"Whenever I go into a restaurant, I order both a chicken and an egg to see which comes first"

Monday, July 23, 2012

Who Needs Gatorade? Not Many Of Us

I am always amazed at the number of people sucking down power drinks at the gym.  These are men and women who haven’t broken a sweat, let alone gone into early stages of dehydration.  Or the number of runners on the C&O Canal who do their workmanlike three miles with a cartridge belt of mini-water bottles strapped around their waists.  Or the Washington young professionals, taking hits of electrolyzed, rehydrating, power-boosting, super-liquids before crossing K Street.  The only time most of us need to rebalance our electrolytes is when we are suffering from acute diarrhea.  The Third World Gatorade – Oral Rehydration Solution (ORS) – has been a lifesaver for millions of adults and children who suffer from frequent bouts of severe illness.  I have been one of those sufferers many times.  No matter how careful I was in my 42 years of travelling in the world’s shitholes, I still got sick.

I particularly remember one time when I ate bad eggs in Tbilisi.  In retrospect eating sunny-side up eggs was a very dumb thing to do.  After all, there was only one hour of electricity in those days, and when it was on people used it to power up the water pump and little more.  Refrigeration was not possible.  But Georgia was Europe after all.  Maybe it was only on the farthest cultural and geographic fringes of Western Civilization, but with all those ancient Christian churches, fancy food, and top-quality wine, it was European enough.  It was a sheer delight to forget all the food- and water-averse habits I had picked up in India, Bangladesh, and Africa, and to just eat without worrying. There was nothing like a fresh tomato or a crispy green salad with fresh peppers and onions straight from the garden in Telavi .and a good glass of Saperavi with them.   

I began to feel sick on the plane to London where I was to connect with a BA flight to Dhaka, but the salmonella in my gut were only massing for the attack which would come soon after my check-in at the Heathrow Hilton.  I squirted rice water every ten minutes, and with the volumes of fluid I was losing, I hoped that the old adage about the human body being made up of 90 percent water was true.  I, however, had forgotten to pack my sachets of Oral Rehydration Solution, indispensable in the Third World, and because of the convenience of the pre-packaged product, I had only a vague idea of the right proportions of water, salt, and sugar necessary to correct the electrolyte imbalance, not fuck it up even more.  Still squirting by morning, I decided to make the trip to Dhaka anyway, and cemented myself with Immodium – never a good idea from a medical point of view because while it stopped diarrhea, it prevented the system from eliminating harmful pathogens and all the waste – stripped intestines, bits and pieces of colon and bowel, the last flecks of Georgian kabob.  Nevertheless, it worked, and although I had this increasing bloated feeling in the 12-hour trip, I was not tripping over seatmates to get to the loo.

The diarrhea abated slightly, but never completely in the first week in Dhaka. I had no appetite and resorted to the diet my mother gave me when I had an upset stomach – soft-boiled eggs, tea, and toast.  I ate this three meals a day.  The irony of all this was that I was sick with diarrhea in Bangladesh from bacteria I had, for the very first time ever, not gotten in that country.  My office prepared a cheap Bangladeshi hot lunch every day – three vegetables, curry, and kilos of rice– and my colleagues wondered why I wasn’t eating it. 

“Is this what Americans eat?”, asked one, referring to my mother’s diet.  No, I explained, only when we are sick.  This of course struck Mr. Ahmed as patently ridiculous.  Everyone knew that eggs were a ‘cold’ food and were the worst things to eat when sick, especially with diarrhea.

“I’ll soon be eating your curry and rice”, I said even though the thought of chopped up fish heads in a greasy sauce made my bowels rumble.

The point of all this is that ORS – Gatorade, basically, is a very good and important product in the developing world, and it has saved millions of lives since it went on the market about 20 years ago.  It is not at all necessary for the 99 percent of us who do not get sick from McDonalds or are not competitive athletes.  We simply do not lose enough fluid to mess up the chemical balance of our bodies to require any form of ORS.  Simple water will do.

In an article in The Atlantic http://www.theatlantic.com/health/archive/2012/07/the-controversial-science-of-sports-drinks/260124/ Lindsay Abrams summarizes recent findings on power drinks reported in the prestigious British Medical Journal (BMJ) which concluded that there was scant evidence for the claims made by drink manufacturers, and that the increased popularity of Gatorade and its clones was due to their intensive and misleading advertising:

Cohen (author of the BMJ article) claims that one of the greatest accomplishments of the Gatorade Sports Science Institute, established in 1985, was to convince the public that thirst is an unreliable indicator of dehydration. There is ample evidence of ways in which the experts who propagated this information were funded or "supported" by sports drinks companies, and while this in itself isn't necessarily wrong, she argues that researchers who have conflicts of interest are not objective enough to be writing guidelines, as is the case here. There is no good evidence to support the ideas, for example, that "Without realizing, you may not be drinking enough to restore your fluid balance after working out" (Powerade), or that urine color is a reliable indicator of the body's hydration levels.

Moreover, as I have suggested above, few of us need these drinks at all:

The European Food Safety Authority upheld the claims that sports drinks hydrate better than water and help maintain performance during endurance exercise -- but added that this did not apply to the ordinary, light exerciser. Says Tim Noakes, Discovery health chair of exercise and sports science at Cape Town University, "They are never going to study a person who trains for two hours per week, who walks most of the marathon -- which form the majority of users of sports drinks," and the majority of people at whom sports drinks marketing is aimed.

Perhaps most damning – but entirely logical from a marketing point of view – is the fact that the power drink companies are pushing their products on children who if anything drink too much:

Both GSK (Glaxo Smith Kline) and Gatorade have developed school outreach programs that further the case for sports drink consumption during exercise. Though the Institute of Medicine says that, in children, "Thirst and consumption of beverages at meals are adequate to maintain hydration," studies either directly funded by or involving authors with financial ties to Gatorade make a major case for the need to promote hydration, claiming, for example, that "children are particularly likely to forget to drink unless reminded to do so."

Not only that:

And, of course, there is the suggestion that sports drink consumption among children is contributing to growing obesity levels. Their association with hydration and athletics means they're not thought of as being unhealthy in the way that other sugary drinks, like soda, are (note that Mayor Bloomberg included sports drinks in his super-size ban). Several studies highlight consumer beliefs that sports drinks are healthy, even essential, showing just how far marketers have been able to push exercise science in the support of sports drinks.

Once again this is American enterprise at its best – creating a product that no one needs, developing an advertising campaign which suggests that they do, and cashing in on the physical fitness craze which has hit much of the country.  The guy at the gym or cycling on the canal in tattered Keds and cutoffs is so yesterday.  Not only should you exercise but you should work out with the proper accoutrements – multi-colored Spandex body suit and aerodynamic helmet for riding and a bottle of cold, refreshing Gatorade to replenish your stores.

I used to joke to my young friends who always carried a bottle of water with them from meeting to meeting at the office that they were doing great damage to their kidneys by drinking so much water.  “Imagine how hard they have to work”, I said.  “They weren’t built for this kind of abuse”.

I was wrong, they said.  The water was absolutely necessary to remove the toxins that built up in the system, especially in this polluted, globally-warmed world where bits and pieces of PCBs, polymers, particulate matter, and abraded asphalt, paint, and rubber were ingested every day. 

In fact drinking too much water is a problem:

The journal recounts that hyponotraemia -- a drop in one's serum sodium levels -- has a bad track record of causing illness and death in marathon runners, and that we know that drinking too much water can cause hyponatremia.

Somehow the makers of power drinks have conflated the two issues – not enough fluid with too much fluid. Drink our power drinks, they say, and achieve the proper balance.  However:

But [the BMJ article] then makes the point that sports drinks do not preclude hyponatremia and that there was an article in The New England Journal of Medicine that found no correlation between hyponatremia and the type of fluid consumed.

The conclusion?  Most of us do not need ORS (Gatorade) but have been convinced of their absolute necessity by savvy marketers.  Not only will these drinks replenish our vital bodily fluids, but we will look cool drinking these emblems of fitness.  We have been had.

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