Drinking guidelines for exercise: What evidence is there that athletes should drink “as much as tolerable”, “to replace the weight lost during exercise” or “ad libitum”?
- 6 April 2007
- journal article
- review article
- Published by Taylor & Francis Ltd in Journal of Sports Sciences
- Vol. 25 (7), 781-796
- https://doi.org/10.1080/02640410600875036
Abstract
The most recent (1996) drinking guidelines of the American College of Sports Medicine (ACSM) propose that athletes should drink “as much as tolerable” during exercise. Since some individuals can tolerate rates of free water ingestion that exceed their rates of free water loss during exercise, this advice has caused some to overdrink leading to water retention, weight gain and, in a few, death from exercise-associated hyponatraemic encephalopathy. The new drinking guidelines of the International Olympic Committee (IOC), recently re-published in this Journal, continue to argue that athletes must drink enough to replace all their weight lost during exercise and to ingest sodium chloride since sodium is “the electrolyte most critical to performance and health”. In this rebuttal to that Consensus Document, I argue that these new guidelines, like their predecessors, lack an adequate, scientifically proven evidence base. Nor have they been properly evaluated in appropriately controlled, randomized, prospective clinical trials. In particular, these new guidelines provide erroneous recommendations on five topics. If novel universal guidelines for fluid ingestion during exercise are to be promulgated by important international bodies including the IOC, they should first be properly evaluated in appropriately controlled, randomized, prospective clinical trials conducted under environmental and other conditions that match those found in “out-of-doors” exercise. This, and the potential influence of commercial interests on scientific independence and objectivity, are the two most important lessons to be learned from the premature adoption of those 1996 ACSM drinking guidelines that are not evidence-based. These concerns need to be addressed before the novel IOC guidelines are accepted uncritically. Otherwise the predictable consequences of the premature adoption of the 1996 ACSM guidelines will be repeated.Keywords
This publication has 81 references indexed in Scilit:
- Case proven: exercise associated hyponatraemia is due to overdrinking. So why did it take 20 years before the original evidence was accepted?British Journal of Sports Medicine, 2006
- Cash interests taint drug adviceNature, 2005
- Exercise-Associated HyponatraemiaSports Medicine, 2005
- The dipsomania of great distance: water intoxication in an Ironman triathleteBritish Journal of Sports Medicine, 2004
- Fluid and fuel intake during exerciseJournal of Sports Sciences, 2004
- Ad libitum fluid intakes and thermoregulatory responses of female distance runners in three environmentsJournal of Sports Sciences, 2001
- Aetiology of skeletal muscle ‘cramps’ during exercise: A novel hypothesisJournal of Sports Sciences, 1997
- Effect of water ingestion on endurance capacity during prolonged runningJournal of Sports Sciences, 1996
- Exercise‐induced muscle cramp: A prospective biochemical study in marathon runnersJournal of Sports Sciences, 1986
- The syndrome of inappropriate secretion of antidiuretic hormoneAmerican Journal Of Medicine, 1967