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Nutrition in Sports MAJ Michael R. Simpson, DO Sports Medicine Fellow VCU- Fairfax Family Practice February 2008.

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Presentation on theme: "Nutrition in Sports MAJ Michael R. Simpson, DO Sports Medicine Fellow VCU- Fairfax Family Practice February 2008."— Presentation transcript:

1 Nutrition in Sports MAJ Michael R. Simpson, DO Sports Medicine Fellow VCU- Fairfax Family Practice February 2008

2 Objectives Understand basic concepts of pre-race, race, and post-race nutritionUnderstand basic concepts of pre-race, race, and post-race nutrition Discuss basic hydration and prevention of exertional hyponatremia strategiesDiscuss basic hydration and prevention of exertional hyponatremia strategies Be able to educate athletes about the facts and fallacies of endurance sports nutritionBe able to educate athletes about the facts and fallacies of endurance sports nutrition

3 Endurance Athlete Questions Training and game day….should I and how do I carbo load?Training and game day….should I and how do I carbo load? What combo of carbs, fat, and protein is best prior to the race and long distance training?What combo of carbs, fat, and protein is best prior to the race and long distance training? During training and game dayDuring training and game day –Water or sports drink? How much do I need to drink? –Gels, carbs, or protein? –How many calories and how often? –Will caffeine help me perform better?

4 Endurance Athlete Questions After the race or game:After the race or game: –What and how much should I drink? –What should I eat? –When should I eat? Are there any proven legal sports supplements that I can use to improve my performance?Are there any proven legal sports supplements that I can use to improve my performance?

5 Keys to Endurance Performance Maximize and maintain fuel (glycogen) supplies Maintain and optimize hydration and electrolyte balance Prevent protein breakdown and maximize synthesis Efficient and timely recovery from prior bout of exercise

6 Lets Talk Carbohydrates Carbos (CHO) converted to glycogen and stored in muscles and liver.Carbos (CHO) converted to glycogen and stored in muscles and liver. Glycogen is #1 fuel source for endurance events of moderate to high intensityGlycogen is #1 fuel source for endurance events of moderate to high intensity Glycogen repletion is slow and recovery time is directly related to ability to replenishGlycogen repletion is slow and recovery time is directly related to ability to replenish Maintaining and restoring glycogen is key to performanceMaintaining and restoring glycogen is key to performance

7 Lets Talk Carbohydrates Carbo loading –Old school: One week low carbs (deplete) with 1-3 day high carbs prior –New school: 3 days of high carbo diet before race or long distance training session –Events longer than minutes Goal: Pre-training/race build up glycogen stores to prevent bonking or hitting the wall

8 Comparison of Diets Low CHO diet (40% kcal from CHO)Low CHO diet (40% kcal from CHO) –Double cheeseburger –Medium fries –Chocolate milkshake High CHO diet (70% kcal from CHO) –12 inch sub sandwich (lots of vegetables & no mayo) –500 ml apple juice –250 ml chocolate milk –banana

9 Day 1Day 2Day 3 Time Muscle Glycogen (mM/kg wet wt) High CHO Low CHO Effects of Diet on Muscle Glycogen Content

10 Lets Talk Carbohydrates (Training and Game/Race Day) Training and race day diet should consist of:Training and race day diet should consist of: –CHO: % (6-10 grams per kilogram of body weight or 8-10 kcals per kilogram) –Fats: 25-30% (no benefit to extra) –Protein: 12-15% ( grams per kilogram) of high quality protein

11 Carbohydrate Snacks Foods supplying 50 grams CHOFoods supplying 50 grams CHO –500 ml juice –3 medium pieces of fruit –1 honey sandwich –2 breakfast bars –1 sports bar (check label) –1.3 bagels –1/2 cup dried fruit –1 cup white rice –1 baked potato *average 70 kg endurance athlete should consume 560 grams CHO per day

12 Sport Bars Developed to provide an easily accessible source of CHODeveloped to provide an easily accessible source of CHO Many bars provide complex proteins and may be high in fat.Many bars provide complex proteins and may be high in fat. –Vary in type and amount of energy, CHO, protein and fat. –Some provide only 150 kcal and others up to 340 kcal –Many contain other agents, herbs, etc –READ LABELS CLOSELY! *average sports bar provides about grams of CHO

13 Brands of Sports Bars Atkins Advantage BarAtkins Advantage Bar Balance BarBalance Bar Bioprotein BarBioprotein Bar Clif BarClif Bar Detour BarDetour Bar Gatorade Energy BarGatorade Energy Bar GeniSoyGeniSoy Ironman Triathlon BarIronman Triathlon Bar Low Carb Keto-BarLow Carb Keto-Bar Luna BarLuna Bar Metabolift BarMetabolift Bar Met-Rx PowerBar PremierNutrition Bar Protein Revolution Low Carb Bar Think Divine Tigers Milk ZonePerfect Sugar-Free ProteinPlus Ultimate Low-Carb Bar

14 Sport Gels Designed to deliver large amount of CHO in compact and easily consumed formDesigned to deliver large amount of CHO in compact and easily consumed form Very slowly absorbed by body and must have adequate amounts of water to dilute and lower osmolalityVery slowly absorbed by body and must have adequate amounts of water to dilute and lower osmolality Gels may be effective source of energy, but challenge is taking in enough fluid.Gels may be effective source of energy, but challenge is taking in enough fluid. About 100 calories per package (25 grams CHO)About 100 calories per package (25 grams CHO)

15 Brands of Sport Gels e-Gele-Gel GUGU Power GelPower Gel Clif ShotClif Shot Hammer GelHammer Gel

16 Composition of Sport Gels Crank Sports e- Gel 82% Complex/ 18% Simple CHO Amino acids, vitamin B6, antioxidants, GU Energy Gel 80% Maltodextrin/ 20% Fructose Amino acids, herbal blend, antioxidants, caffeine Power Gel Maltodextrin, fructose, dextrose Amino acids, vitamins C/E, caffeine, kola nut, ginseng Clif Shot Energy Gel 60% Complex/40% Simple CHO from rice Magnesium, caffeine (some flavors) Hammer Gel 100% Maltodextrin Caffeine (some flavors), amino acids

17 Glycemic Index and Insulin Response Index Glycemic Index (GI): Ranking of food based on blood glucose response to reference foodRanking of food based on blood glucose response to reference food –High GI (dextrose and maltose): Evoke large increases in glucose Carrots, raisins, corn flakes, breads, rice cakesCarrots, raisins, corn flakes, breads, rice cakes –Low/Moderate GI (sucrose and lactose): Evoke small/modest increases in glucose. i.e.. Yogurt, apples, dried fruit, lentils, beansi.e.. Yogurt, apples, dried fruit, lentils, beans Insulin Response Index (IRI): Ranking of food based on blood insulin response to same reference foodRanking of food based on blood insulin response to same reference food

18 Glycemic Index of Foods GI > 85 White BagelWhite Bagel English MuffinsEnglish Muffins DoughnutDoughnut RaisinsRaisins Corn ChipsCorn Chips Ice CreamIce Cream Sports DrinksSports Drinks GI < 60 Yogurt Grapefruit/Oranges Beans Peanuts Apples/Pears/Plums Milk Brown Rice

19 Practical Use of GI and IRI Pre-race/trainingPre-race/training –Low to moderate best to build up glycogen stores, avoid glucose-insulin spikes, GI tolerability During raceDuring race –Moderate to high is best for sustained energy

20 Comparison of CHOs in Gel Products HoneyHoney FructoseFructose Power GelPower Gel SucroseSucrose DextroseDextrose MaltodextrinMaltodextrin CHOGI IRI Research funded by the National Honey Board Richard Kreider, PhD

21 Concerns with Sport Gels High cost alternativeHigh cost alternative Some brands also contain other compoundsSome brands also contain other compounds Gastrointestinal intoleranceGastrointestinal intolerance Should be used during training to assess tolerance for use during raceShould be used during training to assess tolerance for use during race May lead to over consumption/over-reliance on low-nutrient CHO sourcesMay lead to over consumption/over-reliance on low-nutrient CHO sources

22 Carbos During The Race/Training Events lasting longer than 60 minutesEvents lasting longer than 60 minutes Ingest grams of CHO per hour (2 gel packs)Ingest grams of CHO per hour (2 gel packs) GI tolerableGI tolerable With waterWith water Prevent bonkingPrevent bonking

23 Carbos After The Race/Training Timing is everything To replenish glycogen stores after exercise, grams of CHO/kg body weight should be ingested within 30 min and repeated every 2 hr for 4 to 6 hr. Add a little protein Van Hall G et al. J Appl Physiol. 2000;88:

24 Recovery Time (hr) Muscle Glycogen Resynthesis Rate Muscle Glycogen (nmol/kg) van Hall G et al. J Appl Physiol

25 Carbo Summary For Your Athlete For long training runs and game day –60-70% CHO diet for 3 days prior, and decrease the training load –Use low GI foods –Avoid high GI foods 1-3 hours before run/race During run/race –Moderate to high GI source –100 calories every minutes for sessions longer than 60 minutes After run/race –Carbs within 30 minutes and continued for the rest of the day; some protein Practice your nutrition; never try something new on race day!

26 Protein Balance Bottom Line Positive protein/AA balance is important in muscle recoveryPositive protein/AA balance is important in muscle recovery 4:1 carbo to protein replacement after exercise probably helpful4:1 carbo to protein replacement after exercise probably helpful More research neededMore research needed

27 Hydration and Electrolyte Balance WATER IS MOST ESSENTIAL NUTRIENTWATER IS MOST ESSENTIAL NUTRIENT –60% of body is water –75% of skeletal muscle is water Important functions of water Important functions of water –Makes up plasma, which transports and delivers nutrients to tissues –Maintains body temperature and pH –Maintains blood circulation and pressure –Supports energy processes

28 Fluid Balance

29 Dehydration and Performance

30 Urine color test for dehydration LemonadeThe good Apple juiceThe bad TeaThe ugly Monitoring Hydration Status

31 Indices of Hydration % Body Weight Change Urine Color Well Hydrated -1 to +1% 1 or 2 Minimal Dehydration -1 to -3% 3 or 4 Significant Dehydration -3 to -5% 5 or 6 Serious Dehydration > -5% > 6

32 Establishing Fluid Needs Estimate sweat rate or amount of fluid lost in a specified period of time during defined exercise workloadEstimate sweat rate or amount of fluid lost in a specified period of time during defined exercise workload –A:Body weight: Pre - Post –B:Fluid intake: Total volume –C:Urine volume Sweat loss = A + B - CSweat loss = A + B - C Sweat rate = Sweat loss/timeSweat rate = Sweat loss/time

33 Example of Fluid Needs Body weightBody weight –Before = 70 kg and after = 67 kg Fluid intake = 1.8 LFluid intake = 1.8 L Urine volume = 0.7 LUrine volume = 0.7 L Time = 2 hours or 120 min.Time = 2 hours or 120 min. Sweat loss = ( ) = 4.1Sweat loss = ( ) = 4.1 Sweat rate = 4.1 L/2 hrs = 2.05 L/hrSweat rate = 4.1 L/2 hrs = 2.05 L/hr

34 Pre-Exercise Hydration Guidelines Obtain body weight.Obtain body weight. Check color of morning urine - pale color (1 - 3) indicates a good hydration statusCheck color of morning urine - pale color (1 - 3) indicates a good hydration status Drink 16 to 20 fl oz of water or sports beverage 2 to 3 hrs beforeDrink 16 to 20 fl oz of water or sports beverage 2 to 3 hrs before Drink 8 to 12 fl oz of water 0 to 10 min before exerciseDrink 8 to 12 fl oz of water 0 to 10 min before exercise

35 During Exercise Hydration Guidelines Drink 3-8 fl oz of water every min when exercising for < 60 minDrink 3-8 fl oz of water every min when exercising for < 60 min Drink 3-8 fl oz of a beverage with CHO (5% to 8%) and sodium every min when exercising > 60 minDrink 3-8 fl oz of a beverage with CHO (5% to 8%) and sodium every min when exercising > 60 min DO NOT DRINK MORE THAN 1 L or 1 Qt/hr during exerciseDO NOT DRINK MORE THAN 1 L or 1 Qt/hr during exercise *One size does not fit all!

36 Post-Exercise Hydration Guidelines Obtain body weight to estimate fluid losses and correct losses within 2 hrsObtain body weight to estimate fluid losses and correct losses within 2 hrs Consume 1 liter of fluid for every liter lostConsume 1 liter of fluid for every liter lost When re-hydrating rapidly, ingest 25% more than sweat losses to assure optimal hydration within 4 to 6 hrs after exerciseWhen re-hydrating rapidly, ingest 25% more than sweat losses to assure optimal hydration within 4 to 6 hrs after exercise Beverage should contain water to restore hydration status, CHO to replenish glycogen stores, some protein, and sodium to accelerate re-hydrationBeverage should contain water to restore hydration status, CHO to replenish glycogen stores, some protein, and sodium to accelerate re-hydration

37 ACSM Position Thirst is not the best hydration indicator for active people and those who are exposed to heat Athletes should replace fluids in amounts that approximate sweat losses.

38 Hydration Guidance For Your Runner Monitor morning hydration and pre-hydrateMonitor morning hydration and pre-hydrate Estimate your sweat rate and replace ( ml per hour)Estimate your sweat rate and replace ( ml per hour) Never gain weight!Never gain weight! Salty sweater….salt supplementSalty sweater….salt supplement Sports drinks for > 60 minuteSports drinks for > 60 minute Resist temptation to drink at every water stopResist temptation to drink at every water stop Thirst is a poor indicator of hydration statusThirst is a poor indicator of hydration status

39 Endurance Event Performance Enhancement EPO = illegal RBC transfusion = illegal Caffeine does improve endurance performance within legal limits USADA:

40 Summary Nutrition and hydration are key elements to performanceNutrition and hydration are key elements to performance High carb diet with protein and some fatHigh carb diet with protein and some fat Timing is importantTiming is important Sports drink versus waterSports drink versus water Never gain weight and consider salt supplementNever gain weight and consider salt supplement Practice your nutrition and hydration; never experiment on race day!Practice your nutrition and hydration; never experiment on race day!

41 References 1.American College of Sports Medicine: American Dietetic Association and Dietitians of Canada: Joint position statement nutrition and athletic performance. Med Sci Sports Exerc , DiMarco NM, Samuels M: Nutritional considerations, in OConnor FG, Wilder RP (eds): Textbook of Running Medicine, New York, NY, McGraw Hill 2001, pp Casa D.J., Armstrong L.E., Hillman S.K., National Athletic Trainer's Association position statement: fluid replacement for athletes. J Athl Train (2000) 35 : pp Casa D.J., Armstrong L.E., Hillman S.K., National Athletic Trainer's Association position statement: fluid replacement for athletes. J Athl Train (2000) 35 : pp American College of Sports Medicine Position Stand: Exercise and Fluid Replacement. Med Sci Sports Exerc , 2007.

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