Quick Hit Summary

In order to maximize a training session, it appears that consuming a post workout shake/meal is necessary. Although most individuals take protein, an alarming number forget to take carbohydrates. Carbohydrates assist in creating the optimal anabolic environment. It accomplishes this by raising insulin, decreasing cortisol and refueling glycogen stores. This latter part, quickly replenishing glycogen stores, is especially important for those athletes working out 2x/day. Additionally, THE BODY NEEDS ENERGY and it can only utilize so much protein for muscle building purposes. Although you can continue to feed your body more protein, it’s much more economical to spend your money on carbohydrates. Although it must be individualized for the person and the workout they’re doing, I recommend a base of at least 20-30g of high quality protein that contains 10+ g of essential amino acids; Some research has indicated that 20 grams of protein (~0.11 g/lb or ~0.05 g/kg <— breakdown of 20 g per average subject body weight in study) was just as effective as 40 grams of protein at stimulating muscle protein synthesis. With respect to carbohydrates, I’ll go anywhere from a 1:1 – 1:3 ratio of PRO:CHO depending on factors related to to intensity of session, type of session (sprinting vs. ball sport practice vs. weight lifting session) if the athlete has a 2nd workout later in the day, if he/she is trying to lose/gain weight, etc.

Post Workout Nutrition

Is your post workout nutrition measuring up?⁴¹

Previously, I’ve discussed the general goals of post workout nutrition . I then followed it up with research looking about the type, timing and amount of protein to include in you post workout recovery shake/meal (Post Workout Nutrition for Ball/Speed/Strength Athletes Part I). In this concluding segment, I’d like to look at the importance of carbohydrates as part of the post workout meal/shake for ball/speed/strength athletes.

The Importance of Carbohydrates

One of the common mistakes made by strength athletes following a training session is ignoring carbohydrates (CHO) in their post workout shake/meal. Unfortunately, there seems to be a nasty stigma associated with carbohydrates. Although, I understand the argument made by the anti-carbohydrate crowd with respect to gaining fat mass, I must stress that CHO are not “The Devil.” The key thing that strength athletes need to realize is that carbohydrates don’t make you fat. Rather, excessive CHO at the wrong time of the day make you fat. After an intensive workout, CHO are extremely beneficial (assuming they’re not taken in excess). Numerous times I’ve seen athletes down 40-50+ grams of protein in a “low carb” or “no carb” post workout shake. When asking them why they are doing this, I usually get 1 of 2 responses:

Response 1: “CHO, Why would I want to add them into my shake? Everyone knows carbs make you gain weight. I’m trying to lose body fat. Besides, carbs are only useful for endurance athletes. I play football so it’s not like I’m trying to refill my glycogen stores.”

Response 2: “I thought it wasn’t a big deal. I bought a container of Brand “X” Post-Workout Protein Supplement and the directions just say to mix 2 HEAPING scoops of protein into 8 oz. of water shortly after completing a workout. It doesn’t mention anything about CHO.”

To these athletes I share the following ideas:

I’d be lying to you if I said refilling glycogen stores is a big issue for individuals who resistance train for non-sport reasons. However, as explained in a previous article, Post Workout Nutrition, many individuals lift weights in preparation for a specific sporting contest (football, track, etc). Take your typical high school athlete. After depleting their glycogen stores following 6-8 hours of sleep, they wake up early to lift weights prior to the start of the school day. Maybe they grab a bite to eat prior to going to the weightroom. On the other hand, maybe they slept in till the last minute possible and don’t have time to eat before heading out the door. They lift weights for 60-75 minutes, jump in the locker room shower, and hurry off to classes, trying not to be late. If you’re like most of my friends when I was in high school, somewhere in that time-span, you may down a pop-tart or granola bar containing something like ~30g of CHO and ~2-8 grams of protein. In my situation, classes started at 8:00 AM, meaning that I was probably eating this at 7:45 AM. Considering we didn’t eat lunch until 12:35 PM (missing the 4 hours post workout where the rate of glycogen synthesis is at its highest), there is a solid chance that my glycogen stores are less than optimal heading into my respective sport practice at 3:45pm. Due to low glycogen stores, I probably fatigued earlier, causing lackluster performances on the practice field. String together enough bad practices and eventually performance on game day will suffer.

For the non-sport athletes who train just for aesthetic or general health reasons I still recommend carbohydrates post workout. For two simple reasons- 1) Creating an optimal anabolic environment and 2) The human body NEEDS ENERGY.

Creating the Optimal Anabolic Environment: Decreasing Cortisol While Increasing Insulin Levels.

Insulin

Within the last 10-15 years, the exact role that insulin plays in muscle growth has puzzled researchers. At one time (1995), results from one study suggested that insulin alone may stimulate protein synthesis²³. However, 4 years later, a shadow of doubt was cast on this hypothesis. In a study completed by Biolo et al. researchers found that the infusion of insulin did not further stimulate protein synthesis in men following a resistance training session²⁴. They theorized that insulin stimulates protein synthesis only when working muscles had increased access to amino acids. To test this theory, Miller et al. had volunteers (6 male, 4 female) complete 3 bouts of resistance exercise²⁵. After completion of each workout individuals consumed 1 of 3 supplemental drinks immediately and again 1 hour after exercising. The 3 drinks were carbohydrate only (0.23g CHO/lb), protein, in the form of amino acids (6 grams), or a combination of both (0.23g carb/lb+ 6 g PRO). CHO alone did not significantly improve protein synthesis. Although amino acids alone increased protein synthesis, this effect was amplified when taken with carbohydrates. Thus, Miller et al. concluded that carbohydrates only promoted protein synthesis when taken with protein.

In a recent, well-designed study, Greenhaff et al. provided some of the clearest evidence of the role that insulin plays on muscle tissue growth.²⁶ In their study, 8 men (mean age- 20.4 years) completed four different trials. To ensure that ample amounts of amino acids were available for muscle anabolism, participants received 18g of protein/hour via IV during each trial. In addition, the IV also included insulin at concentrations of 5, 30, 70 and 170 mU/l as these represented insulin concentrations while in fasted (5 mU/l), fed (30, 70 mU/l) and supra-physiological (170 mU/l)states. At the lowest dose (5 mU/l of insulin) muscle protein synthesis increased (vs. baseline levels) while no effect was seen in muscle protein breakdown (remember, muscle growth/anabolism = protein synthesis – protein breakdown; commonly forgotten by most is that both processes can go on at the same time in muscle). At the remaining insulin doses(30, 70, 170 mU/l), no further increase was seen in protein synthesis. However, when going from 5 mU/l (insulin concentration while fasted) to 30 mU/l (fed state) of insulin, muscle protein breakdown was reduced by 50%. Further elevations in insulin doses (70, 170 mU/l) had no further effect on protein breakdown. The results of this study provide solid evidence that amino acids alone (as indicated when giving a “fasted” level of insulin) stimulates protein synthesis but has little effect on preventing muscle proteolysis (muscle breakdown). On the other hand insulin plays a minor role (if any) on protein synthesis but has a significant role on preventing muscle proteolysis when amino acids are present.

Cortisol

Insulin has been shown to decrease sarcoplasmic protein breakdown (non contractile protein) in skeletal muscle. However, the possible role of insulin on contractile proteins is still a topic of debate. Bird et al.²⁷ investigated the effects of various macronutrients on muscle protein breakdown following a resistance training workout. Additionally, they sought to find if changes in either insulin or cortisol levels were associated with post-workout muscle proteolysis (the destructive nature of cortisol was discussed in Goals of Post Workout Nutrition) In their study, 32 men (mean age- 21 years) were given the following beverages during a resistance training session:

• Placebo (non caloric flavored drink)
• Carbohydrates (~ 675 ml of a Gatorade beverage)
• Essential Amino Acids (6 g)
• EAA (675 ml of a Gatorade, 6g EAA’s)

Compared to taking the placebo, consuming either the CHO or EAA supplement tended to decrease myofibrillar proteolysis over a 48 hour time span²⁷. However, when taken together, CHO+EAA, significantly reduced muscle myofibrillar protein breakdown (27% vs. placebo) suggesting they have a synergistic effect when combined. Data also indicated that the protective effect seen with this supplement combination was a result of decreased cortisol levels rather than increased insulin. In other words, taking the carbohydrates, in addition to the protein, significantly decreased cortisol levels vs. the placebo treatment. As a result, contractile proteins in muscle tissue were preserved following the resistance training bout. Also worth mentioning at this time, protein is not required to decrease cortisol levels. Multiple studies have demonstrated that carbohydrates alone significantly attenuates the cortisol release commonly observed after intense exercise²⁸⁴⁰.

Are Carbohydrates Still Needed if we Take High Doses of Protein?

The study completed by Bird et al. used relatively small amounts of PRO (6g EAA).²⁷ However, in real world application, most individuals take 20+ grams of PRO following a workout. Thus, the question remain, are carbohydrates still required in a post-workout shake/meal when ample protein is required? To answer this question, Koopman et al. had 10 untrained males (mean age 20.1 years) complete 3 resistance training sessions. After each session, participants took 1 of 3 beverages for 6 hours:

• PRO only (casein hydrolysates)- 0.136 g PRO/lb/hr
• PRO+ Low CHO- 0.136 g PRO/lb/hr + 0.07 g CHO/lb/hr
• PRO+ High CHO- 0.136 g PRO/lb/hr + 0.27 g CHO/lb/hr

For reference, a 150 lb person would take 20 g PRO/hour + 10 or 40g CHO/hr (depending on drink combination).

Over the 6 hour post exercise measurement period, there was no difference in protein synthesis between any of the groups. In other words, adding CHO to the PRO drink did not further stimulate protein synthesis. Also, no difference was present in WHOLE BODY proteolysis. Individuals in PRO only crowd commonly cite this as evidence that CHO are not required in post workout shakes to prevent muscle protein breakdown. This is a somewhat large leap to make though, as whole body proteolysis is not always reflective of muscle proteolysis. Unfortunately, Koopman et al. did not measure muscle protein breakdown or cortisol levels following the ingestion of the various supplements. However, they did provide indirect evidence (based off plasma and muscle BCAA levels) that muscle proteolysis was reduced when carbohydrates were taken along with the protein drink (vs. protein alone). More research, directly measuring muscle proteolysis, still needs to be completed in this area.

UPDATE In July, 2011, a new study completed by researchers at McMaster University provided direct evidence that high doses of protein were able to stimulate a high enough insulin spike to inhibit protein breakdown. In the study, 9 men performed 2 exercise bouts; 1 involved the ingestion of 25g of whey protein (providing 10g of essential amino acids) and the other involving 25 g whey + 50 g of CHO. The addition of CHO did not further either muscle protein synthesis or decrease muscle protein breakdown vs. protein alone.⁴²

In summary, CHO assist in creating the anabolic environment required to maximize muscle growth and refill glycogen stores. This is accomplished by decreasing the release of the catabolic hormone cortisol (which acts to breakdown contractile proteins in muscles) while increasing the release of the anabolic hormone insulin.

How Much Carbohydrate is Needed?

So how much CHO should one consume following a resistance training session? Unfortunately, there has been little direct research on this topic. Furthermore, the amount of CHO that are required can vary greatly depending on how exhausting of a workout you completed. For instance, your post-workout CHO intake will need to be greater following a hypertrophy based training session vs. max strength exercise session. This occurs because hypertrophy sessions deplete glycogen to a much larger extent than max strength sessions. Additional things to consider include the type of training session completed(sprinting vs. ball sport practice vs. weight lifting session), if the athlete has a 2nd workout later in the day, if he/she is trying to lose/gain weight, etc.

As you can see, this question is a little trickier to answer compared to post-workout protein requirements. In attempts to answer this question, one has to understand physiology. Dietary CHO have three fates: burned immediately for energy, stored as glycogen, and fat. Although these processes overlap with each other (ie-one doesn’t go 100% and then shut off as the other one turns on), they generally occur in the order that I have them listed above. Although we don’t want dietary carbohydrates to be stored as fat, we do want to take enough carbohydrates assist in the replenishment of glycogen stores.

After a glycogen depleting workout, its been shown that a 0.54g CHO/lb/hr maximizes glycogen replenishment³⁵. Thus, many “experts” recommend that all athletes need to take this after an exercise session. However, this study was carried out on individuals after a glycogen depleting endurance workout. Also, the goal of this study was to replenish glycogen stores as fast as possible. Yet, for the resistance trained athlete (who is not completing multiple workouts/day) the rate at which glycogen is replaced is not a big issue. Plus, glycogen levels are probably not depleted to the same extent as those after endurance exercise. Thus I usually recommend a 1:1 or 1:2 ratio with respect to PRO:CHO. If you’re a ball/speed sport athlete or looking to gain weight, I may bump it up to a 1:3 ratio. Again all of this varies based off ones personal training goals. Listen to your body, if you’re extremely hungry JUST EAT MORE (unless you have weight issues and are trying to cut back).

Energy Requirements

Often individuals get so caught up in hormone levels, protein synthesis, etc., they forget one of the most fundamental concepts of post-workout nutrition… THE BODY NEEDS ENERGY FOR GROWTH!

Let’s assume that consuming PRO alone can maximize the anabolic environment for post-workout muscle growth. (In other words, completely ignore the fact that CHO are required to prevent excessive muscle proteolysis following an intense workout). It’s been shown that roughly ~0.11 g of PRO/lb of bodyweight maximizes the rate of protein synthesis following a bout of resistance training³⁹. Let’s assume that due to dieting, training protocol, genetics, etc, your body requires 150% more protein (~0.165PRO/lb) than the amount found to maximize protein synthesis in the participants of that study. For the 200 lb individual who has increased PRO needs, this comes out to 33 grams in his/her post-workout shake. Now, do some calculations based off your own body weight (feel free to choose either 0.11 or 0.165g PRO/lb) and think about how you physically feel following an exhaustive exercise session. After consuming this much protein following an intense training session, do you feel satisfied for the next 60-90 minutes? Based off my experience, I’d probably conclude that taking only this amount of protein will leave you pretty hungry within 40-60 minutes.

Yes, you could consume more PRO to meet your energy needs (although it won’t refill glycogen stores with the same speed as simply taking a little CHO or further stimulate muscle protein synthesis). However, looking at it from purely an economic perspective, taking outrageous doses of protein just doesn’t make sense.

PRO is an extremely expensive macronutrient compared to CHO. Most individuals use PRO supplements as their primary source of protein following resistance training sessions. The recommended retail value for NOW’s Whey Protein Isolate® is $81.99/5 lbs or $16.40/lb³¹. Now let’s compare that to NOW’s Carbo Gain® which has a recommended list price of $27.99/8 lbs or $3.50/lb³². For those who enjoy taking carbohydrates as whole food sources (such as smoothies, etc) vs. supplements, take a look a look at Dole’s Frozen Mixed Berry® mix which costs $3.92/12 ounces or $5.23/lb³³. Even taken the higher of these two carbohydrate sources (Dole’s Frozen Mixed Berries®), it’s still ~1/3 the price of NOW’s Whey Protein Isolate®. Furthermore,comparing protein and carbohydrates on a per gram basis, with respect to kcal content, is like comparing apples to oranges. Due to its chemical structure, the body is less efficient breaking down protein than carbohydrates. In fact, ~20% of the energy in a protein rich meal is lost while metabolizing protein (vs. only 5-10% in CHO)³⁴.

Pulling Everything Together

Although the research presented in this article was mostly specific to nutrition following resistance training sessions, most of it can be applied to ball/speed sport athletes as well.

Type of Shake/Meal

The main goals of post-workout nutrition are to create an anabolic environment within one’s body to support tissue growth. For strength/ball/speed sport athletes, this is best accomplished by consuming both protein and carbohydrates. I recommend whey protein isolate (assuming one is not allergic to dairy proteins) to accomplish this goal. Don’t break your bank purchasing whey isolate. Currently I cannot justify paying the added cost to purchase whey hydrolysates vs. isolates due to the lack of supporting research (please read Part 1 of this article for further discussion). If you are allergic to dairy protein and take egg protein, there is some evidence indicating that egg hydrolysates are absorbed faster than their intact protein form³⁶.

In order to minimize the rise in cortisol levels while simultaneously stimulating insulin release, high glycemic carbohydrates are recommended in the post-workout shake/meal. Unlike whey protein isolate, which is impossible to get in large quantities from natural food sources, high glycemic carbohydrates can be obtained from either supplemental (maltodextrin) or whole food sources (GI Food Chart) depending on your personal preferences. Just stay clear of stuff that contains high amounts of the lipogenic fructose.

Timing of Shake/Meal

There is evidence suggesting that it doesn’t really matter if you have your post-workout shake/meal 0, 1, or 3 hours following the completion of a workout in order to maximize muscle protein synthesis. However, muscle anabolism = protein synthesis – protein breakdown. Immediately following exercise, muscle breakdown (proteolysis) exceeds synthesis due to mechanical and hormonal stress²⁷. The hormonal stress is caused by the increased release of cortisol which breaks down contractile proteins. Although cortisol levels significantly increase during and after an intense training session [27], insulin levels stay the same following both moderate and intense lifting sessions²⁸.Therefore, I recommend taking a shake/meal immediately after the completion of a workout simply to spike insulin and reduce cortisol simply to limit muscle proteolysis. Does this mean you need to down a shake immediately as you rack the weight for the final time? Probably not, but I suggest taking it before too much time has passed upon completing the workout.

Also, consume another shake/meal within 60-90 minutes following the first shake/meal. When participants (male and female) consumed multiple supplemental shakes following a training session(6 grams amino acids³⁷ or 6 grams of amino acids + 35 g glucose²⁵), it was found that the increase in protein synthesis from the 2nd shake was equal to that following the 1st shake. One note of caution, 6 grams of amino acids is a relatively low intake compared to my recommendations (~15-30 grams depending on bodyweight). I can’t say with certainty that this same effect would occur if one took higher amounts of protein during the first drink.

Figure 2 Changes in protein synthesis following multiple protein & carbohydrate drinks. PLEASE NOTE THAT THIS IS NOT AN EXACT REPLICA OF ANY PREVIOUSLY PUBLISHED WORK. NOR IS IT INTENDED TO BE AN EXACT REPLICA. This is merely a trend I’ve seen while looking at multiple studies.

As you can see, the same anabolic effect was seen after the 2nd drink (taken at 60 minutes) as there was after the 1st drink (taken at 0 minutes). Also, please note how muscle protein synthesis dropped after 120 minutes. This was observed in a study by Børsheim et al. who observed decreased protein synthesis despite a continuous high supply of amino acids present following a resistance training session followed by multiple protein drinks. Remember, keeping a continuous high supply of amino acids in the blood stream does not lead to a continuous high rate of muscle protein synthesis (read Part 1 of this article for greater detail on this subject).

Macronutrient Profile of Shake/Meal

I recommend that the 1st post-workout shake/meal consist of 0.23 g CHO/lb/hr and ~0.11 grams PRO/lb. If one has a 2nd training session or sport practice later in the day, increase the carbohydrate content up to 0.55 g CHO/lb. Remember, rapidly replenishing glycogen stores is of greater importance for these athletes. As alluded to above, another easy approach one can take is to simply consume usually recommend a 1:1 or 1:2 ratio with respect to PRO:CHO. If you’re a ball/speed sport athlete or looking to gain weight, I may bump it up to a 1:3 ratio.

For the 2nd post-workout shake/meal, stay with the same macronutrient recommendations listed above (if trying to gain weight) or decrease them if you are looking to maintain or lose weight. Remember, it took only 6 grams of amino acids to stimulate the increase in muscle protein synthesis, so one can probably be stingier with protein during this shake/meal without losing out on any significant benefits (assuming the protein source contains the branch chain amino acids- leucine, isoleucine and valine). One thing I would probably not decrease is the carbohydrate content. I realize that most of you are probably thinking that I’m crazy for saying this, but remember, your body handles carbohydrates most efficiently following a workout. Since the human body requires “X” amount of carbohydrates during the day, why not take them now vs. later in the day when the body poorly handles them³⁸? Just don’t go overboard on them as you don’t need to be storing them as fat!

Please note that nothing horrible will happen to you if you go over these recommended intakes (although you may get a little fatter if you eat a 1000 kcal fast food shake vs. those recommended in this article!). It’s just that at these levels, the ability to build muscle appears to be maximally stimulated during the post workout time period.

Bottom Line

In conclusion, there are various steps one can take to maximize the training effects of his/her workout. Chief among these is attending to ones post-workout nutrition. As I’ve presented in this article, muscle anabolism is best achieved through the intake of both carbohydrates and protein following an intense training session.

Dole Mixed Berries is a trademark or registered trademark of Dole Food Company, Inc.

Carbo Gain is a trademark or registered trademark of NOW Foods.

References

²³ Biolo G, Declan Fleming RY, Wolfe RR. Physiologic hyperinsulinemia stimulates protein synthesis and enhances transport of selected amino acids in human skeletal muscle. J Clin Invest. 1995 Feb;95(2):811-9.

²⁴ Biolo G, Williams BD, Fleming RY, Wolfe RR.Insulin action on muscle protein kinetics and amino acid transport during recovery after resistance exercise. Diabetes. 1999 May;48(5):949-57.

²⁵ Miller SL, Tipton KD, Chinkes DL, Wolf SE, Wolfe RR.Independent and combined effects of amino acids and glucose after resistance exercise. Med Sci Sports Exerc. 2003 Mar;35(3):449-55.

²⁶ Greenhaff PL, Karagounis LG, Peirce N, Simpson EJ, Hazell M, Layfield R, Wackerhage H, Smith K, Atherton P, Selby A, Rennie MJ. Disassociation between the effects of amino acids and insulin on signaling, ubiquitin ligases, and protein turnover in human muscle. Am J Physiol Endocrinol Metab. 2008 Sep;295(3):E595-604. Epub 2008 Jun 24.

²⁷ Bird SP, Tarpenning KM, Marino FE.Liquid carbohydrate/essential amino acid ingestion during a short-term bout of resistance exercise suppresses myofibrillar protein degradation. Metabolism. 2006 May;55(5):570-7.

²⁸ Tarpenning KM, Wiswell RA, Hawkins SA, Marcell TJ. Influence of weight training exercise and modification of hormonal response on skeletal muscle growth. J Sci Med Sport. 2001 Dec;4(4):431-46.

²⁹ Bird SP, Tarpenning KM, Marino FE. Independent and combined effects of liquid carbohydrate/essential amino acid ingestion on hormonal and muscular adaptations following resistance training in untrained men. Eur J Appl Physiol. 2006 May;97(2):225-38. Epub 2006 Mar 24.

³⁰ Koopman R, Beelen M, Stellingwerff T, Pennings B, Saris WH, Kies AK, Kuipers H, van Loon LJ. Coingestion of carbohydrate with protein does not further augment postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab. 2007 Sep;293(3):E833-42. Epub 2007 Jul 3.

³¹ NOW Whey Protein Isolate, Chocolate- 5 lbs. Nutribodies. Accessed December 10, 2009 from: http://www.nutribodies.com/index.php?l=product_detail&p=116.

³² NOW Carbo Gain- 8 lb. Nutribodies. Accessed December 10, 2009 from: http://www.nutribodies.com/index.php?l=product_detail&p=36.

³³ Dole Mixed Berries. Metcalfe’s on the Go. 2009. Accessed December 10, 2009 from: http://shop.mywebgrocer.com/shop.aspx?&sid=34507956&sid_guid=a385af6b-5e77-48f2-bdc6-fdb804cf31e6&strid=C2B0158&ns=1.

³⁴ Wardlaw GM, Hample JS, DiSilvestro RA. Perspectives in Nutrition. 6th ed. 2004. McGraw-Hill Companies. Pages 456-57.

³⁵ van Loon LJ, Saris WH, Kruijshoop M, Wagenmakers AJ. Maximizing postexercise muscle glycogen synthesis: carbohydrate supplementation and the application of amino acid or protein hydrolysate mixtures. Am J Clin Nutr. 2000 Jul;72(1):106-11.

³⁶ Grimble GK, Rees RG, Keohane PP, Cartwright T, Desreumaux M, Silk DB. Effect of peptide chain length on absorption of egg protein hydrolysates in the normal human jejunum. Gastroenterology. 1987;92:136–42.

³⁷ Børsheim E, Tipton KD, Wolf SE, Wolfe RR. Essential amino acids and muscle protein recovery from resistance exercise. Am J Physiol Endocrinol Metab. 2002 Oct;283(4):E648-57.

³⁸ Lee A, Ader M, Bray GA, Bergman RN. Diurnal variation in glucose tolerance. Cyclic suppression of insulin action and insulin secretion in normal-weight, but not obese, subjects. Diabetes. 1992 Jun;41(6):742-9.

³⁹ Moore DR, Robinson MJ, Fry JL, Tang JE, Glover EI, Wilkinson SB, Prior T, Tarnopolsky MA, Phillips SM. Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men. Am J Clin Nutr. 2009.

⁴⁰ Venkatraman JT, Pendergast DR. Effect of dietary intake on immune function in athletes. Sports Med. 2002;32(5):323-37.

⁴¹ Photo by kteague. Accessed June 14 from: flickr.com/photos/49503205198@N01/3335735763

⁴² Staples AW, Burd NA, West DW, Currie KD, Atherton PJ, Moore DR, Rennie MJ, Macdonald MJ, Baker SK, Phillips SM.Carbohydrate Does Not Augment Exercise-Induced Protein Accretion versus Protein Alone. Med Sci Sports Exerc. 2011 Jul;43(7):1154-61.