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Causes of Heatstroke

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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June 25th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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