Gethin H. Evans

Postexercise rehydration in man: The effects of osmolality and carbohydrate content of ingested drinks

OBJECTIVE This study investigated the effect of the osmolality and carbohydrate content of drinks on their rehydration effectiveness after exercise-induced dehydration. METHODS Six healthy male volunteers were dehydrated by 1.9+/-0.1% of body mass by intermittent cycle ergometer exercise in the heat before ingesting one of three solutions with different carbohydrate contents and osmolalities over a period of 1h. Thirty minutes after the cessation of exercise, subjects drank a volume that amounted to 150% (130-150, median [range]) of their body mass loss. Drinks contained 25 mmol/L Na(+) and 0%, 2%, or 10% glucose with osmolalities of (mean+/-SD) 79+/-4, 193+/-5, and 667+/-12 mosm/kg, respectively. Blood and urine samples were collected before exercise, after exercise, and 0, 1, 2, 3, 4, and 6h after the end of the rehydration period. RESULTS Significantly more of the ingested fluid was retained in the 10% trial (46+/-9%) than in the 0% trial (27+/-13%), with 40+/-14% retained in the 2% trial. Subjects remained euhydrated for 1h longer in the 10% glucose trial than in the 2% glucose trial. In the 2% glucose trial, plasma volume was elevated immediately after and 1h after rehydration. CONCLUSION This study suggests that, following the rehydration protocol used, hypertonic glucose-sodium drinks may be more effective at restoring and maintaining hydration status after sweat loss than more dilute solutions when the sodium concentration is comparable.

Effect of milk protein addition to a carbohydrate-electrolyte rehydration solution ingested after exercise in the heat.

The present study examined the effects of milk protein on rehydration after exercise in the heat, via the comparison of energy- and electrolyte content-matched carbohydrate and carbohydrate-milk protein solutions. Eight male subjects lost 1·9 (SD 0·2) % of their body mass by intermittent exercise in the heat and rehydrated with 150% of their body mass loss with either a 65 g/l carbohydrate solution (trial C) or a 40 g/l carbohydrate, 25 g/l milk protein solution (trial CP). Urine samples were collected before and after exercise and for 4 h after rehydration. Total cumulative urine output after rehydration was greater for trial C (1212 (SD 310) ml) than for trial CP (931 (SD 254) ml) (P < 0·05), and total fluid retention over the study was greater after ingestion of drink CP (55 (SD 12) %) than that after ingestion of drink C (43 (SD 15) %) (P < 0·05). At the end of the study period, whole body net fluid balance (P < 0·05) was less negative for trial CP (-0·26 (SD 0·27) litres) than for trial C (-0·52 (SD 0·30) litres), and although net negative for both the trials, it was only significantly negative after ingestion of drink C (P < 0·05). The results of the present study suggest that when matched for energy density and fat content, as well as for Na and K concentration, and when ingested after exercise-induced dehydration, a carbohydrate-milk protein solution is better retained than a carbohydrate solution. These results suggest that gram-for-gram, milk protein is more effective at augmenting fluid retention than carbohydrate.

Postexercise rehydration in man: the effects of carbohydrate content and osmolality of drinks ingested ad libitum

The effectiveness of different carbohydrate solutions in restoring fluid balance in situations of voluntary fluid intake has not been examined previously. The effect of the carbohydrate content of drinks ingested after exercise was examined in 6 males and 3 females previously dehydrated by 1.99 +/- 0.07% of body mass via intermittent exercise in the heat. Beginning 30 min after the cessation of exercise, subjects drank ad libitum for a period of 120 min. Drinks contained 31 mmol.L-1 Na+ as NaCl and either 0%, 2%, or 10% glucose with mean +/- SD osmolalities of 74 +/- 1, 188 +/- 3, and 654 +/- 4 mosm.kg-1, respectively. Blood and urine samples were collected before and after exercise, midway through rehydration, and throughout a 5 h recovery period. Total fluid intake was not different among trials (0%: 2258 +/- 519 mL; 2%: 2539 +/- 436 mL; 10%: 2173 +/- 252 mL; p = 0.173). Urine output was also not different among trials (p = 0.160). No differences among trials were observed in net fluid balance or in the fraction of the ingested drink retained. In conclusion, in situations of voluntary fluid intake, hypertonic carbohydrate-electrolyte solutions are as effective as hypotonic carbohydrate-electrolyte solutions at restoring whole-body fluid balance.

Acute effects of ingesting glucose solutions on blood and plasma volume

The change in blood and plasma volume following ingestion of glucose solutions of varying concentrations was estimated in twelve healthy male volunteers. Subjects consumed, within a 5 min period, 600 ml of a solution containing 0, 2, 5 or 10 % glucose with osmolalities of 0 (sd 0), 111 (sd 1), 266 (sd 7) and 565 (sd 5) mOsm/kg, respectively. Blood samples were collected over the course of 1 h after ingestion at intervals of 10 min. After ingestion of the 2 % glucose solution, plasma volume increased from baseline levels at 20 min. Plasma volume decreased from baseline levels at 10 and 60 min after ingestion of the 10 % glucose solution. Heart rate was elevated at 10 and 60 min after ingestion of the 10 % glucose solution and decreased at 30 and 40 min after ingestion of the 2 % glucose solution relative to the average heart rate recorded before drinking. It is concluded that ingestion of hypertonic, energy-dense glucose solutions results in a decrease in plasma and extracellular fluid volume, most likely due to the net secretion of water into the intestinal lumen.

Whey Protein Addition to a Carbohydrate-Electrolyte Rehydration Solution Ingested After Exercise in the Heat

CONTEXT Many active people finish exercise hypohydrated, so effective rehydration after exercise is an important consideration. OBJECTIVE To determine the effects of a rehydration solution containing whey protein isolate on fluid balance after exercise-induced dehydration. DESIGN Randomized controlled clinical trial. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Twelve healthy men (age = 21 ± 1 years, height = 1.82 ± 0.08 m, mass = 82.71 ± 10.31 kg) participated. INTERVENTION(S) Participants reduced body mass by 1.86% ± 0.07% after intermittent exercise in the heat and rehydrated with a volume of drink in liters equivalent to 1.5 times their body mass loss in kilograms of a solution of either 65 g/L carbohydrate (trial C) or 50 g/L carbohydrate and 15 g/L whey protein isolate (trial CPl. Solutions were matched for energy density and electrolyte content. Urine samples were collected before and after exercise and for 4 hours after rehydration. MAIN OUTCOME MEASURE(S) We measured urine volume, drink retention, net fluid balance, urine osmolality, and subjective responses. Drink retention was calculated as the difference between the volume of drink ingested and urine produced. Net fluid balance was calculated from fluid gained through drink ingestion and fluid lost through sweat and urine production. RESULTS Total cumulative urine output after rehydration was not different between trial C (1173 ± 481 mL) and trial CP (1180 ± 330 mL) (F(1) = 0.002, P = .96), and drink retention during the study also was not different between trial C (50% ± 18%) and trial CP (49% ± 13%) (t(11) = -0.159, P =.88). At the end of the study, net fluid balance was negative compared with baseline for trial C (-432 ± 436 mL) (t(11) = 3.433, P = .03) and trial CP (-432 ± 302 mL) (t(11) = 4.958, P = .003). CONCLUSIONS When matched for energy density and electrolyte content, a solution of carbohydrate and whey protein isolate neither increased nor decreased rehydration compared with a solution of carbohydrate.

Effect of Drink Carbohydrate Content on Postexercise Gastric Emptying, Rehydration, and the Calculation of Net Fluid Balance

The purpose of this study was to examine the gastric emptying and rehydration effects of hypotonic and hypertonic glucose-electrolyte drinks after exercise-induced dehydration. Eight healthy males lost ~1.8% body mass by intermittent cycling and rehydrated (150% of body mass loss) with a hypotonic 2% (2% trial) or a hypertonic 10% (10% trial) glucose-electrolyte drink over 60 min. Blood and urine samples were taken at preexercise, postexercise, and 60, 120, 180, and 240 min postexercise. Gastric and test drink volume were determined 15, 30, 45, 60, 90, and 120 min postexercise. At the end of the gastric sampling period 0.3% (2% trial) and 42.1% (10% trial; p < .001) of the drinks remained in the stomach. Plasma volume was lower (p < .01) and serum osmolality was greater (p < .001) at 60 and 120 min during the 10% trial. At 240 min, 52% (2% trial) and 64% (10% trial; p < .001) of the drinks were retained. Net fluid balance was greater from 120 min during the 10% trial (p < .001). When net fluid balance was corrected for the volume of fluid in the stomach, it was greater at 60 and 120 min during the 2% trial (p < .001). These results suggest that the reduced urine output following ingestion of a hypertonic rehydration drink might be mediated by a slower rate of gastric emptying, but the slow gastric emptying of such solutions makes rehydration efficiency difficult to determine in the hours immediately after drinking, compromising the calculation of net fluid balance.

Effect of varying the concentrations of carbohydrate and milk protein in rehydration solutions ingested after exercise in the heat.

The present study investigated the relationship between the milk protein content of a rehydration solution and fluid balance after exercise-induced dehydration. On three occasions, eight healthy males were dehydrated to an identical degree of body mass loss (BML, approximately 1·8%) by intermittent cycling in the heat, rehydrating with 150% of their BML over 1 h with either a 60 g/l carbohydrate solution (C), a 40 g/l carbohydrate, 20 g/l milk protein solution (CP20) or a 20 g/l carbohydrate, 40 g/l milk protein solution (CP40). Urine samples were collected pre-exercise, post-exercise, post-rehydration and for a further 4 h. Subjects produced less urine after ingesting the CP20 or CP40 drink compared with the C drink (P<0·01), and at the end of the study, more of the CP20 (59 (SD 12)%) and CP40 (64 (SD 6)%) drinks had been retained compared with the C drink (46 (SD 9)%) (P<0·01). At the end of the study, whole-body net fluid balance was more negative for trial C (- 470 (SD 154) ml) compared with both trials CP20 (- 181 (SD 280) ml) and CP40 (2107 (SD 126) ml) (P<0·01). At 2 and 3 h after drink ingestion, urine osmolality was greater for trials CP20 and CP40 compared with trial C (P<0·05). The present study further demonstrates that after exercise-induced dehydration, a carbohydrate--milk protein solution is better retained than a carbohydrate solution. The results also suggest that high concentrations of milk protein are not more beneficial in terms of fluid retention than low concentrations of milk protein following exercise-induced dehydration.

The effects of repeated ingestion of high and low glucose-electrolyte solutions on gastric emptying and blood 2H2O concentration after an overnight fast.

The addition of carbohydrate to drinks designed to have a role in rehydrating the body is commonplace. The gastric emptying and fluid uptake characteristics following repeated ingestion of drinks with high and low glucose concentrations were examined in eight subjects (three male and five female). Following a 13 h fluid restriction period, the subjects ingested a volume of test solution amounting to 3 % of the initial body mass over a period of 60 min. Test drinks were 2 and 10 % glucose-electrolyte solutions with osmolalities of 189 (SD 3) and 654 (SD 3) mOsm/kg, respectively. The initial bolus of each test solution contained 10 g of (2)H(2)O. Blood samples were collected throughout drinking and for 60 min afterwards. Gastric volumes were determined via gastric aspiration at 15 min intervals for 120 min. No difference between trials in total stomach volume was observed until 30 min after the ingestion of the first bolus of test drink, but blood (2)H concentration was increased during both trials 10 min after ingestion of the first bolus. Blood (2)H concentration was greater at this time point during the 2 % glucose trial than during the 10 % glucose trial and remained higher for the duration of the trial with the exception of one time point. Urine volume at the end of the trial was greater in the 2 % glucose trial than in the 10 % glucose trial. It is concluded that the reduced overall rate of fluid uptake following ingestion of the 10 % glucose solution was due largely to a relatively slow rate of gastric emptying.

Optimizing the restoration and maintenance of fluid balance after exercise-induced dehydration

Hypohydration, or a body water deficit, is a common occurrence in athletes and recreational exercisers following the completion of an exercise session. For those who will undertake a further exercise session that day, it is important to replace water losses to avoid beginning the next exercise session hypohydrated and the potential detrimental effects on performance that this may lead to. The aim of this review is to provide an overview of the research related to factors that may affect postexercise rehydration. Research in this area has focused on the volume of fluid to be ingested, the rate of fluid ingestion, and fluid composition. Volume replacement during recovery should exceed that lost during exercise to allow for ongoing water loss; however, ingestion of large volumes of plain water results in a prompt diuresis, effectively preventing longer-term maintenance of water balance. Addition of sodium to a rehydration solution is beneficial for maintenance of fluid balance due to its effect on extracellular fluid osmolality and volume. The addition of macronutrients such as carbohydrate and protein can promote maintenance of hydration by influencing absorption and distribution of ingested water, which in turn effects extracellular fluid osmolality and volume. Alcohol is commonly consumed in the postexercise period and may influence postexercise rehydration, as will the coingestion of food. Future research in this area should focus on providing information related to optimal rates of fluid ingestion, advisable solutions to ingest during different duration recovery periods, and confirmation of mechanistic explanations for the observations outlined.

Short-term dietary supplementation with fructose accelerates gastric emptying of a fructose but not a glucose solution

OBJECTIVE Short-term dietary glucose supplementation has been shown to accelerate the gastric emptying rate of both glucose and fructose solutions. The aim of this study was to examine gastric emptying rate responses to monosaccharide ingestion following short-term dietary fructose supplementation. METHODS The gastric emptying rate of a fructose solution containing 36 g of fructose and an equicaloric glucose solution containing 39.6 g glucose monohydrate were measured in 10 healthy non-smoking men with and without prior fructose supplementation (water control) using a randomized crossover design. Gastric emptying rate was assessed for a period of 1 h using the [(13)C]breath test with sample collections at baseline and 10-min intervals following drink ingestion. Additionally, appetite ratings of hunger, fullness, and prospective food consumption were recorded at baseline and every 10 min using visual analog scales. RESULTS Increased dietary fructose ingestion resulted in significantly accelerated half-emptying time of a fructose solution (mean = 48, SD = 6 versus 58, SD = 14 min control; P = 0.037), whereas the emptying of a glucose solution remained unchanged (mean = 85, SD = 31 versus 78, SD = 27 min control; P = 0.273). Time of maximal emptying rate of fructose was also significantly accelerated following increased dietary fructose intake (mean = 33, SD = 6 versus 38, SD = 9 min control; P = 0.042), while it remained unchanged for glucose (mean = 45, SD = 14 versus 44, SD = 14 min control; P = 0.757). No effects of supplementation were observed for appetite measures. CONCLUSION Three d of supplementation with 120 g/d of fructose resulted in an acceleration of gastric emptying rate of a fructose solution but not a glucose solution.