Hyponatremia: causes and symptoms of low sodium levels

At 2015 Ironman Frankfurt, temperatures reached 37°C, making a tough race even more brutal. But iron athletes possess a fortitude that subdues the cerebral cry to stop; instead, they stride onward.

Tragically, that sweltering day in Germany ended the life of 30-year-old Iain O’May, who collapsed soon after the finish line. His condition deteriorated and he died from swelling of the brain caused by insufficient salt intake – in other words, hyponatremia.

Such cases are rare in triathlon but, as a recent study shows, hyponatremia isn’t.

• In-depth look at hyponatremia: What it is and how you can avoid it

How does hyponatremia affect the body?

Researchers in Germany tested the post-race blood of nearly 1,100 competitors in the Ironman European Championships between 2005 and 2013.

They discovered that more than 10% had developed hyponatremia, which often derives from, as in the case of O’May, drinking too great a volume of fluid that lacks sufficient essential minerals like sodium.

This upsets the body’s water balance, leading to cellular swelling, and is often accompanied by nausea, headaches and, tragically, death.

Out of the 115 athletes that developed hyponatremia, 17 cases were deemed serious and three critical. These findings led the authors to conclude that hyponatremia is a serious health concern among triathletes.

Extreme heat and long periods of exercise are a dangerous combination but one that’s unavoidable, particularly at Ironman, and also, to a lesser degree, Olympic and 70.3. So is there a solution?

What causes hyponatremia?

Hyponatremia in triathlon is often caused by over drinking, so learning to listen to your body and ensuring that you don’t over consume drinks low in sodium is the number one priority.

Also note that while consuming sodium before, during and after events can maintain performance, it shouldn’t be used to compensate for going wild with fluid intake.

Do I need a sweat test?

I’m reticent to be overly prescriptive with the ideal sodium intake because athletes’ sweat rates – and, in turn, how much sodium they lose – can vary widely.

Around 10% of the athletes we’ve tested have very high sodium losses.

Also, the mean sodium concentration per litre of sweat is 1,000mg, which is about two to three times higher than the ‘hydration industry’ would have you believe when you look at the composition of standard sports drinks.

That’s why a sweat test is ideal because you can individualise your sodium plan.

• Sweat testing for athletes: is it worth it?

• Dehydration and sodium: why replacing salt is crucial

Andy Blow Sports scientist

About

Andy Blow is a sports scientist with a degree in sports and exercise science from the University of Bath. An expert in sweat, dehydration and cramping, Andy previously worked as the team sports scientist for the Benetton and Renault Formula 1 teams, and remains an adviser to the Porsche Human Performance Centre. He specialises in electrolyte replenishment and founded the company he now runs, Precision Hydration. An elite-level triathlete in his younger days, Andy has finished in the top-10 of Ironman and Ironman 70.3 races, as well as winning an Xterra world title. Andy has also worked alongside Dr Raj Jutley, as well as other top sports scientists, to co-author a number of studies and books which have been published in BMJ Journals, the Journal of the International Society of Sports Nutrition and the Journal of the Endocrine Society.