Sports Nutrition Research
Update 2009
with exercise physiology, strength
conditioning & topics of interest
in sports medicine
G. DOUGLAS ANDERSEN DC
DACBSP, CCN
www.andersEnchiro.com
Carb Loading Update
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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.
Carb Loading Update
Early Problems
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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.
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) 209-13
4
Carb Loading 2009 - 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) 209-13
Protein Uptake in High CHO Beverage
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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) A955 S101
6
Sport Drinks & Protein- Is it the
Protein or Calories?
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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) 363-78
INGREDIANT COMPARISON OF EXPERIMENTAL DRINKS
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) 363-78
Time to Fatigue with each Beverage Treatment
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) 363-78
Plasma Creatine Kinase
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) 363-78
Serum Myoglobin Concentration
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) 363-78
Cystine and Theanine
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15 Subjects (mean age 23) with 4-5 years of
resistance training @ 3x/week enrolled in a 2 week
experiment.
Divided into 2 groups and took either 700 mg
Cystine + 280 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
Beta Glucagon & URI’s
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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.
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)
1463-71
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. 2009 (7) 157-63
Quercetin
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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 (90th 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.
15
Quercetin Increases Power and
Endurance
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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
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.
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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
Caffeine
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Regular use can build intolerance and dependency.
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Addicts will suffer from withdrawal headaches + brain
fog, fatigue.
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Side effects may include insomnia, nervousness,
elevated heartbeat, and headaches.
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Caffeine is not a diuretic. (under 600mg)
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Some report better results and improvement during an
athletic event when they have abstained for 48 hours.
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Caffeine
Continued
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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
20
Caffeine
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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): 1998-2005
Kalmar, J.M. The Influence of Caffeine on Voluntary Muscle Activation Med Sci Exerc.
2005;37(12) : 2113-19
Caffeine Improves Sprint Times
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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.
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) 1835-40
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) 1835-40
Caffeine and Glycogen
Replenishment
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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 + 140 mg caffeine
per hour.
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
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Caffeine and Glycogen
Replenishment
continued
GLYCOGEN LEVELS*
*measured by muscle biopsy
Treatment
Exhaustion
1 Hour Post 4 Hour Post
CHO
75 mmol
121 mmol
234 mmol
CHO + Caff
75 mmol
149 mmol
313 mmol
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
Exercise Frequency and Workload
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30 Obese women 25-38 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 LT@60% 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
Intense Resistance Exercise Can
Lower Post-Prandial Blood Lipids
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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 50-35-15 (%CPF) meal @ 5 cal/kg
bodyweight
Day 2 was identical in all 3 trials. 15.5 hours
after exercise (or rest) subjects returned for
morning meal 25-11-64 (%CPF) meal @ 20
cal/kg bodyweight.
Venous samples were taken before and 3 hours
after the meal.
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Intense Resistance Exercise Can
Lower Post-Prandial Blood Lipids
continued
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Moderate resistance exercise was 3 sets of 16 reps
of 10 exercises @ weight of 50% of 8 rep max.
Intense resistance exercise was 3 sets of 8 reps of
10 exercises @ 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 postprandial 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
Exercise Dependence
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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
Korean Red Ginseng
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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 8th day subjects did two 45 minute uphill
treadmill runs with 5 minute rest break.
Blood was drawn immediately pre-post exercise
and @ 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.)
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Korean Red Ginseng
results
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Interleukin-6 was reduced @2 hour test in Ginseng
group .22 pg/ml vs .26 pg/ml in placebo.
Creatine kinase activity was lower in the ginseng
group @ 72 hour test. 223 IU/L vs 263 IU/L in
placebo.
Cortisol response @ 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
Energy Patch Science Claims
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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
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Energy Patch Experiment - Males
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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
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Energy Patch Experiments – Females
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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
Passive Stretching and Golf Driver
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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
Drink Temperature During Exercise
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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
Drink Temperature During Exercise
Results
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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) 1637-44
38
Athletic Cramping
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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?’
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Cramp Type
Cause/Comment
Treatment
Muscle Fatigue
True EAMC from repetitive
contracture
Stretch
Soft Tissue Lengthening
Muscle Tearing
Reflex guarding to fiber tearing
Ischemic compression then ice
then wrap
Heat
Fluid and electrolyte loss from heavy
sweating = ‘Sweat Cramps’
Fluid and electrolytes, esp. Na
Ischemic compression
Nocturnal
1.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 Body
Precursor to life threatening heat
illness
Cool body. Fluid and electrolytes,
esp. Na. Call 911
Side Stitches
1.
2.
Organ bouncing in runners
leads to swelling and spasm.
Liver trauma is why pain often
occurs on right side.
Diaphragm Ischemia
Stop Activity
Flex Forward
Relax
Pre-competition meal earlier
Types of Cramps and
Treatment
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) 289-92
41
New England Journal of Medicine. March 19, 2009
Reisenauer, C. Solomayer, E. Pelvic-Organ Prolapse and Uterine Inversion
NEJM. 2008; 360 (12) 1238
Fruits in Cure-All Juices
Acai
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From a palm tree in the Amazon
Purple/black berries the size of a grape
12-15 vit’s/min’s; 15-20 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
Fruits in Cure-All Juices
Goji
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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
Fruits in Cure-All Juices
Noni
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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
Fruits in Cure-All Juices
Mangosteen
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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.
Fruits in Cure-All Juices
Indian Gooseberry
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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 (125-475mg/oz)
Does contain Quercetin
Fibrous w/ bitter/sour taste (often dipped in salt
when consumed in India.)
Some say ORAC score doubles Acai
Fruits in Cure-All juices
Oranges
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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
Sodium Levels and Exercise-Associated Muscle
Cramps in 14 NFL Players (6 cramp hx. – 8 n/c)
Substance
Cramp
Non-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
81%
19%
58%
42%
% water
% sports drink
Sweat Na
52.6 mmol/L
38.3 mmol/L
Acute Na balance
-223 mmol
-133 mmol
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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.
49
Sodium Loading
 8 endurance trained males, (~36 yrs) doubleblind trial.
 High vs. Low sodium beverage prior to a run to
exhaustion @ 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
50
Sodium Loading
Continued
Subject
1
2
3
4
5
6
7
8
Time to exhaustion in minutes
Hi Na
49.1
82.2
85.2
136.3
59.0
59.3
70.0
37.4
Low Na__
47.0
47.0
59.8
125.9
48.8
38.3
53.2
38.4
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) 123-130
51
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 3/11/2009
52
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 = 1437.5 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
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
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) 309-16
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
Low Salt Helps EIA Patients
CONTINUED
Dietary NA
Low
Medium
High
FEV 1
-7.9%
-18.3%
-27.4%
Puffs**
12
18
26
** # of Bronchodilator puffs required during the test.
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. 2008
36(3) 135-44
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) 904-19
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. 2008 36(3) 135-44
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) 135-44
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.
61
Vitamin C and EIA
RESULTS
Test
Post
Post
Post
Post
Vitamin C
exercise nitric oxide (ppb)
23.7
ex. leukotriene (ng/mmol/cr)
5.3
ex. prostaglandin F2 (ng/mmol/cr)
8.5
ex. hydrogen peroxide (mmol/L)
5.6
Placebo
34.1
11.1
13.0
12.6
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
62
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)
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) 1149-54
COMPARISON OF FULL BODY & LOWERBODY FASTSKIN SUITS
Chatard, JC., Wilson, B. Effects of Fastskin Suits on Performance, Drag and Energy Cost of
Swimming. Med. Sc. Sports Exerc. 2008;40(6) 1149-54
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 (3-2-12 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
CREATINE, CLA & WHEY vs. CREATINE & WHEY vs. WHEY
Bench Press
Leg Press
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
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) 653-64
Resolved Concussion?



66 subjects 19-22 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
69
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 DOM’s @24 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, S244
11 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
CoEnzyme Q10
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 exercise @70% VO2 max. LCarnitine 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) 567-84
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
72
Iron Deficiency Signs and Symptoms







Fatigue
Shortness of breath
Pallor
Drowsy following exercise
Angular stomatitis
Decreased cold tolerance (especially hands/feet)
Itchy skin
73
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) :P985-988
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; 2103-9
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) 778-87
74
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
75
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<20 mcg/L) subjects were matched with
normal iron subjects (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.
Iron and Activity in Women
Continued
Time In Minutes
16 Hours (960 minutes)
Results
Sedentary
Low
Moderate
Vigorous
Low Iron
650
153
126
31
Normal
Iron
559
195
155
51
Crouter, S., DellaValle D., Haas, J. Relationship Between Iron Status and Physical Activity. Med.
Sci. Sports Exerc. 2008; 40(5) A-1955 S341
Iron Measured in College CrossCountry 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
78
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
79
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) 709-731
ACSM 2009 Nutrition & Performance
Selected Highlights



CHO Rx
Protein Rx
Fat Rx
6-10 gm/kg/bw (2.7-4.5 gm/lb)
1.2-1.7 gm/kg/bw (.5-.8 gm/lb)
20-35% calories
Pre-Ex Meal low fat & fiber, moderate Pro, high CHO
 During Ex
30-60 gm/CHO/hr (120-240 cal/hr)
 Post Ex
w/in 30 min. 1-1.5gm/kg/bw/CHO
(.5-.7 gm/lb) & repeat every 2 hrs up to 6 hrs
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
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
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.
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.
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
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
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
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
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