Page 65 - Journal of Special Operations Medicine - Winter 2016

Mitigating Exertional Heat Illness in Military Personnel
The Science Behind a Rice-Based Electrolyte and Rehydration Drink

Brenda Moore, PhD; Reginald B. O’Hara, PhD

ABSTRACT
Background: Exertional heat illness continues to be Force, Marine Corps, and Coast Guard worldwide,
prevalent among members of active duty personnel, es- 720 incidents of heat injuries were diagnosed and docu-
pecially those in specific military occupational special- mented among military personnel serving in Iraq and
ties such as loadmasters, flight crew, flight maintainers, Afghanistan, and 6.9% of these diagnoses were for heat
and Special Operations Forces. Therefore, the primary stroke. Additionally, 1,953 cases of “other heat-related
objective of this article was to elucidate the various oral injuries” were reported in 2015 for all Servicemembers.
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rehydration solutions (ORSs) on the market that are In addition to hot, humid conditions, protective cloth-
used to mitigate exertional heat illness (EHI) in military ing such as personal protective equipment may induce
personnel, and to focus on the science behind a rice- heat injuries even when environmental conditions alone
based electrolyte drink, CeraSport , currently used by do not impose a significant threat and when wet-bulb
®
US military personnel in mitigating EHI during sustained globe temperatures are as low as 65°F. 2
training operations in high-heat environments. Meth-
ods: A search of the literature (through March 2016) Although consistent water consumption plays a major
was performed using PubMed and ProQuest, in addi- role in preventing heat injury, it may not be sufficient
tion to searching bibliographies and text books. We re- by itself to prevent illness and may actually cause a
viewed 63 articles and three texts. Articles were limited condition known as hyponatremia, defined by a serum
to those published in English and to studies that used sodium concentration of less than 135mmol/L. Sports
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only carbohydrates (e.g., no amino acids) and drinks re- drinks containing electrolytes such as sodium and chlo-
ported to be used by the military in field training and de- ride ions, as well as various sources of carbohydrates are
ployment. Conclusion: Heat illness is prevalent among frequently recommended to increase water absorption
military personnel operating in high-heat environments and retention, and prevent dangerous drops in serum
and a variety of ORSs and sports drinks are available to sodium levels. For example, in a comparison study in-
help mitigate this. However, CeraSport, compared with volving highly fit Soldiers performing high-volume op-
other ORSs and sports drinks, may offer benefits such erational training in hot weather, Gerold and colleagues
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as faster gastric emptying rates and improved absorp- found that a rice-based carbohydrate drink (CeraSport ;
®
tion from the gastrointestinal tract, which can provide Cera Products, http://ceraproductsinc.com/) was supe-
rapidly available carbohydrate substrates for energy rior to the ingestion of water alone in maintaining body
needs, and increased water retention for maintenance of weight, inferring that the Soldiers could better maintain
blood plasma volume. hydration status during high-volume training in hot
weather conditions. Additionally, other approved drinks
Keywords: Special Forces; physical training; heat illness; currently used during military training operations may
oral rehydration solutions; physical performance not provide sustained energy, performance, and hydra-
tion because of their nutrient profiles. Nonetheless,
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they recommended that future research should be con-
ducted comparing CeraSport with other sports drinks
Introduction
containing more osmotically active glucose. 2
Exertional heat illness (EHI) continues to be prevalent
among active duty personnel and poses a significant Most oral rehydration supplements (ORSs) contain
threat to their health and may impair mission and op- concentrations of various electrolytes such as sodium
erational training effectiveness. According to the De- and chloride ions as well as carbohydrates (CHOs),
fense Medical Surveillance System, which is used to which consist mostly of differing concentrations of
record and track hospitalizations and ambulatory visits the monosaccharides glucose and fructose or of the di-
of actively serving military personnel in the Army, Air saccharide sucrose, which consists of a fructose and a

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