Wednesday, October 8, 2014

Carbohydrate Supplementation During Workouts - Who Benefits? How Much and Which Type(s) of CHO are Best?

Compared to liquid beverages, gels have the advantage of causing lower GI stress, when significant quantities of CHOs are consumed during exercise. Bars, can be held in the cheek pouch and chewed during critical phases of a race.
The headline gives it away. Today's SuppVersity article is a brief review of the (mostly sponsored) literature on Gatora.... ah, I mean carbohydrate supplementation during exercise. The headline also implies that the usefulness and efficacy of carbohydrate supplements depends on exercise duration and the type of exercise.

As a seasoned student of the SuppVersity you will know that certain paradox involved with regard to the duration / type of exercise. Short exercise durations, for example, shouldn't require large CHO boluses, long duration exercise, on the other hand, is fueled mostly by fat - so why should you supplement with carbohydrates, anyway?
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I promise to answer this and other questions in the following paragraphs, but before I do so, I would like to point out that there is as of now no evidence that the much-praised "fat adaptation" increases the exercise performance to an "Olympia" level. Carbohydrate supplements, on the other hand, are still part of the regular supplementation regimen for the 99% of the top athletes.

That being said, the human physiology dictates that the use of carbohydrate supplements during aerobic workouts that last less than 60 minutes is useless, because muscle glycogen is generally not limiting to performance when exercise durations are less than ~60 minutes.

It should not work for short duration exercise, but it still does

Interestingly, 16 out of 23 studies, Trent Stellingwerff and Gregory R. Cox from the Canadian Sport Institute-Pacific and the Australian Institute of Sport reviewed for their recent paper in Applied Physiology have found that carbohydrate supplementation and/or oral (mouth) exposure to carbohydrate can improve performance of tasks less than 1 hour in duration:
You won't fully deplete your muscular glyocogen levels
during short duration resistance training (Haff. 2003)
"In 2004 a seminal paper was published showing that a carbohydrate mouth-wash (swirling 25ml of a 6% CHO beverage (only ~1.5g of CHO in 25ml [6.4% maltodextrin solution (CHO)]) around in the mouth for ~10 sec, every 7.5min) significantly improved time trial (TT) performance [in seven male and two female endurance cyclists] by ~3% (Carter et al. 2004a)." (Stellingwerff & Cox. 2014)
This effect of CHO mouth-washing to improve performance in events from 30-60min has now been replicated in several other performance studies (10 of 13 studies) using both cycling and running interventions and with both sweet (sucrose) and non-sweet (maltodextrin) caloric CHO sources,as compared to 5 non-caloric artificial sweetener placebo trials showing no performance enhancing effects.
Figure 1: Hard to believe, but true - In 2010 Pottier et al. observed that CHO mouth-rinsing, but not CHO ingestion increases the 1h high intensity time-trial performance in trained subjects.
 "All these findings have been mechanistically supported with a functional magnetic resonance brain imaging study showing that CHO mouth-washing from both sweet tasting glucose and non-sweet maltodextrin can stimulate the brain areas of the insula/frontal operculum, orbitofrontal cortex and striatum, which are involved with brain centers responsible for reward and motor control (Chambers et al. 2009). Interestingly, if the mouth (oral receptors) and GI tract is by-passed by CHO infusion straight into the blood stream then 1h cycling TT performance was unaltered as compared to no CHO supplementation (Carter et al. 2004b)." (Stellingwerff & Cox. 2014)
Studies evaluating the effects on perceived exertion (Fares et al. 2011) found similar benefits all of which support the idea that the effect does not occur in the musculature, but rather in the head.
So what do you do to benefit during short-duration (<60) minute workouts? To benefit during short duration exercise exercise (<1h) ~1.5g of high GI carbohydrates (30g/h total = max) consumed or used as a mouth-wash in servings of 25ml for 5 to 10 sec every 8 to 10 min of exercise will do the trick. Since it can be difficult to actually drink / mouth-wash with CHO during critical phases of the race, Stellingwerff and Cox suggest "placing a sports confectionary in the cheek cavity" as a more practical option for some athletes.
It should be obvious that the physiological, or rater intra-muscular benefits of carbohydrate supplements increases with the exercise duration.

CHO supplementation during exercise that lasts 60 minutes or longer

In view of the fact that it is 100% logical and well established by studies by Coyle et al. (Coyle 1992a; Coyle 1992b) that the intake of carbohydrate (glucose alone, and glucose + fructose blends) can significantly improve prolonged endurance capacity and performance (>60min of exercise (Jeukendrup 2010)).
Figure 2: Overview of the performance increases in the 50 studies Stellingwerff & Cox reviewed (2014)
Against that background I will not bother you with another overview of the results, but focus on the efficacy of different carbohydrate supplementation strategies and types of carbohydrate supplements for exercise durations beyond the "magical" hour.

Glucose + fructose - the combination advantage

As a SuppVersity reader you've previously heard about the benefits of combining glucose and fructose in your intra-workout beverage. It is thus only logical that most commercially available formulas are mixtures  glucose + fructose (GLU:FRU) or maltodextrin + fructose - so-called "multi-transportable CHOs". The advantage of using both glucose and fructose is that the carbohydrates will be absorbed via SGLT1 and GLUT5 intestinal transporters.
Comparison of single vs. mutliple CHO sources (CHO, carbohydrate; FRU, fruc- tose; GLU, glucose; Perf, performance; P, placebo; TT, time-trial; TTE, time to exhaustion; Signif, Significant; SUC, sucrose; Stellingwerff & Cox. 2014)
Fructose + glucose mixtures excel, but it takes carbohydrate intake rates of more than 60g/h for the advantages to reach statistical significance. Why? Well, less than 60g/h don't overload the regular glucose transporters in the gut, and the advantage of having both SHLT1 and GLUT5 intestinal transport becomes irrelevant. Several studies have now shown that high intake rates (>70g/h) of GLU:FRU blendsduring moderate intensity, prolonged (>2h) exercise, results in ~8% improvement in endurance performance over both a  1h  TT  (Currell  and  Jeukendrup  2008)  and  over  100km  of  cycling  (Triplett,  Doyle  et  al.  2010) compared to glucose alone, and 19.5% versus water (see Table 1). Another research group has shown  further increases in performance with GLU:FRU blends over multiple sprints  after an endurance pre-load (O'Brien and Rowlands 2011; O'Brien, Stannard et al. 2013).
Specifically during long(er) duration exercise, when the carbohydrate consumption can exceed 60g/h there is a significant performance increase with multi- vs. single source carbohydrate supplements (Stellingwerff & Cox. 2014)
An advantage that has been scientifically established among others by Jeukendrup et al. (2010) who found that this pattern of CHO ingestion results in ~20 to 50% higher CHO oxidation rates compared to the ingestion of a drink that contains nothing but glucose or maltodextrin.

Now an increase in carbohydrate oxidation alone does not sound like something you would aim for as an endurance athlete. In practice, increases in carbohydrate oxidation have yet been shown to increase the performance during prolonged exercise bouts compared to isocaloric glucose-only beverages. (Currell et al. 2008; Triplett et al. 2010; O'Brien et al. 2011; O'Brien et al. 2013).
So how much does it take during long(er) 1-2h+ exercise: You've already learned that glucose + fructose mixtures should be preferred to carbohydrate supplements with only one type of CHO. While 30-60g/h, which is the amount of carbohydrates that is currently suggested by the American College of Sport Medicine (ACSM 2000; Sawka, Burke et al. 2007) appears to be be enough for exercise durations ranging from 60-120 minutes, recent evidence suggests that hard exercise bouts which last longer than 2h require up tp 90g/h or carbohydrate solutions with a CHO content of >8%.
Needless to say that there is still research to be done with respect to individual influencing variables of carbohydrate requirements. The currently available evidence, for example, is largely based on results from runners and cyclists. Two other factors / issues that come to mind are...
  • the dose-response relationship, which appears to be capped at 75g/h - at least according to a large-scale multi-center study by Smith et al. (Smith. 2013) who found that their subjects, endurance trained cyclists or triathletes experienced significant performance increases, with increasing amounts of carbohydrates (0, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110 and 120g of CHO/h) during a 2h constant load ride.

    Figure 3: Mean log time to complete time trial (natural) as function of CHO treatment condition with fitted quadratic curve (with 95% CI of mean curves). Differences 100 represent percent change in performance. The quadratic function relating CHO ingestion rate to time complete time trial for 43% (95% CI = 11%–75%,P= 0.059) of the variation in mean performance score (Smith. 2013)
    The CHO given was a 1:1:1 glucose:maltodextrin:fructose blend. Results indicated incremental performance improvements of 1.0%, 2.0%, 3.0%, 4.0%, and 4.7% at 9, 19, 31, 48, and 78g CHO/h, respectively, with diminishing performance enhancement seen at CHO levels >78g/h.

    The optimal amount for performance (+4.7%) was 78g/h, with a range of 68 to 88g/h. However, even at 10g/h, a 1.0% increase in performance was observed, showing even a small amount of carbohydrate has the potential to positively impact performance. 
  • the optimal mix of glucose, dextrose, fructose, maltodextrin or other "special" carbohydrates  - needless to say that waxy maize, hydroxypropyl distarches (learn more) or the expensive fast absorbing highly insulinogenic patented carbohydrate source Vitargo come to mind, when we are talking about finding the optimal mix of different carbohydrate sources - a mix, by the way, of which you can safely assume that it will differ according to the physiological demands of the workout and the exercise duration.

    One thing we shouldn't forget, though, is that next to optimal performance, optimal GI tolerance, i.e. the absence of bloating, diarrhea & co would be an important criteria the "optimal" carbohydrate blend would have to meet.
  • Figure 4: CHO suppl. ameliorates  testosterone reductions in 800m runners (de Sousa. 2010)
    the impact of carbohydrate supplementation on hormonal changes during and in response exercise - several human studies suggest that CHO supplementation attenuates the suppression of the hypothalamic-pituitary-gonadal axis and the rise in stress hormones during periods of intense training; a recent rodent study shows that the provision of carbohydrate supple- ments can prevent / reverse exercise-associated menstrual dysfunction (de Sousa. 2010; Zhao. 2014)
I guess, I could come up with additional research gabs, but in the end, a list of "gaps" is not exactly useful for you. Much in contrast to a conclusion, which I am about to formulate in the bottom line, now.
Bottom line: As of now it looks as if the recommendations I made in the light(er) blue boxes for short (<1h), long (1-2h) and ultra-long (>2g) workouts are the best we have.

For the majority of resistance trainees, intra-workout carbohydrate supplementation is at best facilitative. The repletion of the depleted glycogen stores after your workouts, however, is necessary | learn more about glycogen repletion
What I find particularly interesting is that for shorter duration exercise situations (<1h) and high(er) exercise intensity, similar benefits can be achieved with swallowing vs.  outh-washing with only 30g/h of liquid CHO sources. Performance increases in the 2.6% ± 3.3% range may not sound earth-shattering, but if you were running for an hour, your competitor who made sure to bring a carb bottle would be 83s faster than you are - that's 83s which could make the difference between first and last place.

For longer duration exercise, the studies, Stellingwerff and Cox reviewed in the previously cited article yielded an intermediate improvement of 4.9%±4.9% with significantly higher values in studies investigation long(er) + higher intensity exercise. The notion that carbohydrate supplements were useless and the various position statements of sporting bodies all over the world just a concession to the sponsoring money of the industry is thus unwarranted | Comment on Facebook!
  • Carter,  J.,  Jeukendrup,  A.E.,  Mundel,  T.,  and  Jones,  D.A.  (2003).  Carbohydrate  supplementation  improves moderate and high-intensity exercise in the heat. Pflügers Archiv : European journal of physiology446: 211-9.
  • Carter, J.M., Jeukendrup, A.E., and Jones, D.A. (2004a). The effect of carbohydrate mouth rinse on 1-h cycle time trial performance. Medicine and science in sports and exercise36: 2107-11.
  • Carter, J.M., Jeukendrup, A.E.,  Mann, C.H., and  Jones, D.A. (2004b). The effect of glucose infusion on glucose kinetics during a 1-h time trial. Medicine and science in sports and exercise36: 1543-50. 
  • Chambers,  E.S.,  Bridge,  M.W.,  and  Jones,  D.A.  (2009). Carbohydrate  sensing  in  the  human  mouth:  effects  on exercise performance and brain activity. The Journal of physiology587: 1779-94. 
  • de Sousa, Maysa Vieira, et al. (2010). Effects of carbohydrate supplementation on competitive runners undergoing overload training followed by a session of intermittent exercise." European journal of applied physiology 109.3: 507-516.
  • Fares, E.J. and Kayser, B. (2011). Carbohydrate mouthrinse effects on exercise capacity in pre- and postprandial States. J Nutr Metab2011: 385962.   
  • Pottier, Andries, et al. (2010). Mouth rinse but not ingestion of a carbohydrate solution improves 1‐h cycle time trial performance" Scandinavian journal of medicine & science in sports 20.1: 105-111.
  • Sawka,  M.N.,  Burke,  L.M.,  Eichner,  E.R.,  Maughan,  R.J.,  Montain,  S.J.,  and  Stachenfeld,  N.S. (2007).  American College of Sports Medicine position stand. Exerciseand fluid replacement. Medicine and science in sports and exercise39: 377-90.
  • Smith, JohnEric W., et al. (2013). Curvilinear dose-response relationship of carbohydrate (0-120 g/h) and performance." Med Sci Sports Exerc 45.2: 336-341. 
  • Stellingwerff, T., & Cox, G. R. (2014). Systematic Review: Carbohydrate Supplementation on Exercise Performance or Capacity of Varying Durations. Applied Physiology, Nutrition, and Metabolism (2014). Ahead of Print. 
  • Zhao, Can, et al. (2014). Effects of carbohydrate supplements on exercise-induced menstrual dysfunction and ovarian subcellular structural changes in rats." Journal of Sport and Health Science 3.3: 189-195.