Effect of ingesting carbohydrate only or carbohydrate plus casein protein hydrolysate during a multiday cycling race on left ventricular function, plasma volume expansion and cardiac biomarkers

  • Tanja OosthuyseEmail author
  • Andrew N. Bosch
  • Aletta M. E. Millen
Original Article



Multiday racing causes mild left ventricular (LV) dysfunction from day 1 that persists on successive days. We evaluated ingesting casein protein hydrolysate–carbohydrate (PRO) compared with carbohydrate-only (CHO) during a 3-day mountain bike race.


Eighteen male cyclists were randomly assigned to ingest 6.7% carbohydrate without (CHO) or with 1.3% casein hydrolysate (PRO) during racing (~ 4–5 h/day; 68/71/71 km). Conventional LV echocardiography, plasma albumin content, plasma volume (PV) and blood biomarkers were measured before day 1 and post race on day 3.


Fourteen cyclists (n = 7 per group) completed the race. PV increased in CHO (mean increase (95% CI), 10.2% (0.1 to 20.2)%, p = 0.045) but not in PRO (0.4% (− 6.1 to 6.9)%). Early diastolic transmitral blood flow (E) was unchanged but deceleration time from peak E increased post race (CHO: 46.7 (11.8 to 81.6) ms, p = 0.019; PRO: 24.2 (− 0.5 to 48.9) ms, p = 0.054), suggesting impaired LV relaxation. Tissue Doppler mitral annular velocity was unchanged in CHO, but in PRO septal early-to-late diastolic ratio decreased (p = 0.016) and was compensated by increased lateral early (p = 0.034) and late (p = 0.012) velocities. Systolic function was preserved in both groups; with increased systolic lateral wall velocity in PRO (p = 0.002). Effect size increase in serum creatine kinase (CK) activity, CK-MB and C-reactive protein concentrations was less in PRO than CHO (Cohen’s d mean ± SD, PRO: 2.91 ± 2.07; CHO: 7.56 ± 4.81, p = 0.046).


Ingesting casein hydrolysate with carbohydrate during a 3-day race prevented secondary hypervolemia and failed to curb impaired LV relaxation despite reducing tissue damage and inflammatory biomarkers. Without PV expansion, systolic function was preserved by lateral wall compensating for septal wall dysfunction.


Endurance exercise Sports nutrition Serum albumin content Secondary hypervolemia Echocardiography Inflammation Membrane stability 


Change calculated as post minus pre race


Late diastolic transmitral blood flow velocity


Late diastolic mitral annular velocity


Aortic diameter


Plasma albumin


Peak systolic trans-aortic valve blood flow velocity


Blood volume


Carbohydrate-only supplement


Confidence interval


Creatine kinase


Creatine kinase-MB isoform


Cardiac troponin I


Cohen’s effect size


Diastolic blood pressure


Early diastolic transmitral blood flow velocity


Early diastolic mitral annular velocity


End diastolic volume


Ejection fraction


End systolic volume






High sensitivity C-reactive protein


Left atrium


Left ventricular


Left ventricular chamber diameter in diastole


Casein protein hydrolysate plus carbohydrate supplement


Plasma volume


Pulsed-wave Doppler


Peak systolic mitral annular velocity


Systolic blood pressure


Standard deviation


Stroke volume


Tissue Doppler imaging



This study was funded by the University of the Witwatersrand Faculty of Health Sciences Research Committee.

Author contributions

TO, AB and AM conceived and designed the study. TO and AM conducted data collection and analysis. TO prepared the manuscript. AB and AM reviewed the manuscript. All authors approved the final version.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Physiology, Faculty of Health SciencesUniversity of the Witwatersrand, Medical SchoolParktownSouth Africa
  2. 2.Division of Exercise Science and Sports Medicine, Department of Human BiologyUniversity of Cape TownCape TownSouth Africa

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