[Moo] Marathoners Warned About Too Much Water - New York Times

[Jeanne]

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Published: October 20, 2005

Dr. Lewis G. Maharam, the medical director for the New York City Marathon
and marathons in San Diego, Phoenix, Nashville and Virginia Beach, said he
was taking every opportunity this year to educate runners about the biggest
threat to their lives on race day - drinking too much water.

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Suzy Allman for The New York Times

In a first, the handbook for New York City Marathon runners warns of the
dangers of drinking liquids in excess. 

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Mark Robinson is still spooked by his near-death from hyponatremia after the
2004 Boston Marathon. 

He knows the danger: in their zeal to avoid becoming dehydrated, runners may
end up drinking so much that they dilute their blood. Water rushes into
cells, including cells of the brain. The swollen brain cells press against
the skull, and the result can be fatal. The resulting condition is known as
hyponatremia - too much water. 

"There are no reported cases of dehydration causing death in the history of
world running," Maharam said. "But there are plenty of cases of people dying
of hyponatremia."

No one knows how many have died, said Dr. Arthur Siegel, the chief of
internal medicine at McLean Hospital in Belmont, Mass., and the designated
hyponatremia team leader for recent Boston Marathons. But he said that
perhaps a dozen hyponatremia deaths had been recognized, according to
informal communications among doctors at recent marathons.

So this year, for the first time, the participant handbook for runners in
the Nov. 6 New York City Marathon tells them how much to drink - no more
than eight ounces of water every 20 minutes. 

Maharam also makes sure the message is delivered via television shows that
feature news about the marathon. He makes an announcement at the start of
the marathon about how much to drink. And there will be a flier in the goody
bags telling each runner, once again, of the dangers of drinking too much.

Even though Gatorade is one of the sponsors and the race features Gatorade's
new sports drink, Gatorade Endurance Formula, Maharam said that sports
drinks were no better than water. Eight ounces of fluid every 20 minutes is
plenty.

But it is a message that is not always heard. Last year, one percent of the
more than 35,000 New York City marathoners developed hyponatremia, Maharam
said, and although that is a smaller toll than in other cities' marathons,
doctors say every one of those life-threatening medical emergencies could
have been avoided. 

To make matters worse, medical treatments for hyponatremia are often
disastrous. Some doctors mistakenly think the runner is dehydrated and give
intravenous fluids.

The extent of the problem may go far beyond the number of runners who have
been hospitalized for it. A recent study of runners in the 2002 Boston
Marathon found that 13 percent who finished the race had hyponatremia. And
those were runners who thought they were fine and were just participating in
a study. If such a runner continued to drink after the marathon, perhaps
thinking that feelings of nausea and malaise were due to dehydration, the
runner could end up with seizures or slip into a coma, doctors say.

That is what happened to Mark Robinson, a 27-year-old computer programmer
from West Roxbury, Mass., who sees his story as a cautionary tale. 

The day of the 2004 Boston Marathon dawned unusually hot. The race was on
April 19, but the temperature was projected to reach nearly 90 degrees.
Robinson was concerned. It was his first marathon, he had been training for
six months, and he wanted to run it in four hours or less. "I sweat a lot,"
he said. With weather like that, he worried he might become dehydrated. So
he tried to make sure he drank enough.

"I drank more than a gallon of water before the race, and then at every rest
stop I would stop and have a couple of drinks of water," he said. He was on
pace until Mile 19 when, suddenly, he felt nauseous and his legs began to
cramp. He forced himself to continue, but by Mile 23 he could no longer run.
"I tried to power-walk it in," Robinson said.

His parents met him at the finish line, bringing water. He drank two quarts,
but he felt worse than ever. Not only was he vomiting and having diarrhea,
Robinson said, but "I felt spacey, out of it, almost like I was on drugs." 

His parents got a wheelchair and took him to the medical tent, where the
person doing triage at the entrance asked if he could stand on his own. He
could. He said he was told, "We have people here who are lying down," and
was sent away. His parents helped him walk to the subway and took him to
their home in Wayland, Mass. All the while, Robinson was drinking water and
drinking Gatorade and vomiting.

Robinson said: "I felt completely mentally out of it. It was a strange
sensation. Deep down, I knew something really, really wasn't right. It was
like a feeling of impending doom. My father wanted me to take a bath, but I
didn't want to be alone. I looked at my dad and he was talking and his mouth
was kind of going," but, Robinson said, he could no longer hear what his
father was saying. 

Suddenly, Robinson screamed, leaped into the air, and fell down on his
shoulder, breaking it. He lay on the floor, unconscious and no longer
breathing. 

His mother called 911 and a helicopter arrived. On the flight to Boston
Medical Center, Robinson received intravenous fluids; the medical team
thought he was dehydrated.

He ended up in a coma, on life support, and woke up four days later. His
problem? Hyponatremia - poisoned by drinking too much water. 

Robinson still runs, but much shorter distances. "I'll never run a long race
again," he said. And forget marathons, he added. "My wife would never give
me permission," he said. 

Dr. Paul Thompson, a cardiologist, a marathon runner and a director of the
Athletes' Heart program at Hartford Hospital, said: "Everyone's been told to
drink water, drink water, drink water. Water companies want you to drink
water like a fish. Then you dilute your blood and your brain starts to
swell. You have healthy people running marathons and dying. Has the word
gotten out? No."

Even now, more than a year later, Robinson says he is still shaken from his
near-death experience after the Boston Marathon. "You would never, ever
think that water could kill you," he said.


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