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Alan Fredendall // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Fitness Athlete division leader Alan Fredendall discusses the science and practical application behind hydration & recovery drinks. Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, Alan here, Chief Operating Officer here at ICE. Before we get into today's episode, I'd like to introduce our sponsor, Jane, a clinic management software and EMR with a human touch. Whether you're switching your software or going paperless for the first time ever, the Jane team knows that the onboarding process can feel a little overwhelming. That's why with Jane, you don't just get software, you get a whole team. Including in every Jane subscription is their new award-winning customer support available by phone, email, or chat whenever you need it, even on Saturdays. You can also book a free account setup consultation to review your account and ensure that you feel confident about going live with your switch. And if you'd like some extra advice along the way, you can tap into a lovely community of practitioners, clinic owners, and front desk staff through Jane's community Facebook group. If you're interested in making the switch to Jane, head on over to jane.app.switch to book a one-on-one demo with a member of Jane's support team. Don't forget to mention code IcePT1MO at the time of sign up for a one month free grace period on your new Jane account. ALAN FREDENDALL Good morning, PT on ICE Daily Show. Happy Friday morning, I hope your day is off to a great start. My name is Alan, I have the pleasure of serving as our Chief Operating Officer here at ICE and the Division Leader here in our Fitness Athlete Division. It is Fitness Athlete Friday, it is the best darn day of the week. Today we're gonna be talking about salty science. No, we're not gonna be talking about how upset Drake fans are by how badly they're getting beaten by Kendrick Lamar's diss drops. We are talking about the new era of salt-based hydration and what that means and how that compares to previous eras of things you might be more familiar with. Gatorade, Powerade, those sorts of things. So today we're going to talk about the origin of hydration in recovery drinks. We're going to talk about the pros and cons of what we might call the first generation of those recovery drinks. And then we will move in and talk about the new era of sodium-based drinks that may or may not have any sugar included in them. THE HISTORY OF RECOVERY DRINKS So recovery drinks really started as we know it a long time ago back in the 1960s, actually 1962 at the University of Florida. Researchers created a recovery drink for the Florida Gators. You now know that is Gatorade, A-D-E. Back then it was spelled Gator dash A-I-D like a band-aid, Gatorade. And this formula was rather simple. It was water, sodium, and some lemon juice. And when we look at the macronutrient breakdown of the original formula of Gatorade, if you're old enough, you may, even if you were a kid in the 80s or maybe even 90s, you remember it used to come in that glass bottle and it really had nothing in it. It had 50 calories total, it had 14 grams of carbohydrates, it had some sodium, and that was essentially it. And that was a 20 ounce bottle, 20 ounce serving. So a little bit of sugar, a little bit of sodium, and that was it. A lot of credit went to Gatorade in the 60s and 70s when the Florida Gators went on to win and many other collegiate and professional teams went on to win sporting events, they maybe sarcastically credited Gatorade with their success, and at that point Gatorade took off into orbit. That is very different from the Gatorade of today. The current formula of Gatorade is significantly different. It has a lot more calories, as you may be aware, that is primarily sugar. So for the same serving, a 20 ounce serving, a 20 ounce now plastic bottle that you might find in the store or the gas station, 160 calories, so over three times as much. caloric density, way more carbohydrates, three times the carbs, 42 grams of sugar, which is a lot. More sodium now, giving credit, 10 times more sodium, 300 milligrams of sodium, but also a lot more potassium, 90 milligrams of potassium. What's changed from the 60s to today? Pepsi bought Gatorade, Pepsi sells Gatorade, You may know Pepsi owning a lot of the snack brands and soda drinks that we are very familiar with. So it's not really surprising when you find out that Gatorade is now owned by Pepsi that it's just kind of pumped full of sugar and it's essentially turned into a soda drink. THE CRITICISM OF SUGAR-BASED RECOVERY So that being said, what is the main criticism of Gatorade? as it relates to its functionality as a recovery drink or not. The first thing to consider is just looking at it from a molecular level, it's sugar water. The primary ingredient is sugar. It's a bunch of calories. Yes, it has a little bit of sodium. Yes, it has a little bit of potassium. But it is primarily sugar water. Now, we may think, okay, we know we sweat, we know we burn calories when we work out, surely we can put that sugar to good use. But it's really important to know that the majority of people drinking these drinks are perhaps not exercising at all. They might be sitting at a computer desk and or they may not be exercising to the level that they are losing that much sweat and that much glycogen from their system. Certainly somebody running, cycling, doing a long endurance activity, 90 minutes, 120 minutes, longer, running a marathon, ultramarathon, triathlon, Ironman, that sort of thing, that person does need to consume glycogen to keep their aerobic energy system running. But those folks just recreationally active, going to CrossFit for an hour, going to run a couple miles, working out in an air-conditioned gym where they may not be sweating at all, don't really need that amount of caloric replenishment and sugar during their workout to keep their workout intensity high. Go way back to episode 1552 of the PTA Nice Daily Show if you want to learn a little bit more about fueling during exercise, we talk about how the human body has about 400 grams of glycogen stored inside of it, inside of our muscles, and about another 100 grams in our liver. So we have the ability to go 90 to 120 minutes before we dig deep enough into those reserves that we need to consider drinking glycogen, drinking glucose to sustain our energy system. And again, the argument and the largest criticism, especially in the past 10 to 15 years or so of Gatorade and similar drinks Is it simply too much sugar? Some really good papers here. Zimmerman colleagues way back from 2012, sports drinks, not just sodas, drive up weights in teens, looking at 11,000 kids aged nine to 15 and finding that kids gained two pounds for every two years in which they drank a can of soda per day. So if they drink a can of soda per day for two years, they would have gained two pounds per year. If they drank two cans, they would have gained four pounds, three cans, six pounds, and so on. And so we say, yeah, Alan, we know that. We know soda is bad. But what is really, really, really interesting about this study is they also looked at sports drinks. They looked at things like Gatorade and Powerade. And this is kind of shocking that they found the same level of consumption, one bottle of a sports drink, two bottles of a sports drink, et cetera, following that same scheme for every one bottle consumed per day. kids gained three and a half pounds per year, two bottles per day, seven pounds, three bottles per day, so on and so forth, 10 and a half, 14, all the way up. And so, recognizing that these drinks actually contain as much or more sugar per ounce of basically table sugar than a can of soda, a can of Coca-Cola or Pepsi or something like that. I love the conclusion from this paper, sports drinks fly under the radar, The danger is that they're sold as part of a healthy and active lifestyle, and it's just part of something you do being active. Most kids are not getting the two hours of high-intensity exercise needed every day to justify refueling with a sports drink. And so, finding that because they have so much more sugar per serving, and that it is so much more acceptable to drink a Gatorade versus to drink a Mountain Dew or something like that. Shout out to Brian Melrose, the Mountain Dew King. that these kind of fly under the radar, and there might be kids that drink these every day in their lunch. They might drink one for lunch and one after school, after playing outside, and it's not surprising that we're racking our brains to figure out why we have a childhood obesity and type 2 diabetes epidemic when it's right in front of our face. Gatorade just simply has too much sugar for the folks who are drinking it on a regular basis. Now, if you're out there, you're running marathons, triathlons, Ironmans, whatever, you're working out for hours at a time, you're working in the heat, you're sweating a lot, ignore me. But for most of our patients, for most of our athletes, we need to understand why that criticism of Gatorade is there and that it's pretty cemented that it is simply too much sugar for the small bit of electrolytes that you might get out of Gatorade. And so that's maybe what we call the first generation of recovery drinks. THE ERA OF SODIUM-BASED RECOVERY The new generation you may have heard of a product called LMNT Element. There are a lot of similar brands now. A sodium based recovery drink that has no sugar. This high sodium drink, which also faces criticism of, isn't salt bad? Doesn't that give us high blood pressure? But really finding that these drinks are entirely different on a molecular level from something like Gatorade or Powerade. That again, they have no sugar. They have 10 times more sodium, a thousand milligrams, one gram of sodium. They have a little bit more potassium, usually around 200 to 250 grams. And they also come with some magnesium. What is the scientific argument for drinking something like Element or similar compared to something like Gatorade or similar? Understanding that individuals that are active and exercising may not be using muscle glycogen to the point where they need to drink sugar during or immediately after their workout, but also recognizing they are sweating, which means they are losing especially salt from their system, and that if we replenish that salt, people will probably feel better without feeling the need to go and drink 50 grams of liquid table sugar during or after their workout. A really good article, Sharif and Sawaka, 2011, the Journal of Sports Science, finding that folks can lose up to seven grams of sodium out of their body through sweat per day. If they're active with exercise, if they're maybe somebody outside working, whether that's for a job or just active in the garden for a couple hours on weekend days, that sort of thing. And so we are losing a lot of sodium. And there's kind of a catch-22 here of active individuals don't tend to eat a lot of processed food. And so active folks are not naturally taking in a lot of sodium yet, because they are active, they are losing a lot of sodium at the same time. They're sweating in the gym, they're sweating out running, biking, whatever. Maybe they're sweating outside at work or in the garden or doing lawn work or whatever, and they're simply not replenishing it unless they happen to be somebody that really salts a lot of their food to taste at home. which again may not be the case. So this argument for high sodium, isn't sodium dangerous? Not if you're losing seven grams. Replenishing with just one gram is really just trying to bring you back to balance. We're not as concerned that somebody drinking a sodium based recovery drink is going to run into issues with maybe their blood pressure or any sort of cardiac issues because they're not drinking seven grams at a time. But again, also they're losing it by being active. Why does this matter? What is the science behind a sodium based drink? It's the sodium potassium pump. Way back in like sixth grade biology, you probably remember the pictures of the cell. It looked like a little half sandwich with some ridges in it or something and little circles were moving around. We probably learned about it again in exercise physiology in undergrad and maybe you heard about it again in PT school, but the sodium potassium pump in the membranes of your cells does a lot of work. It is responsible for a lot of body functions. It powers muscular contraction. It transports glucose into your cells to power those contractions, power that cellular activity. It regulates neuronal activity, the actual firing of our nervous system, our synapses. It regulates our body temperature, and overall it maintains our physical performance. of a workout where you sweat a lot, it was really hot, you felt terrible, low energy, you may have even felt cold even though you knew you were really hot, your sodium potassium pump was running out of the sodium needed to power itself. Three molecules of sodium come in, two molecules of potassium come out. So that is the rationale behind a high dose of sodium compared to a relatively smaller dose of potassium. maintaining that sodium potassium pump. And the end goal is, without consuming a lot of sugar that you probably don't need, we can help sustain your current activity or the activity you're about to do, or feel better and recover from the activity you've already done by drinking one of these sodium-based energy drinks. PRACTICAL APPLICATION FOR PATIENTS AND ATHLETES Now, the history of Gatorade, the history of sugar-based recovery, element in similar, the new era of sodium-based recovery, what is the practical application at the end of the day for our patients, for our athletes? For those folks who are not already active in exercise program, which is statistically 90% of the human race, they don't really need to be drinking Gatorade. They probably should never be drinking Gatorade because they're not expending enough calories, they're not burning enough glycogen to really justify housing 50 grams of liquid table sugar. That being said, even folks who are active, if they are not active for 90 to 120 minutes of higher intensity exercise, they probably also don't need that much Gatorade. Certainly if you go out for a run for an hour on a warm day or maybe 90 minutes, You might want to cut that Gatorade with some water and dilute it down. That can be beneficial to maintain your energy levels, maintain your hydration, but you don't necessarily need to take two full bottles of Gatorade out on your run and house 500 calories and 50 grams of table sugar. I'm sorry, 100 grams of table sugar while you're out on that run. Now what about our athletes who are training really hard folks who might be in the gym for a couple hours, folks who are long endurance athletes, I would argue those folks probably already have their fueling plan dialed in for what they're going to be drinking, what they…
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