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the fitness skeptic is a blog that takes a critical look at the health and fitness industry.

in it I'll examine the claims, products, practises and commonly held beliefs and SCRUTINISE the evidence.

My aim is to separate what is true from what is not and encourage fitness consumers and fitness professionals to become skeptics. 

I’ll take no prisoners when it comes to criticising the scam artist or highlightling the bogus but I’ll also give credit where credit is due.

Welcome to the fitness skeptic

The Great Sports Supplement Con Part 2: Sports Drinks.

In the first part of my Great Sports Supplement Con series I wrote about protein and how a belief in the apparent need to supplement our intake had perhaps wrongly permeated into the minds of many who exercise regularly. In part 2 of this series, I'm going to talk about a group of products that are on many levels far more insidious. Products whose efficacy for most is highly dubious yet are marketed to the consumer as a near necessity during exercise. Their manufacturers have funded research to the tune of millions of dollars, bought the influence of world renowned academic bodies and created a mythology that has leeched it's way into the minds of almost everyone. If this all sounds like a loony conspiracy theory I can assure you it's not but it certainly is a great lesson as to why we should all be more skeptical.  Oh, by the way I'm talking about sports drinks. 

Born out of running

Just in case you hadn't noticed, running is really popular. Each year millions of people run marathons around the world not to mention the millions more that run other distances. This popularity can be traced back to the mid 1970s when marathon running began to take a hold of the public consciousness. This was helped along by the well organised mass participation races that began to be held in big cities around the world. Over the subsequent years marathon running moved from being the bastion of the serious athlete to something that almost anyone was willing to give a try.

A gap in the market

This sudden growth in popularity lead to opportunities for selling products to those that participated, with the biggest beneficiaries being perhaps those that sold running shoes and eventually, those that sold sports drinks. Nike's dominance in the sports shoe industry is closely aligned with the increasing popularity of running in the 70's and the sports drink industry quickly followed suit. Today both industries are worth billions of dollars.  

Generating such income demands clever marketing. For Nike their initial marketing revolved around comfort, injury prevention and fashion, the sports drink manufacturers however needed a different approach.

The first sports drink

In the late 60's a renal physician, Dr Robert Cade and his colleagues developed a drink for use during sports activities following a request from the Florida Gators Football Team (that's American football just in case you wondered). Anyway, to cut a long story short they came up with Gatorade (see what they did there?) and by the mid 70's it was already a commercial success mainly due to the copious amounts of the stuff that was pored over the heads of team coaches at the end of matches ;-) Although I'm of course joking here it's not that from the truth. In the absence of any science at the time Gatorades success came from marketing an image rather than a product and this was cemented when in 1969 Gatorade signed a deal with the NFL to become the official sports drink of the league. 

Creating a myth

To persuade the exercising public that they needed to buy sports drinks it was crucial that the act of drinking during exercise took on a significant degree of importance. Now, everyone reading this is probably thinking "it is important isn't it?" to which the answer is yes. The question is however, how important? If the answer is anything less than tremendously so (oh dear a Trumpism!) you're not going to sell sports drinks. This meant that the drinks industry needed to promote the idea that drinking during exercise was of value and that's what they did. In fact they went further and implied that it was absolutely critical for optimum performance.

Tim Noakes, who, for those that don't know (and who would) is an emeritus professor in the Division of Exercise Science and Sports Medicine at the University of Cape Town, stated on the subject;

When the industry wanted to sell more product, it had to develop a new disease to encourage people to overdrink. Here's a disease that you will get if you run. Here's a product that will save your life. That's exactly what they did. They said dehydration was the dreaded disease of exercise. 

Of course if drinking during exercise was crucial for optimal performance then selling that idea would be fine but unfortunately it was far from certain that it was.

Back in the days before running entered the mainstream, advice about fluid intake was somewhat different to what we're familiar with today.  The advice was to drink sparingly. Until sometime in the 70's, marathon runners were actually discouraged from drinking during their races through fear it would slow them down. Tim Noakes recalls that in his first marathon in 1969 there was only one drinks station at the 20mile mark! Obviously none of this means that this advice was particularly pertinent but on the other hand at the time there was no evidence that it was dangerous or impaired performance. After all marathon times had been steadily improving since the 1920s. 

Not that old chestnut

If you've read some of my other posts, you may have recognised a recurring theme and that is one of marketing versus science. The rise of the sports drink is a classic example of this but here we're not talking about some dodgy piece of kit sold to a relative small amount of people, we're talking a product that is sold to millions of people and a multi billion dollar industry. 

The might of the multinationals

The size of the sports drink industry is testament to the size of the companies behind it. In 2001 one of the worlds largest soft drinks company's, PepsiCo, brought Gatorade. It's major competitor in the USA, PowerAde, is owned by Coca-Cola and the UK's biggest sports drink brand Lucozade, is owned by Japanese conglomerate Suntory. However, it's the marketing efforts of Lucozade's previous owners, GlaxoSmithKline or GSK (one of the world biggest pharmaceutical companies), that we'll be turning our attention to soon.  

With little or no evidence for the efficacy of sports drinks, some of the multinational companies behind their manufacture began to invest in finding some. In 1985 Gatorade founded the Gatorade Sports Science Institute (GSSI), which according to it's website is;

committed to helping athletes optimize their health and performance through research and education in hydration and nutrition science.

Slightly later to the party in 2003, GSK formed the Lucozade Sports Science Academy (LSSA) whose mantra was to;

improve sporting performance through better nutrition (better nutrition meaning drinking Lucozade I take it!? ;-)

The aim of these bodies was to essentially lay credence to the notion that drinking during exercise was essential and not doing so impairs performance. And the reason? To sell more sports drinks of course!  So how did they go about doing this?

Creating the 'Science of Hydration'

In sport there are a myriad of factors that determine the performance of an athlete or player and the science of sport (aka sports science or sports and exercise science) examines these. It's goal is to apply scientific principles to exercise and sport with the aim of improving our understanding of human performance. This is all very well perhaps when university departments are carrying out the research but another thing when the research is carried out in labs paid for and funded by companies with something to sell.  

Now I don't want to spend significant time running over the research carried out by the GSSI and LSSA (remember that's essentially Pepsi and GSK) but suffice it to say their research was 'successful' in discovering that it was essential to drink a lot of fluid during exercise and that sports drinks, not water, were the best way forward. By the mid 2000s the big sports drink companies began to promote the idea that thirst was not a good indicator of body hydration and that even low levels of dehydration could effect performance. I like many bought into all this and remember a time when I would check the colour of my urine on a daily basis to make sure I was 'adequately hydrated' before exercising. 

Links with Academia

The marketing of these 'discoveries' however did not wholly rely on the work of the in house research teams. In, what could be considered a genius marketing ploy or something more sinister, the big companies started to strike up relationships with academia. In 1992 Gatorade donated $250000 to the American College of Sports Medicine (ACSM) and a few years later their position stand on hydration suggested that a zero dehydration policy was the best advice for athletes. Further to this, a number of authors and reviewers of subsequent ASCM hydration guidelines declared financial links to Gatorade, GSK and Coca-Cola, as can be seen if you read the conflicts of interest section at the bottom of their 2007 position stand!

In 2004 the Australian Institute of Sport entered a partnership with Gatorade and a year later their first 'Gatorade Fellow' started studying the effect of dehydration on Australian cricketer's. Scientists with financial ties to Pepsi, Coca-Cola and GSK also pepper the editorial boards of many leading sports science journals such as; Medicine and Science in Sports and Exercise, the Journal of Sports Sciences and the International Journal of Sports Nutrition and Exercise Metabolism. None of this attests to their bias or lack there of but it does suggest one should be cautious when reading research in these journals that relate to fluid intake during exercise. It's also worth noting that there seems to be an almost complete lack of studies in the literature that discount the efficacy of sports drinks. Funny that?!

At this point I think it's fair to remind you that GSK sold the Lucozade brand to Suntory in 2013. It's also worth noting that shortly after, GSK changed their general marketing policy by ending the practice of paying healthcare professionals to speak on its behalf about its products to audiences who can prescribe or influence prescribing their pharmaceuticals. They also pledged to stop providing financial support directly to individual healthcare professionals to attend medical conferences, instead funding education for healthcare professionals through unsolicited, independent educational grants. This is an interesting and laudable policy change which, was it in place during GSKs Lucozade era, may have painted them in a different light in this sordid tale.  

Practical implications

So if you're still reading you're probably wondering where all this leads to. Well, for the big multinationals selling sports drinks, it lead to money in the bank and lots of it. For the rest of us (and I count myself in this) it lead to misinformation about hydration during exercise that, at the very least, lead to zero performance benefits for the vast majority of exercisers and at the worst, has arguably lead to the deaths of a number of participants in endurance events.   

Really !?

Yes! people have died in endurance events and surprisingly perhaps, non died from dehydration but rather because they consumed too much fluid and the sad thing is that these deaths were all probably preventable. Just read that sentence again. In case you missed it; no one has ever died in an endurance event from dehydration!! What they have died from is exercise associated hyponatremia (EAH). This is a syndrome that occurs when the bodies sodium (salt if you like) levels fall below what would be recognised as the normal reference range and happens when the bodies fluids become too diluted. This can occur if fluid is over consumed. When it does occur the brain swells leading to unconsciousness and possibly death. Ironically those that have suffered this fate have often been treated for dehydration! Up until 2012, 16 people had died and 1600 people had been taken critically ill from EAH during endurance events around the world. Stunning when you consider all could have been avoided had each consumed less fluid during their race. 

As far as I know (that is according to my research) no elite athletes have died this way and this makes a lot of sense. In a marathon for example, an elite performer is only going to be running for 2 and a bit hours at an intensity and speed that makes a large intake of fluid difficult, where as your average joe is running slowly at low intensities for upwards of 4 hours. This gives them plenty of time to chug down litres of fluid and when you've been told to drink as much as tolerable and ahead of thirst (which is what early guidelines were saying) it's no wonder people got into trouble.

That was then, this is now

Those early guidelines have thankfully been superseded. For example, the hydration guidelines written in 1996 by the American College of Sports Medicine were replaced in 2007 with updated recommendations that removed the 'drink ahead of thirst' mantra.

So what do the 2007 guidelines (which are still current!?) have to say?

brace yourself........

They, to all intents and purposes say, drink as thirst dictates!! Go to the 2017 Lucozade website and it says the same.

Wow...who would have thought it. A mechanism primed by millions of years of evolution that all animals have would be all we need to tell us when to drink!! 

Water versus sports drinks

Lucozade Sport hydrates you better than water.

Remember that slogan?

Lucozade had it plastered all over their advertising together with a plethora of famous sports celebrities faces as recently as 2015. What you may not remember is that the adverts also had the words "Scientifically proven" at the bottom. If you've got this far you probably know by now that this claim should be taken lightly. However the question remains are sports drinks better than water in terms of hydration. My first instinct is to say that water seems to have done a pretty good job up until now! But what about the science? Well from a physiological perspective glucose and other carbohydrates do stimulate the absorption of water in the small intestine and sports drinks do obviously contain carbohydrates. Whether this means Lucozade and other sports drinks hydrate you better than water is less clear. I suspect that in any practical terms the answer is, no they do not.

Are Sports drinks beneficial at all?

This is a difficult question to answer in any truly objective way based on all the issues I've described above. However putting all of this aside there are a few things we can be pretty sure about. Firstly the claimed benefits, true or otherwise, are not applicable to the vast majority of people who buy sports drinks. Even ignoring those that do no exercise, the majority of exercisers simply do not exercise for long enough to benefit from ingesting them.

Carbohydrates?

The carbohydrates they contain can only become of benefit when the bodies own carbohydrate stores (that's muscle and liver glycogen) are inadequate to prolong the exercise and need to be spared. In practical terms this means relatively high intensity exercise for say 60-90 minutes, or lower intensity exercise for somewhat longer. Examples of these would be perhaps a hard 90 minute football match, a long bike ride, running a marathon or playing a long (many hours) 5 set tennis match. As you can see this immediately eliminates the majority of people, who are maybe spending an hour in the gym, going for a short run or doing a class of some description. 

Electrolytes?

Again for your average exerciser in an air conditioned gym or in temperate climates even the sweatiest of people are highly unlikely to need to replace electrolytes. Even if they did, the next meal they ate would likely take care of it. If you were exercising in a hot environment electrolyte replacement may be a more important consideration but again, unless the exercise is of long duration it's not of any significance. 

Fluid replacement?

The rate at which people lose water from their bodies i.e. sweat, varies considerably. Some people naturally sweat buckets while others just swint. Then there's the environmental factor. If someone's exercising in the cold they are going to sweat far less than someone exercising in hot humid conditions. Couple this with the duration factor and can see a one-size-fit's-all approach doesn't work. Again for most casual exercisers, even if we are going to say that 'sports drinks do hydrate better than water' (which I'm not by the way), their consumption does not provide significant benefits. 

What's the bottom line?

We're still bombarded by advertising for sports drinks and given that the majority of purchasers are not athletes and are unlikely to gain benefits, I'd say, as I've said before, "buyer beware".

For those that are athletes, there are arguments for their usage. I won't go into any detail here but for anyone who's interested I suggest using the ACSMs 2007 guidelines on exercise and fluid replacement with the caveat that the authors have been accused of having a conflict of interests, as I've mentioned. Unfortunately at the time of writing this is the best guidance available. 

For everyone else, I'll leave it to Professor Tim Noakes to sum up:

Dehydration is a normal biological response to exercise. You lose water, you get thirsty, you drink, end of story!

Nuff said!!

Fitness Skeptic Score

I'll give two scores here; one for the average exerciser and one for athletes and those taking part in endurance exercise:

For the average exerciser, the FSS is:

Fitness skeptic score (2).png

Don't bother with sports drinks, drinking water to thirst is all you need.

For athletes and those taking part in endurance exercise, the FSS is:

Fitness skeptic score (5).png

Sports drinks are of possible benefit but the circumstances where this may be the case will depend on a variety of factors. Read the 2007 ASCM guidelines (all caveats applied) for clarification. If in doubt however; DRINK WATER TO THIRST and you'll probably be just fine.

References

The Truth about Sports Drinks. BMJ July 2012.

Waterlogged. The serious problem of over-hydration in endurance sports. (Book) Tim Noakes 2012

Too much of a good thing? The danger of water intoxication in endurance sports. British Journal of General Practise. July 2006.

Lobbyists for the sports drink industry: an example of the rise of “contrarianism” in modern scientific debate. British Journal of Sports Medicine Feb 2007.

Beliefs about hydration and physiology drive drinking behaviours in runners. British Journal of Sports Medicine. 2010

GSK announces changes to its global sales and marketing practices to further ensure patient interests come first. Dec 2013. 

Dehydration and endurance performance in competitive athletes. Nutrition Reviews. Nov 2012.

Assessing a commercially available sports drink on exogenous carbohydrate oxidation, fluid delivery and sustained exercise performance. Journal of the International Society of Sports Nutrition. Jan 2014. 

Exercise and Fluid Replacement. ACSM Position Stand. Medicine and Science in Sports and Exercise. Feb 2007.

Rates of fluid ingestion alter pacing but not thermoregulatory responses during prolonged exercise in hot and humid conditions with appropriate convective cooling. European Journal of Applied Physiology. Jan 2009.

Hydration in sport and exercise: water, sports drinks and other drinks. Nutrition Bulletin Nov 2009.

The Effects of Consuming Carbohydrate-Electrolyte Beverages on Gastric Emptying and Fluid Absorption During and Following Exercise. Sports Medicine. Sept 1987

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

manufactured disease dehydration

are drinks companies serving sport or is sport serving the drinks companies.

 

 

 

 

 

 

 

 

Stupid is as Stupid Does.

Caveat Emptor