Nutrition for elite cycling, from the lab to the musette

first of all like to thank the organizers for the invitation to present to you here today and as you can see from our title slide what we tried to do is is emphasize the translation of the science with the journey from a lot of the work research you’ve heard particularly from the morning session and and how that is actually practically applied in an elite cycling so as that as the title outlines from the lab to the musette so we’re going to kind of do a bit of a double-acting and i’ll that louise explained that but i’d first of all like to thank louise for attending and contributing to the session and formally introduced her Louise is the head of nutrition of the is and is going to share some of her wealth of knowledge and experience with you so over to you thanks David now we’ve seen a few nice models that have been provided to us bother the boffins in cycling and my equation for the nutrition model for um success in sport it’s much simpler than theirs you don’t have to log transform anything and what I’m going to try and show you is how each of these parts work so what we were to try and do is sort of work through the process of each of these different paths in my nutrition equation first of all looking at the background science behind some of these ideas particularly the kinds of research that gets done in in laboratory situations and often probing the mechanistic type of some underpinning that’s all really important but I think the next phase is which is the area or the domain in which I work which is trying to take some of that really led based very um physiological approach to to sports nutrition and then try and adapt it into more applied scenarios looking at research that tries to simulate the real event conditions and it really tries to work on this kind of period is very complicated rather than the very simplistic starting point that a lot of research comes from and this is the time when you’re not only just working with elite athletes sort of athlete groups but you’re also peps into the product development phase and so David will be able to talk about that from the industry perspective I think I’m a really important part of the whole equation though is this next bit this is this placebo effect and I think that’s a really important part of what we do and it’s not to be sneered at or thought of as just um of that students that’s why it’s uplands work because people just believe in them and I think the placebo effect is are really important part of what we should be trying to add to our work and that is the the confidence that you build into the to the interactions that you have with your athletes and that you know those best relationships can add a level of support for the athlete where he really or she feels really engaged and feels that they’ve got something special that other people haven’t got and it does help them with their performance because they do have that extra little bit that they feel and sometimes that involves a bit of a mystique and secrecy when it comes to whether you want to publish your research or share it all in a group with some of your competitors some service providers are in the audience but that’s all part of the fun as well and the success outcome is some being able to show that you can implement all those ideas in the field and that there’s some good performance results as a consequence but I think that whole idea of consolidating those relationships with the athlete and making sure this whole equation does work is part of what you should be looking for is the successful outcome so up Dave and I going to try and do for you is to take some of the things in sports nutrition and we’ve picked on carbohydrate supplementation agar Jenna guedes protein and go through each of those some scenarios the background research that led then into some more applied research or individualization of these strategies and then getting some feedback from riders and people who work in the trenches about how it works when they implement it we would have loved to have had someone there with us but in their absence we’ve been able to particularly David’s been able to grab some comments and some feedback from them to feed to you about how well that process works so I’m going to now hand over to David and he can start with the the background science to our first theme sports nutrition Thank You ease so for those that attended the session prior to this I’m going to try and do the same thing that James did in semis 50 years of researching in in five minutes but there’s a recent review that’s I believe it published ahead of print by standing within Cox that really nicely summarizes the the performance effect of carbohydrate supplementation and you can see here the chart outlines it but in red at the top the they collected 661 studies on carbohydrate and endurance performance which included almost 700 subjects in total and of all those studies over 80% of them show the performance effect and that effect increases with the duration of the exercise intensity so for those people that are that want reinforcement of the benefits of carbohydrate supplementation during prolonged endurance event it’s pretty clear but to

briefly give you the history and how we’re going to move through the story of the historical background and the scientific research into application it’s been known for a long time the carbohydrate is an important fuel during exercise and that the body stores a curl of carbohydrate are impacted by exercise and maximizing recovery those stores can ultimately have a significant impact upon endurance capacity and the early work that James alluded to earlier of N equals lab showing that maintenance of blood glucose actually leads to an increased endurance capacity that is obviously linked to a an elevated carbohydrate oxidation and a sparing of muscle glycogen which in 2007 was was consolidated in a CSM position Stan where they recommended 30 to 60 grams of carbohydrate per hour for exercising lasting more than one hour that’s recently been updated by IOC in the recognition of the need for higher amounts and Smith and colleagues have conducted a number of studies in this field particularly addressing the the additional benefit of multiple transportable carbohydrates which I’ll come on to a bit later on and in a nice multicenter study they showed a dose-response effect of carbohydrate intake during prolonged endurance exercise and somewhere in the region of 80 grams per hour appeared to be the optimal amount of carbohydrate intake although they did see benefits from 10 – all wept 120 grams more recently there’s been a lot of interest in the I guess the non metabolic role the carbohydrate may play in endurance performance in a set at a central level so increased amount of research has shown that simply exposing the oral cavity to carbohydrates can have a neurological effect which can impact upon motor performance and and thus endurance exercise performance and this is a recent publication actually linking the the effective mouth rinsing with a carbohydrate drink on brain motor function in total I think there are more now more than seven studies probably more since I’ve been speaking to you that show that endurance performance is enhanced with this particular strategy of simply exposing the mouth the carbohydrate but one important point to note is that those highlighted in yellow here there seems to be an attenuation sorry an accentuation of the effect if you’re in a fasted state so it seems to be more potent if the athlete is either depleted or fasted pre exercise what also seems to be important is the amount of time that the carbohydrate is exposed to the oral cavity so how long you you thrill the the carbohydrate your mouth and in this study they showed Sinclair and colleagues showed that ten-second gave the ten seconds of mouth swelling gave the the biggest benefit which is an important consideration if you think how you’re going to apply that and how achievable that will be in an exercising athlete and one one area that that’s of interest that perhaps may grow in this topic is that it’s well known in in the field of sensory nutrition that the chewing mastication the act of chewing can also have a similar impact upon brain function and motor performance so maybe the the drink format of the mouth of the mouth rinse isn’t the best maybe you need to be thinking at a semi-solid or solid form so I’ll hand back to Louise to tell you how that advice and then scientific evidence can be applied so I’m going to give two case histories where we’ve taken both an example of the metabolic role of carbohydrate to performance and the non metabolic role to see how we could take what was available in the scientific literature and start thinking of ways that we could make it more applicable to athletes in the trenches and the first case history I’ll give you is looking at the idea that it’s good to have these very high rates of carbohydrate going in for the prolonged events but you need to have your athlete being able to tolerate that from the gut point of view and also ensure that that fuel is being delivered to the muscle where it’s going to be used and I’m happy when I’m showing you these case histories it the data are not really just the important outcome because you’ve probably read these studies and know what I’m going to tell you in terms of the results but I’d like to sort of to try and share with you the story of the process of doing the research and how we’ve tried to say well there’s something that belongs in the laboratory but I needed to be over here and I need to find some way of bridging to that and in some cases you do a study that answers all the questions that you might need to get from A to B in some cases you’re just adding a little bit to the story and you’re still having to extrapolate a lot of the information and so I think the whole process of doing the research is just as important as some the so in the case of this story we were really finding a requirement to try and adapt our athletes to be able to tolerate these large amounts of carbohydrate during exercise and we wondered whether just simply practicing

it in training would allow something about either the behavior or the gut or some other physiological function to make the rider better able to tolerate and deliver the carbohydrate to the muscle where we wanted and we wondered whether some of that was about improving a gut reaction to intake or whether some of it was about the muscle learning to take it up we weren’t sure we’re also thinking about the story of the the Train Lo and the idea of well some of the sessions of training that you need to be doing to prepare yourself to compete need to be in that carbohydrate availability environment that you want for competition so how could we try and sort of period eyes into the training program some of these train heist sessions so the study I’m going to talk to you about is some part of Greg Cox’s PhD work and we started very much from the beginning and so I will apologize to in advance by saying this is an example of the kind of research you do when you’re at the beginning where you have to compare black and white so you do all of something or you do all something else and compare things and in this study we had four weeks of training under two different conditions in two different groups where we had one group which did all their training with high carbohydrate availability that was achieved by having carbohydrate fed during the exercise session at these high rates and we had another group that did the same sort of training they had less carbohydrate overall in their diet but they had certainly no carbohydrate going in around the training sessions there the during or just before and we looked at some performance changes and a whole lot of other metabolic adaptations immune system but one of the things we also looked at was the ability of the muscle to receive carbohydrate consumed during exercise and oxidize it and here the main results from that part of the study and you can see that at the beginning of the four weeks of training we’ve measured the amount of carbohydrate that was consumed during exercise that was oxidized by the muscle using a c14 tracer and the match or the groups the beginning were matched with their ability to oxidize the carbohydrate consumed during exercise but after the four weeks of training we found that the group that had consumed carbohydrate and all their training sessions had increased their ability to deliver it to the muscle and oxidize it by 14% and so we’ve been able to show we feel that there’s some evidence for the benefits of being absolutely some of your training sessions with carbohydrate being consumed in the way that you want to be able to do it during the race scenario so if I have a look at some what that study actually achieved well we’re able to show that you can enhance your muscles ability to be able to utilize fuel that’s consumed during exercise if you practice it in training we measured what was happening at the muscle level and couldn’t find any changes in glute 4 or or any of the other enzymes that might have helped explain it at the muscle level and we felt that the adaptation may have been occurring in the gut in line with some of the other data mostly from rats which has shown that when you consume more carbohydrate you up regulate your ability to transport it across the intestine with them certain transporter proteins and we also found that there was a potential that we could not just improve performance through the delivery of the fuel but also reduce the probability that there were going to be gut problems with high rates of carbohydrate intake during exercise because it was actually being absorbed and delivered rather than left in the gut where it could cause some discomfort so there was some benefits to doing that study but we didn’t answer a lot of the questions that you’d like to know in the field we certainly didn’t work out from our study how often you should be doing this kind of Train high training or how long the adaptations last so that in terms of getting that bottom line question of how should you period eyes this into the training program we certainly couldn’t answer it from this kind of study and so we’ve then had to make it do you go back and do more studies that tease out all those little bits of contributions or can you take your best guess and apply it in the individual situation and so far we’ve just gone with that individual situation response but hopefully we may go back to it in the future and included in future research the other case study I’ll talk to you about is the mouth sensing scenario whom we certainly saw the beginning of this literature appearing with the really robust results of this performance advantage just through putting carbohydrate into the mouth but most of those early studies were done in the fastest state and so we wanted to address the questions that will it will still work if that writer has had carbohydrate for breakfast if it’s a short event that we’re doing it or if you’re thinking about this having an additive effect in a long race where the carbohydrate consumed simply in the mouth can have an immediate effect on the brain and make the athlete feel better and this is why you see now riders in those last you know kilometers of the Tour de France even though

there’s not a lot of time for that carbohydrate consumed to get to the muscle to do something for the the fuel side of things certainly we see now the riders grabbing that last gel in the last you know 10 15 K because we know that the mouth feel is going to make them just feel better and taste better but we wondered if the fasted condition was important for getting the best bang for your buck out of this some idea and so rather than actually have carbohydrate could you accentuate the outcome by depriving the athlete of carbohydrate in the hours before or some period of time during a race when you wanted this effectively most felt and we also thought that this idea of being able to just have carbohydrate in your mouth and not necessarily swallow it could have been benefit for athletes who have gut problems or who have a period during the race where they may feel uncomfortable where at least you could say to them well pop it in your mouth and you least feel better and even spit it out and you won’t have to actually tolerate it for that period of time where you’re feeling uncomfortable and hopefully by being able to keep exercising hard you’ll be able to trade through that period and feel better and then start the process of styling it later so here’s Steve Lane and he as part of his PhD work did the study where we looked at both the Fed and fasted conditions we wanted to compare directly rather than looking at a whole lot of studies and trying to have each of them tell the story individually so we had four trials where we had our cyclists either have a breakfast of about two and a half grams of carbohydrate two hours before doing this their 60-minute cycling time trial and they either had the fast or fed condition and then in the time trial either had a placebo mouth rinse or a carbohydrate mouth rinse applied every about eight minutes during that that particular batter burst and we did do the ten-second numb mouth rinse idea here are the results from this study and what you can see here is that the mean power through the UM the 60-minute cycling time trial and if we have a look at the difference between the Percy bo rinse and the actual carbohydrate means you can see the improvement in performance when a pre-race breakfast had been consumed was less in terms then when the athlete had been fasted but the most important outcome is if you want to get the best bang for your buck having both carbohydrate breakfast and the carbohydrate mouserings tells you the story and if you don’t have some the carbohydrate intake pre-race you’re submitting yourself to a decrement in performance so the bottom line from this study is that we were able to confirm that these mouserings benefits are real and worthwhile that there’s a better relative improvement in performance if you are in a carbohydrate deprived scenario but the best effect the best absolute effect is when carbohydrate fueled so if you have athletes that for one reason or another can’t consume carbohydrate during exercise because they’ve got problems then at least you can say that putting the u-men might be useful but if you can actually swallow it it will be beneficial we’re talking about performance here we’re not talking about the training scenario that James mentioned before where you may not want to have it going in for the metabolic effect so we’ve got some good answers from our study but we still left some things unanswered around the protocols for consuming that or having the carbohydrate in your mouth but we also found from not just our study but from just generally talking in the peloton that a lot of people have misinterpreted this literature and one of them Cyprus actually think of all the other efforts think that you should have to spit this some carbohydrate out but part of the reason that it works is that you do spit it out so we’ve had to go back and retell the story to athletes to say unless there’s a gut problem in this performance scenario there’s no reason why you wouldn’t swallow the the carbohydrate it’s not part of the whole mystique that you need to get rid of it and that it’s actually more practical to swallow it that the reason that it hadn’t been fathered in these research trials was to completely divorce the idea that it could have been consumed and contribute to metabolic effects from the central effect now passed over in today so hopefully that’s been a nice step from the scientific evidence and the pinning carbohydrate supplementation and exercise performance and then some nice case studies where you can see how that is applied to an exercising model to give you a little bit of insight into the the product development side for a company like PowerBar is acknowledging that their users are insurance users and that they would benefit from the research on multiple transportable carbohydrates so many of the products are made with that mixture of glucose or glucose polymers and fructose and this is a region of metal ancestor but we were involved in and it’s showing that if we take all the studies that have

looked at multiple transportable carbohydrates utilizing that mechanism of get absorption through different methods through different transporters we see on average a about a 5% improvement endurance performance so the evidence has been taken and applied to a product format and that leads us to the recommendations and this is adapted from askers recent review on carbohydrate supplementation and exercise and it quite nicely summarizes what you would recommend to an athlete a cyclist competing in endurance event if the event is less than 75 minutes then small amounts of carbohydrate will suffice and that can even just be a mouth rinse as we’ve seen the performance benefit of that if we’re looking at one to two hours 30 grams per hour of either single or multiple transportable two to three slightly higher dose up to sixty grams per hour but if you go beyond the two two and a half hours the evidence shows that there is a benefit of consuming the multiple transportable carbohydrate if only to meet the intakes that have been shown to improve endurance performance so as we mentioned at the beginning we’ve had some feedback from one of the teams that competing in the Tour de France Orica GreenEDGE and they’ve been actually able to give us the reality the situation and that’s the purpose of this session here is to show you that in the scientific evidence there’s specific applied research but what’s going on in the real world and this is data taken from a stage of a recent stage race in Germany and the couple things I need to point out to you first of all it’s not a mountainous stage so the energy demands are quite different to the I guess the stereotypical Tour de France stage that involves excessive amounts of mountain climbing and what’s really interesting here is this is average power output during the race an accumulated energy expenditure so you can quite clearly see here the rider who went on to win the race his power up but was below 200 watts for the first five hours of the race and then a almost 350 watts in the latter stages so you can see that there’s a clear pacing strategy that is it’s beneficial for endurance performance and probably resulted in the in the wind the total amount of energy expended was in the region of four and a half thousand calories if we assume that there 2000 of that is with taking up within muscle and liver glycogen in a repeated athlete and we applied those recommendations I outlined to you if we were targeting that you know 90 to 100 grams of carbohydrate per hour products in front of you there on the on the Left that’s what it would look like so four bars six of the gels eight of the carbohydrate electrolyte drinks and then the variety some of the different formats but what happened in reality well the one on the one on the right here so two energy bars one that has a bit of a protein in fat content three gels four drinks and then the popular rice cake and paninis so that’s not I don’t believe that’s the case that the scientific evidence is a mismatch here I think this relates back to the demands of the event if you look here there’s a relatively low intensity for the first five hours he’s providing energy perhaps not slowly through carbohydrate for the first proportion of the race but when it becomes important to deliver that carbohydrate and the latter stages in the race that’s when the carbohydrate supplements are used and in this case the rider reported that he used the three gels in the last hour because he was aware of the benefit in addition to the fact that they contained caffeine so there’s a no genic property there – which leads quite nicely onto the the second theme that we wanted to discuss and that is the role of supplements in endurance performance and as a starting point I’ve taken the AIS and sports supplement program as an outline as to how best to categorize and and and take the evidence surrounding these products and they’ve quite nicely separated supplements into four distinct groups groups a through D and group a is the the ones that are scientifically validated there’s clear evidence to show a beneficial effect in the context of the sporting event Group B is the ones that I guess we get to hear about first they’re the ones that are some promising and there’s growing evidence but you perhaps wouldn’t be entirely confident if the existing evidence would enable you to put your mortgage on it if you’re recommending them to an athlete a group C is the ones that we try to I guess steer away from where there’s a lot of fad science behind it and perhaps the scientific evidence and the mechanisms don’t really stuck up and Group D is ultimately the ones that are either on the banned list or are of detriment to enough feeds help so if I just summarize and draw your attention really to this side of the table those in Group A you can see we’ve already alluded to sports food to the carbohydrate supplements and we’ll come on to talk a little about protein at the end medical supplements obviously they have a specific D depending upon an athletes and a cyclists need in a race but the ones that were I’m going to overview now are the ones that fall under this performance supplement so the ones that are pretty well known caffeine beta alanine bicarbonate introduced and creatine so very briefly I’ve tried to

surmise the recommendations based upon the evidence behind each of these supplements caffeine is as you well know is got a lot of established research behind it as a allergenic supplement the recommendation is three to six milligrams per kilo before exercise and the mechanism is believed to be via stimulatory effects and the benefits can be in the order of one to four percent in endurance performance creatine is more of their requires more of a chronic supplementation for a number a number of days before competition to increase muscle storage and it’s particularly beneficial to high intensity repeated Sprint type exercise in you would typically get in a flat stage of a cycling and the mechanism there is to increase the availability of phosphor creatine and the benefit in the order of one to three percent I’m sure everyone’s aware of sodium bicarbonate comes with a few GI issues and challenges to to address but the recommendations again here is 300 milligrams per kilo in the hours before exercise and its mechanism is through improving buffering capacity so high-intensity exercise where there’s an accumulation of metabolic acidosis as ISIL doses the benefit again in the one to two percent area feet alanine has a very similar mechanism to bicarbonate in that it looks to increase buffering capacity but at a intracellular level by increasing the concentration or the content of muscle carnosine that similar to creatine takes requires a more chronic supplementation period for up to six weeks but as you’re beginning to see the theme here as evidence to suggest that it gives a a 1 to 3 percent improvement in endurance performance and finally I guess the topical currently in the in the last few years at least is the nitrate-rich beetroot juice that has been shown to improve endurance performance by an effect upon oxygen cost of exercise and those performance gains have been again similar in the 1 to 3% so hopefully that nicely captures that so I could hand back to Luiz to show how you wouldn’t apply that so one of the research studies that we did done back in the 1990s involved caffeine used in a different way to what the literature was saying at the time now we already knew that some people had been using caffeine in different ways his Frank Shorter who in his book when he talks about his own gold medal win in 1972 outlines that he drank Coke flat coke at each of the aid stations we thought that was a difficulty but I can remember in mid 1990s getting a phone call from Dave Martin in the middle of the night from a race in the US he said you’re not gonna believe what’s going on here I’m at the feed zone and suddenly at about two-thirds of the race all the gatorade and the Powerade and the sports drinks being thrown out and the handing out coke you won’t believe it why would you do that there’s millions of dollars of money being spent on sports drink research and we know that cokes got great marketing potential but why would you why would you throw out the science and and go with this sticky black stuff and Dave being Dave he sat down and he typed out a survey for money he managed to pull off a little pilot study at that time feed zone and interview all the swan uist of all the teams to find out just how entrenched this this some idea of using caffeine in coke towards the end of the race was and we looked and said this is crazy why would you take such a small amount of coke of caffeine in code at the end of a race when everyone knows that the science behind caffeine is to take these larger doses an hour prior to the event so you’ve got large amounts of caffeine in the bloodstream and high circulating free fatty acids athletes are just so crazy we just have to show them a lesson and do the study to show this is just stupid so we did our study whether we had a cycling protocol which had a two-hour steady-state protocol followed by a time trial where we could measure performance we tried to set up the scenarios where athletes would be practicing good nutrition guidelines with having this pre event meal they drank sports drinks throughout the the two hours of that tomtron trial but actually at about some one about 100 minutes into the steady state portion we changed one of the interventions in this trial because we basically wanted to look at the effect of just having the sports drink all the way through with having the standard dose of caffeine taken one hour prior to exercise versus having that same amount of caffeine spread throughout the 120 minutes of the steady state and in that that last trial or a fourth trial we had the sports drink being switched over to the coke so compared to our perceive o time trial time about some 30 minutes we found that the large doses of caffeine whether they are taken before the event in the standard way according to science at the time or spread throughout the race had a three percent improvement in performance and the coca-cola had a

three percent improvement in performance so we looked at that we said all of that of course you know that was a double-blind did they knew they were getting the coke in the last part of the race so we went did the study again and this time we had everybody having sports drink for that first 100 minutes and then at the hundred minute time point everybody switched to a cola flavored beverage in one case it was just an 11 percent carbohydrate solution recognising that that the coke carbohydrate content was higher than the sports drink another one we had the addition of the small amount of caffeine to the six percent drink and in the other condition we had the real thing so we had extra carbohydrate and that two milligrams per kilogram of caffeine being applied towards the end of the race and we found a 3% improvement in performance now tell you when you replicate your own results with the exact same outcome you are so lucky because that doesn’t often happen in real life but it really told a convincing story this Chansey of this about 3% improvement in performance with caffeine in some you know really quite robust and because of the design we did with the Latin squares were able to tease out that most of the benefit of the coca-cola came from the caffeine content very very small but there was a little bit of an effect having the extra carbohydrate towards the end of the bat which we now can explain why so what we learned from this study was that sometimes athletes already know a lot more than we do and our role is just merely to confirm what they already know or perhaps explain why it works and that we started to contribute to what is now quite a large literature that shows that caffeine is beneficial for sports performance in much smaller doses than have been previously used and it’s particularly beneficial in very small doses when it’s given just before the onset of fatigue that it doesn’t have this metabolic role where you need to have a large time for the the caffeine to be in the circulation and causing metabolic effects and so I guess one of the things that we’ve we learned from this study was also that the way that athletes should use caffeine in sport has got much more similarity to the way that we use it in everyday life I mean none of you got up this morning and had six milligrams of caffeine per kilogram body weight and said that’s it for the day you’ve all just topped up your caffeine over the time as you’ve got a little bit tight so we now can probably draw more on our own experiences of caffeine use in our everyday life when we’re informing what athletes should be doing so there are a lot of things that we didn’t answer with that study but it certainly made us more aware of going back to some of the things we do know about caffeine from our own experiences or other research applications to inform the way you use it in real life now the other thing we need to think about the supplements is in many cases some of the kinds of ways in which supplements work or the kinds of events that they target aren’t unique that in some events you could have a number of different kinds of Aegina Guedes which could address the physiological limitations to performance and so the big question is if you put them all together do you get an additive effect David showed is quite nicely that we can expect a 1% or 2% improvement in performance but if you stack them all up would you end up with a 15% improvement performance by having them all unlikely but we wanted to get to the bottom of how important is it to have a strategic layering of the use of supplements when more than one of them could be a benefit to your kind of event and so the case history that Island give to you now is one that we did prior to the London Olympics where we wanted to look at the the combination of things that we might think would be beneficial for the cycling time trial where we thought that the mouse rinks and caffeine and nitrate might all independently enhance some the time trial outcome we wanted to see if it worked when they all went together we also wanted to see if there were differences between the outcomes for men and women and we wanted to apply it to the specific scenario of the London time trial event so Steve Lane came to the rescue again and we were quite close to London that time we’d gone past the the practice events theum ones that were held in the year prior to the Olympics and so when we did our study with the competitive male and female cycles we were able to recruit we didn’t just get them to do a 60-minute time trial as we’ve done in in Steve’s earlier studies but we actually were able to get the profile of the London time trial course again that was a Dave Martin special and it probably wasn’t done it was done transparently but it was all done legally so he had all the the bits and pieces of that course that were programmed into our Gompers and so we had our cyclists actually compete over the 29k for the females or the 44k distance for the males we had them do the math rings in all the trials because we believed that that was going to be beneficial but one of the things we wanted to work out was how we would do it practically and we didn’t have a lot of thumb time currently something that was high-tech but we came up with this

idea of using the gel blast that could be any cheek which you could just move around from time to time and make different parts of them mouth contact but with our four trials we either had our subjects have the the modest doses of caffeine that we now think is probably the optimal dose we took it in the form of a gum again we’re trying some new application of a different kind of a product and we use the beetroot juice using the high potency nitrate beetroot juice about eight Mele moles of nitrate taken two hours prior to the event so just jumping to the results which are in press at the moment in the applied nutrition metabolism Journal and you can see that compared to the placebo trial or a non caffeinated trial adding our three milligrams of caffeine gives us again very robust result of a three percent improvement in the time trial performance I should say there are no differences between males and females so what I’ve done is collect the data and this is some figure here and because of the differences in the distance and the differences of them power outputs of the men and women are from standardized and just to a percentage of their maximal aerobic power but what we failed to find and other people have them also had the same outcome is that there was no effect of the beetroot juice when it’s given as a single acute dose prior to the time trial on performance so there was no additive effect or no effect in its own so the learnings from this study were that the the caffeine effect is robust the gum was a very useful way of being able to take it we didn’t find any differences in the in the effect of sex on the caffeine benefits but we couldn’t detect any effect of the beetroot juice at that use of just a single acute dose and we also got feedback from the subjects that they felt that it was practical to be able to use the gel blast and move it around to try and achieve the mouth rinse effect because obviously in the time trial you don’t have someone reaching down for the bottle and rinsing with some a fluid solution so the unanswered question in this some scenario was well what do we do with the night drive story what do we tell our athletes going into London we didn’t find an improvement with the beetroot juice is that something about beetroot juice per say the athletes per say the event per se or that we had to deal with the right protocol we’ve still interested in beetroot juice we still probably believe there is some benefit to elite athletes that maybe they have to use it in a different protocol which might involve a loading phase rather than just the single acute event on the morning so some benefits from doing the study but still many unanswered questions so moving on to some feedback from riders that will be competing in the tool as of Saturday so first of all the utilization of caffeine it’s really interesting that they’re very aware of the ergogenic properties but they’re very selective of how they use this so there’s some concern over using it habitually in large dosages like you find in sports supplements and what they try to do is maximize the benefit in and around that the key moment in a race to the closing stages of a race there’s also concern about impact upon sleep and we heard how important sleep is for recovery so if you’re taking very high doses of caffeine at the end of the stage that can subsequently impact upon your recovery process and if it impairs sleep then that can be detrimental in a stage race it’s also some perception that using a caffeine chronically can increase carbohydrate sedation which you would confer an inefficient outcome in in exercise performance this is just an outline of a training plan from a from a cyclist and you can see the pee realization and the general phases and how these these teams and riders are now period izing their nutrition and in this case it’s relatively straightforward with a supplement but they they factor in the period required to load with this particular supplement with vitelloni and to ensure that the maintenance phase coincides with the competition phase so they’re getting the benefits from the ergogenic properties of that supplement and then allow a washout period when there’s a period between competition the carbohydrate mouthwash story is Louise’s already heard to it but that feedback from the riders on this team was that when they tried using the chew or the the gel blast they found that it impaired ventilation because having a sweet item in your mouth and when you were exercising at relatively high intensity that could arguably have a negative effect on performance so they’ve moved to a model where they would prefer to swell the mouth with the carbohydrate drink so it just gives an example the inter-individual variability in these these particular genic aids in performance so finally we just wanted to summarize another aspect of of applied nutrition and one that is gained a lot of interest in in the in the field of strength and power training but which is quite nicely outlined here in this meta-analysis from Naomi Cermak and Luke van Lew you can see that in training I’m trained

individuals over time because this I know this area of research is often criticized for only looking at acute changes and muscles and synthetic changes but in this review they’re quite nicely combined also does it look at more chronic affect on muscle strength and muscle hypertrophy but it appears to be effective but as I mentioned this is predominantly in resistance exercise based models and there is limited evidence for a comparable effect in endurance exercise however there are a few studies that have shown that my afib release of the fraction of protein in the muscle that is important for muscle contraction is synthetic rate is increased following both concurrent so strength and endurance training and endurance training alone so Breen and colleagues here on the Left showed the tear after with with carbohydrate and protein you get an elevation in muscle protein synthesis but no change in mitochondrial and then here you can see the elevation with with the protein in in my fibula again so it might be that the timing of protein synthesis for the mild fibula and mitochondrial fractions differ and often in many cases this response is only measured up to four hours after exercise it also could be that the mitochondrial protein content which we know is important for endurance exercise is it’s proportionally smaller amount of protein in the muscle so this methodologies in sensitive enough to pick it up there has been one study looking at the impact of protein supplementation post training sessions on endurance performance from Thompson and colleagues in New Zealand and they’ve been really tough in protocol where they gave got a group of cyclists to train intensely for three days and afterwards really hit them hard with it with a protein supplement sixty grams of whey and 23 grams of leucine and anyone knows any that quantity that is pretty high and in their performance assessment they didn’t just look at a time trial performance they were interested in a more ecologically valid model where people riders actually did repeated sprints and they found a a higher power output over a ten repeated sprints and Sprint’s with between one to two minutes so an endurance sprint as opposed to a traditional sprint but that’s really the only evidence out there currently that shows the performance impact that group has gone on to look at the dose response and see do you really need these mega doses in endurance sport and they’ve actually shown me looked at a dose response model following endurance training on endurance session and this is the kind of dosage that they did in the in the training study and it appears that if you take the recommendations that come from the resistance strength training so they’re the lower dose of whey protein or dairy protein 20 to 25 grams with a coalition of leucine in the order of 5 grams we know that amino acid is important for muscle protein synthesis you don’t get any more much more benefit by tripling the dose so it appears from the the early research in this field that the recommendations for resistance exercising are are potentially relevant to endurance so we’ve um got into the protein research area as well and I don’t have anything that’s really specific to the cycling scenario for you but one of the questions that we have tried to address does have some relevance to cycling in that we were interested to try and look at that protein dose response when an athlete might be in a negative energy deficit or a low energy availability scenario and that’s probably bread and butter for most dieticians at at some point you’re working with an athlete where they’re needing to lose body fat and you’re wanting them to reduce their energy intake so we chose to look at the effect of resistance exercise as our exercising model because we knew that we could be able to pick up the changes in the my fibula protein content just because it’s been well developed and we feel that the sensitivity of the changes or the sensitivity of the methodology could meet the recommended um changes that we were looking for so we went in and we had our athletes look at some protein synthesis post resistance exercise in four situations one when they are in their normal energy balance scenario and then over three different trials where though in a negative energy balance where we took about 500 calories out of the day both by reducing intake and increasing some exercise and so in that very mild energy deficit we wanted to look at was their effect of the energy deficit on muscle protein synthesis per se and in the response to resistance exercise and we did the three different scenarios of having no protein 15 grams of protein and 30 grams of protein being fed we also did it with males and females because the stage there was no data on females to show their dose response and we wanted to also have a look at the effect of body weight because so far most of the recommendations for protein are in absolute amounts we recommend you know 20 gram dose of protein and yet that same advice is given to a 50 kilo

gymnast to 120 kilo rower so we wanted to see if we could over this with a reasonably large sample size and a whole range of body weights see if you could find a better correlation between protein synthesis dose protein intake and body mass or free fat fat free body mass so here’s just the the bottom line results and this is in press in the moment in American Journal of physiology so here we have the conditions of energy balance and this is looking at muscle protein synthesis at rest and you can see even with a very mild energy restriction added to the day there’s a reduction in resting muscle my tubular protein synthetic rate but you can rescue that by doing some resistance exercise so that might be useful for people who are trying to lose body fat but not wanting to to lose any of their muscle mass that doing some resistance exercise can help you to regain that decrement to the muscle protein synthesis rates when we looked at the amount of protein synthesis in response to the different protein doses we found that there was an increasing fractional synthetic rate response to the increasing amount of protein and it hadn’t topped out at 30 grams so it didn’t find that magic amount but we found that you need more protein when you’re in mild energy restriction to a suit receive the same optimal response to about of exercise and we did find by looking and plotting the body mass outcomes that there was a relationship between the protein synthetic response to a certain amount of protein and body weight and particularly fat free mass and so we now recommend that you would give dosage with some recommendations for protein intake in terms of the the muscle mass or the body mass of the athlete there isn’t a sex difference but it does confirm the message that we’re giving to athletes that if there are in weight loss campaigns or in an energy deficit because of high volume training that you do need larger amounts of protein both over the day and particularly in each of those feelings that you spread over the day to achieve the maximal respond so we still got a lot of it questions that we need to answer in terms of actually 40s that optimal dose we don’t think it’s thirty it could even be higher as I said because we were still seeing increases even when you look at the fat free mass relationship that we didn’t find the topping out of the optimal dose in energy restriction and of course we’ve only looked at very mild in and do restriction and so for athletes who are even in larger amounts of energy deficit the situation may be even more extreme so to conclude on this section on protein there’s some feedback from riders and staff it’s at the top that I’ve tried to outline the current practice post post race in which I guess these riders will be going through posts each stage for the coming weeks so typically despite the the lack of evidence for endurance sport there is an engagement and an appreciation of the value of protein in a recovery beverage following exercise the amount is can exceed 430 grams so beyond that 20 but arguably may be relevant in light of the research that Louise alluded to an energy deficit then obviously there’s travel to the hotel there’s a protein intake that coincides with dinner so this is in this sort of four hour window and then many of you may well be aware now of research emerging on overnight protein or taking a bolus of protein before sleep on the understanding that during sleep your body is trying to recover and if it doesn’t impact upon sleep it may be a great way to maximize recovery and the feedback there is that’s very dependent upon the riders performance go up so I guess it was a rider that’s interested in winning the oval race then it might be a strategy that that’d be worth exploring and also whether that anyone is undergoing a weight management strategy so if there is energy deficit and there’s a need for increased protein intake and it might well be worth considering one feedback we had from the team was the chair with the improved nutrition understanding in an endurance sport it is no longer the case perhaps that people are losing significant amount of weights I know it cases like the Grand Tours there are extreme examples but in the shorter stage races and the one-day races it might be not uncommon that athletes and riders come out gaining weight and I think that’s an important consideration when it comes to applying these recommendations in elite cycling and this I guess a good analogy here that Louise mentioned is in in female cyclists and pubs in and younger cyclists who cover less distance typically have lower energy demands have more time to recover in the day but are utilizing the recommendations perhaps targeted at the more severe prolonged endurance events I like the tour so to conclude I guess our key message is to underline the equation that Louise presented at the beginning that there is a scientific basis behind the recommendations that any applied practitioners is utilizing it is should

be accompanied with practice practice in training and a better understanding of what is suitable to that individual in that environment and important to acknowledge the spasibo effect that the given delivered in the right ways it’s not a bad thing it’s potentially more powerful and useful in communicating and convincing the coach and the rider of the benefits and hopefully that will result in success and the key message really for me is that you don’t take the scientific recommendations literally and fill out your bike like this so thank you very much for your attention and I know some of the speakers are here from the first session so we’re happy to take any questions thank you any questions on carbohydrate specifically I mean that’s an excellent question so I can I can bore you another time with the regular standard power bar is currently submitting a health claim for this and yes I guess one that having been an academic scientist and the applied practitioner now working in industry there’s a lot of red tape and you would be amazed that you know we sit here and listen to a lot of feedback upon recommendations based upon scientific research but that’s literally only 20% of the journey as to how you then get to a product and then unable to make these claims one of the frustrations that you have in Europe which is a very very strict regulatory environment is there’s no subcategory for sports nutrition so you have to show a health benefit and the health benefit is improved performance now you’re all aware that there’s a whole host of mechanistic data out there showing the benefit of carbohydrate but as you saw from the multiple transportable research there’s only six studies so you’ve got to convince this regulatory authority that that is a health benefit so it’s a challenge and maybe it’s a marketing challenge rather than a regulatory one but it’s a good point Berninger exactly if they attention individuals clothes add another point to the last question before I answer the second question and that I think there’s a real problem at the moment that we’ve got a very big bias against carbohydrate because as I said in the previous talk this is a black and white scenario and in the world that you’re either for or against carbohydrate rather than knowing how and when to use it I guess one of the reasons about making health claims is that we might say that it’s very good for the performance aspects of sports nutrition but there’s times when as James is shown is you don’t want to be having the carbohydrate in the adaptive side of sports nutrition so to come up with the perfect statement that gets that right and that could go across the elite athlete to the person who’s exercising in the gym to lose weight I think it’d be really difficult to find the the scenario that you can do that in that simplistic form but because they’ve got thinner so much of this vested interest trying to tell us that carbohydrate is evil you know we we’ve got problems and I mean I was here for the young the London Olympics and I remember that panorama documentary that came out you know just on the eve and the British Medical Journal articles and I just feel aggrieved that you know the the title of that British Medical Journal article was 40 years as sports and nutrition and nothing to show for it I mean that’s tabloid isn’t it but it’s just a really interesting world that we live in at the moment where you know what evidence can be just completely rubbed out and and and completely explained by the by this industry bias and all of us in this room are somehow captured by you know some evil industry that it’s made us thinking and why that’s not truthful so that’s that’s what ends of that question what was sorry I’ve lost the thread of the question oh and so that that’s I guess the next part of it that um the reason that it’s useful in the scenario of the prolonged exercise is if there’s a limit to the amount of intestinal absorption of one particular type of carbohydrate then finding another carbohydrate with an alternative absorption mechanism is a smart way of being able to get more across I think this is a very in a specific scenario for where the fructose role in sports nutrition has a place but that’s a very specific scenario and I think in the bigger broader mixed message of on community nutrition whether again there’s so much some negativity about fructose and rightly so when you think of the amount of the high proctors corn syrups and the consumption of fructose completely out of context and in much larger doses than any of us if you know whatever recommend then it’s really difficult to again get that message across when you know the world is all about 140 characters these days so it’s almost impossible to have the complexity of what we know being

able to be summarized so I’m so insanely hella questions Louise you’ve talked about using and acebos and a placebo effect without the internet so practical said in your experience do you find that continues to work or do they sort of start to get wise to when I talk about the perceiver effect I think I’m talking about the active confidence around using evidence-based products I’m not talking about using just nonsense and saying oh that’s better than nothing or you know I’m tricking my athlete into them to doing better because they believe in Smarties or whatever I’ve given them I believe that it has to be an evidence-based element to start with and then you add to that the whole experience and you know part of the placebo effect is the athlete knowing that they’ve got you in their corner that you’ve spent a lot of time together coming up with something that works for them that they feel special that they’ve got an individualized approach that’s best what I’m calling the perceiver effect but the really interesting symposium that ACSM that I attended this year about the placebo effect and one of the things that’s driven me mad about the supplement um practices a lot of athletes is that even if what they’re using you know all nonsense and they’re they’ll tell you that it’s all about just getting the placebo effect I don’t think they get it well because it’s so chaotic and frenetic the way they use supplements they using a bit of this and a bit of that and something else added and they’ve forgotten this one and and so I don’t think that they’re maximizing that whole way in which you could build up a level of confidence about at the symposium at ACSM a neurologist spoke to us about how the placebo effect only works if you’ve had a preconditioned response to an expected outcome so you only get the placebo effect truly by having some scenario in which you have developed the outcome that you want for so that the improved performance or whatever and you’ve patterned those pathways into your brain in association with something and then independently but that same repetitive activity will achieve the improvement in performance and so there’s a lot that we need to now know about how we build up the best placebo effect but it is a very real effect but it can be applied better than we’ve been currently using it so I’m certainly thinking about going back to some of my you know friends who’ve got connections in this area to see if we can start doing some research on how to get the best out of that perceiver effect but it certainly isn’t just a matter of saying I feel special I’m having something that someone else hasn’t got therefore I’m going to perform better okay I think we’ve got one more time one more question is yeah it gets very bitter and so I guess what we learned to do was to help the athlete to chew it for the certain number of minutes before it becomes bitter and we also did it serially so that we didn’t take it all the one time we took like a little bit then a little bit in a little bit in a closed period of time so that we never got to the point where he had a whole mouthful of very bitter tasting product but we did find that people have completely different reactions to that bitter taste and I was telling Ron more about this and he said oh you can explain that just by asking people if they take sugar in their coffee because those people who like a bit of taste don’t have sugar in their coffee and they’re quite happy to have the caffeine taste predominating whereas people that hate that bitter taste and have to mask it will be more sensitive to it when they have it just in the gum okay thanks for your attention and thanks for your questions I don’t eat into your Thunderstone anymore pun intended so thanks and enjoy the rest of the conference