Sports Nutrition for Athletic Performance

Transcription

1 Sports Nutrition for Athletic Performance Nathan S. Taylor PT, DPT, ATC, CSCS Commonwealth Orthopaedic Associates 1

2 Certification RD- registered dietitian CSSD- certified specialist sports dietetics Selected Issues for Nutrition and the Athlete: A Team Physician Consensus Statement Lori Boyajian- O Neill D.O. Vincent Disabella D.O. R. Robert Franks, D.O. Stanley A. Herring, M.D. W. Ben Kibler, M.D. Margot Putukian, M.D. Stephen O Brien, M.D. Rebecca Jaffe, M.D. Michele LaBotz M.D. 2

3 Resources ACSM Nutrition and Athletic Performance. Medicine & Science in Sports & Exercise. 41(3): , March 2009 International Society of Sports Nutrition National Strength and Conditioning Association nsca- lift.org Selected Issues for Nutrition and the Athlete: A Team Physician Consensus Statement Sports Nutrition = Provision of essential nutrients including both fluids and fuels to provide energy for training, competition, recovery and general health and wellness Sports Nutrition= Ergogenic Aid Ergogenic Aid = Any training technique, mechanical device, nutritional practice, pharmacological method, or psychological technique that can improve exercise performance and/or enhance training adaptations. Nutrition Sleep Equipment Meditation Often thought of as strictly supplements Meet additional needs of athletes High performance sports car 3

4 Pushing the Limit Limited quantity/quality research Limited statistical significance Good theory Safe Legal Cost More than ½ Americans use supplements $32 billion/ year Expected to double in 10 years Goals of Sports Nutrition Prevent injury Prevent illness Increase tolerance Decrease perceived exertion Recovery from intense exercise INCREASE ABILITY TO TRAIN! Adequate Energy, kcal Should be tracked and individualized General fitness program participant kcals/kg/day Moderate to intense training increase needs to kcals/kg/day Tour de France kcals/day or kcal/kg/day 4

5 Inadequate Energy Muscle loss Fatigue Risk of injury Illness Prolonged recovery Most at Risk of Negative Energy Balance Runners, cyclists, swimmers, triathletes, gymnasts, skaters, dancers, wrestlers, boxers, athletes attempting weight loss Hunger patterns changed by training Travel altering feeding schedule Suggestions Frequent feedings, 6-7 meals/day High calorie nutrient dense snacks Convenience supplements to meet calorie demand Meal replacement powders Ready to drink meals Weight gain powders Careful of Banned substances 50-75% most company s sales 5

6 Excessive Intake Weight gain Increase body fat Fatigue Risk of injury Poor performance Health Risks Suggestions Frequent feedings, 6-7 meals/day Nutrient dense snacks High fiber Increase output Macronutrient Calories/gram Carbohydrate 4 Protein 4 Fat 9 Alcohol 7 Water 0 6

7 Carbohydrates 6-10g/kg, 50-70% Maintain blood glucose Replenish muscle glycogen Replenishment immediately after training important for subsequent Most rapid within 30 min post, up to 6hours Stored Carbohydrate Blood glucose 5.5 mmol/l 30% fuel Muscle glycogen mmol/kg Diminished muscle glycogen = fatigue Liver glycogen Replenish blood glucose Increasing Intensity = Increase use of carbohydrate as fuel Type of carbohydrate Complex Vegetables, fruits, whole grains Make up bulk of daily carbohydrate intake Ensure ample muscle glycogen stores Simple Sugar, processed foods Higher amount allowable in athletes Low glycemic Absorbed slowly Minimize insulin spike and fluctuating blood glucose levels High glycemic Rapidly absorbed and utilized Spike insulin levels Use during recovery window 7

8 Protein Facilitates muscle synthesis and repair Current RDA.8g/kg Athlete g/kg/day 10-35% Typically met through diet Most athletes exceed daily requirements Best from whole foods Animal sources most complete Carb intake necessary for optimal protein uptake and use Nitrogen Balance Muscle catabolism Slow recovery Muscle wasting Training intolerance Counteract with frequent protein/amino acid ingestion Super high protein intakes 2-2.5g/kg/day Pros Ensure adequate intake Higher intake excreted in urine May increase protein synthesis Cons Higher calorie intake Cancer risk Saturated fat Check renal function Increased protein intake = increased protein synthesis? 8

9 Pasiakos, S. et al. (2014). Effects of protein supplements on muscle damage, soreness and recovery of muscle function and physical performance: A systematic review. Sports Med Healthy Adults less than 50 years old Evaluate effects of protein supps alone or in combo with CHO Performance metrics Time to exhaustion Time- trial Isometric or isokinetic muscle strength Markers of muscle damage and soreness Pasiakos, S. et al. (2014). Effects of protein supplements on muscle damage, soreness and recovery of muscle function and physical performance: A systematic review. Sports Med Results No relationship between recovery of muscle function and ratings of muscle soreness or markers of muscle damage when protein supplements are consumed prior to, during or after aerobic or resistance exercise Greater benefit noted after daily training sessions or if participants are in negative nitrogen/energy balance Pasiakos, S. et al. (2014). Effects of protein supplements on muscle damage, soreness and recovery of muscle function and performance: A systematic review. Sports Med Limitations Small sample size Lack of dietary control Did not measure direct indices of muscle damage such as myofibrillar disruption Did not measure protein signaling indicative of change in rates of protein synthesis and degradation Conclusions Consistently demonstrate acute benefits of protein on post- ex muscle anabolism To date no measurable reductions in muscle damage or enhanced recovery of muscle function 9

10 Negative media A diet high in animal protein can increase cancer and early death risk and might be just as bad as smoking, especially for middle- aged people. Increased risk for those aged Over 65 actually showed protective effect of high protein IGF- 1 Known to increase cancer After 65, drop in IGF- 1 levels BCAA- Leucine, Isoleucine, Valine Pros Leucine shown to increase protein synthesis Can be converted to glucose in the liver Decreased soreness? Decreased fatigue? Decreased muscle damage? Cons 3g/day effective dosage, can be found in protein rich foods cost Fat 20-35% total kcal Energy Essential fatty acids Fat soluble vitamins A, D, E, K 1/3 sat fat, 1/3 mono, 1/3 poly, avoid trans Consuming <20% does not benefit Many athletes exceed 35% 10

11 Created by USOC Sports Dieticians, retrieved from usoc.org Created by USOC Sports Dieticians, retrieved from usoc.org Created by USOC Sports Dieticians, retrieved from usoc.org 11

12 Micronutrients Energy production Hemoglobin synthesis Maintain bone health Immune function Antioxidant protection Mineral Theory Evidence Calcium Maint and repair bone, regulate muscle contraction, maint blood calcium Iron Improved oxygen carrying capacity, aerobic sports Zinc Decreases exercise related changes in immune function Magnesium Activates enzymes involved in protein synthesis, serum levels decrease with exercise Sodium Helps regulate fluid balance, nerve transmission, acid- base balance, prevents hyponatremia Phosphate Buffering capacity, improve energy transport and storage Fair for fat metabolism and improved body composition Only for iron- deficient athletes Fair for immunity, none for performance Only for athletes with significant deficiency Good especially with athletes in heat or prolonged exercise Sodium phospate may improve aerobic system/capacity Antioxidants C, E, Beta Carotene, Selenium Long- term exercise produces constant oxidative stress leading to lipid peroxidation of membranes Habitual exercise augments antioxidant system, more developed endogenous antioxidant system Low fat diet, restricted energy intake, limited fruits, vegetables, whole grains 12

13 B Vitamins Optimum energy production Thiamin, riboflavin, niacin, pyridoxine, pantothenic acid, and biotin Building and repair of muscle tissue Folate and vit b12 are required Riboflavin, pyridoxine, folate, b12 low in female athletes and vegetarians Some data that exercise may increase need as much as twice recommended amount however needs are addressed with higher intake Vitamin D Required for calcium absorption Regulation of serum calcium and phosphorus levels Promotion of bone health Regulates development and homeostasis of nervous system and skeletal muscle Northern latitudes or indoor athletes at risk Multivitamin 40% supplements used in America are multivitamin Can over consume fat soluble vitamins Most important for non- health conscious Daily multivitamin recommended due to American diet Keep it low dose Use after exercise? Split dose am/pm 13

14 Special Circumstances Vegetarians Eating Disorders Weight Loss Diets Use RD or CSSD Fluids Maintain adequate hydration and regulate body temp Dehydration= >2% body weight loss Compromise aerobic performance Impair mental/cognitive performance Increased perceived effort Decrease balance control Alter immune response Proper Hydration Use wt measurement to estimate fluid loss oz/ pound lost Strategies Sports drink Small frequent sips and meals rather than large volume Tepid fluids empty more rapidly than cold Fructose may upset, use glucose or sucrose Train to tolerate greater amounts of water 14

15 Making Changes Consider timing and implementation when making dietary changes Out of season training Period an athlete is not in competition but training for that purpose In- Season Training Period during competition Out of Season Energy requirements increased or decreased Well balanced diet- moderation Modify energy intake for weight loss or gain Practice and observe tolerance Weight Modification Optimal body weight and composition=optimal performance Body composition over body weight Modification should be accomplished during off- season Use food records Adjust slowly Re- evaluate frequently 15

16 Weight Gain Intake exceeds expenditure, extra kcal/day Increase protein to upper range Avoid skipping meals Proper hydration >2-3 lb/wk is not lean mass Emphasize strength training Weight Gain Weight Gain Supplements Large amount of calories Convenience Careful of banned substances Weight Loss Expenditure exceeds intake kcal net energy deficit/ day =.5-2lb/wk Maintain muscle mass, decrease body fat Energy expenditure preferable to limited intake Aerobic exercise increase expenditure, resistance training preserve muscle Maintain adequate micronutrient levels Females no less than , males no less than Proper hydration Avoid skipping meals to avoid compensatory overeating 16

17 Caffeine for weight loss Pros Increased fat oxidation? Increased thermogenesis? Decreased fatigue Improved mood Cons Little evidence Nervousness Anxiety GI distress Insomnia High calorie beverages Exercise training remains the best method to increase usage of fat. Caution Impaired performance Reduced energy stores Impaired immune function Altered mood Changes in enzyme activity Structural alterations in muscle Health effects Cognitive dysfunction Compromised cardiac function Inability to maintain body temp Disrupted endocrine function Caution Disordered eating due to pressure Proper fuel before sessions to prevent injury Avoid low calorie or fad diets and weight loss drugs 17

18 In- Season Distribution of fluid and fuel Increase emphasis on cho Increase monitoring of fluid and electrolyte Maintain energy balance Caloric expenditure often exceeds intake Adequate energy balance spares protein Balance minimizes fatigue Timing Spread intake throughout the day Maintain hydration Recovery window Carbohydrate Loading Goal = Increase stores of muscle glycogen >150mmol/kg Only reasonable for endurance athletes No longer necessary to go through depletion phase How? 1-4 days increased carbohydrate Up to 70% calories from carbohydrate 1-4 days tapered intensity training Offset total calories by lowering fat intake Weight gain will occur Nutrient Timing - Breakfast First opportunity to replenish glucose and fluid after overnight fast Mental skill Mood Better food choices Morning training sessions 18

19 Nutrient Timing 4 hours pre Spares muscle and liver glycogen Consider individual preference and tolerance Adequate calories Primarily Cho, 3-4g/kg Moderate protein and low fiber and fat Minimize gastrointestinal distress oz water or sports drink Nutrient Timing 1 hour pre Increases availability towards end of bout Decreases exercise induced catabolism Increase availability of amino acids 1g cho/kg, liquid preferably Nutrient Timing - Pre Caution Cho concentration >6-8% decreases absorption Many energy drinks >8% Sufficient to maximize fuel stores but limit undigested food Avoid high fat/fiber due to GI distress 19

20 Caffeine for performance Ergogenic effect on endurance exercise 3-6ml/kg may be effective dose with side effects diminished Peaks in the blood in 1-2 hours Benefits Glycogen sparing by fatty acid mobilization Decrease fatigue Increase mood and mental clarity Restricted Substance IOC 12 ug caffeine per ml of urine NCAA 15 ug caffeine per ml of urine Caffeine Pros CNS stimulant Decreased perceived effort Increased tolerance Increase alertness Mobilize free fatty acids? Glycogen sparing? Cons Restricted by NSCA Ergolytic/dangerous in excess or in combination Anxiety Tachycardia GI distress Insomnia Dehydration/electrolyte imbalance? Energy Drinks Most popular dietary supplement other than multivitamin Carbohydrate/Caffeine primary ergogenic nutrients Multiple ingredients with unknown benefits Unclear levels of caffeine due to other ingredients 20

21 Nutrient Timing - During Why? Energy stores depleted Thirst sensation decreased 30-60g cho/hour shown to extend endurance performance After overnight fast or liver glycogen depleted How? Fluid replacement begin early Over 1 hour sports drink Gastric emptying rate reduced Sports drink 6-8% carb 14-19g carb /8oz, optimum absorption mg sodium /8oz Activities longer than several hours Color, carb and sodium enhance intake 6-12 oz every minutes Protein consumption during? Nutrient Timing - Post Most glycogen resynthesis begins within 30 mins 6 hour window Increases in protein synthesis continue up to 72 hours post- exercise Insulin response 3 or 4:1 Carb to Protein 21

22 Recovery USOC Physical Consequences of Hard Training Dehydration Depletion of glycogen Breakdown of muscle Cell damage and inflammation The 4 R s of Recovery Nutrition Re- hydrate with fluids and electrolytes Replenish muscle glycogen stores with carbohydrates Repair and Regenerate muscle tissue with high quality protein Reinforce your immune system with nutritious, fresh foods Nutrient Timing 30 min post Carbohydrate 1-1.5g/kg cho High glycemic index increase rate of resynthesis Protein Provide amino acids for building and repair Add 10-20g protein Enhanced glycogen resynthesis? Chocolate Milk 4:1 Carb/Protein ratio Whey= fast acting / Casein= slower absorption Calcium Electrolytes Fluids Affordable 22

23 Nutrient Timing 2 hrs post Repeat meal g/kg cho g protein Lower Glycemic Index Slower absorbing proteins Repeat at 4 and 6 hours post Post Event Fluids Replace 1.5 times the amount fluid lost, oz/pound lost Individual sweat rates will vary 1.5 L lost before thirst Electrolytes speed recovery, balance restored 3x faster with SD Food has higher electrolyte concentration than drinks Supplements Need 100% needs from well- balanced nutrition Specific medical conditions may benefit Correcting deficiency most effective and reliable Safety All manufacturers required to analyze identity, purity and strength of ingredients Not required to demonstrate safety and efficacy Contamination of dietary supplements with banned substances 23

24 Supplements Creatine Nitric Oxide Boosters HMB B- Alanine Creatine Creatine Most effective supplement available Anaerobic, repeated bouts, high intensity, short duration activities Increased body mass/ muscle mass Use as training aid 24

25 Creatine Dosage 20g/day for 5-7 days loading dose 3-5g/day maint dose May not be any difference without loading Co- ingestion of carbohydrate may increase muscle uptake Creatine Side- effects Dehydration and muscle cramps myth Actually may maintain hematocrit, aid thermoregulation, reduce ex HR, reduce sweat rate Potential for weight gain Long- term effects? Screen for liver or kidney dysfunction Nitric Oxide Supplements arginine + O2 citrulline + NO NO function to regulate vasodilation, blood flow, mitochondrial respiration, platelet function Improved Oxygen and nutrient delivery Increased stamina 25

26 Nitric Oxide Supplements L- Arginine, L- Citrulline L- Arginine is main precursor of NO via Nitric Oxide synthase activity L- Citrulline can be converted to L- Arginine Not subject to pre- systemic elimination May increase levels of NO Not been related to improved performance HMB- Hydroxymethylbutyrate Metabolite of Leucine Inhibit protein breakdown Some evidence of increased muscle building Especially when taken with glutamine and L- arginine Most studied in patients with AIDS Limited evidence in trained athletes Most useful for more novice 26

27 B- Alanine Enhance intramuscular buffering capacity = attenuating fatigue Beta- alanine can increase intramuscular carnosine levels Increases of 20-80% in skeletal muscle Carnosine already higher in trained muscles or those with higher percentage of type II fibers. 2-6g/day Aerobic vs. Anaerobic Aerobic Carbohydrate Protein Adequate carbohydrate spares protein Fluids Electrolytes Anaerobic Carbohydrate Protein Creatine Bicarbonate Nathan S. Taylor PT, DPT, ATC, CSCS Commonwealth Orthopaedic Associates natedpt@hotmail.com 27