Why lab testing for venous blood pH and electrolytes is important before athletic competitions

Ross A. Hauser, M.D., 5-time Ironman Finisher

It is common knowledge that athletes need to be well hydrated for endurance competitions. What most athletes and sports medicine specialists fail to realize is that optimum venous blood pH and electrolyte levels are also crucial for optimum sports performance. Most doctors who perform Prolotherapy also help patients get healthy with diet, herbs, natural hormones, exercise and other recommendations that they can add into their lifestyles. I specifically listed my qualifications to write this article as a 5-time Ironman Finisher because as an athlete, I can personally vouch for the significance I place on blood laboratory data before competitions to optimize performance. I recently observed a patient experience both a did-not-finish (DNF) and a personal record (PR) in similar events within two months of each other. The results could have easily been predicted by the athlete’s pre-competition laboratory data.

On 6/19/09, the day the athlete was leaving for the hardest one day endurance bike event in the Midwest (Horribly Hilly Hundreds, www.horriblyhilly.com ) his test results were as follows:

The event was a 200K bike ride (124 miles) with over 15,000 feet of climbing. The day was one of the hottest days of the year. Unfortunately for this athlete he did not receive his test results before the event, which was the next day. The athlete felt great for the first few hours, but at mile 80 started to get cramping in his leg muscles. The athlete did not bring any electrolyte tablets with him, but borrowed some at this point from another rider. At around mile 102 he stopped at a local farmer’s house and asked for some soda, as he was feeling awful. At this point he was getting severe cramping of his quadriceps and calve muscles. He was feeling overheated. He was now taking many rest breaks in the ride as he could no longer ride up the hills so he had to walk his bike up the hills. The cramps in his calves and quadriceps just continued to increase. Even cycling on even ground was getting to be difficult. At mile 110 he saw the SAG wagon and hopped in, DNFing (did-not-finish) for the first time in an event in years.

The athlete’s next endurance bike event was two months later. He was determined to finish. The event was the Dairyland Dare bike ride/race (www.dairylanddare.com) , which is also held in southwest Wisconsin and has a similar difficultly level as the Horribly Hilly Hundreds. The event that he signed up for was the 200K ride, with 15,000 feet of climbing with an average grade of 4. The total distance was 130 miles.

This time instead of getting tested the day he was leaving, he was tested early in the week where his blood testing revealed the following:

The athlete had two more days after these test results were discussed before the actual event (he left for out of town to do the event, so his blood could not be checked again before the event). The athlete described what happened during the event this way:

“My longest ride ever in my life was 130 miles. I had only successfully completed one 200K event in my life. In regard to the blood testing, I did what I needed to do to get my blood pH down and my mineral levels (especially magnesium up). The weather was warm, but not as bad as the Horribly Hilly Hundreds (still over 80 degrees). I made sure every hour I took my salt and electrolyte caps. During this event I maybe had one cramp the whole time. I did not get up out of the saddle for a climb until mile 103. This was vastly different from my previous endurance ride this year. At mile 106, I took the turn for the 266K event. In other words, I was feeling so good that I decided to do a much longer event; it was no longer whether or not I would complete a 200K it was by how much I was going to set my personal record for cycling for one day. In the end I finished the 266K event (170 miles of cycling) in just over 13 hours. I completed 177 miles of cycling that day with over 20,000 feet of climbing. I am confident if I did not correct the blood pH issue and low magnesium before the event, my results would have been the same as the Horribly Hilly Hundred event. A DNF!”


Discussion

From the above laboratory data it is clear that the athlete before his first big endurance bike ride (in June) had a low blood pH, but also a low magnesium and potassium level. Had the athlete known this before his event, these levels could have easily been corrected by diet modifications and supplementation. Even if there wasn’t sufficient time to correct the levels before the event, taking extra electrolytes during the event would have proven helpful. Many drinks and capsules contain magnesium and potassium besides just sodium chloride (salt). This athlete did none of this and suffered the consequences, severe cramping that caused a DNF at mile 110 of the endurance bike race. Nutrition and hydration-wise this athlete was fine during the event. I know because I was this athlete! I was on record pace during the first half of this event. The explanation for this is that hyperthermia, as my body heated up during the first half of the event because of the difficulty of the course, as well as my fast pace, , in addition to the over 90 degree temperatures, caused my blood pH actually to be driven into the normal range. Hyperthermia (or raised body temperature) causes blood alkalinity.¹ So for the endurance athlete it is important to start events held in hot weather with the blood pH actually being on the acid side (below normal venous blood pH). The only way an athlete can know there venous whole blood pH is by having it tested. The device used at Caring Medical is a Nova CCX.

As bad as my blood laboratory data was before the Horribly Hilly Hundred bike ride, it was much worse for race number 2. Fortunately, because of the disaster during the first race, I decided to get tested earlier in the week so there was time to make corrections. My initial blood work showed an alkaline blood pH and very low magnesium level. To start an endurance bike race in the heat with an alkaline blood pH would have been disastrous as the venous blood just gets more and more alkaline as the body temperature rises. As an athlete becomes overheated, sweating increases, which then makes the body prone to dehydration and even more hyperthermic.² This coupled with the fact of low magnesium is a sure set up for cramping and another DNF. This time, however, I started making dietary changes and aggressive supplementation as is evidenced by the markedly improved blood pH and magnesium levels the next day. This was a full two days before my actual event. The dietary supplementation and nutritional changes were continued; this surely caused a further lowering of my blood pH and an elevation of my magnesium level. The net result was a personal record for miles cycled in a day and hills climbed in one day. Since these two events were on the same athlete (me) and my physical fitness did not change too much between the events, most likely the markedly different results were from optimizing my blood pH and electrolytes levels prior to the second competition.

In conclusion, blood pH and electrolyte testing are powerful tools that athletes can use to help optimize athletic performance. While the above example represents only a single athlete, Caring Medical has used the same procedure in other athletes to help them, like the athlete discussed, set personal records.


Bibliography

1. Hauser M, Baird N, Hauser R. The Hauser Diet. Beulah Land Press, Oak Park, IL, 2008.
2. Sawka M, Mountain S. Fluid and electrolyte supplementation for exercise heat stress. American Journal of Clinical Nutrition. 2000; 72:564S-572S.