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Re: Article on drinking too much during exercise [Terra-Man] [ In reply to ]
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"Of course not. One should not ignore such signs. But if I'm on the course and have such signs, the one thing I want to know is how much I weigh. Then I know better how to proceed."

in this case it seems appropriate to close the disconnect between the self-diagnosing protocol that you are not sure exists, and the symptoms such as bloating, swelling, and tightness that one should not ignore. if one should not ignore them, then one is engaging in a self-diagnosis, no?

perhaps the idea might be to express to athletes the danger of hyponatremia, but also to help them preserve their races when possible. noakesians present this as a big issue, so big as to send out body language saying you may want to err on the side of what *may* yield a less-successful performance in order to preserve life and limb. if this is how noakesian medical directors truly feel, then why are there not bathroom scales lined up next to the porta potties? and at every aid station?

in this scenario, one can weigh in prior to the race, and there might be a body marker there to write that weight on the inside of the rider's upper arm, let us say. then, if the self-diagnosis of hyponatremia reveals worrisome signs, you pull over at an aid station and weigh yourself (and god help the race organizer if he chooses to buy cheap, unreliable bathroom scales).

maybe my idea is not practical. nevertheless, "one should ignore signs" means there are "signs," and "signs" is another word for "symptoms," and if you have symptoms you have the basis for self-diagnosis. if you get this far, then as medical director you can add your own infrastructure and form an end-user protocol. or am i missing something?


Dan Empfield
aka Slowman
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Re: Article on drinking too much during exercise [Cousin Elwood] [ In reply to ]
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In Reply To:
"I have no scientific or medical advice to offer but, based on my experience, I don't think there is a 'one size fits all' hydration method."
- - Not until one knows one's own sweat rate in ml/min or hour, rather than just thinking that it's high. low or average. Once sweat rates are known, proper hydration strategies can be more intelligently formed. The alternative is to go seat of the pants and hope that you're in the ballpark.

I'm not saying I have the answers, but I'm enjoying pondering the questions. Some very interesting things have been said in this thread.
You have the answer. Go for a run, weigh self before and after, calculate sweat rate.
Go for long training day and hydrate according to sweat rate. See if it keeps you within striking distance of your starting weight.
I think that with all the posters here calculating watts this and watts that, and aerodynamic benefits of this and that, those of us training 10-40 hours a week could do this easily.
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Re: Article on drinking too much during exercise [Slowman] [ In reply to ]
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I love the idea of scales at aid stations, and recording weight on athlete's bodies.

Maybe we could Sharpie it onto foreheads. Or on the calf, right under age, so we can all know a bit more about each other. ; )
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Re: Article on drinking too much during exercise [Slowman] [ In reply to ]
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As triathletes we like feedback. So we wear a hrm. And we wear a watch. And some have a special hub that measures our power. And despite our training and preparation, some of us don't perform up to our potential on race day due to fluid/hydration issues.

Why not make available a way to get feedback by having a bathroom scale next to each porta-potty at each run aid station and in transition? So that when I find an available scale, such as at mile 3, I can hop on and get at least a clue as to my status *before* I develop any signs or symptoms. So that if I'm 5 lbs. up, I won't drink at miles 4 and 5 and then will re-assess at mile 6. All of this before any chance of complications. And it's my responsibility to assess this, just like I follow my hr and wattage. Not the responsibility of aid personnel. No writing of my weight on my chest each time I stop.

So in this way, I could avoid getting into an unsafe situation either hypo or hyper, and I would have a better chance at optimizing my race performance.


Coach at KonaCoach Multisport
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Re: Article on drinking too much during exercise [Slowman] [ In reply to ]
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"maybe my idea is not practical."
- - Who cares if it's practical. It's a start. When you have a problem that can result in death, any step towards solving/minimizing that problem is a good thing. Educating the athletes is futile, because of the high number that simply won't get the message. Educating the RDs who can in turn educate their staff and volunteers is better.
We get new folks in the sport all the time, and even the most zealous and knowledge-hungry are likely to NOT get this information until they've been in the sport for several years, by which time they may be learning it the hard way.
It's discussions like this that make Slowtwitch the most incredible website in all of Internetdom. There is a possibility that this discussion just might lead to something changing out there in triathlon land. That would be awesome indeed.


Cousin Elwood - Team Over-the-hill Racing
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Re: Article on drinking too much during exercise [Cousin Elwood] [ In reply to ]
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Interestingly the recent Missasauga Marathon provided scales at the start and finish to help assess risk of hyponatremia.

http://www.mississaugamarathon.com/...er/2007_issue7.htm#3
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Re: Article on drinking too much during exercise [dkv] [ In reply to ]
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"See if it keeps you within striking distance of your starting weight."
- - OK, but as mentioned elsewhere on this thread, you can lose weight without affecting your fluid and electrolyte balance. So is 3 lbs a safe amount to lose? When evaluating my sweat rate, should I shoot for stasis or for a loss of X%? and if X% should that be X% per hour, per mile or total for the day?
I've always aimed to finish a long day (5 hours or more, so century and above, HIM and longer or big training days) at the same weight that I started, but after reading some of the things here, I'm now convinced that I've been overhydrating. This is also consistent with how I've often felt at the end of those long days (somewhat bloated/overfull).


Cousin Elwood - Team Over-the-hill Racing
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Re: Article on drinking too much during exercise [dkv] [ In reply to ]
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"Maybe we could Sharpie it onto foreheads. Or on the calf, right under age, so we can all know a bit more about each other. ; )"
- - Good. Also measurements (gotta check to see if the weight loss/gain is just in the belly or if the joints or specific body parts are swelling, uh, well, um... I mean like ankles and wrists) and don't forget bra size and marital status (you know, so we know who to contact...). Yeah, vital signs and stats on the calf, then spray liberally with Pam and away it all goes!
The forehead might be the best place, because it's likely not to have tatoos, except for Dennis Rodman and Mike Tyson...


Cousin Elwood - Team Over-the-hill Racing
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Re: Article on drinking too much during exercise [Slowman] [ In reply to ]
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Dan,
It has been fun to be an observer of this thread and in my opinion, getting some better usefulness of opinion than this same stuff last week.
Talking about Noakesian versus not is rather foreign for most physicians as this is old stuff for those of us who really treat severe hyponatremia in ICUs .... reading "sports medicine" journals becomes sort of meaningless when the issues and all their complicating factors have been addressed in core medical publishings for 30+ years. Not to belittle the findings, but Noakesian philosophy as you call it shouldn't be a surprise to any MD ... rather the expectation.
Published "laboratory" studies might sometimes be helpful .... but many times are misleading because the right question isn't being asked or the conditions are different from the real study group being looked at. I think this makes Andy look silly at times in my opinion because he takes his "results" too liberally .... what about those salt pills Andy??
Bottom line ... if you want to be better accurate about hydration status ... use a scale. I personally would use it every race coming out of T2 even though I've learned by trial and error how to take care of myself.
It also is clear that hyponatremia is a potentially bad condition, but the vast majority of people in the medical tent are dehydrated ... usually GI related. In spite of our theoretical discussion that this shouldn't affect performance ... they end up requiring the "tin can transfer" as their legs don't seem to work. All the fluids are being given for that reason in medical tents. Dev's issue should have been noticed by his weight gain ... if that pre-event weight we all get was really ever seen by the medical staff ( I suspect that it wasn't or fluids wouldn't have been given to him).
This is good stuff for those who want to be in better control of their IM distance race hydration.
Dave
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Re: Article on drinking too much during exercise [Terra-Man] [ In reply to ]
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"Why not make available a way to get feedback by having a bathroom scale next to each porta-potty at each run aid station and in transition?"

i'm all for it. the thing is, if we had to stop, leave the course, and stand at attention for several seconds, to get our heart rates, i have this suspicion we'd be racing without knowing our heart rates. but i could be wrong. you may be right. in this case, all you'd need to know is how much you weigh prior to the race, and then you step on the scale at some point mid-race.

but, let's say that my cynical view turns out, unfortunately, to be the truer one, that athletes in the heat of battle are not going to stop in any significant numbers to weigh themselves during the race, absent some very good reason. i think it best if we can find a way to help them determine that very good reason, and that is a way for the athlete to self-diagnose an impending problem.

keep in mind that in each of our scenarios there still needs to be a bathroom scale at every aid station, next to every porta potty, and probably a few scales at the start of the race.


Dan Empfield
aka Slowman
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Re: Article on drinking too much during exercise [Slowman] [ In reply to ]
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"there still needs to be a bathroom scale at every aid station, next to every porta potty, and probably a few scales at the start of the race."


I think thats way too complicated and all of them would have to be calibrated as well. No one needs a weight after the swim. No one is going to stop on their bike, get off, and get weighed.
I don't think anyone needs a weight before T2 ... you could just have 3 or 4 scales at the outrun from T2 and everyone is getting pretty well spread out by then even with NAS IM races and 2200 people. You could even put them on the start of the run course if its a multiple loop course and you could use them twice. Weigh yourself on them before the race for your baseline. Not a big deal at all. Obviously not everyone will use them ... but they would if they were smart!
Dave
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Re: Article on drinking too much during exercise [Slowman] [ In reply to ]
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In Reply To:
but, let's say that my cynical view turns out, unfortunately, to be the truer one, that athletes in the heat of battle are not going to stop in any significant numbers to weigh themselves during the race, absent some very good reason. i think it best if we can find a way to help them determine that very good reason, and that is a way for the athlete to self-diagnose an impending problem.
The very good reason would be not feeling great, and considering dehydration as the source of all life's woes.
The racer would think, "I feel terrible . . . am I dehydrated?" The next thought would be, "I should weigh myself."
Racer weighs self. Uses that info to influence ongoing hydration strategy.

I also agree on the point that you wouldn't need scales in T1 or the bike, but T2 and the run would be nice, since most drinking occurs on the bike and you would know your weight heading into the run and thereafter.
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Re: Article on drinking too much during exercise [dkv] [ In reply to ]
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"I also agree on the point that you wouldn't need scales in T1 or the bike, but T2 and the run would be nice, since most drinking occurs on the bike and you would know your weight heading into the run and thereafter."

i would not know my weight to within 4lb or 5lb on race morning, unless i've been weighing myself regularly (which i do not). hence my comment about scales at the start of the race. i'm talking about 20 or 30 or 40 minutes before the start.

plus, athletes get stupid when they race. i don't know how many ultras you've done, but i can remember hitting, say, 9mi, and having a VERY hard time figuring out what 26 minus 9 equals. and then doing the math all over again at mi-11, and mi-12. hence my comment about writing the pre-race weight down. on the athlete.

all this is predicated upon the view that hyponatremia is as prevalent and serious as you all say it is. i'm stipulating to that, for the sake of the discussion, and trying to come up with some ideas that parallel that threat.


Dan Empfield
aka Slowman
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Re: Article on drinking too much during exercise [dcsxtri10] [ In reply to ]
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The real question is even if the scales are there, how effective would they be. First how many people are going to stop even if they weigh themselves? I'm guess not many. How could it be accurate? A humid day is going to make it difficule somone who's cloths are saturated with water may not look like their weight has changed, or it might look like they've gained weight when they didn't.

The real focus should be on teaching people how to hydrate properly. Getting a handle on your sweat rates should be as important as your training when you're talking long distance racing. Making blanket statements is just dumb either way.
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Re: Article on drinking too much during exercise [indytri] [ In reply to ]
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In Reply To:
The real question is even if the scales are there, how effective would they be. First how many people are going to stop even if they weigh themselves? I'm guess not many. How could it be accurate? A humid day is going to make it difficule somone who's cloths are saturated with water may not look like their weight has changed, or it might look like they've gained weight when they didn't.

The real focus should be on teaching people how to hydrate properly. Getting a handle on your sweat rates should be as important as your training when you're talking long distance racing. Making blanket statements is just dumb either way.
The clothing point is a good one, but with the gear people wear today, how "wet" do they get? Cotton, yes. Space-age wicking synthetics? After run here in Philly they often feel a bit damp, but no more.

Agree about sweat rates.
Last edited by: dkv: Jun 20, 07 16:45
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Re: Article on drinking too much during exercise [dkv] [ In reply to ]
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Think it depends on the type of gear and the humidity. So me a really heavy sweater on a humid day with a loose shirt it can be an amazing amount a water weight. I've had cycling jerseys weigh several pounds after I've taken them off on a "bad" day. Something like a trisuit with nice micro fabric, not so much. Remember pure water weights ~ 1 pound per pint.
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Re: Article on drinking too much during exercise [dkv] [ In reply to ]
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You could use an RFID chip for the timing chip. Every athlete stands on a scale as they're getting body-marked. It gets fed to a wireless network with a reader in each medical tent. Somebody comes in the tent, a simple scan will tell the MDs the relevant info...

Or the athlete could just say "I usually weigh 160lbs".





In Reply To:
I love the idea of scales at aid stations, and recording weight on athlete's bodies.

Maybe we could Sharpie it onto foreheads. Or on the calf, right under age, so we can all know a bit more about each other. ; )
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Re: Article on drinking too much during exercise [dcsxtri10] [ In reply to ]
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Dave, in fairness to the medical staff at the med tent at IMLP 2003 (and I'm not one of those to try and sue an event or staff for my own friggin mistakes that brought me to the med tent in the first place....), the place was like a mash unit. If the person treating you does not know what you are supposed to look like to start (140 lbs vs 150 lbs), and for some reason if the "before" weight (140) was not compared with the "after" (150), then the various symptoms that the athlete is reporting could be very well interpreted as those from dehydration (like the bulk of people that show up in the "mash unit"). In 2003, the docs were more worried about Chis Legh type "loose half of your intenstine from severe dehydation" than "that guy might die from hydration!!!

I BELIEVE, thanks to my escapade, Ironman North America is much more aware of this type of scenario (after much behind the scenes correspondance) and the medical staff is really briefed on this type of situation.

Keep in mind that many of the medical volunteers might be GPs whose specialty is not dealing with severely hyponatremic patients in the ICU.

Dev
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Re: Article on drinking too much during exercise [Slowman] [ In reply to ]
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Several points. First, what we'd all like but we're not going to get is a single, simple, reliable indicator with an absolute interpretation. Humans, being biological beings and not machines, tend to not exhibit such indicators; this is axiomatic throughout the field of medicine. Rather, there are clusters or "constellations" of signs and symptoms (and those words are not synonymous) for various conditions, and interpretations are made in the context of these constellations. So scales may be a useful element, but that's not the whole story. Fluid in my stomach (that I may be about to vomit), fluid in my plasma, and fluid in my third space all look the same on the scale. Further, many of the other indicators can be difficult to detect or interpret, even for physicians.

That said, though, I love the idea of scales as a first iteration measure. Weigh yourself at T1 and again at T2 on the same scale (the one you brought with you). But interpret that result in the greater context: what have you been drinking on the bike? How do you feel? Is your stomach sloshing? In a long event, I and probably many others would find this to be very useful and reassuring information. For those who become ill during the event, scales alone aren't enough, but they'd be an extremely useful element, especially if we take seriously the suggestion to sharpie the pre-race weight right onto the skin of every competitor.

Also worth mentioning is that since we don't yet have full agreement about optimum hydration strategy for either health/survival or performance, we're also not ready to distinguish between the two. But logically, a strategy that is physiologically optimum for circulatory health is likely to simultaneously optimize survival and performance.

Interesting thread.
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Re: Article on drinking too much during exercise [Cousin Elwood] [ In reply to ]
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" I did the Mayor Daley/Americas/Chicago Marathon from '78-'83 as well as a number of other local runs."

Did those in 1980 and 1981. That's where I first learned that I shouldn't drink water at every aid station. Do you remember the Marine band on Wells street. Very inspirational at mile 5; annoying as hell at mile 23.
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Re: Article on drinking too much during exercise [dkv] [ In reply to ]
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In Reply To:
In Reply To:
You have the answer. Go for a run, weigh self before and after, calculate sweat rate.
Go for long training day and hydrate according to sweat rate. See if it keeps you within striking distance of your starting weight.
I think that with all the posters here calculating watts this and watts that, and aerodynamic benefits of this and that, those of us training 10-40 hours a week could do this easily.
As I mentioned in an earlier post, I do this on every single workout. It just makes logical sense, especially after getting badly dehydrated on one race a few years back. I can now easily recognize the signs of dehydration, and with my sweat rate it's nearly impossible for me to get hypervolemic.

Regarding the scales and weight numbers, at some races they sharpie your prerace weight on your race number. That way if you show up at the med tent 5lb over your prerace weight the docs should have the info to know that you do NOT need a bag of IV hydration. This seems like a very important thing for race directors to do, and very trivial to actually implement it. Adding a cheap $10 scale at every aid station or something isn't a bad idea but not always practical. Having several at T2 would be really nice.


Mad
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Re: Article on drinking too much during exercise [MPB1950] [ In reply to ]
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"Do you remember the Marine band on Wells street. Very inspirational at mile 5; annoying as hell at mile 23."
- - My memories of that are sketchy. I remember a lot of music all over the coure (mostly boom boxes) and a couple of bands. One year (I think it was '80 and Howdy-Doody look alike Jane Byrne changed the name to "America's Marathon" instead of the "Mayor Daley Marathon") and everyone was playing the theme from Rocky. I got pretty sick of that song by the end of the race. I also remember an old guy who had done the race nearly every year. He wore his age for a race number and that year I think he was 77, Vic something... Funny how you remember certain things... I also thing that '80 was the second or third year that they had Gatorade on the course. I'm pretty sure we just had water in '77.
Chicago was a marathon that I really liked, because it was a fast course and interesting.
I used to live out in Indian Lakes (Bloomingdale). I really felt special, because we had a hill going in and out of our subdivision. Of course with an elevation gain of about 70 feet, no one in CA would call it a hill, but it was enough that I felt like it gave me a place to do "mound repeats." There was also a hill in Medina that could actually pass muster anywhere (not that it was huge, just that when you called it a hill, people didn't look at you funny), but it was a four-mile run to get there.


Cousin Elwood - Team Over-the-hill Racing
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Re: Article on drinking too much during exercise [devashish paul] [ In reply to ]
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Noakes here.

Thanks for the generally excellent level of debate, marred by the inevitable personalisation of argument especially by those who have nothing better to contribute. May I be allowed to make a few comments.

The first case of (near fatal) exercise-associated hyponatremic encephalopathy (EAHC) happened in the 1981 56 mile Comrades Marathon in South Africa. Although I was involved in a research project in the Comrades medical tent on that day I did not personally see the patient. However she wrote to me a few weeks later to ask my advice. I told her that I had absolutely no idea what had caused her EAHC. Over the next 3 years I interviewed another 3 athletes who had developed exercise-associated hyponatremia (EAH). On the basis of that information, a series of calculations and 3 years of contemplation and reading the literature, I concluded that the condition occurred in athletes who ingested too much fluid during exercise. This was described in a paper published in 1985. In an editorial that accompanied the reprinting of that, by then, classic paper 20 years later, the author wrote that: “Tim Noakes was right 20 years ago and the passage of two decades has done nothing to diminish the accuracy of his conclusions”.

To evaluate our 1985 hypothesis we next completed a prospective, controlled, in-hospital study of 8 athletes as they recovered from either EAH or EAHC developed during the 1988 Comrades marathon. This study published in 1991 proved our 1985 conclusion since it confirmed that all these athletes were over-hydrated by between 2 and 6 litres (4-12lbs). Furthermore we also established that sodium depletion played no role in these cases since their sodium deficits at the end of the race was not different from those that developed in a control group of ultra-marathon runners.

What normally happens in medicine is that such evidence is pretty quickly absorbed and become the mainstream practice. But in this case, this did not happen. Instead I discovered that I became the target of a subtle disinformation program that apparently still continues today, judging by some comments on this blog. I found that I was no longer welcome at certain conferences or athletic events, funded by certain organisations. So I was cast as an evangelist, a religious zealot, someone who ignored all the published evidence that did not agree with his particular “religion”, and an iconoclastic egoist who was more interested in fame than in being correct.

Interestingly at the very time that I was being so typecast, the advice to endurance athletes became that they “should drink as much as tolerable” in order to prevent “dehydration”, heat stroke and an impaired performance. So instead of warning athletes of the dangers of overdrinking, conditions were developed which encouraged overdrinking. Whether or not this was the intended outcome, this was indeed the result as so clearly described by Devashish Paul. (Of course, when athletes like Devashish developed the condition it is natural that they should be blamed – as has occurred in this thread - and not those who gave them such dangerous advice). But it did not take a genius to predict what would be the outcome of this advice to “drink as much as tolerable”. And so predictably people died as a result of this advice. At present, an absolute minimum of 11 avoidable deaths, the majority in marathon runners and army personnel in the US, have occurred; the most recent at the 2007 London Marathon. In contrast in those scientifically-backward countries like South Africa and New Zealand where my opinion and that of my co-researcher Dr Speedy have credence, there have been no deaths from this condition and EAH and EAHC has essentially disappeared. With this background it is perhaps appropriate to correct some errors on some submission on this thread.

Philbert makes that error of labelling me an evangelist which is dismissive and unnecessary. The information I have presented since 1985 is based on hard evidence and is now known to be true. My understanding is that evangelists wish to force a personal belief on others, whether or not that belief is “true”. I studied EAH and EAHC for 10 years before we published the definitive evidence that the condition is due to overdrinking without evidence for sodium deficiency. Only thereafter did I become rather more vociferous in my opinion especially when what I had predicted would happen – avoidable deaths – began to happen. As a doctor my first responsibility is to do not harm. If I know that unnecessary harm is being done as a result of ignorance, I have an ethical responsibility to do something about it. If the price of that activism is to be labelled an evangelist, then perhaps that is a small cost.

Philbert also claims that there were many nephrologists saying the same sort of thing before “Noakes really got any steam behind him”. Again this is dismissive besides being untrue. There is no evidence in the published literature that “many nephrologists” were “saying this sort of thing” at the time of our first publication in 1985. How could they have since the condition was unknown at the time? And if the mechanisms were already so well understood by so many, why is it that so many avoidable deaths occurred in the US between 1993 and 2002, fully 17 years after our first publication? There is a saying that science goes through three phases: First they say that what you say is nonsense. Then they say that what you say is correct but it is irrelevant. Then they say that what you say is true but we have always known it. I appreciate Philbert’s support that we are now in the third phase of the truth of EAH and EAHC but he should be more circumspect in his descriptions of others, particularly if he is not in command of all the facts.

Like many others, I have knocked heads with Dr Coggan frequently over the past 20 years but never on the question of fluids and exercise which, in my understanding, is not within his area of expertise. My review today of his publication list on PubMed reveals that of the 59 listed papers he has published between 1984 and 2007, not one is on fluid balance during exercise. Thus I am surprised that he considers himself to be such an expert on the topic. But I am most relieved that in those 23 years he has not lost his venomous tongue, nor his capacity to use insults as his main weapon of argument. So he claims that I (not he) have not “conducted a single experimental study to support his (ie my) claims”. To combat my abject ignorance he advised that I should do more than just “skim through a few papers and/or chat with a few graduate students to understand the real story here”. To overcome their ignorance, visitors to this blog are also advised that: “you have to dig into the data and base your conclusions on what it actually shows (vs what a self-described iconoclast such as Noakes claims it shows)”.

In my defence, I would suggest that readers should access PubMed to see for themselves whether or not I have done any laboratory studies of fluids and exercise or whether my ideas of the etiology of EAH and EAHC are based solely on a fantasy driven by the egocentric need for a personal aggrandisement so that I can be “iconoclasatic”. (Actually it was a prominent member of the Gatorade Sports Science Institute who first labelled me as iconoclastic, not myself).

Not only has Dr Coggan never undertaken any studies of this topic, but he enjoys the rare privilege of the laboratory exercise scientist – absolute immunity from responsibility for any outcomes resulting from his advice. However in my position as a medical doctor and medical director of a number of ultramarathon and Ironman triathlon races over the past 30 years, I do not enjoy such absence of responsibility. Rather I am accountable for any adverse outcomes that result from the drinking advice that I give athletes in these races and for any treatments that they might receive, based on those opinions. So I am glad to report that the Ironman Triathlon races at which I was the medical director had the lowest reported incidence of post-race medical admissions of any such race on record and a negligible incidence of EAH and EAHC.

But Dr Coggan, who really understands, claims that: “Noakes is, to be blunt, someone who would apparently be just as happy to be known as being right. That is, IMO he is overly willing to ignore data that contradicts his unusual points of view (plural, because this is but one of many issues on which Noakes has adopted a position that is contrary to the evidence… as mentioned before he himself says that he’s an iconoclast”.

Later his insulting diatribe continues: “No, I think that Noakes is a true believer in his own religion, i.e. he’s not tailoring his message to try to achieve some altruistic goal”.

Surprising then that when we apply this incorrect, unscientific, egotistical knowledge purely for the purpose of self aggrandisement and without respect for what is really “true”, we deliver results that no other Ironman race has yet recorded and, in addition, we have an essentially negligible incidence of EAH and EAHC. Perhaps this is the kind of untrue “religion” that others should be adopting rather urgently.

Probably Dr Coggan is not aware that in November 2006, the Runner’s World (USA) magazine voted our work on EAH as one of the 40 most important “people or events” of the past 40 years in running. Which is not bad for work originating outside the United States of America. Such recognition suggests that at least some people consider that this work is rather more than that of an egotistical iconoclast who “just wants to be known”, whether or not he is right.

A great deal of the discussion is based on the concept that the body defends its weight so that if the weight is measured, then the correct drinking guidelines can be arrived at. In fact the body defends its osmolality through the thirst mechanism, and not the body weight. Thus the presence of thirst indicates that the brain considers that the osmolality has changed sufficiently to require correction. We have shown that the extent to which thirst develops is under genetic control so that some drink avariciously during exercise whereas others drink hardly at all. In an upcoming debate with the gentlemanly Dr Michael Sawka to be published in Medicine and Science in Sports and Exercise, I present the argument that the reason why exercise performance is impaired in persons who drink less than their thirst dictates during exercise is not because they are “dehydrated” but rather because they are thirsty.

According to this logic and supported by all the published evidence (including 2 studies of our own of which Dr Coggan appears ignorant – see also my recent article in the Journal of Sports Sciences), exercise performance is maximizes in those who drink enough to avoid thirst during exercise regardless of how “dehydrated” they become. Thus some will be thirsty when they are 2% dehydrated and others will not be thirsty even if they lose 6-10% body weight (as our data on Ironman triathletes seems to show). Interestingly in our as yet unpublished study we show that simply telling people they will not be drinking during exercise impairs their performance right from the start of exercise (that is in anticipation) and before they have become "dehydrated". This shows that the way in which not drinking affects performance is a little more complex than currently understood.

Finally there is now good evidence that humans evolved as long distance runners on the African savannah and that our ability to sweat (and become dehydrated) allowed us to outrun faster antelope whose inability to sweat (and to become dehydrated) prevented them from maintaining low body temperatures during very prolonged (4-6 hours) exercise in extreme dry heat (between 40-46 degrees Centigrade; 104-115 degrees Farenheit) when both had limited access to water. The most effective hunters would be those who developed the least thirst despite high levels of dehydration since they would have been the most likely to continue running for so long and therefore most likely to kill their quarry.

This evolutionary model predicts that the best endurance athletes will therefore be those best able to run without becoming thirsty even though they lose large amounts of weight. The low drinking rates of most of the world’s best endurance athletes in marathon, ultramarathon and Ironman triathlon races provides anecdotal support for this surprising hypothesis.

To follow a 4 hour hunt with minimal fluid replacement by the !kung San (Bushmen) in the Kalahari desert at 46 degrees Centigrade, readers might wish to view The Great Dance – a hunter’s story (http://www.rapidblue.com).

That is my story. I will not respond further but in future scientific publications on this topic. So you are welcome to say what you wish.
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Re: Article on drinking too much during exercise [Tim Noakes] [ In reply to ]
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Wow!! Thanks, and welcome to the jungle......
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Re: Article on drinking too much during exercise [monty] [ In reply to ]
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Second that "wow."
And the thanks.
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