Food Fight

Rachel Scrivin
PG Dip Diet, BPhEd, BCApSc
NZRD / HAAD

Objectives
Describe the current ACSM, SDA, AIS, USOC guidelines for
nutrition for endurance training and team sport
Outline the current LCHF research
Pros and Cons of Carbohydrate vs Fat as a fuel for endurance
athletes and team sports
Recommendations

ACSM, AIS, USOC, SDA current

guidelines
Guidelines are based on years of extensive research into the ideal
diet for an athlete
Pros
Majority of athletes are following these guidelines
Athletes are performing to the best of their physical abilities
Cons
Some sports may benefit from a change in the current
recommendations

Carbohydrate
Most athletes require about 6 -10 g.kg-1.d-1
Depending on training volumes, intensity, type of sport, body
composition
Maintain blood glucose during exercise and replace muscle
glycogen
Guidelines are not substantially different from Dietary Guidelines
for Americans and Eating Well with Canada's Food Guide
55-60 % of dietary intake from carbohydrates
Carbohydrates from mixed sources; fruits, vegetables, starchy
veggies, rice, pasta, breads (wholegrains if possible)

Carbohydrate intake for athletes

Pre-exercise
Meal 3-4 hr, 0.5 g-1 g.kg
carbohydrate foods

-1

prior, easily digested, familiar

Rice, pasta, oats, wholemeal breads

Snack 1-2 hr (50 g carb) before
Banana, low fat yoghurt, creamed rice, milk
Fluids up until event water primarily or Carbohydrate
Electrolyte Solution (CES) if food not tolerated

Carbohydrate intake for athletes

During events
30-60 g.h-1 easily digested will depend on the event and the
duration
Cycling can have more solid carb/pro bars, bananas, sport
cookies, muesli bars etc. plus CES
Running more GI disturbance so gels, sports beans/ GU
chomps, CES.
Recovery
1-1.5 g.kg-1 in mixed meal within 30 min of exercise at 2 hr
intervals
Rice, pasta, breads, cereals, fruit, veggies

USOC Hard Training day plate

Protein
General population or sedentary
RDA is 0.8 g.kg-1.d-1
AMDR >18 yr 10-35 % of total calories
Athletes
Endurance 1.2-1.4 g.kg-1.d-1 to support nitrogen balance
Strength 1.2-1.7 g.kg-1.d-1
Protein supplementation conservative
Food sources mixed sources (animal and vegetable sources)

Protein intakes for athletes

Before Endurance/ team sports
20 g protein serve in a meal 2-4 hr prior to training or event
During
No strong evidence for protein during, however sports > 2 hr
may benefit from protein to prevent excessive protein
catabolism
After/ Recovery
As part of the recovery meal. 20-30 g serve.

Fat
AMDR 20-35 % of energy intake
10 % SFA
10 % PUFA
10 % MUFA
1 g.kg-1.d-1
ACSM does not support intakes >70 % intake

Hydration

ACSM. Joint Position Statement. American Dietetic Association and Dietitians of

Canada. Nutrition and Athletic Performance. Medicine and Science in Sports
and Exercise. 2009: 709-731.

Before exercise

4 h prior 5-7 ml.kg-1.bw (70 kg person = 350-490 ml)

During

Replacement of total fluid (water for short duration and CES endurance/ multi event/
competitions) about 300-600 ml.hr -1

CES = CHO content 6-8 % + Sodium 20 mmol.L -1

Rate will vary amongst individuals and environmental conditions.

Issues with overconsumption in long duration, less trained, overweight athletes

(hyponatremia) *

Recovery

Replace fluid losses, possibly hypertonic solution

Replace 120-150 % fluid losses

* Statement of the Third International Exercise Associated Hyponatremia Consensus development conference, Carlsbad,
California. Clin. J Sport Med. 2015; 25: 303-320.

Low Carbohydrate High Fat (LCHF) for

athletes?

WHY consider?

Example:

70 kg competitive athletic male runner

10 % body fat (3 % essential body fat)

7 % x 70 kg = 4.9 kg fat =
fuel)

44,100 kcal from fat (huge

0.76 % x 70 kg = 0.53 kg glycogen =

2120 kcal from glycogen

Fat vs Glycogen Storage

Energy / Fuel Stores
50000
45000
40000
35000
30000
Energy/ kcals 25000
20000
15000
10000
5000
0

Fat

Glycogen

How can Fat Fuel?

Need to be in ketotic state
How? Consume <50 g carbohydrates daily (i.e. 1 slice
wholegrain bread and 1 banana) while increasing fat intake
Take at least 2 weeks to deplete muscle glycogen stores and
have the cells adapt to using ketones, lactate and glucose
derived from glucogenogensis called keto-adaptation
Surely our abundant body fat stores could provide most if not all
the energy necessary to fuel actives of a sub maximal intensity?

Nutrient needs
70kg male cyclists, 300 km.wk-1
Recommended diet
HCHO

LCHF diet

Carb
Grams of carbs
Kcals

7 g.kg-1
490 g.d-1
1960 kcal

0.5 g.kg-1
35 g.d-1
140 kcals

Protein
Grams of Protein
Kcals

1.5 g.kg-1
105 g.d-1
420 kcal

2 g.kg-1
140 g.d-1
560 kcal

Fat
Grams of fat
Kcals

1g.kg-1
70 g.d-1
630 kcal

3 g.kg-1
210 g.d-1
1890 kcal

Total kcals

2450 kcal.d-1
35 kcal.kg-1.d-1

2590 kcal.d-1
37 kcal.kg-1.d-1

LCHF research
Phinney SD et al. The Human Metabolic Response to
Chronic Ketosis without caloric restriction: Preservation
of submaximal exercise capability with reduced
carbohydrate oxidation. Metabolism. (1983) Vol 32: 769-776
5 cyclists
Eucaloric balanced diet (EBD) one week 35-60 kcal.kg -1, 1.75 g
pro.kg-1 and remaining 2/3 as CHO and 1/3 fat
Then 4 weeks eucaloric ketogenic diet (EKD) <20 g CHO daily
TTE 62-64 % VO2max was 147 +/- 13 min EBD cf 151 +/- 25 min
EKD (no sf diff) 2/5 worse performance
No compromise to endurance however no benefit either!

Results from Phinney (1983) study

LCHF research
Paoli A et al. Ketogenic diet does not affect strength
performance in elite artistic gymnasts. Journal of the
International Society of Sports Nutrition (2012); 9:34.
Very low carbohydrate ketogenic diets (VLCKD)
8 elite male artistic gymnasts
Two diets. VLCKD for 30 days, then 90 days normal diet, then 30
days on Western diet (WD) 30 days. Various performance
strength tasks before and after each diet. Both diets ab libitum.
Not RCT only experimental.
No sf difference between VLCKD vs WD in strength at end of
testing but changes in body weight and body fat (reductions in
VLCKD)

CHO (VLCKD) 0.3 g.kg. d-1

VS
CHO (WD) 3.8 g.kg. d-1

Pro(VLCKD) 2.85 g.kg. d-1

FAT 1.7 g.kg. d-1
VS
Pro (WD) 1.2 g.kg. d-1
FAT 1.3 g.kg. d-1

VLCKD = 1973
kcal.d VS
WD = 2274 kcal.d
300 kcal.d
difference

NO significant
difference in
strength

Significant
difference in lower
body fat (kg and %)
increase in LBM %
and lower weight

Short-term high fat diet with CHO

restoration
Stellingwerth, T. et al. Decreased PDH activation and glycogenoloysis
during exercise following fat adaptation with carbohydrate
restoration. Am J Physiol Endocrinol Metab. 2005. E380-388.

Pyruvate dehydrogenase is a mitochondrial multienzyme complex that catalyzes the conversion

of pyruvate to acetyl-coenzyme A and regulates the entry of carbohydrate into the tricarboxylic
acid cycle for oxidation.

7 Male endurance trained cyclist or triathletes

Randomised crossover design
2 x 7 day trials, 2 week washout
5 day adaptation to high-fat diet then 1 day CHO restoration or 6 day high
CHO diet
5 days of supervised diet and training programme
All meals and snacks were provided

FAT

CHO

PRO

LCHF

2.5 g.kg-1.d-1
67 % Energy

2.5 g.kg-1.d-1
18 % Energy

2.3 g.kg-1.d-1
15 % Energy

HCHO

1.0 g.kg-1.d-1
15 % Energy

10.3 g.kg-1.d-1
70 % Energy

2.3 g.kg-1.d-1
15 % Energy

20 min SS cycling at 70% VO 2max, 1 min sprint at 150% PPO, 5 min rest then TT
(10 mins at 90 % VO2max)

Results indicate that PDH activity was lower during submaximal cycling and
estimated glycogenolysis and PDH activity were also lower during the transition to
exercise in both LCHF compared to the HCHO trial.

One day restoration of muscle glycogen still not adequate for fat adapted athletes

?lack a top gear as reduced capacity to oxidise pyruvate

LCHF vs HCHO meta-analysis

Erlenbusch M. et al. Effect of High-Fat or High-Carbohydrate Diets on

Endurance Exercise: A Meta-Analysis. International Journal or Sport Nutrition
and Exercise Metabolism (2005), 14:1-14.

Analysed 20 published trials to compare exercise performance under different diets,

high fat vs high cho.

Overall the TTE when corrected for Effect Sizes (ES) suggest that endurance
exercise performance is moderately prolonged after a high- carbohydrate diet when
compared to a high-fat diet.

Test for homogeneity revealed significant heterogeneity among effect sizes

therefore a conclusive endorsement on any diet is difficult to make.

Due to the heterogeneity need for future research to adopt consistent experimental
design protocols. Sample size, trained vs untrained, gender, diet control etc.

Current issues with LCHF

Studies show no improvements in athletic performance no detriment
either
Need more studies in different sports not just endurance
Must have strict adherence to remain in ketosis
Long term effects not looked at yet
Possibly sub-optimal diet cut out a lot of diary, fruits, fibre foods as
may have to supplement diet with fibre, vitamins and minerals
Socially more difficult + huge change in mindset
No changes recommended before RIO 2016.
Contraindications;
Renal and liver disease if protein and fat increased
Transient issues of reduced stool volume, frequency, constipation.

LCHF vs HCHO
Sport

LCHF

HCHO

Rationale

Ultramarathon (Marathon
des Sables)
North Pole treks
One day multi-sport

Yes

Use fat for fuel and just

hydrate less to carry
Lower overall intensity

Ironman

Yes*

Have to be lean and

strong not necessarily
fastest

Football

Yes

High intensity largely

anaerobic

Marathon elite
Non-elite

Yes

Elite may need higher

energy compared to
slower runners

Yes

High explosive energy

needed

Yes

Strength sports
Weightlifting
High Jump
Making weight sports
Boxing
Rowing
TKD

Yes

Train in fat adapted no

need to shed or dehydrate
prior to event to make
weight

Gymnastics
Diving

Yes

Lean as possible less

physical body to be
inhibitive

Conclusions

Emerging evidence

Need more RCT

Need to review impact of long term health on long term ketosis diets

Sports specific, event specific

Ketosis cycling for events.train low, compete high

Open minded about new research

Questions???

References

ACSM. Joint Position Statement. American Dietetic Association and Dietitians of Canada.
Nutrition and Athletic Performance. Medicine and Science in Sports and Exercise. 2009:
709-731.

ACSM Position Stand. Exercise and Fluid Replacement. Medicine and Science in Sports and
Exercise. 2007. 377-390.

Phinney SD et al. The Human Metabolic Response to Chronic Ketosis without caloric
restriction: Preservation of submaximal exercise capability with reduced
carbohydrate oxidation. Metabolism. (1983) Vol 32: 769-776

Paoli A et al. Ketogenic diet does not affect strength performance in elite artistic
gymnasts. Journal of the International Society of Sports Nutrition (2012); 9:34.

Erlenbusch M. et al. Effect of High-Fat or High-Carbohydrate Diets on Endurance

Exercise: A Meta-Analysis. International Journal or Sport Nutrition and Exercise Metabolism
(2005), 14:1-14.

Statement of the Third International Exercise Associated Hyponatremia Consensus

development conference, Carlsbad, California. Clin. J Sport Med. 2015; 25: 303-320.