Running the Risk of Too Much Water
Hyponatremia
Can Sometimes Lead to Death for Marathoners
By Dan Steinberg
Special to The Washington Post
Friday, October 24, 2003; Page A01
The last thing Jethro Defensor remembers from the 2000 Walt Disney
World Marathon was pointing at his runner's bib and asking the paramedics in the
ambulance to call his wife. When he regained consciousness 20 hours later, the
explanation for his collapse seemed ridiculous.
Too much water? Impossible.
"I thought I was dehydrating. I kept thinking, 'Drink water, drink
water,' " said Defensor, 48, of Silver Spring. "Who ever thought of water
poisoning?"
In the three years since Defensor nearly died in Orlando, runners,
doctors and race officials have spent countless hours thinking about that very
problem. Hyponatremia, a sodium imbalance brought on by excess fluid
consumption, was once thought primarily to afflict extreme endurance athletes,
such as Ironman competitors. But in the past few years, the condition has become
increasingly associated with marathoners, in particular women and runners who
are on the 26.2-mile course for more than four hours.
At least four marathon runners have died from hyponatremia-related
trauma in the last decade, including one woman at last year's Boston Marathon
and Hilary Bellamy, who collapsed near Mile 22 at last year's Marine Corps
Marathon and died the next day at Georgetown University Hospital. Dozens more,
such as Defensor, have become ill -- sometimes seriously -- but survived.
Sunday's 28th running of the Marine Corps will be the first since USA
Track & Field issued new hydration guidelines in April, cautioning distance
runners against the long-standing advice to drink as much water as possible
before and during a race. The International Marathon Medical Directors
Association issued a similar warning in 2001, urging runners only to drink when
they are thirsty.
Race directors across the country have addressed the problem on Web
sites, in registration packets and during pre-race clinics, urging participants
to drink when they are thirsty instead of reaching toward every outstretched arm
offering a cup of sports drink or water. "It has been the talk,
the issue since Boston and obviously Marine Corps last year," Marine
Corps race director Rick Nealis said.
Marine Corps officials will hand out hydration brochures at Saturday's
runners symposium, and medical team captains discussed the issue at yesterday's
pre-race meeting in Quantico. Since the Marine Corps Marathon course remains
open longer than those of many other marathons, the race -- which calls itself
the "People's Marathon'' -- attracts thousands of first-time marathoners, who
are often slower, less experienced runners. Because they are on the course
longer, they can be more susceptible to overhydration.
Researchers agree that hyponatremia strikes women more often, perhaps
because of their slower average times, lower average weights or different body
chemistry. Bellamy, 35, was running her first marathon and had been on the
course for more than five hours when she collapsed last year.
"As more and more runners are out there for longer and longer periods
of time, and as the running community is changing from professional runners and
club runners to more and more charity runners out there for five, six or seven
hours, we're seeing more and more people hyponatremic," said Lewis Maharam,
medical director of the New York City Marathon.
At this year's Marine Corps race, about 12,500 of the 23,884 registered
runners will be running their first marathon. The median finish time at last
year's race was 4 hours 35 minutes.
"Being the 'People's Marathon' means you may get more inexperienced
runners; that's always a concern, but I can't say we have more people at risk
than other marathons," said Navy Cmdr. Bruce Adams, the race's first-year
medical director.
The Houston Marathon this year cut the number of water stops on its
course from 30 to 16, and put more than 20 scales along the route so runners
could see if they were retaining excess water. Last weekend's Baltimore Marathon
had 15 water stops, three fewer than in past years. Many medical directors
refrain from giving intravenous fluids in medical tents until the sodium level
of runners' blood has been tested by i-STATmachines, reversing previous
practice, which assumed fallen runners were dehydrated.
"Everyone knows about dehydration, and the answer to that used to be
'Drink, drink, drink, you can't overdrink,' " said Arthur Siegel, a researcher.
Siegel examined the blood of Bellamy and Cynthia Lucero, who died of cerebral
swelling caused by hyponatremia at the 2002 Boston Marathon. "Well, you can
overdrink, and overhydration is more dangerous than under."
? 2003 The Washington Post Company
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KC Guevara, right, drank three liters of water before the Boston
Marathon and a small cup every mile for most of race. By Mile 22 she felt
disoriented. (Len Spoden For The Washington Post)
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_____ Marine Corps
Marathon _____
?
Great Falls resident Peter
Sherry paced himself early and used a late surge to earn his first
marathon victory in 2:25:07.
? Running in her first marathon, Heather
Hanscom dominated the field, finishing 20 minutes ahead of her nearest
competitor.
? Notebook:
Inspired by her Marine son, 47-year-old Ellen Hoitsma completed her first
marathon.
? Runners
encountered a a
slightly altered course.
? Many runners, each with a different
story, toed Sunday's starting line.
? Drinking too
much water can lead to death for marathon participants.
? Marine Corps Marathon
organizers worked out of a
new facility dedicated soley to the event.
? Marathon
course
_____ Gallery _____
?
About 18,000
runners took on the 26.2-mile course, which began and ended at the
Iwo Jima Memorial.
_____ Results _____
Men
1.
Peter Sherry, 35, Great Falls, Va., 2 hours, 25 minutes, 7 seconds.
2.
Eric Post, 24, Fairfax, Va., 2:27:49.
3. Aaron Church, 28, South
Riding, Va., 2:28:24.
4. Benjamin Palafox-Lopez, 30, Mexico,
2:29:58.
5. Mark Croasdale, 38, Britain, 2:30:20.
6.
Hipolito Sandoval Godine, 28, Mexico, 2:31:27.
7. Josse Williams, 25,
Baltimore, 2:32:18.
8. Brian Cole, 32, Britain, 2:32:26.
9.
Mark Goodridge, 33, Britain, 2:32:37.
10. Gerardo Aliva, 30,
Washington, D.C. 2:32:59.
Women
1. Heather Hanscom, 25,
Alexandria, Va., 2:37:59.
2. Lindsey Gannon, 38, Britain,
2:58:46.
3. Kristin Van Eron, 31, Timonium, Md. 3:00:14.
4.
Victoria McParland, 27, Washington, D.C. 3:02:26.
5. Sage Stefiuk, 23,
Highlands, N.J., 3:03:34.
6. Janiced Flynn, 44, Redding, Conn.,
3:04:17.
7. Jacqueline Chen, 41, hometown unknown,
3:07:36.
8. Suzanne Himes, 34, Norfolk, Va., 3:07:37.
9.
Heidi McKenna, 36, Beaver Creek, Ohio, 3:08:13.
10. Beth Moras, 44,
Ridgewood, N.J., 3:08:34.
?
Search for more
results
_____ Video _____
?
After months of training, members of the D.C. Road Runners Club
concentrate on their final
preparations for Sunday's race.
_____ Audio _____
? Peter
Sherry talks about the crowd pulling him through to
victory.
? Heather
Hanscom discusses what she had to overcome on her journey to
winning the marathon.
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