IOC Nutrition Consensus

7/30/2019 IOC Nutrition Consensus

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athletesmedicalinformation

nutrition forathletesA practical guide to eating for healthand performance.

Prepared by the Nutrition WorkingGroup of the Medical Commission ofthe International Olympic Committee.

Based on an International ConsensusConference held at the IOC inLausanne in June 2003.

nutrition forathletesA practical guide to eating for healthand performance.

Prepared by the Nutrition WorkingGroup of the Medical Commission ofthe International Olympic Committee.

Based on an International ConsensusConference held at the IOC inLausanne in June 2003.


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The IOC and its MedicalCommission are pleased toprovide athletes with thisbrochure, developed under theleadership of the IOC Nutrition

working group, in close collaboration with theIOC Athletes Commission.

Its simplicity and reader-friendly layout makethis work a reference for all those who, like theIOC Medical Commission, believe that nutritionis one of the decisive elements in high-levelathletes preparations.

Powerade is the partner of the IOCs MedicalCommission for this publication and helps us to

spread the information in a worldwidecampaign to athletes at all levels.

For all those who, without aspiring to takepart in the Olympic Games, place sport andphysical activity as a top priority,this brochurewill ensure better management of their effortsand preparations.

IOCM edical Director

Foreword byDr Patrick Schamasch



The Coca-Cola Company, via thePowerade brand, has formed avery successful partnership withthe IOC Nutrition Working Groupand the IOC Athletes

Commission. This partnership has created anutrition brochure which we hope w ill provideyou with practical information for this mostprestigious sporting event.

We are dedicated to supporting athletes whocontinue to push the boundaries of personalachievement. Powerade was developed to helpathletes perform at their best for longer,thanksto its formulation,w hich can help delay the

onset of fatigue during exercise and preventdehydration.

This brochure also recognises theimportance of diet as a crucial part of sportingperformance and we hope you find theinformation useful.

Good luck in your chosen sport.

A.R.C. (Sandy) AllanPresident and Chief Operating OfficerCoca-Cola Europe Eurasia and Middle East

Message fromPowerade


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A well-chosen diet offers many benefits to

the elite athlete:

Optimal gains from the training program Enhanced recovery between workouts and

events Achievement and maintenance of an ideal

body weight and physique A reduced risk of injury and illness Confidence in being well-prepared to face

competition Consistency in achieving high level

competition performances Enjoyment of food and social eating

occasions

Despite these advantages,many athletes do

not meet their nutrition goals. Common

problems and challenges include:

Poor knowledge of foods and inadequatecooking skills Poor or outdated knowledge of sportsnutrition Inadequate finances Busy lifestyle leading inadequate time toobtain or consume appropriate foods Poor availability of good food choices Frequent travel

Indiscriminate use of large amounts ofsupplements and sports foods

The information in this booklet is designed toprovide coaches and athletes with an overviewof the latest guidelines in sports nutrition.Whilethere is no such thing as a magic diet or food,there are many ways in which eating well can

allow athletes at all levels of performance toachieve the special goals of their training andcompetition programs. It makes no sense totrain hard and ignore the benefits that followfrom good food choices.

Nutrition for Athletes is based on the

conclusions of the IOC Consensus

Conference on Nutrition for Sport, held in

Lausanne in June 2003. We gratefully

acknowledge the contribution of the

conference participants as the expert

scientific sources for this booklet.

This booklet was prepared for theIOC Medical Commission Working

Group on Sports Nutrition by

Professor Louise Burke, Australia Professor Ed Coyle, USA Professor Ron Maughan, UK

We thank Frankie Fredericks andDr Patrick Schamasch for their insightand comments in the preparation of thisbooklet.

Introduction: the benefitsof eating well



Whenever highly talented, motivated and welltrained athletes gather for competition, themargin between victory and defeat is small.Attention to detail can make that vitaldifference.

Diet affects performance,and the foods thatwe choose in training and competition willaffect how well we train and compete.Athletesneed to be aware of their nutritional goals andof how they can select an eating strategy tomeet those goals.

Diet may have its biggest impact on training,and a good diet will help support consistentintensive training without the athlete

succumbing to illness or injury. Good foodchoices can also promote adaptations to thetraining stimulus.

Athletes are all different, and there is nosingle diet that meets the needs of all athletesat all times. Individual needs also changeacross the season and athletes must be flexibleto accommodate this.

Getting the right amount of energy to stayhealthy and to perform well is key. Too muchand body fat increases:too little andperformance falls and illness results.

Carbohydrate is a key nutrient for energysupply.Athletes must be aware of foods thatcan help m eet their carbohydrate needs and

make these a focus of their diet.Protein foods are important for building and

repairing muscles, but a varied diet containingeveryday foods will generally supply more thanenough protein. Well-chosen vegetarian dietscan also meet protein needs.

A varied and wholesome nutrient-rich dietthat meets energy needs and is based largely

on vegetables, fruits, beans, legumes, grains,animal meats, oils and carbohydrate shouldensure an adequate intake of vitamins andminerals.

Maintaining hydration is important forperformance. Fluid intake before, during (whereappropriate) and after exercise is especiallyimportant in hot climates. Salt replacement isimportant when sweat losses are high.

Athletes are cautioned against theindiscriminate use of dietary supplements.

This booklet contains information that

will help athletes to make informed choices

to meet their nutritional needs in differentsituations. It is no substitute for individual

advice from a qualified professional, but

tries to give practical information that will

be of use to the serious athlete.

Key messages


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Energy availability = total dietary energy intake ener gy u sed in dail y ac tivit y/e xerci se

There is good evidence from recent researchthat when energy availability drops belowa daily intake of 30 kcal (135 kJ) perkg fat-free mass (FFM), there aresubstantial impairments ofmetabolic and hormonalfunction, which affectperformance,growth and health.In females,one outcome of lowenergy availability is a disturbance ofreproductive function and menstrual

regularity.Other problems are likely tooccur in male athletes.

Example of low energy availability:

60 kg female with 20% body fat =48kg FFM

Daily energy intake is restricted to1800 kcal (7560 kJ)

Cost of daily exercise (1 h/d) =500 kcal (2100 kJ)

Energy availability = 180 0-50 0 =1300 kcal (5460 kJ)

Energy availability = 130 0/48 or27 kcal/kg FFM (113 kJ per kg FFM)

Athletes requiring advice for weight loss or fatloss should seek guidance from a sportsnutrition expert such as a sports dietitian.To avoid irreversible skeletal damage, athleteswith menstrual disorders should be immediatelyreferred to a medical expert for treatment.



An athletes daily energy intake provides forimmediate energy needs (body functions,activity and growth) as well as influencing bodyenergy stores. Energy stores play a number ofimportant roles related to exerciseperformance, since they contribute to

Size and physique (e.g. body fat and musclemass)

function (e.g. muscle mass) fuel for exercise (e.g. muscle and liver

carbohydrate)

Many athletes try to manipulate these factors

towards the characteristics that offeradvantages to their sport. In most cases, thegoals are to change body weight,reduce bodyfat, increase muscle mass and optimizeimportant fuel stores. Problems can occur when

the athlete is unable to identify goals thatare both suitable for their sport, and for theirindividual make-up

the athlete is unable to monitor the separatecomponents of their goals (for example, todistinguish changes in body fat fromchanges in total body weight, or to seewhether total energy intake provides foroptimal store of body fuels)

the athlete restricts energy intake to thelevel that interferes with the bodysmetabolic and hormonal function

Strategies for managing energy intake and

energy balance:

The athlete should individually manage theirenergy stores of body fat, carbohydrate

(muscle fuel) and protein (muscle mass) bymanaging intake and expenditure of thesenutrients separately. These issues will bediscussed in separate parts of this booklet.

The athlete should eat to a plan thatachieves their specific goals rather thanrelying on appetite to guide energy intake.Advice from a sports nutrition expert is oftenrequired to develop this plan.

The athlete should have a number ofseparate bio-markers to monitor theirprogress in achieving each of their energy-related goals. Body weight is not a reliable or accurate

indicator of energy balance. Monitoringbody weight is often a stressful activityfor athletes,especially when theinformation is misinterpreted or theoutcome is manipulated

Serial monitoring of skinfold fatthicknesses, especially when undertakenby a trained kinanthropometrist, canprovide useful information about changesin body fat stores

Urinary ketones can provide a marker ofinadequate carbohydrate intake

Measurements of changes in musclestrength and endurance provide a usefulbiomarker of muscle development

Special concerns about restricting

energy intake

Although many athletes reduce their energyintake to assist with the loss of body weightand body fat, it is harmful to restrict energyintake below levels that interfere with healthybody function.

Energy needs andweight control


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provided in terms of percentagecontributions to total dietary energy intake.Such recommendations are neither user-friendly nor strongly related to the musclesabsolute needs for fuel.

The athlete should not consume excessiveamounts of alcohol during the recoveryperiod since it is likely to interfere with theirability or interest to follow guidelines forpost-exercise eating.The athlete shouldfollow sensible drinking practices at all times,but particularly in the period after exercise.

Examples of carbohydrate foods withmoderate-high Glycaemic Index:

Most breakfast cereals Most forms of rice White and brown breads Sports drinks and soft drinks Sugar, jam and honey Potatoes Tropical fruits and juices

Examples of nutrient-rich carbohydrate

foods and meal combinations

Breakfast cereal with milk Flavoured yoghurt Fruit smoothie or liquid meal

supplement Sandwich with meat and salad filling Stir-fry w ith rice and noodles



Carbohydrate provides an im portant butrelatively short-lived supply of fuel for exercisethat must be refilled each day fromcarbohydrate foods in the diet.The athleteseveryday eating plan needs to provide enoughcarbohydrate to fuel their training program andto optimise the recovery of m uscle glycogenstores between workouts. General targets canbe provided for carbohydrate needs, based onthe athletes size and the demands of theirtraining program (see Table below). However,actual needs are specific to the individualathlete and need to be fine-tuned withconsideration of the athletes total energy

needs, specific training needs and feedbackfrom their training performance.

Targets for carbohydrate intake

Immediate recovery after exercise (0-4hours):about 1 g per kg BW of theathletes body weight per hour,perhapsconsumed at frequent intervals

Daily recovery from a moderateduration/low intensity training program:5-7 g per kg BW per day

Recovery from m oderate-heavyendurance training: 7-12 g per kg BWper day

Daily recovery from extreme exerciseprogram (more than 4-6 h+ per day):10-12 g or more per kg BW per day

Strategies for choosing carbohydrate foods

and for optimising glycogen recoveryWhen the period between workouts is less

than 8 hours, carbohydrate intake shouldstart as soon as practical after the firstsession to maximise the effective recoverytime. There may be some advantages inmeeting carbohydrate targets as a series ofsnacks during the early recovery phase.

During longer recovery periods (24 hours),the pattern and timing of carbohydrate-richmeals and snacks does not appear to becritical, and can be organised according towhat is practical and comfortable for eachathlete.There is no difference in glycogensynthesis when carbohydrate is consumed inliquid form or as solid foods.

It is valuable to choose nutrient-richcarbohydrates and to add other foods torecovery meals and snacks to provide agood source of protein and other nutrients.These nutrients may assist in other recoveryprocesses, and in the case of protein, maypromote additional glycogen recovery whencarbohydrate intake is below targets or whenfrequent snacking is not possible.

Carbohydrate-rich foods with a moderate tohigh glycaemic index (GI) provide a readilyavailable source of carbohydrate forglycogen synthesis, and should be the majorfuel choices in recovery meals.

Adequate energy intake is also important for

optimal glycogen recovery; the restrainedeating practices of some athletes,particularly females, make it difficult to meetcarbohydrate intake targets and to optimiseglycogen storage from this intake.

Special comments:

Guidelines for carbohydrate should not be

Fuel needs for trainingand recovery


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of a resistance workout, perhaps immediatelybefore training. Further work is required to finetune guidelines for the optimal amount, typeand timing of intake of these nutrients,and toconfirm that these eating strategies lead to anenhancement of the goals of training.

In the meantime, it appears sensible to focuson the total balance of the diet and the timingof protein-carbohydrate meals and snacks inrelation to training,rather than high proteinintakes per se.

Special sports foods such as sports bars and

liquid meal supplements can provide acompact and convenient way to consumecarbohydrate and protein when everydayfoods are unavailable or are too bulky andimpractical to consume. However, theaddition cost of these products must betaken into account. There is little justificationfor using very expensive protein-onlypowders or amino acid supplements.

Protein rich foods

10 g protein is provided by

2 small eggs 300 ml cows milk 20 g skim milk powder 30 g cheese 200 g yoghurt 35-50 g meat, f ish or chicken 4 slices bread 90 g breakfast cereal 2 cups cooked pasta or 3 cups rice 400 ml soy milk

60 g nuts or seeds 120 g tofu or soy meat 150 g legumes or lentils 200 g baked beans 150 ml fruit smoothie or liquid meal

supplement



Protein has been considered a key nutrient forsporting success by athletes of all eras.Whereas ancient Olympians were reported toeat unusually large amounts of meat, todaysathletes are provided with a vast array ofprotein and amino acid supplements toincrease their protein intakes.

Protein plays an important role in the responseto exercise.Amino acids from proteins formbuilding blocks for the manufacture of newtissue including muscle, and the repair of oldtissue. They are also the building blocks forhormones and enzymes that regulate

metabolism and other body functions. Proteinprovides a small source of fuel for theexercising muscle.

Some sports scientists have suggested thatendurance and resistance-training exercisemay increase daily protein needs up to amaximum of 1.2-1.6 g per kg body weight(BW), compared to the recommended intakeof 0.8 g/kg BW for a sedentary person.However, the evidence for this increase inprotein needs is not clear and universal.Partof the confusion is caused by problemsinvolved in scientific techniques used tomeasure protein requirements.

The debate over protein needs of athletes islargely unnecessary. Dietary surveys show thatmost athletes already consume diets providingprotein intakes above 1.2-1.6 g/kg/ d, evenwithout the use of protein supplements.Therefore, most athletes do not need to beencouraged or educated to increase their

protein intakes. Rather, athletes who consumeadequate energy intake from a variety ofnutrient-rich foods should be confident ofmeeting their protein needs,including anyincreases that could arise from high- leveltraining.

Athletes at risk of failing to meet theirprotein needs are those who severely restricttheir energy intake or dietary variety. Anadequate energy intake is also important inpromoting protein balance or increasingprotein retention.

Although some resistance-trained athletes andbody builders consume protein intake in excessof 2-3 g/ kg BM, there is no evidence that suchdietary patterns enhance the response totraining or increase the gains in muscle massand strength. While such diets are notnecessarily harmful, they are expensive andcan fail to meet other nutritional goals, such asproviding the fuel needed to optimise trainingand performance.

Recent studies have focussed on the acuteresponse to workouts of both endurance andresistance training. Enhanced protein balance isa desirable goal of the recovery phase tooverturn the increased rates of protein

breakdown that occur during exercise, and topromote muscle hypertrophy,repair andadaptation following the exercise stimulus.Such studies have found that the intake ofprotein, combined with carbohydrate,enhancesprotein recovery. There is some evidence thatthe response is enhanced when these nutrientsare provided soon after exercise, or in the case

Protein needs for trainingand bulking up


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Special concerns

Iron. Some athletes may develop irondeficiency and this will impairperformance. Unexplained fatigue,especially in vegetarian athletes should beexplored.Routine use of iron supplementsis not wise: too much is just as harmfulas too little. Self-medication with ironsupplements may not address the realcauses of an athletes fatigue or otherissues of poor eating. See Section 11 foriron-rich eating strategies.

Calcium. Calcium is important for healthybones, especially in adolescents and infemale athletes,so it is important toensure adequate calcium intake. The bestsources are dairy produce, including lowfat varieties.Each athlete should aim toinclude at least 3 servings of these foodsin their daily eating plans (e.g.glass ofmilk, slice of cheese, carton of yoghurt).Additional daily servings are requiredduring growth spurts in childhood andadolescence, and for pregnancy andlactation. Fortified soy foods m ay providea useful substitute where athletes

cannot consume dairy foods.



Strenuous bouts of prolonged exercise andheavy training, particularly aerobic exercise,stress the body. Adequate intakes of energy,protein, iron, copper,manganese, magnesium,selenium, sodium zinc,and vitamins A,C, E,B6and B12 are particularly important to healthand performance.These nutrients, as well asothers, are best obtained from a varied andwholesome nutrient-rich diet based largely onvegetables, fruits, beans, legumes, grains,animal meats, oils and carbohydrate energy.Dietary surveys show that most athletes arewell able to meet the recomm ended intakes forvitamins and minerals by eating everyday

foods. Those at risk of sub-optimal intakes ofthese micronutrients include: athletes who restrict their energy intake,

especially over long periods, especially tomeet weight loss goals

athletes who follow eating patterns withrestricted food variety and reliance on foodswith a poor nutrient-density

The best way to correct this situation is to seekadvice from a sports nutrition expert such as asports dietitian.When food intake cannot beadequately improved for example, when theathlete is travelling in a country w ith a limitedfood supply or if an individual is found to be

suffering from a lack of a particular vitamin ormineral, then supplementation can bewarranted. This should be undertaken with theadvice of a qualified sports nutrition expert. Ingeneral, a broad-range multivitamin/mineralsupplement is the best choice to support arestricted food intake,although targetednutrient supplements may be necessary to

correct an established nutrient deficiency (e.g.iron deficiency).

Anti-oxidant nutrients

It is not known whether hard training increasesthe need for dietary antioxidants, as the bodynaturally develops an effective defence with abalanced diet.Supplementation withantioxidants cannot be recommended becausethere is little evidence of benefit,w hile it isknown that over-supplementation can diminishthe body's natural defence system.

Ideas for promoting dietary variety

and nutrient-rich eating

Be open to trying new foods and newrecipes

Make the most of foods in season Explore all the varieties of different

foods Mix and match foods at meals Think carefully before banishing a food

or group of foods from your eatingplans

Include fruits and vegetables at everymeal. The strong colours of many fruits

and vegetables are a sign of a highcontent of various vitamins and otherfood anti-oxidants.Aim to fill your platewith highly coloured foods to ensure agood intake of the range of thesehealth-promoting dietarycompounds

Vitamins, minerals and anti-oxidantsfor training and staying well


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Eat 1-4 g/ kg body weight of carbohydrateduring the 6-h period before exercise,or

Take in no carbohydrate, if preferred,butonly when a carbohydrate loading diet hasbeen followed during the prior 2-3 days andthe competition is not late in the day.

The main mistake athletes might make is toeat too little carbohydrate (less than 1 g CHO/kg bod y w eigh t) d urin g t he 1- 6 h p eriod befo reexercise and then not take in carbohydrateduring exercise.This small carbohydrate mealprimes the body to rely more heavily on bloodglucose, but it does not provide enough

carbohydrate to sustain the athlete.

Five different examples of foods thateach provide 140 g CHO in a pre-competition meal* (2 g/kg for a 70 kgperson) are:

2.5 cups breakfast cereal + milk +large banana

Large bread roll or 3 thick slices bread+ thick spread honey

2 cups boiled rice + 2 slices bread 4 stack pancakes + _ cup syrup 60 g sports bar + 500 ml liquid meal

supplement or fruit smoothie

(*note that other foods may be eaten atthe meal)

Fluid intake prior to competition

Athletes should drink sufficient fluid with mealson the day before competition to ensurehydration on the morning of competition.Theathlete should not refrain from drinking wateror carbohydrate-containing fluids during thehours leading up to warm-up beforecompetition and it is recommended thatapproximately 400-700 ml be ingested duringthe 60-90 minute period before the start of theevent.This will allow sufficient time forurination of excess fluid, and thus rest-roomfacilities should be identified. Duringcompetitions lasting longer than 1 hour and

which cause heavy sweating without sufficientopportunity for fluid intake, athletes oftenbenefit by drinking 300-600 ml of fluid duringthe 15 minute period immediately before thestart of the event.



Many athletes appreciate the need to rest andeat well during the 2-3 days prior tocompetition or a particularly intense day ofquality training, but questions arise regardinghow much to eat, what type of food and whenis the best time. This includes what to eatduring the six-hour period im mediately beforecompetition or intense training.

Carbohydrate is the key energy-providingnutrient that must be optimised during the daysleading up to and including the day ofcompetition. Attention should also be given tooptimising water and salt levels in the body.

However, during the 2-4 days prior to acompetition, an athlete's need for protein andfat, as well as most other nutrients, typicallydoes not increase above the levels that arerecommended for normal m oderate leveltraining.

Carbo-loading

Athletes who compete intensely for more thanabout 90 minutes benefit from carbohydrate-loading for a few days. This loading of muscleglycogen to super-compensated levels can beachieved within 2-3 days by eating a largeamount of carbohydrate (about 8-10 g CHOper kg of body weight per day; see below) at

the same time that training intensity isreduced to no more than easy levels of shortduration. It is assumed that a moderate tohard bout of fatiguing exercise is performed innormal training sometime earlier in the weekprior to competition.

One Day Example of foods providing 630g of carbohydrate for a carbohydrateloading diet* (for a person weighing 70 kgwith an intake of 9 g CHO /kg).

Early AM - 150 g = 2 cups cereal withmilk + 2 50 ml fruit juice + 1 banana+ 2 thick slices toast + thick spread ofjam

Late AM - 50 g = 500 m l soft drink Mid-day - 150 g = 1 large bread roll

+ 1 medium muff in + fruit smoothie Snack- 50 g = 200 g f lavoured

yoghurt + 250 m l fruit juice Dinner - 200 g = 3 cups cooked pasta+ 2 cups fruit salad + 2 scoops icecream + 500 ml sports drink

Snack - 30 gm = 50 g chocolate

(*note that other foods may be eaten atthe meal)

Carbohydrate in the 6-h period before

competition

Athletes sometimes find a favourite pre-competition meal that not only provides extraenergy during the event, but also feels right in

terms of curbing hunger, quieting their stomachand being convenient as well as practical. Insports that do not cause fatigue orcarbohydrate depletion (e.g., gymnastics, ski-jum ping , etc ), the pre- event mea l n eed not bepredominantly carbohydrate.However, inintense competitions lasting longer than about60 m inutes, athletes are advised to either:

Preparation forcompetition


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beverages and foods can enhanceendurance power during the final hour ofprolonged exercise. This benefit can beobtained with relatively small doses ofcaffeine (about 1.5 mg/kg bodyweight; e.g.,100 ml of brewed coffee or 500-750 ml of acola beverage) that are commonly consumedby people of various cultures.

How to estimate sweating rate:

1) Measure body weight both beforeand after at least one hour of exercise

under conditions similar to competitionor a hard practice.2) Measure body weight wearingminimal clothing and while bare footed.

Towel dry after exercise and obtainbody weight as soon as is practical afterexercise (e.g. less than 10 min).3) Sweat loss (Litres) = Body weightbefore exercise (in kg) - Body weightafter exercise4) To convert to a sweat rate per hour,divide by the exercise time in minutesand multiply by 60

Note: 2.2 pounds equals 1.0 kg and

converts to a volume of 1.0 litre or 1,000ml or 34 ounces of water.

Rehydration after exercise

Replacement of sweat losses is an essentialpart of the recovery process. Both water andsalts lost in sweat must be replaced.Aim to

drink about 1.2-1.5 litres of fluid for each kg ofweight loss in training or competition.Drinksshould contain sodium (the main salt lost insweat) if no food is eaten at this time. Sportsdrinks that contain electrolytes are helpful, butmany foods can supply the salt that is needed.A little extra salt may usefully be added tomeals when sweat losses are high, but salttablets should be used with caution.

Recovery after exercise is part of thepreparation for the next exercise session, andall athletes,including strength and powerathletes, will perform below their best if theyare not well hydrated w hen they begin exercise.

Just like shoes,don t try out new plansfor fluid and fuel intake during importantcompetition. Do it in practice and findwhat fits you best.



Athletes generally appreciate the need to drinkfluids during exercise and the im portance ofsometimes adding some carbohydrate andsalts. The next step in applying this theory foroptimal performance and well-being is to learnthe practical aspects of: a) how much, b) whattype of foods, drinks, products, c) when duringexercise,and d) what m odifications should bemade in hot or cold environments. Just asgeneral training and com petition strategiesshould be tailored for individual athletes inaccordance with their unique needs andpreferences, so should their drinking and eatingchoices during exercise. Athletes,c oaches and

trainers should fine tune theserecommendation to identify their own winningformula.

How Much to Drink?

Limit dehydration during workouts andcompetitions by trying to drink at a rate that isclose to sweat rate and thus m inimizes loss ofbody weight.

It may not be necessary to drink enough toprevent loss of body weight,but the am ount ofdehydration should be limited to no more thana 2% loss of body weight (ie, 1.0 kg for 50 kgperson, 1.5 kg for a 75 kg person, and 2 kg fora 100 kg person).

In warm environments, try to minimizedehydration,as dehydration and exerciseintensity interact to cause heat illness.

Dont drink so m uch that you actually gainweight during exercise. It is not necessary for arunner to drink more than 2-4 litres during anentire 42 km marathon run.

When it is not possible to drink during heavy

sweating type exercise lasting longer than 30min, practice drinking during the 15 minutesbefore exercise and find how much is initiallyfilling but comfortable once exercise begins(e.g., 300-800 ml).

When do you need more than water?

In terms of proven performance benefits, nonutrients match water and/or carbohydrate.

During exercise lasting longer than 1 h andwhich elicits fatigue, athletes are advised toingest 20-60 grams per hour ofcarbohydrate that is rapidly converted toblood glucose. This generally improves

performance. The use of commercial sports drinks with acarbohydrate content of about 4-8% (4-8g/100 ml) allows carbohydrate and fluidneeds to be met simultaneously in mostevents.This carbohydrate can come fromsugars (i.e., sucrose, syrups containing nomore than 50% fructose, glucose),maltodextrins or other rapidly digestiblecarbohydrates.

If carbohydrates are ingested immediatelybefore exercise or during rest periods in along contest (more than 40 m inutes) it issometimes beneficial to continue to ingest20-60 grams per hour throughout the

contest. This maintains the flow of glucoseinto the blood-stream. Sodium should be included in fluids

consumed during exercise lasting longerthan 1-2 hours or by individuals during anyevent that stimulates heavy sodium loss (i.e.,more than 3-4 grams of sodium).

Caffeine contained in comm only available

Fluid, carbohydrate and saltneeds during and after exercise

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the bodys immune system, and high levels ofstress hormones reduce its ability to fight theseinfections.

Many nutrition supplements, includingglutamine, zinc, Echinacea, colostrum andothers, are on sale with claims that they canboost the immune system, but there is nostrong evidence that any of these is effective.The best evidence supports the use of a highcarbohydrate diet, which lowers stress hormonelevels,and appropriate rest periods.

Supplements for bone and joint health

Hard training puts extra wear and tear on the

bones, joints and associated structures, andnumerous supplements are claimed to lookafter these tissues.

Healthy bones need a good supply of calciumand Vitamin D. In most cases these nutrientscan be supplied by the diet. Athletes who sufferfrom problems related to sub-optimal bonedensity should seek professional advice andsupervised treatment from a sports physician.

Glucosamine,c hondroitin,methylsulphonylmethane (MSM) and otherproducts are promoted for joint health. There issome evidence that long-term (2-6 months)glucosamine treatment can provide subjectiverelief in elderly individuals suffering from

osteoarthritis, but there little no evidence ofbenefit for otherwise healthy athletes.

Supplements that might work

Some supplements do offer the prospect ofimproved performance: these include creatine,caffeine, bicarbonate, and perhaps a veryfew others.

Creatine. Creatine supplements can increasethe amount of high energy creatine phosphatestored in the muscles, and may improveperformance in single or multiple sprints. Itmay also lead to a gain in muscle mass, whichis helpful for some athletes but harmful forothers. As with all supplements, exceeding themaximum effective dose is not helpful.Creatine is normally found in meat and fish,but the doses used (10-20 g per day for 4-5days to load, and 2-3 g per day formaintenance) are more than is found in normalfoods. Creatine supplementation appears not tobe harmful to health.

Caffeine. A small amount of caffeine (1-3mg/kg) can help performance in prolongedexercise and may also be helpful in exercise ofshorter duration.Such m oderate doses can befound in everyday amounts of coffee, coladrinks and some sports products (e.g. gels).For example, 100 m g of caffeine is supplied bya small cup of brewed coffee or 750 ml of acola drink. Larger doses of caffeine do notseem to be more effective, and may havenegative outcomes such as over-arousal andpoor sleep patterns after an event.This is likelyto be a problem in m ulti-day events and insports involving heats and finals.

Bicarbonate. In very hard exercise, the musclesproduce lactic acid. This is both good (givingenergy to allow hard efforts) and bad (causingpain and interfering with muscle function). Inthe same way that excess stomach acidity canbe neutralised by taking bicarbonate,so sodiumbicarbonate (in a dose of about 0.3 g per kg



Athletes look to nutritional supplements formany benefits, including:

promoting adaptations to training increasing energy supply allowing more consistent and intensive

training by promoting recovery betweentraining sessions

maintaining good health and reducinginterruptions to training due to chronicfatigue, illness or injury

enhancing competitive performance.

Supplement use is widespread among

sportsmen and women, but few of theseproducts are supported by a sound researchbase and some may even be harmful to theathlete.Athletes should look carefully at therisks and rewards of individual supplementsbefore trying them.

Where there is a demonstrated deficiencyof an essential vitamin or mineral, and anincreased intake from food is not possible, asupplement may be helpful. The use ofsupplements, however,does not compensatefor poor food choices and an inadequate diet.Many athletes ignore the need for caution insupplement use, and take supplements indoses that are not necessary,and m ay

even be harmful.

Protein powders and supplements

Protein supplements, high protein bars andamino acid preparations are among the biggestselling sports nutrition products.Although anadequate intake of protein is essential formuscle growth and repair, this can easily be

achieved from everyday foods and extra proteinis seldom required (See section 3).

Protein-carbohydrate supplements m ay havea role as part of a post-exercise recovery plan,but whole proteins have advantages overindividual amino acids (see box above).

Fat reduction and muscle building

A huge array of supplements is on sale withclaims that they can reduce body fat levels andbuild bigger and stronger muscles claimsthat appeal to athletes and non- athletes alike.

The reality is that many of the products thatare effective in doing this are either on the

banned list or are associated with serioushealth risks (or both).Compounds in the muscle building category

include chromium, boron,hydroxymethylbutyrate, colostrum and others.Based on current research, none of these hasanything worthwhile to offer the athlete.

Increasing energy supply

Supplements in this category include carnitine,pyruvate and ribose as well as some moreexotic herbal preparations. None of these islikely to improve performance and, in spite ofadvertising claims, none is supported by goodindependent evidence.

Nutrition and the immune system

There is some evidence that athletes who aretraining hard may be at increased risk of minorillnesses and infections. In themselves, theseare generally trivial, but they can interrupttraining or cause an athlete to miss importantcompetitions. Hard training may compromise

Supplements andsports foods

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Athletes who are liable for drug testing undernational or international programs should beespecially cautious about supplement use.

Some supplements are prepared inunhygienic conditions and contain toxins thatmay cause gastrointestinal problems. Others donot contain ingredients especially theexpensive ones that are listed on the label.Contamination of dietary supplements withsubstances that may cause an athlete to fail adoping test is widespread som e surveys havesuggested that as many as one in foursupplements may result in a positive test.These prohibited compounds have not beendeclared on the label, so there is no way for theathlete to know that they are present.

At present, there can be no guarantee of thepurity of any commercial supplement.The onlyway to be sure is to avoid supplementsaltogether, but many athletes are unwilling toaccept this advice. The sensible athlete willwant to see very good reasons for using asupplement and a very low risk of an adversetest before deciding to use it.

There is no evidence that prohormones suchas Androstenedione and Norandrostenedioneare effective in enhancing muscle mass orstrength. These prohormones are promoted foruse by athletes and are readily available in

shops and via the internet, but they will resultin negative health consequences as well aspositive drug tests.

Many herbal supplements are claimed toincrease testosterone levels and hence have ananabolic action.These include: TribulisTerrestris; Chrysin; Indole-3-Carbinol; SawPalmetto; Gamma-oryzanol; Yohimbine; Smilax;

Mumm io. All of these claims are based onstudies in test tubes and none has been shownto work in humans. Athletes are cautionedagainst the use of these supplements.

Athletes must be aware of the strictliability principle that m akes themresponsible for everything they eat anddrink.

Ignorance is not an acceptable excuse fora positive doping result.

Check all supplements with a medicalofficer. If there is any doubt at all, donttake it.

Supplements anddoping issues



body weight) before an event can counter theharmful effects of lactic acid. This can help inall-out events lasting from about 1-8 minutes.There is a risk of gastrointestinal problems, andathletes should experiment in training.

A number of sports foods have beendeveloped to supply a specific formulationof energy and nutrients in a form that iseasy to consume. These can be valuablein allowing athletes to m eet their specialnutrition needs when everyday foods areunavailable or impractical to eat. This ismost often the case just prior to, during,or after an exercise session. Examples ofuseful sports foods include: sports drinks (providing fluid and

carbohydrate during exercise), sports gels (additional carbohydrate

intake, especially during exercise) liquid meals (carbohydrate, protein,

vitamins and minerals for a pre-eventmeal, post-exercise recovery or ahigh-energy diet)

sports bars (carbohydrate, protein,vitamins and minerals often a solidform of the liquid meal)

Of course, the cost of these sports foods

must be taken into account whendeciding to use them.

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should be based around carbohydrate-richeating. The ideal amount and type of foods anddrinks, and the timing of the pre-event meal,will vary between athletes and should be fine-tuned with experience to avoid gastrointestinaldisturbances during the event.

In long events there may be a need andopportunity to refuel and rehydrate on therun. Sports drinks provide a good balance offluid and carbohydrate to meet both goals, andare designed to taste good to encourage intake.Each athlete should develop a fluid intake planbased on knowledge of expected sweat lossesand how muc h of this is practicable to replace.Fluid intake should not exceed sweat losses. Invery long events,sports bars, gels andeveryday carbohydrate foods provide anadditional source of carbohydrate for varietyand extra fuel intake.Typically, a fuel intake of~ 2 0-60 g per hour is suitable, but should befine-tuned according to individual needs andexperience. Race day strategies should be triedin training, both to enhance the session and tofine-tune the competition plan.

After a race or workout, the athlete shouldeat and drink to promote quick recovery. Lightand portable recovery snacks are a usefulchoice until the normal meal pattern is resumed(See team sports for ideas).

Carbohydrate choices for race fuel

30 g carbohydrate is provided by: 400-500 ml of a sports drink 250 ml of a defizzed soft drink ~ 1 packet sports gel ~ _ sports bar 1 large or 2 small bananas 1 thick slice of bread and jam/honey 35-40 g candy/confectionery

Remember fluid needs too!

thletesmedicalinformation

athletesmedicalinformatio

Training issuesA demanding endurance training programusually involves daily or twice daily workouts.Inadequate refuelling leads to fatigue andineffective training.

Low body fat levels may benefitperformance, and are pursued obsessively bysome athletes. Severe restriction of energyintake and dietary variety can lead to fatigue,nutritional deficiencies, hormonal imbalancesand disordered eating.

Lengthy, high-intensity workouts lead to highsweat losses, particularly in hot weather.

Requirements for protein, vitamins andminerals may also be increased by a heavytraining load.

Competition issues

The main factors causing fatigue duringcompetition are fuel (carbohydrate) depletionand dehydration. Strategies for eating before,during and after the event are important toreduce these effects.

Competition is often undertaken in m ultiplestages, or as a series of heats and finals.Recovery between sessions can be important indetermining the final w inner.

Eating strategies for the endurance athlete

To achieve carbohydrate intake targets to meetthe fuel demands of training and recovery,meals and snacks should be based aroundcarbohydrate-rich foods. Breads and flour-based foods Rice, pasta, noodles and other grain foods Breakfast cereals Fruits

Starchy vegetables and legumes Flavoured dairy foods (e.g. yoghurt) Sugary foods and drinks

Nutrient-dense carbohydrate choices, and theaddition of protein-rich foods and vegetables tomeals, will help to balance fuel needs and othernutrition goals.

Sugary foods and drinks provide a compactform of carbohydrate, which is particularlyuseful when energy needs are high or insituations when it is impractical to eat bulkyfoods.

Endurance athletes with very high energyneeds may find it valuable to spread their dailyfood intake over a series of m eals and snacks.Drinks providing carbohydrate (sports drinks,soft dr inks, juices,fruit smoothies,andmilkshakes) also provide a compact way torefuel.

Key strategies to achieve lighter and leanerphysiques include low-fat eating, and attentionto portion sizes (see section 12). Well-placedsnacks may help prevent hunger and energydrain over the day and may prevent overeatingat the next meal.

Fluid and fuel replacement are key issuesduring most competitive events,and the athleteshould prepare for competition by fuelling up in

the day(s) leading up to the event and ensuringthat they are well-hydrated. For events lastinglonger than about 90-12 0 minutes, manyathletes carbohydrate load, by tapering theirtraining and increasing carbohydrate intake for2-3 days prior to the race.

The pre-event meal offers a final way to top-up fuel and fluid levels,and m enu choices

Special needs forendurance sports

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can find it hard to juggle the teamcommitments, as well as work/school. Manyrecipe books developed for athletes offerquick and nutritious meal ideas suited to thespecial needs of sport.

The pre-event meal is a good opportunity fora shared meal, ensuring good last-minutenutritional preparation as w ell as anopportunity to boost morale and share finaltactics. Ideas for pre-event meals arefound in the Winter sport section, and arebest provided as a buffet,to allow eachteam member to choose their individualneeds and likes.

Various opportunities exist for players torefuel and rehydrate during team sports these include quarter or half time breaks,substitutions and time-outs. Some codeseven allow trainers to carry drinks to playerson the arena during breaks in play. Acreative plan should be developed for eachteam.

Post-game or post-training recovery isanother good opportunity for team nutrition.Alcohol is often a large part of post-gameactivities in team sports but should bediscouraged, unless in moderation and afterrecovery eating goals are achieved.Post-game snacks and light m eals providing

nutritious forms of carbohydrate and proteinas well as rehydration options will helpplayers to recover effectively whilecelebrating or commiserating the results ofthe match.

Ideas for post-exercise recovery snacks

Each choice provides ~ 5 0 gcarbohydrate and a valuable source ofprotein and other nutrients 250-350 ml fruit smoothie or liquidmeal 60 g (1-2 cups) breakfast cereal +milk + 1 fruit 200 g carton of yoghurt +cereal/breakfast bar 1 round of m eat/cheese and saladsandwiches or roll + 250 m l fruit juice 150 g thick crust pizza lean meatand vegetable toppings and easy on thecheese 60 g sports bar + 2 50 ml sports drink

thletesmedicalinformation


Training issues Many team sports involve seasonal

competition. At the recreational level, the off-season can be lengthy and players oftenlose fitness and gain body fat as a result ofdetaining and poor eating practices.Thismay also occur during the season whenplayers are injured. At the elite level, mostteam athletes train all year, with just a briefbreak between seasons.

Refuelling is an important part of therecovery between matches, and from theteam and individual training sessions thatoccur between games.Traditionally, manyteam players have focussed on fuelling uponly on the day before a match or in thepre-event meal. However, the daily demandsof training are best met by a permanentapproach to adequate fuel intake.

Physique is important in the performance ofsome sporting codes, or positions within acode. Many team athletes have specialnutritional needs to support a resistancetraining program, or a rapid growth spurt.While protein needs are often emphasised,total energy and fuel intake, and the timingof meals/snacks in relation to training areperhaps more important.

Large fluid losses often go unrecognised in

team sports, or are even promoted as ameans to lose weight or toughen upplayers.High-intensity work c reates largesweat losses even in cold weather, andspecial needs should be recognised in w armconditions or when heavy clothing andprotective gear is worn.

Match issues Competition can be played in weekly league

games, or as a tournament with games everday or several days. Recovery needs mustbe adjusted according to the schedule.

Depletion of fuel stores can be an issue forteam games lasting longer than 60 minutes,especially for players in mobile positions orwith a running game style.Highcarbohydrate strategies fuelling up for thegame and consum ing extra carbohydrateduring the match have been shown toenhance performance in team sports.Hydration strategies are also important foroptimal performance. Better match nutritionmay not only keep players running furtherand faster in the second half of a match, butmay help to maintain skills and judgementwhen players would otherwise becomefatigued. Games are often won and lost inthe last minutes of the match, and fatiguedplayers are at increased risk of injury.

Eating strategies for team athletes

Team-sport players may adopt the eatingstrategies outlined for endurance athletes, andshould eat well and stay active all year round.The following strategies may be of additionalvalue:

Many team sports have a large contingent ofyoung players who are fresh from home. Itis a good team strategy to organise cookingand shopping classes for young players tohelp them develop the domestic skills andnutrition knowledge that will allow them toreach their full potential as players, Athleteslooking after themselves for the first time

Special needs forteam sports

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stay fuelled and hydrated between events orbouts in a multi-event program.

Strategies for high energy eating

It is usually more efficient to increasethe number of tim es that food is eateneach day for example,a series of 5-9 meals and snacks than tryingsimply to increase the size of meals.

Drinks such as fruit smoothies, liquidmeal supplements and fortifiedmilkshakes and juices can provide asubstantial source of energy andnutrients that are quick and compactto consume, and less likely to causegastrointestinal discomfort than bulkyfoods.

Sugary foods and specialised sportsproducts (drinks, bars) can provide amore compact form of carbohydrateand other nutrients, which isparticularly useful when energy needsare high.

A food record can identify the times ina busy day that arent being w ell usedfor fuelling up. The athlete should usecreative ideas and good planning toarrange a supply of portable snacks

and drinks that can travel with themover their day.

Food combinations supplying

carbohydrate and protein Breakfast cereal and milk Sandwiches with meat, cheese or egg

fillings Meat/fish/chicken stir-fries served with

rice or noodles Fruit smoothies or liquid meal

supplements Fruit and yoghurt Dried fruit and nut mixes

hletesmedicalinformation


Training issues The goal of many power and sprint athletes

is to enhance muscle mass and strengththrough specially designed resistancetraining programs. In most cases,theseathletes believe that their food focus shouldbe on protein intake. In fact, there is noevidence that very high intakes of protein(> 2 g per kg BM) are necessary or evenadvantageous for optimizing the results ofresistance training.It is likely that the bestresults are achieved through enhancedrecovery strategies such as providing asource of protein and carbohydrateimmediately before or after the w orkout.

Many power and sprint athletes forget tobring a drink bottle to training. However,workouts are best undertaken when theathlete is well-hydrated and well-fuelled.Fuelling with a sports drink can help theathlete to keep lifting or training with a goodtechnique, right to the end of a long session.

There are numerous supplements that c laimto promote recovery, increase muscle mass,reduce body fat and enhance performance.These claims are attractive to all athletes,but seem particularly entwined with theworld of body building and strength training.Many athletes are not aware that the claims

made for most products are unsupported orexaggerated, and that the industry operateswith little regulation.

Competition issues

Most sprint events are conducted over ashort time, with minimal impact on fluid andcarbohydrate levels. However, competition

can require the athlete to compete in aseries of heats, semis and finals, or withlong periods between rounds of a field eventor multi-sport competition. This calls forspecial eating strategies to recover betweenevents or to manage fluid and energy levelsover a long day

Eating strategies for power and strength

athletes

A key ingredient in a plan designed toenhance muscle size and strength isadequate energy intake.Energy should besupplied both by carbohydrate-rich foodsthat provide fuel for training as well asprotein- and nutrient-rich foods that canprovide building blocks for the results.

Recent evidence suggests that enhancedeffects on protein balance are achieved byfollowing up a resistance workout with ameal or snack providing a good source ofprotein and carbohydrate soon after thesession. It may be even more valuable toconsume this recovery snack immediatelybefore the workout.

A few supplements and sports foods providevaluable benefits to the athletes training andcompetition program. It is important for theathlete to seek up-to-date and independent

advice from a sports nutrition expert toidentify these products and how to use themto suit the athletes current program, budgetand performance goals.

On the day of competition, the athleteshould consume a comfortable pre-eventmeal, and organise appropriatecarbohydrate-rich drinks and light snacks to

Special needs for powerand sprint sports

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drinking patterns may need to be adjusted tokeep pace with these losses.

There is an increase in carbohydrate useduring exercise at altitude, making it moreimportant to be aggressive with refuellingstrategies during a workout, and over theday.

Since a move to a higher altitude mayincrease oxidative damage during exercise,and promote adaptive response to increaseerythropoiesis (red blood cell production), theathlete should ensure that their diet is rich inanti-oxidant containing fruits in vegetables,and in iron-rich foods.

Ideas for high carbohydrate pre-event

meals*

Breakfast menus Breakfast cereal and milk, fresh or

canned fruit Toast and jam /honey Pancakes and syrup Fruit-flavoured yoghurt Baked beans or tinned spaghetti on toast Liquid meal supplement or fruit

smoothieLunch and dinner menus Rice dishes risotto,fried rice, paella Pasta and light sauce Bread, including rolls and sandwiches Fruit and fruit based desserts Rice pudding* A low-fat or low-fibre menu may help toreduce the risk of gastrointestinalproblems in susceptible athletes

Iron-rich eating Consume moderate servings of red

meats (well-absorbed iron) in 3-5meals per week

Choose iron-fortified cereal productssuch as breakfast cereals

Combine plant and non-meat sourcesof iron (e.g. legumes, cereals,eggs,green leafy vegetables) with foodfactors that enhance iron absorption.These include vitamin C and a factorfound in meat/fish/chicken. Examplesof clever matching include fruit juice orfruit with breakfast cereal,or chilli concarne (meat and beans)


athletesmedicalinformati

Training and competition issues Winter sports encompass a wide range of

events endurance events such as cross-country skiing, team games such as icehockey,sprint events such as speed skating,and weight conscious sports such as figureskating. In most cases, the major nutritionalneeds for these sports are derived from thephysiological characteristics of the event andare covered in the previous pages of thisbooklet.

Additional nutritional issues for Winter sportathletes include the special needs arisingfrom the environments in which they areoften undertaken extreme cold and highaltitude.

Special issues for exercise in cold climates

In cold weather,m any athletes forget abouttheir fluid needs thinking that their sweatneeds are minimal. In fact,sw eat losses canbe substantial in high-intensity sports ofprolonged or intermittent duration,and m aycause some impairment of performanceespecially if allowed to accumulate over anumber of sessions. It can be useful forathletes involved in high-intensity sports toundertake fluid monitoring sessions (seesection 6) during training and events togauge true fluid needs and their success inmeeting them.

Fluid intake during exercise also provides anopportunity for fuel intake for example,sports drinks containing 6-8% carbohydratecomposition are typically able to meet thefuel and fluid needs of warm- weather sportssimultaneously. However, in cold climates,

fuel needs during an event will generally bemaintained while fluid needs are lower thanwhen the same event is undertaken in ahot environment. Therefore, many athletesrefuel with m ore concentrated carbohydratedrinks sometimes up to 25%concentration or add carbohydrate gelsand solid foods to the event menu.Experimentation in training will help theathlete develop a successful competition dayprogram.

Movement on snow and ice is more complexthan running over ground, and has a greaterrisk of injury and accidents.There is someevidence that a fatigued athlete is at greaterrisk of these problems, and the winter sportathlete should take a pro-active role inmaintaining fluid and fuel status duringprolonged workouts or during periods ofintensive training. Since many trainingvenues are held in wilderness areas, somecreativity is required to ensure that anadequate supply of foods and fluids areavailable during exercise and for speedyrecovery after the workout.

Special issues for exercise at moderate

altitudes The cold and dry conditions at moderate

altitudes cause an increase in water lossesduring breathing.This can lead to asubstantial increase in fluid losses atmoderate altitude compared with sea level.The winter sport athlete should takeadditional care to check fluid status over theday and during exercise sessions when theymove to a higher altitude, since habitual

Special needs for wintersports

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Strategies for staying lean and trim

Assess portion sizes at meals toensure that over-eating does not occurdue to habit or unnecessary hunger

Use well-chosen snacks betweenmeals to m aintain fuel levels fortraining sessions or to avoid excessivehunger. However, avoid snacking forentertainment or comfort. Snacks canoften be organised by saving part of ameal for a later occasions,rather thanby eating extra food.

Use low-fat strategies in choosingfoods and while cooking or preparing

meals Make meals and snacks more filling

by including plenty of salads andvegetables,by taking the higher-fibreoption, and by including low glycaemicforms of c arbohydrate.

A food record will help to identify thedifference between an athletesdesired eating plan,and their actualintake. Many people are unaware ofthe habits that sabotage theireating goals

Examples of incorporating low

glycaemic index carbohydrate foods

into meals

Enjoy rolled oats (porridge or low-fatversions of Bircher Muesli) instead ofCornflakes for breakfast

Replace white and wholemeal breadswith wholegrain and multi-grainchoices

Add lentils and legumes to casserolesand pasta sauces

Enjoy flavoured yoghurt as a snack Replace mashed potato with al dente

pasta or buckwheat


athletesmedicalinformat

Training issuesThe key nutritional interest of many athletes isto reduce body weight and body fat.A low levelof body weight and body fat often provides abenefit to performance. In other sports involvingsubjective outcomes (e.g. gymnastics, diving,body building), the athlete who is lean and trimis judged to have a higher aesthetic appeal.Although certain body shapes and physiquesare held up as de rigueur for many sports,each athlete must be realistic in setting targetsfor the weight and fat loss programs theyundertake.

Challenges occur for the athlete whosetraining does not involve high energy

expenditure work for example, the athletewho undertakes lengthy training sessions thatare primarily based on skill and agility. It ismore difficult to create the energy deficitneeded to reduce weight and body fat w henbasal energy needs are low to moderate.

Restrictive eating and fad diets can lead todehydration and fuel depletion, marringtraining performance and increasing the riskof injury and accidents, rather thanachieving effective loss of body fat.

Competition issues

In many combat sports (boxing, wrestling, martialarts), some strength sports (weight lifting) andlightweight rowing, competition involves weightdivisions that attempt to provide a matchbetween athletes of equal size and performance.In such sports, athletes typically try to loseweight in the days before the competition (andits pre-event weigh in), in order to qualify for a

weight division that is lighter than their habitualbody weight and gain an advantage over asmaller opponent. Acute strategies to m akeweight expose the athlete to health andperformance risks arising from dehydration,fueldepletion, inadequate nutrient intake, andpsychological stress.

Strategies for athletes in weight conscioussportsAthletes will benefit from professional advicefrom an expert such as a sports dietitian to setrealistic goals for weight and fat loss attempts,and a suitable long-term eating plan.

The athlete in skill-based sports should seek

their coachs input to introduce or increaseaerobic workouts that can increase overallenergy expenditure without detriment to keytraining sessions.This may include changes tolifestyle to increase incidental exercise oractivity in the day.

Athletes who compete in weight divisionsports should settle for a weight category thatis close to the training weight that can beachieved with a safe and healthy plan. Finalfine tuning of weight prior to the event shouldnot involve changes of >1- 2% body weight,and should be undertaken without resort toextreme techniques of dehydration and fasting.

Athletes in weight conscious sports may beat higher risk of disordered eating andeating disorders than other athletes or thesedentary population. It is important thatathletes who develop warning signs of suchproblems are refereed at an early stage forexpert team-based advice.

Special needs for weightconscious sports

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Ideas for portable supplies for the

travelling athlete Breakfast cereal and powdered milk Cereal and breakfast bars Rice cakes Spreads honey, jam, peanut butter Powdered sports drinks and liquid

meal supplements Sports bars Dried fruit and nuts

5. Use clever tactics in restaurants, all you

can eat dining halls and when choosing

takeawaysStick to an eating plan based on what isnormally eaten at home, or what meets newnutritional needs, rather than being mesmerisedby all the food on offer.

Be assertive in asking for foods to beprepared to your needs for example, with lowfat cooking methods, or with an addedcarbohydrate serving.

Avoid hanging around in restaurants ordining halls for entertainment it can oftenlead to unplanned and unnecessary eating. Remember that your normal eating patterns

probably involve well-timed and well-chosensnacks. If your new catering arrangementsprovide only for main meals, ensure that themenu at meals includes some items that canbe taken away for snack needs.

letesmedicalinformation

athletesmedicalinformat

Most elite athletes are well-seasoned travellers,seeking competition or specialised trainingenvironments far away from home. In manyteam sports, high-level competition is organisedin a national or regional league that requiresweekly or biweekly travel to matches. Frequenttravel can pose a number of challenges: Disruptions to the normal training routine

and lifestyle while the athlete is en route Changes in climate and environment that

create different nutritional needs Jet lag Changes to food availability including

absence of important and familiar foods Reliance on hotels, restaurants and

takeaways instead of home cooking Exposure to new foods and eating cultures Temptations of an all you can eat dining

hall in an Athletes Village Risk of gastrointestinal illnesses due to

exposure to food and water with poorhygiene standards

Excitement and distraction of a newenvironment

The keys to eating well while travelling are:

1. Planning ahead

Investigate food patterns and availability at yourdestination before you leave home. This mayhelp you to plan useful food supplies to take onyour travels that can replace missing andimportant items.

Contact the catering organisers at yourdestination to let them know of your needs formeal timing and menus. Make an eating plan for travel that

incorporates the best of the available food

supplies (e.g. airline catering, restaurants enroute) as well as self-supplied snacks.

2. Eat and drink well while on the move

Recognise that enforced rest w hile travellingwill reduce energy needs,but create moreopportunities for high energy intake if theathlete succumbs to boredom eating. Beaware of eating to real need.

When moving to a new time zone, adopteating patterns that suit your destination assoon as the trip starts. This will help to adaptyour body clock.

Be aware of unseen fluid losses in airconditioned vehicles and pressurised plane

cabins. Have a drink plan that keeps you wellhydrated.

3. Be wary of food and water hygiene

Find out whether it is safe to drink the localwater supply. If risky, stick to sealed bottlesof water and other drinks or hot drinks. Bewary of ice added to drinks it is often madefrom tap water.

In high-risk environments stick to foodproduced in good hotels or well-knownrestaurants.Avoid eating food from local stallsand markets, however tempting it is to have anauthentic cultural experience.

Stick to food that has been well-cooked,andavoid salads or unpeeled fruit that has been incontact with local water or soil.

4. Choose well from local cuisine and

supplement with non-perishable food

supplies brought from home

Special needs for thetravelling athlete

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The amount, composition and timing of foodintake can profoundly affect sportsperformance. Good nutritional practice will helpathletes train hard, recover quickly and adaptmore effectively with less risk of illness andinjury.Athletes should adopt specific nutritionalstrategies before and during competition tohelp maximise their performance.Athletes willbenefit from the guidance of a qualified sportsnutrition professional who can provide adviceon their individual energy and nutrient needsand also help them to develop sport-specificnutritional strategies for training, competitionand recovery.

A diet that provides adequate energy from

the consumption of a wide range of commonlyavailable foods can meet the carbohydrate,protein, fat, and micronutrient requirements oftraining and competition.The right diet will helpathletes achieve an optimum body size andbody composition to achieve greater success intheir sport. When athletes restrict their foodintake, they risk nutrient deficiency that willimpair both their health and their performance.Careful selection of nutrient-dense foods isespecially important when energy intake isrestricted to reduce body and/or fat mass. Fatis an important nutrient and the diet shouldcontain adequate amounts of fats.

Athletes should aim to achieve carbohydrateintakes that meet the fuel requirements of theirtraining programs and also adequately replacetheir carbohydrate stores during recoverybetween training sessions and competition.Thiscan be achieved when athletes eatcarbohydrate-rich snacks and meals that alsoprovide a good source of protein and other

nutrients. A varied diet that meets energy needswill generally provide protein in excess ofrequirements. Muscle mass is maintained orincreased at these protein intakes, and thetiming of eating carbohydrate and protein mayaffect the training adaptation.

A high carbohydrate intake in the daysbefore competition will help enhanceperformance, particularly when exercise lastslonger than about 60 minutes. Dehydrationimpairs performance in most events, andathletes should be well hydrated beforeexercise.Sufficient fluid should be consumedduring exercise to limit dehydration to less thanabout 2% of body mass. During prolonged

exercise the fluid should provide carbohydrate.Sodium should be included when sweat lossesare high especially if exercise lasts more thanabout 2 hours. Athletes should not drink somuch that they gain w eight during exercise.During recovery from exercise, rehydrationshould include replacement of both water andsalts lost in sweat.

Athletes are cautioned against theindiscriminate use of dietary supplements.Supplements that provide essential nutrientsmay be of help w here food intake or foodchoices are restricted, but this approach toachieving adequate nutrient intake is normallyonly a short term option.The use ofsupplements does not compensate for poorfood choices and an inadequate diet. Athletescontemplating the use of supplements andsports foods should consider their efficacy, theircost, the risk to health and performance, andthe potential for a positive doping test.

Excessive training and competition are

IOC Consensus Statementon Sports Nutrition 2003

etesmedicalinformation

athletesmedicalinforma

Nutrition for the athlete is based oninformation discussed at the IOC Consensus

Conference on Nutrition for Sport, held in

Lausanne in June 2003. The papers presented

at that meeting were published as a Special

Issue of the Journal of Sports Sciences

(Volume 22 No.1. January 2004)

1. Energy balance and body composition insports and exercise Anne Loucks2. Carbohydrates and fat for training andrecovery Louise Burke,Bente Kiens, J ohn Ivy3. Pre-exercise carbohydrate and fat ingestion:effects on metabolism and performance MarkHargreaves, J ohn A Hawley,Asker E J eukendrup

4. Fluid and fuel intake during exercise Ed Coyle5. Fluid and electrolyte needs for preparation andrecovery from training and competitionSusan Shirreffs, Samuel Cheuvront,LawrenceArmstrong6. Protein and amino acids Kevin Tipton,Bob Wolfe7. Dietary antioxidants and exercise ScottPowers,Keith C DeRuisseau, J ohn Quindry,Karyn L Hamilton8. Dietary supplements Ron Maughan, DougKing,Trevor Lea9. Exercise,nutrition and immune functionMike Gleeson,Bente Pedersen,David Nieman10. Nutritional strategies to influence adaptationsto training Lawrence Spriet,Marty Gibala

Commentaries

1. Protein and amino acid requirements ofathletes D.J oe Millward2. Exertional Hyponatraemia LawrenceE.Armstrong

References

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athletesmedicalinforma

associated with some negative consequences.Robust immunity and reduced risk of infectioncan be achieved by consuming a varied dietadequate in energy and m icronutrients,ensuring adequate sleep and limiting other lifestress. Attention to dietary intake of calcium

and iron is important in athletes atrisk of deficiency but use of largeamounts of some m icronutrientsmay be harmful. Female athletes

with m enstrual disordersshould be promptly referred

to a qualified specialistphysician for diagnosis

and treatment.

Food can contribute notonly to the enjoyment of life,

but also to success in sport.

Lausanne,18 June 2003

Documents

IOC Nutrition Consensus