BMJ  2003;327:113-114 (19 July), doi:10.1136/bmj.327.7407.113

Editorial

Overconsumption of fluids by athletes

Advice to overdrink may cause fatal hyponatraemic encephalopathy

The first 150 words of the full text of this article appear below.

A recent report that a female participant in the 2002 Boston marathon died from hyponatraemic encephalopathy because she ingested excessive volumes of a sports drink before and during the race,¹ exposes an emotive debate that has raged for more than a decade.² At issue is how much should athletes drink during exercise.³

From antiquity to the late 1960s, athletes were advised not to drink during exercise since it was believed that fluid ingestion impaired athletic performance.² The publication in 1969 of an incorrectly titled article, "The danger of an inadequate water intake during marathon running,"⁴ provided the impetus for change, even though the study neither examined a 42 km marathon race nor did it identify any dangers.² Rather, the most dehydrated athletes won those 32 km races, as is usually the case.² This article's incorrect title provided the intellectual incentive for numerous studies, many funded by a fledgling sports drinks . . . [Full text of this article]

MRC/UCT Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town and the Sports Science Institute of South Africa, PO Box 115, Newlands 7725, Cape Town, South Africa (noakes@iafrica.com)

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This article has been cited by other articles:

• Rosner, M. H., Kirven, J. (2007). Exercise-Associated Hyponatremia. CJASN 2: 151-161 [Abstract] [Full text]  
• Saunders, C. J., de Milander, L., Hew-Butler, T., Xenophontos, S. L., Cariolou, M. A., Anastassiades, L. C., Noakes, T. D., Collins, M. (2006). Dipsogenic genes associated with weight changes during Ironman Triathlons. Hum Mol Genet 15: 2980-2987 [Abstract] [Full text]  
• Noakes, T D, Speedy, D B (2006). Case proven: exercise associated hyponatraemia is due to overdrinking. So why did it take 20 years before the original evidence was accepted?. Br. J. Sports. Med. 40: 567-572 [Full text]  
• Laursen, P B, Suriano, R, Quod, M J, Lee, H, Abbiss, C R, Nosaka, K, Martin, D T, Bishop, D, Sharwood, K, Noakes, T (2006). Core temperature and hydration status during an Ironman triathlon * Commentary * Commentary.. Br. J. Sports. Med. 40: 320-325 [Abstract] [Full text]  
• Hew-Butler, T D, Sharwood, K, Collins, M, Speedy, D, Noakes, T (2006). Sodium supplementation is not required to maintain serum sodium concentrations during an Ironman triathlon.. Br. J. Sports. Med. 40: 255-259 [Abstract] [Full text]  
• Noakes, T. D., Sharwood, K., Speedy, D., Hew, T., Reid, S., Dugas, J., Almond, C., Wharam, P., Weschler, L. (2005). Three independent biological mechanisms cause exercise-associated hyponatremia: Evidence from 2,135 weighed competitive athletic performances. Proc. Natl. Acad. Sci. USA 102: 18550-18555 [Abstract] [Full text]  
• Almond, C. S., Shin, A. Y., Fortescue, E. B., Mannix, R. C., Wypij, D., Binstadt, B. A., Duncan, C. N., Olson, D. P., Salerno, A. E., Newburger, J. W., Greenes, D. S. (2005). Hyponatremia among Runners in the Boston Marathon. NEJM 352: 1550-1556 [Abstract] [Full text]  
• Griffin, L. Y. (2005). Emergency Preparedness: Things to Consider Before the Game Starts. JBJS 87: 894-902 [Full text]  
• Noakes, T (2004). Sodium ingestion and the prevention of hyponatraemia during exercise. Br. J. Sports. Med. 38: 790-792 [Full text]  

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