@gulpNOW www.giveuplovingpop.org.uk

@gulpNOW www.giveuplovingpop.org.uk

Executive Summary 3 Introduction 4 - 5 Emergence of the Industry 5 - 6 Convergence of the Sports Drink Industry 6 - 7 Types of Sports Drinks 7 - 8 Performance Enhancement 9 Water 9 - 10 10 - 11 Electrolytes 11 - 12 Critique of the Sports Drink Industry 13 - 15 The Thirst Fallacy 16 - 17 Urine Colour 17 Recommendations 18 - 21 References 22 Appendices 23 2 Sports drinks are a relatively recent phenomenon, yet anatomically modern humans have been running around for some 200,000 years. So why do we need them? The producers of sports drinks are keen to emphasise that their products provide hydration before, during and after physical activity—and may even be better than water—but the evidence is tenuous. Many issues have been raised with how and why the sports drink industry conducts its research. Experts have concluded that for the general public, water and a balanced diet is all that is required to facilitate regular exercise.

Michael Viggars 3 @gulpNOW www.giveuplovingpop.org.uk

Introduction peaking at 165 million litres sold in 2011, falling to 150 Sports drinks are a particular million litres in 2013—a type of that are decrease of just over 9%. This usually rich in may be attributed to the (in the form of sugar), aggressive marketing minerals, electrolytes and strategies of energy drinks flavourings and are purported targeting the same consumer to optimise hydration before, group as the sports drink during and / or after physical industry. activity and improve athletic performance. They are not to be confused with energy drinks such as Red Bull and Monster, which contain high concentration of designed to increase alertness and fend off drowsiness. In contrast to energy drinks, sales of sports drinks appear to be in decline in the UK,

4 @gulpNOW www.giveuplovingpop.org.uk

Emergence of the Sports approach—as the team’s loss Drink Industry of fluids through sweating led to dehydration, salt depletion In 1965, Dr. Robert Cade, and in some cases heatstroke. assistant professor in the renal division of the College of Medicine at the University of Florida, was contacted by Dewayne Douglas, assistant coach of the Florida Gators Freshman football team, after 25 American football players had been admitted to the hospital infirmary the They found that adding previous weekend due to to a salt-water heat exhaustion and solution increased the rate at dehydration. which both sodium and water Douglas needed something to were absorbed by the small “negative the strain that the intestine. Naturally, they brutal summer heat had concluded that a drink inflicted upon his players”. containing glucose and Cade supposedly knew that sodium would be valuable to replacing fluids would be a athletes requiring instant true advantage for the rehydration. team—hardly a scientific The physiological hunch that

5 @gulpNOW www.giveuplovingpop.org.uk their prototype, lemon- Whilst appears to tinged, glucose-salt solution have been created with would benefits the Gators honest intentions, a quickly paid off. The drink was given developing market saw to players in a game versus several competitors enter due the heavily favoured to the commercial potential. Louisiana State, ranked fifth Gatorade currently dominates in the country. The University the North American sports of Florida Gators came from drink market, holding a 77.2% behind to win 14-7. Gatorade share to ’s 21.7% was born. [2], a share they undoubtedly Convergence of the wish to maintain. Sports Drink Industry When considering the UK market, energy drinks such as In an interview in 2005, Dr. Red Bull are often considered Robert Cade said: a type of sports drinks, and “I never thought about the frequently claim to benefit commercial market. The the consumer in similar ways. financial success of this stuff To learn more about energy really surprised us. I am drinks, please see our energy proud that Gatorade was drinks briefing. based on research into what Contrary to Dr. Cade’s the body loses in exercise. statement, the most common The other sports drinks were UK sports drink— created by marketing Sport—began life as companies.” [1] 6 @gulpNOW www.giveuplovingpop.org.uk

Glucozade and was designed from “Lucozade aids in 1927 by William Owen, a recovery” to “Lucozade Newcastle chemist, as a replaces lost energy” taking source of energy for people on a broader meaning and suffering from illnesses such opening up new markets. as the common cold and Types of Sports Drink influenza. There are three main Following a major rebrand in classifications of sports drinks the 1980s, brought on in part containing various by the commercial success of concentrations of fluid, Gatorade across the pond, electrolyte and . Lucozade shook off the The rationale is that different ‘hospital champagne’ label athletes competing in and began targeting young different sports have different people rather than ‘stay-at- energy requirements before, home mothers’, tripling their during and after exercise; and sales to £75 million in the sports drinks can be tailored process. Their slogan changed to match exact specifications.

7 @gulpNOW www.giveuplovingpop.org.uk

8 @gulpNOW www.giveuplovingpop.org.uk Performance body temperature through Enhancement sweating. As sweat evaporates, heat is released. Sports drinks were initially This can also impact the conceived to be an aid to relative solute athletic performance and concentrations. therefore it is necessary to Sweat production as a understand their constituents consequence of physical and what they may offer activity can amount to 1—2 during exercise. litres per hour (L/hr), Water depending on exercise Water is abundant in the intensity and duration, body, making up 60% of our clothing, air movement and body mass, and serves many humidity [3]. Unless body vital functions, such as water is replaced at transportation of nutrients appropriate and oxygen and removal of waste products, lubrication of joints and serves as a medium for chemical reactions in the body. During exercise, heat is produced during the process of converting chemical energy into mechanical energy; therefore to prevent us overheating, we regulate our 9 @gulpNOW www.giveuplovingpop.org.uk appropriate times and in energy sources are suitable appropriate amounts we may for different types of exercise. become dehydrated. Even At low to moderate intensity mild dehydration (about 2% exercise the body has enough loss of body weight) can time to break down fatty result in headaches, fatigue acids to produce energy. In a and reduced physical and very lean individual there is mental performance [4]. enough adipose tissue and Sugar muscle triglycerides () to The human body can derive sustain exercise for several energy from a number of hours. However, as physical different sources including exertion and energy demand carbohydrates, fats and increases the body switches . The rate at which to carbohydrate as the energy can be produced from primary energy source as it these macronutrients varies, can be metabolised much and therefore different more quickly—although

10 @gulpNOW www.giveuplovingpop.org.uk availability of carbohydrate is Electrolytes much lower and cannot be Before we can move, our sustained for extended brain has to send a signal via periods of time. our nervous system to a The fact that carbohydrate muscle or a group of muscles can be broken down to asking it to contract; the produce energy so quickly muscle(s), which are attached provides the rationale for to bones by tendons, then their presence in sports become shorter, pulling on drinks. Ultimately, glucose is the bone which produces the major useable source of movement. Critically, the carbohydrate energy and can stimulus from the brain must be metabolised anywhere in be sufficient to generate an the body and that is why it is impulse causing contraction found in such vast quantities of the muscle. in sports drinks.

11 @gulpNOW www.giveuplovingpop.org.uk Without sufficient levels of and potassium concentrations sodium and potassium our and increase blood flow to muscles cannot contract this area, providing more of efficiently. When we sweat, these electrolytes [5] - sodium and potassium are negating the need for sports released giving sweat its salty drinks at this intensity. taste. Energy drinks contain from the electrolytes which include brain sodium and potassium, and occasionally calcium and chloride, all intended to prevent muscle fatigue. However, sodium is secreted by the pancreas into the large intestine (where water is Impulse absorbed) and does not necessarily need to be supplemented. Cairns & Lindinger suggested that with moderate intensity exercise, the combined shifts of sodium and potassium would be insufficient to cause to the fatigue. In fact, the body can muscles Neurons transmit signals from our brains to detect falling levels of sodium our muscles, asking them to help us move. Electrolytes are needed to pass the message down the neuron. 12 @gulpNOW www.giveuplovingpop.org.uk

Ultimately, sports drinks are a variety of soft drink andthe harmful effects of consumption of sugar-sweetened beverages are well documented (see our ‘Facts on Sugar’ briefing). However, sports drinks are alleged to perform a specific function—that is to hydrate an individual before, during and / or after exercise and improve athletic performance.

Several issues have arisen regarding the research methodologies used to support the claims made by sports drinks companies as well as the claims themselves bending the truth and misleading customers.

13 @gulpNOW www.giveuplovingpop.org.uk claims to hydrate athletes, replenish electrolytes and provide fuel for working muscles [6]. Noakes suggests it is more accurate to state that, “Gatorade is the sports drink whose effects on the human body during exercise Interestingly, despite have been the most Lucozade’s rebranding thoroughly studied”. exercise in the 1980s, the A systematic assessment of constituent parts of Lucozade the evidence underpinning Sport have remained largely sports performance products the same and not too conducted by Heneghan and dissimilar to Gatorade and colleagues (2012) asked Powerade. In fact, manufacturers to supply disregarding flavourings, details of the studies Gatorade has changed very supporting their product little in the 50 years since its claims [7]. Only inception. GlaxoSmithKline (then owner According to their marketing of Lucozade) complied and department, Gatorade is the supplied data gathered from world’s most successful, most 1971 to 2012. Of the 176 iconic and most scientifically studies supplied, only 106 researched sports drink and could be critically reviewed.

14 @gulpNOW www.giveuplovingpop.org.uk

15 @gulpNOW www.giveuplovingpop.org.uk The Thirst Fallacy stimulating thirst or to excrete water as urine. There is a common misconception that thirst is Dion et al. (2013) found that not a good indicator of long-distance running hydration, a fallacy that has performance was not leant itself well to the improved by fluid intake marketing of sports drinks. above that directed by thirst Gatorade once said, “Your sensation. Extensive research brain may know a lot, but it has been conducted on the doesn’t know when your dangers of overhydration, body is thirsty” [8] - leaving leading to a condition called us all to wonder if the brain hyponatraemia (low can’t figure out when we concentrations of sodium in need a drink, what can? the blood) which can be fatal [9]. The body needs to maintain a balance between the amount A recent systematic review by of water it has and Goulet (2011) of the effects concentrations of dissolved of exercise induced materials—which includes dehydration (EID) on proteins, fats, hormones and performance in long cycling electrolytes. Even small time trials suggested that changes will trigger a relying on thirst sensation to response; either to increase gauge the need for fluid body water content by replacement proves more reducing urinary output and successful than drinking more

16 @gulpNOW www.giveuplovingpop.org.uk or less frequently [10]. Urine Colour Urine colour is sometimes and colleagues found that no proposed as a simple way to study has directly investigated assess hydration status, with the correlation between urine darker urine representing colour and performance or dehydration and lighter urine the correlation between urine characterising good hydration colour and thirst. status. Many sports drink Urine colour should not be manufacturers, including considered as the sole Lucozade, provide a colour determinant of hydration chart to estimate your status. The combination of current hydration status (see thirst, in addition to darker appendix 1). coloured urine, provides a However, an examination of reasonable indication of the evidence by Heneghan dehydration.

17 @gulpNOW www.giveuplovingpop.org.uk Recommendations include bottled water, tap water, beverages and the Before considering evidence- moisture contents of foods. based recommendations it is Fruit and vegetables contain important to remember that between 80-95% water; fish sports drinks are a relatively (~75%), meats (~55%) and recent phenomenon—yet cheeses (45%). anatomically modern humans have been running around for some 200,000 years. So do we really need them for their purported benefits? Hydration Sedentary men are advised to consume approximately 2.5 litres of water per day, rising to 3.5 litres if they are moderately active. Data on the amount of water women should drink is lacking but due to their lower body mass, it is suggested that they should consume 0.5-1 litre less than men [3]. Water is consumed from different sources, which 18 @gulpNOW www.giveuplovingpop.org.uk However, there is so much and moderate physical variation in our shapes and activity levels. Water losses sizes and the types of activity incurred under extreme that we may or may not take conditions of external part in making it very difficult temperature and physical to suggest a ‘one size fits all’ exercise, which can be up to amount. Drinking in response 8000ml/day have to be to our thirst mechanism is the replaced with appropriate best way to maintain amounts. In such instances hydration. concomitant losses of These values apply only to electrolytes have to be conditions of moderate replaced adequately to avoid environmental temperature hypo-osmolar disturbances.

Reference Intake (RI) of water ml/day Children Male Female 6—12 months 800—1000 13—24 months 1100—1200 2—3 years 1300 4—8 years 1600 9—13 years 2100 1900 14+ years 2500 2000 Pregnant women should consume an extra 300mL/day Lactating women should consume an extra 700mL/day 19 @gulpNOW www.giveuplovingpop.org.uk rather than existing On a physiological level, after energy stores. Low to consuming a high- moderate intensity physical carbohydrate sports drink activity is recommended for blood glucose levels rise, those wanting to lose weight levels are elevated and or for individuals starting a fatty acid availability is programme of exercise after reduced [11]. For sedentary an extended period of individuals who do not have a physical inactivity and should high demand for energy, the be accompanied by water. spike in blood sugar levels Recovery causes a cascade of reactions It is important to provide the eventually resulting in the body with the right nutrients conversion of glucose into to refuel and recover after fats. Long-term consumption exercise. If we don’t, our in inactive individuals can muscles may ache for cause weight gain and lead to extended periods and we may obesity, type 2 and feel lethargic and lack cardiovascular disease. motivation. For individuals wanting to is essential for proper lose weight, drinking sports recovery, immune function drinks may lead to extra and the growth and hours in the gym as the body maintenance of lean body is being fuelled by the mass. In sedentary carbohydrate present in the individuals, 0.8—1.0g per kg

20 @gulpNOW www.giveuplovingpop.org.uk bodyweight per day is Milk has been put forward as sufficient but in exercising a healthy post-exercise drink, individuals more is required. providing protein, vitamins Those in endurance exercise and mineral and also need 1.2—1.4g per kg hydration. A 200ml glass of bodyweight and strength semi-skimmed milk contains athletes may need up to 2.0g as much calcium as 63 brussel per kg bodyweight per day in sprouts, which contributes to order to see noticeable the growth and maintenance improvements in the short of teeth and bones and term. Ideally protein should normal muscle and nerve be ingested within 1—2 hours function [14]. after exercise to maximise the benefits [13].

21 @gulpNOW www.giveuplovingpop.org.uk

1. Transcript of interview with Dr. Robert Cade (Accessed 01/09/2015 from: http:// www.huffingtonpost.com/huff-wires/20071127/obit-cade/) 2. Pepsi suing Coca- over Powerade Ads (accessed 01/09/2015 from: http:// www.huffingtonpost.com/2009/04/14/pepsi-suing-cocacola_n_186709.html) 3. EFSA. (2010). Scientific Opinion on Dietary Reference Values for Water. 4. SACN. (2015). Carbohydrates and Health. 5. Cairns, S. P., & Lindinger, M. I. (2008). Do multiple ionic interactions contribute to skeletal muscle fatigue? Journal of Physiology, 4039-4054. 6. Noakes, T. (2012). Waterlogged: The Serious Problem of Overhydration in Endurance Sports. 7. Heneghan, C., et al. (2012). The evidence underpinning sports performance products: a systematic assessment. BMJ Open, 2. 8. Heneghan, C., et al. (2012). Mythbusting sports and exercise products. (Accessed 01.09/2015 from: http://www.bmj.com/content/345/bmj.e4848) 9. Dion et al. (2013). Half-marathon running performance is not improved by a rate of fluid intake above that dictated by thirst sensation in trained distance runners. European Journal of Applied Physiology. 10. Goulet, E. D. B. (2011). Effect of exercise-induced dehydration on time0trial exercise performance: a meta-analysis. British Journal of Sports Medicine, 45 (14), 1149-1156. 11. Horowitz, J. F., et al. (1997). Lipolytic suppression following carbohydrate ingestion limits oxidation during exercise. American Journal of Physiology, 273, 768-775. 12. Benelam, B., & Wyness, L. (2010). Hydration and health: a review. Nutrition Bulletin, 36, 3- 25. 13. BDA. (2014). Food Fact Sheet-Sport. 14. The Dairy Council. (2015). Milk Factsheet.

22 @gulpNOW www.giveuplovingpop.org.uk Appendix 1

This urine chart provides an estimate of your hydration status only. This site is not a substitute for professional advice and does not provide and medical services. You should always promptly seek professional care if you have any concerns about your health. Well Hydrated Well-hydrated—you’re on the right track Your pee is lighter in colour and not too dark, you’re in the target zone. Fluids can be sipped little and often according to your individual needs, but do not over-drinks. Continue to monitor pee colour. Dehydrated Dehydrated—Your pee is deeper / darker in colour, you’re in the dehydration zone. Dehydration of > 2% body mass can affect your physical performance. Top up your fluids by sipping little and often and continue to monitor your pee colour over the next 4-7 hours. Consume a hypotonic of isotonic sports drink which contains sodium to help aid fluid absorption. Aim to move back into the ‘Target Zone’. Severely Dehydrated Severe dehydration—Urine is dark, brown and concentrated. Severe dehydration may limit your body’s ability to function normally. Exercising under these conditions will affect your motivation and performance, especially during warm/ hot condition. This could have a negative impact on your health. Slowly rehydrate by consuming a hypotonic or isotonic sports drink which contains sodium to help aid fluid absorption. Avoid consuming large volumes of fluid in one go, instead sip little and often. If water is consumed, it is best accompanied by a salty snack or main meal. Aim to slowly restore pee colour to the ‘Target Zone’. Accessed from: https://www.lucozadesport.com/products/pee-chart/ 23 @gulpNOW www.giveuplovingpop.org.uk

Health Equalities Group To reference this document 2nd Floor, 151 Dale Street please cite: Liverpool Give Up Loving Pop (2015). Sports Drinks. L2 2JH

T: 0151 237 2686 W: www.hegroup.org.uk Tw: @healthequalgrp

Copyright © 2015 by Health Equalities Group. All rights reserved. All photographs selected were labelled for reuse through the Google search engine at time of publication.

24 25