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ñ‘ Role of CHO
ñ‘ Regulation of glucose intake and glycogen synthesis
ñ‘ ×ietary CHO, digestion and storage
ñ‘ Regulation of glucose concentration
ñ‘ CHO utilization during exercise
ñ‘ CHO intake days before competition
ñ‘ CHO intake hours before exercise
ñ‘ CHO intake 30-60 minutes before exercise
ñ‘ CHO intake during exercise
ñ‘ CHO intake after exercise

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One hundred years ago beef was believed to be the most important component of an athlete¶s
diet, but nowadays pasta, bread and rice seem to form the central part of the same diet½ Since the
beginning of the 20th century, carbohydrate intake has been known to be related to exercise
performance½
Krogh and Lindhardt (1920) were probably the first investigator to recognize the importance of
carbohydrate as a fuel during exercise½

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Carbohydrate plays many roles in the human body, but one of its main functions is to provide
energy for the contracting muscle½
Muscle glycogen is a readily available energy source for the working muscle½
Liver glycogen½ The main role of glycogen in the liver is to maintain a constant blood glucose
level either at rest or exercise½
Glycogen is broken down in the liver to glucose and then released into the circulary system½
However, glycogen that is broken down in the muscle is not released as glucose into circulation,
because muscle lacks the enzyme glucose-6-phosphate½




 



Glycogenolysis is a conversion of glycogen to glucose
Glyconeogenesis is a metabolic pathway that results in the generation of glucose from non-
carbohydrate carbon substrates such as lactate, glycerol and amino acids½

In resting, 60% of glucose produced are from glycogenolysis and 40% are from glyconeogenesis½
In exercise, 90% of glucose are from glycogenolysis and 10% are from gluconeogenesis½

 
 
 




 ½
The dietary carbohydrate family includes the simple carbohydrates (the sugars) and the complex
carbohydrates (the starches and fibers)½ The simple carbohydrates are those that chemist describe
as:
ñ‘ Monosaccharides ± single sugars: glucose, fructose and galactose½
ñ‘ ×isaccharides ± sugars composed of pairs of monosaccharides: maltose, sucrose and
lactose½
The complex carbohydrates are:
ñ‘ olysaccharides ± large molecules composed of chains of monosaccharides: glycogen,
starches and fibers½ Glycogen is a storage form of energy in the animal body; starches
play that role in plants, and fibers provide structure in leaves, sterns, roots and skins of
plants½

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×ietary carbohydrates are hydrolyzed in the stomach and small intestine to monosaccharides,
with glucose typically predominating½ Both glucose and galactose are absorbed by an active
transport mechanism, whereas fructose is absorbed by facilitated diffusion½ The fact that rate of
glucose absorption is more than twice that of fructose has important implications with respect to
the comparative value of ingesting these monosaccharides during exercise½ Absorbed
monosaccharides are transported to the liver via hepatic portal vein½

The liver stores about one-third of the body¶s total glycogen and release glucose into the
bloodstream as needed½ Muscle cells can also store glucose as glycogen (the other two-thirds),
but they hoard most of their supply, using it just for themselves during exercise (understanding
nutrition)½ The body can store only enough glycogen to provide energy for relatively short
periods of time ± less than a day during rest and a few hours at most during exercise
(understanding nutrition)½ To keep providing glucose to meet the body¶s energy needs, a person
has to eat dietary carbohydrate frequently½

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½ In resting, insulin is the most important glucoregulatory
hormone½ It increases the uptake of glucose into various tissues½
After a meal, plasma insulin concentrations increase and as a result glucose uptake by muscle,
liver, and other tissues increases½ Insulin promotes not only uptake but also the storage of
glucose½
×uring exercise, catecholamine release reduces the secretion of insulin by the pancreas, and
plasma insulin concentrations can decrease to extremely low levels½ Muscle glucose uptake is
enhanced by contraction-stimulated glucose transport½

×uring prolonged exercise, liver glycogen becomes depleted, the rate of glucose production may
become insufficient to compensate for the glucose uptake by the muscle and other tissues½ As a
result hypoglycaemia develops½

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Intensity and duration of exercise, level of physical conditioning and initial muscle glycogen
levels are key factors dictating the relative contribution and absolute quantity of carbohydrate
oxidized½
 
  


Muscle glycogen plays a primary role in determining exercise capacity, even when other energy
substrates are available½
A strong relationship between muscle glycogen depletion and exhaustion occurs only at exercise
intensities corresponding to approximately 60 to 75% VO2 max½ At intensities above 90% VO2
max, exhaustion typically occurs before muscle glycogen depletion½
×epletion of muscle glycogen is invariably associated with reduced exercise output and eventual
discontinuation of strenuous exercise½

Exercise intensity also directly related to glucose uptake from the circulation by muscle, as well
as to liver glucose output½ The increased glucose uptake by contracting muscle can be attributed
to increases in muscle blood flow and in the efficiency of muscle glucose extraction½ The
magnitude of blood flow to working muscle is linearly related to the intensity of exercise½

 
 

At the onset of exercise, muscle glycogen declines rapidly½ After the first 5
to 20 minutes, the utilization of blood glucose increases resulting in decrease in the use of
muscle glycogen as the stores of muscle glycogen become partially depleted½
With continuing exercise, there is an increase in plasma glucose utilization while total
carbohydrate oxidation remains constant or decreases½
Heavily reliance on blood glucose as an energy substrate is associated with concomitant increase
in hepatic glucose out put, primarily by means of augmented glycogenolysis in order to maintain
euglycemia½


 


 





 
he increased mitochondrial volume density within
the trained muscle and the corresponding increase in respiratory is the result of endurance
training as it enhances individual¶s ability to perform more aerobically½ What happened in
skeletal muscle, in skeletal muscle, free fatty acid (FFA) oxidation appears to inhibit glucose

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uptake, glycolisis and glycogenolysis½ This carbohydrate-sparing effect of increased fat oxidation
results in slower depletion of muscle glycogen and decreased utilization of plasma glucose
during exercise½ Increased capacity for glycogen storage in muscle also occurs as a result of
endurance training½


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The ability to sustain prolonged moderate to heavy exercise is largerly
dependent on the starting glycogen content in the skeletal muscles½ Hepatic glucose production
during exercise results from a combination of glycogenolysis and gluconeogenesis½ With
restricted carbohydrate intakes, liver glycogen is largely depleted, which necessitates a greater
reliance on gluceneogenesis during exercise½ Increased glucose production from
gluconeogenesis, however, cannot totally compensate for reduced hepatic glycogenolysis, thus
increasing the likelihood of hypoglycaemic during prolonged exercise½ In contrast, exercise-
induced reductions in plasma glucose are less likely after the ingestion of high-carbohydrate
diets because of the relatively greater contribution of glycogenolysis to liver glucose production½

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The depletion of muscle glycogen provides a strong drive for its own resynthesis½ Muscle
glycogen resynthesis takes precedence over restoration of liver glycogen, and even in the
absence of a dietary supply of CHO after exercise it occurs at a low rate, with some of the
substrate being provided through gluconeogenesis½ This effect is supported by increased insulin
sensitivity, increased glycogen synthase, and increased sarcolemma permeability to glucose½


 








 
 



 

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½
×uring exercise and in the first hour after exercise, an abundance of GLUT4 is available at the
cell membrane and glucose uptake into the muscle is facilitated½ This exercise induced effect on
glucose transport, however, lasts only a few hours in the absence of insulin½ The increase in the
permeability of the sarcolemma for glucose after exercise seems to be directly related to the
amount of glycogen in the muscle½ When muscle glycogen concentrations are very low, the
enhanced glucose uptake may last longer½ With high muscle glycogen concentrations, the effect
is rapidly reversed½
Glycogen synthesis in this phase account for as much as 80% of all glycogen synthesis½


 




 

½ When the effect of the exercise-induced
increase in glucose transport wears off, glycogen resynthesis occurs at a much slower rate½

Based on this effect, suitable methods needed to ensure post exercise feeding successful with the
main goal to rapid recovery½
There are factors have recognized as potentially important in promoting restoration of muscle
glycogen stores: (1) timing of carbohydrate intake (2) the type of carbohydrate ingested (3) the
ingestion of protein and carbohydrate after exercise½
 


 
 
  ½ The timing of carbohydrate intake can have an important effect
on the rate of muscle glycogen synthesis after exercise½ Carbohydrate consumed almost
immediately after exercise restores glycogen at almost 2 times the rate than if consumed at 2
hours after exercise½ When carbohydrate intake is delayed until 2 hours after exercise, muscle
glycogen concentration after 4 hours is 45% lower compared with ingestion of the same amount
of carbohydrate immediately after exercise½

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Glycogen synthesis depends on the GI of the meal consumed after exercise½ Muscle glycogen is
more restored with a high-GI meal compared with a low-GI meal½

It is interesting, as glucose and fructose have been shown to increase absorption and delivery to
the muscle during exercise, it is possible that these carbohydrate mixtures can also increase
muscle glycogen synthesis after exercise½ but it was recently observed that a combination of
glucose and fructose ingested at relatively high rates did not improve glycogen synthesis
compared with the ingestion of glucose only½ It is possible that fructose is preferentially stored in
the liver post exercise and therefore does not reach the muscle½




 
 
 


½ Certain amino acids have a potent effect on
the secretion of insulin½ One study concluded that glycogen storage increased when carbohydrate
was ingested½ But most interestingly, glycogen storage increased further when carbohydrate was
ingested together with protein½



!½ No difference in glycogen synthesis with solid or liquid feedings is believed
to exist½

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½
The ingestion of carbohydrate during exercise has a number of effects on metabolism and can
provide a number of benefits for performance½ Convincing evidence from numerous studies
indicates that carbohydrate feeding during exercise of about 45 minutes or longer can improve
performance½ It is important to maintain the circulating blood glucose concentration above about
2½5 mmol/L to provide a concentration gradient for transport into glucose-requiring cells½ The
cells of the central nervous system have an absolute requirement for glucose as a fuel, and when
the blood glucose concentration falls below this level, the rate of uptake by the brain may not be
sufficient to meet its metabolic needs½ Hypoglycaemia leads to a variety of symptoms, including
dizziness, nausea and disorientation½
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½
Glucose uptake in the muscle is through facilitated diffusion by the glucose transporter GLUT 4
Both muscle contraction and insulin secretion will stimulate the translocation of GLUT 4½
×uring exercise, catecholamine release reduces the secretion of insulin by the pancreas, and
plasma insulin concentrations can decrease to extremely low levels½ Muscle glucose uptake is
enhanced by contraction-stimulated glucose transport½

The rate of glycogen synthesis depends on several factors, among others:

à‘ The availability of glucose
à‘ The transport of glucose into the cell
à‘ The activity of enzymes which also depends on insulin concentration: high insulin
stimulates glycogen synthesis½

 
 





 
 

 
½
×uring the first 75 to 90 minutes of exercise, exogenous carbohydrate oxidation continuous to
rise as more and more carbohydrate is emptied from the stomach and absorbed in the intestine½
After 75 to 90 minutes a leveling off occurs, and the exogenous carbohydrate oxidation rate
reaches its maximum value and does not increase further½
So, there are several factors suggested to influence exogenous carbohydrate oxidation including
feeding schedule, type and amount of carbohydrate ingested½
 


  ½ The timing of carbohydrate feedings seems to have relatively little effect on
exogenous carbohydrate oxidation rates½

 


 
 
Adopting an ingestion rate of 70 g/h optimizes exogenous
carbohydrate oxidation½ Ingesting more than this amount of single carbohydrate does not result in
higher carbohydrate oxidation rates and is more likely to cause gastrointestinal discomfort½ This

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amount of carbohydrate can be found in the following sources: 1 L sports drink (Gatorade,
owerade), 600 ml cola drink, 1½5 ower bars, three medium banana½



 
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Combination of glucose and fructose will result in more carbohydrate absorbed and made
available for oxidation½ Compared with a single source of carbohydrate, ingesting multiple
carbohydrate sources results in a smaller amount of carbohydrate remaining in the intestina, and
osmotic shift and malabsorption may be reduced½ This means that drinks with multiple
transportable carbohydrate are less likely to cause gastrointestinal discomfort½
 



 
½ To ingest 50 g of carbohydrate, a person can take 2 bottles (1L) of
a sports drink, 2 carbohydrate gels (typically 25 g each), or one energy bar½ The solid and semi
solid food is more energy dense and easier to carry during sporting events, but solid food may
have a slowing effect on gastric emptying, especially when the food contains fiber and fat½

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Variables than can be
manipulated to alter the functional characteristics of a sports drink are carbohydrates content,
osmolality electrolyte composition and concentration, flavouring compotents½
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 ½ The optimum concentration of carbohydrate to be added to a sports
drink will depend on individual circumstances½ High carbohydrate concentrations will delay
gastric emptying, but will increase the rate of carbohydrate delivery½ High concentrations of
sugar (>10%) may result in increase the danger of dehydration as well as gastrointestinal
disturbances½ ×ilute glucose-electrolyte solutions may be as effective, or even more effective, in
improving performance as more concentrated solutions, and as little as 90 mmol/L (about 16 g/L
or 1½6%) glucose may improve endurance performance½
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 ½ The osmolality of ingested fluids is important as this can influence the rates of both
gastric emptying and intestinal water flux½ Ingestion of strongly hypertonic drinks will promote
net secretion of water into the intestine and, although this effect is transient, it will result in a
temporary exacerbation of the extent of dehydration½ Although most of the popular sports drinks
are formulated to have an osmolality close to that of body fluids, and are promoted as isotonic
drinks, there is a good evidence that hypotonic solutions are more effective when rapid
rehydration is desired½ Although it is argued that a higher osmolality is inevitable when adequate

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amounts of carbohydrate are to be included in sports drinks, the optimum amount of
carbohydrate necessary to improve exercise performance has not been clearly established½
 







  
½ Sodium will stimulate sugar and water uptake in
the small intestine and will help to maintain extracellular fluid volume½ There is much debate as
to the optimum sodium concentration, and it has been argued that equilibrium occurs so rapidly
in the upper part of the small intestine that addition of high concentration of sodium is not
necessary½ A high sodium content although it may stimulate jejuna absorption of glucose and
water, tends to make drinks unpalatable, and it is important that drinks intended for ingestion
during or after exercise should have a pleasant taste in order to stimulate consumption½
 ½ Taste is an important factor influencing the consumption of fluids, and the choice of anion
to accompany sodium may be important in this regard½

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Consuming food and fluid before exercise should be seen as an opportunity to fine-tune
carbohydrate and fluid levels and to ensure athlete will be comfortable and confident½
The ingestion of carbohydrate in the hour before exercise results in a large rise in plasma glucose
and insulin½ With the onset of exercise, however, a rapid fall in blood glucose occurs½ This
phenomenon is called rebound or reactive hypoglycaemia½ This was thought to negatively affect
performance½

Most athletes are able to consume CHO in the hour before exercise without affecting
performance, and in some cases it can ever improve the outcome of the session½
However, a small percentage of athletes experience a drop in blood glucose levels and symptoms
such as fatique, shakiness and dizziness after consuming carbohydrate immediately before
exercise½

Because the metabolic effects of pre exercise carbohydrate ingestion are a consequence of
hyperglycaemia and hyperinsulinemia, interest has developed in strategies that minimize the
changes in plasma glucose and insulin before exercise as follows:
ñ‘ Experiment to find the critical time before exercise that carbohydrate intake should be
avoided
ñ‘ Consume a substantial amount of carbohydrate in the pre-event snack/meal (>1 g/kg): 70
g of carbohydrate½ Small amounts of CHO (<50 g) are more likely to cause problems in
sensitive individuals than larger amounts½ This probably because the small intake of CHO
is swamped by the CHO use½ Larger intake will compensate for greater rate of use,
leaving the athlete with a net gain in available CHO½
ñ‘ Choose low glycaemic index, carbohydrate-rich choices in the pre-event menus; these
have an attenuated and sustained blood glucose and insulin response½
ñ‘ Include some high-intensity sprints during the warm up to the event to stimulate hepatic
glucose output½
ñ‘ Consume carbohydrate during the exercise½

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There are two main things that to be considered in providing carbohydrate hours before exercise½
(1) Liver glycogen concentrations are substantially reduced after an overnight fast½
(2) Ingestion of carbohydrate increases these reserves and contributes to the maintenance of
blood glucose concentration during subsequent exercise bout½

Foods and drinks consumed in the 4 hours prior to exercise have a role in fine-tuning
competition preparation½ The pre-event menu can be eaten largely for comfort or confidence, or
it may play an active role in preparation by contributing to refueling and rehydration goals½ The
goals of the pre-event meal are to
ñ‘ Continue to fuel muscle glycogen stores if they have not fully restored or loaded since the
last exercise session½ Large meal containing 140-330 g of CHO 3 to 5 hours before
exercise increase muscle glycogen level and improves performance½
ñ‘ Restore liver glycogen content, especially for events undertaken in the morning where
liver stores are depleted from an overnight fast½
ñ‘ Ensure that the athlete is well-hydrated
ñ‘ revent hunger, yet avoid the gastrointestinal discomfort and upset often experienced
during exercise
ñ‘ Include foods and practices that are important to the athlete¶s psychology or superstitions½


The ingestion of carbohydrate in the hours before exercise has three important effects:
ñ‘ Transient fall in plasma glucose with the onset of exercise½
ñ‘ Increased carbohydrate oxidation and accelerated glycogen breakdown½
ñ‘ Blunting of FA mobilization and fat oxidation½
However, these metabolic changes do not appear to be detrimental to exercise performance
because increased carbohydrate availability compensates for the greater carbohydrate utilization½

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Carbohydrate intake in days before competition mainly replenishes muscle glycogen stores,
where as carbohydrate intake in the hours before competition optimizes liver glycogen stores½
We seem familiar with the terminology of carbohydrate loading½ µCarbohydrate loading¶ is
probably one of the most misunderstood terms in sports nutrition½ people commonly think
anyone involved in sport needs to µcarb up¶ and the way to do this is to eat µflat out¶ in the days
leading up to an event½
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 ½ The amount of total CHO needed by an athlete depends on
the type of sport and duration and intensity of training½ This varies from as low as 5-7 g CHO per
kg of body mass to around 12 g per kg of body mass½ For most athletes, a total daily intake of
around 7-10 g CHO per kg of body weight is adequate for training and recovery½ One study
concluded that the net glycogen synthesized in 24 hours was highest between 450-660g CHO per
day, intakes higher than this had no further impact on increasing glycogen stores½

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