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Dehydration 101

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Dr.Kaleb Redden

The Signs and Symptoms of Dehydration and How to Drown Them

While dehydration is a common problem, many people may be surprised to know how dangerous it is and how rapidly it can happen. In fact, many patients who arrive at a hospital in critical condition with multiple organ system failure, dehydration is often a major contributing factor.

As an athlete who trains hard, you need to know the common signs and symptoms related to dehydration, along with ways to improve your fluid and electrolyte levels to stay healthy and active. 

What Causes Dehydration?

There are many common factors that can lead to dehydration. Being aware of these factors will allow you to recognize and fix the problem before it impedes your performance, or your health. There are three elements, that when combined, can quickly dehydrate you: the level of physical exertion and body mass, environmental temperature (namely heat and humidity), and baseline hypo-hydration of >2% lean body mass lost. Physical exertion, whether it’s in the gym or on the football field, increases core body temperature, especially when paired with hot, humid conditions. As a result, your body starts to sweat in an effort to regulate your temperature.  Sodium is a key nutrient that makes up sweat, and is often overlooked as a factor in dehydration. As the sweat on your skin evaporates, you begin to cool down, but you’re losing both sodium and free water.

What are the signs and symptoms of dehydration?

  • Increased thirst
  • Headache
  • Muscle cramps
  • Decreased urine output
  • Dark or discolored urine
  • Decreased athletic performance
  • Dry mucus membranes, things like dry eyes and dry mouth
  • Decreased skin turgor or elasticity

Severe dehydration can lead to the following:

  • Confusion
  • Lethargy
  • Tachycardia (increased pulse)
  • Tachypnea (increased breathing rate)
  • Seizure
  • Hypotension (low blood pressure)
  • Decreased peripheral perfusion (lack of blood to the internal organs)
  • End stage organ damage

Your kidneys are the main organs responsible for regulating fluid levels in your body. In the kidney, there is a complex tubal system with many electrolyte channels, namely sodium. The kidneys will concentrate or dilute urine to maintain a healthy, comfortable balance. As the body becomes more dehydrated, the kidneys will pull fluid from the urine, leaving it more concentrated and subsequently a darker color. In a hydrated person, urine is clear to pale yellow, if it darkens, it’s a sign of dehydration. Refer to the chart below for a color guide to urine. Remember that there are other substances that are excreted through the kidneys which can affect the color of urine you need to be aware of. For example, some vitamins can cause your urine to be a very bright, neon yellow. Or, blood will darken the urine and may have no relationship on the level of your hydration.

Does Hydration Impact Athletic Performance?

The answer is yes! A recent article from the Journal of Sports Medicine looked at a number of team sports including soccer, football, basketball, rugby, tennis, ice hockey, field hockey, baseball, beach volley ball, court volleyball netball, water polo, and badminton. The athletes from these team sports were evaluated on their cognitive, technical, and physical performance during a state of dehydration and the outcome was significant. The results varied from one sport to the next, but across the board, athletes consistently demonstrated a decrease in their performance after losing just 2% of their total lean body mass in fluid.

Another study looked the performance of long distance cycling when athletes were properly hydrated and remained well-hydrated through their events. The data suggested that during cycling events lasting greater than one hour at a moderate to high intensity, a minimum of 3% improvement in performance can be expected if proper hydration is achieved and maintained.

How Much Does a Person Need to Drink in Order to Be Adequately Hydrated?

In the athletic community it’s common to hear people discussing their macros for diet, or the weights, set, and reps of their training program. It is far less common to hear people talking about the calculation for fluid and electrolyte replacement. There is actually a formula that can be followed to figure out the volume of liquid needed to ensure the body is hydrated. The American College of Sports Medicine recommends drinking .15 to .35ml /Kg of body weight / minute of exercise. For example, if you take an athlete like Kris Gethin who weighs about 220 lbs, or 100Kg, and do the math, he should be consuming about 2L of fluid per hour during exercise. 

Too Much of a Good Thing Can Be a Bad Thing

Recall how sodium is a key player in managing the fluid status in the body. If a person drinks too much water without replacing electrolytes like sodium, a condition called hyponatremia can occur. There are many different forms of hyponatremia but in the setting of increased water and decreased sodium, it’s called hypervolemia hyponatremia. Hyponatremia is a dangerous disorder that can lead to a number of symptoms including headache, confusion, seizure, coma, and even death if not corrected on time. 

Obviously, drinking water is important and the team at KAGED MUSCLE recommends it over any other form of liquid, but when the goal is adequate hydration during exercise, you need more than just water.  That being said, you don’t want to consume too much sodium either. If you get a surplus of sodium, your body will work to remove it, and as mentioned before, water follows sodium. This will cause rapid dehydration. This is one of the reasons it’s a bad idea to drink salt water when you’re stranded on a boat out in the ocean. You end up secreting more water than you absorb due to the high concentration of salt. Finding the optimal balance between water and sodium is necessary, especially for athletes.

What needs to accompany H2O?

The American College of Sports Medicine has a comprehensive statement regarding the general recommendations for amount, composition, and preparation of fluids to be ingested prior to and after athletic competition. Their recommendations include:

  • Consume a nutritionally balanced diet and drink adequate fluid in the 24 hours prior to the event
  • Drink a minimum of 500ml of fluid at least two hours prior to the event to allow time for excretion of fluid for uninterrupted performance
  • During exercise, start drinking early and often
  • Drink fluids cooler than ambient temperature (between 59-72 degrees)
  • Feel free to add flavor to enhance taste and promote better fluid intake
  • Proper intake of carbohydrates and electrolytes should be achieved to maintain oxidation and delay fatigue
  • Include sodium at a ratio of .5-.7 g per 1 Liter of water ingested during bouts of exercise longer than one hour. This is advantageous in enhancing taste, promoting fluid retention, and can likely prevent hyponatremia

Bottoms Up

The consensus in academic literature and expert opinion is that being well-hydrated is beneficial to health, wellness, and athletic performance. The way to optimize fluid status during exercise is to be aware of the signs and symptoms related to dehydration. Make sure you have enough water to support the amount of physical activity you’ll be performing. Improve water absorption and maintain adequate sodium levels by adding a rehydration solution that will also improve taste and the likelihood of consuming enough fluid.

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Understand the external factors that can increase the likelihood of dehydration, such as hot temperatures and humidity, but also pay attention to things like diuretics. Caffeine is a great supplement for focus and intensity in the gym, but it has a diuretic effect and can decrease your body’s water content. Above all, work hard, play hard and remember, “don’t stay thirsty, my friends”.

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