|CyclingSite > CO Collected Wisdom > Touring Info > Cycling Concerns > Electrolytes & Overhydration|
|What do I need to know about electrolytes & over-hydration?|
|A bizarre, serious medical issue
came up recently that I thought I'd pass along for discussion/input.
I encouraged a Portland friend of mine to sign up for CO this year [CO 12] and after registering, she eagerly began her training with an organized bike tour in Death Valley, six weeks ago or so. Weather was low 80's, sunny, riding days were 30-50 miles/day so nothing outrageous. She kept herself very well hydrated with lots of water, as she'd always been told to do.
On day 2 of the ride she had finished the 35 mile ride for the day and was on her way back to camp in the van (one of those cushy tours..), when she felt a really bad headache coming on. Nothing unmanageable, popped a couple Advil and closed her eyes. Turned into a raging headache by the time she got to camp. Got out of the van, and felt light headed and dizzy. They sat her down on the ground . Suddenly she had a seizure that left her unconscious; tour leaders couldn't revive her. They got her to a nearby city and airlifted her to Las Vegas. She ended up in a coma for 4 days and family was called to her side because doctors claimed a 50/50 chance of her pulling through. On the 5th day she came out of it. Then spent a week recouping in Las Vegas, 3 weeks in Seattle with a sister, and back to Portland last week where she's on the mend but definitely reevaluating her life.
Really scary. Turns out that she had consumed TOO much water over the course of the ride and the water had actually displaced the sodium in her body causing this incredible "shut down" reaction. Her brain swelled, etc. She hadn't replaced the sodium that was lost, not knowing that she had to. Drinking sports drinks would have done the trick, she says, coupled with water.
Strangely enough, I had another friend who did RAGBRAI (race across Iowa) last year and on the 2nd day there, she also had this happen. Fainted, ended up in the hospital but was able to rejoin the ride a couple days later. Again, she'd consumed too much water without replacing the sodium she was losing, via sports drinks, etc.
I had never heard of this, in all my years of cycling and was stunned. I've always been such a water drinker; never really liked those sports drinks though on CO I have drunk my share of those (awful) Allsports. I don't recall ever hearing about this happening on any CO ride.
Anyone ever heard of this affliction and have more detail about it? When Anne's feeling better I'll see if she'll get on here and share what she's learned. I don't know if maybe they hadn't eaten food that day, or what other variables may have also contributed to these episodes.
Not meaning to scare anyone but I think it's useful to remember that there is such a thing as TOO much water, if that's all you're taking in.
Glad you brought that up. Last year [CO 11], I asked the medics if they'd ever had to treat anyone with IV hydration who had been hydrating well with a camelback (as opposed to those old fashioned bottles), and they said yes, indeed, that some folks drink too much water without replacing electrolytes they sweat and pee out. (dilutional hyponatremia's the name, serious is the game) So you have to find some way that works for you. On hot days, I carry water in fanny camelback, and Allsport or Gatorade in my two bottles. (I brought my own Gatorade powder for the first AM bottles, used CO Allsport thereafter.) I also learned to salt my breakfast heavily, unlike my normal habit. Also, on hot days, I carry a 4 oz. can of V-8, which is loaded with both sodium and potassium, and drink that mid-day. (tomato juice has sodium, little potassium; orange juice has some potassium, little sodium). I brought along a six-pack of V-8, one a day.
After growing this program, I've avoided headaches. With all this drinking, I never pass up a portapotty, either. (some trees, too)
I also often had to get up in the middle of the night to pee, can't always find my tent on the way back ;-), but felt dehydrated in the morning when I hadn't drunk enough to have to pee. but that's me. It's about the only time to pee without waiting in line ! :-) I know one man who doesn't drink much all day, and so far has done fine, but that's him, and flies in the face of most experience.
I don't think that your friends could have consumed too much WATER, but not enough sodium or other electrolytes such as potassium. The sports drink of your choice is designed to replace not only glucose (sugar) but those electrolytes. Sodium and potassium are necessary to your heart being able to beat and all sorts of other important functions. That is why Gatorade, the first commercial sports drink, was developed in Florida (University of Florida or wherever they have the Gators teams). My tennis coach in college back in the dark ages (70's) used to use watered down lemonade with a pinch of salt for the team on hot days. So, drink LOTS of water, but also replace those ELECTROLYTES.
On my first Cycle Oregon (COX), I was a victim of overhydration. I'm an Alaskan, day 1 was 97 degrees, I drank water like crazy. About a mile from the top of the hill climb an astute ride director (don't know her name) "suggested" I be checked out by the "medical boys" before continuing on. They took one look at me, escorted me to the ambulance and quickly poked an IV needle in my arm. As 2 liters of fluids dripped into my body the "medical boys" suggested that for the rest of the ride, I salt my food, drink sports drinks, AND highly recommended EmergenC's, an electrolyte replacement powder found in the Health Food section of most grocery stores. The next morning I found that my riding jersey had rings of salts so thick that the jersey would stand on its own.
Thanks to the CO team, I was safe and up and riding the next day, after eating a well salted breakfast of course. I also noticed the paramedics keeping a sharp eye out for me for the remainder of the ride. Thanks "medical guys" and gals!!!!!!
Another side to this issue is that some of us think that the sports drinks taste awful! For those of us that prefer straight water we can also get the same stuff by munching on the appropriate sports bars (check contents on the label) and drinking the equivalent volume of water. Sample the different brands and flavors and find one you like. Some taste like sawdust and some are pretty good. Last year CO had Cliff bars at the morning and afternoon food stops. Some people even like them! :)
It is true overhydration is a concern we deal with on Cycle Oregon. When you receive your Rider Handbook and Tourbook you will notice we discuss this subject. The key to safe healthy riding is to maintain a constant input of fluids, but also eat. Each year we have a cyclist or two that experience overhydration. On more than one occasion a cyclist has not consumed enough fluids, become dehydrated and as a result of not feeling well suddenly began consuming a much greater level of fluids, primarily water, without eating. They were not eating because they didn't feel hungry. The result was overhydration and extreme imbalance with their electrolytes.
The best line of defense is train well, know your own limits and when you feel different don't be afraid to ask. While you are on Cycle Oregon you can always give a thumbs down to one of the seven SAG vans, an ambulance, or staff vehicle. All have communications and can talk with the individuals that are trained in determining what action should be taken. On this subject if you are riding with someone who seems to be experiencing problems don't hesitate to ask them a few questions and give a thumbs down to a vehicle so that they can be checked out. Often when you are experiencing problems like overhydration, hyperthermia, hypothermia, etc. you are not able to recognize the problem.
We hope everyone has a safe cycling season and a wonderful experience on Cycle Oregon.
May there always be a tailwind,
This subject raises an interesting question. Does AlSport provide enough salt? As I remember the label read 50mg sodium and 50mg potassium per serving while Gatorade provides 110mg sodium and 30mg potassium per serving. Seems like a choice of a little more potassium or a bunch more sodium. How much of each do we really need?
Mike "I guess I could just eat another banana" Buondonno
Do remember that the Allsport bottles contain something like 2.3 servings so even if there isn't enough sodium per serving, there might be enough in the whole bottle. (That doesn't make it any good. Me, I hate the stuff and would rather get my salt from the extra bags of potato chips I kept eating at lunch.) The really scary thing is that means there's even more sugar in there too!
Curiously, I noticed that there was more Sodium in a 2-pack of Fig Newtons than in the lunch size bag of chips, or the small salted nuts. Pretty sneaky.
A CO participant (Richard F.) makes his own drink with Lite Salt, which is half Sodium Chloride and half Potassium Chloride. (1/4 tsp.. has 290 mg Sodium, 340 mg Potassium)
One banana contains 396 mg. of Potassium. You can see why they have a lot of bananas offered at bike ride sag stops.
It depends if you eat! According to "Mountaineering First Aid", 1 gram of Salt (sodium) per day is the average requirement. They suggest one 500 mg salt tablet in addition to the salt in your regular diet. That would be a lot easier to take than 5 bottles of AllSport (gag!)
I carried a small baggie of very highly salted sesame sticks in my 'bar bag all through Cycle Oregon. I think that I ate them once. Did you notice that you wanted more salt at dinner than usual? I think that if you listen to your body, it will tell you if and when you need more salt. You just have to forget what the Heart Association has been telling you for the other 51 weeks of the year.
My rule is to eat even if you are not hungry. At the top of the hill on day 2, I was found that I was riding with a woman (Sinthea) who was very riding very strongly at that time, even though she was a novice at long-distance cycling. She said to me that she was planning to continue on down the hill and into camp without stopping, because she wasn't hungry. I told her that I didn't feel hungry either, but that I thought that this was a _very_ bad idea, and that if we stopped to eat, we would realize that we did indeed need food. Fortunately, I didn't have to do any more convincing than that – we stopped and lunched together, and finished strongly drafting each other into Haines.
As they say in the Tour book: eat before you are hungry, drink before you are thirsty, and never pass a line without joining it to see what it's for :-)
Andrew "eating at every opportunity" Black
A recipe I have used in the past is taken from the book "Effective Cycling", by John Forester. Basically it's one 2-quart envelope of unsweetened Kool-Aid (I used Lemonade), 8 tablespoons of sugar, and one-half teaspoon of salt. Divide this 4 ways, and then use one of the parts per water bottle. Worked great for me, you get the sodium you need, and the Kool-Aid adds the flavoring.
I didn't like the sports drink either, and for several years have brought along my own concoction of Cytomax and (don't gag) blue-green algae, that I've found works very well for me and doesn't cause gastric problems as can happen to some folks with some of the sports drinks. In powder form, a week's supply measured out in daily doses is easy to find room for, and I probably get a lot more fluids that way than having to force down that blue stuff that was served. (So what if mine is GREEN?)
Personally, I dislike all of the sports drinks and sports bars. They have a lot of sugar and stuff I cannot handle. I do not like having to find a blue room that urgently. I cannot choke down sports bars. We use different products in place of them.
In place of sports drinks, we use a health food store product called "Emer'gen-C". It is a "SUPER ENERGY BOOSTER, high in potassium, with 38 active minerals and B Vitamins, A Powerful Antioxidant, Electrolyte Balanced."
Emer'gen-C is a small packet of powder that you can mix with water or as the kids do, lick it out of the package. (It is kind of like powdered fizzies.) Personally, I mix a couple little packets in my waterbottle and sip on it. It is a great pick-me-up for every day and great on rides. I have not had it make my water-bottles yucky. It is easy to carry a couple of small packets in your pocket or pack. It sure beats any of the sports drinks and even comes in different flavors. Mikkel's favorite is Raspberry. If you start to get dehydrated this can help replenish your electrolytes. Also, works great on headaches.
This little packet of powder was a life saver when Mikkel was little and would run out of steam in the afternoon. A couple of these and he was ready to go another 30 miles.
A few years ago, we discovered another product that we now use regularly. We do not use sports bars because of the taste and ingredients. In place of them we use Re-Vita products. Mikkel uses both the Re-Vita Liqua Health (a Spirulina and natural vitamin liquid) and Re-Vita Liqua Spirulina.
Re-Vita Liqua Health and Liqua Spirulina both come in single serving packets that Mikkel carries in his jersey pocket. They are liquid and can be mixed with milk or juice or taken straight from the packet. Mikkel just sucks it out of the package and washes it down with water. They come in different flavors, but berry works best for taking straight.
Re-Vita has a new product Lemon-line Liqua Spirulina that is for mixing with water. We have not tried this yet but it seems to be designed for sport use.
Mikkel has never bonked and I think it is in part due to the above products. A few weeks ago, he did a 100 mile ride with TeamOregon . I think, he made it with one Liqua Health, a few Liqua Spirulinas and some fig bars. These products really work for him.
Anyway, that is what we like and use.
Mikkel's Mom (Geri Bossen)
I have a question. Among some minor calf muscle cramping after long rides, I also have been getting a dull headache that night and the following day. Any input would be appreciated. I am upping my mix of Gatorade a bit, and trying a new mix from Endurox at Performance called Accelerade.
Sounds very typical of dehydration. Given what you've written about your liquid intake in the past, this hardly seems likely, but that's sure what I've felt, especially when working in Phoenix and Las Vegas in the summer. Your corrective action sounds like it's on-target, so I hope the headaches disappear.
The non-alcoholic hangover is exactly what I've felt, so, in spite of your intake, I suspect it.
Don't know what else to do besides drag a hose along behind you, but that would only be practical for a few yards. No alcohol is good (not passing judgement, but as Mark says, it's a first-rate diuretic)... been doing any caffeine these days? Never mind those TV ads... stay away from the Mt. Dew when you're on the bike! I know you're probably not using it, but it's worth mention.
If you're still having symptoms that sound so typical of dehydration after taking in that much fluid, you might want to have a chat with your MD. I don't want to sound alarmist or anything, but what would be the harm in asking about it?
Sounds like dehydration. The cramps and the dull headache may indicate dehydration.
My first century lead to what felt like a hangover the next day. And I had made it a point not to drink alcohol (a very effective diuretic) for three days prior! I was dehydrated.
Are you really drinking enough? It will seem like you are drinking too much at first.
Mark "Hydrate, Hydrate, Hydrate" Ramsby
I ride with Jason, and also have adapted to a Camel Back recently. I have run out both times I have worn it. Yesterday, I went through 105 oz of water and 30 oz of diluted Gatorade. I ate before and during the ride and had a couple Odwalla bars during the day and on the way home had a half one too. I ate fruit, bagel, muffins, and cookies at all the stops.
Dehydration would be my guess. The "experts" would argue for at least half again more liquids. You did 100 miles… right? Forcing more hydration is a good bet and a good direction in the long run...you can't drink too much.
Jim " been there, solved that" Bombardier
Although I've never had the symptoms you describe, it took me till last year to find the right balance between Gatorade and water for me to be consistent. I'd always cramp sometimes, have a great time others.
One thing I did learn along the way is proper hydration *before* the ride. I'll down at least one sports drink before bedtime that evening along with extra fluids all day prior. Yeah I'm up a few times at night but the tired I get from that is way less than the tired I get if I don't.
Also. These rides can be stressful. I find myself scrambling getting ready, wondering if I'm gonna have a good day or just suck. Do you get event stressed? I confess, I do:-( It just targets my other end:-(
Don "I did back to back centuries. I'm toast" Bolton
A few years ago on Cycle Oregon, I woke up every morning with a really bothersome headache, which wouldn't go away until I had ridden several miles. Aspirin had no effect, and sometimes I couldn't even eat breakfast. At the time I was mixing a sports drink (can't remember which one, but it might have been the infamous Exceed) half and half with water for the day's ride.
Just to experiment, I quit using the sports drink entirely. Bingo! No more headaches. I made sure to drink plenty of water, and I drank juice at every opportunity, especially right after the ride each day.
I've never touched Gatorade or Allsport or any of the others since!
Susan "don't want anybody messing with my electrolytes" Christie
Different people use different amounts of water and how much you need could change. My son goes through an incredible amount per hour on a bike ride - and gets sick without it, feels fine with it.
If you snack on salty stuff like pretzels you can get interested in getting even more down at snack times.
You should be able to digest at least 40 oz. per hour and probably more as you are pretty good sized.
Also, books for those hard-riding speed enthusiasts suggest that you start hydrating for an event at least 24 hours ahead of time. Sounds like if you have to hit the bathroom several more times than usual the night before you are doing good. During CO it helps to carry a water bottle around with you the whole time you’re off the bike and just sip it constantly - and as Amy suggested once - salt things a lot!
PS Don't forget Magnesium and Potassium, too. Eat a banana and some nuts (or get some pills....)
Golly, Dave, you gave me another perfect opportunity to rave on about electrolytes. When you sweat, and that is both from exercise and insensible loss (i.e., happens all the time and you don't feel it), you lose both water and salt. Insensible loss can vary from 50 cc/hour (about 2 ounces), up to 1600 cc/hour or more in a hot environment during muscular exercise. (do the math-- about 1 1/2 quarts/hour!) (or more) Plus add in the amount of urine you put out, and there is a whole lot of fluid loss. And in a dry climate, your sweat evaporates quickly, so you are less aware if its loss. So you need to replace both water and electrolytes. I will try to find the numbers to impress you with how much Sodium and Potassium you actually lose in sweat. I don't believe we can drink enough Gatorade to fully do the job, though it's better than just drinking straight water. Hence, I say year in and year out:
1. Salt your breakfast heavily- this is key, IMHO (when not biking, I don't salt my food, so it takes a mental adjustment)
2. Eat salty foods during the day (note Fig Newtons have as much sodium as pretzels). I read that some football teams have discovered pickle juice as a magic elixir-- ick, but it should work.
3. Drink salty stuff like V-8 juice. One four ounce can has more Sodium and Potassium than a gallon of palatable Gatorade. On my recent bike trip to the desert, we started using V-8 (with or without water dilution) in our water bottles instead of Gatorade, and no one who did got the hot headaches. I haven't gotten one since I started salting my breakfast and drinking til I had to pee at every stop. (keep it copious and keep it clear.) (The Backroads guides said it'll be a standard part of their shopping list from now on.) I've asked CO to carry V-8, but their supplier doesn't carry it, so one is on one's own. I bring a six-pack of V-8 and bring one per day to drink at lunch. I may bring more this year, if I can figure out how to fit it in. (right).
4. Look for more ways to cool yurself: wear a bandana around your neck and wet it down at every opportunity. I found a neck tie that absorbs water and stays cool all day (Early Winters catalog). Try the wicking head do-rags that some of us wear. I wet it down at every stop. I tried a loose long-sleeved white jersey (with SPF) for the long hot days and it actually worked. I didn't get that hot oven burning feeling on my skin. I got a new helmet with a visor and I think it helped.
OK, OK I quit for now. night, night, hugs to all,
A non-payed endorsement :
The newest thing I've found for over-all recovery is the "Jog Mate" in the tube. After a good hammer session I slug one of these puppies down before I even load the bike. I can't believe how I no longer have to pay the price for the extra exertion that my ol'l bod endured. I must say that it's the best muscle recovery/builder that I have felt. This of course goes along with good hydration. "The Old Dog" in me still prefers the water bottle method - one with Gatorade and the other with water. If the sports drink gets boring then one can always hit the pure water - or also - I have poured water on myself on a couple of CO's, while in the desert for additional cooling. To each their own.
Try the "Jog Mate" guy's - - It's pretty impressive !
Capt. Dink ~
I have to agree... tried one first at last year's RACC, which really knocked the stuffing out of me. Choked a tube of the JogMate down, and I felt none of the usual post-ride aches, etc. It's not tasty, not even a LITTLE bit! But, it does work!
I, too, like using JogMate after a big day...if I remember to bring it w/ me!
I love the stuff, and use it after every ride, long & short. The vanilla (beige tube) tastes like mildly sweetened jello pudding, the pink tube tastes like chocolaty chalk (I don't like chocolate in general). I combine it with a bottle of gatorade and can feel a distinct difference over just the gatorade itself. I don't know that it's not [in part] psychological, but I do feel less tired & fatigued after eating a tube of the stuff.
I want to know:
"What do you eat and drink before & after a [long] ride?"
Hook me up, help me out, I want to know...
Hmm, just a water junky myself, carry around 5-8 gallons on my bike for longer trips. Nothing like having refrigerated water when you're getting super heated by climbing grades (Granny gear or mommy gear, hauling a mountain bike that weighs in at around 600 lbs. when its loaded and including rider is still a pain in the bum to get up a grade because of the pull of gravity).
Hmm... it may be strain from blood pressure in the veins running from the neck up into the lower back part of your head. I get them periodically if I over heat too much on longer trips and don't take enough time out of the sun when I get to my destination.
I've also found that if you take a package of Ritz or Ritz imitation crackers with you and munch on a few every now and then it'll help you keep a constant in take of water.
I use this on both situations in the case that if I bike for a long time and allow my stomach to empty too much and fill it with nothing but water, the biking will make me sick, so I keep crackers to munch periodically to help keep my stomach balance.
I'm a low-carb, high protein fan. I realize this runs counter to everything that everyone will tell you, and possibly against what most of you here have experienced. But I feel a lot better, a lot longer, with something like a large avocado and a couple of hard-boiled eggs for breakfast, and low-carb, high-protein bars throughout the day. Steak and salad for dinner, a night's sleep, and I'm good to go again the next day.
When I'm on the bike, I carry 2 bottles - one with plain ole water, the other with either Cytomax or Revenge. I do very well with both products.
The glucose concentration in the Cytomax is low enough that you don't get the cramps in your gut. There is a person I recommended Cytomax to that had a problem, but I found out it was because he put more mixture in the water than he should have. He had been thinking the more he used, the better it would work. Wrong! Go by the instructions on the can. Also, the electrolyte balance is good. I've never cramped in my legs, and I go out at a hard pace.
Revenge has a small amount of protein in it. I rode a metric century down in Phoenix back in Oct. 99 where my only fuel consumption was a bottle of Revenge, and a gel. I wasn't tired after the ride; felt pretty good.
For recovery, I like Endurox R4. After a hard ride, I want to get the protein and other nutrients in my body within an hour of getting off the bike. What also helps is a 'dead cockroach' massage. After a hot shower or bath, lie on the floor on your back with your legs up and propped against the wall. You can use the heel of your foot to massage your lower legs, your knuckles for quads, hamstrings, whatever works. Massage toward the heart. This helps to break up any garbage in your legs after a hard ride. The gentleman that told me about this goes for a short walk afterwards.
I avoid herbal concoctions while on the bike (other than Ma Huang occasionally (as in Ripped Fuel)), and for recovery drinks. My favorite meal the evening of a hard ride is a nice juicy slab of good red meat. To all you vegetarians out there, I thank you cause that leaves more (meat) for me. Yummy.
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