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Fluid Replacement in Sports Heseker H Position Stand Mosler S 1, Braun H 2, Carlsohn A3, Großhauser M 4, König D 5, Lampen A6, Nieß A7, Oberritter H 8, Schäbethal K 8, Schek A9, Stehle P 10, Virmani K 8, Ziegenhagen R 6, Heseker H 11 ACCEPTED: August 2020 PUBLISHED ONLINE: September 2020 Position of the Working Group Sports Nutrition DOI: 10.5960/dzsm.2020.453 Mosler S, Braun H, Carlsohn A, of the German Nutrition Society (DGE): Großhauser M, König D, Lampen A, Nieß A, Oberritter H, Schäbethal K, Schek A, Stehle P, Virmani K, Ziegenhagen R, Fluid Replacement in Sports Heseker H. Position of the working group sports nutrition of the German Nutrition Position der Arbeitsgruppe Sporternährung der Deutschen Gesellschaft Society (DGE): fluid replacement in sports. Dtsch Z Sportmed. 2020; 71: 178-184. für Ernährung (DGE): Flüssigkeitsmanagement im Sport 1. OLYMPIASTÜTZPUNKT STUTTGART, Summary Zusammenfassung Germany › This position paper represents the current scientific recom- › Dieses Positionspapier stellt die aktuellen wissenschaftli- 2. DEUTSCHE SPORTHOCHSCHULE KÖLN, Institut für Biochemie; Deutsches mendations for fluid management in sports. Sporting activities chen Empfehlungen zum Flüssigkeitsmanagement im Sport dar. Forschungszentrum für should always be commenced with a balanced fluid level (appa- Sportliche Aktivitäten sollten stets mit ausgeglichenem Flüssig- Leistungssport, Köln, Germany rent by urine color, which is light yellow in the case of balanced keitshaushalt begonnen werden. Zur Orientierung kann hier die 3. HOCHSCHULE FÜR ANGEWANDTE fluid level). Farbe des Urins, welcher bei ausgeglichener Flüssigkeitsbilanz WISSENSCHAFTEN HAMBURG, Fakultät Life Sciences/Department › The loss of fluidsduring exercise depends on numerous fac- hellgelb ist, herangezogen werden. Ökotrophologie, Hamburg, Germany tors such as the state of exercise, the intensity, duration, type › Der Flüssigkeitsverlust während der Belastung hängt von 4. OLYMPIASTÜTZPUNKT RHEINLAND-PFALZ/ of exercise and environmental factors. The weighing method to zahlreichen Faktoren wie dem Trainingszustand, der Trainings- SAARLAND, Germany determine individual fluid loss offers guidance for the optimal intensität, -dauer, Art der Belastung sowie Umweltfaktoren ab. 5. ALBERT-LUDWIGS-UNIVERSITÄT fluid intake during exercise. In principle however, athletes should Die Wiegemethode zur Bestimmung des individuellen Flüssig- FREIBURG, Institut für Sport und trust their own feeling of thirst. keitsverlusts gibt eine Orientierung zur optimalen Trinkmenge Sportwissenschaft, Arbeitsbereich Ernährung, Freiburg, Germany › Generally in the case of activities lasting less than 30-40 während der Belastung. Prinzipiell sollten Sportler aber auf ihr 6. BUNDESINSTITUT FÜR RISIKOBEWERTUNG minutes, fluid intake is not necessary, minor fluid deficits during Durstgefühl vertrauen, um sowohl eine Dehydratation als auch (BfR), Berlin, Germany exercise are tolerable. In the case of longer-lasting activity (>1.5 das Risiko einer Hyponatriämie aufgrund zu hoher Flüssigkeits- 7. UNIVERSITÄTSKLINIKUM TÜBINGEN, hours) it is advisable to take in beverages rich in carbohydrates zufuhr unter Belastung zu vermeiden. Abteilung Sportmedizin, Tübingen, and sodium. Therefore, the optimal sports drink should contain › Allgemein ist bei Belastungen unter 30-40 Minuten keine Germany 400-1100 mg / l sodium in addition to carbohydrates (4-8%). Flüssigkeitszufuhr notwendig, geringe Flüssigkeitsdefizite sind 8. DEUTSCHE GESELLSCHAFT FÜR After sport, fluids and electrolytes must be replaced. If there is während der Belastung tolerierbar. Bei längeren Aktivitäten ERNÄHRUNG E. V. (DGE), Germany no renewed physical activity in the next 24 hours and the body (>1,5 Stunden) ist die gleichzeitige Zufuhr kohlenhydrat- und 9. REDAKTION LEISTUNGSSPORT (DOSB), weight is reduced by less than 5%, consumption of normal meals natriumhaltiger Getränke empfehlenswert. Ein Sportgetränk Germany and snacks in combination with an adequate supply of water is sollte daher neben Kohlenhydraten (4-8%) auch 400-1100 mg/l 10. RHEINISCHE FRIEDRICH- WILHELMS-UNIVERSITÄT BONN, sufficient to restore fluid and electrolyte balance. Natrium enthalten. Nach dem Sport müssen der Flüssigkeits- Institut für Ernährungs- und › For quick and complete rehydration, approximately 1.5 l of und Elektrolythaushalt wieder ausgeglichen werden. Steht in Lebensmittelwissenschaften, fluid per kg weight loss is recommended. den nächsten 24 Stunden keine erneute Belastung an und ist Ernährungsphysiologie, Bonn, Germany das Körpergewicht um weniger als 5% reduziert, ist der Verzehr von normalen Mahlzeiten und Snacks in Kombination mit ei- 11. UNIVERSITÄT PADERBORN, Institut für Ernährung, Konsum und Gesundheit, ner ausreichenden Zufuhr an Wasser zur Wiederherstellung des Paderborn, Germany Flüssigkeits- und Elektrolythaushalts ausreichend. › Für eine schnelle und vollständige Rehydratation werden etwa 1,5 l Flüssigkeit pro kg Gewichtsverlust empfohlen. KEY WORDS: SCHLÜSSELWÖRTER: Article incorporates the Creative Commons Sports Drink, Fluid Intake, Sportgetränk, Flüssigkeitszufuhr, Attribution – Non Commercial License. Fluid Balance, Electrolyte Balance Flüssigkeitsbilanz, Elektrolytbilanz https://creativecommons.org/licenses/by-nc-sa/4.0/ Scan QR Code and read Introduction article online. CORRESPONDING ADDRESS: Adequate hydration is an important precondition for hyponatremia (“water intoxication”), which in extre- Dr. Stephanie Mosler the health and performance of athletes. The quanti- me cases has already led to deaths of recreational ath- Olympiastützpunkt Stuttgart ty and type of fluid intake before, during, and after letes (triathletes and marathon runners) (1, 14, 27). Mercedesstraße 83 exercise affect an athlete’s performance. Both inade- This highlights the particular importance of fluid 70372 Stuttgart, Germany quate and excessive fluid intake has a negative effect intake in sports. : [email protected] or represents a health risk. In the past athletes have Since water and electrolyte levels are closely frequently been guided by the principle “drink before connected, the composition of drinks also plays a the thirst hits”. However this can increase the risk of role in water absorption. In the following article the 178 GERMAN JOURNAL OF SPORTS MEDICINE 71 7-8-9/2020 Positionspapier: Flüssigkeitsmanagement im Sport Position Stand importance of balanced fluid and electrolyte levels for sporting It is undisputed that larger fluid losses (over 2-4% of body performance as well as the benefits and risks of fluid intake in weight) and the associated symptoms, such as muscle cramps, sports are presented. From statements by international special- faintness, disturbed brain function (concentration and coordi- ist associations, recommendations are derived for fluid intake nation problems, headaches, dizziness) have a negative effect for all kinds of sporting activity. on performance. For these reasons too it is recommended that, in the case of exercise lasting longer than one hour, drinks are Fluid Loss During Sport taken already during the activity. In the case of intense physical activity there is a greater need Intentional Dehydration in Weight Class Sports for water due to increased sweat production. Sweat producti- on is necessary to protect the body from overheating because In sports with weight classes, so mainly in the case of combat around 75% of the energy obtained from nutrients during sports sports (e.g. judo, wrestling, karate, or taekwondo) and bodybuil- is released in the form of heat (thermal efficiency). This has to ding, many athletes hope to gain an advantage by managing to be released into the atmosphere by the body so that the body’s get into the next lower weight class, and they practice “making core temperature doesn’t get too high, otherwise performance weight”, i.e. rapid weight reduction before competitions. In stu- and health are impaired or endangered (30). Sweat production dies on wrestlers (7, 25) and bodybuilders (20) it has been shown depends on the type of sports, the duration and intensity of that more than half of the athletes use unsuitable methods for the physical activity, climatic conditions, gender (men sweat weight loss before competitions, such as “cutting weight” and more than women), body weight, clothing, and level of trai- radically reducing energy intake shortly before the competiti- ning. Trained athletes generally sweat more and faster than on. In the case of “cutting weight“ on the day before the weigh untrained ones: In the case of endurance athletes and games date and on the day itself the athletes restrict not only energy athletes it has been proven that as the athletes’ maximum oxy- intake, but also water and table salt intake and at the same time gen intake (V˙O2max) increases, their sweat glands react faster increase fluid output (training with heat accumulation through and start to sweat (16, 19). In addition a higher V˙O2max is ac- thermal clothing, saunas and laxatives). In this context the use companied by higher sweat production per gland and higher of diuretics which are on the doping list should also be viewed gland density. This enables trained athletes to release more heat critically. The resulting dehydration with increased excretion to keep their body temperature under the critical level at which of minerals, particularly potassium, magnesium, and sodium, performance is impaired (19). Furthermore, the sweat rate is can cause thickening of the blood, a drop in blood pressure, higher in faster, heavier athletes and at warmer
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