EFFECTS OF CARBOHYDRATE INGESTION
ON ACUTE LEUKOCYTE, CORTISOL, AND
INTERLEUKIN-6 RESPONSE IN HIGH-INTENSITY
LONG-DISTANCE RUNNING
JOHANNA K. IHALAINEN,1 TIMO VUORIMAA,2 RISTO PUURTINEN,1 ISMO HÄMÄLÄINEN,3
ANTTI A. MERO1
1
Department of Biology of Physical Activity, University of Jyva¨skyla¨, Jyva¨skyla¨, Finland; 2Haaga–Helia University of Applied
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Sciences, Vieruma¨ki, Finland; and 3Finnish Athletics Federation, Helsinki, Finland
ABSTRACT
Ihalainen, JK, Vuorimaa, T, Puurtinen, R, Hämäläinen, I and
Mero, AA. Effects of carbohydrate ingestion on acute leuko-
cyte, cortisol, and interleukin-6 response in high-intensity long-
distance running. J Strength Cond Res 28(10): 2786–2792,
2014—The purpose of this study was to investigate the effect
of ingestion of fluids with different carbohydrate concentrations
(0, 1.5, and 7%) on the acute immune stress responses after
high-intensity long-distance running. Continuous 18- to 20-km
run was performed at 75% of maximal oxygen uptake with
carbohydrate supplementation (CHO7%, 7% carbohydrate
solution) and low-carbohydrate supplementation (low-
CHO1.5%, 1.5% carbohydrate solution) in a randomized,
double-blind, placebo (PLA) controlled design. Seven recrea-
tional runners (4 men and 3 women) completed all 3 trials.
Blood was collected at baseline (PRE) and immediately after
the run (POST). The running task induced significant (p #
0.05) increases in leukocyte (white blood cells), neutrophil,
and interleukin-6 (IL-6) counts in every trial. There was a signif-
icant (p # 0.05) increase in cortisol with PLA and low-
CHO1.5% but not with CHO7%. Increase in total leukocyte
and neutrophil concentration was significantly lower with
CHO7% compared with PLA (p # 0.05). Postexercise IL-6
levels were significantly elevated when compared with baseline
in all conditions (p # 0.05). Interleukin-6 (IL-6) concentrations
did not differ significantly between trials. LowCHO1.5% sport
drink did not significantly differ from PLA in measured variables,
which indicated that the amount and rate of carbohydrate
ingestion (15 g, 10 g$h21) in low-carbohydrate sport drink
was not enough to significantly protect from the stress induced
Address correspondence to Johanna K. Ihalainen, johanna.k.ihalainen@
jyu.fi.
28(10)/2786–2792
Journal of Strength and Conditioning Research
Ó 2014 National Strength and Conditioning Association
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2786 Journal of Strength and Conditioning Research
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AND
by high-intensity long-distance running, whereas the ingestion
of CHO7% (45 g$h21) blunted the significant cortisol
response and significantly decreased the leukocyte response.
KEY WORDS endurance exercise, sport drink, cortisol, white
blood cell count, IL-6
INTRODUCTION
M
ost competitors in half-marathon races are
recreational runners and are not familiar with
sport drinks and the effects of sport drinks on
immune system function. It has been sug-
gested that training with low muscle glycogen might improve
metabolic adaptations. These adaptations include greater
activation enzymes involved in carbohydrate metabolism
and adaptive responses that favor fat metabolism (6). Nev-
ertheless, strenuous exercise, such as long-distance running,
results in immunomodulatory responses (11). Exhaustive
endurance exercise typically induces cytokine response, hor-
monal changes, and increases in leukocyte concentrations
(3,16,20). Hormonal responses include increases in the
plasma concentration of stress hormones (corticosteroids,
catecholamines). Cortisol release has been suggested to be
related to an increased level of circulating interleukin 6 (IL-
6) (34). Attenuating the IL-6 and cortisol response has been
suggested to limit the exercise-induced depression of
immune function, which may provide an “open window”
for infections (12,13,19).
Of the various nutritional and pharmacological counter-
measures to exercise-induced changes in the immunological
state of subjects that have been evaluated thus far, ingestion
of carbohydrate beverages during intense and prolonged
exercise has emerged as the most effective (13,21). One
hypothesis is that carbohydrate supplementation increases
plasma glucose and decreases stress hormone release,
thereby reducing immune stress (28). Furthermore, an ath-
lete exercising in a carbohydrate-depleted state experiences
larger increases in circulating stress hormones and a greater

perturbation in several immune function indices. Conversely,
consuming 30–60 g of carbohydrate during sustained inten-
sive exercise attenuates increases in stress hormones and
appears to limit the degree of exercise-induced immune sup-
pression (14). Consumption of carbohydrate during exercise
has been shown to also reduce the increase in plasma
growth hormone and various cytokine concentrations
(21,23). In addition, carbohydrate intake during exercise de-
creases the trafficking of most leukocyte and lymphocyte
subsets, including an increase in the neutrophil/lymphocyte
ratio (2,28), prevents the exercise-induced decrease in neu-
trophil function (2), and reduces the extent of the diminution
of mitogen-stimulated T-lymphocyte proliferation (15) after
prolonged exercise. Walsh et al. stated that carbohydrate
ingestion during heavy endurance exercise has emerged to
be an effective but partial countermeasure to immune dys-
function, as the benefits have been observed to be favorable
regarding stress hormones and inflammation but not to
innate and adaptive immunity (2).
It has been suggested that a dose-response relationship
exists between the effects of carbohydrate ingestion on
physiological stress response. Scharhag et al. (34) did not
find a dose-dependent difference between a 6 and 12% car-
bohydrate sport drink on immunological perturbations. To
the best of our knowledge, the effects of “light” sport drinks
(with low-carbohydrate concentrations) on physiological
stress have not been studied. To minimize the possible neg-
ative effects of carbohydrate intake during training on train-
ing adaptations and to gain the protective effect of
carbohydrate supplementation, it was examined if a light
version of carbohydrate sport drink would be enough to
significantly affect immune perturbations. The purpose of
this study was to examine the effects of ingestion of fluids
with different carbohydrate concentrations (0, 1.5, and 7%)
on the acute immune stress responses after 3 standardized
20 km (men)/18 km (women) runs. It was hypothesized that
immune perturbations and physiological stress measured by
acute leukocyte response and increases in cortisol, C-reactive
protein (CRP), and IL-6 levels that occur during high-
intensity running would be significantly affected by the
consumption of normal (7%) concentration carbohydrate
supplementation that is typically found in sport drinks. It
was also hypothesized that a dose-response relationship
would be observed such that the light sports drink (1.5%
carbohydrate) would not be as effective in attenuating
immune perturbations as a “normal” sport drink (7% carbo-
hydrate). Nevertheless, it was expected that the light sports
drink would be more effective than a placebo (PLA) drink
(0% carbohydrate).
METHODS
Experimental Approach to the Problem
Previous studies have established that leukocytosis and
cortisol responses to high-intensity exercise are attenuated
by carbohydrate ingestion during exercise in a dose-
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dependent manner (36). The minimum amount of carbo-
hydrates in a sport drink that would have a significant
effect on leukocytosis, cortisol, and IL-6 response, how-
ever, has not been elucidated. Therefore, a light low-
carbohydrate sports drink was administered to determine
whether or not the immune response to a light sports drink
differs significantly from a PLA and a sports drink with
normal carbohydrate content. The purpose of this study
was to determine whether or not the postexercise response
in leukocyte count, cortisol, and IL-6 related to endurance
exercise would be altered in recreational athletes when
consuming a normal (CHO7%) or light (lowCHO1.5%)
sport drink vs. placebo drink (PLA, flavored water). The
dosages of carbohydrates were 70 g in the normal carbo-
hydrate drink (7%), 15 g in light or low-carbohydrate drink
(1.5%), and 0 g in PLA drink. A randomized double-blind
design was used to investigate the effect of high-intensity
running including these 3 different drinks on acute re-
sponses of leukocytes and their subpopulations (neutro-
phils, mixed cells, lymphocytes), serum cortisol, and
serum IL-6. All the trials were performed with similar
endurance loadings in terms of intensity and distance.
The duration between each loading was 7 days.
Subjects
Fourteen recreationally active healthy recreational adult
athletes (age: 20–25 years) were recruited to this study, but
only 7 of them were able to complete all 3 trials (4 men and
3 women; age: 22.4 6 1.5 years; height: 1.77 6 0.07 m;
body mass: 73.2 6 9.2 kg). The subjects were recruited
from the degree program of sports and leisure manage-
ment. All participants reported taking part in sport activi-
ties 3–5 times per week and running from 2 to 4 times
a week, but none were competitive athletes and none had
a background in systematic endurance training. Before par-
ticipation in the study, subjects were informed about the
study procedures and possible risks both verbally and in
written form before signing an informed consent. The
Ethics Committee of the University of Jyväskylä, Finland,
approved the study, and the study was conducted accord-
ing to the most recent declaration of Helsinki.
Procedures
All the measurements were conducted during November and
December of 2011. The preliminary measurements included
an information session with fasting blood samples. After a 10-
minute warm-up, the Conconi running test was performed
on a 200-m indoor track (temperature 188 C, humidity 65%).
The initial workload for all subjects was 2.5 m$s21, which
was increased by 0.1 m$s21 after each 200 m until exhaus-
tion. Maximal running speed and oxygen uptake (V_ O2max)
were determined from the test (7). A counterbalanced design
was used in which treatment order was randomly assigned to
subjects. All the trials were performed at the same time of the
day, between 10:00 and 12:00 AM to reduce the possible
effects that time of day may have on immune response.
VOLUME 28 | NUMBER 10 | OCTOBER 2014 | 2787
 Carbohydrate Ingestion in Endurance Running

uptake (12.0 6 0.7 km$h21).

Pacemaker lights (AR-Power
Oy, Jyväskylä, Finland) were
used to adjust the running
speed. Heart rate (HR) was re-
corded continuously during the
exercise using Polar 610i HR
monitors (Polar Electro Oy,
Kempele, Finland). Ratings of
perceived exertion (RPE) were
obtained at 15-minute intervals
using the Borg scale from 6 to
20. Subjects were given one of
the sport drinks (Northforce
Ltd., Kuusamo, Finland) or
PLA during the run: 200 ml just
Figure 1. White blood cell count before and immediately after PLA, CHO7% and lowCHO1.5%.*Significantly before the run and 200 ml after
different from pre-exercise value p # 0.05. #Significantly higher in PLA than in CHO7% p # 0.05. PLA = placebo; every 4 km for men and 3.5 km
CHO = carbohydrate supplementation; lowCHO = low-carbohydrate supplementation. for women during the trial. A
total of 1 L of drink was con-
sumed during the trial. The
The trials were separated by 7 days of rest or very light sport drinks were mixed according to the manufacturer’s
physical activity. To control the experimental conditions, sub- directions. For PLA, flavored water was used.
jects were asked to minimize possible stressors during the day Blood samples were collected from an antecubital vein into
before the loading measurements. Furthermore, subjects were EDTA tubes (Terumo Medical Co., Leuven, Belgium) and
asked to have at least 8 hours of sleep and to keep their serum tubes (Venosafe, Terumo Medical Co.). The samples
nutritional intake similar between the trials. The breakfast were obtained at rest (pre) and immediately after the cessation
before the loadings was controlled before all trials. The load- of the run (post). The whole blood samples were analyzed
ing was continuous endurance running of 20 km for men and within 30 minutes. The total and differential white blood cells
18 for women on a 200-m indoor track in a controlled envi- (WBC), platelets and hemoglobin, and hematocrit were
ronment (temperature 188 C, humidity 65%). The individual determined with Sysmex KX-21N (TOA Medical Electronics
speed for each subject was 75% of their maximal oxygen Co., Ltd., Kobe, Japan). Of the WBCs, neutrophils, lympho-
cytes, and mixed cells (mono-
cytes, eosinophils, basophils,
and immature precursor cells)
were analyzed. Intra-assay coef-
ficient of variation (CV%) for
leukocytes was 2.2% and for
hemoglobin and hematocrit
1.5 and 2.0%, respectively. The
serum tube samples were
centrifuged for 10 minutes at
+48 C with 3,500 rpm (Mega-
fuge 1.0 R, Heraeus, Germany).
Serum was kept at 2808 C until
analyzed for serum cortisol,
high-sensitivity CRP (hsCRP),
and IL-6 using the immuno-
metric chemiluminence method
with Immulite R 1000 (DPC,
Los Angeles, CA, USA). The
detection limit for cortisol was
Figure 2. Neutrophil count before and immediately after PLA, CHO7%, and lowCHO1.5% trials. *Significantly
different from pre-exercise value p # 0.05. #Significantly higher in PLA than in CHO7% p # 0.05. PLA = placebo; 5.5 nmol$L21 and interassay
CHO = carbohydrate supplementation; lowCHO = low-carbohydrate supplementation. CV% 7.9% and 0.2 pg$ml21
and 3.4% for IL-6, respectively.
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2788 Journal of Strength and Conditioning Research

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reliability was tested for inde-

pendent variables with intraclass
correlation coefficient (ICC).
Differences between the trials
in dependent variables were
tested using 3 (treatment: PLA,
CHO7%, lowCHO1.5%) 3 2
(time of measurements: pre,
post) repeated analysis of vari-
ance within-subject design. As
a post hoc, Bonferroni was used.
Statistical analysis was con-
ducted with IBM SPSS 19.0
(SPSS Inc., Chicago, IL, USA).
The level of statistical signifi-
cance was set at p # 0.05.

RESULTS
Performance Variables
Figure 3. Serum cortisol levels before and immediately after PLA, CHO7%, and lowCHO1.5% trials. No significant changes were
*Significantly different from pre-exercise value p # 0.05. PLA = placebo; CHO = carbohydrate supplementation;
lowCHO = low-carbohydrate supplementation.
found in any performance var-
iables between the trials. The
durations of the test runs were
The pre- to postexercise plasma volume changes were not 99 6 3 minutes during PLA, 98 6 5 minutes during
significant (PLA 0.3%, CHO7% 0.3%, and lowCHO1.521.0%) CHO7%, and 98 6 5 minutes during lowCHO1.5%.
therefore, the data presented are not corrected for plasma The average HRs recorded during the runs were 173 6
volume changes. 11, 177 6 10, and 174 6 9 b$min21 during PLA,
CHO7%, and lowCHO1.5%, respectively. The average
Statistical Analyses RPE was 13 6 1 in every trial. The ICC values for dura-
Conventional statistical methods were used for the calculation tion of test, HR responses and RPE were not different
of mean values and SDs. Before applying further statistical across the trials with ICC values of R = 0.78, 0.92, and
methods, the data were checked for normality. The test-retest 0.81, respectively.
Leukocyte and Leukocyte
Subpopulation Count
Leukocytes and neutrophils
significantly increased in all
trials immediately after exer-
cise (p , 0.01), and the con-
centrations were significantly
higher in PLA than in
CHO7% (p = 0.036) but not
in lowCHO1.5% (Figures 1
and 2). No significant differen-
ces in leukocyte and neutrophil
counts were observed between
CHO7% and lowCHO1.5%.
The increase in mixed size cell
count was significant in PLA
(p = 0.043) and in CHO7%
(p = 0.047) but not in low-
CHO1.5% (p = 0.115). No sig-
Figure 4. Serum IL-6 levels before and immediately after PLA, CHO7%, and lowCHO1.5%. *Significantly
different from pre-exercise value p # 0.05. IL = interleukin; PLA = placebo; CHO = carbohydrate nificant changes were found in
supplementation; lowCHO = low-carbohydrate supplementation. the amount of lymphocytes
after any trial.

VOLUME 28 | NUMBER 10 | OCTOBER 2014 | 2789

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 Carbohydrate Ingestion in Endurance Running
Cortisol, C-reactive protein, and Interleukin-6
Serum cortisol concentration increased significantly in PLA
(p = 0.020) and in lowCHO1.5% (p = 0.027), but not in
CHO7% (p = 0.128) (Figure 3). The changes between trials
did not differ significantly as absolute values (PLA-low-
CHO1.5%, p = 0.735; PLA-CHO7.0%, p = 0.063; low-
CHO1.5-CHO7.0%, p = 0.091). When the relative changes
were analyzed, increases were lower during CHO7% than
during PLA (p = 0.028).
There was a significant difference in the pre-exercise
hsCRP between PLA and lowCHO1.5% (p = 0.028). The
postexercise hsCRP values did not significantly differ from
pre-exercise values in any trial. Serum IL-6 levels are shown
in Figure 4. Postexercise IL-6 was significantly elevated
when compared with the baseline in all conditions (PLA:
p = 0.043; CHO7%: p = 0.038; lowCHO1.5%: p = 0.038).
The IL-6 concentrations did not differ significantly between
the trials.
DISCUSSION
The main results of this study were that a typical carbohy-
drate sport drink (7% of carbohydrates, total amount of
carbohydrate 70 g) was able to suppress the acute increase in
WBCs and blunt the significant increase of cortisol after
long-distance high-intensity running. Whereas, the same
significant effect on leukocyte and cortisol response was not
observed with the light sport drink, that contained only
a low-amount concentration of carbohydrates (1.5% of
carbohydrates, total amount of CHO 15 g). Interestingly,
significant differences in IL-6 response between trials were
not observed.
No significant differences were observed between loadings
in performance variables. Consequently, we were able to
compare the effects of sport drinks on changes in leukocyte
count, as it is known that exercise intensity and duration are
important factors in determining the effects of exercise on
immunological state (38). Intraclass correlations were 0.78–
0.92, and there were no significant differences in pre-exercise
blood values, in exercising HR, or in RPE between trials.
High-intensity endurance exercise initiates an acute immune
response, observed immediately after exercise, as an increase
in leukocytes and acute phase proteins (29). The effects of
exercise on immunological state are thought to be largely
mediated by the actions of elevated concentrations of circu-
lating stress hormones (e.g., adrenaline and cortisol) and
altered regulatory cytokines (17).
The effect of carbohydrate on the immune response to
prolonged exercise can be attributed to an attenuation of the
cortisol response to exercise because of the maintenance of
plasma glucose levels. Cortisol has been shown to affect
almost all of the components of the immune and inflamma-
tory responses in humans (8). Pedersen and Hoffman-Goetz
(28) hypothesized that cortisol has a role in maintaining the
neutrophilia and lymphopenia after prolonged intense
exercise, such as a marathon. Glucocorticoids suppress
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2790 Journal of Strength and Conditioning Research
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inflammation and affect immune-cell development, traffick-
ing, and functions through the interacting with specific ste-
roid hormone receptors, GRs (38). Previous study by Fragala
et al. (10) has suggested a possible interaction between cor-
tisol, GR, and leukocytes, especially B lymphocytes. In
a study by Mitchell et al. (21), cortisol levels were signifi-
cantly greater after exercise with low-carbohydrate nutrition
than exercising with high-carbohydrate nutrition. Similar re-
sults were demonstrated by Green et al. (15) who showed
that cortisol concentrations were significantly lower imme-
diately after 2 hours of high-intensity cycling exercise and
during recovery in the carbohydrate trial (average of 240 g
CHO, 120 g$h21) compared with a PLA trial. In this study,
cortisol concentrations significantly increased in PLA and
lowCHO1.5% but not in CHO7%. In this study, ingestion
of 70 g of carbohydrate during the approximately 90-minute
run (45 g$h21) blunted significant increases in cortisol. In
contrast, the lowCHO1.5% sport drink with 15 g of carbo-
hydrate (10 g$h21) did not contain enough carbohydrate to
suppress the cortisol response.
The finding of increased levels of IL-6 after exercise in this
study is consistent with previous studies (6). It has been
demonstrated that IL-6 concentrations in the blood increase
during different bouts of exercise depending on type, dura-
tion, and intensity of exercise. Interleukin-6 has been re-
ported to increase exponentially during exercise and peak
at the end of the exercise (19,31). This study is in agreement
with Nehlsen-Cannarella et al. (23), in that a significant
increase in IL-6 concentration after running was observed
in all trials. In a previous study by Scharhag et al. (34), the
increase was 6-fold when 6% carbohydrate sport drink and
10-fold when PLA were consumed during 4 hours of cycling
at 70% of anaerobic threshold. In this study, the increase was
6-fold with lowCHO1.5%, 8-fold with CHO7%, and 10-fold
with PLA, but the differences between the loadings were
nonsignificant. According to Nieman (25) compared with
PLA, carbohydrate ingestion during a 3-hour treadmill run
attenuated plasma concentrations of IL-1ra, IL-6, and IL-10,
as well as muscle gene expression for IL-6 and IL-8. It was
also showed that anti-inflammatory indicators, such as cor-
tisol and IL-10, were decreased with carbohydrate feeding.
Furthermore, they suggested that carbohydrate feeding at-
tenuates the secondary (IL-6 and IL-8) but not the primary
(IL-1b and tumor necrosis factor alpha) proinflammatory
cascade thereby decreasing the need for immune responses
related to anti-inflammation. Controversially to Nieman
(25), significant differences between trials were not observed
even if there was a trend to a higher response when carbo-
hydrate intake was lower.
Leukocyte response was significant in all trials, and the
significant exercise-induced increase in leukocyte count was
largely because of an increase in neutrophil concentrations.
Increase in leukocyte count has been established to result
from increased cell traffic from the bone marrow to the
blood, demargination from the blood vessel walls (e.g., after

intense physical exercise), and a decreased adhesion to
tissues and the magnitude has been related to the intensity,
duration, and mode of exercise (13,27). Interestingly, the
leukocyte and neutrophil responses were significantly higher
in PLA than in CHO7%. As observed in this study, previous
studies have identified that carbohydrate ingestion is con-
nected with significant reductions in the degree of increase
in leukocyte count immediately after exercise (27). Signifi-
cant reduction in leukocyte response was not observed with
lowCHO1.5%, which might indicate that the concentration
of carbohydrates in lowCHO1.5% was not enough to sup-
press response. This might be due to a combination of re-
sponses, including lower level of blood glucose and slightly
higher stress hormones when lowCHO1.5% was consumed.
C-reactive protein is an inflammatory protein made by the
liver in response to increases in IL-6 and other inflammatory
mediators. An increase in the amount of CRP in the blood
might indicate that the IL-6 produced at the tissue level is
triggering an acute phase, systemic inflammatory response
(4). In this study, the average trend effect of running on
serum CRP was an increase in PLA and lowCHO1.5%
and a decrease in CHO7%; however, these changes were
not significant. Miles et al. (21) stated that the increase in
IL-6 in their study was not sufficient enough to induce a sys-
temic inflammatory response; thus, CRP did not increase in
either the carbohydrate or the PLA condition after the exer-
cise which might have been the case also in this study.
Although, IL-6 increased significantly in every trial, we did
not find significant changes in CRP. Follow-up samples
might have been needed to observe the possible increase.
This study confirmed the results from previous reports that
the ingestion of carbohydrate sport drink compared with PLA
is associated with smaller increase in the number of circulating
leukocytes. In addition, a significant increase in cortisol was
not observed when CHO7% sport drink was consumed.
There seems to be a trend of dose-dependent effect of
carbohydrate ingestion on immunological stress response. In
this study, the increase in leukocyte count when consuming
the light lowCHO1.5% sport drink did not significantly differ
from PLA, which indicated that the amount and rate of
carbohydrates (15 g, 10 g$h21) we used in the low-
carbohydrate sport drink is not enough to protect from
high-intensity long-distance running-induced stress. Whereas,
the ingestion of 70 g of CHO per liter in sport drink (7% CHO
fluid, 45 g$h21) significantly decreased the stress response. As
a conclusion, ingestion of more than 10 grams of carbohy-
drates an hour is recommended for recreational runners dur-
ing high-intensity long-distance running. Clearly, more
research is needed regarding the minimum dose of carbohy-
drate needed to attenuate an increase in stress hormones and
limit the degree of exercise-induced immune perturbations.
PRACTICAL APPLICATIONS
It has been suggested that training with low carbohydrate
availability (e.g., without carbohydrate feeding during exercise)
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could increase the adaptive responses to exercise (5). By
“training low” to maximize metabolic adaptations (e.g., con-
suming only water or light version of sport drink during long
high-intensity exercise), one might be compromising ones
immune system function, which might lead to an increased
risk for infections. At the same time, carbohydrates reduce
immunological stress related to high-intensity long-distance
running. Since immune perturbation might lead to, e.g., sus-
ceptibility to infections, it is recommended that recreational
runners use sport drinks containing an adequate amount of
carbohydrates during high-intensity long-distance running
and especially during competitions, e.g., half marathon.
The present findings indicate that carbohydrate sport drinks
should be preferred during high-intensity long-distance run-
ning over water and the rate of carbohydrate consumption
should be 45 g in an hour.
ACKNOWLEDGMENTS
This study project was funded by the University of Jyväskylä,
Department of Biology of Physical Activity and Ellen and
Artturi Nyyssönen Foundation. The authors declare that
they have no competing interests. The authors would like
to thank research assistants Joonas Prami, Marko Siltamies,
Ville Aaltonen, and Ismo Huotari for their help in data col-
lection and Simon Walker for his valuable suggestions and
assistance in the English language corrections. Results of this
study do not constitute endorsement of the product by the
authors or the National Strength and Conditioning Associ-
ation. None of the authors declare any conflict of interest.
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