Ketogenic, Paleo or High Carbohydrate Diet. What is an athlete to eat? Marlia Braun, PhD, RD University of California, Davis

Transcription

1 Ketogenic, Paleo or High Carbohydrate Diet What is an athlete to eat? Marlia Braun, PhD, RD University of California, Davis

2 Disclosures No conflict of interests

3 Objective Review the available metabolic fuel sources in the endurance athlete for the following diets: High carbohydrate diet Ketogenic diet Paleolithic diet

4 Diet Definition High Carbohydrate 60% CHO, 15% PRO, 25% FAT Ketogenic 10% CHO, 20% PRO, 70% FAT Paleo 30% CHO, 30% PRO, 40% FAT

5 High Carbohydrate Diet History 1925 blood glucose Boston Marathon Runners 1939 CHO diet improves endurance capacity (Christensen and Hansen, 1939) 1960s needle biopsy protocol designed to assess glycogen levels limiting fuel 1977 CHO feeding and fluid intake impact on performance (Saltin, et al.) 1980s CHO feeding before and during exercise to support performance and reduce fatigue (Coyle et al. and others) The birth of Gatorade

6 High Carbohydrate Diet 250 Work Time (min) Mixed High carb 50 Low carb Muscle glycogen (grams/kg/muscle) Bergstrom J et al. JAMA (9);

7 GLYCOGEN glucose GLYCOGEN: 2000 calories stored carbs in muscle and liver. Glycogen (glucose) is a source of fuel during -- lasting about 2 hours!!

8 High Carbohydrate Diet Muscle glycogen CHO loading 6-10 gm/kg/d for high intensity 8-12 gm/kd/d for very high intensity (JADA 2016) Exercise duration (minutes)

9 High Carbohydrate Diet Blood glucose CHO recs of gm/hr up to 90 gm/h in ultraendurance (JADA 2016) Exercise duration (minutes)

10 Intensity Alters Fuel Source

11 High Carbohydrate Diet Glycogen is fuel for brain and muscles Maximizing glycogen stores are key Carbohydrate consumption during exercise is necessary for performance

12 Ketogenic Diet History Hundreds of thousands of years ago migration depended on surviving prolonged periods of fasting Examples: 1878 Dr. Frederick Schwatka expedition with Inuit family (3000 mi in 13 mo) 1921 Prof. V. Stefansson studied Artic Inuit culture (2 y) 1931 Masia herdsmen Central Africa 1971 Bison people of the Northern American Great Plains Metabolism of carbohydrate at current recommended levels is a newer metabolic challenge

13 1928 Bellevue Stefansson Experiment What he ate for 12 mo: 115 gm protein/d (15-20%) >200 gm fat/d (>80%) <10 gm carb/d (<2%) Diet included: meat, fish, poultry (with broth), brains, marrow, liver and kidney Without impairment or signs of nutrition deficiency (McClellan and DuBois, 1930)

14 Ketogenic Diet History 1863 Banting Diet in Britain for weight loss and diabetes control 1920s Mayo Clinic anti-seizure diet for epilepsy 1939 various levels of CHO restriction after 1 week showed reduced endurance time; 81 min in low carb vs 206 minutes in high carb (Christensen EH and Hansen O) 1972 Atkins Diet for weight loss WWII study switching soldiers in winter training from standard high CHO diet rations to pemmican. After 3 days soldiers unable to complete tasks (Kart et al)

15 Ketogenic Diet History week protein-supplemented fast in obese subjects (Phinney S et al.) After 1 wk, treadmill exercise to exhaustion was 80% of baseline, at 6 wks it was 155% of baseline Glycogen fell after 1 wk to 57% of baseline, rose to 69% of baseline at wk well-trained cyclists provided a eucaloric diet containing 20 gm of CHO/d for 4 weeks (Phinney S et al.) At 62-64% of VO 2 max time to exhaustion: 147 min in control group, 151 minutes in experiment group

16 Ketogenic Diet Endurance athlete examples Tim Olson

17 Ketogenic Diet Endurance athlete examples Zach Bitter 100 mile Tack Record and 12hr track world record

18 Ketogenic Diet Endurance athlete examples Mike Morton running faster in his 40s than in his 20s Switched to low carb lifestyle in 2012 and won back to back 100 mile races 1 week apart including setting a course record.

19 Ketogenic Diet Endurance athlete example: Sami Inkinen triathlete; recently rowed from California to Hawaii unsupported on fat and protein; 2,750 miles in 45 days breaking the mixed pair record

20 Ketogenic Diet Sprinter athlete example: Charles Eugster world records in the 200m (indoor) and 400m (outdoor) sprints, as well as British records in the 60m (indoor), 100m (outdoor), and 200m (outdoor) I avoid sugar and eat lots of meat, especially fat. I ve been on a fat trip lately. Fat! Piles of fat. 96 yrs!!

21 Ketogenic Diet Endurance athlete examples Ben Greenfield Fitness expert completed Kona Ironman in under 10 hours Race Breakfast: half-stick of butter, two shots of MCT oil, and a cup of coffee

22 Body Fuels, Adult Male (70kg) Kilogram Kilocalorie Adipose Tissue ,000 Muscle glycogen 0.4 1,600 Liver glycogen Glucose (extracellular fluid)

23 Ketogenic Diet Energy Availability E F E F 2,000 calories >10x 20, ,000+ calories

24 Insulin effects on fat oxidation Carbohydrate +

25 Fat Breakdown Insulin inhibits body fat oxidation 100% Normal range LOW levels of insulin promote fat breakdown for energy generation HIGH levels of insulin promote fat storage Insulin (pmol/l)

26 KETO-Adaptation When first thrown wholly upon a diet of reindeer meat, it seems inadequate to properly nourish the system, and there is an apparent weakness and inability to perform severe exertive fatiguing journeys. But this soon passes away in the course of two to three weeks. Lt. Fredrick Schwatka Royal Navy Franklin Expedition New York Hearld 1880

27 KETO-adaptation How does this happen? 2-4 weeks of carbohydrate restriction < 50 grams total carbohydrate per day 70% of dietary fat

28 Ketone Terminology Ketosis Nutritional Ketosis Small hepatically-derived energy containing substances derived from fatty acids that provide fuel to nearly every cell in the body Process of accelerating production of ketones through restriction of carbohydrate demonstrated by blood levels >0.5mM Keto-acidosis A dangerous side effect of Type 1 Diabetes with ketone levels >10mM Ketoadaptation Process of shifting to using predominately fat for fuel; takes at least several weeks if not months to fully develop

29 The Ketone Zones

30 The Brain on Ketones βohb has shown to be preferential utilized by the brain Owen et al. 2005

31 HI-RES-NU26-01-Cahill.qxd 7/4/06 03:29 PM Page 1 The Brain on Ketones FUEL METABOLISM IN STARVATION C-1 Brain burns 600 kcals per day roughly 20% of energy metabolism The liver produces grams of ketones per day 4.69 kcal/gm Annu. Rev. Nutr :1-22. Downloaded from arjournals.annualreviews.org by CAPES on 04/24/08. For personal use only. Cahill G. 2006

32 The Brain on Ketones 5.5 mm 70 mg/dl 4.5 mm 27 mg/dl (Aoki TT and Cahill GF 1979)

33 Ketogenic Diet The newborn human brain consumes 60-70% of total metabolism at birth, nearly half via βohb Maternal colostrum = fat and protein Cahill G. 2006

34 FASTER Study (Volek J et al. 2015) Fat Adapted Substrate oxidation in Trained Elite Runners The goal was to characterize the metabolic and physiologic differences between high-caliber ultraendurance runners habitually consuming a highcarbohydrate diet versus a low-carbohydrate diet.

35 FASTER Study (Volek J et al. 2015) 20 Well trained, elite ultra-runners Subjects well matched for age, VO 2 max, ht, wt, FFM, %BF High-Carb (HCD; n=10) Low-Carb (LCD: n=10) Carb 60% FAT 25% Protein 15% Protein 20% Carb 10% FAT 70%

36 FASTER Study (Volek J et al. 2015) HCD (n = 10) LCD (n = 10) Mean Range Mean Range Age (yr) Height (cm) Body mass (kg) Body fat (%) Fat mass (g) 6,513 2,774 12,102 5,454 2,953 8,780 Lean mass (kg) VO 2 max (ml/kg/min) VO 2 max (L/min) Competitive running experience (yr)

37 FASTER Study (Volek J et al. 2015) * P value <0.001 HCD (n = 10) LCD (n = 10) Mean ± SD Mean ± SD Energy, kcal 3174 ± ± 814 Protein, g 118 ± ± 32 Protein, % 14.4 ± ± 2.4* Protein, g/kg 1.7 ± ± 0.6 CHO, g 486 ± ± 62* CHO, % 59.1 ± ± 4.9* Fat, g 91 ± ± 66* Fat, % 25.0 ± ± 6.0* Saturated fat, g 21 ± ± 22* Monounsaturated fat, g 29 ± ± 42* Polyunsaturated fat, g 18 ± 9 28 ± 27 Cholesterol, mg 251 ± ± 351* Fiber, g 57 ± ± 17* 6x 2.5x 4x

38 FASTER Study (Volek J et al. 2015) Experimental Design LCD shake: 343 kcal, 4.3 g CHO, 31.3 g fat, 12.6 g protein HCD shake: 332 kcal, 42.7 g CHO, 13.7 g fat, 12.4 g protein

39 FASTER Study (Volek J et al. 2015) Ave. = 1.54 gm fat/min 2.3 fold Ave. = 0.67 gm fat/min

40 Achten et al Oxidation Rate Consensus Curve

41 FASTER Study (Volek J et al. 2015) 70.3 VO 2 max 54.9 VO 2 max

42 Peak Fat Oxidation Differences 120 Peak Fat Oxidation During Exercise grams of fat/hour Keto-adapted Keto-adapted Venables 2005 Phinney 1983 Volek 2015 HCD Volek 2015 LCD Lowest Average Highest

43 FASTER Study (Volek J et al. 2015) RER 0.86 ± 0.08 RER 0.72 ± %

44 FASTER Study (Volek J et al. 2015) Ketones 3 fold higher in LCD

45 Glycogen Stores (Phinney et al. 1983) Trained cyclists (n=5) at 60-65% of VO 2 max 143 Keto-Adaptation Baseline (mmol/kg) 4 wks Ketosis (mmol/kg) 76 Δ60% Δ30% Pre-muscle Glycogen Post-muscle Glycogen

46 FASTER Study (Volek J et al. 2015)

47 Ketogenic Findings Liver can produce βohb for brain fuel Increased fat oxidation rate Burn fat at higher exercise intensity Maintain normal glycogen levels Reduce reliance on exogenous fuel sources

48 Paleo Diet What happens when the diet is evenly mixed and not predominate in carb or fat?

49 Dietary Protein and Carbs by Diet Type Or n SAD Orn = Ornish diet Medit = Mediterranean diet Paleo = Paleolithic diet WFKD = Well formulated ketogenic diet SAD = Standard American Diet Carbs (%) Medit Paleo Generally accepted upper threshold of Low Carb WFKD Nutritional Ketosis Space Protein (%) Protein (g/kg RW) Note: Carbs (%) = Percent of dietary carbs relative to daily energy expenditure Protein (%) = Percent of dietary protein relative to daily energy expenditure Protein (g/kg RW) = Grams of dietary protein relative to reference body weight

50 High-Carb Diet Diet-Driven Regulation Low-Carb Diet

51 Which is Best? What about

52 Who might benefit? The athlete IBS Prediabetic Hypertriglyceridemia Gluten Sensitive Celiac Disease Struggles with body weight Struggle with hunger Struggles to eat adequately during races Complains of GI symptoms during races Always bonking

53 The Many Beneficial Effects of Beta-Hydroxybutyrate (BOHB) Accelerated free fatty acid release to enable weight loss & endurance exercise Ketogenesis Ketones as signals glucose output Ketones as fuel BOHB kcal/d BOHB for colonocytes glycolytic flux allergic mast cell degranulation Histone deacetylase inhibition Modulation of DAF 16/FOXO & SKN 1/Nrf

54 Benefits of Ketogenic Diet Increased efficiency ( work output and oxygen consumption in brain and heart tissue) Decreased free radical production ( the reduce form of co-enzyme Q = mitochondrial free radical production) improves recovery time Improved lipid panel ( HDL, TG, LDL particle size) Improve glycemic control ( insulin, HgbA1c, FBG) Better weight control ( BMI, BF%, Obesity) Reduced inflammation ( TNF-α, IL-8, MCP-1, E-selectin, ICAM, IL-6, PAI-1 Reduced neurodegenerative disease risk (Alzheimer s & Parkinson s Disease)

55 In Conclusion What is an athlete to eat? Which diet optimizes the athlete s performance and long term health?

56 What makes sense? FAT GLYCOGEN

57 Thank you!