Noakes T D
UCT/MRC Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.
J Sports Sci. 2007 May;25(7):781-96. doi: 10.1080/02640410600875036.
The most recent (1996) drinking guidelines of the American College of Sports Medicine (ACSM) propose that athletes should drink "as much as tolerable" during exercise. Since some individuals can tolerate rates of free water ingestion that exceed their rates of free water loss during exercise, this advice has caused some to overdrink leading to water retention, weight gain and, in a few, death from exercise-associated hyponatraemic encephalopathy. The new drinking guidelines of the International Olympic Committee (IOC), recently re-published in this Journal, continue to argue that athletes must drink enough to replace all their weight lost during exercise and to ingest sodium chloride since sodium is "the electrolyte most critical to performance and health". In this rebuttal to that Consensus Document, I argue that these new guidelines, like their predecessors, lack an adequate, scientifically proven evidence base. Nor have they been properly evaluated in appropriately controlled, randomized, prospective clinical trials. In particular, these new guidelines provide erroneous recommendations on five topics. If novel universal guidelines for fluid ingestion during exercise are to be promulgated by important international bodies including the IOC, they should first be properly evaluated in appropriately controlled, randomized, prospective clinical trials conducted under environmental and other conditions that match those found in "out-of-doors" exercise. This, and the potential influence of commercial interests on scientific independence and objectivity, are the two most important lessons to be learned from the premature adoption of those 1996 ACSM drinking guidelines that are not evidence-based. These concerns need to be addressed before the novel IOC guidelines are accepted uncritically. Otherwise the predictable consequences of the premature adoption of the 1996 ACSM guidelines will be repeated.
美国运动医学学院（ACSM）最新（1996年）的饮水指南建议运动员在运动期间应“尽可能多地饮水”。由于一些人能够耐受的自由水摄入速率超过了他们在运动期间的自由水流失速率，这一建议导致一些人饮水过量，进而引发水潴留、体重增加，少数人甚至死于运动相关性低钠血症性脑病。国际奥委会（IOC）新的饮水指南最近在本期刊重新发表，该指南继续主张运动员必须饮用足够的水以补充运动期间所流失的全部体重，并且要摄入氯化钠，因为钠是“对运动表现和健康最为关键的电解质”。在对该共识文件的反驳中，我认为这些新指南与其前身一样缺乏充分的、经科学验证的证据基础。它们也未在适当对照、随机、前瞻性临床试验中得到恰当评估。特别是，这些新指南在五个主题上给出了错误建议。如果包括国际奥委会在内的重要国际机构要颁布关于运动期间液体摄入的全新通用指南，那么首先应在与“户外”运动相匹配的环境及其他条件下进行的适当对照、随机、前瞻性临床试验中对其进行恰当评估。这一点以及商业利益对科学独立性和客观性的潜在影响，是从过早采用那些缺乏证据的1996年ACSM饮水指南中应吸取的两个最重要教训。在不加批判地接受国际奥委会新指南之前，需要解决这些问题。否则，过早采用1996年ACSM指南的可预见后果将会重演。
