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Waterlogged: The Serious Problem of Overhydration in Endurance Sports

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"Drink as much as you can, even before you feel thirsty." That's been the mantra to athletes and coaches for the past three decades, and bottled water and sports drinks have flourished into billion-dollar industries in the same short time. The problem is that an overhydrated athlete is at a performance disadvantage and at risk of exercise-associated hyponatremia (EAH)--a potentially fatal condition.

Dr. Tim Noakes takes you inside the science of athlete hydration for a fascinating look at the human body's need for water and how it uses the liquids it ingests. He also chronicles the shaky research that reported findings contrary to results in nearly all of Noakes' extensive and since-confirmed studies.

In Waterlogged, Noakes sets the record straight, exposing the myths surrounding dehydration and presenting up-to-date hydration guidelines for endurance sport and prolonged training activities. Enough with oversold sports drinks and obsessing over water consumption before, during, and after every workout, he says. Time for the facts--and the prevention of any more needless fatalities.

448 pages, Paperback

First published May 7, 2012

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About the author

Tim Noakes

42 books95 followers
Timothy David Noakes is a South African professor of exercise and sports science at the University of Cape Town. He has run more than 70 marathons and ultramarathons, and is the author of the running book Lore of Running.

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5 stars
77 (41%)
4 stars
62 (33%)
3 stars
42 (22%)
2 stars
4 (2%)
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Displaying 1 - 30 of 30 reviews
Profile Image for Keith.
810 reviews56 followers
May 12, 2013
I've been itching to read this book ever since it was published last year (2012), but I didn't want to buy a copy because, after all, how often do I need to read about the bad advice so often given to drink water to excess. Now that I am taking an Anatomy and Physiology class (Principles of Anatomy and Physiology With A Brief Atlas of the Skeleton, Surface Anatomy, ) my interest got high enough to hunt it down. The Flagstaff Public Library was kind enough to buy a copy at my request. I only had to read a little to decide to award it 5 stars because of 1) it's crucial importance, 2) Noakes writing style is delightful, and 3) the research is there to back up what he says.

Once I finally got this book in hand, I didn't want to put it down.

I've finished the book. I will not attempt any comprehensive summary because I could not do justice to it with a summary. There is way too much in here for me to summarize.

Before reading it, I thought it was simple: 'Don't drink too much.' It turns out to be much more complex than that. It is the story of the development of the sports drink industry, of a drink made with common household ingredients: Sugar, salt, and a dash of lemon. It is a story of marketing mixed with bad science, obfuscation more marketing, more bad science, and more obfuscation, repeated endlessly. It is a tale far too familiar - that when you look closely, the same pattern can be found throughout the centuries. A familiar example from a past century is the battle to get doctors to wash their hands. And, by the way, the danger from drinking too much Gatorade, or other sports drink is the same as the danger from drinking too much water. Drinking more Gatorade when over-hydrated, will make it worse. More sodium in the diet does not help either. Not everyone is at equal risk either. (Read the book)

I am astonished at how persistently the repetition of these falsehoods extended over 30 years. Even now, recommendations about exercise performance, hydration, dehydration, and the medical treatment of collapsed runners cling to a version of the hydration myth. It wouldn't be quite so bad if medical personel knew how to treat collapsed runners, but because of the breadth of the misinformation campaign, deaths have followed the application of exactly the wrong medical treatment. (The correct treatment for severe cases is injection of a hypotonic solution.)

That little summary does not do justice to the detailed tale of how this condition became the major health risk for amateur endurance athletes. (Professionals are not at the same risk.) (Read the book.)

Appendix A: Deaths from over-hydration; Many or all are detailed in the text
Appendix B: 31 pages of over-hydration cases documented in the scientific literature
Appendix C: 2 pages of heatstroke cases documented in the scientific literature
32 pages of references in a small font
16 page index
Profile Image for Tim O'Hearn.
248 reviews1,154 followers
October 3, 2022
A masterful, rigorous, scientific debunking of everything we've ever been told about (de)hydration.

My key takeaways:
- Heat-induced illness (heatstroke) has almost nothing to do with how hydrated you are.
- Hydration does nothing for athletic performance, and drinking too much can and does kill people regularly (EAH/EAHE), especially slow walk/jog marathon runners.
- Overdrinking before or during an endurance event causes weight gain that negatively affects performance.
- Being misdiagnosed and treated as if you are dehydrated when you are in fact overhydrated will in many cases lead to an agonizing and painful death due to brain swelling.
- Glucose consumption during activity does provide a measured performance boost; there is no evidence that sodium (or any other electrolyte) consumption has any similar performance effect. All Gatorade-sponsored studies that show similar results conflate the results of glucose with those provided by the "electrolytes" and "hydration" aspects of the sports drink products.
- Gatorade and Gatorade Sports Science Institute (GSSI) have blood on their hands, the sports drink market is largely useless, and corrupt shill scientists still push dangerous misinformation.
- The sensation of "thirst" is a biological comfort indicator and is not a medical symptom of dehydration.
- The guideline for maximum safe fluid consumption during an endurance event is a rough approximation of how much you actually sweat.
Profile Image for Andd.
1,112 reviews47 followers
September 18, 2012
Dr. Noakes debunks the myth that a marathon runner must drink as much as possible during a race to optimize performance and to prevent dehydration. The author points to the dangers of fluid overload.
Scientific studies by Dr. Noakes and by other researchers prove conclusively that exercise-associated hyponatremia (EAH) and exercise-associated hyponatremic encephalopathy (EAHE) are caused by abnormal fluid retention in certain athletes who drink copious amounts of fluids during (and sometimes after) prolonged exercise lasting at least four hours. Athletes with SIADH (a syndrome of inappropriate ADH secretion) are predisposed to EAH or EAHE because they do not excrete fluid excess before it accumulates.
Dr. Noakes advises coaches and athletes to develop strategies to prevent overconsumption of water and sports drinks. He gives guidelines for how much to drink. The American College of Sports Medicine (ACSM) adopted the author's 2003 drinking guidelines. But the Gatorade Sports Science Institute (GSSI)...
The author provides a chart showing cases of EAH and EAHE from 1983 to 1998, listing age, gender, event, treatment, recovery time, and other categories.
He presents case studies in detail. There is knowledge, when reading about each life and death, that the death could have been prevented if only there had been a don't-drink-to-excess philosophy. The author describes a body of research by himself and by others, over the years, that supports the conclusion that excessive fluids cause EAH and EAHE. Additionally, he documents research that has reached incorrect conclusions.
At greatest risk to develop EAHE are female marathon runners who run a race at a slow pace for more than four hours, gaining weight from drinking to excess before and during running.
During the late 1980s there were cases of EAH and EAHE in the military because the prevailing practice was to drink before becoming thirsty.
In various triathlons and events that the author names, there have been illnesses and fatalities resulting from the misguided notion that drinking to the athlete's level of tolerance is necessary to prevent heatstroke and sodium deficiency.
The author recommends replacing overdrinking with drinking only according to thirst. In this way, EAH and EAHE can be prevented. There will be no deaths from possible incorrect diagnoses of dehydration and consequent inappropriate treatments with fluids.
Gatorade lovers might argue that the oversupply of hyponic fluids (sports drinks) containing electrolytes can prevent EAH. But there is no evidence for this view.
I received this book free through the goodreads FIRST READS program.
Profile Image for Wendy.
498 reviews9 followers
September 30, 2012
If you're an endurance athlete who has ever been told that you should drink before you're thirsty or that you should drink sports drinks with electrolytes to prevent your blood sodium levels from dropping too low, you should read this book. Noakes meticulously outlines the science that proves that a lot of the conventional advice given about hydration is at best useless, and at worst, potentially fatal.

It's also a fascinating look at how the combination of faulty assumptions and commercial interests can skew the interpretation of scientific research. It was actually a bit shocking to me how little we really know about the causes of heatstroke or exercise-induced cramping. Because these conditions are difficult to produce in controlled laboratory conditions, much of what we know has been based on anecdotes or on experiments with less than ideal design.

It's also a very readable book, despite the quantity of detailed scientific data that Noakes discusses. (It might help that I've got a background in chemistry, and went in knowing what "millimolar" means.) I did find that the book got a bit repetitive towards the end - Noakes rightly takes seriously his obligation as a scientist to address all alternative hypotheses and interpretations of the data, but if you're just someone who wants to know how much you should drink while running, you've probably absorbed everything you really need to know by halfway through the book.
Profile Image for AJ.
1,400 reviews109 followers
November 15, 2014
This is a pretty fascinating read, especially if you're one of many athletes who've been told time and again to drink water copiously while exercising. I've heard reports about hyponatremia but always assumed it was because of inadequate sodium intake, and this book explains how that is not the case. Noakes goes through an incredible literature review in this book and lays out the evidence that hyponatremia is caused by consuming too much water. At times this book gets very repetitive, the biology terms are not always well defined for the layperson, and the use of acronyms gets extremely confusing (especially in the case of EAPH vs EAHE). I think a much shorter book more tailored to laypeople would be a great resource for runners. It's too bad the overall message of this book has been ignored and continues to be ignored in the US.
Profile Image for Jill .
78 reviews11 followers
June 17, 2012
Intense read, full of science and it goes against basically EVERYTHING that our world is preaching when it comes to endurance sports these days. But it's thought-provoking and I think everybody who coaches athletes should read it at some point.
Profile Image for Stephen Redwood.
216 reviews6 followers
October 5, 2012
It's hard to imagine a more detailed account being written of what happens to hydration, salts and carb levels during prolonged exercise. A full description of how we evolved to cope with heat and low hydration sets the scene (we are a lot more efficient than other mammals and our brain shuts us down before dehydration kills us). Then an exhaustive analysis of past research and the author's own research shows how the guidelines pushed by Gatorade and other sports drinks producers can lead to fatal over drinking (producing Exercise Associated Hyponatremia). Noakes' guidelines are blessedly simple: drink only as thirst dictates, take in carbs during long events, no need to take in extra salt (the body keeps a homeostatic balance that you are not going to break through in even an ultra event like an Ironman). There's a lot of repetition and it's a long read, but the central messages are important and worth understanding for any serious endurance athlete.
Profile Image for Dave.
50 reviews16 followers
October 20, 2012
Fascinating read! This book has completely changed how I view hydration. The conclusions reached are completely against the current dogma regarding hydration and sodium intake, but the book is exhaustively researched and referenced. I now see that many of my problems in marathons and beyond have been due to over hydrating, not dehydration or lack of sodium. We'll see if following the guidelines in this book make my next ultra better.
170 reviews
Want to read
August 31, 2012
I won this book for free through Goodreads First Reads. Looking forward to reading it. Thank you.
Profile Image for Benjamin Espen.
259 reviews19 followers
August 24, 2017
I received this book for free from LibraryThing's Early Reviewers Program.

In the early 2000s, I was talking with a park ranger at the Grand Canyon. He told me he never really had to help anyone with serious dehydration in the Park. Too much water, leading to a salt deficit, was more common in his experience. Ten years later, I got a copy of this book for free. Timothy Noakes explained, at length, why that park ranger was right.

Noakes runs through a massive amount of material relating to human physiology, looking at the biomechanics of running, the hormonal signals that regulate thirst, and all of the associated research. When I first read this book in 2012, I realized I was completely in over my head. I found Noakes' arguments interesting, but I lack subject matter expertise to really be able to assess the details of his arguments. Which is a pity, because I suspect he might have a point, but it is prudent to see what the best counterarguments are, in the best Thomistic fashion.

I'm also cautious simply because this is a field with lots of axes to grind. Like Gary Taubes, Noakes is a bit of a contrarian, and in this book he claims that Gatorade is partly responsible for the idea that we need to drink all the time during exercise, in order to maximize revenues. I don't have an opinion on this. I find it possible, at least, but I'm not interested enough to find out whether it is true. And to be fair, Noakes is suspicious of Gatorade because he realized that the free shoes Nike used to send him colored his views on running injuries (p xvi).

I also don't think it matters to the core argument of the book. Which is extremely reasonable: only drink when you are thirsty. Even when you run or bike for a really long time. As evidence for this, Noakes can point to historical examples like the early and mid-twentieth century practice of marathon runners to not drink anything during the entire race (pp xiii, 38, 210), or the endurance hunting practiced in places as various as the Kalahari and the American Southwest, where you run an antelope to exhaustion and then kill it easily (p 10).

After establishing this recommendation, Noakes looks at the etiology of exercise-associated hyponatremia (EAH) and exercise-associated hyponatremic encephalopathy (EAHE), which he believes are caused by overdrinking during endurance exercise, especially marathon running. Noakes has documented 1600 cases of EAH and EAHE in an Appendix, and he has plotted the incidence over time.

The clear implication of this juxtaposition of charts is that Gatorade is to blame. I'm not sure of this. For example, Noakes doesn't adjust the incidence of EAH and EAHE for the increasing numbers of people participating in endurance sports, which implies a gradual lessening of average fitness, or the numbers of people participating who fall below some threshold of fitness. On the other hand, Noakes does have some evidence that physicians and scientists who got money from Gatorade advocated for the drinking guidelines that he thinks are causing EAH and EAHE in endurance athletes. On the gripping hand, Noakes has some evidence that reducing the availability of fluids during races decreases the incidence of EAH and EAHE (p 303), and that the US military saw a reduction in incidence of both after fluid intake guidelines were changed (p 321).

Noakes also mentions the cases of EAH in the American Southwest, specifically the Grand Canyon, citing a 1999 paper (Backer, Shopes, et al 1999), which brings us full circle, to that anonymous park ranger I met a few years later. Despite the criticisms I have made, I think Noakes is on to something. In part, that is because his core recommendation is pretty sensible. But it is also because where he says something that outrages conventional opinion, I have seen something with my own eyes, or heard with my own ears, evidence that supports Noakes. This increases the probability he is right, but it isn't quite definitive evidence. Since this isn't my field, I'll call that close enough.
Profile Image for An Te.
382 reviews24 followers
September 17, 2020
Waterlogged? Can you really drink too much water in replenishing lost fluids? You sure can; Tim Noakes demonstrates with case after case that over hydrating before, during or after endurance events (longer than 2 hours and often in excess of this) is detrimental to health, and at times can be life threatening.

His evidence recommendations include drinking according to thirst, replace salts accordingly and take in carbohydrate, if carbohydrate adapted, in sufficient quantities. You ought to listen to your body and respond. It really is as simply as that. Lastly, do not be duped by marketing into things the body does not need. Ask yourself first, seek our medical advice and read, read, read until you are sure it is safe.

It's not page turner and so I would have given it a three but it is full of important information from elite endurance athletes to day-long trekkers; it is this that raised the star rating. It's important not to pass by this information. It now is the norm in all endurance sports to take on water according to thirst.
Profile Image for Nancie Lafferty.
976 reviews7 followers
February 15, 2021
Excellently researched and presented. If you try to pay attention to how much you hydrate, runner or not, then this information will open your eyes and, probably, cause you to make some drastic changes to protect your health.
Profile Image for Marcus Goncalves.
556 reviews3 followers
September 15, 2022
Overall, a well researched book, although a bit outdated on some of the product’s compositions it outlined. But the fundamental premise is very convincing: endurance athletes are (dangerously) drinking too much water. Drink when you are thirsty is the overall message.
Profile Image for Alexei.
48 reviews
October 26, 2022
Interesting stories and scientific studies about effects of dehydration and overhydration on the body when exercising. Though some of the text is hard to read because of mumbo jumbo vocabulary of scientific literature. Recommended though
Profile Image for Adam Schwartz-Lowe.
62 reviews1 follower
March 13, 2017
A great, very technical, description on how hydration works and the importance of not over hydrating during endurance events.

I also have never read so much about rectal temperatures, nor do I expect to in the future.
Profile Image for Jeannie.
18 reviews2 followers
September 20, 2012
I heard that this book was an easy read. That's funny. I don't think so and it is a lot boring, at least it was to me. I agree with what it said however. The idea of drinking several ounces of water prior to a marathon and then drinking at every aid station that is 1 mile apart is definitely way too much!!! It talked about the history of what athletes would drink or not drink at events, which species of animals sweat, which don't and why, salt balance in the body, sports drink industry and their changes and the book explained terms that I have never even heard of like EAH (Exercise Associated Hyponatremia! Good to know. I of course will say sure, every runner should read it, good info to know. But, it was not an easy read.
Profile Image for Stef.
86 reviews
May 15, 2014
Awesome read - I'm doubting anyone EVER tried so hard (and succeeded) to prove a point. Charts, graphs, studies, personal experience, and interviews, all woven perfectly together.

The only downside? I shoulda read this before buying my last hydration pack;-)

Here's the 5¢ tour...
- Drink only when you're thirsty
- If you eat a lotta salt, you sweat/pea a lotta salt
- Cool down
- Never trust a Gatorade
- Relax your body will self regulate (almost) everything
47 reviews
November 6, 2019
Eye-opening and life changing. As a runner, I was fooled and pulled in by the commonly-accepted ideas that you need a bottle of Gatorade to run around the block, a bottle of water in order to make it from the car to the door of the mall. You don't! The lessons on hyponatremia are worth the price of the book. But the rest of the science is amazing. It has helped my fine tune my hydration for marathons and ultras. And I never buy Gatorade.
Profile Image for elstaffe.
747 reviews2 followers
August 31, 2013
I had no idea what to expect from this book, as I (disclaimer) received it for free through Goodreads' First Reads giveaway program. I was pleasantly surprised to find that it contained an abundance of citations and facts to back up the author's claims. Not being familiar with the field of endurance sports at all, I found this book to be very informative, if somewhat repetitive.
Profile Image for Jordan White.
15 reviews3 followers
October 11, 2013
Very heavy scientifically but some incredible information. Concepts in this book are certainly not the normative for our day and age, but Noakes proves his theories time and again. Very interesting stuff.
Profile Image for Kyle.
10 reviews
November 18, 2013
Nice! Very nice! If you're an endurance athlete then get it and read it.
66 reviews
January 9, 2014
Exhaustively researched. This is a must for any one participating in endurance sports.
Profile Image for Cari.
21 reviews
September 6, 2014
Great information, but this book it huge! Obviously a lot of extensive research went into this book, but I need a cliff notes version :)
Profile Image for Ellen Michael.
20 reviews2 followers
June 22, 2014
Great book for anyone who is an athlete, into endurance sports, or just interested in physiology. It's very clinical, but he explains everything really well in layman's terms.
Profile Image for Cherie.
3,219 reviews23 followers
April 2, 2015
I didn’t end up finishing; way too technical for my level of interest. Don’t drink too much water, as it’s bad for you.
Profile Image for Will G.
811 reviews
May 11, 2016
Kinda dry, but given the topic about as exciting as possible.

Changed my entire treatment algorithm for "dehydration" and heat injury.
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