Waterlogged – an important read for endurance athletes

It is a rare occasion when a non-fiction book is published by a highly respected and accomplished author that provides a detailed history, a thorough analysis, and well founded recommendations. It is even a rarer occasion when such a book is almost entirely ignored by the popular press. Such is the case with Dr. T. Noakes’ recent book – Waterlogged – The Serious Problem of Overhydration in Endurance Sport – a singularly stellar critical examination of the biology and physiology of human hydration, development of the sports drink industry, and the advent of of the profit-driven “science” of hydration and fueling for athletes. Given the fact that the sports drink industry accounts for over $3B in revenue per year in the US and that it is likely that there does not exist a single US resident that has not consumed at least one such “sports drink”, I find it curious that there are no reviews of this book in the popular press (e.g. NY Times, Washington Post, SF Chronicle, LA Times, Miami Herald, Boston Globe, Time, Newsweek, etc.) and other mainstream media outlets since it’s publication in May 2012. This reality is perhaps the best encouragement for an endurance athlete (or anyone for that matter) to read this book. One can only wonder why broad exposure of this book to the recreational endurance sport participant (the overwhelming  majority of participants) is so lacking as this segment is the most susceptible to the dangers clearly outlined by Noakes.

I have now read this book twice and can heartily recommend that any endurance athlete put this book on their short list. It is well written and requires the reader to engage in a fair dose of technical and scientific thought, but the text is generally palatable to a non-scientific audience. I will not provide a detailed review here as there is a very nice comprehensive two part review by J. Uhan, Ph.D.  on the ultrarunning site iRunFar with a fairly voluminous commentary by readers who are primarily ultrarunners.  It is this commentary to Mr. Uhan’s review that reveals exactly how susceptible the general ultrarunning populace is to “pseudo-science speak” by the “sports drink/fueling industry”. Such susceptibility is not unique to ultrarunners.

Some take aways

The primary message of the book is that the largest physiologic life threatening danger in competing (or participating) in endurance activities and events is overhydration not dehydration. In fact, dehydration is essentially a non-problem as very few cases of incapacitating dehydration have ever been reported at events and there have been no associated deaths. Noakes calls dehydration a “non-disease” and a manufactured condition made up by the “sports drink/fueling industry”. Overhydration and the potential for exercise associated hyponatremia (EAH) and exercise associated hyponatremia encephalopathy (EAHE) are the most frequently observed dangers and have resulted in more than 1600 reported cases and numerous deaths.

Another primary message of the book, and one that is reinforced in an interview with Noakes that I will link to below, is that the human body is a success not a failure. Much of the “sports drink/fueling industry” is founded on the basic concept that the human body is not able to cope with the stresses that we might put upon ourselves in either racing or just participating in an endurance event. Noakes presents a rich spectrum of data, analysis, and biologic mechanisms that refute such a position. He demonstrates that each of us possess inherent, finely-tuned, and effective responses to the onset of dehydration, reductions in electrolyte concentration, and heatstroke. Much of this can be traced to our unique historic human abilities as successful persistent hunters.

Although there is a distribution in how effectively each of our bodies can deal with such stresses, it is only a small fraction of the populace that may have issues in endurance events when following science-based (not industry-based) guidelines for fluid/fuel consumption. This is borne out by the fact that there were no epidemics of dehydration, hyponatremia, and heatstroke prior to the introduction of “sports drinks” and the associated high volume consumption guidelines as recommended by the American College of Sports Medicine (ACSM)- an organization that Noakes asserts is an apparent puppet for the “sports drink/fueling industry”.

One other observation that I take away from this book is graphically presented in Figure 9.9 (page 263). Here a graph of finishing time for Ironman triathletes as a function of percent body weight gain/loss is shown from data collected at the 1989 Hawaii Ironman Triatholon. Although Noakes fits a straight line to the data and asserts that there is no relationship, casual visual approximation of the data shows that an upward U-shaped curve might fit the data well. I fitted a polynomial to the data and found a reasonable correlation. The upward “U” functionality indicates that finishing time increases when an athlete is either over or under hydrated. Not surprising. However, what is shown (and what many athletes already know instinctively) is that there is an optimum level of hydration associated with a minimum finishing time. This value is about -3% body weight, in other words “substantially dehydrated” according to the “sports drink/fueling industry”. This observation is further confirmed when looking at marathon running finish times where it is found that the top finishers are consistently among the most dehydrated and typically dehydrated in excess of 3%. These and other data that Noakes presents indicate that, from a competitive perspective, it is desirable to exhibit a 3-5%  dehydration at the end of an endurance event. Noakes gives some physiologic basis as to why this may be the case, not the least of which is that you are not carrying around as much weight and that your body has activated the biologic mechanisms that minimize the affect of dehydration on performance.

It is difficult to not feel the frustration that Noakes has with the “sports drink/fueling industry” and he leaves no question as to the techniques and mis-interpretations that have hoodwinked millions of people into using and abusing their products. These parts of the book may go on a bit too long but I think this may have been a part of a cathartic experience for Noakes to get all that he knows out there in print.

Other media sources on this book and Noakes’ work

There are a few recent interviews/videos that feature Noakes speaking about his book and his work and I have found the following worthwhile:

An audio interview which covers a lot of ground-

http://www.stumptuous.com/waterlogged-tim-noakes

and this excellent BBC documentary (from July 2012) entitled The Truth About Sports Products. The documentary has specific focus on the “sports drink/fueling industry” where Noakes as well as numerous other respected scientists are featured-

Note 11 March 2016- the full documentary has been taken down but the approximately 11 minute excerpt from the full documentary with the Noakes interview is now available-

For me, one of the best scenes in the documentary is when Noakes is being interviewed and he is asked about the recent introduction by Coca Cola of Powerade Zero- a sugar-free sports drink. He cannot keep a straight face and the director continues to cue him up and he keeps laughing. He eventually gets it under control and proclaims that the mere existence of such a product is proof that they are no better than water for most users.

Quotable quotes

There is an overwhelming body of evidence showing that humans alter their behaviors to ensure that body temperature is homeostatically regulated regardless of the stresses, either internal (e.g. the level of hydration) or external (e.g. the environmental temperature) experienced. (p 11)
When glycogen is stored in liver and muscle, it attracts water molecules, which are released as the glycogen is used during exercise. In this way, additional water is released as that fuel is used during exercise. This water can offset some of the sweat losses. (p 32)

Humans developed as long-distance runners especially well adapted to run in extreme dry heat in the middle of the day while drinking infrequently and conserving body sodium stores. (p 35)

Thus the only symptom of dehydration is thirst. (p 44)

The point is that dizziness, fainting, and nausea are symptoms not of dehydration but of lack of blood supply to the brain. (p 54)

But either way, the fact that athletes with the greatest levels of weight loss are usually the fastest finishers in endurance events shows that the response of thier brains to body water loss has been entirely appropriate, perhaps optimal. (p 58)

… by the early 1990’s I had concluded that a myth had developed in the exercise sciences, the dehydration myth (p 89)

The authors concluded that how fast a person runs, not how much that person drinks, determines the extent to which body temperature rises during exercise. (p 99)

So it is an astonishing achievement of the sports drink industry that it has convinced us of the exact opposite– that modern human athletes lack biological controls to ensure that they ingest enough salt and so are at risk of developing a syndrome of salt deficiency even when eating a diet that is stuffed with salt. (p 107)

Not a single published scientific paper shows that blood electrolyte concentrations, including the sodium concentration, are abnormal at the time subjects develop exercise associated muscle cramps (EAMC). (p 118)

Evidence simply does not exist that recreational or professional athletes competing in long-duration events will inevitably develop a state of salt deficiency or dehydration. (p 144)

To suggest that the body cannot sustain long-term exercise in the heat without ingesting supplemental sodium ignores not only our biological design but also reams of research proving otherwise. (p 145)

If you wish to develop a medicine to cure or prevent an illness, then it is perhaps important to study patients with the illness or who have a predisposition for developing that illness when exposed to the causative agents. Alternatively, it is rather important that the illness you are trying to prevent actually exist and be caused by the mechanism you are studying. (p 184)

During this time EAH became the single greatest risk to the health of endurance athletes… (p 327)

  • Your body will tell you what it needs, if you just listen.
  • So drink only ad libitum – that is, according to the dictates of thirst.
  • Dehydration is not a disease. Nor does dehydration contribute in any way to any illness associated with prolonged exercise like road, marathon, and ultramarathon running races an triathlons.
  • If you are carbohydrate adapted, to optimize your performance during more prolonged competitive exercise, you will need to ingest some carbohydrate or perhaps preferably a favorite food.
  • There is no need to increase your habitual daily sodium intake above that dictated by your appetite.
  • There is no need to ingest additional sodium during exercise.
  • Understand that much of what you believe about your personal well-being is the result of targeted manipulations of industries whose principal focus is their commercial fitness and not necessarily your heath or safety. (p 353)

Concluding remarks

There is much in this book that will serve the endurance athlete well. Presented is a plethora of information from basic biological function information to a thorough review of available data on hydration to science-based recommendations on what and how much to drink and how to fuel. An excellent read and one that you will likely go back to regularly much as many of us do to Noakes’ other treatise – The Lore of Running.

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6 thoughts on “Waterlogged – an important read for endurance athletes

  1. Hi,

    you say that Waterlogged is mostly ignored in the popular press – and I find it illustrating that you and your blog readers can (until now) use approx. 3500 words to discuss a drinking belt, but no one leaves a comment on your post on this book… For me, Waterlogged has totally changed my view on hydration, and the book deserves more readers. I actually found it highly entertaining as well as informative, of course.

    Anyway, thanks for a really good blog! I bought the Salomon S-Lab Sense Ultra because of your favourable review, and I read Waterlogged after I came across it here.

    But I just want to ask you: Do you have any kind of association with Salomon?

    Kind regards,
    Bjørn Ullevoldsæter
    Norway
    http://bjull.blogspot.no/ (in norwegian)

    • Hi Bjorn,

      Thanks for the compliments as I am glad to hear that these posts serve a purpose for others.

      Yes, Waterlogged continues to be ignored (as far as I can tell anyway) by the major popular press. I think that why this is the case would be an interesting investigative reporting opportunity. Waterlogged is perhaps the most important reading that one can do as an endurance athlete, particularly those that compete regularly.

      You may be interested in the update I just posted on the S Lab Sense Ultra- all initial positive impressions are confirmed and the durability is turning out to be remarkable.

      https://itsallaboutthevertical.wordpress.com/2013/07/17/salomon-s-lab-sense-ultra-review-update/

      As far as an association with Salomon- my wife was sponsored by Salomon as a two time Olympian in cross country skiing many years ago. Neither of us have any current relationship with Salomon. However, we have been using Salomon products for almost 30 years and have found their offerings to be among the best available, if not the best. Also, and for me this is important, Salomon clothing fits me very well as it appears to be designed for a slimmer, more ectomorphic individual. I find the clothing of most US-based and Nordic-based manufacturers (Patagonia, North Face, Swix, Craft, One Way, etc.) to be way too big and/or baggy even in size small. Perhaps I am a perfect ‘petite homme’ in size; in any case it makes buying clothing easy. Salomon also tend to push the technology envelope a bit more than other manufacturers as well and as an avid ‘first user’ I find it interesting to try out the new stuff.

      • Thanks for your reply.

        A small anecdote from Norway w.r.t. Waterlogged: I wrote a blog post on it and asked the leading endurance magazine in Norway to do what you said: Investigate why its findings are mostly ignored – while the existing drinking dogmas are repeated over and over. They found it interesting too, and I hope they will follow up.

        The specific background for my inquiry was that this magazine promotes the blog posts from our long distance runner Ingrid Kristiansen, former world record holder on 10.000m, where she just recently, and while I was writing my blog post, repeated all the worst dogmas, like add salt in the fluid to avoid water intoxication, drink more than the thirst dictates, maintain the body fluid balance to avoid any kind of dehydration etc. She also warned against heat stroke, and listed dangerous signs of it, but avoiding to mention “thirst”. Like we suddenly get so dehydrated that we faint or vomit before we´re thirsty or before the brain slows down the activity.

        So the old dogmas stand stronger than ever.

        About the Salomon S-Lab Sense Ultra: The only thing I hold against them is a minor lack of grip under semi wet conditions (that is, not wet, but not completely dry either). Then I feel a little more comfortable with my old Inov8 X-Talon 212, but they have an exceptionally soft and sticky sole.

        I am sure you´re right about Salomon and their push of technology, but what made me wonder about your association with them, was your use of Salomon XC Zero skis and poles. Those products may be excellent, but Salomon is a totally “unknown” brand in Norway when it comes to XC skis and poles. The XC ski market is totally dominated by Atomic, Rossignol, Fischer and Madshus, although Salomon have good XC ski boots. Anyway, I trust your reviews fully, but it´s nice to know where you stand.

      • Hi Bjorn,

        Hopefully the magazine does an investigation. I am very disappointed that the New York Times has not investigated this.

        As far as Salomon skis- we were Fischer ski advocates for 25 years and used them because they were often the best. However, when Salomon took over the design and manufacture of their own skis from Atomic (Atomic is owned by the same company that owns Salomon) in 2010 we were very impressed with the performance of the post-Atomic skis. We had the opportunity to switch and have not been disappointed- my skis are often the among the fastest of the day in the citizen races that I participate in- and this is among a group of masters skiers who take the sport seriously (numerous Olympians and former national team members- including a Norwegian) and spend ridiculous amounts of money (both for the skis and to have them waxed by an expert technician) to ensure that they have fast skis.

        My view on skis, as I indicated in some of the reviews, is that nearly all the major manufacturers can make excellent skis. The important part is to identify the excellent skis. I now use an expert ‘ski picker’ who goes to the factories in June-August and selects the best skis from the ‘race stock’. This adds to the price of the skis (about $100 US) but is more than worth it, particularly given how expensive glide waxes have gotten- the wax will only make a difference if you start with fast skis. This is why I recommend to all that want to compete that they not buy ‘rack’ skis from a ski shop. Use an expert to select your skis from the factory ‘race stock’ for your parameters as you will have them for a long time and there is no way to make a slow ski fast.

        I tested the Salomon zeros directly against race stock and similarly hand-selected Fischer zeros and found them to be as fast or faster with the same wax, grind, and zero treatment. This test was done on a 1.5 km loop with rolling hills and repeated 3X for each pair. I’ve done the same testing of Salomon vs. Fischer on all of my other ski types (classic and skating) and find the differences to be so small as to negate any preference. So- I like the Salomon graphics better and choose Salomon. I am confident that similar head-to-head testing of Atomic and Madshus would yield the same result. Rossignol on the other hand…. I have never tested a fast Rossi, but some Rossignol competitors do have fast skis. The 3-grooves are just a pain when waxing!!

        Let me know if there is any movement with an article by your endurance magazine on the ‘Waterlogged’ controversy.

  2. About Waterlogged and the endurance magazine: It turns out they have regurarly written about Noakes and his drinking advices since the mid nineties. They had a special theme issue on this in 2008 where the conclusion was in favor of Noakes. But the impact has been minimal in Norway, so they wanted to continue raising his views. But now the summer i almost over, and articles on hydration did not suit their release plans. Though, they gathered all their articles on hydration on a page on their web site, together with a link to my blog post on “Waterlogged”, and published it on their front page. After a few days my blog post has received quite a number of hits, so hopefully I have reached someone with this.

    But it also turns out that this endurance magazine (which is the official magazine for an organization for endurance sports in Norway, so it has a wide range of readers) had done nothing on Noakes “Central Governor” model, which I also wrote a blog post on recently. So now they want me to write an introductory article on this model, and do some interviews with experts in Norway.

    That is an issue I would like to see your view on also – The Central Governor Model.

    When it comes to XC skis, I am lucky enough to know a top racer in Norway that travels around and hand picks his pairs, so I usually get some of his next best pairs, or pairs he has tested and found good, but nonetheless discarded for himself. The only Rossignol pair I have is actually my Zero skis. I cannot compare them to any other Zero ski, all I can say is that this pair is the pair I trust the most – they feel extremely good on the “zero” condition with wet snow or rain in the air. I love them, and I love those conditions, as I see a lot of people struggle around me, while I am not. That is also a pleasure in life… 🙂

    • Hi Bjorn,

      Sorry I did not respond earlier but I did not notice that you had commented.

      As far as ‘central governor’ theory, I do not have a lot to say but the following website seems to represent my views on the subject (and a lot of other subjects as well):

      http://canute1.wordpress.com/

      just search for ‘central governor’ and you will find a few articles.

      Glad to hear of some movement on the hydration front but I still not seen any mainstream publication do a review of Noakes’ book- it should be of significant interest to even casual readers of something like the New York Times.

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