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Everything you know about hydration debunked

Aug. 8, 2012 - 11:31AM   |   Last Updated: Aug. 8, 2012 - 11:31AM  |  
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Beverage makers fire back

We reached out to Coke and Pepsi for their companies’ response to the British Medical Journal and Dr. Timothy Noakes’ claims. Here is what they sent us:
PepsiCo, makers of Gatorade:
"Gatorade has made athlete safety and performance a priority for decades — and we continue to do so. We hold our research to the highest scientific and ethical standards. Any allegation to the contrary has no merit and stands in contrast to Gatorade’s actions to better educate athletes and advance the scientific understanding of athletic performance. The overwhelming majority of experts agree that hydration is very important for athletes — and fluid needs vary from athlete to athlete.
"Experts agree that athletes should understand their individual fluid needs during different kinds of activities. We encourage athletes to learn how to measure their sweat loss and to understand how that is affected by the intensity, duration and weather conditions of their workout. Drinking too much, too little, or arbitrary amounts can be problematic. The dangers of both excessive dehydration and hyponatremia during exercise are real and can be prevented through education and self-management."
Coca-Cola, makers of Powerade:
"We always rely on sound, evidence-based science to ensure that our products deliver on their promise to consumers. Powerade ION4 was developed in collaboration with sports science experts and in full accordance with European regulatory guidelines and is specifically marketed to individuals taking part in intense physical exercise as part of their daily routine. It is designed to help them sustain their physical and mental performance when they exercise.
"The body of evidence shows that people do need to effectively replace the fluids and minerals that are lost in sweat and also replenish the fuel (carbohydrates) in order to help sustain their performance. An appropriately formulated isotonic sports drink plays an important role in delivering this.
"The majority of studies in this area have, in fact, been undertaken using recreational active individuals rather than top elite athletes and we firmly believe that sports drinks have a role in supporting people’s training and hydration needs."

Everything you know about hydration is wrong. That's the message from the prestigious British Medical Journal, which — just in time for the Olympics — has published new research that throws cold water on everything from when to tank up to the truth about sports drinks.

The research, as well as a new book from a top expert on exercise performance that draws many of the same conclusions, is sure to unleash a tsunami of new debate within the military and without. Indeed, with warrior-athletes among the most frequent sports drink consumers — even while fighting a daily battle for hydration in hot spots around the world — the mantra of "hydrate or die" isn't just a sales slogan for those in uniform.

"Prehydrate; drink ahead of thirst; train your gut to tolerate more fluid; your brain doesn't know you're thirsty — the public and athletes alike are bombarded with messages about what they should drink, and when, during exercise," reads the opening salvo of one study.

It's all so much sweat-soaked poppycock, Oxford University researchers conclude in a clutch of studies featured in the July issue of the journal.

Among their findings:

Prehydration: It may sound scientific, but there's no evidence that chugging fluids before exercise does anything more than give you a belly full of water sloshing around. If anything, it slows you down and puts you at serious risk of overhydrating.

Obey your thirst: "Your brain may know a lot, but it doesn't know when your body is thirsty," reads the Gatorade website. Not true, according to researchers. "Drinking ahead of thirst may worsen performance in endurance exercise and carries a rare but serious risk" of overhydration.

Performance boosters: The researchers could find only "limited, low-quality evidence" to support sports drink claims of a performance boost from ingredients such as caffeine, taurine or guarana. "No studies compare the effectiveness of these products with ingesting caffeine alone, and there are important concerns regarding harms."

In a stinging study dubbed "The Truth about Sport Drinks," the British docs zeroed in on 431 performance-enhancing claims made about 104 products, including sports drinks and protein shakes.

The industry topped $3.9 billion in the year leading up to May — up 14.9 percent over the previous year — according to the trade publication Beverage Industry.

BMJ's study deemed suspect nearly all of the product claims offered up by the top two manufacturers, PepsiCo and Olympic sponsor Coca-Cola, makers of Gatorade and Powerade, respectively.

Drilling into the details of industry-sponsored studies from 1971 to 2012, used to support advertising and marketing claims, the British researchers found mostly dry ground. Only 2.7 percent of the studies were judged to be of high quality and at low risk of bias. Three of every four studies provided by manufacturers were deemed "low in quality."

"As it turns out, if you apply evidence-based methods, 40 years of sports drinks research does not seemingly add up to much," the researchers concluded.

Whistle-blower

Sports researcher and physician Dr. Timothy Noakes drew many of the same conclusions in his recent book "Waterlogged: The Serious Problem of Overhydration in Endurance Sports."

"We don't need to be told when to drink — our bodies will tell us. That's where we're falling down a lot," Noakes told Military Times in an exclusive interview from his office in South Africa. "My argument is that dehydration is a nondisease created in order to sell a product."

One of the world's leading performance experts and chief of the exercise and sports science department at Cape Town University, Noakes isn't your typical lab rat.

Sure, he's a founding member of the International Olympic Committee's Olympic Science Academy and a fellow of the American College of Sports Medicine, but he's also an accomplished runner, with dozens of marathons and ultramarathons to his credit.

That blend of book knowledge and running shoe rubber-meets-the-road experience is why one special ops doc describes Noakes as "hugely admired and appreciated in the field of endurance sports."

Noakes' 1991 book "Lore of Running" is still considered a sacred text among distance runners in and out of the military.

Although fears of dehydration are overblown at best, there is a clear and present danger facing athletes and warriors alike when it comes to overhydration, he says.

"It's a behavioral disorder. If you're taught to overdrink, and it's part of the military culture, then you've got real trouble. But as long as you just drink to thirst, you absolutely can't get the condition. That's the problem: So many people have been taught to drink so much, they have forgotten what real thirst is."

Dehydration has only one symptom: thirst. If you have water and drink when you're thirsty, you've got nearly zero risk of dehydrating, he argues.

The connection

Noakes believes we've scared ourselves into a place of toxic overhydration due, in no small part, to savvy — if misleading — sports drink marketing and the questionable science the industry has funded.

"Over the past 40 years, humans have been misled — mainly by the marketing departments of companies selling sports drinks — to believe that they need to drink to be optimally hydrated," Noakes writes.

He believes widespread disinformation about the need for sports drinks to treat dehydration helps explain why doctors often treat patients incorrectly, thinking the patients are dehydrated when, in reality, they are overhydrated.

"It is disturbing that incorrect advice to the public and the public's own susceptibility to promotional efforts resulted in a novel medical condition that affected thousands of soldiers, hikers, runners, cyclists and triathletes, causing some to die," Noakes comments. "Sadly, this phenomenon and the deaths that apparently resulted from it were preventable."

In the 1960s, the trend was to cut off water intake to "train" bodies for endurance events. That was bad, Noakes says, but now the pendulum has slowly swung to the other side to a nearly universal notion of drinking despite lack of thirst.

He sees today's athletes, parents, coaches — even many military and medical professionals — pushing fluid intake far beyond the bounds of what solid research suggests.

"Indeed," Noakes contends, "tens of millions of athletes and fitness enthusiasts are waterlogged" to the point that "the hydration practices to which they religiously adhere adversely affect their health and performance."

Noakes says much of the current conventional wisdom on hydration got its start in the U.S. military about 30 years ago: "A single individual working for the U.S. military literally came up with this idea that water could be used as a tactical weapon."

The premise: If troops drank more during training, they would suffer less heat illness and become better, more productive soldiers. "Where he got that, I have no idea. He plucked it out of the sky," Noakes says.

But it gained traction. Within a few years, the guidelines said troops should drink 1.9 liters per hour, according to Noakes. The same people who drew up those regs then were invited by the American College of Sports Medicine to establish guidelines for civilian runners.

To its credit, he says, "the U.S. military was then the first to notice the problem of overdrinking.

"Because of its exquisite monitoring system, within a few years of producing the wrong guidelines, they realized they had it wrong."

So wrong, in fact, that those guidelines caused more than 100 hospitalizations per year and about half a dozen deaths total from overhydration, or hyponatremia, a sodium deficiency in the blood caused by ingesting too much water and not enough electrolytes.

By 1998, officials cut those guidelines in half, to maximums of 0.9 liters per hour and 11 liters a day, which Noakes says "is pretty good for a hot environment."

"That took great courage. They saved an enormous number of lives as a result. Unfortunately, the rest of the world didn't follow," he says.

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