Gesellschaft für Orthopädisch-Traumatologische Sportmedizin

Ernährung und Sport

Sehr geehrte Damen und Herren,

der Zusammenhang zwischen Ernährung und Sport wird vielfach unterschätzt. Dabei können sinnvolle Maßnahmen – und teilweise auch Verzicht – durchaus leistungssteigernd wirken. Was vor diesem Hintergrund gleichermaßen für Spitzen- und Freizeitsportler von Bedeutung ist, warum die sogenannten Smoothies eine adäquate Ergänzung und Alternative sein können und welchen Einfluss die Ernährung auch auf den Schlaf-Wach-Rhythmus hat, beschreibt der aktuelle GOTS-Newsletter unseres Experten Dr. med. Klaus Pöttgen.

Mit freundlichen Grüßen,
Ihr Andreas Bellinger, GOTS-Pressesprecher presse@gots.org


Der 32. Jahreskongress der Gesellschaft für Orthopädisch-Traumatologische Sportmedizin (GOTS) wird vom 22. bis 24. Juni 2017 im Grand Hotel Esplanade in Berlin stattfinden. Unter anderem Prof. Dr. Ingo Froböse von der Deutschen Sporthochschule in Köln wird dabei neue Verfahren und Erkenntnisse in der Rehabilitation von Sportverletzungen vorstellen. Ebenso wird der Straubinger Knie-Spezialist, Priv.-Dozent Dr. Thore Zantop, zum Thema “return to competition” nach Verletzungen des Vorderen Kreuzbandes Klarheit schaffen, welche Abschnitte der Rehabilitation notwendig sind und welche Messparameter benötigt werden, um einen Sportler voll belastungsfähig in den Wettkampf zurückzugeben. Bereits am PreDay (22. Juni 2017) erwarten Sie interdisziplinäre Workshops und ein eigenes Programm der Young Academy. Weitere Informationen entnehmen Sie bitte der Kongresswebsite (www.gots-kongress.org) sowie dem Anhang dieses Newsletters.


Wir möchten Sie zudem auf drei Veranstaltungen hinweisen: Im Rahmen der Zusatzweiterbildung “Spezielle Orthopädische Chirurgie” bietet die Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC) vom 9. bis 11. März 2017 einen Kursus zum Thema Knie in der Berliner Aesculap Akademie an (Anmeldung unter www.intercongress.de). Am Samstag, dem 25. März 2017, lädt der sportmedizinische Arbeitskreis Ludwigsburg zum Symposium “Prävention und Regeneration im Sport” ins Reha-Zentrum Hess in Bietigheim-Bissingen ein (www.sportmed-lb.de). Zu Ihrem Jahreskongress treffen sich die Landesinnungen Bayern für Orthopädie-Schuhtechnik und Orthopädie-Technik vom 24. bis 26. März 2017 im Kongresshaus Garmisch-Partenkirchen. Weitere Informationen bieten die Flyer im Anhang dieses Newsletters.

Ernährung und Sport: Was hilft – was schadet?

Jede Belastung führt in der beanspruchten Muskulatur durch Anpassung zu einem Anstieg der Proteinbiosynthese sowie zur Spezifizierung der Muskulatur und deren Fasertypen. Die Ausprägung ist im Sport dabei abhängig von der jeweiligen Trainingsform. Ebenso führen eine Reduzierung der Belastung oder sogar eine komplette Ruhigstellung/Unbeweglichkeit, zu der es beispielsweise wegen einer gravierenden Verletzung kommen kann, zum Abbau von Muskelmasse.

Dies ist sowohl mit einem Funktionsverlust der Muskulatur durch Atrophie und katabole Prozesse verbunden als auch mit einer verminderten Proteinbiosynthese. Eine verminderte Proteinbildung in Muskeln und Sehnen sowie eine verminderte Stimulierung durch Aminosäuren führen aber zu einem raschen und dramatischen Abbau von Muskelgröße und Muskelkraft sowie Sehnenstruktur und ihrer Funktion – was vor allem nach Verletzungen relevant ist.

Die Deutsche Gesellschaft für Ernährung (DGE) beziffert den täglichen Proteinbedarf auf 0,8 bis 1,2 Gramm pro Kilogramm Körpergewicht. Leistungssportler haben allerdings einen deutlich höheren Bedarf, der bis zu 2 Gramm pro Kilogramm Körpergewicht betragen kann. Dabei führt eine Proteinaufnahme von unter 1 Gramm pro Kilogramm Körpergewicht bei Leistungssportlern sogar zu einer negativen Stickstoffbilanz.

Eine erhöhte Proteinbiosynthese wird im Wesentlichen erzeugt durch:

Stress und Übertraining haben beispielweise einen Anstieg des Cortisols und einen Abfall des Testosterons zur Folge. Die Herzfrequenzvariabilität (HRV) verschlechtert sich. Daraus wird ersichtlich und klar, warum sich Entspannung, Yoga, physikalische Maßnahmen und Schlaf indirekt positiv auf die Einbauraten auswirken können. Entzündungshemmende und schmerzlindernde Substanzen wie die Kortison-freien nicht-steroidalen Antirheumatika (NSAR) und Glucokorticoide wirken sich dagegen negativ auf die Proteinbiosynthese aus.

Eiweiß kann im Gegensatz zu Fett und Kohlenhydraten nicht gespeichert werden. Aminosäuren wirken damit an sich anabol oder werden, falls nicht eingebaut, im Stoffwechsel verbrannt beziehungsweise in Kohlenhydrate oder Fett umgebaut. Neue Studien unterscheiden mit markierten Aminosäuren die Proteinbiosynthese, den Proteinabbau und aus der Differenz die sogenannte Nettobilanz.

Regeneration ist somit direkt mit Einbauraten verbunden. Die Proteinbiosynthese beträgt ein bis zwei Prozent am Tag. Damit wird ein  Muskel in ca. drei Monaten komplett neu durchbaut. Da man Eiweiß nicht speichern kann, wird die Regenerationszeit – zum Remodelling und zur Reparatur – durch die Qualität und den Zeitpunkt der Zufuhr bestimmt. Belastung und Anpassung bedeuten nichts anderes, als dass Zellen zerstört werden, um solche mit einer höheren Qualität aufzubauen.

Prophylaxe

Es ist zudem zu beachten, dass nicht nur nach harten Belastungen, sondern nach jeder Belastung eine Eiweißgabe wegen der erhöhten Proteinbiosynthese Sinn macht. Dies sollte in der Rehabilitation nach Verletzungen ebenso Standard sein wie etwa beim sogenannten Auslaufen am Tag nach einem Punktspiel oder anderen Wettkampf. Durch diesen geförderten Anabolismus lassen sich Verletzungen und Überlastungsschäden ebenso verhindern wie die Folgen von Übertraining. Dies darf als ein probates Mittel zur Vermeidung von Problemen gelten, die sich im Laufe einer Saison summieren können.

Eiweiß sollte zusammen mit Kohlenhydraten direkt nach der Belastung zugeführt werden. Kohlenhydrate bremsen dagegen nur den Proteinabbau; sie wirken aber nicht anabol. Eiweißgabe vor dem Schlafen führt zu einer positiven Nettobilanz über Nacht. Bei der Gabe verschiedener Mengen von Hühnereiweiß nach dem Krafttraining zeigte sich in einer Untersuchung bei sechs männlichen Probanten im Alter von 20 bis 24 Jahren, dass die Proteinsyntheserate ab einer Gabe von 20 Gramm abflacht (Moore 2009).


Abb.1:
Muskelproteinbiosynthese in Abhängigkeit der Proteingabe bei jungen Männern

Bei älteren Menschen (>70 Jahre) liegt die maximale Stimulation deutlich höher – im Schnitt bei einer Einnahme von mehr als 35 bis 40 Gramm. Zudem brauchen sie mehr Aminosäure wie Leucin (>2,5 bis 3 g), um den anabolen Stimulus zu gewährleisten. Erwachsene verlieren zwischen dem 25. und 65. Lebensjahr circa 20 Prozent an Muskelmasse. Dies sollte im Falle einer Verletzung, aber auch darüber hinaus insbesondere bei der Verpflegung im Krankenhaus beachtet werden.

Milch oder Soja?

Was aber führt zu einer höheren Proteinbiosyntheserate: Milcheiweiß oder Sojaeiweiß, Molke oder Kasein? In Studien wurde nachgewiesen, dass Milcheiweiß, welches sowohl durch einen höheren Anteil an verzweigtkettigen als auch an essentiellen Aminosäuren (wie Leucin) gekennzeichnet ist, nach Belastung zu einer 34 Prozent höheren Proteinbiosyntheserate führt als die Gabe von Sojaeiweiß. Molke (Whey Protein) zeigte sich effektiver als Kasein (Wilkinson 2007).


Abb.2: Syntheserate 34 Prozent höher bei Milch vs. Soja.

Es lässt sich daraus folgern, dass der Verzicht auf tierische Produkte wie Hühnerei, Milch und Fleisch zu einer geringeren Proteinbiosynthese führt. Der Grund ist, dass diese insbesondere über einen höheren Anteil an essentiellen Aminosäuren und Leucin verfügen. Leucin wird eine anabole Schlüsselfunktion zugeschrieben. Inzwischen kann man allerdings durch Mischen verschiedener pflanzlicher Produkte auch vegane Eiweißpulver mit hoher Wertigkeit herstellen.

Regeneration, Training und Wettkampf

Im Zusammenhang mit der Ernährung im Sport müssen die Abschnitte Regeneration, Training und Wettkampf mit den sportartspezifischen Unterschieden wie aerober und anaerober Belastung sowie generell der Dauer von Training und Wettkampf unterschieden werden. So sollte die letzte feste Mahlzeit spätestens zwei bis drei Stunden vor einem Wettkampf eingenommen werden. Danach sollten nur noch Kohlenhydrate in flüssiger Form – als Gel oder als Getränk – zugeführt werden. Dies ist zudem die einzige relevante Möglichkeit zur Ernährung während einer Belastung.

Bei langen aeroben Ausdauerbelastungen kann die Energiezufuhr in Form bestimmter Nährstoff-Riegel sinnvoll sein. Bei einem Ironman beispielsweise mit seinen enormen Belastungen über viele Stunden (3,8 Kilometer Schwimmen, 180 Kilometer Radfahren und ein Marathonlauf über 42,195 Kilometer) sollten Glucose und Fructose im Verhältnis von 2:1 enthalten sein.

Neben der oben beschrieben Eiweißzufuhr wirken folgende Substanzen positiv:

Omega 3 Fettsäuren

Die Omega 3 Fettsäuren, die vom menschlichen Organismus nicht selbst hergestellt werden können, schützen vor kardiovaskulären Risiken und unterstützen die im Sport notwendigen Regenerationsprozesse. Sie wirken zudem anti-inflammatorisch, bilden im Körper wichtige Strukturlipide (Fettstoffe insbesondere zum Aufbau der Zellmembranen) und beeinflussen die Muskelfunktion sowie Entzündungs- und Immunreaktionen. Darüber hinaus wird vermutet, dass über eine günstigere Zusammensetzung der Zellmembran und der intrazellulären mTor-Signalwege ein positiver Einfluss auf die Proteinbiosynthese entsteht. mTor werden zudem unter anderem Funktionen bei der Regulation der Zellproliferation (Zellteilung), des Zellwachstums (Hypertrophie) und dem Überleben von Zellen zugeschrieben.

Empfehlungen der DGE

Die Deutsche Gesellschaft für Ernährung (DGE) empfiehlt deshalb, zweimal pro Woche Fisch zu essen. Kabeljau zum Beispiel oder Seelachs, Seehecht, Scholle und Rotbarsch, die ca. 280 Milligramm Eicosapentaensäure (EPA) und 840 Milligramm Docosahexaensäure (DHA) pro 100 Gramm Fisch enthalten. Oder auch Lachs, Makrele und Hering, die reich an langkettigen n-3-Fettsäuren sind (3.000 Milligramm EPA und DHA pro 100 Gramm).

Zudem rät die DGE täglich 600 bis 650 Gramm Obst (250 g) und Gemüse (400 g) zu sich zu nehmen. Bei einer Portionsgröße von ca. 125 Gramm entspricht dies einer Menge von fünf Portionen verteilt über den Tag. Daraus ergibt sich allerdings ein logistisches Problem, weil die Einnahme nur schwer zu organisieren ist. Außerdem sind die meisten Sportler über einen längeren Zeitraum nur schwer zu motivieren, jeden Tag einen solchen Berg an Obst und Gemüse zu verspeisen.

Smoothies als Alternative

Die nicht nur bei Sportlern zunehmend beliebten Smoothies sind vor diesem Hintergrund eine durchaus akzeptable Alternative. In die hochfrequenten Mixer sollten bei der Zubereitung Samen und/oder Eiweiß zugesetzt werden.

Vitamin D

Vitamin D wird darüber hinaus eine zunehmende Rolle zugewiesen. Vitamin-D-Rezeptoren kommen auch an der Muskulatur vor und spielen nicht nur im knöchernen Einbau eine Rolle. Bei einer Untersuchung in Deutschland wiesen von 723 Patienten, die sich einer orthopädischen Operation unterziehen mussten, 43 Prozent einen Mangel an Vitamin D auf.

Geringe Vitamin-D-Spiegel haben einen negativen Einfluss auf die neuromuskuläre Funktion. Eine Metaanalyse aus sechs Studien mit Teilnehmern im Alter von 18 bis 40 Jahren zeigte einen Anstieg der Muskelkraft der oberen und unteren Extremitäten nach der Supplementierung, also der gezielten und ergänzenden Aufnahme von Vitamin D. In einer Metaanalyse von neun Studien mit 2.634 Soldaten konnte gezeigt werden, dass ein niedriger Vitamin-D-Spiegel mit einer erhöhten Rate an Stressfrakturen der unteren Extremität assoziiert ist.

Bei Verletzungen wurde wiederum unter Vitamin D der Anstieg von Muskelschäden-Markern abgeschwächt. Es empfiehlt sich also dringend, bei Stressfrakturen oder Knochenödemen den Spiegel zu bestimmen. Dies bestätigen auch die vom Autor selbst angestellten Untersuchungen an Spielern der Fußball-Bundesliga, die teils deutliche Defizite offenbarten. Um dem erhöhten Magnesium-Bedarf der Sportler gerecht zu werden, empfiehlt sich die Gabe eines Mineralwassers, das mehr als 100 Milligramm Magnesium pro Liter enthält.

Ernährung und Schlaf

Zu beachten ist zudem, dass die Ernährung über Neurotransmitter auch den zirkadianen Schlaf-Wach-Rhythmus beeinflusst. So führt Fettleibigkeit zu kurzer Schlafdauer – viele Ballaststoffe dagegen zu mehr erholsamen Tiefschlafphasen. Mehr gesättigte Fette haben kürzere Tiefschlafphasen zur Folge. Feste Nahrung fördert den Schlaf mehr als flüssige Nahrung. Ein hoher Kohlenhydratanteil verkürzt die Einschlafzeit. Ein hoher Eiweißanteil verbessert die Schlafqualität.

Begleitende Maßnahmen

Als begleitende Maßnahmen haben sich Körperanalysen unter anderem mit Hilfe der BIA-Messung (Biompedanzanalyse) erwiesen. Mittels dieser Methode können der Ernährungszustand und die Widerstandsfähigkeit des Sportlers/Probanten ermittelt werden. Als leistungssteigernde Nahrungsergänzungsmittel sind Kreatin, Beta Alanin und Koffein gut untersucht; das gilt präventiv gegen Verletzungen auch für Vitamin D und Omega-3-Fettsäuren.

Über den Autor:

Dr. med Klaus Pöttgen ist Facharzt für Allgemein- und Arbeitsmedizin, Chirotherapie und  Sportmedizin in Darmstadt. Als Mannschaftsarzt von Darmstadt 98 hat er in den Jahren von 2011  bis 2016 den Aufstieg der “Lilien” bis in die Fußball-Bundesliga begleitet. Von 2002 bis 2014 war Pöttgen Medizinischer Leiter des Ironman Germany. Er absolvierte siebenmal den Ironman auf  Hawaii und wurde 1999 Altersklassen-Weltmeister auf der Langstrecke.

 

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