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Water and sodium intake habits and status of ultra-endurance runners during a multi-stage ultra-marathon conducted in a hot ambient environment: an observational field based study

Ricardo JS Costa12*, Ana Teixeira3, Luis Rama3, Abigail JM Swancott2, Lisa D Hardy2, Benjamin Lee2, Vera Camões-Costa4, Samantha Gill2, Jessica P Waterman2, Emily C Freeth1, Edel Barrett1, Joanne Hankey2, Slawomir Marczak2, Encarna Valero-Burgos5, Volker Scheer6, Andrew Murray7 and Charles D Thake2

Author Affiliations

1 Department of Health Professions, Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom

2 Sport & Exercise Science Applied Research Group, Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom

3 Faculty of Sport Science & Physical Education, Coimbra University, Pavilion 3, Santa Clara, 3040-156, Portugal

4 School of Psychology, Bangor University, Penralt Road, Bangor, LL57 2AS, United Kingdom

5 Emergency Department, Vinalopo Salud Hospital, Calle Tonico Sansano Mora 14, Elche, 03293, Spain

6 Sports Medicine Department, University of Heidelberg, Im Neunheimer Feld 710, Heidelberg, 69120, Germany

7 SportsScotland Institute of Sport, Airthrey Road, Stirling, FK9 5PH, United Kingdom

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Nutrition Journal 2013, 12:13  doi:10.1186/1475-2891-12-13

Published: 15 January 2013



Anecdotal evidence suggests ultra-runners may not be consuming sufficient water through foods and fluids to maintenance euhydration, and present sub-optimal sodium intakes, throughout multi-stage ultra-marathon (MSUM) competitions in the heat. Subsequently, the aims were primarily to assess water and sodium intake habits of recreational ultra-runners during a five stage 225 km semi self-sufficient MSUM conducted in a hot ambient environment (Tmax range: 32°C to 40°C); simultaneously to monitor serum sodium concentration, and hydration status using multiple hydration assessment techniques.


Total daily, pre-stage, during running, and post-stage water and sodium ingestion of ultra-endurance runners (UER, n = 74) and control (CON, n = 12) through foods and fluids were recorded on Stages 1 to 4 by trained dietetic researchers using dietary recall interview technique, and analysed through dietary analysis software. Body mass (BM), hydration status, and serum sodium concentration were determined pre- and post-Stages 1 to 5.


Water (overall mean (SD): total daily 7.7 (1.5) L/day, during running 732 (183) ml/h) and sodium (total daily 3.9 (1.3) g/day, during running 270 (151) mg/L) ingestion did not differ between stages in UER (p < 0.001 vs. CON). Exercise-induced BM loss was 2.4 (1.2)% (p < 0.001). Pre- to post-stage BM gains were observed in 26% of UER along competition. Pre- and post-stage plasma osmolality remained within normal clinical reference range (280 to 303 mOsmol/kg) in the majority of UER (p > 0.05 vs. CON pre-stage). Asymptomatic hyponatraemia (<135 mmol/L) was evident pre- and post-stage in n = 8 UER, corresponding to 42% of sampled participants. Pre- and post-stage urine colour, urine osmolality and urine/plasma osmolality ratio increased (p < 0.001) as competition progressed in UER, with no change in CON. Plasma volume and extra-cellular water increased (p < 0.001) 22.8% and 9.2%, respectively, from pre-Stage 1 to 5 in UER, with no change in CON.


Water intake habits of ultra-runners during MSUM conducted in hot ambient conditions appear to be sufficient to maintain baseline euhydration levels. However, fluid over-consumption behaviours were evident along competition, irrespective of running speed and gender. Normonatraemia was observed in the majority of ultra-runners throughout MSUM, despite sodium ingestion under benchmark recommendations.

Water; Drinking; Beverages; Total body water; Dehydration; Euhydration; Hyponatraemia; Carbohydrate