I often use this blog as place to “store” my writing that otherwise gets censored or lost in translation when I do interviews for foreign press with my music. In this case I wrote much of this for New Balance as their resident coach in Raleigh NC. These are my opinions. They are not objective and do not represent New Balance. Much of this was chopped down by our marketing company to be factual, objective, non-political, and not emotionally-jarring in any way. I am doing some public speaking in the Raleigh & Durham NC store concerning running and nutrition/hydration so this blog is meant to be a counterpart to these clinics. Again, during these speeches I’ll remain objective but here’s where I can “let it rip”.
Part 1 deals in nutrition. Part 2 is an interview as well as cautionary tale with myself speaking to ultrarunner Roy Gilb about the very reason runners pop salt tabs: hypnoatremia (or) water intoxication. Lastly, my wife Mary is currently working on getting her Plant-Based Nutrition cert from eCornell. We plan on taking to the streets preaching the gospel of eating plants wearing some neo-60’s jesus-cult-esque robes so they’ll know we mean business! And no, we don’t live anywhere near California. We’re in Raleigh NC, arguably just about at the epicenter of some of the greatest ethical issues surrounding the plant-based topic, but that’s another blog. The point is, we’re in the thick of the action and not “screaming in the echo chamber”. While I was insanely jealous of my best friend’s neighborhood in Louisville CO, where he is surrounded by snowy mountains and “environmental voter” bumper stickers, it’s probably more productive to be trying to get the message out down here in ‘Ol Dixie. At least that’s what I tell myself now before I drop off the grid and become an organic farmer in Hawaii.
PART I: The Plantbased Runner (Eat & Run)
Eat & run. I wish that meant what it means to me to most other Americans. I also wish we’d take the word “diet” out of the vernacular we use when educating people on food, wellness and a healthy lifestyle. It implies an impermanent state of deprivation as opposed to a positive shift in lifestyle. It’s my observation that diets are perceived by many as some obligatory and nearly insufferable, yet mercifully ephemeral state of tribulation in which they eat things that disgust them to keep The Body-Shamers at bay. I recently saw a bumper sticker that read, “I dieted for two weeks and all I lost was two weeks.” This rather droll and sardonic quip encapsulates the ethos that permeates large pockets of our culture. One day in the park I ran past an older lady and and a small child. The child asked her elder about me, “Why’s that man running?” The elder replied, “He’s trying to get healthy.” Sure, I remembered it, I held on to it, and something about it stabbed my ego. I’d considered myself an accomplished runner who’d been “healthy” for several years. Couldn’t she see that? The sheer nerve! With a little space and time, I got over myself and saw the bigger picture. The lady’s opinion is seemingly indicative of a larger shared paradigm. A collective myopia enabled by an innumerable indifferent agencies offering us what we want to hear. When your pendulum swings too far in one direction, all you need to do is “get healthy” then go about your business. I perceive that there is a significant preponderance of those who view exercise as an “atonement band-aide” for habitual poor decision-making. Is it Southern culture? I love my parents and I’d like to believe my thinking isn’t erring towards agism, but the aforementioned ethos looks a lot like some wholesale generational public health blunder from my perspective. I cannot help but see mathematics like this: High-fructose corn syrup in The 1970’s = ⅓ U.S. adults obese now. I quit drinking and smoking by changing my mindset and submitting to the truth of my addictions. I did the same with pizza. I know there’s stigma around comparing food to cigarettes but consider this statistic issued by the CDC:
“As many as 1 in 3 U.S. adults could have diabetes by 2050 if current trends continue, according to a new analysis from the Centers for Disease Control and Prevention.”
I know we can go down the rabbit hole debating the objectivity and thus validity of funded statistics when we unveil their often dubious benefactors. Sparing us all a day’s worth of googling comparative perspectives on America’s obesity problem in the left vs. right media, and which industries and organization make strange bedfellows, I’d venture to say that the brunt of scientific opinion can meet in the middle on our obesity epidemic. I’d say we’re due for a collective paradigm shift in the narrative we tell ourselves concerning food. Most of us in Western Civilization have experienced life through a lense where there’s a veritable blitzkrieg of conflicting and frantically ever-changing messages and signage on how food correlates to your health. Butter is back! Sugar’s the Devil! Low Fat. Zero Fat. Now with more Protein. Extra Fiber. No preservatives. Gluten Free. Non GMO. Organic. What the hell is going on!?!?!
Dare I say at the risk of sounding a bit conspiracy theorist-ish that I think we’re overthinking it. People don’t want to be told what to eat but irrespective of our American values (namely freedom), we’re bombarded relentlessly and daily with assertions about what we should put in our mouths. If choose you not to burden yourself with the quest for a personal understanding of nutrition, then you’re choosing to put the matter in someone else’s hands. Normally that person is actually business and businesses are in the business of making money and not holding your hand on your journey to wellness. I’m not hating on our Capitalist system or our country. I love both. It is your personal obligation to yourself to take dominion over your own health. Think of food as that which you pick up with your hands, put into your mouth, digest and make part of you. What process could be more intimate? I like to know who I’m doing business with and if you’re following me, I keep the company of fairly transparent characters. You know – the likes which don’t historically seem to have many “skeleton in their closets.” I’m talking about the produce aisle, stuff that came from the Earth, stuff that God made, stuff that doesn’t come in a box, and stuff that rots. I’m talking about whole foods. Mr. Orange & Mrs. Broccoli. Those are the “people” I like to do business with. They’ve never let me down.
When I was trying to bridge the gap between marathoning and ultrarunning I was vaguely aware that there was a disparity between what I ate and the lifestyle I aspired to. I’d run 30 miles and eat an entire pizza under the assumption that due to my unique caloric deficit I was entitled to eat like a billy goat. Warning: corny intended pun coming your way. I had a “gut feeling” that all the cheese and grease was holding me back. I googled “ultra running diet” and found Rich Roll’s book “Finding Ultra”. The book resonated with me on a very personal level for reasons completely removed from any dietary advice it gave. Towards the end of the book he challenges the reader to try a whole foods mostly plant-based “diet” for 30 days and that if it doesn’t change your life dramatically, then no harm no foul. I’m paraphrasing the latter from memory lest there be any fact checkers trolling about. The challenge changed my life. I hope everything I’ve said here doesn’t come off as overtly “less than objective” as I simply want to relay my experience and would hope that it helps others as it’s helped me.
If I’ve peaked your curiosity, a recent episode of the Rich Roll podcast features Cardiologist Kim Williams discusses eradicating Heart Disease with a plant-based diet. It’s not a bad place to start if you want to hear some very grounded and intelligent conversation around this topic:
As for runners and food stuffs here’s the general idea: Within a half hour of your run, supply your muscles with fluid, carbs and some protein. Aim for a 4-to-1 ratio of carbs to protein. I suggest non-processed foods. When I was trying to bridge the gap between marathons and 50-100 mile marathons my nutrition was the prime factor holding me back. When I switched to a whole foods – mostly plant-based diet my muscles repaired at a dramatically faster rate and continue to years later. The runner’s body is a big personal science experiment you should be lovingly, mindfully, and safely conducting on yourself. Afterall, if you’re an endurance runner (that includes my 5k peeps to my 100+ miler peeps), you need not to to only condition your core, leg muscles, ligaments, VO2 max etc etc – but also your gastrointestinal system. When we’re distance running we’re dealing with a unique caloric deficit which our body isn’t used to. You need to find what your stomach accepts and what fuels you best. We’re all very different. Doctors, experienced runners and nutritionists van point you in the right direction but ultimately it’s up to you to figure out.
I’ll be doing two public speaking in-store clinics on Nutrition and Hydration for Runners in both the Raleigh and Durham New Balance stores Nov 28-29.
- Raleigh Nutrition & Hydration Clinic MeetUp: https://www.meetup.com/Raleigh-Durham-New-Balance-Running-Group/events/243653426/
- Raleigh Nutrition & Hydration Clinic Facebook Event: https://www.facebook.com/events/127475338021290/
- Durham Nutrition & Hydration Clinic MeetUp: https://www.meetup.com/Raleigh-Durham-New-Balance-Running-Group/events/243653554/
- Durham Nutrition & Hydration Clinic Facebook Event: https://www.facebook.com/events/368463210259465/
Discussion led by Scott Waldrop (ultra runner, RRCA Certified Coach, New Balance Coach, The Herren Project Ambassador Runner). Covering multiple topics specific to NUTRITION & HYDRATION, while sharing stories of personal experience with the intent of keeping us healthy and happy while running. In-depth conversation, visual demonstrations, and Q&A. Drinks, snacks and seating provided. No running, clinic only.
In these clinics you can look forward to the following discussions, demonstrations and features:
- How changing what I ate changed my life, the mindset that was involved and how I arrived at it all.
- Demonstrations on making delicious green smoothies with Scott’s Vitamix (yes I’ll make it right there and you can try it right there!)
- Juicing vs. Smoothies?
- Examples of my daily meals during training and in-general
- How a poor dietary lifestyle can have counterproductive effects on your training in ways you may not have imagined
- leveraging H2O with Electrolytes – why it’s key to performance and possibly dangerous
- Demystifying all the white noise around diet fads and the conflicting news about what you should and shouldn’t eat as an athlete and human.
- What’s up with the Ketogenic diet? What’s up with Paleo? What’s up with Plant Based? What’s up with gluten and organic? We’re all going to die, why can’t I just eat steak??? Arrrghhh!!! …I’ll help! 🙂
- Talking about making traditional dishes that taste wonderful and are GOOD for the body
- Why we crave what we crave and breaking the cycle of poor eating habits
PART II: Hypnoatremia
Today we’re talking about “water poisoning”, “water intoxication”, or if you like your “50 cents words” it’s proper name is “hyponatremia”. It’s not as simple as there being a toxic substance in your water supply. This condition first came under my radar in the 90’s when I was hiking down into the Grand Canyon. The rangers warned us not to drink too much water as can become toxic in your system. That sounded preposterous to me at the time as it does to most people, and I didn’t think of it much again until I became a running coach and started doing 100-mile races. In The Leadville 100 handbook they break the condition down into such simple terms that its cause suddenly made perfect sense to me (probably because at that point I had pretty much figured it out on my own). If I may paraphrase it says something to the effect of, “you drink so much water that you urinate excessively which flushes all the essential minerals out of your system”. It’s funny how “The Universe” connects the dots and brings the right people along at the right time. This coming week I’ll be speaking in The New Balance Stores about proper hydration and nutrition for runners.To preface the following statement so that it makes sense, I’m a “man of many interests” I suppose is the best way to say it. Aside from being an ultra runner and running coach, I have a long history as a musician. If I’m being honest, when my heavy metal guitar partner of some 20+ years (aka Dave Boyd) told me that a co-worker suffered “water poisoning” during a “marathon”, I instinctively took it “with a grain of salt” – no pun intended but my oh my it just fell right in there! I presumed the individual in-question to be a “weekend warrior” trying to earn a 26.2 oval to stick on their commuting cruizer. I assumed a versed marathoner would have their electrolyte knowledge under control. Nonetheless, I thought that a story on hyponatremia from an “every person” would engage most sane runners (unlike myself who will run 50+ miles for a “psychological” training). Man, was I humbled by my dismissive assumptions when I read Roy’s story! This guy’s not only an experienced marathoner and ultrarunner, but a great one. I got into ultra as I was a slow marathoner. Roy can run great distances and he’s fast. Thus, we need to go ahead and “throw out” the notion of this story reflecting common running conditions. We are indeed putting an outlier runner under the microscope. While it doesn’t suggest that every runner is highly susceptible to hyponatremia. this account provides detailed insight into the conditions from which it can arise. I also wanted to say that It is not my intention to carve out the Odyssey Trail as a dangerous race. I thought it was pertinent information which would help paint the picture of Roy’s ordeal. And let’s be honest, inquiring minds want know. Furthermore, When I ask Roy about his H20 intake just subsequent to his malady, bear in mind how tentative we both are on this issue. It’s a very nebulous guess. With all that out of the way, let’s dive in.
Scott Waldrop: Please give us a synopsis of your history with running and athleticism in-general which lead you to the particular race where you experienced hyponatremia. Go!
Roy Gilb: I’ve always loved running, but I was drawn to it in earnest when I was a junior (16 years old) in high school and joined the cross-country team. I then did indoor and outdoor track and stuck with all of those until graduating high school. I took a running break my freshman year of college, and then fell back in love with running soon after. I ran a couple half-marathons, 10ks, and 5ks the next couple years, ran my first marathon in 2013, and caught the long-distance bug after that. Then I moved to Cape Town, South Africa after graduating where I read McDougall’s ‘Born to Run,’ and got really into trail running out there. When I moved back to the US in 2015 I signed up for my first ultra (Mt. Hood 50 Miler), which I ran in the summer of 2016. I was truly hooked after running that race, and went on to do the Richmond Marathon, the VA Beach 50k, the Promise Land 50k, the Broken Arrow Skyrace 52k, some half marathons, and then the Odyssey Trail 40 Miler, where I had my hyponatremia mishap.
Scott Waldrop: Okay, so this makes the whole equation more interesting! I had a preconceived and terribly presumptuous gut-feeling that you might be a marathoning newb or something to that effect. I stand humbly corrected. It would seem we’re cut from the same cloth in that we’ve got the “trail & ultra bug”. I think we all to some degree find catharsis and solace within those long hours in the wild devoid of right angles and human clutter. As ultrarunners we both know that this sport isn’t something you can fake. We need to experiment and condition our gastrointestinal systems and attempt to figure out at least a few the innumerable self-specific variables to fueling that allow us to complete these treks. Knowing your running history makes me feel like I need to unpack assumptions I have about myself and whether or not I really have any quantifiable mastery over knowing how to “put gas in the tank”. I know I constantly experiment with it and screw up, albeit not with the catastrophic results you experienced. This once counter-culture sport is gaining mainstream appeal much to the well-publicized ire of some of its seminal community. A lot of this has to do with the grassroots nature and familial ethos being diluted. Another source of the ultra community’s ambivalence towards its popularity (I believe), stems from the idea that people want to “hack” the ultra so they can put the sticker on their car. I think there’s this perception that there’s now hoards of ill-prepared runners puking-up the courses who are contributing to the sport’s attritional infamy in their sheer numbers coupled with the inherent dangers of ultrarunning such as cliffs & snakes. I’m not distancing myself from this riffraff and I’m not lumping you into this category as you have a demonstrated running history. it is uncomfortable for me to really face my own forthcoming question as I am part of the aforementioned “new ultrarunners numbers statistic”. I’ve seen several extremely frightening medical emergencies transpire on ultra courses in a brief time. During my RRCA Certification course one of the main coaches predicted this trend will result in an unnecessary number of injuries and possible death due to general inexperience (I’m paraphrasing). You had a near-death experience. What would you say to the people who think this sport is too dangerous for the general public?
Roy Gilb: I would use the old trope and say to go out and experience life rather than avoiding something that could be scary or dangerous. If you enjoy it, then do it. There’s inherent dangers in almost everything – tell them driving to the race is more dangerous than running it (disclaimer: I don’t know this for a fact, but it must be true, right?). Also tell them to be smart in their training and nutrition; at least smarter than I was in September.
Scott Waldrop: I highly doubt that assertion requires a fact check. So, which race did this occur at and what was the distance you were running?
Roy Gilb: The Odyssey Trail 40 Miler in Douthat State Park :
This was a really beautiful and well-run race! Highly recommend it.
Scott Waldrop: What were the atmospheric conditions on the day in-question (as you best recall)?
Roy Gilb: It was a beautiful day, albeit a bit hot for ultra-running. I think it was sunny, clear, and 65-75 degrees most of the race.
Scott Waldrop: In retrospect and if you can remember, during said race, where you cognizant of imbibing what may have seemed like an inordinate volume of H2O? I (think) I know from experience, that this condition doesn’t creep out of wanton carelessness, being clueless, or having some freakish anxiety about becoming uncomfortably thirsty, but rather, the fact that the heat, humidity or altitude are dictating that you hydrate more – you know – you are thirsty. You need that water. You just don’t really think about what you’re flushing out. Was that your experience as well?
Roy Gilb: I was not cognizant at all that I was drinking too much water. I think it was a combination of factors that led to the over-imbibing. I’m a bit OCD about most things, and staying hydrated is one of them (sipping on a 32 hydroflask of ice water as I type this). I just feel way better when I drink water. During the Promise Land 50k back in April I had decided to run with just a 16oz handheld for water. It turned out to be really hot that day and tons of people were running out of water well before the aid stations. This turned into a dehydrated/leg-cramping death march towards the end of the race for me, so I was determined to avoid that situation in the future. Fast-forward to the Odyssey Race – I was in the lead at the marathon mark and feeling really good. During an uphill climb, I started to feel a twinge of muscle-cramping in my quads. My brain went into OCD-mode and I remember drinking a ton of water during that climb to ‘counteract’ the cramping, which I KNOW is not always the right thing to do. The in-the-moment excitement and past cramping experience made me throw common sense out the window. I was peeing clear the few times I stopped during the race, so I figured: “Great, I’m staying hydrated.” Bad call. I’m much more cognizant about ‘drinking-to-thirst’ now, rather than ‘staying ahead of thirst.’ This past experience, combined with my OCD tendencies led to bad hydrating decisions on my part.
Scott Waldrop: That’s impressive that you were in the lead and interesting that the “high” it brought on clouded your judgement. I can see that. I’ve been in race situations where I was doing well so I put my brain on “stand by” and let it rip. It resulted in cramps and fartleking the last few miles. So, again with my presumptions – but I’m guessing by “OCD” is a euphemism for that classic runner Type-A personality. If you have OCD then I apologetically digress. Irrespective of the psychology, I’m wondering if there’s insight competitive runners can glean from your description of the situation. Many of us have “gone out the gate blazing” in a race just to see what will happen knowing that if we bonk and pull a positive split, so be it. We figure the worst that will happen is that we’ll just feel like crap and be embarrassed as the other runners fly past us. In your case this gritty mentality which we need as competitors did not serve you. Will your experience degrade your ability to “let go” and test your body’s full athletic capability or will you approach endurance running from more of a “live to fight another day” conservative approach?
Roy Gilb: I don’t think the experience will change how I approach races in the future, except obviously I will pay much stricter attention to nutrition/hydration. However, I tend to play it safer (damage-control) as I try new and longer distances, which will definitely be the case as I give 100ks and 100-milers a shot in 2018.
Scott Waldrop: Ultrarunning gear nerdery time! What “delivery system” were you using to drink? Where you rocking the hydration backpack, water bottle belt, or handheld water bottle?
Roy Gilb: I had a 2 liter Nathan running vest that I used for water. I also had a 16oz bottle I would refill with HEED from the aid stations.
Scott Waldrop: I’m admittedly rather generally aloof as my wife will attest to, therefor if it were me I’d probably never be able to even approximate what I’m getting ready to ask you. Premature apologies aside, do you have any idea how much water you were taking in and how often and if not get you take a stab at a wild guess?
Roy Gilb: This is definitely a wild guess – the course was three 13.1 mile loops and I would estimate that I drank 1.5-2 liters of water per loop. So 5-6 liters total? Typing that out makes me realize how absurd that is.
Scott Waldrop: Despite the outcome, during the race were you taking in any electrolytes via tablet, food, sports drink etc?
Roy Gilb: Starting the race – I was eating a GU or 3 Cliff Block gummies every 45-60 minutes, as well as a saltstick capsule every 90 minutes. I also had a 16oz water bottle I was refilling with HEED (not a fan of this stuff – I usually go with NUUN or Tailwind) from the aid stations every 2 hours or so, and had a couple handfuls of pretzels throughout the race. This general nutrition plan has worked for me in the past, but I was clearly taking in way too much water, and my eating schedule fell all out of whack after ~30 miles or so as I was getting more delirious and not thinking clearly.
Scott Waldrop: It rather freaks me out to hear that you were taking salt tabs on what I consider to be a very responsible shedule. Coveresley, your nutrition situation is a huge red flag. I can definitely seeing myself throwing caution to the wind in the situation whilst “killing it”. How strongly do you feel that if you had forced yourself to take in the requisite calories you would have had the clarity of mind to monitor your water intake appropriately?
Roy Gilb: Hmm, that is tough to say. I would imagine that more calories late in the race would have definitely helped my presence of mind, however I think that I already flooded myself at that point. I made sure to stick to my nutrition schedule for the marathon this weekend and felt great!
Scott Waldrop: I don’t think there’s much point on ruminating on those “gray” areas anyway. It’s all pontification after a certain point but thanks for entertaining my frivolous inquiry. So, were you aware of hyponatremia acutely or even peripherally prior to your endeavor?
Roy Gilb: I was peripherally aware of the condition, after I had heard about a friend-of-a-friend who experienced minor hyponatremia during a marathon. But it was a vague “that-will-never-happen-to-me’ abstraction in the back of my head. Definitely did not see it coming.
Scott Waldrop: All right man, here’s where we need to unpack things, get real, and get weird. The next few questions will be about the experience itself. Your ordeal was undoubtedly frightening and emotional, so please just walk us through your “break down” being as in-depth, vulnerable, and graphic as possible while maintaining your personal comfort threshold. Be mindful of the fact this will be published, people will probably find it on google and you may save a life if not more than one. Here we go. Do you remember feeling “off” or certain symptoms began to manifest first?
Roy Gilb: Sure thing – happy to get weird. Honestly, this was one of the scarier parts, in that I didn’t feel very ‘off’ until I was well past the threshold of dangerous consumption. At one of the last aid stations (mile ~34) I stopped for a snack, where the volunteers asked how I was feeling (also where the 2nd place guy passed me to take the lead – I didn’t even realize he ran by!). I gave an honest answer that I was feeling pretty good, but a bit woozy and wobbly on my feet. These feelings became more amplified the closer I got to the finish, but I still never even considered that there was an imbalance or something wrong with me. I figured it was the longest race I’ve run this year, so I must be feeling extra exhausted. Nothing more.
Scott Waldrop: Was the onset of your symptoms and ultimate illness, slow, sporadic, or sudden as you recall (if you recall)?
Roy Gilb: You know that boiling frog parable? The one where a frog is in a pot of warm water that is heated up so slowly that the frog can’t perceive any danger, and then it eventually ends up boiling alive. I would equate the experience to that frog. It was such a slow creep of delirium that I never even perceived that I was endangering myself. I’m not sure this is the case for other people who have had hyponatremia, but that’s how I remember the experience. No perception of danger at all, mostly because I was unaware of the symptoms of hyponatremia.
By mile ~36 however, this delirium started to affect my stride and I felt intoxicated, like I had taken a couple shots of whisky back-to-back or something. This hit a breaking point at mile 39, where there were some undulating rocky trails. I took a misstep and face planted hard on the trail. I gashed my head open, blood everywhere, saw stars and the whole shebang. I did a wobble/stumbling walk for a bit to regain my feet and I felt very out of it – eventually continued jogging to the finish.
Scott Waldrop: Was there a moment when you definitively knew there was something very wrong with you? Describe the last things you remember before things went completely south.
Roy Gilb: I still didn’t even realize that there was anything wrong with me after my spill at mile 39. I thought it was a run-of-the-mill trail misstep that led to a face plant. Hindsight is 20/20, and I definitely should have clued into how woozy and drunk I was feeling around mile 36, but my goal was in sight and I just marched on. I didn’t even hear my Dad or girlfriend cheering for me as I crossed the finish line, and some fellow runners were looking at me like I was a ghost (bloodied face, unfocused eyes, etc.).
Everyone walked me right over the EMTs after washing my face off – I’m so thankful they were there. They took my vitals, asked me some questions (age, location, what happened, etc.) as I slowly lost consciousness. They informed me that I had to go to the emergency room for my head wound and strapped me onto a stretcher. *Funny aside here: I had duct tape over my nipples to avoid the dreaded chafe, and the EMT said, “I have to ask, what the hell is up with the duct tape?”*
Things started to get extremely nebulous now, and the last thing I remember is looking at my Dad and saying “I’m scared.” I had never fainted in my life up to that point, and it felt like an extremely deep sleep was enveloping me, whether I wanted it to or not. I passed out a few seconds later for 20 hours straight, and woke up in the ICU at the UVA hospital with 6 IVs, a catheter, medical-glue on my head, and my hands all wrapped up to prevent me from tearing things out of my body in my sleep, and my family in the hospital room with me.
Scott Waldrop: From what I understand you were in The ICU for a few days. Give a description of this time including the pain level(s), psychological disposition, and bodily sensations you were experiencing.
Roy Gilb: I was unconscious for about 20 hours from the end of the race until I woke up in the hospital. The only vague memory I have during that time period was semi-waking up in a feverish nightmare and having to pee more than I ever have but I couldn’t do it. I had a distended bladder from all the liquid. Other than that I don’t have a single memory or dream from that time period.
While I was out-of-it, my family was going through hell. Apparently the ambulance took me to a small hospital near the racecourse, where they were putting me through a bunch of tests and one doctor said I might have neurological damage. Somebody made the decision to transfer me to UVA where there were better resources. My family was worried to death about me, since they didn’t know if I’d wake up normal again. Throughout the day while I was unconscious, my family recounted to me that I was in a sort-of ‘waking dream-state.’ I would open my eyes and stare right into their eyes, put on a sleepy half-smile and mumble some incoherent words. I don’t have any memory of this.
When I woke up I felt extremely confused and groggy, however there was no pain at all aside from the bruises where I fell, and a slight headache. I felt tired, slow, and generally ‘off’ for about 5-7 days afterwards. It would take me a bit longer to formulate my thoughts or think of a certain word, etc. It felt like an extended mind and body hangover. I felt 100% a week or so later.
Scott Waldrop: The 20 hours of sleep – was this the nature of hyponatremia or did they have you sedated to get your body back in balance?
Roy Gilb: This 20 hour sleep was all from the hyponatremia – no sedation from the doctors. Another aside that my family reminded me of – I was grinding my teeth something fierce while I was passed out in the hospital. Interesting side effect from the condition.
Scott Waldrop: Did your doctors have any profound insight into this condition such as things they may have said which punctuate your memories in the hospital?
Roy Gilb: I learned surprisingly little about the condition while I was in the hospital. This was partially due to how groggy and out-of-it I was feeling, and partially due to all the inherent jargon associated with hyponatremia. I was of course informed about what happened, that I need to ‘drink-to-thirst’ in the future, and that the biggest symptoms of exercise-induced hyponatremia are headaches, poor balance, muscle cramps, and impaired thinking ability. They also told me that they had to inject saline into my system slowly to get me back to stasis. I plan to learn much more about nutrition in the future.
Scott Waldrop: I’m no stranger to catastrophic sports injuries. When I was 13 I flew of my skateboard which shattered my elbow leaving a splintered and bloody bone penetrating my skin. I woke up in the middle of night more than a day later alone in a dark hospital room. My entire left arm was suspended and mummified in thick cast. That’s all I remembered noticing before I proceeded to have an epic projectile barfing session all over myself. My surgeon told my father that he wanted to round up all of the skateboards in the world and have one giant bonfire. So, what was the general discussion your doctor and caretakers held with you and did they express any negative feelings towards your sport?
Roy Gilb: Ouch! That sounds like a rough hospital visit.
This was actually pretty interesting. Since I was at UVA, a research hub, I probably had 10-15 different doctors/nurses take care of me or come talk to me about the experience. At one point, there was a group of probably 20 people gathered outside of my room taking notes from the head doctor about what had happened, since I exhibited the most straightforward example of exercise-induced hyponatremia they had seen: a relatively young, healthy, athletic-type with off-the-charts low sodium levels.
There were various opinions from the doctors, many of which said I was crazy for running too far (I’m sure you know that schtick very well), all of them said to monitor my hydration levels more closely in the future, one who said I should stick to shorter distances in the future (not happening), and one who was an athlete and said he knew I would get back to running soon. So, only one semi-negative response about ultra-running from the ensemble of doctors.
Scott Waldrop: Yes, I know all too well the “you were asking for it” ethos that permeates “popular opinion”, ha ha ha. I’ve always been attracted to lesser understood “fringe” sports so of course when there’s not a larger frame-of-reference for folks to draw from, it’s easy for you to become the “posterchild”. Anyway, I’m going too far down a tributary so I digress. Sorry if I’m getting overly metaphysical for your sensibilities with the forthcoming question. I’m a rather “airy” dude and love touching upon ethereal subject matter as it tends to pull a degree of very-human authenticity into conversation (in my opinion). I think that a common thread among many runners is this ethos of “seeking” and by that, I mean that many of us run to clear our minds, find our limits, or look for better versions of ourselves. Conversely, others among us hate running and do it because the doctor said so. Not sure where you stand on this. That said, did you glean any profound or existential wisdom from your experience you be willing to share?
Roy Gilb: I really like this question, and as much as I wish I could answer with some profound insight, the fact is that I didn’t gain much orphic wisdom from this experience. I know that the feeling of ‘going under’ was very scary and a powerful reminder of my mortality and that I am not invincible. I would have died if I wasn’t taken straight to a hospital, and that is a very humbling and terrifying thought.
Tangentially, as an ultra-runner – you know that elusive, ecstatic feeling deep into a race or training run, whether it be mile 10, 30, 50, or 80, where the rest of the world disappears and there’s nothing but you, the trail, and a stream-of-consciousness with revelations about life, our place in the universe, human history, family, friends, pizza, time-travel, etc…? I have had this feeling during every ultra-race I’ve done, except for this one. It’s the feeling that helped hook me into the sport and keeps me coming back. I think that the intoxicated/hyponatremic condition muted by mind’s emotional response to the endorphins, and I felt more like a zombie towards the end of the run than an ecstatic human being who just ran through the mountains for 7 hours.
Scott Waldrop: Not a tangent at all! Again, this freaks me out as it resonates deeply with me.. As endurance runners we pride ourselves on being tough as nails and embrace the delirium. I’ve talked myself out of all sorts of dark thoughts while running through the night and feeling generally screwed up. My past is marked by drug and alcohol abuse which I (sometimes) believe makes me uniquely qualified for this support in that I’m skilled in the art of feeling like garbage. Hearing your story, and knowing my personal threshold for physical suffering, makes me question how close I’ve come during ultras to a similar disaster. We’re stubborn to the bone. During a 100-miler I will experience all sorts of physical, psychological and emotional fluctuations which I am constantly taming. As an alcoholic, the word “intoxication” sounds like I really wouldn’t mind the sensation if it occurred, especially while I’m already whacked out of my mind from exertion. Of course, I know what you mean about that “elusive, ecstatic feeling” as an ultrarunner, and I think it comes out of the phantasmagoric euphoria created through the mind-willed kinesis which propels your body through distance, time, two dawns etc. The distinction between the “intoxicated/hyponatremic” state you describe and the “wackiness” you feel deep in an ultra race still seems rather blurry to me. Can you definitively articulate the difference between the two?
Roy Gilb: After cogitating on this for a bit, I think that the line between the intoxication and euphoria I described is inherently blurry, at least in my mind (and how I experienced it). Also, perhaps ‘intoxication’ was the wrong word to use here, since that could be spun with a quasi-positive connotation. Inebriated? Muddled? I can’t seem to find a fitting word here. Anyway, those last few miles seemed like some of the more negative affects of excessive alcohol consumption (unsteady feet, poor depth perception, muddled thoughts), coupled with complete body and mind exhaustion. My mind seemed to laser focus on one singular goal – death marching to the finish line, even though my body was on the verge of shutting down. Alternatively, that ‘euphoria’ I described from other races was a much happier, psychedelic experience – interconnected tangential thoughts about anything and everything.
Scott Waldrop: Will this deter you from running again, why or why not?
Roy Gilb: Definitely not – never even crossed my mind. It was a (hopefully) one-time scare that will better equip me for future adventures and makes me all the more grateful for the two legs and functioning body that I have. I can’t imagine not running again. Although it was torturous to sit in a bed for 2+ days straight – I’d never done that before.
Scott Waldrop: Cool! Roy, thank so much for taking the time to entertain my inquisition regarding what must have been (for lack of a more eloquent vernacular) just a really spooking and $h!t+? tribulation my friend. Do you have any last thing you can leave to our readers which really encapsulates what you went through which they can take with them? Feel free to add anything I didn’t ask you which you think is important.
Roy Gilb: You’re welcome! I hope this is helpful for people. I don’t have much more to add, other than the old trope ‘listen to your body (and mind),’ and be grateful for your legs!
You can follow Roy on Strava and check out some stats from the race in-question at:
- Strava profile: https://www.strava.com/athletes/11540629
- Strava Odyssey Race (part 1 due to Garmin mishap): https://www.strava.com/activities/1179377609/overview
- Strava Odyssey Race (part 2): https://www.strava.com/activities/1179377767/overview
Further Literature on Hypnoatremia:
- Journal Article about hyponatremia that the UVA doctor gave me to read: http://cjasn.asnjournals.org/content/2/1/151.full
- Roy says, “Interesting-looking book I came across after doing some research”: https://www.amazon.com/Waterlogged-Serious-Problem-Overhydration-Endurance/dp/145042497X Scott says, “RRCA strongly suggests that all of their coaches read this book as the go-to for understaning this condition.”