In elite sport, where opponents are evenly matched, small factors can determine the outcome of sporting contests. Not all athletes know the value of making wise nutrition choices, but anything that might give a competitive edge, including dietary supplements, can seem attractive. Between 40% and 100% of athletes typically use supplements, depending on the type of sport, level of competition, and the definition of supplements. However, unless the athlete has a nutrient deficiency, supplementation may not improve performance and may have a detrimental effect on both performance and health. Dietary supplements are classified as a subcategory of food, so manufacturers are not required to provide evidence of product safety and efficacy, nor obtain approval from regulatory bodies before marketing supplements. This creates the potential for health risks, and serious adverse effects have been reported from the use of some dietary supplements. Athletes who compete in sports under an anti-doping code must also realize that supplement use exposes them to a risk of ingesting banned substances or precursors of prohibited substances. Government systems of regulations do not include specific laboratory testing for banned substances according to the WADA list, so a separate regulatory framework to evaluate supplements for their risk of provoking a failed doping test is needed. In the high-performance culture typical of elite sport, athletes may use supplements regardless of possible risks. A discussion around medical, physiological, cultural, and ethical questions may be warranted to ensure that the athlete has the information needed to make an informed choice.
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Ina Garthe, Truls Raastad, and Jorunn Sundgot-Borgen
Context:
When weight loss (WL) is needed, it is recommended that athletes do it gradually by 0.5–1 kg/wk through moderate energy restriction. However, the effect of WL rate on long-term changes in body composition (BC) and performance has not been investigated in elite athletes.
Purpose:
To compare changes in body mass (BM), fat mass (FM), lean body mass (LBM), and performance 6 and 12 mo after 2 different WL interventions promoting loss of 0.7% vs. 1.4% of body weight per wk in elite athletes.
Methods:
Twenty-three athletes completed 6- and 12-mo postintervention testing (slow rate [SR] n = 14, 23.5 ± 3.3 yr, 72.2 ± 12.2 kg; fast rate [FR] n = 9, 21.4 ± 4.0 yr, 71.6 ± 12.0 kg). The athletes had individualized diet plans promoting the predetermined weekly WL during intervention, and 4 strength-training sessions per wk were included. BM, BC, and strength (1-repetition maximum) were tested at baseline, postintervention, and 6 and 12 mo after the intervention.
Results:
BM decreased by ~6% in both groups during the intervention but was not different from baseline values after 12 mo. FM decreased in SR and FR during the intervention by 31% ± 3% vs. 23% ± 4%, respectively, but was not different from baseline after 12 mo. LBM and upper body strength increased more in SR than in FR (2.0% ± 1.3% vs. 0.8% ± 1.1% and 12% ± 2% vs. 6% ± 2%) during the intervention, but after 12 mo there were no significant differences between groups in BC or performance.
Conclusion:
There were no significant differences between groups after 12 mo, suggesting that WL rate is not the most important factor in maintaining BC and performance after WL in elite athletes.
Oliver C. Witard, Ina Garthe, and Stuart M. Phillips
Track and field athletes engage in vigorous training that places stress on physiological systems requiring nutritional support for optimal recovery. Of paramount importance when optimizing recovery nutrition are rehydration and refueling which are covered in other papers in this volume. Here, we highlight the benefits for dietary protein intake over and above requirements set out in various countries at ∼0.8–1.0 g·kg body mass (BM)−1·day−1 for training adaptation, manipulating body composition, and optimizing performance in track and field athletes. To facilitate the remodeling of protein-containing structures, which are turning over rapidly due to their training volumes, track and field athletes with the goal of weight maintenance or weight gain should aim for protein intakes of ∼1.6 g·kg BM−1·day−1. Protein intakes at this level would not necessarily require an overemphasis on protein-containing foods and, beyond convenience, does not suggest a need to use protein or amino acid-based supplements. This review also highlights that optimal protein intakes may exceed 1.6 g·kg BM−1·day−1 for athletes who are restricting energy intake and attempting to minimize loss of lean BM. We discuss the underpinning rationale for weight loss in track and field athletes, explaining changes in metabolic pathways that occur in response to energy restriction when manipulating protein intake and training. Finally, this review offers practical advice on protein intakes that warrant consideration in allowing an optimal adaptive response for track and field athletes seeking to train effectively and to lose fat mass while energy restricted with minimal (or no) loss of lean BM.
Ina Garthe, Truls Raastad, Per Egil Refsnes, Anu Koivisto, and Jorunn Sundgot-Borgen
When weight loss (WL) is necessary, athletes are advised to accomplish it gradually, at a rate of 0.5–1 kg/wk. However, it is possible that losing 0.5 kg/wk is better than 1 kg/wk in terms of preserving lean body mass (LBM) and performance. The aim of this study was to compare changes in body composition, strength, and power during a weekly body-weight (BW) loss of 0.7% slow reduction (SR) vs. 1.4% fast reduction (FR). We hypothesized that the faster WL regimen would result in more detrimental effects on both LBM and strength-related performance. Twenty-four athletes were randomized to SR (n = 13, 24 ± 3 yr, 71.9 ± 12.7 kg) or FR (n = 11, 22 ± 5 yr, 74.8 ± 11.7 kg). They followed energy-restricted diets promoting the predetermined weekly WL. All athletes included 4 resistance-training sessions/wk in their usual training regimen. The mean times spent in intervention for SR and FR were 8.5 ± 2.2 and 5.3 ± 0.9 wk, respectively (p < .001). BW, body composition (DEXA), 1-repetition-maximum (1RM) tests, 40-m sprint, and countermovement jump were measured before and after intervention. Energy intake was reduced by 19% ± 2% and 30% ± 4% in SR and FR, respectively (p = .003). BW and fat mass decreased in both SR and FR by 5.6% ± 0.8% and 5.5% ± 0.7% (0.7% ± 0.8% vs. 1.0% ± 0.4%/wk) and 31% ± 3% and 21 ± 4%, respectively. LBM increased in SR by 2.1% ± 0.4% (p < .001), whereas it was unchanged in FR (–0.2% ± 0.7%), with significant differences between groups (p < .01). In conclusion, data from this study suggest that athletes who want to gain LBM and increase 1RM strength during a WL period combined with strength training should aim for a weekly BW loss of 0.7%.
Gary J. Slater, Ava Farley, Luke Hogarth, Jose L. Areta, Gøran Paulsen, and Ina Garthe
Dual-energy X-ray absorptiometry (DXA) is a popular technique used to quantify physique in athletic populations. Due to biological variation, DXA precision error (PE) may be higher than desired. Adherence to standardized presentation for testing has shown improvement in consecutive-day PE. However, the impact of short-term diet and physical activity standardization prior to testing has not been explored. This warrants investigation, given the process may reduce variance in total body water and muscle solute, both of which can have high daily flux amongst athletes. Twenty (n = 10 males, n = 10 females) recreationally active individuals (age: 30.7 ± 7.5 years; stature: 176.4 ± 9.1 cm; mass: 74.6 ± 14.3 kg) underwent three DXA scans; two consecutive scans on 1 day, and a third either the day before or after. In addition to adhering to standardized presentation for testing, subjects recorded all food/fluid intake plus activity undertaken in the 24 hr prior to the first DXA scan and replicated this the following 24 hr. International Society of Clinical Densitometry recommended techniques were used to calculate same- and consecutive-day PE. There was no significant difference in PE of whole-body fat mass (479 g vs. 626 g) and lean mass (634 g vs. 734 g) between same- and consecutive-day assessments. Same- and consecutive-day PE of whole-body fat mass and lean mass were less than the smallest effect size of interest. Inclusion of 24-hr standardization of diet and physical activity has the potential to reduce biological error further, but this needs to be verified with follow-up investigation.
Thomas Birkedal Stenqvist, Anna Katarina Melin, Ina Garthe, Gary Slater, Gøran Paulsen, Juma Iraki, Jose Areta, and Monica Klungland Torstveit
The syndrome of Relative Energy Deficiency in Sport (RED-S) includes wide-ranging effects on physiological and psychological functioning, performance, and general health. However, RED-S is understudied among male athletes at the highest performance levels. This cross-sectional study aimed to investigate surrogate RED-S markers prevalence in Norwegian male Olympic-level athletes. Athletes (n = 44) aged 24.7 ± 3.8 years, body mass 81.3 ± 15.9 kg, body fat 13.7% ± 5.8%, and training volume 76.1 ± 22.9 hr/month were included. Assessed parameters included resting metabolic rate (RMR), body composition, and bone mineral density by dual-energy X-ray absorptiometry and venous blood variables (testosterone, free triiodothyronine, cortisol, and lipids). Seven athletes (16%) grouped by the presence of low RMR (RMRratio < 0.90) (0.81 ± 0.07 vs. 1.04 ± 0.09, p < .001, effect size 2.6), also showed lower testosterone (12.9 ± 5.3 vs. 19.0 ± 5.3 nmol/L, p = .020) than in normal RMR group. In low RMRratio individuals, prevalence of other RED-S markers (—subclinical—low testosterone, low free triiodothyronine, high cortisol, and elevated low-density lipoprotein) was (N/number of markers): 2/0, 2/1, 2/2, 1/3. Low bone mineral density (z-score < −1) was found in 16% of the athletes, all with normal RMR. Subclinical low testosterone and free triiodothyronine levels were found in nine (25%) and two (5%) athletes, respectively. Subclinical high cortisol was found in 23% of athletes while 34% had elevated low-density lipoprotein cholesterol levels. Seven of 12 athletes with two or more RED-S markers had normal RMR. In conclusion, this study found that multiple RED-S markers also exist in male Olympic-level athletes. This highlights the importance of regular screening of male elite athletes, to ensure early detection and treatment of RED-S.
Tia Herberts, Gary J. Slater, Ava Farley, Luke Hogarth, Jose L. Areta, Gøran Paulsen, and Ina Garthe
Background: Bioelectrical impedance analysis (BIA) is a popular technique which can be used to track longitudinal changes in body composition. However, precision of the technique has been questioned, especially among athletic populations where small but meaningful changes are often observed. Guidelines exist which attempt to optimize precision of the technique but fail to account for potentially important variables. Standardization of dietary intake and physical activity in the 24 hr prior to assessment has been proposed as an approach to minimizing the error of impedance-derived estimates of body composition. Methods: Eighteen recreational athletes, male (n = 10) and female (n = 8), underwent two consecutive BIA tests to quantify within-day error, and a third test (the day before or after) to quantify between-day error. All food and fluid intake plus physical activity from the 24 hr prior to the first BIA scan was replicated during the following 24 hr. Precision error was calculated as the root mean square standard deviation, percentage coefficient of variation, and least significant change. Results: There were no significant differences in precision error of within- and between-day fat-free mass, fat mass, and total body water. Differences in precision error of fat-free mass and total body water, but not fat mass, were less than the smallest effect size of interest. Conclusion: The 24-hr standardization of dietary intake and physical activity may be an effective approach to minimizing precision error associated with BIA. However, further research to confirm the validity of this protocol compared to nonstandardized or randomized intake is warranted.
Ronald J. Maughan, Louise M. Burke, Jiri Dvorak, D. Enette Larson-Meyer, Peter Peeling, Stuart M. Phillips, Eric S. Rawson, Neil P. Walsh, Ina Garthe, Hans Geyer, Romain Meeusen, Luc van Loon, Susan M. Shirreffs, Lawrence L. Spriet, Mark Stuart, Alan Vernec, Kevin Currell, Vidya M. Ali, Richard G.M. Budgett, Arne Ljungqvist, Margo Mountjoy, Yannis Pitsiladis, Torbjørn Soligard, Uğur Erdener, and Lars Engebretsen
Nutrition usually makes a small but potentially valuable contribution to successful performance in elite athletes, and dietary supplements can make a minor contribution to this nutrition program. Nonetheless, supplement use is widespread at all levels of sport. Products described as supplements target different issues, including the management of micronutrient deficiencies, supply of convenient forms of energy and macronutrients, and provision of direct benefits to performance or indirect benefits such as supporting intense training regimens. The appropriate use of some supplements can offer benefits to the athlete, but others may be harmful to the athlete’s health, performance, and/or livelihood and reputation if an anti-doping rule violation results. A complete nutritional assessment should be undertaken before decisions regarding supplement use are made. Supplements claiming to directly or indirectly enhance performance are typically the largest group of products marketed to athletes, but only a few (including caffeine, creatine, specific buffering agents and nitrate) have good evidence of benefits. However, responses are affected by the scenario of use and may vary widely between individuals because of factors that include genetics, the microbiome, and habitual diet. Supplements intended to enhance performance should be thoroughly trialed in training or simulated competition before implementation in competition. Inadvertent ingestion of substances prohibited under the anti-doping codes that govern elite sport is a known risk of taking some supplements. Protection of the athlete’s health and awareness of the potential for harm must be paramount, and expert professional opinion and assistance is strongly advised before embarking on supplement use.
