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Pediatric Sports Medicine: Essentials for Office Evaluation
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Thanks to CHOC Children's Hospital for filming my January, 2016 Grand Rounds presentation on Top Sports Nutritional Topics in Adolescent Athletes.
Topics include:
It seems that water bottles are virtual necessities in the sports world, right up there with the latest in athletic shoes, balls, and other key equipment. Reliance on forced drinking schedules and repeated admonitions to drink, drink, and oh yes, don't forget to drink seem to be just as commonplace.
While water or other sports fluid intake is generally considered a positive factor in sports, is there a chance that dependence, or namely over-dependence on drinking during exercise could actually cause more harm than good?
The answer is yes.
According to the Statement of the 3rd International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015, over-indulgence of water and sports fluids can lead to a lowering of sodium levels in the blood stream, creating a situation called hyponatremia which can lead to fatigue, confusion, seizures, and ultimately death from brain swelling.
Related Topic:
My exposure to exercise-associated hyponatremia has been with marathons and Ironman triathlon distance events, and common teaching indicates that such endurance events indeed have the highest risk profiles.
What is particularly alarming and frightening is the growing series of reported symptomatic hyponatremia events in previously less suspected activities such as football (high school, college and professional levels), yoga, hiking and swimming. Probably several more cases that have never reached the medical literature.
All because sustained and excessive water or sports drink intake volume that became greater than sweat, urination and respiratory fluid losses leading to over-hydration and lower blood salt levels.
Yes, sports beverage do have some salt content, but often those sodium levels are too low to offset the large amount of fluid ingested. Thus, one cannot safely assume that ingesting sports beverages with their higher salt content than water will completely prevent the development of hyponatremia.
So then, should we just throw away all those sports drink bottles? Or how about do away with any forced recommendations to drink? What then are some sensible recommendations for amount of fluid intake during exercise?
I'll paraphrase from the Consensus Statement:
Bottom line- like many things in life, too much of a good thing can actually be a bad thing.
Focusing on finite amounts of fluids (bottles drank, ounces consumed) may not be the best guide, for according to the consensus statement, most healthy athletes should use thirst as a reputable guide in most exercise conditions and situations, and if there are any doubts, please do not hesitate to contact a trusted sports medicine professional for more individualized advice.
This blog post is not intended to provide specific diagnostic or treatment advice in the absence of a established professional evaluation. Individuals who read this should freely discuss information with their medical professional or sports medicine professional before changing any behaviors or practices.
In appreciation of CHOC Children's Hospital inviting me to speak on Top Sports Nutrition Concerns Seen in Adolescent Sports Medicine first at their RDs in Practice – Pediatric Sports Nutrition conference and following up with a Pediatric Grand Rounds on the same subject, figured I would compile a list of past blog posts that will form the backbone of those presentations.
Courtesy:http://www.gocomics.com/peanuts/2016/03/26
In one corner stands water, in the other stands sports drinks.
Just as young athletes go head to head on sporting fields, seems that these two heavyweightsare seemingly in competition for the designation of "best fluid choice".
Even good ol' Charlie Brown wants to know the answer, "Is there an outright winner in this battle?"
Is one better for pre-activity, during activity, or for post-activity?
Could there actually be other fluid choices that can rise up and seize the coveted title?
Let the contest begin....
The Winner: Water just ahead of sports drinks
Why: Water provides an inexpensive, readily accessible and low-calorie option to maintain hydration. Cold water is better absorbed. For kids who for some reason won't drink water and prefer a flavored beverage, then sports drinks right before exercise are a sensible option. Keep in mind that the American Academy of Pediatrics counsels against routine consumption of sports drinks outside of sport activity due to concerns that include excessive sugar intake impacting dental health and body weight.
Guidelines for Use: The American College of Sports Medicine recommends these pre-exercise guidelines:
Other Things to Consider: Dehydration can affect quality of exercise, ability to maintain appropriate body temperature, and lead to early fatigue and cramping. Keep an eye on body weight, especially in hot or humid environments and when performing multiple exercise sessions with short recovery periods. More than 2% weight loss from regular weight suggests dehydration and requires adequate fluid intake (usually with water) to replenish losses and correct the reduction in body weight.
The Winner: Kinda depends
Why: For most exercise activities that last under an hour, water is a very sensible choice that meets the needs of young athletes. If the exercise session lasts over an hour, water is still a solid selection, but there is an increased role for sports beverages to help replace sugar (carbohydrate) and electrolytes (salts). For those athletes who tend to be salty sweaters (white salt rings on headgear and uniforms, sweat has a distinct salt taste), sports beverages can help replace those sweat salt losses.
Guidelines for Use: Main Goal- use thirst as a guide rather than a forced schedule
Here are suggestions from our colleagues at the American College of Sports Medicine:
Other Things to Consider: Drinking too much water can actually be dangerous, especially in ultra-endurance activities lasting several hours. Excessive water ingestion without adequate salt intake can lead to low sodium levels in the blood stream (hyponatremia) with risks of seizures, brain swelling and even death. Thus, many authorities recommend against rigid or forced consumption of water during ultra-endurance events such as marathons or triathlons.
The Winner: Neither
Why: Well, you actually cannot go wrong with water or measured amounts (again to reduce sugar/calorie burden) of sports drinks after exercise, but if the ultimate goal is optimizing immediate (first 30 minutes after exercise) recovery including rehydration, then let me suggest some more favorable choices.
Guidelines for Use: One 8-12 ounce serving of chocolate milk or tart cherry juice within 30 minutes of completing activity. Can use similar amount of sports beverage as well. Measure weight after activity- for every one pound of weight loss, recommend consumption of 16-24 ounces of fluid, of which water should be the primary component.
Other things to consider: In addition to chocolate milk, protein-rich foods such as peanut butter and Greek yogurt are helpful for muscle recovery. Berries and actual cherries are also good anti-inflammatory food sources. Limit sugar-filled sports drinks or chocolate milk to the immediate post-exercise period, and also watch high sugar content snacks after exercise.
More winning advice: do not encourage sharing of containers (which can encourage sharing of illness) and do serve beverages cold for better absorption.
