Dr Tamara Hew-Butler is the Queen of Hyponatremia (@hyponaqueen on X). What's hyponatremia, you may be wondering? It is a condition that is far more dangerous than dehydration, and which can develop when we drink too much fluid during exercise, with potentially lethal and often tragic consequences. We have been conditioned to fear the health and performance risks of dehydration during exercise, to believe that we cannot afford to lose fluid, and that by the time we are thirsty, it's too late. But Hew Butler, a world authority on fluid requirements during exercise, is here to set the record straight, to explain how exquisitely our bodies regulate our sodium and fluid levels, and why we can and should trust our physiology instead of the marketing messages of sports drinks and water companies. This is an episode that will challenge beliefs, and set the record straight on exercise hydration.

Show notes

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Links to articles on the subject matter of the podcast

• Tami is lead author on a series of consensus statements on Exercise Associated Hyponatremia. This is the most recent version of that consensus
• The Men's Health article mentioned on the show, discussing overhydration and quoting Tami
• A review article by Tami, published in 2017, with details on the physiology, treatment and prevention of hyponatremia
• A 2022 paper by Tami, on the Physiology, Psychology and pathophysiology of overhydration
• A study Tami was involved in looking at soldiers doing a 40km march, showing that drinking to thirst avoided the dangers of both hyponatremia and dehydration
• In the show, we spoke about research we did at the Comrades Ultramarathon. Here is one of the papers from those studies in the medical tent
• Two papers on what typically happens during ultra-endurance exercise, first in Ironman athletes, by Sharwood et al
• A second paper describing over 2000 endurance athletes and the changes in body weight, sodium levels and hydration status
• The first case series of hyponatremic athlete in the Comrades, going all the way back to the 1980s
• Tami's X handle: @hyponaqueen

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