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By Lisa Profera MD

It seems logical, yet there’s a lot of confusing advice out there regarding proper hydration and electrolyte replacement when exercising. When I was at a CrossFit Health seminar last summer at CrossFit Headquarters in sunny southern California, the founder of CrossFit, Greg Glassman, put it very simply: Drink when you’re thirsty, don’t drink when you’re not.

Thirst is one of our strongest survival instincts. We can ignore hunger for a period of time, but it’s more difficult to ignore the urge to drink. Our brains tell us to drink when receptors in our bodies sense a relative lack of water (higher osmolarity). When we’re exercising and sweating, we lose water and electrolytes. If we don’t have access to fluids, or if we’re exercising for a long period of time, our kidneys produce a hormone (anti-diuretic hormone) that helps our bodies conserve water (by making less urine) until we’re able to rehydrate. The balancing of fluids and electrolytes in our bodies is a simple, sensitive system; all we have to do is listen to the cues. 

Over the last three decades, the sports drink industry took this concept and ran with it. Prior to 1990, athletes would “recover” by drinking fluids and eating food. Along came Gatorade, who blasted our TVs and magazines with images of sports superstars sweating profusely, drinking their new sports drink — implying that it gave them a competitive edge. Electrolyte drinks became very popular and flooded the market. People started consuming them all the time as a regular beverage, instead of just in the context of exercise. 

The problem with this is that many of these drinks are loaded with sugar, too much salt (when you’re not sweating), artificial flavors and colors, and calories! They aren’t much better for you than soda drinks. It’s no surprise that many sports drinks are produced by companies that are owned by larger soda companies, such as PepsiCo.

Most of the research done on the need for sports drinks is biased or flawed. According to the sports drink industry, athletes are often unaware of how dehydrated they are. They recommend drinking at least 40 oz of fluid every hour of sports participation — that’s five 8-ounce glasses of liquid per hour! This fluid intake guideline disregards body weight or the athlete’s feelings of thirst. 

Overhydration can be very dangerous, even leading to death in some athletes. This condition is known as exercise-associated hyponatremia. Our bodies have reserves of electrolytes it can draw on if needed. Truth be told, in most circumstances — even if we exercise for several hours — our bodies can correct for the loss of water and electrolytes pretty readily just by listening to our own drive for food and drink. There’s a ton of salt added to many of the processed foods we eat, meaning that most of us don’t need more salt that what we already consume. That being said, if you choose to run a marathon in Death Valley during the summer, you may need some help. 

Carl Heneghan and his associates at the University of Oxford’s Centre for Evidence-Based Medicine did an analysis of the published research done in the last several decades. “As it turns out,” he writes, “if you apply evidence-based methods, 40 years of sports drinks research does not seemingly add up to much.”

Humans and animals have managed to stay hydrated for tens of thousands of years (and millions of years, for many organisms). If you take your dog out for a run, do you give him/her some Powerade or water afterwards? No, of course you don’t. According to a consensus statement published by the American College of Sports Medicine (ACSM) in 1996, athletes should be drinking fluids constantly, even when they aren’t thirsty. The ACSM had received financial support from Gatorade, by the way. 

Constant drinking can lead to overhydration, which can have serious health consequences. Hyponatremia, or abnormally low sodium concentration in the blood, can occur when a person drinks too much water. Hyponatremia can cause confusion, seizures, coma, and death. The condition known as psychogenic polydipsia, or psychogenic water drinking, is usually seen in mentally ill patients.

Most people with healthy kidney function and normal blood sugar levels are able to adapt well to water and electrolyte loss. The sports drink industry leads us to believe that the only path to true rehydration and recovery is to drink their products whether we’re thirsty or not. Kelly Anne Hyndman, a leading expert on kidney physiology, writes:


“The problem with this model of hydration is that it overlooks basic physiology. It turns out your body is highly adapted to cope with losing multiple liters of fluid, especially during exercise. When you exercise, you lose fluid and salts through sweat, and that translates into a small change in what’s called your ‘plasma osmolality’ — the concentration of salts and other soluble compounds in your blood. You need enough fluid and electrolytes in your blood for your cells to function properly, and this balance is tightly regulated by a feedback loop.”

I’m not saying that all sports drinks are bad in all situations, but please don’t drink them as a regular beverage when you’re not exercising. Also be mindful of added sugars, artificial ingredients, and other synthetic chemicals in the drinks that you choose. 

There are some decent options on the market. One of my favorites is Superieur, named after one of our Great Lakes (with the French spelling). This company is committed to using all-natural ingredients such as pink Himalayan sea salt and ionic sea minerals from the Great Salt Lake — both rich sources of salts and minerals with a higher pH than plain old table salt.  They extract all their flavorings and colors from natural sources, and they use stevia leaf extract as a natural sweetener. Their drinks also contain Vitamin C from acerola berry extract, as well as bamboo stem extract to provide naturally-derived silica to support the vitality of skin, hair, and nails. At only 10 calories per 10-oz serving and two grams of carbohydrates, it’s a much healthier choice compared to Gatorade (70 calories, 18 grams of carbohydrates per 10 oz). 

Trust the signals your body gives you. By all means, drink and rehydrate when you’re thirsty. Eat regular balanced meals to support your athletic endeavors, and consider natural sources of electrolyte replacement when appropriate.


Lisa Profera MD

Owner and Founder of PROJUVU MD

Aesthetics and Lifestyle Medicine in Ann Arbor, MI

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Please note that the information in this article has been designed to help educate the reader regarding the subject matter covered. This information is provided with the understanding that the author and any other entity referenced here are not liable for the misconception or misuse of the information provided. It is not provided to diagnose, prescribe, or treat any disease, illness, or injured condition of the body. The provider of this information shall have neither liability nor responsibility to any person or entity concerning any loss, damage, or injury caused or alleged to be caused directly or indirectly by this information. The information presented is in no way intended as a substitute for medical counseling or care. Anyone suffering from any disease, illness, or injury should consult a qualified healthcare professional. These statements have not been evaluated by the FDA.

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