CYCLING PERFORMANCE TIPS

A Healthy Lifestyle with an Emphasis on Dietary Factors

I recently attended an interesting conference on the effects of diet on cardiovascular risk facotrs. I was impressed with both the benefits of diet on vascular disease risk factors as well as the data that demonstrated diet to be even more effective than many "high powered" prescription medications in reversing the metabolic changes of abnormal glucose and lipid metabolism. I thought it would be fun to summarize a few of the ideas and then to speculate on what lifestyle changes one might easily make to keep themselves healthy. But before we go further, I want to stress again that this is about a baseline healthy lifestyle - and all evidence continues to point towards carbohydrates alone as the underpinning for the energy needs of the cyclist on their bike.

Abnormal lipids, probably as a result of abnormal glucose metabolism (insulin resistance or pre diabetes) are a significant factor in the development of cardiovascular disease. There are proven dietary and life style strategies that are proven to help pts with severe vascular disease (prior MI, stroke, etc.), so it would seem safe to speculate that the same strategies would be beneficial for everyone (but especially if they had undiagnosed insulin resistance). The current presumption is that this "prediabetic" condition can be present for years before full fledged diabetes with an elevated blood sugar is diagnosed - and the entire time blood vessel damage is ongoing.

Here is another way to look at this. There are multiple risk factors:

• Aging
• Obesity
• Genetics
• Sedentary lifestyle

• Dyslipidemia (decreased HDL, increased LDL and triglycerides)
• Hypertension
• Atherosclerosis

In reviewing the literature, it is extremely common to note that certain dietary changes improve both the risk of DM and risk of heart disease in the same direction and by the same relative amount. Again, strong suggestive evidence that it is insulin resistance that is the common factor for both development of overt diabetes mellitus and cardiovascular disease. In fact, I heard one lecturere say that if one followed all the dietary and life style recommendations that follow, the chances of developing diabetes type 2 were almost nil.

The dyslipidemia CV risk factors include

• an increase in the LDL (or bad cholesterol) levels
• a decrease in HDL - HDL functions to clear cholesterol from the periphery and transport it back to the liver. (a 1 mg/100ml increase in HDL = 2-4% lower risk of a cardiac event)
• and an increase in triglycerides.

Many of these dietary recommendations are elements of the Mediterranean diet (actually Cretan diet as that island is the locale where it is eaten most consistently). The Med Diet stresses increasing the intake of fruits, vegetables, whole grains, olive oil, omega 3 fatty acids, nuts, beans/legumes, and minimizing saturated and trans fats.

Does the Mediterranean Diet work? The EPIC study (NEJM 2003:348:2599-608) followed 22, 0423 people over 44 months. Adherence to a Med Diet was rated on a scale of 0 to 9. For each 2 point improvement in adherence, there were 33% fewer deaths from heart disease and 24% less from cancer.

Why do we think a Mediterranean diet is so effective in decreasing cardiovascular and cancer risk factors?

• The increase in omega 3 fatty acids Circulation 2002:105:1874-5
• Its anti-inflammatory effect (lower CRP) JAMA 2004:292:1440-1446
• By improving endothelial function JAMA 2004:292:1440-46
• By minimizing insulin resistance and lowering the serum insulin levels, it reverses early metabolic syndrome JAMA 2004:292:1440-46

• Mediterranean Diet Cookbook (Harmon-Jenkins)
• Whole food weight loss eating plan from Texas Tech

• Avoid rapidly absorbed carbohydrates
  • These are foods with a high glycemic index and include sweets, potatoes, white flour, white rice, and potatoes
• Fiber
  • Will lower LDL levels
  • Eggplant 200 gm every other day or okra 100gm every other day (viscous fiber)
  • Psyllium fiber 10gm day = 7% lower LDL (Am Jr Clin Nut 2000:71:472-9
  • Oat Bran 4 - 8 Tablespoons/day 10-26% decrease in LDL (JACN 1998:17:601-608)
• Whole grain diet
  • The coarser the better. Pumpernickel rye is good!
  • Sterols and stanols - present in whole foods
    • 2 gm/day will lower LDL by 10%
  • essentially absent in most breads, bagels, pastries, pasta. If it doesn't say 100% whole grain, it probably isn't.
  • 1 serving of whole grains per day decrease cardiac death rate by 30% AJCN 1998:68:218-19, 248-57
  • demonstrated decrease in the risk of DM on a whole grain diet Diabetes Care 1997:545-550
• Smoking - not good for anything
• Alcohol
  • From 3 alcoholic drinks per week up to 2 drinks per day provide a 20-50% cardiac risk reduction. JAMA 2001:285:2004-2005
  • 5 - 10 drinks per week have lowest risk of developing DM Diabetes Care 2000:26:18-22 (type of alcohol didn't matter in this study)
  • Resveratrol which is in red wine has a CV protective effect.
    • More in Cabernet Savignon than in Pinot Noir
    • Also present in cranberry juice - a glass a day will increase your HDL levels
• Fuits and vegetables
  • increase fruits and vegetables - 5 to 9 servings a day
  • fruit juices generally bad because of free sugar.
• Fats - the focus should be on replacing satuated fats and trans fats with unsaturated fats (read more about fats).
  • Mono unsaturated (olive oil and nuts) are the best. Will improve the lipid profile with lower LDL and lower TG. JAMA 1994:271:1421-8, Am J Clin Nut 1998:67:577S, Diabetes Care 1999:22:889
  • extra virgin olive oil or canola oil are good fats
    • 40 gm of olive oil per day led to a 48% decrease in daily antihypertensive med dose Ann Int Med 2000:160:837-42
  • oil from nuts 5 oz/wk 35% decrease in IHD risk BMJ 1998:317:1341-345
  • Trans fats - partially hydrogenated vegetable oils used in many baked foods and margarines. 2-10 x worse than saturated fats for IHD risk. Increases risk of DM by 40%
  • more fish (omega 3 fats) light tuna in water, wild salmon, herring, sardines, mackerel and less preserved meats
    • 30 grams of fish per day = 50% reduction in cardiac mortality NEJM 1985:312:1205-9
    • 5 times per week = 31% less heart disease in diabetic pts Circulation 2003:107:1852-57
  • Volunteers fed a 60% CHO, 25% fat diet versus 40% CHO, 45% fat with Calories equal had lower HDLs without a change in LDL questioning the idea of substituting CHO for fat to lower risk. Am J Cardiol 2000:85:45-48
  • When used in a diet, a 33% fat diet was more effective in achieving weight loss than a 20% diet. Int J Obesity 2001:25:1503-1511
• Nuts - preferred are raw almonds, pecans, hazelnuts, Brazil nuts.
  • Less DM, even peanut butter 5z/week JAMA 2002:288:2554-60
  • Almonds improve metabolic syndrome versus pasta 84g/day Int J Obesity 2003:27:1365-72
  • Raw almonds 2 handfuls (73 gm) LDL down 9% (Circulation 2002:106:1327-32)
• Cheese - aged cheeses are better than processed cheese.
• Beans - 4x/wk = 19% lower Ischemic Heart Disease (IHD) risk
• Coffee >6 cups per day had 30-50% decrease in risk of DM
  • Catechins 50 mg/day = 25% decrease in CHD mortality
    • Black tea also contains catechins
    • 5 cups of coffee per day lowered LDL 7.5 - 11.5% (Davies Jr Nut 2003:133:3298S-3302S)
    • 1 -2 cups of coffee per day loweed relative risk of heart disease and stroke J. Epid 1999:149:162-7)
    • Chocolate (also high in catechins)
      • Aim for >70% dark chocolate when you buy it
      • 20 gram per day
• Vitamins/minerals/supplements
  • Magnesium increases insulin sensitivity JAMA 2004:291:1056-57
    • In green vegetables, nuts, cereals, beans, chocolate
  • Higher Vit D = less insulin resistance 800 units per day JACN 2004:79:820-5
  • Niacin - a 5 to 25% reduction in LDL as well as increasing the HDL (one of the few things that will do so)
  • Garlic 1.8 gm/day lowered total cholesterol 9% (Ann Int Med 1993:119:599-605)
  • Cinnamon 1g/day with decrease in FBS of 18-29%, triglycerides 23-30%, LDL 7-27% Diabetes Care 2003:26:3215-18

There is evidence that carbohydrates eaten at night will form fat more easily than those eaten at noon (when you are still more active). It is reasonable to speculate that as you are using CHO for energy, they are selectively metabolized (over glycogen stores) in the afternoon, while at night instead of replacing glycogen stores, absorbed carbohydrates are converted into fat. Emphasize lean meat and vegetables at night - carbs in the morning or midday.

Life style Issues

• Regularly eating breakfast decreased risk of DM 37-55%
• Exercise
  • walk 30 min daily - LDL particles changed in size and become less atherogenic
  • exercise 1 hr 4x a week increases HDL 10%
  • Being fit is better than being thin JAMA 2004:292:1179-87
• Less than 6 hrs sleep per night = 1.6 to 2.5 risk ratio to get DM

1. Eat breakfast
2. Eat the bulk of your carbohydrates at breakfast and lunch
3. Take those vitamins with a glass of cranberry juice
4. Take a multivitamin daily - and be sure it has have 800 units of vitamin D; add in 1 gram of fish oil as a capsule and also magnesium supplements
5. Eliminate as much as reasonable all white flour, white rice, and potatoes - use brown rice and whole grain breads.
6. Eat a cooked whole grain cereal or steel rolled oats when possible for breakfast (cold cereals are not comparable, even granolas).
7. Use only low fat milk
8. Peanut butter on a piece of 100% whole grain toast is a quick breakfast
9. A couple of cups of coffee a day can be a good thing - even three or four
10. A snack during the day might be a handful of almonds (raw or at least not roasted in transfats)
11. 1 alcoholic drink a day - make it red wine if possible
12. Use olive oil whenever feasible (canola is second)
13. The more vegetables the better.
14. Sweets only for special occasions - grab the dark chocolate if you have it handy
15. Have fish as often as possible (see below)
16. Blue cheese and other aged cheeses are better than processed cheeses
17. Fat Calories are not necessarily bad - even if you want to loose weight - and may be better than an equivalent number of CHO calories

Reader's Questions

Q.You suggest eating fish as much as possible. I ate tuna 4 times a day until I heard about murcury. You should mention eating lower mercury fish more often (eg: sardines), and higher mercury fish less often (eg: tuna). - CR

A.You make a good point. This is particularly an issue for women who are prgnant or are considering becoming pregnant as mercury is a toxin on the developing fetal nervous system. The same may be true in young children. Less is known about the potentially harmful effects of mercury on men (or women who are not interested in having children) as an adult's nervous systems is felt to be much less sensitive to the effects of mercury.

There is a significant variation in the mercury content of fish, and even in tuna there are some forms which are safer than others from the perspective of mercury levels (light tuna is better than white tuna, for example). And perhaps the safest approach of all is to use fish oil capsules daily.