Dental Health and Performance

When I run workshops for young athletes encouraging them to take care of their general health and wellbeing, I advise them to look after their teeth and to visit a dentist regularly. Right on que, a hand will go up (often one of a parent), and I can predict what the next question will be. “What have teeth to do with performance?”

Yes Eliz, what have teeth to do with performance?

Well let me start with an extreme case. Alan Campbell…. British rower….training for 2008 Beijing Olympics…abscessed lower-left wisdom tooth… disaster! The infection from the abscess spread to his shoulder, back and later his right knee. The knee required surgery two months before the games and required Campbell to miss six weeks on-water training, in the run-up to what was meant to be the biggest race of his life. 

Campbell finished fifth in the single-sculls final in what may, forever, have been a case of ‘what could have been’. Thankfully, this story has a happy ending. Campbell won bronze in London four years later. And learned an important life lesson in the process: our teeth can not only ruin our sleep, they can trample all over our dreams.

Campbell’s case is not an isolated one. Empirical (controlled scientific studies done by the scientists) and anecdotal evidence (observations of those in the know, this case people like dentists) suggests that athletes have poor dental health. Their finely honed bodies, often epitomising the very picture of health, often cover up a mouth full of bad teeth.

Causes

There are a number of proposed reasons why high-performance athletes have bad teeth, though little research has been done specifically on the causes of poor dental health in athletes.

Direct impact or trauma is a major cause of dental morbidity in sportspeople. Impact sports such as hockey, basketball and rugby have a high incidence of broken teeth, and worse. 

This is the obvious stuff. But there is substantial poor dental health even in those who participate in sports which involve no person-to-person impact.

The high volumes of carbohydrates required to meet energy demands can have a negative effect on teeth, particularly when a large portion of those carbohydrates come in the form of sugary, acidic sports drinks, gels and energy bars.

Physiological changes which occur during exercise may also play a role. These include decreased salivary flow and drying of the mouth (saliva is needed to regenerate tooth enamel) and exercise-induced immune suppression.

Grinding of teeth when lifting weights, or generally at night from stress, may also wear down teeth.

And then there’s the practical things like not making oral health a priority. Frequent travel may lead to busy high-performance athletes missing their regular check-ups, or pushing them down the to-do list. 

And then there’s the expense of keeping your teeth in check. Athletes struggling to make ends meet may simple not be able to afford regular check-ups or the cost of any follow-up maintenance work required.

The role of eating disorders, particularly bulimia, which is not uncommon in sport, cannot be overstated. Stomach acid, which will come in contact with teeth during vomiting, has a catastrophic effect on teeth, and can erode away dental enamel in a relatively short time period.

Something else to bear in mind is that individuals generally have the most trouble with their teeth, especially problem wisdom teeth, from the early twenties to their mid-thirties, the age bracket in which the vast majority of high performing athletes fall.

Effects

Dental health has a direct effect on general wellbeing and quality of life. The effect on sports performances can be both direct and indirect. 

Pain - from sensitivity, cavities and abscesses -  is the most obvious consequence of poor dental health. This can lead to sleepless nights, effecting performance and training, and indirectly leading to an increased risk of injury. Pain and dental discomfort can affect eating, and can have psychological impact on performance.

Tooth and gum infections can lead to systemic inflammatory response – a condition which is closely related to sepsis – and which isn’t good for either your general health or your sporting performance. 

A mouth full of bad teeth can also make an individual self-conscious which doesn’t do much for confidence.

Recommendations

• Brush and floss regularly

• Have regular dental check-ups. Use the off season to get any work required done.

• If you participate in an impact sport, always wear a custom made mouth guard in potential impact situations (games and contact training)

• If you find yourself grinding your teeth at night, seek help, both in reducing the stress that is causing the grinding, but also in protecting your teeth. You may need to wear a mouth guard at night.

And keep smiling!

Some further reading:

Oral health and elite sport performance A Consensus Statement, Needleman et al, 2015.

'Garbage mouth': Why many Olympic athletes have terrible dental problems Leicester, 2016. 

Milk.... The Perfect Recovery Drink?

Athletes of all abilities are looking for marginal gains, for the added extras that will improve their performance. When exploring marginal gains, diet is one of the first areas to look at. And athletes who are spending lots of time training, travelling and competing need to ensure they have a diet that is meeting their nutritional demands. They often turn to supplements as a quick fix to filling any nutritional gaps. Trying to fill these gaps with a natural source will not only be a cheaper approach, but may also be a healthier one, and some natural foods may also provide nutritional benefits beyond those intended.

Milk is one of these foods and may well be a suitable alternative to many sports drinks on the market. In terms of recovery products, there is none better than milk!

What is milk made up of?

Milk is a nutrient dense food containing lactose, proteins, fats, minerals, vitamins and water. Lactose, the major carbohydrate present, is essentially only found in milk. Milk contains a number of specific proteins, but the most common is casein, which compared to other proteins is very digestible in the intestine. Like eggs, milk also provides all nine essential amino acids. Calcium and phosphorous are the major minerals found in milk, and there are relatively small amounts of most other minerals required by the body, including zinc, magnesium, iron and copper. In addition, compared to other beverages, milk contains relatively large quantities of the electrolytes sodium, chloride and potassium. Milk contains varying quantities of many vitamins, including the fat soluble vitamins A, D, E, and K, found primarily in the milk fat.

Milk and performance

Due to issues relating to ease of consumption, the speed of release and the palatability of milk, it is less popular as a sports drink immediately before and during exercise and commercial sports drinks often become the preferred choice. But it's as a recovery drink that milk really comes into its own, and elite athletes often consume bottles of flavoured milk or milkshakes immediately after training or competition.

Post Recovery Nutrition

Many athletes will be familiar with the ‘golden window’, the period 30-60 mins immediately following exercise, during which nutrition can aid recovery. Refuelling correctly during this period is vital to those who may be training or competing more than once a day.

Recovery includes a number of processes, and milk can play a role in all of these:

1. Refuelling the muscle and liver glycogen stores (carbohydrate):

Athletes should aim for around 1g carbohydrate per kg of body weight to help refuel after exercise. Around 600ml of milk will provide 50g of carbohydrate, approximately the same amount as around 500-700ml of a sports drink (depending on the brand).

2. Replacing the fluids and electrolytes lost in sweat:
Athletes should aim to replace around 150% of their sweat lost during the 4-6 hours after training or competition. They should also replace the electrolytes lost in sweat, to ensure that fluids taken on board aren't just excreted in the urine. As well as being 87% water, milk is also a source of sodium, potassium and magnesium, all important electrolytes. Some but not all sports drinks contain electrolytes.

3. Manufacturing new muscle protein, red blood cells and other cellular components as part of the repair and adaptation process:
Early intake after exercise (within the first hour) of essential amino acids from good quality protein foods helps to promote protein rebuilding. Though research into the optimal type (e.g. casein versus whey), timing and amount of protein needed to maximise the desired adaptation from the training stimulus continues, most agree that both resistance and endurance athletes will benefit from consuming 15-25g of high quality protein in the first hour after exercise. Adding a source of carbohydrate to this post exercise snack will further enhance the training adaptation by reducing the degree of muscle protein breakdown. Around 300ml of milk contains 10g of naturally occurring protein and amino acids.

4. Allowing the immune system to handle the damage:
Ensuring adequate carbohydrate stores before exercise and consuming carbohydrate during and/or after a prolonged or high intensity workout has been shown to reduce the disturbance to immune system markers. The carbohydrate reduces the stress hormone to exercise, thus minimising its effect on the immune system, as well as also supplying glucose to fuel the activity of many of the immune system white cells. Milk provides a good source of protein and carbohydrates as well as a number of key vitamins and minerals to enhance the immune system and support overall health.

Milk can play a role in all the key recovery processes, is a naturally occurring product, supplies a number of key nutrients, and is cheaper than many sports drinks and recovery supplements. It could well be the best sports drink available!

Feeling a little peckish? Suitable lunch time meals

Aims

The role of lunch for an athlete is twofold. Its first is to assist with the recovery process after a morning training session  (if relevant), and the second is to ensure that your muscle glycogen stores are topped up ready for an afternoon/evening session. It has a third role in that it will also help concentration and energy levels in the afternoon for those at college or in employment.

Your training demands and needs will influence the size and content of this meal. Those who have a hard training session in the late afternoon/evening should take care to ensure that they are adequately fuelled.

Try to avoid missing lunch - you will often find this leads to more unhealthy food choices/snacks later in the day.

Examples
Salad Bar - Salad is a good option to start your meal as it provides a wide range of vitamins and minerals. Energy content is low, but you can increase this by including bread, jacket potatoes, pasta or rice. Add slices of chicken, ham or beans, pulses and nuts to increase the protein content. Beware of salad dressings which can be high in fat.

Soups - Vegetable soups are another easy way of getting a variety of nutrients in, and can be a substantial energy provider which is sometimes easier to consume and welcoming in the winter months. Homemade soups can be easy to make and to suit an individual’s taste and needs. Again you can boost the energy by eating with wholegrain bread, or by adding pasta.

Pasta/rice - Pasta and rise dishes are a good source of carbohydrate and are an even better option if you can choose wholegrain. Combine with a protein source such as fish or chicken and a sauce for a flavor. Adding a variety of vegetables to your pasta meal is a quick and easy way to increase nutrient variety of your meal.

Jacket Potato - Jacket potatoes can provide a quick easy energy source, and will digest quickly avoiding leaving you feeling uncomfortable before your training session. Including a high protein source such as tuna or chicken or even baked beans will give you an all-round high quality meal.

Dessert
Yoghurts and fruit are excellent choices for dessert, due to their nutritional value and low fat content. Although treat desserts are appealing, try to limit the intake of these at every meal and have a varied choice. Yoghurt is a good source of protein and good choices offer a good source of vitamins and low in fat and sugars. Combining with fruit will also add to the nutritional content of the meal.

Alongside the meal, ensure that at lunch and throughout the day you are taking fluids in to ensure hydration before a later training session.

Breakfast for athletes

There are many athletes who choose to train in the morning, before work, school or college; there are also sports that require training twice a day, one of these being in the morning. Some athletes will be able to consume a small amount of food in the morning before this session; others struggle to face anything until the training session is complete. Post training breakfast is an important way to ensure that adequate recovery is achieved and even if there is no morning training, a good breakfast is key to fuelling activities throughout the day. 

In terms of recovery there should be three aims:

Refuel - If training has taken place that morning or the night before, breakfast is vital to the recovery process, and helps to replace the muscle glycogen used during training.

Repair - During training, muscles are damaged.  It is important that you help your body repair these damaged muscles as soon as possible to aid recovery and prevent injury.

Adaptation - Training produces stimuli which cause your body to adapt so that it is able to cope with sessions better.  These adaptions, which include enhanced energy production and increased muscle size and strength, need energy to happen, and breakfast will help to fuel these after a morning training session.

What you can choose:

Cereals - Wholegrain cereals are a good choice as they provide quick and easy carbohydrate to help you refuel. Milk is a good source of protein, will help hydration, and is a good source of important vitamins and minerals like calcium. Many wholegrain and fortified cereal will also provide B vitamins and iron, both of which are important for energy breakdown.

Porridge - Porridge has Slow releasing energy, is high in carbohydrate and will keep you feeling full for longer. Milk will also add protein content and wholegrain oats will act as a good source of B vitamins. By adding a fruit compote, syrup or honey, a quick source of energy will be supplied which will help those who have had a hard morning training session.

Toast - Toast is another option for carbohydrates and toast from wholegrain bread will provide more nutritional value. If you wanted to add protein to toast you could choose a high protein spread such as peanut butter or serve with baked beans and or an egg (see below).

Baked Beans - Baked beans can be high in sugar, which can act as a source of fast carbohydrates which can be helpful following a hard training session.  Beans are a good protein source to go alongside toast.

Egg - Eggs are an excellent source of high quality protein, and contain most of the essential vitamins (except vitamin C). It is particularly rich in B vitamins, which are important for energy release, and Vitamin D, which athletes are normally low on. Eggs also contain antioxidants for healing, growth and fighting infection, which can be important during heavy periods of training for athletes.

Fresh Fruit - Breakfast is a good opportunity to get a healthy fruit portion in, so make the most of the selection that is on offer. Combine with your cereal or add to your porridge to boost the energy content, or simply take away for a mid-morning snack.

Yoghurts -  Yoghurts can be a good option on their own or with the addition of fruit or muesli. 

Hydration:

Not only is it important to refuel following morning training, but it is also important to make sure that all your fluid losses during training are replaced. Even if no training has taken place that morning, there has been a sustained period of time while you have been asleep and not taken any fluid on board. Ensure you are hydrated before you start your day.

Smoothies -  Are a great option for those needing extra energy or for those who may struggle with breakfast in the morning. To read a previous blog on Smoothies please click here http://www.athletelifedevelopment.com/resourceblog.htm

Concentrated Fruit Juice - This is a good option to be included with your breakfast meal and can count towards your portions of fruit and vegetables. Fruit juice will provide a good source of vitamin C which will not only help immune function, but also help the absorption of iron from your breakfast. If the athlete has had a hard morning training session, where sweat rates are high, fruit juice may not be the best option for rehydration, but a good option alongside water.

Squash/Water - Fruit juice and water will help rehydration following a session and should be drunk throughout the day. Squash has better rehydrating properties than water alone due to the solutes contained.

Coffee/Tea - The caffeine may help with alertness, but it’s not the best choice for hydration so try to have squash or fruit juice alongside.  Also, if you depend on coffee to wake you up in the morning, you may need to consider getting more sleep.

Hot Chocolate - Milk is now one of the most promoted recovery drinks and a natural source to. Its combination of protein and carbohydrate help promote recovery from training and it also includes many vital vitamins and minerals which many commercial recovery drinks fail to include. By adding coco powder to milk and warming provides a drink option which promotes recovery.

Helping recovery from late training and competition

With more and more clubs struggling to get time in sports facilities, many athletes are face training, competition or matches late at night. I've known many swimming clubs have pool time 9-10pm (and then followed by a 7am morning session), and was recently expected to be on court for a match for 9.15. This provides an athlete with a few challenges- Motivation, fueling, and then recovery so that the athlete is able to train again efficiently the next day, especially if it is an early start.

So how can athletes best fit their preparation and recovery at this time at night in order to be able to train or compete at the best, and be able to recover quickly and effectively?

1) Be prepared- You will have a time table or schedule which will give you notice when these late sessions may be. Make sure you are aware of this, especially if its not frequent so you can get ready. Plan your day, and meals so that there is one less thing to think about.

2) Try to understand how long your body needs between a meal and training. Individuals will vary, but you should allow at least an hour between the meal and training time. If you know it will be an intense training session or match, try to have small snacks at regular intervals to top up energy levels. This would also apply to those who struggle to stomach meals before they have to train and compete, or those who suffer with nerves.

3) Be flexible with your meals. Perhaps have a larger, later lunch which is high in carbohydrate and then have smaller snacks closer to the game or training and after the match.

4) As its later, an athlete may struggle to replace their fluid needs before they go to bed. So athletes should try to ensure they start the match or training session hydrated as normal, paying more attention to taking fluid on board than they normally would. At the end of the match or training session, again attention should be paid to replacing fluid losses, taking a drink with them to bed that they can drink if they wake during the night.

5) Even though it is late, attention should be paid to a post recovery snack or meal. There may be little or no appetite, but in order to help recovery there should be something consumed immediately after which is high in carbohydrate to help restore carbohydrate used in exercise and a good source of protein to help muscle repair. This should be approximately 1g Carbohydrate per kg of body weight.

Some good choices for smaller recovery snacks before bedtime which are quick and easy:

• Healthy Breakfast Cereal and Milk 
• Milk and Banana
• Yoghurt and fresh fruit
• Wholegrain bread- as toast with jam. Or as a sandwich with a light filling
• Jacket Potato with filling- Tuna & Sweetcorn, Chicken, Baked Beans

Nutritional Practices for Ultra-Endurance Events

Following on from last week’s blog about the demands of ultra endurance events, this week I will start to look at some of the nutritional practices that athletes can apply when training and competing in ultra-distance events.  

Appropriate and consistent training is one of the key factors in ensuring a successful performance in an ultra- distance event and supporting this training with the appropriate nutrition will also ensure that the athlete is ready to give their best performance on race day.

Preparation is also vital for race day success and  thorough planning and organisation when it comes to nutrition will ensure that a compromise is reached between achieving a light pack weight and carrying sufficient and effective fuel for the race.

Hydration

Staying hydrated and replacing fluid lost through sweat is important for not only performance but also for health reasons. Minor levels of dehydration will affect both physical and mental output whilst training and competing. Significant dehydration creates a significant risk of heat stroke and severe dehydration could lead to death.

During the week prior to the competition, the athlete should drink the recommended 2L per day and replace fluids lost through sweat in training to make sure that hydration levels are optimum levels before the start of the race.   

On race day, the athlete should start drinking as soon as they have woken up, and try to consume approximately 500ml before the start of the race.  This will ensure that any small fluid losses overnight are replaced.

During the race, the athlete should aim to replace the fluid lost through dehydration. This will be difficult, as most athletes cannot tolerate large fluid intake, especially in hot conditions.  A good compromise is to limit dehydration levels to less than 2% of the body weight. Measuring sweat rates during training and build-up races, as mentioned in an earlier blog, will help estimate how much they will need to drink.

Athletes should choose a drink which is palatable, not fizzy and, for these events, fluid which provides carbohydrate and electrolytes. This doesn't need to be a branded sports drink; in fact, a home made squash drink with a pinch of salt can be as effective and, for some, more tolerable than a sports drink. 

Carbohydrate

A lot of focus was previously been put on carbohydrate loading in preparing glycogen stores for the race. However, this will occur naturally providing that high carbohydrate intake is consumed alongside a pre-race taper and the focus which was previously suggested is not necessary.

Ultra endurance events often have early starts with minimal time on the morning of the race to get the appropriate nutrition on board. High Carbohydrate, low fat and low fibre foods should be on the list for athletes to eat and at least 100g of carbohydrate is a good amount to aim for to top up glycogen stores. Good examples include white bread jam sandwiches, cereal bars, breakfast cereals, bananas and fluids such as fruit juices, soft drinks and sports drinks. To facilitate rapid gastric emptying and nutritional absorption food should ideally be consumed 3-4 hours before race start.  Closer to the start of the race (1hr), a further carbohydrate snack will help prevent decreases in blood sugar levels during the early section of the race.

During the race, muscle and glycogen levels will normally last between 60-90 minutes, before the body needs to turn to other energy sources. At this point, the athlete is unlikely to maintain the same output and is sometimes known as hitting the wall. Maintaining carbohydrate levels during the competition will help the athlete to maintain output for longer.

The recommended intake is 1g of carbohydrate per kg of body weight per hour, and can be consumed in a variety of forms. For most athletes this will mean an intake of at least 50gms of carbohydrate every hour. Common sources include sports drinks, gels and bananas, but, during the latter stages of longer distance events, sandwiches and more savory snacks are common choices.  The following foods contain 30-60g of carbohydrate:

• 500ml fruit juice or soft drink 
• 500ml Sports Drink  
• Sports or Energy Bar
• 2 handful of sweets or dried fruit
• 4-6 Jaffa Cakes
• Cereal Bar
• 2 Carbohydrate Gels

Food choices will often depend on the race provisions, athlete preferences and the ability to transport them during the event, all of which should be researched and practiced during training, and preferably a test race. Athletes must also have a 'plan b' just in case things don't go to plan on race day, or the athlete suffers stomach discomfort.

Nutritional Considerations for Ultra-Endurance Events

Participation in ultra-endurance events has been increasing as cycling, Ironman triathlons and running events are all becoming popular challenges for people to test their physical limits. So when my partner asked for nutrition advice for his 12hr Time Trial event, I thought this could be a good topic to blog about.  I have split the topic into two sections - the first will look at the physical challenges the body faces when being put through ultra-endurance events and the second will look at the nutritional strategies that athletes can use to ensure they achieve their goals.

By definition, an ultra-endurance is an event which last over 6hrs in duration, and the athletes who are successful are those who have the ability to sustain higher absolute speed for a given distance than the other competitors. The three main demands which are placed on the body during this time are:

• Meeting energy demands
• Maintaining body temperature
• Replacing fluid and electrolyte loss

Alongside that, there are increased injury and immune function risk after the event has taken place, and these have to be managed.

Hyperthermia - Maintaining Core Body Temperature

As well as supplying oxygen-rich blood to the body, the heart helps control body temperature by pumping warm blood to the skin where body heat is lost through the evaporation of sweat. During prolonged periods of exercise, heat is produced and increased heat loss needs to occur through sweating to maintain a constant body temperature and body functions.

There are certain factors which can prevent or reduce sweating and heat loss - high humidity can reduce evaporation and dehydration can impair the ability to transfer heat from muscles to the skin. In both situations, the increase in the core body temperature will increase the risk of heat problems. Muscle weakness and disorientation can develop with smaller increases in body temperatures with more serious effects occurring as the body temperature rises. Ways in which an athlete can maintain a constant body temperature will be looked at in the next blog.

Hyponatremia - Fluid and Electrolyte Loss

In recent years, it has been suggested that dehydration in marathon runners is over emphasised and results in some runners suffering with hyponatremia. During exercise, electrolytes, as well as fluids, are also lost in sweat.  Sodium and potassium are the main two electrolytes lost and need to be replaced at some point, depending on the duration and intensity of the event. 

Hyponatremia is the dilution of sodium levels in the blood often caused by the consumption of too much fluid and not replacing the lost electrolytes in sweat. This eventually causes swelling of the brain which can be fatal and has been reported during marathon events in recent years.  This is more common in slower runners who have more time to drink, and are often encouraged to do so. Ways in which athletes can maintain their electrolyte levels will be discussed in the next blog. 

Glycogen Depletion

Carbohydrates are the main energy source during endurance events and provide energy to the muscles at a rate which can sustain a fast pace optimal for performance. Carbohydrates are found as glycogen in the muscles and liver and as blood glucose. As blood glucose is used up, the body converts glycogen into glucose and releases it into the bloodstream to maintain a constant supply of energy. However, glycogen stores are and can only sustain a high work rate for about 60-90mins. If carbohydrates are not replaced at or before the point of glycogen depletion, the body must turn to other energy sources to maintain this work rate. The main alternative source is fats which can sustain exercise for much longer than glycogen, but at a much slower rate. It is much harder to maintain the same pace following the shift in fuel source, a point which is often known as ‘bonking’ or ‘hitting the wall.’ It is important to maintain levels of muscle glycogen and blood glucose for as long as possible. Ways to do this will be discussed in the next blog.

Injury and the Immune System

Due to the length of time an athlete will be performing the same activity and the same action over and over again, there is going to be a considerable amount of stress placed on certain muscles, bones and other soft tissues. Muscle damage and inflammation can remain for several days after completion of the event, and tissues can take much longer than normal to fully repair. Even while the athlete may be celebrating completing the event or achieving their goal, there are a number of things which they can do to aid recovery and prepare for the next training session or event.

As well as the muscle damage, as part of the repair process, cytokines are released from the injured area to promote an influx of white blood cells from the immune system, and these remain elevated following prolonged exercise.  However, there are other markers of immune function which are lower after completing an endurance event, leaving the immune system less able to protect the body from infections. This is why many athletes become ill after endurance events or high intensity training. There are certain practices athletes can do to ensure that both injury and muscle soreness can be reduced and this will be looked at next time.

What should you drink?

Continuing the blog on hydration, I thought I would look at the different types of drinks and when they may be useful in different situations.

When training or exercising, athletes need to consider the intensity of their session, the duration of the activity and the environmental conditions, and how these may affect their sweat rates. For example, if their session is a light aerobic session in a cool environment, their sweat rates and energy needs are going to be lower than if they were training at a high intensity on a hot summer's day.

Some sports have very little change in environmental conditions such as swimming or indoor sports, whereas some sports involve varying conditions and therefore athletes need to understand how their body responds to different conditions and be prepared in order to ensure they maximise their training and recovery.

There are three different types of drinks, based on the solute concentration and their osmotic pressure. 

Hypotonic - generally contains less than 4g of carbohydrates per 100ml. It provides little energy, but will be taken up by the body quickly, and therefore ideal for recreational sports or shorter or less strenuous exertion.  Examples include:

• Water
• WeakCordial 

Hypertonic - this type of drink generally has more than 8g of carbohydrates per 100ml and greater osmotic pressure than bodily fluids. Its main aim is to supply energy and the fluid is taken up more slowly than water. Ideal use is 30-60 mins before exercise and immediately after sports.  They are also useful for athletes who find they need a bit more energy.

• Milkshakes
• Smoothies
• Concentrated Fruit Juices 

Isotonic - this type of drink contains between 4-8g of carbohydrate per 100ml and has about the same osmotic pressure as bodily fluids. An Isotonic drink is taken up by the body about as quickly as water and they are intended to help hydration and provide energy.

• Sports Drinks
• Squash

Also considering the different times athletes may need to choose different drinks. 

Before Exercise - The main aims are to ensure the athlete is hydrated before exercise, as athletes will be able to meet energy needs through solid foods, therefore a hypotonic drink such as squash or water will be adequate. If it is prior to competition, and athletes struggle to eat, then isotonic drinks can help meet energy requirements while making sure athletes are hydrated. 

During - This will be dependent on the training programme. Many athletes will be fine with a hypotonic sports drink replacing fluid loss and athletes should choose drinks which are palatable to encourage consumption. However, if the training session or competition is high intensity and longer than 90 min, some athletes may need to include some energy, therefore an isotonic drink will meet an athletes needs. Other ways to meet this need if athletes prefer to drink water is to take a high carbohydrate snack to have alongside training which can be consumed at an appropriate interval. 

After - The session type and environment conditions will influence the athlete's choice of drink. After a  high intensity session, it is going to be important to replace energy and fluid needs. If an athlete is able to eat immediately after a session, a high carbohydrate snack alongside squash or water should be sufficient to meet their needs. However, if an athlete struggles to consume any food following a training session, a hypertonic drink which is high in carbohydrate will be able to support this. This is why many athletes now choose to drink milk or milkshakes after a training session. Athletes should be aware of when their sweat rates are high and make sure they adequately replace their fluid intake in the hour after a training session.

Athletes can monitor their hydration by comparing to a pee chart, a simple indication of their hydration status, with the idea to be on the paler side of the chart.  One of the main things is to to be happy and comfortable with what you drink. It could be the best drink which will help performance, but if the athlete doesn't like the taste they probably won't consume as much as is needed. 

Nutrition: Alternative carbohydrate sources

The diet of endurance athletes is likely to consist of large amounts of pasta, rice and breakfast cereal.  Athletes don’t have to stick to these traditional, reliable old carbohydrates though, and can benefit from adding some less well known cereals and carbohydrate-rich foods to their diet.  Those with gluten or wheat intolerance will appreciate the variety, and foods like couscous and polenta are a lot quicker to prepare than rice and pasta.  Here are some of the available options, and what they can contribute to a healthy balanced diet:

Potatoes, unlike cereal based carbohydrates, are a vegetable, and as a result are particularly nutrient dense.  Among the micronutrients which they contain is vitamin C, something which you won’t find in pasta, noodles, or rice.  Cook potatoes in their skins to minimise vitamin C loss during cooking.  There is practically no fat or cholesterol in potatoes, and their skins, if consumed, are a good source of fibre.  Potatoes do have a higher GI than most other starchy foods, and are too often served deep fried (in the form of chips or crisps), or smothered in butter.

Sweet potatoes, like common potatoes, are versatile, and nutrient dense.  They have a lower GI, and unlike white potatoes, they can be mashed and creamed without butter.  They are a good source of fibre, Vitamins A, B6 and C, and Beta-carotene and also contain some protein.  They can be boiled, mashed and roasted, similar to potatoes, and can also be added to curry, risotto and pasta dishes.

Yams, a West African staple, are similar, but not related to sweet potatoes.  The can be cooked in a variety of ways, but traditionally are most often boiled, roasted or fried.  Yams have a lower GI than potatoes, and are a good source of fibre, potassium, manganese, vitamin B6 and vitamin C.

Other vegetables which are high in carbohydrates include cassava, artichokes, sweetcorn, winter squashes, and pumpkin.  Legumes, including peanuts, lentils, peas and beans are also sources of carbohydrate, and as low GI foods, can be added to rice, pasta and potato dishes to lower the overall GI of the dish.

Oats is a great breakfast food for athletes.  Hulled oats is not stripped of its bran or germ, like other processed grains.  In addition to high fibre content, oats has cardio-protective properties, and helps protect against a range of diseases.  Oats is generally served as porridge, though it can also be added to soups and stews, or used as the basis of flapjacks and a range of other sweet treats.

Polenta is a staple food in much of northern Italy.  The word ‘polenta’ literally means ‘cornmeal mush’ and is made from naturally low fat, low cholesterol, high fibre cornmeal ground cornmeal flour.  Polenta can be boiled, fried, baked in breads and cakes, or served alongside stews.  Instant powered polenta is widely available.  To make polenta, simply mix the cornmeal with water, and simmer until it thickens. ‘Wet’ polenta is served hot.  It can taste somewhat bland, but adding Italian cheese, herbs, pesto, or strong flavoured foods can greatly enhance the taste.  Alternatively, polenta can be left to cool, cut into slices and grilled or fried.

I recently discovered polenta, and stuck for time one day, came up with my own special recipe, which takes just 10 minutes to prepare.  It goes something like this:

1. Prepare some instant polenta as per packet instructions (stir some polenta into a saucepan of boiling water; add more until becomes a thick paste, simmer for 2 to 3 minutes).

2. Meanwhile poach two eggs.

3. Chop half a red pepper, grate 1 carrot, chop 1 tomato.  (I’ve chosen these vegetables because they don’t need to be cooked, but you can of course choose any vegetable that doesn’t need to be cooked, or stir-fry some vegetables in a separate pan.)

4. Grate or dice a small amount of cheese.  (A strong-flavoured soft cheese such as feta or blue cheese would help add taste to the bland polenta.)

5. Add the vegetables and cheese to the polenta and stir in with a large spoon of pesto, and some sunflower seeds or chopped walnuts.

6. Serve with the eggs.

This is a good dish for eating after training as it is quick to prepare, and is high in carbohydrates, protein and vitamins.  You can add some smoked salmon instead of the eggs, and experiment with different nuts and seeds.

Couscous, like pasta, is made from rolled semolina wheat.  It has more protein than rice or potatoes, and with a magical carbohydration:protein ration of 4:1, it is an ideal recovery food.  Quick-cook couscous takes no more than five minutes to prepare, and since it can be made with boiling water in a bowl, it is an ideal food for busy travelling athletes.  Couscous can be served hot or cold, and is an ideal accompaniment to salads.  Add cooked vegetables, smoked salmon and seeds for a great lunchbox meal, or mix in dried fruit, chopped nuts and a tablespoon of yoghurt for a sweet treat.

Quinoa is the edible seeds of a South American grain-like crop.  It has a light, fluffy texture, and a slight bite to it.  It is high in protein as well as carbohydrates.  Quinoa is boiled in water, similar to rice, until the germ and seed separate. Quinoa can be served with nuts, dried fruit, berries and honey for a great high-protein breakfast.

Rice is a calorie-dense, high carbohydrate, low fat crop, and the world’s most popular carbohydrate food.  Rice is also a good source of thiamin, niacin and vitamin E.  Basmati rice has a lower GI than other forms of white rice (the longer the grain, the lower the GI), and brown rice is packed with protein and fibre, and is a good source of B vitamins.  Rice is pretty versatile, and makes a great accompaniment to a range of meals.  Chilli con carne, vegetable and chicken curries and risottos are good carbohydrate-packed meals for athletes.  Risottos are a great way to use up leftovers, and can be made with whatever food is available in the fridge – roast chicken, peas, mushrooms, diced bacon, etc.

Rice noodles take just 3-4 minutes to prepare, have a low GI, and are a good addition to Thai curries and oriental soups.

Noodles are essentially a type of pasta, made with wheat, rice, buckwheat, mungbean or potato flour combined with egg.  Noodles tend to take less time than dried pasta to prepare, and are very versitile, making them a store cupboard favourite.  Choose to boil rather than fry the noodles, and add plenty of vegetables and nuts for a healthy, balanced change to standard pasta and rice.

Bread is a very versatile food, though how healthy it is depends on the type of flour and cooking method used.  More processed flour (e.g. white flour), has a higher GI than wholemeal flour.  Adding nuts and seeds can increase the nutritional content, and reduce the overall GI of the bread.  Rye bread is a particularly low GI option, and is high in soluble fibre.  Making your own bread is a good way to ensure that there are no nasty ingredients and is a lot easier than you would think.

Bulgar wheat has a nice nutty texture and flavour, and a medium-low GI.  It is a good source of fibre, thiamine and vitamin E.  Bulgar wheat, like couscous is as good cold as it is warm, and can be added to salads for a great lunchbox meal. 

Buckwheat, despite its name, is no relative to wheat, and is in fact a gluten-free grain.  It is popular in Russian and Eastern European cuisine, and has a strong flavour.  It is high in carbohydrate, protein and fibre, and low in cholesterol and fat.  Buckwheat flour, available in most health food stores, can be combined with wheat flour in pancakes and other wheat-based recipes.

Pearl barley is barley which has had the bran and outer hull removed.  It is low in fat and cholesterol and is a good source of fibre, and is quicker to prepare than other forms of barley.  Pearl barley is often added to stews, and other one-pot dishes.

Amaranth, unlike most other grains, is gluten-free, and suitable for individuals with celiac disease.  It has an excellent balance of carbohydrate, protein and fat, and is packed with both iron and calcium.  It also has a considerably lower GI than pasta.  Amaranth was a staple of the aztect, but its cultivation was banned by the conquistadores.  Today, it is often popped and mixed with honey for a nutritious snack.

Gnocci are small Italian dumplings that are made by binding potato and flour together with egg. Ready-made gnocci take just a few minutes to prepare, and can simply be served with pesto or a tomato-based pasta sauce.

Other staples from around the world include ingera (Ethiopia), a sourdough flatbread made from the iron-rich flour of the teff crop; ugali (Kenya), a dough food made from ground maize, and unsurprisingly, similar to polenta; and plantains, a banana like fruit which can only be eaten cooked, and which is a major staple in Camerron and DR Congo, Central America, the Caribbean, Colombia and Venezuela.

Go Faster Food is a particularly good book for endurance athletes looking to add some variety to their diets.  It includes recipes for a range of pasta, rice and couscous dishes.