Hydrate, Hydrate, Hydrate...

Subject: Hydrate, Hydrate, Hydrate... Sun Jul 24, 2011 2:07 pm

Here's a few words of wisdom from Tactical Paintball's own Doc Rob in terms of keeping hydrated during those long games... Please bare with me, because this is allot of information that he covers, but it is critical information to know, unless you like spending time with and IV hooked up to you, or the cost of a trip to the ER...

Doc Rob wrote:: It might seem silly to be discussing heat injury in the middle of winter, but remember, I'm writing this from south Texas: It's 17 Feb 08 as I write this, and it's 76 degrees (F. Nope, not going to use Centigrade or even Kelvin in this section; I was raised with degrees F and that's where I'm stayin'...). Heat injury is an important subject in Texas 9-10 months out of the year.

When discussing heat injury, it's important to keep in mind that human beings function best with a body core temperature of about 98.6 degrees. This can vary a little bit, but 98.6 is a good approximation of 'normal' body core temperature. Add or subtract 5 degrees to that core temperature and most folks are miserable indeed. We are pretty good at supplying our own body heat (in technical terms we are homeothermic...no, it doesn't mean what it sounds like, it means we maintain our body temperature via our body metabolism), but the 'good' range of body temperature is quite narrow. Depending on the environmental conditions we find ourselves in, we either have to generate/conserve heat (cold conditons) or radiate/remove heat from the body to maintain that narrow core temperature range.

We are pretty much designed to be tropical critters: We handle high heat load conditions much better than cold conditions. Experiments that the Air Force and NASA did in the early days of the space program showed that humans can quite easily withstand enviromental temperatures of well over 150 degrees.

Before we go any further, I should define what I mean by 'heat load conditions'. The ambient temperature is only one part of what makes up heat load. Factors such as humidity, wind speed, amount of solar radiation (sunlight), clothing and physical activity must be included to accurately determine heat load conditions.

One method for doing this is to use the Wet Bulb Globe Temperature, or WBGT. This is the standard method for estimating ambient heat load condition in the US military. It uses three seperate temperature measurements: Ambient temperature ('dry bulb temp'), humidity ('wet bulb temp') and amount of solar radiation ('globe temp'). These readings are plugged into a mathmatical formula with gives the WBGT. There are various electronic instruments available that will give the WBGT directly, or an older version that has all three thermometers and a slide rule calculator to determine the WBGT. This isn't ideal, since it does not take into account wind conditions, clothing, physical activity and the like, but it's a better measure of the heat load conditions than simple ambient temperature.

What does all this mean? It means you can't look at the temperature alone to determine heat load conditions: Multiple other factors that affect your microenvironment have to be taken into account. This is why you can see heat injury in Texas at virtually any time of year. For example, lets say you like to play in winter-weight BDU's, prefer to keep the sleeves down, it's 75 degrees, bright sun, no wind, and you're playing a game that requires a lot of running around (as versus hiding and waiting). Is this high heat load conditions? You bet! Can heat injury occur? Also you bet!

Next post, we'll discuss types of heat injury.

Subject: Re: Hydrate, Hydrate, Hydrate... Sun Jul 24, 2011 2:08 pm

Doc Rob wrote:: To continue the series on heat injury:

In high heat load environments, we have to somehow transfer heat energy from the body to the environment to avoid overheating. There are four ways you can transfer heat from one object to another: Conduction, Convection, Radiation and Evaporation. In terms of human physiology in a high heat load environment, the most important of these mechanisms is evaporation. For those of that remember your physics, chemistry or physiology, what we're talking about here is the heat of evaporation. Without going into too much detail, the upshot is if you evaporate a gram of sweat off the body, you transfer a relatively large amount of heat energy to the environment. So sweating is one of the most important methods the human body uses to control internal temperature.

Sweating is much more efficient in a low relative humdity environment: It's 'easier' to evaporate water in a low humidity environment than in high humidity environment. This is why a dry climate feels 'cooler' at a given ambient temperature than a humid climate: 95 degrees in Las Vegas (relative humidity of 5-10% on a good day) feels 'cooler' than south Texas, where 95 degrees and 70% relative humidty is common. Since the sweat evaporates more rapidly off you in low humidity, you feel cooler.

So what happens if you start getting sick from heat exposure? In general, we divide heat injury into two categories: Minor heat injury (heat cramps, heat exhaustion, heat syncopy, heat rash) and major heat injury (heat stroke). Minor heat injury is relatively easily treated, and usually resolves without serious long-term problems. Major heat injury (basically heat stroke) can kill or cripple you.

Next post we'll talk about minor heat injury, then later we'll discuss major heat injury, and finally we'll finish up with the most important topic, prevention of heat injury.

Subject: Re: Hydrate, Hydrate, Hydrate... Sun Jul 24, 2011 2:08 pm

Doc Rob wrote:: OK, so next up is Minor Heat Injury.

Keep in mind that recent thinking on heat injury is that it is a spectrum of illness, rather than a series of distinct clinical syndromes. This can range from pretty mild illness, like heat cramps, all the way to full-blown heat stroke. Today however, we will be limiting the discussion to mild heat injury, such as heat cramps, heat exhaustion and heat syncope.

Heat Cramps is a sudden-onset of severe, painful contractions of large muscle groups (most commonly the calves and thighs) during or shortly after strenuous exercise in high heat load conditions. It is remarkably painful, and can easily put somebody on the ground saying -many- nasty words. People who have alcohol on board, are sick, are dehydrated, or are not acclimated to heat are predisposed to develop heat cramps. There is usually NO fever associated with this syndrome, and the mental status is NORMAL.

Heat Exhaustion is a syndrome of fatigue, nausea, lightheadedness, vomiting, and sometimes mild-to moderate fever, associated with exercise in high heat load conditions. Predisposing factors are the same as for heat cramps. Fever in this syndrome is usually mild to moderate (usually under 103 F), and again, mental status is NORMAL.

Heat Syncope is a sudden loss of consciousness (or near loss) also associated with exercise in high heat load conditions. The important thing in heat syncope is that once the patient passes out and hits the ground, they wake up in a short time (usually less than 15 seconds), there is no evidence of seizures, and the mental status is NORMAL once they wake up. Predisposing factors in this syndrome is the same as the above.

Treatment for all of these syndromes is symptomatic: The patient should rest in a cool area, drink plenty of fluids (see the thread on 'Dehydration' on what to drink in these situations), and basically chill out. If there is enough nausea and vomiting that the patient can't take oral fluids, then it's IV time: Not fun.

In the case of heat syncopy, if somebody looks like they are about to pass out, or they have passed out and somebody has caught them, lay them on the ground (gently, and NOT on top of a fire ant mound...true story, it was ugly...), and GET HELP (Syncope can be a minor problem or it can be a symptom of life-threatening illness. If somebody passes out, don't take any chances, GET HELP!). It the patient has heat syncopy the patient will usually be awake and alert by the time help arrives. Again, the treatment is rest in a cool area and rehydrate.

Note the emphasis I put on these folks having NORMAL MENTAL STATUS. Altered mental status in the face of exertion in high heat load conditions is heat stroke until proven otherwise.

What is altered mental status? Do they respond normally to you when you ask them a question? Are they making sense when they talk? Do they know who they are? Where they are? What day it is? Who the President is? If they aren't replying to you (unconscious), or if they aren't making sense when they talk to you, or aren't oriented (those 'who, what, where' questions'), then it's altered mental status and it's time to call the paramedics.

Personally I think that somebody with heat cramps can go back to playing IF they feel fine and have rested for at least an hour. People with heat exhaustion and heat syncope are done playing for the day: Go out again and things are likely to get worse.

Prevention of these syndromes is to keep well-hydrated, acclimate to the heat, and know when to take a break. I'll discuss heat acclimation and heat injury prevention in more detail in a later post.

Next up: The bad boy, HEAT STROKE.

Subject: Re: Hydrate, Hydrate, Hydrate... Sun Jul 24, 2011 2:10 pm

Doc Rob wrote:: Well, on with the subject at hand: Heat injury.

The most severe form of heat injury is Heat Stroke. This is a no-kidding, life-on-the-line medical emergency. If treated early and aggressively, heat stroke has about a 10-15% mortality (death) rate. If treated late in the course, mortality can be as high as 80%. Make no mistake about it, we're talking about a disease that can eat your lunch. If you suspect somebody has heat stroke, call 911 and start treatment RIGHT NOW!

The form of heat stroke most people have heard about is known as 'Classic' or 'non-exertional' heat stroke. This is most common among the elderly, the very young, and in people taking certan types of medication. In this condition, the patient is unable to compensate for high heat load conditions, and body core temperature rises until the system starts to break down.

There is a second type of heat stroke, known as 'Exertional Heat Stroke' where the patient CAN be sweating: This is the type most commonly seen among military personnel, and the type we are most likely to see at a paintball field. This type of heat stroke is seen in a younger, more physically fit population. It usually develops over several hours, typically involving strenous physical activity in high heat load conditions. In this situation, the increased heat production overwhelms the body's ability to lose heat: So in exertional heat stroke the victim can still be sweating.

There are some differences in the pathophysiology of the two forms of heat stroke, but basically in either case, the body is unable to get rid of sufficient heat, or respond appropriately to high heat load conditions, and the body's heat regulation system goes haywire. Body core temperature rises, frequently above 106 degrees (one definition of heat stroke is a patient with a body core temperature above 105.8 degrees (41 C) and who is not sweating...not the best diagnostic criteria for exertional heat stroke). As the temperature of the brain rises, neurological function is impared, and as temperature continues upwards, the brain cells start to die. Many other complications can result from heat stroke,, such as severe muscle breakdown (called 'rhabdomyolysis...how'd you like to try to use that word in an sentance??), heart attacks, kidney damage, liver damage, all kinds of bad things.

Risk factors for developing either type of heat stroke include obesity, poor physical fitness, poor acclimatization to high heat load conditions, dehydration, and use of some types of medications. Illicit drug use, especially stimulants such as cocaine and amphetamines is also strongly linked to heat stroke. Several case reports have linked certian nutritional supplements (notably those containing Ephedra) to heat stroke.

In field situations where trying to get an accurate body core temperature is difficult to say the least ("You're going to put that thermometer WHERE? You and what army, Bozo??"), it is better to go with easier diagnostic criteria:

Altered mental status in the setting of high heat load conditions is heat stroke until proven otherwise

Field diagnosis of heat stroke can be difficult: Basically if somebody looks like they have heat exhaustion and has ANY evidence of neurological disfunction, they have heat stroke until proven otherwise. Neurological dysfunction can range from being unusually irritable, having difficulty walking or talking, altered mental status (that 'Who, What Where' thing I talked about in an earlier post), to seizures, loss of consciousness and coma.

What is the treatment for heat stroke? First and foremost, GET HELP! We are dealing with a no-kidding deadly problem here, and minutes count. Once help is on the way, the next thing is to start field treatment. First and always, remember the ABC's : Airway, Breathing and Circulation. Once that has been addressed, you need to deal with the heat problem: If the problem is they are too hot, the solution is to cool them off. How to do that? By any means available. Get them out of the sun, get them into an air-conditioned area, loosen clothing, fan them, pour cool water on them (especially the head and neck area), put ice packs in the groin and armpits, whatever you can do to cool the patient off. I'm not too fond of dumping a lot of ice on a person, or putting them in an ice bath, but other folks in the ER world recommend that technique for cocaine-induced heat stroke and reports are that it works. In any event, cool the patient down any way you can.

A sneaky trick we used in the desert was to put the patient in a nylon hammock, spray them with lukewarm water (cold water causes the skin to vasoconstrict (decrease blood flow to the skin) and can decrease heat loss) and put a high-powered fan on them. This would increase heat loss by evaporation, a very efficient way of cooling, especially in a dry climate.

One thing NOT to do: Don't give anything by mouth, including water to somebody who is not fully awake and responsive. It's bad enough to have heat stroke, but having heat stroke AND choking on water/soda/beer (yep I saw that once) is pretty much the definition of a Bad Day.

How do you prevent heat stroke? Same way you prevent any other type of heat injury: Stay hydrated, pace yourself, rest if it's too hot, and get properly acclimated to the local conditions. Watch yourself, watch your buddy, watch the other players, and if somebody looks like they're having a problem with the heat, get them off the field and get them checked out.

So, to sum up:

--Neurological dysfunction in the setting of high-heat load conditions is heat stroke until proven otherwise

--A heat exhaustion patient with altered mental status/neurolgical dysfunction has heat stroke until proven otherwise.

--A patient with heat stroke can be 'hot and dry', but can also be sweating. The presence of sweat DOES NOT rule out heat stroke.

--If you suspect heat stroke, GET HELP NOW!

--If it looks like heat stroke, start cooling the patient by any means possible until professional help arrives and takes over.

--As with most kinds of environmental illness, prevention is the key! Stay hydrated, pace yourself, acclimate to local conditions, and if you start feeling bad, take a break!

Subject: Re: Hydrate, Hydrate, Hydrate... Sun Jul 24, 2011 2:11 pm

Doc Rob wrote:: If I had to name the one condition I see most often in paintball, it would have to be dehydration. Dehydration is a fancy medical term meaning you don't have enough water in your system. This can be a result of not consuming enough water, or excessive water loss, or a combination of both. In most cases what we see in paintball is increased water loss due to exertion and sweating, combined with inadequate intake.

I usually see at least one or two cases of mild to moderate dehydration every big game. Dehydration can cause minor problems like headache, sluggishness, irritability and excessive tiredness, but it can also be a life-threatening situation: People can and do die of dehydration.

The human body requires a relatively large amount of water in our diet on a daily basis. The exact amount of water each indivdual requires on a daily basis varies quite a bit, but suffice it to say VERY few people in the US drink enough water (We tend to substitute other fluids for water, like sodas, fruit juices, beer, etc).

Some folks think dehydration is a 'summer disease' and don't worry about it in cold weather. Wrong, wrong, wrong: Dehydration can be as much a problem in the winter as it is in summer. So yes, I do see dehydration at paintball fields in the middle of winter. It tends to sneak up on people in cold weather, but it's still a problem.

Increased physical exertion, increased environmental temperature and some diseases can greatly increase the amount of water an indivdual needs daily. In some conditions (hot, humid environments where heavy work is necessary) people may require upwards of a liter of water an hour to maintain proper hydration. Adding to the fun and games, the thirst mechanism of the human body isn't very accurate: You're usually significantly dehydrated before you start to feel thirsty.

So what can you do to prevent dehydration? OK, this isn't rocket science, if the problem is not consuming enough water, the solution is...(there will be a quiz later, so pay attention) Drink More Water! Hummm, sounds simple, doesn't it? Actually, it is.

More on this subject later: I'll be covering how much to drink, what to drink (actually more like what NOT to drink), signs and symptoms of dehydration, and what to do if you get dehydrated.

Subject: Re: Hydrate, Hydrate, Hydrate... Sun Jul 24, 2011 2:12 pm

Doc Rob wrote:: So, we all now know that we must drink water to stay alive and play efficiently. So, how much is enough? Recall that under high heat stress conditions, an acclimated indivdual may need to consume upwards of 1 liter of water an hour to stay hydrated. How do you know when you're well hydrated?

(By the way, this entire series assumes you have normal renal (kidney) function, aren't diabetic, aren't taking diuretics, don't have congestive heart failure, etc, etc, ect. If you have a medical condition that requires you to watch your fluid intake/output, you need to talk to your own medical provider about maintaining proper hydration)

There are all kinds of formulas that can be used to estimate water requirements for a given workload in specific environmental conditions. These formulas are nice for estimating how much potable (drinkable) water a group of people will need, but it's hard to interpolate that data to a single indivdual: Too many variables. Best bet is to let the body handle its own water.

If you are well hydrated, you will feel the urge to relieve your bladder (pee) every 2-3 hours or so. The urine your body makes under these conditins will be almost clear, or slightly yellow in color. If you are drinking enough water to make this happen, you're probably doing fine. Under moderate heat load conditions, most people will attain this state (dare we call it the Zen of Pee?? How about the Tao of Tinkle? OK, I'll stop...) drinking about 1/2 liter of water an hour. So think how long it's been since your last Porta-Potty call: If it's been over 2 hours and you don't need to pee, you need be be drinking more water. If you're running to the biffy every 30 minutes because your back teeth are singing 'Anchors Aweigh', you can probably cut back a bit.

(By the way, if you DO sing 'Anchors Aweigh' at the field, don't be suprized if Archangel shoots you in the butt. Multiple times. From close range. Has something to do with attending the School for Young Persons on the Hudson. However, being a graduate of the University of California (NO, not Berzerkley or those UCLA bozos, I'm from UC Irvine), what do I know? But I digress...)

How often should you drink? Well, the human digestive system is relatively efficient in absorption of water. However, chugging a full 1/2 liter of water in a few minutes then attempting to go run around the field is a recipe for rapid emesis (barfing): It's better to take that water in small sips over an extended time, rather than a large series of gulps in a short time.

This is one of the reasons I like drinking tube hydration systems, like CamelBak, Hydrastorm or any number of other brands. Sling one of these puppies on your back and you can be carrying upwards of 3 liters of water all over the field. Even better, you can take a sip anytime you like without lifting your mask. These systems work very well, they've been proven time and time again to increase fluid intake, even under combat conditions. If you are a scenario paintball player, get one of these systems and use it!

OK, so now we have some idea of how much we should drink, now we need to talk about WHAT to drink. Yes, I've been saying 'drink water' all along, but we all know that nobody is going to drink 'just plain water': There is a multi-billion (yep, 'Billion' with a B) dollar industry out there trying to convince you to drink their version of water. That subject we'll discuss in the next post.

Subject: Re: Hydrate, Hydrate, Hydrate... Sun Jul 24, 2011 2:12 pm

Doc Rob wrote:: All righty then, on with the subject... What should you drink to stay hydrated? Well, for the vast majority of people under the majority of circumstances, just plain water is just plain fine. Yep, that's the bottom line, at least as far as medical physiology goes. Yes, there are some circumstances where electrolyte replacement is important, even vital (extreme heat load conditions, heavy exertion in high heat load situations...think combat in 115 degree heat while wearing 20 pounds of body armor). But for most folks who have a reasonable diet, water does just fine.

Of course, there is a multi-billion dollar industry out there trying to convince you that you need to drink their version of water: Water plus sugar, water plus sugar and electrolytes, water plus vitamins, water plus minerals from some fancy spring...you get the picture. So how do you wade through all these claims? Well, just to get started, we'll talk about what NOT to drink...

What Not To Drink:
Beer, wine, anything with alcohol in it. Aside from the fact that alcohol (or technically 'ethanol') is a mild diuretic (makes you pee), there is no way in hell you should be playing paintball with alcohol on board. No. Way. In. Hell. If you are drinking alcohol, you don't play, period. There are very good reasons why Tactical Paintball has strict 'no drinking' policies at the field. Friday night before the game? Great, no problem, just don't do it to excess, don't drive (and don't mess with your marker)and observe the 'Time to stop drinking' rules. However, since alcohol (yes, even beer) actually dehydrates you, you might want to consider drinking a couple of glasses of water before you nod off: For one thing, the full bladder will wake you up in the morning, and for another, one of the things that contributes to hangover misery is dehydration.

After the game? Have some water before you hit the beer. Remember, alcohol is a diuretic, it makes you pee. Strange as it may seem, you can end up with a net water loss from drinking beer.

Sodas:
Basically, sodas are water with sugar and flavoring. Many of them also have caffeine, which is a mild stimulant and a mild diuretic. Recent research has shown that some sodas will give you a slightly positive water water gain. You can increase this water gain by diluting your soda with water---like put ice in it. Still, all in all, sodas aren't the best way of rehydrating yourself. The amount of carbohydrate (sugar) in sodas tends to slow down water absorption from the gut, so it takes longer for the water to get into your system.

Energy drinks:
These are mainly water, sugar, caffeine and a bunch of other stuff with unproven effects. Most have WAY too much sugar and caffeine. Don't rely on these to hydrate you.

Sports Drinks:
Oh, boy, the sports drinks...All the wonderful claims, all the great ads. The reality? They can be helpful in some situations, but in even in those cases, they should be diluted.

Yes, sport drinks do have electrolytes (sodium, potassium, chloride, that sort of thing), but in most cases, full-strength sports drinks have too much carbohydrate in them to be absorbed quickly. Why do they have so much carbohydrate? To mask the taste of the sport drink...after all, you are drinking mildly salty water. One good thing sports drinks will do is encourage you to drink more. Why? They taste good (all that sugar y'know). So I don't think sport drinks are necessarily a bad thing: I use them myself.

The two major sport drinks out there, Gatorade and Powerade, have a bit too much carbohydrate (sugar) in them for optimal absorption from the gut. What I do is dilute them: I buy the stuff in powder form, and make it half strength if it's Gatorade, and 2/3 strength if it's Powerade. You can do the same thing with the pre-made stuff by diluting it with water. Another method is to drink the stuff full strength, but follow it with an equal amount of water.

So what's the bottom line?
-Just plain water is fine as long as you aren't in heavy heat load conditions. Even then, water is OK as long as you keep your electrolytes replenished, either by diet or with sport drinks.

-No alcohol, for a variety of reasons.

-Sodas may help somewhat in maintaing hydration, but they have way too much sugar and many have caffeine. If you do drink sodas, dilute them with water/ice.

-Energy drinks aren't a good idea for hydration

-Sport drinks are OK if you like them, but for most efficient absorption you should dilute them with water.

The next post: What are the symptoms of dehydration, and what can you do about it?

Subject: Re: Hydrate, Hydrate, Hydrate... Sun Jul 24, 2011 2:13 pm

Doc Rob wrote:: Heading in to the home stretch, hang in there...

So what are the symptoms of dehydration? First off, you can't trust your thirst mechanism to keep you hydrated. By the time you start getting thirsty, you're already significantly dehydrated. Plus, once you start drinking, your thirst mechanism tends to shut off before you've consumed enough water. So don't count on thirst to help you much: By the time you're getting real thirsty, you're already far behind the power curve.

Mild dehydration has vague symptoms: Malase, fatigue, body aches, maybe a mild headache. You are impared, but the symptoms aren't usually enough to get your attention. The symptom most people notice is headache: If it's a warm day (or even a cold day...remember you can get dehydrated in cold weather too!) and you've been getting a slow onset nagging headache, it's time to get more water on board.

As dehydration progresses, the headache usually gets more and more severe, many people can become nauseated, and may even begin to throw up (thus increasing fluid loss!). Symptoms can progress to syncope (fainting), extreme weakness, altered mental status, and eventually seizures and death. Not a pleasant way to go.

So what can you do about it? Aside from prevention which we've already discussed, treatment can be as simple (or as complicated) as replenishing water to the body.

With mild dehydration, oral rehydration with water or diluted sports drinks is the best way to go. Don't try to chug down a liter or two over five minutes: You'll just make yourself sick, and partially used Gatorade is nasty, especially when it's all over your boots... Take small sips frequently. I recommend people take 1-2 teaspoons every 15-30 seconds, so you're drinking 20-40 cc's of fluid per minute. This usually won't overload your stomach and make you sick. I prefer to keep people drinking like this until they have to pee, then continue for at least another 30 minutes beyond that, just to make sure the tank is topped off.

Oral rehydration will even work in severe dehydration: In fact it's become the treatment of choice for treating cholera, a disease that induces severe diarrhea and dehydration. Just drink small amounts frequently, and it adds up pretty quick.

If you can't keep things down orally, there are only two other choices. One is IV hydration, the other is, well, uhh, rectal rehydration. IV rehydration has to be done by a physician or by a paramedic, and involves getting a needle stuck in your arm. Not fun. Rectal rehydration? You don't want it, and that's as far as I'm going with THAT one...

Dehydration that is severe enough to require an IV IS NOT a minor problem. It means you're done playing for the day, and you're going to be observed by me or the paramedics for several hours. If you don't improve real quick, you're taking a trip via EMS to the closest ER. Don't let it get that far!

Dehydration is an almost 100% preventable problem! Pace yourself, take breaks, get fluids on board, watch your intake, and most especially, watch your output. If it's a long game, use a Camelbak or other portable hydration system on the field. If it's been two to three hours since you had to pee, and you don't feel the need to go, you're not drinking enough! When you pee, your urine should be pale yellow or clear (this is one of the times when yellow isn't mellow).

One of the greatest (and most underappreciated) gifts we have here in the U. S. is abundant clean drinking water. Make your Muni Water District happy, consume more of their product! Your body will thank you for it.

Subject: Re: Hydrate, Hydrate, Hydrate... Sun Jul 24, 2011 2:15 pm

Doc Rob wrote:: The latest thing going these days is 'Fitness Water'. These are not the same as sport drinks, in that most don't contain electrolytes, and have much less sugar in them. Most have vitamin C and a vitamin B complex as well.

Is this stuff any better than sports drinks, or plain water? In a word, no. I like that these are lightly flavored and have less carbohydrates than sports drinks, but then I usually dilute sport drinks anyway. The vitamins are mainly for marketing: It's REALLY hard to have a vitamin difficiency here in the US. The vitamins you get from this water are mainly going down the biffy (to explain: The human body doesn't store excess water soluble vitamins (like the B vitamins and vitamin C): If you have more than your body needs right now, the excess is disposed of via the kidneys--The vitamin and supplement industry in the US have done incredible marketing convincing people that 'more is better' when it comes to vitamins. Nope, not the case. All more vitamins do is make incredibly expensive pee).

If you look at the Propel web site, the main message they give in the 'Professional' section is that Propel has less sugar than normal sports drinks, but tastes better than plain water, so people will drink more of it. There is a certian amount of truth to that: We here in the US are conditioned to drink flavored water, not plain water.

So is there any problem with drinking this stuff? No, not at all. Just remember that most of them have few if any electrolytes, so if it's a high-heat load day, make sure you have a regular diet, or have some dilute sports drinks to replenish electrolytes. Other than that, if you like the flavor, go for it.

On the other hand, is there any advantage to drinking this stuff? No, not really. Drinking enough water will do just as well for the vast majority of people out there.

Subject: Re: Hydrate, Hydrate, Hydrate... Sun Jul 24, 2011 2:20 pm

Doc Rob wrote:: Nope, this is not a treatise on how to drink ethanol, can’t help you there. This is a posting on how to stay hydrated while playing in the South Texas summer…It gets hot here, y’know…

In the dehydration thread I talked in some detail about fluid balance, water consumption and such. However, a few folks asked for a quick, down-and-dirty ‘How To’ on staying hydrated. So, here it is.

What to drink: Cool water, or cool diluted sports drink. Why cool? Cool water absorbs faster than warm water, and tastes much more refreshing. So if cool is good, ice water is better? Not necessarily, if it’s too cold and you take too much at once, it can give you stomach cramps and/or nausea and vomiting (not good). Do sports drinks do you any good? Well, in some cases yes, in other cases no. As long as you are eating normally, all you should need is water. However, studies have shown that sport drinks increase fluid consumption (they taste good, duh!), so I don’t discourage their use. Personally I dilute them a bit, as I think most of them are too sweet.

When/How much to drink: Several recommendations here. The American College of Sports Medicine recommends that the average well-hydrated adult should consume about 500 ml of water (about ½ quart) two hours before sports activities. During exercise there are several schools of thought: One is to take small amounts of water frequently: 10-15 ml at a time (about 2-3 teaspoons) every minute or so (Camelbacks and other sipping-type canteen systems are great for this method). Another method is to drink 150-300 ml of water every 15-30 minutes. Notice this is about the same amount of total fluid, regardless of method. Either way works fine. My personal preference (based on WAY too many years of treating barfing adults and kids in the ER) is to take small amounts frequently. However, whatever floats your boat (or your kidneys).

How to drink: Scenario players, either paintball or airsoft, should have on on-field method of drinking. I think the Camelback or other tube-type or canteen systems are ideal: You can easily carry up to three liters of water onto the field and you drink from a tube so you don’t have to lift your mask. You can put some ice cubes in the reservoir to keep the water cool, and it can cool your back as well. I have a Hydrastorm canteen attached to the back of my paintball vest, and I really like it. If you put sports drinks in your canteen, remember to clean it out properly: You don’t want green fuzzies growing in your fluid reservoir or in the drinking tube!

Couple of other points:
-Should you start hydrating yourself several days before an event? This is not a bad idea. No, we’re not camels, we can’t store the water. However it gets you well-hydrated (most of us walk around a little dehydrated most of the time), and gets you used to the idea of drinking water frequently.

-Should you take salt pills? No. Don’t do this. They don’t help, and they can hurt you. If you think you need extra salt (remember, the normal American diet has WAY too much salt in it), go with a sports drink.

-Do you need to drink sports drinks? In most cases, no: As long as you’re eating a normal diet, water will do just fine. If you’re not eating normally, and it’s VERY hot, alternate a liter of water with a liter of sports drink and you should do fine. If you WANT to drink sport drinks, that’s fine too. I just recommend diluting them a bit.

-How about drinking sodas? In most case, sodas have too much carbohydrate (sugar) in them to be absorbed rapidly. Adding to the fun, many contain caffeine, which will make you pee more. That being said, a nice soft drink with plenty of ice on a hot day is one of life’s little pleasures: Just don’t overdo it.

-How about beer? No. Nope. Un uhh. Non! Nada! Nyet! Negative Ghostrider! Not only no, but BLEEP NO! Not when you’re playing. Alcohol and paintball do not mix: Do one or the other, not both. Note that Tactical Paintball has strict rules about drinking on game days.

Want to learn more? Excellent resource: Auerbach’s Wilderness Medicine, 5th Edition. Specifically, Chapter 11, pp228-267, ‘Clinical Management of Heat-Related Illnesses’ by Moran and Gaffin, Chapter 64 pp1464-1476, ‘Dehydration, Rehydration and Hyperhydration’, by Moran, Mendel and Gaffin. (full disclosure, I wrote Chapter 35 ’Aeromedical Evacuation’ in the same textbook.)