Guest guest Posted April 6, 2007 Report Share Posted April 6, 2007 Coaches, Just got back from Children's Hospital in Pa. Daughter has been having dizzy spells. Cardiologist did a complete work up on my daughter. He told that she was very fit for her age. He was astounded by her conditioning. however, he was concerned with her sodium levels and her hydration level. He recommended her to drink two bottles of sports drinks a day. What would you recommend? She doesn't drink juices or soda. She only drinks water. Any input would be appreciated. Thanks Warren Warren Buirch 109 Road sville, NJ 08012 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 8, 2007 Report Share Posted April 8, 2007 > > > Coaches, > > Just got back from Children's Hospital in Pa. Daughter has been having dizzy > spells. [...] You don't mention how old your daughter is, so this is only speculative and may not apply. If I had an adolescent girl (particularly one concerned with athletics) experiencing these symptoms I would look further into her eating habits, and see whether there were signs of disordered nutrition. Young female athletes are extremely susceptible to eating disorders and there may be underlying behaviours of which you are unaware. Only a suggestion -- may not be pertinent. Best wishes, Krista -Dixon Toronto ON kristascottdixon@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 9, 2007 Report Share Posted April 9, 2007 Hi Warren, If you're daughter is particular with her sports drinks, Gatorade has a lightly flavored water -- Propel. That might have the electorlytes that she needs, and taste decent. I think they also came out with a special " water " -- it is not flavored -- but still has all the electrolytes -- Unfortunately, I don't know what it's called. I'm sure you can find it at the grocery store near the gatorades. Best of luck! Dias Santa Clara, CA ================= Wbuirch@... wrote: Coaches, <<<<Just got back from Children's Hospital in Pa. Daughter has been having dizzy spells. Cardiologist did a complete work up on my daughter. He told that she was very fit for her age. He was astounded by her conditioning. however, he was concerned with her sodium levels and her hydration level. He recommended her to drink two bottles of sports drinks a day. What would you recommend? She doesn't drink juices or soda. She only drinks water. Any input would be appreciated.>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 9, 2007 Report Share Posted April 9, 2007 Warren: I think Krista's points are well-made, but do you mind if I ask if you know what your daughter's serum sodium levels were after the cardiologist tested her? And were her dizzy spells following an exercise bout? And if so, how long. I would be very surprised if there were to be a case of hyponatremia here. But as the attending physician specifically spoke to sodium levels, I'm interested in the outcome. Hydration, electrolyte replacement and, sadly, hyponatremia, together with the underlying endocrine systems are an area of special interest to me. Regards Woofie C. " Woofie " Humpage, CSCS USA Triathlon Level 1 Certified Coach A Joe Friel's ULTRAFIT Associate www.mastersathletic.com sdale AZ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2007 Report Share Posted April 10, 2007 >Hi Warren, Woofie's idea of hyponatremia might be an answer, specially is you say your daughter drinks only water. Unfortunately, you haven't mentioned the amount of water she drinks daily. Water is not a good choice for every sport person, specially during training , competitions and recovery. If she drinks too much, her plasma serum level will drop and according to the latest ACSM’s position stand on exercise and fluid intake, on the long term it might cause cerebral damage. I think this is not the case of your daughter but it's something to bear in mind anyway. Drinking a sport drink during a training session might be beneficial but at that point other factors such as the nature of the exercise, intensity and duration and environmental temperature should be considered. All the best, Luca Cardilli Oxford, UK Warren: > > I think Krista's points are well-made, but do you mind if I ask if you > know > what your daughter's serum sodium levels were after the cardiologist > tested > her? And were her dizzy spells following an exercise bout? And if so, how > long. > > I would be very surprised if there were to be a case of hyponatremia here. > But as the attending physician specifically spoke to sodium levels, I'm > interested in the outcome. > > Hydration, electrolyte replacement and, sadly, hyponatremia, together with > the underlying endocrine systems are an area of special interest to me. > > Regards > Woofie > > C. " Woofie " Humpage, CSCS > USA Triathlon Level 1 Certified Coach > A Joe Friel's ULTRAFIT Associate > www.mastersathletic.com > sdale AZ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2007 Report Share Posted April 10, 2007 Following Luca's additional comments on hyponatremia and the new ACSM position stand, let me add a few brief comments. I'm curious about what's going on here with the (referred to) plasma sodium levels as: 1. It would be hard, absent a prolonged exercise bout and serious over-drinking to imagine how *symptomatic* hyponatremia would result. That said: 2. If dizziness indicated symptomatic hyponatremia then I doubt Warren's daughter would have been discharged. FWIW, " mental " or neurological symptoms combined with weight gain are a huge red flag at endurance event medical stations. As an aside, a lot of supplement industry related hype is written about electrolytes. In Triathlete magazine this month (the May issue) there is a rare but simple and good article called " Fact and Fiction: The truth about sodium and endurance sports " by Dr. Craig Horswill. For US listers not familiar w/Triathlete magazine I should say I class it rather like Runners World. If you have read it for a year, you have read what they have to say, but the adverts are good. On this occasion, they managed a good short piece. C. " Woofie " Humpage, CSCS USA Triathlon Level 1 Certified Coach A Joe Friel's ULTRAFIT Associate www.mastersathletic.com sdale AZ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2007 Report Share Posted April 11, 2007 > > Coaches, > > Just got back from Children's Hospital in Pa. Daughter has been having dizzy > spells. Cardiologist did a complete work up on my daughter. He told that she > was very fit for her age. He was astounded by her conditioning. however, he > was concerned with her sodium levels and her hydration level. He recommended > her to drink two bottles of sports drinks a day. What would you recommend? She > doesn't drink juices or soda. She only drinks water. Any input would be > appreciated. *** I've heard the same about chocolate milk and some other common drinks. Though, I don't think Gatorade would have nearly the amount of fat and other stuff you could do w/out. IMO, the best thing about a quality sports drink is its simplicity .... replace what's immediately needed and nothing else. As much of a closet addict as I am w/ Gatorage(get it for free at a gym I work at), I'm also a believer of frequent quality snacks that consistently keep my hydration/electrolyte levels - well, level throughout week. Just so I don't have to worry about it come gameday! It also helps w/ low blood pressure and inconsistent sugar levels That's a good point made earlier re: eating disorders. Crawford Washington, DC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 2007 Report Share Posted April 12, 2007 I also was having dizzy spells and my doc recommended having a V8. Since having one a day, I have not been having the dizzy spells. Also like your daughter I drink water, and not soda or juice. This maybe would help her and she would get some nutrients from it being a veggie drink. Best of luck Day BC Canada Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 12, 2007 Report Share Posted April 12, 2007 As a physician I am always stressing to my patients with high blood pressure that they need to be careful in using salt and in some patients their Hypertension is salt sensitive. Unfortunately this advice given to older patients with Hypertension is taken by young healthy and active individuals, who are trying eat a healthy diet, that they too should avoid salt. Just as sugar does not cause diabetes salt does not cause Hypertension. However just as an individual with diabetes has to limit their sugar intake so does an individual with Hypertension have to limit their sodium intake. In your case as well as Warren Buirch's daughter you are more likely to be suffering from hypovolemia rather than hyponatremia. The hypovolemia is causing " low blood pressure " which in turn is the cause of your dizzy spells. By taking in more sodium your body will retain more fluid and consequently raise your blood pressure to normal values. Hyponatremia does not occur as often as you think. In athletes it will occur only if they are sweating profusely for a long time (the rule of thumb > 3 hrs) and replacing the lost sweat with plain water. In the study from the New England Journal of Medicine, which reported the findings of runners in the Boston Marathon, hypnatremia was more likely to occur in th slower runners whose time was very slow and who drank just water during the entire race. The front runners were least likely to suffer from hyponatremia. On the other hand in the elderly and sick this condition is unfortunately more common, not because they lack sodium in their diet but rather because the kidneys and other mechinisms for controlling osmolality and fluid not longer function properly. Ralph Giarnella MD Southington Ct USA --- Day wrote: > I also was having dizzy spells and my doc > recommended having a V8. Since > having one a day, I have not been having the dizzy > spells. Also like your > daughter I drink water, and not soda or juice. This > maybe would help her and > she would get some nutrients from it being a veggie > drink. > > > Best of luck > Day > BC Canada > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 13, 2007 Report Share Posted April 13, 2007 Hi Ralph, I looked up hypovolemia as this is a new term for me. I don't believe this is something I have. Causes:Common causes of hypovolemia can be dehydration, bleeding, severe burns and drugs such as diuretics or vasodilators typically used to treat hypertensive individuals. Rarely, it may occur as a result of a blood donation.[1] I drink 2-4 litres of water a day; no bleeding or burns; and completely drug-free. Also a low resting pulse rate. I run 5 km a day on various inclines (6 days a week); lift weights every other day, and stay active with hiking, mnt biking; swimming etc. I also eat cleanly and well : ) Im 36. Thanks for your email reply. Day BC Canada <<<< Re: Re: Low sodium As a physician I am always stressing to my patients with high blood pressure that they need to be careful in using salt and in some patients their Hypertension is salt sensitive. Unfortunately this advice given to older patients with Hypertension is taken by young healthy and active individuals, who are trying eat a healthy diet, that they too should avoid salt. Just as sugar does not cause diabetes salt does not cause Hypertension. However just as an individual with diabetes has to limit their sugar intake so does an individual with Hypertension have to limit their sodium intake. In your case as well as Warren Buirch's daughter you are more likely to be suffering from hypovolemia rather than hyponatremia. The hypovolemia is causing " low blood pressure " which in turn is the cause of your dizzy spells. By taking in more sodium your body will retain more fluid and consequently raise your blood pressure to normal values. Hyponatremia does not occur as often as you think. In athletes it will occur only if they are sweating profusely for a long time (the rule of thumb > 3 hrs) and replacing the lost sweat with plain water. In the study from the New England Journal of Medicine, which reported the findings of runners in the Boston Marathon, hypnatremia was more likely to occur in th slower runners whose time was very slow and who drank just water during the entire race. The front runners were least likely to suffer from hyponatremia. On the other hand in the elderly and sick this condition is unfortunately more common, not because they lack sodium in their diet but rather because the kidneys and other mechinisms for controlling osmolality and fluid not longer function properly. Ralph Giarnella MD Southington Ct USA >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 13, 2007 Report Share Posted April 13, 2007 Hi Ralph, I looked up hypovolemia as this is a new term for me. I don't believe this is something I have. Causes:Common causes of hypovolemia can be dehydration, bleeding, severe burns and drugs such as diuretics or vasodilators typically used to treat hypertensive individuals. Rarely, it may occur as a result of a blood donation.[1] I drink 2-4 litres of water a day; no bleeding or burns; and completely drug-free. Also a low resting pulse rate. I run 5 km a day on various inclines (6 days a week); lift weights every other day, and stay active with hiking, mnt biking; swimming etc. I also eat cleanly and well : ) Im 36. Thanks for your email reply. Day BC Canada <<<< Re: Re: Low sodium As a physician I am always stressing to my patients with high blood pressure that they need to be careful in using salt and in some patients their Hypertension is salt sensitive. Unfortunately this advice given to older patients with Hypertension is taken by young healthy and active individuals, who are trying eat a healthy diet, that they too should avoid salt. Just as sugar does not cause diabetes salt does not cause Hypertension. However just as an individual with diabetes has to limit their sugar intake so does an individual with Hypertension have to limit their sodium intake. In your case as well as Warren Buirch's daughter you are more likely to be suffering from hypovolemia rather than hyponatremia. The hypovolemia is causing " low blood pressure " which in turn is the cause of your dizzy spells. By taking in more sodium your body will retain more fluid and consequently raise your blood pressure to normal values. Hyponatremia does not occur as often as you think. In athletes it will occur only if they are sweating profusely for a long time (the rule of thumb > 3 hrs) and replacing the lost sweat with plain water. In the study from the New England Journal of Medicine, which reported the findings of runners in the Boston Marathon, hypnatremia was more likely to occur in th slower runners whose time was very slow and who drank just water during the entire race. The front runners were least likely to suffer from hyponatremia. On the other hand in the elderly and sick this condition is unfortunately more common, not because they lack sodium in their diet but rather because the kidneys and other mechinisms for controlling osmolality and fluid not longer function properly. Ralph Giarnella MD Southington Ct USA >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2007 Report Share Posted April 15, 2007 --- Day wrote: > Hi Ralph, > > I looked up hypovolemia as this is a new term for > me. I don't believe this is something I have. > > Causes:Common causes of hypovolemia can be > dehydration, bleeding, severe burns and drugs such > as diuretics or vasodilators typically used to treat > hypertensive individuals. Rarely, it may occur as a > result of a blood donation.[1] > I drink 2-4 litres of water a day; no bleeding or > burns; and completely drug-free. Also a low resting > pulse rate. > > I run 5 km a day on various inclines (6 days a > week); lift weights every other day, and stay active > with hiking, mnt biking; swimming etc. I also eat > cleanly and well : ) Im 36. > > Thanks for your email reply. > > Day > BC Canada It is great that you drink 2-4 liters daily but that does not guarantee that you are not at times suffering from chronic dehydration. This is not an uncommon finding amongst athletes especially if they base their fluid intake on thirst. The average sedentary non athletes needs a minimum of 2 liters daily just to maintain normal fluid homeostasis. On average the kidneys need about 1 liter daily to filter the blood daily. On the average a sedentary (non sweating) individual loses at least another 1 liter daily in what is known as insensible water loss. This fluid is lost through the lungs every time we exhale (ever sit in a parked car when it is cold out a note that the windows get fogged up? We also lose fluid through our skin even when not visibly sweating. 9 liters daily are excreted into our intestinal tract to aid digestion daily, although approximately 95% is reabsorbed through our colon. ************************ <<A Primer on Fluids and Sodium By , MS, RD This report filed June 10, 2004 In early 2004 the Institute of Medicine's (IOM) Food and Nutrition Board released Dietary Reference Intakes (DRIs) for water and sodium (potassium, chloride, and sulfate recommendations were also included in this report). You may have heard about these dietary guidelines for Americans and Canadians, which are designed for the average adult who may be sedentary or mildly active, not for triathletes and cyclist who training regularly, often for more than two hours per session. In establishing the guidelines, the expert panel reviewed the scientific literature for quality of the research and the resulting data. The IOM panel determined that male adults require 3.7 liters of fluid daily and female adults require 2.7 liters. The panel also decided that caffeinated and alcoholic beverages could contribute to the total fluid intake states noting that their diuretic effect seems to be transient in nature. They also advise that drinking that fluid intake should be driven by thirst and the consumption of beverages at mealtime. These recommendations will not fit endurance athletes who should rely on my more than thirst to maintain adequate fluid consumption. You are likely thirsty when your body fluid levels are fairly low and there is an increase in sodium concentration, not a good indicator for preventing dehydration.>> ************************** In the athlete who exercises these loses are greatly increased. An athlete can sweat 1+ liters of fluid for every hour that they exercise. The 3 liters are the minimum you should be drinking when not exercising and then you probably need to add another 1+ liters per hour of exercise, depending on the conditions under which you exercise and the intensity of the exercise. While sweating the athlete also loses a considerable amount of sodium. ************************* <<Salt of the Earth http://velonews.com/train/ By , MS, RD This report filed June 30, 2004 The IOM has recommended that sodium intake be at 1500 milligrams daily. This recommendation is based on the fact that research supports that reduced intake of sodium coupled with increased potassium intake can help prevent the increase in blood pressure that occurs with aging. However, sodium sweat losses can vary greatly and be significant during hard and long training sessions outdoors. Athletes have had measured sodium sweat losses ranging from 460 to 1800 mg sodium per liter sweat. How much sodium you lose in an hour of training is also a product of your sweat rate. Some well-acclimated triathletes and cyclists may be very efficient sweaters and lose only one-half to one liter of sweat per hour, while others may reach higher levels of two or three liters per hour in hot and humid weather, despite being acclimated.>> ******************************************** If you are losing a large amount of sodium through your sweat and your sodium intake is low your body will not retain enough of the water you drink to maintain your blood pressure. Just as too much sodium may be associated with Hypertension low sodium can be associated with hypotension or low blood pressure. How does this occur? Well the needs to maintain a sodium level of between 137 mmol/l and 145 mmol/l. If the sodium concentration levels begin to drop the kidneys will dump water and retain sodium to return the equilibrium. This can result in hypovolemia or dehydration and is manifested in a low blood pressure. This can be compensated for with an increase in heart rate. However when there is a sudden change in position such as going from a lying position to a sitting position or a standing position there can be a sudden uncompensated drop in blood pressure causing a short period of light headedness. The hypotension then causes several compensation mechanisms and the dizziness passes. If it were not for the compensating mechanisms the individual would lose consciousness and fall down. In women this condition may be exacerbated by a mild chronic anemia caused by their monthly menstruation. By your own account you are a very active individual and may in fact need more than 4 liters daily as well as an increase of sodium in your diet. The case cited by someone of correcting dizziness by drinking V8 juice had less to do with the particular product other than the fact that that particular juice contains sodium. That is also the reason why the cardiologist made the recommendation of increasing sodium to prevent dizziness. The scientific way of testing for dehydration is to check the urine specific gravity. The non scientific way, is to check the color of your urine. Dark yellow indicates a very concentrated urine (possible dehydration) and very light yellow or clear urine indicates a very dilute urine (adequately hydrated). The exception is if you are taking high doses of vitamins many of which will turn your urine a bright yellow. Ralph Giarnella MD Southington Ct USA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2007 Report Share Posted April 15, 2007 --- Day wrote: > Hi Ralph, > > I looked up hypovolemia as this is a new term for > me. I don't believe this is something I have. > > Causes:Common causes of hypovolemia can be > dehydration, bleeding, severe burns and drugs such > as diuretics or vasodilators typically used to treat > hypertensive individuals. Rarely, it may occur as a > result of a blood donation.[1] > I drink 2-4 litres of water a day; no bleeding or > burns; and completely drug-free. Also a low resting > pulse rate. > > I run 5 km a day on various inclines (6 days a > week); lift weights every other day, and stay active > with hiking, mnt biking; swimming etc. I also eat > cleanly and well : ) Im 36. > > Thanks for your email reply. > > Day > BC Canada It is great that you drink 2-4 liters daily but that does not guarantee that you are not at times suffering from chronic dehydration. This is not an uncommon finding amongst athletes especially if they base their fluid intake on thirst. The average sedentary non athletes needs a minimum of 2 liters daily just to maintain normal fluid homeostasis. On average the kidneys need about 1 liter daily to filter the blood daily. On the average a sedentary (non sweating) individual loses at least another 1 liter daily in what is known as insensible water loss. This fluid is lost through the lungs every time we exhale (ever sit in a parked car when it is cold out a note that the windows get fogged up? We also lose fluid through our skin even when not visibly sweating. 9 liters daily are excreted into our intestinal tract to aid digestion daily, although approximately 95% is reabsorbed through our colon. ************************ <<A Primer on Fluids and Sodium By , MS, RD This report filed June 10, 2004 In early 2004 the Institute of Medicine's (IOM) Food and Nutrition Board released Dietary Reference Intakes (DRIs) for water and sodium (potassium, chloride, and sulfate recommendations were also included in this report). You may have heard about these dietary guidelines for Americans and Canadians, which are designed for the average adult who may be sedentary or mildly active, not for triathletes and cyclist who training regularly, often for more than two hours per session. In establishing the guidelines, the expert panel reviewed the scientific literature for quality of the research and the resulting data. The IOM panel determined that male adults require 3.7 liters of fluid daily and female adults require 2.7 liters. The panel also decided that caffeinated and alcoholic beverages could contribute to the total fluid intake states noting that their diuretic effect seems to be transient in nature. They also advise that drinking that fluid intake should be driven by thirst and the consumption of beverages at mealtime. These recommendations will not fit endurance athletes who should rely on my more than thirst to maintain adequate fluid consumption. You are likely thirsty when your body fluid levels are fairly low and there is an increase in sodium concentration, not a good indicator for preventing dehydration.>> ************************** In the athlete who exercises these loses are greatly increased. An athlete can sweat 1+ liters of fluid for every hour that they exercise. The 3 liters are the minimum you should be drinking when not exercising and then you probably need to add another 1+ liters per hour of exercise, depending on the conditions under which you exercise and the intensity of the exercise. While sweating the athlete also loses a considerable amount of sodium. ************************* <<Salt of the Earth http://velonews.com/train/ By , MS, RD This report filed June 30, 2004 The IOM has recommended that sodium intake be at 1500 milligrams daily. This recommendation is based on the fact that research supports that reduced intake of sodium coupled with increased potassium intake can help prevent the increase in blood pressure that occurs with aging. However, sodium sweat losses can vary greatly and be significant during hard and long training sessions outdoors. Athletes have had measured sodium sweat losses ranging from 460 to 1800 mg sodium per liter sweat. How much sodium you lose in an hour of training is also a product of your sweat rate. Some well-acclimated triathletes and cyclists may be very efficient sweaters and lose only one-half to one liter of sweat per hour, while others may reach higher levels of two or three liters per hour in hot and humid weather, despite being acclimated.>> ******************************************** If you are losing a large amount of sodium through your sweat and your sodium intake is low your body will not retain enough of the water you drink to maintain your blood pressure. Just as too much sodium may be associated with Hypertension low sodium can be associated with hypotension or low blood pressure. How does this occur? Well the needs to maintain a sodium level of between 137 mmol/l and 145 mmol/l. If the sodium concentration levels begin to drop the kidneys will dump water and retain sodium to return the equilibrium. This can result in hypovolemia or dehydration and is manifested in a low blood pressure. This can be compensated for with an increase in heart rate. However when there is a sudden change in position such as going from a lying position to a sitting position or a standing position there can be a sudden uncompensated drop in blood pressure causing a short period of light headedness. The hypotension then causes several compensation mechanisms and the dizziness passes. If it were not for the compensating mechanisms the individual would lose consciousness and fall down. In women this condition may be exacerbated by a mild chronic anemia caused by their monthly menstruation. By your own account you are a very active individual and may in fact need more than 4 liters daily as well as an increase of sodium in your diet. The case cited by someone of correcting dizziness by drinking V8 juice had less to do with the particular product other than the fact that that particular juice contains sodium. That is also the reason why the cardiologist made the recommendation of increasing sodium to prevent dizziness. The scientific way of testing for dehydration is to check the urine specific gravity. The non scientific way, is to check the color of your urine. Dark yellow indicates a very concentrated urine (possible dehydration) and very light yellow or clear urine indicates a very dilute urine (adequately hydrated). The exception is if you are taking high doses of vitamins many of which will turn your urine a bright yellow. Ralph Giarnella MD Southington Ct USA Quote Link to comment Share on other sites More sharing options...
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