A systematic review and meta-analysis of carbohydrate benefits associated with randomized controlled competition-based performance trials.

BACKGROUND: Carbohydrate supplements are widely used by athletes as an ergogenic aid before and during sports events. The present systematic review and meta-analysis aimed at synthesizing all available data from randomized controlled trials performed under real-life conditions. METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched systematically up to February 2015. Study groups were categorized according to test mode and type of performance measurement. Subgroup analyses were done with reference to exercise duration and range of carbohydrate concentration. Random effects and fixed effect meta-analyses were performed using the Software package by the Cochrane Collaboration Review Manager 5.3. RESULTS: Twenty-four randomized controlled trials met the objectives and were included in the present systematic review, 16 of which provided data for meta-analyses. Carbohydrate supplementations were associated with a significantly shorter exercise time in groups performing submaximal exercise followed by a time trial [mean difference -0.9 min (95 % confidence interval -1.7, -0.2), p = 0.02] as compared to controls. Subgroup analysis showed that improvements were specific for studies administering a concentration of carbohydrates between 6 and 8 % [mean difference -1.0 min (95 % confidence interval -1.9, -0.0), p = 0.04]. Concerning groups with submaximal exercise followed by a time trial measuring power accomplished within a fixed time or distance, mean power output was significantly higher following carbohydrate load (mean difference 20.2 W (95 % confidence interval 9.0, 31.5), p = 0.0004]. Likewise, mean power output was significantly increased following carbohydrate intervention in groups with time trial measuring power within a fixed time or distance (mean difference 8.1 W (95 % confidence interval 0.5, 15.7) p = 0.04]. CONCLUSION: Due to the limitations of this systematic review, results can only be applied to a subset of athletes (trained male cyclists). For those, we could observe a potential ergogenic benefit of carbohydrate supplementation especially in a concentration range between 6 and 8 % when exercising longer than 90 min.

Carbohydrates and exercise performance in non-fasted athletes: a systematic review of studies mimicking real-life.

There is a consensus claiming an ergogenic effect of carbohydrates ingested in the proximity of or during a performance bout. However, in performance studies, the protocols that are used are often highly standardized (e.g. fasted subjects, constant exercise intensity with time-to-exhaustion tests), and do not necessarily reflect competitive real-life situations. Therefore, we aimed at systematically summarizing all studies with a setting mimicking the situation of a real-life competition (e.g., subjects exercising in the postprandial state and with time-trial-like performance tests such as fixed distance or fixed time tests). We performed a PubMed search by using a selection of search terms covering inclusion criteria for sport, athletes, carbohydrates, and fluids, and exclusion criteria for diseases and animals. This search yielded 16,658 articles and the abstract of 16,508 articles contained sufficient information to identify the study as non-eligible for this review. The screening of the full text of the remaining 150 articles yielded 17 articles that were included in this review. These articles described 22 carbohydrate interventions covering test durations from 26 to 241 min (mostly cycling). We observed no performance improvement with half of the carbohydrate interventions, while the other half of the interventions had significant improvement between 1% and 13% (improvement with one of five interventions lasting up to 68 min and with 10 of 17 interventions lasting between 70 and 241 min). Thus, when considering only studies with a setting mimicking real-life competition, there is a mixed general picture about the ergogenic effect of carbohydrates ingested in the proximity of or during a performance bout with an unlikely effect with bouts up to perhaps 70 min and a possible but not compelling ergogenic effect with performance durations longer than about 70 min.

Role of dietary proteins in sports.

The previously separate dietary protein recommendations for strength and endurance athletes are no longer supported, and the daily intake for adult athletes suggested by most of the entities is about 1.5 g · kg(-1) body mass with a range of perhaps 1.0 to 2.0 g · kg(-1) body mass. This recommendation is a broad landmark that needs to be adapted to the individual circumstances of the athlete. Research of the past decade indicates a beneficial effect with respect to a positive net muscular protein balance if athletes ingest some protein before an exercise bout. The amount of protein to be ingested to elicit the highest benefit is about 10 to 20 g · h(-1), but due to the insufficient amount of available data, it is not possible yet to rank different protein types or sources according to their anabolic potential. A simple way to translate the nutrient-based recommendations is the Swiss Food Pyramid for Athletes, which ensures a sufficient intake of energy, and all macro- and micronutrients in relation to the volume and intensity of the daily exercise.

No effects of three-week consumption of a green tea extract on time trial performance in endurance-trained men.

The purpose of this study was to examine the effects of three-week consumption of green tea extract (GTE) supplementation on time trial performance and metabolism during cycling in endurance athletes. Nine endurance-trained men participated in this double-blind and placebo-controlled cross-over study. At the end of the supplementation period with GTE (159 mg/day total catechins) or placebo, respectively, subjects cycled at 50 % of the individual maximal power output for 2 hours, followed by a 30-minute time trial. Respiratory gas exchange, fatty acids, 3-beta-hydroxybutyrate, lactate, glucose, interleukin-6, thiobarbituric acid reactive substances, creatine kinase, and C-reactive protein (CRP) were measured 1 hour before, during, and 1 hour after the exercise test. Blood lipids were measured at rest before cycling. There was no significant effect on performance, energy metabolism, or any other measured parameter, except for CRP, which was significantly reduced (p = 0.045) after GTE supplementation compared to placebo. GTE supplementation did not affect time trial performance and energy metabolism in endurance-trained men in the non-fasting state. Further studies with athletes, particularly in the fed state, but with higher GTE doses, are needed to address the question whether green tea may influence energy metabolism and performance in athletes.

Additive postprandial blood glucose-attenuating and satiety-enhancing effect of cinnamon and acetic acid.

Cinnamon and vinegar or acetic acid were reported to reduce the postprandial blood glucose response. We hypothesized that the combination of these substances might result in an additive effect. Therefore, we determined the 2-hour postprandial blood glucose and satiety response to a milk rice meal supplemented with either cinnamon or acetic acid on their own or in combination. Subjects (n = 27) consumed the meal on 4 occasions as either pure (control trial), with 4 g cinnamon, 28 mmol acetic acid, or the combination of cinnamon + acetic acid. Blood glucose and satiety were assessed before eating and 15, 30, 45, 60, 90, and 120 minutes postprandially. At 15 minutes, the combination of cinnamon + acetic acid resulted in a significantly reduced blood glucose concentration compared with the control meal (P = .021). The incremental area under the blood glucose response curve over 120 minutes did, however, not differ between the trials (P = .539). The satiety score of the cinnamon + acetic acid trial was significantly higher than that in the control trial at 15 (P = .024) and 30 minutes (P = .024), but the incremental area under the curve of the satiety response did not differ (P = .116) between the trials. In conclusion, the significant effect of the combination of cinnamon and acetic acid on blood glucose and satiety immediately after meal intake indicated an additive effect of the 2 substances. Whether larger doses of cinnamon and acetic acid may result in a more substantial additive effect on blood glucose or satiety remains to be investigated.

Development and validation of a food pyramid for Swiss athletes.

Food-guide pyramids help translate nutrient goals into a visual representation of suggested food intake on a population level. No such guidance system has ever been specifically designed for athletes. Therefore, the authors developed a Food Pyramid for Swiss Athletes that illustrates the number of servings per food group needed in relation to the training volume of an athlete. As a first step, an average energy expenditure of 0.1 kcal . kg(-1) . min(-1) for exercise was defined, which then was translated into servings of different food groups per hour of exercise per day. Variable serving sizes were defined for athletes' different body-mass categories. The pyramid was validated by designing 168 daily meal plans according to the recommendations of the pyramid for male and female athletes of different body-mass categories and training volumes of up to 4 hr/d. The energy intake of the meal plans met the calculated reference energy requirement by 97% +/- 9%. The carbohydrate and protein intakes were linearly graded from 4.6 +/- 0.6-8.5 +/- 0.8 g . kg(-1) . d(-1) and 1.6 +/- 0.2-1.9 +/- 0.2 g . kg(-1) . d(-1), respectively, for training volumes of 1-4 hr of exercise per day. The average micronutrient intake depended particularly on the dietary energy intake level but was well above the dietary reference intake values for most micronutrients. No tolerable upper intake level was exceeded for any micronutrient. Therefore, this Food Pyramid for Swiss Athletes may be used as a new tool in sports nutrition education (e.g., teaching and counseling).

Effects of 3-week consumption of green tea extracts on whole-body metabolism during cycling exercise in endurance-trained men.

The consumption of green tea has been generally associated with beneficial effects on human whole-body metabolism and recent investigations with animals indicate favorable effects of green tea extracts (GTE) on energy metabolism during exercise and aerobic exercise performance. Therefore, the purpose of this study was to examine the effects of a three-week supplementation with GTE on human energy metabolism during submaximal cycling exercise. In a randomized, double-blind crossover setting, ten healthy endurance-trained men exercised for 2 hours at 50 % W(max) before and after three weeks of placebo or GTE supplementation (GTE containing about 160 mg x day(-1) total catechins, of which about 70 mg x day(-1) was epigallocatechin-3-gallate). The GTE supplementation did not influence indices of fat and energy metabolism (fatty acids, 3-beta-hydroxybutyrate, triacylglycerol, low-density-lipoprotein cholesterol, total cholesterol, lactate, glucose, oxygen uptake, respiratory exchange ratio, energy expenditure), inflammation processes (interleukin-6, C-reactive protein), and oxidative stress (thiobarbituric-acid reactive substances, oxidized low-density-lipoprotein cholesterol), but plasma creatine kinase concentration at rest and during exercise was significantly lower (p = 0.039) and high-density-lipoprotein cholesterol concentration at rest was significantly higher (p = 0.043) compared to placebo. In conclusion, these results suggest only slight effects on whole-body metabolism after supplementation with GTE.

Regular endurance training does not influence the glycemic index determination in women.

OBJECTIVE: This study investigated the influence of regular endurance training on the glycemic index (GI) of a breakfast cereal in women as previous results from men indicate that endurance training may influence the GI. METHODS: Subjects were 17 sedentary (SE) and 19 endurance trained (ET) healthy, young, adult women of normal body mass index. All subjects performed two tests with the reference food glucose and two tests with a breakfast cereal in a randomized order. Capillary and venous whole blood glucose as well as venous plasma insulin was measured. RESULTS: The GI did not differ between SE and ET, irrespective of its calculation from the capillary (mean +/- standard error: 61.4 +/- 4.3 and 69.5 +/- 4.7 for SE and ET respectively, p = 0.21) or the venous blood glucose (60.8 +/- 8.1 and 64.4 +/- 6.2, p = 0.72). The insulinemic index did not differ between the SE and ET subjects (p = 0.75). CONCLUSION: The results come along with many other data, indicating that the GI seems to be independent of subject-specific factors, but are in contrast to previous results obtained with men where we found a GI dependence on the training state.

Hyponatremia among runners in the Zurich Marathon.

OBJECTIVE: Hyperhydration and exercise-associated hyponatremia (EAH) are critical issues during endurance events. We studied a cohort of marathon runners to examine EAH's prevalence in a marathon with a short time limit and to investigate underlying mechanisms that may be responsible for its development. DESIGN: Observational cohort study. SETTING: 2006 Zurich Marathon (cool and rainy weather, time limit of 5 hours). PARTICIPANTS: 167 marathon runners were recruited the month before the race. MAIN OUTCOME MEASURES: Body mass, plasma sodium, and osmolality were measured just before the start and immediately after the race. Fluid intake during the race was ascertained by a recall questionnaire. RESULTS: Five subjects (3 %) developed asymptomatic EAH, and no symptomatic EAH was found. Body mass change during the race correlated similarly with postrace sodium levels (r = -0.72, P < 0.0001) and with sodium change during the race (r = -0.66, P < 0.0001). Postrace sodium levels correlated significantly with sodium change during the race (r = 0.74, P < 0.0001). Fluid intake correlated significantly (r = -0.43, P < 0.0001) with plasma sodium change between the start and finish of the race. Postrace sodium levels and postrace osmolality were significantly correlated (r = 0.68, P < 0.0001). CONCLUSION: In this study we observed a relatively low incidence of EAH in subjects running the marathon in around 2.5 to 5 hours and in a cool environment. Plasma sodium change during the race and postrace sodium levels correlated with body mass change. There was also a direct correlation between fluid intake and plasma sodium change during the race.

The influence of 30 minutes of light to moderate intensity cycling on postprandial lipemia.

BACKGROUND: Elevated postprandial lipemia is an independent risk factor for coronary heart disease, and bouts of moderate intensity exercise of 60 min or more are often reported to lower postprandial lipemia. Information on moderate intensity exercise bouts of shorter duration corresponding to the current recommendations of health-maintaining exercise (i.e. 30 min or energy expenditure of approximately 630 kJ), however, is scarce. Therefore, we searched for the lowest exercise intensity during 30 min of light to moderate intensity cycling that still reduced postprandial lipemia. DESIGN: We employed a repeated measures cross-over design. METHODS: Twelve healthy, not endurance trained, young men performed three activity trials (30 min cycling with a target energy expenditure of 420, 630 and 840 kJ) before ingestion of two mixed meals with a macronutrient composition corresponding to current recommendations and a control trial (no physical activity before meal ingestion). Capillary triacylglycerol was measured in the fasting state and hourly for 6 h after the first meal. Respiratory gases were analyzed in the fasting state, and 3 and 6 h after the first meal. Triacylglycerol and respiratory responses between the trials were compared with analyses of variance. RESULTS: Postprandial lipemia and the incremental area under the triacylglycerol curve were not significantly different with the activity trials compared with the control trial. The postprandial respiratory exchange ratio was also not significantly affected by activity. CONCLUSIONS: Thirty minutes of light to moderate intensity cycling did not reduce postprandial lipemia after two mixed meals with a moderate fat content in healthy, not endurance trained, young men.

Influence of training status on glycemic index.

The glycemic index (GI) represents the relative postprandial blood glucose response to the ingestion of a food containing carbohydrate. Although regular physical exercise may influence glucose metabolism, it is not yet known if chronically performed exercise also affects the GI. The objective of this study was, therefore, to determine the GI of common meals (three breakfast cereals: B, C, D) in healthy, nonsmoking young males 2 who were either endurance-trained (n = 12) or sedentary (n = 11). Glucose was used as the reference food. The GI value between the endurance-trained and sedentary subjects differed significantly (p < 0.01). Pair-wise comparisons between endurance-trained and sedentary subjects within the different test meals were significant for test meal D (p = 0.002), marginally non-significant for meal C (p = 0.052) and not significant for meal B (p = 0.204). These results suggest that the GI of some complex foods may depend on the training status of healthy young subjects.

The influence of walking performed immediately before meals with moderate fat content on postprandial lipemia.

BACKGROUND: Postprandial lipemia is an independent risk factor for coronary heart disease. Single bouts of moderate exercise may lower this risk, but the minimum duration of moderate intensity exercise that still lowers postprandial lipemia is not known. We, therefore, performed a dose-response study with a normal, daily life setting, to identify the minimum duration of moderate intensity walking that lowers postprandial lipemia in sedentary, healthy young men. METHODS: Sixteen men performed three activity trials (30, 60, or 90 min of treadmill walking at 50% of their individual VO2max) and a control trial with no physical activity in a repeated measures crossover design. The subjects walked immediately before ingestion of the first of two mixed meals, which were served 3 h apart. The meals had a moderate fat content (0.5 g per kg body mass and 33% of total energy per meal) and a macronutrient composition corresponding to current recommendations. Each meal provided one third of the subject's estimated daily energy requirement. Venous blood samples were taken in the fasted state, and then hourly for 6 h after the first meal to assess the postprandial phase. Postprandial lipemia (the incremental area under the curve (dAUC) of triacylglycerol) was compared with a mixed model analysis and Tukey's adjustment. RESULTS: Postprandial lipemia (dAUC of triacylglycerol) was, compared to the control trial, +2% (P = 1.00), -14% (P = 0.24), and -15% (P = 0.23) in the 30, 60, and 90 min walking trials, respectively. CONCLUSION: Moderate intensity walking of 60 and 90 min duration slightly, but insignificantly, reduced postprandial lipemia after two mixed meals with moderate fat content in sedentary, healthy young men, compared to inactivity. Therefore, it should be reconsidered if the acute exercise-induced reduction in postprandial lipemia usually observed in studies using high fat meals is of importance in a real, daily life setting.

Glycemic index and load-dynamic dietary guidelines in the context of diseases.

The concepts of glycemic index (GI) and glycemic load (GL) are among a new generation of so-called dynamic dietary guidelines. In contrast to classical static guidelines, these new guidelines do not primarily consider the absolute amount of energy or nutrient to be ingested within 24 h, but rather are focused on the postprandial response. It is claimed that low-GI and -GL diets favorably affect many noncommunicable diseases that are prevalent in developed countries, including type II diabetes, insulin resistance, obesity, cardiovascular disease (CVD), and cancer. During the past 20 years, considerable evidence has accumulated suggesting that low-GI or -GL diets indeed positively influence some but not all diseases. Because virtually no deleterious effects of low-GI and -GL diets have been documented thus far or are to be expected, the promotion of these diets should be considered in the management of noncommunicable diseases.

Effects of acute chromium supplementation on postprandial metabolism in healthy young men.

BACKGROUND: Chromium (Cr) potentiates the action of insulin in the cell and improves glucose tolerance after long-term supplementation. OBJECTIVE: We hypothesized that Cr may also have acute effects and might be beneficial in lowering the glycemic index of a meal. METHODS: We studied the effects of short-term Cr supplementation using a randomized crossover design. Thirteen apparently healthy, non-smoking young men of normal body mass index performed three trials each separated by one week. Test meals, providing 75 g of available carbohydrates, consisted of white bread with added Cr (400 or 800 microg as Cr picolinate) or placebo. RESULTS: After addition of 400 and 800 microg Cr incremental area under the curve (AUC) for capillary glucose was 23% (p = 0.053) and 20% (p = 0.054), respectively, lower than after the white bread meal. These differences reached significance if the subjects were divided into responders (n = 10) and non-responders (n = 3). For the responders AUC after 400 and 800 microg Cr was reduced by 36% and 30%, respectively (Placebo 175 +/- 22, Cr400 111 +/- 14 (p < 0.01), Cr800 122 +/- 15 mmol. min/L (p < 0.01)). Glycemia was unchanged after addition of Cr in the non-responders. Responders and non-responders differed significantly in their nutrient intake and eating pattern, and total serum iron concentration tended to be lower in the responder group (p = 0.07). CONCLUSIONS: Acute chromium supplementation showed an effect on postprandial glucose metabolism in most but not all subjects. The response to Cr may be influenced by dietary patterns.

Metabolic and cognitive coefficients in the development of hunger sensations after pure macronutrient ingestion in the morning.

The effect of pure carbohydrate, protein and fat ingestion on different aspects of short-term satiety and their relation to metabolic and cognitive performance indices were studied in 15 healthy male students. Subjects were tested in three sessions for short-term changes in blood indices, indirect calorimetry, different aspects of hunger sensations as well as mood and objective cognitive performance using a repeated-measures, counterbalanced cross-over design. Measurements were made after an overnight fast before and hourly during 3 h after macronutrient ingestion. Preloads were isoenergetic (1670 kJ) spoonable creams with similar sensory properties of either pure carbohydrates, protein or fat. Overall 'desire to eat' and 'gastric emptiness' represented principal components for overall 'hunger' ratings, which were larger after fat and carbohydrate compared with protein ingestion. In the first hour, the hunger suppression of carbohydrates was similar to that of protein and related to changes in beta-hydroxybutyrate and insulin concentrations accompanied with a preference for carbohydrate-rich food. In the third hour, it was similar to the low satiating power of fat and related to diet-induced thermogenesis together with a preference for protein-rich food. For all macronutrients feelings of 'energy' were negatively related to hunger sensations, whereas objective cognitive performance was positively related. Our findings suggest that the subjective satiating effect of carbohydrates seems to change with time in relation to postprandial metabolic changes, presumably mainly dependent on the glycemic response and diet-induced thermogenesis.

Carbohydrate to protein ratio in food and cognitive performance in the morning.

The effect of different carbohydrate to protein ratios in food on cognitive functions and the relation between postprandial metabolic and cognitive changes were studied in 15 healthy male students. Subjects were tested in three sessions, separated by 1 week, for short-term changes in mood states, objective cognitive functions, blood parameters, and indirect calorimetry using a repeated-measures, counterbalanced cross-over design. Measurements were made after an overnight fast before and hourly during 3.5 h after test meal ingestion. The isoenergetic (1670 kJ) test meals consisted of three carbohydrate to protein ratios, i.e. a carbohydrate-rich (CHO[4:1]), balanced (BAL[1:1]), and protein-rich (PRO[1:4]) meal, respectively. Overall accuracy in short-term memory was best after the PRO[1:4] meal concomitant to the least variation in glucose metabolism and glucagon to insulin ratio (GIR). Related to changes in glucose metabolism and/or in the ratios of large neutral amino acids (LNAA), respectively, attention and decision times were transiently improved within the first hour after the CHO[4:1] meal, whereas after the first hour the BAL[1:1] and PRO[1:4] meal resulted in improved performance. Overall reaction times of a central task were fastest after the BAL[1:1] meal concomitant to the highest overall tyrosine (Tyr) to LNAA ratio. Our findings suggest that the carbohydrate to protein ratio in food specifically influences higher cognitive functions in the morning. Except for a transient positive effect of rising blood glucose after a carbohydrate-rich meal, a protein-rich or balanced meal seems to result in better overall cognitive performance presumably because of less variation in glucose metabolism and/or higher modulation in LNAA ratios indicated by the overall GIR.