30/2005

Quench your thirst safely this summer and avoid dehydration

By Denise Mann
WebMD Weight Loss Clinic - Feature

Reviewed By Charlotte E. Grayson, MD

As a seasoned marathon runner, 36-year-old Jeri Salazar has her hydration needs down to a science. And well she should. In addition to being an executive at Disney, this Irvine, Calif., resident is also the Team in Training Marathon Coach for South Orange County and often preaches what she practices to a group of novice runners.

"I drink 64 ounces of water each and every day so I'm always in a well-hydrated state," she tells WebMD. In two days before the recent Boston Marathon, she included a sports drink replete with electrolytes as part of her daily fluid diet. "I figured that getting the extra sodium and potassium in my system couldn't hurt, especially considering what a "salty" sweater I am," she says.

Turns out, that was a good call as at this year's Boston marathon. An unusually large number of runners were treated for dehydration because the temperature reached 72 degrees. Fortunately, Salazar was not one of them.

But alas, dehydation is not the only problem that athletes may acquire. Fluid overload, called hyponatremia, is also surprisingly common. That's why it's crucial for athletes to strike the proper balance when it comes to hydration. Whether you're a marathon runner like Salazar or a weekend warrior, knowing precisely how much fluid to consume before, during, and after workouts -- especially in the heat of the summer -- can help stave off both conditions.

Hydration in the Heat

"Staying hydrated is fundamentally important to a successful summer exercise regimen, in fact, for any activity," says Survivor consultant Adrian Cohen, MD, of Neutral Bay, Australia. As the medical advisor for many reality shows, including Survivor and Eco Challenge, Cohen has seen firsthand the havoc that dehydration can wreak on performers and performance. "Whilst we tend to focus on hard, sweaty workouts and long jogging sessions, even a brisk walk or a scratch basketball game in the hotter weather puts demands on the human body, and without the 'fuel' (water) the engine runs dry," says Cohen, author of several books including Survivor First Aid.

Successful, balanced hydration starts with prepping yourself for exercising in the heat, says New York City-based sports medicine expert Lewis G. Maharam, MD. "Take 10 days to two weeks to get used to hot weather, building workout intensity and duration gradually," he says. Engage in higher-intensity activities during cooler morning hours and do easier work during the heat of the afternoon, he suggests.

Choosing Your Hydration Fluid

If you are not running a race, "the rule of thumb is to drink 8 ounces of a sport drink or water possibly every 20 minutes," says Maharam, who advises the ING New York Marathon. No more, no less. "If you are exercising less than 40 minutes, water is fine, but for anything over 40 minutes, you want a sports drink that has sugar or salt in it because this helps you increase the fluid that goes into the body. Most sports drinks contain the equivalent of an "active pump" that gets more water into the body faster than the unassisted process -- simple diffusion of water -- would have.

When choosing a sports drink, look for salt and sugar on the label and choose a flavor that you like. While shoppers may be bombarded with vitamin-infused beverages, Maharam says added vitamins are useful for recovery and post-event muscle soreness -- not for hydration the day of the event.

It's also important to replace the fluid you lose during exercise, he says. Weigh yourself right before and after workouts and for every pound lost, drink eight ounces of fluid.

Moreover, "step out of bed every morning and onto the scale, and if you're anywhere from 1% to 3% lighter than yesterday, rehydrate by drinking eight ounces of fluid for each pound lost before training again," he says. "If you are between 3% and 6% lighter, rehydrate and back off that day's training intensity. And if you lost over 7%, get to the doctor."

Dehydration is somewhat insidious, adds Cohen. You can't always tell when it's starting.

"Most people are chronically dehydrated."

"Humans don't have a 'fuel gauge' like your car, so there is no way to tell if you're full or even approaching empty, and thirst is typically a poor guide," he says. Early signs of dehydration may include poor concentration, headache, and inability to think clearly.

"Most people are chronically dehydrated as it is," says Eric von Frohlich, a group exercise instructor at Equinox in New York City and the chief exercise officer of Roadfit, an outdoor training group fitness organization. "Drink before your thirst kicks in," he says, touting the benefits of prehydration. "Drink 16 ounces before an event or session so have some extra fluid. You don't want to suck down two glasses of water and bolt out the door for a run." So wait about two hours before engaging in your activity of choice.

During fitness classes, "I constantly remind people to drink," he says. You should work through a water bottle within 45 minute of any class.

The best way to tell if you are dehydrated is to check your urine, he says. "If your urine is pale to very clear it's a pretty good indication that you are well hydrated, while darker, more concentrated urine suggest you may be dehydrated."

But beware: Guzzling too much water can also cause serious problems for summer athletes. Drinking excessive amounts of water can cause a rare, life-threatening condition called hyponatremia, experts tell WebMD. It's often coined "water intoxication" and has been getting a lot of attention of late. As hikers, runners, and sports enthusiasts "get" the message about staying well hydrated, increasing numbers become overly hydrated. At this year's Boston Marathon, the majority of the 240 cots in the medical units were filled with dehydrated runners. By contrast, hospital officials reported a single case of hyponatremia in this year's marathon.

Hyponatremia refers to low levels of salt in the blood. This occurs when someone drinks so much water that they dilute the sodium in their blood. Low sodium levels can cause a clouding of consciousness, nausea/vomiting, lightheadedness, dizziness, and in severe cases, seizures, unconsciousness or death. The condition is less likely in the weekend athlete, but those participating in endurance sports like marathons are at higher risk and should take precautions.

Drinking no more than eight ounces every 20 minutes -- as Jeri Salazar does -- provides enough but not too much fluid, Maharam says. He is one expert who believes that "the risk of dehydration, even in the heat, is far less than developing hyponatremia." Why? Although dehydration is more common, hyponatremia can kill. One easy way to stay safe during a race: Don't drink water at every station, he advises.

Publicity about hyponatremia, however, raises concerns among many trainers, who say that dehydration remains the key problem for summer athletes.

"It is a very real problem, and you have athletes saying, 'I don't what to get hyponatremia,' and invariably they end up not drinking enough and get dehydrated," von Frohlich says.

Adds Jeri Salazar: "Many of the people I train initially believe that they should drink "as much water as possible" to avoid becoming dehydrated. However, more and more often these days, runners and the medical staff at races are being warned about the dangers of over-hydrating when running for an extended period of time."

"My runners ask me, 'How much should I drink?' I tell them, 'The answer lies in the process of determining individual fluid needs and developing a hydration strategy based on those needs,'" she says. "An appropriate hydration strategy can maximize running performance and reduce any risks of sub-optimal performance and or health issues."

Published June 10, 2005.

Sources: Jeri Salazar, Irvine, Calif. Adrian Cohen, MD, Neutral Bay, Australia. Eric von Frohlich, group exercise instructor, Equinox, New York; chief exercise officer, roadfit.com. Lewis G. Maharam, MD, medical director, ING New York Marathon.

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