1. 1. The Importance of Carbohydrates in Performance Iigo San Milln, PhD Assistant Professor, Department of Physical Medicine and Rehabilitation University of Colorado School of Medicine Director, Sports Performance CU Sports Medicine and Performance Center Inigo.sanmillan@ucdenver.edu @doctorinigo
2. 2. Iigo San Milln, PhD Director of Sports Performance CU Sports Medicine and Performance Center Assistant Professor, University of Colorado School of Medicine Inigo.sanmillan@ucdenver.edu @doctorinigo
3. 3. Todays Main Topics Performance Glycogen Muscle ContractionOvertraining Muscle Damage
4. 4. Carbohydrates Public Enemy #1?? Are they really that bad for you??
5. 5. Embedded PowerPoint VideoBy PresenterMedia.com
6. 6. Humphrey et al. Earliest evidence for caries and exploitation of starchy plant foods in Pleistocene hunter- gatherers from Morocco. Proceedings of the National Academy of Sciences. 2014 94% of the 50 sets of teeth found in a Paleolithic cave in Morocco had Caies and Tooth Decay as a result of starchy foods Hardy et al. Dental calculus reveals potential respiratory irritants and ingestion of essential plant-based nutrients at Lower Palaeolithic Qesem Cave Israel. Quaternary International 2015. Starch granules found in teeth show evidence of plants and starchy foods in Paleolithic diets. In fact.Paleo diet was rich in Starchy foods!
7. 7. We have seen amazing advances in the science of the sport These Advances are based on Scientific Evidence When it comes to Carbohydrates We need to keep applying the scientific approach and evidence
8. 8. Endurance Coaching Summit | 2015 What Does Science Say?
9. 9. Systematic review: Carbohydrate supplementation on exercise performance or capacity of varying durations Trent Stellingwerff, Gregory R. Cox. Appl Physiol Nutr Metab, 2014. 61 published studies on Carbohydrate and Performance 82% Shows Statistically significant performance benefits (50 studies) 18% of studies shows no change compared to placebo NO study shows detrimental performance with CHO What Does Science Say?
10. 10. 67:00:00 60:47:00 56:07:00 Placebo Glucose (90g/h) Glucose + Fructose (90g/h) Effects of Carbohydrates in a 40k time trial after a 120min at 55% WMax 275W 254W 231W Currell and Jeukendrup, 2008
11. 11. CHO/h During Ironman Pfeiffer et al. "Nutritional intake and gastrointestinal problems during competitive endurance events." Med Sci Sports Exerc 2012
12. 12. Kenyan runners have dominated for decades and are the skinniest athletes in the world
13. 13. Kenyan runners have dominated for decades and are the skinniest athletes in the world Kenyans diets Energy Intake: 2987Kcal -Carbohydrates: 76.5%!! -10.7g/kg/day!! -Fat: 13.4% -Protein: 10.1% -20% Simple sugars!! HIGH CHO and LOW FAT diet!! Onywera, V.O. et al. Food and macronutrient intake of elite Kenyan distance runners. Int. J. Sport. Nutr. Exerc. Metab. 14: 709-719, 2004.
14. 14. Carbohydrates during the Tour de France Garmin Riders at TdF Total Energy Intake: 6000-9000 Kcal/day -Carbohydrates: 70-75% -About 1,000 g/day of CHO -400g simple sugars!!! -4000 kcal/day of CHO -1600 Kcal/day Simple Sugars! -13-14g/kg/day!!
15. 15. Low CHO Diets and Performance?? Can low CHO Diets (Therefore High Fat or High Protein) increase Fat utilization? YesHOWEVER, no improvements in performance (normally detrimental). NO Scientific Study has shown improvements in performance. In fact, overall, studies show to be detrimental for performance
16. 16. Substrate Utilization CHO FAT FATmax San Milln, I.; Gotshall, R.W.; Gonzlez-Haro, C.; Gil, J.; Irazusta, J. Sensitivity of Crossover Concept to Discriminate Different Levels of Performance: A New Approach. Med Sci Sports Exerc 40:293. 2008. Gonzlez-Haro, C.; San Milln, I. Application of the Crossover Concept to UCI Pro Tour Level Professional Cyclists: A New Approach. Med Sci Sports Exerc 40:396-397. 2008
17. 17. Recreational Athlete World Class Athlete
18. 18. Low CHO Diets Increase Fat Utilization and Performance?? LOW CHO Diet Restored Normal CHO Diet Max Power Output= 315W (4.5w/kg) Max Power Output= 350W (5w/kg)
19. 19. Glycogen and Performance What is Glycogen?? Glycogen is Carbohydrate store in the body 85% in Muscles 15% in Liver We can only store ~1lb Of CHO!
20. 20. Can we measure Glycogen? Absolutely!!
21. 21. Muscle Biopsy Very invasive and aggressive Impractical and not possible to apply
22. 22. A Novel Methodology to Measure Glycogen in a non-invasive way Hill, J. C., & San Milln, I. S. Validation of musculoskeletal ultrasound to assess and quantify muscle glycogen content. A novel approach. The Physician and sportsmedicine, 42(3), 45-52, 2014
23. 23. A Novel Methodology to Measure Glycogen in a non-invasive way Hill, J. C., and San Milln, I. "Validation of musculoskeletal ultrasound to assess and quantify muscle glycogen content. A novel approach." The Physician and sportsmedicine 42.3 (2014): 45-52.
24. 24. Correlation Results Hill, J. C., and San Milln, I. "Validation of musculoskeletal ultrasound to assess and quantify muscle glycogen content. A novel approach." The Physician and sportsmedicine 42.3 (2014): 45-52.
25. 25. Glycogen and Performance
26. 26. The relationship of muscle glycogen content, work time and dietary carbohydrate intake (adapted from Borgstrm et al. 1967). Scientific Study Glycogen and Performance Time to Exhaustion
27. 27. Scientific Study Glycogen and Performance Costill, D. L., and J. M. Miller. "Nutrition for endurance sport: carbohydrate and fluid balance 1980
28. 28. Want More on Glycogen?
29. 29. Glycogen Regulates Muscle Contraction rtenblad, Niels, et al. "Role of glycogen availability in sarcoplasmic reticulum Ca2+ kinetics in human skeletal muscle." The Journal of physiology 2011.
30. 30. Glycogen Regulates Muscle Contraction rtenblad, Niels, et al. "Role of glycogen availability in sarcoplasmic reticulum Ca2+ kinetics in human skeletal muscle." The Journal of physiology 2011. It is not just about Bonking!
31. 31. A 25% decrease in Glycogen in the legs will decrease Ca++ release from SR by a 10%! rtenblad, N., Nielsen, J., Saltin, B., & Holmberg, H. C. (2011). Role of glycogen availability in sarcoplasmic reticulum Ca2+ kinetics in human skeletal muscle. The Journal of physiology, 589(3), 711-725. Glycogen Content Regulates Muscle Contraction
32. 32. 80 45 0 10 20 30 40 50 60 70 80 90 Pre Race Post Race Glycogen Content Pre and Post 165km Cycling Race ~45% Lower Glycogen! San Milln, I., Unpublished data Glycogen Evolution Throughout Pre and Post-Race
33. 33. Glycogen Evolution Throughout Pre and Post-Game 55 70 75 75 70 55 75 70 70 68.3 45 65 65 45 65 45 60 50 60 55.6 18.2 7.2 13.4 40 7.2 18.2 20 28.6 14.3 18.6 0 10 20 30 40 50 60 70 80 Torres Brown Burch Klute Labrocca Sanchez Watts Wynne Jose M Team Average Glycogen Content Pre-PostGame PRE Game Post Game % Change Hill, J. C.; San Milln, I. Changes in Skeletal Muscle Glycogen Content in Professional Soccer Players before and after a Match. Med Sci Sports Exerc ; 2015
34. 34. INDIRECT ASSESSMENT OF GLYCOGEN STATUS IN COMPETITIVE ATHLETES I. San Milln1, C. Gonzlez-Haro2, J. Hill, FACSM1, 1School of Medicine, University of Colorado Denver, Denver, CO.; 2Department of Pharmacology and Physiology, School of Medicine, University of Zaragoza, Spain CONCLUSION: The measurement of [La-]b max and CHOox max in competitive athletes could be a good and practical approach to indirectly evaluate glycogen status as well as to identify suboptimal glycogen storages that can ultimately affect athletic performance. RESULTS: The results of the present study sowed that 30% for men and 24% for women showed suboptimal [La-]b max (GS). The correlation between [La-]b max and CHOox max was high in men (r=0.771, p