1. Reported & Searched checked by: Ryan Post Florida Gulf Coast University: Human Performance - Spring 2012 DISCERNING CARBOHYDRATE LOADING PRIOR TO COMPETITION IN ENDURANCE SPORTS

2.  In Healthy endurance specific athletes who compete in Triathlon, would consuming a diet low in carbohydrates the days prior competition, when compared to that of one high in carbohydrate increase performance?  Patient- Athletes, primarily Triathletes (Swim – Bike – Run)  Intervention- Carbohydrate Restriction vs. Carbohydrate Loading  Comparison- Consuming more, or consuming less, and determining the outcome  Outcome- The outcome being observed is an overall decrease in GI issues. Furthermore the body learns to become more efficient in Gluconeogenesis, becoming less reliant on external sources of glucose, to maintain blood glucose during that “fight or flight” paradigm “Competition and even Training at times” P.I.C.O

3. By Communicating with people already knowledgeable in the topic at hand, I had a better understanding on where to gage my initial search. By searching FGCU’s Health & Exercise related library databases, with key words and reading through relevant texts, I found detailed information specific to my topic. Key Words Searched: 1.Triathlon 2. Cycling 3. Running 4. Jeukendrop 5. Carbohydrate Metabolism 2. 6. Blood Glucose Databases used: PubMed EVIDENCE BASED LITERATURE

4. DETERMINING THE LEVEL OF EVIDENCE From bottom to top of the pyramid the level or quality of evidence Increases. “Bottom to Top” Systematic Reviews are considered the highest most significant evidence, located at the top of the pyramid Expert Opinions are considered the lowest least significant piece of evidence, therefore they are located at the bottom

5. THREE PART QUESTION

6.  After I had gathered a sufficient amount of information, I than had to go back and decipher each of my articles per level of evidence. Most of the articles I had collected contained valid information, but not all of the articles than related to my topic. Reasons being they either misrepresented the population, or used they measured insignificant variables separate from what I was searching for.  Search Outcome Ten references were found on the topic of Carbohydrate loading vs. Non Loading – specific to Triathlon. Two of the Ten were considered an expert opinion, retrieved from relevant blogs, these were not included as they lacked evidence and scholarly significance Three of these ten mentioned articles were pertinent to this topic being discussed and therefor were included in the CAT summary DETERMINING RELEVANCE

7. CAT SUMMARY REFERENCES Author and DatePatient GroupStudy Type (Level of Evidence) OutcomeKey ResultsStudy Weakness Burgomaster, K. A. (2006). Sixteen young healthy men volunteered to participate in the study (8 were tested, and 8 were used for a control). Case- Controlled StudyAdaptations in resting glycogen were evident as well as increases in the maximal output and blood glucose during testing and the days between. This occurred quickly after intense exercise had been initiated. Sprint training improves aerobic exercise performance and gluconeogenesis. Each individual was specific to there needs and wants prior t o testing and food choice. Not all of the subjects were engaged in sport. Jeukendrup, A. (2011). Collection of other Randomized control Trials pertinent to the topic being studied Systematic ReviewThese results suggest that it is not necessary to ingest large amounts of carbohydrate during exercise or even prior to exercise A individualized nutritional strategy may need to be developed on an individual basis dependent on intensity and the duration of the event. Events lasting less than 60 minutes, carbohydrate ingestion was deemed unnecessary. This particular journal article per Sackett Hierarchy of evidence had little to any weakness. Jeukendrop et. al. explained and supported the thoughts of numerous cohort studies. Jeukendrup, E. A., Jentigens, L. P. G. R., Moseley, L. (2005). Collection of other Randomized control Trials pertinent to the topic being studied Systematic ReviewCarbohydrate ingestion during exercise and racing improves endurance capacity. Blood glucose concentrations and the oxidation of CHO will remain high per ingestion Carbohydrate super compensation in the days preceding competition has been proven not to increase performance in endurance related sport lasting less than 90minutes. This particular journal article per Sackett Hierarchy of evidence had little to any weakness. Jeukendrop et. al explained and supported the thoughts of numerous cohort studies.

8.  Clinical bottom line: My research concluded with the finding that high muscle glycogen concentrations at the start of training or even racing may be specific to performance in endurance disciplines. A high concentration does not necessarily have to be achieved by the traditional super compensation protocol. An individualized nutritional strategy can be developed that aims to deliver carbohydrate to the working muscle at a rate that is dependent on the absolute exercise intensity as well as the duration of the event. In theory - If an athlete is dependent on glucose during training, there blood glucose, and the livers need to convert glycogen to glucose would become less significant, essentially detraining the liver to do what it was designed to do. If an athlete can practice a diet abstinent of constant glucose in the training phase, or even the months leading up to their race. There liver will become more efficient at gluconeogenesis, therefore the body will maintain blood glucose naturally than through external sources. Considering this phenomenon, the body has the ability to increase blood glucose through hormones as well (epinephrine, norepinephrine, and dopamine). This natural phenomenom is often triggered by racing, and is hard to reproduce in training. If an athlete can than train effcetively limiting Glucose intake whilst training, and than get to the line while expierienceing the “phenemoneom” to some degree one would assume that there blood glucose compared to that of one reliant of glucose is training may be hire – pottentially resulting in better result. This information in its entirety is not proven, but though this literature and my reading I have come to the conclusion that it may. After digesting all the relevant and “Tested” literature, It has been determined that glucose intake in an event less than 90 minutes in duration, has little to no impact. CLINNICAL BOTTOM LINE

9.  Three Questions Based on the Topic  1. In endurance related sports is it best to be reliant of free fatty acids?  2.Can the human body be trained to be more efficient in gluconeogenesis?  3. Can an athlete restricts carbohydrate intake prior to competition, and expect to perform?