BOOK REVIEW. “Waterlogged: The Serious Problem of Overhydration in Endurance Sports”

Rarely are specific subjects in sports and health so well detailed with objective research and unbiased opinions. But such is the case with a new book on the topic of hydration and sodium for endurance athletes. Dr. Tim Noakes is a South African-based physician, sports researcher and endurance athlete. Most runners know of his classic The Lore of Running. His new bookWaterlogged is the best and most comprehensive compilation of essential information on water, sports drinks and sodium regulation for athletes.

Waterlogged is the culmination of work that Noakes began decades ago, when he became the first health care professional to expose the dangers of too much fluid ingestion—overhydration—and exposed the problem of hyponatremia (low blood sodium)—in athletes. Exercise-associated hyponatremia (EAH) is a potentially fatal condition associated with the body’s hormones, causing water retention and severe sodium loss. It can develop during or within 24 hours of racing (or training). When EAH is more advanced it can produce edema in lungs and the brain (called exercise associated hyponatremia encephalopathy, or EAHE) causing alterations in mental status, respiratory distress, seizures, coma and death.

Just as important, Waterlogged pulls no punches when it comes to the sports drink industry’s blatant cover up of the facts, especially by beverage giant Gatorade, which encouraged unhealthy hydration practices by athletes, and non-athletes alike. In addition to his great scientific mind, Noakes is a savvy investigative reporter. Maybe because of its title, but while reading Waterlogged, I kept thinking of Woodward and Bernstein and how they uncovered the Watergate break-in scandal that led to Nixon’s resignation. But there’s one difference: the sports drink industry has gotten a free pass. It seems to be accountable to no one. Not then. Not now. And it’s the endurance athlete, the marathon runner, the Ironman competitor, or even the weekend warrior who suffers from the never-ending exposure to ads and marketing that is sending the wrong message. Of course, they will be inclined to drink more, even when it’s in their body’s interest to limit fluid intake.

In exposing the myth and conventional wisdom that more fluids—water as well as electrolyte replacement drinks—are better, Noakes writes how the sports drink industry actually prevented objective research from being published in medical journals. When the same individuals who work with Gatorade are also editors for medical journals, their ability to objectively accept or reject studies for publication is affected when those studies suggest that drinking too much Gatorade can be harmful.

In the absence of this vital information being made public, the sports drink industry has generated hundreds of millions of dollars of profits through increased product sales. Great for their bottom line. But for many athletes, the opposite is true, since they needlessly experienced a decline in their performances and some even risked death.

Noakes highlights the battles he fought against the so-called experts in science who were paid consultants to the sports drink industry. Gatorade’s recommendations, for example, to drink as much as possible before, during and after endurance events, have been shown to cause serious problems of water toxicity and EAH. Rather than get overly academic, Noakes provides athletes, coaches and health care professionals with important details about what fluids they really need to perform better and stay healthy, thereby avoiding the medical tent and serious side effects of racing. This is a book all endurance athletes should devour, and one that coaches and health care professionals should also have as required reading.

This book is not another opinion on sports nutrition. Nor is it attached to any competing sports product. It’s the unbiased, up-to-date science of sports nutrition, presented carefully and objectively.

Science and our understanding of optimal human function is an evolving art. We are all continuously learning how to make ourselves healthier and more fit using facts and experiences to guide us. The quest for improvement continues, and for me, including other health care professionals like Tim Noakes, objectively sharing our findings is of upmost importance.

If you want to continue your journey to optimal health and fitness, avoid the hype and get the facts, and if you’re a student of sports nutrition—which every athlete and health care professional should be—Waterlogged is a must read.

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