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Sports Nutrition Research Update 2009 with exercise physiology, strength conditioning & topics of interest in sports medicine G. DOUGLAS ANDERSEN DC DACBSP,

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Presentation on theme: "Sports Nutrition Research Update 2009 with exercise physiology, strength conditioning & topics of interest in sports medicine G. DOUGLAS ANDERSEN DC DACBSP,"— Presentation transcript:

1 Sports Nutrition Research Update 2009 with exercise physiology, strength conditioning & topics of interest in sports medicine G. DOUGLAS ANDERSEN DC DACBSP, CCN

2 Carb Loading Update CHO loading was first studied in the early 1960’s Vigorous exercise of 1-3 days followed by 3 days of rest accompanied simultaneous dietary manipulation of low and high carbohydrates. Various protocols had mixed results with some responding while others did not. The theory that super compensating glycogen stores would provide biochemical advantage Performance was not always improved and sometimes (loading CHO) it was harmful.

3 Carb Loading Update Early Problems Marked dietary changes prior to competition were hard to follow Major dietary changes often disrupt GI rhythm leading to gas, bloating and stool changes. Exercise increases (to deplete glycogen) so close to competition altered established tapers. Increased injuries from glycogen depleting exercise.

4 Carb Loading Improvements   In the 1980’s 3-4 days of exercise taper followed by 3 high CHO days made the process much more practical.   Research then showed depletion exercise was not required to super-compensate contractile tissues and, once elevated, would remain so for 3-5 days provided calories were adequate & activity was low   In a 2002 study, 1 day of inactivity with a high (10g/kg/bw) CHO intake of high glycemic index CHO’s elevated glycogen 90% with no additional benefit with 2 more days. Sedlock, D., The Latest Carbohydrate Loading: A Practical Approach. Cur. Sports Med. Reports 2008; 7(4)

5 Carb Loading Summary Glycogen super-compensation can remain elevated for up to 5 days. For each gram of stored glycogen, 3-5 grams of water are stored. The type of CHO is less important than the amount of CHO. Events must be at least 90 minutes for any benefit. Sedlock, D., The Latest Carbohydrate Loading: A Practical Approach. Cur. Sports Med. Reports 2008; 7(4)

6   10 Subjects consumed a CHO-protein drink on 3 occasions under 2 conditions (rest or exercise) with 3 types of protein.   Protein types were Casein 100%, Whey 100% & Casein-Whey 85-15%   Drinks all had 19 gm protein, 76 gm CHO & 2 gm fat.   Measurements were taken at rest after 3 different drinks and after 60 minutes of exercise with 3 different drinks (6 weeks total) Results Protein type had no impact on post prandial A.A. concentration after rest or exercise. T.J. Smith, S.J.Montain, J.McClung, et. al Milk Protein Type Does Not Impact Plasma Amino Acid Concentration When Incorporated Into a High Carbohydrate Beverage. Med. Sci. Sports Excer. 2008; 40 (5) A- 955 S101 6 Protein Uptake in High CHO Beverage

7 Sport Drinks & Protein- Is it the Protein or Calories? Adding small amounts of protein to CHO-Electrolyte (E) drinks is superior to traditional CHO-E drinks for cyclists. In most trials the added protein means the comparison is not isocaloric. 11 trained cyclists completed 4 rides to exhaustion in a double blind randomized fashion. Every 15 minutes the subjects drank 250 ml. (8.45 oz.) of 1 of 4 drinks. Placebo, 7.75% CHO-E 9.69% CHO-E 7.75% CHO 1.94% Protein. Blood was drawn before, ~8 hours after and ~24 hours after each round of the trial. Valentine, R.J., Saunders, M.J., Todd, M.K., St. Laurent, T.G. Influence of Carbohydrate – Protein Beverage on Cycling Endurance and Indices of Muscle Disruption. Int. J. Sport Nut. Excerc. Metab. 2008; 18 (4)

8 INGREDIANT COMPARISON OF EXPERIMENTAL DRINKS

9 Valentine, R.J., Saunders, M.J., Todd, M.K., St. Laurent, T.G. Influence of Carbohydrate – Protein Beverage on Cycling Endurance and Indices of Muscle Disruption. Int. J. Sport Nut. Excerc. Metab. 2008; 18 (4) Time to Fatigue with each Beverage Treatment

10 Valentine, R.J., Saunders, M.J., Todd, M.K., St. Laurent, T.G. Influence of Carbohydrate – Protein Beverage on Cycling Endurance and Indices of Muscle Disruption. Int. J. Sport Nut. Excerc. Metab. 2008; 18 (4) Plasma Creatine Kinase

11 Valentine, R.J., Saunders, M.J., Todd, M.K., St. Laurent, T.G. Influence of Carbohydrate – Protein Beverage on Cycling Endurance and Indices of Muscle Disruption. Int. J. Sport Nut. Excerc. Metab. 2008; 18 (4) Serum Myoglobin Concentration

12 Cystine and Theanine 15 Subjects (mean age 23) with 4-5 years of resistance 3x/week enrolled in a 2 week experiment. Divided into 2 groups and took either 700 mg Cystine mg theanine or placebo after dinner. Week one subjects continued with normal workout. Week two subjects doubled their workout (6 days) Blood was drawn at beginning and end of each week. Results Natural killer cell activity decreased 30% in placebo group following high intensity, high frequency resistance exercise with no decrease in C/T groups. Kawada, S., Kobayashi, K., Ohtani, M., Fukusaki, C. Protective Effects of Cystineand Theanine Supplementatio On Immune System In High-Intensity Resistance Training. Med. Sci. Sports Exerc. 2008; 40(5) A-2204 S402 12

13 Beta Glucagon & URI’s A Class of Soluble fibers found in plants especially oats and barley best known for modest cholesterol reduction. Promoted to prevent upper respiratory infections following strenuous endurance exercise. 36 male cyclists were randomized into 2 groups under double blind conditions Subjects took either 5.6 grams of Beta Glucagon (N=19) or placebo (N=17) for 17 days the last 3 of which were intense 3 hour rides. Pre and Post blood tests were done on all subjects.

14 Beta Glucagon for URI’s RESULTS   Natural Killer Cell activity, lymphatic proliferation various interleukin and plasma cytokines did not differ pre-post between groups.   URI incidence was 9/19 for Beta Glucagon and 6/17 for placebo   The URI rate 47% in Beta Glucagon and 35% in placebo groups did not statistically differ according to the authors. Neiman, DC, Hensen, DA, McMahon, M et al. Beta Glucagon Immune Function and Upper Respiratory Tract Infections in Athletes. Med. Sci. Sports Exerc. 2008;40(8) New study: B-G lowers total + low density cholesterol & tri’s but not HDL’s Bandayl, L. Dietary Soluble Fiber may be Beneficial for Adults w & w/out Hypercholesterolemia. Ann. Int. Med (7)

15 15 Quercetin A flavonoid found in onions, kale, apples and broccoli Typical US diet contains ~107mg/d Estimated intake of persons with the highest intake of fruits and vegetables (90 th percentile) ~225 mg/d Quercetin is a powerful antioxidant (much stronger than vitamin C) with high levels anti-carcinogenic activity and other properties including protection of proteins, DNA and regulation of gene expression 1000 mg/d 3 wks prior to exhaustive endurance exercise reduced URI’s post exercise challenge fm 9/20 to 1/20.

16 Quercetin Increases Power and Endurance 12 fit college age students tested in double blind fashion. Baseline fitness on exercise bike was established. Took 500 mg Quercetin 2x/day for 7 days or placebo Measured lab test ride then protocol was repeated so all subjects were tested with both treatments. Quercetin (1000mg/day) x 7 days increased maximum aerobic power 3.9% and time to exhaustion by 13.2%. S.C. Chen, J.M. Davis, C. Carlsted et.al Effects of Quercetin Feedings on Maximal Oxygen Consumption and Fatigue During Prolonged Exercise.Med. Sci. Sports Excer. 2008; 40 (5) A-1250 S165 16

17 Beta-Alanine   Beta-alanine is the only natural occurring AA in beta form   It is the rate limiting molecule for Carnosine synthesis   Carnosine is a dipeptide which buffers hydrogen ions. Muscles contain most of the bodies carnosine   Ample carnosine allows muscles to buffer hydrogen ions produced during contraction.   The more hydrogen we buffer, the more work we can do before the ‘burn’ stops us.   Carnosine (also composed of histidine) is not absorbed well and is best elevated by increasing Beta-alanine which is absorbed well and, because of the Beta group is not incorporated into other proteins. 17

18 Beta Alanine with Resistance Exercise   Double Blind trial with resistance trained subjects   4 weeks of 4.8 grams of Beta Alanine or placebo.   6 sets of 12 reps of squats with blood draws at baseline, after exercise and 30 minutes after exercise.   Protocol was repeated for 4 weeks with a second test.   Results: 4 weeks of B.A. increased reps by 22%. No changes in growth hormone, testosterone or cortisol levels. J.R. Hoffman, N.A. Ratamess et. al Effects of B-Alanine Supplementation on the Acute Hormonal Response to Resistance Exercise. Med. Sci. Sports Exerc. 2008;40 (5) A-1253 S166 18

19 19 Caffeine Regular use can build intolerance and dependency. Addicts will suffer from withdrawal headaches + brain fog, fatigue. Side effects may include insomnia, nervousness, elevated heartbeat, and headaches. Caffeine is not a diuretic. (under 600mg) Some report better results and improvement during an athletic event when they have abstained for 48 hours.

20 20 Caffeine Continued Increases time to exhaustion in both endurance exercise and in shorter, higher intensity activities Studies are negative for events lasting under 1 minute Can improve concentration Can increase speed of reaction (i.e., a shorter time to react) Increases strength of contraction Improves ventilation in asthmatics A vasoconstrictor, it can relieve headaches

21 Caffeine Mobilization of free fatty acids – it blocks enzymes that breakdown C-AMP Higher C-AMP increases lipolysis allowing preservation of glycogen Reduction of potassium gradient run down Stimulation of CNS motor control Increase neurotransmitter release Increase motor unit firing rates Translocation of calcium to a more favorable membrane position for excitation – contraction coupling in skeletal muscle Binds to adenosine receptors which prevents adenosine from causing drowsiness thus improving alertness. Stewart, G.R., Hopkins, W.G., Cook, C., Caims, S.P. Multiple Effects of Caffeine on Simulated High-Intensity Team-Sport Performance. Med Sci Sp Ex. 2005; 37 (12): Kalmar, J.M. The Influence of Caffeine on Voluntary Muscle Activation Med Sci Exerc. 2005;37(12) :

22 Caffeine Improves Sprint Times 21 males (age 18-21) participated in a double blind trial preceded by establishing a baseline. Subjects took 5 mg/kg/bw caffeine or placebo 1 hour prior to sprint testing. Test was 12 sprints of 30 meters with a 35 second break after each run and repeated 4-5 days later with the opposite treatment.

23 Caffeine Improves Sprint Times RESULTS   20/21 had their fastest sprint time with caffeine.   9/21 were able to ID which trial they took caffeine.   There was a placebo effect, with mean times faster than baseline. (But slower than caffeine)   Caffeine’s effect decreased in later stages (6-12 ) Glaister, M., Howatson,G., Abraham, C.S., et al. Caffeine Supplementation and Multiple Sprint Running Preformance. Med.Sci. Sports Exerc. 2008;40(10)

24 CAFFEINE IMPROVES SPRINT TIMES Glaister, M., Howatson,G., Abraham, C.S., et al. Caffeine Supplementation and Multiple Sprint Running Preformance. Med.Sci. Sports Exerc. 2008;40(10)

25 Caffeine and Glycogen Replenishment 7 males volunteered for a 2-trial double blind study. Interval cycling to exhaustion followed by low CHO dinner. Next morning ride to fatigue then consume either 4 gm CHO/kg bodyweight or 4gm/kg/bw of CHO + 8mg/kg/bw of caffeine. Drinks were consumed over 4 hour period. For a 175 pound person, the treatment was 70 grams of CHO per hour or 70gm/CHO/hr mg caffeine per hour. 25 Hawley, J., Pedersen, D., Lessard, S. et al. High Rates of Muscle Glycogen Resynthesis After Exhaustive Exercise When Carbohydrate Is Co-Ingested With Caffeine. Med. Sci. Sports Exerc. 2008; 40(5) A-669 S36

26 Caffeine and Glycogen Replenishment continued GLYCOGEN LEVELS* *measured by muscle biopsy TreatmentExhaustion1 Hour Post4 Hour Post CHO75 mmol121 mmol234 mmol CHO + Caff75 mmol149 mmol313 mmol 26 Hawley, J., Pedersen, D., Lessard, S. et al. High Rates of Muscle Glycogen Resynthesis After Exhaustive Exercise When Carbohydrate Is Co-Ingested With Caffeine. Med. Sci. Sports Exerc. 2008; 40(5) A-669 S36

27 Exercise Frequency and Workload 30 Obese women years old were divided into 2 groups: 8 weeks of 75 minute exercise 2x/week 8 weeks of 30 minute exercise 5x/week Both groups exercised at 90-95% lactate threshold (typical untrained individuals reach VO2 max) RESULTS No difference between groups in fitness improvement, insulin resistance or reduction in waist circumference. CONCLUSION Total time per week at a similar intensity yields similar benefit regardless of frequency. Manthou, E., Gill, J., Malkova, D. Impact of Exercise Programs With Different Frequency On Physical And Metabolic Characteristics In Overweight Women. Med. Sci. Sports Exerc. 2008; 40(5) A-875 S83 27

28 Intense Resistance Exercise Can Lower Post-Prandial Blood Lipids 10 males (ages 21-30) performed 3 two day trials. Day 1 was one of three routines; no exercise, moderate exercise, or intense exercise followed by a (%CPF) 5 cal/kg bodyweight Day 2 was identical in all 3 trials hours after exercise (or rest) subjects returned for morning meal (%CPF) 20 cal/kg bodyweight. Venous samples were taken before and 3 hours after the meal. 28

29 Intense Resistance Exercise Can Lower Post-Prandial Blood Lipids continued Moderate resistance exercise was 3 sets of 16 reps of 10 weight of 50% of 8 rep max. Intense resistance exercise was 3 sets of 8 reps of 10 a weight of 100% of 8 rep max. Meals for 70 kg (154lb) subject averaged 350 calories post-exercise and 1400 calories the next morning. RESULTS High intensity R.E. the day before lowered post- prandial lipids following high calorie, high fat breakfast. Moderate intensity of equal work had no effect on post-prandial lipids. Singhal, A., Trilk, J., Jenkins, N., et al. Effect of Intensity of Resistance Exercise on Postprandial Lipemia. Med. Sci. Sports Exerc. 2008; 40(5) A-757 S56 29

30 Exercise Dependence Exercise dependence is defined as 3 or more of the following: -Tolerance -Symptoms of Withdrawal -More exercise than intended -Inability to reduce exercise -Excessive time spent exercising -Conflict with other activities -Exercising despite contraindications Bartholomew, J., Hodgkinson, M., Exercise Motivation and Dependence: A Cluster Analysis of Endurance Athletes. Med. Sci. Sports Exerc. 2008; 40(5) A-1424 S209 30

31 31 Korean Red Ginseng 8 male students were divided into 2 groups. Ginseng group took 7 grams of Korean Red Ginseng extract 3x/day for 7 days in 6 oz. liquid. Placebo group followed same protocol. On the 8 th day subjects did two 45 minute uphill treadmill runs with 5 minute rest break. Blood was drawn immediately pre-post exercise 30 min, 1,2,3,24,48, 72 hours and 10 days following exercise. Interleukin, creatine kinase and cortisol were determined (3 factors at 8 times = 24 data points.)

32 Korean Red Ginseng results Interleukin-6 was hour test in Ginseng group.22 pg/ml vs.26 pg/ml in placebo. Creatine kinase activity was lower in the ginseng 72 hour test. 223 IU/L vs 263 IU/L in placebo. Cortisol 72 hours was lower in ginseng 13.6 vs 18.7 ug/dl in placebo There were no significant differences in any other factors over the 8 measurements taken. 3/24 data points showed benefit. Park, S., Jung, H.L., Hong, S. et al. Effects of Red Ginseng Intake on Interleukin-6 (IL-6) and Cortisol Responses after High-Intensity Exercise. Med. Sci. Sports Exerc. 2008; 40(5) A-2329 S432 32

33 33 Energy Patch Science Claims Organic nanoscale biomolecular antennas are imbedded in a matched pair of patches. They are placed on the skin in two locations. The patches emit a frequency that resonates in unison with intracellular biomolecules. These biorhythms are able to signal metabolic pathways causing a shift of substrate to fat utilization by activation of Beta-oxidation. This enables greater ability to use fat for fuel thus spares glycogen. Smith, D., Jacobson,B., Fedick, J. et. Al. The Effect of Energy Patches on Graded Exercise Test Performance in College Male Cross-Country Runners. Med. Sci. Sports Exerc. 2008; 40(5) A-2269 S418

34 34 Energy Patch Experiment - Males 14 collegiate cross country males were measured in the laboratory. Oxygen consumption, respiratory exchange ratio, rate of perceived exertion, heart rate and time to exhaustion were measured in a baseline test, with energy patches and with placebo patches. Results There were no differences between placebo and active patches in any of the measured variables. This included no change in fat utilization. Smith, D., Jacobson,B., Fedick, J. et. Al. The Effect of Energy Patches on Graded Exercise Test Performance in College Male Cross-Country Runners. Med. Sci. Sports Exerc. 2008; 40(5) A-2269 S418

35 Energy Patch Experiments – Females 17 women (ages 18-43) were divided into 2 groups. Body mass, body fat %, oxygen consumption and respiratory exchange ratio were determined. Every other day for 2 weeks energy patches or placebo were worn in different areas (ankle, knee, shoulder, wrist). Diet and exercise diaries were kept. Results Energy patches had no effect on any of the monitored factors. Witt, J., Wooten, N.D. Effect of LifewaveTM Patches on Fat Metabolism in Moderately Active Women. Med. Sci. Sports Exerc. 2008; 40(5) A-1894 S326 35

36 Passive Stretching and Golf Driver 15 Male Competitive golfers underwent 2 trials 1. Dynamic warm-up with golf clubs 2. Same warm-up plus 20 minute total-body passive stretching After warm-up subjects hit 10 balls at full velocity with their drivers. RESULTS – EFFECTS of STRETCHING Accuracy decreased 31% Distance dropped 5.6% Ball Contact lost 16.3% Club speed slowed 4.2% Gergley, J., Austin, S. Acute Effects of Passive Static Stretching During Warm-up on Driver Clubhead Speed, Distance, Accuracy, and Consistent Ball Contact in Young Male competitive Golfers. Med. Sci. Sports Exerc. 2008; 40(5) A-2263 S417 36

37 Drink Temperature During Exercise 8 males (ages 18-29) completed 2 trials in a random fashion separated by 1-2 weeks. Food and activity 48 hours prior to testing were identical. Subjects rode exercise bike in a chamber with a temperature of 95 degrees and relative humidity of 60%. Every 10 minutes they drank 100 ml (~3.5 oz) of orange flavored water (sugar free). The beverage temperature was either 4˚C or 37˚C (39˚F or 98.6˚F) 37

38 Drink Temperature During Exercise Results Average time to exhaustion with cold water 63:48 Average time to exhaustion with hot water 52:00 Cold drinks extended time to exhaustion during exercise in the heat by 23%. Lee, J.K.W., Shirreffs,S.M., Maughan, R.J. Cold Drink Ingestion Improves Exercise Endurance Capacity in the Heat. Med Sc Sport Exerc. 2008;40(8)

39 Athletic Cramping Exercise associated muscle cramps (EAMC) is an umbrella term that describes any cramp sustained during a workout, practice, training or competition. Ask a health professional ‘what causes EAMC?’ and most likely a debate will ensue. Ask a grocer ‘What color is fruit?’ and he will reply ‘What kind of fruit?’ 39

40 Cramp TypeCause/CommentTreatment Muscle FatigueTrue EAMC from repetitive contracture Stretch Soft Tissue Lengthening Muscle TearingReflex guarding to fiber tearingIschemic compression then ice then wrap HeatFluid and electrolyte loss from heavy sweating = ‘Sweat Cramps’ Fluid and electrolytes, esp. Na Ischemic compression Nocturnal1.Following overload workout and or incomplete fluid replacement 2. Mineral Deficiency (Calcium is most common) 1. Stretch, fluid + electrolyte if bodyweight loss. 2. Cal-Mag with dinner 3. R/O medication side effects Whole BodyPrecursor to life threatening heat illness Cool body. Fluid and electrolytes, esp. Na. Call 911 Side Stitches 1. Organ bouncing in runners leads to swelling and spasm. Liver trauma is why pain often occurs on right side. 2. Diaphragm Ischemia Stop Activity Flex Forward Relax Pre-competition meal earlier

41 Types of Cramps and Treatment Eichner E.R. Heat Cramps in Sports. Curr. Sports Med. Rep. 2008;7(4)178-9 Eichner E.R. Heat Cramps in Sports. Curr. Sports Med. Rep. 2008;7(4)178-9 Eichner E.R. Stitch in the Side: Causes Workup Solutions. Curr Sports Med. Rep. 2006; 5(5) Eichner E.R. Stitch in the Side: Causes Workup Solutions. Curr Sports Med. Rep. 2006; 5(5)

42 New England Journal of Medicine. March 19, 2009 Reisenauer, C. Solomayer, E. Pelvic-Organ Prolapse and Uterine Inversion NEJM. 2008; 360 (12) 1238

43 Fruits in Cure-All Juices Acai From a palm tree in the Amazon Purple/black berries the size of a grape vit ’ s/min ’ s; amino & fatty acids High anthocyanin content (class of flavonoids known for red/purple/blue pigment & anti oxidant properties Claims of highest ORAC score (but can ’ t quench hydroxyl radical) Tastes like unsweetened dark chocolate

44 Fruits in Cure-All Juices Goji Berries from a vine-like bush in Tibet, western China and Mongolia. AKA Wolfberry, it is the size of a raspberry; when dried looks like red/orange raisin Has bitter/sour taste 17 vit ’ s/mins, 18 amino acids, 5 fatty acids Goji is a rich source of 5 carotenoids & vitamin C (50 mg/oz) Some claim Goji has highest ORAC score

45 Fruits in Cure-All Juices Noni Fruit from a South Pacific evergreen tree Pale yellow, oval w/ bumpy skin ~ 2 ” long When ripe, has a foul smell Taste is bitter; juice is dark brown Grape & other juices are added to commercial products ~ 20 vitamins & minerals Over 120 phytochemicals

46 Fruits in Cure-All Juices Mangosteen A fruit from an Asian evergreen tree A thick dark purple skin with juicy white tangerine sized wedges in the center Tastes like a grape/strawberry mix Low in vitamins & minerals Has 40 of the known 200 xanthones which are anti oxidants in the polyphenol family Mangosteen marketers also claim it has the highest ORAC score.

47 Fruits in Cure-All Juices Indian Gooseberry From a tree native to foothills of India AKA Amalaki Fruit is cherry sized, lime green, w/ 6 furrows Low in most vitamins and minerals - except Very high in vitamin C ( mg/oz) Does contain Quercetin Fibrous w/ bitter/sour taste (often dipped in salt when consumed in India.) Some say ORAC score doubles Acai

48 Fruits in Cure-All juices Oranges Grown on trees, named after it ’ s color 17 vitamins and minerals 18 amino acids 20 carotenoids Over 150 phytochemicals A medium orange has ~ 100mg vitamin C, 75 mg calcium, 325 mg potassium, 3 gm fiber and 12.5 mg omega 3 fatty acids Taste is delicious

49 49 Sodium Levels and Exercise-Associated Muscle Cramps in 14 NFL Players (6 cramp hx. – 8 n/c) SubstanceCrampNon-cramp Fluid intake 3.0 L 2.1 L Net dehydration 2.9 L 2.7 L Sweat loss 5.9 L 4.8 L % water % sports drink 81% 81% 19% 19% 58% 58% 42% 42% Sweat Na 52.6 mmol/L 38.3 mmol/L Acute Na balance -223 mmol -133 mmol Players with a history of cramping lost more sweat, drank less sports drink, and lost more sodium compared to players without a cramping history. Stofan J.R., Horswill, C.A., Lacambra, M., Torriscelli, T., Murray, R. Acute Change in Blood Sodium During a Two-a-day Training in Professional Football Players. Med. Sci. Sports Exerc. 2007; 39(5): S15, A-572.

50 50 Sodium Loading   8 endurance trained males, (~36 yrs) double- blind trial.   High vs. Low sodium beverage prior to a run to 70% VO2 max in 90 degree heat with 50% relative humidity.   Repeated 2 weeks later with opposite treatment.   65 minutes prior to the run, subjects drank 25 oz. in equal portions (3.5 oz. every 9 minutes)   High sodium 164mmol Na/L   Low sodium 10mmol Na/L

51 51 Sodium Loading Continued Time to exhaustion in minutes SubjectHi NaLow Na__ High Na increased plasma volume, decreased perceived exertion and improved exercise capacity in the heat in 7/8 subjects. Sims, S.T, Vliet, L., et. al. Sodium Loading Aids Fluid Blance and Reduces Physiological Strain of Trained Men Exercising in the Heat. Med.Sci.Sports.Exerc. 2007; 39 (1)

52 Salt Reduction Could Reduce Incidence of Myocardial Infarction Salt is 99% sodium chloride (NaCl) NaCl is ~40% sodium and 60% chloride US RDA is <2400 mg sodium 6000 mg NaCl contains 2400mg Na Average U.S. daily salt intake has doubled since 1970 and is now ~12 grams. 3 grams/day reduction in US could reduce M.I. 8% and death by 3%. Domingo,K.B., Fonarow,G.C. Slight Cut in Salt would reduce heart attacks. American Heart Association Cardiovascular disease Epidemiology and Prevention Conference 3/11/

53 U.S. Dietary Sodium 77% Restaurants, canned, frozen & processed foods 12% Naturally present in food 6% Added to table salt 5% Added by the cook Salt - Conversion to Sodium ¼ level tsp = mg = 575 mg ¼ rounded tsp = 1500 mg = 600 mg ½ level tsp = 2875 mg = 1150 mg ½ rounded tsp = 3000 mg = 1200 mg Mickleborough,T.P. A Nutritional Approach to Managing Exercise Induced Asthma. Exerc.Sport Sci.Rev. 2008;36(3)135-9

54 Effects of Salt at Rest   9 Normotensive male subjects volunteered and spent 2.5 hours at rest with temperature of 82 degrees.   BP, Core Temperature, Skin Temperature, and Oxygen consumption were monitored every 10 minutes   Salt pills were ingested every 3 minutes for 2 hours or until BP increased 20mmHG or 25 salt pills were ingested. RESULTS BP increased mean arterial pressure 16mm/Hg Core Temp decreased.45 degrees F. CONCLUSION NaCl lowers core temperature and raises blood pressure in males at rest in warm conditions. Kim, C., Ryan, E., Blankfield, R. et al. Effects of Sodium Chloride Ingestion on Blood Pressure, Core Temperature, and Oxygen Consumption in Normotensive Men. Med. Sci. Sports Exerc. 2008; 40(5) A-1497 S227 54

55 Exercise Induced Asthma Exercise induced asthma (EIA) is defined by a 10% (or greater) reduction in post-exercise forced expiratory volume (FEV1) vs pre-exercise values. Forced expiratory volume 1 is the amount of air that can be forcefully exhaled in 1 second after taking a deep breath. Post-exercise FEV1 reduction greater than 7% indicated abnormal pulmonary function. Rundell,KW, Wilber,R.L., Szmedra, L et al. Exercise-induced Asthma Screening of Elite Athletes; Field versus Laboratory Exercise Challenge. Med. Sci. Sports Exerc. 2000;32(2)

56 Low Salt Helps EIA Patients Epidemiological studies have identified an association between salt intake and asthma. 24 Subjects w/Exercise Induced Asthma (EIA) enrolled in a double blind randomized study. On 3 occasions they did an exercise challenge test and ran on a treadmill that had a 1 ̊ grade increase each 60 seconds until exhaustion. For 2 weeks prior to each challenge, participants consumed a low, moderate and high sodium diet. Mean dietary Na levels were: Low Sodium ~ 1450 mg from 3625 mg salt Medium Sodium ~ 3540 mg from 8850 mg salt High Sodium ~ 9870 mg from 24,675 mg salt

57 Low Salt Helps EIA Patients CONTINUED Dietary NA LowMediumHigh FEV %-18.3%-27.4% Puffs** ** # of Bronchodilator puffs required during the test.

58 Low Salt Helps EIA Patients CONCLUSION   Salt increases airway sensitivity and causes a greater bronchoconstrictor response in EIA patients.   Salt impedes arterial oxygen saturation in EIA patients by augmenting capillary permeability (leakage)   Salt promotes mucus & edema formation, airway inflammation and raises leukotriene and interleukin production.   Salt reduction reverses the above reactions and therefore can reduce the degree of asthmatic response to vigorous activity.   Salt ingestion during training and/or competition in the form of sports drinks, gels or salt pills has not yet been studied in EIA patients. Mickleborough, T.D., A Nutritional Approach to Managing Exercise –Induced Asthma. Exerc. Sports Sci. Rev (3) Mickleborough, T.D., Lindley, M.R., Ray, S. Dietary Salt Airway Inflammation, and Diffusion Capacity in Exercise Induced Asthma. Med.Sci.Sports Exerc. 2005; 37(6)

59 EIA and Caffeine #1   10 patients with EIA received 1 of 3 treatments 2 hours prior to exercise on 3 occasions.   Intervention was placebo, moderate caffeine (3.5 mg/kg/bw) or high caffeine (7mg/kg/bw). RESULTS FEV1 post exercise declined 25% placebo 14% moderate caffeine 10% high caffeine Mickleborough, T.D., A Nutritional Approach to Managing Exercise –Induced Asthma. Med.Sci.Sport. Exerc (3)

60 EIA and Caffeine # 2   11 patients with EIA received 1 of 3 treatments 90 minutes prior a dry gas challenge (which served as an exercise surrogate)   Intervention was placebo, moderate caffeine (5mg/kg/bw ) or high caffeine (10mg/kg/bw) RESULTS FEV1 post exercise declined 16.7% placebo 10.2% moderate caffeine 7.1% high caffeine Mickleborough, T.D., A Nutritional Approach to Managing Exercise –Induced Asthma. Med.Sci.Sport. Exerc. 2008;36(3)

61 61 Vitamin C and EIA   8 subjects with exercise-induced asthma (EIA) consented to this trial   1500 mg of vitamin C or placebo was taken for 2 weeks   Following a one-week washout, protocol was repeated with the opposite treatment   Procedure: pre and post-exercise pulmonary function was evaluated, pre and post-exercise urine samples were assayed for pro-inflammatory chemicals, and pre- and post-exercise exhaled breath nitric oxide was measured.

62 62 Vitamin C and EIA RESULTS Test Vitamin C Placebo Post exercise nitric oxide (ppb) Post ex. leukotriene (ng/mmol/cr) Post ex. prostaglandin F2 (ng/mmol/cr) Post ex. hydrogen peroxide (mmol/L) Conclusion: In this trial vitamin C reduced severity of exercise-induced asthma Tecklenburg, S., Stager, J.M., et al. Ascorbic Acid Supplementation Reduces Severity of Exercise-Induced Asthma. Med Sci Sports Exerc. 2006;38(5) A-2158; S382

63 High Tech Swimsuits   14 Competitive Swimmers were studied in 3 types of swimsuits.   Subjects swam 25, 50, 100, 200, 400 and 800 meters in each of the 3 types of suits.   Appropriate control measures were implemented   Suits were normal, fastskin lower-body, fastskin full-body   There were 5 brands used (Speedo, Tyr, Nike, Arena and ASCI) so this was not a brand vs. brand trial.   6 distances X 14 Swimmers=84 Swims (done for each suit)

64 High Tech Swimsuits Results   The 84 fastest times were with the Fastskin suits.   63 were in the Full Body and 21 were in the Lower Body.   Full Body suits had 3.2% benefit.   Lower Body suits had 1.8% benefit.   Drag reduction was 6.2% Full Body and 4.7% Lower Body.   Average energy savings in Fastskin was 5%. Chatard, JC., Wilson, B. Effects of Fastskin Suits on Performance, Drag and Energy Cost of Swimming. Med. Sc. Sports Exerc. 2008;40(6)

65 COMPARISON OF FULL BODY & LOWERBODY FASTSKIN SUITS

66 Creatine, Whey and CLA   69 Experienced weight lifter (Age 18-30) (52M, 17F) were divided into 3 groups for a 5 week study.   Before and after each workout and at bed the groups consumed the supplements mixed with water.   Workouts were free-weights, 3 on - 1 off (1. Chest/Triceps 2.Back/Biceps 3. Legs/Shoulders 4.off)   Supplements were: Creatine 9 gm, CLA 6 gm, Whey 36 gm ( x3) Creatine 9 gm, Safflower oil 6 gm, Whey 36 gm Whey 45 gm, Safflower oil 6 gm Cornish, S.M., Candow, D.G., Jantz, N.T., et al Conjugated Linoleic Acid and Compound with Creatine Monohydrate and Whey Protein Supplementation During Strength Training. Int. J. Sport Nutr. Exerc. Metab. 2009;19(1)79-96

67 Bench Press Leg Press CREATINE, CLA & WHEY vs. CREATINE & WHEY vs. WHEY

68 Ginger   Promoted to reduce pain and inflammation and increase oxygen consumption.   25 college students were studied in a double blind, crossover design to test ginger and its influence during and following 30 minutes of moderate intensity cycling. Results 2000 mg of Ginger 30 min prior to exercise did not effect muscle pain or muscle recovery. There was no difference between ginger and placebo in heart rate, oxygen consumption or work output. Black, CD., O’Connor PJ Acute Effects of Dietary Ginger on Quadriceps Muscle Pain During Moderate-Intensity Cycling Exercise. It. J. Sports. Nutr. Exerc. Metab. 2008;18(6)

69 69 Resolved Concussion? 66 subjects years old were divided into groups based on concussion history (none, 1+). All 66 were free of concussion residuals. Neurocognitive assessment, tasks and stimuli were measured by event-related potentials. Results There was suppression of neuroelectric activity in subjects with concussion history even though they had normal cognitive function on standard clinical measures. Broglio, S., Heo, S., O’Connor, P., et al. The Chronic Effect of Concussion on Clinical Neurocognition And Neuroelectric Indices of Attention. Med. Sci. Sports Exerc. 2008; 40(5) A-811 S69

70 Best Tuning Fork to Detect Fracture 256 Hz was more accurate than 128 Hz or 512 Hz A1759 Vincent, K., Vincent, H., Stewart, J., Wilder, R. Clinical Use of Tuning Forks to Identify Running-Related Stress Fractures. Med. Sci. Sports Exerc. 2008; 40(5) A-1759 S293 Glycerol Hyperhydrates Glycerol ½ gm/lb pre-event and ¼ gm/lb/per hour during event reduced urine out put 4oz/hr. Burns, S., Physiological Responses To Glycerol Ingestion and Hyperhydration. Med. Sci. Sports Exerc. 2008; 40(5) A-1339 S188 Black Tea Reduced Muscle Soreness 9 Days of 1750 mg of Black Tea reduced and 48 hours post eccentric exercise Arent, S.M., Pellegrino, J., Senso, M. et al. Black Tea Reduces DOMS, Oxidative Stress, and Cortisol Responces to High-Intensity Interval Training. Med. Sci. Sports Exerc. 2008; 40(5) A1562, S Days for Altitude Adaptation Time for erythropoietic response to altitude training in elite cyclists was 11 days. Ten additional days had no additional hematological advantage. Garvican, L.A., Martin, D.T., Clark, M.A., et al. The Time Course of the Erythropoietic Reponse to Natural Altitude Training In Elite Endurance Cyclists. Med. Sci. Sports Everc. 2008; 40(5) A738 S52

71 2 weeks of 200 mg Co Q10 in soft gel form showed a ‘trend’ for increased endurance during an exercise challenge. Cooke, M., Iosia, M., Buford, T., et al. Effects of Coenzyme Q10 Supplementation On Exercise Performance in Trained and Untrained Individuals. Med. Sci. Sports Exerc. 2008; 40(5) A-2203 S402 L-Arginine increases ‘The Pump’ 6 grams of Arginine 1 hour before workout incerased muscle blood volume during recovery. Alvares, T., Meirelles, C., Matsuura,C., et al. L-Arginine Supplementation Increases Muscle Blood Volume During Recovery After Sets Of Resistance Exercise. Med. Sci. Sports Exerc. 2008; 40(5) A-2201 S402 L-Carnitine & Ammonia 2 grams/day L-Carnitine for 2 wks reduced exercise induced plasma ammonia accumulation by ~20% during 60 & 90 minutes VO2 max. L- Carnitine did not effect fat, protein or carbohydrate metabolism during exercise Broad, E.M., Maughan, R.J. Gallowa, SDR. Carbohydrate, Proteinand Fat Metabolism During Exercise After Oral Carnitine Supplementation in Humans. Int.J. Sport Nutr. Exerc.Met. 208;18(6) CoEnzyme Q10

72 72 Iron Major Functions A component of both hemoglobin and myoglobin Involved in oxygen transportation Required for collagen synthesis and immune function A component of cytochrome enzymes, which are involved in electron transport chain reactions These enzymes also help in the detoxification of drugs, alcohol, and carcinogens

73 73 Iron Deficiency Signs and Symptoms Fatigue Shortness of breath Pallor Drowsy following exercise Angular stomatitis Decreased cold tolerance (especially hands/feet) Itchy skin

74 74 Other Side Effects of Iron Deficiency Hair Loss Women who complain of hair loss when compared to normal controls had much lower mean ferritin levels. Kantor, J., Cotsarelis, G. Decreased Serum Ferritin Is Associated With Alopecia in Women, J Invest Dermatol, November 2003; 121(5) :P Restless Legs Syndrome 21/22 patients with normal serum iron had resolution after Fe supplementation. When serum ferritin is at or below 50 mcg/L, a high % respond to Fe. Earley, C.J. Restless Legs Syndrome. New England Journal of Medicine 348 (21) 2003; Cognition Low ferritin is associated with reduced cognitive performance & low hemoglobin is associated with slower processing speed. Both symptoms were reversed with Fe. Murray-Kolb, L.E., Beard, J.L., Iron Treatment Normalizes Cognitive functioning in Young Women. Am. J. Clin. Nutr. 2007; 85(3)

75 75 Iron Comments Iron is the most common mineral deficiency in the U.S. 20% of women are deficient, which may be elevated in pregnancy. Deficiencies are also seen in infants, children, adolescents, and even males Heme iron from animal sources is absorbed 11 times better than nonheme vegetable sources Oxalates in tea, chocolate, berries, and spinach along with phytates in grains and the preservative EDTA all bind iron and reduce absorption, which is enhanced by taking vitamin C. It can take 3-6 months to fully replenish reserves. It will only take 3-6 days to feel a marked benefit with supplement use

76 Iron and Activity in Women   Iron deficiency is typically diagnosed when serum ferritin is under 12 mcg/L   Endurance capacity loss can occur when iron is under 20 mcg/L   47 women (age 28-30) volunteered to be studied.   Blood tests for iron status were performed.   Low iron (SF 20mcg/L) for age and self reported activity level.   Subjects wore accelerometers for 5 days (3 week days and 2 weekend) 16 hours/day.   Activity levels were divided into 4 categories for sedentary, low, moderate and vigorous.

77 Time In Minutes 16 Hours (960 minutes) ResultsSedentaryLowModerateVigorous Low Iron Normal Iron Crouter, S., DellaValle D., Haas, J. Relationship Between Iron Status and Physical Activity. Med. Sci. Sports Exerc. 2008; 40(5) A-1955 S341 Iron and Activity in Women Continued

78 78 Iron Measured in College Cross- Country Runners Distance runners tend to be prone to iron deficiency Serum Ferritin (SF) and hemoglobin (Hb) were measured 4 times in collegiate cross country team (9-F;15-M) over a 5 month season Iron deficiency was defined as SF <20mcg/L was Anemia was defined as Hb<13.5g/dl

79 79 Iron Measured in College Cross Country Runners Results Iron Deficiency was present in at least 1 test for 33% of males and 89% of females. Anemia was present in at least 1 test for 33% of males and 44% of females This occurred despite a weekly team cookout with red meat. Frye, A., Solberg, B., Eichinger, M., Pasche, S. Iron Status In Collegiate Cross Country Runners. Med. Sci. Sports Exerc. 2008; 40(5) A-1956 S342

80 2009 American College of Sports Medicine Joint Position Stand on Nutrition and Athletic Performance with The American Dietetic Association and Dietitians of Canada Medicine & Science in Sports & Exercise 2009; 41(3)

81 ACSM 2009 Nutrition & Performance Selected Highlights CHO Rx 6-10 gm/kg/bw ( gm/lb) Protein Rx gm/kg/bw (.5-.8 gm/lb) Fat Rx 20-35% calories Pre-Ex Meal low fat & fiber, moderate Pro, high CHO During Ex gm/CHO/hr ( cal/hr) Post Ex w/in 30 min gm/kg/bw/CHO (.5-.7 gm/lb) & repeat every 2 hrs up to 6 hrs

82 ACSM 2009 Nutrition & Performance Selected Highlights In athletes w/ Iron deficiency, replacement - increases work capacity, oxygen uptake - reduces heart rate, lactate & muscle fatigue - improves endurance Sodium - many endurance athletes require much more than the daily upper limit (under 2400mg) - “Muscle cramps are more common in profuse sweaters who experience large sodium losses” - sports drinks should contain.5-.7 gm/Na/L

83 ACSM 2009 Nutrition & Performance Selected Highlights   When air temperature approaches & exceeds body temp., heat dissipation via radiation ceases.   When humidity is high, ability to dissipate heat by evaporation of sweat is greatly inhibited.   Sweat rates can be as high as 2.4 L/hr   Sweat Na averages ~50 mmol/L (~1000 mg/Na/L)   Dehydration can also occur in cold temps due to low fluid intake.   Elevation from sea level increases fluid losses from respiration & at ~8000 feet can be 1.9/L (64 oz) day

84 ACSM 2009 Nutrition & Performance Selected Highlights ERGOGENIC AIDS THAT PREFORM AS CLAIMED Creatine Caffeine Sports drinks, gels & bars ( For CHO & electrolytes) They mentioned over 20 that do not perform as claimed & 4 (colostrum, HMB, glutamine, ribose & Na bicarbonate) that may work but lack proof.

85 Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle Regarding research on breast pain during running, the authors contend: 1. Kinematic research of the breast while running is limited. 2. Most of the focus has been on displacement in the coronal plane. 3. Only two studies reported on breast acceleration and they only analyzed motion in the vertical axis. 4. There have been no studies on breast acceleration during running in 3-D.

86 Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle Continued 15 Subjects (19-33) with D cups were recruited They were filmed on the treadmill with a 5 camera infrared motion capture system in 3D. Scurr, J., White, J., Hedger, W. Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle. Med. Sci. Sport Exerc. 2008;40(5) A-1471, S221

87 Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle Continued I know what you’re thinking….. 15 women…D Cups…5 camera’s….3D Who are these guys, Scurr, White & Hedger? Scurr, J., White, J. Hedger, W. Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle. Med. Sci. Sport Exerc. 2008;40(5) A-1471, S221

88 Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle Continued Those ‘guys’ go by Joanna Jennifer Wendy Scurr, J., White, J. Hedger, W. Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle. Med. Sci. Sport Exerc. 2008;40(5) A-1471, S221

89 Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle Continued Results Breast displacement and velocity significantly increased during the deceleration phase of the gait cycle. However, the peak acceleration values were greater during the acceleration phase of the gait cycle. Scurr, J., White, J., Hedger, W. Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle. Med. Sci. Sport Exerc. 2008;40(5) A-1471, S221

90 Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle Continued The author’s concluded “…future research on breast pain and breast support should report breast acceleration in 3D…” I concluded the authors must be using assumed names. Scurr, J., White, J., Hedger, W. Three Dimensional Displacement, Velocity and Acceleration of the Breast During a Running Gait Cycle. Med. Sci. Sport Exerc. 2008;40(5) A-1471, S221


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