LOW CHO / HIGH FAT (LCHF) FOR ATHLETES WHAT DOES THE EVIDENCE SAY? - - PowerPoint PPT Presentation

LOW CHO / HIGH FAT (LCHF) FOR ATHLETES – WHAT DOES THE EVIDENCE SAY?

Trent Stellingwerff, PhD Canadian Sport Institute Pacific

Saturday Jan. 13th, 2018 10:35 – 11:15am (40min) Canadian Nutrition Society; Toronto Ontario

Conflict of Interest / Funding Disclosures

– Grants/Research Support: Own The Podium i4G funding, MITACS Funding, Canadian Foundation for Innovation (CFI) Equipment Grant – Speakers Bureau/Honoraria: Post Cereals – PowerBar (2015- 2016); Pepsi-Co – Gatorade (2015-2016); B2ten (2015-current) – Consulting Fees: Post Cereals – PowerBar (2015-2016); B2ten (2015-current) – Other: Employee of Canadian Sport Institute Pacific, Victoria, B.C.

My real over-riding conflict of interest: Making Olympic athletes go faster in Olympic events within the rules of sport

Presentation overview

1) Physiology of High Intensity Endurance 2) LCHF: Fat Adaptation vs. Ketogensis 3) Fat Adaptation & Ketogensis and Performance 4) What do Champion Endurance Athletes Eat? 5) Summary

PHYSIOLOGY OF HIGH INTENSITY ENDURANCE PERFORMANCE

Athlete energetic demands - Lots of misconceptions?

• Some/many believe that fat oxidation plays an important

role in elite athlete performance and training in events up to 3 to 4hrs.

• Some/many believe that the substrate for the “aerobic”

system is primarily fat at training and competition intensities in elite athletes.

• Some/many believe there is no difference in the whole-body

efficiency / cost in metabolizing CHO vs. FAT for ATP production

• Some/many believe that PCr is the only substrate for maximal

power/speed production under durations of 10 sec and for resistance (weight-room) training

Glucose FFA-ALB Glycogen G-6-P G-1-P blood cytosol FFA-FABP TG Pyruvate Lactate Glucose PHOS HK fatty acyl-CoA

CAT

CPT-I CPT-1I

PDH fatty acyl-CoA acetyl-CoA b-oxidation TCA cycle CO2

NAD NADH NAD NADH NADH NADH NAD NAD

E T C O2 H20 H+ H+ H+

ATP ADP PCr Cr ATP ADP NAD NADH

PFK LDH

ATP ADP

PM OM IM matrix LIPASE

ATP

Transport

(Rxn 1) (Rxn 2) (Rxn 3) (Rxn 4) (Rxn 5) (Rxn 6) (Rxn 7) (Rxn 8)

Energy production during exercise

Blood Lactate

Glycogen (CHO stores) Pyruvate

Lactic acid

TCA Cycle

La- + H+

MCT

Mitochondria Aerobic PowerHouse

AEROBIC CHO Energy Production = 36 ATP! ANAEROBIC Energy Production = 3 ATP!

PDHa

7000 2000 275000 5500 50000 100000 150000 200000 250000 300000 1 Type of Energy Stored Energy (kJ) Muscle glycogen Liver glycogen Adipose tissue (fat) Muscle Triglycerides (fat)

Body Energy Stores of a ~70kg person

(~1600 kcals) (~500 kcals) (~65,000 Kcals = 21 marathons!) (~1,300 kcals)

Energy required for 65kg to run a marathon: ~3000 to 3500 kcals

Rapoport, B. I. (2010). Metabolic factors limiting performance in marathon runners. PLoS Comput Biol, 6(10), e1000960.

Exercise intensity (%VO2max)

Energy expenditure (kcal/kg/min)

Romijn et al Am J Physiol 265: E380, 1993

Fuel Utilization at different exercise intensities

Fuel utilization during marathon running in elite athletes?

Bosch et al Eur. J. Appl. Physiol. 61: 68-72, 1990. O’Brien et al MSSE 25: 1009-1017, 1993.

~85% CHO metab. ~15% Fat metab.

RQ ~0.93 to 0.97 Recovery / Soft-Pedaling ~10-20% of Tour Cycling ~30% of Tour Cycling ~30-40% of Tour Cycling

Fernandez-Garcia et al MSSE 32(5): 1002-1006, 2000

HR (% HRmax)

CHO Energy production during exercise is more efficient!

5.5% more kcals of energy produced per liter of oxygen consumed when utilizing 100% CHO vs. 100% fat (= lower VO2 per given power = 5.5% more efficient!) OR ~ 1% more energy liberated per L of O2 consumed for a 0.05 increase in RQ

• Prof. Andy Jones estimates a 0.05 increase in RQ (more CHO dependent) could

be worth a 60-90 sec faster marathon performance!

~50% of a 6 sec sprint is CHO dependent!

3 bouts of 30 second sprints with 4’ rests with measurements at rest, 6, 15 and 30 seconds (all measurements based on biopsy data, not whole-body respiratory data, which violates methodological principles as non-steady state)

Sprint #1 Sprint #3

(aerobic energy – mainly via CHO pyruvate disposal) (anaerobic)

Parolin et al.- AJP, 1999

Fuel utilization during training in elite athletes (NOT fasted!)

Noakes T, Volek JS, Phinney SD. Low-carbohydrate diets for athletes: what evidence? Br J Sports Med. 2014;48(14):1077-8.

“Why, for example, should athletes involved in prolonged submaximal exercise—probably the most common form of exercise performed by most elite and recreational athletes in training and competition—need always to eat high carbohydrate diets…. Surely our abundant body fat stores could provide most if not all the energy necessary to fuel activities of a submaximal intensity?”

Boorsma RK, Whitfield J, Spriet LL. Beetroot juice supplementation does not improve performance of elite 1500-m runners. Med Sci Sports Exerc. 2014;46(12):2326-34.

Athletics Canada Testing Data Base // Male avg VO2max = 71.0 +/- 2.9 ml/kg/min Avg tested easy run pace = 3:39 to 4:50 min/km pace (~60 to 85% of VO2max)

LCHF: FAT-ADAPTATION (3 TO 5 DAYS)

• VS. KETOGENSIS (>3 WEEKS)

Training with periodic low CHO-availability is NOT chronically training on a low CHO (or high fat) diet. LCHF: Amount of CHO and timing of diet are not scientifically validated and inconsistent. But, fat-adaptation can occur in as little as 3 to 5 days and ketogensis in ~3 weeks, w/ some athletes saying a few years are needed for optimal adaptation. In most instances, LCHF approach requires <50g CHO / day

Keto-adaptation

Ketogenic Adaptation can more than double fat oxidation!

Volek JS, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci. 2015;15(1):13- 20.

FASTER Study- Dr. Jeff Volek (FASTER=Fat-Adapted-Substrate

• xidation in-Trained-Elite-Runners)

1 g/min 1.5 g/min

1.5g FAT/min = 90 g FAT/hr = 810 calories of fuel per hour at 60% VO2peak

Volek, J.S., et al., Metabolic characteristics of keto-adapted ultra-endurance runners. Metabolism, 2016. 65(3): p. 100-10.

Time (min)

10 20

PDHa (mmol ·kg w.w.-1· min-1)

1 2 3 4 5 FAT-adapt HCHO

Post 1 min Sprint @ 150% PPO † * * * * ‡

Decreased PDHa after FAT-adapt

(or a 5 day low CHO diet)

Stellingwerff T, Spriet LL, Watt MJ, et al. Decreased PDH activation and glycogenolysis during exercise following fat adaptation with carbohydrate restoration. Am J Physiol Endocrinol Metab 2006;290:E380-8.

FAT ADAPTATION OR KETOGENSIS & PERFORMANCE

Maughan RJ, and Poole DC. The effects of a glycogen-loading regimen on the capacity to perform anaerobic exercise. Eur J Appl Physiol Occup Physiol 46: 211-219, 1981.

Glycogen and performance during high-intensity exercise

1 2 3 4 5 6 7 8 9 Normal Diet High CHO Low CHO

# *

Time to exhaustion (min) at 105% Vo2max

6 males undertook 3 dietary conditions for 2.5 days preceding TTE tests

Normal Diet (3.9g CHO/kg/day) High CHO (6.1g CHO/kg/day) Low CHO (0.3g CHO/kg/day)

Ketogenic Data – Phinney 1983

Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism. 1983;32(8):769-76..

five well-trained cyclists were fed a eucaloric balanced diet (EBD) for one week providing 35-50 kcal/kg/d, 1.75 g protein/kg/d and 66% CHO, then followed by four weeks

• f a eucaloric ketogenic diet

(EKD, less than 20g of CHO). Cycling endurance test was ride to exhaustion (ENDUR) at 62%-64% of Vo2max (~2.5hrs)

With Subject JP p-value here = 0.9488 // Change in ES = -0.03 (trivial at best) Odds ratios of clinical or mechanistic relevance: 32% possibly positive, 32% possibly trivial 36% possibly negative. Without Subject JP p-value here = 0.4943 // Change in ES = -0.33 (small to moderate) Odds ratios of clinical or mechanistic relevance: 15% possibly positive, 24% possibly trivial 61% possibly negative.

• 84’

146’ 130’

Performance Improvement or Decrement?

Havemann et al. Fat adaptation followed by carbohydrate loading compromises high-intensity sprint performance J Appl Physiol. 100: 194–202, 2006.

“…what was initially viewed as “glycogen sparing” after FAT-adapt may be, in fact, a down-regulation of CHO metabolism or “glycogen impairment”. [Stellingwerff et al.] recently reported that FAT-adapt caused a reduction in the activity of pyruvate dehydrogenase; this change would act to impair rates of glycogenolysis...[it may] compromise the ability of well-trained cyclists to perform a high- intensity sprint when they need it most- at the end of a race.”

Published Data –Fat Adaptation or Ketogenic Dietary Impact on Exercise Performance (each individual perf. test per study shown)

Performance Decrease (12) No Effect (7) Improved Performance (2)

Phinney, S.D., et al., Metabolism, 1983. 32(8): p. 769-76. Havemann, L., et al., 100km

• performance. J Appl Physiol

(1985), 2006. 100(1): p. 194- 202. Burke LM, et al. J Appl Physiol 89: 2413–2421, 2000. Burke LM, et al.. Med Sci Sports Exerc 34: 83–91, 2002. Carey AL,et al. . J Appl Physiol 91: 115–122, 2001. Lambert, E.V., et al., No Change High Intensity Test. Eur J Appl Physiol Occup Physiol, 1994. 69(4): p. 287- 93. Goedecke, J.H., et al., Metabolism, 1999. 48(12): p. 1509-17. Bergstrom, J., et al., Acta Physiologica Scandinavica, 1967. 71(2): p. 140-50. CHRISTENSEN, E. H.,et al. . Scand. Arch. Physiol. 81:160– 171, 1939. GALBO, H. et al. Acta Physiol. Scand. 107:19–32, 1979. Pitsiladis, Y.P. Et al. The Journal of physiology, 1999. 517 ( Pt 3): p. 919-30. Starling, R.D., et al., Journal of Applied Physiology, 1997. 82(4):

• p. 1185-9.

Maughan, R.J. and D.C. Poole, Eur J Appl Physiol Occup Physiol, 1981. 46(3): p. 211-9. Greenhaff, P.L., et al. European journal of applied physiology and occupational physiology, 1987. 56(3): p. 331-7. Greenhaff, P.L., et al., European journal of applied physiology and occupational physiology, 1987. 56(4): p. 444-50. Greenhaff, P.L., et al. European journal of applied physiology and occupational physiology, 1988. 57(5): p. 583-90. Havemann, L., et al., 1k sprint performance. J Appl Physiol (1985), 2006. 100(1): p. 194-202. Havemann, L., et al., 4k sprint performance. J Appl Physiol (1985), 2006. 100(1): p. 194-202. O’KEEFFE, et al. Nutr. Res. 9:819–830, 1989. Lambert, E.V., et al.,. International journal of sport nutrition and exercise metabolism, 2001. 11(2): p. 209-25. Lambert, E.V., et al., Inc. Perf. Prolonged Test. Eur J Appl Physiol Occup Physiol, 1994. 69(4): p. 287-93.

“…what was initially viewed as “glycogen sparing” after FAT-adapt may be, in fact, a down-regulation of CHO metabolism or “glycogen impairment”. [Stellingwerff et al.] recently reported that FAT-adapt caused a reduction in the activity of pyruvate dehydrogenase; this change would act to impair rates of glycogenolysis...[it may] compromise the ability of well-trained cyclists to perform a high- intensity sprint when they need it most- at the end of a race.”

Recent LCHF Social Media Push: LET’S TRY AGAIN… THIS TIME FOR A FULL 3 WEEKS!

PROJECT SUPERNOVA!

We investigated the effects of adaptation to a ketogenic low-carbohydrate (CHO), high-fat diet (LCHF) or perodized CHO (PCHO) during 3 wk of intensified training on metabolism and performance of world-class endurance athletes all on isoenergetic diets in elite race walkers:

Burke, L.M., et al., Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J Physiol, 2017. 595(9): p. 2785-2807.

PROJECT SUPERNOVA!

Burke, L.M., et al., Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J Physiol, 2017. 595(9): p. 2785-2807.

PROJECT SUPERNOVA!

VO2, CHO and fat oxidation rates during 25km walk test in elite race-walkers

PROJECT SUPERNOVA!

But the study didn’t go long enough… It was only 3 weeks!

Jan 4, 2018

But the study didn’t go long enough… It was only 3 weeks!

Volek, J.S., et al., Metabolic characteristics of keto- adapted ultra-endurance runners. Metabolism, 2016. 65(3): p. 100-10. (average of 20months of keto adaptation) Burke, L.M., et al., Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J Physiol, 2017. 595(9): p. 2785-2807. (3 weeks of keto adaptation)

3hr run at 65% VO2peak= ~1.2 g/min fat oxidation 25km walk at ~80% VO2peak = ~1.5 g/min fat oxidation

But the study didn’t go long enough… It was only 3 weeks!

Volek, J.S., et al., Metabolic characteristics of keto- adapted ultra-endurance runners. Metabolism, 2016. 65(3): p. 100-10. (average of 20months of keto adaptation) Burke, L.M., et al., Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers. J Physiol, 2017. 595(9): p. 2785-2807. (3 weeks of keto adaptation)

3hr run at 65% VO2peak= ~700 umol/L at rest ~900 umol/L during exercise 25km walk at ~80% VO2peak = ~1200 umol/L at rest ~ 1400 umol/L during exercise

WHAT DO CHAMPION ENDURANCE ATHLETES CONSUME?

Do Kenyan Runners eat a LCHF Diet?

Marathon All-Time Rankings

77% CHO! ~10.5 g CHO/kg/day! (607 g CHO/day) 67% CHO! ~9.9 g CHO/kg/day! (552g CHO/day)

SUMMARY

Explosion of news…but what does the current evidence say?

http://www.diabetes.co.uk/blog/2016/07/low-carb-diet-propelled-chris-froome-three-tour-de-france-titles/

via Dr. James Morton

Glycogen threshold concept?

• Dr. Graeme Close & Dr. James Morton

Periodic Low CHO training?

Slide adapted from Keith Baar

Long Duration and/or High Intensity + Glycogen / Low glucose

Is there a time that fat oxidation potentially contributes to performance???

Ultramarathoning? - Case calculations: Rob Krar won Leadville 100miler at 9:46/mile or 6 min/km from Athletics Canada physiological testing data base 6min/km in elite male distance runners projects to ~45 to 50%

• VO2max. (still ~60 to 70% CHO
• xidation when fed and fueling!)

BUT, 70g/hr of CHO intake = ~280kcals/hr, which can completely satisfy the CHO requirement of elite ultra- marathoning!

(note: Rob Krar fuels ~75g CHO/hr while racing…)

And this calculates to: 283 +/- 114 kcals per hour of carbohydrate oxidation (or about 719 +/- 94 kcals per hour of total required energy need).

Conversely, keto-adaptation can double fat oxidation at these lower intensities (Phinney, 1983; Volek, 2015, Burke,

2016): 1.5g FAT/min = 90 g FAT/hr =

810 calories of fuel per hour, which also satisfies caloric requirement

PROS vs CONS to either approach? No published data whatsoever… Individual trial and error…(background fiber type,

metabolism, insulin sensitivity, GI symptoms, individual efficiency/economy etc.

Effect of body weight on marathon performance

2017

Leger, L., & Mercier, D. (1984). Gross energy cost of horizontal treadmill and track running. Sports Med, 1(4), 270-277

VO2 (ml/kg/min) = 2.209 + 3.163 speed (km/h)

for 130 subjects (trained and untrained males and females) and 10 treadmill studies.

e.g. 100kg w/ VO2 of 25ml/kg/min = 5h 51min marathon A 10% drop in body weight (to 90kg) would give a 5h 13min marathon A 38min improvement! (without any extra training) (go to 75kg and marathon = 4h 17min Almost 1 hr quicker)

Ultra-ultra endurance? Trekking to Antarctica

Stroud, M. A., et al. Energy expenditure using isotope-labelled water (2H218O), exercise performance, skeletal muscle enzyme activities and plasma biochemical parameters in humans during 95 days of endurance exercise with inadequate energy intake. EJAP. 76(3), 243-252., 1997

In November 1992, two men set of from the Atlantic coast of the Antarctic pulling sledges weighing 222 kg each which contained 100 days of food and fuel and other essential survival equipment. The expedition was the first to successfully complete a crossing of Antarctica without the use of aircraft to ferry food and equipment, and was the longest unsupported walk ever made. (95 days they aborted as lost ~30% of BW ) From days 20 to 30 = ~45 to 48 MJ/day EE = ~11,000 kcals per day! (~7x BMR!) Average caloric intake = ~5,000 kcals per day of ~56% fat, 35% CHO, 8% PRO (so daily CHO intake = ~1,750 kcals = ~400g CHO per day)

Would the have been successful or faster if keto-adapted?

The vast majority of sports/events are CHO dependent

CHO dependency for ATP production

• CHO oxidation is the dominate substrate

for elite athlete performance and training in events >30” and up to 3 to 4hrs.

• CHO derived pyruvate oxidation via

PDH in the mitochondria is the primary substrate for aerobic metabolism during intense exercise.

• CHO oxidation is more efficient per L of
• xygen consumed than the oxidation of

fat.

Ketogenic Data – Phinney 1983

Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism. 1983;32(8):769-76..

Thank you!

Conference organizers & all in attendance! Athletes Canadian Sport Institute Pacific / UVIC & UBC