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The Clinic.

Q. Baking Soda in Training?

Does sodium bicarbonate (baking soda) improve performance? Sodium bicarbonate may reduce acidity and therefore delay fatigue caused by lactic acid accumulation. Does it inhibit the body's natural response to training stress? Although sodium bicarbonate may help get you through a workout easier, does it prevent the metabolism from adapting to aerobic exercise and becoming more efficient from training improvements?

A. Burke Koncelik East Hamptom, NY In theory, bicarbonate improves performance by decreasing the acidity in blood and muscle. Therefore, energy use and muscle fiber contraction may be improved. Studies show a consistent reduction in blood acidity and an increase in blood lactate with sodium bicarbonate at maximal intensities. Some tests have shown modest improvement in muscle power at peak exercise. Other studies have suggested faster recovery time for certain muscle groups. Improvements may be modest and although safe in general, sodium bicarbonate may cause stomach upset.

I have not seen a study that addresses your question directly It does seem possible that taking bicarbonate in training consistently might impair natural adaptation to the usual physiologic changes of exercise. If that is so, you would need to train without using bicarbonate, and then use the bicarbonate before the single event in which maximal performance is desired.

Your focus should be on maximizing your training without ergogenic aids. Most rgogenic aids provide limited benefits. Best to train wisely, without the risks, side effects and slim benefits of ergogenic aids.

Jeffery M. Hubbard, M.D.

Clovis, CA

A. It is my feeling that sodium bicarbonate will not prevent the metabolism from adaptation to aerobic exercise. Although the supplementation of sodium bicarbonate will in fact reduce the acidity in the cell, it will not totally prevent the adaptation mechanisms which are occurring within the muscle. The only concern that I may have is that your body would adapt to the use of sodium bicarbonate such that without it the ability to perform may be impaired to a slight extent.

You might try sodium bicarbonate and determine how it affects your training. I do not feel that it will be detrimental to performance and in fact may be of some benefit.

Kim Edward LeBlanc, M.D., F.A.C.S.M. Breaux Bridge, LA

Q. Nausea Runs the Runner

I am a track coach and have a female runner who gets sick and throws up every time she runs. It does not matter if she eats or doesn't eat. After about two to four miles, she gets ill and throws up. This young lady is an excellent runner and enjoys running. Any ideas?

Mike Gentry

Madison, MS

A. Upper gastrointestinal problems are quite common among runners. Causes of sports-related vomiting are diverse. It is well established that stomach emptying is markedly slowed during endurance exercise. Mental and emotional stress can also slow gastric emptying. However, there are three key factors that predispose athletes to vomiting. These include dehydration, drinking beverages with high sugar content, and high exercise intensity at more than 75% VO2 max. All of these factors tend to slow gastric or stomach emptying. You may remember Bob Kampeinan vomiting late in the marathon during the Olympic Trials which was probably due to dehydration and high exercise intensity. Treating the problem can be very difficult.

Perhaps most important is to avoid drinks with more than 10% sugar content. During exercise, drinking water or sports drinks with 5% to 8% carbohydrates is much better. I would also recommend having her try Zantac 300 mg or Tagamet 400 mg about an hour prior to her event. If this is not effective, her physician may wish to prescribe Propulsid in a 10 mg dose which can be taken about one hour prior to her race and can help to speed gastric emptying. I would avoid using antacids as they may contribute to abdominal cramping or diarrhea. Even with these measures, exercise-induced vomiting may still occur. It may be comforting to know that exercise induced vomiting tends to decrease when an athlete gets in better physical shape.

Douglas J. Johnson, MD., F.A.A.F.P. Morganfield, KY

Q. Graves' Slows Runner

I am a 29 year old male. I was recently diagnosed with a pretty serious case of Graves' disease. Since then, I've been treated with medications including propylthiouracil pills and Inderal. I was also given a dose of radioactive iodine about six weeks ago. Before Graves' struck, I was running between 25 and 50 miles a week. I was also very active in all other areas of my life. I had also been diagnosed with Attention Deficit Hyperactive Disorder (ADHD). Will I get better? Will I regain my energy? Most of all, will my thinking clear up? I feel like I'm losing my mind.

Ken Issac

Newport, RI

A. Graves' disease is an autoimmune disease of the thyroid gland, which results in hyperthyroidism, or an overactive thyroid gland. Because the thyroid controls many organ systems such as the heart, muscles, and brain, dysfunction of this gland can have many adverse consequences. It sounds like you have a fairly severe case of hyperthyroidism, which has been appropriately treated.

What you have experienced as a loss of energy and mood problems is very common in this disorder. The mainstays of treatment for Graves' disease include beta-blockers (Inderal) which counteract the effects of excess thyroid hormone; antithyroid drugs, (such as propylthiouricil), which lower thyroid hormone concentrations; and radioactive iodine treatment, which destroys the thyroid gland. Surgical removal of the thyroid, a more common therapy 20 years ago, is occasionally performed in unusual cases.

Unfortunately, none of these treatments has an immediate response. It can take months of medical treatment to lower thyroid hormone concentrations in severe cases. Radioactive iodine treatment may take up to six months to destroy the thyroid gland. In severe cases, some patients require two or more treatments with radioactive iodine to achieve success.

You are not alone, as many young athletes have suffered from this disorder, including Olympic medallist Gail Deavers and Olympic marathoner Margaret Gross. But take heart--this is a completely curable disease with appropriate treatment. Because your body has probably been experiencing wide variations in thyroid hormone concentrations, it will take time for you to feel normal again. Your doctor should be monitoring your blood thyroid hormone concentrations to determine how you are responding to the treatment you have received so far.

One of the long-term side effects of radioactive iodine treatment is hypothyroidism, or an underactive thyroid. This can occur months to years after radioactive iodine treatment, and can result in energy loss and mood changes. Fortunately, hypothyroidism is easier to treat than hyperthyroidism and involves giving an appropriate dose of replacement thyroid hormone in the form of one pill per day. It is unlikely that you have hypothyroidism only six weeks after your treatment, and it is probably too soon for you to be cured of the hyperthyroidism. Thus, I suspect that you are still suffering from the consequences of hyperthyroidism, as well as the side effects of your medications. You should improve in the months to come.

I urge you to be patient and allow your body enough time to recover from the ravages of hyperthyroidism. This has likely developed over a number of years and will not disappear overnight; however, you will get better in time. Your ADHD may in fact have been symptoms of developing hyperthyroidism. Discuss your rehabilitation with your doctor and don't try to over-do physical activity before you are ready, as this may hamper your recovery.

Take heart in the fact that Gail Deavers recovered from a severe case of Graves' disease and went on to win a gold medal in the Olympic games. I assure you that you will be able to run again.

Theresa A Guise, M.D.

San Antonio, TX

Q. Monster Biking Headaches

I've been experiencing severe headaches during my high-mileage bike rides. During the rides that are 25 to 50 miles long, I begin to get sharp headaches (generally in the back of my head). On the lower mileage days, there are no problems. I've been told it could be dehydration, but I drink a lot of water and carbohydrate drinks before and during my rides. Could it be I'm exerting myself too much on the long rides?

I am 6'2" and 180 pounds. I average 140 miles a week, recently increased from 100 miles a week.

Michael Chung

Burntonsville, MD

A. I am making several important assumptions from your letter. Severe headaches can have serious causes that you should not overlook. I am assuming that you do not experience these severe headaches at any time other than when you are on high-mileage bike rides and that your general health is excellent. If that is not the case, and you are having headaches at times when you are not exercising, or you have health problems at present, then you need to have the headaches evaluated by your personal physician or a neurologist, particularly if they are getting worse.

If your health is excellent, and as you seem to indicate, the headaches are only occurring when you are doing high-mileage bike rides, I would suggest the problem is probably mechanical and related to your posture during the long rides.

During long rides, depending on seat height, the neck is severely extended, and for many individuals this becomes painful after 45 minutes or so. Experiment with different seat and handlebar positions to see if there is any improvement. Make sure that during your ride you frequently change positions, including sitting up for short periods of time and waggling your head to loosen the neck muscles. You might want to borrow a friend's mountain bike or hybrid and see if the more upright posture helps the headaches.

Another possibility to consider is helmet fit. Make sure it is not too tight and that the straps are adjusted properly. In the extended neck position, the base of the helmet may be causing additional pressure on your neck.

John C. Hagan, III, M.D.

North Kansas City, MO

Incorporate upper trapezius and neck strengthening exercises. This can help improve your posture and the increased strength will improve your muscular endurance. It may not alleviate the headaches, but could help delay them and provide other benefits as well.

Doug Lentz, C.S.C.S.

Chambersburg, PA

Ask the Clinic!

Are you bothered by an injury? Do you have a training or diet question? If so, ask The Clinic, in care of AR&FA, 4405 East West Highway, Suite 405, Bethesda, MD 20814, FAX (301)913-9520, e-mail arfarun@aol.com. Free personalized sports medicine, training, and diet advice is an exclusive benefit for AR&FA and AMAA Members only. AR&FA has more than 255 Clinic Advisors representing more than 27 specialities. Include as much relevant information as possible about you (age, weight, etc.) and your injury (type and location of pain), training schedule (typical weekly workouts, pace, surface), athletic and medical history, sole wear, recent changes in training, etc. Type or print your letters. Handwritten FAXed letters will not be accepted. Include your address and phone number in case the Advisor has additional questions or would like to discuss your case with you. Responses usually lake three to four weeks, but can take as long as five.
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Publication:Running & FitNews
Date:Mar 1, 1999
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