Kona update, heat acclimation, female athletes are not men, and the dangers of taking NSAIDs during ironman

Hi Folks,

well we are having a blast here in Kona. We are settling in well, training is strong, recovery even better, and we are now settled into the heat and humidity as the body has had time to adjust.

It takes time to acclimate to high heat and humidity (also called acclimatization – I am going to stick with the easier to spell word!). And although being fit helps; it is not something that an athlete can out-train, out smart, or achieve faster and quicker than others. It takes time, patience and being intuitive with your body and sensible with what you do. The more extreme the climate shift then the more aware you must be of how your body is coping with the different conditions. For example I am Irish and taking a little more time to adjust than my South African boyfriend; also he is fitter!

Heat (and humidity) acclimation is something that coaches must research and study so that they are familiar with what their athlete’s bodies are physiologically trying to cope with, so as to not overly stress the body and lead to excess fatigue, dehydration, immune system suppression, increased body inflammation and oxidative stress, or worse still dangerously high core body temperatures, heat stroke, and hyponatraemia.

The body has to make many adjustments so that it can cope with exercise in these conditions; in a nutshell it is all about COOLING. Heat is dangerous to us especially humid heat as humidity makes it harder to lose heat via sweating so we get hotter despite sweating a lot because the sweat remains for longer on our skin.

The body functions only in a narrow window of temperatures and rising above this is dangerous to all our vital functions. We maintain optimal body temperatures in a process called “thermoregulation” – in-built strategies that allow your body to maintain its internal core temperature. The cardiovascular, central nervous system, and endocrine systems bear the brunt of most of these adaptations and in summary we see adjustments to total body water and blood volume, sweating, skin blood flow, and heart rate (pulse). Some athletes may notice postural hypotension where rapid changes in posture such as standing up leads to slight dizziness while the body is adjusting to all these changes; or nausea if things are pushed too far.

It is important to remember that training in the heat and humidity is not only uncomfortable and frustrating, but stressful on the body. We see elevations of cortisol and other immune, free-radical and inflammatory markers when first exercising in a hot-humid environment. What this means is that if you push it too far and too fast you will fatigue yourself, create increased inflammation in the body and perhaps also deplete the immune system leaving your more susceptible to getting run down. If you are a number cruncher each sessions TSS will be underestimating the stress of the session on the body.

Despite the initial negative impact on antioxidant, immune and inflammation systems in the body once acclimated the body adapts and training is no longer as stressful as systems upgrade so to speak. There is no need to take antioxidant supplements; give the body time and eat well.

This training stress added to any long-haul travel can spell disaster if the athlete falls ill. It is in your favour to allow the body adapt with a gradual return over a few days to full training volume and intensity. Some athletes adjust faster than others. Inform your coach of how you are adjusting and allow them to tweak the plan accordingly.

Remember that you are in training for an event; and getting to race day as fit and healthy as possible is your goal. You have trained for months if not the whole year and more to race Ironman world championships in Kona. You may not be able to control the weather conditions, but you are in control of how you prepare in them and how respond to them on race day. Kona is very different to all other races, and Hawaii is different to most other environments. She demands respect. 

I urge you to read this article for a more in-depth discussion of what is going on and how best to deal with it: Heat Acclimation for Runners by Bill Henderson, MD (update 22/08/2018 for some reason this article despite many of us referring to it seems to be awol; click here for another great one!). This article is worth reading alone for the superb timeline of heat acclimation; very helpful for athletes to urge them to trust in the process and go easy in the first few days of training in the heat.

Here are two very important paragraphs from Dr. Hendersons article (thanks you Dr Henderson!) which spell out just why the heat takes it out of you!

“Why are we slower in hot conditions? There are a variety of proposed mechanisms, but the one that is most widely accepted is based on cardiac output limitations.

When we exercise, we produce a great deal of heat. One of the principle ways that we get rid of this excess heat is through sweating (evaporative heat loss), as well as conduction and radiation of heat from our skin. To achieve this, our bodies have to send a considerable amount of blood to the skin. This blood is therefore not available to perfuse working muscles and deliver oxygen to them. So a portion of our blood volume is essentially no longer able to participate in oxygen delivery and energy formation in our exercising muscles. The greater the amount of heat that we need to dissipate, the greater the proportion of blood that is diverted to the skin (up to a point – this can’t increase forever).

What is necessary for cooling isn’t the hemoglobin (the red blood cells in blood) but the plasma, which is essentially water with a number of different proteins and electrolytes in it. However, your body can’t separate the red cells (which are the oxygen carriers) from the plasma – they all go along for the ride to the skin.”

And if this gets your juices running then come back to this one Heat Acclimation for Runners: A Coach’s Analysis by Bryon Powell, and here is Joe Friel’s take; even he dials it back when exercising in the heat. Friel also recommends allowing your body to recover when doing intense workouts and perhaps doing less total high-intensity work, to not go by heart rate as  it is not a good indicator of intensity when it’s hot, to consider racing at a slower initial pace (to last the race) and to be aware that your heart rate will be higher than normal for any given sub-maximal pace or power.

The articles listed above are written for ease of understanding. A search of PubMed, a service of the US National Library of Medicine, will deliver numerous hard-core science papers on this topic.

When you read into what is happening in your body and how blood volume expands (more blood plasma), it stands out just how important elevating your intake of electrolytes is and also, ensuring that you have optimal ferritin and red blood cell/ blood iron levels. If you are trying to heat acclimate with low iron levels, haemodilution will effectively bring your iron levels and hence oxygen carrying capacity down even further.

It has been commented that heat acclimation may be challenged by low iron levels and furthermore high sweat volumes will lead to some iron loss through the sweat further compounding the problem. What does this mean? Less oxygen can get to exercising muscles and you feel pooped. 

I don’t suggest that this is something you should worry about; perhaps if you have a tendency towards low ferritin levels (< 30-50 ng/ ml) or low haemoglobin levels then you have your levels checked before you arrive in Kona and take action as necessary. DON’T TAKE IRON SUPPLEMENTS WITHOUT DIAGNOSING A DEFICIENCY. 

What can you do?

THIS is what you face
  • Take a few days to ease back into full training volume; in other words lower the intensity and duration and total training volume or TSS for a few days.
  • Train by feel (RPE) and not heart rate.
  • Increase your intake of electrolytes and fluids for the first few days guided by how you feel; add electrolytes to non-training drinks as well as training drinks, or slightly more salt to food and especially if you are tolerating the heat poorly or have low blood pressure. Avoid over-drinking on water only.

    This strategy may not specifically aid heat adaptation but may aid your comfort and limit symptoms such as dizziness and swollen ankles etc especially in females in the luteal phase. Also the acclimation process increases the amount of sodium initially lost in sweat as well as raising sweat rates (and the loss of minerals and electrolytes) so it makes sense to replace what you have lost.
    Subtle improvements to training or reductions to the negative effects of acclimation may not show up in small clinical studies but it makes absolute sense to me if you are going to be training in the heat for a week or longer before you race, that you raise your electrolyte intake and eat a mineral rich diet. Similarly if you do not have time to acclimate then raise your electrolyte intake when racing in hot and humid environments.

    Furthermore sodium is required to aid the absorption of sugar in the digestive system; which can be already stressed in the heat.


  • Avoid excess heat when not training.
  • Allow the body to adjust by avoiding the over-use of air conditioning in your home.
  • Let your coach know how you are feeling.
  • Consider taking adaptogenic and immune supporting herbs to assist your body tolerance to stress better (this may not necessarily improve how fast you adapt but will support your body’s overall resilience to all the changes that you face).
  • When racing adopt cooling strategies such as drinking cold or iced beverages often, using specialist clothing for hot environments, and frequently cooling yourself with cold and iced water.

It may be even more effective to apply cold or ice water to your body’s pulse points. Practical ones when racing include the back of the neck (might as well start by throwing it back of the head but an iced towel will be even more effective), the temples (might as well hit the forehead also), inside the elbows, and the wrists. 


Drink one, pour one

  • If you are a female athlete and arrive into heat and humidity in your luteal phase (10-14 days before your period) bear in mind that you may tolerate the heat less well. The higher levels of oestrogen and progesterone in your body make you more susceptible to fluid overload, bloating, low electrolytes, and less tolerant of the heat. LISTEN TO YOUR BODY.

But hey it’s not all negative!


Once you have acclimated to the heat did you know that it is associated with positive physiological adaptations that IMPROVE EXERCISE PERFORMANCE?

Getting your strategy for heat acclimation correct will achieve the following; to read more click into this article by the Gatorade Sports Science Institute. Remember that all this takes between 4 and 10 days to achieve so be patient and don’t run yourself down in the process.


Also the sun is an amazing source of energy, Vitamin D, and improved markers of mood and emotional well-being.

So lap it up and enjoy it; see the sun as your friend that once respected reaps the rewards.

Sunset at the Natural Energy Lab - Ironman 2007 Photo by Rich Cruse on Fivehundredpx
Sunset at the Natural Energy Lab – Ironman 2007
Photo by Rich Cruse on Fivehundredpx

New video blog

Here is my little update for you all where I discuss tips for health, sleep and mossies.

Female athletes are not men

I am here to work and study amongst the playing in the sea and Kona running; here is a superb article for female athletes, and a must read for any coaches of female athletes.

Grab a coffee and close your eyes as you soak in the wisdom of this interview; Stacy really does cover a lot.
Stacy Sims, PhD: The ‘Everything’ Guide for Female Athletes — How to Navigate Your Menstrual Cycle, the Menopause Years, Cortisol and Stress, Nutrition Needs, and More

I would love to know your thoughts coaches; do you proactively change the program or just allow us athletes to be more intuitive and feedback to you so that ‘big hormone feeling’ weeks can be dealt with as they happen? After all every cycle is very different; and some weeks female athletes feel super strong and other weeks a miserable under-performing mess. Surely these poor weeks are the ones when we should cut ourselves some slack and adjust things to reap the benefits but with less volume. Please do add your comments to benefit all reading this blog.

There are some very interesting comments about hydration, which must be taken into account racing full IM and 70.3 distances and marathon distances or longer. I think that a nice approach is to use a combination of water and electrolytes. For example on the bike, use electrolytes in one bottle, water in a second and then have some extra capsules or saltstick chews to hand for when needed.

Regarding carbohydrates and required intake, I think an athlete empowered with healthy and balanced eating should be more in tune with the body needs so that the adjustment is done intuitively for days when more or less are needed. Restrictive, controlling, or disordered eating athletes will not be able to do this; and so we must support the athlete in their journey to trust and to learn this given their fight against natural appetite. We must empower our athletes with the skill to eat intuitively and encourage them to be more liberal in their carbohydrate intake in the luteal phase of their menstrual cycle.

 I cannot over emphasize the importance of eating to appetite.
You will love the chocolate comments, which FYI are totally true!
Click here to listen to the podcast…..

Why you shouldn’t take NSAIDs during an ironman event, especially in the heat in the heat

A high percentage of athlete use NSAIDs (non-steroidal anti-inflammatory drugs such as ibuprofen, advil, nurofen and other over-the-counter or prescription anti-inflammatories in the class of drug) during long endurance events; for various reasons including the limitation of pain as well as enabling the athlete to race due to ongoing injury.
I am not going to bang on about this topic, only highlight a few reasons that I would urge you to consider before popping NSAIDs for your next race or over-using them to get through training. I am writing this in non-technical lingo despite being a qualified pharmacist because it just keeps it simple.
Bear in mind that context is everything; while I don’t endorse the over-use of NSAIDS or any painkillers for that matter, and urge you to conserve their use for only when needed; it is also highly unlikely that very occasional use will create harm. BUT it does happen; just as it can for every medication and you don’t wish for something as serious as hyponatraemia to happen on race day due to an underlying predisposition for renal related NSAID induced side-effects.

  1. They are hard on your stomach; may increase gastrointestinal inflammation and increase your already higher chances of suffering with gastrointestinal distress and perhaps even minor to severe stomach bleeding (yes really; NSAIDS irritate the gut directly and also reduce the secretion of compounds protective to the stomach lining. Endurance sports and especially at intensity and in the heat divert blood away from the intestines leading to inflammation and in some athletes minor bleeding. So add the two together in vulnerable athletes and it is not a great combo.
  2. Chronic use increases your risk of a stomach ulcer or bleeding disorders (NSAIDs inhibit anti-platelet function).
  3. Contra-indicated if you have never taken them and suffer from severe asthma or allergy to aspirin or other NSAIDs.
  4. They mask pain – pain is your body’s indicator that something is wrong. It is not always good to mask pain.
  5. Increased risk of hyponatraemia especially when coupled with drinking only water and longer duration events. Hyponatraemia is also called fluid overload and occurs when blood sodium levels drop dangerously (rare but serious when it does happen).
  6. May upset your body regulation of fluid balance and acid-base balance via an effect on renal prostaglandin synthesis (suppressed): Electrolyte and Acid-Base Disturbances Associated with Non-Steroidal Anti-Inflammatory Drugs
  7. May actually increase the inflammatory response to an endurance race and with it elevate toxins in the circulation with minimal benefits on muscle soreness. (read this if you don’t believe me: Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition.
  8. NSAID may have mixed effects on injury healing such as tendon, soft tissue, or bone fractures. I have read in more places than one about how long term chronic use may suppress tendon and soft tissue repair.
  9. Finally, NSAIDs suppress the natural inflammation response to training which is actually a stimulus to adaptation. We need to suffer a little to get better so to speak and science is confirming this lately. Stress = benefits even though it hurts 🙂
 If you want to read an interesting review with a nice take home thought click here.
Natural alternatives that can be built up in the diet include ginger, turmeric, fish oil and omega 3, tart cherry extract, astaxanthin, polyphenol rich plants, green tea, and a diet focused on plant-based foods.

A few pics of our stay so far

I am here working, studying and writing; but that doesn’t mean that i am not out enjoying some relaxed training, me time, and explorations.

Much love,



This is what happens in the heat when you get your strategy wrong and fail to listen to your body. The race is Triathlon World Series final in Cozumel, Mexico. Johnny Brownlee has probably raced a race that will have taught him more lessons about racing in the heat than most!

It was a controversial moment in sport. Here are the lads discussing it the day after.


Some more science papers for the nerds that interested me while writing this:

The Effect of Exercise and Heat on Mineral Metabolism and Requirements

Effects of Heat Acclimation on Changes in Oxidative Stress and Inflammation Caused by Endurance Capacity Test in the Heat

The Effect of Exercise and Heat on Mineral Metabolism and Requirements

Responses of Soldiers to 4-gram and 8-gram NaCl Diets During 10 Days of Heat Acclimation

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