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Kelsey Beckmann
HUN 3800

Do Men and Women Metabolize Carbohydrates Differently in Endurance Activities?


In the endurance athletics realm today, participants more than consider the
difference between men and womens physiology and the implications involved. Hence,
all professional sports having sex separated divisions. It does not seem reasonable for a
man, that has the advantage of a larger thoracic cavity, an average of ten times more
testosterone, and different muscle anatomy, to be compared to and to compete with a
woman. Exercise physiologists even have created time standards based off Olympic
runners that mathematically determine a time difference that would make a man and a
woman of a same fitness level. For example, in the 2016 Olympic marathon trials, men
will have to run a 2 hour and 18 minute marathon, where as a woman, that would be
considered to be equally as elite, will have to run a 2 hour and 43 minute marathon. This
proves that athletic officials have more than acknowledged woman having different
anatomic and physiologic characteristics.
These contrasting facets involve several areas, and suggest that female endurance
athletes bear a body with specific nutritional needs. Not only the amount of energy intake
(kcal), but the type of substrate and timing of energy intake can be tailored to optimize
her performance. Particularly when considering the bodys optimal fuel, carbohydrates, a
universal recommendation for people does not suffice. Once one understands the role of
carbohydrates within the body, they can examine the different determinants of what
affects the metabolism of them, and link it to how a man versus woman could possibly
have different utilization of them as a macronutrient.
According to current findings, research suggests that women have lower rates of
glucose appearance and disappearance than men do 1. The reason why is not 100%
accounted for, but focuses such as VO2 Max, muscle fiber recruitments, body mass, and
hormonal differences are being investigated.

Definition and Types of CHO
As endurance athletes exert themselves into long duration of exercise and
competition, it is well known that they must have plentiful available carbohydrates. It
is the bodys preferred substrate to use before tapping into fat, and worse, protein
storages. When the structure of carbohydrates is discussed, this becomes apparent.
Imagine a very short train, with maybe only one or two boxcars attached to the
cab. Now, imagine a train that consists of so many goods, that it must have dozens of
boxcars linked together. The first train that was explained, with only one to two boxcars
of goods can be explained as a simple carbohydrate. However, the cab that has several
boxcars attached can be compared to a complex carbohydrate. These are the two major
classifications of carbohydrates, but what makes a substance a carbohydrate at all? There
are several ways to understand what actually makes up a carbohydrate. Structurally
speaking, Sareen S. Gropper and Jack Smith, authors of Advanced Nutrition and Human
Metabolism, define this macronutrient as a polyhydroxyl aldehyde or ketone, or
substances that produce these compounds when hydrolyzed2. Carbons contain carbon,
oxygen, and hydrogen, hence the name hydrocarbon2 3.
Among the short train, simple carbohydrates, there are monosaccharides and
disaccharides. Glucose, a six-carbon sugar, is nutritionally considered the most beneficial
monosaccharide. In disaccharides, two monosaccharides conjoin by a covalent bond.
Lactose, milk sugar, is a disaccharide that consists of galactose and glucose molecules 23.
The longer chain of boxcars, complex carbohydrates, refers to oligosaccharides
and polysaccharides. Like disaccharides, oligosaccharides are multiple monosaccharides
attached by covalent bonds. However, it is three or more monosaccharides. With
polysaccharides, the links of monosaccharides range from several to a thousand 2. From a
nutrition stand point, glycogen is a common polysaccharide that is focused on that gets
stored in the liver and skeletal muscles of organisms. This is the one that an endurance
athlete would be concerned with, which is where they gather energy. When they carb
load, they are expanding their glycogen storages, to be able to have a larger bank of
energy 3 4.

Absorption of CHO
When speaking about carbohydrate metabolism, it is important to recognize how
both simple and complex carbohydrates are digested and absorbed. Everybody, including
those not participating in endurance activities, men, and women, use these sources to fuel
day-today activities and to maintain overall health. Digestion begins in the mouth, with
saliva. Saliva amylase, an active enzyme in saliva, breaks down starch into smaller
polysaccharides5. With carbohydrates that are not monosaccharides, they must be further
hydrolyzed so that the small intestine can absorb them 45. Some structures simply cannot
be further broken down by saliva amylase, and form dextrins that live in the brush border
membrane. 452. No carbohydrate digestion occurs in the stomach due to the high
concentration of hydrochloric acid, which overpowers saliva amylase.
All the contents that have yet to be digested will defer to the small intestine,
where most of the digestions occur 5. The pancreas secretes pancreatic amylase that
allows for any starches to be reduced to maltose, or limit dextrins. Specific enzymes of
the small intestine are able to break maltose (a disaccharide), into fragments of
monosacchardes. The monosaccharide size allows for the small intestine to absorb, and
enter the bloodstream to the liver via the portal vein. With glucose and galactose, ATP is
needed to allow for this absorption that requires active transport across the membrane.
Fructose can be absorbed with facilitated diffusion, and takes longer to be absorbed.
Once the contents reach the liver, they then can be converted to glucose and used by cells
to provide energy. The excess amount of glucose is either stored in the liver or skeletal
muscles as glycogen 425.

Importance of CHO for Endurance Athlete
On average, the skeletal muscles can store 120 grams of glycogen. This is where
the idea of carb loading comes in. Endurance athletes attempt to expand glycogen
storages by increasing the amount of glucose within carbohydrates they consume. While
lipids can also be used to fuel exercise, glycolysis is much faster, and lipids require
oxygen to be broken down. When runners or triathletes use the phrase that they
bonked, they simple ran out of muscle glycogen storages, and now will move to fat,
and even protein storages to yield energy 5. Without stored glycogen, an athletes focus
can also be jeopardized because carbohydrates can cross the brain membrane, where as
lipids cannot. Also, the muscles begin to cramp as they run out of glycogen. As a result of
depleting glycogen storages, the body uses a different metabolic pathway for muscle
fibers to get more energy that does not require oxygen, anaerobic respiration, which
produces lactic acid as a by product. At this point, the athlete does not have the same
energy as they did under aerobic respiration, but her muscles are still functioning.
Eventually, the body becomes susceptible to micro fractures, tears, and other injuries due
to the fatigued state of the body. Also, the body has to work harder to maintain intensity
of effort, and heart rate increases.
Typically, the more physically fit you are, the more oxygen you can deliver to
your muscles so that fatty acids can be used as a fuel source, which is helpful when
muscle glycogen storages become depleted 5.

Determinants of CHO Metabolism
While it is known that carbohydrates are an optimal source for prolonged
exercise, an athlete must pay attention to individual factors that pertain to them to
determine how much carbohydrates expenditure they are experiencing. In a theoretical
study conducted by the Journal of Athletic Training, the macronutrients and energy
expenditure of three types of elite distance runners according to body mass, respiratory
quotient, and percentage of fast twitch muscle fibers were calculated. Although these
studies compared males, it revealed a lot about anatomical and physiologic differences
that women bear. For example, an individual that is 115 lbs that runs a mile in six
minutes will expend fewer carbohydrates than an individual that weighs 185 lbs and runs
a mile in six minutes. Not all women have less body mass than men, but there is
definitely a common trend that they do. The study presented that the men of larger body
mass (compared 72kg, 67 kg, and 60kg), utilized more energy expenditure in general,
which proportionally affected carbohydrate expenditure 6.
In this same study, the respiratory quotient was also examined. Those that were
the Type I athletes (those with the most fast-twitch muscles fibers), had the highest
respiratory quotient which is simply the respiratory exchange rate, or carbon dioxide to
oxygen ratio. Ones optimal respiratory quotient is produced when he or she has
increased carbohydrate consumption 7. The respiratory quotient is directly proportional
to an athletes VO2 max. Typically, men have a higher a VO2 max for no other reason
than that they have a larger thoracic cavity that can consume more oxygen at a time. This
in turn, requires more carbohydrates as a medium of substrate utilization. An elite male
runner can have a VO2 max of 80 ml/kg/min, whereas elite women can be 70 ml/kg ,
which is a considerable difference 6.
As introduced before, the study also separates the three elite distance runners into
the thee categories of Type I , which have the most fast twitch oxidative (FTO) fibers in
the legs muscles, Type II, containing equal amounts of slow-twitch (ST) and FTO, and
then Type III, with more ST fibers in the leg muscles. In the runners that contained the
highest percentages of FTO fibers, they utilized more carbohydrates. For example, when
being put in a prescribed heart rate zone of 70% VO2 max, the Type I used 67 mg of
CHO, Type II used 55 mg, and Type III used 32 mg 6. Hence, Type II was getting a
larger percentage of substrate utilization from lipids than Type I, and Type III was getting
more substrate utilization from lipids that both Type I and Type II. In comparing the
carbohydrate metabolism in males and females, this matters because of the muscle fiber
recruitment differences. Men recruit more FTO fibers than women, therefore their
muscles are causing them to metabolize more carbohydrates 8. ST muscle fibers oxidize
more lipids, which is the main muscle fiber recruitment of women. By comparing the
three different types of men, having different percentages of FTO to ST fibers, one could
draw parallels to women that substantially have more ST recruitment.
Another determinant of carbohydrate, as well as overall caloric expenditure is
intensity of ones training. This can be calculated via using a perceived effort, or more
accurately, heart rate or percentage of ones VO2 max. Overall, slower exercise
(stimulation of ST) derives energy from fat oxidation. This is true for about 65% of VO2
max. However, once ones intensity rises to about 80% of his or her VO2 max, fat
oxidation rapidly declines 1, provoking more carbohydrate utilization. For example,
someone with the same VO2 max, and same mass, that runs at different efforts, will
metabolize different amounts of carbohydrates. The person training at the more intense
effort will use more carbohydrates in grams than the person at a lower effort.
The occurrence of womens menstrual cycles plays a significant role in the
efficiency of carbohydrate metabolism as well. Within a normal 28-day cycle, the body
goes through menses for up to a week; a follicular phase until ovulation, then after
ovulation the body undergoes a luteal stage. Different phases greatly determine substrate
utilization, and thus, glycogen utilization 9. This is mostly because of the fluctuations of
estrogen and progesterone in the body. It is during the late follicular phase where there is
an influx of estrogen, and lower progesterone levels. This can result in an improved
performance because estrogen improves glucose appearance. There is another time that
glycogen storage is augmented during the 28-day cycle, and that is also when estrogen is
higher during the midluteal phase 1. However, both estrogen and progesterone suppress
glucogenesis, the main metabolic pathway mechanism that disables blood glucose levels
from dropping too much in a prolonged endurance activity.
The American Journal of Physiology: Regulatory, Integrative, and Comparative
Physiology supported that progesterone and estrogen play a role in glycogen storages in
women during exercise. They specifically conducted a study to determine the effect of
the menstrual cycle phase and sex upon glucose turnover and muscle glycogen utilization
during endurance exercise9. They took 13 female cyclists, and put them through a time
trial of 90 minutes. All the women were tested during their follicular phase which was
around day 9, and day 21 of their luteal phase in the single-blind, randomized, cross-over
design 9. Subjects were advised to maintain normal diet and exercise levels prior to the
test, and were all given identical meals the night before the test. A baseline blood sample
was taken to determine natural appearance of glucose within the thirteen athletes. Within
the period of exercise, an infusion of glucose in equivalent amounts was given to the
athletes. Before and after exercise, muscle biopsies were taken to determine the muscle
glycogen. Carbohydrate oxidation was determined by a formula to calculate the
respiratory exchange rate.
The results found that during the womens follicular phase, all thirteen womens
time trial time got faster, their VO2 max was increased, and more CHO utilization was
implemented. The luteal phase marked more fat utilization by the women. Also, the
percentages of plasma glucose identified by the muscle biopsies were increased during
the follicular phase at an average of about 2%. Men do not experience this fluctuation of
hormones and metabolize substrates uniformly through a given time based on a similar
fitness level.
Conclusion/ Application to Dietetic Practice
After considering all of the different factors that alter a females metabolism of
carbohydrates, it seems that the recommendation that a lot of endurance athletes are
given, of 6-9 grams of carbohydrates per kg of body mass, need to be modified to
specifically meet a womens need. The differences that were discussed, hormones,
muscle fiber recruitment, body mass, and VO2 max, are all significant determinants that
greatly dictate overall metabolism and cannot be ignored. To go even further, there is an
opportunity to make dietary recommendations for females in regards to what phase of
menstrual cycle they are undergoing.
To make an average for females would be considerably rigorous and indefinite
because of the irregularity of menstrual cycles and consumption of birth control that
affects hormones. However, an average could be provided so that sports focused
dieticians could more accurately prescribe a nutrition plan for a female endurance athlete
to meet her needs.
Also, a more specific nutrition plan could be prescribed for elite athletes that have
the resources to be involved in the study such that The Journal of Physiology conducted.
That way, whoever is making dietary recommendations have factored in variables such as
any birth control pills, VO2 max, menstrual cycle timing, and natural percentage of blood
glucose. The general recommendation presented to every endurance athlete is not precise
enough to optimize an elite females performance.

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