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If you have been following along in my past articles, you saw the evidence for whether or not a keto diet is beneficial for endurance athletes. However, I wanted to also share my thoughts and some research on the keto diet for my non-athlete readers. In this article I will discuss why keto may, or may not, be a good choice for you.

 First off, I want to say that keto is likely not meant to be a life-time eating style.

Typically for weight loss, keto could be used for 2-4 months and then one could switch into a long term maintenance phase where you are including healthy carbohydrates.

Secondly there are some warnings that come with the keto diet. Our brains and hearts run exclusively on carbohydrates and when we severely restrict carbs, our body needs to switch to the use of ketones for fuel instead. There is a 3-4 day period of “brain fog” when you initially switch to a keto diet, where your ability to think is reduced. Not to mention food selection is quite limited and your social life may take a hit due to your restrictions. Plus, fair warning, your breath will smell bad too!

There are risks!

Very close monitoring is required for implementing a keto diet (especially to assess if keto would be a benefit to you). You also have to have a solid plan for transitioning into a regular diet, which should also be lead by a dietitian or qualified health care professional. The latter is quite important. This is because when you starve yourself of carbohydrates and then suddenly reintroduce a large load of carbohydrates, the body switches to an anabolic (or build up) mode and causes increased insulin, increased uptake of carbohydrates into the cells, increased utilization of those carbohydrates, all which increases the uptake and use of potassium, magnesium, phosphate, thiamine and increased sodium and water retention. The sudden changes in these electrolytes and vitamins can cause serious issues that can be as severe as a heart attack. AKA you can not have a cheat day in a keto diet and have yourself a big old piece of cake.

iron sources

Keto & weight loss

Most of the research as a whole shows that you MAY lose more weight on a keto diet vs. regular diet.  However, when studies include body composition analysis they show that on average keto leads to more overall weight loss, but the amount of fat lost is the same. This means that keto diets lead to more muscle mass loss compared to a traditional diet.

Therefore, you may see a better outcome when you step on the scale but it may have less desirable body composition changes.

 The main reason for this finding is that you have to have a moderate protein intake while on a keto diet because protein can be used in a process called gluconeogenesis, where amino acids are (inefficiently) used to make glucose, thus keeping you out of ketosis, where as a traditional weight loss diet will be higher in protein to support the muscle mass retention. Other reasons could also include you can not have dairy, which has been shown to be an important food group to stimulate weight loss and muscle mass retention due to its leucine content.

It is also important to note that resistance exercise is a VERY powerful stimulus of muscle protein synthesis and muscle retention during weight loss, and regardless of diet should be included in your weight loss plan.

There may be benefits too

Keto may work for certain people. For instance, people who are on a keto diet often feel more satisfied with their diets. This is likely because higher fat foods are often pleasurable foods and provide flavour and mouth-feel to food (ie cheese, who doesn’t want to eat a brick of cheese every day!). Johnstone et al. (2008) conducted a study where participants were able to eat ad libitum (ie no restrictions or standards for caloric consumption) and participants were assigned to a keto group or a moderate carbohydrate group. They found that people on a keto diet felt less hungry, and lead to them eating less than compared to a moderate carbohydrate diet.

To my surprise, keto does seem to have a beneficial effect on decreasing blood glucose and HbA1c levels, decrease triglyceride levels, LDL cholesterol, and may increase HDL cholesterol levels. One thing I think is important to remember here is that in most cases, healthy dietary changes (ie more vegetables, fibre, less processed carbohydrates and sweets etc.), decreasing alcohol consumption, and increasing exercise can do the same for you, without doing something as intense or dramatic as a keto diet.

 Take home:

My personal and professional opinion on this is that I would first have someone try a to make healthy diet changes which would include consuming good sources of carbohydrates such as beans, lentils and whole grains before trying a keto diet. Keto in my mind is a last ditch effort if no other dietary interventions have worked.

Summary:

  • Keto diets can be somewhat dangerous and should be eased into and out of with the help of a qualified health care professional
  • Keto diets sometimes result in more weight loss but fat loss is comparable to typical diet
  • There must be a caloric restriction to create weight loss, no different than a regular diet
  • Keto may help keep you full and more satisfied with the diet and may help you adhere to the diet plan
  • Keto does seem to have beneficial therapeutic effects for type 2 diabetes, pre-diabetes and on blood lipid profiles (but so does healthy diet/exercise)
  • Ultimately the diet needs to be something you can follow and stick to before transitioning to your maintenance phase, if that’s keto, great!
  • Bottom line: Try traditional approaches first, if that is not successful, you could consider the keto diet for the short term and transition into a healthy diet intervention for maintenance

I hope you found this helpful, this is not a full list of keto uses and I did not list all the pros and cons for you, as I wanted to keep this conversation relatively short. If you have any further questions about dietary interventions for building a healthier you, please feel free to come in for a visit. To learn more about me, you can find my bio here.  

Reference:

Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. 2008. Effects of a high-protein diet on hunger, appetite and weight loss in obese men feeding ad libitum. Am J Clin Nutr. 87, 44–55.

Here at Delanghe Chiropractic & Health we are really excited to be leading our first beginner run program!

Date: Starts Sept 4th, 2018

Price: FREE

SIGN UP NOW

The idea is simple:

Every week, you will tackle a progressive plan that will take you from zero all the way to 5K in 6 weeks!

Each week will also include an information session from trained medical professionals.  Your coaching team includes:

Together, we will be tackling the VERY fast and fun course at the Run Waterloo Fall 5K Classic.   

Afraid you won’t be able to do it?  Don’t be!  Both Karen (mom of 4, new to running) AND Amanda (Olympic medalist, but now busy mom of two) of Delanghe Chiropractic will be starting from scratch and going through the plan with you!

Oh, and did we mention it is FREE?  Join us, have some fun, and reach your fall fitness goals! You can register HERE or by e-mailing info@drdelanghe.com or calling (519)885-4930

learn2run5K

We’ve all heard of DOMS (delayed onset muscle soreness) and the majority of us have experienced it at least once.

It’s that muscle pain and weakness that we feel a day or two after some exercise. It can be caused by any type of muscle contraction but it is most commonly caused by an eccentric exercise such as downhill running and resistance training. (Reminder: an eccentric exercise is a movement where the muscle is under load as it lengthens. For example, a raising part of a bicep curl is a concentric exercise but the lowering part of a bicep curl is the eccentric part)

The typical symptoms include strength loss, pain, muscle tenderness, stiffness and swelling. Symptoms typically peak 24-48 hours after exercise and fade within 96 hours. The severity of DOMS depends on several factors but in general, more damage occurs with higher intensity and unfamiliar actions.

Physiologists do not have clear understanding of the mechanism behind DOMS, however the proposed theory involves a mechanical disruption to the sarcomeres (the fundamental unit of a muscle structure) which then sets off an inflammatory response. The swelling is caused from the movement of cells and fluid from the blood stream to the muscle, where it contributes to the sensation of pain.

I’ve often been asked if it’s okay to continue exercising and/or what can someone do to help reduce the feeling of DOMS. A recent meta-analysis looked to compare the effects of the most commonly used recovery techniques on muscle damage, DOMS, inflammation and the feeling of fatigue from physical exercise. The authors looked at the effects of 1 session of several different types of recovery techniques after physical exercise on:

  • DOMS
  • Perceived fatigue (ie: how much someone feels tired)
  • Inflammatory markers (IL-6, CRP)
  • Muscle damage markers (CK – creatine kinase)

Let’s have a look at the evidence!

Massage

Based on this meta-analysis, massage was the most effective for DOMS and perceived fatigue! The authors reported that a 20-30 min massage performed immediately after or up to 2 hours after exercise has been shown to help reduce DOMS for 24-96 hours after exercise. Elite athletes (in this case ultra-marathon runners) reported a significant improvement in lower perceived pain after massage. Not only does a massage feel good, but it has also been shown to reduce CK and IL-6 in the blood after exercise which may help towards a faster recovery.

Rationale:

Massage seems to help the symptoms of exercise-induced muscle damage by increasing blood and lymph flow which can stop the CK response and clear it from the blood. It’s assumed that massage flushes out neutrophils (an immune cell that responds to inflammation) from the damaged area which would otherwise cause more CK in the area.

Compression Garments

Compression garments have a significant and positive impact on DOMS up to 96 hours after exercise. It has been shown that wearing a whole-body compression garment over a 24-h period after intense heavy resistance training significantly reduces perceived fatigue. That might not be realistic for us but other compression garments such as leggings and socks can be used.36391146502_1bd4d6090e_k (2)

Rationale:

The beneficial effect of compression garments might be explained by:

  • A reduction in the space available for swelling and edema
  • Better venous return (blood flow back to the hear)

Cold Water Immersion

Cold water immersion (CWI), aka: ice baths, showed a significant effect on DOMS and perceived fatigue after training and competitions/tournaments as well as after strenuous exercise in both trained athletes and recreational subjects.

Ice baths in water at 11-15⁰C for 11-15 minutes is considered the optimal dose to have a positive impact and reduce DOMS.

Rationale:

CWI seems to help reduce exercise-induced inflammation, edema, pain sensation, and muscle damage through these ways:

  • The hydrostatic pressure from being immersed in water may help transport fluids from the muscle to the blood and therefore eliminate inflammatory products
  • Narrowing of blood vessels from the cold temperature may reduce fluid diffusion into space in the muscle and reduce the inflammatory reaction

Contrast Water Therapy

Contrast Water Therapy (CWT) which is bathing alternately in warm and cold water seems to have a small effect on DOMS but not perceived fatigue. CWT has been able to reduce the perception of pain at 24, 48, and 72 hours post-eccentric exercise. CWT also reduced CK concentrations in the blood.

Rationale:

CWT promotes the opening and narrowing opening of blood vessels which may reduce the formation of edema, inflammatory pathways and decrease feeling of pain.

Active Recovery

Active recovery also has a significant effect on DOMS, but not effect on perceived fatigue however, the impact of active recovery is only significant during a short period after exercise. There seems to be no influence of active recovery on CK, IL-6 and CRP concentrations in the blood.

Rationale:

Active recovery seems to help DOMS by enhancing blood flow in muscle tissue, which helps to remove metabolic waste and therefore reduce muscle pain.

Cryotherapy

Cryotherapy is the exposure to a cold chamber and appears to be effective in reducing DOMS after exercise. The authors found that cryotherapy had an effect on DOMS but only for about up to 6 hours after exercise and any cryotherapy done 24 hours after the end of exercise is ineffective in alleviating DOMS.

Stretching/Electrostimulation

The meta-analysis did not find any significant influence of stretching or electrostimulation on DOMS and fatigue. In fact, results showed that stretching less than 6 hours after exercise might even produce DOMS.

Take Home Points!

At some point we will experience DOMS and with time, it will go away on its own but there are some ways to help reduce the feeling and possibly recover faster. Massage seems to be the most effective in relieving DOMS and fatigue. Ice baths and compression garments can also help but are less effective.

Keep in mind that the outcomes from this meta-analysis looked at many studies with different protocols and the results can vary depending on many things such as the type of exercise, level of immersion in water, and amount of pressure from compression garments to name a few.

One final note is that while research shows that these post-workout techniques can make us feel better faster, over time we might we lose some of the benefit from that hard workout or training session since the signal to adapt to the training is blunted from using these recovery methods. So, it is important to use them strategically (ie: after a race where you went too hard or leading into a big race) and to avoid using them during base training and instead just give yourself more time to recover.

Hope this helps with your recovery!  If you have any other questions, or would like to learn more about me, check out my profile HERE.

References:

Dupay et al. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Frontiers in Physiology. 2018

 Connolly et al. Treatment and prevention of delayed onset muscle soreness. Journal of Strength and Conditioning Research. 2003

Are you a constant sufferer of stress related bone injuries? An endurance athlete? Female?

There are many different contributing factors of stress fractures in endurance athletes. Overcoming these challenges and working toward the prevention of these injuries is so important in order to continue with our training and competition schedule. In this article ,I will discuss why female endurance runners are more susceptible to these injuries along with some modifiable risk factors (i.e. nutrition interventions) that can be manipulated to reduce your risk of suffering one!

(Men, I did not forget about you. Stay tuned for an article on stress fractures in male endurance athletes!)

Possible Reasons for Stress Fractures

There are many endurance athlete-specific reasons why stress fractures may occur. One reason for this is the fact that distance running has a high metabolic demand. It costs a lot of energy to run fast for long periods of time and thus increases our need for a higher caloric intake. This can put us at risk if we are inadvertently under consuming calories. Inadequate food intake including both overall energy and micronutrient intake, can play a role in increasing our risk of fractures.

Excessive negative energy balance aside, runners seem to be especially at risk compared to other endurance athletes who also consume lots of calories. Although running does indeed increase bone mineral density (bone strength) with the proper balance of training and recovery, the repetitive nature of high-volume running often leads to the athletes not taking adequate rest days and/or programming in periodized reduced training weeks. This can lead to insufficient recovery and healing of the bone in between bouts of stress and therefore not enough time for the bone to adapt and become stronger. I would refer you to my colleagues, Dr. Sean and Kayla Ng, at the clinic to find out more about how to structure your training schedule.

Version 3 On top of inadvertent negative energy balances and insufficient recovery, some endurance athletes neglect the inclusion of a strength program into their training schedule. Lifting will act as a stimulus to increase bone mineral density. Not only this, but strength training can also aid in enhancing hours muscles ability to direct forces optimally through bones (i.e. compressive vs. sheer forces). For more on this, again I would encourage you to discuss this with my colleagues Dr. Sean and Kayla Ng.

Another risk factor is related to how in some circles, runners are often pressured to fit into the very thin and light body category. First off, low BMI or low weight in itself can be correlated with low bone mineral density. In addition, if that low weight is combined with weight loss efforts and low energy intake, this can wreak havoc on your bone health due to hormonal changes (i.e. decreased estrogen production) and resulting menstrual dysfunction (which can act as an early sign that your are consuming insufficient calories).

BUT, all is not lost!  There is a lot we can do to overcome our bone health challenges. Nutrition, for one, is an easily modifiable risk factor that can have positive outcomes for our bone health.

Nutrition & Bone Related Injuries

To put the need for proper nutrition in maintaining bone health in perspective, here are the results of 3 interesting and very applicable studies on the topic:

  1. Negative energy balance and estrogen: Low energy availability, which is the amount of energy left over after exercise for normal physiological function expressed in calories/kg fat free mass, decreases estrogen levels. This results in a 4x greater risk of bone injury compared to those who have adequate energy availability.
  2. Insufficient calcium: Low calcium intake (800mg) resulted in 6x more risk for bone injury compared to high calcium (1500mg).
  3. NFL players and Vitamin D: In NFL male players, players with 1+ fractures had higher rates of inadequate levels of circulating Vitamin D.

Practical Applications:

So, here’s what you can do:

  1. Make sure nutrition intake closely matches energy demand of sport & daily life.
  2. Consume enough bone building materials (i.e. calcium, vitamin D, and magnesium)
  3. Weight loss tactics should be introduced at appropriate times (likely in the low training/off season) to reduce risk of injury close to race season.

I hope these statistics and general tips reinforce how important nutrition planning is for endurance female athletes. If you still have questions or need guidance on planning for your race season, come visit me at the clinic!  You can check out more about me on my profile HERE.

References:

Tenforde AS et al., 2016. Association of the female athlete triad risk assessment stratification to the development of bone stress injuries in collegiate athletes. The American Journal od Sports Medicine 45(2), 302-310.

Heikura IA, Uuitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. 2017. Low energy availability is difficult to assess but outcomes have a large impact on bone injury rates in elite distance athletes. International Journal of Sport Nutrition and Exercise Metabolism.

Barrack et al., 2014. Higher incidences of bone stress injuries with increasing female athlete triad-related risk factors. The American Journal of Sports Medicine. 42(4). 949-958.

Papageorgiu M, Dolan E, Elliot-Sale KJ, Sale C. 2018. Reduced energy availability: implications for bone health in physically active populations. Eur J Nutr. 57:847-859.

Maroon JC, Mathyssek CM, Bost JW, Amos A, Winkelman R, Yates AP, Duca MA, Norwig. 2015. Vitamin D profile in National Football League players.

By: Steph Boville MSc, RD

Welcome to the third part of the discussion on if ketogenic diets are beneficial for endurance athletes.

In our first article we discussed the fuels we use during exercise, and especially intense endurance exercise. To summarize we learned that exercise at or around 75-85% VO2max is largely relying on carbohydrates for our fuel source.  Carbs breakdown is simply more efficient and and they can be more quickly broken down compared to fat. We also learned that bursts of intense exercise (ie running up a hill) will increase that reliance on carbs, ATP and CP over fat oxidation.

In the second article we learned that ketogenic diets do in fact increase fat oxidation during exercise but that it also comes with a cost!

The costs include suppressing your ability to metabolize carbohydrates, decrease training response, decrease ability to work at maximal effort and decrease running economy. In general, most studies find that performance is reduced with ketogenic diets in endurance athletes.  However some athletes do respond well, and there may be some sports (week long treks) that may benefit from being keto adaptation.

In this last article we will dive into whether or not ketone diester supplementation along with traditionally high carbohydrate diets can be helpful for performance in endurance athletes. Does it help to tap into the best of both worlds? Let’s look at the research!

 Study 1: Can ketone supplement help acutely during a cycling TT?

The theory revolves around this question: Can an athlete can ingest a ketone supplement that will force that individual into a “ketogenic state” without having a high fat, low carb diet?  With the ketone supplement absorbed in the blood stream, the body, in theory, will be forced to metabolize it without having to go high fat, low carb.

Take for instance this study by Leckey et al. (2017).  In the study, 11 elite cyclists complete a 31.17km time trial that simulated the 2017 Bergen World Championship time trial course. They had optimal race nutrition strategies (high carbohydrate) prior to the trial and completed a placebo trial and a ketone diester trial. The ketone diester trial resulted in side effects for most athletes ranging from such severe dizziness, nausea and vomiting that one participant had to dropping out, to moderate-mild nausea, reflux or minor discomfort.  Not good!

All participants completed the time trial faster and achieved higher power output in the placebo trial compared to the ketone diester trial. Further investigation is needed as these findings could have been a result of gastrointestinal discomfort. Fat and carbohydrate oxidation rates were not measured and therefore we cannot explain what happened metabolically but due to the large amounts of ketones found in the urine, the authors speculated that the ketones were not used for energy production.

Vit D

Study 2: Carbs vs. Carbs + Ketones

To play devils advocate, let’s take a look at another paper.  Cox et al. (2016) conducted a study to show the effects of a carbohydrate + ketone beverage vs carbohydrate alone vs a control on endurance performance in a cross over designed study. They showed that consuming the carbohydrate + ketone beverage increased circulating ketones (no surprise), increased free-fatty acids (no surprise), decreased blood lactate levels, had a glycogen “sparing” effect (maybe good, maybe bad) and showed that about 10-18% of energy production came from ketones during exercise.

This supports other theories and research findings that ketosis inhibits the use of carbohydrates as a fuel source, even if it is available for use, and decreases ability to reach maximal intensity of exercise shown by the reduced blood lactate (the anaerobic by-product of glycolysis). The body likely does this to protect and save the available glucose for the brain, as sugar is its preferred fuel source.  Not good if the goal is to go fast!

We have also discussed why shifting to fat as a major fuel source can decrease our economy and efficiency in a previous article. However, this study found that there was a 2% increase in performance with the carbohydrate + ketones. That being said, the hour steady state ride and 30 minute time trial, there was no carbohydrate intake, which very likely could have increased performance vs the ketone drink prior to exercise as glycogen stores can be limiting after 1h of exercise. Therefore, more testing is necessary to compare the high carbohydrate + ketones vs high carbohydrate + carbohydrates during exercise to determine the efficacy of using a ketone diester supplement.

It would also be interesting to see the impact of long term use of a ketone supplement throughout a periodized training plan that utilizes optimal levels of carb consumption. Would this allow for enhanced fat oxidation while also reaping the benefits of ingesting sufficient carbs?

 Practical Applications:

Based on studies like the ones found above and in my previous articles, in general, the best practice for endurance athletes is to:

  • Continue with a high carbohydrate fuelling regiment compared to the ketogenic diets. This way, when athletes are fuelled with carbohydrates (the fuel used in high intensity endurance athletes) they are more equipped to train harder, longer and reap the benefits from all of their hard work on the road, track or treadmill.
  • Remember you are still burning some fat! Athletes don’t need to be too worried about maxing out their ability to metabolize fats because most athletes have a very active and healthy metabolic system and are very efficient at burning fat as a fuel source. Therefore, you don’t have to risk decreased training and injury due to inadequate carbohydrate intake while training.
  • It is also worth noting that some may benefit from pushing their metabolic systems by doing a fasted run on their easy run days, one where you are not sacrificing quality or volume- but make sure you’re getting those important sessions without issue before you start adding these sessions!

I hope this helps!  If you need more help with this or any other nutritional needs, feel free to give the clinic a call.  You can check out more about me on my profile HERE.

 References:

Leckey JJ, Ross ML, Quod M, Hawley JA, Burke LM. (2017) Ketone diester ingestion impairs time-trial performance in professional cyclists. Front. Physiol. 8 (806) 1-10.

Cox PJ, Kirk T, Ashmore T, Willerton K, Evans R, Smith A, Murray AJ, Stubbs B, West J, McLure SW, King MT, Dodd MS, Holloway C, Neubauer S, Drawer S, Veech RL, Griffin JL & Clarke K (2016). Nutritional ketosis alters fuel preference and thereby endurance performance in athletes. Cell Metab 24, 256–268.

Welcome to part 2 of the my exploration of very low carb diets for endurance athletes.  My last article provided the basis for understanding this article as it explored how and when our body choses to use fat vs. carbs.  Check it out here.

In this article, I will now explore (1) do low carb diets actually enhance fat metabolism and (2) does that actually makes us faster.

Does VLCD increase fat burning capacity?

Short answer, yes, the body is forced to increase fat use to support the energy needs during exercise. Research clearly shows that after adapting to a keto diet for as little as 3 weeks results in significantly elevated rates of fat oxidation (0.6g/min to 1.5g/min) during exercise. Fat oxidation at moderate intensities (65% VO2max) in elite ultra-endurance athletes on a keto diet contributed 88% of the fuel for exercise verses 56% in athletes consuming high carbohydrate diets. Now, if we remember what we discussed in the last article, we learned that as we increase intensity we increase the amount of carbohydrates burned. This begs the question “will those high fat oxidation rates continue at intense ecercise (80% VO2max)?”. Another study investigated the fuel usage of elite race walkers at 80% VO2max, and they too found that fat oxidation was elevated to the same levels as previous research (1.5g/min).

low carb

Research Outcomes of VLCD and Performance:

The more important question in my mind (and likely yours as well) is “well that is fine and dandy- my body will burn more fat, but what will happen to my performance?!”. We will review some key research studies that have looked at fat adaption diets (high fat diets for 3-7days), keto diets and their effect on performance. The majority of high fat diet adaptation and keto diets find that performance decreased and a handful found they had no-statistically significant effect. Only two articles find a performance benefit.

Keto, Training and Performance

Louise Burke et al. (2017) conducted a large study investigating the effects of a keto diet, chronically high carbohydrate diet or periodised carbohydrate diet on race performance of elite race walkers after a 3 week intervention and training camp. Athletes on the keto diet perceived the training to be significantly more difficult and experienced an inability to complete the exercise training sessions planned. This is a very important point because if an athlete cannot train as hard as they could they won’t see much improvement in their sport.

After the 3 weeks of intense training, the keto group had higher fat oxidation compared to the two high carbohydrate groups. All groups had significant increases in their maximal oxygen uptake (VO2max) as a result of the training. As we discussed in the previous article, burning fat is less efficient and this study clearly demonstrated that at all competition race speeds there was significantly more oxygen used in the keto group and there was no change in the fraction of VO2max at various speeds. The high carbohydrate and periodised carbohydrate groups used less oxygen and were able to keep the same pace at lower fraction of VO2max. In plain English, the two carbohydrate groups improved their running economy and efficiency with the training where the keto group did not reap the benefits of the training because the cost of burning fat is so high.

Lastly, this study compared pre and post training performance walk times in a real 10km race. They found that both carbohydrate groups had a reduction in their time by 5-6% (on average 190s and 124s faster for high carbohydrate and periodised carbohydrate group). There was no improvement in the keto group and on average their times were 23s slower. There was a wide variability in performance for the keto group, ranging from 162s faster to 208s slower, meaning that keto worked for some individuals but not others.

High Fat Diet With Carbohydrate Loading

What if we don’t go into ketosis and we use a fat adaptation strategy + carbohydrate load, best of both worlds right? Havemann et al. (2006) showed that when elite cyclists consumed a high fat diet (68%) for 6 days with 1 day of carbohydrate loading that there was no significant difference in time to complete a 100km simulated bike race compared to a traditional high carbohydrate diet. However, if we look at the time to completion, we find that the high carbohydrate trial was completed on average 3 minutes 44 seconds faster (likely significant in the real world), leading us to believe that on average high carbohydrate diet may be superior to high fat diets. Again, 3 out of 8 racers on the high fat diet did improve their time compared to high carbohydrate diet, demonstrating that there may be some athletes who may respond well to a high fat diet.

More importantly, this research included 1km sprints throughout the ride to simulate a race like situation and found that the power output was significantly lower in the high fat diet group which lead to slower sprint times. Despite having lower power output in the high fat trial, they perceived they were working as hard as they were in the high carbohydrate trial. There was no difference in muscle recruitment during the sprints, meaning the high fat trial worked just as hard as the carbohydrate trial but did not achieve the same results in the sprint performance. The researchers thought that the high fat diet + a carbohydrate loading period would result in glycogen sparing due to increased reliance on fat for fuel, thus improving sprint times as sprinting relies on glucose to provide fuel. This was not the case and it is possible that high fat/fat adaptation diets reduce the ability to effectively burn carbohydrates.

Summary

  • VLCD do result in higher rates of fat oxidation during exercise
  • VLCD may reduce response to training
  • VLCD decreases economy in elite athletes
  • VLCD decreases ability to work at maximal effort which is important when there is change in work intensity- ie running up a hill, breaking away from the pack
  • Most studies show that on average VLCD negatively affect performance in endurance athletes, however there are some that may respond well
  • Remember that VLCD are not the same as training fasted or temporarily low carb diets to train your body to use fat more effectively, as this is an effective training method

In my final article in this series, I will explore the roll of supplements, the keto diet, and how that relates to athletic performance.

References:

Volek JS, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci. 2015;15(1):13- 20.

Volek JS, Freidenreich DJ, Saenz C, Kunces LJ, Creighton BC, Bartley JM, Davitt PM, Munoz CX, Anderson JM, Maresh CM, Lee EC, Schuenke MD, Aerni G, Kraemer WJ, Phinney SD. Metabolic Characteristics of keto-adapted ultra –endurance runners. Metabolism. 2016;65(3):100-10.

Burke LM, Ross ML, Garvican-Lewis LA, Welvaert M, Heikura IA, Forbes SG, Mirtschin JG, Cato LE, Strobel N, Sharma AP, Hawley JA. Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J. Physiol. 2017;595(9):2785-2807.

Havemann L, West SJ, Goedecke JH, Macdonald IA, Gobson ASC, Noakes TD, Lambert EV. Fat adaptation followed by carbohydrate loading compromises high intensity sprint performance. J. Appl. Physiol. 2006;100: 194-202.

Leckey JJ, Ross ML, Quod M, Hawley JA, Burke LM. Ketone diester ingestion impairs time-trial performance in professional cyclists. Front. Physiol. 2017;8(806).

There has been a burst of social media hype around the idea of using very low carbohydrate (ketogenic or keto) diets for endurance events. The keto diet usually consists of 5-10% of total kcal (~50g or less) from carbohydrates per day, 75% from fat and 10-20% from protein, although there is no set standard of carbohydrate level. In this article I want to talk about how the body uses energy during exercise before we get into the research.

If we look at the stores of energy in the body, we know that our ability to store carbohydrates as glycogen is limited. We can store carbohydrates in our muscles and liver and the more trained an individual is the more they can store, however it is still limited and can only supply about 1500-2000kcal and muscle glycogen is depleted within 1hour of intense exercise. Fat on the other hand is very calorically dense and we can store 65 000 kcals (could fuel about 20 marathons!) in our adipose (fat) tissue and within the muscle. Fat can supply significantly more energy than carbohydrates without supplementation. This diet is seen as attractive because it promotes the idea that we can max out our capacity to burn fat as a fuel while running, reducing the amount of food or energy we need to take on the run. Therefore, it seems logical to adopt a keto diet, max out our ability to burn fat as a fuel, right? Well let’s look at this topic a little deeper.

low carb

 

Understanding Energy Production During Activity

Our body uses two processed to produce energy in the form of adenoside triphosphate (ATP). The first method is anaerobic (without oxygen) and the second is aerobic (with oxygen). There are 3 energy systems that the body uses depending on a few factors, such as intensity, length of event, and availability of oxygen.

(1) Phosphocreatine System

This system is the quickest way to produce energy and is the first system to turn on to crank out ATP. Let’s say as you are reading this article your fire alarm stated to ring, you would immediately jump up and run out the door. In this fight or flight response you are using mostly the phosphocreatine system. It works by taking the phosphocreatine that is stored in the muscles, and through an enzymatic reaction the phosphate is split off and added to adenosine diphosphate to make ATP. This is a very simple reaction, and the body can use this system for about 8-10 seconds before it’s tapped out. This system can recover; it takes about 4 minutes before the system is ready for another intense bout.

(2) Anaerobic glycolysis

This is the second system to turn on to support energy production. To continue with out analogy from above, after our initial jumping and sprinting for the door, after the 8ish seconds our body tends to rely more heavily on the anaerobic glycolysis system. This system uses carbohydrates (glucose) and through a series of steps breaks down 1 glucose molecule into 2 pyruvate molecules. Without oxygen, this pyruvate can be further broken down into lactate and a hydrogen ion and ATP. This system will last about 1-2 minutes. In repeated sprints, such as hockey shifts, research shows that subsequent sprints rely on anaerobic glycolysis to provide 50% of the energy.

(3) Oxidative phosphorylation (Aerobic system)

This system takes a while to get warmed up and to get going once you start exercising. In untrained individuals, it can take a few minutes for this engine to get running fully, but in elite athletes it can fully turn on within about 30-60seconds. In our analogy above, lets say we lived in the country and we needed to go run to the fire station down the road, after our initial sprint and quick getaway, our aerobic system turns on and produces a majority of the energy needed. This system can last forever; at rest we are aerobically oxidizing mostly fats to provide energy for the body at rest.

The aerobic system can burn carbohydrates, fat and protein depending on availability and intensity. Protein used in very small amounts to provide energy for exercise and we wont discuss it further here. I want to discuss the differences between fat and carbohydrate oxidation.

The classic study from Romijn et al. showed that the fuel sources changed depending on the intensity of exercise. They looked at 25% VO2Max, 65% VO2Max and 85% VO2Max. The found that as intensity increased, so did caloric expenditure and the more intense exercise relied more heavily on carbohydrate use. This is because at higher intensity of exercise the fat breakdown and transport into the mitochondria and oxidation rates are too slow to keep up with the energy demands.

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Carbohydrate is also the preferred fuel during intense activity as it provides 5.5% more kcal/L of oxygen compared to fat oxidation, meaning it is a more efficient fuel source. Research shows that elite level marathoners fuel use is 85% carbohydrate and 15% fat oxidation.

One thing to note is, you do not only use one system at a time, your aerobic system is always running in the back ground. Think of these systems like dimmer switches, they can be turned up or turned down depending on the situation. For example, if we take a cyclist who is riding on a flat surface, they have their aerobic system pumping out most of the ATP to cover the cost of their cycling. When they hit a hill, there is an increased demand for ATP. The aerobic system take a little while to adjust, and therefore the anaerobic system has to kick in to provide some quick energy, and that means the phosphocreatine system turns on, and the anaerobic glycolytic system turns on to meet the ATP needs of the body.

Key points:

  • Fat is slower to provide energy, and therefore intensity is lower when using fat as a fuel source
  • Fat is less efficient; it uses more oxygen to produce less ATP
  • High burst of exercise- ie the energy change when cycling or running up a hill is usually covered by anaerobic glycolysis which uses glucose (carbohydrate)
  • Most elite athletes run at high %VO2 and burn a large amount of carbohydrates

References:

Romijn JA, Coyle EF, Sidossis LS, Gastaldelli A, Horowitz JF, Endert E, Wolfe RR. Regulation of endogenous fat and carbohydrate metabolism in relation to exercise intensity and duration. Am J Physiol. 1993;265:E380-E391.

O’Brien MJ, Viguie CA, Mazzeo RS, et al. Carbohydrate dependence during marathon running. Med Sci Sports Exerc. 1993;25:1009–1017. doi: 10.1249/00005768-199309000-00007

Bosch, AN, Goslin BR, Noakes TD, Dennis SC. Physiological differences between black and white runners during a treadmill marathon. Eur J Appl Physiol. 1990;61:68-72.

The days of my protein rambling have almost come to an end! In my last post, I discussed how much protein should be ingested/day and how that protein should be distributed. The article before that discussed whether acute protein consumption before and activity enhances performance.iron sources

In my final article in the protein series, I want to discuss acute protein ingestion related to an acute bout of exercise. This is something that I get asked about all the time at the club: is it important to quickly ingest protein directly after a given activity to enhance recovery from that bout of training?

CLICK HERE to read the rest in the RW Magazine.

Vit D

By: Stephanie Boville MSc., RD

As the snow and cold weather rolls in, it is often accompanied by the common cold or worse, the flu. Endurance athletes are more at risk of illness, specifically upper respiratory tract infections (URTI) because they often engage in intense training sessions outdoors that often last over an hour and athletes who are overtrained are even more at risk. Studies show that runners training for 96km/week doubled their odds of illness compared to those training only 32km/week and about 40% of marathoners experience an URTI in the 2 months of winter training leading up to a marathon race.

Along with the vigorous training, other factors such as stress, lack of sleep and inadequate nutrition can lead to immune suppression, increasing risk of illness. Being a Registered Dietitian, I would like to explain how vitamin D may help boost your immune function this winter season.

Immune function in athletes:

There are a few reasons why URTI’s are common, although this is not a complete list of all the immunological changes that occur with heavy exercise, it will provide background as to why illness is specific to the upper respiratory system.

  1. Cortisol, a stress hormone, is increased which temporarily suppress the immune system.
  2. Specific biomarkers of inflammation increase and have been linked to immune suppression.
  3. Natural Killer cell (cells that kill viruses) activity is reduced for at least 6 hours by 40-60% following exercise lasting over an hour.
  4. Nasal neutrophil phagocytosis (cells responsible for searching for and destroying bacteria) is decreased
  5. Nasal and salivary Immunoglobuin A (IgA) (antibodies secreted in the saliva which are responsible for protecting the immunity of the respiratory tract) concentration is decreased by 70% for 18h after a 31km race.
  6. Nasal mucociliary transit time is prolonged post marathon race for several days, meaning the movement of foreign particles and bacteria out of the upper respiratory tract and away from the lungs is less efficient.

All of these aspects combined demonstrate that there is possibly a window of increased risk of contracting an URTI after exercise because the immune system is compromised. The last three points demonstrate a few possible reasons to why the upper respiratory tract is so vulnerable, especially because the nose and throat are the first line of defense against pathogens entering the body.

Nutrition and Immunity:

The first point I want to make is that overall adequate nutrition plays a role in maintaining a healthy immune system. If we look at the IOC paper discussing the consequences athletes face when they are in a relative energy deficient state (inadequate overall energy intake), we see that one of the many systems affected is immunity. Therefore, you might want to think again before you try and “shred those Christmas and New Year’s gains” in mid flu season unless absolutely necessary. We need to understand that good dietary basics are necessary to support a healthy immune system before we start to get more specific with our micronutrients.

Vitamin D and Immunity:

There are three studies I want to discuss:

Study 1:

Study 1 was an observational study investigating the effects of vitamin D status on the incidence and immune function during winter training in 239 endurance athletes. They found that being vitamin D deficient resulted in significantly more symptom days and increased symptom severity of URTI when compared to optimal, adequate and inadequate vitamin D levels. They also investigated saliva samples which showed that salivary IgA concentration was significantly reduced in athletes with deficient levels of vitamin D, and that athletes with adequate, inadequate and deficient levels of vitamin D had reduced salivary IgA secretion rates compared to optimal levels. From the information in the paragraphs about we see that one area in common, the salivary IgA. Both exercise and reduced levels of vitamin D results in decreased salivary IgA concentration and secretion rates which suggests that having an optimal levels of vitamin D has an important role to play in maintaining immunity in athletes. Lastly this study found that the antimicrobial peptides in the blood were positively correlated with vitamin D status suggesting that optimal vitamin D may result in better immune function and protection.

One limitations of this study is that it was an observational study and therefore no clear links can be determined whether an intervention with vitamin D supplement in vitamin D deficient athletes will reduce frequency, length and severity of illness. Rather this study concludes that there is an association between reduced vitamin D status and increased illness length and severity along with reductions in immunological markers.

Study 2:

Study 2 investigated the effect of a 2000IU vitamin D supplement on length and severity of URTI in non-athletic adults. They supplemented participants for 12 weeks with Vitamin D or placebo and found no differences in URTI incident or severity. However, there are a few things to consider. First, we know athletes have a higher risk of URTI’s, and therefore the results may not be generalizable to an athletic population. Second, even though there was a significant increase in Vitamin D levels with supplementation it was not enough to get participants to an “optimal” level as set out by study 1 and vitamin D levels may not have been sufficient enough to show changes in immunity. Third, both groups had adequate baseline levels of vitamin D and it could be possible immune function is only compromised at inadequate or deficient levels of vitamin D. Fourth they did not do any salivary or plasma samples and therefore we can not see the immunological changes.

Study 3:

Study 3 investigated the effects of 14 weeks of 5000IU vitamin D3 supplements in 39 athletes on antimicrobial peptides and proteins. They found that the 5000IU dose for 14 weeks was enough to elevate blood levels of vitamin D to optimal levels and that 14 weeks of winter training without supplementation decreased vitamin D levels. 5000 IU of vitamin D per day resulted in significantly higher percent change in antimicrobial peptide concentration compared to placebo and increased the salivary IgA and antimicrobial peptide secretion rates. Therefore, their conclusion was that optimal vitamin D may help up-regulate the systems needed to protect against URTI.

Some limitations of this study include participants started at adequate levels of vitamin D and therefore the changes might underestimate the importance of vitamin D’s effect on immunity and bigger changes might be seen when vitamin D levels start at an inadequate/deficient level. Another limitation to this study is they did not record incidents of URTI and therefore no conclusion could be made as to whether the immunological changes resulted in decreased illness.

Main points:

Research has clearly demonstrated that vitamin D is of critical importance in the bodies immune system however there is more to learn about how vitamin D levels impact the frequency of illness and severity, and at what level is the immune system compromised.

From the studies above we learn that:

  1. Optimal levels of vitamin D increase antibacterial peptides in the blood
  2. Optimal levels increase salivary IgA secretion rates and concentration
  3. Observational studies show that illness severity and length is decreased compared to lower levels of vitamin D.

Because salivary IgA is suppressed after intense exercise and taking vitamin D increases the IgA secretion rate and concentration, this may be one mechanism that optimal vitamin D is used in to protect against upper respiratory tract infections.

Practical application:

Should we be supplementing? Usually my belief is “food first, supplement second”. With that being said, there are few foods that contain high levels of vitamin D. We can make vitamin D from the sun, however we are too far north for adequate sun exposure to make vitamin D this time of year (fall through spring). Even in the summer we may make inadequate amounts of vitamin D from the sun if we wear sunscreen, have dark skin or train inside or early/later in the evening. It is likely a good idea to supplement to make sure you are getting adequate amounts of vitamin D. Not only does it play a role in immunity, but it also helps maintain bone and muscle health, and therefore it is an important nutrient.

How much vitamin D: Health Canada has set the Adequate Intake (AI) level of vitamin D at 600 International Units (IU)/day and the upper limit at 4000 IU/day for most ages with some exceptions. First AI means that there is not sufficient evidence to set a Recommended Dietary Allowance (set to meet the needs of 97-98% of healthy individuals) but the AI is assumed to be adequate. There is debate about the AI for vitamin D as many think this AI is set too low, and people are also supplementing over the upper limit (like in study 3 from above). In the following years this AI could see and increase.

Food Sources: People often think milk is the best source of vitamin D, however 1 cup of milk only provides around 100IU or 1/6 of your daily needs of vitamin D. One of the best sources is actually salmon, which, depending on the kind can provide anywhere between 200-600IU in one 2.5oz serving (the size of a deck of cards).

Supplements: Depending on diet and your current vitamin D status, supplementing with 1000-2000IU is should be enough to give your vitamin D levels a boost and is recommended, especially in the winter.

There are many other tactics athletes can try to maintain and help with increased immune function. If you would like to learn more, book an appointment so we can optimize your nutrition intake to support your health, wellbeing and athletic performance!

Related Article: Does Vitamin C help to prevent the common cold?  Check out Dr. Delanghe’s past article.

Reference:

Nieman, D.C. Exercise effects on systemic immunity. Immunology and Cell Biology. 2000. 78: 496-501.

Gleeson, M. Immunological aspects of sport nutrition. Immunology and Cell Biology. 2016. 94: 117-123.

He, C.S., Handzlik, M., Fraser, W.D., Muhamad, A., Preston, H., Richardson, A., Gleeson, M. Influence of vitamin D status on respiratory infection incidence and immune function during 4 months of winter training in endurance sport athletes. Exerc Immunol Rev. 2013. 19: 86–101.

Li-Ng M., Aloia, J.F., Pollack, S., Cunha B.A., Mikhail, M., Yeh, J., & Berbari N. A randomized controlled trial of Vitamin D3 Supplementation for the prevention of symptomatic upper respiratory tract infections. Epidemiol. Infect. 2009. 137: 1396-1404.

He, C.S., Fraser, W.D., Tang, J., Brown, K., Renwich, S., Rudland-Thomas, J., Teah, J., Tanqueray E., & Gleeson. M. The effects of 14 weeks of vitamin D3 supplementation on antimicrobial peptides and proteins in athletes. Journal of Sports Sciences. 2016. 34: 67-74.

What is Acupuncture?

Modern acupuncture is defined as a therapeutic technique in which sharp, thin needles are inserted into specific points on the body. Mechanical, electrical or physical stimulation is sometimes added to the needle to increase the effect. Needles are inserted into acupuncture points, aka: acupoints which were first established in traditional Chinese medicine.

Classical vs. Anatomical Acupuncture: What’s the difference?

Classical acupuncture is based on Tradition Chinese Medicine (TCM). Ancient Chinese believed that everything in the universe was energy. The philosophy that emerged from this thinking is called Taoism which translates to the energy of the universe. The energy is also referred to as Qi (chi).

Qi consists of two equal and opposing energies, Yin and Yang and is commonly represented by the picture above. The curved line represents movement and dynamic fluid between the 2 energies. They are mutually supportive and interdependent.

It was believed that Qi flows through the body along energy channels (referred to as meridians) and could flow into specific sites aka: acupoints. If Qi was deficient, blocked, or out of balance, symptoms such as pain would appear. Needling these sites relieved the symptoms by unblocking and restoring flow of Qi and re-establishing energy balance in the body.

Anatomical acupuncture was originated by Dr. Joseph Wong in the mid 1970s and bridges the gap between TCM and Western medicine. The acupoints are chosen based on anatomy and physiology.

The main difference between classical and anatomical acupuncture is the paradigm used in the selection of points.

The Points

Early studies show most acupoints are located on or near peripheral nerves. There is no evidence to support the existence of new or special structures under these acupoints, however, histological studies (ie: looking under a microscope) have shown a higher concentration of neural tissue and neuroactive components at acupoints compared to non-acupoints.

Neural tissues are the actual tissues themselves and include nerve endings and sensory receptors. Neuraoactive components are cells that release chemical mediators that can excite or inhibit signals to the brain.

The Neural Acupuncture Unit (NAU)

The NAU is a collection of the neural and neuroactive components surrounding the needle. In the diagram, the NAU is the area within the dotted lines. These tissues would be stimulated by the needle.

What Happens When the Needle is Inserted?

Local Effects

When a needle is inserted, it causes some damage to the issue near the insertion point, which stimulates a chain of biochemical reactions in your body. As a result, your body produces various inflammatory and immune response in the NAU. Basically, it is a micro-injury which does negligible harm to the body while creating a therapeutic response.acu2

Non-local Effects

Without getting too in-depth, the non-local effects involve altering pain signals through receptors in the spinal cord and how they relay messages to the brain. The nerve signals from the local tissue travel to the spinal cord and through complex mechanisms, block the original pain signals from getting to the brain.

Another area of the brain is also involved. The hypothalamus-pituitary complex (don’t have to remember this name!) is also stimulated when a needle is inserted and releases anti-inflammatory chemicals into the bloodstream that can help to reduce pain.

These local and systemic responses help to explain the pain-relieving effects of acupuncture.

In my next article, we’ll look at the effects that acupuncture can have for different injuries!

REFERENCES:

Wang, Kain, White. Acupuncture analgesia: I. The scientific basis. Pain Medicine. 2008

Zhang, Wang, McAlonan. Neural acupuncture unit: A new concept for interpreting effects and mechanisms of acupuncture. Evidence-Based Complementary and Alternative Medicine. 2012

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