What do they have in common? They drank hypotonic fluids in excess while exercising and died from overhydration’s consequences. More specifically, they drank too much Gatorade and died from exercise-associated hyponatremic encephalopathy. What’s Gatorade doing about it?
Gatorade is still telling people not to worry about hyponatremia. There’s no excuse for that. Lives are at stake. The Gatorade Sports Science Institute’s “Preventing Hyponatremia” video brazenly states:
“Hyponatremia is not very common, so the typical athlete does not have to concern him or herself with hyponatremia too much, unless they’ve shown in the past to be particularly sensitive to it.”
The Gatorade researcher also claims that “the occurrence of hyponatremia is about 2 or 3 percent in the population. So, it’s very low.”
This is not consistent with a study in the New England Journal of Medicine that reported a 13% rate of EAH and .6% rate of critical EAH in 488 Boston Marathon finishers. This is the largest study of sodium levels in endurance athletes at a single race that I’ve found. Note that the NEJM rate is around 5 times the rate of hyponatremia that Gatorade portrayed.
Many other published studies support a 5-30% rate of hyponatremia in endurance racers of various sports. For example:
Higher prevalence of exercise-associated hyponatremia in female than in male open-water ultra-endurance swimmers: the ‘Marathon-Swim’ in Lake Zurich.
Do male 100-km ultra-marathoners overdrink?
Higher prevalence of exercise-associated hyponatremia in triple iron ultra-triathletes than reported for ironman triathletes.
Prevalence of exercise-associated hyponatremia in male ultraendurance athletes.
First reported cases of exercise-associated hyponatremia in Asia.
Prevalence of hyponatremia, renal dysfunction, and other electrolyte abnormalities among runners before and after completing a marathon or half marathon.
To be fair, some studies have not found hyponatremia in endurance athletes. But that doesn’t disprove the rates that have been documented in major events such as the Boston Marathon and Hawaii Ironman. What percentage of hyponatremia at the Boston Marathon would Gatorade classify as greater than “not very common?”
Gatorade’s recommendation that athletes only concern themselves with hyponatremia if they’ve had it before is highly irresponsible. It presumes that they’d know it if they’d had it. Unfortunately, most athletes with hyponatremia don’t realize it. Athletes can approach dangerously low blood sodium levels without showing acute symptoms, or without those symptoms being accurately identified.
And Stachenfeld isn’t the only GSSI representative downplaying hyponatremia. This GSSI publication described it as “rare.”
At this time, Gatorade should be urging caution to avoid further deaths. Ignorance is no longer a credible excuse. There is no way that Gatorade is unaware of Cynthia Lucero, Zyrees Oliver, and Walker Wilbanks’ deaths. Gatorade has an ethical responsibility to prevent further loss of life.
Instead, Gatorade’s scientists are telling athletes not to worry about hyponatremia. Their refusal to adapt safe hydration guidelines just further reinforces the need to drive Gatorade from health and fitness science.
“Everyone’s been told to drink water, drink water, drink water. Water companies want you to drink water like a fish. Then you dilute your blood and your brain starts to swell. You have healthy people running marathons and dying. Has the word gotten out? No.”
Watch the full GSSI video here: