This is a guest post by Jon Phillips, CISSN, Applied Physiology Lab, Mississippi College.
I will not accept the unsubstantiated claims made by Dr. Joe M. Pressler in regards to the events that led to the death of high school football player Walker Wilbanks of Jackson Preparatory School in Jackson, Mississippi. On Monday August 25th, Wilbanks was pronounced dead at University of Mississippi Medical Center from complications related to an abnormal hydration status that presented during the previous Friday’s football game.
Few individuals know every minute detail pertaining to Wilbanks’ death, but the locals who were with him on game day have said enough to identify the glaring issue of this player’s willful excessive over-drinking. But for some reason that sentiment has not been reflected by professional messages presented to local news.The limited attention paid to this ordeal by major media outlets in Wilbanks’ own hometown simply will not do, and I will not stand for such a casual sweeping under the rug
The tragic reality of Wilbanks’ death is that, extenuating circumstances aside (and being from the Jackson area, I’ve heard plenty) his death likely could have been prevented. Human life is far too valuable to go undefended and too costly for its loss to go unspoken for. Walker’s parents honorably requested the attending physician share his story so that other parents could be informed. While I earnestly sympathize with the Wilbanks family’s desire to educate the public on the nature of this tragedy, I can confidently say the answer provided to the public by the attending physician on this matter was inadequate and not consistent with the current body of literature on the topic of hydration in relation to human performance.
During the press release that followed the announcement of Walker’s death, Dr. Pressler stated the following:
“This was an unfortunate, isolated incident… It was in no way a reflection of him being over hydrated or under hydrated. Walker did nothing wrong in preparation for this game. His coaches did nothing wrong in preparing him for this game… This was a fluke – a freak event that occurred in him that could not be predicted and most likely could not have been avoided.”
I respect the physician’s desire to comfort the public during the time of the tragedy but his statements were simply not true. If he has recanted those statements since the press release, it hasn’t been in public forum nor have local media outlets reported it. Walker Wilbanks’ death was an accident – and a horrible one at that, but saying that nothing could have been done to offset the chances of the negative cascade of physiological changes that ultimately led to the unnecessary death of this young man is misleading to the watching world and deals him and his family a great disservice.
The official cause of this player’s death was what is formally known as Exercise-Associated Hyponatremic Encephalopathy (EAHE) – abnormal, systemic, fluid retention that typically presents during rigorous, physical exertion and promotes consequential brain swelling, sometimes resulting in brain death. This is not be confused with the condition’s precursor, Exercise Associated Hyponatremia (EAH), which is similar in nature to EAHE but with separate, less severe characterizing features.
EAH often presents with symptoms such as nausea, vomiting, unexplained fatigue, impaired exercise performance, evidence of weight gain, and diluted blood sodium concentration slightly below normal range. EAHE tends to present with some if not all the symptoms of EAH along with symptoms unique to EAHE such as headache, altered levels of consciousness, coma, seizure, diluted blood sodium concentration significantly bellow normal range, fluid buildup in the lungs, and brain swelling.
Dr. Timothy Noakes, Professor in the Discovery Health Chair of Exercise and Sports Science and Director of the UCT/MRC Research Unit for Exercise and Sports Medicine at the University of Cape Town, Sports Institute of South Africa is one of the world’s leading experts on the role of hydration in human performance and a accomplished, published researcher. His meta-analysis on the topic of hydration, Waterlogged, exposes myths surrounding dehydration fear mongering and highlights the purposeful misleading of the masses that has been led by the sports drink industry.
It is important to note that Walker’s mortality, while related to hydration status, does not necessarily mean he simply had low sodium levels. Noakes has heralded for years, “In 1991 [my research team] provided definitive evidence that EAHE is due to abnormal fluid retention in those who overdrink during prolonged exercise and to which a sodium deficit plays little if no part”. Therefore, Walker’s death can almost exclusively be attributed to his abnormal retention of large volumes of fluid ingested on game day and not a lack of sodium nor too little fluid.
It is common knowledge here in Jackson that Wilbanks was encouraged to drink large quantities of various fluids, beyond his thirst (and likely his comfort), in hopes of offsetting chances he would become dehydrated or succumb to heat-related illness during that evening’s game. He reportedly consumed a variety of electrolyte-containing drinks and sports beverages during the hours leading up to the game, so he may very well have had “normal” or “supra-normal” levels of sodium present in his blood, but the concentration thereof was likely drastically diluted by excessive fluid intake and retention that the sodium present was not sufficient to maintain normal bodily function.
Using a basic logic and understanding of human physiology, Dr. Noakes and others long ago squashed sports drink company’s claims that their electrolyte containing beverages are able to replace sodium lost through heavy sweating. Contrary to what the sports drink industry would like us to think, their drinks don’t actually contain enough sodium to contribute to the maintenance of normal blood sodium concentration, even under resting conditions.
In a piece Noakes wrote for Practical Gastroenterology in 2008, he sums up his thoughts on the matter saying, “Since EAH and EAHE are due to abnormal fluid retention, only drinks containing sodium at a concentration well in excess of that found in blood would theoretically play some role in the prevention of these conditions. In reality, such drinks are unpalatable and likely to induce vomiting”.
During my recent phone interview with the Director of the HEAT Institute in West Chester, PA, Dr. Sandra Godek expressed her alignment with Dr. Noakes’ research and shared dissent for the sports drink industry’s erroneous claims, saying “An amount of sodium given in a dilution already less than what is typically found in the blood can only serve to further increase total blood volume upon absorption, thereby further diluting the sodium already in circulation so consuming large amounts of sports beverages with the intention of replacing sodium lost from heavy, salty sweating doesn’t do much in terms of helping someone”.
The individuals pulling the strings at Gatorade, GSSI, and others have so vehemently monopolized the so-called “science of hydration” they could not care less that the dogma they preach as gospel truth has been the root cause of thousands of unnecessary athlete injuries both stateside and internationally. The current lot of documented deaths related to excessive voluntary fluid intake hasn’t been enough to shake up anyone in the higher-ups willing change published guidelines and recommendations on this issue. The American College of Sports Medicine (ACSM) and National Athletic Trainer’s Association (NATA) are otherwise trustworthy and respectable organizations, but their failure to properly address issues pertaining to major conflicts of interest influencing their position statements on hydration practices is not only shameful and inexcusable – but as a student member of the ACSM, I personally find it embarrassing.
Tears have been shed and sleeplessness has followed many into recent nights as crushed hearts continue to mourn Walker’s passing. The deaths of athletes like Walker slipped through the fingers of many that, if better informed or educated could have had some part in catching anomalies before they result in the tragic loss of life. We know better now, so a collective responsibility has been placed on us all, especially those who knew, loved, and worked with Walker, to strive to see that unnecessary athlete death from EAHE doesn’t arise again in some other player down the road.
For the time being, life-saving information regarding best practices for athletic hydration won’t come from Gatorade or the GSSI. You won’t hear it from the ACSM or NATA either. But you can expect to hear it from the likes of us who see this issue for the evil it is. How many more athletes have to die before we see some change?