Chapter Two

2. Carbohydrate (CHO)
CHO is the most important fuel for high intensity muscular work. CHO makes up part of the
energy reserves in our body and CHO metabolism is influenced by exercise.
2.1 Importance of carbohydrates
Carbohydrates are the macronutrient that we need in the largest amounts. 60-65% of daily energy
consumption should come for CHO. We need this amount of carbohydrate because:
 Carbohydrates are the body’s main source of fuel.
 Carbohydrates are easily used by the body for energy.
 All of the tissues and cells in our body can use glucose for energy.
 Carbohydrates are needed for the central nervous system, the kidneys, the brain, the muscles
(including the heart) to function properly.
 Carbohydrates can be stored in the muscles and liver and later used for energy.
 Carbohydrates are important in intestinal health and waste elimination.
Carbohydrates are mainly found in starchy foods (like grain and potatoes), fruits, milk, and yogurt.
Other foods like vegetables, beans, nuts, seeds and cottage cheese contain carbohydrates, but in lesser
amounts.
Although carbohydrates are commonly grouped into sugars and starches, that these compounds can be
chemically classified into monosaccharide, disaccharides, and polysaccharides, based on the
number of sugar units in the molecule.
a. Monosaccharide
Monosaccharide is the basic building block of all carbohydrates, and glucose the most abundant of
these sugars. During the process of digestion, many carbohydrates are broken down or converted into
glucose, which is then transported by the blood to all the cells in the body. Within cells, the process of
cellular respiration metabolizes glucose to produce the energy necessary to sustain life. Other common
monosaccharide’s are fructose and galactose, which have the same chemical makeup as glucose,
6H12O6, differing only in the arrangement of the atoms within the molecules. In the body, most fructose
and galactose are converted into glucose and metabolized as such. An inexpensive sweetener for many
types of processed foods is high-fructose corn syrup, often preferred because fructose is sweeter
tasting than table sugar. Fructose is commonly found in many fruits, unlike galactose, which does not
normally occur free in nature.

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 B. Disaccharides
Disaccharides are composed of two monosaccharides chemically joined together. The most common
disaccharide is sucrose, or table sugar, formed from a molecule of glucose and a molecule of fructose.
Other disaccharides are the milk sugar lactose (a combination of glucose and galactose) and maltose
(formed by two glucose molecules), which is largely found in germinating grains. Table sugar, which
primarily comes from sugarcane and sugar beet, is at least 97% pure sucrose with little nutritional
value, thereby supplying only calories. During digestion, these disaccharides are broken down to yield
their component monosaccharides.
C. Polysaccharides
Polysaccharides, also known as complex carbohydrates, contain hundreds to thousands of individual
sugar units, and for the most part, glucose is the only monosaccharide present. The different
polysaccharides are distinguished by the way in which the glucose units are joined together, their
arrangement, and their number. Starch is the storage form of glucose found in plants; it occurs
abundantly in seeds, some fruits, tubers, and taproots. The presence of starch in foods can be traced
directly to its plant origin; the starch in white bread or pasta was originally stored in the grain of a
wheat plant. The major grain crops (wheat, rice, and corn), the major underground crops (potato,
sweet potato, and cassava), and the major legumes (beans and peas) supply the majority of starch in
the human diet. In the body, starch is broken down into glucose by enzymes in saliva and the small
intestine and is transported by the bloodstream to body cells.
Glycogen is the body’s storage form of glucose, found in the liver and skeletal muscles. When the
levels of glucose in the blood are higher than the demands of the cells, the excess is used for the
synthesis of glycogen in liver and muscle cells. Only a limited amount of glycogen can be stored as a
reserve—no more than a day’s worth of energy needs. Excess glucose beyond this amount is generally
converted to fat. During strenuous exercise, the body’s glycogen reserves are called upon; therefore,
athletes training for a competition practice a regime of carbohydrate loading by eating lots of starchy
foods to build up muscle glycogen reserves.
Fiber in the Diet
Another important dietary component is fiber, which is derived from plant sources. Fiber refers to
certain types of carbohydrates that our body cannot digest. Although not digestible, it does provide
bulk and other benefits. Humans do not have the enzymatic ability to break the bonds connecting the
glucose molecules in cellulose as they do for starch and glycogen, and thus cellulose passes through

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the digestive tract as roughage, largely unaltered.
These carbohydrates pass through the intestinal tract intact and help to move waste out of the body.
Diets that are low in fiber have been shown to cause problems such as constipation and hemorrhoids
and to increase the risk for certain types of cancers such as colon cancer. Diets high in fiber; however,
have been shown to decrease risks for heart disease, obesity, and they help lower cholesterol. Foods
high in fiber include fruits, vegetables, and whole grain products.
Gluconeogenesis
Gluconeogenesis refers to the process of making glucose from non-carbohydrate substances. Blood
glucose is critical for central nervous system function, aids in the metabolism of fat, and supplies fuel
to working cells. However, because of its limited storage capacity, a minimum level of glucose is
always available through the manufacture of glucose from non-carbohydrate substances. There are
three primary systems for gluconeogenesis:
1. Triglycerides are the predominant storage form of fat in the human body and consist of three fatty
acids attached to a glycerol molecule. The breakdown of triglycerides results in free glycerol (a three-
carbon substance), and the combination of two glycerol molecules in the liver results in the production
of one glucose molecule (a six-carbon substance). Glycerol is the only simple lipid (fat) in human
nutrition that can ultimately be metabolized like a carbohydrate.
2. Catabolized muscle protein results in an array of free amino acids that were the building blocks of
the muscle. Several amino acids are glucogenic (i.e., capable of creating glucose) and can be
converted by the liver to form glucose. After only 40 minutes of strenuous activity, free alanine (a
glucogenic amino acid) can increase by 60 to 96 percent, even more if work occurs under conditions
of low blood sugar. This strongly suggests that muscle breakdown can occur quickly if an athlete
allows blood sugar to drop during physical activity.
3. In anaerobic glycolysis, lactate is produced and removed by the cell as a means of maintaining
cellular pH. This lactate can be converted back to pyruvic acid for the aerobic production of ATP, or
two lactate molecules can combine in the liver to form glucose. The conversion of lactate to glucose is
referred to as the Cori cycle (lactate removed from the muscle and glucose returned to the muscle).
Lactate (often used synonymously with lactic acid) should not be thought of as a bad, because it helps
to preserve cellular function and can be used as fuel.

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2.2 Carbohydrate Reserves
In the body CHO is stored as long chains of glucose units, called glycogen, in the liver and in the
muscles. This form of storage is in principle comparable to that of starch present in potatoes,
banana and other plant foods.
2.3 Liver Glycogen and Influence of Exercise
The amount of glycogen stored in the liver amounts to approximately 100g. This quantity may
change periodically depending o the amount of glycogen that is broken down for the supply of
blood glucose in periods of fasting and the amount of glucose that is supplied to the liver after
food intake. Accordingly, liver glycogen reserves increase after meals but diminish in
between, especially during the night, when the liver constantly delivers glucose into the blood
stream to maintain a normal blood glucose level. A constant blood glucose level, within a narrow
physiological range, is important because blood glucose is the primary energy source for the
nervous system.
Influence of Exercise
During physical exercise a number of metabolic and hormonal stimuli will lead to an increased
uptake of blood glucose by the working muscles to serve as a fuel for muscular contractions. To
avoid the blood glucose level falling below the normal physiological value, the liver will at the
same time be stimulated to supply glucose to the bloodstream .This supply is mainly derived
from the liver glycogen pool and to a small degree from the process of gluconeogenesis (de novo
glucose synthesis) by t h e l i v e r cells f r o m precursors such as lactate, glycerol, and
glycogenic amino acids. Thus, appropriate glycogen availability in the liver is a key factor for
maintenance of a normal blood glucose level during prolonged exercise. As soon as the liver
glycogen store is emptied and exercise is executed without concomitant food intake, the liver may
become glycogen depleted. Since the blood glucose utilization and uptake during exercise by
active muscles remains high, blood glucose may than fall to hypoglycemic levels. Glucose uptake
by the muscles from blood will drop to marginal levels and the working muscles will then totally
depend on the local CHO supply from remaining muscle glycogen. Depending on the rate at which
hypoglycemia develops, this may or may not impair performance capacity. Central as well as
local fatigue may then occur.
A condition of hypoglycemia during exercise will gradually induce the maximal use of
alternative fuels such as fat and protein and therefore stimulate fat mobilization, protein break

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down and the use of fatty acids and amino acids. The best way to circumvent the consequences of
a developing CHO shortage during exercise is to maintain an appropriate CHO supply to the
blood by means of oral intake.
2.4 Muscle Glycogen and Influence of Exercise
The amount of glycogen that is stored in total muscle in the body amounts to approximately 300g
in sedentary people and may be increased to>500g in trained individuals by a combination of
exercise and the consumption of a CHO rich diet. The total intramuscular stored CHO may thus
rangeinenergeticequivalentfrom1200to2000kcal.
Influence of Exercise
The rate at which muscle glycogen is mobilized for the production of energy needed for muscle
contraction depends on the training status of the athlete as well as on the duration and intensity
of the exercise. Very small pool of energy rich phosphates (adenosine triphosphate and creatine
phosphate), which is immediately available for muscle contractions at any moment of suddenly
increased energy need, may deliver energy for a period of up to maximally10-15s. For any
longer lasting events, the energy requirements for muscle work will have to be covered by the
mobilization and subsequent metabolism of substrates from the CHO and fat pools in muscle,
liver and adipose tissue. The use of any of these pools will never be exclusive. Thus, at any time
muscle will use a mixture of CHO, fat and (to a very small degree) protein and amino acids
for energy production.
However, depending on exercise intensity and duration, one of the fuels may become the major
energy deliverant. For example, at rest practically all the energy needed for the resting
metabolism is derived from fat, with the exception of the central nervous system and the red
blood cells, which rely primarily on blood glucose. In this situation the possible energy supply
ratio may be in the order of 90% from fat and about 10% from CHO. During a situation of
increased physical activity, i.e. light physical work, or a moderately intensive sports activity, the
body will use metabolic, hormonal and nervous control mechanisms to mobilize glucose from
glycogen pools to serve as a rapid energy deliverant. Synchronously the mobilization of fatty
acids will be stimulated. After about 20-30min anew metabolic steady state will be achieved in
which the energy supply ratio of fat to CHO may be about 50%:50%.Thus, a gradual shift from
high fat to low CHO utilization at rest to enhanced CHO utilization during physical activity has
taken place.

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At even higher work intensities the body will start to use more and more CHO as fuel.
Accordingly, during strenuous sports activity, such as middle distance running, 1000 m speed
skating and other events lasting 1-3min, CHO will become the most important fuel. The ratio of fat
to CHO may then be10%:90%.The reason for this shift to the dominant use of CHO is that the
maximal amount of energy that can be produced from CHO, per unit of time, is higher than that of
fat. In addition, the amount of oxygen required for energy production from CHO is about 10%
lower than that of fat. Besides these energetic advantages the process of substrate mobilization,
substrate transport to and uptake by muscle cells also plays a role. This process is relatively fast in
the case of CHO and slow with fat. Thus, it turns out that the muscle shifts to the most economic a
land rapidly available energy source in periods of suddenly increased energy requirements.
Such a fine-tuned regulation of energy rich substrate selection enables athletes to work at a
higher intensity when using CHO as the main energy source.
Intense and lasting muscle work cannot be performed without appropriate availability of CHO.
As soon as specific muscles or muscle fibers become glycogen depleted they will be impaired in
their ability to perform repeated high intensity contractions. Glycogen depletion, either by
exercise or by a combination of exercise and low CHO intake, leads to a reduction in work
capacity of about 50%ofthenormalmaximal working capacity. Alternatively, when the CHO
stores in muscle and liver are increased by diet manipulation, athletes are able to perform longer
at high exercise intensity. These examples show that the availability of CHO and the size of the
glycogen stores are important and limiting factors for endurance performance.
Moreover, CHO is also the prime energy source for the central nervous system and for the red
bloodcells.CHO is also required for the deliverance of pyruvate to the citric acid cycle
(Krebscycle).The oxidation of fatty acids (and also amino acids) in the citric acid cycle would be
compromised if there was a lack of the required intermediate compounds. In these
circumstances the body will start to produce glucose from other substrates(a process called
gluconeogenesis)in conditions that lead to a lack in circulating blood glucose.
2.5 Time Course of Glycogen Depletion
Four important factors determine the speed a n d the extent to which CHO stores will be emptied.
1. Exercise intensity.
2. Exercise duration.
3. Training status.

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4. CHO ingestion.
Exercise Intensity and Duration
The use of glycogen depends primarily on exercise intensity and duration At low to moderate
intensities, fat will also serve as a substantial energy source, while CHO reserves will be utilized
slowly, for example in a cycling event lasting 4h, during which exercise intensity
approximates55% 60%ofVO2 max. Also, the relative contribution of fat production will be less
during shorter events with a higher intensity, such as a run of1.5h at 65%VO2max. A maximal
contribution of CHO and relatively low contribution of fat will be present in events that require
a maximal exercise capacity, for example, during highly intensive training sessions such as interval
and tempo training bouts. Oxygen uptake increases with increasing exercise intensity until a
maximum is achieved. The exercise intensity at this point is determined as 100% VO2.)
Training Status
The time course of glycogen depletion will also be influenced by the training status of the individual.
Compared to less well trained individuals, highly trained individuals have an enhanced capacity to
mobilize fatty acids from the fat depot, transport these to muscle and use them as an energy
source. Thus, when working at the same absolute exercise intensity (e.g. running at a speed of 15
km/h), trained individuals will use less CHO and more fat for muscle contractions. Under competition
circumstances, however, this may not necessarily be the case as any individual then will
work at his or her individual maximal capacity. For example, the trained runner will run at a
speed of 20km/h while the less trainedrunnerrunsataspeedof15km/h.
2.6 Carbohydrate Ingestion during Exercise
The rate of utilization of glucose from stored glycogen in the body can be reduced by supplying
oral CHO. For example, when food containing CHO is ingested, digested and absorbed, the
digested CHO will enter the circulation as the constituent monosaccharide’s, mainly glucose
and fructose. Accordingly, blood glucose rises after oral CHO intake. This rise reduces the need to
breakdown liver glycogen for the maintenance of an appropriate blood glucose level.
Additionally ,glucose supply to and glucose uptake by the muscle will be elevated. Indeed, a
large body of scientific evidence shows that oral CHO intake reduces liver glucose output but
increases blood glucose at a similar rate. The increased blood glucose after CHO intake will
stimulate insulin release and with it glucose uptake by the muscle as well as subsequent CHO
oxidation.

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Theoretically these events will reduce the rate of muscle glycogen and protein degradation for
energy production and delay the onset of fatigue and improve performance. For exercise lasting
longer than 45min it is recommended that at least 20g,but optimally up to60g,beconsumed,with
sufficient fluid, during every following hour of exercise. Such amounts have been shown not to
delay gastric emptying to a physiologically important degree and to stimulate water absorption
in the intestine. This aspect is of particular importance in endurance events in the heat, where
both CHO and fluid availability may be performance limiting factors. The CHO sources used
should be rapidly digestible and absorbable. Most efficient are (soluble) CHO sources which can
be ingested with fluid. The gastric emptying rate should be relatively fast and the physical form
of the CHO should allow rapid digestion and enzymatic hydrolysis. This is not the case with all
CHO sources. For example, the dietary fiber in which some CHO sources are packed may form a
physical barrier to digestive enzymes and may also reduce gastric emptying rate.
2.7 Carbohydrate Intake at Rest

After exercise the endogenous CHO pools should be replenished. Depending on the time
available for total recovery, i.e .the time elapsing between finishing exercise and the next sport
activity, there may or may not be a need for speeding up recovery. Glycogen synthesis has been
shown to be most rapid during the first few hours after exercise. Thereafter, the synthesis rate
will gradually decline. Glycogen synthesis itself is only possible if the required building
substances, i.e. glucose molecules, are supplied.Net glycogen synthesis rate, therefore,
depends on the rate of up regulating synthesis and the quantitative glucose supply. The latter
depends largely on the type of food ingested, i.e. the rate of digestion and absorption. The CHO
source itself may also be important. Glucose favors muscle glycogen recovery, where as fructose
is primarily taken up by the liver, thus favoring liver glycogen recovery. When the next activity
takes place after one or two days, the athlete can recover properly by ingesting normal meals with
a high CHO content, i.e. 55-65. these meals can best be composed of low glycemic index foods
s u c h a s whole grains, cereals, pulses, fruits, v e g e t a b l e s , etc. Are relatively slow digestion
and absorption rate is favorable in this condition. Under the second 400-600 g of CHO per day
should b sufficient to recover glycogen stores from eating daily energy requirements of up
to4000kcal.
However, if daily energy expenditure is very high, such as during multi- day cycling
competitions, and exercise intensity is high, the CHO need may reach >12g/kg body weight per

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day. In this condition, CHO intake by normal meals composed of low glycemic index CHO sources
may result in too much gastro intestinal bulk and may cause gastrointestinal distress. Therefore,
athletes who ingest only normal meals in such circumstances will not be able to ingest enough
food, which will result in a negative energy balance and an insufficient CHO intake to compensate
for the glycogen used during the exercise. This will lead to starting the next exercise day in a state
of incomplete recovery. Sports practice and also controlled experiments have shown that the
high needs for energy and CHO during days with an energy expenditure exceeding 4500kcal/day
can only be covered appropriately by the ingestion of CHO foods and solutions with a high
glycemic index.(Foods that lead to a slow increase in blood glucose have a low glycemic index,
while those that induce a rapid rise in blood glucose have a high glycemic index.) Additionally,
when the time for recovery is very limited, for example because a second training session or
competition will take place on the same day, the food intake in between the normal meals should
be composed of foods that are rapidly digested and absorbed ,i.e. Have a highg l y c e m i c index.
Processed, cooked and mashed potato, rice, noodles or corn starch belong to this category.CHO
solutions can be taken during exercise in any situation in which CHO intake through the
consumption of normal food cannot take place or is insufficient. This will help to enhance 6
glycogen recovery in the first few hours after exercise.

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