Hydration 4 of 4: What’s Next?

Dr. Tim Noakes is a well-renowned scientist notorious for his publications on hydration in endurance sports. He is THE reference of choice in hyponatremia. Several runners know him from being the author of running masterpiece “Lore of Running.” We conclude our series of posts on “Waterlogged, The Serious Problem of Overhydration in Endurance Sports” with the fourth and last publication on this subject.



Be careful to make accurate diagnoses so that the treatment plan can be optimally effective rather than inappropriate.


  • Diagnoses of heat stoke must be done only if you have: clear alteration of mental function (confusion or loss of consciousness) AND body temperature (rectal) >41˚C AND a positive response over giving treatment of active whole body cooling. (p.333)
  • The most effective way to cool patients with heatstroke is to place them in ice-cold water for 20 to 30 minutes (p.243)
  • Symptoms of exercise-associated hyponatremia are typically (appear usually in this order): impaired exercise performance, nausea and vomiting, headache, altered level of consciousness, seizure (convulsions). (p.348)
  • The most common cause of post race collapse in athletes is Exercise-Associated Postural Hypotension (EAPH) (p.53)
  • Dehydration or sodium deficit do not cause EAPH (p.132)
  • The simple treatment for EAPH is to elevate the base of the bed where the patient's feet are laid. (p.53)


Finally, although slower runners spend less energy, sweat less and have a lower body temperature, they are still recommended to drink more, have more opportunities to drink during competitions and, thus, actually drink more, which is sometimes too much.


BE WARY! This was the fourth and last of our series on hydration in endurance sports, which allowed us to unveil conclusions that might have shaken your deepest foundations. Remember that confrontation is often the path toward evolution! Get out there and purchase Tim Noakes’ “Waterlogged, The Serious Problem of Overhydration in Endurance Sports”. It still holds many more secrets to be revealed, so enjoy!