A few weeks back I discussed fueling and hydration during a marathon (see Carbs, Protein, Electrolytes, and Water). In that post I mentioned the role of sodium intake during the run. As sodium is lost to the body via sweat, it must simultaneously be consumed by the runner so as to maintain the fluid balance across the cell membrane.
What happens when there is not enough sodium in the fluids surrounding the cells?
Well, then water is absorbed by the cells and they swell a bit putting pressure on surrounding tissues.
What about, hypothetically, when it’s a hot day and you are running a marathon and you are drinking a lot of water without replenishing the sodium?
That spells trouble. It leads to a condition called hyponatremia where the body’s cells swell so much from water build up that the pressure on surrounding tissue can cause some very serious issues.
Hyponatremia is also known as overhydration or water poisoning. Symptoms include muscle cramping, nausea, vomiting, fatigue, weakness, headache, confusion . . . your basic shit show.
This is something that I’ve known already from a theoretical point of view. I’m happy to report that I am now intimately aware of the symptoms in practice thanks to my poorly conceived and sloppily executed hydration strategy during the Berlin Marathon.
How utterly embarrassing.
Turns out, I’m not alone. This week I read a study done on a random sampling of runners of the 2002 Boston Marathon and 13% of them had hyponatremia during the race, some of them severely, and this skewed heavily towards newbies with finish times greater than four hours who drank a lot of water during the race. I’m sheepishly raising my hand here.
Elites don’t typically encounter this issue because they know better and they have trainers to reprimand them when they do something foolish.
The good news is that the risk can be completely avoided with a better hydration plan. And I have been looking forward to making that correction in the London Marathon.
While in London I had the chance to meet with other members of Team Fox who, like myself, have been engaged in grassroots fundraising for the Michael J Fox Foundation for Parkinson’s Research.
Our leader is Liz Diemer, Team Fox Director. Liz is very good at her job. Cheerful, friendly, smart, and energetic, she juggled her schedule to create several opportunities for Team Fox members in London to connect before the marathon.
Liz also made the effort to cheer on the team from the sidelines of the course. I spotted her amongst the crowd and through the throng of runners and we exchanged a brief enthusiastic greeting.
There were nine (I think) of us running the marathon for Team Fox. I couldn’t tell if all of the others had PD but that’s often not easy to discern anyway. Nevertheless they all had a reason to devote this effort to Team Fox and all of them were pleasant company.
One of the team, Jeremiah, is nearly at the elite marathon level. He was running in honor of his uncle, Bill Egley, who battled the disease for 25 years up until his death. Jeremiah turned in a time of 2:35:17, good for 16th place in his cohort of the Age Group World Championships that was held as part of the London Marathon.
But the stars of the show were Bill Bucklew (US) and John MacPhee (UK). They had just completed their epic collaboration The Long Walk for Parkinson’s, a 670 mile trek over the course of 17 days that started in the northern reaches of Scotland and ended in London.
They did this to raise $1.1M for the Michael J Fox Foundation an amount equal to $1 for each person in the United States and the United Kingdom living with Parkinson’s.
Bill capped this effort by running in the marathon the day after the trek ended. He turned in a 4:53:36, an astounding time given that he had just walked an average of nearly 40 miles a day for the previous 17 days.
Bill and John both have PD. They are both unfailingly polite, curious, and fun to share a pint with.
Over some Guinness, the discussion turned to a point that I have mentioned in previous posts to this blog: What is it about Parkinson’s sufferers that there are so many of them attempting such physically demanding feats?
Dopamine lust is no doubt one justification. We’re short on the stuff and these adventures trigger its release from unimpaired parts of the brain. As addictions go this is not such a bad one to have.
And then there’s the growing realization that intense physical activity can slow the progression of the disease. Bill, who was diagnosed with PD nine years ago at the age of 43, remarked to me that his doctor is amazed at how slowly the disease has advanced in him.
Or maybe the damage in the substantia nigra imparts just enough crazy into a Parkie’s mind that these enterprises of great pith and moment are met with cheerful anticipation and stubborn determination.
It may be a combination of these and other reasons. Who knows? But it is comforting and inspiring to know that there are more out there like me who share these fits of insanity.
Recovery from Berlin took most of the following five days so I wasn’t too eager or energetic enough for diving into the fantastic array of cultural opportunities that London presents.
I did however spend time in both the British Museum and the National Gallery so don’t mistake me for an uncivilized brute.
I also got a greater appreciation for why Warren Zevon would sing of a werewolf walking the streets of SoHo in search of a Chinese restaurant. The SoHo district includes London’s Chinatown and the AirBnB where I stayed; SoHo is the place to find a big dish of beef chow mein in London. Can’t say for sure about the presence of werewolves though.
From the point of view of event organization, the London Marathon exceeded what I experienced in Berlin. Where Berlin single-streamed the process for gaining a runner’s bib resulting in large time-consuming bottlenecks, London relied on massive parallel processing and therefore lickety-split thru-times.
What London provided in terms of refreshing efficiency they made up for in cumbersome COVID testing protocols. Some of this can’t be placed on the shoulders of the marathon organizers.
My stay in Germany (UK Green list) was brief and therefore I needed to follow protocol as if I was arriving from the US (UK Amber list).
Not only did I need a recent negative COVID PCR test in order to board the plane to London despite my fully vaccinated status, I also had to take another PCR test within two days of landing.
And whereas Berlin adorned runners at the Expo with a tamper-proof bracelet that absolved the wearer of any further COVID testing, London required a rapid flow test for both getting into the expo and for gaining admission to the starting area. The tests had a 48 hour shelf-life so one could arrange one’s schedule to cover all needs with a single test but if that were not convenient or possible then two tests would be needed to meet the requirements.
Curiously, these free lateral flow tests were self-administered and self-reported so London was putting a great deal of faith in the honor system to control the spread of COVID, an approach that has been shown repeatedly to be flawed during the course of this pandemic.
Otherwise, the two race atmospheres were remarkably similar. Thousands lined the streets of both Berlin and London to cheer on the runners, London’s apparently ignored crowd-limiting “one supporter per runner” policy notwithstanding. Bands played, drummers drummed, people sang, it was all very exciting and at times enormously uplifting to a runner’s spirit.
London, however, had more costumed runners. I saw a rhinoceros, a giraffe, a pair of scissors, several buildings, a unicorn, the list goes on. At one point I passed The Flash and felt very smug about that.
Knowing that I could not count on the hydration and nutrition that was supplied on the course, I devised a strategy that involved carrying everything with me save the water. Roughly every three miles I stopped to refuel. These stops coincided with water stations so when I passed them I’d grab a bottle or two.
At my pit stops I would mix up 300 ml of water with the electrolytes from a Nuun tablet and drink that down.
The tablet requires a few minutes to dissolve in the water so after drinking up I’d add another tablet to a splash of water in the flask then stash it in the Flipbelt I was carrying. That way the tablet would dissolve and be ready for immediate guzzling at the next pit stop.
At each stop I would also down a Maurten Gel 100 to provide the carbs for the latter miles of the race. As appropriate, I would also take any PD medication that was due at the time.
All told each pit stop racked up two to three minutes of stationary time.
The results were nonetheless compelling. Though the cooler temperature undoubtedly had a large impact, I shaved off about 18 minutes from my finish time of the week prior and the leg cramps that so possessed me in Berlin were exorcised. Also, my pace throughout held fairly constant so the wall that I hit in the last few miles was not so impenetrable.
There’s still room for improvement of course. I needed a lot of post-race hydration; it took five hours and a full tube of Nuun tablets for the nausea to subside. So I suspect that I should double my in-race electrolyte consumption next week in Chicago and Boston.
Chicago is going to be critical especially because it is likely to be as hot as Berlin was. And I can’t afford five hours of daze following that marathon or I’d never find my way back to Boston in time. I’m going to have to dial it way back to have any chance of keeping this streak going. I suspect that means a Chicago Marathon time of five hours plus.
Also, I have to get the Chicago recap blog post done before running Boston the next day. It’s likely to be very brief and I apologize up front about that.
And Boston? Well, my primary goal is to get to the start line. I’m confident that I’ll finish if I make it to the start.
While I struggled to my personal worst 4:55:26 in the Berlin Marathon, Shalane Flanagan breezed to a 17th place finish at 2:38:32 in her first race coming out of retirement. She is a wonder.
The ratio of my finish time to hers got me thinking. I have personal goals for these Majors somewhere closer to four hours that are becoming increasingly out of reach, but I now have a back-up goal: to finish in no more than twice the time it takes Shalane to finish.
Definitely not one of my more aggressive objectives but if I can finish within a factor of two of one of the greatest American marathoners, well then, I’ll take that.
In London she ran 2:35:04 to my 4:37:21. So far so good.
I am a charity runner in the London, Boston, and New York marathons this year. There’s still time to contribute to my cause (assuming that you have not already done so).
If you share the passion that the Michael J Fox Foundation and I have for finding a Parkinson’s cure please consider contributing to any of the WMM I am running in as a member of Team Fox (links below). All donations are meaningful and greatly appreciated.
fundraise.michaeljfox.org/boston-marathon-2021/joesgottarun
fundraise.michaeljfox.org/londonmarathon2021/joesgottarun
fundraise.michaeljfox.org/tcs-nyc-marathon-2021/joesgottarun
