CrossFit Discussion Board

CrossFit Discussion Board (http://board.crossfit.com/index.php)
-   Injuries (http://board.crossfit.com/forumdisplay.php?f=12)
-   -   Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM (http://board.crossfit.com/showthread.php?t=86218)

Russell Berger 03-02-2014 08:00 PM

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.

Christopher Morris 03-02-2014 10:41 PM

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.

Clint Harris 03-02-2014 10:53 PM

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

Steven Nedorolik 03-03-2014 01:20 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Lynne, I'd be interested in a book also please

On the list - Lynne

Russell Greene 03-03-2014 02:00 PM

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 (Post 1221915)
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


Steven Wingo 03-03-2014 10:23 PM

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.


On the list - Lynne

Brian Watts 03-04-2014 09:16 AM

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.

on the list - Lynne

Russell Greene 03-04-2014 06:09 PM

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?

Christopher Morris 03-04-2014 10:18 PM

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"?

Dale F. Saran 03-05-2014 10:37 AM

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.

Russell Greene 03-05-2014 11:41 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Great find, Chris.

Even if athletes were wise enough to ignore "the maximal amount that can be tolerated" and focus on drinking to replace "body weight loss," that still would create hyponatremia.

For one, how will a competitor know when he's finally replaced all body weight lost and needs to stop drinking? Are we to assume that the athlete has tracked their sweat, urine, and drinking in mL throughout the race? Or that they practiced their hydration in an environment that perfectly mirrored the race environment?

Furthermore, hyponatremia has occurred in athletes who lost small amounts of body weight while exercising.

Neither "the maximal amount that can be tolerated," nor "sufficient to replace all the water lost through sweating" are safe drinking recommendations.

And, as bad as the 1996 ACSM recommendations were, Gatorade's ads were worse: http://i0.wp.com/www.sportsscientist...atorade_ad.jpg (link is W/F safe)


Quote:

Originally Posted by Christopher Morris (Post 1222315)
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"?


Clint Harris 03-05-2014 11:54 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Thanks Dale, that was nice and clear.

Does HQ have any plans on what they are going to do ? Other than in here?

Are you planning on rattling the ACSM's cage? Have already done so ? Banning these drinks from the games? Adding this to a new lecture?

Is it just Gatorade and the ACSM.at fault here? What about other big soda companies that did nothing to argue against this "science". They are benefiting from people drinking more too, so may well have clammed shut.

Dale F. Saran 03-05-2014 01:57 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Clint - we've had discussions with several of the largest law firms in the world on the subject. We're not an aggrieved party, so to speak, regarding GatorAde deaths. We lack "standing" in legal parlance, as we are not (for example) a relative of Dr. Lucero - or any of the other dozen or so who were killed by excessive drinking during endurance events.

I think at this point our goal is first to let our cousins in the endurance community know what's up. We've probably ruffled their feathers a bit over the years, by either pointing out that excessive endurance work had muscle-wasting consequences (a fact that even the greats in their field had openly discussed in the 80's, but it's always less palatable coming from outsiders), or by challenging endurance as the fitness paradigm (see Coach's minor shot at Outside magazine's pick for fittest man back in "What is Fitness?"), but notwithstanding, we still feel obligated to try to educate them and keep them from dying by excessive hydration - as per what were considered "industry" (ACSM) guidelines, derived from "science." Noakes and Speedy all but eliminated hyponatremia in their countries by simply restricting the frequency of those water stations that are unbiquitous at Marathons. You don't need to drink every freaking mile; you didn't lose anything worthy of consideration in the 10 minutes between one station and the next one a mile away.

We'll start there. ACSM will have to answer both in court - both a real one and the court of public opinion - for their part in trumpeting science that hurts people. Maybe people will start to see them for what they really are and stop pointing to every wonky academic paper or alleged "study" that proves one ACSM claim or another - and start asking (a) about the merits of the paper rather than pointing to its "peer reviewed-ness" - which their 1996 guidelines certainly were - and (b) daring to ask "qui bono?"

Russell Berger 03-05-2014 07:44 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Another source of evidence regarding Gatorade’s continued negative influence on hydration guidelines can be seen in the publications of the Academy of Nutrition and Dietetics. AND receives sponsorship funding from Gatorade’s parent company, PepsiCo (source WFS). Regarding hydration for baseball, the AND suggests players:
“Stay well hydrated by drinking about 4 to 8 ounces of fluid every 15 minutes. Don't rely on thirst to alert you about when you should drink since at that point dehydration is already setting in. Instead, use sports bottles with ounces clearly marked to keep the right hydration pace through the game.”
The average baseball game lasts 2.5 hours. This means the AND is recommending 16-32 oz. (473-946ml) of “fluid” per hour, or 40-80 ounces (1183-2366 ml) of fluid over the course of the average game. This is on par with what is suggested for competitive endurance athletes, who are expending energy continuously hour after hour, clearly a serious exaggeration of the hydration needs of athletes engaged in a game that produces roughly 18 minutes of action (WFS). What’s worse is the AND’s continuation of the deadly mantra that athletes should drink even when they aren’t thirsty- a mantra begotten from the shoddy science of the ACSM. But it gets better:
“Start with water but then after about 1 hour of playing and sweating switch to a sport drink. Sports drinks provide electrolytes such as sodium that are lost in sweat and also carbohydrates to replenish muscle energy.”
Unfortunately, when a Harvard study of Boston marathon runners found that 13% had some degree of hyponatremia, it turned out that the condition was just as likely to happen among those who drank sports drinks during the marathon as it was among those who chose water (source WFS). It is also documented that Cynthia Lucero consumed “large amounts of Gatorade” before her death in the 2002 Boston marathon (source WFS). On the AND’s website, there is also a section titled “training for a marathon?” On this page, the AND offers an exaggerated version of the “dehydration harms performance” claim, here suggesting that poor performance results from 2% dehydration, not dehydration greater than 2%. Their motive becomes transparent in the next paragraph:
“...be sure to check which sport beverage will be available on the marathon course. You may want to carry your own flavor or brand or have someone offer you your brand on the route. Don't find out at mile 13 that you hate the sport beverage the race offers."
In short, the AND is another example of an authoritative organization in the field of health and fitness who is taking big soda’s sponsorship money and publishing erroneous and potentially deadly hydration recommendations in exchange. Is the AND just clueless about hyponatremia? Apparently not, as they have made their position on hyponatremia prevention clear:
“Sports beverages containing carbohydrates and electrolytes may be consumed before, during, and after exercise to help maintain blood glucose concentration, provide fuel for muscles and decrease risk of dehydration and hyponatremia.” (source WFS)

I believe that Gatorade’s financial influence here is obvious. Rather than admitting their mistakes and educating the public about the dangers of consuming large amounts of Gatorade, they would rather spend money to have academic puppets paint their product as necessary for preventing the very condition it has been shown to cause.

Shane Scott 03-05-2014 09:19 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Hi Lynne!

If there are any copies of Waterlogged left, I would love to read one!

Thank you!
Shane

on the list! ~Lynne

Preston Sprimont 03-06-2014 11:16 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Interesting topic, glad it has been brought up here for discussion.

It seems pretty evident that Gatorade and its partners have botched the science to better peddle their product. And unfortunately, this is about par for the course in corporate sponsorship and in marketing. I'm interested to see how this will play out over time, and if/how the knowledge will disseminate beyond discussion boards like this. Gatorade is huge, and, as others have mentioned, pretty ubiquitous in all kinds of sports at both professional and amateur levels. That ubiquity/popularity will be tough to trump.

Lynne, if still available, I'd love a copy of the book. Please and thank you.

on the list! ~Lynne

Coach 03-06-2014 01:04 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
As recently as 2009, the ACSM, the American Dietetic Association, and the Dietitians of Canada in a joint position paper, on page 718, included the following...."hyponatremia (serum sodium concentration less than 130mmol/L) can result from prolonged, heavy sweating with failure to replace sodium, or excessive water intake".

There's never been any evidence to support the claim that prolonged or heavy sweating can produce EAH. Scientific evidence supports only the claim that excessive water intake can produces EAH.

So the ACSM's response to the EAH deaths that followed from their hyperhydration campaign was to continue to distort the scientific record and hydration science, again, we have to conclude, to support their "platinum sponsor", Gatorade.

It's telling that in backpedalling from the "drink all that can be tolerated" recommendation we find not guidelines that propose MAXIMUMS but reduced minimums and more "abnormal science" as the British Journal of Sports Medicine called it.

And...in prevention of what are these minimums being offered? To date nothing adverse has been demonstrated in under drinking during athletic competitions yet at least a dozen deaths and thousands of injuries have resulted from over drinking. I see the ACSM's serial perversion of the scientific record on the subject of hydration, and specifically EAH and electrolyte consumption, coupled with a failure to offer not maximums but reduced minimums as compelling evidence that the ACSM has surrendered any presumed or claimed scientific authority. The parallels to big tobacco and it's "scientists" and "science" are remarkable. The ACSM has become a shill for big soda.

Dave Rubin 03-06-2014 02:48 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Lynne

I'd love a copy if there are any left!

on the list! ~Lynne

Quote:

Originally Posted by Lynne Pitts (Post 1220322)
To "sweeten the pot" :D CrossFit has 500 copies of Noakes' book available to give to interested parties; reply in this thread if you would like one. We'll grab your email from the admin side, so you don't need to post your email publicly, and our team will contact you for the rest of your information.
Requests so far - will keep this updated, so hit me if I miss you.

Joshua J Grenell
Chris Cooper
Christopher Morris
Dakota Base
Andy Shirley
Russel K Olofson
Teena Escobar
Amy Hollingsworth
Jason Donaldson
Alden Hingle
Christopher E Bloom
Jesse Phillips
Barry Stockbrugger
Ryan Kingsbury
Darrel White
Kirez Reynolds
Darby Darrow
MIchael Wuest
Jason David
Kevin Keast
Joey Dussel
Adam Manery
Robert D Taylor Jr
Mark Lamoree
Greg Whitekettle
Rob McBee
Josh Murphy
William J Mallon


Chris Russell 03-06-2014 07:56 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Lynne,
Not sure if there are any books left, but I would be overcome with joy of I could get a copy...Hook me up!

Respectfully,
Chris

on the list! ~Lynne

Sean Rockett 03-06-2014 08:08 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Lynne, I will take a book. Thank you, Sean Rockett.

on the list! ~Lynne

Brian Chontosh 03-06-2014 08:20 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
"A key to athletic success is avoidance of a state of underhydration. …people rely on 'thirst' as an alarm bell for when to drink. Thirst, however, is a delayed sensation that does not occur until the person has already lost 1 to 2L of fluid. … Because of this, athletes should learn to consume fluids on a fixed time interval rather than relying on thirst for when to drink."

"Staying optimally hydrated… has multiple benefits, including:… a less pronounced body core temperature, improvement in skin blood flow (enabling better sweat rates and improved cooling)"

"Fluid intake recommendations are to… drink as much as needed to match sweat loses… not rely on thirst as a stimulus to drink (the thirst sensation will only occur after 1 to 2L (1 to 2% of body weight) has already been lost)."

"Sweat rates are often 1 to 2L per hour, and it is difficult to consume and absorb enough fluid to match these loses."

"Ingesting large volumes of dilute, low- (or no-) sodium fluid may increase the risk of hyponatremia."

"…athletes will often develop dehydration when there are sufficient fluids nearby for them to consume"

Bushman, Battista,... American College of Sports Medicine (2014). ACSM'S RESOURCES FOR THE PERSONAL TRAINER, 4th Ed. Lippincott Williams and Wilkings. Chapter 6; pp177-191.

Any one of these statements taken singularly might sound fairly reasonable (despite this message board thread's continued references that suggest they are inaccurate/unfounded). But, allow me to link the chain for what we are given...

The key is to drink. I am not thirsty now but I should start soonest because thirst isn't on time. This drinking will keep my body cooler and increase the ability to sweat so I can cool, my already cooler, body better. Then, drinking more helps me sweat more so that I will need to replace more water losses and do so faster, else I become underhydrated again. Unfortunately, my body already can not keep up with sweat losses because I can not consume and absorb well enough anyways. And even though there are already ample fluids around for me to drink, I will fail to consume them.

If I were to quote concepts around respiratory loses (which I've briefly researched and find to be pretty much irrelevant compared to urinary and sweat loses) and the strategy/methodology with considering this, it compounds the issue a third way into contradiction to drink more because of the effects despite the causes and requirements are opposite to the said situation of the effects that are needed. Uhm... right effects but for the wrong situation. Nevermind.

"To ensure better athlete compliance, fluids should be cool and taste good…" [same source]

The answer? Let them drink Sports Drinks. Cool and really tasty Sports Drinks. Show pictures of athletes using Gatorade drinks (fig 6.10, 6.11, 6.12) and listing Gatorade products by name in tables (6.15).

I refuse to consider what the 'pre-sportdrink man' ever did to survive in the efforts against nature when he only had water.

What is of more interest is the publish date; 2014. This is the latest and greatest information that the ACSM is propagating. A text that is updated every 4 years (2001, 2006, 2010). This is the primary source used to study, test and receive their CPT certification. Hyponatremia is mentioned one time (EAH zero times) in 14 pages of fluid and hydration guideline text, yet it may affect over 13% of endurance athletes. Chapter 6 references do not include any of the more recent scientific publications regarding fluid and hydration post 2000 other than their own publications or those from the GSSI. Every scientific reference provided by Russell Greene calls into question, at worst, or flat out contradicts, at best, the arguments that tie these fluid statements of requirement/interest together.

((Sidenote: HomeOwner's Associations got greater word count hits in their marketing and sales sections of Business Basics and Planning; even received an Index entry.))

It is really almost as if a collection of 'research' was gathered, some interesting points are pulled from each of them fairly independently, and presented as a collage of factoids. In the end, the final position really is 'every athlete is different and you will need to take caution to stay hydrated at all times, when in doubt, drink a sports drink'. I can not accept this as science - especially after reading Waterlogged and 100's of pages of separate and supporting scientific research.

If these things are so obvious (and I understand that they appear so because we are diligently investigating) what else in the entire curriculum is suspect? What is the supervising body that truly reviews this material for accuracy? Better asked maybe is who do they work for - public health and safety or $$$? At least in the Fluids and Hydration section, everything appears to be self-referential, without any real scientific strength, and built like an elementary textbook. How do they have the credibility that they claim?

In my personal domain of interest, my concern is that there is a significant reluctance to decouple the relationship of Dehydration from Heat Injury. At least a reconciliation of the appropriate nature of the relationship is begged between the two. My hope is that as we kick the door open further, events like cramping, rhabdomyolysis, hypothermia, and others will take different shapes. My fear is that if we don't decouple the GSSI from the ACSM (and the other many private interest funded relationships in our health and fitness community) we will never be able to make the necessary progress.

I am hesitant to dig into the "High Carb, Low Fat diet for performance" that precedes this subchapter.

Brian Chontosh 03-06-2014 08:39 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
In all fairness and credit, in the ACSM's Guidelines for Exercise Testing and Prescription, 9th ED (2014) pp218, hyponatremia receives two word hits.

They define EAH as a state of lower than normal blood sodium (typically <135) and then:

"Hyponatremia tends to be more common in long duration physical activities and is precipitated by consumption of hypotonic fluid (water) alone in excess of sweat losses (typified by body weight gains). The syndrome can be prevented by not drinking in excess of sweat rate and by consuming salt-containing fluids and foods…"

They then politely ask you to refer to the ACSM 2007 Position Stand on fluid replacement for further information.

What isn't being said is more damaging than the suspect items that are and how they are being said.

Ask them how we determine sweat rates so we can match and not exceed them. Certainly we do not want to fall short of them else the dangerous underhydration.

They answer "it is very complex". I rebut: thirst is pretty simple, water is pretty economical."

Graham Leck 03-07-2014 12:55 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I would be interested in a book if any left.
Graham.

on the list! ~Lynne

Preston Sprimont 03-07-2014 11:55 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Quote:

Originally Posted by Coach (Post 1222579)

To date nothing adverse has been demonstrated in under drinking during athletic competitions yet at least a dozen deaths and thousands of injuries have resulted from over drinking.

"Under drinking" seems kind of vague, so I guess it depends on how that's defined... but as far as I know, dehydration (do we have a working definition for dehydration for this discussion yet?) can still pose health risks; and, to my knowledge, there is record of injury and death occurring from dehydration. Again, "under drinking" is not defined here; if defined as less hydration than optimal, sure, there's a good chance there's no evidence of injury and death; if defined as less than necessary, however, I imagine we are entering the realm of health-risk-posing dehydration. But I'm not interested in arguing semantics ad nauseum...
My point is this: let's not demonized hydration. Yes, the GSSI and ACSM have skewed, distorted, and butchered the science, seemingly to their benefit, and have disseminated and advertized and pushed this "information" at the expense of the public's knowledge and of some individuals' health. They are in the wrong here. That has been thoroughly demonstrated. However, hydration is not the enemy. Hydration does not threaten the public health or the health of athletes. Super-hydration to the point of hyponatria is the problem. Yes, we all know hydration is important, and maybe that's why it hasn't received much mention here, but I'd hate to see the responses (which are intended to educate and expose) to the GSSI's and ACSM's erroneous claims and falsified science be tainted by error on the opposite end of the spectrum.
If I am in error in claiming that dehydration poses a health risk, and if hydration is in fact an issue, I'm all ears.

Cliff notes: hydrate, but not too much.

Edit/note: I quoted Coach Glassman here because his succinct statement about over- and under-drinking directly addresses what I wanted to comment on, but my comment is a "reply" to many of the quotes in this thread from a number of users that expressed such a sentiment.

Jeff Glassman 03-07-2014 11:57 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Quote:

Originally Posted by Dakota Base (Post 1220500)
While deaths from faulty data are tragic, I don't think the format in which you're fighting this "war" is productive, or ethical. Coach's arguement here is passing off that the ACSM/Gatorade are STILL promoting hyperhydration, which just isn't true.

Part I of II:

ACSM promoted incompetent, if not unconscionable, over-drinking in its 1996 Position Stand: Exercise and Fluid Replacement, written by Victor A. Convertino, (Chair), Lawrence E. Armstrong, Edward F. Coyle, Gary W. Mack, Michael N. Sawka, Leo C. Senay, Jr., and W. Michael Sherman. The names will prove important.

All hold PhDs, and all are Fellows of the ACSM. Convertino and Sawka, who may have retired, at one time were Research Physiologists with the US Army, Convertino at the Institute of Surgical Research (USAISR), and Sawka at the Research Institute of Environmental Medicine (USARIEM). Sawka was on the Panel on Dietary Reference Intakes for Electrolytes and Water, L.J. Appel (Chair), 2005 (Appel (2005)). Sawka chaired the ACSM revision of its 1996 Position Stand in 2007, with five co authors, including Scott J. Montain. Here is a capsule summary of ACSM’s Positions:
>>During exercise, athletes should start drinking early and at regular intervals in an attempt to consume fluids at a rate sufficient to replace all the water lost through sweating (i.e., body weight loss), or consume the maximal amount that can be tolerated. Convertino, V.A., et al., (1996) ACSM Position Stand, Exercise and Fluid Replacement, p. 517.
Updated to read:
>>The goal of drinking during exercise is to prevent excessive (>2% body weight loss from water deficit) dehydration and excessive changes in electrolyte balance to avert compromised performance. Sawka, M.N., et al., (2007) ACSM Position Stand, Exercise and Fluid Replacement, p. 377.
The latter introduces overdrinking, even considering possible health advantages, but allowing that it can be a threat to life. Id., p. 381. However, it does not use the phrases water intoxication or water poisoning, a phenomenon known for almost a century. Rowntree, L.G., Water Intoxication, ArchIntMed, v32, n2, August 1923. ACSM now recognizes that overdrinking can cause hyponatremia, but not that the body normally reduces water volume during intense or prolonged work, just as it increases pulse rate.

Definitional problems

Exercise physiologists almost exclusively refer to a reduction in body water as dehydration, measuring it as the ratio (percent) of body weight loss, impliedly referenced to some set point corresponding to steady state resting. Other physiologists use dehydration to mean a disease with symptoms similar to hyponatremia. Appel (2005), p. 163. Dehydration symptoms begin with thirst, then progress to include dry mouth, oliguria (low urine volume), dark urine, dry or inelastic skin, orthostatic hypotension (light-headedness upon standing) to syncope (fainting), and to confusion, organ damage, coma, and death. See ICD10, E86.0, Dehydration; Merck Manual online.

The two definitions, dehydration-as-weight-loss and dehydration-as-disease, are incompatible. ACSM’s Position Stands try to medicate dehydration-as-disease by combatting dehydration-as-weight-loss with a glut of its favored sponsor’s product. The effect bristles with scientific arrogance as well as unethical conduct. This ACSM recommendation works against nature, trying to force the athlete into a presumed rest state while his body is trying to adjust its regulation for intense exercise.

Homeostasis vs. Heterostasis

Perhaps ACSM’s recipe was attractive to physiologists who misunderstand homeostasis, the fundamental principle of their field that the body adjusts its parameters to maintain a well-state. The confusion lies in applying homeostasis to mean that the body has a unique well-state under all conditions.

That the human body does not have a unique set point is supported by the evidence from athletes under stress, as, for example, when pulse rate increases and heart stroke volume decreases. That the rest state is neither a unique set point nor the optimum under stress is recognized in modern physiology by the terms heterostasis (multiple, discrete set points, attributed to Selye (1973)) and allostasis (dynamic, adaptive set points, named by Sterling and Eyer (1988)). See Berntson, G.G. & J.T. Cacioppo, Integrative Physiology: Homeostasis, Allostasis, and the Orchestration of Systemic Physiology, Ch. 19 in J.T. Cacioppo, L.G. Tassinary, & G.G. Berntson (Eds), Handbook of Psychophysiology, 2007, 3ed Ed, NY: Cambridge University Press, p. 436.

ACSM Prescribes MINIMUMs, never MAXIMUMs

Both the Convertino (ACSM PS 1996) and the Sawka (ACSM PS 2007) versions of Gatoraded physiology conclude with a prescription for the MINIMUM amounts to drink, without regard to any MAXIMUMs. For Convertino, the athlete was to lose no body weight by drinking as much as could be tolerated. Sawka removed the reference to “drinking the amount that can be tolerated”, but only lowered the maximum body weight loss from zero to 2%, still achieved by drinking beyond the body’s thirst signal. Neither Position Stand recognized the danger of water intoxication.

To the contrary, several studies over the years investigated whether hyperhydration could be beneficial. Sawka, writing with Latzka in 1998, concluded that the only possible benefit of hyperhydration is that it delayed hypohydration during exercise. In 2001, Sawka went further, indicating that his 1998 study found not just no benefit, but in fact no effect at all from hyperhydration. Sawka, M.N. & K.B. Randolf, Physical Exercise in Hot Climates: Physiology, Performance, and Biomedical Issues, Ch. 3 in Medical Aspects of Harsh Environments, Vol. 1, Textbooks of Military Medicine, 2001, Table 3-3, p. 107.

Sawka Leads the Army To Abandon MINIMUMs for MAXIMUMs

In fact for a decade, the U.S. Army conducted an experiment with hyperhydration, with disastrous results. Since 1988, the U.S. Army regulations set minimums for water intake. They were “At least ½” quarts/hour in the most benign environment, increasing to “At least 1” quarts/hour, then to “At least 1½” quarts/hour, and finally to “More than 2” quarts/hour. So drinking more than 2 quarts/hour would satisfy all conditions.

Sawka, writing behind Montain and Latzka, observed:
>>The U.S. Army's fluid replacement guidelines emphasize fluid replacement during hot weather training to prevent degradation of performance and minimize the risk of heat injury. Little consideration has been given, however, to possible overhydration and development of water intoxication. Sufficient epidemiological evidence is available to demonstrate an increasing incidence of water intoxication during military training. … revised guidelines will sustain hydration and minimize the number of heat injuries during military training while protecting the soldier from becoming sick from overdrinking. Montain, S.J., Latzka, W.A., & M.N. Sawka, Fluid Replacement Recommendations for Training in Hot Weather, July 1999, abstract.
“Little consideration has been given” by whom?

From 1988 to 2000, the US Army prescribed MINIMUMs for water intake, which were at least 2 quarts per hour at a Wet Bulb Global Temperature of 90ºF or higher. This resulted in 190 hospitalizations between 1989 and 1999 for hyponatremia attributed to over-drinking. Kolka, M.A., W.A. Latzka, S.J. Montain, & M.N. Sawka, Current U.S. Military Fluid Replacement Guidelines, USARIEM, December, 2013, p. 6-1. In 2000, the Army, joined now by the US Marine Corps, revised the Army regulations following trials, replacing MINIMUMs entirely with MAXIMUMs for the first time, and emphasizing that the fluid of choice was water. The overarching regulation includes that hourly water intake should not exceed 1 1/4 quarts under any conditions, i.e., the intakes are MAXIMUMs.

ACSM Continues To Defend Its Position Stand on Drinking MINIMUMs

ACSM has yet to follow suit, to set maximum fluid intake to prevent hyponatremia and water intoxication. Its 2007 Position Stand, above, prepared by Sawka, still recommends a MINIMUM intake of fluid, preferably fortified water (aka Gatorade).

Continued

Jeff Glassman 03-07-2014 01:16 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Quote:

Originally Posted by Dakota Base (Post 1220500)
While deaths from faulty data are tragic, I don't think the format in which you're fighting this "war" is productive, or ethical. Coach's arguement here is passing off that the ACSM/Gatorade are STILL promoting hyperhydration, which just isn't true.

Part II

ACSM has not not been swayed by the facts. January of this year, in the latest publication reasonably attributable to ACSM, Samuel N. Cheuvront, PhD, and Robert W. Kenefick, PhD, of USARIEM unveiled a "comprehensive review of dehydration assessment [to present] a unique evaluation of the dehydration and performance literature." Cheuvront S.N. & R.W. Kenefick, Dehydration: Physiology, Assessment, and Performance Effects, January 2014.

USARIEM and ACSM are joined at the hip Sawka-t. As COL K. E. Fiedl, Commander of USARIEM with J. H. Allen, his Chief of Staff, said in USARIEM: Physiological Research for the Warfighter, October 2004:
>>The influence of USARIEM researchers in the exercise physiology community is highlighted by large representation of our scientists in the professional activities of the American College of Sports Medicine (ACSM), including as senior editor of the primary journal of the ACSM and in the authoring of many of the organizations position statements. Id., p. 40.
Exercise Physiologist Writing Is a Team Sport

Cheuvront & Kenefick’s comprehensive review has 385 references, some with as many as 12 authors for a total of 1,302 author credits. The authors cited number 899, unique to the first initial (951 unique to the second initial, unfortunately often omitted). The top fifteen authors according to the number of credits, in parenthesis, are Sawka M (29), Cheuvront S (20), Kenefick R (15), Armstrong L (14), Fraser C (13), Montain S (10), Nadel E (10), Casa D (8), Ely B (8), Maresh C (8), Maughan R (8), Adolph E (7), Convertino V (7), Gonzalez-Alonso J (7), Greenleaf J (7). The next five have six credits, and the next 11 have five each. However, these credits are not solo performances (which total 76), but most frequently are partnerships, averaging 3.4 authors per paper. Five references have 10 authors, three have 11, and one has the record of 12. Casa, for example, has written on dehydration eight times, but always with Armstrong.

Cheuvront’s name appears on 20 papers of the 385 reference (which does not incude his comprehensive review), but never alone, and 17 times with Sawka, the most prolific on the subject and the lead author on both Army and ACSM papers. Over half (17 of 29) of Sawka’s papers are partnered with Cheuvront, and 85% of Cheuvront’s papers are written with Sawka. All of this is to observe that Cheuvront has earned credence as a spokesman for ACSM alongside and second only to Sawka.

Cheuvront’s Comprehensive Survey on Dehydration Ignores Overhydration

Cheuvront (2014) restricts its discussion to dehydration, as promised in its title, but only admits the subject of overhydration through its references. It fails to be comprehensive because it omits the parts of its own references that contradict the ACSM hyperhydration 2007 Position Stand, Reference 309. Two examples are Reference 187, Appel (2005), above, with Sawka, and Reference (312), Sawka & Noakes, Does dehydration impair exercise performance? The latter is an unusual paper, being a debate in two columns with opening statements and responses. Sawka is in the left column, Noakes on the right.

Cheuvront quotes Sawka from #312, Sawka & Noakes, but never Noakes.

In #187 Appel (2005), the summary for water has water intoxication as the lead topic. Hyperhydration is the first word in the title of three of its sections. It refers to water toxicity 4 times, and water intox 22 times, including 17 times in its reference titles.

Cheuvront (2014) does not use the phrases or fragments hyper[-]hydra, over[-]hydra, tox, poison, or hyponatremia.

Cheuvront (2014), ACSM's Latest Stand, Fails: It Is Not Comprehensive with Respect to Dehydration

Cheuvront (2014) omits the 1999 paper by Montain, Latzka, and Sawka, above, that responded to the Army’s bad experience with hyponatremia, which the Army attributed to water intoxication. In the 2014 comprehensive survey, Cheuvront, a member of USARIEM for his professional career, and legitimately a spokesman for ASCM, omits Sawka’s research on the failure of Army regulations to prevent dehydration, and Sawka’s recommendation to replace entirely its 1988 MINIMUMs for water intake with MAXIMUMs, a recommendation adopted by the Army and Marines in 2000.

Thus Cheuvront (2014) is not comprehensive with respect to its subject, dehydration because it omits the Army’s retreat from hydration to prevent dehydration. The ACSM spokesmen have failed to rescue ACSM from its misconduct.

Thanks in large part to the work of Timothy Noakes, reinforced by Army experience, fears over dehydration are obsolete, replaced by the rediscovered dangers of water (Gatorade) poisoning — except at ACSM.

End Part II of II.

Russell Greene 03-07-2014 01:31 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Preston,
Our species has drunk water when thirsty since at least 195,000 years pre-Gatorade. Hydration, the activity, is a modern invention. The urge to "hydrate," suggests an effort to consume water at a rate greater than thirst. Hydration can kill.

Gatorade/ACSM advocate the idea that dehydration increases the risk for heatstroke. As usual, this rests on a partial truth. Dehydration has been found to result in a slightly higher temperature. This is not the same as causing heatstroke, however. "Gatoraded physiology," ignores the fact that heatstroke is predominantly a risk during shorter, high intensity activities. Dehydration, in contrast, requires a longer time frame.

Tim Noakes notes in Waterlogged:
"I was able to trace the reports of 1,939 cases of heatstroke in the literature from 1941 to 2008 in running or other forms of exercise. Of these cases, the majority (1,536 cases) were reported in the militaries of various nations with far fewer numbers in football (predominantly U.S. gridiron) (153 cases) and running (137 cases). The only other large number of cases was reported from the South African gold mines (97 cases). The exercise duration measured as distance run was reported in all but two of the cases of heatstroke in those runners or military personnel who developed heatstroke while running ... Eighty-nine percent of all cases occurred in those who ran less than 20 km; 44% occurred at distances less than 10 km. Remarkably, 10% of subjects developed heatstroke even though they had run less than 5 km. The clear observation is that heatstroke is more likely to occur in those running less than 20 km. Since such a large number of athletes now run marathons each year in different locations around the world, the small number of heatstroke cases in marathon runners cannot be because fewer people run marathons than they do shorter distances. Similarly, the frequency of reported distances that military personnel had marched before they developed heatstroke mirrors that found with the runners: Even when marching rather than running, and hence expending less energy than if they were running, the majority of cases (51%) occurred before the subject had marched even 10 km, and 75% occurred in soldiers who had marched less than 20 km. Thus heatstroke is more likely to occur in exercise of short duration, in which dehydration cannot be a factor (Epstein, Moran, et al., 1999)."

Quote:

Originally Posted by Preston Sprimont (Post 1222794)
"Under drinking" seems kind of vague, so I guess it depends on how that's defined... but as far as I know, dehydration (do we have a working definition for dehydration for this discussion yet?) can still pose health risks; and, to my knowledge, there is record of injury and death occurring from dehydration. Again, "under drinking" is not defined here; if defined as less hydration than optimal, sure, there's a good chance there's no evidence of injury and death; if defined as less than necessary, however, I imagine we are entering the realm of health-risk-posing dehydration. But I'm not interested in arguing semantics ad nauseum...
My point is this: let's not demonized hydration. Yes, the GSSI and ACSM have skewed, distorted, and butchered the science, seemingly to their benefit, and have disseminated and advertized and pushed this "information" at the expense of the public's knowledge and of some individuals' health. They are in the wrong here. That has been thoroughly demonstrated. However, hydration is not the enemy. Hydration does not threaten the public health or the health of athletes. Super-hydration to the point of hyponatria is the problem. Yes, we all know hydration is important, and maybe that's why it hasn't received much mention here, but I'd hate to see the responses (which are intended to educate and expose) to the GSSI's and ACSM's erroneous claims and falsified science be tainted by error on the opposite end of the spectrum.
If I am in error in claiming that dehydration poses a health risk, and if hydration is in fact an issue, I'm all ears.

Cliff notes: hydrate, but not too much.

Edit/note: I quoted Coach Glassman here because his succinct statement about over- and under-drinking directly addresses what I wanted to comment on, but my comment is a "reply" to many of the quotes in this thread from a number of users that expressed such a sentiment.


Preston Sprimont 03-07-2014 03:11 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Quote:

Originally Posted by Russell Greene (Post 1222820)
Preston,
Our species has drunk water when thirsty since at least 195,000 years pre-Gatorade. Hydration, the activity, is a modern invention. The urge to "hydrate," suggests an effort to consume water at a rate greater than thirst. Hydration can kill.

I agree, the human body has a wonderful way of figuring things out for itself. When you feel thirsty, drink. When you feel satisfied and your thirst is quenched, stop drinking. However, I was using a different definition of hydration than the one you've suggested here--again, whether I like it or not, I guess it comes down to semantics. I do not think hydration suggests drinking beyond thirst. I consider hydration (the noun) as the absence of dehydration, but not to the point of over-/super-/hyper-hydration (that's why we have all those prefixes); and I consider hydration (the verb) to mean the act of preventing or eliminating dehydration by whatever means (just as when one "wets" something, there is the implication that the thing was previously dry).
Now, how the general public defines hydration, I have no idea. So I guess it's good that definitions are being provided here should someone stumble across it.
So yes, with the definition you provided, hydration can be a bad thing--it is essentially defined as an excess, and we have already shown that excess can jeopardize health. We have also shown that Gatprade's advertising implies a similar, unhealthy definition of hydration.
By my definition, hydration is not a bad thing. In fact, it is a good and necessary thing.



Quote:

Originally Posted by Russell Greene (Post 1222820)
Gatorade/ACSM advocate the idea that dehydration increases the risk for heatstroke. As usual, this rests on a partial truth. Dehydration has been found to result in a slightly higher temperature. This is not the same as causing heatstroke, however. "Gatoraded physiology," ignores the fact that heatstroke is predominantly a risk during shorter, high intensity activities. Dehydration, in contrast, requires a longer time frame.

Tim Noakes notes in Waterlogged:
"I was able to trace the reports of 1,939 cases of heatstroke in the literature from 1941 to 2008 in running or other forms of exercise. Of these cases, the majority (1,536 cases) were reported in the militaries of various nations with far fewer numbers in football (predominantly U.S. gridiron) (153 cases) and running (137 cases). The only other large number of cases was reported from the South African gold mines (97 cases). The exercise duration measured as distance run was reported in all but two of the cases of heatstroke in those runners or military personnel who developed heatstroke while running ... Eighty-nine percent of all cases occurred in those who ran less than 20 km; 44% occurred at distances less than 10 km. Remarkably, 10% of subjects developed heatstroke even though they had run less than 5 km. The clear observation is that heatstroke is more likely to occur in those running less than 20 km. Since such a large number of athletes now run marathons each year in different locations around the world, the small number of heatstroke cases in marathon runners cannot be because fewer people run marathons than they do shorter distances. Similarly, the frequency of reported distances that military personnel had marched before they developed heatstroke mirrors that found with the runners: Even when marching rather than running, and hence expending less energy than if they were running, the majority of cases (51%) occurred before the subject had marched even 10 km, and 75% occurred in soldiers who had marched less than 20 km. Thus heatstroke is more likely to occur in exercise of short duration, in which dehydration cannot be a factor (Epstein, Moran, et al., 1999)."

Thanks for posting that quote. To my knowledge, dehydration and heatstroke are two different things. Often found together, and correlative to each other, but not the same thing, and not causal. This is how I have been considering dehydration in my thoughts and comments.

Christopher Morris 03-08-2014 11:28 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Quote:

Originally Posted by Jeff Glassman (Post 1222795)
Definitional problems

Exercise physiologists almost exclusively refer to a reduction in body water as dehydration, measuring it as the ratio (percent) of body weight loss, impliedly referenced to some set point corresponding to steady state resting. Other physiologists use dehydration to mean a disease with symptoms similar to hyponatremia. Appel (2005), p. 163. Dehydration symptoms begin with thirst, then progress to include dry mouth, oliguria (low urine volume), dark urine, dry or inelastic skin, orthostatic hypotension (light-headedness upon standing) to syncope (fainting), and to confusion, organ damage, coma, and death. See ICD10, E86.0, Dehydration; Merck Manual online.

Sawka Leads the Army To Abandon MINIMUMs for MAXIMUMs

In fact for a decade, the U.S. Army conducted an experiment with hyperhydration, with disastrous results. Since 1988, the U.S. Army regulations set minimums for water intake. They were “At least ½” quarts/hour in the most benign environment, increasing to “At least 1” quarts/hour, then to “At least 1½” quarts/hour, and finally to “More than 2” quarts/hour. So drinking more than 2 quarts/hour would satisfy all conditions.

When I was in the Army I once did five days of field training in Texas in the summer. We were outside in the heat all day doing land navigation, med evac drills, etc. A lot of sweat losses. The drill sergeants encouraged us to drink one canteen of water per hour (one quart or 32 oz per hour). A couple of days into it we were asked to raise our hands if we had followed this recommendation and still felt symptoms of dehydration, despite drinking as much as recommended. More than half raised their hands. We were told that dehydration can happen even when you drink as much as you "should."

I am now convinced we were actually having symptoms of hyponatremia, not dehydration.

One soldier there passed out during land navigation and was found unconscious by another soldier. He was disoriented and didn't remember where he was or why he was there. He was taken to the hospital and fully recovered. I don't know whether he was following the 1 quart/hour recommendation or not. He may have had hyponatremia or dehydration, as you point out the symptoms can be very similar.

Sean McCue 03-08-2014 11:36 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
If there are still copies of the book available I would appreciate a copy.

on the list! ~Lynne

Russell Berger 03-09-2014 09:45 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Some personal anecdote on this subject.

While serving in the Army, I regularly experienced periods of difficult labor in extreme heat. Two contrasting experiences stand out in my mind.
The first was during the final phase of Ranger School on Eglin AFB (FL) during the month of July. The heat was oppressive, and the cadre were in full "heat injury" prevention mode. We were instructed to drink profusely, and were given oral rehydration salts (ORS) to mix into our water source. These were considered so critical to our well being that you would be immediately kicked out of the course if you were caught wasting or not using your salts. Perhaps we were given ORS packets to supplement our poor diet (because we were being slowly starved), but my current understanding is that these packets were thought of as a way to avoid hyponatermia in those that were still being told to drink profusely and ahead of thirst.

During the few weeks I spent in the swamps, I remember at least two individuals in my class becoming what we generically referred to as "heat casualties." The first was a medic from battalion, who surely knew better than most the importance of staying hydrated and consuming his ORS packets. What I didn't find strange at the time, and now recognize as telling, was that his symptoms (confusion, disorientation, memory loss) began at sundown, well after the hottest part of the day had passed. Our initial reaction was to provide him with more fluid (something we had witnessed him drinking regularly) and amazingly, we didn't recognize his complete lack of thirst as a sign that his condition had nothing to do with dehydration.
Needless to say, he remained confused and disoriented until taken by the cadre medical team and infused with what I believe was a hypertonic IV solution. This type of "heat injury" was surprisingly common during this time, and at least one student died during the first phase of Ranger school in July under similar conditions.

In the summer of 2007, I had a very different experience with hydration. My platoon flew out of Ramadi one night in June and conducted a raid in a rural area of Norther Iraq. These night missions were typical for us, and lasted a few hours at most. On this particular night, we did not find our target, and the call was made for us to "stay over day" in an attempt to locate him in the small village during the next 24 hour period. This was unusual, and our unit was prepared for a few hours of night operations, not 24 hours of operations in oppressive desert heat.

Amazingly, our early-morning resupply consisted of only a few bottles of water, batteries, and a pallet of pop-tarts. By daylight many of us were out of water and yet these few bottles were meant to suffice for the roughly 40 men on the ground.

The morning and early afternoon saw our squads patrolling the village in the heat, searching for our target. We rationed our fluids as best possible, but by noon almost everyone was out of water. This mean almost no fluids for hours, and most of us had never sweat so much in our lives. The situation was looking bad, so we quit the search and camped out in the original target until we took fire and had to move to a more defensible position. By late afternoon I had never been more thirsty in my life. This was the same heat, and type of work I had experienced many other times in training, but our symptoms were completely different. None of us were confused. None of us had memory loss or disorientation. All of us were just extremely thirsty.
By late afternoon we knew, by our incredible thirst, that things were getting serious. We broke into a small cement shop on the side of the road and stole a few liter size bottles of air-temperature Pepsi imported from Saudi Arabia. I chugged that warm pepsi. It was the most refreshing and delicious thing I have ever tasted. That is what real dehydration does to you.

These two examples, to me, show the difference between the imagined threat of dehydration/heat injury in the presence of ample fluids, and real dehydration caused by insufficient fluid intake. We had no "heat injuries" or casualties of any kind during this mission, and yet in training I constantly experienced a predictable number of casualties from "heat injury" who had access to as much fluid (and electrolyte enhanced fluid) as they could drink.
What Noake's has proposed regarding hydration in his book better explains the evidence from my personal experience than any of the competing theories I have read.

1. Drinking as thirst dictates is not only safer than drinking water "ahead of thirst", but also electrolyte enhanced water.
2. Drinking "ahead of thirst" or to try to prevent any % of dehydration is a dangerous recipe for hyponatremia.
3. And most obvious, the defining symptom of true dehydration is thirst. Incredible, unquenchable thirst.

Jeff Glassman 03-09-2014 10:37 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Quote:

Originally Posted by Dakota Base (Post 1220419)
#22: What I read from this is that you're calling anyone that isn't as passionate about your "war" on so-called "big soda" as yourself uneducated or unintelligent. … As I stated before, know what you're drinking, and why you're drinking it, and assume anyone that profits from information skewed the information in their favor, and assume that anyone that DOESN'T profit from information may have made a mistake.

Part I of II

Good Libertarian-think. Caveat emptor uber alles.

Science Illiteracy: a Postmodern Art

But pitifully few emptors anywhere in the world can caveat. They aren’t equipped to judge scientific claims, including especially two varieties: Madison Avenue science, and science validated by peer review or consensus. Large numbers of PhDs in the physical sciences, and related fields like medicine, lack basic scientific literacy for a simple pair of reasons – their parent’s lacked scientific literacy, and it is not taught in schools.

An exalted science professor was challenged on that point by a colleague at a seminar. The colleague urged, “One can’t teach a subject if he can’t define it!” The revered professor famously answered, "Science is like love — I can't define it, but I know it when I see it." Thus, science, or more precisely the science of science, was, as Post Modern climatologists are wont to say, settled.

Since the end of World War II, academia has taken the easy route. It has left budding scientists to watch, to osmose from examples, to deduce for themselves as the learned professor deduced for himself but was unable to teach. If these pupils stay in the publish-or-perish world of academia, they're on their way to be becoming full fledged Popperians, i.e., Post Modern Scientists, where scientific models don't actually have to work!

Modern Science Wins in the End

But the chickens will come home to roost. Modern Science always gets the last laugh. Even with all prescribed conditions met, the Beautiful Blue Planet refuses actually to warm. Distance runners will, as Dakota Base observes, mistakenly drink to make the prescribed minimums, only to sicken, some to die. This is where reality trumps both Post Modern Science and caveat emptor.

Popperians seem unaware that they are academically cloistered, moles who pop up in papers published (publish: to make public) in doctrinaire scientific journals. From this enclave, Popperians, their associations, and their publishers claim a consensus validating their dogma, ripe to cultivate for fame, for profit, and for power. As Richard Horton, MD, editor of the Lancet, once said in a lucid moment,
Peer review as a reliable technique for assessing the validity of scientific data is surely discredited. ¶ The mistake, of course, is to have thought that peer review was any more than a crude means of discovering the acceptability – not the validity – of a new finding. Editors and scientists alike insist on the pivotal importance of peer review. We portray peer review to the public as a quasi-sacred process that helps to make science our most objective truth teller. But we know that the system of peer review is biased, unjust, unaccountable, incomplete, easily fixed [jiggered, not repaired], often insulting, usually ignorant, occasionally foolish, and frequently wrong. Richard Horton, Editor, The Lancet, London, UK, Med.J.Au, 2/21/00.
The Birth of the Paper Mills of Science

But en route to the consensus, an unnamed, opportunistic law of economics comes into play. It goes something like this: Thirty scientists in a department work alone to produce a qualifying paper every few years or so. Hence every few years, each player one adds one to his publication list for promotions. But look what happens if they put all their names of every paper. Then they get credit for 30 papers every few years! Publishing turns into a consensus-forming paper mill.

Some papers come cheap — write a case report! Or, for those with a little more ambition, run some trials; measure what can be (who knows, you might get lucky and measure something significant!); rationalize the effort as supporting the dogma; condense the measurements in a cocoon of esoteric statistics by including a section called “Statistical Analysis”, including a sampling of Fisher exact tests, Pearson product moment analysis, Student’s t-tests, D’Agostino tests, Wilcoxon rank sum tests, Tukey or Newman-Keuls or Dunnett’s post-hoc tests with a Bonferroni adjustment, n-factor ANOVA; but hold back the data lest someone check the work or, worse, its predictions; put everone’s name on it; and presto! Tenure!

How Score Might Be Kept

Of course, if Dr. Smith actually has a contribution to make, something that conceivably could evolve into the Smith Theory or Smith's Law, Smith is not likely to ante up. The more significant the paper, the smaller the committee. Accordingly, the scientific potential of peer-reviewed papers tends to be inversely proportional to the number of authors. In general, an author should get 1/n2 credit for each publication on his CV, one nth for the number of participants, times another nth for the scientific potential. Has there ever been a notable scientific achievement credited to a committee?

Give Sawka one credit for his solo paper in 1962 titled Physiological consequences of hypohydration: Exercise performance and thermoregulation. And give him 1/64 = 0.016 credit for his 2010 paper Effect of hypohydration and altitude exposure on aerobic exercise performance and acute mountain sickness shared with Castellani JW, Muza SR, Cheuvront SN, Sils IV, Fulco CS, Kenefick RW, and Beidleman BA. Sawka subtotal: 1.016 effective papers.

By the forces of scientific illiteracy, promoted by unionized education, the US has led the Western World in producing a largely vulnerable populace, spawning charlatans and conspiracies that wittingly or not, do public harm and with a religious fervor.

Notions like caveat emptor must yield so as not to condone fraud in a practical society. Caveat emptor is sound advice, in extreme a slogan to weaken the bonds individuals have with trusted sources (in law, confidential relationships), and citizens with their government.

Continued.

Jeff Glassman 03-09-2014 11:02 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Quote:

Originally Posted by Dakota Base (Post 1220419)
#22: What I read from this is that you're calling anyone that isn't as passionate about your "war" on so-called "big soda" as yourself uneducated or unintelligent. … As I stated before, know what you're drinking, and why you're drinking it, and assume anyone that profits from information skewed the information in their favor, and assume that anyone that DOESN'T profit from information may have made a mistake.

Part II of II

By the forces of scientific illiteracy, promoted by unionized education, the US has led the Western World in producing a largely vulnerable demographic of victims, spawning charlatans and conspiracies that wittingly or not, do public harm and with a religious fervor.

Notions like caveat emptor must yield so as not to condone fraud in a practical society. Caveat emptor is sound advice, in extreme a slogan to weaken the bonds individuals have with trusted sources (in law, confidential relationships), and citizens with their government.

Libertarianism Is Like Love

Libertarianism is like both science and love — we can’t define it, but we know it when we see it. The boundary between Libertarianism and anarchy is unclear: down with government; down with regulations and whole batches of laws; down with collectives. Utopia in the By and By. Libertarian, no longer a word from liberty, but a word for freedom or better, license, the right to color outside the lines, to do harm to the unwary. Caveat emptor.

Governments are fragile, e.g., the Kaiser, the Third Reich, the Soviet Union v. 0, Somalia, Ukraine, Chicago often, Phenix City once. Taking down governments might satisfy a Libertarian urge, but the lessons learned are indeed expensive when allowed to fester for the sake of feeding the ideal of isolationism.

And don't forget Free Markets, which in Libertarian lingo means laissez faire, utterly unfettered, and monopolistic. The idea is dangerous and counterproductive, but seductive, all other things being equal. But as usual, the other things are not. Free Markets uniquely maximize prosperity when they have the effect of setting prices through competition. Government by its absence or presence plays the key role in whether a market exists for competition.

The Inevitability of Evil and Its Destruction

Man can't stop bands of outlaws from forming in his midsts, like particles clustering in weightlessness, like viruses finding invisible cracks in armor. Like hydrogen, the unregulated cosmic dust, condensing, spinning, compressing, forming stars, and black holes that pin galaxies and grow until they disintegrate cataclysmically into high-power, low-grade cosmic waste, all bound up by dark energy and dark matter, necessary supernaturals to balance our equations, and which may in the last analysis exist to condense into fresh hydrogen, closing a perpetual cycle.

Too little government promotes defenselessness against inevitable sociopolitical onslaughts, toothless and unable to process the lessons of two World Wars, the Cold War, and an aborted War on Terror, a petri dish for the re-ignition of the Cold War and Islamic terrorism. Al Qadea is on the run, and they're coming this way. We need a leader to sic ‘em on Putin.

In society little ideas grow into cataclysms. Bands of marauders range from simple lefties morphed progressively into Marxists then Communists; Brown Shirts turning into the Third Reich; a spectrum of religious cultists that go nova, like Jim Jones to Jonestown, Marshall Applewhite to Heaven’s Gate, environmentalism restoring the epidemic of malaria, Jeremiah Wright to the disintegration of a presidency and a world of hurt. Active cults today include IPCC academics who morphed climatology into the pseudo sciences of CO2-caused global warming and ACSM/USARIEM professors who turned physiology into Gatorade poisoning.

So we form governments and societies with teeth. We organize to match forces with organizations, to fight fire with fire. We have laws, as we must, against the concerted frauds, as with Bernie Madoff, Dan Rostenkowski, and Charles Ponzi.

How & Why We Fight Back

But for the more cultured, more subtle affronts, as with Jan Hendrick Shoen, Andrew Wakefield, Margaret Mead, Charles Dawson, Pons & Fleishman, Mann & Jones, et al., we have guidelines of scientific principles backed by a code of ethics. We have conflict-of-interest oaths, sometimes written into publishers' policies, sometime averred in published papers, and sometimes not. Formal codes don't ban conflicts of interest, but disinfect with sunlight.

Nonetheless, the ethical standards for financial involvement with research are weak. They proscribe direct payment for research, but ignore the ultimate fungible nature of cash. So Gatorade dollars fall into ACSM's left rear pocket, funding the College's publication of an array of journals, doctrine peer-reviewed for the profession. For the exercise scientist, these controlled journals are the medium for conforming studies that advance academic careers, studies that ACSM condenses into sponsor friendly Position Stands. The cash loop is closed and Gatoraded science flourishes.

Humans generally seem to have an instinct to expose such shenanigans. But when the mischief results in people sickening and dying, the spirit rises to a duty, a moral imperative to do what one can before it gets so bad the government comes to help. We start in this thread with a generous dose of sunshine.

Kenny Markwardt 03-09-2014 11:32 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Quote:

Originally Posted by Lynne Pitts (Post 1220322)
To "sweeten the pot" :D CrossFit has 500 copies of Noakes' book available to give to interested parties; reply in this thread if you would like one. We'll grab your email from the admin side, so you don't need to post your email publicly, and our team will contact you for the rest of your information.
Requests so far - will keep this updated, so hit me if I miss you.

Joshua J Grenell
Chris Cooper
Christopher Morris
Dakota Base
Andy Shirley
Russel K Olofson
Teena Escobar
Amy Hollingsworth
Jason Donaldson
Alden Hingle
Christopher E Bloom
Jesse Phillips
Barry Stockbrugger
Ryan Kingsbury
Darrel White
Kirez Reynolds
Darby Darrow
MIchael Wuest
Jason David
Kevin Keast
Joey Dussel
Adam Manery
Robert D Taylor Jr
Mark Lamoree
Greg Whitekettle
Rob McBee
Josh Murphy
William J Mallon

I would love a copy if there are any still available. Thanks in advance!

on the list! ~Lynne

Russell Greene 03-11-2014 10:08 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
The paper "2009 Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance" states:

"hyponatremia (serum sodium concentration less than 130mmol/L) can result from prolonged, heavy sweating with failure to replace sodium, or excessive water intake."

Source: http://www.sportsnutritionworkshop.c...es/53.SPNT.pdf (w/f safe)

This is logically true, but bad science. It clearly displays Gatorade's pernicious influence on hydration guidelines.

Excessive water intake intake can cause hyponatremia (as can excessive Gatorade intake). There is no evidence, however, that "prolonged heavy sweating with failure to replace sodium," absent excessive fluid intake, can cause hyponatremia. That part is baseless.

I can group two statements together with an "or", one accurate and one ridiculous. The entire sentence will still be true, despite one half being false. In logic this is known as a disjunction. The Stanford Encyclopedia of Philosophy states:

"Disjunction is a binary truth-function, the output of which is a sentence true if at least one of the input sentences (disjuncts) is true, and false otherwise."

Source: http://plato.stanford.edu/entries/disjunction/ (w/f safe)

For example, I could accurately state, "ACSM fellow Michael Bergeron is a researcher or a pedophile." Even if he is not a pedophile, the entire sentence holds. Though true, this sentence allows me to insert a false and misleading claim. Through repetition, I can ingrain a connection between Bergeron and pedophilia into your brain.

So, why didn't the researchers just say "hyponatremia (serum sodium concentration less than 130mmol/L) can result from excessive water intake?" Why add the baseless statement? If not evidence, what motivated the authors to associate prolonged sweating with hyponatremia?

PepsiCo, the owner of Gatorade, sponsors the three organizations behind this paper. And, the influence is obvious:

"Sports beverages containing carbohydrates and electrolytes may be consumed before, during, and after exercise to help maintain blood glucose concentration, provide fuel for muscles, and decrease risk of dehydration and hyponatremia."

If excessive drinking, and only excessive drinking, causes hyponatremia, then Gatorade can't possibly solve the problem. It can only be part of the problem. Gatorade only gains if people associate prolonged sweating with hyponatremia through influenced hydration guidelines and research.

Gatorade-funded science follows the evidence to the extent that it can support the consumption of Gatorade. Thus, the ACSM's guidelines present Gatorade as the solution to both dehydration and hyponatremia (i.e. overhydration).

Adam Morden 03-12-2014 09:40 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
If there are still copies available I would love one - I have probably been over-hydrating for years since in school and the military the drink, and drink more, before you're thirsty mantra was hammered into me.

On the list.... Lynne

Alex Kowalewski 03-13-2014 06:46 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I would like a copy of the book please if there are any left! Great resource as a coach to inform members and athletes!

On the list.... Lynne

Mike D Lawson 03-13-2014 11:53 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I would really appreciate a copy of waterlogged if you guys have any left. Thank you very much!


On the list.... Lynne

Greg Boyd 03-13-2014 12:06 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Quote:

Originally Posted by Kenny Markwardt (Post 1223035)
I would love a copy if there are any still available. Thanks in advance!

on the list! ~Lynne

I'll take a copy if there are any left. Thanks!

On the list.... Lynne

Gretchen Ross 03-13-2014 12:08 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Lynne, I would also love a copy of the book if there are copies still available. Thanks!

On the list.... Lynne


All times are GMT -7. The time now is 06:23 PM.

Powered by vBulletin® Version 3.6.8
Copyright ©2000 - 2020, Jelsoft Enterprises Ltd.
CrossFit is a registered trademark of CrossFit Inc.