Fueling the Triathlete...5/14/2018 1 Fueling the Triathlete Current, practical and evidence-based guidelines for triathletes of all sizes and levels Cindy Milner, MSEd, RDN, CSSD,
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5/14/2018
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Fueling the Triathlete
Current, practical and evidence-based guidelines for
triathletes of all sizes and levels
Cindy Milner, MSEd, RDN, CSSD, CSOWM
Cayuga Medical Center
Sports Medicine and Athletic Performance
Cayuga Center for Healthy Living
Ithaca, NY
Financial Disclosures
• None
Current Sports Medicine Reports, 2017 Jul/Aug;16(4):240-246. Objectives
• Provide up-to-date, evidence-based and practical
sports nutrition and supplementation guidelines for
triathletes
• Include guidelines for athletes of varying abilities and
sizes
• Focus on race day fueling!
Defining “Fueling”
• Ingestion of “fuel” during the race to produce and
“restock” energy stores– Includes nutrition and hydration consumed in the days
leading up to the race and morning of the race
–Goal of fueling is to maximize race
performance
Goals of the Sports RDN/CSSD
Provide recommendations and guidance that is:
● Individualized○ Practical and reasonable for the individual
● Current
● Evidenced-based
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Triathletes –
Many Variables
• Recreational to elite
• Age
• BMI
• Health and fitness
status (including post-
bariatric surgery
athletes)
• Race Variables
(length, course,
weather)
• Participant’s goals– compete or complete?!
+
Fueling the
Triathlon –
Race Day
Concerns
Running out of fuel (hitting the wall, bonking)
GI problems (cramps, bloating, diarrhea)
Dehydration to level that performance is impacted
Carb Supercompensation Prior to Race
● Purpose - normalize liver glycogen stores prior to competition
*consider distance of the Tri and expected intensity of competitor when recommending
CHO loading amount
● Ex. 155 lb (70 kg) elite athlete before Full distance Tri○ 10 -12 gm/kg/day = 700 – 840 gm CHO/day for ~2 days prior to race
Medicine & Science in Sports & Exercise 48(3):543-568, March 2016
AND, ACSM, Dietitians of Canada Joint Position Statement
Nutrition and Athlete Performance, March 2016
Triathlon Duration Time before race CHO Intake Goal
Sprint ~24 hours >6 gm/kg/day
Tri longer than
90 minutes*
36 – 48 hours 10 -12 gm/kg/day
RACE DAY!
Pre-Race Fueling
Goal – “top” off glycogen stores
• Consume 1 to 4 gm CHO/kg in the 1 to 4 hours prior to the race
• Closer to race, choose CHO rich foods lower in fiber, fat and protein
• Liquid meal supps may be good choice due to more rapid GI emptying
Medicine & Science in Sports & Exercise 48(3):543-568, March 2016
Pre-Race Fueling Example
Female Ironman® (Full 140.6 m) athlete
• 57 kg (1 to 4 gm/kg = 57 to 228 gm CHO)
• 3 hour prior to race (4 am)
Meal:– Large mug tea + milk
– 3 English muffins
– 1 banana
– 2 slices white bread with jelly and cheese
– 1 slice white bread with honey and cheese Jeukendrup.http://www.winninglane.com/fi
les/Fuelling_an_Ironman_World_Champio
n.pdf
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Fueling DURING
the RACE!
Exogenous
CHO is
ergogenic
during
exercise
● Spares skeletal
muscle glycogen
● Prevents liver
glycogen depletion
>> hypoglycemia
● CNS benefits
because low CHO
availability during
racing:
○ impairs pacing
○ motor skills
○ concentration
○ increases
perception of
fatigue
In Ironman distance triathlons, higher race
CHO intake is corelated with faster finish times.
Carbohydrate Needs for Triathlon Fueling
Getzin AR, Milner C, Harkins M, Curr Sports Med Rep. 2017
Potential role of carb rinse
• Frequent mouth rinsing with CHO solution every 5 to
10 min with ~10-sec contact between the oral cavity
and a CHO source
• Elicits performance benefit which is believed to occur
due to the neural effects on decreasing fatigue
• Especially potential
benefit if GI upset, nervous
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Multiple Transportable Carbs? A Quick Review
• Monosaccharides:
– Glucose (Dextrose)
– Fructose
– Galactose
• Disaccharides:
– Sucrose (Glucose + Fructose)
– Maltose (Glucose + Glucose)
– Lactose (Glucose + Galactose)
• Longer-chain CHO such as:
– Maltodextrin* (oligosaccharide -
glucose chain)
– Starch (longer chain of
glucose)
– Fiber
*absorbed similarly to Glucose
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Why Multiple-transportable CHOs?
● Use multiple-transportable CHO sources for
exercise lasting longer than 2.5 hours
● Use a mix of glucose/glucose polymers and
fructose CHO sources vs. glucose alone
○ Improved GI tolerance
○ Increased oxidation of exogenous CHO (sparing
of endogenous CHO)
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Endurance Exercise (1 hour – 2 ½ hours) 30 - 60 gm/hrUltra-endurance (> 2 ½ - 3 hours) 60-90 gm/hr
Food/Drink/Product (portion) Carb (gms) Source of Carbohydrate
Gatorade Original Sports drink (12 oz bottle) 20 Sucrose (=glucose + fructose) and dextrose
Honey Stinger “Waffle” (1 waffle) 21 Starch (chain of glucose units), sucrose, fructose, glucose NOTE: 7 gm of fat
Gu Roctane Ultra Endurance Energy Gel (1 packet) 21 Maltodextrin, Fructose
Perpetuem (2 scoops powder) 54 Maltodextin, Energy Smart® (fruit juice, natural
grain dextrin) = fructose & glucose
Heed sports drink powder (1 scoop= 29 gm) 26 Maltodextrin, Xylitol
GU Brew - Electrolyte Brew (2 scoops) 26 Maltodextrin, fructose
Sports beans (1 packet) 24 Sucrose and fructose
Jelly Beans (37 pieces) 35 Sucrose, fructose + glucose
Dried Figs (1 oz - ~1/4 cup) 18 Fructose, glucose (contains ~3 gm fiber)
Fig Newton bars (2) 22 Starch (chain of glucose units), sucrose, fructose,
glucose
Banana (1 medium) 30 Glucose, fructose, fiber
Bagel (1 large) 60 Starch, glucose, sucrose (fructose + glucose),
?fiber
Triathlon: Duration: Carb Amount: Notes:
Shorter duration <1 – 1.5 hours None or small
amount
or carb rinse only
Not needed by
most
Endurance ~1.5 - 2 1/2 hours 30-60 gm/hour
Carb rinse an
option
Practice in
training.
Ultra-endurance >2 1/2 – 3+ hours ~90 gm/hr
(especially in
longer distance
triathlons)
Carb rinse an
option
Practice in training
Requires multiple
transportable
carb sources.
Recap – Carb Recommendations for Fueling During Exercise
Case Example
• 30 yr old professional female triathlete
• History of GI problems
• 57 kg (123 lb), 176 cm (5’9”), BMI – 18.2
• Competing in Kona Ironman
Jeukendrup, A. Chap. 15, http://www.winninglane.com/files/Fuelling_an_Ironman_World_Champion.
Case Athlete’s
Nutrition Goals For Ironman World Championship
1) Avoiding major GI distress
2) Providing energy throughout the event and in a way
that does not exacerbate GI distress
3) Maintaining fluid balance
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>2.5 hours – CHO goal ~90 gm/hour, multiple
transportable CHO sources
Jeukendrup, A. Fueling an Ironman World Champion. 2011
= 86 gm/hr
Jeukendrup, A. Chap. 15http://www.winninglane.com/files/Fuelling_an_Ironman_World_Champion
Ironman Case Study Athlete, Review:
Days before the race- 9 gm/kg CHO/day (~585 gm/day)
• Reduced fiber and dairy in diet 2 days prior to race
Pre-Race Meal: consumed 221 gm CHO = ~4 gm/kg, 3 hr
before race
During Race:
T1 & T2 – 1 Gel each transition
Bike – Two 750 ml (25 oz) bottles of highly concentrated
sports drinks (20 scoops total powder)
• Sipped sports drink mix followed by sips of water
• Drank mix/water every ~10 minutes
• Refilled water bottle at aid stations
Run – gel every ~25 min + water
Hydration
• Individualize hydration
• Determine sweat rate in different environmental conditions.
– Weigh before and after exercise to calculate sweat rate
– For each 1 lb of weight lost, replace ~16 - 20 oz of fluid
• ~ 13 - 26 oz (390 – 780 ml) per hour is range for many athletes
• Depends on temperature, humidity, size and fitness of athlete, intensity/pace, length of race
Pugh LGCE, 1967, Wyndham NB, 1969, Noakes T. , 2003, Getzin AR, Milner C,
Harkins M, Curr Sports Med Rep. 2017
General Hydration Guidelines
• Practice during training, including
INTENSE (race-pace) training!
• Use same products in training and
competition
• During the run -- Crunch the cups!
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Sodium Supplementation?
• Why?
– Avoid “Exertional Hyponatremia”
– Potentially helpful to avoid muscle cramping
• Who’s at risk?
– Hyponatremia: smaller, slower athletes
– Cramping: larger, faster athletes, & “salty sweaters”
Sodium: Recommendations
• Hyponatremia:
– Don’t “over-drink” (~13 - 26 oz/hour = ~ 400 -800 ml/hr)
– Individualize to fluid intake to sweat rate and thirst
• Cramping:
– 500 - 1000 mg sodium/hour, if at risk. (Especially in ultra
endurance events)
• Remember: sodium added to many sports products
• Experiment in training – Potential for GI side-effects
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Sodium Supplementation
Product Sodium (mg) Notes
Salt 1 tsp 2400 Role into heated sports bar?
Endurolytes (Hammer) 2capsules
80 Contains other minerals
Endurolytes Extreme 1 capsule
120 Contains other minerals
NUUN Active 1 tab 360 Contains other minerals
The Right Stuff 20ml 1780 Liquid
Goldfish crackers (60) ~250 -280 Carb source/not sweet
Gu Roctane Gel 125 Carb/caffeine source
Gatorade 12 oz 160 Carb source
Salt sticks 1 capsule 215 Contain other minerals
Caffeine Supplementation
• May lower perception of intensity/difficulty of exercise
• Reduces fatigue, increases alertness, improves mood,
enhances concentration, and helps to speed reaction
time
• Many sports products contain caffeine
• Important to try in training because individual
responses vary greatly
Caffeine
Many athletes consume ~150-200mg 30-60
min before race and redose during Tri
• 15 – 60 min before exercise ~2 - 3 mg/kg (~1.5 mg/lb)
➢155 lb (70 kg) = ~210 mg caffeine
• Redosing ~2-5 hours with 25-50 mg/hr
• Side-effects: nausea, palpitations, anxiety, increased BP, headaches, diarrhea
• Recommend caution with use before the swim
Tarnopolsky, Ann Nutr Metab 2010;57(suppl 2):1–822
Caffeine Content
Product Amount Caffeine (mg)
Salt Stick Plus 1 capsule 30
GU Roctane Gel (passion fruit)
1 gel 35
GU Energy Gel (salted caramel)
1 gel 20
Clif Shot Turbo Gel (choc cherry)
1 gel 100 mg
Clif Shot Bloks Cherry 3 pieces 50 mg
Coffee ~ 8 oz ~130 mg
Mountain Dew 12 oz 54
Cola 12 oz 55-75
Brewed Tea 12 oz 20-50 mg
Case Study: Amateur 70.3 Tri. 42 yr old male, 70”, 170 lb (76 kg), BMI – 24.
Concerns: fueling, GI tolerance, cramping. Finish time ~5 hours
Timing Fuel CHO (gm) Sodium (mg) Caffeine (mg)
Pre- Race 2 Bagels w/jellyCereal + skim milkClif® bar12 oz coffee
~290 ~200
goal 1-4 gm/kg =76 -300 gm
goal ~3mg/kg = ~228 mg
T1 Powerbar® gel (w/caf) 27 200 50
Bike (~2:40 hr) Dried Figs ~1/2 – 1 cup ~50 -100 0 0
2 bottles Hammer® Perpetum (1 mocha)
108 420 50
~4 gels 100 800 100
2 Thermotabs®/hr 0 360 0
T2 ¼ c figs 26 0 0
1 Thermotab® 0 180 0
Run (~1:40 hr) 3 gels 75 200 – 400 50 -100
RACE Total ~390 – 440 ~2,160 – 2,360 250 – 300
Guidelines ~ 90 gm/hr = ~ 450 gm ~500 – 1000mg/hr Redosing~ 25- 50 mg/hr
Case Study: Recreational Triathlete
Sprint Tri – male 70”, 200 lbs (91 kg), BMI - 29
Est. finish time 1 hr 45min, Concern - cramping
Timing Fuel CHO (gm) Sodium (mg) Caffeine (mg)
Pre- Race 2 English muffin, PB, ½ banana 16 oz Sports Drink
~103(goal 1-4 gm/kg, 1-4 hrs pre-race = 91 – 364 gm)
None (nervous about swim)
T1 Mocha Gel, waterNuun® E’lyte tab
251
60360
50
Bike Water
T2 4 oz Sports drinks 7 ~50 0
Run Water
RACE Total 33 370 50
Guidelines: ~ 30 – 60 gm/hr ~500 – 1000 mg/hr
Redosing with~ 25- 50 mg/hr
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Post-Bariatric
Surgery Triathlete
Type of Surgery Impacts Fueling:
• Sleeve Gastrectomy– Volume restriction
• The Roux-en-Y Gastric Bypass– Volume restriction
– Possible simple CHO intolerance
• “Dumping syndrome”
• Simple CHO intake <10 gm at a time often recommended
– Risk of dumping lessens with time
• No research-based guidelines for post-op athletes
RNY Gastric
Bypass
Post-Bariatric Surgery Triathlete Fueling
Suggested Guidelines
• Practice in training
• Advanced CHO consumed during exercise slowly in
training
– Example: begin with 5gm CHO every 20 -25 min, increase
to 5gm every 15 min, to 8 - 10gm every 15 min
– Example: ¼ gel every 15 minutes = ~25 gm/hr
• Exercise >1 hr, begin CHO/fluid intake early
Post-RNY Triathlete Hydration
Suggested Guidelines
• Hydration – challenging
• Practice sipping frequently
• If tolerated, choose liquid forms of CHO and electrolytes during exercise (sports drinks & low-calorie sports drinks, like G2)
• Hydrate soon and often after exercise
– choose salty liquids (broth/soup), low-cal sports drinks
– high-liquid foods (yogurt, applesauce, cottage cheese)
– homemade smoothies
Case Study: Post-RNY
Intermediate Distance Triathlete,
40 yr old female.
Current wt: 162 lb, 62.5”, BMI: 29
(pre-surgery – 230 lb, BMI- 43)
• Practiced in training
• Honey Stinger Chews and
• PB pretzels worked well (1-3 at frequent
intervals)
– (10 pretzels = 15 gm CHO, 5 gm
prot, 7 gm fat, 330 gm sodium)
• “Ultima Replenisher” powdered
electrolyte mix
What about
Nitrates?
• Nitrates
–Beet Root
Juice (BRJ)
–BRJ
Concentrate
Beet Root Juice?
• Nitrate-rich Beet Root Juice (BRJ) is a popular supplement
• Nitrate in beets converted to Nitrite and then to Nitric Oxide (NO)
• NO increased with supplementation of nitrate rich foods or supplements
• Lowers oxygen utilization at submaximal exercise
Jones, A. Dietary Nitrate Supplementation and Exercise
Performance. Sports Med. 2014; 44(Suppl 1): 35–45.
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Jones, A. Dietary Nitrate Supplementation and Exercise Performance. Sports Med. 2014; 44(Suppl 1): 35–45.
Nitrite (NO2-) Nitric Oxide (NO)
Increased NO =
Fatigue Resistance
Improved Exercise Efficiency
Increased Exercise Performance
Acute (~2.5 hr pre-exercise) and chronic (daily for 6 d)
supplementation has been shown to increase plasma
nitrite concentration
About 25% of ingested nitrate enters the enterosalivary
circulation, where it is reduced to nitrite by oral bacteria
Beet Root Juice
Potential Benefits
• Improved exercise
tolerance & performance
• Improved cognitive function
• Lowered BP
Potential Concerns• GI complaints
• Taste….
• Cost, calories…
• Long-term use not studied
• Less benefit in elite/well-trained athletes
• Avoid Sodium Nitrite supplements = toxic
• Avoid Sodium Nitrate supplements
• Nitrite toxicity possible w/improperly stored juice
Getzin AR, Milner C, Harkins M, Curr Sports Med
Rep. 2017
BRJ – Practical Applications
• Consume diet high in nitrate (i.e. beets, BRJ, cress, celery, lettuce, arugula)
• If using BRJ:
– Trial in intense training first
– Use 5-9 mmol (300 – 550 mg) nitrate 2-3 hours before exercise
– Possibly redose in longer triathlons
– Use 3rd party verified or established brand
– Store in fridge after opened
Summing Up: Goals for Fueling the Triathlete
• Appropriate CHO intake (multiple transportable CHO for >2.5 hr race, consider CHO rinse)
• Individualize fueling & hydration recommendations tothe athlete’s pace, race length, goals, size and level of fitness)
• Supplements sodium and caffeine may benefit some athletes
• Encourage a food-first approach for nitrate intake, nitrate supplements may benefit some racers
Thank you!
Resources
• SCAN (Sports, Cardiovascular and Wellness
Dietetic Practice Group) SCANDPG.org
• USOC
• Australian Institute of Sport
• The Science of Ultra (Podcast)
• Guru Performance – We Do Science (Podcast)
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