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Fractured fairy tales: hyponatraemia and the American College of Sports Medicine fluid recommendations
  1. William O Roberts
  1. Department of Family Practice, School of Medicine, University of Minnesota, UMN Phalen Village Clinic, 1414 Maryland Avenue East St Paul, MN 55106, USA;

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    Noakes and Speedy,1 in the article “Case proven: exercise associated hyponatremia is due to overdrinking,” deliver a shot at the 1996 American College of Sports Medicine (ACSM) exercise and fluid replacement position stand2 that is off the mark. Much as the popular 1960s’ television cartoon series Rocky and Bullwinkle Show presented Aesop’s fables in “Fractured fairy tales” a key element of the story is missing. The ACSM position stand recommends that athletes should “consume the maximal amount of fluids during exercise that can be tolerated without gastrointestinal discomfort “up to a rate equal to that lost from sweating”, not “drink as much as you can,” as stated in the text of “Case proven.” The recommendation is briefly summarised in the abstract of the position stand, which creates a possibility for misunderstanding or misquoting if one reads only the abstract and not the position stand itself. Reading the entire document is required to avoid a “fractured” message. Attributing “drink as much as you can” to the 1996 ACSM exercise and fluid replacement position stand is a recurring theme in the works of a few authors, but the problem is simply misapplication of the ACSM advice. …

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    • Competing interests: I have no financial or advisory ties to any water or sports drink companies. I did receive an honorarium from the Gatorade company for appearing on an educational film clip regarding exertional heat stroke in 2003.