Review Article | Published:

Chocolate milk for recovery from exercise: a systematic review and meta-analysis of controlled clinical trials

European Journal of Clinical Nutrition (2018) | Download Citation

Abstract

Background/objectives

Chocolate milk (CM) contains carbohydrates, proteins, and fat, as well as water and electrolytes, which may be ideal for post-exercise recovery. We systematically reviewed the evidence regarding the efficacy of CM compared to either water or other “sport drinks” on post-exercise recovery markers.

Subjects/methods

PubMed, Scopus, and Google scholar were explored up to April 2017 for controlled trials investigating the effect of CM on markers of recovery in trained athletes.

Results

Twelve studies were included in the systematic review (2, 9, and 1 with high, fair and low quality, respectively) and 11 had extractable data on at least one performance/recovery marker [7 on ratings of perceived exertion (RPE), 6 on time to exhaustion (TTE) and heart rate (HR), 4 on serum lactate, and serum creatine kinase (CK)]. The meta-analyses revealed that CM consumption had no effect on TTE, RPE, HR, serum lactate, and CK (P > 0.05) compared to placebo or other sport drinks. Subgroup analysis revealed that TTE significantly increases after consumption of CM compared to placebo [mean difference (MD) = 0.78 min, 95% confidence interval (CI): 0.27, 1.29, P = 0.003] and carbohydrate, protein, and fat-containing beverages (MD = 6.13 min, 95% CI: 0.11, 12.15, P = 0.046). Furthermore, a significant attenuation on serum lactate was observed when CM was compared with placebo (MD = −1.2 mmol/L, 95% CI: −2.06,−0.34, P = 0.006).

Conclusion

CM provides either similar or superior results when compared to placebo or other recovery drinks. Overall, the evidence is limited and high-quality clinical trials with more well-controlled methodology and larger sample sizes are warranted.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Shirreffs SM, Watson P, Maughan RJ. Milk as an effective post-exercise rehydration drink. Br J Nutr. 2007;98:173–80.

  2. 2.

    Pascoe DD, Costill DL, Fink WJ, Robergs RA, Zachwieja JJ. Glycogen resynthesis in skeletal muscle following resistive exercise. Med Sci Sports Exerc. 1993;25:349–54.

  3. 3.

    el-Sayed MS, Rattu AJ, Roberts I. Effects of carbohydrate feeding before and during prolonged exercise on subsequent maximal exercise performance capacity. Int J Sport Nutr. 1995;5:215–24.

  4. 4.

    Temesi J, Johnson NA, Raymond J, Burdon CA, O’Connor HT. Carbohydrate ingestion during endurance exercise improves performance in adults. J Nutr. 2011;141:890–7. https://doi.org/10.3945/jn.110.137075.

  5. 5.

    Jeukendrup A, Brouns F, Wagenmakers AJ, Saris WH. Carbohydrate-electrolyte feedings improve 1 h time trial cycling performance. Int J Sports Med. 1997;18:125–9. https://doi.org/10.1055/s-2007-972607.

  6. 6.

    Davison GW, McClean C, Brown J, Madigan S, Gamble D, Trinick T, et al. The effects of ingesting a carbohydrate-electrolyte beverage 15min prior to high-intensity exercise performance. Res Sports Med. 2008;16:155–66. https://doi.org/10.1080/15438620802103155.

  7. 7.

    Andersen G, Orngreen MC, Preisler N, Jeppesen TD, Krag TO, Hauerslev S, et al. Protein-carbohydrate supplements improve muscle protein balance in muscular dystrophy patients after endurance exercise: a placebo-controlled crossover study. Am J Physiol Regul Integr Comp Physiol. 2015;308:R123–130. https://doi.org/10.1152/ajpregu.00321.2014.

  8. 8.

    Howarth KR, Moreau NA, Phillips SM, Gibala MJ. Coingestion of protein with carbohydrate during recovery from endurance exercise stimulates skeletal muscle protein synthesis in humans. J Appl Physiol. 2009;106:1394–402. https://doi.org/10.1152/japplphysiol.90333.2008.

  9. 9.

    Wong SH, Chen Y. Effect of a carbohydrate-electrolyte beverage, lemon tea, or water on rehydration during short-term recovery from exercise. Int J Sport Nutr Exerc Metab. 2011;21:300–10.

  10. 10.

    Saunders MJ, Kane MD, Todd MK. Effects of a carbohydrate-protein beverage on cycling endurance and muscle damage. Med Sci Sports Exerc. 2004;36:1233–8.

  11. 11.

    Saunders MJ, Luden ND, Herrick JE. Consumption of an oral carbohydrate-protein gel improves cycling endurance and prevents postexercise muscle damage. J Strength Cond Res. 2007;21:678–84.

  12. 12.

    Skillen RA, Testa M, Applegate EA, Heiden EA, Fascetti AJ, Casazza GA. Effects of an amino acid carbohydrate drink on exercise performance after consecutive-day exercise bouts. Int J Sport Nutr Exerc Metab. 2008;18:473–92.

  13. 13.

    Ivy JL, Goforth HW Jr., Damon BM, McCauley TR, Parsons EC, Price TB. Early postexercise muscle glycogen recovery is enhanced with a carbohydrate-protein supplement. J Appl Physiol. 2002;93:1337–44. https://doi.org/10.1152/japplphysiol.00394.2002.

  14. 14.

    Berardi JM, Price TB, Noreen EE, Lemon PW. Postexercise muscle glycogen recovery enhanced with a carbohydrate-protein supplement. Med Sci Sports Exerc. 2006;38:1106–13. https://doi.org/10.1249/01.mss.0000222826.49358.f3.

  15. 15.

    Jentjens R, Jeukendrup AE. Determinants of post-exercise glycogen synthesis during short-term recovery. Sports Med. 2003;33:117–44.

  16. 16.

    Wiswedel I, Hirsch D, Kropf S, Gruening M, Pfister E, Schewe T, et al. Flavanol-rich cocoa drink lowers plasma F 2-isoprostane concentrations in humans. Free Radic Biol Med. 2004;37:411–21.

  17. 17.

    Watson P, Love TD, Maughan RJ, Shirreffs SM. A comparison of the effects of milk and a carbohydrate-electrolyte drink on the restoration of fluid balance and exercise capacity in a hot, humid environment. Eur J Appl Physiol. 2008;104:633–42.

  18. 18.

    Macdougall JD, Ray S, Sale DG, Mccartney N, Lee P, Garner S. Muscle substrate utilization and lactate production during weightlifting. Can J Appl Physiol. 1999;24:209–15.

  19. 19.

    Josse AR, Atkinson SA, Tarnopolsky MA, Phillips SM. Increased consumption of dairy foods and protein during diet-and exercise-induced weight loss promotes fat mass loss and lean mass gain in overweight and obese premenopausal women. J Nutr. 2011;141:1626–34.

  20. 20.

    Wilkinson SB, Tarnopolsky MA, MacDonald MJ, MacDonald JR, Armstrong D, Phillips SM. Consumption of fluid skim milk promotes greater muscle protein accretion after resistance exercise than does consumption of an isonitrogenous and isoenergetic soy-protein beverage. Am J Clin Nutr. 2007;85:1031–40.

  21. 21.

    Boirie Y, Dangin M, Gachon P, Vasson M-P, Maubois J-L, Beaufrère B. Slow and fast dietary proteins differently modulate postprandial protein accretion. Proc Natl Acad Sci. 1997;94:14930–5.

  22. 22.

    Dangin M, Guillet C, Garcia‐Rodenas C, Gachon P, Bouteloup‐Demange C, Reiffers‐Magnani K, et al. The rate of protein digestion affects protein gain differently during aging in humans. J Physiol. 2003;549:635–44.

  23. 23.

    Salejda AM, Krasnowska G. Effect of dietary rapeseed oil and humus-containing mineral preparation on cholesterol and cholesterol oxidation products content in pork. Eur Food Res Technol. 2016; 242:1441–6. https://doi.org/10.1007/s00217-016-2644-x.

  24. 24.

    Lunn WR, Pasiakos SM, Colletto MR, Karfonta KE, Carbone JW, Anderson JM, et al. Chocolate milk and endurance exercise recovery: Protein balance, glycogen, and performance. Med Sci Sports Exerc. 2012;44:682–91. https://doi.org/10.1249/MSS.0b013e3182364162.

  25. 25.

    Karp JR, Johnston JD, Tecklenburg S, Mickleborough TD, Fly AD, Stager JM. Chocolate milk as a post-exercise recovery aid. Int J Sport Nutr Exerc Metab. 2006;16:78–91.

  26. 26.

    Ferguson-Stegall L, McCleave EL, Ding Z, Doerner PG 3rd, Wang B, Liao YH, et al. Postexercise carbohydrate-protein supplementation improves subsequent exercise performance and intracellular signaling for protein synthesis. J Strength Cond Res. 2011;25:1210–24. https://doi.org/10.1519/JSC.0b013e318212db21.

  27. 27.

    Gilson SF, Saunders MJ, Moran CW, Moore RW, Womack CJ, Todd MK. Effects of chocolate milk consumption on markers of muscle recovery following soccer traininfg: a randomized cross-over study. J Int Soc Sports Nutr. 2010;7:19. https://doi.org/10.1186/1550-2783-7-19.

  28. 28.

    Fraga CG, Actis-Goretta L, Ottaviani JI, Carrasquedo F, Lotito SB, Lazarus S, et al. Regular consumption of a flavanol-rich chocolate can improve oxidant stress in young soccer players. Clin Dev Immunol. 2005;12:11–17.

  29. 29.

    Spaccarotella KJ, Andzel WD. The effects of low fat chocolate milk on postexercise recovery in collegiate athletes. J Strength Cond Res. 2011;25:3456–60. https://doi.org/10.1519/JSC.0b013e3182163071.

  30. 30.

    Pritchett KL, Pritchett RC, Green JM, Katica C, Combs B, Eldridge M, et al. Comparisons of post-exercise chocolate milk and a commercial recovery beverage following cycling training on recovery and performance. J Exerc Physiol Online. 2011;14:29–39.

  31. 31.

    Thomas K, Morris P, Stevenson E. Improved endurance capacity following chocolate milk consumption compared with 2 commercially available sport drinks. Appl Physiol, Nutr Metab. 2009;34:78–82. https://doi.org/10.1139/H08-137.

  32. 32.

    Pritchett K, Bishop P, Pritchett R, Green M, Katica C. Acute effects of chocolate milk and a commercial recovery beverage on postexercise recovery indices and endurance cycling performance. Appl Physiol Nutr Metab. 2009;34:1017–22. https://doi.org/10.1139/H09-104.

  33. 33.

    Azadbakht L, Fard NRP, Karimi M, Baghaei MH, Surkan PJ, Rahimi M, et al. Effects of the dietary approaches to stop hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial. Diabetes Care. 2011;34:55–57.

  34. 34.

    Papacosta E, Nassis GP, Gleeson M. Effects of acute postexercise chocolate milk consumption during intensive judo training on the recovery of salivary hormones, salivary SIgA, mood state, muscle soreness, and judo-related performance. Appl Physiol Nutr Metab. 2015;40:1116–22. https://doi.org/10.1139/apnm-2015-0243

  35. 35.

    Potter J, Fuller B. The effectiveness of chocolate milk as a post-climbing recovery aid. J Sports Med Phys Fitness. 2015; 55:1438–44.

  36. 36.

    Upshaw AU, Wong TS, Bandegan A, Lemon PW. Cycling time trial performance 4h following glycogen-lowering exercise is enhanced similarly with recovery non-dairy chocolate beverages vs chocolate milk. Int J Sport Nutr Exerc Metab 2016;26:65–70. https://doi.org/10.1123/ijsnem.2015-0056.

  37. 37.

    Higgins JPT, Green S, Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions. Chichester: Wiley-Blackwell; 2008.

  38. 38.

    Higgins J, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Stat Med. 2002;21:1539–58.

  39. 39.

    Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

  40. 40.

    Morato PN, Rodrigues JB, Moura CS, e Silva FGD, Esmerino EA, Cruz AG, et al. Omega-3 enriched chocolate milk: a functional drink to improve health during exhaustive exercise. J Funct Foods. 2015;14:676–83. https://doi.org/10.1016/j.jff.2015.02.034.

  41. 41.

    Abd El-Khair AA. Optimization of a new version of chocolate milk for endurance performance and post-exercise recovery. J Appl Sci Res. 2009;5:482–9.

  42. 42.

    Ferguson-Stegall L, McCleave E, Ding Z, Doerner Iii PG, Liu Y, Wang B, et al. Aerobic exercise training adaptations are increased by postexercise carbohydrate-protein supplementation. J Nutr Metab 2011; 2011:623182. https://doi.org/10.1155/2011/623182.

  43. 43.

    Mitchell CJ, Oikawa SY, Ogborn DI, Nates NJ, MacNeil LG, Tarnopolsky M, et al. Daily chocolate milk consumption does not enhance the effect of resistance training in young and old men: a randomized controlled trial. Appl Physiol Nutr Metab. 2015;40:199–202. https://doi.org/10.1139/apnm-2014-0329.

  44. 44.

    Alberici JC, Farrell PA, Kris-Etherton PM, Shively CA. Effects of preexercise candy bar ingestion on glycemic response, substrate utilization, and performance. Int J Sport Nutr. 1993;3:323–33.

  45. 45.

    Pritchett K, Pritchett R. Chocolate milk: a post-exercise recovery beverage for endurance sports. Med Sport Sci. 2012; 59:127–34.

  46. 46.

    Saunders MJ. Carbohydrate-protein intake and recovery from endurance exercise: Is chocolate milk the answer? Curr Sports Med Rep. 2011;10:203–10. https://doi.org/10.1249/JSR.0b013e318223ccb4.

  47. 47.

    Spaccarotella KJ, Andzel WD. Building a beverage for recovery from endurance activity: a review. J Strength Cond Res. 2011;25:3198–204. https://doi.org/10.1519/JSC.0b013e318212e52f.

  48. 48.

    Volpe. Recovery beverages: A review of two recent studies. ACSM’s Health Fit J. 2007;11:33–34. https://doi.org/10.1249/01.FIT.0000288540.54363.e4.

  49. 49.

    Saunders MJ. Glycogen replenishment with chocolate milk consumption. Curr Sports Med Rep. 2011;10:390 https://doi.org/10.1249/JSR.0b013e318237c0ed.

  50. 50.

    Bellar D, LeBlanc NR, Murphy K, Moody KM, Buquet G. The impact of chocolate goat’s and cow’s milk on postresistance exercise endocrine responses and isometric mid-thigh pull performance. J Diet Suppl. 2016;13:560–9. https://doi.org/10.3109/19390211.2015.1124164.

  51. 51.

    Jeukendrup AE. Carbohydrate intake during exercise and performance. Nutrition. 2004;20:669–77. https://doi.org/10.1016/j.nut.2004.04.017.

  52. 52.

    Pritchett KL, Pritchett RC, Bishop P. Nutritional strategies for post-exercise recovery: a review. South Afr J Sports Med. 2011;23:20–25.

  53. 53.

    Valentine RJ, Saunders MJ, Todd MK, St. Laurent TG. Influence of carbohydrate-protein beverage on cycling endurance and indices of muscle disruption. Int J Sport Nutr Exerc Metab. 2008;18:363–78.

  54. 54.

    Zawadzki KM, Yaspelkis BB 3rd, Ivy JL. Carbohydrate-protein complex increases the rate of muscle glycogen storage after exercise. J Appl Physiol. 1992;72:1854–9. https://doi.org/10.1152/jappl.1992.72.5.1854.

  55. 55.

    Bergstrom J, Hermansen L, Hultman E, Saltin B. Diet, muscle glycogen and physical performance. Acta Physiol Scand. 1967;71:140–50. https://doi.org/10.1111/j.1748-1716.1967.tb03720.x.

  56. 56.

    Davis JM, Bailey SP, Woods JA, Galiano FJ, Hamilton MT, Bartoli WP. Effects of carbohydrate feedings on plasma free tryptophan and branched-chain amino acids during prolonged cycling. Eur J Appl Physiol Occup Physiol. 1992;65:513–9.

  57. 57.

    Saunders MJ. Coingestion of carbohydrate-protein during endurance exercise: influence on performance and recovery. Int J Sport Nutr Exerc Metab. 2007;17:S87–S103.

  58. 58.

    Hickson R, Rennie M, Conlee R, Winder W, Holloszy J. Effects of increased plasma fatty acids on glycogen utilization and endurance. J Appl Physiol. 1977;43:829–33.

  59. 59.

    Brechtel K, Dahl DB, Machann J, Bachmann OP, Wenzel I, Maier T, et al. Fast elevation of the intramyocellular lipid content in the presence of circulating free fatty acids and hyperinsulinemia: a dynamic 1H-MRS study. Magn Reson Med. 2001;45:179–83.

  60. 60.

    Bloomer RJ, Goldfarb AH. Can nutritional supplements reduce exercise-induced skeletal muscle damage? Strength Cond J. 2003;25:30–37.

  61. 61.

    Saunders MJ, Luden ND, Herrick JE. Consumption of an oral carbohydrate-protein gel improves cycling endurance and prevents postexercise muscle damage. J Strength Cond Res. 2007;21:678–84. https://doi.org/10.1519/r-20506.1.

Download references

Funding

The present systematic review was supported by the Research Council of the Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Author contributions

AS-A and MA conceived the study. All authors contributed in defining the search strategy. MA and AS-A carried out the literature search and data extraction. MA and AS-A accomplished the quality assessment of the included studies and data analysis. MA, AS-A, and RG contributed in the interpretation of study results. MA wrote the first draft of the manuscript. MA, AS-A, MK, and SF facilitated with preparation of the manuscript, its finalization. All authors contributed to the study conception, design, and drafting of the manuscript.

Author information

Affiliations

  1. Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    • Mojgan Amiri
    •  & Amin Salehi-Abargouei
  2. Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    • Mojgan Amiri
    •  & Amin Salehi-Abargouei
  3. Food Security research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    • Reza Ghiasvand
  4. Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

    • Reza Ghiasvand
  5. Faculty of Pure & Applied Science, School of Nutrition and Dietetics, Acadia University, Wolfville, NS, Canada

    • Mojtaba Kaviani
  6. Department of Physical Education, Faculty of Education, Brandon University, Brandon, MB, Canada

    • Scott C. Forbes

Authors

  1. Search for Mojgan Amiri in:

  2. Search for Reza Ghiasvand in:

  3. Search for Mojtaba Kaviani in:

  4. Search for Scott C. Forbes in:

  5. Search for Amin Salehi-Abargouei in:

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Amin Salehi-Abargouei.

Electronic supplementary material

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/s41430-018-0187-x