Ketogenic, Paleo or High Carbohydrate Diet What is an athlete to eat? Marlia Braun, PhD, RD University of California, Davis
Disclosures No conflict of interests
Objective Review the available metabolic fuel sources in the endurance athlete for the following diets: High carbohydrate diet Ketogenic diet Paleolithic diet
Diet Definition High Carbohydrate 60% CHO, 15% PRO, 25% FAT Ketogenic 10% CHO, 20% PRO, 70% FAT Paleo 30% CHO, 30% PRO, 40% FAT
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
High Carbohydrate Diet 250 Work Time (min) 200 150 100 Mixed High carb 50 Low carb 0 0 10 20 30 40 50 Muscle glycogen (grams/kg/muscle) Bergstrom J et al. JAMA 1972 21(9);999-1006
GLYCOGEN glucose GLYCOGEN: 2000 calories stored carbs in muscle and liver. Glycogen (glucose) is a source of fuel during -- lasting about 2 hours!!
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)
High Carbohydrate Diet Blood glucose CHO recs of 30-60 gm/hr up to 90 gm/h in ultraendurance (JADA 2016) Exercise duration (minutes)
Intensity Alters Fuel Source
High Carbohydrate Diet Glycogen is fuel for brain and muscles Maximizing glycogen stores are key Carbohydrate consumption during exercise is necessary for performance
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
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)
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)
Ketogenic Diet History 1980 6 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 6 1983 9 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
Ketogenic Diet Endurance athlete examples Tim Olson
Ketogenic Diet Endurance athlete examples Zach Bitter 100 mile Tack Record and 12hr track world record
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.
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
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!!
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
Body Fuels, Adult Male (70kg) Kilogram Kilocalorie Adipose Tissue 12 110,000 Muscle glycogen 0.4 1,600 Liver glycogen 0.1 400 Glucose (extracellular fluid) 0.014 56
Ketogenic Diet Energy Availability E F E F 2,000 calories >10x 20,000 100,000+ calories
Insulin effects on fat oxidation Carbohydrate +
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 0 100 200 300 Insulin (pmol/l)
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
KETO-adaptation How does this happen? 2-4 weeks of carbohydrate restriction < 50 grams total carbohydrate per day 70% of dietary fat
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
The Ketone Zones
The Brain on Ketones βohb has shown to be preferential utilized by the brain Owen et al. 2005
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 100-150 grams of ketones per day 4.69 kcal/gm Annu. Rev. Nutr. 2006.26:1-22. Downloaded from arjournals.annualreviews.org by CAPES on 04/24/08. For personal use only. Cahill G. 2006
The Brain on Ketones 5.5 mm 70 mg/dl 4.5 mm 27 mg/dl (Aoki TT and Cahill GF 1979)
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
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.
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%
FASTER Study (Volek J et al. 2015) HCD (n = 10) LCD (n = 10) Mean Range Mean Range Age (yr) 33 22 40 34 21 45 Height (cm) 173.9 167.1 182.0 175.7 165.1 189.4 Body mass (kg) 66.5 57.9 79.9 68.8 55.5 81.6 Body fat (%) 9.6 4.7 15.5 7.8 4.5 12.3 Fat mass (g) 6,513 2,774 12,102 5,454 2,953 8,780 Lean mass (kg) 57.3 49.4 64.2 60.9 50.2 71.7 VO 2 max (ml/kg/min) 64.3 54.8 76.0 64.7 59.6 71.1 VO 2 max (L/min) 4.25 3.34 4.86 4.41 3.78 4.95 Competitive running experience (yr) 9 4 22 11 1 25
FASTER Study (Volek J et al. 2015) * P value <0.001 HCD (n = 10) LCD (n = 10) Mean ± SD Mean ± SD Energy, kcal 3174 ± 611 2884 ± 814 Protein, g 118 ± 38 139 ± 32 Protein, % 14.4 ± 3.5 19.4 ± 2.4* Protein, g/kg 1.7 ± 0.4 2.1 ± 0.6 CHO, g 486 ± 128 82 ± 62* CHO, % 59.1 ± 10.2 10.4 ± 4.9* Fat, g 91 ± 31 226 ± 66* Fat, % 25.0 ± 7.4 69.5 ± 6.0* Saturated fat, g 21 ± 10 86 ± 22* Monounsaturated fat, g 29 ± 14 82 ± 42* Polyunsaturated fat, g 18 ± 9 28 ± 27 Cholesterol, mg 251 ± 249 844 ± 351* Fiber, g 57 ± 27 23 ± 17* 6x 2.5x 4x
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
FASTER Study (Volek J et al. 2015) Ave. = 1.54 gm fat/min 2.3 fold Ave. = 0.67 gm fat/min
Achten et al. 2002 Oxidation Rate Consensus Curve
FASTER Study (Volek J et al. 2015) 70.3 VO 2 max 54.9 VO 2 max
Peak Fat Oxidation Differences 120 Peak Fat Oxidation During Exercise grams of fat/hour 100 80 60 40 20 0 Keto-adapted Keto-adapted 112 104 90 92 74 69 60 52 40 28 24 11 Venables 2005 Phinney 1983 Volek 2015 HCD Volek 2015 LCD Lowest Average Highest
FASTER Study (Volek J et al. 2015) RER 0.86 ± 0.08 RER 0.72 ± 0.05 88%
FASTER Study (Volek J et al. 2015) Ketones 3 fold higher in LCD
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% 56 53 Pre-muscle Glycogen Post-muscle Glycogen
FASTER Study (Volek J et al. 2015)
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
Paleo Diet What happens when the diet is evenly mixed and not predominate in carb or fat?
Dietary Protein and Carbs by Diet Type 60 50 Or n SAD Orn = Ornish diet Medit = Mediterranean diet Paleo = Paleolithic diet WFKD = Well formulated ketogenic diet SAD = Standard American Diet Carbs (%) 40 30 Medit Paleo Generally accepted upper threshold of Low Carb 20 10 WFKD Nutritional Ketosis Space 10 20 30 40 Protein (%) 0.8 1.6 2.4 3.2 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
High-Carb Diet Diet-Driven Regulation Low-Carb Diet
Which is Best? What about
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
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 300-600 kcal/d BOHB for colonocytes glycolytic flux allergic mast cell degranulation Histone deacetylase inhibition Modulation of DAF 16/FOXO & SKN 1/Nrf
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)
In Conclusion What is an athlete to eat? Which diet optimizes the athlete s performance and long term health?
What makes sense? FAT GLYCOGEN
Thank you! mmbraun@ucdavis.edu