Basic fluid and electrolyte management can be a massive challenge for individuals with Cystic Fibrosis as they tend to lose huge amounts of salt in their sweat.
In fact, the saltiest sweater we've ever tested has CF and his sweat came in at a whopping 2,641mg of sodium per litre of sweat (the average amongst the thousands of non-CF athletes we've tested is about 950mg/l).
Cystic Fibrosis research is a cause close to our hearts here at PH. The Sweat Testing kit we use at PH was originally developed to diagnose CF in infants (it's done at rest and it's not invasive, so it's one less needle going near the baby and, handily, it also means you can avoid putting the little one on a treadmill for 30 minutes...).
We also co-authored a paper that was published in the BMJ with a prominent CF Doctor - Dr Doug Lewis from Wichita, Kansas - and part of the thinking behind our continued collaboration with Dr Lewis is the desire to help produce some more concrete information to help athletes and CF sufferers get their own hydration replacement levels dialed in more accurately.
A high sweat sodium concentration and many other issues can make exercising difficult for people with CF, but it certainly isn't an insurmountable barrier, as ultra-runner Hannah Campbell has proven.
Hannah kindly took time out from her job with outdoor retailer Trekitt (and from her role as Head of Women’s Development Group for the Team BMC Equity Committee) to discuss ultra-running, CF, and how she uses PH to help fuel her adventures...
Hi Hannah! Great to meet you. So, what’s the main motivation for your ultra-running?
Hi guys, I have Cystic Fibrosis so I think I’m literally trying to run away from my problems!
Since I started running, it’s the healthiest I’ve ever been.
Before I started training for ultras, I did a lot of long-distance walking, so I was used to being outside on my feet for 12 hours at a time. I guess running rather than walking means I’m able to strip my pack size right down and cover more distance in less time.
It’s why I started doing it and I never intended to race... but I then signed up for races to keep me accountable for my training and have a goal.
Speaking of goals, I see you did the Great Strides 65km race in 2019, what inspired you to take on that challenge in particular?
The Great Strides are a series of charity walks and runs to raise money for the Cystic Fibrosis Trust.
I did one of their walks in the Brecon Beacons and didn’t finish. I got 30 miles in, but in hindsight, I hadn’t done enough training, I didn’t eat well and I didn’t drink enough. I was walking and I’d already been out for 12 hours before it all came to a head at about 30 miles.
I spent a couple of days after the event thinking ‘I’m never going to do that again’... a few days later I signed up for another one!
It came about when I was walking with a friend a couple of weeks after the event in the Brecons and I suggested we train for an ultra, so we decided to do that! We then found a training plan, stuck to the training plan really, really well over the whole winter and I was impressed with how fit we got in that time.
Brilliant, it’s always good to have a training partner. How much training were you typically doing each week?
Not as much as I see the elites doing, obviously they’re quite full on. I was running between 30 and 60 miles a week during the peak of the training plan and then lots of physio and stretching sessions at home, as well as one gym day a week.
How does Cystic Fibrosis impact on your ability to train?
As long as I keep up with my treatments and my tablets, and I eat well and have enough salts, I’m fine. As soon as I get a chest infection, that can take me out of training for anything from two to six weeks though. I try not to let it affect my training for as long as that but it will take me out for a week or two.
Is there much nutritional advice out there for people with CF who want to exercise like you?
No, not really. The nutritional advice for people with CF is changing as I get older, but definitely one of the biggest worries when I was younger was not being able to hold weight.
People with CF can’t normally hold weight very well so they plaster you with cream and put butter on everything. My mum used to put butter in my rice, double cream in my milk - it was a lot of dairy!
That didn’t really work for me, even as a teenager, I still didn’t hold weight very well.
I started training and ‘gyming’ when I was about 21 and that’s when I started to put on good weight, which was muscle. I found muscle easier to hold on to than fat was.
I then went plant-based with my diet, so I went vegan about a year ago, and that cleared up all of my tummy issues. I had really bad issues from CF anyway but because I had a very dairy-heavy diet - I don't think dairy is very good for anyone - and I don’t think it did me any favours.
I took it all away and my body was like, ‘ah, it’s cool, I can deal with this’.
Sounds like a real turning point. So, rather than milk and cream, what would you typically take with you on a training run or race day in terms of nutrition?
I can actually pretty much run a whole long distance event on just electrolytes, salted peanuts at checkpoints and bananas. If I’m running anything much longer I might have something with a bit more sustenance at the halfway point - so a bit of soup and bread for example, although it depends what’s on offer at the particular race.
I’d drink about 500ml every hour. I’ll have two bottles on me - one will be with PH 1500 and one will be just water.
Good to hear you’re using PH. Did you receive much advice about your salt and fluid intake before taking on your ultras?
I’m very lucky because my dietician at the hospital is a vegan ultra-runner. He’d always given me the advice to drink lots of milk, milk is good, but then I told him I wasn’t doing the milk thing anymore. He was obviously fine with that and he said, ‘let’s make a plan’.
He knows my body physiologically better than I do and he was a really good resource to have. It's never been anything set in stone, we tend to plan more off body feel.
The amount of sodium I lose in my sweat fluctuates. I’m on a tablet that not everyone with CF is on - it depends on your genetic mutation - and it allows my body to use more sodium than normal because otherwise, I’d lose about 99% of sodium I take in.
I do sweat tests every year to see how well I’m absorbing the tablet and how well I’m using it, and that fluctuates a little bit. The amount of salt in my sweat is still higher than the ‘normal’ person but when I first did that Sweat Test it was about three or four times higher than some people.
How has using PH impacted on your own performance then?
You guys were the highest sodium electrolyte drink that I found and you tend to recommend the PH 1500 for preloading, although I use it for everything because I need a higher salt intake than everyone else!
I actually fatigue much less quickly and get on really well with it.
And what (if anything) have you learned since discovering PH?
My hydration strategy changed a little bit when I first bought PH products and I started to read your blogs. Now I’m making sure I’m starting my run hydrated!
I’m certain I was starting dehydrated and I wouldn’t drink anything for the first 45 minutes of my run, which is maybe why I was struggling!
Does Cystic Fibrosis impact on your day-to-day life?
There’s a few things. I’m never going to have children, that’s ok, I’m going to adopt maybe 27 dogs. We’ve got one dog, called Affy, and I’m in the process of starting a written application to my partner for another two!
She’s so fit, she’ll quite happily run 40-50km, which is bonkers!
My favourite thing is to drive up to the Lake District and then run for a day, stop at a dog-friendly B&B, and then run for another day and maybe do a nice big loop.