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Old 03-02-2014, 08:00 PM   #121
Russell Berger
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Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM

There is an obvious qualitative difference between the man who drives his car into a crowd of people and is found by police weeping and administering first aid to his victims, and the man who drives his car into a crowd of people and is found hiding in his basement, refusing to speak to police until he sees his lawyer.


I think it is safe to assume that the GSSI had no idea that inflating the already high ACSM hydration recommendations would lead to so many deaths from EAHE, but it is also obvious that advertisements claiming these recommendations were based on “over 15 years of research” and “Thousands of tests” was a complete lie (WFS). Noakes also makes it painfully obvious that these hydration guidelines were both a dramatic departure from the accepted norm in endurance sports, and could claim little to no supporting data. In other words, this was not just "the best hydration advice scientific knowledge could provide at the time."


I think this information alone is a huge embarrassment to both organizations, and specifically harms the credibility and authority of the ACSM… but that’s not even what bothers me. I keep coming back to this question- what ethical responsibility does an organization have when they discover their product is fatal when used as directed?

In my mind, there is only one correct course of action, to publicly retract the bogus and dangerous recommendations, and become the most active and vocal proponent of hyponatremia prevention. This would certainly include applying warnings and recommended limits to products that continued to be marketed as anything other than salty lemon aid. Not only would this be the right course of action from an ethical standpoint, but to fail to do this appears to be a breach of the GSSI’s own charter, (WFS) which touts a commitment "to helping athletes optimize their health and performance through research and education in hydration and nutrition science.” Certainly preventing deaths your product recommendations have been shown to cause falls into the scope of this mission statement?


In reviewing the current literature available from the GSSI, it is clear they have done nothing even close to this. As far as I can tell they have quietly adjust their hydration recommendations in step with the ACSM, decades late and with a dozen lives to show for it. What is even more shocking, is that the GSSI’s stance on hyponatremia and hydration are built on two assumptions that seem to lack any basis in empirical data and yet work wonderfully for marketing sports drinks:

assumption 1- anything over 2% dehydration is bad for performances, therefore you should drink fluid to prevent this state.
assumption 2- sweating leads to electrolyte deficiency, which means that you had better not choose water as your fluid, or you are increasing the risk of hyponatremia.

source (WFS)


It therefore follows inescapably that the solution to both dehydration AND hyponatremia is to buy more Gatorade! Amazingly, both of these assumptions are now understood to be false (WFS) by the ACSM itself!


So after fudging science to sell sports drinks, accidentally killing people in the process, and adjusting course, Gatorade seems principally interested in framing the narrative in a way that continues to sell the most sports drinks. In my mind, this is as compelling a reason as any to remove big soda from our industry.
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Old 03-02-2014, 10:41 PM   #122
Christopher Morris
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Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM

Russell,
I've been reading some of the links you provided earlier. I've also tried to review the GSSI research that predates the 1996 "drink as much as tolerable" recommendation. I wanted to learn what research they had done to support this idea.

On the GSSI website (wfs) I looked at hydration and thermoregulation articles and ranked them oldest to newest.

In 1992 this article (wfs) studies carbohydrate replacement in cycling test. The abstract says, "the same phenomenon probably applies to running." That "probably" bugs me. It shows a logical leap I'm not willing to make in honest research. This abstract advocates hydration replacement, i.e., drinking as much fluid as you've lost in sweat weight. It does not advocate drinking more than that.

I've read through other abstracts and can't find where their research relates QUANTITY of fluid intake to performance. There is a lot about concentrations and carbohydrates or sodium. I might be missing it, but it appears that the recommendation to "drink as much as tolerable" was at most supported by fluid replacement research. With hyponatremia deaths there is clearly a difference between fluid replacement and drink as much as tolerable. (I know Noakes advocates even less than fluid replacement.) My point is that their own research doesn't seem to support the 1996 recommendation. Did they think that if someone could tolerate drinking a lot it would never exceed fluid replacement?

A different topic here in response to the slideshow you linked in the "understood to be false" hyperlink:
The slide "A Misleading Dictum" references research from 1988 by Saltin and Costill showing a decline in performance correlated to dehydration. It also references Sawka in 2001 claiming the same. I don't see that these names are linked to GSSI. Do you have more knowledge about these researchers?

The slide showing African hunters is also interesting, pointing out that they didn't hydrate pre-workout, during training, post-workout, etc.(possibly a jab at the current Gatorade G Formulas). If hunting survival fitness is the pinnacle of fitness, as implied by this slide, then it would be short- to mid-burst fitness, and rarely if ever long endurance fitness.
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Last edited by Christopher Morris : 03-02-2014 at 10:44 PM.
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Old 03-02-2014, 10:53 PM   #123
Clint Harris
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Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM

So what is the call to action here ?
For us and for HQ ?

Will Gatorade, Red Bull, Powerade etc all be banned from the Games ?

My biggest fear, is I'll buy a Gatorade from Home Depot and someone in toe-shoes behind me is going to pass judgement on me for doing so.
The thing is, I don't buy my sports nutrition from Home Depot, I was simply thirsty from lugging wood around all day. It was either that or Pepsi. It was also probably the first one I bought in 5+ years.

I also don't understand how anyone could manage to drink 40oz of water in an hour, hour over hour, whilst running a marathon. They must have some sort of compulsive disorder.

While I see the problem here with the science, the unethical behavior (because there is no more important thing than human life) and what has transpired in the past. I'm just not sure what it is I'm supposed to do with it.

There's corruption in the world. It's in politics, sports, science, IT, war etc. Those dollars are spent on someone's agenda. Many a sport/event would not have taken place without big-soda's dollars. But those same wallets will have paid for the death's of many too. (other such diseases and problems). Their wallets may have also paid for some positive science too. Let's not forget that.

That might be where some of us are just like "whatever". It's all over the place and just don't see what it is that is going to change. This is also not unlike problems in the professional world. It's easy to complain about problems and even identifying them - it's much more powerful to come up with a problem and offer a couple of solutions.
The problem has been identified. What is the solution ?

If this has already been identified here, I missed it but are genuinely interested.

Still don't understand the banning. You cannot tell overall emotion/intent well through one post in a 2 dimensional board. Sometimes people fire off once in a while. Other times the reader is all fired up. The result is a total miscommunication and people getting butt-hurt

Last edited by Clint Harris : 03-02-2014 at 10:59 PM.
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Old 03-03-2014, 01:20 PM   #124
Steven Nedorolik
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Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM

Lynne, I'd be interested in a book also please

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Old 03-03-2014, 02:00 PM   #125
Russell Greene
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Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM

In October 2002, CrossFit published "What is Fitness?" Greg wrote:

"For CrossFit the specter of championing a fitness program without clearly defining what it is that the program delivers combines elements of fraud and farce"

I wish someone had asked CrossFit back then "The problem has been identified. What is the solution?"

What would a one-car garage gym with a workout blog do to affect the fitness industry?

Twelve years later, there are more CrossFit gyms than any other brand of gym in the world. CrossFit is the global leader of the $75-billion dollar fitness/gym industry. To be sure, by revenue the top brand is Life Time Fitness. They have 109 locations, however. Number two, by revenue, is Virgin Active. They have less than 300 locations. They added 13 gyms in 2012. CrossFit is approaching 10,000 locations and adding thousands a year.

Conventional business analysts miss the import of CrossFit because the affiliates are making most of the money. By design.

Sports drinks are 1/10th the size of fitness. Unlike 2002, CrossFit now has an entire community built around effective practices in health and fitness. This is a significantly smaller challenge than what CrossFit has already overcome. And, it's fully within the realm of our demonstrated competence and expertise.

CrossFit warned about excessive carbohydrate intake well before that was a popularly-recognized risk. While excess carbohydrate is a slow killer, EAHE is a quick one. The need to control carbohydrate consumption is now mainstream, but the danger of over-hydration has not received the attention it deserves.

Gatorade is a sweet drink with a purchased facade of science. That's why it's Gatorade (i.e. Gator lemonade), not Gator-Aid. According to Darren Rovell:

"'Gator-Aid' was also brought up, but the doctors realized that they probably shouldn’t use the 'Aid' suffix, since that would mean that if the drink were ever marketed, they would have to prove that it had a clear medicinal use and perform clinical tests on thousands of people."

Source: http://www.amazon.com/First-Thirst-G.../dp/0814410952 (link is w/f safe)

Gatorade never should have entered fitness and health science. They never should have spent millions marketing dangerous hydration levels. All we can do now is prevent further damage.

The "call to action" is to spread the message and drive Gatorade out of health and fitness. 12 have died, at least. Do those asking why we care think we can afford more deaths?

Quote:
Originally Posted by Clint Harris View Post
So what is the call to action here ?
For us and for HQ ?

Will Gatorade, Red Bull, Powerade etc all be banned from the Games ?

My biggest fear, is I'll buy a Gatorade from Home Depot and someone in toe-shoes behind me is going to pass judgement on me for doing so.
The thing is, I don't buy my sports nutrition from Home Depot, I was simply thirsty from lugging wood around all day. It was either that or Pepsi. It was also probably the first one I bought in 5+ years.

I also don't understand how anyone could manage to drink 40oz of water in an hour, hour over hour, whilst running a marathon. They must have some sort of compulsive disorder.

While I see the problem here with the science, the unethical behavior (because there is no more important thing than human life) and what has transpired in the past. I'm just not sure what it is I'm supposed to do with it.

There's corruption in the world. It's in politics, sports, science, IT, war etc. Those dollars are spent on someone's agenda. Many a sport/event would not have taken place without big-soda's dollars. But those same wallets will have paid for the death's of many too. (other such diseases and problems). Their wallets may have also paid for some positive science too. Let's not forget that.

That might be where some of us are just like "whatever". It's all over the place and just don't see what it is that is going to change. This is also not unlike problems in the professional world. It's easy to complain about problems and even identifying them - it's much more powerful to come up with a problem and offer a couple of solutions.
The problem has been identified. What is the solution ?

If this has already been identified here, I missed it but are genuinely interested.

Still don't understand the banning. You cannot tell overall emotion/intent well through one post in a 2 dimensional board. Sometimes people fire off once in a while. Other times the reader is all fired up. The result is a total miscommunication and people getting butt-hurt
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Old 03-03-2014, 10:23 PM   #126
Steven Wingo
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Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM

I would love a copy of Waterlogged. If it is the same quality as Noakes' The Lore of Running, it will be very valuable reading.

I'm interested to learn whether the original formulations of Gatorade, which according to some commentators and my own personal observations "tasted like swill," was a quality product for serious athletes if used in the right amounts. There was never any danger the general public would take up drinking that stuff.

Unfortunately, the soft drink industry got ahold of the rights to it, added a bunch of sugar (and probably reduced the sodium and electrolytes) and then over promoted the need for it so that your average Joe doing 30 minutes easy on the treadmill in an air conditioned gym thought he/she not only needed it but a bunch of it.


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Old 03-04-2014, 09:16 AM   #127
Brian Watts
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Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM

I'd love a copy of Waterlogged as well, if there are still any available, Lynne.

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Old 03-04-2014, 06:09 PM   #128
Russell Greene
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Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM

The Gatorade Sports Science Institute has a section on Hyponatremia: http://www.gssiweb.org/ask-the-expert/all/hyponatremia (link is w/f safe)

In the "Preventing Hyponatremia" video, the Gatorade researcher, Dr. Nina Stachenfeld of Yale University, states:

"Hyponatremia is not very common, so the typical athlete does not have to concern him or herself with hyponatremia too much, unless they've shown in the past to be particularly sensitive to it."

Gatorade is still misrepresenting and downplaying the risk of hyponatremia.

The Gatorade researcher also claims that "the occurrence of hyponatremia is about 2 or 3 percent in the population. So, it's very low."

This is not consistent with a study in the New England Journal of Medicine that reported a 13% rate of EAH and .6% rate of critical EAH in 488 Boston Marathon finishers. This is the largest study of sodium levels in endurance athletes at a single race that I've found. Note that the NEJM rate is around 5 times the rate of hyponatremia that Stachenfeld portrayed. Source: http://www.nejm.org/doi/full/10.1056/NEJMoa043901 (w/f safe)

Stachenfeld's recommendation for athletes to only concern themselves with hyponatremia if they've had it before presumes that they'd know so. Unfortunately, many athletes with hyponatremia are not aware of it. Athletes can near dangerously low blood sodium levels without showing acute symptoms, or without those symptoms being accurately identified.

At this time, Gatorade should be urging caution to avoid further deaths. Ignorance is no longer a viable excuse. Instead, Gatorade's scientists are telling us not to worry about yyponatremia. Convenient, isn't it?
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Old 03-04-2014, 10:18 PM   #129
Christopher Morris
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Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM

Russell,
I also found on their website this summary of hyponatremia: http://www.gssiweb.org/Article/sse-8...ia-in-athletes (wfs)

Under the section "WHAT FLUID-REPLACEMENT GUIDELINES SHOULD ATHLETES FOLLOW?" they say none of the position stands say that athletes should drink as much as possible. Then they quote four associations, including the ACSM that states, in their quote, that athletes should "consume the maximal amount that can be tolerated." After these four quotes they again state that "none suggests that athletes 'drink as much fluid as possible during exercise.'"

Huh? Holy crap. This semantics is killing people, and they see a difference between "drink as much as possible," and "consume the maximal amount"?
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Old 03-05-2014, 10:37 AM   #130
Dale F. Saran
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Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM

The absolute cherry on top is a bit of simple logic that GatorAde and the ACSM are either too dumb to understand or too stubborn to admit: If hyponatremia is real - and let's assume that this is a real thing that actually kills people - it means that human beings can drink to "tolerance" an amount that is fatal. Thus, any guidelines that tell people to drink "as much as tolerable" have in them, implicitly, a prescription that could be fatal.

It would be like having a bottle of aspirin that said "Take as much as tolerable." If an aspirin bottle had that on it we'd all be wondering if (a) the manufacturer had lost their mind, or (b) if the FDA had been completely bought off, or (c) both a and b. You won't know how much is "tolerable" to yourself until you're either seriously injured or dead. Awesome prescription.

What Noakes, Speedy, et al. did was point out this simple, ineluctable fact, but it only took years and deaths - and the NEJM study - before there was any kind of backpedal by ACSM. GatorAde, however, is still telling endurance athletes to drink themselves to death (in short).

Someone asked about the call to action: knowledge. One of my daughters was a cross-country runner and the prevailing wisdom is still "pre-hydrate" for "performance" by her high school coach. Thankfully, she doesn't run XC any more. I've told her - and other kids - while driving them to a "pasta party" (I know, don't get me started on that) - to drink only when thirsty and I'm treated like the deranged loony guy. Their school - a well-to-do suburban high school has "hydration stations" all over the place and kids are encouraged to "hydrate" throughout the day - as if they're in sub-Saharan Africa facing a long hunt, rather than the burbs of Boston in school, facing the prospect of a tough 15 minute bus ride home.

How did we get to this point? GatorAde's advertising is so pervasive - and had the backing of "science" from the ACSM - and now we've got an entire generation of kids who are trying to drink "as much as tolerable." You decide what the call to action should be for yourself. But now you know the deal.
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