Thursday, July 19, 2012

The BMJ's Amazing Shock and Awe Assault on Sport Drink Science


Wow, WOw, WOW!

What words would you use to describe a situation where one of the world's most prominent medical journal publishes, not just one article critical of a specific category of food, but seven such articles, and where those articles come to the conclusion that the food is being marketing on the basis of food industry funded hype and collusion?

I'd use the words, "Thank You"!

You'll definitely hear about it in the news today as the British Medical Journal has 7 incendiary pieces that are highly critical of sport and energy drinks, their Big Food parents and the researchers that are conflicted by them.

The first piece, Research: The evidence underpinning sports performance products: a systematic assessment has researchers analyzing sport drink advertising and identifying an astonishing 431 performance enhancing claims for 104 different products. Those claims were "backed up" by references made on the products' websites to 146 references. Of those 146, the authors could only actually find half of them, and of that half,
"84% were judged to be at high risk of bias",
while only 3 were deemed to be of high quality and of low risk of bias. Ultimately the authors not surprisingly concluded that,
"The current evidence is not of sufficient quality to inform the public about the benefits and harms of sports products"
The next piece, The truth about sports drinks sees BMJ's Investigations Editor Deborah Cohen explore the funding and financial ties between sports drinks' parent Big Food companies and professional sport organizations and expert advisory panels. Her hard hitting piece is absolutely fascinating and covers how sport drink friendly messaging evolved and later became questionably incorporated into official medical and sport recommendations, often by advisory boards with multiple members on sport drink payrolls.

Then the BMJ tackles the EFSA's criteria for sport drink claims in, How valid is the European Food Safety Authority’s assessment of sports drinks?. The authors were highly critical of the two claims approved by the EFSA, that sport drinks, "improved water absorption during exercise" and that they helped with "maintenance of endurance performance" stating that the EFSA asked Big Food to supply the references upon which their decision was based, had no formal criteria to evaluate which studies warranted inclusion in the analysis (Big Food submitted non-peer reviewed book chapters, opinion pieces, etc), and that of those studies supplied to the EFSA many were absent methodologies.

For the "maintenance of endurance" claim the authors combed through the 26 scientific studies presented to the EFSA and concluded 19/26 were of poor quality; that 89% of the subjects were men; that 73% of the subjects were endurance trained men; that 65% of subjects were endurance trained men between the ages of 20 and 30; and that only one measured performance in a race setting.

For the "improved water absorption during exercise" claim, there were only 22 scientific studies of which 17 were deemed to be of poor quality, and where of the predominantly male subjects only 3 studies included people over the age of 30 and not a one had an outcome that included performance in a race or a sporting event.

The next explosion comes from Tim Noakes, the Discovery Health Chair of Exercise and Sport Science from the University of Capetown in his commentary on, Role of hydration in health and exercise where his take can succinctly be summarized as, if you get thirsty you should drink and that over-hydration is much more common and dangerous risk to the athlete than dehydration.

Next up is an analysis of the science behind the GSK sport drink Lucozade's claims that it boosts performance in, Forty years of sports performance research and little insight gained where the authors' conclusion says it all,
"From our analysis of the current evidence, we conclude that over prolonged periods carbohydrate ingestion can improve exercise performance, but consuming large amounts is not a good strategy particularly at low and moderate exercise intensities and in exercise lasting less than 90 minutes. There was no substantial evidence to suggest that liquid is any better than solid carbohydrate intake and there were no studies in children. Given the high sugar content and the propensity to dental erosions children should be discouraged from using sports drinks."
And there's still more!

Next authors explore the marketing of sports drink through social media and user endorsements in, Medicine and the Media: Miracle pills and fireproof trainers: user endorsement in social media. Not surprisingly, Big Food are savvy marketers, and Facebook and Twitter let them get away with making claims that even the EFSA would frown upon. Basically what companies do is try to encourage "user-generated content" which in turn they can then claim they didn't themselves write.

Next comes mythbusting in, Mythbusting sports and exercise products. Among the busted myths,
  • The colour of urine accurately reflects hydration (nope)
  • You should drink before you feel thirsty (nope)
  • Energy drinks with caffeine or other compounds improve sports performance (nothing other than equivocal benefit from caffeine)
  • Carbohydrate and protein combinations improve post-workout performance and recovery (nope)
  • Branched chain amino acids improve performance or recovery after exercise (subjectively did help, objectively equivocal)
  • Compression garments improve performance or enhance recovery (performance probably not, recovery yes)
Finally there is another piece on how to stay hydrated in, Commentary: To drink or not to drink recommendations: the evidence. Their 4 conclusions?
  1. There's a wide range of hydration within which our amazing bodies work wonderfully.
  2. Freely chosen rates of fluid intake among elite athletes match sport body recommendations (0.4-0.8 litres per hour).
  3. Intake at rates higher than sport body recommendations confer no advantages.
  4. Athletes who lose the most body mass during marathon, ultra-marathon or Ironman races do the best
These articles are all unbelievably important, both in regard to the recommendations we give ourselves and our children, as well as in regard to just how unwise it is to let Big Food push an agenda.  They are not our friend.

Huge props to the BMJ and to their investigative partner BBC Panorama for this groundbreaking series.