Maximizing Post-Exercise Recovery with Carbohydrate plus Protein: How and Why It Works

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1 Maximizing Post-Exercise Recovery with Carbohydrate plus Protein: How and Why It Works Lisa Ferguson-Stegall, PhD The University of Texas at Austin Exercise Physiology & Metabolism Laboratory The critical role of proper post-exercise nutrition has been well established through decades of scientific research and practical application. While the importance of carbohydrate intake has been well documented, recent investigations have demonstrated the effectiveness of carbohydrate plus protein supplementation in improving exercise performance in an acute bout, as well as in a second bout the same day. In addition, carbohydrate+protein supplementation post-exercise has been shown to be effective in restoring muscle glycogen, repairing muscle damage, attenuating protein degradation and initiating protein synthesis all positive outcomes that lead to improved rate of recovery and adaptation to exercise training. In this article, we describe the mechanisms by which carbohydrate+protein supplementation can improve recovery and increase training adaptations more effectively than when ingesting either nothing at all or carbohydrate only following an intense endurance exercise session. THE POST-EXERCISE STATE The body is in a catabolic state after an intense exercise session. Stress hormones are high, muscle tissues is damaged, and fuel stores such as muscle glycogen are low or

2 possibly depleted. Making a shift to an anabolic, or rebuilding, state must happen quickly in order to recover from the bout and adapt to the training stimulus. Endurance athletes must often compete in multiple events per day, such as in cycling stage races, or train twice per day, which means that there is little time to recover in between each bout. Therefore, to facilitate this shift quickly and adequately, proper post-exercise nutrition must be ingested, and the timing of intake must also be performed properly. We have known for many years that carbohydrate intake can maintain blood glucose and extend time to exhaustion during endurance exercise (4, 5), attenuate cytokine & immune cell perturbations (20), increase glucose & insulin levels, and restore glycogen levels (14, 29). In recent years, however, carbohydrate+protein has been shown to increase time to exhaustion in endurance exercise beyond that of carbohydrate alone, increase insulin and glycogen storage, and increase the rate of recovery such that subsequent performance later in the same day is improved. Also, carbohydrate+protein can increase the activation of pathways responsible for increased protein synthesis (11, 13, 24, 25). This is important for repairing damaged tissue and adapting to the training stimulus through the synthesis of new proteins. THE IMPORTANCE OF TIMING

3 The minutes after an intense exercise session is often called the recovery window, and for a good reason. Immediately post-exercise, the muscles are more sensitive to nutritional stimuli, so this is the ideal time to take in nutrients in order to restore muscle glycogen and activate protein synthesis. Nutrient intake during this time can also help prevent additional protein breakdown that occurs in the absence of nutrient intake post-exercise (2), and can attenuate the cortisol response, which if left unchecked leads to further catabolism (19). The co-ingestion of carbohydrate and protein is more effective than either of the macronutrients alone because they activate different but cooperative signaling pathways that control glucose uptake, glycogen synthesis, and protein synthesis, as well as protein degradation. This is illustrated in the figure below. Just as skeletal muscle is most sensitive to insulin and nutritional substrate for glycogen resynthesis immediately post-exercise, the stimulation of protein synthesis, which will be discussed more below, is most responsive immediately after exercise as well. One group of researchers assessed the role of supplement timing on protein synthesis by providing a carbohydrate+protein supplement either immediately after, or 3 hours after a moderate-intensity cycling exercise bout (18). They found that when the supplement was ingested immediately post-exercise, whole body protein synthesis was increased by 300%, compared to only 12% when the supplement was delayed by 3 hours (18). This illustrates the importance of ingesting carbohydrate+protein immediately postexercise, rather than delaying supplementation.

4 Two key intracellular signaling pathways are activated when a supplement containing both carbohydrate and protein is ingested post-exercise. Blood glucose rises due to the carbohydrate, which stimulates an increase in blood insulin. When insulin binds to its receptor of the membrane of the muscle cells, it activates a signaling cascade, which reaches downstream targets AS160 and GSK-3. AS160 normally inhibits the process through which glucose enters the cell, but when the signaling protein Akt phosphorylates it, the inhibition is relieved and cellular glucose uptake can occur. In a similar fashion, the enzyme glycogen synthase, which controls glycogen synthesis, is normally inhibited by GSK-3. When GSK-3 is phosphorylated by Akt, the inhibition is removed and the process of glycogen synthesis can proceed. Phosphorylation of GSK-3 also affects mrna translation initiation and protein synthesis by relieving the inhibition of eif2b, which is a critical initiation factor. The protein component of the supplement increases the level of blood amino acids, which leads to activation of the mtor pathway. This pathway ultimately controls protein synthesis, which is at the heart of recovery and adaptation to the exercise stimulus. Arrows between the pathways show that the pathways interact, which amplifies the signals further. OPTIMIZING GLYCOGEN RESYNTHESIS A long, intense endurance exercise session can leave your body s carbohydrate stores (e.g., muscle and liver glycogen) extremely low or even depleted, and without adequate

5 carbohydrate intake, very little glycogen resynthesis and storage can occur (12, 13, 30). Ingesting carbohydrate immediately after exercise is beneficial because it provides an immediate source of fuel for muscle to use to replace the glycogen that has been used. We know that ingesting a carbohydrate supplement immediately post-exercise doubles the rate of glycogen synthesis compared to ingesting the very same supplement 2 hours following exercise (12). Although some studies have shown that more frequent supplementation such as every 15 to 30 minutes results in rates of synthesis 25-30% higher than when supplementing every two hours (8, 28), this is a high amount of carbohydrate to ingest, and simply may not be practical for many individuals. A more realistic and practical strategy is simply to ingest a supplement immediately postexercise, and again about 2 hours later. Generally, the amount of carbohydrate and protein that is most effective after prolonged endurance exercise ranges between grams of carbohydrate per kg body weight and grams protein per kg when provided immediately post-exercise and 2 hours later. This can be achieved in the form of commercial supplements or as a meal. TURNING ON PROTEIN SYNTHESIS FOR REPAIR AND ADAPTATION Increased muscle protein synthesis is at the heart of adaptation to exercise training. The increased proteins include contractile fibers, oxidative enzymes, mitochondria, membrane receptors, hemoglobin, substrate transporters, and many other important cellular and molecular factors that have key functions related to exercise performance.

6 Many investigations have shown that the addition of protein, especially the essential amino acids, to a post-exercise carbohydrate supplement can optimize protein synthesis, create a positive protein balance, repair muscle damage, and stimulate positive training adaptations (1, 7, 9, 10, 16, 17, 21, 26). Carbohydrate+protein can reduce muscle protein breakdown, primarily due to increased insulin levels. Insulin, known for its key role in clearing glucose from the blood and stimulating its uptake into cells, is one of the body s most anabolic hormones. Insulin s most powerful role postexercise is in reducing protein degradation (2, 3). Therefore, when a supplement containing carbohydrate causes an increase in insulin and the protein component provides the amino acids as building blocks for tissue repair and protein synthesis, the result is that the net protein balance shifts because the rate of synthesis now exceeds the rate of breakdown (26). Several investigations have demonstrated reduced muscle damage following intense endurance exercise in response to carbohydrate-protein supplementation compared to carbohydrate alone or a placebo treatment (6, 22-25). In one such study, trained cyclists performed an intense cycling ride to exhaustion while receiving carbohydrate, carbohydrate+protein or a placebo during the ride (27). After a 24-hour recovery period, the cyclists performed leg extensions to fatigue. The cyclists were able to perform a greater number of leg extension repetitions after having the carbohydrate+protein treatment compared to the carbohydrate or placebo treatments. In addition, the time to exhaustion during the initial cycling session was longer during the carbohydrate+protein treatment, and a significant decrease in markers of muscle damage was detected with

7 the carbohydrate+protein supplement after the cycling bout (27). While the mechanisms by which carbohydrate+protein may reduce muscle damage are yet to be completely elucidated, it is likely that insulin s role in reducing muscle protein degradation is a key factor. APPLYING THIS TO YOUR TRAINING AND NUTRITIONAL PLAN We all know that recovery from intense endurance exercise is a multifaceted process, and is very important. Ingestion of carbohydrate+protein supplementation after exercise can optimize many aspects of the recovery process, as well as facilitate adaptations to training. Providing carbohydrate+protein supplementation immediately and 2 hours post exercise can increase the rate and amount of muscle glycogen restoration, reduce muscle damage, and increase the rate of muscle protein synthesis to a greater degree than when ingesting carbohydrate or protein alone. This means that you can both recover and adapt better to the training stimulus. Therefore, in order to apply this nutritional strategy to your post-endurance exercise routine, ingest a beverage or a meal containing grams of carbohydrate plus grams protein per kg of body weight immediately after exercise and again about 2 hours later. (Whenever possible, the protein source should contain whey, as this has been found to be most effective in stimulating protein synthesis (51).) For a 70 kg

8 person, these recommendations translate to about g carbohydrate plus g protein, totaling kcal per supplement after workouts are intense and prolonged. For workouts that are less intense or of short duration, a good rule of thumb is to replace about 50% of the calories expended in your workout with a carbohydrate+protein supplement. Intake of the right amounts of carbohydrate and protein and at the optimal times after exercise can help assure that you get the most out of your workout and your training program. REFERENCES 1. Biolo G, Tipton KD, Klein S, and Wolfe RR. An abundant supply of amino acids enhances the metabolic effect of exercise on muscle protein. Am J Physiol Endocrinol Metab 273: E , Biolo G, Williams BD, Fleming RY, and Wolfe RR. Insulin action on muscle protein kinetics and amino acid transport during recovery after resistance exercise. Diabetes 48: , Borsheim E, Cree MG, Tipton KD, Elliott TA, Aarsland A, and Wolfe RR. Effect of carbohydrate intake on net muscle protein synthesis during recovery from resistance exercise. J Appl Physiol 96: , Coggan AR, and Coyle EF. Effect of carbohydrate feedings during high-intensity exercise. J Appl Physiol 65: , Coggan AR, and Coyle EF. Reversal of fatigue during prolonged exercise by carbohydrate infusion or ingestion. J Appl Physiol 63: , Combest T, Saunders M, Kane M, and Todd K. Attenuated CPK Following Carbohydrate/protein Intervention Improves Subsequent Performance. Med Sci Sports Exc 37: S42, Cribb PJ, and Hayes A. Effects of supplement timing and resistance exercise on skeletal muscle hypertrophy. Med Sci Sports Exerc 38: , Doyle JA, Sherman WM, and Strauss RL. Effects of eccentric and concentric exercise on muscle glycogen replenishment. J Appl Physiol 74: , 1993.

9 9. Flakoll PJ, Judy T, Flinn K, Carr C, and Flinn S. Postexercise protein supplementation improves health and muscle soreness during basic military training in marine recruits. J Appl Physiol 96: , Gautsch TA, Anthony JC, Kimball SR, Paul GL, Layman DK, and Jefferson LS. Availability of eif4e regulates skeletal muscle protein synthesis during recovery from exercise. Am J Physiol Cell Physiol 274: C , Ivy JL, Ding Z, Hwang H, Cialdella-Kam LC, and Morrison PJ. Post exercise carbohydrate-protein supplementation: phosphorylation of muscle proteins involved in glycogen synthesis and protein translation. Amino Acids 35: 89-97, Ivy JL, Katz AL, Cutler CL, Sherman WM, and Coyle EF. Muscle glycogen synthesis after exercise: effect of time of carbohydrate ingestion. J Appl Physiol 64: , Ivy JL, Lee MC, Brozinick JT, Jr., and Reed MJ. Muscle glycogen storage after different amounts of carbohydrate ingestion. J Appl Physiol 65: , Ivy JL, Miller W, Dover V, Goodyear LG, Sherman WM, Farrell S, and Williams H. Endurance improved by ingestion of a glucose polymer supplement. Med Sci Sports Exerc 15: , Ivy JL, Res PT, Sprague RC, and Widzer MO. Effect of a carbohydrate-protein supplement on endurance performance during exercise of varying intensity. Int J Sport Nutr Exerc Metab 13: , Koopman R, Wagenmakers AJM, Manders RJF, Zorenc AHG, Senden JMG, Gorselink M, Keizer HA, and van Loon LJC. Combined ingestion of protein and free leucine with carbohydrate increases postexercise muscle protein synthesis in vivo in male subjects. Am J Physiol Endocrinol Metab 288: E , Levenhagen DK, Carr C, Carlson MG, Maron DJ, Borel MJ, and Flakoll PJ. Postexercise protein intake enhances whole-body and leg protein accretion in humans. Med Sci Sports Exerc 34: , Levenhagen DK, Gresham JD, Carlson MG, Maron DJ, Borel MJ, and Flakoll PJ. Postexercise nutrient intake timing in humans is critical to recovery of leg glucose and protein homeostasis. Am J Physiol Endocrinol Metab 280: E , Nieman DC. Immune response to heavy exertion. J Appl Physiol 82: , Nieman DC. Influence of carbohydrate on the immune response to intensive, prolonged exercise. Exerc Immunol Rev 4: 64-76, Rasmussen BB, Tipton KD, Miller SL, Wolf SE, and Wolfe RR. An oral essential amino acid-carbohydrate supplement enhances muscle protein anabolism after resistance exercise. J Appl Physiol 88: , 2000.

10 22. Romano B, Todd M, and Saunders M. Effect of a 4: 1 Ratio Carbohydrate/Protein Beverage on Endurance Performance, Muscle Damage and Recovery. Med Sci Sports Exc 36: S126, Romano-Ely B, Todd M, Saunders M, and St. Laurent T. Effect of an Isocaloric Carbohydrate-Protein-Antioxidant Drink on Cycling Performance. Med Sci Sports Exc 38: , Saunders M, Kane M, and Todd K. Effects of a Carbohydrate-Protein Beverage on Cycling Endurance and Muscle Damage. Med Sci Sports Exc 36: , Saunders MJ, Luden ND, and Herrick JE. Consumption of an oral carbohydrateprotein gel improves cycling endurance and prevents postexercise muscle damage. J Strength Cond Res 21: , Tipton KD, Borsheim E, Wolf SE, Sanford AP, and Wolfe RR. Acute response of net muscle protein balance reflects 24-h balance after exercise and amino acid ingestion. Am J Physiol Endocrinol Metab 284: E76-89, Valentine RJ, Saunders MJ, Todd MK, and St Laurent TG. Influence of carbohydrate-protein beverage on cycling endurance and indices of muscle disruption. Int J Sport Nutr Exerc Metab 18: , van Hall G, Shirreffs SM, and Calbet JAL. Muscle glycogen resynthesis during recovery from cycle exercise: no effect of additional protein ingestion. J Appl Physiol 88: , Yaspelkis BB, 3rd, and Ivy JL. Effect of carbohydrate supplements and water on exercise metabolism in the heat. J Appl Physiol 71: , Zawadzki KM, Yaspelkis BB, 3rd, and Ivy JL. Carbohydrate-protein complex increases the rate of muscle glycogen storage after exercise. J Appl Physiol 72: , Abbott Laboratories The EAS ACADEMY website and its content is owned by Abbott Nutrition, a division of Abbott Laboratories. All rights reserved. Any redistribution or reproduction of any part or all of the contents in any form is prohibited other than the following: 1. you may print or download to a local hard disk extracts for your personal and non-commercial use only; 2. you may copy the content to individual third parties for their personal use, but only if you acknowledge the website as the source of the material. You may not, except with our express written permission, distribute or commercially exploit the content. Nor may you transmit it or store it in any other website or other form of electronic retrieval system.

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