On Electrolyte Content of Fluid
Electrolytes are chemical substances that, when dissolved or melted, dissociate into electrically charged particles (or ions such as sodium and potassium).
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During prolonged exercise, the body is forced to deplete its fluid stores as a consequence of the sodium chloride losses in sweat. This is because the amount of sodium and potassium in the body determined the amount of water, not the other way around. If this did not occur and fluid stores were allowed to remain normal in response to drinking during exercise, a dilutional hyponatremia would develop.
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It follows that the only way to prevent dehydration during exercise is to replace both the sodium and the water losses in sweat, as these losses develop by drinking an appropriate fluid that contains the optimum amount of sodium.
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Yet, if the sweat rate exceeds about 750 ml per hour, it is impossible to replace all that fluid, probably because the fluid cannot be ingested and absorbed by the intestine at such high rates, at least during exercise. Thus, even if fluid is ingested at sufficiently high rates to replace all the water lost, that fluid must also contain sodium in the same concentrations found in sweat, which is between 40 and 80 mmol per litre, or from two to four times higher than the sodium concentrations currently found in athletic drinks.
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Although it has been argued that both carbohydrate and sodium replacement during exercise cannot occur at the same time, when a solution containing both a high carbohydrate (6 - 8%) and a high sodium (50 mmol per litre) content was evaluated so that the osmolality* was also high (330 mosmol per litre), the rates of water and carbohydrate absorption were satisfactory.
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It is important to maintain the ability of urine production, thereby preventing fluid retention, rather than the small extra amount of sodium ingested, that reduces the fall in blood sodium concentrations in all athletes, regardless of how much sodium they ingest. It is this ability that prevents the development of hyponatremia in those who ingest fluid at excessive rates. As athletes are not at risk of developing deficiencies of either magnesium or potassium during exercise, neither needs to be replaced until after exercise.
On Carbohydrate and Fat Content of Fluid
Carbohydrate ingestion prevents hypoglycemia, which profoundly affects performance. The most important factor determining the rate of gastric emptying is the volume of the solution in the stomach, not its carbohydrate content. The greater the degree of gastric distension an athlete maintains during exercise, the more carbohydrate and water will be delivered to the intestine, irrespective of the carbohydrate content of the ingested solution. How, then, do you make sure that you aren’t drinking too much? The answer is that vast majority of athletes do not drink enough to match their sweat rates and hence are not at risk of developing hyponatremia. Only those drinking more than 1.0 - 1.5 L per hour for many hours are ever likely to get into trouble -athletes who drink less than this should be within safe limits, unless they are very light (less than 45 kg) and exercise very slowly.
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On Muscle Uptake of Carbohydrate
The factor limiting the oxidation of ingested carbohydrate is the rate of glucose released by the liver. As this is set at about 1 g per minute, it follows that ingesting carbohydrate at rates much faster than 1 g per minute during exercise will not be beneficial, as the carbohydrate will be stored in the liver and not used during exercise.
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It is now known that the fate of the ingested carbohydrate is the same whether it is taken 3 hours before or 15 or 120 min after the start of exercise. It is believed that ingested carbohydrate is oxidised at a maximum rate of about 1 g per minute during exercise, provided the rate of ingestions is at least 70 to 100 g per hour. The optimum fuels for ingestion are glucose, maltose and fructose polymers, or soluble, branched-chain starches with high glycemic indexes, as present in spaghetti, bread and potatoes. In contrast, fructose, the sugar present in fruits, galactose, lactate and alcohol are all oxidised to a lesser extent than is glucose ingested during exercise. The ingestion of even quite modest amounts (about 50 g) of fructose, like that of lactate, produces gastrointestinal discomfort, becuase there is a limited capacity to absorb fructose from the intestine.
*Osmolality is determined by the concentration of all the particles -electrolytes, proteins, etc.- dissolved in the solution. Osmolality is, therefore, proportional to the total number of all the molecules dissolved in the solution.
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There is a maximum rate at which carbohydrate ingested during exercise can be used by the muscles. The rate-limiting step appears to be the rate of release of glucose by the liver. Only when a “second liver” is introduced -by infusing glucose directly into the bloodstream at much faster rates (up to 3 g per minute) than the normal liver chooses to release glucose (1 g per minute)- can muscle glucose oxidation rates be increased to what may be a maximal capacity of about 2.5 g per minute. However, this procedure produces very high blood glucose concentrations (approximately 10 mmol per litre), which are twice the normal values.
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The human was designed to maintain a blood glucose concentration of about 5 mmol per litre. During prolonged exercise (longer than 90 min), this balance is reached at a rate of glucose release by the liver and its use by muscles, both equal to 1 g per minute. when carbohydrate is ingested at sufficiently rapid rates (approximately 80 g per hour), the ingested carbohydrate completely suppresses liver glucose production, so that all the glucose oxidised by the muscles (1 g per minute) comes from the ingested carbohydrate. One reason for the limiting rate of glucose release might be the relatively small amount of carbohydrate (approximately 120 g) stored in the liver. Were very high rates of glucose release possible, the liver’s glycogen stores would be rapidly depleted, causing hypoglycemia and exercise would be terminated.
During Recovery
Increasing the sodium content of the fluid ingested during recovery reduces the urine losses and increases the rate of rehydration in proportion to the sodium concentration of the ingested fluid. As fluid ingestion will initiate some urine loss, the ingested volume needs to exceed the total fluid deficit by 25% to 50%.
The Ideal Sports Drink
The maximum rates of fluid loss for the faster athletes competing in moderate environmental condition is about 1000 ml per hour. However, no one has yet shown that, in competition, these athletes can ever drink more than 700 ml per hour without developing symptoms of fullness and bloating.
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The key to developing the optimum replacement fluid for ingestion during exercise would seem to be to develop a drinking pattern that provides optimum fluid, electrolyte and carbohydrate replacement at an ingested rate of 500 to 800 ml per hour without causing gastric distress by forcing the athlete to maintain a large gastric volume or abdominal fullness as a result of a failure of fluid absorption.
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A 7% carbohydrate solution ingested in 100 ml every 10 min and maintaining a gastric volume of only 200 ml is probably the more usual drinking pattern chosen by most athletes during competition.
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Different carbohydrate concentrations would provide quite different rates of carbohydrate delivery. The latter, rather than the rate of water delivery, may really be the more important factor to consider, at least during more prolonged exercise lasting more than 3 hours.
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To optimise intestinal absorption of carbohydrate and water and to replace the sodium lost in sweat, the ingested solution should have a sodium chloride content of about 60 mmol per litre.
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The intake must be sufficient to provide the muscles with 1 g per minute of glucose. This is probably achieved with an intake of 60 to 90 g per hour. Higher rates do not appear to aid performance any further.
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At a practical level, what should the average athlete do? An ideal solution (assuming a drinking rate of 500 to 800 ml per hour) that is also palatable could go along the following lines:
Carbohydrate Content: 7.5% to 12% (depending on the rate of drinking)
Carbohydrate Type: anything but fructose
Osmolality: 200 to 400 mosmol per litre (osmolality will depend on the type of carbohydrate used -glucose polymers will have lower osmolalities at any carbohydrate concentration)
Sodium Content: 60 mmol per litre
At present, there is still no solution conforming to the above criteria. Here are some guidelines, however, on what to look for when buying currently available sports drinks:
Palatability -the most scientifically formulated drink is of no value, if it is so unpalatable that it cannot be drunk.
Carbohydrate Concentration of 5% to 10% -higher carbohydrate concentrations only become important near the end of prolonged, competitive exercise, when the desire to drink falls, but the need for carbohydrate replacement is greatest.
Carbohydrate from a Variety of Source -a mixture of carbohydrate sources (glucose and maltodextrins) is necessary to maximise palatability and to maintain a low to moderate osmolality.
Sodium Concentration of 20 to 60 mmol per litre -the higher sodium concentrations aid fluid balance, when athletes are able to ingest fluid at high rates.
Source: T. Noakes (2001) Lore of Running. Human Kinetics.