How You’re Being Manipulated By The Sports Drink Industry And What You Can Do About It – Audio Interview Transcript

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Ben:                Hey folks, it’s Ben Greenfield and with me today is Dr. Tim Noakes.  The South African Physiologist who has been on the show in the past and has shared with us a great deal of valuable knowledge about electrolyte intake and also about something called the central governor.  And today, we're gonna be discussing some of the concepts that Dr. Noakes lays out in his new book which is called Waterlogged: The Serious Problem of Overhydration in Endurance Sports.  I read this book, I finished it a couple of weeks ago, and it’s pretty mind-blowing in terms of the amount of knowledge that it contains that you never ever learn.  You know, I spent five years in University learning, I always supposed to be everything you need to know about how to fuel the human body during exercise and did not learn any of the stuff that Tim talked about in this book.  So, Dr. Noakes thanks for coming on the call today.

Dr. Noakes:   Thank you Ben, I appreciate you having me back again.

Ben:                So, let's jump right then, you start this book out with a case study about this girl named Cynthia Lucero, who is gonna run in Boston Marathon.  Can you talk about what happened there and why it’s a perfect way to outline why this book needs to be written?

Dr. Noakes:   Well, the tragedy for Cynthia here is that we predicted this is gonna happen.  I predicted in 1992 we have the editors of Runners World here, I’m sorry it was 1993 and we have the editors of Runners World here including Amby Burfoot who write the introduction to my book.  And the first lady had died from this over drinking during the Valley of the Giants Race in California that very weekend.  And I said to Amby, there'll gonna be many more American females who gonna die in marathon races unless we do something about it.  Because you guys are over promoting drinking in the United States and it’s gonna have tragic consequences.  And so the next case that occurred was in the Chicago Marathon in 1998.  The death case went under the radar but Cynthia didn't.  She, well her case is reported in the front pages of the Boston Globe and the New York Times.  And so then I realized that this was the real case that put change in everything.  And particularly what was important was when it was reported it said that she died because she drank too much fluid, including too much of that particular sports drink.  And that if we came, I really wanted to know what had happened and fortunately we could get some of the medical records on Cynthia from the Boston Hospital where she was treated.  And once we had those that information we could calculate exactly how much she had drunk during the race.  And it turned out she had done exactly what she been told to do.  She drank 1.2 liters per hour, that's 40 ounces per hour.

Ben:                And who advised her to do that?

Dr. Noakes:   Well, I can't say exactly but she [03:12.0]_______ Mr. [03:13.1]______ and they were advised to drink lots.  But there was an advert in some of the running magazines in January 2002, and I have that advert and it says you must drink 40 ounces per hour or else your performance could suffer.  And it has a picture in fact of a young woman running.  And say, had she seen that advert that's clearly what she would have wanted to do.  So, the story is exactly what happened that she just graduated with a PhD from a university in Boston.  The family had come up from Ecuador to watch her finish the race and tragically she never reaches the finish.  She collapses at 35 kilometers.  She has all the symptoms of hyponatremia.  She loses consciousness, she becomes confused, she loses consciousness and she's unconscious when she's admitted to hospital.  And I don't know what happened thereafter, I cannot speculate, but we do know that she was declared brain dead within 24 hours.  And her five organs were transplanted into five other people.  And that was her tragic case that her parents never got to see her finish the race.

Ben:                It was a very, kind of tragic way to write a book, but I mean you gave me pause just because three months before I even open this book, I was told the same advise by an exercise physiologist, that you know, I did sweat sodium an ounces, and I was losing, I was actually losing more than 40 ounces per hour.  And he told me I need to be drinking exactly that, if I wanted to keep myself from decreased performance.  So it's scary, how much of this, is still out there despite this another case studies that you layout in your book.  Now, you get into the anatomy of humans in the way that we're built and the way that we're designed to thermo-regulate.  Can you explain a little bit of that in terms of how we actually handle heat?


Dr. Noakes:   Yes, and when I have written my previous books of course I didn’t know about this. In Australia in 2004 that we suddenly began to realized that humans, our long distance run is a natural we evolve.  And if we hadn't been long distance runners we wouldn't be where we are today.  And that of course happen on the savanna of South Africa and East Africa.  And I had a great interest in anthropology all my life.  But didn't link it to running, so for that I was very proud that humans evolved in Africa and I knew the history of it, I didn't really know too much about it.  But then when Dan Lieberman published the paper Nature in 2004 saying that we have all these adaptations, which are specific for running and not for walking.  Then I began to ask the question well did we have other adaptations that could be related?  And the first one you look at is why we search good heart with the runners and of course is because we can sweat so much.  But then what people hadn't understood was that if you're going to chase an antelope for four hours or six hours in the heat in the Southern Africa on the savanna, there is no water, you don't have time to find water so it meant that these guys must have been hunting without water.  And so, therefore the idea revolved that people developed to run for four to six hours without drinking.  And when the hunters are studied, what they do is they kill the antelope.  And then they drink the fluid from the guts and they probably drink blood as well.  And so they’re delayed drinkers, and then it made me realized that humans really are delayed drinkers.  We don't need to replace the fluid loss as it develops.  We need to replace it at the end of the day, when we have our meal at night.

Ben:                Yeah.  I like the way you explain in the book, you say that thirst is the link from the actual water requirement during exercise.

Dr. Noakes:   Yeah, precisely.  And then, because this has to be the reason that if you got ever thirsty you would stop running and that the antelope would disappear and we would never revolve as we are today.  So that made me realized that humans are designed to run with the aggression and in fact, I read a paper in 1995 talking about the dehydration myth, but I just looked to the published literature and on the published literature is clear that the most dehydrated athletes win races and so that seem to be the case to me and in fact when I was running competitively ultramarathons we drank so little.  And we’d fine and that was the history of running right after the 1980's when then suddenly these guidelines were produced that said you have to drink 1.2 liters per hour.  And the question is how could it have been that for a hundred years athletes run without drinking very much, why all of a sudden there we need  to start drinking so much?

Ben:                Yeah, exactly.  I mean, like prior to that point where you seen a lot of issues in terms of heat management during exercise that would have sparks this sudden urge or sudden encouragement to drink as much as your losing or in some cases more?

Dr. Noakes:   Quite the opposite.  Now, I used to be the Medical Director of a couple of races in Cape Town thinking we have a long 35 miles 56 kilometer, to Asians Marathon.  And I've been the Medical Director literally I would run the race.  And when I finished absolute amble of the medical tent and there'd be a guy with blisters, and another guy was something wrong and maybe there's an asthma attack or something.  But that was it, we didn't see  patients and then all of a sudden after 1976 when many many more people started running, and we started providing fluid at every few kilometers, every two or three kilometers, then you suddenly saw large numbers of athletes needing treatment for collapsing off to the race.  And it takes a long time to realize that they actually just tracking their blood pressures and if you lift their legs that's all they need.  And in my estimate its simply that their not adapted to running in the heat, and if it's a hot day we know that we get ten times as many people in the medical tent as when it's on a cold day no one comes  to the medical tent.  So that the heat is the key issue and that’s in my view, it’s because people are not trained properly and they're not adapted for the heat and that's why they collapse and then they compounded by drinking too much.  So far from reducing the problems, we saw many more problems when people started drinking more during marathon races.


Ben:                So, if you're drinking, when you're thirsty, that's still somehow, you know, causing dehydration.  Does that actually have an effect on your performance?  Because you know, what I have grown up with and what I was taught in school was that, once you get to about two percent dehydration, performance will start to significantly suffer.

Dr. Noakes: Well, that's the eve the start of the mantra from the United States of my research in Institute for Environmental Medicine that it’s kind of, I don't know where it came from but that's the mantra that all these guys say.  And they are the most influential people because they direct what happened to the American College of Sports Medicine and to some extent they've directed what happened in the Gatorade Sports Science Institute.  In other ways they direct all the advice that American runners get.  And they have this mantra and it’s fully embedded in the 2007 American College of Sports Medicine drinking guidelines.  So, they have said, an excerpt writes “you should drink to thirst, but if you're gonna lose more than two percent of your body weight then you must drink ahead of thirst.”  And there's absolutely no evidence for that and again I argue that very convincingly in the book that there's absolutely no evidence if you drink ahead of thirst such your performances enhanced, in fact it’s impaired.

Ben:                What about body temperature?

Dr. Noakes:   That's a great question! You see water has got nothing to do with body temperature or it’s the same as sugar has nothing to do with water body temperature.  The factor that determines your body temperature during exercise is how fast you run.  And the fast you run the high your body temperature, I present all the evidence for that.  However, there is a phenomenon known as Adopted Heterothermy and that's a big name.  And what it tells you is that for desert dwelling animals and humans evolved with desert dwelling animals, we have this ability to raise our body temperature when we’ve got drinking less water than we require. So, there's a wonderful animal the [0:12:29.1] which can live in a desert at 45°C it does not need to drink water.  It gets all its water from the grass and things that it eats. So not the grass they’re cassia plants.  But what it does is raise its body temperature 40°C to 46°C, so that's outside temperatures of 45 it can loses temperature down that gradient.  However, if you fill it with water, it immediately starts to sweat and brings the temperature down to 37.  So, as long as it’s got watered it regulates its body temperature at 37, as soon as you take water away from it, it allows its body temperature to rise.  And there are many other animals do the same, so what happens on humans we show exactly the same response.  If you don't drink as much as you need during exercise, for whatever reason, if you’re in a [00:13:15]______ and you’re not getting any fluid during exercise your temperature will be 1°C higher than when you drink lots of fluid.  But that's a biological adaptation which is a huge would benefit, cause it allows you to regulate your temperature without losing more fluids and sweating more heavily, so having a high temperature when you’re not drinking is a biological adaptation that is hugely valuable.

Ben:                So, so far as far as water intake basically what you're saying is that the recommendations to avoid kind of venturing in the two percent dehydration range really aren’t going to improve performance may actually hurt you and you should drink when you’re thirsty that's kind of what you layout at this point.

Dr. Noakes:   That's correct.  And the evidence is there, that if you drink ahead of thirst you become edematous, you retain water, you become heavier than you need to be.  And as a consequence your performance is impaired.  And what other studies which was, which I didn't actually interpret properly where the only one was published said “that you got about two liters of fluid in your body that you have to get rid of during exercise.”  So think if you can lose two pounds or two kilograms about four pounds of weight without changing body water contents.

Ben:                Four pounds.

Dr. Noakes:   Yeah.  That, we haven't been ever saw that, but in others we have look not people and see when does their body water content got down.  And we found that they have to lose more than a kilogram or two pounds before their body water contents down.  But I think we're still underestimating the volume of reserve water that you have.  Because the guts is full of water and you probably extract that water initially when you start to lose water and become dehydrated.  The point that what your weight on your scale that you lose, it's not all water and it's not all water that you need to replace.  And people need to understand that.


Ben:                So, you know that the one thing that we haven't really talked here all about yet is sodium and electrolytes.  I know we discuss this a little bit on the previous show but you know you talked about the evidence in terms of what exist out there about how athletes competing in long duration events.  You know, what kind of risk there is for salt deficiency?  Is there a risk at all in terms of becoming salt deficient during exercise?

Dr. Noakes:   Well, the way I read the literature is that there's absolutely no risk.  And the reason I say that is because people have tried to induce certain deficiency in free living humans.  And it’s only possible if you restrict this sodium intake to nothing and you can make them exercise three or four hours a day for at least seven days and as if as you can't generate it.  And what people have to understand is that when you exercise, you're actually excreting the sodium excess that you ingested the day before.  So, if our daily sodium requirements are about two grams a day, which is what I think they are in most athletes now to be up to three grams, if  you're exercising three or four hours a day.  But your intake of six grams and in fact you got three grams of sodium you're gonna have to lose the next day in your urine and sweat.  And so when we study at this during exercise, they are excreting an excess that they generated the day before.

Ben:                So, are you saying that it's like during the week of let's say Hawaii Ironman Hot Human Race.  During the week of Hawaii Ironman there's a lot of advice out there for athletes to say like, salting your food.  Almost during like salt loading laying after the race.  I know that you've said before that's taking in salt during the race is basically just gonna drive you to lose more salt and not help you at all, but what about in the days leading up to the race using something like salt loading?  Are you saying that, that's not gonna be beneficial either?

Dr. Noakes:   Well, it's really interesting because what happens with, you have to be in salt balance everyday or you’re going to die. So everyday you have to excrete the excess because if you accumulate it your body water contents gonna go up and you're going to die from edema.  So you have to get rid of the sodium everyday.  So if, let's say you came to the Ironman and you are sodium deficient, you would then replace all the sodium that you needed it would be stored inside the cells.  That's the only place you can store it.  So an athlete coming to the Ironman, the only site of sodium deficiency could possibly have is in a storage site inside the cells.

Ben:                And how much can we store in it?

Dr. Noakes:   Well probably a substantial amount, maybe 10 to 15 grams maximum, maybe 20 grams.  And so you can see it would take you two days to full the storage.  Now, what happens is you can do the Ironman and you will start extracting from the storage if you need to.  But again this is a little bit speculative because all these work was done in the 1950’s, so we know that there's more sodium in the body than we can account for.  And it has to be inside the cells, and it has to be reserve, which you can actively source if you are sweating a lot in for example the Ironman and you're doing something exceptional.  You can easily access that source and sustain your sodium without becoming deficient.  But the point is, that blood sodium concentrations are elevated in people running the Ironman if they lose water and they become slightly dehydrated.  So, they're not sodium deficient, the only way they might be slightly sodium deficient is that might have extracted sodium from their internal reserves which they will fill up the next day when they get back and take more sodium in their diets.

Ben:                And there's enough reserves there for 10, 12, 15, 17 hours?

Dr. Noakes:   Absolutely!  So the key if you want to know if you're sodium deficient just measure sodium at the end of the race in your urine, that's the key, it’s not in your sweat.  And if you were really sodium deficient, you would have no sodium in your urine and no sodium in your sweat.  So that if you can taste sodium in your sweat, you've got a sodium excess, an advert that they're very few on man triathletes.  You can't taste the salt in their sweat.

Ben:                In your book, you talked about Gatorade which I know is kind of a dirty “G” word in the book, and how it’s influenced our hydration recommendations that we’re exposed to, in the world of exercise.  And you talked about many of the studies that were done to develop Gatorade.  What were some of the problems that were the mistakes that were made in terms of generating that formula and the recommendations that came along with it?


Dr. Noakes:   You see there are top two sans, the 1 sans is you stop the sans without knowing what the outcome will be and that’s real sans.  When you influence the Sans that will produce an outcome that you want.  Then you’re in trouble and that’s called Ben sans.  And what you’re after look for is there any evidence that sans was done in order to produce   predertermined _______[0:20:55.1].  And that that’s the question that I need to answer.  So, the remaining studies that were covered but the key study was 1992.  In which had was Gatorade founded and the group in Texas studied athletes of good quality who exercise for two hours in hot environmental conditions, and they drank either nothing or substantially more up to 1.2 liters per hour.  But the key was they exercise very hard in hot conditions at a high intensities and there was no convict of cooling or since you know, very little convict of cooling.  And the conclusion from that study was that athletes needed to drink 1.2 liters per hour.  And that then became the mantra with the American College promoted in 1996.  They came along and said that all athletes must drink 1.2 liters per hour.  Now, what’s the problem?  The problem is, that, that study was of very good athletes exercising in extreme heat, when there was very little convictive cooling.  And I would ask the question, why would you setup an experiment like that except to have a very high sweat rate so that you could then tell people they have to drink a lot during exercise?

Ben:                Right.

Dr. Noakes:   Now, someone has got to come on to me and said that's not true.  The problem was, Cynthia Lucero in August she runs the Boston Marathon at 10°C, with a facing wind and it’s under cloud cover.  And she's told she must drink 1.2 liters per hour even though she's running at eight kilometers an hour.  She's not cycling at 40 kilometers per hour or 35 kilometers per hour at very high intensity.  She's jogging, and her sweat rate, I know, would have been 400 to 500 ml per hour.  Why should she drink at 1.2 liters per hour, when she's sweating at 400ml per hour?  Now, had those people in 1992 put Cynthia Lucero on a treadmill in Boston at 10°C and had her run at eight kilometers an hour.  They would have found she sweated at 400ml per hour.  Then the drinking guidelines would have been, everyone must drink at 400ml per hour.  And they would have been equally wrong, but they would have been more correct for athletes like Cynthia Lucero.  So, that was the problem.  That design was in my view to find conditions where people would sweat a lot, so that then people would be told to drink a lot.  And it was the guidelines that never modified for people running slowly and in cold conditions, when they absolutely don't need to drink that amount.

Ben:                You know, one of the things that appears to be the case in your book is that, they didn't separate when they tested Gatorade, the effect of the actual carbohydrate in a Gatorade.  Did I understand that correctly?

Dr. Noakes:   That's true.  And in fact I was asked that even just this morning.  And what's the evidence that you need the carbohydrate?  Well, the evidence for that does come from other studies but again they were done in people who are fasted for 12 hours.  So I know, I can prove that you need carbohydrate during exercise.  If I take carbohydrate after the activities, the athlete will drink lots of carbohydrate.  And I starve them for 12 hours, if I did it for 24 hours it would be even easier to prove it.  But you starve them for 12 hours and then they are gonna run out of carbohydrates sometime if you can make sure the exercise is long enough.  And it was done up to three hours the people's performance went down and when they took carbohydrate it went up, it was improved.  So that's the one group of studies in prolonged exercise saying you could benefit from carbohydrate.  But again it didn't look at the opt-alternate explanation that if you had people who were fat-adapted and to who might well not made carbohydrate during exercise.  The other problem is that carbohydrates do clearly have some sort of brain stimulating effect.  And as soon as they hit the back of your mouth they improve your performance.  And so you'll always get that effect of carbohydrates.  If, in a kids studies lasting say less than an hour, if you take in the carbs they are gonna help you, your benefit performance.  But again these are carbohydrate adapt to the athletes you are used to the stimulation.


Ben:                But in the actual Gatorade studies did they control the studies with a group that was consuming a carbohydrate plus electrolyte solution with the group that was consuming an electrolyte solution only?  I mean is it the glucose in the Gatorade that can help you and not the electrolytes?

Dr. Noakes:   I would guess so.  I mean, what they did compare that it compared to water and they’d generally found that taking more water after setting them on improved performance and taking more carbohydrate improve performance.  But for example, drinking a little bit of carbohydrate was or should I say [00:26:01]______to the best drinking a lot more water was almost as beneficial as drinking a little of carbohydrate.  So they are interactions and but no one really looked what role the electrolytes, and I would say the electrolytes, because they play no real biological role you don't need them during exercise.  I can't see how they would make much difference.

Ben:                So from, like a physiological perspective to geek out on this a little bit, you know you talk about exercises associated hyponatremia in the book, you know this water intoxication, how this actually happen?  I mean, what happens as you're taking in, you know water or drinking as much as most folks are recommending these days.

Dr. Noakes:   Let's make the point that it’s the first problem is the behavioral problem. You want this nerve biological drive to make you over drink.  You have to be told to over drink and you have to believe it and then continue to do it.  So that's the first problem.  Now, second in most people are over drink for simply stop passing urine and they will stop at the side of the road and find that they have to pass urine so much to those who are over drinking and they'll stop drinking.  The problem is that people who develop hyponatremia secrete the hormone antidiuretic hormone in excess, and that causes them to retain the water.  So, for whatever reason the body is responding completely abnormally.  And they drink to excess and they retain the water and they become progressively more waterlog.  And the brain doesn't detect it.  And they continue to drink even though they are killing themselves.  What happens is the water's retained and then the brain starts to swell.  And because the brain is contained in a rigid skull it cannot swell too far.  So its swells and it swells and it swells and then the pressure starts to rise and that obstructs the blood flow into the brain.  So you get areas which become under profuse and they stop functioning.  And the first thing that happens then is that your general brain function goes down so you become unconscious, then the certain parts of the brain maybe under profuse and you have epileptic seizures and if it goes further you stop breathing because the brain snick the breathing centers on not getting an adequate blood supplies so they stop working, you stop breathing.  And that unfortunately is terminal you can’t reverse that.

Ben:                And you see a lot of these in specifically like Ironman Triathlon  over the past few decades, right?

Dr. Noakes:   Well Ironman is defined that there were more than 600 cases of hyponatremia.

Ben:                Wow.  Now, in the New Zealand Ironman that rate significantly dropped, you were somewhat responsible for that, correct?

Dr. Noakes:   Well, I wouldn't claim all the responsibility, my colleague Dale Speedy was the man.

Ben:                And what did you do, how did you do that?  What do you tell the athletes or how did you kinda achieve the reduce rate of hyponatremia in that race?

Dr. Noakes:   Well, the interesting thing was that there had 14 hospitalized cases of hyponatremia, people unconscious, and this happened in the capital of New Zealand.  And so, what happened was that if they would have to have 15 cases they would have had shut down then, and have their medical emergency and procure all the doctors in to treat the problems.  And the doctor realized he didn't want to get all his colleagues out the next year says,  we'd better do something about it.  So what he did was he reduced the number of _________[00:29:25] stations on the cycling leg and on the running leg, and so you could only get fluids every 20 kilometers in the cycling and every 5 kilometers in the running leg, and he told everyone don't over drink.  He told them you may not ever drink, you may drink only to thirst and never ever ever drink more than 800 ml per hour.  And that reduce the incidents from 14 really serious cases adding to one the next year.  And so that was the difference.  That made all the difference.

Ben:                In your book you say that imperfect health has always been perfect health.  And you say that we're not gonna self destruct if we wanna go running the Comrades Marathon or complete the Ironman Hawaii Triathlon, what exactly do you mean when you say that imperfect health has always been perfect health?


Dr. Noakes:   That, I stole from I bet wonderful book, in God's House, I think that was the name.  And I was given that book by in fact the person who asked me to write the drinking guidelines for the International Marathon Medical Directors Association.  He said if you haven't read this book, you're not a doctor you can't be a doctor.  And it’s a wonderful book about this ________[00:30:38] and all the problems you faced and working too hard and having patience we've been survive and so on.  And imperfect health is what we are. It's just doing your best with what you have.  And what happens in medicine is we look for all these abnormalities we try to correct that.  And we shouldn't be doing that, because the body is quite capable of coping with these imperfections.  And that's the point that we are so over medicalized and over medicated.  And that's what happen in running, you know we didn't understand what we would it bring and we we're saying that human body is imperfect.  It can't get through the Ironman without drinking 2 liters an hour or taking in all the salt and all these carbohydrate.  And the reality is that humans are profoundly successful species.  We are incredibly robust and our robustness is such that we can easily do the Ironman, drinking relatively little and eating relatively little.  That is our design.  That is our imperfect design which in fact is perfect.  You can improve it by adding all these medical medication and all these supplements in sun.

Ben:                Gotha!  Okay.  It makes sense.  So you've got these athletes with hyponatremia.  I know a lot of doctors and people who work in medical tents, people end up in medical tents, listen to the show.  What do you do, is there a problem plots being done right now when people wandering to a medical tent by after having had too much to drink, and you know what are kind of the recommendations if you find yourself in that spot where you have taken on too much water?

Dr. Noakes:   Okay, well it's really simple.  If you walk in a medical tent and you see lots of drips hanging up, intravenous  drips hanging up, and if you see all the beds lying flat, then just get out of it because you're gonna get killed.  Just get out there because the people running that medical tent have not the first idea how to treat you.  On the other hand, if you come into the medical tents that we run, you will see all the beds with one end lifted up and that's where we will put your feet, we'll put your feet up and you won't see any drips, you'll see none.  And then you know these guys know what they're doing. And so when you come into my medical tent, the first thing I do is I look to see whether you're conscious or not conscious.  If you're conscious, I know whatever is wrong with you is irrelevant or it's minor.  When I see you're unconscious I know that I need all the medical help I can get and I’ll call in all the experts to help, because you could have had a heart attack, you could have had heat stroke or you could have had hyponatremia.  So, we will immediately examine you to see how is your heart beating, is your cardiovascular system stable, if it's stable would you have not a heart attack?  Then I know you've either had heat stroke or you were hyponatremia or maybe something else but less common.  So we'll immediately measure your rectal temperature and if it's 42°C we will treat you the heat stroke.  At the same time we will take blood and we will measure for your sodium concentration.  And if your sodium concentration is normal then I know you've not got hyponatremia then and only then would you be allowed to receive intravenous fluids.  We would not normally treat, we don't use intravenous fluids but if your sodium is 140 or higher, yes we will consider giving you intravenous fluids, but I need them.  So then we have caught out the major causes of the problem.  The rest of the patients who come in are fully conscious but they’re a bit dizzy and hypertensive, their blood pressures are bit low.  We lift their legs up and within 30 seconds they say “Doc I'm feeling fantastic, can I go out?”  And you say no, you  must lie down for another 10 minutes, 20 minutes, and 30 minutes.  Let your circulation sort itself out and then we'll see if you can stand.  And as soon as you can stand for a minute or two without being aided then you can leave the tent.  And if you do that, that's all you need to do.  And it makes it so simple, but what happens is people say “oh there are athletes got dehydrated by heat, they're almost dead.”  Those two diagnoses do not exist.  You're either have heat stroked or you die.  So if you died of heat stroke then you’ve got a low blood pressure for some other cause and we'll sort you up by getting your legs up.  And the confusion is this industry driven concept that dehydration is the condition that can cause collapse.  It doesn't, it’s got nothing to do with it.  And so finally if the athlete's dehydrated they will say I'm thirsty.  So if you ask the athlete, “are you thirsty?” he says “no,” then I said “then you're not dehydrated, then whatever's wrong with you has got nothing to do with dehydration.”


Ben:                Wow.  So, in terms of drinking to thirst, that is one the truth is in there because I've done it before.  I do sometimes find that in hot human conditions I can get close to 40 ounces per hour drinking to thirst.  I know some people say that you're never gonna come close to drinking enough, but I've found that my body can seems to adapt based on the weather I'm exercising, in cold conditions, in hot conditions, humid conditions, it's almost like I automatically vary water intake based after warm up.  Have you found that to be the case when you're telling people to drink to thirst, I mean does it really vary depending on conditions?

Dr. Noakes: Yeah, absolutely it does.  And we don't always understand the conditions that make things different.  But you see if cycling hard you can easily lose 1.2 liters per hour, when it comes to, you play American football you can lose up to 3 liters per hour, we know that Haile Gebrselassie loses 3 liters now when he's running the marathon.  And he will lose as 67 kilograms, and he actually does drink far, he drinks up to 800 to 900 ml per hour which is remarkable for a man running that fast. I can expect he takes 2 kilograms every hour that he runs.

Ben:                You go over a ton more research than we've actually covered in your book, Waterlogged and this is in my opinion a book that everyone should pick-up.  You know, it’s having enough to where I know that those who like to geek out on this stuff will enjoy but they're certainly it's written in way that's very understandable.  And so, I will make sure that I put a link to this book in the show notes, and the few of the notes that I took when I was reading the book, some of my takeaways in the show notes.  And then if you have questions after having listened then, then go ahead and just leave them, write there in the comments underneath the show notes for this episode with Dr. Tim Noakes and I'll be sure that to hunt down an answer for you.  Dr. Noakes, thank you so much for coming on talking about this problem of over hydration.

Dr. Noakes:   Thank you Ben again for having me, I really appreciate it.  Now I really appreciate your getting these ideas and I was driven by my concern.  Would you believe that last week there was a death from hyponatremia in a paddling race on a river in Texas?  And this got art paddling, I think it was an incredible race.  It was like 200 miles but off than 90 miles this guy went unconscious and he died before they could treat him.  And it was clear he was over drinking and so he’s lead the wrong idea and in fact try to abuse the picture of him paddling and he’s got a camel back and he’s sucking on the water.  And I can’t imagine that he was doing that for the thirst, 90 miles of the race and that was half, you know you’re not doing really hard work when you’re canoeing.  And so he was  over drinking and it’s a tragedy, it’s still happening and it’s absolutely preventable.

Ben:                Well, I appreciate that you’re bringing this knowledge to the masses with your book.  So thanks for your time today and folks this is Ben Greenfield and Dr. Timothy Noakes signing out from



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