Waterlogged: The Serious Problem of Overhydration in Endurance Sports

I was amazed to know that a topic that had been so very important had always been left behind. My first thought before I read the book was that finally that a topic that was so very important would not be ignored and would be given due importance so that many can benefit from the knowledge that is imbibed in the book waterlogged. To begin with I would say Waterlogged by Timothy Noakes does an excellent work of diving deep down into the core of the topic that has been ignored for a such a long time. Waterlogged is based on a very important subject that is the excessive intake of fluids for hydration. 
It brings into light and bursts various myths stating that one should not consume excess fluids rather one should hydrate one's self when it's required. My most amazing experience while reading the book was to know about the marathon runners who consumed from no water to barely very little water during their races and their performance was not at all impacted based on the consumption of water. The book waterlogged is a masterpiece in itself that involves in-depth research and case studies. Also if one feels lost in the middle as the book involves a lot of data, the book still provides you with all the answers and gets you on track as you read further. The book feels like a path of many years as it brings with it a journey of millions of years from around the globe. Another memorable and interesting part for me from the book was that how our bodies have over the years become so accustomed to working out in extremely warm conditions. I admire Noakes for his in-depth research and the work that he has put into this book. The book waterlogged can sometimes make the reader feel lost because of the excessive data but as one reads along one can adjust to the authors writing style. I am going to surely recommend this book to all my clients and everyone I know for them to gain from this and burst the age-old myths.

Waterlogged by Timothy Noakes is a book based on the approach to excessive intake of fluids for hydration, "Drink when you're thirsty" in other words, listen to your body, contradicting the myths about hydration and dehydration that we are used to following.
We live in a society where the culture imposed since we were born, is that an individual normally must drink X amount of fluid per day, if that individual is an athlete, this amount tends to increase, in Waterlogged by Noakes, this Timothy paradigm is controversial. After all, we are evolved beings and we tend to adapt according to environmental changes as well as resistance exercises, whether in hot or cold conditions.
Another view that we noticed is the relation to the electrolyte disturbance (serum sodium disturbance) whether it is hypernatremia or hyponatremia. If hypernatremia is due to dehydration due to difficulty in accessing water or renal or extra-renal losses, hyponatremia is the reduction in plasma sodium concentration due to excess water in relation to the solute. Before, athletes were instructed to drink significant amounts of water during exercise, which could lead to hyponatremia. We are constantly being taught to drink more water. However, drinking more water is not always better.
On the other hand, in contrast, the media relentlessly manipulates the concept of ingesting liquids rich in sodium, such as Gatorade and other sports drinks, ensuring deeper hydration, a marketing ploy for the profit of the industries.
The concept of hydrating or dying, which generates so much controversy, where the athlete needs to be at the forefront of dehydration, as if their body were to become a water storage container, since this one when feeling exhausted during an endurance test, could take advantage of this storage and exceed the limit of your body, this is the question that Dr. Noakes gives us, when trying to exceed the limit of your body, it collapses, which would be to serve as a steppe for dehydration, it ends up affecting in hyponatremia, which can cause permanent damage or even death.
"Drink when you're thirsty" is simple, easy and of enormous value
As a CrossFit Coach, receiving this information makes us more aware of our athletes and the type of training we expose them to, depending on intensity, time and endurance, and guide you on their hydration.

     I can remember my devotion to the idea of drinking lots of water from high school sports through endurance efforts in college. Carrying a water bottle from class to class and drinking as much as I could. I've long since moved away from that habit, and reading Waterlogged backs up a more intuitive approach: "drink when thirsty."
     Noakes's expose on the flimsy (criminal?) science behind the sports drink industry falls in line with the other book club readings I've covered in the last two months. At the cost of people's health, the sugar industry pushes sugar, the food industry pushes processed food, the healthcare system pushes more procedures and more drugs, and the sports drink industry pushes more sports drinks. Welcome to America. The comprehensive approach to spending less money and staying healthy is to avoid putting anything in your body that corporate America has touched.

With so many misconceptions on staying hydrated I decided to give Waterlogged a read.

From being prior military like Joe Masley (comment from 5/2/2020) and being forced to consume 8+ canteens (16oz) of water per day to becoming a personal trainer and carrying my gallon of water around everywhere to stay hydrated I found this as a very interesting read. I witnessed a few fellow comrades during basic training fall out due to being "dehydrated" when in reality they suffered from heatstroke. Although I've never been an endurance athlete there's been a part of me that has felt that you should consume food and drink water instinctually (when your body is telling you to).

I enjoyed learning that some marathon runners consumed zero to very little water during their race yet suffered no lack in performance. The term hyponatremia was completely new to me so to learn about that and the cases of people who've died from drinking too much water/sports drink was mind blowing. Dr. Noakes does a great job of exposing the sports drink industry through his many years of research and studies. Dehydration is not a disease. It just means you've lost some fluids from the body. The only symptom of dehydration is thirst.

It's time for me to lose my gallon of water per day mindset and consume water when I feel thirsty. Besides, I was tired of waking up multiple times a night to go pee. 

Some time ago, I watched a TV show with an evolutionary slant and it noted how humans are extremely well adapted to handling low levels of hydration. At the time I also knew the story of the Florida Gators and Gatorade, but I never got around to resolving the paradox of these two "facts." It was great to read this book where Noakes really digs through the history and presents the data in an objective fashion.

It was fascinating to see that effectively one key paper (Malawer et al 1965) was behind the creation of Gatorade and that other salient realities (like how the pancreas can secrete sodium into the bowel) were not incorporated into the thought process. It was also telling to see that a placebo effect for gatorade was a very plausible reason for why it worked when it did (and that it didn't always).

The other striking part of this book, for me, was how Noakes admitted that as a medical student he was taken with the notion that marathon runners needed more fluids and, out of professional duty, exhorted others to employ this "science." That he was swayed so easily is a great example of the risk we take when we believe the experts with out critically evaluating data. That he admitted to this misconceptions is a great example of how to be respected as a doctor and truly serve in this capacity.

Waterlogged by Timothy Noakes was a very informative book. The main premise of the book is based on the concept of too much fluid ingestion or over hydration which is a novel concept in today's society. Exercise induced Hydronatremia is also discussed as a particular case that can affect the athlete to a large degree. 

One of the simplest concepts that is discussed is the idea of drinking to thirst. We are constantly taught to drink more water. However, drinking more water is not always better. We usually always rely on our typical mentality that more is always better. However, consuming the optimal amount is the best.  The human body is an incredibly intricately designed organism that can regulate its own requirements for water.

As individuals we are constantly being put in front of marketing. For example, I think most of us don’t realize how many gatorade commercials we see on a daily and weekly basis. The marketing we are exposed to on a daily basis continues to seep into the fabric of society. It’s very difficult to refute facts when we are told over and over again. For example, when you are told 1 million times that you need to hydrate you begin to believe it. Waterlogged does an excellent job of getting to the bottom of a topic that has been swept under the rug for too long.

As coaches we can do our part to ensure that our clients are well educated with regard to hydration. Consuming the optimal amount of fluid is important with regard to maintaining good overall balance. The more we continue to work as a team, the more we can begin to turn the tide and reeducate the general public.

One thing I have learned is that nearly every subject is both simpler and more complex than it seems.  In Waterlogged, Tim Noakes, highlights this to the extreme.  Through misunderstanding observations and the basic science, the endurance community thought it understood the complexity of hydration to the point of overriding our innate simple needs of drinking to thirst.  Through a broad range of observational studies and complex biology, Noakes breaks down the complexity of just how our bodies regulate with a simple conclusion the dehydration is not a performance and health issue as previously believed.

Human beings have evolved to be the best endurance animals on the planet.  Our upright posture and ability to sweat help us to dispel heat and our structure also allows us to breath whenever we need to, while a 4 legged running animal can only take 1 breath per stride while running.  Through that evolution as the planet's greatest endurance athlete our bodies developed ways to handle that stress, regulating water and salt content in our bodies.  I was fascinated to learn that we hold much more sodium in our bodies than I previously thought.

It was fascinating to learn that heatstroke happens in short, intense exercise rather than long endurance exercise even in high temperatures.  It is sad and concerning to see how financial gain can cloud judgement, prevent questioning assumptions, and create an industry that has put so many athletes in danger with their recommendations.  There should be more accountability for being wrong, whether it was willfull or not, and making recommendations that have hurt so many people.

This book was an interesting if not a little verbose read. However, it did back up with science, something that I've felt for years. Everyone always tells me that I don't drink enough water (I weight 220 lbs.). However, I have always felt that if I'm thirsty, then I will drink more water. Further, I have always felt and performed well with my current intake. When I have undergone efforts in the past to increase consumption, I feel like I just ended up peeing more and never really performed better. I know athletes right now who are drinking  several gallons of water daily! Much time in the bathroom there just taking away from training time. Now I am validated that I was/am on the right path regarding hydration! 

It's very interesting to hear about the science with ultra endurance athletes. More water does not make you perform better! So contrary to what we are used to hearing. Besides the pseudo-science of the energy dring companies, I really think it boils down to the fact that it's just easy to tell your athletes to drink more water. What could happen right? It's kind of like saying "eat more vegetables". How could you go wrong saying this? Well, as it turns out, lots can go wrong! Becoming ill or dying from drinking too much water is a travesty and is so easily avoided!

I'm also angry with the electrolyte replacement/sport drink industry after reading this book! How can such a big, rich industry continue to publish garbage research and flat out lie to people? I guess that money is the right answer unfortunately. I almost always read research studies with an element of caution and skepticism, but this just reinforces it! Always look and see who did the research that you are reading and take it with a grain of salt (no pun intended). Do not trust these people and don't give them your money! 

Dr. Noakes is a wealth of information on hydration and over-hydration and has written the end all book on the subject. It is sad that so many athletes have died or become very ill when these were very easily avoidable occurrences.  I really hope that the sport drink industry would come to their senses and do what is right for the health of their consumers and make adjustments to their recommendations. Better yet, change the sugar/salt water formula to something that might actually benefit athletes. Oh wait, that would be water. But not too much!

Waterlogged was a very dense book, full of myriad studies
and appendixes, but the book boiled down to the simple idea that since 1976 the
endure world has been encouraged to ‘drink more’ without any real science
backing.  Prior to this, endurance
athletes drank very little and had very little deaths.  There are even some anecdotes in there about
how far man can actually push himself with little fluid intake in some of the
harshest climates.  Between the rhetoric
and commercial interests of sports drinks, such as Gatorade, the public has
been told more and more they NEED to hydrate, so much so that ‘hydrate or die’
has become a common mantra in some communities. 
Rather than listen to our bodies natural process of ‘hey, I’m thirsty’
to hydrate, athletes were being told to ‘stay ahead’ of the thirst so it never
occurs, even though thirst is the process of the solutes becoming greater in
concentration as water is lost so drinking would maintain a steady state of
percentages.  Whereas ‘staying ahead’
dilutes the electrolytes and puts it out of the correct concentration
range.  They used the passing out from
low blood pressure to sell it as ‘dehydrated’ and further they assumed
heatstroke’s singular cause was dehydration, despite evidence that during
trials athletes who did not drink did not develop heat ‘illnesses’ and that
their blood-sodium concentration actually rose despite the lack of
salty-drinks.  As a former Recon Marine,
we ourselves experienced too much liquid intake.  I personally went down for hyponatremia
during ‘the crucible’ when we were forced to drink a canteen of ‘salted-water’
ever hour, punishment following if we failed to kill the entire canteen on
command.  After a few hours I started
burning up and passed out, only to wake up with a medic putting ice on my neck
telling me to stop drinking so damn much as I had peed out everything.  After that experience I stopped drinking as
much or sport-drinks, and went on to feel better during long (up to three hours),
performance based rucks.  Even in Iraq we
only drank when we felt thirsty and performed at high-intensity for hours on
end without a single heatstroke case.  I
thought it was very interesting that American based endurance has far greater
cases of heat related injury than Australia or New Zealand, given they buy so
much less into the Gatorade marketing. 
In the end, LISTEN TO YOUR BODY. 
Although my days of Ironmans and enduro races behind me, it is nice that
I can pass this knowledge on to the next generation.  

The fact is that there's a clear misconception and maybe a myth about water consumption and "sports" Drinks.
What brings us more attention is that scientist that supposed to advise people for the right way of hydration and healthy . They Made and still making us be in danger. Unfortunatelly they haven't done healthier advises it and still doing a bad job.
Some physiological aspects like the amount of water absorbed rate for our body and amount sodium needed to have a balanced system were "forgotten" intentionally or not for people and academics.
If it's clear that we can't absorb more than 400ml / hour why someone should drink 1200ml / hour?
and more if elite runners can ran a marathon without drink water, why a regular runner which runs slower and produce less power and heat should drink more?
Many studies described in the book has some gross mistakes that lead us to think if there's an intention beyond keeping people far from heart strokes or any heat problem caused by dehydration.
As a CrossFit trainer we have to be more cautious about our kind of training because short and high intensity training sessions are more prone to heart disorder than long and slow training modalities but NONE of then are related to dehydration.
We have a built in system that allow us to move, lift, run and survive by ourselves with no food or water for a long period with no hazard, but academics ignored and suggested and still saying us to change our millenary behaviour of consumption when you fell hungry and or thirsty.
None of "high dehydrated " athletes which loose more than 5% BW after a race showed any healthy risk, in fact if you running for 2-4 hours a smart person would avoid take in more weigh (1,2kg/hour as related) it would you make heavier and slower.
Despite a higher temperatures the runners were not in risk, so the recommendation of drinking as much as possible doesn't make any sense.
Most of cases and evaluations studied by  "academics"do not reflects the right scenario (whether conditions, game day,  etc) its something that should make us sceptic from journals and articles  in special those supported by commercial industries.
Lastly as CF Coaches we can spread the right message and teach our clients about hydration during CF Sessions and running workouts. The majority do not need anything else than follow their instinct and keep moving.

Again, I was surprised by an interesting, detailed and well-crafted reading.
Perhaps the most interesting and challenging of all the readings carried out here was the fact that we broke some concepts that were internalized in our history, as in the case of this book.
It was very common to see athletes who were instructed to drink plenty of water during exercise and, on the other hand, we heard about the concept of hyponatremia and the book also leads us to link these concepts to each other. Quite simply, everything in excess is bad, including water. 

During the entire reading, sometimes a little repetitive), the author explains that excessive water consumption can also lead to hypo, which could cause strangeness, but, with all the examples and also searching within the knowledge we have, does everything sense.


I believe that this book needs to be read by coaches, athletes and also those who are interested in the subject in order to have a better idea about the consumption of liquids and which ones are the best for a healthy performance.

Is it so inconcievable to think that our hydration requirements were trained into us no differently to how a high carb/low fat diet has been?

Dr Noakes does a wonderful job 'coming clean' in relation to the role he played in the corrupted science of food health and then communicates a wonderful comparison to how the science around how we should hydrate, imparticulary as an athlete, has been tainted in the same way.

It's definitely easy to follow and the holes he pokes in all of the science draws us to a wonderfully simple solution..... Drink when thirsty (water) and eat when hungry (high fat/low carb/moderate protein).

Bravo Dr. Noakes for being a pioneer in your field and helping us simple folk understand and find the hidden path to good health.

I’m very happy I made the effort to read this book. I say effort because this a topic I know very little about and when the chapters got technical it wasn’t easier to read. Now analysing the book, I like how the chapters were ordered, it feels like it was telling a story. The summaries throughout the book helped to understand the overall reaching idea of the book. 

I had a lot of mixed emotions as I read this book. I felt embarrassed because I would think back to times that I recommended what I now know is over hydration. I felt sad when I read about the cases of athletes who died because they were wrongly diagnosed which led to incorrect treatment. I felt frustrated because I remember for several years as an athlete before, during and after competition forcing my self to drink thinking I was doing the write thing. I felt angry because we are easily manipulated to believe what is considered healthy. 

Although my understanding of this topic is minimal, I feel confident that I can make proper recommendations to my athletes about hydration and other relating topics while being able to reference them to a great book. 

Drink when you are thirsty. I love how simple this recommendation is. The body has a mechanism that has allowed us to evolve, our thirst. It is not broken, so we don’t need to fix it. 

Well, yet again I have discovered how little I know about a topic that I thought I understood. Prior to reading this book, and thanks to the CrossFit Essentials page, I was very aware that we should drink to thirst to avoid Hyponatremia. I knew that over-drinking was ill-advised but I hadn't made the connection that dehydration may not be causal to Hyperthermia. It seemed intuitive that the best performers at the end of an endurance event would be the ones with the least dehydration and lowest body temperatures, that is, least affected by the conditions. That would make sense, right? It also seemed logical that the athletes that I had witnessed on TV staggering and losing consciousness at the end of races would be suffering from the effects of extreme dehydration. But as Dr Noakes explains "In fact, the best endurance athletes in the world are typically those who lose the most weight during exercise, who have the least thirst, and who run the fastest when they are quite markedly dehydrated, perhaps because the weight loss is beneficial to performance, just as the avoidance of thirst must have been an advantage to early hominid". To my surprise, it is likely that the staggering athletes were actually over-hydrated and had gained body weight during the race from over-drinking. I also would not have thought that the risks were greater in shorter duration events. As Nokes notes "the highest . . .temperatures and the greatest incidence of heatstroke are found in highly-trained athletes competing in shorter distance events lasting 20-40 min”. I am not sure to what degree this is a failure of my intuition, or simply the degree to which I have subconsciously fallen victim to the hydration marketing messages that were prevalent during my triathlon days. Nonetheless, I feel like my eyes have been opened up. 

There is a degree of repetition to this book, partly because it seems to be compiled from a collection of articles written over a passage of time, and partly due to the author's diligence in providing supporting research that was accompanied by its own commentary and analysis. It was heady going in parts and I found myself experiencing deja vu at times, but the read was worth it. Not only for being able to walk away better educated about dehydration, hyperthermia, exercise-associated hyponatremia (EAH) and exercise-associated hyponatremic encephalopathy (EAHE), but also for the insights into quality scientific thinking. Many times during the read I felt like I was locked into Dr Noake's thought process as he pulled apart previous research. I was also impressed that the author was willing to highlight and acknowledge his own previous errors, and his clear passion and curiosity. 

There were many takeaway messages in this book, but there were two in particular that stood out to me. The first, which I think reinforces the impact of intensity, is that running speed drives body temperature during races. "We concluded that the metabolic rate (running speed multiplied by body weight) is the major determinant of the body temperature during exercise and that the level of dehydration plays only a small (permissive) role. Thus, “Athletes who run slowly during marathon competition could . . . become . . . dehydrated if they did not drink, but would be protected from hyperthermia by . . . low metabolic rates”. Intensity pushes body temperature high, if the environment doesn't allow heat to be dissipated, then the athlete will naturally slow down to reduce intensity accordingly. But what if the athlete does not slow down? I could see this explaining heatstroke risk for motivated and highly trained CrossFit competitors that are wearing weight vests and clothing that may trap heat and prevent sweat from cooling the body, but are mentally able to keep pushing intensity. The ability to dissipate heat in 20-40 min workouts may be the thing that separates the field in competition. Optimizing convection is the name of the game.

The second takeaway is that the body regulates itself amazingly well to optimize survival. As Dr Noakes notes ..."No one bothered to ask this question: If thirst is an imperfect index of the body’s fluid requirements, how is it possible that every (other) creature on Earth that relies solely on thirst to regulate fluid balance seems to achieve this balance rather well? " I feel like this type of question does not get asked enough. I think the author has highlighted a major thought problem with much research, which is, it often starts with an incorrect premise that the way the body works is not optimal. The reality seems to be that if we operate in accordance with our evolved ability to regulate body processes we will thrive, and if we mess with the mechanisms bad things happen.

An enjoyable read and highly recommended.

“Waterlogged: The serious Problem of
Overhydration in Endurance Sports” by Dr. Timothy Noakes has well deserved the praise for the quality of the literature. This is a diligent, in depth piece of literature that arduously provides supports for its views, does so with professional tact, and gives a clear look into the basin of hydration theory/recommendations that we are experiencing the trickle down effect of. 
 

The most notable quality of this book the breadth and depth of scientific research and case studies that Noakes provides for each of the points he makes. I admire the work and support put into each piece of the book. I recommend reading Jobst Olschewski’s comment for a nice set of topic highlights from the book. Admittedly, for every reason I admire the diligence with which Noakes has approached the topics of the book it also, at times, made the book a labored read. If you’re not ready to go over all the details you might feel overwhelmed or bored. If you feel that way stick with it, Noakes always does a good job to answer questions he raises and finished with succinct bullets or summaries to get you back on track if you feel lost. 
 

I have to agree with Jobst’s comment, that Noakes displays a great amount of integrity. In a book like this is could easily turn into a righteous, indignant pointing of the finger. However, Noakes makes it about the science. He does not belittle is peers as we have come to see in many types of debates. Rather he makes it about the science. He works to understand how and why others have their viewpoint and then provides well-structured arguments against them. He is also honest about his journey of viewpoints on topic. One of my favorite parts to read, was his own transition of beliefs starting with the first cases of EAH and EAHE in with the female runners in 1981. One of my favorite quest form the book “There is a touching innocence in such certainty.”  This book is a great example of how to argue something well. 
 

With the book club, I always try to stay away from giving a summary. You can get that many other places. I still stick with trying to bring it back around for someone who loves CrossFit and GPP. With each book, it is interesting to have those “oh ya” moments where I remember how these I came into contact with these topics and dogmas growing up. While not being an endurance athlete, I still felt the off shoot of hydration recommendations. Playing competitive hockey growing up I remember jokingly being the team’s proverbial camel as I never drank as much as the others. Hydration was big topic but by the time I reached collegiate sports, right around the time the ACSM was revising the its guidelines, there was distinctly less emphasis on needing to hydrate in a game and more focus to per and post exercise nutrition. While this book focuses primarily on ultra-marathon, marathon, ironman athletes and military personnel its is interesting to see how those guidelines permeate the rest of sports culture. It reminds me of the scene in "Devil Wears Prada" where the designer goes through how runway fashion trickles down to a sale sweater. This topic might be one end of the spectrum but its effects are far spread.
 

For CrossFit, the information regarding what, where, when, and how to look for and expect things like dehydration vs heat illness is good baseline knowledge for the safety of your athletes. It is a good reminder dehydration is something we most likely won’t be dealing with, rather that heat illness are more likely what we would be dealing with as they their likely hood is increased with shorter duration work at high intensity. So if you’re going for your water bottle as a way to get some more rest in the workout, resist and enjoy a bit more intensity. 

Waterlogged was not my favorite read so far from the CrossFit Book Club.  I found much of the information interesting in regards to human physiology making us the most efficient at handling heat and staving off dehydration ( The comparisons between humans and African mammals was pretty cool).    I just found that Noakes got bogged down in the science aspects of this.  This is valuable information that most people do not know.  I would have preferred Noakes to make this information more “readable” for those who are not as accustomed to reading factual or scientific writing.  My fear with Waterlogged is that many people will start this book and never FINISH this book because they will get lost in the data.  I believe firmly that Noakes is passionate about the subject of Hyponutremia and that most people do not even know what that is.  I am stuck on this one because I also believe that the best teachers are those that can take complex subjects or concepts and make them very readable for everyone to understand.  I just did not feel like that occurred in this book.  It might just be my take on this one...but I found it very hard to get through.  Sorry:(-  On to the next read...super excited about this one!!!

Waterlogged - excessively saturated with or as if with water.

Sounds simple enough, but my bet is that anyone who reads the book by the same title by Prof. Tim Noakes, will not only learn more about this word and its meaning, but about anything that is physiologically related to this condition of specifically the (muscle) cell saturation with water, its causes and consequences.

By virtue of living in closer proximity geographically to Noakes than most for many years (I opened a CrossFit gym in Cape Town in 2009), I have been regularly exposed to some of his publications (some of which were mentioned to my members, some via CrossFit.com) and become a fan. Two qualities specifically stand out to me: His integrity (e.g. adjusting his scientific stance on nutrition after new findings – or holding his ground even in court when exercising his right to freely voice his dietary recommendations) and his obvious passion for what he does (in this case for running and teaching, which can be experienced in the lecture of “waterlogged”).

The book is thorough to say the least and as someone that is not the most avid runner (besides the volume common in CrossFit workouts) what helped me a lot with the study of the book was the obvious passion of the author for the topic of running, its physiological implications and everything related to it.

Waterlogged indicates dangers associated with overhydrating (i.e. Exercise- Associated Hyponatremia (EAH)). During the investigation of the topic, Noakes mentions several solutions that are showing how our bodies are able to self-regulate: Drink only to thirst. Drinking does not prevent heat illness. Ingesting salt is unnecessary in long endurance events. Urine frequency and color had nothing to do with hydration or kidney function.

There is simply too much information to do justice in a short review, so here are some of my “random” highlights: 
Of all creatures, Homo sapiens is the best adapted for prolonged running in extreme dry heat. Through my own challenges with running I doubted that for the longest time, but the points outlined are very compelling: We are bipedal and able to run upright which gives us less surface area for heat accumulation, have little body hair, we are able to sweat and pant for better thermoregulation, etc. This might give me some confidence when going out to run next time.
Drinking: Just like Noakes mentioned, when I studied Sports Science we were taught about a hydration schedule for running (alongside of carb loading). The problem: “It is when we do not listen to our bodies and override our biological instincts with advice from external sources that we run into problems that can, in fact, lead to catastrophe”.
How did Gatorade become popular and how can this experimental “electrolyte solution” be supremely dangerous? Although this is just a relatively small part of the overall volume of the book, the commercial influence may be one of the biggest reasons why waterlogged is so important. It may actually save lives. “Understand that much of what you believe about your personal well-being is the result of targeted manipulations by industries whose principal focus is their commercial fitness and not necessarily your health or safety.”
“Humans cannot survive by drinking sea water, as salt concentration is higher than the kidney can process.” I had been wondering about the “why” on this forever: If your out in the ocean how can you still due to lack of hydration?
Similar to how Dr. Fung wrote in “Obesity Code” that we have a set point for body weight/fat that the body will “defend”, we have similar mechanisms like this in other areas, e.g. “humans alter their behaviors to ensure that body temperature is homeostatically regulated regardless of the stresses, either internal (e.g. the level of hydration) or external (e.g. the environmental temperature) experienced.”. E.g. the body self-regulates blood sodium concentration via several mechanisms, including sodium sparing in sweat and urine – or excretion of excess sodium.
Weight loss during endurance exercise is normal (not all fluids must be replaced by drinking during the event).
There is no relationship between fluid intake and 1) hydration and 2) the incidence of heat exhaustion / heatstroke.

Simple instructions, drink when thirsty.

I appreciated how detailed supporting evidence for the instructions was all set up within a simple framework of: 1) is the human body a fragile piece of engineering with limited control mechanisms, prone to failure in extreme situations or user misuse, potentially leading to sudden death; or 2) is the human body pretty resilient with built in redundant mechanisms to prevent catastrophic failure whether they be from the environment of purposeful abuse by the user? So, the lesson - don’t over think it. Why drink every 400m of running or at regular intervals when exercising if you are not experiencing the sensation of thirst; I certainly hope the answer is not “because someone told me so.”

Reading Waterlogged was a unique experience for me and really resonated. While in the military, I wound up from the ICU for 5 days from a massive heatstroke. We were constantly reminded to push fluids and that hydration was "continuous" and that if you were thirsty, it was too late - you were already on your way to dehydration; I wish I had heard of Dr. Noakes back then....

This book encouraged me to go back through my medical records and look to see if EAHE was the ultimate cause. It was cool to look back with an objective lens at this incident in my life that I rarely revisit with a sharper eye. 

Following the prevailing theme in this book club, it was, again, very unsettling to see how flawed science (with no legitimate, scientific supporting evidence to back it) combined with corporate dollar signs perpetuated ACSM hydration guidelines that ultimately killed people. More disturbing was the attempt by these same people to silence those like Dr. Noakes, who dug deeper into the problem and worked tirelessly to bring this life-threatening condition to light.

However, it was truly inspiring to read how Dr Noakes dedicated his life to trying to fix a mistake he made early in his career and do his best possible to see that no one else suffered the same near death-experience as those two runners who wrote to him following their running of the Comrades Marathon. 

It was also encouraging to see how Dr. Noakes' hard work and dedication has helped lead to a reversal in hydration guidelines and shed light on the dangers of EAH and EAHE. 

As a first responder, his detailed guide of signs and symptoms, in conjunction with those commonly found in dehydration and heatstroke are very useful tools that I will use in my profession going forward. A few of my peers already want to read this after I told them about it.

Thanks for all of your hard work Dr. Noakes!! 

Drink when you’re thirsty. Don’t when you’re not. This simple summary doesn’t quite do Waterlogged justice, but it is the take home message. This book is a journey spanning millions of years and destinations around the globe. One of the most interesting parts for me was his exploration of our evolutionary past and how our bodies became so well adapted to endurance exercise in hot conditions.

I had no idea that humans were so unique in terms of thermoregulation. My understanding was that we humans dominate the world because we’re the smartest, not the sweatiest. It turns out that our unsurpassed ability to cool our bodies through evaporation gives us a unique advantage in hunting. We are the only predators active in the midday heat. And it turns out we didn’t hunt with superior cunning and strength. We simply chased animals around until they nearly dropped dead from heat exhaustion. These chases could last upwards of 10-12 hours and end with an antelope or other beast laying on the ground motionless, unable to fight back.

To enable our prodigious levels of sweat, we have evolved several mechanisms to maintain homeostasis in our body despite losing upwards of 8% of our weight in fluid loss. One is that we can regulate our blood osmolality by changing the amount of salt in our sweat and urine. Our body does an incredible job of maintaining salt levels in all but the most extreme (and self-imposed) circumstances.

The principle example of this is the main focus of the book— hyponatremia. This condition is brought about when runners drink so much fluid that their cells begin to swell. This is a major problem for the brain, which has no room for enlargement. This deadly condition is called exercise-associated hyponatremic encephalopathy (EAHE).

Why would someone drink so much fluid that it becomes deadly? The answer of this book is bad science of the kind only the Gatorade Sports Science Institute (GSSI) could produce. Their advice for athletes was to drink as much as they could tolerate in order to prevent dehydration and heatstroke. They base this recommendation on the notion that the human body is not capable of properly regulating its fluid intake. I’ve heard many times that if you feel thirsty, it’s too late. You’re already dehydrated. Noakes refers to dehydration as a symptomless, non-disease.

Athletes took the GSSI recommendations so seriously that many of the victims of this flawed advice actually gained weight while running a marathon. This does not even seem possible. Dehydration was so demonized that people would drink to the point of discomfort. Sadly, doctors would often treat these people for dehydration, when in fact they were suffering from overhydration. The addition of fluids provided through an IV only made the condition worse.

Dr. Noakes treats this topic with an attention to detail and thoroughness that is rare for any topic. Along the way, he debunks the entire body of knowledge produced by the GSSI. Not only does dehydration not impair performance, but the top performing runners lose the most weight and reach the highest rectal temperature. (As an aside, there is a whole lot of rectal temperature measurement going on in the world of long-distance running. Is this something they sneak into the fine print on the sign-up sheets?) If you reach a very high body temperature in spite of losing many pounds of sweat, you clearly have the highest metabolic rate and therefore run the fastest.

For entirely selfish reasons, the GSSI promoted the idea of zero percent dehydration. The idea is that performance is significantly impaired if you lose more than 2% of your bodyweight. Ideally you would replace all fluids lost during a race with a hypotonic solution of electrolytes and glucose, such as Gatorade. That this fails to match the data collected from race results gathered for many years prior to the invention of Gatorade is shocking. It should have been a non-starter. World records were set in marathons by people who drank nothing at all during the entire race. How do you go from drinking nothing to drinking as much as tolerable?

One of Noakes’ other interests is in the psychological aspects of performance. He has done pioneering work on the central governor theory. This is the idea that your brain regulates performance in such a way as to protect the body. Performance is not dictated entirely by blood glucose levels or body temperature or hydration levels. The brain creates sensations of discomfort long before the body reaches critical levels of temperature, glucose or hydration. One of the interesting examples of this is that beverages containing glucose improve running performance. However, injection of glucose does not improve performance. Thus, without the sensation of tasting the glucose, performance does not improve. Injection serves to bypass the brain. The only logical conclusion is that the brain regulates performance, not blood glucose levels.

Lastly, Noakes is enjoyable to read in large part because he has a genuine interest in and love of people. This shines through in the introduction, when we meet Dr. Cynthia Lucero, who died of EAHE. This is also evident when we meet the scientists who invented the doctrines that led to the emergence of hyponatremia as the greatest danger to face long-distance runners. Noakes could have ridiculed these men, but instead says quite nice things about many of them, while shredding apart their work. When it comes to the science of hydration, Tim Noakes has the final word. The comprehensiveness of Waterlogged is truly a discussion-ender.

It is hard to go against the dogma.  It is even harder to go past your biases!  It takes courage to realize what you knew is not the truth and that you made a mistake. This book is about hydration and : 

« (…) I listen to my body and try to unlearn being an educated specialist. It’s a lifetime work, this becoming a simple and seamless whole. » George Sheehan

I strongly encourage all to read this book and recommandations.  I realized that I spent a good part of my life believing I was doing the best for my health and performance by drinking as much as possible, by making sure my urine was clear. 

I even « self diagnosed » myself during last years FTD sanctional as dehydrated during the 10 km run because of symptoms that I now can recognize as Exercices Associated Hyponatremia!  Because I didn’t have the knowledge I have now I decided to drink even more!  I am so lucky that I didn’t go to the point of no return and only looked confused and dizzy until my body pee all the extra fluid all night.  

Coaches, athlete, doctors, all health personal need to know that dehydration during sport events is really rare and shouldn’t be a reason to make people drink more water.  Drinking more does no protect you against heat illness nor does it make you perform better.  You have to believe that evolution made us the mammal with the best adaptation to exercice in hot weather on earth!  

Let’s stop this catastrophe theory that our body cannot regulate itself and is running to it’s death if «the scientists of sports » don’t intervene!  This makes no sense and only profits compagnies and but athletes at enormous risk!

This sums up the attitude we should have to all guidelines put forward in sporting events where compagnies can make money from it.  

« Understand that much of what you believe about your personal well-being is the result of targeted manipulations by industries whose principal focus is their commercial fitness and not necessarily your health or safety. »  Noakes, Timothy. Waterlogged