Sunday, August 19, 2012

Secrets of Bodyweight Manipulation, Part Nine - J.M. Blakley




Fluid Replenishment


This seems to be easy. Just drink. The problem is that the thirst mechanism is slaked well before full rehydration is complete. Drinking when not thirsty is uncomfortable to say the least. Athletes who are not watching the scale feel rehydrated but usually fall well short of recovery (and totally miss out on rebound). The athlete cannot trust his thirst. He can watch his weight and urine color and volume. An athlete can not be said to be fully rehydrated until his weight is recovered and his urine output reaches a point (usually mid-morning on the next day just prior to competing) where he is urinating 150-250 ml. every 15 minutes and the appearance of the urine is crystal clear. During this time (which should last only about 2 hours) the athlete can begin to slow and even stop pushing fluids. Blood pressure will be re-elevated from a low point the evening before (which followed a very high point just after the weigh-in and re-introduction of fluids) and body weight should be higher than the start point.

This is not any guarantee but it is a good sign that the job has been successful. This event is unmistakable. The athlete must be sure to keep drinking back the amount that is urinated for the first hour. Then the fluids can be consumed based on thirst until the competition.
Until this event the athlete can be thought of as dehydrated and must force fluids. As with food the first bouts of drinking should be limited to 32 oz. and then at regular intervals increased to the point where the athlete is drinking to full bloat of the stomach. This must continue under strict discipline. The athlete must not let up. 
As a rule of thumb, 4 gallons of Gatorade should be ingested for a 10 pound dehydration in the 24 hour period. Gatorade is a good choice because it has the best combination of electrolytes especially sodium. Other options include Pedialyte, Powerade, and equine electrolyte powders that can be added to water (yuck) or fruit juices. Water alone is not the best choice because the others offer calories and electrolytes. Drinking bouts should be between 32 and 64 oz. at a time. The duration between bouts will vary but the athlete must drink as often as possible.
The fluids will first refill the plasma compartment. Then over time leak into the interstitium. Only after these two compartments are replenished will any rehydration of the cells begin )with exception of water stored with glycogen). Every effort was made to avoid cellular dehydration, but doubtless some has occurred. The sooner the other two compartments are refilled, the sooner the cells will get theirs. And the sooner the better. 
Dehydration imparts a very fatigued and weak feeling to the athlete that can have serious psychological effects on confidence. The athlete feels bone-tired and weak as a kitten. The truth is that it doesn't matter how the athlete feels the day before the meet, just as it makes no difference how he feels after the meet.
What is important is how he feels at the meet. With full reconstitution, he will feel fine. And with a little rebound he will feel great. But some athletes are spooked by the extreme fatigue the day prior. They are certain in their minds that they will be affected. They can't let it go. They hold the memory of the weak feeling like a lost lover. The sooner the athlete begins to rehydrate and shake the fog off from the cutting process the better their spirits. They must understand that the feeling is temporary (unless they don't reconstitute fully . . . they they're stuck with it!) and will pass. The sooner they start to feel better the less the psychological ill-effects. Water must be replaced as rapidly as possible after an initial ramping.

Some athletes will use an I.V. to aid the speed at which they replenish fluids. This is fine as long as the blood pressure is not allowed to rise too quickly. A slow constant drip of dextrose solution or lactated Ringer's solution is preferable to straight sodium solution. The process is time consuming especially if more than one bag is going to be used (1.5 liters +). This process is a little creepy looking and requires lots of know-how. Many athletes find a nurse or paramedic to help them.

For a body weight loss of less than 13 pounds this process is entirely unnecessary. Full replenishment is easily accomplished without the added complications of an I.V. for moderate weight loss and restoration. Without proper assistance the procedure is full of risks and complications.

Some athletes will opt to take in extra salt and electrolyte tablets at this time in an effort to aid rehydration. There are preparations of sodium, chloride, magnesium, calcium, phosphorus, and potassium. It is debatable whether these really help over and above the amounts seen in force feeding. However, they are inexpensive and low risk as long as they are taken late the first day or on the day after weigh-in. By this time the body has probably achieved a semi-normal balance of electrolytes and any excess will simply be excreted.

On occasion an athlete will use a prescription potassium supplement called Slo-K. The athlete must be positive they are not using a potassium-sparing diuretic and that their blood levels of potassium are not elevated to begin with. There are ways to formulate how much Slo-K to take (in mEQs) based on urine output during diuresis. A typical estimate is 20 mEQ of potassium lost per liter of urine. This is not a complete estimate because potassium is also lost by other routes such as sweating but provides a safe "low estimate". It is better to shoot low on this one. An overestimate here can really screw things up. The athlete must measure the urine output with a container each urination. Each Slo-K tablet is 600 mg. of which only 325 is potassium (the rest is chloride). Each tablet is equivalent to 8 mEQ of potassium. It can be thought of as two tablets per liter of urine (again a slight under-estimate) roughly. The dose is divided throughout the day.

As always athletes tend to be overanxious about everything and by their very nature do things to extreme. Lots of trouble can arise with high dose potassium drugs. Over the counter potassium tablets are available in 99 mg. per tab and would take handfuls to cause problems. Of course taking 4 OTC potassium tabs every one Slow-K would have the same effect. But an athlete is more likely to think twice when taking 16-20 pills of one medication or supplement (it doesn't stop some though). I suppose it could be overdone with bananas but the athlete would have to really like bananas as well as be a total idiot to pull that off.

In general, unless there is a real problem with cramping in the athlete's history, it is probably best to avoid potassium supplements altogether. It is a lot of work and effort. The risk is low but present. Most likely the potassium will easily be replaced by Gatorade and in the force feed.

Some athletes have used anti-histamines and anti-inflammatory drugs, claimed to cause water retention. While the use of Hismanal and phenylbutazone may affect water retention, it is most likely too late for real practical aid within 24 hours. Often the peak is 3 or 4 days later, well after it can contribute to the performance. I have seen athletes swell up on "bute" by several pounds (up to 6!) but never in time for the meet. This was invariably a day or two late. And it doesn't work for everyone. The risks are exceptionally high. A quick read of the Physician's Desk Reference section on side effect of phenylbutazone reads like a horror story. It is rarely used in humans! It is a last-chance anti-inflammatory drug for severe arthritis. Still many athletes are willing to risk it. The usual dosage is 250 mg. per gallon of fluid up to one gram (4 gallons). I have never heard of anyone taking more than one gram. Many only do 250-500 mg. and stop. I also have no idea where this dosing schedule came from. Veterinary dosing for dogs is 20 mg. per pound of bodyweight with a max of 800 mg. Some athletes swear by bute but the risk seems to high.

In general these methods may not impart much more fluid retention than forced feed and forced fluids. The small benefit is offset by the risk. If the result were more pronounced or reliable they might be more considerable. They are just another complication.

Glycerol is also a candidate to aid re-hydration. Glycerol pulls fluids into the plasma. It sounds great and seems sound on paper but the results are inconsistent and unpredictable. Under normal circumstances, this may be a decent way to hyper-hydrate. But after wide swings in body fluid volumes and reconstitution, it is hit and miss. It can elevate blood pressure if taken too early. It can peak too soon or too late. It is in general a tough nut to crack. However if an athlete were to sustain multiple trials and carefully note all the variables with different dosing schedules, it may prove helpful with little risk. A dosing schedule that I have seen that seems plausible is 5 ml. per kg. (20% solution) of bodyweight initial dose and follow up dosings of 5 ml/kg (4% solution). The first dose is taken over an hour and subsequent dosings may follow at a lower concentration and over several hours.

Blood pressure and hematocrit can be measured to evaluate the success of the procedure. Just how long its effect will last depends on clearance of the glycerol. Timing the administrations to correlate with the event is tricky. But even if the plasma volume begins to lose some of the hyper-hydration, it is still above normal hydration and during the time in which the plasma volume was filled the extra fluids taken in by mouth would have been pushed into refilling the interstatia. So all in all this is still a worthwhile endeavor for the athlete.

The procedure should begin late the day or weigh-in or early the day of the meet. Glycerol loading done too soon after severe dehydration may elevate blood pressure to dangerous levels.

There are medications that slow the urine flow (Detrol) in the kidneys. They may or may not be useful. This seems safer than bute but they may have other complications. I have yet to encounter someone who has used this medication to help re-hydrate. I can offer no insight into its value.

There are anti-diarrhea meds like loperamide (Imodium) which can slow the gastro-intestinal tract down a bit and also conserve electrolytes. 2 to 4 mg. at the onset of reconstitution and 2 mg. repeated several hours later is a common dosing regime. The athlete should never exceed 12 mg. This may cause a bloated feeling but other than that is very low risk. It has the added benefit of electrolyte conservation.

Full fluid replenishment is by and large a factor of willpower and forced drinking. Other things may help retain the water, but the fact remains that the fluids must be ingested in the first place.


DON'T TRY THIS AT HOME

The preceding work is meant to serve as a looking glass into the practices of some successful athletes. It was written devoid of actual advice. It explains the theory of the methods practiced by some. Outlining the training protocol for a world class squatter does not advocate the method nor should it encourage the reader to load a barbell to 880 lbs. on the next leg training day for an attempt at a double. But it is interesting to learn how some people do certain special things. It is important to realize that the things athletes do in the pursuit of sport are not always healthy (I can't imagine any health benefits attributed to running 26.2 miles in one afternoon) or safe. But still we marvel at feats of athleticism and discipline. This work is meant to chronicle the exploits of others to answer the question, "how did they do that?", not to serve as a recipe book for unsupervised experimentation.

I'm trying to avoid the "Evil Knievel Syndrome" whi9ch happened in backyards across America shortly after ABC's airing of every Wide World of Sports daredevil jump. Kids immediately got on their bicycles and set up makeshift ramps and went at it despite the admonition, "Kids, don't try this at home!"

If cutting weight is indeed an art, then sit back and respect the artwork. Going to the museum and viewing a particular painting by one of the masters does not prompt a person to set up an easel and buy a palette. This, too, would probably just make a mess of things.

End.






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