What are the key factors that negatively impact performance (and health) during ultra-endurance events (> 6 hours)?

A recent meta analysis by Martinez-Sanz (2020) aimed to answer this question concerning both the possible/probable nutritional and medical complications experienced during competition.

Ultimately, if we can identify the risk factors, we can navigate through them accordingly to maintain both physical and mental performance.

The three adverse outcomes identified were:

1) Dehydration (DH) + Exercise associated hyponatremia (EAH).

DH is a problem of great concern as a result of increased cardiovascular strain. Paradoxically however, approx. 30% of athletes will over hydrate and develop EAH. This is in part due to high sodium losses via sweat, but also due to increased water intake without appropriate sodium intake (water intoxication). As a result, blood sodium concentrations become overly diluted which is harmful to performance and health. (sometimes fatal).

Early detection signs of EAH are; Intake of large volumes of fluid, nausea, transient confusion, or exhaustion. These are symptoms are often superimposed with other issues, but remain vigilant.

2) Heat stroke by exertion (EHS).

During prolonged efforts in the heat, HYPERthermia can set in and cause a thermoregulatory challenge. When hot climates (external heat) are combined with the increased bodily temperature from muscle contractions (internal heat), dissipating heat is problematic and can cause heat stroke.

The diagnostic signs of EHS are collapsing, aggressiveness, irritability, confusion, convulsions, and alterations of consciousness.

3) Gastrointestinal issues (GI).

30-70% of athletes experience GI issues. Most of the time, this is not considered to be harmful to health, only performance. However, severe cases can lead to hemorrhagic gastritis or intestinal ischemia which can be a serious medical problem.

These adverse factors have multiple origins, however can be minimised through (1) developing personalised hydration strategies (fluid + electrolytes), (2) acclimation and cooling strategies, (3) not trialling any new foods or supplements in competition, including amounts or dose, and (4) swapping low GI for high GI foods and reducing dietary FODMAPS.

The aforementioned factors can lead to severe consequences to both performance and health. These can however be avoided with the correct planning and preparation.

Therefore, have a plan. Then have a backup plan…just in case

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