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Christopher C. Webster, Jeroen Swart, Timothy D. Noakes and James A. Smith

This case study documents the performance of an elite-level, exceptionally well-fat-adapted endurance athlete as he reintroduced carbohydrate (CHO) ingestion during high-intensity training. He had followed a strict low-CHO high-fat (LCHF) diet for 2 y, during which he ate approximately 80 g of CHO per day and trained and raced while ingesting only water. While following this diet, he earned numerous podium finishes in triathlons of various distances. However, he approached the authors to test whether CHO supplementation during exercise would further increase his high-intensity performance without affecting his fat adaptation. This 7-wk n = 1 investigation included a 4-wk habitual LCHF diet phase during which he drank only water during training and performance trials and a 3-wk habitual diet plus CHO ingestion phase (LCHF + CHO) during which he followed his usual LCHF diet but ingested 60 g/h CHO during 8 high-intensity training sessions and performance trials. After each phase, rates of fat oxidation and 30-s sprint, 4-min sprint, 20-km time trial (TT), and 100-km TT performances were measured. Compared with LCHF, 20-km TT time improved by 2.8% after LCHF + CHO, which would be a large difference in competition. There was no change in 30-s sprint power, a small improvement in 4-min sprint power (1.6%), and a small reduction in 100-km TT time (1.1%). The authors conclude that CHO ingestion during exercise was likely beneficial for this fat-adapted athlete during high-intensity endurance-type exercise (4–30 min) but likely did not benefit his short-sprint or prolonged endurance performance.

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Christopher C. Webster, Kathryn M. van Boom, Nur Armino, Kate Larmuth, Timothy D. Noakes, James A. Smith and Tertius A. Kohn

Very little is known about how long-term (>6 months) adaptation to a low-carbohydrate, high-fat (LCHF) diet affects insulin signaling in healthy, well-trained individuals. This study compared glucose tolerance; skeletal muscle glucose transporter 4 (GLUT4) and insulin receptor substrate 1 (IRS1) content; and muscle enzyme activities representative of the main energy pathways (3-hydroxyacetyl-CoA dehydrogenase, creatine kinase, citrate synthase, lactate dehydrogenase, phosphofructokinase, phosphorylase) in trained cyclists who followed either a long-term LCHF or a mixed-macronutrient (Mixed) diet. On separate days, a 2-hr oral glucose tolerance test was conducted, and muscle samples were obtained from the vastus lateralis of fasted participants. The LCHF group had reduced glucose tolerance compared with the Mixed group, as plasma glucose concentrations were significantly higher throughout the oral glucose tolerance test and serum insulin concentrations peaked later (LCHF, 60 min; Mixed, 30 min). Whole-body insulin sensitivity was not statistically significantly different between groups (Matsuda index: LCHF, 8.7 ± 3.4 vs. Mixed, 12.9 ± 4.6; p = .08). GLUT4 (LCHF: 1.13 ± 0.24; Mixed: 1.44 ± 0.16; p = .026) and IRS1 (LCHF: 0.25 ± 0.13; Mixed: 0.46 ± 0.09; p = .016) protein content was lower in LCHF muscle, but enzyme activities were not different. We conclude that well-trained cyclists habituated to an LCHF diet had reduced glucose tolerance compared with matched controls on a mixed diet. Lower skeletal muscle GLUT4 and IRS1 contents may partially explain this finding. This could possibly reflect an adaptation to reduced habitual glucose availability rather than the development of a pathological insulin resistance.

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James M. Rhodes, Barry S. Mason, Bertrand Perrat, Martin J. Smith, Laurie A. Malone and Victoria L. Goosey-Tolfrey


To quantify the activity profiles of elite wheelchair rugby (WCR) players and establish classification-specific arbitrary speed zones. In addition, indicators of fatigue during full matches were explored.


Seventy-five elite WCR players from 11 national teams were monitored using a radio-frequency-based, indoor tracking system across 2 international tournaments. Players who participated in complete quarters (n = 75) and full matches (n = 25) were included and grouped by their International Wheelchair Rugby Federation functional classification: groups I (0.5), II (1.0–1.5), III (2.0–2.5), and IV (3.0–3.5).


During a typical quarter, significant increases in total distance (m), relative distance (m/min), and mean speed (m/s) were associated with an increase in classification group (P < .001), with the exception of groups III and IV. However, group IV players achieved significantly higher peak speeds (3.82 ± 0.31 m/s) than groups I (2.99 ± 0.28 m/s), II (3.44 ± 0.26 m/s), and III (3.67 ± 0.32 m/s). Groups I and II differed significantly in match intensity during very-low/low-speed zones and the number of high-intensity activities in comparison with groups III and IV (P < .001). Full-match analysis revealed that activity profiles did not differ significantly between quarters.


Notable differences in the volume of activity were displayed across the functional classification groups. However, the specific on-court requirements of defensive (I and II) and offensive (III and IV) match roles appeared to influence the intensity of match activities, and consequently training prescription should be structured accordingly.