Is it possible to drink too much water?

Have you heard of this advice – Drink as much water as you can because by the time you are thirsty, it is already too late? This has been the advice given to many sports participants to prevent symptoms of dehydration at least until 1985. following a scientific report entitled a paper entitled “Water intoxication: a possible complication of endurance exercise”.

Our body is made up of about 60% water, it is the medium in which cellular reactions takes place and nutrients and wastes are transported. During an exercise, the breakdown of energy providers raises our core body temperature. In order to cool the body, we produce and excrete sweat which causes the body to lose water. If this water is not replaced, the body will become dehydrated. Conversely, it is also possible to get overhydrated, resulting in exercise-associated hyponatraemia (EAH).

The diagram below describes what happens when the body gets dehydrated¹ and overhydrated².

Dehydration is indicated as a percent of weight loss (the percentage of body weight at the start of exercise that has lost at the end). For example, a weight loss of 2% if the loss of about 1.1kg for a 57kg person. Bearing this in mind, however, some loss of body weight is expected with prolonged physical activity due to the burning of glycogen and to a lesser extent body fats and proteins. For example, during a typical 42 km marathon a 1–2% decrease in body weight typically occurs without a change in total body water.

How can drinking too much water be bad?

Researchers have noted the prevalence of hyponatremia (low blood sodium) amongst participants of endurance sports such as ultra marathons and triathlons who had hydrated excessively. These runners developed exercise associated hyponatraemia due to an excess of total body water relative to the amount of sodium in the body. Contrary to the term hyponatraemia, EAH is not due to excessive sodium loss since research has shown that sodium loss is no greater in individuals who develop EAH than in individuals who do not.

Several factors have been linked to EAH which include:

Athlete-related

·         excessive drinking

·         weight gain during exercise

·         low body weight

·         female sex

·         slow running or performance pace

·         event inexperience

·         use of nonsteroidal anti-inflammatory agents and medical risk factors

 Event-related

·         high availability of drinking fluids

·         4 hours exercise duration

·         unusually hot environmental conditions

·         extreme cold temperature

How can we prevent EAH?

Since EAH is caused primarily by the consumption of fluid in excess of urinary and sweat losses, the Statement of the Second International Exercise-Associated Hyponatremia Consensus Development Conference in 2007²  recommends 1) avoiding excess fluid retention and 2) aim to lose up to two percent of body weight and never to gain weight during exercise. This includes drinking only when thirsty, and to and monitor body weight during exercise. Specifically, for an Ironman distance triathlon, cycle aid station placement every 20 km, and run stations every 2.5 km are recommended. In a standard marathon footrace, placement of aid stations every 5 km is associated with an absence of EAH.

Of interest is that ingestion of electrolyte-containing sports drinks (so called isotonic drinks) cannot prevent the development of EAH in athletes who drink to excess. This is due to two factors: 1) such drinks have sodium concentration less than 135 mmol/L and therefore will cause dilution of sodium if excess water is retained in the body during exercise and 2) it is well known that even administration of isotonic saline in hyponatremic patients with SIADH will not help because the infused sodium will be excreted in the urine rather than retained. What about taking salt tablets or capsules? There is conflicting evidence as to the effect of sodium supplementation, either by tablet or drink, on the incidence of EAH. Moreover, there may be some risks associated with excessive sodium supplementation in combination with overhydration.

So how much water should I take?

For regular daily hydration needs about 33-39 ml/kg body weight makes a more accurate standard than the eight glasses a day commonly recommended.

Prior to a workout or race::

1)       One liter of fluid (about 34 ounces) in the two hours prior to the start (about 17 ounces/500 milliliters per hour), ceasing consumption about 30 minutes before you begin the workout or race; or

2)       About 295-355 milliliters (10-12 ounces) of fluid each hour up to 30 minutes prior to the start (24-30 ounces total fluid intake).

During an exercise under most conditions, 500-750 ml/hr (about 17-25 oz/hr) will fulfill most athletes' hydration requirements³.

Keep in mind that these are general guidelines, you need to determine what works best for your system and adjust according to a particular race or training session.

REFERENCES

1.       Nutrition for Cyclists, Grandjean & Ruud, Clinics in Sports Med. Vol 13(1);235-246. Jan 1994

2.       Clin J Sport Med  Volume 18, Number 2, March 2008

3.       TOP 10 - The biggest mistakes endurance athletes make by Dr. Ian Rogers

Babybeats at Wolfgang Violin Studio

I attended a trial session with my no.2 last Sunday, 5^th Oct 2014. It was the last session of the term for an ongoing class, in which many of the students were progressing to their Kinderviolin program. Details of the class are as follows:

Description: A parent accompanied music and movement playgroup with an emphasis on the violin

Duration: 45 minutes

Group size: Max 8 parent-child pair

Number of facilitators: 2

Target age group: 2.5 to 4 years

I could see how the curriculum was well thought to incorporate fun and play into the teaching of music to preschoolers. The session progressed as follows:

1)      sing-along in twos, groups of four and the entire class

2)      classical violin music appreciation with illustrations of animals, fruits etc

3)      teaching rhythm using various percussion instruments, castanets, tambourines, drums, triangle etc

4)      using finger puppets for fingering awareness

5)      method and practice to hold violin bow

6)      identifying and reading notes

7)      violin setup, playing notes A and E on the violin and a simple tune (Twinkle Twinkle Little Star) 1 child to 1 facilitator

Time was very short and my no.2 enjoyed herself thoroughly.

Wolfgang Violin Studio was started by Min Lee, a renowned classical violinist from Singapore and her mother Annie Lee. A child prodigy, Min Lee gave her first public performance at the age of 5. For more info http://www.wolfgangviolin.com/index.aspx

Other music playgroup:

Music For Kids by Liberal Music & Arts School (tel: 6562 5661)

Duration: 60 minutes

Group size: Max 8 children

Target age group: 3 to 5 years

Methodology: Uses the Orff Method to introduce music through a mixture of singing, dancing, acting and use of percussion instruments. Developed by German composer Carl Orff (1895-1982), the Orff philosophy encourages children to experience music at their own level of understanding.
"Tell me, I forget…show me, I remember…Involve me, I understand." Carl Orff

Kindermusik  (Newborn to 7 years) licensed educator list

Minimaestroes (6 months to 5 years)

Ourmusicstudio (Newborn to 6 years)

Musicfactory (Newborn to 6 years)

..and the list goes on…………….

Counting calories burned

Do you eat to run or run to eat? I enjoy eating ice cream, potato chips, chocolates and all high caloric foods but I am also very weight conscious. Thus if someone were to ask me the question my response is definitely ‘run to eat’. In fact, I try to incorporate 30 minutes of running 3 times a week so that I do not gain weight even after indulging in cakes, ice cream, chocolates etc.

Does anyone eat to run, then? Yes my husband, he is an avid ultrarunner and he ingests energy gels during his long runs. It is thus important that we know the amount of calories consumed while performing the exercise. The desired result for me is to get a calorie deficit, whereas an ultrarunner would want to limit this deficit.

During an exercise, our body needs to convert calories from the stored nutrient state to the form that can be used by the muscle cells. This process requires oxygen, as in aerobic respiration and is dependent on the delivery of oxygen via the bloodstream. Blood flow is in turn directly related to heart rate. From this relationship, we can estimate the calorie burned (energy expenditure) from our heart rate. Essentially, with increased exercise intensity our muscles must burn more calories, and so our heart must beat faster to provide the oxygen necessary to convert those calories to the form of energy that can be burned by our muscles.

Below is a step-by-step guide on how we can calculate the amount of calories burned per minute:

1.      Ensure heart rate is within 41 to 80% VO2 max using table below

The equations used to calculate calories burned cover an exercise intensity level that ranges between 41% to 80% of VO2max. Below 41% of VO2max, the relationship between heart rate and caloric expenditure is not reliable. Above 80% of VO2max, the calories burned is based on an extrapolation (i.e. an assumption that the data correlation holds outside the limits of the gathered data points) of the experimental data.

2.      Equation for Determination of Calorie Burn per 10 minutes

Male: ((-55.0969 + (0.6309 x HR) + (0.1988 x W) + (0.2017 x A))/4.184) x 10 

Female: ((-20.4022 + (0.4472 x HR) - (0.1263 x W) + (0.074 x A))/4.184) x 10

HR = Heart rate (in beats/minute) 
W = Weight (in kilograms) 
A = Age (in years) 
T = Exercise duration time (in hours)

For a woman age 37, weight 44kg, the amount of calories burned per 10 minutes follows the graph below:

For a man age 39, weight 57 kg, the amount of calories burned per 10 minutes follows the graph below:

If you'd wish to have the excel file to generate your own graph, do contact me.

References

Keytel LR, Goedecke JH, Noakes TD, Hiiloskorpi H, Laukkanen R, van der Merwe L, Lambert EV. Prediction of energy expenditure from heart rate monitoring during submaximal exercise. J Sports Sci. 2005 Mar;23(3):289-97.

Swain DP, Abernathy KS, Smith CS, Lee SJ, Bunn SA. Target heart rates for the development of cardiorespiratory fitness. Med Sci Sports Exerc. January 1994. 26(1): 112–116.

Tanaka, H., Monhan, K.D., Seals, D.G., Age-predicted maximal heart rate revisited. Am Coll Cardiol 2001; 37:153-156.

Pros and cons of Suzuki violin method

This method of teaching violin originated from Japanese violinist Shinichi Suzuki (1898–1998) in the mid-20th century, As he realized that learn to speak their native language with ease, he utilised this basic principle of language acquisition to the learning of music, music being another language. 

Below is an article reproduced from this site which lists the pros and cons of the Suzuki method:

Early beginning. Students begin very early, even as young as age 3.

Pros

1. The early years are often considered prime for developing muscle coordination and mental processing.

2. Children may have a greater chance of quickly learning an instrument.

Cons

1. Some educators believe children age 3-5 is too young to begin violin since the student may not really understand what is going on. Coupled with the high demand for structured practice, this may be detrimental in their musical progress. 

Suzuki violin method uses common repertoire and a standardized curriculum.

Pros

1. This enables group practice and performance because all the students play the same songs.

2. For a home with multiple Suzuki students this can ease financial burden of buying books as each sibling uses the same materials.

Cons

1. Many of the Suzuki songs used are of the same style and time period. Unless a Suzuki teacher is flexible and supplements with outside material, students will be limited in their playing styles.

2. Although non-competitiveness and positive peer interaction is encouraged, it might be easy for students to compare themselves to others around them who are playing in the same books but are further ahead than themselves.

Review of past Suzuki songs takes the place of the traditional etude or theory books.

Suzuki believed that every technical problem or difficulty that a student needs to learn can be taught right in the context of their song book repertoire. Repetition and review is key in the Suzuki violin method to mastering songs and moving on to the next level.

Pros

1. Repeating and reviewing music can serve as wonderful building blocks to new music.

2. Constant review of music facilitates group lessons and performance.

3. Going back to the basics (simpler, familiar music) allows students to easily work on the fundamentals of proper form, technique, and intonation.

4. Etude and theory books can sometimes be non-motivating for children. Learning technique under the guise of a fun song is much more appealing and motivating for children.

Cons

1. Students may miss out on building a repertoire of many wonderful and useful etudes that have been written for the exact purpose of teaching students a specific technique.

2. Although reviewed frequently, repetition of techniques may not be enough in the context of a fun song. Etudes are designed to give student ample practice by repeating a specific technique over and over again.

3. Etudes give variety to practice and lesson time, and can serve as wonderful warm-ups.

Suzuki Students practice and perform frequently in a group setting.

Pros

1. It is beneficial for students to hear and see other students playing the violin, especially playing the music and songs they themselves are learning.

2. When playing in a group, a student learns valuable skills; keeping perfect rhythm and beat, following a leader, and to keep playing or 'catch up' when they make a mistakes.

3. Students meet and become friends with other youth that have a common interest in music.

4. Students become very comfortable in performing with their group. Performing becomes a non-stressful, enjoyable event.

Cons

1. Depending on the size and playing ability of the group, certain techniques of a student when played poorly, like intonation and proper form, may go unnoticed and uncorrected by a teacher.

2. Student may develop a tendency of robotic playing at the expense of their individual musicianship.

3. Performing always as a group may make a student dependent on the ability of others to perform. As a result, they may not develop the ability to perform as well as a soloist.

Suzuki violin method teaches students how to play violin by ear (listening to recordings and other violinists), not by reading music.

Pros

1. Students develop a strong ear. This means they are able to listen to music and replicate it.

2. When students do begin learning note reading they have already developed the ability to hear phrasing and predict the melodic direction of a song.

Cons

1. Learning music first by ear and later by note reading may compromise sight reading ability.

2. Students may develop the tendency to be dependent on others and not take ownership of their practicing and learning.

3. Students may struggle to develop their own style and interpretation of music because they are always copying others, and recordings.

Parents are very involved at lessons. They take notes and attend every lesson. They then become the at-home violin teacher.

Pros

1. For the very youngest students, parental involvement is necessary.

2. Parental involvement boosts student's self-esteem and confidence.

3. Parent helps student to stay on track during the week and make practice time more effective between lessons.

Cons

1. Students may become slack in taking responsibility and listening to their violin teacher if their parent is always taking notes at lessons and directing their practicing at home.

2. Students may be less likely to take ownership for their own learning, and as result could lack intrinsic motivation.

3. Older students may become dependent on teaching styles better suited for younger students.

My take is that I will choose the Suzuki method to start my child on the instrument. Due to the strong parental involvement, it also encourages the child’s sense of security and promotes bonding. The delayed reading 3 allows the students to focus on learning the instrument in entirety without having to struggle with note reading at the same time.

List of centres in Singapore that use the Suzuki Violin method:

Mac's music school

Mandeville conservatory of music

Klassique Musik

Other centres that teach violin to preschoolers

Wolfgang Violin Studio

Comparison of different brands of energy gels for endurance sports

During an exercise the body uses fat and carbohydrates as a source of energy. While fat is abundant, it is ineffective if the exercise intensity is above the aerobic threshold (70% maximum heart rate). Thus the major fuel source in high intensity exercises is from carbohydrates. The problem with carbohydrates is that we can only store a limited amount. For example, we use them up in 2 hours when running at marathon pace.

This is where energy gels come in place - to replenish carbohydrate stores that are used up. Unfortunately, energy gels don’t provide a simple one-to-one replacement and so timing and type of gel could be important. Most recommend taking a gel 45 to 60 minutes into the race and every 45-60 minutes thereafter. And now for the most difficult part - not all energy gels are the same. Some are more viscous, some taste better, and contains different ingredients. 

I have compiled a list of energy gels that are available in Singapore, prices correct as of posting and will vary during promotions.

Ranking of Highest energy per g of sachet

1	GU Energy Gel	3.13 Kcal/g
2	32Gi	3.07 Kcal/g
3	Clif Shot	2.94 Kcal/g

Ranking of Highest energy per dollar

1	Weider in Jelly	62 Kcal/$
2	PowerGel (PowerBar)	52.91 Kcal/$
3	GU Energy Gel	48.10 Kcal/$

Ranking of Highest simple sugar by % carbohydrate

1	Honey Stinger	100%
2	Accel Gel	65%
3	32Gi	61%

Ranking of Cheapest per sachet or serving pack

1	High5 Energy Gel	$2.00
2	Clif Shot , GU Energy Gel, Hammer Gel, PowerGel (PowerBar Gel)	$2.08
3	Honey Stinger	$2.20

Key points of various energy gels in alphabetical order

Brand	Carbohydrate source	Other feature
32Gi Sports Gel	rice syrup	Packaging is easy to carry
Accel Gel	maltodextrin, fructose, sucrose	Patented 4:1 ratio of carbs to protein.  Accel Gel users performed 13% longer vs. GU gel users, and 50% better muscle recovery. Also contains Vitamin C, Vitamin E, Whey Protein Isolate & Hydrolysate 5g
Clif Shot	maltodextrin, cane syrup	Patented design allows the tear tab to stay attached to the bottom of the packet after use.
GU Energy Gel	maltodextrin, fructose	Patented carbohydrate blend (70%-80% maltodextrin and 30-20% fructose). Also contains Vitamin C, Calcium, Vitamin E
Hammer Gel	maltodextrin, dextrin	Concentrated source of complex carbohydrates with four amino acids, trace amount of sugar
High5 Energy Gel	maltodextrin, glucose	Light consistency, not overly sweet
Honey Stinger Gel	honey	Only honey, honey is comprised of glucose, fructose, maltose, trisaccharides, and sucrose. The glucose to fructose ratio for honey is the same as fruits, 1:1. Also contains Thiamin, Riboflavin, Niacin, Vitamin B6, Vitamin B12, Pantothenic Acid
Maxifuel Viper Active Energy Gel	4 carbohydrate blend	Contains Maxcarb, an exclusive fast-acting blend of four energyboosting carbohydrates
PowerGel (PowerBar Gel)	maltodextrin, fructose	C2MAX 2:1 glucose to fructose blend, found to deliver 20 to 50 percent more energy to muscles than glucose alone and improve endurance performance by 8 percent.
Shotz Energy Gel	maltodextrin
Weider in Jelly	dextrin, fructose	Also contains Vitamin C, Calcium pantothenate,Niacin,Vitamin E, Vitamin B1,Vitamin B2,Vitamin B6,Vitamin A,Folic acid,Vitamin D,Vitamin B12

Which gel works best for you? If you’d like to have my compiled list in excel file, do drop me a note. If you’d like me to list your store as one selling energy gels, do drop me a note too.

Delaying a visit to the doctor

My #2 fell sick with mild fever (temperature 37.5 to 38.0 °C) on 14^th September with some sore throat. We brought her to see the doctor on that day itself and the general practitioner who had prescribed a course of antibiotics for my husband’s sore throat a few days ago was contemplating on whether to prescribe the same antibiotics. 

Eventually we were advised to administer the antibiotics if her condition worsens and to manage her fever with paracetamol/ibuprofen. Then two days later, she had itchy rashes on her legs, body, hands and scalp – while still having a mild fever all these while. We brought her to see the same doctor again and the doctor was sure this time round that she is suffering from a viral attack and advised against taking the antibiotics. 

Perhaps sometimes it is better to delay seeing the doctor. 

Earlier I have experienced the same situation with #3. Visiting the doctor at the early infection days did not prevent the condition from getting worse and there were not enough signs/symptoms for the doctor to make a definite diagnosis.

Have you experienced the same situation?