Heat Related Illnesses among Vegan

Athletes
Ameer Shihadeh

Abstract
Background: heat related illness is a leading cause of deaths among high school
athletes. Identifying signs and symptoms and instilling safeguards are essential to
prevent illnesses from occurring. Although, vegan diets elicit similar signs and
symptoms to that of heat related illnesses. This study will focus on the similar
effects vitamin deficiency and heat related illnesses has on the body, and if any
heat related illnesses are diagnosed correctly.
Case presentation: a 14 year old vegan high school freshman girls soccer player has
experienced two episodes of what was diagnosed as exertional heat exhaustion.
Discussion: heat related illnesses is caused by dehydration and have ties with low
aerobic power and body fat percentages. Women are more at risk because of the
nature of their bodies due to a higher threshold of core body temperature which
makes them perspire at higher temperatures. Each mineral or vitamin that is
deficient in a vegan diet play significant role respectively that have similar
symptoms to that of exertional heat illnesses. These vitamins and minerals include,
iron, magnesium, zinc, B-vitamins and a fatty acids.
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Background Women in general are at a

Heat illness is a major concern
for athletes being the 3rd leading
cause of death for high school athletes
in the United States.1 Exertional heat
illness (EHI) and exertional heat stroke
(EHS) could be a fatal threat to
athletes who engage in physical
activity under extreme environments.2
This usually occurs under hot and
humid weather. A rise in body core
temperature exceeding 104 degrees
Fahrenheit accompanied by organ
failure and central nervous system
dysfunction could be a characteristic
for EHI and EHS.2 Identifying risk
factors and implementing safeguards
is the best method to protect athletes
from possible heat related illnesses. 2
Besides dehydration and improper
acclimation to extreme weather, high
body fat percentage and poor aerobic
power are the two strongest risk
factors, especially among women.2
higher risk than men to experience EHI
because of the nature of their makeup.
Women have a higher standard core
temperature than men do, especially
during their mensural cycle, making
them sweat at higher temperatures. 2
As a result, women dissipate sweat at
a slower rate than men do because it
takes longer for women to reach their
threshold to perspire.
To avoid any heat related
illnesses, prevention strategies and
treatment regiments are crucial to be
instilled in every sport activity, for
disregarding such strategies can
debilitate and threaten athletes lives.3
EHI is described to happen due to the
bodys inability to acclimatize to hot
and humid weather. According to the
Journal of Athletic Training, repeated
exposer to the hot environments
increases skin and core temperature
thus eliciting a sweat response.3 This
process can take 8 to 14 days or even
more.3
This case study does not solely
focus on the effects heat related
illnesses has on athletes, another
aspect of this study focuses on the
adverse effects of improper dieting,
and the possible link to that of heat
related illnesses. Diets other than of
the typical omnivores has become
increasingly popular among the
younger population, especially among
females. One diet in particular, the
vegan diet, stresses on the importance
of the earths environment and ethical
issues on animal care.4
There are many benefits to a
vegan diet, although, low sodium diets
that do not contain any meats may
cause mineral depletion. A diet lacking
micronutrients could weaken cellular
energy production, resulting in
tiredness and a deficiency of energy.5
Women who partake in vegan diets are
at risk to developing marginal vitamin
deficiencies.5 Deficiencies in B
vitamins and folate reduces endurance
and impairs performance. Conversely,
athletes with poor energy intake
typically have poor mineral intakes. 5
Calcium, iron, magnesium, zinc and B
complex vitamins are important for
athletes because of the significant role
they play in energy production,
maintenance in bone health and
immune function, as well as
hemoglobin synthesis.5
A restrictive diet with limited
nutritional intake could interfere with
the ability to mentally focus and can
cause symptoms of headaches,
nausea, dizziness, and syncope.5
These symptoms are similar to those
of heat related illnesses. A decrease in
food consumption, which is a common
trait among vegans, without the
increase in fluids, causes dehydration,
which can lead to fainting. If the body
does not contain enough iron,
hemoglobin cannot transport
adequate oxygen sufficient for the
brain, which can also cause fainting.
These signs and symptoms are closely
related to those of heat exhaustion.
This case study will focus on the
similar effects heat related illnesses
and mineral and vitamin deficiencies
has on athletes. This study will also go
in depth on what effects each mineral
or vitamin that is deficient in a vegan
athlete has on their body. Lastly, an
explanation to why complications and
deficiencies from a diet can be
misdiagnosed as a heat related illness.
Case Presentation
This study involves a 14 year
old female high school freshman
soccer player who weighs 120lbs and
stands at 54. This high school soccer
player is a vegan who has been a
vegan for the past 6 months. During
the 6 months she has been a vegan,
the athlete did not participate in any
sports or athletics up until august
when girls soccer preseason has
started. Athletes who play fall sports
must practice lightly a week prior to
official preseason in order to acclimate
to the hot climate in the summer. The
athlete had no past illnesses nor did
she have any previous injuries leading
to the soccer season.
Less than a week into
preseason, a call was made to the
athletic trainings office from the head
soccer coach explaining that an
athlete had collapsed and was
delirious, suggesting that the athlete
may be experiencing heat exhaustion.
Upon arrival to the scene, the athletic
trainer noticed the athlete laying on
the ground in the shade. The athlete
was breathing heavily, explained that
she was confused, dizzy, and felt
tingly throughout her body. The
athletic trainer checked the athletes
vitals and applied ice around her body
and covered her with an ice towel.
The athlete was then
transported back to the athletic
training room for further evaluation.
After the evaluation, the athlete had
explained that she only had fruits to
eat the night before practice, and did
not eat anything at all the morning of
the incident. She also explained that
she is a vegan and that she does not
consume any animals or any animal
based products such as eggs and
dairy. She was given a granola bar and
Gatorade to replenish her energy and
fluids. She was under constant
monitoring because the athletic
trainer did not want her to fall into
hypothermic shock when being cooled
down. The athlete also explained that
she was not used to the humid
weather because it does not get
humid in Utah, where she moved from.
The mother of the athlete was
called to pick her child up, she was
notified about the situation and was
told that an emergency visit was not
warranted but should not hesitate to
go if the athlete experiences any
symptoms.
Results
The athlete did experience
similar symptoms of heat exhaustion,
although, the second episode did not
occur under warm or hot weather. The
episode occurred mid-season which
raised flags to the athletic trainer. The
athlete was instructed to eat and drink
fluids more frequently. The athletic
trainer believed her symptoms are due
to her poor diet habits and her recent
lifestyle change from being an
omnivore to being a vegan.
The athlete no longer became
asymptomatic and she would
frequently check into the athletic
trainers office to notify the athletic
trainer that she has been eating well.
The athlete plans to remain vegan as
long as she could but would better
monitor her eating habits during
intense exertion.
Discussion
Athletic Performance suffers
substantially with just 2-3%
dehydration.1 Additional to that, humid
climates along with dehydration
causes profound effects on physical
performance. Heart rate was a more
concerning component than body core
temperature in a heat tolerance test,
thus making cardiovascular strain
more of a focus in heat related
illnesses.2 Aerobic power and body fat
percentage were the two strongest
factors that may elicit EHI, although
the two risks were strongly negatively
correlated, they were both directly
linked to EHI.2
Dehydration, low aerobic power
or fatigue, cardiovascular deficiencies,
headaches, confusion, and fainting are
also traits of malnutrition and poor
dieting. It is possible that a diagnosed
heat illness injury can be a possible
insufficiency in someones diet. There
are no studies that clarifies whether
there is a correlation where one
condition may affect the other, but it
is important to understand the root
cause of these symptoms if they
should ever appear in an athlete.
Vegans who lack
polyunsaturated fats in their diets,
lack the nutrients that are important
for their cardiovascular health, as well
as their brain and eye functions. 4 EHI
can put a strain on the heart, but that
can be mistaken for a privation of a
nutrient because the athlete is a
vegan. Vegans also have a shortage of
iron, which is essential for hemoglobin
oxygen transport. Without iron,
oxygen cannot be stored in the
muscles and used for muscles
contractions, nor can it transport itself
to the brain which can lead to fainting.
Fainting is an involuntary response the
body executes in order to achieve
equilibrium to regulate the bodys
vitals. This occurs when an athlete
lack both vitamins and minerals, or
during a heat related illness. B-
complex vitamins are another
essential vitamin the body needs for
physical activity, a depletion in just
one of the vitamins can lead to a
compromise in the biochemical
sequence that allows transforming
food into physiological energy.5 DNA
production difficulties, weakness,
fatigue, and fainting spells are all
symptoms of B-vitamins deficiency.5
Females whos diets are restricted like
those of a vegans, are most
susceptible to be at risk to experience
symptoms previously mentioned. To
maintain the same diet but avoid
depletion of essential vitamins and
minerals, vegans must add
supplements to their diets for health
purposes.
Comments
Because no blood work was
made prior to the illness the athlete
had sustained, there was no evidential
factors that indicated that the
athletes condition was caused by
micronutrient deficiencies.
On site of a predicted heat
related illness, an athletic trainer may
not suspect nutritional deficits to have
caused the symptoms that have
occurred.
The athletic trainer, physician,
and coaches should stress the
importance of nutrition and vitamin
and mineral intake to their athletes to
insure their health and well-being,
especially under extreme weather.
References
1. Coris EE, Ramirez AM, Van
durme DJ. Heat illness in
athletes: the dangerous
combination of heat, humidity
and exercise. Sports Med.
2004;34(1):9-16.
2. Kazman JB, Purvis DL, Heled Y,
et al. Women and exertional
heat illness: identification of
gender specific risk factors. US
Army Med Dep J. 2015;:58-66.
3. Cooper ER, Ferrara MS, Casa DJ,
et al. Exertional Heat Illness in
American Football Players:
When Is the Risk Greatest?. J
Athl Train. 2016;51(8):593-600.
4. Craig WJ. Health effects of
vegan diets. Am J Clin Nutr.
2009;89(5):1627S-1633S.
5. Huskisson E, Maggini S, Ruf M.
The role of vitamins and
minerals in energy metabolism
and well-being. J Int Med Res.
2007;35(3):277-89.