Slow-Absorbing Modified Starch before and during Prolonged Cycling Increases Fat Oxidation and Gastrointestinal Distress without Changing Performance

Influence of modified starches on mental performance and physical activity following an exhaustive bout of exercise

Slow-releasing carbohydrates may delay the effects of fatigue after exhaustive exercise. The purpose of this study was to observe the influence that hydrothermally modified starches (HMS) and traditional maltodextrin (MAL) supplements had on physical endurance and mental performance following exhaustive exercise. Male participants completed a VO2 max and 2 days of cycling sessions using a Velotron ergometer. Cycling sessions were performed at 70% of the VO2 max workload for 150 min. Supplements were consumed 30 min before cycling and during exercise at the 120-min mark (1 g CHO/kg body weight). Brain activity was measured using a Neuroscan 64-channel electroencephalogram cap. Go-no-go and N-back tasks were performed before and after cycling bouts. Blood glucose, lactate, ketones, and urine-specific gravity were measured before, during, and after cycling. VO2 and rate of perceived exertion were recorded in 15-min intervals. Ketones increased significantly more for HMS than MAL from pre- to postcycling measurements (p < 0.05). Reaction times for go-no-go and N-back were faster for HMS postexercise. Event-related potential differences were present in both mental tasks following exhaustive exercise. HMS supplementation decreased the impact of cognitive and physical fatigue postexercise.

For Flux Sake: Isotopic Tracer Methods of Monitoring Human Carbohydrate Metabolism During Exercise

Isotopic tracers can reveal insights into the temporal nature of metabolism and track the fate of ingested substrates. A common use of tracers is to assess aspects of human carbohydrate metabolism during exercise under various established models. The dilution model is used alongside intravenous infusion of tracers to assess carbohydrate appearance and disappearance rates in the circulation, which can be further delineated into exogenous and endogenous sources. The incorporation model can be used to estimate exogenous carbohydrate oxidation rates. Combining methods can provide insight into key factors regulating health and performance, such as muscle and liver glycogen utilization, and the underlying regulation of blood glucose homeostasis before, during, and after exercise. Obtaining accurate, quantifiable data from tracers, however, requires careful consideration of key methodological principles. These include appropriate standardization of pretrial diet, specific tracer choice, whether a background trial is necessary to correct expired breath CO2 enrichments, and if so, what the appropriate background trial should consist of. Researchers must also consider the intensity and pattern of exercise, and the type, amount, and frequency of feeding (if any). The rationale for these considerations is discussed, along with an experimental design checklist and equation list which aims to assist researchers in performing high-quality research on carbohydrate metabolism during exercise using isotopic tracer methods.

Gastrointestinal Assessment and Therapeutic Intervention for the Management of Exercise-Associated Gastrointestinal Symptoms: A Case Series Translational and Professional Practice Approach

This translational research case series describes the implementation of a gastrointestinal assessment protocol during exercise (GastroAxEx) to inform individualised therapeutic intervention of endurance athletes affected by exercise-induced gastrointestinal syndrome (EIGS) and associated gastrointestinal symptoms (GIS). A four-phase approach was applied. Phase 1: Clinical assessment and exploring background history of exercise-associated gastrointestinal symptoms. Phase 2: Individual tailored GastroAxEx laboratory simulation designed to mirror exercise stress, highlighted in phase 1, that promotes EIGS and GIS during exercise. Phase 3: Individually programmed therapeutic intervention, based on the outcomes of Phase 2. Phase 4: Monitoring and readjustment of intervention based on outcomes from field testing under training and race conditions. Nine endurance athletes presenting with EIGS, and two control athletes not presenting with EIGS, completed Phase 2. Two athletes experienced significant thermoregulatory strain (peak core temperature attained > 40°C) during the GastroAxEx. Plasma cortisol increased substantially pre- to post-exercise in n = 6/7 (Δ > 500 nmol/L). Plasma I-FABP concentration increased substantially pre- to post-exercise in n = 2/8 (Δ > 1,000 pg/ml). No substantial change was observed in pre- to post-exercise for systemic endotoxin and inflammatory profiles in all athletes. Breath H2 responses showed that orocecal transit time (OCTT) was delayed in n = 5/9 (90-150 min post-exercise) athletes, with the remaining athletes (n = 4/9) showing no H2 turning point by 180 min post-exercise. Severe GIS during exercise was experienced in n = 5/9 athletes, of which n = 2/9 had to dramatically reduce work output or cease exercise. Based on each athlete's identified proposed causal factors of EIGS and GIS during exercise (i.e., n = 9/9 neuroendocrine-gastrointestinal pathway of EIGS), an individualised gastrointestinal therapeutic intervention was programmed and advised, adjusted from a standard EIGS prevention and management template that included established strategies with evidence of attenuating EIGS primary causal pathways, exacerbation factors, and GIS during exercise. All participants reported qualitative data on their progress, which included their previously presenting GIS during exercise, such as nausea and vomiting, either being eliminated or diminished resulting in work output improving (i.e., completing competition and/or not slowing down during training or competition as a result of GIS during exercise). These outcomes suggest GIS during exercise in endurance athletes are predominantly related to gastrointestinal functional and feeding tolerance issues, and not necessarily gastrointestinal integrity and/or systemic issues. GastroAxEx allows for informed identification of potential causal pathway(s) and exacerbation factor(s) of EIGS and GIS during exercise at an individual level, providing a valuable informed individualised therapeutic intervention approach.

Uncooked cornstarch for the prevention of hypoglycemic events

Hypoglycemia is a pathological condition characterized by a low plasma glucose concentration associated with typical autonomic and/or neuroglycopenic symptoms, and resolution of these symptoms with carbohydrate consumption. Hypoglycemia is quite common in clinical practice, particularly in insulin-treated patients with diabetes and in other inherited or acquired conditions involving the regulation of glucose metabolism. Beyond symptoms that might strongly affect the quality of life, hypoglycemia can lead to short- and long-term detrimental consequences for health. Hypoglycemia can be prevented by appropriate changes in dietary habits or by relevant modifications of the drug treatment. Several dietary approaches based on the intake of various carbohydrate foods have been tested for hypoglycemia prevention; among them uncooked cornstarch (UCS) has demonstrated a great efficacy. In this narrative review, we have summarized the current evidence on the UCS usefulness in some conditions characterized by high hypoglycemic risk, focusing on some inherited diseases -i.e. glycogen storage diseases and other rare disorders - and acquired conditions such as type 1 diabetes, postprandial hypoglycemia consequent to esophageal-gastric or bariatric surgery, and insulin autoimmune syndrome. We also considered the possible role of UCS during endurance exercise performance. Lastly, we have discussed the dose requirement, the side effects, the limitations of UCS use, and the plausible mechanisms by which UCS could prevent hypoglycemia.

Carbohydrate supplementation: a critical review of recent innovations

PURPOSE

To critically examine the research on novel supplements and strategies designed to enhance carbohydrate delivery and/or availability.

METHODS

Narrative review.

RESULTS

Available data would suggest that there are varying levels of effectiveness based on the supplement/supplementation strategy in question and mechanism of action. Novel carbohydrate supplements including multiple transportable carbohydrate (MTC), modified carbohydrate (MC), and hydrogels (HGEL) have been generally effective at modifying gastric emptying and/or intestinal absorption. Moreover, these effects often correlate with altered fuel utilization patterns and/or glycogen storage. Nevertheless, performance effects differ widely based on supplement and study design. MTC consistently enhances performance, but the magnitude of the effect is yet to be fully elucidated. MC and HGEL seem unlikely to be beneficial when compared to supplementation strategies that align with current sport nutrition recommendations. Combining carbohydrate with other ergogenic substances may, in some cases, result in additive or synergistic effects on metabolism and/or performance; however, data are often lacking and results vary based on the quantity, timing, and inter-individual responses to different treatments. Altering dietary carbohydrate intake likely influences absorption, oxidation, and and/or storage of acutely ingested carbohydrate, but how this affects the ergogenicity of carbohydrate is still mostly unknown.

CONCLUSIONS

In conclusion, novel carbohydrate supplements and strategies alter carbohydrate delivery through various mechanisms. However, more research is needed to determine if/when interventions are ergogenic based on different contexts, populations, and applications.

Pre-Sleep Low Glycemic Index Modified Starch Does Not Improve Next-Morning Fuel Selection or Running Performance in Male and Female Endurance Athletes

To determine the effects of pre-sleep supplementation with a novel low glycemic index (LGI) carbohydrate (CHO) on next-morning substrate utilization, gastrointestinal distress (GID), and endurance running performance (5-km time-trial, TT). Using a double-blind, randomized, placebo (PLA) controlled, crossover design, trained participants (n = 14; 28 ± 9 years, 8/6 male/female, 55 ± 7 mL/kg/min) consumed a LGI, high glycemic index (HGI), or 0 kcal PLA supplement ≥ 2 h after their last meal and <30 min prior to sleep. Upon arrival, resting energy expenditure (REE), substrate utilization, blood glucose, satiety, and GID were assessed. An incremental exercise test (IET) was performed at 55, 65, and 75% peak volume of oxygen consumption (VO_2peak) with GID, rating of perceived exertion (RPE) and substrate utilization recorded each stage. Finally, participants completed the 5-km TT. There were no differences in any baseline measure. During IET, CHO utilization tended to be greater with LGI (PLA, 56 ± 11; HGI, 60 ± 14; LGI, 63 ± 14%, p = 0.16, η² = 0.14). GID was unaffected by supplementation at any point (p > 0.05). Performance was also unaffected by supplement (PLA, 21.6 ± 9.5; HGI, 23.0 ± 7.8; LGI, 24.1 ± 4.5 min, p = 0.94, η² = 0.01). Pre-sleep CHO supplementation did not affect next-morning resting metabolism, BG, GID, or 5-km TT performance. The trend towards higher CHO utilization during IET after pre-sleep LGI, suggests that such supplementation increases morning CHO availability.

Carbohydrate hydrogel beverage provides no additional cycling performance benefit versus carbohydrate alone

PURPOSE

This study examined the effects of a novel maltodextrin-fructose hydrogel supplement (MF-H) on cycling performance and gastrointestinal distress symptoms.

METHODS

Nine endurance-trained male cyclists (age = 26.1 ± 6.6, mass = 80.9 ± 10.4 kg, VO_2max = 55.5 ± 3.6 mL·kg·min^-1) completed three experimental trials consisting of a 98-min varied-intensity cycling protocol followed by a performance test of ten consecutive sprint intervals. In a cross-over design, subjects consumed 250 mL of a treatment beverage every 15 min of cycling. Treatments consisted of 78 g·hr^-1 of either (a) MF-H, (b) isocaloric maltodextrin-fructose (ratio-matched 2:1; MF), and (c) isocaloric maltodextrin only (MD).

RESULTS

There were no differences in average sprint power between treatments (MF-H, 284 ± 51 W; MF, 281 ± 46 W; and MD, 277 ± 48 W), or power output for any individual sprint. Subjective ratings of gastrointestinal distress symptoms (nausea, fullness, and abdominal cramping) increased significantly over time during the cycling trials, but few individuals exceeded moderate levels in any trial with no systematic differences in gastrointestinal discomfort symptoms observed between treatments.

CONCLUSIONS

In conclusion, ingestion of a maltodextrin/fructose hydrogel beverage during high-intensity cycling does not improve gastrointestinal comfort or performance compared to MF or MD beverages.

Case Study: Long-Term Low-Carbohydrate, High-Fat Diet Impairs Performance and Subjective Well-Being in a World-Class Vegetarian Long-Distance Triathlete

The aim of this case study was to report on the performance outcomes and subjective assessments of long-term low-carbohydrate, high-fat (LCHF) diet in a world-class long-distance triathlete who had been suffering from gastrointestinal distress in Ironman competition. The lacto-ovo vegetarian athlete (age = 39 years; height = 179 cm; usual racing body mass = 75 kg; sum of seven skinfolds = 36 mm) changed his usual high carbohydrate (CHO) availability diet to an LCHF diet for 32 weeks (∼95% compliance). He participated in three professional races while on the LCHF diet, but acutely restored CHO availability by consuming CHO in the preevent meals and during the race as advised. The athlete had his worst-ever half-Ironman performance after 21 weeks on the LCHF diet (18th). After 24 weeks on LCHF, he had his second worst-ever Ironman performance (14th) and suffered his usual gastrointestinal symptoms. He did not finish his third race after 32 weeks on LCHF. He regained his usual performance level within 5 weeks back on a high CHO diet, finishing second and fourth in two Ironman events separated by just 3 weeks. Subjective psychological well-being was very negative while on the LCHF diet, with feelings of depression, irritability, and bad mood. In conclusion, this long-term (32 weeks) LCHF intervention did not solve the gastrointestinal problems that the athlete had been experiencing, it was associated with negative performance outcomes in both the half-Ironman and Ironman competitions, and it had a negative impact on the athlete's subjective well-being.

Pre-Sleep Consumption of Casein and Whey Protein: Effects on Morning Metabolism and Resistance Exercise Performance in Active Women

Consuming milk proteins (casein (CP) and whey (WP)) at night before sleep has been shown to positively influence next morning resting metabolic rate (RMR). No data exist regarding the effect of pre-sleep consumption of CP and WP on the ability to perform resistance exercise (RE) the following morning. The present study compared the effects of low (24 g) and high (48 g) doses of CP and WP and a non-energetic placebo (PLA) consumed 30 min before sleep on morning RMR, and RE performance. Nine active women participated in this randomized, double-blind, crossover study. Next morning RMR was measured via indirect calorimetry. RE was performed on six machines for 2 sets of 10 repetitions, and a 3rd set to failure at 60% of one-repetition maximum to calculate RE volume (weight lifted × sets × repetitions). Magnitude based inferences were used. Compared to the PLA, 48 g CP had a likely increase in RMR (4.0 ± 4.8%) and possibly trivial (1.1 ± 7.0%) effect on RE volume. There were no clear effects of 24 g CP, 24 g and 48 g of WP on RMR and RE volume. In conclusion, 48 g CP elicited favorable changes in morning RMR, with only trivial changes in RE performance.

Effect of Preexercise Ingestion of Modified Amylomaize Starch on Glycemic Response While Cycling

Amylomaize-7 is classified as a resistant corn starch and is 68% digestible. When modified by partial hydrolysis in ethanol and hydrochloric acid its digestibility is 92%, yet retains its low glycemic and insulinemic properties. The purpose of this study was to characterize the metabolic response when modified amylomaize-7 or dextrose is consumed in the hour before exercise, and to compare the effect on performance of a brief high-intensity cycling trial. Ten male, trained cyclists were given 1 g/kg body mass of dextrose (DEX) or modified amylomaize-7 (AMY-7) or a flavored water placebo (PL) 45 min prior to exercise on a cycle ergometer. A 15-min ride at 60% W_max was immediately followed by a self-paced time trial (TT) equivalent to 15 min at 80% W_max. When cyclists consumed DEX, mean serum glucose concentration increased by 3.3 ± 2.1 mmol/L before exercise, compared to stable serum glucose observed for AMY-7 or PL. Glucose concentrations returned to baseline by pre-TT in all treatments. However, the mean post-TT glucose concentration of the DEX group was significantly lower than baseline, AMY-7, or PL. Serum insulin concentration increased nine-fold from baseline to preexercise in the DEX trial, whereas PL or AMY-7 remained unchanged. Time required to complete the performance trial was not significantly different between DEX, AMY-7 or PL. Preexercise ingestion of modified amylomaize-7 compared to dextrose resulted in a more stable serum glucose concentration, but did not offer a performance advantage in this high-intensity cycling trial.