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Fueling the Triathlete

Current, practical and evidence-based guidelines for

triathletes of all sizes and levels

Cindy Milner, MSEd, RDN, CSSD, CSOWM

Cayuga Medical Center

Sports Medicine and Athletic Performance

Cayuga Center for Healthy Living

Ithaca, NY

Financial Disclosures

• None

Current Sports Medicine Reports, 2017 Jul/Aug;16(4):240-246. Objectives

• Provide up-to-date, evidence-based and practical

sports nutrition and supplementation guidelines for

triathletes

• Include guidelines for athletes of varying abilities and

sizes

• Focus on race day fueling!

Defining “Fueling”

• Ingestion of “fuel” during the race to produce and

“restock” energy stores– Includes nutrition and hydration consumed in the days

leading up to the race and morning of the race

–Goal of fueling is to maximize race

performance

Goals of the Sports RDN/CSSD

Provide recommendations and guidance that is:

● Individualized○ Practical and reasonable for the individual

● Current

● Evidenced-based

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Triathletes –

Many Variables

• Recreational to elite

• Age

• BMI

• Health and fitness

status (including post-

bariatric surgery

athletes)

• Race Variables

(length, course,

weather)

• Participant’s goals– compete or complete?!

+

Fueling the

Triathlon –

Race Day

Concerns

Running out of fuel (hitting the wall, bonking)

GI problems (cramps, bloating, diarrhea)

Dehydration to level that performance is impacted

Carb Supercompensation Prior to Race

● Purpose - normalize liver glycogen stores prior to competition

*consider distance of the Tri and expected intensity of competitor when recommending

CHO loading amount

● Ex. 155 lb (70 kg) elite athlete before Full distance Tri○ 10 -12 gm/kg/day = 700 – 840 gm CHO/day for ~2 days prior to race

Medicine & Science in Sports & Exercise 48(3):543-568, March 2016

AND, ACSM, Dietitians of Canada Joint Position Statement

Nutrition and Athlete Performance, March 2016

Triathlon Duration Time before race CHO Intake Goal

Sprint ~24 hours >6 gm/kg/day

Tri longer than

90 minutes*

36 – 48 hours 10 -12 gm/kg/day

RACE DAY!

Pre-Race Fueling

Goal – “top” off glycogen stores

• Consume 1 to 4 gm CHO/kg in the 1 to 4 hours prior to the race

• Closer to race, choose CHO rich foods lower in fiber, fat and protein

• Liquid meal supps may be good choice due to more rapid GI emptying

Medicine & Science in Sports & Exercise 48(3):543-568, March 2016

Pre-Race Fueling Example

Female Ironman® (Full 140.6 m) athlete

• 57 kg (1 to 4 gm/kg = 57 to 228 gm CHO)

• 3 hour prior to race (4 am)

Meal:– Large mug tea + milk

– 3 English muffins

– 1 banana

– 2 slices white bread with jelly and cheese

– 1 slice white bread with honey and cheese Jeukendrup.http://www.winninglane.com/fi

les/Fuelling_an_Ironman_World_Champio

n.pdf

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Fueling DURING

the RACE!

Exogenous

CHO is

ergogenic

during

exercise

● Spares skeletal

muscle glycogen

● Prevents liver

glycogen depletion

>> hypoglycemia

● CNS benefits

because low CHO

availability during

racing:

○ impairs pacing

○ motor skills

○ concentration

○ increases

perception of

fatigue

In Ironman distance triathlons, higher race

CHO intake is corelated with faster finish times.

Carbohydrate Needs for Triathlon Fueling

Getzin AR, Milner C, Harkins M, Curr Sports Med Rep. 2017

Potential role of carb rinse

• Frequent mouth rinsing with CHO solution every 5 to

10 min with ~10-sec contact between the oral cavity

and a CHO source

• Elicits performance benefit which is believed to occur

due to the neural effects on decreasing fatigue

• Especially potential

benefit if GI upset, nervous

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Multiple Transportable Carbs? A Quick Review

• Monosaccharides:

– Glucose (Dextrose)

– Fructose

– Galactose

• Disaccharides:

– Sucrose (Glucose + Fructose)

– Maltose (Glucose + Glucose)

– Lactose (Glucose + Galactose)

• Longer-chain CHO such as:

– Maltodextrin* (oligosaccharide -

glucose chain)

– Starch (longer chain of

glucose)

– Fiber

*absorbed similarly to Glucose

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Why Multiple-transportable CHOs?

● Use multiple-transportable CHO sources for

exercise lasting longer than 2.5 hours

● Use a mix of glucose/glucose polymers and

fructose CHO sources vs. glucose alone

○ Improved GI tolerance

○ Increased oxidation of exogenous CHO (sparing

of endogenous CHO)

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Endurance Exercise (1 hour – 2 ½ hours) 30 - 60 gm/hrUltra-endurance (> 2 ½ - 3 hours) 60-90 gm/hr

Food/Drink/Product (portion) Carb (gms) Source of Carbohydrate

Gatorade Original Sports drink (12 oz bottle) 20 Sucrose (=glucose + fructose) and dextrose

Honey Stinger “Waffle” (1 waffle) 21 Starch (chain of glucose units), sucrose, fructose, glucose NOTE: 7 gm of fat

Gu Roctane Ultra Endurance Energy Gel (1 packet) 21 Maltodextrin, Fructose

Perpetuem (2 scoops powder) 54 Maltodextin, Energy Smart® (fruit juice, natural

grain dextrin) = fructose & glucose

Heed sports drink powder (1 scoop= 29 gm) 26 Maltodextrin, Xylitol

GU Brew - Electrolyte Brew (2 scoops) 26 Maltodextrin, fructose

Sports beans (1 packet) 24 Sucrose and fructose

Jelly Beans (37 pieces) 35 Sucrose, fructose + glucose

Dried Figs (1 oz - ~1/4 cup) 18 Fructose, glucose (contains ~3 gm fiber)

Fig Newton bars (2) 22 Starch (chain of glucose units), sucrose, fructose,

glucose

Banana (1 medium) 30 Glucose, fructose, fiber

Bagel (1 large) 60 Starch, glucose, sucrose (fructose + glucose),

?fiber

Triathlon: Duration: Carb Amount: Notes:

Shorter duration <1 – 1.5 hours None or small

amount

or carb rinse only

Not needed by

most

Endurance ~1.5 - 2 1/2 hours 30-60 gm/hour

Carb rinse an

option

Practice in

training.

Ultra-endurance >2 1/2 – 3+ hours ~90 gm/hr

(especially in

longer distance

triathlons)

Carb rinse an

option

Practice in training

Requires multiple

transportable

carb sources.

Recap – Carb Recommendations for Fueling During Exercise

Case Example

• 30 yr old professional female triathlete

• History of GI problems

• 57 kg (123 lb), 176 cm (5’9”), BMI – 18.2

• Competing in Kona Ironman

Jeukendrup, A. Chap. 15, http://www.winninglane.com/files/Fuelling_an_Ironman_World_Champion.

Case Athlete’s

Nutrition Goals For Ironman World Championship

1) Avoiding major GI distress

2) Providing energy throughout the event and in a way

that does not exacerbate GI distress

3) Maintaining fluid balance

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>2.5 hours – CHO goal ~90 gm/hour, multiple

transportable CHO sources

Jeukendrup, A. Fueling an Ironman World Champion. 2011

= 86 gm/hr

Jeukendrup, A. Chap. 15http://www.winninglane.com/files/Fuelling_an_Ironman_World_Champion

Ironman Case Study Athlete, Review:

Days before the race- 9 gm/kg CHO/day (~585 gm/day)

• Reduced fiber and dairy in diet 2 days prior to race

Pre-Race Meal: consumed 221 gm CHO = ~4 gm/kg, 3 hr

before race

During Race:

T1 & T2 – 1 Gel each transition

Bike – Two 750 ml (25 oz) bottles of highly concentrated

sports drinks (20 scoops total powder)

• Sipped sports drink mix followed by sips of water

• Drank mix/water every ~10 minutes

• Refilled water bottle at aid stations

Run – gel every ~25 min + water

Hydration

• Individualize hydration

• Determine sweat rate in different environmental conditions.

– Weigh before and after exercise to calculate sweat rate

– For each 1 lb of weight lost, replace ~16 - 20 oz of fluid

• ~ 13 - 26 oz (390 – 780 ml) per hour is range for many athletes

• Depends on temperature, humidity, size and fitness of athlete, intensity/pace, length of race

Pugh LGCE, 1967, Wyndham NB, 1969, Noakes T. , 2003, Getzin AR, Milner C,

Harkins M, Curr Sports Med Rep. 2017

General Hydration Guidelines

• Practice during training, including

INTENSE (race-pace) training!

• Use same products in training and

competition

• During the run -- Crunch the cups!

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Sodium Supplementation?

• Why?

– Avoid “Exertional Hyponatremia”

– Potentially helpful to avoid muscle cramping

• Who’s at risk?

– Hyponatremia: smaller, slower athletes

– Cramping: larger, faster athletes, & “salty sweaters”

Sodium: Recommendations

• Hyponatremia:

– Don’t “over-drink” (~13 - 26 oz/hour = ~ 400 -800 ml/hr)

– Individualize to fluid intake to sweat rate and thirst

• Cramping:

– 500 - 1000 mg sodium/hour, if at risk. (Especially in ultra

endurance events)

• Remember: sodium added to many sports products

• Experiment in training – Potential for GI side-effects

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Sodium Supplementation

Product Sodium (mg) Notes

Salt 1 tsp 2400 Role into heated sports bar?

Endurolytes (Hammer) 2capsules

80 Contains other minerals

Endurolytes Extreme 1 capsule

120 Contains other minerals

NUUN Active 1 tab 360 Contains other minerals

The Right Stuff 20ml 1780 Liquid

Goldfish crackers (60) ~250 -280 Carb source/not sweet

Gu Roctane Gel 125 Carb/caffeine source

Gatorade 12 oz 160 Carb source

Salt sticks 1 capsule 215 Contain other minerals

Caffeine Supplementation

• May lower perception of intensity/difficulty of exercise

• Reduces fatigue, increases alertness, improves mood,

enhances concentration, and helps to speed reaction

time

• Many sports products contain caffeine

• Important to try in training because individual

responses vary greatly

Caffeine

Many athletes consume ~150-200mg 30-60

min before race and redose during Tri

• 15 – 60 min before exercise ~2 - 3 mg/kg (~1.5 mg/lb)

➢155 lb (70 kg) = ~210 mg caffeine

• Redosing ~2-5 hours with 25-50 mg/hr

• Side-effects: nausea, palpitations, anxiety, increased BP, headaches, diarrhea

• Recommend caution with use before the swim

Tarnopolsky, Ann Nutr Metab 2010;57(suppl 2):1–822

Caffeine Content

Product Amount Caffeine (mg)

Salt Stick Plus 1 capsule 30

GU Roctane Gel (passion fruit)

1 gel 35

GU Energy Gel (salted caramel)

1 gel 20

Clif Shot Turbo Gel (choc cherry)

1 gel 100 mg

Clif Shot Bloks Cherry 3 pieces 50 mg

Coffee ~ 8 oz ~130 mg

Mountain Dew 12 oz 54

Cola 12 oz 55-75

Brewed Tea 12 oz 20-50 mg

Case Study: Amateur 70.3 Tri. 42 yr old male, 70”, 170 lb (76 kg), BMI – 24.

Concerns: fueling, GI tolerance, cramping. Finish time ~5 hours

Timing Fuel CHO (gm) Sodium (mg) Caffeine (mg)

Pre- Race 2 Bagels w/jellyCereal + skim milkClif® bar12 oz coffee

~290 ~200

goal 1-4 gm/kg =76 -300 gm

goal ~3mg/kg = ~228 mg

T1 Powerbar® gel (w/caf) 27 200 50

Bike (~2:40 hr) Dried Figs ~1/2 – 1 cup ~50 -100 0 0

2 bottles Hammer® Perpetum (1 mocha)

108 420 50

~4 gels 100 800 100

2 Thermotabs®/hr 0 360 0

T2 ¼ c figs 26 0 0

1 Thermotab® 0 180 0

Run (~1:40 hr) 3 gels 75 200 – 400 50 -100

RACE Total ~390 – 440 ~2,160 – 2,360 250 – 300

Guidelines ~ 90 gm/hr = ~ 450 gm ~500 – 1000mg/hr Redosing~ 25- 50 mg/hr

Case Study: Recreational Triathlete

Sprint Tri – male 70”, 200 lbs (91 kg), BMI - 29

Est. finish time 1 hr 45min, Concern - cramping

Timing Fuel CHO (gm) Sodium (mg) Caffeine (mg)

Pre- Race 2 English muffin, PB, ½ banana 16 oz Sports Drink

~103(goal 1-4 gm/kg, 1-4 hrs pre-race = 91 – 364 gm)

None (nervous about swim)

T1 Mocha Gel, waterNuun® E’lyte tab

251

60360

50

Bike Water

T2 4 oz Sports drinks 7 ~50 0

Run Water

RACE Total 33 370 50

Guidelines: ~ 30 – 60 gm/hr ~500 – 1000 mg/hr

Redosing with~ 25- 50 mg/hr

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Post-Bariatric

Surgery Triathlete

Type of Surgery Impacts Fueling:

• Sleeve Gastrectomy– Volume restriction

• The Roux-en-Y Gastric Bypass– Volume restriction

– Possible simple CHO intolerance

• “Dumping syndrome”

• Simple CHO intake <10 gm at a time often recommended

– Risk of dumping lessens with time

• No research-based guidelines for post-op athletes

RNY Gastric

Bypass

Post-Bariatric Surgery Triathlete Fueling

Suggested Guidelines

• Practice in training

• Advanced CHO consumed during exercise slowly in

training

– Example: begin with 5gm CHO every 20 -25 min, increase

to 5gm every 15 min, to 8 - 10gm every 15 min

– Example: ¼ gel every 15 minutes = ~25 gm/hr

• Exercise >1 hr, begin CHO/fluid intake early

Post-RNY Triathlete Hydration

Suggested Guidelines

• Hydration – challenging

• Practice sipping frequently

• If tolerated, choose liquid forms of CHO and electrolytes during exercise (sports drinks & low-calorie sports drinks, like G2)

• Hydrate soon and often after exercise

– choose salty liquids (broth/soup), low-cal sports drinks

– high-liquid foods (yogurt, applesauce, cottage cheese)

– homemade smoothies

Case Study: Post-RNY

Intermediate Distance Triathlete,

40 yr old female.

Current wt: 162 lb, 62.5”, BMI: 29

(pre-surgery – 230 lb, BMI- 43)

• Practiced in training

• Honey Stinger Chews and

• PB pretzels worked well (1-3 at frequent

intervals)

– (10 pretzels = 15 gm CHO, 5 gm

prot, 7 gm fat, 330 gm sodium)

• “Ultima Replenisher” powdered

electrolyte mix

What about

Nitrates?

• Nitrates

–Beet Root

Juice (BRJ)

–BRJ

Concentrate

Beet Root Juice?

• Nitrate-rich Beet Root Juice (BRJ) is a popular supplement

• Nitrate in beets converted to Nitrite and then to Nitric Oxide (NO)

• NO increased with supplementation of nitrate rich foods or supplements

• Lowers oxygen utilization at submaximal exercise

Jones, A. Dietary Nitrate Supplementation and Exercise

Performance. Sports Med. 2014; 44(Suppl 1): 35–45.

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Jones, A. Dietary Nitrate Supplementation and Exercise Performance. Sports Med. 2014; 44(Suppl 1): 35–45.

Nitrite (NO2-) Nitric Oxide (NO)

Increased NO =

Fatigue Resistance

Improved Exercise Efficiency

Increased Exercise Performance

Acute (~2.5 hr pre-exercise) and chronic (daily for 6 d)

supplementation has been shown to increase plasma

nitrite concentration

About 25% of ingested nitrate enters the enterosalivary

circulation, where it is reduced to nitrite by oral bacteria

Beet Root Juice

Potential Benefits

• Improved exercise

tolerance & performance

• Improved cognitive function

• Lowered BP

Potential Concerns• GI complaints

• Taste….

• Cost, calories…

• Long-term use not studied

• Less benefit in elite/well-trained athletes

• Avoid Sodium Nitrite supplements = toxic

• Avoid Sodium Nitrate supplements

• Nitrite toxicity possible w/improperly stored juice

Getzin AR, Milner C, Harkins M, Curr Sports Med

Rep. 2017

BRJ – Practical Applications

• Consume diet high in nitrate (i.e. beets, BRJ, cress, celery, lettuce, arugula)

• If using BRJ:

– Trial in intense training first

– Use 5-9 mmol (300 – 550 mg) nitrate 2-3 hours before exercise

– Possibly redose in longer triathlons

– Use 3rd party verified or established brand

– Store in fridge after opened

Summing Up: Goals for Fueling the Triathlete

• Appropriate CHO intake (multiple transportable CHO for >2.5 hr race, consider CHO rinse)

• Individualize fueling & hydration recommendations tothe athlete’s pace, race length, goals, size and level of fitness)

• Supplements sodium and caffeine may benefit some athletes

• Encourage a food-first approach for nitrate intake, nitrate supplements may benefit some racers

Thank you!

Resources

• SCAN (Sports, Cardiovascular and Wellness

Dietetic Practice Group) SCANDPG.org

• USOC

• Australian Institute of Sport

• The Science of Ultra (Podcast)

• Guru Performance – We Do Science (Podcast)