Interview with Dr. Warren Scott

by Amy White, 11.29.01 (www.slowtwitch.com)

Dr. Warren Scott, a sports medicine physician in Soquel, California, has been the chairman of the Ironman Medical Conference in Kona since 1994. The conference, which runs concurrently with Ironweek in October, brings medical professionals from around the country together in Hawaii to learn about a full range of sports medicine issues.

The conference concludes with practical experience working the medical tent at the Ironman. "They love it," Scott said. "It’s a great experience. It’s an educational medical tent." Thanks to the conference, he said, the tent is usually staffed with more volunteers than any other Ironman race in the world—about 75 each year.

The conference also has been the site of a number of interesting research projects related to endurance athletes. Over the years research topics have included how an athlete’s intestinal walls are affected by an Ironman, studies of the heart muscle’s reaction to the day’s racing, and osteoporosis. "The Ironman is the best physiology lab in the world," Scott said.

Scott also has his own experience in training and on the lava fields to fire his imagination: He’s been an avid runner and triathlete most of his life and in 1992 completed the race in Kona in 10:43. He’s worked in the medical tent in Kona for the last 12 years. He’s also authored numerous studies on sports medicine topics and is the co-author, with Jerry Lynch, of Running Within.

This October, Scott and other researchers had three projects on their plate. They surveyed hundreds of athletes about their use of non-steroidal anti-inflammatories, and whether they planned to take them on race day. They sought to get data on pre- and post-race competitor weight using more precise, controlled measurements. And they embarked on a cutting-edge project aimed at measuring an athlete’s core temperature during the course of an Ironman.

"We have these capsules, like giant vitamins, and in the capsule is a thermometer, battery and transmitter," Scott said. Athletes swallow the capsules and wear a receiver unit the size of a Palm Pilot in a fanny pack. The thermometer records their core temperature and sends the data to the receiver. Scott said that while this year’s sample was fairly small, researchers plan to try again next year.

The results of their research could benefit endurance athletes in a host of ways as they seek to regulate their temperature while racing in an extreme climate. "We know that on the Queen K Highway, a foot above the lava, it’s about 115 degrees," Scott said. "The surface of the highway is very hot."

We thought it was high time to ask Dr. Scott a few questions about Ironman training and racing, and how athletes can best avoid seeing him on race day in the tent.

Amy White: What are the biggest things you’ve learned about ultra-distance triathletes over the years as a result of research connected with the conference?

Dr. Warren Scott: Fluid and sugar absorption during the race is much more complicated than you think, and if you don’t have that wired for your body—and this is especially so with pros—you’re going to have inconsistent performances. The amount that you need to drink and the amount that you need to eat—personally, I would go all liquid—needs to be very, very carefully calculated. Your bell curve is going to be really tight. If you put too much or too little into your system, your body is going to perform suboptimally. Being heat-acclimatized is critical, too. That’s a process that takes 10-14 days. You can do it in seven, but if you want to perform at your best, you need 10-14 days.

AW: What are the most common mistakes you see Ironman athletes make in their preparation for the race? And what are the big mistakes that get made on race day?

WS:In preparation: Not carbohydrate loading sufficiently. Not tapering for the race, training too much during Ironman week. Race day: Changing their nutritional plan on race day just because they get a little ill feeling, a little sick to their stomach. It throws them off-kilter. Probably 40 to 50 percent of people who get dehydrated are going to get nauseous and feel sick to their stomach. Pulled muscles on the run come from athletes not heeding the warning signs of impending muscle cramping and stopping to stretch. I went 10:43 and stopped a lot. If you cramp up badly, you will be limping the rest of the race.

AW: Are there a couple of pieces of advice you’d give someone to avoid a trip to the medical tent?

WS:Do the race within your level of conditioning and preparation and you will avoid the medical tent. Make sure you can do the distance. People don’t train properly for the race. I think they need to do very long exercise sessions to help prepare their fluid intake, nutritional plan, stretching and cramping prevention. A sample "mega" goes like this: An hour to an hour and a half of running, immediately followed by a three- to four-hour bike, immediately followed by another hour to hour and a half walk/run, immediately followed by an hour swim. It’s a long session. When you swim you’re non-weight-bearing but have to pay attention to cramping. Weigh yourself; track how much you’re peeing. Do four megas before your race, backing up three weeks each time.

AW: What is the most common complaint people bring into the tent?

WS: The big complaint is fatigue. People feel sick, they have cramps. They don’t come in complaining of hyponatremia. About 30 percent are hyponatremic.

About hyponatremia, Scott says it’s "usually dilutional," meaning there’s too much free water in the athlete's system. Most at risk are properly trained women with 12- to 14-hour finish times and low sweat rates. "Research at the New Zealand Ironman shows that you can over-hydrate during an Ironman race," he said. His advice: Drink one liter per hour, or about two standard bike bottles' worth. But, he cautions: "The proper fluid intake is highly individual and dependent on temperature, humidity, wind, acclimatization and effort."

Also at risk, in a slightly different way, are the young (20-30 years old) and fast (under 10 hours). Usually, he said, these are first-timers who are going hard and are not acclimatized to the heat and humidity. "These athletes can become dehydrated and hyponatremic," he said. "This is less common than the dilution form."

And he offers these prevention tips: "Don’t drink water unless you supplement with added sugar and salt. Don’t dilute electrolyte beverages. In fact, add slightly more salt: For long races (greater than five hours), add pinches of salt to your Gatorade (or equivalent) until it just barely tastes salty. Or eat salted pretzels or use salt tablets. Be careful experimenting on race day. Practice frequently on training rides held under similar conditions as race day."

Also, in training, measure your sweat rate and only replace what you lose, Scott said. Replace with water, sugar (6 to 7 percent) and salt (use an electrolyte beverage like Gatorade as a starting point). "Pre-mixed solutions are probably best," he said. Athletes can safely go with water, salt tablets and carbohydrate gels like GU, he said, but he cautions that "the stomach and intestines are very sensitive during races."

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