Re: Training/performance question

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Posted by Cris (24.66.94.141) on November 05, 2003 at 16:29:02:

In Reply to: Re: Training/performance question posted by Nigel on November 05, 2003 at 14:54:10:

I imagine the U of T should be able to do the steady state test in the exercise phys. lab.

if your lactate was steady after one hour that eliminates that one hour. test after two and three hours, blood sugar as well.

There is no portable device to measure plasma FFA on the market that I am aware of, you would have to have this sampled in the lab (Uof T). however, because FFA has increased in blood, does not mean muscles are using FFA more. It may be reasonably concluded though that if FFA is low, then less is available to muscles.

If you wanted absolute certainty, you could have a needle biopsy in your quads done near the end of an endurance ride and look for carnitine palmityl transferase activity. that’s getting pretty serious, we may find an answer before getting to this point.

There is some evidence to suggest that consuming carbs durring training rides of 90 minutes and less is not required, and may in fact reduce the stimulus for the need to metabolize FFA because sugar is being continuously supplied. I’ll find the reference for you.

Anecdotally I have noticed that in athletes I train with a similar problem have mostly overcome this problem by using only water on rides of 90 to 105 minutes, as well a increasing training volume at low intesity and increasing recovery time after high intensity training. The problem is I am unable to determine if the athletes would have adapted anyway, or if it was this change of no carbs for rides that last 90 to 105 minutes that caused the adaptation. It has taken between 3 and 9 weeks for the adaptation to occur.

I would not classify a 120 minute ride as a recovery ride, perhaps if it is low intensity it may be described as and unloading training stimulus, but 120 minutes is still enough to deplete glycogen, so is 90 minutes. You may be chronically depleted in glycogen stores because your “recovery rides” although at a diminished intensity would still use glycogen. Have you tried more time off and only 20 to 40 minute recovery rides? This may be the best place to look first.

Typically a moderate to high intensity day of training requires 2 or more days of reduced training (as little as 20 to 40 minutes) or no training to facilitate recovery.

What is your typical training diary for 10 days? What is you post exercise dietary intake (amount of grams or calories from carbs durring the first 90 minutes post training).

There is some consensus that protein intake beyond the 90 minute mark in endurance events may be important. More research is needed, but there would be no harm in trying. Be sure to change only one variable at time so you can capture the causality.

Sports Med. 2001;31(8):577-82. Related Articles, Links

Zinc status in athletes: relation to diet and exercise.

Micheletti A, Rossi R, Rufini S.

School of Sports Medicine, University of Perugia, Italy. alessandramicheletti@hotmail.com

Zinc is involved in the biochemical processes supporting life, such as cellular respiration, DNA reproduction, maintenance of cell membrane integrity and free radical scavenging. Zinc is required for the activity of more than 300 enzymes, covering all 6 classes of enzyme activity. Zinc binding sites in proteins are often of distorted tetrahedral or trigonal bipyramidal geometry, made up of the sulphur of cysteine, the nitrogen of histidine or the oxygen of aspartate and glutamate, or a combination. Zinc in proteins can either participate directly in chemical catalysis or be important for maintaining protein structure and stability. The nutritional habits of elite athletes during training and competition are quite different from the recommended diet in the majority of the population. Endurance athletes often adopt an unusual diet in an attempt to enhance performance: an excessive increase in carbohydrates and low intake of proteins and fat may lead to suboptimal zinc intake in 90% of athletes. Mild zinc deficiency is difficult to detect because of the lack of definitive indicators of zinc status. In athletes, zinc deficiency can lead to anorexia, significant loss in bodyweight, latent fatigue with decreased endurance and a risk of osteoporosis.

Publication Types:
· Review
· Review, Tutorial

PMID: 11475319 [PubMed - indexed for MEDLINE]

Int J Sports Med. 1998 Jan;19(1):61-7. Related Articles, Links

Macronutrients intake of top level cyclists during continuous competition--change in the feeding pattern.

Garcia-Roves PM, Terrados N, Fernandez SF, Patterson AM.

Department of Functional Biology (Physiology), Faculty of Medicine, University of Oviedo, Spain.

In order to quantify the nutritional status and the feeding pattern of professional cyclists during continuous competition, food intake was accurately measured and recorded using the weighed inventory of food (over three 24 h periods) during all meals in ten top professional cyclists during a real 3 weeks' competition. A 24 h period was defined as the time between the start of one stage and the next start. The 24 h period intake of energy, protein, fat, and carbohydrate was used to discover whether these intakes met requirements for endurance exercise. The average intake of energy and macronutrients was: energy = 23.5 +/- 1.8 MJ/24 h period, carbohydrate = 841.4 +/- 66.2 g/ 24h period; protein = 201.8 +/- 17.7g/24 h period; and fat = 158.6 +/- 16.3 g/24 h period. The carbohydrate, protein and fat contribution to energy was 60.0%, 14.5%, and 25.5% respectively. Fluid intake per 24h period was 3.29 +/- 0.94l (1.26 +/- 0.55 l during the race). Our study shows a similar energy intake in comparison with the only previous study in 1989 but there is a change in the feeding pattern of top level cyclists. A more important role is given to the intake of carbohydrate just after competitions together with an increase in protein intake. Both changes could have a positive effect on performance.

PMID: 9506803 [PubMed - indexed for MEDLINE]

Int J Sport Nutr. 1994 Jun;4(2):166-74. Related Articles, Links

Nutritional intake during an ultraendurance running race.

Eden BD, Abernethy PJ.

School of Sport and Leisure Studies, University of New South Wales, Oatley, Australia.

The food and fluid intake of a male ultraendurance runner was recorded throughout a 1,005-km race completed over 9 days. The nutrient analysis showed an average daily energy intake of 25,000 kJ with 62% from carbohydrate, 27% from fat, and 11% from protein. Carbohydrate intake was estimated to be 16.8 g.kg-1.day-1. The protein intake was estimated to be 2.9 g.kg-1.day-1 and water intake to be 11 L per day. These figures are within the recommended levels for ultraendurance athletes. Food and fluid were consumed in small amounts every 15 to 20 min to ensure maintenance of blood glucose levels and adequate hydration. This case study suggests that if the guidelines for prolonged exercise are followed, then athletes can successfully complete ultraendurance events.

PMID: 8054961 [PubMed - indexed for MEDLINE]
Sports Med. 1993 Apr;15(4):242-57. Related Articles, Links

Is the gut an athletic organ? Digestion, absorption and exercise.

Brouns F, Beckers E.

Department of Human Biology, University of Limburg, Maastricht, The Netherlands.

Digestion is a process which takes place in resting conditions. Exercise is characterised by a shift in blood flow away from the gastrointestinal (GI) tract towards the active muscle and the lungs. Changes in nervous activity, in circulating hormones, peptides and metabolic end products lead to changes in GI motility, blood flow, absorption and secretion. In exhausting endurance events, 30 to 50% of participants may suffer from 1 or more GI symptoms, which have often been interpreted as being a result of maldigestion, malabsorption, changes in small intestinal transit, and improper food and fluid intake. Results of field and laboratory studies show that pre-exercise ingestion of foods rich in dietary fibre, fat and protein, as well as strongly hypertonic drinks, may cause upper GI symptoms such as stomach ache, vomiting and reflux or heartburn. There is no evidence that the ingestion of nonhypertonic drinks during exercise induces GI distress and diarrhoea. In contrast, dehydration because of insufficient fluid replacement has been shown to increase the frequency of GI symptoms. Lower GI symptoms, such as intestinal cramps, diarrhoea--sometimes bloody--and urge to defecate seem to be more related to changes in gut motility and tone, as well as a secretion. These symptoms are to a large extent induced by the degree of decrease in GI blood flow and the secretion of secretory substances such as vasoactive intestinal peptide, secretin and peptide-histidine-methionine. Intensive exercise causes considerable reflux, delays small intestinal transit, reduces absorption and tends to increase colonic transit. The latter may reduce whole gut transit time. The gut is not an athletic organ in the sense that it adapts to increased exercise-induced physiological stress. However, adequate training leads to a less dramatic decrease of GI blood flow at submaximal exercise intensities and is important in the prevention of GI symptoms.

Publication Types:
· Review
· Review, Academic

Eur J Appl Physiol Occup Physiol. 1993;66(1):5-10. Related Articles, Links

Effects of protein supplementation during prolonged exercise at moderate altitude on performance and plasma amino acid pattern.

Bigard AX, Satabin P, Lavier P, Canon F, Taillandier D, Guezennec CY.

Division de Physiologie Metabolique et Hormonale, Centre d'Etudes et de Recherche de Medecine Aerospatiale, Base d'Essais en Vol., Bretigny/Orge, France.

The effects of two levels of protein intake on muscle performance and energy metabolism were studied in humans submitted to repeated daily sessions of prolonged exercise at moderate altitude. For this purpose, 29 healthy males, were exposed to seven successive stages of ski-mountaineering at altitudes between 2500 and 3800 m, and to an isocaloric diet (4000 kcal.day-1, 16,760 kJ.day-1) with either 1.5 g.kg-1.day-1 (C group, n = 14), or 2.5 g.kg-1.day-1 (PR group, n = 15) protein intake. Measurements made after the ski-mountaineering programme did not show any change in body mass. The peak torque during maximal isometric voluntary contraction (MVC) of the quadriceps muscle was unaffected by the repeated exercises, whereas the endurance time at 50% MVC was decreased in PR subjects (-26.8%, P < 0.001). Increased levels of both free fatty acids (+ 147%, P < 0.001) and glycerol (+ 170%, P < 0.001) observed in C subjects would suggest that lipolysis was enhanced after the repeated exercise. The plasma amino acid pattern was altered after completion of the ski-mountaineering programme; the plasma concentration of the three branched-chain amino acids (BCAA) was significantly decreased in C subjects, whereas the higher level of protein intake (PR group) greatly minimized the exercise-induced decrease in serum BCAA.

PMID: 8425512 [PubMed - indexed for MEDLINE]

Int J Sport Nutr. 1991 Jun;1(2):118-26. Related Articles, Links

Nutritional considerations for ultraendurance performance.

Applegate EA.

Department of Nutrition, University of California, Davis 95616.

The nutritional considerations of the ultraendurance athlete center around proper caloric and nutrient intake during training as well as adequate energy and fluid replacement during competition to maintain optimal performance. Energy needs of ultraendurance athletes during training vary widely, depending upon duration, intensity, and type of exercise training. These athletes may train several hours daily, thus risking inadequate caloric intake that can lead to chronic fatigue, weight loss, and impaired physical performance. It is not known whether protein needs are increased in ultraendurance athletes as a result of extended exercise training. Additionally, micronutrient needs may be altered for these athletes while dietary intake is generally over the RDA because of high caloric intake. Prior to competition, ultraendurance athletes should consider glycogen supercompensation and a prerace meal eaten 4 hrs before as a means of improving performance. Carbohydrate feedings during prolonged exercise can significantly affect performance. During events lasting over several hours, sodium sweat losses and/or the consumption of sodium-free fluids may precipitate hyponatremia.

Publication Types:
· Review
Int J Sports Med. 1989 May;10 Suppl 1:S26-31. Related Articles, Links

Study on food intake and energy expenditure during extreme sustained exercise: the Tour de France.

Saris WH, van Erp-Baart MA, Brouns F, Westerterp KR, ten Hoor F.

Department of Human Biology, University of Limburg, Maastricht, The Netherlands.

Food intake and energy expenditure (EE) were studied in five cyclists during the 22-day race of the Tour de France. The course is about 4000 km including 30 mountain passages (up to 2700 m altitude) and can be considered as one of the most strenuous endurance endeavors. Nutritional intake was calculated from daily food records. EE was estimated from sleeping time and the low activity period. EE during cycling was predicted based on detailed information. Mean energy intake (EI) was 24.7 MJ with a highest mean daily EI of 32.4 MJ. Mean EE was 25.4 MJ with a highest mean daily EE of 32.7 MJ. Relative contribution of protein, CHO, and fat was 15, 62, and 23 En% resp. 49% of EI was taken during the race resulting in a CHO intake of 94 g.h-1 representing 69 en%. It is questioned whether this amount of CHO is optimal in relation to CHO oxidation and performance. About 30% from CHO intake came from CHO-rich liquids. High EI resulted in high Ca and Fe intake. For vitamins, especially B1, this relation was not found. Vitamin B1 nutrient density dropped to 0.25 mg/4.2 MJ during the race caused by a large intake of refined CHO-rich food items. However, vitamin supplementation was high. Daily water intake was 6.71 with extremes up to 11.81. Therefore, the strategy of intake of large quantities of CHO-rich liquids seems to be the appropriate answer to maintain energy and fluid balance under these extreme conditions.

PMID: 2744926 [PubMed - indexed for MEDLINE]

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: I imagine the U of T should be able to do the steady state test in the exercise phys. lab. : if your lactate was steady after one hour that eliminates that one hour. test after two and three hours, blood sugar as well. : There is no portable device to measure plasma FFA on the market that I am aware of, you would have to have this sampled in the lab (Uof T). however, because FFA has increased in blood, does not mean muscles are using FFA more. It may be reasonably concluded though that if FFA is low, then less is available to muscles. : If you wanted absolute certainty, you could have a needle biopsy in your quads done near the end of an endurance ride and look for carnitine palmityl transferase activity. that’s getting pretty serious, we may find an answer before getting to this point. : There is some evidence to suggest that consuming carbs durring training rides of 90 minutes and less is not required, and may in fact reduce the stimulus for the need to metabolize FFA because sugar is being continuously supplied. I’ll find the reference for you. : Anecdotally I have noticed that in athletes I train with a similar problem have mostly overcome this problem by using only water on rides of 90 to 105 minutes, as well a increasing training volume at low intesity and increasing recovery time after high intensity training. The problem is I am unable to determine if the athletes would have adapted anyway, or if it was this change of no carbs for rides that last 90 to 105 minutes that caused the adaptation. It has taken between 3 and 9 weeks for the adaptation to occur. : I would not classify a 120 minute ride as a recovery ride, perhaps if it is low intensity it may be described as and unloading training stimulus, but 120 minutes is still enough to deplete glycogen, so is 90 minutes. You may be chronically depleted in glycogen stores because your “recovery rides” although at a diminished intensity would still use glycogen. Have you tried more time off and only 20 to 40 minute recovery rides? This may be the best place to look first. : Typically a moderate to high intensity day of training requires 2 or more days of reduced training (as little as 20 to 40 minutes) or no training to facilitate recovery. : What is your typical training diary for 10 days? What is you post exercise dietary intake (amount of grams or calories from carbs durring the first 90 minutes post training). : There is some consensus that protein intake beyond the 90 minute mark in endurance events may be important. More research is needed, but there would be no harm in trying. Be sure to change only one variable at time so you can capture the causality. : : Sports Med. 2001;31(8):577-82. Related Articles, Links : Zinc status in athletes: relation to diet and exercise. : Micheletti A, Rossi R, Rufini S. : School of Sports Medicine, University of Perugia, Italy. alessandramicheletti@hotmail.com : Zinc is involved in the biochemical processes supporting life, such as cellular respiration, DNA reproduction, maintenance of cell membrane integrity and free radical scavenging. Zinc is required for the activity of more than 300 enzymes, covering all 6 classes of enzyme activity. Zinc binding sites in proteins are often of distorted tetrahedral or trigonal bipyramidal geometry, made up of the sulphur of cysteine, the nitrogen of histidine or the oxygen of aspartate and glutamate, or a combination. Zinc in proteins can either participate directly in chemical catalysis or be important for maintaining protein structure and stability. The nutritional habits of elite athletes during training and competition are quite different from the recommended diet in the majority of the population. Endurance athletes often adopt an unusual diet in an attempt to enhance performance: an excessive increase in carbohydrates and low intake of proteins and fat may lead to suboptimal zinc intake in 90% of athletes. Mild zinc deficiency is difficult to detect because of the lack of definitive indicators of zinc status. In athletes, zinc deficiency can lead to anorexia, significant loss in bodyweight, latent fatigue with decreased endurance and a risk of osteoporosis. : Publication Types: : · Review : · Review, Tutorial : PMID: 11475319 [PubMed - indexed for MEDLINE] : Int J Sports Med. 1998 Jan;19(1):61-7. Related Articles, Links : Macronutrients intake of top level cyclists during continuous competition--change in the feeding pattern. : Garcia-Roves PM, Terrados N, Fernandez SF, Patterson AM. : Department of Functional Biology (Physiology), Faculty of Medicine, University of Oviedo, Spain. : In order to quantify the nutritional status and the feeding pattern of professional cyclists during continuous competition, food intake was accurately measured and recorded using the weighed inventory of food (over three 24 h periods) during all meals in ten top professional cyclists during a real 3 weeks' competition. A 24 h period was defined as the time between the start of one stage and the next start. The 24 h period intake of energy, protein, fat, and carbohydrate was used to discover whether these intakes met requirements for endurance exercise. The average intake of energy and macronutrients was: energy = 23.5 +/- 1.8 MJ/24 h period, carbohydrate = 841.4 +/- 66.2 g/ 24h period; protein = 201.8 +/- 17.7g/24 h period; and fat = 158.6 +/- 16.3 g/24 h period. The carbohydrate, protein and fat contribution to energy was 60.0%, 14.5%, and 25.5% respectively. Fluid intake per 24h period was 3.29 +/- 0.94l (1.26 +/- 0.55 l during the race). Our study shows a similar energy intake in comparison with the only previous study in 1989 but there is a change in the feeding pattern of top level cyclists. A more important role is given to the intake of carbohydrate just after competitions together with an increase in protein intake. Both changes could have a positive effect on performance. : PMID: 9506803 [PubMed - indexed for MEDLINE] : : Int J Sport Nutr. 1994 Jun;4(2):166-74. Related Articles, Links : Nutritional intake during an ultraendurance running race. : Eden BD, Abernethy PJ. : School of Sport and Leisure Studies, University of New South Wales, Oatley, Australia. : The food and fluid intake of a male ultraendurance runner was recorded throughout a 1,005-km race completed over 9 days. The nutrient analysis showed an average daily energy intake of 25,000 kJ with 62% from carbohydrate, 27% from fat, and 11% from protein. Carbohydrate intake was estimated to be 16.8 g.kg-1.day-1. The protein intake was estimated to be 2.9 g.kg-1.day-1 and water intake to be 11 L per day. These figures are within the recommended levels for ultraendurance athletes. Food and fluid were consumed in small amounts every 15 to 20 min to ensure maintenance of blood glucose levels and adequate hydration. This case study suggests that if the guidelines for prolonged exercise are followed, then athletes can successfully complete ultraendurance events. : PMID: 8054961 [PubMed - indexed for MEDLINE] : Sports Med. 1993 Apr;15(4):242-57. Related Articles, Links : Is the gut an athletic organ? Digestion, absorption and exercise. : Brouns F, Beckers E. : Department of Human Biology, University of Limburg, Maastricht, The Netherlands. : Digestion is a process which takes place in resting conditions. Exercise is characterised by a shift in blood flow away from the gastrointestinal (GI) tract towards the active muscle and the lungs. Changes in nervous activity, in circulating hormones, peptides and metabolic end products lead to changes in GI motility, blood flow, absorption and secretion. In exhausting endurance events, 30 to 50% of participants may suffer from 1 or more GI symptoms, which have often been interpreted as being a result of maldigestion, malabsorption, changes in small intestinal transit, and improper food and fluid intake. Results of field and laboratory studies show that pre-exercise ingestion of foods rich in dietary fibre, fat and protein, as well as strongly hypertonic drinks, may cause upper GI symptoms such as stomach ache, vomiting and reflux or heartburn. There is no evidence that the ingestion of nonhypertonic drinks during exercise induces GI distress and diarrhoea. In contrast, dehydration because of insufficient fluid replacement has been shown to increase the frequency of GI symptoms. Lower GI symptoms, such as intestinal cramps, diarrhoea--sometimes bloody--and urge to defecate seem to be more related to changes in gut motility and tone, as well as a secretion. These symptoms are to a large extent induced by the degree of decrease in GI blood flow and the secretion of secretory substances such as vasoactive intestinal peptide, secretin and peptide-histidine-methionine. Intensive exercise causes considerable reflux, delays small intestinal transit, reduces absorption and tends to increase colonic transit. The latter may reduce whole gut transit time. The gut is not an athletic organ in the sense that it adapts to increased exercise-induced physiological stress. However, adequate training leads to a less dramatic decrease of GI blood flow at submaximal exercise intensities and is important in the prevention of GI symptoms. : Publication Types: : · Review : · Review, Academic : Eur J Appl Physiol Occup Physiol. 1993;66(1):5-10. Related Articles, Links : Effects of protein supplementation during prolonged exercise at moderate altitude on performance and plasma amino acid pattern. : Bigard AX, Satabin P, Lavier P, Canon F, Taillandier D, Guezennec CY. : Division de Physiologie Metabolique et Hormonale, Centre d'Etudes et de Recherche de Medecine Aerospatiale, Base d'Essais en Vol., Bretigny/Orge, France. : The effects of two levels of protein intake on muscle performance and energy metabolism were studied in humans submitted to repeated daily sessions of prolonged exercise at moderate altitude. For this purpose, 29 healthy males, were exposed to seven successive stages of ski-mountaineering at altitudes between 2500 and 3800 m, and to an isocaloric diet (4000 kcal.day-1, 16,760 kJ.day-1) with either 1.5 g.kg-1.day-1 (C group, n = 14), or 2.5 g.kg-1.day-1 (PR group, n = 15) protein intake. Measurements made after the ski-mountaineering programme did not show any change in body mass. The peak torque during maximal isometric voluntary contraction (MVC) of the quadriceps muscle was unaffected by the repeated exercises, whereas the endurance time at 50% MVC was decreased in PR subjects (-26.8%, P < 0.001). Increased levels of both free fatty acids (+ 147%, P < 0.001) and glycerol (+ 170%, P < 0.001) observed in C subjects would suggest that lipolysis was enhanced after the repeated exercise. The plasma amino acid pattern was altered after completion of the ski-mountaineering programme; the plasma concentration of the three branched-chain amino acids (BCAA) was significantly decreased in C subjects, whereas the higher level of protein intake (PR group) greatly minimized the exercise-induced decrease in serum BCAA. : PMID: 8425512 [PubMed - indexed for MEDLINE] : : Int J Sport Nutr. 1991 Jun;1(2):118-26. Related Articles, Links : Nutritional considerations for ultraendurance performance. : Applegate EA. : Department of Nutrition, University of California, Davis 95616. : The nutritional considerations of the ultraendurance athlete center around proper caloric and nutrient intake during training as well as adequate energy and fluid replacement during competition to maintain optimal performance. Energy needs of ultraendurance athletes during training vary widely, depending upon duration, intensity, and type of exercise training. These athletes may train several hours daily, thus risking inadequate caloric intake that can lead to chronic fatigue, weight loss, and impaired physical performance. It is not known whether protein needs are increased in ultraendurance athletes as a result of extended exercise training. Additionally, micronutrient needs may be altered for these athletes while dietary intake is generally over the RDA because of high caloric intake. Prior to competition, ultraendurance athletes should consider glycogen supercompensation and a prerace meal eaten 4 hrs before as a means of improving performance. Carbohydrate feedings during prolonged exercise can significantly affect performance. During events lasting over several hours, sodium sweat losses and/or the consumption of sodium-free fluids may precipitate hyponatremia. : Publication Types: : · Review : Int J Sports Med. 1989 May;10 Suppl 1:S26-31. Related Articles, Links : Study on food intake and energy expenditure during extreme sustained exercise: the Tour de France. : Saris WH, van Erp-Baart MA, Brouns F, Westerterp KR, ten Hoor F. : Department of Human Biology, University of Limburg, Maastricht, The Netherlands. : Food intake and energy expenditure (EE) were studied in five cyclists during the 22-day race of the Tour de France. The course is about 4000 km including 30 mountain passages (up to 2700 m altitude) and can be considered as one of the most strenuous endurance endeavors. Nutritional intake was calculated from daily food records. EE was estimated from sleeping time and the low activity period. EE during cycling was predicted based on detailed information. Mean energy intake (EI) was 24.7 MJ with a highest mean daily EI of 32.4 MJ. Mean EE was 25.4 MJ with a highest mean daily EE of 32.7 MJ. Relative contribution of protein, CHO, and fat was 15, 62, and 23 En% resp. 49% of EI was taken during the race resulting in a CHO intake of 94 g.h-1 representing 69 en%. It is questioned whether this amount of CHO is optimal in relation to CHO oxidation and performance. About 30% from CHO intake came from CHO-rich liquids. High EI resulted in high Ca and Fe intake. For vitamins, especially B1, this relation was not found. Vitamin B1 nutrient density dropped to 0.25 mg/4.2 MJ during the race caused by a large intake of refined CHO-rich food items. However, vitamin supplementation was high. Daily water intake was 6.71 with extremes up to 11.81. Therefore, the strategy of intake of large quantities of CHO-rich liquids seems to be the appropriate answer to maintain energy and fluid balance under these extreme conditions. : PMID: 2744926 [PubMed - indexed for MEDLINE]

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