By Timothy Dillon
Photo courtesy of Rene Schwietzke.
There have been an average of 649 marathons each year in the United States and Canada over the past four years. That is hundreds of thousands of runners pounding their feet against the pavement, pushing themselves to that finish line one stride at a time. A marathon is 26.2 miles and in order to complete one of these monsters, a runner must be trained, rested, nourished, and of course, hydrated. And, just like with all things, there is an excess that exists.
Let’s say, for a moment, you finish a marathon. You are surrounded by exhausted runners, perhaps your family if they came to support you, and every muscle in your body is yelling at you to sit down and relax. You grab a bottle of water and start to gulp it down. After all, you’ve been sweating the whole race. You’re tired, you’re thirsty; this is pretty typical among runners who have just finished a race. So you keep guzzling that water and you suddenly are having trouble hearing the crowd and your family.
That ground you were banging the whole race is suddenly made of jello, and so are your knees. You try to ask for help staying upright, but the words flop out of your mouth along with tongue, slurred, and inaudible. You feel faint and before you feel the pavement meet your face, you’ve already blacked out, and on your way to never running again.
This disturbing chain of events can happen to any athlete during and after any major endurance sporting event, and we have seen it happen, time and time again. Hyponatremia, better known as water intoxication, is a condition that sets in once the blood sodium concentration drops too low. The reason this happens to endurance athletes is, they have used up salt, an electrolyte during their activity.
Once a person’s body has entered into that phase, their body begins to store water and vital nutrients. By gorging on water, you’re no longer adding water to a system that will continue to flush it out. The body, and the cells within, become more like a balloon with no way out. The real danger is in the swelling of brain cells. Once they fill up and expand, so does the brain tissue, and there is no room for a brain to swell in a skull. Water intoxication is, essentially the expansion of the brain to the point of seizure, and inevitably, death.
“It comes down to people following advice that is not thought out. Over zealous advice toted as common sense,” says John Cianca M.D. Dr. Cianca has spent years becoming an expert on the field of hydration and hyponatremia. This type of ‘common sense’ he is talking about is something that can be seen all over the web when preparing for marathons. Even the REI website gives advice that could potentially be lethal, since stopping at every water station in a marathon could lead to you drinking more than is actually needed. While Cianca is one of the foremost experts on the condition, there is not much new in the way of immediate treatment.
When a person has crossed that threshold and are at risk to suffer water intoxication, there are no indicators beforehand. It is only after water intoxication has begun that you can see signs of it and begin to try and treat it. For instance, take the case of Cynthia Lucero. She was drinking water throughout the 2002 Boston Marathon, and by all accounts was running strong, but ended up collapsing before reaching the 20 mile marker. She died soon after.
Yet, even with attention to the details, runners can still succumb to this eerie condition. During the 2002 Marine Corps Marathon Hilary Bellamy, 35, actually dropped out of the race to seek medical attention, yet she was unable to undo what had already been done.
“Body weight is a great indicator. If you’re gaining weight during or after activity, then you are retaining water and you are at risk for water intoxication. Beyond that, how much is someone sweating versus how much are they taking in, is a good indicator,” though Dr. Cianca admits, this is a difficult thing to measure. The reason why weight is so important is that when a person is “water drunk” their body will begin to swell and retain that fluid, in essence, gain a noticeable weight.
There have been other examples of people suffering water intoxication in the past decade. One example was a radio contest that went horribly awry. ‘Hold Your Wee for a Wii‘ was the name of the contest, and after drinking excessive amounts of water, one contestant, mother of three Jennifer Strange, died due to swelling in her brain.
Water is considered to be the molecule of life — no living thing can survive without it. That said, the old saying that, ‘too much of a good thing…’ certainly applies here. Yet, the most important moral to glean from this story is to know your body and be prepared. This condition is completely preventable if you take steps to ensure you are not over hydrating.
“Most people think, ‘the event is done, so everything is fine,'” says Cianca. “But it’s what happens in those next couple hours that can really make a difference.”