The End of Tolerance

CrossFit questions the leadership of the fitness and exercise-science communities.

“Consume the maximal amount that can be tolerated.”

The line seems innocuous at first, just a recommendation in a 1996 position stand on hydration published by the American College of Sports Medicine (ACSM). But if you read it a few times, the words don’t sit well. Their imprecision alone seems enough to disqualify them from a publication titled Medicine & Science in Sports & Exercise, the ACSM’s “flagship monthly journal.”

Consider this farcical, tragic and extreme application of drinking to tolerance: On Jan. 12, 2007, a radio station in California asked listeners to consume the maximum amount of water they could tolerate without urinating as part of a contest. Later in the day, participant Jennifer Strange, 28, died of water intoxication, also known as hyponatremia.

Prior to the 1970s, hyponatremia was almost unheard of. And while not common today, it is not nearly as rare as it should be. It occurs when a person consumes so much fluid that the body’s sodium becomes diluted, causing swelling of the cells and intercranial pressure. It’s a painful condition that can result in everything from seizures to death.

You can perhaps blame Strange’s death on a foolish contest, but athletes have also died following questionable hydration guidelines. At least 12 people have died from exercise-associated hyponatremic encephalopathy between 1993 and 2008. Updated by the ACSM in 2007, the guidelines are still woefully inadequate. Misinformation and bad science persist, and people still suffer.

Last August, Zyrees Oliver, 17, died in Georgia after consuming 2 gallons of water and an equal amount of Gatorade after cramping up in football practice. Also in August 2014, football player Walker Wilbanks, 17, died of hyponatremia in Mississippi. And there are others.

So why do people drink too much? Stupid contests are one answer. But another answer is that authorities in the medicine and exercise-science communities have told people to drink “the maximal amount that can be tolerated” in the interests of safety and athletic performance. Athletes have also been told to drink before they’re thirsty, and to consume sports drinks to maintain sodium levels. Interestingly, the authorities producing these guidelines are sponsored by Gatorade and the Gatorade Sports Science Institute.

It doesn’t take a genius to see an obvious question: If “Waterlogged” author Dr. Tim Noakes says EAHE can be prevented “simply by always drinking to thirst,” shouldn’t we be concerned when athletes still follow other guidelines based on questionable science?

If the answer is yes, shouldn’t we be horrified when athletes die?