Dr. David Ryan, D.C.; Co-Chairman/Medical Director Arnold Fitness Weekend
Arnold Fitness Weekend Medical Team & Olympia Weekend
Special review and content by "The Man"
Brian F. Griffin, MD, FACEP, DABAPM, DAAPM
Co-Chairman, Arnold Fitness Weekend Medical Team, Executive Director of all Expo athletic events
Additional review by:
Brian Hiestand, MD, FACE, Arnold Fitness Weekend, Ohio State University Emergency Department Physician
Joe Donovan, MD, Director of Physique athletes; Co-Chairman, Arnold Fitness Weekend
Randy Yee, DO, Orthopedic Surgeon; Co-Chairman, Olympia Weekend
Loren Leidheiser, DO FACEP, Director St. Ann's and Mt. Carmel Hospital's Emergency Departments
Rick Cavender, MD, FACEP, Certified Ringside Physician, anti-aging specialist
Don Norris, MD FACEP, Ohio State University, Emergency Department Physician
Reviewed also by IFBB athletes; Lee Labrada, Vince Taylor, Vicki Gates, Elaine Goodlad, Jenny Hendershot, & Kim Klein
Several times a year, while covering contest, I have to deal with individuals who have pushed themselves too far. They have dehydrated themselves to the point of lightheadedness and even passing out. The athlete will start to feel a sense of light-headedness and may even stumble and fall. The situation can become critical quickly if the proper steps are not taken immediately.
The effects of dehydration are more devastating then most people realize. The use of "over and/or under the counter" supplementation/pharmacological diuretics are widespread in the world of bodybuilding and their effects are the most devastating to those particular athletes. In some cases diuretics have lead to death. Recently, the interest in Ultimate Fighting Championships (UFC) has lead to similar problems being noted in that sport.
The problem is the effects of salt and the crossing of the blood brain barrier. You actually will change the pressures inside of your brain when you dehydrate to extreme levels. In short it makes your brain swell and that can kill you. Most of the time, you will die of other problems associated with neurological brain dysfunction, such as a heart attack or stroke.
The Basic Physique Athletes' Competition Senerio:
You are drinking two gallons of water per day, you taper quickly, to make your kidneys continue to remove as much water from your body as possible. In some cases you use various supplements or drugs to force the kidneys to loose even more water. The common problem is loosing too much water. Then you might feel light headed and instead of drinking water, you reach for the pedilite.
Once you have ingested a salt solution, your body is geared to continue to quickly remove the water from the solution, and you are left with the high concentration of salt in your body. This will set off a chemical reaction in your body and you are left with fluid problems that can be fatal. The high salt concentration will literally pull fluid off the brain and that is very dangerous.
Don't Make The Mistake Of Taking In Salt Solutions:
Drinking GATORADE or PEDIALYTE can actually make your situation worse. Your body has minerals in the blood steam called electrolytes. The two main types are potassium and sodium in a 2:1 ratio respectively.
When you drink these solutions with salt, the body can go into shock due to the ingestion of high levels of electrolytes. The older you are the more likely you are to have this severe reaction. Several problems can occur as a direct result of drinking high salt containing drinks and these are compounded by the use of other stimulants such as caffeine or ephedrine.
How Pedialyte Or Gatorade Can Make You Very Ill:
Drinking electrolyte solutions when you have signaled to your kidneys to get rid of as much water as possible is simple. You drink the solution and more and more of the salt stays behind as you continue to remove fluids from your body.
Eventually the salt content is so high that it can become imbalanced (potassium to sodium) or the high concentration of salt will suck fluid out of your brain or heart or some other organ that you might need to live.
Dehydration Alone Is Dangerous:
You don't have to just take in salt solutions or electrolyte solutions to be in danger. Not taking in fluids will result in dehydration and that is very dangerous.
Two Terms You Have To Learn:
Hypernatremia: Hypernatremia is due to too little water, too much salt, or a combination thereof.
Hyponatremia: Hyponatremia is due to too much water, not enough salt, or a combination thereof.
The point is simple, you have a balance, go too high or too low and you die.
|FROM AN ARTICLE IN THE NEW YORK TIMES|
How To Spot Someone Who Is Dehydrated
Dehydration can occur when the body loses too much fluid.
Symptoms Of Mild Dehydration Include:
- Increased thirst.
- Dry mouth and sticky saliva.
- Reduced urine output with dark yellow urine.
Symptoms Of Moderate Dehydration Include:
- Extreme thirst.
- Dry appearance inside the mouth, and the eyes don't tear.
- Decreased urination, or half the number of urinations in 24 hours (usually 3 or fewer urinations). Urine is dark amber or brown.
- Lightheadedness that is relieved by lying down.
- Irritability or restlessness.
- Arms or legs that feel cool to the touch.
- Rapid heartbeat.
Symptoms Of Severe Dehydration (Even If Only One Of Them Is Present) Include:
- Altered behavior, such as severe anxiety, confusion, or not being able to stay awake.
- Faintness that is not relieved by lying down, or lightheadedness that continues after standing for 2 minutes.
- Inability to stand or walk.
- Rapid breathing.
- Weak, rapid pulse.
- Cold, clammy skin or hot, dry skin.
- Little or no urination.
- Loss of consciousness.
*Be aware that diarrhea over several days can lead to dehydration. Uncontrolled vomiting leads to dehydration. Begin by drinking 8oz of water at the top of the hour and Pedialyte or Gatorade on the half hour. See a physician if the diarrhea continues longer than 48 hours or immediately if any fever associated with a rash.
What To Do 1 2 3
If someone faints:
Call an ambulance - 911 or defer to Medical staff. No matter what the athlete tells you, if they regain consciousness; it's time for a ride in the squad. If you don't send them, then you are taking on a huge risk. Consider that most people don't die immediately; it usually takes a day or two.
Do not give them any fluids if they are passed out. They will choke and likely die on the fluids.
If they are concious, only give them water. Ice on the back of their neck is a good idea too and lie them on their back with their legs and feet elevated. They should be constantly monitored for changes in their condition for several hours by a physician.
Continue to monitor for
- Airway obstructions
If they stop any of the ABC's then begin CPR immediately.
If you use an electrolyte drink, dilute it in half with water. Drink at room temperature. Only drink 8 oz per half hour.
At the Arnold Fitness Weekend, Brian Griffin, MD and Joe Donovan, MD (both are over worked, Co-Chairman of the Arnold Medical Team). All three of us have been overseeing our pro athletes for many years. We all closely attend to each pro physique athlete specifically. Our docs do a particularly great job with monitoring bodybuilders with fluid problems. To date, our main concern with the bodybuilders is dehydration.
Effects Of Dehydration On Breathing:
The extreme loss of fluid affects your body's ability to absorb oxygen. You will keep breathing, but you just can't get enough air. The bigger that you are and the more dehydrated that you are, the worse this problem becomes. Another major problem which comes from dehydration is nerve mis-conduction.
Nerve impulses will either fire too much or not at all. This can lead to a fatal situation. Each athlete is informed of who is actually part of our medical staff and what we expect from the competitor. Their safety is our first and only concern.
Intravenous vs. Ingestion (Needle In Your Arm Verses Drinking):
Both take approximately the same amount of time to deliver fluids. Sure the intravenous is a little quicker, but you have a hole in your arm and how clean is it backstage? Given all the effects the choice is simple. Drink the water and if you do drink any salt solution, dilute it 50/50 with plain water.
There is a product called SmartWater, which we use at the Arnold and Olympia for the athletes, when necessary. It has no salt in it and has lots of electrolytes to help you recover. The next time you are at the health food store, grab a bottle and remember to drink it after your next competition. I challenge you to see how much better you feel after two days.
Brian F. Griffin Recommendations:
Brian F. Griffin, MD, FACEP, DABAPM, DAAPM
Executive Medical Director, Arnold Expo
Co-Chairman, Arnold Fitness Weekend Medical Team, Executive Expo Medical Director; recommends the following guidelines as well:
"Hydration is really simple, if you're not urinating fairly clear urine you are dehydrated and if your eyes sting when a drop of sweat gets in your eyes you are loosing too much electrolytes BECAUSE you have lost too much water. Your body must now shed the electrolytes (that keep you alive). They are getting too concentrated by the loss of the water in your body's effort to cool itself. This is the critical period. Re-hydrate NOW or bad things will happen.
"Hydration is really simple, if you're not peeing fairly clear urine you are dehydrated and if your eyes sting when a drop of sweat gets in your eyes you are loosing too much electrolytes BECAUSE you have lost too much water. Your body must now shed the electrolytes (that keep you alive). They are getting too concentrated by the loss of the water in your body's effort to cool itself. Your electrolyte balance is now seriously disrupted and even with the shedding of electrolytes you will be at risk. This is the critical period. Re-hydrate with an electrolyte based but diluted drink or bad things will happen."
There is no value in the destruction of your muscle, heart muscle included. The muscle that becomes damaged begins to disproportionally break down and release chemicals, some of which are dangerous (i.e. potassium).
What To Do If You Are Cramping Uncontrollably
- Call 911, start drinking room temperature water immediately.
Main Steps To Preventing Cramping Or Death
Weigh yourself the morning of the competition and two days before you start to cut water.
- You should never loose more than 15% of your bodyweight in one day. If you do, then drink it back or you are risking a dangerous side effects - including death.
- Always drink back the amount of weight that you loss. Remember that 1 gallon of water = 8 pounds
So if you started the day at 178 and now weigh 174 lbs, that is four pounds or a half gallon of water that you need back. Now let's say you started at 184 and now weigh 174, that is ten pounds and over a gallon of water needs replaced. Consider that 184-174=10 pounds and that is very close to your 15% danger zone.
Be aware of your danger zone and also how much water you need to replace. If you are taking water loss supplements of any kind then you need to track your weight gain closely to maintain the fluid levels in your body.
Another article to read to make the point is written by Steven L Stephanides, MD, Staff Physician, Department of Emergency Medicine, Eisenhower Medical Center:
- Petit L, et. al., Controlled hypernatremia Ann Fr Anesth Reanim. 2006 Jul 21; Unite de reanimation chirurgicale et traumatologique, departement d'anesthesie-reanimation, CHU Pellegrin, 1, place Amelie-Raba-Leon, 33076 Bordeaux cedex, France.