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Crossfire

Do you have to eat a high-carbohydrate diet to perform in endurance sport?

What the experts say

Louise Mary BurkePhD, APD · sports dietitian and Chair in Sports Nutrition, Australian Catholic University

In some scenarios, yes. Fat oxidation can fuel hard exercise, but it yields about 5 to 7 percent less ATP per litre of oxygen, so at the oxidative thresholds that decide elite races the same oxygen buys less speed. Adaptation also blunts the muscle's ability to use carbohydrate when you put it back. There is no single best diet: build a periodised plan for the event you are actually doing, and for some events that plan is ketogenic.

What it rests onHer Supernova trials in world-class race walkers: 5 to 6 days of a ketogenic diet more than doubled fat oxidation to about 1.43 g/min while raising relative oxygen consumption by 5 to 8 percent at race speeds, and 6 of 7 LCHF athletes were slower in the subsequent race while all 6 controls were faster (P = 0.009, n = 13, all male). Acute carbohydrate restoration recovered only 61 to 78 percent of previous carbohydrate oxidation and did not overturn the impairment. Declared interests: unpaid short-term membership of sports nutrition advisory boards including the Gatorade Sports Science Institute expert panel and Science in Sports, and travel grants from organisations related to BOTH the carbohydrate and the LCHF industries.

Source: pmc.ncbi.nlm.nih.gov ↗
Timothy David NoakesMBChB, MD, DSc(Med) · emeritus professor of exercise science, University of Cape Town

No. After four to six weeks of adaptation, trained athletes perform equivalently on a low-carbohydrate high-fat diet, because muscle glycogen is not an obligatory fuel. Take about 10 g of carbohydrate an hour during long efforts to prevent hypoglycaemia, and eat how you like the rest of the time.

What it rests onA decade of randomised controlled trials showing equal performance on both diets in a VO2max test, in 5 km and 1.6 km treadmill time trials, in a 6 x 800 m interval session, and in prolonged cycling to exhaustion at 70% VO2max, with 10 g/h of carbohydrate improving the last of those by 22 percent equally on either diet. Declared interests: author of low-carbohydrate nutrition books and shareholder in The Nutrition Network, with proceeds assigned to The Noakes Foundation.

Source: pmc.ncbi.nlm.nih.gov ↗

Overview

Neither side addresses a general reader, and the elite-versus-recreational split is the hidden axis of the whole dispute. Her evidence is in world-class race walkers and Olympic medallists, and she reports the decrement being larger in the highest-calibre athletes; his is in recreational and trained athletes. He argues her findings do not generalise down; she argues his do not generalise up.

Both bodies of evidence are overwhelmingly male: her Supernova trial is 13 men. Neither side engages the female-specific hormonal argument Stacy Sims makes at sim-carbs-endurance, and Burke has separately published audits counting exactly this under-representation. None of this is settled for women, and none of it is advice for someone who is not training for a race.

Where they agree

Documented in a paper they both wrote and both approved. From Table 1, Points of agreement: carbohydrate ingestion during prolonged exercise improves performance by maintaining euglycemia, including in keto-adapted athletes; adaptation to an LCHF diet substantially increases fat oxidation; that adaptation can occur in as few as 5 to 7 days in elite athletes; high rates of fat oxidation occur at 65 percent VO2max and above in adapted athletes; the adaptation raises the oxygen requirement for the same power output; and respiratory gas analysis is not reliable above the lactate threshold.

What is left, in their own words: 'whether strategies to promote highest rates of CHO oxidation provide advantages over the amounts needed to prevent hypoglycemia'.

What would settle it

Their own answer, in Table 3 of the consensus paper, eight items agreed by both: stable-isotope measurement of fat oxidation above 80 percent VO2max; the time course of adaptation over months rather than weeks; the consequences of the increased oxygen cost; randomised comparisons in real-world competition, in endurance and team sports; an elite versus regular athlete comparison; the effect of combining several dietary strategies rather than testing one; a dose response for carbohydrate during prolonged exercise, to test whether preventing hypoglycaemia is really its only role; and blinding both athletes and researchers to manage the belief effect.

Note the disclosure asymmetry a replication would also settle: his stake is in books and a shareholding pointing one way, hers is in advisory roles and travel grants she discloses as pointing both ways.

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