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W W W. B A R B E L L M E D I C I N E . C O MS T R E N G T H M D @ G M A IL . C O M

Nutrition for the High Performance Athlete: An Evidence Based Approach

What is Nutrition?

Macronutrtients Protein Carbohydrates

Fiber??

Fat Calories = Macros or Macros= Calories?

Are these equivalent?

Calories 2000 2000

Protein 100 250

Carbohydrates 300 150

Fat 44 44

What is Nutrition?

Micronutrients Vitamins Minerals + Trace elements Multivitamin?

“Our results suggest that administration of vitamins C and E to individuals with no previous vitamin deficiencies has no effect on physical adaptations to strenuous endurance training.” Yfanti et al. Antioxidant Supplementation Does Not Alter Endurance Training Adaptation. Medicine in Sports and Exercise. July

2010. 42 (7). 1388-1395

“In older women, several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk” Mursu et al. Dietary supplements and mortality rate in older women: the Iowa Women’s Health Study. Archives of

Internal Medicine. 2011 Oct. 10; 171 (18). 1625-33

“These results suggest that multivitamin use is associated with an increased risk of breast cancer. This observed association is of concern and merits further

investigation.” Larsson et al. Multivitamin use and breast cancer incidence in a prospective cohort of Swedish women. American

Journal of Clinical Nutrition. 2010 May; 91 (5): 1268-72

By performing a meta-analysis of RCTs, the current study provides the highest level of evidence to indicate that MVMM supplementation has no significant effect on the risk of all-cause mortality, mortality of vascular etiology, or mortality due to cancer. Macpherson et al. Multivitamin- multimineral supplementation and mortality: a meta-analysis of randomized

controlled trials. American Society for Nutrtion. 2013.

What is Evidence Based Practice?

Evidence Based Evidence based behavioral practice

Science + Experience A disclaimer

Biased population? Personal beliefs/values?

What is the role of nutrition in performance?

Fuel Training Increased performance in training > increased

performance in competition?Fuel Recovery

Increased ability to recover > increased potential training volume > increased performance?

Facilitate optimal body composition and weight Individualized for each person Individualized for each sport Better strength to weight ratio > better performance?

Why do we even eat in the first place?

Each feeding is an opportunity to stimulate MPS MPS= muscle protein synthesis

Protein intake “In fact, the reduced model revealed that total protein intake was by far the

most important predictor of hypertrophy…”• Schoenfeld et al. The effect of protein timing on muscle strength and hypertrophy: a

meta analysis. Journal of the International Society of Sports Nutrition. 2013 Carbohydrates are synergistic

“..in our lab we have always found that there is about a 5-10% better response when carbs are added to protein compared to protein alone. Now that response was never STATISTICALLY different, however, we have observed it several times and do believe that while we could not statistically show a significant different, that it does enhance the effect slightly, and for athletes and bodybuilders, a 5-10% difference is actually a big deal”- Layne Norton

Tl;dr RECOVERY!!!

Why do we even eat in the first place?

Fuel Training Active skeletal muscle

Glycogen/Glucose/Lactate Spares liver glycogen ~Spares skeletal muscle glycogen Central effects (CNS?)

• “trained cyclists received a CHO solution or an identical- tasting placebo. The subjects were asked to use the solution as a mouth rinse and spit it out rather than swallow the solution. Similar, additional time trials of approximately 60-min duration were performed, and it was found that the CHO solution improved performance by 2.8%. These results suggest that receptors exist in the oral cavity that communicate with the brain.” Jeukendrup et. al. Carbohydrate Intake During Exercise and Performance. Nutrition.

2004

Fatty acids contribute Only to basal level

Protein metabolism isn’t fast enough

Why do we even eat in the first place?

Enjoyment Satiety index

Satiety/calorie Fiber/Protein/Water

content + low palatability and low fat

Holt SH, Miller JC, Petocz P, Farmakalidis E. A Satiety index of common foods. European Journal of Clinical Nutrition. 1995 Sep; 49 (9); 675-90

Food Reward Emotions + social cues +

mouth feel/palatability Similar pathway to drug

abuse Hans-Rudolf Berthoud, Natalie R. Lenard,

Andrew C Shin. Food Reward, hyperphagia, and obesity. American Journal of Physiology. June 2011. Vol. 300.

Designing an Optimal Nutrition Template

Endurance Athletes Intraworkout/Competition Considerations

Hydration Status “Typical drinking practices appear to limit body mass (BM) losses to ~2 % in non-elite competitors.

There are events, however, in which mean losses are greater, particularly among elite competitors and in hot weather, and evidence that individual participants fail to meet current guidelines by gaining BM or losing >2 % BM over the competition activity. Substantial (>5 %) BM loss is noted in the few studies of elite competitors in endurance and ultra-endurance events”• Garth et al. What do athletes drink during competitive sporting activities? Sports Medicine. July 2013

GI effects/availability of Nutrients Individual variability Carbs?

• “There was a significant negative relationship between energy intake and time taken to complete the race …. Only carbohydrate and fat intake were associated with time taken to complete the race” Black et al. Energy intakes of Ultraendurance cyclists during competition, an observational study.

Iner• “High CHO intake during exercise was related not only to increased scores for nausea and flatulence

but also to better performance during IM races.” Beate et al. Nutritional Intake and Gastrointestinal Problems during Competitive Endurance Events. Medicine and Science in Sports and Exercise.

February 2012. BCAAS?

Non peri-workout meals Remarkably similar to strength/power athletes

i.e. 3-5 meals/day spread 3-5 hours apart• Optimal levels of protein• Correct amount of carbohydrates and fat to support optimal body comp/weight

Designing an Optimal Nutrition Template

Strength Power Athletes Protein Dosing

Hypertrophy Muscle CSA correlated to force production

Recovery Supports training volume

Muscle glycogen replenishment Anabolic “Window?”

“The current meta analysis does not support the presence of a limited anabolic window..”• Schoenfeld et al. The effect of protein timing on muscle strength and hypertrophy: a meta analysis. Journal of the International Society of

Sports Nutrition. 2013

Carbohydrate timing • Synergistic with increased MPS rates PWO

Making Weight In conclusion, data from this study suggest that athletes who want to gain LBM and

increase 1RM strength during a WL period combined with strength training should aim for a weekly BW loss of 0.7%. Bench Press improved 13.6% in slow loss group vs. 6.4% in fast loss group. Squat 1RM improved 12% in slow, 9% in fast. Garthe et. al. Effect of Two Different Weight Loss Rates on Body Composition and Strength and Power

related Performance in Elite Athletes. International Journal of Sport Nutrition and Exercise Metabolism. 2011.

What about losing weight for health?

Is achieving a “healthy” BMI really a useful goal? Study: Association of All-Cause Mortality With Overweight

and Obesity Using Standard Body Mass Index Categories* Results: “Relative to normal weight, both obesity (all grades)

and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality.”

Healthy=18.5-24.9 Overweight= 25-29.9 Grade 1= 30-34.9 Grade 2= 35-39.9 Grade 3= >40

*Flegal, Katherine M. Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories. JAMA. 2013. January. http://jama.jamanetwork.com/article.aspx?articleid=1555137

Maybe it’s not a fad….

We don’t know that much, really. Restrictive diets (e.g. Twinkie or Potato diet)

Mark Haub nutrition professor decreased BMI from 29-25, LDL went down, HDL went up 20% and triglycerides decreased by 40.

Low Carbohydrate and Ketogenic diets Ketogenic diets in ASD*

• Reduces seizure frequency by > 50% in ½ patients and by > 90% in 1/3 of pts Low carb diet**

• 311 overweight/obese premenopausal women were randomized to 4 diets: A low-carb Atkins diet, a low-fat vegetarian Ornish diet, the Zone diet and the LEARN diet. Zone and LEARN were calorie restricted.

• The Atkins group lost the most weight, although the difference was not statistically significant (though it was at least double). The Atkins group had the greatest improvements in blood pressure, triglycerides and HDL. LEARN and Ornish (low-fat) had decreases in LDL at 2 months, but then the effects diminished.

Vegetarian/Vegan/Paleo/DASH/Ornish/Intermittent Fasting, etc. If it produces calorie restriction and compliance, it doesn’t matter. The Mediterranean Diet is okay too

Requiring eating “clean” is borderline Orthorexia* *Bratman, Steven. What is Orthorexia? www.orthorexia.com. June 4, 2010

*Kossoff EH, Zupec-Kania BA, Rho JM. Ketogenic diets: an update for child neurologists. J Child Neurol. 2009 Aug;24(8):979–88.

**Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study. The Journal of The American Medical Association, 2007

Supplementation for Performance

Whey Protein Protein quality spectrum

Branched Chain Amino Acids Decreases RPE and increases time to fatigue in

endurance athletes Improves recovery/strength in strength athletes

CreatineCarbohydrates

Vitargo= Low molecular weight, high tonicity= isotonic (gastric emptying)

Beta alanine Increases Muscle carnosine levels- a buffer of acid

Supplementation for Performance

Vitamin D 3 “Vitamin D may improve athletic performance in vitamin D-deficient athletes. Peak athletic performance may occur

when 25(OH)D levels approach those obtained by natural, full-body, summer sun exposure, which is at least 50 ng·mL-1” Vitamin D also increases the size and number of Type II (fast twitch) muscle fibers. Most cross-sectional studies show

that 25(OH)D levels are directly associated with musculoskeletal performance in older individuals Very recently, Melamed et al., using population data, found that total mortality was 26% higher in those with the lowest

25(OH)D levels compared with the highest.

Betaine Six-weeks of betaine supplementation improved body composition, arm size, bench press work capacity, attenuated the rise in

urinary HCTL, and tended to improve power and muscular endurance. Cholewa et. al Effects of betaine on body composition, performance, and homocysteine thiolactone. Journal of International Society of

Sports Nutrition 2013. Hoffman et al. Effect of betaine supplementation on power performance and fatigue. Journal of International Society of Sports

Nutrition. 2009.

HMB “Thirty-eight mg·kg·BM-1 daily of HMB has been demonstrated to enhance

skeletal muscle hypertrophy, strength, and power in untrained and trained populations when the appropriate exercise prescription is utilized.” Wilson et al. International Society of Sports Nutrition Position Stand: beta hydroxy-beta-methylbutyrate (HMB). Journal of

the International Society of Sports Nutrition 2013.

Pre workout? After 8 weeks of training, MIPS supplementation significantly contributed to a LBM increase of 7.8%, which was

significantly greater than the increases resulting from the placebo group of 3.6%. After 8 weeks of training, the MIPS contributed to bench press strength increases of 18.4%, which was significantly greater than the increases resulting from the training alone in the placebo group of 9.6% . Lowery et al. Effects of 8 weeks of Xpand 2x pre workout supplementation on skeletal muscle hyperrophy, lean body mass, and

strength in resistance trained males. JISSN 2012

Practical Application

Develop some initial macronutrient goals Download MyFitnessPal

http://www.myfitnesspal.com/ Sign up/log in

Track dietary habits for 5-7 days to get baseline Food scale is more accurate, but on the whole…probably not

100% accurate anyway All food information on label is for the food in the form it’s sold

(besides bacon)

After initial data collection, setup diet within isocaloric framework Before After

Calories 2000 2000Protein 100 200Carbohydrates 300 200Fat 44 44Fiber 25 35

Measuring Progress

Objective Measures Weight Waist/hip/etc. measurements Body Fat Performance

Subjective Measures Mood/Feelings Visual changes Clothes fitting differently Performance

Use all feedback to figure out the next move!

Questions?