PART 1

NUTRITION AND ATHLETE HEALTH
The sport of athletics includes a wide range of events whose requirements range
from speed to endurance, from a light physique to explosive power, and from multiple
events lasting less than a minute to a single race lasting more than 2–3 hours. Despite
the extreme contrast in these characteristics, all athletes share some common nutrition
goals (see Table 6-1). This chapter will brieﬂy explore these goals.
Table 6-1. The athlete’s nutrition goals.
Characteristic

The athlete’s nutrition-related goals

Everyday eating or training diet

• Achieve and maintain a physique that is suited
to the event• Eat to stay healthy and injury-free• Train hard and promote optimal adaptations
and recovery from the training programme• Practice competition eating in training to ﬁnetune strategies

Competition eating• Prepare adequate fuel stores for the event• Eat and drink well on competition day to prepare for an event and to recover between multiple events• During prolonged events (> 1 hour), replace
ﬂuid and carbohydrate to enhance performance• Achieve competition strategies when travelingSports foods and dietary supplements• Make use of specialised sports foods to meet
nutritional goals when it is impractical to eat
everyday foods• Make wise decisions about the use of nutritionalergogenic aids based on cost: beneﬁt analysis

A. The Training Diet

1. Achieving Energy Needs
Energy needs vary according to body size, the energy cost of training (volume,
frequency, and intensity of workouts) and requirements for growth or changes inbody physique. As a result, energy needs vary not only amongst athletes, but vary
between phases of the season and over the athlete’s career. It is important for eachathlete to achieve a suitable energy intake since this affects hormonal and metabolic
function as well as the ability to provide adequate fuel for training, and to consume
the range of nutrients and food components that promote good health.
There are often problems at the extremes of energy intake or requirement.
Examples include the athlete who over-restricts their energy to reduce body

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weight and body mass levels, the athlete who is unable to adjust to a new energy
requirement while they are injured or in the off-season, and the athlete with very
high energy requirements who is unable to consume adequate food in a busy day.
A consultation with a sports dietitian can help such athletes to recognise their trueenergy requirements and adopt appropriate eating patterns and food choices.
A new concept that is being promoted is that of energy availability—that is, theenergy that is left for body functions once the energy cost of training is taken into
account (see Table 6-2). There is evidence that the body can tolerate a certain levelof reduction in energy intake, but energy availability lower than 30 kcal (126 kJ) per
kg of lean body mass is associated with impairments of metabolic, hormonal, andreproductive function. This is now identiﬁed as being important in the developmentof menstrual disorders in female athletes.
Table 6-2. Calculation of energy availability.
Deﬁnition of energy availability

Total energy intake—energy cost of training

Example of low energy availability
Athlete = 50 kg distance runner, 10%
body fatTraining programme = 1000 kcal/day
Energy intake = 2250 kcal

Calculations: Body fat = 10% or 5 kg
Lean body mass (LBM) = 45 kg
Energy availability = 2250 -1000 = 1250 kcal
= 1250/45 kg= 28 kcal/kg LBM

Example of adequate energy availability
Athlete = 60 kg distance runner, 10%
body fatTraining program = 1000 kcal/day
Energy intake = 3250 kcal

Calculations: Body fat = 10% or 6 kg
Lean body mass (LBM) = 54 kg
Energy availability = 3250 -1000 = 2250 kcal
= 2250/54 kg= 42 kcal/kg LBM

2. Maintaining the Ideal Physique
In many events, the athlete’s physique plays an important role in promoting
optimal performance. For example, a high level of muscularity is required to achieve
explosive power in sprints or strength for throwing events. Furthermore, when
the athlete is required to move their own body mass over long distances (distancerunning and walking) or against gravity (jumps and hilly running courses), a
favorable “power to weight” ratio is achieved by being light and lean.
Some athletes automatically arrive at a desirable physique for their event, as aresult of genetics and the conditioning effects of training and healthy eating. Other
athletes need to manipulate their training and diet to produce an increase in muscle
mass and/or a loss of body mass and body fat levels. In many cases, the expectationsof such a program are unrealistic or the dietary strategies are unsound.
Loss of body fat/body mass should be gradually achieved by a program ofmild energy deﬁcit that still permits the achievement of the athlete’s other dietary
goals and allows the athlete to be reasonably free of food-related stress. The

CHAPTER 6, NUTRITION

athlete should not strive for minimal body fat levels per se, but rather a physiquethat is associated with good performances and health over both the long term andshort term. An increase in muscle mass and strength is achieved by an appropriate
resistance program with the support of adequate energy intake and strategic timingof food intake around training sessions.
3. Protein Needs
Athletes in events requiring strength and power (e.g. sprinters and throwers)
often believe that protein intake is their most important nutritional concern, and thathigh protein diets and protein supplements are a required part of their preparation.
The perceived link between a high protein intake and gain of muscle protein isunderstandable but is not supported by scientiﬁc evidence. By contrast, many
athletes in endurance events (e.g. distance runners and walkers) pay little attention
to dietary protein despite the importance of protein synthesis in the achievement of
their desired training adaptations (e.g. repair of muscle damage and the synthesis offunctional body proteins such as enzymes).
Whether heavy training increases protein requirements is still debated. Studies
typically show that protein intakes needed to achieve nitrogen balance are not elevatedin subjects habituated to an exercise load. However, this may not reﬂect the situation
for athletes who practice progressive overload in their training. Nevertheless when
the possible increases in protein requirements have been calculated for athletes inheavy training, they appear to be within the range of 1.2–1.6 g/kg body mass per day
for both strength and endurance activities. Dietary surveys show that such intakes areachieved by most athletes, especially those consuming high-energy intakes. Therefore,
an exaggerated focus on protein-rich foods or high protein supplements is unnecessary.
Athletes who are most at risk of consuming protein intakes below this range are those
who restrict total energy intake to lose weight. This is particularly the case for female
athletes.
Recent studies suggest that the total amount of protein consumed by the athlete
is not as important as the timing of intake in relation to training. The consumptionof protein before and after a resistance workout has been shown to enhance protein
synthesis and net protein balance in response to the training stimulus; this enhancement is still evident in the 24-hour picture of protein balance. This strategy should
be integrated into the athlete’s recovery eating program.
4. Meeting Fuel Requirements for Training
Although various substrates combine to provide the fuel for exercise, the body’s
carbohydrate stores are limited and are often less than the fuel cost of daily training.
The athlete’s everyday eating should provide adequate carbohydrate to fuel training
and promote adequate recovery of muscle glycogen stores between workouts. Older
dietary guidelines promoted a single recommendation for the carbohydrate content
of the athlete’s diet, expressing this as a percentage of total energy intake (e.g.
55–70% of daily energy).

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However, it is now recognised that this terminology fails to recognise thevarying fuel needs associated with different types of training, and falsely assumes
that these fuel needs are always aligned with total energy requirements. Therefore,
new guidelines express carbohydrate needs according to the type and volume oftraining, and the size of the athlete. It is suggested that daily carbohydrate needsvary from ~5 g/kg body mass for athletes undertaking a light training program
or training that is not dependent on muscle glycogen, to intakes of 7–10 g/kg for
prolonged and strenuous daily workouts or where optimal synthesis of glycogen isrequired. Of course, these guidelines are considered “ball park” ﬁgures and should
be ﬁne-tuned by the athlete according to their total energy budget and feedback fromtraining performances.
5. Vitamins, Minerals, and Anti-oxidants
Food contains a variety of vitamins, minerals, anti-oxidants, and other foodcomponents that promote optimal function and health. Generally, we can be
conﬁdent that a moderate to high energy intake (>2000 kcal or 8.4 MJ per day),chosen from a wide variety of nutrient-rich foods, is able to supply all needs forthese micronutrients and food components. Athletes are at risk of inadequate intakeof these compounds when they restrict energy intake, dietary variety, or both ofthese factors. This includes athletes following weight loss diets or other programs
that limit food choices, fussy eaters, and athletes who are traveling to areas in whichfood availability is limited. These athletes should be directed to a sports dietitian foradvice to improve the quantity and quality of their food intake. Where the athlete
is unable or unwilling to implement such changes, a low-dose broad range multivitamin/mineral supplement should be considered.
The micronutrients that are at most likely to be consumed in inadequate amounts
are iron and calcium. Iron deﬁciency occurs in athletes for the same reason that it
occurs in the general population; intake of bio-available iron that is less than iron
requirements or iron losses. Risk factors for low iron intake include low energy
intake, vegetarian eating, and other eating patterns that restrict dietary variety
and intake of red meats. While iron requirements are increased during growthand pregnancy, iron losses are increased by problems of gastrointestinal bleedingor malabsorption (e.g. ulcers, Crohn’s disease, or parasitic infections), excessive
hemolysis associated with footstrike, and unusual blood loss (frequent blood
donations, traumatic bleeding, and abnormal menstrual blood loss). It appears thatthe prevalence of iron deﬁciency anemia in athletes is similar to that of the sedentary
population. However, there is a higher prevalence of iron deﬁciency without anemia(hemoglobin within normal ranges, but serum ferritin levels below 20–30 ng/ml) andrecent studies show that this condition is associated with a reduced responsivenessto training. It is now recommended that interventions occur at this stage, even if it is
only to prevent a further decline into anemia.
Prevention and treatment of reduced iron status should include attention to thefactors that are causing iron drain, including dietary modiﬁcations to increase theintake of bio-available iron. Such dietary changes may include the frequent intake ofCHAPTER 6, NUTRITION

small servings of foods containing the heme form of iron (e.g. red meats, shellﬁsh,liver) and increased consumption of good sources of non-heme or plant iron (e.g.
fortiﬁed breakfast cereals, nuts and legumes, wholegrain cereals, and green leafy
vegetables). The athlete should also plan meals to combine the plant sources of ironwith factors that promote iron absorption (e.g. Vitamin C and “meat factor”), while
reducing interaction with excessive amounts of food factors that reduce the bioavailability of this iron (e.g. phytate in bran or tannin in tea). Vegetarians should pay
particular attention to such planning. Iron supplements may be part of the therapy
required to achieve good iron status in athletes. However, athletes should be warned
about self-prescribing iron supplements on the basis of perceptions of fatigue.
Iron deﬁciency needs to be diagnosed and treated by appropriate experts in sports
medicine and sports nutrition.
Some athletes also fail to consume adequate calcium in their diets; this is a factor
but not a primary cause in the development of poor bone health and stress fractures. The
athlete should receive early intervention in the treatment of such problems (see Female
Athlete Triad, below). This may include dietary advice to correct low energy availability,
and to increase dietary calcium intake, principally through the consumption of low-fat
dairy products or calcium-fortiﬁed soy alternatives.
B. Special Issues

1. Eating for Recovery
The training and competition programs of high-level athletes often require several
sessions of exercise each day. This has focused the attention on eating strategies that
promote recovery after strenuous exercise and enhance the adaptations achieved by thetraining program. Nutrition-related aspects of recovery include refueling, rehydration,
rebuilding and staying healthy. Rehydration requires the replacement of the ﬂuids andelectrolytes lost in sweat, and when the ﬂuid deﬁcit remaining after a workout or raceis greater than 2% of body mass, it is sensible to implement a rehydration plan rather
than relying on thirst or good luck. Strategies to remain as well-hydrated as practicalduring exercise are discussed in the section on competition eating (below). These
strategies should also be used during training sessions, to enable the athlete to train
optimally as well as to ﬁne-tune the drinking practices that might occur during
prolonged competitive events.
During the hours after exercise, the athlete should be guided to consume avolume of ﬂuids equal to 125–150% of the remaining ﬂuid losses. The replacementof electrolyte losses, particularly sodium, is also needed to maximise the retentionof these drinks and the re-equilibration of body ﬂuids. Sodium replacement can beachieved via the intake of electrolyte replacement products (e.g. oral rehydration
solutions), foods with high sodium levels (e.g. bread, breakfast cereals, and otherprocessed foods), or the addition of salt to meals.
The speedy resynthesis of muscle glycogen levels is assisted by the intake ofcarbohydrate-rich foods and drinks, and where there is less than 6–8 hours between
workouts, it makes sense to maximise the time for efﬁcient muscle refueling by

CHAPTER 6, NUTRITION

consuming a carbohydrate supply as soon as practical after the ﬁrst session of
exercise. The inclusion of protein to post-exercise recovery eating is valuable inpromoting net protein synthesis after exercise, including gains in muscle mass andstrength and the repair of muscle damage. Such recovery eating probably requires
the intake of ~10–20 g of high quality protein and 1 g of carbohydrate per kg bodymass in the hour following exercise. In the case of resistance training, there is someevidence that the consumption of protein prior to the session is particularly effective
in promoting the net protein gain following a workout.
To achieve recovery eating goals for key sessions of training or competition, theathlete should organise a suitable supply of snacks that can be taken to their exercise
venue, or re-organise their daily timetable so that meals can be eaten in proximity to
the session. Examples of food combinations that provide protein and carbohydrate
are found in Table 6-3.
Table 6-3. Examples of foods that can be used for rebuilding and refueling goals.
Foods providing 50 g carbohydrate forrefueling goals

Foods providing 50 g carbohydrate and at
least 10 g high quality protein for refuelingand rebuilding• 600–800 ml sports drink• 1.5–2 cups breakfast cereal with1/2 cup milk

• 450 ml soft drink or orange juice• 200 g carton fruit-ﬂavored yoghurt + 35 g
cereal/granola bar• 60–70 g packet of jelly beans• 1 round sandwich with cheese/meat/chicken
ﬁlling + piece of fruit• 2 sports gels

• 500 ml ﬂavored low-fat milk

• 3 medium pieces of fruit or 2 bananas• 300 ml liquid meal supplement• 2 thick slices of bread with jam or honey• 2 slices of toast + 1 cup baked beans

2. Staying Healthy and Injury Free
To maximise the length and success of a sporting career, an athlete needs to stayhealthy and injury free. Sound nutrition is one of the factors that can assist this goal.
Conversely, poor eating practices can increase the risk of succumbing to sickness or
injury, or lengthen recovery time. Heavy training is associated with a suppressionof the immune system, especially during the hours following a bout of prolonged orstrenuous exercise. Although products such as vitamin C, Echinacea, glutamine andbovine colostrum have been proposed as immune protectors, the available researchfails to support overall beneﬁts to the athlete’s health. Instead the nutritional factorsthat are most likely to inﬂuence immune health are energy and carbohydrate status.
Inadequate energy intake is known to impair immune function and increase
susceptibility to illness and infection. Carbohydrate depletion during exercise
is associated with an increase in stress hormones and a suppression of immune

CHAPTER 6, NUTRITION

parametres. Strategies that enhance carbohydrate availability, such as carbohydrate
intake during and after exercise, have been shown to reduce these effects. Studies
that track the success of these strategies in reducing the incidence of illness andinfection in athletes are required.
Energy restriction and carbohydrate depletion can also be factors in injury.
Training while fatigued can increase the risk of both traumatic and overuseinjuries. More importantly, there are clear links between restrained eating andpoor bone health. New research shows that low energy availability affects rates ofbone turnover; this is in addition to its indirect effects on bone via disturbances toreproductive hormones in females. This is discussed in more detail in the section
on the Female Athlete Triad. Since athletes are usually concerned about illness andinjury, emphasis on the beneﬁts of well-chosen eating practices could provide a new
education message in sports nutrition.
3. The Female Athlete Triad
The term Female Athlete Triad was coined over a decade ago to describe theinter-relatedness of eating disorders, amenorrhea, and osteopenia in female athletes.
At this time the syndrome involved a clinical diagnosis of these three medical issues
and was often described in female distance runners. The aim of drawing attention tothis syndrome was to change perceptions about the problem of impaired menstrual
status in female athletes.
Originally, the cessation of regular periods was considered a benign condition,
and was sometimes prized by female runners as a convenience or reward forheavy training. However, the past decades have seen accumulating evidence of thenegative effects of disturbances to reproductive hormones on bone accumulation andbone density. Immediate problems include an increased risk of stress fractures, while
the long-term picture includes a premature onset of osteoporosis. (See Chapter 13,
Part 1, Endocrine/Menstrual Factors for additional details.)
The updated version of the Female Athlete Triad now targets energy availability,
menstrual health, or bone density. It considers that each of these issues enjoys acontinuum between optimal health and frank disorder, and that the athlete shouldbe alerted to any change in their status of any issue. In other words, athletes must
be educated that negative outcomes occur at a much earlier stage than previously
considered, and that there are beneﬁts of an earlier diagnosis and treatment ofproblems. The detection, prevention, and management of the Female Athlete Triad,
or individual elements within it, require expertise and, ideally, the teamwork ofsports physicians, dietitians, psychologists, and the coach/ﬁtness advisor.
C. Competition Eating

1. Fueling Up for Competition
In the days and hours prior to competition, the athlete should consume foods
to prepare adequate fuel stores for their event. The normalised muscle glycogenlevels of a trained athlete are considered adequate for the needs of events lastingCHAPTER 6, NUTRITION

up to 60–90 minutes. Preparation for such events can be managed by 24 hours ofhigh carbohydrate eating and tapered exercise. Races lasting longer than this—for
example, a marathon or 50 km race walking—are associated with the depletion ofmuscle glycogen which causes fatigue known as “hitting the wall”.
Carbohydrate loading is a technique of maximising or super-compensating
glycogen stores in the days leading up to the event. The original technique,described from research undertaken on relatively untrained subjects, required aperiod of low carbohydrate intake and hard training to deplete muscle glycogenlevels (= 3 day depletion) followed by 3 days of high carbohydrate eating andexercise taper to supercompensate glycogen stores. More recent studies haveshown that this depletion phase is unnecessary in trained individuals, and glycogensupercompensation can be achieved in as little as 36–48 hours of taper and highcarbohydrate eating (~10 g/kg/d). Optimising muscle glycogen stores will allow
the endurance athlete to run or walk longer in their event at their optimal race pace.
Carbohydrate consumed in the hours before, and during prolonged events canprovide additional fuel for the muscle and central nervous system.
2. Eating On the Day of Competition: Pre-Event and Between Events
The goals of the pre-event meal are to provide a ﬁnal top-up of fuel andﬂuid stores, and to leave the athlete feeling conﬁdent and prepared to compete
at their best. In general, a carbohydrate-rich meal is promoted, and the athlete
should experiment with the type, amount, and timing of food intake to ﬁnd an
individualised plan that suits the needs of their events. When high-intensity exercise
or competition nerves increase the risk of gastrointestinal upsets during the event,the athlete should try to reduce the ﬁbre intake, fat intake, or volume of their lastmeal. Some athletes ﬁnd that a liquid meal (commercial liquid meal supplement or
fruit smoothie) is a convenient option.
The competition requirements of sprinters, jumpers and multi-event athletes(heptathletes and decathletes) often include a series of events over a day or days.
Food and ﬂuid intake over these days should be organised to refuel and rehydrate
according to the needs of the event and the environmental conditions. The athlete
should organise a nutrition plan of meals and snacks that suits the timetable ofwarm-up, competition and recovery.
3. Fluid and Fuel Intake During Events Lasting More Than 1 Hour
In events of greater than one hour duration, there is both an opportunity andneed to consume ﬂuid and carbohydrate during exercise to promote optimal
performance. The loss of ﬂuid and electrolytes through sweating leads to a reduction
in body water. Fluid deﬁcits of as little as 2% of body mass can impair performance,
particularly in hot weather, with the impairment increasing in ratio to the size ofthe ﬂuid deﬁcit. Fluid intake during a race should be undertaken in consideration of
the athlete’s likely sweat rates balanced against the practicalities of the time lost in
grasping and consuming the supplies at an aid station, and the risk of gastrointestinal
problems. Monitoring weight changes before and after training sessions and events

CHAPTER 6, NUTRITION

can provide an estimate of sweat rates (1 kg loss ~1 liter of sweat), and help todevelop a personalised ﬂuid intake plan. (See Appendix 5, IAAF Policy on Fluid
Replacement, for additional information.)
Ideally, the athlete should try to match ﬂuid intake with sweat losses as well as
is practical, or to keep the ﬂuid deﬁcit to less than 2% of body mass. Although thisis sometimes difﬁcult for elite athletes running at high speeds in hot-weather races,
practicing drinking during training can help to improve the skills and toleranceof ﬂuid intake “on the run”. Slower runners are better able to match ﬂuid intake
to their sweat losses, and in some cases, need to be warned about the dangers ofoverdrinking. Runners should not drink excessive amounts of ﬂuid during an event
so that they increase their body mass over the race. Overdrinking increases the riskof developing hyponatremia, which is a potentially fatal condition.
In events lasting greater than 60–90 minutes, race intake should also include
carbohydrate to provide an additional fuel source. A strong literature shows thatthe intake of 30–60 g of carbohydrate per hour of a prolonged event can enhance
performance by maintaining carbohydrate availability at a time when bodycarbohydrate stores are becoming depleted. This can be achieved by drinking
commercial sports drinks that typically contain 4–8% carbohydrate and 10–20
mmol/l sodium. Such drinks have been manufactured to allow simultaneous
replacement of ﬂuid and fuel during exercise, and their pleasant taste has beenshown to increase the voluntary intake of ﬂuid compared to plain water. Recent
studies have shown that the intake of carbohydrate may enhance performance ofhigh-intensity events lasting about 1h (e.g. a half marathon). This is curious sincemuscle glycogen are not limiting in this event, at least if the athlete has undertaken
a good nutritional preparation for competition. It is thought that beneﬁts might bederived through the central nervous system, whereby carbohydrate supplementation
causes enhancements of the perception of effort and pacing strategies. Further
research is needed, and athletes in these shorter events should experiment with arace plan including carbohydrate intake from sources such as sports drinks, sports
gels or confectionery items.
4. The Travelling Athlete
Most elite athletes are well-seasoned travelers, undertaking trips to training
camps or specialised environments (e.g. altitude), and to compete. Athletes must beable to achieve their peak performance at important competitions such as Olympic
Games or World Championships in an environment that is often both far awayand different to their home-base. Many athletes compete in series like the Golden
League or Grand Prix, which require them to travel almost weekly to compete
against other athletes in this competition. Frequent travel can pose a number ofchallenges. These include disruptions to the normal training routine and lifestyle
while the athlete is en route, jet lag, changes to food availability including absenceof important and familiar foods, and a reliance on hotels, restaurants, and takeaways
instead of home cooking. Even in an Athlete’s Village there are the temptations ofan “all you can eat” dining hall. Depending on the destination, the athlete may be at

CHAPTER 6, NUTRITION

risk of gastrointestinal illnesses due to exposure to food and water with poor hygiene
standards (see Chapter 12, Infectious Diseases).
There are many strategies that an athlete can put into place to overcome thesechallenges. These include preparation techniques such as investigating the likely
food issues in the new environment, and organising a supply of important or missing
foods to accompany the athlete. Items that are portable and practical for travelinclude powdered sports drinks and liquid meal supplements, sports bars, cereal/
granola bars, breakfast cereal and skim milk powder, dried fruit and nut mixes, andrice cakes/crackers with spreads. Having an “emergency” supply of foods can allow
the athlete to supplement inadequate meals, provide additional snacks, and be selfreliant in looking after nutritional needs at key times such as post-training or postevent.
D. Sports Foods and Supplements

Sports foods and supplements represent a multi-billion dollar industry, supportedby aggressive marketing from manufacturers and word of mouth between athletes
and coaches. Sports scientists believe that well-controlled research should underpin
the promotion of any sports nutrition practice and are understandably frustrated
that supplement manufacturers often make impressive claims about their products
without adequate (or in some cases, any) proof. However, in most countries,
legislation regarding supplements or sports foods is either minimal or not enforced,
allowing unsupported claims to ﬂourish and products to be manufactured with poor
compliance to labeling and composition standards (see also Part 2 of this chapter,
A Rational Approach to Supplements, for additional details). Athletes are usually
unaware of these lapses.
Before making a decision to use a supplement or sports food, athletes andcoaches should consider the likely beneﬁts, balanced against the cost of the productand the risk of negative outcomes. Problems include the risk of side-effects or
inadvertent intake of a substance that is banned in sport, leading to a “positive”
doping outcome. The advice of a sports nutrition expert should be sought to provide
such information.
The ever-growing range of sports nutrition products can be divided into two
separate groups. Some supplements and sports foods address the special nutritional
needs of athletes, and offer a simple or practical way to meet known nutritional
goals. This group includes sports drinks, sports bars, liquid meal supplements andmicronutrient supplements that are part of a prescribed dietary plan. Many of theseproducts are specially designed to help an athlete meet speciﬁc needs for energy
and nutrient, including ﬂuid and carbohydrate, in situations where everyday foods
are not practical to eat. The use of many of these products has been discussed inprevious parts of this chapter. These sports foods and supplements can be shown to
improve performance when they allow the athlete to achieve their sports nutrition
goals. However, they are more expensive than normal food, and this considerationmust be balanced against the convenience they provide.

CHAPTER 6, NUTRITION

Conversely, some products claim a direct ergogenic beneﬁt to sports performance.
Very few of these products have clear scientiﬁc evidence to support these claims,
with a few exceptions including caffeine, creatine, and bicarbonate/citrate. Athletesshould seek expert advice about such supplements to see if their sport/exercise
warrants experimentation with these products to ensure that a correct protocol istried. It should be noted, however, that supplements and sports foods are neither ashort cut to optimal performance nor a replacement for the sound principles that
underpin good training.
References

1.
2.
3.

Burke, L. M. Practical Sports Nutrition. Champaign, IL: Human Kinetics
Publishers, 2006.
Maughan, R. J., L. M. Burke, and E. F. Coyle (eds.). Foods, Nutrition andSports Performance II. London: Routledge, 2004.
Maughan, R. J. (ed.). Encyclopedia of Sports Medicine: Nutrition in Sport.
Oxford: Blackwell Science, 2000.

PART 2A RATIONAL APPROACH TO SUPPLEMENTS
Nutrition scientists in recent years have identiﬁed an increasing number of
elements that are now deemed essential for a complete diet. In addition to the wellknown critical need for vitamins and macro-nutrients (energy fuels), they have noted
the importance of the ‘essential’ amino acids, trace minerals, fatty acids, and phytochemicals, as well as many other organic compounds. With the increasing use ofindustrial food production processes, many of these elements have been found to bedeﬁcient in various segments of the population, including possibly athletes who aretraining intensively.
It is well known that the diets of many pre-adolescents and adolescents, including athletes, are often lacking in adequate calcium and iron. In this age group theconsumption of “empty calories” (sugars and sweets) is well documented. This isespecially true among young women. Further, those women athletes in whom weightcontrol is a concern are often calorie-deﬁcient and suffer from an “energy deﬁcit”
that may have long-term effects on skeletal and reproductive health.
A. Athletes and the Supplements Industry

In order to ensure that athletes are obtaining nutrients sufﬁcient for their training
needs, they should have a complete dietary analysis and counseling by a qualiﬁed
sports nutritionist, including a blood analysis for macro- and micro-nutrients.
Instead, athletes and coaches have been convinced by the dietary supplement
industry that all athletes’ diets are inadequate, and routinely need supplementation.
The “nutritional supplement” industry has now become a multi-billion dollar
enterprise. This industry utilises modern advertising techniques and mass-marketing,which is often based upon pseudo-science, factual distortion, and nutritional halftruths, in order to promote its products.
The U.S. “Dietary Supplements and Health Education Act” of 1994 establishedthe legal framework for the manufacture of supplements. A dietary/food or
nutritional supplement is deﬁned as:
1. A product (other than tobacco) that is intended to supplement the diet thatbears or contains one or more of the following ingredients:
a. a vitaminb. a mineralc. an herb or botanicald. an amino acide. a dietary substance for use by man to supplement the diet byincreasing the total dietary intake
f. or a concentrate, metabolite, constituent, extract, or combinationof any ingredient described above.
2. Is intended for ingestion in pill, capsule, tablet, or liquid form.

CHAPTER 6, NUTRITION

3. Is not represented for use as a conventional food or the sole item of ameal or diet
4. Is labeled as a “dietary supplement”
These products are sold primarily as “ergogenic aids”, “natural” or “legal”
steroids, “fat burners”, energy or immune system “boosters”, etc. Many of thesecontain or are contaminated with androgenic pro-hormones that the body may
convert to active anabolic steroids, resulting in a positive doping test.
The dietary supplement industry is unregulated, as these products are classiﬁed
as “foods.” They are not required to demonstrate the efﬁcacy of their claims, so longas they do not purport to treat diseases.
Numerous studies have shown that:• The quantity of the listed products on the label may vary widelyfrom the amount listed.
• Many products contain ingredients that are not listed.
• “Natural” products are not necessarily safe.
• Side-effects are seldom listed.
• They may interfere with other prescription medications.
• They may create deﬁciencies of other nutrients.
• Some products that are purported to contain “legal” or “natural”
pro-hormones actually contain banned anabolic steroids.
Many studies have shown that a signiﬁcant number of supposedly “legal” or“safe” supplements may contain anabolic steroid precursors or pro-hormones thatwill result in a positive doping test. This is especially true if the manufacturer
also produces a line of products that contain these banned substances, as crosscontamination may occur during the manufacturing process. In addition, Geyer etal. (2004) have shown that a sizable percentage of supplements are contaminated withandrogenic-anabolic steroids, even those manufactured by a company that does notproduce a line of anabolic products. The majority of these products are manufactured
in the U.S., but labels are not required to list the country of origin.
It has been suggested that athletes use only supplements that 1) have been
approved by such agencies as the U.S. Pharmacopeia (USP) or similar, or 2) havebeen tested and certiﬁed by the manufacturer as being free of pro-hormones or otherbanned substances, and have had no contact with these substances during theirproduction or transport. Such certiﬁcation ensures the quantity and purity of the
product, but does not ensure its being free of banned substances.
However, it is unlikely that this type of certiﬁcation will occur to any extent,
unless laws governing the manufacture of these supplements are altered radically.
The number of elite athletes who are subject to doping control is minisculecompared to the total number of consumers. Hence, such testing and approval would
not be cost-effective for the manufacturer. Further, even if the manufacturer were to
test and certify its products, in the event of a positive doping test such veriﬁcation
would not likely render it immune from a legal liability suit.

CHAPTER 6, NUTRITION

B. IAAF Recommendations

In view of the foregoing, the IAAF must still recommend that:
1. Athletes must review their diet carefully, along with a qualiﬁed sports
nutrition professional, to ensure its adequacy, and to determine whether
any supplementation is necessary (see Part 1 of this chapter, Nutrition
and Athlete Health).
2. In nearly all cases, the athlete’s complete nutritional needs can best
be met by a well-selected menu of properly-prepared foods. This menu
is more likely to provide the essential micro- and macro-nutrients,
vitamins, and essential amino acids in a well-balanced, readily
absorbable combination than can be obtained by the use of a barrageof expensive, randomly-chosen “supplements.” However, many healthprofessionals do now recommend a simple multi-vitamin preparation
daily for all adults, and speciﬁc supplementation may be required if atrue deﬁciency is detected by reliable testing.
3. Athletes and coaches must realise that the consumption of supplements,
even under the best of circumstances, risks the possibility of causing a
positive test for a banned substance during doping control. This possibility
may vary from manufacturer to manufacturer, and even from batch tobatch by the same manufacturer. Hence, we cannot avoid the adage—
CAVEAT EMPTOR! (LET THE BUYER BEWARE).
References

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2.

3.
4.

5.
6.

Ayotte, C. et.al. Sports nutritional supplements: quality and doping control.
Canad. J. Appl. Physiol. 26 (Suppl.):S 120-129, 2001.
Geyer, H. et al. Analysis of non-hormonal nutritional supplements foranabolic-androgenic steroids—results of an international study. Int. J. Sports
Med. 25:124-129, 2004.
Juhn, M. S. Popular sports supplements and ergogenic aids. Sports Medicine
33(12):921- 939, 2003.
Nutrition and Athletic Performance: Position of the American Dietetic
Association, Dietitians of Canada, and the American College of Sports
Medicine Nutrition. J. Am. Diet. Assoc. 100:1543-1556, 2000.
Pipe, A., and C. Ayotte. Nutritional supplements and doping. Clin. J. Sports
Med. 12(4):245-249, 2002.
World Anti-Doping Agency International Symposium on Supplements in Sport.
Montreal, 30/31 May 2004. www.WADA.org; www.CCES.ca