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

Dale F. Saran 02-25-2014 02:47 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Christopher - I'm on a plane at the moment, so my interwebz are spotty, but if you search the British Journal of Sports Medicine site (and I can't remember now if I was behind a paywall or I got a 30 day trial for free or something), you get this amazing back and forth between Dr. Noakes and the ACSM detractors who are attacking his work in the editorials. It's almost like watching a debate, except in "slow time," but now that we're years past, you can just read through them rapid fire, as Noakes points out the various studies, the hydration science perversion, etc. And then, there's finally the New England Journal of Medicine Publication that basically proves the point Noakes has been making all along, only NOW it's the NEMJ who's weighed in after a study of runners at the Boston Marathon. The ACSM has this kind of half-hearted withdrawal, then "non-argument" ("Of course we agree with the consensus paper...") followed by a claim that we'll still not know how many lives have been saved from heatstroke by [ahem, a certain sugary beverage] the prior hydration "science." When I get home tonight I'll see if I can't find the links to the various papers, then editorials. It's an amazing read, but it's also tragic when you transpose the dates of death and injuries on top of the editorials. The postscript is Noakes pointing out that it took a publication like the NEMJ and a study of Boston Marathon finishers to finally make a difference, as opposed to his and Speedy's work (and others before him) that had already staved off the harm years earlier in New Zealand and South Africa.

Adam Manery 02-25-2014 02:51 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
This thread has certainly gone in an interesting direction, but I am interested in a copy of the book if one is still available Lynne. [COLOR="Blue"][I]on the list - Lynne[/I][/COLOR]

[QUOTE=Lynne Pitts;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[/QUOTE]

Christopher Morris 02-25-2014 04:33 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Dale,
I have started looking through the BJSM for articles by Noakes since you referenced it. I'll find the editorial apology eventually. I didn't know if had come from another source.

A list of articles that shows the back and forth of the debate would be helpful, but would involve a lot of legwork (unless you've already made such a list in the lead up to this call out). Otherwise I'll make my way through what I can find.

Brad Allen Jones 02-25-2014 05:08 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Robert D Taylor Jr;1220631]Doc,

That's different than I was taught (at EMT school, TCCC, and by 18D corpsmen). Where did you get that gouge? HM A school? Was that before or after the Take Motrin, Drink water, Change your socks class? ;)

The way I learned it was:
IV

rectal

drink.[/QUOTE]


Robert,

The way we were taught here is that of they able to drink water that is always preferred over getting IV access because, not only did it save you time, it hydrates you better (although IV is obviously preferred if it is severe dehydration or hypovolemic shock). This is what is taught at FMSS... I can't find the reference right now but it was something like 30% of fluid is retained IV and 90% orally (when I confirm this I'll let you know).

Just out of curiosity when did you recieve this training? 18D's obviously know what they are talking about.

Also, if people would change their socks more often they wouldn't have to worry about this overhydrating electrolyte B.S. ;)

Brad Allen Jones 02-25-2014 05:23 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Dale F. Saran;1220862]Crap - never mind. At some point in a thousand posts if you've never once added to the collective efforts there's only one conclusion: trolling.[/QUOTE]

Yes, two of the most helpful people on the boards recently are banned because they disagree with something that the founder posted. Good discussion though.

Robert D Taylor Jr 02-25-2014 07:17 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Brad Allen Jones;1221068]Robert,

The way we were taught here is that of they able to drink water that is always preferred over getting IV access because, not only did it save you time, it hydrates you better (although IV is obviously preferred if it is severe dehydration or hypovolemic shock). This is what is taught at FMSS... I can't find the reference right now but it was something like 30% of fluid is retained IV and 90% orally (when I confirm this I'll let you know).

Just out of curiosity when did you recieve this training? 18D's obviously know what they are talking about.

Also, if people would change their socks more often they wouldn't have to worry about this overhydrating electrolyte B.S. ;)[/QUOTE]

I was an assistant detachment medical rep for a Mark V SOC det at SBT-20 from 98-04. Lots of training with 18Ds there. Admittedly that's a little bit dated information and obviously drinking is always better than letting the hungover SEAL Corpsman try to find your shrunken vein. :)

You're probably right about the socks.

Robert D Taylor Jr 02-25-2014 07:19 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Lynne can I please get a book? Thanks.

[COLOR="Blue"][I]on the list - Lynne[/I][/COLOR]

Brad Allen Jones 02-26-2014 01:28 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Robert D Taylor Jr;1221085]I was an assistant detachment medical rep for a Mark V SOC det at SBT-20 from 98-04. Lots of training with 18Ds there. Admittedly that's a little bit dated information and obviously drinking is always better than letting the hungover SEAL Corpsman try to find your shrunken vein. :)

You're probably right about the socks.[/QUOTE]

Just don't let then do it WHILE drinking!

Brian Mulvaney 02-26-2014 05:57 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Brad Allen Jones;1221072]Yes, two of the most helpful people on the boards recently are banned because they disagree with something that the founder posted.[/QUOTE]

Brad, I've been disagreeing with the founder for over a decade--often vehemently. He's got boundless energy for disagreement: disagreement is an opportunity for debate, discussion and synthesis. Or even an opportunity to simply agree to disagree. Lack of collegiality, however, can and will get you shown the door.

Russell Greene 02-26-2014 10:17 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Here are some sources that may enlighten the debate. I hope commenters will begin to research the matter, instead of asking why CrossFit cares about bad science and unnecessary deaths.

1996: [B]“American College of Sports Medicine position stand. Heat and cold illnesses during distance running.”[/B]
[url]http://www.ncbi.nlm.nih.gov/pubmed/8970149[/url]

This is the Gatorade/ACSM document that recommends drinking "as much as tolerable" during exercise. Note that Cynthia Lucero and the 11 other confirmed EAH kills all must have found their drinking rates tolerable.

2006:
[B]"Case proven: exercise associated hyponatraemia is due to overdrinking. So why did it take 20 years before the original evidence was accepted?"[/B]
[url]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564296/[/url]
by Noakes and Speedy
Quote:
"In 1996 the American College of Sports Medicine (ACSM), an organisation whose only two 'platinum' sponsors are Gatorade and the Gatorade Sports Science Institute (GSSI), produced its modified guidelines, which promoted the concept that subjects should drink 'as much as tolerable' during exercise. This was linked to an extensive marketing campaign, directed by the sports drink industry through the GSSI, to promote this novel dogma."

2007:
[B]"Drinking guidelines for exercise: what evidence is there that athletes should drink 'as much as tolerable', "to replace the weight lost during exercise" or 'ad libitum'?"[/B]
[url]http://www.ncbi.nlm.nih.gov/pubmed/17454546/[/url]
Prior to the release of the new Gatorade/ACSM guidelines later that year, Tim Noakes states:
"The most recent (1996) drinking guidelines of the American College of Sports Medicine (ACSM) propose that athletes should drink 'as much as tolerable' during exercise. Since some individuals can tolerate rates of free water ingestion that exceed their rates of free water loss during exercise, this advice has caused some to overdrink leading to water retention, weight gain and, in a few, death from exercise-associated hyponatraemic encephalopathy."

2007:
[B][B]"Manufactured arguments: turning consensus into controversy does not advance science"
[/B][/B][url]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658914/#ref1[/url]
Gatorade/ACSM's Billy Murray defends the 1996 position stand.
He says that it does not advocate drinking "as much as tolerable," even though those exact words are found in the text.

2007:
[B]"American College of Sports Medicine position stand. Exercise and fluid replacement."
[/B]
[url]http://www.ncbi.nlm.nih.gov/pubmed/17277604[/url]
Here the Gatorade/ACSM document that finally lowered their drinking recommendations, modifying their 1996 stance. This was 6 years after Cynthia Lucero died, and 26 years after the first death from exercise associated hyponatremic encephalopathy. A bit late.

Russell Greene 02-26-2014 01:03 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Sorry, the ignominious 2007 "Manufactured arguments" letter was by Bob, not Billy, Murray.

Mark Lamoree 02-26-2014 01:11 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
This is an interesting discussion, although I must admit that I don't feel educated enough to comment. The first question that came to mind for me is, "How does consuming gatorade, which should at least be isotonic, if not hypertonic, lead to sodium loss?" I presume that the excretion of excess fluid pushes out more salt than is being taken in, but I'm not sure what the mechanism would be.

Given that, I'd like to educate myself with a copy of the book, if any are available. Please and thank you.

[COLOR="Blue"][I]on the list - Lynne[/I][/COLOR]

Brian Chontosh 02-26-2014 01:37 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Gatorade is 'hypo' tonic. More so than a standard IV; which itself is an issue when treating EAH and EAHE.

This simple confusion right here is what has masses of athletes so easily confused. It really falls right into the strategy of the sports drink industry.

For a solution to be 'hyper' tonic it would be beyond tolerable taste thresholds. Thus necessitating intravenous administration.

Christopher Morris 02-26-2014 01:41 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Perfect! I've glanced over these links, and there will be some interesting discussion points, for sure.

I'm going to do some reading...

Mark Lamoree 02-26-2014 01:43 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=brian chontosh;1221227]Gatorade is 'hypo' tonic. More so than a standard IV; which itself is an issue when treating EAH and EAHE.

This simple confusion right here is what has masses of athletes so easily confused. It really falls right into the strategy of the sports drink industry.

For a solution to be 'hyper' tonic it would be beyond tolerable taste thresholds. Thus necessitating intravenous administration.[/QUOTE]

That makes sense. I've tasted isotonic 0.9% NS IV fluid (I'm a curious guy), and found it way too salty. I presumed that the boatload of sugar in Gatorade was meant to cover that taste.
Thanks for the info.

Russell Greene 02-26-2014 01:51 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Mark Lamoree;1221222]This is an interesting discussion, although I must admit that I don't feel educated enough to comment. The first question that came to mind for me is, "How does consuming gatorade, which should at least be isotonic, if not hypertonic, lead to sodium loss?" I presume that the excretion of excess fluid pushes out more salt than is being taken in, but I'm not sure what the mechanism would be.

Given that, I'd like to educate myself with a copy of the book, if any are available. Please and thank you.[/QUOTE]

Gatorade is hypotonic.

As Gatorade's Bob Murray has said, "overdrinking is the root cause of most cases of exercise‐associated hyponatraemia." Source (w/f safe) [url]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658914/[/url]

Overdrinking of both Gatorade and water can dilute blood sodium levels below 135mmol/L, causing hyponatremia and possibly killing the athlete.

For example, excessive Gatorade consumption killed Cynthia Lucero. Source: [url]http://www.apnewsarchive.com/2002/Fluid-Cited-in-Marathoner-s-Death/id-424edce6ed89d8adcb14d4d97c0448a3[/url] (w/f safe)

Greg Whitekettle 02-26-2014 03:54 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
This is a really interesting thread / topic. I would love to get a copy of Waterlogged if there are any still available.

Thank you!

[COLOR="Blue"][I]on the list - Lynne[/I][/COLOR]

Alden Hingle 02-26-2014 07:24 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I've been following this thread with great interest and remembered today that we lost a Marine at Quantico to overhydration in 2001. I looked it up and learned that three service members are among the documented deaths. An Air Force member in 1999, a Soldier in 2000 and the Marine in 2001. The deaths were documented in "Military Medicine" 2002; 167: 432-434.

Christopher E Bloom 02-27-2014 12:47 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Russell Greene;1221182]Here are some sources that may enlighten the debate.[/QUOTE]

Russell,
Thanks for the great references. I'm in a Graduate Sport and Health Science program and this is some excellent discussion material for my class!!! I'm sure this will prompt some enlightening conversations among my classmates!

-Chris

Andy Shirley 02-27-2014 02:15 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Gatorade is pretty isotonic. So is 5%dextrose in water, with absolutely no sodium at all. The relative amounts of sodium are what are relevant for cerebral edema(hyponatremic encephalopathy), which is why in my earlier post I said we consider Gatorade to be roughly equal to water in our patients on fluid and free water restrictions.

Hypertonic fluids are pretty foul, but not that bad. I've tasted 3% saline and 23% hypertonic saline(normal saline is 0.9%). Hypertonic solutions also cause terrible diarhea when consumed PO(by mouth) from the osmotic gradient, which is one reason why they are given IV.

Normal saline is slightly higher than serum sodium at 154meq/liter, compared to normal serum sodium of 135-145.

[QUOTE=brian chontosh;1221227]Gatorade is 'hypo' tonic. More so than a standard IV; which itself is an issue when treating EAH and EAHE.

This simple confusion right here is what has masses of athletes so easily confused. It really falls right into the strategy of the sports drink industry.

For a solution to be 'hyper' tonic it would be beyond tolerable taste thresholds. Thus necessitating intravenous administration.[/QUOTE]

Brian Chontosh 02-27-2014 10:14 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Andy Shirley;1221326]Gatorade is pretty isotonic. So is 5%dextrose in water, with absolutely no sodium at all. The relative amounts of sodium are what are relevant for cerebral edema(hyponatremic encephalopathy), which is why in my earlier post I said we consider Gatorade to be roughly equal to water in our patients on fluid and free water restrictions.

Hypertonic fluids are pretty foul, but not that bad. I've tasted 3% saline and 23% hypertonic saline(normal saline is 0.9%). Hypertonic solutions also cause terrible diarhea when consumed PO(by mouth) from the osmotic gradient, which is one reason why they are given IV.

Normal saline is slightly higher than serum sodium at 154meq/liter, compared to normal serum sodium of 135-145.[/QUOTE]


Andy, it is my understanding that Gatorade can have anywhere from 270-800mg Sodium per liter of solution (I suppose depending on the formula and generation of product). A standard .9% Saline IV has 9g of NaCl.

I'm not a scientist, mathematician, of doctor so if someone would like to just come in and trump me up I'm offering:

For .9% Saline
Molecular mass of Sodium = 23mg/mmol and Chloride is 35.4mg/mmol.
9000mg / 23mg/mmol = 391

For Gatorade (sodium considerations, I'm not interested in Glucose)
270mg (800mg) / 23mg/mmol = 11.7 (34.7)

It looks to me that Gatorade is 'hypo'tonic to a standard saline IV in regards to sodium. True? Isn't blood plasma ~134? If I am missing something, I apologize.

Christopher Morris 02-27-2014 10:26 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Andy and Brian,
What is the effect of a hypotonic P.O. fluid, then? The osmotic gradient would draw fluid from the digestive tract into the circulatory system of the body. From the circulatory system the fluids would either hydrate tissue or be excreted in the kidneys.

If the appropriate amount of sodium in the Gatorade is also getting absorbed, it would keep the sodium levels in the body constant. Normal sodium levels are 135-147 milliequivalents/L. If excessive fluid is being absorbed and diluting the sodium in the body, this would cause hyponatremia and its consequences. Severe hyponatremia is less than 120 mEq/L.

I'm just thinking this through.

Drinking too much Gatorade has caused hyponatremia. Drinking too much water would also cause hyponatremia. Would a moderate amount of Gatorade be beneficial over water? In the cases of hyponatremia deaths, were the victims drinking both Gatorade and water?

Brian Chontosh 02-27-2014 11:14 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Every time I try to wrap my head around the science it starts to hurt. My background doesn't fairly allow to dig into a cursory understanding of the biochemistry of AVP/ADH and such. I'll leave this for someone with the credentials to tackle it.

However, the reductionist in me wants to refocus the point: Overhydration is the issue. Let's not conflate tonicity, heat illness, or CHO consumption to increase performance.

Overhydration is killing.

Before the ACSM/GSSI changed the rules on hydration this disease (EAH & EAHE) didn't appear to exist. The first reported case was 1981. This disease was created when endurance athletes started consuming excessive fluids. It doesn't matter if the fluid is water or sports drink really. How and Why were recommendations changed so suddenly when there wasn't a problem? And, why have the recommendations only gradually and softly started to return to original dictates of thirst? I would have expected the opposite - a gradual changing of the rules at the onset and when deaths occurred an immediate, loud, and exhaustive correction.

Christopher Morris 02-27-2014 11:39 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=brian chontosh;1221398]Every time I try to wrap my head around the science it starts to hurt. My background doesn't fairly allow to dig into a cursory understanding of the biochemistry of AVP/ADH and such. I'll leave this for someone with the credentials to tackle it.

However, the reductionist in me wants to refocus the point: [B]Overhydration is the issue.[/B] Let's not conflate tonicity, heat illness, or CHO consumption to increase performance.

Overhydration is killing.

Before the ACSM/GSSI changed the rules on hydration this disease (EAH & EAHE) didn't appear to exist. The first reported case was 1981. This disease was created when endurance athletes started consuming excessive fluids. [B]It doesn't matter if the fluid is water or sports drink really.[/B] How and Why were recommendations changed so suddenly when there wasn't a problem? And, why have the recommendations only gradually and softly started to return to original dictates of thirst? I would have expected the opposite - a gradual changing of the rules at the onset and when deaths occurred an immediate, loud, and exhaustive correction.[/QUOTE]

This answered my question.

I'm still working on reading the articles Russell linked. I'm interested in going back to the ACSM/GSSI studies on heat exhaustion, etc. to see why they recommended excessive drinking in the first place.

Andy Shirley 02-27-2014 12:06 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Normal serum sodium is 135-145 meq/liter. And I completely agree that Gatorade has much less sodium than blood or normal saline, essentially zero. Anyone who acutely drops their serum sodium will have brain swelling to some degree. At a certain point this becomes too much edema and you die.

I'm not interested in glucose either. But it contributes to tonicity.

[QUOTE=brian chontosh;1221377]Andy, it is my understanding that Gatorade can have anywhere from 270-800mg Sodium per liter of solution (I suppose depending on the formula and generation of product). A standard .9% Saline IV has 9g of NaCl.

I'm not a scientist, mathematician, of doctor so if someone would like to just come in and trump me up I'm offering:

For .9% Saline
Molecular mass of Sodium = 23mg/mmol and Chloride is 35.4mg/mmol.
9000mg / 23mg/mmol = 391

For Gatorade (sodium considerations, I'm not interested in Glucose)
270mg (800mg) / 23mg/mmol = 11.7 (34.7)

It looks to me that Gatorade is 'hypo'tonic to a standard saline IV in regards to sodium. True? Isn't blood plasma ~134? If I am missing something, I apologize.[/QUOTE]

Andy Shirley 02-27-2014 12:15 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
Again I agree that over hydration kills, and the water and Gatorade are roughly equivalent as far as the effect on serum sodium.

It is fairly simple in how we manage serum sodium in the ICU. If we want the sodium higher to bring down cerebral edema, we give salt(IV)to drive it up(some time up to 160-170 in extreme cases). If the sodium is too high and there is no longer cerebral edema, we bring the sodium down gently, with oral water, or with IV water(with dextrose, or lower than normal saline--half normal or quarter normal)

[QUOTE=brian chontosh;1221398]Every time I try to wrap my head around the science it starts to hurt. My background doesn't fairly allow to dig into a cursory understanding of the biochemistry of AVP/ADH and such. I'll leave this for someone with the credentials to tackle it.

However, the reductionist in me wants to refocus the point: Overhydration is the issue. Let's not conflate tonicity, heat illness, or CHO consumption to increase performance.

Overhydration is killing.

Before the ACSM/GSSI changed the rules on hydration this disease (EAH & EAHE) didn't appear to exist. The first reported case was 1981. This disease was created when endurance athletes started consuming excessive fluids. It doesn't matter if the fluid is water or sports drink really. How and Why were recommendations changed so suddenly when there wasn't a problem? And, why have the recommendations only gradually and softly started to return to original dictates of thirst? I would have expected the opposite - a gradual changing of the rules at the onset and when deaths occurred an immediate, loud, and exhaustive correction.[/QUOTE]

Brian Chontosh 02-27-2014 02:14 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Andy Shirley;1221418]Normal serum sodium is 135-145 meq/liter. And I completely agree that Gatorade has much less sodium than blood or normal saline, essentially zero.[/QUOTE]

9000mg / [23mg/mmol Na + 35.4mg/mmol Cl] = 154 ((.9% Saline IV))

Blood Serum Sodium 135-145meq/L has ~3100-3300 mg/L of Sodium. Divide out the molecular weight of 23mg/mmol and you get 135-143 meq/L.

So we are talking the same circular language. But, Exercise Associated Hypo(Na)tremia = I really care about the Sodium.

Gatorade 845mg Na / 23mg/mmol = 37.

If administering a .9% Saline IV (isotonic sodium solution) to an athlete suffering EAH continues to threaten livelihood through overhydration and further reducing sodium levels (in the presence of SIADH), drinking a Gatorade (hypotonic sodium solution) seems to do so at a factor of x10.

[QUOTE]I'm not interested in glucose either. But it contributes to tonicity.[/QUOTE]

Introducing tonicity again is why so many people get confused. Yes, Dextrose contributes to tonicity (Glucose in the case of Gatorade). In a D5NS (5% Dextrose Normal Saline) IV it increases tonicity to assist in hydration. While in Sports Drinks it is also for purported energy and most significantly for taste.

If someone is already hydrated, overhydrated even, why do I care about hydration? And when the low sodium levels are what I am most concerned with why would I want to hydrate more with a product that contains significantly less sodium in solute to hydrate with?

I don't care about Tonicity. I care about Sodium regulation. Again, we get off tracků Why are we over drinking? Who told Cynthia that she needed to drink 1.2 L/hour to stay safe?

Russell Greene 02-27-2014 02:51 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=brian chontosh;1221445]

I don't care about Tonicity. I care about Sodium regulation. Again, we get off track… Why are we over drinking? Who told Cynthia that she needed to drink 1.2 L/hour to stay safe?[/QUOTE]

Tosh,

I fear you may be letting Gatorade/ACSM get off easy. The 1.2 L/hour was a bare minimum for Gatorade:

"as recently as January/February 2002 (ie, 11 years after EAH was proved to be due to overdrinking), the GSSI placed an advertisement in the New York Runner magazine, and presumably elsewhere, with the banner statement: 'Research shows your body needs at least 40 oz. of fluid every hour (ie, 1200 ml per hour) or your performance could suffer'. This conclusion is allegedly based on the results of 'thousands of tests' conducted by the 'scientists of the Gatorade Sports Science Institute' who have 'studied it for over 15 years in research facilities all across the country'."

source (w/f safe): [url]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658915/[/url]

In short, Gatorade did not stop at funding the ACSM's bad hydration science - they distorted and misrepresented the ACSM's bad science. The New York Runner ad also ran in the North West Runner magazine, and presumably elsewhere: [url]http://faculty.washington.edu/crowther/Misc/RBC/confuse2.shtml[/url] (w/f safe)

Contrary to Gatorade's distortion, the 1996 ACSM recommendations used 1.2 L/hour as a maximum, not a minimum value, with the caveat that a runner should only drink as much as he could tolerate. The 1996 recommendations were excessive, and the 2007 ACSM recommendations implicitly recognize that. Yet Gatorade was still not satisfied with how much hydration the 1996 guidelines recommended.

If the ACSM objected to their platinum sponsor's misrepresentation of their guidelines, I've found no record of it. An ethical scientific body would have spoken up.

The need to remove Gatorade's pernicious influence from exercise science could not be clearer.

Rob McBee 02-27-2014 04:20 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Lynne Pitts;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[/QUOTE]

Hi Lynne! I would be very interested in reading "Waterlogged" if copies remain. Will buy my own if not due to the interesting discussion. Seeing you, Coach, Dale, Russ all posting in one thread! Feels like 2005-7. Thank you and take care all.

Rob

[COLOR="Blue"][I]on the list - Lynne[/I][/COLOR]

Dustin Wintczak 02-28-2014 04:31 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
What exactly just happend over the past 11 pages?

[I]"...what you've just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul."[/I]

I think that sums up this entire discussion. :shrug:

But really, are we moralizing about the marketing of sugar water because a statistically insignificant amount people don't understand the idea of moderation? Really? This is a battle you'd like to fight?

The cognitive dissonance on display in the arguments for driving "big soda" out of the fitness industry is, frankly...well not surprising.

So "big soda" = bad, then alcohol would have no place in fitness right? Even if it was marketed in a way that would appeal to a younger fitter demographic. CF would never take money and allow a compan...

Oh right...

[url]http://games2011.crossfit.com/content/games-sponsors-and-vendors.html[/url]

But that was just vendor, just there to sell product to all the fans. They wouldn't, oh I don't know allow a corporate sponsor who markets fat, salt and sugar laden food to spon....

[url]http://games2009.crossfit.com/sponsors/[/url]

Ohhhh! Man...really? Ok, ok...well we know after reading all these studies from as far back as 1996 according to one of the Russell's, that Gatorade is bad right? So we've known about this and would NEVER allow them to spons...

[url]http://games2008.crossfit.com/[/url]

godamnitsomuch

So I'm a bit confused now, is this just moral relativism or did HQ give back the money paid to them by Gatorade, Panda Express and Michelob Ultra?

I'm sure you're aware all links are wfs

"Smokey, you're cool.....I'm outta here."

Russell Greene 02-28-2014 05:52 PM

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

Gatorade's involvement in science would not be a problem if the ACSM's research was untainted by its sponsor's influence. In contrast, the CrossFit Games have had sponsors, but none had any impact on CrossFit's programming and recommendations. The issue is not sponsorship, but corrupt science.

The Gatorade/ACSM relationship failed doubly. First, the ACSM recommended a level of hydration with no measured performance benefit and a well-documented risk of hyponatremia. Second, Gatorade misrepresented the ACSM's guidelines and exaggerated the need for hydration even beyond the ACSM's already excessive guidelines. The ACSM never corrected Gatorade's dangerous distortion of their 1996 guidelines. Source (w/f safe): [url]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658915/[/url]

The impact was not "statistically insignificant," as you claim. The New England Journal of Medicine found a 13% rate of hyponatremia among finishers of the Boston Marathon. Source (w/f safe): [url]http://www.nejm.org/doi/full/10.1056/NEJMoa043901[/url]. With around 500,000 Americans finishing marathons each year, that would extrapolate out to at least tens of thousands of cases of hyponatremia yearly. The .6% of Boston Marathon finishers tested who suffered from "critical hyponatremia" would represent 3000 cases of near death amongst 500,000 marathon finishers, yearly.

We are not asking you to take our word for it. We're asking you to read Waterlogged (for free if you ask Lynne Pitts), read Gatorade and the ACSM's research and guidelines, and come to your own conclusions. Once you've read the primary sources, you will be able to intelligently critique the arguments presented so far. Hopefully.

It's clear, however, that you're not yet ready to do that.

[QUOTE=Dustin Wintczak;1221672]What exactly just happend over the past 11 pages?

[I]"...what you've just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul."[/I]

I think that sums up this entire discussion. :shrug:

But really, are we moralizing about the marketing of sugar water because a statistically insignificant amount people don't understand the idea of moderation? Really? This is a battle you'd like to fight?

The cognitive dissonance on display in the arguments for driving "big soda" out of the fitness industry is, frankly...well not surprising.

So "big soda" = bad, then alcohol would have no place in fitness right? Even if it was marketed in a way that would appeal to a younger fitter demographic. CF would never take money and allow a compan...

Oh right...

[url]http://games2011.crossfit.com/content/games-sponsors-and-vendors.html[/url]

But that was just vendor, just there to sell product to all the fans. They wouldn't, oh I don't know allow a corporate sponsor who markets fat, salt and sugar laden food to spon....

[url]http://games2009.crossfit.com/sponsors/[/url]

Ohhhh! Man...really? Ok, ok...well we know after reading all these studies from as far back as 1996 according to one of the Russell's, that Gatorade is bad right? So we've known about this and would NEVER allow them to spons...

[url]http://games2008.crossfit.com/[/url]

godamnitsomuch

So I'm a bit confused now, is this just moral relativism or did HQ give back the money paid to them by Gatorade, Panda Express and Michelob Ultra?

I'm sure you're aware all links are wfs

"Smokey, you're cool.....I'm outta here."[/QUOTE]

William J Mallon 02-28-2014 07:27 PM

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

I study Clinical Psychology where Cynthia Lucero received her doctorate shortly before her death in 2002. I would love a copy of Waterlogged to share w/ professors of mine who knew her very well. [COLOR="Blue"][I]on the list - Lynne[/I][/COLOR]

Also, prior to starting my doctorate in Psychology, I worked in Clinical Research and a majority of my work pertained to research ethics/IRB's so this is subject that is vey interesting to me.

With that being said, I take respectfully take issue with your last post.

If Gatorade was a sponsor in recent years, then it is completely reasonable for someone to point out such a discrepancy. If your CrossFit HQ has such a strong stance against Gatorade, the fact that they have allowed them to sponsor the CrossFit games is a contradiction, regardless of how great/little an impact the latter has on the games of HQ.

Pointing this out (As Dustin did) does not make someone unwilling to look at the source data. I do not mean to come across as inflammatory, but I do not understand the logic behind this claim.

Also, I am not doubting the veracity of the claims you are and your colleagues are making. Before making judgment, I would like to read the source myself..

All the best,

William

[QUOTE=Russell Greene;1221679]Dustin,

Gatorade's involvement in science would not be a problem if the ACSM's research was untainted by its sponsor's influence. In contrast, the CrossFit Games have had sponsors, but none had any impact on CrossFit's programming and recommendations. The issue is not sponsorship, but corrupt science.

Dale F. Saran 02-28-2014 10:33 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
William: not unless there's a time machine are we hypocrites. Gatorade was a sponsor before we knew anything about any of this, when the Games was 75 of us in Dave's parents back yard, the first time, and perhaps 300 the next year.

Up until recently, we were unaware of Dr. Noakes, the issue of hyponatremia, and GSSI/ACSM faking science to sell product to the marathoning public (and the larger sporting community), at all. Surprise to us. I suppose if we'd been diligently looking in the annals of the British Journal of Sports Medicine, we would have stumbled upon it. Unfortunately, however, we were growing this thing (and a little busy) and generally one isn't required to assume that organizations publishing "peer reviewed" literature are actually exaggerating possible injuries (heatstroke) to create favorable "science" for one of the Platinum sponsors. If, in fact, we were to be held to that standard ("Why didn't you know this, CrossFit???) the same could well be asked of anyone here. Why didn't anyone else notice - it all took place right there in public!! WE ALL MISSED IT.

BUT, we're willing to say, "Holy Crap?!" Because now that we know - and have a venue to talk about it, we think it's morally incumbent upon us to tell everyone. "Look!! Look what they did!!" You have an organization that's supposed to be responsible for doing research that helps and (one would presume) protects athletes: they did neither and if that was all they'd done, they'd just be bad at their jobs. No, they did worse. They took money to intentionally distort science and make invalid claims using their authority in order to convince an entire community to drink more sugary beverage, in excess of a prescription that was fatal. They did a lot worse than simply be bad at their jobs.

I'm not sure how we're the hypocrites in any of this. If Gatorade was a sponsor, they won't be now (I'm guessing) and that's perfectly fine. People can drink that stuff if they want or not, that's fine, too.

The real crux of this is an organization claiming to be a "peer reviewed" journal, using its 501c3 status as some kind of mantle of educational authority, while they're getting industry money (and I'm betting more than a few pesatas) to promote faulty, flawed science, which they publicly defended long after it was clear their "science" - in the form of Guidelines - was causing serious injury and even death.

Oh, and Dustin's banning had nothing to do with disagreement. It had to with how he did it to someone supposedly "in the family." We all disagree at times - LOUDLY - even possibly a little too heatedly, but ultimately, we treat each other with respect because we actually do respect (and love) each other. Dustin's disagreement was well past a line. He opens it with insulting everyone's intelligence (but revealing his own), though I don't know if you got the movie quote reference to "Billy Madison." It gets worse after that. Regardless, you can only call someone a#@^oles in Coach's living room for so long before he shows you the door.

Jayne Whittingham 03-01-2014 03:36 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I have no axe to grind here but I think the banning of individuals who disagree with the opinions of the OP reflects badly on the forum.

For instance, I have read Jeff's posts lots over the last year & they are usually very helpful. Having been a member of all sorts of fora, you get to recognise a troll & disagreeing is not trolling, particularly when I thought part of Crossfit's ethos was to be libertarian.

If you want to sort out trolls, look at the sexist rubbish in the comments on your Facebook page under most photos there.

Cam Peavy 03-01-2014 08:10 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=Jayne Whittingham;1221717]I have no axe to grind here but I think the banning of individuals who disagree with the opinions of the OP reflects badly on the forum.

For instance, I have read Jeff's posts lots over the last year & they are usually very helpful. Having been a member of all sorts of fora, you get to recognise a troll & disagreeing is not trolling, particularly when I thought part of Crossfit's ethos was to be libertarian.

If you want to sort out trolls, look at the sexist rubbish in the comments on your Facebook page under most photos there.[/QUOTE]

Spot on. Multiple members have been banned who in my eyes, offer an insane amount of help and knowledge to this forum. Wouldn't have viewed their posts as trolling; just with some emotion.

Greg Light 03-01-2014 08:35 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
I'd like a copy of the book please if still available


[COLOR="Blue"][I]on the list - Lynne[/I][/COLOR]

William J Mallon 03-01-2014 01:59 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
May I have a book???







[QUOTE=Greg Light;1221739]I'd like a copy of the book please if still available


[COLOR="Blue"][I]on the list - Lynne[/I][/COLOR][/QUOTE]

William J Mallon 03-01-2014 02:00 PM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=William J Mallon;1221767]May I have a book???[/QUOTE]


My apologies LynnE I see I'm already on the list...thank you!

Coach 03-02-2014 06:00 AM

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

We've generally found it impossible to act on things ahead of our awareness of them - that's the straightforward answer. The greatest difficulty in empirical/evidenced based methodology is the challenges inherent in not relying on clairvoyance or other extrasensory data.

Darryl Shaw 03-02-2014 08:58 AM

Re: Exercise Associated Hyponatremic Encephalopathy, Gatorade and the ACSM
 
[QUOTE=William J Mallon;1221691]Also, I am not doubting the veracity of the claims you are and your colleagues are making. Before making judgment, I would like to read the source myself...[/QUOTE]

I posted links to some of the BMJ articles [URL="http://www.board.crossfit.com/showpost.php?p=1220376&postcount=19"]here[/URL] and you can read the 1996 ACSM Position Stand, Exercise and Fluid Replacement [URL="http://www.mhhe.com/hper/nutrition/williams/student/appendix_k.pdf"]here.[/URL] You can read the 2007 ACSM Position Stand [URL="http://journals.lww.com/acsm-msse/Fulltext/2007/02000/Exercise_and_Fluid_Replacement.22.aspx"]here.[/URL]

*All links wfs*


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