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Description : Check out this medical presentation on Bodybuilding Dietary Supplements and Sports Nutrition, which is titled "SPORTS NUTRITION FOR ENDURANCE ATHLETES", to know about endurance athletes fueling and hydration needs.

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Slide 1-

SPORTS NUTRITION FOR ENDURANCE ATHLETES Lecture content provided by GSSI, a division of PepsiCo, Inc. Any opinions or scientific interpretations expressed in this presentation are those of the author and do not necessarily reflect the position or policy of PepsiCo, Inc.
Slide 2-

Lecture Outline The endurance athlete Energy Hydration Structure Key takeaways
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THE ENDURANCE ATHLETE
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What do you think are some unique characteristics of an endurance athlete (think marathon runner or Ironman triathlete) that might impact their nutrition needs?
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Endurance athlete considerations All Athletes Use and need fuel for energy to train/compete Sweat and need hydration Use muscles and need strength Endurance Athlete Specific Train and compete for long durations – typically 2+ hours at a time Low-moderate intensity exercise Steady state vs. intermittent high intensity exercise Sport specific: runners, cyclists, or triathletes Compete in marathons, triathlon, and ultra endurance events
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ENERGY HYDRATION STRUCTURE
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Carbohydrate improves endurance performance Consuming carbohydrate during exercise results in: Maintenance of blood glucose levels Maintenance of carbohydrate oxidation Spares muscle and/or liver glucose supplies Coyle EF, Coggan AR, Hemmert MK, et. al. J Appl Physiol. 1986;61(1):165-172
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One of the first studies to show that Carbohydrate ingestion benefits endurance exercise 60 120 240 180 0 Time (min) 60 120 240 180 0 60 120 240 180 0 Time (min) Time (min) 5.0 4.5 4.0 3.5 3.0 2.5 2.0 2.6 2.2 1.8 1.4 1.0 200 150 100 50 0 Blood glucose (mmol/L) CHO oxidation (g/min) Muscle glycogen (mmol/kg ww) Coyle EF, Coggan AR, Hemmert MK, et. al. J Appl Physiol. 1986;61(1):165-172
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Carbohydrate is limited in the body Energy is stored in the body as fat and carbohydrate Fatty acids are stored in the adipose tissue Everyone, even the leanest athletes have enough stored fats to exercise for a very long time The body relies primarily on fats during lower intensity exercise Carbohydrates are stored in the liver and the muscles There is limited storage capacity for carbohydrate The body relies primarily on carbohydrates during higher intensity exercise Eating carbohydrates helps replenish glycogen stores van Loon, L. J Appl Physiol (2004) 97(4):1170-1187, https://doi.org/10.1152/japplphysiol.00368.2004
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As intensity increases, carbohydrate use for energy increases and fat decreases INTENSITY Jeukendrup & Achten. Eur J Sports Sci. 2001;1(5):1-5
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Exercise intensity & carbohydrate utilization Exercise intensity impacts how quickly our muscle glycogen stores are used up At lower levels of exercise intensity muscle glycogen utilization is spared The blue line indicating 31% exercise intensity shows that exercise time is extended and muscle glycogen decreases slower At high levels of exercise intensity muscle glycogen is utilization accelerates The purple line indicating 150% exercise intensity shows that exercise time is limited and muscle glycogen decreases sharply In general, there is a dose/response relationship between exercise intensity and muscle glycogen use
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Substrate utilization & exercise duration Endurance Athlete Zone
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Enhancing carbohydrate stores - chronic We can adapt how much carbohydrate is stored in our muscles through diet In this study, those with higher carbohydrate diet (red oval) have significantly more muscle glycogen Those with higher carbohydrate diets have longer time to exhaustion Time to Exhaustion (min) Muscle Glycogen (mmol.kg dw-1) Bergstrom J, Hermansen L, Hultman E, et. al. Acta Physiol Scand. 1967;7(2-3):140-150
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Enhancing carbohydrate stores - acute There are few ways that we can absorb carbohydrate through our gut Glucose is absorbed via the SGLT1 transporter This transporter can only sustain a rate of 1.0 g/min or 60 g/h Carbohydrate sources, like glucose are absorbed quickly That doesn’t mean there isn’t a role for a slow sugar, like fructose It has a separate transporter, the glut 5 transporter It can be absorbed in addition to the 60g/h of glucose Slowly absorbed carbohydrate, you would not want to consume much more than 30 g/h. This combined type of carbohydrate is especially important for endurance athletes This is why carb recommendations aren’t based on body weight, but are standard amounts based on exercise duration Jeukendrup AE. Sports Science Exchange. 2013;26(108):1-5
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CARBOHYDRATE TRANSPORTERS INTESTINAL LUMEN BLOODSTREAM GLUCOSE FRUCTOSE GLUCOSE FRUCTOSE SGLT1 GLUT5 ~30 g/h max ~60 g/h max
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Carbohydrate intake and use The body’s ability to use the carbohydrate we take in is limited We are able to use about 1 gram of glucose alone per minute We can use, more multiple source carbohydrate of glucose and fructose We can increase it to about 1.5 grams per minute of carbohydrate However, if we try to take in more than about 1.5 grams per minute combined type, we do not seem to get any additional benefit – and typically end up with GI discomfort. Jeukendrup AE. Curr Op Clin Nutr Metab Care. 2010;13(4):452-457 Single source carbohydrate Multiple source carbohydrate
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Multiple source carbohydrate improves fluid delivery Multiple sources of carbohydrate of glucose and fructose emptying the gut quicker This resulted in the fluid and carbohydrate getting into the blood faster than glucose and almost as fast as water This means that the body can use this fluid and fuel quicker Water Glucose + Fructose Glucose Time (min) Plasma 2H2O enrichment (ppm) compared to t=60 sample Jentjens RLPG, Underwood K, Achten J, et. al. J Appl Physiol. 2006;100(3):807-816
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Performance and carbohydrate blends 00:56:07 01:00:41 Currell K & Jeukendrup AE. Med Sci Sports Exerc. 2008;40(2):275-281 8% 19% Performance and Carbohydrate Blends 01:07:00
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Carbohydrate during training and competition Thomas TD, Erdman KA, Burke LM. Med Sci Sports Exerc. 2016;48(3):543-568
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Amount of Carbohydrate (grams) 1 hour Swim 4 hour Ride 2 hour Run 30 0 60 90 Examples of how to use the recommended carbohydrate amounts
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GI issues with carb intake The stomach is an organ that can be trained It is important that an athlete gradually increase the amount of fluid and fuel intake during exercise to meet the recommendations Consuming more fluid or carbohydrates than an athlete is used to can result in a “sloshy” stomach and other more intense gastrointestinal (GI) discomfort Train your gut Stellingwerff & Jeukendrup. JAP. 2011 Murray R. Curr Sports Med Rep. 2006;5(3):161-164
Slide 22-

Summary: Energy Carbohydrate is well known to improve endurance Endogenous stores are limited and disappear quicker as exercise intensity increases Chronically, through diet, we can manipulate endogenous stores Acutely, by feeding carbohydrate before and during, we can also top up our fuel supply and improve performance One of the limitations to using fed carbohydrate is gut absorption, with single carbohydrate absorption and oxidation limited around 60 g/h This rate can be increased to 90 g/h with multiple transportable carbohydrates Such carbohydrates also have benefits on fluid delivery and performance
Slide 23-

ENERGY HYDRATION STRUCTURE
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Dehydration impairs the ability to remove heat Increased cardiovascular strain Increased glycogen use Altered metabolic & CNS function Decreased fluid absorption Risk of heat illness Thomas TD, Erdman KA, Burke LM. Med Sci Sports Exerc. 2016;48(3):543-568
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Hydration and performance Dehydration can cause performance impairment for endurance athletes Typically, the more dehydrated, the greater chance of performance decrements 2% body mass loss during exercise is a threshold when performance can be impacted Some athletes can tolerate slightly greater losses and some can tolerate less Practicing hydration strategies is key to endurance athletes to find out what is tolerable for each athlete The next slide shows results from a review paper regarding the amount of studies that show endurance performance decrements at different levels of dehydration
Slide 26-

Cheuvront SN & Kenefick RW. Compr Physiol. 2014;4(1):257-285 2/2 1/1 Hydration and performance
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Hyponatremia Hyponatremia is a result of a decreased plasma sodium concentration below 135 mmol/L The longer it remains low, the greater the risk of dilutional encephalopathy and pulmonary edema Contributing factors to exercise-associated hyponatremia: Overdrinking hypotonic fluids Longer duration events Large sweat sodium losses This is why it is important for endurance athletes to know their losses and have a hydration strategy Stachenfeld NS. Sports Science Exchange. 2014;27(122):1-5 Murray B, Stofan J, Eichner RE. Sports Science Exchange. 2003;16(1):1-6
Slide 28-

Fluid Intake Water Fluid Absorption Carbohydrate Fluid Distribution Sodium Fluid Retention Sodium Temperature & Humidity Training Status & Intensity Beverage Preferences Environment & Equipment Factors Influencing Hydration SSE#152 Sawka MN & Cheuvront SN. Sports Science Exchange. 2015;28(152):1-5
Slide 29-

Body MassPRE-EX – Body MassPOST-EX – Fluid IntakeEX + Urine LossEX Exercise Duration https://www.gssiweb.org/toolbox/fluidLoss/calculator Sweating rate calculation To measure how much fluid an athlete loses sweating rate will need to be measured. Here are the steps: Obtain body mass before practice Know the mass of the food and fluids that you consume during this session Know the mass of any urine or stool lost during this training Obtain post-exercise body weight after toweling dry Know how long your training session lasted – meaning how long from the pre-exercise to post-exercise body mass.
Slide 30-

Example hydration strategy Sweat test exercise duration: 90 minutes Sweating rate: 1.5 L / 1.5 hours = 1 L per hour 4 hour marathon = 4 L or 4 kg body mass loss (in similar conditions at similar intensity as sweat test) Drinking volume (sweat loss – 2% window): 4-1.4 = 2.6 L Hydration strategy: 2.6 L/4 h = 650 ml/h OR 220 ml/20 min Example of an athlete that conducted a sweat test during training and how to use that information to build a hydration plan for a marathon
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Endurance compared to other sports Endurance athletes lose more sodium than many other sports Endurance athletes sweat sodium losses very and can be quite high Endurance athletes lose more fluid than several other sports despite being smaller in stature on average Endurance athletes sweating rate is highly variable between and within athletes Sweat sodium loss by sport Sweating rate by sport Barnes KA, Anderson ML, Stofan JR, et. al. J Sports Sci. 2019;37(20):2356-2366
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Summary: Hydration During Exercise Practice your hydration strategy You should expect to lose some weight during exercise due to dehydration – this is normal However, you should try to drink enough fluid throughout exercise to maintain body weight change within 2% for hot conditions and 3% for cooler conditions when possible Sweat losses vary between and within sports, so you need to know your losses whenever possible throughout a season Don’t overdrink Include sodium to improve palatability, stimulate drinking, retain fluid Focus on sodium intake >2h exercise, when sodium losses are high (>3-4 g) Daily Intake Drink gradually throughout the day Avoid drinking too much too quickly
Slide 33-

ENERGY HYDRATION STRUCTURE
Slide 34-

Do you think post-exercise protein intake is important for endurance athletes? Why or why not?
Slide 35-

Protein Human body is about 45% protein All athletes need protein for success The primary function of proteins in the human body are: Structure – example, collagen Movement – contractile proteins Immune function – Antibodies Transport – hemoglobin Hormones Enzymes – facilitate biochemical reactions Cell signaling, or communication pathways in cells
Slide 36-

Protein for Recovery from Endurance Exercise Different types of exercise stimulate the synthesis of different sets of proteins: Resistance type exercise strongly stimulates the synthesis of muscle contractile (myofibrillar) proteins Endurance type exercise has a greater impact on stimulating the synthesis of mitochondrial proteins This allows for exercise-specific muscle adaptations van Loon LJ. Sports Science Exchange. 2013;26(109):1-6
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Endurance exercise also stimulates increased amino acid oxidation Protein replenishment is necessary to restore amino acid building blocks after exercise Post-Exercise: Protein ingestion increases muscle fiber and mitochondrial protein synthesis Aim for ~20 g, or 0.25-0.3 g/kg Daily Intake Needs are elevated above the RDA to support the demands of training and adaptation Consume ~1.2-1.4 g/kg/d protein Rodriguez NR, DiMarco NM, Langley S, et. al. J Am Diet Assoc. 2009;109(3):509-527 Moore DR. Front Nut. 2019;10 Protein for Recovery from Endurance Exercise
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QUANTITY OF PROTEIN FOR ENDURANCE ATHLETES 170 LBS X 1.3 (g/kg) 88G PROTEIN PER DAY 120 LBS X 1.3 (g/kg) 71G PROTEIN PER DAY ~1.2-1.4 g/kg/d
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Protein and Endurance Performance 12 week protein supplementation after exercise and prior to sleep did not improve endurance performance when compared to an energy matched carbohydrate placebo Chronic endurance training improved performance in both groups by 11% There were no differences between groups Protein intake is important for recovery, but does NOT further improve endurance performance based on VO2 max 11% improvement pre to post 12 week training in both groups CHO PRO Pre Pre Post Post Jonvik KL, Paulussen KJM, Danen SL, et. al. Med Sci Sports Exerc. 2019;51(10):2041-2049
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Protein + Carbohydrate During & Endurance Performance The literature on the addition of protein to a sport nutrition beverage containing carbohydrate DURING exercise shows mixed results. Some of the variability in results could be from: The type of study: time to exhaustion vs. time trial The placebo used The caloric differences of the beverage/gel EXAMPLE: When a study looked at CHO+PRO vs. Placebo, CHO, and CHO that was energy matched to the CHO+PRO: CHO+PRO and CHO+CHO were longer than PLA Placebo and CHO were not different CHO+PRO was not different from CHO or CHO calorie match Valentine RJ, Saunders MJ, Todd MK, et. al. Int J Sport Nutr Exerc Metab. 2008;18(4):363-378
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Protein + Carbohydrate & Endurance Performance van Loon, LJ. Sports Science Exchange. 2013;26(109):1-6 The ingestion of protein with carbohydrate during exercise does not acutely improve exercise performance above carbohydrate ingestion alone, when ample carbohydrate is ingested. SSE#109
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Summary: Protein Endurance exercise may stimulate increased amino acid oxidation and synthesis specifically of mitochondrial proteins, leading to training adaptations Endurance athletes should consume at least 1.2-1.4 g/kg/d of quality protein per day and ~20 g post-training Protein intake during endurance training is not warranted
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Overall Summary Endurance athletes fueling and hydration needs are unique and require specific replacement during and after exercise to perform optimally Therefore, endurance athletes need to experiment and adapt Do that by logging: Exercise intensity and duration Nutrition content & timing (start lower and increase) Hydration/sweating rate assessments Environmental conditions Self assessment of performance rating (1-5, +/-) Comments Racing Fine tune and practice nutrition and hydration during build up races Include nutrition as part of your race/event report