Athletes: Drinking Too Much Water Can Be Fatal

One always hears about how important it is to drink enough water while exercising, but in rare cases people have actually died from overhydration according to Loyola Medicine family medicine and sports medicine physician James Winger, MD.

Overhydration by athletes is called exercise-associated hyponatremia. It occurs when athletes drink even when they are not thirsty.

Drinking too much during exercise can overwhelm the body’s ability to remove water. The sodium content of blood is diluted to abnormally low levels. Cells absorb excess water, which can cause dangerous swelling in the brain.

Hyponatremia can cause muscle cramps, nausea, vomiting, seizures, unconsciousness and, in rare cases, death. In recent years there have been more than a dozen documented and suspected deaths from hyponatremia among recreational runners and high school athletes.

In 2015, Dr. Winger helped re-write guidelines regarding exercise associated hyponatremia and those new guidelines, along with the original study, are available to read here.

Dr. Winger said it’s common for coaches to encourage athletes to drink profusely before they get thirsty. But he noted that expert guidelines recommend athletes drink only when thirsty.

Dr. Winger also recommends athletes should not drink a predetermined amount or try to get ahead of their thirst. Drinking only when thirsty can cause mild dehydration, which is normal and does not harm performance in real-world studies.

“However, the risks associated with dehydration are small,” Dr. Winger said. “No one has died on sports fields from dehydration, and the adverse effects of mild dehydration are questionable. But athletes, on rare occasions, have died from overhydration."

Dr. Winger is co-author of a 2011 study that found that nearly half of Chicago-area recreational runners surveyed may be drinking too much fluid during races.

In the study, Dr. Winger and colleagues found that, contrary to expert guidelines, 36.5% of runners drink according to a preset schedule or to maintain a certain body weight and 8.9% drink as much as possible.

“Many athletes hold unscientific views regarding the benefits of different hydration practices,” Dr. Winger and colleagues concluded. Their study was published in the British Journal of Sports Medicine.

James Winger, MD, is a family medicine and sports medicine physician at Loyola Medicine. His clinical interests include annual wellness visits, musculoskeletal injuries, sports injuries and telehealth.

Dr. Winger earned his medical degree at the University of Virginia School of Medicine. He completed a residency in family medicine at West Suburban Hospital Medical Center and a fellowship in family medicine: sports medicine at Lutheran General Hospital.

Book an appointment today to see Dr. Winger or another Loyola specialist by self-scheduling an in-person or virtual appointment using myLoyola.