Last week in Frankfurt, Germany, on a very hot and humid summer day the European Championship IRONMAN Germany took place. For those of you who never heard of an event of this kind or came across the famous IRONMAN label. It is all about a triathlon longdistance race: a 3,8 km swim, 180 km on the bike and a marathon distance of 42,2 km. Biestmilch is involved with longdistance triathlon races since 2002.

You might ask why. Very simple. Biestmilch stabilizes and can even increase endurance performance and speeds up recuperation. A sport like triathlon not only takes its toll during the race but also during the hard and time-consuming periods of intensive training. Strenuous prolonged exercise makes you vulnerable to infectious diseases, injuries, pains and many an ailment no laboratory parameter can tell you the clear-cut reason behind the problem. With biestmilch there exists an amazing substance that is capable to intervene positively with the stressed overbalanced system of your body.

Back to this specific race in Frankfurt
As I mentioned already it was terribly hot the whole week already. Before race all athletes have take part in the race conference where they a taught the rules and regulations, and where they get tips how manage this long day – for some of them it takes around 15 hours and more – without major health problems. This time because of the extreme temperature the race’s physician gave the advice to get salt tablets. Within a few hours all the pharmacies in the vicinity of the race had sold out all salt stores.
Athletes were almost panicking because of this salt problem forgetting that salt needs not necessarily be taken in form of tablets. Salt from your salt shaker at home or at a restaurant might be a solution and probably a much cheaper one.

For those who are interested I had a look into the literature whether and when salt substitution makes sense. Again, as it is the case with so many advices and recepies one might give, there is always the exception to the rule, and, there is solid data undermined by other data not less solid.

Keep the balance between hypo- and hyperhydration

Hypohydration and hyperthermia alone have negative effects on performance but their combination is particularly serious, both in terms of performance and health. Dehydration can be prevented by fluid ingestion pre-exercise and during exercise. Because of large individual differences it is difficult to individualise the advice. Perhaps the best guidance for athletes is to weigh themselves to assess fluid losses during training and racing and limit weight losses to 1% during exercise lasting longer than 1.5 hours. Excessive fluid intake has been associated with hyponatremia. Post-exercise the volume of fluid ingested and sodium intake are important determinants of rehydration.

The problem of overdrinking

To prevent hyponatremia it is recommended to avoid overhydration and to inform athletes about the potential dangers of drinking too much water or sodium free beverages.
Vrijens and Rehrer (1999) investigated the effect of replacing sweat losses by a sodium containing drink compared with water and found that the sodium containing drink attenuated the fall in plasma sodium. Interestingly, Speedy, Thompson, Rodgers, Collins, and Sharwood (2002) recently investigated
the effects of sodium ingestion on the development of hyponatremia. Thirty-eight athletes competing in an Ironman distance triathlon were given salt tablets (700 mg/h) to ingest during the race. Data collected from these athletes were compared with data from athletes not given salt. Sodium ingestion was associated with a decrease in the extent of weight loss during the race. There was no evidence that sodium ingestion significantly influenced changes in plasma sodium concentration or plasma volume more than fluid replacement alone in this study. The authors therefore suggested that sodium supplementation was not necessary to prevent the development of hyponatremia in these athletes.

In conclusion, dehydration can reduce exercise performance and fluid intake before and during exercise can prevent this. Fluid should be ingested at regular intervals and should contain some sodium (at least 20 mmol/l). The inclusion of carbohydrate can be beneficial especially when the duration of the exercise is long (>1 h). However, very concentrated solutions ( >8%, 80 g carbohydrate/l) can impair fluid delivery. During ultraendurance exercise hyponatremia can develop especially when excessive amounts of water are consumed. After exercise fluid balance should be restored and this is best achieved by drinking relatively large volumes (150% of fluid lost) of a high sodium drink (60-90 mmol/l).

Sodium supplementation is not required to maintain serum sodium concentrations during an Ironman triathlon
T D Hew-Butler, K Sharwood, M Collins, D Speedy and T Noakes
University of Cape Town, Cape Town, South Africa

Their study concludes that sodium supplementation was not necessary to preserve serum sodium concentrations in athletes competing for about 12 hours in an Ironman triathlon. The Institute of Medicine’s recommended daily adequate intake of sodium (1.5 g/65 mmol) seems sufficient for a healthy person without further need to supplement during athletic activity.