Fuel for football: post-match recovery

Ask the expert – we put your questions to a leading expert in type 1 diabetes, exercise, and nutrition

Author: Dr Matthew Campbell | PhD ACSM-CEP MIFST RNutr FHEA BSc hons.

A REMINDER – this blog post is written by a healthcare professional but no changes should be made to the treatment of your condition without consultation with your own Diabetes team. 

Read time: 5-10 minutes

Introduction

The primary objectives for a footballer with type 1 diabetes after a match is to reduce the time needed to fully recover and to reduce the risk of developing a hypo later in the day. To meet both of these objectives, it is important to replenish the body’s carbohydrate stores which may have been (partially) depleted during exercise.

How much carbohydrate should I eat after exercise and when?

After exercise, muscle cells that have sustained a depletion in carbohydrate stores are metabolically primed for rapid carbohydrate repletion. In simple terms, glycogen use during exercise turns on glycogen synthesis during recovery. When carbohydrates are eaten soon after exercise, insulin sensitivity in muscle cells, glucose uptake from the blood by muscle cells, and the conversion of glucose to glycogen in muscle cells all increase. Collectively these responses provide the best physiological opportunity to replenish carbohydrate stores. Although the responses can be increased for up to 48 hours^1,2, there is a golden window of opportunity shortly after exercise (within the first hour after exercise) where these responses are dramatically upregulated and carbohydrate stores will be replenished more quickly. Consuming 1-1.2 grams of carbohydrate per kilogram of body weight for the first hour after exercise will take advantage of these metabolic circumstances to stimulate high rates of carbohydrate storage. Continue to focus on carbohydrate intake for 24-48 hours after the game, aiming for 6-8 grams of carbohydrate per kilogram of body weight in the 24 hours following a game to ensure that carbohydrate stores are continuing to be replenished; don’t exceed 10 grams of carbohydrate per kilogram of body weight per day – beyond this level does not seem to confer any additional advantage and it may make insulin dosing difficult. Furthermore, simply overconsuming carbohydrate has been shown to be ineffective at preventing post-exercise hypoglycaemia – read this article about preventing post-exercise hypoglycaemia

 

Does the type of carbohydrate matter?

Carbohydrates with a high glycaemic index (i.e., those that easily digested and rapidly absorbed) tend to replenish muscle carbohydrate stores quicker than lower glycaemic index carbohydrates (those that are difficult to breakdown and are absorbed slowly)³. However, consuming large amount of high glycaemic index carbohydrates is not recommended for people with type 1 diabetes, because this can result in large blood glucose spikes which are difficult to control. However, one potential option to trial is changing type of carbohydrate consumed. Carbohydrates come in many different forms and their structure, composition, and delivery method all impact how they affect glucose levels. Glucose is a type of simple sugar that is easily and rapidly digested resulting in spikes in blood sugar. However, mixing glucose with other types of sugar – in particular fructose (which can be bought as a powder) results in a lower glucose spike whilst maintaining total carbohydrate intake⁴. Figure 1 shows data pooled from several different research studies investigating the effect of different types of carbohydrate consumed after exercise in people without type 1 diabetes. As shown in Figure 1A, changing the type of carbohydrate neither increased nor decreased the rate of muscle glycogen repletion. Interestingly however, most studies report lower insulin levels when glucose and fructose was taken together which implies that this has less of an impact on blood glucose levels. Furthermore, liver glycogen repletion rates were increased when glucose and fructose was taken together as compared to glucose alone. This is potentially important for people with type 1 diabetes, because repletion of liver carbohydrates stores reduces the risk of late-onset hypoglycaemia – read this article about late-onset hypoglycaemia.

Figure 1. The impact of different types of carbohydrates on restoring muscle and liver carbohydrate stores after exercise. Figure reproduced from Gonzalez at al⁵. GLU = glucose alone, GLU+FRU = glucose and fructose taken together, SUC = sucrose (table sugar).

 

Protein is also (very) important for post-exercise recovery

Sore muscles after exercise are a key indicator of muscle damage – tiny microtears in muscle fibres. To speed up the repair process, and also enhance physiological adaptions, 20-35 grams of high-quality forms of protein should be eaten at regular 3-4 hour intervals^6,7. The aim of this is to increase muscle protein synthesis rates – the rate at which cells build and repair muscle. Although protein intake after exercise increases rates of muscle protein synthesis, this is a slow process. This means that protein intake should be increased to a minimum of 1.2-1.4 grams per kilogram of body weight in the days following a match or heavy training session and trying. Where possible, you should try and spread out the total amount of protein to be consumed over the day in the form of smaller but more regular meals. As described above, there is a ‘golden window of opportunity’ shortly after exercise (within the first hour after exercise) to coordinate nutrient intake with the upregulation of key metabolic processes. During this window, muscle protein synthesis rates are rapidly increased if easily digestible and rapidly absorbable protein is consumed. Alongside carbohydrate intake, 30-45 grams of leucine-rich protein (such as whey protein) can be taken to maximise muscle repair and recovery; whey protein can be bought in powered form and taken as a drink but other whole food sources rich in leucine are also available – cottage cheese is an excellent example. As well as lean meat, legumes, and fish, another excellent source of protein is milk which can be drank on its own or mixed with protein powders. The benefit of drinking milk in the post-exercise period is that this has been shown to reduce muscle soreness and quicken recovery⁸. Additionally, before sleep, a slowly digested and absorbed protein can be taken to provide a gradual and sustained availability of protein⁹. Aiming for around 30-60 grams of slow-releasing protein (such as casein which is found in milk and can be bought as a powder) as a bedtime snack will be effective in minimising muscle protein breakdown during the night⁹. Figure 2 shows the pattern of how muscle protein is built-up and broken-down during the day. Timing protein-rich meals to be consumed during periods of protein breakdown will improve muscle reconditioning, especially during long periods of protein breakdown such as sleep.

Figure 2. The pattern of muscle protein breakdown (MPB) and build-up (MPS) during the day. Eating protein stimulates the build-up and repair of muscle protein and allows for net muscle protein accumulation (green areas). In between mealtimes (termed the post-absorptive state), rates of muscle protein breakdown exceed rates of muscle protein build-up, resulting in a net loss of muscle protein (red areas). As shown by Figure 1A, overnight sleep is the longest post-absorptive period of the day (expect for Ramadan for those who observe this). Figure 1B ingesting protein before bedtime stimulates overnight protein build-up rates thereby improving muscle reconditioning during the night. Figure adapted from Trommelen & Loon¹⁰.

 

What about supplements?

Vitamins and minerals are important for maintaining key physiological processes including the body’s repair mechanisms. You should try and obtain sufficient amounts of vitamins and minerals naturally through eating a well-rounded healthy diet. This is because dietary sources of vitamin and minerals are more effective than taking isolated vitamins and minerals in supplement form. One supplement which is recommended for most individuals is vitamin D – especially those in the northern hemisphere because most people who live in Northern regions are vitamin D deficient¹¹. If taking vitamin D, this should be coupled with sufficient calcium intake as this helps vitamin D to be absorbed¹². Vitamin D is important for several health outcomes, as well as reducing the risk of bone fractures which are common in football, and may contribute to improved muscle recovery¹³. In addition, dietary iron is important for muscle recovery and repair¹³. Iron-rich sources of food include red meat as well as green leafy vegetables, eggs, seafood and fortified breads and cereals. Iron-deficiency is common is women, because blood is lost during menstruation, vegans and vegetarians who may struggle to obtain sufficient amounts of iron through diet alone, and teenagers who have increased iron requirements during maturation¹⁴.

Some studies have shown that taking branch-chain amino acids can help with recovery¹⁴, however the overall effects are small and may make little contribution to the recovery process¹⁵. Consuming foods rich in antioxidants have been shown to reduce inflammation and accelerate muscle recovery in difference sports¹⁶, but more recent investigations in football failed to show an improvement in recovery or subjective muscle soreness. An issue with this is that certain foods (like beetroot) which are rich in antioxidants are typically found in boiled or pickled form which is known to reduce their antioxidant value meaning that these are large quantities of these foods are likely needed to have any effect. Also, reducing muscle inflammation, particularly with large doses of antioxidants (including vitamins C and E) may interfere with adaptative processes in muscle¹⁷, which, if taken after training may reduce the training adaptation. Therefore, based on the available evidence, antioxidant supplements are not recommended.

If you are interested in learning how to improve managing your type 1 diabetes around exercise book a consultation with the author, Dr Matthew Campbell: matt@t1dcoaching.co.uk

About Matthew

Matthew is an internationally recognised research scientist specialising in exercise, diet, and type 1 diabetes. He also provides consultancy and diabetes coaching to people living with type 1 diabetes and those that support them.

Matthew has a PhD in nutrition and exercise metabolism, is author to over 150 research publications, and holds honorary titles with the University of Cambridge and University of Leeds. He is a certified clinical exercise physiologist accredited by the American College of Sports Medicine, a registered nutritionist, and a member of the Institute of Food Science and Technology. He also provides consultancy to professional bodies and professional athletes including NHS England, the World Health Organisation, and TeamGB.

If you are interested in learning how to improve your type 1 diabetes management, contact Matthew at: matt@t1dcoaching.co.uk

References

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