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Review
. 2024 Jan 26:6:1264814.
doi: 10.3389/fspor.2024.1264814. eCollection 2024.

The acute effects of pre- and mid-exercise carbohydrate ingestion on the immunoregulatory stress hormone release in experienced endurance athletes-a systematic review

Tabea Christ  1 , Miriam Ringleb  1   2   3 , Simon Haunhorst  2   4 , Lena Fennen  1 , Paul M Jordan  5 , Heiko Wagner  1 , Christian Puta  2   4   6
Affiliations
Review

The acute effects of pre- and mid-exercise carbohydrate ingestion on the immunoregulatory stress hormone release in experienced endurance athletes-a systematic review

Tabea Christ et al. Front Sports Act Living. .

Abstract

Background: In times of physical stress, the body orchestrates a multisystemic regulatory response. The hormones epinephrine and norepinephrine play a role in the immediate regulation chain, while cortisol is involved in delayed regulation. The release of those stress hormones in response to exercise has previously been reported to elicit diverse immune reactions.

Objective: The aim of this systematic review was to examine and present the acute effects of immediate pre- and mid-exercise carbohydrate ingestion on cortisol, epinephrine and norepinephrine levels in experienced endurance athletes.

Methods: A systematic literature search was conducted using PubMed, Cochrane Library and Web of Science in accordance with PRISMA guidelines up to February 2023. Randomized controlled trials in English or German language were included if baseline and at least two follow-up measures of blood plasma or serum of chosen stress hormones (cortisol, epinephrine, norepinephrine) were collected in response to prolonged continuous endurance activity. Eligibility furthermore required an acute carbohydrate ingestion of at least 30 g of carbohydrates per hour no more than 30 min before start of the exercise, as well as a placebo-controlled study design.

Results: Eleven studies of moderate to high quality were included in this review. Carbohydrate ingestion of at least 30 g per hour was able to attenuate rises in cortisol concentration in majority of the included studies. Epinephrine levels were considerably lower with ingestion of carbohydrates compared to placebo in all studies. Norepinephrine concentrations were largely unaffected by acute carbohydrate feeding.

Conclusion: Pre- and mid-exercise ingestion of carbohydrates seems an effective dietary strategy to attenuate rises in cortisol and epinephrine levels and, thus, an effective countermeasure for endurance exercise-induced increases in stress hormone levels.

Keywords: carbohydrates; dietary strategy; endurance exercise; immunonutrition; stress hormones.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Flow chart of literature search and study selection.
Figure 2
Figure 2
Immediate effects cortisol expressed in change in %; *significant group × time interaction at p < 0.05 (differences from baseline values) and Hedge's g effect size.
Figure 3
Figure 3
Follow-up effects cortisol expressed in change in %; *significant group × time interaction at p < 0.05 (differences from baseline values) and Hedge's g effect size.
Figure 4
Figure 4
Immediate effects epinephrine expressed in change in %; *significant group × time interaction at p < 0.05 (differences from baseline values) and Hedge's g effect size.
Figure 5
Figure 5
Follow-up effects epinephrine expressed in change in %; *significant group × time interaction at p < 0.05 (differences from baseline values) and Hedge's g effect size.
Figure 6
Figure 6
Immediate effects norepinephrine expressed in change in %; *significant group × time interaction at p < 0.05 (differences from baseline values) and Hedge's g effect size.
Figure 7
Figure 7
Follow-up effects norepinephrine expressed in change in %; *significant group × time interaction at p < 0.05 (differences from baseline values) and Hedge's g effect size.
See this image and copyright information in PMC

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