Sodium supplementation has no effect on endurance performance during a cycling time-trial in cool conditions: a randomised cross-over trial

Effect of Sodium Supplements and Climate on Dysnatremia During Ultramarathon Running

OBJECTIVE

Analyze the effect of sodium supplementation, hydration, and climate on dysnatremia in ultramarathon runners.

DESIGN

Prospective observational study.

SETTING

The 2017 80 km (50 mile) stage of the 250 km (150 mile) 6-stage RacingThePlanet ultramarathon in 2017 Chilean, Patagonian, and 2018 Namibian, Mongolian, and Chilean deserts.

PARTICIPANTS

All race entrants who could understand English were invited to participate, with 266 runners enrolled, mean age of 43 years (± 9), 61 (36%) females, average weight 74 kg (± 12.5), and average race time 14.5 (± 4.1) hours. Post-race sodium collected on 174 (74%) and 164 (62%) participants with both the blood sample and post-race questionnaire.

INTERVENTION

Weight change and finish line serum sodium levels were gathered.

MAIN OUTCOME MEASURES

Incidence of exercise-associated hyponatremia (EAH; <135 mmol·L-1) and hypernatremia (>145 mmol·L-1) by sodium ingestion and climate.

RESULTS

Eleven (6.3%) runners developed EAH, and 30 (17.2%) developed hypernatremia. Those with EAH were 14 kg heavier at baseline, had significantly less training distances, and averaged 5 to 6 hours longer to cover 50 miles (80 km) than the other participants. Neither rate nor total ingested supplemental sodium was correlated with dysnatremia, without significant differences in drinking behaviors or type of supplement compared with normonatremic runners. Hypernatremic runners were more often dehydrated [8 (28%), -4.7 kg (± 9.8)] than EAH [4 (14%), -1.1 kg (± 3.8)] (P < 0.01), and EAH runners were more frequently overhydrated (6, 67%) than hypernatremia (1, 11%) (P < 0.01). In the 98 (56%) runners from hot races, there was EAH OR = 3.5 [95% confidence interval (CI), 0.9-25.9] and hypernatremia OR = 8.8 (95% CI, 2.9-39.5) compared with cold races.

CONCLUSIONS

This was the first study to show that hot race climates are an independent risk factor for EAH and hypernatremia. Sodium supplementation did not prevent EAH nor cause hypernatremia. Longer training distances, lower body mass, and avoidance of overhydration were shown to be the most important factors to prevent EAH and avoidance of dehydration to prevent hypernatremia.

Prospective Observational Study of Weight-based Assessment of Sodium Supplements on Ultramarathon Performance (WASSUP)

BACKGROUND

Sodium supplements are ubiquitous in endurance running, but their impact on performance has been subjected to much debate. The objective of the study was to assess the effect of sodium supplementation as a weight-based predictor of race performance in ultramarathon runners.

METHODS

Prospective observational study during an 80 km (50 mi) stage of a 6-stage 250 km (155 mi) ultramarathon in Chile, Patagonia, Namibia, and Mongolia. Finish line hydration status as measured by weight change, point-of-care serum sodium, and questionnaire provided sodium ingestion categories at 33rd percentile and 66th percentile both for weight-adjusted rate and total sodium consumption, then analyzed for significant relationships to race performance, dysnatremia, and hydration.

RESULTS

Two hundred sixty-six participants were enrolled, with 217 (82%) with complete sodium supplement rate data, 174 (80%) with finish line sodium, and 161 (74%) with both pre-race weights and total sodium ingestion allowing weight-based analysis. Sodium intake ranged from 131-533 mg/h/kg (2-7.2 gm), with no statistically significant impact on pace, race time, or quintile rank. These outcomes did not change when sodium intake was analyzed as a continuous variable or by sub-group analysis of the 109 (68%) normonatremic runners. When controlled for weight-adjusted sodium intake, performance was poorly correlated with hydration (r = - 0.152, 95% CI - 0.348-0.057). Dehydrated runners outperformed those overhydrated, with 11% of top 25th percentile finishers dehydrated (versus 2.8% overhydrated), with 3.6 min/km faster pace and time 4.6 h faster finishing time.

CONCLUSIONS

No association was found between sodium supplement intake and ultramarathon performance. Dehydrated runners were found to have the best performance. This reinforces the message to avoid overhydration.

[Exercise-Associated Hyponatremia in Endurance Performance]

Exercise-Associated Hyponatremia in Endurance Performance Abstract. Exercise-associated hyponatremia is defined as a plasma sodium concentration of <135 mmol/l and was first described by Timothy Noakes at the Comrades Marathon in South Africa in the mid-1980s. A decrease in plasma sodium <135 mmol/l occurs with excessive fluid intake. Risk factors include long to very long endurance performance, extreme climatic conditions, female gender and competitions in the USA. Regarding its prevalence by sport, exercise-associated hyponatraemia tends to occur while swimming and running, but rarely when cycling. While mild exercise-associated hyponatremia does not lead to clinical symptoms, severe hyponatremia due to cerebral edema can lead to neurological deficits and even death. The best prevention of exercise-associated hyponatremia is the reduction of fluid intake during exercise.

The Role of Mineral and Trace Element Supplementation in Exercise and Athletic Performance: A Systematic Review

Minerals and trace elements (MTEs) are micronutrients involved in hundreds of biological processes. Deficiency in MTEs can negatively affect athletic performance. Approximately 50% of athletes have reported consuming some form of micronutrient supplement; however, there is limited data confirming their efficacy for improving performance. The aim of this study was to systematically review the role of MTEs in exercise and athletic performance. Six electronic databases and grey literature sources (MEDLINE; EMBASE; CINAHL and SportDISCUS; Web of Science and clinicaltrials.gov) were searched, in accordance with PRISMA guidelines. Results: 17,433 articles were identified and 130 experiments from 128 studies were included. Retrieved articles included Iron (n = 29), Calcium (n = 11), Magnesium, (n = 22), Phosphate (n = 17), Zinc (n = 9), Sodium (n = 15), Boron (n = 4), Selenium (n = 5), Chromium (n = 12) and multi-mineral articles (n = 5). No relevant articles were identified for Copper, Manganese, Iodine, Nickel, Fluoride or Cobalt. Only Iron and Magnesium included articles of sufficient quality to be assigned as 'strong'. Currently, there is little evidence to support the use of MTE supplementation to improve physiological markers of athletic performance, with the possible exception of Iron (in particular, biological situations) and Magnesium as these currently have the strongest quality evidence. Regardless, some MTEs may possess the potential to improve athletic performance, but more high quality research is required before support for these MTEs can be given. PROSPERO preregistered (CRD42018090502).

Evaluation and review of body fluids saliva, sweat and tear compared to biochemical hydration assessment markers within blood and urine

Evaluating and testing hydration status is increasingly requested by rehabilitation, sport, military and performance-related activities. Besides commonly used biochemical hydration assessment markers within blood and urine, which have their advantages and limitations in collection and evaluating hydration status, there are other potential markers present within saliva, sweat or tear. This literature review focuses on body fluids saliva, sweat and tear compared to blood and urine regarding practicality and hydration status influenced by fluid restriction and/or physical activity. The selected articles included healthy subjects, biochemical hydration assessment markers and a well-described (de)hydration procedure. The included studies (n=16) revealed that the setting and the method of collecting respectively accessing body fluids are particularly important aspects to choose the optimal hydration marker. To obtain a sample of saliva is one of the simplest ways to collect body fluids. During exercise and heat exposures, saliva composition might be an effective index but seems to be highly variable. The collection of sweat is a more extensive and time-consuming technique making it more difficult to evaluate dehydration and to make a statement about the hydration status at a particular time. The collection procedure of tear fluid is easy to access and causes very little discomfort to the subject. Tear osmolarity increases with dehydration in parallel to alterations in plasma osmolality and urine-specific gravity. But at the individual level, its sensitivity has to be further determined.

Nutrition behaviors, perceptions, and beliefs of recent marathon finishers

OBJECTIVES

To describe the nutrition behaviors, perceptions, and beliefs of marathoners.

METHODS

A survey-based study was conducted with 422 recent marathon finishers (199 men, 223 women). Participants reported their running background, demographics, diets followed, supplements used, and food/fluid intake during their most recent marathon (median 7 days prior), as well as beliefs about hydration, fueling, and sources of nutrition information.

RESULTS

Median finishing times were 3:53 (3:26-4:35) and 4:25 (3:50-4:59) h:min for men and women during their most recent marathon. Most participants (66.1%) reported typically following a moderate-carbohydrate, moderate-fat diet, while 66.4% carbohydrate-loaded prior to their most recent marathon. Among 139 participants following a specific diet over the past year, the most common were vegetarian/vegan/pescatarian (n = 39), Paleolithic (n = 16), gluten-free (n = 15), and low-carbohydrate (n = 12). Roughly 35% of participants took a supplement intended to improve running performance over the past month. Women were more likely to follow specific diets (39.0% vs. 26.1%), while men were more likely to recently use performance-enhancing supplements (40.2% vs. 30.0%). Most participants (68.3%) indicated they were likely or very likely to rely on a structured plan to determine fluid intake, and 75% were confident in their ability to hydrate. At least 35.6% of participants thought they could improve marathon performance by 8% or more with nutrition interventions. Scientific journals ranked as the most reliable source of nutrition information, while running coaches ranked as the most likely source to be utilized.

CONCLUSIONS

Findings from this investigation, such as diets and supplements utilized by marathoners, can be used by practitioners and researchers alike to improve the dissemination of scientifically-based information on nutrition and marathon running.

Effects of oral sodium supplementation on indices of thermoregulation in trained, endurance athletes

Guidelines recommend the consumption of sodium during exercise to replace losses in sweat; however, the effects of sodium on thermoregulation are less clear. To determine the effects of high-dose sodium supplementation on indices of thermoregulation and related outcomes, 11 endurance athletes participated in a double-blind, randomized-sequence, crossover study in which they underwent 2-hrs of endurance exercise at 60% heart rate reserve with 1800 mg of sodium supplementation (SS) during one trial and placebo (PL) during the other trial. A progressive intensity time-to-exhaustion test was performed after the 2-hr steady state exercise as an assessment of exercise performance. Sweat rate was calculated from changes in body weight, accounting for fluid intake and urinary losses. Ratings of perceived exertion (RPE) and heat stress were assessed using verbal numeric scales. Cardiovascular drift was determined from the rise in HR during the 2-hr steady state exercise test. Skin temperature was measured with an infrared thermometer. Dehydration occurred in both SS and PL trials, as evidenced by substantial weight loss (2.03 ± 0.43% and 2.27 ± 0.70%, respectively; p = 0.261 between trials). Sweat rate was 1015.53 ± 239.10 ml·hr(-1) during the SS trial and 1053.60±278.24 ml/hr during the PL trial, with no difference between trials (p = 0.459). Heat stress ratings indicated moderate heat stress ("warm/hot" ratings) but were not different between trials (p = 0.825). Time to exhaustion during the SS trial was 6.88 ± 3.88 minutes and during the PL trial averaged 6.96 ± 3.61 minutes, but did not differ between trials (p = 0.919). Cardiovascular drift, skin temperature, and RPE did not differ between trials (all p > 0.05). High-dose sodium supplementation does not appear to impact thermoregulation, cardiovascular drift, or physical performance in trained, endurance athletes. However, in light of the possibility that high sodium intakes might have other adverse effects, such as hypertension, it is our recommendation that athletes interpret professional recommendations for sodium needs during exercise with caution. Key pointsBased on current professional recommendations to replace sodium losses in sweat during exercise, some endurance athletes consume salt or other electrolyte supplements containing sodium during training and competition, however the effects of sodium on thermoregulation are less clear.High-dose sodium supplementation does not appear to impact thermoregulation, cardiovascular drift, or physical performance in trained, endurance athletes.The possibility remains that high sodium intakes might have other adverse effects. It is our recommendation that athletes interpret professional recommendations for sodium needs during exercise with caution.

Physiopathological, Epidemiological, Clinical and Therapeutic Aspects of Exercise-Associated Hyponatremia

Exercise-associated hyponatremia (EAH) is dilutional hyponatremia, a variant of inappropriate antidiuretic hormone secretion (SIADH), characterized by a plasma concentration of sodium lower than 135 mEq/L. The prevalence of EAH is common in endurance (<6 hours) and ultra-endurance events (>6 hours in duration), in which both athletes and medical providers need to be aware of risk factors, symptom presentation, and management. The development of EAH is a combination of excessive water intake, inadequate suppression of the secretion of the antidiuretic hormone (ADH) (due to non osmotic stimuli), long race duration, and very high or very low ambient temperatures. Additional risk factors include female gender, slower race times, and use of nonsteroidal anti-inflammatory drugs. Signs and symptoms of EAH include nausea, vomiting, confusion, headache and seizures; it may result in severe clinical conditions associated with pulmonary and cerebral edema, respiratory failure and death. A rapid diagnosis and appropriate treatment with a hypertonic saline solution is essential in the severe form to ensure a positive outcome.