Nutrition Essentials | Fueling for Fitness with Erik Van Iterson, PhD

Podcast Transcript

John Horton:

Hey there, and welcome to another episode of Nutrition Essentials, an offshoot of our popular Health Essentials Podcast. I'm John Horton, your co-host, with registered dietitian, Julia Zumpano.

Julia Zumpano:

Hey, John. I'm excited today to talk about our topic, Fueling for Fitness.

John Horton:

Oh, Julia, we see so often that people put all this focus into their workouts and exercise routines, but sometimes, I think a lot of us forget that what we eat before and after exercising can just have a huge impact on the benefits we get from all that sweating. What we put in the tank is really pretty important, right?

Julia Zumpano:

Absolutely. It makes such a big difference in your workout and your recovery, and that's what we're going to dive into with Dr. Erik Van Iterson. He's the clinical exercise physiologist and director of the Cardiac Rehabilitation at the Cleveland Clinic.

John Horton:

It should be a great conversation, Julia. I'm sure we are going to have a lot to chew on.

Dr. Van Iterson, welcome to the podcast. We've really been looking forward to having you on for a while.

Dr. Erik Van Iterson:

Well, thank you for having me. I appreciate this opportunity to talk on today's topic.

John Horton:

Well, and I know in your role here at the Clinic, you work closely with cardiac patients, but exercise is obviously something that benefits folks from their ticker to their toes, no matter where you're at in the whole medical world here. Your whole body just seems to work better if you move it regularly. But as we all know, breaking sweat is a good thing. But it seems like we can undermine all that hard work if we don't fuel up properly before and after our workouts.

Dr. Erik Van Iterson:

Yes. I would agree, in terms of some really basic things that individuals can do to greatly alter, just how they feel during the exercise and then, consequently, the performance and meeting their expectations of what all that hard work went into.

Julia Zumpano:

I think it's important to note, too, the role nutrition plays here to really enhance your performance, to be able to have you feeling the best when you're exercising and, of course, being able to recover the best, because we don't want to feel achy or sore or overly tired after workouts because then that's going to inhibit us to keep going. So I think nutrition plays such a key role here.

John Horton:

Well, I know I'm looking forward to a lot of these tips and things we're going to talk about today, because I often feel achy after workouts. It's kind of one of the things that come with doing this at a certain age.

So to jump in here, I know one of the big questions that comes up revolves around timing, and specifically, when and what to eat ahead of workouts. So let's kind of dig in there and get started.

Dr. Erik Van Iterson:

I think, in order to just keep it simple, I'd say that, in a very loose way, a good heuristic to go by is a 60 and 30 rule, and that being, basically, 60-minute increments, and 30-unit increments of fuel that you're going to take in. And 60 minutes, say, for the length of the session itself, in general, you probably don't need to be worrying about fuel strategies. And session lengths that start to extend beyond 60 minutes, and incrementally then increase beyond that, then that's when you really want to start to think about different fuel strategies and using the 30-unit increment of substrate, that typically being predominantly focused on glucose.

And starting off, generally pretty conservatively, at that sort of 30-gram-unit mark and, conservatively, working your way up, perhaps up to 60 grams as the duration of the session were to continue to, say, additional 60 minutes and 120 minutes and 180, and so on and so forth.

John Horton:

There's a lot of math we're already thrown out here, Dr. Van Iterson.

Dr. Erik Van Iterson:

Well, that's why, in terms of, you just have to remember six and three. And in general, I think it can be pretty safe with that ratio, in terms of, it's basically doubling each of those numbers based on the duration of the event or duration of the session, and what type of fuel you need. And the fuel doesn't need to be too complicated for some of these shorter duration things, focusing, again, predominantly on some simple carbohydrates, like energy gels and apples and that type of carbohydrate.

Julia Zumpano:

So Dr. Van Iterson, what I think I'm hearing you say, is that when you're exercising for about an hour or less, there's probably no need for us to be overly concerned about fueling, during, of course, and maybe even before. So I know the question comes up a lot, and should I be eating before workout, right after workout, and really, it depends. It depends on the person, their preference, and their timing of their workout.

So if you're like myself, I'm working out within the first hour of when I'm waking up. So I prefer not to eat anything. Just because I kind of have a sensitive stomach, I don't really want to put anything besides fluids into my system. I feel like it fuels my workout the best.

But then again, I'm trying to have something quite shortly after I'm done with my workout, kind of refueling. But no, if you're someone that's working out a little bit later in the afternoon or you have a good enough timeframe to be able to consume a meal, and typically that's two to three hours. It’s just based on your digestion. You want to eat a full meal two to three hours before your workout.

If you're only having about 60 to 30 minutes before, then a small snack would be appropriate. Just something, you know, you can digest well, you know your body best, but something very simple, like a banana, a scoop of peanut butter. Again, if that's easy for you to digest. That's one of my favorite recommendations is a banana with peanut butter. Some people like the good old-fashioned chocolate milk, that could be post or pre, because that can work with a little bit of protein and carb. I like to use a protein shake instead of a chocolate milk, just because you're going to maximize some protein in there.

And if you are, afterward, it is really great to replenish some of that energy use loss, whether your glycogen stores or you're breaking down muscles, so you really need to replenish that. I usually recommend 30 minutes after, and then you can wait until you have a meal up to two hours after. So it just depends on timing, depends on personal preference, and it also depends on your digestive system. So there's a lot of things that go into play.

John Horton:

So in looking at that before question, and are you better off, if you're going to err, should you err on the side of fueling up ahead of time or kind of holding off and not getting as much in? When I think of that question, I always think back to my son's varsity cross-country coach, and he always used to swear that there were far more issues caused by starting that workout with a full stomach than a little bit empty. So how on the mark was he?

Dr. Erik Van Iterson:

Well, I would say that it's very contact-specific in terms of the experience of the athlete, or the person exercising. And that, in your example of the cross-country coach, he's working with well-trained athletes who, likely up to that point, had been very diligent about their nutrition in addition to the exercise training itself. And so, those individuals can be a little bit more conservative about not needing to think about real fuel strategies prior to their training sessions or their events because they have that foundation already established.

Whereas an individual who isn't a regular endurance athlete and maybe does it once in a while or has a very acute training goal of endurance event, 5K, 10K, half-marathon, now that's the individual that may have to think a little bit more about what they're consuming immediately prior to the race, and what were they doing in preparation in the three, four hours ahead of time. But also, the several days ahead of time. And I think that can almost better drive the decision as to whether you need to be eating something 60 minutes before the event, and also, of course, thinking about what the event is itself.

Julia Zumpano:

Yeah, I would agree. I tend to err on the side of caution as well. So I usually recommend, better to wait than to have something and then feel uncomfortable the whole time you're working out.

Liquids are generally better tolerated. So I do often recommend liquids versus solid food, if someone has a sensitive stomach and they're coming closer to the time that they're actually going to be working out.

Just to piggyback on what Dr. Van Iterson said, I think it also depends on the athlete and then the activity you're doing, too. So running, it really can jar your whole system. Where if you're going to be doing something more along the lines of weightlifting, some people may be able to tolerate more food in that sense.

John Horton:

Yeah. Running's definitely a little tough. There was a reason why they put giant trash cans after the finish line. I quickly found out after going to a few of those meets.

You had mentioned the timing as far as that's kind of 60 minutes... If you're going to exercise for at least 60 minutes, you maybe need to get a little something in or pay a little more attention to it. Let's focus on what you should get in. And I think we touched on this a little bit, but I just want to make sure we really dive in, as far as what the best foods are to get in ahead of one of these workouts.

Julia Zumpano:

So prior to, I think it would be ideal to have a little bit of carb and protein. So we want at least 15 to 30 grams of carbohydrate, again, depending on the length of your activity. And then, I would suggest about 10 grams of protein — or about an ounce of protein — seven to 10 grams would be appropriate. Combining those together would be great.

Fat takes the longest to digest, so you do want to minimize fat because it will slow down your digestion, keep that food in your belly a little bit longer. So, easily digested foods, quick-digestible foods are ideal. So like I mentioned, an apple with maybe a little bit of peanut butter, although that does have fat, keeping the portion controlled, maybe a cheese stick and an orange. So something very simple, a protein shake with some milk and protein powder, a protein bar or energy ball that you can make or energy bar that you could purchase.

So those are some quick, easy examples that you could do, a piece of toast with an egg or a piece of lean deli meat would be fine, too.

John Horton:

I'm a big fan of the toast, and I like putting a little honey on it, whatever. I feel like it gives it a little bit of a little jolt and maybe, say, that sugar in there.

Julia Zumpano:

Right.

Dr. Erik Van Iterson:

Well, yeah, so I think that brings up a good point in terms of the honey. And that's a really easy, digestible type of carbohydrate that your body can really appreciate almost immediately, with very little work to break that down and immediately oxidize that for the fuel that you need to perform your event.

And with certain carbohydrates, of course, I think you have to be careful with overall fiber content and making sure that you're not eating carbs that are too high in fiber, which are going to be problematic for digestion. So even thinking about bananas and that you preferably want to eat bananas that are very ripe, as opposed to the bananas that are still sort of green in the edges, just because at that point, the carbohydrates and the fruit itself is going to be a little bit more starchy and, believe it or not, more difficult for that digestion to occur.

And so, it's a lot of times simple things, where individuals really do have to think about their gut sensitivity to some of these types of foods that they wouldn't normally be taking in, to make sure that they don't experience unnecessary GI distress during their event and have to use that trash can by the side of the road.

John Horton:

It's never a good thing. Yeah, it's never a good thing if you have to use the trash can. And with what you just said, Dr. Van Iterson, it really is very specific person to person, right? As far as what kind of settles in there right and what kind of makes you feel ready to go.

Dr. Erik Van Iterson:

Yeah. I think part of the training really does need to be training your gut, too, in terms of that should be an active part of the strategy leading up to your event or your training sessions. And the first time you're taking in a mix of carbohydrates, like glucose and fructose, shouldn't be the day of the event. That's going to be a disastrous situation for how you feel and, consequently, your performance. If you've never experienced that concentrated amount of quick carbohydrates, and you're doing an event that is 90, 120 minutes or so, it's probably a situation where you're not going to feel well enough to actually complete the event. Not because of the physiology, but likely just because of the GI distress that you'll experience.

John Horton:

I love that idea to train your gut. We always just think about our muscles, but you got to look a little bit beyond that.

Julia Zumpano:

Yeah, I can't agree more. You really do have to trial all these foods and see what works for you. There's no right or wrong answer here.

John Horton:

So we've kind of talked about the before. And Julia, you kind of started getting into the after a little bit, too. How much do we really need to focus on, on what goes in after a workout, just to make sure that our body, like you said, recovers as best that it can, and that you're kind of getting the benefits that you want out of that workout?

Julia Zumpano:

Yeah, I think after is really important. Your muscles are hungry, your glycogen stores have been maybe depleted, most likely depleted, depending on the timing of your exercise. So it's time to replete. It's time to give back what you just burned.

So I think consuming, within 30 minutes, some carbohydrate and protein, and that could just be something very simple. It doesn't have to be that you have to sit down and have a meal, but something within 30 minutes just to replete those glycogen stores to give your muscles the energy, the repletion it needs. They're hungry, so you want to feed them right then.

It does help repair and build muscle if you do it within 20 to 30 minutes after exercise, some studies have shown. So I think something quick and easy after. And then preparing a good, nice, healthy meal within two to three hours after exercise would be appropriate, if, sooner if you can, but at least within two to three hours.

Dr. Erik Van Iterson:

Yeah, I would definitely agree with you, Julia, and that the recovery is oftentimes an overlooked part of training and performance, but if you can't recover from training, then the training typically isn't any good anyway. And so, the carbohydrates are critical post-session, and if you can start immediately and again, really focusing on some of those simple carbohydrates.

The protein, I agree with Julia, is very important and really keeping that up probably up to four hours after your sessions or your event. But making sure you don't overdo it with the protein, in that we're not talking about having to take massive amounts of protein shakes in, but really kind of looking at a rough range of 20 to 40 grams of protein over that three-to-four-hour period of time. And that's something that your body can tolerate and be able to break down and utilize for that repair cycle.

Julia Zumpano:

Yeah. And at that amount, I mean, it's very easy to consume that through nutritious food. You don't need to supplement. Supplements work well in convenience or if you don't have the food available to you, but things like cottage cheese and Greek yogurt and, of course, meat. Dairy products like milk, and then, of course, protein shakes if you need them. But there's several food sources that can easily meet the 20 to 40 grams.

John Horton:

So from what you're saying, it sounds like the protein is really what you want to get in to help your muscles kind of restore themselves, and go through that repair process. What happens if you don't put that protein in and you don't replenish? Do you start to undermine any gains that you're hoping to make through your workout?

Dr. Erik Van Iterson:

Yeah, I think wholly, and, unfortunately, with exercise, there is that inflammation, but you can think of it, when done properly, a good type of inflammation and break down the tissue. But that also means that the fuel needs to be in place to help facilitate that repair process or the broken-down tissue. And that includes muscle fibers, which are a great deal … amount of protein, and the glucose to replenish the glycogen stores that you just burn through your exercise event.

And so, if you don't have the glycogen stores rebuilt for the next training session, then you're already starting on the back foot in terms of just raw energy, but that if you haven't repaired the muscle from the previous breakdown, then you're already generally starting a little bit inflamed, having not really even done anything, but still trying to repair from the previous training cycle, making the subsequent training cycle typically less effective and less optimal from a performance standpoint.

Julia Zumpano:

I think it's key that you want to feel your best, right? We're trying to maximize the work we're putting in and how we feel. So I think if you're able to time your meals and your snacks appropriately and the timing of your nutrients appropriately, and it doesn't have to be very strict, but just an understanding of replenishing those stores, I think you'll recover better, you'll feel better. The next day, your workout may be even better and stronger, and you may even see improved muscle growth, improved muscle mass, you'll see that you're actually working toward a goal. You can see the visual effects of it, too.

So I think it's just important to understand that the timing is just about supporting your body with what it needs at the appropriate time. And that is variable. It's not specifically set in stone. Everybody is a little different based on their tolerance, but there are general guidelines for sure.

John Horton:

And it sounds like you could really maybe reduce your injury risk if you're doing that, too, because that, I mean, that's one of the biggest problems I know people have. I mean, you push and you push and you push, and eventually, if you overdo it, those muscles kind of break down and you end up with one of those problems. It sounds like through nutrition and diet, you might be able to head that off a little bit.

Dr. Erik Van Iterson:

Well, yeah, I absolutely agree with that, because by definition of training, it is meant to be consistent, repetitive. But that also means there is increased risk of overuse injury, and that if you're not training properly with puritization, then of course that overuse injury risk was going to increase. But it's certainly going to increase further if the nutrition isn't there to help the acute as well as medium-term repair process occurring as it should.

John Horton:

Now, we've kind of talked about before and after, and I think we've kind of hit those pretty well, but I want to spend a little bit of time also, on guys eating or taking nutrients in during an activity. We see so many times now … it's like nobody will go to the gym or out on a walk or anything without packing snacks and things like that. Are we kind of, sometimes, maybe even over-consuming on some of these exercise sessions, like during it, and we really can just focus on getting our workout in and not worry about having supplies with us?

Dr. Erik Van Iterson:

Fully agree.

Julia Zumpano:

Yeah, me, too. Me, too. I think it can get out of hand for sure. It's very simple. I think we're just complicating it.

So I think it's important, as Dr. Van Iterson very plainly said, that if you're exercising for greater than 60 minutes, that's when you start thinking about replenishing. And it depends on the intensity of your exercise. So, if you're running a marathon, we're really thinking about replenishing, running a half-marathon, running a 10K, something that's going to take you greater than 60 minutes, then we have to start thinking about replenishing our needs.

Most of us are not consistently exercising more than 60 minutes. But if you are, that's where you want to think about it. But oftentimes, I'll hear, "I was at the gym for two and a half hours." I'm like, "Well, what were you doing for those whole two and a half hours?" And the first 30 minutes we're stretching, then we might be leisurely walking on the treadmill at a three-mile-per-hour rate, just a very low rate and that-

John Horton:

…catching up on gossip here and there. Yeah.

Julia Zumpano:

...lifting a little bit. So it's a matter of just understanding your intensity and what you're training for and what your exercises are like. And then also, I think really important is recognizing your body. Is your body telling you in the middle of your exercise, "I am depleted. I need more energy. I'm crashing." If it is, you're not fueling properly before, and you may need to fuel during because your body's burning up what you've stored pretty quickly.

John Horton:

Yeah, that's a great point, Julia, because that is something maybe we should use as a little bit of a tip. If you do have that, you bonk, mid-workout, maybe you do need to look at what you're reading ahead of time and adjust that a bit so that way, you have the energy supplies to get through what you're looking to do.

Julia Zumpano:

When you're doing something that intense … like my husband did a hundred-kilometer bike race, mountain bike race. So it was a nine-hour race. We had to map out every 60 to 90 minutes and what he's taking and when, and we had to pack it and plan it. I mean, that's intense. That's something where your body's really going to need all the fuel to get through that. But most of us aren't doing that.

So anyone who's run a marathon, same. You've got to map it out. You got to make sure you're providing your body what it needs so it can optimally perform. And then, again, you can recover properly because you haven't depleted everything you have. So I think it's important in those cases, but for basic exercise, 60 minutes or less, I think that really hydrating is key. And then replenishing nutrition before and after.

John Horton:

Let's mention … let's talk about hydration a little bit, because you just mentioned it there, Julia. We talk about that all the time on this podcast, and you hear that endlessly, you got to hydrate, you got to hydrate. It seems like everybody is walking around with a water vessel these days. I mean, it does not seem like a lot of people are short on fluids.

But when you're going into a workout, how much focus should you put on getting fluids in ahead of time? How often should you do it during? What are just some rules of thumb people should take into this?

Dr. Erik Van Iterson:

Yeah, that's an excellent point and question in that, like Julia has stated before, it really should be the focus on the pre-workout. What are you doing ahead of time? And it's ideal, optimal to be what you would call “you-hydrated” before even starting your workout. And that if you're not you-hydrated or optimally hydrated to start the workout, then you're not typically going to optimize the hydration during the workout itself, as well as loss of performance, is going to typically occur during that workout.

And so I think within the first hour before starting a workout, you really do need to think about, I'd say, roughly 5 to 7 milliliters per kilogram body weight for some basic hydration leading into your workout. And that seems like it might be a lot of water, but it really ends up being roughly anywhere from say 6 to 800 milliliters of water, gradually sip throughout that hour.

We're not talking about bulk dosing yourself with water five minutes before that workout and making that be your hydration strategy. But really, then during the actual session itself, you can allow yourself to really just sip to thirst. And you don't have to really worry about how much fluid am I taking in and performance-related aspects associated with the hydration. And that again, less than 60 minutes, there really shouldn't be a concern about the dehydration term, or more probably appropriately being under-hydrated.

Julia Zumpano:

Yeah. So Dr. Van Iterson, same recommendations. I provide the same, that roughly about two to three cups of water before your workout, and then about two to three cups after, same amount, and then sipping during based on thirst, right? Your body will tell you what it needs. So same exact recommendation. And then, after 60 minutes, if you're exercising extended periods of time, that's where electrolytes can help, can play a role.

John Horton:

I'd imagine ahead of time, too, a lot depends on the conditions. I know I run, and I'm not a treadmill guy. I go outside no matter what. And there are days where it's brutal, and you go out there, it's like 95 plus, the sun's out, everything else. I know in those days, I try to start hydrating a lot, even two hours ahead of time, just to get some fluids in, let them settle, so that way, I'm not going to just hit a wall when I'm out.

Dr. Erik Van Iterson:

Yeah. So that's critical in terms of the preparation. And so yes, that window, the two to four hours before the session, that really is an excellent opportunity to withstand the heat, humidity of that environmental condition, and that you're not going to get you-hydrated within the hour in that type of setting you're describing. But that does your body a favor by giving it the fluid that it wants to help fill blood volume and allow you to move blood in your body through pressure gradients, as opposed to relying so much on how fast your heart rate is, your body will then translate that into, thank you, by giving you the performance you expect.

And so, during that session in that very warm, humid environment, you don't really then have to worry so much about how much extra water that you need to take in. And typically, you don't really need to alter your hydration strategy during the session as long as, again, you're prepared ahead of time and were dehydrated and maybe accounted slightly for the increase in temperature and humidity, but nothing substantial.

Julia Zumpano:

I also think, John, you make a good point. When it's hot outside, we're sweating more. So I think that's really key to understand, too, just to plan for that. So if you're running on a treadmill or you're doing a hot yoga class or something where you're sweating more than normal, you have to properly rehydrate for those increased losses, so fluid losses through sweat. So it's important to do that.

And then, if you're knowing that you are going to be doing that for an extended period of time, you definitely could utilize some electrolytes, will really help you feel better after that workout.

John Horton:

If you're in the middle of a workout, and all of a sudden you realize you did not hydrate enough and you start feeling woozy. And I've had this where you're out and it's like all of a sudden you're like, "Wow, I do not feel good." How quickly can you refill that tank? Is that a matter of, you get a drink, you should be OK? Or once you get to the point where you're kind of experiencing some symptoms, do you need to shut it down for a little while and let things kind of catch back up?

Dr. Erik Van Iterson:

Yeah. The latter is that if you're feeling symptoms, it's already time to stop, and that symptoms are your body's way to communicate with you without literally talking to you. And so, there's really not a whole lot you're going to do in a very acute period of time that's going to be beneficial in terms of your training performance, your exercise performance, but also your general health.

And that feeling like you're going to pass out, near syncopal, that certainly is a dangerous cascade to continue with, because that could be, of course, dangerous from a situation of actually passing out and harming yourself, or in other circumstances, possibly even life-threatening, indicative of some other condition.

Julia Zumpano:

Yeah, I can't agree more. I think it's so important to listen to your body. I mean, if your body's giving you signs, it's time to stop. It's telling you not to push through, and you really can make things worse if you push through it. So I think a couple sips of water is not necessarily going to make you feel better. So it's time to stop, think about what your body needs, what it's missing, properly hydrate, maybe consume some food if that's what you're feeling, but it's certainly important not to push through.

John Horton:

Then, after a workout, how much do we need to put back in fluid-wise? Does it just depend on the workout? Is there a general rule of thumb where if you work out for so long, you should drink about this much afterwards?

Dr. Erik Van Iterson:

I think it's very much dependent on the type of workout, the event and the individual. And so there's not going to be some, I'd say, broad brush guideline for all circumstances, but if it's, again, a longer duration type of event, more than 60 minutes or so, then you do want to be thinking about, well, you thought about the lead-up hydration strategy, you thought about the hydration during the event and then you should be thinking about the hydration strategy following the event.

And typically, you want to think about body weight, and you don't want to be losing a significant amount of body weight through fluid. You want to think about, do you have symptoms of lightheadedness or dizziness? You want to think about, is my urine very dark in color? And these things, collectively, providing information, and not necessarily a single thing, providing you absolute information and hydration. But that if you're experiencing those symptoms or dark urine or very large increases in body weight loss, typically more than say 2% of the initial body weight that you had before the event, then you then really do need to think about hydration. Typically, about 1.5 liters per kilogram body weight loss, and think about some sodium electrolytes, typically 50 to possibly up to 80 millimoles per liter for that electrolyte replenishment and to help your body hold that water again.

Julia Zumpano:

Yeah. My general rule of thumb is most people's water bottles are between 20 to 32 ounces. That's average. So I usually say about that afterward, depending on the size of the person and the amount they sweat, the minutes they worked out. But I think if you can finish a water bottle, ideally 20 to 32 ounces for 60 minutes or less of activity would be appropriate. Of course, if you increase activity-wise, you're going to have to do more. But just a general rule of thumb, finish up that water bottle afterward.

John Horton:

I was going to ask, can you just go off of thirst or after a workout, does your body almost need more than what your thirst is going to signal?

Dr. Erik Van Iterson:

I think that depends on the person. Some people just aren't thirsty regardless of whether they worked out. And so, I don't think that you can wholly trust the thirst mechanism. But that, again … really think about what did you just do, and how intense was the act that you were doing? How long was it? Was it a race or was it just a training session? What was the environmental condition? Were you at altitude? Was it hot and humid?

And these things all really need to be put together as a sort of algorithm in your brain, in terms of deciding whether you need to take that extra fluid in or whether the event that you just did didn't necessarily warrant that, and you prepared well ahead of time. So you should be generally good with a sip to thirst strategy afterwards.

Unfortunately, there's not going to be an absolute right answer with the individual at home. They don't live in a laboratory, so we can't take those advanced types of measurements to tell individuals. So you do have to really be consistent with your choices and preparation, during and after, so that you can also learn how your body is responding and what a typical response is to exercise, following exercise so then you can better identify what is abnormal.

Julia Zumpano:

I agree with that. I think a lot of times, my patients will come to me and be like, "I don't feel thirsty. I never feel thirsty. I have to force myself to drink water." So I think thirst is relative. It's so hard. I think a lot of people think they're thirsty and they feel like they're hungry, so they overconsume food. I find that often, is that you almost have to train your body around feeling thirsty again.

And the more you drink, and some of those electrolyte drinks can actually help, because they're designed to kind of enhance thirst. So sometimes, I'll even have people start using those a little bit even before their exercise or during, just for the enhancement of that thirst feeling, just to be able to get them to get more fluid into their system, too.

John Horton:

And I think we spent a good bit of time talking about food and hydration and things like that. But one big topic I want to make sure that we get to here involves kind of supplements and powders. And those have just become so incredibly popular in the workout world. I know my sons, they lift every time they go, they're starting it with some powders and maybe some pre-workout and things like that. How important are those if you're going into a workout? I mean, are they beneficial? Are they just kind of extraneous things that we've just kind of been marketed, so we think it's going to do some wonderful things for us? How do they fit into the whole “Fueling for Fitness” program?

Dr. Erik Van Iterson:

Yeah, I think to put it simply, it comes down to personal preference. And in terms of … I think that the mental benefit that you perceive to be gaining through taking those supplements before you start the workout — because you don't really need those pre-workout drinks or food types to actually perform the exercise — but that it's more about the mental drive of … if there's caffeine in there, that's certainly going to be what you call an “ergogenic aid” to help you feel like you're energized. But the reality being, for a typical training session, you don't really need caffeine to perform for that less than 60-minute session. Perhaps for your event that you're doing, some caffeine can be helpful, assistive to the performance, but within moderation, of course.

Julia Zumpano:

Yeah, I agree. A lot of those pre-workout drinks are powders that have simple carbohydrates in them and then some caffeine added. So a simple carb could be like a juice, right? It's just you could do something like a fresh juice that you have, like an orange or an apple juice or a fruit and vegetable juice blend if you wanted something before, just to give you a little boost of carb that's easy, quick, easy digested into your bloodstream.

Caffeine has been shown to help. As Dr. Van Iterson said, it really has been shown to help increase your level of performance. Everyone's a little different. Caffeine can also be sensitive for certain people's stomachs, so it can actually be a stimulant, so that could create other issues. So it's a matter of, again, this trial and error, but a little caffeine and a little carbohydrate can go a long way, but it doesn't need to be in these expensive powders. It can be through real food that we have available in our homes.

John Horton:

Yeah. In your guys' view, are we at the point where some of these are being overused by people, that they think there's some sort of magical powder and they're going to take them to great heights?

Julia Zumpano:

I think, in some cases, they can because they can be high in calories. So you want to keep that in mind, too. I mean, you're burning calories, which is excellent, but do we really need these extra calories? And they're costly. They're very expensive, these powders. So you want to be cost-efficient at what you're purchasing.

So I would much rather have people use this money to buy fresh produce and whole foods, to really properly nourish their body with whole foods, not necessarily using powders that are supposedly going to help. And in some cases, they could. It's just, again, a trial and error. But I think in most cases, supplements can help meet needs, but most of the time, you can get it through diet.

Dr. Erik Van Iterson:

I fully agree with Julia on that point. And I think you can think of supplement, and the literal word of supplement, and that being on the rare occasion where you're running around, you have a busy schedule and you can't sit down and have a proper meal after your workout, or before the workout, because of situational sort of time constraints or responsibilities, but that in all other circumstances, eating properly, general heart-healthy diet, you should be delivering to your body the proper balance of nutrients, macronutrients, that your body can appreciate and perform with for the workout and the recovery. And so, you're spending a lot of money on supplements that you actually don't really need if you're doing the right thing for overall general heart health and dietary habits.

John Horton:

Yeah. It sounds like you really need to go into it in a thoughtful way. It shouldn't be a willy-nilly. You're just taking something with lightning bolts on it that's promising you big returns. Kind of really be thoughtful about why you're taking it and what you're hoping to accomplish with it.

Julia Zumpano:

When I think of supplements, I think of, we are supplementing what we cannot consume through our body, our diet. So when, as Dr. Van Iterson said, you're traveling, you're on the go, maybe you're doing a specific race or something where you're needing more than you're able to keep up with. That's when I think supplements can play a great role. Day-to-day, though, we shouldn't necessarily need to use supplements. We should be able to consume it through our diets.

Dr. Erik Van Iterson:

Yeah. And so, if you need sugar, eat an apple. That simple sugar in the apple is really the same simple sugar that you're going to get in that pre-workout drink. And if you need the caffeine, have a cup of coffee. And that cup of coffee is roughly 60 milligrams of caffeine, and that's generally going to be enough for that ergogenic aid benefit. You don't need the 200 milligrams of caffeine that the lightning-bolt can has for the performance. And that too much caffeine can actually have a counterproductive effect, and it loses its ergogenic benefit.

Julia Zumpano:

Yeah, I completely agree. I love to use green tea as well, as a little bit of a lower caffeine option. So coffee has between 60 to 100 milligrams per cup, but green tea has a little bit less than that. So we're looking at a little bit more like 35 to 55, 30 to 60, somewhere within that range.

John Horton:

And I'm really struck throughout this whole conversation — while it can sound complex when you're throwing out some numbers and figures and milligrams per kilogram and all this sort of stuff, sounds very complicated — but yet it seems like at its core, I mean, really, the whole “Fueling for Fitness” concept is really simple.

So if you want people to take some key points away from this discussion, what would it be? And let's start with you, Dr. Van Iterson.

Dr. Erik Van Iterson:

Yeah, I think that's a good way to conclude here. And I'd say keep it simple, and that, don't overthink what you need to eat or drink. Think about, what have you done to prepare for your workouts? How long is your workout, and what is the workout? Is it an event or is it an actual workout?

And I think, if it's not a long event, again, the 60-minute sort of golden marker, then you almost don't need to be thinking about, what should I be doing during that session? And you need to be more thinking about, what was I doing in the, I'd say, up to four hours prior to the session, with hydration and fuel. And that's going to be a better indicator of how you're going to feel during the workout. And then, following the workout, make sure that you're just eating, generally, a heart- healthy, balanced meal — and skip the supplements — and you're giving your body the glycogen regeneration replenishment and the protein for the repair and the rebuilding of broken-down tissues.

Julia Zumpano:

Yeah. My take-home message would be, listen to your body. That's most important. And eat real food, hydrate well, and just enjoy your workout, and don't be overly focused on the timing of exactly everything. It's just really proper nutrition, proper hydration and listening to your body.

John Horton:

Well, that's a perfect way to end things. I think we can all kind of go now and get our workout gear, and maybe look and make sure we had some fluids in and maybe a little snack and get to it. So thank you both very much for everything today, and just really bringing some life to an interesting topic.

Julia Zumpano:

Great discussion.

Dr. Erik Van Iterson:

Yeah. Thank you very much for having us. Appreciate the interest.

John Horton:

Julia, that was just a fabulous discussion. And I have to say, with all the numbers and data and facts that were thrown out there, the thing that really just jumped out to me was the notion of keeping it simple.

Julia Zumpano:

Absolutely. I mean, it comes down to listening and knowing your body, hydrating well and having nutrient-dense foods — supporting your body with good nutrition is what we're always talking about.

John Horton:

Yeah. And really tailoring what you eat and what you need to the activities that you're doing.

Julia Zumpano:

Absolutely. For most of us, our bodies will tell us what we need. If we're doing more intense workouts, maybe a longer length or we're training for something, then we might really need to meet with a registered dietitian or an exercise physiologist, to really get an idea of what our needs are and how to time that properly. But for most of us, just proper nutrition and hydration are key.

John Horton:

Perfectly said, Julia.

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Speaker 4:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.