Discussion: Ibuprofen Use update

All Athletes: Ibuprofen/NSAID Update by Woofie Humpage

As a follow-up to my April e-Tips article on ibuprofen use, I would like to offer the results of some just-published research.

In an article by Tim Noakes and others (Wharam, Speedy, Noakes, Thompson, Reid and Holtzhausen) entitled “NSAID Use Increases The Risk of Developing Hyponatremia during an Ironman Triathlon” in the journal Medicine & Science in Sports & Exercise (Vol. 38, No. 4), the authors concluded (in part): “This study shows that NSAIDs are commonly used in ultraendurance events and that their use is associated with an increased risk of the development of biochemically diagnosed exertional hyponatremia. The effect is likely due to an alteration of renal function.”

Please note that the subjects—participants in the 2004 Ironman New Zealand—were clinically diagnosed with hyponatremia but were asymptomatic. However, NSAID use appears to be a contributory factor to them developing clinically diagnosed hyponatremia based on blood sampling post-race. Just another factor to consider if you were thinking of taking NSAIDs during that next ultraendurance event.

Anthony C. "Woofie" Humpage, CSCS, is an Ultrafit Associate and USA Triathlon certified coach. He coaches Masters and female athletes for ultra-endurance events. Woofie specializes in performing in extreme environments. Contact him at woofie@teamwoofie.com.

Speedy at work :)

I think I'll change my AP name to "Woofie Humpage".

not if I do it first.....

kissy woofie humpage. Even better.

Sounds like a name from the xxx industry.

Sounds like something that you break up with a blast from a garden hose if you see it in going on in your yard.

i got a bad case of hyponutreamia at the aussie 5-days in december and its not much fun(i ended up having to get airlifted to canberra). im interested to know if anyone knows of any other orienteering related hyponutreamia cases or whether im the only one who cannot control their fluids?
lets turn this into a discussion about bad orienteering related injuries illnesses....

Just curious - realistically, how much did you drink before, during, and after the events? How much was water, and how much was sport drink (and no, beer doesn't count...)? If sport drink, was it full strength?

I got fairly hyponatrermic at the 5WRC at the end of our first loop. The Czech kids who were manning the hash house were completely freaked out to see the "American" be dragged in, sit down, and eat two full tablespoons of salt.

Our second loop was flyin'.

I seem to recall Tex getting himself into that situation in New Hampshire in the summer of 2003.

how much did i drink? i didnt have much just before the race. After the race probably about ~3L of mainly water, a bit of apple juice. Later on when i started feeling sick, other orienteers and myself thought i was dehydrated so i drank about another 2L this included 600ml powerade, 600ml lemonade and water.
The problem was it was a multi-day race and the first day was ran in about 36 degree heat, thats celsius, and when i finished they had run out of water at the finish(mind you i didnt have much in the car either). I got really dehydrated after this race and could not eat that night, i think this had a dramatic affect on the concentration of salt in my blood.
I was very naive about hyponutreamia and the symptoms were much like those of dehydration. confusion between the two can be very dangerous, after this experience ive learnt that its important to rehydrate gradually instead of walking over to the drink stop and doing it in one big hit. Also i dont think i'll be running the summer 5 days in aus any more, my new summer sport is watching the cricket.

The hypothesized mechanism by which NSAIDs increase risk of hyponatremia: they reduce prostaglandin levels, which reduces blood flow to the kidneys, one of whose functions it is to regulate the levels of sodium in the blood. This hypothesis is supported by the results of the article Coach cites, which showed worse levels of blood indicators of kidney function in 330 triathlon runners. 30% of the 330 took NSAIDs. Only 6 people in the study experienced hyponatremia.

Some people have suggested using acetaminophen (Tylenol) during a race instead of ibuprofen. Unlike aspirin and ibuprofen, acetaminophen does not appear to affect prostaglandin levels, at least as far as can be observed by downstream effects like inflammation.

The sports medicine articles seem to blame over-hydration as a major cause for hyponatremia, with NSAID use being a possible minor contributing factor.

One article (J Emerg Med. 2001 Jul;21(1):47-57) states that marathon runners with hyponatremia "were more likely to be female, use NSAIDS, and have slower finishing times." (Pretty much defines me. Except for the marathon-running part.) Coach's 2006 article also identifies being female as a risk factor, along with lower prerace body weight (a pro-dessert finding), younger age (phew), and smaller weight loss during the race (obviously could be related to over-hydration).

I've never encountered it in an O meet, but have run into trouble on two long runs (> 30miles). On both occaisions, I was normally hydrated starting the run, and drank quite a bit during the run (around 1 liter per hour, the weather was moderately hot). About four hours into the run I felt nauseus and in onc case, had to cut the run short (at 30 miles, planned 35) due to vomitting.

After the second time, I decided it wasn't a fluke and did some research as to what was going on. I started taking electrolyte tablets on my long, hot runs (and adventure races, rogaines, etc.) and haven't had any trouble since (I still drink a lot of water - St. Louis summers have you sweating a lot). I'm generally loathe to use any form of medication during competition, but on the times when I have injured something and need an anti-inflamatory, I've used IB without noticing any negative effects.

Any advantage to using Aleve (naproxen sodium), or is the amount of sodium inconsequential?

Regarding Aleve: naproxen is an NSAID just like aspirin and ibuprofen, so you have the potential for the same effect on the kidneys. The amount of sodium is only 20mg per tablet, compared with 370mg in a scoop of Eload, so I don't think the presence of sodium in Aleve is a relevant mitigating factor as far as hyponatremia is concerned.

I have had 3 encounters with hyponatremia, all of them during long, hot events: during a 50-hour trek in 35 degree heat, after 50 hours in a 3-day adventure race, and during a 30 hour multi-sport event in hot, dry conditions.

My initial symptoms always include swelling and tightness in my hands, progressing to swelling and puffiness around the eyes, and then neurological symptoms such as confusion, lethargy, and apathy. I also experience a hyper-sensitvity to temperature changes, especially to cold. The slightest breeze or any temperature below 20 celsius would send me into uncontrollable shivering. Left untreated, I would eventually have had seizures, slipped into a coma, and died.

I was able to treat the condition and recover by drinking lots of full strength Eload. The same thing could be accomplished by drinking fluids and taking electrolyte capsules/re-hydration salts.

The biggest danger right now is the use of the term "over-hydration". It implies that hyponatremia is caused by drinking too much, and therefore racers think they should cut back on their fluid intake and end up risking serious dehydration. Once that happens, your race is done, and it can be every bit as serious and fatal as severe hyponatremia. KEEP DRINKING!!

The cause of hyponatremia in ultra-endurance athletes is a decrease in the concentration of salt in the body fluids. This is caused by drinking plain water or other fluids that have either no saltor too little. If you lose water and salt through sweat, and replace it with plain water, then you end up diluting the salt solution in your body: hyponatremia.

The important thing is to rehydrate with either a full strength electrolyte replacement sports drink, or supplement your beverage of choice with regular electrolyte capsules. Basically what you want to try to do is drink enough fluid to keep your blood volume up, and drink something with enough electrolytes to replace what you lose through sweating.

Hope this helps.

I have recently begun using eLoad for all of my long runs, races and anything in hot weather. It is by far the best decision I have made. In addition to helping prevent dehydration and hyponatremia by stimulating your thirst and providing lots of salt (and other stuff) it has also helped me avoid getting muscle cramps, isn't sweet or undrinkable at full strength and thus avoids that gatorade gut-rot feeling, and finally tastes like nothing which to me, esp. in a race, is equivalent to tasting good.

I do not stand to benefit from posting this, but you might. I love this stuff.

Another advantage of keeping electrolyte levels up: less chance of blisters. My blistering problems (which were severe in the first few 24-hour events I did) have virtually disappeared since paying attention to electrolyte levels. It's not a miracle cure, I did other things as well (changing socks more often, regular foot maintenance, etc.), but I do think it helped.

What is it about electrolyte levels that effects blister formation?

Tex got severe hyponutremia at the 2003 1000 Day at Lake George. He was camped near us and we watched him drink large containers of water before and after the events for several days. Then he got it and Lisa was able to get him to the hospital for treatment. We hadn't heard much about it up until then, though a woman died at a marathon that year from too much water. Perhaps Tex can provide more.

Don't forget the Gookinaid!

Eat pistachios regularly!

seems more common than i thought. since then ive been drinking a lot more full electrolyte drinks and ive noticed another benefit, you dont cramp up nearly as much.