Athletes Should Drink Only When Thirsty | News | Loyola Medicine
Tuesday, June 30, 2015

Athletes should drink only when thirsty, according to new guidelines

MAYWOOD, Ill.   In recent years, at least 14 deaths of marathon runners, football players and other athletes have been attributed to exercise-associated hyponatremia, a condition that results from drinking too much water or sports drinks.

But there’s an easy way to prevent hyponatremia, said Loyola University Medical Center sports medicine physician James Winger, MD. Simply put, drink only when you’re thirsty,

Dr. Winger serves on a 17-member international expert panel that has published new guidelines on preventing and treating hyponatremia.

“Using the innate thirst mechanism to guide fluid consumption is a strategy that should limit drinking in excess and developing hyponatremia while providing sufficient fluid to prevent excessive dehydration,” according to the guidelines, published in the Clinical Journal of Sport Medicine.

Dr. Winger, who has published studies on hyponatremia in athletes, is an associate professor in the Department of Family Medicine of Loyola University Chicago Stritch School of Medicine. Corresponding author of the guidelines is Tamara Hew-Butler, DPM, PhD, of Oakland University in Rochester, Mi.

Exercise-associated hyponatremia (EAH) occurs when drinking too much overwhelms the ability of the kidneys to excrete the excess water load. Sodium in the body becomes diluted. This leads to swelling in cells, which can be life-threatening.

Symptoms of mild EAH include lightheadedness, dizziness, nausea, puffiness and gaining weight during an athletic event. Symptoms of severe EAH include vomiting, headache, altered mental status (confusion, agitation, delirium, etc.), seizure and coma.

EAH has occurred during endurance competitions such as marathons, triathlons, canoe races and swimming; military exercises; hiking; football; calisthenics during fraternity hazing; and even yoga and lawn bowling, the guidelines said.

Athletes often are mistakenly advised to “push fluids” or drink more than their thirst dictates by, for example, drinking until their urine is clear or drinking to a prescribed schedule. But excessive fluid intake does not prevent fatigue, muscle cramps or heat stroke.

“Muscle cramps and heatstroke are not related to dehydration,” Dr. Winger said. “You get heat stroke because you’re producing too much heat.”

Modest to moderate levels of dehydration are tolerable and pose little risk to otherwise healthy athletes. An athlete can safely lose up to 3 percent of his or her body weight during a competition due to dehydration without loss of performance, Dr. Winger said.

The guidelines say EAH can be treated by administering a concentrated saline solution that is 3 percent sodium – about three times higher than the concentration in normal saline solution.

The guidelines are published in an article titled “Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015.”

The conference was supported by CrossFit, Inc. However, no members from CrossFit participated in the development of the guidelines or had access to the guidelines document before publication.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.