CrossFit | Greg Glassman and Dr. Timothy Noakes

Greg Glassman and Dr. Timothy Noakes

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ByCrossFitMay 20, 2020
Found in:200521,Health

In this May 2020 interview, Greg Glassman and Dr. Timothy Noakes discuss Noakes’ 2013 book Waterlogged and the role of organizations such as the American College of Sports Medicine in promoting (over)hydration guidelines that led to multiple fatalities. The two also discuss how industry influence and the pressures of “consensus science” have led to the widespread corruption of the health sciences, and Noakes reflects on his experiences with CrossFit and the CrossFit community.


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Guy Dufour
May 23rd, 2020 at 6:55 pm
Commented on: Greg Glassman and Dr. Timothy Noakes

Great video. Extremely informative and now I have to read Waterlogged. Thank you for making this video.

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David Williams
May 21st, 2020 at 9:04 pm
Commented on: Greg Glassman and Dr. Timothy Noakes

1 week in after taking 4 years off.


  • Standard Kipping pull-ups
  • 20lb dumbbells
  • Only had to break the round of 15, at 11 for both movements


4:40



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Allison Autrey
May 21st, 2020 at 6:26 pm
Commented on: Greg Glassman and Dr. Timothy Noakes

Thanks for sharing this video!

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Will Wright
May 21st, 2020 at 4:01 pm
Commented on: Greg Glassman and Dr. Timothy Noakes

Derrick,


I too am a physician, former avid runner and avid Crossfitter. I take offense at some of your comments. First, the statement that Dr Noakes has a "superficial understanding of soduim and water balance" is laughable. If you have not read Waterlogged, I recommend it. Dr Noakes is at the pinnacle of understanding the pathophysiology of sodium and water balance. Second, the "serious allegation" of stating that doctor's administration of iv fluids iatrogenically led to handfuls of fatalities is serious but both true and unfortunate. Unfortunate because we physicians are often self righteous and don't take well our mistakes. Fluids given to someone who is not dehydrated is a MISTAKE AND IATROGENIC. We at Crossfit have a list of names of the unfortunate athletes who have succumbed this way. And, death can result sooner than you think. Finally, the idea of watching "two lay people talking about something they didn't understand" sheds light on your deficiency to identify two of the bright minds in the Fitness/Health arena talking about something they understand quite well.


Go back and read/watch early Crossfit media. Greg, himself was clearly ahead of his time with regard to nutrition. "Eat meat, vegetables, nut, seeds, some fruit, little starch and no sugar. This regimen of a quality, healthy diet was a put forth at a time when we physicians were promoting "avoid saturated fat, it leads to heart disease". And Dr Noakes is not only a great athlete over a lifetime but a superb scientist, one guided by the scientific method. Both Greg and Dr. Noakes share a common thread. They are unafraid to stand up and speak the truth against the monstrocity of academic CONSENSUS. In the last several years of Dr Noakes academic career he was tormented by the academic establishment for doing so.


Remember, the art of medicine is a daily practice of applying our knowledge base and experience to the betterment of the patients we are privileged to take care of. Making mistakes is part of life, even for physicians. To not learn from them reflects one's ignorance/arrogance and is shameful.

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Derrick Antoniak
May 24th, 2020 at 5:10 am

Tried to convey in my post that I support CrossFit and that I realize the doc knows more than he can share in a snippet. Entire textbooks are written on the subject, so i thought the brevity of the way their arguments were represented was the problem.


I read the doc’s response to my comment as well. I stand by the following (I won’t explain the difference between dehydration and volume depletion since you’re a physician, other readers can look it up if needed): volume depletion is a powerful drive for ADH release and is the cause for hyponatremia in endurance athletes. Once you replete volume, the drive for ADH shuts off. For almost all endurance athletes, the solution for hyponatremia is volume. Even if the athlete has been drinking water or other hypotonic beverages, and thus has a critically low sodium, normal saline at 154 mEQ of sodium will be hypertonic to the athlete’s blood. And since the volume turns off their ADH, they will be able to excrete free water (unlike a patient with SIADH). If you see a symptomatic athlete at the end of a marathon, draw blood, and diagnose hyponatremia, the rational response is to administer volume. The doc says in his response that, to die from the condition he describes, you would have to have concomitant SIADH, a condition almost always associated with CNS or lung disease, cancer, drugs, or advanced age. If someone fit these categories, you would be more diligent in your sodium work up. Still, unless the athlete carries a known prior diagnosis of SIADH, if their clinics exam suggests hypovolemia, you’re going to administer volume.


I should say that as an inpatient physician, I’m talking about volume as IV isotonic fluids. I agree that oral fluids could possibly exacerbate the hyponatremia unless an actual oral rehydration solution, which isn’t usually commercially available.


if I get a chance I will try to find waterlogged and take a look. And again, I’m not detracting one any way from CF, which I’ve been doing since my brother in law preached it after his Special Forces training. And I’ve been practicing conservative, less-is-more, evidence-based medicine since well before that.

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Timothy Noakes
May 31st, 2020 at 8:15 pm

Hi Dr. Derick, Unfortunately you are wrong again. Persons with exercise-associated hyponatremic encephalopathy (EAHE) have marked fluid overload. One patient we studied in our 1991 Journal of Applied Physiology publication had a fluid excess at the end of the race of 6 litres; in those 8 runners with EAHE there was a linear relationship between their fluid excess at the end of the 56-mile Comrades Marathon and their post-race/hospital admission serum sodium concentrations.


Subsequent studies have confirmed that athletes with hyponatremia have measurable ADH concentrations indicating that they have SIADH (since ADH concentrations should be undetectable in those with fluid overload as you correctly imply). Here's a relevant reference: Siegel A.J., Verbalis J.G., Clement S., Mendelson J.H., Mello N.K., Adner M., Shirey T., Glowacki J., Lee-Lewandrowski E., Lewandrowski K.B. Hyponatremia in marathon runners due to inappropriate arginine vasopressin secretion. Am. J. Med. 2007;120:461.e11–461.e17. doi: 10.1016/j.amjmed.2006.10.027. 


Treating these patients with intravenous solutions that contains less than 3-5% saline would place a physician at risk of a charge of malpractice since they conflict with the Consensus Guidelines of the experts in the field and will produce an adverse outcome in anyone with EAHE and associated SIADH.


The book Waterlogged records what I learned in the first 30 years I spent studying the condition after describing the world's first case in 1981.


Please read it as a matter or urgency.

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Nancy Bodet
May 21st, 2020 at 3:06 pm
Commented on: Greg Glassman and Dr. Timothy Noakes

Thank you for this interview. Crossfit does save lives. Mine included!!

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Kathy Glassman
May 21st, 2020 at 3:00 pm
Commented on: Greg Glassman and Dr. Timothy Noakes

Love this. Brilliant!

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Grant Shymske
May 21st, 2020 at 2:34 pm
Commented on: Greg Glassman and Dr. Timothy Noakes

This collaboration and Dr. Noakes' work is so important and undoubtedly saving lives. 5 years ago I was standing at my wife's bedside in the hospital on Ft. Bragg. Over-hydration mythology runs deep in the military and they had essentially force hydrated her and all the other participants in the Expert Field Medical Badge course which culminates in a 12 mile forced march under load. She and 3-4 other candidates lost consciousness on the route, and, as was mentioned in the video, they were all treated for DEHYDRATION with no actual attempt to diagnose, just assumed. Thank goodness she is tough as nails and they were not able to kill her, she came back one year later and passed the course, without all the Gatorade nonsense. We are so thankful for what you are doing and so appreciative to be able to know better now and help others.

(edited)
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Cristhiaan Ochoa
May 21st, 2020 at 1:29 pm
Commented on: Greg Glassman and Dr. Timothy Noakes

This was absolutely refreshing! Thank you for sharing.

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Grace Patenaude
May 21st, 2020 at 1:14 pm
Commented on: Greg Glassman and Dr. Timothy Noakes

Love this! Thank you CrossFit Health!

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Derrick Antoniak
May 21st, 2020 at 3:37 am
Commented on: Greg Glassman and Dr. Timothy Noakes

I’m a physician and supporter of CrossFit (obviously since I’m here), but... the beginning of this video reflects a superficial understanding of sodium and water balance. SIADH (mentioned in the video) is a specific medical cause of hyponatremia. The I stands for “inappropriate”. ADH is released for “appropriate” reasons as well, one of which is low blood volume, as may be the case after running a marathon. The suggestion that doctors providing IV fluids to marathon finishers has resulted in iatrogenic fatalities is 1) a serious allegation and 2) a physiologic stretch. I treat hospitalized patients with SIADH and other causes of low sodium on a regular basis and can tell you that a bag of IV saline may indeed worsen the sodium level of a patient with SIADH, but to attain lethally low sodium would require extreme amounts over prolonged periods. Since the doctor in this interview is a doctor, I assume he knows better, but the beginning of this video left me thinking I was listening to two lay people discussing something they didn’t understand. If the premise is that the beverage industry is corrupt, I have no comment as that’s beyond my expertise. But people who exercise, then have bad outcomes from over hydration usually have bad outcomes because they are replacing their sodium containing volume lost (I.e. sweat) with non-salt-containing volume (eg water, beer, soda, etc). Gatorade and the like contain enough sodium to be less likely to cause such an outcome.

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Timothy Noakes
May 21st, 2020 at 7:18 am

Thanks Derrick for your comments.


I'm "the doctor" in the interview. I was the first person to describe the condition of Exercise-Associated Hyponatremic Encephalopathy (EAHE) in 1985 and with my colleague Dr Tony Irving the first to work out what causes it in 1991. I wrote the definitive book on the condition, Waterlogged, which I would encourage you to read.


Still to believe that EAHE is caused in those who are "replacing their sodium containing volume lost (i.e. sweat) with non-salt containing volume" unfortunately reflects grievous misunderstanding of the real pathophysiology of the condition. Continuing to promote this misinformation is potentially dangerous it if encourages inappropriate treatment of persons with EAHE.


Without SIADH it is almost certainly impossible to develop EAHE. The action of ADH on the kidney is to active sodium loss and water retention. Giving intravenous normal (0.9%) saline to anyone who has developed EAHE (as a result of drinking too much during prolonged exercise and inappropriately retaining excess fluid because of SIADH) simply causes additional water retention and sodium loss, further exacerbating the state of gross fluid overload. The most probable outcome will be cerebellar coning through the foramen magnum leading to death from respiratory arrest. On the other hand giving a hyper-concentrated sodium solution (3-5%) intravenously overrides the action of ADH producing an immediate renal sodium diuresis with prompt reversal of even the worst cases of EAHE within 5-10 hours.


Thank you for giving me the opportunity to include this explanation. The biology of EAHE is well described in our published works and is pretty well described also in the series of columns I wrote for CrossFit Health last year.


Here are some relevant references:

  1. Noakes TD. Comrades makes medical history—again. S.A. Runner (4 Sept. 1981): 8-10.
  2. Noakes TD, Goodwin N, Rayner BL, et al. Water intoxication: a possible complication during endurance exercise. Med Sci Sports Exerc. 17(1985): 370–375.
  3. Irving RA, Noakes TD, Buck R, et al. Evaluation of renal function and fluid homeostasis during recovery from exercise-induced hyponatremia. J Appl Physiol. 70(1991): 342-348.
  4. Noakes TD, Sharwood K, Speedy D, et al. Three independent biological mechanisms cause exercise-associated hyponatremia: Evidence from 2,135 weighed competitive athletic performances. PNAS (102): 18550-18555, 2005.
  5. Noakes TD. Waterlogged: The Serious Problem of Overhydration in Endurance Sports. Champaign, IL: Human Kinetics, 2012.
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Alfred Zambrano
May 21st, 2020 at 1:49 am
Commented on: Greg Glassman and Dr. Timothy Noakes

this workout popped up when I opened the page, I assumed it was today’s, I was a day early!

M/50/6’/325.4#

21 - 15 - 9 - 6

> 20kg DBs

> Sub: Row (# reps for cal rowed)

15:01

Finisher: 2 min 2 hand 22kg KB swings

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Kevin Croom
May 21st, 2020 at 1:47 am
Commented on: Greg Glassman and Dr. Timothy Noakes

Them: "Hydrate before you get thirsty!"

Me: "But I'm not thirsty before I'm thirsty."

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Katina Thornton
May 21st, 2020 at 1:44 am
Commented on: Greg Glassman and Dr. Timothy Noakes

It makes me smile to know that 71 year old Professor Tim Noakes is not only a "messologist," but also embraces CrossFit and the CrossFit methodology. Now, if we could just get Dr. Aseem Malhotra to commit to just one month....

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Karen Thomson
May 21st, 2020 at 2:06 am

Yes Katina! Aseem promised that he would. I’ll check up on that.

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Tyler Hass
May 21st, 2020 at 6:03 am

Nice to see you and it is inspirational to me too that Dr. Noakes is doing CrossFit. I love his story of getting started.

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Karen Thomson
May 21st, 2020 at 12:38 am
Commented on: Greg Glassman and Dr. Timothy Noakes

Simple and powerful. I absolutely loved watching this.

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