Western States 100

⛰ I volunteered in the medical tent at the finish line for Western States 💯 … .

Was hoping for some extreme medical cases to treat 🤕 but 😀 no one needed it!!

Most avoided using ibuprofen during the race as well!!! 👍

The 1 missing piece I did notice from speaking with finishers – was the lack of a nutrition recovery plan! The reason I mention it is because for several days the body will be inflamed which is completely normal & also trying to manage the damage done to every tissue used to cross the finish line.


Those of you I saw limping out of medical, know what I am talking about 😫 

Even if you are nauseous and have no appetite you must take in small amounts of easily absorbable protein that is highly bioavailable! Sorry vegans but whey is best for this due to the leucine (or fortified vegan protein powders).. and glycine in the form of collagen. 

Start your recovery Immediately! 💪🍽

It’s understandable considering the logistics of getting to the start line, preparing drop bags for aid stations, organizing crews, taking care of niggles, aches & pains….

💡But: if it’s practiced on a regular basis after usual training runs, it will become just another bag of food to pack without much to think about!

The Crossroads

Food decisions, weight loss
Food Decisions.” Learn how to turn a ‘bad’ day into a ‘good’ food day.

To remain motivated, committed and disciplined to train for triathlon or any bigger-than-life event requires characteristics commonly recognized in Type “A” personalities. These characteristics are great for completing to-do lists, setting and attaining goals. When it comes to diet and food, these characteristics can be helpful or they may create parameters that limit our chance of success. 

Almost all of us, experience a moment in time each day, when a decision is made to commit or stray from a diet, or eating plan we consider ‘healthy.’  I refer to this as the “Crossroads.” For some of us it’s simple: Should I eat the slice of banana chocolate chip bread after my long run?  I didn’t work out today, but I’m hungry and couldn’t resist two bowlfuls of tortilla chips. Is eating two scoops of peanut butter/chocolate frozen yogurt acceptable if I biked 50 miles? 

For others, this moment in time, when a choice to eat a handful of M&M’s or a piece of fruit, can somersault into a cascade of ‘bad’ food decisions the rest of the day. The danger in this cascade effect is not the actual consumption of unhealthy food, but the mental judgement that begins and becomes difficult to turn off. Making one bad decision, can quickly elicit feelings of failure, and instead of brushing the instance off, a little voice in their head, continues the conversation, reminding them of their bad judgement and daring them to falter again. 

Join me in this “day in the life” article of a typical person on a typical day, at the crossroads.

It is Monday morning. You woke up early with your day mentally planned, and ready to execute. You completed your 75 minute bike trainer workout, which in itself is cause for a pat on the back and then ate a well deserved breakfast. You have snacks and lunch packed for work, and plan on getting in an afternoon swim. As long as things go as planned, the day should be easy and the world will be bright.

Driving to work you are feeling ready for the day. Workout one is behind you and now its time to focus on what lies a head. Your plan is to get to the pool after work for a short swim and then call it a day.  You arrive at work, and it is status quo until lunch. Work crosses your desk but you are able to manage and reprioritize it, keeping on schedule to leave work on time. You ate your lunch and are looking forward to your afternoon snack to fuel your swim. Your eyes are on the clock. Lap hours are limited at your pool and getting there after 6:00 pm isn’t enough time for the workout. 

It’s 3 pm and you get a call from your supervisor explaining that one of your clients is unhappy which requires you to schedule a phone call at 4 pm to discuss. The phone call lasts 45 minutes during which time you commit to revamping the portfolio for them before tomorrow morning. You hang up the phone, look at the clock, and sigh.  You knew this would happen; regardless of how much you try to get in your workouts, something always gets in the way. 

This is the gray moment; right here and now. You woke up and exercised, which made you feel good about yourself, motivating you to eat a healthy breakfast and stick to your planned meals for the day. Then, the curveball comes – beyond your control, but it still comes and forces you off your planned routine for the day. Prevents you from feeling the sense of accomplishment from completing your plan – completing two workouts for the day. 

This is when the cogs in your mind begin to turn and for some people it is the make or break part of your day.  You begin to recalibrate the day with new outcomes. There are only two options: success and failure. You enter that place in your mind that you know too well. It’s the place in your psyche where you aren’t your usual, rational, purposeful self. It’s the place where you feel irrational, a bit ouf of control, anxious, and vulnerable.

You have been here before, so you should have it figured out by now. You should have a strategy in place, or a plan “B” for these situations. You’re smart and you know yourself well. Then why can’t you get through these slices of time, maintaining control; not feeling like you succumbed to your old habits and defaults?  You know if you just got in that second workout you would have been motivated to eat a healthy dinner instead of the take-out which has become too frequent. You are at the crossroads. 

Scenario #1: recognize that the situation is beyond your control, and continue on with your day. You have your emergency stash of somewhat healthy snacks in your drawer that should hold you until you get home for dinner. You decide to get a tall decaf latte with whipped cream to feel better. If you have the energy after dinner, maybe you will do some stretching at home to feel like you did “something.”  

Scenario #2: recognize the situation is beyond your control, but even knowing this does not make it any better. You had been eyeing the chocolate muffins sitting on the table in the employee kitchen all day, but purposefully did not eat one because you had the confidence and motivation not to. Now, your day has completely derailed as expected, so you might as well have a chocolate muffin. At this point, what difference does it make? 

The chocolate muffin is tasty and a nice reward for the aggravation that lies a head. Back at your desk, the taste of chocolate still on your mind, you begin to feel tired and distracted. The lightbulb in your mind flashes – you need to wake up and focus to get this project done as quickly as possible!  You might as well get a vente mocha latte with whipped cream. After the client call, while you work on the project, you snack on a bag of tortilla chips and without even realizing it, the bag is empty. Seeing the empty bag on your desk, you are in disbelief and angry with yourself for eating so mindlessly.  You get a diet coke from the vending machine, clear off your desk and finish the project.

Its 8 pm and you are driving home tired and aggravated. You know the 7-eleven has Dunkin’ Donuts and you could use a pick-me-up from the sour mood you are in. You decide that you will buy a dozen, but only eat one and bring the rest to work tomorrow. At home, you heat up leftover chicken, toss it in mixed greens, and bake french fries. You eat the chicken and french fries and push the salad greens around the plate. When you walk into the kitchen, the donuts catch your eye. You are still hungry, your day went down the tubes, so why not have another donut? An hour later during a commercial on TV, you walk into the kitchen for a glass of water, and only see six donuts left. Enraged, you throw them in the trash, have a glass of wine, and then go to bed.

The two scenarios’ above are very realistic and common for anyone trying to revamp their diet, or lose weight.  The stressors (causes) may be different, but the consequences/effect (stress, derailment of plan) are the same. The scenarios themselves are not individually good or bad, and neither of the subsequent reactions are better than the other. If the reactions to the situations are labeled generally as success/good or failure/bad, then it makes it extremely difficult for anyone to move on and start fresh the next day. However, the person in the scenario itself usually cannot think this way. They are standing in the middle of the forest within their own mind full of created realisms and judgement. I as the dietitian have an advantage because I am free of the judgement, and can place a client’s situation in a different perspective; instead of being in the forest with them, I am overhead. 

The scenarios above target two very strong emotions related to self-worth: a) sense of accomplishment and control we feel when we exercise regularly and/or complete workouts as planned, and b) the effect of “A” on our food choices that day. In this particular example, the focus is on the close relationship between exercise and our ability to follow through on the second goal (eating well).  For people who experience scenario #2  more often than #1, having a Plan “B” usually helps. It may not always work or be feasible, but creating a pre-set mental plan in advance is better than not having one at all.

If you work with a triathlon coach, and trust the workout plan, simply knowing that the missed workout is not going to ruin your training cycle can be sufficient reassurance to not feel like your day has ‘gone off the rails.’ If you don’t feel like your day has ‘gone of the rails’ then you may not feel compelled to sabotage your diet. If the reassurance from your coach will not penetrate your own mental rationale, planning a form of exercise that usually gets skipped due to lack of time (e.g. Bosu ball, swiss ball, foam roller) are good alternatives because they work on weaknesses without expending a lot of energy. If your goal of training is performance, I would not recommend substituting a workout at the gym at 9 pm to compensate because this would most likely affect the quality of workout the following day. If your goal is weight loss I would still not recommend a workout at 9 pm, so that you do not get overly fatigued the remainder of the week. If you became overly fatigued or stressed the rest of the week, this could lead to more potential options for failure if you do not complete a workout.  The goal is to prevent a ‘landslide’ effect of one bad day ruining an entire week. 

As much as planning in advance (having healthy foods on hand) and having a plan “B” ready to mentally switch to, can relieve anxiety there is another reality.  Even though we may not like our choices (eating pattern in #2) and wholeheartedly want to change, there is comfort in our identity and what we expect from ourselves. I explain it as a form of subconscious self-fulfilling prophecy, which is by no means a scientific definition. A person does not ‘want’ to derail their day; they do not want to lose control; they do not want to eat a box of donuts, and if they do, they will be upset with themselves.  BUT they do like eating chocolate muffins and doughnuts and maybe they deserve to eat them considering the situation?

As a dietitian, not a psychologist or therapist, part of my job is to understand where a client has been in their weight loss journey and the implications of that. The amount of self awareness varies greatly between people, and where they lie along the Stages of Change Model, may be different for mental goals and physical goals. One person may already be at the ‘preparation’ or ‘action’ stage of change, implementing an exercise program into their normally sedentary lifestyle when I begin to work with them, showing they are very motivated to become active. However, their readiness to face mental obstacles that include identity, self-perceptions, judgement and permission to change, may be at the ‘precontemplation’ stage. It is completely fine to be at different stages of change, and actually may be advantageous so that a person is not overwhelmed with taking on excessive personal changes at once. Often, starting with a physical change can provide the self confidence —> to fuel the motivation —> to develop healthy coping strategies, needed to face mental obstacles. 

Inner beliefs we may not even be aware of, take time to come to the surface and from my experience, this happens when the time is right and the person is ready. The difficulty for a dietitian comes when a person does not see or is not willing to see obstacles, and become defensive at any suggestion of such. Respecting where a person is at in their own journey is a priority and the goal is to provide the support and guidance to help them move forward.

Getting back to the scenario’s above, just like implementing a new exercise routine takes  deliberate focused effort, so does changing our mental concept of ourselves. Implementing new mental mantra’s and recordings, to change the same familiar theme we hear when a bad decision is made, is crucial to getting over the hurdle between success and failure.  Good luck on your journey!

Muscle Cramps: Hydration, Salt and Fatigue

The heat and humidity this summer has many of our clients suffering from muscle cramps. Looking at past research and theories on muscle cramps, we must conclude that the elusive question of what causes muscle cramps remains unanswered.

The three main causes cited for causing EAMC (Exercise Associated Muscle Cramps) are:

  • Loss of serum electrolytes (sodium, potassium, magnesium, chloride, calcium) because of dehydration.
  • Pre-mature muscle fatigue caused by performing exercise at a higher relative exercise intensity or duration, when compared with normal training.
  • Inhibited range of motion as a result of tight muscles.

The loss of serum electrolytes happens when you train and neglect to consume enough fluids. This dehydration occurs in all weather, training intensity, or terrains. However, it is most detrimental when you train in hot, humid conditions.  It is detrimental because electrolytes are lost through sweat and perspiration.  Electrolytes are a group of ions required by the body to stimulate multiple neurological reactions. The five primary electrolytes are sodium, potassium, chloride, magnesium and calcium. Sodium, potassium and chloride are the most important for muscle contraction.
Many people believe all muscle cramps can be explained by a lack of potassium, but most physiologists do not.

While there is no replicated scientific evidence to date, most scientists believe it is the depletion of sodium and chloride, that causes cramping because of the role they play in maintaining fluid balance in the body. How does depletion of sodium and chloride effect training? As an athlete exercises for an extended duration in hot weather, their core body temperature increases. This leads to dehydration. Blood pressure will decrease, and the heart rate rises. One of the ways the body tries to compensate for this is to release hormones that increase sodium permeability in the kidneys. This, in turn, increases the uptake of water into the kidney. These combined responses slow the decrease in blood pressure, and the body reserves water and sodium for necessary core body functions. When there is a higher percentage of water in and outside of cells than electrolytes, athletes experience hyponatremia. This disrupts the balance of electrolytes inside and outside of cells, causing a decrease in neural signals within the muscle, thus decreasing performance.

The only instance I found that may somewhat support the theory that sodium loss causes EAMC was a case report of an experienced triathlete during the course of the Western Australian Ironman Triathlon. The athlete’s sodium levels stayed relatively the same from before the start of the race to transition number two. However, from transition number two to the end of the race, the athlete lost 2% of his body weight due to fluid loss. “The athlete slowed during the run phase of the race after his core temperature rose to critically high levels.  As he slowed and his core temperature increased, there was an unusually rapid reduction in blood sodium that preceded cramping, despite presenting with signs of dehydration.” (5)

Other studies have hypothesized a decreased serum sodium concentration would cause muscle cramping but have proved to be inconclusive (2, 4). Noakes et. al. studied Ironman South Africa athletes to analyze serum electrolyte levels, and even though the decrease in sodium concentrations was significant, the difference compared to a control group was within the normal clinical range of post-race serum sodium concentrations. They were unable to correlate decreased sodium concentration to an increase in exercise-associated muscle cramping. Instead, they concluded “the increased activity of cramping muscles post-race may reflect increased neuromuscular activity.”(2)

The second hypothesized cause of EAMC, is pre-mature muscle fatigue.  “No mechanism explains how such imbalances in serum electrolytes result in localized muscle cramping. The “muscle fatigue” hypothesis suggests that EAMC is the result of an abnormality of neuromuscular control at the spinal level in response to fatiguing exercise. The development of premature muscle fatigue appears to explain the onset of EAMC.”(3) The diagnosis of EAMC is made clinically, and the most effective immediate management of EAMC is rest and passive stretching. The key to the prevention of EAMC is to reduce the risk of developing premature muscle fatigue. (6)

Hunter Allen, a USA cycling Level 1 coach, agrees that rest and stretching are the best way to prevent muscle cramps. If you exercise your muscles when they are already in a stretched (weakened) state, you will not gain fitness or strength. As you exercise without stretching, your muscles will become tight and they aren’t able to work in the range of motion necessary for optimal muscle recruitment. If you add the extreme conditions and intensity of a race, the muscles may not be able to respond without cramping. He recommends massage and yoga to keep muscles open.

You can’t use a “one size fits all” approach to muscle cramping since the cause will vary person to person. A veteran Ironman-distance triathlete could complete in an extremely hot and humid Austin 70.3 and need 2L of IV at the finish, but never get muscle cramps.  However, someone new to endurance racing could race a sprint triathlon in the same conditions and complain of calf cramps during the run.

The best prevention of exercise-associated muscle cramping would be:

  • Sodium load during taper week:  This has to be customized per diet and hydration plan. I wont give general recommendations here. I have athletes use The Right Stuff and pre-drink the week prior so the body has time to absorb and manage total fluid status.
  • Drink 16 ounces of an electrolyte drink such as nuun before your workout in hot conditions, and sip an electrolyte drink during workouts lasting 60 minutes or longer in hot conditions. To prevent bloating and discomfort, the electrolyte drink should be non-carbonated and have low concentrations of carbohydrate. Carbonation and high sugar content inhibits the digestion and absorption of the electrolytes and glucose.
  • If you usually eat a low-sodium diet, speak with your doctor about adding salt to your meals on the days you work out for 60 minutes or longer in hot conditions. If your diet consists of packaged foods and eating out, you consume enough salt to compensate for loss during exercise and should not add it to your meals.Work with a Trismarter.com Sports Nutritionist to create a customized training nutrition plan. They will help you determine the amount of gels, chomps, water, and electrolyte drink you should be consuming per workout.
  • Avoid pre-mature muscle fatigue by:
    •  Scaling down your workouts during hot and humid conditions: Don’t force the pace of a run even if it was scheduled to be a sub-threshold workout. Your heart rate will naturally be higher as the mercury rises, so if it’s in the ‘endurance’ zone instead of the ‘recovery’ zone during your warm-up, back-off and adjust the workout even though you feel like your exertion level is low.
    • Staying loose: Befriend a foam roller and use it religiously, attend yoga class, or get a massage.
    • Avoiding weekend warrior syndrome: If you haven’t been riding your bike all summer and decide to head out on a four hour ride in 93’ temps with 90% humidity, you are setting yourself up for muscle fatigue and nail-biting muscle cramps.

What to do when you get a cramp?  Once you get a cramp, you cannot make it disappear right away. This is why prevention is key. Most cramps are relieved through light stretching, massage, and hydration.

During a race, walk through the aid stations, sip de-fizzed cola, and stretch the affected area. If you feel a stitch in your side during a run, try to slow your rate of breathing and consciously breathe deeper into your abdominal cavity or reach hands overhead to stretch the affected side.  You can try to run through a stitch if you can manage the discomfort. Cramps in the quadriceps or calves should be slowly stretched and massaged as well, followed by suggested prevention tips above.

1.    Laursen PB, Watson G, Abbiss CR, Wall BA, Nosaka K.  Hyperthermic fatigue precedes a rapid reduction in serum sodium in an Ironman triathlete: a case report. Int J Sports Physiol Perform. 2009 Dec, 4(4):533-7.
2.    Sulzer NU, Schwellnus MP, Noakes TD. Serum electrolytes in Ironman triathletes with exercise-associated muscle cramping. Med Sci Sports Exerc. 2005 Jul, 37(7):1081-5.
3.    Schwellnus MP. Muscle cramping in the marathon: aetiology and risk factors. Sports Med. 2007, 37(4-5):364-7.
4.    Maughan RJ. Exercise-induced muscle cramp: a prospective biochemical study in marathon runners. J Sports Sci. 1986 Spring, 4(1):31-4.
5.    Laursen PB, Watson G, Abbiss CR, Wall BA, Nosaka K. Hyperthermic fatigue precedes a rapid reduction in serum sodium in an Ironman triathlete: a case report. Int J Sports Physiol Perform. 2009 Dec, 4(4):533-7.
6.    Schwellnus MP, Drew N, Collins M.  Muscle cramping in athletes–risk factors, clinical assessment, and management.  Clinical Sports Med. 2008 Jan, 27(1):183-94, ix-x.
7.    Hunter Allen’s theory on cramping    http://www.peakscoachinggroup.com/ASPX/articles/articles.aspx?AspxAutoDetectCookieSupport=1

Semantics of Hydration

cross published: Trifuel
Recently while running up Pikes Peak,  I came upon a fellow with good intentions explaining hydration to a woman who was new to mountain running. He said: “You don’t need to carry water with you during the race, they have plenty of aid stations. Besides, most people over-hydrate anyway.” In this particular instance, this man was referring to drinking too much water as being overhydrated, but using the phrase “overhydrate” without explanation of or differentiation between water and electrolytes can give two very different implications.

The problem with telling an athlete unfamiliar with the semantics of hydration is that the person receiving this message, might interpret that to mean they should not drink a lot during the race. However, telling them to drink an electrolyte and carbohydrate drink when they are thirsty is a completely different message. This question of semantics might not make a difference to an experienced athlete who uses the term hydration interchangeably with drinking electrolytes, but for someone new to running at altitude, it should be clarified. Dr. Tim Noakes, one of the initial authors involved in creating protocols for hydration recommendations in endurance sports, has now done an about face in his latest book “Waterlogged” published in 2012. This article does not delve into the controversial debate surrounding the book, but instead focuses on differences in terminology related to hydration status.

Semantics are important when it comes to hydration to distinguish between two common terms associated with sweating: dehydration and hyponatremia. Differentiating terminology related to over and under consuming fluids and the concern for each is important. Consuming an insufficient amount of water that results in total body water weight loss is a condition called dehydration. Drinking too much water during exercise can cause water intoxification, (exercise associated hyponatremia (EAH)), a condition defined by dangerously low serum sodium levels. The media has used the terms dehydration and exercise associated hyponatremia (EAH) to mean the same and in doing so it has falsely led readers to assume that the symptoms for the two different conditions are the same. Due to specific events like the Boston Marathon which gained a lot of hype and press in 2002 when athletes over consumed water and/or total fluid including carbohydrate beverages, guidelines have been created and recommendations on fluid intake have been updated.

Dehydration, or insufficient water status in the body, is important because water makes up 45% – 75% of our body weight (60% average) and is tightly regulated to within 0.2 – 0.5% of our daily body mass. A reference range is used because each person’s water mass percentage will vary depending on fluid consumption and body composition. The more lean mass and glycogen stores a person has, the higher the percentage of water in body composition. The main symptom of mild dehydration is thirst, but as the percentage of water loss increases, perceived exertion, core temperature, and heart rate may increase.

The goal of hydration plans is not to prevent weight loss but to reduce the amount of it. There has been debate whether or not dehydration affects performance, and each person’s tolerance to it will vary. It is recommended that athletes minimize weight loss to 2 – 3% of body weight in exercise lasting longer than 90 minutes. Many professional marathon runners accumulate much higher percentages of body weight loss than the recommendation without perceived decrement to their performance. However, the physiological adaptations that take place as a result of their training in combination with the elevated threshold for discomfort elite athletes exhibit; make them the minority, not the norm.

Determining accurate water loss using sweat rates is difficult since there are several sources of error, including respiratory loss of water and water as a byproduct of the breakdown of glycogen, fat, and protein. In addition, sweat rates focus on the loss of body weight which can be altered without a change in body water status. However, sweat rates are the least burdensome for athletes to use to measure body water status and can provide approximations for a variety of environments and intensities of training.

Exercise associated hyponatremia (EAH) can occur when a person is in a state of water balance or water deficit (dehydration), but it is usually associated with excessive water intake. In general, if a person consumes an electrolyte beverage when they are thirsty, EAH can be avoided. However, if a person drinks electrolyte containing beverages excessively (as if trying to prevent sweat loss), they can experience EAH. Exercise associated hyponatremia is usually asymptomatic and even though we usually associate excessive intake of water with weight gain, many times there is no change in body weight. The only way to diagnose EAH is to have your blood drawn for evaluation of sodium levels. Exercise associated hyponatremia is diagnosed when serum sodium levels fall below 135 mmol/L. Symptoms of EAH include feeling bloated, a ‘puffy’ appearance, nausea, and vomiting. These are all symptoms that can be experienced from simply participating in an endurance event. EAH is not a condition one would experience after a normal training day, so just because you feel bloated, you most likely are not experiencing EAH. Studies have found that even a moderate intake of sodium as part of a carbohydrate electrolyte drink prevented dramatic changes in serum sodium levels, and sodium intake while exercising in the heat is necessary in preventing EAH due to sodium loss that occurs when an athlete tries to match fluid intake with sweat loss.

The balance of water inside and outside of cells in relation to the concentration of sodium and chloride determines sodium balance. Hew-Butler et al. found that athletes who lost up to 3.8% of their body weight after Ironman South Africa (2006) still maintained serum sodium and plasma volume, showing us that our bodies work to maintain the balance of water, sodium and chloride inside and outside of cells. Weight loss >4% may result in a disturbance to sodium balance however, this depends on sex, amount and type of fluid ingested during event, and sweat rate. Pahnke et al. found that men had a higher overall sweat rate than women during the 2003 Hawaii IronmanⓇ Triathlon World Championship in Kailua-Kona, Hawaii and women on average drank more of a sodium containing beverage than the men, which attenuated their decline in sodium levels. Out of the men and women who completed this race, those that lost >4% body weight did not show a significant change in their serum sodium concentrations. The average concentration of sodium per pound of sweat is 400 – 500 mg, but it can range as high as 1100 mg. This large degree of variability is why it is difficult to make definitive recommendations about the use of salt tablets.

Some research has shown sodium supplementation does not affect sodium loss or performance during a 12.5 hour Ironman competition but it did minimize total weight loss in subjects who consumed 700 mg/hr salt compared to those that did not during Ironman South Africa. In addition, in the same race, none of the athletes that finished the race had EAH defined as < 135 mmol/L sodium regardless if they consumed a salt tablet or not. Most athletes did not fully replace or match fluid intake with loss. This is important because if they did try to match loss through intake, serum sodium levels most likely would have decreased. However, by not matching sweat loss with fluid intake, their kidneys preserved sodium concentration levels while total body mass (mostly water) decreased. Many professional Ironman athletes positively attribute their success in Kona, HI to salt supplementation during the race. The training and acclimatization that a professional athlete does in preparation for Kona cannot be compared to an age group triathlete with less fitness, experience, and who trains in a different environment.

Key points:

  • Monitoring your sweat rate is a great way to follow trends in your rate of water loss from different types and duration of workouts and also comparing the same workout in two different environments; however, it is very easy to become caught up in the numbers and almost obsessed with fluid in and fluid out. Don’t try to make this equation equal to zero.
  • Instead of fighting your sweat rate, accept it and learn to become comfortable with it. Yes, we want to drink as much fluid and electrolytes as is comfortable within reason, but the other half of this is that you also have to train. You have to train enough that your body acclimates to the environment (e.g., hot and humid) and you mentally learn to manage the discomfort of sweating.
  • Hydrating in advance of training and rehydrating 24 – 48 hours in advance and after workouts in which you lose > 2% body weight is important. You can work with a sports nutritionist or dietitian to determine how much and what types of fluid to use, but in general, you should replace 24 oz (750 ml) per pound of weight lost. Drink these fluids throughout the day and not in one sitting. During this time, urine color is not necessarily an accurate indicator of hydration status.
  • To enhance hydration status the week preceding a half or full Ironman distance race in a hot and humid environment, consume electrolytes (calcium, magnesium, potassium, sodium and chloride) in addition to water. These will enhance total body water status.
  • Replenishing glycogen stores will also enhance hydration status since up to three grams of water is drawn into cells and stored in muscle bound to a gram of glycogen. Carbohydrate loading may not be necessary to accomplish this. It depends what kind of nutrition plan you are currently following (e.g., low carbohydrate or paleolithic) and the training you completed the week before your event.
  • There are different opinions on using thirst as a reminder to drink. Consuming a carbohydrate beverage that contains sodium has shown to increase palatability and stimulate thirst (McKinley). From our experience we have noticed that thirst works for lower intensity workouts completed in moderate environments for shorter durations. When it comes to a half or full ironman distance triathlon, fatigue and fitness of the athlete can affect their ability to recognize when they are thirsty. Sometimes their mental status is skewed due to fatigue or low energy intake and they don’t recognize thirst.
  • The efficiency at which you sweat increases with fitness, so you may notice that as soon as you step outside on a hot and humid day, you begin to sweat buckets. This is good – your natural AC is turning on!

Regina Hammond has a Master’s Degree in Sports Nutrition and works for Trismarter Triathlon Coaching and Nutrition (http://www.trismarter.com). Staying abreast of the latest research she believes in an individualized approach to nutrition. With a background in competitive swimming, biking and running, she understands what it takes to be a competitive triathlete and works with clients on performance fueling plans, periodized nutrition plans, weight loss, and behavior change.


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  • Pahnke, M.D., Trinity, J. D. Zachwieja, J. J., Stofan, J. R., Hiller, W.D., Coyle, E. F. Serum Sodium Concentration Changes Are Related to Fluid Balance and Sweat Sodium Loss. Med. Sci. Sports Exerc. 2010;42(9):1669–1674. (Funded by Gatorade Sports Science Institute)

Spilling the Beans about Green Coffee Bean Extract

cross published: Trifuel

One of the most discussed weight loss supplements on the market today is green coffee bean extract. Personalities such as Dr. Oz, and popular media have discussed promising results without actual endorsement of any specific products. I took a closer look at recent literature on the efficacy of the extract to find out if it was hype or legit.

To learn more about the science behind the weight loss claims, I reviewed the research article, “Randomized, double-blind, placebo-controlled, linear dose, cross-over study to evaluate the efficacy and safety of a green coffee bean extract in overweight subjects (1). In this study, green coffee bean extract marketed as GCAⓇ and manufactured by Applied Food Sciences Inc., showed significant results in reducing weight, body fat percentage, and BMI in sixteen people who had an average BMI of 26, which categorized them as “overweight.” Subjects consumed the supplement at a high dose, low dose, and then using a placebo for a total of 22 weeks. The study of this design worked well in that each subject experienced the different dosages and also used a placebo so that they acted as their own “control.”

Coffee beans have been researched in weight loss studies because they contain specific compounds that have been linked to improved glucose metabolism by the liver, and their caffeine content. One of these compounds is chlorogenic acid (CGA) the active ingredient in green coffee bean extract. Green coffee beans contain the largest amounts of CGA found in plants, ranging from 6 to 12% (3) making them an ideal weight loss solution if their effectiveness is proven.

CGA is composed of several individual phenolic compounds, the concentrations of which vary depending upon the degree that coffee is roasted. The longer a coffee bean is roasted the lower the levels of CGA. Previous research using CGA consumption in rats has improved glucose metabolism demonstrated by significantly lower levels of triglycerides after CGA supplementation. High triglyceride levels put one at risk for type 2 diabetes and heart disease. Caffeine promotes weight loss by inhibiting the enzymes and hormones related to the storage of fat while stimulating the breakdown of fat, when carbohydrate is not readily available.

The current study showed an average weight loss of 8 kg (17.6 lb) over 22 weeks with a varying dose. This is high compared to 2.5 – 5 kg (5.5 – 11 lb.) in unpublished studies that used human subjects. The average 8 kg weight loss is significant in that it moved six subjects from overweight to normal BMI, while consuming an average of 2400 calories. However, looking more closely at the study design shows that the average weight loss taking 1050 mg/day for six weeks was 4 – 9 lb, and average weight loss taking 700 mg/day for six weeks was 3 – 7 lb. Side effects did not present in the current study, however others have cited instances of an abnormal increase in heart rate and increase in systolic blood pressure.

SvetolⓇ green coffee bean extract manufactured by Berkem/Naturex has been used in previous research (2). This brand is distributed in the United States by Reserveage Organics contains 200 mg green coffee extract and 90 mg CGA (45%). If taken within the low range used in the current study (700-800 mg/day), and for a minimum of six weeks would require 4 capsules/day and three, 60 capsule bottles costing $30 each.

As with most supplements, ingredients and the amount of each contained per serving is not always accurate. This was found recently through testing by consumerlab.com. When shopping for green coffee bean extract pay attention to the amount in mg of CGA’s and percentage of caffeine. For maximum benefit, a minimum of 45% CGA’s are recommended. The amount of caffeine varies per extract and should be considered if you are sensitive to caffeine.

Should athletes use green coffee bean extract? First, keep in mind that research has only been conducted on pre-obese and obese subjects, not athletes or people who are trying to drop five pounds for performance gains. For any level of athlete the two concerns are total caffeine intake and contamination. If you don’t currently drink coffee or energy drinks that contain caffeine, it could be used short term. I would not recommend using it in conjunction with other caffeinated beverages because any increase in energy that excessive amounts of caffeine provide, may lead to lingering fatigue in the future. The possibility of contamination makes all supplements a risk. Elite athletes should not need a weight loss supplement if their training plan and recovery are methodical. If you are just getting off the couch and need to lose weight for health reasons, it is up to you to decide if the cost and risk are worth it. Short term use to initiate weight loss may help with initial motivation and lifestyle changes, but I would not recommend taking it longer than 18 weeks since that is the longest duration used in trials.

1 Vinson, J.A., Burnham, B.R., Nagendran, M.V. Randomized, double-blind, placebo-controlled, linear dose, cross-over study to evaluate the efficacy and safety of a green coffee bean extract in overweight subjects. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2012, 1(17):5,21-27.
2 Thom, E. A randomized, double-blind, placebo-controlled trial of a new weight-reducing agent of natural origin. J Int Med Res., 2000;28:229–233.
3 Farah, A., de Paulis, T., Trugo, L.C., and Martin, P.R. Effect of Roasting on the formation of chlorogenic acid lactones in coffee. J Agric Food Chem., 2005,53(5):1505-13.
4 Monteiro, M., Farah, A., Perrone, D., Perrone, L.C., and Donangelo, C. Chlorogenic acid compounds from coffee are differentially metabolized in humans. J. Nutr., 2007,137(10):2196-2201

Regina Hammond has a Master’s Degree in Sports Nutrition and assists athletes with their training & race day nutrition plans, sorting through the chaos of sports supplements, debunking weight loss fads, and periodized fueling plans. Staying abreast of the latest research she believes in an individualized, practical approach to nutrition.

Impact Loading and Nutrition in Cyclists

I presented the findings of my research during a thematic poster session on “Energy Availability” at the 60th Annual Meeting of the American College of Sports Medicine held at the Indiana Convention Center in Indianapolis, Indiana, June 1, 2013. The abstract was published in Medicine and Science in Sports and Exercise, Volume 45:5 Supplement.

Impact Loading and Nutrition in Cyclists: A Clinical Intervention to Enhance Bone Mass

The purpose of this clinical intervention was to increase aBMD of  23 elite-level cyclists through a standardized jumping program in combination with individualized meal plans created to maintain energy balance or increase energy availability defined by energy intake minus resting and exercise energy expenditure. The jumping program and meal plans were used in combination with Vitamin D and Calcium supplementation when necessary to increase bone mass.

The methodology required an initial consultation during which I collected biochemical, clinical, and environmental data for our intake assessment form. I met with each of the 23 subjects (elite cyclists) who agreed to participate in the research study to discuss the protocols for logging their food and exercise using the website Trainingpeaks.com. Since some subjects were unfamiliar with this website, I provided a brief tutorial and created instructional guides for them to keep.  Each subject was required to complete a weekly protocol of vertical jumps, log their meals and training three days per month, note their menstrual cycles, and get Vitamin D (25[OH]D), IGF-1, Testosterone, Estradiol, and Serum Ferritin measured with a Complete Blood Count. Pre and post-testing used DXA for measurement of bone mass, fat free mass, lean, and total mass, and a Vertec to measure height of vertical jump.

As a previous bike racer, I was able to build a relationship through my understanding of cycling equipment (power meter), the physiology of cycling performance, and nutrition/weight concerns of cyclists. Throughout the course of the study I provided feedback, support, and motivation for subjects to encourage thorough reporting and commitment to the study.

I co-lead phase 1 of this thesis, in support of my colleague (not a cyclist), and because I was the only person who used Training Peaks.com.   To assist with Phase 1 of the study, I created the following documents:

  • Phase 1: Instructions & Training Peaks User Guide for Subjects
  • Phase 1: Slide presentation: My role in Phase 1 of the study
  • Phase 1: Recruitment Flyer 

Phase 2 of the Study: I was lead investigator of this phase of the study.

Subjects: Were recruited from Phase 1 (n=10, 5= male, 5 = female)

Methods: Continued the maximum jumping protocol. This included a 3 week progressive increase in jumps from 5 jumps/day – 3 days/week, to 5 jumps/day – 5 days/week, to 10 jumps/day – 5 days/week. This equalled 50 jumps/week from weeks 3 – 16 of the study.

  • Each athlete was required to continue food and exercise logging three days per month
  • Weekly logging of their jumps
  • Weekly logging of Vitamin D & Calcium supplementation
  • Three blood draw were conducted to measure: Vitamin D, Cortisol, CBC, Ferritin, Estradiol, Testosterone, and IGF-1.

Goal of Phase 2 of the study: Increase bone density through a combination of the same vertical jumping protocol, individualize customized periodized menu for athletes based upon their estimated energy expenditure to improve or maintain energy balance, Vitamin D3 and Calcium supplementation.
In addition to looking at changes in BMD over time, I also examined the influence of the following factors:

  • Low energy availability [EA],
  • Insulin like growth factor-1 [IGF-1],
  • Vitamin D status [25(OH)D],
  • Dietary/supplemental calcium and vitamin D intake

Phase 2 of the study:

  • Sample Meal Plans customized based upon:
    • energy expenditure (calculated using power meters, heart rate monitors, METS),
    • RMR (Cunningham and physiologic testing in lab),
    • subject food logs, and
    • periodization of their training season.
  • Handouts that included  a list of which foods to increase/decrease depending upon the intensity/volume of training (Easy, Medium,Hard)
  • Handouts of how to adjust ratio of macronutrients per meal (images of various plates and percentages of portions)
  • Each subject received a final handout that showed changes in all serum values, % jumps completed, meal comparisons, from phase 1 to phase 2