In reading
through all of the online discussions concerning the recent Ironman
Chattanooga, and all of the casualties due to the extreme conditions, I have
decided that I'd share some of my experiences and knowledge that might help
some make better choices next time around. Disclaimer: I am not a Medical
Professional and make no claims to be an expert. My thoughts written here are
purely anecdotal, based on my personal experiences, the experiences of others,
and whatever knowledge I have acquired in over 25 years of training and racing,
over 10 years of coaching other athletes, and the extensive reading and
studying that I have done through these years. Thus, take whatever I say here
with a grain of salt (pun intended).
As many of you
know, Chattanooga was hit with extremely hot and humid weather, temperature and
humidity both registering in the mid to high 90sF for the recent Ironman 144.6
and water temperatures measuring in the range of 83F. These conditions resulted
in a DNF rate of over 25% of the starting field, definitely high above the
average for Ironman races. Many athletes ended up in the Medical Tent, and some
in local hospitals. Dehydration, nausea, and severe cramping were among the
most common causes of dropping from the race, and the same symptoms were also
reportedly suffered by a large number of finishers. Were there common errors
made? Were athletes adequately prepared for the race and the conditions? Were
corrections made to hydration/nutrition plans to account for the extreme
conditions? Let's look at these possibilities.
The first thing
that comes to my attention is the water temperature. Swimming 2.4 miles in 83F
water, even with a current assist, is a 1-2 hour assault on the body's cooling
system from the beginning. No doubt most athletes emerged from the river
already somewhat dehydrated. My usual plan in any long course event is to drink
nothing but water for at least the first 15 minutes on the bike, until I get a
rhythm and feel comfortable to begin fueling. Since so many accounts have the
athletes starting to cramp early on the bike would indicate that they weren't
getting their bodies rehydrated right away. Once you are running behind, it is
difficult to catch up again. These conditions would probably require a full
bottle of water during that 15 minutes, maybe more for some. That said, lets
move on. Many athletes take great care to plan their nutrition/hydration
strategy, and have it dialed in to the ounces of fluids and number of calories
per hour. What many do not do, however, is practice the plan exactly during
training for long sessions at race pace. Taking in 300 calories per hour at
130watts on a 3 hour training ride is not the same as trying to ingest the same
caloric load for 5-6 hours at 160watts on a crowded race course. The stomach
becomes less efficient at higher efforts. Add in the extreme heat component,
and we have the body really struggling to absorb those calories. It might be
necessary to reduce the caloric intake slightly, and dilute the mixture more
than normal. Too high of a concentration in the gut can cause everything to
shut down. More fluids, especially water, are needed. I saw one athlete's
account of dropping at mile 34, suffering from extreme cramps and requiring 3
bags of IV fluid in the Medical Tent. He had consumed something like 4 bottles
of his fuel mixture and 2 bottles of gatorade at this point. What happened?
Assuming an hour and a half to two hours on the bike at this point, he had
already consumed 800+ calories, and he was already somewhat dehydrated from the
swim. Likely his gut could not process this load and shut down, cutting off the
absorption of the fluid, too. Its common for athletes to drink a ton and have
it all stuck in their stomach and continue to get more dehydrated. Solution?
Maybe start drinking plain water to dilute his stomach contents and get things
working again. That's what I would try, anyway.
Another thing I
see and hear frequently, more frequently after this past weekend, is, "I
was taking a ton of salt and still kept cramping". Somehow, the idea has
taken hold that salt will relieve cramps, so athletes are gulping down salt
tablets and other sodium supplements in huge quantities. First, salt does not
stop cramping on its own. Salt supplementation in endurance events is to
prevent the symptoms of hypomatremia. Hyponatremia is an imbalance of
electrolytes in the system so severe that the body cannot absorb water through
the cell walls, resulting in extreme dehydration, even though the athlete keeps
drinking like the example above. This condition comes about, usually, when the
athlete is sweating for a long time, losing salt and other electrolyte through
the perspiration, drinking a large volume of water, and not supplementing
electrolytes. Notice the one phrase, "drinking a large volume of
water". This can become very apparent if the athlete is drinking and the
stomach begins to feel bloated and has a feeling of water sloshing inside.
Salt, alone will not reduce cramping. Salt will help to restore proper
electrolyte balance, which can help absorb water, allowing it to flow through
the cell walls to the circulatory system and the muscles to maintain proper
hydration and allow the body to function. THAT is what can help reduce
cramping, nausea, and reduce the chances of hyponatremia. Hydration is the key,
salt helps achieve that, but only if you also drink. Drinking a lot of fluid
without restoring electrolytes or supplementing electrolytes without drinking
enough can both lead to trouble, and extreme heat multiplies the chances of
serious problems.
So, my thoughts
for future consideration are:
1. Drink plain
water immediately upon exiting the swim and for the first 15 minutes of the
bike ride.
2. Don't
overload calories, especially when conditions are extreme, and supplement your
caloric intake, whether liquid, solid, or gels, with plenty of water to keep
the concentration diluted in your gut.
3. If drinking
large volumes of water or other fluids in an endurance event, especially in
extreme conditions, use a sodium supplement and, conversely, if taking a sodium
supplement, be sure you are drinking enough water to allow it to function
properly.
4. Practice
your hydration/nutrition plan in long training sessions AT RACE PACE to test
your ability to absorb your nutrition during the stress of the race.
5. Pour water
over your head, put ice in your cap, hold ice in your hands (extremely
effective), even pour ice in your shorts, to try and reduce core temperature
when the heat and humidity climb.
6. Enjoy the
day, be prepared for anything, and always have a Plan B.
