Avoid Heat Related Illness & Dehydration. By John M. Wolkstein DC, NCSF, NESTA None of us is immune to heat related illness. Infants, young children, athletes, adults and senior citizens may suffer from the signs and symptoms of dehydration. Over the years, there have been highly publicized deaths due to heat related illnesses. Many of these unfortunate deaths could have been avoidable. It is important to know the benefits of proper hydration and the signs and symptoms of dehydration and heat related illnesses. The warning signs of heat related illness are typically an elevated body temperature and a heat headache, dizziness, fatigue, anxiety, chills, nausea, and muscle cramping. Without proper fluid intake before exercise or exertion, you can quickly become dehydrated. As progressive dehydration occurs, anything can result on the continuum from muscle cramping to hyperthermia, heat exhaustion or in extreme cases even death. Infants and seniors are susceptible to dehydration due to the low body weight and lack of eating and drinking. What is Dehydration: Fluids are lost from the body through a number of mechanisms; direct bodily waste such as urine and feces and indirect loss through sweating and breathing and mucus. During exercise or exertion, we sweat and this is our body’s way of a releasing heat and cooling us down. The human body is approximately 60% water and many organ systems rely on hydration for their function. These include the heart, lungs, muscles, nerves and the thermoregulatory system. When a person loses bodily fluid through sweating and breathing, that fluid moves from inside body tissues into the arteries and veins to maintain adequate circulation. This is a normal physiologic process that the body uses to maintain body temperature within set limits. When too much fluid is lost, the circulation becomes overwhelmed, unable to keep body temperature from rising too high. When this happens, heat exhaustion sets in and the body begins to show warning signs of dehydration and possible shut down. Dehydration is a significant underlying cause of heat related illnesses. When exercising or working in the heat and humidity, it is very important to pay close attention to fluid intake. Probably the single most important action that people and athletes can take is to be proactive about hydration. Research suggests that, the body starts recognizing thirst when a person is approximately 2% dehydrated; athlete's performance begins to decrease dramatically with as little as 1% dehydration. Optimal bodily function and peak athletic performance cannot be achieved without proper fluid intake before, during and after exercise. The most common symptom manifestation is the "cramp up" that typically occurs in the 4th quarter. Muscle cramping is muscle fatigue, salt loss, and dehydration – all three acting together - playing a role in muscle cramping. On a hot day, a 160 – 180 pound athlete can easily lose as much as one gallon of sweat in the course of a practice or a game. In losing that much sweat, the player can also lose enough sodium chloride to equal 2 to 3 teaspoons of table salt. Compared to the trivial loses of potassium, calcium, and magnesium in sweat, the loss of sodium can be huge.

Sodium is key not only to maintain blood volume but also to help nerves fire and muscles work. Sodium depletion short-circuits the coordination of nerves and muscles as muscles contract and relax. The result can be muscle cramping. Athletes most prone to disabling whole-body cramps are those most lean and fit, intense and explosive at their position, who take many reps in the heat, sweat early and heavily, and cake with salt. So the first line of defense against cramping is to encourage your athletes to consume more liquids with salts and that contain electrolytes. For those who are prone to severe muscle cramps or who are "salty sweaters" – that may not be enough. Players with extreme cramps need even more sodium which they can get by adding ¼ teaspoon salt to a 16 to 20 oz beverage.” Football players are particularly prone to dehydration. The extreme physical demands of the sport combined with the required bulky equipment predispose a football player to have a higher body temperature and sweat more. The helmet, shoulder pads, and other padding act as insulation, keeping the heat close to the body and increasing fluid losses from sweat. During twice-a-day workouts, the average football player can lose up 10 pounds of fluid. Dehydration can actually hinder athletic performance. So what is the best way to stay well hydrated? Athletes should drink a minimum of 16 oz. of water or sports drink 1 -2 hours before exercise. This should be repeated 15 –20 minutes before the warm up, during and after exercise. Athletes should use the summer to get used to this level of fluid intake. At the beginning of practice, the athlete may become nauseous or vomit if his body is not accustomed to drinking this much. If the athlete is adequately hydrated before exercise, the urine will be clear. If your urine is cloudy there is a good chance that you need to hydrate. During exercise, athletes lose large amounts of electrolytes and burn many calories that water alone will not replenish. Sports beverages, such as Gatorade® or Powerade®, have electrolytes and simple sugars, taste good and can be easily taken during practice or competition. It is also important to drink them in the first 15 minutes after exercise, when muscles are replenishing energy stores most efficiently. But the most important hydration factor for all is to drink fluids the night before the activity, during and well after. A general rule for all is to drink ounces of fluid for every pound of body weight lost during exercise. Weigh yourself before and after activities. Anyone who loses more than 2% of his pre- activity body weight should gain it before the next activity. There are a number of other "performance sports drinks" on the market. While some are considered better than others, sports drinks are not inherently good for you. An individual who does not exercise and drinks these beverages will accumulate extra calories and gain weight. There are some fluids that won't help you re hydrate. Alcoholic and caffeine beverages actually promote dehydration by causing the body to lose more fluid in the form of urine. Don’t wear dark colored clothing in the heat. Avoid a wet cotton t-shirt which can actually act as an insulator in hot weather and hinder heat loss. Avoiding the hottest part of the day 11 AM - 2 PM. A shaded area is also recommended for players on a break. Become and educated athlete. Popular foods rich in sodium include tomato juice, canned baked beans, dill pickles, pretzels and canned soups. Eat fruits and veggies, which also contain large amount of water. Above information in conjunction with information from the American College of Sports Medicine, The Sport Science Institute and John Wolkstein DC, NCSF, NESTA. He can be reached at or