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Calories burned, and water and minerals loss during running

Calorie, carbohydrate, fat, and protein expenditure, and water and mineral losses during runningDuring running, athletes burn calorie, and lose water and salts in amounts depending on various factors such as the technique, training level, environmental conditions, and physiological characteristics of each runner. The knowledge of these factors allows to plan an adequate diet both during workout  and recovery, with the aim of optimizing performance.
Below we will analyze the energy expenditure of runners engaged in workouts on various distances, the amounts of carbohydrates, lipids, and proteins oxidized to meet the energy requirements, and which minerals are lost in sweat.

CONTENTS

Energy expenditure during running

During running energy expenditure is equal to 0.85-1.05 kcal per kilogram per kilometer.
This range is due to the fact that athletes with a good technique spend less than those with a poor technique.
A 70 kilogram (154 pound) athlete has an energy expenditure per kilometer between:

70 x 0.85 x 1 = 59.5 kcal
and
70 x 1.05 x 1 = 73.5 kcal

The table shows the calculations to determine the energy expenditure of the athlete to run 10, 20, 30, and 40 kilometers.

Distance

Energy expenditure

10 km 0.85 x 70 x 10 = 595 kcal
1.05 x 70 x 10 = 735 kcal
20 km 0.85 x 70 x 20 = 1190 kcal
1.05 x 70 x 20 = 1470 kcal
30 km 0.85 x 70 x 30 = 1785 kcal
1.05 x 70 x 30 = 2205 kcal
40 km 0.85 x 70 x 40 = 2380 kcal
1.05 x 70 x 40 = 2940 kcal

Note: who has started running for a short time ago has an energy expenditure even higher than 1.05 kcal per kilogram per kilometer.

During running, the energy for muscle work derives from the oxidation of carbohydrates, lipids, and proteins. Carbohydrates and lipids are the main energy source, and their oxidation rate depends on the intensity of exercise: as it increases, the percentage of lipid oxidation decreases whereas that of carbohydrates increases, as summarized below.

Intensity Fuel
30% VO2max Mainly fats
40-60% VO2max Equally fats and carbohydrates
75% VO2max Mainly carbohydrates
80% VO2max Almost only carbohydrates

Note: The failure to use the suitable fuel can promote fatigue and lead to overtraining.

Then, when running above the anaerobic threshold, the oxidation of carbohydrates can provide the entire energy requirement. At marathon pace, carbohydrates provide 60-70% of the energy requirement, whereas at lower pace they provide less than 50% of energy requirement.
Below, the amounts of carbohydrates, lipids, and proteins oxidized during workout are analyzed. During workout ,the energy expenditure is covered for about 60% by carbohydrates, for about 40% by lipids, whereas the residual percentage, between 3 and 5%, by proteins.

Carbohydrate oxidation during workout

For a 70 kilogram runner the amount of carbohydrates oxidized per kilometer is between:

(0.6 x 59.5) /4 = 8.9 g/km
and
(0.6 x 73.5) /4 = 11 g/km

Note: carbohydrates provide, on average, 4 kcal per gram.
The table shows the calculations to determine the amount of carbohydrates oxidized when the athlete runs 10, 20, 30, and 40 kilometers.

Distance Carbohydrate expenditure

10 km

[(0.85 x 70 x 10) x 0.6 ] / 4 = 89 g
[(1.05 x 70 x 10) x 0.6 ] / 4 = 110 g

20 km

[(0.85 x 70 x 20) x 0.6] / 4 = 179 g
[(1.05 x 70 x 20) x 0.6] / 4 = 221 g

30 km

[(0.85 x 70 x 30) x 0.6] / 4 = 268 g
[(1.05 x 70 x 30) x 0.6] / 4 = 331 g

40 km

[(0.85 x 70 x 40) x 0.6] / 4 = 357 g
[(1.05 x 70 x 40) x 0.6] / 4 = 441 g

Lipid oxidation during workout

By calculations similar to those for carbohydrates, we determine the amount of lipids oxidized per kilometer, which is between:

(0.4 x 59.5) / 9 = 2.6 g/km
and
(0.4 x 73.5) / 9 = 3.3 g/km

Note: lipids provide, on average, 9 kcal per gram.
The table shows the calculations to determine the amount of lipids oxidized when the athlete runs 10, 20, 30, and 40 kilometers.

Distance

Lipid expenditure

10 km [(0.85 x 70 x 10) x 0.4] / 9 = 26 g
[(1.05 x 70 x 10) x 0.4] / 9 = 33 g
20 km [(0.85 x 70 x 20) x 0.4] / 9 = 53 g
[(1.05 x 70 x 20) x 0.4] / 9 = 65 g
30 km [(0.85 x 70 x 30) x 0.4] / 9 = 79 g
((1.05 x 70 x 30) x 0.4] / 9 = 98 g
40 km [(0.85 x 70 x 40) x 0.4] / 9 = 106 g
[(1.05 x 70 x 40) x 0.4] / 9 = 131 g

Protein oxidation during workout

Protein requirements of adults are equal to 0.9 grams per kilogram of body weight, and, for a 70 kilogram athlete is:

70 x 0.9 = 63 g

During workout  the energy expenditure is covered for about 3-5% by protein oxidation.

The table shows the calculations to determine the amount of proteins oxidized when the athlete runs 10, 20, 30, and 40 kilometers, and proteins provide 3% of the energy requirement.

Distance

Protein expenditure (3%)

10 km [(0.85 x 70 x 10) x 0.03)] / 4 = 4.5 g
[(1.05 x 70 x 10) x 0.03)] / 4 = 5.5 g
20 km [(0.85 x 70 x 20) x 0.03)] / 4 = 8.9 g
[(1.05 x 70 x 20) x 0.03)] / 4 = 11 g
30 km [(0.85 x 70 x 30) x 0.03)] / 4 = 13.4 g
[(1.05 x 70 x 30) x 0.03)] / 4 = 16.5 g
40 km [(0.85 x 70 x 40) x 0.03)] /4 = 17.9 g
[(1.05 x 70 x 40) x 0.03)] /4 = 22.1 g

Note: proteins provide, on average, 4 kcal per gram.

For energy expenditure of 0.85 and 1.05 kcal per kilogram per kilometer, the average additional protein oxidation per kilogram to run 10, 20, 30, and 40 kilometers, rounded to the second decimal place, is:

  • 10 km: [(4.5 + 5.5) / 2] / 70 = 0.07 g
  • 20 km: [(4.5 + 5.5) / 2] / 70 = 0.14 g
  • 30 km: [(4.5 + 5.5) / 2] / 70 = 0.21 g
  • 40 km: [(4.5 + 5.5) / 2] / 70 = 0.29 g

Finally, adding the daily protein requirement of adults, the total protein requirement of a 70 kilogram runner, for the four distances, is:

  • 10 km: 0.07 + 0.9 = 0.97 g
  • 20 km: 0.14 + 0.9 = 1.04 g
  • 30 km: 0.21 + 0.9 = 1.11 g
  • 40 km: 0.29 + 0.9 = 1.19 g

By calculations similar to the previous ones, we determine the overall protein requirement when proteins provide 5% of the energy requirement.

  • 10 km: 0.12 + 0.9 = 1.02 g
  • 20 km: 0.24 + 0.9 = 1.14 g
  • 30 km: 0.36 + 0.9 = 1.26 g
  • 40 km: 0.48 + 0.9 = 1.38 g

Excluding athletes who run 30 kilometers or more every day, the values are slightly higher than 0.9 grams per kilogram of body weight.
In reality, the daily protein requirement is just slightly higher because a certain amount of nitrogen, hence proteins, is lost, as well as in the urine, also through sweating.

Water and minerals loss during running

Water losses depend on the amount of sweat produced, that depends on:

  • air temperature and humidity;
  • solar radiation.

The loss will be greater the higher these values are.
Finally, the amount of sweat produced is different from person to person.

Minerals lost in sweat are mostly:

  • sodium (Na+) and chlorine (Cl), about 1 gram per liter of sweat in heat acclimatized athletes;
  • potassium (K+), in an amount equal to about 15% of the sodium lost;
  • magnesium (Mg2+), in an amount equal to about 1% of the sodium lost.

The amount of minerals lost depends on how much sweat is produced, and it increases in non-heat acclimatized athletes.

The table shows the values, in grams per liter, of the minerals lost in sweat for non-heat and heat-acclimated athletes.

  Non-heat acclimated athletes

heat acclimated athetes

Sodium

1.38

0.92

Chlorine

1.5

1.00

Potassium

0.20

0.15

Magnesium

0.01

0.01

Total

3.09

2.08

Therefore, during physical activity, sodium is the mineral we need most of all.
After physical activity, runner, or who sweats heavily, tends to eat saltier food. This effect, known as selective hunger, was discovered, for sodium, in studies conducted on foundry workers. Probably, the selective hunger doesn’t not exist for potassium and magnesium.

References

Mahan L.K., Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000

Sawka M.N., Burke L.M., Eichner E.R., Maughan, R.J., Montain S.J., Stachenfeld N.S. American College of Sports Medicine position stand: exercise and fluid replacement. Med Sci Sport Exercise 2007;39(2):377-390 doi:10.1249/mss.0b013e31802ca597

Shils M.E., Olson J.A., Shike M., Ross A.C.: “Modern nutrition in health and disease” 9th ed. 1999

Shirreffs S., Sawka M.N. Fluid and electrolyte needs for training, competition and recovery. J Sport Sci 2011;29:sup1, S39-S46 doi:10.1080/02640414.2011.614269

Maltodextrin, fructose and endurance sports

Carbohydrate ingestion can improve endurance capacity and performance.
The ingestion of different types of carbohydrates, which use different intestinal transporters, can:

  • increase total carbohydrate absorption;
  • increase exogenous carbohydrate oxidation;
  • and therefore improve performance.

Glucose and fructose

When a mixture of glucose and fructose is ingested (in the analyzed literature, respectively 1.2 and 0.6 g/min, ratio 2:1, for total carbohydrate intake rate to 1.8 g/min), there is less competition for intestinal absorption compared with the ingestion of an iso-energetic amount of glucose or fructose,  two different intestinal transporters being involved. Furthermore, fructose absorption is stimulated by the presence of glucose.

This can:

  • contribute to a faster rate of monosaccharide absorption;
  • increase the availability of exogenous carbohydrates in the bloodstream;
  • cause the higher exogenous carbohydrate oxidation rates in fructose plus glucose combination compared to high glucose intake alone.

The combined ingestion of glucose and fructose allows to obtain exogenous carbohydrate oxidation rate around 1,26 g/min, therefore, higher than the rate reported with glucose alone (1g/min), also in high concentration.
The observed difference (+0,26 g/min) can be fully attributed to the oxidation of ingested fructose.

Sucrose and glucose

The ingestion of sucrose and glucose, in the same conditions of the ingestion of glucose and fructose (therefore, respectively 1.2 and 0.6 g/min, ratio 2:1, for total carbohydrate intake rate to 1.8 g/min), gives similar results.

Glucose, sucrose and fructose

Very high oxidation rates are found with a mixture of glucose, sucrose, and fructose (in the analyzed literature, respectively 1.2, 0.6 and 0.6 g/min, ratio 2:1:1, for total carbohydrate intake rate to 2.4 g/min; however, note the higher amounts of ingested carbohydrates).

Maltodextrin and fructose

High oxidation rates are also observed with combinations of maltodextrin and fructose, in the same conditions of the ingestion of glucose plus fructose (therefore, respectively 1.2 and 0.6 g/min, ratio 2:1, for total carbohydrate intake rate to 1.8 g/min).

Such high oxidation rates can be achieved with carbohydrates ingested in a beverage, in a gel or in a low-fat, low protein, low-fiber energy bar.

The best combination of carbohydrates ingested during exercise seems to be the mixture of maltodextrin and fructose in a 2:1 ratio, in a 5% solution, and in a dose around 80-90 g/h.

Maltodextrin and Fructose: Oxidation of Ingested Carbohydrates
Fig. 1 – Oxidation of Ingested Carbohydrates

Why?

  • This mixture has the best ratio between amount of ingested carbohydrates and their oxidation rate and it means that smaller amounts of carbohydrates remain in the stomach or gut reducing the risk of gastrointestinal complication/discomfort during prolonged exercise (see brackets grafa in the figure).
  • A solution containing a combination of multiple transportable carbohydrates and a carbohydrate content not exceeding 5% optimizes gastric emptying rate and improves fluid delivery.

Example of a 5% carbohydrate solution containing around 80-90 g of maltodextrin and fructose in a 2:1 rate; ingestion time around 1 h.

  • 1.5 L solution: 80 g of carbohydrates, including around 55 g of maltodextrin and around 25 of fructose.
  • 1.8 L solution: 90 g of carbohydrates, including 60 g of maltodextrin and 30 of fructose.

Conclusion

During prolonged exercise, when high exogenous carbohydrate oxidation rates are needed, the ingestion of multiple transportable carbohydrates is preferred above that of large amounts of a single carbohydrate.
The best mixture seems to be maltodextrin and , in a 2:1 ratio, in a 5% concentration solution, and at ingestion rate of around 80-90 g/h.

References

Burke L.M., Hawley J.A., Wong S.H.S., & Jeukendrup A. Carbohydrates for training and competition. J Sport Sci 2011;29:Sup1,S17-S27. doi:10.1080/02640414.2011.585473

Jentjens R.L.P.G., Moseley L., Waring R.H., Harding L.K., and Jeukendrup A.E. Oxidation of combined ingestion of glucose and fructose during exercise. J Appl Physiol 2004:96;1277-1284. doi:10.1152/japplphysiol.00974.2003

Jentjens R.L.P.G., Venables M.C., and Jeukendrup A.E. Oxidation of exogenous glucose, sucrose, and maltose during prolonged cycling exercise. J Appl Physiol 2004:96;1285-1291. doi:10.1152/japplphysiol.01023.2003

Jeukendrup A.E. Carbohydrate feeding during exercise. Eur J Sport Sci 2008:2;77-86. doi:10.1080/17461390801918971

Jeukendrup A.E. Nutrition for endurance sports: marathon, triathlon, and road cycling. J Sport Sci 2011:29;sup1, S91-S99. doi:10.1080/02640414.2011.610348

Prolonged exercise and carbohydrate ingestion

Prolonged Exercise: Open Water Swimming
Fig. 1 – Open Water Swimming

During prolonged exercise (>90 min), like marathon, Ironman, cross-country skiing, road cycling or open water swimming, the effects of supplementary carbohydrates on performance are mainly metabolic rather than central and include:

  • the provision of an additional muscle fuel source when glycogen stores become depleted;
  • muscle glycogen sparing;
  • the prevention of low blood glucose concentrations.

How many carbohydrates should an athlete take?

The optimal amount of ingested carbohydrate is that which results in the maximal rate of exogenous carbohydrate oxidation without causing gastrointestinal discomfort”. (Jeukendrup A.E., 2008, see References).

Prolonged exercise: which carbohydrates should an athlete take?

Until 2004 it was believed that carbohydrates ingested during exercise (also prolonged exercise) could be oxidized at a rate no higher than 1 g/min, that is, 60 g/h, independent of the type of carbohydrate.
Exogenous carbohydrate oxidation is limited by their intestinal absorption and the ingestion of more than around 60 g/min of a single type of carbohydrate will not increase carbohydrate oxidation rate but it is likely to be associated with gastrointestinal discomfort (see later).
Why?
At intestinal level, the passage of glucose (and galactose) is mediated by a sodium dependent transporter called SGLT1. This transporter becomes saturated at a carbohydrate intake about 60 g/h and this (and/or glucose disposal by the liver that regulates its transport into the bloodstream) limits the oxidation rate to 1g/min or 60 g/h. For this reason, also when glucose is ingested at very high rate (>60 g/h), exogenous carbohydrate oxidation rates higher 1.0-1.1 g/min are not observed.

The rate of oxidation of ingested maltose, sucrose, maltodextrins and glucose polymer is fairly similar to that of ingested glucose.

Fructose uses a different sodium independent transporter called GLUT5. Compared with glucose, fructose has, like galactose, a lower oxidation rate, probably due to its lower rate of intestinal absorption and the need to be converted into glucose in the liver, again like galactose, before it can be oxidized.
However, if the athlete ingests different types of carbohydrates, which use different intestinal transporters, exogenous carbohydrate oxidation rate can increase significantly.
It seems that the best mixture is maltodextrins and fructose.

Prolonged Exercise: Maltodextrin and Fructose: Oxidation of Ingested Carbohydrates
Fig. 1 – Oxidation of Ingested Carbohydrates

Note: the high rates of carbohydrate ingestion may be associated with delayed gastric emptying and fluid absorption; this can be minimized by ingesting combinations of multiple transportable carbohydrates that enhance fluid delivery compared with a single carbohydrate. This also causes relatively little gastrointestinal distress.

Conclusion

The ingestion of different types of carbohydrates that use different intestinal transporters can:

  • increase total carbohydrate absorption;
  • increase exogenous carbohydrate oxidation;
  • improve performance.
References

Burke L.M., Hawley J.A., Wong S.H.S., & Jeukendrup A. Carbohydrates for training and competition. J Sport Sci 2011;29:Sup1,S17-S27. doi:10.1080/02640414.2011.585473

Jentjens R.L.P.G., Moseley L., Waring R.H., Harding L.K., and Jeukendrup A.E. Oxidation of combined ingestion of glucose and fructose during exercise. J Appl Physiol 2004:96;1277-1284. doi:10.1152/japplphysiol.00974.2003

Jentjens R.L.P.G., Venables M.C., and Jeukendrup A.E. Oxidation of exogenous glucose, sucrose, and maltose during prolonged cycling exercise. J Appl Physiol 2004:96;1285-1291. doi:10.1152/japplphysiol.01023.2003

Jeukendrup A.E. Carbohydrate feeding during exercise. Eur J Sport Sci 2008:2;77-86. doi:10.1080/17461390801918971

Jeukendrup A.E. Nutrition for endurance sports: marathon, triathlon, and road cycling. J Sport Sci 2011:29;sup1, S91-S99. doi:10.1080/02640414.2011.610348

Mahan L.K., Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000

Shils M.E., Olson J.A., Shike M., Ross A.C.: “Modern nutrition in health and disease” 9th ed. 1999

Carbohydrate ingestion during exercise of relatively short duration and high intensity

High Intensity: During-Exercise Nutrition
Fig. 1- During-Exercise Nutrition

Carbohydrate ingestion during intermittent high intensity or prolonged (>90 min) sub-maximal exercise can:

  • increase exercise capacity;
  • improve exercise performance;
  • postpone fatigue.

The intake of very small amounts of carbohydrates or carbohydrate mouth rinsing (for example with a 6% maltodextrin solution) may improve exercise performance by 2-3% when the exercise is of relatively short duration (<1 h) and high intensity (>75% VO2max), that is, an exercise not limited by the availability of muscle glycogen stores, given adequate diet.
The underlying mechanisms for the ergogenic effect of carbohydrates during this type of activity are not metabolic but may reside in the central nervous system: it seems that carbohydrates are detected in the oral cavity by unidentified receptors, promoting an enhanced sense of well-being and improving pacing.
These effects are independent of taste or sweet and non-sweet of carbohydrates but are specific to carbohydrates.

It should be noted that performance effects with drink ingestion are similar to the mouth rinse; therefore athletes, when they don’t complain of gastrointestinal distress when ingesting too much fluid, may have an advantage taking the drink (in endurance sports, dehydration and carbohydrate depletion are the most likely contributors to fatigue).

Conclusion
It seems that during exercise of relatively short duration (<1 h) and high intensity (>75% VO2max) it is not necessary to ingest large amounts of carbohydrates: a carbohydrate mouth rinsing or the intake of very small amounts of carbohydrates may be sufficient to obtain a performance benefit.

References

Burke L.M., Hawley J.A., Wong S.H.S., & Jeukendrup A. Carbohydrates for training and competition. J Sport Sci 2011;29:Sup1,S17-S27. doi:10.1080/02640414.2011.585473

Jentjens R.L.P.G., Moseley L., Waring R.H., Harding L.K., and Jeukendrup A.E. Oxidation of combined ingestion of glucose and fructose during exercise. J Appl Physiol 2004:96;1277-1284. doi:10.1152/japplphysiol.00974.2003

Jentjens R.L.P.G., Venables M.C., and Jeukendrup A.E. Oxidation of exogenous glucose, sucrose, and maltose during prolonged cycling exercise. J Appl Physiol 2004:96;1285-1291. doi:10.1152/japplphysiol.01023.2003

Jeukendrup A.E. Carbohydrate feeding during exercise. Eur J Sport Sci 2008:2;77-86. doi:10.1080/17461390801918971

Mahan L.K., Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000

Shils M.E., Olson J.A., Shike M., Ross A.C.: “Modern nutrition in health and disease” 9th ed. 1999

Hydration before endurance sports

Pre-hydration
Fig. 1 – Pre-hydration

In endurance sports, like Ironman, open water swimming, road cycling, marathon, or cross-country skiing, the most likely contributors to fatigue are dehydration and carbohydrate (especially liver and muscle glycogen) depletion.

Pre-hydration

Due to sweat loss needed to dissipate the heat generated during exercise, dehydration can compromise exercise performance.
It is important to start exercising in a euhydrated state, with normal plasma electrolyte levels, and attempt to maintain this state during any activity.
When an adequate amount of beverages with meals are consumed and a protracted recovery period (8-12 hours) has elapsed since the last exercise, the athlete should be euhydrated.
However, if s/he has not had adequate time or fluids/electrolytes volume to re-establish euhydration, a pre-hydration program may be useful to correct any previously incurred fluid-electrolyte deficit prior to initiating the next exercise.

Pre-hydration program

If during exercise the nutritional target is to reduce sweat loss to less than 2–3% of body weight, prior to exercise the athlete should drink beverages at least 4 hours before the start of the activity, for example, about 5-7 mL/kg body weight.
But if the urine is still dark (highly concentrated) and/or is minimal, s/he should slowly drink more beverages, for example, another 3-5 mL/kg body weight, about 2 hours before the start of activity so that urine output normalizes before starting the event.

It is advisable to consume small amounts of sodium-containing foods or salted snacks and/or beverages with sodium that help to stimulate thirst and retain the consumed fluids.
Moreover, palatability of the ingested beverages is important to promote fluid consumption before, during, and after exercise. Fluid palatability is influenced by several factors, such as:

  • temperature, often between 15 and 21 °C;
  • sodium content;
  • flavoring.

And hyper-hydration?

Hyper-hydration, especially in the heat, could improve thermoregulation and exercise performance, therefore, it might be useful for those who lose body water at high rates, as during exercise in hot conditions or who have difficulty drinking sufficient amounts of fluid during exercise.
However there are several risks:

  • fluids that expand the intra- and extra-cellular spaces (e.g. glycerol solutions plus water) greatly increase the risk of having to void during exercise;
  • hyper-hydration may dilute and lower plasma sodium which increases the risk of dilutional hyponatraemia, if during exercise, fluids are replaced aggressively.

Finally, it must be noted that plasma expanders or hyper-hydrating agents are banned by the World Anti-Doping Agency (WADA).

Conclusion
“Pre-hydrating with beverages, if needed, should be initiated at least several hours before the exercise task to enable fluid absorption and allow urine output to return toward normal levels. Consuming beverages with sodium and/or salted snacks or small meals with beverages can help stimulate thirst and retain needed fluids” (Sawka et al., 2007, see References).

References

Jeukendrup A.E. Nutrition for endurance sports: marathon, triathlon, and road cycling. J Sport Sci 2011:29;sup1, S91-S99. doi:10.1080/02640414.2011.610348

Mahan L.K., Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000

Sawka M.N., Burke L.M., Eichner E.R., Maughan, R.J., Montain S.J., Stachenfeld N.S. American College of Sports Medicine position stand: exercise and fluid replacement. Med Sci Sport Exercise 2007;39:377-390. doi:10.1249/mss.0b013e31802ca597

Shils M.E., Olson J.A., Shike M., Ross A.C.: “Modern nutrition in health and disease” 9th ed. 1999

Shirreffs S., Sawka M.N. Fluid and electrolyte needs for training, competition and recovery. J Sport Sci 2011;29:sup1, S39-S46. doi:10.1080/02640414.2011.614269

Hypoglycemia and carbohydrate ingestion 60 min before exercise

Hypoglycemia: Fatigue
Fig. 1 – Fatigue

From several studies it appears that the risk of developing hypoglycemia (blood glucose < 3.5 mmol /l or < 63 mg/l) is highly individual: some athletes are very prone to develop it and others are much more resistant.

Strategies to limit hypoglycemia in susceptible subjects

A strategy to minimize glycemic and insulinemic responses during exercise is to delay carbohydrate ingestion just prior to exercise: in the last 5-15 min before exercise or during warm-up (even though followed by a short break).
Why?

  • Warm-up and then exercise increase catecholamine concentrations blunting insulin response.
  • Moreover, it has been shown that ingestion of carbohydrate-containing beverages during a warm-up (even if followed by a short break) does not lead to rebound hypoglycemia, independent of the amount of carbohydrates, but instead increases glycemia. When carbohydrates are ingested within 10 min before the onset of the exercise, exercise will start before the increase of insulin concentration.

Therefore, this timing strategy would provide carbohydrates minimizing the risk of a possible reactive hypoglycaemia.
In addition, it is possible to choose low glycemic index carbohydrates that lead to more stable glycemic and insulinemic responses during subsequent exercise.

Example: a 5-6% carbohydrate solution, often maltodextrin (i.e. 50-60 g maltodextrin in 1000 ml) or maltodextrin plus fructose (e.g. respectively 33 g plus 17 g in 1000 ml).

An intriguing observation is the lack of a clear relation between hypoglycaemia and its symptoms (likely related to a reduced delivery of glucose to the brain). In fact, symptoms are often reported in the absence of true hypoglycemia and hypoglycemia is not always associated with symptoms. Though the cause of the symptoms is still unknown, it is clearly not related to a glycemic threshold.

Conclusion
Some athletes develop symptoms similar to those of hypoglycemia, even though they aren’t always linked to actual low glycemia. To minimize these symptoms, for these subjects an individual approach is advisable. It may include:

  • carbohydrate ingestion just before the onset of exercise or during warm-up;
  • choose low-to-moderate GI carbohydrates that result in more stable glycemic and insulinemic responses;
  • or avoid carbohydrates 90 min before the onset of exercise.
References

Jeukendrup A.E. Carbohydrate feeding during exercise. Eur J Sport Sci 2008:2;77-86. doi:10.1080/17461390801918971

Jeukendrup A.E., C. Killer S.C. The myths surrounding pre-exercise carbohydrate feeding. Ann Nutr Metab 2010;57(suppl 2):18-25. doi:10.1159/000322698

Mahan L.K., Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000

Moseley L., Lancaster G.I, Jeukendrup A.E. Effects of timing of pre-exercise ingestion of carbohydrate on subsequent metabolism and cycling performance. Eur J Appl Physiol 2003;88:453-8. doi:10.1007/s00421-002-0728-8

Shils M.E., Olson J.A., Shike M., Ross A.C.: “Modern nutrition in health and disease” 9th ed. 1999

Carbohydrate loading before competition

Carbohydrate loading is a good strategy to increase fuel stores in muscles before the start of the competition.

What does the muscle “eat” during endurance exercise?

Carbohydrate loading: Alberto Sordi and SpaghettiMuscle “eats” carbohydrates, in the form of glycogen, stored in the muscles and liver, carbohydrates ingested during the exercise or just before that, and fat.

During endurance exercise, the most likely contributors to fatigue are dehydration and carbohydrate depletion, especially of muscle and liver glycogen.
To prevent the “crisis” due to the depletion of muscle and liver carbohydrates, it is essential having high glycogen stores before the start of the activity.

What does affect glycogen stores?

  • The diet in the days before the competition.
  • The level of training (well-trained athletes synthesize more glycogen and have potentially higher stores, because they have more efficient enzymes).
  • The activity in the day of the competition and the days before (if muscle doesn’t work it doesn’t lose glycogen). Therefore, it is better to do light trainings in the days before the competition, not to deplete glycogen stores, and to take care of nutrition.

The “Swedish origin” of carbohydrate loading

Very high muscle glycogen levels (the so-called glycogen supercompensation) can improve performance, i.e. time to complete a predetermined distance, by 2-3% in the events lasting more than 90 minutes, compared with low to normal glycogen, while benefits seem to be little or absent when the duration of the event is less than 90 min.
Well-trained athletes can achieve glycogen supercompensation without the depletion phase prior to carbohydrate loading, the old technique discovered by two Swedish researchers, Saltin and Hermansen, in 1960s.
The researchers discovered that muscle glycogen concentration could be doubled in the six days before the competition following this diet:

  • three days of low carb menu (a nutritional plan very poor in carbohydrates, i.e. without pasta, rice, bread, potatoes, legumes, fruits etc.);
  • three days of high carbohydrate diet, the so-called carbohydrate loading (a nutritional plan very rich in carbohydrates).

This diet causes a lot of problems: the first three days are very hard and there may be symptoms similar to depression due to low glucose delivery to brain, and the benefits are few.
Moreover, with the current training techniques, the type and amount of work done, we can indeed obtain high levels of glycogen: above 2.5 g/kg of body weight.

The “corrent” carbohydrate loading

If we compete on Sunday, a possible training/nutritional plan to obtain supercompensation of glycogen stores can be the following:

  • Wednesday, namely four days before the competition, moderate training and then dinner without carbohydrates;
  • from Thursday on, namely the three days before the competition, hyperglucidic diet and light trainings.
Carbohydrate Loading
Fig. 1 – Carbohydrate Loading: 2500 kcal Diet

The amount of dietary carbohydrates needed to recover glycogen stores or to promote glycogen loading depends on the duration and intensity of the training programme, and they span from 5 to 12 g/kg of body weight/d, depending on the athlete and his activity. With higher carbohydrate intake you can achieve higher glycogen stores but this does not always results in better performance; moreover, it should be noted that glycogen storage is associated with weight gain due to water retention (approximately 3 g per gram of glycogen), and this may not be desirable in some sports.

References

Burke L.M., Hawley J.A., Wong S.H.S., & Jeukendrup A. Carbohydrates for training and competition. J Sport Sci 2011;29:Sup1,S17-S27. doi:10.1080/02640414.2011.585473

Hargreaves M., Hawley J.A., & Jeukendrup A.E. Pre-exercise carbohydrate and fat ingestion: effects on metabolism and performance. J Sport Sci 2004;22:31-38. doi10.1080/0264041031000140536

Jeukendrup A.E., C. Killer S.C. The myths surrounding pre-exercise carbohydrate feeding. Ann Nutr Metab 2010;57(suppl 2):18-25. doi:10.1159/000322698

Mahan L.K., Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000

Moseley L., Lancaster G.I, Jeukendrup A.E. Effects of timing of pre-exercise ingestion of carbohydrate on subsequent metabolism and cycling performance. Eur J Appl Physiol 2003;88:453-8. doi:10.1007/s00421-002-0728-8

Shils M.E., Olson J.A., Shike M., Ross A.C.: “Modern nutrition in health and disease” 9th ed. 1999

Endurance sports and nutrition

Endurance Sports
Fig. 1 – Endurance Sports

In the last years endurance sports, defined in the PASSCLAIM document of the European Commission as those lasting 30 min or more, are increasing in popularity and competitions as half marathons, marathons, even ultramarathons, half Ironmans, or Ironman competitions attract more and more people.
They are competitions which can last hours, or days in the more extreme case of ultramarathons.
Athletes at all levels should take care of training and nutrition to optimize performance and to avoid potential health threats.
In endurance sports the most likely contributors to fatigue are dehydration and carbohydrate depletion (especially liver and muscle glycogen).

Dehydration and endurance sports

Dehydration is due to sweat losses needed to dissipate the heat that is generated during exercise. To prevent the onset of fatigue from this cause, the nutritional target is to reduce sweat losses to less than 2–3% of body weight; it is equally important to avoid drinking in excess of sweating rate, especially low sodium drinks, to prevent hyponatraemia (low serum sodium levels).

Glycogen depletion

Muscle glycogen and blood glucose are the most important substrates from which muscle obtains the energy needed for contraction.
Fatigue during prolonged exercise is often associated with reduced blood glucose levels and muscle glycogen depletion; therefore, it is essential starting exercise/competition with high pre-exercise muscle and liver glycogen concentrations, the last one for the maintaining of normal blood glucose levels.

Other problems which reduce performance and can be an health threat of the athlete, especially in long-distance races, are gastrointestinal problems, hyperthermia and hyponatraemia.
Hyponatraemia has occasionally been reported, especially among slower competitors with very high intakes of low sodium drinks.
Gastrointestinal problems occur frequently, especially in long-distance races; both genetic predisposition and the intake of highly concentrated carbohydrate solutions, hyperosmotic drinks, as well as the intake of fibre, fats, and proteins seem to be important in their occurrence.

References

Burke L.M., Hawley J.A., Wong S.H.S., & Jeukendrup A. Carbohydrates for training and competition. J Sport Sci 2011;29:Sup1,S17-S27. doi:10.1080/02640414.2011.585473

Saris W.H., Antoine J.M., Brouns F., Fogelholm M., Gleeson M., Hespel P., Jeukendrup A.E., Maughan R.J., Pannemans D., Stich V. PASSCLAIM – Physical performance and fitness. Eur J Nutr. 2003;42(Suppl 1):i50-i95. doi:10.1007/s00394-003-1104-0

Jeukendrup A.E. Carbohydrate feeding during exercise. Eur J Sport Sci 2008:2;77-86. doi:10.1080/17461390801918971

Jeukendrup A.E. Nutrition for endurance sports: marathon, triathlon, and road cycling. J Sport Sci 2011:29;sup1, S91-S99. doi:10.1080/02640414.2011.610348

Mahan L.K., Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000

Sawka M.N., Burke L.M., Eichner E.R., Maughan, R.J., Montain S.J., Stachenfeld N.S. American College of Sports Medicine position stand: exercise and fluid replacement. Med Sci Sport Exercise 2007;39:377-390. doi:10.1249/mss.0b013e31802ca597

Shils M.E., Olson J.A., Shike M., Ross A.C.: “Modern nutrition in health and disease” 9th ed. 1999

Shirreffs S., Sawka M.N. Fluid and electrolyte needs for training, competition and recovery. J Sport Sci 2011;29:sup1, S39-S46. doi:10.1080/02640414.2011.614269

Carbohydrate mouth rinse and endurance exercise performance

The importance of carbohydrates as an energy source for exercise is well known: one of the first study to hypothesize and recognize their importance was the study of Krogh and Lindhardt at the beginning of the 20th century (1920); later, in the mid ‘60’s, Bergstrom and Hultman discovered the crucial role of muscle glycogen on endurance capacity.
Nowdays, the ergogenic effects of carbohydrate supplementation on endurance performance are well known; they are mediated by mechanisms such as:

  • a sparing effect on liver glycogen;
  • the maintenance of glycemia and rates of carbohydrate oxidation;
  • the stimulation of glycogen synthesis during low-intensity exercise ;
  • a possible stimulatory effect on the central nervous system.

However, their supplementation, immediately before and during exercise, has an improving effect also during exercise (running or cycling) of a shorter and more intense nature: >75% VO2max (maximal oxygen consumption) and ≤1 hour, during which euglycaemia is rarely challenged and adequate muscle glycogen store remains at the cessation of the exercise.

Hypothesis for carbohydrate mouth rinse

In the absence of a clear metabolic explanation it was speculated that ingesting carbohydrate solutions may have a ‘non-metabolic’ or ‘central effect’ on endurance performance. To explore this hypothesis many studies have investigated the performance responses of subjects when carbohydrate solutions (about 6% carbohydrate, often maltodextrins) are mouth rinsed during exercise, expectorating the solution before ingestion.
By functional magnetic resonance imaging and transcranial stimulation it was shown that carbohydrates in the mouth stimulate reward centers in the brain and increases corticomotor excitability, through oropharyngeal receptors which signal their presence to the brain.
Probably salivary amylase releases very few glucose units from maltodextrins which is probably what is needed in order to activate the purported carbohydrate receptors in the oropharynx (no glucose transporters in the oropharynx are known).
However, the performance response appears to be dependent upon the pre-exercise nutritional status of the subject: most part of the studies showing an improving effect on performance was conducted in a fasted states (3- to 15-h fasting).
Only one study has shown improvements of endurance capacity; in both fed and fasted states by carbohydrate mouth rinse, but in non-athletic subjects.

References

Beelen M., Berghuis J., Bonaparte B., Ballak S.B., Jeukendrup A.E., van Loon J. Carbohydrate mouth rinsing in the fed state: lack of enhancement of time-trial performance. Int J Sport Nutr Exerc Metab 2009;19(4):400-9. doi:10.1123/ijsnem.19.4.400

Bergstrom J., Hultman E. A study of glycogen metabolism during exercise in man. Scand J Clin Invest 1967;19:218-28. doi:10.3109/00365516709090629

Bergstrom J., Hultman E. Muscle glycogen synthesis after exercise: an enhancing factor localized in muscle cells in man. Nature 1966;210:309-10. doi:10.1038/210309a0

de Salles Painelli V.S., Nicastro H., Lancha A. H.. Carbohydrate mouth rinse: does it improve endurance exercise performance? Nutrition Journal 2010;9:33. doi:10.1186/1475-2891-9-33

Fares E.J., Kayser B. Carbohydrate mouth rinse effects on exercise capacity in pre- and postprandial States. J Nutr Metab 2011, Article ID 385962. doi:10.1155/2011/385962

Krogh A., Lindhard J. The relative value of fat and carbohydrate as sources of muscular energy. Biochem J 1920;14:290-363. doi:10.1042/bj0140290

Rollo I. Williams C. Effect of mouth-rinsing carbohydrate solutions on endurance performance. Sports Med. 2011;41(6):449-61. doi:10.2165/11588730-000000000-00000

Strategies to maximize muscle glycogen resynthesis after exercise

An important energy source for working muscle is its glycogen store, whose level is correlated with the onset of fatigue.
The highly trained athlete not only has glycogen stores potentially higher but he is also able to synthesize it faster thanks to more efficient enzymes.

Glycogen
Fig. 1 – Glycogen Structure

To synthesize glycogen it is necessary to ingest carbohydrates; but how many, which, when, and how often?

CONTENTS

The two phases of muscle glycogen synthesis after exercise

In order to restore as quickly as possible muscle glycogen depots, it is useful to know that, as a result of training sessions that deplete muscle glycogen to values below 75% those at rest and not fasting, glycogen synthesis occurs in two phases.
To know and therefore take advantage of the biphasicity is important for those athletes who are engaged in more daily training sessions, or who otherwise have little time for recovery between a high intensity exercise and the subsequent one (less than 8 hours), in order to maximize glycogen synthesis and achieve the optimal performance during a second close exercise session.
The two phases are characterized by:

  • a different sensitivity to circulating insulin levels;
  • a different velocity.

The first phase

The first phase, immediately following the end of an activity and lasting 30-60 minutes, is insulin-independent, i.e. glucose uptake by muscle cell as glycogen synthesis are independent from hormone action.
This phase is characterized by an elevated rate of synthesis that however decreases rapidly if you do not take in carbohydrates: the maximum rate is in the first 30 minutes, then declines to about one fifth in 60 minutes, and to about one ninth in 120 minutes from the end of exercise.
How is it possible to take advantage of this first phase to replenish muscle glycogen stores as much as possible? By making sure that the greatest possible amount of glucose arrives to muscle in the phase immediately following to the end of exercise, best if done within the first 30 minutes.

  • What to ingest?
    High glycemic index, but easy to digest and absorb, carbohydrates.
    Therefore, it is advisable to replace foods, even though of high glycemic index, that need some time for digestion and the subsequent absorption, with solutions/gel containing for example glucose and/or sucrose. These solutions ensure the maximal possible absorption rate and resupply of glucose to muscle because of they contain only glucose and are without fiber or anything else that could slow their digestion and the following absorption of the monosaccharide, that is, they are capable of producing high blood glucose levels in a relatively short time.
    It is also possible to play on temperature and concentration of the solution to accelerate the gastric transit.
    It should be further underlined that the use of these carbohydrate solutions is recommended only when the recovery time from a training/competition session causing significant depletion of muscle glycogen and the following one is short, less than 8 hours.
  • How many carbohydrates do you need?
    Many studies has been conducted to find the ideal amount of carbohydrates to ingest.
    If in post-exercise the athlete does not eat, glycogen synthesis rate is very low, while if he ingests adequate amounts of carbohydrates immediately after cessation of exercise, synthesis rate can reach a value over 20 times higher.
    From the analysis of scientific literature it seems reasonable to state that, as a result of training sessions that deplete muscle glycogen stores as seen above (<75% of those at rest and not fasting), the maximum synthesis rate is obtained by carbohydrate intake, with high glycemic index and high digestion and absorption rates, equal to about 1.2 g/kg of body weight/h for the next 4-5 hours from the end of exercise.
    In this way, the amount of glycogen produced is higher than 150% compared to the ingestion of 0.8 g/kg/h.
    Because further increases, up to 1.6 g/kg/h, do not lead to further rise in glycogen synthesis rate, the carbohydrate amount equal to 1.2 g/kg/h can be considered optimum to maximize the resynthesis rate of muscle glycogen stores during post-exercise.
  • And the frequency of carbohydrate ingestion?
    It was observed that if carbohydrates are ingested frequently, every 15-30 minutes, it seems there is a further stimulation of muscle glucose uptake as of muscle glycogen replenishment compared with ingestion at 2-hours intervals. Particularly, ingestions in the first post-exercise hours seem to optimize glycogen levels.

The second phase

The second phase begins from the end of the first, lasts until the start of the last meal before the next exercise (hence, from several hours to days), and is insulin-dependent i.e. muscle glucose uptake and glycogen synthesis are sensitive to circulating hormone levels.
Moreover, you observe a significant reduction in muscle glycogen synthesis rate: with adequate carbohydrate intake the synthesis rate is at a value of about 10-30% lower than that observed during the first phase.
This phase can last for several hours, but tends to be shorter if:

  • carbohydrate intake is high;
  • glycogen synthesis is more active;
  • muscle glycogen levels are increased.

In order to optimize the resynthesis rate of glycogen, experimental data indicate that meals with high glycemic index carbohydrates are more effective than those with low glycemic index carbohydrates; but if between a training/competition session and the subsequent one days and not hours spend, the evidences do not favor high glycemic index carbohydrates as compared to low glycemic index ones as long as an adequate amount is taken in.

Muscle glycogen synthesis rate and ingestion of carbohydrates and proteins

The combined ingestion of carbohydrates and proteins (or free insulinotropic amino acids) allows to obtain post-exercise glycogen synthesis rate that does not significantly differ from that obtained with larger amounts of carbohydrates alone. This could be an advantage for the athlete who may ingest smaller amount of carbohydrates, therefore reducing possible gastrointestinal complications commons during training/competition afterward to their great consumption.
From the analysis of scientific literature it seems reasonable to affirm that, after an exercise that depletes at least 75% of muscle glycogen stores, you can obtain a glycogen synthesis rate similar to that reached with 1.2 g/kg/h of carbohydrates alone (the maximum obtainable) with the coingestion of 0.8 g/kg/h of carbohydrates and 0.4 g/kg /h of proteins, maintaining the same frequency of ingestion, therefore every 15-30 minutes during the first 4-5 hours of post-exercise.

The two phases: molecular mechanisms

The biphasicity is consequence, in both phases, of an increase in:

  • glucose transport rate into cell;
  • the activity of glycogen synthase, the enzyme that catalyzes glycogen synthesis.

However, the molecular mechanisms underlying these changes are different.
In the first phase, the increase in glucose transport rate, independent from insulin presence, is mediated by the translocation, induced by the contraction, of glucose transporters, called GLUT4, on the cytoplasmatic membrane of the muscle cell.
In addition, the low glycogen levels also stimulate glucose transport as it is believed that a large portion of transporter-containing vesicles are bound to glycogen, and therefore they may become available when its levels are depleted.
Finally, the low muscle glycogen levels stimulate glycogen synthase activity too: it has been demonstrated that these levels are a regulator of enzyme activity far more potent than insulin.
In the second phase, the increase in muscle glycogen synthesis is due to insulin action on glucose transporters and on glycogen synthase activity of muscle cell. This sensibility to the action of circulating insulin, that can persist up to 48 hours, depending on carbohydrate intake and the amount of resynthesized muscle glycogen, has attracted much attention: it is in fact possible, through appropriate nutritional intervention, to increase the secretion in order to improve glycogen synthesis itself, but also protein anabolism, reducing at the same time the protein-breakdown rate.

Glycogen synthesis rate and insulin

The coingestion of carbohydrates and proteins (or free amino acids) increases postprandial insulin secretion compared to carbohydrates alone (in some studies there was an increase in hormone secretion 2-3 times higher compared to carbohydrates alone).
It was speculated that, thanks to the higher circulating insulin concentrations, further increases in post-exercise glycogen synthesis rate could be obtained compared to those observed with carbohydrates alone, but in reality it does not seem so. In fact, if carbohydrate intake is increased to 1.2 g/kg/h plus 0.4 g/kg/h of proteins no further increases in glycogen synthesis rate are observed if compared to those obtained with the ingestion of carbohydrates alone in the same amount (1,2 g/kg/h, that, as mentioned above, like the coingestion of 0,8 g/kg/h of carbohydrates and 0,4 g/kg/h of proteins, allows to attain the maximum achievable rate in post-exercise) or in isoenergetic quantities, that is, 1.6 g/kg (proteins and carbohydrates contain the same calorie/g)

Insulin and preferential carbohydrate storage

The greater circulating insulin levels reached with the coingestion of carbohydrates and proteins (or free amino acids) might stimulate the accumulation of ingested carbohydrates in tissues most sensitive to its action, such as liver and previously worked muscle, thus resulting in a more efficient storage, for the purposes of sport activity, of the same carbohydrates.

References

Beelen M., Burke L.M., Gibala M.J., van Loon J.C. Nutritional strategies to promote postexercise recovery. Int J Sport Nutr Exerc Metab 2010:20(6);515-32 doi:10.1123/ijsnem.20.6.515

Berardi J.M., Noreen E.E., Lemon P.W.R. Recovery from a cycling time trial is enhanced with carbohydrate-protein supplementation vs. isoenergetic carbohydrate supplementation. J Intern Soc Sports Nutrition 2008;5:24 doi:10.1186/1550-2783-5-24

Betts J., Williams C., Duffy K., Gunner F. The influence of carbohydrate and protein ingestion during recovery from prolonged exercise on subsequent endurance performance. J Sports Sciences 2007;25(13):1449-60 doi:10.1080/02640410701213459

Howarth K.R., Moreau N.A., Phillips S.M., and Gibala M.J. Coingestion of protein with carbohydrate during recovery from endurance exercise stimulates skeletal muscle protein synthesis in humans. J Appl Physiol 2009:106;1394–1402 doi:10.1152/japplphysiol.90333.2008

Jentjens R., Jeukendrup A. E. Determinants of post-exercise glycogen synthesis during short-term recovery. Sports Medicine 2003:33(2);117-144 doi:10.2165/00007256-200333020-00004

Millard-Stafford M., Childers W.L., Conger S.A., Kampfer A.J., Rahnert J.A. Recovery nutrition: timing and composition after endurance exercise. Curr Sports Med Rep 2008;7(4):193-201 doi:10.1249/JSR.0b013e31817fc0fd

Price T.B., Rothman D.L., Taylor R., Avison M.J., Shulman G.I., Shulman R.G. Human muscle glycogen resynthesis after exercise: insulin-dependent and –independent phases. J App Physiol 1994:76(1);104–111 doi:10.1152/jappl.1994.76.1.104

van Loon L.J.C., Saris W.H.M., Kruijshoop M., Wagenmakers A.J.M. Maximizing postexercise muscle glycogen synthesis: carbohydrate supplementation and the application of amino acid or protein hydrolysate mixtures. Am J Clin Nutr 2000;72: 106-111 doi:10.1093/ajcn/72.1.106