Dalla prevenzione alla terapia nutrizionale: ruolo di carboidrati e fibra alimentare

Milano 29-30 novembre 2007

Diete ad alto e basso apporto di carboidratill’ li i d ll inell’alimentazione dello sportivo

L. Gatteschi, Sezione Medica del Settore Tecnico FIGC, Centro Tecnico “L. Ridolfi”, Firenze f

Alimentazione in funzione dell’attivitàAlimentazione in funzione dell attività

F i iFrequenza impegni

All tAllenamento

Alimentazione Recupero

M PMedico Preparatore

APPORTO GLUCIDICO : LINEE GUIDA GENERALIAPPORTO GLUCIDICO : LINEE GUIDA GENERALI

Variazione dei carichi di allenamento :Variazione dei carichi di allenamento :

•• minima attività fisica: 2minima attività fisica: 2--3 g/ Kg/ die3 g/ Kg/ die

••33--4 ore / week di attività fisica: 44 ore / week di attività fisica: 4--5 g/Kg/die5 g/Kg/die

••10 ore /week di attività fisica: 610 ore /week di attività fisica: 6 7 g/Kg/die7 g/Kg/die••10 ore /week di attività fisica: 610 ore /week di attività fisica: 6--7 g/Kg/die7 g/Kg/die

••20 ore/week di attività fisica: >7 g/Kg/die20 ore/week di attività fisica: >7 g/Kg/die

Apporto glucidicoAllenamenti di resistenza

7 7 –– 10 10 g/kg/dieg/kg/die

FABBISOGNO FABBISOGNO GLUCIDICO GLUCIDICO

GIORNALIEROGIORNALIERO g/kg/dieg/kg/die

Apporto glucidicoApporto glucidicoAllenamenti di potenza

5 5 –– 7 7 g/kg/dieg/kg/die

FABBISOGNO FABBISOGNO GLUCIDICO GLUCIDICO

GIORNALIEROGIORNALIERO g/kg/dieg/kg/die

A t l idiA t l idiApporto glucidicoApporto glucidicoAllenamenti di potenzaAllenamenti di potenzapp

COSA DEVE ASSICURARE L’APPORTO DI CARBOIDRATICOSA DEVE ASSICURARE L’APPORTO DI CARBOIDRATI

1. Adeguate scorte di glicogeno per sostenere gli allenamenti e le Adeguate scorte di glicogeno per sostenere gli allenamenti e le gare:gare:

•• Rigenerare ATP aerobica ( pause)Rigenerare ATP aerobica ( pause)Effi i d i i i l tt idi (f i ltEffi i d i i i l tt idi (f i lt•• Efficienza dei meccanismi lattacidi (fasi alta Efficienza dei meccanismi lattacidi (fasi alta intensità)intensità)

2 I processi di recupero post2 I processi di recupero post--esercizio (ANABOLISMO)esercizio (ANABOLISMO)2. I processi di recupero post2. I processi di recupero post--esercizio (ANABOLISMO)esercizio (ANABOLISMO)

•• Aumento della massa muscolare( preparazione)Aumento della massa muscolare( preparazione)

Apporto carboidrati elevato

PrestazionePrestazione Recupero

SSalute

Bergstrom et al 1967Bergstrom et al. 1967

Aumento concentrazione glicogeno muscolare prima di esercizio prolungato g g p p gdi intensità media-moderata migliora la prestazione

Ali i “Hi h f /l b ” i “l f /hi h b ”Alimentazione “High fat/low carbo” e successiva “low fat/high carbo” per breve periodo (3 giorni)

S lS lSupercompensazione glicogenoSupercompensazione glicogeno

Dieta dissociata classica (Hultman et al. 1971)

Assunzione carboidrati

Gara-6 -5 -4 -3 -2 -1

Allenamento

Gara

Apporto E CHO giorni 6-4 < 20%Apporto E CHO giorni 3-1 > 80%

Allenamento

Aumento glicogeno muscolare:160-200% valore basale

S i liS i liSupercompensazione glicogenoSupercompensazione glicogeno

Dieta dissociata modificata

Assunzione carboidrati

-6 -5 -4 -3 -2 -1

Allenamento

Introito carboidrati da 50 55% a 75%Introito carboidrati da 50-55% a 75%

Aumento glicogeno muscolare: 150% valore riposo

FATICA/OVERTRAINING

Esaurimento o non disponibilità delle fonti energetiche

Attività prolungate di intensità superiore al 75% VO2maxAttività intermittenti con fasi elevata intensità (calcio)

• Concentrazione glicogeno muscolare pre esercizio i

v à e e co as e eva a e s à (ca c o)

e tempo esaurimento

C i li l i• Concentrazione glicogeno muscolare e tasso errori.

Ri d i f i i i i b id i• Ritardata insorgenza fatica con somministrazione carboidrati durante esercizio

A CA/O A GFATICA/OVERTRAINING

•Bangsbo 1992dieta elevato contenuto CHO = maggior distanza percorsa in test corsa che simula impegno tipico partita

•Miles 1992somministrazione maltodestrine durante allenamento (20’) =minor sensazione soggettiva fatica fisica e psichicaintensità sopportata maggiore

Carbohydrate intake and multiple sprint sports: with special reference to football (soccer)special reference to football (soccer).Balsom PD, Wood K, Olsson P, Ekblom B.Int J Sports Med. 1999 Jan;20(1):48-52

Six male football players competed in a 90 min game (4-a-side) on two occasions following an exercise and diet (either high- approximately 65% or low- approximately 30% carbohydrate intake) regimen designed to manipulate muscle glycogen concentrations. p g y g

The main finding from this study was that the carbohydrate content of the diet influenced the amount of high intensity exercise performed during a small-sided f b llfootball game. This suggests that to optimise performances, in not only football but possibly also other multiple sprint sports of similar duration, a high carbohydrate diet should be administered in preparation for intense training and competition.

HIGHS AND LOW OF CARBOHYDRATES DIET

Coyle E.F.Sports Science Exchange, Gatorade Sports Science Institute, 17, 2004

A low carbo diet in athletes impairs their exercise tolerance and their ability to beneficiallyA low carbo diet in athletes impairs their exercise tolerance and their ability to beneficially adapt to long term physical training.

Physical performance and mood state seem better maintained with a high vs. moderate carbo y p gdiet, thus reducing the symptoms of overreaching and possibly overtraining.

During the 24 h prior to a hard training session athletes should consume 7-12 g CHO/kg b.w.

During the 24 h prior to a moderate or easy day of training athletes should consume 5-7 g CHO/kg b.w.

Helge (J Physiol 1996): young men, endurance training 3-4 times week for 7 weeks. Low carbo, 15% of total calories, high carbo, 65% of total calories. Th h l d d h “ l b di d i d i i iThe authors concluded that “ a low carbo diet during an endurance training program is detrimental to improvement in endurance”.

Rowland and Hopkins Int J Sports Nutr Exerc Met Settembre 2002

Esercizio 185 min. a carico progressivo ed intermittente su cicloerg.

Pasto 90’ pre: A) Pro 10%, Carb. 5%, Lip 85% ) pB) Pro 30%, Carb. 40%, Lip 30%C) Pro 10%, Carb. 85%, Lip 5%

Supplementazione durante: Bevanda 6% CHO (50% fruttosio 50% maltodestrine)Bevanda 6% CHO (50% fruttosio, 50% maltodestrine)

Diversa risposta metabolicaNessun effetto sulla prestazione

A i i à li i iAttività glicogeno sintetasi: aumento post esercizioprogresssivo declino

Fino a 72 ore con apporto energetico 50-55%

progresssivo declino

Fino a 72 ore con apporto energetico 50-55%

Ripristino più lento a parità impegno in presenza p p p p g pdi elevato impegno di tipo eccentrico

Fairchild et al. Med Sci Sport Exerc Giugno 2002p g

Attività intensità elevata = maggiore velocità glicogeno sintetasi

150 secondi 130% VO2 peak + 30 sec massimali150 secondi 130% VO2 peak + 30 sec massimali

Somministrazione 10.3 g kg –1 nelle 24 ore, inizio entro 20 min

Aumento 82% glicogeno muscolare in tutte le fibre

Bishop et al. Int J Sports Nutr Exerc Met Giugno 2002

Simulazione impegno partita calcio determina elevata risposta cortisolo, con possibile alterazione temporanea funzione immune.

6 x 15 corsa a velocità/direzione varia, rec 3

5 ml kg –1 6% CHO dopo riscaldamento + 2 ml kg –1 durante pause

Aumento Cort, IL-6, TNF, riduzione degranulazione neutrofili

Attenuazione dell’effetto con somministrazione CHO

Incremento del metabolismo ossidativo dei carboidrati durante esercizio, riduce liberazione ed ossidazione acidi grassi con possibili conseguenze negative

sulla disponibilità energetica e prestazionep g p(M. Erlenbusch et al., Int J Sport Nutr 2, 1-14, 2005)

Interventi

Risparmio glicogeno muscolare ?

Assunzione/liberazione grassi pre eserciziog p

Minore utilizzazione glucosio (effetto risparmio)

“High fat diet“

Aumento della capacità ossidativa mitocondriale per acidi grassiu e to de a capac tà oss dat va toco d a e pe ac d g ass

Allenamento ed utilizzazione lipidi

Nel soggetto allenato, a gg ,pari intensità relativa di lavoro, si ha un incremento del contributo dei lipidi alla produzione di energia

Diete “Low Carbo” (LC)( )

Aumento Lipidi Aumento Proteine

Riduzione peso (massa grassa)Aumento sensibilità insulinica

Aumento contributo acidi grassi quale sorgente energia

Prestazione ?

Diete “Low Carbo” (LC)( )

Aumento Lipidi Aumento Proteine

Rid i ( )

Aumento Proteine

Riduzione peso (massa grassa)Aumento sensibilità insulinica

Aumento contributo acidi grassi quale sorgente energiaAumento contributo acidi grassi quale sorgente energia

Prestazione ? Salute ?

The influence of low versus high carbohydrate diet on a 45-min strenuous cycling exercise.y gKavouras SA, Troup JP, Berning JR.Int J Sport Nutr Exerc Metab. 2004 Feb;14(1):62-72.

On days 1-3, subjects consumed a mixed diet for both trials and for days 4-6 consumed i l i di t th t t i d ith 600 100 f b h d tisocaloric diets that contained either 600 g or 100 g of carbohydrates, for the H-CHO and the L-CHO trials,

Heart rate, ratings of perceived exertion, oxygen uptake, and respiratory quotient during exercise were not significantly different between the 2 trials.

The findings suggest that L-CHO had no major effect on 45-min cycling exercise that was not observed with H-CHO when the total energy intake was adequate.

Adaptations to short-term high-fat diet persist during exercise despite high carbohydrate availability.p g y yBurke LM, Hawley JA, Angus DJ, et alMed Sci Sports Exerc. 2002 Jan;34(1):83-91.

Eight well-trained subjects consumed either a high-CHO (9.3 g x kg(-1) x d(-1) CHO, 1.1 g x kg(-1) x d(-1) fat; HCHO)(9.3 g x kg( 1) x d( 1) CHO, 1.1 g x kg( 1) x d( 1) fat; HCHO) or an isoenergetic high-fat diet (2.5 g x kg(-1) x d(-1) CHO, 4.3 g x kg(-1) x d(-1) fat; FAT-adapt) for 5 d followed by a high CHO diet and rest on day 6for 5 d followed by a high-CHO diet and rest on day 6.

CONCLUSION: Adaptations to a short-term high-fat diet persisted in the face of high CHO availability before and during exercise, but failed to confer a performance advantage during a TT lasting approximately 25 min undertaken after g g g pp y2 h of submaximal cycling.

EFFECT OF ADAPTATION TO A HIGH-FAT DIET ON SUBSTRATE UTILIZATION AT DIFFERENT EXERCISE INTENSITIESUTILIZATION AT DIFFERENT EXERCISE INTENSITIESMedicine & Science in Sports & Exercise, 34(5) S260, 2002Burke, L M., Cox, G R.; Anderson, M et al.

Overall rates of fat oxidation across exercise intensities were greater after Fat-adapt g pthan the CHO treatment (P < 0.05). CHO restoration reduced rates of fat oxidationin both trials, but rates with Fat-adapt remained above those of CHO treatment on Day 7 (P < 0 05) Maximal rates of fat oxidation were attained whenon Day 7 (P < 0.05). Maximal rates of fat oxidation were attained when cycling at 57% PPO (65% VO2peak) for both treatments.

Metabolic adaptations leading to increased rates of fat oxidation over a range of cycling intensities occur with a brief period of high-fat intake in well-trained y g p gindividuals.

Effects of Dietary Fat on Muscle Substrates, Metabolism,and Performance in Athletesand Performance in Athletes.Medicine & Science in Sports & Exercise. 35(6):952-960, June 2003.VOGT, M., PUNTSCHART A.; HOWALD H; et al.

Muscle glycogen stores were maintained after a 5-wk high-fat diet period whereas IMCL content was more than doubled. Endurance performance capacity was maintained at moderate to high-exercisep p y gintensities with a significantly larger contribution of lipids to total energy turnover

Long-term fat diet adaptation effects on performance, training capacity, and fat utilizationtraining capacity, and fat utilizationJØRN WULFF HELGEMedicine & Science in Sports & Exercise 3, 2002, 1499-1503

CONCLUSIONCONCLUSIONOverall, there is evidence to suggest that endurance performance at best can only be maintained after longterm adaptation to fat-rich diets when compared withcarbohydrate rich diets and therefore long term fat diet usage cannot becarbohydrate-rich diets, and therefore long-term fat diet usage cannot be recommended as a tool to improve endurance performance. There is good evidence that a reasonably high training intensity was possible over prolonged

i d f f di i i i d d l i d bj dperiods of fat diet consumption in untrained to moderately trained subjects, and that high intensity interval training could be tolerated by elite athletes duringshort-term fat-rich diet adaptation. However, in both untrained, moderately trained, and elite athletes, a highermental effort was required to perform the exercise training, possibly due to a fat-diet–induced higher sympathetic nervous activation.g y p

Long-term fat diet adaptation effects on performance, training capacity, and fat utilizationtraining capacity, and fat utilizationJØRN WULFF HELGEMedicine & Science in Sports & Exercise 3, 2002, 1499-1503

“ .. although we now 80 years after can explain a large part of the biochemicalg y p g padaptations behind the adaptations observed by Krogh and Lindhard (24), there is to the best of my knowledge still not solid evidence to explain these individual differencesindividual differences. Thus, future studies should address whether indeed there is such an individual response to high fat diets and subsequently provide the physiological explanation behind a such difference “explanation behind a such difference.“

Diete “Low Carbo” (LC)Diete Low Carbo (LC)

Riduzione contenuto muscolare glicogeno pre esercizio

•Aumento enzimi ossidativiAumento enzimi ossidativi•Aumentata densità mitocondriale•Maggiore deposito ed utilizzo trigliceridi intramuscolari•Stimolo uptake muscolare acidi grassi liberi plasmatici•Stimolo uptake muscolare acidi grassi liberi plasmatici

Effetti sull’allenamento giornaliero?

Rosenkranz R R et al Int J Sport Nutr Exerc Metab 3 296 308 2007Rosenkranz R.R. et al, Int. J. Sport Nutr. Exerc. Metab., 3, 296-308, 2007

Training on a Low Carbo diet: a case study

Rosenkranz R.R. et al, Int. J. Sport Nutr. Exerc. Metab., 3, 296-308, 2007

Traithlon, età 34 aa, peso LC 78.8-75.6, GB 77.1-77.7

LC GB Spontanea

Carbo % 21.5 58.7 68.9

Carbo g/d 208 603 822

Li idi % 54 7 28 3 19 1Lipidi % 54.7 28.3 19.1

Lipidi g/d 235 129 102

Prot % 23.5 12.1 12

Prot g/d 227 125 143g

Kcal 3736 3949 4659

Training on a Low Carbo diet: a case study

Rosenkranz R.R. et al, Int. J. Sport Nutr. Exerc. Metab., 3, 296-308, 2007

+

Riduzione Massa grassaAumento sensibilità insulina ? -

•Stato umore•Allenamento giornalieroAllenamento giornaliero•Frequenza cardiaca durante sforzo (effetto allenamento?)

Effects of a low carbohydrate diet and graded exercise during the follicular and luteal phases on the blood antioxidant status pin healthy women.Sadowska-Krepa E, Manowska B, Pilis W, Sobczak A, Danch A.Eur J Appl Physiol. 2002 Aug;87(4-5):373-80

Seven healthy physical education students under four different phase-diet conditions of theSeven healthy physical education students ..... under four different phase-diet conditions of the menstrual cycle, i.e. twice either during the mid-follicular or the mid-luteal phase, in each case either after 3 days of eating a normal mixed diet (59% carbohydrate, 27% fat, 14% protein) or 3 days of eating an isoenergy L-CHO diet (5% carbohydrate, 52% fat, 43% protein).or 3 days of eating an isoenergy L CHO diet (5% carbohydrate, 52% fat, 43% protein).

The 3 days of the L-CHO diet which had been preceded by glycogen-depleting exerciseThe 3 days of the L CHO diet, which had been preceded by glycogen depleting exercise, resulted in a stimulation of the blood antioxidant defence system in young eumenorrhoeic women both at rest and during the graded cycling exercise to maximal oxygen uptake......which resulted in better protection of the cell membranes against damage from peroxides, p g g p ,as reflected by a limited release of creatine kinase into plasma.

Carboidrati/Proteine/Lipidi40/30/30

Distanza massima tra i pasti 5 oreRapporto (gr) prot/carbo: circa 0 75Rapporto (gr) prot/carbo: circa 0.75

Valutazione non solo quantitativa (apporto energetico) dei singoli nutrienti/alimentiValutazione non solo quantitativa (apporto energetico) dei singoli nutrienti/alimenti ma anche qualitativa: risposte ormonali.

Ricerca dell’equilibrio ormonale che permetta di ottimizzare catabolismo dei depositiRicerca dell equilibrio ormonale che permetta di ottimizzare catabolismo dei depositi adiposi ed anabolismo proteico

Ricerca dell’equilibrio ormonale che permetta di ridurre le “situazioni flogistiche” eRicerca dell equilibrio ormonale che permetta di ridurre le situazioni flogistiche e dismetaboliche

Ricerca dell’equilibrio ormonale che permetta di ridurre il rischio di malattie cronicheRicerca dell equilibrio ormonale che permetta di ridurre il rischio di malattie croniche

Diete ad alto e basso apporto di carboidratinell’alimentazione dello sportivo

“A low carbohydrated diet rapidly compromises energy reserves for vigouros physical activity or regular trainingfor vigouros physical activity or regular training

McArdle W.D., Katch F.I., Katch V.L.

“Their diet should contain at least 50-60% of calories as carbhoydrates, d i tl t h f fib i h d ipredominantly starches from fiber rich, unprocessed grains,

fruits and vegetables.McArdle W D Katch FI Katch VLMcArdle W.D., Katch F.I., Katch V.L.

Effects of High–Fat or High–Carbohydrates Diets on endurance exercise: a Meta Analysisa Meta Analysis.

M. Erlenbusch et al Int J Sports Nutr. Exerc. Met. 2, 1-14, 2005

V l t i l i t di t di “T di E i t ”Valutazione complessiva e separata di studi su “Tempo di Esaurimento” e su “ prestazione (Time Trial)” .

Considerazione dell’influenza delle variabili:livello di allenamento;durata dell’esperimento;intensità esercizio svolto.

Effects of High–Fat or High–Carbohydrates Diets on endurance exercise: a Meta Analysisa Meta Analysis.

M. Erlenbusch et al Int J Sports Nutr. Exerc. Met. 2, 1-14, 2005

Livello di allenamento

Vantaggio per le “high carbo diets nei soggetti non allenati. Differenza minima nei soggetti allenati

Durata esperimento

Da 3 a 49 giorni. Trials di durata < 7 giorni riflettono variazioni acute glicogeno più che adatt. Metab.

Effects of High–Fat or High–Carbohydrates Diets on endurance exercise: a Meta Analysisa Meta Analysis.

M. Erlenbusch et al Int J Sports Nutr. Exerc. Met. 2, 1-14, 2005

Intensità attivitàIntensità attività

Variabile dal 60% al 90% VO2max. Valutare intensità relativa alla soglia anaerobica individuale ?

Percentuale nutrienti

“ i h f di ” 30% 84% li idi 0% 8% b“High fat diets”: 30%-84% lipidi con 0%-58% carbo. “High carbo”: 53%-90% carbo con 3%-35% lipidi

Diete ad alto e basso apporto di carboidratinell’alimentazione dello sportivo

“.. In conclusion we found that endurance performance is enhanced following an high carbohydrated diet compared to a high fat dietfollowing an high carbohydrated diet, compared to a high fat diet, in untrained individuals, while the performance response in trained individuals appears to be blunted.”individuals appears to be blunted.

Effects of High–Fat or High–Carbohydrates Diets on endurance exercise: a Meta Analysis.

M Erlenbusch et al Int J Sports Nutr Exerc Met 2 1-14 2005M. Erlenbusch et al Int J Sports Nutr. Exerc. Met. 2, 1-14, 2005

Diete ad alto e basso apporto di carboidratinell’alimentazione dello sportivo

“With carbohydrated depletion exercise intensity decreasesWith carbohydrated depletion, exercise intensity decreases to a level governed by the body’s ability to mobilize and oxidize fat”

McArdle W.D., Katch F.I., Katch V.L.

i l i i i à i

, ,

Tipologia attività sportiva

Livello allenamento

“Timing”

Diete ad alto e basso apporto di carboidratinell’alimentazione dello sportivo

MODERATO APPORTO CARBOIDRATI MEDIO BASSO IGMEDIO BASSO IG

Influence of high and low glycemic index mealson endurance running capacity.on endurance running capacity.Wee SL, Williams C, Gray S, Horabin J.Med Sci Sports Exerc. 1999 Mar;31(3):393-9

The purpose of this study was to examine the effect of high and low glycemic index (GI) carbohydrate (CHO) pre-exercise meals on endurance running capacity. Eight active subjects (five male and three female) ran on a treadmill at approximately 70% VO2max to exhaustion on two occasions separated by 7 d. a app o a e y 70% VO a o e aus o o wo occas o s sepa a ed by 7 d.

During the first 80 min of exercise in the LGI trial, CHO oxidation was 12% lower and fat oxidation was 118% higher than in the HGI trial. Although serum insulin concentrations did not differ between trials, blood glucose at 20 min into exercise in the HGI trial was lower than that during the LGI trial at the same time. During exercise, plasma glycerol and serum free fatty acid concentrations were lower g , p g y yin the HGI trial than in the LGI trial. CONCLUSIONS: This results demonstrate that although there is a relative shift in substrate utilization from CHO to fat when a low GI meal is ingested before exercisesubstrate utilization from CHO to fat when a low GI meal is ingested before exercise compared with that for a high GI meal, there is no difference in endurance running capacity.

Da: nessuna colazione A: colazione mista