International Journal of Sport Nutrition and Exercise Metabolism, 2019, 29, 73-84
https://doi.org/10.1123/ijsnem.2019-0065© 2019 Human Kinetics, Inc.

CONSENSUS STATEMENTInternational Association of Athletics Federations Consensus
Statement 2019: Nutrition for Athletics
Louise M. Burke

Linda M. Castell

Australian Institute of Sport and University of Oxford
Australian Catholic University

Douglas J. Casa

Graeme L. Close

University ofConnecticut

Liverpool John
Moores University

Ricardo J. S. Costa

Ben Desbrow

Shona L. Halson

Dana M. Lis

Monash University

Grifﬁth University

Australian Catholic University

University of California Davis

Anna K. MelinPeter Peeling

Philo U. Saunders

Gary J. Slater

Linnaeus University

The University ofWestern Australia

Australian Institute of Sport andUniversity of Canberra

Australian Institute of Sport andUniversity of theSunshine Coast

Jennifer Sygo

Oliver C. Witard

Stéphane Bermon

Trent Stellingwerff

Athletics Canada

University of StirlingInternational Associationof Athletics Federations andUniversité Côte d’Azur

Canadian Sport Institute – Paciﬁc,Athletics Canada, andUniversity of Victoria

The International Association of Athletics Federations recognizes the importance of nutritional practices in optimizing an Athlete’s
well-being and performance. Although Athletics encompasses a diverse range of track-and-ﬁeld events with different performance
determinants, there are common goals around nutritional support for adaptation to training, optimal performance for key events, andreducing the risk of injury and illness. Periodized guidelines can be provided for the appropriate type, amount, and timing of intake
of food and ﬂuids to promote optimal health and performance across different scenarios of training and competition. Some Athletes
are at risk of relative energy deﬁciency in sport arising from a mismatch between energy intake and exercise energy expenditure.
Competition nutrition strategies may involve pre-event, within-event, and between-event eating to address requirements forcarbohydrate and ﬂuid replacement. Although a “food ﬁrst” policy should underpin an Athlete’s nutrition plan, there may beoccasions for the judicious use of medical supplements to address nutrient deﬁciencies or sports foods that help the athlete to meet
nutritional goals when it is impractical to eat food. Evidence-based supplements include caffeine, bicarbonate, beta-alanine, nitrate,and creatine; however, their value is speciﬁc to the characteristics of the event. Special considerations are needed for travel,
challenging environments (e.g., heat and altitude); special populations (e.g., females, young and masters athletes); and restricteddietary choice (e.g., vegetarian). Ideally, each Athlete should develop a personalized, periodized, and practical nutrition plan via
collaboration with their coach and accredited sports nutrition experts, to optimize their performance.
Keywords: performance supplements, RED-S, track and ﬁeld

Burke and Slater are with the Australian Institute of Sport, Canberra, ACT, Australia. Burke is also with the Mary MacKillop Institute for Health Research, Australian
Catholic University, Melbourne, Victoria, Australia. Castell is with Green Templeton College, University of Oxford, United Kingdom. Casa is with the Korey Stringer
Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA. Close is with the Research Institute for Sport and Exercise Sciences, Liverpool John
Moores University, Liverpool, United Kingdom. Costa is with the Department of Nutrition Dietetics & Food, Monash University, Melbourne, Victoria, Australia. Desbrow iswith the School of Allied Health Sciences, Grifﬁth University, Gold Coast, Queensland, Australia. Halson is with the School of Behavioural and Health Sciences, Australian
Catholic University, Melbourne, Victoria, Australia. Lis is with the Neurobiology, Physiology and Behavior Department, University of California Davis, Davis, CA, USA.
Melin is with the Department of Sport Science, Linnaeus University, Växjö, Sweden. Peeling is with the School of Human Sciences (Exercise and Sport Science), The
University of Western Australia, Crawley, Western Australia, Australia. Saunders is with Performance Services, Australian Institute of Sport, Canberra, ACT, Australia; andwith the University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia. Slater is also with the School of Health and Sport
Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia. Sygo and Stellingwerff are with Athletics Canada, Ottawa, Ontario, Canada. Witard iswith the Physiology, Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, United Kingdom. Bermon is with the Health andScience Department, International Association of Athletics Federations, Monaco, Principality of Monaco; and LAMHESS, Université Côte d’Azur, Nice, France.
Stellingwerff is also with the Canadian Sport Institute—Paciﬁc, Victoria, British Columbia, Canada; and the Department of Exercise Science, Physical & Health Education,
University of Victoria, British Columbia, Canada. Burke (Louise.burke@ausport.gov.au) is corresponding author.

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The sport of athletics (track and ﬁeld) encompasses a wide
range of events involving running, walking, jumping, andthrowing, in which success is underpinned by a diversity ofphysiological, psychological, and biomechanical attributes. Its
governing body, the International Association of Athletics Federations (IAAF), recognizes a number of distinct disciplines:
sprints, middle/long distance, hurdles, and relays on the track;
throws and jumps on the ﬁeld; the combined events of heptathlon
and decathlon; road running; race walks; cross-country; andmountain running and ultrarunning (www.iaaf.org). The term
“athlete” can be used as a generic description for any type ofsports person, whereas athletics is known as “track and ﬁeld” inNorth America: to avoid confusion, this statement will use theterms Athletics and Athletes (with a capital “A”) to denote thedisciplines within the IAAF umbrella and their participants.
Despite the extreme range in the characteristics between andwithin these disciplines, high-performance Athletes share somecommon goals: to train as hard as possible with optimal adaptation and recovery, to remain healthy and injury free, to achieve aphysique that is suited to their event, and to perform at their beston the day(s) of peak competitions.
The IAAF has long recognized the role of diet and nutrition
strategies in helping the athlete to achieve these goals. In 1995, it
hosted the ﬁrst meeting on nutrition for Athletics in Monaco,
followed by an update in 2007. Both meetings led to a consensus
statement on the importance of nutrition in the preparation
for, and performance of, events in the track-and-ﬁeld program(International Association of Athletics Federations, 2007;
Maughan & Horton, 1995). These statements were underpinned
by review papers, published in special issues of the Journal ofSports Science (13: [Suppl. 1] 1995 and 25: [Suppl. 1] 2007,
respectively). Other outputs from these meetings have included
booklets for Athletes and coaches, provided at major Athletics’competitions and accessible via the IAAF communications link
(Maughan & Burke, 2012).
Knowledge and practice of nutrition evolve over time andmust be constantly updated and integrated into the Athlete’s
preparation. Indeed, in the decade since the last IAAF consensus
meeting, a range of new developments in sports nutrition has beenrecognized globally by expert bodies such as the American
College of Sports Medicine, Academy of Nutrition and Dietetics,
and Dietitians of Canada (Thomas et al., 2016). In the light ofsome profound changes, the IAAF has recently commissioned areview of the current status of knowledge, attitudes/cultures,practices, and opportunities for sports nutrition to be speciﬁcallyapplied to events in Athletics. This consensus statement provides
a summary of the contemporary principles of sports nutrition,
identifying strategies that may be used by competitors in Athletics
to enjoy a long, healthy, and successful career in their chosen
event. The focus targets high-performance Athletes, while
acknowledging the needs of some special elite populations(e.g., adolescents, females, masters) as well as the opportunity
for the many nonelite competitors who enjoy Athletics(e.g., recreational marathon runners) to beneﬁt from an appropriate translation of these principles into their own pursuits.

Recognizing the Special Issues of Event
Groups in Athletes
For the purposes of this summary, the IAAF disciplines in track andﬁeld were divided into ﬁve event groups for individual review(sprints, jumps/throws/combined events, middle distance, long
distance, and ultradistance/mountain running; Table 1). The considerable heterogeneity of events present within each group is
acknowledged; nevertheless, this strategy achieves a pragmaticbalance between the need for efﬁciency and the challenge ofaddressing unique and speciﬁc needs of each event. These reviews
were charged with summarizing key nutrition goals and concerns
within each event group, discussing novel aspects such as contemporary beliefs and dietary practices, identifying the scenarios inwhich the rules or conditions of events assist or hinder the optimal
intake of nutrients, especially in the competition scenario, andreviewing event-speciﬁc research on nutritional issues. The key
ﬁndings of these reviews are presented in Table 1.
Issues identiﬁed in the event group summaries are expanded inthis consensus statement below, and the special issue of theInternational Journal of Sport Nutrition and Exercise Metabolism,via the examination of 12 themes that provide a framework ofnutrition for Athletics and allow a more global understanding of therecent changes in sports nutrition knowledge and practice. Contemporary sports nutrition should be underpinned by a recognition
that Athletes often share common goals (e.g., to meet the energy
and speciﬁc fuel requirements needed to support training andcompetition); common challenges (to balance such intake against
the desire to manipulate body composition, while remaining free of
illness and injury); and common scenarios (e.g., periods of travel
away from their home base and its familiar food environment).
However, the speciﬁc features of each event, including optimal
physique, typical training protocols, competition characteristics,
and the parameters that limit performance, create differences innutritional requirements as well as the opportunities to address
them. The principles of sports nutrition for each event must be
further individualized and periodized for each Athlete, then implemented via translation into practical eating practices and foodchoices, and, sometimes, the judicious use of special sports products and supplements. Thus, Athletes and coaches are advised towork collaboratively with sports science, medicine and nutrition
experts to develop a model that identiﬁes where nutrition canenhance event- and individual-speciﬁc performance, to reﬁne thismodel through experimentation and experience, and to achieve it inreal-life practice.

Theme 1. Periodization of Nutrition Strategies in theYearly Training Plan (Stellingwerff et al., 2019b)
Periodization is a cornerstone concept in training for Athletics
whereby the exercise load (mode, frequency, intensity, andduration) is strategically manipulated within a sequence ofcycles to gradually achieve the physical, biomechanical, physiological, neuromuscular, and psychological attributes needed forsuccess at chosen competition(s). It is self-evident therefore that
the Athlete’s dietary intake and nutrition strategies should becontinually changing to optimize the adaptive effects fromthe ever changing training program. Although a repositioningof the Athlete’s diet from static and universal, to changing andindividualized, was speciﬁcally targeted in the 2007 consensus
statement, there have been further developments in the principles
and practices around periodized nutrition since then. The overarching philosophy of periodized nutrition is that each training
session, micro-, meso-, and macro-cycle of training should beanalyzed in terms of how it addresses an individual Athlete’s
gaps to achieving the event speciﬁc attributes of success, withnutrient intakes and dietary strategies being arranged around

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Table 1

Common Characteristics of Different Event Groups in Athletics

Event group/key events

Special features

Key nutritional challenges

Key nutritional strategies

Sprints(Slater et al., 2019)
100 m, 100/110 m hurdles
200, 400, 400 m hurdles
4 × 100, 4 × 400 relays• Performance determined pri-

• Much greater metabolic de-• Greater focus on training

marily by reaction time,
acceleration, maximum running velocity, and the ability
to sustain this in the presenceof increasing fatigue• Large dependence on anaerobic energy generation• Training typically involves
brief maximum intensity repetitions of varying length,with either long or short
recovery periods, while competition involves single efforts
through heats and ﬁnals

nutrition given the metabolic
demands of training far
exceed those of competition• Emphasis placed on the strategic timing of nutrient intake
before, during, and after
exercise to assist in optimizing training capacity, recovery, and body composition• Some evidence to support theuse of a small number ofsupplements (e.g., caffeine
and creatine, plus beta-alanine
and bicarbonate for longer
sprints) to assist in the training
and/or competition
environment

Jumps/throws/combined
events(Sygo et al., 2019)
Long, triple, high, polevault, shot put, hammer,
javelin, discus
Heptathlon and decathlon• An emphasis on speed andmands in training (via multiple daily sessions) comparedwith competition• Power to weight needs to be
optimized rather than maximized. Currently, there areinsufﬁcient morphological
data to provide detailed
guidance• When contrasted against otherAthletes, relative energy andmacronutrient intake is lower
than in middle-distance andlong-distance Athletes.
• Nutrition strategies to amplify
training-induced adaptive
signals outside of protein
metabolism remain to be
explored• Optimization of athlete bodymass, which varies widely by
event, with emphasis on
optimal power–weight ratio insome events• Recovery from training that
may result in substantial
muscle damage and neuromuscular fatigue• Energy requirements that canvary considerably between
peak training vs. competitionphase• “Trade-offs” for combined
event Athletes of maintaining
a more powerful physique
suitable for shorter sprints andthrows vs. a lower body mass
for jumps and middle-distanceevents• Huge variability of training• Periodization of nutrition tothroughout the season (large
differences in volume andintensity) dictates very different caloric and macronutrient demands• High-metabolic acidosis limits
performance• Important of exceptional
power to weight ratios for
optimal competition performance while staying healthy
in a structurally demanding
sport (risk of stress fractures)• 2–3 training bouts/day and 2–
3 races over several days inmajor competitions require
optimized nutritional recovery

meet the demands of training
and competition volumes andintensity to dictate caloric andmacronutrient requirements• Potential use of exogenous(sodium bicarbonate) andendogenous (beta-alanine
leading to carnosine) buffering approaches• Periodized approach to bodycomposition throughout the
yearly training plan to optimize power–weight ratio fortargeted competition season.
• Optimized nutrition and ﬂuidbased recovery routines during intensive training days andcompetition periods

Middle distance(Stellingwerff et al., 2019a)
800/1,500 m
3,000 m steeplechase,
5,000 mexplosive movements alongwith technical proﬁciency toconvert forward or rotational
movement into the highest
jump or longest jump or throw• Wide ranging somatotypes
that share the commonality of
optimal strength–weightratios and Type II muscle ﬁber
typing• Competition consists of shortrepeated explosive bouts but
often includes prolonged timein the ﬁeld of play.
• The additional challenge ofcounterbalancing speed/
power with middle-distanceaerobic/anaerobic bioenergetics demands for combined
event Athletes• Exceptional aerobic andanaerobic bioenergetic development, with emphasis on
sprint biomechanical/structure performance components• Large dependence on exogenous and endogenous buffering systems for performance• Large individual and seasonal
diversity of training programs,with large volumes during
general preparation phase, andsprint-based workouts in thecompetition phase• 2–3 races in major championships with minimal days
for recovery between races• Periodization of energy andmacronutrient intake to meettraining demands across theyearly training plan andcompetition cycle• Appropriate use of ergogenic
aides, such as creatine, betaalanine, and/or caffeine, depending on event, stage ofseason, and performance
goals• Periodized body composition
over the season, reaching peak
power–weight ratio for key
competitions• Planning of nutrition andhydration strategies to support
extended competition days,
often occurring in peak sun
and/or heat(continued)

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Table 1 (continued)
Event group/key events

Special features

Key nutritional challenges

Key nutritional strategies

Distance(Burke et al., 2019)10,000 m
Half marathon/marathon
20/50 km race walks
Cross-country• Race times for elite performers• High training volume requires• Periodization of energy anddietary energy and CHO support, especially for highquality and race practice
workouts• High power to weight ratio(i.e., low body mass/fat content) associated with successbut poses another risk for low
energy availability.
• Race success requires highavailability of economical
CHO fuels• Longer races permit withinevent intake of CHO andﬂuid, but must be balanced
against time lost in obtaining/
consuming supplies from feedzones and risk of gut upset

Ultradistance and mountainrunning(Costa et al., 2019)>Marathon distance:
self-sufﬁcient, semisupported, and full support• Much longer race distances• Establishing the ideal power–(∼50–250 km than otherAthletics events; however,conducted at much lower
intensities, across varied terrain and surfaces (i.e., desert,
mountain, forest, jungle, arctic)• Large dependency of endogenous fat energy substrate but
requires a constant supply ofexogenous CHO energy substrate for synergistic energy
provisions and prevention of
metabolic fatigue• May include additional burdenof carrying day or self-sufﬁciency packweight ratio for speciﬁc racecharacteristics• High training volumes andquality running require sufﬁcient carbohydrates before,
during, and posttraining.
• High-risk events for promoting ﬂuid overload and exercise-associated hyponatremia• High prevalence of gastrointestinal symptoms, including
gradual development of foodand ﬂuid intolerance as distance progresses

CHO intake according totraining volume and goals tobalance performance andadaptation goals of each session and cycle• Periodization of body composition to balance health andperformance• Race nutrition strategies tomeet event-speciﬁc CHO requirements including appropriate pre-race glycogenstorage, within-event CHO
intake according to opportunity to achieve muscle andcentral nervous system beneﬁts• Event-speciﬁc hydration plan
before and during race to ﬁnd
individual balance between
rates of sweat loss and opportunities to drink• Well practiced use of evidence-based performance
supplements (e.g., caffeine)• Periodization of nutrition tomeet speciﬁc (i.e., terrain,
surface and environmental
conditions) training andcompetition demands• Ad libitum ﬂuid intake forprotection against dehydration and overhydration.
Assess gastrointestinal tolerance to race food and ﬂuid,
and adjust accordingly• Practice race nutrition prior tocompetition (i.e., train the gut)

span ∼26 min–>4 hr• Elite performers typicallypeak for two races/year• Key factors for success arehigh aerobic power, the ability
to exercise at a large fractionof this power, and higheconomy of movement• High-volume training typically maintained

Note. CHO = carbohydrate.

each period, from individual session to overall season, to contribute to the changes that will address the Athlete’s long-termgoals. The diversity and complexity of the needs for successacross different Athletic events means that many models of
periodized nutrition are possible.
An illustration of periodized nutrition is provided in Figure 1
in relation to four different concepts: carbohydrate (CHO) fuel for
support and adaptation of “aerobic” events, protein for adaptationand physique manipulation, special needs around micronutrient
support, and understanding the different roles of supplements fortraining support and performance optimization. The ﬁrst of theseconcepts provides an example of an evolving subtheme in nutritional periodization: Nutritional strategies employed to achieve one
goal might be contradictory for another. More speciﬁcally,
although proactive nutrient support directed at the speciﬁc factorsthat limit performance is an important goal for competition andperformance-focused training sessions, in some cases, the deliberate or accidental exposure to the absence of nutrient support canaccentuate adaptive responses to an exercise stimulus. This is
illustrated by robust evidence demonstrating that strategies which
provide high CHO availability enhance the performance of sustained exercise conducted at intensities below the so-called anaerobic threshold. Yet, when such exercise is undertaken with low
CHO availability (particularly low muscle glycogen stores), there
is a further upregulation of the signaling pathways underpinningvarious adaptive responses. The deliberate integration andsequencing of adaptation-focused and performance-focused
nutrition strategies into an Athlete’s training program is a highly
individualized and specialized task that should involve the inputof Athlete, coach, and scientists specializing in nutrition, whilefeaturing continual modiﬁcations according to feedback andexperience.

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Nutrition for Athletics

Figure 1 — A theoretical model highlighting periodization considerations for three common nutrition interventions of CHO, PRO, and iron in relation
to the Athletics event performance determinants. CHO = carbohydrate; PRO = protein.

Theme 2. Energy Availability in Athletics: Managing
Health, Performance, and Physique (Melin et al.,
2019)
Dietary energy must meet the energy cost of an Athlete’s training
load and competition program as well as support the body’s
nonsport function/activities related to health and well-being.
The conventional interest in energy targets the concept of energybalance where differences between dietary energy intake and total
daily energy expenditure create opportunities for changes in bodycomposition to store or utilize body fat and protein. This is
recognized as an important concept in Athletics since, at different
times in their sporting career or each annual training plan, many
Athletes deliberately manipulate both sides of the energy balance
equation to achieve physique changes that optimize performancein their event (e.g., gain in body mass [BM]/muscle mass, loss of
BM/body fat). However, the contemporary concept of energy
availability examines energy intake in relation to the energythat is left to address the body’s myriad nonexercise needs oncethe energy expenditure committed to training and competition isremoved. Here it should be noted that, as the energy expenditureassociated with the Athlete’s prescribed training load is alreadycommitted, an energy mismatch (i.e., initial energy deﬁcit) leads
to an adjustment in expenditure on the nonexercise body functions

to conserve energy, with potential impact on health and performance. Low energy availability (LEA) underpins the Female
Athlete Triad syndrome, but new insights over the last decade
have identiﬁed its occurrence in male Athletes and its impact on a
range of body systems and performance factors, beyond bone andmenstrual health. Thus, the concept of relative energy deﬁciency
in sport was developed to address this expanded range of concerns, together with the sequelae of functional hypothalamic
amenorrhea (females), reduced testosterone levels and libido(males), poor bone health, increased risk of illness and injuries,
gastrointestinal disturbances, cardiovascular disease, impaired
hematological, training capacity and performance. LEA is known
to occur in Athletics, and, although the highest prevalence appears
to be in the weight-sensitive endurance and jump events, all
Athletes may be at risk of its development via disordered eating,misguided weight loss programs, and inadvertent failure to recognize or address increased energy expenditure associated withtraining/competition. Preventive educational programs andscreening to identify Athletes with LEA/relative energy deﬁciency in sport are important for early intervention to prevent
long-term secondary health consequences. Treatment for these
Athletes is primarily to increase energy availability and often
requires a team approach including a sports physician, sports
dietitian, physiologist, and psychologist.

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Theme 3. Protein Needs for Adaptation andPhysique Manipulation (Witard et al., 2019)

Theme 4. Fluid Needs for Training, Competition,
and Recovery (Casa et al., 2019)

Whether the recommended daily allowances for protein for thegeneral population, set at 0.8–1 g/kg in most countries, aresuitable for high-level Athletes has been a point of controversy
for many decades. It is only recently that there has been agreement that allowances, which target the absence of protein insufﬁciency in largely sedentary populations, are not relevant tocompetitive Athletes who need to optimize the adaptive responseto training and to achieve the physique attributes of lean mass tobody fat ratio needed for successful performance in their events.
There is now clear evidence of the beneﬁts of consuming highquality proteins (those providing relevant amounts of all essential
amino acids) in a well-timed distribution over the 24-hr
period following key workouts or events; this promotes the
manufacture of new body proteins in response to the speciﬁctraining stimulus as well as replacing damaged ones. Highquality protein-rich foods (high in leucine), when consumed inamounts equivalent to ∼0.3–0.4 g/kg of rapidly digested protein
at four to ﬁve eating occasions per day, can optimize the training
response in Athletes with optimal energy availability. This target
probably should be increased to 0.4–0.5 g/kg in the case of mixed
meals that slow the protein digestion/absorption kinetics andscenarios of energy deﬁcit/weight loss in which rates of muscle
protein synthesis are suppressed. Overall, dietary protein intakesof 1.3–1.7 g·kg−1·day−1 represent optimal targets for the physiqueand adaptation goals of weight-stable Athletes. Meanwhile,
Athletes who wish to achieve effective weight loss, which
promotes the retention or even an increase in lean mass, areadvised to engage in resistance exercise and to consume dietary
protein in quantities of 1.6–2.4 g/kg. Protein-rich whole foodsources are the preferred source of protein due to cost, safety andnutrient content. However, protein supplements may sometimes
provide a valuable option when it is impractical to transport,
prepare, or consume food sources of protein (e.g., immediately
postexercise). Table 2 summarizes the current recommendations
for protein intakes for high-performance Athletes according totheir major goals.

The past decade has seen controversy over guidelines for ﬂuid
intake during sport. The best advice to enable adequate replacementof sweat losses has been debated, as have the beneﬁts/impairment
to performance associated with proactive or passive hydration
strategies. What is irrefutable is that the ﬂuid needs of mostAthletes are determined by their reliance on the evaporation ofsweat to dissipate the heat produced during exercise or absorbed
from a hot environment. Athletics, probably more than any sport,
illustrates the futility of trying to apply a single set of guidelines forbehavior regarding ﬂuid and electrolyte replacement around sport.
Not only is there great diversity in terms of sweat loss during
different Athletic events, but there are also differences in opportunities for ﬂuid intake and the penalty for incurring a ﬂuid
mismatch. At one end of the spectrum are events such as jumps
in which the risk of becoming dehydrated during an event is low
and where there may even be beneﬁts to performance if a mild levelof hypohydration on competition day creates an increase in power–
weight ratios. Conversely, distance and ultradistance events areassociated with large rates and absolute volumes of sweat loss due
to sustained high-intensity exercise, prolonged duration, hot/humid
weather, or combinations of these three. However, opportunities
for ﬂuid intake from aid stations or the Athletes’ own supplies
range from minimal to excessive in comparison with sweat losses.
In the case of high-level competitors, at least, ﬂuid intake duringcontinuous events needs to be balanced against the time lost in
drinking and the risk of gut upsets. Fluid losses equivalent to >2–
3% BM are typically associated with increases in perceived exertion and reductions in plasma volume, cardiac, and thermoregulatory function and performance in warm–hot conditions. However,the difﬁculty in drinking during some races means that the winners(i.e., those who are most successful at maintaining an absolutespeed despite hypohydration) may incur ﬂuid losses >5% of BM.
Advice for ﬂuid intake for training and events in track and ﬁeld
should encourage Athletes to understand the characteristics of theirevent in terms of the likelihood of large sweat losses, the opportunities to replace these by drinking during the event, and theTable 2

Guidelines for Protein Intake for Athletes

Current recommendations based on available evidence
1
The optimum daily protein intake for weight stable Athletes exceeds the protein RDA (0.8–1.0 g/kg BM/day) set for the general adult population.
2
The optimum daily protein intake for Athletes who have a goal of weight maintenance or weight gain ranges from 1.3 to 1.7 g/kg BM/day.
3
The optimum per meal/serving of protein for Athletes who have a goal of weight maintenance or weight gain ranges from 0.3 to 0.4 g/kg BM/
meal.
4
Very high protein intakes of >2.5 g/kg BM/day offer no adaptive advantage.
5
The optimum daily protein intake for Athletes who are undertaking high-quality weight loss exceeds 1.6 g/kg BM/day and may be as high as
2.4 g/kg BM/day.
6
Athletes who consume a high-protein diet (e.g., 2.4 g/kg BM/day) during weight loss are not at increased risk of kidney problems or poor bonehealth.
Areas for future research1
Event-speciﬁc protein needs in Athletics related to body composition manipulation.
2
Dose response of muscle protein synthesis to different protein-rich food sources and meals rather than isolated proteins (e.g., whey, soy)3Long-term beneﬁts and/or protein needs of Athletes undertaken high-quality weight loss.
4
Individual variability in body composition responses to manipulation of dietary protein during weight loss in Athletes.
Note. RDA = recommended daily allowance; BM = body mass. High-quality weight loss is deﬁned as the loss of fat mass while preserving, or even increasing, lean BM(Witard et al., 2019).
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consequences of being hypohydrated. It may be possible and usefulto drink to the dictates of thirst when sweat losses are low and theopportunities to drink are plentiful. However, other circumstances
require a proactive plan, that is, when performance is affected byhypohydration and the likelihood of large losses is matched withfewer opportunities for hydration. In very hot and/or humid environments, such as may be encountered in high-level competition(e.g., 2019 IAAF World Championships in Doha or 2020 Tokyo
Olympic Games), strategies for hyperhydration and precoolingprior to events may provide an additional advantage. Table 3
summarizes some of the events in Athletics in which withinrace ﬂuid plans may be beneﬁcial. All strategies should be wellpracticed in training and ﬁne tuned for the speciﬁc event. In the caseof Athletes who undertake distance and ultradistance events at
slower paces with lower sweat rates, speciﬁc advice against overconsuming ﬂuids may be necessary to avoid the problems

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associated with hyponatremia (low blood sodium levels, usually
due to excessive ﬂuid intake). In some scenarios where large sweatassociated electrolyte losses occur, replacement of electrolytes,
particularly sodium, may be beneﬁcial in within and postexercise
plans; this may be achieved via the use of whole foods or sports
food/supplement choices.

Theme 5. Competition Fuel Needs for Longer
Events (Burke et al., 2019; Costa et al., 2019)
Most of the power used in long and ultradistance events is provided
by oxidative fuel-generating pathways. As CHO is a more economical fuel source than fat (i.e., it produces great amounts of
adenosine triphosphate for a given amount of oxygen) and can
produce adenosine triphosphate via oxygen-independent pathways, it becomes the dominant fuel source at higher intensities.

Table 3 Nutritional Strategies for CHO and Fluid Intake Before and During Distance and Ultrarunning Events inAthletics

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Issue and general
guidelines

21.1-km half marathon 20-km race walk

42.2-km marathon

50-km race walk Ultramarathon

Pre-race refueling:
Glycogen normalization
Accentuated glycogen CHO loading, especially CHO loading,
CHO loading especially• Normalization of
normalization
with low-residue dietespecially with
with low-residue dietglycogen =low-residue dietand removal of foods
7–12 g/kg/day for 24 h
known to cause gut• CHO loading =issues
10–12 g/kg/day for
36–48 hFamiliar pre-race meal + Familiar pre-race meal Familiar pre-race meal + Familiar pre-race Familiar pre-race meal
Pre-race meal:• 1–4 g/kg CHO in
CHO after warm-up+ CHO after warm-up CHO after warm-up
meal + CHO after + CHO after warm-up
1–4 h pre-racewarm-up• Reduced fat, ﬁber, andprotein according torisk of gut issues
Opportunities for
Typically every 5 km in Every lap of 2 km loop Typically every 5 km in Every lap of 2 km Ranges from fully or
in-race nutrition:
elite races
course (sometimes
elite races. Frequency dif- loop course
semisupported to(availability of drink Frequency differs in large course = 1 km loop)
fers in large city marathons:requiring runner tostations)
city races
may be every 1–2 miles
carry own supplies
In-race fueling goals: Trial CHO mouth rinse up Trial CHO mouth rinse 30–60 g/hr CHO; Consider Target 60–90 g/hr Target 30–90 g/hr ac• 45–75 min: mouth to intake of 30–60 g from up to intake of 30–60 g trialing intakes up to 90 g/hr from mix of CHO cording to needs (rate ofrinse/small CHO
CHO drinks or gels/from CHO drinks or from mix of CHO drinks drinks or concen- CHO use decreases
amountconfectionerygels/confectionery
and more concentrated
trated gels/with slower pace of• 1–2.5 h: 30–60 g/h
gels/confectionery
confectionery
longer races) and what
• >2.5 h: up to 90 g/h
is tolerated/practical
Fast runners will ﬁnd it
Drink stations
BM changes less likely
In-race hydration goals: Cost–beneﬁt analysis may Drink stations allow• Aim to keep net ﬂuid show that time cost ofplentiful opportunities difﬁcult to drink large
allow plentiful
to reﬂect true ﬂuid defdeﬁcit <2–3% BM,
drinking may negate
for frequent small in- volumes
opportunities for icit. Lower sweat rates
especially in hot
beneﬁts in elite runners
takes of CHO containfrequent small
with slower pace inweathering ﬂuid toward a race
intakes of CHO
longer races might
plan
containing ﬂuids mean drinking to thirst
within the race plan may underpin race plan
Special issues for hot Consider pre-cooling with ice slurry in addition to external cooling strategies if signiﬁcant thermal challenge is anticipatedweather events
Consider pre-race hyperhydration if large ﬂuid deﬁcit is anticipated
Adjust ﬂuid intake during event where possible in view of increased sweat losses. Be aware of sweat rates for an array ofenvironmental conditions so that rehydration plans can be individualized and rehearsed prior to the event
Special comments for Do not overdrink by consuming ﬂuid in excess of sweat losses. A good tip is to avoid drinking beyond thirst cessation if notnonelite or slower
aware of individual ﬂuid needs
competitors
Note. BM = body mass; CHO = carbohydrate (Burke et al., 2019; Casa et al., 2019; Costa et al., 2019).
All strategies should involve a personalized and well-practiced plan that is suited to the speciﬁc needs of the events. General guidelines can be found in more detail in
the guidelines by Thomas et al. (2016).
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The depletion of the body’s ﬁnite CHO stores can be a limiting
factor in the performance of distance and ultradistance events, andstrategies that increase CHO availability to meet their fuel demands
are associated with performance enhancement. Such strategies
including CHO intake during the days prior to the event tonormalize or supercompensate muscle glycogen stores, CHO
intake in the pre-race meal to restore liver glycogen after overnight
fasting, and the intake of CHO during the event. Table 3 summarizes guidelines for strategies that are commensurate with thedemands of different events on the Athletics program, as well as theopportunities to achieve feeding during a race. Contemporary
evidence regarding events of over 90 min in duration indicatesthat within-race CHO becomes more important in supplying
substrate to the muscle and brain as endogenous supplies dwindle;
indeed, with races of >2 hr, higher CHO intakes (e.g., up to 90 g/hr
from mixed CHO sources) are often associated with larger performance beneﬁts. However, with the longest ultraendurance events,
realistic/optimal rates of intake may start to scale down due toreduced fuel needs at lower exercise intensities, the logistics ofgaining access to such supplies, and the increasing importance ofmanaging gastrointestinal comfort and function during the race.
Although the role of within-race CHO intake as additional
substrate for the muscle and brain has been understood for nearly acentury, there is now evidence that CHO consumed during exercise
can provide an additional performance beneﬁt via central (brain/
nervous system) effects. More speciﬁcally, CHO intake can stimulate areas of the brain that control pacing and reward systems via
communication with receptors in the mouth and gut. This “mouthsensing” of CHO provides another reason for frequent intake of
CHO during longer events (Table 3) as well as some of the shorter
events in which it may not be necessary to provide muscle fuel(e.g., half marathon, 20-km race walk). All strategies used during
races should be personalized to the event and the individual: theyshould be well practiced and able to be achieved within the event
logistics which include considerations of supply, consumption
while running/walking, and gut comfort.
Meanwhile, there is interest in nutritional strategies including
chronic or periodized exposure to high-fat, low-CHO diets that
may allow Athletes in ultraendurance (>4 hr) events to increase
their ability to oxidize fat as a muscle fuel in view of its relatively
unlimited pool size and capacity to support exercise at intensities
up to ∼75–80% VO2peak. However, it should also be noted thatmost ultramarathon runners already have a high capacity for fat
oxidation, regardless of dietary background. Furthermore, althoughtargeted adaptation to a high-fat diet with CHO restriction isassociated with very high rates of fat utilization across a rangeof exercise intensities, this comes at a cost of a greater oxygen
demand during exercise (lower speed for a given oxygen supply or
greater oxygen requirement for the same speed) as well as adownregulation of the capacity of CHO oxidation pathways.
Such adaptations have been shown to impair performance of races,or selected segments within a longer race conducted at higher
exercise intensities (>80–85% VO2peak), probably limiting theutility of high-fat, low-CHO diets to selected individuals, events, or
scenarios.

Theme 6. Staying Healthy (Castell et al., 2019)
The physiological, metabolic, and psychological stresses involvedin training and competition may be linked to immune dysfunction,
inﬂammation, oxidative stress, and muscle damage. Physicallydemanding bouts of exercise reduce the metabolic capacity of

immune cells, with this transient immunodepression lowering theresistance to pathogens and increasing the risk of subclinical andclinical infection and illness. Indeed, early studies reported a highincidence of postexercise upper respiratory tract illness among
marathon and ultramarathon runners, especially among the fasterrunners and those with greatest training volumes. Illness surveys
conducted at major competitions have reported high levels of upper
respiratory tract illness among Athletes within mixed sport events(e.g., the London Olympic Games), while among Athletics groups
at IAAF World Championships females and endurance Athletes
reported the highest incidence of illness.
Optimizing training load management (e.g., excessively large
training volumes and/or sudden changes in training) plays a majorrole in reducing the incidence of illness. Illness interferes withtraining consistency and can directly affect performance for several
days if it occurs during competition. Athletes who start an endurance event with systemic acute illness symptoms are two to threetimes less likely to ﬁnish the race. Other factors to be considered
include high levels of depression/anxiety, long-haul ﬂights, wintercompetitions, lack of sleep, and LEA.
Immunonutrition may help to combat exercise-induced immunodepression, with important considerations including energy
availability and adequate intakes of protein, CHO, fatty acids, andmicronutrients (iron, zinc, magnesium, and Vitamins A and D).
Traveler’s diarrhea is a frequently reported illness among
Athletes who travel across multiple time zones and continents totrain or compete in remote countries. Pathogens vary from country
to country but contamination of food and water by Escherichia coli
is a frequent cause, while Norovirus and Rotavirus are the mostfrequently reported, and highly contagious, viruses. Although
recovery may occur within a couple of days, an infectious episodemay seriously impair the Athletes’ ability to train or compete. The
effectiveness of precautions around food and water management inhigh-risk areas is unclear; nevertheless, it makes sense to avoid
unsafe drinking supplies or foods (see Table 4). An illness prevention program should be implemented, requiring coordinatedinvolvement of medical staff, coaches, and Athletes, focusing
on preventative precautions for high-risk individuals, with isolation
and appropriate treatment of team members who are ill.
Athletes may experience various gastrointestinal problems
during exercise, with the main complaint being diarrhea known
as “runner’s diarrhea.” During running or racewalking, reduced
splanchnic blood ﬂow is sometimes associated with reperfusion,
creating intestinal barrier function loss, increased permeability andbacterial translocation. Aggravating factors include a hot environment, consumption of nonsteroidal anti-inﬂammatory medicines,
long duration or high-intensity exercise and, potentially, the jarring
action of running. Nutritional factors include high dietary intakes ofﬁber, intakes of fructose, and other fermentable CHO sources(known as FODMAPS [fermentable oligosaccharides, disaccharides, monosaccharides, and polyols]) in susceptible individuals, theuse of bicarbonate or caffeine as performance supplements, andwithin race intake of drinks of high CHO content and osmolality.
The stomach and gut can possibly be trained to improve tolerance,
gastric emptying, and absorption during exercise. Other strategies
to reduce gut problems include the removal of problem foods insusceptible people.
Iron status is an important factor in health and performance,
but compromised iron status is a common occurrence among
endurance Athletes, particularly females. This occurs due to factors
from both exercise (e.g., hemolysis and alterations to the iron
regulatory hormone hepcidin) and nonexercise origin (e.g.,

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Table 481

Strategies to Promote Athlete HealthTraining and competition load management• Develop detailed and personalized training and competition
plans, which promote adequate recovery using sleep,
nutrition, hydration, and psychological strategies• Use small increments when changing training loads (typically <10% weekly)• Develop competition calendar based on the Athletes’ health• Monitor for early signs and symptoms of overreaching,overtraining, and illness• Avoid intensive training when experiencing illness or earlysigns and symptoms

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Psychological load management• Follow stress management techniques to reduce the extraneous load of life hassles and stresses• Develop coping strategies to minimize internalized impact
of negative life events and emotions• Periodically monitor psychological stresses using available
instruments

Hygienic, lifestyle, and behavioral strategies• Maintain appropriate vaccination schedule for home (e.g., annual ﬂuvaccine) and travel (recommended protocols for foreign countries)• Minimize general exposure to pathogens by avoiding close contact with
infected individuals in crowded spaces and avoiding the sharing of drinking/eating implements and personal items• Establish good hygiene practices that limit hand to face contact, including
regular and effective hand washing and capturing sneeze/cough expectorantin the crook of the elbow• In group situations (e.g., travel, communal living) encourage Athletes/
entourage to report illness symptoms at an early stage to allow expedited
isolation of persons with potentially infectious illnesses• Implement practices that limit all infection types including safe sex/condom
use, insect repellant and skin coverage strategies, and protection against skininfections in public places• Facilitate regular, high quality sleep• Avoid excessive alcohol intake
Nutritional strategies
To promote general immune health:• consume well-chosen diet with adequate energy availability and nutrient
provision
To minimize traveler’s diarrhea:• drink only safe ﬂuids: hot drinks made from boiled water, cold drinks fromsealed bottles• avoid high-risk foods, for example, unpeeled fresh fruit and vegetables,
buffet meals that have been standing without precise temperature andhygiene control, undercooked meat, street vendors’ foods
To minimize runner’s diarrhea in susceptible individuals:• avoid poorly tolerated nutrients/ingredients in pre-exercise meals; these may
include ﬁber, fat, protein, fructose, and caffeine or bicarbonate supplementation• experiment with the type and amount of drinks/sports foods/foods consumed
during longer sessions or races to develop a protocol that can be tolerated
with practice• with Irritable Bowel Syndrome, trial the avoidance of fermentable oligosaccharide, disaccharide, monosaccharide, polyol carbohydrates in somefoods
To maintain adequate iron status:• include iron-rich foods in the diet (e.g., red meats, nuts, seeds and fortiﬁed
cereals, leafy green vegetables, legumes, etc) and use strategies to enhancebioavailability (mixing plant iron sources with Vitamin C or animal ironsources)• check iron status regularly if in high-risk group for suboptimal iron status(females, endurance Athletes, and vegetarians)• To treat deﬁciency or suboptimal status, use intravenous or intramusculariron supplements but only under medical supervision

Note. Adapted from Castell et al. (2019).

inadequate iron intake, heavy menstrual blood losses). Routine
screening of iron status according to standardized protocols andtreatment of suboptimal iron stores is recommended. Options
include dietary counseling to improve iron intake, oral iron supplements and, in the case where the athlete is unresponsive or where
faster approaches are needed, an intramuscular or intravenous
supplement. These latter options must only be undertaken in a
medical setting under the supervision of a physician. Strategies toaddress issues of illness in athletes are summarized in Table 4.

Theme 7. Preventing and Treating Injuries (Closeet al., 2019)
Injuries are an inevitable consequence of participation in high-level
Athletics with most competitors sustaining one or more during theirathletic careers. This can directly affect performance if it occurs

during a major competition, as well as have indirect effects on
performance due to interrupted training. Injuries to skeletal muscle
account for over 40% of all injuries with the lower leg being thepredominant injury site. Other common injuries include fractures,
especially stress fractures in Athletes with LEA, and injuries totendons and ligaments, especially those involved in high-impact
sports such as jumping. Given the high prevalence of injury inAthletes, it is not surprising that there has been a great deal ofinterest in factors that may reduce the injury risk or that decrease
the recovery time should an injury occur.
Low energy availability is known to be a major risk factor in thedevelopment of bone stress fractures and should be corrected in boththe prevention and treatment of such problems. Attention to VitaminD status and intake of protein and calcium may also be of value.
Nutrition goals during the rehabilitation of muscular injuries include
adjustment to new energy requirements and distribution of daily

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legal, and effective, and, moreover, that such supplements aretrialed thoroughly by the individual before committing to using
them in a competition setting. Table 5 provides a summary of
performance supplements that might be of value in different eventsin Athletics, as well as evidence-based uses of medical supplements
and sports foods.

protein intake to minimize loss of lean mass and increase muscle
repair. The prevention and treatment of injuries to tendons andligaments are an area of recent active research with initial data on therole of nutritional support from collagenous proteins and micronutrients (e.g., Vitamin C, copper) showing potential beneﬁts.

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Theme 8. Supplements and Sports Foods (Peeling
et al., 2019)

Theme 9: Special Environments: Altitude and Heat
(Saunders et al., 2019)

Athletes represent an enthusiastic audience for the numerous supplements and sports foods that are marketed with often questionableclaims of optimizing health, function, and performance. Although a“food ﬁrst” philosophy is promoted in relation to nutritional needs,
medical supplements may be used under supervision to treat or
prevent nutrient deﬁciencies (e.g., iron deﬁciency, see Theme 6),
while sports foods may assist the Athlete to meet their nutritional
goals or nutrient targets in scenarios where it is impractical to eat
whole foods. The majority of performance products lack evidence tosupport their efﬁcacy. However, ﬁve evidence-based performance
supplements (caffeine, creatine, nitrate/beetroot juice, beta-alanine,and bicarbonate) may contribute to performance gains, according to
the event, the speciﬁc scenario of use and the individual Athlete’s
goals and responsiveness (Table 5). Speciﬁc challenges include
developing protocols to manage repeated use of performance supplements in multi-event or heat ﬁnal competitions or the interaction
between several products that are used concurrently. Potential disadvantages of supplement use include expense, false expectancy, andthe risk of ingesting substances banned under the World Anti-Doping
Agency’s List, which are sometimes present as contaminants orundeclared ingredients. However, major organizations and expert
bodies now recognize that a pragmatic approach to supplements andsports foods is needed in the face of the evidence that some products(previously mentioned) can usefully contribute to a sports nutrition
plan and/or directly enhance performance. We conclude that it ispertinent for sports foods and nutritional supplements to be considered only where a strong evidence base supports their use as safe,

High-level Athletes are often required to compete in environments(e.g., hot weather, altitude) that reduce performance. Furthermore,in the continual search for ways to optimize competition performance in normal conditions, it has become popular to train in suchchallenging/altered environments to increase the adaptive stress.
Indeed, this may be further potentiated by associated nutrition andhydration interventions. Although altitude training was ﬁrst used
to prepare for competition in a similar environment (e.g., 1968
Mexico City Olympic Games), it is now more routine for elite
Athletes to undertake a series of altitude training camps to improvetheir sea-level performance. Similarly, the use of heat acclimation/acclimatization to optimize performance in hot/humid environmental conditions (e.g., 2019 IAAF Doha World Championships)
is a common and well-supported practice. However, the use of heattraining to improve exercise capacity in temperate environments isa more recent theme that may produce positive outcomes. When
Athletes expose themselves to blocks of training with either orboth environmental challenges, it is important to provide ample
dietary support to optimize training quality and the resultant
adaptive responses. For example, LEA, poor iron status, andillness are known to attenuate the response to altitude training
and should be addressed prior to the training block. In addition, thespecial or additional nutrition needs of the training block(e.g., increased energy and CHO utilization or ﬂuid losses) due
to the environment or changed training load should be recognized
and addressed.

Table 5 Performance Supplements and Sports Foods That May Achieve a Marginal Performance Gain in Athletics
Events as Part of a Customized and Periodized Training and Nutrition Plan
Event
100/200 m + 100/110 m
hurdles, 4 × 100 m relay
400 m + 400 m hurdles
4 × 400 m relay
800 m
1,500 m + 3,000 m steeplechase3,000 m steeplechase5,000/10,000 m, cross-country
20/50 km race walk
Half marathon/marathon
Mountain/ultrarunning
Jumps (long, high, triple, andpole vault)
Throws (discus, hammer, javelin, and shot put)
Heptathlon and decathlon

Caffeine Creatine Nitrate Beta-alanine Bicarbonate Sports foods
✓

✓

✓

✓

✓
✓
✓
✓
✓

✓

✓
✓

✓

✓

✓

✓

✓

✓
✓
✓
✓
✓

✓

✓

✓
✓
✓

✓
✓
✓

✓

✓

✓

✓

Sports drinks• Can be used to achieve hydration and fuelstrategies around longer/high-quality training
sessions and longer races
Electrolyte supplements• Can be used to achieve (re)hydration goals by
replacing electrolytes lost in sweat
Sports gels/confectionery• Can be used to achieve fueling strategies
during longer training sessions/races
Protein supplements• Can provide a convenient source of quickly
digested, high-quality protein when it isimpractical to eat foodLiquid meals• Can provide a convenient source of carbohydrate, protein, and nutrients when it isimpractical to eat foodNote. Readers are referred to Burke et al. (2019), Costa et al. (2019), Slater et al. (2019), Stellingwerff et al. (2019a), Sygo et al. (2019).
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Theme 10. Special Populations: Young, Female andMasters Athletes (Desbrow et al., 2019)
Adolescent, female, and masters Athletes have unique nutritional
requirements as a consequence of undertaking daily training andcompetition in addition to the speciﬁc demands of age and sexrelated physiological characteristics. Dietary education and recommendations for these special populations require a focus on eating
for long-term health, with particular consideration given to “at risk”
dietary patterns and nutrients (e.g., sustained periods of restrictedeating, low calcium, Vitamin D and/or iron intakes relative toincreased requirements). Recent research highlighting strategies toaddress age-related changes in protein metabolism and the development of tools to assist in the management of relative energy
deﬁciency in sport are of particular relevance to Athletes in these
special populations. Whenever possible, young Athletes should be
encouraged to meet their nutrient needs by the consumption ofwhole foods rather than supplements, as the recommendation of
dietary supplements to this population overemphasizes their ability
to manipulate performance in comparison with other training/
dietary strategies.

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Theme 11. Special Needs for Travel (Halson et al.,2019)
Domestic and international travel represents a regular challenge tohigh-performance Athletes, particularly when associated with thepressure of competition or the need to support specialized training(e.g., altitude or heat adaptation). Jetlag is a challenge for transmeridian travelers while fatigue and alterations to gastrointestinal
comfort are associated with many types of long haul travel.
Planning food and ﬂuid intake that are appropriate to the travel
itinerary may help to reduce problems. Resynchronization of the
body clock is achieved principally through manipulation of zeitgebers such as light exposure and the typical timing of meals. Moreinvestigation of the effects of melatonin, caffeine, and the timing/
composition of meals will allow clearer guidelines for their contribution to be prepared. At the destination, the Athlete, the teammanagement, and catering providers each play a role in achieving
eating practices that support optimal performance and success inachieving the goals of the trip. Best practice includes pretrip
consideration of risks around the quality, quantity, availability,and hygiene standards of the local food supply and the organizationof strategies to deal with general travel nutrition challenges as well
as issues that are speciﬁc to the area or the special needs of thegroup. Management of buffet style eating, destination-appropriate
protocols around food/water and personal hygiene, and arrangement of special food needs including access to appropriate nutritional support between the traditional “3 meals a day” cateringschedule should be part of the checklist.

Theme 12. Special Diets: Vegetarians, Food
Intolerances, and Fasting (Lis et al., 2019)
Some Athletes implement special diets in accordance with theirculture or beliefs or with a speciﬁc aim to improve health and/or
performance. Four diets of contemporary interest are: vegetarianism;
diets with low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; gluten-free eating; and fasting. An
evidence-based approach to any diet is recommended to minimize
the risks associated with unnecessary dietary restriction, which may
potentially do more harm than good. Gluten-free diets and low

83

fermentable oligosaccharides, disaccharides, monosaccharides, andpolyols diets have emerged as novel regimens thought to improve
gastrointestinal health and reduce the risk of exercise-associatedgastrointestinal symptoms. No direct beneﬁts have been associatedwith the avoidance of gluten by clinically healthy athletes. However,a gluten-free diet is associated with other dietary changes, particularly a reduction in fermentable oligosaccharides, disaccharides,monosaccharides, and polyols, for which emerging evidence suggests a potential improvement in adverse gastrointestinal symptoms.
Vegetarian diets can theoretically support athletic demands, but
special attention and good planning are required to ensure adequate
intake of energy and speciﬁc nutrients that are less abundant or lesswell absorbed from plant sources (e.g., iron). Finally, intermittent
fasting is a long-standing concept, undertaken on an obligatory basis(e.g., Ramadan fasting), or a voluntary pattern (e.g., time-restricted
feeding, intermittent energy-restricted days) in search of putative
health or body composition beneﬁts. Strict obligatory fasting islikely to require the implementation of tailored nutrition strategies tohelp Athletes cope with their sports-related demands. Overall, amultitude of factors inﬂuence adherence to special diets. Even whenadherence to a special diet is a necessity, education and advice froman accredited dietitian/nutritionist are recommended to allow the
Athlete to integrate nutrition strategies for optimal health andperformance.

Conclusions
The IAAF recognizes that the Athlete’s well-being, performance, andrecovery from sporting activities are enhanced by well-chosen nutrition strategies. Although Athletics encompasses a diverse range of
events with different requirements for success, there are common
goals around nutritional support for adaptation to training, optimaltraining performance, and remaining at low risk of injury and illness.
This includes guidelines for the appropriate type; amount; and timingof intake of food, ﬂuids, and occasionally, some supplements andsports foods, to promote optimal health and performance acrossdifferent scenarios of training and competition. Ideally, Athletesshould develop a personalized, periodized, and practical nutrition
plan via collaboration with their coach and sports science/medicine
team, including accredited sports nutrition experts.
Acknowledgments
All authors contributed material to the preparation of this manuscript.
The authors declare no conﬂicts of interest in the preparation of thisreview. We wish to acknowledge the contribution of our colleagues to the
preparation of the material in this consensus statement. We thank Keith
Baar, Ingvill Bovim, Nicholas Burd, Robert Chapman, Sam Cheuvront,
Olivier De Hon, Wim Derave, Kirsty Elliott-Sale, Stuart Galloway, Ina
Garthe, Laura Garvican-Lewis, Ida Heikura, Martin Hoffman, Asker
Jeukendrup, Andrew Jones, Majke Jorgensen, Alice Kendig Glass, Sophie
Killer, Daniel King. Beat Knechtle, Enette Larsen-Meyer, Daniel Moore,
Martin Mooses, James Morton, Margo Mountjoy, David Nieman, Jeni
Pearce, Julien Periard, Stuart Phillips, Craig Sale, Susan Shirreffs, Mark
Tarnopolsky, Adam Tenforde and Jamie Whitﬁeld for their expertise andassistance in undertaking this project.

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