Scientists on the same page on water issue

22 August 2005

It's no easy thing putting a ragbag of scientists and medical practitioners - hailing from all corners of the globe and specialisations - into a room and getting them to agree on anything.

But that's just what Professor Tim Noakes and Dr Tamara Hew of the UCT/MRC Research Unit for Exercise Science and Sports Medicine (Essm) pulled off in March. They assembled an independent council of world leaders for their Hyponatraemia Consensus Symposium at the Sports Science Institute of South Africa (SSISA), with the safety of professional and recreational athletes foremost on their minds.

The aim of the gathering was to pinpoint the causes, risk factors, preventative strategies, treatment options and current guidelines on exercise-associated hyponatraemia (EAH) and fluid intake. At the end of the three-day powwow they wanted to come up with a consensus statement that would once and for all put paid to the conventional wisdom that athletes taking part in endurance races should be drinking more (much more) than their fill - the dictum that the Essm scientists and others have long been saying is behind the countless cases of hyponatraemia, which is the dilution of the blood's salts to critical levels, and more than a few deaths at marathons and ultra-marathons across the world.

In July, Noakes and Hew got their dream paper. It appeared in that month's edition of the Clinical Journal of Sports Medicine of the American Medical Society for Sports Medicine (AMSSM), listing all of its 12 big-name contributors, with Hew its principal author.

In the paper, the researchers laid out the definition, severity, causes and symptoms, risk factors, preventative measures and treatment, including an unconventional but necessary (and small) dose of a high-saline solution, for EAH.

If the paper hasn't yet caused the stir it was expected to do, especially in the United States, it's probably because Dr Christopher Almond, a paediatric cardiologist at the Children's Hospital Boston and one of the contributors to the Essm paper, struck an early blow for the cause. In April, he published Hyponatraemia among Runners in the Boston Marathon in the New England Journal of Medicine, in which he also put incidences of hyponatraemia at America's darling race down to over-drinking. Red flags include weight gain and slow running, the authors pointed out.

Almond's findings made it into the pages of The New York Times, and soon even bloggers were passing the word. At this year's Boston and London races, organisers had more than halved the cases of hyponatraemia.

"It caused a huge furore in America," says Noakes of Almond's article, "because people were saying, we'd been told to drink as much as possible, now what are you telling us?"

Back at Essm, Noakes and Hew are enjoying the moment. Although Hew admits that, as they planned to pull the panel together for the March symposium, she wasn't too sure how things would pan out.

"We came from so many different ideas, I was very anxious that we wouldn't come to a consensus, that we'd be arguing and just not get anywhere. But it went really well, and we came to a consensus on every point."

Hew expects that the backlash will come, especially from the sports-drink producers in the US. So no-one's resting on their laurels just yet.

At this year's Comrades Marathon, Essm scientists ran tests on thousands of runners in what they hope will become the definitive study on hyponatraemia and the management of collapsed runners.

They expect that the data will bear out what, particularly, Noakes has been saying for the past 20 years. And provide proof that is truly water-tight.

More information on hyponatraemia can be found on the Essm website at

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