Effect of graded fructose coingestion with maltodextrin on exogenous 14C-fructose and 13C-glucose oxidation efficiency and high-intensity cycling performance

Carbohydrate Ingestion before Exercise for Individuals with McArdle Disease: Survey Evidence of Implementation and Perception in Real-World Settings

In individuals with McArdle disease (IWMD), the ingestion of carbohydrates before exercise has previously been shown in laboratory studies to significantly decrease the exercising symptoms of the condition and increase exercise tolerance during the early stages of exercise. As a result, carbohydrate ingestion pre-exercise is currently included in management guidelines, and often advised by medical professionals treating the condition. The aim of the current study was to determine whether positive lab-based results for the ingestion of carbohydrate before exercise in laboratory studies are being effectively translated into practice and produce perceptions of the same positive outcomes in real-world settings (RWS). An online survey method was used to collect responses from 108 IWMD. Data collected on the amount and type of carbohydrate consumed prior to exercise found that most surveyed participants (69.6%) who supplied qualitative data (n = 45) consumed less than the 37 g currently recommended in management guidelines. Survey data also revealed a large variation in the type and amount of carbohydrate ingested when IWMDs are applying carbohydrate ingestion before exercise in RWS. Consistent with these findings, only 17.5% of participants stated that they found carbohydrate ingestion before exercise relieved or minimised their MD symptoms. Results suggest that positive lab-based findings (increased exercise tolerance) of carbohydrate ingestion before exercise are not being effectively translated to RWS for many IWMD. There is a need for improved patient education of IWMD on the application of carbohydrate ingestion before exercise in RWS.

Functional Beverages in the 21st Century

Underlying the dawn of humanity was primarily the search for food and access to drinking water. Over the course of civilization, there has been a significant increase in drinking water quality. By the average of the nutritional standards, the daily water demand is 2.5 L (also including liquid products such as tea, coffee, or soup). However, it is worth noticing that the need is strictly individual for each person and depends on two major factors, namely, epidemiological (sex, age state of health, lifestyle, and diet) and environmental (humidity and air temperature). Currently, our diet is more and more often enriched with isotonic drinks, functional drinks, or drinks bearing the hallmarks of health-promoting products. As a result, manufacturing companies compete to present more interesting beverages with complex compositions. This article will discuss both the composition of functional beverages and their impact on health.

Increased exogenous but unaltered endogenous carbohydrate oxidation with combined fructose-maltodextrin ingested at 120 g h-1 versus 90 g h-1 at different ratios

Purpose

This study aimed to investigate whether carbohydrate ingestion during 3 h long endurance exercise in highly trained cyclists at a rate of 120 g h⁻¹ in 0.8:1 ratio between fructose and glucose-based carbohydrates would result in higher exogenous and lower endogenous carbohydrate oxidation rates as compared to ingestion of 90 g h⁻¹ in 1:2 ratio, which is the currently recommended approach for exercise of this duration.

Methods

Eleven male participants (V̇O_2peak 62.6 ± 7 mL kg⁻¹ min⁻¹, gas exchange threshold (GET) 270 ± 17 W and Respiratory compensation point 328 ± 32 W) completed the study involving 4 experimental visits consisting of 3 h cycling commencing after an overnight fast at an intensity equivalent to 95% GET. During the trials they received carbohydrates at an average rate of 120 or 90 g h⁻¹ in 0.8:1 or 1:2 fructose-maltodextrin ratio, respectively. Carbohydrates were naturally high or low in ¹³C stable isotopes enabling subsequent calculations of exogenous and endogenous carbohydrate oxidation rates.

Results

Exogenous carbohydrate oxidation rates were higher in the 120 g h⁻¹ condition (120–180 min: 1.51 ± 0.22 g min⁻¹) as compared to the 90 g h⁻¹ condition (1.29 ± 0.16 g min⁻¹; p = 0.026). Endogenous carbohydrate oxidation rates did not differ between conditions (2.15 ± 0.30 and 2.20 ± 0.33 g min⁻¹ for 120 and 90 g h⁻¹ conditions, respectively; p = 0.786).

Conclusions

The results suggest that carbohydrate ingestion at 120 g h⁻¹ in 0.8:1 fructose-maltodextrin ratio as compared with 90 g h⁻¹ in 1:2 ratio offers higher exogenous carbohydrate oxidation rates but no additional sparing of endogenous carbohydrates. Further studies should investigate potential performance effects of such carbohydrate ingestion strategies.

13C-glucose-fructose labeling reveals comparable exogenous CHO oxidation during exercise when consuming 120 g/h in fluid, gel, jelly chew, or coingestion

We examined the effects of carbohydrate (CHO) delivery form on exogenous CHO oxidation, gastrointestinal discomfort, and exercise capacity. In a randomized repeated-measures design [after 24 h of high CHO intake (8 g·kg^-1) and preexercise meal (2 g·kg^-1)], nine trained males ingested 120 g CHO·h^-1 from fluid (DRINK), semisolid gel (GEL), solid jelly chew (CHEW), or a coingestion approach (MIX). Participants cycled for 180 min at 95% lactate threshold, followed by an exercise capacity test (150% lactate threshold). Peak rates of exogenous CHO oxidation (DRINK 1.56 ± 0.16, GEL 1.58 ± 0.13, CHEW 1.59 ± 0.08, MIX 1.66 ± 0.02 g·min^-1) and oxidation efficiency (DRINK 72 ± 8%, GEL 72 ± 5%, CHEW 75 ± 5%, MIX, 75 ± 6%) were not different between trials (all P > 0.05). Despite ingesting 120 g·h^-1, participants reported minimal symptoms of gastrointestinal distress across all trials. Exercise capacity was also not significantly different (all P > 0.05) between conditions (DRINK 446 ± 350, GEL 529 ± 396, CHEW 596 ± 416, MIX 469 ± 395 s). Data represent the first time that rates of exogenous CHO oxidation (via stable isotope methodology) have been simultaneously assessed with feeding strategies (i.e., preexercise CHO feeding and the different forms and combinations of CHO during exercise) commonly adopted by elite endurance athletes. We conclude that 120 g·h^-1 CHO (in a 1:0.8 ratio of maltodextrin or glucose to fructose) is a practically tolerable strategy to promote high CHO availability and oxidation during exercise.NEW & NOTEWORTHY We demonstrate comparable rates of exogenous CHO oxidation from fluid, semisolid, solid, or a combination of sources. Considering the sustained high rates of total and exogenous CHO oxidation and relative lack of gastrointestinal symptoms, consuming 120 g CHO·h^-1 appears to be a well-tolerated strategy to promote high CHO availability during exercise. Additionally, this is the first time that rates of exogenous CHO oxidation have been assessed with feeding strategies (e.g., coingestion of multiple CHO forms) typically reported by endurance athletes.

Nutrition and indoor cycling: a cross-sectional analysis of carbohydrate intake for online racing and training

Cycling is a sport characterised by high training load, and adequate nutrition is essential for training and race performance. With the increased popularity of indoor trainers, cyclists have a unique opportunity to practice and implement key nutritional strategies. This study aimed to assess carbohydrate (CHO) intake of cyclists training or racing in this unique scenario for optimising exercise nutrition. A mixed-methods approach consisting of a multiple-pass self-report food recall and questionnaire was used to determine total CHO intake pre, during and post-training or racing using a stationary trainer and compared with current guidelines for endurance exercise. Sub-analyses were also made for higher ability cyclists (>4 W/kg functional threshold power), races v. non-races and 'key' training sessions. Mean CHO intake pre and post-ride was 0·7 (sd 0·6) and 1·0 (sd 0·8) g kg/BM and 39·3 (sd 27·5) g/h during training. CHO intake was not different for races (pre/during/post, P = 0·31, 0·23, 0·18, respectively), 'key sessions' (P = 0·26, 0·89, 0·98) or higher ability cyclists (P = 0·26, 0·76, 0·45). The total proportion of cyclists who failed to meet CHO recommendations was higher than those who met guidelines (pre = 79 %, during = 86 %, post = 89 %). Cyclists training or racing indoors do not meet current CHO recommendations for cycling performance. Due to the short and frequently high-intensity nature of some sessions, opportunity for during exercise feeding may be limited or unnecessary.

The validity and reliability of a novel isotope ratio infrared spectrometer to quantify 13C enrichment of expired breath samples in exercise

The traditional method to measure ¹³CO₂ enrichment in breath involves isotope ratio mass spectrometry (IRMS), which has several limitations such as cost, extensive training, and large space requirements. Here, we present the validity and reliability data of an isotope ratio infrared spectrometer (IRIS)-based method developed to combat these limitations. Eight healthy male runners performed 105 min of continuous running on a motorized treadmill while ingesting various carbohydrate beverages enriched with ¹³C and expired breath samples were obtained every 15 min in triplicates. A total of 213 breath samples were analyzed using both methods, whereas 212 samples were repeated using IRIS to determine test-retest reliability. Bland-Altman analysis was performed to determine systematic and proportional bias, and intraclass correlation coefficient (ICC) and coefficient of variation (CV) to assess level of agreement and magnitude of error. The IRIS method demonstrated a small but significant systematic bias to overestimate δ¹³CO₂ (0.18‰; P < 0.05) compared with IRMS, without any proportional bias or heteroscedasticity and a small CV (0.5%). There was a small systematic bias during the test-retest of the IRIS method (-0.07‰; P < 0.05), no proportional bias, an excellent ICC (1.00), and small CV (0.4%). The use of the Delta Ray IRIS to determine ¹³C enrichment in expired breath samples captured during exercise has excellent validity and reliability when compared with the gold standard IRMS.NEW & NOTEWORTHY The use of IRIS to determine ¹³C enrichment in expired breath samples captured during exercise to determine exogenous glucose oxidation during exercise has excellent validity and reliability when compared with the gold standard IRMS.

Concordance between 13 C:12 C ratio technique respect to indirect calorimetry to estimate carbohydrate and Fat oxidation rates by means stoichiometric equations during exercise. A reliability and agreement study

Indirect calorimetry is a tool used routinely by sport/exercise physiologist to assess the metabolic response to training and to nutritional interventions. There are different stoichiometric equations to estimate fat (FatOxR ) and carbohydrates (CHOOxR ) oxidation rates, however there are not enough information in literature about what are the most accurate equations. The purpose of this study was to determine the concordance between indirect calorimetry and a method of reference for stoichiometric equations used to estimate FatOxR and CHOOxR . Concordance between indirect calorimetry and the method of reference (13 C to 12 C ratio (13 C:12 C ratio) technique) for key stoichiometric equations was assessed in well-trained triathletes. Subjects carried out a carbohydrate depletion-repletion protocol, labeling the glycogen stores with 13 C, and a laboratory test to assess the 13 C metabolic response during a wide range of aerobic intensities during exercise. All the equations showed a narrow agreement interval (Δ) (CHOOxR nPC (protein component negligible): -0.308, 0.308, CHOOxR PC (protein component): -0.268, 0.268, FatOxR nPC and PC: -0.032, 0.032 (g·min-1 )). FatOxR showed a similar concordance (28-32%) with CHOOxR nPC ranging from 55% to 75%, and for CHOOxR PC between 51% to 71%. None of the stoichiometric equations met a perfect agreement with the method of reference. The Jeukendrup and Wallis equation showed the best concordance for CHOOxR nPC whilst the Frayn and Ferrannini (Glu) equations had the best agreement for CHOOxR PC. All FatOxR equations showed similar concordances and they are able to be used indistinctly.

Liver and muscle glycogen oxidation and performance with dose variation of glucose-fructose ingestion during prolonged (3 h) exercise

PURPOSE

This study investigated the effect of small manipulations in carbohydrate (CHO) dose on exogenous and endogenous (liver and muscle) fuel selection during exercise.

METHOD

Eleven trained males cycled in a double-blind randomised order on 4 occasions at 60% [Formula: see text] for 3 h, followed by a 30-min time-trial whilst ingesting either 80 g h^-1 or 90 g h^-1 or 100 g h^{-1 13}C-glucose-¹³C-fructose [2:1] or placebo. CHO doses met, were marginally lower, or above previously reported intestinal saturation for glucose-fructose (90 g h^-1). Indirect calorimetry and stable mass isotope [¹³C] techniques were utilised to determine fuel use.

RESULT

Time-trial performance was 86.5 to 93%, 'likely, probable' improved with 90 g h^-1 compared 80 and 100 g h^-1. Exogenous CHO oxidation in the final hour was 9.8-10.0% higher with 100 g h^-1 compared with 80 and 90 g h^-1 (ES = 0.64-0.70, 95% CI 9.6, 1.4 to 17.7 and 8.2, 2.1 to 18.6). However, increasing CHO dose (100 g h^-1) increased muscle glycogen use (101.6 ± 16.6 g, ES = 0.60, 16.1, 0.9 to 31.4) and its relative contribution to energy expenditure (5.6 ± 8.4%, ES = 0.72, 5.6, 1.5 to 9.8 g) compared with 90 g h^-1. Absolute and relative muscle glycogen oxidation between 80 and 90 g h^-1 were similar (ES = 0.23 and 0.38) though a small absolute (85.4 ± 29.3 g, 6.2, - 23.5 to 11.1) and relative (34.9 ± 9.1 g, - 3.5, - 9.6 to 2.6) reduction was seen in 90 g h^-1 compared with 100 g h^-1. Liver glycogen oxidation was not significantly different between conditions (ES < 0.42). Total fat oxidation during the 3-h ride was similar in CHO conditions (ES < 0.28) but suppressed compared with placebo (ES = 1.05-1.51).

CONCLUSION

'Overdosing' intestinal transport for glucose-fructose appears to increase muscle glycogen reliance and negatively impact subsequent TT performance.

Carbohydrate dose influences liver and muscle glycogen oxidation and performance during prolonged exercise

This study investigated the effect of carbohydrate (CHO) dose and composition on fuel selection during exercise, specifically exogenous and endogenous (liver and muscle) CHO oxidation. Ten trained males cycled in a double‐blind randomized order on 5 occasions at 77% V˙O2max for 2 h, followed by a 30‐min time‐trial (TT) while ingesting either 60 g·h⁻¹ (LG) or 75 g·h⁻¹¹³C‐glucose (HG), 90 g·h⁻¹ (LGF) or 112.5 g·h⁻¹¹³C‐glucose‐¹³C‐fructose ([2:1] HGF) or placebo. CHO doses met or exceed reported intestinal transporter saturation for glucose and fructose. Indirect calorimetry and stable mass isotope [¹³C] tracer techniques were utilized to determine fuel use. TT performance was 93% “likely/probable” to be improved with LGF compared with the other CHO doses. Exogenous CHO oxidation was higher for LGF and HGF compared with LG and HG (ES > 1.34, P < 0.01), with the relative contribution of LGF (24.5 ± 5.3%) moderately higher than HGF (20.6 ± 6.2%, ES = 0.68). Increasing CHO dose beyond intestinal saturation increased absolute (29.2 ± 28.6 g·h⁻¹, ES = 1.28, P = 0.06) and relative muscle glycogen utilization (9.2 ± 6.9%, ES = 1.68, P = 0.014) for glucose‐fructose ingestion. Absolute muscle glycogen oxidation between LG and HG was not significantly different, but was moderately higher for HG (ES = 0.60). Liver glycogen oxidation was not significantly different between conditions, but absolute and relative contributions were moderately attenuated for LGF (19.3 ± 9.4 g·h⁻¹, 6.8 ± 3.1%) compared with HGF (30.5 ± 17.7 g·h⁻¹, 10.1 ± 4.0%, ES = 0.79 & 0.98). Total fat oxidation was suppressed in HGF compared with all other CHO conditions (ES > 0.90, P = 0.024–0.17). In conclusion, there was no linear dose response for CHO ingestion, with 90 g·h⁻¹ of glucose‐fructose being optimal in terms of TT performance and fuel selection.

Role of Functional Beverages on Sport Performance and Recovery

Functional beverages represent a palatable and efficient way to hydrate and reintegrate electrolytes, carbohydrates, and other nutrients employed and/or lost during physical training and/or competitions. Bodily hydration during sporting activity is one of the best indicators of health in athletes and can be a limiting factor for sport performance. Indeed, dehydration strongly decreases athletic performance until it is a risk to health. As for other nutrients, each of them is reported to support athletes' needs both during the physical activity and/or in the post-workout. In this study, we review the current knowledge of macronutrient-enriched functional beverages in sport taking into account the athletes' health, sports performance, and recovery.

Altitude Acclimatization Alleviates the Hypoxia-Induced Suppression of Exogenous Glucose Oxidation During Steady-State Aerobic Exercise

This study investigated how high-altitude (HA, 4300 m) acclimatization affected exogenous glucose oxidation during aerobic exercise. Sea-level (SL) residents (n = 14 men) performed 80-min, metabolically matched exercise (V˙O₂ ∼ 1.7 L/min) at SL and at HA < 5 h after arrival (acute HA, AHA) and following 22-d of HA acclimatization (chronic HA, CHA). During HA acclimatization, participants sustained a controlled negative energy balance (-40%) to simulate the “real world” conditions that lowlanders typically experience during HA sojourns. During exercise, participants consumed carbohydrate (CHO, n = 8, 65.25 g fructose + 79.75 g glucose, 1.8 g carbohydrate/min) or placebo (PLA, n = 6). Total carbohydrate oxidation was determined by indirect calorimetry and exogenous glucose oxidation by tracer technique with ¹³C. Participants lost (P ≤ 0.05, mean ± SD) 7.9 ± 1.9 kg body mass during the HA acclimatization and energy deficit period. In CHO, total exogenous glucose oxidized during the final 40 min of exercise was lower (P < 0.01) at AHA (7.4 ± 3.7 g) than SL (15.3 ± 2.2 g) and CHA (12.4 ± 2.3 g), but there were no differences between SL and CHA. Blood glucose and insulin increased (P ≤ 0.05) during the first 20 min of exercise in CHO, but not PLA. In CHO, glucose declined to pre-exercise concentrations as exercise continued at SL, but remained elevated (P ≤ 0.05) throughout exercise at AHA and CHA. Insulin increased during exercise in CHO, but the increase was greater (P ≤ 0.05) at AHA than at SL and CHA, which did not differ. Thus, while acute hypoxia suppressed exogenous glucose oxidation during steady-state aerobic exercise, that hypoxic suppression is alleviated following altitude acclimatization and concomitant negative energy balance.

A comparison of isomaltulose versus maltodextrin ingestion during soccer-specific exercise

Purpose

The performance and physiological effects of isomaltulose and maltodextrin consumed intermittently during prolonged soccer-specific exercise were investigated.

Methods

University soccer players (n = 22) performed 120 min of intermittent exercise while consuming 8% carbohydrate–electrolyte drinks (equivalent to ~ 20 g h⁻¹) containing maltodextrin (Glycaemic Index: 90–100), isomaltulose (Glycaemic Index: 32) or a carbohydrate-energy-free placebo in a manner replicating the practices of soccer players (i.e., during warm-up and half-time). Physical (sprinting, jumping) and technical (shooting, dribbling) performance was assessed.

Results

Blood glucose and plasma insulin (both P < 0.001) concentrations varied by trial with isomaltulose maintaining > 13% higher blood glucose concentrations between 75 and 90 min versus maltodextrin (P < 0.05). A decline in glycaemia at 60 min in maltodextrin was attenuated with isomaltulose (−19 versus −4%; P = 0.015). Carbohydrates attenuated elevations in plasma epinephrine concentrations (P < 0.05), but isomaltulose proved most effective at 90 and 120 min. Carbohydrates did not attenuate IL-6 increases or reductions in physical or technical performances (all P > 0.05). Ratings of abdominal discomfort were influenced by trial (P < 0.05) with lower values for both carbohydrates compared to PLA from 60 min onwards.

Conclusions

Although carbohydrates (~ 20 g h⁻¹) did not attenuate performance reductions throughout prolonged soccer-specific exercise, isomaltulose maintained higher blood glucose at 75–90 min, lessened the magnitude of the exercise-induced rebound glycaemic response and attenuated epinephrine increases whilst maintaining similar abdominal discomfort values relative to maltodextrin. When limited opportunities exist to consume carbohydrates on competition-day, low-glycaemic isomaltulose may offer an alternative nutritional strategy for exercising soccer players.

Glucose-fructose ingestion and exercise performance: The gastrointestinal tract and beyond

Carbohydrate ingestion can improve endurance exercise performance. In the past two decades, research has repeatedly reported the performance benefits of formulations comprising both glucose and fructose (GLUFRU) over those based on glucose (GLU). This has been usually related to additive effects of these two monosaccharides on the gastrointestinal tract whereby intestinal carbohydrate absorption is enhanced and discomfort limited. This is only a partial explanation, since glucose and fructose are also metabolized through different pathways after being absorbed from the gut. In contrast to glucose that is readily used by every body cell type, fructose is specifically targeted to the liver where it is mainly converted into glucose and lactate. The ingestion of GLUFRU may thereby profoundly alter hepatic function ultimately raising both glucose and lactate fluxes. During exercise, this particular profile of circulating carbohydrate may induce a spectrum of effects on muscle metabolism possibly resulting in an improved performance. Compared to GLU alone, GLUFRU ingestion could also induce several non-metabolic effects which are so far largely unexplored. Through its metabolite lactate, fructose may act on central fatigue and/or alter metabolic regulation. Future research could further define the effects of GLUFRU over other exercise modalities and different athletic populations, using several of the hypotheses discussed in this review.

Glucose Plus Fructose Ingestion for Post-Exercise Recovery-Greater than the Sum of Its Parts?

Carbohydrate availability in the form of muscle and liver glycogen is an important determinant of performance during prolonged bouts of moderate- to high-intensity exercise. Therefore, when effective endurance performance is an objective on multiple occasions within a 24-h period, the restoration of endogenous glycogen stores is the principal factor determining recovery. This review considers the role of glucose-fructose co-ingestion on liver and muscle glycogen repletion following prolonged exercise. Glucose and fructose are primarily absorbed by different intestinal transport proteins; by combining the ingestion of glucose with fructose, both transport pathways are utilised, which increases the total capacity for carbohydrate absorption. Moreover, the addition of glucose to fructose ingestion facilitates intestinal fructose absorption via a currently unidentified mechanism. The co-ingestion of glucose and fructose therefore provides faster rates of carbohydrate absorption than the sum of glucose and fructose absorption rates alone. Similar metabolic effects can be achieved via the ingestion of sucrose (a disaccharide of glucose and fructose) because intestinal absorption is unlikely to be limited by sucrose hydrolysis. Carbohydrate ingestion at a rate of ≥1.2 g carbohydrate per kg body mass per hour appears to maximise post-exercise muscle glycogen repletion rates. Providing these carbohydrates in the form of glucose-fructose (sucrose) mixtures does not further enhance muscle glycogen repletion rates over glucose (polymer) ingestion alone. In contrast, liver glycogen repletion rates are approximately doubled with ingestion of glucose-fructose (sucrose) mixtures over isocaloric ingestion of glucose (polymers) alone. Furthermore, glucose plus fructose (sucrose) ingestion alleviates gastrointestinal distress when the ingestion rate approaches or exceeds the capacity for intestinal glucose absorption (~1.2 g/min). Accordingly, when rapid recovery of endogenous glycogen stores is a priority, ingesting glucose-fructose mixtures (or sucrose) at a rate of ≥1.2 g·kg body mass-1·h-1 can enhance glycogen repletion rates whilst also minimising gastrointestinal distress.

Effects of glucose-fructose versus glucose ingestion on stride characteristics during prolonged treadmill running

Scarce research has examined the effects of carbohydrate composition on running stride characteristics. On two occasions, 14 males and 6 females completed a 120-min sub-maximal run followed by a 4-mile time trial. Participants consumed glucose (GLU) or glucose-fructose (GLU-FRU) beverages supplying 1.3 g/min carbohydrate. Substrate use, psychological affect [Feeling Scale (FS)], and stride characteristics (stride frequency, stride length, and contact time) were assessed. Effects were expressed as Cohen's d (90% confidence limits [90% CL]). CLs for stride frequency differences at 53 min (90% CL = 0.04-0.21) and 113 min (90% CL = 0.02-0.24) did not cover 0, indicating a positive effect of GLU-FRU. However, effect sizes were small (d = 0.13) and likely-to-very-likely trivial. Energy expenditure differences at sub-maximal end were very likely trivial (d = 0.08; 90% CL = 0.00-0.17), while FS ratings were possibly higher for GLU-FRU at 50 (d = 0.19; 90% CL = -0.10-0.48) and 110 min (d = 0.16; 90% CL = -0.13-0.45). During the time trial, stride length was possibly higher with GLU-FRU (d = 0.13; 90% CL = -0.08-0.33). Glucose-fructose co-ingestion has no significant effect on stride characteristics during constant-velocity running but may result in slightly higher stride length during self-paced running.

Physiological and performance effects of carbohydrate gels consumed prior to the extra-time period of prolonged simulated soccer match-play

OBJECTIVES

The physiological and performance effects of carbohydrate-electrolyte gels consumed before the 30min extra-time period of prolonged soccer-specific exercise were investigated.

DESIGN

Randomised, double-blind, crossover.

METHODS

Eight English Premier League academy soccer players performed 120min of soccer-specific exercise on two occasions while consuming fluid-electrolyte beverages before exercise, at half-time and 90min. Carbohydrate-electrolyte (0.7±0.1gkg(-1) BM) or energy-free placebo gels were consumed ∼5min before extra-time. Blood samples were taken before exercise, at half-time and every 15min during exercise. Physical (15-m and 30-m sprint speed, 30-m sprint maintenance and countermovement jump height) and technical (soccer dribbling) performance was assessed throughout each trial.

RESULTS

Carbohydrate-electrolyte gels improved dribbling precision (+29±20%) and raised blood glucose concentrations by 0.7±0.8mmoll(-1) during extra-time (both p<0.01). Supplementation did not affect sprint velocities (15m and 30m), 30-m sprint maintenance or dribbling speed as reductions compared to 0-15min values occurred at 105-120min irrespective of trial (all p<0.05). Plasma osmolality and blood sodium concentrations increased post-exercise vs. the opening 15min (p<0.05) but no effect of supplementation existed. Selected markers of physical performance (jump height, 30-m sprint velocity and 30-m repeated sprint maintenance) also reduced by >3% during half-time (all p<0.05).

CONCLUSIONS

Carbohydrate-electrolyte gel ingestion raised blood glucose concentrations and improved dribbling performance during the extra-time period of simulated soccer match-play. Supplementation did not attenuate reductions in physical performance and hydration status that occurred during extra-time.

Saccharide Composition of Carbohydrates Consumed during an Ultra-endurance Triathlon

OBJECTIVE

Ingesting a mix of glucose and fructose during exercise increases exogenous carbohydrate oxidation while minimizing gastrointestinal (GI) distress. Several studies have suggested that a glucose-to-fructose ratio of 1.2:1 to 1:1 is optimal. No studies have quantified saccharides consumed during a nonsimulated endurance event. The aim of this investigation was to quantify saccharide sources used during an ultra-endurance triathlon and provide a resource for athletes desiring to manipulate the saccharide content of carbohydrate consumed during training and competition.

METHODS

Participant self-report and direct measurement were used to assess foods and beverages consumed during an ultra-endurance (70.3-mile) triathlon. Manufacturer-supplied information, high-performance liquid chromatography, and the US Department of Agriculture Food Database were used to quantify saccharide profiles of foods and beverages. Participants reported GI distress during the run on a 0-10 scale. A subanalysis examined associations between saccharides and GI distress among participants consuming ≥ 50 g·h(-1) of carbohydrate during the swim and cycle.

RESULTS

Fifty-four participants (43 men) used 80 foods and beverages with a unique saccharide profile. Of total carbohydrate, median proportions as glucose, fructose, and sucrose were 64%, 5%, and 10%, and only 7 foods (8.8%) had a glucose-to-fructose ratio of 1.2:1 to 1:1. The median glucose-to-fructose ratio of carbohydrate ingested was 2.9:1 (2.2:1-5.3:1). Twenty participants consumed ≥ 50 g·h(-1) of carbohydrate during the swim and cycle, and significant correlations with incident GI distress at mile 1 of the run were found for glucose (r = 0.480, p = 0.032) and fructose (r = -0.454, p = 0.044).

CONCLUSIONS

The majority of foods and beverages consumed during an ultra-endurance triathlon did not contain an optimal saccharide profile. Furthermore, glucose intake was associated with greater GI distress among participants consuming a high rate of carbohydrate.

A step towards personalized sports nutrition: carbohydrate intake during exercise

There have been significant changes in the understanding of the role of carbohydrates during endurance exercise in recent years, which allows for more specific and more personalized advice with regard to carbohydrate ingestion during exercise. The new proposed guidelines take into account the duration (and intensity) of exercise and advice is not restricted to the amount of carbohydrate; it also gives direction with respect to the type of carbohydrate. Studies have shown that during exercise lasting approximately 1 h in duration, a mouth rinse or small amounts of carbohydrate can result in a performance benefit. A single carbohydrate source can be oxidized at rates up to approximately 60 g/h and this is the recommendation for exercise that is more prolonged (2-3 h). For ultra-endurance events, the recommendation is higher at approximately 90 g/h. Carbohydrate ingested at such high ingestion rates must be a multiple transportable carbohydrates to allow high oxidation rates and prevent the accumulation of carbohydrate in the intestine. The source of the carbohydrate may be a liquid, semisolid, or solid, and the recommendations may need to be adjusted downward when the absolute exercise intensity is low and thus carbohydrate oxidation rates are also low. Carbohydrate intake advice is independent of body weight as well as training status. Therefore, although these guidelines apply to most athletes, they are highly dependent on the type and duration of activity. These new guidelines may replace the generic existing guidelines for carbohydrate intake during endurance exercise.

Fructose-maltodextrin ratio governs exogenous and other CHO oxidation and performance

INTRODUCTION

Fructose coingested with glucose in carbohydrate (CHO) drinks increases exogenous-CHO oxidation, gut comfort, and physical performance.

PURPOSE

This study aimed to determine the effect of different fructose-maltodextrin-glucose ratios on CHO oxidation and fluid absorption while controlling for osmolality and caloricity.

METHODS

In a crossover design, 12 male cyclists rode 2 h at 57% peak power then performed 10 sprints while ingesting artificially sweetened water or three equiosmotic 11.25% CHO-salt drinks at 200 mL·15 min, comprising weighed fructose and maltodextrin-glucose in ratios of 0.5:1 (0.5 ratio), 0.8:1 (0.8 ratio), and 1.25:1 (1.25 ratio). Fluid absorption was traced with D2O, whereas C-fructose and C-maltodextrin-glucose permitted fructose and glucose oxidation rate evaluation.

RESULTS

The mean exogenous-fructose and exogenous-glucose oxidation rates were 0.27, 0.39, and 0.46 g·min and 0.65, 0.71, and 0.58 g·min in 0.5, 0.8, and 1.25 ratio drinks, representing mean oxidation efficiencies of 54%, 59%, and 55% and 65%, 85%, and 86% for fructose and glucose, respectively. With the 0.8 ratio drink, total exogenous-CHO oxidation rate was 18% (90% confidence interval, ±5%) and 5.2% (±4.6%) higher relative to 0.5 and 1.25 ratios, respectively, whereas respective differences in total exogenous-CHO oxidation efficiency were 17% (±5%) and 5.3% (±4.8%), associated with 8.6% and 7.8% (±4.2%) higher fructose oxidation efficiency. The effects of CHO ratio on water absorption were inconclusive. Mean sprint power with the 0.8 ratio drink was moderately higher than that with the 0.5 ratio (2.9%; 99% confidence interval, ±2.8%) and 1.25 ratio (3.1%; ±2.7%) drinks, with total- and endogenous-CHO oxidation rate, abdominal cramps, and drink sweetness qualifying as explanatory mechanisms.

CONCLUSIONS

Enhanced high-intensity endurance performance with a 0.8 ratio fructose-maltodextrin-glucose drink is characterized by higher exogenous-CHO oxidation efficiency and reduced endogenous-CHO oxidation. The gut-hepatic or other physiological site responsible requires further research.

The ingestion of protein with a maltodextrin and fructose beverage on substrate utilisation and exercise performance

The study investigated the ingestion of maltodextrin, fructose, and protein on exogenous carbohydrate oxidation (CHOEXO) and exercise performance. Seven trained cyclists and (or) triathletes (maximal oxygen consumption, 59.20 ± 9.00 mL·kg−1·min−1) performed 3 exercise trials that consisted of 150 min of cycling at 50% maximal power output (160 ± 11 W), followed by a 60-km time trial. One of 3 beverages were randomly assigned during each trial and consumed at 15-min intervals: (i) 0.84 g·min−1 maltodextrin + 0.52 g·min−1 fructose + 0.34 g·min−1 protein (MD+F+P); (ii) 1.10 g·min−1 maltodextrin + 0.60 g·min−1 fructose (MD+F); or (iii) 1.70 g·min−1 maltodextrin (MD). CHOEXO and fuel utilisation were assessed via measurement of expired air 13C content and indirect calorimetry, respectively. Mean total CHO oxidation (CHOTOT) rates were 2.35 ± 0.18, 2.76 ± 0.08, and 2.61 ± 0.17 g·min−1 with MD, MD+F, and MD+F+P, respectively, although not significantly different. Peak CHOEXO rates with MD+F were significantly greater by 41.4% (p = 0.001) and 45.4% (p = 0.0001) compared with MD+F+P and MD, respectively (1.57 ± 0.22 g·min−1, 1.11 ± 0.08 g·min−1, and 1.08 ± 0.11 g·min−1, respectively). Performance times were 2.2% and 5.0% faster with MD+F compared with MD+F+P and MD, respectively; however, they were not statistically significant. Ingestion of an MD−fructose−protein commercial sports beverage significantly reduced peak and mean CHOEXO rates compared with MD+F, but did not significantly influence CHOTOT. The addition of protein to an MD+F beverage did not enhance performance times.

Effects of carbohydrate-hydration strategies on glucose metabolism, sprint performance and hydration during a soccer match simulation in recreational players

OBJECTIVES

This study compared the effects of three carbohydrate-hydration strategies on blood glucose concentration, exercise performance and hydration status throughout simulated soccer match-play.

DESIGN

A randomized, double-blind and cross-over study design was employed.

METHODS

After familiarization, 14 recreational soccer players completed the soccer match simulation on three separate occasions. Participants consumed equal volumes of 9.6% carbohydrate-caffeine-electrolyte (∼ 6 mg/kg BW caffeine) solution with carbohydrate-electrolyte gels (H-CHO), 5.6% carbohydrate-electrolyte solution with electrolyte gels (CHO) or electrolyte solution and electrolyte gels (PL). Blood samples were taken at rest, immediately before exercise and every 15 min during exercise (first half: 15, 30, 45 min; second half: 60, 75, 90 min).

RESULTS

Supplementation influenced blood glucose concentration (time × treatment interaction: p<0.001); however, none of the supplementation regimes were effective in preventing a drop in blood glucose at 60 min. Mean sprint speed was 3 ± 1% faster in H-CHO when compared with PL (treatment: p=0.047). Supplementation caused a 2.3 ± 0.5% increase in plasma osmolality in H-CHO (p<0.001) without change in CHO or PL. Similarly, mean sodium concentrations were 2.1 ± 0.4% higher in H-CHO when compared with PL (p=0.006).

CONCLUSIONS

Combining high carbohydrate availability with caffeine resulted in improved sprint performance and elevated blood glucose concentrations throughout the first half and at 90 min of exercise; however, this supplementation strategy negatively influenced hydration status when compared with 5.6% carbohydrate-electrolyte and electrolyte solutions.

Fructose metabolism in humans - what isotopic tracer studies tell us

Fructose consumption and its implications on public health are currently under study. This work reviewed the metabolic fate of dietary fructose based on isotope tracer studies in humans. The mean oxidation rate of dietary fructose was 45.0% ± 10.7 (mean ± SD) in non-exercising subjects within 3–6 hours and 45.8% ± 7.3 in exercising subjects within 2–3 hours. When fructose was ingested together with glucose, the mean oxidation rate of the mixed sugars increased to 66.0% ± 8.2 in exercising subjects. The mean conversion rate from fructose to glucose was 41% ± 10.5 (mean ± SD) in 3–6 hours after ingestion. The conversion amount from fructose to glycogen remains to be further clarified. A small percentage of ingested fructose (<1%) appears to be directly converted to plasma TG. However, hyperlipidemic effects of larger amounts of fructose consumption are observed in studies using infused labeled acetate to quantify longer term de novo lipogenesis. While the mechanisms for the hyperlipidemic effect remain controversial, energy source shifting and lipid sparing may play a role in the effect, in addition to de novo lipogenesis. Finally, approximately a quarter of ingested fructose can be converted into lactate within a few of hours. The reviewed data provides a profile of how dietary fructose is utilized in humans.

Composite versus single transportable carbohydrate solution enhances race and laboratory cycling performance

When ingested at high rates (1.8-2.4 g·min(-1)) in concentrated solutions, carbohydrates absorbed by multiple (e.g., fructose and glucose) vs. single intestinal transporters can increase exogenous carbohydrate oxidation and endurance performance, but their effect when ingested at lower, more realistic, rates during intermittent high-intensity endurance competition and trials is unknown. Trained cyclists participated in two independent randomized crossover investigations comprising mountain-bike races (average 141 min; n = 10) and laboratory trials (94-min high-intensity intervals followed by 10 maximal sprints; n = 16). Solutions ingested during exercise contained electrolytes and fructose + maltodextrin or glucose + maltodextrin in 1:2 ratio ingested, on average, at 1.2 g carbohydrate·kg(-1)·h(-1). Exertion, muscle fatigue, and gastrointestinal discomfort were recorded. Data were analysed using mixed models with gastrointestinal discomfort as a mechanism covariate; inferences were made against substantiveness thresholds (1.2% for performance) and standardized difference. The fructose-maltodextrin solution substantially reduced race time (-1.8%; 90% confidence interval = ±1.8%) and abdominal cramps (-8.1 on a 0-100 scale; ±6.6). After accounting for gastrointestinal discomfort, the effect of the fructose-maltodextrin solution on lap time was reduced (-1.1%; ±2.4%), suggesting that gastrointestinal discomfort explained part of the effect of fructose-maltodextrin on performance. In the laboratory, mean sprint power was enhanced (1.4%; ±0.8%) with fructose-maltodextrin, but the effect on peak power was unclear (0.7%; ±1.5%). Adjusting out gastrointestinal discomfort augmented the fructose-maltodextrin effect on mean (2.6%; ±1.9%) and peak (2.5%; ±3.0%) power. Ingestion of multiple transportable vs. single transportable carbohydrates enhanced mountain-bike race and high-intensity laboratory cycling performance, with inconsistent but not irreconcilable effects of gut discomfort as a possible mediating mechanism.

L-Arginine but not L-glutamine likely increases exogenous carbohydrate oxidation during endurance exercise

The addition of L-arginine or L-glutamine to glucose-electrolyte solutions can increase intestinal water, glucose, and sodium absorption in rats and humans. We evaluated the utility of L-arginine and L-glutamine in energy-rehydration beverages through assessment of exogenous glucose oxidation and perceptions of exertion and gastrointestinal distress during endurance exercise. Eight cyclists rode 150 min at 50% of peak power on four occasions while ingesting solutions at a rate of 150 mL 15 min(-1) that contained (13)C-enriched glucose (266 mmol L(-1)) and sodium citrate ([Na(+)] 60 mmol L(-1)), and either: 4.25 mmol L(-1) L-arginine or 45 mmol L(-1) L-glutamine, and as controls glucose only or no glucose. Relative to glucose only, L-arginine invoked a likely 12% increase in exogenous glucose oxidation (90% confidence limits: ± 8%); however, the effect of L-glutamine was possibly trivial (4.5 ± 7.3%). L-Arginine also led to very likely small reductions in endogenous fat oxidation rate relative to glucose (12 ± 4%) and L-glutamine (14 ± 4%), and relative to no glucose, likely reductions in exercise oxygen consumption (2.6 ± 1.5%) and plasma lactate concentration (0.20 ± 0.16 mmol L(-1)). Effects on endogenous and total carbohydrate oxidation were inconsequential. Compared with glucose only, L-arginine and L-glutamine caused likely small-moderate effect size increases in perceptions of stomach fullness, abdominal cramp, exertion, and muscle tiredness during exercise. Addition of L-arginine to a glucose and electrolyte solution increases the oxidation of exogenous glucose and decreases the oxygen cost of exercise, although the mechanisms responsible and impact on endurance performance require further investigation. However, L-arginine also increases subjective feelings of gastrointestinal distress, which may attenuate its other benefits.

Carbohydrate ingestion during team games exercise: current knowledge and areas for future investigation

There is a growing body of research on the influence of ingesting carbohydrate-electrolyte solutions immediately prior to and during prolonged intermittent, high-intensity exercise (team games exercise) designed to replicate field-based team games. This review presents the current body of knowledge in this area, and identifies avenues of further research. Almost all early work supported the ingestion of carbohydrate-electrolyte solutions during prolonged intermittent exercise, but was subject to methodological limitations. A key concern was the use of exercise protocols characterized by prolonged periods at the same exercise intensity, the lack of maximal- or high-intensity work components and long periods of seated recovery, which failed to replicate the activity pattern or physiological demand of team games exercise. The advent of protocols specifically designed to replicate the demands of field-based team games enabled a more externally valid assessment of the influence of carbohydrate ingestion during this form of exercise. Once again, the research overwhelmingly supports carbohydrate ingestion immediately prior to and during team games exercise for improving time to exhaustion during intermittent running. While the external validity of exhaustive exercise at fixed prescribed intensities as an assessment of exercise capacity during team games may appear questionable, these assessments should perhaps not be viewed as exhaustive exercise tests per se, but as indicators of the ability to maintain high-intensity exercise, which is a recognized marker of performance and fatigue during field-based team games. Possible mechanisms of exercise capacity enhancement include sparing of muscle glycogen, glycogen resynthesis during low-intensity exercise periods and attenuated effort perception during exercise. Most research fails to show improvements in sprint performance during team games exercise with carbohydrate ingestion, perhaps due to the lack of influence of carbohydrate on sprint performance when endogenous muscle glycogen concentration remains above a critical threshold of ∼200  mmol/kg dry weight. Despite the increasing number of publications in this area, few studies have attempted to drive the research base forward by investigating potential modulators of carbohydrate efficacy during team games exercise, preventing the formulation of optimal carbohydrate intake guidelines. Potential modulators may be different from those during prolonged steady-state exercise due to the constantly changing exercise intensity and frequency, duration and intensity of rest intervals, potential for team games exercise to slow the rate of gastric emptying and the restricted access to carbohydrate-electrolyte solutions during many team games. This review highlights fluid volume, carbohydrate concentration, carbohydrate composition and solution osmolality; the glycaemic index of pre-exercise meals; fluid and carbohydrate ingestion patterns; fluid temperature; carbohydrate mouthwashes; carbohydrate supplementation in different ambient temperatures; and investigation of all of these areas in different subject populations as important avenues for future research to enable a more comprehensive understanding of carbohydrate ingestion during team games exercise.

Fructose-maltodextrin ratio in a carbohydrate-electrolyte solution differentially affects exogenous carbohydrate oxidation rate, gut comfort, and performance

Solutions containing multiple carbohydrates utilizing different intestinal transporters (glucose and fructose) show enhanced absorption, oxidation, and performance compared with single-carbohydrate solutions, but the impact of the ratio of these carbohydrates on outcomes is unknown. In a randomized double-blind crossover, 10 cyclists rode 150 min at 50% peak power, then performed an incremental test to exhaustion, while ingesting artificially sweetened water or one of three carbohydrate-salt solutions comprising fructose and maltodextrin in the respective following concentrations: 4.5 and 9% (0.5-Ratio), 6 and 7.5% (0.8-Ratio), and 7.5 and 6% (1.25-Ratio). The carbohydrates were ingested at 1.8 g/min and naturally (13)C-enriched to permit evaluation of oxidation rate by mass spectrometry and indirect calorimetry. Mean exogenous carbohydrate oxidation rates were 1.04, 1.14, and 1.05 g/min (coefficient of variation 20%) in 0.5-, 0.8-, and 1.25-Ratios, respectively, representing likely small increases in 0.8-Ratio of 11% (90% confidence limits; ± 4%) and 10% (± 4%) relative to 0.5- and 1.25-Ratios, respectively. Comparisons of fat and total and endogenous carbohydrate oxidation rates between solutions were unclear. Relative to 0.5-Ratio, there were moderate improvements to peak power with 0.8- (3.6%; 99% confidence limits ± 3.5%) and 1.25-Ratio (3.0%; ± 3.7%) but unclear with water (0.4%; ± 4.4%). Increases in stomach fullness, abdominal cramping, and nausea were lowest with the 0.8- followed by the 1.25-Ratio solution. At high carbohydrate-ingestion rate, greater benefits to endurance performance may result from ingestion of 0.8- to 1.25-Ratio fructose-maltodextrin solutions. Small perceptible improvements in gut comfort favor the 0.8-Ratio and provide a clearer suggestion of mechanism than the relationship with exogenous carbohydrate oxidation.

Fructose and glucose co-ingestion during prolonged exercise increases lactate and glucose fluxes and oxidation compared with an equimolar intake of glucose

BACKGROUND

When fructose is ingested together with glucose (GLUFRU) during exercise, plasma lactate and exogenous carbohydrate oxidation rates are higher than with glucose alone.

OBJECTIVE

The objective was to investigate to what extent GLUFRU increased lactate kinetics and oxidation rate and gluconeogenesis from lactate (GNG(L)) and from fructose (GNG(F)).

DESIGN

Seven endurance-trained men performed 120 min of exercise at ≈60% VO₂max (maximal oxygen consumption) while ingesting 1.2 g glucose/min + 0.8 g of either glucose or fructose/min (GLUFRU). In 2 trials, the effects of glucose and GLUFRU on lactate and glucose kinetics were investigated with glucose and lactate tracers. In a third trial, labeled fructose was added to GLUFRU to assess fructose disposal.

RESULTS

In GLUFRU, lactate appearance (120 ± 6 μmol · kg⁻¹ · min⁻¹), lactate disappearance (121 ± 7 μmol · kg⁻¹ · min⁻¹), and oxidation (127 ± 12 μmol · kg⁻¹ · min⁻¹) rates increased significantly (P < 0.001) in comparison with glucose alone (94 ± 16, 95 ± 16, and 97 ± 16 μmol · kg⁻¹ · min⁻¹, respectively). GNG(L) was negligible in both conditions. In GLUFRU, GNG(F) and exogenous fructose oxidation increased with time and leveled off at 18.8 ± 3.7 and 38 ± 4 μmol · kg⁻¹ · min⁻¹, respectively, at 100 min. Plasma glucose appearance rate was significantly higher (P < 0.01) in GLUFRU (91 ± 6 μmol · kg⁻¹ · min⁻¹) than in glucose alone (82 ± 9 μmol · kg⁻¹ · min⁻¹). Carbohydrate oxidation rate was higher (P < 0.05) in GLUFRU.

CONCLUSIONS

Fructose increased total carbohydrate oxidation, lactate production and oxidation, and GNG(F). Fructose oxidation was explained equally by fructose-derived lactate and glucose oxidation, most likely in skeletal and cardiac muscle. This trial was registered at clinicaltrials.gov as NCT01128647.

Carbohydrate and exercise performance: the role of multiple transportable carbohydrates

PURPOSE OF REVIEW

Carbohydrate feeding has been shown to be ergogenic, but recently substantial advances have been made in optimizing the guidelines for carbohydrate intake during prolonged exercise.

RECENT FINDINGS

It was found that limitations to carbohydrate oxidation were in the absorptive process most likely because of a saturation of carbohydrate transporters. By using a combination of carbohydrates that use different intestinal transporters for absorption it was shown that carbohydrate delivery and oxidation could be increased. Studies demonstrated increases in exogenous carbohydrate oxidation rates of up to 65% of glucose: fructose compared with glucose only. Exogenous carbohydrate oxidation rates reach values of 1.75 g/min whereas previously it was thought that 1 g/min was the absolute maximum. The increased carbohydrate oxidation with multiple transportable carbohydrates was accompanied by increased fluid delivery and improved oxidation efficiency, and thus the likelihood of gastrointestinal distress may be diminished. Studies also demonstrated reduced fatigue and improved exercise performance with multiple transportable carbohydrates compared with a single carbohydrate.

SUMMARY

Multiple transportable carbohydrates, ingested at high rates, can be beneficial during endurance sports in which the duration of exercise is 3 h or more.

Metabolic effects of fructose and the worldwide increase in obesity

While virtually absent in our diet a few hundred years ago, fructose has now become a major constituent of our modern diet. Our main sources of fructose are sucrose from beet or cane, high fructose corn syrup, fruits, and honey. Fructose has the same chemical formula as glucose (C(6)H(12)O(6)), but its metabolism differs markedly from that of glucose due to its almost complete hepatic extraction and rapid hepatic conversion into glucose, glycogen, lactate, and fat. Fructose was initially thought to be advisable for patients with diabetes due to its low glycemic index. However, chronically high consumption of fructose in rodents leads to hepatic and extrahepatic insulin resistance, obesity, type 2 diabetes mellitus, and high blood pressure. The evidence is less compelling in humans, but high fructose intake has indeed been shown to cause dyslipidemia and to impair hepatic insulin sensitivity. Hepatic de novo lipogenesis and lipotoxicity, oxidative stress, and hyperuricemia have all been proposed as mechanisms responsible for these adverse metabolic effects of fructose. Although there is compelling evidence that very high fructose intake can have deleterious metabolic effects in humans as in rodents, the role of fructose in the development of the current epidemic of metabolic disorders remains controversial. Epidemiological studies show growing evidence that consumption of sweetened beverages (containing either sucrose or a mixture of glucose and fructose) is associated with a high energy intake, increased body weight, and the occurrence of metabolic and cardiovascular disorders. There is, however, no unequivocal evidence that fructose intake at moderate doses is directly related with adverse metabolic effects. There has also been much concern that consumption of free fructose, as provided in high fructose corn syrup, may cause more adverse effects than consumption of fructose consumed with sucrose. There is, however, no direct evidence for more serious metabolic consequences of high fructose corn syrup versus sucrose consumption.