Season 2, Episode 7 - Tamara Hew-Butler, Ph.D., Associate Professor of Exercise Physiology, on challenging sports medicine conventions
Tamara Hew-Butler, Ph.D., associate professor of exercise physiology, on how her research into athletic performance is challenging some long-standing — and perhaps misguided — sports medicine conventions.
Tamara Hew-Butler, Ph.D., associate professor of exercise physiology, talks with host Darrell Dawsey about her cutting-edge sports medicine research, challenging the orthodoxy of exercise and why drinking eight glasses of water daily may not be good for you after all.
Dr. Tamara Hew-Butler is a podiatric physician and associate professor of exercise and sports science at Wayne State University. She obtained her B.S. in kinesiology at the University of California at Los Angeles; Doctor of Podiatric Medicine (D.P.M.) at Temple University in Philadelphia; and Philosophy Doctor (Ph.D.) at the University of Cape Town, South Africa. Dr. Hew-Butler is a fellow of the American College of Sports Medicine (FACSM) and specializes in both sports medicine and exercise physiology. Her expertise is in exercise-associated hyponatremia and the endocrine regulation of water and sodium balance. Her scientific work has been highlighted on radio shows, television, podcasts, newspapers, the comic strip xkcd and the reality television show Adam Ruins Everything.
Follow Tamara Hew-Butler on Twitter https://twitter.com/hyponaqueen
Follow the WSU College of Education on Twitter https://twitter.com/waynestatecoe
Follow WSU Kinesiology/Center for Health & Community Impact on Twitter https://twitter.com/waynestateKHS
Read Tamara Hew-Butler's essay on why we don't need to drink eight glasses of water a day https://theconversation.com/do-you-really-need-to-drink-8-glasses-of-water-a-day-an-exercise-scientist-explains-why-your-kidneys-say-no-159020
Watch Hew-Butler explain why we should exercise to fight disease https://www.youtube.com/watch?v=ECRc5m-HecE&t=1s
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Darrell Dawsey: Welcome to the Today@Wayne podcast. In the world of sports and fitness there are certain tenets that are held so tightly that they become something akin to gospel. "No pain, no gain," we tell ourselves. "Winners never quit. Quitters never win," we say, and of course there's that most basic of fitness directives, drink plenty of water and stay hydrated. But what if we've got some of these ideas wrong, or at least hold some misperceptions about them? In the case of the last example, the need to constantly have water during or after physical exertion, Tamara Hew-Butler, Ph.D., and associate professor of exercise and sports science at Wayne State has become something of an outlier. While certainly an advocate for proper hydration, Hew-Butler has gained national notice in recent years for her willingness to challenge the idea that water is only helpful, never harmful, to athletes.
In fact, earlier this year, Hew-Butler drew attention and some ire for a piece she penned for the Washington Post in which she challenged the conventional wisdom that all people need to drink eight glasses of water a day to ensure good health and proper hydration. "Not to burst anyone's water bottle," she wrote, "but healthy people can actually die from drinking too much water." But her heterodox views on hydration are only part of what makes Hew-Butler so fascinating. In addition, she has led the relaunch of the 10,000 Warriors research screening project, which seeks to get a snapshot of the physical, metabolic and mental health of WSU students ranging from those who've never exercised to some of the university's most elite athletes. Hew-Butler also works with Jordan Sabourin, a WSU doctoral student who serves as the head strength and conditioning coach for the Detroit Pistons.
Together, they test body composition and sweat sodium on the Pistons players to help monitor physical changes related to their training and nutrition. Now, Hew-Butler is here with us on the Today@Wayne podcast to update us on her work and tell us how she's faring in her role as a bit of a fitness maverick. Welcome, Dr. Hew-Butler.
Tamara Hew-Butl...: Glad to be here, Darrell.
Darrell Dawsey: Always good to have you, great to have you. So, let's jump into this. I was reading a little bit of background on you, profiles, and one piece I came across says you've been described as a weird outsider in the world of physiology. I was wondering if you could tell us a little bit about what that means. Is this because of the conclusions you've drawn, your approach to research, or for some other reasons? What makes you a weird outsider in the world of physiology?
Tamara Hew-Butl...: When most people think about science and physiology, you think about the elegance of working in the lab with these Rodin or cell culture models, and everything's really, really controlled and you get these beautiful studies, that there's no outside interference. And that's really what people think about science, like nerds in the lab with their white coats on and their pipettes, and I love that, that's the mechanistic work that actually drives the foundation of our understanding. On the flip side of that is what we see in the clinic. It's the people who get sick, the people in the hospitals, and because humans are messy, and that's what makes us human and makes us special. We're not cells in a dish without any outside interference. So, my work spans a lot of testing humans in trying to bridge the elegance of basic science with the disease associated with what we see in hospitals and in the clinic.
So, in one sense our studies are not clean and beautiful enough and on the other side we're not diseased enough. And so we're at this really weird interface where you study healthy people and see, looking at the fringes, how healthy people actually get sick and how to make them better. But again, too, with sports medicine, it's how uber-healthy people actually overtrain and get injured. So again, to me, there's parallels in both of those fringes that I think inform both athletes but inform health and disease along the continuum that we try to bridge. So, it's kind of like an unwelcome spot because we serve the uncomfortable and not a lot of people like being in that realm.
Darrell Dawsey: One area where you—
Tamara Hew-Butl...: That's messy.
Darrell Dawsey: Well, a little water will clean it up, speaking of water, right? One area where you have certainly made a bit of a mark, earned a little bit of attention, is in the area of hydration and overhydration and, it seems, when I look at your work, when I look at the pieces that you've written, it seems to be that you think that there's some mythology that's going on around hydration, to the point where you say we don't need eight glasses of water a day, which is something that many of us were told by our parents and by our pediatricians, by our physicians. First of all, tell us how you came to that conclusion, and then I'd be really interested in hearing how some of the reaction throughout the worlds of fitness has been to that idea.
Tamara Hew-Butl...: I've gotten into hydration almost by accident. I'm a marathon runner and so I was working in one of the marathon medical tents and it was really hot that day, and so people were told that they needed to drink a lot because they needed to avoid dehydration and dehydration was going to like, "They're going to cramp up and they're going to have heat stroke." So, in the medical tent that very hot day, runners were being brought in left and right. And again, to make matters worse, we didn't know it at the time, was we were actually giving people IVs because we actually thought that they needed more water and water was going to be what cured them. And what happened in that day is four of the runners actually had seizures and they were taken to the hospital, and they were in intensive care, in comas, for a week.
And so, because they were marathon runners and marathon running was my family, it was really, "What caused this?" And so subsequently a bunch of runners died from what we thought was a condition where you drink too much water. At the time we didn't know, so people don't know that if you drink too much water that it's actually fatal. It causes your brain to swell, and it actually causes your lungs to fill up with fluid. And so, from that incident, I went into science, and it drove my fascination of how much water can actually kill you and how much water is safe. So, when I went back into like, "Why are people drinking that much water?" It was like, "Where did this 'eight glasses of water' come from?" And we actually don't know where that came from.
And so, scientifically, we think that somebody made it up. There's even been some really nice reviews where... There are recommendations that say, "Well, most humans probably need about two liters, which is eight glasses, of water a day to survive." But when they made that recommendation back in 1945, that included all of the moisture in foods and all other beverages, the soups and the juices and the coffee and the beer, it included all fluids that we ingested. But somewhere along the way, water, particularly water bottle industries, got whiff of this and they kind of morphed that recommendation as everybody needed eight glasses of water, not everything else, water, per day, and so that myth has been propagated for decades. And so everyone's like, even at sports fields, like "Drink a lot of water, drink water," and that's like the whole thing.
But if you go back to the physiology of what our bodies actually defend? It's not just water. It's actually a balance between water and salt. That's important. So, there's a lot of misinformation that's driven by advertising. It's not even just water and the alkaline water and the oxygenated water and the vitamin water and the sport drink. Everyone's trying to sell you something or even like the CamelBaks, water bottles that ring. So, everybody makes us fearful of dehydration to sell products. Do we all humans, you, me, Jordan who's seven foot tall, need eight glasses of water per day? Is that this magic recommendation that's going to suit everybody? Here am I sitting in front of you, talking to you in an air-conditioned office, is that going to work for the football players going to be out there, you know, 300 pounds, working?
There isn't one size that fits all, but this myth has been propagating for long periods of time and it's really hard to actually push against it because everybody... The advertising is hot and it's cool and there's no regulation to that. When I try to talk about, like, kidneys and, like, nephrons and, like, aquaporin shoveling, no one wants to hear about that. And so that's where we are, but in my world I'm very attendant to people who die, people still drinking too much water, their brain swells up and it's dying and it's completely preventable.
Darrell Dawsey: Have you gotten any pushback from people who do disagree with you, other folks in the field, other scientists?
Tamara Hew-Butl...: Yeah. I'm like the pariah.
Darrell Dawsey: You're the pariah.
Tamara Hew-Butl...: Well, because dehydration is hot and even the scientists and even our organizations like American College of Sports Medicine, they're funded by water, by sport drink industries. And so, if you're funded by that, that's not going to be like, "Oh, you drink when you're thirsty." They're going to actually push the water. So, for most of my career it's actually been very venomous about like, "No, you know, she's wrong, you know. You need to drink a lot of water." But to get to it on my side, it's like I see people die and I see people in the hospital because they've done that. I think, over time, people are starting to realize the influence of advertising or the influence of trying to... And becoming more like, "Gee, do we need that?"
And then also I think we have to be mindful of climate change. People are like, "Well, most people aren't going to die. Well, why would you need to do extra?" I mean, that's my thing, it's like when water is going to become very, very scarce, why do we need to waste it? And so, I think that, with the younger generation, that has actually helped change the tide of information going forward. So, some of those articles in the Washington Post and The New York Times certainly have gotten a lot of debate and commentary, but I think that's what we need right now.
Darrell Dawsey: Is there any sort of clear-cut examples of the sort of changes that have been enacted or are being put in place as a result of your findings?
Tamara Hew-Butl...: The recommendations that we used to have to drink eight glasses, drink before you get thirsty, those recommendations are being toned down by some of the flagship organizations and they're recognizing that you can over-drink. So, I think that tide is turning, but it is very hard to undo something that your parents have taught you and people tell you for long periods of time, so I still get it with the coaches, I still get it with my own parents, "Bring your water bottle." I'm like, "Okay."
Darrell Dawsey: So do your parents, do they disagree with your research? Or...
Tamara Hew-Butl...: They always have a water bottle. I don't think they really understand my research to be honest with you. They're like, my mother, "I don't know," she says, "hypoonootreemia." And so, they kind of don't, they don't really understand what I study, but now they're sort of like, "Well, you can die." So, they realized that. But I think, too, the more that we can educate, the more that I educate my students and I educate the younger coaches and get the data out there, people are like, "Yeah." They're like, "Hah, that makes sense, that we all don't need exactly the same and maybe we don't need that much."
Darrell Dawsey: Now, you talk about educating the younger coaches, have any of your ideas taken hold at Wayne State in terms of the athletics department? Are we seeing some changes there?
Tamara Hew-Butl...: Well, what I'm really happy about, I've been working with the football team because football players have died from drinking too much water because of cramps, you know, "Drink the water." I'm out there. But I'm really pleasantly surprised, they let them drink when they're thirsty and they have a wide variety of water and sports drinks available, and we give them watermelon with salt. So, to me, they've really embraced what is the right message. Some locker rooms, they have the urine pee chart out there and they give them IVs before every game, but I'm really happy at Wayne State that I think that they're very pragmatic in their approach to hydration and so I've been very happy about that [inaudible 00:14:09]. Even with the Pistons, we test them with sweat sodium, so again, understanding it's not just about the water but about some of the sodium that you lose through sweat.
Darrell Dawsey: I wanted to ask you that, moving from sort of college to the pros, tell me a little bit more about your work with the Pistons and how did it start?
Tamara Hew-Butl...: I was in another place, and they were at Auburn Hills. I was testing, I guess you can delete this, I was testing basketball players at Oakland and they're like, "Oh, you have a DEXA and you do sweat." I'm like, "Yeah." So, then they were at Auburn Hills at the time and so they came into the lab kind of like unofficially but again then I had the opportunity to do more research here at Wayne State and I took it, and I also took it on the premise I knew that they were coming down here. Also, too, they knew who I was and what we can offer, which is body [inaudible 00:15:02] sweat sodium. And then Jordan Sabourin, who I work with, he was the strength and conditioning coach, he wanted to do his Ph.D., and that made it even easier for us to study what's going to make these guys better.
But also, they have this relationship where he and I can do some tests and now the G League has come in, we got the Motor City Cruise here and that's going to be another avenue. I started out studying runners, but basketball players are so tall that their physiology is really interesting. So that's how that started, and again, tagged to having Jordan as a Ph.D. student, a Wayne State Ph.D. student and working with the Pistons, that's really been nice. And I think that's where a lot of pro teams are going and the big collegiate teams, and Wayne State being a part of that, data science is going to infiltrate sports, where we're going to be led by the science and I think it's moving in that direction. So, sports performance is our niche. And again, too, that's the area that, that we feel that we can really make a difference within, inside of coaching, inside of athletics, as well as the work that we do with the normal population.
Darrell Dawsey: We talked a little bit about the hydration issue, but are there other sort of myths, other misperceptions, that folks who are interested in fitness, athletes, coaches, trainers, parents, are there other myths that are out there that are very closely held and perhaps pose the same sort of potential dangers as overhydration?
Tamara Hew-Butl...: I mean, there's myths everywhere, and they all probably come with supplements and that's the biggest thing. So, even for us, we did a study on vitamin D and again, tuning in, "Oh, that's hot," anything that's going to help performance. So anyway, with most of the literature, if you do randomized controlled trials, they find that there's no difference, but again [inaudible 00:17:08] we just do like screenings, there's relationships. But other myths that might hurt people? I mean, that's hard to say because, I mean, you go to social media and you hear something every day, B2, sleep, that it's hard to pinpoint but is it going to kill you? I mean, 10,000 steps, yeah, well, I mean, people argue do we need that 10,000, but they get too few or less or more, there's some variation to that.
But again, too, if there's any answer that I feel that might be relevant to that is, and peripherally related, is that the definition of exercise though has changed. Whereas exercise for us meant high vigorous activity, your heart rate gets up, 20 minutes three times a week, that will get increase your fitness. And now, in our sedentary societies, just like standing up from your computer is exercise. "Ooh, you know, one minute that's all you need to be healthy." So, I don't know if that's information that kills you, but from my perspective is, you know, studying people who overexercise, the minimum threshold has really, really moved where I'm not exactly sure all of that is healthy other than the fact that we do need to move, and that has to be a priority in going forward.
Darrell Dawsey: And too often we're not moving enough, right?
Tamara Hew-Butl...: Now, look at us.
Darrell Dawsey: Sedentary is [inaudible 00:18:45]. We're running a little low on time so I want to get ready to wrap up but I did want to ask you what's next on the horizon in terms of your work, what other things can we expect to see come from your research, from the work that you're doing here and in other places?
Tamara Hew-Butl...: I think we have two avenues. One is peak performance. We want to know how do we measure people's progression so that they actually don't overtrain? How do we bring them back alive? Two, we're looking at heart rate monitors, we're looking at body composition, we're looking at mental stress, to pull that all together. That will always continue because I think that is our biggest niche with high performance sports. But on the flip side, being here in Detroit, we have something called 10,000 Warriors where we want to get a snapshot of what does the community health look like? Again, too, we have a screening process where we're looking at physical health. So, we do the body composition with the DEXA scan. We do the strength testing and peak power jobs.
And then we look at metabolic health, blood pressure, blood glucose, and visceral belly fat. And then we look at depression and it gets you, people are like, "No, I don't want to. Like, let me get in shape." After the pandemic, they say that on average people have gained 26 pounds, so we have to address that now. We actually have to like, assessment, "Okay, here you are now, where do you want to go?" And we make some recommendations, so, "Try these things and then come back in six months," to see actually if we can improve health of Detroit and especially Wayne State students and faculty by actually just like doing preventative mechanisms by actually getting people moving, getting people exercising. And I think our lab, so that you have your own data to work with and then working to improve it, that's what we want to see come out of the lab work that we're doing.
Darrell Dawsey: OK. Ok. And hopefully that'll lead to a healthier Detroit, right? I mean, we have a big impact on what goes on in the city. Many of us are part of the city. Maybe these are ideas that hopefully we can take out to our respective communities.
Tamara Hew-Butl...: We hope so.
Darrell Dawsey: Make an impact. Well, Dr. Hew-Butler, I want to say thank you again for taking the time. I really enjoyed the conversation. I appreciate your energy and your very unique perspective on a lot of issues. I really thank you for taking your time to join us today.
Tamara Hew-Butl...: Thank you, and don't drink too much.
Darrell Dawsey: I will, at least I walk. I'll try not to. Thanks so much. You have a wonderful day.
Tamara Hew-Butl...: Thanks again, Darrell. Right. You, too.
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