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Hoffman, MD and Stuempfle, KJ. Is sodium supplementation necessary to avoid dehydration during prolonged exercise in the heat? J Strength Cond Res 30(3): 615–620, 2016—The primary purpose of this work was to gain further insight into the need for sodium supplementation for maintenance of appropriate hydration during prolonged exercise under hot conditions. Participants of a 161-km ultramarathon (ambient temperature reaching 39° C) underwent body weight measurements immediately before, during, and after the race, and completed a postrace questionnaire about supplemental sodium intake and drinking strategies during 4 race segments. The postrace questionnaire was completed by 233 (78.7%) race finishers. Significant direct relationships were found for percentage weight change during the race with intake rate (r = 0.18, p = 0.0058) and total amount (r = 0.24, p = 0.0002) of sodium in supplements. Comparing those using no sodium supplements throughout the race (n = 15) with those using sodium supplements each race segment (n = 138), body weight change across the course showed significant group (p = 0.022), course location (p < 0.0001), and interaction (p = 0.0098) effects. Posttests revealed greater weight loss at 90 km (p = 0.016, −3.2 ± 1.6% vs. −2.2 ± 1.5%, mean ± SD) and the finish (p = 0.014, −3.2 ± 1.5% vs. −1.9 ± 1.9%) for those using no sodium supplements compared with those using sodium supplements each segment. Six runners who used no sodium supplements, drank to thirst, and only drank water or a mixture of mostly water with some electrolyte-containing drink finished with mean weight change of −3.4%. Although the use of supplemental sodium enhanced body weight maintenance, those not using sodium supplements maintained a more appropriate weight than those consistently using sodium supplements. Therefore, we conclude that the supplemental sodium is unnecessary to maintain appropriate hydration during prolonged exercise in the heat.