How Healthy is Your Sports Drink?

Remember the old adage: “treat your body well and it will treat you well.”  As an athlete, you should be even more concerned about what goes in your body.  It never ceases to amaze me; many athletes will pound their bodies into the ground day after day, eat highly specialized diets, and abstain from many of the common pleasures of life, all in the hopes of achieving supreme fitness.  However, if it comes in a pill, powder, or gel form, they do not discriminate and will put just about anything in their body.

Since the introduction of Gatorade, the sports drink industry has come a long way.  There is an almost dizzying array of products to choose from, with each one stating to be better than the other.  Although, it appears clear that they can enhance your performance (at least when compared to water), the question is: Are they really healthy?

Here are a couple of reasons why they may not be:

Stevia

Stevia is a collection of about 150 herbs and shrubs in the sunflower family. It is native to parts of Central and South America.  Since stevia is about 300 times sweeter than sugar and virtually devoid of calories, it has garnered much attention as a “natural sugar substitute”.  However, due to conflicting evidence regarding the safety of stevia, the European Commission has banned the use of stevia in food in the European Union.  The Food and Drug Administration (FDA) has also banned its use as a sweetener. In the United States, stevia cannot be labeled and sold as any type of sweetener.  However, Stevia can be packaged and sold as a nutritional supplement, which is how it can be found in some sports drinks.

High Fructose Corn Syrup (HFCS)

HFCS is a sweetener and preservative used in many processed foods including sports drinks.  The reason HFCS is so popular is that it is cheaper and sweeter than sugar and extends the shelf life of foods.  Many experts blame increased consumption of HFCS for the growing obesity problem and adverse health effects such as diabetes.

Sucralose

Sucralose is an artificial sweetener, which was originally sold under then trade name Splenda.  It is about 600 times sweeter than household sugar and when metabolized does not produce any energy (or calories).  Let me say that again: does not produce energy.   Now why would you want to have something in your sports drink that makes it sweet and does not give you energy?  If that is not enough, recent evidence may suggest that artificial sweeteners may actually promote weight gain.

Vitamins

Another old adage: “More is better”.  Well, when it comes to vitamins this may not be necessarily true.  I will not subject you to the details of the hundreds of published studies on vitamin supplementation, but I will say this:  There is very little evidence (if any) to suggest mega supplementation does any good and much more evidence to suggest that it in fact may do harm.  So what is mega supplementation anyway?  When you look at the label and see you are ingesting several times the recommended daily allowance (RDA) that is mega supplementation.

Artificial Colors

You can recognize that your sports drink contains artificial colors by the letters FD&C (Food, Drugs & Cosmetics) that precedes the name of the color (for example, FD&C Blue 1 or FD&C Yellow 5).  Although, they are generally deemed as safe, they are artificial, and really do not belong in your sports drink.  That is, unless you really truly believe, that it is the flaming red color of your sports drink that makes you go faster.

Artificial Flavors

These are too numerous to list but let us just say this:  if you crack open the latest sports drink and it has a taste that is out of this world, chances are that it is.   It was probably made in a chemistry lab somewhere.  When picking a sports drink look for one that specifically states it contains no artificial flavors.

Unfortunately, these are not the only things to look out for, there are many, many more.  Next time you pick up your favorite sports drink, take a close look at the label.  If you see something on the ingredients list and you do not know what it is, look it up.  What you find may surprise you.  Remember, you are an athlete; your body is a temple. Only good things must go in to get unparalleled performance out.  Think about it, when was the last time you saw a neon blue temple?

______________________________

Salvatore J. Tirrito M.D., F.A.C.C.
Pima Heart Associates
HeartWise Fitness & Nutrition- President/CEO
Proud makers of XOOD Natural Healthy Endurance Drinks
www.xoodhealth.com

Does it pay to be Vegan?

By Salvatore J. Tirrito M.D., F.A.C.C.

First, let us go over some terminology. A vegetarian diet is one that excludes meat (poultry, pork, beef etc…). A vegan diet is one that, in addition to excluding meat, also excludes dairy (milk, cheese, & eggs). This seems to be the path that most people who identified themselves as vegetarian or vegan tend to follow. However, if you want to be technical about it, a true vegetarian in addition to not eating meat does not eat seafood and a true vegan, in addition to not eating meat and dairy does not eat seafood or honey (Bees are people too). For the purposes of this article we will define a vegetarian as someone who does not eat meat and a vegan as someone who does not eat meat or dairy.

In 21st century America it is easy to be a vegetarian.  There is an abundance of meatless options available that will satisfy just about anyone’s taste buds (perhaps, with the exception of the most devout carnivore). The problem with being a vegetarian is that it may not be as healthy as you think. Many vegetarian diets can be extremely rich in dairy. As a cardiologist this creates a dilemma for me. Do I eat a turkey patty (low fat, low carbohydrate & high protein) or a vegetarian three-cheese lasagna (high fat, high carbohydrate & low protein)? From a moral point of view, I definitely feel better about milking a cow than cutting a turkey’s head off. From a health point of view, the turkey patty is clearly a better choice (sorry turkey).

Since I was already a vegetarian (99.9% of the time), but faced with these facts I decided the only choice I had was to go vegan. The problem is that it is not easy to be vegan. Poorly planned vegan diets can be deficient in calories, low protein and lacking important vitamins and minerals such as calcium, iodine, vitamin B12 and vitamin D.  This may become even more of an issue if you are a teenager (and still growing), an expectant/nursing mother or an athlete.

I thought I was doing a decent job at following a vegan diet. Not eating dairy was easier than I thought it would be. I cut out eggs, drink soy milk instead of cow’s milk and eat soy cheese instead of cow’s (regular) cheese. However, as I sat there munching on my son’s favorite cookies reading the ingredient label on the box I realized that dairy or a derivative of it is in almost everything. Then I went out to a restaurant and my favorite pasta dish was off limits. The sauce had a cream (milk) base and it was covered with cheese. All of a sudden, my culinary options were rapidly diminishing. I felt the world closing in around me. I had to make a choice. Was I never going to eat out again realizing how hard it was to get a truly vegan meal? Was I going to angrily throw my Café Macchiato back at my local barista’s head because she used cow’s milk instead of soymilk? Was I going to obsess about the tiny amount of milk powder in the cookie I was eating? No I was not.

I obsess about enough things and I did not feel like adding to the list. So what did I do? I came up with a plan that works for me. I don’t eat meat, but if the soup or noodles I am eating was made with a chicken broth instead of a vegetable broth, I deal with it. I stay away from dairy but if my favorite energy bar is made with egg protein instead of soy protein, again, I deal with it.

This is my rationale. I adapted a vegetarian lifestyle primarily for animal right’s reasons. I choose or try to be as vegan as possible for health reasons. As I alluded to earlier the health advantages to following a vegan diet are substantial. There is very compelling evidence to support that populations whose protein intake primarily comes from plant sources (as opposed to animal sources) clearly have a lower incidence of heart disease, diabetes, hypertension, autoimmune disease and cancer. So what are animal sources of protein? If you have not figured it out already, it is meat and dairy. So people who limit or eliminate animal sources of protein tend to lead healthier lives.

Do we see an advantage to veganism in the rest of the animal kingdom? Let’s take a look, but first, if it has been a long time since elementary school, let me refresh your memory on a few terms.

Carnivore- diet consists only of animals

Herbivore- diet consists only of plants

Omnivore- diet consists of both animals and plants

Looking at the above table, it is clear that herbivores win when compared to carnivores. Even dolphins whose diet consists of nothing but fish do not live nearly as long as humans do. When it comes to life span we are only bested by a few animals such as the Galapagos Land Tortoise (up to a whopping 200 years) and strangely enough several species of parrots (so choose your pet carefully otherwise you might have to bequeath it to someone in your will). However, of all the land mammals, humans, of which the bulk of them are omnivores, have the longest lifespan (some whales are thought to live for over 200 years but this has not been conclusively proven).

Although there clearly are health advantages to leading a vegan lifestyle, I must admit that this does not necessarily equate to living longer. There are really no studies to support that vegetarians or vegans live longer than your average omnivore. But then again, what is the goal of life? To live as long as possible? Or to live a meaningful life, surround yourself with good people and be happy and healthy? For me the answer is easy. I see way too many people suffering from chronic diseases every day and if the answer is adopting more of a vegan lifestyle, I am all for it.

So what should you do? Here are my recommendations:

• Don’t smoke. This has nothing to do with this article but can never be mentioned enough.
• Maintain an appropriate body weight. There is nothing worse then a fat vegan. Being overweight is a risk factor for many diseases regardless of whether you are vegetarian or vegan. On the flipside do not become a vegan or vegetarian to control your weight. It’s bad form. Unfortunately, it seems that a lot of young men and women choose the vegetarian or vegan lifestyle not for animal right’s or for health reasons but for body image issues.
• Get a lot of good quality aerobic exercise. Do not mistake eating a healthy diet with being healthy. I know some vegans and vegetarians who can’t walk up a flight of steps without getting short of breath. Eating a healthy diet without engaging in regular aerobic exercise is like quitting when the job is only halfway done. Your body is a temple. Treat it well and it will treat you well.
• Eat a diet that is more plant based than animal based. This means limiting your intake of meat and dairy. Most importantly, educate yourself. Make good food choices. Make sure you are getting the appropriate amount of calories, protein, vitamins and minerals that you need to stay healthy. Don’t give those carnivores a chance to say: “See what happens when you don’t eat meat.”
• Don’t stress. If you follow a vegan diet for health reasons and find out that your significant other’s mother baked you cookies using cow’s milk instead of soymilk, eat them. If you are a vegan for animal right’s reasons, don’t look down those who are trying to live a more vegan lifestyle but occasionally slip up. It’s obnoxious and at least they are trying.
• Be Happy. Remember we are all here trying to do our part to make the world a better place (at least most of us are).

By the way, my local barista happily remade my café  macchiato with soymilk.

Salvatore J. Tirrito M.D., F.A.C.C.

Pima Heart Associates

HeartWise Fitness & Nutrition Inc- President/CEO

Proud maker of XOOD Natural Healthy Endurance Drinks

www.xoodhealth.com

5 minute consult by Dr. Sal Tirrito

Is protein really needed in endurance events?

Although, carbohydrates and fatty acids are the primary fuel sources utilized during endurance events, more recently there has been a lot of data to support supplementation with protein during endurance events. In the past few years, clinical trials have clearly demonstrated that a protein/carbohydrate drink enhances performance when compared to a carbohydrate drink alone.

The reason for this is likely manifold and somewhat elusive.  It is unlikely that the small amount of addition calories gained by drinking a carbohydrate/protein drink plays a significant role.  It is more likely because during prolonged exercise, as glycogen levels become depleted, the body undergoes a process called gluconeogensis.  Gluconeogenesis is a process that results in the generation of glucose from non-carbohydrate substrates such as pyruvate, lactate, glycerol, and amino acids.  Gluconeogensis is an energy intensive process that can lead to accelerated muscle breakdown in order to liberate amino acids to drive the gluconeogenic process.  Ingestion of small amounts of protein may help fuel the gluconeogenic process with enough protein to allow the body to avoid having to breakdown muscle.

However, having said this, this is still probably not the primary reason that a protein/carbohydrate drink enhances performance over a carbohydrate alone drink.  Another, probably, more important reason is that a protein/carbohydrate drink appears to help stem cortisol release better than a carbohydrate only drink.  Cortisol is a hormone (often referred to as “the stress hormone”) which is released in large quantities during intense exercise (a very stressful state to the body).

Normal cortisol release has widespread actions that help restore homeostasis (getting back to baseline functioning) after stress.  In the normal situation, this is desirable, but for the endurance athlete it may have grave consequences.  Although, cortisol increases circulating glucose concentrations (in the blood) which is desirable, it does this mainly by supplying amino acids for gluconeogensis by inhibiting collagen formation, decreasing amino acid uptake by muscle, and inhibiting protein synthesis. Also of importance to the endurance athlete is that cortisol also increases gastric acid secretion, potassium loss and is a potent diuretic.  So by using a protein/carbohydrate drink to stem cortisol release, and by supplying a steady stream of protein (or ultimately amino acids) use may spare valuable muscle protein.

A last and more straightforward reason (one purposed by myself) has to do with recovery.  It is widely accepted and practically endurance athlete dogma that protein/carbohydrates supplementation aides in recovery.  The question I have often asked myself is, when does recovery start?  The notion that recovery starts with the cessation of exercise is ludicrous and arbitrary.  For the endurance athlete recovery happens before, during and after exercise.  Recovery is an ongoing process that really has no starting or stopping point.  Let’s face it, exercise is a highly catabolic process. It only makes sense that you want to start rebuilding muscle (or at least slow down muscle breakdown) the minute you start exercising.

As for the issue of how much protein, the answer is no one really knows but it is probably not very much (a few grams/hour).  Protein is much harder to digest than carbohydrates (try eating a steak and than going for a run).  So, if you have too much protein during an endurance event you risk some serious GI distress, too little and you may not get any benefit.

(Reprinted from Triathlete Magazine – September 2008)

Salvatore J. Tirrito M.D., F.A.C.C.

HeartWise Fitness & Nutrition –President/CEO

Makers of XOOD Endurance Drinks

www.xoodhealth.com

5 minute consult by Dr. Sal Tirrito

Single or multiple carbohydrates sources:
Which is better for performance?

First, let us be clear on one thing.  Peak performance is all about desire. The desire to push your body to the extreme.  However, don’t expect great things from you body unless you treat it well.  That means getting plenty of sleep, eating a healthy diet, and using a sports drink that delivers what you need when you need it.

Every sport drink out there claims to have the “right stuff” in order to improve your performance, but most of them really don’t back up there claims with any real scientific data.  First, let’s understand the difference between improving your performance and peak performance.  I can take a bag of Skittles let them dissolve in my water bottle and all of a sudden I have a drink that will improve my performance (at least when compared to water).  The point I am trying to make is that in any activity (ride, run, swim etc…) over an hour any source of carbohydrate will help improve your performance compared to water.  Therefore, those “scientific” papers that show that “product X” increased their athletes’ performance by some percentage when the control group is water are just stating the obvious.

Now that we know basically anything is better than water, let us look at the data on single versus multiple carbohydrate sources, but first a quick chemistry lesson.

Carbohydrates are one of the major sources of calories (the others being protein and fat) in our diets.  They are commonly classified as simple sugars (monosaccharides and disaccharides) or complex carbohydrates (oligosaccharides and polysaccharides).

Monosaccharides or “one sugar” are the simplest form of carbohydrates and cannot be broken down into any other sugars.  When they are metabolized they release energy which is used to fuel the body.  Examples of monosaccharides are glucose and fructose. Disaccharides or “two sugars” are (you guessed it) when two monosaccharides are combined together.  Examples are sucrose (your common table sugar), which is fructose and glucose joined together and lactose (or milk sugar), which is glucose and galactose (another monosaccharide) joined together.

Complex carbohydrates are oligosaccharides (”few sugars”) and polysaccharides (”many sugars”).  There are hundreds and hundreds of different types of complex carbohydrates.  The two that are probably most familiar to athletes are glycogen and maltodextrin.

Glycogen is how your body stores glucose and is just thousands of glucose molecules linked together.  Glycogen is mainly stored in the liver and muscles.  Your body can only store a limited amount of glycogen (about 2000 kcal) so after long periods of exertion without any energy consumption, glycogen stores become depleted (called glycogen debt) and performance significantly decreases.  So next time your on a group run or ride and you see your buddy starting to bonk, hand him one of your gels and tell him “its time to repay your glycogen debt” and then just smile at the confused look on his face.

Maltodextrin is produced from starch (which is polysaccharide consisting of a large number of glucose molecules joined together).  It is a very common additive in sports nutrition products, because although technically a complex carbohydrate, it is easily digestible and absorbed as rapidly as glucose. However, unlike glucose, Maltodextrin is not very sweet.

So when you look at a nutrition label and it says for example, carbohydrates 30 grams (g) and sugars 10g,  what that means is that out of the total 30g of carbohydrates, 10g are  monosaccharides or disaccharides (simple sugars) and the rest (20g) are oligosaccharides and polysaccharides (complex carbohydrates).

Ok, chemistry lesson over.  So which is better, a sports drink that contains just simple sugars (like Gatorade), a sports drink that contains just complex carbohydrates (like Hammer’s Heed), or a sports drink that contains both (like XOOD).  It turns out there is a fair amount a good scientific data on this topic.

Your gut has a limited number of receptors to transport carbohydrates into your bloodstream to be used for fuel. So by using a drink that contains only one source of carbohydrates (whether simple or complex) you run the risk of overwhelming those receptors, transport will slow down, leading to less available energy, and those extra carbohydrates sitting around will cause water to leave your bloodstream to enter your gut. This can lead to abdominal pain, dehydration and decreased performance during exercise. Studies have shown that by using two different sources of carbohydrates (for example maltodextrin and fructose) that are absorbed by different receptors you can get increased absorption, supply more energy, faster, to metabolizing tissues and get increased performance.

However, don’t take my word for it check out some of the following articles and believe for yourself.

Wallis GA, Rowlands DS, Shaw C, Jentjens RL, Jeukendrup AE. “Oxidation of combined ingestion of maltodextrins and fructose during exercise.” Medicine & Science in Sports & Exercise, 2005; 37(3):426-32.

Currell K, Jeukendrup AE.
Superior endurance performance with ingestion of multiple transportable carbohydrates.
Med Sci Sports Exerc. 2008 Feb;40(2):275-81.

Jentjens RL, Achten J, Jeukendrup AE.
High oxidation rates from combined carbohydrates ingested during exercise.
Med Sci Sports Exerc. 2004 Sep;36(9):1551-8.

Salvatore J. Tirrito M.D., F.A.C.C.
Pima Heart Associates
HeartWise Fitness & Nutrition- President/CEO
Proud makers of XOOD Natural Healthy Endurance Drinks
www.xoodhealth.com

Women as endurance athletes: What you need to know

Women are very quickly becoming the fastest growing segment of endurance athletes.   Studies suggest that women utilize less glycogen and more fat than men in long, lower-intensity exercise. This makes female athletes particularly well suited for, and may potentially provide an advantage over men in endurance events. Training and competition in endurance events have obvious health benefits, but there are some short-term and long-term negative health consequences, particularly in women, to avoid.

Females clearly have different nutrient requirements than males. Many of these differences are simply based on body size, but others are due to physiological differences.  It is by understanding these physiological differences, that the female endurance athlete can reduce her risk of some immediate and long-term health problems.

Menstrual cycle dysfunction and bone loss

Female endurance athletes who train intensely are at risk for menstrual cycle dysfunction such as amenorrhea (complete lack of menses) or oligomenorrhea (decrease frequency of menses).  This risk likely has to do with a chronic under consumption of calories.  Insufficient caloric intake leads to malnutrition, which increases the likelihood of menstrual dysfunction.  Menstrual dysfunction then leads to hormonal imbalances, which cause a reduction in bone density.  This reduction in bone density in the short-term places the female endurance athlete at increased risk of injuries such as stress fractures.  In the long-term and much, more insidiously these hormonal imbalances can lead to osteoporosis, which is a very common cause of disability and reduced quality of life in older women.  Ensuring that you are eating enough calories and getting enough calcium in your diet may help reduce the risk of menstrual dysfunction and the associated reduction in bone density.

Anemia

Iron is an integral component of red blood cells (RBCs) and without enough iron, anemia (decreased RBC count) develops which can lead to a reduction in exercise capacity, impaired performance, tiredness, cramping and headaches. In both men and women, iron is lost in sweat, feces, urine, and heel strike hemolysis (the destruction of RBCs caused when the heel hits the ground with force, i.e. running). Due to the added blood loss that women experience with menstruation, iron deficiency is another common problem found in female athletes.
The best way to prevent iron deficiency anemia is to eat a diet that is well fortified in iron and secondarily by wearing well cushioned shoes and running on softer surfaces (to reduced heel strike hemolysis).

Recommendations:

-  Eat!  Make sure you are taking in enough calories to meet your energy demands.  If you are unsure how, than is consider talking to a trained sports nutritionist.  You may even consider undergoing testing.  Using oxygen consumption analysis you can find out your basal metabolic rate (how many calories you burn up in a day just being alive) and the amount of calories burned at varying levels of exercise.  You can then use this information to make sure that your energy consumption is always greater than your energy expenditure.  If you do experience menstrual cycle dysfunction, talk to your doctor.

-  Make sure you are getting at least the recommended daily allowance (RDA) of calcium and iron.  Depending on your level of activity, you may need even more than the RDA.

-  Get your blood checked at least yearly to assess calcium levels, make sure that your RBC count is normal and that your iron levels and stores are adequate.

-  Consider bone density testing every few years to make sure your bone density levels are appropriate for your age.

-  Defy expectations, shatter all stereotypes and let your competitive side shine though.

Salvatore J. Tirrito M.D., F.A.C.C.
Pima Heart Associates
HeartWise Fitness & Nutrition- President/CEO
Proud makers of XOOD Natural Healthy Endurance Drinks
www.xoodhealth.com