Hydration Blog

Placebo effect?

Thursday, July 26, 2022

We received the email below from a customer a few days ago and thought it would be a good idea to share his question our response and his subsequent reply online - especially given the amount of interest there has been in sports drinks since the BBC Panorama documentary highlighting the British Medical Journal's latest thinking on sports drinks was aired on July 18th....

We'll follow on with a more in-depth comment on the BMJ article and also on Dr Tim Noakes' book 'Waterlogged' soon. 


Hi Guys,

I would be interested in your thoughts on the lack of need for hydration products as currently proposed by Tim Noakes. He says there is no need for anything like this. He also says that sweat with high levels of sodium are just because of high intakes of sodium and to cut this out also means that the sodium levels in sweat will in turn drop. I went to the talk at all 3 motion and have been using your products and have got on fine so far but I’m wondering if this is placebo or not?


Our response:

Thanks for your email.

It's a very interesting question, one that we're being asked more and more here is our take on it: 

Firstly whilst we have a huge amount of respect for Tim Noakes and his work he has a record of being quite provocative in his approach to certain topics. He likes to challenge exists dogmas and this is both healthy and necessary in science. However, sometimes he adopts quite an extreme position (in this case that sports drinks are completely unnecessary and that the companies that sell them are conning us) partly, I think, to get people to sit up and take notice and this certainly works!

For starters we do agree with his point that listening to thirst is a good idea. Too many people do force fluid down too frequently and suffer as a result and in our advice to athletes we take a similar position. 

However, one of the main points that we'd disagree with in his new book is in the way it dismisses that there is a large variation in sweat sodium losses; saying that they are relatively similar between people and mainly driven by dietary sodium intake. Our own data (which is probably one of the most comprehensive sets available) shows a much wider variance in sweat sodium values (approximately 19mmol/l to 84mmol/l) in well trained athletes than he quotes in the book (around 20-40mmol). 

It's certainly possible that at the extremes when people are taking in huge volumes of sodium, or virtually none at all, the body could respond by losing more or less in sweat but the fact remains that the main mechanism for regulation of sodium is in the kidneys absorbing or excreting more in urine. From the large numbers of people we have tested (some of whom in professional rugby and football teams all eat similarly controlled diets to one another yet still show this wide variation in sweat sodium levels) it is clear there must be something other than just sodium intake dictating sodium loss in sweat and it would appear that this is genetics. 

On a personal level as I explained in the talk at All3Motion one of the biggest drivers for me in getting my own sweat tested many years ago and looking into this topic further was that I had found by trial and error that by taking in lots of sodium in races I a) stopped cramping (as I had done a lot beforehand) and b) generally my performances improved dramatically. The consistent way in which this happened (and from listening to the experiences of other athletes we've tested and talked to over the years) leads us to strongly believe it cannot just be put down to a placebo effect.

Also, although Dr Noakes is very sure in his opinion that sodium loss has absolutely nothing to do with cramping a lot of anecdotal evidence would suggest otherwise. For sure we don't believe it to be the only factor involved but the amount of athletes who have stopped cramping when we've upped their sodium intake in endurance events is significant. Again our own data from sweat tests and questionnaires shows a statistically significant correlation between athletes who report that they cramp regularly and the fact they tend to have higher sweat sodium levels. This may not offer definitive 'proof' of a link but it ties up with enough anecdotal experience to be taken seriously.

As with a lot of topics in science and sports performance if you search hard enough you can definitely come up with a lot of evidence to prove and disprove most theories. Do we agree with Dr Noakes that many of the big sports drink companies have 'hyped' the efficacy of their products in order to sell more of them? Absolutely. Do we think that there is no benefit to be derived from intelligent use of certain supplements (such as sodium) to prevent performance dropping off as the body gets depleted during extended periods of exercise? No. 

Kind regards


Subsequent reply:

Thanks for the very detailed reply. It’s refreshing to get that sort of detail.

For my experience with your products I have not suffered any cramps this year since I started taking them. 

This year I have run Ultras, 40, 50 and 100 miler and all using your 1000mg product. I found they helped with hydration and absorbtion of food which is something that I think gets little coverage and is vital.

In the Cardiff 50 this year at mile 46, I came across a guy who could not stand, let alone walk due to massive cramping.  He was actually trying to call his wife as he was going to withdraw as he was in so much pain.

Luckily for him I had your tablets freshly prepared from the last aid station and I made sure he drank the majority of my bottle, I left him alone to deal with his pain and carried on hoping that he may be able to stumble the remaining 4 miles.

Well I'll be! He came flying past me about 10 minutes later saying I had saved him and the drink was an elixir of life! This really pleased me but because I was now being beaten by Lazarus I had to step up my game as there was no way I was going to be beaten by someone who was practically DNFing 10 minutes earlier. Needless to say we both finished in just over 8 hours and I did beat him and came 28th. He was all over me with emotion at the finish line and kept telling everyone he could how I had saved him. In fact it was your product that saved him I just happened to have some ready and was willing to share.

I used it on the 100 I finished 2 weeks ago and has no issues at all although my ankle did swell up like crazy due to terrain etc but I finished in 24.08 and beat myself up for ages for not going under 24 hours but I knocked 2 hours 27 off my 85 mile time from 2 years ago and ran 15 miles further and on harder terrain and elevation so that cant be bad! I have also got my mate Max Dillon who came 3rd at Cardiff on to the product and he loves it too and has had no issues.


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