Thursday, August 29, 2013

What Does Sugary Water Do To Your Body? Thoughts On Racing With A Water Balloon.

I listened to this podcast interview with David “Wolverine” Smith the other day:

David "Wolverine" Smith – Survivor

It’s a remarkable, if completely infuriating, story about medical malpractice and human resilience.  In short, through a series of gross medical mishaps after a minor procedure, he wound up having his large and small intestines removed, and then replaced with a transplanted large and small intestine.

I discovered Wolverine’s site about 18 months ago, posted a comment, and engaged in a email dialog with him which was most interesting.

He eats basically a paleo diet:

“I eat mostly meat from grass fed animals (I own a small farm and raise my own cattle for meat).  I knew that I would have to eat very nutritionally dense foods, because the transplanted organ does not work at 100%.  I have to avoid sugary beverages, especially any containing caffeine, because they cause me to dehydrate.  I only have a total of about 22 inches of colon, so I can dehydrate easily.  I am the only member of the transplant patients from 2010 who does not require to have a port for hydration fluid infusions.  Because I only drink water (and [raw] milk).  I add a small amount of Himalayan sea salt to my water to add in minerals and electrolytes that I lose due to having a short colon.”

This was the part of the interview that I found particularly fascinating, as they apply directly to training.  I’d not read Dr. Tim Noakes’ Waterlogged when I first encountered Wolverine, and so really didn’t put two and two together.

One of the things I’ve noticed since going Paleo three-and-a-half years ago (post to come!) is that my hydration requirements are much lower than they used to be, and follow a particular pattern.  I used to get thirsty regularly, and pee regularly.  I’ve since learned that this is a symptom of diabetes, and since my doctor had informed me that I was pre-diabetic, I was happy to see it go.  But I didn’t understand why it happened.

The new pattern is that I drink some fluids, and then need to urinate within a short period of time.  Then nothing, until I drink more fluids.  It’s as if my body’s water sensor senses incoming fluids and feels free to release fluids.  It works quite well, and means that unscheduled potty breaks (or waking up at night) no longer occur.  

Wolverine, in the interview above, describes his experiences with dehydration, which are an elaboration of the quote above.

After having his intestines removed, but prior to his intestinal transplant, he had a short length of small intestine descending from his stomach which was routed out to a bag outside his body.  There was no connection to his colon. In the normal course of business, your colon absorbs most, if not all, of the water you consume.  In Wolverine’s case, since the colon was no longer having water routed through it, he needed IV hydration. 

What he discovered was that if he drank sugary water, his body reacted to it by flooding his stomach with water.  This flowed into what little bit of small intestine he had, and thence into the ostomy bag.  (The cause of his dehydration was revealed to him by a pharmacist, as the doctors, unsurprisingly, were clueless about how the body worked.)

Wolverine had already learned about toxicity of sugar to the body the hard way: he was being fed by having sugar and soybean oil pumped directly into his veins, and his veins would break down from sugar poisoning.  It seems that the stomach has a self-defense mechanism: flood the stomach with water to dilute the sugar.

Unfortunately in Wolverine’s case, this was a problem, since his body couldn’t reabsorb the water.  It turned out to really be a problem when he drank some sweetened ice tea.  His body reacted by dumping nearly three gallons of water into his stomach, and then into his ostomy bag.  Which required a great deal of IV replenishment, and put his life in jeopardy.  The combination of caffeine and sugar is a dangerous one, apparently.

In a person with a normal intestinal system, all of this water would be gradually absorbed back into the body, of course.  But in the meanwhile it sits in the intestines, doing nothing but protecting your body from sugar poisoning.

Two lights went on over my head on hearing this.  The first is that this explains diabetics’ frequent thirst and urination: they’re thirsty because diabetics consume a lot of sugar, which requires their bodies to dump water into their guts.  They need to replenish this water in their systems, and perhaps drinking the water helps in diluting the sugar in their guts.  Secondly, they’re peeing a lot because as their body reabsorbs all this water, they have too much in their blood, and the body starts dumping it the only way it can.  It’s a vicious cycle.

The second light was that if you’re running a race or training, the last thing in the world you want to do is cause your body to need to dump a lot of water into your gut, when it would be better off by maintaining a normal hydration balance.  The water in your gut does nothing to help you to keep cool through sweating, and only makes you more thirsty.  And what do runners love to drink?  Sugary water like Gatorade.  Back to the vicious cycle.  So the runner weighs more, needs to carry more water, and is going to wind up with a lot of water getting reabsorbed back into the blood stream, necessitating urination.  Moreover, having this load of water getting reabsorbed by your colon means that you’re at increased risk of hyponatremia (water poisoning), which is the topic of Waterlogged.

(I’ve often observed that runners in endurance races seem to be trying to induce diabetes.  This may be more true than I thought.)

Now as Noakes points out in his book, you’re at no risk of dehydration in a short race.  There’s no need, normally, for your body to drink.  And unless you’re a sugar-burner, there’s no requirement for sugar.  (If you are a sugar-burner, you can train your body not to be, and be healthier and faster for it.)  And, as Noakes also points out, losing water weight is a big advantage in a running race: if you want to find the most dehydrated runner in a race; the runner who’s lost the most weight, look to the top of the winner’s podium.  It certainly does you no good sloshing around in your gut; it’s dead weight.

Since reading Noakes’ book and going low-carb (not in that order); I’ve discovered that I can go hours and hours in warm temperatures with no water.  I’ve lost 8-10 pounds with no ill effects.  And I’ve gotten faster.

There’s an argument that really elite athletes may need some sugar for maximum performance, but non-elite athletes over-consume water and sugar.  To the detriment of their performance, I think.

The other comment Wolverine made above was about adding a smidge of salt to his water.  When you drink water, your body tries to normalize the salt content (blood is as salty as sea water).  I think this is a lot less important, as Noakes wrote, your body is normally pretty good at managing sodium balance, but it might explain why these athletes dumping sugar into their guts are craving salt; their bodies are trying to bring the salt content of the water they’re consuming up to normal.

I did a long run recently, and ate a couple of beef snack sticks in the middle of it, but no carbohydrates.  They were a lot saltier than I was expecting, and I think the salt was a big mistake: I immediately became madly thirsty, and started cramping at once.  Cramping in your feet for 10 miles ain’t fun.  I’ll not repeat that mistake…  But that said, I’ve never craved salt on a run.  Usually I’m dumping salt in sweat, which, as Noakes notes, is a normal state for an over-salted person. (This was a fine example of why you try experiments like those beef sticks on a training run.)

Do read Wolverine’s story on his site, and listen to the podcast above.  His story is incredibly informative, even if it does leave you shaking with anger, as it did me.  And Noakes’ book, as you may have gathered from my many references to it, is a fascinating read.