Are Sports Drinks Safe & Effective?

Are Sports Drinks Safe & Effective?
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Commercial influences may have corrupted American College of Sports Medicine hydration guidelines.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

If you had to name the greatest medical advance over the past two centuries, what would you pick? Smallpox vaccine jumped to my mind, until I realized it was discovered back in the 1700s. The British Medical Journal compiled a list of 15 contenders, but which would take the crown? Would it be anesthesia? Kinda nice to be asleep during surgery. Would it be antibiotics? One of the 15 may be surprising. The medical marvel that was “water with sugar and salt.”

“The discovery that [sugar and salt were absorbed together] in the small intestine…was potentially the most important medical advance [of the] century…[because] [i]t opened the way to oral [re]hydration” therapy—which is to say, simple packets of sugar and salt, in the right ratio, that could be added to water to save the lives of children losing electrolytes through severe diarrhea from diseases like cholera. Here, we’d just hook you up to an IV, give you intravenous rehydration therapy. But cheap, easy oral rehydration has saved millions and millions of children’s lives every year, such that UNICEF can now put out reports like this to help finish the job.

It only costs pennies, though. If only there was a way to sell salty sugar water for two bucks a bottle. Sports drinks are a multi-billion dollar industry fueled by Coke and Pepsi, and even drug companies are now getting in on the action. Researchers went online to see what kind of hydration advice people were getting. Pop quiz! True or false: Fluid consumption during exercise should be based upon thirst. Is that a true or false statement? Fluid consumption during exercise should be based upon thirst. Get a piece of paper, write down your answer. All right, ready? Next question: Electrolyte intake is not generally necessary during exercise. Keeping score? True or false: Dehydration is not generally a cause of exercise-associated muscle cramping. And, last one: Exercise-associated muscle cramping is not generally related to electrolyte loss. And, the answers are: True, true, true, and true. If you said false to any of them, you’re wrong—but in good company. 93% of top websites got the first question wrong, 90% got the second question wrong, 98% got the third question wrong, and they all got the last one wrong. And: “To make matters worse, those websites that would generally be perceived as being [more] trustworthy by the public [like websites of medical or professional organizations] appear[ed] to [do] no better.” So, you shouldn’t feel bad if you got any wrong. No wonder “athletes often have misunderstandings about proper hydration during exercise.”

Doesn’t dehydration hurt performance? Surprisingly, when they looked at triathletes, they didn’t see a correlation between dehydration and marathon-finishing times. In fact, some that lost the most water actually had among the fastest times, as has been noted in other studies.

Your body’s not stupid; it will tell you when you need to drink. “There is now ample evidence” that we can just drink to thirst. And, you do not have to drink your electrolytes. But wait, if you’re sweating and just drink pure water, aren’t you risking washing out too much salt, too much sodium, and ending up with “exercise associated hyponatremia,” too little sodium? That’s caused by drinking too much of anything—”water or sports drinks.” In one of the high-profile cases of a high school athlete who died from it drank two gallons of Gatorade. So, how do we prevent such deaths? Simple, we “drink according to thirst.” So, these “don’t wait until you feel thirsty” statements you hear may actually be doing more harm than good.

We’ve known this since the early 90s, but it “was ignored.” The American College of Sports Medicine instead started telling athletes they should drink ‘as much as tolerable’ during exercise. And, “[w]hat followed was an epidemic of” cases of hyponatremia. “Commercial interests [may have played a role in] “delay[ing] the [acknowledgement] of [these] findings for…decades.”

The current ACSM statement no longer says that—in fact, emphasizing how dangerous it can be to drink too much. But, they still plug sports beverages as sometimes preferable to water. Hmm, I wonder who these authors are? Funding received from the Gatorade Sports Science Institute or on the Gatorade Sports Science Institute Speakers Bureau, Gatorade Science Institute, more Gatorade, a quick step over to the Coca-Cola company, and then back to Gatorade.

So, anyway, which of the 15 medical marvels won? Was it oral rehydration to prevent deaths from cholera? Or, antibiotics to kill off the cholera bugs? No, our greatest medical miracle over the last two centuries was “sanitation”—preventing the cholera from getting into our drinking water in the first place.

Please consider volunteering to help out on the site.

Image credit: Gellinger via Pixabay. Image has been modified.

Motion graphics by Avocado Video.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

If you had to name the greatest medical advance over the past two centuries, what would you pick? Smallpox vaccine jumped to my mind, until I realized it was discovered back in the 1700s. The British Medical Journal compiled a list of 15 contenders, but which would take the crown? Would it be anesthesia? Kinda nice to be asleep during surgery. Would it be antibiotics? One of the 15 may be surprising. The medical marvel that was “water with sugar and salt.”

“The discovery that [sugar and salt were absorbed together] in the small intestine…was potentially the most important medical advance [of the] century…[because] [i]t opened the way to oral [re]hydration” therapy—which is to say, simple packets of sugar and salt, in the right ratio, that could be added to water to save the lives of children losing electrolytes through severe diarrhea from diseases like cholera. Here, we’d just hook you up to an IV, give you intravenous rehydration therapy. But cheap, easy oral rehydration has saved millions and millions of children’s lives every year, such that UNICEF can now put out reports like this to help finish the job.

It only costs pennies, though. If only there was a way to sell salty sugar water for two bucks a bottle. Sports drinks are a multi-billion dollar industry fueled by Coke and Pepsi, and even drug companies are now getting in on the action. Researchers went online to see what kind of hydration advice people were getting. Pop quiz! True or false: Fluid consumption during exercise should be based upon thirst. Is that a true or false statement? Fluid consumption during exercise should be based upon thirst. Get a piece of paper, write down your answer. All right, ready? Next question: Electrolyte intake is not generally necessary during exercise. Keeping score? True or false: Dehydration is not generally a cause of exercise-associated muscle cramping. And, last one: Exercise-associated muscle cramping is not generally related to electrolyte loss. And, the answers are: True, true, true, and true. If you said false to any of them, you’re wrong—but in good company. 93% of top websites got the first question wrong, 90% got the second question wrong, 98% got the third question wrong, and they all got the last one wrong. And: “To make matters worse, those websites that would generally be perceived as being [more] trustworthy by the public [like websites of medical or professional organizations] appear[ed] to [do] no better.” So, you shouldn’t feel bad if you got any wrong. No wonder “athletes often have misunderstandings about proper hydration during exercise.”

Doesn’t dehydration hurt performance? Surprisingly, when they looked at triathletes, they didn’t see a correlation between dehydration and marathon-finishing times. In fact, some that lost the most water actually had among the fastest times, as has been noted in other studies.

Your body’s not stupid; it will tell you when you need to drink. “There is now ample evidence” that we can just drink to thirst. And, you do not have to drink your electrolytes. But wait, if you’re sweating and just drink pure water, aren’t you risking washing out too much salt, too much sodium, and ending up with “exercise associated hyponatremia,” too little sodium? That’s caused by drinking too much of anything—”water or sports drinks.” In one of the high-profile cases of a high school athlete who died from it drank two gallons of Gatorade. So, how do we prevent such deaths? Simple, we “drink according to thirst.” So, these “don’t wait until you feel thirsty” statements you hear may actually be doing more harm than good.

We’ve known this since the early 90s, but it “was ignored.” The American College of Sports Medicine instead started telling athletes they should drink ‘as much as tolerable’ during exercise. And, “[w]hat followed was an epidemic of” cases of hyponatremia. “Commercial interests [may have played a role in] “delay[ing] the [acknowledgement] of [these] findings for…decades.”

The current ACSM statement no longer says that—in fact, emphasizing how dangerous it can be to drink too much. But, they still plug sports beverages as sometimes preferable to water. Hmm, I wonder who these authors are? Funding received from the Gatorade Sports Science Institute or on the Gatorade Sports Science Institute Speakers Bureau, Gatorade Science Institute, more Gatorade, a quick step over to the Coca-Cola company, and then back to Gatorade.

So, anyway, which of the 15 medical marvels won? Was it oral rehydration to prevent deaths from cholera? Or, antibiotics to kill off the cholera bugs? No, our greatest medical miracle over the last two centuries was “sanitation”—preventing the cholera from getting into our drinking water in the first place.

Please consider volunteering to help out on the site.

Image credit: Gellinger via Pixabay. Image has been modified.

Motion graphics by Avocado Video.

Doctor's Note

That’s one of my personal fave videos of late. Got all the things I love: sweeping historical context, corporate malfeasance, myth busting—you name it! Hope it was as good for you as it was for me :)

What about using coconut water? See my last video, if you missed it: Coconut Water for Athletic Performance vs. Sports Drinks.

More videos on hydration, if you get thirsty:

A quick reminder: Captions for videos are available in several languages. To find yours, click on the settings wheel on the lower-right of the video and then “Subtitles/CC.” 

If you haven’t yet, you can subscribe to my videos for free by clicking here.

106 responses to “Are Sports Drinks Safe & Effective?

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  1. Salt is the origin word for salary because the Romans payed their soldiers with salt. There was a time when salt was worth more than gold. People would be pressed into slavery and worked to death to obtain salt which for those involved was a considerably higher price paid than gold for salt.

    There was a time when I though that I had to salt my food because my taste buds craved the taste of salt so much, but after weaning myself off of added salt and avoiding processed foods that contained salt, I found that I could taste the salt that occurs naturally in the foods I was eating. I can feed the effects of eating too much store bought bread or over salted restaurant food as a excessive thirst as my body complains about the excessive sodium load and strives to flush it from my body. I can now taste the salt that naturally occurs in food, and when I look at my sodium intake in Cronometer, I routinely get well over 500 mg of sodium by just eating whole natural plant foods,

    I am now stating to wonder if it is even possible for a healthy person on a whole foods plant based diet to become sodium deficient if he or she is getting enough calories to meet their physical exertion requirements.

    1. I used to hike and run all day in the East TN heat and not add any salt to my food. The key is to decrease the salt intake gradually so hormones adapt. The only time I seriously craved salt was when I was briefly on high blood pressure medicine, ironically.

    2. My sodium levels were always very low on Cronometer even with adding a small amount of Himalayan salt to one meal a day, I was eating over 2,000 calories. I liked that my intake showed up as low though. I don’t use cronometer anymore… not a fan of food measuring systems.

  2. I ended up at the ER about eight summers ago. I’d always heard that we need to cut way down on salt/sodium and drink lots of water to prevent high BP. So I’d “lemon” everything instead of salt it, and always toted a big bottle of water with me wherever I went. During the hot summers, water guzzling was said to be especially important. I knew nothing about keeping electrolytes in proper order.

    One day a friend called me about something. When I seemed groggy and asked, “Who is this?,” she said she was coming right over to take me to the hospital (don’t remember this). Once in the ER I was able to answer various questions, but again, I don’t remember doing so. (Where did my “I” go?) Am told they did a battery of tests to see if I had a stroke (nope), and concluded that my sodium level had gone waaaaay down. It hovered around 21 or whatever. When I came to, I found myself in a hospital nightie, and sitting on a bed with a saline solution thingie on my arm. Official diagnosis: hyponatremia.

    1. question i’d have is what were you eating when on this mission to cut your salt/sodium levels? I ask because the evidence covered in blogs/videos on this site suggests if you are on a wfpb nutrition you are going to get enough salt intake. If you were on wfpb nutrition was it the volume of water you were drinking, or the fact it contained lemon, that was flushing the naturally occurring salt/sodium you were getting out of your system?

      1. myusrn, the (Brita pitcher filtered) water I drank did NOT contain lemon. I used lemon only as a salt substitute for veggies and whatever else one is prone to salt. No particular “mission.” It may have been the general thinking at the time that we should drink lots of water, especially during the hot months, and cut waaaay down on salt so we didn’t get high BP (Maybe I was reading the wrong health advice articles that we often see on the dear ol’ Internet.) Can’t remember if I was doing plant-based at that time. I’m one of those on again — off again folks. Now I’m ON again. :-)

        ron, I had taken my usual morning walk, and got the phone call around noon….about an hour after I returned to the apartment. It was probably too hot to be out walking, but did it anyway. I consider myself fit…never had a weight problem, etc.

    2. YR…what was your behavior that day prior to the incident.
      Was this following a run a day or work or this or that. What time of day and what were your typical physical activity level then?

      I am assuming young fit but please exemplify.

      1. P.S. to ron. You wrote “young” fit, but maybe you meant to say “you’re fit”? I’m certainly not young…no teeny-bopper, that’s for sure. Don’t take any prescription meds either. Those sonsofbees can kill ya.

        1. YR…I am not making a judgement………. as the oldest women alive for quite a few years holding the record did that form of exercise in her life time, a woman from France. She did moderate exercise such as walking riding a bike those sort of things.

          So living long that is it seemingly that form of exercise.
          A person who does that probably should use thirst as a indicator of hydration. A person competing In ultra marathons…no. I could see plainly why drinking to much at that level of exercise is a negative.Study reflects that usually as it is usually on such levels of activity and/or fitness levels.
          And not saying you are unfit but your level is not that of a extreme event participant.

          I would also say a person that fits your descripition has no need for any salt other than that found in WFPB vegan diet.
          A other person…perhaps that is not the situation, is my point.
          Of course any meat eater is going to have way enough salt…but a vegan extreme event participant on a WFPB diet…like we find in the case of additional protein requirement, 1.6 as opposed to .8 per KG……dietary modification is necessary to accommodate the training expenditure/

          1. ron,

            I do more than take daily walks. For many years I’ve also bounced on a rebounder (don’t lift feet, just bounce…good for lymphatic system), and various yoga and other exercises before breakfast. A bit of meditation thrown in there as well. It’s all good!

            1. Well it is all good and likely as I mention will increase the odds of a long life.
              But none of those activities are tending one to a extreme deficit of salt or fluid or any other electrolyte.

              Run 12 miles in training for a hot marathon, which means you must train for the heat and thus train in it…and those are your stressors regardless of conditioning level. Or do a NFL two a days workout in the hot sun for hours upon hours…same thing.

              It is just different and requiring a bit differing nutrition and hydration which is my contention.
              WE probably still cannot conclusively prove steroids make muscle. But they do. In similar fashion we cannot prove one doing a bike race the tour de France needs copious amounts of food/glycogen replacement and drink in race to survive by study…but they do.
              Generally such study if there is one, is observational, as who would be the control…..those who do the tour De Frace without fluids or replacement drink…well none of that sort exist.
              Why…they would crash and burn bonk as the term goes.

              So there is a limiting factor to this form of study which may tend to draw untoward conclusions.
              Like less hydrating peoples doing better in a competition..it may mean the athlete is better trained to the heat and nothing more. Or it can be that the race one is in, is their only race or last race of a season, so there is not a need to hydrate beyond a halfway point, recovery is not necessary……so it is difficult.

              You no offense but you do not need to hydrate as much as any one of those I mention based on activity level. It is not that you are not active but the form of activity is different.

                1. Yes YR they are overselling it to sell things. Your average sports participant does not need any additional hydration.

                  Demonizing salt is a bit over the top as well. And our community tends that way. I could look up the studies spend a little time with it but suffice it perhaps to say we need salt to live and be active. It is just normally…. meat and all we get so much in excess. The idea of adding any salt to anything from a tableshaker is absurd to me. But just veggies no processed things, lots of fruit and very active in the hot sun all day…..I could see a problem.
                  But I run into the same exact things with protein requirements in our community.
                  Your average sports participant does not need additional protein. A powerlifter to recover…yes they do. Could look up those studies.
                  Suffice it to say all communities hold bias.

                  We want to be natural but some of us are not..running a hundred miles in a couple of days..kills people it is not natural to do that. Pro football two a days..what natural environment would approximate that? Lifting in total thousands of pounds in a days workout…who does than in prehistoric evolutionary terms…none. Active walking around perhaps jogging with occasional bursts of speed or strength that was it I think.

                  So for most Dr Gregers statements here apply. The corporations I think tend to take the elite class athletically and apply it to the normal person…which rarely works. And internally we do not account for our natural variance at times in activity and diet.
                  Imagine your average person eating what they do reads your article on salt…..they do not know they are already in a context of very high salt intake by generally being just American.

    3. I had this problem and was hospitalized twice I Florida. I have been checked regularly and while I came up to only within one digit low, the chloride is also on the low side. I am 84 and in fair health with many issues in past. I saw a Nephrologist at Cleveland Clinic and was advised to not drink more liquid than about 32 oz. water. No idea what causes this, He also suggested more protein.

  3. So…
    [In summary – because the video isn’t particular clear about the ‘take-home’ message]:

    A) An appropriate ratio of sugars and salts added to drinking water can replenish electrolytes if your body is lacking electrolytes (an example being having suffered from severe diarrhea), however…
    B) Most people, even when doing moderate exercise, will not experience an electrolyte imbalance such that it would be beneficial to consume such a sugar and salt drink combination.

    Would someone please advise – have I understood this video correctly?

    Thank you

    1. Alan- You got it! If you have severe diarrhea, or are running long distance, or exercising vigorously for an hour in the heat, electrolyte and sugar replacement are helpful. But for most situations, water is sufficient for hydration.

      Dr Anderson, Health Support Volunteer

      1. I know some pretty serious fasting advocates. To me it seems like long term fasting could have many repercussions and even a day-3 day fast seems like it could be harmful. Does Dr. Greger have any videos on fasting coming up?

      2. Hi
        I don’t believe the video take home message was what you said above? I believe it was drink when you are thirsty water or electrolyte replacement. But not too much?

        I didn’t hear the hour or more electrolyte message…

    2. Alan, that’s how I understood the video. In summary: Drink water. According to thirst.

      Corollaries: Save money, and avoid excess plastic waste as well as resource waste (from making the plastic in the first place, then the “sports drink,” then transporting the “sports drink” hither and yon) by drinking tap water. Carry a reusable bottle or two filled with water from home.

  4. So it’s not true that thirst is a lagging indicator of dehydration? My information, which makes logical sense to me, is that dehydration, even if mild, makes all body fluids more viscous, which slows blood flow and intracellular metabolism, including the delivery of oxygen to muscles and the chemical reactions that generate ATP to fuel athletic performance. The numbers I saw were that being down a quart resulted in a 30% drop in athletic performance (which just might have been research-based).

    1. You commented on thirst being a valid indicator of dehydration and you mentioned a study. I tried to find that study on the PubMed data base but of the articles I found on dehydration this was the one that seemed to be most relevant : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908954/. It did not however give the specifics you mentioned. I think the bottom line as other commenters have pointed out is that we should indeed drink water as needed and avoid dehydration even if specifics of how the body is affected by lack of fluids is not totally clarified.

  5. To me this is all a matter of perspective…
    Dr Greger is perfectly right and correctly reporting on sport drinks for your average American involved in typical activity to include sports.

    But take any ultramarathoner who has successfully completed one and ask them if they did indeed not have to force themselves to eat and drink when in the middle of the run……and they will tell you absolutely they have to and had to. By my guess simple overt fatigue will dampen the thirst indicator. If up and running for 20 some odd hours one cannot depend upon a thirst or hunger indicator. It is like asking a drunk to evaluate a physical indicator…..

    And to mention athletes suffered cramping when exercising in the hot sun even back in the day. That day being when coaches in many sports purposely denied those in training drink as it was a sign of weakness. Cramping and such often presented.
    Point being we must of course balance overconsumption of drink with amount consumed but the denial of drink as well leads to fatal outcomes. Who is most likely to suffer hyperthermia with fatal outcome….a well or excessively hydrated person or one who is not…I venture almost always one who is not.
    I would venture by experience of coaching outcomes in sports in the fifties when denial of hydration was the rule not the exception……the potential of a fatal outcome with denial of drink is more probable amongst young fit kids.
    Overconsumption of drink could occur but how many would simply throw up to prevent that outcome.
    Of course one must not drink 2 gallons of Gatorade. Over hydration as proven by some participating in water drinking contests proves fatal as well.

    In a marathon the rule used to be after the half way mark any hydration is for the purpose of recovery after the race not affecting the result of the race at all.
    But hydration prior to the half will affect outcome. So one was advised to not hydrate past the half necessarily if that particular race was the only goal.Of course this applied for the young fit extremely trained participants.

    So yes indeed one with less hydration may have a faster end time. But the read on hydration is a false one as the athlete may only hydrate in the first half with intention. And/or the fittest athlete has trained their body to the forced necessity of water retention and balance. So who shows up in study to be the best at the thing…it appears those who do not hydrate but it is not a hydration amount function but a fitness function. How much salt one excretes in sweat for instance…is a function of training. More better training in heat and one will excrete less in sweat.

    The problem being as I see it the difficulty of study on elite athlete whose behaviors may be atypical are very hard to ascertain.As we get into the area beyond typical we venture into this unknown.
    Thirst running a 10k a average runner in a local race…seems a good indicator to me.
    Thirst a ultamarathoner in the middle of a 100 mile run to depend on that for hydration indication….means she he will not finish. They do indeed eat and drink as much as they can without making themselves sick or hindering performance. Eating is always a part of that but that does not mean drinking to accompany it is not.
    Of course it must be balanced.

    So I agree for most. I think demonization of salt is ill advised for all but well advised for the average American on the typical processed food and meat diet.
    How much salt do foods like many meats contain….and then we add table salt to that…of course the person will have difficulty.
    A WFPB diet vegan……a athlete to boot…show me the salt source???

  6. I find this confusing, as some of you earlier commenters seem to. An 80-something friend who lives in a retirement home for low income seniors often takes neighbors to the hospital emergency room for what turns out to be low sodium, or perhaps low electrolytes. I’m guessing these older folks are on blood pressure meds that flush them out. They’ve been told to avoid salt, and over time they have lost their taste for it. So they get into trouble.

    1. The assisted living centers and the retirement homes typically use a salt substitute like a potassium. So if they avoid salt, flush out salt via medication, and give a salt substitute it’s not surprising they get low salt. They had to give my mother her real salt, salt-shaker back. She’s 82 and doesn’t exercise. And almost died due to low sodium.

      I agree with Ron. This is good general info for general people who get plenty of salt daily and hard exercise less than 1:30. Not for semi pro level athletes competing at 2-4 hour or more events in the heat of the day.

  7. I have a AMPD1 deficiency gene polymorphism. According to SNPedia, “some individuals – but by no means all or even a majority apparently – who are AMPD1 deficient get muscle cramps and pains when they exert themselves.” When I would get cramps at the gym, people would always tell me it was dehydration. I would force myself to guzzle liters of H20, and this obviously did no good.

    I would be grateful if Dr. G would do some videos on genes and nutrition. Metabolic defects are relatively common (e.g. MTHFR and UTG1A1 defects, both of which I also have), and the “one size fits all” mentality of most medical and nutritional advice can cause problems.

      1. Julie, excellent article! I do nutritional counseling and have understood that not all people do well on the same diet.
        Have gotten in trouble on this site stating that. :)

  8. I play baseball for 3 hours in the hot sun with 25 year olds, and I’m 54. I eat a lunch of beans, beets, turmeric, celery, and green leafies with garlic and ginger thrown in. When I don’t eat this, I am much more likely to get cramps and pain. These are the kinds of foods that have electrolytes: calcium, magnesium, potassium, sodium, chloride. I also drink water and coffee, usually to thirst.
    It works for me.
    JOhn S

    1. Not meaning to be derogatory but just using your post as an example. I think as human beings we are easily lulled into the thinking that what we do, or someone we know does, and the outcomes that creates is a statistically relevant example.

      The blogs/videos published on this site involve painstaking effort to always discuss qualified evidence, and dismiss evidence of studies done improperly or with bias, and point to the fact that finds are always in the form of statistics. Which is to say nothings a 100% guarantee but given that the cause and effect being provided in conclusions presented by referenced study[ies] the findings can be expected to be what happens most often.

      This all has me rethinking how often I project what I do and what it leads to as not really definitive of any specific cause and effect because without through controls how can I really know if some desirable or undesirable outcome is not a result of some other factor(s) I’m overlooking. For us to make conclusions about our own experiences or those of family/friends we’d have to have a way to ensure all other factors were held constant.

      Just raising this as food for thought given how often I hear personal testimony arise as push back, or a counter argument, when I bring up wfpb nutrition [ and therapeutic fasting ] as an interesting topic for conversations with friends and acquaintances.

      1. myusm, I agree. It is so easy for us humans to project our experiences onto other people. Just because something works fantastic or terrible for me, does not mean others will experience the same outcome. Also research studies use statistical significance–rarely does a study show that the result occurred 100% of the time.

      2. M…there is a limitation to study in this field. AS a fact the AMA had a certain response to steroids back in the sixties and seventies….they did not work it was all placebo effect.
        But every strength athlete in any country knew quite definitively they worked based on their evidence in performance…those who used them recovered better and performed better…
        So eventually they were determined a unfair advantage and outlawed in sports…for good reason, they absolutely worked.
        Why the science that showed otherwise…they work only in very highly trained individuals to assist in recovery enableing future harder workouts.
        The science was based on ordinary joes who may work out but way way different than competitive athletes or pro athletes.

        Based on that experience the medical field in some aspect of sports nutrition is always a day late and dollar short. Creatine its benefits came not from science which followed about 15 years post but from track and field athletes in the sprinting events. It works as well…but up until 10 or so years ago as far as the science was concerned it was unknown.

        HGH testerone EGO this and that, there is no science to support their use but it is unequivocally known to enhance performance. So the sporting authorities ban them. Does the science support that…maybe not. But is is fact they work.

        A professional football player is a million dollar machine expected to perform…..and peoples are employed docs to see they do, it is a investment..

        Cramps on the sideline, they try to work them out sit in front of a fan and this and that. Nothing works..halftime they run a IV Normal saline to hydrate.
        And know what…it works.
        So it is personal experience of a sort but of a sort that demands performance in the interest of money. But a pro athlete in football is simply not the experience of a ordinary American.
        Scientific study is simply not tailored to this group of individuals….as what application does their use or behavior have upon the rest of us….very little.

        1. In following professional athletes and “what worked” and “what didn’t” how do they rule out the subjective aspects of those findings. Its not like they staged properly structured randomized clinical trials with placebos and had an objective way to measure who performed better and who didn’t. For an athlete who performed better how did/do they rule out the placebo effect?

          The recent analogy to this that came up in the Netflix “take your pills” documentary was college student use of adderall [ / amphetamine ] vs ritalin [ / methylphenidate ]. The current myth amongst high school seniors and colledge kids is that these drugs improve their ability to focus and get better grades. Then latter in the documentary they refer to a properly orchestrated study that was done, where they removed the subjective component of assessing differing results, and what they found was kids on these pills when measured objectively in fact do worse. I’d hazard a guess that if a properly run study was done on coffee [ / caffeine ] used by the adult work force we’d find the same thing.

          My point is that subjective measurements, even those from large groups of professional althletes and their trainers, are not replacements for objective measurements produced from properly run randomized control trials with double blind placebos. In cases where a placebo is not possible, as the substance or treatment can not be silently hidden from recipients, dr. greger recently published https://nutritionfacts.org/video/do-any-benefits-of-alcohol-outweigh-the-risks/ which I thought called out this tidbit which was very relevant “Mendelian randomization [mr] is a new tool that sits at the interface between observational and interventional epidemiology. Used in cases where randomized control trial [rct] is not feasible.”

          1. My…pro football players are peoples who have been doing this for years and years and are as the word infers professional.
            A..“For an athlete who performed better how did/do they rule out the placebo effect?

            athlete who is beset with cramps it is simply a way to get back onto the field. They will try this and that. Halftime they will give them a IV and about most of the time it works. If it was placebo the this and that would work. The trainers will try to stretch them out the athletes may try a bike type thing in front of a fan, try to loosen up stretch, hydration by mouth dousing with water and everything includeing the kitchen sink.
            All fails a IV and almost always it works.

            The terminal results for heat stress and hydration amongst pro players was back in the day ephedra and ephedra stimulant drinks which cause dehydration.

            Steroids that was the claimed cause by the medical community back in the sixties. Now we can point to specific areas of enhancement that certain steroids provide, trapezoid for instance with certain steroids one causes hypertrophy extreme muscle growth…of one specific area.
            And this and that. Using the basic thing steroids they have been tailored for specific effects over the years. You want this effect you take this in this amount and frequency. You want that effect you do this…and on and on.

            Placebo is some kid in high school. Massive massive peoples with 20 inch plus arms did not just occur in sports due to our better nutrition than in the past…they were, are created. And that research has extended in other directions such as with bikers runners and such.
            They suffer the negative effects and die young but they are a result of enhancement that the medical community did firmly call placebo at one time.

            Why because the studies did not capture it. Docs are paid by the teams to put the player back on the field in the least amount of time wasted. If they do not succeed they will be summarily fired. They do absolutely anything then to get them back(legal) and with cramps that means IV.
            Last thing but if bad enough and a key player…it is just what is done..and it works.

            Who needs a study of that if it works about always? Why would anyone bother to study it? Hyperthermia is well studied but it is a different animal. Pro football players are generally not hyperthermic. If so they would treat them with tubs of ice. Cramps of musculature such as legs is not hyperthermia though hyperthermic people may have cramping.

            1. my…no offense but the idea steroids were or are a placebo effect has bitten the dust about around 1975 in even the medical community.
              The results amongst pro athletes of every sort and description were just to strikingly different to in any way discount the effect.

              Now with the research and development….what they are able to accomplish with those things is just truly remarkable and unnatural.
              I am no advocate but that debate medically was given up about that time.
              The current monsters In bodybuilding probably speak to the most extreme results coupled with HGH and testosterone and a number of lesser known products such as insulin.
              People just have never looked like that in our genetic line. They are monsterous, no other word for it.
              A product of drug enhancement.

              One the AMA their official line was to say it was placebo.. Why I don’t know. It flew in the face of obvious observational evidence for quite some time probably mid sixties. That a thing is observational based does not infer it to be biased or faulted.

              1. Here is a pretty good example. Damage control within the industry of bodybuilding tried initially to claim this was a case of choking on food.
                Truth is on autopsy his heart was found to have become three times roughly the average size heart. He was big naturally 6ft 2 or something but in no way shape or form at his young age(twenties) without steroids would his heart have been that size absent CHF or similar medical cause of disease. He was not 600 pounds and actually was appearance wise very very fit low body fat. Look at the pictures.
                https://spotmebro.com/news/dallas-mccarver-autopsy-report-sad-insight-steroid-abuse-effects/
                No placebo can produce that result. Another famous one, Rich Piana just died as well..stroke it seems though autopsy was incomplete. He was claimed to have been murdered and this and that. His heart the same size ratio as this poor fellow, grossly enlarged. Neucrotic tissue was found in his brain matter pointing to initial stroke as cause though he was kept on life support for a couple of weeks.

                A untoward result of steroids is not only muscle growth but organ growth. The monsters now about all, have some degree of a distended gut as result…..enlarged heart leads to cardiac arrest eventually without treatment.
                Treatment for these monsters would involve stopping steroids which they cannot do as it is in their field a necessity. Lance Armstrong, a caution on the particular steroid he was taking prior to his testicular cancer diagnosis(different steroids have differing negative result as well)…..testicular cancer. He stopped that particular one and it went into remission. But he later used others and other things.
                Both these guys Piana was a millionare times over and Dallas was well off though new to the sport.
                Dallas had testerone levels something in the range of a thousand times normal as well.

                Lance was worth close to a billion at one time and has yet to suffer any negative results sans the cancer early on in his career…it is their price to pay, or luck out and not pay. Arnold S has had multiple heart problems and claims it is all genetics…but now he is vegan. He was a known steroid abuser for years. His dad was pretty normal living to about 70 no heart problems prior that I know of prior to death so pretty typical…so it is BS……… damage control by my read. Like this first fellow they say he choked the second was murdered or hit his head….
                There is no debate and this is only part of the evidence…steroids work.

                To the negative eventually. I could produce bunches more.

                1. From the article on Dallas here is the conclusion..this is a industry publication source
                  “It’s important to keep things balanced and stay within limits if you are going to be cycling any form of drug to enhance your performance. This keeps the gains coming and your organs as safe as possible. But there will always be risks.
                  With Dallas passing as young as he did, you’ve sort of got to ask the question about when steroid use becomes a full drug problem. Bodybuilding today wouldn’t exist without these types of drugs, but with physiques getting bigger and bigger, is it time to look at honing things in a little?

                  Deaths are bad for the sport. HGH had a part to this as well, this fellow was on it all.
                  But placebo…..how can placebo grow enlarged organs in young otherwise healthy people?
                  I have had acquaintance with a female powerlifter who for all intents and purposes changed from a woman to a man in the space of ten years. A world record holder. She has somewhat now reverted by my guess with female hormone therepy but the full beards these gals get are not placebos as well. At the start she was a pretty attractive female of normal size. At the end of her career….appearance wise she was a man with strength to match. A very strong man.

                  Why would one assume these things only grow beards in women and not muscles as well?
                  Placebos do not these things.

  9. Greetings! I have severe dysautonmia/POTS that has left me from an active, fulltime working, triathlete RN, to being homebound due all of the problems when you autonomic nervous system that is damaged (syncope, hr, migraines, low gi motility, poor perfusion, heat intolerance, etc). I have low sodium levels and looking for “healthier” electrolyte drink options. Any suggestions? Also, do you know of any patients with success improving or reversing their dysautonmia with a whole plant based diet? This mama will do anything :) Thank you so much for your time!

    1. Not speaking for anyone here and with no qualification, as simply another blogger…

      AS to sports drinks I think the ordinary ones with sugar . and such are not healthy. If I was looking for one I would(of course check with my doc first) make it myself. A green tea roobis or rhoidola base with a bit of uniodized salt thrown in and as glycose tends to assist in hydration some crushed berries to sweeten. Checking on the potassium and salt level proportion desired one could select a berry with say…this amount of potassium and then add the required amount of sodium to balance.

      Would work for me if I needed additional salt due to medical condition. But again check with your doc first.

  10. I got the impression that the info cited in the video applies to the general population, participating in exercise, using drinks containing sodium and sugar (like popular brands). I was hoping for a bit more…I’d be very interested to know whether other types of sports drinks containing BCAA’s, proteins, electrolytes and carbs, are effective in improving performance (and recovery) for high intensity sports like ice hockey. Any good data on that? Thanks!

    1. I’d be interested in that too. My sport is mountaineering and we are often working at a moderate to high level of intensity for 8 to 16 hours. The only way to avoid bonking is to keep those simple carbs coming in. I think of sports drinks with maltodextrine as mother’s milk for endurance athletes. Great way to stay hydrated and feed your muscles. And in add some electrolytes as well.

      Of course, when you are back to civilization, it’s back to WFPB.

  11. “Your body’s not stupid; it will tell you when you need to drink. “There is now ample evidence” that we can just drink to thirst.”

    Sorry Dr. Greger, but this misleading statement needs an important qualification and correction.

    While this statement does hold true for most people, it overgeneralizes and incorrectly assumes that no matter what their age, people only need to drink when they feel thirsty. However, many older individuals experience hypodipsia – a reduced ability to feel thirst. As a result, the bodies of older people can become dehydrated – even pathologically dehydrated – without their feeling thirsty at all. And to paraphrase, “There is now ample evidence” that many older individuals CANNOT just drink to thirst.” And if these people only drink when they feel thirsty, they can end up in the emergency room.

    ww.ncbi.nlm.nih.gov/pubmed/7124762

    https://www.ncbi.nlm.nih.gov/pubmed/1587971

    https://link.springer.com/chapter/10.1007/978-3-642-47073-8_5

    “Normal aging is associated with changes in body composition, thirst perception, renal function, and the hormonal regulatory systems involved in the maintenance of water and sodium balance. The presence of many diseases and drugs common in the elderly can interact with the impaired homeostatic systems to result in clinically significant disturbances of water and sodium with accompanying symptoms, morbidity, and mortality. These disorders, which include dehydration, hypernatremia, hyponatremia, urinary frequency, and urinary incontinence can either be prevented or promptly recognized and appropriately treated by understanding the physiological changes and clinical circumstances which put the elderly person at increased risk for deranged water and sodium balance.”

    1. Question I would have on the above studies is do they assertions change in case of an elderly person who had spent their prior 10-20 years on wfpb nutrition have these thirst awareness and other chronic illness related deficiencies?

      Note that from what I can see on this site dr. greger is doing the leg work of reading and making sense of properly done and unbiased research based evidence and then bubbling up the conclusions in terms a person without research and medical education can make sense of. I don’t get the idea that he is providing his opinion vs providing what can be considered facts and leaving it to us to make our own interpretation of whether or not we think they are applicable.

      1. “Question I would have on the above studies is do they assertions change in case of an elderly person who had spent their prior 10-20 years on wfpb nutrition have these thirst awareness and other chronic illness related deficiencies?”

        I have the same question. A lot of what we popularly think of as “aging” does not actually derive from aging processes at all, but instead, from disease processes resulting from eating poor diets and living unhealthy lifestyles for decade after decade. And a lot of so called “aging effects” and diseases that one sees in older individuals eating the SAD diet may not show up, or only minimally, in healthier older people living more optimal lifestyles. Two recent examples:

        “Study finds healthy older men and women produce as many new brain cells as younger individuals”

        http://www.cell.com/cell-stem-cell/abstract/S1934-5909(18)30166-8
        http://www.lifeextension.com/Newsletter/2018/4/Research-changes-what-we-know-about-older-brains/Page-01

        and:

        “Physical Fitness Tied to a Nearly 90% Reduction in Dementia Risk. A high level of cardiovascular physical fitness in middle-aged women is associated with close to a 90% reduction in dementia risk in later life, results of a longitudinal study show.”

        https://www.medscape.com/viewarticle/894032?nlid=121387_1521&src=WNL_mdplsfeat_180320_mscpedit_wir&uac=66042FN&spon=17&impID=1585869&faf=1

        I’d love to see what sort of what we now consider “aging effects” a group of people on an optimized WFPB diet and overall lifestyle from birth would have – and which ones they wouldn’t! I don’t doubt that the results would prove both startling and enlightening.

        1. “A lot of what we popularly think of as “aging” does not actually derive from aging processes at all, but instead, from disease processes resulting from eating poor diets and living unhealthy lifestyles for decade after decade.” Exactly!!

    2. Alef1 As you write ” this statement does hold true for most people”

      So too do the statements, advice and recommendations from the World Health Organization, World Cancer Research Fund and the US dietary guidelines. They do not add qualifications etc regarding people with eg kidney disease, diabetes. gluten intolerance, prescription drug use, special requirements or particular genetic variations. They “overgeneralise” too.

      Consequently, I think it is a little harsh to say that this video is misleading – by this standard, all dietary and exercise advice is misleading because it does not and cannot apply to all people everywhere. Surely the point about major reports on nutrition and health, dietary guidelines and NF videos is that they apply to the average person not every single person? I understand your point, and itis a good one, but short videos and broad guidelines about health topics can’t cover everything and, if they did, no conclusions, advice or guidelines would be possible.

      1. Hi Tom
        I like this series. Both my husband and I are endurance athletes.

        I do think there there is a bit of confusion in the comment section. One is what these videos are dealing with dehydration and whether electrolyte replacement is necessary.

        But the other issue that is getting thrown in there is actually a separate topic and that is fueling during exercise that lasts hours at a high level. That then deals with stored muscle glycogen and replenishing for energy.

        Anyhow sounds like drink when thirsty. Water will do it. And for me if I am out for awhile running hard I’ll eat some dates. Which again can be tricky because when exercising at a high level stomachs aren’t our first priority.

        Anyhow. Are you still in Spain?

        1. Hi WFPBRunner

          Dates? I thought it was bananas that were advised for you endurance athletes.

          I don’t really have any experience in endurance sports but I know that armies have literally thousands of years of experience in forced marching over long distances carrying heavy loads in very hot climates. More recently, they have also conducted/funded trials and studies of what works best. The soldiers doing these long distance, heavily loaded forced marches really are endurance athletes.

          They have standard operating procedures (SOPs) for these circumstances which involve regular drinking of water and use of salt tablets in paricular circumstances. Most English-speaking militaries have similar SOPs I believe. I don’t know what the climate is like where you live but you might want to check out the US Army’s SOPs in case any of it might be relevant to you (see especially appendix D)

          https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/ARN3051_ATP%203-21×18%20FINAL%20WEB.pdf

        2. Hi again WFPBRunner

          No, not Spain – that is my brother.

          I am currently in Australia, having arrived back here the Thursday just gone. But I will return to the Philippines at the end of the month. Actually, there lots of Americans retired in the Philippines as well. The low cost of living and the hot weather are the big drawcards.

          Cheers

      2. “The number of people age 65 and older in the United States on July 1, 2015. This group accounted for 14.9 percent of the total population.”

        https://www.census.gov/newsroom/facts-for-features/2017/cb17-ff08.html

        About 1 in 7 people counting everyone in the U.S. – not exactly a trivial %. And from what I’ve seen of the postings on this board, I’d bet tover 65 segment for the people who trust in accurate information from NFO goes a LOT higher than 15%. I imagine that, because of this, Dr. Greger would have qualified his statement had he known of it – hopefully he will now do so in future videos on thirst.

        1. Alef1

          Yes but similar considerations apply to eg salt consumption and older people. However, I don’t see say the US dietary guidelines or CDC qualifying their advice to say that people aged 65 and over may need more. Dr G isn’t really out on a limb here.

          This may be because it is not clear if these qualifications actually apply to all older people or just those with morbidities (diagnosed or undiagnosed) and/or prescription drug use It’s entirely possible that the differences between the younger population and older age groups in these areas is not a simple function of age but merely reflects the fact that older people are more likely to be frailer, have morbidities and use prescription drugs. And these affect thirst and/or serum sodium levels.

          These sorts of things always remind me of the studies apparently showing that being overweight/obese and having high cholesterol are “protective” in older people unlike younger people. Whereas it’s much more likely to be a consequence of the fact that older people tend to be sicker and frailer than younger people and various diseases (and medications) result in declining weight and cholesterol. I suspect that this may be also be the case with thirst, salt consumption and even protein requirements

          Perhaps Dr G will do a video on some of these topics in due course.

        2. I think this is a valid critique…”I’d bet tover 65 segment for the people who trust in accurate information from NFO goes a LOT higher than 15%. I imagine that, because of this, Dr. Greger would have qualified his statement had he known of it – hopefully he will now do so in future videos on thirst“.

          I have found suggestion that amongst the elderly hyponatremia may be a commonly found circumstance. One study referenced up to 30% of elderly in nursing home care suffering this by medical evaluation.
          The part of the brain that regulated blood fluid level composition through hormonal production we know by study to be affected by age and activity level meds and all sorts of things.

          I wonder if this is just a commonly found thing of degeneration with age. WE can ponder if it is caused by this or that and if it will present with better diet or not but it seems …a large amount of elderly have problems with maintaining a properly balanced blood composit.
          This is indeed a sport oriented video but others may take untoward unintended result from it.
          For those in compromised or potential compromise as to hydration…I really think weight assessment following exercise which produces sweat is the way to go.

          And since most americans by most considerations are on one med or another at least once per year …..who can say their internal balances and or thirst mechanism in this specific are not affected?
          Any morphine derivative affects thirst mechanism…how many are on opioids or other variant…..seems quite a lot.

          Do agree this all is applicable for the majority of americans but by any count…in the other direction we have professional athletes ultrarunners football players…..the proportion that reflects the exception is significant.

          What is hurt by mentioning the exceptions? Not to hit on DrGreger, great work always…. this sport drink nonsense is complete nonsense…. but it seems reasonable to make this suggestion.

          1. Fair point Ron. As is Alef1’s. But Dr G is doing the same here as virtually all the official guidelines etc – ie he is talking about what applies to the bulk of he population.

            However, perhaps he might consider doing some future videos about the specific requirements of older people.

            The problem there is that what might benefit the old and sick might actually harm the old and healthy. That’s the issue (or at east one issue) with drawing conclusions from observational studies of older populations in wealthy countries.

    3. Thanks for the disclaimer about old diseased people on drugs and their wtaer needs. But it doesn’t make the general a misleading statement. Put some humility in there.

  12. A observational study that shows, at least with fatal outcomes in a Boston Marathon race that seemingly points to excess hydration as being not the root of the problem but a deficiency in the hormone responsible for urination of fluid.

    The study pointed to this inability to pee out the excess as the problem more than the amount taken in…though one is cautioned not to drink to much.
    https://www.medpagetoday.com/nephrology/generalnephrology/5534

    Supporting my opinion that thirst cannot be a sole indicator of hydration status. The tell here would be peoples who go on hot training runs and self hydrate but come back weigh themselves and find weight gain not loss. Such a person would be at risk for death by over hydration.
    What supposes they were necessarily drinking more than any other runner but not that they were simply peeing out any excess?
    This study agreed observational and limited in size points to that fact.

    Does extreme exercise inhibit the thirst mechanism? Seems to vary that but can we suggest it does not normally or does it normally? Can all depend on thirst as prime indicator for hydration status?
    Elderly and drugs may confound that but is there not a normal variance? Were not these two fatalities suffering the inverse…..thinking they needed to drink perhaps with a dry mouth but not needing to?
    Seems so or why would they get into a superhydrated state in the middle of a marathon? We assume them just stupid about it I guess….but were they really?
    This suggest a medical cause a deficiency in hormone production which caused the overhydration state.

    1. Here is a abstract for the actual study….https://www.amjmed.com/article/S0002-9343(07)00167-2/abstract.

      Again to state I agree with Dr Gregers basic conclusions and the cause of this problem amongst many who endeavor sports due to sponsorship of varying corporations selling sports drinks.
      But I would not apply that caution to all athletes. From those who participate in ultramarathons the problem can be not enough salt in things like Gatorade which make hydration actually impossible despite a gut full of the stuff. The key being to get the hydration into the muscles blood and such where it can be utilized for functional capacity. But admittedly some races favor more hydration and some more glycogen. A western states perhaps as opposed to a death valley run.

      Recreational athletes this all applies. Elderly peoples as mentioned by Alf….this also is not applicable.

      1. The death valley run meaning the race called the badwater from death valley in the middle of summer to mount Whitney.
        One is required(ones team) this is a invite only race…. to bring a scale to allow for the runner to be assessed for overhydration or dehydration.
        Beyond recognized norms and you will be discontinued. Typically 80 or so are invited.

        Salt is a highly recommended item for foods and/or drinks to contain to retain hydration levels. You carry hydration/some foods and your team sets up to assist at various locations. Could anyone finish this thing without having salt as a part of their diet in the race added in like salted pretzels or salt containing sport drink….I think firmly not. To restate salt is not a demon depending upon circumstance.
        How much of this applies to normal americans in their sporting activities and typical diet…about zero.

  13. Did someone already dive into the quoted articles?

    20 minutes of a dry Finnish sauna at 120 degrees °C with high humidity.
    Could it cause the need for electrolytes?

    1. N to venture a reply……there have been studies in regards to adaptation to heat and humidity. One of the more relevant refers to deaths by high school and college athletes in their football training for 15 or so years. The conclusions were pretty straightforward. The athletes almost all died in the first two weeks of training usually in the morning under high humidity conditions. Virtually all the athletes had very high BMI.
      The conclusion was the athletes must be allowed to have time to condition to adapt to the heat and exertion levels. 2 weeks was given for this time.
      And Alef has mentioned older peoples may have problems with heat and fluids. It may not just be thirst indicator but also a actual decrease in hormone levels produced by the hypothamus which regulated isotonic concentrations in our bodily fluids. By some study 30% of nursing home residents were in a overhydrated state by blood analysis, so it may simply be a result of age.

      In any event it is all a experiment of one is the point. A heat trained athlete may barely break a sweat in a hot sauna. A person who lives in a air conditioned environment(that also has been studied and requires more time for athletes to adapt to heat if present) may be sweating to beat the band in that same environment.
      So it depends. Amount of sweat is a good indicator in a healthy not elderly person. Problems with fluid balance and other issues may affect amount of sweat in a elderly person as well. To my experience they do as a rule just not sweat as much, which is a bad thing as regards heat adaptation. But would require less fluid and electrolyte replacement as well in non hyperthermic condiitions.
      As a aside but this point bares stating, A complete absence of sweat is present in the later stages of the occasionally terminal event of hyperthermia. But one has very significant symptoms before that occurs. Vomiting syncopy chills rapid heartbeat to mention but a few proceed that state.

      Personally when I was very much younger I would train running up to 12 miles in the sun 100 degree temps. Often two or even three runs per day on occasion. Took a visit to death valley in that time period 120 at that visit…..I don’t think just sitting in a car(a unairconditioned one) I sweated at all.
      Would I need electrolyte replacement..heck no. I was adapted fully to heat. Most all others would, I would now on that same trip.

      To mention also those who have prior critical heat experience such as heat stroke seem to retain a propensity to repeat the occurance in future times.

      So it always..just depends. One blanket answer in this specific is not possible.

      1. So in short…..It could, but the answer bears elaboration which I have provided. But it as well could not.

  14. As a former occasionally competitive, recreational athlete in endurance cycling, I can say that it was a few years ago when I quit mixing in special powdered hyper-super-ultimate concoctions into my water. Also I learned that daily diet could have a huge effect on hydration. When going through my “fruitarian” spell, my first 60-miler taught me about hydration levels. I was drinking according to my schedule long established of about a bottle per hour (16oz,1/2l). BUT as I was eating mostly fresh greens and fruits for every day fare, I wound up completely miserable stopping for breaks entirely too often. Ideally I’d “break” only once during any event and none in shorter ones. And a bottle per hour resulted in a few pounds of dehydration, which came back up quickly. Longer rides required eating as well. That’s can be another set of issues-but works better for me than the fancy waters ever did.

    Weighing before and after every workout helped me understand that I could never drink enough as to not lose weight. I got over that, but monitored and expected to lose a few pounds with any significant effort. Never a problem.

    I’m talking about the more expensive and specialized stuff than you see in the supermarkets or in general public advertising. Also that Gatorade was WAY too sweet for my tastes but could mix it 50/50 with water, but then only if desperate. I never wanted artificial colors in my drink.

    Every time I had an issue with cramping it was completely due to overtaxing an undertrained body. I have theories on the mechanism, but no research or reason to present/defend it.

    Someone was just speaking of how difficult something was some years back (before “sports market” drinks) and specifically that there were no salt tabs for the sweaty workers. I just let it pass. Those convinced against their will are of the same opinion still. I’m tired of arguing with the established way. I have other stuff to do now. Cheers.

    1. You want to see some Top Level “performance nutrition” mumbo jumbo (BS) marketing? Check out Hammer Nutrition. Looks like they’re making a mint. The name evaded me above.

  15. Wade we all have our personal theories and we are all different, one cause of cramping may be not anothers.

    But as to cramping………. the NFL had extensive history and treatment history of this event. Most cramping is due to lack of conditioning to the heat but midseason and later this still occurs. And the definitive treatment is always IV NS.
    Here from a team doc talking on the issue…. http://www.nationalfootballpost.com/Monday-Morning-MD-8309/

    I mentioned all this earlier but perhaps it is better coming from a qualified source.
    There is no mystery on what solves the problem about always in real time and real world not study…..IV NS.
    If it did not work to my opinion we could then go about venturing this or that.

    Keep in mind this is not to refute your personal experience but to state the norm in athletes who encounter this every year and docs and trainers who treat it every year. This doc is reflecting standard NFL treatment.
    IV NS with perhaps glucose a bit added/or not…..the problem is muscle dehydration. Fluids in the gut do not translate to fluids in other areas of the body necessarily. Only with time and proper isotonic solution does that translation occur.
    Exertion of a extreme sort also does not favor that.

    Iv’s work about always for cramping with fit young athletes suffering from extreme exertion in hot environments.
    A study showing otherwise can only be capturing a other variable.
    This happens probably a thousand times per season in the NFL training pre season and regular season. Every do manages it this way and it works.

    1. Checked through Doc’s reference and can not find the reference for these statements made in video..
      Dehydration is not generally a cause of exercise-associated muscle cramping. And, last one: Exercise-associated muscle cramping is not generally related to electrolyte loss. “

      I’d guess it may be a linguistic variance, as in……….. can one with a quart of Gatorade in a belly be not be dehydrated by definition of dehydrated, body weight staying the same as prior to exercise(a key measure of dehydration)….. but suffering from muscle cramps due to a internal state of dehydration….fluid in the belly not translating to fluid in blood and then muscles.
      AS to electrolyte loss…..could this also be a linguistic variance……the internal blood composite would with dehydration show a relative concentration of electrolyte pointing to then a increase not decrease by measurement of electrolyte in blood. But a loss of fluid resultant in the perceived higher electrolyte concentration not being a read not on electrolyte but a loss of fluid volume.

      Coupling the two together…..then a person who is having cramps self administers a quart of Gatorade brings his body weight up to norm but has still a state of dehydration due to fluid being in the gut not assimiliated and as such electrolyte measurement in blood being elevated as well.
      Then we have this as a proven conditional circumstance.
      But it in no manner would mean cramping is not due to dehydration. It would mean one attempted to remedy cramp by mouth hydration and failed.

      Just to venture some guesses as stated I cannot find the substantive source from listed sources.
      But this certainly seems counter to normal NFL experience. If this was true…cramping would not be remedied by IV NS or LR…..but it is.
      And what field of endeavor would suffer more cramping than NFL especially in preseason conditioning. Three a day per team is not unusual.

      1. Of course the NFL would not want you to know of any ineffectual use of Gatorade and not make it known many players hydrate to prevent cramps mid game by IV……as Gatorade is a paying entity.

        But they do to prevent or treat cramps and it works. Drinking mid game…there is not time to assimilate the fluid, it stays in the gut. Exertion heat and electrolyte concentration variance prevent rapid assimilation. Which nevertheless takes a bit to endeavor.

        1. Times I get cramps is when my muscles get super hot. And dehydrated. I know some sports drinks help at the 2-3 hour mark. I also wonder if as the fluid level gets low inside the cell causes an electorate imbalance or the heat or over excitement causes the nerves to misfire. And lastly I wonder if the IV helps cool the body. The one time I was a heat casualty in a race in Houston ( water only) I had stopped sweating and was getting chill bumps at 100 degree day. I was so sick after the ride I couldn’t breath well, or recover was flushed and got. A couple of medics I was staying with offered to give me an I.V. Saline. I was drinking all the fluid I could take and was sick to my stomach. So they gave me the IV and by the time they finished the quart I felt like a new man. I mean wow oh wow did I feel good. The next day went out and placed too 5. No way that would have happened with out the salt or the iv or smart people watching me. Wished I could give myself an iv on hot days like that.

    2. “Lack of Conditioning” is what I said. I just said it differently. “Overtaxing Undertrained Systems” where “training” is “conditioning”.

      1. I’m just one person, which is a horrible study with zero controls. But a lot of time working out what works for me. And now I can feel the onset of cramping before it LOCKS up and “work around it” and pull back the wick enough to survive. My goal was rarely the podium, just the finish line.

  16. I’m still unsure how best to ensure i’m hydrated enough and not risking hyponatremia during hot yoga.

    I weigh myself before and after class and aim to weigh the same before and after class. On most days that requires approximately 3 liters of water, or 3 kgs of water. Yesterday I drank my 6.6 lbs of water (3 liters) and still was 1.4 kg (3.08 lbs) below the weight I was when the hot yoga class began.

    By my calculation, I sweated 4.4 kg or 9.68 lbs. As an aside the sweat appears very low in salt or electrolyte from its taste and it’s very slippery. (When I was not trained it was very different, salty and certainly not as slippery)

    The last subjective experience I wish to share was that on this day as well as a day I became dehydrated during a marathon and was treated with IV, my ears or hearing were blocked. It felt like descending in an airplane – I kept need to swallow to clear or “pop” my ears.

    Any comments, suggestions about wether or not more or less water or salt would be useful or prescriptive for over or under hydrating with or without sugar and salt.

    Btw, hot yoga is yoga in a room temperature of 104 degrees and 40 % humidity.

    Regards,

    Yoga Pete

    1. Just another blogger here expressing opinion Pete…

      But Dr Greger did provide a useful recommendation from study that is published and probably represents the current thinking…from his source list…https://www.ncbi.nlm.nih.gov/pubmed/17277604

      In the document keep in mind it states the aim is to keep body weight loss not greater than 3%.
      My personal opinion is that to do hot yoga which is tailored to a very heat stressed environment and you are not loosing any weight after the class…..you are probably overhydrating, or you have some other prescription drug or medical problem which is preventing loss of fluid in urine .
      Assuming you are young and fit.

      So the weight loss appears it could be within normal perameters, assuming you are normal weight for a male. You did not mention body weight so you can do the calculation yourself. That is a lot of water and I wonder how much before the class you are taking it in?
      Water sitting in a gut is doing nothing. Keep in mind your ability to assimilate the water may be hampered by the activity level and heat.
      It is best to go into a heat event prior to the event well hydrated, which means consuming water or fluid a hour or so at least before the event. 2 hours may be preferable.

      On the ears…are you describing vertigo or just plugged up ears? If it is not vertigo are you perhaps getting sweat into the ear canal?
      If not the ears are not separate from other bodily systems and are dependent in a indirect way on bodily fluid levels. But I would consult a specialist to rule out any specific cause. Probably it is benign and related in some way to ear wax but it is best to have it checked. Hearing is not a thing we want to take lightly.

      If it is vertigo that supposes a complete check up for medical condition which may precipitate this…there are many some are benign and others may be significant.

      Less perceived salt in sweat is a personal acclimatization to heat stress and exercise load and is a very common expected outcome

      1. To correct myself from the linked document…. greater than 2% The aim is to keep it body weight loss in that range by water consumed during exercise in the heat event. Keep in mind that is a optimal aim not a absolute necessity.

        Point being a little body weight loss in such a environment is normal and I would say desired. If one maintains or gains weight during such a event to my opinion one has to be more on the watch for overhydration. Gain of weight by water consumed during a heat event is a very strong negative and great caution must be exercised if in that state.

        I personally don’t see how you are drinking that much doing that without throwing up. It is very challenging and positional which would tend to that.
        But your body weight loss would indicate probably you are slightly in deficit(but do the calculation based on your weight which is a unknown to us .The question I would have is….are you going into the event with in a slightly dehydrated state? Are your drinking one or two hours prior to the event?

        Slightly above or below 2% I would not worry about.
        Lack of perceived salt in sweat does not infer one is overhydrated or needs to consume more salt, it commonly means one has adapted to heat stress and exercise.

      2. Thanks Ron,

        My starting weight was 165 lbs. and given all the info you provided and from reading the referenced article and the groups detailed threads, i’m simply healthily drinking enough to keep my fluid in the recommended range. ie not greater than 3 %. I could drink only 2 instead of 3 liters and be right in the range.

        The hearing is not vertigo, so more to investigate here, but great to hear about the lack of salty sweat is a sign of a well trained athlete. I’ve been doing this type of yoga for a number of years so I guess it’s paying off.

        Thanks again for you info!

        Pete

    2. I personally found it impossible to not lose weight–but I’m talking 90-minutes to 3 hours training.

      Losing a little bit is my best balance. And RE-HYDRATION afterward is judged by urination frequency and color. No math.

  17. Okay if dehydration doesn’t cause muscle cramping what does? The Mayo Clinic says “Overuse of a muscle, dehydration, muscle strain or simply holding a position for a prolonged period can cause a muscle cramp.”

    I have been prone to a cramp on my left calf muscle all my life. My theory is it is a circulatory issue that is exacerbated by position.

    I have tried magnesium supplements, salty water, vitamin B pills with no particular positive effect. However, the study was hardly scientific.

    I’d like to see some references for the answers to the videos questions, especially the last two. My quick Google research seems to indicate no broad consensus on cause.

    1. William….just to pose a question as your statement made me curious…have you been checked for a leg length discrepancy? This may present by a very slight perceptible only my measurement hip displacement.

      I have noticed this may tend one to have a inordinate amount of stress related to hamstrings in the calf, if one only is affected.
      The other known cause of this is perhaps prior injury to a hamstring or calf muscle which tends one towards a cramp.

      Just another blogger here but I was curious.

    2. I used to get HORRIBLE cramps in my calves. I suspect it was an electrolyte imbalance – too much salt and not enough potassium in my diet.
      I actually sometimes cramp up if I drink a lot right before a hard workout, but it’s just in the abdomen and not too severe and goes away pretty quickly. By a lot, I mean a lot though, not just a glass.

      You might find yoga a helpful! It’s made a huge difference for me. The more I stretch and the more flexible I am, the better I feel.

    1. In those studies they always pick sodium junkies as volunteers:

      • Frassetto L et al. “Diet, evolution and aging–the pathophysiologic effects of the post-agricultural inversion of the potassium-to-sodium and base-to-chloride ratios in the human diet.” Eur J Nutr (2001 Oct) vol. 40 (5) pp. 200-13
      https://www.ionizers.org/pdf/3-scientific-articles/Diet_Evolution_and_Aging.pdf
      https://www.ncbi.nlm.nih.gov/pubmed/11842945

      • Chinevere TD et al. “Effect of heat acclimation on sweat minerals.” Med Sci Sports Exerc (2008 May) vol. 40 (5) pp. 886-91
      http://www.dtic.mil/dtic/tr/fulltext/u2/a480325.pdf
      https://www.researchgate.net/publication/5443315
      https://www.ncbi.nlm.nih.gov/pubmed/18408609

      • Nielsen B et al. “Human circulatory and thermoregulatory adaptations with heat acclimation and exercise in a hot, dry environment.” J Physiol (Lond) (1993 Jan) vol. 460 pp. 467-85
      http://onlinelibrary.wiley.com/doi/10.1113/jphysiol.1993.sp019482/abstract
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1175224
      https://www.ncbi.nlm.nih.gov/pubmed/8487204

      • Takamata A et al. “Relationship of osmotic inhibition in thermoregulatory responses and sweat sodium concentration in humans.” Am J Physiol Regul Integr Comp Physiol (2001 Mar) vol. 280 (3) pp. R623-9
      http://ajpregu.physiology.org/content/280/3/R623.long
      https://www.ncbi.nlm.nih.gov/pubmed/11171638

      • Shibasaki M and Crandall CG. “Mechanisms and controllers of eccrine sweating in humans.” Front Biosci (Schol Ed) (2010 Jan 1) vol. 2 pp. 685-96
      https://www.researchgate.net/publication/40785731
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866164
      https://www.ncbi.nlm.nih.gov/pubmed/20036977

      • Armstrong LE et al. “Responses to moderate and low sodium diets during exercise-heat acclimation.” Int J Sport Nutr (1993 Jun) vol. 3 (2) pp. 207-21
      http://dtic.mil/dtic/tr/fulltext/u2/a273292.pdf
      http://www.dtic.mil/dtic/tr/fulltext/u2/a480325.pdf
      https://www.ncbi.nlm.nih.gov/pubmed/8508197

      • Magalhães FC et al. “Thermoregulatory efficiency is increased after heat acclimation in tropical natives.” J Physiol Anthropol (2010) vol. 29 (1) pp. 1-12
      https://www.jstage.jst.go.jp/article/jpa2/29/1/29_1_1/_article
      https://www.ncbi.nlm.nih.gov/pubmed/20453428

    2. Joseph,

      I can’t agree with you more….. There are some interesting studies suggesting an upset thirst perception and hydration status leading to under hydration secondary to exercise. ( As a note this paper has a lot of referenced materials for those wanting more detail)

      Cardiovascular and thermoregulatory considerations should be high on our list when we consider hydration and exercise and a slightly hyper not hypo condition should be considered.

      Perhaps the issue/s are more along the lines of personal level of exercise endurance conditioning as suggested by this study: Separate and combined effects of dehydration and thirst
      sensation on exercise performance in the heat
      . Knowing your level of hydration needs is much more in line with body composition, diet and other factors.

      To be on the safe side I would prefer to have people hydrate slightly in excess and reduce their CV and thermoregulatory stresses.

      Dr. Alan Kadish Health Support volunteer for Dr. Greger http://www.CenterofHealth.com

    3. Good links. Thanks.

      However, the video is not about maximising exercise performance, it is about preventing death (4.05) and maintaining proper hydration and attenuating circulatory and themal strain (3.36)

      As for age being a factor, and requirements being different for elderly people, this has been discussed previously but findings from observational studies may be confounded by the fact that morbidities and drug use are more common in the elderly. I note also that one of your references on this states

      “Indicators that correlated best with dehydration severity but were unrelated to patient age included: tongue dryness (P less than 0.001), longitudinal tongue furrows (P less than 0.001), dryness of the mucous membranes of the mouth (P less than 0.001), upper body muscle weakness (P less than 0.001), confusion (P less than 0.001), speech difficulty (P less than 0.01), and sunkenness of eyes (P less than 0.01).”
      https://www.ncbi.nlm.nih.gov/pubmed/1624737

  18. The takeaway from the video is that even though you may be planning a long run or bike ride, then you don’t have to consume any more water than normal. Just satisfy your thirst.

    From my experience I can run to the point of where I stop sweating before I become thirsty. A danger sign according to just about every authority out there.

    If one is sweating profusely, would it not be advisable to start consuming at least a moderate amount of water regardless of you sense of thirst?

    1. One who is suffering from heat exhaustion and stops sweating……it is usually close to a terminal event and is the body’s last ditch attempt to save itself from death.

      The cautions on that are usually based on treatments for hyperthermic indiduals.
      If they are hot and wet there is a good chance of recovery. If hot and dry(usually the patient is completely incommunicado at this point), immediate interventional therepy is mandated. Usually the patient is also expressing significant heart pattern and functional disruption by that point.
      So that serves as basis for cautions on sweat and heat relationship.

      Your response to heat in that regard seems idiocyncratic, or particular to you. If you have always been that way I would not worry about it. If older and you have become that way and/or are now on some meds which you were not…it may be more significant.
      But body weight is a indicator of response to hydration. If one is maintaining a reasonable deficit around 2% or so of loss of body weight during heat exercise events there is usually nothing to worry about. If one finds one is loosing much more weight than that one is probably dehydrated and should drink more.
      If one is gaining weight during heat exercise events that is a danger sign for overhydration.

      1. Thank you. That seems like good advice as I tend to loser at least 2 to 3 pounds during a run on a hot day. I wouldn’t know where to go to do a “cycle ergometer” evaluation.

    2. I don’t think that was the takeaway… of course you’re going to need more water the more you sweat/exert yourself, but your thirst will indicate how much you need and you don’t need to worry about sports drinks.

  19. That pop quiz was my favorite.

    I was in the 100% who got the last one wrong.

    That part of the video, and the topic of internet advice could be its own video series on every topic you have.

    The thing is, the media quotes the internet sources, even the Doctor’s shows use the same logic a lot of the time.

    The children getting the packets of the sugar and salt mix versus American reality, which is more of a “fantasy reality” is when the real things become important.

    I was watching a show this morning of people spending 7 months in the dark in Puerto Rico and a man bought a bucket truck and taught himself how to fix the wires on the utility poles and has restored power to 3000 people by himself and when they asked what motivated him, he got misty-eyed and said, “I have 4 kids and I don’t want them to have to go through this.”

    I ended up tearing up. Kids are vulnerable all around the world and adults aren’t always protective.

    My 7 year old pal, found out what my phone number is and stole my heart. She called me and said, “Hold on, I have to get a piece of paper and a pencil” and she started doing make pretend math homework on the phone long-distance with me and when she finished she gave herself an A on each page of the “play” homework and she gave herself a star and a heart and a smiley face on each side. She alternated where she would read a math question to me and I had to make one up and ask it to her and she would count with her fingers and toes, until her grandmother found out that she had called me long distance and “play homework” was over.

    1. The people in Puerto Rico are coming into the next year’s hurricane season and they don’t have tarps on the roofs of their houses or power back from the last storm.

      Part of trying to eat WFPB is that “compassion resources” have to be split among so many problems all around the world.

      The concept that we could reverse heart disease and cancer and diabetes and have the money and time and energy to solve things like natural disasters and education of children and maybe help some of the inner cities is such a powerful concept to me.

  20. Just a personal note…..thinking about hydration curiously enough :)

    Today I will pretty soon go running about a hour 7200 ft up and down hills in what they call the manzanita mountains. It is about 80 here full sun pretty much. I will throw 3 pick ups in during the run max intensity for 20 seconds or so each. I may hit and kick the heavy bag after.

    Tomorrow I anticipate hiking in wilderness at above 10,000 to 11,000 ft, going probably three hours with a significant incline for almost all of it with a 50 pound pack.I will stay out there three days. It will likely be high 70’s full sun. Below freezing at night. Likely very dry single digit humidity.

    The first I will not even consider hydration…..I will not need it a bit. The second I will very much so but can only carry a 1 quart bottle and there are no unfilterable water sources. I will have hibiscus tea with a dash of salt thrown in. Nuts to supplement

    I have not considered thirst as a indicator as it does not matter a bit for years and years. If I am thirsty when back from the run I will probably drink some but anticipate I will be real hungry. I will eat as it is past lunch. Drink only to accompany that.

    On the second it is opportunity so I must plan and thirst does not matter a bit. I will try a bit to superhydrate prior to the hike, consuming larger amounts of fluids 1-2 hours prior.
    So I by necessity plan hydration when it Is necessary. I have learned to utterly disregard thirst. So meaningless for so many years I think in majority I don’t feel it in any exercise environment.

    No offense to doc and many others here but probably this is quite not normal for them. But I am not abnormal as there are plenty doing this thing like me, I will likely see a few on trail.
    When necessity demands thirst is inconsequential.
    Which aside the topic completely as opposed to just in part….is why humans have a evolutionary advantage to my view. We may plan our things independent of indicators such as thirst by necessity.
    Would a person die in this second environment dependent upon thirst as indicator….possibly. I would not superhydrate nor carry any water as I would not be thirsty, nor such until about a hour in…….but none would be available. Hyperthermia no..but I would have to stop in a place with likely no water, how would
    I sleep replenish cook…and on and on.

    Of course sports drinks are pretty much all garbage.
    But does our anthropological history speak of thirst only as indicator for hydration….I would suppose not. More chance of death occurs with those who use thirst as indicator than those who plan to replenish.

    So I contend it is to evolutionary advantage to prepare for hydration…but are all in our specie of this character?
    Suppose perhaps half of us were and half were not…would this affect then study result depending upon which half was the studied?
    Is my choice of hobby a indicator of this capacity?. Would one who does not think in this way just think….well that is a stupid sport?

    I suppose so.

    Just food for thought ;)

    1. To be clear…following this train of thought our evolutionary tendency would be to plan for hydration as we plan for food consumption. Thirst and hunger being auxiliary to the fundamental mechanism not core.
      We eat and drink generally and evolutionarily by opportunity not desire.

      So we can get into trouble with both, overhydrate and overeat…but usually we tend to protect ourselves through this function of planning overeating and overdrinking at times.
      A functional adaptation it may present as well with variance. Excess of either may have a terminal outcome. Lack of either and we are susceptible to harm in other than controlled/controllable environments.
      Abeit modern life is largely a controlled environment.

  21. This is huge! I just got through an introductory nutrition class. The last section was sports nutrition and we spent a lot of time on exercise sports drinks where the professor continually advocated their consumption!

  22. Thanks for this video D. Greger !
    There is some items missing and very important for the running :
    1) what about the stomach issue ? Even if it’s not necessary clear when you look at the studies, lot of stomach issues and Gi distress are linked with dehydration. So don’t plan to drink enough and soon during a race can make huge difference !
    2) What about the salty sweater ? We are not equal at this point and some need probably to add salt…

    I would like to have your point of vue about this 2 questions, if you have some informations about that. I also recommend to have a look to this podcast made by Dr. Sam Cheuvront and Dr. Robert Kenefick (2 doctors specialists for the hydratation and working for the US Army). Really interesting to have another approach about the subject ! But one thing is clear everywhere : Sports drinks are a waste of money !!

    Thanks again for all you awesome work !

  23. I hope some of my athlete friends are still following this post. I’ve got a question with regards to calories. Some of my cycling rides burn in excess of 2500 calories, and I’m at a ideal weight ratio low body fat% like 8-10%. How or what do you eat to make up that much calories with out eating junk- like cheese, or dairy or meat, or oils oh and beer. . Can’t eat enough green smoothies and beans to keep from losing muscle and weight.

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