Beslenme

1
Performance Nutrition Clyde Wilson, Nutrition
Intern Health Promotion Services Stanford
University 13 May 2002
2

• Notes to Tribe Members
• The slide entitled Ironman (slide 17) is a
  summary of information from the reference under
  the heading (on slide 17). This review article
  has tons of information on untraendurance
  triathlons and I recommend it to everyone. I
  gave a copy of this paper to Jesse.
• In my talk I stated that the amount of salt in 1
  L of water during training should be between ¼
  and ½ teaspoons, and at other times said just
  under ½ teaspoon. I measured it all out again
  today more carefully 1 g sodium (2.5 g table
  salt) is 1/3 teaspoon.
• My sincere apologies for the confusion. My
  handout stated 1/2 teaspoon. Please put 1/3
  teaspoon.
• This power point does not include my overheads of
  graphs, images, and cover pages copied directly
  from research papers. In my opinion these are
  the most poignant overheads because they show
  some of the sources from which I have gathered
  information. Nonetheless, I hope this power
  point will be helpful to you.
• I look forward to telling you about food on the
  July 10th.

3
glucose WHY WE EAT
muscle contraction
to other muscles or to bloodstream
ATP
pyruvate
lactate
aerobic
ADP
TCA
carnitine
mitochondrion
fat WHY WE EAT
produces electron current which produces proton
current which produces ATP
4 e-1 4 H O2 ? 2H2O WHY WE BREATH
4
Ion currents in neurons, muscle, and mitochondria
produce MEMBRANE (lipid) free radicals. Combat
this with vitamin E and C.
C radical
E
membrane lipids
C
E radical
5
Caffeine possible mechanism ? adrenalin (fat
burning, heart stroke volume)
? beta endorphins (less
pain) Int. Olympic Committee NTE 12 ?g/ml
urine (3 cups coffee) 3 and 6 mg/kg ? time to
exhaustion _at_ 85 VO2 by 22, 9 mg/kg did
NOT (no dose response) J Appl Physiol 1995 (78)
867074 5, 9 and 13 mg/kg each ? time to
exhaustion _at_ 80 VO2 by 23 (again, no
dose response) but only 5 mg/kg lt 12 ?g/ml
urine Int J Sports Med 1995 (16)
225-30 effects negated by coffee peak blood
caffeine 1 hour after intake half-time in body
4-6 hours CONCLUSION 3 mg/kg body weight
caffein (not coffee)
1 hour prior to competition
6

• Taurine no studies related to exercise
  performance (Im aware of)
• inhibits artherosclerotic lesions in mice Clin
  Exp Pharmacol Physiol 2001 (10) 809-15
• ? oxidative stress to nerves
  Exp Neurol 2001 (172) 211-9
• 
  J Neurosci Res 2001 (66)
  612-9
• nerve growth in infants Nutr
  Neurosci 2001 (4) 439-43
• ?oxidative stress in liver in rats Hum Exp
  Toxicol 2001 (20) 251-4
• in endoplasmic reticulum in rats Circulation
  2001 (104) 1165-70
• in myocardium in guinea pigs Free
  Radical Biology Medicine 1995 (19) 461-71
• related to age in rats Biochem Pharmacol
  2001 (62) 29-39
• memory in mice Neual Plast 2000 (7)
  245-59
• plasma taurine ? 19 after 90 min _at_ 75 VO2,
  77 after Marathon, 36 after 100 km run i.e. ?
  intensity (muscle breakdown)

7

• Red Bull
• caffeine, taurine, and glucuronolactone (vit. C
  precursor)
• alertness, memory Seidl R, Peyrl A, Nicham R, and
  Hauser E. Amino Acids 2000 (19) 635-42
• 
  Alford C, Cox H, and
  Wescott R. Amino Acids 2001 (21) 139-50
• 
  Warburton DM, Bersellini E,
  and Sweeney E. Psychopharmacology 2001 (158)
  322-8
• 
  
  ? cardiac stroke volume by 22 Bauin M
  and Weiss M. Amino Acids 2001 (20) 75-82
• my opinion only the caffein has immediate
  effects on performance
• (taurine and vit. C reduce
  oxidative damage and
• improve performance the
  next day, week, etc)

8
B vitamins needed to metabolize CHO, fat,
aminos. Calories taken in
during training are typically low in B
vitamins. B1 (thiamine) needed for TCA cycle,
membrane/nerve conduction TOXICITY none
orally, 100xRDA intravenous ? convulsions,
anaphylactic shock B2 (riboflavin) needed for TCA
cycle, no reported toxicity B3 (niacin/nicotinimid
e) the N in NAD/NADH TOXICITY gt1
g/day (RDA16 mg) harms liver and skin B6
(pyridoxine) needed for amino acid metabolism
TOXICITY gt0.2 g/day (RDA1.3 mg) causes
numbness, impaired reflexes, sensory
nerve and spinal dorsal root
ganglia degeneration B12 (cobalamin) needed for
TCA cycle, no toxicity reported Pantothenic Acid,
1/3 of CoA molecule, no toxicity reported
9
Zinc intake may be low for athletes (fatigue, ?
endurance, ? T, weight loss, bone
loss) but excess intake (gt 2x RDA) can cause
Copper deficiency (impaired immunity, enzyme
activity, bone loss) Carnitine 4 g /day did
not improve Marathon time for 7 athletes
but did ? mitochondrial enzyme
activity in 14 athletes 2 g /day
for 6 months prevented ? in carnitine in 24
athletes ? PDH activity,
but did not ? fat transfer activity
most research shows no change in VO2 max or
RQ the few which do involve
highly trained athletes Phosphatidylserine has
shown benefits for neurological membranes.
10
DEHYDRATION by 1 Quart INHIBITS gastric
emptying (by 50 exercise-induced nausea) food
intake (dehydration-associated anorexia) gene
expression, hormonal control, growth endurance
(3/4 time to exhaustion) strength (by 5) kidney
function protein turnover in liver (by
25) perception and short-term memory (myelin
tubules)
11
Hydration throughout the day 1 Quart water /
1000 Calories of food example 2000 Cal food ?
you need 2 quarts of water ? 8 cups
3000 Cal food ? you need 3 quarts of water ?
12 cups Soda and Fruit Juice 100 Cal /
8-ounce cup Only 2/5 of
volume counts towards hydration for food.
Instead of 12 cups (3/4 gallon) of
water for a 3000 Cal diet, you
would need 30 cups (nearly 2 gallons) of soda or
fruit juice, which would in
itself contain at least 3000 Cal,
so that you end up eating and drinking 6000 Cal
per day.
12
Hydration during exercise drink 1.5 times the
amount you lose in perspiration with 1/3
teaspoon of salt per quart of water that you
drink. Pure water will NOT hydrate you during
exercise unless taken with food containing
electrolytes this is because the body needs to
replace both salts and water when you exercise.
When not exercising, drink pure water because
this water is to digest your food, not to replace
perspiration losses. Natural salt in food
replaces normal perspiration.
13
Pure water throughout the day. Electrolytes
when you exercise.
14
Dehydration achieved by 1. not drinking pure
water throughout the day as food digest 2.
drinking water only with meals 3. not taking in
salts with water during exercise

• Tips
• drink water BEFORE your morning diuretic coffee
• carry a water bottle
• have a sports drink or a small container with
  salts
• in your gym bag, OR eat food containing
  salt after exercise

If all the water you drink goes straight to your
bladder but you are still thirsty, you are either
low or high in salt, or you are only drinking
with meals.
15
Ultraendurance sport hydration and energy intake
is a different world You will sweat 0.5-2 L / hr
but can only ingest 1-1.25 L / hour. Sweat is 1
g/L Na, about 1/3 the concentration in
blood. Thus, salts in blood CONCENTRATE as you
sweat. If you are replacing lt 2/3 of your sweat
losses, drink pure water. But if replacing lt 2/3
of your sweat losses, you risk dehydration. Maximi
zing fluid intake and minimizing sweat losses
crucial. Maximize fluid intake 1 g/L Na i.e.
2.5 g table salt (1/3 teaspn)
with 1/5 as much potassium
salts
50-75 g (200-300 cal) carbohydrates If you can
only drink lt 2/3 as much as losses forget about
salts. Reducing salt by 5 reduced
performance, 10 collapse.
16
Trained cyclists energy burned during
training. VO2 max g/hr energy used carbo prot fat
50 137 105 13 19
70 (calculated) 208 177.5 13.5 18
80 243 212 14 17 Sports
Med 2001 (31) 701-15 You can digest fewer
calories at higher VO2 but burn more. Carb intake
and glycogen stores allow you to exceed 50
VO2. You may have gastric distress if trying to
take in more than 50-75 g (200-300 cal) of
carbohydrates (1/2-3/4 cup maltodextrine). Fructos
e and Na are both co-absorbed with glucose.
17
Ironman Factors Affecting Performance in an
Ultraendurance Triathlon Laursen PB and Rhodes
EC, Sports Med 2001(31)195 8-17 hours in the
heat 8500-11500 cal with sweat rates up to 2 L
/hr Maintaining glycogen and thermoregulation
becomes a challenge. Losing body water ? body
cooling and causes cardiovasuclar drift. Peak
central temperature ? causes ? performance,
central fatigue. Eletrolytes ? gastric emptying
and ? glucose water absorption. Most common
reason for needing medical assistance in
Ironman DEHYDRATION (performance ?
already w/ 4 weight ?). Most common electrolyte
imbalance hyponatraemia.
18
Tour de France Int J Sports Med 1989 (10)
S26 5500-7000 cal /day (highest recorded for
event gt 7 days long) 50 energy taken in during
competition (lowers nutrient value, vit Bs) 69
energy during race is CHO (1/2 from liquids), 25
fat (sweets) Up to 12 L water intake /day (1.3 L
/hr during competition). Athletes supplemented
with 2 mg B1, 5 mg B2, 2.4 mg B6, 1.6 mg
C. Syringe injections of pantothenic acid, B1, 2,
3, 6, and especially 12
(B12 levels 4x higher for those using
injections). Simulations 13 highly trained
cyclists Int J Sports Med 1989 (10)
S32,41,49 Normal high CHO diet cant maintain
energy balance. Equal parts maltodextran and
fructose also falls short (gastric distress). 85
maltodextrine (150 g/L), 15 fructose achieved
energy balance.
19

• We all sweat at different rates, and salt in
  sweat ? w/training.
• How to figure out your personal needs
• Weigh yourself before and after training in high
  and low temps.
• Know how many liters you drank during training.
• If you drank 1 L but still lost 1 kg in weight,
  you sweat 2 L.
• Divide the amount you drank by how much sweat you
  lost
• (in this example drank 1 L / sweat 2 L
  0.5 or ½ ).
• If you replace lt 2/3 of your sweat losses, forget
  salts.
• If you replace all of your sweat losses,
  1/3 teaspoon table salt
• with 10-20 potassium salt.
• 50-75 g carbs (as much as you can absorb i.e.
  avoid gastric distress)
• Small amount of protein is beneficial (5-10 g /
  hr).

20
HammerGel Goo Cytomax Gatorade
SustainedEnergy 33 g packet 32 g
1 packet 0.5 L 1
scoop calories 100 100
160 100 111 CHO/sugar
28/0 20/4 30/17 28/28
24/2 protein 0 0
0 0 3
(soy) fat 0 2
0 0 1
(lecithin) sodium mg 15 50
140 220 0 potassium
yes yes 154 60
0 sugar type malto malto
malto sucrose malto
fructose
fruct/gluc add-ons
herbs various
carnitine all but Gatorade contain BCAAs and vit.
C

21
Most ingested sugar goes to muscle or liver
initially
dairy lactose glucose galactose
muscle
liver
fruit/veg. sucrose glucose fructose
starch dextrines glucose chains
22

• Bicycling magazine Oct 1997 Top bicycle racers
  (Indurain,
• Riis, Jonker, and Tofi) increased their
  performance after the
• achievement of an emaciated frame and pipestem
  arms.
• This article says to lose weight by
• hard training in the fasted state
• eat only breakfast and dinner, go to bed hungry
• suppress appetite with diet drugs
• under-eat during a stage race (but not during the
  Tour)

Lance Armstrongs autobiography (p. 224) There
was an unforseen benefit of cancernow I was
almost gauntI had lost 15 pounds. It was all I
needed to win the Tour de France.
23

• CNN Presents on 5 May 2002
• Fat Chance America is facing an obesity
  epidemic.
• 1. expect failure but keep trying to lose
  weight, weigh yourself often
• dont deny yourself, but mostly eat low fat
  high carb
• 5 meals /day
• exercise 1 hour / day and add little bits of
  exercise throughout day

This CNN program concludes by saying that during
the past 40 years there has been obesity
research, research, and more research but that
we are, as a society, just getting fatter,
fatter, and fatter, with no end in sight until
science can help us.
24
Diets high in fat do not appear to be the
primary cause of the prevalence of excess body
fat in our society, and reductions in fat will
not be a solution. Willett WC, Am J Clin Nutr
199867, 556S-62S. Dept. of Nutrition and
Epidemiology, Harvard School of Public Health
At this stage there is no conclusive evidence
from epidemiological studies that under
isoenergetic conditions dietary fat intake
promotes the development of obesity more so than
other macronutrients. Seidell JC, Am J Clin
Nutr 199867, 546S-50S. Dept. of Chronic Diseases
and Env. Epidemiology, National Inst. of Pub.
Health, Netherlands
Replacement of saturated fats by carbohydrates
adversely affects plasma HDL concentrations
replacement of saturated fat by unsaturated
fatty acids deserves consideration as an
alternative. Katan MB, Am J Clin Nutr 199867,
573S-6S. Dept. of Human Nutrition, Wageningen
Agricultural University
25
insulin

• 1. shuttles nutrients into organs, keeps blood
  sugar down
• 2. halts the use of fat use from fat cells for
  energy
• shuttles nutrients into fat cells so fat cells
  make more fat
• increases LDL, total cholesterol, TGs

Refined carbohydrates cause insulin to spike in
the blood. Insulin lowers blood sugar to protect
the body (coma and death). After several weeks,
the body develops insulin resistance. Basal
(24-hour, around the clock) insulin levels
rise. Your body has become a fat storage,
non-body fat burning machine. Insulin resistance
precedes (leads to) obesity, diabetes, heart
disease.
26
YO-YO dieting what really happens

• eliminate fat and calories
• insulin spikes, lower blood sugar than ever, more
  hunger,
• lower metabolism, insulin resistance
• 20-40 of weight loss is normally muscle loss
• when weight loss achieved, normal diet resumed
• metabolism is still low and body is still insulin
  resistant
• weight rebounds faster than ever
• body even overcompensates and stores extra fat
  for
• the next fast (diet)
• the weight regained is all fat (the lost muscle
  does not return)
• heavier and less muscle than ever before
• go back to step (1)

27
Red meat has gotten a partially bum rap
10 g/day red meat ? colorectal cancer 11, 26 if
well done / very well done or cooked with
high-temp (pan fried, grilled). These results
are consistent with the hypothesis that
carcinogenic compounds formed by high-temperature
cooking techniques, such as heterocyclic amines
and polycylic aromatic hydrocarbons, may
contribute to the risk of developing colorectal
tumors. Sinha R, et al., Cancer Res
1999594320-4.
Diets containing primarily lean red meats (beef,
veal, pork) and lean white meats (poultry, fish)
produced similar reductions in LDL and elevations
in HDL cholesterol levels, which were maintained
throughout 36 weeks of treatment. Davidson MH,
et al., Arch Intern Med 2000160395-8.
Consumption of red meat, especially fried and/or
well-done red meat, was associated with increased
risk of lung cancer. Sinha R, et al., Cancer
Causes Control 19989621-30.
Red meat and colon cancer dietary haem, but not
fat, has cytotoxic and hyperproliferative
effects on rat colonic epithelium. Sesink ALA,
et al., Carcinogenesis 2000211909-15.
28
High (gt20) Protein Diet
heart disease (cholesterol, homocystein) high
blood pressure purines ? gout ? arthritis calcium
loss ? osteoarthritis less fruit / vegetables /
grains ? cancer vitamin / mineral
deficiency inhibited platelet function ?
bruising fatigue similar to diabetes renal
disease cerebral swelling
?Weight loss due to water loss and appetite
suppression.
29
But far-northern indigenous peoples eat high
protein and have, for nearly all their history,
been extremely healthy
Elevated concentrations (by 4-13x) of plasma
omega-3 polyunsat. fatty acids among Alaskan
Eskimos. Parkinson, AJ et al., Am J Clin Nutr
1994, 59, 384-8 Marine diet was positively
associated with serum HDL and blood glucose and
inversely with VLDL and TG. Bjerregaard, P et
al., Eur J Clin Nutr 2000, 54, 732-7 In the
last 30 years, sociocultural and political
changes have profoundly affected the way of life
of the Cree and Inuit or Northern Quebec. Their
health status profile has also changed. Thouez,
JP et al., Arctic Med Res 1990, 49,
180-8. Obesity among Inuit is as prevalent as
it is in the general North American population.
This is a new development over the past two or
three decades, the result of rapidly changing
physical activity, diet, and lifestyle. Young,
TK, Hum Biol 1996, 68, 245
30

• Protein Balance (Nitrogen Balance)
• in your body is LESS a function of protein, and
  more a function of
• meeting your calorie needs
• protein efficiency after 2 weeks of exercise

How to choose your proteins All protein sources
are healthy. But minimize saturated fat visible
animal fat and deep-fried foods. Examples of how
easy it is to meet daily protein needs are in the
handout.
31
Alcohol negative aspects
benefits to the cardiovascular system are in
doubt increased NADH/NAD ratio results in fatty
liver, heart vision (inhibition of retinal
production) protein, carbohydrate, and fat
metabolism altered thrombosis / stroke
risk oxidative damage to heart dehydration sleep
/ growth hormone reduced testosterone
32
Alcohol has gotten some good press for the wrong
reasons
Moderate alcohol intake, increased levels of HDL
and its subfractions, and decreased risk (by 50
for moderate intake) of myocardial infarction.
Gaziano JM, et al., N Eng J Med 19933291829-34
But hidden in the fine print Various
lipids(HDL, TGs, etc) were added to the
risk-factor model one at a time. Similarly, we
added the levels of apolipoproteinsto determine
the degree to which apolipoproteins mediate the
effect of alcohol, beyond the effect of
HDL. Based on HDL and total cholesterol risk
was 50 less with moderate alcohol. As soon as
apolipoproteins were included in the
calculation risk was 8 MORE with moderate
alcohol consumption.
Guess what was reported in the title and
abstract? (see title at top of page alcohol
decreases myocardial infarction risk)
33
Its not the wine, its the entire diet that
matters
Moderate alcohol consumption raises homocystein
levels by 20 which raises chances of coronary
heart disease by 20. Except for beer which
contains folate.
We postulate that elevated levels of
homocysteine in social drinkers with regular
moderate alcohol intake are at risk of developing
cardiovascular diseases, which contradicts
the cardioprotection of alcohol according to the
French Paradox. Bleich S, et al. Alcohol and
Alcoholism 200136189-92.
My personal comment homocyteine levels rise
when not taking in folate i.e. whole grains,
fruits, and vegetables. Wine contains
antioxidants, so as long as you are eating a
healthy diet red wine can contribute to health.
Otherwise it will not.
34
Womens nutrient needs
Increasing vitamin C intake by 10 (to 1000 mg)
increases IRON absorption by 10. Hallberg L, et
al. Ann N Y Acad Sci 1987498324-32. sources of
vit. C broccoli, lettuce, onions, tomatoes,
apples, cantaloupe,
citrus, pineapples, strawberries sources of
iron whole grains, fruits, vegetables, nuts

• For healthy bones
• weight-bearing exercise
• 1200-1500 mg calcium / day (3 glasses of milk)
• vitamin D helps calcium absorption (also in milk)
• Dairy has more calcium and is more absorbable
  than any other food.
• If you dont like dairy this is a rare instance
  to use supplements.

35
Conclusions What you DO eat is as important as
what you do NOT eat. EAT minimally
(appropriately) processed foods.
moderate amounts of all food types (fat, protein,
carbohydrates). DRINK water (electrolytes only
when exercising or in high heat). AVOID
processed foods (refined carbohydrates,
hydrogenated oils). substituting
carbonated beverages for water.
Even diet soda may cause dehydration if contains
caffeine. Soda, ice cream, and doughnuts have a
place in your diet if you want them. They are
for enjoyment. Eat a solid meal or drink water
FIRST, THEN enjoy. Otherwise insulin soars and
your diet is in control of you.
36
Performance nutrition is a matter of being
healthy. This includes performance in thinking,
daily activities, as well as athletics. To lose
body fat minimize processed foods. Including
exercise more than doubles the effectiveness of
this. To lose overall weight requires slight
caloric deficit. Exercise and non-processed foods
maximizes fat loss. Cutting calories simply
lowers metabolism (not good). To gain weight
requires slight caloric excess. Exercise and
non-processed foods minimizes fat gain. Simply
eating more of the standard US diet will cause
fat gains. Refined foods are more easily
digested and, during exercise, adrenaline
reduces insulin release. Therefore, refined foods
are preferred during exercise.