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Sodium supplementation is not required to maintain serum sodium concentrations during an Ironman triathlon
  1. T D Hew-Butler,
  2. K Sharwood,
  3. M Collins,
  4. D Speedy,
  5. T Noakes
  1. University of Cape Town, Cape Town, South Africa
  1. Correspondence to:
 Dr Hew-Butler
 University of Cape Town, PO Box 115, Newlands, Cape Town, South Africa; thew{at}


Context: Critical assessment of recommendations that athletes consume additional sodium during athletic events.

Objective: To evaluate if sodium supplementation is necessary to maintain serum sodium concentrations during prolonged endurance activity and prevent the development of hyponatraemia.

Design: Prospective randomised trial of athletes receiving sodium (620 mg table salt), placebo (596 mg starch), or no supplementation during a triathlon. The sodium and placebo tablets were taken ad libitum, with the suggested range of 1–4 per hour.

Setting: The 2001 Cape Town Ironman triathlon (3.8 km swim, 180 km cycle, 42.2 km run).

Subjects: A total of 413 triathletes completing the Ironman race.

Main outcome measures: Sodium supplementation was not necessary to maintain serum sodium concentrations in athletes completing an Ironman triathlon nor required to prevent hyponatraemia from occurring in athletes who did not ingest supplemental sodium during the race.

Results: Subjects in the sodium supplementation group ingested an additional 3.6 (2.0) g (156 (88) mmol) sodium during the race (all values are mean (SD)). There were no significant differences between the sodium, placebo, and no supplementation groups with regard to age, finishing time, serum sodium concentration before and after the race, weight before the race, weight change during the race, and rectal temperature, systolic and diastolic blood pressure after the race. The sodium supplementation group consumed 14.7 (8.3) tablets, and the placebo group took 15.8 (10.1) tablets (p  =  0.55; NS).

Conclusions: Ad libitum sodium supplementation was not necessary to preserve serum sodium concentrations in athletes competing for about 12 hours in an Ironman triathlon. The Institute of Medicine’s recommended daily adequate intake of sodium (1.5 g/65 mmol) seems sufficient for a healthy person without further need to supplement during athletic activity.

  • sodium supplementation
  • exercise
  • hyponatraemia
  • Ironman triathlon

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  • Competing interests: none declared