reposted from a previous blog

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.