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4/1/14 Sports Nutrition for Athletic Performance Nathan S. Taylor PT, DPT, ATC, CSCS Commonwealth Orthopaedic Associates 1 4/1/14 Certification • RD-‐ registered dietitian • CSSD-‐ certified specialist sports dietetics Selected Issues for Nutrition and the Athlete: A Team Physician Consensus Statement • Lori Boyajian-‐O’Neill D.O. • Vincent Disabella D.O. • R. Robert Franks, D.O. • Stanley A. Herring, M.D. • W. Ben Kibler, M.D. • Margot Putukian, M.D. • Stephen O Brien, M.D. • Rebecca Jaffe, M.D. • Michele LaBotz M.D. 2 4/1/14 Resources • ACSM • Nutrition and Athletic Performance. Medicine & Science in Sports & Exercise. 41(3):709-‐731, March 2009 • International Society of Sports Nutrition • http://www.sportsnutritionsociety.org/ • http://www.jissn.com/ • National Strength and Conditioning Association • nsca-‐lift.org Selected Issues for Nutrition and the Athlete: A Team Physician Consensus Statement Sports Nutrition = Provision of essential nutrients including both fluids and fuels to provide energy for training, competition, recovery and general health and wellness Sports Nutrition= Ergogenic Aid • Ergogenic Aid = Any training technique, mechanical device, nutritional practice, pharmacological method, or psychological technique that can improve exercise performance and/or enhance training adaptations. • Nutrition • Sleep • Equipment • Meditation • Often thought of as strictly supplements • Meet additional needs of athletes • High performance sports car 3 4/1/14 Pushing the Limit • Limited quantity/quality research • Limited statistical significance • Good theory • Safe • Legal • Cost • More than ½ Americans use supplements • $32 billion/ year • Expected to double in 10 years Goals of Sports Nutrition • Prevent injury • Prevent illness • Increase tolerance • Decrease perceived exertion • Recovery from intense exercise INCREASE ABILITY TO TRAIN! Adequate Energy, kcal • Should be tracked and individualized • General fitness program participant • 25-‐35 kcals/kg/day • Moderate to intense training • increase needs to 50-‐80 kcals/kg/day • Tour de France • 12000 kcals/day or 150-‐200 kcal/kg/day 4 4/1/14 Inadequate Energy • Muscle loss • Fatigue • Risk of injury • Illness • Prolonged recovery Most at Risk of Negative Energy Balance • Runners, cyclists, swimmers, triathletes, gymnasts, skaters, dancers, wrestlers, boxers, athletes attempting weight loss • Hunger patterns changed by training • Travel altering feeding schedule Suggestions • Frequent feedings, 6-‐7 meals/day • High calorie nutrient dense snacks • Convenience supplements to meet calorie demand • Meal replacement powders • Ready to drink meals • Weight gain powders • Careful of Banned substances • 50-‐75% most company s sales 5 4/1/14 Excessive Intake • Weight gain • Increase body fat • Fatigue • Risk of injury • Poor performance • Health Risks Suggestions • Frequent feedings, 6-‐7 meals/day • Nutrient dense snacks • High fiber • Increase output Macronutrient Calories/gram Carbohydrate 4 Protein 4 Fat 9 Alcohol 7 Water 0 6 4/1/14 Carbohydrates • 6-‐10g/kg, 50-‐70% • Maintain blood glucose • Replenish muscle glycogen • Replenishment immediately after training important for subsequent • Most rapid within 30 min post, up to 6hours Stored Carbohydrate • Blood glucose • 5.5 mmol/L • 30% fuel • Muscle glycogen • 65-‐90 mmol/kg • Diminished muscle glycogen = fatigue • Liver glycogen • Replenish blood glucose Increasing Intensity = Increase use of carbohydrate as fuel Type of carbohydrate • Complex • Vegetables, fruits, whole grains • Make up bulk of daily carbohydrate intake • Ensure ample muscle glycogen stores • Simple • Sugar, processed foods • Higher amount allowable in athletes • Low glycemic • Absorbed slowly • Minimize insulin spike and fluctuating blood glucose levels • High glycemic • Rapidly absorbed and utilized • Spike insulin levels • Use during recovery window 7 4/1/14 Protein • Facilitates muscle synthesis and repair • Current RDA .8g/kg • Athlete 1.2-‐1.7g/kg/day 10-‐35% • Typically met through diet • Most athletes exceed daily requirements • Best from whole foods • Animal sources most complete • Carb intake necessary for optimal protein uptake and use Nitrogen Balance • Muscle catabolism • Slow recovery • Muscle wasting • Training intolerance Counteract with frequent protein/amino acid ingestion Super high protein intakes 2-‐2.5g/kg/day Pros Cons • Ensure adequate intake • Higher intake excreted in urine • May increase protein synthesis • Higher calorie intake • Cancer risk • Saturated fat • Check renal function Increased protein intake = increased protein synthesis? 8 4/1/14 Pasiakos, S. et al. (2014). Effects of protein supplements on muscle damage, soreness and recovery of muscle function and physical performance: A systematic review. Sports Med • Healthy Adults less than 50 years old • Evaluate effects of protein supps alone or in combo with CHO • Performance metrics • Time to exhaustion • Time-‐trial • Isometric or isokinetic muscle strength • Markers of muscle damage and soreness Pasiakos, S. et al. (2014). Effects of protein supplements on muscle damage, soreness and recovery of muscle function and physical performance: A systematic review. Sports Med • Results • No relationship between recovery of muscle function and ratings of muscle soreness or markers of muscle damage when protein supplements are consumed prior to, during or after aerobic or resistance exercise • Greater benefit noted after daily training sessions or if participants are in negative nitrogen/energy balance Pasiakos, S. et al. (2014). Effects of protein supplements on muscle damage, soreness and recovery of muscle function and performance: A systematic review. Sports Med Limitations • Small sample size • Lack of dietary control • Did not measure direct indices of muscle damage such as myofibrillar disruption • Did not measure protein signaling indicative of change in rates of protein synthesis and degradation • Conclusions • Consistently demonstrate acute benefits of protein on post-‐ex muscle anabolism • To date no measurable reductions in muscle damage or enhanced recovery of muscle function 9 4/1/14 Negative media • A diet high in animal protein can increase cancer and early death risk and might be just as bad as smoking, especially for middle-‐aged people. • Increased risk for those aged 50-‐65 • Over 65 actually showed protective effect of high protein • IGF-‐1 • Known to increase cancer • After 65, drop in IGF-‐1 levels BCAA-‐Leucine, Isoleucine, Valine Pros Leucine • shown to increase protein synthesis • Can be converted to glucose in the liver • Decreased soreness? • Decreased fatigue? • Decreased muscle damage? Cons • 3g/day effective dosage, can be found in protein rich foods • cost Fat • 20-‐35% total kcal • Energy • Essential fatty acids • Fat soluble vitamins A, D, E, K • 1/3 sat fat, 1/3 mono, 1/3 poly, avoid trans • Consuming <20% does not benefit • Many athletes exceed 35% 10 4/1/14 Created by USOC Sports Dieticians , retrieved from usoc.org Created by USOC Sports Dieticians , retrieved from usoc.org Created by USOC Sports Dieticians , retrieved from usoc.org 11 4/1/14 Micronutrients • Energy production • Hemoglobin synthesis • Maintain bone health • Immune function • Antioxidant protection Mineral Theory Evidence Calcium Maint and repair bone, regulate muscle contraction, maint blood calcium Fair for fat metabolism and improved body composition Iron Improved oxygen carrying capacity, aerobic sports Only for iron-‐deficient athletes Zinc Decreases exercise related changes in immune function Magnesium Activates enzymes involved in protein synthesis, serum levels decrease with exercise Sodium Helps regulate fluid balance, nerve transmission, acid-‐base balance, prevents hyponatremia Phosphate Buffering capacity, improve energy transport and storage Fair for immunity, none for performance Only for athletes with significant deficiency Good especially with athletes in heat or prolonged exercise Sodium phospate may improve aerobic system/capacity Antioxidants • C, E, Beta Carotene, Selenium • Long-‐term exercise produces constant oxidative stress leading to lipid peroxidation of membranes • Habitual exercise augments antioxidant system, more developed endogenous antioxidant system • Low fat diet, restricted energy intake, limited fruits, vegetables, whole grains 12 4/1/14 B Vitamins • Optimum energy production • Thiamin, riboflavin, niacin, pyridoxine, pantothenic acid, and biotin • Building and repair of muscle tissue • Folate and vit b12 are required Riboflavin, pyridoxine, folate, b12 low in female athletes and vegetarians • Some data that exercise may increase need as much as twice recommended amount however needs are addressed with higher intake Vitamin D • Required for calcium absorption • Regulation of serum calcium and phosphorus levels • Promotion of bone health • Regulates development and homeostasis of nervous system and skeletal muscle Northern latitudes or indoor athletes at risk Multivitamin • 40% supplements used in America are multivitamin • Can over consume fat soluble vitamins • Most important for non-‐health conscious • Daily multivitamin recommended due to American diet • Keep it low dose • Use after exercise? • Split dose am/pm 13 4/1/14 Special Circumstances • Vegetarians • Eating Disorders • Weight Loss Diets • Use RD or CSSD Fluids • Maintain adequate hydration and regulate body temp • Dehydration= >2% body weight loss • Compromise aerobic performance • Impair mental/cognitive performance • Increased perceived effort • Decrease balance control • Alter immune response Proper Hydration • Use wt measurement to estimate fluid loss • 16-‐24 oz/ pound lost • Strategies • Sports drink • Small frequent sips and meals rather than large volume • Tepid fluids empty more rapidly than cold • Fructose may upset, use glucose or sucrose • Train to tolerate greater amounts of water 14 4/1/14 Making Changes • Consider timing and implementation when making dietary changes • Out of season training • Period an athlete is not in competition but training for that purpose • In-‐Season Training • Period during competition Out of Season • Energy requirements increased or decreased • Well balanced diet-‐moderation • Modify energy intake for weight loss or gain • Practice and observe tolerance Weight Modification • Optimal body weight and composition=optimal performance • Body composition over body weight • Modification should be accomplished during off-‐season • Use food records • Adjust slowly • Re-‐evaluate frequently 15 4/1/14 Weight Gain • Intake exceeds expenditure, extra 500-‐1000 kcal/day • Increase protein to upper range • Avoid skipping meals • Proper hydration • >2-‐3 lb/wk is not lean mass • Emphasize strength training Weight Gain • Weight Gain Supplements • Large amount of calories • Convenience • Careful of banned substances Weight Loss • Expenditure exceeds intake 250-‐1000 kcal net energy deficit/ day = .5-‐2lb/wk • Maintain muscle mass, decrease body fat • Energy expenditure preferable to limited intake • Aerobic exercise increase expenditure, resistance training preserve muscle • Maintain adequate micronutrient levels • Females no less than 1200-‐1400, males no less than 1500-‐1700 • Proper hydration • Avoid skipping meals to avoid compensatory overeating 16 4/1/14 Caffeine for weight loss Pros Cons • Increased fat oxidation? • Increased thermogenesis? • Decreased fatigue • Improved mood • Little evidence • Nervousness • Anxiety • GI distress Insomnia • High calorie beverages Exercise training remains the best method to increase usage of fat. Caution • Impaired performance • Reduced energy stores • Impaired immune function • Altered mood • Changes in enzyme activity • Structural alterations in muscle • Health effects • Cognitive dysfunction • Compromised cardiac function • Inability to maintain body temp • Disrupted endocrine function Caution • Disordered eating due to pressure • Proper fuel before sessions to prevent injury • Avoid low calorie or fad diets and weight loss drugs 17 4/1/14 In-‐Season • Distribution of fluid and fuel • Increase emphasis on cho • Increase monitoring of fluid and electrolyte • Maintain energy balance • Caloric expenditure often exceeds intake • Adequate energy balance spares protein • Balance minimizes fatigue • Timing • Spread intake throughout the day • Maintain hydration • Recovery window Carbohydrate Loading • Goal = Increase stores of muscle glycogen >150mmol/kg • Only reasonable for endurance athletes • No longer necessary to go through depletion phase • How? • 1-‐4 days increased carbohydrate • Up to 70% calories from carbohydrate • 1-‐4 days tapered intensity training • Offset total calories by lowering fat intake • Weight gain will occur Nutrient Timing -‐Breakfast • First opportunity to replenish glucose and fluid after overnight fast • Mental skill • Mood • Better food choices • Morning training sessions 18 4/1/14 Nutrient Timing – 4 hours pre • Spares muscle and liver glycogen • Consider individual preference and tolerance • Adequate calories • Primarily Cho, 3-‐4g/kg • Moderate protein and low fiber and fat • Minimize gastrointestinal distress • 12-‐20 oz water or sports drink Nutrient Timing – 1 hour pre • Increases availability towards end of bout • Decreases exercise induced catabolism • Increase availability of amino acids 1g cho/kg, liquid preferably Nutrient Timing -‐ Pre • Caution • Cho concentration >6-‐8% decreases absorption • Many energy drinks >8% • Sufficient to maximize fuel stores but limit undigested food • Avoid high fat/fiber due to GI distress 19 4/1/14 Caffeine for performance • Ergogenic effect on endurance exercise • 3-‐6ml/kg may be effective dose with side effects diminished • Peaks in the blood in 1-‐2 hours • Benefits • Glycogen sparing by fatty acid mobilization • Decrease fatigue • Increase mood and mental clarity • Restricted Substance • IOC 12 ug caffeine per ml of urine • NCAA 15 ug caffeine per ml of urine Caffeine Pros Cons • CNS stimulant • Decreased perceived effort • Increased tolerance • Increase alertness • Mobilize free fatty acids? • Glycogen sparing? • Restricted by NSCA • Ergolytic/dangerous in excess or in combination • Anxiety • Tachycardia • GI distress • Insomnia • Dehydration/electrolyte imbalance? Energy Drinks • Most popular dietary supplement other than multivitamin • Carbohydrate/Caffeine primary ergogenic nutrients • Multiple ingredients with unknown benefits • Unclear levels of caffeine due to other ingredients 20 4/1/14 Nutrient Timing -‐ During • Why? • Energy stores depleted • Thirst sensation decreased • 30-‐60g cho/hour shown to extend endurance performance • After overnight fast or liver glycogen depleted • How? • Fluid replacement begin early • Over 1 hour sports drink • Gastric emptying rate reduced Sports drink • 6-‐8% carb • 14-‐19g carb /8oz, optimum absorption • 100-‐165mg sodium /8oz • Activities longer than several hours • Color, carb and sodium enhance intake • 6-‐12 oz every 15-‐30 minutes • Protein consumption during? Nutrient Timing -‐ Post • Most glycogen resynthesis begins within 30 mins • 6 hour window • Increases in protein synthesis continue up to 72 hours post-‐exercise • Insulin response 3 or 4:1 Carb to Protein 21 4/1/14 Recovery USOC Physical Consequences of Hard Training The 4 R s of Recovery Nutrition Dehydration Re-‐hydrate with fluids and electrolytes Depletion of glycogen Replenish muscle glycogen stores with carbohydrates Breakdown of muscle Repair and Regenerate muscle tissue with high quality protein Cell damage and inflammation Reinforce your immune system with nutritious, fresh foods Nutrient Timing – 30 min post • Carbohydrate • 1-‐1.5g/kg cho • High glycemic index increase rate of resynthesis • Protein • Provide amino acids for building and repair • Add 10-‐20g protein • Enhanced glycogen resynthesis? Chocolate Milk • 4:1 Carb/Protein ratio • Whey= fast acting / Casein= slower absorption • Calcium • Electrolytes • Fluids • Affordable 22 4/1/14 Nutrient Timing – 2 hrs post • Repeat meal • 1-‐1.5 g/kg cho • 10-‐20 g protein • Lower Glycemic Index • Slower absorbing proteins • Repeat at 4 and 6 hours post Post Event Fluids • Replace 1.5 times the amount fluid lost, 16-‐24 oz/pound lost • Individual sweat rates will vary • 1.5 L lost before thirst • Electrolytes speed recovery, balance restored 3x faster with SD • Food has higher electrolyte concentration than drinks Supplements • Need • 100% needs from well-‐balanced nutrition • Specific medical conditions may benefit • Correcting deficiency most effective and reliable • Safety • All manufacturers required to analyze identity, purity and strength of ingredients • Not required to demonstrate safety and efficacy • Contamination of dietary supplements with banned substances 23 4/1/14 Supplements • Creatine • Nitric Oxide Boosters • HMB • B-‐Alanine Creatine http://medbio.info Creatine • Most effective supplement available • Anaerobic, repeated bouts, high intensity, short duration activities • Increased body mass/ muscle mass • Use as training aid 24 4/1/14 Creatine • Dosage • 20g/day for 5-‐7 days loading dose • 3-‐5g/day maint dose • May not be any difference without loading • Co-‐ingestion of carbohydrate may increase muscle uptake Creatine • Side-‐effects • Dehydration and muscle cramps myth • Actually may maintain hematocrit, aid thermoregulation, reduce ex HR, reduce sweat rate • Potential for weight gain • Long-‐term effects? • Screen for liver or kidney dysfunction Nitric Oxide Supplements arginine + O2 citrulline + NO • NO function to regulate vasodilation, blood flow, mitochondrial respiration, platelet function • Improved Oxygen and nutrient delivery • Increased stamina 25 4/1/14 Nitric Oxide Supplements • L-‐Arginine, L-‐Citrulline • L-‐Arginine is main precursor of NO via Nitric Oxide synthase activity • L-‐Citrulline can be converted to L-‐Arginine • Not subject to pre-‐systemic elimination • May increase levels of NO • Not been related to improved performance HMB-‐ Hydroxymethylbutyrate • Metabolite of Leucine • Inhibit protein breakdown • Some evidence of increased muscle building • Especially when taken with glutamine and L-‐arginine • Most studied in patients with AIDS • Limited evidence in trained athletes • Most useful for more novice 26 4/1/14 B-‐Alanine • Enhance intramuscular buffering capacity = attenuating fatigue • Beta-‐alanine can increase intramuscular carnosine levels • Increases of 20-‐80% in skeletal muscle • Carnosine already higher in trained muscles or those with higher percentage of type II fibers. • 2-‐6g/day Aerobic vs. Anaerobic Aerobic • Carbohydrate • Protein • Adequate carbohydrate spares protein • Fluids • Electrolytes Anaerobic • Carbohydrate • Protein • Creatine • Bicarbonate Nathan S. Taylor PT, DPT, ATC, CSCS Commonwealth Orthopaedic Associates [email protected] 27
