Causes of Heatstroke
June 29, 2008
A recent report from South Africa shows that the most
likely cause of death during hot weather sports events is heat
stroke, when the body temperature rises so high that it cooks the
brain (Medicine and Science in Sports and Exercise, July 2008).
The treatment for a person who collapses from heat stroke is
immediate immersion in cold water.
An excessive rise in body temperature is caused either by
producing too much heat or by inability to dissipate the extra heat.
When you exercise, almost 80 percent of the energy that is used
to drive your muscles is lost as heat. That means that the harder
you exercise, the more heat you produce. But heat stroke is
more likely to be caused by inability to get rid of heat than by
producing too much heat. Stimulants such as amphetamines,
caffeine or ecstacy increase the likelihood of heatstroke.
Those most likely to suffer heat stroke are those who
have arteriosclerosis, are overweight or are in poor shape. An
athlete or exerciser who passes out from overheating should be
immersed in cold water immediately to prevent brain and multiple
organ damage. However, a heart attack can also cause a person
to pass out and this should not be treated with cold water
immersion.
If you exercise in the heat and start to feel dizzy, stop
exercising because your temperature could be rising too high.
When your temperature starts to rise, your muscles start to burn.
As your temperature rises further, you become short of breath and
the air you breathe feels like it is coming from a hot furnace. Stop
exercising and cool off because if your temperature continues to
rise, you will develop brain symptoms such as headache, blurred
vision, and ringing in your ears. If you press on further, you can
pass out and die.
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Dear Dr. Mirkin: You often say that recovery days are necessary
between hard workouts. How can "stress and recover" apply to
Tour de France cyclists and other athletes in multi-day
competitions?
Athletes who are able to qualify for these long
endurance events recover faster than normal humans because
they train specifically to ride hard day after day. By the time they
arrive at the Tour de France or any other multi-day event, they are
in peak condition. During the race, the riders are on "stress and
recovery" all the time. They race exactly the same way as they
train. As soon as the day's race is over, they eat a meal loaded
with protein and carbohydrates. The sugar increases insulin
production which drives protein building blocks into muscle cells to
help them recover. They also get a massage and stay off their
feet. Just walking will hinder the next day's performance.
At the end of these long endurance events, even the best-
conditioned athletes have lost weight and muscle mass, and need
several weeks or months to regain peak performance.
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Dear Dr. Mirkin: Do you believe the study that showed diabetics
on tight blood sugar control die earlier than those who did not
achieve good control?
I believe that diabetes should be controlled first with
lifestyle changes, and this study did not even consider whether
the patients had lost weight or exercised. The ACCORD study
only compared people who took many drugs to control their blood
sugar levels with people who took fewer drugs for less control
(New England Journal of Medicine, June 12, 2008). They did not
compare lifestyle changes such as losing weight, avoiding refined
carbohydrates or exercising. In the tight control group, 77 percent
were on insulin, compared to only 55 percent in the less controlled
group. The authors then calculated the chance of death from
each medication used to control blood sugar levels and found that
rapid-acting injectable insulin and pre-mixed insulins were
associated with a significantly increased risk of death. The
intensely controlled blood sugar group also had more serious side
effects of medication such as low blood sugars and weight gain.
Insulin increases heart attack risk by constricting arteries
leading to the heart and makes a person fat by increaseing
hunger and forcing the liver to make more fat. This study shows
that diabetics should take insulin only if their pancreas have
stopped making insulin. Every diabetic who makes insulin should
work harder to control his environment by exercising and avoiding
refined carbohydrates. He should not take insulin unless blood
sugar levels cannot be controlled with lifestyle changes and all
of the other drugs available to treat diabetes.
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