The effects of dehydration, moderate alcohol consumption, and rehydration on cognitive functions

Menthol mouth rinsing and performance in elite football referees in the heat: A study protocol for a randomized crossover trial

Background

Within professional European competitions, matches can be played in extreme environmental temperatures, ranging from -5 °C to +30 °C in different countries. Furthermore, the World Cups are usually played in the summer months, when temperatures can exceed 35 °C, increasing physiological stress. Practical and cost-effective cooling strategies may be implemented to help players and referees to cope with exercising in the heat. No study has evaluated the effect of non-thermal internal cooling techniques regarding performance responses on elite football referees, so far. This study aims to analyse the effects of a menthol mouth rinse regarding physical, physiological, and perceptual performance in elite male football referees, during a 90-min football protocol in the heat.

Methods

At least thirteen male football referees will be recruited to perform two intermittent football protocols, separated by no less than 7 days. After passing the eligibility criteria, the participants will be randomly assigned to 1 of 2 beverages: (1) intervention - menthol solution 0.01% and (2) placebo - noncaloric berry-flavored solution, both at room temperature. The beverages will be given before warm-up (pre-cooling) and at the half-time (per-cooling). The trials will follow a randomized counterbalanced crossover design, single blinded, and will take place in indoor facilities, with Wet Bulb Globe Temperature (WBGT) > 30 °C, at the same time of the day to control for circadian variations.

Impact of the project

The results of this study are expected to determine whether mouth rinsing a menthol solution before and during a football exercise protocol performed in the heat will alter perceptual measures and help ease physiological strain and attenuate performance decrements in elite male football referees, comparing to a non-cooling strategy. Thus, we can be closer to defining nutritional strategies of internal cooling that may be an advantage for the performance of the football referees in the heat.

Trial registration

www.ClinicalTrials.gov NCT05632692 registered on 20 November 2022.

Meta-analysis of acute alcohol effects on response inhibition

Alcohol intoxication impairs response inhibition; however, discrepant findings have been reported regarding the magnitude and moderators of this effect. This meta-analysis of human laboratory studies aimed to quantify acute effects of alcohol on response inhibition and evaluate moderators of this effect. Eligible studies examined alcohol's effects on response inhibition with the Go/No-Go (GNG) task (n = 1616 participants) or Stop Signal Task (SST) (n = 1310 participants). Results revealed a detrimental effect of acute alcohol on response inhibition overall (g = 0.411, 95 % CI [0.350, 0.471]), with similar effects in studies using GNG (g = 0.431, SE = 0.031) and SST (g = 0.366, SE = 0.063). Effect sizes were larger in studies involving higher breath alcohol concentration levels and under GNG conditions that established a prepotent response set. These findings establish the magnitude, precision, and potential moderators of alcohol's effects on inhibitory control, furthering understanding of a key neurobehavioral mechanism proposed to underlie alcohol-related impulsivity and impaired control over consumption.

Behavioral effects of ethanol in the Red Swamp Crayfish (Procambarus clarkii)

Alcohol abuse remains one of the primary preventable sources of mortality in the United States. Model species can be used to evaluate behavioral and other biological changes associated with alcohol and to identify novel treatments. This report describes methods for evaluating the behavioral effects of ethanol (EtOH) in crayfish. Crayfish (Procambarus clarkii) were immersed in ethanol concentrations ranging from 0.1 to 1.0 molar, for 10-30 min. Studies evaluated hemolymph alcohol concentration, locomotion in an open field and anxiety-like behavior using a Light/Dark transfer approach. EtOH immersion produced dose-dependent increases in hemolymph EtOH (up to 249 mg/dL) and reductions in open field locomotion that depended on EtOH concentration or exposure duration. Untreated crayfish exhibit avoidance of the open parts of the locomotor arena and a preference for a covered portion. Acute EtOH immersion decreased time spent in the covered portion of the Light/Dark arena, consistent with a decrease in anxiety-like behavior. Daily EtOH immersion for 5 days did not alter locomotor responses, however, activity was increased 3 days after the repeated EtOH regimen. Overall, this study shows that this inexpensive, easily maintained species can be used for behavioral pharmacological experiments designed to assess the acute and repeated effects of EtOH.

Does Hydration Status Influence Executive Function? A Systematic Review

BACKGROUND

Cognitive function, including executive function (EF)-related capacities (eg, working memory, inhibitory and attentional control), has been linked to adherence to healthy lifestyle behaviors. Dehydration is associated with impaired cognitive function, whereas improvements in hydration status may improve inhibitory and attentional performance. No systematic reviews have examined the effects of both dehydration and euhydration on EF.

OBJECTIVE

The objectives of this systematic review are to examine studies that have investigated the spectrum of hydration status and EF in adults, and to identify future research needs.

DESIGN

The review was conducted according to the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. The database search was initially conducted on May 12, 2019 and then updated on April 26, 2020. Databases searched included PubMed, Medline, Psyc Info, SCOPUS, Proquest, and ISI Web of Science. Data extraction included the following: method used to assess de/hydration status, study design, participant characteristics, EF tasks and domain, and results. Article quality ratings were performed on included studies using the Academy of Nutrition and Dietetics Quality Rating Checklist.

PARTICIPANTS/SETTING

Studies done with healthy or diseased adults, aged older than 18 years, in any setting, were included. Studies of individuals with disease states that impact fluid balance or require fluid restrictions as treatments were excluded.

MAIN OUTCOME MEASURE

All EF-related outcomes were included, such as working memory, inhibitory control, task switching, and attention.

RESULTS

Four thousand eight hundred thirty-three articles were screened using title/abstracts. Seventy-one full-text articles were assessed for eligibility; 33 were included (26 included investigations of dehydration; 27 included investigations of rehydration/euhydration) with 3,636 participants across all studies. Little consistency was found across outcomes. Roughly half of the available studies suggested unclear or neutral EF effects, and half suggested effects on EF domains, particularly working memory, inhibitory control, and attention. Studies including a euhydration condition were slightly more likely to demonstrate improvements to EF capacities.

CONCLUSIONS

Overall, there is a strong need for consistent methodological approaches and a greater number of long-term (ie, >3 days) studies of dehydration and euhydration and EF.

Organic Winemaking and Its Subsets; Biodynamic, Natural, and Clean Wine in California

From the ancient times, when wine/oenos was described as "Wine, the benevolent demon" by ancient Greek gastronomist and philosopher Athinaios in "Dipnosofistes", to modern days, the craft has seen significant fruition. The wine industry has evolved over time, and more so recently, to encompass many different subsets, one of which is the organic wine market. The organic wine industry has grown in recent years, especially in California. This rapid gain in interest has resulted in the evolution of several subsets, including biodynamic, natural, and clean wine. While biodynamic and natural wine, function more as a fulfillment of niche markets, clean wine may provide benefits for consumers that otherwise suffer from side effects of wine consumption. Low sulfite levels and lack of histamines in clean wine plausibly decrease headaches and adverse effects some consumers experience when drinking wine. An overview of the organic wine industry and its evolution with potential contributions to consumers, with an emphasis on clean wine, is discussed herein.

Intoxicated aggression: Do alcohol and stimulants cause dose-related aggression? A review

RATIONALE

Violence and drug use are significant public health challenges that are strongly linked. It is known that alcohol plays a major role in the causation of unnatural deaths and that stimulants like cocaine and amphetamine are often implicated in aggressive acts or violence. However, a clear causal relationship between these substances and aggression, and more specifically a blood concentration threshold at which intoxicated aggression emerges is lacking. In case of a crime and subsequent law enforcement, knowledge about dose-response relationships could be of pivotal importance when evaluating the role of alcohol and drugs in aggressive offences.

AIMS

The present review aimed to determine whether there is a causal relation between intoxication with these psychoactive substances and aggression, and to define blood concentration thresholds above which these substances elicit aggression.

METHODS

Empirical articles published between 2013 and 2017 and review papers containing the predefined search strings were identified through searches in the PubMed and Embase databases and additional reference list searches. The complete search query yielded 1578 publications. Initially all articles were manually screened by title and abstract. Articles with irrelevant titles, given the selected search terms and review aims were discarded. Remaining articles were carefully studied and those that did not comply with the main objectives of this review were discarded. At the end of this process, 167 titles were found eligible for review.

FINDINGS AND CONCLUSION

While placebo-controlled experimental studies clearly showed a causal link between alcohol and aggression, it is evident that such a link has not yet been established for cocaine and amphetamines. In case of alcohol, it is clear that there are various individual and contextual factors that may contribute to the occurrence of an aggressive act during intoxication. A clear threshold blood alcohol concentration has not been defined yet for alcohol, but a statistically significant increase of aggression has been demonstrated at a dose of 0.75 g/kg and higher. Future studies into intoxicated aggression should include multiple doses of alcohol and stimulants and take into account individual and contextual factors.

Effects of Dehydration and Rehydration on Cognitive Performance and Mood among Male College Students in Cangzhou, China: A Self-Controlled Trial

Water accounts for 75% of brain mass. Associations may exist between hydration and cognitive performance. The objective of this study was to investigate the effects of dehydration and rehydration on cognitive performance and mood. In this self-control trial, 12 men were recruited from a medical college in Cangzhou, China. After 12 h of overnight fasting, the participants took baseline tests at 8:00 AM on day 2. First morning urine and blood osmolality were analyzed to determine hydration state. Height, weight, and blood pressure were measured following standardized procedures. A visual analog scale for the subjective sensation of thirst was applied, and a profile of mood states questionnaire was applied. Tests were conducted for cognitive performance, including a test of digit span forward and backward, digit-symbol substitutions, dose-work, and stroop effects. Participants were required not to drink water for 36 h but were given three meals on day 3. On day 4, the same indexes were tested as a baseline test. At 8:30 AM, participants drank 1500 mL of purified water over 15 min. After a 1 h interval, the same measurements were performed. Compared with baseline test results, during the dehydration test, participants had lower scores of vigor (11.9 vs. 8.8, %, p = 0.007) and esteem-related affect (8.2 vs. 5.7, %, p = 0.006), lower total scores of digit span (14.3 vs. 13.3, %, p = 0.004), and higher error rates for dose-work (0.01 vs. 0.16, %, p = 0.005). Compared with the dehydration test scores, rehydration test scores showed that fatigue (4.3 vs. 2.1, %, p = 0.005) and total mood disturbance (TMD) (99.0 vs. 90.2, %, p = 0.008) improved, and scores of forward, backward, and total digit span increased (7.7 vs. 8.6, p = 0.014; 5.7 vs. 1.2, p = 0.019; 13.3 vs. 15.4, p = 0.001). Increases were also noted in correct number of digit symbol substitutions, reading speed, and mental work ability (70.8 vs. 75.4, p < 0.001; 339.3 vs. 486.4, n/min, p < 0.001; 356.1 vs. 450.2, p < 0.001), and reaction time decreased (30.2 vs. 28.7, s, p = 0.002). As a conclusion, dehydration had negative effects on vigor, esteem-related affect, short-term memory, and attention. Rehydration after water supplementation alleviated fatigue and improved TMD, short-term memory, attention, and reaction.

Evaluation of a new non-invasive measurement technique based on bioimpedance spectroscopy to estimate blood alcohol content: a pilot study

The gold standard for estimating blood alcohol content (BAC) after alcohol consumption is a blood sample analysis. An innovative technology to estimate BAC is based on impedance cardiography and bioimpedance spectroscopy (BIS). This study investigated whether it is possible to estimate increasing blood alcohol levels during a drinking trial with bioimpedance measurement techniques. Twenty-one healthy volunteers were assigned to a test (ethanol) group (ETH) or a reference group (H2O). After baseline measurements, the ETH group ingested 120 ml of vodka, followed by a resorption phase of 50 min. Then, bioimpedance and breath alcohol measurements were performed. Thereafter, 60 ml of vodka was ingested and another resorption phase of 50 min was followed by bioimpedance and breath alcohol measurements. This procedure was repeated until alcohol levels exceeded 0.4 mg/l. The H2O group performed in the same way with water. For all measurements, extracellular resistance (Re) and the base impedance (Z0) were computed. Regarding BIS, several parameters differed significantly between the ETH and the H2O group. Re increased in ETH (p=0.005), but not in the H2O group when comparing the first and last measurements. Z0 also increased significantly in the ETH group (p=0.001). To conclude, with BIS measurements, it is possible to measure increasing blood alcohol levels.

Effects of Consuming a Low Dose of Alcohol with Mixers Containing Carbohydrate or Artificial Sweetener on Simulated Driving Performance

The Australian National Drug and Alcohol Research Centre (NDARC) devised gender-based drinking recommendations to ensure blood or equivalized breath alcohol concentrations (BrAC) remain <0.050%. However, these may be inappropriate for individuals consuming alcohol without carbohydrate (CHO), which results in higher BrACs. This study investigated the effects of ingesting alcohol with and without CHO on BrACs and simulated driving performance. Thirty-two participants (16 males; age: 23 ± 6 years) completed two randomized single-blinded trials. Participants performed a baseline drive (Drive 1), then an experimental drive (Drive 2), following alcohol consumption (males: 20 g; females: 10 g). Alcoholic beverages contained either 25 g sucrose or aspartame (AS). Driving performance was assessed using lateral control (standard deviation of lane position [SDLP] and number of lane departures) and risk-taking (number of overtaking maneuvers and maximum overtaking speed). BrAC and subjective ratings (e.g., intoxication) were also assessed. BrAC was significantly lower as Drive 2 commenced with CHO compared to AS (0.022 ± 0.008% vs. 0.030 ± 0.011%). Two males provided BrACs >0.050% with AS. Neither beverage influenced changes to simulated driving performance. Ingesting alcohol in quantities advised by the NDARC results in no detectable simulated driving impairment. However, the likelihood of exceeding the legal drink-driving BrAC is increased when alcohol is consumed with artificially-sweetened mixers.

Hydration: The New FIFA World Cup's Challenge for Referee Decision Making?

Various continental sporting events have exposed team sports referees to different environmental conditions. Several studies have focused on strategies to prevent athlete performance impairment induced by heat or warm (or both) conditions, but few authors have investigated the effect of heat on referees' performance. In a thermoneutral environment, referees' physical activity induced mild 2.0% dehydration, which was responsible for reductions in physical, psychomotor, and cognitive performances. Therefore, the hydration status of referees should be taken into account to reduce referees' errors and misjudgments in the heat.

Dietary nitrate improves sprint performance and cognitive function during prolonged intermittent exercise

It is possible that dietary nitrate (NO3 (-)) supplementation may improve both physical and cognitive performance via its influence on blood flow and cellular energetics.

PURPOSE

To investigate the effects of dietary NO3 (-) supplementation on exercise performance and cognitive function during a prolonged intermittent sprint test (IST) protocol, which was designed to reflect typical work patterns during team sports.

METHODS

In a double-blind randomised crossover study, 16 male team-sport players received NO3 (-)-rich (BR; 140 mL day(-1); 12.8 mmol of NO3 (-)), and NO3 (-)-depleted (PL; 140 mL day(-1); 0.08 mmol NO3 (-)) beetroot juice for 7 days. On day 7 of supplementation, subjects completed the IST (two 40-min "halves" of repeated 2-min blocks consisting of a 6-s "all-out" sprint, 100-s active recovery and 20 s of rest), on a cycle ergometer during which cognitive tasks were simultaneously performed.

RESULTS

Total work done during the sprints of the IST was greater in BR (123 ± 19 kJ) compared to PL (119 ± 17 kJ; P < 0.05). Reaction time of response to the cognitive tasks in the second half of the IST was improved in BR compared to PL (BR first half: 820 ± 96 vs. second half: 817 ± 86 ms; PL first half: 824 ± 114 vs. second half: 847 ± 118 ms; P < 0.05). There was no difference in response accuracy.

CONCLUSIONS

These findings suggest that dietary NO3 (-) enhances repeated sprint performance and may attenuate the decline in cognitive function (and specifically reaction time) that may occur during prolonged intermittent exercise.

Postexercise rehydration with beer impairs fluid retention, reaction time, and balance

Beer is promoted by popular media as a good choice for rehydration, but there is limited support for the claim. To assess the effect of beer alcohol on rehydration and motor control, 11 young (24.4 ± 3.7 years old) males of legal drinking age were dehydrated to 2.12% ± 0.20% body mass (mean ± SD) by exercising in a climatic chamber (31.7 ± 1.6 °C, 55.0% ± 8.3% relative humidity) on 3 different days, 1 week apart, and rehydrated with 100% of their sweat loss using water (WATER), 4.6% alcohol beer (BEER), or low-alcohol beer (LAB), in random order. Urine output, blood alcohol content (BAC), reaction time (RT), and balance (as measured by center of pressure velocity (VCoP)) were measured every 30 min over 3 h and compared via 2-way, repeated-measures analyses of variance (ANOVAs). After consuming ≈1.6 L in 1 h, urine output was greater for BEER (1218 ± 279 mL) than for LAB (745 ± 313 mL, p = 0.007) and WATER (774 ± 304 mL, p = 0.043). BAC remained at 0 with WATER and LAB; with BEER, BAC reached 0.857 g/L (95% confidence intervals [0.752, 0.963]) immediately postrehydration. RT was longer for BEER (0.314 ± 0.039 s) than for LAB (0.294 ± 0.034 s, p = 0.009), but was no different from WATER (0.293 ± 0.049 s, p = 0.077). VCoPx was significantly higher for BEER (0.0284 ± 0.0020 m/s) compared with LAB (0.0233 ± 0.0010 m/s) or WATER (0.0238 ± 0.0010 m/s) (p = 0.022), but VCoPy was not different among beverages. In conclusion, rehydration with BEER resulted in higher diuresis, slower RT, and impaired VCoP than rehydration with LAB or WATER.

Cognitive effects of hospital calls in anaesthesiologists

BACKGROUND

The work hours of Norwegian physicians are under scrutiny because of an increased public focus on patient safety. Ample international research indicate harmful effects of doctor fatigue based on studies on physicians working long weeks and on-call shifts of more than 30 consecutive hours. There is a lack of research on effects relevant for short or intermediate length of work weeks and call shifts. This study intended to study cognitive effects of short or intermediate duration in-hospital calls.

METHODS

Eighteen anaesthesiology residents working on-call at an operation ward or an intensive care unit at Haukeland University Hospital were invited to participate. Schedules were adapted to allow for two additional experimental shifts. Participants were subjected to Cambridge Neuropsychological Test Automated Battery cognitive testing in a rested state and on three occasions after call. Amount of sleep and self-assessed sleepiness were recorded.

RESULTS

Ten residents completed all four tests during 10 months. Reaction time was longer post-call. It was significantly increased only after the 18 h night call, by 21.1 and 20.5 ms for simple and five-choice reaction time, respectively. Executive function was not significantly altered post-call. Visual memory was improved post-call. Karolinska Sleepiness Score was increased by 3.3 (long day), 2.1 (short night) and 2.5 (long night) points post-call.

CONCLUSION

Reaction times were increased after 18 h night calls and non-significant increases in reaction times were apparent after the other on-call shifts. Self reported sleepiness was increased post-call. We were not able to conclude whether executive function or memory was negatively affected post-call.

Mild to moderate dehydration combined with moderate alcohol consumption has no influence on simulated driving performance

OBJECTIVE

Many people consume alcoholic beverages following a period of physical activity that results in fluid loss through sweating (e.g., after sports, work). Adequate rehydration following physical activity may not occur, consequently resulting in the consumption of alcohol in a dehydrated state. This may have serious implications for the safety of individuals operating motor vehicles. Therefore, this study investigated the impact of mild-moderate dehydration in combination with moderate alcohol consumption on simulated driving performance.

METHODS

Fourteen healthy males participated in a placebo-controlled crossover design study involving 4 experimental trials (separated by 4 days or more). In each trial, participants were dehydrated by ∼2 percent body mass through exercise. After a 30-min recovery, participants completed a 15-min computerized simulated driving task (drive 1). In 2 of the trials, participants were provided with water equivalent to either 50 or 150 percent body mass loss and also received salt capsules (NaCl, 50 mmol/L). A set volume of alcohol or placebo was then consumed in each trial, incorporating the conditions: dehydration-placebo (DP), dehydration-alcohol (DA), partial rehydration-alcohol (PA), and full rehydration-alcohol (FA). The volume of the alcoholic beverage was individually calculated and intended to raise the blood alcohol content (BAC) to ∼0.05 percent. The same driving task was then readministered (drive 2). Primary outcome measures of driving consisted of standard deviation of lateral position (SDLP), number of side and center line crossings (LC), number of failures to stop at red traffic signals (FTS), number of impacts/collisions with other vehicles or objects (IMP), and time to collision with a specified lead vehicle (TTC). In addition, reaction time (RT) and incorrect inhibition response (IIR) behavior to critical events were collected throughout each experimental drive. Subjective ratings of mood and estimates of alcohol intoxication and driving impairment were also recorded in each trial.

RESULTS

No effects of trial condition were observed on any of the driving performance measures or on subjective ratings of mood, alcohol intoxication, and driving impairment. SDLP was higher following the consumption of alcohol compared to the placebo trial. However, no differences in SDLP were recorded between the alcohol trials, indicating that hydration level had no observable interaction with alcohol to influence SDLP performance.

CONCLUSIONS

Overall, it appears that dehydration does not exacerbate impairment in driving performance caused by mild-moderate alcohol intoxication. Further research is required to clarify the effects of alcohol and dehydration at various alcohol doses.