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Tuesday, July 24 2018

Refreshing information about Dehydration and Sports Drinks

With the recent hot summer weather, it is very important that we stay hydrated because without doing so, an extremely hot day could turn into a medical emergency.  We should all be aware of the dangerous progression of symptoms listed below that occur from extreme heat and the fact that young children and the elderly are most susceptible to having problems.

Mild:  1% dehydration level:  increase in thirst

Moderate:  2% dehydration level: dizziness, dry skin, headaches, intense thirst, physical fatigue, dry mouth, swollen tongue, constipation

Severe:  5% dehydration level: fever, racing pulse, lack of sweat, sunken eyes, low blood pressure, dark colored urine, or no urine. 

Extreme: At a 7% dehydration level, intravenous fluids become necessary. 

At a 9% dehydration level or higher, delirium, loss of consciousness, or death could result. 


The British Medical Journal determined that one of the fifteen greatest medical advancements in the past century was the fact that sodium and glucose coupled together with water in the small intestine accelerates the absorption of the solution to orally hydrate and treat dehydration from severe diarrhea; the leading cause of death in children in the developing world.  The right ratio of sugar and salt added to water saved millions of lives from diseases like cholera, costing relatively little for people who didn’t have access to IV therapy.  


What does this have to do with sports drinks?

Sports drinks are a multi-billion-dollar industry.  Coke, Pepsi, and even drug companies like Smith Kline Glaxo sell their version of sweet and salty water for dollars for what costs pennies to make.  The beverage industry took this research on saving people from severe dehydration from diarrhea and created a market to rehydrate us when we sweat a lot.  There are a lot of misconceptions about how to replenish our bodies during and after exercise, or when we are in extreme heat.  For instance, all the following statements are true, but if you were to ask many people or even doctors they would probably get some of these statements wrong.

  1. Fluid consumption during exercise should be based on thirst
  2. Electrolyte intake is not necessary during most exercise
  3. Dehydration is not generally a cause of exercise associated muscle cramping
  4. Exercise associated muscle cramping is not generally related to electrolyte loss


Regarding electrolyte loss or more specifically sodium, the common belief was that this needed to be replaced during exercise, but studies show that isn’t the case.  Additionally, excess water intake, or drinking sports drinks over hydrate us and create a lower concentration of sodium.  The condition called E.A.H. or exercise associated hyponatremia (low sodium), can be caused by drinking too much water, sports drinks or any liquid by diluting our electrolytes.  The idea that we should be drinking all the time to prevent dehydration has been disproven since the early 1990’s.  Despite this information the American College of Sports Medicine (ACSM) continued to recommend drinking “as much as tolerable” and what followed was an epidemic of cases of E.A.H., including many deaths. It was the commercial interests of companies selling sports drinks that fought back against the scientific facts and it wasn’t until recently that the ACSM changed their recommendations, by now advocating a more sensible approach to water intake.  Unfortunately, because many researchers also get funding from the Gatorade Sports Science Institute, so their recommendations regarding sports drinks are still incorrect.


What’s wrong with Sports drinks?

Gatorade is probably the most famous sports drink, and it was discovered in the mid 1960’s at the University of Florida, whose mascot is a “Gator” by Dr. J. Robert Cade a nephrologist, and it rose in popularity in 1967 when the Florida Gators beat Georgia Tech in the Orange Bowl.  The Georgia Tech coach said his team lost because they didn’t have “Gatorade”.  Regardless, the original formula was just lemon juice, sugar and salt and not like the modern commercialized version with its added artificial ingredients.  Most sports drinks have excess sugar, refined salt, and artificial ingredients that detract from our health.  The average Gatorade bottle has refined sugars as its second ingredient which include white sugar, sucrose syrup and sucralose all of which are associated with high blood pressure, dental cavities, diabetes, obesity, and coronary heart disease.  Their ingredients also include wood rosins, or brominated vegetable oil (used in fire retardants), which can cause thyroid problems, (and is banned in Europe and Japan), monopotassium phosphate which is used in fertilizer, citric acid a preservative, modified food starch, and artificial food coloring.  


There are a multitude of sports drinks in addition to Gatorade.  There is Powerade, Power Sport, Accelerade, vitamin waters, etc.  They all have similar ingredients and there isn’t one that I would recommend.  With 90% of Americans consuming too much salt, the added sodium in these drinks would likely cause more problems for the average American. The added sugar and calories in the drinks, would negate any benefit to the calories burned during any mild to moderate exercise.  There really isn’t any reason to consider adding salt to your water, unless you were a conditioned athlete involved in a vigorous activity and sweating for 90 minutes or more.  And while I am a fan of coconut water, research doesn’t show added hydration benefit over plain water in a 90 minute or less timed exercise period. 



Unless you are sweating heavily for over 90 minutes you don’t need to worry about replacing electrolytes and if you did, you could simply add some juice to your water or eat some fruit with your water.  If you listen to your body, and drink when thirsty you can ward off any potential problems including those that result from overhydration.  If you are a very conditioned athlete who regularly exercises for times over 90 minutes in hot and humid weather, you may want to consider making your own sport drink.  Here is a link to a video on a good way to do so.


Posted by: Dr. Goldstein AT 03:50 pm   |  Permalink   |  0 Comments  |  Email

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