Life During and After an Eating Disorder

“Sometimes, though, when things don’t go as planned you end up with far more than you would have if life went according to script.”

via Jennifer Kirk.

Poignant glimpse into the spirit that claims victory over an eating disorder from former olympic hopeful Jennifer Kirk.

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Hydration=More Than Water

Last week, I asked my Facebook followers for some suggestions regarding blog post topics. I received some interesting ones and over the next few weeks, I plan to address the “reader’s choice” topics.  Please feel free to leave comments below listing other topics you’re curious about…It’s much less anxiety inducing (for me, anyway) to write about topics I know people want to read about!

Ok, so this week thanks to popular demand (well, really, thanks to my dear friend Laura and my boyfriend’s penchant for calf cramps) we’re talking about hydration… not just what “being (de)hydrated” means but the importance of staying hydrated, especially during summer and especially, especially, if one is pursing any sort of athletic endeavor.

I’ll start with the basics of what hydration and being hydrated means, then I’ll get into a little “nitty-gritty” information about electrolytes, their function in the body and why they are important. Next, I’ll address factors affecting hydration and the choice of hydration beverage.  Lastly, I’ll compare some popular hydration options including NUUN, endurolyte tablets, and coconut water.

Let’s get started, shall we?

What does it mean to be hydrated? 

Did you know that the person you love is ~60-70% water? The EXACT percentage will vary amongst people of different ages and body compositions (babies have more water than adults, and men more than women, thanks in part to their greater lean muscle mass (muscle holds more water than fat)) but one thing is common amongst all: Water is a critical component of human existence. Among other things, water helps digest food, transport waste, and control body temperature. The ability of water to dissolve substances allows our cells to use the nutrients, vitamins, minerals, and chemicals vital for biological processes to occur; water’s surface tension plays a part in our ability to transport materials, such as nutrients derived from food and waste products of our metabolism through the body.

Due to respiration, sweat, and voiding of metabolic wastes (how’s that for a euphemism for defecation and urination?! ), each day we lose ~ 2.4 L of water (and maybe more if we live in warm, dry climates or sweat excessively) which must be replaced by the fluids we drink or the foods we eat (more about this in a bit).

Are you hydrated?

Look at your pee.

No, really.

Look at your pee.

Does it look like clear-light yellow lemonade? Yes? Great! You’re hydrated. If it’s darker than that, you’re probably not*.  What can you do about it? Drink water! And drink it slowly and consistently. And check your pee.  Again.  A rule of thumb for BASELINE hydration (ie. before exercise or exposure to a warm climate) is .5 – 1 ounce of water per pound of bodyweight per day.  Go here for more info on the pee test and how it can be used as a tool to track hydration during training and competition.

If you find your pee (wow, I am saying that word a lot, sorry, but “urinate” isn’t much better now, is it?) dark, it’s time to find water. Stat. But be careful. Too much water too soon, and if also deficient in electrolytes (What are they? I’ll get there), can be deadly.  Yes, deadly. Remember that story about the marathoner dying during the Boston Marathon in 2008? The condition is called hyponatremia, which is what results from the dilution of blood sodium that is often the result of excessive water intake. It can also be caused by a rapid rehydration without adequate electrolyte replacement after electrolyte loss from excessive sweating. Symptoms are similar to dehydration (cramping, dizziness), which makes it even more deadly because one may try to consume more water thinking that it’s needed, when in fact, it might be further contributing to their demise.

Wait, did I mention a baseline hydration need of  .5 – 1 ounce of water per pound of bodyweight per day?

If you want to be more precise, drink to match your sweat rate. Don’t know your sweat rate (Um, I don’t, but I should),  Runner’s World wrote a short column about it a few years ago and included how to calculate your sweat rate. I could retype it all here, but…I won’t.

What are electrolytes and why do you need them?

Electrolytes, in global terms, are substances containing free ions that make it electrically conductive.  In the body, electrolytes are  minerals that help nerves and muscles to function. Muscle and nerve tissue are both considered electric body tissues and are activated by electrolyte activity between the extracellular fluid or interstitial fluid, and intracellular fluid. Muscle contractions are dependent upon the presence of calcium, sodium, and potassium. In the absence of these electrolytes, muscle weakness or severe muscle contractions (i.e. cramps) can occur. Clearly, for someone competing in an athletic event, this could be the difference between a DNF and a win. For someone just out for a long run, it’s probably not as “costly”, but can be just as concerning! And for someone with an eating disorder like Bulimia or Anorexia, the imbalance of electrolytes (stemming from binging or purging, or fluid and food restriction) can lead to heart failure, since the heart is a muscle and relies on the presence of these electrolytes to keep beating.

As I mentioned earlier, electrolytes can become depleted in hot weather and during intense or long duration exercise (or both). They are also depleted  with  diarrhea, vomiting, intoxication (yep, alcohol, despite being a “liquid” will dehydrate you) or starvation. No matter the cause, electrolytes must be replenished for optimal performance…and health.

How?

The easy way to replenish electrolytes is to have a sports drink and/ or electrolyte mix on hand. Which one you need and IF you need one will be dependent on a multitude of factors including how the electrolytes became depleted in the first place. For ease of this post, let’s say it’s athletic endeavors. So time spent exercising, what intensity, your sweat rate, body weight, fitness, weather, acclimatization level and biological predisposition all play into what and how much of a replacement you will need.  

Who needs sports drinks?

Sports drinks should be used to replace fluid, carbohydrate, and yes, electrolytes lost in sweat.  Generally speaking, if one is exercising for less than 75 minutes at an easy or 60 minutes at a moderate pace, water is sufficient. Yes, you are burning fuel, but your body’s stores of electrolytes and carbohydrates (provided your nutrition is adequate) can handle it.

How much water? According to the American College Of Sports Medicine, they recommend the following “schedule”

Hydration Before Exercise

  • Drink about 15-20 fl oz, 2-3 hours before exercise
  • Drink 8-10 fl oz 10-15 min before exercise

Hydration During Exercise

  • Drink 6-8 fl oz every 10-15 min during exercise

Hydration After Exercise

  • Weigh yourself before and after exercise and replace fluid losses.
  • Drink 20-24 fl oz water for every 1 lb lost.
  • Consume a 4:1 ratio of carbohydrate to to protein within 30 minutes of finishing your workout to replenish glycogen stores

There are some exceptions to this water only 60-75 minute rule: 1) warm weather, 2) heavy sweating, 3) intense exercise.  All of these exceptions would warrant taking in a sports drink in place of water or water+electrolyte mix to maintain hydration and electrolyte balance during shorter workouts.

Sports drinks are most valuable to endurance athletes training and competing in prolonged, intense activity.  For them, I recommend 30-60 grams of carbohydrate/ hour. The American College of Sports Medicine recommends that athletes get 500-700 milligrams of sodium per liter of water consumed. Compared to the leading sports drinks, this is up to 3x what they contain. Often times an additional electrolyte support is needed, especially for exercise lasting longer than 2 hours or in temperatures above 80F and 70% humidity.  Since sports drinks vary in carbohydrate and electrolyte content, I’ll let you do the math for your preferred drink. However, if you’d like my help, send me a note  and let’s schedule a consultation 🙂

I would be remiss if I failed to mention the obvious: Sports drinks are loaded with high glycemic sweeteners and can, if not needed, contribute to unwanted body fat which, depending on your goals, isn’t awesome. Duh. But like I said, sometimes I can’t help but to mention the obvious.  There are lower calorie sports drinks (G2, Propel, or Vitamin Water Zero), or electrolyte tablets (see below) that can replace critical electrolytes without the unnecessary carbohydrates.  Again, I need to do my duty and mention that some of the lower calorie sports drinks contain artificial colors and sweeteners. I generally recommend my clients avoid both of these chemical substances. Vitamin Water Zero uses stevia,which isn’t quite as nasty.

Electrolyte Replacement Options**

Water: Pure Hydrogen + Oxygen…nothing else. Ok, that’s a stretch. Some municipal water supplies do contain pharmaceutical derivatives that pollute our water…but this is a loaded issue and most definitely a topic for a different blog post!  BOTTOM LINE: NOT a replacement! 

Nuun: based on one tablet dissolved in 16 ounces of water <8calories

Active Ingredients level (mg)
Sodium (carbonates) 360.0
Potassium (bicarbonate) 100.0
Calcium (carbonate) 12.5
Magnesium (sulfate) 25.0
Vitamin C 37.5
Vitamin B2 500 mcg

Other Ingredients: citric acid, sorbitol, sodium carbonate, natural colors flavors, sodium bicarbonate, potassium bicarbonate, polyethylene glycol, magnesium sulfate, sodium benzoate, calcium carbonate, acesulfame potassium, riboflavin-5-phosphate.

(side note: I googled polyethylene glycol. See the “other uses” on its Wikipedia page. Then tell me in the comments below if you will continue using Nuun products based on what you read.)

U-Natural Hydrationbased on one tablet dissolved in 16 ounces of water for <8calories

Active Ingredients level
Vitamin A 1375 IU
Vitamin C 10.0 mg
Thiamine 330 mcg
Riboflavin 460 mcg
Niacin 5.5 mg
Vitamin B-6 550 mcg
Folate 110 mcg
Vitamin B-12 1 mcg
Biotin 66 mcg
Pantothenic Acid 2.0 mg
Magnesium 20.0 mg
Zinc 2.0 mg
Sodium (carbonates) 180 mg
Potassium (bicarbonate) 77 mg
Choline (bitartrate) 110 mg
Stevia Leaf Extract 41 mg

Other Ingredients: dextrose, citric acid, natural flavors, vegetable juice color, sesame oil.

(Side note: Nuun claims their products have no corn in them but some of the ingredients are processed from corn as starting material (i.e. I am guessing citric acid, dextrose, and maybe natural flavors) and thus cannot guarantee it’s products are “corn-free”. Their products are also gluten free and contain no animal derived raw materials.)

Nuun produces a hypotonic solution which means that our bodies should absorb Nuun quicker than other sports drinks or water. They also don’t put carbohydrates in their tablets. This can be helpful for those strictly needing electrolytes.  Carbohydrates can slow the rate at which one’s stomach empties, thereby delaying the absorbability of water and electrolytes. Carbohydrates can also increase the osmolality of what you are drinking, which will also slow absorption beyond the stomach. BOTTOM LINE: Try using the Nuun U-Natural product when seeking replenishment of electrolytes after sweating due to running in the hot Austin summers or after a hot yoga class. You’ll need more than 1 tablet if this is your only source of electrolytes, however.  And if running or hot yoga’ing for longer than 75 minutes, you’ll need some sort of carbohydrate beverage or gel in addition to the Nuun product.

Emergen-C Electrolyte formula: one packet makes 1 liter of sports drink with no calories

Active Ingredients level
Manganese 2 mg
Magnesium 120 mg
calcium (carbonate) 100 mg
Potassium (bicarbonate and carbonate) 408 mg
Chromium (aspartate) 20 mcg
Stevia Leaf Extract 10 mg

BOTTOM LINE: Emergen-C contains no sodium so it is not adequate to be used as the sole electrolyte replenishment. If you’ve been sick for a few days this might be a good option to get you started, but it would need to be supplemented with something salty, say, chicken broth?

Endurolytes Fizz, Grapefruit flavor

Calories 10
Total Carbohydrate <1g
Vitamin B6 (as Pyridoxine Hydrochloride) 13mg
Calcium (as Calcium Carbonate, Calcium Chloride) 100mg
Magnesium (as Magnesium Oxide) 50mg
Manganese (as Manganese Gluconate) 3mg
Chloride (as Calcium Chloride) 60mg
Sodium (as Sodium Bicarbonate) 200mg
Potassium (as Potassium Bicarbonate) 100mg

Endurolytes are a full spectrum electrolyte support without any manufacturing lubricants (so no polyethylene glycol). In addition, they contain no animal derivatives.  Based on the spectrum of their product, they may be used as needed. Their website recommends that they be used when exercise is longer than 2 hours regardless of temperature or humidity or when exercise is less than 2 hours and temperature is above 80F and/or 70% humidity or temperature and humidity is 10F + above what you are accustomed to. As with any electrolyte supplement, body weight, fitness, weather, acclimatization level and biological predisposition are all factors, so these suggestions may not be adequate for you. BOTTOM LINE: I personally would use these over Nuun. Polyethylene glycol? No thanks.

(Side note: some flavors contain wheat germ oil, so if you have a gluten sensitivity, I would avoid any product containing ingredients derived from wheat)

Coconut water: gained popularity a few years ago as an electrolyte replacement and hydration option. Since they contain sugar, they can theoretically be used for a carbohydrate source as well.

Consumer reports did an independent analysis of three popular brands ZICO, Vita Coco and O.N.E and found that only Zico matched its stated content for sodium, potassium, magnesium and sugar. Additionally, it was the only one that had enough sodium to rival a sports drink.  O.N.E. and Vita Coco fell short when it came to sodium and magnesium content, though they contained the stated amounts for both potassium and sugar. One of these brands only contained 18% of its claimed amount of sodium!! O.N.E. is produced by PepsiCo in Brazil; and VitaCoco is mired in a class action lawsuit. enough said. BOTTOM LINE: If you are drinking coconut water, choose Zico. You will need to supplement with additional carbohydrates and electrolyte tablets if using Zico for your main source of hydration.

Zico: 14 ounces, 60 calories (12 grams of sugar/ carbohydrate)

Sodium   160mg
Magnesium  35mg
Phosphorus  30mg
Calcium  27mg

Ingredients:
100% natural coconut water from concentrate, natural flavors

I work with a variety of clients and  every one of them has a different hydration situation. For those with eating disorders, we need to make sure that electrolytes are replenished after multiple binge-purge cycles or days without adequate nutrition, to ensure cardiac stability.  For athletes, whether it’s the weekend warrior or the elite professional, sudden cardiac death from electrolyte imbalance is less likely but it IS possible. Still, hydration status is critical for performance.  I know I have covered  quite a bit of information here. I tried to parse it down but if after reading this you are even more confused, send me a note or leave a comment below. It’s my job (and joy!) to help you navigate the waters.

*some supplements, especially those containing high levels of B vitamins, can turn one’s urine a fluorescent yellow color.  This will clearly skew your results.

**For the electrolyte tablets and sports drinks, I pulled the data straight from the company’s website