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-   -   Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM (http://board.crossfit.com/showthread.php?t=86218)

Coach 03-15-2014 11:04 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
If A and B, then ~A or B.

That's the slight of hand. Connect ANY statement (true, false, or meaningless) with an "or" to a true statement, and logically, we have a true statement.

The 2009 ACSM Joint Position Statement is junk science, designed to deceive the exercising public and health/fitness professionals in order to promote Gatorade thirteen years after launch of their deadly hyper-hydration campaign.

It is also recklessly dangerous in light of the published scientific evidence on EAHE, it's etiology, and the past deaths/injuries from EAHE.

The Gatorade/ACSM nexus has been a threat to athletes, the public, health science, fitness science, athletic performance, and human health for as long as it's existed.

Here's the formula for evading the FDA...put your crap on the grocery store shelf without any life-threatening inferences on the label and then pay scientists to prescribe it's consumption at commonly fatal doses, and it all goes unnoticed.

Russell Greene 03-17-2014 12:01 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
One wonders how much Gatorade has paid the ACSM in total over the years. It's hard to find much publicly available information since the ACSM and the ACSM Foundation are both 501(c)(3) organizations.

That said, reporter Oliver Thring found out how much the ACSM was worth to Gatorade in 1992: (link is w/f safe)

"In 1992, Gatorade donated $250,000 to the American College of Sports Medicine, the largest body of its kind, with over 45,000 members. In 1993, Gatorade and the ACSM held a 'roundtable' meeting on 'exercise and fluid replacement'. The results of this were published in 1996 when the ACSM released guidelines claiming that athletes should strive for '0% dehydration' and 'drink as much as tolerable [sic]'."

There is little reason to believe that Gatorade's sponsorship of the ACSM has decreased since then.

Matt A. Windsor 03-17-2014 01:03 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I would also like a copy of the book, if any are still available. :) Thanks!


You're on the list - Regards,
Lynne

Jeffrey Cain 03-17-2014 03:56 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Gatorade is the "Premier" corporate sponsor of ACSM's 2014 Health and Fitness Summit and Exposition in Atlanta on April 1-4, 2014.

http://acsmsummit.org/exhibit-information/supporters/ YOU MUST ANNOTATE ALL LINKS WHETHER WORK AND FAMILY SAFE

Corporate sponsorship benefits include:

"targeted opportunities such as Presenting Rights to the exhibit area, keynote speakers, conference socials, and sessions. Tailored partnerships are available and may
include ACSM member promotions and web advertising."

More here in the sponsor prospectus:

http://acsmsummit.org/wp-content/upl...prospectus.pdf YOU MUST ANNOTATE ALL LINKS WHETHER WORK AND FAMILY SAFE

Richard Deyan 03-17-2014 06:36 PM

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

Originally Posted by Jeffrey Cain (Post 1224379)
Gatorade is the "Premier" corporate sponsor of ACSM's 2014 Health and Fitness Summit and Exposition in Atlanta on April 1-4, 2014.

http://acsmsummit.org/exhibit-information/supporters/

Corporate sponsorship benefits include:

"targeted opportunities such as Presenting Rights to the exhibit area, keynote speakers, conference socials, and sessions. Tailored partnerships are available and may
include ACSM member promotions and web advertising."

More here in the sponsor prospectus:

http://acsmsummit.org/wp-content/upl...prospectus.pdf

And this isn't just ACSM, we are seeing the same kind of companies over the last decade absolutely storm and take over the funding of annual nutrition expo's. Companies like Pepsi, Nestle, General Mills etc. dumping tons of money to sponsor seminars and expo's. Nutritionists are being paid $50,000 by these companies to hold seminars explaining (somehow) that sugar is good for kids and not bad. Absolute corruption. Plain to see why people are not taking the didactic nutritionist route.

Jesse Gray 03-17-2014 08:58 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Didn't read between pages 2 and 16 (because who cares?) but all I can say is THANK YOU!!! The guys over at Science of Sport (wfs) turned my head on this issue a couple years ago and ever since then it has felt like I was on a one man crusade to explain what Coach has summed up so nicely. Gatorade et al created the BS research to sell their product and in the process, changed sport science not only for the worse but in a truly dangerous manner.

Your body has a perfect mechanism for keeping itself hydrated, it's called "thirst". Look it up.

I highly recommend reading all the following links (all are WFS) and if there are any left, I would love a copy of the book! You're on the list - Regards, Lynne

http://www.sportsscientists.com/2013...n-heat-stroke/

http://www.sportsscientists.com/2007...t-of-interest/

http://www.sportsscientists.com/2007...rcise-part-ii/

http://www.sportsscientists.com/2007...cise-part-iii/

http://www.sportsscientists.com/2007...rcise-part-iv/

And once again, thank you to Coach and to CrossFit for having the balls to question the status quo and speak the truth.

Gary Moody 03-18-2014 12:22 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Interesting stuff. If it is not too late, I would like a copy of the book too.

You're on the list - Regards,
Lynne

Steven Wingo 03-19-2014 05:56 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Here is an unfortunate sporting death needing further investigation, occurring immediately following the conclusion of a half marathon. The potential causes are still wide open, but possible hyponatremia needs to be on the list to be considered.

http://www.weather.com/health/virgin...athon-20140318 YOU MUST ANNOTATE ALL LINKS WHETHER WORK AND FAMILY SAFE

Christopher Morris 03-19-2014 07:57 AM

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

Originally Posted by Steven Wingo (Post 1224588)
Here is an unfortunate sporting death needing further investigation, occurring immediately following the conclusion of a half marathon. The potential causes are still wide open, but possible hyponatremia needs to be on the list to be considered.

http://www.weather.com/health/virgin...athon-20140318

I saw this story and immediately thought of hyponatremia. The report sights cardiac arrest as a possible cause, which has been known to happen in young athletes with hypertrophic cardiomyopathy. Unfortunately the first symptom of cardiomyopathy is often death.

It will be interesting to see if more information comes out about her case. Very sad.

Steven Wingo 03-19-2014 08:22 AM

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

Originally Posted by Christopher Morris (Post 1224604)
I saw this story and immediately thought of hyponatremia. The report sights cardiac arrest as a possible cause, which has been known to happen in young athletes with hypertrophic cardiomyopathy. Unfortunately the first symptom of cardiomyopathy is often death.

It will be interesting to see if more information comes out about her case. Very sad.

Cardiomyopathy would definitely be a possibility as well.

In the vast majority of deaths, the immediate cause of death is cardiopulmonary arrest--the heart stops beating. That is almost certainly what happened as the immediate cause in a case such as this one. The key is determining what caused the heart to stop beating. Hyponatremia, if causing death, would do so by causing cardiopulmonary arrest--I'm pretty sure the mechanism is a lack of the electrolytes which are necessary for continued heart function.

I would anticipate they would do an autopsy and also run post-mortem toxicology and lab work which would allow a determination to be made regarding whether hyponatremia was a cause or contributing cause.

Roy Anger 03-25-2014 07:03 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.


Kenny Markwardt

If there are copies left, I would love to get on the list.

You're on the list - Regards,
Lynne

Russell Greene 03-25-2014 02:08 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Most popular wisdom about hydration is wrong; some is hazardous. Take pee. How many times have you heard that darker urine indicates dehydration, and that clearer urine is a sign of adequate hydration?

This one makes sense, at first. Darker urine levels indicate higher concentrations of urine solutes such as urea, uric acid, and creatinine. They do not, however, necessarily indicate blood solute concentrations. Source (w/f safe): http://www.kickthecan.info/files/doc...tsProducts.pdf

Darker, more concentrated urine does not necessarily mean dehydration. And clearer, less concentrated urine does not necessarily mean an athlete is hydrated . The British Medical Journal notes that, "vitamins and medicines interfere with the results by making urine darker, variations in diet and dietary supplements affect accuracy, and, if large volumes of hypotonic drink are consumed following exercise, copious volumes of dilute urine will be produced before normal hydration is achieved."

So, if you take a multivitamin with a glass of water, you may become more hydrated with darker urine. The most important exception to the urine color test, though, is hyponatremia.

Athletes with SIADH (syndrome of inappropriate antidiuretic hormone secretion), may have high antidiuretic hormone levels even though their blood sodium levels are low. They won't pee much, even though they should.

This means that people with SIADH may have darker urine despite being severely over-hydrated and suffering from hyponatremia. If they drink more because of their darker urine, they will worsen their hyponatremia and put themselves at risk for hyponatremic encephalopathy.

In Waterlogged, Noakes explains that "because they have SIADH, athletes with EAH typically excrete concentrated urine even though they are severely overhydrated with blood osmolalities that are greatly reduced (and should be excreting very dilute urine)."

(I don't have my hard copy at hand, so please excuse my lack of page number).

So, what to do? I think Tim Noakes' advice is the best: "You lose water, you get thirsty, you drink. End of story."

No need to stare at urine - unless you're into that sort of thing.

Robert D Taylor Jr 03-25-2014 05:06 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
The difference in color from vitamin pee and "dehydrated" pee is clear.
I wouldn't call the urine color thing an exact measurement, more of a general guide.

I concur with the drink if you're thirsty thing, generally.

Thank you for the book. I look forward to reading it.

Russell Greene 03-26-2014 09:41 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Robert,
I didn't realize that about vitamin pee. It doesn't affect the main point about urine color, though. Of what value is a "guide" that works in reverse when it matters most?

The urine color guide does not work for people at risk for low blood sodium, i.e. those with SIADH. This is a significant portion of the exercising population - it could be around 13%.

Source (w/f safe):
http://www.nejm.org/doi/full/10.1056...articleMethods

I'm looking forward to hearing your thoughts on the book.

Quote:

Originally Posted by Robert D Taylor Jr (Post 1225569)
The difference in color from vitamin pee and "dehydrated" pee is clear.
I wouldn't call the urine color thing an exact measurement, more of a general guide.

I concur with the drink if you're thirsty thing, generally.

Thank you for the book. I look forward to reading it.


Robert D Taylor Jr 03-26-2014 06:18 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Guides are useful if they are kept in context. There are many reasons for urine color hydration being one of them. These guides are useful in like a military gym where folks often believe hoo-yah surpasses hydration. I have genuinely seen people genuinely not know they were thirsty, and it's easy to get too busy while working etc. to drink enough water on say a flight deck. Checking their pee is a good reminder and indicator to drink. I know that overlooks more serious conditions, but the guide is for horses not zebras.

Excellent hydration never helped my work or fitness performance, but dehydration certainly hurt it.

Matt Solomon 03-27-2014 05:05 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Hey Lynne,
any copies of the book still available?

Many thanks

You're on the list - Regards,
Lynne

Kevin Keast 03-29-2014 05:04 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I got my book in the mail today, thanks!

Craig Copeland 04-04-2014 06:49 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
If there are any copies of "Waterlogged" still available, I would greatly appreciate a copy. Thanks to all who have posted info, guidance, science, links, and comments here.

You're on the list - Regards,
Lynne

Alden Hingle 04-06-2014 12:30 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I am really enjoying the book. Good science presented in an easily understandable manner. Thanks again for providing these to us!

Phil Washlow 04-08-2014 11:56 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Lynne if there are copies of the book left I would love one, thanks!

You're on the list - Regards,
Lynne

Preston Sprimont 04-08-2014 02:44 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Received my copy of the book in the mail today. Thanks for the generosity, Crossfit HQ!
Plenty of reading to do now...

Christopher Morris 04-13-2014 10:21 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Early report on a death after the London marathon:

http://news.sky.com/story/1241957/ma...ondon-marathon (wfs)

Of course it's too soon to know the cause in this case. Since learning of EAHE, I'm always going to suspect it when seeing a story like this. I don't think EAHE overhydration deaths are in the forefront of general public knowledge enough. It's not the first thing suspected in media reports.

Russell Greene 04-15-2014 10:30 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Thanks for the link, Chris.

It doesn't look like they know what caused his death yet, but I found this line interesting:

"Runners were advised to take on plenty of water as bright sunshine and light breeze meant conditions were warm, reaching 16C in St James's Park."

16 degrees celsius is equivalent to 61 degrees Farenheit - hardly Saharan conditions.

I also noticed an interesting story from a race in the U.K (w/f safe): "Sheffield Half Marathon water shortage causes chaos"

The water delivery didn't show up, so the organizers canceled the race out of concern for the runners' health. They ran anyway, with some help from a few volunteers spontaneously supplying water.

I haven't heard any reports of injury or death from the race yet. An investigation into the lack of water is ongoing.

Kenny Markwardt 04-15-2014 11:25 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Received my book a few days ago. Just about a chapter or so in. Fascinating stuff. Thank you!

Christopher Morris 04-15-2014 01:50 PM

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

Originally Posted by Russell Greene (Post 1228065)
I also noticed an interesting story from a race in the U.K (w/f safe): "Sheffield Half Marathon water shortage causes chaos"

It looks like the video of the race being canceled shows weather that was not necessarily high risk for dehydration (damp roads, people in jackets, overcast). I understand why the race organizers canceled, but I can also understand why the runners decided, "To heck with it, I'm running anyway."

I would have hopped that Noakes research at the British College of Sports Medicine would have greater influence on the way their races are planned, but it seems that overhydration philosophy is in effect there too.

The link I provided now has a video that names the runner who died in London. The video shows an interview with a doctor where she speculates common causes of athletic event deaths:
- heart problems,
- energy supplements that put extra strain on the heart, or
- dehydration.

Overhydration is not on the radar yet. Keep working at it, HQ. Spread the word.

Andy Shirley 04-22-2014 02:43 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Lynne,
Never saw an email about the book. Maybe got lost in junk mail? Can you resend, I updated my email address.
Thanks!

Hi Andy

I'll ask the support team to re-contact you at the new email addy.

Regards,
Lynne

Christopher Murphy 05-13-2014 03:34 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Hello Lynne, I would like a copy of the book if there are any left. Thanks HQ for the education on this topic.


Best Regards,
Chris Murphy

Hi Chris,

You're on the list.

Regards,
Lynne

Pete Deiwert 06-02-2014 07:17 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Could I get a copy?

Tighe Crovetti 06-02-2014 07:55 AM

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

Very interested in a copy if available!


I have been fighting this battle, ignorant of the science, for a while now. My kids play baseball/softball, I coach with my son's teams. I routinely see players (these are 9-12 y/o's) showing up with one OR TWO 32 oz. of Gatorade/Powerade, for two hours of baseball practice, in 65-degree weather, with parents sending them out of the car with "stay hydrated!!" cries. My wife is one of those people. Heck, sometimes when they are going to simply WATCH a game, there is a last minute out-the-door panic of, "do you have a water bottle?!?!" I keep trying to tell her: I never had water during a game or practice, I drank before I left, and drank after the game, or maybe I would run to a water fountain for a couple ounces at a time. Even during August football camp, we would only get a break every 30 minutes or so, at which time we got to drink about 6-8 ounces of water. There was only one stretch, as a coach, my boys were playing a tournament where they would have multiple games a day, and the temperatures were going to be triple-digit and high humidity: I brought a 5-gallon cooler, about half full of Gatorade (made from powder). More importantly, IMO, I brought a small Playmate cooler with ice water and washcloths, which I still use myself on very hot days (I play on a men's league baseball team).

As far as "what are we doing to fight the fight," I think it can be very simple. Read up on some facts, and disseminate it. Simple things like social media posts, can spread quickly (yes, just like misinformation, unfortunately). If 10 people read my FB wall and read, that they are overhydrating their child, that's a start.

Doug Lantz 06-02-2014 07:18 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
http://www.nbcnews.com/id/16614865/n.../#.U40tuXJdWVo (probably not WFS, disturbing content)

I vividly recall this incident but wasn't aware until now that certain people involved in this "contest" received warnings of this possibility. Probability is moire like it.

I also vividly recall reading as a young boy in a LIFE science book about water poisoning, it was along the lines of "drinking a gallon of water can kill you"

I believe this ties right in with the "8 glasses of water per day" that's been around for decades but no one seems to know from where it came. Maybe the Gatorade / ACSM made it up ? ?

I'd like a copy of "Waterlogged" if you have any more of the 500.

Russell Greene 08-20-2014 06:54 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
On August 6th Zyrees Oliver, a 17-year old with a 3.8 GPA, attended high school football practice in the 90-degree Georgia summer heat. Five days later, he died in the hospital.

But it wasn’t the heat that got him.

During practice, Zyrees complained of cramps. His aunt Dr. Tammy Chavis reports that he drank approximately 2 gallons of water, and two gallons of Gatorade. It’s not clear if his excessive drinking preceded or followed the cramps.

I am not sure if anyone precisely measured Zyrees’ fluid consumption, so take that 4 gallon figure with a healthy dose of electrolytes. And as of right now we don’t know the full story behind Zyrees’ death. Perhaps something in addition to over-hydration played a role. When the autopsy comes out, we’ll know more.

Nonetheless, the press reports that “Relatives said doctors told them Oliver suffered massive swelling around the brain from overhydration.” They also indicated that he had water intoxication (over-hydration). In other words, it sounds like Zyrees died from exercise associated hyponatremic encephalopathy (EAHE).

For more please visit:
http://therussells.crossfit.com/2014...ion-and-death/ (link is w/f safe)

Jon Fuller 08-20-2014 07:38 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Would also like to read a copy of the book.

Alexander Granick 08-21-2014 07:41 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I would like to read this book.

Christopher Morris 08-21-2014 10:13 AM

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

Originally Posted by Steven Wingo (Post 1224588)
Here is an unfortunate sporting death needing further investigation, occurring immediately following the conclusion of a half marathon. The potential causes are still wide open, but possible hyponatremia needs to be on the list to be considered.

http://www.weather.com/health/virgin...athon-20140318

Quote:

Originally Posted by Christopher Morris (Post 1227920)
Early report on a death after the London marathon:

http://news.sky.com/story/1241957/ma...ondon-marathon (wfs)

Of course it's too soon to know the cause in this case. Since learning of EAHE, I'm always going to suspect it when seeing a story like this. I don't think EAHE overhydration deaths are in the forefront of general public knowledge enough. It's not the first thing suspected in media reports.

We've discussed two cases of death and long distance running in this thread. An update on Cameron Gallagher reports she died of an irregular heartbeat and dehydration caused by physical exertion. She did not die of EAHE. If she had died of EAHE, swelling in the brain would be apparent to the medical examiner.

http://wtvr.com/2014/07/14/cameron-g...ause-of-death/ (wfs)

I can't find any updated report on Robert Berry.

Darryl Shaw 08-21-2014 11:17 AM

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

Originally Posted by Russell Greene (Post 1240481)
On August 6th Zyrees Oliver, a 17-year old with a 3.8 GPA, attended high school football practice in the 90-degree Georgia summer heat. Five days later, he died in the hospital.

But it wasn’t the heat that got him.

During practice, Zyrees complained of cramps. His aunt Dr. Tammy Chavis reports that he drank approximately 2 gallons of water, and two gallons of Gatorade. It’s not clear if his excessive drinking preceded or followed the cramps.

I am not sure if anyone precisely measured Zyrees’ fluid consumption, so take that 4 gallon figure with a healthy dose of electrolytes. And as of right now we don’t know the full story behind Zyrees’ death. Perhaps something in addition to over-hydration played a role. When the autopsy comes out, we’ll know more.

Nonetheless, the press reports that “Relatives said doctors told them Oliver suffered massive swelling around the brain from overhydration.” They also indicated that he had water intoxication (over-hydration). In other words, it sounds like Zyrees died from exercise associated hyponatremic encephalopathy (EAHE).

For more please visit:
http://therussells.crossfit.com/2014...ion-and-death/ (link is w/f safe)

From your blog post -

Quote:

Zyrees did not die from an unpredictable accident, or an act of nature. His death was a predictable consequence of excessive hydration and extreme hyponatremia. With the right hydration guidelines made public to all coaches and athletes, he may have survived today.
From the comments in your blog post -

Quote:

Originally Posted by Russell Berger
A kid has died because of the perpetuation of a myth that was exposed over a decade ago. There is no excuse for NATA sitting around waiting for consensus before they change what are effectively life-threatening recommendations. If their organization is so ineffectively slow on issues of this magnitude, I suggest they disband and find something else to do."

Using a childs death to support your anti ACSM/Gatorade agenda is in really poor taste. Might I suggest you edit this post and remove this comment and wait until the autopsy results are known before exploiting this tragedy for your own (CrossFit's) aims?

Christopher Morris 08-21-2014 06:03 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I'm a little puzzled by your comments, Darryl. The way I understand it, they're using a child's death to avoid other preventable deaths. That doesn't seem in poor taste to me.

I also don't see that CrossFit HQ has much to gain from this campaign. They're encouraging good research, good recommendations, and safer hydration.

Darryl Shaw 08-22-2014 04:00 AM

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

Originally Posted by Christopher Morris (Post 1240565)
I'm a little puzzled by your comments, Darryl. The way I understand it, they're using a child's death to avoid other preventable deaths. That doesn't seem in poor taste to me.

I also don't see that CrossFit HQ has much to gain from this campaign. They're encouraging good research, good recommendations, and safer hydration.

While I am happy to support any campaign that highlights the risks of over-hydration it must be evidence based if it is to be taken seriously. Therefore, using this childs death to further this campaign before the cause of death has been established is simply indefensible, and I hope 'The Russells' have the decency to either edit their blog or remove that post until after the autopsy results are known.

Christopher Morris 08-22-2014 10:05 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Okay, I see your point. My comment before was to follow up on previous cases discussed in this thread, and it takes months for autopsy reports to come out. I fear that the media loses interest in a late autopsy report, but I do hope they follow up.

Christopher Morris 08-23-2014 08:45 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Here are a few things I've learned from Tim Noakes' book Waterlogged so far:

- those who die from EAHE have a metabolic disfunction caused by genetics
- our bodies are extremely efficient at storing and processing salt
- most cases of heat stroke are not due to dehydration.

Genetic disfunction
Pages 4-5 (beginning with the last paragraph on 4) describe the metabolism of EAHE. Exercise/profuse sweat and overhydration are conflicting signals to the body. Which signal wins determines if overhydration will kill you.

Exercise/profuse sweat causes:
- reduction in total body water
- increased sodium concentrations
- kidneys retain water and excrete sodium

The book goes on at length about how a loss of 2-3% body weight due to sweat has been the norm in endurance sports, and up to 6% can be within tolerance without heat injury.

Overhydration causes:
- fluid loss through kidneys

The amount of fluid the kidneys excrete is controlled by antidiuretic hormone (ADH). Some people have Syndrome of Inappropriate ADH (SIADH), which the book calls a genetic disfunction. The ADH signal is telling the kidneys to retain water when it should be excreting water (as in times of overhydration). You don't really know if you are genetically disposed to ADH malfunction, EAHE, and death until you overhydrate. Better not to overhydrate either way.

Even without genetic SIADH, I wonder if you could die of EAHE in certain conditions (low to moderate exercise, overhydration, cool damp weather), or would appropriate kidney function keep you safe? The state of exercise with enough intensity to produce excessive sweat also tends to diminish the desire to drink; the book cites circumstances where runners won a marathon without drinking at all during the race. If you're jogging at a slow to moderate pace and can stomach drinking 40 oz. per hour, you're don't need that much fluid.

Salt

Hydration science in question says we are at risk of dehydration and heat injury if we don't intake more salt and other electrolytes during exercise. The book counters that this thinking is flawed because of misunderstanding about how our bodies store and use salt, and also the connection between dehydration and heat injury.

The first three pages of chapter 4 blew my mind on the history of salt. Later the book cites studies where salt intake and sweat loss are measured for a long period of time. There were days that subjects lost more in salt that the took in, proving that the body is highly efficient at storing salt for later use. The details about this provided by the book really cast doubt on any urgent need for any salt intake during a relatively short exersion (like a two and a half hour marathon).

Heat injury not connected to dehydration

From page 160: "Most cases of heatstroke occur within 60 minutes of the start of exercise... 'Dangerous dehydration,' a term favored by some scientists working with the sports drink industry, could not have been a factor, since such dehydration requires at least 3 hours to develop." This case is made by citing multiple studies.

So if dehydration is not connected to heat injury, and our bodies are actually very efficient at storing and using salt, then the need for immediate and continuous electrolyte hydration is in question.

As I continue to make my way through the book I still have questions.
Is drinking a hypertonic fluid helpful in exercise and EAHE? We know that a hypertonic IV fluid of 3% sodium is helpful in EAHE, but I wonder about digestion's effect on hypertonics and if they're actually helpful.

If we follow the "Drink when you're thirsty," guideline, will that have any effect on the development of kidney stones? Kidney stones may be more a function of diet and overhydration is meant to overcome a poor diet in kidney stone prevention.

Russell Greene 08-25-2014 11:12 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
If you have received your copy of Waterlogged then you may be familiar with Dr. Sandra Fowkes Godek. She has a blurb on the back cover and her research is cited throughout the book. Dr. Godek's resume is available here, but some of the highlights are she is Director of the HEAT Institute at West Chester University and she works with NFL, NHL, and college teams on electrolyte balance and hydration. And she has worked as a reviewer for both the ACSM and NATA. In other words, she is one of the world's foremost experts on sports hydration and standard hydration guidelines.

Our work caught the attention of Dr. Godek last week. She posted the following comment to TheRussells.CrossFit.com. I have since been in contact with both Dr. Godek and Zyrees Oliver's family. You can read more of Dr. Godek's thoughts on this tragedy on her Facebook page . She is also working on an article. Stay tuned. This is just beginning.

I am so sorry I have been out of the loop since posting nearly continuously on FB last week about Zyree’s unfortunate and completely preventable tragic death due to over-drinking. The HEAT Institute at West Chester University has actually been deep in extensive data collection on this very issue (fluid and electrolyte balance) in collegiate football players (which is by the way who we are talking about – football players).

The very thought of EAH and EAHE finding it’s way into the sport of football (there was another death of a high school player from CA a few years ago and a case study of an NFL player hospitalized for EAH as well) is mind-boggling and can only be explained by the constant reminder from the media and marketing giants, who do sponsor NATA and ACSM, with millions if not billions of dollars. Any athletic trainer who doesn’t believe that NATA and it’s leaders and “experts” on this issue (who have a very close “affiliation” with the sports drink industry) is not at all biased by that “affiliation” is terribly naive.

I invite those skeptics on this issue to do some close background checking to see how may of the original authors of the NATA position statement on fluid replacement, and for that matter the one on exertional heat illness have direct ties (paid or “research supported”) by Gatorade/PepsiCo or in the past the Quaker Oats company. Beware however – if you don’t want certain expert names to appear on your list, don’t dig too deep!!!

My biggest issue is how much the sports drink industry has influenced the publication of “pseudo-science” papers and the outright censorship of others that might question the “drink ahead of thirst”, “drink beyond thirst” dogma that has existed for several decades. Might I add – Tim Noakes began warning sports medicine professional about the problems related to overdrinking long before 1998. His first paper about hyponatremia was published in 1981. Not by chance – Gatorade and the GSSI would never think to acknowledge that this might be a problem – even decades later.


(links are w/f safe)


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