In a recent study, a group of Canadian and Australian researchers found that four 20g doses of protein evenly spaced through the day is optimal for muscle building (1). Twenty four men took a total of 80g of whey protein over 12 hours starting immediately after training. One group took eight 10g doses every 1.5 hours. The second group took four 20g doses every 3 hours; the third group took two 40g doses, with one post-workout and the second after 6 hours.

The results showed two things. First, the 20g dose taken every 3 hours produced a better balance between protein breakdown and synthesis after the workout. Second, there’s no advantage to be gained by consuming more than 20g per meal – taking 40g did not result in greater muscle synthesis.

But what about the type of protein you consume? If you’re looking to maximise muscle repair and growth, opt for high quality proteins that contain all essential amino acids, say researchers at McMaster University in a review of studies(2). Milk, whey, casein (the latter two are derived from milk), egg, and meat have produced best results in studies. All essential aminos are important for muscle synthesis but leucine is perhaps the most potent. It acts as a signal for protein synthesis in the muscles, triggering key metabolic pathways. Fortunately, its found in abundance in dairy, egg and meat so there’s no need to take separate supplements provided you’re getting your 20g protein dose (studies with leucine-enriched whey found no benefit compared with ordinary whey).

So, here’s what 20g of high quality protein looks like:

• 3 eggs
• 600ml milk (or flavoured milk)
• 27g whey protein powder
• 85g Cheddar cheese
• 85g meat or poultry
• 450g plain yoghurt
• 250g Greek yoghurt
• 100g fish e.g. salmon, plaice

(1)   Moore D.R. et al (2012) ‘ Daytime pattern of post-exercise protein intake affects whole-body protein turnover in resistance-trained males’ Nutrition & Metabolism 2012, 9:91 http://www.nutritionandmetabolism.com/content/9/1/91

(2)   Tyler A Churchward-Venne  et al (2012)  ‘Nutritional regulation of muscle protein synthesis with resistance exercise: strategies to enhance anabolism’ Nutrition & Metabolism 2012, 9:40 http://www.nutritionandmetabolism.com/content/9/1/40

Coconut water isn’t the same as coconut milk – it’s the clear liquid extracted from young coconuts. The unflavoured version contains 18 calories and 5g sugars per 100ml, which is similar to most sports drinks (3.9 – 6.6g/ 100ml). This makes it an isotonic drink. But that’s where the similarity ends; the big difference between coconut water and sports drinks is its high potassium and low sodium content. It contains more than 10 times the potassium (195mg vs 12mg 100ml) and less than a quarter of the sodium (12 mg vs 50mg sodium/ 100ml).

All of which is very good news if you’re exercising for an hour or more. The sugars speed fluid uptake and supply additional fuel for your muscles. And the lack of sodium isn’t an issue. Yes, that’s right – you don’t need sodium during exercise, contrary to popular belief. Current research and says sodium doesn’t accelerate fluid uptake nor boost performance (1, 2, 3).

Researchers have discovered that sodium passes from the blood plasma into the intestine, where it then stimulates water absorption. In other words, the body sorts out the sodium concentration of the liquid in your intestines all by itself, so the addition of sodium to sports drinks is unnecessary if you want speedy water absorption. Sodium simply increases thirst and encourages you to drink more. Tim Noakes asserts that sodium is a marketing ploy by manufacturers, that its only role is to promote palatability and perhaps a placebo effect (4). The truth is that glucose is more important than sodium for promoting fluid absorption.

So does coconut water work? According to a randomised, cross over, single blind study at the University of Memphis, coconut water rehydrates as well as water or sports drinks after exercise (5). Twelve volunteers exercised on a treadmill until they had lost 2% body weight (ie they were mildly dehydrated). They then drank 1 of 4 drinks (on 4 separate occasions): 2 varieties of coconut water, a sports drink or water. After 2 hours, there was no difference in their hydration status (weight, fluid retention, plasma osmolality, urine specific gravity) and subsequent performance (treadmill time to exhaustion). In other words, coconut water was no better and no worse than water or the sports drink. Two earlier studies carried out at the University of Malaysia reported similar results (6, 7).

So what’s the bottom line? It’s not necessarily better than water for keeping you hydrated during light exercise lasting less than an hour but if you’re working out very hard or for longer than an hour (ie when dehydration or lack of carbs would otherwise affect your performance), coconut water could be a good alternative to squash or sports drinks. What’s appealing is that it’s completely natural (there’s no preservatives, flavours, acids), and its not contrived in a lab nor made in a factory.

References

1. Sawka M.N. et al (2007), ‘American College of Sports Medicine Position stand. Exercise and fluid replacement’. Med Sci Sports Exerc, vol 39 pp 377 – 390.
2. Jeukendrup AE et al (2009) Effect of beverage glucose and sodium content on fluid delivery. Nutr Metab (Lond). 2009 Feb 20;6:9.
3. Shirreffs, S.M. & Sawka, M.N (2011), ‘Fluid and electrolyte needs for training, competition, and recovery.’ J Sports Sci., vol. 29 suppl1, S39 – 46.
4. Noakes, 2012 ‘Waterlogged’ Chapter 11: Guidelines for fluid intake and diagnosis of EAH. Human Kinetics
5. Kalman D, Feldman S, Krieger DR, Bloomer RJ. Comparison of coconut water and a carbohydrate-electrolyte sport drink on measures of hydration and physical performance in exercise-trained men. J Int Soc Sport Nutr. 2012. 9:1.
6. Ismail I, Singh R, Sirisinghe RG. Rehydration with sodium-enriched coconut water after exercise-induced dehydration. Southeast Asian J Trop Med Public Health. 2007. 38(4):769-85.
7. Saat M, Singh R, Sirisinghe R, Nawawi M. Rehydration after Exercise with Fresh Young Coconut Water, Carbohydrate-Electrolyte Beverage and Plain Water. Journal of Physiological Anthropology and Applied Human Science 2002; 21(2):93-104.

A 2011 study from University of Cape Town researchers looked at 209 Ironman triathletes before and after a race, and tried to detect any differences between the 43 who developed muscle cramps and the 166 who didn’t (1). The major finding is that there was no significant difference in the levels of dehydration or electrolyte loss between the two groups, challenging the prevailing electrolyte-depletion hypothesis of cramps.

The same research team 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 (2). They were unable to correlate decreased sodium concentration to an increase in exercise-associated muscle cramping. Instead, they concluded “Acute EAMC in ironman triathletes is not associated with a greater percent body mass loss or clinically significant differences in serum electrolyte concentrations. The increased EMG activity of cramping muscles may reflect increased neuromuscular activity.”

Schwellnus and his colleagues published a study later the same year in the British Journal of Sports Medicine looking at 49 runners in the 56K Two Oceans Marathon in Cape Town (3). Those who suffered cramp were more likely to have set off too fast relative to their fitness and have trained more in the final week before competition, thus leaving their muscles fatigued.

Researchers are now studying an alternative theory that pins much of the blame for muscle cramps on factors like training, recovery and pacing, as well as genetic susceptibility- the theory of “altered neuromuscular control”. In other words, muscle fatigue leading to abnormal functioning at the spinal level of the muscle contraction mechanism.

Here are some ways that may help to prevent cramps:
* Train for the conditions (pace, terrain, temperatures, duration, etc.) you plan to compete in
* Follow a regular stretching program
* Work on correcting any muscle imbalances or incorrect movement patterns; develop an efficient technique required for your sport
* Take in enough carbohydrates before, during and after events > 2hours; the amount will vary among individuals but aim for 250 – 400 calories per hour during the event
* Hydrate properly during the event, especially events lasting longer than 3 hours

If you do cramp, try to:
* Slow down and lower the intensity of the activity
* Stretch and try to relax the affected muscle(s)
* Apply pressure to the affected muscle group(s) to get the muscles to “release”

References
(1) Schwellnus MP, Drew N, Collins M (2011) Increased running speed and previous cramps rather than dehydration or serum sodium changes predict exercise-associated muscle cramping: a prospective cohort study in 210 Ironman triathletes. Br J Sports Med. 2011 Jun;45(8):650-6. doi: 10.1136/bjsm.2010.078535. Epub 2010 Dec 9.
(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, Allie S, Derman W, Collins M (2011) Increased running speed and pre-race muscle damage as risk factors for exercise-associated muscle cramps in a 56 km ultra-marathon: a prospective cohort study. Br J Sports Med. Nov;45(14):1132-6. doi: 10.1136/bjsm.2010.082677. Epub 2011 Mar 13.

If fat loss is your main goal, exercising on an empty stomach – such as first thing in the morning – may encourage your body to burn slightly more fat for fuel. Researchers at Northumbria University asked 12 male volunteers to do a moderate-intensity treadmill workout at 10am either after an overnight fast or after eating breakfast (Gonzalez et al, 2013). They gave them a milk recovery drink 90 after their workout followed by a pasta lunch a little later to see whether there were any differences in their appetite or the amount of food consumed. They found that those who exercised on an empty stomach burned up to 20% more fat compared with breakfast eaters. What’s more, contrary to popular belief, they had a smaller appetite later in the day and did not consume more calories to compensate for their missed breakfast.

There’s the intriguing possibility that training on low carbohydrate diet followed by a high carbohydrate prior to competition (‘train low, compete high’) may benefit performance in competition (Hawley & Burke, 2010). The idea is that training with low muscle glycogen stores forces the muscles to adapt to using fat as a fuel instead of carbohydrate.

Indeed a recent study by Belgian researchers found that exercising in a fasted state not only burned more fat but also increased the capacity of the muscles to burn fat in preference to carbohydrate (Proeyen et al, 2011). Ten physically active males trained in the fasted state for 6 weeks, while ten consumed carbohydrates before and during training. The two groups increased their fitness (maximal aerobic capacity) equally but those who trained after fasting burned a higher % of calories from fat and increased the number of fat-burning enzymes in their muscles. In other words, exercising on an empty stomach caused metabolic adaptations on the muscles – it ‘trains’ the muscles to burn fat in preference to carbs.

However, despite increasing enzyme levels in the muscles, low carbohydrate diets have not been shown to enhance exercise performance. Another study by the Belgian researchers demonstrated found that when volunteers overate by 30%, they gained 0.7kg when they trained on an empty stomach (Proeyen et al, 2010). Those who trained after eating carbs gained 1.4kg over 6 weeks. But – and here’s the important bit – their VO2 max (maximal aerobic capacity i.e. aerobic fitness) increased significantly over the 6 weeks while the fasting group saw no change.

The bottom line is that if you’re exercising to lose or maintain weight, then exercising on an empty stomach may help you shed the pounds a little faster. But if you’re training to gain muscle or improve athletic performance then its best to eat carbs before your workout (Chryssanthopoulos et al., 2002; Neufer et al., 1987; Sherman et al., 1991; Wright et al., 1991).  In any case, if training on empty makes you feel lightheaded or hungry half way through your workout, then you should eat before you train.

Gonzalez JT, Veasey RC, Rumbold PL, Stevenson EJ (2013) Breakfast and exercise contingently affect postprandial metabolism and energy balance in physically active males. Br J Nutr. 2013 Jan 23:1-12. [Epub ahead of print

Van Proeyen K et al (2011),Beneficial metabolic adaptations due to endurance exercise training in the fasted state J Appl Physiol. 2011 January; 110(1): 236–245.

Van Proeyen, K (2010), Training in the fasted state improves glucose tolerance during fat-rich diet J Physiol. 2010 November 1; 588(Pt 21): 4289–4302.

Hawley J.A. & Burke, L.M. (2010) Carbohydrate availability and training adaptation: effects on cell metabolism. Exerc Sports Sci Rev, 38 pp 152 – 160.

Chryssanthopoulos, C. et al. (2002), ‘The effect of a high carbohydrate meal on endurance running capacity’, Int. J. Sport Nutr., vol. 12, pp. 157–71.

Neufer, P.D. et al. (1987), ‘Improvements in exercise performance: effects of carbohydrate feedings and diet’. J Appl. Physiol., vol. 62, pp. 983–988.

Sherman, W. M. et al. (1991), ‘Carbohydrate feedings 1 hour before exercise improve cycling performance’, Am. J. Clin. Nutr, vol 54, pp. 866–870.

The idea that sugar is bad for you isn’t new. 40 years ago, British physiologist John Yudkin first suggested that sugar was deadly, and prophesised that continued consumption would lead to widespread obesity and other metabolic diseases. He was silenced by the food lobby who sought to divert attention to fat. Now an avalanche of scientific opinion is suggesting that he was right all along, that we are eating far too much of the stuff, and it is probably the most significant part of the obesity epidemic.

This week a meta-analysis of 68 studies by NZ researchers, published in the British Medical Journal (http://www.bmj.com/content/346/bmj.e7492), concluded that eating less sugar is linked to weight loss, and eating more is linked to weight gain. The study, commissioned by the World Health Organisation (WHO), found that reducing sugar in the diet produced an average weight reduction of 0.8kg, while increasing sugar intake produced a corresponding increase. It also suggested that sugar promotes overconsumption of calories. In other words, the taste of sugar could lead you to want to eat more of it.

We don’t think of sugar as an addictive drug. But research tells us that sugar acts on the same hormonal pathways in the brain that reward behaviour, and therefore may be highly addictive in certain people. In his book Fat Chance: The Bitter Truth About Sugar, Robert Lustig, an American professor of paediatrics, argues that sugar is as addictive as nicotine, alcohol and cocaine. Rather than satisfying your appetite when you eat it, sugar makes you want to eat more. He explains that sugar down regulates the dopamine receptors in the brain so you need to eat more and more to get the same pleasure. When obese people eat less, they get withdrawal symptoms.

But sugar doesn’t act only on the brain. In the liver, sugar – or, more specifically, fructose – is converted directly into fat (sucrose is made up of glucose and fructose). Fructose can only be broken down by the liver cells – you cannot transport it to other cells – and then converted either to glycogen or fat. When liver glycogen stores are full (which isn’t hard because they are very small), fructose is made into fat. So, unless you have just done intense exercise and are glycogen-depleted any sugar (fructose) that you eat will be converted to fat. The bottom line is that its very easy to get fat from eating sugar.

Lustig (and others such as David Gillespie in Sweet Poison: Why sugar makes us fat) goes as far to say that sugar is a poison. He warns against high fructose corn syrup, called ‘glucose-fructose syrup’ on UK food labels. Its found in so many foods and drinks from ice cream to breakfast cereals to soft drinks. The problem is that fructose doesn’t satisfy hunger or tell your brain to stop eating. Unlike glucose, it doesn’t trigger insulin, nor increase leptin (the hormone that signals the brain you’re full) or reduce the hunger hormone ghrelin. In other words, its like eating invisible calories.

Now you may be thinking that all this doesn’t matter if you’re not overweight. But that’s not the point. There’s convincing evidence that high levels of sugar (or fructose) causes profound metabolic changes that, over time, can result in type 2 diabetes, high blood pressure, high blood cholesterol, high triglyceride levels, cardiovascular disease, cancer and dementia. Everyone would benefit from cutting sugar. And I don’t mean just the obvious things like chocolate bars, doughnuts and cola. I’m also talking about the less obvious ‘natural’ sugar in fruit juice (there’s no fibre to mitigate the rapid absorption of fructose) and smoothies. Perhaps the only people who can justify consuming sugar are athletes who can make good use of sugar during high-intensity workouts and post-exercise when muscle and liver glycogen stores require re-filling.

It will be interesting to see whether the WHO acts on the New Zealand study and changes it’s recommendations (currently 10%) or whether food manufacturers signed up to the government’s responsibility deal make any meaningful sugar reductions in their products (GSK announced a token 10% cut in sugar in Ribena and Lucozade, http://mediacentre.dh.gov.uk/2013/01/22/sugar-and-calories-cut-in-soft-drinks/) or whether Labour would set legal limits on sugar if they should come to power

 Milk may seem a little ordinary next to the huge array of commercial recovery products on offer but actually the science leans in milk’s favour. It appears to do just about everything – aid muscle growth, promote muscle repair, reduce muscle soreness and rehydrate the body – after both resistance and endurance exercise, in men as well as women. Compared with traditional sports drinks, 500ml milk consumed after training produces greater gains in muscle mass and strength as well as a greater aerobic capacity, and reduced body fat levels (Cockburn et al, 2012, Ferguson-Stegall et al, 2011; Josse, 2010; Elliot, 2006; Hartman et al, 2007; Wilkinson, 2007; Karp et al, 2006). It also rehydrates you as well as if not better than isotonic sports drinks (Shireffs et al, 2007).

 In short, milk helps you recover faster and perform better in your next workout. A 2008 study by researchers at Northumbria University found that athletes who drank 500 ml of semi skimmed milk or chocolate milk immediately after training had less muscle soreness and more rapid muscle recovery compared with commercial sports drinks or water (Cockburn et al, 2008).

 What’s more, a 2009 study from James Madison University, US, found that football players who drank chocolate flavoured milk after training had less muscle damage and faster muscle recovery compared with those who consumed a sports drink (Gilson et al, 2009).  

 Just how milk works isn’t clear but it is thought that the dairy peptides formed during digestion alter protein metabolism in the muscle and promote training adaptations. The key is to get 15- 20g protein after training, ideally in a 4:1 or 3:1 ratio of carbs to protein. The good news is that you can get all this from milk or any brand of flavoured milk – at a fraction of the cost of any commercial recovery drink.

 The winners = Milk; Nesquik, supermarket own brands, Yazoo

 The losers = commercial recovery drinks

 Take home message: Shun commercial recovery drinks – they contain the same amount of carbs and protein as flavoured milk but are a staggering 6 times more expensive. The heavily promoted ‘For Goodness Shakes’ looks superior to milk but, in fact, contains the same ingredients as flavoured milk (with some added vitamins and minerals) but is 3 times more expensive. (You can get your vits and mins from real food or from a separate less expensive supplement). Save your money!

 Karp JR, Johnston JD, Tecklenburg S, Mickleborough TD, Fly AD, Stager JM. ‘Chocolate Milk as a Post-Exercise Recovery Aid’ (2006) International Journal of Sports Nutrition and Exercise Metabolism. 16. 78-91.

 Shirreffs SM, Watson P, Maughan RJ.(2007) ‘Milk as an effective post-exercise rehydration drink’. British Journal of Nutrition 1-8. 2007.

 Ferguson-Stegall L et al (2011) Aerobic exercise training adaptations are increased by postexercise carbohydrate-protein supplementation. J Nutr Metab. Epub 2011 Jun 9

 Cockburn, E. ,et al  (2008) ‘Acute milk-based protein-CHO supplementation attenuates exercise-induced muscle damage.’ Appl Physiol Nutr Metab. Aug;33(4):775-83.

 Cockburn E, Robson-Ansley P, Hayes PR, Stevenson E (2012) ‘Effect of volume of milk consumed on the attenuation of exercise-induced muscle damage.,’ Eur J Appl Physiol. Jan 7. [Epub ahead of print]

 Josse A.R. et al (2010), ‘Body composition and strength changes in women with milk and resistance exercise’, Med Sci Sports Exerc.Vol 42(6) pp1122-30.

 Elliot, T.A. et al (2006), ‘Milk ingestion stimulates net muscle protein synthesis following restistance exercise,’ Med Sci Sports Exerc vol 38 (4) pp667 – 74.

 Hartman J.W. et al (2007), ‘Consumption of fat-free fluid milk after resistance exercise promotes greater lean mass accretion than does consumption of soy or carbohydrate in young, novice, male weightlifters’, Am J Clin Nutr. Vol 86(2) pp373-81.

 Wilkinson, S.B (et al (2007), ‘Consumption of fluid skim milk promotes greater protein accretion after resistance exercise than does consumption of an isonitrogenous and isoenergetic soy-protein beverage,’ Am J Clin Nutr, vol 85 (4), pp1031 – 40.

 Gilson S.F. et al. (2009) Effects of chocolate milk consumption on markers of muscle recovery during intensified soccer training. Medicine & Science in Sports & Exercise; 41:S577

Priority 1: Replace fluids

Your muscles cannot fully recover until your cells are properly hydrated. So make drinking your priority – start drinking while stretching, before you’ve showered. The exact amount you need to drink depends on how dehydrated you are after swimming. The ‘pee test’ (see the chart below) will give you an idea how dehydrated you are, otherwise weigh yourself before and after training.  For each 0.5 kg (1 lb approx) of body weight lost, drink 600 – 750 ml of fluid (e.g. water, diluted juice or squash, milk – but not all in one go. 

Drink little and often – I suggest 100 – 150 ml every 10 or 15 minutes over the next hour or so until your urine is very pale yellow.

Priority 2: Refuel  

You need to replace the fuel (carbs) that you’ve used otherwise you will feel sore, achey and tired during your next session.

Take advantage of the 30-minute window: This is when your muscles restock energy levels faster than normal.  The sooner you supply your muscles with carbs and protein after training, the quicker they will repair and rebuild. So have your recovery drink/ snack ready in your kit bag or in the car to eat on your journey home.

Eat carbs with protein: To help the body repair and rebuild, you need carbs with protein in a ratio of 3: 1. Ideally you should consume approx 20g protein. You can achieve this either in the form of drink (milk) or food (see below). You don’t need commercial recovery drinks

Opt for a milk drink: Milk, flavoured milk and milk shakes are near-perfect recovery drinks. Research shows that all types of milk after training speed up fuel recovery, encourage muscle gain and even reduce muscle soreness after training. They also help rehydrate the body more effectively than sports drinks, according to recent studies. Opt for whole, semi or skimmed milk; ready-to-drink milk shakes (e.g Yazoo) or make your own yoghurt smoothie from fruit, yoghurt and milk OR milk shake powder and milk.

Here are some ideas for post-workout snacks supplying 20 g protein:

• 500ml of milk or milkshake plus a banana
• 250ml milk or milkshake plus 2 pots of fruit yoghurt
• 500 ml milk or milkshake plus an oat-based bar or flapjack
• 200ml milk or milkshake plus 1 pot yoghurt plus 1 slice of toast and honey
• Homemade milk shake: Blend 1 cup milk, 1 banana, 1 pot yogurt, 1 tbsp chopped walnuts, 1 scoop chocolate milkshake  powder and 6 to 8 ice cubes
• Fruit yoghurt smoothie: whizz together 2 pots of yoghurt, 1 banana or a handful or berries and 150ml fruit juice in a blender
• 50g nuts (e.g. almonds or cashews) plus 2 pots of yoghurt

It’s pretty thin on the ground as it happens. In fact, more and more studies are emerging that show saturated fat isn’t harmful to heart health as once thought (1). Old villains, such as milk and butter have now been vindicated. My search on Medline reveals that saturated fat isn’t synonymous with heart disease.

Fundamentally, not all saturated fatty acids behave the same in the body. For example, stearic acid (found in meat) and palmitic acid (found in dairy fat) have been shown to have no effect on cholesterol (2). In fact, dairy fat raises only the large (not harmful) LDL particles and therefore does not cause furring of the arteries, as widely believed (3).

Surprisingly, saturated fat from certain foods (e.g. dairy) may even be beneficial. Milk – regardless of fat level – is in fact associated with a lower blood pressure and a reduced risk of heart disease, stroke and type 2 diabetes. This is partly explained by the fact that dairy foods contain protein, calcium and other nutrients that may modulate the effect of saturated fat on health.

Need more reasons to switch to butter and whole milk? A University of Texas study found that people with the highest intakes of dairy fat had the lowest cardiovascular risk (4). And two research reviews by Cardiff University researchers suggest that milk may even protect against heart disease, stroke and type 2 diabetes – the risk was lower in those with the highest consumption of dairy foods (5, 6).

So why have obesity and diabetes rates been rising? One of the problems is that people have been replacing fat with highly processed refined carbohydrates – a recipe for disaster. We now know that such a diet (high-carb low-fat) sends blood triglyceride (fat) levels soaring and makes a heart attack more likely. One UK study found that those following current government guidelines ie a high carb low fat diet, ended up with higher levels of blood fats and lower levels of ‘good’ HDL levels, changes that increased, not decreased, their risk of heart disease (7). Cutting saturated fat and replacing it with carbs is probably the worst thing you can do.

So why has saturated fat been assigned the role of villain for so long? Its wrongful accusation stems from Ancel Keys seven countries study, which showed that countries with the highest saturated fat intake had the highest number of deaths from heart disease. This research has now been discredited – he ignored the data from 15 other countries (including France, Spain and Italy) that didn’t tally with his hypothesis. I was fascinated by John Briffa’s analysis of 2008 data from more than 40 countries that shows the opposite relationship to be true (8, 9)! It turns out that countries with the highest % calories from saturated fat have the lowest rate of death due to heart disease.

The real culprits? Processed fats and sugar. According to a 2011 review published in the American Journal of Clinical Nutrition replacing saturated fat with highly refined carbohydrates results in a higher risk of heart disease (10). Sugar-sweetened drinks, in particular, are to blame for weight-gain, type 2 diabetes and cardiovascular disease, say researchers, writing in the journal Circulation (11).

So what does all this mean in practice, what should you be eating?
• This isn’t a licence to gorge yourself on saturated fats; you still need to keep a check on total calories!
• I’m not advocating a ‘high fat’ or a ‘low carb’ diet either – I’d advise a sensible balance of around 35 – 40% fat, 20 – 25% protein (depending on your exercise programme) and the rest from low or moderate GI carbs
• If you step up your fat intake, cut carbs so you don’t end up over eating calories
• Include foods naturally rich in fats, whether saturated e.g. butter, cheese, milk, eggs, fish, organic meat and coconut oil, or unsaturated e.g. nuts, olive oil, avocado, seeds
• Avoid processed fats, hydrogenated fats, processed meats. Choose butter, not margarine or reduced fat spreads
• Minimise sugar, especially soft drinks, biscuits, confectionery
• Stick to ‘real’ foods; avoid highly processed carbs, and ‘reduced fat’ foods (spreads, cookies, cakes, desserts)

(1) Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010;91(3):535-546.
(2) Lock AL, Destaillats F, Kraft J, German JB. Introduction to the proceedings of the symposium “Scientific Update on Dairy Fats and Cardiovascular Diseases.” J Am Coll Nutr. 2008;27(6):720S-722S.
(3) German JB, Gibson RG, Krauss RM, et al. A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk. Eur J Nutr. 2009;48(4):191-203.
(4) de Oliveira Otto MC, Mozaffarian D, Kromhout D, et al. Dietary intake of saturated fat by food source and incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2012;96(2):397-404.
(5) Elwood PC, Givens DI, Beswick AD, Fehily AM, Pickering JE, Gallacher J. The survival advantage of milk and dairy consumption: an overview of evidence from cohort studies of vascular diseases, diabetes and cancer. J Am Coll Nutr. 2008;27(6):723S-734S.
(6) Elwood PC, Pickering JE, Givens DI, Gallacher JE. The consumption of milk and dairy foods and the incidence of vascular disease and diabetes: an overview of the evidence. Lipids. 2010;45(10):925-939.
(7) Arefhosseini SR et al Effect of advice to increase carbohydrate and reduce fat intake on dietary profile and plasma lipid concentrations in healthy postmenopausal women. Ann Nutr Metab. 2009;54(2):138-44. Epub 2009 Apr 1.
(8) http://www.drbriffa.com/2012/10/02/the-french-paradox-is-not-a-paradox/
(9) European cardiovascular disease statistics (2008 edition). British Heart Foundation Health Promotion Research Group Department of Public Health, University of Oxford and Health Economics Research Centre, Department of Public Health, University of Oxford
(10) Astrup A. et al The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010? Am J Clin Nutr. 2011 April; 93(4): 684–688.
(11) Vasanti S. et al Sugar Sweetened Beverages, Obesity, Type 2 Diabetes and Cardiovascular Disease risk. Circulation. 2010 March 23; 121(11): 1356–1364.
(12) Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr. 2009;89:1037–1042.
(13) Jeff S Volek 1 and Cassandra E Forsythe The case for not restricting saturated fat on a low carbohydrate diet Nutr Metab (Lond). 2005; 2: 21.

Looks aside, increasing muscle mass is an important goal for many young athletes as it confers a performance advantage. But many have a hard time putting on weight (and keeping it on). This is partly down to genetics and their stage of development around puberty – hormonal rises accelerate muscle growth -  but also due to the fact that some children (and adults) are naturally ‘fast burners’: they burn more calories than other folk. They fidget, they don’t like sitting still, they pace, they hop from foot to foot while standing, they are animated when they talk. Not only are they active with sport but they are also more active when doing everything else! The technical term for these spontaneous movements is ‘non-exercise activity thermogenesis’, or N.E.A.T.

Tips for boosting calories

You can’t change their genetics or their tendency to fidget but you can boost your athlete’s calorie intake. Instead of filling them up with ‘junk’, focus on high calorie nutrient-dense foods (see the box below). Here are 5 tips to help them bulk up healthily

• Make eating and drinking a priority. Aim for 3 meals with 3 or 4 nutritious snacks in between
• Plan ahead. Help them schedule their meals and snacks around their training, education and social commitments so they always have access to suitable foods and drinks.
• Eat consistently. They should never skip meals
• Add high-energy, nutritious foods: cheese, nuts, dried fruit and healthy oils . Scatter grated cheese on vegetables, soups, potatoes, pasta dishes and hotpots. Mix nuts, seeds and dried fruit into breakfast cereals, porridge and yoghurt. Spread bread, toast or crackers with peanut butter or hummus. Drizzle olive oil, dressing or mayo over veggies and salad.
• Serve bigger portions –  particularly of pasta, potatoes, rice, cereals, dairy products and protein-rich foods.
• Think liquid nutrition. Provide nutritious milk-based drinks, e.g. milk, flavoured milk, hot chocolate, milkshakes, yoghurt drinks, and fruit & yoghurt smoothies. Studies show that milk-based drinks increase muscle protein manufacture after exercise.

High calorie nutrient-dense foods for weight gain

How much protein?

To put on muscle, they need to consume adequate calories as well as protein. Protein needs of young swimmers are greater than those of their non-athletic peers – around 72 – 84g for a 60kg swimmer. They can get this from a balanced diet.

In fact, the timing of their food intake in relation to training sessions is just as important as the amount. Encourage your athlete to consume around 10 – 20g protein within 30 minutes of training. This will help repair muscle tissue damaged during training and support the making of new muscle tissue proteins. The meal or snack should contain carbohydrate plus protein.

Good options include:

• 500ml milk or flavoured milk or milkshake
• A 125g pot of yoghurt plus an oat-based bar
• 250ml milk plus a handful (25g) of nuts and a banana
• A slice of toast with peanut butter plus a 125g pot of yoghurt

What about supplements?

Weight gain and protein supplements claim to increase muscle mass but there is little scientific evidence to support them. These products are expensive and not necessary. There is no guarantee that supplements are drug-free, even when all the ingredients listed are permitted substances. All sports governing bodies advise CAUTION before taking any supplement as its the athlete’s responsibility to ensure they are not taking a banned substance. Refer to www.informedsport.com for a list of tested sports nutrition products.

Athletes should be able to meet their increased calorie requirements and nutrients through ‘real’ food options. You can make your own weight gain drink by blending 300 ml milk with 2 tablespoons milk powder, a 125g pot of yoghurt and a banana.

 For more information and easy healthy recipes: Sports Nutrition for Young Athletes  by Anita Bean, available from www.amazon.co.uk