Sports Nutrition

800.892.4772 • ISSAonline.com

Sports Nutrition
Daniel Gastelu, MS, MFS Fifth Edition
Frederick C. Hatfield, PhD

Course Textbook for SPECIALIST IN SPORTS NUTRITION

Fifth Edition
Course Textbook for SPECIALIST IN SPORTS NUTRITION
International Sports Sciences Association
1015 Mark Avenue • Carpinteria, CA 93013
1.800.892.4772 • 1.805.745.8111 (international)
ISSAonline.com
Sports Nutrition

Daniel Gastelu, MS, MFS

Frederick C. Hatfield, PhD
Sports Nutrition (Edition 5)
Official course text for: International Sports Sciences Association’s Specialist in Sports Nutrition Program
10 9 8 7 6 5 4 3 2

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Published by the International Sports Sciences Association, Carpinteria, CA 93013.

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Revie wers
Charles Staley, Alex Hoffmann

Editors
Charles Staley, Judy Hobbisiefken, Connie Bernardo, Heather Rothman

Disclaimer of Warranty
This text is informational only. The data and information contained herein are based upon information from various published and
unpublished sources that represents training, health, and nutrition literature and practice summarized by the author and publisher.
The publisher of this text makes no warranties, expressed or implied, regarding the currency, completeness, or scientific accuracy of
this information, nor does it warrant the fitness of the information for any particular purpose. The information is not intended for use
in connection with the sale of any product. Any claims or presentations regarding any specific products or brand names are strictly the
responsibility of the product owners or manufacturers. This summary of information from unpublished sources, books, research journals,
and articles is not intended to replace the advice or attention of health care professionals. It is not intended to direct their behavior or
replace their independent professional judgment. If you have a problem or concern with your health, or before you embark on any health,
fitness, or sports training programs, seek clearance and guidance from a qualified health care professional.
Table of Contents
PART ONE: NUTRIENTS AND ATHLETIC
PERFORMANCE FROM A TO Z, P.1
1 Sports Nutrition: The Vital Link to
Supercharging Athletic Performance, p. 3
2 Food, Ingredients, and
Nutrients: An Overview, p. 27
3 Carbohydrates:
The Ultimate Performance Food, p. 73
4 Protein and Amino Acids:
Muscle Builders and More, p. 107
5 Lipids and the Athlete:
Energy and Growth Factors, p. 157
6 Water and Oxygen, p. 177
7 Vitamins, p. 205
8 Minerals, p. 233
9 Metabolites and Botanical PART THREE: FINE TUNING YOUR
Supplements, p. 255 PERFORMANCE, P. 437
10 Guide to Food and Supplement 17 Sports Nutrition Approach
Product Labeling, p. 289 Concepts and Examples, p. 439
11 Label Claims for Conventional Foods 18 Fat Loss and Muscle Gain
and Dietary Supplements, p. 313 for Athletes, p. 501
19 Glycogen Loading
PART TWO: ANATOMY AND METABOLISM (Super Compensation), p. 523
DETERMINE NUTRIENT NEEDS, P. 345
20 Special Concerns of Athletic Females, p. 539
12 Anatomy of an Athlete:
21 Putting It All Together: Athletic Performance
Cells, Tissues, and Systems, p. 347
Improvement Approach, p. 555
13 Digestion and Absorption, p. 367
14 Body Composition, p. 383 APPENDIX
15 Calorie Needs and Metabolism, p. 403 References, p. 573
16 Dietary Guidelines for Americans, p. 425 Glossary of Key Words, p. 629
This page is intentionally blank.
PART ONE
Nutrients and Athletic
Performance from A to Z

Sports Nutrition: The Vital Link to Water and Oxygen, p. 177

Supercharging Athletic Performance, p. 3
Vitamins, p. 205
Food, Ingredients, and
Minerals, p. 233
Nutrients: An Overview, p. 27
 etabolites and Botanical
M
Carbohydrates:
Supplements, p. 255
The Ultimate Performance Food, p. 73
Guide to Food and Supplement
Protein and Amino Acids:
Product Labeling, p. 289
Muscle Builders and More, p. 107
Label Claims for Conventional Foods
Lipids and the Athlete:
and Dietary Supplements, p. 313
Energy and Growth Factors, p. 157
This page is intentionally blank.
 Topics Covered In This Unit

Introduction

Innovative sports nutrition course

A word about sports nutrition

supplements and other sports
nutrition products

United States and Canada

Dietary Reference Values

Athletic perfection from imperfection

The Dynamic Nutrition Approach

Origins of sports nutrition

 odern science discovers how

M
nutrition improves athletic
performance

The new age of sports nutrition

Nutrition defined

The three Es of nutrition

Essential Nutrition for

Health and Survival

Essential Nutrition for

Athletic Performance

Performance Daily Intakes (The PDIs™)

Effectiveness and safety

Healthy adults

Nutrition intake approaches

Conclusion

UNIT 1

SPORTS NUTRITION: THE VITAL LINK TO

SUPERCHARGING ATHLETIC PERFORMANCE
4 | Unit 1

Unit Outline
I. Introduction XI. Nutrition defined
II. Innovative sports nutrition course XII. The three Es of nutrition
III. A word about sports nutrition a. Essential Nutrition for Health and Survival
supplements and other sports
i. Dietary Reference Intakes
nutrition products
ii. Dietary Reference Intake terminology
IV. United States and Canada
iii. Essential nutrition for optimum health
V. Dietary Reference Values
(The ODAs)
VI. Athletic perfection from
b. Essential Nutrition for Athletic
imperfection
Performance
VII. The Dynamic Nutrition Approach
c. Performance Daily Intakes (The PDIs™)
VIII. Origins of sports nutrition
XIII. Effectiveness and safety
IX. Modern science discovers how
XIV. Healthy adults
nutrition improves athletic
performance XV. Nutrition intake approaches
X. The new age of sports nutrition XVI. Conclusion

Learning Objectives
After completing this Unit, you will be able to:
• Understand the basic distinctions between nutrition for survival and nutrition for athletic
performance (sports nutrition).

• Determine the pros and cons of the dietary reference value approach.

• Discuss the 3 Es of nutrition.

• Define the essential nutrients.

Introduction
Although it was once thought that nutrition During the recent years of nutrition research, a
was merely required to survive and be healthy, diversity of information has continued to grow
the most recent research makes it is clear that about how nutrients affect the structure and
nutrition can also make people thrive in many function of the human body, improve health and
ways, including improving athletic performance. athletic performance, and even prevent a large

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 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 5

number of nutrition-based diseases—in addition reaching peak physical performance found in

to nutrition’s traditional role. Early nutrition the growing body of sports science research.
research solely focused on identifying which For example, prevention of diseases such as
nutrients the human body required to prevent cardiovascular diseases can be accomplished
nutrient deficiency diseases, such as scurvy and from eating certain foods every day. The
promote general health. While this remains a research about how the right nutrition can
central focus of nutrition research, the scope help prevent cardiovascular diseases, and even
continues to widen to include determining how certain cancers, is so compelling that the Food
nutrients can make the human body work better, and Drug Administration (FDA) approved
live longer, and attain peak athletic performance. the use of certain individual and groups of
foods for these disease-prevention purposes.
With all this new research at hand, and Preventing cardiovascular diseases and certain
marvelous new discoveries, this updated cancers is certainly a goal in anybody’s athletic
course book edition has been expanded to performance and fitness nutrition programs.
include nutrition information focused on Learning what foods and dietary supplements
athletic performance, but it can also apply for are associated with disease prevention (reduced
general health and fitness goals, as a feature risk) will help focus on which foods to eat more
to his updated edition includes information of, versus consumption of the empty calorie
about the 2015–2020 Dietary Guidelines for or disease-causing unhealthy foods (disease-
Americans, Eighth Edition. Therefore, this most causing foods to avoid or reduce consumption
recent dietary guidelines-based information of). This is especially vital when you consider
will add additional insights about how nutrition that athletes typically consume a few to several
can help prevent certain diseases along with thousand calories of food per day during the pre-
research-based sports nutrition findings for competition and competition seasons.

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Innovative Sports Nutrition Course

It is interesting to note that the introduction of this ISSA course during
the 1990s was unique in many ways, including being among the first
sports nutrition courses to be based in clinical research findings and
experience—and a first-of-its-kind comprehensive scientific model, years
ahead of what was even being taught in the top universities.

Some of the noteworthy innovative sports nutrition course

features include:
• A comprehensive evidence-based model

• Bio-energetic based protein, carbohydrate, and lipid requirements.

• The performance daily intake approach for essential nutrients

• Use of novel ergogenic dietary supplement ingredients such as creatine,

carnitine, and coenzyme Q10, to name a few

• Meal timing

• Carbohydrate loading options

• Focus on healthy lipids, such as omega-3 fatty acids

• Use of clinically research based botanicals and other ingredients

• Pre-, during, and post-training nutrition

• Healing and recovery nutrition

• Nutrition for improving mental focus/arousal

• Nutrition for improving tissue healing

• Nutrition for reducing pain/inflammation

Aerobic: With oxygen.
• Nutrition for improving aerobic and anaerobic energy
Anaerobic: Without
oxygen. • Nutrients for getting stronger

• Nutrients for building muscle mass

• Targeted fat loss for athletes

• Use of various sports supplements with clinical evidence

One of the processes of the scientific process is duplication of research

studies to reconfirm the results of other research studies. As the body
of sports nutrition science has grown tremendously during the past
few decades and continues to grow, this sports nutrition course, and

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 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 7

scientific model, continues being refined when • Use of certain sports foods, such as
new discoveries warrant. Additionally, new drinks, bars, gels, electrolytes, protein,
meal replacements
research findings often reconfirm old scientific
discoveries. For example, the use of sugar- • Ergogenic supplements with best scientific
and salt-containing sports drinks, caffeine- evidence, such as, creatine, caffeine, sodium
containing drinks and supplements, and creatine bicarbonate, beta-alanine, nitrate sources
(beet root), beta-hydroxy-beta-methylbutyrate
supplements; and old discoveries but still
(HMB)
effective athletic performance sports nutritionals.
• Special concerns regarding weight loss and
Confirmation of what works can even be found management for athletes
in position papers of other organizations.
• Knowledge about the Female Athlete Triad
Position papers typically are a works in progress
of gathering and reviewing the scientific research
evidence, one of the processes first established A Word about Sports
through this ISSA course and decades of
independent work by the authors. For example,
Nutrition Supplements
here are some of the sports nutrition issues and Other Sports
collaborated by independent research reviews: Nutrition Products
• Individual athlete energy requirements and
Students should be aware that including
body composition analysis
information about sports supplements and other
• Diet high in carbohydrates, in relation to sports nutrition type products is based on what
protein and lipids the scientific evidence shows can be useful for
• Types of carbohydrates athletic performance and health. However, also
be aware that it is not a mandate or obligation
• Nutrition practices for daily needs and
pre-competition / competition / that you use any particular types of sports
post-competition nutrition products or ingredients or recommend
their use to your clients.
• Meal timing, composition, calories,
and frequency This course is for educational purposes, and
• Protein needs for different types of athletes, all each individual must be involved in the ultimate
above the dietary guidelines for non-athletes. decisions of his or her nutrition program,
• Types of proteins
the food and supplements he or she wishes to
consume, from working with a personal expert
• The right lipids/fats, and lower calories from
support team—one ideally supervised by the
lipids/fats
team and/or personal physician, in addition to
• Hydration guidelines other health professionals such as fitness trainers.
• Achieving adequate glycogen stores This will help provide some assurances as to
the suitability of individualized sports nutrition
• Use of certain essential nutrient dietary
supplements to prevent nutrient deficiencies
programs and also help check for substances

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that may be of concern from a sports governing reading, you may be interested to know that
organization rules standpoint, concerning with the Canadian process, dietary supplements,
avoiding banned substances and practices. This including most sports nutrition supplements
point is made at the onset of your course work ingredients and claims, are reviewed, approved,
due to occasionally having some students make and licensed before being allowed to enter the
comments about the evidence-based sports Canadian market. Also of interest is that Health
nutrition type products or ingredients contained Canada develops, approves, and maintains
herein. To clarify, the authors and ISSA remain ingredient monographs for many of the
neutral regarding your use of the information ingredients used in supplement type products,
contained in the course materials. referred to as Natural Health Products in
Canada.
The point? With the Canadian process,
United States and Canada controversy is eliminated through product
As you will soon be learning in a following licensing, with the highest level of credibility
section of this unit regarding dietary reference being attained. Most of the same ingredients that
intakes, the United States and Canada worked are used in Canada’s natural health products
closely in this major undertaking to update are also being used in US dietary supplement
essential nutrition science and national products, including sports supplements. These
guidelines. Additionally, regarding food and Canadian-approved ingredients and claims will
dietary supplement heath products, the United be noted in subsequent units. Therefore, while a
States and Canada also work closely. While the level of nonsense (non-science) is encountered in
conventional food laws of the two countries the United States over these issues by the non-
are similar, the dietary supplement laws have experts (typically in the uninformed media),
some differences that will be elaborated on paradoxically, the same ingredients and claims
in subsequent units. But at this point in your are approved in Canada and in other countries.

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 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 9

Dietary Reference Values

There has been much progress in the United States and other countries
to determine nutrition requirements for promoting health and disease
prevention/reduction related to nutrition. The limitations of the
approached used are acknowledged by the groups of experts involved
in creating the massive research reports. For example, the Dietary Dietary Reference
Reference Intake series of reports, by the IOM (Institutes of Medicine) Intakes (DRIs): DRIs are
dietary reference values
is several thousand pages, published in several volumes, noted in a for the intake of nutrients
following section of this unit. These and other similar publications and food components by
Americans and Canadians.
typically state that the nutrient amounts, such as the RDA, are not
intended individual intakes—that for each person, a goal of planning
nutrient intakes for individuals is to achieve nutrition intakes that
work best for them but are safe and do not exceed upper limit amounts
that could cause adverse health effects. So ranges of intakes for
nutrients sets lower and upper limit boundaries, in which a particular
person’s requirements may fall within. Noting that a person’s nutrient
requirements can be changing, based on physical activity, state of health,
special requirements, and life stage.

For students who are new to the IOM’s Dietary Reference Intake report
series, a good one to start with is the Dietary Reference Intakes: The
Essential Guide to Nutrient Requirements (2006). This is an overview of
the previous thousands of pages of DRI reports and consolidates the
various macronutrient and micronutrient topics in one publication.
Electronic copies are available online free, and on the National
Academy of Sciences website, and may be located for download at
the USDA’s website. A list of these reports is presented in a following
section of this unit.

Athletic Perfection from Imperfection

Something to be aware of is that one distinction of sports nutrition
versus general nutrition is that nutrition programs for athletes become
highly customized and quantified. This takes plenty of work, typically a
team effort, and constant fine-tuning during the various athletic periods
of the year, relating nutrition intake to athletic performance outcomes;
the best types of foods and supplements; body composition goals; and
measures of health. Therefore, while striving for athletic performance
perfection, a challenge is dealing with dietary, body composition,

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10 | Unit 1

caloric intake, and other measurements that are this quest for athletic training and nutrition
not perfect. For example, nutrient and caloric knowledge, we reviewed almost every textbook
content of foods can be plus or minus 10 to and research study on nutrition that was
20 percent, or more, especially when dealing available, the meager chapters about nutrition
with whole foods. The nutrient content of food for athletes usually found in athletic training
reference tables and databases also has a wide guides and books, and a variety of directed
margin of variability. In addition, the methods research studies and case studies.
for determining body composition and caloric
During this research and development episode,
intake requirements are also variable. Then,
it became apparent that on the surface there
there is also variability in the dietary reference
were seemingly many ways to achieve the
intakes and other reference values to contend
same result. In fact, until the first edition of
with. Dealing with this variability is similar
this course book, there were no texts dedicated
to dealing with the athletes’ variable response
to sports nutrition that had a scientific basis,
to physical training approaches. But once the
which is the point we would like to underscore.
nutrition and training variability is mastered,
Our pioneering spirits and determination led
athlete’s will gain a major sports performance
us to applying the scientific approach to sports
advantage compared to athletes that are not
nutrition. The Dynamic Nutrition Approach
undergoing the same levels of nutrition and
(coined by coauthor Daniel Gastelu) is therefore
training program sophistication.
a comprehensive scientific approach that was
Dealing with nutrition variability also provides based on the intricacies of how the essential
insights why particular athletes or teams may nutrients and other beneficial substances cause
seem to have a characteristic selection of foods the human body to work best overall and under
and supplements, usually not that diversified. conditions of exercise, athletic training, and
Typically, this is due to a combination of athletic competition.
factors such as being more reliable sources of
As you will soon discover, the Dynamic
the nutrients and calories with less variation,
Nutrition Approach model to sports nutrition
affordability, preparation, availability, and good
has stood the test of time. Subsequent
athlete compatibility in terms of digestibility,
independent scientific research continues to
utilization, and good tolerance.
confirm what this model already includes.
For example, while scientists debated whether
The Dynamic athletes in general needed more protein then
nonathletes did, the Dynamic Nutrition
Nutrition Approach Approach model not only acknowledged that
Because the authors’ personal athletic quests athletes need more protein than nonathletes,
have always been to attain peak athletic it also noted that different types of athletes
performance to excel in sports, nutrition require different amounts of protein. Turning
became a point of focus early in our lives when attention to fat loss and weight maintenance, it
aspiring to be champion athletes. During was coauthor Dr. Hatfield who developed the

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 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 11

ZIGZAG diet approach in the 1970s, which traditional foods and rituals for increasing
has become part of this course. Since then, the athletic performance. Nevertheless, aside from
ZIGZAG approach had been written about in these many anecdotal accounts of ancient
numerous publications. Independent researchers nutrition practices, it is in the home of the
and authors have even claimed that it as a Olympics that we find the first legitimate
medical breakthrough of the 21st century. documented attempt to improve sports
performance through nutrition. Historians
The Dynamic Nutrition Approach to sports
estimate the time and place around 450 BC in
nutrition also focuses on providing health-
Greece. It was here that Dromeus of Stymphalus
promoting guidelines in addition to athletic
is credited with adopting special nutrition
performance enhancing guidelines. It is
practices for the improvement of athletic
also dynamic regarding the evolving flow of
performance. Most noteworthy of these practices
information, retaining the time tested and
was the consumption of large amounts of meat
reconfirmed nutrition sciences, with room for
to improve muscular strength. Many athletes
allowing in new discoveries and sometimes
continue to eat high-protein diets for increased
replacing old effective technologies with new,
performance in various sports.
more effective ones.
Keeping with the tradition of emulating what
athletes do to be their best has shaped the way
Origins of we approach fitness nutrition, too. When you
Sports Nutrition eat correctly for peak physical performance,
peak fitness will result as well. It is just a matter
When we look through human history, the
of extent. A person engaged in a competitive
search for performance enhancing foods is
sport will follow a more precise and demanding
clearly evident and dates back several thousand
nutrition and supplement program than will
years before even the earliest civilizations
the individual who exercises for general health
had risen. It is thought that in these primitive
and fitness reasons. Historically, people also
times the early humans searched for foods that
sought to be the healthiest (fittest) they could be
increased strength and performance to be better
through nutrition for some important reasons.
hunters and win wars, not races. History is filled
First, ancient humans needed a fit body to
with tales of warriors who ate and drank various
survive the primitive times. If you were not
foods to boost their combat prowess. There are
strong and fit, you probably were not going to
even gruesome accounts of victors eating the
survive. Then there was the matter of not getting
hearts of their opponents to capture the spirit of
sick or developing degenerative diseases. “Let
their strength.
food be your medicine, let medicine be your
What these early competitors realized in food” was the health mantra of the day. It is
their own crude way was that nutrition is an interesting to note that the most ancient texts
important factor of physical performance. Just include food laws and eating guidelines. More
as most cultures have a variety of potions to interesting is that modern science has confirmed
boost sexual performance, they also have their that this ancient whole-food eating approach is

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also a healthy way to eat even in modern times. athletic events began. Many of you may still
The nutrition-disease connection is increasingly remember the days when marathon runners
apparent. As such, it makes perfect sense to experienced the phenomena of “hitting the
eat foods every day that make you healthy and wall” at the end of the race when they depleted
prevent disease and to avoid eating foods that their body’s store of carbohydrates and were
may lead to causing disease and to eschew running primarily on stored body fat. By simply
a poor diet that makes the body weak and ingesting a carbohydrate drink during the race,
malfunction—making you more susceptible to marathoners could increase their speed and
contracting infectious diseases or developing avoid hitting the wall.
degenerative diseases.
We know much more today about improving
athletic performance and fitness with nutrition
Modern Science than our predecessors could have ever imagined.
Discovers How Nutrition The past decades have yielded thousands of
studies about how nutrients and nutrition
Improves Human Athletic practices can improve athletic performance,
Performance fitness, and health. Still, people succumb to
misguided information spread around the locker
We now know much more about how nutrition
room, in magazines and the internet. Usually
affects athletic performance, and we reserve
younger do-it-yourself athletes are at greatest risk
higher than normal protein diets for special
for misinformation. Performance athletes require
times and fine-tuned for certain groups of
nutrition and training programs specific to excel
athletic individuals, such as strength athletes
in their sport.
versus endurance athletes. Furthermore, athletic
individuals must be using all aspects of nutrition Additionally, surprising recent scientific surveys
correctly. There is no single food solution that reveal that the majority of athletes, coaches,
will increase athletic performance and health. trainers, and other professionals tending
The misconception of the “magic food solution” to the sports person do not have a working
is the reason there are so many nutrition myths knowledge of what constitutes a good sports/
and such tremendous controversy within the fitness nutrition program. This is why many
field of sports and fitness nutrition. Nutrition people continually resort to ridiculous nutrition
for athletics and health is an involved science, practices and may end up turning to snake oils
and many factors must be considered to achieve or even illegal drugs in an attempt to compensate
optimum results. for poor nutrition and training approaches.
This ignorance is not only dangerous but also
When you think of the high-tech society we live
counterproductive.
in today, it is hard to believe that it was only a
few decades ago that the practice of carbohydrate Also, every athletic person has experienced
loading and intake of carbohydrates during directly or indirectly the need to lose weight for

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 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 13

sports like wrestling, football, and gymnastics or to be healthier and

look their best. In fact, losing weight has grown into multibillion-dollar-
a-year industry. However, do you think that the common methods for
losing weight like starving, taking laxatives, engaging in nutritionally
unbalanced fad diets, and spitting or sweating off the weight are healthy
or effective methods? Of course not!

The New Age of Sports Nutrition

Now is the time to exit the dark ages of hit-or-miss performance
nutrition and enter into the scientifically based renaissance of high-tech
performance nutrition for athletes. This text is written for every fitness
trainer, strength coach, athletic trainer, other health professionals,
athletes, and even athletic exercisers. The rest of this unit will provide
some general background information about the evolution of nutrition,
building up to sports nutrition.

Nutrition Defined
Defining nutrition seems to be an appropriate starting point, so here we Nutrition: the process
of the body using food to
go. Nutrition is the process of eating and converting food into structural sustain life.
and functional body compounds like skin, muscle, and hair. Nutrition
is required for energy production, growth, maintenance of bodily
functions, repair of body tissues, physical performance, and promotion
of good health. Different parts of the body need special nutrients to
function properly. For example, your nervous system has different
nutritional needs than your muscles have. These differences must be
considered to make the whole body perform at its best.

On the surface, getting the nutrition you need seems easy enough. After
all, everyone eats something every day. But recent government reports
have concluded that the vast majority of Americans eat too much of the
wrong things (such as saturated fats, sodium and sugar) and not enough
of the good stuff (like whole-food complex carbohydrates, lean meats,
vegetables. and fruits). It is unbelievable how many athletic people eat
frequently at fast food restaurants, consume large amounts of snack
foods, and believe that they are on health sports nutrition diets. In truth,
they are on high-fat, high-sodium diets that are low in essential nutrients.

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Nonessential Doesn’t Mean Unimportant

Traditionally, the term “essential nutrient” refers to a nutrient that the body cannot make at all or
cannot make in sufficient amounts to maintain good health. Scientists have discovered over 40
nutrients that fit into this category. They include the carbohydrate glucose, certain amino acids from
protein, certain fatty acids (linolenic acid), thirteen vitamins, and seventeen minerals.
The term “non-essential” nutrient is terribly misleading and includes all the other nutrients that
are not considered essential. When you are eating for maximum performance and health, the non-
essential nutrients can be just as important as the essentials. For example, by eating a full profile
protein that contains both non-essential and essential amino acids, your body will get the amino
acids it needs more quickly, as it will not have to spend time making the non-essentials from the
essentials. For maximum performance and health, eating the right proportions and amounts of both
essential and non-essential nutrients is important. Plus, there are other performance factors like herbs,
metabolites (creatine, choline, inosine, L-carnitine), and phytochemicals that are not essential for
survival, but are essential for improved performance. In fact, the FDA recently declared that Choline
is an essential nutrient, and established intake standards. Also recently, the benefits of carnitine were
acknowledged by the federal government, and carnitine is now begin referred to as a semi-essential or
conditionally essential nutrient.

The problems of poor nutrition are highly from fatal diseases due to poor nutrition. A
complex but originate from the simple fact qualitative approach to nutrition does not deal in
that most people and the people preparing our exact amounts of nutrients for each individual;
meals learned about nutrition way back in grade nor does it compensate for the special needs
school, years ago. What was taught then and of athletes. It only recommends eating several
even today has nothing to do with nutrition for servings of different foods each day. Additionally,
athletes, and barely provides a good nutrition you cannot be certain that the food you eat
program for the non-athlete to follow. The basic will provide reliable nutrition. Scientists have
guidelines that you remember probably use the determined that the nutrition content of most
food group approach to good nutrition. This foods will vary greatly depending upon where
includes eating a balanced diet consisting of it is grown. This means that the potato you buy
foods from the following groups: from Maine may have different amounts of
1. Fruits and Vegetables
vitamins and minerals then the one grown in
Idaho. Many studies report about how athletic
2. Meat, Poultry, Fish
people are deficient in important minerals and
3. Dairy vitamins; they are simply not eating right.
4. Breads and Cereals
Nutrition, especially sports nutrition, is has
In theory, this food group approach should become a quantitative science. While the
work. In practice, we are a nation suffering nonathlete may survive day to day by following

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 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 15

general guidelines, the athletic persons needs performance and fitness. For this reason, the
a more sophisticated and precise approach to athletic persons must always maintain a special
nutrition to achieve performance and fitness performance nutrition program. The average
excellence. This means a 150-pound female athlete’s diet consists of two to three or more
swimmer eats differently from a 250-pound shot- times the amount of daily caloric intake than
putter, for example. that of a nonathlete. Typically, a competitive
athlete consumes a few to several thousand
Billions of people eat and live every day. The
calories per day. At these high levels of food
food supply is quite varied all over the world,
intake, an athlete had better make sure to eat
and so is health. Most of us associate a well-
the right foods. The same is true for fitness
fed person with a healthy person. However,
individuals. While their total nutrition intake
millions of people die each year from diet-borne
will be less than that of a competitive athlete,
diseases caused by eating too much of the wrong
what they eat needs to be both performance
fats and not enough of the essential nutrients.
enhancing and healthy.
Athletic persons must do more than just eat and
live. They must operate at an optimum level of

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The Three Es of Nutrition nutrients can help improve and protect health.
For example, research shows that taking certain
The following will present a picture of the nutrients in amounts more than the RDA
different levels of nutrition commonly practiced recommends can reduce the risk of certain
and will shed new light on the reasons someone’s diseases. This recent shift away from the
nutrition program may be incomplete. There are strict RDA approach to nutrition is founded
three general categories of nutrition approached on a health-driven philosophy of achieving
practiced today, excluding clinical nutrition for optimum nutrition. The RDAs, and other
disease treatment: similar government nutrition standards found
• Essential Nutrition for Survival and Basic Health worldwide, are primarily concerned with
preventing diseases that result from essential
• Essential Nutrition for Optimum Health
nutrient deficiencies like scurvy from the lack
• Essential Nutrition for Athletic Performance of vitamin C.

These government-based guidelines are not

Essential Nutrition for Survival aimed at achieving optimum health. In fact,
and Basic Health most of the RDA values are based on the average
Most of the diets eaten by the general population nutrient intakes of our entire population. For
fit into the “Essential Nutrition for Survival this approach to be valid, it must be assumed
and Basic Health” category. This category that everyone is eating a healthy diet and that
is based on the United States government everyone’s nutrition requirements are the same.
standard you have heard so much about; the But, as mentioned earlier, the National Research
RDA (recommended dietary allowances). The Council has determined that the majority of
RDAs were first established in 1943 to serve people are eating poor diets. In fact, the typical
as a goal for good nutrition. It was recognized American diet is responsible for causing diseases
that nutrition goals must be established and and the deaths of millions of people each year.
met to propagate good health on a national Thus you see right from the start that the RDA
basis. Every several years, the National Research system is not meant to promote optimum
Council publishes a new, updated edition of health. A short run through the RDA story will
the RDAs to reflect the best scientific judgment demonstrate this point.
on nutrient allowances for good health. The To begin with, the following nine nutrients
RDAs also serve as the basis for evaluating were the only ones with RDAs first established
the adequacy of diets for specific groups of by 1963.
people. This data baseline is a particularly
1. Protein 6. Riboflavin
useful reference point for health practitioners.
2. Vitamin A 7. Niacin
However, many progressive health practitioners
3. Vitamin D 8. Calcium
claim that the RDAs are not adequate for
the best health. New and evolving research 4. Vitamin C 9. Iron
is demonstrating how eating more of certain 5. Thiamin

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 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 17

The Essential Nutrients:

Nutrients that the body cannot make at all or in insufficient amounts to maintain good health

Carbohydrate: As a source of Glucose

Fat: As a source of Linoleic Acid and Linolenic Acid
Protein: As sources of essential amino acids
Histidine Isoleucine Leucine Lysine
Methionine plus Cystine Phenyalanine Tyrosine Threonine
Tryptophan Valine
Minerals:
Calcium Phosphorus Sodium Potassium
Chloride Magnesium Sulfur Iron
Iodide Zinc Copper Manganese
Cobalt Fluoride Selenium Chromium
Molybdenum
Vitamins:
Vitamin A Vitamin D Vitamin E Vitamin K
Thiamin (B1) Riboflavin (B2) Niacin (B3) Pyridoxine (B6)
Cobalamin (B12) Ascorbic Acid (C) Folic Acid Biotin
Pantothenic Acid (B6) Choline Inositol
Other essential nutrients to be discovered?

Now turn your attention to the list of more nutrition needed for optimum health and
than two dozen nutrients that has grown to certainly has limitations for athletes. This is why
be essential enough to have values: Protein, essential nutrient dietary supplements can be
Vitamin A, Vitamin D, Vitamin E, Vitamin important to include as part of an athlete’s sports
K, Vitamin C, Thiamin, Riboflavin, Niacin, nutrition program in addition to other dietary
Vitamin B6, Folate, Vitamin B12, Calcium, supplements for special athletic performance
Phosphorus, Magnesium, Iron, Zinc, Iodine and uses. In the new DRI system, it was recognized
Selenium, Biotin, Choline, Pantothenic Acid, more than ever that although nutrient
Copper, Manganese, Fluoride, Chromium and requirement data on the population level are
Molybdenum, and macronutrients too. important, better determining the nutrition
requirements of the individual is even more
Dietary Reference Intakes important, including how nutrition requirements
change during the different stages of life.
Since the writing of the previous editions of
this course book, another set of standards was As noted in one of the DRI reports, the DRI
introduced called DRI’s (Dietary Reference values replace the former Recommended Dietary
Intakes). However, this system provides no Allowances (RDAs) for the United States and
reliable assurance that people are getting the Recommended Nutrient Intakes (RNIs) for

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Canada. In the past, RDAs and RNIs were the However, as with the previous RDA system, it
primary values available to US and Canadian is noted, “The Dietary Reference Intakes (DRIs)
health professionals for planning and assessing are developed and published by the Institute of
the diets of individuals and groups. The DRIs Medicine (IOM). The DRIs represent the most
represent a more complete set of values. They current scientific knowledge on nutrient needs
were developed in recognition of the growing and of healthy populations. Please note that
diverse uses of quantitative reference values and individual requirements may be higher or lower
the availability of more sophisticated approaches than the DRIs.”
for dietary planning and assessment purposes.

Dietary Reference Intakes Reports

by the Food and Nutrition Board, Institute of Medicine, National Academy of Sciences

Dietary Reference Intakes for Vitamin D and Calcium (2011).

Dietary Reference Intakes: The Essential Guide to Nutrient Requirements (2006).

Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids
(Macronutrients) (2005).

Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2004).

Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese,
Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001).

Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000).

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin,
and Choline (1998).

Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997).

Meeting Summary: IOM DRI Chronic Disease Indicators Planning Meeting (2009).

Background Paper: Framework for DRI Development (2008).

The Development of DRIs, 1994–2004: Lessons Learned and New Challenges. Workshop Summary (2007).

Dietary Reference Intakes: A Risk Assessment Model for Establishing Upper Intake Levels for Nutrients (1998).

How Should the Recommended Dietary Allowances be Revised? (1994).

[Source: http://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-nutrient-reports]

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 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 19

Dietary Reference Intake terminology

Here is some of the terminology used in relationship to the Dietary
Reference Intakes and reports:
• Dietary Reference Intakes (DRIs): are dietary reference values for the
intake of nutrients and food components by Americans and Canadians.

• Estimated Average Requirement (EAR): The average daily nutrient

intake level that is estimated to meet the requirements of half of the
healthy individuals in a particular life stage and gender group.

• Recommended Dietary Allowance (RDA): The average daily dietary

nutrient intake level that is sufficient to meet the nutrient requirements
of nearly all (97–98 percent) healthy individuals in a particular life stage
and gender group.

• Adequate Intake (AI): The recommended average daily intake level

based on observed or experimentally determined approximations or
estimates of nutrient intake by a group (or groups) of apparently healthy
people that are assumed to be adequate; used when an RDA cannot
be determined.

• Tolerable Upper Intake Level (UL): The highest average daily

nutrient intake level that is likely to pose no risk of adverse health effects
to almost all individuals in the general population. As intake increases
above the UL, the potential risk of adverse effects may increase.

• Acceptable Macronutrient Distribution Range (AMDR): An

AMDR is the range of intakes of an energy source that is associated with
a reduced risk of chronic disease, yet can provide adequate amounts
of essential nutrients. The AMDR is expressed as a percentage of total
energy intake. A principal feature of each AMDR is that it has a lower
and upper boundary. For example, the AMDR for carbohydrates ranges
from 45 to 65 percent of total energy intake. Intakes that fall below or
above this range increase the potential for an elevated risk of chronic
diseases. Intakes outside of the range also raise the risk of inadequate
consumption of essential nutrients.

Subsequent units will elaborate about the Dietary Reference Intakes

as they pertain to the unit’s specific topics. But also note that there is
additional terminology for food and supplement labeling, presented in
Unit 10. This related labeling terminology includes:
• Daily Reference Value (DRV)

• Reference Daily Intake (RDI)

• Daily Value (DV)

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20 | Unit 1

Essential Nutrition for in higher amounts for optimum health than

Optimum Health (The ODAs) the RDAs recommend for optimum health. Dr.
Lieberman is one of the nutritional pioneers
As discussed above, the early focus of the who coined the term ODA (Optimum Daily
government and many nutrition professionals Allowance) to indicate that we require higher
who follow the government’s nutrient intake amounts of vitamins and minerals than
standards is providing nutrition that provides those identified in the RDAs and more of the
a minimum amount of the essential nutrients nonessential nutrients and herbal factors as well.
to prevent nutrient deficiencies. The focus is
There are many reasons for this greater need,
not necessarily to achieve optimum nutrition.
including that our bodies are faced with warding
Furthermore, there is no emphasis put on
off a host of environmental stresses, such as
the “non-essential” nutrients. Thanks to the
air pollution, poor quality or contaminated
developing health industry, however, the
drinking water, pesticides, additives, and other
past few decades have fostered a nutrition
non-nutritive toxins. Furthermore, our food
revolution that promotes a diet that is rich in all
supply does not provide the proper amounts
nutrients, in greater amounts than previously
of nutrients for optimum health. Research is
recommended. Finally, we are looking at an
finding new uses for nutrients besides their
integrated nutrition approach.
role in basic survival. For example, a group
Progressive nutritionists like Shari Lieberman, of vitamin and mineral nutrients called the
PhD, author of The Real Vitamin & Mineral antioxidants has been found to protect the body
Book, tells us that the body needs more nutrients from the wear and tear caused by free radicals.

Sports Nutrition
 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 21

Free radicals are formed naturally in the body, Essential Nutrition

and higher amounts of free radicals are caused
for Athletic Performance
by increased physical activity, exposure sunlight,
and exposure to everyday chemicals. This means Essential nutrition for athletic performance
that athletic people need to reduce the amount is the most recent advancement in the field
of free radical damage to their bodies by taking of nutrition. Sports and fitness scientists
nutrients with antioxidant activity. This will make new discoveries daily, uncovering the
stimulate quicker recovery and more rapid intimate connection between nutrition, athletic
movements in performance. As it turns out, performance, and fitness. Eating for maximum
although some of the essential nutrients, like athletic performance includes eating foods for
vitamins E and C are important antioxidants, maintenance of optimum health plus extra
the most recent research has determined that nutrients to achieve peak athletic performance
it is groups of chemicals from plants that and to compensate for the increased caloric
are turning out to be even more potent and and essential nutrient requirements associated
important antioxidants. In recent DRI Reports, with athletic training and competition. Peak
it seems that the ODA approach is now being athletic performance includes being your best
acknowledged, in particular when presenting 24 hours a day. This means having the energy
information related to individual nutrition to sustain workouts or competitions along with
programs, with essential nutrient intake being the proper nutrition for recovery and rest and
between the lower limit and below the ULs. superior health.

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Performance Daily Intakes The PDI summary chart for vitamins and
minerals is presented in Units 7 and 8,
(The PDIs™)
which also contain other reference values for
The PDIs provide a set of guidelines based on comparison. Note that too often individuals take
the science of nutrition, sports nutrition, and too much of a few supplements and not enough
fitness nutrition. These guidelines provide safe of many of the essential vitamins and minerals.
and efficacious nutrition information based Remember, all are important, and there is no
on research and a vast review of the reference magic pill.
publications on nutrition. (Note that the
original edition of this course book used the When using the PDI guidelines, keep in mind
term “Performance Daily Allowance,” and this that they:
has been changed to keep in pace with the new • are intended for athletes and healthy, physically
recent RDI terminology.) active adults;

The PDIs for each nutrient should be obtained • are dynamic and consider a wide range of
needs, activity levels, and size of athletic
from a total nutrition plan, consisting of both individuals;
food and supplement sources taken together.
• are for both men and women;
In most cases, the lower limit of the PDI range
is equal to or higher than the RDA/RDI/DRI • compensate for the higher nutrition
values are. Therefore you can expect that food requirements that athletes and physically active
people have when compared with nonathletes;
sources alone will not provide or will just barely
provide the lower amount of the PDI range. • are for working with physician and other
applicable health professional supervision.
To ensure that adequate levels of nutrients are
maintained each day, you may need to use
We now know that for peak performance and
dietary supplements.
fitness, you must consume certain foods before
The PDI ranges for each nutrient reflect the and after exercise to yield optimum results.
different needs of individuals based on their Breakfast will be different from dinner. Meals
size and activity level. Smaller or less active will vary from day to day depending on your
individuals therefore target their nutrient activity level. The powerlifter will eat differently
intake at the lower end of the range, whereas than the basketball player does. The proportions
larger and more active individuals follow of carbohydrates, protein, fat, and cofactors must
intake levels on the upper end of the range. match the metabolic needs all day long to achieve
Always consult the specific detailed sections peak performance. This requires knowledge
on each nutrient for comprehensive guidelines about unique individual metabolic demands.
and information about each nutrient. Also Body type, type of sport or fitness program,
note that supervision of a physician is always training, activity level, and body composition
required, and testing the athlete’s blood all determine what custom fuel mix is required.
levels of the essential nutrients, and other Meal timing and nutrient composition is also
biomarkers would be the ideal approach to important to achieve optimum performance and
fine-tune food and supplement intake. fitness nutrition.

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 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 23

Effectiveness and Safety life, but can potentially cause adverse side
effects if consumed in excessive amounts
Regarding the nutrients themselves found in or inadequate amounts. As the following
food and supplements, there are dietary intake reference chart below illustrates, when nutrient
issues based on both sides of the dietary intake intake levels are low (to the left), nutrient
equation; inadequate consumption (not enough) deficiency diseases or conditions can develop.
and overconsumption (too much). In general, When nutrient intake is too high (to the right),
foods and supplements have an excellent the risk of potential nutrient overconsumption-
safety record. When you review effectiveness related side effects may occur.
and safety issues, the point is to establish a
Theoretically, the nutrient intake zone between
performance-enhancing range of effective
the lowest level and the highest level is the
intake for nutrients and related substances so
optimum health zone and athletic performance
that you will ingest enough to make a positive
intake zone. However, for whatever reason, the
difference, but not excessive amounts that
“authorities” establish nutrient intake standards
might not provide any extra benefits or may
at the lowest level of intake—even below the
possibly develop rare, but unwanted side
level at which inadequate nutrient intake is
effects from this overconsumption.
estimated to occur, the EAR and RDA values are
This phenomenon may be new to some people, actually in the risk of inadequacy area, as seen in
one in which an essential nutrient is vital to the illustration.

1.0 EAR 1.0

Risk of Adverse Effects

Risk of Inadequacy

RDA UL

0.5 Performance 0.5

Intake
Optimum Zone
Intake
Zone

0.0 0.0
Observed Level of Intake

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Technically, the UL is an estimated upper larger and more active athletes and particularly
value of intake representing the point at which during training and competition periods.
is the highest level of daily nutrient intake Additionally, dietary intake surveys conducted
that is likely to pose no risk of adverse health among athletes consistently report about how
effects to almost all individuals in the general most athletes’ diets are deficient in one or more
population. At intakes above the UL, the risk of the essential vitamins and minerals. When
of adverse effects may increase. This is because a person is deficient in a nutrient, he or she
these are general guidelines are used for health sometimes must ingest amounts of the nutrient
planning at the national level. It is recognized in large amounts to overcome and correct
that individuals, or groups of individuals with the nutrient deficiency. This underscores the
special dietary needs, such as athletes, will have importance of working under the supervision
different nutrient intake needs and sensitivities. of a health professional—to determine the exact
The activity level of an individual, his or her size, needs of an individual and to monitor his or
and the nutrient status will all factor in when her health when self-prescribed nutrition and
determining the optimum range of intake for training programs are being used.
nutrients. It is also interesting to note that just
in 1997, the UL began to be published, and for
some of the essential nutrients, no ULs could be Healthy Adults
established because there was no research that
Note that any nutrition examples contained in
supported any adverse effects.
the units and other course materials could apply
Thus while the “authority” adopted system is to healthy adults, based on their individual
useful for general nutrition intake purposes, the requirements, as determined by their physicians
DRI guidelines and nutrient intakes may be too and or qualified health professionals. This
low, or inadequate for athletes, especially for information does not apply to everybody the

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 Sports Nutrition: The Vital Link to Supercharging Athletic Performance | 25

same way, or it does not apply to children or on an individual basis, a combination of

teenagers or to older adults. The information these approaches can be useful, in particular
contained in the units therefore is intended percentage of energy intake and on a per-
to provide an understanding of the various kilogram-of-body-weight basis, keeping in mind
nutrients and other dietary substances and to that there are pros and cons for each individual
provide a framework for reference purposes. approach. When applicable in subsequent units,
Creating personalized sports nutrition programs more details about these approaches will be
for athletes will depend on many factors, reviewed. For example, when dealing with grams
including legal aspects, such as any professional per kilograms of body weight per day, people
health practitioner licensing requirements; years with different amounts of lean body mass and
of experience, training, education, and other body fat will get different dosages based on a lean
required skills; and working as part of a heath body mass basis. Also, if one is using this g/kg
professional team, including physicians. body weight / day approach, total daily energy
expenditure may not be accurately accounted for,
such as 3,000-calorie days or 6,000-calorie days.
Nutrition Intake
Approaches
Conclusion
Ways of determining nutrition intake approaches
are also evolving. For example, for some This introductory chapter has presented a new
nutrients, an approach may be to establish one perspective on nutrition that many people never
fixed value per day, such as 60 milligrams per consider. From this point on in your study
day for adult males; or on a gram per kilogram program, the road to understanding sports
of body weight per day, such as 0.66 grams nutrition will be made simpler each step along
of protein per kilogram of body weight per the way as you progress from unit to unit, which
day; or on a percentage of total daily calories will ultimately lead you to a comprehensive
(energy intake), such as 65% of energy intake understanding of the Dynamic Nutrition
for carbohydrates. In reality, when dealing Approach to Sports Nutrition.

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Key Words
Aerobic Recommended Dietary Allowance (RDA)
Anaerobic Adequate Intake (AI)
Dietary Reference Intakes (DRIs) Tolerable Upper Intake Level (UL)
Estimated Average Requirement (EAR) Acceptable Macronutrient
Distribution Range (AMDR)

Sports Nutrition
 Topics Covered In This Unit

Introduction
Food
Ingredients
Ingredients and Dietary Labeling
Dietary Supplement Definitions
Macronutrients: Meeting Energy and
Growth Requirements
Macronutrient Manipulation/Modula-
tion
Water and Electrolytes
Micronutrients: Metabolic Cofactors
Nutrient Density
The Limiting Nutrient Concept
Ergogenic Aids
Nutraceutal
Research on Nutrients
Food Safety
GRAS
New Dietary Ingredients
Special Topics
Adultertation
Misbranding
Food and Allergy Intolerance
BSE (Bovine Spongiform Encephalopa-
thy)
Genetically Engineered (GE) Foods
Gluten
Foodborne Pathogens
Conclusion

UNIT 2

FOOD, INGREDIENTS, AND NUTRIENTS:

AN OVERVIEW
28 | Unit 2

Unit Outline
I. Introduction VIII. Research on Nutrients
II. Food a. Food Safety
III. Ingredients b. GRAS
a. Ingredients and Dietary Labeling IX. New Dietary Ingredients
IV. Dietary Supplement Definitions X. Special Topics
V. Macronutrients: Meeting Energy and a. Adultertation
Growth Requirements
b. Misbranding
a. Macronutrient Manipulation/Modulation
c. Food and Allergy Intolerance
b. Water and Electrolytes
d. BSE (Bovine Spongiform Encephalopathy)
VI. Micronutrients: Metabolic Cofactors e. Genetically Engineered (GE) Foods
a. Nutrient Density f. Gluten
b. Bioavailability g. Foodborne Pathogens
c. The Limiting Nutrient Concept
XI. Conclusion
VII. Ergogenic Aids
a. Nutraceutal

Learning Objectives
After completing this Unit, you will be able to:
• Define and describe terms related to ingredients and nutrients.

• Discuss food additives the FDA approves and regulates.

• Macronutrients and micronutrients.

• Compare US and Canadian definitions for dietary supplements and natural health products.

• Discuss various food and supplement topics, nutraceuticals, food safety, food-borne illness,
GRAS, adulteration, and misbranding.

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 Food, ingredients, and Nutrients: An Overview | 29

Introduction
Every day the human body requires many nutrients for energy, growth,
structure, function, performance, and health. Scientists, nutritionists,
and health professionals developed special terminology to categorize and
represent many nutrition concepts. There are several main categories
of nutrients that you need be concerned with to increase athletic
performance and fitness. Most of the essential nutrients are lumped Essential Nutrient: a
into two main categories: macronutrients and micronutrients. This nutrient that the body
cannot produce itself or
chapter will provide an overview of the basic food and ingredient basis that it cannot produce
jargon, which will include substances that occur in food, in addition to in sufficient amounts to
maintain good health.
the essential nutrients.
Macronutrient: a
Going beyond pure science, the regulatory agencies such as the macronutrient is any
nutrient that the body uses
Food and Drug Administration (FDA) and lawmakers have in relatively large amounts.
created terminology related to food and ingredients, noting that Macronutrients include
carbohydrates, fat, and
dietary supplements are a special category of food in the United
proteins. Macronutrients
States. Presentation of some of this regulatory/legal terminology are different from
is also included, as this is what appears on food labeling and is micronutrients, such as
vitamins and minerals,
encountered when dealing with FDA-regulated products. which the body needs in
smaller amounts.
This unit contains a new section under the heading “Special Topics.”
Micronutrients: nutrients
This section was added in response to student inquiries about these present in the diet and body
food-, ingredient-, and nutrient-related topics. The Special Topics section in small amounts
includes information about subjects such as Adulteration, Misbranded,
BSE (Bovine Spongiform Encephalopathy), Genetically Engineered
Foods, Food Allergies and Intolerances, Gluten, and Foodborne Illness.

Food
According to the legal definition from the Federal Food, Drug and
Cosmetic Act:

“The term ‘‘food’’ means (1) articles used for food or drink for man or
other animals, (2) chewing gum, and (3) articles used for components of
any such article.”

The term ‘‘processed foodwd includes any raw agricultural commodity

that has been subject to processing, such as canning, cooking, freezing,
dehydration, or milling.

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The FDA’s terminology related to defining food includes “means a raw,

cooked, or processed edible substance; ice, beverage, or ingredient
used or intended for use or for sale in whole or in part for human
consumption; or chewing gum.”

Aside from definitions, the important issue to consider related to sports

nutrition is that foods are the source of essential nutrients and water
and other health and performance-promoting substances. However,
as presented in the following information, food often contains “other
ingredients” not essential to health or athletic performance. As athletes
are training strenuously to attain peak sports performance while
maintaining good health, reducing dietary intake of the non-nutritive
substances added to foods for technical purposes and extra effort to
avoid foodborne pathogens becomes an important strategy. Consuming
higher amounts of healthy, fresh whole foods and fresh prepared foods,
organic when possible, is a good starting point for a “cleaner” or “purer”
sports nutrition program to reduce the body’s burden of processing the
“other ingredients” and avoiding any metabolic disruption or unwanted
health issues that may occur.

INGREDIENTS
From a scientific research perspective, ingredients related to foods
usually focuses on nutritive aspects and substances, like macronutrients,
micronutrients, the growing list of plant bioactive substances, water, and
Creatine (also, metabolite substances such as creatine and Beta-alanine. From an FDA
phosphocreatine): a regulation standpoint, food ingredients go beyond the required nutritive
compound produced in the
body, stored in the muscle substances to include technical ingredients like preservatives, flavors,
fibers, and broken down sweeteners, and colors for example. The following summary from the
by enzymes to quickly
replenish the adenosine-
FDA lists the types of common food ingredients, why they are used, and
triphosphate stores. Also a some examples of the names that can be found on product labels.
supplement ingredient.
Antioxidant: a nutrient
that has been found to Ingredients and Dietary Ingredients Labeling
seek out and neutralize free
radicals in the body and
Although the topic of food labeling is presented in detail in another
to stimulate the body to unit, it is appropriate to review some information related to the topic of
recover more quickly from ingredients. Regarding packaged foods, such as frozen vegetables, and
free-radical damage.
of processed foods, like pasta, a list of ingredients is located next to the
Nutrition Facts panel. For conventional foods bearing a Nutrition Facts

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 Food, ingredients, and Nutrients: An Overview | 31

Ingredients
TYPES OF WHAT THEY DO EXAMPLES OF USES NAMES FOUND ON
INGREDIENTS PRODUCT LABELS

Preservatives Prevent food spoilage from Fruit sauces and jellies, bev- Ascorbic acid, citric acid, sodi-
bacteria, molds, fungi, or erages, baked goods, cured um benzoate, calcium propi-
yeast (antimicrobials); slow meats, oils and margarines, onate, sodium erythorbate,
or prevent changes in color, cereals, dressings, snack sodium nitrite, calcium sorbate,
flavor, or texture and delay foods, fruits and vegetables potassium sorbate, BHA, BHT,
rancidity (antioxidants); EDTA, tocopherols (Vitamin E)
maintain freshness

Sweeteners Add sweetness with or with- Beverages, baked goods, Sucrose (sugar), glucose,
out the extra calories confections, table-top sugar, fructose, sorbitol, mannitol,
substitutes, many processed corn syrup, high fructose corn
foods syrup, saccharin, aspartame,
sucralose, acesulfame potassi-
um (acesulfame-K), neotame

Color Additives Offset color loss due to ex- Many processed foods, (can- FD&C Blue Nos. 1 and 2, FD&C
posure to light, air, tempera- dies, snack foods margarine, Green No. 3, FD&C Red Nos.
ture extremes, moisture and cheese, soft drinks, jams/ 3 and 40, FD&C Yellow Nos. 5
storage conditions; correct jellies, gelatins, pudding and and 6, Orange B, Citrus Red No.
natural variations in color; pie fillings) 2, annatto extract, beta-caro-
enhance colors that occur tene, grape skin extract, cochi-
naturally; provide color to neal extract or carmine, paprika
colorless and “fun” foods oleoresin, caramel color, fruit
and vegetable juices, saffron
(Note: Exempt color additives
are not required to be declared
by name on labels but may be
declared simply as colorings or
color added)

Flavors and Add specific flavors (natural Pudding and pie fillings, Natural flavoring, artificial
Spices and synthetic) gelatin dessert mixes, cake flavor, and spices
mixes, salad dressings, can-
dies, soft drinks, ice cream,
BBQ sauce

Flavor Enhancers Enhance flavors already pres- Many processed foods Monosodium glutamate (MSG),
ent in foods (without provid- hydrolyzed soy protein, auto-
ing their own separate flavor) lyzed yeast extract, disodium
guanylate or inosinate

Fat Replacers Provide expected texture and Baked goods, dressings, Olestra, cellulose gel, carra-
(and components of a creamy “mouth-feel” in frozen desserts, confections, geenan, polydextrose, modified
formulations used reduced-fat foods cake and dessert mixes, dairy food starch, microparticulated
to replace fats) products egg white protein, guar gum,
xanthan gum, whey protein
concentrate

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Ingredients continued
TYPES OF WHAT THEY DO EXAMPLES OF USES NAMES FOUND ON
INGREDIENTS PRODUCT LABELS
Nutrients Replace vitamins and minerals Flour, breads, cereals, rice, Thiamine hydrochloride,
lost in processing (enrich- macaroni, margarine, salt, riboflavin (Vitamin B2), niacin,
ment), add nutrients that milk, fruit beverages, energy niacinamide, folate or folic
may be lacking in the diet bars, instant breakfast drinks acid, beta carotene, potassium
(fortification) iodide, iron or ferrous sulfate,
alpha tocopherols, ascorbic
acid, Vitamin D, amino acids
(L-tryptophan, L-lysine, L-leu-
cine, L-methionine)

Emulsifiers Emulsifiers allow smooth Salad dressings, peanut Soy lecithin, mono- and
mixing of ingredients, prevent butter, chocolate, margarine, diglycerides, egg yolks,
separation frozen desserts polysorbates, sorbitan
monostearate
Keep emulsified products sta-
ble, reduce stickiness, control
crystallization, keep ingre-
dients dispersed, and help
products dissolve more easily
Stabilizers and Produce uniform texture, Frozen desserts, dairy Gelatin, pectin, guar gum, car-
Thickeners, Bind- improve “mouth-feel” products, cakes, pudding rageenan, xanthan gum, whey
ers, Texturizers and gelatin mixes, dressings,
jams and jellies, sauces

pH Control Control acidity and alkalinity, Beverages, frozen desserts, Lactic acid, citric acid, am-
Agents and prevent spoilage chocolate, low acid canned monium hydroxide, Sodium
acidulants foods, baking powder carbonate

Leavening Promote rising of baked Breads and other baked Baking soda, monocalcium
Agents goods goods phosphate, calcium carbonate

Anti-caking Keep powdered foods Salt, baking powder, confec- Calcium silicate, iron ammoni-
agents free-flowing, prevent moisture tioner’s sugar um citrate, silicon dioxide
absorption

Humectants Retain moisture Shredded coconut, marsh- Glycerin, sorbitol

mallows, soft candies,
confections

Yeast Nutrients Promote growth of yeast Breads and other baked Calcium sulfate, ammonium
goods phosphate

Dough Strength- Produce more stable dough Breads and other baked Ammonium sulfate, azodicar-
eners and goods bonamide, L-cysteine
Conditioners
Firming Agents Maintain crispness and Processed fruits and Calcium chloride, calcium
firmness vegetables lactate

Enzyme Modify proteins, polysaccha- Cheese, dairy products, Enzymes, lactase, papain, ren-
Preparations rides and fats meat net, chymosin

Gases Serve as propellant, aerate, or Oil cooking spray, whipped Carbon dioxide, nitrous oxide
create carbonation cream, carbonated
beverages

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 Food, ingredients, and Nutrients: An Overview | 33

panel, all of the ingredients, food, Enrichment: the addition

nutrients, or technical ingredients of specific nutrients (i.e.,
iron, thiamin, riboflavin,
must be included in ingredient and niacin) to refined
list, usually in descending order of grain products to replace
weight. Then the Nutrition Facts losses of the nutrients that
occur during processing.
panel contains information about Enrichment of refined
the nutrition / nutrients provided by grains is not mandatory;
however, those that are
these ingredients. labeled as enriched (e.g.,
enriched flour) must meet
When it comes to the special the standard of identity
category of foods referred to as for enrichment set by the
FDA. When cereal grains
dietary supplements, the underlying are labeled enriched, it is
principles are similar to Nutrition mandatory that they be
Facts panel bearing foods, with some fortified with folic acid. (The
addition of specific nutrients
minor difference and overlap in the to whole-grain products is
food labeling regulations. The actual referred to as fortification;
see Fortification.)
nutritionally active ingredients used
to make dietary supplements are Fortification: as defined
by the US Food and Drug
referred to as dietary ingredients. A Administration (FDA), the
short definition of a dietary ingredient is as follows: a vitamin; a mineral; deliberate addition of one
or more essential nutrients
an herb or other botanical; an amino acid; a dietary substance for use to a food, whether or not it
by human to supplement the diet by increasing total dietary intake; or is normally contained in the
food. Fortification may be
a concentrate, metabolite, constituent, extract, or combination of any of
used to prevent or correct
the above dietary ingredients. a demonstrated deficiency
in the population or specific
The listing of ingredients for dietary supplements can use two population groups; restore
naturally occurring nutrients
approaches. The first ingredient list approach is to list all the ingredients
lost during processing,
together the same as for Nutrition Facts bearing foods. The second storage, or handling; or
ingredient list approach is to list the sources of the dietary ingredients to add a nutrient to a
food at the level found in
in the Supplement Facts panel and just list the other non-dietary a comparable traditional
ingredient ingredients under the heading “Other Ingredients” next to the food. When cereal grains
are labeled as enriched, it
Supplement Facts Panel. Therefore, for example, a dietary supplement
is mandatory that they be
product containing vitamin C, the Supplement Facts Panel can list fortified with folic acid.
Vitamin C, or Vitamin C (as ascorbic acid). If Vitamin C is only listed in Emulsifier: a substance
the Supplement Facts Panel, and then all the ingredients must be listed that, during digestion,
helps disperse fats in water
under the ingredient heading. If vitamin C (as ascorbic acid) is used, mediums.
then all the other ingredients contained in the product would be listed
under the heading “Other Ingredients,” excluding ascorbic acid that was
already declared in the Supplement Facts Panel. Many more rules and
requirements related to food labeling will be covered in a subsequent unit.

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34 | Unit 2

Dietary Supplement Definition

(and Dietary Ingredient, Too)
For reference purposes, here is the official definition of dietary
supplements in the United States, which includes defining a dietary
ingredient, as dietary supplements must contain dietary ingredients,
along with other considerations regarding their use:

The term ‘‘dietary supplement’’—

(1) means a product (other than tobacco) intended to supplement the diet
that bears or contains one or more of the following dietary ingredients:

(A) a vitamin;

(B) a mineral;

(C) an herb or other botanical;

(D) an amino acid;

(E) a dietary substance for use by man to supplement the diet by

increasing the total dietary intake; or

(F) a concentrate, metabolite, constituent, extract, or combination of

any ingredient described in clause (A), (B), (C), (D), or (E);

(2) means a product that—

(A)(i) is intended for ingestion in a form described in section 411(c)(1)

(B)(i); or (ii) complies with section 411(c)(1)(B)(ii);

(B) is not represented for use as a conventional food or as a sole item

of a meal or the diet; and

(C) is labeled as a dietary supplement; and

(3) does—

(A) include an article that is approved as a new drug under section

505 or licensed as a biologic under section 351 of the Public Health
Service Act (42 U.S.C. 262) and was, prior to such approval,
certification, or license, marketed as a dietary supplement or as a
food unless the Secretary has issued a regulation, after notice and
comment, finding that the article, when used as or in a dietary

Sports Nutrition
 Food, ingredients, and Nutrients: An Overview | 35

supplement under the conditions of use and dosages set forth in

the labeling for such dietary supplement, is unlawful under section
402(f); and

(B) does not include—

(i) an article that is approved as a new drug under section 505,

certified as an antibiotic under section 507 1, or licensed as a
biologic under section 351 of the Public Health Service Act (42
U.S.C. 262), or

(ii) an article authorized for investigation as a new drug,

antibiotic, or biological for which substantial clinical
investigations have been instituted and for which the existence of
such investigations has been made public, which was not before
such approval, certification, licensing, or authorization marketed
as a dietary supplement or as a food unless the Secretary, in the
Secretary’s discretion, has issued a regulation, after notice and
comment, finding that the article would be lawful under this Act.

Except for purposes of sections 201(g) and 417, a dietary supplement

shall be deemed to be a food within the meaning of this Act.

For comparison to the definition of dietary supplements in the United

States, here is the definition related to Natural Health Products
in Canada, which includes dietary supplement-type products and
ingredients and also includes natural drug products, primarily
nonprescription (over the counter). The Natural Health Product
category includes both topical and ingestible health products. The active
ingredients are referred to as medicinal ingredients. The following list is
referred to as Schedule 1: List of Included Substances:

1. A plant or a plant material, an alga, a bacterium, a fungus or a non-

human animal material.

A plant is a member of the biological Kingdom Plantae and is

either the whole plant or parts thereof. A plant consists of complex
multicellular eukaryotes that have a cell wall composed primarily of
cellulose. A plant usually produces its own food by photosynthesis
using chlorophylls a and b. Example of plants are Allium sativum and
Cassia angustifolia. Examples of plant parts are bark, wood, leaves,
stems, roots, flowers, fruits, seeds and berries, or parts thereof.

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36 | Unit 2

A plant material is material obtained from a plant, including

pollens, nucleic materials, mitochondria, chlorophyll and exudates
such as resin.

An alga is a member of one of the protist biological Kingdoms.

It consists of unicellular, colonial. or relatively simple multicellular
eukaryotes and has a cell wall containing cellulose or silica.
Algae usually produce their own food by photosynthesis and are
mostly aquatic. Examples of algae are Chlorella pyrenoidosa and
Laminaria digitata.

A bacterium is a member of one of the biological Kingdoms of the

Domains Bacteria or Archaea. It consists of usually unicellular
(sometimes aggregated, colonial or simple multicellular) prokaryotes
whose cells lack nuclei or other internal compartmentalization but
that have a cell wall external to the plasma membrane in most species.
An example is Spirulina (cyanobacteria).

A fungus is a member of the biological Kingdom Fungi. A fungus

consists mainly of complex multicellular eukaryotes that have a cell
wall composed primarily of chitin. Fungi are heterotrophs that absorb
nutrients from their surroundings by decomposing organic materials.
Examples are Lentinus edodes (Shiitake mushroom) and Grifolia
frondosa (Maitake mushroom).

An animal is a member of the biological Kingdom Animalia. An

animal consists of complex multicellular eukaryotes whose cells
have a membrane but no wall. Most members have muscles and
nervous tissues. They are heterotrophs that mostly ingest food into a
specialized cavity, where it is digested. Examples are Squalus acanthias
(shark) and Gadus morhua (cod).

A non-human animal material is a body part or secretion obtained

from an animal other than a human and is used in the preparation
of a natural health product. Examples are elk antler velvet, bovine
colostrums, shark cartilage, and attenuation prepared from canine
milk (Lac caninum).

To be acceptable as homeopathic medicines under the Natural Health

Products Regulations, a non-human animal material must be listed in
one of the following: the Homeopathic Pharmacopoeia of the United
States, the Homöopathische Arzneimittel, the Pharmacopée française,
or the European Pharmacopeia.

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 Food, ingredients, and Nutrients: An Overview | 37

2. An extract or isolate of a substance described in item 1, the primary

molecular structure of which is identical to that which it had prior to
its extraction or isolation.

An extract is a substance prepared by treating a plant or a plant

material, an alga, a bacterium, a fungus or a non-human animal
material with solvents to obtain the desired compounds. Examples are
Echinacea angustifolia solid extract, Panax ginseng tincture and St.
John’s Wort fluid extract.

An isolate is a purified constituent of a defined molecular structure

obtained from a plant or a plant material, an alga, a bacterium, a
fungus or a non-human animal material.

Examples are glutathione and capsaicin.

3. Any of the following vitamins:

1. Biotin 7. Vitamin A

2. Folate 8. Vitamin B6

3. Niacin 9. Vitamin B12

4. Pantothenic acid 10. Vitamin C

5. Riboflavin 11. Vitamin D

6. Thiamin 12. Vitamin E

Vitamins are naturally occurring organic substances required by the

body to maintain health. Dietary Reference Intakes (DRIs) are the
standards for referencing upper levels of vitamins. More information
on DRIs can be found at http://www.hc-sc.gc.ca/hpfbdgpsa/onpp-
bppn/diet_ref_e.html. In some cases, Health Canada’s Therapeutic
Products Directorate has established lower levels for vitamins; in other
words, the amount of vitamin in a natural health product cannot be
lower than this level.

Recognizing that the natural health product definition excludes

substances that require a prescription, and that vitamin K is currently
listed on Schedule F to the Food and Drug Regulations without
specifying parameters, NHPD has removed vitamin K from Schedule
1 until the parameters for vitamin K have been determined.

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38 | Unit 2

4. An amino acid.

An amino acid is a class of organic molecule that contains amino

and carboxyl groups. Amino acids form the main constituents of
proteins that are found in a plant or a plant material, an alga, a fungus,
a bacterium or a non-human animal material. The following are
acceptable amino acids:. NHPD acknowledges that there are other
amino acids not captured under this definition. These amino acids
will be captured under the isolate category:
1. L-alanine 11. L-leucine

2. L-arginine 12. L-lysine

3. L-asparagine 13. L-methionine

4. L-aspartic acid 14. L-phenylalanine

5. L-cysteine 15. L-proline

6. L-glutamine 16. L-serine

7. L-glutamic acid 17. L-threonine

8. L-glycine 18. L-tryptophan

9. L-histidine 19. L-tyrosine

10. L-isoleucine 20. L-valine

5. An Essential Fatty Acid

An essential fatty acid cannot be synthesized in the body; hence, it

must be supplied through the diet or a supplement. Linoleic acid and
alpha linolenic acid are essential fatty acids. All other fatty acids (such
as oleic acid, conjugated linoleic acid, gamma-linoleic acid, arachidonic
acid, eicosapentaenoic acid and docosahexaenoic acid) are considered
extracts or isolates (see item 2, above). For more information, see the
Evidence for Quality of Finished Natural Health Products Guidance
Document.

Sports Nutrition
 Food, ingredients, and Nutrients: An Overview | 39

6. A synthetic duplicate of a substance described in any of items 2 to 5

A synthetic duplicate is a substance that shares an identical chemical

structure and pharmacological properties with its natural counterpart.
Examples are vitamin E - DL alpha-tocopherol.

A semi-synthetic substance may also be acceptable as a natural

health product provided it shares an identical chemical structure and
pharmacological properties with its natural counterpart. A semi-
synthetic substance is produced by a process that chemically changes
a related starting material that has been extracted or isolated from a
plant or a plant material, an alga, a fungus or a non-human animal
material. An example is ginsenosides (the starting compound used is
betulafolienetriol).

7. A Mineral

A mineral is a naturally occurring solid, inorganic substance with a

definite and predictable chemical composition and physical properties.

8. A probiotic

The Natural Health Products Regulations define a probiotic as a

monoculture or mixed culture of live micro-organisms that benefit
the microbiota indigenous to humans. A probiotic is limited to non-
pathogenic microorganisms. An example is Lactobacillus acidophilus.

[Source: Natural Health Products Directorate, Overview of the Natural Health Products
Regulations Guidance Documents, 2003.]

It is interesting to make a direct comparison to the US and Canadian

“definitions” related to dietary supplement type products. Note that
in practice, both approaches have strong points and weaknesses,
with room to evolve via interpretation and or updating the laws and
regulations. In either case, this brings the highest level of credibility to
the various ingredients used in dietary supplements, including sports
supplements. Since the Natural Health Product was established in 2004,
over 50,000 products have been licensed, using hundreds of ingredients
and associated claims, including the same ingredients used in sports
nutrition supplements in the United States.

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40 | Unit 2

Protein: one of the

nutrients that provides
Macronutrients: Meeting Energy and
calories to the body. Protein
is an essential nutrient that
Growth Requirements
helps build many parts of
the body, including blood,
Macronutrients are nutrients that are required daily in large amounts
bone, muscle, and skin. and are thought of in quantities of ounces and grams. They include
Protein provides 4 calories carbohydrates, protein, lipids, and water. Macronutrients are important
per gram and is found
in foods like beans, dairy for providing the body with a supply of energy and serving as the
products, eggs, fish, meat, building blocks the body needs for growth and repair. Macronutrients
nuts, poultry, and tofu.
Proteins are composed
occur in all foods but vary in amount and proportion. For example,
of amino acids, nine of meats can be high in protein and fat, with almost no carbohydrate
which are indispensable content. Pasta however is very high in carbohydrates, with moderate
(essential), meaning they
cannot be synthesized amounts of protein and a low fat content.
by humans and therefore
must be obtained from the Carbohydrates and lipids are the macronutrients primarily used
diet. The quality of dietary to provide the body with energy. Proper energy substrate intake is
protein is determined by its
amino acid profile relative important to balance energy expenditure and maintain desired body
to human requirements as composition and performance. Your energy requirements will vary with
determined by the body’s
requirements for growth,
age, activity, and foods eaten. Adult daily energy requirements may
maintenance, and repair. range from a low of 1,800 (or even lower) to more than 6,000 calories
Protein quality is determined per day. Although alcohol is not an essential nutrient, for those who
by two factors: digestibility
and amino acid composition. choose to consume alcoholic beverages, you may be interested to know
Fat: a major source of that daily alcohol consumption can contribute large amounts of “empty”
energy in the diet, fat helps calories to your diet.
the body absorb fat-soluble
vitamins, such as vitamins The approximate caloric content of the macronutrients and alcohol are
A, D, E, and K. Some kinds
of fats, especially saturated as follows:
fats and trans fatty acids,
may raise blood cholesterol Caloric Content of Macronutrients and Alcohol
and increase the risk
for heart disease. Other Calories per Gram Calories per Ounce
fats, such as unsaturated Carbohydrate 4 113.6
fats, do not raise blood
cholesterol. Fats that are Protein 4 113.6
in foods are combinations Fat 9 255.6
of monounsaturated, Alcohol 7 198.8
polyunsaturated, and
saturated fatty acids. Water 0 0.0

Energy Expenditure: The

amount of energy that you As you can see, on a weight basis, fat has the most calories followed by
use measured in calories.
You use calories to breathe, alcohol, carbohydrates, and protein. In the past, it was assumed that all
send blood through your calories supplied by nutrients were metabolized the same way and that
blood vessels, digest food,
maintain posture, and be their total caloric content was equally used for energy. However, in recent
physically active. years, scientists have determined that the energy content of different

Sports Nutrition
 Food, ingredients, and Nutrients: An Overview | 41

macronutrients may vary slightly in the body depending upon the

relative proportions of the other macronutrients present in the diet, the
type of macronutrient, the presence of vitamin and mineral cofactors,
the level of hydration, and the physical conditioning of the individual.
For example, protein is considered a protected nutrient because the
body reserves its use for the synthesis of tissues and molecules instead
of energy use. Therefore, the body has a tendency to use carbohydrates, Thermogenic Response:
the rise in the metabolic
including glycogen stores and lipids (fats), for energy instead of using rate. Also known as the
ingested protein and the protein that makes up muscle tissue. In fact, thermogenic effect or
a thermogenic response has been detected in response to eating diets specific dynamic action
(sda).
high in protein, indicating that more energy is used in the digestion and
Thermogenesis: the
metabolism of proteins; see box on thermogenesis for details. Although, process by which the body
with increased athletic conditioning and training volume and energy generates heat, or energy,
expenditure, some protein and amino acids get used for energy, and by increasing the metabolic
rate above normal.
minimizing this occurrence and compensating for it in a sports nutrition
Metabolic Rate: the
plan is a vital strategy—in addition to the preferred high-energy body’s total daily caloric
substrate intake. expenditure.

Thermogenesis
Thermogenesis is a term generally used to describe metabolic heat production by the body. Some
different terms maybe used to describe different aspects of thermogenesis. For example, related to
nutrition, there is a thermic effect of food (TEF), also referred to as diet-induced thermogenesis (DIT).
This is due to the energy it takes to digest, process, and use or store food by the body. This is some-
times also referred to as the thermogenic effect of food. This is usually in relationship to an increase
of the rate of energy expenditure above the basal metabolic rate. The food related raise in metabolic
rate is also referred to as specific dynamic action (SDA).
After a meal, the metabolic rate and energy expenditure increases. It is estimated this increase may be
about 10 percent per day from food consumed. The type of macronutrients seems to have different ef-
fects on the thermogenic response. When food is ingested the metabolic rate (energy used) increases
above the fasting level. In the case of proteins, it is thought that this occurs because the body must use
energy to process the proteins, which are then used as building blocks for tissue growth and repair.
On the other hand, carbohydrates and fats function primarily as fuel, and the metabolism can more ef-
ficiently use them for energy without much energy input to process them, when compared to protein.
They therefore have a lower thermogenic effect compared to protein. Some example DIT values re-
ported in the research for separate nutrients include: 0 to 3% for fat, 5% to 10% for carbohydrate, and
20% to 30% for protein. [Westerterp K. Diet induced thermogenesis. Nutr Metab (Lond) 2004;1(1):5.]
A thermogenic effect is also experienced from physical activity and shivering in response to exposure
to cold. Aside from conventional food consumption, some ingredients may have a thermogenic effect;
caffeine for example may increase the metabolic rate in some people. Again, this is in relationship to
the basal metabolic rate.

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42 | Unit 2

Several types of carbohydrates will affect your energy and performance

depending on when you eat them and what kind of carbohydrate you eat.
There are complex carbohydrates (starches) and simple carbohydrates,
Glucose: a simple like glucose and fructose. Starch (which is composed of chains of
carbohydrate that is a glucose) may provide the body with a slow and steady supply of glucose,
monosaccharide. Also called
dextrose or grape sugar. depending on the type of food. Generally, simple carbohydrates, like
Starch: a complex glucose, get into the bloodstream fast and serve as a quick supply of
carbohydrate that occurs energy. Fructose gets into the bloodstream at a slower rate than glucose
only in plants.
does and has a typically slower metabolic series of pathways. However,
ingesting too much fructose must be avoided, as should restricting the
consumption of other simple carbohydrates to certain nutrient timing
opportunities, as reviewed in the corresponding unit.

Lipids are a technical term that refers to fats and other plant and animal
nutrients that are insoluble in water. The fatty acids that make up fats
and oils contain the highest energy of any macronutrient on a per weight
basis. Other lipids, like cholesterol, are not important energy sources,
but are major components of steroid hormones and bile acids. Your
body is always using a mixture of carbohydrate and fat for energy, plus a
little protein. This energy mixture will vary depending upon a person’s
program of training and level of fitness, the intensity and duration of
physical activity and the composition of the diet. Endurance sports
tend to cause the body to burn a higher proportion of fat, and condition
the body to be better at using fats for energy. Compare this with power
sports, like sprinting, which burn a greater amount of carbohydrates
for energy during these types of physical activity. Thus, physical
activity will dictate the proportion of macronutrients needed in your
diet. For example, a marathon runner will generally need a diet high
in carbohydrates and moderate in fat and protein. On the other hand,
the power lifter needs a diet high in carbohydrates and protein with
low amounts of fat. This is one of the several aspects of the Dynamic
Nutrition Approach model.

Protein utilization during and after exercise is more complicated than is

the use of carbohydrates and fats for energy. Protein provides the body
with essential building blocks in the form of its subunits, called amino
acids. The body therefore has a tendency to avoid using protein/amino
acids for energy. However, during exercise, the body will use certain
amino acids for energy and other metabolic functions. This cannot be
prevented, but it can be compensated for by ingesting proteins with

Sports Nutrition
 Food, ingredients, and Nutrients: An Overview | 43

higher amounts of the certain amino acids used during exercise—the

branched chain amino acids, for example. Research has also shown
that even during rest, the athletes’ highly trained muscles will still use
certain amino acids for energy, even in the presence of carbohydrates
and fat. Special nutrition supplements can be used to boost the efficiency
and utilization of dietary proteins, along with certain vitamin and
mineral cofactors to prevent muscle breakdown and encourage muscle
repair, such as amino acid tablets and protein supplement drinks and
nutrition bars.

Macronutrient Manipulation/Modulation
A constant intake of protein and the other macronutrients is needed
all day long for optimum nutrition. However, the proportions of these
macronutrients may vary around your training, meal and resting
periods. This variation in macronutrient intake has been termed by
sports nutritionists as “macronutrient modulation” or “macronutrient Macronutrient
manipulation.” This simply refers to the practice of varying the intake Modulation: the practice
of varying the ratio of
of macronutrients to meet your specific nutrition needs. For example, the macronutrients in
right before and during the time that a person exercises, intake of the diet to meet specific
water, electrolytes, some amino acids, and simple carbohydrates will metabolic needs to
enhance performance.
be desirable to maintain energy and spare glycogen stores and muscle Also called macronutrient
tissue. Fat and large amounts of proteins are not desirable right before or manipulation.
during training or athletic events because they take longer to digest and
will impair performance. During exercise bouts or athletic competition,
intake of water and or hypotonic (carbohydrate - electrolyte) beverages
is typically needed to prevent glycogen depletion. Of course, glycogen Glycogen Depletion:
depletion causes fatigue and reduced exercise output, so athletic the draining of the body’s
glycogen stores.
individuals want to avoid depletion of their glycogen (carbohydrate body
stores). Finally, studies have shown that ingestion of carbohydrates, or
a mixed meal about 60 minutes after exercise will result in significant
glycogen repletion. Mastering meal timing and macronutrient
modulation can help fine-tune the most sophisticated performance and
fitness nutrition improvement programs.

Water and Electrolytes

Water is the most essential macronutrient to life but provides no calories
or nutrition. Water is the universal solvent that all life on earth depends
on and is the medium for transporting the food materials to be used

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44 | Unit 2

in the body. A person can survive several weeks without food but only
several days without water. The importance of water has always been
recognized, but recently, more and more research has shown that
maintaining optimum levels of hydration is important in maintaining
peak performance and recovery. In sports like soccer and basketball, the
athletes can lose several pounds of water weight in just one game. This
can adversely affect performance and, in the long run, cause peaks and
valleys in the athlete’s performance curve.

In addition to maintaining hydration, the body also needs to maintain

Electrolyte Balance: the its electrolyte balance. The major electrolytes found in body fluids
ratio of chloride, potassium, include sodium, chloride, and potassium along with calcium, phosphate,
sodium, and the other
electrolytes in the body. and magnesium. Water constitutes a small or large part of every cell,
depending on the function of the cell. Likewise, specific quantities of
electrolytes are found in both cellular and extra cellular water. Water
and electrolyte concentrations in the body are closely controlled,
even under extreme temperature conditions. Like water, electrolytes
can be lost through sweat and excretion. Replenishing water and
electrolyte losses during exercise and throughout the day has become
an increasingly complex task for athletic individuals as new discoveries
about the dynamics of these critical nutrients are made, such as different
rates of loss.

Micronutrients: Metabolic Cofactors

Even more diverse than the macronutrients is the group of nutrients
called micronutrients. As the name implies, micronutrients are nutrients
present in the diet and body in small amounts. They are measured in
milligrams and micrograms. They do not provide significant amounts
of calories to the body but act as cofactors in making biomolecules,
have structural roles, function as electrolytes, and function as enzymes.
Broadly speaking, the essential vitamins and minerals, the non-essential
vitamins and minerals, vitamin-like substances, and other dietary
biomolecules which are important in performance, fitness, and health
fall into the micronutrient category.

Vitamins are organic compounds that are required by the body for
maintenance of good health and growth. Vitamins are further classified
as fat-soluble and water-soluble. By convention, the word vitamin has
been reserved for certain nutrients that the body cannot manufacture

Sports Nutrition
 Food, ingredients, and Nutrients: An Overview | 45

and must get through eating food. The fat such as calcium are required in large amounts
soluble vitamins include vitamins A, D, E, and every day, about 1,200 milligrams (mg) or more,
K. Because they are soluble in fat (lipids), they whereas other minerals, such as chromium,
tend to store themselves in the body’s fat tissue, are needed in microgram (mcg) amounts. A
fat deposits, and liver. This storage capability microgram is 1,000th of a milligram. Even
makes it possible to take so much of the fat though there is a relatively wide range of intake
soluble vitamin that the effect on the body is observed, the relative importance of each mineral
toxic. Concern over the intake of fat-soluble is equal. Some minerals are found in the body in
vitamins should be exercised. Guidelines will their inorganic form, such as calcium salts in the
be provided in subsequent Units regarding safe bone and sodium chloride in the blood. Other
limits of intake. minerals are present in the body in organic
combinations, such as iron in hemoglobin and
The water soluble vitamins include the B iodine in thyroxin. Absorption of minerals into
vitamins and vitamin C. In contrast to the fat- the body will vary greatly depending upon the
soluble vitamins, the water-soluble vitamins type of mineral. Researchers are discovering
are not easily stored by the body. More often, that just because a food contains a mineral, or
they are lost from foods during cooking or vitamin, does not mean that all of it will get
eliminated from the body. The B vitamins into the body. This is another reason sports
function mainly as coenzymes. Vitamin C has supplements are recommended. They ensure that
several important metabolic roles. Vitamins the exact amount of nutrients will be supplied to
are not usually metabolized for energy, but the body. Additionally, you can get high-quality
some of them are essential for the production nutrients without the fat, salt, pesticides, and
of energy from the macronutrients and act as other junk that is found in many foods.
cofactors. As with the macronutrients, vitamin
research has only begun to illuminate how In addition to the essential vitamins and
these nutrients benefit performance and health minerals, there exists a host of other
beyond nutritional deficiency prevention. micronutrients that the body can make on
However, current findings give us a good picture its own but can also benefit from by eating.
of how vitamins are important for health and These are sometimes referred to as “accessory
performance. In fact, you may be aware of some nutrients” or “nonessential nutrients.” When it
multivitamin supplements designed for athletic comes to the athlete, many of these nutrients
people, typically containing higher amounts of will actually improve performance. Sodium
the B vitamins. bicarbonate can improve performance in
explosive power sports. L-Carnitine is essential
The mineral nutrients are inorganic nutrients for the oxidation of long-chain fatty acids into
or inorganic-organic complexes that are found energy. While carnitine can be made from the
in the body; and, although they only comprise amino acids lysine and methionine, research
about 4 percent of the body’s weight, they are has shown that supplemental amounts can
essential structural components and necessary benefit fat metabolism and increase endurance.
for many vital metabolic processes. Minerals Another nutrient, creatine, is widely taken by

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athletes in supplement form and touted for its The nutrient content of food will also vary
energy-enhancing effects and usefulness in depending upon when and where it is grown.
strength sports.
In these modern times, a vast portion of food
In addition to the vitamins, minerals, and is processed. Most of these processed foods are
accessory nutrients, there is a growing awareness very low in micronutrients. For example, white
of other substances found in plants and animals pasta, which is a good source of carbohydrates,
that can improve health and performance. A has been stripped of most of its micronutrient
group of naturally occurring plant compounds, content and its fiber from the external bran layer
the bioflavonoids, beneficially maintain the in processing its flour. In fact, most pasta is now
artery walls of the circulatory system and have vitamin fortified to compensate for this low
other beneficial health effects. Furthermore, nutrient content. Canned vegetables can also lose
vitamins, minerals, and supplements like much of their vitamin content in the preparation
glucosamine and herbal curcumin can be process, including enzymes lost from the
important for optimizing healing and recovery cooking process.
of exercise-induced wear and tear. Then there are
Eating whole foods and supplements is
the probiotics, which are live microorganisms
necessary for high-quality nutrition. This is
with beneficial health effects, such as promoting
the real solution. If you are eating a great many
gastrointestinal wellness and some immune
carbohydrates from sugar, for example, the
system function.
essential vitamin cofactors will not be present in
proper amounts to obtain the most efficient and
Nutrient Density highest level of energy out of this food. Too much
Foods contain macronutrients and sugar intake also can cause imbalances in your
micronutrients in a variety of combinations insulin levels. These factors have a direct effect
and amounts. A potato is high in complex on how you body uses nutrients for energy or
carbohydrates, contains some protein and for conversion to fat. Therefore, maintaining an
B vitamins, and is a good source of vitamin intake of foods that are high in quality nutrients
C, some minerals, (especially potassium and is important for reaching top performance. For
phosphorus), and a trace amount of fat. Meat, the athlete, attaining a nutrient dense diet will
like steak for example, is high in protein and include combining fresh healthy whole foods
fat but has no carbohydrates. Steak also acts as with the right supplements for your sport or
a good source of vitamin A, some B vitamins, fitness activity. For example, a long-distance
phosphorus, potassium, iron, and magnesium. runner can improve performance by taking
Creatine is also found in steak but can get co-enzyme Q-10 and carnitine supplements,
converted during the cooking process to the whereas a power lifter will benefit from ingesting
inactive creatinine. Just a brief look at these two extra protein and taking a creatine monohydrate
foods demonstrates that although they contain supplement, and a range of athletes and
some of the essential nutrients, they lack others. exercisers may benefit from Beta-alanine.

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 Food, ingredients, and Nutrients: An Overview | 47

Bioavailability Nutrient Dense: a

characteristic of foods and
It was once assumed that the presence of a nutrient in a particular food beverages that provide
vitamins, minerals, and
meant that the body would make full use of it. We now know that this other substances that
assumption does not hold true for many nutrients. Bioavailability contribute to adequate
nutrient intakes or may
refers to the ability of an ingested nutrient to enter from the digestive
have positive health effects,
tract, into the bloodstream, and on to the cells where it is utilized. A with little or no solid fats
nutrient’s bioavailability is affected in many ways. Certain nutrients and added sugars, refined
starches, and sodium.
compete with each other for intestinal absorption. Food preparation Ideally, these foods and
can affect bioavailability. Problems with your digestive system will beverages also are in
forms that retain naturally
interfere with nutrient absorption, and some nutrients are absorbed
occurring components,
better in the presence of other nutrients–the intestinal absorption of such as dietary fiber. All
phosphorus by vitamin D for example. When constructing a nutrition vegetables, fruits, whole
grains, seafood, eggs,
program, you need to pick foods and supplements that contain highly beans and peas, unsalted
bioavailable nutrients to achieve maximum nutrition performance. Even nuts and seeds, fat-free
and low-fat dairy products,
the nutrients used in supplement formulation can vary. Thus choosing and lean meats and
supplements with highly bioavailable nutrients is important. poultry—when prepared
with little or no added
solid fats, sugars, refined
starches, and sodium—are
nutrient-dense foods.
Nutritional Revelations These foods contribute
to meeting food group
The following list includes typical main nutritional problems in that
recommendations within
can occur in people’s diets. The basis of any healthy sports nutrition calorie and sodium limits.
program should be structured to prevent and correct these nutrition- The term “nutrient dense”
al inadequacies and imbalances. indicates the nutrients and
other beneficial substances
Most American diets are: in a food have not been
“diluted” by the addition
Too high in total fat Too low in calcium of calories from added
Too high in saturated fats solid fats, sugars, or refined
Too low in magnesium
starches or by the solid fats
Too high in cholesterol Too low in antioxidants naturally present in the
food.
Too high in sodium Too low in alpha linolenic
Bioavailability: the ability
acid of an ingested nutrient to
Too high in sugar
Too low in EPA and DHA cross from the digestive
Too high in processed foods tract into the bloodstream
Too low in other essential and then from the
Too high in empty calorie foods
vitamins and minerals bloodstream into the cells in
Too high in snack foods which it will be utilized.
Too low in protein
Too high in junk foods
Too low in fiber
Too high in refined flours
Too low in fluid (water)
Too high in total calories
Too low in potassium
48 | Unit 2

The Limiting Nutrient Concept

While more than 90 percent of the nutrients in food are usually
absorbed into the body, the absence of even one nutrient can limit the
utilization of other nutrients. For example, the mineral chromium
is an essential cofactor for the proper functioning of the hormone
insulin. When you eat a meal, insulin is secreted into the bloodstream
and is required for the passage of glucose and amino acids from the
bloodstream to the cells. Chromium is needed for insulin to function
properly. Even if your body is making enough insulin, a shortage of
Assimilation: conversion chromium can prevent the complete assimilation of dietary glucose
of food into living tissue. and amino acids. Researchers have determined that chromium is not
present in optimal amounts in most diets, especially among athletes.
When chromium is not present in optimal amounts, dietary glucose and
amino acids in the bloodstream that cannot enter the cells will circulate
back to the liver and may end up being converted to fat. Additionally,
muscle cells will be deprived of amino acids for proper growth and
recovery and of glucose for replenishment of glycogen stores. In this
example, chromium is a limiting nutrient because its lack limits the
cellular uptake of other nutrients.

Some of the same amino acids that build proteins can also become
limiting nutrients for the athlete. As mentioned earlier, during exercise,
some amino acids are used for energy. The amino acid leucine is one of
these. Leucine is an essential amino acid. It is used to make other amino
acids and is important in metabolic pathways and especially for muscle
growth and maintenance. For the athlete, leucine can become a limiting
nutrient and affect the utilization of the other amino acids when it is
selectively used for energy and the other amino acids are not. Amino
acids are used to build proteins, which are chains of amino acids. The
result of an amino acid running out, is the inhibition and reduction of
the rate of protein synthesis and a slowing down of the body’s growth
and repair. One way to compensate for the disproportionate use of
leucine for energy is to eat supplemental amounts of leucine and other
amino acids that are used for energy and can become potential limiting
nutrients. It is equally important to ingest the right amount of the
“nonessential” amino acids and other “nonessential” nutrients so the
body does not need to waste time and energy making these nutrients.

You can begin to see how sports nutrition is different from just eating
for survival or optimum health. First, determine which nutrients (both

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 Food, ingredients, and Nutrients: An Overview | 49

essential and nonessential) the athlete’s body uses and how and when it
uses them. Then supply them in the diet from foods and supplements. It’s
like formulating a super-charged fuel for a high-performance engine. But
the engine in this case is the human body, and it is a dynamic one that
can have different needs each day and changing needs over time from
progressive athletic training and development.

Ergogenic Aids
Ergogenic Aids: a
“Ergogenic aids” is a catchall term to describe athletic performance- catchall term that describes
enhancing substances and training techniques. Ergogenic aids can be anything that can be
used to enhance athletic
nutritional and non-nutritional and include special training techniques, performance. Ergogenic
blood doping, mental strategies, and drugs. Substances range from aids can be dietary or
water to large dosages of vitamins. In the most fundamental sense of non-dietary and include
dietary supplements, special
the definition, a nutritional ergogenic aid would cause some immediate training techniques, and
observable benefit for athletic performance. mental strategies.

Although there are many viable ergogenic aids, as far as this course
is concerned, your entire nutrition and training program should be
approached as an ergogenic aid. Therefore, do not just focus on one or
two magic nutritional bullets. While certain short-term performance-
enhancing methods are employed as part of the Dynamic Nutrition
Approach (like macronutrient modulation and carbohydrate loading),
you must focus on perfecting your total nutrition and training programs
to increase and maximize performance and fitness. If your baseline
nutrition is not optimum to begin with, then use of a nutritional
ergogenic aid will not allow you to derive the maximum benefits it may
offer. For example, if athletes are given large amounts of vitamin B12
for energy and are not eating the proper amounts of carbohydrates,
the potential performance-enhancing benefits of the B12 will not be
realized. As you review the nutrients one by one in the units that follow,
remember that it is the sum total nutrition approach that will far exceed
any of the individual parts.

Nutraceutical
The term “nutraceutical,” sometimes spelled “nutriceutical,” was
created from the words “nutrition” and “pharmaceutical” in the
1980s by Stephen DeFelice, MD, founder and chair of the Foundation
for Innovation in Medicine in New Jersey. According to DeFelice, a

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nutraceutical is any substance that is a food soy isoflavones, lutein, lycopene, curcumin,
or a part of a food, medical food, or dietary sphingolipids, resveratrol, isothiocynates,
supplement and provides medical or health conjugated linoleic acid, quercetin, beta-
benefits, including the prevention and treatment carotene, capsaicin, lecithin, fiber, catechins
of disease. This concept of nutraceutical goes and probiotics. Thus, in addition to eating the
beyond the simple notion of simply providing right foods and supplements to ensure optimum
adequate nutrition to prevent nutrient deficiency intake of the essential nutrients, eating foods
diseases or health, as it widens the view to with nutraceutical value will serve to make your
include prevention and treatment of all diseases. diet even healthier.

Health Canada has taken the lead in publishing Dr. DeFelices’s pioneering vision of creating a
official definitions of nutraceutical and a related new branch of medicine has caught on somewhat
term, functional foods: with the FDA. In fact, as you will learn more
about in a subsequent unit, the US’s FDA
• A nutraceutical is a product isolated or
purified from foods that is generally sold in
recognized the disease prevention importance
medicinal forms not usually associated with of food. It created a health claim system in
food. A nutraceutical is demonstrated to have which foods/nutrients can obtain approvals for
a physiological benefit or provide protection helping prevent diseases based on their review
against chronic disease. of the science. Under this system, foods and
• A functional food is similar in appearance to, foods substances can also have health claims to
or may be, a conventional food, is consumed avoid or reduce their intake of due to potential
as part of a usual diet, and is demonstrated disease-causing effects. Since the health claim
to have physiological benefits and/or reduce regulations were in effect, the FDA approved
the risk of chronic disease beyond basic
more than a dozen foods/nutrients that can help
nutritional functions.
prevent diseases, ranging from cardiovascular
While the term nutraceutical is recent relative diseases to cancer. Health claims are for
to medical history, the concept of preventing conventional foods and dietary supplements.
and treating diseases is thousands of years old.
In fact, there is a famous quote from an ancient
Greek doctor, Hippocrates, who is considered the
Research on Nutrients
founder of scientific medicine: Historically, the majority of research on nutrition
focused on nutrient deficiencies, nutritional care
“Let food be thy medicine and medicine
for metabolic disorders like diabetes, and clinical
be thy food.”
nutrition. Nutrition research on improving
In addition to essential nutrients, some examples physical performance and optimum health was
of foods and food substances that have been historically scanty. However, from the late 1970s
regarded as nutraceutical include whole-grain to the present, more and more research is being
foods, fruits and vegetables, whey protein, conducted on the ways in which nutrition affects
soy protein, garlic, onions, fish oils, green tea, athletic performance and health. Researchers

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 Food, ingredients, and Nutrients: An Overview | 51

are breaking the confines of traditional dogma, delving into unexplored

areas of nutrition, and looking at the relationships between human
performance, fitness, and nutrition. In fact, there are scientific journals
filled with new research on how food and supplements affect athletic
performance, and as an example, The International Journal of Sport
Nutrition and Exercise Metabolism is dedicated to this one subject
and to a growing list of other journals.

There is still opportunity for new discoveries, and this area of research
is rapidly growing. The good news is that many fundamental and
even some quite sophisticated discoveries have been made concerning
the effects that nutrition has on athletic performance and fitness.
These important scientific findings will be included in the following
units about the nutrients. It is important to note, however, that most
studies conducted on the effects that different nutrition programs
and supplements may have on performance or body composition are
often short in duration, several weeks to a few months. Therefore, it
is important to understand that he long-term safety of some of the
sports supplements may only be determined for these short periods.
As such, if you or your clients practice certain supplement loading or
use techniques, they are best done under the supervision of a doctor
or nutritionist as a safeguard. There are very few cases reported in the
scientific literature on supplements’ causing adverse effects on healthy
individuals. But you know that many athletes do not follow balanced
diets, and they may rely on certain supplements as a majority of their
food intake. This type of inadequate nutrition can lead to problems.
Remember, supplements are intended to do just that: supplement the
diet. They are not intended to replace good eating habits, meals, or
whole foods.

While on the topic of research, another consideration is regarding old

and new, effective or not effective. Old research findings are still valid Energy Drink: a beverage
for sports nutrition and other nutrition science. The Dietary Reference that contains caffeine as an
ingredient, along with other
Intake reports for example review and rely on research that is sometimes ingredients, such as taurine,
decades old. The use of sugary and salty energy drinks by athletes herbal supplements,
continues and recommended by most sports medical and nutrition vitamins, and added sugars
or other carbohydrates.
experts, and this original research is decades old. Part of the scientific It is usually marketed as a
process is repeating research studies, so ingredients like creatine may product that can improve
perceived energy, stamina,
have over 100 research studies, most just reconfirming the initial findings athletic performance, or
of strength athlete benefits reported in the 1990s. Using the creatine concentration.

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example again for another consideration is How do we know then whether the food we
conducting experiments for different dosages, are eating is safe? How do scientists determine
timing of ingestion and other types of athletes. whether a nutrient is harmful? Two primary
As a result of diversified research studies, ways are used to detect whether a food or food
some using ineffective dosages or creatine for constituent is harmful / injurious to health. The
endurance athletes that rely on aerobic energy first is epidemiological evidence, which results
pathways versus the anaerobic energy pathway from studying groups of people in various areas
creatine is most involved with, this “other of the world. You periodically read articles or
research” will often find no benefit. Diversified watch news reports about a group of people
research therefore includes testing the limits of living in a particular region that develops fewer
use and benefits, and is common with nutrition numbers of certain cancers because their diets
research. Therefore, carefully read the research are low in fat and high in fiber. Epidemiological
findings in light of the entire body of research to evidence can also be examined for the same
better judge the big picture and reality. population or group from year to year. In this
One more point regarding old versus new way, researchers try to correlate the changes in
research can be made with drugs. Most drugs diet from year to year to see whether there are
being used are based on research that is more increases or decreases in diet-related diseases.
than a decade old, and older. For example, the
The next way to determine whether a food will
generic drugs are decades old. One of the oldest
synthetic drugs, aspirin (acetylsalicylic acid), is cause a disease is through direct experimental
still in use and still effective for reducing fever, evidence. Because it is unethical to experiment
pain, and inflammation for 100 years, in addition on people with harmful substances, laboratory
to new uses. animals are used. The experimental animals
eat different amounts of the suspected food
substance to see what happens. In the case of
Food Safety cancer, the researchers might have observed
Multiple factors can be related to food safety, epidemiological evidence indicating a food
including dietary supplements which tend to be component as the cause of breast cancer. Lab
the safest type of food. A primary factor is that researchers would then isolate the suspected
the food, ingredients, and dietary ingredients are compound, test different concentrations on lab
determined to be safe for human consumption animals, and observe the incidence of cancer
to begin with. The next factor is that during formation. Even when the government agencies
the transportation, processing, manufacturing, and independent researchers do their best, it
packing, storage, and handling, quality practices may not be until years after a food is being
are used to prevent contamination of injurious used by the population before any harmful
substances or pathogens. Finally, another major effects are detected. Then there is the reality
factor is in the store, restaurant, and at home of individuality, when a particular food or
storage and handling. ingredient may be safe for one person but may

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 Food, ingredients, and Nutrients: An Overview | 53

cause health problems for another person—food higher level raising a concern not to eat these
allergies for example. foods or to minimize their consumption, as the
case may be.
It’s interesting to note that even when a
substance is proven harmful to human health, it The same is true with high levels of highly
may still be available for human consumption. saturated fat foods, which may cause health
Some artificial ingredients used in foods have problems when consumed in excess. Most
shown some evidence to cause cancers in recently the department of Health and
laboratory animals or other laboratory tests but Humans Services (HHS) determined that
remain available in foods. Sometimes they are recent studies that indicate that consumption
permitted in foods, under the condition that of trans fatty acids (also called trans fats,
their labels bear a warning that studies show the formed from the hydrogenation of oils used
product causes cancer in laboratory animals. in foods) contributes to increased blood LDL-
California has standards for the presence of cholesterol (“bad: cholesterol) levels, which
known or potentially toxic substances, primarily increase the risk of coronary heart disease
focused on cancer and reproductive health. As (CHD). Recent information from the American
a result, consumers will sometimes encounter Heart Association indicates that CHD causes
a warning statement such as “This product about 500,000 deaths annually, making it the
may contain a chemical known to cause cancer number one cause of death in the United States.
or birth defects or other reproductive harm.” Trans fats (hydrogenated oils / fats), a common
Such warnings may be found occurring on a ingredient in many foods, have now been
variety of consumer products, not just ingestible determined to be unhealthy at any level in the
products. Regarding ingestible products, diet. In the United States, trans fats are being
presence of heavy metals, such as lead, mercury, phased out as a food additive. However, be aware
and arsenic, above certain minimum amounts that trans fats do occur naturally, and keep
can be what triggered the need for the warning checking the nutrition labels if you want to avoid
statement. Keep in mind that under federal trans fat-containing foods.
FDA regulations, harmful substances referred In light of many unanswered question regarding
to as adulterants are not permitted in foods or artificial ingredients in foods, you can follow
supplements and other regulated heath products. a “purest” health food approach, as it is best to
When it comes to the heavy metals, which occur create the healthiest nutrition starting point.
naturally in the soil and are present in food at In practice, it may not be possible to avoid
usually very low levels, there are limits that are or minimize some of the more undesirable
usually tested for, in particular with processed/ ingredients found in foods, as they are
manufactured foods that need to pass finished commonly used. You will most likely have to
product testing. Mercury in some seafood is adopt a health food, or organic, way of eating.
another example of a potentially toxic substance Start by making the best selections for the foods
in foods, where levels may not be detectable or you most often eat. As you develop the habit of
low and not of concern or may be found at a examining what’s in the foods you eat, eventually

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your diet will consist of healthier foods. Do your to determine food allergies or intolerances. The
best and keep your diet as healthy as possible. variety of food additives, pesticides and other
chemicals that may be presence in the diet can
Foodborne illness is another major concern
certainly complicate the evaluation process. For
because a major percentage of problems with
competitive athletes, the elimination diet process
foods are linked to pathogenic organisms,
would be ideally conducted in the off-season.
such as certain bacteria, fungi, protozoa,
worms, viruses, prions, and natural toxins.
Examples of top food pathogens is presented GRAS
in the following Special Topics section. Some According to the FDA “GRAS” is an abbreviation
examples of natural toxin include: Ciguatoxin, for the phrase Generally Recognized as Safe.
Shellfish toxins (PSP, DSP, NSP, ASP, AZP), Under sections 201(s) and 409 of the Federal
Scombrotoxin, Tetrodotoxin, Mushroom Food, Drug, and Cosmetic Act (the Act), any
toxins, Aflatoxins, Gempylotoxin, Pyrrolizidine substance that is intentionally added to food is a
alkaloids, Venomous fish, Grayanotoxins, food additive, that is subject to premarket review
Phytohaemagglutinin. and approval by FDA, unless the substance is
generally recognized, among qualified experts, as
Some foods can also cause devastating allergic
having been adequately shown to be safe under
responses (see below for information about
the conditions of its intended use, or unless the
food allergies). Food allergies can be tricky to
use of the substance is otherwise excluded from
determine and live with. There is even some
the definition of a food additive. Using this
evidence that certain foods eaten before exercise
GRAS approach:
can cause a food allergic response during
exercise due to exercise physiology related • The use of a food substance may be GRAS
changes that occur during exercise. Then there either through scientific procedures or, for a
the category of food intolerance, such as lactose substance used in food before 1958, through
experience based on common use in food.
intolerance. For athletes who want to perform
their best, and for everybody how wants to be • General recognition of safety through scientific
their healthiest, one option is to work with a procedures requires the same quantity and
quality of scientific evidence as is required
medical professional trained in determining
to obtain approval of the substance as a
food allergies and intolerances. This typically
food additive and ordinarily is based upon
involves following a medically supervised published studies, which may be corroborated
elimination diet. Elimination diets usually by unpublished studies and other data and
eliminate the top problem foods and may be information.
followed for a few to several weeks. Then the • General recognition of safety through
trained medical expert will start to reintroduce experience based on common use in foods
different types of potentially problem foods one requires a substantial history of consumption
at a time, and determine how the body reacts. for food use by a significant number of
The process continues for weeks or months consumers.
until all types of foods are rotated in the diet

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 Food, ingredients, and Nutrients: An Overview | 55

New Dietary Ingredients market dietary supplements that contain “new

dietary ingredients” notify the FDA about
(Dietary Supplements) these ingredients. Generally, the notification
must include information that is the basis on
When the Dietary Supplement Health and
which the manufacturer or distributor has
Education Act was enacted in 1994, and the
concluded that a dietary supplement containing
special food category of dietary supplements
a new dietary ingredient will reasonably be
was created, the law and subsequent regulations
expected to be safe under the conditions of use
created a process to address new dietary
recommended or suggested in the labeling.
ingredients based on the GRAS and infant
The FDA has also created a lengthy guidance
formula approaches. One approach is that if an
document and other publications to clarify the
ingredient is determined to be GRAS and used
process and assist companies when they have a
in conventional foods, it can be used as a dietary
new dietary ingredient they want to start using
ingredient, assuming it meets the definition of
in dietary supplements. In practice, the FDA
dietary ingredient. The other approach unique
can delay and prolong the notification process
for dietary supplements is referred to as New
if after it receives the initial submission, it has
Dietary Ingredients Notification Process.
additional questions or concerns. regarding
According to the FDA, the Federal Food, Drug, “other ingredients,” the technical ingredients, as
and Cosmetic Act (the FD&C Act) requires with other foods, dietary supplements have to
manufacturers and distributors that wish to use other ingredients that have GRAS status.

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Special Topics

Adulteration
Historically speaking, a major focus of the history of FDA laws and
regulations was on the prevention of adulteration of foods. In the
simplest sense, adulteration is concerned with substances that are
injurious to health. But as with most laws and regulations, the related
issues are usually more complex. The best way to gain an understanding
of the issues related to adulteration of foods, including dietary
supplements, is to read the legal definition, as follows.
§342. Adulterated food

A food shall be deemed to be adulterated-

(a) Poisonous, Insanitary, Etc., Ingredients

(1) If it bears or contains any poisonous or deleterious substance which

may render it injurious to health; but in case the substance is not an
added substance such food shall not be considered adulterated under this
clause if the quantity of such substance in such food does not ordinarily
render it injurious to health.1 (2)(A) if it bears or contains any added
poisonous or added deleterious substance (other than a substance that
is a pesticide chemical residue in or on a raw agricultural commodity
or processed food, a food additive, a color additive, or a new animal
drug) that is unsafe within the meaning of section 346 of this title; or (B)
if it bears or contains a pesticide chemical residue that is unsafe within
the meaning of section 346a(a) of this title; or (C) if it is or if it bears
or contains (i) any food additive that is unsafe within the meaning of
section 348 of this title; or (ii) a new animal drug (or conversion product
thereof) that is unsafe within the meaning of section 360b of this title; or
(3) if it consists in whole or in part of any filthy, putrid, or decomposed
substance, or if it is otherwise unfit for food; or (4) if it has been prepared,
packed, or held under insanitary conditions whereby it may have become
contaminated with filth, or whereby it may have been rendered injurious
to health; or (5) if it is, in whole or in part, the product of a diseased
animal or of an animal which has died otherwise than by slaughter; or
(6) if its container is composed, in whole or in part, of any poisonous or
deleterious substance which may render the contents injurious to health;
or (7) if it has been intentionally subjected to radiation, unless the use of
the radiation was in conformity with a regulation or exemption in effect
pursuant to section 348 of this title.

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 Food, ingredients, and Nutrients: An Overview | 57

(b) Absence, Substitution, or Addition of Constituents

(1) If any valuable constituent has been in whole or in part omitted or

abstracted therefrom; or (2) if any substance has been substituted wholly
or in part therefor; or (3) if damage or inferiority has been concealed in
any manner; or (4) if any substance has been added thereto or mixed or
packed therewith so as to increase its bulk or weight, or reduce its quality
or strength, or make it appear better or of greater value than it is.

(c) Color Additives

If it is, or it bears or contains, a color additive which is unsafe within the

meaning of section 379e(a) of this title.

(d) Confectionery Containing Alcohol or Nonnutritive Substance

If it is confectionery, and-

(1) has partially or completely imbedded therein any nonnutritive

object, except that this subparagraph shall not apply in the case of any
nonnutritive object if, in the judgment of the Secretary as provided
by regulations, such object is of practical functional value to the
confectionery product and would not render the product injurious or
hazardous to health;

(2) bears or contains any alcohol other than alcohol not in excess of one-
half of 1 per centum by volume derived solely from the use of flavoring
extracts, except that this clause shall not apply to confectionery which
is introduced or delivered for introduction into, or received or held for
sale in, interstate commerce if the sale of such confectionery is permitted
under the laws of the State in which such confectionery is intended to be
offered for sale; or

(3) bears or contains any nonnutritive substance, except that this

subparagraph shall not apply to a safe nonnutritive substance which is
in or on confectionery by reason of its use for some practical functional
purpose in the manufacture, packaging, or storage of such confectionery
if the use of the substance does not promote deception of the consumer
or otherwise result in adulteration or misbranding in violation of
any provision of this chapter, except that the Secretary may, for the
purpose of avoiding or resolving uncertainty as to the application of
this subparagraph, issue regulations allowing or prohibiting the use of
particular nonnutritive substances.

(e) Oleomargarine Containing Filthy, Putrid, Etc., Matter

If it is oleomargarine or margarine or butter and any of the raw material

used therein consisted in whole or in part of any filthy, putrid, or
decomposed substance, or such oleomargarine or margarine or butter is
otherwise unfit for food.

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58 | Unit 2

(f) Dietary Supplement or Ingredient: Safety

(1) If it is a dietary supplement or contains a dietary ingredient that-

(A) presents a significant or unreasonable risk of illness or injury under-

(i) conditions of use recommended or suggested in labeling, or

(ii) if no conditions of use are suggested or recommended in the labeling,

under ordinary conditions of use;

(B) is a new dietary ingredient for which there is inadequate information

to provide reasonable assurance that such ingredient does not present a
significant or unreasonable risk of illness or injury;

(C) the Secretary declares to pose an imminent hazard to public health

or safety, except that the authority to make such declaration shall not
be delegated and the Secretary shall promptly after such a declaration
initiate a proceeding in accordance with sections 554 and 556 of title 5 to
affirm or withdraw the declaration; or

(D) is or contains a dietary ingredient that renders it adulterated under

paragraph (a)(1) under the conditions of use recommended or suggested
in the labeling of such dietary supplement.

In any proceeding under this subparagraph, the United States shall bear
the burden of proof on each element to show that a dietary supplement
is adulterated. The court shall decide any issue under this paragraph on a
de novo basis.

(2) Before the Secretary may report to a United States attorney a violation
of paragraph 2 (1)(A) for a civil proceeding, the person against whom
such proceeding would be initiated shall be given appropriate notice and
the opportunity to present views, orally and in writing, at least 10 days
before such notice, with regard to such proceeding.

(g) Dietary Supplement: Manufacturing Practices

(1) If it is a dietary supplement and it has been prepared, packed, or held

under conditions that do not meet current good manufacturing practice
regulations, including regulations requiring, when necessary, expiration
date labeling, issued by the Secretary under subparagraph (2).

(2) The Secretary may by regulation prescribe good manufacturing

practices for dietary supplements. Such regulations shall be modeled
after current good manufacturing practice regulations for food and may
not impose standards for which there is no current and generally available
analytical methodology. No standard of current good manufacturing
practice may be imposed unless such standard is included in a regulation
promulgated after notice and opportunity for comment in accordance
with chapter 5 of title 5.

Sports Nutrition
 Food, ingredients, and Nutrients: An Overview | 59

(h) Reoffer of Food Previously Denied Admission

If it is an article of food imported or offered for import into the United

States and the article of food has previously been refused admission
under section 381(a) of this title, unless the person reoffering the article
affirmatively establishes, at the expense of the owner or consignee of the
article, that the article complies with the applicable requirements of this
chapter, as determined by the Secretary.

(i) Noncompliance with Sanitary Transportation Practices

If it is transported or offered for transport by a shipper, carrier by motor

vehicle or rail vehicle, receiver, or any other person engaged in the
transportation of food under conditions that are not in compliance with
regulations promulgated under section 350e of this title.

[Source: http://uscode.house.gov/browse.xhtml]

Misbranding
Misbranding on the surface is a simple concept: The information on
product labels has to be correct, but because of the numerous ways
information mistakes can occur, combined with the numerous labeling
laws and regulations, misbranding is more complex than adulteration
is. Note that labeling of foods and dietary supplements will be reviewed
in detail in another unit. But for now, an FDA-regulated food or dietary
supplement product can be declared misbranded if there are mistakes
in the information, such as not listing an ingredient that is contained
in a product, listing an ingredient that is not contained in a product,
omitting information required by FDA’s labeling regulations, or
including information that is not truthful or is misleading. Depending
on the specific misbranding circumstance, the FDA may require
products to be recalled, or it may choose to warn the offending company
and demand corrections as soon as possible on new product inventory.
Recalls are typically requested when the misbranding can result in
adverse health outcomes, such as not listing an ingredient that is a
known allergen, or if an unauthorized new ingredient is in a product
with potential health concerns.

Food Allergy and Intolerance

According to the FDA, food allergies can range from merely irritating
to life-threatening. Each year, millions of Americans experience food
allergies, some cases resulting in hospitalization or, in some cases,

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60 | Unit 2

even death. A food allergy is a specific type of adverse food reaction

involving the immune system. The body produces what is called an
allergic, or immunoglobulin E (IgE), antibody to a food. Once a specific
food is ingested and binds with the IgE antibody, an allergic response
occurs. Although note that some experts claim there may be additional
mechanisms to an allergic response, the IgE appears to be the most
prevalent one.

A food allergy should not be confused with a food intolerance or other

nonallergic food reactions. Food intolerance refers to an abnormal
response to a food or additive, but it differs from an allergy in that it
Blood Pressure: the does not involve the immune system. For example, people who have
pressure of the blood
against the walls of the recurring gastrointestinal problems when they drink milk may say they
arteries. have a milk allergy. But they really may be lactose intolerant. One of
Food Groups: a method the main differences between food allergies and food intolerances is
of grouping similar foods that food allergies can result in an immediate life-threatening response.
for descriptive and guidance
purposes. Food groups in Thus, typically compared with food intolerances, food allergic reactions
the USDA Food Patterns are pose a much greater health risk; however, both types of food reactions
defined as vegetables, fruits,
are health concerns that should be identified and treated by expert
grains, dairy, and protein
foods. Some of these groups health professionals.
are divided into subgroups,
such as dark-green Symptoms of a food allergy usually develop within about an hour after
vegetables or whole grains,
eating the offending food. The most common signs and symptoms of a
which may have intake
goals or limits. Foods are food allergy include:
grouped within food groups
based on their similarity • Hives, itching, or skin rash
in nutritional composition
and other dietary benefits. • Swelling of the lips, face, tongue and throat, or other parts of the body
For assignment to food
groups, mixed dishes are • Wheezing, nasal congestion, or trouble breathing
disaggregated into their
• Abdominal pain, diarrhea, nausea, or vomiting
major component parts.
• Dizziness, lightheadedness, or fainting

In a severe allergic reaction to food—called anaphylaxis—you may have

more extreme versions of the above reactions. Or you may experience
life-threatening signs and symptoms such as:
• Swelling of the throat and air passages that make it difficult to breathe

• Shock, with a severe drop in blood pressure

• Rapid, irregular pulse

• Loss of consciousness

Sports Nutrition
 Food, ingredients, and Nutrients: An Overview | 61

Food labels are required to state clearly whether allergy labeling does not protect everyone with
the food contains a major food allergen. A major a food allergy but should likely protect the
food allergen is defined as one of the following majority of people who may have severe allergic
foods or food groups or is an ingredient responses to foods.
that contains protein derived from one of the
If you have food allergies, you must be prepared
following foods or food groups:
for unintentional exposures. The National
• Milk Institute of Allergies and Infectious Diseases
• Eggs (NIAID) recommends that people with food
allergies do the following:
• Peanuts
• Wear a medical alert bracelet or necklace
• Tree nuts such as almonds, walnuts, and
stating that you have a food allergy and are
pecans
subject to severe reactions.
• Soybeans
• Carry an auto-injector device containing
• Wheat epinephrine (adrenaline) that you can get by
prescription and give to yourself if you think
• Fish
you are experiencing a food allergic reaction.
• Shellfish such as crab, lobster, and shrimp
• Seek medical help immediately if you
An important point to consider regarding this experience a food allergic reaction, even if you
have already given yourself epinephrine, either
situation is that these foods or food groups
by calling 911 or getting transportation to an
account for about 90 percent of all food allergies
emergency room.
in the United States, with focuses on IgE-related
food allergies. Therefore, this required food

International Sports Sciences Association

62 | Unit 2

BSE (Bovine Spongiform face, arms, and legs and trouble understanding,
remembering, talking, and walking, which
Encephalopathy)
becomes extreme.
According to the FDA, BSE is thought to
arise due to disease causing prions. Prions Note that the FDA also works with the US
(pronounced “PREE – ons”) aren’t living things Department of Agriculture (USDA) to keep cows
but may cause a certain type of rare, deadly in the United States healthy and free of BSE. The
disease if infected cattle are eaten. Prion disease USDA prevents high-risk cows and cow products
in cattle isn’t common (there have been only from entering the United States from other
three known cattle cases in the United States) countries. The USDA also makes sure that high-
and affects the brain, some nerves, the spinal risk cow parts, such as the brains and spinal
cord, eyes, tonsils, and bowel. cords, and cows that are unable to walk or that
show other signs of disease are not used to make
Since 1996, when it first appeared in humans, food for people. The steps the FDA and USDA
only 217 people in the world are known to have have taken to prevent cows in the United States
contracted the disease, whose medical name is from contracting BSE are working very well.
“variant Creutzfeldt‐Jakob disease,” shortened Only four cows with BSE have been found in the
to vCJD. It’s thought that the meat these people United States. Three of these cows were born
ate was contaminated because the cattle had in the United States, and the fourth was born
been given feed that contained parts of other in Canada. According to information published
dead cattle (as a protein source) that were by the FDA, the last cow with BSE in the United
contaminated with disease‐causing prions. Since States was found in 2012.
that kind of cattle feed has been banned, the
[http://www.fda.gov/AnimalVeterinary/ResourcesforYou/
number of new cases has dropped even lower.
AnimalHealthLiteracy/ucm136222.htm]
In both humans and cattle, disease‐causing
prions are a protein that has taken on the wrong Genetically Engineered
shape. Normally, the correctly shaped prion
(GE) Foods
protein helps the brain and nerves work properly,
but when it takes on the wrong shape, it can Foods from genetically engineered plants is
result in vCJD in humans. Once meat from a topic that can fill volumes of course books.
diseased cattle is eaten and diseased prions enter The FDA is involved in regulating GE plants
a person’s system, they turn the normal prions and notes: “We regulate human and animal
into disease‐causing prions, and the brain and food from genetically engineered (GE) plants
nerves no longer work properly, leading to death. like we regulate all food. The existing FDA
It’s thought that symptoms don’t appear until safety requirements impose a clear legal duty
about 10 years after the infectious meat is eaten. on everyone in the farm to table continuum to
The illness may begin with depression or other market safe foods to consumers, regardless of
psychiatric problems and develop into neurologic the process by which such foods are created.
symptoms, such as unpleasant feelings in the It is unlawful to produce, process, store, ship

Sports Nutrition
 Food, ingredients, and Nutrients: An Overview | 63

or sell to consumers unsafe foods. FDA’s role This general practice extends to foods produced
is to ensure that everyone in the farm to table using genetic engineering techniques.” The
continuum is meeting this obligation. We following information from the FDA addresses
encourage producers of new foods and food some of the common questions asked by health
ingredients to consult with FDA when there is a professionals and consumers.
question about an ingredient’s regulatory status.

Consumer Info about Food from Genetically Engineered Plants

FDA regulates the safety of food for humans and animals, including foods produced from genetically
engineered (GE) plants. Foods from GE plants must meet the same food safety requirements as foods
derived from traditionally bred plants.
While genetic engineering is sometimes referred to as “genetic modification” producing “genetically
modified organisms (GMOs),” FDA considers “genetic engineering” to be the more precise term.
Crop improvement happens all the time, and genetic engineering is just one form of it. We use the
term “genetic engineering” to refer to genetic modification practices that utilize modern biotechnol-
ogy. In this process, scientists make targeted changes to a plant’s genetic makeup to give the plant a
new desirable trait. For example, two new apple varieties have been genetically engineered to resist
browning associated with cuts and bruises by reducing levels of enzymes that can cause browning.
Humans have been modifying crops for thousands of years through selective breeding. Early farmers
developed cross breeding methods to grow numerous corn varieties with a range of colors, sizes, and
uses. For example, the garden strawberries that consumers buy today resulted from a cross between a
strawberry species native to North America and a strawberry species native to South America.
Why genetically engineer plants?
Developers genetically engineer plants for many of the same reasons that traditional breeding is used.
They may want to create plants with better flavor, higher crop yield (output), greater resistance to
insect damage, and immunity to plant diseases.
Traditional breeding involves repeatedly cross-pollinating plants until the breeder identifies offspring
with the desired combination of traits. The breeding process introduces a number of genes into the
plant. These genes may include the gene responsible for the desired trait, as well as genes responsible
for unwanted characteristics.
Genetic engineering isolates the gene for the desired trait, adds it to a single plant cell in a laboratory,
and generates a new plant from that cell. By narrowing the introduction to only one desired gene from
the donor organism, scientists can eliminate unwanted characteristics from the donor’s other genes.
Genetic engineering is often used in conjunction with traditional breeding to produce the genetically
engineered plant varieties on the market today.
Am I eating food from genetically engineered plants?

International Sports Sciences Association

Consumer Info about Food from Genetically Engineered Plants, continued
Foods from GE plants were introduced into our food supply in the 1990s. Cotton, corn and soybeans
are the most common GE crops grown in the U.S. In 2012, GE soybeans accounted for 93 percent of all
soybeans planted, and GE corn accounted for 88 percent of corn planted.
The majority of GE plants are used to make ingredients that are then used in other food products.
Such ingredients include:
• Corn starch in soups and sauces

• Corn syrup used as a sweetener

• Corn oil, canola oil and soybean oil in mayonnaise, salad dressings, breads, and snack foods

• Sugar from sugar beets in various foods

Other major crops with GE varieties include potatoes, squash, apples, and papayas.
Are foods from GE plants safe to eat?
Yes. Credible evidence has demonstrated that foods from the GE plant varieties marketed to date are as
safe as comparable, non-GE foods.
Are Foods from GE plants regulated?
Yes. FDA regulates foods from GE crops in conjunction with the U.S. Department of Agriculture (USDA)
and the Environmental Protection Agency (EPA).
FDA enforces the U.S. food safety laws that prohibit unsafe food. GE plants must meet the same legal
requirements that apply to all food. To help ensure that firms are meeting their obligation to market
only safe and lawful foods, FDA encourages developers of GE plants to consult with the agency before
marketing their products. For more information about the Plant Biotechnology Consultation Program,
see How FDA regulates food from GE plants.
The mission of USDA’s Animal and Plant Health Inspection Service APHIS is to safeguard the health,
welfare and value of American agriculture and natural resources, including regulating the introduction
of certain genetically engineered organisms that may pose a risk to plant health. To learn more about
APHIS regulation of genetically engineered organisms, visit their website.
EPA regulates pesticides, including those genetically engineered into food crops, to make sure that
pesticides are safe for human and animal consumption and won’t harm the environment. For addition-
al information, see the EPA’s Regulating Biopesticides web page.
How Does FDA Evaluate the Safety of GE Plants?
During the FDA consultation process, the food developer conducts a safety assessment. This safety
assessment identifies the distinguishing attributes of the new traits in the plant and assesses whether
any new material in food made from the GE plant is safe when eaten by humans or animals. As part of
this assessment, the developer compares the levels of nutrients and other components in the food to
those in food from traditionally bred plants or other comparable foods.
The developer submits a summary of its safety assessment to FDA for FDA’s evaluation. When the
safety assessment is received by FDA, our scientists carefully evaluate the data and information. FDA
considers the consultation to be complete only when its team of scientists is satisfied that the develop-
er’s safety assessment has adequately addressed all safety and other regulatory issues. To learn more
about the consultation process, see How FDA regulates food from GE plants.

[http://www.fda.gov/Food/FoodScienceResearch/GEPlants/ucm461805.htm]
Gluten characteristics are also useful for other types of
processed foods, imitation meats for example.
Gluten is a term that refers to a mixture of Health concerns about gluten were generated
proteins that occur in some grains, such as from its association with a disorder called celiac
wheat. Gluten exhibits viscoelastic properties, disease along with non-celiac gluten sensitivity
providing elasticity to dough and structure and wheat allergy. The following FDA article
and chewy texture to bread and other provides additional information about gluten
gluten-containing food products. Gluten’s and the label referred to as “Gluten-Free”

‘Gluten-Free’ Now Means What It Says

In August 2013, the Food and Drug Administration issued a final rule that defined what characteristics
a food has to have to bear a label that proclaims it “gluten-free.” The rule also holds foods labeled
“without gluten,” “free of gluten,” and “no gluten” to the same standard.
Manufacturers had one year to bring their labels into compliance. As of August 5, 2014, any food
product bearing a gluten-free claim labeled on or after this date must meet the rule’s requirements.
This rule was welcomed by advocates for people with celiac disease, who face potentially life-
threatening illnesses if they eat the gluten found in breads, cakes, cereals, pastas and many other foods.
Andrea Levario, executive director of the American Celiac Disease Alliance, notes that there is no cure
for celiac disease and the only way to manage the disease is dietary—not eating gluten. Without a
standardized definition of “gluten-free,” these consumers could never really be sure if their body
would tolerate a food with that label, she adds.
As one of the criteria for using the claim “gluten-free,” FDA set a gluten limit of less than 20 ppm (parts
per million) in foods that carry this label. This is the lowest level that can be consistently detected in
foods using valid scientific analytical tools. Also, most people with celiac disease can tolerate foods
with very small amounts of gluten. This level is consistent with those set by other countries and
international bodies that set food safety standards.
“This standard ’gluten-free’ definition eliminates uncertainty about how food producers label their
products. People with celiac disease can rest assured that foods labeled ‘gluten-free’ meet a clear
standard established and enforced by FDA,” says Felicia Billingslea, director of FDA’s division of food
labeling and standards.
What Is Gluten? Gluten is a mixture of proteins that occur naturally in wheat, rye, barley and
crossbreeds of these grains.
As many as 3 million people in the United States have celiac disease. It occurs when the body’s
natural defense system reacts to gluten by attacking the lining of the small intestine. Without a
healthy intestinal lining, the body cannot absorb the nutrients it needs. Delayed growth and nutrient
deficiencies can result and may lead to conditions such as anemia (a lower than normal number of red
blood cells) and osteoporosis, a disease in which bones become fragile and more likely to break. Other
serious health problems may include diabetes, autoimmune thyroid disease and intestinal cancers.
Before the rule, there were no federal standards or definitions for the food industry to use in labeling
products “gluten-free.” An estimated 5 percent of foods formerly labeled “gluten-free” contained 20
ppm or more of gluten.

Anemia: a condition in which the oxygen-carrying capacity of the blood is reduced. It is the most
common symptom of iron deficiency.
International Sports Sciences Association
Gluten-Free’ Now Means What It Says, continued
How Does FDA Define ‘Gluten-Free’? In addition to limiting the unavoidable presence of gluten to less
than 20 ppm, FDA now allows manufacturers to label a food “gluten-free” if the food does not contain
any of the following:
• an ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains

• an ingredient derived from these grains and that has not been processed to remove gluten

• an ingredient derived from these grains and that has been processed to remove gluten, if it
results in the food containing 20 or more parts per million (ppm) gluten

Foods such as bottled spring water, fruits and vegetables, and eggs can also be labeled “gluten-free” if
they inherently don’t have any gluten.
Under the final rule, a food label that bears the claim “gluten-free,” as well as the claims “free of glu-
ten,” “without gluten,” and “no gluten,” but fails to meet the requirements of the rule is considered
misbranded and subject to regulatory action by FDA.
According to Felicia Billingslea, director of FDA’s division of food labeling and standards, consumers
should know that some foods labeled “gluten free” that are in the marketplace may have been labeled
before the rule’s compliance date of August 5.
Some of these foods, like pasta, have a longer shelf life and may legally remain on the shelves a little
bit longer. Therefore, it is possible that stores may still be selling some foods that are labeled “glu-
ten-free” produced before the compliance date of the final rule.
If consumers have any doubts about a product’s ingredients and whether or not the product is glu-
ten-free, they should contact the manufacturer or check its website for more information.
What About in Restaurants? Some restaurants use the term “gluten-free” in their menus. The glu-
ten-free final rule applies to packaged foods, which may be sold in some retail and food-service
establishments such as some carry-out restaurants. However, given the public health significance of
“gluten-free” labeling, restaurants making a gluten-free claim on their menus should be consistent
with FDA’s definition.
State and local governments play an important role in oversight of restaurants. FDA will work with
partners in state and local governments with respect to gluten-free labeling in restaurants.
Billingslea suggests that consumers who are concerned about gluten-free claims in restaurants ask the
following questions when ordering foods described as gluten-free:
• •What does the restaurant mean by the term “gluten free?”

• •What ingredients are used in this item?

• •How is the item prepared?

“With the new FDA gluten-free regulations now being enforced, restaurants will be well-served to
ensure they are meeting the FDA-defined claim,” said Joy Dubost, Ph.D., R.D., Senior Director of Nutri-
tion, National Restaurant Association. “We will continue to work with restaurant operators and chefs
to assist and ensure a favorable dining experience for consumers.”
This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.
August 5, 2014 http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm363069.htm
 Food, ingredients, and Nutrients: An Overview | 67

Foodborne Pathogens
The Centers for Disease Control and Prevention
(CDC) estimates that each year roughly 48
million people become sick from a foodborne
illness, 128,000 are hospitalized, and 3,000 die.
The 2011 estimates provide the most accurate
picture of which foodborne bacteria, viruses,
microbes (pathogens) are causing the most
illnesses in the United States. According to the
2011 estimates, the most common foodborne
illnesses are caused by norovirus and by the
bacteria salmonella, Clostridium perfringens,
and Campylobacter. Foodborne pathogen
infection is certainly a major impediment for
athletes in training and during competition.
In addition to your taking food safety steps,
reviewed in another Unit, insights as to the
sources and reasons of top foodborne pathogens
will provide information to assist you with inadequate nutrition, from improperly cooked
preventative actions and to also recognize foods, and from eating larger quantities of foods
common symptoms to be alert to for seeking that are likely to contain foodborne pathogens.
medical treatment.
A major step for reducing the risks of consuming
The chart on the following page, from the FDA, foodborne pathogens is being aware of the
includes foodborne disease-causing organisms sources, types of foods that carry pathogens,
that frequently bring about illness in the proper food handling, and proper food
United States. As the chart shows, the threats preparation along with reducing consumption
are numerous and varied, with symptoms of high-risk food sources, especially when
ranging from relatively mild discomfort to eating outside the home. The following table
extremely serious and even life-threatening presents some of the top foodborne pathogens.
illness. Although the very young, the elderly, Take note of the common food pathogen food
and persons with weakened immune systems sources. This can provide you with insights on
are at greatest risk of serious consequences how to reduce the risk of foodborne illnesses,
from most foodborne illnesses, some of the including proper purchasing, handling, and
organisms shown below pose grave threats to all preparation of these foods and/or reducing or
persons. Athletes may be of increased risk from avoiding their consumption if foodborne illness
foodborne illness due to a possible weakened problems persist with particular clients, upon
immune system from over training, from confirmation by their physicians.

International Sports Sciences Association

68 | Unit 2

Foodborne disease-causing organisms

Organism Common Onset Signs & Duration Food Sources
Name of Time after Symptoms
Illness Ingesting

Bacillus cereus B. cereus food 10–16 hrs Abdominal 24–48 Meats, stews,
poisoning cramps, watery hours gravies, vanilla
diarrhea, nausea sauce

Campylobacter Campylobacte- 2–5 days Diarrhea, cramps, 2–10 Raw and under-
jejuni riosis fever, and vomit- days cooked poultry,
ing; diarrhea may unpasteurized
be bloody milk, contaminat-
ed water

Clostridium Botulism 12–72 hours Vomiting, diar- Variable Improperly

botulinum rhea, blurred canned foods,
vision, double especially home-
vision, difficulty canned vegeta-
in swallowing, bles, fermented
muscle weakness. fish, baked pota-
Can result in toes in aluminum
respiratory failure foil
and death

Clostridium Perfringens 8–16 hours Intense abdom- Usually Meats, poultry,

perfringens food poisoning inal cramps, 24 hours gravy, dried or
watery diarrhea precooked foods,
time and/or tem-
perature-abused
foods

Cryptosporidium Intestinal cryp- 2–10 days Diarrhea (usually May be Uncooked food
tosporidiosis watery), stomach remit- or food contam-
cramps, upset ting and inated by an ill
stomach, slight relapsing food handler after
fever over cooking; contam-
weeks to inated drinking
months water

Cyclospora Cyclosporiasis 1–14 days, Diarrhea (usually May be Various types

cayetanensis usually at watery), loss of remit- of fresh pro-
least 1 week appetite, substan- ting and duce (imported
tial loss of weight, relapsing berries, lettuce,
stomach cramps, over basil)
nausea, vomiting, weeks to
fatigue months

E. coli E. coli infection 1–3 days Watery diar- 3–7 or Water or food
(Escherichia coli) (common cause rhea, abdominal more contaminated
producing toxin of “travelers’ cramps, some days with human feces
diarrhea”) vomiting

Sports Nutrition
 Food, ingredients, and Nutrients: An Overview | 69

Foodborne disease-causing organisms, continued

E. coli O157:H7 Hemorrhagic 1–8 days Severe (often 5–10 Undercooked

colitis or E. bloody) diarrhea, days beef (especially
coli O157:H7 abdominal pain hamburger),
infection and vomiting. unpasteurized
Usually, little or milk and juice,
no fever is pres- raw fruits and
ent. More com- vegetables (e.g.
mon in children 4 sprouts), and
years or younger. contaminated
Can lead to kid- water
ney failure.

Hepatitis A Hepatitis 28 days aver- Diarrhea, dark Variable, Raw produce,

age (15–50 urine, jaundice, 2 weeks contaminated
days) and flu-like to 3 drinking water,
symptoms, i.e., months uncooked foods
fever, headache, and cooked
nausea, and ab- foods that are not
dominal pain reheated after
contact with an
infected food
handler; shellfish
from contaminat-
ed waters

Listeria Listeriosis 9-48 hrs for Fever, muscle Variable Unpasteurized

monocytogenes gastro-in- aches, and nau- milk, soft cheeses
testinal sea or diarrhea. made with un-
symptoms, Pregnant women pasteurized milk,
2-6 weeks may have mild ready-to-eat deli
for invasive flu-like illness, meats
disease and infection can
lead to prema-
ture delivery or
stillbirth. The
elderly or immu-
nocompromised
patients may de-
velop bacteremia
or meningitis.

Noroviruses Variously called 12–48 hrs Nausea, vomit- 12–60 Raw produce,
viral gastro- ing, abdominal hrs contaminated
enteritis, winter cramping, diar- drinking water,
diarrhea, acute rhea, fever, head- uncooked foods
non- bacterial ache. Diarrhea is and cooked
gastroenteritis, more prevalent in foods that are not
food poison- adults, vomiting reheated after
ing, and food more common in contact with an
infection children. infected food
handler; shellfish
from contaminat-
ed waters

International Sports Sciences Association

70 | Unit 2

Foodborne disease-causing organisms , continued

Salmonella Salmonellosis 6–48 hours Diarrhea, fever, 4-7 days Eggs, poultry,
abdominal meat, unpasteur-
cramps, vomiting ized milk or juice,
cheese, contam-
inated raw fruits
and vegetables

Shigella Shigellosis 4–7 days Abdominal 24-48 hrs Raw produce,

or Bacillary cramps, fever, contaminated
dysentery and diarrhea. drinking water,
Stools may con- uncooked foods
tain blood and and cooked
mucus. foods that are not
reheated after
contact with an
infected food
handler

Staphylococcus Staphylococcal 1–6 hours Sudden onset of 24-48 Unrefrigerated

aureus food poisoning severe nausea hours or improperly re-
and vomiting. frigerated meats,
Abdominal potato and egg
cramps. Diarrhea salads, cream
and fever may be pastries
present.

Vibrio V. parahaemo- 4–96 hours Watery (occasion- 2-5 days Undercooked or

parahaemolyticus lyticus infection ally bloody) diar- raw seafood, such
rhea, abdominal as shellfish
cramps, nausea,
vomiting, fever

Vibrio vulnificus V. vulnificus 1–7 days Vomiting, diar- 2-8 days Undercooked or
infection rhea, abdominal raw seafood, such
pain, bloodborne as shellfish (espe-
infection. Fever, cially oysters)
bleeding within
the skin, ulcers
requiring surgical
removal. Can be
fatal to persons
with liver disease
or weakened im-
mune systems.

[http://www.fda.gov/Food/FoodborneIllnessContaminants/FoodborneIllnessesNeedToKnow/default.htm]

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 Food, ingredients, and Nutrients: An Overview | 71

CONCLUSION
The contents of this unit bring awareness to a is to also be aware of the non-nutrient substances
diversity of important topics and considerations that can occur in foods that can be unhealthy or
related to foods and dietary supplements. unnecessary and the need to eliminate or greatly
Although a major focus for an athlete’s diet is to reduce these non-nutritive substances from an
provide good nutrition sources for health and athlete’s diet.
athletic importance, an equally important focus

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Key Words
Essential Nutrient Glucose

Macronutrient Starch

Micronutrients Macronutrient Modulation

Creatine (also, phosphocreatine) Glycogen Depletion

Antioxidant Electrolyte Balance

Enrichment Nutrient Dense

Fortification Bioavailability

Emulsifier Assimilation

Protein Ergogenic Aids

Fat Energy Drink

Energy Expenditure Blood Pressure

Thermogenic Response Food Groups

Thermogenesis Anemia

Metabolic Rate

Sports Nutrition
 Topics Covered In This Unit

Introduction

Carbohydrates and athletes

Athletic significance of carbohydrates

Types of carbohydrates

Simple carbohydrates

Complex carbohydrates

Digestion of carbohydrates

About the glycemic index

Glycemic load

 arbohydrates in the body—glucose

C
and glycogen

Carbohydrates for increased athletic

performance

Carbohydrates pre-exercise, during

exercise, and post-exercise

Food and supplement sources of car-

bohydrate

Conclusion

UNIT 3

CARBOHYDRATES:
THE ULTIMATE PERFORMANCE FOOD
74 | Unit 3

Unit Outline
I. Introduction V. Carbohydrates in the body—glucose
and glycogen
II. Carbohydrates and athletes
VI. Carbohydrates for increased athletic
a. Athletic significance of
performance
carbohydrates
VII. Carbohydrates pre-exercise, during
III. Types of carbohydrates
exercise, and post-exercise
a. Simple carbohydrates
VIII. Food and supplement sources of
b. Complex carbohydrates carbohydrate
i. Fiber IX. Conclusion
1. Overview of some common dietary
and functional fibers
IV. Digestion of carbohydrates
a. About the glycemic index
b. Glycemic load

Learning Objectives
• After completing this unit, you will be able to:

• Define and describe key terms related to carbohydrates.

• Understand the different types of carbohydrates.

• Determine Glycemic Index and Glycemic Load

• Discuss how carbohydrates affect athletic performance and health.

Introduction other issues related to carbohydrates concern

possible adverse health effects (for certain types,
For many people, and even some health
that is). However, for athletes and just about
professionals, carbohydrates are a macronutrient
everybody else, a plentiful daily intake of healthy
sometimes surrounded with controversy and
carbohydrates is a vital part of the diet.
misconceptions. Some of these issues have
arisen related to the focus on weight loss and Taking a closer look at carbohydrates reveals
weight maintenance, labeling carbohydrates as this macronutrient is of vital importance for
bad for people watching their weight, whereas health and athletic performance. In general,

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 Carbohydrates: The Ultimate Performance Food | 75

most people require that a major part of their balanced by being healthy, can be challenging at
food intake consist of healthy carbohydrates. The times but worth the effort in terms of improved
acceptable distribution range (ADR) for adults athlete performance and good health.
of daily carbohydrate intake is 45 to 65 percent
of total daily calories, reported in the Dietary
Reference Intake report. Carbohydrates
Regarding health issues related to carbohydrates,
and Athletes
what matters is are the types of carbohydrates For athletes, carbohydrates are vital for
and the amounts per day, along with other high-energy production and peak athletic
dietary factors. Healthy dietary carbohydrate performance. Most athletes eating for top
trends are related to lower intake of simple performance should consume in the range of
refined sugars, increasing fiber intake, 55 percent to 60 percent of their total daily
increasing more whole grain and whole complex calories from carbohydrates for maximum
carbohydrate-containing foods, and consuming performance, from day to day. For some
higher amounts of the lower glycemic index value athletes, the percentage can even be higher,
foods. But note that some dilemmas can arise in particular on competition days or during
when dealing with athletes, such as the use of the glycogen loading, 60 percent to 70 percent.
sugary and salty energy drinks and lower fiber Then for some other athletes, lower than 55
foods for quicker digestion related to exercise, percent may be required based on individualized
training, and competitions. Therefore, fine- needs, in particular in weight class sports
tuning carbohydrate intake to best meet the food and other sports in which achieving low body
intake requirements for top athletic performance, fat levels is required. Moreover, research has

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shown that the type of carbohydrate and food source ingested can
affect performance, so consuming the right carbohydrate-containing
foods and supplements is important for maximum energy, and other
carbohydrate type considerations can be appropriate from meal to meal
eating, and before, during, and after exercise, training, and workouts.

In addition to maintaining a balanced, diet rich in carbohydrates from

meal to meal, with special emphasis on the pre-exercise/competition
meal, carbohydrate energy beverage consumption timing can be a
crucial factor for improving athletic performance. Properly timing
consumption of a carbohydrate energy drink at the start of athletic
activity or training and continuing consumption during exercise can
Glycogen: a complex help maintain energy levels and can help spare the body’s glycogen
carbohydrate that occurs stores, while post-exercise carbohydrate consumption is necessary for
only in animals; the form in
which glucose is stored in adequate replenishment of an athlete’s glycogen body stores.
the body.
Providing the body with an external source of carbohydrate during
exercise may increase the time it takes the body to become exhausted,
especially for athletes who train or compete strenuously for 45 minutes
or longer. In other words, it increases athletic performance and duration
and delays the onset of fatigue. Forty-five minutes may seem on the short
side when considering glycogen depletion for endurance athletes that can
usually take longer for total glycogen depletion. However, a shorter time
period is set is to be mindful of the fact that it is common for athletes
to have low glycogen stores from strenuous day-to-day training, and if
glycogen stores start out low, then they can be depleted more quickly.
When carbohydrate ingestion timing is right, if the body is exercising
when the ingested carbohydrate starts to enter the blood stream, it is
Insulin: a hormone made more readily used for energy and does not cause a rapid rise in insulin
by the pancreas, insulin
that could conflict with glucagon function and energy production
helps move glucose (sugar)
from the blood to muscles that is vital for high-performance muscle contractions during athletic
and other tissues. Insulin activities. This can also spare the use of the body’s glycogen stores. More
controls blood sugar levels.
information about this topic is provided later in this UNIT 19.

Research continues to show that carbohydrates are the body’s primary

“high-energy” fuel source for athletic activities. Fat is important too,
especially for endurance athletes. But lessons learned from researchers in
the early 1900s who studied the effects of nutrient intake among runners
and labor work performance revealed when physical work output was
reduced as related to carbohydrates. By putting their subjects on a

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 Carbohydrates: The Ultimate Performance Food | 77

variety of experimental nutritional regimens, ranging from outright

starvation to diets consisting of different proportions of fat, protein, and
carbohydrates, these early researchers found a few interesting dynamics
that hold true today, based on the volume of redundant research studies
in this area of nutrition.

When the body runs out of its stored glycogen and is forced to just use
fatty acids as the primary source of energy, physical performance can
decline dramatically. Use of protein/amino acids also increases under
glycogen depletion conditions. Endurance athletes call this “hitting
the wall” or “bonking”—when their body’s glycogen stores become
depleted and they must rely on fatty acids and amino acids for energy
production during training or events. Historically, long-distance athletes
experienced the performance reducing effects of glycogen depletion
before the performance enhancing benefits of carbohydrate loading,
glycogen maintenance, and ingesting carbohydrate drinks during
exercise was discovered.

Since the initial research was conducted, more insights about the
importance carbohydrates have for athletic performance and health have
been revealed. Thus, while the annual barrage of the many low-carb
weight-loss fad diets might cause some confusion about carbohydrates,
when it comes to optimum health and peak athletic performance, there
is no confusion: adequate healthy carbohydrate consumption is an
essential part of an athlete’s nutrition program.

Also important is consuming an adequate daily supply of carbohydrates

as part of a comprehensive, mixed nutrient diet and from use of sports
supplements. As such, for peak athletic performance and health,
athletes must consider the type of carbohydrates they eat, the time of
day they eat them, their intake of nutrient cofactors, and adequate Cofactor: a substance that
intake of the other essential nutrients. All these elements together help must be present for another
substance to be able to
maintain the body’s glycogen stores and enhance energy production perform a certain function.
during exercise. Glycogen is a complex molecule that contains glucose
and is found in muscle, the liver, and other tissues. Glycogen therefore
acts as a reserve of glucose energy, which is released when needed to
provide energy for exercising muscles and other parts of the body.
As the glycogen stores are small, and thus quickly depleted, daily
carbohydrate consumption is mandatory to ensure maximum glycogen
stores for peak energy production.

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The rate of carbohydrate digestion, absorption from the digestive system,

rise in blood sugar levels, utilization as energy substrates, and storage in
the body as glycogen are all important considerations. To gain a better
understanding of these dynamics of carbohydrates in the body, the
glycemic index was created, followed by the development of the concept
of glycemic load, which will be reviewed herein.

Athletic Significance of Carbohydrates

• Carbohydrates are a high-energy-producing fuel source for muscles and
other body tissue cells.

• Glucose is the major carbohydrate in the diet and used by the body for
energy.

• Glucose is the primary fuel for the brain and nervous system tissues.

• Complex carbohydrates should be eaten more than simple

carbohydrates should be.

• Carbohydrate ingestion before, during, and after exercise needs to be

timed properly.

• The body stores glucose in the form of glycogen.

• Carbohydrates are involved in maintaining blood glucose levels, which is

vital to physical performance and health.

• Glucose also has a structural role, used to make glucosamine, which is

used to form connective tissues.

Types of Carbohydrates
There are several types of energy-yielding carbohydrates and a diversity
of common and scientific terminology related to dietary carbohydrates,
for example, simple carbohydrates or sugars and complex carbohydrates
or starches. The various types of carbohydrates are usually based on
the sugar units present. Some of the scientific classification categories
Disaccharide: a simple that will be elaborated on include monosaccharides, disaccharides,
carbohydrate composed of
oligosaccharides, and polysaccharides. [Note that terminology related
two sugar molecules.
to carbohydrates and the other nutrients reviewed in the other units
Polysaccharide: a
complex carbohydrate. continually evolves and can sometimes vary.]

The following information reviews some further details about

the different types of carbohydrates. One point of interest about
carbohydrates is how they behave and function in the body and how

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 Carbohydrates: The Ultimate Performance Food | 79

to use this knowledge for athletic performance carbohydrates, sucrose, maltose, lactose, and
advantage. In addition to the different rates glucose (dextrose), for example.
of absorption from the digestive system, the
The principal monosaccharide’s in food are
primary monosaccharide’s, glucose and fructose,
glucose and fructose. Glucose, also called
behave differently in the body, with glucose being
dextrose or grape sugar, is found commonly
used more rapidly and efficiently by muscles
in fruit, sweet corn, corn syrup, certain roots,
and fructose being more slowly used. Getting
and honey. Glucose is also contained in starch/
the carbohydrate balancing act perfected is vital
complex carbohydrates. Fructose, also called
for intensively training athletes. This is also
levulose or fruit sugar, is found occurring freely,
important for recreational athletes and fitness
as part of the sucrose molecule in honey and
exercisers but less critical when compared with
fruit, and is part of the fructans.
competitive elite athletes who have to maintain
championship peak performance. Although glucose has traditionally been a
frequently encountered dietary sugar, fructose’s
Simple Carbohydrates popularity began due to the discovery that it
does not cause the rapid rise and fall in the
The main types of simple carbohydrates include
blood sugar level that glucose does. Researchers
the following:
realized this in the early 1980s when they
Monosaccharides. Monosaccharide carbohy- undertook the first extensive comparisons of
drates consist of one sugar unit. Examples of the various carbohydrates and carbohydrate-
monosaccharide type carbohydrates include containing foods. They found that the main
glucose (also referred to as dextrose) and reason fructose is easier on the blood sugar
fructose. level is that the body absorbs and metabolizes
fructose at a slower rate than it does glucose. In
Disaccharides. Disaccharides are compounds fact, fructose must be converted to glucose in
consisting of two sugar units. Examples of the liver before being used by most cells in the
disaccharides include sucrose, which is made body, which further explains why it causes a
of one molecule each of glucose and fructose; slower rise in blood glucose levels. Because of the
maltose, made of two molecules of glucose; and slower utilization of fructose and slower rise in
lactose, made of one molecule each of glucose blood sugar levels, it was thought that fructose
and galactose. ingestion could help people with blood sugar
control problems or issues, such as diabetics,
The term sugar is a catchall term that refers to
manage their blood sugar levels. Keep in mind
various types of carbohydrates. For example,
that useful for nutritional management of
table sugar is sucrose, sugar units may refer to
diabetics does not necessarily mean good for
glucose or fructose, and blood sugar usually
health or improved athletic performance.
refers to the glucose present in the blood. This
means that your blood sugar levels, glucose Fructose-containing products began to appear
levels, are influenced by the type of carbohydrate on the market in health food stores, promoted
glucose sources you ingest—complex as a healthy alternative natural sweetener to

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table sugar. Although fructose may seem to effects on the blood-sugar level, fructose has
have benefits over the other sugars from a blood also been found to help replenish the glycogen
glucose response point of view, it is still a sugar stores in the liver at a fast rate. Note that glucose
and supplies raw energy without much other replenishes both liver and muscle glycogen
essential nutrition. Another issue with fructose quickly. This is important because the brain
is that increasing the amount being consumed derives most of its energy supply from the
can tend to increase fatty acid production in the liver, which is especially low in glycogen in the
liver, leading to fatty liver, higher levels of fatty morning. Perhaps the desire to drink juices
acids in the blood stream, and an increase in high in fructose in the morning is more than
total body fat stores. Furthermore, the athletic coincidence, as these juices provide the mental
benefits of increasing consumption of fructose surge of energy that so many people need to start
are not clearly apparent. Glucose can be used the day. Note that once fructose is mixed with
by all cells, but fructose primarily needs to food, its benefits on blood sugar level becomes
be metabolized in the liver first and then is less clear depending on the other carbohydrates
metabolized for energy. This is important in contained in the meal.
muscle cell bio-energetics because muscle cells
The blood sugar balancing act becomes a little
can use glucose more quickly than they can use
tricky based on information that is in circulation,
fructose. Some research indicates fructose may
primarily weight-loss related. Weight loss is a
play a role in replenishing liver glycogen at a
special subject treated in UNIT 18, which should
higher rate, at the right amount, based on each
not be confused with nutrition for maximum
athlete and in the context of his or her entire
athletic performance. Athletes need to consume
diet composition. Also, some research indicated
two or more times the number of calories per
that athletes engaging in lower intensity, longer
day than nonathletic people do. Athletes need
duration endurance-type exercise, over two
to be eating foods that are more easily digested
hours for example, may benefit from glucose and
and can be used by the body for fuel and growth.
fructose ingestion, along with adequate water
Athletes typically have the opposite problem
and electrolytes. This is thought to be because at
compared with overweight people, meaning that
the lower intensity, longer duration exercise, the
athletes use calories at a faster rate and may have
metabolism is able to maximize the utilization
trouble ingesting adequate amounts of calories.
pathways of glucose and fructose.
Overall glucose, principally from healthy
In addition, remember that eating too much of
complex carbohydrates, is the primary or
any sugar can lead to tooth decay. Concern over
preferred carbohydrate energy source for
cavities is not just for children. Adult athletes
athletic people, but the strategic consumption
with tooth decay may end up with disrupted
of sucrose, glucose, and fructose can also play a
athletic seasons due to root canal surgery or
role in sports nutrition. Pure fructose-containing
tooth extractions.
products can be useful to help slow down the
Fructose does have its place in nutrition in rise in blood sugar level and have applications for
minor amounts. In addition to its slow rising people with weight maintenance concerns.

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 Carbohydrates: The Ultimate Performance Food | 81

In the current food supply, fructose and glucose come together in High-intensity sweeteners:
ingredients commonly used
a few different ways in prepared foods. as sugar substitutes or sugar
alternatives to sweeten and
As sugar, which is 50% fructose and 50% glucose enhance the flavor of foods
and beverages. People may
As high fructose corn syrup, which is about 42% to 55% fructose,
choose these sweeteners in
and the remaining portion glucose. place of sugar for a number of
reasons, including that they
In varying amounts in energy drinks, sports drinks, gels, nutrition contribute few or no calories
bars, and other prepared foods. to the diet. Because high-
intensity sweeteners are many
Although most people have a constant struggle with reducing times sweeter than table sugar
(sucrose), smaller amounts of
consumption of refined sugars, a variety of synthetic and natural high-intensity sweeteners are
sugar substitutes are present in foods and supplements. The needed to achieve the same level
of sweetness as sugar in food
following article from the FDA provides an overview on Sugar and beverages. (Other terms
Substitutes, followed by short mention about the natural sugar commonly used to refer to sugar
substitutes or alternatives include
substitute referred to as Stevia. Note that while students requested non-caloric, low-calorie, no-
more information about this topic to have a better understanding calorie, and artificial sweeteners,
which may have different
of this subject matter for communicating with clients, avoiding or definitions and applications. A
minimizing the use of nonessential nutrient synthetic additives high-intensity sweetener may or
is usually preferred for a high-performance athletic diet. may not be non-caloric, low-
calorie, no-calorie, or artificial.)

Sugar Substitute Overview from the FDA

How Sweet It Is: All about Sugar Substitutes
Whether it’s to cut down on the number of calories they consume or any of a variety of other reasons,
some people use sugar substitutes—also called high-intensity sweeteners—to sweeten and add
flavor to their foods. They can be used alone to sweeten foods and beverages such as iced tea or coffee
or as an ingredient in other products. There are a number of sugar substitutes on the market from
which to choose.
“Sugar substitutes are called ‘high-intensity’ because small amounts pack a large punch when it
comes to sweetness,” says Captain Andrew Zajac, US Public Health Service (USPHS), director of the
Division of Petition Review at the Food and Drug Administration (FDA).
According to Zajac, unlike sweeteners such as sugar, honey, or molasses, high-intensity sweeteners
add few or no calories to the foods they flavor. Also, high-intensity sweeteners generally do not raise
blood sugar levels.
The FDA has approved a new high-intensity sweetener called advantame.
Advantame—which does not yet have a brand name (such as Sweet’N Low, a brand name for saccha-
rin, or Equal, a brand name for aspartame)—has been approved as a new food additive for use as a
sweetener and flavor enhancer in foods, except meat and poultry.

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Examples of uses for which advantame has been approved include baked goods, non-alcoholic bev-
erages (including soft drinks), chewing gum, confections and frostings, frozen desserts, gelatins and
puddings, jams and jellies, processed fruits and fruit juices, toppings, and syrups.

How Do You Know It’s Safe?

FDA is required by law to review all new food additives for safety before they can go on the market.
The process begins when a company submits a food additive petition to FDA seeking approval. One
exception is for substances “generally recognized as safe,” or GRAS, because those substances are
generally recognized by qualified experts as safe under the conditions of intended use and are exempt
from the food additive approval process.
Zajac explains that the agency’s scientists thoroughly review all the scientific evidence submitted by a
company to ensure the product is safe for the intended use.
“In determining the safety of advantame, FDA reviewed data from 37 animal and human studies de-
signed to identify possible toxic (harmful) effects, including effects on the immune, reproductive and
developmental, and nervous systems,” Zajac says.
Advantame is chemically related to aspartame, and certain individuals should avoid or restrict the use
of aspartame. To that end, FDA evaluated whether the same individuals should avoid or restrict advan-
tame, as well.
People who have phenylketonuria (PKU), a rare genetic disorder, have a difficult time metabolizing
phenylalanine, a component of both aspartame and advantame. Newborns are tested for PKU using a
common “heel-prick” test before they leave the hospital.
Foods containing aspartame must bear an information statement for people with PKU alerting them
about the presence of phenylalanine. But advantame is much sweeter than aspartame, so only a very
small amount needs to be used to reach the same level of sweetness. As a result, foods containing
advantame do not need to bear that statement.

Five Already on the Market

The last high-intensity sweetener approved by FDA was Neotame (brand name Newtame) in 2002.
There are four others on the market They include:
• Saccharin, was first discovered and used in 1879, before the current food additive approval
process came into effect in 1958. Brand names include Sweet‘N Low

• Aspartame, first approved for use in 1981. Brand names include Equal

• Acesulfame potassium (Ace-K), first approved for use in 1988. Brand names include Sweet One

• Sucralose, first approved for use in 1998. Brand name is Splenda

In addition to the six high-intensity sweeteners that are FDA-approved as food additives, the agency
has received and has not questioned GRAS notices for two types of plant/fruit-based high-intensity

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 Carbohydrates: The Ultimate Performance Food | 83

sweeteners: certain steviol glycosides obtained from the leaves of the stevia plant (Stevia rebaudiana
(Bertoni) Bertoni) and extracts obtained from Siraitia grosvenorii Swingle fruit, also known as Luo Han
Guo or monk fruit.
While these high-intensity sweeteners are considered safe for their intended uses, certain individuals
may have a particular sensitivity or adverse reaction to any food substance. Consumers should share
with their health care provider any concerns they have about a negative food reaction.
In addition, FDA encourages consumers to report any adverse events through MedWatch: FDA’s safety
information and adverse event reporting program.
This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated
products.

May 19, 2014 http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm397711.htm

The Natural Sugar-Free Sweetener-Stevia

The plant Stevia rebaudiana, also referred to as Stevia, sugarleaf, sweetleaf or candyleaf, is the source
of plant compounds that have sweetness. The active compounds of stevia leaves are referred to as
steviol glycosides. The main compounds sold as sweeteners are stevioside and rebaudioside). Current-
ly in the United States, FDA has not objected to the use of highly refined stevia preparations in food
products. Rebaudioside A is a principle purified and concentrated molecule recognized by FDA as the
sweetener that is obtained from Stevia leaves.

Complex Carbohydrates and amylopectin (made of chains of glucose

molecules). Glycogen is an example of another
The main types of complex
type of polysaccharide that is used to store
carbohydrates include:
carbohydrate energy in the body.
Oligosaccharides. Complex carbohydrates
Fiber. Another kind of complex carbohydrate
containing 3 to 10 sugar units. Some examples
is fiber, which is described as the carbohydrates
include raffinose and stachyose. Note that it is
(also lignins, a type of complex organic
common to encounter oligosaccharides also
polymers) that are not digested and not absorbed
being referred to polysaccharides.
in the small intestine. Fiber is also referred to as
Polysaccharides. Polysaccharides are roughage or nonstarchy polysaccharides. Some
complex carbohydrates that have 10 or more fiber examples include cellulose, hemicellulose,
monosaccharide molecules linked together. pectin, fructans, beta-glucans, and a variety
The main dietary, energy yielding food source of gums, mucilage, and algal polysaccharides.
polysaccharide is referred to as starch (amylum) Fibers are usually components of plant cell
and consists of amylose (a linear molecule) walls and intracellular structures. The Dietary

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Guideline definition is also noteworthy to particle sizes, which can be digested more
review as follows: Fiber—Total fiber is the sum when compared with coarser or lager complex
of dietary fiber and functional fiber. “Dietary carbohydrate particle sizes.
fiber consists of nondigestible carbohydrates
When starch-containing foods are eaten, they
and lignin that are intrinsic and intact in
are usually digested at a slow to moderate rate,
plants (i.e., the fiber naturally occurring in
releasing glucose molecules from the intestines
foods). Functional fiber consists of isolated,
into the bloodstream at a steady rate. This is
nondigestible carbohydrates that have beneficial
unlike simple glucose, which is absorbed quickly
physiological effects in humans. Functional
from the digestive system into the bloodstream.
fibers are either extracted from natural sources
Quick absorption leads to a rapid and high blood
or are synthetically manufactured and added to
sugar level. You will read below that there are
foods, beverages, and supplements.”
certain times a rapid absorption of glucose is
The two polysaccharides that are the most advantageous, but for the general population
important energy contributors to the body are and weight-conscious athletes, for most meals,
starch from foods and from glycogen stored in a slower to moderate rate of carbohydrate
the body. Processed forms of polysaccharides digestion is more desirable. Athletes consuming
include maltodextrin and glucose polymers, higher numbers of calories, a few to several
which can be shorter glucose polymers than thousand calories per day, many need to
starch, and are commonly used in sports drinks maintain a higher rate of digestion and nutrient
because they are more soluble in water than absorption, so consuming meals that have a
starch is. Starch occurs in various parts of plants moderate to high rate of carbohydrate digestion
and consists of long chains of glucose units. The can be more desirable.
primary forms of starch molecules are amylose
and amylopectin. Starch occurs in varying Fiber
amounts in plant foods, such as grains, fruits, Fiber is generally though as being indigestible by
roots, vegetables, pasta, bread, and legumes. the small intestine. Fiber does play an important
role as the main contributor to the roughage
Some research indicates the amylopectin is content of the diet. Among its protective
digested faster than amylase is and that the qualities, roughage, which is also known as
glucose from amylopectin is absorbed into the dietary fiber, helps promote efficient intestinal
blood faster. This may explain why different functioning and aids the absorption of sugars
complex carbohydrate-containing foods have into the bloodstream. A formal definition of fiber
different glycemic index values and affect the rise developed in the United States by the Institute of
in blood sugar levels at different rates. However, Medicine is as follows: Dietary Fiber consists of
there are other factors, such as fiber content that nondigestible carbohydrates and lignin that are
affect digestibility of carbohydrate foods. Also, intrinsic and intact in plants. Put another way,
the size of how fine flour is ground; the finer the dietary fiber consists of nondigestible food plant
flour, the higher the glycemic index becomes. carbohydrates and lignin in which the plant
Finer flour means smaller complex carbohydrate matrix is largely intact.

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There are two types of dietary fiber, and most sugar) by preventing rapid rises in blood glucose
plant foods contain some of each kind: following a meal.

Soluble fiber dissolves in water to form a Insoluble fiber does not dissolve in water
thick gel-like substance in the stomach. It is and passes through the gastrointestinal tract
broken down by bacteria in the large intestine relatively intact and, therefore, is not a source of
and provides some calories, about 2 kilocals calories. Insoluble fiber provides “bulk” for stool
or Calories per gram, from the carbohydrate formation and speeds up the movement of food
breakdown products of bacterial metabolism. and waste through the digestive system, which
Soluble fiber can interfere with the absorption can help prevent constipation.
of dietary fat and cholesterol. This, in turn,
Both soluble and insoluble fiber may contribute
can help lower low-density lipoprotein (LDL or
to the feeling of fullness.
“bad”) cholesterol levels in the blood. Soluble
fiber also slows digestion and the rate at which Functional Fiber consists of isolated,
carbohydrates and other nutrients are absorbed nondigestible carbohydrates that have beneficial
into the bloodstream. This can help control the physiological effects in humans. Functional fibers
level of blood glucose (often referred to as blood may be isolated or extracted using chemical,

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enzymatic, or aqueous steps. Synthetically absorption. This interference, however, can

manufactured or naturally occurring isolated be offset by a daily dietary supplement or
oligosaccharides and manufactured resistant even by the nutrients already present in the
starch are included in this definition. high-fiber foods themselves—another reason
for consuming healthy nutrient dense foods.
Total Fiber is the sum of dietary fiber and
One issue of potential concern for athletes is
functional fiber.
getting too much fiber from the high-calorie
Fiber is usually found along with digestible diets required for energy balance during high-
simple and complex carbohydrates in various volume training periods and competition
plant foods, such as fruits, leaves, stalks, and season. Another concern is fiber’s potential effect
the outer coverings of grains, nuts, seeds, and on slowing down digestion and suppressing
legumes. Dietary fiber helps soften the stool appetite. Then there is digestive upset from
and encourages normal elimination. Fiber-rich higher fiber diets experienced by some people,
diets also promote satiety. In addition, research causing gas and having a laxative effect. Thus,
has shown that people who eat high-fiber diets health professionals may need to strive to keep
experience reduced rates of cardiovascular fiber intake at a healthy level, but on the low end
disease, colon cancer, and diabetes. A high-fiber of the range.
diet works best when it includes plenty of fluids.
Some supplements are specifically made to be Overview of Some Common Dietary and
pure fiber. Functional Fibers
How much dietary fiber do adults need to gain The following is a short overview of the common
these benefits? The National Research Council dietary fibers and functional fibers found in
established the daily adequate intake range of whole foods, processed foods, specialty foods,
fiber for adults, ranges from 21 to 38 grams. and dietary supplements.
Some health experts recommend even a higher
Cellulose. Cellulose is a nondigestible
daily fiber intake. The estimated average fiber
polysaccharide consisting of glucose molecules
intake for men and women is only 12 to 18
linked together with a special bond. Cellulose
grams per day. The 2015 Dietary Guidelines
is the main structural compound of plant cell
recommend 14 grams of fiber per 1,000 calories
walls. The beta-(1,4) bond that links the glucose
consumed. A 2,000-calorie-per-day diet would
molecules cannot be digested by humans, as
aim at supplying at least 28 grams of fiber. It’s
humans lack digestive enzymes to break the
clear from these numbers that many people are
beta-(1,4) linkages. In addition to cellulose that
eating diets too low in fiber. You can achieve this
occurs naturally in foods, it is also separated
intake goal by eating foods high in fiber and by
out to make powder cellulose to use in food and
adding a fiber supplement to your diet.
supplement formations. Some uses of powdered
It is important to note that there is some cellulose include its being added to foods as a
concern that diets high in fiber may interfere thickening agent. Cellulose may decrease transit
with mineral and other essential nutrient time in the GI tract.

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 Carbohydrates: The Ultimate Performance Food | 87

Chitin. Chitin, chemically know as (poly-N- can contain a terminal molecule of glucose at the
acetyl-glucosamine) is one of the most common end of their chains. They are also referred to as
natural polymers. Chitin is present in the group fructans. Inulin and oligofructose are examples
of animals called arthropods. It occurs in the and occur naturally in a variety of plants. Some
shells of crustaceans and insects. Chitin is also plant sources of fructans include chicory root,
found in other organisms including fungi, algae, onions, and Jerusalem artichoke. As most fibers,
and yeast. Commercially, chitin is isolated from the human digestive system lacks enzymes to
the shells of crustaceans after the edible parts digest them. However, certain bacteria in the
have been removed, such as shrimp, lobsters, colon can metabolize fructans. Fructans tend
and crabs. Chitin is an amino-polysaccharide to be the preferred food for the “beneficial”
that contains the beta-(1,4) linkages present in intestinal bacteria. Fructans, like inulin, are
cellulose. used in dietary supplements aimed at improving
gastrointestinal wellness. As dietary supplement
Chitosan. Chitosan, chemically know as poly-
ingredients, they are also referred to probiotics
D-glucosamine, also occurs naturally and is
because they cause the beneficial intestinal
produced commercially from chitin using a
bacterial to increase in number.
simple manufacturing process. Chitosan is
sometimes used in dietary supplements for its Gums. Gums consist of a diverse group of
fat-binding abilities. Some research has shown polysaccharides. They are typically derived from
that ingesting chitosan may slow down the seeds for commercial applications. Gums are
absorption of cholesterol and fatty acids. characteristically viscous in texture. One type
of gum used in foods and supplements is called
It is interesting to note that in the
guar gum, which is produced by the milling of
manufacturing processing of chitin and c
the endosperm portion of the guar seed and is
hitosan, the glucosamine found in supplement
high in galactomannans. Galactomannans are
products, can also be produced. As an aside,
highly viscous soluble fibers and are typically
there is also a process for creating glucosamine
used as food ingredients for their thickening and
from plant sources.
gelling properties. Guar gum is also a common
Beta-Glucans (β-Glucans). β-glucans are ingredient used in some fiber supplements.
polysaccharides of branched glucose resides.
Hemicelluloses. Hemicelluloses are a group of
These β-linked D-glucopyranose polymers are
polysaccharides found in plant cell walls. These
found in fungi, algae, and other plants. Barley,
polymers can consist of glucose, arabinose,
oat, and psyllium products contain beta-glucans.
mannose, xylose, and galacturonic acid. One
Beta-glucans are considered a soluble fiber and
type of hemicellulose you will see used in
have cholesterol-binding properties. Therefore,
food or supplement products is glucomannan.
foods high in beta- glucans are recognized for
Glucomannan is a viscous soluble fiber that
their cholesterol-lowering properties.
absorbs water and is sometimes used in the
Fructo-oligosaccharide (FOS ). Fructo- treatment of constipation or to promote
oligosaccharides are polymers of fructose and intestinal regularity. Glucomannan may also

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have cholesterol-lowering effects similar to

beta-glucan. Some research indicates that it Prebiotics
may help with appetite control. Similar to other
Prebiotics is a term used in relation to probi-
fiber supplement-type products, glucomannan otics, the live microorganisms in the digestive
products are usually ingested by adding the tract that have beneficial effects. These types
glucomannan powder to water and then of carbohydrates are usually not very digest-
ingesting/drinking the beverage. ible by humans, but digestible by the probi-
otics and are referred to as prebiotics because
Pectins. Pectins are found in the cell wall and they help probiotics to grow and maintain a
intracellular tissues of many fruits and berries. good population in the intestines. Inulin is a
Pectins consist of galacturonic acid units with primary prebiotic found in foods and supple-
rhamnose interspersed in linear chains. Pectins ments. Inulin is primarily a polysaccharide
of fructose units, but also contains a glucose
are also water-soluble viscous fiber. Fruits
molecule at the end of each fructose chain.
and vegetables contain about 5 to 10 percent
naturally occurring pectin. Commercially,
pectins are typically extracted from citrus peels
and apple pomace. Isolated pectins have gelling to note that the composition and amount of
properties and are added to jams, jellies, and the beverage, food, or meal being digested will
other foods. Pectins are sometimes added to determine the rate at which the stomach empties,
dietary supplement and other food products to also called the gastric emptying rate.
increase the fiber content, typically along with Starting with pure water, in general, water can
other types of fibers. empty from the stomach quickly. Depending
An interesting aside concerning pectins is their on the amount and temperature of the water
use in some cough and sore throat lozenge being ingested, water can leave the stomach
products. They have the ability to soothe and enter into intestines within a few minutes
inflamed and irritated tissues, and this helps to several minutes in most cases and perhaps
alleviate sore throat and mouth. up to 30 minutes. Keep in mind that this is an
approximate range of stomach emptying for
water and will vary depending on the individual.
Digestion of Also, when it comes to just water intake, in
Carbohydrates general and during exercise, a larger quantity
of ingested water generally empties from the
The chemical digestion of carbohydrates begins
stomach faster than a smaller quantity does.
immediately in the mouth via enzymes that
are present in the saliva and continues in the More details about hydration will be reviewed in
intestines where digestive juices further break UNIT 6, but some basics are needed here too, as
down the long chains of glucose that make up drinking a carbohydrate beverage can be useful
disaccharides or polysaccharides. Maximum for most athletes during their training and for
absorption occurs once the stomach empties many types of athletes depending on the length
its contents into the intestines. It is important of the athletic event. Maintaining adequate

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 Carbohydrates: The Ultimate Performance Food | 89

hydration is important for all athletes and fitness body are used, and blood flow is diverted to the
exercisers for all sports and training. Therefore, it digestive system. As these are also vital bodily
is mandatory to begin exercise in a well-hydrated resources needed for the exercising muscles, if
condition and to periodically drink water during the body is still digesting a meal when exercise
exercise and athletic events. begins, the amounts of fluids and blood flow
available to muscles for peak performance
When it comes to regular meals, snacks, and could be reduced. Noting that some sports
other solid foods, depending on their size and require strategic ingestion of energy-containing
contents, it can take one to a few hours for the beverages during competition and training that
stomach contents to completely empty into work in harmony with the digestive system
the intestines. Keep in mind that the stomach functioning. In addition, the rules for fitness
usually empties the contents of a meal slowly in exercisers have some flexibility because peak
squirts of digested fluid, a little at a time. Once athletic performance is not required, although
the contents are in the intestines, it can take sometimes desirable.
another one to few hours for the nutrients to be
absorbed into the body. These issues of the relationship between what is
being ingested and the rate of digestion are of
Thus, from start to finish, it can take hours particular importance to competitive athletes
for nutrients ingested from a meal to clear wanting to be certain they are properly fueled
the gastrointestinal tract and be completely for maximum performance. This is important
absorbed into the body. This rate of digestion to athletes not just for competitions, but also
varies based on the meal size and food/nutrient for training sessions. As such, start thinking
composition but also based on the individual’s about how a pre-competition or pre-exercise
digestive system abilities and rate. A nutritional meal or beverage is going to be digested and
digestion challenge for most athletes is to absorbed to be available in your body for
ingest foods for a healthy but faster rate of utilization and not still in your stomach and or
digestion to absorb the nutrients they need, intestines being digested. Also, think about how
which is typically double or more compared your competition or workout beverage is being
to nonathletes. The faster rate of digestion is digested to be used during physical activity.
required to nourish and replenish the body on
Ask yourself this: is the pre-exercise meal just
a daily basis and for some athletes who need to
sitting in the stomach causing belching and
consume calorie-containing beverages during other gastrointestinal disruption?
exercise to maintain their peak performance.
Is it slowing down the emptying rate of the
stomach as to cause dehydration and early onset
For athletes who consume higher amounts of
of fatigue or blood flow conflicts between the
calories, digesting meals at a faster rate can be digestion system and muscles?
an important factor to properly nourish the
body—allowing for a cleared gastrointestinal One goal in endurance performance sports
track of the previous meal eaten to enable peak nutrition was to determine how to best provide
performance. During digestion, fluids from the maximum hydration and also provide some

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energy to spare the body’s supply of glycogen athletes with a primary goal of losing body fat
during athletic competition and training that and perhaps may want to maximize fat use
lasted for a period that due to its length depleted during exercise for fat-loss purposes.
the body’s glycogen stores. During strength
Regarding ingestion of a carbohydrate beverage
and aerobic exercise, glucose is a primary high-
during exercise, generally: dilute 4 percent to 8
energy source, and it is beneficial to prevent the
percent glucose solutions, empty the stomach
depletion of the body’s supply of glucose during
at a fast enough rate to supply meaningful
physical activity. More will be explained about
amounts of water and energy during exercise,
this below.
to help maintain high physical performance
Therefore, for some athletes, and other people longer. As the concentration of the solution
who are undergoing physical activity for increases, the rate of stomach emptying can be
prolonged periods, ingesting a carbohydrate- slower. This depends on the individual and his
containing beverage can help the body maintain or her conditioning. Most studies examining
a supply of high-energy carbohydrates for the effects of carbohydrate energy beverages
maintaining peak physical performance and during exercise were conducted during single-
mental performance, too, as glucose is the event observations; the athletes show up that day,
primary fuel for the brain and for exercising with no prior experience drinking the beverage
muscles. As the duration of exercise progresses, during exercise. This limits the scope of results,
the body’s use of fatty acids for fuel increases, but as there is evidence that the gastrointestinal
high-energy glucose is still used at a high rate system can become conditioned over a period
during exercise as long as glucose is present. of carbohydrate drink training to be better at
absorption during exercise. In other words,
Research continues to focus on determining
when athletes make drinking beverages part
what type and amount of carbohydrates could
of their practice, their gastrointestinal system
be added to water that would not reduce the
will become better conditioned to digest and
fast stomach-emptying rate that is possible
absorb the beverage during exercise. Thus,
with water alone. Keeping in mind that most
when practicing to be better “on the run,” it
of the initial and majority of research was
is important to also practice being better at
conducted using endurance athletes, it was
“drinking on the run.”
determined experimentally that very dilute,
low concentration carbohydrate-containing In addition, other ingredients added to the
beverages were able to pass through the digestive beverage must be considered, as their presence
system quickly during exercise and could be will increase the total concentration of the
absorbed at a rate that could both rehydrate beverage solution. These usually include
and supply an external source of carbohydrate mineral electrolytes, such as sodium, chloride,
energy. It was also determined that providing magnesium and potassium that are lost via
an ingested source of carbohydrate beverages sweat during exercise or might help increase
during exercise can reduce fat metabolism the rate of water and carbohydrate absorption.
during exercise. This may be a concern of Sometimes amino acids and other ingredients

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 Carbohydrates: The Ultimate Performance Food | 91

are added to the exercise energy drinks. As most especially important for athletes and individuals
drinks report the nutrition ingredient content in undergoing physical activity for a few to several
grams and liquid contents in both ounces and hours, during which meal breaks are needed. For
milliliters, you can make a rough estimate of the ultra-endurance events, this means conditioning
percent concentration of your exercise beverage the body to “eat on the run,” in addition to
using this label information. consuming adequate hydration beverages,
and becomes an important part of the overall
For estimating the percentage of a solution, you
training and conditioning program.
total carbohydrate and other nutrient contents
on a gram basis for a serving size and divide this As such, drinking/eating is part of practice for
number by the mL (milliliters) of the serving most athletes. Yes, do not wait until the day of
size and then multiply this number by 100. This the competition to start ingesting beverages
will give you the approximate percentage of the or eating performance foods during physical
solution. For example, 8 grams divided by 200 activity. Conditioning an athlete’s body during
mL = 0.04. Then, 0.04 times 100 = 4 percent. practice and training to ingest drinks and/or
For multiple servings, use the same approach, performance foods is required to determine what
adding up the nutrient contents and fluid volume works best with their digestive system. Realize
of all of the servings. You can also check with that it can take several days or longer for the
the manufacturer of the product, which is highly digestive system to adjust. For long-distance
recommended for competitive athletes who need athletes performing their physical activity on a
the most accurate nutrient content information. continual basis, ingesting fluids is usually not a
problem. However, for athletes who are in “stop
Be aware that as more research is being and go sports,” like soccer, basketball, tennis,
conducted on the upper range of beverage and football, or “jumping sports” like volleyball,
concentration, there is some indication there may be certain challenges associated with
that under certain circumstances, higher “stomaching” an exercise beverage that may be
concentrations may also be feasible. For the swishing around until the stomach empties.
competitive athlete, this is something to Therefore, development of individualized
experiment with in conjunction with health exercise/competition hydration and energy
professionals to determine what works best for beverage consumption strategies is often needed.
each individual athlete.
Use of carbohydrate beverages becomes more
Intensity and duration of exercise also play important in athletic events that are longer,
roles in the hydration and carbohydrate which may result in depleting the body’s muscle
utilization dynamics. First it must be realized and liver glycogen stores. This also depends
that there is a replenishment limitation of on how adequate the glycogen stores are at the
hydration and carbohydrate beverage intake, beginning of exercise. Therefore, it is extremely
where at high-performance levels, water loss important to maintain proper caloric and
and carbohydrate utilization exceeds what can carbohydrate intake all day long, each day, to
be replenished during exercise. This becomes ensure adequate glycogen replenishment and

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maintenance. Assuming glycogen stores are measure of the differential absorption rates of
adequate to begin with, glycogen depletion carbohydrates and carbohydrate foods and their
to the point of reducing athletic performance effect on blood glucose levels is measured using
may become an issue after about 45 minutes the glycemic index, reviewed below in detail.
of continuous strenuous exercise. This will be The intensity of exercise also affects the
elaborated on in the following sections. metabolism of carbohydrates during exercise—to
Once carbohydrates reach the intestines, glucose maintain a balance of glucose production from
and fructose are absorbed at their respective liver and muscle glycogen stores and glucose
rates, with glucose taken up more quickly than uptake and utilization by the cells for energy. In
fructose is; galactose is absorbed similar to how the early days, it was observed that exercising
fructose is. When complex carbohydrates are muscles (contracting muscles) had what
eaten, either alone or with sugars, their short appeared to be an insulin-independent ability to
chains of glucose polymers release glucose for take up and use glucose.
absorption at the rate of digestion and digestive Upon closer examination however, from research
enzyme action. This rate of digestion and with athletes and with diabetics, this is partially
absorption is usually slower when compared with the case, but insulin levels and function during
that of ingesting pure glucose and can provide a exercise appear to be more important than
prolonged supply of glucose to the bloodstream previously thought. With low- to moderate-
and a supply of nutritional energy that further intensity continuous exercise, insulin production
spares and replenishes muscle glycogen. One and levels are present at a baseline level that is

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 Carbohydrates: The Ultimate Performance Food | 93

usually lower than measured when compared regarding the glucose production and glucose
with levels stimulated from nutrient ingestion utilization model during exercise is that after
during rest. As exercise progresses, the insulin intense exercise, a rapid increase in insulin
levels eventually begin to decline as the duration levels is observed. The need for the increase of
of exercise progresses. Some researchers point post-intense exercise insulin levels is thought
out that the insulin production and levels during to be a result of the high-intensity exercise-
exercise may be skewed on the low side due stimulated endogenous liver production and
to rapid insulin use from exercising muscles. rapid glucose release and subsequent rapid
Whatever the case may be, with new insights to rise in blood glucose levels. Under intense
be determined, when glucose becomes present exercise conditions, the strenuously exercising
in the blood stream from ingesting an exercise muscle contractions stimulate glucose uptake,
beverage, or from glucose released from the independent of insulin, so during exercise this
body’s glycogen stores, the production of insulin surge in blood glucose can be delivered and used
is expected to be stimulated at some level. by the intensively contracting muscles. However,
once exercise stops, the muscle contraction-
Another group of substances in the body
stimulated uptake of glucose stops, and the
associated with gluco-regulation during
body needs to increase insulin levels to clear the
exercise is the catecholamines; epinephrine
blood stream of the exercise-induced high levels
and norepinephrine. As moderate exercise
progresses, the catecholamine levels have of glucose to prevent prolonged hyperglycemia:
been measured to increase. However, a more high blood sugar levels.
significant rapid rise in catecholamines occurs These differing effects of exercise intensities
during higher intensity continuous exercise and are of interest to athletes and underscore the
intensive anaerobic, explosive-type exercise and importance of properly warming up and cooling
athletic performance. down at the physical and physiological levels.
It is thought that the catecholamines simulate Understanding of the rates of glucose production
a rapid production of glucose from the liver, and glucose utilization influenced by exercise is
based on experimentally measuring rates of especially important for the diabetic athlete or
catecholamine levels and glucose production fitness exerciser and others who need to keep
during exercise. In addition to the production tight control over their blood sugar levels for
of glucogon-stimulated glucose, this health reasons.
catecholamine-induced glucose production offers
The concern about the presence of high insulin
the exercising muscles a plentiful supply of high-
levels at the beginning of exercise is that it
energy glucose needed for anaerobic metabolism
tends to suppress the liberation of glucose from
and seems to provide a dual control mechanism
glycogen, and fats from body fat stores, and
to endogenous glucose production.
favors the storage of the ingested nutrients.
More research about gluco-regulatory When the body needs energy, between meals
mechanisms is needed to sort out some of these for example, the levels of the hormone glucogon
intricate physiological details. Of significance increase to liberate glucose from glycogen

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stores and fat from fatty acids stores. However, About the Glycemic Index (GI)
it appears that the presence of glucose, from
The glycemic index is a method used to group
ingestion or liberation from glycogen can
carbohydrate foods based on their effect on
stimulate the release of insulin.
blood glucose levels. When a carbohydrate-
A concern regarding insulin levels is not to be containing food is eaten and digested, as it is
starting exercise or athletic events with insulin absorbed from the intestines to the blood stream,
levels being too elevated at the start of exercise a rise in blood sugar occurs, namely glucose. This
as caused by the pre-exercise/pre-event meal or rise is usually accompanied by a rise in insulin.
beverage. High levels of insulin can suppress This rise of blood glucose and insulin that occurs
the liberation and use of energy in the body after consumption of carbohydrate-containing
during exercise, as insulin’s function is to favor foods is then followed by a fall in blood glucose
cell uptake of nutrients. High insulin levels and insulin levels. This rise and fall in blood
can also cause a temporary hypoglycemic glucose can be rapid or slow, depending on the
state: low blood sugar levels. As glucose is a types and amounts of carbohydrate contained in
primary fuel for all physical activity, this could foods and sports nutrition products.
reduce athletic performance. In the traditional Thus, as different carbohydrates and different
athletic competition model, starting ingestion carbohydrate foods have different rates of
of a carbohydrate-containing beverage at the digestion and absorption, researchers wanted to
beginning of physical activity and during devise a way of classifying carbohydrate foods
physical activity, lessens the carbohydrate according to their effect on blood glucose levels.
ingestion insulin level effect, because exercising This initial interest was primarily motivated to
muscle has the ability to stimulate the uptake gain a better understanding of the food intake/
of glucose independent of insulin. The ability insulin production relationship to help improve
of muscle to do this appears to increase with dietary management of diabetes. But as with
increasing levels of exercise intensity / effort. most research, there are other applications,
namely for athletes, fitness, and general health.
In general, carbohydrates are more quickly
released from the stomach to the intestines The glycemic index is defined (determined)
than is either protein or fat. The more protein as the area under the curve for the increase in
and fat that you eat, the longer your stomach blood glucose after the ingestion of a set amount
will take to empty. Logically, therefore, you of carbohydrate in a particular food, in the
should eat and drink foods that are very high two-hour post-ingestion period compared with
in carbohydrates before and during exercise to that of a reference food. The standard amount is
take advantage of this process. Again, this is typically 50 grams, and the reference foods are
why specially designed sports nutrition drinks either glucose or white bread. For example, using
can help increase athletic performance during glucose as the standard, the GI for glucose would
competition and practice, especially the drinks be 100, and the other foods would be compared
that have been tested in clinical research studies. with this reference curve.

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 Carbohydrates: The Ultimate Performance Food | 95

David Jenkins and coworkers reported in their

1981 study, titled “Glycemic index of foods: A
physiological basis for carbohydrate exchange,”
the first research to measure blood glucose
response to foods. A copy of this pioneering
research can be found at http://www.ajcn.org/cgi/
content/abstract/34/3/362. For the majority of
the foods and sugars tested, 50 grams were used.
Blood samples were taken at 0, 15, 30, 45, 60, 90,
and 120 minutes after the meals were eaten. By
comparing the area under the plotted data curve
for each food versus glucose, the Glycemic Index
was born. As the reference point, the GI for
glucose is 100. Most foods measured are below
this value, with few exceptions.

The international table of glycemic index and

glycemic load values was created and updated
by scientists Kaye Foster-Powell, Susanna H.A.
Holt, and Janette C. Brand-Miller and is located
at: http://www.ajcn.org/cgi/content/full/76/1/5.
When you review these comprehensive data,
you will notice that some of the foods use a
three-hour evaluation period, in addition to the
original standard two-hour period. In addition,
insights about carbohydrate digestion and
it is important to realize that although the
metabolism that have applications for planning
reference tables are useful, the GI is food specific.
diets for health, athletic performance, and
Thus, similar foods and products may differ from
management of other diet-related diseases, such
region to region and between different brands
as heart diseases and obesity. Some points to
of the same types of foods. This will become
keep in mind about the GI reference information
apparent when you review the table. Also
are that the 50 grams reference values are small
important to note is that when mixing foods, the
when compared with the amount of foods people
GI can change.
eat, especially athletes. Also, a mixed meal will
The initial interest in the glycemic response of obscure the GI of an individual food. Typically,
foods was thought to have practical applications a meal of different GIs will end up being a
for creating diets to help people with diabetes weighted average, the final GI of the mixed meal
control their blood sugar levels. Eventually this usually being somewhere between the highest
glycemic response research provided important and lowest of the individual GI food values.

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Glycemic Index (GI) Examples of Common Foods

100% 91% to 99% 80% to 90% 70% to 79%

Glucose Lucozade (Sports Corn Flakes Carrots Parsnips Whole Meal Bread
Drink)
Instant Potatoes Millet

Honey White Rice

Broad Beans

Potato

60 to 69 50 to 59 40 to 49

White Bread Buckwheat Oranges & Orange Juice

Brown Rice Spaghetti Whole Meal Spaghetti

Muesli Sweet Corn Porridge Oats

Shredded Wheat All Bran Cereal Sweet Potato

Ryvita Oatmeal Biscuits Beans

Water Biscuits Bananas Raisins Tea Biscuits Peas

Mars Bar Peas

30 to 39 20 to 29 10 to 19

Butter Beans Kidney Beans Peanuts

Tomato Soup Lentils Soya Beans

Haricot Beans Fructose

Black-Eyed Peas

Chick Peas

Golden Delicious Apples

Ice Cream

Skim or Whole Milk

Yogurt

Source of GI data: David J. A. Jenkins, Thomas M. S. Wolever, Rodney H. Taylor, Helen Barker, Hashmein Fielden, Janet
M. Baldwin, Allen C. Bowling, Hillary C. Newman, Alexandra L. Jenkins, and David V. Goff. Glycemic index of foods: a
physiological basis for carbohydratre exchange. The American Journal of Clinical Nutrition 34: March 1981, pp. 362–366.

For more examples of GI and GL values for various foods, refer to the following table that is available online: Atkinson FS, Foster-
Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: 2008. Diabetes Care 2008;31:2281–3.

http://care.diabetesjournals.org/content/31/12/2281?ijkey=a344a60d41d0cb6e6fe9ad93a26bc2c8895be631&keytype2=tf_ipsecsha

By Internet searching “glycemic index” and “glycemic load,” additional reference tables and scientific studies can be located.

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 Carbohydrates: The Ultimate Performance Food | 97

Glycemic Load (GL) There is some growing evidence at the general

population level that people who eat diets with
Since the advent of the glycemic index, a related
higher than average GI and GL values are more
concept was developed called the glycemic load,
prone to becoming overweight or obese. This
abbreviated as GL. Although the glycemic index
notion makes metabolic sense, as the average
of a food provides an expectation of how fast
person overeating a diet abundant in high GI
a food will raise blood sugar levels, the GL is
foods will have higher insulin levels, causing a
a calculation that considers the amount of the
tendency to store more body fat and to hold onto
carbohydrate from food being ingested. It is
it. The growing consensus is that diets with low
ultimately how much of the food ingested that
to moderate GI and GL values will be digested
matters from a blood sugar elevation standpoint.
and processed in the body at a slower rate and
Eating a mouthful of a high GI food will have
cause lower average blood sugar levels and
very little short-term effects on raising blood
insulin levels. Additionally, the thinking is that
sugar levels. However, eating large amounts,
this also allows the body to process the calories
many mouthfuls of a high GI food, will cause a
more effectively for energy use, opposed to the
rapid and sustained high blood sugar level, with
rapid influx of calories from high GI meals,
accompanying stimulation of high insulin levels.
which may cause a surplus of caloric load that
The GL is calculated as follows: encourages fat storage.

When it comes to athletes and physically active

(GI value of the food times the people, the picture changes. Athletes are better
quantity of carbohydrate of the at using calories and use more of them when
food serving)/100
compared with sedentary people, who in contrast
For example,
are leading a low physical activity lifestyle, one
for a food with a GI of 54, and an
available 20 grams of with little or no exercise. As indicated herein,
carbohydrate per serving, there are times that athletes will benefit from
the GL would be
ingesting higher GI beverages and foods. Also,
(54 x 20) / 100 = 10.8
considering the large amount of food athletes
have to consume each day for meeting caloric
Eq. 3.1
and nutrient needs, consumption of a diet that is
It is important to note that the practical easily digested and absorbed may be warranted
applications of using the GI and GL are at times for athletes: a diet that consists of foods
ongoing. One thing is certain though: both the and meals with moderate to high GI and GL
glycemic index and glycemic load measures can ratings. However, for a healthy athlete, low GI
be useful for determining the potential behavior foods/meals can make a good foundation to the
that carbohydrate-containing foods or meals athlete’s diet, along with moderate to high GI
have in the body as related to blood sugar levels foods, meals, and sports nutrition supplements
and the accompanying rise and eventual fall of as may be required to achieve certain athletic
insulin levels. performance nutrition goals.

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For the athletic person, knowing which Insulin Index

carbohydrate foods and sugars will provide a Another index you may encounter related to
quick supply of energy, or will replenish glycogen the glycemic index is called the Insulin Index
stores rapidly, has led to many studies examining or Food Insulin Index. Blood levels of insu-
the different effects of sugar- and carbohydrate- lin are measured in response to an ingested
containing beverages and foods and their effects food or meal. As the blood glucose response
on athletic performance, glycogen status, muscle may not be proportional to the blood insulin
response, measuring the insulin response
growth, immune system function, and other
provides additional information about the
measures of health and performance. body. This also allows testing of other foods
in addition to carbohydrate foods, such as
Carbohydrates in protein and fats. Data collected can also be

the Body-Glucose used to calculate an Insulin Load. The Insulin

Index is primarily used by researchers and
and Glycogen may be useful for medical professionals when
dealing with people who have blood glucose
Glycogen is similar to the starch found in and insulin-related problems.
plants in that it consists of chains of glucose
units. However, glycogen and starch differ in
structure. In addition, although starch occurs way, the liver and muscles act as reservoirs for
only in plants, glycogen occurs only in animals. glucose. The liver’s glycogen supply is used to
Very little glycogen is found in food however. regulate the blood sugar level. Furthermore, the
This is mainly because meat contains only small glucose that is fed into the bloodstream from
amounts of glycogen. Due to the human body’s the liver’s glycogen supply is the main source
small storage capacity for glycogen, it needs of energy for the brain. The brain can use more
a relatively constant supply of carbohydrates than 400 calories per day of glucose from the
throughout the day. The body normally converts liver’s glycogen. Athletes and other physically
a portion of all ingested complex carbohydrates active individuals sometimes have a feeling of
into glycogen, thereby replenishing its limited being bogged down. Many times, this feeling is
glycogen supply. It is estimated that depending due to a low level of liver glycogen. Eating a good
on a person’s size, the total glycogen supply amount of complex carbohydrates, especially
is about 1,800 to 2,600 calories. As control at night, will replenish the glycogen supply and
of blood sugar levels is important for normal restore mental alertness and physical energy.
metabolism and health, the body is constantly High fructose-containing drinks also replenish
storing and releasing glucose based on the influx the liver glycogen.
of glucose from ingestion, between meals, or
Glycogen is not stored by itself in the liver.
during physical activity when energy demands
Rather, it is stored together with water. In
dramatically are increased.
fact, every 1 ounce of glycogen is stored with
In the human body, glycogen is found in all the about 3 ounces of water. This means that when
cells. However, it is present in greater percentages glycogen is used, water is also removed from
in the muscle fibers and liver cells. In this the body. Many fad diets take advantage of this

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 Carbohydrates: The Ultimate Performance Food | 99

phenomenon by requiring a low caloric intake however, and experienced bodybuilders know
coupled with a high protein consumption, which how to add size and hardness to their physiques
causes liver and muscle glycogen to be depleted on contest days for an added competitive edge
in 24 to 48 hours. This glycogen depletion can through manipulation of diet composition.
result in a loss of several pounds of water, which
Understanding glycogen storage and dynamics is
many dieters mistake for a loss of body fat.
a cornerstone of improving athletic performance
Moreover, because most weight-loss diets are low nutritionally. Knowledgeable athletes recognize
in calories, the body eliminates a few pounds that they must keep their muscle and liver
of gastrointestinal bulk within a few days. glycogen stores filled. They acknowledge that
Dieters usually mistake this for a loss of body they must follow a daily nutrition program that
fat. Thus, a week or two of fad dieting may result encourages glycogen replenishment and spares
in a loss of several pounds of water weight and glycogen utilization.
gastrointestinal bulk but perhaps only a mere
Muscle glycogen is preferentially replenished
pound or two of body fat. This is one reason fad
over liver glycogen. As mentioned previously,
dieters quickly, almost overnight, gain back the
this can diminish the supply of glucose available
weight they lost. Understanding this is especially
important for weight-conscious athletes, who to the brain. Researchers have determined a
typically deplete their glycogen supplies on direct correlation between glycogen supply
low-calorie diets, blow up when they return and performance. When glycogen supplies run
to a normal diet, and then have to lose several low or are depleted, physical performance is
pounds again a few days later. By keeping their reduced. This is especially true for endurance
caloric and carbohydrate intakes at normal sports that are more than one to one and a half
levels, athletes can help their bodies work better hours in duration. But strength sport and team
and can maintain their glycogen supplies for sport athletes must also conserve and replenish
better overall performance. glycogen stores every day to keep energy levels
high and to maximize recovery. This glycogen
Glycogen depletion followed by glycogen maintenance translates into steady, faster
replenishment, which is also known as improvements in performance.
glycogen loading (or supercompensation or
carbohydrate loading), can cause the muscles Thus, for the athlete, some carbohydrate
to increase their water content considerably in management goals include the following:
association with the increased glycogen stores. 1. Keep muscle and liver glycogen
When glycogen replenishment is complete, the stores filled;
increased body weight may induce the muscles 2. Structure a daily nutrition program that
to feel heavy and stiff. This may interfere with encourages glycogen replenishment and
physical performance in certain athletic events, spares glycogen utilization; and
particularly in connection with sports that rely 3. Maximize glycogen stores using glycogen
on repeated short bursts of all-out effort, such as loading for endurance sports and for
sprinting, football, and basketball. Bodybuilders tournaments (long competition days) for
can take advantage of this phenomenon, other sports.

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Carbohydrates for Increased

Athletic Performance
To maintain glycogen stores, carbohydrate intake must be considered on
a 24-hour per-day basis and pre-event basis. This means devoting your
attention to several important factors:
1. Daily maintenance of carbohydrate balance for each meal

2. Pre-event and pre-exercise carbohydrate intake increase

3. Selective carbohydrate ingestion during exercise

4. Carbohydrate ingestion after exercise, and in some cases, the

methodical buildup of muscle and liver glycogen prior to an event

5. Carbohydrate loading; for events lasting more than 1 or 1.5 hours or

for tournaments of most sports

6. High intake of complex carbohydrates, with larger amounts of simple

carbohydrates with breakfast, during exercise, and directly after
exercise to quickly replace depleted glycogen stores

Maintaining carbohydrate balance is easily accomplished by eating

several servings of carbohydrates per day. In general, eating a plentiful
amount of complex carbohydrates with each meal is recommended, with
simple carbohydrate intake reserved for special parts of the day. This
means making sure to maintain consumption of carbohydrates every
meal and with snacks.

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 Carbohydrates: The Ultimate Performance Food | 101

Carbohydrates Pre-Exercise, during Exercise, and

Post-Exercise
Details regarding pre-, during, and post-exercise exceeding 90 minutes in length, it is important to
carbohydrate intake are contained in Unit 17 make sure a carbohydrate source and a supply of
along with details regarding sports nutrition electrolytes are in the drink. Preferably, glucose
approaches. The following will provide some or sucrose is mixed with a complex carbohydrate
overview information. like maltodextrin. For events under 90 minutes,
it is still a good practice to drink at least water
Pre-exercise, exercise, and post-exercise
to rehydrate, along with carbohydrates and
carbohydrate ingestion also needs to include
electrolytes, depending on the athlete’s specific
fluid and electrolyte requirements. The pre-
training goals and requirements.
exercise meal is ideally high in carbohydrates,
moderate to low in protein and fat, and eaten The benefits of drinking beverages containing
about two to three hours prior to exercise carbohydrates and electrolytes are less clear
depending on the size of the meal, composition, for exercise lasting less than 90 minutes for
and an athlete’s rate of digestion. Carbohydrate performance, assuming glycogen levels are
type is generally complex and in the low to replenished prior to exercise. The benefits might
medium glycemic index range to provide a not be immediate but may help reserve glycogen
sustained blood sugar level response that can stores and prevent glycogen depletion on a daily
be useful for providing carbohydrate energy basis. Research indicates that many athletes may
in addition to pre and during exercise energy suffer from chronic glycogen depletion, with
drinks. This is important because it takes this decreased performance and increased recovery
long for the stomach to empty and glucose to time. Therefore, pre-exercise and during-exercise
enter the bloodstream. Too much protein, fiber, carbohydrate beverages and other appropriate
and fat in the pre-exercise meal will serve to carbohydrate supplements, with personalized
lengthen the time it takes the stomach to empty. hydration and electrolytes, is an important
Several glasses of water should be consumed sports nutrition practice to enable athletes to
after the pre-exercise meal and 30 minutes before maintain a high level of athlete performance
exercise. Studies have shown that several minutes during exercise/training and competition.
before exercise, drinking fluids with glucose
After any exercise, it is vital to replenish the body
and some electrolytes is the most beneficial in
with water, carbohydrates, protein, and other
sparing the body’s supply of glycogen.
essential nutrients. This can be accomplished
During exercise, water and/or a sports beverage by preparing or purchasing a supplement drink
with water and dilute carbohydrates per serving designed for this purpose, followed by a full
and a supply of electrolytes should be ingested. meal. If training after the last evening meal,
If the carbohydrate and electrolyte content is one option is to prepare and drink a high
too high, the time it takes the stomach to empty carbohydrate multi-nutrient supplement drink
will increase. For practice sessions and events that contains 300 to 600 calories, with vitamins,

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minerals, protein and essential fatty acids. Additional water consumption

will also be required during the post-exercise period, which is appropriate
to replenish the water loss from sweat that could not be prevented during
exercise hydration.

Note: Details about “Glycogen Loading” are provided in Unit 19.

Food and Supplement Sources of

Carbohydrate
Carbohydrates tend to be the cheapest of the macronutrients when
compared with protein and fat. For example, athletes can purchase several
pounds of potatoes for only a few dollars and have a week’s supply of high-
quality complex carbohydrates. Some foods high in carbohydrates (more
than 60 percent of calories) include ready-to-eat and cooked cereals (oats
being one of the favorites) whole-grain breads, crackers, popcorn, rice,
pasta, corn, potatoes, winter squash and yams, and some carbohydrate
supplements.

Supplement sources include carbohydrate sport drinks that vary in

caloric content and carbohydrate type. Caloric content generally runs
from 90 to 400 calories per 8-ounce serving. There are many types, but
they primarily contain either a simple carbohydrate source or a complex
formula containing a mixture of simple carbohydrates, glucose polymers,
Glycogen sparing: the
saving of glycogen by the
and micronutrients. Some research indicates that although you can use
body for other functions. foods alone for glycogen sparing and carbohydrate loading, use of these

Sports Nutrition
 Carbohydrates: The Ultimate Performance Food | 103

special supplement products is slightly better for improving performance.

However, they are also more expensive. Most athletes on a tight budget
will use these special products during the season or the weeks directly
preceding an important competition.

Some examples of foods that contain carbohydrates include the following:

• grains, such as bread, noodles, pasta, crackers, cereals, and rice

• fruits, such as apples, bananas, berries, mangoes, melons, and oranges

• dairy products, such as milk and yogurt

• legumes, including dried beans, lentils, and peas

• snack foods and sweets, such as cakes, cookies, candy, and other desserts

• juices, soft drinks, fruit drinks, sports drinks, and energy drinks that
contain sugars

• vegetables, especially “starchy” vegetables such as potatoes, corn, and

peas

Potatoes, peas, and corn are called starchy vegetables because they are
high in starch. These vegetables have more carbohydrates per serving
than nonstarchy vegetables do. Examples of nonstarchy vegetables are
asparagus, broccoli, carrots, celery, green beans, lettuce and other salad
greens, peppers, spinach, tomatoes, and zucchini.

Conclusion
Carbohydrates are a diverse group of macronutrients that contribute a
major source of high-yielding energy for athletic performance. Athletes
commonly are deficient in total daily carbohydrate intake and need to
make an extra effort to consume the required intake of carbohydrates.
Focusing on healthy types of carbohydrates is also important. Unit 17 will
provide details regarding carbohydrate nutrition guidelines for athletes,
including specialty topics, such as timing nutrient intake and percentage
versus grams per kilogram of body weight carbohydrate-intake approaches.

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Fiber-Containing Food Examples.

Food Standard Calories in Dietary Fiber Calories per Dietary Fiber
Portion Size Standard in Standard 100 per 100
Portion (g) grams (g)
High fiber bran ready-to-eat ½ to ¾ 60 9.1 200 29.3
cereal
Navy beans, cooked ½ 127 9.6 140 10.5
Small white beans, cooked ½ 127 9.3 142 10.4
Yellow beans, cooked ½ 127 9.2 144 10.4
Shredded wheat ready-to-eat 1 155 5.0 321 9.6
cereal (various)
Cranberry (roman) beans, ½ 120 8.9 136 10
cooked
Adzuki beans, cooked ½ 147 8.4 128 7.3
French beans, cooked ½ 114 8.3 129 9.4
Split peas, cooked ½ 114 8.1 116 8.3
Chickpeas, canned ½ 176 8.1 139 6.4
Lentils, cooked ½ 115 7.8 116 7.9
Pinto beans, cooked ½ 122 7.7 143 9
Black turtle beans, cooked ½ 120 7.7 130 8.3
Mung beans, cooked ½ 106 7.7 105 7.6
Black beans, cooked ½ 114 7.5 132 8.7
Artichoke, globe or French, ½ 45 7.2 53 8.6
cooked
Lima beans, cooked ½ 108 6.6 115 7
Great northern beans, canned ½ 149 6.4 114 4.9
White beans, canned ½ 149 6.3 114 4.8
Kidney beans, all types, cooked ½ 112 5.7 127 6.4
Pigeon peas, cooked ½ 102 5.6 121 6.7
Cowpeas, cooked ½ 99 5.6 116 6.5
Wheat bran flakes ready-to-eat ¾ 90 4.9 310 16.9
cereal (various)
Pear, raw 1 medium 101 5.5 57 3.1
Pumpkin seeds, whole, roasted 1 ounce 126 5.2 446 18.4
Baked beans, canned, plain ½ 119 5.2 94 4.1
Soybeans, cooked ½ 149 5.2 173 6
Plain rye wafer crackers 2 wafers 73 5 334 22.9
Avocado ½ 120 5 160 6.7
Broadbeans ½ 94 4.6 110 5.4
Pink beans, cooked ½ 126 4.5 149 5.3
Apple, with skin 1 medium 95 4.4 52 2.4

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 Carbohydrates: The Ultimate Performance Food | 105

Food Standard Calories in Dietary Fiber Calories per Dietary Fiber

Portion Size Standard in Standard 100 per 100
Portion (g) grams (g)
Green peas, cooked (fresh, ½ 59 3.5 69 4.1
frozen, canned)
Refried beans, canned ½ 107 4.4 90 3.7
Chia seeds, dried 1 Tbsp 58 4.1 486 34.4
Bulgur, cooked ½ 76 4.1 83 4.5
Mixed vegetables, cooked from ½ 59 4 65 4.4
frozen
Raspberries ½ 32 4 52 6.5
Blackberries ½ 31 3.8 43 5.3
Collards, cooked ½ 32 3.8 33 4
Soybeans, green, cooked ½ 127 3.8 141 4.2
Prunes, stewed ½ 133 3.8 107 3.1
Sweet potato, baked in skin 1 medium 103 3.8 90 3.3
Figs, dried ¼ 93 3.7 249 9.8
Pumpkin, canned ½ 42 3.6 34 2.9
Potato, baked, with skin 1 medium 163 3.6 94 2.1
Popcorn, air-popped 3 cups 93 3.5 387 14.5
Almonds 1 ounce 164 3.5 579 12.5
Pears, dried ¼ 118 3.4 262 7.5
Whole wheat spaghetti, cooked ½ 87 3.2 124 4.5
Parsnips, cooked ½ 55 3.1 71 4
Sunflower seed kernels, dry 1 ounce 165 3.1 582 11.1
roasted
Orange 1 medium 69 3.1 49 2.2
Banana 1 medium 105 3.1 89 2.6
Guava 1 fruit 37 3 68 5.4
Oat bran muffin 1 small 178 3 270 4.6
Pearled barley, cooked ½ 97 3 123 3.8
Winter squash, cooked ½ 38 2.9 37 2.8
Dates ¼ 104 2.9 282 8
Pistachios, dry roasted 1 ounce 161 2.8 567 9.9
Pecans, oil roasted 1 ounce 203 2.7 715 9.5
Hazelnuts or filberts 1 ounce 178 2.7 628 9.7
Peanuts, oil roasted 1 ounce 170 2.7 599 9.4
Whole wheat paratha bread 1 ounce 92 2.7 326 9.6
Quinoa, cooked ½ 111 2.6 120 2.8

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Key Words
Glycogen Polysaccharide

Insulin High-intensity sweeteners

Cofactor Glycogen sparing

Disaccharide

Sports Nutrition
 Topics Covered In This Unit

Introduction
What is protein?
The amino acids
Proteins/amino acids and energy

Rating the quality of proteins

Complete versus incomplete proteins
Protein efficiency ratio
Net protein utilization
Biological value
Amino acid score
Protein quality for athletes
Nitrogen balance
 esigning protein and amino-acid
D
products
F ree form and peptide-bonded
amino acids

Digestion of protein and amino acids

Amino Acid Review
 pecial protein and amino acid needs
S
for the athlete
Food and Supplement Sources of Pro-
tein.
Whey protein gets results too
Effects of creatine monohydrate plus
whey
 ecommended dietary allowances for
R
protein
Estimating daily protein requirements
Summary of protein and the athlete

Conclusion

UNIT 4

PROTIEN AND AMINO ACIDS:

MUSCLE BUILDERS AND MORE
Unit Outline j. Glutamine
I. Introduction i. Creatine and glutamine
II. What is protein? k. Glycine
a. The amino acids l. Histidine
b. Proteins/amino acids and energy m. Isoleucine

III. Rating the quality of proteins n. Leucine

a. Complete versus incomplete proteins o. Lysine

b. Protein efficiency ratio p. Methionine

c. Net protein utilization q. Ornithine

d. Biological value r. Phenylalanine

e. Amino acid score s. Proline

f. Protein quality for athletes t. Serine

g. Nitrogen balance u. Taurine

h. Designing protein and amino-acid v. Threonine

products w. Tryptophan
i. Free form and peptide-bonded amino x. Tryosine
acids
y. Valine
IV. Digestion of protein and amino acids z. A final word on amino acids
V. Amino Acid Review
VI. Special protein and amino acid needs
a. Alanine & Beta Alanine for the athlete
b. Arginine (GH, IGF, Nitric Oxide a Food and Supplement Sources of Protein.
stimulation and more)
b. Whey protein gets results too
c. Asparagine
c. Effects of creatine monohydrate plus whey
d. Aspartic Acid
d. Recommended dietary allowances for
e. Branch-chain amino acids (Leucine, protein
Isoleucine and Valine)
e. Estimating daily protein requirements
i. Leucine, a key BCAA
i. Cofactors
ii. BCAAs help increase training strength,
endurance, and muscle mass ii. Check those labels

f. Citrulline iii. Connective tissue

g. Cysteine f. Summary of protein and the athlete

h. Cystine VII. Conclusion

i. Glutamic acid

Learning Objectives
After completing this unit, you will be able to:
• Define and describe key terms related to protein and amino acids.
• Understand the different types of protein and amino acids and their major functions.
• Determine essential and nonessential amino acids

• Discuss how protein and amino acids affect athletic performance and heath.
 Protien and Amino Acids: Muscle Builders and More | 109

INTRODUCTION
In this unit, the basics of protein are reviewed
and the building blocks of proteins, referred to
as amino acids, are discussed. The relationship
between protein and the athlete has become
something of legendary importance. Dating
back to the first Olympic Games in ancient
Greece, one of the earliest recorded athletic
nutritional practices was that of consuming large
amounts of protein to improve strength and
performance. The most recent research confirms
protein’s role as a vital component of health
and performance. However, studies have also
established that diets that are too high in protein
may be as counterproductive as are diets that are
too low in protein. One thing is certain: active
athletes require at least twice or more protein as
nonathletes do.

Protein is an essential part of the diet and plays many roles in the body.
Protein’s roles are primarily structural but can be used by the body
for energy during intensive exercise or when nutrition is inadequate.
In these situations, to meet its metabolic needs, the body breaks down
precious muscle tissue, which is a setback for an athlete who has been
training hard to make gains. In addition, athletes need to eat just the
right amount of protein to minimize the formation of metabolic waste
products. When too much protein is consumed, the body converts the
excess to fat and increases the blood levels of ammonia and uric acid. Ammonia: A toxic
metabolic waste product.
Ammonia and uric acid are metabolic waste products.
Uric acid: toxic metabolic
The athlete’s goal therefore is to maintain proper protein intake based waste product.
on body weight, activity level, and muscle fiber composition. In general,
endurance athletes with a higher level of slow-twitch muscle fibers
require more protein than nonathletes do but not as much as strength
athletes do. Strength athletes have larger muscles and more of the fast-
twitch muscle fibers, requiring these athletes to increase the amount of
protein intake. Then there are the athletes who are somewhere between
these two extremes of endurance and strength. In addition to muscle
fiber growth and repair, there are also different bio-energetics that need
to be considered among the different athletes.

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What Is Protein?
Protein is a large molecule called a macromolecule or super-molecule.
Polypeptide: four or more It is a polypeptide, a compound containing from 10 to 100 amino acid
amino acids linked together. molecules. The amino acids are linked together by a chemical bond

Athletic Significance of Proteins and Amino Acids

• Protein is a source of amino acids.

• Athletes require a higher intake of protein.

• Amino acids are essential building blocks for growth, recovery, and production of many proteins
occurring in the body.

• Branched Chain Amino Acids are a special group of amino acids that can be used for energy and
are required in extra amounts.

• Individual Amino Acids can elicit targeted effects, for example, increasing growth hormone, IGF,
testosterone, and nitric oxide production.

• Collagen—connective tissue—makes up one-third of total body protein content, making it one of

the most common proteins in the body.

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 Protien and Amino Acids: Muscle Builders and More | 111

called a peptide bond. When we consider protein from a nutritional Urea cycle: the metabolic
process in which ammonia
standpoint, we are concerned with the amino acid subunits. There are
is converted to the waste
about 22 amino acids that are considered biologically important, but product urea, which is then
many more exist in nature, including in the body. Amino acids are excreted from the body.
important not only for being the building blocks of protein but also for Hormone: one of the
numerous substances
the individual roles that they play in the body. For example, some amino produced by the endocrine
acids are used by the body in metabolic processes such as the urea cycle, glands that regulate bodily
and others act as neurotransmitters, the chemical substances that help functions.

transmit nerve impulses. Deoxyribonucleic acid

(DNA): the substance in the
Protein is needed for the growth, maintenance, and repair of cells, cell nucleus that contains
the cell’s genetic blueprint
including muscle cells, and for the production of enzymes, hormones, and determines the type of
and deoxyribonucleic acid (DNA) expression. Protein occurs in various life form into which the cell
will develop.
sizes and shapes and is divided into two main categories—simple
proteins and conjugated proteins. Simple proteins consist only of amino Collagen: a simple protein
that is the chief component
acids, whereas conjugated proteins also have non-protein molecules as of connective tissue.
part of their structures. Some simple proteins are serum albumin, which Connective tissue: tissue
is present in blood; lactalbumin, which is present in milk; ovalbumin, that either supports other
which is present in eggs; myosin, present in muscle; collagen, present in tissue or joins tissue to
tissue, muscle to bone, or
connective tissue; and keratin, present in hair. Examples of conjugated bone to bone. It includes
proteins are nucleic acid, found in chromosomes; lipoprotein, found cartilage, bone, tendons,
ligaments, reticular tissue,
in cell membranes; glycoprotein, chromoprotein, and metaloprotein, areolar tissue, adipose
all found in blood; and phosphoprotein, found in casein (milk protein). tissue, blood, bone marrow,
and lymph.
Protein constitutes the majority of the dry weight of most body cells.
Lipoprotein: a compound
Some of the major properties of proteins include: made up of fat and protein
that carries fats and fat-
• Contractile, such as actin and myosin found in skeletal and other like substances, such as
muscles, required for movement cholesterol, in the blood.
Cell membrane: the
• Hormonal, such as insulin, growth hormone, and insulin-like growth outer boundary of a cell.
factors Also called the plasma
membrane.
• Structural, such as collagen, a component of connective tissues
Hemoglobin: the oxygen
• Transporter, such as hemoglobin for transporting oxygen carrier in red blood cells.

• Enzymes, for digestion and required as catalysts for many biochemical

reactions in the body DNA/Gene expression, as the information stored in
genes is replicated into proteins

• Receptors, protein molecules that are imbedded in cell membranes and

detect signals

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112 | Unit 4

Cytoplasm

DNA

Nucleus Transcription

Amino acid chain (protein)

Amino acid
mRNA

tRNA

Translation

mRNA

Ribosome

How genes direct the production of proteins.

Most genes contain the information needed to make functional
molecules called proteins, whereas just a few genes produce other
molecules that help the cell assemble proteins. Going from gene to
protein consists of two major steps: transcription and translation.
Together, transcription and translation are known as gene expression.

During the process of transcription, the information stored in a gene’s

Ribonucleic acid DNA is transferred to a similar molecule called RNA (ribonucleic acid)
(RNA): the substance in the cell nucleus. Both RNA and DNA are composed of a chain of
that carries the coded
genetic information from nucleotide bases, but they have slightly different chemical properties. The
the deoxyribonucleic acid type of RNA that contains the information for making a protein is called
(DNA), in the cell nucleus,
to the ribosomes, where the
messenger RNA (mRNA) because it carries the information, or message,
instructions are translated from the DNA out of the nucleus into the cytoplasm.
into the form of protein
molecules. Translation takes place in the cytoplasm of the cell. The mRNA
interacts with a specialized complex called a ribosome, which “reads”
the sequence of mRNA bases. Each sequence of three bases, called a
codon, usually codes for one particular amino acid. A type of RNA
called transfer RNA (tRNA) assembles the protein, one amino acid at a
time. Protein assembly continues until the ribosome encounters a “stop”
codon (a sequence of three bases that does not code for an amino acid).

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 Protien and Amino Acids: Muscle Builders and More | 113

THE AMINO ACIDS The amino acids listed in the tables are the
major ones that are important to the body and
Nutritionally, amino acids are classified based
commonly encountered in the diet from foods
on their dietary need by the body. Indispensable
and supplements. As amino acid nutritional
refers to the amino acids the body cannot
science has evolved the past few decades, so
synthesize and requires from dietary intake.
too have the terminology and concepts. For
Conditionally indispensable amino acids are
example, originally the amino acids were
those requiring a dietary source when the
considered essential or nonessential depending
body’s rate of synthesis cannot meet metabolic
on whether the body can make them. Now the
needs. Then there are some amino acids that are
new terminology is indispensable, conditionally
categorized as dispensable, which implies that
indispensable, and dispensable. Indispensable is
the body can make them in sufficient quantities
similar to essential, and dispensable is similar to
on an as-needed basis. Keep in mind that most
nonessential. Conditionally indispensable amino
foods contain proteins with most of the amino
acids are amino acids that are needed from the
acids present, as do most protein supplements,
diet when the body’s biosynthesis cannot meet
too. Maintaining a nutritional source of all types
the metabolic demands.
of the amino acids (indispensable, conditionally
dispensable, and dispensable), will help provide The following tables summarize the amino
the athlete with a rich supply of amino acids for acids using two approaches wherein the USA
immediate use by the body in addition to the DRI approach uses the new terminology and
amino acids the body can make more of. the Canadian approach uses the essential and

Amino Acids and Their Nutritional Status

(USA DRI Terminology)
Indispensable Conditionally Indispensable Dispensable
Histidine Arginine Alanine
Isoleucine Cysteine Aspartic Acid
Leucine Glutamine Asparagine
Lysine Glycine Glutamic Acid
Methionine Proline Serine
Phenylalanine Tyrosine
Threonine
Tryptophan
Valine

Note: The letters D and L sometimes precede the name of the amino acid and indicate which form is present; or isomer.
In general, the L form of amino acids is the biologically active form and used to make proteins. In nutrition products,
however, examples of two DL mixtures of amino acids reported to have metabolic advantages are reported for the
amino acids phenylalanine and methionine. Glycine has no D or L form. There is inconsistent use of these letters on
products and in the research. Check with the manufacturer if you have a question about the amino acids contained in
their products.

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Amino Acids and Their Nutritional Status

(Canadian Terminology)
Essential Nonessential
L-Histidine L-Alanine Alanine
L-Isoleucine L-Arginine L-Serine
L-Leucine L-Asparagine L-Tyrosine
L-Lysine L-Aspartic acid
L or DL-Methionine L-Cysteine
L or DL-Phenylalanine L-Glutamic Acid/L-Glutamate
L-Threonine L-Glutamine
L-Tryptophan Glycine (Aminoacetic acid)
L-Valine L-Proline

nonessential terminology, which also lists the are essential (indispensable) amino acids, but get
amino acids preceded by their L, D, or DL used for energy at a higher rate by athletes. This
designations. Note that the amino acid glycine will help offset the amounts used for energy and
has one molecular configuration and does use provide adequate branched-chain amino acids
the D or L designation. to be available for growth and repair functions.
Then there are the amino acids that help support
Keep in mind that the Dietary Reference
and promote peptide hormone production
report is primarily for the general
growth hormone, insulin and insulin-like
population. From this progression in amino
growth factors. One of the recent uses of certain
acid research and development, it is easy
amino acids is for boosting the production of
to acknowledge how ingesting specialty
nitric oxide production, which is important in
protein and amino acid products for athletes
blood circulation and other body functions.
has a scientific basis and importance for
promoting health and performance.
Proteins/Amino Acids and Energy
Another important amino acid nutrition concept In addition to the functions discussed above,
is designing nutrition programs and sports protein—the same as fat and carbohydrates—
nutrition products that enable fortification of can also be used for energy, but this occurs in a
certain amino acids or groups of amino acids minor role. Under conditions of severe calorie
to maintain the higher demands of an athlete’s restriction and starvation, the body releases
protein building or to stimulate the body’s amino acids from muscle tissue for use as
production of certain hormonal and metabolite energy or in energy cycles. In a well-fed state,
substances—for example, providing the body athletes use some amino acids for energy at a
with extra branched-chain amino acids, which higher rate during exercise and even at rest. This

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catabolism (breakdown) of protein occurs during exercise—especially

during intensive workouts, in particular power exercises and prolonged
endurance activities—or when the body runs out of carbohydrates from
the diet or glycogen from its muscle and liver stores. Even though the
body can depend on the fat it has stored, it still may use some muscle
protein, unless it is fed protein as food. When dietary circumstances
cause the body to use amino acids as a source of energy, the body
cannot also use these amino acids for building muscle tissue or for
performing their other metabolic functions. This is why personalized
daily protein intake is essential for the athlete—to best meet the
individual’s protein needs.

Even if athletes consume a proper diet, their bodies will still use
certain amino acids as fuel during grueling exercise bouts. The muscles
use the branched-chain amino acids (BCAAs)—isoleucine, leucine,
and valine—to supply a limited amount of energy during strenuous
exercise. However, research has shown that although the body can use
all three BCAAs for energy during exercise, it uses leucine the most. As
demonstrated by studies, a trained person’s muscles use leucine even
while that person is at rest. This disproportionate use of leucine, along
with the other BCAAs, affects the body’s overall use of amino acids for
growth. Here, the BCAAs, especially leucine, are limiting nutrients: Limiting nutrient:
a nutrient that has the
that is, nutrients which, through their absence or presence, restrict the
ability, through its
utilization of other nutrients or the functioning of the body. absence or presence, to
restrict the utilization of
For optimum muscle growth, cellular growth, metabolism, and recovery, other nutrients or the
functioning of the body.
the body needs to receive the amino acids in the proper proportions.
Merely eating amino acid sources, such as meat and eggs, does not
ensure that the amino acids they supply will be available for muscle
growth or for the formation of other proteins. For example, suppose an
athlete consumes a total of 100 grams of protein, with all the essential
amino acids present in equal amounts. How will his or her body use
these amino acids? To begin, it will use a considerable percentage of the
leucine for energy for exercising muscles. This means that a reduced
amount of leucine will be available for growth and repair purposes.
When leucine supply runs out, protein formation will be negatively
affected because leucine is an essential amino acid—that is, the body
cannot manufacture it. The result is that perhaps only a portion of the
original 100 grams of protein will be available for growth and repair.

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Rating the Quality of Proteins

Just as there are differences among the carbohydrates, the various
proteins are not created equal. Some proteins have a more complete
amino acid content than others do and are therefore better suited for
growth purposes. Scientists are currently using a number of methods to
rate proteins. Most of these rating methods do not account for the extra
protein and the specific amino acids required by athletes, but they offer a
baseline of information to work from. The following reviews some of the
approaches and methods used by scientists to rate the quality of proteins
for the general population.

Complete Versus Incomplete Proteins

Because adequate protein intake is essential for optimum growth
in children, the World Health Organization (WHO) has conducted
significant research on protein requirements. What the WHO
researchers determined was that not all proteins supply the proper
amounts and proportions of the amino acids necessary for adequate
Complete protein: a growth and development. Complete proteins are proteins that
protein that contains the
essential amino acids in
contain the essential or indispensable amino acids in amounts that are
amounts that are sufficient sufficient for the maintenance of normal growth rate and body weight.
for the maintenance of Indispensable amino acids are those that the body cannot make, and it
normal growth rate and
body weight. therefore requires a constant dietary supply of these. Complete proteins
are therefore said to have a high biological value. Most animal products
have complete proteins.

Incomplete protein: Incomplete proteins are usually deficient in one or more of the
a protein that is usually indispensable amino acids. This amino acid deficiency creates a limiting-
deficient in one or more of
the essential amino acids. amino-acid condition, which adversely affects growth and development
rates. Most plant proteins are incomplete. However, considering the
dynamics of amino acids in the body, even high-quality proteins can
be incomplete for athletes’ needs. Furthermore, research indicates that
the proper proportions of both the essential and nonessential amino
acids are required for optimum growth and recovery. This means that
athletes should consume protein supplements along with high-quality
food protein sources. Athletes’ dietary goals should be to eat a diet
fortified with the amino acids that are used for energy and non-growth
functions and to ensure an adequate intake of the amino acids needed
for optimum performance, growth, and recovery.

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Protein Efficiency Ratio of the protein’s weight in indispensable amino

acids. Adults, however, require complete dietary
Another method of determining the quality of proteins containing just 15 percent of the
protein is the protein efficiency ratio (PER). The protein’s weight in indispensable amino acids.
PER is calculated using laboratory animals. It This demonstrates that the proportion of essential
refers to the amount of weight gained versus the to nonessential amino acids is an important
amount of protein ingested. For example, casein factor in growth and development. Athletes
has a PER of 2.86, which means that 2.86 grams training to develop stronger and bigger muscles
of body weight are gained for every 1 gram of should try to maintain higher proportions of the
casein eaten. essential amino acids in their diets.
One criticism of the PER system as a method for
determining the quality of proteins for human Net Protein Utilization
consumption is that the values were derived Net protein utilization (NPU) is a way of
through testing on animals, mostly rats. Does a determining the digestibility of a protein. It does
rat’s growth rate correlate to a human’s? Perhaps this by measuring the percentage of nitrogen
not. Additionally, rats and other laboratory that is absorbed from a protein’s amino acids.
animals have a large amount of fur all over their Generally, the more nitrogen that is absorbed
bodies. This places an extra demand on amino from a protein, the more digestible the protein is.
acids such as methionine, which is used in fur
growth and is a common limiting amino acid in The NPU of a protein is calculated by measuring
plant protein sources. Moreover, we now realize an individual’s intake of nitrogen from amino
that athletes need higher amounts of certain acids, comparing that amount to the amount
amino acids, such as the BCAAs. Therefore, the of nitrogen that the individual excretes, and
PER and other similar data should be used only determining how much of the protein in
as guidelines for determining minimum intakes question is needed to balance out the two
of protein for nonathletes. Additionally, different amounts. If a protein has a low NPU, more of
proteins can be combined to improve the quality it is needed to achieve nitrogen balance. (For a
of the individual proteins. This is commonly more complete discussion of this, see “Nitrogen
done to increase the PER of plant proteins. Many Balance,” below.) Therefore, proteins with high
powder supplements now include a mixture of NPU values, such as egg and milk proteins, are
two or more of the less expensive lesser quality more desirable for athletes.
proteins, such as soy and casein, which boost
each other’s PERs when used together, instead Biological Value
of using one of the more expensive high-quality
Although the methods used to determine a
protein sources, such as egg white.
protein’s biological value (BV) are not entirely
An interesting note is that the WHO standardized, the one that most scientists prefer
recommended that newborns need complete is described as “the efficiency with which that
dietary proteins containing about 37 percent protein furnishes the proper proportions and

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amounts of the indispensable amino acids rating system based on the amino acid content
needed for the synthesis of body proteins in in relationship to what would be an ideal protein
humans or animals.” for humans.

The general formula for determining BV is In the 1980s, the concept of using a system
as follows: based on amino acid content began to emerge.
This eventually evolved into the development
BV = nitrogen retained divided by of what has become known as the PDCAAS
nitrogen absorbed x 100 (Protein Digestibility Corrected Amino Acid
Score). The PDCAAS is based on creating a
Eq. 4.1 reference standard of the indispensable amino
acid composition that would be considered ideal
The BV value does not indicate the ultimate for humans. This method therefore considers
fate of the amino acids in the body—that is, it the indispensable (essential) amino acid
does not show whether they will be used for composition of a protein, the digestibility, and
muscle growth or enzyme synthesis. In addition, the ability of the protein source to supply the
BV measurements vary for the same protein indispensable amino acids in adequate amounts
according to the animal species tested. For required by humans.
example, chickens have different amino acid
needs than do rats do because, among other It is interesting to note that when a type
things, chickens have feathers, and rats have fur. of protein gets a low rating, it can have the
Because feathers require different amino acids rating improved with fortification of the low
than fur does, the two animals need different content amino acid(s). In fact, many plant
proportions of the amino acids. Therefore, unless proteins are limiting in one or more of the
the BV for a particular type or brand of protein essential amino acids, thereby giving them
was determined specifically for humans, that low ratings on an individual food basis.
protein may not offer any advantages to humans, However, when these plant protein sources
even though it may have a high BV according to are fortified with the essential amino acids,
the testing done with animals. or combined with other plant proteins that
have amino acid content profiles that fill in
each other’s amino acids gaps, the result can
Amino Acid Score
be a higher quality plant protein source.
The previous protein quality methods and
research made scientists realize that the primary
magic of proteins is the amino acids that they Protein Quality for Athletes
contain along with the digestibility of the For athletes, trying to ingest high-quality
proteins being digested. Due to the limitations proteins based on the ratings systems for the
of using biological testing to evaluate the general population is mandatory. In addition to
protein quality of different foods, there was a this, using protein and amino acid supplements
movement toward developing a protein quality to fortify the athlete’s diet has led to the

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development of a variety of products to help athletes meet their total

protein needs along with their amino acid specific needs. In addition to
the basic protein needs athletes must maintain, the increased ingestion
of certain amino acids to help further boost metabolic processes has
become commonplace. In addition to the branched-chain amino acids,
the extra ingestion of amino acids like arginine, glutamine, lysine,
and glycine is practiced to enhance anabolic hormone production and
immunity, boost protein synthesis, increase strength, improve body
composition, foster better healing, and improve athletic performance.
Thus as scientific discoveries continue, so too will the evolution of the
athlete’s diet and sports nutrition. Unit 17 contains information about
putting today’s science into practice for creating the ultimate sports
nutrition and supplement plans.

Nitrogen Balance
Nitrogen balance is a topic frequently encountered when one reads
articles about athletes’ protein and amino acid requirements. In
addition to carbon and hydrogen, amino acids also contain nitrogen as
part of their molecular structure. This is a unique characteristic, one
that we can use to our advantage, because it allows us to determine
whether protein intake is adequate. Specifically, nitrogen balance
refers to the condition in which the amount of dietary nitrogen
taken in is equal to the amount of nitrogen excreted. A nitrogen
balance that is positive indicates a possible net growth in body
tissues. A nitrogen balance that is negative indicates an inadequate
protein intake and the possibility that the body is cannibalizing Cannibalization: the
breakdown of muscle tissue
its muscle tissue. An important nutritional goal for athletes is to
by the body for the purpose
aim for achieving and maintaining a positive nitrogen balance. of obtaining amino acids for
other metabolic purposes
Determining nitrogen balance is not an easy task though. Because and may also include other
nitrogen from broken-down amino acids can be excreted in both body tissues.

the urine and the feces, and because some is lost as sweat, all these
excretions must be collected and analyzed. In addition, all the nitrogen
ingested from protein must be accurately measured. This is impractical
for most individuals. However, some companies have now developed
methods that enable athletes to get a rough idea of their nitrogen balance
by taking measurements using just their urine and by measuring their
nitrogen ingested as protein. This approach makes assumptions about
the relative amount of nitrogen lost in feces and sweat. Although you

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would have to spend time making calculations protein and amino acids a very interesting field
every day, you would probably find it interesting of research, a practical application, and a vital
to learn what your nitrogen balance is to give part of the athlete’s nutrition program.
you an approximate guideline for what your
The take-home lesson about protein quality is
daily protein intake should be. You could then
that although some protein sources are naturally
experiment with combining different food and
higher quality than others are, by combining
supplement protein sources to tailor-make an
various types of proteins and/or adding specific
efficient protein-intake program for yourself.
amino acids, the quality of any protein product
or diet can be improved with modern food
Designing Protein and science technology.
Amino Acid Products
The direction and application for protein and Free Form and
amino acid sports science lies in designing an Peptide-Bonded Amino Acids
amino acid source that brings about nitrogen
When referring to the amino acid content of
balance using a minimum amount of protein.
food or supplements, the terms free form and
This goal can be reached in several ways,
peptide bonded are used. In fact, the debate
and manufacturers have already developed
pioneering ingredients and products that seems to be constant over which supplement
accomplish it. Creating an amino acid profile form is better. Free form amino acids are amino
that has all the essential amino acids with extra acids that are in their free state, or single. When
BCAAs and the nonessential amino acids is protein is digested, some of its amino acids are
a start. Products with a variety of amino acid eventually broken down into their free forms
combinations are available. Among their benefits for transport and use in the body. Peptide-
are growth hormone (GH) stimulation, blood bonded amino acids are amino acids that are
ammonia detoxification, increased mental linked together. Di-peptides are two amino
alertness, and mental relaxation. acids linked together, tri-peptides are three
amino acids linked together, and polypeptides
Absorption is also an important factor. Some are four or more amino acids linked together.
protein manufacturers are inventing better Interestingly, the intestines can absorb free form,
ways to purify the protein from milk and other di-peptide, and tri-peptide amino acids but not
sources. The development of whey protein isolate polypeptides.
is an example of improving the quality of a food
source protein. Adding non-protein ingredients Because the body has the capacity to digest
can further improve utilization as well as supply protein, it can make use of whole-protein
other growth factors, such as glucosamine for supplement sources. However, many supplements
connective tissue, along with other cofactors, now contain free-form amino acids or
including the basics like vitamins and minerals. combinations of free form and peptide-bonded
The diversity of amino acid combinations amino acids. Some also contain hydrolyzed
possible and the benefits they offer can make proteins. Hydrolyzed proteins are already

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 Protien and Amino Acids: Muscle Builders and More | 121

broken down, usually by enzymes, and are a mixture of free form, di- Free-form amino acids:
amino acids that are in their
peptide, and tri-peptide amino acids. Many people consider them better
free state, or single.
than non-hydrolyzed proteins because their partial digestion possibly
Di-peptide: two amino
makes them more easily absorbed by the body. acids linked together.

The use of free form amino acids is still common in clinical applications Tri-peptide: three amino
acids linked together.
when intravenous solutions are used to supply amino acids directly into
Hydrolyzed protein: a
the bloodstream. Free form amino acids can also be used to fortify food protein that has already
proteins. Taking the BCAAs with meals can be useful for compensating been broken down,
for the amino acids already used for energy. Additionally, when you just usually by enzymes, and
is a mixture of free-form,
want to take extra amounts of one or several amino acids, a free form di-peptide, and tri-peptide
amino acid formulation makes perfect sense. Free form amino acids amino acids.
are also sometimes added to protein products to selectively increase the
amount of specific amino acids.

Another reason a mixture of free form and peptide-bonded amino acids

could be better than free form amino acids alone are for general protein
intake is that the intestines can better absorb mixtures for transport
into the bloodstream. Although it might seem logical that free form
amino acids could be absorbed more quickly, the upper part of the small
intestine is better able to absorb amino acids in twos and threes.

Digestion of Protein and Amino Acids

The mechanical digestion of protein begins in the mouth during
chewing. In the stomach, the enzyme pepsin joins in, breaking down the
protein into shorter peptides. The partially digested protein then passes
into the intestines, where the free form, di-peptide, and tri- peptide
amino acids are absorbed—beginning immediately. Enzymes continue
to digest any polypeptides as they travel down the intestines.

Once the free form, di-peptide, and tri-peptide amino acids enter the
bloodstream, they are transported to the liver, where a few things may
happen to them. They may be converted into other amino acids, they
may be used to make other proteins, they may be further broken down
and either used for energy or excreted, or they may be placed into
circulation and continue on to the rest of the body.

Proteins empty from the stomach in two to three or even more

hours depending on how much fat is present and how much food
was consumed. This means that you should keep the protein content

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of pre-competition meals on the low side, fat too, to enable the

digestive system to be clear of the meal and to pass nutrients into your
bloodstream and cells before you begin your athletic event. However,
take note that the specially prepared various protein sports nutrition and
supplement products in ready-to-drink and protein powders made in to
drinks can be digested and absorbed faster, usually within an hour. Whey
protein isolate is an example of a protein sports nutrition product that
can be digested and absorbed at a fast rate. However, whey’s naturally
occurring companion milk protein, casein, is slower digested and
absorbed over a longer period. Thus, taking advantage of these different
digestion and absorption dynamics can prove useful when targeting in
on fine-tuning meeting an athlete’s protein needs under the challenging
demands of athletic training and event schedules. More about meal
composition and timing will be reviewed in the Digestion Unit.

Amino Acid Review

The following provides an overview of the primary amino acids of
nutritional and biological importance. This includes the indispensable,
conditionally dispensable, and dispensable amino acids. When
applicable, the athletic performance significance is noted. While most
of these amino acids have well-established functions and importance
based on historical use and more than a hundred years of research,
there are always new functions of amino acids being discovered,
especially for athletic performance. Therefore, some of the amino acid
entries include a few highlights of recent research discoveries relating
to athletic performance as well as reviewing the well-established, time-
tested functions.

When reviewing the functions of amino acids, we see that most amino
acids have multiple functions and multiple benefits to health and athletic
performance. Some amino acids are just part of proteins, others function
in the body as biochemical intermediates or precursors of other amino
acids or substances, and some amino acids can function in the body as
part of proteins, as metabolic intermediates, or directly in their intact
form. Whatever the functionality of these amino acids may be, it will be
easy to appreciate their use in sports nutrition products: ranging from
single amino acid products to multiple amino acid products to a variety
of multiple ingredient sports nutrition products that use amino acids in
different ways to create comprehensive and balanced sports nutrition
products for specific uses.

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Alanine & Beta-Alanine

Alanine is a dispensable amino acid found in high concentrations
in most muscle tissue and is grouped with the dispensable amino
acids because the body can manufacture it. Alanine is involved in an
important biochemical process that occurs during exercisea; the glucose-
alanine cycle. In the muscles, glycogen stores are broken down to glucose
and then to a 3-carbon-atom molecule called pyruvate. Some of the
pyruvate is used directly for energy by the muscles. Some of it, however,
is converted to alanine, which is transported through the bloodstream
to the liver, where it is converted once again into glucose. The glucose
is then transported back to a muscle and again used for energy. The
glucose-alanine cycle serves to conserve energy in the form of glycogen.
Sports physiologists postulate that this helps maintain the glucose level
during prolonged exercise. In this way, supplementing with L-alanine
may be useful in a similar way to supplementing with the BCAAs—the
supplemental L-alanine may help spare muscle tissue and liver glycogen.
However, research studies exploring the exact dosages and benefits of
supplemental alanine need to be conducted on athletes to clearly confirm
athletic performance benefits. In the general population, dietary intake
of alanine is reported to be approximately a mean of 3.6 grams per day
to a high of 8.5 grams per day.

Beta-alanine is a relatively new comer in sports supplements compared

with the other amino acids, but it has gained in popularity due to
numerous clinical research studies demonstrating certain exercise and
athlete performance benefits. Beta-alanine differs slightly in molecular
configuration from the conventional alanine molecule.

Analine Beta-Analine
O O

H2N
OH H2N OH

CH3

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Attention was directed toward beta-alanine when it was found that

taking beta-alanine supplements can increase the body’s supply of
carnosine. Carnosine is found occurring in skeletal muscles and other
tissues of animals including humans. Thus, carnosine is present in the
diet. Carnosine is reported to be synthesized in the body from beta-
alanine and L-histidine. Carnosine has a few biological functions.
These include antioxidant activity, activation of myosin ATPase activity,
enhancement of copper update, and of particular interest to athletes,
buffering the acidic pH increase from exercising muscles. Exercise and
athletic competition performance may therefore be enhanced from
an increase in intracellular buffering capacity, which can delay the
fatigue caused by increasing muscle acidosis, noting that a majority of
the research studies reported exercise performance increases. Highly
significant benefits reported in the research studies were especially
observed for high-intensity exercise bouts lasting between one and
four minutes.
The body of beta-alanine human performance research continues to
grow. The following includes overviews of some of this body of research.
For example, research by R. C. Harris and coworkers published in 2006
observed an increase in muscle carnosine from a few weeks of dietary
supplementation of beta-alanine. Regarding athletic performance
effectiveness from dietary supplementation of beta- alanine, scientific
evidence is beginning to be reported. For example, C. A. Hill and
coworkers reported that four to ten weeks of beta-alanine supplement
use increased carnosine levels and increased total work done in exercise
tests using males who undertook a cycle capacity test. The beta-alanine-
taking group increased total work done by 13 percent at four weeks,
compared with the placebo group and then an additional 3.2 percent
increase was observed at ten weeks, a total of 15.2 percent increase.
Another group of researchers, J. R. Stout and coworkers reported that
28 days of beta-alanine supplementation improved submaximal cycle
ergometry performance and time to exhaustion in young women. This
was attributed to an increased buffering capacity due to elevated muscle
carnosine concentrations.
It is important to note that beta-alanine is different from creatine, and
some articles have mistakenly reported beta-alanine as being the next
creatine. Metabolically, creatine functions differently from beta-alanine.
Additionally, creatine has hundreds of scientific studies backing its
effectiveness, whereas the research indicated benefits of beta-alanine are
in the early stage.

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With these differences in mind, some research was aimed at determining

what effects would occur by combining creatine and beta-alanine. One
research study examined the effects of 28 days of beta-alanine, creatine,
and beta-alanine & creatine supplementation compared with a placebo
group. The researchers wanted to measure the effects of the supplements
of the onset of neuromuscular fatigue in untrained men. After 28 days,
the beta-alanine and beta-alanine & creatine-taking groups exhibited
a delay of neuromuscular fatigue using a continuous incremental cycle
ergometry test. Keep in mind that other research reported that creatine
loading might delay the onset of fatigue.

Another research study examined the effects of creatine and beta-alanine

supplementation on performance and endocrine responses in strength
athletes, football players. The football players followed a 10-week
resistance training program. They were divided into groups that ingested
creatine, creatine & beta-alanine, or a placebo. Significant changes in
lean body mass were measured in the group of football players taking
creatine and beta-alanine together, football players taking either creatine
or creatine & beta-alanine together experienced significant increase
in strength performance, and football players taking just creatine also
experienced an increase in testosterone levels.

Smith and coworker (2009) reported benefits experienced by

recreationally active men from taking beta-alanine supplementation for
six weeks. Significant improvements were observed in high-intensity
interval training endurance exercise performance measurements. A
significant increase in lean body mass was also determined. Brisola
and coworkers (2016) examined the effects of beta-alanine on repeated
sprint ability in male water polo players. After 28 days of beta-alanine
supplementation, slight improvements were measured in swimming
performance, especially in the first set of sprint ability tests, which would
be related to the first quarter of a water polo match.

The beta-alanine research is growing and encouraging for the use of

beta-alanine supplements by both athletes and fitness exercisers as part
of a total nutrition program. Although more studies may be needed to
conclusively determine the dosages and duration of use, dosages used
in the studies ranged from a few to several grams per day. While Health
Canada has established a maximum total daily dosage of 3 grams per
day, the research and some organizational guidelines establish up to 6
gram per day. Beta-alanine is taken in divided dosages 2 to 4 per day, for

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example, two 1.5-gram dosages per day, for 3 grams total per day. Results
may be experienced in two to four weeks of use. Long-term studies are
required to determine how long beta-alanine may be used, but based
on the research, two to three months is likely a safe duration of use but
needs to be closely supervised by a doctor.

A word of caution concerning beta-alanine supplement use is a minor

annoying side effect that has been reported by supplement users and
documented in the research studies. For example, Health Canada
notes the following for their beta-alanine use instructions: “May cause
a flushing, tingling and/or prickling sensation of the skin, in which
case, reduce the dose.” Of course, individuals experiencing these skin
reaction symptoms should consult their doctor, and discontinue use,
until a safe, minimum daily dosage can be established. Athletes can
start with smaller dosages and work up to higher dosages, for example,
0.5 grams twice a day week 1; 1 gram twice a day week 2; and 1.5 grams
twice a day week 3 or longer. Current thinking is that beta-alanine
may have measurable benefits for exercise and athletic performance
under 25 minutes in duration, high intensity. Keep in mind however, as
with the water polo research study, improved performance in the first
quarter can benefit subsequent quarters. Although beta-alanine use
may be considered experimental for other sports and durations, keeping
good exercise, training, and competition performance notes may reveal
benefits for all types of athletes.

Arginine
(GH, IGF, Nitric Oxide stimulation, and more)
Arginine is a conditionally indispensable amino acid that influences
several metabolic factors that are important to athletes. Arginine
is most popular for its role in stimulating the release of human GH
(somatotropin) and related Insulin-like Growth Factors (IGF) levels.
Several studies have measured the ability of supplemental L-arginine,
both alone and in combination with other amino acids, to increase the
GH level in athletic and nonathletic individuals. Potential benefits of
an increased GH level include reduction in body fat, improved healing
and recovery, and increased muscle growth rate and muscle mass. Other
major benefits of arginine supplementation include improving immune
system function, protein synthesis, nitrogen detoxification (reducing

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ammonia levels/ ammonia removal, and increasing the production),

creatine synthesis, and increasing levels of nitric oxide (NO).

Arginine dosages used in research studies vary considerably; a gram,

a few grams, several grams, or even higher daily dosage amounts.
Based on the results of numerous arginine studies, a variety of
favorable responses is reported, ranging from minor responses to
larger significant improvements in the attributes being measured.
This would be expected when you consider that the human body
can manufacture arginine, but as it is a conditionally indispensable
amino acid, this indicates that from time to time, people may
not be able to produce enough of it. For the athlete, especially
strength athletes, supplemental arginine is considered essential.

Some of the types of the arginine-containing molecules used in

supplements include: Arginine HCl, Arginine AKG, Arginine-2-
pyrrolidone-5-carboxylate. The primary purpose of these arginine-
containing molecules is to increase the body’s levels of arginine.
Arginine has also been combined with other amino acids in research
studies, such as lysine, glycine, ornithine, and aspartate, and is found
naturally occurring with all of the other amino acids.

In addition to the other benefits reported from consuming arginine

supplements, the nitric oxide (NO) boosting effects are among the most
recent addition of interest to certain athletes. It is first interesting to
note that previous to the athletic performance interest, when researchers
discovered that arginine supplements can stimulate NO production,
they immediately began testing it for treating erectile dysfunction. Nitric
oxide in the blood stream causes relaxation of the vascular tissues and
vasodilatation, thereby promoting improved blood flow. Some cases of
erectile dysfunction are thought to be related to poor NO production.
As NO is made from arginine, researchers wanted to evaluate whether
male subjects with erectile dysfunction would show improvements from
taking arginine supplementation. After taking 2,800 milligrams of
arginine a day for a two-week period, six of fifteen subjects reported an
improvement of erection function from taking the arginine supplements.
The responders were the younger males of the experimental group, age
rage 25–43. Other researchers have also evaluated arginine supplement
taking for improvement in patients with cardiovascular disorders with
promising results.

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From an athlete’s perspective, maintaining good blood flow is

essential for athletic performance and recovery. The NO stimulating
action of arginine supplements, as it relates to increasing athletic
performance is a new area of research. A study in 2006 revealed
that taking an arginine supplement, in the form of Arginine AKG,
daily for eight weeks increased blood levels of arginine. At the end
of the study period, it was determined that the strength-training
athletes significantly increased their 1RM bench press and peak
power performance. This is consistent with previous studies of
strength athletes ingesting arginine-containing supplements.

Based on the numerous research studies, supplemental intake of arginine

can benefit athletes because of its ability to detoxify nitrogenous wastes,
increase GH & IGFs, increase nitric oxide, increase creatine production,
improve immune system function, and improve the rate of healing.
L-arginine supplementation can especially help athletes involved
in strenuous sports or training. In addition to athletics, arginine
supplementation may have benefits for people with diabetes, insulin
resistance, and metabolic syndrome.

Existing research reports measurable responses from daily arginine

supplement dosages ranging from 1,000 to 5,000 milligrams for periods
up to four months. Higher amounts may be required based on individual
needs. Note that in the majority of studies, arginine supplements were
taken during the day, and improvements in GH, IGF and NO were
observed during the day and were also reported in the evenings. In
the general population, dietary intake of arginine is reported to be
approximately a mean of 4.2 grams per day to a high of 10.1 grams per
day. Arginine supplementation does not always produce significantly
positive results in all individuals, which may be due to such factors
as dietary arginine being already optimum, age, level of training, and
metabolic differences.

Health Canada has established the following benefits for L-arginine

supplementation: May help support a modest improvement in exercise
capacity in individuals with stable cardiovascular diseases. (This is of
course a disease treatment indication, not applicable to competitive
athletes and requires medical supervision. And L-Arginine is a non-
essential amino acid that is involved in protein synthesis.) Health
Canada further notes a maximum single dosage of 8 grams, and a wide

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 Protien and Amino Acids: Muscle Builders and More | 129

range of dosages depending on the use, from 0.21 to 21 grams per day.
Also, duration limits are specified and other conditions, which can be
found online in the monograph if you want more details:

http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monoReq.do?id=124&lang=eng

Note that arginine products in Canada will have detailed dosage,

duration, and other use instructions the product labeling.

Asparagine
Asparagine is a dispensable amino acid manufactured in the
body from aspartic acid. Asparagine appears to be involved in
the proper functioning of the central nervous system because it
helps prevent both extreme nervousness and extreme calmness.
L-asparagine supplementation by athletes has not yet been
evaluated. Asparagine can be found occurring naturally in foods
and supplements containing whole protein ingredients. In the
general population, dietary intake of asparagine is reported to
be approximately 7.4 g/100 g of dietary protein consumed.

Aspartic Acid
Aspartic acid, also referred to as L-aspartic acid or L-aspartate, is a
dispensable amino acid that has been shown to help reduce the blood-
ammonia level after exercise. Aspartic acid occurs naturally in plants
and animals and is found in the diet. In addition, the artificial sweetener
aspartame contains aspartic acid. Aspartic acid is an amino acid that is
typically present in products containing whole proteins, such as whey
protein, but occurs in all protein-containing foods, both animal and
plant origin.

Aspartic acid is metabolized from glutamic acid in the body. It is

involved in the urea cycle and in the Krebs cycle. In the Krebs cycle,
energy is released from glucose, fatty acid, or protein molecules and used
to form adenosine-triphosphate (ATP) molecules, which are the form of
energy that the body can utilize. The exact benefits of single-ingredient
aspartic acid supplement use for well-conditioned athletes in active
training require further research. In the general population, dietary
intake of aspartic acid is reported to be approximately a mean of 6.5
grams per day to a high of 15.4 grams per day.

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Branched-Chain Amino Acids

(Leucine, Isoleucine and Valine)
The branched-chain amino acids (BCAAs) are the indispensable amino
acids isoleucine, leucine, and valine. Together, these three amino acids
make up about 35 percent of the amino acid content of muscle tissue.
Each of these amino acids is also used by the body for energy. Studies
confirm that under conditions of stress, injury, or exercise, the body uses
a disproportionately high amount of the BCAAs to maintain nitrogen
balance. Studies also indicate that leucine is used at a rate two or more
times greater than those of isoleucine and valine. Many amino acid
formulations on the market therefore have about twice as much leucine
as the other two BCAAs do.

The BCAAs have a history of use starting in medical settings with people
in stressed states, such as burn victims, surgical and trauma patients,
and those experiencing starvation. These patients were given BCAAs to
stimulate their protein synthesis and nitrogen balance. Then, during the
1980s, sports nutrition companies picked up on these clinical practices
and sponsored research using animals and athletes that revealed that
the BCAAs are used for energy, especially by exercising skeletal muscle.
The researchers hypothesized that taking supplemental BCAAs would
compensate for the BCAAs used for energy, promote muscle growth, and
restore nitrogen balance. Additionally, leucine was found to have other
growth-related metabolic effects including releasing GH and insulin and
playing a role in controlling protein production.

Eventually, research began to examine the benefits that the taking

supplemental amounts of the BCAAs would have on athletic
performance, body composition, and health. Some of the exercise-related
benefits observed in research studies include:
• Increase in exercise endurance

• Reduction of exercise-related fatigue

• Improved mental performance and increased energy levels

• Stimulation of protein synthesis

• Improved nitrogen balance

• Improved immune system function

• Increase in lean body mass and increased strength

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The amounts of the BCAAs supplied vary with the different products
available. Some products contain just the BCAAs, others have the
BCAAs along with a few additional ingredients, and still others contain
the full spectrum of amino acids with extra amounts of the BCAAs.

Athletes, especially bodybuilders, report muscle growth and strength

benefits from effective BCAA formulations. However, the BCAAs are
not just for bodybuilders and power athletes. Endurance athletes can
also benefit from BCAA supplementation. Research has determined that
endurance athletes use more than 50 percent of their total daily leucine
for energy purposes. This means that endurance athletes might need
to eat several times the normally recommended amount of protein to
maintain nitrogen balance. An alternative method these athletes can use
is to fortify their base diet of food proteins with supplement BCAAs.

Leucine, a Key BCAA

It is important to note that in addition to luecine’s being a crucial BCAA

use for energy production, the most recent research has shown that
leucine plays a major role in protein synthesis. In addition to BCAA
supplements coming in capsule form, powdered protein products contain
extra leucine plus other important amino acids of athletic importance.
The special report at the end of this unit reviews this important research
and product development trend. In the general population, dietary
intake of the BCAAs is reported to be approximately 6.1 grams per
day for leucine to a high of 14.1 grams per day; 3.6 grams per day for
isoleucine to a high of 8.2 grams per day; and 4 grams per day for valine
to a high of 9.1 grams per day.

Based on a scientific conference about BCAAs, it was determined that

BCAAs are very safe. A wide range of BCAA supplement intake has been
experimented with. The exact amount of BCAA will depend on your level
of activity, protein intake, and other protein/amino acid supplements
you are taking. In addition to the BCAA product instructions you may
be using, here are some further guidelines. In general, daily intake of
between 10 to 30 grams of BCAAs, which are high in leucine, has been
reported to be safe and effective. BCAAs are typically ingested in divided
dosages taken two or more times a day. This way, your body will be
supplied a constant supply of BCAAs, in particular leucine, which plays
an important role in protein synthesis control.

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One approach to getting more BCAAs into your diet is to include a

product that is high in BCAA content before or with meals. This can
include protein powders fortified with BCAAs, products that just
contain BCAAs, or high-quality multi-ingredient specialty products
that contain extra BCAAs, protein, other amino acids, and a variety
of additional clinically proven muscle-building and fat-metabolizing
ingredients. This will ensure that you have enough of these vital essential
amino acids during mealtime to maximize protein synthesis, growth,
and recovery of muscle.

Another approach for taking BCAA supplements is before and after

exercise. Supplemental amounts of the BCAAs could range from 1,500
to 6,000 milligrams for L-leucine and 1,000 to 3,000 milligrams each for
L-isoleucine and L-valine. Divide the dosage between two servings a day.
Depending on your rate of stomach emptying, experiment with taking
a serving about 60 to 30 minutes before exercising and another serving
after exercising on training days, or along with meals on non-training
days, to fortify the dietary proteins. Note that BCAA dosage can be
approached based on body size (lean body mass) and activity, with larger
and more active individuals, for example, requiring higher amounts of
the ranges. Another BCAA dosage approach reported in the research
is based on milligrams per kilogram of body weight. For example, 77
milligrams per kilogram of body weight caused a benefit of reducing
muscle protein breakdown during exercise. In addition, approaching safe
and effective BCAA use will depend on the total daily protein intake and
doctor supervision.

BCAAs Help Increase Training Strength,

Endurance, and Muscle Mass
A study reported in the journal Medicina Dello Sport examined the
effect that supplemental BCAAs have on athletic progress. The study
involved 31 male bodybuilders between the ages of 18 and 34, all of
whom were drug free, or “natural,” bodybuilders. The subjects were
divided into two groups: 16 took a placebo and fifteen took a BCAA
supplement. The results showed that while both groups experienced
increases in body weight, the BCAA group had greater weight gains. An
analysis of the weight gain in the BCAA group showed increases in the
lean body mass in both the legs and arms, with no changes in the trunk
area of the body. In contrast, the group taking the placebo showed no
lean mass gains in these areas. The BCAA group also showed strength

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 Protien and Amino Acids: Muscle Builders and More | 133

gains in both the squat and bench press exercises, whereas the placebo
group gained strength only in the squat exercise. In addition, the BCAA
group showed improvements in measures of exercise intensity.

Using BCAAs to fortify whey protein can further enhance the anabolic
and strength-boosting actions. In July 2004, independent researchers
reported findings of their newest research that serves to reconfirm my
earlier discovery that fortification of whey protein with BCAAs, in
particular leucine, will result in greater gains in strength and muscle
size. D. J. Housh and coworkers conducted their study at the exercise
physiology lab at the University of Nebraska -Lincoln. Men were divided
into either a placebo group or a leucine-fortified whey protein group.
Subjects trained three times a week for eight weeks. At the end of the
eight weeks, the males who had strength trained and ingested the leucine-
fortified whey protein had significantly greater increases in strength and
muscle size compared with the males who had taken a placebo.

Citrulline
Citrulline is a dispensable amino acid and has a role in the urea
cycle for the removal of ammonia from the blood. As more research
continues using citrulline supplementation, the benefits of citrulline
supplementation are evolving. For example, research reports preliminary
observations of citrulline-containing supplements used in experimental
settings increasing nitric oxide levels and exercise performance. Based
on these reports, nitric oxide-boosting supplements have appeared in
the sports nutrition market containing citrulline as a main ingredient.
Other related potential exercise and athletic performance benefits
of citrulline supplementation reported in the research may include
ammonia detoxification; increase in muscle protein synthesis, reduction
of exercise-related muscle soreness, a decrease in fatigue during exercise,
improved vascular health and function, and improved blood flow.

Some common supplemental citrulline dosage ranges used in the

research are 3 to 6 grams per day. Note that Health Canada has
established a 3-gram per day maximum dosage. Citrulline is taken
in divided dosages, two to three times a day for example. Like other
supplements, it is best used under doctor supervision. Short-term use
has been reported in the research studies, but long-term supplement use
safety is yet to be determined. Consult with product use instructions or
contact a citrulline supplement company for use recommendations.

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Cysteine
Cysteine is a conditionally dispensable sulfur-bearing amino acid. The
body manufactures it from methionine and serine. Cysteine is important
in the production of protein, hair, skin, connective tissues, connective
tissue growth factor, glutathione, taurine, and insulin. Besides its major
role as a component of proteins, it functions as a detoxifying agent,
helping to rid the body of dangerous chemicals. In addition, it helps form
glutathione, which is an important antioxidant and detoxifying agent.
Cysteine also plays a role in energy production. Like other amino acids,
it can be converted to glucose and either used for energy or stored as
glycogen. As it is naturally occurring, L-cysteine is a common ingredient
found in protein and multi-amino acid formulas. Some supplements also
contain the N-acetyl-L-cysteine form. In the general population, dietary
intake of cysteine is reported to be approximately 1 gram per day to a
high of 2.2 grams per day.

Cystine
Cystine is another conditionally dispensable sulfur-bearing amino
acid related to cysteine, as it is made from two molecules of cysteine,
and the two are typically considered together for nutritional
evaluation purposes. Cystine plays a vital role in helping many
protein molecules hold their shape as they are carried around the
body. It is generally poorly absorbed when taken in supplemental
form and is more effectively derived by formation from cysteine.
The same as cysteine, cystine is important in the formation of hair
and skin. It is also a detoxifying agent. The athletic benefits of
supplementation with free form cystine have not yet been evaluated.

Glutamic Acid
Glutamic acid, also known as glutamate, is a dispensable amino acid
occurring in proteins. It acts as an intermediary in the Krebs cycle and
is therefore important for the proper metabolism of carbohydrates. It
is also involved in the removal of ammonia from the muscles. It does
this by combining with the ammonia to form glutamine. Glutamic
acid is also needed for the production of energy from the BCAAs. In
fact, some research has indicated that the amount of energy produced
from the BCAAs may depend on the available supply of glutamic acid.

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 Protien and Amino Acids: Muscle Builders and More | 135

Fortunately, glutamic acid is plentiful in the diet and easily made by

the body. Similar to glucose, glutamic acid can pass readily through the
blood-brain barrier, a semi-permeable membrane that keeps the blood Blood-brain barrier: a
semipermeable membrane
that is circulating in the brain away from the tissue fluids surrounding
that keeps the blood that
the brain cells. Glutamic acid is typically present in full-profile amino is circulating in the brain
acid products like protein powders and other protein-containing away from the tissue fluids
surrounding the brain cells.
products. In the general population, dietary intake of glutamic acid is
reported to be approximately a mean of 15 grams per day to a high of
33.7 grams per day.

Glutamine
Glutamine is a conditionally dispensable amino acid found in
dietary proteins and made by the body. Glutamine is generally one
of the most plentiful amino acids present in the body. However,
researchers observed in medical settings from people who were
under stress from injury or disease that their glutamine levels were
decreased below normal levels. Eventually doctors determined that
this decrease in glutamine among stressed patients was related
to poor immune system function and reduced protein synthesis.
When patients were provided with supplemental amounts of
glutamine, their immune system function was improved, and
their nitrogen balance was restored, indicating anabolic effects.

Glutamine is also reported to have anti-catabolic effects, reduce cortisol

levels, improve wound healing, act as an energy source in certain cells,
elevate growth hormone levels, stimulate glycogen synthesis, combat
overtraining syndrome, promote protein synthesis (anabolic effects),
support the blood buffering system, and promote gastrointestinal
tract health. From this list of the primary benefits of using glutamine
supplements in research studies, it is easy to understand why use by
athletes eventually caught on.

Like the BCAAs, glutamine began in medical settings. Eventually

the ability of glutamine to restore immune system function attracted
attention by the athletic community. Researchers in the mid 1990s
from Oxford University, UK, are credited with being among the first
to hypothesize that amino acid imbalances may result from strenuous
exercise and, consequently, induce a number of phenomena that are
collectively referred to as the “overtraining syndrome.”

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The initial athlete glutamine supplement research was conducted among

long-distance athletes, like marathon runners, who were known to have
lower glutamine levels after their races and suppressed immune system
function and subsequently were thought to be at greater risk for a higher
rate of infections. When athletes were given 5 grams of glutamine
supplement after running a marathon, the researchers observed a
reduced number of infections among the athletes taking glutamine
during the seven days following exercise. In other similar research, a
similar result was observed, in which the athletes taking glutamine
supplements experienced a reduced rate of infection compared with
athletes not taking glutamine.

Although these benefits are of importance for all athletes, in addition to

the endurance athletes tested, using glutamine supplements has become
very common among strength athletes, in particular bodybuilders. This
common use has been promoted from glutamine’s reported benefits
in boosting protein synthesis, having anti-catabolic effects and blood
buffering effects, boosting growth hormones and offering other muscle-
building-related benefits, in addition to use based on case studies.

Similar to the other amino acids, glutamine products range from single-
ingredient to multi- ingredient mixtures. In research studies, glutamine
has been shown to be effective in dosage ranges as low as 2 to 5 grams
per day. Athletes typically consume supplemental amounts of glutamine
in the 5 to 10 gram a day range, with some athletes periodically
ingesting even higher daily amounts of glutamine, such as bodybuilders.
Glutamine is taken by dividing the total daily dosage into two to three
smaller dosages during the day to help maintain adequate levels.

Creatine and Glutamine

A study conducted by M. Lehmkuhl and coworkers who recruited 29
athletes, 17 men and 12 women, who were collegiate track and field
athletes. Ten were randomly assigned to take creatine monohydrate, ten
to take creatine monohydrate and glutamine, and nine to take a placebo.
The creatine monohydrate-taking group received 0.3 grams creatine
per kilogram of body mass per day for one week, followed by 0.03 g
creatine per kilogram of body mass per day for 7 weeks. The creatine
monohydrate–glutamine-taking group received the same creatine dosage
scheme as the creatine monohydrate taking group did plus 4 grams

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of glutamine per day. All three treatment groups participated in the

same strength and conditioning program during preseason training.
Measurements observed during the study included body composition,
vertical jump, and cycle performances before and after the eight-week
supplementation period. After the study period, it was determined
that body mass and lean body mass increased at a greater rate for the
creatine monohydrate and creatine monohydrate–glutamine-taking
groups compared with the placebo treatment. Additionally, the creatine
monohydrate and creatine monohydrate–glutamine-taking groups
exhibited significantly greater improvement in initial rate of power
production compared with the placebo treatment.

Glycine
Glycine is a conditionally dispensable amino acid that is synthesized
from serine, with folate acting as a coenzyme (enzyme cofactor). Coenzyme: an enzyme
Glycine gets its name from the Greek word meaning “sweet.” It is a cofactor.

sweet-tasting substance. Glycine is an important precursor of many Precursor: an intermediate

substance in the body’s
substances in the body, including protein, DNA, phospholipids, collagen, production of another
and creatine. It is also a precursor in the release of energy and has been substance.
shown to increase growth hormone levels. Glycine is found in high
amounts in connective tissues: collagen and gelatin.

Additionally, glycine is used by the liver in the elimination of toxic

substances and in the formation of bile salts, exhibiting hepato-
protective effects. It is necessary for the proper functioning of the central
nervous system and is an inhibitory neurotransmitter. During rapid
growth, the body’s demand for glycine increases. Studies have confirmed
that the use of glycine supplements causes an increase in growth
hormone. Some studies have also noted that glycine ingestion causes an
increase in strength, possibly due in part to its elevation of the GH level
or increased collagen synthesis. Supplemental glycine has additionally
been shown to increase body creatine levels.

The use of supplemental glycine for increasing athletic performance is

still in the early stages of development. However, short-term use of 1 to
6 grams per day, in divided dosages, may be beneficial for power athletes
and bodybuilders training for increased strength and muscle mass and
for connective tissue repair and maintenance. As with all free-form
amino acids, use glycine supplements with caution. In full profile amino

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acid products, glycine is typically contained in protein supplements and

supplements that contain hydrolyzed collagen and gelatin. In the general
population, dietary intake of alanine is reported to be approximately a
mean of 3.2 grams per day to a high of 7.8 grams per day.

Histidine
Histidine is an indispensable amino acid, important in the growth and
repair of human tissue. Histidine is also important in the formation and
maintenance of hemoglobin, the oxygen transport protein in red blood
cells. In addition, histidine is used in the body to make histamine and
carnosine (as previously reviewed in the Alanine entry). Carnosine is
chemically beta-alanyl-L-histidine.

The benefits of prolonged use of extra supplemental free form histidine

by athletes needs to be established in terms of improved athletic
performance, beyond histidine’s role as a required amino acid to
promote growth and health. Histidine is typically found in all proteins,
and you will see it listed on protein supplement labels along with the
other common amino acids. The mean dietary intake is reported to be
2.2 grams per day with the highest intake about 5.2 grams per day in the
general population.

Isoleucine
Isoleucine is an indispensable acid that, along with leucine and valine,
is one of the BCAAs. Isoleucine is found in proteins and is needed for
the formation of hemoglobin. It is involved in the regulation of blood
sugar and is metabolized for energy in muscle tissue during exercise.
Supplemental intake of L-isoleucine, along with the other BCAAs, has
been shown to help spare muscle tissue, maintain nitrogen balance, and
promote muscle growth and healing. For dosage recommendations, refer
to “The Branched-Chain Amino Acids” heading.

Leucine
Leucine is an indispensable amino acid found in proteins that is, like
the other BCAAs, important in energy production during exercise.
For many years, the three BCAAs were assumed to contribute equally
to energy. Recent studies, however, have shown that both exercising
and resting muscle tissue uses far more leucine for energy than either

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of the other two BCAAs do. According to estimates, over 50 percent

of dietary leucine may be used for energy in exercising muscles. This
makes leucine a very limiting amino acid if supplemental amounts
are not taken to compensate for the loss. Leucine may also stimulate
the release of insulin, which increases protein synthesis and inhibits
protein breakdown. The most recent new function attributed to leucine
is in controlling protein synthesis, via the mTOR pathway. Review the
special article at the end of this unit for more details about this. For
supplemental L-leucine dosage examples, refer to “The Branched-Chain
Amino Acids” heading.

Lysine
Lysine is an indispensable amino acid that is found in large quantities in
muscle tissue. It is needed for proper growth and bone development, and
it aids in calcium absorption. Lysine has the ability to enhance immune
system function and is reported to be useful for fighting cold sores and
herpes viruses. It is required for the formation of collagen, enzymes,
antibodies, and other compounds. Together with methionine, iron,
and vitamins B1, B6, and C, Lysine helps form carnitine, a compound
that the body needs in the production of energy from fatty acids. Mean
dietary intake of lysine is 5.3 grams per day, and the highest intake is
about 12.6 grams per day in the general population.

Lysine deficiency can limit protein synthesis and the growth and
repair of tissues, in particular the connective tissues. Lysine has been
shown to increase growth hormone levels, usually in association
with other amino acids, like arginine. Lysine should be part of all
full-spectrum amino acid supplements and in protein powders.
Beyond lysine’s importance as an indispensable amino acid for
good nutrition and health, the effects of the use of supplemental
free form L-lysine by athletes needs to be determined for measures
in significant training or athletic performance improvements.

Methionine
Methionine is an indispensable sulfur-bearing amino acid. It is Transmethylation: the
involved in transmethylation, a metabolic process that is vital to the metabolic process in which
an amino acid donates a
manufacture of several compounds, is involved in the synthesis of methyl group to another
creatine and important in muscle performance. In transmethylation, an compound.

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amino acid donates a methyl group to another compound. These methyl

donors often function as intermediaries in many biochemical processes.
Methionine is the major methyl donor in the body. Mean dietary intake
of methionine is 1.8 grams per day, with the highest intake about 4.1
grams per day in the general population.

Methionine is a limiting amino acid in many proteins, especially in plant

proteins. It functions in the removal of metabolic waste products from
the liver and assists in the breakdown of fat and the prevention of fatty
buildup in the liver and arteries. It is used to make choline, which makes
taking supplemental choline a mandatory practice for athletes to spare
methionine for its other functions. Methionine is commonly added to
meal replacement drinks and other nutrient beverages containing soy
protein because it increases the quality of the protein.

Ornithine
Ornithine is a dispensable amino acid that does not occur in proteins.
Ornithine’s primary role in the body is in the urea cycle, which makes
it important in the removal of ammonia. It is formed from arginine
in the urea cycle. Like arginine, ornithine has been proven to be an
effective GH releaser. This specific role has brought ornithine widespread
recognition among athletes in recent years.

Supplementation with L-ornithine in various dosages, ranging from

2,000 to 4,000 milligrams per day, has been studied. Research using
L-ornithine with other amino acids has also been conducted. Research
study using 1,000 milligrams of L-ornithine and 1,000 milligrams of
L-arginine per day along with five weeks of weight training showed
a decrease in body fat and an increase in muscle mass. However,
indications are that the effective dose of L-ornithine might be higher.
Another study examining the effects of bodybuilders taking only
ornithine supplements reported an increase in growth hormone levels.
More research needs to be conducted to determine the exact dosage
and the specific benefits. Ornithine-containing supplements may be
particularly beneficial for bodybuilders, powerlifters, sprinters, and other
strength athletes.

Ornithine is also an important component of ornithine

alphaketoglutarate, a compound that is gaining popularity among
bodybuilders and power athletes. Ornithine Alphaketoglutarate (OKG).
OKG is used in clinical nutrition based primarily on its anabolic action.

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Studies report the use of OKG in Europe for a number of years—as far
back as the early ’70s—mainly for the treatment of burn victims, trauma,
post-surgical healing, and cases of severe malnutrition. OKG consists
of two ornithine molecules and one alphaketoglutarate molecule. OKG
is a stimulus for a variety of metabolic functions. It acts as an ammonia
scavenger; improves nitrogen balance; increases glutamine pool in
muscle tissue, thereby reducing muscle break down (catabolism); elevates
growth hormone levels; increases protein synthesis; increases insulin
secretion; plays a role in glutamine synthesis; and provides an anti-
catabolic effect. OKG is used in multi-ingredient formulas from 1 gram
to a few grams and in single-ingredient formulas at higher dosages,
typically a few grams or more, twice daily.

Phenylalanine
Phenylalanine is an indispensable amino acid and a precursor of the
nonessential amino acid tyrosine. Ingestion of supplemental tyrosine
therefore spares phenylalanine for its other functions. Mean dietary
intake is 3.4 grams per day, with the highest intake about 7.7 grams
per day.

Phenylalanine has many functions in the body and is a precursor of

several important metabolites, such as the skin pigment melanin, and
several catecholamine neurotransmitters, such as epinephrine and
norepinephrine. The catecholamines are important in memory and
learning, locomotion, sex drive, tissue growth and repair, immune
system functioning, and appetite control. Phenylalanine suppresses
appetite by increasing the brain’s production of norepinephrine
and cholecystokinin (CCK). CCK is the hormone thought to be
responsible for sending out the “I am full” message. These functions of
phenylalanine can be of tremendous value to athletes, especially those
who need to stimulate mental alertness, to lose weight, or to maintain
low levels of body fat.

DL-phenylalanine (DLPA) has been shown to be useful in combating

pain. This can be beneficial for athletes who suffer from acute or chronic
pain from injury. Dosages of 500 to 1,500 milligrams of DLPA per
day have been reported to be effective for this purpose. The theorized
mechanism is that DLPA “protects” the endorphins in the body from
destruction, thereby allowing them to distribute their morphine like
pain relief. Endorphins are a thousand times more powerful than

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morphine is. Remember, however, that more is not always better. If you
experience just partial pain relief, contact your health-care practitioner
to evaluate your condition. Do not take mega doses of DLPA, especially
without medical supervision.

Dosages of supplemental L-phenylalanine ranging from 100 to 500

milligrams, taken one to three times a day, has been reported to produce
no major side effects. However, note that higher dosages have been
reported to cause headaches in some people. Cofactors that appear to be
necessary in phenylalanine metabolism include vitamin B3, vitamin B6,
vitamin C, copper, and iron.

A word of caution: The artificial sweetener aspartame is a di-peptide

made up of phenylalanine and aspartic acid. Soft drinks containing
aspartame carry warnings that are aimed at people with phenylketonuria
(PKU), a disease in which phenylalanine is not properly metabolized and
can be very damaging. People with phenylketonuria should not take any
supplemental L- or DL-phenylalanine.

People who drink a great number of caffeine-containing beverages

or take energy supplements with caffeine-containing herbs, such as
guarana, may need more phenylalanine. Caffeine tends to cause some
of the neurotransmitters that are made with phenylalanine to become
depleted in the central nervous system. This is one of the reasons people
sometimes feel mentally fuzzy after drinking a lot of coffee. Taking
supplemental L- or DL-phenylalanine may help offset the depletion, or
reduce your caffeine consumption.

Proline
Proline is a conditionally indispensable amino acid. It occurs in
high amounts in collagen tissue. It can be synthesized from and also
converted to glutamic acid. Hydroxyproline, which is also abundant in
collagen, is synthesized in the body from proline. Proline is important
in the maintenance and healing of collagen tissues such as the skin,
tendons, and cartilage. Proline and hydroxyproline are typically
provided in supplements from hydrolyzed collagen or gelatin, which
contain high amounts of these amino acids in addition to other amino
acids. Hydrolyzed collagen and gelatin have been used in studies and

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 Protien and Amino Acids: Muscle Builders and More | 143

were found to promote improved joint function and improved mobility

and to reduce pain and stiffness, in particular, in knee joints. The mean
dietary intake of proline is 5.2 grams per day, with highest intakes
reported to be about 12 grams per day.

Serine
Serine is a dispensable amino acid found in proteins and derived
from glycine. Its metabolism leads to the formation of many
important substances, such as choline and phospholipids, which are
essential in the formation of some neurotransmitters and are used to
stabilize membranes. It is part of an important phospholipid called
phosphatidylserine found in cell membranes, is reported to have
anti-catabolic effects, and is important in brain and nervous system
health and function. Serine is important in the metabolism of fat and
the promotion of a healthy immune system. Serine is usually found
occurring in supplements from whole proteins. The mean dietary intake
of serine is 3.5 grams per day, with a highest reported intake of about 7.9
grams per day.

Taurine
Taurine is a dispensable sulfur-bearing amino acid that plays a major
role in brain tissue and in nervous system functioning. It is involved in
blood pressure regulation and in the transportation of the electrolytes
across cell membranes. It is found in the heart, muscles, central
nervous system, and brain. Taurine is also found in the eye and may
be important for maintaining good vision and eye functioning. Other
reported functions of taurine include bile acid function, detoxification
of xenobiotics (foreign substances in the body), membrane stabilization,
antioxidant activity, osmoregulation, cell proliferation, modulation
of neuronal excitability, and intracellular and extracellular calcium Intracellular: inside
regulation. A more recent suspected function of taurine is as a the cell.

constituent of mitochondrial tRNA. Taurine is made in the body from Extracellular: outside
the cell.
cysteine and methionine, with vitamin B6 as a cofactor. Taurine is
typically found in sports nutrition products and energy drinks due to its
diverse and important functions to ensure adequate levels in strenuous
training athletes.

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Threonine
Threonine is an indispensable amino acid found in proteins. It is an
important component of collagen, tooth enamel, protein, and elastic
tissue. It can also function as a lipotropic agent, a substance that prevents
fatty buildup in the liver. Mean daily dietary intake of threonine is about
3 grams per day with a high intake of 7.1 grams per day.

Supplemental threonine has a reported medical use in the treatment of

depression in patients with low threonine levels. Studies still need to be
undertaken to determine the exact benefits of taking extra threonine
supplementation for athletes, besides the expected benefits associated
with its essential functions in protein synthesis and other tissues.

Tryptophan
Tryptophan is an indispensable amino acid necessary for the production
of vitamin B3 and neurotransmitter serotonin. Taking supplemental
vitamin B3 can help conserve tryptophan for its other functions. The
mean daily intake of tryptophan is about 0.9 grams per day, with an
upper intake of 2.1 grams per day in the general population.

Supplemental tryptophan has been taken for years by millions

of people for its pronounced calming effects, which include the
promotion of sleep and the treatment of depression. Serotonin
helps control the sleep cycle, causing a feeling of drowsiness.
Research reported that taking supplemental tryptophan was
effective in correcting certain sleep disorders. Tryptophan has
also been reported to increase the GH levels and was a popular
ingredient in nighttime GH-releasing supplement products.

Tryptophan is one of the least abundant amino acids in food, which

makes it one of the limiting essential amino acids. Some foods high in
tryptophan are cottage cheese, pork, wild game, duck, and avocado.
Eating these foods along with vitamin B3 and the cofactors vitamin
B6 and magnesium may help athletes derive some of the benefits that
tryptophan offers.

Tryptophan has been commercially used as a single-form amino acid for

many years. It has been used by doctors and self-prescribed for treating

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 Protien and Amino Acids: Muscle Builders and More | 145

depression, managing pain, and helping with sleep. In 1989, there was a
sudden outbreak of a rare blood disorder observed in the United States.
The National Institute of Health quickly linked development of the
disorder to use of certain tryptophan supplements. As a result of this
occurrence, the US Food and Drug Administration (FDA) limited the
use of tryptophan as an individual supplement and only allowed its use
to fortify protein and other limited applications. The vast majority of
supplement users were surprised because, based on decades of use, the
rare blood disease had never before been linked to tryptophan. Almost
immediately during the investigation, health officials found that the
tryptophan supplements used by people who developed the blood disease
came from the same manufacturer located in Japan. Upon further
investigation, it was finally discovered that there was a contaminant in
several batches of tryptophan and that the contaminant was responsible
for causing the blood disease, not the supplemental tryptophan. Time
has passed, and tryptophan products are beginning to appear on the
market again.

Tryptophan is also found in many protein and amino acid products

in the amino acid profile information section of the nutrition labels.
Tryptophan, like many amino acids, is a naturally occurring essential
amino acid found in all dietary proteins. In fact, you cannot live without
it. As a result, many of the supplements you purchase indicate that the
tryptophan content is from natural sources, not to be confused with the
synthetic form of tryptophan. However, some companies have begun to
sell single-ingredient tryptophan supplements again.

Tyrosine
Tyrosine is a conditionally indispensable amino acid and is made from
the essential amino acid phenylalanine. Supplementation with L-tyrosine
can have a sparing effect on phenylalanine, leaving phenylalanine
available for functions not associated with tyrosine formation. Mean
daily intake of tyrosine is reported to be about 2.8 grams a day, with
high daily intake of 6.4 grams per day in the general population.

Tyrosine plays many roles in the body. It is a precursor of the

catecholamines dopamine and norepinephrine, regulates appetite, and
aids in melanin skin pigment production. These functions are similar

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to the ones with which phenylalanine is associated as a precursor of

tyrosine. However, tyrosine is believed to be better at stimulating these
effects because it is one step closer as a precursor. An antidepressant
effect and an increased sex drive in men have also been observed with
tyrosine supplementation. Studies conducted under experimental
conditions have yet to report any improved athletic performance from
ingesting tyrosine supplements. A word of caution: tyrosine supplement
use may trigger migraine headaches in some people when it is broken
down into a product called tyramine.

Valine
Valine is an indispensable amino acid and a member of the branched-
chain amino acids. The same as the other BCAAs, isoleucine and leucine,
valine is an integral part of muscle tissue and may be used for energy by
exercising muscles. It is involved in tissue repair, nitrogen balance, and
muscle metabolism. For supplemental L-valine dosage recommendations,
refer to “The Branched-Chain Amino Acids” heading.

A Final Word on Amino Acids

Although the above information is comprehensive, many uses for the
individual amino acids were not included. These mainly deal with
clinical and metabolic disorders and their treatment, which is beyond
the scope of this course. As more research is being performed on amino
acids and the athlete, new discoveries and uses of amino acids will
very likely be discovered. Also, be aware that just because a clinical
research study reports a positive finding for an amino acid, or other
dietary substance, the application of research findings needs to be
evaluated for each individual athlete, in the context of his or her health,
training, and nutrition and under doctor supervision—along with other
suitable health professionals as required. Duration of use may also be of
some concern, as the clinical research studies generally are conducted
over a few to several weeks, with some longer. As such, long-term use
safety and efficacy may not be established. In addition, the research
studies typically use small study groups, which may not provide a
comprehensive representation of how all people will respond
to supplementation.

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 Protien and Amino Acids: Muscle Builders and More | 147

Special Protein and Amino Acid Needs of the Athlete

Based on the above information, which explains grams/kilogram of body weight (Hoerr, Young,
some of the dynamic metabolic aspects of amino and Evans), which is about 50 percent higher
acids, sport nutritionists now realize that simply than the RDA.
eating a fixed amount of protein is not the only
It is estimated that, depending on your type of
requirement of optimum protein intake. The
sport, the requirement for protein is about 1.5
type of protein will affect how it is used by the
to 2.5 grams/kilogram of ideal body weight.
body, and fortification of certain amino acids
And in some special instances, for example
and other cofactors can be used to make more
a bodybuilder preparing for a contest, the
efficient use of food source proteins. At the very
requirement may exceed 3 grams/kilogram of
least, protein intake for athletes is becoming a body weight. How much food does this translate
sophisticated science. Just how much protein to? For an athlete weighing 79 kilograms, protein
an athlete requires will depend on his or body intake should be between 118 to 198 grams per
weight, the quality of protein eaten, and the day. That’s two to three times the RDA and a lot
intensity and duration of exercise. of protein to eat (about 14 ounces to 22 ounces
A look at the RDA guidelines for protein will of chicken per day). Remember that excess
provide a baseline for the athlete’s protein protein does not get converted to muscle. It is
requirements. The following guidelines are what either broken down and used as energy in the
the National Research Council recommends for liver, or converted to fat. Because protein is also
average protein consumption for different age one of the most expensive nutrients, you should
groups and genders. The protein allowances are take special care to eat just the right amount for
determined on a body weight basis. These values your sport, lean body weight and activity level.
assume that you are of normal body weight. If Another consideration for protein consumption
you are over fat, you will end up over calculating is making the proteins you eat more efficient.
your protein needs from the RDA basis. This can be accomplished by using a multi-
amino acid and BCAA supplement to fortify the
It is interesting to observe that on a weight basis, protein you are eating. By providing potential
children require more protein per kilogram limiting amino acids from supplement sources,
of body weight for growth. For an adult male you may be able to maintain nitrogen balance
between the ages of 25 and 50, getting 63 grams or positive nitrogen balance with less protein
of protein per day can be obtained by eating intake. While some general protein supplement
about 6 ounces of chicken. However, research guidelines will be given, the only way you can
has shown that athletes engaged in daily exercise determine this for sure is to monitor how your
have difficulty maintaining nitrogen balance nitrogen balance varies with different levels of
when dietary protein intake is less than 1.5 protein intake and supplement use.

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Also, protein cofactors are required for the

proper metabolism of amino acids. Vitamin
B6 (pyridoxine) is the most important amino
acid cofactor because it is required for the
function of amino acid metabolizing enzymes.
Niacin is an important vitamin because it
can spare tryptophan, which is converted
to niacin in the body. However, don’t take
large amounts of niacin during exercise,
as studies have shown that large intakes of
niacin can increase glycogen use, resulting in
faster fatigue. Intake of all the other essential
vitamins and minerals is important for
optimum amino acid use. Researchers have
determined that there is an increase in calcium
excretion with increased protein intake. An
increase in phosphorus seems to minimize
this effect, as does an increase in calcium
intake for individuals on high protein diets.

Food and Supplement

Sources of Protein
Proteins are found in both animals and plants, complete proteins. That is beyond the scope of
and in special supplement formulations. this course book.
Protein and fat are usually found together in Some good low-fat sources of protein include the
foods, especially animal products. Most animal following: low-fat/skim milk and other low-fat
proteins tend to be of higher quality than plant dairy products; most fish – cod, sole, halibut,
proteins in that animal proteins contain the tuna, sardines, salmon; most shellfish – scallops,
proper proportions of essential amino acids. lobster, crab, shrimp, mussels; lean red meats
Most plant protein sources, such as beans and with the fat trimmed; poultry skinned.
peas, are often incomplete in their essential
amino acid content. Combinations of different You may find it interesting to note though that
plant proteins are required to obtain an adequate if you were to search the scientific literature
balance of amino acids. Some combinations for human studies, you would find that one
include combining peas with corn or kidney of the more impressive studies was conducted
beans with brown rice. If you are a vegetarian on SUPRO isolated soy protein. The research
or decide to become one, you must learn to was conducted in 1992 by I. Dragan and
combine legumes with grains to formulate coworkers, who worked with 66 Romanian

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 Protien and Amino Acids: Muscle Builders and More | 149

Olympic endurance athletes (30 kayak-canoe, 36 Effects of Creatine Monohydrate

rowing, 45 males and 21 females). These athletes
plus Whey Protein
participated in this 12-week study to determine
the biological effects of SUPRO-isolated soy A study conducted by D. G. Burke and coworkers
protein. The athletes were split into two groups: sought to measure muscular developments
the A group received 1.5 grams per kilogram of during six weeks of resistance training, among
body weight of SUPRO a day. The athletes in the 36 males who were randomly assigned to
B group did not receive any protein supplement. supplementation with whey protein, whey
This means that right from the start the A group protein and creatine monohydrate, or a placebo
ingested about twice the protein per day than the (maltodextrin). At the end of the six-week study
B group did. Here are the results reported from period, the following results were observed:
the A group; the group experienced an increase Lean body tissue mass increased to a greater
in body mass of about 6 pounds, strength extent in the whey-creatine group compared
improved, and there was a decrease in fatigue with the other groups and also in the whey
after training sessions. No damage to the liver, group when compared to the placebo group: +
kidney, or fat metabolism were noted. 4 kg, 6.5% in the whey-creatine group; +2.3 kg,
3.8% in the whey group; and +0.9 kg, 1.5% in the
Whey Protein Gets Results, Too placebo group. Bench press strength increased
While high-quality whey protein isolate is to a greater extent in the whey-creatine group
the most expensive of the primary protein compared with that of the other groups: +15.2
sources used in protein products, it has some kg, 17% in the whey-creatine group; 6.3 kg, 7%
distinct nutritional advantages. It enhances the in the whey group. Knee extension peak torque
production of glutathione, one of the body’s most increased significantly with training in the
powerful natural antioxidants. It has high levels whey-creatine and whey groups, but not for the
of BCAAs and has been shown to boost immune placebo group. The researchers also observed
system functioning and promote and support that continued training for an additional six
protein synthesis. It is high in glutamine and weeks without supplementation resulted in
arginine. It has a good proportion of essential maintenance of strength and lean tissue mass
and nonessential amino acids. Additionally, in all groups. The study’s results revealed a
whey protein has been clinically proven to build synergistic effect among males taking the whey
muscle and improve athletic performance. It protein and creatine supplement, which resulted
has also been shown to help reduce body fat, in greater increases in lean tissue mass and
while at the same time increase lean muscle bench press performance.
mass when taken as part of an exercise program. W. Derave and coworkers wanted to determine
Another important benefit of the protein is its the effects of creatine monohydrate and creatine
ability to raise levels of IGF-1, a muscle-building plus protein supplementation on GLUT-4 and
biochemical, and decrease levels of cortisol, a glycogen content of human skeletal muscle. Note
muscle and tissue degrading substance. that GLUT stands for glucose transporter. There

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are five main GLUTs, which tend to be tissue specific, and GLUT-4 is
Adipose tissue: fat tissue more abundant in skeletal muscle tissue and in adipose tissue. This
in the body. double blind, placebo-controlled trial was performed on 33 young healthy
subjects (26 men and 7 women). The subjects’ right legs were immobilized
with a cast for two weeks, followed by a six-week resistance-training
program for the right knee extensor muscles.

The research participants were supplemented throughout the study with

placebo (maltodextrin) or creatine & maltodextrin, or with creatine plus
protein during immobilization, and creatine plus protein, maltodextrin,
amino acid blend, and multivitamin blend during retraining. Needle
biopsies were bilaterally taken from the vastus lateralis (a muscle of the
quadriceps group, of the thigh). GLUT-4 protein expression was reduced
by the immobilization in all groups. During retraining, GLUT-4 content
increased in both creatine (+24%) and creatine-protein (+33%) groups,
which resulted in higher post-training GLUT-4 expression.

When compared with the placebo group, the muscle glycogen content
was higher in the trained leg in both creatine and creatine-protein
groups. Supplements had no effect on GLUT-4 expression or glycogen
content in control legs. Area under the glucose curve during the oral
glucose tolerance test was decreased from 232 mmol per liter per
minute at baseline to 170 mmol per liter per minute at the end of the
retraining period in the creatine-protein group, but it did not change in
the creatine or placebo groups. The researchers concluded that creatine
intake stimulates GLUT-4 and glycogen content in human muscle only
when combined with changes in activity level and that combined protein
and creatine supplementation improved oral glucose tolerance. Unit 9
contains details about creatine.

Another type of milk protein, called casein, is ingested from dairy

products along with whey and is used in its isolated from as an
ingredient in sports nutrition products. Casein is more slowly digested
compared with whey and provides a sustained delivery of amino acids
into the bloodstream. This could offer an advantage during longer
periods of eating separation due to daily schedules and during sleep.
Research has been conducted examining the benefits of pre-sleep
ingestion of casein along or in combination with whey to gain the
benefits of shorter-term boost in amino acids into the body followed
by a more sustained delivery of amino acids. Pre-sleep protein, and
other nutrient-ingestion strategies, may help improve exercise-related
recovery for all athletes and increase muscle mass and strength gains

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 Protien and Amino Acids: Muscle Builders and More | 151

for resistance-training athletes. Amounts and the age group reference body weight. Details can
timing of pre-sleep protein ingestion need to be found in the IOM publication. It is obvious
be personalized to consider tolerance and what that these protein values are low in general for
works best for an athlete. Some studies include active adults and would be considered very low
carbohydrate and other nutrients in the pre-sleep for most competitive athletes.
protein formulas.
Recommended Dietary Protein Allowances
Recommended Dietary Protein (some adult age group examples)
Allowances for Protein Category Age Group Protein RDA
Years g/day
The following table contains a list of some of the
Males
Protein Recommended Dietary Allowance values
14–18 52
for a sample of adult age groups. The Appendix
19–30 56
contains the entire table. These are the 2002/2005
31–50 56
Dietary Reference Intake values issued by the
51–70 56
Institutes of Medicine, National Academy of
Females
Sciences, minimum protein intake goals for the
general population. Note that the Protein RDA 14–18 46

values were calculated based on grams protein 19–30 46

per kilogram of body weight for reference body 31–50 46

weights; for adults 0.8 g/kg body weight times 50–70 46

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Estimating Daily Protein Requirements

The following table for Estimating Daily “dynamic” approach that considers individual
Protein Requirements was developed by differences based on an individual’s lean
coauthor Dr. Frederick Hatfield. It uses a body mass and need factor (activity).

Estimating Daily Protein Requirements

Lean Body Weight (lbs) x Need Factor = Daily Protein Requirement (g)

0.5 - Sedentary, no sports or training

0.6 - Jogger or light fitness training

Need Factors:

0.7 - Sports participation or moderate training 3X a week

0.8 - Moderate daily weight training or aerobic training

0.9 - Heavy weight training daily

1.0 – Heavy weight training daily plus sports training, or “2-a-day” training

LBW* (lb.) Need Factor

(protein requirements expressed in grams per day)

0.5 0.6 0.7 0.8 0.9 1.0

90 45 54 63 72 81 90
100 50 60 70 80 90 100
110 55 66 77 88 99 110
120 60 72 84 96 108 120
130 65 78 91 104 117 130
140 70 84 98 112 126 140
150 75 90 105 120 135 150
160 80 96 112 128 144 160
170 85 102 119 136 153 170
180 90 108 126 144 162 180
190 95 114 133 152 171 190
200 100 120 140 160 180 200
210 105 126 147 168 189 210
220 110 132 154 176 198 220
230 115 138 161 184 207 230
240 120 144 168 192 216 240
*LBW – Remember that your fat cells do not require protein Thus, it doesn’t make any sense to compute your protein
requirements from total Body weight. Your LBW (lean body weight, or fat-free weight) can be estimated using any one
of several anthropometric, ultrasound, electrical impedance, or under water weighing techniques.

Developed byDr. Fredrick Hatfield, PhD

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 Protien and Amino Acids: Muscle Builders and More | 153

Cofactors
The vitamin and mineral cofactors are also important, as are herbal
factors that have been found to benefit protein utilization. Many sports
nutrition companies now understand this and as such are including these
cofactors into their formulations, such as Vitamin B6, glutamine, and
glucosamine.

Check Those Labels

Amino acids and proteins come in many forms and combinations.
When purchasing supplement formulations that supply one or several
amino acids, it is important to learn how to determine how much of the
actual amino acid you are getting. For example, the ingredient list for a
supplement containing L-Arginine and L-Ornithine may read:
Each Capsule Supplies:
L-Arginine | 500 mg
L-Ornithine | 500 mg

This means that the amounts of arginine and ornithine are being reported
as their molecular amounts. Now, you may also come across products
that contain arginine and ornithine combined with other molecules. For
example, the label may read:
Each Capsule Supplies:
L-Arginine Hydrochloride | 500 mg
L-Ornithine Hydrochloride | 500 mg

This can also be written L-Arginine HCL. This means that each capsule
has 500 mg of the entire molecule of L-Arginine Hydrochloride, of which
arginine may only make up 60 percent. The first example actually has 500
mg of arginine and ornithine per capsule and is a better product. The label
may report the ingredient as follows:
Each Capsule Supplies:
L-Arginine (HCL or Hydrochloride) | 500 mg
L-Ornithine (HCL or Hydrochloride) | 500 mg

The parentheses around the Hydrochloride let you know that the product
contains in each tablet 500 mg of arginine and ornithine in the form of
Hydrochloride, which means that you are getting the full 500 mg per
capsule as in the first example. This is important to understand, especially
when you are comparing formulations from different companies.

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Always beware of a product that does not give the amount of the amino
acid you desire. Some products only list the amino acid in the ingredient
listing and do not give its quantity. This is of no use to you, as there is no
way of determining your daily amount needed.

Connective Tissue
There are several types of connective tissues. Cartilage, tendons,
ligaments, intervertebral discs, pads between joints, and cellular
membranes all are comprised of connective tissue. All connective
tissues have two common components, chief of which is collagen. One-
third of your body’s total protein volume is comprised of collagen,
making it the most common protein in the body. The other component
Hyaluronic acid: a
polysaccharide molecule is proteoglycans (PGs). PGs form the “framework” for collagenous
which is one of the chief tissue. These huge structural “macromolecules” are comprised mainly
components of connective
tissue, forming a gelatinous of glycosaminoglycans (GAGs) -- long chains of modified sugars. The
matrix that surrounds cells. principal sugar in PGs is called hyaluronic acid, of which 50 percent is

Fat cell
Melanocyte

Reticular fibers

Lymphocyte
(a type of white blood
cell)
Mast cell

Macrophage Elastic fibers

(a type of white blood
cell)

Capillary Collagen fibers

Connective tissue components

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 Protien and Amino Acids: Muscle Builders and More | 155

composed of glucosamine. The principal amino acids forming collagen

are glycine, proline, lysine, hydroxyproline, and hydroxylysine.

Collagen and PGs must somehow “get together” during the production
of new connective tissue. Of the multitude of biochemical reactions
that must take place during the synthesis of connective tissue, there is
one critical “rate-limiting” step that once reached guarantees that new
connective tissue is being successfully synthesized. That rate-limiting
step is the conversion of glucose to glucosamine. Refer to Unit 9 for
details about glucosamine and chondroitin sulfate.

Summary of Protein and the Athlete

• Athletes need about two to three times the amount of the DRI for protein.

• Ideally protein requirement should be calculated on a lean body weight basis.

• High quality proteins should be a dominant part of the diet.

• Protein supplements and amino acid tablets can be used to

fortify dietary proteins from food sources.

• Protein should be consumed with each meal, but not for pre-event meals.

• Branched Chain Amino Acids and Multi-Amino Acid formulations high in Branched
Chain Amino Acids can be taken with meals to fortify food proteins and alone
before exercise to spare muscle tissue. Protein powders can be used as well.

• Vitamin B6 and calcium might need to be increased for athletes on high protein diets,
and should be part of amino acid formulations taken for muscle growth and recovery.

• Individual amino acids can be taken alone or in combination for special uses, like growth
hormone release, ammonia detoxification, relaxation, stimulation, or as antioxidants.

• Remember that collagen is the most abundant protein in the body, comprising fully one third of
the total body protein volume. Its importance to athletes is clearly critical due to the connective
tissue repair requirement brought on by microtrauma during intense training and competition.

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Conclusion
Proteins and amino acids are a diverse group high for less active nonathletes, and protein
of macronutrients, which are vital building intake can be even further fine-tuned based on
blocks of the human body for growth, each athlete’s individual requirements and type
maintenance, and repair; used to make a variety of sport. Focusing on healthy types of protein
of biomolecules required for body function and sources is also important. Unit 17 will provide
structure; and also contribute a minor source of details regarding protein nutrition guidelines
high yielding energy for athletic performance. for athletes, including specialty topics, such as
Protein requirements for athletes are generally timing nutrient intake.

Keywords
Ammonia Incomplete protein

Uric acid Cannibalization

Polypeptide Free-form amino acids

Urea cycle Di-peptide

Hormone Tri-peptide

Deoxyribonucleic acid (DNA) Hydrolyzed protein

Collagen Blood-brain barrier

Connective tissue Coenzyme

Lipoprotein Precursor

Cell membrane Transmethylation

Hemoglobin Intracellular

Ribonucleic acid (RNA) Extracellular

Limiting nutrient Adipose tissue

Complete protein Hyaluronic acid

Sports Nutrition
 Topics Covered In This Unit

Introduction

Lipids – The most misunderstood mac-

ronutrient

About the different lipids

Triglycerides and fatty acids

Essential fatty acids

Phospholipids

Lipid digestion

You are what you eat

How much lipid does an athlete need?

Dietary sources of fat

Fats and athletic performance

Conclusion

UNIT 5

LIPIDS AND THE ATHLETE:

ENERGY AND GROWTH FACTORS
158 | Unit 5

Unit Outline
I. Introduction c. Medium-chain triglycerides
II. Lipids – The most misunderstood d. Trans fatty acids
macronutrient
IV. Lipid digestion
a. About the different lipids
V. You are what you eat
III. Triglycerides and fatty acids
VI. How much lipid does an athlete need?
a. Essential fatty acids
VII. Dietary sources of fat
i. Eicosapentaenoic acid (EPA) and docosa-
VIII. Fats and athletic performance
hexaecoic acid (DHA)
IX. Conclusion
ii. Gamma linoleic acid (GLA)
b. Phospholipids
i. Lecithin
ii. Phosphatidylserine
iii. Cholesterol
iv. Congegated linoleic acid

Learning Objectives
After completing this unit, you will be able to:
• Define and describe key terms related to lipids (fats and oils).

• Understand the different types of lipids and their major functions.

• Determine essential and nonessential lipids, such as fatty acids.

• Discuss how lipids affect athletic performance and heath.

Introduction
Lipids compose the third major macronutrient category. Like
carbohydrates, lipids are made up of carbon, hydrogen, and oxygen.
Lipids are necessary for numerous reasons. They are involved with the
storage and supply of the fat-soluble vitamins A, D, E, and K. They are a
source of essential fatty acids, which play many vital roles in maintaining
the function and integrity of cellular membranes. They serve as a

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 Lipids and the Athlete: Energy and Growth Factors | 159

concentrated source of energy; they add palatability to the meal; and

they are important in other biochemical and biophysical functions, such
as steroid hormone synthesis.

Prevalent types of lipids used for energy include triglycerides Triglycerides: a type
(consisting of glycerol and three fatty acids), also referred to as of fat in your blood,
triglycerides can contribute
triacylglycerol, and the free fatty acids. As an energy substrate, to the hardening and
the importance of lipids will depend on the type of exercise being narrowing of your arteries
if levels are too high. This
performed. During endurance events, more triglycerides are used for puts you at risk of having
energy. For high-intensity sports, like sprinting, glycogen is used as a a heart attack or stroke.
Triglycerides are measured
primary fuel, but some lipids are also used. It is important to understand
along with cholesterol as
that lipids are always being metabolized for energy by the body; it’s just part of a blood test. Normal
a matter of degree. Research also shows that the trained athlete will use triglyceride levels are below
150 mg/dL. Levels above
more lipids for energy than the untrained athlete will. 200 mg/dL are high.

Strength athletes are prone to becoming fat because of this differential

use of energy substrate. That is, they use mostly glycogen stores for
energy and ingested carbohydrate, with a minor amount from body
fat stores. This category of athletes must therefore follow nutrition
programs that are low in fat and high in fat metabolizing nutrients.
But even though the marathon runner can get away with eating a high-
fat diet, too much fat in the diet can impede performance and prove
unhealthy, especially when high-fat diets are lower in adequate amounts
of carbohydrates and protein.

Athletic Significance of Lipids

• Essential fatty acids are required for growth, recovery, and overall health.
• Essential fatty acids are part of each cell, including muscle cells.
• Fatty acids are an important source of energy, especially for endurance athletes.
• Intake of saturated fats and cholesterol should be kept at healthy intake levels to avoid develop-
ment of coronary heart diseases their over consumption is linked to, plus other diseases.
• Daily intake of fat metabolizing vitamin and mineral cofactors is necessary for efficient fat metab-
olism.
• Omega-3 fatty acids, such as gamma-linolenic acid, DHA, and EPA cause beneficial effects on the
cardiovascular system, act as moderators of inflammation, and play possible roles in improve-
ment of strength and aerobic performance.

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Lipids – The Most Misunderstood

Macronutrient
Some dietary lipids (also referred to just fats) have gained a bad
reputation over the years. Medical research has linked a diet high
in saturated fats and cholesterol to many diseases, such as cancers,
coronary heart disease, and obesity. The fact remains, however, that
certain lipids are essential to your health. It’s really a matter of balance
and a habit of trimming down the total amount of fat in your diet. Be
aware that even with the healthy lipids, athletes need to keep total daily
lipid intake in check, to allow for consumption of high carbohydrates
and extra protein intake that athletes require. Regarding lipids, a focus
on the healthy essential lipids is a crucial goal.

Historically, the primary problem with lipid intake in the diet is simple:
most people get too much total lipid, too much of the wrong kind of
lipids, and not enough of the good lipids. The ultimate goal for the
athlete will be to keep total lipid intake below 30 percent of total daily
calories or less, maximize the essential fatty acids and omega 3 fatty
acids, and minimize saturated fatty acids and cholesterol. The main
functions of dietary lipids include:
• To provide fuel; fatty acids are a major fuel source during exercise

• To provide insulation as body fat stores

• To aid in the absorption of fat-soluble vitamins

• To act as an energy storehouse

• To supply essential fatty acids

• To provide protective padding for body structures and organs

• To serve as a component of all cell membranes and other cell structures

• To promote healthy skin

• To supply building blocks for other biomolecules

For the athlete, getting enough lipid in the diet is usually not a problem.
In fact, the opposite is more often the case. Although fats are necessary
for health, too many of the wrong kinds of fats can have negative
effects on the body and lead to certain cancers and atherosclerotic
cardiovascular diseases. Saturated fats and cholesterol are common
culprits. Of course, too much dietary intake of any fat can contribute

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to excess body fat and, for some, obesity. Most experts recommend
a total dietary fat intake of less than 30 percent of the total daily
calories. Some sources even recommend keeping fats at 20 percent
or lower; for example, “The IOC (International Olympic Committee)
recommends following a diet that does not contain less than 15–20%
fat of total energy” (in Potgieter 2013, Sundgot-Borgen 2011). Ingestion
of a high amount of saturated fats and cholesterol is clearly linked
to various cardiovascular diseases and certain cancers. Because the
athlete generally consumes more than 3,000 calories a day during the
competitive season, they can easily get an overdose of fat in the diet.
Getting adequate amounts of the right fats is therefore a major focus
for sports and fitness nutrition, while being careful not to overdo lipid
ingestion, to leave room for the other important macronutrients vital to
athletic performance and health: carbohydrates and protein.

About the Different Lipids

Lipids occur in both plants and animals but vary slightly in chemical
composition. By definition, lipids are compounds soluble in organic
solvents but not in water. Mammal fats tend to be more saturated than
fish oils and plant oils are. Beef tends to be more saturated than pork
and poultry are. The degree of hardness of a fat at room temperature is
an indication of how saturated the fat is. Compare hard beef fat with soft
fish fat and vegetable oils, which have lower amounts of saturated fats
and high amounts of polyunsaturated fats.

The following summarizes the major lipids found in the diet and body.
They include:
• Triglycerides (consisting of glycerol and 3 fatty acids)

• Fatty Acids (saturated, monounsaturated, and polyunsaturated)

• Essential Fatty Acids (Linoleic, Alpha-Linolenic)

• Omega 3 Fatty Acids (EPA and DHA)

• Gamma-Linolenic Acid (GLA)

• Medium-Chain Triglycerides

• Phospholipids

• Lecithin

• Cholesterol

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Oils: lipids that are liquid

at room temperature, oils
Triglycerides and Fatty Acids
come from many different
plants and from seafood. Triglycerides and fatty acids are the lipids that compose the fats and oils
Some common oils include in your diet and in the fat that your body stores. They make up about
canola, corn, olive, peanut,
98 percent of all the fats in the diet. The difference between fat and oil
safflower, soybean, and
sunflower oils. A number is simple: fats are solid at room temperature, and oils are liquid. This
of foods are naturally high solid and liquid state of fatty acids also tells us something about their
in oils, such as avocados,
olives, nuts, and some fish. composition. Triglycerides consist of 3 fatty acids attached to a 3-carbon
Saturated fatty acids:
glycerol molecule. The hundreds of different fatty acids come in various
fatty acids that have no lengths, between 4 and 24 carbons. Fatty acids are then grouped as
double bonds. Fats high follows: short chain (4–5 carbons), medium chain (6–12 carbons), long
in saturated fatty acids
are usually solid at room chains (13–19 carbons), and very long chain (20 or more carbons).
temperature. Major sources
include animal products Fatty acids are also rated by the degree of hydrogen atoms that are
such as meats and dairy attached to the carbon chain. Saturated fatty acids have the maximum
products, and tropical oils
such as coconut or palm oils. number of hydrogen atoms they can hold, with no double-bonded
Unsaturated fat: carbon atoms. This is why saturated fatty acids are more solid. The
unsaturated fats are liquid process of hydrogenation takes unsaturated fatty acids and saturates
at room temperature. them to become solid, like the vegetable oil fatty acids in margarine
Vegetable oils are a major
source of unsaturated fat in are. Monounsaturated fatty acids have one double bond, and
the diet. Unsaturated fats polyunsaturated fatty acids have more than one double bond.
include polyunsaturated
fats and monounsaturated Saturated fatty acids tend to be solid at room temperature. Therefore,
fats. Other foods, such as
avocados, fatty fish like solid fats are high in saturated fatty acid content. Polyunsaturated
salmon and tuna, most nuts, fatty acids tend to be liquid at room temperature. Oils are high in
and olives are good sources
of unsaturated fat. polyunsaturated fatty acids. Saturated fatty acids, along with fatty acids
containing 16 carbons or less, are always used for energy or stored
Polyunsaturated fatty
acids (PUFAs): fatty as body fat. The shorter the fatty acid length, the easier it is to use it
acids that have two or as energy. The longer fatty acids can also be used as energy or stored
more double bonds and
are usually liquid at room as body fat but have other functions as well, such as being used in
temperature. Primary structures of cell membranes.
sources are vegetable oils
and some nuts and seeds. Out of the many fatty acids that exist, only two are considered essential:
PUFAs provide essential fats
such as n-3 and n-6 fatty linoleic and linolenic. Both are 18 carbons long and unsaturated. The
acids. following section will review the so-called essential fatty acids.
Solid fats: fats that are
usually not liquid at room
temperature. Solid fats The Essential Fatty Acids
are found in animal foods,
except for seafood, and can
The three fatty acids that make up a triglyceride molecule will vary in
be made from vegetable composition. Composition depends upon whether the fatty acid’s origin
oils through hydrogenation. is from plants or animals. Out of the many fatty acids, only two are of
Some tropical oil plants,

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essential dietary concern, and one is conditionally essential in the diet. such as coconut and
palm, are considered as
Linoleic acid (an Omega-6 fatty acid) is a primary essential fatty acid
solid fats due to their fatty
the body cannot manufacture. It therefore must be obtained from the acid composition. The fat
diet for normal growth and health. However, recent research indicates component of milk and
cream (butter) is solid
that diets too high in linoleic acid may cause the metabolism to be at room temperature.
sluggish and promote a tendency toward developing a condition that Solid fats contain more
saturated fats and/or trans
favors storage of body fat. Such diets may also cause an increase in some fats than liquid oils (e.g.,
inflammatory substances the body produces naturally. soybean, canola, and corn
oils), with lower amounts
A major researcher in this area of fatty acid balance and obesity, Artemis of monounsaturated or
polyunsaturated fatty acids.
P. Simopoulos, MD, believes that our food supply may be too high in Common fats considered to
linoleic acid (Omega 6 fatty acid) and too low in <bl>alpha-linolenic be solid fats include: butter,
acid (an Omega-3 fatty acid). She contends that humans evolved on beef fat (tallow), chicken fat,
pork fat (lard), shortening,
a diet that was much higher in protein, lower in carbohydrates, but coconut oil, palm oil and
higher in fruits and vegetables, and much lower in saturated fat than palm kernel oil. Foods
high in solid fats include:
today’s conventional diets are. Furthermore, the consumption of refined full-fat (regular) cheeses,
carbohydrate products–sugar, fructose, high-fructose corn syrup, and creams, whole milk, ice
trans fatty acids from hydrogenated vegetable oils and margarines–adds cream, marbled cuts of
meats, regular ground beef,
to the metabolic disruption. The issues of proportions of dietary fat- bacon, sausages, poultry
carbohydrate-protein are more involved for athletic performance, and skin, and many baked
goods made with solid fats
guidelines are presented as part of the “Dynamic Nutrition” approach to (such as cookies, crackers,
planning a nutrition program. doughnuts, pastries, and
croissants).
A modified form of linoleic acid called conjugated linoleic acid (CLA) Linoleic acid (LA): one
has emerged on the shelves of health food stores in various supplement of the n-6 fatty acids, is
essential in the diet because
product, including some sports nutrition products. The marketers
it cannot be synthesized by
promote CLA as having fat-metabolizing effects that result in burning humans. Primary sources are
more fat, thereby increasing lean body mass and decreasing body fat. nuts and liquid vegetable
oils, including soybean oil,
Recent human studies confirm this effect. CLA details are presented in a corn oil, and safflower oil.
following section. Also called omega-6 fatty
acids.
Another fatty acid, arachidonic acid, is made in the body from linoleic Alpha-linolenic acid
acid. Arachidonic acid is thought to become essential when linoleic (ALA): an n-3 fatty acid
that is essential in the
acid deficiency exists. However, because arachidonic acid must be made
diet because it cannot be
from linoleic acid and arachidonic acid is a polyunsaturated fatty acid, synthesized by humans.
the presence in the diet will have a linoleic sparing effect. This may be Primary sources include
soybean oil, canola oil,
beneficial to the athlete because arachidonic acid is also an important walnuts, and flaxseed.
structural fatty acid present in cell membranes.

Alpha-Linolenic acid is the other essential fatty acid (an Omega-3

fatty acid). Alpha-Linolenic acid has several functions, is important

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in growth, and is the precursor of two other alpha-linolenic acid as published by the Institute
important fatty acids (EPA and DHA) discussed of Medicine 2006:
below. As with protein/amino acids, the body
Linoleic Acid. DRI-Adequate Intake examples:
would rather use the essential fatty acids for
17 grams per day for men ages 19 through 50
growth and functional needs instead of fuel
years; 12 grams per day for women 19 through
needs. A diet that is high in essential fatty
50 years of age.
acids and low in nonessential fatty acids will
therefore increase metabolism and discourage Alpha-Linolenic Acid. DRI-Adequate Intake
increased body fat formation, assuming examples: 1.6 grams per day for men 19 to 50
that a person is not overeating. Remember, years; 1.1 grams for women ages 19 to 50 years.
excess carbohydrates and amino acids can
be converted to body fat stores. Flax seed For Total Fat. DRIs for men or women were not
oil, fish, and poultry are good foods to eat to determined (ND).
increase your intake of alpha-linolenic acid. These essential fatty acid DRI-AI values are
Some of the specific functions of the essential general, and each individual requires intake
fatty acids include the following: determination, especially for athletes, with
higher levels being expected, especially for alpha-
• Presence in phospholipids, which are
linolenic acid.
important for maintaining the structure and
function of cellular and subcellular membranes
Eicosapentaenoic Acid (Epa)
• Function as precursors for eicosanoids, which
and Docosahexaenoic Acid (Dha)
are important in regulating a wide diversity of
physiological processes During the 1980s, there was a resurgence
• Involvement in the transfer of oxygen from the of attention focused on two fatty acids
lungs through the alveolar membrane belonging to the Omega-3 family of fatty
• Formation of a structural part of all cells
acids: eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA). Researchers in
• Maintenance of proper brain and nervous
the 1950s documented the cholesterol-lowering
system function
effects of EPA and DHA. However, it was not
• Production of prostaglandin, group of until 25 years later, when reports of low rates of
hormones important in metabolism cardiovascular diseases were documented among
• Formation of healthy skin and hair fish-eating Greenland Eskimos, that conclusive
results were achieved. This early research put
• Wound healing
these dietary fatty acids in the spotlight.
• Growth enhancement
EPA and DHA can be made in the body
The following is some information regarding from the essential fatty acid alpha-linolenic
Dietary References Intakes for Total Fat and acid, and they are found in human tissues as
the essential fatty acids linoleic acid and normal components. Even though the body

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 Lipids and the Athlete: Energy and Growth Factors | 165

can manufacture EPA and DHA, dietary sources have beneficial effects
when part of a diet low in saturated fatty acids. Some experts refer
to EPA and DHA as semi-essential, in particular for people with low
production levels due to inadequate precursor alpha-linolenic acid,
or for other individual reasons. EPA and DHA have the tendency to
disperse fatty acids and cholesterol in the bloodstream, which seems to
be how their presence helps reduce arterial clogging. They have a blood-
thinning effect and discourage excessive blood clotting. They also may
lower blood triglycerides and raise HDLs (high-density lipoproteins, High-density
the good lipoproteins). lipoprotein (HDL): HDL
is a compound made up of
fat and protein that carries
EPA and DHA exert an anti-inflammatory effect and work by competing cholesterol in the blood
with arachidonic acid, which forms pro-inflammatory compounds. to the liver, where it is
Besides all of these known health benefits, recent studies on athletes broken down and excreted.
Commonly called “good”
have documented improvement in athletic performance. Studies using cholesterol, high levels of
2 to 4 grams per day of EPA and DHA from supplements and fish have HDL cholesterol are linked
to a lower risk of heart
reported significant increases in strength and aerobic performance.
disease. Men should aim
Improvements include higher repetitions in bench press, increased for an HDL of 40 mg/DL or
one-repetition maximum, faster running times, reduction in muscular higher. Women should aim
for an HDL of 50 mg/DL or
inflammation, and longer jumping distances. Scientists believe that these higher.
improvements in various athletic performance parameters are due to the
combined effects that EPA and DHA have on the body, including growth
hormone production, anti-inflammatory action, enhanced aerobic
metabolism, lower blood viscosity leading to better oxygen and nutrient
delivery to muscles, and improved recovery.

Gamma Linolenic Acid (GLA)

Gamma linolenic acid is another important fatty acid that can be made
in the body from the main essential fatty acid, linoleic acid. GLA is an
important precursor for the series 1 prostaglandins, a group of hormones
that regulates many cellular activities. The series 1 prostaglandins keep
blood platelets from sticking together, control cholesterol formation,
reduce inflammation, make insulin work better, improve nerve function,
regulate calcium metabolism, and are involved in immune system
functioning. Therefore, ingestion of foods and supplements high in GLA
can benefit overall health. However, getting GLA containing foods is not
that simple. GLA is not found in many foods. In fact, the major sources
are evening primrose oil, borage oil, and black currant oil. These oils are
also high in linoleic acid.

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Phospholipids
Phospholipids are a second major class of lipids, next to fatty acids/
triglycerides. They are a major structural lipid in all organisms and part
of every living cell. In combination with proteins, phospholipids are
constituents of cell membranes and membranes of subcellular particles.
Phospholipids consist of two fatty acids attached to glycerol and a
phosphate-containing compound attached to the third carbon.
For example, in lecithin, choline is part of this phospholipid molecule.

The phospholipids’ main function is maintaining the structural

integrity of cell membranes. They also act as emulsifiers in
the body which, during digestion, help disperse fats in water
mediums. Phospholipids are important structural components
of brain and nervous system tissue and of lipoproteins – the
carriers of cholesterol and fats in the blood. Phospholipids are
manufactured by the body but become deficient in the diet.

Phospholipids are generally contained in the “invisible” fat of plants

and animals, not the visible fat. Out of the many phospholipids,
supplemental use has been mainly focused on lecithin. Studies have
also been conducted regarding the inositol containing phospholipids,
“phosphoinositides.” Their primary role is that of precursors to
messenger molecules. In this capacity, they can exert a profound effect
on cellular function and metabolism, particularly the metabolism of fats.
This research was promoted on observations associated with choline
and inositol-deficient diets. Both nutrients are important in fatty acid
metabolism and are said to help de-fat the liver. Nutrients that have this
Lipotropic: a substance defatting action on the liver have come to be called lipotropics. Diets
that prevents fatty buildup deficient in choline have also been associated with memory impairment.
in the liver and helps the
body metabolize fat more For the athlete, these important structural, metabolic, memory, and
efficiently. lipotropic roles of phospholipids are vital for peak performance. Krill has
Bile: a substance secreted become a popular supplement due to containing phospholipids, EPA and
by the liver that is essential
DHA, and the compound astaxanthin (a natural antioxidant pigment
for the digestion and
absorption of fats. with associated health benefits).

Lecithin (Phosphatidylcholine)
Lecithin is a type of phospholipid that contains choline attached to the
phosphate molecule, plus 2 fatty acids. It is high in linoleic acid. Lecithin
supplies choline, which is essential for liver and brain function. Egg yolk,

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liver, and soybeans contain high amounts of phosphatidylserine (PS) compared with a placebo
lecithin. The body also manufactures lecithin. on the serum-hormone level of cortisol, the
perception of well-being, and muscle soreness
Use of lecithin supplements came into vogue
during two-week intensive training sessions. In
when researchers made the choline–memory
this study, the subjects were given either a PS
link. That is, choline-deficient diets impair
supplement or a placebo for the first two-week
memory function. Lecithin’s emulsifying
session, and then the opposite for the second
properties are also thought to help keep
two-week session. The subjects rested for three
the blood system clean of fatty deposits.
weeks in between the two sessions. During both
Researchers have documented reduced choline
of the two-week sessions, the subjects did five sets
levels among athletes running in the Boston
of exercises, each set consisting of ten repetitions
Marathon and speculate that lower choline
of thirteen exercises, four times a week. Well-
levels might adversely affect performance and
being and muscle soreness were estimated using
have detrimental long-term nervous system
a 10-point scale. PS supplement-taking subjects
effects. Choline is also important in creatine
experienced reduced delayed onset muscle
synthesis and is therefore suspected as playing
soreness and an improved state of well-being. This
a role as a strength-building nutrient. Studies
research and other research provide interesting
on athletes using dosages of 20 to 30 grams of
insights to this beneficial phospholipid.
lecithin have produced mixed results, some
reporting beneficial effects on muscular power,
performance, and endurance. Cholesterol

Cholesterol is a member of a group of fats called

Phosphatidylserine sterols. Cholesterol is made by the body and
Research has been directed to another only occurs naturally in foods of animal origin.
phospholipid, phosphatidylserine (PS), to The highest concentrations are found in liver
determine its health benefits. In the PS molecule, and egg yolk and are also high in meats, poultry
serine is attached to the phosphate molecule. (especially the skin), whole milk, and cheese.
Serine is an indispensable amino acid whose Cholesterol has many important functions. It is
metabolism leads to the synthesis of PS. Serine a component of all cells, precursor of bile acids,
functions in fat metabolism and is vital to the precursor of various sex and adrenal hormones,
health of the immune system. Intake of 200 to precursor of vitamin D, and an important aid in
300 milligrams of PS has been associated with brain and nervous system tissues.
improved memory and learning. Intake of 400
The body needs a constant supply of cholesterol
to 800 milligrams has been linked to a reduced
for proper health and performance; however,
level of cortisol, which is a catabolic hormone,
too much has been linked with a variety of
and to improved muscle growth and recovery
cardiovascular diseases in some people. For
after exercise.
promotion of general health, it is recommended
A double-blind crossover study measured to keep cholesterol nutrition intake levels
the effects of 800 milligrams a day of under 300 mg per day. Considering most

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meats contain about 90 mg per 3 ounces, this mass and it help to stimulate reduction of
is an almost impossible task for athletes, who body fat stores. Additionally, scientists foresee
generally need to consume high protein levels. broader applications for human health. Research
Athletes therefore need to take special care to has reported that CLA acts as a powerful
include cholesterol-free or lower cholesterol antioxidant, benefits the immune system, and
sources in their diets, such as vegetable source possesses other beneficial health properties. CLA
proteins, egg whites, high-protein/low-fat supplementation has benefits for people who
and low cholesterol-containing food and need to burn fat while preserving or building
supplements, in particular during the periods of muscle mass, particularly athletes such as
high calorie consumption, such as preseason and bodybuilders and other strength athletes. Based
competition season times of the year, in addition on the research, for healthy people, an example
to the cholesterol-containing animal sources. of a daily dose of CLA ranges from 3,000 to
Family history of cholesterol-related health 5,000 (or 6,000) milligrams per day, typically
problems and other potential metabolic issues taken in divided dosages, and for use of several
related to cholesterol should be determined by months, based on physician supervision to
the athlete’s doctor. determine personal needs.

In Canada, CLA has an authorized monograph

Conjugated Linoleic Acid (CLA)
and is an approved ingredient for Natural Health
CLA is a very interesting supplement that has Products. Some of the approved claims in the
gained popularity with people, including some monograph are related to CLA supplementation
athletes, concerned about maintaining healthy and may helping support a modest improvement
body composition. The fatty acid CLA occurs in body composition and reduction in fat mass
naturally in a number of foods, primarily beef when used with a program of reduced intake of
and dairy products. The word “conjugated” dietary calories and increased physical activity.
in its name refers to the variation in chemical
structure that sets it apart from the essential
Medium-Chain Triglycerides
fatty acid linoleic. Linoleic acid belongs to a
family of essential fatty acids called the omega-6 Medium-chain triglyceride (MCT) formulations
fatty acids and performs a number of important were first made in the 1950s using coconut oil.
metabolic functions in the body. A slight MCTs contain saturated fatty acids with chains
change in the double bonds that hold its atoms of six to twelve carbon atoms. MCT formulations
together transforms it from linoleic acid to CLA. are high in caprylic acid and capric acid, which
This molecular reconfiguration has profound are saturated fatty acids.
effects on its function and bestows upon CLA
MCT formulations were originally developed
nutritional benefits different from those of
as calorie sources for individuals who have
regular linoleic acid.
certain pathologic conditions that do not allow
CLA’s rising popularity among athletes stems normal digestion and utilization of long-chain
from its ability to significantly increase muscle fatty acids. MCTs tend to behave differently in

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the body from long-chain triglycerides (LCTs). Do MCTs have a place in every athlete’s diet?
MCTs are more soluble in water, and they More research is needed to determine the exact
can pass from the intestines directly into the benefits of MCT’s for athletes in general. While
bloodstream. Fatty acids usually pass from the bodybuilders appear to derive certain benefits,
intestines first into the lymphatic system and some people can experience mild side effects
then into the bloodstream. Because MCTs get from eating too much MCT.
into the bloodstream more quickly than LCTs
The most common complaints are abdominal
do, they are more easily and quickly digested.
cramping and diarrhea. Prolonged use
In addition, it has been reported in the medical may also be of concern to cardiovascular
literature that although MCTs can be converted wellness. MCTs are saturated fatty acids, and
to body fat, they are not readily stored in fat consuming more than 10 percent of total
deposits and are quickly used for energy in the daily calories from saturated fatty acids is not
liver. They can also pass freely, without the aid of recommended because of the link to various
carnitine, into the mitochondria of cells. MCTs diseases. Additionally, in recent research, some
are therefore a potentially quick source of high individuals who ingested only moderate amounts
energy for the body. MCTs reportedly also have of MCTs developed elevated triglyceride and
a thermogenic effect, estimated to be 10 to 15 cholesterol blood levels. This concern will
percent higher than their caloric value, but only depend on the individual’s total saturated fat
when the MCTs in the diet exceed 30 percent of intake, sensitivity to saturated fat intake, and
the total calories. Thermogenesis is the process duration of use. If planning to experiment with
by which the body generates heat, or energy, by MCTs, start slowly, with low dosages, using
increasing the metabolic rate to above normal. formulations that also contain the essential fatty
acids and the EPA and DHA omega-3 fatty acids
These features of MCTs have attracted the
under physician supervision to monitor for any
attention of athletes, especially bodybuilders.
potential health effects that might arise due to
Bodybuilders feel that these features benefit their
increased saturated fatty acid consumption.
restricted contest-preparation diets, which are
Another approach could be to just try using
aimed at reducing body fat and sparing muscle
healthy essential fatty acid EPA- and DHA-
tissue. The implications of the use of large
containing oil products and food sources.
amounts of MCTs by athletes on restricted diets
are not entirely clear though. Some bodybuilders Marie-Pierre St-Onge and Aubrey Bosarge (2008)
report that they are able to get “super lean” reported the results of their study examining the
when they eat about 400 calories per day of weight-loss aid effects of MCTs versus olive oil.
MCTs as part of pre-contest low-calorie diet. Their study used a 1,500 kcal/day diet for women
Remember, though, that bodybuilders are not and an 1,800 kcal/day diet for men. Women
concerned with physical athletic performance. In consumed 18 grams of MCT oil or olive oil per
bodybuilding contests, physique development is day in their diet, and men consumed 24 grams of
judged. Long-term use of MCTs is of a concern MCT oil or olive oil in the diet. Both oil groups
due to their saturated fatty acid content. lost body fat by the end of the 16-week study,

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Trans fatty acids: a with the MCT subjects losing slightly more body fat versus the olive
type of fat produced when
liquid fats (oils) are turned
oil subjects. However, regarding lean body mass, the olive oil subjects
into solid fats through a gained lean body mass, whereas the MCT subjects lost lean body mass.
chemical process called Computed tomography scans revealed significantly greater muscle area
hydrogenation. Eating a
large amount of trans fatty with olive oil and greater loss of trunk fat mass with MCT oil.
acid, or “trans fats,” also
raises blood cholesterol and Note that although there seems to be a lack of unanimous scientific
risk of heart disease. evidence regarding MCTs’ playing a nutrition role for athletic
Hydrogenation: a performance, there is a possible benefit as a weight-loss aid. Because
chemical process that turns
liquid fats (oils) into solid
MCTs are used in some sports nutrition, weight loss, and other food
fats, hydrogenation creates products, this information may be useful when addressing questions
a fat called trans fatty from clients or evaluating its potential use.
acid (also known as “trans
fat”). Trans fats are found
in frostings, shortening, Trans Fatty Acids
some margarines, and
some commercial baked
Trans fatty acids, also known as trans fats, are made during partial
foods, like cakes, cookies,
muffins, and pastries. hydrogenation of vegetable oils. Hydrogenation is the process by which
Eating trans fats may raise hydrogen atoms are added to unsaturated sites on fatty acids, thereby
heart disease risk. Federal
dietary guidelines [found eliminating double bonds. Partial hydrogenation relocates some double
at http://www.health.gov/ bonds, and hydrogen atoms end up on different sides of the chain. This
dietaryguidelines/External
Link Disclaimer] recommend
type of configuration is called “trans” (means “across” in Latin). The
keeping trans fat intakes as structure of a trans unsaturated chemical bond is represented in the
low as possible. following diagram.
Low-density lipoprotein
(LDL): LDL is a compound Saturated Fatty Acid Unsaturated Fatty Acid Trans Fatty Acid
made up of fat and protein
that carries cholesterol in the H H H H H
blood from the liver to other
parts of the body. High
levels of LDL cholesterol, C C C C C C
commonly called “bad”
cholesterol, cause a buildup
of cholesterol in the arteries H H H
and increase the risk of
heart disease. An LDL level
of less than 100 mg/dL is The primary reason for attention directed toward Trans Fats was due
considered optimal, 100 to
to human studies demonstrating increased bad cholesterol levels (low-
129 mg/dL is considered
near or above optimal, 130 density lipoprotein-cholesterol, LDL-C), similar to saturated fatty
to 159 mg/dL is considered acids. It is now a requirement to list the amount of Trans Fats on food
borderline high, 160 to 189
mg/dL is considered high, labeling. The following FDA press release provides an update regarding
and 190 mg/dL or greater is the FDA’s actions related to partially hydrogenated oils, the primary
considered very high.
source of artificial trans fats.

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 Lipids and the Athlete: Energy and Growth Factors | 171

June 16, 2015

Release
Based on a thorough review of the scientific evidence, the U.S. Food and Drug Administration today
finalized its determination that partially hydrogenated oils (PHOs), the primary dietary source of
artificial trans fat in processed foods, are not “generally recognized as safe” or GRAS for use in human
food. Food manufacturers will have three years to remove PHOs from products.
“The FDA’s action on this major source of artificial trans fat demonstrates the agency’s commitment to
the heart health of all Americans,” said FDA’s Acting Commissioner Stephen Ostroff, M.D. “This action
is expected to reduce coronary heart disease and prevent thousands of fatal heart attacks every year.”
This determination will significantly reduce the use of PHOs, the major source of artificial trans fats,
in the food supply. In 2013, the FDA made a tentative determination that PHOs could no longer be
considered GRAS and is finalizing that determination after considering public comments.
Since 2006, manufacturers have been required to include trans fat content information on the
Nutrition Facts label of foods. Between 2003 and 2012, the FDA estimates that consumer trans fat
consumption decreased about 78 percent and that the labeling rule and industry reformulation
of foods were key factors in informing healthier consumer choices and reducing trans fat in foods.
While trans fat intake has significantly decreased, the current intake remains a public health concern.
The Institute of Medicine recommends that consumption of trans fat be as low as possible while
consuming a nutritionally adequate diet.
“Studies show that diet and nutrition play a key role in preventing chronic health problems, such as
cardiovascular disease and today’s action goes hand in hand with other FDA initiatives to improve the
health of Americans, including updating the nutrition facts label,” said Susan Mayne, Ph.D., director
of the FDA’s Center for Food Safety and Applied Nutrition. “This determination is based on extensive
research into the effects of PHOs, as well as input from all stakeholders received during the public
comment period.”
The FDA has set a compliance period of three years. This will allow companies to either reformulate
products without PHOs and/or petition the FDA to permit specific uses of PHOs. Following the compli-
ance period, no PHOs can be added to human food unless they are otherwise approved by the FDA.
The FDA encourages consumers seeking to reduce trans fat intake to check a food’s ingredient list for
partially hydrogenated oils to determine whether or not a product contains PHOs. Currently, foods are
allowed to be labeled as having “0” grams trans fat if they contain less than 0.5 grams of trans fat per
serving, including PHOs, the primary dietary source of artificial trans fat in processed foods.
Many companies have already been working to remove PHOs from processed foods and the FDA
anticipates that many may eliminate them ahead of the three-year compliance date.
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public
health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and
other biological products for human use, and medical devices. The agency also is responsible for the
safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off
electronic radiation, and for regulating tobacco products.

Source: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm451237.htm

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Lipid Digestion energy needs, fat stores are increased, and body
fat weight is increased.
Most lipids take the longest time and the
most effort to digest due to their insolubility
in water and their complex structure. As they You Are What You Eat
pass through the mouth and stomach, they
The type of fat you eat can affect your body’s
are retreated mechanically and chemically for
composition of fatty acids. As all cellular
their main digestive processes to take place in
membranes contain fatty acids, comparisons
the intestines. Fats take the longest to empty
between vegetarians and meat eaters have
from the stomach (three to four hours or more
revealed that vegetarians have bodies made up
depending on the size of the meal). Digestion of
of more unsaturated fatty acids. It also revealed
fats takes place chiefly in the small intestines,
that those people on high saturated fat diets
where bile from the liver assists in bringing fat
have bodies made of more saturated fatty acids.
in contact with fat splitting enzymes from the
Saturated fatty acids tend to be less stable than
pancreas and from the intestinal wall. In the
unsaturated fatty acids are and therefore more
intestines, the fatty acids are disassociated from
susceptible to damage from free radicals and
the glycerol molecules and are reassembled as
metabolic toxic waste products. This means that
they pass through the intestinal cells. Along the
a body made of more unsaturated fatty acids may
way, they become coated with protein and pass
be more resistant to certain cellular damage.
into the lymph system.

Under normal dietary fatty acid conditions,

about 60–70 percent of ingested fat is absorbed
How Much Lipid
via the lymph system, and medium- and short- Does an Athlete Need?
chain fatty acids can enter into the bloodstream
The National Research Council (NRC)
and be transported directly to the liver. Once
recommends that total fat intake stay below 30
in the bloodstream, fats and cholesterol are
percent of total daily calories and that saturated
transported in conjunction with special proteins
fat intake stay below 10 percent of total daily
called lipoproteins. Fats that are not needed
calories (assuming you are only eating the
are converted to fat stores. The liver is the main
recommended total daily calories for your
processing center for fats. In the liver, fats can
age and body size and not more). As for the
be used for energy and modified by shortening
essential fatty acids, linoleic and alpha-linolenic
or lengthening fatty acids and saturating or
acids, the NRC recommends 1 to 2 percent of
un-saturating fatty acids. The liver cells also
total daily calories, roughly 3 to 6 grams. Some
synthesize triglycerides, lipoproteins, cholesterol,
health professionals estimate that males may
and phospholipids. Fats are constantly broken
require three times this amount because of their
down, resynthesized, and used for energy. But
hormonal differences.
they are in equilibrium when caloric intake is in
balance with energy needs. When caloric intake As far as athletes are concerned, the total
from fats, proteins, or carbohydrates exceeds amount of fat intake will vary with the type of

Sports Nutrition
 Lipids and the Athlete: Energy and Growth Factors | 173

sport, body size, and personal requirements. In Most athletes should concentrate on reducing
general, endurance athletes will need to maintain total fat intake and saturated fat intake and
a higher level of fat intake than power athletes on increasing essential fatty acid intake, and
will. This is directly related to the energetics of a EPA and DHA. Because of the total high-
particular sport. Additionally, when we consider caloric intake athletes maintain, consumption
that an athlete’s diet consists of two to three of over 25 percent of total daily calories is not
times the amount of what is considered “average” recommended during high activity periods
caloric intake, fat intake can become high using when energy expenditure increases but when
the high percentage of about 30 percent of total personalized sports nutrition plans may require
daily calories—intended as a general guideline lower total daily fat intake.
for the population of nonathletes.
Bile: a substance secreted by
the liver that is essential for the
digestion and absorption of fats.

Too Much Fat in Our Diets

Most of us get too many fats in our diet. The typical American consumes 45% of their calories from fat.
When you consider that each gram of fat contains more than twice the number of calories of a gram of
either carbohydrate or protein, you can easily see why fats and oils are such villains.
Not only that, but the very latest scientific studies reveal that fats and oils might be even more villain-
ous than their caloric values suggest. In direct comparisons of high-fat and low-fat diets, even when
the number of calories in each is exactly the same, the high-fat diet causes much more fat to be stored.

1 tsp fat 5 grams 45 calories

1 Tbsp fat 15 grams 135 calories
40 grams of fat 360 calories

How much fat should you get in your diet? The American Heart Association recommends 30% of your
total calories as an absolute maximum. But the closer you can move to 20% (or below), the easier your
fat-loss and weight-maintenance goals will be achieved:

Total caloric intake 30% fat diet 20% fat diet

720 cal 480 cal
2,400 calorie diet:
<6 Tbs. <4 Tbs.
900 cal 600 cal
3,000 calorie diet:
<8 Tbs. <5 Tbs.
(<) means less than

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Flax Oil – Nature’s Essential Fatty Acid Bounty

When turning to the market place to find a product that supplies a good source of alpha-linolenic acid,
flax oil stands out. Flax oil contains about 51% to 57% alpha-linolenic acid. It also contains 15% to 18%
linoleic acid. Using flax as a substitute for cooking and salad oils, butter and margarine can help with
nutritional efforts to increase alpha-linolenic in the diet.

Dietary Sources of Fat Regarding pure sources of fat (such as oils),

intake of unsaturated fats should be substituted
It seems that plant sources of fats tend to for food sources high in saturated fats. Some
be healthier than animal fats are because fat sources that are low in saturated fats and
plant sources are unsaturated. However, cholesterol are margarine, corn oil, olive oil,
remember that most plant sources of proteins peanut oil, cottonseed oil, safflower oil, sunflower
are incomplete and low quality, while animal oil, and most nuts (which also contain protein).
proteins are complete and high quality. A Fats to avoid or to keep at a very low intake
balance must be maintained to minimize include butter, bacon fat, cream, mayonnaise,
saturated fats and high-cholesterol sources that and mayonnaise salad dressings.
occur in meats but to benefit from the complete
proteins they contain.
Fats and Athletic
As a general rule, here are some of the foods Performance
athletes should avoid or eat infrequently to keep
saturated fatty acids and cholesterol intake low: • Excess body fat should be avoided. It only
creates dead weight and slows you down.
kidneys, liver, excessive egg yolks, custard, fatty
animal meats, coconut oil, butter, palm oil, • Keep fat intake below 30 percent of total daily
bacon, pork sausage, cream cheese, whole milk calories or less, depending on your sport.
products, hot dogs, bologna, and hamburger. • Minimize intake of saturated fatty acids and
cholesterol.
Instead, eat lean meats like fish, egg whites, skim
milk products, chicken, turkey, a combination • Eat a low-fat meal before and after training and
of plant proteins that make complete protein competition. Fat makes the stomach empty
slowly, thus preventing nutrients from getting
sources, and protein formulas. This is why pure
into the body quickly.
supplement formulations of proteins/amino acids
are beneficial to health and an athlete’s high- • Include good sources of essential fatty acids,
DHA, EPA, and gamma-linolenic acid.
performance nutrition program.

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 Lipids and the Athlete: Energy and Growth Factors | 175

Conclusion
Lipids are a diverse group of macronutrients, which are vital building
blocks of the human body for growth, maintenance, and repair; used to
make a variety of biomolecules required for body function and structure;
and also contribute a source of energy for athletic performance. Focusing
on healthy types of lipid food sources is also important. Unit 17 will
provide details regarding lipid nutrition guidelines for athletes, including
specialty topics, such as timing nutrient intake.

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Keywords
Triglycerides Alpha-linolenic acid (ALA)

Oils High-density lipoprotein (HDL)

Saturated fatty acids Lipotropic

Unsaturated fat Trans fatty acids

Polyunsaturated fatty acids (PUFAs) Hydrogenation

Solid fats Low-density lipoprotein (LDL)

Linoleic acid (LA) Bile

Sports Nutrition
 Topics Covered In This Unit

Introduction

Water

A word of caution

Athletic training for water conservation

Water and the athlete

Water balance

Metabolic Water

Liquids

Food

Glycogen-Bound Water

Skin-sweat

Lungs

Kidneys

Feces

Hypohydration/dehydration
effects on performance and health

Beware of the limitations

How much water does an athlete need

Sources of Water

Hydrating with glycerol

Oxygen

Oxygen and the athlete

EPO and blood building

Conclusion

UNIT 6

WATER AND OXYGEN

178 | Unit 6

I. Introduction
II. Water VI. Oxygen
a. A word of caution a. Oxygen and the athlete
b. Athletic training for water conservation i. The lungs
III. Water and the athlete ii. The blood
a. Water balance iii. The blood vessels
b. Metabolic Water b. EPO and blood building
c. Liquids i. EPO – red blood cells – oxygen
d. Food ii. Sports performance benefits of EPO
e. Glycogen-Bound Water iii. Endurance athletes and EPO
f. Skin-sweat iv. Natural/nutritional EPO building
g. Lungs v. Red blood cell (erythrocytes building)
h. Kidneys vi. Major function of hemoglobin
i. Feces vii. Carbon dioxide transport and
hemoglobin
IV. Hypohydration/dehydration effects
viii. Natural EPO and red blood boosters
on performance and health
ix. EPO blood building and synergistic
a. Beware of the limitations
effects of nitric oxide
b. How much water does an athlete need
x. NO-boosting ingredients summary
i. Bodyweight fluctuations for estimating
VII. Conclusion
hydration requirements
ii. Daily hydration guideline examples

V. Sources of Water
a. Hydrating with glycerol

Learning Objectives
After completing this unit, you will be able to:
• Define and describe key terms related to hydration and oxygenation for athletes;

• Understand water balance;

• Estimate hydration requirements for athletes;

• Discuss the adverse effects of dehydration on athletic performance;

• Understand role of oxygen in the human body;

• Discuss nutrients and nutritional substances related to blood flow and oxygen in the body.
 Water and Oxygen | 179

Introduction
Water and oxygen are two of the most important nutrients for health
and performance. Studies have verified that even small fluctuations in
the body’s water balance can, and often does, adversely affect athletic
performance. Similarly, the availability of oxygen is vital for top athletic
performance, and research has determined that oxygen utilization can
be maximized by physical training and nutritional means. However,
many people take water and oxygen for granted or neglect them. This
is equally true for athletes and nonathletes. In this unit, we will take an
in-depth look at water and oxygen. We will review their functions and
approaches to potentially optimize water intake and oxygen utilization
for maximum athletic performance.

Water
Water (fluid) consumption for adequate hydration is needed every day
for good health and physical and athletic performance. In spite of this,
inadequate hydration is common among nonathletes and athletes, also
referred to as hypohydration and dehydration. Hypohydration occurs Hypohydration: occurs
when water intake does not meet the body’s hydration requirements. when water intake does not
meet the body’s hydration
Studies have verified that even very small fluctuations in the body’s water requirements
balance can, and often do adversely affect physical and even mental Euhydration: a term
performance. Euhydration is a term used to indicate as state of adequate used to indicate a state of
adequate hydration.
hydration. Hyperhydration refers to excess body water.
Hyperhydration: excess
body water.
A Word of Caution
Although on the surface achieving adequate hydration appears to be
easily accomplished, a variety of issues can occur when working with
athletes to achieve euhydration, in particular, other related nutrients,
such as electrolytes. For many athletes, a challenge to achieve and
maintain euhydration is related to the physiology of water balance in
the body, in particular that water loss can exceed water intake capability
during exercise, training, physical activity, and athletic events.

Hydration complications can and do occur with athletes, for example,

during training sessions and athletic events, athletes can lose more
body water than can be replenished during these physical activities.
Total daily activities, climate, health status, clothing, and even food

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consumption can all contributed to an athlete’s plasma osmolality, urine osmolality, and urine-
daily water balance. While general hydration specific gravity, which is beyond the intention
reference information for healthy adults is of this sports nutrition fundamentals course.
contained in this unit, determining adequate Osmolality is a measure of the concentration of
hydration for each individual athlete requires chemicals found in the body fluids. These useful
one-on-one detailed evaluation and medical data involve medical testing and analysis by
analysis under physician supervision and by qualified health professionals.
other trained health professionals. Also, note
that variation exists in the different position Athletic Training for Water
papers, scientific studies, and authoritative
body information related to hydration
Conservation
guidelines, which underscores the importance An important consideration, besides fluid
of determining hydration, and other athlete intake, is management of fluid losses. For
nutrition requirements, on an individual athlete example, while athletes may not have much
basis, starting with general guidelines and control over the environmental conditions
fine-tuning them under appropriate physician they will encounter during events, they are
supervision, which can include the athlete’s more in control of environmental conditions
doctor and team doctor. Although examples they are exposed to during daily training.
of general hydrations guidelines are contained In general, daily training conditions should
in this unit, be aware that additional hydration be conducted during times of the day in
reference information and guidelines can exist which fluid losses during physical activity are
published by an athlete’s individual team, sports minimized. Athletic clothing should also be
organization, team doctors, or other team selected that is appropriate for evaporation.
health professionals or from the various health For specific event training that anticipates
professional position papers. These team and high sweat losses, special training conditions
health professional additional reference sources may be warranted for acclimation purposes
should also be considered when creating an so an athlete’s body can have time to adjust
athlete’s hydration program. to the conditions, typically weeks or longer.

Note that while body weight measurements, The past crazy and hazardous training methods
reviewed below, can be used as a type of that exposed athletes to extreme heat and
“biomarker” for tracking general hydration sweating should be avoided. Examples of such
status, these do not provide important insights practices to be avoided include “hell week”
about the body’s status of other related nutrients, reported in some American football training
such as electrolytes, sodium, chloride, and programs and practicing in plastic sweats and
potassium for example. For a comprehensive layers of clothing in hot rooms—items associated
hydration evaluation to be conducted, the with wrestling and other weight-class sports.
assessment of more involved biomarker testing In addition, excessive use of saunas and other
can be warranted, such as determination of situations that promote excess loss of body fluids

Sports Nutrition
 Water and Oxygen | 181

should be avoided. Physical conditioning and Water and the Athlete

skill training should be approached to minimize
fluid loss and to compensate (replenish) fluid loss Water, otherwise known as H2O, consists of
during training and athletic events. two hydrogen atoms and one oxygen atom. It
is the aqueous medium used for transporting
A simple rule is to prevent fluid loss during the body’s food materials and the place where
physical activity that results in more than 2% the body’s biochemical reactions occur. Water
reduction in total body weight from water loss. is found in all parts of the body and, depending
However, less water loss is always better. Note on a person’s body fat content, its content can
that for some sports, and under certain weather vary from about 45% in very obese individuals
conditions, the rate of fluid replacement may not to 70% in lean individuals, with an average of
be able to achieve this general rule, primarily about 60%. The different parts of the body also
due to the body’s limitation to ingest enough vary in water content. For example, approximate
water during physical activity to replenish water water content in blood is normally the highest
lost from sweating. Obviously, longer duration at about 83%; in muscle tissue, water content is
athletic training sessions and events result in about 75%; bone contains about 22% water, and
higher amounts of net body water loss. An fat tissue may only contain about 10% water. Of
approach can be justified for shorter training course, these values vary from person to person.
sessions each day to reduce fluid loss that cannot
be replaced adequately during “marathon”
Water Balance
training sessions, in addition to other nutrients
such as electrolytes and carbohydrates. The state of hydration that a person exhibits is
affected by the current rate of water intake in
The reality is that some sports events, ultra- relationship to the rate of water loss. At rest,
endurance sports that don’t allow for adequate water turnover is smaller than under conditions
rehydration, for example, are unhealthy and of high-intensity exercising. Water intake occurs
put the athlete’s health at risk, even with from fluids that are ingested, fluids in food,
medical supervision and before and during and water produced from metabolism. The
hydration and other nutrient-replenishment following will summarize the major types of
programs. It is common for athletes in these water intake/availability and water output. This
ultra-endurance events to experience mild just serves as a generalized overview. It must
to severe medical problems that require
immediate medical attention and that often Water Intake/Availability Water Output
require intravenous fluid, electrolyte, and
Metabolic Water Skin: Sweat
glucose treatment and, sometimes, even
hospitalization for treatment. In some tragic Liquids Lungs: Exhalation
instances, death can even occur. Adequate, Food Kidneys
healthy nutrient intake is important along with
water intake for adequate hydration status. Glycogen Bound Water Digestive System: Feces

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be emphasized that water intake and output contains about 75% water if cooked rare and
varies with activity, size of the individual, 45% or lower if cooked well done. Dry cereals
age, gender, duration and intensity of the and pastas contain some water, about 3% to 5%
activity, clothing, and weather conditions. water content. Generally, about 1/3 of daily water
intake is derived from food.
Metabolic Water. Metabolic water is
Glycogen-Bound Water. This water is stored
the often overlooked water that is produced
in the muscles along with glycogen. About 3
as a result of energy metabolism. Metabolic
or 4 ounces of water are stored with 1 ounce of
water is produced in the body from oxygen
muscle glycogen. The availability of this water
and hydrogen atoms. The oxygen is derived
becomes important when your glycogen supply
from the atmosphere and brought into the
is depleted for energy use. This depletion will
body via the lungs during breathing. The
occur during training and endurance events
hydrogen atoms are from catabolism of
lasting more than an hour and during periods of
carbohydrates, fatty acids, and other carbon
calorie restriction. This water bound to glycogen
molecules that are broken down for energy.
can release about 16 fluid ounces of water per
hour of intense endurance activity. This will only
Liquids. These are by far the most abundant last as long as the amount of glycogen remains
source of the body’s water, accounting for about stored in the body, and any hydration benefit
two-thirds, or more, of water intake per day. might be offset by water loss from the skin and
However, on hot days, and at high-training lungs depending on the climate conditions. Some
volumes or competition events, liquid intake estimates report that approximately 3 to 4 pints
can be a higher proportion related to the other of glycogen-bound water can be stored in the
water sources, such as from food. Liquids body, but it varies from person to person. This
can readily be taken in by the body without water must be replenished when used, unlike
much digestive effort. However, pure water is metabolic water, which is constantly being
generally utilized by the body the fastest. As produced. For endurance athletes and athletes
the amount of carbohydrates and electrolytes performing in day-long tournaments, this
are increased in a beverage, the length of time glycogen-bound water may be an important
the stomach takes to empty is increased, which component of hydration during physical activity.
slows delivery of water and nutrients into the Glycogen-bound water can be maximized
body for utilization. Drinking liquids with the through carbohydrate loading, which results
proper concentration of carbohydrates and in more glycogen and therefore more glycogen-
electrolytes depends on the sport, training bound water.
program, and level of physical activity.
Skin – Sweat. Water is lost through the
Food. All foods consist of water and solids. skin when the body sweats. Sweating is always
The amount of water varies with the food type. occurring at some rate and becomes evident
For example, fruits, vegetables, cooked cereals, when conditions such as increased activity or
and milk consist of 80% to 95% water. Meat hot humid days cause sweat to accumulate on

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 Water and Oxygen | 183

the skin. Sweating is the body’s cooling mechanism and removes excess Metabolic water: the
water that is produced
heat to keep the body’s core temperature within a limited range to
in the body as a result of
prevent it from overheating. If the body overheats from hypohydration, energy production.
thermoregulatory problems can cause heat stroke, fainting, and even Glycogen-bound water:
death. Sweat must be evaporated from the skin to result in heat removal. the water that is stored in
the muscles along with
The mere production of sweat is just the first step in the process. Sweat
glycogen.
that just drips off the body does not add to the cooling process. It must
Diuretic: a substance that
evaporate from the body to have a cooling effect. Heat is removed from increases urination.
the body only when water is converted from the liquid state to a gaseous
state on the surface of the skin. Water loss from sweat becomes a major
mode of water loss during exercise. A quart of water or more per hour
can be lost from sweat during prolonged exercise. This loss will obviously
occur in long-distance running events but is also significant in sports
like basketball, football, soccer, and swimming.

Lungs. A small amount of water is lost as water droplets in exhaled air

and becomes increased during exercise.

Kidneys. Water that is filtered out through the kidneys is excreted as

urine. Interestingly, water loss from the kidneys is usually minimized
during exercise. During exercise, the fluid loss from the kidneys is Some Factors
Affecting Rate of
slowed down. This occurs through hormonal control, in particular,
Water Loss Include:
through the action of “antidiuretic hormone – ADH” (vasopressin).
Hot Weather
ADH levels are increased during exercise, which increases the amount
Intensive Exercise
of water reabsorbed by the kidneys, thereby decreasing water loss. Note
Heat-Trapping Clothes
that alcohol (ethyl alcohol) and caffeine have diuretic effects because
they are inhibitors of ADH and therefore increase water output via the Obesity

kidneys. Alcohol and caffeine beverages and other not-needed diuretic High Rate of Sweating
substances should be avoided during the season and several days prior Inadequate Acclimation
to Heat
to a major athletic event. For individuals consuming caffeine as part of
Disease, Illness
their training and competition nutrition program, extra water intake
may be required, determined on an individual basis. Alcohol/Caffeine
Consumption
High Humidity
Feces. Under normal conditions, water loss through the feces is Exercise Longer
relatively small. However, when gastrointestinal disorders set in than 1 Hour
(diarrhea and vomiting), 32 to 160 fluid ounces can be lost per day. It is Diarrhea/Vomiting
therefore important for any athlete with a gastrointestinal problem to Diuretic Drugs
make sure he or she consumes larger than normal amounts of liquids to Diuretic Foods
compensate for this extra water loss. and Supplements

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Some Hydration Information from Institutes of Medicine Reports, Such As The Daily
Reference Intake Reports (Values Are for Healthy Adult and Approximate). Note
That There Are Limitations for Applying to Individuals and Athletes That Need To Be
Determined on a Personal Basis.
Dietary Reference Intake for total water: an AI (adequate intake) was established for different age
groups and genders. Total water includes water contained in food, beverages and drinking water.
Remember the AIs are not intended to be interpreted as a specific requirement.
The DRI tables are in the Appendix, but here are some examples:
The highest value AI for adult males is 3.7 liters per day. (about 125 fluid ounces, 1 gallon).
This includes about 3 liters as total beverages, including drinking water. (about 101 ounces, 13 cups).
The highest value AI for adult non-pregnant females is 2.7 liters
per day. (about 91fluid ounces, 0.7 gallon).
This includes about 2.2 liters as total beverages, including
drinking water. (about 74 fluid ounces, 9 cups).
Respiratory Daily Water Loss, approximate: 200–350 milliliter per day for sedentary
people, 500-600 milliliter per day for active people; temperate climates at sea level.
Urinary Daily Water Loss, approximate: 1–2 liters per day.
Fecal Daily Water Loss, approximate: 100–200 milliliters per day.
Skin, Insensible Diffusion, Daily Water Loss, approximate: 450 milliliters per day.
Skin, Daily Sweet, Daily Water Loss: too variable to set an approximate value.
Active Adults: physical activity can double to triple daily fluid
intake needs to make up water lost via sweating.
• People in very hot (e.g., desert) climates, who often have sweating rates
of 0.3–1.2 L/hour while performing occupational activities.
• People wearing protective clothing, who often have sweating rates of 1–2 L/
hour while performing light-intensity exercise in hot weather.
• Male competitive runners, who can have sweating rates of 1
to > 2 L/hour while training or racing in the heat.
• Female competitive runners may increase their sweat losses from
approximately 0.7 L/hour in temperate weather to approximately 1.1 L/
hour in warm weather when performing the same event.

The UL (Tolerable Upper Limit) was not established for water. However, the DRI report(s) note that
acute water toxicity has been reported from the rapid consumption of large amounts of fluids that
greatly exceed the kidney’s maximal excretion rate of approximately 0.7–1.0 liter per hour (24–33 fluid
ounces per hour). Note that sweating rate must also be considered when dealing with athletes and
other people during physical activity.

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According to NHANES III (1988–1994), the highest total water intake (99th percentile) reported
was 8.1 L/day. No adverse intakes have been reported with chronic high intakes of water in health
people consuming a normal diet, as long as fluid intake is approximately proportional to losses.
According to data from NHANES III, adults in the United States
obtained total water from the following sources:
• 35–54 percent from drinking water.
• 49–63 percent from other beverages (with juice, carbonated
drinks, coffee, and milk being the major sources).
• 19–25 percent from foods (such as fruits, vegetables, soups, ice cream, and meats).

Note: A liter of water weighs 1 kilogram. A kilogram converts to 2.2 pounds, so a liter of water
weighs 2.2 pounds. This assumes that the weighing takes place at sea level and the water is at 4
degrees centigrade (39.2 degrees Fahrenheit).

1 liter = 33.8 fluid ounces; 1 liter = 1.06 quart; 1 cup = 8 fluid ounces, USA.

Hypohydration / Dehydration Effects on

Performance and Health
Hypohydration can adversely affect physical result in similar losses in body water content.
performance, mental function, and motor In addition, during tournaments, all athletes
control. As the body loses water, core must make sure to increase their water intake to
temperature rises, affecting all metabolic compensate for the prolonged physical activity
pathways, interfering with cardiovascular over the one or two days of the tournament.
function, and reducing total work capacity. Moreover, major water losses can occur during
When water losses reach just 1% to 2% of body everyday training, which if not adequately
weight, reduction in physical performance can rehydrated day to day, will adversely affect
start to occur, with significant adverse side athlete performance during events.
effects observed at over 2%. Marathon runners
can lose several quarts of water during a race, Other sports in which participants must meet
which represents 6% to 10% of their body weight. certain weight classes (boxing and wrestling for
Without properly rehydrating during the race, example) are also associated with dehydration.
this amount of water loss will significantly Wrestlers typically dehydrate themselves to
impair performance and put the runner’s make a lower weight class. This type of chronic
health at risk. Even “non-endurance sports” dehydration will decrease performance and
like football, basketball, hockey, or soccer can adversely affect health.

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Chronic dehydration will develop in any athlete results in a reduction of flow-mediated dilation,
who does not make an effort to keep adequately which is vital for blood flow, and decreased
hydrated. The thirst response in humans is plasma volume, both negative outcomes related
not as fine-tuned as it should be. This means to health and athletic performance.
that an athlete’s body can enter into a state of
A reduction in plasma volume is also associated
dehydration, and you will not feel the sensation
with an increase in plasma osmolality, which
of thirst until hours later. If athletes solely rely
is a measure of concentration of substances
on the thirst response, chances are they will have
in the blood. This can make the blood
become dehydrated by the time they become
thicker and harder to move through the
thirsty. It is therefore mandatory to rehydrate all
blood vessels, further reducing the rate of
day long, based on individual needs.
blood flow. The following presents results of
While reduced body water has obvious overall two studies related to the negative effects of
expected negative effects on health and athletic hypohydration under experimental conditions,
performance, researchers are constantly one focused on endothelial function related
examining the various negative effects on to flow-mediate dilation effects and the
the body’s structure and function and the other study regarding negative effects of
mechanisms of action. For example, researchers hypohydration on exercise performance.
have determined that hypohydration of 2%

Hypohydration Negative Effects Research Study Examples

The effect of hypohydration on endothelial function in young healthy adults.
In this research study, Arnaoutis and coworkers in 2017 examined the effects of hypohydration on
body mass, plasma volume, plasma osmolality and flow-mediated dilation (FMD), versus euhydrated
state. Flow-mediated dilation occurs in blood vessels in response to blood flow; as the blood flow
increases, the blood vessel dilation increases to allow for increased blood flow. Impaired FMD results
in poor blood flow, which reduces the rate of oxygen and other nutrients delivered to cells, and
also reduces the clearance of metabolic waste products from the cells. Poor blood flow is related to
reducing athletic performance and has a negative impact on health.
For this research study ten young, healthy males participated. The study design was crossover. The
characteristics of the male subjects were as follows: average age was about 24.3 years; average weight
was about 80.8 kg; and average BMI was about 24.3 kg m-2. Flow-mediated dilation measurements
were made for each subject in the euhydrated and hypohydrated states. The measurements were
separated by 24 hours. The subjects completed 100 minutes of low-intensity intermittent walking
exercise to achieve hypohydration of about -2 % of individual body mass. For the rest of the day, a
standardized, low water content diet was provided. The following morning, hydration markers and
endothelial function were recorded.

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On average, the subjects achieved levels of hypohydration of about -1.9% of body mass. This
hypohydration resulted in decreased plasma volume by about -3.5% and increased plasma osmolality
by about 9 mmol kg-1; and FMD as a response to hypohydration decreased by about -26.8 %. Based
on the results of this study the researchers reported that a small degree of hypohydration induced by
moderate exercise and fluid restriction significantly impaired endothelial function. This study did not
measure impacts to physical performance. However, another research study conducted by James and
coworkers in 2017 examined the adverse effects of hypohydration on endurance exercise performance.

Hypohydration impairs endurance performance: a blinded study.

In this study by James and coworkers in 2017, these researchers examined the effect of hypohydration
in a single blind manner. Seven males average age 25 years were subjects in this study. The exercise
test followed an exercise preload followed by a 15-minute all-out exerciser performance test on a cycle
ergometer. Both states of euhydration and hypohydration of about – 2.5% body mass were examined.
Work completed during the exercise performance test was lower during hypohydration. Therefore,
related to exercise performance the researchers reported that exercise performance was impaired by
hypohydration.

Sources:Arnaoutis G, Kavouras SA, Stratakis N, Likka M, Mitrakou A, Papamichael C, Sidossis LS, and Stamatelopoulos K.,
The effect of hypohydration on endothelial function in young healthy adults. Eur J Nutr. 2017 Apr;56(3):1211-1217.
James LJ, Moss J, Henry J, Papadopoulou C, Mears SA. Hypohydration impairs endurance performance: a blinded study.
Physiol Rep. 2017 Jun;5(12).

Warning: Remember to Include Water Loss from Other Daily Physical

Activities in Addition to Athletic Training Activities.
For example, the 2004 “Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate”
report, presents a variety of water loss data. One figure on page 130 includes approximate daily water
requirements as a function of climatic temperature and activity levels based on calories per day.
Light work (2800 kcal/day) range was 2.5 to 10 quarts per day (80 to 320 fluid ounces).
Hard work (5600 kcal/day) range was 6 to 19 quarts per day (192 to 608 fluid ounces).
Other data presented from military studies reported similar ranges of approximate daily fluid
requirements related to climate and physical activity.

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Beware the Limitations frequently throughout the day. Daily hydration

guidelines are important for all athletes to
Similar to limitations with other sports nutrition
follow. Studies have shown that endurance
requirements at the personal level, the same
athletes who compete for periods lasting longer
limitations apply to generalized water loss and
than 30 minutes improve their competition
hydration data, too. For example, researchers
performance by drinking during the activity.
report a wide range of water loss from sweat
However, for shorter events, athletes need to be
among athletes, with sweating rates during
properly hydrated from the start to achieve peak
exercise or sports activities ranging from 0.3 to
performance. For all athletes, besides paying
2.4 liter per hour. However, recent (as reported
special attention for adequate hydrate related
by Davis 2016) noted that American football
to competition, day-to-day adequate hydration
players have mean sweating rates from 1 to 2.9
during training is of utmost importance, too.
liters per hour during exercise, with some of the
larger players experiencing 3 or more liter-per-
hour sweat rates. Body Weight Fluctuations
for Estimating Hydration
Requirements
How Much Water
Does an Athlete Need? One approach to obtain estimates regarding an
athlete’s water balance is to track changes in
The amount of water needed will vary greatly body weight several times a day, including before,
based on initial level of hydration, the climate, during, and after exercise, training, and athletic
the duration and intensity of exercise, and events. Working in kilograms can be convenient,
other daily activities. As a general rule, as 1 liter of water is about 1 kilogram.
evaluate fluid intake by fluid output, namely
frequency of urination, and also using body The first step is to establish a baseline of being
weight fluctuations. When well hydrated, a adequately hydrated (euhydrated). This can be
person may be urinating about once every one accomplished using body weight measurements
and a half to two hours. In addition, the color taken in the morning before and after urination,
of urine can indicate hydration status, with for several days, including a two-day rest period
the lighter color possibly indicating adequate from exercise or other physical activities,
hydration and darker colored urine indicating including work, along with adequate daily
inadequate hydration. Adequate hydration is a hydration. Body weight measurement may be
serious medical matter, and health practitioner taken without clothing.
supervision is required to determine hydration For the water-loss-during-exercise evaluations,
requirements on an individual basis. If urination immediately before starting exercise, take a body
is only a few times per day, you probably need to weight measurement. Then depending on the
increase water/fluid intake. climate and expected rate of sweating during
Because the thirst response takes longer to exercise, low, medium, or high, plan for taking
tell the body it needs water, athletes should a body weight measurement after 30 minutes of
get in the habit of drinking water/fluids exercise, or longer, depending on conditions. If

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fluid is consumed during exercise, the weight sweating/lungs, this would result in a gain in
must be factored in. Body weight measurement body weight. The total actual water loss from
may be taken without clothing: have the athlete sweating is about 0.500 liters (500 milliliters)
remove sweat from the body with a dry towel. when considering the measured reduction of
body weight and the additional water lost from
In the following example, 0.250 kilograms of
sweating during exercise that was replaced
body weight was lost during 30 minutes of
by water consumption during exercise. The
exercise from fluid loss (sweating), during which
following table summarizes the measurements
0.250 ml of water was consumed. Note that
and calculations.
if water/beverage intake exceeds fluid loss by

Body Weight at Start of Body Weight at 30 Minutes of Sweat Rate Based on Total Water
Exercise = 70 kilograms Exercise = 69.750 kilograms Loss:

1 liter of water = about 1 kilogram Fluid intake was 0.250 liters water - 0.250 kg BW reduction
(250 milliliters)
- 0.250 L (or 0.250 kg) fluid intake during
exercise, would be about

-0.500 L total water loss per 30 minutes

Estimation of – 1 liter per hour water loss

Note: Here are some water weight estimates, keeping in mind that water volume/mass varies at different temperatures.

A liter of water weighs about 1 kilogram or 2.2 pounds (35.2 ounces).

1 pound is about 454 grams. 1 milliliter is about 1 gram. 1 kilogram is about 33.8 fluid ounces.

About 30 milliliters per fluid ounce.

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Daily Hydration
Guideline Examples
The following fluid intake examples
are intended for an approach based on
daily energy expenditure. Note that each
individual needs to have his or her hydration
requirements confirmed on an individual
basis by qualified health professionals. It has
been determined that relating water intake can be fine-tuned using the body weight-
to daily energy expenditure is one approach based approach to crosscheck body loss water
reported in some publications. (Refer to the dynamics with the energy expenditure approach
unit related to energy expenditure needs.) estimations. In fact, the body weight approach
can be used to validate energy expenditure
In the following hypothetical examples, a
approach values for an athlete to fine-tune
minimum daily water intake range estimate
and personalize their energy expenditure
is provided to accommodate for individual
based daily water intake estimates. Whichever
differences and climatic differences that
approach or combination of approaches is
are determined. As temperature and
used, good data collection and analysis are
humidity climb over 70 degrees F and 70%
required to determine an athlete’s daily water
humidity, water loss will be increased due
intake to achieve the desired euhydration
to increased sweating, especially during
and to avoid dehydration (hypohydration)
exercise, and appropriate increase in daily
and excess hydration (hyperhydration)
water intakes should be determined, above
that can have adverse health effects and
minimum range estimation values.
adverse effects on athletic performance.
Daily Energy Minimum Daily
Expenditure Water Intake
2,000 calories 64 to 80 ounces SOURCES OF WATER
3,000 calories 102 to 118 ounces
Concern over the quality of water and other
4,000 calories 138 to 154 ounces
beverages has become a preoccupation for
5,000 calories 170 to 186 ounces
many people. Reports of the harmful effects
6,000 calories 204 to 220 ounces
of contaminants in drinking water and
Along with estimating calorie and chemicals in beverages will certainly make
macronutrient requirements with energy the health-minded individuals think twice
expenditure-based approaches, using the about looking for pure and natural products
daily energy expenditure-based approach to drink. Because athletes consume far greater
for hydration requirements can provide a amounts of beverages than do nonathletes,
compatible method for health professionals. the exposure to impurities is greater. In
However, this energy expenditure approach general, water is preferable to soda, juices,

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 Water and Oxygen | 191

and other calorie-containing beverages. But hyperhydration on improving cycle time trial
specialty sports beverages have their place in performance. Each time trial was preceded in
an athlete’s performance nutrition program, a single dose, about 2 to 2.5 hours prior to time
when used wisely on a daily basis, as needed. trial, by ingestion of either a glycerol solution
[1 g x kg(-1) body mass (BM) in a diluted
NOTE that Unit 17 contains additional
carbohydrate (CHO)-electrolyte drink] or a
information related to the entire sports
placebo of equal volume (the diluted CHO-
nutrition program.
electrolyte drink). The total fluid intake in each
trial was 22 ml x kg(-1) BM. Glycerol ingestion
Hydrating with Glycerol: expanded body water by approximately 600 ml
Effective, but Proceed over the placebo treatment. Glycerol treatment
with Caution significantly increased performance by 5%
compared with the placebo group.
Glycerol is a three-carbon-atom molecule that is
the backbone of triglycerides and phospholipids. In a more recent study, Patlar and coworkers
Triglycerides consist of three fatty acids attached (2012) consumed glycerol (1.2 g/kg body weight)
to a glycerol molecule, and phospholipids followed by water (26 ml/kg body weight). The
consist of two fatty acids attached to a glycerol results demonstrated an athletic performance-
molecule, with a phosphate-containing enhancing benefit for soccer players.
compound attached to the third carbon atom.
A word of caution: Some side effects, including
When glycerol is removed from these fats
bloating, nausea, and lightheadedness, have
by hydrolysis, it is a clear, syrupy liquid. The
been reported with glycerol use. If an athlete
liquid has been used in a variety of ways over
chooses to try a glycerol-containing beverage,
the years, but it is especially popular as an
he or she should test it out at least several times
emollient in skin-care products and cosmetics
before competition to see how the body reacts
and as a sweetening agent in pharmaceuticals.
to it. When taking food or supplements for the
As a supplement, glycerol has been found by first time, under the supervision of a physician,
researchers to possibly help the body remain starting with low dosages/amounts to determine
better hydrated. Studies have shown that athletes allergy reaction, intolerance, or other issues
training for prolonged periods (more than one is an evaluation approach used. This should
hour) are able to run cooler and longer when befFollowed by incrementally, each few days,
they ingest a water-glycerol mixture. Researchers increasing the dosage to the effective range.
report variable results, some positive and some
In addition, it is crucial to check legal status for
neutral, on athletic performance enhancement.
use of glycerol in certain competitive sports.
Examples of dosages used in research that WADA and other sports governing organizations
reported a benefit are high in comparison with can have bans on the use of glycerol. So be
other ergogenic supplements. The 1999 Hitchins sure to confirm the legal status before use by
and coworker study examined effects of glycerol competitive athletes.

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Oxygen

Oxygen and the Athlete

Oxygen, like water, is something that most people do not consider a
nutrient but that the body cannot survive without. It is basic to human
life. Oxygen not only keeps the lungs breathing and the heart pumping
but also feeds every cell of the body. Knowing the dynamics of oxygen
uptake and utilization can help you plan a scientific and sound athletic
performance-enhancement program. The best training program not
only builds muscles and increases stamina but also improves the body’s
ability to take in and properly utilize oxygen, which builds bigger
muscles and increases stamina even further.

Oxygen takes a circuitous route through the body. It enters by the lungs
and then travels via the bloodstream through the heart to the cells of the
muscles, brain, and other tissues. The lungs are also the last stop for the
waste products of oxygen metabolism, which are carried away from the
cells through the blood vessels and eventually exhaled into the air.

The Lungs
The lungs are the first step in the operation that brings oxygen into the
body system. The lungs are a pair of organs that sit in the chest on either
side of the heart. They process the air that is breathed in, removing
the oxygen and transferring it to the bloodstream for distribution
throughout the body. The amount of air that the lungs can process varies
with the condition of the person—a conditioned person can process
more air than a deconditioned person can. The amount of air that the
lungs can process is therefore a limiting factor.

To use an analogy, the lungs are like a dairy that processes milk. When
bulk milk comes in, the cream is separated from it and then bottled
and sent off for distribution. When the empty bottles come back,
they are flushed out, filled with more cream, and sent out once again.
The air that we breathe is like the bulk milk, and oxygen is like the
cream. When bulk air comes into the lungs, the oxygen is extracted
from it, “bottled” in red blood cells, and sent off in the bloodstream
for distribution. When the “bottles” reach the tissues that they are to
Carbon dioxide: a feed, they exchange their oxygen for carbon dioxide and water, waste
metabolic waste product. products that they then carry back to the lungs to be flushed out of the

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body. Once emptied of these waste products, is also capable of exhaling more waste products
the “bottles” are again filled with oxygen because the muscles around the lungs have been
and sent out once more for distribution. trained to do more work.

The air that we breathe is approximately The second factor that limits how much air
21percent oxygen and 78 percent nitrogen, with the lungs can process is the condition inside
negligible traces of other gasses. This ratio never the lungs. Lungs vary in size. A larger person
varies. What does vary is the amount of air that naturally has proportionately larger lungs than a
can be processed. If the lungs cannot process smaller person does. Thus, in fitness and sports,
enough air, they cannot extract enough oxygen we are less concerned with the size of the lungs,
to produce enough energy. Two factors limit the or total lung capacity, than with how much of
lungs’ ability to process air. that capacity is usable. The usable portion of
the lungs is called the vital lung capacity, and
First, the lungs have no muscles of their own. it is measured in the laboratory by the amount
To expand and contract, they must depend of air that can be exhaled in one deep breath.
completely on the muscles of the rib cage and Numerous tests have shown that a conditioned
diaphragm. Upon inhalation, the muscles person’s vital lung capacity is about 75 percent of
surrounding the lungs increase the available total lung capacity. Often, however, an otherwise
space within the lung cavity. When they do this, deconditioned person can match this, so we
they cause a partial vacuum, which helps suck look at one more factor—the maximum minute
air into the lungs. Upon exhalation, assisted volume. This is the amount of air a person can
somewhat by the natural elasticity of the lungs process during one minute of vigorous exercise,
and the chest wall, the muscles contract to create and it usually separates the fit from the unfit.
greater atmospheric pressure inside the lungs Conditioned persons can force as much as 20
than outside the body. This causes the air to be times their vital capacity through the lungs in
pushed out. one minute, whereas deconditioned persons
are often hard-pressed to force even 10 times
This normal breathing is done by the body at through. Deconditioned persons simply lack the
rest. As was already mentioned, all resting bodies muscle and strength endurance to perform at a
consume essentially the same amount of oxygen higher level.
and consequently inhale and exhale about the
same amount of air. When the body is in action, The remainder of the lungs—or, more
however, the amount of air that the lungs can specifically, the remainder of the air in the
inhale and exhale becomes limited by the size of lungs—is called the residual volume. The residual
the vacuum the muscles can create for the lungs volume is fixed, and even a conditioned person
to expand into and the size of the area the lungs cannot breathe this remaining air in or out.
can squeeze back down into. A conditioned Because residual volume is inversely related to
person in action obviously is able to inhale vital lung capacity, too much residual volume
more air and for longer periods of time than a is unhealthy. If your body deteriorates from
deconditioned person can. A conditioned person inactivity or disease, the unusable portion of

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your lungs increases, blocking off more and flows. The alveoli are like tiny balloons that
more space and allowing less space for normal are filled with air and dangle in the liquid of
breathing, let alone vigorous exercise. Ultimately, the bloodstream. The air was originally forced
you will find yourself short of breath from even into the alveoli by atmospheric pressure, and
light activity, such as climbing a flight of stairs. now, obeying the law of gaseous diffusion, the
oxygen transfers from the air in the sacs, in
Thus, when athletes allow their bodies to
which the pressure is higher, to the red blood
deteriorate, they may live their lives with two
cells, or “empty bottles,” in which the pressure is
handicaps in their lungs alone. When you need
lower. The limiting factors here are the number
more oxygen in a hurry, you may have trouble
of red blood cells that exist and the amount of
getting it because the muscles controlling your
hemoglobin these blood cells can carry. Even if
lungs will not be in good enough condition to
the lungs could process more oxygen, the tissue
force large volumes of air through the lungs. In
cells would not receive more unless additional
addition, the usable space within your lungs may
“bottles” existed to deliver it.
be seriously reduced.
Training helps here, too. Training produces
Training can reverse both these trends. more hemoglobin to carry oxygen, more red
Exercising the muscles surrounding the lungs blood cells to carry the hemoglobin, more
can increase the muscles’ strength and efficiency, blood plasma to carry the red blood cells, and,
allowing them to open more usable lung space. consequently, more total blood volume. Red
Opening more usable lung space has the net blood cells, also referred to as erythrocytes,
effect of increasing the vital lung capacity and contain hemoglobin. Laboratory tests have
reducing the residual volume. In each instance, repeatedly shown that individuals in good
the lungs become more efficient at processing air physical condition have a larger blood supply
and extracting oxygen. than do deconditioned individuals of comparable
A simple way to test the breathing condition size. An average-sized person can increase his or
of your lungs is to take a deep breath and then her blood volume by nearly a quart in response
see how long you can hold it. Most adults in to aerobic conditioning. The red blood cell count
moderately good physical condition and with increases proportionately.
healthy lungs are able to hold their breath for 60 The additional “bottles” produced by training
seconds or longer. not only deliver more oxygen to the tissue
cells but also carry away more metabolic waste
The Blood products, such as carbon dioxide. The removal
of carbon dioxide and other metabolic waste
From the lungs, the oxygen extracted from the
products is important for reducing fatigue and
bulk air goes directly into the bloodstream, the
increasing athletic performance.
body’s “assembly line.” This is accomplished
because the lungs contain millions of tiny air One process by which the “bottles” unload their
sacs, called alveoli, around which the blood oxygen into the tissue cells and pick up waste

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 Water and Oxygen | 195

products is called osmosis. The oxygen and food substances, now in liquid Blood plasma: the liquid
part of the blood; the
form, pass through the cell membranes into the cells in one direction,
substance in the blood that
while the waste products exit the cells through the cell membranes in the carries the red blood cells.
opposite direction. This is the life cycle—materials for nourishment and
energy go in, and waste products come out. The carbon dioxide and other
waste products are then carried away in the bloodstream via the veins,
and when they reach the lungs, they follow the law of gaseous diffusion in
reverse. The pressure of the carbon dioxide in the veins is greater than the
pressure in the empty alveoli is, so the carbon dioxide passes freely into the
alveoli and is exhaled with the expired air.

The efficiency and capacity of this cycle are both functions of the effects
of training. If you increase the system’s capacity, you help increase its
efficiency. If you do nothing, the system deteriorates.

The Blood Vessels

Muscular activity speeds up the rate of a normal heart, forcing it to pump
more blood per minute and increasing the amount of blood returning to
the heart. This increases the circulation. As the volume of blood increases,
so does the blood supply to the muscles. This improved blood flow,
resulting from tissue vascularization (creation of new blood vessels), is Vascularization: the
creation of new blood
probably the most remarkable training effect. Capillarization is another vessels in the tissues.
term related to the formation and development of capillaries, which is
activated by exercise and athletic training. To carry on our analogy, it is
similar to a dairy’s expanding its regular delivery routes by opening up
new routes into many small neighborhoods that up until now had been
neglected.

In addition to helping create new blood vessels, training also improves

the condition of the existing blood vessels, which has a beneficial effect on
the blood pressure. When a blood pressure reading is taken, two figures
are noted. A common reading is 120 over 80, written as 120/80. The top
figure is the systolic pressure, the pressure of the blood against the walls
of the arteries when the heart is in the process of ejecting blood into the
system. The lower figure is the diastolic pressure, the pressure during
the relaxed phase of the pumping cycle. In other words, the two figures
represent the maximum and minimum pressures inside the blood vessels.
In a conditioned person, these figures are usually lower because the

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blood vessels are more pliable, and the resistance to blood flow is at a
minimum. In a deconditioned person, the figures are higher because the
arteries tend to lose elasticity with disuse (inactivity), and the resistance
to blood flow is increased.

When physical activity or emotional stress is added, trouble can result.

Heart rate: the rate at The heart rate is increased, which raises the blood pressure because
which the heart pumps the the heart is pumping more blood into the system at a faster rate. In a
blood through the body.
treadmill test, a conditioned man might start with a diastolic pressure of
70 and experience only a slight increase during his run. After the test, his
blood pressure returns to normal within a few minutes. A deconditioned
person, however, and especially an overweight deconditioned person,
might start with a diastolic pressure of 90 and have it shoot up to 105
during the test and then take 10 minutes or more to recover.

Almost everyone, especially people with clinical conditions, may

reduce their blood pressure significantly by adhering to an appropriate
medically supervised exercise program for even just a few weeks.
First, blood vessels tend to make compensatory adjustments to handle
increased exercise capacity, something that almost all body systems
do in response to increased stress. Once again, this is an effect of
training. Second, conditioning the blood vessels causes the creation of
an augmented blood supply, the new routes that are opened up into the
small “neighborhoods,” as discussed above.

One of the most famous, and amusing, tests done in this area was
reported by a researcher who lifted a weight with a finger. The
researcher set the weight on the floor, tied a rope to it, ran the rope
over a pulley fastened to the edge of a table, and then sat on the other
side of the table and looped the end of the rope over the middle finger
of his right hand. In time to a metronome, he repeatedly lifted the
weight with his finger. The first time, and for many weeks thereafter,
the best he could do was 25 lifts before his finger became fatigued.
To expand the experiment, he occasionally had a mechanic in his
building lift the weight with a finger. The mechanic always beat him.
Then one day, about two months into the test, the researcher did
his usual routine but found that his finger was not tired at 25 lifts.
He kept going and ultimately reached 100 lifts. He suspected what
had happened and brought the experiment to a rather unorthodox
conclusion. He invited the mechanic in again and made a small bet
that he could beat the man. The mechanic accepted the bet and lost.

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 Water and Oxygen | 197

What the researcher had suspected was that his Due to the increase in oxygen-carrying capacity
finger muscles had undergone vascularization in and other vasoactive effects of interest, EPO has
response to the stress of the lifting exercise. More also gained interest among athletes outside of the
blood vessels had opened up/developed, creating endurance crowd: strength athletes, including
new routes for delivering more oxygen. However, bodybuilders, who are looking to increase
the new blood vessels apparently did not open exercise intensity, training session volume, and
up one at a time but an entire network at a time. quality of their workouts, and those who are
Many people practicing conditioning programs equally interested in achieving the “perpetual
recount how they agonized for months and then, pump.” But there are even more interesting
boom! Almost overnight, the exercise became aspects to the EPO blood-boosting story,
relatively effortless. Athletes report similar including combating the fatigue-causing drop in
“plateaus of progress,” improving not only day by pH levels, a synergistic Nitric Oxide connection,
day but also in quantum leaps. and enhancing nutrient delivery to stimulate
muscle growth.
Vascularization is an essential factor in building
endurance and reducing fatigue in the skeletal Keep in mind that this information about EPO
muscles, in saturating the tissues with oxygen, and rhEPO is for awareness, not for use of
and in carrying away more waste products. It rhEPO.
is also an extremely vital factor in the heart’s
health and in other parts of the body’s health.
EPO—Red Blood Cells—Oxygen
EPO and Blood Building From a straightforward athletic performance
bio-energetic perspective, oxygen is required for
One of the hottest topics capturing the attention the body to make energy (aerobically) to produce
of athletes, coaches, and other people in sports muscle contractions in addition to anaerobic-
focuses on the illegal use of the drug rhEPO produced energy. Within muscle cells are energy-
(recombinant erythropoietin) by some athletes. producing structures called mitochondria.
EPO (erythropoietin) is a hormone that is Oxygen is used inside the mitochondria to drive
naturally produced in the body and primarily the biochemical reactions that break down
functions to stimulate the production of new red carbohydrates, fats, and certain amino acids to
blood cells. Increasing the number of red blood produce energy in the form of ATP (adenosine
cells increases the oxygen-carrying capacity of tri-phosphate). This enables the body to convert
the blood to deliver more oxygen to exercising the energy stored in foods to a form that the
muscles. The extra oxygen significantly increases body can use—in the form of ATP.
the muscles’ energy production and can therefore
help improve athletic performance output ability; These high-energy ATP molecules are then used
higher intensity and longer duration. These by the muscles as an energy source to power
benefits of the body’s natural EPO has led to the muscle contractions. Thus, more oxygen in
illegal use of synthetic rhEPO drug doping by the body/muscles yields more ATP generation,
some athletes. increasing muscle contractions, which results

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in improving athletic performance. This benefit about this topic to explain what is going on with
of increasing oxygen in the body has led to the some athletes and the science behind this drug
reported use or suspected use of rhEPO by top and is not intended to encourage the illegal use
endurance athletes. of rhEPO by athlete.

Now, with the sports authorities cracking

Natural/Nutritional Epo Boosting
down on illegal rhEPO used in sports and the
additional risk of potential harmful side effects The current trend among some athletes is to use
of using rhEPO unsupervised, athletes are legal specialized sports nutrition supplements
seeking alternative ways to boost their own EPO designed to naturally boost production of EPO,
levels and red blood cells in addition to boosting taking the legal sports supplement route to
their nitric oxide (NO) levels. boost the body’s ability to maximize EPO, red
cell building, and oxygen uptake. The natural/
Sports Performance nutritional approach may offer ways for all
Benefits of EPO athletes to perhaps improve their oxygen-
carrying capacity.
Medically, rhEPO is used to increase red blood
cell count. Logically, because EPO accelerates
Red Blood Cell
red blood cell production, it also increases the
(Erythrocytes) Building
oxygen-carrying capacity of the blood and more
oxygen to muscles and to other body tissues. This Red blood cells, also known as erythrocytes
primary benefit of rhEPO attracted the attention or red corpuscles, primarily function in the
of the athletic community and led to the use (or transport of oxygen and carbon dioxide in the
alleged) of rhEPO by elite athletes. body. The red blood cells are specialized types
of cells that are loaded with a substance called
Endurance Athletes and rhEPO hemoglobin. Naturally produced EPO in the
body stimulates the production of red blood cells
The use of rhEPO is reported by the athletic
from stem cells that originate in bone marrow.
community to help increase oxygen-carrying
capacity of the blood by building more red blood Because blood cells have a short life in the
cells, thereby improving athletic performance bloodstream (only a few to several weeks), it
and reducing exercise fatigue. This enables is important to optimize this blood-building
performance improvements in endurance type process to maintain an optimum level of red
and other sports because of the extra oxygen- blood cells. This is vital to people who are more
carrying capacity. It is also believed that rhEPO physically active, such as athletes, because
and naturally produced EPO increase the intensive exercise will increase the breakdown
metabolism and the healing process of muscles of red blood cells. Furthermore, it is additionally
because the extra red cells carry more oxygen beneficial to maintain optimum levels of
and nutrients, improving recovery ability. This nutrients and substances that increase the red
review of rhEPO is meant to present information blood cell-building stem cell populations and to

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 Water and Oxygen | 199

protect red blood cells once they are produced During exercise, CO2 tissue levels build up
and delivered into the bloodstream. during exercise, which contributes to the onset of
fatigue, reducing the ability to maintain high-
Major Function of Hemoglobin normal levels of exercise/athletic performance.
It is therefore of paramount importance to
The major function of the hemoglobin molecules have high levels of red blood cells, plus good
found densely packed in red blood cells is the blood circulation, to create the conditions in the
transport of oxygen from the lungs through bloodstream that will rapidly clear away CO2
the bloodstream to the tissues and trillions from exercising muscles and eliminate it from
of cells in the body. During hemoglobin’s the body.
functioning in the body, hemoglobin will
alternate between two physiological states based
Natural EPO and
on whether it is carrying oxygen molecules or
Red Blood Boosters
not: oxyhemoglobin and deoxyhemaglobin. In
the oxyhemoglobin state, hemoglobin is loaded In a quest to find natural alternatives to rhEPO,
up with oxygen. In the deoxyhemoglobin state, that is, substances to naturally enhance EPO
hemoglobin is devoid of oxygen, which is also levels and boost red blood cell production in
known as empty hemoglobin. the body, there is a growing list of research-
backed ingredients being reported about in the
Biochemically, hemoglobin is a specialized
scientific and medical literature and appearing
protein molecule, a conjugated globular protein,
in sports nutrition products. The following are
which consists of heme groups containing
some nutrients/ingredients found in sports
iron. The iron components of hemoglobin
supplements that are reported to boost EPO
function to “lock on” to oxygen and also onto
and red blood cell production along with other
carbon dioxide molecules. Therefore, adequate
benefits of interest to athletes. Note that this is an
dietary/supplement intake of iron is vital for
emerging area of sports nutrition, and examples
the development and functioning of red blood
are intended for providing some preliminary
cells. Forms such as ferrous fumarate are used in
background to the ingredients found in the
supplements as an “organic” alternative to iron
natural EPO-boosting sports nutrition products
oxide and other inorganic forms.
you or your clients may encounter.

Carbon Dioxide Arachidonic Acid: The EPO production

Transport and Hemoglobin stimulating effects of arachidonic acid are
attributed to its involvement in the biochemical
In addition to carrying molecules of oxygen, process leading to the actual production of
hemoglobin also transports the metabolic waste EPO in the body and phospholipase activation
product carbon dioxide from cells through the in erythroid progenitor cell proliferation.
bloodstream and to the lungs where it is exhaled Arachidonic acid is abundant in the body and
into the atmosphere. (Yes, humans are a source involved in many structural and biochemical
of CO2.) functions. Regarding EPO production,

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arachidonic acid is the precursor molecule in the vasodilation properties, especially for dilating
production of eicosanoids, which are substances the micro-circulatory system that is responsible
in the body found to be involved in stimulating for the delivery of oxygen, nutrients, and
EPO production. Additionally, recent research hormones to the muscle cells and for clearance of
has reported anabolic muscle-building effects of metabolic waste products.
arachidonic acid.
Portulaca oleracea: This botanical contains
Cobalt: Cobalt is another vital research-based high concentration flavones that scientific
EPO/red blood cell production stimulator, which research reports may improve the expression
is needed by humans in small amounts. It is level of EPO and accelerate the generation of
also a necessary component of vitamin B12. erythrocytes and hemoglobin.
In the research report titled “Blood Doping
Vitamin B-6 (As Pyridoxine HCl and
by Cobalt,” researchers reported that cobalt is
Pyridoxine 5-Phosphate): An essential vitamin
a naturally occurring element that enhances
needed for red blood cell production. Vitamin
erythropoiesis and angiogenesis (growth of new
B-6 also helps increase the amount of oxygen
blood vessels), resulting in increasing red blood
carried by hemoglobin (the iron-containing
cell concentration and circulation. The proposed
oxygen transport metallo-protein in red blood
mechanisms of action include more efficient
cells). Note that a vitamin B-6 deficiency can
transcription of the erythropoietin gene.
result in some health problems.
Echinacea: More recent research has
Vitamin B-12 (Methylcobalamin,
demonstrated that Echinacea stimulates
Cyanocobalamin, Dibencozide): This essential
production of erythroid (red blood cell) growth
vitamin is vital for red blood cell production.
factors, induces erythropoiesis, and increases
Deficiency in vitamin B-12 is responsible for
the oxygen-transport capacity of the blood, in
a reduction in red blood cells and can lead to
addition to its well-known role for beneficially
muscle fatigue and weakness.
stimulating the immune system. The blood-
building and improved oxygen-carrying capacity
EPO Blood Building and the
effects of taking standardized Echinacea
Synergistic Effects of Nitric Oxide
supplements was reported in a recent study
using male subjects. This research, along with Although EPO and NO boosting have well-
other research studies, has found that the use known distinct benefits, the question arises
of Echinacea-containing supplements increased whether boosting both EPO and NO will
EPO levels, interleukin-3 (IL-3) levels, red blood produce synergistic effects. Let’s examine how
cell count, the number and size of red blood cells, these two performance agents work in tandem to
and maximal oxygen consumption VO2 max.
•
give athletes a new competitive edge.
Niacin: This essential vital vitamin that is Here’s a short recap of the science of NO. Major
required by the body for the formation of attention was first directed to NO when the
coenzymes NAD and NADP. Niacin also has Nobel Prize in Physiology or Medicine in 1998

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 Water and Oxygen | 201

was awarded to Robert F. Furchgott, Louis J. oxygen and nutrients to the muscles and other
Ignarro, and Ferid Murad for their discoveries tissues, with a new level of performance expected
concerning “the nitric oxide as a signaling from these synergistic effects.
molecule in the cardiovascular system.” One
Hundreds of products now feature ingredients
of the main functions performed by NO in
for promoting NO-mediated vasodilation,
the cardiovascular system is dilating blood
primarily by two modes of action: precursors
vessels. This function helps increase blood flow
that are involved in NO production and
to muscle and other tissues in the body. As
stimulators that are involved in the production
more research has been focused on NO, more
of NO. Here is a summary of some of the
functions have been identified, such as NO’s role
ingredients being used in NO-stimulating
as an important signaling molecule outside the
products and that are also contained in
cardiovascular system, signaling between nerve
the newest class of dual-action EPO–NO-
cells in the brain, and enhancing the olfactory
stimulating products.
sense and immune system functioning.

Chief among NO’s many functions in the NO-Boosting Ingredients Summary

sports nutrition product industry is its role in
vasodilation – leading to achieving the resistance Arginine: Arginine is a crucial amino acid used
exercise-induced PUMP. Vasodilating during to make nitric oxide in your body. NO products
exercise is vital to accommodate increasing found on the shelves usually contain arginine
blood volume and to enhance blood flow rate as a single ingredient or in other forms, for
for maximum delivery of oxygen, nutrients, example, Arginine Alpha Keto Glutarate and
and anabolic hormones to muscle tissue and Arginine Ethyl Ester. Some products contain a
to improve metabolic waste clearance, such as multisource arginine blend claiming to ensure
fatigue-causing carbon dioxide. fast, complete, and sustained absorption of the
arginine molecule provided in free form and
Therefore, although EPO boosting provides a special organic complexes, such as with Alpha
means to stimulate more red blood cells and Keto Glutarate and Ethyl Ester for dynamic
higher nutrient and oxygen-carrying capacity, physiological action.
NO provides the means to widen the blood
vessels to promote greater blood flow. In this Citrulline: Citrulline is another amino acid
way, EPO and NO working together are the found in NO-stimulating supplements, primarily
vasoactive cart and horse of maximizing for its purported function of boosting the body’s
performance-enhancing enriched blood and arginine levels, thereby supporting the NO
blood vessel super-pumps. production pathway. Citrulline can be used on its
own as a supplement, but it is typically included
Nitric oxide stimulates the blood vessel dilating along with arginine and other NO-stimulating
effects to create a wider circulatory system ingredients as a way of saturating the nitric oxide
conduit for the EPO-stimulated red blood cell- production pathways to ensure that peak nitric
enriched volumized bloodstream to deliver more oxide production is achieved because arginine

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has a variety of other functions in the body in synergistic role with NO precursor substances,
addition to NO production. like arginine.

Cnidium monnier: This botanical ingredient Norvaline: Norvaline is related to the branched-
is reported to be traditionally used to support chain amino acid valine. Norvaline is reported
already normal male sexual performance. to inhibit the arginase enzyme, thus increasing
However, modern research determined that arginine levels available for NO production.
a primary physiological function of this Norvaline can in this way optimize the NO-
botanical is to increase the release of nitric boosting effects of a multi-ingredient NO-
oxide by cells lining the circulatory system, boosting formula, in formulas containing
thereby promoting vasodilation. This NO- arginine and/or citrulline, by optimizing the
boosting effect reveals a viable reason for its NO-synthesizing biochemical pathway.
traditional use of promoting normal male
Pycnogenol®: Pycnogenol® is brand name of a
sexual function and as an ingredient used in
dietary ingredient used in dietary supplements.
NO-boosting sports nutrition products.
Compositionally, it is a well-researched and
Folate: This essential vitamin is involved in highly standardized botanical, referred to as
the hematopoietic system and is required French maritime bark extract, with multiple
for red blood cell production. Folate also has health benefits. Regarding NO, it may play an
beneficial effects on endothelial function, important role with physical activity because
as measured with the use of flow-mediated it was shown to aid the body in producing
dilatation (FMD). A study reported that nitric oxide (NO), thus enhancing blood
folic acid improved endothelial function microcirculation and improving blood flow to
and increased flow-mediated dilation. the muscles. This can help achieve peak muscle
Folate also lowers homocysteine levels, performance and speed recovery after exercise.
which is beneficial because a high level of It is reported that Pycnogenol® helps relax blood
homocysteine impairs cardiovascular function vessels and improves blood flow. Pycnogenol®
and blood flow. Furthermore, research stimulates the enzyme “endothelial nitric oxide
revealed that folic acid is involved in the synthase” (eNOS) for enhanced generation of NO
regeneration of tetrahydrobiopterin, which from the precursor molecule L-arginine. Two
enhances nitric oxide synthase function clinical studies have shown that Pycnogenol®
and maximizes nitric oxide production. causes vasodilatation and consequently improves
blood micro-circulation. An increased presence
Gynostemma pentaphyllum: Gypenosides
of oxygen and decreased carbon dioxide after
extracted from Gynostemma pentaphyllum
consumption of Pycnogenol® was shown.
have been shown to elicit vasorelaxation and
Pycnogenol® contributes to better blood flow
vasodilation through the direct release of
and oxygenation of muscle. Pycnogenol® has
endothelium-derived nitric oxide. In this way,
other benefits related to exercise and sports
Gynostemma serves to directly stimulate NO
performance that will be elaborated on in Unit 9.
levels in the cardiovascular system and plays a

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 Water and Oxygen | 203

Conclusion
An athlete’s personalized adequate water established prior to events to increase hydration
intake (hydration) and oxygen consumption is success. The suitability of using glycerol and
a major factor for achieving and maintaining other hydration sports nutrition products needs
peak athletic performance and good health. to be evaluated on an individual basis should use
Determining hydration requirements for each be justified.
athlete is an involved process that needs to be

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Keywords
Hypohydration Diuretic
Euhydration Carbon dioxide
Hyperhydration Blood plasma
Glycogen-bound water Vascularization
Metabolic water Heart rate

Sports Nutrition
Topics Covered In This Unit

Introduction

The lipid-soluble vitamins-

A, D, E, and K

 itamin A- retinol and pro-vitamin A

V
(beta-carotene)

Vitamin D

Vitamin E

Vitamin K

The water-soluble vitamins

Vitamin C

Thiamin

Riboflavin

Niacin

Vitamin B6

Folate

Vitamin B12

Biotin

Pantothenic acid

Choline

Inositol

Daily Vitamin Intake

Reference Summary

Conclusion

UNIT 7

VITAMINS
206 | Unit 7

Unit Outline
I. Introduction d. Niacin
II. The lipid-soluble vitamins- i. Niacin in food and supplements
A, D, E, and K
e. Vitamin B6
a. Vitamin A- retinol and pro-vitamin A (be-
i. Vitamin B6 in food and supplements
ta-carotene)
f. Folate
i. Vitamin A and beta-carotene in food and
supplements i. Folate in food and supplements
b. Vitamin D g. Vitamin B12
ii. Vitamin D in food and supplements i. Vitamin B12 in food and supplements
c. Vitamin E h. Biotin
i. Vitamin E in food and supplements i. Biotin in food and supplements
d. Vitamin K i. Pantothenic acid
i. Vitamin k in food and supplements i. Pantothenic acid in food and supplements

III. The water-soluble vitamins j. Choline

a. Vitamin C i. Choline in food and supplements

i. Vitamin C in food and supplements k. Inositol

b. Thiamin i. Inositol in food and supplements

i. Thiamin in food and supplements IV. Daily Vitamin Intake

Reference Summary
c. Riboflavin
V. Conclusion
i. Riboflavin in food and supplements

Learning Objectives
After completing this unit, you will be able to:
• Define and discuss terms related to vitamins;

• Discuss the main functions of vitamins;

• Determine benefits of vitamins for health and performance of athletes;

• List food sources of vitamins.

 Vitamins | 207

INTRODUCTION
Vitamins are a group of naturally occurring nutrients found in food and
supplements that are required in the diet for maintenance of good health,
normal metabolic functioning, growth, recovery, and performance. They
are organic compounds, which means they are biologically produced and
contain carbon atoms as part of their chemical structure. By definition,
vitamins are necessary in trace amounts for health (micrograms to
milligrams) and are essential in the diet because the human body either
does not make them at all or does not make them in adequate quantities.
If any one of these nutrients is lacking in the diet, metabolism will be
affected, and essential vitamin deficiency symptoms can arise.

Athletic Significance of Vitamins

• Vitamins are needed for normal metabolism, growth, and maintenance of tissue.
• Adequate vitamin intake is essential for performance and health.
• When vitamin intake is low (deficient) health and athletic performance are compromised.
• Health and athletic performance improvements may be experienced with vitamin
supplementation.
• Dietary surveys show that athletes can be deficient in one or several vitamins.
• Optimum vitamin intake is attained from food and supplements.

Traditional nutrition views have focused primarily on providing

minimum amounts of vitamins to prevent deficiency symptoms. As
mentioned earlier, this is the “nutrition for survival” approach. New
research has determined that greater amounts of vitamins can offer
other benefits for health and performance. However, although more is
indeed better, there is an upper limit of safety and efficacy. This unit
will present information about the “essential” vitamins and present
information about their form, function, and recommended daily
amounts. Data on estimated safe intakes of vitamins were derived from
several reputable sources, including the National Research Council and
the Council for Responsible Nutrition.

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Note that reference intake data from multiple sources is provided in

a summary table at the end of this Unit for vitamins for educational
purposes only. While a variety of useful scientific information about
vitamins is contained in this unit, it is important to realize that
personalization of vitamin intake for each athlete requires doctor
supervision and testing to determine whether vitamin deficiencies or
excesses are present and need to be corrected.

Vitamins are classified into two groups based on their solubility

characteristics. There are the fat-soluble and water-soluble vitamins.
This categorical grouping was devised back when researchers were first
working on isolating nutrition factors that prevented nutritional diseases.
Scientists called the fat-soluble fraction “fraction A” and the water-soluble
fraction “fraction B.” Vitamin A was the first vitamin identified in the
fat-soluble fraction, thus the name. Similarly, the B vitamins were the
first identified in the water-soluble fraction. As research progressed, other
vitamins were found in each fraction, and the letter system was used to
name the vitamins.

The Lipid-Soluble Vitamins –

A, D, E, and K
The fat-soluble vitamins are vitamin A, vitamin D, vitamin E, and vitamin
K. These vitamins are soluble in lipid and organic solvents. This fat-soluble
property allows them to be stored in the body in large amounts along with
body fat stores in the liver. Water-soluble vitamins can also be stored, but
usually in much smaller amounts, as they have the tendency to be flushed
out of the body easily.

The fat-soluble vitamins, especially vitamin A, have been posted with a

warning sign because their levels can be built up in the body. There is a
concern that this build-up may reach harmful levels, even though very
Vitamin toxicity: vitamin few vitamin toxicity cases have been reported. However, this concern
poisoning. has grown during recent years and peaked with the emerging use of
supplements and the popularized practice of mega-dosing vitamins to
combat and prevent diseases and aging. Although vitamin toxicity is
rarely seen, you should be aware of its potential occurrence, especially
when striving for peak performance. Even though you may not develop a
clear case of vitamin toxicity, overdoing it may impair performance. When
it comes to nutrition, more is not always better.

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 Vitamins | 209

Additionally, proper digestion and absorption of the fat-soluble vitamins

may require the presence of fat in the diet. Athletes on low-fat and low-
calorie diets should be cautioned that deficiency of these vitamins is
possible due to absorption malfunctions. Those taking supplements as a
source of fat-soluble vitamins should look toward the ones in an oil base
or take them with a meal. The following will review the basics on the fat-
soluble vitamins.

Vitamin A – Retinol and Pro-Vitamin A

(Beta-Carotene)
Vitamin A and its function in vision make it one of the most widely
known vitamins. As children, we were all forced to eat carrots, like the
cartoon character Bugs Bunny, so our vision would be improved and
we wouldn’t need glasses. Night blindness is a well-recognized disease,
accounts of which can be traced back to ancient Egypt. The cure practiced
then was to squeeze the liquid out of cooked liver onto the eyes. Later,
other civilizations included liver in the diet to combat night blindness.
As we know today, liver is very high in vitamin A content, which lends
credibility to this ancient health practice.

Vitamin A actually designates a group of compounds that display vitamin

A activity. The principal vitamin A compound is retinol and belongs to a
class of chemicals called retinoids, which have varying degrees of vitamin
A activity. Retinol is the standard to which the other compounds that
display vitamin A activity can be rated against. The retinoids occur in
animals.

The carotenoids are another class of chemicals that display vitamin A

activity. They are made by plants and function as pigments, but can also
be stored in animal fat. They occur in the precursor form of vitamin A.
The body converts some carotenoids to vitamin A, to mostly retinol, and
referred to as provitamin A. The carotenoids can build up in the body, but
do not appear to develop signs of toxicity. Persons desiring to maintain
high vitamin A intake will usually combine a moderate amount of vitamin
A with a higher intake of Beta-carotene. Beta-carotene is the most popular
carotenoid and has about one-sixth the biological vitamin activity of
retinol. Other carotenoids with vitamin A activity include alpha-carotene
and beta-cryptoxanthin. Carotenoids may have additional benefits beyond
vitamin A activity, especially due to their antioxidant activity. Other
dietary carotenoids of interest include lycopene, zeaxanthin, and lutein.

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The carotenoids are yellow-red plant pigments, and taking high amounts
of them may affect a person’s skin color with a yellow tint due to
accumulation in subcutaneous fat. This condition is called carotenemia.
Coloration disappears when the high dosages are discontinued. If
carotenemia develops, just cut back on your dosage of Beta-carotene.
Beta-carotene also displays antioxidant activity, which is important for
protecting the body against free radical damage.

Vitamin A has many functions and is essential for vision as a component

of rhodopsin; cellular growth and development; reproduction (involved
in testicular and ovarian function); integrity of the immune system;
formation and maintenance of healthy skin, hair, and mucous
membranes; promotion of bone growth and tooth development; and anti-
cancer functions. In addition to these important functions of vitamin A,
beta-carotene functions as an antioxidant, with the ability to quench the
free radicals, particularly singlet oxygen. This antioxidant function will
help reduce cellular, molecular, and tissue damage of free radicals, which
are greatly increased by exercise and increased oxygen uptake.

Deficiency signs of vitamin A include development of night blindness;

glare blindness; rough, dry skin; dry mucous membranes; loss of
appetite; increased susceptibility to infections; and slow growth.
Deficiency is found mostly with children under the age of five and is
usually due to an insufficient dietary intake. Deficiency also occurs as
Malabsorption: incorrect a result of chronic fat malabsorption. The primary signs of vitamin A
absorption. deficiency are indicated by eye disorders.
International unit (IU):
a measure of potency Excess intake of vitamin A can occur acutely or chronically. Toxic
based on an accepted effects include headaches, vomiting, dryness of mucous membranes,
international standard. It
is usually used with beta- bone abnormalities, and liver damage. Signs of toxicity in adults seem to
carotene and vitamins A, appear after prolonged daily intakes of 15,000 micrograms (50,000 IU)
D, and E. Because this unit
is a measure of potency, of retinol and 6,000 micrograms (20,000 IU) of retinol in children and
not weight or volume, the infants. These dosages are well above the RDA and are difficult to obtain
number of milligrams in an from food unless large amounts of liver are eaten every day for long
IU varies, depending on the
substance being measured. time periods or unless supplements are taken in enormous quantities.
In women, ingestion of high therapeutic doses of vitamin A has been
reported to cause spontaneous abortions and birth defects. Women
who are pregnant, or planning on becoming pregnant, should consult
their doctors to determine the proper dosage of vitamin A or any other
supplements, but note some authorities caution not to exceed amounts
of 10,000 IU of retinol per day. Beta-carotene ingested in high amounts

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 Vitamins | 211

is not known to be toxic and is preferred to retinol in higher amounts

to derive the benefits of vitamin A and simultaneously gain the benefits
of antioxidant activity. However, as mentioned above, discoloration of
the skin may occur at high levels of intake due to the accumulation of
carotenoids in subcutaneous fat.

Athletic Performance Considerations of Vitamin A or Beta-

Carotene. Studies support the adequate intake of vitamin A and
beta-carotene for maintenance of overall health and performance.
Studies have not supported the use of megadoses for immediate
improvements in athletic performance. As determined by a
physician, maintain intake within PDI guidelines from dietary
and supplement sources. Beta-carotene may be increased
proportionally to activity levels to derive the antioxidant benefits.

Vitamin A and Beta-Carotene in

Food and Supplements
The vitamin A that is most commonly used in supplements is vitamin
A acetate and palmitate. These are effective and economical synthetic
forms of retinol. Natural vitamin A retinol forms are available but are
more expensive because they are concentrated and extracted from
natural animal sources, such as fish liver oil. Beta-carotene, though of
plant origin, comes in a synthetic form used mostly in supplements.
Beta-carotene is several more times expensive than vitamin A is. Both
vitamin A and beta-carotene are found in gel caps, capsules, and tablets.
The dry forms tend to be more stable than are those suspended in oils.

Antioxidants Overview
During progressive research on the possible metabolic roles that nutrients may play in addition to
prevention of nutrient-deficiency disorders, a group of vitamins, minerals, and enzymes called anti-
oxidants have been identified that protect the body from chemical damage. Because “free radicals”
damage biomolecules, they are responsible for aging and for causing diseases like cancer, degenera-
tive diseases, and environmental-reactive contaminants. Oxygen itself also causes damage. Because
athletes are overexposed to more free radicals, it is crucial that every athlete’s diet contain the antioxi-
dant nutrients for protection. Specifically, antioxidants protect against free radical damage and oxida-
tion. The antioxidant group of nutrients is growing, and the following are examples of antioxidants or
antioxidant cofactors: beta-carotene and other carotenoids, vitamin C, vitamin E, cysteine, glutathi-
one, selenium, bioflavonoids, polyphenols, proanthocyanidins, and SOD (super oxide dismutase).

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Taking a combination of vitamin A and beta-carotene is a common

approach, along with eating a diet rich in vegetables that are high in
beta-carotene.

Dietary sources of Vitamin A and Beta-carotene. Vitamin A sources:

liver and fish liver oils, egg yolk, crab, halibut, whole milk products,
butter, cream, margarine, vitamin A-fortified milk. Beta-carotene
sources: carrots and green leafy vegetables, spinach, broccoli, squash,
apricots, sweet potatoes, and cantaloupes.

Note that ingestion of over 25,000 IU of beta-carotene may lead

to yellow or orange coloration of the subcutaneous fat. However,
the coloration is reported to be harmless. Additionally, a note of
caution to women who are pregnant or planning on becoming
pregnant: high amounts of vitamin A have been associated
with the incidence of certain birth defects. Consult a physician
about supplementation before and during pregnancy.

Vitamin D
Vitamin D was originally revealed as the active nutrient in cod liver oil
that was used for the treatment of rickets and other disorders. Later,
researchers also determined that ultraviolet light from sunlight or lamps
could cure rickets. We know that vitamin D occurs in high amounts in
cod liver oil and that the body can make vitamin D when exposed to
ultraviolet light.

Several compounds that exert vitamin D activity. The most commonly

encountered are calciferol, cholecalciferol, and ergocalciferol.
Cholecalciferol is the major form of vitamin D that is formed in the
body. Ultraviolet light induces the conversion of a compound called
7-dehydrocholesterol into vitamin D3 (cholecalciferol). Vitamin D2,
ergocalciferol, may be produced commercially by ultraviolet irradiation
of the plant sterol, ergosterol. The body can use these forms of vitamin
D in the body by converting them to the biologically active form,
25-hydroxycholcalciferol.

Vitamin D has several important functions and is essential for

normal growth and development. Its main function is the absorption
and metabolism of calcium and phosphorus to support normal
mineralization (hardening) of bones and teeth. Vitamin D is involved

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in many aspects of calcium and phosphorus metabolism, including

mediating intestinal absorption and use. Maintenance of the appropriate
level of serum calcium is also necessary to promote proper functioning
of the neuromuscular system and heart action. There is also some
evidence that vitamin D functions to improve muscle strength, helps
maintain immune function, helps reduce osteoporosis, and is involved
in the cell division process. There appear to be no added benefits for
athletes from ingesting megadoses of vitamin D.
The signs of vitamin D deficiency are characterized by inadequate
mineralization of bone and associated abnormalities such as soft bones,
bowed legs, poor teeth, and various skeletal deformities. In children, this
deficiency can result in severe deformation of the skeleton (rickets). In
adults, bone loss and an increased susceptibility to fractures can occur.
Although vitamin D deficiencies are rarely seen due to fortification
of milk and other foods with vitamin D, the condition is of concern
for some infants who are breastfed without supplemental vitamin D
or adequate exposure to sunlight. Characteristic biochemical changes
include low blood calcium and phosphorus levels. For the growing child,
normal adults, and athletes, vitamin D is a crucial nutrient. Elderly
people and persons who spend most of their time indoors should make
an effort to get at least the RDA amount from dietary sources.
However, excess vitamin D intake is potentially harmful, especially
for young children. The effects of excessive vitamin D intake can
lead to calcium buildup in soft tissues and irreversible kidney and
cardiovascular damage. Harmful levels have not been clearly established;
however, consumption of as little as 45 micrograms (1,800 IU) of
cholecalciferol per day has caused hypervitaminosis (overdose toxicity)
in children. Because exposure to sun forms vitamin D, intake of this
nutrient should be closely monitored. In some cases, only five times the
RDA has produced side effects. Although greater intake than the RDA
may be beneficial for athletes, megadosing of this vitamin should be
avoided unless under the prescription and supervision of a doctor.
Athletic Performance Considerations of vitamin D. Studies support
the adequate intake of vitamin D for maintenance of overall health and
performance. Studies have not supported benefits for using megadose
amounts of vitamin D for immediate improvements in athletic
performance. As determined by a physician, maintain intake within PDI
guidelines from dietary and supplement sources.

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Vitamin D in Food and Supplements

The types of vitamin D generally used in supplements are vitamin D2
(ergocalciferol) and vitamin D3 (cholecalciferol). These occur mostly in
dry tablet form, and supplements containing both vitamin D3 and D2
should be sought.

Dietary sources of vitamin D include fish liver oil, eggs, butter, cream,
halibut, herring, liver, mackerel, salmon, sardines, and shrimp. In the
United States, foods fortified with vitamin D are a major dietary source,
especially milk. Sunlight-produced vitamin D can also be a major
contributing factor, making precise dietary guidelines difficult. Persons
who do not get frequent sun exposure need more vitamin D from
dietary sources.

Vitamin E
Identification of vitamin E’s role in reproduction is widely recognized,
which has led to the popular supplemental use practiced by many in the
hopes of enhancing sexual performance. Recent research has proven
other potential benefits of vitamin E supplementation that are of interest
to athletes and the population at large, including antioxidant activity,
which helps protect the body’s substances, cells, and tissues from
oxidative/free radical damage.

Two major groups of compounds are found in foods that display vitamin
E biological activity: tocopherol and tocotrienols. The tocopherols
display a much higher activity than the tocotrienols do and are therefore
the primary source of vitamin E. There are several major tocopherols.
Natural d-Alpha tocopherol is the most active form of vitamin E.

Vitamin E’s major function is as a chain-breaking antioxidant that

prevents the spread of free-radical reactions and that scavenges radicals
to protect fatty acids within membrane phospholipids and plasma
lipoproteins. Other vitamin E functions include normal red blood cell
formation and prostanoid synthesis modulation. These compounds
are important in the reproductive process, blood platelet aggregation,
energy metabolism, synthesis of DNA and RNA, and aging and heart
disease retardation. Vitamin E therefore protects cell membranes
against oxidation, inhibits coagulation of blood by preventing blood
clots, retards oxidation of the other fat-soluble vitamins, participates
in cellular respiration, and treats and prevents vitamin deficiency in

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premature or low-birth-weight infants. Of interest to athletes, vitamin E

supplementation has been shown to lower blood lactate levels, decrease
lipid peroxidation products formed during exercise, reduce oxidative cell
damage, maintain muscle tissue, and play a possible role in testosterone
production. High experimental intakes of vitamin E have been reported
to benefit athletes by improving energy functioning, reducing cellular
damage, and stabilizing cell membranes. Supplementation has also
had noticeably beneficial effects on physical performance and tissue
protection at high altitudes.
Vitamin E deficiencies have been observed in animals but are less
clear in humans. Newborn infants have a low tissue concentration of
vitamin E. Hemolytic anemia and dermatitis have been noticed in
infants, especially premature ones. A common instance of what appears
to be vitamin E deficiency is muscle weakness. Increased destruction
of cellular membranes is also suspected, as are abnormal disposition
of fat in muscles and rupture of red blood cells. Clear determination
of vitamin E deficiencies in humans is complicated by the additional
factor that the mineral selenium plays a role in vitamin E’s metabolism
and that symptoms in animals sometimes disappear by the addition of
selenium or the sulfur-containing amino acids. Vitamin E is clearly an
important essential nutrient whose amounts should be ingested above
the RDA amount.
Compared with the other fat-soluble vitamins, vitamin E is relatively
nontoxic when orally ingested, but individual tolerance will vary. This
is fortunate considering the large number of people who self-prescribe
megadoses of vitamin E in the hopes of curing or preventing many
disorders. However, high levels of vitamin E may interfere with the
activity of vitamin K, leading to anticoagulant effects and prolonged
blood clotting time.
Athletic Performance Considerations of Vitamin E. Studies support
the higher than average intake of vitamin E by athletes. As determined
by a physician, maintain intake within PDI guidelines from dietary and
supplement sources. For athletes in high altitudes (over 5,000 feet above
sea level), maintaining vitamin E intake at the upper end of the PDI
range during training and competition may be warranted. Higher than
normal intakes of vitamin E are also indicated for those recovering from
an injury or surgery. Natural vitamin supplement may be preferred over
synthetic vitamin E containing supplements depending on the total daily
dosages and individual requirements.

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Vitamin E in Food and Supplements

Both natural and synthetic forms of vitamin E are found in supplements.
The natural form, D-Alpha tocopheryl succinate is generally preferred
due to its reported higher rate of absorption. Other bioactive forms
include alpha-tocopherol and alpha-tocopheryl acetate. The DL-alpha
tocopheryl appears to be less bioactive. A combination of the two forms
is also recommended (mixed tocopherols). Other forms of vitamin E also
exist. Vitamin E is found in gel caps, in oil, or as a solid. Both delivery
systems are OK, but the dry form is likely to be more stable.

Dietary sources of vitamin E vary greatly depending on their storage

and preparation. The richest sources are vegetable oils, such as soybean,
corn, cottonseed, peanut, and safflower. Products containing vitamin E
include margarine, wheat germ, and nuts. Meat, fish, animal fats, and
fruit are mostly low in vitamin E.

Vitamin K
The need for vitamin K was suspected in about 1929, when researchers
observed that newly hatched chickens on diets containing only the
known essential nutrients developed a hemorrhagic disease. Later
in 1939, vitamin K was isolated, and its role in blood clotting was
established.

Several compounds display vitamin K activity. Phylloquinone (K1) is

the principal one. Other forms of vitamin K include the menaquinones
(K2), which are produced by intestinal bacteria, and menadione (K3),
which is a synthetically produced form of vitamin K. Phylloquinone
occurs naturally in green plants. Menaquinone is formed in the human
intestines from bacterial metabolism. The synthetic form of vitamin
K, menadione, is fat soluble and about twice as potent as the naturally
occurring phylloquinone form is. Menadione is also synthesized in
water-soluble forms.

Vitamin K’s major function as a coenzyme is the formation of

prothrombin and procoagulants, which is vital for blood clotting/
coagulation, by converting these proteins into their biologically active
forms. It is therefore essential for maintenance of prothrombin levels

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 Vitamins | 217

and blood clotting. Vitamin K is also involved in bone metabolism and

helps maintain bone tissue. As athletes undergoing strenuous training
are constantly damaging tissue, a supplemental amount of vitamin K is
warranted to ensure adequate vitamin K daily intake.

Deficiency of vitamin K is rarely encountered in healthy individuals

eating a balanced diet. However, deficiency can develop if green
vegetables are restricted from the diet or drugs are taken that inhibit the
formation of vitamin K by intestinal bacteria. Most instances of vitamin
K deficiency are encountered with infants. Ingestion of too much aspirin
can interfere with the metabolic pathways vitamin K is involved in and
prevent normal blood clotting. A deficiency of vitamin K would decrease
the amount of prothrombin made by the body and increase the tendency
Hemorrhage: bleed
for hemorrhage. It is sometimes given to patients before surgery to aid
excessively.
in blood clotting.

Excessive intake of vitamin K, even over long periods, has not readily
yielded toxic side effects. However, excessive dosages in experimental
Hemolytic anemia: a
animals and in infants have been shown to cause hemolytic anemia condition in which the
(separation of the hemoglobin from red blood cells). The synthetic water- hemoglobin becomes
separated from the red
soluble forms may have a wider margin of safety. blood cells.

Athletic Performance Considerations of Vitamin K. Few studies

have been conducted on vitamin K’s direct effects on performance. As
determined by a physician, maintain intake within PDI guidelines from
dietary and supplement sources. Megadosing Vitamin K is not supported
by current research.

Vitamin K in Food and Supplements

Phylloquinone (K1) and menadione (K3) are commonly used in
supplements, primarily tablets and powders. Taking a supplement that
combines the two forms is recommended. Dietary sources primarily
include green leafy vegetables. Small amounts are found in milk and
dairy products, eggs, cereals, fruits, and vegetables. Another important
source is the vitamin K made in your intestines by bacteria. However,
this supply is difficult to evaluate and may or may not be responsible as a
major source.

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The Water-Soluble Vitamins

The water-soluble vitamins include vitamins C, B1 (Thiamin), B2
(Riboflavin), B3 (Niacin), B6, folate, vitamin B12, biotin, and pantothenic
acid. These vitamins are not normally stored in the body in any great
amount. Therefore, a constant daily intake is needed to avoid depletion
and interference with normal metabolic functions. The B vitamins
basically act as coenzymes and are involved in the metabolism of fats,
proteins, and carbohydrates. Vitamin C has been in the spotlight for
many years and is best known for combating colds and functioning as
an antioxidant. Because the water-soluble vitamins are not stored by the
body in significant amounts, it is critical to maintain an adequate daily
intake of these vitamins.

Vitamin C
Scurvy is the dreaded disease that sailors, explorers, and other
travelers used to develop when deprived of fresh fruit and vegetables
for prolonged periods. It has been written about in scientific literature
and novels time and time again. Doctors discovered that eating limes,
lemons, and oranges prevented and reversed scurvy. In fact, the English
sailors were nicknamed “Limeys” because of their frequent ingestion
of lemons, limes, and other citrus fruit during voyages. Later, it was
determined that citrus fruit contained vitamin C, and in the 1930s,
scientists isolated and identified vitamin C from citrus fruit.

Vitamin C, also called ascorbic acid, is primarily a water-soluble

antioxidant that cannot be synthesized by humans and is essential. There
is also a slightly altered form of ascorbic acid present in the diet, called
dehydroascorbic acid. This oxidized form also displays some vitamin C
activity. There is extremely little storage of vitamin C in the body.

Vitamin C has multiple functions as a cofactor or coenzyme. It is

involved in the formation and maintenance of collagen, which is an
important constituent of connective tissues and intercellular substances.
Collagen is a protein and an important component of skin, ligaments,
and bones. Vitamin C promotes healthy capillaries, gums, and teeth;
aids in intestinal iron absorption, transport, and storage; prevents the
oxidation of folacin; helps heal wounds; may provide resistance against
infections; aids in the metabolism of tyrosine and phenylalanine;
increases immune function; and protects cells from free radical damage.

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 Vitamins | 219

Vitamin C has been touted as a general cure all by many. It gained great
attention when the esteemed Nobel prize-winning biochemist, Dr. Linus
Pauling, advocated its use to help prevent the onset of the common
cold. As with the other antioxidants, vitamin C may play an important
role in the prevention and correction of many dietary-borne diseases.
For athletes, these functions of vitamin C are crucial, especially as an
antioxidant. Studies have also indicated vitamin C’s role in increasing
muscular strength, reducing lactate blood levels, and sparing glycogen.

A deficiency in vitamin C can lead to scurvy, which is a serious disease

characterized by weakening of collagenous tissues and structures that
results in widespread capillary hemorrhaging. Scurvy is rarely seen in
adults in the United States but is sometimes observed in infants and
the elderly.

Excessive intake of vitamin C (usually more than 3 to 5 grams per

day or more) has been associated with several potential side effects:
headache, increased urination, diarrhea, and nausea. Megadosing
vitamin C is commonly practiced by those wishing to derive the proven
and speculative health benefits. As with all vitamins, megadosing many
times above the RDA for long periods is not recommended.

Athletic Performance Considerations of Vitamin C. As determined

by a physician, maintain intake within PDI guidelines from dietary
and supplement sources. There could be benefits for increasing levels of
intake as activity increases for some athletes. Endurance athletes may
need higher amounts of this and other antioxidants. Megadosing vitamin
C above the PDI is not reported to cause any improvements in athletic
performance. However, some individuals find that taking higher amounts
vitamin C a day when they feel a cold or flu developing may help reduce
the duration, along with other physician-supervised treatment.

Vitamin C in Food and Supplements

The primary form of vitamin C used in supplements is synthetic ascorbic
acid. Other forms include buffered vitamin C and mineral ascorbates,
such as calcium and magnesium ascorbate. Natural supplemental form
of vitamin C is supplied by rose hips and is a very expensive ingredient
when compared with the synthetic form. Supplements that contain a
combination of ascorbic acid and vitamin C from rose hips are preferred.
Also, bioflavonoids may increase the vitamin C absorption. There is

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also a patented form of vitamin C, called Ester C™. The company that
manufactures it ran independent studies that indicate that it may have a
higher bioavailability than do other forms of vitamin C.

Dietary sources of vitamin C include fruits and vegetables, especially

citrus fruits, green and red peppers, collard greens, broccoli, spinach,
tomatoes, potatoes, and strawberries.

Thiamin
Thiamin (as thiamin pyrophosphate or TPP), also called vitamin B1. In
the body, thiamin joins with phosphate to form thiamin pyrophosphate
(TPP), also known as thiamin diphosphate (TDP), and functions as
a coenzyme required in carbohydrate and branched-chain amino
acid metabolism. Thiamin is water soluble and not readily absorbed
by the body. Thiamin, along with other B vitamins, is converted into
coenzymes that aid in the complete breakdown of carbohydrates. Other
functions of thiamin include the production of ribose, which is needed
for the synthesis of nucleic acids (RNA and DNA), the promotion of
normal growth and function, and for appetite simulation. As athletes eat
more carbohydrates, more thiamin is needed. Additionally, performance
improvements have been reported in endurance athletes ingesting higher
amounts of thiamin.

Signs of deficiency include abnormalities of carbohydrate metabolism,

fatigue, loss of appetite, constipation, depression, confusion, poor
coordination, and a disease called Beri Beri or beriberi. Beri Beri is
the disease associated with prolonged intake of a diet low in thiamin.
Primary symptoms involve the cardiovascular system and nervous
system. Symptoms include muscular weakness, atrophy, heart failure,
and depression. The cells of the nervous system are sensitive to
carbohydrate metabolism, which may be why this system is the first to
show signs of thiamine deficiency. Thiamin deficiency is also observed in
individuals who drink alcohol excessively.

Excessive intakes of thiamine are cleared by the kidneys. Thiamine

toxicity is rarely reported in healthy adults.

Athletic Performance Considerations of Vitamin Thiamin. As

determined by a physician, maintain intake within PDI guidelines from
dietary and supplement sources. Increase levels of intake as activity

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 Vitamins | 221

increases. Some research indicates that endurance athletes may derive

acute performance enhancing effects by ingesting megadoses of thiamin
for three to five days prior to competition. However, more research
is needed to conclusively verify these effects and determine the exact
range of thiamin intake for this purpose. Additional research reports
that supplemental thiamine may significantly improve firing accuracy
in marksmen.

Thiamin in Food and Supplements

Thiamin HCl (hydrochloride) and thiamin mononitrate are two forms
commonly used in supplements in various amounts. Both forms seem to
perform equally well.

Dietary sources of thiamin include brewer’s yeast, peas, pork, wheat

germ, whole grain pasta, peanuts, beans, organ meats, and enriched and
fortified grains and cereals.

Riboflavin
Riboflavin (Vitamin B2) functions as a coenzyme involved in energy
production and cellular respiration. In the body, riboflavin functions
primarily as part of two coenzymes: flavin mononucleotide (FMN)
and flavin adenine dinucleotide (FAD). These coenzymes are involved
in many oxidation-reduction reactions, which produce energy from
carbohydrates, fatty acids, and some amino acids. Because of riboflavin’s
role in energy-producing reactions, it is a vital nutrient for the health of
all tissues, in particular the skin, eyes, and nerves. Riboflavin therefore
helps in energy production, tissue formation, to maintain red blood cells,
to maintain normal metabolism of iron, and to maintain the body’s
ability to metabolize nutrients.

Apart from these essential functions, riboflavin taken in 10 mg/per

day amounts was reported to produce a lowering of neuromuscular
irritability after electrical stimulation of muscles. This indicates that
riboflavin taken in higher amounts may improve muscular excitability
and result in better overall performance, but this needs to be confirmed
with further research.

Deficiency symptoms of riboflavin include inflamed lips, cracks in skin,

growth reduction, hair loss, cataracts, generalized seborrheic dermatitis,

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and behavioral changes such as depression, moodiness, nervousness, and

irritability. Riboflavin is also essential to the functioning of vitamins B6
and niacin. Some symptoms often attributed to riboflavin deficiency are
actually caused by the failure of these other nutrients to operate effectively.
Excessive intake of riboflavin does not appear to produce toxic effects.
This vitamin is considered nontoxic even in quantities many times above
the RDA value.

Athletic Performance Considerations of Vitamin Riboflavin. As

determined by a physician, maintain intake within PDI guidelines from
dietary and supplement sources. Additional performance effects of
megadosing riboflavin above the PDI are not supported by the research
and therefore not recommended.

Riboflavin in Food and Supplements

Pure riboflavin is used in supplements.

Dietary sources of riboflavin include brewer’s yeast, meats, poultry, fish,

dairy products, nuts, enriched grain products, green vegetables, broccoli,
asparagus, spinach, turnip greens, wheat germ, kidney, and liver.

Niacin
Niacin, vitamin B3, is a water-soluble vitamin of the B complex family
that is used in a general sense for both nicotinic acid and niacinamide
(nicotinamide). Niacin is functionally active in the body as two very
important coenzymes: NAD (nicotinamide adenine dinucleotide)
and NADP (nicotinamide adenine dinucleotide phosphate). NAD and
NADP are present in all cells and function in many vital metabolic
processes, such as energy production, glycolysis, carbohydrate and protein
metabolism, fatty acid synthesis, and steroid synthesis. Niacin is also
known for its ability to reduce both cholesterol and fatty acids in the
blood. Thus, niacin plays many important roles in the body, including in
normal growth and development, energy metabolism, tissue formation,
and in helping maintain the body’s ability to metabolize nutrients.

Niacin can also be synthesized by the body from the amino acid tryptophan
to form some nicotinamide, which can contribute to meeting niacin
requirements. However, as discussed in the unit on protein, tryptophan is
often a limiting amino acid, and its function as a niacin producer should be
minimized by ensuring a daily intake of supplemental niacin.

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 Vitamins | 223

Niacin’s role as a cholesterol-controlling nutrient brought it major acclaim

as a miracle nutrient and resulted in its widespread use in megadose
quantities. Nicotinic acid seems to perform better than niacinamide does
for lowering cholesterol and fatty acid blood levels. However, nicotinic
acid in amounts over 50 milligrams causes the blood capillaries to dilate,
resulting in what has become known as the niacin flush. This flushing
produces red skin, itching, and heating of the skin. This response is not
observed with the niacinamide form of niacin.

Caution: Excessive Niacin Intake May Impair Performance. It is

interesting to note that although niacin is critical for cellular respiration,
energy-production research conducted with athletes clearly shows that
niacin reduces performance in some instances. The higher amounts
of niacin administered before exercise caused glycogen to deplete at a
faster rate and caused earlier onset of fatigue. Niacin apparently blocks
the release of fatty acids from adipose tissue, thus making this source of
energy less available during exercise. Thus, niacin megadosing should
be avoided by endurance athletes. However, there is some evidence that
high dosages of niacinamide given before anaerobic exercise may improve
performance because these athletes get more energy from stored glycogen,
and faster glycogen liberation may result in better anaerobic energy. More
research is warranted.

Deficiency symptoms of niacin include depression, confusion, headaches,

elevated body fats, fatigue, and development of pellagra. Pellagra is a
disease characterized by dermatitis, inflammation of mucus membranes,
dementia, and inflamed and discolored skin.

Athletic Performance Considerations of Niacin. As determined by

a physician, maintain intake within PDI guidelines from dietary and
supplement sources. Current research does not support megadosing
niacin above the PDI. In fact, as noted above, endurance athletes may
need to keep niacin intake on the low end of the healthy range, especially
before events.

Niacin in Food and Supplements

Both forms of niacin should be taken as supplements and are commonly
found individually in many nutrition formulas.

Dietary sources of niacin include liver, brewer’s yeast, lean meats, whole
grains, nuts, legumes, and potatoes.

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Vitamin B6
Vitamin B6, also known as pyridoxine, is an essential vitamin that
functions as a coenzyme, has become most noted by athletes for its role
in amino acid metabolism, and is also involved in the metabolism of
glycogen and sphingoid bases. Vitamin B6 actually occurs in nature as
pyridoxine, pyridoxal, and pyridoxamine. In the body, B6 is converted
to its active forms, pyridoxal phosphate (PLP) and pyridoxamine
phosphate (PMP), and serves primarily in many of the same types of
Transamination transamination reactions that take place in amino acid metabolism.
reaction: the process in
which an amino group is Due to vitamin B6’s role in protein/amino acid metabolism, the
transferred from an amino requirement for vitamin B6 increases as the intake of protein increases.
acid to a molecule, usually Vitamin B6 in also involved in conversion of the essential fatty linoleic
to produce another amino
acid. acid to arachidonic acid and in glycogen breakdown, energy production,
tissue formation, and synthesis of red blood cells.

Studies with athletes indicate similar results as with niacin, due to B6’s
tendency to increase utilization of glycogen stores and decrease fatty
acid energy substrate use. Thus, for endurance athletes, high dosages
of vitamin B6 should be avoided. However, short-term anaerobic
activity may benefit from extra B6 due to the glycogen-liberating
action. In sports such as weight lifting, sprinting, shot put, and so on.
The primary energy source is glycogen. It is possible that extra B6 will
promote greater glycogen utilization and result in greater power output.
Coincidentally, strength-power athletes are on higher protein diets, and
their B6 requirements therefore increase. Athletes undergoing glycogen
depletion as part of a carbohydrate-loading program may expect more
rapid depletion of glycogen stores with as little as 8 milligrams of B6 per
day, but individual requirements and responses need to be determined.
This effect can be useful during the first glycogen depletion days of a
carbohydrate-loading cycle. Vitamin B6 intake has also been reported to
increase the exercise-induced rise in growth hormone, which is another
potential benefit for strength athletes.

Deficiency symptoms associated with low intakes of vitamin B6 include

depression, skin problems, poor wound healing, anemia, fatigue, and
convulsive seizures. High dosages taken over several months have been
reported to be linked to nervous system disorders. Symptoms included
tingling and numbness of arms and legs.

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 Vitamins | 225

Athletic Performance Considerations of Vitamin B6. As determined

by a physician, maintain intake within PDI guidelines from dietary and
supplement sources. Megadosing of vitamin B above PDI guidelines is
not recommended.

Vitamin B6 in Food and Supplements

Vitamin B6 is most commonly used in supplements as pyridoxine
hydrochloride.

Dietary sources of vitamin B6 include chicken, fish, kidney, liver, eggs,

rice, soybeans, banana, lima beans, peanuts, and walnuts.

Folate
Folate, also referred to as folacin, is a water-soluble B vitamin naturally
occurring in foods. The folic acid form is generally used in supplements
and fortified foods. Folate compounds function metabolically as
coenzymes that transport carbon molecules from one compound to
another in amino acid metabolism and nucleic acid synthesis, making
it involved as a coenzyme in the metabolism of amino acids and
nucleic acids. In this way, folate is very important as a cofactor in DNA
(deoxynucleic acid) and RNA (ribonucleic acid) formation, protein
synthesis, and cell division. Folate also stimulates the formation of
red blood cells and vitamin B12. In particular, folate affects tissues
that grow rapidly, such as the skin, lining of the gastrointestinal tract,
bone marrow where blood cells are formed, and regenerating muscle
tissue. Studies have also indicated that increasing the intake of folate
during pregnancy has reduced the incidence of premature births and
birth defects, such as neural tube defects, by supporting normal early
development of the fetal brain and spinal cord.

Deficiency of folate can result in anemia, birth defects, sore tongue,

digestive problems, growth problems, fatigue, poor memory, and
megoblastic anemia. Excessive folate intake may stimulate convulsions
in persons with epilepsy, kidney damage, and lower zinc levels.

Athletic Performance Considerations of Folate. As determined by

a physician, maintain intake within PDI guidelines from dietary and
supplement sources. Megadosing of folate is not indicated.

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Folate in Food and Supplements

Folate is found in supplement formulations as folic acid.

Dietary sources of folate include beef, lamb, pork, chicken liver, eggs,
asparagus, whole wheat, deep-green leafy vegetables, salmon, and yeast.

Vitamin B12
Vitamin B12 (cyanocobalamin, methylcobalamin and other biologically
active cobalamins) has been regarded in athletic circles as the primary
energy vitamin. In fact, it is a common practice for athletes to get
vitamin B12 shots during the season. Vitamin B12 is only part of
the nutrition picture but does play an essential role in maintaining
performance. Vitamin B12 and cobalamins are terms used to describe a
group of cobalt-containing compounds that display vitamin B12 activity.
Vitamin B12 forms essential coenzymes that are necessary for neural
tissue development and function, folate metabolism, DNA synthesis
along with folacin, energy metabolism, new cell growth, conversion
of homocysteine to methionine, immune system function, and red
blood cell synthesis. Studies conducted on nonathletes experiencing
tiredness are credited with prompting widespread megadosing and B12
injections among athletes. These studies used injections of B12. However,
studies show that megadosing of B12 by athletes may not be indicated
or required. Various studies examining strength and endurance
effects of B12 have not demonstrated apparent immediate increases in
performance. Thus far, B12’s role is in promoting its essential metabolic
functions and red blood cell formation.
Some attention has focused on a coenzyme form of B12 called
cobamamide, or Dibencozide. This has recently been touted as an
anabolic nutrient form of B12 comparable to anabolic steroids. In a study
conducted on children with growth deficiency disorders, cobamamide
improved growth. Direct comparison to anabolic steroids and an
anabolic growth effect in healthy adults has not been proven. However,
cobamamide has been reported by athletes to increase perceived energy
levels and increase appetite. Use of coenzyme B12 by athletes may be
warranted, along with B12.

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 Vitamins | 227

Deficiency symptoms of B12 include a disease called pernicious anemia,

fatigue, irritability, loss of appetite, constipation, headache, and sore
tongue. B12 deficiency in the diet is rarely seen, and most deficiencies
are attributed to poor B12 absorption. Pernicious anemia is actually
a disease that develops from inhibited absorption of B12. Vitamin
B12 must be activated before it can be absorbed. This is the job of a
substance that is secreted by the stomach called intrinsic factor. Vitamin
B12 injections are needed in treatment of pernicious anemia because
increasing the amount of B12 taken orally still needs intrinsic factor
for activation and absorption. Excessive intakes of B12 do not appear to
exhibit side effects. This does not mean that you should megadose this
vitamin, as there may be unidentified performance-inhibiting effects yet
to be discovered.

Athletic Performance Considerations of Vitamin B12. As determined

by a physician, maintain intake within PDI guidelines from dietary
and supplement sources. Megadosing Vitamin B12 above the PDI is
not indicated.

Vitamin B12 in Food and Supplements

Vitamin B12 is found in supplements such as cyanocobalamin. Other
forms are not recommended. Vitamin B12 and cobamamide are unstable
when exposed to light, so make sure your supplements with B12 are
in light-protected bottles. Be sure to look for light-protected forms of
cobamamide (Dibencozide).

Dietary sources of vitamin B12 occur primarily in animal products, such

as lamb, beef, herring, mackerel, pork livers, oysters, poultry, clams, eggs,
and tofu.

Biotin
Biotin is water-soluble vitamin of the B vitamin family. It is a sulfur-
containing vitamin that functions as a coenzyme. Biotin functions as
a coenzyme in bicarbonate-dependent carboxylation reactions. It is
involved in energy metabolism, urea formation, protein synthesis, and
in the metabolism of amino acids, glucose, and fatty acids. Biotin plays

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an important role in energy production and fat metabolism. It functions

in the biosynthesis of fatty acids, replenishment of tricarboxylic acid
cycle, amino acid metabolism, gluconeogenesis, and as a coenzyme
for a number of carboxylase enzymes. Biotin helps maintain cognitive
function and helps maintain healthy nail, hair, skin, and mucous
membranes. Biotin is manufactured by intestinal bacteria.

Deficiency symptoms can be produced from insufficient dietary sources

of biotin being low or from ingestion of large amounts of a biotin-
binding glycoprotein found in raw egg whites. Biotin deficiency is
characterized by nausea, vomiting, mental depression, pallor, dry scaly
dermatitis, increased serum cholesterol, and loss of muscle tone.

Athletic Performance Considerations of Biotin. As determined by

a physician, maintain intake within PDI guidelines from dietary and
supplement sources.

Biotin in Food and Supplements

Biotin is a common ingredient in multiple vitamin formulas and is
not frequently found in single dosage form. Dietary sources of biotin
include liver, egg yolk, soy flour, cereals, yeast, nuts, cauliflower, milk,
and legumes.

Pantothenic Acid
Pantothenic acid plays many important metabolic roles, primarily
as a component of coenzyme A (CoA). These metabolic reactions are
important in the release of energy from carbohydrates and fatty acids,
helping in energy metabolism. Pantothenic acid is also involved in
steroid and cholesterol synthesis and in tissue formation, membrane
phospholipids, amino acids, and neurotransmitters. Studies on
athletes have yielded results that indicate pantothenic acid may have
performance-enhancing effects when taken by endurance athletes in
higher amounts for short periods.

Deficiency symptoms of pantothenic acid include weakness, irritability,

burning feet, vomiting, and insomnia. Excessive pantothenic acid
intakes may be related to causing diarrhea or water retention.

Athletic Performance Considerations of Pantothenic Acid.

As determined by a physician, maintain intake within PDI

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 Vitamins | 229

guidelines from dietary and supplement sources. Note that

megadosing pantothenic acid above the PDI guidelines may be
beneficial for endurance athletes for short time periods (seven
to fourteen days) before athletic competition, which can be
determined on an individual basis under physician supervision.

Pantothenic Acid in Food and Supplements

Pantothenic acid is found in supplements as d-calcium pantothenate.

Dietary sources of pantothenic acid include potatoes, eggs, pork, beef,

fish, milk, whole wheat, whole grain cereals, fruits, and vegetables.

Choline
Choline is involved in fatty acid metabolism, liver function, and
structural integrity of cell membranes. The term “lipotropic” is used
to describe the effects of choline and other substances that prevent
deposition of fat in the liver. Choline is a component of the phospholipid
phosphatidylcholine (lecithin) and a part of all cell membranes
and lipoproteins. Choline is also used by the body to make the
neurotransmitter acetylcholine, which is critical for optimum nervous
system functioning. Exercise can deplete the supply of choline, and this
may theoretically impair acetylcholine amounts in the nervous system.

Choline deficiency can have major consequences on the liver, memory,

nerve functioning, and normal growth. Deficiencies in humans are
rarely observed. Excess intakes of choline, 2 or more grams per day, can
result in diarrhea, depression, and dizziness.

Athletic Performance Considerations of Choline. As determined by

a physician, maintain intake within PDI guidelines from dietary and
supplement sources.

Choline in Food and Supplements

Choline is commonly found in multiple vitamin mineral formulations,
lipotropic fat-burner supplements, and lecithin. Choline is available as
choline bitartrate, choline dihydrogen citrate, and phosphatidyl choline.
Dietary sources of choline include lecithin, egg yolk, liver, soybeans,
most fatty foods, meat, whole grains, asparagus, green beans, spinach,
and wheat germ.

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Inositol
Like choline, inositol is a lipotropic agent. A biologically active form
of inositol found in foods is myo-inositol. It is involved in fatty acid
metabolism, carbohydrate metabolism, and intracellular calcium
mobilization. There is no RDA for inositol, nor have there been reports
on the effects of megadosing on athletic performance. It is included
here because inositol is used in sports nutrition products and other
supplements, and while the body can make inositol, similar to other
metabolites, there may be benefits for increasing inositol in the diet
from foods and dietary supplements. The FDA has acknowledged in its
regulations (21 CFR, Section 184.1370) that inositol, or myo-inositol,
is generally recognized as safe for use in supplements and for specialty
dietary foods and infant formulas.

Deficiency of inositol results in build-up of fat in the liver and may affect
nervous system function. Inositol appears to be relatively nontoxic in
healthy individuals. The average adult diet contains about 1 gram of
inositol per day.

Athletic Performance Considerations of Inositol. As determined by

a physician, maintain intake within PDI guidelines from dietary and
supplement sources.

Inositol in Food and Supplements

Inositol is commonly found in multiple vitamin mineral formulations
and fat-metabolizing enhancement supplements. Dietary sources of
inositol include heart, organ meat, whole grains, fruit, milk, nuts, meats,
and vegetables.

Sports Nutrition
Daily Vitamin Intake Reference Information Summary (For Educational Purposes Only)
USA Minimum and Upper Vitamin Reference Intakes Vitamin Reference Intakes Performance Daily
(total intake from food and supplements) (intake from supplements) Intake (PDI), 2017

Council for Responsible Nutrition

and Canadian Health
Daily DRI* Men DRI* Tolerable CRN’s Upper Canadian For PDI (Performance
Values To- Total Women Upper In- Level for Sup- Supplements Daily Intake range,
tal Intake Intake Total take Total plements 3rd (maximum) including all nutri-
Intake Intake Edition, 2014 ent sources; foods
and supplements).

Vitamin A 5,000 IU 900 mcg 700 mcg 3,000 mcg 3,000 mcg, 10,000 IU 5,000 to 15,000 IU
(retinol and (3,000 IU) (2,330 IU) 10,000 IU 10,000 IU with (not for pregnant
its esters) low dietary women).
retinol. 1,500
mcg, 5,000 IU
with high dietary
retinol.
Beta-Caro- Not Not Not Not 25 mg nonsmok- Not Established 5 to 30 mg
tene Established Established Established Established ers. Smokers
should not use.
Vitamin C 60 mg 90 mg 75 mg 2,000 mg 2,000 mg 1,500 mg 500 to 3,000 mg
Vitamin D 400 IU 15 mcg 15 mcg 100 mcg 250 mcg I,000 IU 400 to 4,000 IU
600 IU 600 IU 4,000 IU 10,000 IU
Vitamin E 30 IU 15 mg 15 mg 1,000 mg 1,600 IU (1,000 1,000 IU 200 IU to 1,000 IU
mg)
Vitamin K 80 mcg 120 mcg 90 mcg Not 10,000 mcg (10 Not Established 80 to 180 mcg
Established mg)
Thiamin 1.5 mg 1.2 mg 1.1 mg Not 100 mg 100 mg 15 to 135 mg
Established
Riboflavin 1.7 mg 1.3 mg 1.1 mg Not 200 mg 100 mg 15 to 135 mg
Established
Niacin 20 mg 16 mg 14 mg 35 mg 500 mg 20 to 100 mg
(Nicotinic 500 mg / 250
Acid) mg SR
(Nicotin- 1,500 mg
amide)
Vitamin B6 2 mg 1.7 mg 1.5 mg 100 mg 100 mg 250 mg 10 to 100 mg
Folate 400 mcg 400 mcg 400 mcg 1,000 mcg 1,000 mcg 1,000 mcg 400 to 1,200 mcg
Vitamin B12 6 mcg 2.4 mcg 2.4 mcg Not 3,000 mcg 1,000 mcg 12 to 200 mcg
Established
Pantothenic 10 mg 5 mg 5 mg Not 1,000 mg 500 mg 20 to 200 mg
Acid Established
Biotin 300 mcg 30 mcg 30 mcg Not 2,500 mcg 500 mcg 300 to 600 mcg
Established
Choline Not 550 mg 425 mg 3.5 g Not Established 1,000 mg 600 to 3,500 mg
Established
Inositol Not Not Not Not Not Established 650 mg 600 to 1,200 mg
Established Established Established Established
Vitamin intake reference information is for total per day nutrient intake from conventional foods and dietary supplement sources, unless
otherwise noted.

mg = milligrams, mcg = micrograms, g = grams.

Note: This information is for educational purposes only. The example guidelines are for model healthy adult athletes, for short-term use
during periods of athletic training. Typically, the exact nutrition requirements for each person can differ, and for best results should be deter-
mined working with a health care professional.

* = highest DRI reported on a gender basis, excluding pregnant or lactating women.

DRI (Dietary Reference Intakes) includes Recommended Dietary Allowances (RDA) and Adequate Intakes (AI).
References: Office of Dietary Supplements, NIH, Dietary Supplement Fact Sheets, 2017.; Institute of Medicine, Dietary Reference Intakes for vitamin D and
Calcium, 2011.; Institute of Medicine, Dietary Reference Intakes: The Essential Guide to Nutrient Requirements, 2006.; Vitamin and Mineral Safety, 3rd Edition,
Council for Responsible Nutrition, Washington, D.C., 2014.; Health Canada 2017.
232 | Unit 7

Conclusion
Vitamins represent essential nutrients vital for health and athletic
performance. Food and supplements play a role in providing athlete’s
with essential substances. Vitamin deficiencies or excess requires doctor
testing and supervision to determine and resolve. In general, healthy
adult athletes, as their physical activity increases with athletic training
and competition seasons, may require an increase of daily amounts of
vitamins compared to the DRI and DV intakes for non-athletes and
during off season, when activity levels are lower. In addition, vitamin
intake requirements can be body weight depend, with increasing daily
intake amounts being require. However, while reference information is
useful, doctor supervised metabolic testing is required to determine an
athlete’s vitamin status and personal requirement.

Key Words
Vitamin toxicity Hemorrhage

Malabsorption Hemolytic anemia

International unit (IU) Transamination reaction

Sports Nutrition
Topics Covered In This Unit

Introduction

Calcium

Phosphorus

Magnesium

Iron

Zinc

Iodine

Selenium

Copper

Manganese

Chromium

Molybdenum

Fluoride

The electrolytes

Boron

Conclusion

UNIT 8

MINERALS
234 | Unit 8

Unit Outline
I. Introduction IX. Copper
II. Calcium X. Manganese
III. Phosphorus XI. Chromium
IV. Magnesium XII. Molybdenum
V. Iron XIII. Fluoride
VI. Zinc XIV. The electrolytes
VII. Iodine XV. Boron
VIII. Selenium XVI. Conclusion

After completing this unit, you will be able to:

• Define and discuss terms related to minerals;

• Discuss the main functions of minerals;

• Determine benefits of minerals for health and performance of athletes;

• List food sources of minerals.

Introduction
Minerals have long been regarded as essential nutrients for proper health
and vigor. With the invention of more sophisticated scientific equipment,
scientists keep discovering more minerals essential to our health. Trace
minerals, which are required only in very small microgram amounts,
are an example of this growing category of nutritionally important
minerals. Minerals are inorganic elements that are required by the body.
They are commonly referred to as minerals (or macrominerals), trace
minerals, ultra-trace minerals, and electrolytes. The minerals covered
in this unit include calcium, magnesium, and phosphorus. Minerals
(macrominerals) are required in larger amounts. The trace minerals,
which are required in smaller amounts, are boron, chromium, copper,

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 Minerals | 235

fluoride, iodine, iron, manganese, selenium, and zinc. The ultra-trace

minerals include boron, germanium, and vanadium. The electrolytes
discussed in this unit are chloride, potassium, and sodium; however,
take note that calcium and magnesium also have electrolyte activity and
other essential roles. Recall that all the minerals fall into the general
“micronutrient” category, as do the vitamins.

Food and supplement sources of minerals are supplied either as part of

mineral-organic compounds (like copper lysinate) or in inorganic forms
(like potassium chloride). Although minerals are found throughout the
body, they are estimated to make up only about 4 to 6 percent of the body.
They are, however, important in many structural and metabolic roles.
Minerals occur in the body as components of tissues, such as calcium in
bone. They also are found as part of organic molecules, such as iodine in
thyroxine and iron in hemoglobin. Some minerals, such as electrolytes,
also occur in their free ionic form in body fluids in blood, cells, and so on. Ionic form: in the form
of ions, which are atoms
For enhanced athletic performance, minerals are just as essential as or groups of atoms that
have either a positive or a
vitamins and other metabolite factors are. However, current research negative charge from having
indicates that although athletes generally require higher mineral intake lost or gained one or more
than nonathletes do, there are no clear benefits for mega-dosing minerals electrons.

as with some of the vitamins and other nutrients. Most minerals are not
immediately lethal if overdosed, with the exception of iron for children (see
iron section). However, special care must be exercised when supplementing
with minerals not to overdo it. The increased amounts required by athletes
is due to greater metabolic demands created from increased physical
activity and replenishment needs of minerals lost through sweat and
excretion and also due to larger body size and more lean body mass,
including muscle and bone.

Athletic Significance of Minerals

• Minerals are needed for normal metabolism, growth, and health of the body.
• Adequate mineral intake is essential for athletic performance and health.
• Dietary surveys have discovered that many athletes’ diets are deficient in one or more minerals.
• Optimum mineral intake is best attained from a combination of food and supplements.

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Inadequate intake of minerals is associated with decreased athletic

performance and negative effects on health, so you want to make sure
that you are getting the amounts you need. Additionally, inadequate
intake of important structural minerals, like calcium, can result in
weakening of the skeleton and connective tissues, making the athlete
more susceptible to injury. Mineral intake should be attained from
dietary and supplement sources for best results. Although food offers
variable amounts of minerals, supplements can be relied on to supply
precise amounts of minerals in highly bioavailable forms to supplement
the diet with.

Note that reference intake data from multiple sources are provided in
a summary table at the end of this unit for minerals for educational
purposes only. While a variety of useful scientific information about
minerals is contained in this unit, it is important to realize that
personalization of mineral intake for each athlete requires doctor
supervision and testing to determine whether mineral deficiencies or
excesses are present and need to be corrected.

Calcium
The average adult body contains approximately 1,200 grams of calcium,
99 percent of which is present in the skeleton. Calcium is found in
the skeleton primarily as calcium phosphate. This is why calcium
and phosphate intake are important to the integrity of bone tissue.
Calcium also occurs in the body in its free ionic state and as calcium
carbonate. The role calcium plays in bone formation is well known, but
calcium also has other vital functions as well. Calcium plays essential
roles in nerve conduction, transmission of nerve impulses, normal
heartbeat, muscle contraction, increased membrane permeability,
and blood clotting. Calcium also functions as an enzyme cofactor.
Calcium has been connected to controlling blood pressure in some
individuals. While calcium is a primary nutrient in bone formation and
maintenance, other nutrients are also important in bone formation and
the proper utilization of calcium. These include vitamin D, copper, zinc,
manganese, and boron.

Mineralization of bone requires a positive calcium balance; that is, more

calcium being absorbed than being excreted. This balance is important to
maintain during growth years and during adulthood. Until recently, most

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 Minerals | 237

medical authorities believed that once an individual attained the ripe old
age of 30, it was not possible to build more bone tissue. But research has
finally proven what many sports fitness scientists already knew. Exercise
and proper dietary intake of calcium will result in increased bone mass
in adults. The benefits are obvious for everyone who wants to maintain
a healthy body. High-intensity exercise appears to stimulate increase
in bone mass more than aerobic-type exercise does. From an athlete’s
standpoint, adequate calcium must be maintained all year long, and
from childhood through adulthood. This means eating a diet adequate in
calcium based on the individual athlete’s extra requirements in addition
to taking a comprehensive supplement with the other nutrients, good
sources of calcium, and the calcium cofactors as required.

Deficiency/Excess Symptoms. Researchers have determined that

deficiency of calcium is more common than previously thought. Dietary
surveys have determined that both athletes and nonathletes exhibit
inadequate calcium intake. This results in poor bone formation or onset
of a bone disease, such as osteoporosis. Poor calcium intake also results
in muscle cramping and reduced energy levels. Rickets and stunted
growth are also potential disorders related to a calcium-deficient diet.
Besides most diets being low in total calcium, the calcium in many diets
is in a form that is poorly absorbed. Like other minerals, different forms
of calcium will be absorbed by the body better than others will. In fact,
the 1989 RDA book estimates that young adults absorb only 20 percent
to 40 percent of their ingested calcium. This is another reason for taking
a good-quality calcium supplement every.

Excess calcium taken during short or long periods normally does not
cause major side effects in adults aside from constipation and possible
increased risk of urinary stone formation for people susceptible to
forming stones due to calcium. A high calcium intake can also interfere
with the absorption of iron, zinc, magnesium, and other minerals. Very
high calcium intake for long periods can lead to renal function problems.

Athletic Performance Considerations of Calcium. Studies support

the adequate daily intake of calcium for maintenance of overall health
and performance. The research does not report benefits of mega-dosing
calcium for increased performance. Maintain calcium intake within the
PDI guidelines from dietary and supplement sources, as determined by
doctor evaluation and supervision.

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Calcium in Food and Supplements. Good sources of calcium include

the following: dairy products, milk, cheese, ice cream, sour cream,
cottage cheese, yogurt, broccoli, kale, collards, oysters, shrimp, salmon,
clams, calcium-precipitated tortillas, and calcium-fortified foods. Some
supplement sources of calcium include calcium carbonate, calcium
citrate, calcium malate, calcium glycinate, and certain antacids, of which
some are labeled with Supplement Facts and Drug Facts panels.

Phosphorus
Like calcium, phosphorus is an important part of bone and plays
several other important roles in the body. Phosphorus occurs in bone
at approximately a 1:2 ratio with calcium. Phosphorus is present in
bone, in cellular fluids as phosphate ion, and in lipids, proteins, nucleic
acids, ATP, creatine phosphate, and so on. Phosphorus is also involved
in cell permeability, metabolism of fats and carbohydrates, formation
of ATP and high-energy storage, modulation of enzyme activity, and
phospholipid transport of fatty acid. The chemical energy of the body
is stored in high-energy phosphate compounds, such as ATP and CP.
Phosphorus also plays a role in collagen synthesis. Most diets normally
supply adequate amounts of phosphorus, about 1,500 milligrams per
day. Even so, some supplement intake is recommended for athletes, along
with a full profile of the other essential vitamins and minerals.

Athletic Performance Considerations of Phosphorus. Studies support

the adequate daily intake of phosphorus for maintenance of overall
health and performance. Maintain phosphorus intake within the PDI
guidelines from dietary and supplement sources, as determined by
doctor evaluation and supervision.

Deficiency/Excess Symptoms. Because phosphorus is readily available

in most foods, deficiency is rarely seen in adults, although it has been
observed in cases of malnutrition and in clinical settings among the ill.
Deficiency symptoms over long periods include poor bone formation,
poor growth, weakness, anorexia, and malaise. Excessive intake of
phosphorus has been reported to adversely affect calcium metabolism
and to stimulate bone loss.

Phosphorus in Food and Supplements. Phosphorus is found in most

foods, but protein-rich foods and cereal grains contain especially high
amounts. Good sources also include milk, fish, eggs, and asparagus.

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 Minerals | 239

Some multi-nutrient supplements contain phosphorus as part of a

complete multivitamin/mineral formula, when required.

Magnesium
The majority of magnesium (about 24 grams) in the body occurs in the
bones, muscles, and soft tissues. Magnesium has many metabolic and
structural roles. It constitutes part of bone and teeth, plays a role in
muscle and nervous system function, activates enzymes, assists calcium
and potassium uptake, assists glycolysis, and aids many biosynthetic
processes. Of particular interest to athletes are the several studies that
show that supplementing the diet with moderate amounts of magnesium
(200 mg to 400 mg) improves several athletic performance factors,
including, for example, enhanced physical endurance and increased
strength. Maintenance of bone tissue is also an important function of
magnesium that should not be overlooked. In addition, magnesium plays
a role in the proper functioning of smooth muscle tissue. When physical
activity is increased, depletion of magnesium is observed, especially
among athletes involved in long-distance sports.

Athletic Performance Considerations of Magnesium.

Studies support the adequate daily intake of magnesium for
maintenance of overall health and performance. The research does
not currently report benefits of megadosing magnesium for increased
performance. Maintain magnesium intake within the PDI guidelines
from dietary and supplement sources, as determined by doctor
evaluation and supervision.

Deficiency/Excess Symptoms. Deficiency of magnesium is rarely

seen, but symptoms include muscle weakness, irritability, nausea,
and depression. Of interest to female athletes, studies show that
suboptimum intake of magnesium can cause or increase premenstrual
tension and discomfort, which may be corrected with magnesium
supplementation. Excess intake of magnesium to the point of causing
side effects is rare. Healthy individuals seem to be able to tolerate
magnesium intake well. Large amounts have a laxative effect, and
several laxative products contain magnesium compounds for this
express purpose. Individuals with abnormal renal function can be
subject to hypermagnesemia, symptoms of which include depression,
nausea, vomiting, and hypotension.

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Magnesium in Food and Supplements. Food sources of magnesium

Whole grains: grains and include green vegetables, whole grains, nuts, legumes, oats, and fruit.
grain products made from
Examples of supplement forms of magnesium are magnesium oxide,
the entire grain seed, usually
called the kernel, which magnesium glycinate, and magnesium carbonate.
consists of the bran, germ,
and endosperm. If the kernel
has been cracked, crushed,
or flaked, it must retain the
Iron
same relative proportions of
Iron’s well-known function is its role as a part of hemoglobin, which is a
bran, germ, and endosperm
as the original grain to be carrier of oxygen in the body. Iron also is a constituent of myoglobin and
called whole grain. Many a number of enzymes. Iron stores primarily occur in the body in bone
but not all whole grains are
also sources of dietary fiber. marrow, the spleen, and the liver. When iron intake is low, these stores
are depleted so that individuals can sustain for a while on a diet low in
iron without developing anemia. However, when anemia does occur due
to severe depletion, it takes a long time to reverse the condition. For the
athlete, this can be extremely detrimental. Dietary surveys have reported
many athletes’ diets being low in iron. Women athletes, long-distance
athletes, and athletes on low-calorie diets are more commonly iron
deficient than others.

Athletic Performance Considerations of Iron. Studies support

the adequate daily intake of iron for maintenance of overall health
and performance. The research does not currently report benefits of
megadosing iron for increased performance. In fact, high dosages of
iron can have detrimental effects. Maintain iron intake within the PDI
guidelines from dietary and supplement sources, as determined by
doctor evaluation and supervision.

Deficiency/Excess Symptoms. The most commonly seen deficiency

symptom of inadequate iron intake is the development of anemia.
Anemia causes a reduction in the oxygen-carrying capacity of the
blood, resulting in decreased performance. Additionally, iron deficiency
has been linked to lower immune system function, which will make
individuals more susceptible to disease. However, excess iron intake can
result in death if the amount is large enough. Each year, a few thousand
cases of iron poisoning are reported in the United States. Several of these
cases a year result in death. Deaths have been reported in very small
children who eat large quantities of iron-containing supplements. High
dosages can cause abdominal cramping, constipation or diarrhea, and
nausea. Excessive iron intake may also cause certain liver disorders. An
additional note of caution is directed at some individuals who may have

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 Minerals | 241

the rare hereditary condition called idiopathic hemochromatosis. When

this inherited condition exists, individuals will absorb iron at a higher
rate than normal and slowly accumulate high iron content in their
bodies, which may lead to problems with liver and other organ function.

Iron in Food and Supplements. Foods high in iron include red meats,
poultry, fish, iron-fortified foods, liver, molasses, nuts, clams, chocolate,
legumes, and bread. Supplements have become a primary source of iron
for most people concerned with iron intake. However, the right source of
iron supplement is required for safety, absorption, and efficacy. Choose
multivitamin/mineral supplements with iron as part of the total nutrient
profile. Look for supplements that provide iron as iron fumarate (ferrous
fumarate) and iron glycinate.

Zinc
In athletic circles, zinc has developed a reputation as one of the primary
“healing” nutrients and one of the prime contributors to male fertility.
Zinc has many important metabolic roles in the body and is part
of various metalloenzymes that play roles in growth, testosterone Metalloenzyme: a
production, DNA synthesis, cell replication, fertility, reproduction, mineral-containing enzyme.

and prostate gland function. Zinc functions as a free ion in cells, as a

part of the synthesis of biomolecules, and as a part of enzymes. For the
athlete, maintaining proper zinc intake is vital, especially for growth
and repair of muscle tissue to meet training’s recovery demands.
Dietary surveys on athletes report that low zinc intake is common. This
occurs especially in endurance athletes, athletes on low-calorie diets,
strength athletes, bodybuilding athletes, and female athletes. Very few
studies have examined the actual effects of zinc supplementation on
performance, but one study did show increased muscle endurance with
zinc-supplemented athletes. Further research will reveal more beneficial
effects on performance. However, be advised that too much zinc may
impair performance. The role zinc plays in healing and testosterone
production should not lead you to think that more is better. Stick to the
PDI guidelines for zinc intake and don’t megadose, as determined by
doctor evaluation and supervision.

Athletic Performance Considerations of Zinc. Studies support

the adequate daily intake of zinc for maintenance of overall health
and performance. The research does not currently report benefits of

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megadosing zinc for increased performance. Maintain zinc intake within

the PDI guidelines from dietary and supplement sources, as determined
by doctor evaluation and supervision. As with the other essential
nutrients, take supplemental zinc as part of a complete multivitamin/
mineral formulation.

Deficiency/Excess Symptoms. A deficiency in zinc can cause growth

retardation, loss of appetite, skin changes, disrupted immune system,
delayed sexual maturation, night blindness, and impaired healing. These
conditions of inadequate zinc intake are obviously detrimental to athletic
performance. Excessive zinc intake can result in adverse effects, such as
lowering of high-density lipoproteins, inhibition of copper absorption,
nausea, gastric distress, headaches, dizziness, and other metabolic
disturbances. Diets high in protein and fiber can impair zinc absorption.
Because athletes are normally on such diets (either high in protein, fiber,
or both), supplementation can be a way to ensure that adequate zinc
intake is achieved.

Zinc in Food and Supplements. Some food sources of zinc include meat,
whole grain products, liver, eggs, seafood, herring, oysters, oatmeal,
maple syrup, and dry yeast. Supplemental zinc can be found in many
forms, such as zinc citrate and zinc arginate.

Iodine
The form and function of iodine in the body is the simplest of the
minerals. Iodine occurs in two thyroid gland hormones: thyroxin and
Triiodothyronine: a triiodothyronine. Iodine is therefore required for the proper function
thyroid hormone that affects
of the thyroid gland, which is essential for normal metabolism, energy
almost every physiological
process in the body, production, growth, and overall physical performance.
including growth and
development, metabolism, Athletic Performance Considerations of Iodine. Studies support the
body temperature, and
adequate daily intake of iodine for maintenance of overall health and
heart rate
performance. The research does not currently support megadosing
iodine for increased performance. Maintain iodine intake within the
PDI guidelines from dietary and supplement sources, as determined by
doctor evaluation and supervision.

Deficiency/Excess Symptoms. Because iodine is only essential for

thyroid gland function, a deficiency of iodine is associated with thyroid
gland disorders. The classic iodine deficiency is goiter. Goiter is a

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 Minerals | 243

condition that is manifested by enlargement of the thyroid gland. A

mental disorder known as cretinism also develops from iodine-deficient
diets. Excess iodine intake will promote various side effects, including
rash, headache, metallic taste in the mouth, and thyroid
gland dysfunction.

Iodine in Food and Supplements. Iodine food sources include iodized

salt, seafood, cod, cod liver oil, halibut, oysters, kelp, spinach, meat,
and dairy products. Iodine in supplements is provided as iodine from
kelp concentrate and should be part of your daily multivitamin/mineral
supplement. Iodized salt can also be considered a supplemental source of
iodine, and sodium.

Selenium
Selenium’s role in influencing antioxidant activity in the body is well
known. Selenium is a vital component of an antioxidant enzyme called
glutathione peroxidase. Glutathione peroxidase protects the body from
free radical damage, in particular, hydroperoxides. In this role as an
antioxidant, selenium helps prevent damage to the body’s tissues, cells,
and molecules, which can lead to reduced risk of degenerative diseases
such as coronary heart disease, arthritis, and certain cancers. For
athletes, protection against free radicals is important for protection of
tissues, shortened recovery times, and protection from the extra added
free radical load that exercise causes. The few studies on athletes’ taking
selenium supplements report encouraging findings that indicate a
reduction in lipid peroxidation, which translates into less tissue damage.

Athletic Performance Considerations of Selenium. Studies support the

adequate daily intake of selenium for maintenance of overall health and
performance. The research does not currently support megadosing of
selenium for increased performance. Maintain selenium intake within
the PDI guidelines from dietary and supplement sources.

Deficiency/Excess Symptoms. Low selenium intakes have widespread

adverse effects on the body due to lowering the body’s defense against
hydroperoxide free radicals. Deficiency symptoms include hair loss,
growth retardation, pancreatic problems, Keshan disease, muscular
discomfort, and weakness. Excessive intake of selenium results in
fingernail changes, hair loss, fatigue, abdominal pain, nausea, increased
dental caries, diarrhea, and irritability. Some studies report side effects

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due to excessive selenium intake starting at 5 milligrams per day and

as little as 1 milligram per day (1,000 micrograms) may cause fragility
in finger nails. Therefore, although selenium is essential for good health
and performance, stay within PDI guidelines, as determined by doctor
evaluation and supervision.

Selenium in Food and Supplements. Some food sources of selenium

include brazil nuts, meat, seafood, kidney, liver, and some whole grain
products. Selenium content of food is extremely dependent on the
selenium content of the soil in which crops are grown and on the food
eaten by animals. Selenium content of foods is therefore highly variable.
For a reliable supply of dietary selenium, take supplements containing
selenium. Look for multivitamin/mineral complete formulations; a
selenium source example is selenomethionine.

Copper
Copper is another trace mineral with several important functions.
Copper is present in many enzymes. It is part of the antioxidant
SOD, it is important in formation of collagen, and it is involved in
energy production, melanin pigment synthesis, myelin formation,
immune function, glucose metabolism, and cholesterol metabolism.
Some attention was directed toward copper by athletic researchers
as a result of copper’s role in energy production. Copper is part of
cytochrome oxidase, an enzyme that is found in the electron transport
system. Because dietary surveys indicate that many athletes, especially
endurance athletes, have inadequate copper intake, additional
supplemental amounts of copper have been researched. The role copper
plays as a component of antioxidant SOD is again vital for the protection
of the body at the cellular level, for improved performance, and for
shorter recovery times after exercise.

Athletic Performance Considerations of Copper. Studies support the

adequate daily intake of copper for maintenance of overall health and
performance. The research does not currently support megadosing of
copper for increased performance. Maintain copper intake within the
PDI guidelines from dietary and supplement sources, as determined by
doctor evaluation and supervision.

Deficiency/Excess Symptoms. Deficiency symptoms of inadequate

copper intake include anemia, bone abnormalities, defects in skin

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 Minerals | 245

pigmentation, reproductive failure, decreased arterial elasticity, low SOD

activity, and defective formation of connective tissues. Excessive copper
intake can cause nausea, vomiting, hepatic necrosis, and abdominal
pain. Furthermore, excessive copper intake can be fatal, especially for
individuals with a hereditary disorder called Wilson’s disease. Wilson’s
disease is characterized by the accumulation of copper in the body,
leading to toxic effects on the liver, kidney, eyes, and nervous system.

Copper in Food and Supplements. Rich sources of copper in the diet

include organ meats (especially liver), nuts, seafood, cocoa, chocolate,
meat, and mushrooms. When selecting a supplement containing copper,
look for products supplying a full profile of vitamins and minerals and
copper sources that include copper lysinate or copper gluconate.

Manganese
Manganese is a trace mineral with several important functions. It is
required for energy production, is part of enzymes, aids in bone and
connective tissue formation, is part of the antioxidant superoxide
dismutase (SOD), aids in collagen synthesis, and facilitates carbohydrate
metabolism. The role manganese plays in bone and connective tissue
formation and in antioxidant activity are of particular importance to
athletes. The strength and maintenance of bone and connective tissues
is essential for performance. Adequate manganese intake is therefore
required. Injury prevention and recovery can be benefited by manganese.
Maintaining the body’s proper supply of SOD is also an important
function linked to manganese. SOD is a powerful antioxidant and helps
protect the body from free radical damage.

Athletic Performance Considerations of Manganese. Studies support

the adequate daily intake of manganese for maintenance of overall health
and performance. The research does not currently support megadosing
of manganese for increased performance. Maintain manganese intake
within the PDI guidelines from dietary and supplement sources, as
determined by doctor evaluation and supervision.

Deficiency/Excess Symptoms. Although manganese deficiency is

rarely observed, symptoms include growth retardation, poor bone and
connective tissue formation/maintenance, low superoxide dismutase
production, and disturbance of energy metabolism. Because of
manganese’s essential role in bone and cartilage formation, and because

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of its role as a part of antioxidant SOD, certain degenerative diseases

may be caused from inadequate manganese intake, such as osteoporosis
and arthritis. Excessive manganese intake exhibits a relatively low level
of toxicity under normal circumstances. Not many cases of nutritional
manganese overdosing are currently reported.

Manganese in Food and Supplements. Food sources of manganese

are Brussels sprouts, spinach, peas, turnip greens, wheat germ, meat,
buckwheat, barley seed, beets, bananas, corn, lettuce, oatmeal, and other
whole grain and cereal products. Look for supplements that contain
manganese as part of a complete multivitamin/mineral formulation.
Supplement sources of manganese include manganese arginate,
manganese glycinate, and manganese gluconate.

Chromium
Chromium is another nutrient that has received a vast amount of
attention in the media and is touted as a muscle-building anabolic
steroid alternative and as the 1990s miracle fat-loss aid. Chromium is
merely another essential nutrient that the body requires for proper health
and functioning. Chromium’s major role is in the functioning of insulin;
it is needed as a cofactor. Chromium also plays a role in the metabolism
of nucleic acids (DNA and RNA) and helps maintain their structure and
gene expression. Chromium aids in fatty acid and cholesterol formation
in the liver, and some studies have shown a lowering of cholesterol with
chromium supplementation. Furthermore, chromium-deficient diets are
linked to higher incidence of diabetes and heart disease.

It is chromium’s role as an insulin cofactor that has brought it so

much recent media attention. Early researchers found that chromium
exhibited a lowering of blood glucose levels. Because of this
characteristic, chromium is referred to as a glucose tolerance factor.
The glucose tolerance test is used to determine how well a person
can remove high levels of glucose from the bloodstream. The subject
being tested is fed high amounts of glucose, and the blood levels are
tested over several hours. The test is used to determine diabetes and
hypoglycemia. It is also used to measure the efficacy of nutrients and
drugs that possess blood glucose-removal properties, like chromium.
Due to chromium’s role with insulin function, glucose and amino

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 Minerals | 247

acids that circulate in the bloodstream after ingestion will have a

higher rate of uptake by the cells. This does not necessarily mean
that the levels of insulin are increased. And it does not mean that
chromium has a direct effect on muscle building (as testosterone does)
or on fat loss (as growth hormone does). It just means that increasing
dietary chromium levels will improve the functioning of insulin,
which should result in a higher rate of cellular uptake of glucose Cellular uptake:
and amino acids into the cells. The cells then use these nutrients for absorption by the cells.

energy and growth. If insulin is not working 100 percent, then glucose
and amino acids will circulate back to the liver and most likely be
converted to fat. Moreover, insulin malfunction can also lead to the
development of diabetes, heart disease, and other metabolic disorders.

This does not make chromium itself an anabolic agent but an important
cofactor for energy production and tissue growth and repair. For the
athlete, adequate chromium intake is essential. Several studies have
shown that individuals taking supplemental amounts of chromium in
association with training and a good diet has been reported to increase
the rate of muscle gains and increase the rate of fat loss. However, other
studies have not reported significant improvements in muscle building
and fat loss. As with most nutrient interventions, the rate of effectiveness
will depend on the research subject’s nutritional status; if a research
subject is deficient in chromium, improvements can be greater and
significant, compared with research subjects who may have adequate
chromium status, and taking extra chromium may not then cause
significant improvements.

Deficiency/Excess Symptoms. Researchers in the 1950s first discovered

chromium’s essential role in nutrition when they fed chromium-deficient
diets to laboratory animals and noticed the development of glucose
intolerance. Further experiments caused health demographers to link
impaired glucose tolerance, certain forms of diabetes, poor appetite
control, and heart disease with low amounts of chromium in the diet.
Because of chromium’s low occurrence in food, toxic encounters are
rarely reported.

Athletic Performance Considerations of Chromium. Studies

support the adequate daily intake of chromium for maintenance
of overall health and performance. The research doesn’t report

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benefits of megadosing chromium for increased performance.

Maintain chromium intake within the PDI guidelines, as
determined by doctor evaluation and supervision.

Chromium in Food and Supplements. Food sources of chromium

include meats, mushrooms, liver, bread, brewer’s yeast, black pepper,
cheese, beer, brown rice, and potatoes. Supplement forms of chromium
include chromium dinicotinate glycinate, chromium picolinate, and
chromium polynicotinate.

Molybdenum
Molybdenum is a trace mineral whose content in the body is extremely
low but is recognized as an essential nutrient and required by the body
for maintenance of good health. Molybdenum is present in enzymes,
such as xanthine oxidase, sulfite oxidase, and aldehyde oxidase. These
compounds are involved in energy production, nitrogen metabolism,
and uric acid formation.

Athletic Performance Goals of Molybdenum. Studies support the

adequate daily intake of molybdenum for maintenance of overall health
and performance. The research does not report benefits of megadosing
molybdenum for increased performance. Maintain molybdenum intake
within the PDI guidelines from dietary and supplement sources, as
determined by doctor evaluation and supervision.

Deficiency/Excess Symptoms. No deficiency of molybdenum in humans

has been reported. Because molybdenum is required in such small
quantities, adequate amounts of it can be found in most diets. Ingestion
of large amounts of molybdenum may cause gout (15 milligrams daily
for several months), retarded growth, and loss of copper.

Occurrence in Supplements and Foods. Molybdenum is found in milk,

beans, breads, cereals, and organ meats. Amounts vary considerably in
regional food supplies. Molybdenum is found in many supplements in
different forms, such as molybdenum chelate and sodium molybdate.
Choose supplements that contain molybdenum as part of a complete
multivitamin/mineral formulation.

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 Minerals | 249

Fluoride
The role of fluoride in prevention of tooth decay is well known.
Fluoride is also found in bone and in soft body tissues in very small
amounts as calcium fluoride. Fluoride’s role in increasing resistance to
tooth decay is most notably seen in children. Fluoride intake has also
been associated with increased bone integrity. There is some evidence
that maintaining good fluoride intake may help reduce osteoporosis.
For the athlete, however, fluoride intake is not related to any increase
in athletic performance. Its importance lies in the maintenance of
good teeth for proper eating and the maintenance of a healthy skeleton.
Additionally, fluoride supplements are only available by prescription.
The primary intake of fluoride is from the water supply and the diet. A
link of low fluoride in water with increased tooth decay has led to the
practice of adding fluoride to water supplies in areas without naturally
occurring fluoride.

Deficiency/Excess Symptoms. A deficiency of fluoride has been linked

to increased tooth decay and possibly to osteoporosis. Excess fluoride
intake causes mottling of teeth and affects bone health, kidney function,
and possibly muscle and nerve function. Intake of high amounts of
fluoride (5 to 10 grams of sodium fluoride) has been reported to cause
death. This amount is far above the normal range of fluoride ingestion, 1
to 4 mg per day.

Fluoride in Food. Fluoride occurs in most foods in extremely low

amounts. It does occur in tea in moderate amounts. In fact, a dietary
survey conducted in the United Kingdom found that tea was the main
source of fluoride in adult diets and accounted for 1.3 milligrams of a
total daily intake of 1.8 milligrams.

The Electrolytes
(Sodium, Chloride, and Potassium)
Sodium, chloride, and potassium are collectively referred to as the
electrolytes. Although the other minerals may have electrolyte activity,
these three are generally considered the main electrolytes in the body.

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Magnesium is sometimes grouped with these three electrolytes by some

authorities but is treated separately here due to its unique functions and
supplement requirements. The primary function of these electrolytes
is maintenance of the balance of fluids in the body between cells and
the bloodstream. Other functions of these electrolyte minerals are
summarized in the following table.

Electrolyte Main Functions

Sodium • Extracellular cation

• Regulation of osmolality

• Regulation of body fluid balance

•A
 ctive transport across cell membranes

• Uptake of some nutrients in intestines

•M
 uscle contraction and nerve impulse transmission

Chloride • Extracellular anion

• Control of fluid balance

Potassium • Intracellular cation

• Fluid balance

•N
 erve transmission and muscle contraction

• Glycogen formation

Deficiency/Excess Symptoms. Deficiency of the electrolytes is not

normally observed except under conditions of severe dehydration,
during prolonged periods of exercise without proper hydration or
electrolyte replenishment, and in conditions of renal disease. Side effects
include dizziness, fainting, and reduced performance. Excessive intake
Dietary sodium: also
called “salt,” sodium helps
of sodium and chloride (because they occur together in food) causes
your nerves and muscles hypertension, fluid balance problems, and edema. High potassium
work properly. Table salt intake, 18 grams or more, will lead to acute hyperkalemia, which can
is composed of sodium
and chloride. Your kidneys cause cardiac arrest and prove fatal.
control how much sodium
is in your blood, releasing it Electrolytes in Food and Supplements. These three electrolytes occur
when needed and flushing in all foods. Sodium and chloride are supplied by food mostly as
out any excess. Too much
sodium building up in the sodium chloride. Sodium bicarbonate and monosodium glutamate also
blood may raise blood contribute to dietary sodium intake. Table salt (sodium chloride) and
pressure. High blood
pressure is linked to serious
processed foods are by far the largest contributors. Potassium is present in
health problems. all foods but is particularly high in fruits and vegetables. Most individuals

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 Minerals | 251

want to maintain moderate sodium and chloride intake and maintain

higher potassium intake. Athletes in particular have higher demands of
these minerals due to excessive sweating and increased physical activity.
But do not think you have to load up on table salt. The higher food intake
of athletes usually compensates for higher electrolyte demands.

Many sports drinks on the market contain water, carbohydrates, and

electrolytes. Use of these drinks is recommended for active athletes.
Drink them during and after exercise. Long-distance and ultra long-
distance athletes need to make sure they are first maintaining adequate
water and carbohydrate intake and then maintaining appropriate levels
of electrolytes. Drinks lower in electrolytes are best during exercise
because higher electrolyte concentrations will delay gastric emptying
and impair hydration and carbohydrate supply during physical activity.

Supplement intake of sodium and chloride are not usually required.

There is typically more than enough in most diets. Athletes wishing to
add more sodium or chloride to their diets can do so with the addition
of table salt to their foods. However, excess intake of sodium chloride
is usually the condition with most diets. Potassium, however, can range
quite considerably in the diet. Individuals concerned with possible low
potassium intakes should look for multivitamin/mineral supplements
that contain some potassium, such as potassium chloride.

Boron
Boron is an ultra-trace mineral that occurs in the body in small
amounts. It has been established as an essential mineral in humans.
Boron appears to have several functions, including influencing calcium,
phosphorus, and magnesium metabolism; parathormone action;
functionality of membranes; and bone formation. Attention by athletes
has been directed toward boron because of its alleged role in increased
testosterone production. It all began in 1987 when a study was published
reporting increased testosterone levels in postmenopausal women as
a result of born supplementation. Translating this effect to younger
adult males and females is speculative at best. One study in 1992 was
conducted with bodybuilders taking 2.5 milligrams of boron per day for
seven weeks. The subjects did not report any increases in testosterone
levels or significant increases in lean body mass and strength over that of
the placebo group.

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Boron intake is required daily for health and performance, but like the
other minerals, side effects can occur if too much boron is taken. The
estimated safe intake range for boron in healthy adults is daily amounts
up to 20 milligrams. Side effects of overconsumption have been observed
with amounts ranging from 5 to 10 grams and include nausea, vomiting,
diarrhea, dermatitis, lethargy, nervous system irritability, renal failure,
and shock. Boron intake should be kept within the PDI guidelines from
food and supplement sources. Boron tri-chelate is a preferred boron
supplement form, as determined by doctor evaluation and supervision.

Conclusion
Minerals represent essential nutrients vital for health and athletic
performance. Food and supplements play a role in providing athletes
with these essential substances. Adequate mineral intake should
be determined by doctor evaluation and supervision to determine
whether mineral deficiency or excess is present and to resolve these
issues if so. In general, healthy adult athletes, as their physical
activity increases with athletic training and competition seasons,
may require an increase of daily amounts of minerals compared
with the DRI and DV intakes for nonathletes and during off-
season, when activity levels are lower. In addition, mineral intake
requirements can be body-weight dependent, with increasing
daily intake amounts being required. However, while reference
information is useful, doctor-supervised metabolic testing is required
to determine an athlete’s mineral status and personal requirement.

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 Minerals | 253

Daily Mineral Intake Reference Information Summary (For Educational Purposes Only)
USA Minimum and Upper Vitamin Reference Intakes Vitamin Reference Intakes Performance Daily
(total intake from food and supplements) (intake from supplements) Intake (PDI)

Council for Responsible Nutrition

and Canadian Health
Daily DRI* Men DRI* Tolerable CRN’s Upper Canadian For PDI (Performance
Values To- Total Women Upper In- Level for Sup- Supplements Daily Intake range,
tal Intake Intake Total take Total plements 3rd (maximum) including all nutri-
Intake Intake Edition, 2014 ent sources; foods
and supplements).

Calcium 1,000 mg 1,300 mg 1,300 mg 2,500 mg 1,500 mg 1,500 mg 1,200 to 2,600 mg

Chromium 120 mcg 35 mcg 25 mcg Not 1,000 mcg 500 mcg 200 mcg to 600 mcg
Established Any form of Cr III
Copper 2 mg 0.9 mg 0.9 mg 10 mg 9 mg 8 mg 3 to 10 mg
Iodine 150 mcg 150 mcg 150 mcg 1,100 mcg 500 mcg 800 mcg 150 to 1,100 mcg
Iron 18 mg 11 mg 18 mg 45 mg 60 mg (full 45 mg 18 to 60 mg
stomach)
Magnesium 400 mg 420 mg 320 mg 350 mg 400 mg 500 mg 400 to 800 mg
Manganese 2 mg 2.3 mg 1.8 mg 11 mg 10 mg 9 mg 4 to 30 mg
Molybdenum 75 mcg 45 mcg 45 mcg 2,000 mcg 350 mcg 2,000 mcg 100 to 300 mcg
Phosphorus 1,000 mg 1,250 mg 1,250 mg 4,000 mg 1,500 mg 2,000 mg 1,000 to 4,000 mg
Selenium 70 mcg 55 mcg 55 mcg 400 mcg 200 mcg 200 mcg 100 to 400 mcg
Zinc 15 mg 11 mg 8 mg 40 mg 30 mg 50 mg 15 to 60 mg
Potassium 3,500 mg 4,700 mg 4,700 mg Not 1,500 mg 200 mg 3,500 to 4,700 mg
Established (500 mg,
3x per day)
Sodium 2,400 mg 1,500 mg 1,500 mg 2,300 mg Not Established Not Established 1,500 to 4,500 mg +
Chloride 3,400 mg 2,300 mg 2,300 mg 3,600 mg Not Established Not Established 2,300 to 4,500 mg +
Boron Not Not Not 20 mg 6 mg 0.7 mg (700 0.7 to 20 mg
Established Established Established mcg)
Fluoride Not 4 mg 3 mg 10 mg 6 mg (UL) Not Established 3 to 10 mg
Established
Mineral intake reference information is for total per day nutrient intake from conventional foods and dietary supplement sources, unless
otherwise noted.

mg = milligrams, mcg = micrograms, g = grams. Note: This information is for educational purposes only. The example guidelines are for
model healthy adult athletes, for short-term use during periods of athletic training. Typically, the exact nutrition requirements for each per-
son differ and for best results should be determined working with a health-care professional.

* indicates the highest DRI was included as reported on a gender basis, excluding pregnant or lactating women.

+ indicates that dietary intake requirement for sodium and chloride can be periodically higher for individuals who lose sodium and chloride
in excess or when in extremely hot or prolonged strenuous conditions. Extra sodium and or chloride intake may be required, estimated to
be several or more additional grams for replenishment of these minerals lost from sweating and excretion. Also, note that some individuals
can be sensitive to high sodium chloride intake levels, and high sodium chloride intake may cause high blood pressure in these sensitive
individuals.

DRI (Dietary Reference Intakes) includes Recommended Dietary Allowances (RDA) and Adequate Intakes (AI).
References: Office of Dietary Supplements, NIH, Dietary Supplement Fact Sheets, 2017.; Institute of Medicine, Dietary Reference Intakes for vitamin D and
Calcium, 2011.; Institute of Medicine, Dietary Reference Intakes: The Essential Guide to Nutrient Requirements, 2006.; Vitamin and Mineral Safety, 3rd Edition,
Council for Responsible Nutrition, Washington, DC, 2014.; Health Canada 2017.

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Keywords
Ionic form Metalloenzyme

Whole grains Triiodothyronine

Cellular uptake Dietary sodium

Sports Nutrition
 Topics Covered In This Unit

Introduction
Metabolites
Botanicals
 tandardizing botanical supplements
S
for consistency
Variability with efficacy and safety
Dosages
Ingredient entries included in this unit
Alkalinizers, blood buffers
Beta-hydroxy beta-methylbutyrate
(BHMB or HMB)
Caffeine
Carnitine/Acetyl-L-carnitine
Coenzyme Q10 (ubiquinone)
Creatine
Gamma oryzanol and ferulic acid
Ginsengs
Glucosamine and chondroitin
sulfate (CS)
 enefits for athletes are actually
B
old news
 esearch reports more benefits from
R
taking G&CS supplements
Melatonin
Nitrates
Pycnogenol
Summary of commonly available
botanicals, standardization, and
use examples
Conclusion

UNIT 9

METABOLITES AND
BOTANICAL SUPPLEMENTS
256 | Unit 9

Unit Outline
I. Introduction X. Gamma oryzanol and ferulic acid
II. Metabolites XI. Ginsengs
III. Botanicals XII. Glucosamine and chondroitin sulfate
(CS)
a. Standardizing botanical supplements
for consistency a. Benefits for athletes are actually
old news
b. Variability with efficacy and safety
b. Research reports more benefits from
c. Dosages
taking G&CS supplements
d. Ingredient entries included in this unit
XIII. Melatonin
IV. Alkalinizers, blood buffers
XIV. Nitrates
V. Beta-hydroxy beta-methylbutyrate
XV. Pycnogenol
(BHMB or HMB)
XVI. Summary of commonly available
VI. Caffeine
botanicals, standardization, and use
VII. Carnitine/Acetyl-L-carnitine examples
VIII. Coenzyme Q10 (ubiquinone) XVII. Conclusion
IX. Creatine

Learning Objectives
After completing this unit, you will be able to:
• Define and describe core terms related to metabolite and botanical supplements;

• Understand some of the different types of metabolite and botanical supplements and their
major functions; and

• Discuss how metabolite and botanical supplements may affect athletic and exercise
performance, and heath.

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 Metabolites and Botanical Supplements | 257

Introduction
In addition to the macronutrients and traditional
micronutrients, a variety of other substances
are in foods and supplements. These substances
fall into the general categories of botanicals,
metabolites, and other nutritional health
and performance enhancers. The following
information in this unit will review some of
these topics and substances of particular interest
for athletic performance, noting that most of
these substances have a variety of useful and
health promotion effects.
any adverse side effects, which may range from
Although these various nutritional substances mild temporary stomach upset to something
have a history of use backed by clinical research more severe, such as allergic reaction. For
studies, evaluation and supervision by a doctor, example, gastrointestinal upset is a common
coach, trainer, and other health professionals complaint by some users of creatine, which may
involved with the adult athletes is mandatory. be resolved using lower dosages for a few weeks
Companies manufacturing the various products to get the body used to the creatine, taking
can be contacted for proper use instructions. creatine with protein and or carbohydrates,
Any known adverse health effects or any other trying different brands of creatine, and making
issues may be reported to these companies. sure the creatine is completely dissolved. As
with any nutritional substance, some people
As with the other parts of an athlete
can experience allergic reactions, which require
performance diet program, upon doctor
immediate medical attention.
approval, start slowly with metabolite and
botanical supplement use, usually using dosages
lower than recommended in the product Metabolites
instructions so the athlete can determine
Metabolites are substances that take part in
whether he or she has any sensitivities. Adding
metabolism and are made by the body. Some are
one new substance at a time for several weeks to
produced in the body as part of the metabolic
a few months to adequately determine the safety
process, while others are derived from food
and effectiveness on an athlete’s health and
sources. Some are also available in supplemental
performance can be useful for comprehensive
form, for example, creatine, carnitine, and Co-
evaluation, in the content of the entire training
Q10 are metabolites.
and nutrition program. Keep good records to
determine if there are any significant benefits to Even though the body can make many of
training and athletic performance, and general these substances, loading up on them allows
health, or if there are not measurable benefits, or athletes to prevent shortages during exercise

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and to have an immediately available supply The study and the practice of prescribing plants
in reserve. Much of the pioneering research to for health and athletic performance is one of
determine which metabolites are important the oldest health sciences. Many plants have
to athletes was conducted in clinical settings powerful components that can be of great
using both individuals with metabolic disorders benefit. In fact, the pharmaceutical industry got
and patients recovering from injuries or its start when druggists began isolating these
surgery, in addition to athletes. The researchers components and making them available in their
discovered that the subjects not only overcame purer forms. Historically, humans have used
their disorders but also often went on to attain botanicals for a variety of health-related uses.
a state of health better than what they had Some plants offer many health and performance
started with. Studies conducted with athletes benefits, but they must be used with care. Some
demonstrated that certain metabolites improve plants should be used for only short periods:
factors important to athletic performance such to help heal the body of an illness or to treat a
as strength, agility, speed, and aerobic capacity, certain symptom. Some should not be combined
in addition to promoting and maintaining good with certain medications or other plants, as their
health. Metabolites, similar to other ingredients primary components may interact negatively.
used in sports nutritionals, are available as Some plants should be avoided by competitive
single-ingredient formulations or as part of athletes because they may contain a substance(s)
multiple ingredient formulations. They come banned by sports-governing organizations.
in a variety of dosage forms like other food and Experts knowledgeable about botanicals should
supplement products. be consulted, and athletes should be under
physician supervision if they decide to use
this diverse and beneficial category of health
Botanicals products. The legal status also needs to be
Botanicals is a catchall term for plants. determined for competitive athletes.
When you start reading about plants used in
supplements and medicine, you will see the Standardizing
term herb commonly used. Technically, the
Botanical Supplements for
term herb refers to the general characteristic of
a certain plant form that is typically non-woody Consistency (Quality)
plants. However, in the botanical world, wood It is often the concern of athletes that not all
and non-woody plants, and their parts, are used herbs or herbal products are created equal. The
in foods and supplements. Therefore, when reason: the chemical composition of plants
you read about botanicals, you will encounter varies greatly depending on where the plants
a variety of terms, all relating to the fact that were grown, the soil in which they were grown,
the ingredient(s) are from plants. On dietary the weather conditions during their growing
supplement product labels that contain botanical season, and how they were harvested. To provide
dietary ingredients, the part of the plant used products with consistent bioactive content, the
must be listed next to the name of the plant. processes of concentration and extraction are

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 Metabolites and Botanical Supplements | 259

examined. Standardized botanical ingredients due to the complexity of human physiology

will typically list the amount of the bioactive as and metabolic processes, some people can be
a percentage of the total plant ingredient, and expected to respond better to some botanicals
sometimes the amount of botanical bioactives versus other people who may have metabolic
are listed. Standardizing botanical ingredients differences that reduce or prevent responsiveness.
also makes it easier to duplicate research studies.
When it comes to safety of botanicals and
Quality of ingredients is one of the important metabolites, variability is again expected due to
factors; however, equally important is the quality various individual differences between people.
of the manufacturing processes. This is where Independent researchers; expert reviewers;
current good manufacturing practices come in, health practitioners; private and public
which are required by law and are mandated organizations, such as Council For Responsible
through comprehensive FDA regulations in the Nutrition, the Food and Drug Administration,
United States and by Health Canada. Sports the National Institutes of Health, and Health
nutrition product food and supplement companies Canada; and scientific and medical experts
actually are inspected by the regulators to working for ingredient and finished product
ensure the quality of products consumers use. sports nutrition product companies determine
Misconceptions proffered by the media and other the safety of these substances.
parties that dietary supplements are not regulated Additionally, any person with a heath disorder
are completely wrong: the opposite is true—foods should avoid use of these substances, unless use
and dietary supplement products are both well is approved and supervised by a doctor. And
regulated for safety. However, as with even the women who are planning to become pregnant,
most clinically studied and regulated of products, are pregnant, or are lactating and breastfeeding
drugs, 100 percent safety may not be possible for should avoid use of these and other metabolites
botanicals and metabolites. and botanicals, unless use is approved and
supervised by a doctor.
Variability with
Efficacy and Safety Dosages
When it comes to botanicals and metabolites Similar to the essential nutrients, daily dosages
and athlete responsiveness, variability is of most metabolite and botanical products are
expected—versus a higher responsiveness taken in divided dosages, taken two, three, or
rates to the essential nutrients. Why? With more times per day. In this way, effective levels
metabolites like creatine or carnitine, because of the bioactives can be sustained in the body
there are metabolites being made by the body, for longer periods. Some companies even offer
people with low levels may display significant sustained release formulas, which are usually
measurable effects, whereas people with high taken once or twice a day. Some products may
natural levels might not display significant also be enteric coated as to avoid digestion in
measurable effects. Regarding botanicals, the stomach to protect the often delicate natural

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plant bioactives and metabolites. Moreover, when include adding additional safe and effective
taking a metabolite or botanical supplement for evidence-based ingredients to your personal list
the first time, you can test smaller dosages than and contacting the ISSA to evaluate ingredients
what is recommended on the labels to determine of interest for new editions of this course book
the level of tolerance. This test period can be and or for continuing education courses.
followed by slowly increasing the dosage over
a few to several days to what is directed on the Alkalinizers,
labels and deemed appropriate for a particular Blood Buffers
athlete by health experts.
Most of the research on blood buffers has
Another interesting point regarding dosages for centered around Sodium Bicarbonate (baking
these substances is opportunity to personalize soda). Many studies have reported ergogenic
daily intake and duration of use—under close effects for individuals undergoing repeated
medical supervision. For example, although the maximum workloads ranging from seconds
results of clinical research studies using a range to several minutes; short-term sprint type
of dosage amounts might result in beneficial performance; physical activity that would be
effects, sometimes lower amounts may be limited by acidosis from exercising muscles’
suitable to achieve the same benefit as the greater fast metabolism; may also include benefits for
researched amounts, whereas higher than the sprint bursts during endurance exercise or
research amounts for some larger athletes may athletic events. It is crucial to note that sodium
provide additional benefits. Metabolic differences bicarbonate is ingested as a fluid after mixing
that occur will also play a role in determining with water and completely dissolved (hydrated).
the optimum daily dosage and duration of safe
and effective usage for each athlete. Studies performed on sprinters, 800-meter
runners, and world-class rowers have
documented, for example, the ergogenic
Ingredient Entries
effects of sodium bicarbonate. Large amounts
Included in This Unit are needed, however, which are typically
The list of ingredients being used in sports associated with gastrointestinal upset/distress
nutrition products and other health products side effects. For example, from some research-
used by athletes has grown substantially since based approaches, about 0.1 gram is required
the first edition of this course book. With for every pound of lean body mass, and some
this in mind, the following main ingredient studies even used higher dosages. For an
entries were chosen by their widespread use individual with 150 pounds of lean body mass,
in various products and based on clinical the amount of sodium bicarbonate would
research evidence. And in some instances, be approximately 150 times 0.1 grams = 15
Health Canada has published monographs for grams. From the body of research that has
ingredients, based on its independent review evolved over the decades reporting dozens of
of the scientific evidence. Part of your ongoing bicarbonate exercise-related research studies,
work in this area of sports nutrition should 0.3 grams per kilogram of body mass/weight

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A Lesson from Dr. Albert Szent-Gyorgyi’s Research

Dr. Albert Szent-Gyorgyi, a famed Nobel Prize-winning researcher, discovered a “bioflavonoid effect”
during his pioneering work on vitamin C in the early 1900s. He found that vitamin C from lemon
juice extract was the most effective treatment for the fragile blood vessels caused by the vitamin C
deficiency disease, scurvy, versus solely vitamin C alone, which was also beneficial. He observed an
improvement in capillary permeability, which appeared to reduce the bleeding he was trying to
alleviate. This discovery led him to conclude that another “vitamin factor” was present in the lemon-
juice extract, which he called “vitamin P.”
As Dr. Szent-Gyorgyi’s research continued, it was determined that the vitamin P factors were
chemically related substances derived from a group of natural chemicals called phenols. Upon
further investigation, he determined that the vitamin P factors belong to a category of phenols
called bioflavonoids, noting that chemical analysis techniques were also in develop this time. Shortly
thereafter, the term vitamin P was discontinued because further research failed to establish that
bioflavonoids are essential nutrients—meaning that they were not proven to be necessary for survival
or required by the body to prevent nutrient-deficiency diseases. Despite their “nonessential” (but
important) nutrient status, the many bioflavonoids play an essential role in health maintenance and
disease prevention and in the structure and function of the human body, too.
Contemporary researchers believe that bioflavonoids play vital roles in the promotion of health and
longevity. Since the early nutrition research by Dr. Szent-Gyorgyi, many researchers have turned
their attention to the so-called nonessential, many now recognized to be “conditionally essential”
or “semi-essential” substances in the human diet nutrients that serve to enhance the structure,
function, and health of the human body but that are not absolutely required for existence. Carnitine,
a metabolite, is such a substance that has been referred to as conditionally essential by some experts.
Then there are the Dietary Guidelines that include recommendations to eat several servings of fruits
and vegetables each day for essential nutrients, but also for the many beneficial bioactives they too
contain which are important to health.
It is interesting to note that Dr. Szent-Gyorgyi’s research over his lifetime also included pioneering
breakthroughs in muscle anatomy, physiology, muscle contraction, biochemistry of muscle
movement, actin, myosin, and energy production, in addition to health benefits vitamin C,
bioflavonoids and other substances. His research at the final chapter of his career also included
understanding and treating cancer, which included using vitamin C and bioflavonoids. In the United
States during the 1940s, he founded the Szent-Gyorgyi Foundation for muscle research, according
to the National Library of Medicine. Dr. Albert Szent-Gyorgyi and his work is admired by and was
influential to the authors of this course, among other distinguished scientists around the world.
A point about this pioneering scientist’s work is the determination of health benefits of these
“other substances” like bioflavonoids, caffeine, creatine, Pycnogenol, nitrate, HMB, sodium
bicarbonate, and carnitine, aside from essential nutrient function like with vitamin C and the
other essential micronutrients.

Capillary: a tiny blood vessel through which nutrients and waste

products travel between the bloodstream and the body’s cells.

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of sodium bicarbonate is a typical effective other drugs. Consult your doctor immediately
dosage reported being used in some research if gastrointestinal pain and discomfort persist
studies. Therefore, for a 70-kilogram athlete (154 and for proper use. Some side effects noted on
pounds), 70 × 0.3 = 21 grams per day of sodium sodium bicarbonate Drug Facts labeling include
bicarbonate, which is very high compared the following: Ask a doctor before use if on
with antacid sodium bicarbonate drugs. Use of a sodium restricted diet; ask a doctor before
sodium bicarbonate for athletic performance use if taking a prescription drug; STOMACH
uses, while effective, is obviously experimental WARNING: to avoid serious injury, do not take
and requires close medical supervision by until powder is completely dissolved. It is crucial
experienced health professionals. There are not to take this product when overly full from
also lower dosages-per-day options taken for food or drink. Consult a doctor if severe stomach
several days that may offer athletes alternatives. pain occurs after taking this product.
The higher dosages may be beneficial used
A 2014 study examining effects of sodium
in short-term use of one to five days.
bicarbonate on high-intensity endurance
Dosage administration depends on whether the performance in cyclists (Egger and coworkers)
individual is subject to possible side effects, such is also worth mentioning, as this is a growing
as diarrhea, nausea, cramps, or flatulence. Note area of research. This study examined the effects
that sodium bicarbonate antacid drug products of oral ingestion of sodium bicarbonate at the
recommend about a maximum daily dosage of dosage rate of 0.3 grams per kilogram of body
4 grams per day, so the ergogenic dosages used mass versus placebo of 4 grams of sodium
in athletic research studies are much higher and chloride, dissolved in 0.7 liters of water. Subjects
can have adverse effects. were males and females who were well-trained
cyclists. One hour after ingestion. the exercise
Hydrated dosages can be taken on an empty
test was conducted, consisting of 30 minutes
stomach, one hour before strenuous activity
at 95 percent of the individual anaerobic
for example. If gastrointestinal side effects
threshold (IAT), followed by 110 percent IAT
occur, start two hours before the activity and
to exhaustion. Cycling time to exhaustion was
take one-quarter dosage with water every 15
improved by the sodium bicarbonate-taking
minutes. Sodium bicarbonate loading will also
subjects, 49.5 minute versus 45 minutes for the
load the body up with a few grams of sodium,
placebo group. An increase in body pH and
thus caution should be used by individuals
bicarbonate was also reported. Although this
with blood pressure problems, hypertension,
was an exercise test, the researchers note in their
and other sodium concerns. To avoid injury
conclusions that ingestion of sodium bicarbonate
to the gastrointestinal system, make sure the
might improve prolonged, high-intensity cycling
powder is completely dissolved and do not take
performance.
sodium bicarbonate when you are overly full.
Do not take sodium bicarbonate for more than Another interesting related topic involves
a few days at a time. Sodium bicarbonate is also dietary control over body alkalinity or acidity.
considered an antacid, which may interact with For example, S. L. Caciano and coworkers

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reported in their 2015 research study on satellite cells, vital for muscle cell regeneration
how food composition that promotes body and growth. It is easy to understand how these
alkalinity resulted in improvement in exercise multiple functions can result in increasing and/
performance, versus acid-causing diets. Unit or maintaining lean body mass, which is of
17 contains more details about this study and interest to athletes and nonathletes alike.
important topic.
An interesting research review worth
mentioning was conducted in 2003 (Crowe and
Beta-Hydroxy coworkers) examining the effects of BHMB and
Beta-Methylbutyrate creatine. It was reported that creatine was most
effective in producing significant gains in lean
(BHMB or HMB) body mass and strength with resistance training.
BHMB is metabolite supplement that gained However, the research review also reported that
immediate popularity and use in weightlifting BHMB produced gains lean body mass and net
and bodybuilding circles from initial research strength gains that were less than those that
that reported increased strength and lean were produced by creatine but that were also
body mass when taken as part of a resistance- significant when compared to with a placebo.
training program. BHMB is made in the body Another study reported that an additive effect
from the amino acid leucine. During BHMB’s when creatine and BHMB were taken together.
evolution of research and usage benefits, it is Benefits for aerobic athletes are possible too from
now found in a variety of products for athletes the anti-catabolic and anabolic metabolic effects.
and the general public to help to build, rebuild, In 2015, researchers K. Durkalec-Michalski and
and maintain muscle. BHMB is an example of J. Jeszka reported benefits for elite rowers taking
a metabolite with a primary benefit for some 3 grams of BHMB for 12 weeks. The benefits
people of helping to significantly increase the observed included reduction of body fat mass,
rate of muscle mass gain, strength, and other increase in aerobic capacity, and an increase
related benefits, which may result in increasing in peak anaerobic power. In 2016, L. P. Lowery
athletic performance. Most measurable benefits and coworkers examined the effects on muscle
are reported in the research among untrained mass, strength, and power on resistance-trained
subjects and older adults. Mixed benefits are individuals who received a combination of 3
reported for elite athletes. grams per day BHMB and 400 milligrams per
day of ATP supplementation. After the 12-week
Functionally, BHMB is reported to work study period, the researchers observed benefits
biochemically in a few primary ways as noted of the supplementation with resistance training,
by J. M. Wilson and coworkers (2013), which such as increasing lean body mass, power, and
include anti-catabolic (role in reducing muscle strength. In addition, during an overreaching
protein breakdown) and anabolic (role in muscle training cycle, the supplement-taking subjects
protein synthesis). The research additionally were still able to experience gains in strength,
reports a very interesting and beneficial BHMB whereas the placebo group experienced a decline
function related to activation of skeletal muscle in strength and power. The 12-week study

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included three resistance training phases: 8-week supplements, caffeine drugs, and caffeine-
periodized resistance training program (phase 1), containing foods is misuse and abuse because
followed by a 2-week overreaching cycle (phase caffeine can cause unhealthy side effects. The
2), and a 2-week taper (phase 3). FDA notes side effects related to caffeine use,
including the following:
According to most studies, 3 grams per day is a
common effective dosage producing measurable • Causes nervousness or jitteriness
improvements. Health Canada has established • Makes it hard to fall asleep, stay asleep, or get a
a minimum and maximum daily intake range good night’s sleep
of 3 to 6 grams per day. BHMB can be taken
• Makes the heart beat faster
in divided dosages, for example 1.5 to 3 grams
twice a day. While related to leucine, note that • Causes an uneven heart rhythm

BHMB is not a replacement for leucine, as • Raises blood pressure

leucine is an indispensable amino acid with
• Causes headaches, nervousness, and/or
many important essential functions, including dizziness
making BHMB in the body. Expect a few weeks
• Raises health concerns for pregnant and
of use or longer to experience measurable
lactating women
benefits among people who have the capacity to
respond to BHMB supplementation. BHMB is The FDA noted in the May 2013 Consumer
also found used in multi-ingredient formulas. Health Information article “FDA to Investigate
Added Caffeine,” up to 400 milligrams per day
intake for healthy non-pregnant adults to be
Caffeine
safe, which is about four to five cups of coffee.
Increasing mental (cognitive) and physical The European Food Safety Authority established
performance, including athletic performance, that habitual caffeine consumption up to 400 mg
is well established for adequate caffeine per day does not give rise to safety concerns for
dosages and under safe use and certain non-pregnant adults. The FDA and other expert
conditions. However, a major issue with caffeine groups have reported single dosages of 100 to

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 Metabolites and Botanical Supplements | 265

200 milligrams as safe for healthy adults, non- stimulates thermogenic activity. Almost
pregnant. Health Canada notes that 100–400 mg, the entire world relies on a daily caffeinated
per day is safe, not to exceed 200 mg per single beverage to get the day started. However, for
dose (HC 2012). the athlete, caffeine may offer much more than
a good morning drink. Studies report that
Why this general review of some of the safety
intakes of caffeine can have beneficial effects
information about caffeine at the start? It’s to
on performance, in particular for endurance
make a point that although there is perhaps
athletes, such as exercising for longer periods, a
a safe daily caffeine dosage range for healthy
decrease in glycogen utilization, an increase fat
non-pregnant adults, and upper daily intake is
oxidation, enhanced motor performance, and a
recognized at 400 milligrams, use by athletes can
reduction in the perception of fatigue. Cognitive
typically be more than 400 milligrams per day.
performance effects can be of interest to athletes
Thus, when higher per day dosages are reported
for whom reaction time is important. It can
in the research and by organizations, make
also foster mental alertness and help athletes
note that these higher dosages may come with
combat sleepiness. Caffeine tends to increase the
some unwanted side effects and are not intended
use of fatty acids for energy, which in turn has
for prolonged usage. In addition, competitive
a glycogen sparing effect. Caffeine as a nervous
athletes need to check with their coach, team
system stimulant provides a mental boost to
doctor, and/or athletic organization to determine
help the athlete through rigorous training
whether there is a caffeine limit or ban for their
sessions. Research even shows that caffeine can
individual sports.
increase the rate of fat loss. The military is a big
Caffeine is a naturally occurring compound proponent of the use of caffeine for enhancing or
that belongs to a group of substances called sustaining physical and cognitive performance.
methylxanthines. It is found in coffee, tea, Use of caffeine was even reported to increase the
chocolate, cola, and botanical supplement time to exercise exhaustion at high altitudes, at
ingredients, such as, guarana, yerba mate, and 4,300 meters. (Refer to box below titled “Military
green tea, or just as a synthetic or naturally and Caffeine.”)
purified isolate of caffeine. Although
Due to the combination of effects that caffeine
caffeine is naturally occurring, it is also
has on the body, it is also used as a weight-loss
synthesized, and sold as nonprescription
aid. Caffeine has thermogenics effects, increasing
drug, as an alertness aid and stimulant.
the calorie expenditure rate, and promotes the
(Refer to box below titled “Over-the-Counter
use of fatty acids for energy. The mild diuretic
Caffeine Drug Regulation from FDA.”)
effect may help reduce water retention. The
Caffeine has several main effects that are stimulatory effects provide a mental energy boost
desirable: it increases alertness by stimulating that some dieters find useful in offsetting the
the nervous system, acts as a mild diuretic, mental energy drain that may occur while on a
simulates cardiac muscle tissue, increases reduced calorie diet plan.
lipolysis, increases physical activity, and it

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Caffeine primarily works by stimulating the such strength athletes working with their team
nervous system to increase production of doctors can try experimenting for themselves
excitatory neurotransmitters. If an individual to determine whether there is an ergogenic
takes too much caffeine, or takes it for prolonged effect from caffeine, neutral effect, or a negative
periods, the precursor nutrients that produce ergolytic effect during training or athletic events.
these excitatory neurotransmitters become All competitive athletes must make an effort to
depleted and cause a mentally burned out feeling. evaluate the health and athletic performance
Caffeine’s diuretic affects are most detrimental to effects caffeine has on an individual basis and
endurance athletes. under doctor supervision.

Caffeine should be used sparingly by athletes The European Foods Safety Authority published
until the individual athlete, under doctor its scientific opinion in 2011 on health claims
supervision, determines the exact performance- related to caffeine and physical performance.
enhancing effects it has for him or her. Caffeine Based on its scientific review, 3 milligrams
can be used periodically to provide a mental per kilogram of body dosages were associated
boost to enhance workouts. In addition, some with improvements in endurance performance
studies indicate that heavy caffeine intake, for and increased endurance capacity, such as
long periods, may deplete the body of calcium; improved time. A higher dosage of 4 milligrams
therefore, adequate calcium intake is mandatory, per kilogram of body weight one hour prior
and heavy caffeine use should be avoided for this to exercise is required for a reduction in the
and other reasons. As an ergogenic aid taken perceived exertion/effort during exercise.
before competition, you first have to check on the Dosages are taken 60 minutes prior to physical
legality of caffeine in your sport. activity. Note that dosages on a per kilogram
of body weight must be crosschecked with
Though individual dosage will vary, researchers
maximum safe dosages. It is also important
recommend 200 to 600 milligrams (about three
to note that use should be limited to bouts of
to five cups of coffee) about one hour before
exercise in which a boost in physical and mental
competition, but make certain that you are
performance is needed, and day-to-day use
well hydrated to offset any diuretic effects of
should be avoided due to unwanted side effects,
caffeine. However, the synthetic form of caffeine
including a reduction in the positive effects
or purified natural caffeine may be a more
of caffeine use. These dosages are within the
reliable source, such as the caffeine contained
ranges reported in the scientific literature and in
in nonprescription caffeine products sold in
position papers.
drugs stores, which is also inexpensive Also,
note that studies indicate that caffeine may The nonprescription drug use of caffeine is 100
reduce the strength-improving effectiveness to 200 milligrams, every three to four hours,
of creatine. In strength athletes, caffeine may for occasional use. Common side effects are
slow down the muscle contraction cycle and nervousness, irritability, sleeplessness, and
may reduce strength potential, which still needs rapid heartbeat. In addition to the various side
to be resolved with more research. However, effects that people may experience from caffeine

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use, hypersensitivity or allergy may occur and acute dosages, over 10 grams for adults and
caffeine should be discontinued and avoided a lower acute dose for children. (Also refer to
in these cases. Caffeine intake of less than 300 box below titled “FDA Consumer Advice on
milligrams per day, from ingestion of a few to Pure Powdered Caffeine (FDA Safety Alert.”)
several cups of coffee or tea, spread out over Make sure you keep your caffeine-containing
the day, may reduce or eliminate the potential products away from children and from pets,
dehydrating effects. In addition to being aware of too. Significant mild side effects in adults are
all food, supplement, and drug caffeine sources reported to be observed with acute dosages
to determine total daily intake, you should starting at about 1 gram. A daily maximum
identify the use of other stimulants, too, as an dosage of 1 gram (1,000 milligrams) per day
additive effect may occur from these, such as is reported by some authorities for short-term
synephrine and other stimulant drugs of food usage—for example, days. Note that the extent
substances. And be sure to be aware of other of side effects will depend on an individual’s
drugs or health conditions that may cause health metabolism and ability to metabolize caffeine.
problems with caffeine use. Therefore, complete safe use of caffeine cannot
be guaranteed, following product directions and
Caution: The potential down side of caffeine
determination of each person’s caffeine safe use
is that it may cause dependency and alter
limits as determined by a doctor.
physiology. Also, caffeine can be lethal at high

International Sports Sciences Association

 Over-the-Counter Caffeine Drug Regulation from the FDA PART 340
STIMULANT DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE
Subpart A--General Provisions
Sec. 340.1 Scope.
(a) An over-the-counter stimulant drug product in a form suitable for oral administration is generally
recognized as safe and effective and is not misbranded if it meets each of the conditions in this part
and each of the general conditions established in 330.1.
(b) References in this part to regulatory sections of the Code of Federal Regulations are to chapter I of
title 21 unless otherwise noted.
Sec. 340.3 Definition.
As used in this part:
Stimulant. A drug which helps restore mental alertness or wakefulness during fatigue or drowsiness.
Subpart B--Active Ingredient
Sec. 340.10 Stimulant active ingredient.
The active ingredient of the product consists of caffeine when used within the dosage limits estab-
lished in 340.50(d).
Subpart C – Labeling
Sec. 340.50 Labeling of stimulant drug products.
(a) Statement of identity. The labeling of the product contains the established name of the drug, if
any, and identifies the product as an “alertness aid” or a “stimulant.”
(b) Indications. The labeling of the product states, under the heading “Indications,” the following:
“Helps restore mental alertness or wakefulness when experiencing fatigue or drowsiness.” Other
truthful and nonmisleading statements, describing only the indications for use that have been es-
tablished and listed in this paragraph, (b) may also be used, as provided in 330.1(c)(2), subject to the
provisions of section 502 of the Act relating to misbranding and the prohibition in section 301(d) of
the Act against the introduction or delivery for introduction into interstate commerce of unapproved
new drugs in violation of section 505(a) of the Act.
(c) Warnings. The labeling of the product contains the following warnings under the heading “Warn-
ings”:
(1) “The recommended dose of this product contains about as much caffeine as a cup of coffee. Limit
the use of caffeine-containing medications, foods, or beverages while taking this product because too
much caffeine may cause nervousness, irritability, sleeplessness, and, occasionally, rapid heartbeat.”
(2) “For occasional use only. Not intended for use as a substitute for sleep. If fatigue or drowsiness
persists or continues to recur, consult a” (select one of the following: “physician” or “doctor”).
(3) “Do not give to children under 12 years of age.”
(d) Directions. The labeling of the product contains the following information under the heading
“Directions”: Adults and children 12 years of age and over: Oral dosage is 100 to 200 milligrams not
more often than every 3 to 4 hours.

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Military and Caffeine

Based on a report by the National Academy Sciences funded by the military, the following is a sum-
mary of some of the key recommendations of interest for use by military personnel.

• Caffeine in amounts of 100 to 600 mg can be effective in maintaining cognitive performance

particularly in situations of sleep deprivation. Specifically it can be used in maintaining speed of
reactions and visual and auditory vigilance, which in military operations could be a life or death
situation.
• A similar amount (200 to 600 mg) of caffeine is also effective in enhancing physical endurance
and may be especially useful in restoring some of the physical endurance lost at high altitude.
• Use of caffeine under conditions of sustained military operations would not appear to pose
any serious, irreversible acute or chronic health risks for military personnel in situations where
increased doses might be recommended.
• Caffeine use increases the risk of dehydration, so fluid and food intake of personnel should be
closely monitored in these situations.
• A caffeine delivery vehicle that provides caffeine in 100-mg increments with a total content
not exceeding approximately 600 mg would appear to be the most appropriate dose for use in
sustained military operations.
• An in-depth training program on the benefits, directions for use, and potential side effects of
caffeine should be designed for command personnel. Military personnel should be given ade-
quate training to ensure the benefits of caffeine supplementation and avoid any potential side
effects.
• Such training should include the use of caffeine during periods of sleep deprivation and altered
work–rest cycles in non-operational situations.
• The military should have in place a doctrine related to the importance of sleep prior to extend-
ed missions and the importance of naps whenever possible during operations.
• At this time, caffeine should be the compound of choice for counteracting cognitive deficits
since many personnel have personal experience with the compound, it is not a restricted sub-
stance, it does not interfere with recovery sleep following periods of sleep deprivation, and it
has very low abuse potential.
• Military women should be informed that very high doses of caffeine may slightly increase risk of
spontaneous abortion in the first trimester of pregnancy.
Source: Caffeine for the Sustainment of Mental Task Performance: Formulations for Military Operations. Committee
on Military Nutrition Research, National Academy of Sciences 2001

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FDA Consumer Advice on Pure Powdered Caffeine (FDA Safety Alert)

Key Advice
The FDA is warning about pure powdered caffeine being marketed directly to consumers and recom-
mends avoiding these products. In particular, the FDA is concerned about pure powdered caffeine
sold in bulk bags over the Internet.
The FDA is aware of at least two deaths of young men who used these products.
These products are essentially 100 percent caffeine. A single teaspoon of pure caffeine is roughly
equivalent to the amount in 28 cups of coffee.
Pure caffeine is a powerful stimulant and very small amounts may cause accidental overdose. Parents
should be aware that these products may be attractive to young people.
Symptoms of caffeine overdose can include rapid or dangerously erratic heartbeat, seizures and
death. Vomiting, diarrhea, stupor and disorientation are also symptoms of caffeine toxicity. These
symptoms are likely to be much more severe than those resulting from drinking too much coffee, tea
or other caffeinated beverages.
Who should know
All consumers seeking caffeinated products should be aware of the potentially high potency of these
pure powdered caffeine products. Parents should recognize that teenagers and young adults may be
drawn to these products for their perceived benefits.
What to do
The FDA advises consumers to avoid pure powdered caffeine.
It is nearly impossible to accurately measure pure powdered caffeine with common kitchen measur-
ing tools and you can easily consume a lethal amount.
If you believe that you are having an adverse event related to caffeine, stop using it and seek immedi-
ate medical care or advice.
The FDA wants to know about adverse events associated with pure powdered caffeine and other
highly caffeinated products. You or your health care provider can help by reporting these adverse
events to FDA in the following ways:
By phone at 240-402-2405
By email at [email protected]
Why this advice is important
Pure powdered caffeine products are potentially dangerous, and serious adverse events can result,
including death. People with pre-existing heart conditions should not use them.
Additional information
FDA Voice: A blog by Mike Landa, Director of the FDA’s Center for Food Safety and Applied Nutrition,
addresses how two tragic deaths highlight the dangers of pure powdered caffeine.

Source: http://www.fda.gov/food/recallsoutbreaksemergencies/safetyalertsadvisories/ucm405787.htm

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Carnitine / Acetyl-L-Carnitine
Carnitine is made by the body and has a primary health-promoting effects derived from taking
role is the transportation of fatty acids into carnitine supplements, including heart health,
mitochondria. The effectiveness of carnitine mental wellness, healthy aging, and increased
in various studies has been so impressive that male fertility.
it is now considered a conditionally essential
With all of the reported research-proven health,
nutrient, meaning that the body can benefit from
healing, and performance benefits carnitine
supplemental intake, as the body’s intake may
has to offer, the decision to declare carnitine a
not be adequate for optimal health and function.
conditionally essential nutrient was a good one.
Carntine’s primary role is in the mitochondria
Carnitine supplementation of 2 to 4 grams per
of cells, where it moves fatty acids into the
day is reported to yield performance-enhancing
mitochondria to be used for energy.
results, taken starting at least several weeks
Research has demonstrated certain athletic before competition. Carnitine loading 2 to 5
performance improvements with carnitine grams per day, one to two weeks before events
supplementation, with some mixed results can also be evaluated, especially for larger
similar to those from other metabolites. Athletic athletes. Divided dosages is also used, two to
benefits could include increased endurance, three times per day for example. Both endurance
•
improved VO2 max, reduced lactate levels during and strength athletes may benefit from using
exercise, and improved anaerobic strength carnitine supplementation; the L-carnitine form
output along with antioxidant protection is the bioactive form used in supplements.
effects. Studies support the use of carnitine
In 2014, researchers G. E. Orer and N. A. Guzel
supplementation for intensively training,
reported the results of their study examining
competitive athletes involved in primarily
carnitine supplementation on endurance
endurance activities lasting over several minutes.
performance in professional male footballers.
However, benefits for strength athletes have
Footballers took 3 grams or 4 grams of carnitine
been reported, in particular during weightlifting
prior to exercise testing, running. Running speed
exercise. In addition to lactate reduction,
was increased during the test until subjects chose
improved recovery potential after resistance
to quit. The test was repeated after one week
training from carnitine supplementation has
as a group of placebos. The carnitine groups
been reported.
showed that running speeds were increased,
Carnitine is also useful in increasing the rate and beneficial lactate concentration and heart
of fat loss by increasing the rate of fat used for rate responses were decreased in both carnitine
energy; carnitine encourages the body to use groups versus placebo testing. The researchers
more fat for energy. Thus as part of a reduced- concluded that the results of this short-term
calorie diet, carnitine may increase the rate of carnitine-use study show that taking carnitine
fat loss in some people. There is also a variety of before physical exercise prolonged exhaustion.

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Carnitine occurs in supplements in a few forms: damage measurements. After two weeks of
L-Carnitine Fumarate and Acetyl-L-Carnitine carnitine supplementation, the male test
are high-quality forms used in supplements. subjects performed a 14 km run on the track
Adding the “acetyl” compound to L-Carnitine at their highest ability. The researchers found
improves its ability to be taken up and used in that carnitine supplementation increased total
various tissues, such as the brain. Using the antioxidant capacity and had positive alleviating
combination of these two forms may result in effects on biomarkers of muscle damage and
greater distribution to all the tissues in the body. lipid peroxidation.

Health Canada has issued a monograph for Then there is the 2001 research study by Y.
carnitine (2013) that includes various purposes S. Cha and coworkers that examined the
(benefits) for using carnitine supplements and effects of carnitine, caffeine, and carnitine
dosage ranges. Some of the purposes include: coingested with caffeine on metabolism and
endurance capacity in a small group of healthy
• Aids in the muscle recovery process by
reducing muscle tissue damage associated with
rugby players. High dosages were used in this
a resistance-training regimen; study compared with other studies, and not
recommended for general use, but it is worth
• Helps support muscle tissue repair in
mentioning due to the interesting improvement
individuals involved in resistance training;
results. This research study used the following
• Helps improve physical performance when drinks: caffeine at 5 mg/kg body mass in 250
used in conjunction with a training regimen;
ml water; carnitine 15 grams in 250 ml water;
• Helps delay fatigue during physical activity; caffeine 5 mg/kg body mass plus 15 grams
• Helps support fat metabolism and fat
carnitine in 250 ml water; and 250 ml water. The
oxidation; and subjects were first provided a 640 kcal meal 150
minutes prior to exercise, followed by ingestion
• Serves as an antioxidant.
of one of the experimental drinks. The exercise
testing was performed on a bicycle ergometer,
In Canada, the carnitine daily dosage range is
and metabolic testing was performed. Same-
from 1 to 4 grams per day and should not exceed
day benefits were observed, such as prolonged
2 grams per single dosage. Additionally, for
exercise to exhaustion in which all treatments
muscle recovery, muscle tissue repair, workout
were better than placebo, carnitine was better
supplement, physical performance, and anti-
than caffeine, and carnitine plus caffeine was
fatigue, take a dosage of up to 2 grams two to
better than placebo, caffeine, or carnitine.
four hours prior to exercise. It is best to refer to
The researchers concluded that their study
carnitine product directions for adequate usage
showed carnitine ingestion could promote
under doctor supervision.
fat oxidation and enhance performance in
Another study of interest by K. Parandak athletes, and carnitine plus caffeine yielded
and coworkers 2014 examined the effects of 2 greater improvements under the experimental
milligrams L-carnitine taken for two weeks on conditions. Caffeine and carnitine have different
exercise-induced oxidative stress and muscle roles in fat metabolism; for example, caffeine

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can increase release of fatty acids and increase long-distance athletes, CoQ10 may provide an
fatty acids in the blood and spare glycogen, and added boost in athletic performance.
carnitine functions by transporting fatty acids
Athletes choosing to test CoQ10 supplements
in to the mitochondria for energy production.
for athletic performance should keep detailed
As such, the study results support that although
records of their athletic performance to
both functions are important for fatty acid
determine whether measurable benefits are
metabolism and exercise endurance benefits,
occurring. Depending on the person’s natural
carnitine’s function may be more of a limiting
CoQ10 status, it may take a few to several
step in the chain of metabolic events.
weeks for performance-enhancing benefits to
occur. Endurance ergogenic dosages may range
Coenzyme Q10 from 60 milligrams to 300 milligrams per
day. Other benefits reported include improved
(Ubiquinone) aerobic power, anaerobic threshold, exercise
CoQ10 has a history of use in clinical application performance, and/or recovery after exercise.
for people suffering from cardiovascular Lower dosages are typically used in multiple
disorders. Its safety and effectiveness are well ingredient supplements, primarily for CoQ10’s
established for most people, under doctor antioxidant properties for promoting health.
supervision. Some research studies with athletes
Note that ubiquinol is a reduced form of CoQ10
report ergogenic effects, such as improved
with similar benefits. For example, Alf and
physical performance in endurance events.
coworkers (2013) found that 300 milligrams
CoQ10 is a coenzyme found in every cell’s
per day of ubiquinol for six weeks significantly
mitochondria and plays a role in oxidative
enhanced physical performance measured as
energy production of the high-energy molecule
power output among male and female German
ATP. CoQ10 is also reported to have antioxidant
Olympic athletes. Gokbel and coworkers (2010)
abilities and free-radical scavenging abilities
found a benefit of 100 milligrams per day of
to protect body cells, tissues, and so on. Much
CoQ10 supplementation after their eight-week
research has also been conducted using CoQ10
study period and concluded in their research
supplementation to improve heart function
study that according to these results, CoQ10 may
There have been a number of studies reporting show performance-enhancing effects during
benefits of CoQ10 supplement use for endurance- the repeated bouts of supramaximal exercises
type exercise and athletic performance. However, and that CoQ10 might be used as ergogenic
similar to research results on some of the other aid. Armanfar and coworkers (2015) examined
metabolites, the results of these studies have effects of CoQ10 supplement use on male
reported either a significant benefit or neutral distance runners. After subjects spent 14 days
results when compared with a placebo, which taking CoQ10 at a body weight-based dosage
means CoQ10 may or may not work the same of 5 milligrams per kilogram of body weight
way for everybody to produce significant per day, the researchers reported that, based
improvements in athletic performance. Thus for on current results, it can be concluded that the

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14-day coenzyme Q10 supplementation is more effective than is the acute

supplementation to overcome the exercise-induced adverse responses in
some oxidative, inflammatory, and biochemical parameters. Therefore,
short-term coenzyme Q10 supplementation is recommended to reduce
exercise-induced adverse consequences.

Health Canada in its monographs for Coenzyme Q10 and Ubiquinol

report the following purposes and dosage ranges: helps maintain and/
or support cardiovascular health; antioxidant for the maintenance of
good health, (CoQ10 daily dosage is 30 to 100 milligrams, one to three
times per day, and Ubiquinol daily dosage is 15 to 300 milligrams); and
as a medical use, helps reduce the frequency of migraine headaches
and associated symptoms such as nausea and vomiting, when taken as
a prophylactic (CoQ10 and Ubiquinol daily dosage range is 75 to 100
milligrams, 2 to 3 times per day.) Refer to the Canadian monographs
and product for more details, such as additional directions.

Creatine
Creatine has been used nutritionally to increase the amount of creatine
and high-energy creatine phosphate in muscle tissue. Creatine is present
in food and is manufactured in the body. It occurs in animal products,
such as meat and fish. One pound of raw steak contains about 2 grams
of creatine. But it should be noted that cooking will convert the creatine
Creatinine: a waste into its creatinine, which is quickly excreted from the kidneys. Creatine
product of creatine monohydrate is the form used most in clinical studies and proven over
metabolism.
and over again to promote significant muscle-building and strength
performance benefits.

In the body, creatine is made from the amino acids glycine, arginine,
and methionine. Normal daily dietary creatine requirements are
estimated at 2 grams per day in nonathletic individuals. ATP (adenosine
triphosphate) and CP (creatine phosphate or phosocreatine) are stored in
muscle cells and function as a pool of immediate energy. The bigger the
amounts in the muscles, the more the muscle can lift and perform short-
term maximum strength performance. CP is used to quickly replenish
ATP in fast-twitch glycolytic muscle fibers. This process takes only a
fraction of a second. Continued high-intensity levels of performance
cause fatigue to set in from metabolic waste products.

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Creatine loading can therefore result in help provide the body and muscle tissues with a
improving training intensity and recovery in constant supply. Consistency of use is important,
anaerobic sports by loading up the muscles’ using safe and effective dosages, and duration
resting reserve of creatine phosphate. In other of use as determined by experts under doctor
words, the more creatine and creatine phosphate supervision.
the muscles have on hand, the more ATP can be
replenished during bursts of all-out effort. Of If meal intake is timed correctly around
the dozens of studies conducted using creatine workouts, then taking creatine around mealtime
supplementation during the 1990s to today, will be sufficient. Creatine can be combined with
improvements in strength performance were other nutrients and metabolites, like vitamins,
observed mostly in sports that exhibited all-out minerals, protein, BCAAs, and glutamine. In
effort for less than 30 seconds. For example, addition, creatine monohydrate has the most
creatine supplementation improved performance research studies backing its effectiveness.
in weightlifting, powerlifting, football, short
Health Canada has issued an evidence-based
duration track and field events (sprinting,
creatine monograph in 2011 for creatine
jumping, throwing, etc.), vertical jump
monohydrate. Some of the benefits of taking
performance, 300-meter sprint, and short rowing
creatine supplements include:
events. Increases in VOmax have been observed
in a limited number of studies on untrained • Increases body/muscle/lean and mass/size
and moderately active individuals. In addition, when used in conjunction with a resistance-
training program;
the most consistent effect of taking creatine is
an increase in lean body mass, which has made • Improves strength/power/performance
creatine popular among bodybuilders and other in repetitive bouts of brief, highly intense
physical activity from increasing muscle and
athletes wanting to increase muscle mass and
intramuscular creatine, phosphocreatine, and
body weight.
energy levels, for example, sprints, jumping,
One thing is clear from all of this research: if and resistance training.

you are exercising to improve strength, muscle • Creatine monohydrate dosage examples for
mass, and physical performance, creatine works healthy adults include a short-term loading
to enhance these effects more significantly. phase followed by a lower daily dosage
Most research also reports that athletes taking maintenance phase, for example:

creatine are in fact reported to reduce the risk • Loading phase option 1:15 to 20 grams per
of all injuries, including muscle cramps when day, not to exceed 5 grams per dosage; five to
compared with taking a placebo. seven days

• Or Loading phase option 2: 3 to 5 grams per

The table on the following page provides an
day, for a minimum of four weeks
overview of creatine benefits. Like the other
nutrients, taking creatine on a consistent basis, • Maintenance phase: 2 to 5 grams per day
in divided dosages two or more times a day, will

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Summary of Some of the Effects of Creatine Monohydrate Supplementation

This table includes a summary of the major conclusions about how creatine monohydrate supplementation improves
body composition, physiology, physical performance, and athletic performance.

Body Composition and Physiolo- Athletic Performance Related Athletic Performance Improve-
gy Related Improvements Improvements ments Sports
• Promotes greater gains in increasing • Improves rate of training induced Reported In Research Studies:
FFM (Fat Free Mass, which includes gains.
muscle mass). • Bodybuilding
• Improves maximal strength and
• Increases muscle fiber size power about 15%. • Football
• (hypertrophy). • Improves work performed during • Handball / Squash
maximal effort muscle contractions • Hockey
• Increases muscle mass.
about 15%.
• Increases myosin muscle fiber • Military Performance
• Improves anaerobic power.
content. • Powerlifting
• Improves single-effort sprint perfor-
• Improves strength training • Softball / Baseball
mance about 5%.
adaptations.
• Improves multiple sprint • Soccer
• Improves limb blood flow.
performance. • Sprint running Sprint cycling Sprint
• Reduced ammonia levels. rowing Weightlifting Wrestling
• Improves work performed during
• Reduced lactate levels. repetitive sprint performance about Sports In Which Improvements Are
• Raises lactate threshold. 15%. Expected Due to the Bio- energetic
• Improves performance during exer- Nature of the Sport:
• Reduces cholesterol levels.
cise of high to maximal intensity. • Sports involving short-term sus-
• Reduces homocysteine levels.
• Increased number of weightlifting tained, or periodic maximum effort
• Increases in muscle satellite cells repetitions. strength and power, such as:
(muscle fiber precursor cells).
• Increased number of weightlifting • Basketball
Benefits have been measured in men sets. • Bobsledding
and women; young and old (teenag-
• Greater gains in vertical jump height • Bowling
ers to over 70 years of age); and inac- and power.
tive, active, and athletic individuals. • Boxing
• Increased 1 repetition maximum.
Note: creatine supplementation has • Canoeing / Kayaking
• Increased peak force.
not been shown to increase long-term • Curling
endurance physical / sport / exercise • Increased peak power.
• Decathlon Fencing Golf
performance. Other supplements, • Reduction of athletic injury rates,
such as carnitine, certain carbohy- such as: reduced muscle cramp- • Ice Skating
drates, etc. have been reported to ing, reduced dehydration, reduced • Lacrosse Martial Arts Rodeo
stimulate significant improvements. muscle tightness, reduced muscle
pulls, reduced muscle strains, re- • Skiing, downhill
duced joint injuries, reduced contact • Tennis
injuries, reduced illness, reduced
number of missed practices, and • Track and Field events that use an-
reduction in total injuries during the aerobic energy systems, such
season. • as shot put, high jump, long jump,
• etc.

These dosage examples are consistent with the based on the daily amount. Larger strength
dosages proven effective in the research studies. athletes may require higher daily dosages during
Note that creatine is best taken in divided the loading and maintenance phase, which can
dosages each day, two to four smaller dosages, be determined for individual athletes under

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 Metabolites and Botanical Supplements | 277

doctor supervision, especially for people with to 200 milligrams of ferulic acid per day and/or
kidney disorders or any other abnormal health 300–900 milligrams of gamma oryzanol per day.
condition. Gastrointestinal distress may occur.
Eslami and coworkers (2014) found that 600
It is important to completely dissolve creatine
monohydrate before digesting. Creatine is also milligrams per day of gamma oryzanol resulted
compatible with other supplements and food, in improving gains in strength, in the strength-
such as protein or carbohydrates, but if mixed training male subjects at the end of the nine-
with other nutrients, faster digestion rate is week study period. The significant increases
important to maintain to reduce breakdown of in strength included 1-RM of bench press and
creatine to creatinine in the stomach. Also note leg curl, which showed that gamma oryzanol
that elevated creatinine blood and urine levels improved muscle strength following resistance
can occur. Doctors will observe this and may training. Changes in body composition were
be concerned about disorders that are related to not significant. This 2014 study demonstrates
high creatinine levels, such as kidney diseases. how the earlier researchers were indeed on to
Explain to the doctor about creatine supplement something and is confirmation of previous
use, which may need to be discontinued until findings and widespread use by athletes of a
normal creatinine levels are demonstrated and potential gamma oryzanol supplement benefit
kidney disorder is ruled out. Product labels will that may have practical applications for strength-
also have use instructions. training athletes and for fitness exercisers.
Research also reports cardiovascular health
benefits of rice bran oil and gamma oryzanol
Gamma Oryzanol that may be of interest to athletes, such as
and Ferulic Acid lowering cholesterol levels.
Gamma oryzanol is a substance extracted
from rice bran oil that has been reported to
Ginsengs
promote a variety of metabolic effects, including
increased endorphin release, antioxidant action, Several types of ginseng have been in use for
lipotropic action, stress reduction, growth thousands of years as overall promoters of
hormone stimulation, growth, and recovery in good health and improved energy. The types
various types of research studies. Ferulic acid is of ginseng primarily found in supplements are
a part of the gamma oryzanol molecule that is Chinese ginseng (Panax ginseng), American
also available as a supplement. Improvements ginseng (Panax quinquefolius), and the related
reported in the scientific literature include species, Siberian ginseng (Eleutherococcus
increased strength, improved recovery, reduced senticosus), also referred to as Ciwujia and
muscle soreness, reduced sensation of fatigue, Eleuthero. Herbalists report that American
and decreased catabolic effects of cortisol. Short- ginseng is less stimulatory. Chinese ginseng and
term use in research studies reported some Siberian ginseng are the ones most researched
potential benefits with dosages of 30 milligrams and used for improving athletic performance.

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The primary “active” components of ginseng are a With ginseng, most preparations use 2 to 4
group of sponin compounds called ginsenosides/ percent standardized ginseng products as a
panaxosides and eleutherosides in Siberian common guideline. Ginseng products range
Ginseng. Ginseng also contains the trace mineral from single ingredient to multiple ingredients.
germanium, which has been shown to exhibit Chinese ginseng combined with royal jelly is
overall health effects and increase the body’s a traditional combination for energy. Siberian
supply of oxygen. Ginsengs also contain other ginseng has been the favorite of Russian athletes,
substances, including botanical antioxidants. who are reported to use it regularly. Chinese
ginseng is also widely used and well researched.
Some of the benefits reported in the research and Another researched combination is ginseng
based on traditional use include the following: with ginkgo. Dosages of ginseng range between
• Improved physical performance Improved 100 milligrams to 1 gram per day during the
oxygen uptake Improved post exercise season and preseason and as needed during
recovery Improved exercise total workload the off-season. Ginseng is also found in some
• Improved aerobic capacity
good-quality sports multi-vitamin/mineral
supplements, which offer convenience. Safe
• Improved strength performance Increased time and effective types of ginseng(s), dosage, and
to exhaustion
duration of use should be determined by experts,
• Reduction of lactate levels during exercise under doctor supervision. There are various
• potential health concerns and contraindications
• Improved VO2 max
related to using the ginseng(s). Also, note that
• Reduced body fat ginseng has stimulant effects, so use with other
• Increased fatty acid utilization for energy stimulant supplements, foods, or drugs is of
concern, as is use with other types of drugs.
• Improved heart rate recovery

• Improved mental performance Improved Health Canada has also published

visual reaction time Improved psychomotor monographs for ginsengs. Some examples
performance Reduced feelings of fatigue of ginsengs’ uses/benefits of interest to
Improved visual reaction times Improved recall athletes may include the following:
• Improved alertness • Improve mental and or physical
• Improved motor skill coordination performance after periods of mental
and or physical performance
• Improved auditory reaction time
• Help maintain a healthy immune system
• Decreased eyestrain
• May affect glucose levels
Research reports a range of results from neutral • Support cognitive function and/or reduce
to very significant improvements. When you mental fatigue in cases of mental stress
add up the results from the dozens of research • Help enhance physical capacity/performance
studies, one thing is certain” taking ginseng in cases of physical stress
provides some level of benefit for improved • Offer other medical uses that may apply
physical and or mental performance. to athletes

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Ciwujia (Eleuthero Root) Research Study Focus Examples

Kuo and coworkers reported from their study that after eight weeks of supplementation ciwujia “en-
hanced endurance capacity and improved cardiovascular function.” The study used a double-blind,
placebo-controlled crossover design with a washout period of four weeks between cycling trials.
Cyclists consumed either a placebo or 800mg of ciwujia. Following a 5-minute warm-up, the pace
•
increased to 75% VO2 peak. Ratings of perceived exertion, heart rate and respiratory exchange ratio
were measured at rest, 15, 30 min and exhaustion. Subjects receiving ciwujia supplementation had
•
a 23% improvement in endurance time to exhaustion, a 12% improvement in VO2 peak, an increase
in heart rate with no increase in ratings of perceived exertion and an increase in fatty acid oxidation.
(Kuo 2010)
In another research study, Kuo and coworkers found that ciwujia supplementation for eight weeks
increases fat oxidation in working muscles during hig-intensity exercise and improves cardiorespirato-
ry function. Eighteen healthy male and female college students participated in an eight-week dou-
ble-blind study. Subjects consumed daily an oral dose of 600mg of ciwujia and at week 0 and week 8
completed a cycling exhaustion exercise test. The subjects receiving ciwujia supplementation had a
statistically significant increase in endurance time of 36%, an increase in maximum heart rate of 4%,
a decrease in blood lactic acid of 18%, and a 20% increase in fatty acid metabolism. No side effects
were reported (Kuo 2007).
In yet another research study, Kuo and coworkers again showed that after 28 days of treatment with
ciwujia, there was a significant increase in running time to exhaustion, heart rate, and fat metabo-
lism. Ten long distance runners consumed ciwujia or placebo for 28 days and then were evaluated for
running time to exhaustion, heart rate max and fat metabolism. The group consuming ciwujia had an
increase in endurance, an increase in heart rate and an increase in fatty acid metabolism. The authors
concluded that supplementation with 800mg of ciwujia for 28 days improved endurance capacity
and had no side effects during the study period. (Kuo 2006)
In a study previous to the Kuo et al. series of studies, Wu and coworkers determined that ciwujia
increased fat metabolism, increased the anaerobic threshold, and delayed the occurrence of fatigue.
Sixteen healthy male adults received ciwujia or a placebo for two weeks. Both before and after two
weeks, subjects underwent tests measuring aerobic and anaerobic power. Researchers found that
subjects receiving ciwujia had a decrease in blood lactate levels of 31%–33%. The change in lactate
levels was paralleled by a similar change in heart rate. Based on change in respiratory quotient, ciwu-
jia increased energy contributed from fat by 43%. The authors concluded that these results indicated
that use of ciwujia can have positive implications for athletes because of a glycogen-sparing effect
and increase in the anaerobic threshold (Wu 1996).

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Glucosamine and
Chondroitin Sulfate (CS)
In the body, there are several types of connective
tissues. Cartilage, tendons, ligaments,
intervertebral discs, pads between joints,
and cellular membranes all are composed of
connective tissue. All connective tissues have
two common components, chief of which is
collagen. One-third of the body’s total protein
volume is composed of collagen, making it the
most common protein in the body. The other
component is proteoglycans (PGs). PGs form the
“framework” for collagenous tissue. in the first place by maintaining adequate
These huge structural “macromolecules” are connective tissues in your body. In human
composed mainly of glycosaminoglycans clinical trials, glucosamine given orally in
(GAGs)—long chains of modified sugars. The doses of 750–1,500 milligrams daily was
principal sugar in PGs is called hyaluronic acid, observed to initiate a reversal of connective
50 percent of which is composed of glucosamine. tissue degeneration, promote connective tissue
The principal amino acids forming collagen maintenance, and also reduce pain in the knee
are proline, glycine, and lysine. Collagen and of athletes. Glucosamine as a supplement clearly
PGs must somehow “get together” during the aids in connective tissue synthesis. All athletes
production of new connective tissue. Of the need such a substance, as the repair and growth
multitude of biochemical reactions that must of connective tissue is never-ending. Research
take place during the synthesis of connective has confirmed that both glucosamine HCl and
tissue, there is one critical “rate-limiting” glucosamine sulfate are effective and may be
step that, once reached, guarantees that useful for athletes to help maintain and promote
new connective tissue is being successfully healthy connective tissues and joints.
synthesized. That rate-limiting step is the
conversion of glucose to glucosamine. Benefits for Athletes Are Actually
Glucosamine is the single most important
Old News
substance in the synthesis of connective tissue. In 1984, researchers in Frankfurt, Germany,
More than 30 years of research has gone into brought to the attention of the world the
understanding how glucosamine acts as the benefits of glucosamine for healing knee
precursor of GAG synthesis. Glucosamine is problems in young athletes. A condition called
so effective, it repairs connective tissue and chondropathia patellae is a common disorder of
may very well be a way to reduce the risk of the knee in young athletes. The healing of this
connective tissues problems from occurring affliction must be rapid to avoid the development

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of future serious degenerative joint disease. After Research has found that when taken together,
taking a glucosamine supplement (1,500 mg they have a synergistic effect. One issue with
per day for a few months), the teenage athletes CS is the high-quality, standardized raw
quickly recovered and returned to training. material is several times more expensive than
Reduction in knee pain was observed in just glucosamine and unstandardized powdered
a few weeks. Furthermore, after a 12-month forms of CS are. Thus, glucosamine tends
period of these athletes’ returning to training, to be a cost-effective approach to promote
researchers observed that the athletes did not connective health. People who do not respond to
experience a recurrence of the knee problem. glucosamine supplementation after three months
The results of this landmark study clearly of use should consider using CS along with the
demonstrated the potent connective tissue glucosamine. There are even connective tissue
repair, growth-promoting, and maintenance supplements now sold for pets that you may
abilities of glucosamine supplements for athletes. know about from the advertising or may already
The supplements also can help prevent future be using for your pet.
joint problems, including development of
Health Canada has approved-use monographs
osteoarthritis; this is all too common among
for glucosamine and CS. Some of the purposes
athletes and the physically active.
and uses include:
• For Glucosamine Sulfate: Helps to relieve joint
Research Reports More Benefits pain associated with osteoarthritis; Helps to
from Taking G&CS Supplements relieve pain associated with osteoarthritis of the
knee; Helps to protect against the deterioration
The more recent studies even show that taking
of cartilage; and A factor in maintaining good
G&CS supplements helps reduce joint space cartilage and/or joint health. Adult dosage
narrowing due to connective tissue wear-and- example is 1,500 milligrams per day, minimum
tear and can even prevent osteoarthritis from four weeks to see beneficial effects.
developing in the first place. Remember G&CS • For Glucosamine Hydrochloride: A factor
builds connective tissues, such as skin, tendons, in maintaining healthy cartilage; Helps
ligaments, bone, and cartilage, which form the to maintain healthy cartilage; A factor in
matrix that is involved in holding the entire body maintaining joint health; and Helps to maintain
together. G&CS are made by the body similar joint health. Adult dosage example is 1,500–
2,000 milligrams per day, minimum four weeks
to other metabolites, such as creatine, but active
to see beneficial effects.
people (especially athletes) create a demand for
• For Chondroitin Sulfate: Helps to relieve joint
these substances that can be greater than the
pain associated with osteoarthritis; and Helps
body can supply.
to relieve pain associated with osteoarthritis of
Similar to glucosamine, chondroitin sulfate the knee. Adult dosage example is 800–1,200
milligrams per day, minimum of three months
has been tested in humans as a promoter
to see beneficial effects.
of connective tissue maintenance, growth,
and repair. It is important to note that both Consult the monographs for complete
glucosamine and CS are effective on their own. information for safe and effective use.

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Melatonin
Melatonin is another metabolite substance The amounts typically used successfully in
produced by the body. Melatonin supplements studies for short-term use have ranged from 0.5
have not necessarily been shown to directly milligrams to 6 milligrams per day, although
improve athletic performance, but they have up to 10 milligrams per day is sometimes
been shown to indirectly improve performance recommended. However, until researchers
by stimulating certain bodily processes. determine the effects of long-term supplemental
Melatonin causes deep restful sleep. When use of melatonin, use only when needed for
quality sleep is had, growth hormone, IGF, and short periods of time, several days up to 4 weeks.
testosterone levels are increased, which promote There are also approved melatonin products in
muscle growth and repair. Additionally, the deep Canada that are sublingual, for faster absorption
sleep reduces cortisol levels, so the melatonin- and action. Research has also been conducted
promoted deep sleep has beneficial anti-catabolic using sustained release melatonin, with seems to
effects along with anabolic effects. work better at prolonging sleep by maintaining
effective melatonin blood levels longer, compared
According to several studies, melatonin helps to the regular dosage forms. Health Canada
people fall asleep more quickly, stay asleep, and determined various sleep related purposes for
enjoy a more restful sleep. Furthermore, it does melatonin, including possible side effects and
this without causing sleep hangover, which warnings published in their monograph.
is an after-effect of most sleep medications.
Researchers have determined that when the For safest use, consult your doctor before using,
sun sets, the body’s melatonin level begins as there are some potential side effects, including
to rise. At dawn, the body’s melatonin incompatibility with drugs and for people with
level begins to drop again. There are times, certain conditions. In addition, disturbed sleep
however, when the body’s natural melatonin could be a symptom of a disease. Some potential
production may be upset. Traveling across use concerns include people with hormonal
time zones disrupts melatonin production, disorders, diabetes, liver disease, cerebral palsy,
causing what is commonly known as jet lag. seizure disorders, migraine, depression, and
hypertension and may be incompatible with
Nervousness before an important athletic event immunosuppressive, sedative, and hypnotic
affects melatonin production, as does the stress medications. As melatonin causes sleepiness,
of training. Staying up late to study for a test, avoid driving, operating machinery or similar
catch up on work, reading, or watching television activities for at least five hours after taking
can also be disruptive because, according melatonin. Avoid use with alcohol and sedative
to researchers, lamplight may be enough to supplement products and drugs. Disturbed sleep
suppress proper melatonin production. Millions may be a symptom of a serious health condition,
of people have been using supplemental which requires proper diagnosis and treatment
melatonin with no apparent major side effects. by a doctor.

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 Metabolites and Botanical Supplements | 283

Nitrates
Research has determined that dietary nitrates involving a placebo condition and at least one
are associated with health promoting effects, condition using nitrate supplementation.
in particular for the circulatory system, and • 12 studies used beetroot as source of nitrate
additional research conducted using dietary (11 juice, 1 whole beetroot).
nitrates has revealed a sports and exercise
• 5 studies used sodium nitrate, and 1 study
performance benefit for some types of athletes used potassium nitrate.
and exercisers. Dietary nitrate increases body
• 8 studies looked at effects from single dosing
plasma nitrate, and this in turn can increase the
75 to 180 minutes before exercise.
nitric oxide (NO) levels. Increased NO levels
can improve blood vessel dilation, improve • 10 studies used chronic dosing, ranging from
several boluses over a 24-hour period before
blood flow, and improve glucose uptake and
exercise, to 15 days of nitrate loading.
other body functions beneficial for exercising
muscle and cardiovascular system health. Note • Research evidence suggests dietary nitrate may
aid in endurance exercise performance. Small
that arginine- and citrulline-mediated NO
benefits were observed in some studies.
production uses a different pathway.
Benefits for athletes and nonathletes are
Benefits from nitrate supplements, such as from
possible from dietary nitrates in terms of
beetroot, may be variable due to other dietary
increasing physical endurance during exercise
nitrate sources, use of other NO-boosting
or athletic events and improving cardiovascular
supplements, and health conditions of an
health. Although there are various foods and
athlete. In studies where significant benefits
supplements that now contain ingredients like
in endurance exercise performance based on
beetroot juice to boost dietary nitrate content,
statistical analysis were not attained, researchers
it is challenging to provide general dosage
report that a trend toward improvements are
examples due to the other dietary factors that
often observed that might not meet the level of
supply dietary nitrate or have similar NO-
statistical significance but that may be important
increasing effects, such as arginine, citrulline,
to competitive athletes looking to improve their
and the following entry, Pycnogenol. Health
athletic performance by any amount in a positive
concerns, such as lowering blood pressure from
direction. Regardless, dietary nitrates are
increasing NO in the body, causing vasodilation,
certainly an interesting evolving area of sports
may be a problem for some people. People
and health nutrition to be aware of.
interested in application of this new growing
Scientific evidence is mounting, and Hoon area of sports and healthy nutrition can consult
and coworkers (2013) gathered and reviewed the scientific references for additional details and
17 studies. Nine studies used athletic trained contact sports nutrition and other health product
subjects. Eight studies used recreationally fit companies that sell beetroot juice and other
subjects. All studies were controlled trials nitrate-containing products for safe and effective
that employed a randomized crossover design use under doctor supervision.

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Pycnogenol
Pycnogenol is a trade name for a compound of The clinically proven benefits of Pycnogenol
natural antioxidants extracted from the bark of are numerous. Here are some benefits of
the French Maritime pine tree—Pinus pinaster, interest to athletes:
referred to as French Maritime pine bark extract. • Increased nitric oxide in blood vessels, causing
Loaded with bioflavonoids and other biologically increased blood flow
active phytonutrients, or plant nutrients, • Antioxidant activity; reduced exercise-related
Pycnogenol is backed by clinical research and a oxidative stress
history of use. Studies show that Pycnogenol— • Strengthening of capillary walls
a powerful antioxidant—has cardiovascular • Improve healing time
benefits, boosts the immune system, • Reduce edema
improves the appearance of the skin,
• Alleviates cramping and muscular pain in
treats varicose veins, relieves the pain of sports
arthritis, and reduces inflammation.
• Enhances sports endurance
Pycnogenol is indeed a bioflavonoid-containing • Increase in 2-mile running time
plant extracts that has undergone numerous • Increase number of push-ups and sit-ups
experimental and clinical research studies to • Swimming, biking, and running performance
determine its effects on the human body. Because scores improved
Pycnogenol is a standardized extract—meaning • Triathlon time improved, reduced
that each batch of Pycnogenol contains the same • Improved cognitive function
amounts of bioflavonoids and procyanidins—
• Skin, eye, joint, circulatory system health
other researchers can use it in their experiments improvements
to confirm the results of previous studies. This
• Reasonable suggested daily dosage
is one of the important criteria of scientific
research—that experiments can be successfully Dosages reported to be effective in the research
reproduced by other researchers and important studies for athletes and fitness exercisers: 100–
for consistency of beneficial effects. Once a 200 milligrams per day. Good record of safety
substance becomes standardized, it often attracts based on research study dosages and duration
much scientific attention to duplicate previous of uses. Measurable benefits may take a few to
research and for new research. several weeks.

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Conclusion
Metabolites and botanicals are a diverse group use, under doctor supervision. Evaluate
of ingredients used in supplements. They can during the off- and preseasons which of these
affect body function and structure; promote supplements may provide a benefit for athletes.
athletic performance, some exhibiting direct Keep detailed notes and use a scientific research
measurable ergogenic benefits; while others approach evaluating one at a time to determine
influence general body function that can safety and effectiveness. Then, if appropriate,
support improved health. Duration of use is add another metabolite or botanical to the
generally short, such as a few to several months, program that may provide even more benefits
with some that may be suitable for long-term for improved athletic performance.

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 Summary of Commonly Available Botanicals,
Standardization, and Use Examples
The following botanicals are commonly used by athletes and nonathletes. Fitness trainers and other
health professionals can be confronted with discussing such botanical products with their clients.
Although some of the botanicals may provide benefits that can improve health and or athletic perfor-
mance, the primary intent of this table is for overview purposes and general knowledge.
The table contains the following columns:
• Botanical names. Common name and scientific name.
• Standardized constituent. Primary bio-active(s). But be aware that additional bio-actives may be
present.
• Examples of Some Uses. Uses based on traditional use and or clinical research evidence. Addi-
tional uses may also exist.
• Personal Notes Section. A column for making various notes, such as dosages from product
labels or other sources; input from other sources, health professionals and clients.
Note: The use of botanicals should be undertaken with caution and doctor supervision. Some herbs
can be used on an almost a daily basis for health purposes, such as grape seed extract and garlic;
while some herbs are intended for short-term use, which may range from several days, several weeks,
or a few months at a time. The following table is for information purposes, and is not intended to re-
place medical advice. If you have any concerns about using a particular herb, consult your health-care
practitioner and the product manufacturing company to confirm proper safe and effective usage.

Botanical Standarization Examples of Some Uses Personal Notes

Section
Names Constituent Including Examples of Traditional Uses
and Clinical Research Evidence- Based
Uses.
Bilberry Anthocyanosides Supports eye health and visual acuity, treats
eye disorders. Antioxidant.
Vaccinium myrtillus 15% to 25%
Bromelain Gelatin-digesting units Treatment of sports injuries to promote
(GDU) healing and anti-inflammation.
Ananas comosus
2,000 GDU per gram
Black Cohosh Triterpenes Used to relieve symptoms associated with
(27-deoxyaceteine), 1% PMS and menopause.
Cimicifuga racemosa
Chamomile Apigenin,1% to 2% Treats some gastrointestinal disturbances,
and promotes calming.
Matricaria chamomilla Essential Oil, 0.5%
Echinacea Phenolics, echinaco- Simulates immune system, treats colds and
sides, or sesquiterpene flu, and reduces associated symptoms and
Echinacea purpurea esters, 4% duration.
E. angustifolia
Feverfew Parthenolide, 0.1% to Prevents migraine headaches.
1.2%
Tanacetum parthenium

Sports Nutrition
Botanical Standarization Examples of Some Uses Personal Notes
Section
Names Constituent Including Examples of Traditional Uses
and Clinical Research Evidence- Based
Uses.
Garlic Allicin, 1%. Lower cholesterol and blood pressure.

Allium sativum
Ginkgo Ginkgo flavone gly- Improves blood flow, brain function, and
cosides, 24%, and memory; antioxidant activity.
Ginkgo biloba terpenes, 6%
Gotu kola Asiaticosides, 10% to Stimulates connective tissue development
30% and healing; increases skin building; may
Centella asiatica improve mental function.
Grape Seed Extract Protanthocyanidins, Antioxidant, protects capillaries and connec-
40% to 95% tive tissues, decreases platelet aggregation,
Vitis vinifera improves circulation.
Green Tea Catechins/polyphenols Antioxidant; protects against digestive and
(epigallocatechin gal- respiratory infections. Preventative health
Camellia sinensis late), 50% to 65%. Also for some cancers and cardiovascular disease.
contains caffeine Weight-loss aid; thermogenic.
Guarana Xanthines: guaranine Stimulant activities due to xanthines; anti-fa-
(natural caffeine), theo- tigue; mild diuretic.
Paullinia cupana bromine, theophylline),
12.5 to 60%
Horse Chestnut Aescin, 2% to 12% Increases tonus of veins. Used in treatment
of hemorrhoids, varicose veins, and other
Aesculus hippocastanum venous insufficiencies.
Kava Kava Kavalactones, 30% Promotes relaxation, reduces anxiety, pro-
motes restful sleep.
Piper methysticum
Licorice root Glycyrrhizin, 2 % to Anti-inflammatory activity; used in treating
12%. GI ulcers, as an adrenal insufficiency, and as
Glycyrrhiza glabra an expectorant.
Milk Thistle Silymarin, 80% Heals liver; liver protectant; counteracts
some substances that damage liver.
Silybum marianum
Rhodiola 0.8–3% salidroside Adaptogen to temporary relieve symp-
toms of stress, such as mental fatigue and
Rhodiola rosea 1–6% rosavins sensation of weakness. Supports cognitive
function such as mental focus and stamina.
Provides antioxidants.
Saw Palmetto Fatty Acids (sterols), Used to treat benign prostatic hypertrophy.
80% Reduces prostate inflammation. May reduce
Serenoa repens the conversion of some testosterone to
estrogen.
St. John’s Wort Hypericin, 0.3% Used to promote a positive mood and to re-
duce depression, nervousness, and anxiety.
Hypericum perforatum
Turmeric Curcuminiods Antioxidant, aid digestion, liver protectant,
anti-inflammatory, relieves pain, and assists
Curcuma longa healing.
Tribulus (Tribulin tm) Saponins (furanos- Traditionally used for impotence and an-
terols), 20% ti-aging, not for muscle-building anabolic
Tribulus terrestris properties.
Valerian Root Valerianic acids, 0.8% Used for sleep, a sedative, and to reduce
nervous tension.
Valeriana officinalis
White Willow Salicin, 8%. Also con- Reduces pain and inflammations.
tains salicortin and oth-
Salix alba er phenolic glycosides International Sports Sciences Association
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Key Words
Capillary Creatinine

Sports Nutrition
 Topics Covered In This Unit

Introduction

All foods are not created equal

Understanding food and

supplement labels

Food and supplement labeling basics

Revised nutrition facts

Super foods:
dietary supplements are born

Revised Supplement Facts Panel

Foods versus supplements

 ajor dietary supplement forms

M
and delivery systems

 ajor categories of sport nutrition

M
and supplements

The economics of sports nutrition

 evised Daily Reference Values (DRVs)

R
and Reference Daily Intakes (RDIs)

Conclusion

UNIT 10

GUIDE TO FOOD AND

SUPPLEMENT PRODUCT LABELING
290 | Unit 10

Unit Outline
I. Introduction viii. Why is trans fat still on the label if the
FDA is phasing it out?
II. All foods are not created equal
ix. Why are vitamin D and potassium being
III. Understanding food and
added to the Nutrition Facts label?
supplement labels
x. Why is the FDA no longer requiring
a. Food and supplement labeling basics
vitamins A and C to be included on
i. Principal display panel (PDP) the label?
ii. Nutritional Panel xi. Serving Sizes

b. Revised nutrition facts IV. Super foods:

dietary supplements are born
i. Features a refreshed design
a. Revised Supplement Facts Panel
ii. Revised information and
nutrition science V. Foods versus supplements
iii. Updated serving sizes and labeling VI. Major dietary supplement forms
requirements for certain package sizes and delivery systems
iv. Label format: original versus revised VII. Major categories of sport nutrition
v. Revised label with changes and supplements

vi. Serving size changes VIII. The economics of sports nutrition

vii. How does the FDA define IX. Revised Daily Reference Values (DRVs)
“added sugars”? and Reference Daily Intakes (RDIs)
X. Conclusion

Learning Objectives
After completing this unit, you will be able to:
• Define and describe terms related to food and supplement labeling and packaging;

• Discuss the different forms and types of supplements;

• Be aware of revised nutrition labeling and nutrient reference values for 2018; and

• Discuss application of “chrononutritionals.”

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 Guide to Food and Supplement Product Labeling | 291

Introduction
The nutrients, metabolites, and herbs described in previous units occur
in different combinations and amounts as foods and supplements.
Foods come in many types, such as whole foods, processed foods, Whole food: food that
frozen foods, canned foods, and aged foods. The selection of is in its natural, complete
state; unprocessed food.
supplements is also quite diversified. Vitamins, minerals, herbs,
many types of sports supplements, energy pills, and powdered meal
replacements can be found on the shelves in the form of tablets,
capsules, liquids, and powders.

The growing available supply of food and supplement choices often

leaves the athlete bewildered and forced into a great deal of trial and
error shopping and experimentation. This unit will provide an overview
of the different types of nutrient sources available to you so that you
are familiar with the various options and can target the right stuff.
This unit also reviews some of the main features of labels and labeling
requirements required by FDA regulations.

Athletic Significance of Food and Sports Supplements

Food supplies the basic caloric and macronutrient intake of an athlete’s diet.
Choose wholesome foods.
Avoid or minimize processed foods.
Avoid foods high in saturated fat, cholesterol, and sodium.
Choose foods high in complex carbohydrates and fiber, protein sources low in fat, foods high in nutri-
ents (nutrient dense), and whole grains.
Eat several servings of fruits and vegetables each day.
Make use of Sport Nutrition Supplements.
Sports supplements can provide superior high performance nutrition.
Sports supplements are scientifically developed super foods that target athletes’ special performance
nutrition needs.
Scientific studies show that many sports supplements do improve performance and recovery, improve
heath, and can even reduce risk of certain diseases.

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All Foods Are Not Created Equal

From the start, you should know that the after about 100 years of experimenting with
nutrient content of food varies considerably. This chemicals in foods, the 21st century was greeted
variation can occur from location to location with the growing trend of more organic whole
and even within the same location from year foods of local origin.
to year. This inconsistency has been one major
But even when eating the heathiest of foods, you
flaw in the nutrition approaches taken at the
need to watch the kind and the amounts you are
institutional level, which assume a potato from
eating. A common misconception is that you
Idaho has the exact same nutrient content as
can eat as much as you want of every food found
a potato grown in Maine does. In the past,
in a health food store. Nevertheless, eating even
dealing with this unknown nutrient content
too much of a good thing can be unhealthy and
variable was difficult, but with the help of
can eventually slow you down. If you check the
today’s modern food technology, meeting your
labels, you will see that many health foods are
special athletic nutrient demands is now more
high in fat, albeit unsaturated healthy fats.
effectively accomplished. The use of special
food preparations and sport supplements makes Aside from fresh whole foods, there are myriad
getting the performance nutrition you need more processed foods. In some respects, processed
reliable and economical. foods are similar to supplements. They are made
from various ingredients concocted to make
To add to this food saga, some foods tend to be
edible (if not delicious) food products. Some
healthier than others. The term “wholesome” has
processed foods may have reduced nutrition
become a popular way to describe foods that are
potential from the processing, but primarily they
supposed to be fresh, healthy, and packed with
are typically loaded with chemical additives to
nutrients. However, many marketing companies
help with the manufacturing process, increase
use “wholesome” to describe whatever food they
shelf life, improve appearance, and add to flavor.
are selling, including high-fat baked goods. The
In addition, it is common that processed foods
primary good foods to look for are fresh fruit
are higher in fat or sodium content. Looking
and vegetables, whole grains and cereals, lean
at processed foods as a group, you will see that
meats, fish, and poultry: whole foods.
some may offer poor nutrition choices; however,
In response to a growing demand to offer the some like nutrition bars and drinks and frozen
consumer healthier foods, health food stores foods may offer adequate or healthier processed
and the health food trade continues to grow, and food choices. Also, fresh prepared processed
health food sections can be found in grocery foods of all types can be on the healthier side
stores. Keep in mind that prior to the 1900s, in general, due to being made, for example, at
before the invention and widespread use of the the stores, deli, bakery, juice bar, restaurants,
many chemicals used both on and in foods, the farmer’s markets, other local fresh prepared food
world was organic. Thus, it is interesting that product stores, or health food stores. The lesson

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ORGANIC AGRICULTURE IN THE USA

According to the United States Department of Agriculture, organic agriculture produces products us-
ing methods that preserve the environment and avoid most synthetic materials, such as pesticides and
antibiotics. USDA organic standards describe how farmers grow crops and raise livestock and which
materials they may use.
Organic farmers, ranchers, and food processors follow a defined set of standards to produce organic
food and fiber. Congress described general organic principles in the Organic Foods Production Act,
and the USDA defines specific organic standards. These standards cover the product from farm to
table, including soil and water quality, pest control, livestock practices, and rules for food additives.
• Organic farms and processors:
• Preserve natural resources and biodiversity
• Support animal health and welfare
• Provide access to the outdoors so that animals can exercise their natural behaviors
• Only use approved materials
• Do not use genetically modified ingredients
• Receive annual onsite inspections
• Separate organic food from non-organic food

for purchasing foods for preparation at home and built-in cravings that, once triggered, allow us to
when eating out is to do your homework to make consume large amounts of food containing these
sure they are the freshest, most nutritious foods specific nutrients. That’s why most of us can eat a
available and read the nutrition information of pound of potato chips in a few minutes, but when
food products to help select products that are it comes to the good stuff, like broccoli, we can’t
healthier nutrition choices and nutrient dense. stand to eat even a few pieces. When striving for
What are the good things about processed maximum performance, athletes must exercise
foods? They generally taste great, and this is willpower over what they eat. Stay away from the
what keeps us coming back for more. Scientists junk foods and the processed foods: eat the good
speculate that the reason we crave snack foods stuff! One exception, supplements. Supplement
is due to the nutrient content such as fat, simple products are a type of processed super-food, a
carbohydrates, and sodium that were not type of food that is intentionally designed to
plentiful eons ago when humans depended on be healthy, with multiple functions including
hunting and gathering their food. To compensate supporting and promoting athletic performance
for this, it seems we have evolved certain and good health.

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Understanding Food
and Supplement Labels
How do you know what you are getting from the foods you eat? This is a
good question with no simple answer. Look at the foods you have around
your house. Although most products have a list of ingredients and some
Calorie: a unit of also have calorie and nutrients-per-serving information, most whole
measurement used to foods do not have any nutrients listed. No whole foods, the healthy
express the energy value
of food. Carbohydrates, foods that should constitute the majority of your diet—like fresh fruits,
fats, protein, and alcohol vegetables, fresh proteins, and so on—have labels on them displaying the
in the foods and drinks we
eat provide food energy or nutrients supplied. Figuring out exactly what is supplied by the foods you
“calories.” Carbohydrates eat can develop into a full-time job and therefore requires nutritional
and proteins provide 4
training on your part. You should make an effort to start learning
calories per gram, fat has
9 calories per gram, and what foods are good sources of the nutrients you and your clients need.
alcohol has 7 calories per This education can be accomplished by reading the nutrition labels of
gram.
products that have Nutrition Facts and Supplement Facts part of labels.
Start keeping track of what you are eating and teach your clients to
do the same. By reading labels, you will be able to decide for yourself
whether you should be eating a particular food. Start building a personal
healthy food list for your clients. Have them rely on your experience
and help them with understanding healthy food choices and building a
healthy foods list of whole foods and processed foods.

Under the Food and Drug Administration’s (FDA) nutrition labeling

regulations, certain ingredients and nutrition information should
be listed on most packaged foods. Food labels will have ingredient
listings and other nutritional information, such as the amount of
fat, protein, carbohydrates, and certain vitamins and minerals. By
convention, ingredient charts will list each ingredient in descending
order of predominance. If water is the first ingredient, then water is
the most prevalent ingredient. This is only a qualitative listing, so you
cannot determine exactly what amount of each ingredient you are
getting. Therefore, additional nutritional information is provided, and
it includes calories per serving, macronutrient content, and selected
micronutrient content.

For the athlete, the nutrition information most useful is the total calories
and macronutrient information. Because not all the micronutrients are
listed, it is impossible to rely on nutrition label information to determine
whether you are getting the micronutrients you need from food.

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 Guide to Food and Supplement Product Labeling | 295

Food and Supplement Labeling Basics

The FDA actually has extensive regulations regarding every aspect of
ingredients, packing, manufacturing, labeling, testing, and everything
else related to the foods and supplements under its legal authority.
Regarding labeling, there is a variety of required information along with
rules on placement of the information within different parts of the labels,
proper terminology, legal ingredients, size of the fonts used, and use of
legal claims. The following provides the basics of food labeling, including
the Principal Display Panel and the Information Panel.

Principal Display Panel (PDP).

The PDP, front of packaging contains:
• Product Brand Name

• Statement of Identity (Name of the food)

• Net Quantity of Product (Amount of product)

Information Panel
The Information Panel Contains:
• Nutrition Facts or Supplement Facts

• Ingredients or Other Ingredients List

• Required Major Allergens

• Name and Address of Manufacturer, Packager, or Distributor

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REVISED NUTRITION FACTS

In 2016, the FDA published regulations to update the Nutrition Facts
panel part of food labels—to be implemented by companies by 2018.
Here is an overview of the revised Nutrition Facts Panel. The Nutrition
Facts label is designed to provide information that can help consumers
make informed choices about the food they purchase and consume.
It is up to consumers to decide what is appropriate for them and their
families’ needs and preferences.

Features a Refreshed Design

The “iconic” look of the label remains, but important updates have been
made to ensure consumers have access to the information they need to
make informed decisions about the foods they eat. These changes include
increasing the type size for “calories,” “servings per container,” and the
“serving size” declaration and bolding the number of calories and the
“serving size” declaration to highlight this information.

Manufacturers must declare the actual amount, in addition to percent

Daily Value of vitamin D, calcium, iron, and potassium. They can
voluntarily declare the gram amount for other vitamins and minerals.

The footnote is changing to better explain what percent Daily Value

means. It will read: “*The % Daily Value tells you how much a nutrient
in a serving of food contributes to a daily diet; 2,000 calories a day is
used for general nutrition advice.”

Revised Information and Nutrition Science

“Added sugars,” in grams and as percent daily value will be included on
the label. Scientific data show that it is difficult to meet nutrient needs
while staying within calorie limits if you consume more than 10 percent
of your total daily calories from added sugar, and this is consistent with
the 2015–2020 Dietary Guidelines for Americans.

The list of nutrients that are required or permitted to be declared is being

revised. Vitamin D and potassium will be required on the label. Calcium
and iron will continue to be required. Vitamins A and C will no longer
be required but can be included on a voluntary basis.

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While continuing to require “Total Fat,” “Saturated Fat,” and “Trans

Fat” on the label, “Calories from Fat” is being removed because research
shows that the type of fat is more important than the amount is.

Daily values for nutrients such as sodium, dietary fiber, and vitamin D
are being revised based on newer scientific evidence from the Institute
of Medicine and other reports such as the 2015 Dietary Guidelines
Advisory Committee Report, which was used in developing the 2015–
2020 Dietary Guidelines for Americans. Daily values are reference
amounts of nutrients to consume or not to exceed and are used to
calculate the percent daily value (% DV) that manufacturers include
on the label. The % DV helps consumers understand the nutrition
information in the context of a total daily diet.

Updates Serving Sizes and Labeling Requirements

for Certain Package Sizes
By law, serving sizes must be based on amounts of foods and beverages
that people are actually eating, not what they should be eating. How
much people eat and drink has changed since the previous serving size
requirements were published in 1993. For example, the reference amount
used to set a serving of ice cream was previously ½ cup but is being
revised to ⅔ cup. The reference amount used to set a serving of soda is
changing from 8 ounces to 12 ounces.

Package size affects what people eat. Thus for packages that are between
one and two servings, such as a 20-ounce soda or a 15-ounce can of
soup, the calories and other nutrients will be required to be labeled as
one serving because people typically consume it in one sitting.

For certain products that are larger than a single serving but that could
be consumed in one sitting or multiple sittings, manufacturers will
have to provide “dual column” labels to indicate the number of calories
and nutrients on both a “per-serving” and “per-package”/“per-unit”
basis. Examples would be a 24-ounce bottle of soda or a pint of ice
cream. With dual-column labels available, people will be able to easily
understand how many calories and nutrients they are getting if they eat
or drink the entire package/unit at once.

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Label Format: Original vs. Revised

Note: The images are meant for illustrative
Original Label

purposes to show how the revised Nutrition Facts

label might look compared with the old label.
Both labels represent fictional products. When
the original hypothetical label was developed
in 2014 (the image on the left-hand side), added
sugars was not yet proposed, so the “original”
label shows 1g of sugar as an example. The image
created for the “new” label (shown on the right-
hand side) lists 12g total sugar and 10g added
sugar to give an example of how added sugars
would be broken out with a % Daily Value.

Revised Label with Changes

Servings: larger, Serving sizes

bolder type updated
New Label

Updated
daily
values
New:
added
sugars
Actual
amounts
declared

Change in
nutrients
required

New footnote

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Serving Size Changes 

What’s considered a single serving has changed be more realistic to reflect how much people
in the decades since the original nutrition label typically eat at one time.
was created. Therefore, now serving sizes will

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Why are vitamin D and

potassium being added to the
Nutrition Facts label?
Vitamin D and potassium are nutrients that
Americans do not always get enough of,
How does the FDA according to nationwide food consumption
define “added sugars”? surveys (http://www.cdc.gov/nchs/nhanes/), and
The definition of added sugars includes sugars when lacking, are associated with increased risk
that are either added during the processing of of chronic disease. Vitamin D is important for its
foods, or are packaged as such, and consists role in bone health, and potassium helps lower
of sugars (free, mono-, and disaccharides), blood pressure. Calcium and iron are already
sugars from syrups and honey, and sugars from required to be included and will continue to be
concentrated fruit or vegetable juices that are in on the label.
excess of what would be expected from the same
volume of 100 percent fruit or vegetable juice of Why is the FDA no longer
the same type. The definition excludes fruit or requiring vitamins A and C?
vegetable juice concentrated from 100 percent In the early 1990s, American diets lacked
fruit juice that is sold to consumers (e.g., frozen vitamins A and C, but now vitamin A and C
100 percent fruit juice concentrate) along with deficiencies in the general population are rare.
some sugars found in fruit and vegetable juices, Manufacturers can still list these vitamins
jellies, jams, preserves, and fruit spreads. voluntarily.

Why is trans fat still on the label Serving Sizes

if the FDA is phasing out its use?
Some serving sizes will actually be
Trans fat will be reduced but not eliminated bigger. That doesn’t seem to make sense
from foods, so FDA will continue to require given the current obesity epidemic.
it on the label. In 2015, the FDA published a
final determination that partially hydrogenated Some serving sizes will increase, and others will
oils (PHOs), the source of artificial trans decrease because, by law, the serving sizes must
fat, are not generally recognized as safe, but be based on the amounts of food and drink that
this determination will not affect naturally people typically consume, not on how much
occurring trans fat, which will still exist in the they should consume. Recent food consumption
food supply. Trans fat is present naturally in data show that some serving sizes need to be
food from some animals, mainly ruminants revised. For example, the reference amount used
such as cows and goats. In addition, industry to set a serving of ice cream was previously ½
can currently use some oils that are approved as cup and now is changing to ⅔ cup. The reference
food additives and can still petition the FDA for amount used to set a serving size of soda was
specific uses of PHOs. previously 8 ounces and now is changing to

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 Guide to Food and Supplement Product Labeling | 301

12 ounces. The reference amount for yogurt is benefits. Thus, it depends. For example, caffeine
decreasing from 8 ounces to 6 ounces. Nutrient is found in some conventional foods, in some
information on the revised label will be based drugs, and in dietary supplements. Glucosamine
on these revised serving sizes so it matches what is another example; in the United States, as a
people actually consume. supplement, glucosamine is claimed to support
connective tissues and joint health. But based on
additional clinical research among people with
Super Foods: Dietary osteoarthritis, Health Canada approved disease
Supplements Are Born treatment claims for glucosamine as a Natural
It is unclear where the controversy stems from Health Product for relieving pain associated
regarding dietary supplements, also referred to with osteoarthritis in addition to the general
as supplements, food supplements, and nutrition maintaining good joint health claims. The unit
supplements, but in the United States, the official about claims will elaborate on these issues
term under FDA laws and regulations is dietary related to foods and supplements.
supplements. Supplements represent a major The first use of nutrients as supplements likely
scientific advancement in nutrition, especially originated in medical applications. Doctors
sports nutrition. Supplements are more highly and clinical nutritionists have long employed
regulated compared with conventional foods. special nutrient solutions to feed their patients
Supplements have an overall better safety back to health. These products mainly consisted
record, especially regarding rare incidences of of intravenous solutions that delivered a liquid
food-borne illness, compared with millions nutrient mix right into the bloodstream. Today,
of people each year who become ill from doctors prescribe supplements to many patients
ingesting conventional foods. Supplements are for a abundance of health reasons, particularly
intentionally made to be healthy. Supplements for post-surgery patients, young people, the
are a special category of food, similar to infant elderly, and pregnant women. Use of nutrients to
formulas and medical foods. accelerate healing is also practiced in hospitals
When thinking about supplements, think due to new research demonstrating the rapid
pasta (food), not penicillin (drug)! recovery of patients who had surgery and took
supplements to promote healing.
When people think of supplements, they tend
to relate them more to drugs than to food. In spite of these clinical uses, it was not until the
This is partly due to the way they look (tablets, space program that mass-market potential use of
capsules, etc.,) and from their origins in clinical supplements became a reality. It was during the
settings. It is also due in part because much of early days of the space program, when scientists
the scientific research is about medical use of performed a wealth of research about feeding
the dietary ingredients used in supplements, the astronauts with specially designed foods, in
and in some countries like Canada, the same the form of meal replacements and supplements
dietary ingredients used in supplements have aimed at maintaining optimum health and
nutrition benefits and also disease treatment performance, versus sick care of nutrition for

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survival. Among the many other spin-off benefits 1950s with weight-loss-related products.
derived from the space program, supplements Researchers discovered that subjects eating
are another group of products with “astronaut” only chemically defined diets would experience
appeal. When scientists were preparing to send an immediate loss of body weight. It was also
a man into space for the first time, they had no interesting to note that the initial weight loss
idea how his digestive system would react to of up to 11 pounds would occur only after a
a zero gravity environment. They also wanted short period—several days. Scientists attributed
to supply a complete diet to the astronauts this weight loss to clearance of bulk from
and reduce the amount of waste products for the gastrointestinal tract and a drop in water
practical reasons. weight. This contention was supported by the
observed gain in weight following the first
This space program nutrition research was a
week of normal food after the break with the
breakthrough for human nutrition because
experimental liquid diets. Typically, subjects
scientists had the funding to experiment on
gained weight equal to that amount lost during
healthy, athletic individuals. Previous research
the first week. This may explain why many of
relied mainly on laboratory animals and ailing
the meal replacement products now available on
hospital patients. For the first time, research
the market will produce an initial rapid loss of
would be conducted on healthy individuals to
body weight, followed by a period of slower loss
optimize their performance. The astronauts were
of body weight.
subjected to numerous experiments in which
their body weights, blood chemistry, and caloric Ever since the 1960s, nutritional supplements
output were measured along the way. Much vital have become increasingly widespread. Many
information on nutrition and human physiology categories of products have evolved as more and
was gathered during this space age research. more research has discovered how nutrients
can benefit health and performance. One of
Looking back to initial research published in the
the first categories of sports supplements began
1950s, we see that laboratory animals were first
with weight-gain powdered drinks. Use of these
used to formulate what was to become known as
products has been widespread by bodybuilders,
“chemically defined diets.” Chemically defined
athletes, and teenagers seeking to increase
diets are nothing more than liquid meals that
body weight. An emerging subculture of health
contain a full profile of amino acids, vitamins,
conscious individuals also uses supplements
minerals, fatty acids, and so on that are required
and eats healthy foods. Supplements are used by
to support life. Through this research, much was
almost every person in the United States at some
learned about nutrition, growth, and health of
point in his or her life, and use is increasing.
laboratory animals. Once the hypotheses were
Sports nutrition represents one of the largest and
tested, formulations were made and supplied to
fastest growing supplement categories because
humans for refinement.
athletes know that they can derive better results
Going from a clinical setting to the mass when using these super foods as part of their
market was a step that also occurred in the total sports nutrition program.

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 Guide to Food and Supplement Product Labeling | 303

Revised Supplement Facts Panel

Current Supplement Facts Panel Example Revised Supplement Facts Panel Example

Note some differences with Vitamin IU vs. mcg; Folate DFE and folic acid; Vitamin D with
mcg and IU; different %DVs.

In 2016, the FDA published revised regulations update is reprinted, along with other related
to update the Supplement Facts panel portion labeling rule and format updates.
of dietary supplement labels, to be implemented
It is interesting to note that in the FDA
by companies by 2018. Here is an overview
examples, in addition to the expected essential
of the revised Supplement Facts panel. The
macronutrients and micronutrients, the other
Supplement Facts label is designed to provide
types of dietary ingredients are also used, for
information that can help consumers make
example: German Chamomile, Hyssop, Oriental
informed choices about the food they purchase
Ginseng, Betaine, Glutamic Acid, Inositol, para-
and consume. It is up to consumers to decide
aminobenzoic acid, Deoxyribonucleic acid, and
what is appropriate for themselves and for
boron. This helps debunk the controversy about
their families’ needs and preferences.
the use of these types of ingredients in dietary
More Supplement Facts Panel examples can be supplement products.
observed in the Appendix, where the regulation

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Food Nutrients Dietary Supplement Nutrients

Random amounts in the diet Controlled, consistent amounts
Nutrients supplied indiscriminately Target specific requirements
Small, inconsistent nutrient amounts Concentrated, specific nutrient amounts
Varied bioavailability Designed to be highly bioavailable
Contains calories, wanted and unwanted Contains no calories or controlled caloric content

May dislike food supplying nutrients No taste to “tablet-” type supplements.

Costly, time consuming, perishable Convenient, long shelf life
Often more expensive, on a nutrient basis Often less expensive, on a nutrient basis
Usually no instructions Label/manufacturer use instructions
May have to overeat to get the nutrients needed Nutrient dense, can avoid overeating unwanted calories
Mandatory, we must eat healthy foods Strategic nutritional use

Foods versus herbal extracts, and bars. When you examine

a product label, the presence of a Supplement
Supplements Facts panel or Nutrition Facts panel will further
The above table lists some of the major points serve to help you identify the products type.
concerning how nutrients from foods and Also on supplement products, the term Dietary
dietary supplements compare. Supplement, or Supplement as part of the
statement of identity is located on the product’s
principal display panel. For example, Vitamin
Major Dietary C Supplement can be used versus Dietary
Supplement Forms and Supplement. Note that the labeling regulations
Delivery Systems are based on conventional food regulations
that require naming the food or food type on
Supplements come in several types and forms. the statement of identity. Thus, the FDA likely
Supplement forms can also be referred to as prefers companies using the name or names of
delivery systems, a term borrowed from the the dietary ingredients as part of the statement
pharmaceutical industry. of identity, like in the vitamin C supplement for
The major types of dietary supplement forms example. But based on the supplement products
include: on the shelves, it seems most product labels
contain Dietary Supplement.
Tablets Powders
Tablets/Caplets. These start out as a powder
Caplets Liquids
blend of nutrients that are then pressed by
Capsules Herbal Extracts machines into the characteristic tablet form.
Softgels Bars Tablets come in different shapes and sizes that
are safe to swallow. Tablets are also made in
Some of these forms are also used for chewable form. The term “caplet” is currently
conventional foods, such as powders, liquids, being used to describe tablets that are shaped as

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 Guide to Food and Supplement Product Labeling | 305

capsules. Originally, the caplet was a tamper proof, one-piece capsule

with a hard outer layer and loosely bound contents.

Tablet delivery systems vary. Current manufacturing technology allows

tablets to digest quickly, or provide to sustained release of nutrients, or
even to provide time released nutrients. These features give tablets an
edge over other pill form supplements. Tablets also have a long shelf
life, typically two or more years. Tablets need to be made properly
by experienced manufacturers to perform these dynamic delivery
functions.

Capsules. These are delivery systems that consist of two halves into
which a powder blend is injected. The two halves are brought together
to form the capsule. In general, supplement capsules will be quickly
digested. They are not designed with a sustained released system, and
very few nutrient capsule products are timed released. Some capsules are
made from plants, and most are from animal products.

Softgels. Softgels were developed to hold liquid nutrient supplements

like lecithin, cod liver oil, and vitamin E. They consist of an outer
gelatin shell, soft or hard, and an inner liquid. They are generally quickly
digested and absorbed. Softgel manufacturing technology has advanced
to allow a greater diversity of dietary ingredients to be contained in the
softgel dosage form.

Powder Supplements. There are many types made for multiple reasons
containing a wide diversity of nutrients. The most common powder
formulations are protein powders, diet powders, energy powders, and
weight-gain powders. Supplement powders are a convenient way to
get high-quality nutrition in the exact amounts you need, when you
need it. Many athletes have hectic schedules and cannot find the time
to eat five to six complete meals per day (20 minutes each meal would
be two hours just eating). Powdered nutrition supplements therefore
provide a convenient high-density source of nutrition to meet individual
needs. However, note that technically under FDA regulations, powder
supplements can be used to supplement the diet, not replace a meal. But
there are similar meal-replacement powder drink mix products with
Nutrition Facts panels that do qualify as meal replacements.
Carbohydrate drink: a
Liquid Supplements. Liquid sport supplements include protein drinks, sports beverage designed
to provide energy substrate
carbohydrate drinks, weight-gain drinks, herbal extracts, herbal and to replenish the
tinctures, gels, and liquid vitamins and minerals. Many of these glycogen (energy) stores.

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Controlled-Release Supplements
Regarding the various controlled-release delivery systems, there are two primary reasons they are
being used for dietary supplements. For example, dietary ingredients that would maintain higher
potency by shielding them from digestion in the stomach or that would protect the stomach from
ingredients that may cause upset or odorous regurgitation (like garlic). Then controlled release is used
for ingredients that would benefit the body optimally when their release is slower and prolonged to
maintain ideal levels in the bloodstream for longer periods. A combination of both of these controlled-
release technologies can be applied to a tablet system and to some other systems developed by the
pharmaceutical industry. Thus, control releasing a dietary supplement allows overall effectiveness to
be enhanced.
Controlled-Release Technologies
Historically, controlled-release technologies for tablets were designed by the pharmaceutical industry.
Since the development of the basic types of delayed-release and sustained-release systems, a variety
of more sophisticated systems has been developed; however, the basic types are primarily in use in
the dietary supplement industry, as their cost is typically more affordable, with some of the more
sophisticated systems being more time consuming and expensive to make in comparison.
Development of controlled-release tablets generally uses the following types of technologies:
• Enteric coating, which is resistant to digestion in the stomach but is digestible in the
intestines. Also referred to as delayed release.

• Sustained-release matrix, which forms a binder matrix that is more slowly digested. This results
in a gradual or extended release of the dietary ingredients.

• Sustained-release pellets, which is a more involved process in producing, making it a higher

priced approach compared with the sustained-release matrix. With pellets, a more sophisticated
sustained-release delivery can be achieved. Timed-release is often used to describe these types
of sophisticated controlled-release delivery system, especially with containing pellets with
different coating thicknesses to be released in target areas of the intestines.

• Combination enteric coating and sustained-release matrix, which will protect ingredients
susceptible to stomach acid breakdown and will perform sustained release in the intestines

• Some of the other more expensive controlled release systems include time-controlled explosion
systems and sigmoidal-release systems.

In addition to tablet product applications, some controlled-release delivery system technologies are
also suitable for other dosages systems: capsules, softgels, gelcaps, and liquidcaps. In fact, the classic
timed-release product is pellets in a capsule.

continued on next page

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 Guide to Food and Supplement Product Labeling | 307

ChronoNutritionals – Next Generation Dietary Supplements?

Although there is plenty of opportunity for controlled-release delivery systems to enhance dietary
supplement effectiveness by delaying and or sustaining supplement release, an opportunity exists for
creating the next generation line of products that are specifically designed to be synchronized to meet
the body’s metabolic demands created by the natural endogenous cycles, such as circadian rhythms.
This approach was again pioneered in the pharmaceutical industry for enhancing the effectiveness
of drugs based on the body’s natural and disease-caused daily metabolic rhythms. Therefore,
chronotherapeutics, chronopharamacokinetics, and chronopharmaceutics are terms that are gaining
the attention of dietary supplement developers who are searching for innovations to create the next-
generation series of scientifically advanced products. The nutrition industry is no stranger to the
idea of nutrient timing of foods and supplements. This has become common practice in specialized
areas of nutrition, such as sports nutrition, and for supplements for daytime or nighttime use and
among some weight-loss products that are designed to ignite and sustain thermogenic and fat-
burning effects during the day and even night, with or without stimulants. Thus, using controlled-
release systems can be a vital technology for developing this next generation of dietary supplements:
“chrononutritionals.”

concoctions are also available in dry form, as either powders or solid Enteric coating: a coating
on tablets that delays
dosage forms. Most common to the athlete are the host of carbohydrate
digestion of the tablets until
drinks, gels, protein, and weight-gain drinks. they pass from the stomach
into the intestines.
Bars. Nutrition and supplement bars for athletes have been around for
many years but are currently quite popular as more athletes recognize
their value. They are designed to
offer a way to get a scientifically
developed snack that is high in
healthy carbohydrates and protein
and low in fat. This is the opposite
of what most mass-market candy
bars offer. Bars are a suitable
delivery system for macronutrient,
micronutrient, and specialty
ergogenic ingredients offering high-
density, scientifically engineered
sports nutrition.

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Major Categories of Sports Nutrition and

Supplements
When you walk into any of the major health food kind of athlete. When shopping online for sports
stores, you will find up to half the store dedicated nutrition products, it can be overwhelming to
to hundreds of different sports nutrition and sort through the thousands of products. The
sports supplements. At first glance, it might following chart is a summary of some sports
seem that many of these products appear to be nutrition product categories/types typically
targeted to the bodybuilding or muscle-building encountered, including Nutrition Facts and
crowd. But as you look more closely, you will see Supplement Facts panel-bearing products.
that there are sports nutrition products for every

Multivatims Energy Drinks Nutrition Bars

Multiminerals Energy Gels Nutrition Drinks
Protein Pre-workout Nutrition Powders
Amino Acids During workout Botanicals
Essential Fatty Acids Post-workout Creatine
Conjugated Linoleic Acid Endurance L-carnitine
Fish Oils Weight gain Beta-alanine
Carbohydrates Weight loss BCAAs
Fiber Meal replacements Nitric Oxide Boosters
Metabolites Testosterone Support Joint Support
Probiotics

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 Guide to Food and Supplement Product Labeling | 309

The Economics of Sports Nutrition

Eating the right foods is usually cheaper than the added chemicals, try making batches of
eating a hit-or-miss diet that consists of large homemade nutrition bars. These will also offer
amounts of expensive restaurant cuisine and fast the added benefit of being to your exact liking,
foods. However, because the typical athlete will serving sizes customized to your caloric needs,
eat about twice as much as would a nonathlete, and macronutrient content to suit nutrient
use supplements, consume more beverages, and timing goals, such as high-carbohydrate bars
eat higher amounts of protein, the grocery bills and a mix of carbohydrate, protein, and essential
can get expensive. The best approach is to plan fatty acid bars.
and to look for coupons and sales. You may also
consider teaming up with some of your friends, Preparing meals to go is a signature
forming a co-op, and approaching wholesalers characteristic of competitive athletes, who have
to buy products by the case at 20 percent to a reputation for having an array of plastic food
60 percent off the regular retail price. Online containers packed in their cooler bag along
retailers usually offer the biggest discounts, and with their beverages. For people who do not
when joining their email lists, you can often have the time or talent, talk to family members
receive additional discounts. or neighbors who like to cook and may be
interested preparing to-go meals. In addition,
When planning your nutrition program, the local healthy food restaurants, delis, juice
you know that you will need a great many bars, and other local healthy food establishments
carbohydrate foods and protein foods. You can be a vital to-go food resource. Some will
should look for sales and buy these foods. even have the experience of preparing meals for
Instead of purchasing a few pieces of chicken athletes, a big plus. Some will work with you to
or meat here and there, buy a whole chicken make customer to-go meals, while keeping the
and larger cuts of meat. The same is true for costs down.
potatoes and pasta. In addition, drink a lot
of water instead of expensive beverages that When eating out, select healthy restaurants
consist primarily of water anyway. Buy fresh with good quality food, good reputation, and
vegetables and fruits on sale and freeze them a salad bar or buffet. These will offer the most
for future use to minimize spoilage. Packaged food for the price and a nice diversity of foods to
frozen vegetables are also a good choice. choose from. However, conversely, people who
have trouble selecting the healthy food choices
Although the selection of sports nutrition of a buffet or end up overeating to the point of
products, like nutrition bars, offers a good gaining excess unwanted body fat, should avoid
choice of athlete nutrition and performance the buffets.
enhancements that are convenient, consuming
high quantities of these products can become We all love to eat, and a sports nutrition diet can
expensive. To reduce costs of sports nutrition be tasty, diversified, fun, and affordable with a
bars and have fresh-made options without little effort and creativity.

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Reference Daily Intakes: VItamins and Minerals Essential in Human Nutrition
According to the FDA’s revised labeling regulations, the following RDIs, nomenclature, and units of measure are estab-
lished for the following vitamins and minerals that are essential in human nutrition:
RDI
Nutrient Unit of measure Adults and Infants  Children 1 Pregnant women and
children ≥4 through 3 lactating women
years years
Vitamin A Micrograms RAE  900 500 300 1,300
Vitamin C Milligrams (mg) 90 50 15 120
Calcium Milligrams (mg) 1,300 260 700 1,300
Iron Milligrams (mg) 18 11 7 27
Vitamin D Micrograms (mcg)  20 10 15 15
Vitamin E Milligrams (mg)  15 5 6 19
Vitamin K Micrograms (mcg) 120 2.5 30 90
Thiamin Milligrams (mg) 1.2 0.3 0.5 1.4
Riboflavin Milligrams (mg) 1.3 0.4 0.5 1.6
Niacin Milligrams NE  16 4 6 18
Vitamin B Milligrams (mg) 1.7 0.3 0.5 2.0
Folate  Micrograms DFE  400 80 150 600
Vitamin B Micrograms (mcg) 2.4 0.5 0.9 2.8
Biotin Micrograms (mcg) 30 6 8 35
Pantothenic acid Milligrams (mg) 5 1.8 2 7
Phosphorus Milligrams (mg) 1,250 275 460 1,250
Iodine Micrograms (mcg) 150 130 90 290
Magnesium Milligrams (mg) 420 75 80 400
Zinc Milligrams (mg) 11 3 3 13
Selenium Micrograms (mcg) 55 20 20 70
Copper Milligrams (mg) 0.9 0.2 0.3 1.3
Manganese Milligrams (mg) 2.3 0.6 1.2 2.6
Chromium Micrograms (mcg) 35 5.5 11 45
Molybdenum Micrograms (mcg) 45 3 17 50
Chloride Milligrams (mg) 2,300 570 1,500 2,300
Potassium Milligrams (mg) 4,700 700 3,000 5,100
Choline Milligrams (mg) 550 150 200 550
Protein Grams (g) N/A 11 N/A 8
1
RDIs are based on dietary reference intake recommendations for infants through 10 months of age.
2
RAE = Retinol activity equivalents; 1 microgram RAE = 1 microgram retinol, 2 microgram supplemental β-carotene, 12 micrograms β-carotene,
or 24 micrograms α-carotene, or 24 micrograms β-cryptoxanthin
3
The amount of vitamin D may, but is not required to, be expressed in international units (IU), in addition to the mandatory declaration in mcg.
Any declaration of the amount of vitamin D in IU must appear in parentheses after the declaration of the amount of vitamin D in mcg.
4
1 mg α-tocopherol (label claim) = 1 mg α-tocopherol = 1 mg RRR- α-tocopherol = 2 mg all rac-α-tocopherol.
5
NE = Niacin equivalents, 1 mg NE = 1 mg niacin = 60 mg tryptophan.
6
“Folate” and “Folic Acid” must be used for purposes of declaration in the labeling of conventional foods and dietary supplements. The declaration
for folate must be in mfg DFE (when expressed as a quantitative amount by weight in a conventional food or a dietary supplement), and percent
DV based on folate in mcg DFE. Folate may be expressed as a percent DV in conventional foods. When folic acid is added or when a claim is made
about the nutrient, folic acid must be declared in parentheses, as mcg of folic acid.
7
DFE = Dietary Folate Equivalents; 1 DFE = 1 mcg naturally-occurring folate = 0.6mcg folic acid.
8
Based on the reference caloric intake of 2,000 calories for adults and children aged 4 years and older, and for pregnant women and lactating
women.
 Guide to Food and Supplement Product Labeling | 311

Daily Reference Values: Food Components

According to the FDA’s revised labeling regulations, the following DRVs, nomenclature, and units of measure are estab-
lished for the following food components:
DRV
Food Unit of measure Adults and Infants  Children 1 Pregnant women and
Component children ≥4 through 3 lactating women
years years
Fat Grams (g) 1 78 30 2 39 1 78
Saturated fat Grams (g) 1 20 N/A 2 10 1 20
Cholesterol Milligrams (mg) 300 N/A 300 300
Total Grams (g) 1 275 95 2 150 1 275
carbohydrate
Sodium Milligrams (mg) 2,300 N/A 1,500 2,300
Dietary Fiber Grams (g) 1 28 N/A 2 14 1 28
Protein Grams (g) 1 50 N/A 2 13 N/A
Added Sugars Grams (g) 1 50 N/A 2 25 1 50
1Based on the reference caloric intake of 2,000 calories for adults and children aged 4 years and older, and for pregnant women and lactating
women.
2Based on the reference caloric intake of 1,000 calories for children 1 through 3 years of age.

Revised Daily Reference Values (Drvs)

and Reference Daily Intakes (RDIs)
In 2016, the FDA also published in its revised food and dietary
supplement labeling regulations, updates to the RDIs and DRVs for the
macronutrients and micronutrients. The predeeding tables present this
revised nutrient reference information.

These revised nutrient intake values for product labeling appear to be an

example of nutrition for survival, or barely so.
How can adults and children four years or older have the
same nutrient requirements?

Consider the increased essential nutrient and caloric intake

demands of athletes.

Conclusion
Consumers have more food and dietary supplement choices than ever,
which can be used to perfect a winning sports nutrition program. The
revised nutrition labeling may have practical implication to better assist
athletes in making appropriate food choices.

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Keywords
Whole food Carbohydrate drink

Calorie Enteric coating

Sports Nutrition
 Topics Covered In This Unit

Introduction

Claims for foods and dietary supple-

ments

Nutrient content claims

Other nutrient content claim examples

Health claims

Health claims

 tructure/function claims and related

S
dietary supplement claims

 eview of FDA’s guidance related to

R
structure/function claims for dietary
supplements

Conclusion

UNIT 11

LABEL CLAIMS FOR CONVENTIONAL

FOODS AND DIETARY SUPPLEMENTS
314 | Unit 11

Unit Outline
I. Introduction e. Structure/function claims and related di-
etary supplement claims
II. Claims for foods and dietary supple-
ments f. Review of FDA’s guidance related to struc-
ture/function claims for dietary supple-
a. Nutrient content claims
ments
b. Other nutrient content claim examples
III. Conclusion
c. Health claims
d. Health claims

Learning Objectives
After completing this unit, you will be able to:
• Define and describe key terms related to food and dietary supplement claims;

• List the types of scientific evidence required by the FDA to support claims;

• Discuss examples of structure/function claims and the related scientific evidence; and

• Distinguish between structure/function claims and drug/disease claims.

Introduction
In addition to product label and packaging between the FDA and FTC when undertaking a
content reviewed in another unit related to the regulatory compliance review of claims related to
nutrition information, product statement of a particular product or products.
identity, and contents, another way the FDA,
Regarding Canada’s Natural Health Products,
and also the FTC, are involved with regulating
foods and supplements is regarding claims made the country’s regulatory agency, Health Canada,
about the ingredients and their function. The reviews, approves, and licenses each product.
FDA primarily is concerned with regulating This includes ingredients, claims, and labeling.
claims on the product labeling, packaging, Health Canada also publishes ingredient
inserts, and other promotional materials directly monographs that include approved claims
associated with the products, whereas the FTC and other related information and product
is primarily concerned with regulating claims in requirements. This unit is focused primarily on
advertisements. There is certainly cooperation a special category of claims used in the United

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 Label Clains for Conventional Foods and Dietary Supplements | 315

States referred to as structure/function claims. Students interested in

learning more about Health Canada’s Natural Health Products should
visit the website, which contains a library of reference documents.

Main webpage is found at

http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php

Ingredient monograph webpage is found at

http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monosReq.do?lang=eng

Claims for Foods

and Dietary Supplements
Among the claims that can be used on food and dietary supplement
labels are three categories of claims: health, nutrient content, and
structure/function.

A common general requirement is that claims must be truthful and not

misleading. Certain types of claims require good-quality human studies
as evidence to support a claim. Other claims, such as nutrient content
claims, are published by the FDA in the regulations, so companies just
need to know about these specific requirements and terminology.

Nutrient Content Claims

A nutrient content claims is a claim on a
food product that directly or by implication
characterizes the level of a nutrient in the
food. Some examples of nutrient content
claims include “low fat,” “high in oat bran,”
“good source of vitamin C,” or “contains
100 calories.” The following tables are from
the FDA’s Food Labeling Guide and provide
additional details related to nutrient claim
examples. Note that the citation used in
the tables “CFR” is the Code of Federal
Regulations, Title 21, which are the official
FDA regulations the summary information
derives from.

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Content Claims (“Free,” “Low,” “Reduced/Less”)

Free Low Reduced/Less Comments
Synonyms for “Free”: “Zero,” Synonyms for “Low”: “Little,” Synonyms for “Reduced/Less”: For “Free”, “Very Low”, or
“No,” “Without,” “Trivial (“Few” for Calories), “Contains “Lower” (“Fewer” for Calories) “Low”, must indicate if food
Source of”, “Negligible Source a Small Amount of”, “Low meets a definition without
of”, “Dietarily Insignificant Source of” “Modified” may be used in benefit of special processing,
Source of” statement of identity alteration, formulation or
reformulation; e.g., “broccoli,
Definitions for “Free” for meals Definitions for meals and main
a fat-free food” or “celery, a
and main dishes are the stated dishes are same as for individu-
low-calorie food”
values per labeled serving but al foods on a per 100 g basis
are not defined for calories

Nutrient Free Low Reduced/Less

Calories Less than 5 cal per RACC and per 40 cal or less per RACC (and per 50 At least 25% less calories per RACC
labeled serving (b)(1) g if RACC is small) (b)(2) than an appropriate reference food
21 CFR (for meals and main dishes, at least
101.60(b) Meals and main dishes: 120 cal or 25% fewer calories per 100g)
less per 100 g (b)(3)
Reference food may not be “Low
Calorie”

Uses term “Fewer” rather than “Less”

(b)(4) & (5)
Comments

“Light” or “Lite”: if 50% or more of the calories are from fat, fat must be reduced by at least 50% per RACC. If less than 50% of calo-
ries are from fat, fat must be reduced at least 50% or calories reduced at least 1/3 per RACC 21 CFR 101.56(b)

“Light” or “Lite” meal or main dish product meets definition for “Low Calorie” or “Low Fat” meal and is labeled to indicate which
definition is met 21 CFR 101.56(d)

For dietary supplements: Calorie claims can only be made when the reference product is greater than 40 calories per serving 21 CFR
101.60(a)(4)

Nutrient Free Low Reduced/Less

Total Fat Less than 0.5 g per RACC and per 3 g or less per RACC (and per 50 g if At least 25% less fat per RACC than
labeled serving (or for meals and RACC is small) (b)(2) an appropriate reference food (or for
21 CFR main dishes, less than 0.5 g per meals and main dishes, at least 25%
101.62(b) labeled serving) (b)(1) Meals and main dishes: 3 g or less less fat per 100g) (b)(4) & (5)
per 100 g and not more than 30%
Contains no ingredient that is fat or of calories from fat (b)(3) Reference food may not be “Low Fat”
understood to contain fat, except
noted below (*).
Comments
“__% Fat Free”: may be used if food meets the requirements for “Low Fat” 21 CFR 101.62(b)(6)

100% Fat Free: food must be “Fat Free” (b)(6)(iii)

“Light”—see previous Calorie comments

For dietary supplements: total fat claims cannot be made for products that are 40 calories or less per serving 21 CFR 101.62(a)(4)

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Content Claims (“Free,” “Low,” “Reduced/Less”), continued

Nutrient Free Low Reduced/Less

Saturated Less than 0.5 g saturated fat and 1 g or less per RACC and 15% or less At least 25% less saturated fat per
Fat less than 0.5 g trans fatty acids per of calories from saturated fat (c)(2) RACC than an appropriate reference
RACC and per labeled serving (or for food (or for meals and main dishes, at
21 CFR meals and main dishes, less than 0.5 Meals and main dishes: 1 g or less least 25% less saturated fat per 100g)
101.62(c) g saturated fat and less than 0.5 g per 100 g and less than 10% of calo- (c)(4) & (5)
trans fatty acids per labeled serving) ries from saturated fat (c)(3)
(c)(1) Reference food may not be “Low
Saturated Fat”
Contains no ingredient that is
understood to contain saturated fat
except as noted below (*)
Comments

Next to all saturated fat claims, must declare the amount of cholesterol if 2 mg or more per RACC, and the amount of total fat if
more than 3 g per RACC (or 0.5 g or more of total fat per RACC for “Saturated Fat Free”) ( or for meals and main dishes, per labeled
serving) 21 CFR 101.62(c)

For dietary supplements: saturated fat claims cannot be made for products that are 40 calories or less per serving 21 CFR 101.62(a)(4)

Nutrient Free Low Reduced/Less

Cholesterol Less than 2 mg per RACC and per 20 mg or less per RACC (and per 50 At least 25% less cholesterol per RACC
labeled serving (or for meals and g of food if RACC is small) (d)(2) than an appropriate reference food
21 CFR main dishes, less than 2 mg per (or for meals and main dishes, at least
101.62(d) labeled serving) Meals and main dishes: 20 mg or 25% less cholesterol per 100g) (d)(4)
less per 100 g (d)(3) & (5)
Contains no ingredient that contains
cholesterol except as noted below Reference food may not be “Low
(*) (d)(1) Cholesterol”

Comments

Cholesterol claims only allowed when food contains 2 g or less saturated fat per RACC; or for meals and main dish products, per
labeled serving size for “Free” claims or per 100 g for “Low” and “Reduced/Less” claims

Must declare the amount of total fat next to cholesterol claim when fat exceeds 13 g per RACC and labeled serving (or per 50 g of
food if RACC is small), or when the fat exceeds 19.5 g per labeled serving for main dishes or 26 g for meal products

For dietary supplements: cholesterol claims cannot be made for products that are 40 calories or less per serving
Nutrient Free Low Reduced/Less

Sodium Less than 5 mg per RACC and per 140 mg or less per RACC (and per At least 25% less sodium per RACC
labeled serving (or for meals and 50 g if RACC is small) (b)(4) than an appropriate reference food
21 CFR 101.61 main dishes, less than 5 mg per (or for meals and main dishes, at least
labeled serving) (b)(1) Meals and main dishes: 140 mg or 25% less sodium per 100g)
less per 100g (b)(5)
Contains no ingredient that is so- Reference food may not be “Low Sodi-
dium chloride or generally under- “Very Low Sodium”: 35 mg or less um” (b)(6) & (7)
stood to contain sodium except as per RACC (and per 50g if RACC is
noted below (*) small). For meals and main dishes:
35mg or less per 100g (b)(2) & (3)
“Salt Free” must meet criterion for
“Sodium Free” (c)(1)
Comments

“Light” (for sodium reduced 21 CFR products): if food is “Low Calorie” and “Low Fat” and sodium is reduced by at least 50%. 21 CFR
101.56(c)(1)
“Light in Sodium”: if sodium is reduced by at least 50% per RACC. 21 CFR 101.56(c)(2)
For meals and main dishes, “Light in Sodium” meets definition for “Low in Sodium” 21 CFR 101.56(d)(2)
“No Salt Added” and “Unsalted” must declare, “This is Not A Sodium Free Food” either adjacent to the claim or on the information
panel. if food is not “Sodium Free” 21 CFR 101.61(c)(2)
“Lightly Salted”: 50% less sodium than normally added to reference food and if not “Low Sodium”, so labeled on information panel
21 CFR 101.56(g)
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Content Claims (“Free,” “Low,” “Reduced/Less”), continued

Nutrient Free Low Reduced/Less

Sugars “Sugar Free”: Less than 0.5 g sugars Not Defined. At least 25% less sugars per RACC than
per RACC and per labeled serving an appropriate reference food (or for
21 CFR (or for meals and main dishes, less May not be used meals and main dishes, at least 25%
101.60(c) than 0.5 g per labeled serving) (c) less sugar per 100g)
(1)
May not use this claim on dietary
Contains no ingredient that is a supplements of vitamins and minerals
sugar or generally understood to (c)(5) & (6)
contain sugars except as noted
below (*)

Disclose calorie profile (e.g., “Low

Calorie”)
Comments
“No Added Sugars” and “Without Added Sugars” are allowed if no sugar or sugar-containing ingredient is added during processing.
State if food is not “Low” or “Reduced Calorie” (c)(2)

The terms “Unsweetened” and “No Added Sweeteners” remain as factual statements (c)(3)

The claim does not refer to sugar alcohols, which may be present.

For dietary supplements: “Sugar Free” and “No Added Sugar” may be used for vitamins and minerals intended to be used by infants
and children less than 2 years of age. (c)(4)
Notes: * Except if the ingredient listed in the ingredient statement has an asterisk that refers to footnote (e.g., “* adds a trivial amount of fat”).

RACC = Reference Amounts Customarily Consumed.

Small RACC = Reference Amounts Customarily Consumed of 30 g or less or 2 tablespoons or less (for dehydrated foods that are typically consumed
when rehydrated with water or a diluent containing an insignificant amount, as defined in 21 CFR 101.9(f)(1), of all nutrients per RACC, the per 50 g
criterion refers to the prepared form of the food).

When levels exceed: 13 g Total Fat, 4 g Saturated Fat, 60 mg Cholesterol, and 480 mg Sodium per RACC, per labeled serving or, for foods with small
RACC, per 50 g, a disclosure statement is required as part of claim (e.g., “See nutrition information for content” with the blank filled in with nutrient(s)
that exceed the prescribed levels).

The term “light” may be used to describe a physical or organoleptic attribute of the food if it clearly conveys the nature of the product, e.g., “light in
color,” “light in texture.” 21 CFR 101.56(e)

If there has been a long history of use of the term “light” associated with a product it may continue to be used, e.g., “light corn syrup,” “light brown
sugar.” 21 CFR 101.56(f)

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Other Nutrient Content Claim Examples

Claim Requireent
“High,” “Rich In,” or “Excellent Source Of” Contains 20% or more of the DV per RACC. May be used on meals or main dishes to
indicate that the product contains a food that meets the definition but may not be
used to describe the meal. 21 CFR 101.54(b)
“Good Source,” “Contains,” or “Provides” 10%-19% of the DV per RACC. These terms may be used on meals or main dishes to
indicate that the product contains a food that meets the definition but may not be
used to describe the meal. 21 CFR 101.54(e)
“More,” “Fortified,” “Enriched,” “Added,” 10% or more of the DV per RACC than an appropriate reference food. May only be
“Extra,” or “Plus” used for vitamins, minerals, protein, dietary fiber, and potassium. 21 CFR 101.54(e)
“Lean” On seafood or game meat products that contain less than 10g total fat, 4.5g or
less saturated fat, and less than 95mg cholesterol per RACC and per 100g (for
meals & main dishes, meets criteria per 100g and per labeled serving). On mixed
dishes not measurable with a cup (as defined in 21 CFR 101.12(b) in table 2)
that contain less than 8g total fat, 3.5g or less saturated fat and less than 80 mg
cholesterol per RACC. 21 CFR 101.62(e)(1)-(3)
“Extra Lean” On seafood or game meat products that contains less than 5g total fat, less than 2g
saturated fat and less than 95mg cholesterol per RACC and per 100g (for meals and
main dishes, meets criteria per 100g and per labeled serving). 21 CFR 101.62(e)(4)
& (5)
“High Potency” May be used on foods to describe individual vitamins or minerals that are present
at 100% or more of the RDI per RACC or on a multi-ingredient food product that
contains 100% or more of the RDI for at least 2/3 of the vitamins and minerals
with RDIs and that are present in the product at 2% or more of the RDI (e.g., “High
potency multivitamin, multimineral dietary supplement tablets”). 21 CFR101.54(f)
“Modified” May be used in statement of identity of a food that bears a relative claim (e.g.,
“Modified fat cheesecake, contains 35% less fat than our regular cheesecake.”) 21
CFR 101.13(k)
“Fiber” Claims If a fiber claim is made and the food is not low in total fat, then the label must
disclose the level of total fat per labeled serving. 21 CFR 101.54(d)(1)
Claims using the term “antioxidant” For claims characterizing the level of antioxidant nutrients in a food:

1. an RDI must be established for each of the nutrients that are the subject of
the claim;

2. each nutrient must have existing scientific evidence of antioxidant activity;

3. the level of each nutrient must be sufficient to meet the definition for
“high,” “good source,” or “more”;

Beta-carotene may be the subject of an antioxidant claim when the level

of vitamin A present as beta-carotene in the food is sufficient to qualify for
the claim.

4. Name(s) of nutrient(s) that is (are) the subject of the claim is (are) included
as part of the claim. (e.g., high in antioxidant vitamins C & E) 21 CFR
101.54(g)

Seafood: marine animals that

live in the sea and in freshwater
lakes and rivers. Seafood includes
fish (e.g., salmon, tuna, trout, and
tilapia) and shellfish (e.g., shrimp,
crab, and oysters).

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Health Claims
The FDA reviews and authorizes health claims. considered structure/function claims, reviewed
Health claims describe a relationship between in a following section. Structure/function claims
a food substance (a food, food component, or are not related to a disease. Improving athletic
dietary supplement ingredient) and reduced risk performance, increasing muscle growth, and
of a disease or health-related condition. There improving appetite control would be some
are a few categories of health claims, and some examples of structure/function claims.
examples are presented herein.
NLEA-Authorized Health Claims. The
A “health claim” by definition has two essential Nutrition Labeling and Education Act of 1990
components: (1) a substance (whether a food, (NLEA) gives the FDA authority to require
food component, or dietary ingredient) and (2) a nutrition labeling of most foods regulated by the
disease or health-related condition. A statement agency; and to require that all nutrient claims
lacking either one of these components does not and health claims meet FDA regulations. FDA
meet the regulatory definition of a health claim. authorizes these types of health claims based on
For example, statements that address a role of an extensive review of the scientific literature,
dietary patterns or of general categories of foods generally as a result of the submission of a health
(e.g., fruits and vegetables) in maintaining good claim petition, using the significant scientific
agreement standard to determine whether the
health are considered dietary guidance rather
substance/disease relationship is well established.
than health claims. Dietary guidance statements
They are also referred to as health claims
used on food labels must be truthful and non-
meeting significant scientific agreement (SSA).
misleading. Note that statements related to a role
of a specific substance in maintaining normal The following table presents some examples of
healthy structures or functions of the body are NLEA-Authorized Health Claims.

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 Label Clains for Conventional Foods and Dietary Supplements | 321

Examples of NLEA-Authorized Health Claims

Approved Claims Requirements for Claim Requirements Model Claim,
the Food Statements
Calcium and For calcium and The claim makes clear the importance Calcium and Osteoporosis:
Osteoporosis and osteoporosis claim- of adequate calcium intake, or when Adequate calcium
calcium, vitamin D, high in calcium appropriate, adequate calcium and throughout life, as part
and osteoporosis vitamin D intake, throughout life, in of a well-balanced diet,
For calcium, vitamin healthful diet, are essential to reduce may reduce the risk of
(21 CFR 101.72) D and osteoporosis osteoporosis risk. The claim does not osteoporosis.
claim-high in calcium imply that adequate calcium intake,
and vitamin D or when appropriate, adequate Calcium, vitamin D, and
calcium and vitamin D intake, is the osteoporosis: Adequate
-assimilable calcium and vitamin D, as
(Bioavailable) only recognized risk factor for the
development of osteoporosis. part of a well-balanced diet,
Supplements must along with physical activity,
disintegrate and The claim does not attribute any degree may reduce the risk of
dissolve, and of reduction in risk of osteoporosis osteoporosis.
to maintaining an adequate dietary
Phosphorus content calcium intake, or when appropriate, an
cannot exceed adequate dietary calcium and vitamin D
calcium content intake, throughout life.
Dietary Fat and (Fish & game meats: Required terms: Development of cancer
Cancer “Extra lean“) depends on many factors.
“Total fat” or “Fat” A diet low in total fat may
(21 CFR 101.73) reduce the risk of some
“Some types of cancers” or “Some
cancers” cancers.

Does not specify types of fats or fatty

acids that may be related to risk of
cancer.
Sodium and Low sodium Required terms: Diets low in sodium may
Hypertension reduce the risk of high
“Sodium“, “High blood pressure“ blood pressure, a disease
(21 CFR 101.74) associated with many
Includes physician statement
(Individuals with high blood pressure factors.
should consult their physicians) if claim
defines high or normal blood pressure
Dietary Saturated Low saturated fat, Required terms: While many factors affect
Fat and Cholesterol, heart disease, diets low
and risk of Coronary Low cholesterol, and Saturated fat and cholesterol, in saturated fat and
Heart Disease Low fat “Coronary heart disease“ or “heart cholesterol may reduce the
disease“ risk of this disease.
(21 CFR 101.75)
Includes physician statement
(individuals with elevated blood total-
-or LDL--cholesterol should consult
their physicians) if claim defines
high or normal blood total--and
LDL--cholesterol.
Fiber-Containing A grain product, fruit, Required terms: Low fat diets rich in fiber-
Grain Products, or vegetable that containing grain products,
Fruits, and contains dietary fiber; “Fiber“, “Dietary fiber“, or “Total dietary fruits, and vegetables may
Vegetables and fiber“ reduce the risk of some
Cancer Low fat, and types of cancer, a disease
“Some types of cancer“ or “Some
Good source of cancers“ associated with many
(21 CFR 101.76) factors.
dietary fiber (without
fortification) Does not specify types of dietary fiber
that may be related to risk of cancer.
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322 | Unit 11

Health Claims Based on Authoritative “authoritative statement” from certain scientific

Statements. The Food and Drug Administration bodies of the US government or the National
Modernization Act of 1997 (FDAMA) provides a Academy of Sciences, for example, whole grains
second way for the use of a health claim in food reducing the risk of heart disease. The following
labeling to be authorized. Under FDAMA, a new table presents additional examples of FDAMA
health claim can be authorized by submitting health claims from the FDA.
a notification to FDA of a claim based on an

FDAMA (FDA Modernization Act) Health Claims (Health Claims Authorized Based on an Au-
thoritative Statement by Federal Scientific Bodies)
Approved Claims Food Requirements Claim Requirement Model Claim
Statements
Whole Grain Foods and Contains 51% or more whole grain Required wording of the claim: NA
Risk of Heart Disease and ingredients by weight per RACC, and
Certain Cancers “Diets rich in whole grain foods
Dietary fiber content at least: and other plant foods and low
(Docket No. 1999P-2209) • 3.0 g per RACC of 55 g in total fat, saturated fat, and
• 2.8 g per RACC of 50 g cholesterol may reduce th
• 2.5 g per RACC of 45 g
• 1.7 g per RACC of 35 g
Potassium and the Risk of Good source of potassium Required wording of the claim: NA
High Blood Pressure and Low sodium
Stroke “Diets containing foods that
Low total fat are a good source of potassium
(Docket No. 2000Q-1582) Low saturated fat and that are low in sodium may
reduce the risk of high blood
Low cholesterol pressure and stroke.”
Fluoridated Water and Bottled water meeting the standards Required wording of the claim: NA
Reduced Risk of Dental of identity and quality set forth in 21
Carries CFR 165.110 “Drinking fluoridated water may
reduce the risk of [dental caries
Meet all general requirements for
(Docket No. 2006Q-0418) or tooth decay].”
health claims in 21 CFR 101.14) with
the exception of the minimum nu-
trient contribution (21 CFR 101.14(e)
(6)),
Total Fluoride: >0.6 to 1.0 mg/L
Excluding bottled water products
Saturated Fat, Choles- Low saturated fat Required wording of the claim: NA
terol, and Trans Fat, and Low cholesterol
Reduced Risk of Heart “Diets low in saturated fat and
Disease Bear quantitative trans fat labeling cholesterol, and as low as possi-
Contain less than 0.5 g trans fat per ble in trans fat, may reduce the
(Docket No. 2006Q-0458) RACC risk of heart disease.”
Contain less than 6.5 g total fat
Substitution of Saturat- Low fat Required wording of the claim: NA
ed Fat in the Diet with
Unsaturated Fatty Acids Low cholesterol “Replacing saturated fat with
and Reduced Risk of Heart similar amounts of unsaturated
Meets all general requirements for fats may reduce the risk of heart
Disease health claims in 21 CFR 101.14 disease. To achieve this benefit,
(Docket No. 2007Q-0192) total daily calories should not
increase.”
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 Label Clains for Conventional Foods and Dietary Supplements | 323

Qualified Health Claims. This is a special was reached for health-claim submissions based
category for health claims resulting from a on emerging scientific evidence resulted in a
lawsuit filed by industry members against the system in which the FDA authorizes a claim
FDA. This allows for the submission of health with a disclaimer to alert a consumer as to its
claims that are based on emerging research that opinion about the level of research. The following
might not have yet met the level of significant provides examples of claims and disclaimer
scientific agreement standard used for NLEA- statements for phosphatidylserine.
authorized health claims. The compromise that

Dementia claim and disclaimer:

“Consumption of phosphatidylserine may reduce the risk of dementia in the elderly.
Very limited and preliminary scientific research suggests that phosphatidylserine may reduce the risk
of dementia in the elderly. FDA concludes that there is little scientific evidence supporting this claim.”
Cognitive dysfunction claim and disclaimer:
“Consumption of phosphatidylserine may reduce the risk of cognitive dysfunction in the elderly.
Very limited and preliminary scientific research suggests that phosphatidylserine may reduce the risk
of cognitive dysfunction in the elderly. FDA concludes that there is little scientific evidence supporting
this claim.”

http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm072999.htm

Structure/Function Claims and Related Dietary Supplement Claims

Structure/function claims have historically human body, for example, “calcium builds strong
appeared on the labels of conventional foods bones.” In addition, they may characterize the
and dietary supplements and drugs. The Dietary means by which a nutrient or dietary ingredient
Supplement Health and Education Act of 1994 acts to maintain such structure or function, for
(DSHEA) established some special regulatory example, “fiber maintains bowel regularity,” or
requirements and procedures for using structure/ “antioxidants maintain cell integrity.”
function claims and two related types of dietary
General well-being claims describe general well-
supplement labeling claims, claims of general
being from consumption of a nutrient or dietary
well-being, and claims related to a nutrient
ingredient. Nutrient deficiency disease claims
deficiency disease.
describe a benefit related to a nutrient deficiency
Structure/function claims may describe the role disease (like vitamin C and scurvy), but such
of a nutrient or dietary ingredient intended to claims are allowed only if they also say how
affect the normal structure or function of the widespread the disease is in the United States.

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Structure/function claims for conventional

What is the definition of a foods focus on effects derived from nutritive
disease? value, whereas structure/function claims for
Section 101.93(g) defines disease as: dietary supplements may focus on non-nutritive
...damage to an organ, part, structure, or and nutritive effects. The FDA does not require
system of the body such that it does not conventional food manufacturers to notify the
function properly (e.g., cardiovascular FDA about their structure/function claims,
disease), or a state of health leading to such and disclaimers are not required for claims on
dysfunctioning (e.g., hypertension); except conventional foods.
that diseases resulting from essential nutrient
deficiencies (e.g., scurvy, pellagra) are not
included in this definition. Review of FDA’s Guidance
http://www.fda.gov/Food/GuidanceRegulation/ Related to Structure/Function
GuidanceDocumentsRegulatoryInformation/
ucm103340.htm Claims for Dietary Supplements
The following will be a comprehensive review,
Note that in the United States, these three types including excerpting FDA’s publication
of claims are not pre-approved by the FDA, “Guidance for Industry: Substantiation for
but the manufacturer must have substantiation Dietary Supplement Claims Made Under
that the claim is truthful and not misleading Section 403(r) (6) of the Federal Food, Drug,
and must submit a notification with the text and Cosmetic Act.” US Department of
of the claim to the FDA no later than 30 days Health and Human Services, Food and Drug
after marketing the dietary supplement with the Administration, Center for Food Safety and
claim. If a dietary supplement label includes such Applied Nutrition, December 2008.
a claim, it must state in a “disclaimer” that the
http://www.fda.gov/Food/GuidanceRegulation/
FDA has not evaluated the claim. The disclaimer
GuidanceDocumentsRegulatoryInformation/
must also state that the dietary supplement
DietarySupplements/ucm073200.htm
product is not intended to “diagnose, treat, cure,
or prevent any disease,” because only a drug can Due to the tens of thousands of dietary
legally make such a claim (with the exception supplement products, including sports nutrition
of an approved Health Claim, and reduction of supplements, bearing a variety of structure/
diseases.) It is through this notification process function claims, students have requested more
that the FDA has the chance to review the information in this area of the FDA regulation
structure/function claims a company is using requirements. The next several pages will
on its product labels, and the FDA can and does therefore contain information reprinted from
contact a company if it has issues with claims— the FDA’s guidance document, with some minor
for example, if the claim is a drug claim, or if the editing, which is within public domain. The
FDA is aware of claims being used that are not unedited guidance document can be viewed
supported by the scientific evidence. online at the aforementioned website address.

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 Label Clains for Conventional Foods and Dietary Supplements | 325

[Start of FDA’s Guide Excerpt]

Section 403(r)(6) of the Federal Food, Drug, and Cosmetic Act (the
Act) (21 U.S.C. 343(r)(6)) requires that a manufacturer of a dietary
supplement making a nutritional deficiency, structure/function, or
general well-being claim (2) have substantiation that the claim is
truthful and not misleading.

Under the Act, FDA has exclusive jurisdiction over the safety, and
primary jurisdiction over the labeling, of dietary supplements.
The FTC has primary jurisdiction over advertisements for dietary
supplements. Given these jurisdictional assignments, we and the FTC
share an interest in providing guidance on what “substantiation”
means. In April 2001, FTC issued a guidance document entitled,
“Dietary Supplements: An Advertising Guide for Industry.” (6) Our
guidance document is modeled on, and complements, the FTC
guidance document.

Dietary supplement manufacturers should be familiar with the

requirements under both DSHEA and the Federal Trade Commission
Act that they have substantiation that labeling and advertising
claims are truthful and not misleading. Our approach provides
manufacturers flexibility in the precise amount and type of evidence
that constitutes adequate substantiation. Providing a standard for
substantiation may also help to preserve consumer confidence in these
products. To ensure compliance with the Act, we recommend that
dietary supplement manufacturers carefully draft their labeling claims
and carefully review the support for each claim to make sure that
the support relates to the specific product and claim, is scientifically
sound, and is adequate in the context of the surrounding body of
evidence.

The FTC has typically applied a substantiation standard of “competent

and reliable scientific evidence” to claims about the benefits and safety
of dietary supplements and other health-related products. FDA intends
to apply a standard for the substantiation of dietary supplement claims
that is consistent with the FTC approach. This guidance document,
using examples of claims that might be made for a dietary supplement,
describes criteria to be considered in evaluating the nature of the claim
and the amount, type, and quality of evidence in support of the claim.

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A. What is the Substantiation Standard?

The FTC standard of competent and reliable scientific evidence has been
defined in FTC case law as “tests, analyses, research, studies, or other
evidence based on the expertise of professionals in the relevant area, that
has been conducted and evaluated in an objective manner by persons
qualified to do so, using procedures generally accepted in the profession
to yield accurate and reliable results.”(7)

Although there is no preestablished formula regarding how many or

what type of studies are needed to substantiate a claim, we, like the
FTC, will consider what the accepted norms are in the relevant research
fields and consult experts from various disciplines. If there is an existing
standard for substantiation developed by a government agency or other
authoritative body, we may accord some deference to that standard.

In determining whether the substantiation standard has been met with

competent and reliable scientific evidence, we recommend that firms
consider the following issues in their assessments:
1. The meaning of the claim(s) being made

2. The relationship of the evidence to the claim

3. The quality of the evidence

4. The totality of the evidence

Each of these issues is discussed further in this guidance.

B. Identifying the Meaning of the Claim

The first step in determining what information is needed to substantiate

a claim for a dietary supplement is to understand the meaning of the
claim and to clearly identify each implied and expressed claim. When a
claim may have more than one reasonable interpretation, we recommend
that a firm have substantiation for each interpretation. Consumer testing
may be useful to determine consumer understanding of each claim,
in context. We recommend that firms focus on not only individual
statements or phrases but also on what expected effect or benefit is
being promoted when all the statements being made for the product are
considered together. Although it is important that individual statements
be substantiated, it is equally important to substantiate the overall
“message” contained when the claims are considered together.

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Example 1: The label of a dietary supplement containing “X” uses the

following claims: “The amino acid ‘X’ is the chemical precursor to nitric
oxide. Blood vessel cells contain enzymes that produce nitric oxide.
Nitric oxide is important in maintaining blood vessel tone.” Assuming
this statement were supported by sound science so that each individual
statement has been substantiated, the “message” conveyed by the claims,
when considered together, is that taking oral “X” will affect nitric oxide
production and blood vessel tone. Therefore, we recommend in this
case that the dietary supplement manufacturer have substantiation that
taking the amount of “X” provided by the product affects nitric oxide
production and blood vessel tone under the product’s recommended
conditions of use.
The firm’s clear understanding of the meaning of the claim is useful in
ensuring that the evidentiary basis for substantiation is appropriate for
the claim. Understanding the claim’s meaning will help identify the
appropriate study hypotheses and measurable endpoints, which can be
used to ensure that the firm has appropriate studies to substantiate the
claim. For example, a firm making a claim that a dietary supplement
“helps maintain blood vessel tone” or “supports healthy immune system”
should have a clear understanding of the claim’s meaning to develop
endpoints that could be measured and replicated in studies used as a
basis for substantiation.
Example 2: The labeling of a dietary supplement includes the statement
“promotes weight loss.” The dietary supplement contains various
vitamins and minerals and a botanical extract. The manufacturer relies
on a randomized controlled double-blind clinical study showing that
subjects who took the botanical extract had a small but significant
increase in metabolism over subjects taking a placebo over a 24-hour
period. The study did not examine the effect of the extract on subjects’
weight, and there is no research showing that a short-term increase in
metabolism will translate into any measurable weight loss. The weight-
loss claim would likely not be adequately substantiated.
Example 3: The labeling for a dietary supplement contains a statement
saying, “Recommended by Scientists,” in connection with the product’s
claim. The statement gives consumers the impression that there is a
body of scientists, qualified experts, who believe that the claim being
made is supported by evidence. Consumers might also reasonably
interpret the statement as meaning that there is general scientific

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agreement or consensus regarding the claim. If the manufacturer does

not possess evidence to demonstrate such a consensus, the claim may
not be substantiated. The opinion of a single scientist or small group of
scientists not adequate substantiation for such a claim.
Example 4: The labeling states, in connection with the product’s claim,
that the dietary supplement has been “studied for years” in a particular
country or region and is the subject of clinical or “university” research.
Here, the labeling conveys the impression that the product has been
studied and also conveys the impression that there is a substantial body
of competently conducted scientific research supporting the claim. We
recommend that manufacturers possess evidence to substantiate both
the express statements and their implied meaning.

C. The Relationship of the

Evidence to the Claim

Whether studies or evidence has a relationship to the specific claim

being made or to the dietary supplement product itself is an important
consideration in determining whether a claim is substantiated. The
following are some threshold questions in determining this relationship:
• Have the studies specified and measured the dietary supplement that is
the subject of the claim? We recommend that the studies being used as
substantiation for dietary supplement claims identify a specific dietary
supplement or ingredient and serving size and that the conditions of
use in the studies are similar to the labeling conditions of the dietary
supplement product. Factors that would tend to indicate a stronger
relationship between a substance that is the subject of a study and the
substance that is the subject of the dietary supplement claim include
similarities in formulation, serving size, route of administration, total
length of exposure, and frequency of exposure. Manufacturers should
be aware that other substances involved in the study or included in
the dietary supplement product itself might also affect the dietary
supplement’s performance or the study results.

Example 5: To illustrate this issue, assume that a firm has high-quality

studies that are also consistent with the totality of the scientific evidence.
The firm would like to use these studies to substantiate a claim that its
dietary supplement has a particular effect on the human body, but the
studies involved the effect of a specific ingredient in foods on the human
body and did not involve the dietary supplement product itself. In this
instance, although the studies might be of high quality, the results of

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these studies of conventional foods are not applicable to the specific

dietary supplement product. (8)
• Have the studies appropriately specified and measured the nutritional
deficiency, structure/function, or general well-being that is the subject
of the claim? We recommend that the studies clearly identify the
endpoints that are to be used to substantiate the claimed effect.

• Were the studies based on a population that is similar to that which

will be consuming the dietary supplement product? For example, if the
study involved young adults, but the product’s claims involve conditions
seen only in the elderly, the study might not be applicable to the claims.

• Does the claim accurately convey to consumers the extent, nature, or

permanence of the effect achieved in the relevant studies and the level
of scientific certainty for that effect?

A note on foreign research: Foreign research could be sufficient to

substantiate a claim as long as the design and implementation of the
foreign research are scientifically sound and the foreign research pertains
to the dietary supplement at issue. In evaluating data from studies
conducted in a foreign population, care should be taken in extending the
results to what might be expected in consumers in the United States who
will use the product. Differences between the two populations, such as
differences in diets, general health, or patterns of use, could confound
the results. In addition, it is important to make sure that the study
examined the same dietary ingredient about which the claim is being
made since there may be instances where, due to provincial or regional
differences in custom, language, or dialect, the same name is given to
different substances or different names to the same substance.

Example 6: A firm claims that its dietary supplement contains an

ingredient shown to promote claim Y. The firm conducts a literature
search and finds several references for carefully conducted, well-
controlled studies demonstrating that the substance appears to be
helpful in persons with claim Y associated with aging when the
substance is applied topically to the affected area. However, there is
no information provided concerning the effect of the substance when
taken orally. Although the evidence may demonstrate that the product
is effective when used topically, this information would generally not be
useful to substantiate a claim for a dietary supplement (by definition, a
product that is intended for ingestion (section 201(ff)(2)(A) of the Act (21
U.S.C. 321(ff)(1)(A)).

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Example 7: A dietary supplement firm wants to promote an amino acid

product to improve blood circulation and improve sexual performance.
The firm conducts a literature search and finds many abstracts and
articles about the amino acid’s effect on biological mediators of
circulation and a few animal and human studies designed to study the
effect of the amino acid on blood flow. The firm intends to use this list of
studies as substantiation for its claim.

Although the firm appears to have a significant amount of information

for its claim, the list is likely not adequate because the firm has not
demonstrated that the information is directly related to the claim
being made. For example, in this situation we would recommend that
the firm provide information to clarify the meaning of “improves
blood circulation” and “improves sexual performance.” We would also
recommend that the firm determine whether the studies examined a
dosage of product similar to the firm’s product and whether any study
measured outcomes (i.e., improved sexual performance) other than
blood flow/blood circulation. Until the firm has reviewed the underlying
studies, it should not assume that merely finding studies testing the same
substance constitutes adequate substantiation.

Example 8: A firm wishes to market its mineral supplement by using a

claim that “studies show that the mineral supplement promotes “Z.” The
firm has the results of a randomized, double-blind, placebo-controlled
study conducted in a foreign country showing that a similar product did,
in fact, promote “Z,” although the study indicates that the foreign study
subjects had low blood levels of the mineral at the start of the study. The
general US population does not have such a mineral deficiency. Although
this study is a high-quality one, it may not be adequate to substantiate
a claim about the product’s use intended for consumers in the United
States because it is confounded by the initial abnormal blood levels of
the mineral. Because the study is not designed to answer the question of
whether the effect would be expected to occur in subjects with normal
blood levels of the mineral, the study might not be adequate evidence to
substantiate the claim.

Example 9: A firm is marketing a product specifically to reduce

nervousness during stressful everyday situations, such as public
speaking. The firm has results from several small studies demonstrating
that the product will raise blood levels of a chemical well known to relax
people in stressful situations. The firm also has two small, randomized,

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placebo-controlled studies showing that its product positively affected

measurable indices of anxiety in people placed in stressful situations,
including public speaking. These studies may be adequate evidence
to support the product claims. Although the studies may be small in
terms of the numbers of subjects tested, they are well-designed studies
that resulted in statistically significant positive results, consistent with
the larger body of scientific evidence related to stress anxiety in public
situations.

Example 10: A firm has developed a product to improve memory and

cognitive ability and now intends to market the product to parents for
their school-age children. The firm has several high-quality clinical
studies that examined the ingredient’s effect in elderly people with
diagnosed, age-related memory problems. These studies alone would
likely not be adequate substantiation for a claim about memory
improvement in young children because the patient population (elderly
people with memory problems) is completely different from the intended
population (children) in the claim.

Example 11: A dietary supplement firm is marketing an iron dietary

supplement with the claim that the dietary supplement is to correct
iron-deficiency anemia in the 10 percent of menstruating women with
menorrhagia. The firm has not studied the product in this population
of women directly, but has assembled and carefully reviewed the
scientific literature of studies that have investigated the oral dosage and
intestinal absorption of the type of iron used in its product, both in the
population in general and in women who match the product’s target
consumer. Using this information, the firm has formulated its product
to provide the amount of bioavailable iron needed by this population
of women. Even though the firm did not test its product directly, it
has examined the existing scientific literature and has formulated the
product in a manner to meet the standards of products shown effective
in well-controlled studies. There is, therefore, a basis to conclude that the
existing literature is applicable to the product in the target population
for whom it is intended. Thus, the firm’s claim that the product will be
useful in correcting iron-deficiency anemia would likely be adequately
substantiated.

Example 12: A firm claims that its multivitamin, multi-mineral product

“provides the vitamins and minerals needed to promote good health
and wellness.” In this case, the firm’s claim is likely substantiated by

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the substantial scientific evidence showing that certain vitamins and

minerals are essential nutrients needed to maintain good health, despite
that the firm does not have data from specific scientific studies to show
that its product results in any measurable outcome. Scientific evidence
studying the firm’s particular product formulation probably would not
be needed for this claim unless the firm were to make claims that its
formulation is different from or superior to other formulations or confers
benefits above and beyond the benefits demonstrated to be associated
with adequate intake of vitamins and minerals.

D. The Quality of the Evidence

In deciding whether studies substantiate a claim, an important

consideration is the scientific quality of studies. Scientific quality is
based on several criteria including study population, study design
and conduct (e.g., presence of a placebo control), data collection (e.g.,
dietary assessment method), statistical analysis, and outcome measures.
For example, if the scientific study adequately addressed all or most
of the above criteria, it could be considered of high quality. Generally
accepted scientific and statistical principles should be used to determine
the quality of the studies used as evidence to substantiate a claim. The
“gold” standard is randomized, double-blind, placebo-controlled trial
design. However, trials of this type may not always be possible, practical,
or ethical. Several systems are available to rate scientific information.
(9) Firms making claims are encouraged to refer to these systems when
developing substantiation for claims or relying on existing information.
The following provides some commonly accepted scientific principles in
evaluating the quality of scientific evidence.

What Are the Types of Evidence That May Substantiate a Claim?

As a general principle, one should think about the type of evidence that
would be sufficient to substantiate a claim in terms of what experts in the
relevant area of study would consider competent and reliable. Competent
and reliable scientific evidence adequate to substantiate a claim would
consist of information derived primarily from human studies.

Human studies can be divided into two types: intervention studies

and observational studies. (10) Of these types of studies, intervention
studies can provide causal evidence to substantiate the effect of a dietary
supplement in humans because they can evaluate the product’s direct
effect in the human body. Observational studies have a more limited

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ability than intervention studies have to distinguish relationships

between a substance and the outcomes being evaluated and cannot
provide causal evidence.

Intervention studies

In intervention studies, an investigator controls whether the subjects

receive the treatment or intervention of interest to test whether the
intervention or treatment supports a predetermined hypothesis. Firms
should determine the hypothesis that should be supported or tested
prior to identifying supportive documentation or developing a study
protocol. Randomized, double-blind, parallel group, placebo-controlled
trials offer the greatest assessment of a relationship between a dietary
supplement and an outcome. Although intervention studies are the
most reliable studies for determining a cause-and-effect relationship,
generalizing from such evidence on selected populations to different
populations may not be scientifically valid. For example, as described in
Example 10 above, if there is evidence to demonstrate a relationship in a
specific population (elderly patients with diagnosed age-related memory
problems), then such evidence should not be extrapolated to a different
population (children).

Observational studies

In observational studies, the investigator does not have control over the
exposure to the treatment or intervention of interest. In prospective
observational studies, investigators recruit subjects and observe them
before a particular outcome occurs. In retrospective observational
studies, investigators review the records of subjects and interview
subjects after the outcome has occurred. Retrospective studies are
usually considered more vulnerable to recall bias (error that occurs
when subjects are asked to remember past behaviors) and measurement
error, but are less likely to require large sample size or high costs or to
encounter the ethical problems that may occur in prospective studies.
Types of observational studies include:
• Case reports, which describe observations of a single subject or a small
number of subjects.

• Case-series studies, which are a descriptive account of a series of

“outcomes” observed over time and reported for a group of subjects.
No control group is described.

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• Case-control studies, which compare subjects with a condition (cases)

to subjects who do not have the same condition (controls). Subjects are
enrolled based on their outcome rather than based on their exposure.

• Cohort studies, which compare the outcome of subjects

who have been exposed to the substance to the outcome
of subjects who have not been exposed.

• Cross-sectional (prevalence) studies, which compare, at a single point

in time, the number of individuals with a condition who have been
exposed to a substance to the number of individuals without the
condition who were not exposed to the substance.

• Time-series studies, which compare outcomes during

different time periods, e.g., whether the rate of occurrence
of a particular outcome during one five-year period
changed during a subsequent five-year period.

• Epidemiological studies, which compare the rate of a condition across

different populations.

What types of information are useful

as background to support a claim?

The following additional types of information would generally be

considered background information but alone may not be adequate to
substantiate a claim.
• Animal studies – Animal studies may provide useful background on the
biological effects of a substance. However, they often have limited or
unknown value in predicting the effect of the substance in humans. Care
should be exercised in extrapolating results obtained in animal research
directly to the human condition. The strongest animal evidence is based
on data from studies in appropriate animal models, on data that have
been reproduced in a variety of laboratories, and on data that give a
statistically significant dose-response relationship. Without any data
from human studies, the results of animal studies alone are not sufficient
to substantiate a claim.

• In vitro studies are studies conducted outside a living body. For example,
such studies might examine a product’s effect on isolated cells or tissues.
These studies are of limited value in predicting the effect of a substance
when consumed by humans. The strongest in vitro evidence would be
based on data that have been reproduced in different laboratories, but
this evidence alone would not substantiate a claim.

• Testimonials and other anecdotal evidence – This type of evidence

includes descriptions of experiences of individuals using a dietary

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supplement product or ingredient. It might also include descriptions

of the use of the product or ingredient by others, for example, by
other cultures in the past or present. It might consist of an opinion
or statement of an expert or someone who endorses the product.
Anecdotal evidence generally would not be sufficient to substantiate
claims regarding a dietary supplement’s effect because each individual’s
experience might be attributable to factors other than the dietary
supplement itself. For example, a person might have experienced
a placebo or coincidental effect rather than an effect attributable
to the dietary supplement itself. Additionally, the “honest opinion”
of a consumer testimonial or an expert endorsement would not be
enough to substantiate a claim; rather, the endorsement should also be
supported by competent and reliable scientific evidence.

• Meta-analysis is the process of systematically combining and evaluating

the results of clinical trials that have been completed or terminated.
Meta-analysis may identify relevant reports, which may provide
substantiation for the claim.

• Review articles summarize the findings of primary reports. Review

articles may identify relevant primary reports, which may provide
substantiation for the claim. Review articles may also provide
background information that is useful to understand the scientific issues
about the relationship between the substance and the claimed effect.

• Comments and letters to the editor usually focus on a particular issue

or issues from a study, presentation at a meeting, and so on. Comments
generally do not present a study’s results. Comments and letters to
the editor may identify relevant primary reports, which may provide
substantiation for the claim. Comments and letters to the editor may
also provide background information that is useful to understanding the
scientific issues about the relationship between the substance and the
claimed effect.

• Product monographs are prepared by the manufacturer to convey

specific information about a product such as its specifications. Product
monographs may provide background information that is useful to
understanding the scientific issues about the relationship between the
substance and the claimed effect.

Example 13: A dietary supplement claim states, “Data suggest

that including Substance X in the diet may promote brain neuron
health in healthy individuals.” The firm cites a study in which
rats were fed diets containing Substance X, and the brains of
all rats were examined for ischemia-induced brain damage. The
study does not provide a basis that Substance X would have the

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same effect on brain health in otherwise healthy humans. This

study alone likely would not provide adequate substantiation of
the claim being made because it relies solely on animal data.

Example 14: A dietary supplement claim states, “Grain Y has been used
effectively for centuries to promote gastrointestinal health.” The firm
has no clinical studies in humans but has an industry monograph that
relies only on historical descriptions of grain Y use by pre-modern
civilizations. Although the monograph may be an accurate review of the
historical use of grain Y, it would likely not constitute competent and
reliable evidence to support the claim because it is not based on objective
scientific evidence. Rather, it is largely anecdotal evidence that cannot be
objectively evaluated to determine whether it applies to the consumers
who would use the product.

Example 15: A dietary supplement label claims that, in laboratory tests

(i.e., in vitro tests), the enzymes in the supplement can digest up to 20
grams of protein and 15 grams of dietary fat, and the firm is promoting
the supplement to assist in breaking down protein and fat that its
users eat. The firm has not tested its product or the ingredients in the
supplement in humans. Although this evidence may be accurate, it
would generally not be adequate substantiation for the claimed effects on
dietary components because it is insufficient for reaching a conclusion on
whether the enzymes, when consumed, would behave equivalently in the
human body. Corroborating evidence from some human studies would
likely be needed to determine whether the in vitro findings reflect the
outcomes of the product when consumed by humans.

Example 16: A botanical product label uses the claim “improves vitality.”
The substantiation that the firm is relying on consists of testimonial
experience it has collected from consumers and descriptions of the
botanical product’s traditional use. Although the firm may have
testimonial experience to back up the basic claim being made, the
claimed benefit would likely not be adequately substantiated because
neither source is based on scientific evidence. If the firm wants to make
a claim of this type, we recommend that it have scientific evidence that
some measurable outcome(s) associated with the general conditions cited
in the claim is (are) significantly improved.

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What Design Factors Affect the Quality of a Study?

Multiple factors should be considered in study design. These include,

but are not limited to, bias, confounders, and other limitations.
Potential sources of bias include lack of appropriate randomization
and blinding, the number of subjects called for in the protocol
vs. the number of subjects who actually participated in the trial,
demographics, adequacy of primary variables, compliance, control
agent, dropouts, statistical procedures, subgroup analysis, safety
issues, and reproducibility of results. Confounders are factors
associated with the intervention and the outcome in question and thus
prevent the measured outcome from being attributed unequivocally
to the intervention. Potential confounders include variability in
the quantity of the dietary supplement being administered or the
presence of other dietary ingredients that may have their own
independent effects. These factors can limit the study’s reliability.

Quality assessment criteria – Factors that contribute to higher quality

studies include:
• Adequacy and clarity of the design
• The questions to be answered by the study are clearly described
at the outset.
• The methodology used in the study is clearly described and appropriate
for answering the questions posed by the study.
• The duration of the study intervention or follow-up period is sufficient to
detect an effect on the outcome of interest.
• Potential confounding factors are identified, assessed, and/or controlled.
• Subject attrition (subjects leaving the study before it is completed) is
assessed, explained, and reasonable.

Population studied
• The sample size is large enough to provide sufficient statistical
power to detect a significant effect. (If the study is underpowered,
it may be impossible to conclude that the absence of an effect is not
due to chance.)
• The study population is representative (with respect to factors such
as age, gender distribution, race, socioeconomic status, geographic

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location, family history, health status, and motivation) of the population

the claim will be targeted to.
• The criteria for inclusion and exclusion of study subjects were clearly
stated and appropriate.

• The study used recruitment procedures that minimized selection bias.

• For controlled interventions, the subjects were randomized. If matching

was employed to assign the subjects to control and treatment groups,
appropriate demographic characteristics and other variables were used
for the matching. The randomization was successful in producing similar
control and intervention groups.

Assessment of intervention or exposure and outcomes

• The analytical methodology and quality control procedures to assess
dietary intake are adequate.

• The dietary supplement serving size is well defined and

appropriately measured.

• The background diets to which the dietary supplement was added,

or the control and interventional diets, are adequately described,
measured, and suitable.

• In studies with crossover designs, the “washout” period (the period

during which subjects do not receive an intervention) between dietary
supplement exposures is appropriate. Lack of a sufficient washout
period between interventions may lead to confusion as to which
intervention produced the health outcome.

• The form and setting of the intervention represent the way the product
will be normally used.

• Other possible concurrent changes in diet or health-related behavior

(weight loss, exercise, alcohol intake, and smoking cessation) present
during the study that could account for the outcome identified are
assessed and/or controlled.

• The study’s outcomes are well defined and appropriately measured.

• Efforts were made to detect harmful and beneficial effects.

Data Analysis and Assessment

• Appropriate statistical analyses were applied to the data.

• “Statistical significance” was interpreted appropriately.

• Relative and absolute effects were distinguished.

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Peer Review – The nature and quality of the written report of the
research are also important. Although studies or evidence used to
substantiate a claim do not have to be published in a peer-reviewed
journal or publication, such publications do give some level of assurance
that qualified experts have reviewed the research and found it to be
of sufficient quality and validity to merit publication. In contrast, an
abstract or informal summary of an article is less reliable because such
documents usually do not provide the reader enough insight into how
the research was conducted or how the data were analyzed to objectively
evaluate the quality of the research data and the conclusions drawn
by the authors. Moreover, the mere fact that the study was published
does not necessarily mean that the research is competent and reliable
evidence adequate to substantiate a particular claim.

Example 17: A dietary supplement label claims, “Randomized, double

blind, placebo-controlled studies demonstrate that herbal extract ‘Z’ is
beneficial in relieving menopausal symptoms.” The firm is relying on the
results of more than one randomized, double-blind, placebo-controlled
intervention study using menopausal women as subjects, and the results
of those studies are in general agreement. The claim would likely be
substantiated because it relies on high-quality studies in humans that
directly addressed conditions described in the claim.

E. Consider the Totality of the Evidence

How Well Does the Totality of Evidence Support the Claims?

In determining whether there is adequate evidence to substantiate a

claim, one should consider the strength of the entire body of evidence,
including criteria such as quality, quantity (number of various types of
studies and sample sizes), relevance of exposure, and consistency and
replication of the findings.

To determine whether the available scientific evidence is adequate to

substantiate a claim, it is important to consider all relevant research,
both favorable and unfavorable. Ideally, the evidence used to substantiate
a claim agrees with the surrounding body of evidence. Conflicting or
inconsistent results raise serious questions as to whether a particular
claim is substantiated. If conflicts or inconsistencies exist in the scientific
evidence, one should determine whether there are plausible explanations

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for such conflicts or inconsistencies. For example, an inconsistency

between two studies might be attributable to different concentrations
of the dietary supplement, different test methodologies, different study
populations, (11) or other factors.

There is no general rule for how many studies, or what combination

of types of evidence, is sufficient to support a claim. However, the
replication of research results in independently conducted studies makes
it more likely that the totality of the evidence will support a claim.

Although the quality of individual pieces of evidence is important, each

piece should be considered in the context of all available information;
that is, the strength of the total body of scientific evidence is the critical
factor in assessing whether a claim is substantiated.

Example 18: A firm intends to promote an herbal product “X” to “help

maintain cognitive performance” of people who are fatigued. The firm
has researched the scientific literature and found many studies that
demonstrate that the botanical ingredient is effective. However, some
studies demonstrate no effect. Still other studies examined the botanical
ingredient combined with other ingredients, typically caffeine, which
demonstrated mixed positive and negative results. Many reports do
not adequately describe the study participants and products examined.
Consequently, it is not possible to explain the disparate results. However,
the firm’s review suggests that either the botanical and/or caffeine
are the most likely dietary ingredients that act to maintain better
cognition test results in fatigued study participants. As a result, the firm
conducts a large, randomized, placebo-controlled study to compare
the botanical ingredient against caffeine in the treatment of cognitive
performance deficits associated with fatigue. The results demonstrate
that caffeine improved cognition test results in all the fatigued subjects
who received caffeine, whereas test performance was unaffected in all
subjects receiving the botanical ingredient. The study cannot explain the
results reported in the earlier studies; however, it demonstrates that the
botanical ingredient studied is most likely ineffective in improving or
maintaining cognitive performance in fatigued people.

Example 19: A firm plans to promote its herbal product “to effectively
relieve occasional nocturnal leg cramps.” The firm has one study
demonstrating the product to be effective in ameliorating nocturnal
leg cramps. The firm is also aware of several other randomized

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controlled trials that do not show a benefit. All these studies are of
equal quality and used similar patient populations and test materials.
When considered as a whole, even though some evidence to support the
claim exists, the totality of the evidence does not support the proposed
claim. If no plausible explanation can be found to explain the disparate
results, the available evidence would likely not be considered adequate to
substantiate the claim.

Example 20: An herbal product is promoted “to help you get to sleep
when you have difficulty falling asleep.” The firm has one randomized,
placebo-controlled study in volunteers who had trouble falling asleep.
The study showed that those who used the product decreased the
amount of time needed time to fall asleep. There are several other high-
quality studies, however, that found that the herbal ingredient used in
the product did not consistently help people get to sleep. It is not clear
whether the different results of the various studies are a consequence of
differences in product formulation or dosage or some other factor. Even
though the firm’s single study is positive, it may not provide adequate
substantiation, because the totality of existing evidence suggests that
the herbal ingredient does not decrease time to fall asleep in persons
who have trouble falling asleep. Given the contrary evidence against the
claim, it is unlikely that this sleep-related claim would be substantiated
for this product.

Example 21: A company plans to promote its product containing

ingredient X to athletes “to improve endurance performance.” There
are some well-designed published studies demonstrating that other
products containing ingredient X are effective, but other well-designed
studies show no effect for certain products containing ingredient X.
The firm sponsored a randomized, blinded, six-month study comparing
its product to four other products containing ingredient X in a dose
(serving size)-response fashion. The findings demonstrate that the firm’s
product and two other products that provided the highest amount
of ingredient X per day produced substantial, statistically significant
improvements in athletic endurance. When the firm compared the
results of this study to those of prior studies, the firm concluded that
the explanation for previous conflicting study results is that when
the serving size of ingredient X is below a certain amount, there is no
measurable benefit. Taken together, the positive results from its study,
and the identification of a plausible explanation to explain why some

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studies showed no positive effects, would likely provide evidence to

substantiate adequately the endurance performance claim for the
dietary supplement.

F. Conclusion

Section 403(r)(6) of the act requires dietary supplement manufacturers

to have substantiation that structure/function, nutrient deficiency, and
general well-being claims on a dietary supplement product’s labeling are
truthful and not misleading. We recommend that to meet this statutory
requirement, manufacturers should possess adequate substantiation
for each reasonable interpretation of the claims. We intend to apply a
standard that is consistent with the FTC standard of “competent and
reliable scientific evidence” to substantiate a claim. We consider the
following factors important to establish whether information would
constitute “competent and reliable scientific evidence:”
• Does each study or piece of evidence bear a relationship to the
specific claim(s)?

• What are the individual study’s or evidence’s strengths and weaknesses?

Consider the type of study, the design of the study, analysis of the
results, and peer review.

• If multiple studies exist, do the studies that have the most reliable
methodologies suggest a particular outcome?

• If multiple studies exist, what do most studies suggest or find? Does the
totality of the evidence agree with the claim(s)?

Guidance Document References:

(1) The Office of Nutrition, Labeling, and Dietary Supplements in FDA’s Center for Food Safety
and Applied Nutrition prepared this guidance document.

(2) Under section 403(r)(6)(A) of the Act (21 U.S.C. 343(r)(6)(A)), such a statement is one that
“claims a benefit related to a classical nutritional deficiency disease and discloses the prevalence
of such disease in the United States, describes the role of a nutrient or dietary ingredient
intended to affect the structure or function in humans, characterizes the documented
mechanism by which a nutrient or dietary ingredient acts to maintain such structure
or function, or describes general well-being from consumption for a nutrient or dietary
ingredient....”

(3) Comments to the Draft Guidance published November 9, 2004 (69 FR 64942), questioned
the constitutionality, under the First Amendment, of the substantiation requirement in
section 403(r)(6), as interpreted by the Draft Guidance. This Guidance offers FDA’s non-
binding interpretation of what constitutes substantiation and does not change the statutory or
Constitutional requirement in any way. We believe the statutory substantiation requirement in
section 403(r)(6) is constitutional under the Supreme Court’s analysis governing commercial
speech in Central Hudson Gas & Electric Corp. v. Public Service Commission of New York
(447 U.S. 557 (1980)). Claims made under section 403(r)(6) are misleading when made

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 Label Clains for Conventional Foods and Dietary Supplements | 343

without substantiation. The misleading nature of a claim made under section 403(r)(6) that is not
substantiated cannot be cured by a disclaimer stating that the claim lacks support. For example,
a product cannot claim “to promote the structure and function of the skeletal system” and then
attempt to cure the misleading nature of the claim with a statement “no evidence exists that this
product promotes the structure and function of the skeletal system.” However, nothing in this
Guidance addresses the circumstances under which a claim made under section 403(r)(6) that
includes qualifying language may be substantiated.

(4) This guidance does not discuss the criteria to determine whether a statement about a dietary
supplement is a structure/function claim under section 403(r)(6) of the Act or a disease claim.
Please see the Federal Register of January 6, 2000 (65 FR 1000, codified at 21 CFR 101.93) (www.
cfsan.fda.gov/~lrd/fr000106.html) for the final rule defining structure/function claims for dietary
supplements and the January 9, 2002 Small Entity Compliance Guide for structure/function
claims (www.cfsan.fda.gov/~dms/sclmguid.html)(Updated web reference: Structure/Function
Claims; Small Entity Compliance Guide).

(5) See Report of the Commission on Dietary Supplement Labels, November 1997, at page 42. The
Commission’s recommendations on substantiation are at pages 42 through 45 of the report.

(6) See Bureau of Consumer Protection, Federal Trade Commission, “Dietary Supplements: An
Advertising Guide for Industry,” April 2001 (hereinafter referred to as “FTC Advertising Guide”),
available at www.ftc.gov.

(7) See, e.g. Vital Basics, Inc., C-4107 (Consent April 26, 2004); see also In Re Schering Corp., 118
F.T.C. 1030, 1123 (1994).

(8) For example, a study using a conventional food or a multi-nutrient supplement would not
substantiate a single ingredient dietary supplement claim. When the substance studied contains
many nutrients and substances, it is difficult to study the nutrient or food components in isolation
(Sempos, et al., 1999). It is not possible to accurately determine whether any observed effects
of the substance were due to: 1) the substance alone; 2) interactions between the substance and
other nutrients; 3) other nutrients acting alone or together; or 4) decreased consumption of other
nutrients or substances contained in foods displaced from the diet by the increased intake of
foods rich in the substance at issue. Furthermore, although epidemiological studies based on the
recorded dietary intake of conventional foods have indicated a benefit for a particular nutrient, it
has been subsequently demonstrated in an intervention study that the single ingredient nutrient-
containing dietary supplement did not confer a benefit or actually was harmful. See Lichtenstein
and Russell, 2005. We note that the D.C. Circuit Court in Pearson v. Shalala, 164 F.3d 650, 658
(D.C. Cir. 1999) indicated that FDA had “logically determined” that the consumption of a dietary
supplement containing antioxidants could not be scientifically proven to reduce the risk of cancer
where the existing research had examined only foods containing antioxidants as the effect of those
foods on reducing the risk of cancer may have resulted from other substances. The court, however,
concluded that FDA’s concern with granting antioxidant vitamins a qualified health claim could
be accommodated by simply adding a prominent disclaimer noting that the evidence for such a
claim was inconclusive given that the studies supporting the claim were based on foods containing
other substances that might actually be responsible for reducing the risk of cancer. Id. The court
noted that FDA did not assert that the dietary supplements at issue would “threaten consumer’s
health and safety.” Id. at 656. As the agency has stated in the context of qualified health claims,
that is, claims regarding the relationship between a substance and the reduced risk of a disease,
there is a more fundamental problem with allowing qualified health claims for nutrients in dietary
supplements based solely on studies of foods containing those nutrients than the problem the
D.C. Circuit held could be cured with a disclaimer. As noted in endnote 3, even if the effect of the
specific component of the food constituting the dietary supplement could be determined with
certainty, recent scientific studies have shown that nutrients in food do not necessarily have the
same beneficial effect when taken in the form of a dietary supplement. Such studies established
either that there was no benefit when the nutrients are taken as a supplement and some studies
even showed an increased risk for the very disease the nutrients were predicted to prevent. We
would expect similar issues with structure/functions claims made under § 403(r)(6). Thus, an
observational study based on food does not provide competent and reliable scientific evidence for
a dietary supplement and, and therefore, cannot substantiate a claim made under § 403(r)(6).

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(9) See “Systems to Rate the Strength of Scientific Evidence. Evidence Report/Technology
Assessment Number 47, ”Agency for Healthcare Research and Quality and Research (AHRQ),
Publication No. 02-E016, April 2002.

(10) See Spilker, B. Guide to Clinical Trials. Raven Press, New York, 1991.

(11) For example, with respect to human drug products, it is fairly well known that children
and the elderly may experience different drug effects compared to those seen in the adult
population. These differences may be due to physiological differences (such as hormonal
differences, differences in kidney function, etc.) between children, adults, and the elderly.

[End of FDA’s Guide Excerpts]

Conclusion
Making claims for foods and dietary supplements is a highly regulated
area of labeling and advertising. Both the FDA and FTC are involved
in the United States. In Canada, the Natural Health Product approach
utilizes preapproved claims, product review, and licensing. This
Canadian approach may offer advantages, as it nearly eliminates
controversy about the regulated health products.

In the United States, the FDA authorizes health claims and nutrient
content claims. The category of claims referred to as structure/function
claims are not preapproved by the FDA, and the responsibility for basing
claims in adequate scientific evidence is required by each company
selling such products. In the health product market, sports nutrition
food and supplements represent a major segment of the market and
typically are packed with a variety of claims, including structure/
function claims.

The information in this unit can therefore can applied for fitness trainers
and other health professionals to review product claims, determine
whether the evidence is adequate to support claims, and improve
communication about the variety of product claims with clients and
when dealing with sports nutrition product companies.

Key Word
seafood

Sports Nutrition
PART TWO
Anatomy and Metabolism
Determine Nutrient Needs

Anatomy of an Athlete:
Cells, Tissues, and Systems, p. 347
Digestion and Absorption, p. 367
Body Composition, p. 383
Calorie Needs and Metabolism, p. 403
Dietary Guidelines for Americans, p. 425
This page is intentionally blank.
 Topics Covered In This Unit

Introduction

Cells, cells, cells

The cell – Fundamental unit of life

Cellular components
Tissues

Epithelial tissues

Connective tissues

Muscle tissues

Systems

Skeletal system

Skeletal muscle system

Nervous system

Respiratory system

Cardiovascular (circulatory) system

Digestive system

Urinary system

Reproductive system

Endocrine system

Conclusion

UNIT 12

ANATOMY OF AN ATHLETE:
CELLS, TISSUES, AND SYSTEMS
348 | Unit 12

I. Introduction
II. Cells, cells, cells V. Systems
III. The cell – Fundamental unit of life a. Skeletal system
a. Cellular components b. Skeletal muscle system
IV. Tissues c. Nervous system
a. Epithelial tissues d. Respiratory system
b. Connective tissues e. Cardiovascular (circulatory) system
c. Muscle tissues f. Digestive system
i. The mechanics of muscular contraction g. Urinary system
ii. Fast-twitch and slow-twitch muscle fibers h. Reproductive system
iii. Muscular hypertrophy i. Endocrine system
i. Control of hormone action
VI. Conclusion

Learning Objectives
After completing this unit, you will be able to:
• Define and describe key human anatomy terms;

• Discuss cell structure;

• Understand the main systems of the body; and

• Describe the different skeletal muscle fiber types and muscle contraction.

Introduction
The pages of this book—locker room talk, in this area of science. This unit also includes
magazine articles, and visits with your doctor, some interesting discussion on the makeup of
trainer, or coach—all share a common element: muscle tissue and its functions. The following
terminology that relates to the human body and will serve to acquaint you with the fundamental
its parts. This unit is included as a reference unit units of the body, anatomic terms, and concepts
so that you can build a fundamental knowledge commonly encountered in sports science.

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 Anatomy of an Athlete: Cells, Tissues, and Systems| 349

estimated 100 trillion cells of various form

Anatomy & Physiology and function. Striated muscle cells can be
Simple Definitions. several inches long and have the unique ability
Anatomy = body structures. to shorten in length, thereby causing muscle
Physiology = body functions.
contractions. Fat cells are small and round in
shape and function to store fatty acids for energy
needs during lean times.

Another magnificent characteristic of cells is

Cells, Cells, Cells that they can reproduce themselves. In fact,
The human body is an incredible biological cells can only arise from preexisting cells. Our
phenomenon composed of several complex body originates from the union of
interdependent systems responsible for two existing cells, the female egg and the male
maintaining life. For example, the muscle system sperm. These sex cells merge to form one larger
needs the nervous system to fire-off muscle cell called the zygote, which is the starting point
contractions. The circulatory system is needed of a multitrillion-celled human body. The zygote
to provide the muscle system with nourishment divides and forms two cells. (Sometimes, these
and at the same time carry away metabolic waste two zygote cells become separated and develop
products. These complex systems are made up of independently of each other. That’s how identical
fundamentally simpler units, or building blocks. twins come about.) The two zygote cells continue
The digestive system consists of several organs, to divide and form four cells. This process
which in turn consists of tissues, which in turn continues forever. Even when the total number
consist of cells of different form and function. of cells reaches a relatively fixed amount, cells
Furthermore, each individual cell possesses continue to divide to replace old or dead cells.
subcellular organelles, such as the mitochondria,
As we live, cells are continually dying and being
which are involved with making energy. Finally,
produced. This remarkable process goes on
organelles are composed of various molecules
automatically. All we have to do is eat food to
(e.g., proteins, DNA) that serve as the building
keep it going. But proper nutrition practices can
blocks of the human body and are involved in
make the body work much better and be much
biosynthesizing molecules for use by cells.
healthier. For example, scientists have suspected
for years that a byproduct of metabolism, the
The Cell– so-called free radical, can damage cell structures
Fundamental Unit of Life and molecules. Free radicals also become
more prevalent during strenuous activity and
Just as every molecule has building blocks, periods of fat loss. Cellular damage due to free
so do tissues and structures. Cells form the radicals must be repaired, which takes time
fundamental units of life. Together they and can impair your rate of recovery. Free
somehow organize themselves into a human radical damage has also been linked to the
body. The human body is composed of an development of cancer, cardiovascular disease,

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cataract formation, and aging. The body can the body can consist of three fatty acids attached
manufacture antioxidant compounds, such as to the three carbon glycerol molecules, thus the
superoxide dismutase and glutathione, which can name, triglycerides.)
be optimized with nutrition, and additionally
The plasma membrane can allow the transport
benefit from intake of antioxidants from foods
of molecules through it and also actively
and supplements, to be reviewed in another unit.
transport certain compounds across it via special
mechanisms. It is therefore referred to as a semi-
Cellular Components permeable plasma membrane. This gives the cell
Each cell has its own anatomy and physiology. control over which substance and how much of a
This is accomplished by subcellular structures substance it wants inside it. Additionally, the cell
called organelles. Each cell typically contains the can rid itself of undesirable compounds while
following organelles. retaining desirable ones. Insulin is an important
hormone that is responsible for stimulating the
Plasma membrane. Picture the cell as an uptake of glucose and amino acids across the
inflated balloon. The outer boundary is called plasma membrane. Insulin levels increase in the
the plasma membrane, or cell membrane. It is a body after a meal to ensure these vital nutrients
complex structure made up of mostly proteins get into the cells. There are ways to maximize
and a phospholipid bilayer. The phospholipid insulin’s functioning through supplementation
bilayer (which is made up of glycerol, two fatty and timing of meals around training, which will
acids, and a phosphate group) forms a double- be discussed later.
walled balloon like structure, with proteins
embedded in these bilayer sheets. Proteins in the Nucleus. The nucleus was first discovered
cell membrane provide structural support, form more than a century and a half ago in 1830 and
channels for passage of materials, act as receptor credited to the scientist Robert Brown. Usually
sites, function as carrier molecules, and provide it is situated in approximately the center of each
identification markers. cell and is slightly darker than the surrounding
cytoplasm is. The nucleus is essentially a cell
The nutritional significance of this structure is within a cell, which has a membrane of its own
that the cell membrane is made up of fatty acids, and houses the cells’ genetic material, DNA
which are part of the phospholipid bilayer. This (Deoxyribonucleic Acid). Strands of DNA form
means that fats are an important part of the diet chromosomes. The human cell contains two sets
for energy production but also for bodybuilding of 23 chromosomes making a matching set of
materials, and while we need to make sure we 23 pairs and a total of 46 chromosomes. Each
do not eat too much, we do need an appropriate parent contributes one set of chromosomes from
amount to serve as the essential building blocks his and her sex cells, the sperm and egg. The
for all cells. Fats are especially important for chromosomes contain the genetic information
athletes training to gain muscle mass and for responsible for the way we look. The nucleus is
long-distance athletes whose metabolism burns commonly called the cell’s control center. The
up a tremendous amount of fatty acids. (Fats in chromosomes are suspended in a liquid called

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 Anatomy of an Athlete: Cells, Tissues, and Systems| 351

the nucleoplasm. The liquid between the plasma along the messenger RNA strand, they function
membrane and nuclear membrane is called to connect each code point along the RNA to
cytoplasm, or cytosol. the corresponding transfer RNA, which has an
amino acid attached to it. In the same way that
The nucleus typically functions to initiate
the ribosomes roll along the messenger RNA,
production of substances needed by the cell. The
amino acids are strung together to form proteins,
process is initiated by an intracellular (within
enzymes, and so on. If certain amino acids are
the cell) signal, which causes specific genes on
missing, the protein chains cannot be completed.
certain chromosomes to produce exact copies
This is why adequate and effective protein intake
of the gene sequence being activated. These
is mandatory for the athlete. If an essential
pieces of material-carrying genetic information
amino acid is lacking, protein synthesis can be
are called messenger RNA (Ribonucleic Acid).
reduced or temporarily stopped. This concept of
The information contained on the messenger
the limiting nutrient is important to consider.
RNA strands may be the sequence of amino
The diet can be abundant in calories, but a short
acids needed for a protein molecule, such as
supply of an essential nutrient can limit certain
insulin. The messenger RNA is then transported
reactions needed for the cell to thrive.
from the nucleus, through pores in the nuclear
membrane, and on to the cytoplasm. Once in the The nucleus has another important function.
cell’s cytoplasm, the strand of messenger RNA It initiates cell division. During cell division,
is used as a template to make molecules in the each chromosome must duplicate itself so the
cytoplasm. For this to occur, ribosomes must be new cell will contain a full set of 23 pairs of
connected to the messenger RNA strand. chromosomes.

Ribosomes, discussed below, are also organelles. Ribosomes. The next organelle, which was
They run along the messenger RNA strands just mentioned above, plays a role in the
while in the cytoplasm. As the ribosomes go synthesis of proteins and cellular components.

Phenotype and Genotype

Talk of genetics has grown in popularity in recent decades, and along with discussion of this topic
came a host of scientific terms. Two of these terms, genotype and phenotype, are commonly used and
misused. The word genotype refers directly to the genetic information stored on your chromosomes.
The word phenotype refers to actual morphological characteristics you possess: eye color, hair color,
foot size, and so on.
Your phenotype is said to be a result of your genotype and the surrounding environmental factors.
Some of your phenotypic makeup cannot be greatly influenced by the environment, such as the color
of your eyes. But other aspects, such as body weight, athletic performance, and some diseases can be
controlled. Environmental factors include your surroundings, climate, food, activity, stress, and so on.
Expression of genes (phenotype) is therefore dynamic.

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Ribosomes are extremely small in size and were not discovered until the
electron microscope was in use. The electron microscope can achieve
magnification many times more than the traditional light microscope
that most people are familiar can. Light consists of energy waves with a
certain range of wave lengths. Think of the waves that are formed when
a stone is dropped into water. The distance between the top of two waves
is the wavelength. Our eyes can only detect certain wave lengths, and
you must have entire wave lengths to see. Thus, one limitation of the
light microscope is the wave length of visible light. The lenses of the light
microscope actually function to bring your eye closer and closer to the
subject. The maximum magnification, or the closest your eye can be to
something and see it, is one wavelength of visible light.

Scientists wanted to increase magnification to see smaller particles. To

do this, they developed the electron microscope. This microscope sees
with electrons, which are many times smaller than light waves are.
The only limitation is that we cannot directly look through an electron
microscope because our eyes cannot see electrons. As such, we either
take photos with special film or use special cameras to view the subject
on a TV monitor, as with the scanning electron microscope.

Ribosomes are extremely small, spherical organelles made up of protein

and RNA. They are by far the most numerous of cell organelles. They
are found scattered throughout the cell’s cytoplasm and also along the
surface of another organelle, the endoplasmic reticulum. Ribosomes
function in pairs as two subunits, with one subunit smaller than the
other. Ribosomes are located in the cytoplasm and make various
compounds from messenger RNA for local cellular needs. Ribosomes
situated on the endoplasmic reticulum synthesize compounds for use
outside the cell and can be channeled out of the cell for export, such as
Digestive enzyme: an with hormones, digestive enzymes, and the like.
enzyme that acts as catalysts
for the breakdown of food Endoplasmic Reticulum (ER). This organelle forms a network of
components.
intracellular canals within the cytoplasm involved in transport of
materials in the cell. ER exists in two forms, rough ER and smooth ER.
Rough ER is ER with ribosomes attached. Here then is where proteins
and other biomolecules can be made and transported through the ER’s
canal network to other parts of the cell and outside the cell. Smooth ER
is without ribosomes, and its function is less clear, although it appears
that smooth ER may be the site of steroid synthesis in the testes and

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adrenal glands. Evidence also indicates that They also play a limited role in the engulfing and
some lipid and cholesterol metabolism occur in destroying of bacteria that may enter the cell.
smooth ER of the liver cells.
Mitochondrion (plural, mitochondria). Next
Golgi Apparatus. The Golgi apparatus consists to the nucleus, this is probably the most known
of stacks of tiny oblong sacs embedded in the and talked about organelle, in the athletic arena,
cell’s cytoplasm near the nucleus. It is active due to its role in the generation of energy. Called
in the modification and transport of proteins. the cell’s powerhouse, mitochondria are small
Research has presented evidence that the Golgi complex organelles that resemble a sausage in
sacs are responsible for synthesis of certain shape. They consist of a smooth outer membrane
carbohydrate biomolecules. These carbohydrates that surrounds an inner membrane, forming a
are then combined with the proteins made in the sac within a sac. The inner membrane is folded
endoplasmic reticulum to form glycoproteins. like an accordion and forms a number of inward
Glycoproteins function as enzymes, hormones, extensions called cristae.
antibodies, structural proteins, and so on. As It is here in the mitochondria that the enzymes
the amount of glycoprotein produced within the exist that are essential for making one of the
Golgi sac increases, the sac becomes inflated. At most important biomolecules: ATP (adenosine
this point, small spheres form along the surface triphosphate). ATP stores a great deal of energy,
of the Golgi sac and break away. These globules which is used to power biological functions.
contain the glycoproteins, which are transported More will be said about ATP in the units
to the cell membrane and then out of the cell and to follow. Within the inner mitochondria
into the bloodstream to be used by other cells. membrane, catabolic enzymes (which are
Other functions are possible and being explored. involved in breaking down of biomolecules)
catalyze reactions that provide the cells with life-
Lysosome. Lysosomes are other sac-like
sustaining energy.
structures whose size and shape change with
the degree of their activity. They start out Nutrients like glucose and fatty acids are made
small and, as they become active, increase in of carbon atoms linked together with chemical
size. Lysosomes contain a variety of enzymes bonds. When these chemical bonds are broken,
(which act as catalysts, directing all major energy is released. Within the intricate confines
biochemical reactions). These enzymes are of the mitochondria, this energy can be trapped
capable of breaking down all of the cell’s main and stored in the ATP molecule, which can then
components, such as protein, fat, and nucleic make use of it. In other words, the energy from
acid. The breakdown products formed inside glucose is transferred to the ATP molecule, and
the lysosome can be used as raw materials for the energy is now in a form that the body’s bio-
synthesis of new biomolecules or for energy. In machinery can make use of. Quite remarkable.
this way, lysosomes serve to contain and isolate The popular nutrient L-carnitine is involved in
these important cellular digestive enzymes and transport of fatty acids from the cytoplasm into
thereby prevent complete digestion of the cell. the mitochondria and is a supplement commonly

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taken with the intent of increasing the amount of fatty acids used for
energy, which may help spare glycogen and speed up fat loss and the
energy-producing process of endurance athletes. There are other ways
the body can make ATP; however, it is in the mitochondria where the
greatest ATP generally occurs.

Another interesting fact about mitochondrion is the discovery of its own

DNA. Mitochondrial DNA is circular.

These are the cell’s main components. Some of the other structures
include glycogen granules, which store glycogen and enzymes for
glycogen breakdown and synthesis, and peroxisomes, which contain
enzymes and function to get rid of toxic cellular substances. Although
not a structure, the cytoplasm is worth mentioning. This liquid portion
Gluconeogenesis: the of the cell is the site of many reactions, including gluconeogenesis
metabolic process in which (glucose and glycogen formation), fatty acid synthesis, activation of
glucose is synthesized from
noncarbohydrate sources. amino acids, and glycolysis (the first phase of breaking down glucose to
Glycolysis: the metabolic make ATP molecules for energy).
process in which glucose is
converted to lactic acid.
Tissues
Although the cell is the fundamental unit of life, tissues are the
fundamental units of function and structure for the human body. Tissues
are defined as the aggregation of cells bound together that work together
to perform a common function. For example, cells of the adrenal cortex
form a glandular tissue that produces several hormones, including
androgens, glucocorticoids, and mineralocorticoids. Then there is muscle
tissue, which is made up of special muscle fiber cells that have the ability
to shorten in length and that form the basis of contractile tissue.

In this section, you will learn about the basic tissues that make up your
body. Despite that the human body seems considerably complex, the
tissues that form it can be separated into five basic groups: epithelial,
connective, muscle, nervous, and reproductive.

Epithelial Tissues
These tissues are found throughout the body: as a continuous external
layer over the whole body (skin), on most of the body’s inner cavities, or
making up the body’s several glands. On the surface, epithelial tissues
function to protect underlying cells from bacterial invasion, adverse

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 Anatomy of an Athlete: Cells, Tissues, and Systems| 355

chemicals, and drying. On the inside, they Blood, for example, is considered a connective
function as absorbing and secreting tissues, such tissue because it consists of a fluid matrix with
as digestive system glands. Epithelial tissues are cells suspended within.
divided into four groups and are distinguished
Some connective tissues have the consistency
according to the shape of the cells they are
of soft gels that are firm but flexible, whereas
composed of. They are as follows:
others are hard, tough, and rigid. Most of us
1. Squamous epithelium – tissue composed of have chewed into a very hard, tough structure
one layer of flat cells. Located in the linings while eating meat. This was most likely a piece
of the mouth, esophagus, and blood and
of connective tissue that the butcher left behind.
lymphatic vessels. Substances can easily diffuse
The important distinguishing characteristic
through this layer of cells.
of connective tissues is that the matrix gives a
2. Cuboidal epithelium – cube-shaped cells as particular connective tissue its identity.
found in the lining of kidney tubules.

3. Columnar epithelium - tissue cells resembling

Connective tissues are made up of many
columns or pillars in shape. They are constituents. Many types of connective tissues
widespread throughout the body, forming are formed from the same substance made
linings in the digestive tract and respiratory up of a mixture of salts, water, protein, and
tract. They function as secretory cells or carbohydrates. Embedded in this substance
absorptive cells. Some also have small hairs, are cells and fibers. Among the cells and
called cilia, which beat rhythmically and move
fibers are elastic fibers for elasticity, collagen
materials out of a passage, as in the respiratory
tract where cilia serve to sweep out foreign
fibers for strength, reticular fibers for support,
matter that may pass into the lungs. microphages and white blood cells to fight
infection, fat cells for storage, and plasma cells to
4. Glandular epithelium – epithelial cells that
produce antibodies.
specialize to secrete mucus and hormones, like
those of the salivary and thymus glands One or more of the three fibers (collagen,
reticular, and elastic) are contained in connective
Connective Tissues tissue. The three fibers are listed below with their
characteristics and main functions.
Connective tissues are widespread tissues in
the body and serve to connect and support. 1. Collagen Fibers – tough, strong fibers that
For example, connective tissue joins other form the major fibrous component of the skin,
tissues to each other, muscles to bone, and tendons, cartilage, ligaments, and teeth. Made
of the amino acids glycine, proline, lysine,
bone to bone. Connective tissues are composed
hydroxyproline, and hydroxylysine. Collagen
of cells embedded in a nonliving matrix. The
gives connective tissue its versatility because of
nature of the matrix, rather than that of the its ability to interconnect with other molecules
cells themselves, determines the function of a and minerals and thereby form an alloy of a sort,
particular type of connective tissue. Connective with a higher tensile strength than its separate
tissues consist predominantly of intercellular parts have. Collagen fibers occur in bundles,
material interspersed among relatively few cells. which gives them great tensile strength.

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2. Reticular Fibers – delicate, supporting fibers of Tendons and ligaments are flexible but strong.
connective tissue that occur in networks and In fact, they are the strongest connective tissues.
support delicate structures such as capillaries The intercellular matrix consists of a collagen
and nerve fibers.
and reticular fiber network, which originates
3. Elastic Fibers – elastic and extendible. from the cells that tendons surround. Tendons
can be thick, as with the Achilles tendon. They
The connective tissues covered here will be those
can be thin, as with the epicranial aponeurosis,
most familiar to the athlete. The other types of
a thin layer of connective tissue that covers the
connective tissues will be listed at the end of this
skull. Tendons function to connect muscle to
section. The connective tissues to be discussed
bone or other structures. Ligaments join bone to
are cartilage, bone, tendons, and ligaments.
bone, usually as joints.
Cartilage forms the foundation of bone tissue. It
Because of the nature of connective tissue, you
is found at bone ends, in spinal disks and makes
can appreciate that damage to this tissue is a
up the soft “bone” in the nose. Mature cartilage serious occurrence. As connective tissues consist
does not contain blood vessels or nerves. It only of a few cells and mostly nonliving matrix,
obtains nutrition through small holes that allow they have a very limited capacity to regenerate
nutrients to seep in. There are three types of themselves. This is one reason that tendon and
cartilage, the hardness of which depends on the ligament injuries often need surgery for repair.
number of collagen fibers. They include elastic Proper nutrition and strength training can help
cartilage in ear and Eustachian tubes; tough build strong connective tissues that will become
fibrous cartilage, found between bones of the more resistant to injury.
spine (disks); and hard hyaline cartilage, found
in bone ends, nose, larynx, and trachea. The connective tissues discussed above are the
types most often referred to in the realm of
Bones form the skeleton, which act to support athletics. Some other types of connective tissues
and protect the body. Bone both resembles are reticular tissue of the spleen, lymph nodes,
and differs from cartilage. Like cartilage, bone and bone marrow, which functions as a filtering
consists more of intercellular substances (matrix) media for blood and lymph; areolar tissue,
than of cells. But in bone, the intercellular which occurs between organs and other tissues
substance is calcified and hardened as opposed and functions to connect; and adipose tissue,
to cartilage, which is a firm gel. Calcium salts which contains fat and is found under the skin
impregnate and cement the matrix, a fact that in various spots throughout the body. Adipose
explains the rigidity of bones. Collagen fibers are tissue functions to protect, insulate, support,
embedded in the calcified matrix. and serve as a food reserve. Also included as
connective tissues are blood, myeloid (red bone
Bones are not as lifeless as they seem. Within
marrow), and lymph.
this hard, non-living, calcified, intercellular
matrix exist many living cells that continually Examples of dietary supplements that have
receive food and oxygen and that excrete their been shown to exhibit beneficial effects for
wastes through the numerous blood vessels connective tissue health include glucosamine
found in bone tissue and bone marrow. and chondroitin sulfate.

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Muscle Tissues It also moves food during the first part of

Muscle tissue makes up approximately 43 swallowing. Skeletal muscle tissue is made up
percent of a man’s body weight and 34 percent of long muscle cells (muscle fibers) that bear the
of a woman’s. Some 620 muscles work together unique characteristic of containing many nuclei,
with the support of the skeletal system to create called multi-nucleate. Characteristically, skeletal
motion. An additional 30 or so muscles are muscle tissue cannot sustain prolonged all-effort
required to ensure the passage of food through contractions, as they easily fatigue.
the digestive system, to circulate blood, and
With few exceptions, single muscles never
to operate specific internal organs. In exercise
contract by themselves. Rather, specific sets
physiology, muscles are the main operative
of muscles contract together or in sequence.
tissue, expending energy, generating wastes, and
The production of complex movements
requiring substantial nutrition.
responsible for even the simplest of tasks
The main function of muscle tissue is depends on a correspondingly subtle control
contraction. This contraction of muscle can be mechanism. This is the responsibility of
brought about by either involuntary or voluntary the nervous system, which neutralizes the
stimuli. Voluntary muscle tissues receive actions of muscles that are not required and
nerve fibers from the somatic nervous system. causes the contraction of muscles that are
Therefore, their contraction can be voluntarily required. The spinal cord and brain exercise
controlled. Skeletal muscles are the major this control through the motor nerve fibers.
voluntary muscle tissue. Involuntary muscle
Each muscle cell does not have an individual line
tissues receive nerve fibers from the autonomic
from the CNS (central nervous system). Impulses
nervous system and cannot be voluntarily
travel down the nerve axon from the CNS,
controlled, except in a few rare cases. The eternal
branching off to supply a group of muscle cells
pump, the heart, is an example of an involuntary
that contract together. To coordinate muscular
muscle tissue.
movement, the CNS must be supplied with
Muscles also differ in appearance when observed information about the length of the muscle and
under the microscope because of their underlying the tension of the tendons that attach it to the
cellular structure. Two appearances are skeleton. This information is provided by special
recognized: striated muscle tissue and smooth sense organs called “muscle spindles,” which
muscle tissue. Based on functional and structural measure the strain in the muscle and can be used
differences, muscle tissue is divided into three to preset the tension of muscles.
types (skeletal, cardiac, and smooth).
Skeletal muscles must contract rapidly in
Skeletal muscle tissue (striated-voluntary response to signals from the CNS, and they
muscle tissue) – is found attached to bones, must develop adequate tension at the same
in extrinsic eyeball muscles, and in the upper time to produce an effective mechanical force.
third portion of the esophagus. Skeletal muscle Examination of skeletal muscle reveals a junction
tissue functions to move the bones and eyes. between the nerve fiber and the muscle surface.

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The surface acts as an amplifier, increasing the effect of the tiny current
coming down the nerve fiber to stimulate the larger muscle fiber. The
arrival of the nerve impulse triggers the release of a chemical called
Acetylcholine: a acetylcholine from the motor nerve ending. This passes across the gap
neurotransmitter that is to stimulate the membrane of muscle fiber. This stimulation, in the form
critical for optimum nervous
system functioning. of an electric current, passes along the surface of the muscle and causes
it to contract. It takes only 1/1000th of a second for the current to pass
along the surface of the muscle fiber. The fiber releases unless yet another
impulse arrives. If this chemical mechanism were blocked, the result
would be paralysis.

The Mechanics of Muscular Contraction

To the naked eye, the external skeletal muscles appear grainy because
they are made up of small fibers. These fibers are cylinder-like and
may be several centimeters long. In length, they are divided into bands
(striations), much like coins stacked in a pile. Each individual fiber
is surrounded by a thin plasma membrane, the sarcolemma. Some
80 percent of the fiber’s volume is filled with tiny fibrils, known as
myofibrils, which may number from several hundred to several thousand
per fiber. These fibrils are the structures directly involved in contraction
of the muscle fiber. The remainder of the muscle fiber is filled with a
jelly-like intracellular fluid called sarcoplasm. The sarcoplasm contains
many nuclei and other cell constituents, such as mitochondria, within
which energy-producing biochemical reactions take place.

Further examination of the fibrils shows that they are made of two types of
protein—actin and myosin—which are in the form of long filaments. The
thick ones consist of myosin, and the thin ones are made of actin. These
filaments are able to interlock and slide over each other to accommodate
the stretching of the muscle. During shortening (contraction), they slide
into one another, and it appears that cross-links are made between the
actin and myosin filaments. These cross-links are almost instantaneously
broken, and new links are set up farther along the filaments. The process
of breaking these cross-links causes the two filaments to move toward one
another, causing the muscle to shorten (contraction).

The term “contraction” does not always refer to the shortening of a

muscle. Technically, it refers to the development of tension within a
muscle. There are two major contractions. A contraction in which the

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muscle develops tension but does not shorten is The excess lactic acid eventually enters the
termed “isometric.” A contraction in which the bloodstream and is circulated to the liver
muscle shortens but retains constant tension where it can be reassembled into glucose and
is said to be “isotonic.” For example, a person returned into the bloodstream or stored as
trying to curl a heavy barbell strains against the glycogen. Some of the lactic acid can also be
weight. The arm muscles develop tension but do converted back into the molecule pyruvic
not shorten because the amount of resistance acid and enter into the mitochondria to be
generated by the heavy barbell is greater than completely broken down for energy. The heart,
the muscle’s tension. But when the barbell is and perhaps other organs and tissues, can utilize
lightened by removing some plates, the load is lactate for energy. More about lactate will be
lightened, and the working muscles shorten as reviewed in the unit related to metabolism.
they contract. This is an isotonic contraction.
When muscles shorten by overcoming resistance Muscles (and other tissues) store glucose in a
to a load (weight), the isotonic contraction is form of complex carbohydrates called glycogen.
said to be concentric. When the biceps lengthen It is this storehouse of energy that the body
while the barbell is let down, but they maintain calls upon during a high-intensity, low-duration
a constant tension during the lengthening activity, such as weightlifting (as opposed to
movement, this type of isotonic contraction is caloric draw during a low-intensity, high-
termed “eccentric.” The muscles lengthen as they duration activity, such as long-distance running,
act to maintain tension. which uses a mixture of glucose from glycogen
and fatty acids from fat stores).
The energy for contraction is derived from the
chemical reaction between the food components
Fast-Twitch and
we eat and the oxygen we breathe. Blood,
Slow-Twitch Muscle Fibers
therefore, is needed to bring the essential
nutrients and oxygen to the muscles and to Skeletal muscle tissue is composed of two
remove waste products. The biochemical process general types of muscle fibers: fast twitch and
of energy production involves the breakdown slow twitch. Fast-twitch fibers are selectively
of glucose (fatty acids or fructose) to eventually recruited when heavy workloads are demanded
just carbon dioxide and water. This breakdown of the muscles and strength and power are
releases the energy used by muscle proteins to needed. They are recruited for high-intensity,
cause contraction. This specific chemical reaction short-duration work. They contract quickly,
requires an extremely abundant supply of oxygen, yielding short bursts of energy, and are
which is often unavailable. Even during intense recruited in high numbers during brief, intense
exercise, the blood supply is often insufficient to exercises such as sprinting, weightlifting, shot
carry enough oxygen to the muscles. The muscles putting, or even swinging a golf club. But these
solve this problem by converting glucose into fast-twitch muscle fibers exhaust quickly. Pain
lactic acid, without oxygen, which still gives an and cramps settle in rapidly from byproducts of
ample release of energy. their own metabolism.

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Slow-twitch muscle fibers produce a steadier low- individual muscle cells increasing the number
intensity, repetitive contraction, characteristic of their myofibrils. This probably occurs as
of endurance activities. They are capable of a result of increased amino acid transport
sustaining workloads of low intensity and into the cells (caused by tension), which
long duration, such as long-distance running. enhances their incorporation into contractile
Athletes of high-intensity sports such as protein. However, muscle hypertrophy also
weightlifting, wrestling, and sprinting, tend to occurs as a result of proliferation (in size
have a greater percentage of fast-twitch muscle and number) of mitochondria, myoglobin
fibers. Athletes of low-intensity sports, such as (storage protein), extracellular and intracellular
long-distance running, tend to have a higher fluid, capillarization (tiny blood vessels
percentage of slow-twitch muscle fibers. surrounding cells), and fusion between
muscle fibers (principally Type IIb) and
There are several points of interest to the athlete.
surrounding satellite cells. Buildup of creatine
The first is that when you train, the intensity
phosphate (phosphocreatine), from creatine
and duration will influence the physiology of
supplementation, can also contribute to
muscle tissue and development of muscle fibers.
muscular hypertrophy.
The long-distance runner tends to develop slow-
twitch muscle fibers, whereas the power lifter In addition to increasing the size of the muscle
develops fast-twitch muscle fibers. One reason fibers, increasing the number of muscle fibers
the fast-twitch muscle fibers increase in size is also seems to be a logical mechanism of muscle
to increase the capacity to store more adenosine growth. Increasing the number of muscle cells is
triphosphate and creatine phosphate (ATP and called “hyperplasia.” Researchers have reported
CP). ATP and CP are needed for explosive energy the possibility of fiber splitting in their research
that lasts only a few seconds. The second reason reports (longitudinal division of muscle fibers
is that the physiological conditioning of muscle resulting in new muscle cells). However, new
tissue determines which fuel source is used. muscle fiber development from special cells
Power athletes need more muscle glycogen to referred to as muscle precursor cells also occurs
fuel their muscles, whereas endurance athletes with the correct training stimulus, nutrition
need both muscle glycogen and fatty acids. One program, period of rest, and good sleep to
reason it is typical for some power athletes to maximize the nocturnal anabolic cascade, which
tend to carry excess fat is that their diets are too is important for muscle recovery, regeneration,
high in fats, and their mode of training does not and growth.
burn much fat. The excess fat develops into large
Cardiac Muscle Tissue. Cardiac muscle tissue
fat stores.
(striated-involuntary muscle tissue) composes
the wall of the heart. It functions to contract the
Muscular Hypertrophy
heart and pump blood through body. Cardiac
Muscular hypertrophy is simply the increase muscle cells are often branched, and their nuclei
in the size of muscle fibers. The principal are more centered than with skeletal muscle
mechanism for muscular hypertrophy is by cells. They have a tendency to branch and fuse

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into each other. Fortunately, cardiac muscle Nervous Tissues. The nervous tissues are
tissue does not fatigue easily; the period of rest in composed of several types of cells that are
between contractions is all it needs. Even during responsible for the control of the bodily
periods of intense exercise, skeletal muscles functions. Nervous tissues are found in the
fatigue first. brain, spinal cord, and nerves that branch out to
all parts of the body. The types of nervous tissues
Smooth Muscle Tissue. Smooth muscle tissue
are neurons, neuroglia, and neurosecretory cells.
(smooth-involuntary muscle tissue) is found
1) Neurons conduct nerve impulses, register
in walls of the tubular viscera of digestive,
sensory impulses, and conduct motor impulses.
respiratory, and genitourinary tracts; in walls
The central neuron body contains a nucleus
of blood vessels and large lymphatics; in ducts
surrounded by cytoplasm and two projections
of glands; in intrinsic eye muscles (iris and
at either end. The two types of projections
ciliary body); and in arrector pili muscle of
are axons and dendrites. 2) Neuroglia may
hairs. It functions to move substances along
provide nutrients for neurons or play a role in
their respective tracts, change diameter of blood
their embryological growth and orientation.
vessels, move substances along glandular ducts,
3) Neurosecretory cells, as their name implies,
change the diameter of pupils and the shape of
secrete substances that may have an effect
the lens, and erect hairs. Like cardiac muscle
elsewhere in the body.
tissue, smooth muscle tissue cells are elongated
but differ in having pointed ends and only one Reproductive Tissues. The final and most vital
nucleus per cell. They contract more slowly tissue responsible for propagating the human
than striated muscle does and therefore do not species is reproductive tissue. As its name
fatigue easily. implies, reproductive tissue is composed of

Skeletal Muscle Fiber Types

Type I (Slow-Twitch Oxidative, SO)
Slow twitch (slow speed of muscle fiber contraction), low-force capacity, high oxidative metabolism
capacity, highly fatigue resistant, with little capacity for exercise-induced hypertrophy, high resistance
to exercise-induced structural damage. High density of mitochondria per fiber, which increases with
aerobic endurance training. Small diameter, high capillary density.
Type II a (Fast-Twitch Oxidative-Glycolytic, FOG)
Fast twitch (fast speed of muscle fiber contraction), medium-force capacity, oxidative-glycolytic
metabolism, highly fatigue resistant, high capacity for exercise-induced hypertrophy, moderate
resistance to exercise-induced structural damage. Medium density of mitochondria per fiber. Important
for sustained power endurance. Medium diameter, intermediate capillary density, intermediate
glycogen content.
Type II b (Fast-Twitch Glycolytic, FG)
Fast twitch (fast speed of muscle fiber contraction), high-force capacity, high capacity for glycolytic
metabolism, low-oxidative capacity, highly susceptible to fatigue, great capacity for exercise-induced
hypertrophy, great susceptibility to exercise-induced damage. Low mitochondria density per fiber.
Generates explosive strength and power. Larger diameter, high glycogen content, low capillary density.

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cells specialized to produce the next generation. tissue (blood cell-forming tissue in red bone
These cells are the egg cell (ovum) in females marrow – myeloid tissue, also in lymphatic
and the spermatozoa (sperm) in males. Egg tissue). The skeletal system provides these basic
cells are spherical in shape and contain yolk to functions: support, protection, movement, and
feed the developing offspring from the instant hematopoiesis.
of fertilization until it can obtain food in some
alternative way. Skeletal Muscle System
The skeletal muscle system is composed of
Systems skeletal muscle tissue (striated-voluntary)
and tendons, is nourished by the circulatory
All of the tissues interact in one way or another system, and is controlled by the somatic nervous
to form functional body units referred to as system. Skeletal muscles function mainly in
systems. Actually, the body is one living system movement of the body. Skeletal muscle also
made up of subsystems. However, for academic functions to a limited extent as a storage tissue
purposes, anatomists and physiologists refer to of protein (amino acids). However, degradation
these subsystems as systems. These basic tissue of muscle tissue is undesirable to the athlete and
types are organized together to form the systems only beneficial for survival during periods of
of the human body. As previously mentioned, starvation.
the body is composed of several interdependent
systems, meaning that although each system
can be separated out from the rest, and without Nervous System
the other systems, its function cannot be The nervous system is composed of neurons,
carried out to completion. For example, if the neuroglia, and neurosecretory cells. The nervous
muscular system were disconnected from the system’s function is to provide memory and
nervous system, nerve impulses sent down to integrate bodily functions, communication,
neurons would have no effect on stimulating and control. Its responses are generally rapid,
muscle contractions. The following nine whereas those of the endocrine system are
major systems are generally recognized as the generally slow.
systems composing the human body. General
information is included here, and a few of the Respiratory System
systems whose understanding is more pertinent
to the athlete and nutrition will be reviewed The respiratory system is composed of the
again in subsequent units. following organs: nose, pharynx, larynx, trachea,
bronchi, and lungs. It functions to connect the
gaseous external environment with the trillions
Skeletal System of internal cells that make up the human body.
The skeletal system comprises all the bones The respiratory system provides a conduit for the
plus the joints formed by their attachments intake of required oxygen and the expulsion of
to each other. Predominant tissues include the gaseous metabolic waste—carbon dioxide.
bone, cartilage, ligaments, and hematopoietic The respiratory system requires the circulatory

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system to complete its functions of transferring gases from the lungs,

through the lung membrane, into the bloodstream, and to the cells. The
reverse is true for the waste gas (carbon dioxide) and water.

Cardiovascular (Circulatory) System

This system consists of the heart, veins, arteries, and the lymph system.
The lymph system is considered part of the circulatory system since it
consists of a moving fluid, lymph, derived from the blood and a group of
vessels called lymphatics. The circulatory system performs vital pickup
and delivery service for the body. Blood picks up food and oxygen from
the digestive and respiratory systems and delivers them to the cells.
From cells, blood picks up wastes and delivers them to excretory organs,
the kidneys for example. Blood also picks up endocrine hormones and
delivers them to target tissues. Directly or indirectly, the circulatory
system contributes to every function of every cell.

Digestive System
Five organs form the alimentary canal (also called gastrointestinal tract).
They are the mouth, pharynx, esophagus, stomach, and intestines. Six
accessory organs are connected to or exist in the digestive system. They
include the salivary glands, teeth, liver, gall bladder, pancreas, and
vermiform appendix. The digestive system functions to break down food
so it can be absorbed by cells and metabolized through the body. Because
this book is about nutrition, an entire unit is dedicated to reviewing the
digestive system. (Refer to Digestion Unit for more details.)

Urinary System
The urinary system consists of the following organs: kidney, ureters,
bladder, and urethra. They all function in the following manner.
The kidneys (two of them) filter wastes from the blood (e.g., urea),
maintain electrolyte balance and acid-base balance, and play a role in
homeostasis. They are also known to influence blood pressure. Any Homeostasis: the
waste products that are selectively removed from the blood by the tendency of the body
to maintain an internal
kidneys are collected and transported via the two ureters to the bladder. equilibrium.
It should be pointed out that the kidneys also reabsorb 97 percent to 99
percent of the substances needed by the body that are initially filtered
out with wastes. The bladder collects and stores the waste fluid (urine).
When the bladder fills, the urine is then expelled from the body through

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the single urethra. Urine normally contains The above systems that compose the body
nitrogenous wastes from protein metabolism must be functioning at maximum efficiency for
(urea, uric acid, ammonia and creatine); optimal athletic performance. Proper nutrition is
electrolytes, which mainly contain sodium, essential for this to occur.
potassium, ammonia, chloride, bicarbonate,
phosphate, and sulfate; toxins; pigments; Endocrine System
hormones; and various abnormal constituents,
such as glucose, albumin, blood, and so on. The endocrine system consists of several
glands which release their secretions into
the blood stream. They function in control,
Reproductive System communication, and integration. The
The reproductive system contains those endocrine system is similar to the nervous
organs that function to produce viable sperm system, but accomplished through different
in the male and fertile eggs and an internal mechanisms, namely endocrine gland secretions
environment for the fertilized egg to develop (hormones). Chemically, hormones may be
in the female. The male reproductive organs classified as either proteins or steroids. All
include a pair of testes, which produce sperm of the hormones in the human body, except
and testosterone, the hormone responsible for the sex hormones and those from the adrenal
masculinity; a pair of seminal vesicles, which cortex, are proteins or protein derivatives.
store the sperm until it is time for ejaculation;
Hormones’ activities are carried by the blood
one prostate gland, which produces the nutritive
throughout the entire body, yet they affect
media that enable the sperm to survive in the
only certain target cells. The specific cells that
vaginal environment; and a pair of bulbourethral
respond to a given hormone have receptor sites
glands, which secretes an alkaline fluid to be
for that hormone, referred to as the lock-and-
included in the semen. Various ducts connect
key mechanism. If a hormone fits the receptor
these organs together.
site, then there will be an effect. If a hormone
The female reproductive system consists of: and a receptor site do not match, then there is
two ovaries, which contain the unfertilized no reaction. All the cells that have receptor sites
eggs; two fallopian tubes, which carry the eggs for a given hormone make up the target tissue
down to the uterus; a uterus, which is the site for that hormone. In some cases, the target
of implantation of the fertilized egg; the cervix, tissue is localized in a single gland or organ.
which is a small cylindrical muscle that allows In other cases, the target tissue is diffuse and
the flow of menstrual blood from the uterus scattered throughout the body so that many
to the vagina, and directs the sperms into the areas are affected. Hormones bring about their
uterus during intercourse; and the vagina, which characteristic effects on target cells by modifying
functions as the vestibule for the erect penis and cellular activity.
as the birth canal.

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Protein hormones react with receptors on the to secrete its hormone. A third method of
surface of the cell, and the sequence of events regulating hormone secretion is by direct
that results in hormone action is relatively rapid. nervous stimulation.
Steroid hormones typically react with receptor
Note that some glands also have non-endocrine
sites inside a cell. Because this method of action
regions that have functions other than hormone
actually involves synthesis of proteins, it is
secretion. For example, the pancreas has a
relatively slow.
major exocrine portion that secretes digestive
enzymes and an endocrine portion that secretes
Control of Hormone Action
hormones. The ovaries and testes secrete
Hormones are incredibly potent substances, hormones and produce the ova (egg) and sperm.
which means that very small amounts of a Some organs, such as the stomach, intestines,
hormone might have profound effects on and heart, produce hormones, but their primary
metabolic processes. Due to their potency, functions are not hormone secretion.
hormone secretion must be regulated within
very narrow limits to maintain homeostasis in
the body. Many hormones are controlled by a
Conclusion
negative feedback mechanism. In this type of The structure and function of the human body
system, a gland is sensitive to the concentration is very complex with cells, tissues, and systems
of a substance that it regulates. A negative interconnected and interdependent upon each
feedback system causes a reversal of increases other. Regarding sports nutrition, a focus of food
and decreases in body conditions to maintain a and supplement intake needs to be purposeful
state of stability or homeostasis. Some endocrine to consider the needs of the entire body at every
glands secrete hormones in response to other level. This thinking goes beyond simply eating
hormones. The hormones that cause secretion to satisfy hunger but to satisfy the structure and
of other hormones are called tropic hormones. function of the athlete’s body for maximum
A hormone from gland G1 causes gland G2 performance and optimum health.

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Some of the Body’s Glands and Hormones

Gland Hormone Secreted Examples of Effects
Adrenal Cortex Mineralocorticoids; Aldosterone Regulation of some blood mineral levels.
Glucocorticoids; cortisol Catabolism, increases blood sugar levels.
Ovaries Estrogens Develops feminine characteristics; egg production.
Pancreas Insulin Decreases blood sugar level; promotes glycogen, protein
and lipid synthesis.
Glucagon Increases blood sugar level; glycogenolysis,
breakdown of glycogen to glucose.
Parathyroid Parathyroid Hormone (PTH) Regulation of calcium levels.
Pineal Melatonin Control of circadian rhythms.
Pituitary Follicle Stimulating Hormone (FSH) Stimulates testosterone secretion and sperm
(Anterior) development in testes; egg production and estrogen
secretion by the ovaries.
Growth Hormone (GH) Helps regulate metabolism, stimulates both hard and soft
tissue growth.
Thyroid Stimulating Hormone (TSH) Stimulates secretion of the thyroid gland.
Andrenocorticotropic Hormone (ACTH) Stimulates secretion of the adrenal cortex gland, cortisol.
Luteinizing Hormone In males, testosterone production in testis. In females,
stimulates progesterone and estrogen secretion (ovaries),
ovulation, prepares uterus for fertilized egg, aids in
mammary gland development.
Prolactin Stimulates milk secretion from mammary glands.
Pituitary Vasopressin, or Antidiuretic Hormone Regulates water absorption by kidneys, causes arteriole
(Posterior) (ADH) constriction.
Oxytocin (OT) Stimulates uterine contraction and mammary milk
ejection.
Testes Testosterone Develops masculine characteristics; develops male sex
organs; sperm production.
Thymus Thymosin T lymphocyte production and function.
Thyroid Thyroxine Increases metabolic rate.

Glycogenolysis: the metabolic

process in which glycogen is
broken down.

Key Words
Digestive enzyme Acetylcholine

Gluconeogenesis Homeostasis

Glycolysis Glycogenolysis

Sports Nutrition
 Topics Covered In This Unit

Introduction

The digestive system– physical com-

ponents

Mouth

Esophagus

Stomach

The small intestine

Large intestine and rectum

Pancreas

Liver and gallbladder

Factors affecting digestion

About digestive supplement aids

Lactose intolerance

Intestinal microbials (microorganisms)

Fiber and digestion

Conclusion

UNIT 13

DIGESTION AND ABSORPTION

368 | Unit 13

Unit Outline
I. Introduction III. Factors affecting digestion
II. The digestive system– physical compo- IV. About digestive supplement aids
nents
a. Lactose intolerance
a. Mouth
b. Intestinal microbials (microorganisms)
b. Esophagus
V. Fiber and digestion
c. Stomach
VI. Conclusion
d. The small intestine
e. Large intestine and rectum
f. Pancreas
g. Liver and gallbladder

Learning Objectives
After completing this unit, you will be able to:
• Define and describe terms related to digestion;

• Discuss how digestion takes place in the human body;

• Understand the anatomy of the digestive system; and

• Identify the digestive enzymes.

Introduction
Most people enjoy eating. In fact, the average The digestive system starts at the mouth, runs
person eats several hundred pounds of food some 25 feet through the trunk of the body,
every year. When you think about it, it’s amazing and ends at the anus. It is essentially a strong
that all we need to do to survive is shovel some muscular tube lined with thick epithelium
food in our mouths, drink some liquid, and with specialized cells, which differ depending
let our bodies do the rest. If you are just eating on which part of the digestive system you
for survival, this approach is fine. But if your examine. The digestive system is also referred
goal is to extend your life and improve athletic to as the alimentary canal, gastrointestinal
performance, attaining an understanding of system, and the gut. The digestive system is the
digestion is necessary. This unit will cover the body’s life support connection with the external
basics of digestion. environment. Food is eaten, and somehow the

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body breaks it down into useful biomolecules provide essential functions to the entire process
to obtain the energy necessary for life and the of digestion. The pancreas, for example, supplies
building blocks necessary for growth. important enzymes to help break apart complex
food substances. The following will review these
Digestion is therefore the process that breaks
major structures and discuss their functions.
food down through chemical and physical
means. Via this process, the nutrients contained
in food can be absorbed through the intestinal Mouth
walls, transported by the blood to the liver, Food enters the digestive system through the
and then transported further onto the trillions mouth. The mouth then has four functions that
of cells via the bloodstream. As you will soon it exerts on the ingested food. First, it physically
discover, the digestive system is quite complex breaks apart food by chewing and reducing it in
and remarkable. Note that because of the size. Second, it mixes the food with saliva into a
complex issues involved in determining the moist mass, called a bolus, which is then made
functioning of digestive system in humans, this ready for swallowing. In this way, saliva serves
area of anatomy and physiology is constantly to lubricate the food for its journey down the
being refined as new discoveries are made related esophagus into the stomach. Mucus also makes
to digestive enzymes and other issues concerning the food particles stick together with a protein
digestive system structure and functioning. it contains. Second, the saliva also contains the
digestive enzyme ptyalin, also known as salivary
The functions of the digestive system include:
amylase, which begins the chemical breakdown
• Receipt, mastication (chewing), and transport of starch (carbohydrates).
of ingested substances and waste products;

• Secretion of acid, mucus, digestive enzymes,

The masticated food mass is swallowed and
bile and other materials needed to break passed through the pharynx and then into the
down food; esophagus. Chewing your food thoroughly is
• Digestion of ingested foodstuffs; vital to the digestive process. By thoroughly
chewing your food, you will get the full benefit
• Absorption of nutrients;
of the digestive enzyme ptyalin and physically
• Storage of waste products; reduce in size the other foodstuffs, like protein,
• Excretion; and so the stomach can perform its digestion
• Certain auxiliary functions.
functions more easily.

Third, the mouth regulates temperature by either

The Digestive System– cooling or warming the food. Temperature
regulation is important as enzymes function at
Physical Components their best in a narrow temperature range. For the
The digestive system is composed of several human, this range is tightly held around body
anatomically different structures that make up temperature. In addition, delivery of cold food
the gut and several organs attached to the gut that can hasten the emptying of the stomach and

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reduce the efficiency of digestion. One exception food into the small intestine, digestion through
is when drinking fluid before and during exercise chemical secretions and the physical activity of
or competition, emptying faster will rehydrate churning the digesting food, and transport of
the body faster. The fourth major function of the ingested food down the gut.
mouth is that it consciously initiates swallowing
The stomach secretes substances to aid in the
when the bolus is ready.
breakdown of food. Mucus acts as a protective
layer to lubricate the stomach wall and to
Esophagus buffer the acid secretions. Hydrochloric acid
The esophagus extends between the pharynx helps keep the stomach relatively free of
and stomach and is the transport conduit for microorganism (bacteria) and maintains a low
food and water traveling to the stomach. When pH in the stomach. Hydrochloric acid also acts
the bolus enters the esophagus, an involuntary to catalyze the action of pepsin, a protease,
wave of muscle contractions is triggered, which which begins the digestion of proteins. Then
propels the food mass down into the stomach. there is an intrinsic factor secretion, which
This muscle contraction action is known as binds with vitamin B12 and allows it to be
peristalsis. This peristaltic wave travels down the absorbed in the small intestine. The hormone
esophagus about three inches per second. Once gastrin is also secreted in the stomach and helps
at the base of the esophagus, a ring-like muscle regulate stomach secretions during digestion.
is reached, the esophageal sphincter, which Gastrin is a hormone involved in gastric activity
relaxes to let the food into the stomach. Keep in regulation and in stimulating gastric acid release
mind that at the same time food is let into the (hydrochloric acid, potassium chloride, and
stomach, the esophageal sphincter is keeping sodium chloride).
food from spurting out of the stomach and back
When macronutrients are taken alone, they
up the esophagus. If the sphincter weakens or
leave the stomach at different rates of time.
malfunctions, the acidic contents of the stomach
Carbohydrates will empty from the stomach the
might shoot up into the esophagus and produce
most quickly. For this reason, pure carbohydrate
an unpleasant, bitter sensation in the throat
drinks taken during exercise can get into the
known as heartburn, which has nothing to do
bloodstream fast and replenish the body’s
with the heart except that pain may develop in
primary energy source, glucose. Proteins empty
the area of the heart. To reduce stress on the
from the stomach next in time sequence, and fats
esophageal sphincter, it is a good practice to eat
take the longest to empty. When carbohydrates,
sitting up and to try not to over fill the stomach
proteins, and fats are consumed together,
with huge meals.
because they will all be mixed together, the
stomach will take longer to empty. Carbohydrate
Stomach and some lipid breakdown also occur in the
The stomach is a muscular sac about two quarts stomach. The stomach normally takes one to four
in size but varies in size from person to person. hours to empty, depending on the amount and
It functions in the storage and gradual release of kinds of foods eaten.

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Although the intestines are known as the primary location for absorption, Hydrochloric acid: a
stomach secretion that
some nutrients can be absorbed by the stomach. In general, the following
functions in protein
can be absorbed by the stomach: some water, alcohol, glucose, and some metabolism, helps keep the
vitamins, such as niacin. These are the main examples, and undoubtedly, stomach relatively bacteria-
free, and assists in the
others of lesser importance or new ones are yet to be determined. maintenance of a low pH
balance in the stomach.
The fact that water and glucose can partially be absorbed through the
stomach is a benefit for quick replenishment of these nutrients during
exercise. Some popular sports drinks take advantage of this and contain
glucose as an ingredient, along with fructose, which is more slowly
absorbed, and complex carbohydrates, which release glucose at a slow
rate as they are digested. Glucose ingestion can help spare your body’s
glycogen supply, but glucose must be ingested just prior to exercise, within
one half hour, or it can cause an influx of insulin that will upset energy
generation during exercise.

The stomach only begins the process of breaking down complex

molecules, like proteins, into their smaller components, such as amino
acids in the case of proteins. This breakdown process, also called
hydrolysis, continues in the intestines. The partially digested material of
the stomach that enters the small intestine through the pyloric sphincter
muscle in squirts is called chyme. Generally, chyme consists of gastric
juices and partially digested food.

The Small Intestine

The small intestine stretches about 12 feet long and is divided
into three main regions: duodenum, jejunum, and ileum.
The duodenum is connected to the stomach and composes
the first part of the small intestine. Some absorption takes
place here, but it is a location of continued breakdown of
food and storage. The next regions of the small intestine
are responsible for the majority of nutrient absorption:
these are the jejunum and ileum.

Some of the digestive enzymes in the small intestines are

provided by the pancreas (see pancreas section below)
and some from the intestinal cells, for example, maltase,
lactase, peptidases, and nucleosidases. Bile from the gall
bladder is introduced to help digest fats.

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Anabolism: the To accomplish complete absorption, the inside surface of the small
biochemical process in
which different molecules
intestine has a unique anatomy. Instead of being a flat surface, like that
combine to form larger, of the skin, the small intestine is lined with special cells called villi.
more complex molecules. These villi are very small finger-like projections that line the entire inner
surface of the intestine. In this way, the surface area of the intestine is
greatly increased. Each villus has blood vessels that run into it. When
nutrients pass through the cells of the villus, they are transported
into the blood vessels and then transported to the liver. In addition
to the breakdown of fats, the small intestines absorb proteins and
carbohydrates and vitamins and minerals.

Another transport system is also present in the villus: the lymphatic

system. A small projection called a lacteal also extends into the villus.
The lymphatic system primarily transports fats. About 60 to 70 percent
of the ingested fats are transported to the liver in this way. Shorter fats
can be taken up through the blood vessels and transported directly
to the liver from the intestines. These short-chain and medium-chain
triglycerides have become popular in athletes’ diets for this reason
and because they do not convert easily to body fat. The medium-chain
triglycerides are the most known and used for this purpose.

Large Intestine and Rectum

The large intestine (colon) is about three feet long. The area where
the ileum and large intestine join is called the cecum. The vermiform
appendix is also located in this area. In the large intestines, some final
absorption of water, some minerals, and some vitamins occurs. Here is
where live microbes are present, and through their metabolism,
they produce some vitamins that are absorbed, such
as Vitamin K. The large intestine (also called colon)
stores the waste products of digestion. The further
decomposition of fecal matter by microbial action
produces gas, and depending on the nutrient
substrata that makes it down to the colon, the
amount of gas produced varies.

When the proper stimulus occurs, the colon will

empty its contents into the rectum, triggering
defecation. The more fiber in the diet, the softer
the feces, and the easier it is to eventually defecate.

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Pancreas are connected directly to the liver by the portal

vein. In this way, the nutrients taken up from
The pancreas is situated along the small
the intestines are delivered directly to the
intestine near the stomach and is an accessory
liver. Fats that travel through the lymphatic
organ of the gut. The pancreas produces
system enter the bloodstream directly and
several secretions important for digestion
then are circulated to the liver for processing.
and absorption of the nutrients that are
In general, nutrients are control-released
secreted into the small intestine. Examples
from the liver into general circulation.
of pancreatic digestive enzymes include
lipase, amylase, trypsin, and nuclease. The liver cells process the digested nutrients and
store many substances for later use or release
Another vital type of secretion the pancreas
nutrients for immediate use. These cells can
produces helps control carbohydrate
change nutrients into substances the body will
metabolism. These hormonal secretions are
need and store them until they are required. The
insulin and glucagon. Insulin is secreted into
liver acts as a processing organ that is responsible
the bloodstream during a meal. It functions to
for maintaining nutrient balance and storing
mediate the transport of glucose and amino acids
some essential nutrients and glycogen (glucose)
across cell membranes. It also fosters lipogenesis,
for energy. Glucose stored in the liver is used
the formation of fat. Insulin, therefore, has an
mainly to supply the brain with energy. The gall
anabolic function. Anabolism includes all the
bladder is a storage sac for a digestive mixture
chemical reactions and changes that build new
called bile.
substances for growth and maintenance.
Bile is a solution of cholesterol, bile salts, and
Glucagon is a hormone that is functionally
pigments. Bile is secreted into the small intestine
the opposite of insulin. It initiates a series of
in the duodenum. It is essential for the action of
reactions that causes the breakdown of glycogen
lipase, for the digestion and absorption of fats,
to mobilize glucose into the blood for energy.
and for the absorption of fat-soluble vitamins.
During exercise, glucagon levels in the blood are
increased, liberating energy for exercise. Insulin Liver
and glucagon work together in a seesaw fashion
to maintain appropriate blood glucose levels.
Pancreatic enzymes include amylase, trypsin,
peptidase, and lipase. Pancreatic secretions
are controlled by the hormones secretin and
cholecystokinin.

Liver and Gall Bladder

Digestion is not complete until the nutrients
Gallbladder
have been delivered to the liver and then
released into the bloodstream. The intestines Pancreas

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Factors Affecting Digestion

Eating should not be taken for granted. The • Allow some time for digestion to occur.
proper digestion of food requires developing Strenuous physical activities should be avoided
directly after eating.
good eating habits. To get the most out of meals,
consider the following points. • Avoid foods that may irritate the stomach, such
as hot spices and alcohol.
• Eat slowly and chew food thoroughly.
• Consulting a physician when digestive system
• Maintain posture in an upright position. Avoid disorders are present or suspected.
eating while lying down.
• When consuming multi-nutrient liquid meal-
• Eat several meals of moderate size as opposed type products and protein powders, drink
to eating a few large meals. slowly, sip by sip, so the digestive system
• Eat while calm. Nervousness can affect the recognizes that nutrients are being ingested
movements of the digestive system and cause from a meal.
gastrointestinal disturbances.

Hunger Pangs
The body has developed an intricate communication system that sends “I’m full” and “I’m hungry”
signals to the brain. Hunger pangs are the body’s signal that says “feed me.” But what are hunger
pangs, and what causes them?
Experiments on human subjects provide some answers. A device used to measure the contractions of
the stomach was used to determine what causes hunger pangs. The subjects would signal the experi-
menter when feeling hunger pangs. The experimenter would then make a mark on the readout device
that was charting the contractions of the stomach. The results showed that hunger pangs are caused
by increased contractions of the empty stomach.
The scientific evidence on what triggers the hunger pangs is less clear. The stomach contractions caus-
ing the hunger pangs were not controlled by the nervous system, because they still occurred when
the gastric nerves were cut. Sugar content in the blood may initiate hunger pangs. When blood sugar
levels are reduced, hunger pangs are initiated. Thus, to a limited extent, hunger pangs are controlled
by blood sugar levels. This is not always the case however.
In conditions of out-right starvation, hunger pangs gradually reduce in frequency. It is thought that
the ketones from incomplete fat metabolism play a role in this phenomenon. Though some of the
puzzle remains unsolved, maintaining adequate blood glucose levels is one proven way to control
hunger pangs. That is why eating a plentiful amount of complex carbohydrates is a good nutrition
practice and an easy way to control hunger, including whole grains. Complex carbohydrates, such as
those found in rice, potatoes, and pasta, provide a prolonged supply of glucose to the bloodstream.
Another part of the puzzle that has not been conclusively solved yet is finding out why contractions of
the empty stomach cause pangs and why contractions of the full stomach do not.

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About Digestive Lactose Intolerance

Supplement Aids Lactose intolerance is an example of a condition
Digestive enzyme supplements have been experienced by millions of people that requires
available for many decades and are appearing medical supervision and a special diet and
more and more in sports nutrition products, such may require medication and/or use of digestive
as in some protein products. Digestive enzymes enzyme supplements. Lactose intolerance is
are special molecules that act as catalysts for the a condition in which people have digestive
breakdown of food components. (Note: enzymes symptoms after eating lactose-containing dairy
also catalyze building-up processes and speed products, including bloating, diarrhea, and gas.
up many biochemical reactions.) It must first Lactase deficiency and lactose malabsorption
be noted that under normal circumstances, a may lead to lactose intolerance.
healthy digestive system is generally efficient, • Lactase deficiency. In people who have a
and a healthy digestive system will usually adjust lactase deficiency, the small intestine
to increased food consumption by increasing produces low levels of lactase and cannot
enzyme production accordingly. digest much lactose.

• Lactose malabsorption. Lactase deficiency

Digestive enzymes in the form of supplements
may cause lactose malabsorption. In lactose
are of plant or animal origin and can be derived malabsorption, undigested lactose passes to
from microbial commercial production. Example the colon where bacteria may break down
of plant enzymes include bromelain (from undigested lactose and create fluid and gas
pineapple) and papain (from papaya). Bromelain and upset.
has also gained popular use as a nutritional aid
It is interesting to note that people who
for the healing and reduction of inflammation.
experience lactose intolerance may be able to
Some microbial-produced digestive enzymes
tolerate a minor amount of lactose per eating
include bacterial protease, beta-glucanase,
occasion. What’s more, the types of lactose-
catalase, hemicellulase, maltase, and phytase.
containing foods may have different levels of
The variety of digestive enzyme supplements
tolerance, milk versus yoghurt for example,
also includes distase, glucoamylase, pectinase,
in which a person may be extremely sensitive
xylanase, pepsin, and lipase.
to milk but less sensitive to yoghurt. Lactase
Caution: As with any health problem, supplements are sometimes used by people who
gastrointestinal disorders should be promptly experience lactose intolerance, but they should
treated by physicians. When experiencing check with their doctors about this. People
pain, excessive gas, blood in the stool, or taking protein supplements of dairy origin
any gastrointestinal irregularity, you should should be aware that lactose can be present in
immediately seek a physician’s advice. Individuals sometimes significant amounts. Even people
with existing gastrointestinal problems should who are not normally lactose intolerant may
not use digestive enzymes unless they are under experience some symptoms when ingesting high
the supervision of their physicians. amounts of lactose.

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The following article published by the FDA provides an overview of lactose intolerance and various
issues of interest.

Problems Digesting Dairy Products?

Does your stomach churn after you drink milk? Do you have diarrhea soon afterward? If so, you may
be lactose intolerant. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
estimates that 30 to 50 million Americans are lactose intolerant.
Being lactose intolerant means you can’t digest lactose—the natural sugar found in milk and other
dairy products. People who cannot digest lactose have a shortage, or deficiency, of an enzyme called
lactase, which is produced in the small intestine. Lactase breaks down milk sugar into two simpler
forms of sugar, which are then absorbed into the bloodstream.
Intolerance Is Not Allergy
Lactose intolerance is not the same as a milk allergy, says Kavita Dada, Pharm.D., a senior health
promotion officer in the Food and Drug Administration’s (FDA’s) Division of Drug Information. “For
most people with lactase deficiency, it’s a discomfort.” People who have trouble digesting lactose
can learn which dairy products and other foods they can eat without discomfort and which ones they
should avoid.
But a food allergy—an abnormal response to a food triggered by the immune system—can be
life-threatening. People with food allergies must avoid certain foods altogether. People with food
intolerances can often eat small amounts of the offending foods without having symptoms.
Symptoms
When there is not enough lactase to digest the lactose in the foods a person eats or drinks, the person
may have
• gas
• stomach cramps
• bloating
• nausea
• diarrhea

These symptoms typically occur within 30 minutes to two hours after consuming food containing
lactose. Some illnesses can cause these same problems, but a health care professional can do tests to
see if the problems are caused by lactose intolerance or by another condition.
Who Becomes Lactose Intolerant?
Lactose intolerance is more common in some ethnic groups than others. NIDDK estimates that up
to 75% of all adult African Americans and Native Americans and 90% of Asian Americans are lactose
intolerant. As people age, their bodies produce fewer lactase enzymes, so most people don’t have
symptoms until they are adults.

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Most people inherit the condition from their parents. Lactose intolerance is not very common in
children under two years of age, unless the child has a lactase deficiency because of an injury to
the small intestine. If you think your infant or child may be lactose intolerant, talk to your child’s
pediatrician.
Managing Lactose Intolerance
There is no treatment to make the body produce more lactase enzyme, but the symptoms of lactose
intolerance can be controlled through diet.
Most older children and adults do not have to avoid lactose completely. People have different levels of
tolerance to lactose. Some people might be able to have a tablespoon of milk in a cup of coffee with
little or no discomfort. Others have reactions that are so bad they stop drinking milk entirely. Some
people who cannot drink milk may be able to eat cheese and yogurt—which have less lactose than
milk—without symptoms. They may also be able to consume a lactose-containing product in smaller
amounts at any one time.
Common foods with lactose are
• milks, including evaporated and condensed
• creams, including light, whipping, and sour
• ice creams
• sherbets
• yogurts
• some cheeses (including cottage cheese)
• butters
• Lactose may also be added to some canned, frozen, boxed, and other prepared foods such as
• breads and other baked goods
• cereals
• mixes for cakes, cookies, pancakes, and biscuits
• instant potatoes, soups, and breakfast drinks
• lunch meats (other than Kosher)
• frozen dinners
• salad dressings
• margarines
• candies and other snacks

Dietary supplements with lactase enzyme are available to help people digest foods that contain
lactose. However, the FDA has not formally evaluated the effectiveness of these products, and you may
want to ask your doctor if these supplements are right for you.

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Look at Labels
“Lactose-free” or “lactose-reduced” milk and other products are widely available in grocery
stores. These products may be fortified to provide the same nutrients as their lactose-containing
counterparts.
There is no FDA definition for the terms “lactose free” or “lactose reduced,” but manufacturers must
provide on their food labels information that is truthful and not misleading. This means a lactose-
free product should not contain any lactose, and a lactose-reduced product should be one with a
meaningful reduction. Therefore, the terms lactose free and lactose reduced have different meanings,
and a lactose-reduced product may still contain lactose that could cause symptoms.
Lactose-free or lactose-reduced products do not protect a person who is allergic to dairy products
from experiencing an allergic reaction. People with milk allergies are allergic to the milk protein, which
is still present when the lactose is removed.
Look at the ingredient label. If any of these words are listed, the product probably contains lactose:
• Milk
• Cream
• Butter
• Evaporated milk
• Condensed milk
• Dried milk
• Powdered milk
• Milk solids
• Margarine
• Cheese
• Whey
• Curds

Highly sensitive individuals should also beware of foods labeled “non-dairy,” such as powdered coffee
creamers and whipped toppings. These foods usually contain an ingredient called sodium caseinate,
expressed as “caseinate” or “milk derivative” on the label, which may contain low levels of lactose.
Testing for Lactose Intolerance
A doctor can usually determine if you are lactose intolerant by taking a medical history. In some cases,
the doctor may perform tests to help confirm the diagnosis. A simple way to test at home is to exclude
all lactose-containing products from your diet for two weeks to see if the symptoms go away and then
reintroduce them slowly. If the symptoms return, then you most likely are lactose intolerant. But you
may still want to see your doctor to make sure that you are lactose intolerant and do not have a milk
allergy or another digestive problem.

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Tips for Consumers

If you are lactose intolerant, try lactose-free milk or dairy products lower in lactose, such as yogurt and
cheese. You may be able to consume dairy products in small amounts without symptoms.
Consume milk or other dairy products with other foods. This helps slow down digestion, making it
easier for your body to absorb lactose.
If you’re eating few or no dairy products, ask your doctor or dietitian if you are getting enough
calcium in your diet. You may need to take dietary supplements with calcium to keep your bones
healthy.
Raw Milk and Lactose Intolerance
FDA warns consumers not to drink raw, or unpasteurized, milk. “Raw milk advocates claim that
pasteurized milk causes lactose intolerance,” says John Sheehan, director of FDA’s Division of Plant and
Dairy Food Safety. “This is simply not true. All milk, whether raw or pasteurized, contains lactose, and
pasteurization does not change the concentration of lactose, nor does it convert lactose from one form
into another.”
Raw milk advocates also claim that raw milk prevents or cures the symptoms of lactose intolerance.
Arguing that raw milk contains Bifidobacteria, they claim these microorganisms are beneficial
(probiotic) and create their own lactase, which helps people digest the milk.
“This is not true, either,” says Sheehan. “Raw milk can contain Bifidobacteria, but when it does, the
bacteria come from fecal matter (animal manure) and are not considered probiotic, but instead are
regarded as contaminants.”
Drinking raw milk will still cause uncomfortable symptoms in people who are correctly diagnosed as
being lactose intolerant. But worse than this discomfort are the dangers of raw milk, which can harbor
a host of disease-causing germs, says Sheehan. “These microorganisms can cause very serious, and
sometimes even fatal, disease conditions in humans.”

Source: https://www.fda.gov/forconsumers/consumerupdates/ucm094550.htm

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Intestinal Microbials from foods, in particular cultured foods like

yoghurt, and in fermented foods.
(Microorganisms)
Within everyone’s intestinal tract live billions When using probiotics, be sure to follow the
of microscopic bacteria, fungi, and other directions as indicated on the labels for proper
microorganisms. Human babies are born with use under supervision of a physician or other
a group of bacteria called the Lactobacillius health professional. When used correctly,
present in their bodies. A week or two later, probiotics can provide health benefits. However,
another group of bacteria also begins to inhabit they are not a replacement for poor nutrition.
the intestines, the Bifidobacteria. These bacteria To get the best benefits from dietary probiotics,
are the indigenous flora of the intestines and follow a healthy diet. Note that a diet that is
are important in maintaining proper intestinal high in processed foods, added sugar, and
functioning and overall health. Probiotics is a preservatives can work against the healthy
term used to connote live microorganisms in the probiotics becoming established in the gut.
body that can have a health benefit versus the
Here are some of the approved uses/purposes
pathogenic microorganisms in the body that can
presented by Health Canada, in general:
cause adverse health effects.
• Help support gastrointestinal health
Two crucial microbial species are Lactobacillius
• Promote regularity
acidophilus and Bifidobacterium bifidum.
These bacteria benefit the health of the entire • Could promote a favorable gut flora
body by suppressing growth of harmful • Aid in digestion, improves nutrient absorption
microorganisms in the bacteria, producing
• For certain species, help reduce the symptoms
some vitamins, and maintaining of the
of diarrhea
intestinal environment for proper intestinal
absorption to occur. Both Lactobacillius Improving immune system health is another
and Bifidobacterium species are available in benefit associated with regular use of probiotic
supplement form. Probiotics are also provided supplements. In the United States, there are

Examples of some Probiotic Species used in dietary supplements:

Bifidobacterium adolescentis Bifidobacterium animalis Bifidobacterium bifidum
Bifidobacterium breve Bifidobacterium longum Lactobacillus acidophilus
Lactobacillus brevis Lactobacillus buchneri Lactobacillus casei
Lactobacillus crispatus Lactobacillus curvatus Lactobacillus fermentum
Lactobacillus johnsonii Lactobacillus kefiranofaciens Lactobacillus kefiri
Lactobacillus mucosae Lactobacillus panis Lactobacillus paracasei
Lactobacillus paraplantarum Lactobacillus plantarum Lactobacillus pontis
Lactobacillus reuteri Lactobacillus rhamnosus Lactobacillus salivarius
Lactobacillus sanfranciscensis Saccharomyces boulardii Saccharomyces cerevisiae

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a variety of probiotic supplements and foods supplements. Refer to Unit 3 for a reference chart
containing probiotics with similar health containing foods high in dietary fiber and for
benefit claims, usually determined by the information about prebiotics, which are certain
product companies, based on their independent types of complex carbohydrates that are the
reviews of the scientific evidence. Although preferred food for the probiotics.
most probiotics are bacterial microorganisms,
there are some like Saccharomyces (yeasts) that
are fungi.
Conclusion
Digestion and digestive system health is of
Fiber and Digestion vital importance for athletes to optimize the
digestion and absorption of nutrients and to
The importance of fiber intake has gained notice avoid gastrointestinal update that becomes
recently. Nutrition surveys indicate that during counterproductive to athletic performance.
the past 60 years, daily fiber consumption has Care must be exercised for the selection,
dropped in the United States. Researchers storage, and preparation of foods that are
have determined an array of health benefits to most compatible for the athletic client. Even
be associated with a high fiber diet, including healthy foods can cause annoying side effects,
proper bowel function, increased satiety, and such as gastrointestinal gas, increased rate of
cholesterol lowering (bran and pectin).
defecation, or reduction in appetite, followed
In the United States, the dietary reference by inadequate caloric consumption. Food and
intakes for total fiber ranges from 25.2 to 33.6 supplement strategies should be developed
grams of dietary fiber per day for adults. This is to optimize digestion and digestive function,
accomplished primarily by eating more whole provide the required nutrients and calories,
grain products, fruits and vegetables, and fiber and promote health and athletic performance.

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Key Words
Hydrochloric acid Anabolism

Sports Nutrition
 Topics Covered In This Unit

Body composition assessment

Methods of body
composition determination

 ow to use the Fat-O-Meter

H
skinfold caliper

 eneralized adult equations to

G
determine percent body fat most
accurately

Use of skinfold data

Percentage of body fat?

Body mass index (BMI)

Body types (somatotype)

Conclusion

UNIT 14

BODY COMPOSITION
384 | Unit 14

Unit Outline
I. Introduction V. Body mass index (BMI)
II. Body composition assessment VI. Body types (somatotype)
III. Methods of body composition determi- VII. Conclusion
nation
IV. How to use the Fat-O-Meter skinfold
caliper
a. Generalized adult equations to determine
percent body fat most accurately
i. The sites listed in the formulas and charts
are as follows:
b. Use of skinfold data
c. Percentage of body fat?

Learning Objectives
After completing this unit, you will be able to:
• Define and describe terms related to body composition;

• Discuss the variety of body composition measurement approaches; and

• Determine body composition.

Introduction
To achieve maximum athletic performance, you of is vital information. Additionally, you need
must mold and sculpt the athlete’s body to best to know about metabolism. How is an athlete’s
meet specific goals. Trainers and athletes need metabolism working? How many calories are
to know more information about their bodies needed? Is nutrition intake adequate based on
than what the bathroom scale or the height- body composition and metabolic needs and
weight charts can provide. You need to know other factors? This unit provides this essential
what the body is made of and how it responds information, which you can then apply to an
to nutrition and training. The amount of body athletic performance program.
fat and lean body weight the body is composed

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Body Composition Assessment

Body composition assessment is an important part of your initial
assessment procedure with new athlete clients and an important ongoing
evaluative test with existing clients and with other types of clients as
well. Excessive levels of body fat are associated with cardiovascular
disease, cancer, and other maladies. Body composition assessment is
also a crucial source of motivation for clients, as it demonstrates (we
hope) positive changes in overall fitness levels. Although many methods
of determining body fat levels exist, use of skinfold calipers offers a Skinfold calipers: the
specialized calipers used to
choice between accuracy, profitability, and cost-effectiveness. The Fat-O-
measure the thickness of
Meter is available through online retailers. Examples of other brands of skinfolds.
skinfold calipers include Lange and Harpenden. Skinfold measurement:
a method for determining
Skinfold measurements are one type of body measurement. In scientific body composition that
research and surveys, skinfold and other physical body measurements involves measuring the
thickness of selected folds of
are referred to collectively as anthropometric measurements. Examples skin using special calipers.
of other anthropometric measurements include the ones considered
routine and part of any fitness trainers approach, such as weight, height,
BMI, and body circumferences.

Methods of Body Composition

Determination
Before we review use of skinfold calipers, let’s examine some of the
various techniques available to determine body composition to become
acquainted with other options.

Underwater Weighing. A widely used technique is underwater or

hydrostatic weighing. A comparison is made of weight in air to weight Hydrostatic weighing:
of the completely submerged subject who has exhaled completely. A a method for determining
body composition that
statement of body’s density is then determined (fat is less dense than involves weighing the body
water is). A person with a high amount of fat will weigh less underwater underwater.
than will a person of similar weight who has less fat. Correlations are, of
course, made for amount of air in the lungs during the measurements
(i.e., corrected for residual volume—the amount of air left in the lungs
after a complete exhalation) and for gastrointestinal air. This technique,
in the hands of skilled technicians and subjects who are comfortable
underwater, provides a good estimate of the density of the body, which
can then be converted to an estimate of fat percentage.

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Air Displacement Plethysmograph. The BOD good practice. Be aware that dehydration may
POD Gold Standard Body Composition Tracking alter the results of BI, as can body temperature.
System is an air displacement plethysmograph When using BI, and other methods, make sure
that uses whole-body densitometry to to choose a time of day when the athlete is rested
determine body composition (fat and fat- and adequately hydrated to serve as a good
free mass) in adults and children and can baseline measurement. Experimenting with
accommodate a wide range of populations. A taking measurements during and post-exercise
full test requires only about five minutes and can also provide additional insights. When
provides highly accurate, safe, comfortable, accumulating a database of anthropometric
and fast test results. Each BOD POD Gold measurements, using these data for fine-tuning
Standard is a complete turnkey system with an athlete’s training and nutrition program can
a dedicated computer system, the ability to often provide a competitive advantage, as do
measure thoracic gas volume (TGV), and data exercise physiology and medical data.
management capabilities. Note that McCrory
Dual Energy X-Ray Absorptiometry (DEXA,
and coworkers (1995) conduced a comparison of
or DXA). Highly sophisticated, DEXA machine
air displacement to underwater weight and found
body composition determination uses what is
that the two approaches yielded similar results.
referred to as a three-compartmental model that
Note too that when comparing air displacement
differentiates the body into the components of
to other approaches like skinfold, the skinfold
bone, fat soft tissue, and lean soft tissue. The
technique used by the researchers was similar
DEXA method is usually expensive and requires
to the air displacement, which helps provide
a qualified radiologist. This method is commonly
additional scientific evidence on the usefulness
used in research studies.
of both techniques (Bentzur 2008).
B-mode (brightness mode) ultrasound. The
Bioelectrical impedance. This approach was
use of ultrasound is growing in many fields of
developed on the basis that water conducts
medicine and recently has gained attention by
electricity better than fat does. Because muscle
researchers for determining subcutaneous body
has high water content and fat has a very low
fat measurements as an alternative to using
water content, the rate at which your body
skinfold calipers. The use of a Brightness Mode
conducts electricity can be used to estimate
(B-mode) ultrasound as a measure of body
body fat. Many bioelectrical impedance devices
composition has been found to be a valid and
have been developed. They are easy to use
reliable way to estimate an individual’s body
hand-held versions that give an instant reading.
fat. B-mode ultrasound imaging functions by
These devices were developed primarily for
sending an acoustic wave from a transducer
the population at large and use calculations
and interpreting the reflection of the wave by a
and norms for the average person but can be
receiver, which is located within the transducer.
used with athletes. However, they should be
These reflections are interpreted by the machine
compared with another method for verification
and displayed as an image, and on-screen
when possible. In general, crosschecking of any
measurements can be determined from this.
of the body composition methods is typically a

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 Body Composition | 387

Parker Hyde (2015) conducted a study for a skin and fat but not the underlying muscles), the
Master of Science thesis requirement comparing greater the amount of fat a person is carrying.
skinfold calipers to B-mode ultrasound, taking Specially designed calipers are used to measure
measurements from football players. Hyde’s the thickness of representative sites throughout
study results provided more evidence of similar the body. These measurements are put in as a
results using skinfold caliper measurements mathematical equation to estimate the body’s
compared with the B-mode ultrasound device. density. The measurements are then converted
Some advantages noted for the ultrasound into a body fat percentage. This technique of
included speed of use, having images records of measuring skinfolds is inexpensive, portable,
the sites, and not needing to fold the skin. and appropriate in both laboratory and field
settings when used by experienced and skilled
Skinfold Caliper (Fat-O-Meter). This method
individuals. For example, it is widely used in
of body fat determination is the skinfold caliper,
school systems, by athletic teams, and in YM/
taking the measurement of a skinfold. Because
YWCAs, for example. The following section
some body fat is subcutaneous (under the skin),
focuses on this technique.
it follows that the thicker the skinfolds (a fold of

NOTE: Cadaver Analysis—The direct analysis of a human cadaver.

The body’s fat is measured by direct examination of the fat stores throughout the body. Human stud-
ies are rare and have only accounted for a handful of cadavers. Animal studies are more plentiful. In
humans, the limitations of the cadaver procedure are obvious. It is interesting to note, however, that
many of the body composition calculations are based on assumptions made on cadaver analysis per-
formed on one reference man and one reference wom

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How to Use the Fat-O- Skinfold measurement is a two-handed operation

and requires practice. Take hold of the skin and
Meter Skinfold Caliper subcutaneous fat (no muscle) in the left thumb
Before you actually get started with clients and forefinger, or middle finger; grasp the caliper
predicting leanness/fatness, we recommend in the right hand with the scale facing you.
the following to provide you with the most
With your thumb on the serrated portion of
accurate results:
the caliper, slide the caliper open, enabling you
1. Allow a considerable amount of practice using to easily place the caliper around the selected
the skinfold calipers, taking measures one skinfold site. Slowly, allow the caliper to close
at a time at many sites in rotational order. around the fold. Note the caliper location on
Check your test-retest reliability after all the
the crest of the fold about one centimeter (cm)
measurements have been taken.
away from the fingers. Next, take the reading in
2. Be careful in locating the site for measurement millimeters to the nearest one-half mm. Finally,
by using the appropriate anatomical reopen the caliper to remove. Manually close the
landmarks.
caliper, but do not allow the spring to close the
3. Check the caliper jaw pressure to ensure caliper.
that no damage has occurred to the spring.
Springs are warranted for one year against Notes:
normal usage. Researchers agree that the
1. When taking measurements, do so directly on
pressure exerted by the caliper jaw should be
the skin, not through the clothes. Readings
approximately 10g/mm2 and remain constant
should be taken in a standing position and on
with repeated openings and closings.
one side of the body—normally the right side.
4. Measure the sites in the rotational order, taking
2. Take readings in triplicate and use the average
one measurement at each site throughout the
of the two closest readings for use in the
full complement of tests. Check each site two
appropriate formula.
to three times and use the average.
3. Practice, Practice, Practice,
5. Select the most valid prediction equation to
and More Practice.
make your prediction.

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 Body Composition | 389

Generalized Adult Equations to Determine

Percent Body Fat Most Accurately
Numerous investigations have produced large easy way to look up percent body fat. You will
numbers of equations for use on the general also notice that nomograph carts using just two
populations and on specific subgroups, such as sites are also provided. You should use both the
athletes. What has been discovered is that these three-site and two-site methods to see how the
equations have high correlations only with the percent body fat will differ. As you become more
populations upon which they were developed, sophisticated using skinfold methods, you can
and subsequent use has produced substantially employ calculations that use 12 or more sites.
lower correlations. Studies have developed But always remember that there is roughly up to
this set of prediction equations, which were a 5 percent margin of error using the skinfold
generalized for males and females, see below. and other body composition measurements. As
such, it is important to keep track of how the
This body density formula is then used in other
skinfold measurements are changing and how
formulas to calculate percent body fat. Two of
the total percent body fat is changing, along with
the following tables provide the calculations
the primary body circumferences. You need to
for men and women for a wide range of
look at the whole body to keep track of how it is
skinfold thicknesses and ages. Note that the
changing from diet and training.
Siri formula was used to calculate the percent
[Prediction equations are from McArdle, W.D., Katch, F.I., and
body fat numbers on the chart. You simply need Katch, V.L., “Essentials of Exercise Physiology, 2nd Edition,
to measure the sites as specified for men and 2000, with permission].
women and then refer to these charts for an

Prediction Equations
Adult Women: Density = 1.0994921- 0.0009920 (X3) + 0.0000023 (X3) 2 - 0.0001392 (Age)
Note: X3 = Site 2+ Site 8 + Site 4

Adult Men: Density = 1.10993800 - 0.0008267 (X2)0.0000015 (X2) 2 - 0.0002574 (Age)

X2 = Site 10 + Site 9 + Site 8

Eq. 14.1

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The Sites Listed in the Formulas and Charts Are as Follows:

Common Skinfold Sites

The most common skinfold sites are the triceps, subscapular, suprailiac, abdominal, and upper thigh. An average of
two or three measurements are made at each site on the right side of the body with the subject standing. The following
photos show the anatomical location for the most frequently measured skinfold sites.
Site 1 (S1) – Subscapula: Site 2 (S2) – Triceps:
Oblique fold just below Vertical fold at the
the bottom tip of the posterior midline of
scapula. the upper arm, halfway
between the tip of the
shoulder and the tip of
the elbow; elbow remains
extended in a relaxed
position.

Site 4 (S4) – Suprailiac Site 8 (S8) – Thigh: Ver-

(iliac crest): Slightly tical fold at the midline
oblique fold just above of the thigh, two-thirds
the hipbone (crest of the of the distance from the
ileum); the fold follows middle of the patella
the natural diagonal line. (kneecap) to the hip.

Site 9(S9) – Abdomen: Site (S10) – Chest: From

Vertical fold 1 inch to the the front crease of the
right of the umbilicus armpit to the nipple, mea-
(navel). sure way up; using same
angle, take a pinch.

Use of Skinfold Data 5

women

Skinfolds provide meaningful information 4

Centimeters

about body fat and its distribution. There are

3 men
essentially two ways to use skinfolds. Use the
skinfold measurements in equations or charts 2

to determine percent body fat. Use skinfold 20 40 60 80

measurements to determine changes in

Age in Years

subcutaneous fat distribution of the body. Figure 14.1 Average Sum of Skinfolds for Adults 18 to 79
Years of Age. (H.W. Stoudt, A. Damon, R.A. McFarland & J.
Roberts. “Skinfolds, body girths, biacronial diameter, and
selected anthropometric indices of adults.” Vital and Health
Statistics, Series 11. 1973 (47).

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 Body Composition | 391

Percentage of Body Fat?

Percent body fat is an estimate of the percent of 10 percent can be considered minimum, whereas
total body weight (mass) that is fat. “Normal” 10 to 15 percent is a minimum for females,
values for percent fat vary somewhat from report which should be confirmed by the athlete’s
to report. However, the following tables are a physician and team medical policy. In addition,
compilation of a number of studies and may help be aware that it is common for sports governing
you interpret your results (adapted from Katch & organizations and schools to have lower limits for
McArdle 1977). Care should be taken with respect minimum percentage body fat levels of athletes.
to the low end of the scale. Clients should be Body fat levels that are too low can have adverse
advised against too low a body fat. For males, 5 to health effects for men and women.

Male Female
USA Averages Interpreting Results* USA Averages Interpreting Results*
20% Elite Athletes 5-10%** 24.8% Elite Athletes 10-15%**
Younger (Under 30) Good 11-14% Younger (Under 30) Good 16-19%
25% Acceptable 15-17% 31.2% Acceptable 20-24%
Older (Over 30) Too Fat 18-19% Older (Over 30) Too Fat 125-29%
Obese 20% & up Obese 30% & up

*Applies to adults only.

**Some medical problems cause low% fat. If you suspect a health problem, consult a physician.

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Percent Fat Estimates for Women, Sites 2, 4 & 8 Sum of Triceps, Suprailium & Thigh Skinfolds*
Age of the Last Year
Sum of Skinfolds
(mm) Under 23-27 28-32 33-37 38-42 43-47 48-52 53-57 Over 58
22
23–25 9.7 9.9 10.2 10.4 10.7 10.9 11.2 11.4 11.7
26–28 11.0 11.2 11.5 11.7 12.0 12.3 12.5 12.7 13.0
29–31 12.3 12.5 12.8 13.0 13.3 13.5 13.8 14.0 14.3
32–34 13.6 13.8 14.0 14.3 14.5 14.8 15.0 15.3 15.5
35–37 14.8 15.0 15.3 15.5 15.8 16.0 16.3 16.5 16.8
38–40 16.0 16.3 16.5 16.7 17.0 17.2 17.5 17.7 18.0
41–43 17.2 17.4 17.7 17.9 18.2 18.4 18.7 18.9 19.2
44–46 18.3 18.6 18.8 19.1 19.3 19.6 19.8 20.1 20.3
47–49 19.5 19.7 20.0 20.2 20.5 20.7 21.0 21.2 21.5
50–52 20.6 20.8 21.1 21.3 21.6 21.8 22.1 22.3 22.6
53–55 21.7 21.9 22.1 22.4 22.6 22.9 23.1 23.4 23.6
56–58 22.7 23.0 23.2 23.4 23.7 23.9 24.2 24.4 24.7
59–61 23.7 24.0 24.2 24.5 24.7 25.0 25.2 25.5 25.7
62–64 24.7 25.0 25.5 25.5 25.7 26.0 26.7 26.4 26.7
65–67 25.7 25.9 26.2 26.4 26.7 26.9 27.2 27.4 27.7
68–70 26.6 26.9 27.1 27.4 27.6 27.9 28.1 28.4 28.6
71–73 27.5 27.8 28.0 28.3 28.5 28.8 29.0 29.3 29.5
74–76 28.4 28.7 28.9 29.2 29.4 29.7 29.9 30.2 30.4
77–79 29.3 29.5 29.8 30.0 30.3 30.5 30.8 31.0 31.3
80–82 30.1 30.4 30.6 30.9 31.1 31.4 31.6 31.9 32.1
83–85 30.9 31.2 31.4 31.7 31.9 32.2 32.4 32.7 32.9
86–88 31.7 32.0 32.2 32.5 32.7 32.9 33.2 33.4 33.7
89–91 32.5 32.7 33.0 33.2 33.5 33.7 33.9 34.2 34.4
92–94 33.2 33.4 33.7 33.9 34.2 34.4 34.7 34.9 35.2
95–97 33.9 34.1 34.4 34.6 34.9 35.1 35.4 35.6 35.9
98-100 34.6 34.8 35.1 35.3 35.5 35.8 36.0 36.2 36.5
101-103 35.3 35.4 35.7 35.9 36.2 36.4 36.7 36.9 37.2
104-106 35.8 36.1 36.3 36.3 36.8 37.1 37.3 37.5 37.8
107-109 36.4 36.7 36.9 37.1 37.4 37.6 37.9 38.1 38.4
110-112 37.0 37.2 37.5 37.7 38.0 38.2 38.5 38.7 38.9
113-115 37.5 37.8 38.0 38.2 38.5 38.7 39.0 39.2 39.5
116-118 38.0 38.3 38.5 38.8 39.0 39.3 39.5 39.7 40.0
119-121 38.5 38.7 39.0 39.2 39.5 39.7 40.0 40.2 40.5
122-124 39.0 39.2 39.4 39.7 39.9 40.2 40.4 40.7 40.9
Percent fat calculated by the formula of Siri30.

Percent fat = [(4.95/Body Density)-4.5] x 100

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 Body Composition | 393

Percent Fat Estimates for Men, Sites 8, 9, & 10 Sum of Chest, Abdominal, & Thigh Skinfolds
Age of the Last Year
Sum of Skinfolds
(mm) Under 23-27 28-32 33-37 38-42 43-47 48-52 53-57 Over 58
22
8-10 1.3 1.8 2.3 2.9 3.4 3.9 4.5 5.0 5.5
11-13 2.2 2.8 3.3 3.9 4.4 4.9 5.5 6.0 6.5
14-16 3.2 3.8 4.3 4.8 5.4 5.9 6.4 7.0 7.5
17-19 4.2 4.7 5.3 5.8 6.3 6.9 7.4 8.0 8.5
20-22 5.1 5.7 6.2 6.8 7.3 7.9 8.4 8.9 9.5
23-25 6.1 6.6 7.2 7.7 8.3 8.8 9.4 9.9 10.5
26-28 7.0 7.6 8.1 8.7 9.2 9.8 10.3 10.9 11.4
29-31 8.0 8.5 9.1 9.6 10.2 10.7 11.3 11.8 12.4
32-34 8.9 9.4 10.0 10.5 11.1 11.6 12.2 12.8 13.3
35-37 9.8 10.4 10.9 11.5 12.0 12.6 13.1 13.7 14.3
38-40 10.7 11.3 11.8 12.4 12.9 13.5 14.1 14.6 15.2
41-43 11.6 12.2 12.7 13.3 13.8 14.4 15.0 15.5 16.1
44-46 12.5 13.1 13.6 14.2 14.7 15.3 15.9 16.4 17.0
47-49 13.4 13.9 14.5 15.1 15.6 16.2 16.8 17.3 17.9
50-52 14.3 14.8 15.4 15.9 16.5 17.1 17.6 18.2 18.8
53-55 15.1 15.7 16.2 16.8 17.4 17.9 18.5 19.1 19.7
56-58 16.0 16.5 17.1 17.7 18.2 18.8 19.4 20.0 20.5
59-61 16.9 17.4 17.9 18.5 19.1 19.7 20.2 20.8 21.4
62-64 17.6 18.2 18.8 19.4 19.9 20.5 21.1 21.7 22.2
65-67 18.5 19.0 19.6 20.2 20.8 21.3 21.9 22.5 23.1
68-70 19.3 19.9 20.4 21.0 21.6 22.2 22.7 23.3 23.9
71-73 20.1 20.7 21.2 21.8 22.4 23.0 23.6 24.1 24.7
74-76 20.9 21.5 22.0 22.6 23.2 23.8 24.4 25.0 25.5
77-79 21.7 22.2 22.8 23.4 24.0 24.6 25.2 25.8 26.3
80-82 22.4 23.0 23.6 24.2 24.8 25.4 25.9 26.5 27.1
83-85 23.2 23.8 24.4 25.0 25.5 26.1 26.7 27.3 27.9
86-88 24.0 24.5 25.1 25.7 26.3 26.9 27.5 28.1 28.7
89-91 24.7 25.3 25.9 25.5 27.1 27.6 28.2 28.8 29.4
92-94 25.4 26.0 26.6 27.2 27.8 28.4 29.0 29.6 30.2
95-97 26.1 26.7 27.3 27.9 28.5 29.1 29.7 30.3 30.9
98-100 26.9 27.4 28.0 28.6 29.2 29.8 30.4 31.0 31.6
101-103 27.5 28.1 28.7 29.3 29.9 30.5 31.1 31.7 32.3
104-106 28.2 28.8 29.4 30.0 30.6 31.2 31.8 32.4 33.0
107-109 28.9 29.5 30.1 30.7 31.3 31.9 32.5 33.1 33.7
Percent fat calculated by the formula of Siri30.

Percent fat = [(4.95/Body Density)-4.5] x 100

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Simple Formulas for Calculating Percent Bodyfat

The nomogram to the right is slightly the chart for each site indicated and draw a
less accurate than other anthropometric connecting line between them. Your percent
measurement formulas are. However, they will body fat is where the connecting line crosses the
allow you to calculate a quick approximation center column.
of percent body fat for men and women. Mark

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 Body Composiiton | 395

Body Mass Index (BMI)

The following will provide an overview of BMI
From the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic
Disease Prevention and Health Promotion

An important fact to emphasize that is well known to health

professionals who work with athletic people is that the BMI value can be
high for athletes with higher-than-average muscle mass and low body
fat. Therefore, BMI has limitations for athletes as a predictor of body
composition, in particular, excess body fat determination.

What is BMI?
BMI is a person’s weight in kilograms divided by the square of height in Body mass index (BMI):
meters. BMI does not measure body fat directly, but research has shown BMI is a measure of body
weight relative to height.
that BMI is moderately correlated with more direct measures of body fat The BMI tool uses a formula
obtained from skinfold thickness measurements, bioelectrical impedance, that produces a score often
used to determine if a
densitometry (underwater weighing), dual energy X-ray absorptiometry person is underweight, at a
(DXA), and other methods. Furthermore, BMI appears to be as strongly normal weight, overweight,
correlated with various metabolic and disease outcome as are these more or obese. For adults, a BMI
of 18.5 to 24.9 is considered
direct measures of body fatness. In general, BMI is an inexpensive and healthy (or “normal”).
easy-to-perform method of screening for weight category; underweight, A person with a BMI of
25 to 29.9 is considered
normal or healthy weight, overweight, and obesity. overweight, and a person
with a BMI of 30 or more is
considered obese.
How is BMI used?
A high BMI can be an indicator of high body fatness. BMI can be
used as a screening tool but is not diagnostic of an individual’s body
fatness or health.

To determine whether a high BMI is a health risk, a health-care provider

would need to perform further assessments. These assessments might
include skinfold thickness measurements; evaluations of diet, physical
activity, and family history; and other appropriate health screenings10.

What are the BMI trends for adults in the United States?
The prevalence of adult BMI greater than or equal to 30 kg/m2 (obese
status) has greatly increased since the 1970s. Recently, however, this
trend has leveled off, except for older women. Obesity has continued to
increase in adult women ages 60 years and older.

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Why is BMI used to measure overweight and obesity?

BMI can be used for population assessment of overweight and obesity.
Because calculation requires only height and weight, BMI is inexpensive
and easy to use for clinicians and for the general public. BMI can be used
as a screening tool for body fatness but is not diagnostic.

What are some of the other ways to assess excess body

fatness besides BMI?
Other methods to measure body fatness include skinfold thickness
measurements (with calipers), underwater weighing, bioelectrical
impedance, dual-energy X-ray absorptiometry (DXA), and isotope
dilution. 1,2,3 However, these methods are not always readily available,
and they are either expensive or need to be conducted by highly trained
personnel. Furthermore, many of these methods can be difficult to
standardize across observers or machines, complicating comparisons
across studies and time periods.

How is BMI calculated?

BMI is calculated the same way for both adults and children. The
calculation is based on the following formulas:

Calculating BMI for Adults and Children

Measurement Units Formula and Calculation
Kilograms and Formula: weight (kg) / [height (m)]2
meters
With the metric system, the formula for BMI is weight in kilograms divided by height in
(or centimeters) meters squared. Because height is commonly measured in centimeters, divide height in
centimeters by 100 to obtain height in meters.

Example: Weight = 68 kg, Height = 165 cm (1.65 m)

Calculation: 68 ÷ (1.65)2 = 24.98

Pounds and inches Formula: weight (lb) / [height (in)]2 x 703
Calculate BMI by dividing weight in pounds (lbs) by height in inches (in) squared and multi-
plying by a conversion factor of 703.

Example: Weight = 150 lbs, Height = 5’5” (65”)

Calculation: [150 ÷ (65)2] x 703 = 24.96

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How is BMI interpreted for adults?

For adults 20 years old and older, BMI is interpreted using standard
weight status categories. These categories are the same for men and
women of all body types and ages.

The standard weight status categories associated with BMI ranges for
adults are shown in the following table.

Interperting BMI for Adults | Standard Weight Status Catgories Associated with BMI
BMI Weight Status
Below 18.5 Underweight
18.5–24.9 Normal or Healthy Weight
25.0–29.9 Overweight
30.0 and Above Obese

For example, here are the weight ranges, the corresponding BMI ranges, and the weight status
categories for a person who is 5’ 9”.

Height Weight Range BMI Weight Status

124 lbs or less Below 18.5 Underweight
125 lbs to 168 lbs 18.5 to 24.9 Normal or Healthy Weight
5’9”
169 lbs to 202 lbs 25.0 to 29.9 Overweight
203 lbs or more 30 or higher Obese

Is BMI interpreted the same way for

children and teens as it is for adults?
BMI is interpreted differently for children and teens than for adults,
even though it is calculated using the same formula as adult BMI.
Children and teens’ BMI need to be age- and gender-specific because the
amount of body fat changes with age, and the amount of body fat differs
between girls and boys. The CDC BMI-for-age growth charts accounts
for these differences and visually show BMI as a percentile ranking.
These percentiles were determined using representative data of the US
population of 2- to 19-year-olds that was collected in various surveys
from 1963–1965 to 1988–1994 11.

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Obesity among 2- to 19-year-olds is defined as a BMI at or above the

95th percentile of children of the same age and gender in this 1963–1994
reference population. For example, a 10-year-old boy of average height
(56 inches) who weighs 102 pounds would have a BMI of 22.9 kg/m2.
This would place the boy in the 95th percentile for BMI – meaning that
his BMI is greater than that of 95 percent of similarly aged boys in this
reference population – and he would be considered to have obesity.

How good is BMI as an indicator of body fatness?

The correlation between the BMI and body fatness is fairly strong,1,2,3,7
but even if two people have the same BMI, their levels of body fatness
might differ12.

In general,
• At the same BMI, women tend to have more body fat than men do.

• At the same BMI, blacks have less body fat than do whites,13,14 and Asians
have more body fat than do whites do.15

• At the same BMI, older people, on average, tend to have more body fat
than younger adults do.

• At the same BMI, athletes have less body fat than do nonathletes.

The accuracy of BMI as an indicator of body fatness also appears to be

higher in persons with higher levels of BMI and body fatness16. Though
a person with a very high BMI (e.g., 35 kg/m2) is very likely to have high
body fat, a relatively high BMI can be the result of either high body
Lean body mass: all of fat or high lean body mass (muscle and bone). A trained health-care
a body’s tissues apart from provider should perform appropriate health assessments to evaluate an
the body fat: the bones,
muscles, organs, blood, individual’s health status and risks.
and water. Also called fat-
free mass.
If an athlete or other person with a lot of muscle has a
BMI higher than 25, is that person still considered to be
overweight?
According to the BMI weight status categories, anyone with a BMI
between 25 and 29.9 would be classified as overweight, and anyone with
a BMI above 30 would be classified as obese.

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 Body Composiiton | 399

However, athletes may have a high BMI because of increased muscularity High blood pressure:
your blood pressure rises
rather than increased body fatness. In general, a person who has a high
and falls throughout the
BMI is likely to have body fatness and would be considered overweight day. An optimal blood
or obese, but this may not apply to athletes. A trained health-care pressure is less than 120/80
mmHg. When blood
provider should perform appropriate health assessments to evaluate an pressure stays high—greater
individual’s health status and risks. than or equal to 140/90
mmHg—you have high
blood pressure, also called
What are the health consequences of obesity for adults? hypertension. With high
blood pressure, the heart
People who are obese are at increased risk for many diseases and health works harder, your arteries
take a beating, and your
conditions, including the following: chances of a stroke, heart
attack, and kidney problems
• All causes of death (mortality) are greater. Uncontrolled
high blood pressure may
• High blood pressure (Hypertension)
lead to blindness, heart
• High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides attacks, heart failure,
kidney disease, and stroke.
(Dyslipidemia) Prehypertension is blood
pressure between 120 and
• Type 2 diabetes
139 for the top number, or
• Coronary heart disease between 80 and 89 for the
bottom number.
• Stroke

• Gallbladder disease

• Osteoarthritis (a breakdown of cartilage and bone within a joint)

• Sleep apnea and breathing problems

• Chronic inflammation and increased oxidative stress 19,20

• Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)

• Low quality of life

• Mental illness such as clinical depression, anxiety, and other mental

disorders 21,22

• Body pain and difficulty with physical functioning 23

Note: for cited references, see the reference section in the Appendix.
Page last reviewedand reviewed: May 15, 2015. Content source: Division of Nutrition, Physical Activity,
and Obesity, National Center for Chronic Disease Prevention and Health Promotion

www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

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400 | Unit 14

Body Types (Somatotype)

The way your body looks is a result of your genetics and environmental
factors such as training and nutrition. The genetic factor has dominant
influence on your body structure, inside and out. The scientist W. H.
Sheldon devised a system of classifying the different human body types
and called this system “somatotype.” With this system, humans can be
classified in three body types:
• Mesomorphic or muscular body type

• Ectomorphic or slim, linear body type

• Endomorphic or fat, round body type

Sheldon’s system uses a somatotype number with three digits, on a scale

from 1 to 7. The first digit refers to the degree of endomorphy, the second
digit refers to the degree of mesomorphy, and the third digit refers to
the degree of ecotmorphy. An extreme endomorph has the somatotype
711, an extreme mesomorph has the somatotype 171, and an extreme
ectomorph has the somatotype 117.

Most individuals have a dominant somatotype and also display

some characteristics of the other two. An average person may fall
somewhere around a 333 or a 444 rating. This system is useful
because it helps you understand your genetic predisposition.

Figure 14.2. Sheldon’s Somatotype Distribution Triangle. Note that elite athletes
nearly always fall in the mesomorphic sector of the triangle.

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 Body Composiiton | 401

For example, on a pound for pound body-weight basis,

ectomorphs usually require more calories. Mesomorphs are
next in line, and endomorphs demand the fewest calories.

If you are a determined, competitive athlete, you should have your

somatotype determined by a trained individual. Elite world-class
athletes usually have a mesomorphic rating of 5 to 7, endomorphic of 1
to 3, and ectomorphic of 4 to 1. This indicates that being predominantly
mesomorphic is a common trait of elite athletes. This makes sense, as
mesomorphs have a higher body composition of muscle mass, which is
the primary tissue responsible for athletic performance. This does not
mean that ectomorphs or endomorphs cannot become superior athletes;
however, they should use training and nutrition methods to build more
muscle mass and keep percent body fat within desirable levels for their
gender and sport.

CONCLUSION
Determining body composition, somatotype, and other
anthropometric measurements will provide useful information
for tracking an athlete’s progress and determining whether
and when there may be nutritional inadequacies or other issues
of concern related to training and nutrition programs.

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402 | Unit 14

Keywords
Skinfold calipers Body mass index (BMI)

Skinfold measurement Lean body mass

Hydrostatic weighing High blood pressure (Hypertension)

Sports Nutrition
 Topics Covered In This Unit

Introduction

Guide to estimating calorie needs

Average daily activity level

Metabolic equivalent

Overview of metabolism

Homeostasis

Homeostatic feedback control systems

Metabolism

Metabolic set point

Food and metabolism

Metabolic testing device example

The environment and metabolism

Exercise and metabolic responses

Aerobic system changes

Anaerobic system changes

Energy metabolism

Glycogen depletion
and metabolism of fatigue

Conclusion

UNIT 15

CALORIE NEEDS AND METABOLISM

404 | Unit 15

Unit Outline
I. Introduction X. The environment and metabolism
II. Guide to estimating calorie needs XI. Exercise and metabolic responses
III. Average daily activity level a. Aerobic system changes
IV. Metabolic equivalent b. Anaerobic system changes
V. Overview of metabolism XII. Energy metabolism
VI. Homeostasis XIII. Glycogen depletion and metabolism
of fatigue
a. Homeostatic feedback control systems
XIV. Conclusion
VII. Metabolism
VIII. Metabolic set point
IX. Food and metabolism
a. Metabolic testing device example

Learning Objectives
After completing this unit, you will be able to:
• Define and describe terms related to calorie needs and metabolism;

• Calculate estimated daily caloric requirements;

• Understand role of metabolism in the body; and

• Describe the muscle fiber types.

Introduction
How many times has someone asked you, “How many calories should
I eat?” The key to answering any such question is always going to be
related to determining how many calories the person needs. And while
we are on the subject, what exactly are calories?

Guide to Estimating Calorie Needs

Calories are the unit of measure used to calculate the amount of energy
in foods. If you recall, the primary energy yielding nutrients are fats,
carbohydrates, and protein. The Calorie (with a big C), or kilocalorie,

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 Calorie Needs and Metabolism | 405

is the terminology used to represent how much used and carbon dioxide exhaled is a direct
heat-yielding potential there is contained in result of how much energy is being expended.
a food’s contents. Technically speaking, one Sophisticated technology is required to use these
kilocalorie is the amount of heat needed to raise laboratory techniques. Therefore, the following
the temperature of 1 kilogram of water 1 degree calculations and charts listed below are provided
Celsius. The calorie (with the small c) would then to serve as a handy reference tool for estimating
be 1000th of a kilocalorie. daily caloric requirements.

Therefore, the “Calorie or calorie” used in Just as with the determination of body
nutrition and on nutrition labeling is technically composition, all these energy expenditure
a kilocalorie. For example, the daily caloric techniques have a margin of error in them.
requirements are in the thousands, 2,115 calories Keep this in mind because even the most
per day in the first example. If authors are using sophisticated methods may yield daily caloric
the real small calorie convention, then this daily rates that are too high or too low. That is why it
caloric requirement would have been 1,000 times is important to keep track of body composition
larger or, 2,115,000 calories. Thus you can easily changes, to fine-tune caloric intake based
see why the kilocalorie is used instead, to keep on the individual’s metabolic rate, not just
the numbers smaller and easier to work with, what some chart estimates. Keep in mind
but can be referred to as calories or Calories that ectomorphs usually will require more
depending on the use. Scientific journals and energy than the charts estimate, mesomorphs
textbooks usually will be more scientific and use are about what the charts estimate, and
the scientific-based terms, but not always.
endomorphs will usually require less than the
Another measure of energy used by scientists charts estimate. Therefore, you may find that
and internationally is called the kilojoule you need to make a few hundred calorie (plus
(kJ). To convert kilocalories to kilojoules, just or minus) adjustments to maintain the desired
multiply the kilocalorie number by 4.2. You will body composition and performance goals.
commonly encounter the kJ in the scientific
Everybody expends a different amount of energy
literature, used in dietary guidelines from foreign
each day, which depends on many factors such
countries outside of North America, and on
as physical activity and the composition of
food packaging from foreign countries outside of
the diet. However, the basal metabolism, or
North America.
basal metabolic rate (BMR) remains somewhat
The rate of the body’s energy expenditure is constant from day to day. Your BMR is the
sometimes referred to as the “metabolic rate”, rate at which the body expends energy for
which is the total daily caloric expenditure. As a maintenance activities, such as keeping the
starting point, traditional methods of science for body alive, organ function, and so on. Your
measuring metabolic rate use the measurement BMR is lowest when sleeping; however, most
of oxygen consumption, which will indirectly methods measure your BMR when awake, but
reflect metabolism because the amount of oxygen under controlled conditions of resting and

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406 | Unit 15

room temperature. Your BMR is therefore an estimate of the number of

calories you’d burn over 24 hours while lying down, but not sleeping.
Your actual metabolic rate is estimated by adding the caloric cost of all
the activities you engage in throughout the day to your BMR. A rough
estimate of BMR is as follows:

Men’s BMR in calories =

1 × Body weight in kilograms ×24 hours

Women’s BMR in calories =

0.9 × Body weight in kilograms × 24

Eq. 15.1

These formulas are reasonably accurate for people with average levels
of body fat (i.e., 20 percent and 28 percent for men and women,
respectively). One kg (kilogram) equals 2.2046 pounds. The higher your
body fat percentage, the fewer calories you will burn (lower activity level,
and less muscle to burn calories). The lower your body fat percentage,
the more calories you’ll burn. (Bigger muscles burn more calories than
little ones do.) Energy requirements above the BMR will depend on your
activity level, and can be as low as 130 percent of your BMR to over 200
percent of your BMR as listed in the charts below.

Thus, it becomes much easier to eliminate fat by increasing your

metabolic rate and not overeating. You do this by increasing both your
muscle mass and your activity level. You can (and SHOULD) gain
muscle mass and lose fat simultaneously. Never sacrifice muscle tissue
during the fat-loss process. Instead, build more muscle to burn more
calories. You’ll lose more fat faster, and you will be more likely to keep
it off. The following methods provide more accurate determinations of
BMR and daily energy expenditure.

Average Daily Activity Level

The hour-by-hour approach is the best way to estimate your daily calorie
needs, but it is also the most involved. Once you know your average
BMR for 24 hours, you can estimate your BMR for an hour by dividing
by 24. After that, all you really need to do is add the number of calories
your activity level demands. But a few factors mitigate, not the least of
which is your body fat percentage versus your lean mass (bigger muscles
burn more calories than little ones do). In addition to the detailed hourly

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 Calorie Needs and Metabolism | 407

calorie requirement method, a Daily Calorie Requirement Guide is also

provided. In either case, the information in the following chart is used.
Just follow the step-by-step instructions to make the calculations.

First determine your percent body fat using one of the methods
described in Unit 14.

Key to Reading the Charts Below

Lean Clinical Lean Factor Percent Multiplier
Factor Description Body Fat Levels
1 Lean Men 10% - <14% 100%
(1.0)
Women 14% - <18%
2 Normal Men 14% - <20% 95%
(0.95)
Women 18% - <28%
3 Clinically Men 20% - 28% 90%
Obese (0.90)
Women 28% - 38%
4 Chronically Men over 28% 85%
Obese (0.85)
Women over 38%

Then determine your lean factor from the chart above. For this example,
let’s use a woman who weighs 130 pounds, with 28 percent body fat.
This would give her a lean factor of 3. This lean factor is then used in the
Daily Caloric Requirement Guide that follows. For the below example,
you need to use the lean factor multiplier also listed in the above table,
which would be 90 percent (0.9).

Example: Follow these steps when determining your client’s or your own
calorie needs:

For each of the 24 hours in one of your “average” days, determine your
energy expenditure by adding or subtracting your activity’s caloric cost
to (from) your BMR. Let’s use a clinically obese female in our example:

Body weight 130 pounds (58.5 kilograms)

Lean Factor 3 (clinically obese – use 0.9 Lean Factor Multiplier)

Daily BMR 0.9 x 24 x 58.5 = 1263.6 calories

Hourly BMR 1264 calories / 24 = 52.37 calories/ hour

Lean Factor 52.37 calories/hour x .9 = 47.4 rounded to 47 calories per hour

Adjusted
BMR

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408 | Unit 15

Then, using the information in the Energy Expenditure Guide and the
47 calories per hour BMR, you can determine the estimated calories per
hour used. An example of this is illustrated in the Example of Estimating
Daily Caloric Expenditure Using the Hourly Method table.

Example of Estimating Daily Caloric Expenditure

Using the Hourly Method
Hour Activity Percent of BMR Calories Used
Midnight to 1 a.m. - 22% 47 x .78 = 37
1-2 a.m. - 22% 47 x .78 = 37
2-3 a.m. - 22% 47 x .78 = 37
3-4 a.m. Sleeping - 22% 47 x .78 = 37
4-5 a.m. - 22% 47 x .78 = 37
5-6 a.m. - 22% 47 x .78 = 37
6-7 a.m. - 22% 47 x .78 = 37
7-8 a.m. Light Activity 270% 47 x 2.7 = 127
8-9 a.m. 360 % 47 x 3.6 = 169
Moderate Activity
9-10 a.m. 360 % 47 x 3.6 = 169
10–11 a.m. Light Activity 270% 47 x 2.7 = 127
11 am – Noon 360 % 47 x 3.6 = 169
Noon - 1 p.m. 360 % 47 x 3.6 = 169
1-2 p.m. Moderate Activity 360 % 47 x 3.6 = 169
3-4 p.m. 360 % 47 x 3.6 = 169
4-5 p.m. 360 % 47 x 3.6 = 169
5-6 p.m. All-out training 720% 47 x 7.2 = 388
6-7 p.m. Moderate Activity 360 % 47 x 3.6 = 169
7-8 p.m. Light Activity 270% 47 x 2.7 = 127
8-9 p.m. Moderate Activity 360 % 47 x 3.6 = 169
9-10 p.m. 120% 47 x 1.2 = 56
Very Light Activity
10-11 p.m. 120% 47 x 1.2 = 56
11 PM - Midnight Sleeping - 22% 47 x .78 = 37
Daily Total = 2,825 Calories

Another effective way to estimate average daily caloric requirements is to

use the Daily Calorie Requirements Guide provided below. This method
is not as exact as the hour-by-hour approach is, but it is quick and
relatively accurate. To use the Daily Calorie Requirement Guide, choose
a total body weight closest to your own. For example, if you weigh 217
pounds, choose the 220-pound weight class. Each weight class on the
table also has the average BMR of a male and female of that weight
listed in the first column on the left. After finding your weight class, use

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 Calorie Needs and Metabolism | 409

your Lean Factor to select the correct row. Then at that bottom of the
guide, look at the different Average Daily Activity Level descriptions and
choose one that best fits your activity for that day. Note that this uses
different percentages than does the Energy Expenditure Guide used in
the hour-by-hour method.

Energy Expenditure Guide

Women Men Activity
-22% -20% Sleeping
-0.1% 0% Lying down completely relaxed but not sleeping (this is your “basal metabolic rate.”)
180% 200% Very Light: Sitting, studying, talking, little walking or other activities.
270% 300% Light: Typing, teaching, lab/shop work, some walking.
360% 400% Moderate: Walking, jogging, gardening-type job.
450% 500% Heavy: Heavy manual labor such as digging, tree felling, climbing.
540% 600% Exceptionally Heavy: Fitness-oriented weight training, aerobic dance, cycling, or similar vigorous
activities.
630% 700% Sports: Vigorous sports competition such as football, racquetball, tennis, or other extended-play
sports activities.
720% 800% All-Out Training: Extremely high-intensity weight training with little rest between sets or exercises.
810% 900% Extended Maximum Effort: Extremely high-intensity and high-duration sports competition such as
triathlon, cross-country skiing, or marathon.

Daily Calorie Requirement Guide

Refer to notes at end of chart for use. This chart is more generalized than is the previous hour-by-hour method but
serves as a handy, quick reference to determine approximate daily caloric needs.
Average Daily Activity Level
Total
Lean
Weight 130% 155% 165% 200% 230%
Factor
& BMR
M F M F M F M F M F
1 1418 1277 1691 1522 1800 1620 2182 1964 2509 2259
100 lbs 2 1347 1213 1606 1446 1710 1539 2073 1866 2384 2146
M = 1091
F = 982 3 1276 1149 1521 1370 1620 1458 1964 1768 2258 2033
4 1205 1085 1437 1294 1530 1377 1858 1669 2133 1920
1 1560 1404 1860 1674 1980 1782 2400 2160 2760 2484
110 lbs 2 1482 1334 1767 1590 1881 1693 2280 2052 2622 2360
M = 1200
F = 1080 3 1404 1264 1674 1501 1782 1604 2160 1944 2484 2236
4 1326 1193 1581 1423 1683 1515 2040 1836 2346 2111
1 1701 1531 2029 1826 2160 1944 2618 2356 3010 2709
120 lbs 2 1616 1454 1928 1735 2052 1847 2487 2238 2860 2574
M = 1309
F = 1178 3 1531 1378 1826 1643 1944 1750 2356 2120 2709 2438
4 1446 1301 1725 1552 1836 1652 2225 2003 2559 2303
1 1843 1659 2198 1978 2340 2105 2836 2552 3261 2935
130 lbs 2 1751 1576 2088 1879 2223 2000 2694 2424 3098 2788
M = 1418
F = 1276 3 1659 1493 1978 1780 2106 1895 2552 2297 2935 2641
4 1567 1410 1868 1681 1989 1789 2411 2169 2772 2495
410 | Unit 15

Average Daily Activity Level

Total
Lean
Weight 130% 155% 165% 200% 230%
Factor
& BMR
M F M F M F M F M F
1 1985 1788 2367 2131 2520 2269 3054 2750 3512 3163
140 lbs 2 1886 1699 2249 2024 2394 2156 2901 2613 3336 3005
M = 1527
F = 1375 3 1787 1608 2130 1917 2268 2041 2749 2474 3161 2847
4 1687 1520 2012 1811 2142 1929 2596 2338 2985 2689
1 2127 1915 2536 2283 2699 2430 3272 2946 3763 3388
150 lbs 2 2021 1819 2409 2169 2564 2309 3108 2799 3575 3219
M = 1636
F = 1473 3 1914 1724 2282 2055 2429 2187 2945 2651 3387 3049
4 1808 1628 2156 1941 2294 2066 2781 2504 3199 2880
1 2269 2042 2705 2435 2879 2592 3490 3142 4014 3613
160 lbs 2 2156 1940 2570 2313 2735 2462 3316 2985 3813 3432
M = 1745
F = 1571 3 2042 1838 2435 2191 2591 2332 3141 2827 3613 3251
4 1929 1736 2299 2070 2447 2203 2967 2671 3412 3071
1 2412 2170 2875 2587 3061 2754 3710 3338 4267 3839
170 lbs 2 2291 2062 2731 2458 2908 2616 3525 3171 4054 3647
M = 1855
F = 1669 3 2171 1953 2588 2329 2655 2479 3339 3005 3840 3456
4 2050 1845 2444 2199 2602 2341 3154 2837 3627 3263
1 2553 2297 3044 2739 3241 2916 3928 3534 4517 4064
180 lbs 2 2425 2182 2892 2602 3079 2770 3732 3357 4291 3861
M = 1964
F = 1767 3 2298 2068 2740 2466 2917 2625 3535 3182 4065 3659
4 2170 1952 2587 2328 2755 2479 3339 3004 3839 3454
1 2694 2425 3213 2891 3420 3077 4146 3730 4768 4290
190 lbs 2 2559 2304 3052 2746 3249 2923 3939 3544 4530 4076
M = 2073
F = 1865 3 2424 2183 2892 2603 3078 2770 3731 3358 4291 3862
4 2290 2061 2731 2457 2907 2615 3524 3171 4053 3647
1 2837 2553 3382 3044 3600 3241 4364 3928 5019 4517
200 lbs 2 2695 2425 3213 2892 3420 3079 4146 3732 4768 4291
M = 2182
F = 1964 3 2553 2298 3044 2739 3240 2916 3928 3535 4517 4065
4 2411 2170 2875 2587 3060 2755 3709 3339 4266 3839
1 2978 2681 3551 3196 3780 3402 4582 4124 5269 4743
210 lbs 2 2829 2547 3373 3036 3591 3232 4353 3918 5006 4506
M = 2291
F = 2062 3 2680 2412 3196 2876 3402 3062 4124 3711 4742 4269
4 2531 2279 3018 2717 3213 2892 3895 3505 4479 4032

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 Calorie Needs and Metabolism | 411

Average Daily Activity Level

Total
Lean
Weight 130% 155% 165% 200% 230%
Factor
& BMR
M F M F M F M F M F
1 3120 2808 3720 3348 3960 3564 4800 4320 5520 4968
220 lbs 2 2964 2668 3534 2668 3762 2668 4560 4104 5244 4720
M = 2400
F = 2160 3 2808 2527 3348 3023 3564 3207 4320 3888 4968 4471
4 2652 2387 3162 2846 3366 3029 4080 3672 4692 4223
1 3262 2935 3889 3500 4140 3726 5018 4516 5771 5193
230 lbs 2 3099 2788 3695 3325 3933 3540 4767 4290 5482 4933
M = 2509
F = 2258 3 2936 2642 3500 3150 3726 3353 4516 4065 5193 4674
4 2603 2495 3306 2975 3519 3167 4265 3839 4905 4414
1 3403 3063 4058 3652 4320 3887 5236 4712 6021 5419
240 lbs 2 3232 2910 3855 3469 4104 3693 4974 4476 5720 5148
M = 2618
F = 2356 3 3063 2756 3652 3287 3888 3499 4712 4241 5419 4877
4 2893 2604 3449 3104 3672 3304 4451 4005 5118 4606
1 3545 3192 4227 3805 4500 4051 5454 4910 6272 5647
250 lbs 2 3368 3032 4016 3615 4275 4285 5181 4665 5958 5365
M = 2727
F = 2455 3 3191 2971 3804 3424 4050 3645 4090 4418 5645 5080
4 3013 2713 3593 3234 3825 3443 4636 4174 5331 4800
1 3687 3319 4396 3957 4679 4212 5672 5106 6523 5872
260 lbs 2 3503 3153 4176 3759 4445 4001 5388 4851 6197 5578
M = 2836
F = 2553 3 3318 2986 3956 3561 4211 3790 5105 4594 5871 5284
4 3134 2821 3737 3363 3977 3580 4821 4340 5545 4991
1 3829 3446 4565 4109 4859 4374 5890 5302 6774 6097
270 lbs 2 3638 3274 4337 3904 4616 4155 5596 5037 6435 5792
M = 2945
F = 2651 3 3446 3101 4109 3698 4373 3936 5301 4771 6097 5487
4 3255 2929 3880 3493 4130 3718 5007 4507 5758 5182

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Metabolic Equivalent in that the health benefits of 1,000 MET-minutes

per week are greater than are those of 500 MET-
Metabolic equivalent (MET) is a term used minutes per week. MET terminology can also be
related to energy. For example, 1 MET is defined encountered relating to athletes.
as the energy to lie/sit quietly. It is equivalent to
a metabolic rate of consuming 3.5 mL O2/kg/
minute, the rate of energy expenditure at rest.
Overview of Metabolism
Looking at it another way, 1 MET can also mean The unit on digestion discussed how the body
1 kcal/kg/hour. Therefore, under conditions of procures nutrients for growth, maintenance,
physical activity, the MET values will increase, as energy, repair, and life sustenance. For these
1 is a resting value, reflecting no activity. functions to be accomplished, an astounding
number of chemical reactions constantly
Furthermore, an MET is the ratio of the rate of
occur. Each reaction must be carefully
energy expended during an activity to the rate of
controlled to prevent overproduction or
energy expended at rest. For example, 1 MET is
underproduction of the desired end product of
the rate of energy expenditure while at rest. A 4
that particular metabolic phase. This section
MET activity expends four times the energy used
addresses how the body processes these
by the body at rest.
nutrients to perform these tasks and provides
MET-Minutes, is another aspect referred to that the crucial points of energy metabolism.
is related to the MET approach. For example, if
As pointed out in previous units, the body
a person does a 4 MET activity for 30 minutes,
consists of trillions of cells, which are organized
then 4 × 30 = 120 MET-minutes, or 2.0 MET-
into tissues, organs, and systems. All the body’s
hours of physical activity. A person could also
components work together in a highly organized
achieve 120 MET-minutes by doing an 8 MET
manner to maintain a balance. Distinct
activity for 15 minutes. Numerous health benefits
physiological control mechanisms are self-
have been related to exercise type and duration.
adjusting. These controls are constantly turning
Various government guidelines now include on and off and adjusting their rate of reaction to
some exercise recommendations in terms of keep the body in a state of relative equilibrium.
METS. For example, the USA Physical Activity Hormone production, body temperature, and
Guidelines report mentions that a dose-response heartbeat are all part of this tightly controlled
relationship exists between physical activity and human system.
health benefits. A range of 500 to 1,000 MET-
minutes of physical activity per week provides
Homeostasis
substantial benefit, and amounts of activity above
this range have even more benefit. Amounts of In the early twentieth century, the American
activity below this range also have some benefit. physiologist Walter Bradford Cannon became
The dose-response relationship continues even credited for coining the term homeostasis to
within the range of 500 to 1,000 MET-minutes, refer to the processes that maintain a constant

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 Calorie Needs and Metabolism | 413

internal body environment. A good example of training regimens. If you spend most of your
homeostasis is the method by which the body time lifting heavy weights, your muscles will
maintains a constant temperature of 98.6 degrees grow larger. A shift in your homeostasis has
Fahrenheit. If physical exertion or external heat occurred. The simple action of weightlifting
causes the body temperature to rise, the brain causes more protein synthesis in the muscles
sends a signal to increase the rate of sweating. being exercised with weights. Hormone levels
Heat is carried away in the evaporating sweat. change to accommodate this growth. Muscle
If body temperature begins to drop due to a fibers increase in size and can store more
cold external environment, shivering begins to adenosine triphosphate (ATP) and creatine
generate heat to keep the body temperature at phosphate (CP), the two energy-supplying
that critical 98.6 degrees F. molecules used up during explosive power
exercise. However, if you choose to run several
Homeostatic Feedback miles per day, your muscles will take a different
form, develop a higher endurance capacity,
Control Systems
stimulate the formation of more fat-burning
For homeostasis to work, there must be feedback slow-twitch muscle fibers, and develop a higher
systems that various physiological functions capacity to use oxygen in energy production.
turn off and on. In the two cases just mentioned,
imagine if the body kept on sweating or Nutrient intake is an important factor that can
shivering, which would happen if there were no affect your homeostatic balance. Eating too
on/off mechanisms. Other metabolic functions much of the wrong foods, or too little of the right
under homeostatic control include: foods, can cause homeostasis to shift. Too much
fat and calories, and your body becomes fat. Not
• Hormone production and concentration level enough protein, and your muscles break down.
maintenance;
Not enough carbohydrates, and you will feel
• Maintenance of serum oxygen levels and tired sooner. To achieve optimum homeostasis
carbon dioxide levels; and metabolism, eating the right nutrients in the
• pH balance in the blood and cells; right amounts at the right times is vital.

• Water content of cells and blood;

Metabolism
• Blood glucose levels and other nutrient levels
in the cell; and The many biochemical processes that compose
• Metabolic rate. the body’s metabolism are categorized into
two general phases: anabolism and catabolism.
The concept of homeostasis is of special From the start, it must be understood that
interest to the athlete. Indeed, you are in anabolism and catabolism occur simultaneously
equilibrium with the environmental stimuli and continuously. However, the two differ in
imposed on you. Think for example, how magnitude depending on the level of activity or
your muscles change in response to different rest and on when the last meal was eaten.

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414 | Unit 15

To build biomolecules and sustain life, the body needs energy. The body
gains its energy from the breakdown of nutrients like glucose and fatty
acids. Thus, to construct molecules, there must be molecular destruction
occurring simultaneously to provide the energy required to drive these
biochemical reactions. When anabolism exceeds catabolism, net growth
occurs. When catabolism exceeds anabolism, the body experiences a net
loss of substances and body tissues and may lose weight.

Anabolism includes the chemical reactions that combine different

biomolecules to create larger, more complex ones. The net result of
anabolism is that new cellular material is produced, such as enzymes,
proteins, cell membranes, new cells, and growth of the many tissues. That
energy is stored in the form of glycogen and/or fat and in muscle tissue.
Anabolism is necessary for growth, maintenance, and repair of tissues.

Catabolism: the chemical Catabolism is the term used to describe the chemical reactions
reactions that break down that break down complex biomolecules into simpler ones for energy
complex biomolecules into
simpler ones for energy production. A recent trend in sports nutrition has emerged focusing on
production. “anti-catabolic” training and nutrient intake. For example, when the
muscles are strenuously training and the muscle fibers are damaged,
cortisol is released at higher levels, which will speed up the breakdown
of body tissues. There is some indication that nutrients like the amino
acid L-glutamine reduces the effects of cortisol, which results in less
Anti-catabolic: describing tissue breakdown—anti-catabolic action. Antioxidants, and a host of
a substance that prevents phytochemicals, along with good nutrient intake can also have an anti-
catabolism.
catabolic effect. Through the reduction of the rate of catabolic actions
and substances, the net amount of anabolism is increased, resulting in
faster recovery, higher levels of performance, and increased growth rates.

Metabolism includes only the chemical changes that occur within

tissue cells in the body. It does not include those changes to substances
that take place in the digestion of foods in the gastrointestinal system.
A healthy metabolism needs many nutrients to function optimally. A
slight deficiency of even one vitamin can slow down metabolism and
cause chaos throughout the body. The body builds thousands of enzymes
to drive your metabolism in the direction influenced by activity and
nutrition. Thus, when you are training several hours a day, you must
Metabolic pathway:
a sequence of metabolic
make sure that your diet contains the nutrients it needs to feed the many
reactions. metabolic pathways.

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 Calorie Needs and Metabolism | 415

Metabolic Set Point metabolic rate. The processing of the excess

protein seems to require more energy. Fat
From the discussion of homeostasis and reduction diets should be low in fat and higher
metabolism above, you can see that the body in protein. Some studies have shown that certain
is a tightly run collection of many biochemical substances like caffeine also increase your
reactions. During the intensive study of weight metabolic rate. Other plant compounds, like
loss, it was discovered that the body seeks to ephedrine, found in the herb Ma Huang, have
maintain a certain base rate of metabolism, a thermogenic effect similar to that of caffeine.
which has come to be called the metabolic set There are many supplements that contain
point (which results in the basal metabolic guarana to supply caffeine and Ma Huang to
rate). This set point is controlled by genetics supply ephedrine. They are sold as metabolic
and the environmental factors. Researchers boosters, also referred to as thermogenic aids.
have demonstrated that you can change your Thermogenesis occurs when the body produces
metabolic set point through dietary means and more heat in response to ingestion of certain
physical activity. food compounds or exercise. In other words,
The metabolic set point is the average rate at thermogenesis increases your metabolic rate
which your metabolism runs and will result in a above normal. Although increased caffeine
body composition set point. People with a slow intake is not generally recommended, studies
metabolism seem to store fat easily, whereas have demonstrated a significant loss of fat can be
people with a fast metabolism seem to be able to influenced by caffeine intake.
eat and never get fat. Your metabolic set point One question commonly asked is which nutrients
can be influenced by the external environment does your body generate energy from – lipids
(climate), nutrition, exercise, and other factors. or carbohydrates? Like most topics discussed
Studies have demonstrated that when individuals
herein, it is not an easily answered question
go on low-calorie diets, the body’s metabolic
because of the many variations from person
set point becomes lower to conserve energy.
to person and the limitations on performing
It actually resets itself to burn fewer calories,
good controlled studies on people. However, a
thereby conserving energy. Exercise tends to
method of determining the “fuel mix” being
keep the metabolic rate up, and more aerobic
used has been developed, called the Respiratory
exercise tends to cause the body to burn more
Quotient (RQ), which gives us a way to measure
fat for energy.
the relative amounts of fats, carbohydrates, and
proteins being burned for energy.
Food and Metabolism
The respiratory quotient is a measure of the
The type of food eaten can also influence ratio of the volume of carbon dioxide expired to
metabolism. Diets low in fat and high in protein the volume of oxygen consumed. Because the
and carbohydrates can increase the basal amount of oxygen used up for the combustion of

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fat, carbohydrate, and protein will be different, differences in the RQ will

indicate which nutrient source is being predominantly used for energy
purposes. The formula for calculating RQ is

RQ = Volume of CO2 expired/ volume of O2 utilized.

Eq. 15.2

The RQ for carbohydrates is 1.0, whereas the RQ for fat is 0.7. Fat has a
lower RQ value because fatty acids require more oxygen for oxidation
than the amount of carbon dioxide produced. The RQ for energy
production from protein is about 0.8. The average person at rest will
have an RQ of about 0.8; however, this is from using a mixture of fatty
acids and carbohydrates for energy production, not from protein as the
number might indicate. Remember, protein/amino acids are not usually
used for energy. In a normal diet, containing carbohydrate, fat, and
protein, about 40 to 45 percent of the energy is derived from fatty acids,
40 to 45 percent from carbohydrates, and 10 to 15 percent from protein.
However, this rate of energy production will vary depending on the diet,
physical activity, and level of physical training.

Research indicates that when the diet is high in carbohydrates, the

RQ is higher, and therefore more energy is being produced from
carbohydrates. When the diet is low in carbohydrates and higher in fat,
then more energy is produced from fat. Additionally, training intensity
will affect the energy source during exercise. Exercise rate below 60
• •
VO2 max: the maximum percent of maximum oxygen uptake (VO2 max) results in RQ of about
rate at which oxygen can be 0.8, which indicates an equal portion of energy derived from fatty acids
consumed. •
and carbohydrates. As training intensity increases above 60% VO2 max,
more carbohydrate is used for energy. Exercise intensity at 100% VO
max (which can only be sustained for minutes) yields an RQ of 1. You
must also keep in mind that amino acids, in particular the BCAAs, are
also being used for energy during exercise and at rest—perhaps as much
as 10 percent or more during exercise.

In general, physical conditioning lowers the RQ, which means more

energy is being obtained from fatty acids in the trained individual.
However, more energy is also being obtained from protein in the trained
individual. Carbohydrate is always being used for energy and the fuel
mixture varies depending on the composition of the diet and type of
training (anaerobic or aerobic, or a combination thereof). For example,
when the RQ of untrained individuals versus trained individuals during

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 Calorie Needs and Metabolism | 417

exercise was compared, the RQ of the untrained With portable metabolic testing technology,
individuals was 0.95, and the RQ of the trained fitness trainers and other health professionals
individuals was 0.9. This means that although can collect and analyze these important
both groups were using mostly carbohydrate metabolic measurements to gain insights
for fuel during exercise, the trained individuals into a client’s metabolic functioning related
were using a higher amount of fatty acids for to energy expenditure, anaerobic threshold,
energy. At rest, fatty acids are the predominant aerobic threshold, metabolic rate, rate of
•
energy source in most people; as exercise begins, recovery, RQ, and VO2 max. With a program of
carbohydrate use increases. High-intensity retesting, tracking changes of these metabolic
exercise uses more carbohydrate, whereas low- measurements in response to athletic training
to moderate-intensity exercise uses fatty acid and nutrition programs will provide useful
and carbohydrate for energy. Although this information about what is working to produce
discussion of RQ is very brief, you can see that progressive improvements and to detect when
the energy substrate utilization of the body is progress may be slower than expected. Applied
quite varied, and both composition of the diet exercise physiology!
and intensity of physical activity will determine
which energy substrates are used. Therefore, it is The Environment
easy to see why different sports require different
dietary considerations. and Metabolism
The outside environment will also influence
metabolic rate. When you are exposed to a
Metabolic Testing
progressively colder climate, your body will
Device Example increase its metabolic rate to keep the body
Metabolic exercise testing is traditionally temperature constant and to prevent shivering.
conducted in a research laboratory or specialized Shivering is invoked when the core temperature
testing facility, using expensive equipment. of the body begins to drop from being in the
However, now with the development of portable cold. Shivering is a series of involuntary muscle
metabolic testing units, certain metabolic contractions triggered to create heat in the body,
testing is now practical in the gym or in private like turning on a furnace. When exposed to
fitness trainer studios. The CardioCoach is higher-than-average cold conditions for a few
an example of a metabolic testing unit for days, the body increases its basal metabolic rate to
•
VO2 max testing but also provides additional run hotter than average to compensate for being
test data related to resting metabolic rate, in a colder climate. When things begin to warm
exercising metabolic rate, O2, and CO2 and up, even a 60-degree F day can seem extremely
therefore provides actual individual data about hot because your metabolic rate is still running
energy expenditure and RQ. The CardioCoach at a fast rate. After several days of acclimation to
has also been subjected to independent the hot climate, your metabolic rate will decrease,
research testing to validate accuracy; citations and 80 degrees F will feel as hot as the 60 degrees
can be found in the reference section. F day did a few months earlier.

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Exercise and Aerobic System Changes

Metabolic Responses Aerobic training greatly increases the body’s
functional capacity to transport and use oxygen
Exercise will stimulate a series of metabolic
and to burn fatty acids during exercise. Some of
responses that affect the body’s anatomy,
the major changes measured as a result of aerobic
physiology, and biochemical makeup.
exercise include:
Here are some of the changes stimulated
by endurance exercise: • Increased mitochondria density in slow
twitch muscle fiber, which results in higher
• Increased muscle glycogen storage capacity energy production from fatty acids. Maximum
• Increased muscle mitochondria density oxidative capacity develops in all fiber types;
• Higher aerobic capacity;
• Increased resting ATP content in muscles
• Increase in trained muscle capacity to utilize
• Increased aerobic enzymes and mobilize fat, resulting from higher
• Increased slow twitch muscle fiber percent amounts of fat metabolizing enzymes, and
increased blood flow;
• Decreased fast twitch muscle fiber percent
• Greater development of slow-twitch muscle
• Decreased muscle size, when compared to fibers; and
strength training
• Increased myoglobin, which is an iron-protein
• Increased cardiac output compound in muscle that acts to store and
transport oxygen in the muscles
• Decreased resting heart rate

• Decreased body fat

Anaerobic System Changes
• Increased Krebs cycle enzymes
Anaerobic training greatly increases the body’s
• Increased capillaries functional capacity for development of explosive
The magnitude of these changes is driven strength and maximization of short-term energy
primarily by the type of exercise undertaken: systems. Some of the major changes measured as
anaerobic or aerobic. The type and duration a result of anaerobic exercise include
of exercise will physically stimulate muscles to • Increased size and number of fast-twitch
develop more fast- or slow-twitch muscle fibers muscle fibers;
and in turn dictate the primary energy mix used. • Increased tolerance to higher levels of blood
High-intensity exercise simulates fast-twitch lactate;
muscle fiber development, whereas low-intensity • Increases in enzymes involved in the anaerobic
exercise results in slow-twitch muscle fiber phase of glucose breakdown (glycolysis);
development. A series of hormonal changes also • Increased muscle resting levels of ATP, CP,
occur on an overall basis during exercise and creatine, and glycogen content; and
during non-exercising periods. These changes • Increased growth hormone and testosterone
also are benefited and facilitated by a nutrient levels after short bouts (45 to 75 minutes) of
profile that matches the type of metabolic flux. high-intensity weight training.

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 Calorie Needs and Metabolism | 419

Energy Metabolism energy. ATP and CP are replenished from energy

derived from complete breakdown of glucose,
Energy metabolism is a series of chemical fatty acids, and some proteins.
reactions that result in the breakdown of
foodstuffs (carbohydrate, fat, protein) by which ATP is the molecule that stores energy in a form
energy is produced, used, and given off as heat. that can be used for muscle contractions. Energy
Roughly, the body is about 20 percent efficient production then revolves around rebuilding ATP
at trapping energy released. About 80 percent is molecules after they are broken down for energy
released as heat, which explains why your body utilization. The human metabolism can make
heats up quickly when you exercise. A closer look ATP in several ways, which correlate to the three
at your muscle anatomy reveals that the mode of main categories of energy use.
energy storage and energy systems used is related
to your physical activity. To better understand how each of these energy
systems relate to each other, let’s take a look at
Physical activities can be classified into what happens when muscles contract. First, the
four basic groups, based on the energy immediate energy systems. The brain sends a
systems that are used to support these signal along the nerves, which triggers a release
activities. They are as follows: of calcium ions in the muscles, which stimulates
• Strength-Power. Energy from immediate ATP the muscles to contract, and in the process,
stores. Shot put, power lift, high jump, golf the high-energy molecule ATP (adenosine
swing, tennis serve, and throwing. About 0–3 triphosphate) releases energy and is reduced
seconds of all-out effort; to adenosine diphosphate plus one phosphate
• Sustained-Power. Energy from immediate atom. In this way, the immediately available ATP
ATP and CP stores. Sprints, fast breaks, stores are depleted extremely rapidly, the first few
football line man. About 0–10 seconds of near seconds of a maximum muscle contraction.
maximum effort;
The second immediate source of cellular energy
• Anaerobic Power-Endurance. ATP, CP, and
is creatine phosphate (CP). There are several more
Lactic Acid. A 200–400 meter dash, 100-yard
swim. About one to two minutes; and times CP molecules in the cell than ATP. Creatine
phosphate serves to instantaneously regenerate
• Aerobic-Endurance. Aerobic oxidative
ATP molecules. Therefore, the ATP that is
energy. Over two-minute events.
broken down to ADP during muscle contraction
In power events, which last a few seconds or is restored to the high energy ATP by CP. The
less, the muscles depend on the immediate third immediate energy system enables the cell
energy system, namely ATP and CP reserves. In to regenerate ATP from two ADP molecules,
speed events, the immediate and non-oxidative resulting in one ATP and one AMP (adenosine
(glycolytic) energy sources are used. In endurance monophosphate) molecule. This immediate
events, the immediate and non-oxidative energy energy source is depleted in a matter of seconds
sources are used, and the oxidative energy under conditions of all-out effort, under
mechanisms become a more important source of conditions of maximum muscle contractions.

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Some Useful Metabolism-Related Terms

ATP – Adenosine Triphosphate. Primary energy storehouse molecule used in the human body. It is
used in many biosynthetic processes which require energy and is essential for muscle contraction.

CP – Creatine Phosphate (also, phosphocreatine). Found in muscle tissue, where it is an energy

source for muscle contraction. CP stores are used as a means to immediately replenish ATP, and fuel
high intensity muscle contractions. (Together this immediate source of energy from resting levels of ATP
and CP is referred to the phosphagen system.)

Glycolysis – The metabolic process that creates energy via splitting a molecule of glucose to form
either pyruvic acid or lactic acid and produce some ATP molecules.

Krebs Cycle – This is part of the oxidative portion of energy production where carbon chains from
the breakdown of glucose, fatty acids, and protein are used for more ATP production. This takes
place in the mitochondria.

Glycogenolysis – The cellular breakdown of stored glycogen for energy use.

It is interesting to note that the storage capacity of ATP and CP in a cell

is quickly reached for a particular muscle size. To increase the amount of
ATP and CP on hand, the muscle fibers must increase in size. This is why
power athletes get big muscles. The workload demands that more ATP
and CP are on hand. To meet this demand, the muscle fibers increase
in size, causing the entire muscle to get big. When you train, different
energy systems are conditioned to work best at the particular workload
imposed on the muscles.

As the immediate energy supply is quickly depleted through high

intensity physical activity, the non-oxidative energy source kicks in.
The non-oxidative system is a major contributor of energy during 4 to
50 seconds of effort. Non-oxidative metabolism (glycolysis) involves
the breakdown of glucose to regenerate ADP into ATP. Muscle tissue
is densely packed with non-oxidative enzyme systems. Chemically,
what happens is that the glucose molecule is split in half, and energy
is released. This energy is enough to regenerate 2 ATP molecules and
leave two pyruvate molecules. In general, these pyruvate molecules
are immediately converted to lactic acid molecules. The amount of
free glucose is generally low in the cells, so glucose is derived from the
breakdown of glycogen.

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 Calorie Needs and Metabolism | 421

Fast-twitch muscle fibers, those associated with strength and size,

are also referred to as fast glycolytic muscle fibers because they house
the metabolic machinery to get quick energy through fast glycolysis
pathways. The fast twitch fibers have a low capacity for oxidative
metabolism and are instead set up to run glucose through their fast
glycolysis pathways. Lactic acid then builds up because it is being
produced too rapidly to enter into the oxidative pathways. Lactic acid
is then cleared from the muscle, fed into the blood stream, taken to the
liver, and there made into glucose and glycogen. Glycolysis takes place in
the cytoplasm of the cell.

For physical activities lasting more than 2 minutes in duration, the

oxidative metabolic pathways produce the majority of energy to
maintain muscle contractions. Potential oxidative energy sources include
glucose, glycogen, fats, and amino acids. Oxidative energy production
takes place in the mitochondria of the cells. Far more energy is produced
when glucose is completely broken down in the mitochondria. Glucose
is still first split in half by glycolysis. The pyruvate molecules then enter
into the mitochondria where they are completely broken down. The
oxidative pathways are called the Krebs cycle and electron transport. Oxidative pathways: the
Fatty acids, from fat, are a major energy source during endurance systems that supply energy
for low-intensity, high-
events. The processes of fat utilization are activated more slowly than duration activities lasting
carbohydrate metabolism and proceed at a lower rate. Fatty acids are more than approximately
three or four minutes, such
activated and combined with the molecule carnitine, which enables them as marathon running and
to be transported into the mitochondria. aerobic dance. They include
oxidative glycolysis and beta
oxidation.
Glycogen Depletion
and Metabolism of Fatigue
Glycogen is essential to performance for both anaerobic and aerobic
activities. Muscles being strenuously exercised will rely on glycogen
to power these strength generating muscle contractions. In endurance
exercise, while the primary fuel is fatty acids, glycogen is also utilized.
In fact, fat catabolism is believed to work better when carbohydrates
are being metabolized. Research on long-term exercise and work
performance all indicate the onset of fatigue when glycogen is depleted. Glycogen
replenishment: the
This again underscores the importance of adequate carbohydrate intake refilling of the body’s
and glycogen replenishment. glycogen stores.

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Glycogen depletion: Glycogen depletion is just one factor that contributes to the onset of
the draining of the body’s
glycogen stores.
exercise fatigue, including neuromuscular fatigue. This occurs when a
decrease in muscle contraction and force output occurs. The following
lists other factors that an athlete experiences related to fatigue.
• ATP and CP depletion, faster than rate of formation

• Metabolic acidosis, decrease in pH, associated with an increase in acid

forming hydrogen ion concentration (H+)

• Alterations in central nervous system neurotransmitters, such as

dopamine and serotonin

• Neural activity decrease

• Ionic imbalances, such as with calcium, potassium, and sodium

• Oxygen depletion, reduction of aerobic energy production

Body Composition, Metabolic Rate Summary Chart

Useful reference information that can be used for nutrition planning and other purposes relying on using these
measurements.
Body Weight: Lean Factor: LF Multiplier: Males Females

S8 (Thigh): S2 (Triceps):

% Body Fat Body Fat Mass Protein Requirement S9 (Abdomen): S4 (Suprailiac):

from page Chapter 4
S10 (Chest): S8 (Thigh):

% Lean Body Weight Lean Body Weight

S1 (subscapula):

BMR
130% 155% 165% 200% 230%

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 Calorie Needs and Metabolism | 423

CONCLUSION
We need energy to maintain the many metabolic processes occurring in
the human body. Under conditions of athletic training, energy demands
increase. As muscle fibers develop in response to the training stimuli,
the body’s energy utilization can change. This creates dynamic nutrition
intake demands that a sports nutrition program must be customized to
satisfy, supplying the athlete’s nourishment requirements from food and
dietary supplements.

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Keywords
•
Catabolism VO2 max

Anti-catabolic Glycogen replenishment

Metabolic pathway Glycogen depletion

Oxidative energy systems

Sports Nutrition
 Topics Covered In This Unit

Introduction

Why dietary guidelines?

Dietary Guidelines (DGs)

 ey recommendations: Components of
K
healthy eating patterns

DASH Diet

 ealth benefits of the DASH eating

H
plan – study results

Following the DASH eating plan

Conclusion

UNIT 16

DIETARY GUIDELINES FOR AMERICANS

426 | Unit 16

Unit Outline
I. Introduction
II. Why dietary guidelines?
III. Dietary Guidelines (DGs)
a. Key recommendations: Components of healthy eating patterns
IV. DASH Diet
a. Health benefits of the DASH eating plan – study results
i. DASH trial
ii. DASH-sodium trial
iii. Premier trial

b. Following the DASH eating plan

V. Conclusion

Learning Objectives
After completing this unit, you will be able to:
• Define and describe terms related to the Dietary Guidelines for Americans;

• Discuss the core elements of healthy eating;

• Determine the dietary shifts needed to align with health-eating patterns;

• Identify points to consider for sports nutrition applications; and

• Be aware of the DASH diet and health benefits.

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 Dietary Guidelines for Americans | 427

Introduction Why Dietary Guidelines?

Although the dietary guidelines are not The main purpose of the Dietary Guidelines
specifically designed for sports nutrition is to inform the development of federal food,
purposes, they are useful to know about to nutrition, and health policies and programs.
integrate healthy nutrition practices into a sports The primary audiences are policy makers and
nutrition program and are useful to keep athletes nutrition and health professionals, not the
eating healthy in the off-season and to develop general public.
health nutrition practices that will benefit health
The Dietary Guidelines is a critical tool for
throughout life.
professionals to help Americans make healthy
Note that a copy of the 2015–2020 Dietary choices in their daily lives to help prevent
Guidelines is contained in the Appendix for chronic disease and enjoy a healthy diet.
handy reference use and to gain familiarity. This It serves as the evidence-based foundation
unit will review a summary level of the Dietary for nutrition education materials that are
Guidelines, and you are directed to review the developed by the federal government for the
entire Dietary Guidelines in the Appendix as public. For example, federal dietary guidance
part of this unit’s study. publications are required by law to be consistent
with the Dietary Guidelines. The guidelines
The following information in this unit
are also used to inform USDA and HHS food
will provide overview information
programs, such as USDA’s national School
of the Dietary Guidelines, including
Lunch Program and School Breakfast Program,
sports nutrition considerations.

The first half of the 122-page Dietary Guidelines

contains chapters related to various nutrition topics.
The second half of the Dietary Guidelines
contains the Dietary Guidelines Appendix with
many useful tables covering foods, nutrient
sources, and calorie intake charts.
In addition to nutrition, the Dietary Guidelines also
contain information about physical activity guidelines
for Americans. A glossary is included as well.

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which feed more than 30 million children which share the common goal of serving the
each school day, and the Special Supplemental general public, include businesses, schools,
Nutrition Program for Women, Infants, and community groups, media, the food industry,
Children (WIC), which uses the Dietary and state and local governments.
Guidelines as the scientific underpinning for
The 2015–2020 Dietary Guidelines translate
its food packages and nutrition education
science into succinct, food-based direction that
program with about 8 million beneficiaries.
can be relied upon to help Americans choose
At HHS, the Administration on Aging foods that provide a healthy and enjoyable diet.
implements the Dietary Guidelines through Its recommendations are ultimately intended to
the Older Americans Act Nutrition Services help individuals improve and maintain overall
programs (i.e., nutrition programs for older health and reduce the risk of chronic disease—its
adults), with about 5,000 community-based focus is disease prevention.
nutrition service providers who together serve
The Dietary Guidelines is not intended to
more than 900,000 meals a day across the
be used to treat disease. Regardless of an
United States. Other departments, such as
individual’s current health status, nearly all
the Department of Defense (DOD) and the
people in the United States could benefit from
Department of Veterans Affairs, also use the
shifting choices to better support healthy eating
Dietary Guidelines to inform programs. The
patterns. Thus, the Dietary Guidelines may
Dietary Guidelines also may be used to inform
be used or adapted by medical and nutrition
the development of programs, policies, and
professionals to encourage healthy eating
communication by audiences other than the
patterns for their patients.
document’s principal audiences. These audiences,

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 Dietary Guidelines for Americans | 429

Dietary Guidelines (DGs)

The DGs is organized in a progressive approach, starting with core
concepts, followed by details. The following are considered the five
crucial elements of the DGs. Comments are added with respect to sports
nutrition programs.
1. Follow a healthy eating pattern across the lifespan. All food
and beverage choices matter. Choose a healthy eating pattern at an Eating pattern (also
appropriate calorie level to help achieve and maintain a healthy body called “dietary
weight, support nutrient adequacy, and reduce the risk of chronic pattern”): the
combination of foods and
disease. [Comment: Can be applied to a sports nutrition program.] beverages that constitutes
an individual’s complete
2. Focus on variety, nutrient density, and amount. To meet
dietary intake over time.
nutrient needs within calorie limits, choose a variety of nutrient-dense This may be a description
foods across and within all food groups in recommended amounts. of a customary way of
[Comment: Can be applied to a sports nutrition program.] eating or a description
of a combination of
3. Limit calories from added sugars and saturated fats and reduce foods recommended for
sodium intake. Consume an eating pattern low in added sugars, consumption. Specific
examples include USDA
saturated fats, and sodium. Cut back on foods and beverages higher in
Food Patterns and the
these components to amounts that fit within healthy eating patterns. Dietary Approaches to
[Comment: with respect to saturated fats, sports nutrition programs Stop Hypertension (DASH)
should also keep these in check; with respect to sodium, athletes Eating Plan. (See USDA Food
typically require higher than average sodium intakes to compensate Patterns and DASH Eating
Plan.)
for sodium and other electrolytes lost by sweating and other physical
activity related losses, but should strive to avoid excessive intake beyond Whole fruits: (Pg. 79) all
fresh, frozen, canned, and
what is needed; with respect to added sugars, most energy sports
dried fruit but not fruit juice.
drinks contain added sugars, so minimizing the use of these sugary
sports nutrition products should be considered, and making a shift to
healthier choices when possible, such as fruit and other suitable healthy
carbohydrate choices.]

4. Shift to healthier food and beverage

choices. Choose nutrient-dense foods and
beverages across and within all food groups in
place of less healthy choices. Consider cultural
and personal preferences to make these shifts
easier to accomplish and maintain. [Comment:
can be applied to a sports nutrition program.]

5. Support healthy eating patterns for all. Everyone

has a role in helping create and support healthy eating
patterns in multiple settings nationwide, from home
to school to work to communities. [Comment: can be
applied to a sports nutrition program.]

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The following figure shows how personal, social, Advisory Committee.” It provides a model of
organizational, and environmental contexts interrelated factors related to an individual’s diet
and systems interact powerfully to influence an and physical activity and behaviors for health
individual’s diet and physical activity behaviors promotion and disease prevention across the
and patterns and illustrate how diverse health lifespan. Of interest to fitness trainers and other
outcomes result from this dynamic interplay. health practitioners is a clear role in this model
This was developed and presented in the approach. This model is important to consider
“Scientific Report of the 2015 Dietary Guidelines when working with athletes on- and off-season.

Diet and Physical Activity, Health Promotion and Diease Prevention at Individual and Population
Levels across the Lifespan.

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 Dietary Guidelines for Americans | 431

Key Recommendations: Components of Healthy Eating Patterns

The Dietary Guidelines’ Key Recommendations individuals achieve healthy eating patterns
for healthy eating patterns should be applied within calorie limits:
in their entirety, given the interconnected
• Consume less than 10 percent of calories per
relationship that each dietary component can day from added sugars 3
have with others. As illustrated later in this
• Consume less than 10 percent of calories per
chapter, there is more than one way to put these day from saturated fats 4
recommendations into action; this is exemplified
• Consume less than 2,300 milligrams (mg) per
by the three eating patterns that translate and
day of sodium 5
integrate the key recommendations into an
• If alcohol is consumed, it should be done so
overall healthy way to eat.
in moderation—up to one drink per day for
women and up to two drinks per day for men—
Key Recommendations Include and only by adults of legal drinking age. 6

Consume a healthy eating pattern that Notes: [2] Definitions for each food group and subgroup are
accounts for all foods and beverages within an provided throughout the chapter and are compiled in Appendix
3. USDA Food Patterns: Healthy U.S.-Style Eating Pattern.
appropriate calorie level.
[3] The recommendation to limit intake of calories from added
sugars to less than 10 percent per day is a target based on food
A healthy eating pattern includes: 2 pattern modeling and national data on intakes of calories from
added sugars that demonstrate the public health need to limit
• A variety of vegetables from all of the calories from added sugars to meet food group and nutrient
subgroups—dark green, red, and orange; needs within calorie limits. The limit on calories from added
sugars is not a Tolerable Upper Intake Level (UL) set by the
legumes (beans and peas), starchy, and other
Institute of Medicine (IOM). For most calorie levels, there are
• Fruits, especially whole fruits not enough calories available after meeting food group needs
to consume 10 percent of calories from added sugars and 10
• Grains, at least half of which are whole grains percent of calories from saturated fats and still stay within
calorie limits.
• Fat-free or low-fat dairy, including milk,
[4] The recommendation to limit intake of calories from
yogurt, cheese, and/or fortified soy beverages
saturated fats to less than 10 percent per day is a target based
• A variety of protein foods, including seafood, on evidence that replacing saturated fats with unsaturated fats
is associated with reduced risk of cardiovascular disease. The
lean meats and poultry, eggs, legumes (beans
limit on calories from saturated fats is not a UL set by the IOM.
and peas), and nuts, seeds, and soy products For most calorie levels, not enough calories are available after
meeting food group needs to consume 10 percent of calories
• Oils
from added sugars and 10 percent of calories from saturated fats
and still stay within calorie limits.
A healthy eating pattern limits:
[5] The recommendation to limit intake of sodium to less
than 2,300 mg per day is the UL for individuals ages 14 years
• Saturated fats and trans fats, added sugars,
and older set by the IOM. The recommendations for children
and sodium younger than 14 years of age are the IOM age- and gender-
appropriate ULs (see Appendix 7. Nutritional Goals for Age-
Key recommendations that are quantitative Sex Groups Based on Dietary Reference Intakes and Dietary
Guidelines Recommendations).
are provided for several components of the
[6] It is not recommended that individuals begin
diet that should be limited. These components drinking or drink more for any reason. The amount of
are of particular public health concern in the alcohol and calories in beverages varies and should be
accounted for within the limits of healthy eating patterns.
United States, and the specified limits can help Alcohol should be consumed only by adults of legal
drinking age. There are many circumstances in which
individuals should not drink, such as during pregnancy.
See Appendix 9. Alcohol for additional information.
432 | Unit 16

Some Terms to Eat By

Several terms are used to operationalize the principles and recommendations of the 2015–2020 Di-
etary Guidelines. These terms are essential to understanding the concepts discussed herein:
Eating pattern—The combination of foods and beverages that constitute an individual’s complete
dietary intake over time. Often referred to as a “dietary pattern,” an eating pattern may describe a
customary way of eating or a combination of foods recommended for consumption. Specific examples
include USDA Food Patterns and the Dietary Approaches to Stop Hypertension (DASH) Eating Plan.
Nutrient dense—A characteristic of foods and beverages that provide vitamins, minerals, and other
substances that contribute to adequate nutrient intakes or may have positive health effects, with little
or no solid fats and added sugars, refined starches, and sodium. Ideally, these foods and beverages
also are in forms that retain naturally occurring components, such as dietary fiber. All vegetables,
fruits, whole grains, seafood, eggs, beans and peas, unsalted nuts and seeds, fat-free and low-fat dairy
products, and lean meats and poultry—when prepared with little or no added solid fats, sugars, re-
fined starches, and sodium—are nutrient-dense foods. These foods contribute to meeting food group
recommendations within calorie and sodium limits. The term “nutrient dense” indicates the nutrients
and other beneficial substances in a food have not been “diluted” by the addition of calories from add-
ed solid fats, sugars, or refined starches, or by the solid fats naturally present in the food.
Variety—A diverse assortment of foods and beverages across and within all food groups and sub-
groups selected to fulfill the recommended amounts without exceeding the limits for calories and oth-
er dietary components. For example, in the vegetables food group, selecting a variety of foods could
be accomplished over the course of a week by choosing from all subgroups, including dark green, red,
and orange; legumes (beans and peas), starchy, and other vegetables.

Dash Diet (Dietary Approaches to Stop Hypertension)

DASH is a flexible and balanced eating plan The DASH eating plan requires no special
that helps achieve a heart-healthy eating style foods and instead provides daily and weekly
for life. It has been brought to your attention nutritional goals. This plan recommends:
in this unit for a few reasons. Fitness trainers
• Eating vegetables, fruits, and whole grains
and other health professionals taking this
Sports Nutrition course will find knowing • Including fat-free or low-fat dairy products,
fish, poultry, beans, nuts, and vegetable oils
about clinically proven healthy diets useful.
Although the Dietary Guidelines are based • Limiting foods that are high in saturated fat,
on an array of evidence from many scientific such as fatty meats, full-fat dairy products, and
studies, evolving from update to update every tropical oils such as coconut, palm kernel, and
palm oils
five years, the DASH diet itself has undergone
a variety of clinical research studies, noting • Limiting sugar-sweetened beverages
it is based on the Dietary Guidelines. and sweets

Sports Nutrition
 Dietary Guidelines for Americans | 433

Based on these recommendations, the following table gives examples Food pattern modeling:
(Pg. 79) the process of
of daily and weekly servings that meet DASH eating plan targets for a
developing and adjusting
2,000-calorie-a-day diet. daily intake amounts from
food categories or groups to
meet specific criteria, such
Daily and Weekly DASH Eating Plan Goals as meeting nutrient intake
for a 2,000 Calorie-a-Day Diet goals, limiting nutrients or
other food components,
Food Group Daily Servings or varying proportions or
amounts of specific food
Grains 6–8
categories or groups. This
Meats, poultry, and fish 6 or fewer methodology includes using
current food consumption
Vegetables 4–5 data to determine the
Fruit 4–5 mix and proportions of
foods to include in each
Low-fat or fat-free dairy products 2–3 group, using current
Fats and oils 2–3
food composition data to
select a nutrient-dense
Sodium 2,300 mg* representative for each
food, calculating nutrient
Food Group Weekly Servings profiles for each food group
using these nutrient-dense
Nuts, seeds, dry beans, and peas 4–5
representative foods,
Sweets 5 or fewer and modeling various
combinations of foods and
*1,500 milligrams (mg) sodium lowers blood pressure even further than 2,300 mg
amounts to meet specific
sodium daily.
criteria.
USDA Food Patterns:
a set of eating patterns
Health Benefits of the DASH Eating Plan – that exemplify healthy
eating, which all include
Study Results recommended intakes
for the five food groups
Three NHLBI-funded trials showed the health benefits of the DASH diet, (vegetables, fruits, grains,
such as lowering high blood pressure and LDL (bad) cholesterol in the dairy, and protein foods)
and for subgroups within
blood, and shaped the final DASH eating plan recommendations.
the vegetables, grains,
and protein foods groups.
• DASH (Dietary Approaches to Stop Hypertension Trial): The DASH diet
They also recommend an
lowers blood pressure and LDL (bad) cholesterol compared with a allowance for intake of
typical American diet alone or a typical American diet with more fruits oils. Patterns are provided
and vegetables. at 12 calorie levels from
1,000 to 3,200 calories to
• DASH-Sodium (DASH Diet, Sodium Intake, and Blood Pressure Trial): The meet varied calorie needs.
DASH diet lowers blood pressure better than a typical American diet at The Healthy U.S.-Style
Pattern is the base USDA
three daily sodium levels does. Combining the DASH diet with sodium
Food Pattern. See: Healthy
reduction gives greater health benefits than the DASH diet alone does. U.S.-Style Eating Pattern,
Healthy Mediterranean-Style
• PREMIER clinical trial: People can lose weight and lower their blood
Eating Pattern, and Healthy
pressure by following the DASH eating plan and increasing their Vegetarian Eating Pattern.
physical activity.

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434 | Unit 16

DASH Trial American diet. Blood pressure decreased with

each reduction of sodium. These results showed
This trial included 459 adults, some
that lowering sodium intake and eating the
with and without confirmed high blood
DASH diet is more beneficial for lowering blood
pressure, and compared three diets
pressure than is following the DASH diet alone.
including 3,000 mg daily sodium:
• Typical American diet (higher in sodium,
saturated fats, and calories; lower in fiber,
PREMIER Trial
fruits, and vegetables, and some essential The PREMIER trial included 810 participants
nutrients)
who were placed into three groups to lower blood
• Typical American diet plus more fruits and pressure, lose weight, and improve health. The
vegetables groups included:
• DASH diet • Advice-only group, did not receive counseling
None of the plans were vegetarian or used on behavior changes

specialty foods. After two weeks, participants • Established treatment plan, including
who added fruits and vegetables to a typical counseling for six months
American diet or those on the DASH diet had • Established treatment plan, plus counseling
lower blood pressure than did those who followed and use of the DASH diet
a typical American diet alone. However, the
participants on the DASH diet had the greatest After six months, blood pressure levels declined
effect of lowering their high blood pressure. in all three groups. The two groups that received
counseling and followed a treatment plan
Follow-up reports from the DASH trial showed had more weight loss than the advice-only
that in addition to improving blood pressure, group. However, participants in the established
the DASH diet also lowered LDL cholesterol treatment plan who followed the DASH diet had
levels. High blood pressure and elevated LDL the greatest improvement in their blood pressure.
cholesterol are two major risk factors for
cardiovascular disease.
Following the DASH Eating Plan
DASH—Sodium Trial The DASH eating plan is intended to be easy to
follow using common foods available in grocery
This trial randomly assigned 412 participants
stores. The plan includes daily servings from
to a typical American diet or the DASH diet.
different food groups. The number of servings
While on their assigned diet, participants were
depends on daily calorie (energy) needs. The
followed for a month at a high daily sodium level
following table estimates the number of servings
(3,300 mg) and two lower daily sodium levels
from each food group that a person could have to
(2,300 mg and 1,500 mg). Reducing daily sodium
meet the prescribed goals.
lowered blood pressure for participants on either
diet. However, blood pressures were lower for Note that serving quantities are per day, unless
participants on the DASH diet versus a typical otherwise noted.

Sports Nutrition
 Dietary Guidelines for Americans | 435

DASH Eating Plan—Number of Food Servings by Calorie Level

Food Group 1,600 1,800 2,000 2,600 3,100
Grains ª 6 6 6–8 10–11 12–13
Vegetables 3–4 4–5 4–5 5–6 6
Fruits 4 4–5 4–5 5–6 6
Fat-free or 2–3 2–3 2–3 3 3–4
low-fat dairy products b
Lean meats, poultry, and fish 3–4 or fewer 6 or fewer 6 or fewer 6 or fewer 6–9
Nuts, seeds, and legumes 3–4 per week 4 per week 4–5 per week 1 1
Fats and oils c 2 2–3 2–3 3 4
Sweets and added sugars 3 or less per 5 or less per 5 or less per ≤2 ≤2
week week week
Maximum sodium limit d 2,300 mg/day 2,300 mg/day 2,300 mg/day 2,300 mg/day 2,300 mg/day
a Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

b For lactose intolerance, try either lactase enzyme pills with dairy products or lactose-free or lactose-reduced milk.

c Fat content changes the serving amount for fats and oils. For example, 1 Tbsp regular salad dressing = one serving;
1 Tbsp low-fat dressing = one-half serving; 1 Tbsp fat-free dressing = zero servings.

d The DASH eating plan has a sodium limit of either 2,300 mg or 1,500 mg per day.

DASH Eating Plan—Serving Sizes, Examples, and Significance

Food Group Serving Sizes Examples and Notes Significance of Each
Food Group to the
DASH Eating Plan
Grains ª 1 slice bread Whole wheat bread and rolls, whole Major sources of energy
wheat pasta, English muffin, pita and fiber
1 oz dry cereal b
bread, bagel, cereals, grits, oatmeal,
½ cup cooked rice, pasta, brown rice, unsalted pretzels and
or cereal b popcorn
Vegetables 1 cup raw leafy vegetable Broccoli, carrots, collards, green Rich sources of potassium,
beans, green peas, kale, lima beans, magnesium, and fiber
½ cup cut-up raw or
potatoes, spinach, squash, sweet
cooked vegetable
potatoes, tomatoes
½ cup vegetable juice
Fruits 1 medium fruit Apples, apricots, bananas, dates, Important sources of po-
grapes, oranges, grapefruit, grape- tassium, magnesium, and
¼ cup dried fruit
fruit juice, mangoes, melons, peach- fiber
½ cup fresh, frozen, or es, pineapples, raisins, strawberries,
canned fruit tangerines
½ cup fruit juice
Fat-free or 1 cup milk or yogurt Fat-free milk or buttermilk; fat-free, Major sources of calcium
low-fat dairy prod- 1½ oz cheese low-fat, or reduced-fat cheese; fat- and protein
ucts c free/low-fat regular or frozen yogurt
Lean meats, poul- 1 oz cooked meats, poultry, Select only lean; trim away visible Rich sources of protein and
try, and fish or fish fats; broil, roast, or poach; remove magnesium
skin from poultry
1 egg

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DASH Eating Plan—Serving Sizes, Examples, and Significance, continued

Food Group Serving Sizes Examples and Notes Significance of Each
Food Group to the
DASH Eating Plan
Nuts, seeds, and 1/3 cup or 1½ oz nuts Almonds, filberts, mixed nuts, Rich sources of energy,
legumes peanuts, walnuts, sunflower seeds, magnesium, protein, and
2 Tbsp peanut butter
peanut butter, kidney beans, lentils, fiber
2 Tbsp or ½ oz seeds split peas
½ cup cooked legumes
(dried beans, peas)
Fats and oils d 1 tsp soft margarine Soft margarine, vegetable oil (cano- The DASH study had 27%
la, corn, olive, safflower), low-fat of calories as fat, including
1 tsp vegetable oil
mayonnaise, light salad dressing fat in or added to foods
1 Tbsp mayonnaise
2 Tbsp salad dressing
Sweets and added 1 Tbsp sugar Fruit-flavored gelatin, fruit punch, Sweets should be low in fat
sugars hard candy, jelly, maple syrup, sor-
1 Tbsp jelly or jam
bet and ices, sugar
½ cup sorbet, gelatin
dessert
1 cup lemonade
a
Whole grains are recommended for most grain servings as a good source of fiber and nutrients.
b
Serving sizes vary between ½ cup and 1¼ cups, depending on cereal type. Check the product’s Nutrition Facts label.
c
For lactose intolerance, try either lactase enzyme pills with dairy products or lactose-free or lactose-reduced milk.
d
F at content changes the serving amount for fats and oils. For example, 1 Tbsp regular salad dressing = one serving; 1
Tbsp low-fat dressing = one-half serving; 1 Tbsp fat-free dressing = zero servings.
http://www.nhlbi.nih.gov/health/health-topics/topics/dash/followdash

CONCLUSION
From this overview, it is apparent how It is interesting to note the multiple benefits of
useful the DGs and DASH Diet can be for the DASH Diet include help with losing weight,
a variety of fitness and athletic clients. In improving health, lowering blood pressure,
addition to the credibility of being developed and lowering the bad LDL cholesterol. The
by Health and Human Services and being unit addressing sports nutrition approaches
clinically proven, there is still room for will elaborate on adjusting the DASH Diet and
some knowledgeable fine-tuning to best Dietary Guidelines for athletic performance.
meet a client’s individual requirements.

Keywords
Eating pattern USDA Food Patterns

Food pattern modeling Whole fruits

Sports Nutrition
PART THREE
Fine Tuning Your Performance

Sports Nutrition Approach Concepts

and Examples, p. 439
Fat Loss and Muscle Gain for
Athletes, p. 501
Glycogen Loading
(Super Compensation), p. 523
Special Concerns of Athletic Females, p. 539
Putting It All Together: Athletic Performance
Improvement Approach, p. 555
This page is intentionally blank.
 Topics Covered In This Unit

Introduction
Sports nutrition legal aspects
Intent of examples and guidelines
Sports nutrition is a skill
 hat about the many, many different diet
W
approaches
Limitations of research studies
Sports nutrition plan approaches
 ietary Guidelines (2015–2020) and the
D
Dynamic Nutrition Approach
 aily training session versus athletic event
D
nutrition
ISSA’s 1-2-3 eating rule of thumb
 he dynamic nutrition approach, a bio-
T
energetic model to performance nutrition
 ow does exercise affect muscle fiber
H
development and composition?
 ports nutrition supplements are part of the
S
dynamic nutrition approach
Nutrition conditioning of athletes
 ationale behind the different athlete-type
R
sports nutrition plan examples
 ynamic Nutrition athlete-type eating plan
D
examples
 ercentages versus amounts per pound/
P
kilogram of body weight
Macronutrients – some summary points
Water/hydration
Electrolytes
Carbohydrates
Protein
Fats
Meal timing and training timing
Sports nutrition fine-tuning is ongoing
Food lists
Conclusion

UNIT 17

SPORTS NUTRITION APPROACH

CONCEPTS AND EXAMPLES
440 | Unit 17

Unit Outline
I. Introduction f. Percentages versus amounts per pound/
kilogram of body weight
II. Sports nutrition legal aspects
g. Macronutrients – some summary points
III. Intent of examples and guidelines
h. Water/hydration
IV. Sports nutrition is a skill
i. Electrolytes
V. What about the many, many differ-
ent diet approaches j. Carbohydrates
VI. Limitations of research studies i. PDP: pre-during-post exercise, training,
workouts, events, and competitions.
VII. Sports nutrition plan approaches
ii. Pre-event meal/sports nutritionals
a. Dietary Guidelines (2015–2020) and
the Dynamic Nutrition Approach iii. Carbohydrate intake during long dura-
tion events and training sessions
b. Daily training session versus athletic
event nutrition iv. Post-event or post-exercise meal
c. ISSA’s 1-2-3 eating rule of thumb k. Protein

VIII. The dynamic nutrition approach, a i. What about protein intake during train-
bio-energetic model to performance ing sessions or athletic events?
nutrition l. Fats
a. How does exercise affect muscle fiber m. Meal timing and training timing
development and composition?
i. “Clock approach” meal
b. Sports nutrition supplements are part of scheduling examples
the dynamic nutrition approach
n. Sports nutrition fine-tuning is ongoing
c. Nutrition conditioning of athletes
IX. Food lists
d. Rationale behind the different ath-
lete-type sports nutrition plan examples X. Conclusion

e. Dynamic Nutrition athlete-type eating

plan examples

Learning Objectives
After completing this unit, you will be able to:
• Define and describe key terms related to sports nutrition approaches and concepts;

• Understand the Dynamic Nutrition Approach; and

• Discuss the Athlete-Type nutrition examples.

Sports Nutrition
 Sports Nutrition Approach Concepts and Examples | 441

Introduction
The Dynamic Nutrition Approach is a For example, consider two athletes from different
scientifically founded nutrition model, which sports, an American football lineman weighing
addresses the many aspects of nutrition, and 300 pounds and a marathon runner weighing
provides a logical approach to follow based on 150 pounds. The Dynamic Nutrition Approach
exercise physiology, anatomy, and biochemistry provides sports nutrition examples for both types
of athletes. As you have read about in previous of athletes who have differences in nutritional
units, as with any scientific model, there is requirements. This approach is dynamic in
always room for growth related to any new several ways that are reviewed in this unit, to
discoveries and modification based on an provide a starting point example to build from
individual athlete’s specific needs. This is a and to personalize calories, macronutrients,
vital consideration: any examples, guidelines, micronutrients, and ergogenic bioactive
models, or other approaches in this course or substances. Note that the Dynamic Nutrition
other publications need fine-tuning to meet the Approach is meant for healthy athletic adults and
specific needs of an athlete. What the Dynamic is not intended to treat any disorder or replace
Nutrition Approach can offer is a framework the advice of an athlete’s physician, nutritionist,
to build a personalized sports nutrition plan or another health practitioner.
from, with an awareness of the previously stated
limitations and of the need for personalization Furthermore, the foods and number of meals
and under a physician’s and/or other health in the examples are not intended to be followed
professionals’ supervision. exactly but do provide a potential starting

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point to build a personalized nutrition program legal issues related to sports nutrition can range
from. Instead of five meals/snacks (eating from local, state, and federal health professional
occasions) used in the examples, some athletes requirements to sports organization rules to
may determine that spreading out their daily lawsuit case law-based concerns for example.
food intake requires six meals/snacks (eating Although there may be a general position that
occasions) per day. In addition, each athlete will developing and prescribing a sports nutrition
have different food preferences that need to be program or providing input on an existing
considered. Remember that a major reason the nutrition program of an adult client in good
many prescribed diets in books fail is that after a health, without diseases, may be permitted
few weeks of people trying to follow them, they by non-licensed health professionals, this is
may give up simply because they do not like the something that should be verified in your
foods in these plans, and they do not have the location/venue.
expert understanding or supervision to make
food substitutions. Moreover, it is important to Check with your liability insurance company
note that the percentages of macronutrients in about these issues and practice limitations and
plan examples can be fine-tuned based on an how to best effectively communicate concerns
individual’s exact requirements determined by to your adult clients that protect your mutual
qualified expert examination. Similar to creating interests from an insurance coverage standpoint,
an effective personalized training program, the in addition to the other parties who may be
crucial word is “dynamic.” Any information in involved. Suggestions or recommendations
this unit or other units is not intended for any about sports nutrition products can be of legal
adults with diseases or women who are pregnant concern, too. Consultation with the athlete’s
or lactating or for people with other health team compliance officer and team-published
conditions that require extra and/or special rules regarding sports nutrition guidelines and
medical attention. prohibitions should be gathered and reviewed to
be knowledgeable about an athlete client’s team
and other legal requirements.
Sports Nutrition
It is typical for athletic/fitness centers and
Legal Aspects athletic teams to have doctors and other licensed
When you deal with others’ health, a variety of health professionals involved with the athlete
legal issues exist that most fitness trainers and training program development and activities.
other health professionals are aware of. ISSA- Working under the supervision of the team and/
certified fitness trainers are educated about many or clients doctor is important because doctors
of these issues and procedures to address them, are the best equipped to identify via testing
including liability insurance, client forms and and, from their training, any health concerns
disclosures, doctor approvals, team approvals, that might arise—including but not limited
and limiting personal training activities within to nutritional imbalances or deficiencies that
the applicable legal boundaries that may apply could occur during intensive athletic training
for health professionals. Similar and additional or stem from a person’s special needs. However,

Sports Nutrition
 Sports Nutrition Approach Concepts and Examples | 443

realistically, no guarantee of 100 percent safety products. As the legal and medically supervised
and efficacy can be made for sports example sports nutrition program continues to develop,
nutrition approaches and products. There it is a good idea for you to reconfirm legal,
may be known and unknown health hazards regulatory compliance, team rules, and scientific
related to food allergies, food intolerances, aspects each season. Additionally, it is crucial to
food sensitivities, microbial contamination, clearly communicate to athlete clients about the
and chemical contamination, for example, that need to maintain an “(illegal) drug-free” sports
typically need to be considered. In addition, the training and nutrition program. “Illegal drugs”
demands of an adult athlete’s training program may include illegal recreational drugs and legal
and daily schedule can impose time constraints drugs banned by sports organizations.
for achieving adequate nutrition intake—
potential mission impossible conditions that
hinder achieving an optimum sports nutrition Intent of Examples
program. Training schedule modifications can and Guidelines
be worth investigating, as athletes typically have
training programs that are unbalanced and/or As noted throughout this course, and by
excessive. “Optimum” training and nutrition independent experts and organizations such
programs for athletic performance are the goal, as the International Olympic Committee in
not excessive or extreme programs that can its Nutrition in Sport Publication (2000), it
be counterproductive and even unhealthy, for is difficult and challenging to make specific
example, too much resistance training or too recommendations that will meet the needs
much caffeine. of all individuals in all situations. Therefore,
the suggested approach is to formulate
Effective communications with clients entails
general guidelines about sports nutrition,
that the clients realize that a sports nutrition
with the understanding that these guidelines
program takes time to develop at that, at times,
need to be adapted to best suit an individual
some trial and error can be expected. Foods,
athlete, under qualified health professional
including sports nutrition product suitability and
supervision. Thus, to summarize, the intent of
usage, should be determined by the clients, their
doctors, and with consultation with their team examples, guidelines, and information from
and sports organizations to determine these research studies; Health Canada’s ingredient
products are legal, safe, and effective. A starting monographs; and other independent sources is
point can be to first evaluate an athlete’s training solely academic and not meant to be used exactly
and nutrition program, to determine whether for any individual person. Clinical practice
there are any obvious areas of concern with the approaches by qualified health professionals
nutrition basics, such as following a healthy diet, can be required to determine the exact sports
adequate caloric intake, carbohydrates, protein, nutrition needs of an individual, and monitor
essential fatty acids, water (hydration), vitamins their health and athletic performance, adjusting
and minerals; and the use of safe, effective, individualized sports nutrition programs as
permitted, and otherwise legal sports nutrition need, on a case-by-case basis.

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Sports Nutrition Is a Skill

What the thousands of scientific studies If you are new to sports nutrition, working with
conducted over the past decades have shown is established experts is a good start. If you are
that when a person engages in athletic training already a sports nutrition expert, building and
and competition, the demands of physical reconfirming your skills with courses like this
activity will create above average nutrition and other continuing education efforts will help
requirements. Then, over the months and years fine-tune these skills, as will your own research
and as the body develops, there are expected to review education efforts.
be additional changes, requiring evaluation and
Forming a local sports nutrition expert group/
updating of the nutrition requirements. Athletic
club can provide additional benefits for your
conditioning therefore influences what food and
sports nutrition skill development, and it can
supplements will work best for a specific athletic
be fun to share knowledge with colleagues. It
training program. For example, a marathon
is sometimes useful to conduct a retrospective
runner needs to eat different amounts of protein,
analysis of your approaches, along with being
carbohydrates, and fat than a power-lifter does.
progressive. For example, look at what you were
However, all athletes need to follow the rules of
doing previously with your athlete clients and/
healthy eating and modify their dietary intakes
or personal sports nutrition programs. Then
so they can achieve maximum performance.
run an analysis to confirm the time-tested
It will take an ongoing effort to establish, fine-
sports nutrition practices and products that
tune, maintain, and evolve an athlete’s sports
continue to work best. Doing so will also verify
nutrition program.
which practices or products did not produce
It will also take time for fitness trainers and other measurable benefits and help you determine
health professionals to develop sports nutrition what can be applied for future sports nutrition
skills. It can take years of expert supervised program optimization.
training to become an expert in sports nutrition.

Sports Nutrition
 Sports Nutrition Approach Concepts and Examples | 445

Demystifying Nutrition
By this point in your learning efforts, you have discovered the many facets of nutrition and special
considerations related to sports nutrition. You know about the macronutrients, micronutrients, and
ergogenic nutrients. You know that a person’s individual metabolism and activity levels determine his
or her total caloric needs along with the amount of protein, carbohydrates, and fat to be consumed.
As you read this unit, you will learn how to synthesize and use your new nutrition knowledge by using
the Dynamic Nutrition Approach examples as a starting point to be personalized. Included is a general
review of existing nutrition plans you have been introduced to. Look at why they may or may not be
valid and answer the question:
Why So Many Diets?
This is the number one question that arises from students and clients related to sports nutrition and
weight-loss diets. The answer is a simple one as it relates to weight-loss diets and to what most weight-
loss diets share in common.
• First, the many weight-loss diets that currently exist prescribe a daily caloric intake, which is less
than the total daily calories used. Following a calorie-restricted (deficient) diet will obviously
result in some type of weight loss.
• Second, these fad weight-loss diets provide you with a structured plan to follow. When you have
a problem with food control and overeating, structure is your best friend. Therefore, following a
structured eating plan, which is low in calories, will result in weight loss.

With thousands of foods to choose from, you can easily see how many diets can exist using various
food combinations and dieting angles. However, upon close examination, you’ll see that many of
these trendy diets may be deficient in important macronutrients and micronutrients. Most of these di-
ets do not provide adequate nutrition and are not meant for individuals in a fitness or athletic training
program because of this lack. Theses fad weight-loss diets can be too low in protein or carbohydrates,
and some of them are too high in fat. They can also leave the dieter in a poor state of health, with a
damaged metabolism from the lack of one or more essential nutrients. For example, fad diets low in
protein can cause an unhealthy loss of lean body mass.
Typically, the weight lost from following a low-calorie fad diet consists of water weight, fat, and
muscle mass. This is where the problem lies. Loss of muscle mass reduces the body’s ability to burn
calories. Therefore, when the fad dieter has lost weight, his or her body has a lower capacity to burn
calories. As most dieters soon return to their old eating habits, they tend to gain more weight as body
fat and can end up having a higher percentage body fat, even if they do not return to their previous
weight. When you see what happens to a dieter who takes his or her body through a few cycles of fad
diets, you can see why many adults have difficulty losing weight the third, fourth, and fifth times. Unit
18 presents a scientifically based and clinically verified approach to losing fat, one that also preserves
and builds up the body’s precious lean body mass. The unit also presents some of the nutritional diet
aids that scientific studies have discovered can assist in the weight-loss process.
When you apply your new nutritional knowledge to understanding the nutrition plans that exist, you
will be able to see what their good and bad points are. Remember, as humans, we can survive on dif-
ferent kinds of diets. But as stated in Unit 1, this course is not about tolerating mere survival diets; it is
about applying scientific nutritional knowledge and following a quantitative nutrition plan best suited
for healthy athletic performance needs.

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What about The Many, Many Different Diet Approaches?

Each time this course was updated, questions most are too low in calories; are low in certain
arose from students about the various diet essential nutrients required in higher amounts
approaches published in books and offered as by athletes, usually do not include the ergogenic
programs. One general answer to these is to ingredients, and can be insufficient and/or
apply your nutrition knowledge to determine unbalanced in the required macronutrient
what these diets supply in terms of total daily profiles and amounts athletes need.
calories, amounts of macronutrients and the
Note that some of these diets may be classified
other essential nutrients, and other beneficial
as elimination diets, for example the ones
nutrition substances that may promote health
that eliminate a type or types of foods or food
and perhaps athletic performance benefits, too.
substances. There may be many reasons for
When you break down and analyze the fad diets,
following these; some are trendy, or some may
you will find that the answers you seek will
have a valid medical purpose, like with food
reveal themselves. When you strip the labels/
allergies or intolerances. These types of issues
titles and focus on understanding the nutrients
are ideally addressed by a person’s doctor,
the diets provide, you will see that some elements
nutritionist, and other related health professional
of these diets may even apply to a sports
to accurately determine whether elimination of
nutrition program, such as focusing on eating
certain foods is warranted for medical reasons.
healthy whole foods. However, it’s clear from
analyzing the many diets over the decades that

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Limitations athlete types, and generally. In other words, not

all research and research results are intended to
of Research Studies be used and may not apply to everybody.
In terms of the growing body of sports nutrition
In addition, be research study-minded when
research and related research studies, some is
working with clients. After reading several
useful and some not. In many instances, research
research studies and becoming familiar with
studies that use human subjects, animals, or test
the formats and methods, you can take this
tubes are not necessarily designed or intended
approach with your clients. For example, when
to be directly applied to the general population.
trying a nutritional intervention, like extra carbs
Carefully read the actual research studies
or an ergogenic supplement like creatine, create a
that attract your interest and the ones you are
record-keeping approach to track improvements
considering for application in a sports nutrition
in athletic performance, exercise performance,
program. This means tracking down a copy of
or body composition changes to confirm the
the study mentioned in articles or of an abstract
intervention is working. Before you know it,
found in a database like PubMed. You can even
you may have enough data to publish in an
contact the researchers directly via their e-mail
article with ISSA or even to submit to a scientific
contact to request reprints of the study you
journal. Teaming up with your colleagues can
are interested in and for follow-up questions.
speed up the process and provide even more
Sometimes they will respond, sometimes not.
evidence via more subjects.
If not, studies are usually available for purchase
online by the journals or from the service that
offers a wide array of journal articles. Sports Nutrition Plan
Approach Examples
Another consideration is related to the type
of subjects used in the research, for example, When this course was introduced in the 1990s,
type of sport, and what level ability, such as the situation regarding viable, scientifically based
recreational, college, professional, or Olympic. sports nutrition approaches was bleak, hit-or-
In addition, consider that there are specific miss, and evolving. Sure, there were some books
types of sports and athletes for certain types along with massive amounts of misinformation
of products, such as endurance energy drinks. or misapplication in the magazine articles.
Although there are certain similarities among For example, while not technically an athletic
athletes of different sports, it is not expected performance sport, bodybuilding training
that a 150-pound long-distance athlete will and the associated nutrition and supplement
have the same energy requirements or digestion approaches tend to dominate magazines, the
and utilization ability compared with that of a Internet, and books. Although people active
300-pound football player. Thus, when applying in the sport of bodybuilding are among the
research results among the different athletes, most dedicated types of athletes, building
think about how these common sports nutrition supersized muscles and achieving very low body
areas apply to the specific types of athletes, fat levels are not primary goals in most other

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the scientific principles learned in this and

other courses, scientific studies, experience of
colleagues, and your direct experience. It is
impossible to create a general sports nutrition
plan in writing that will be best suited for
everybody. Examples in this course, other
courses, and elsewhere are typically intended to
be starting points that need to be personalized
under doctor supervision and with direction
of other applicable health and wellness
professionals, which fitness trainers are part of,
focused on determining an athlete’s individual
specific needs and personalized nutrition
program, and for adequate medical monitoring
of health and athletic performance.

athletic performance sports. However, when Dietary Guidelines (2015–2020) and

non-bodybuilding athletes are on their own, the Dynamic Nutrition Approach
they often use these popularized bodybuilding
As presented in Unit 16, healthy nutrition
nutrition and training approaches, which are
should form the basis of a sports nutrition
not the most effective for them to achieve their
program. When selecting foods to include
athletic performance goals. Muscle size and
in a sports nutrition program to provide the
low body fat levels are typically a side effect of
required carbohydrates, protein, fats, fiber, other
a performance athlete’s training, not the goal.
essential nutrients, and other health-promoting
The functioning and condition of the muscles
substances, refer to the Dietary Guidelines
to achieve the required athletic performance is
to refine your selections. Moreover, consider
a crucial goal while simultaneously optimizing
new research findings along with findings
muscle size and body fat levels.
implemented in other countries about the health-
Similar to other ISSA pioneering sports and promoting foods and food substances, including
fitness courses, thousands of health professionals dietary supplements. Research studies examining
throughout the world were influenced by this nutrition status of competitive adult athletes
course and other education efforts by the consistently report inadequacy of some essential
authors. You will frequently find when reading nutrients and total daily calories. A continual
articles and books that some of these expert effort must be made by the athlete and health
authors and researchers have taken this course professional team to achieve sports nutrition
and are ISSA certified. A consideration when success. The following box provides a summary
reviewing and evaluating sports nutrition of the Key Recommendations of the Dietary
and other nutrition approaches is to apply Guidelines to consider.

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 Sports Nutrition Approach Concepts and Examples | 449

Key Recommendations
Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate
calorie level.
A healthy eating pattern includes:
• A variety of vegetables from all of the subgroups—dark green, red and orange, legumes
(beans and peas), starchy, and other
• Fruits, especially whole fruits
• Grains, at least half of which are whole grains
• Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
• A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes
(beans and peas), and nuts, seeds, and soy products
• Oils

A healthy eating pattern limits:

• Saturated fats

• trans fats

• added sugars

• and sodium

Key recommendations that are quantitative are provided for several components of the diet that
should be limited. These components are of particular public health concern in the United States,
and the specified limits can help individuals achieve healthy eating patterns within calorie limits:
• Consume less than 10 percent of calories per day from added sugars

• Consume less than 10 percent of calories per day from saturated fats

• Consume less than 2,300 milligrams (mg) per day of sodium

Based on the general Key Recommendations, via large amounts of sweating can require and
some healthy sports nutrition dilemmas may benefit from simple carbohydrate and electrolyte
arise related to added sugars and salt intake. For beverages that result in higher added sugar and
example, endurance and other athletes training higher sodium daily intakes, especially during
many hours per day and/or who have long the athletic preseason and season. In general,
duration events in which they expend high levels most athletes will need higher sodium intakes
of glycogen-depleting energy demands and lose of more than 2,300 mg per day, as previously
potentially detrimental amounts of electrolytes reviewed in Unit 8. These issues are something

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Daily Training Session versus

Athletic Event Nutrition
For most sports, daily training dominates in
terms of hours of physical activity versus during
athletic event/competition days. The basic plan
examples are intended as base diet starting
point examples for day-to-day training, but
can also be suited for competition preparation.
to consider, especially with athletes who may In general, for the day of athletic competitions
have family history or personal issues with or events, and perhaps the previous day(s)
health concerns related to added sugars and salt too, higher carbohydrate can benefit most
(sodium) dietary intake. athletes of all types. For some of the model
examples, this could mean increasing the daily
In addition, note that some sports nutrition carbohydrate content by 5 to 10 percent. Aside
products, like the nutrient powders and bars, from helping to keep the body’s glycogen levels
may contain “added sugars.” This is something saturated and high-energy glucose available to
to look for when trying to maintain the balance meet the athlete’s energy demands, the higher
of healthiest levels of adequate intake. The carbohydrate diet is typically easier to digest
Dietary Guidelines notes the following regarding and facilitates stomach emptying, which is
added sugars, “Healthy intake: Added sugars an important factor for athletic performance.
include syrups and other caloric sweeteners. However, note that for some weight-class sports,
When sugars are added to foods and beverages coaches and athletes sometimes break the
to sweeten them, they add calories without rules of sports nutrition by using potentially
contributing essential nutrients. Consumption of hazardous methods of dehydration and glycogen
added sugars can make it difficult for individuals depletion to keep body weight lower than
to meet their nutrient needs while staying within normal. These means should be avoided.
calorie limits. Naturally occurring sugars, such
as those in fruit or milk, are not added sugars. Speaking of glycogen, remember that even for
Specific examples of added sugars that can be sports that are shorter in duration, having the
listed as an ingredient include brown sugar, body’s glycogen supplies loaded up has certain
corn sweetener, corn syrup, dextrose, fructose, metabolic advantages, versus having the body’s
glucose, high-fructose corn syrup, honey, invert glycogen supplies low or depleted. When
sugar, lactose, malt syrup, maltose, molasses, glycogen supplies are too low and run out during
raw sugar, sucrose, trehalose, and turbinado training or athletic competition, the body’s
sugar.” With a little work, combining whole mental and physical performance is impaired,
foods sources, like fruits and no-added-sugar and athletic performance can be compromised/
fruit juices, may serve to provide healthier reduced. Immunity can be adversely affected,
simple carbohydrate sources, as might using the too. But when glycogen stores are simply low, a
prepared sports nutrition products. metabolic distraction or conflict can be caused

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 Sports Nutrition Approach Concepts and Examples | 451

in which the glycogen-building biosynthesis who are weight training and exercising to lose
pathways are highly active. During physical excess body fat, build muscle, and maintain
activity, energy production for peak athletic health. This approach is indeed revolutionary
performance may be impaired. Low body and evolutionary in many ways. (ISSA-certified
glycogen stores may even have adverse effects, fitness trainers learn about this in the CFT
disrupting cognitive function and mood. It is certification course.) If you follow this simple
certainly one of the many nutritional balancing rule, you and your clients will maintain a diet
acts that needs to be considered for a sports that is low fat, moderate in protein, and high
nutrition program. in carbohydrates, or another way to consider
this would be: optimum fat, optimum protein,
and optimum carbohydrates for an exercising
ISSA’s 1-2-3 Eating Rule of Thumb individual. The lesson of the 1-2-3 rule is to have
If you are an ISSA-certified fitness trainer, then an easy way to put a priority on your nutritional
you are probably wondering how the 1-2-3 rule thinking when purchasing foods, preparing
fits into this Dynamic Nutrition Approach. meals, and eating out. This ratio can be modified
This general nutritional intake guideline, of depending on an individual’s sports performance
approximately 1 part fats, 2 parts protein, and or fitness goals. The 1-2-3 approach is part of the
3 parts carbohydrates, is valid for most people Dynamic Nutrition Approach’s foundation.

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The Dynamic Nutrition Approach:

A Bio-Energetic Model to Performance Nutrition
When athletes train for a sport, they are walking, running, cycling, or swimming long
conditioning muscles to produce strength and distances, usually distances that take several or
contractions that generate motion specific to more minutes or longer to accomplish. However,
the physical demands of the sport. For example, running a mile in under four minutes has highly
a marathon runner needs to display a lower developed oxidative muscle fiber capacity too.
intensity muscular output that can be sustained This type of physical conditioning results in
for long periods. Compare this to the explosive shaping muscles that are small and have a great
strength needed for a hundred-meter sprinter many mitochondria packed into each slow-
to run a short distance as fast as humanly twitch muscle fiber. The muscle tissues consist of
possible. In the sprinter, muscles are much a high proportion of cardiovascular components
larger compared with those of other runners, needed to supply oxygen for aerobic metabolism
and there is a high-intensity muscle output and quickly clear away metabolic wastes. A
over a very short time. This explosive strength well-conditioned oxidative athlete burns a great
generates tremendous power. Therefore, the type deal of energy-rich fatty acids for energy and
of physical conditioning results in promoting can maintain muscle output for a long period.
athletic performance abilities and shapes the size Glucose is also an important energy source for
and bio-energetic conditioning of muscles. Other oxidative athletes, as are amino acids, such as
tissues and systems of the body also respond the BCAAs.
and develop in a sport-specific way. This affects Strength athletes require conditioning that
what type of muscle fibers athletes develop and will preferentially develop fast-twitch muscle
their metabolic functioning, in other words, fibers. Fast-twitch muscle fibers are capable of
anatomy and exercise/sport physiology. These are a large output of strength over a short period.
crucial concepts to consider and will help you in However, metabolic waste products build up
sports nutrition and athletic training and fitness and cause muscle fatigue to quickly set in and
development endeavors. impair strength performance. Fast-twitch muscle
fibers have some oxidative capacity, the extent of
How does exercise affect which depends on training methods. The large
muscles of power athletes are conditioned to
muscle fiber development
utilize anaerobic energy pathways, such as the
and composition? immediate energy systems, which use readily
Skeletal muscles are composed of two main available adenosine triphosphate (ATP) and
types of muscle fibers, which are classified creatine phosphate (CP). Additionally, energy
as slow-twitch and fast-twitch by exercise is derived from glycolysis, which makes energy
physiologists. Slow-twitch muscle fibers are from muscle glycogen (glucose) to make ATP
the ones preferentially developed when you molecules. Remember, too, that all athletes
undertake long-distance training. This includes continually use fatty acids for energy. However,

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 Sports Nutrition Approach Concepts and Examples | 453

power athletes tend to be more conditioned to which is of interest to long-distance athletes,

use muscle glycogen during exercise. This in there are special energy drinks that can be used,
one reason strength athletes need to make sure in addition to special metabolites. Some research
that they are following a lower fat diet compared even supports the use of supplement nutrition
with the diet of oxidative athletes. In fact, this therapy to help reduce pain and inflammation,
frustrates many people who are well-conditioned and to help heal some injuries. Some doctors
strength-training athletes, who struggle to keep include nutrition/supplements as part of their
off excess body fat due to their strength athlete treatment programs.
anatomy and physiology.
The safety of supplements will always depend
on an athlete’s specific state of health, tolerance,
Sports Nutrition Supplements proper use, and level of physical activity. It
Are Part of the Dynamic is also contingent on the fact that a person
is using a “legal” sports nutrition product
Nutrition Approach.
correctly and following the product’s directions,
Scientific studies show that in addition to well- not overdosing, and confirming proper use
known benefits of maintaining proper health, with a physician and other appropriate health
athletes can also enhance physical and mental professional. Keep in mind that research studies
performance with sports nutrition supplements. on supplements may be only performed over
Protein supplements offer a convenient and short periods—a few weeks or a few—months,
economical way to get daily high-quality protein with small number of subjects, dozens not
intake. For strength athletes, several supplements thousands, and some research over years using
can help achieve optimum muscle growth and thousands of subjects. This means that the long-
repair muscle. For maximum aerobic energy, term effects of using some supplements may not

Examples of Some Sports Nutrition Specialty Foods and

Supplements for Potential Occasional Use Reviewed in Previous Units.
Typically, one or more of these are used at a time, depending on the type of athletic performance and health goals.
Carbohydrate/Electrolyte Sports Drinks & Gels Beetroot Juice/Nitrate

Protein Supplements Pycnogenol

Meal Replacements Ginsengs

Nutrition Bars Caffeine

Multivitamins/minerals Essential Fatty acids

Probiotics EPA & DHA

Add Your Additional Items:

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have been determined yet. Note that reference Healthy use relates to using caffeine on an
to the Canadian-approved ingredients and as-needed basis, under doctor supervision, in
monographs has been made in previous units, appropriate dosage forms and amounts. Because
which brings an additional level of credibility caffeine affects the nervous system and energy
and independent expert review regarding safety use, it is important to make sure athletes are
and effectiveness and duration of use along with first following optimal nutrition and training
other concerns when applicable. programs that result in maximum athletic
performance to then rate the extra performance
When taking supplements and some of the
benefits of caffeine and the other ergogenic
other sports nutrition products sold as foods, as
substances. Otherwise, caffeine use may mask
a general rule, it is always important to follow
nutrition or training program inadequacies,
the proper usage directions provided on the
which could ironically lead to jeopardizing
packaging/labeling, under doctor supervision,
athletic performance and health when the body
and to contact the company directly for
eventually crashes and needs time to recuperate
additional use information when required. For
from inappropriate caffeine use.
many of the essential vitamins and minerals,
you will find recommended daily values
(DV) on the labels. In some instances, certain Nutrition Conditioning
vitamins and minerals will need to be taken of Athletes
in at least 100 percent of the daily values and
Similar to how the body makes changes in
sometimes in higher amounts. When it comes
response to physical training and acclimates to
to the newer or novel metabolite supplements
environmental conditions, the body can take
found on the market such as creatine, although
time to make anatomical, biochemical, and
these nutrients are found naturally in the diet
physiological adjustments to nutritional changes
and are made and used in the body, more
that are part of a sports nutrition program. Thus,
caution is needed for their safe use. It is a
as total daily caloric intake is increased, it will
wise practice to be under the supervision of
take time for the body to become efficient at
a physician, team physician, or other health
processing the extra nutrients, including higher
professional to ensure a safe and effective
water intake. This includes eating occasions and
sports nutrition and supplement program that
any special sports nutrition practices before,
will work for athletes, not against them.
during, and after training and events. For
Caffeine is an example of an ergogenic substance example, if a sport event is strenuous and long
with a long history of use and backed by many in duration and is expected to require intake of
clinical studies supporting several potential water and carbohydrate/electrolyte beverages
beneficial effects, which are reviewed in Unit during the event, this should be practiced during
9. Some general points to reiterate here include training to fine-tune the nutrition intake, and
the legal and healthy use of caffeine. The legal condition the body to process the nutrient
use relates to being legal under the conditions intake. Testing different foods or nutrients or
of the sports organizations and legal products. supplements may be required depending on how

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 Sports Nutrition Approach Concepts and Examples | 455

the athlete responds to higher consumption of Rationale behind the Different

the foods he or she typically eats and new types
Athlete-Type Sports Nutrition
foods/supplements being tried.
Plan Examples
Gastrointestinal upset, including gas and
diarrhea, is an example of one of the common The steps and following table summarize
sports nutrition program or product symptoms the main types of bio-energetic needs and
reported occurring in some people. When macronutrient profiles to meet energy, growth,
gastrointestinal update occurs and is reported recovery, and performance demands. Keep
by athlete clients, they need to work urgently in mind that these are categories to serve as a
with the health professional team to resolve starting point and that each athlete can have
the annoying condition, as health and athletic different needs. However, by using this Athlete-
performance can be adversely affected—even Type bio-energetic sports nutrition model,
with minor gastrointestinal upset conditions. you may achieve goals more quickly versus
Resolving such types of gastrointestinal upset undertaking years of unscientific trial and
may include adjusting a sports nutrition error. This summary also follows the Dynamic
program to allow the athlete’s gastrointestinal Nutrition’s Hierarchical approach. In other
system to acclimate or even avoiding certain words, when you are designing a sports nutrition
foods or products. plan, the following approach will make the work

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easy for you. Refer to the corresponding units amounts of the essential fatty acids and linoleic
for details about determining some of the items, and alpha-linolenic acids. Add healthy sources of
essential fatty acids, along with EPA and DHA as
such as body composition.
required for health.
Step 1: Determine body composition.
Step 7: Maintain proper fluid intake estimate
Step 2: Determine daily caloric expenditure to meet daily requirements, as determined by
range for training and non-training days and for amount of physical activity, environmental
competition days. factors, and specific athletic training,
performance, and health needs.
Step 3: Define the bio-energetics the
sport primarily demands for peak athletic Step 8: Determine the needs for using special
performance, Athlete-Type, Anaerobic – sports nutrition and dietary supplement
Immediate Energy System, Anaerobic Glycolytic; products.
Anaerobic Glycolytic – Oxidative Glycolytic, and
Step 9: Be consistent. Consistency is the key to
Oxidative. Some examples of sports will follow.
a successful sports nutrition program.
Step 4: Determine daily protein intake estimate
Step 10: Make Champions. Being a champion
and the foods and supplements to achieve
is more than just winning. It is about living
it. Remember from your lessons that protein
a certain lifestyle that leads to winning. This
requirements can differ between different
lifestyle includes a constant effort to improve all
athlete-types and among individual athletes.
the factors (planning, physical, mental, athletic
Step 5: Determine daily carbohydrate estimate training, nutritional, spiritual, medical, social,
and the foods and supplements to achieve it. etc.) that result in being the best an athlete can
Remember to plan for carbohydrate beverage be. Planning is a major part of success in sports
intake before, during, and after practice and and life. Implementing a plan is one thing;
for sport events as appropriate. Modulate the other is regularly measuring the outcome
carbohydrate type and amount with meals and and identifying both strengths and areas of
snacks to attain specific nutrition goals. improvement.

Step 6: Determine fat (essential fatty acids) Step 11: Repeat steps 1 to 10 periodically. As an
intake estimate and plan and select foods and athlete’s body develops from training and from
cooking methods to achieve it. Keeping fat year to year aging, his or her body and nutrition
intake under 30 percent of total daily calories requirements can change, even in a short
will be an ongoing skill to master. For certain period, so repeating steps 1 to 10 periodically is
sports, maintaining low fat intake during the a good practice. Weekly can be an appropriate
season of about 15-20 percent of total daily starting point, and then adjust appropriately
calories can be challenging and requires extra after a collection of data is established for an
effort to make sure athletes ingest adequate athlete. Fine-tune the intervals.

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Athlete-Type Sports Nutrition Plan Examples

Scientific Rationale of the Athlete-Type Sports
During Season
Nutrition Plan Examples
15% Fat Anaerobic – Immediate Energy Sports. For individuals in
30% Protein sports in which explosive strength and power is required,
55% Carbohydrates immediately available ATP and CP anaerobic energy is
used. High protein is required to maintain positive nitro-
gen balance and repair fragile fast-twitch muscle fibers.
Low fat, high carbohydrate intake is suggested because
these athletes use mostly muscle glycogen to replenish
ATP and CP stores.
20% Fat Anaerobic Glycolytic Sports. For individuals in sports
25% Protein in which explosive strength and power is required on a
55% Carbohydrates sustained or highly repetitive basis. Muscle glycogen is a
primary source of energy for these athletes. High protein
is required to maintain positive nitrogen balance and
repair fast-twitch muscle fibers.
20% Fat Anaerobic Glycolytic – Oxidative Glycolytic Sports. For
20% Protein individuals in sports in which the aerobic pathway is the
60% Carbohydrates predominant energy source, but glycolysis is also relied
on. Fatty acids and muscle glycogen thus become import-
ant energy sources. Moderate protein intake is required
to maintain positive nitrogen balance and repair muscle
fibers. This is a good daily nutrient intake for cross-train-
ing sports or multi-energetic sports and for general health
and fitness.
25% Fat Oxidative Sports. For individuals in sports in which oxida-
15% Protein tive endurance is required for long-distance events. Slow
60% Carbohydrates twitch muscle fibers predominate. High carbohydrate
is required to maintain glycogen stores. As endurance
athletes utilize a high amount of fatty acids for energy,
moderate dietary fat intake is warranted. Protein intake
is lowest for this group of athletes, but is about twice as
high as nonathletes.
Comments: Short-term use during athletic season, for healthy adults. Starting point to modify based on individual
athlete needs, under qualified health practitioner supervision and approval, such as a doctor. Does not apply to special
need sports, such as ultra-endurance and high-altitude sports and sporting events. Actual percent fat, protein, and
carbohydrates can vary based on the individual.

Dynamic Nutrition Athlete-Type Eating Plan Examples

Prescribed diets that are found in books, which of the prescribed diets include foods you do
include recipes and special foods over several not want to eat, which is another factor for the
weeks, are difficult to follow. Let’s face it: most high failure rate. Finally, when confronted with
people try them for a few days, find following real-life situations, (eating out, eating at friends’
them frustrating, and shortly return to their houses, or traveling) it’s close too impossible to
old ways of eating. It seems that unless you are follow a month-long eating plan that someone
confined to an institution where someone else else created without knowing a person’s
prepares all your meals every day, it’s hard to individual preferences.
follow most prescribed diets. Additionally, many

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With these issues in mind, look at the following may also mean packing a brown bag meal to take
examples. They use daily diet examples and food for snacks and meals while out of the house.
category lists to assist in selecting foods to meet
The examples are summarized in a convenient
sport-specific daily fat, protein, and carbohydrate
format, which can be used when shopping and
intake goals. The daily diet examples illustrate
when eating out. Additionally, the food category
how to spread out caloric intake on training days
lists include common foods to get started. To
and demonstrate example foods to meet sport-
make the plans work the best, you need to add
specific daily nutrient intake.
favorite foods to the list based on a person’s food
There are two caloric examples for each of the preferences and determine how much of these
four different diet types: 2,500 Calories per to eat to meet daily caloric and macronutrient
day and 3,500 Calories per day. The daily diet goals. Many grocery foods have the nutrition
examples are dynamic, so you can easily add or information you need on their labels in the
subtract foods from these example diets to match Nutrition Facts box found on most food products
your individual daily caloric intake. Individuals or on the Supplement Facts box found on dietary
with enormous daily caloric requirements, like supplement products.
5,000 Calories per day, or 7,000 Calories per day, Another thing to remember when constructing
can simply double the amounts of portions in nutrition plans is not to become overly
the example 2,500 Calorie and 3,500-Calorie concerned if you find that you cannot exactly
example diets, respectively. You can even get the foods to meet target caloric and
modify the number of eating occasions to best macronutrient goals. You should realize that
suit individual needs, 5 to 6 times per day for it’s OK to be a little flexible. When scientists
example. Here is an example for which tracking calculate the energy and macronutrient content
body weight and body composition at regular of foods, many assumptions are made, and
intervals becomes important to determine an acceptable range of error is to be expected.
whether the total daily caloric intake is too This means that when you deal with foods,
much, causing unwanted weight gain, or too the nutrition content information is not
little, causing unwanted weight loss—in addition exact. However, when you deal with dietary
to the other measures of athletic performance supplements, the information is usually more
and health that are being tracked. accurate. But remember that a margin of error of
plus or minus 10 percent is typical, and even up
When following a doctor-approved nutrition
to a 20 percent margin of error has been known
program, it’s expected to deviate somewhat from
to occur. With some whole foods, even a higher
time to time. Athletes should be taught to start
margin of error can occur with caloric and
back on the right track at the next meal when
nutrient content.
this occurs. But to be successful, some planning
is required, making sure that the refrigerator and The example diets demonstrate how to spread
pantry are well stocked with the required foods out the calories throughout training days. Note
and supplements. Meeting daily nutrition goals that following a 15-30-55 diet does not mean

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 Sports Nutrition Approach Concepts and Examples | 459

that each meal consists of 15% fat, 30% protein, when sweating is excessive leading to weight loss
and 55% carbohydrates. This is the total daily during the workout.
intake goal. The way the diets are structured
Here’s another point on beverage intake before,
focus on eating more carbohydrates around
during, and after sporting events. For short-
training time of day.
term, explosive sports like sprinting, wrestling,
With the practice of ingesting a carbohydrate high jump, and martial arts, athletes may not
beverage (or similar sports nutritionals) before, need to drink carbohydrate beverages right
during, and after training sessions and athletic before or during events, unless a benefit has
events, an evaluation period may be needed to been determined. Short-term sporting events/
determine how an athlete’s digestive system competitions usually are not reported to
will respond. Note that it may take a few to benefit from the glycogen-sparing effects of
several weeks to adjust to doing this. If athletes carbohydrate beverage ingestion. Note however
cannot “stomach” drinking a carbohydrate that a psychological benefit may occur from
beverage before and during training or during consuming carbohydrate beverages for such
events, then make sure they take in extra athletic events, which generally are not at
carbohydrates during the pre-training meal, risk for glycogen depletion, and may benefit
during and directly after training, and for the an athlete in other ways not directly related
subsequent meals/snacks to ensure adequate to muscle energetics. But for longer duration
glycogen replenishment. Keep well hydrated sports, generally more than an hour long, or
during practice sessions by drinking water along during day-long tournaments, most types of
with a carbohydrate drink when warranted athletes can benefit from carbohydrate ingestion

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a few months at a time, during the competitive

seasons, and could also be suited for other
athletic training phases, such as preseason. Most
athletes can follow a 20% fat, 20 % protein, and
60% carbohydrate diet on the off-season. But
because long-distance athletes tend to train all
year, they can stick to their 25% fat, 15% protein,
and 60% carbohydrate diet all year, except as
otherwise directed by their health practitioners.
Moreover, remember that the best macronutrient
to eat three hours, plus or minus, before practice
and competitions is low fat, moderate protein,
and high in carbohydrates; low fiber; easy to
digest but with some low to moderate glycemic
index behavior for sustained blood glucose
levels. Don’t wait until right before a competition
before and during the events. However, for all to determine what pregame meal works best;
athletes, during daily practice and training, athletes must work on perfecting their sports
it is important to maintain carbohydrate nutrition program every day, like they do with
beverage intake to maintain glycogen stores, their sports training. Each person has a different
as most training sessions last more than two rate of digestion and assimilation, so individual
hours in duration, in addition to taking in meal timing and nutrient composition needs
water and electrolytes. Finally, if a person finds to be determined and prove effective well in
it hard to stomach ingestion of a certain type advance of competitions. Comprehensive
of carbohydrate beverage, before and during record keeping and analysis are required to
training or a sporting event, experiment with determine the relationship between peak athletic
different brands of drinks and different caloric performance and the sports nutrition program.
amounts to evaluate a compatible source of
This table provides a summary of examples of
activity-related intake.
how the different diets may best meet sport
When working from the following plan specific nutrition requirements for a year-
examples, remember that they are for illustration round training program. The rationale for
purposes only, and you will need to modify changing diets during the year in some sports
them to meet the exact nutrition and supplement is determined by the intensity of physical
needs of each adult athlete. There is no way to activity during the off-season, preseason,
guess total daily and workout or event caloric and competition season. For example, power
expenditure in a book without working directly athletes not intensively training may not
with an athlete. In addition, note that these plans require the same level of protein intake they do
are meant to be used by healthy adults, for only when intensively training.

Sports Nutrition
Sport Off-Season Preseason In-Season
%Fat - %Protein - %Carb %Fat - %Protein - %Carb %Fat - %Protein - %Carb
Baseball 20-20-60 20-25-55 15-30-55
Basketball 20-20-60 20-20-60 20-25-55
Bodybuilding 20-25-55 15-30-55 10-15/30 to 40/50-55
Bowling 20-20-60 20-25-55 20-25-55
Boxing 20-20-60 15-30-55 15-30-55
Cycling-Sprint/Mid-Dist 20-20-60 20-25-55 20-25-55
Cycl-Long Dist 20-20-60 20-20-60 20-20-60
Dancing, Power 20-20-60 20-20-60 20-25-55
Dancing, Stamina 20-20-60 20-20-60 20-20-60
Equestrian, Power 20-20-60 20-25-55 20-25-55
Equestrian, Mid-Distance 20-20-60 20-20-60 20-20-60
Field Hockey, Power Players 20-20-60 20-25-55 20-25-55
Field Hockey, Mid-Dist. Players 20-20-60 20-20-60 20-20-60
Fitness, Power Exercisers 20-20-60 20-20-60 20-25-55
Fitness, Mid-distance Exercisers 20-20-60 20-20-60 20-20-60
Fitness, Endurance Exercisers 25-15-60 25-15-60 25-15-60
Football 20-20-60 15-30-55 15-30-55
Golf 20-20-60 20-20-60 20-25-55
Gymnastics 20-20-60 20-25-55 15-30-55
Hockey, Ice 20-20-60 20-20-60 20-25-55
Martial Arts 20-20-60 20-25-55 15-30-55
Motor Sports 20-20-60 20-20-60 20-25-55
Powerlifting 20-25-55 15-30-55 10-15/30 to 40/50-55
Racket Sports 20-20-60 20-25-55 20-25-55
Rock Climbing 20-20-60 20-25-55 20-25-55
Skiing, All Downhill Events 20-20-60 20-25-55 15-30-55
Skiing, Mid-Distance 20-20-60 20-25-55 20-25-55
Skiing, Endurance, Long Distance 25-15-60 25-15-60 25-15-60
Soccer, Power Positions 20-20-60 20-25-55 20-25-55
Soccer, Mid-Distance Positions 20-20-60 20-20-60 20-20-60
Swimming, Power/Sprint Events 20-20-60 20-25-55 15-30-55
Swimming, Mid-Distance Events 20-20-60 20-25-55 20-25-55
Swimming, Long-Distance Events 20-20-60 20-20-60 20-20-60
Tennis 20-20-60 20-25-55 20-25-55
Track & Field, Power/Sprint Events 20-20-60 20-25-55 15-30-55
Track & Field, Mid-Distance Events 20-20-60 20-25-55 20-25-55
Track & Field, Long-Distance Events 25-15-60 25-15-60 25-15-60
Triathlon 25-15-60 25-15-60 25-15-60
Volleyball 20-20-60 20-25-55 20-25-55
Weightlifting 20-25-55 15-30-55 10-15/30 to 40/50-55
Wrestling 20-20-60 20-25-55 15-30-55
Athlete 1
Athlete 2
462 | Unit 17

15% Fat, 30% Protein, 55% Carbohydrate Athlete-Type Sports

Nutrition Plan Examples

The 15% fat, 30% protein, 55% carbohydrate daily nutrition plan can be
suitable for massive power athletes, driven by the extremely short-term
immediate energy system. Athletes such as football players, powerlifters,
sprinters, and bodybuilders will do best following this nutrition plan
during the season. When training or competing, these athletes rely
primarily on the immediate, and to a lesser extent, the glycolytic energy
systems. They have massive muscles, with highly developed fast-twitch
muscle fibers. Because of this, these athletes require a high amount of
protein to maintain positive nitrogen balance and to repair their fragile
fast-twitch muscle fibers. Because muscle glycogen is the primary energy
source used for replenishing the ATP and CP stores, a diet that is low in
fat and rich in carbohydrates is indicated. It should be low in fat because
not much fat is used up during training and competition and rich in
carbohydrates because the muscles’ supply of glycogen needs to be
restored every day, or performance and recovery will be impaired.

Note: Although many athletes are reported to be at risk or deficient in

either total daily calories and/or one or more of the essential nutrients,
low carbohydrate intake is a top concern. Therefore, as a reminder, the
following has been added to each eating occasion in the examples: (Extra
carbohydrates as required.) Extra carbohydrates may be required at one
or more of the eating occasions depending on whether the total daily
intake requirements have been met or whether extra carbs are needed
to prepare for long training sessions or events to reduce glycogen use, or
post training session or events to replenish glycogen levels.

Sports Nutrition
15% Fat, 30% Protein, 55% Carbohydrate Training Days Examples (for illustration only)
2,500 Calories Per Day Eating Plan Example 3,500 Calories Per Day Eating Plan Example
15% Fat, 375 Calories, 42 grams 15% Fat, 525 Calories, 58 grams
30% Protein, 750 Cal, 188 grams 30% Protein, 1,050 Cal, 263 grams
55% Carbohydrates, 1,375 Cal, 344 grams 55% Carbohydrates, 1,925 Cal, 481 grams
Trainig Days
Breakfast–Meal Goal: 500 cal, 40g P, 62.5g C, 10g F Breakfast–Meal Goal: 573 Cal, 51g P, 64g C, 13g F

• Take dietary supplements as required • Take dietary supplements as required

• 2 c. Egg alternative, Fleishmann’s Egg Beaters Vegetable • 2 1/2 c. Egg alternative, Fleishmann’s Egg Beaters Vegetable
Omelet, 200 cal, 28g P 20g C, 0g F Omelet, 250 cal, 35 g P, 25g C, 0gF

• 1 slice Canadian Bacon, 86 cal, 11.3g P, 0.6g C, 3.9g F • 1 slice Canadian Bacon, 86 cal, 12g P, 0g C, 3.9g F

• 4 oz Boiled potato, no skin, 99 cal, 2.1g P, 22.8g C, 0.1g F • 4 oz Boiled potato no skin, 99 cal, 2.1g P, 22.8 g C, 0.1g F

• 1/2 T. Butter, 50 cal, 0.1g P, 0g C, 5.7g F • 2/3 T. Butter, 67 cal, 0.1g P, 0g C, 7.6g F

• 6 oz Grapefruit juice, 60 cal, 1g P, 15g C, 0g F. • 12 oz Grapefruit Juice, 120 cal, 2g P, 30g C, 0g F.

Morning Snack–Meal Goal: 225 cal, 30g P,15g C, 5g F Morning Snack–Meal Goal: 470, 40g P, 64g C, 6g F
• Take dietary supplements as required. • Take dietary supplements as required
• Protein Nutrition Bar, Low Calorie, 225 cal, 30g P, 15g C, 5g • Protein Nutrition Bar, Medium Calorie, 470 calories, 40g P,
F. 64g C, 6g F.
Lunch–Meal Goal: 500 cal, 40 g P, 62.5 g C, 10g F Lunch–Meal Goal: 573 Cal, 51g P, 64g C, 13g F
• Take dietary supplements as required. • Take dietary supplements.
• 1 orange, medium, 62 cal, 1.2g P, 15.4g C, 0.2g F • 1 orange, medium, 62 cal, 1.2g P, 15.4g C, 0.2g F
• 2 slices, bread, whole grain, 170 cal, 7.8g P, 34.8g C, 3.2g F • 2 slices, bread, whole grain, 170 cal, 7.8g P, 34.8g C, 3.2g F
• 4 oz chicken breast, no skin, 124 cal, 26g P, 0g C, 1.6g F • 6 oz chicken breast, no skin, 186 cal, 39g P, 0g C, 2.4g F
• 1 T. Salad Dressing, oil & vinegar, 45 cal, 0g P, 1g C, 4g F • 1 1/2 T., Salad Dressing, (Seven Seas), oil & vinegar, 68 cal,
0g P, 1.5g C, 6g F
• 2 oz, Lettuce, iceberg, trimmed, 8 cal, 0.6g P, 1.2g C, 0.2g F
• 2 oz, Lettuce, iceberg, trimmed, 8 cal, 0.6g P, 1.2g C, 0.2g F
• 4 oz, broccoli spears (Birds Eye), 30 cal, 4g P, 6g C, 0g F
• 4 oz, broccoli spears (Birds Eye), 30 cal, 4g P, 6g C, 0g F
• 2 oz carrot, raw, 24 cal, 0.6g P, 5.8g C, 0.2g F.
• 2 oz carrot, raw, 24 cal, 0.6g P, 5.8g C, 0.2g F.
Pre-Training Snack– 2 1/2 hours before training. Pre-Training Snack– 2 1/2 hours before training.
• Protein Drink, Low Calorie, 225 cal, 30 g P, 15 g C, 5 g F • Protein Drink, Medium Calorie, 470 cal, 40g P, 64g C, 6g F
• THEN BCAAs supplement 30 minutes before workout with • THEN BCAAs supplement 30 minutes before workout with
water. water.
• Workout carbohydrate sports drink, high calorie, 16 oz • Workout carbohydrate sports drink, high calorie, 20 oz
during workout, 400 cal, 0g P, 100g C, 0g F. during workout, 500 cal, 0g P, 125g C, 0g F.
Dinner–Meal Goal: 650 cal, 48g P, 87.5g C, 12g F Dinner–Meal Goal: 914 cal, 81g P, 100g C, 20g F
• Take dietary supplements. • Take dietary supplements.
• 1 lean pork chop, (Master Choice), 120 cal, 22g P, 0g C, 4g • 2 1/2 lean pork chops, (Master Choice), 300 cal, 55g P, 0g
F C, 10g F
• 8 oz, Baked Beans, Barbecue (B&M), 260 cal, 15g P, 48g C, • 8 oz, Baked Beans, Barbecue (B&M), 260 cal, 15g P, 48g C,
6g F 6g F
• 6 oz Spinach, 36 cal, 4.8g P, 6g C, 0.6g F • 6 oz Spinach, 36 cal, 4.8g P, 6g C, 0.6g F
• 1 Tomato, 26 cal, 1g P, 5.7g C, 0.4g F • 1 Tomato, 26 cal, 1g P, 5.7g C, 0.4g F
• 8 oz Skim Milk, 86 cal, 8.4g P, 11.9g C, 0.4g F • 8 oz Skim Milk, 86 cal, 8.4g P, 11.9g C, 0.4g F
• 4 oz, fruit cocktail, canned, in light syrup, Cal 65, 0.5g P, • 4 oz, fruit cocktail, canned, in light syrup, Cal 65, 0.5g P,
16.9g C, 0.1g F. 16.9g C, 0.1g F.
Additional meal/snack/sports nutritionals, supplements. Additional meal/snack/sports nutritionals, supplements.
(Extra carbohydrates as required). (Extra carbohydrates as required).
Note that pre-workout and post-workout caloric beverages will add to the total daily caloric intake, as will extra caloric
drinks during the workout. Changes are required for each athlete.
464 | Unit 17

20% Fat, 25% Protein, 55% Carbohydrate Athlete-Type Sports

Nutrition Plan Examples

The 20% fat, 25% protein, 55% carbohydrate daily nutrition plan
can be suitable for individuals who participate in sports and fitness
activities that require explosive strength and power on a sustained or
highly repetitive basis. When training for or during competition, these
individuals rely primarily on the glycolytic energy systems. Muscle
glycogen is their primary source of energy. These individuals need
to consume large amounts of protein to maintain a positive nitrogen
balance and to repair their fragile fast-twitch muscle fibers.

Note: Although many athletes are reported to be at risk or deficient in

either total daily calories and/or one or more of the essential nutrients,
low carbohydrate intake is a top concern. Therefore, as a reminder, the
following has been added to each eating occasion in the examples (Extra
carbohydrates as required): Extra carbohydrates may be required at one
or more of the eating occasions depending on whether the total daily
intake requirements have been met or whether extra carbs are needed
to prepare for long training sessions or events to reduce glycogen use, or
post training session or events to replenish glycogen levels.

Sports Nutrition
15% Fat, 25% Protein, 55% Carbohydrate: Examples (for illustration only)
2,500 Calories Per Day Eating Plan Example 3,500 Calories Per Day Eating Plan Example
20% Fat, 500 Calories, 56 grams 20% Fat, 700 Calories, 78 grams
25% Protein, 625 Calories, 156 grams 25% Protein, 875 Cal, 219 grams
55% Carbohydrates, 1375 Calories, 344 grams 55% Carbohydrates, 1925 Cal, 481 grams
Trainig Days
Breakfast–Meal Goal: 465 Calories, 27g P, 60g C, 13g F Breakfast–Meal Goal: 579 cal, 38.5g P, 61g C, 18.5g F
• Take dietary supplements as required. • Take dietary supplements as required.
• 1 cup Egg alternative, Fleishmann’s Egg Beaters Vegetable • 1 1/2cups Egg alternative, Fleishmann’s Egg Beaters Vegeta-
Omelet, 100 cals, 14g P 10g C, 0g F ble Omelet, 150 cal, 21 g P, 15g C, 0g F
• 1 slice Canadian Bacon, 86 cals, 12g P, 0g C, 4g F • 1 slice Canadian Bacon, 86 cal, 12g P, 0g C, 4g F
• 4 oz Boiled potato, pulp, 117 cals, 2g P, 28g C, 0g F • 4 oz Boiled potato pulp, 117 cal, 2g P, 28 g C, 0g F
• 2/3 tbsp Butter, 81 cals, 0g P, 0g C, 9g F • 1 tbsp Butter, 100 cal, 0g P, 0g C, 11.4g F
• 9 oz Grapefruit juice, 90 cals, 0g P, 22.5g C, 0g F. • 6 oz Grapefruit Juice, 60 cal, 0g P, 15g C, 0g F
• 4 oz Milk, 2%, 60 cal, 4g P, 5.5g C, 2g F.
Morning Snack–Meal Goal: 225 cal, 30g P,15g C, 5g F Morning Snack–Meal Goal: 470, 40g P, 64g C, 6g F
• Take dietary supplements as required. • Take dietary supplements as required
• Protein Nutrition Bar, Medium Calorie, 470 calories, 40g P, • Protein Nutrition Bar, Low Calorie, 225 cal, 30g P, 15g C, 5g
64g C, 6g F. F.
Lunch–Meal Goal: 465 cal, 27g P, 60g C, 13g F Lunch–Meal Goal: 579 cal, 38.5g P, 61g C, 18.5g F
• Take dietary supplements as required. • Take dietary supplements as required.
• 1 orange, medium, 62 cal, 1g P, 13g C, 0g F • 1 orange, medium, 62 cal, 1g P, 13g C, 0g F
• 2 slices, bread, whole grain, 170 cal, 8g P, 34g C, 3g F • 1 roll, Hoagie, 210 cal, 8g P, 34g C, 5g F
• 2 oz chicken breast, no skin, 62 cal, 13g P, 0g C, 1g F • 4 oz chicken breast, no skin, 124 cal, 26g P, 0g C, 2g F
• 2 tbsps, Salad Dressing, (Seven Seas), oil & vinegar, 90 cal, • 3 tbsps, Salad Dressing, (Seven Seas), oil & vinegar, 135 cal,
0g P, 2g C, 8g F 0g P, 3g C, 12g F
• 2 oz, Lettuce, iceberg, trimmed, 8 cal, 0.5g P, 1.5g C, 0g F • 2 oz, Lettuce, iceberg, trimmed, 8 cal, 0.5g P, 1.5g C, 0g F
• 4 oz, broccoli spears (Birds Eye), 30 cal, 4g P, 6g C, 0g F • 4 oz, broccoli spears (Birds Eye), 30 cal, 4g P, 6g C, 0g F
• 2 oz carrot, raw, 24 cal, 1g P, 6g C, 0g F. • 2 oz carrot, raw, 24 cal, 1g P, 6g C, 0g F.
Pre-Training Snack– 2 1/2 hours before training. Pre-Training Snack– 2 1/2 hours before training.
• Protein Drink, Low Calorie, 225 cal, 30 g P, 15 g C, 5 g F • Protein Drink, Medium Calorie, 470 cal, 40g P, 55g C, 10g F
• THEN BCAAs supplement 30 minutes before workout, with • THEN BCAAs supplement 30 minutes before workout with
water. water.
• Workout carbohydrate sports drink, high calorie, 16 oz • Workout carbohydrate sports drink, high calorie, 20 oz
during workout, 400 cal, 0g P, 100g C, 0g F. during workout, 500 cal, 0g P, 125g C, 0g F.
Additional meal/snack/sports nutritionals, supplements. Additional meal/snack/sports nutritionals, supplements.
(Extra carbohydrates as required). (Extra carbohydrates as required).
Note that pre-workout and post-workout caloric beverages will add to the total daily caloric intake, as will extra caloric
drinks during the workout. Changes are required for each athlete.
Dinner–Meal Goal: 724 cal, 42g P, 94g C, 20g F Dinner–Meal Goal: 901 cal, 62g P, 98g C, 29g F
• Take dietary supplements as required. • Take dietary supplements as required.
• 3 oz Beef, Bottom Round, prime, untrimmed, 192 cal, 17.1g • 5 oz Beef, Bottom Round, prime, trimmed, 225 cal, 31g P,
P, 0g C, 13.2g F 0g C, 10.5g F
• 2 oz pasta, 210 cal, 9g P, 41g C, 1g F • 2 oz pasta, 210 cal, 9g P, 41g C, 1g F
• 4 oz pasta sauce, (Ragu), Mushroom Thick and Hearty, 100 • 1/2 tbsp olive oil, cal 60, 0g P, 0g C, 7g F
cal, 2g P, 15g C, 3g F • 4 oz pasta sauce, (Ragu), Mushroom Thick and Hearty, 100
• 12 oz Spinach, 72 cal, 9.6g P, 12g C, 1.2g F cal, 2g P, 15g C, 3g F
• 8 oz Skim Milk, 86 cal, 8.4g P, 11.9g C, 0.4g F • 12 oz Spinach, 72 cal, 9.6g P, 12g C, 1.2g F
• 4 oz, fruit cocktail, canned, in light syrup, Cal 65, 0.5g P, • 8 oz Milk, whole, 150 cal, 8g P, 11g C, 8g F
16.9g C, 0.1g F. • 4 oz, fruit cocktail, canned, in light syrup, Cal 65, 0.5g P,
16.9g C, 0.1g F.
466 | Unit 17

20% Fat, 20% Protein, 60% Carbohydrate Athlete-Type Sports

Nutrition Plan Examples

The 20% fat, 20% protein, 60% carbohydrate daily nutrition plan can be
suitable for individuals who participate in sports or fitness activities that
require explosive strength and power on a sustained or highly repetitive
basis. However, although these individuals rely to some extent on the
glycolytic energy systems, they also depend primarily on the oxidative
energy systems. Fatty acids and muscle glycogen are these individuals’
primary fuel sources during activity. Therefore, these athletes need to
consume just moderate amounts of protein to maintain positive nitrogen
balance and to repair their fragile fast-twitch muscle fibers.

Note: Although many athletes are reported to be at risk or deficient in

either total daily calories and/or one or more of the essential nutrients,
low carbohydrate intake is a top concern. Therefore, as a reminder, the
following has been added to each eating occasion in the examples: (Extra
carbohydrates as required.) Extra carbohydrates may be required at one
or more of the eating occasions. This will depend on whether the total
daily intake requirements have been met, whether extra carbs are needed
to prepare for long training sessions or events to reduce glycogen use or
for post training sessions or events to replenish glycogen levels.

Sports Nutrition
20% Fat, 20% Protein, 60% Carbohydrate: Examples (for illustration only)
2,500 Calories Per Day Eating Plan Example 3,500 Calories Per Day Eating Plan Example
20% Fat, 500 Calories, 56 grams 20% Fat, 700 Calories, 78 grams
20% Protein, 500 Cal, 125 grams 20% Protein, 700 Cal, 175 grams
60% Carbohydrates, 1500 Cal, 375 grams 60% Carbohydrates, 2100 Cal, 525 grams
Trainig Days
Breakfast–Meal Goal: 475 cal, 23.5g P, 67g C, 12.5g F Breakfast–Meal Goal: 489 cal, 36g P, 52.5g C, 15g F
• Take dietary supplements as required. • Take dietary supplements as required.

• 3 pancakes, buttermilk, Hungry Jack, prepared, 200 cal, 6g • 3 pancakes, buttermilk, Hungry Jack, prepared, 200 cal, 6g
P, 28g C, 7g F P, 28g C, 7g F

• 3 oz ham, fresh, trimmed, 117 cal, 18g P, 0g C, 4.5g F • 4 oz ham, fresh, trimmed, 156 cal, 24g P, 0g C, 6g F

• 8 oz Vegetable juice (V8), 47 cal, 1.3g P, 10.7g C, 0g F • 8 oz skim milk, 86 cal, 8.4g P, 11.9g C, 0.4g F

• 3 1/2 tbsp Pancake Syrup, (Hungr y Jack), lite, 88 cal, 0g P, • 2 tbsp Pancake syrup, (Hungry Jack), lite, 50 cal, 0g P, 14g
24.5g C, 0g F. C, 0g F.

Morning Snack–Meal Goals: 270 cal, 12gP, 45gC, 6g F Morning Snack–Meal Goals: 440 cal, 16gP, 68gC, 12gF
• Take dietary supplements as required • Take dietary supplements as required.
• 1 Food Bar, (Earth Grains), Banana apple walnut, 270 cal, • 1 Food Bar, Pemmician, carob-cocoa, (Bear Valley), 440 cal,
12g P, 45g C, 6g F. 16g P, 68g C, 12g F.
Lunch–Meal Goal: 425 cal, 23.5g P, 67g C, 12.5g F Lunch–Meal Goal: 489 cal, 36g P, 52.5g C, 15g F
• Take dietary supplements as required. • Take dietary supplements as required.
• 1/2 oz American cheese, 55 cal, 3 g P, 0.5 g C, 4.5g F • 1/2 oz American Cheese, 55 cal, 3 g P, 0.5g C, 4.5 g F
• 1 sandwich roll, 123 cal, 4.5g P, 21.6g C, 3.3 g F • 1 sandwich roll, 123 cal, 4.5g P, 21.6 g C, 3.3 g F
• 3 slices, turkey (Tyson), 60 cal, 12g P, 0.9 g C, 1.2g F • 6 slices, turkey (Tyson), 120 cal, 24 g P, 1.8g C, 2.4g F
• 2 oz Iceberg lettuce, trimmed, 8 cal, 0.6g P, 1.2g C, 0.2g F • 2 oz Iceberg lettuce, trimmed, 8 cal, 0.6g P, 1.2g C, 0.2g F
• 3 tablespoon mustard, 30 cal, 3g P, 3g C, 3g F • 3 T. mustard, 30 cal, 3g P, 3g C, 3g F
• 2 oz Apricot Dried (Del Monte), 140 cal, 2g P, 35g C, 0g F. • 1 banana, w/o skin, 105 cal, 1.2g P, 26.7g C, 0.6g F.
Pre-Training Snack– 2 1/2 hours before training. Pre-Training Snack– 2 1/2 hours before training.
• Protein Drink, High Calorie, 548 cal, 30g P, 80g C, 12g F • Protein Drink, Low Calorie, 225 cal, 30g P, 15g C, 5g F
• THEN BCAA’s supplement 30 minutes before workout with • THEN BCAA’s supplement 30 minutes before workout with
water. water.
• Workout carbohydrate sports drink, high calorie, 20 oz • Workout carbohydrate sports drink, high calorie, 16 oz
during workout, 500 cal, 0g P, 125g C, 0g F. during workout, 400 cal, 0g P, 100g C, 0g F.
Dinner–Meal Goal: 748 cal, 36g P, 106g C, 20g F Dinner–Meal Goal: 1,034 cal, 57g P, 147g C, 24g F

• Take dietary supplements. as required • Take dietary supplements as required.

• 4 oz tuna, bluefin, 164 cal, 26.4 g P, 0g C, 5.6g F • 6 oz tuna, bluefin, 246 cal, 39.6 g P, 0g C, 8.4g F
• 1 tomato, 4.75 oz, 26 cal, 1g P, 5.7g C, 0.4g F • 1 tomato, 4.75 oz, 26 cal, 1g P, 5.7g C, 0.4g F
• 8 oz Iceberg lettuce, trimmed, 32 cal, 2.4g P, 4.8g C, 0.8g F • 8 oz Iceberg lettuce, trimmed, 32 cal, 2.4g P, 4.8g C, 0.8g F
• 2 oz onion, trimmed, 22 cal, 0.6g P, 4.8g C, 0.2g F • 2 oz onion, trimmed, 22 cal, 0.6g P, 4.8g C, 0.2g F
• 3 oz brown rice, 315 cal, 6.9g P, 65.7g C, 2.4g F • 1 oz garbanzo bean, 103 cal, 5.5g P, 17.2 g C, 1.7g F
• 6 oz cauliflower, 42 cal, 23.6g P, 8.4g C, 0.6 g F • 3 oz brown rice, 315 cal, 6.9g P, 65.7g C, 2.4g F
• 2 T. Salad dressing, (Seven Seas), oil & vinegar, 90 cal, 0g P, • 6 oz cauliflower, 42 cal, 3.6g P, 8.4g C, 0.6 g F
2 g C, 8g F • 2 T. Salad dressing, (Seven Seas), oil & vinegar, 90 cal, 0g P,
• 3 oz grape juice, 60 cal, 0g P, 15g C, 0g F. 2 g C, 8g F
• 3 oz grape juice, 60 cal, 0g P, 15g C, 0g F.
Additional meal/snack/sports nutritionals, supplements. Additional meal/snack/sports nutritionals, supplements.
(Extra carbohydrates as required). (Extra carbohydrates as required).
Note that pre-workout and post-workout caloric beverages will add to the total daily caloric intake, as will extra caloric
drinks during the workout. Changes are required for each athlete.
468 | Unit 17

25% Fat, 15% Protein, 60% Carbohydrate Athlete-Type Sports

Nutrition Plan Examples

The 25% fat, 15% protein, 60% carbohydrate daily nutrition plan can
be useful for individuals who participate in aerobic sports or fitness
activities. When training or during competition, these individuals rely
primarily on oxidative energy systems. Their muscles are composed
of highly developed slow-twitch muscle fibers. Because of this, these
individuals need to consume large amounts of carbohydrates to
maintain their glycogen stores, due to the long duration of training and
events. However, fatty acids are their primary source of energy, so they
should consume a moderate amount of healthy fats and oils. The amount
of protein for this group of individuals is the lowest of the four plans, but
is still about two times more than non-athletes require.

Note: Although many athletes are reported to be are risk or deficient in

either total daily calories and or one or more of the essential nutrients,
low carbohydrate intake is a top concern. Therefore, as a reminder the
following has been added to each eating occasion in the examples: (Extra
carbohydrates as required.). Extra carbohydrates may be required at
one or more of the eating occasions depending if the total daily intake
requirements have not been met, or if extra carbs are needed to prepare
for long training sessions or events to reduce glycogen use, or post
training session or events to replenish glycogen levels.

Sports Nutrition
25% Fat, 15% Protein, 60% Carbohydrate: Examples (for illustration only)
2,500 Calories Per Day Eating Plan Example 3,500 Calories Per Day Eating Plan Example
25% Fat, 625 Calories, 69 grams 25% Fat, 875 Calories, 97 grams
15% Protein, 375 Cal, 94 grams 15% Protein, 525 Cal, 131 grams
60% Carbohydrates, 1500 Cal, 375 grams 60% Carbohydrates, 2100 Cal, 525 grams
Trainig Days
Breakfast–Meal Goal: 440 cal, 20g P, 50g C, 16.5g F Breakfast–Meal Goal: 550 cal, 24g P, 70g C, 20.5g F

• Take dietary supplements as required. • Take dietary supplements as required.

• 3 pancakes, buttermilk, Hungry Jack, prepared, 200 cal, 6g • 3 pancakes, buttermilk, Hungry Jack, prepared, 200 cal, 6g
P, 28g C, 7g F P, 28g C, 7g F

• 2 oz ham, fresh, trimmed, 78 cal, 12g P, 0g C, 3g F • 3 oz ham, fresh, trimmed, 117 cal, 18g P, 0g C, 4.5g F

• 12 oz Vegetable juice (V8), 70 cal, 2g P, 16g C, 0g F • 12 oz Vegetable juice (V8), 70 cal, 2g P, 16g C, 0g F
• 2 T. Pancake Syrup, (Hungry Jack), lite, 50 cal, 0g P, 14g C, • 4 T. Pancake Syrup, (Hungry Jack), lite, 100 cal, 0g P, 25g C,
0g F 0g F

• 1/2 tablespoon butter, 50 cal, 0.1g P, 0g C, 5.7g F. • 2/3 tablespoon butter, 67 cal, 0.1g P, 0g C, 7.6g F.

Morning Snack–Meal goal: 230 cal, 10gP, 45gC, 2.5g F Morning Snack–Meal Goal: 440 cal, 16gP, 68gC, 12g F
• Take dietary supplements as required. • Take dietary supplements as required.
• 1 Power Bar, 230 cal, 10g P, 45g C, 2.5g F. • 1 Food Bar, Pemmician, carob-cocoa, (Bear Valley), 440 cal,
16g P, 68g C, 12g F.
Lunch–Meal Goal: 440 cal, 20g P, 50g C, 16.5g F Lunch–Meal Goal: 560 cal, 24g P, 70g C, 20.5g F
• Take dietary supplements as required. • Take dietary supplements as required.
• 1 oz American cheese, 110 cal, 6g P, 1g C, 9g F • 1 oz slice American cheese, 110 cal, 6g P, 1g C, 9g F
• 1 sandwich roll, 123 cal, 4.5g P, 21.6g C, 3.3 g F • 1 sandwich roll, 123 cal, 4.5g P, 21.6g C, 3.3 g F
• 2 slices, turkey (Tyson), 40 cal, 8g P, 0.6 g C, 0.8g F • 3 slices, turkey (Tyson), 60 cal, 12g P, 0.9 g C, 1.2g F
• 2 oz Iceberg lettuce, trimmed, 8 cal, 0.6g P, 1.2g C, 0.2g F • 2 oz Iceberg lettuce, trimmed, 8 cal, 0.6g P, 1.2g C, 0.2g F
• 2 T. mustard, 20 cal, 2g P, 2g C, 2g F • 2 tbsp mustard, 32 cal, 2g P, 2g C, 2g F
• 2 oz Apricot Dried (Del Monte), 140 cal, 2g P, 35g C, 0g F. • 2 oz Apricot Dried (Del Monte), 140 cal, 2g P, 35g C, 0g F
• 1/3 tablespoon safflower oil, 40 cal, 0g P, 0g C, 4.7g F
• 6 oz grapefruit juice, 60 cal, 1.0g P, 15g C, 0g F.
Pre-Training Snack– 2 1/2 hours before training. Pre-Training Snack– 2 1/2 hours before training.
• 1 Food Bar, (Earth Grains), Banana Apple Walnut, 270 cal, • Protein Drink, High Calorie, 548 cal, 30g P, 80g C, 12g F
12 g P, 45 g C, 6 g F • THEN BCAA’s supplement 30 minutes before workout with
• THEN BCAA’s supplement 30 minutes before workout with water.
water. • Workout carbohydrate sports drink, high calorie, 20 oz
• Workout carbohydrate sports drink, high calorie, 16 oz during workout, 500 cal, 0g P, 125g C, 0g F.
during workout, 400 cal, 0g P, 100g C, 0g F.
Dinner–Meal Goal: 720 cal, 32g P, 85g C, 27.5g F Dinner–Meal Goal: 892 cal, 37g P, 112g C, 32g F
• Take dietary supplements as required. • Take dietary supplements as required.
• 3 oz tuna, bluefin, 123 cal, 19.8g P, 0g C, 4.2g F • 3 oz tuna, bluefin, 123 cal, 19.8g P, 0g C, 4.2g F
• 1 tomato, 4.75 oz, 26 cal, 1g P, 5.7g C, 0.4g F • 1 tomato, 4.75 oz, 26 cal, 1g P, 5.7g C, 0.4g F
• 4 oz Iceberg lettuce, trimmed, 16 cal, 1.2g P, 2.4g C, 0.4g F • 4 oz Iceberg lettuce, trimmed, 16 cal, 1.2g P, 2.4g C, 0.4g F
• 2 oz onion, trimmed, 22 cal, 0.6g P, 4.8g C, 0.2g F • 2 oz onion, trimmed, 22 cal, 0.6g P, 4.8g C, 0.2g F
• 3 oz brown rice, 315 cal, 6.9g P, 65.7g C, 2.4g F • 4 oz brown rice, 420 cal, 9.2g P, 87.6g C, 4g F
• 6 oz cauliflower, 42 cal, 3.6g P, 8.4g C, 0.6 g F • 6 oz cauliflower, 42 cal, 3.6g P, 8.4g C, 0.6 g F
• 4 T. Salad dressing, (Seven Seas), oil & vinegar, 180 cal, 0g • 5 T. Salad dressing, (Seven Seas), oil & vinegar, 225 cal, 0g
P, 4 g C, 16g F. P, 5 g C, 20g F.
Additional meal/snack/sports nutritionals, supplements. Additional meal/snack/sports nutritionals, supplements.
(Extra carbohydrates as required). (Extra carbohydrates as required).
Note that pre-workout and post-workout caloric beverages will add to the total daily caloric intake, as will extra caloric drinks during the
workout. Changes are required for each athlete.
470 | Unit 17

Date: Type of day: training r or nontraining r

Macronutrients ratio to follow: 15:30:55 r 20:25:55 r 20:20:60 r or 25:15:60 r

Daily goals: calories, grams protein, grams carbohydrates, and grams fat
Breakfast
Meal goals: calories, grams protein, grams carbohydrates, and grams fat
FOOD AND PORTION CALORIES PROTEIN (GRAMS) CARBS (GRAMS) FAT (GRAMS)

Meal subtotals
Supplements taken with or after meal:

Morning Snack
Meal goals: calories, grams protein, grams carbohydrates, and grams fat
FOOD AND PORTION CALORIES PROTEIN (GRAMS) CARBS (GRAMS) FAT (GRAMS)

Meal subtotals
Supplements taken with or after meal:

Lunch
Meal goals: calories, grams protein, grams carbohydrates, and grams fat
FOOD AND PORTION CALORIES PROTEIN (GRAMS) CARBS (GRAMS) FAT (GRAMS)

Meal subtotals
Supplements taken with or after meal:

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Afternoon Snack
Meal goals: calories, grams protein, grams carbohydrates, and grams fat
FOOD AND PORTION CALORIES PROTEIN (GRAMS) CARBS (GRAMS) FAT (GRAMS)

Meal subtotals
Supplements taken with or after meal:

Dinner
Meal goals: calories, grams protein, grams carbohydrates, and grams fat
FOOD AND PORTION CALORIES PROTEIN (GRAMS) CARBS (GRAMS) FAT (GRAMS)

Meal subtotals
Supplements taken with or after meal:

GRAND TOTALS

Notes:

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Nutrient/Supplement Intake Worksheet Example

NUTRIENT / INGREDIENT AMOUNTS FROM DAILY TOTALS / NOTES
EXAMPLES Supplements/Food

Vitamin A (preformed, such as

retinol)
Beta Carotene

Vitamin B1 (thiamin)

Vitamin B2 (riboflavin)

Vitamin B3 (niacin)

Vitamin B5 (pantothenic acid)

Vitamin B6 (pyridoxine)

Vitamin B12 (cobalamin)

Biotin

Folate

Vitamin C

Vitamin D

Vitamin E

Vitamin K

Boron

Calcium

Chromium

Copper

Iodine

Iron

Magnesium

Manganese

Molybdenum

Phosphorus

Potassium

Selenium

Sodium

Zinc

Protein

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NUTRIENT / INGREDIENT AMOUNTS FROM DAILY TOTALS / NOTES

EXAMPLES Supplements/Food
Carbohydrates

Fiber

Glutamic acid

Glutamine

Branched-Chain Amino Acids

(BCAAs)
Fat

Alpha-linolenic acid

Docosahexaenoic acid (DHA)

Eiocosapentaenoic acid (EPA)

Gamma linolenic acid (GLA)

Linoleic acid

Inositol

Choline

Pycnogenol ®

Coenzyme Q10

L-carnitine

Beta-Alanine

Creatine

Glucosamine

Chondroitin Sulfate

BHMB

Bicarbonate

Caffeine

Gamma Oryzanol / Ferulic

Acid
Ginsengs

Nitrates (e.g., Beet Root)

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Percentages versus Amounts per

Pound/Kilogram of Body Weight
A frequent question from students and a topic of debate among experts
is about percentages of fats, protein, and carbohydrates versus grams
per kilogram of body weight (mass) for determining a sports nutrition
diet. The simple answer is that they both have value. In some ways,
these two approaches are different sides of the same coin so to speak.
Both approaches end up with quantitative amounts. Although both
approaches have strong points in support of them and their viability,
there is feasibility to use both approaches for double-checking, for
analysis, and for calculations.

The percentage approach, based on actual daily calorie expenditure

needs, is tied to a metabolic measurement and can make constructing
a program an easier task. Percentages based on the actual daily energy
expenditure help provide adequate calories and carbohydrates, with
protein and fats falling into place. Because the percentage approach
has been introduced, it has caught on and can be found being used
in various forms by athletic organizations, in scientific research, and
in textbooks (McArdle 2007, IOC 2000, Weatherwax-Fall 2006).
This includes the trend for sports nutrition programs that are higher
carbohydrate, lower fat, and higher protein, relatively speaking. In
addition, there are different percentages or percentage ranges for
different types of athletes, such as for endurance and strength athletes
and multi-energetic sports.

However, the grams per kilogram of body weight or lean body mass
is also important, especially for protein as reviewed in Unit 4, which
is based on lean body mass. This helps provide a cross-check to the
percentage approach. Therefore, using both methods can be useful,
especially during the initial stage of determining an athlete’s nutrition
requirements. One major limitation of the grams per kilogram of body
weight approach is variations in the body fat of individuals and having
to rely on making estimates of activity and actual caloric expenditure.
Furthermore, day-to-day differences in total caloric expenditure
based on physical activity / training variations may be challenging to
estimate. Some examples of grams per kilogram of body weight will be
provided in the following macronutrients section. Grams per kilogram
of lean body mass can be considered a preferred approach when body
composition data are gathered.

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Another issue worth repeating here concerns sports nutrition for day-
to-day training/workouts/exercise and for athletic events/competitions.
Examples in this unit and others are primarily offered as a guide for day-
to-day training sports nutrition. These examples can also serve to build
from for pre-competition day and competition day sports nutrition, as
noted in the respective units. Interestingly, for some sports, the daily
calories can be more for training days than for competitions/events, and
for other sports, the daily calories can be more for competitions/events
than for training days.

Another point is that as daily caloric intake requirements become very

high, further adjustments to the relative intakes of fats, carbohydrates,
and protein are required. For example, reducing protein and increasing
fats and carbohydrates may be required as high protein intake maxes
out. This area of sports nutrition fine-tuning is challenging but
worth the effort and can be a major factor for achieving peak athletic
performance, in addition to training and other athletic performance
factors. Using rates of intake based on body weight or body mass implies
that individuals are in good shape, with athletic body fat levels. Some
norming of the rates may be needed when dealing with athletes with
excess body fat levels, by estimating ideal body weight using normal
body fat ranges.

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Macronutrients – Some Summary Points

To start, the following reference tables provide a summary of how the different macronutrient
percentages result in total daily grams based on various daily caloric intakes. This provides a
quick summary that can be used for nutrition planning. Some additional information regarding
macronutrients is also included below.

Protein Daily Intake at 15% of Protein Daily Intake at 20% of

Total Daily Caloric
Total Daily Calories Total Daily Calories
Intake Example Values
(Calories and Amount) (Calories and Amount)
2,000 Calories 300 Cals, 75 grams 400 Cals, 100 grams
2,500 Calories 375 Cals, 94 grams 500 Cals, 125 grams
3,000 Calories 450 Cals, 113 grams 600 Cals, 150 grams
3,500 Calories 525 Cals, 131 grams 700 Cals, 175 grams
4,000 Calories 600 Cals, 150 grams 800 Cals, 200 grams
Protein Daily Intake at 25% of Protein Daily Intake at 30% of
Total Daily Caloric
Total Daily Calories Total Daily Calories
Intake Example Values
(Calories and Amount) (Calories and Amount)
2,000 Calories 500 Cals, 125 grams 600 Cals, 150 grams
2,500 Calories 625 Cals, 156 grams 750 Cals, 188 grams
3,000 Calories 750 Cals, 188 grams 900 Cals, 225 grams
3,500 Calories 875 Cals, 219 grams 1050 Cals, 263 grams
4,000 Calories 1000 Cals, 250 grams 1200 Cals, 300 grams
Protein Daily Intake was calculated as follows, Total Daily Caloric Intake times 0.15, 0.20, 0.25, or 0.30.

Example: 3,000 Calories × 0.20 = 600 Calories.

Protein Daily Intake in grams was calculated as follows, Total Daily Caloric Intake divided by 4 calories per gram. Exam-
ple: 600 Calories / 4 calories per gram = 150 grams

Carbohydrate Daily Intake at Carbohydrate Daily Intake at

Total Daily Caloric
55% of Total Daily Calories 60% of Total Daily Calories
Intake Example Values
(Calories and Amount) (Calories and Amount)
2,000 Calories 1,100 Cals, 275 grams 1200 Cals, 300 grams
2,500 Calories 1,375 Cals, 374 grams 1,500 Cals, 375 grams
3,000 Calories 1,650 Cals, 413 grams 1,800 Cals, 450 grams
3,500 Calories 1,925 Cals, 481 grams 2,100 Cals, 525 grams
4,000 Calories 2,200 Cals, 550 grams 2,400 Cals, 600 grams
4,500 Calories 2,475 Cals, 619 grams 2,700 Cals, 675 grams
Carbohydrate Daily Intake was calculated as follows, Total Daily Caloric Intake times 0.55 or 0.60.

Example: 3,000 Calories × 0.60 = 1,800 Calories.

Carbohydrate Daily Intake in grams was calculated as follows, Total Daily Caloric Intake divided by 4 calories per gram.
Example: 1,800 Calories / 4 calories per gram = 450 grams

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Total Daily Caloric Fat Daily Intake at 15% of Fat Daily Intake at 20% of Fat Daily Intake at 25% of
Intake Example Total Daily Calories Total Daily Calories Total Daily Calories
Values (Calories and Amount) (Calories and Amount) (Calories and Amount)
2,000 Calories 300 Cals, 33 grams 400 Cals, 44 grams 500 Cals, 56 grams
2,500 Calories 375 Cals, 42 grams 500 Cals, 56 grams 625 Cals, 69 grams
3,000 Calories 450 Cals, 50 grams 600 Cals, 67 grams 750 Cals, 83 grams
3,500 Calories 525 Cals, 58 grams 700 Cals, 78 grams 875 Cals, 97 grams
4,000 Calories 600 Cals, 67 grams 800 Cals, 89 grams 1000 Cals, 111 grams
Fat Daily Intake was calculated as follows, Total Daily Caloric Intake times 0.15, 0.20, or 0.25.

Example: 3,000 Calories × 0.20 = 600 Calories.

Fat Daily Intake in grams was calculated as follows, Total Daily Caloric Intake divided by 9 calories per gram. Example:
600

Calories / 9 calories per gram = 67 grams

Focus on consuming essential fatty acids, EPA, DHA, and other healthy unsaturated fats/oils.

The following information is intended to Another general point concerns pre-, during,
provide some summary level information and post-training session or athletic event
regarding the macronutrients. Refer to the nutrition approaches. No single approach works
main units for more detailed information. Be for everybody the same way, and guideline
mindful that even though a body of scientific information is intended to provide concepts
research evidence exists for “guidelines” and and general points of reference that need to
“examples,” each athlete needs his/her sports be personalized for each athlete and tested to
nutrition program to be customized and refined. result in optimizing athletic performance. This
Another consideration to keep in mind is information should therefore be considered
that the research evidence may be biased to a introductory, and these advanced topics can
certain athlete-type. For example, based on the require years of specialized education and
volume of research, carbohydrate, hydration, experience to master.
and electrolyte intake research during athletic
events has historically been conducted on long- Training, which creates the extra nutritional
distance endurance athletes. Furthermore, the demands of athletes, should be scheduled into
muscle-building and strength-training research two or more shorter sessions per day when
using a variety of subjects (untrained, trained, possible, versus a very long, exhaustive session
recreational athletes, and elite athletes) with that makes it difficult to prevent nutrient
showing increases in strength or muscle mass depletion. In addition, it is necessary to modulate
did not necessarily evaluate for increases in (alternate) training intensity from day to day
athletic performance outcomes. However, the (low, medium, and high intensities) to avoid
principles and insights gained from the various overtraining syndrome and allow for adequate
research studies may apply to other athletes too, recovery and injury prevention. Of course, event/
during both athletic events and training sessions. competition days have established schedules

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and require the best efforts to provide adequate be posted in locker rooms or provided by the
nutrition intake for peak athletic performance, team doctor. During rest and low activity, water
health, and recovery: this includes athletes intake from hour to hour is relatively constant,
bringing along to events an adequate sports under similar climate conditions. Water intake
nutrition supply. The goals of athletic training increases during physical activity as the rate of
are generally for attaining and maintaining the sweating and the amount of water lost through
required athletic performance conditioning the skin increases.
and skills, plus good health. They are not
for dangerously over-working the body or Other noncaloric beverages, such as tea, coffee, or
intentionally creating circumstances that prevent adding lemon juice to water, and caloric/nutrient
or curtail achieving adequate nutrition status beverages when appropriate, offer an option to
that may be counterproductive to an athlete’s help avoid water consumption fatigue that can
health and athletic performance. occur when just drinking plain water. Drinking
multi-nutrient beverages can provide convenience
to help with calorie and essential nutrient intake,
Water/Hydration as athletes can even experience eating fatigue,
The amount of water a person can ingest at which leads to caloric and important nutrient
one time and during a certain time frame deficiencies that lead to symptoms.
depends on the size of the stomach, stomach
emptying rate, intestinal absorption rate, use Another consideration is during long duration
in the body, and rate excretion via the kidneys training and events in which hydration
and sweating. Thus, any hydration reference plus carbohydrate and electrolytes intake is
numbers should not be considered suitable important. This balancing act can require use
for everyone and requires personalization. of water plus a carbohydrate/electrolytes sports
Water is certainly one of the nutrients for beverage to maintain adequate hydration levels,
which too much or too little of can have acute alternating intake to maximize water intake,
(immediate) negative effects on health and carbohydrate intake, and electrolyte intake. This
athletic performance, and just the right amount is related to how the stomaching emptying rate
is required for optimal hydration resulting in the is slowed as the concentration of substances
conditions for optimal athletic performance. in a beverage is increased. More on this in the
following section.
Some practical points to consider once an
athlete’s daily water intake is established is to But note that realistically during some of
have athletes carry water and other suitable the longer athletic events, especially during
beverages with them and consume adequate hotter and more humid climate conditions
water throughout the day as required. Trips that increase the rate of sweating, 100 percent
to the bathroom will also increase and should of hydration, carbohydrate, and electrolyte
be planned for. The color of the urine is one replenishment is not always possible. Another
indicator of adequate hydration, and appropriate dose of reality to be considered is this: should an
urine color charts can be consulted that may athlete even be involved in these long duration

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 Sports Nutrition Approach Concepts and Examples | 479

events that put their health at risk? As a matter long in duration and incur a high volume of
of fitness trainer practice, serious thought should sweating accompanied by loss of sodium in
be given to determine whether taking on athletes particular, electrolytes in energy drinks or other
involved in such potentially hazardous sports appropriate beverages or dosage forms pre-,
should be avoided. During the more controlled during, and post-training may be required to
athletic training sessions, with adequate prevent electrolyte depletion that is detrimental
planning, dehydration and nutrient depletion to heath and or athletic performance. Similar to
should be able to be avoided or minimized carbohydrate content in a beverage, electrolyte
to avoid unhealthy and athletic performance content can slow down the stomach-emptying
limiting conditions. rate depending on the total concentration of the
beverage, and needs to be factored in.
In addition to the various hydration-related
information provided in Unit 6, some additional
hydration intake guideline examples published Electrolytes
in the scientific literature and from team Unit 8 presented information about the main
guidelines you may encounter include the electrolytes with daily reference intakes that
following: two to four hours before exercise, 5 include sodium, chloride, and potassium.
to 10 milliliters per kilogram of body weight; Additionally, other minerals like magnesium
rate of water intake in small amounts 150–200 and sulfate are sometimes grouped in. Because
milliliters every 10 to 20 minutes; 15 minutes electrolytes and other essential nutrients are
before exercise, 300 to 800 milliliters when not vital for health and performance, the focus on
possible to drink during exercise; during exercise electrolytes for athletes is related to maintaining
0.4 to 0.8 liters per hour, or maybe higher; after adequate intake to compensate for increased
exercise, at an individual’s appropriate rate physical activity and electrolytes that may be
of fluid intake during a few or more hours to excreted in higher amounts via an increased
regain water lost that resulted in loss of body amount of sweating during exercise. Usually
weight during exercise, in appropriate divided meal and supplement intake provides the
dosages, which can include hydration from other majority of electrolyte intake. Electrolytes are
beverages in addition to water. also a common ingredient in sports drinks used
during exercise, which usually contain sodium,
As with other sports nutrition consumption
chloride and potassium, and carbohydrates.
issues, take time to determine what is required
Some sports drinks contain additional minerals,
for each athlete and what rate of intakes best
vitamins, amino acids, and other substances,
suits each athlete. Seek to perfect the hydration
such as caffeine.
approach during training sessions that will work
best during athletic events. Include sodium Electrolyte depletion can become a concern
and other electrolytes as needed, keeping in when inadequate daily intake occurs and
mind that eating occasions should supply these possibly during long bouts of exercise or athletic
and other essential nutrients too. However, events or any physical activity accompanied by
during training sessions and events that are a high rate of sweating and loss of electrolytes

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via sweat. D. J. Casa and coworkers (2005) noted Regarding the glycemic index, ingestion of
an example of sodium loss during endurance carbohydrate sources and meals in the low
exercise of about 460 mg/L to 1,840 mg/L during to medium GI range will be a good nutrition
endurance exercise. At this rate of loss, it is practice to maintain sustained healthy blood
possible for an athlete to lose a few to several glucose levels. Periodic use of high GI foods
grams of sodium at high rates of sweating over and sports nutritionals, like energy drinks,
two or more hours of continuous exercise. can provide a quicker source of energy when
As with hydration requirements, estimating required. But remember that the GI for
electrolyte requirements will involve various individual foods can change when added into a
measurements and calculations by trained health mixed food meal with other foods of different
professionals. This may even include collecting GI values. The GI of a mixed meal will generally
and analyzing the electrolyte content of an trend in the direction of reducing GI, especially
athlete’s sweat. when lower GI foods are mixed with higher GI
foods and when mixed with proteins and fats
Carbohydrates that slow down the stomach emptying rate.

As carbohydrates, especially glucose, are a Regarding some additional carbohydrate intake

primary high-energy substrate for all types of information, extra carbohydrates for athletes
athletes, daily adequate intake is vital for peak had been acknowledged and practiced for
athletic performance. For the “anaerobic” and many decades, so an abundance of research
“aerobic” athletes, glucose is the primarily high- and different rates of intakes are published in
energy fuel source. As previously mentioned, research and guidelines. For athletes training
during strenuous, short-term strength athletic about two to five hours a day, a range of
activities, glucose is a primary fuel for anaerobic carbohydrate intake guidelines commonly
energy production. However, glucose is also a reported is 6 to 12 grams per kilogram of body
primary high-energy fuel for aerobic energy weight per day—the lower part of the range for
production, too, in addition to the slower shorter duration training sessions, and smaller
metabolized fatty acids and, to a minor extent, athletes, and the upper part of the range for
amino acids, like the BCAAs. With longer longer duration training, and larger athletes.
duration aerobic (oxidative) athletic events and
training, fatty acids also contribute to energy
PDP: Pre-During-Post Exercise,
production; however, glucose helps maintain
Training, Workouts, Events, and
athletic performance at a higher level. Glucose
Competitions
plus specialized glycose polymers and/or sucrose,
and/or some fructose can provide additional While maintaining consistency from meal to
energy substrate, especially during the longer meal (eating occasion to eating occasion) is an
duration endurance events, those lasting more essential foundation of a healthy sport nutrition
than 90 minutes. program, pre-, during, and post-exercise

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 Sports Nutrition Approach Concepts and Examples | 481

nutrition is an area of additional focus. With

some exceptions, PDP is similar for most athlete-
types for exercise, training, and workouts,
but with some differences with athletic events
and competitions, for example, long-duration
endurance athletic events compared with short-
duration strength athlete events.
Yes, for all athletes, an inadequate sports
nutrition program from meal to meal and
PDP can deplete an athlete’s energy supply,
electrolytes, protein, and other essential
nutrients, leading to reduced physical and
mental performance, reduced recovery, and
compromised health. Thus, even if meal-to- peak athletic performance and health. However,
meal nutrition is “adequate,” “inadequate” PDP during a short duration event, sports drinks may
nutrition can have adverse effects, especially not be needed or practical. In addition, some
for hydration status, glycogen stores, and sporting events during which athletes have a
electrolytes. Note that when an athletic event or fluid swishing around in their stomachs, or even
training session is longer in duration and higher the extra weight, may suffer in terms of athletic
in intensity, 100 percent hydration /nutrient performance.
depletion prevention is not always possible. A good starting point for fitness trainers working
Therefore, the following will serve to summarize with athletes is to consult with the PDP that is
some of the major PDP sports nutrition issues. used by the athlete’s team or may be prescribed
Note that PDP related to exercise, training, by other health professionals working with the
and workouts is just as important as PDP that athlete. In addition to your independent expert
is related to athletic events and competitions review, if the team PDP is adequate, discussing
is. When athletes neglect training session- it with your athlete clients and making efforts
related PDP, this may lead to training in a to encourage them to follow their PDP during
depleted state, resulting in suboptimum athletic training sessions and athletic events are
performance. PDP related to athletic events warranted. Additionally, getting feedback from
and competitions will vary based on the type of the athletes is vital for determining whether the
sport. Some sports like long endurance events team-prescribed PDP is resulting in improved
require a comprehensive program of hydration, training and athletic performance during events,
carbohydrates, and electrolytes, whereas for including feedback on any gastrointestinal upset
some sports with athletic events that are short or other issues that need to be resolved for best
in duration, like a wrestling match or sprinting, results. Opportunities for improvement may also
going in to the event well-nourished benefits be identified for consideration and discussion.

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It is important to note that athletes may encounter low blood sugar

levels at the start of their training or events even when undertaking a
reasonable carbohydrate-focused PDP routine. If an athlete encounters
Hypoglycemia: low blood diet-induced hypoglycemia (or from other reasons), reduced athletic
sugar. performance can occur when the athletes begin their activities because
of the low available energy substrate in the blood and glucose and
perhaps due to energy-storing insulin levels competing with energy-
liberating glucagon levels. Therefore, how an athlete is expected to
respond to a PDP nutrition program needs to be evaluated during
training sessions to determine a PDP nutrition program that works
best. Note that 100 percent certainty cannot be expected for event
days, even when a program has been proven during training sessions.
While a few approaches exist that could address energy-draining
hypoglycemia, in healthy people, one example would be to, at the start
of athletic training or events, have the athlete move around at a warm-
up level of activity and to then have him or her start slowly ingesting an
appropriate carbohydrate/electrolyte beverage to achieve and maintain
a normal blood sugar level. The exercising muscles stimulating glucagon
levels along with the exogenous carbohydrate source may overcome
the hypoglycemia condition. Changing the timing and composition
of the pre-event meal and sports nutritionals may also be warranted if
hypoglycemia occurs at the start of training sessions or athletic events.
Of course, the team doctor should be consulted to determine the cause
and best course of action.

Pre-Event Meal/Sports Nutritionals

Although all athletes should get their pre-event meal composition and
timing perfected, this is especially important for athletes undergoing
long duration events that may deplete their glycogen supplies during
athletic events and training, usually continuous events lasing 90 minutes
or more. However, all athletes should strive to time the pre-event meal
in a way in which it has cleared their gastrointestinal systems because if
food is still being digested, blood and energy will be diverted away from
exercising muscles and could also create gastrointestinal upset, resulting
in decreased athletic performance.

A major goal of the pre-event meal emphasizes carbohydrates to make

sure adequate glycogen stores are present when athletes start their
competitions along with blood glucose levels to provide exogenous

Sports Nutrition
 Sports Nutrition Approach Concepts and Examples | 483

energy substrate. The pre-event meal therefore solutions, to empty from the stomach quickly,
should be timed properly so it is completely with the lower percentage drinks usually
digested and absorbed in to the body, before the emptying from the stomach more quickly. This
athletic event begins. This may take three hours, is about what most sports beverages contain,
plus or minus, assuming the meal is higher but you can check with the manufacturer to
in carbohydrates. Ingestion of other sports confirm this. Higher percentage solutions may
nutritionals or smaller snacks that are consumed also be suitable depending on the individual’s
closer to training sessions of events, 60 minutes beverage digestion ability during physical
plus or minus, for example, need to ideally be activity. Observations suggest that even short
cleared from the stomach at the start of athletic duration sport athletes not at risk for glycogen
activity, marked by the warm-up period. Pre- depletion may benefit from sipping small
training meals can be similar to pre-event meals amounts of a carbohydrate energy drink, as
in conditioning the digestive system, as can doing so may promote neurological benefits.
protein and an appropriate healthy fat content, There is even some emerging research using
which will not significantly slow down the carbohydrate beverage mouth rinsing, which
stomach emptying rate. will be interesting to report on in the future as
more research develops.
Carbohydrate Intake during
Some additional reference intakes, based on
Long Duration Events and
Training Sessions endurance athletes include 30 to 60 grams per
hour carbohydrate, for events 1 to 2.5 hours
During events and training sessions, the body in duration and up to 90 grams per hour
uses carbohydrates, fatty acids, and some minor carbohydrate for events more than 2.5 hours in
amounts of amino acids for energy. The extent duration. These guidelines should be adjusted
of the proportional energy substrate use will for each athlete but are starting points found
depend on the type of physical activity and
published in the scientific literature. As indicated
duration, with longer duration physical activity
in the 2017 Trommelen study below, higher rates
increasing the risk of depleting glycogen stores
of exogenous carbohydrate may be possible.
and reducing mental and physical performance.
(Note that larger team sport and strength athletes
To help to spare the body’s internal stores
may have the potential for higher per hour
of energy, especially glucose from glycogen,
carbohydrate digestion and utilization rates.)
athletes can ingest exogenous energy in
the form an energy drink is. Carbohydrate Regarding the type of carbohydrate, for elite level
ingestion during events and training sessions performance, ones up to a couple to a few hours
usually is accomplished by consuming dilute in duration, glucose-containing beverages will
carbohydrate/electrolyte beverages. Depending provide the fastest available energy. As studies
on several factors, examples of ranges of with endurance athletes have reported exogenous
carbohydrate beverage intake is about 6 to 12 glucose use during events to be about 1 to 1.2
ounces every 15 to 20 minutes. Carbohydrate grams per minute, 60 to 72 grams per hour
beverages need to be diluted; 4 to 8 percent would be a starting point range for just glucose.

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Because the intensity of the continuous exercise at a moderate level of intensity. The researchers
is low to moderate, and longer in duration, observed that both the glucose-plus-sucrose and
over about two hours, the mixed-carbohydrate glucose-plus-fructose treatments resulted in
source may have an advantage because some higher total oxidation rates, versus just glucose
recent research indicates that the total amount treatments, which reconfirmed previous study
of ingested carbohydrate per hour that can be results. The increase of oxidation rates was more
used for energy may be at a higher rate of use. pronounced during the latter 120 minutes of
This was indicated in test beverages containing exercise, which is to be expected. The researchers
high amounts of glucose, sucrose, or fructose noted some limitations of this study, such as its
(see Trommelen study overview below). Fast not being an exercise performance study, that
digesting glycose polymers are also used in some fructose takes extra energy to be converted into
energy drinks. All athlete needs to evaluate what lactate or glucose before being used in exercising
works best for them individually, especially muscles, and that a fructose group was not
ultra-endurance athletes who as a group have included. An interesting observation was that
extremely special event nutrition needs that can fatty acid metabolism was highest in the water-
only be determined by working directly with a only group, and then the next highest was in
sports nutrition expert. the glucose-only group, followed by the mixed-
carbohydrate groups. Moreover, upper gastric
It is interesting to note that energy requirements distress scores were highest for glucose only,
during exercise or events are relatively constant, versus glucose plus sucrose or fructose, and for
whereas hydration needs can vary depending water only.
on rates of sweating, which can vary from day
to day. Thus, becoming more sophisticated with Rates of carbohydrate ingestion and oxidation
fluid, electrolyte, and energy substrate intake from the study are as follows:
during exercise will require making estimates
• Rages of ingestion: 1.8 grams per minute
based on climate conditions and expected rates glucose; 1.2 grams per minute glucose &
of sweating for each day. This can be challenging 0.6 grams per minute fructose; 0.6 grams
for outside sporting events and usually more per minute glucose & 1.2 grams per minute
constant for inside sporting events. sucrose. [Total fluid/experimental drinks
provided during 180 minutes was about 2.25
Research efforts are constantly being conducted liters per subject. Rate of fluid intake was
to fine-tune approaches for maximum use of 600 ml during first three minutes of exercise,
exogenous energy sources during exercise, such followed by 150 ml every fifteen minutes.]
as carbohydrates during events and training
• Rates of exogenous carbohydrate oxidation:
sessions. For example, J. Trommelen and
glucose-only peak oxidation rate was 0.96
coworkers (2017) reported in their research that grams per minute; glucose & fructose peak-
co-ingestion of glucose plus sucrose and glucose oxidation rate was 1.4 grams per minute; and
plus fructose resulted in higher oxidation rates glucose and sucrose peak-oxidation rate was
compared with ingestion of glucose alone, during 1.29 grams per minute. (Note that endogenous
180 minutes of endurance-type cycling exercise carbohydrate oxidation was also estimated and
using trained male cyclists. The cyclists exercised reported in the study.)

Sports Nutrition
 Sports Nutrition Approach Concepts and Examples | 485

An interesting point of these research results is to meal when food composition and caloric
that the exogenous mixed simple carbohydrate content is adequate. Therefore, it is beneficial to
intake resulted in higher oxidation rates (energy be able to time post-exercise or post-event meals
use) versus those of just glucose. But this highest to be consumed within about one hour after
oxidation rate was less than the 1.8 grams per exercise, depending on the workout length and
minute rate of intake. intensity and depending on any post-exercise
water and on carbohydrate/protein/electrolyte
The researchers review additional measurements
drinks ingested directly after training/events.
and data that can be found by reading the
This may then require the post-training meal
entire study. For example, Figure 2 in their
to be in the 30-minute to two-hour range.
study report provides an illustration of the
Some people like to think of post-exercise or
relative contribution of substrates to total energy
post-event supplements and meals as several
expenditure. An interesting trend from the
courses spread out over an hour or more,
illustration is that when compared with water
eating slowly to not overwhelm the stomach.
only, more carbohydrates (endogenous and
Moreover, consuming a post-workout beverage
exogenous) contribute to energy expenditure in
that contains carbohydrates and protein, first,
all the carbohydrate treatment groups and to
followed by a complete post-exercise meal will
less endogenous fat. In addition, the water-only
allow for optimal muscle recovery. This will get
treatment had a higher percentage of endogenous
carbohydrates, protein, and other nutrients into
carbohydrate oxidation compared with that
your body fast, in an easy-to-digest hydrated
of the carbohydrate treatment groups. Thus,
form for rehydration. This is done in addition to
ingestion of exogenous carbohydrates helped
ingesting plain water. Some post-training /event
“spare” or use less endogenous carbohydrate and
carbohydrate and protein supplement intake
fat for energy. But remember to keep the added
examples include 15 to 25 grams of high-quality
sugars under control by avoiding excessive intake
protein and 1 to 1.5 grams per kilogram of
of added sugars.
bodyweight. This is more important if the post-
exercise meal is delayed.
Post-Event or Post-Exercise Meal
Post-exercise meals or sports nutrition drinks
There are some misconceptions about post- for post-exercise consumption can be high in
exercise eating. One is that there is only a tiny carbohydrates and moderate in protein, and
window of opportunity to replenish glycogen; low in fat, something that will be easily and
some people are led to think that it is a matter quickly digested. In addition, high glycemic
of minutes, but it is longer. It is true that after- index carbohydrates will further increase the
exercise glycogen replenishment can be at a rate of glycogen replenishment in the post-
higher rate with a post-exercise meal, but the exercise period. Some athletes may also need to
time of this window runs up to a couple of hours, increase their consumption of salty foods to help
a period in which athletes should be eating as replace the sodium lost during high sweat-loss
part of their routine. Additionally, glycogen exercise or events, along with potassium and
stores can be replenished ongoing from meal other essential vitamins and minerals. This is

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why the consumption of a complete post-exercise High-quality protein consumption should

meal with supplements is desirable for optimum be emphasized. This can be provided by a
nutrient replenishment in general. The GI value combination of conventional healthy protein
of meals following the post-exercise meals are foods and protein supplements, such as whey,
less critical and can range from high to medium casein, egg, high-quality soy isolates, and various
to low GI values based on nutritional preference. protein combinations. This last item may include
Generally, for weight loss, or athletes with fortification with individual amino acids, such
weight management issues, medium to lower GI as the essential amino acids. The other factor
meals will promote better appetite control and a of high-quality proteins is healthy fat content,
higher rate of fat metabolism. Starting by eating minimizing protein food sources that are high in
carbohydrates first during the meal can favor saturated fats.
faster carbohydrate digestion, whereas eating
Regarding some additional protein intake
protein first and any mixed macronutrient meal
information, although it has taken many years
can start to slow down stomach emptying. So
for the academic researchers and various sports
even meal to meal, there is potentially a conflict
organizations to break away and recognize
between intake of water and nutrients, based
that the low RDA protein intake for adults (0.8
on the rate of stomach emptying and intestinal
grams per kilogram of body weight per day)
absorption and assimilation.
is not sufficient for athletes, with some still in
catch-up mode, the overall trend has been to
Protein increase the protein intake guidelines for athletes
The issue of protein intake can become in the 1.2 to 2 grams per kilogram of body
complicated when including whole proteins weight per day range, or higher, as a general
and extra amino acid supplementation. In sports nutrition approach. Note that this course
short, the key to maintaining adequate protein was among the first to establish higher protein
intake is to divide the daily high-quality intake requirements for athletes, decades ago.
protein intake requirement of an athlete over In addition, various studies reported a further
the several daily eating occasions of meals, breakdown based on athlete type, similar to the
snacks and sports nutrition products, which Dynamic Nutrition Approach. This includes, for
may include consumption of protein drinks example, 1 to 1.6 grams per kilogram of body
and protein bars and high-protein meal weight per day for endurance training/exercise;
replacements. This will provide a steady supply 1.4 to 1.7 grams per kilogram of body weight per
of amino acids to the body’s tissues and amino day for intermittent stamina type sports; and
acid pool. Additional specialized supplements 1.6 to 2 grams per kilogram of body weight per
previously reviewed include BCAAs, essential day for power and strength training/exercise.
amino acid blends, some individual amino Regarding even higher protein intake, J. Antonio
acids, and the various protein sports nutrition and coworkers (2015) reported their results of
products with added amino acids and other safety and efficacy of a high protein diet of 3.4
nutrients and ergogenic substances. grams per kilogram of body weight per day using

Sports Nutrition
 Sports Nutrition Approach Concepts and Examples | 487

male and female subjects who were resistance What about protein intake during
training, during an eight-week treatment period training sessions or athletic events?
of a high-protein diet and resistance training.
As previously reviewed, spacing protein intake
J. Antonio and coworkers (2016) also reported
over several eating occasions provides a steady
on another high protein intake study conducted
supply of amino acids required for growth,
over a year, in a crossover design. During this
maintenance, and other protein/amino acid-
study, the high-protein diet was followed for
related functions. This approach should cover the
two months, and four months, at a rate of 3.32
pre-training and post-training training session/
grams per kilogram of body weight per day.
athletic event eating occasions, in addition
Among various health parameters tested during
to eating main meals and/or snacks. This
the study periods, there were no harmful effects
leaves the time at training sessions and during
found regarding measures of blood lipids and
athletic events periods—for these, the sports
liver and kidney function. For bodybuilders
nutrition focus has usually been on hydration,
during contest preparation, E. R. Helms and
carbohydrates and electrolytes, and certain
coworkers (2014) provided evidence-based
ergogenic substances.
nutrition recommendations for protein of 2.3 to
3.1 grams per kilograms of lean body weight per There are then two main considerations
day, especially for periods of calorie restriction to regarding “protein during,” that is, during
help reduce loss of lean body mass. training sessions and during athletic events. The
current consensus published in independent
Remember that short-term use of higher
research studies and reviews indicates that
protein diets for athletes is intended to
protein supplementation during exercise does
achieve multiple goals in addition to just
not appear to promote immediate/acute athletic
maintaining positive nitrogen balance. These
performance benefits, especially when compared
goals include increasing lean body mass,
with other nutrients, like carbohydrate, or some
including muscle mass; preventing loss of
of the ergogenic substances previously reviewed
lean body mass during high-intensity, long
(van Loon 2014, Beck 2015, Thomas 2016).
duration training during the preseason and
season; lowering body fat; compensating However, in terms of training sessions, there
for amino acids that are used for energy; could be potential benefits from some protein
and supporting progressive, compensatory intake during exercise with carbohydrates,
improvements from athletic training. Higher related to potentially reducing muscle damage,
protein diets for healthy athletes should be enhancing recovery, and promoting muscle
for short-term use such as a few months to protein synthesis. Potential benefit could be
several months and monitored closely by a expected for longer duration training sessions
doctor to determine whether any side effects that can have greater depletion effects on
occur and whether changes to the diet or the amino acid pool, for both endurance
treatment are needed. Extra water intake can and strength sports, assuming this is not at
be required with higher dietary protein intake. the expense of hydration, electrolyte, and

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488 | Unit 17

carbohydrate supply. This would need to be increased above the basic plan goals, the good
determined from working with individual news when it comes to fat content is that it is
athletes on a cost-benefit evaluation basis, ideally easy to increase it in the diet. Adding healthy
in the off-season or early preseason as to not oils to foods and in cooking, taking healthy fat
interfere with athletic performance during the supplements, and eating healthy fat food sources
season. Traditionally, it is common among some like nuts and nut butters, avocados, and oily
strength athletes to drink low-concentration fish, for example, is fairly straightforward. Just
protein or protein multi-nutrient- containing pay attention to how the extra dietary fat affects
beverages during training sessions, especially stomach emptying rate, which may be longer
among athletes with shorter duration training when the fat content of a meal is increased, in
sessions who are not at risk for dehydration or addition to other factors.
glycogen depletion. Note that while being an
advanced specialty topic not covered in this Meal Timing and Training Timing
course, it is worth mentioning the potential
benefits for ultra-endurance athletes of drinking Each athlete needs to determine what works
low-concentration protein or protein nutrient- best for his or her personal rate of digestion
containing beverages, which along with other from working with the health professional
nutrients during the long training sessions team. Note that in general, a person’s rate of
and athletic events, could help reduce tissue digestion is expected to increase as daily physical
breakdown and promote recovery. activity increases; this is the body’s mechanism
to make sure the increased nutrition demands
can be met. Thus, there can be variation in the
Fats amounts consumed per eating occasion and
The term “fat” is frequently used in a way that rate of intake from eating occasion to eating
follows conventional usage, not to mean only occasion. Achieving the optimum intake of total
saturated fats. An example of conventional daily calories and required nutrients involves
usage of the term fats is on food and supplement expert evaluation and planning. Sports nutrition
product labeling, which includes saturated and coaching is involved, which athletes sometimes
unsaturated fats. Regarding dietary fats, the refer to as sports nutrition nagging. Even what
focus should be the healthy lipids, including would seem to be the simplest nutrition factor,
the essential fatty acids, EPA, DHA, and other adequate hydration, is often deficient for many
unsaturated fatty acids. athletes in training. In addition, if athletes need
to eat or drink fluids during their competition,
Controlling total daily fat intake results from
this needs to be part of their training to
emphasizing carbohydrate and protein intake,
condition the gastrointestinal system to process
so fat intake comes in on the low side of the
nutrition during athletic performance.
range. Recall that although fats are important,
athletes’ diets can be too high in fats and Many athletes who do not consume the
inadequate in carbohydrate and protein content. required fluids, and sometimes the solid
If for individual reasons, fat intake needs to be sports nutritionals during their training

Sports Nutrition
 Sports Nutrition Approach Concepts and Examples | 489

day, caloric intake requirements will typically

be different depending on an athlete’s training
duration and intensity and on other daily
physical activity demands, which are sometimes
tragically overlooked and can cause detrimental
caloric and nutrient deficiencies. Modulating
the relative proportions of fat, carbohydrate,
and protein, especially before, during, and after
training or competitions, is required. Then
there is the specialized practice of glycogen
supercompensation reviewed in Unit 19,
along with the general approach of increasing
carbohydrates before and the day of athletic
events/competitions.

A good starting point example for meal

scheduling or timing is the “Clock Approach”

“Clock Approach”
periods that are required during competitions/ Meal Scheduling Examples
events, experience gastrointestinal upset
during competitions from not having properly The Clock Approach was developed by Dr.
conditioned the gastrointestinal system. In Hatfield to help as a visual aid to align nutrition
addition to conditioning an athlete’s digestive with training and competition schedules. This
system during training, this allows for fine- can best be done by consuming five or six meals
tuning the fluids and foods that promote easy each day. Pay attention to maintaining adequate
digestion and enhanced athletic performance blood sugar levels. Following a meal, blood
versus the opposite. Remember that athletic sugar will be elevated. This will allow a person
competitions may be a regular season event or to perform physical activity without the loss of
daylong or multiple-day tournaments. Then energy. Of course, the more intense the physical
there are the very physical and nutritionally activity, the quicker these blood sugar levels will
demanding multi-day endurance event sports drop. If you learn to listen to your body, you
like the Tour de France that require a very will realize that your blood sugar is low and that
sophisticated sports nutrition program involving replenishment is needed.
daily medical monitoring by highly qualified
As a starting point, a meal every three or so
health professionals.
hours is suggested, which can be plus or minus
Calorie and macronutrient modulation is an based on an individuals’ rate of digestion and
important part of an athlete’s sports nutrition meal composition. Pace caloric intake for the
program, which is dynamic in nature. Day to hours following the meal, for example, the meal

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prior to a low-energy activity or a sedentary The following Clocks include examples for
activity like sitting will be fewer calories different numbers of workouts per day, with
compared with the meal prior to a high-activity meals following the 1-2-3 rule of Fat/Protein/
athletic training. Simply ask, “What am I going Carb ratio, noting that meals can be fine-tuned
to do in the next three hours?” By carefully using the Dynamic Nutrition Approaches for the
evaluating your next three hours of activity, you different athlete-types.
can determine approximately how many calories
to consume at the present meal.

A 7:30 AM Meal #1.

Follow 1-2-3 rule.
(Fat/Protein/Carb ratio)

8:30 PM MEAL #5.

Follow 1-2-2 rule.
(Fat/Protein/Carb ratio)

7:35 PM
BCAAs and L-glutamine
directly after workout

7:00 - 7:30 PM 10:30 AM MEAL #2.

Cardio Follow 1-2-3 rule.
(Fat/Protein
6:15 – 7:00 PM /Carb ratio)
Workout

6:00 – 6:15 PM
Warm-up and
flexibility stretching

5:45 PM
BCAAs and L-glutamine
before workout

4:30 PM MEAL #4. 1:30 PM MEAL #3.

Low-glycemic Follow 1-2-3 rule.
(Fat/Protein/Carb ratio)

Clock A, above. Clock B top right. Clock C, bottom right.

Sports Nutrition
 B 7:30 AM Meal #1.
Follow 1-2-3 rule.
(Fat/Protein/Carb ratio)
10:00 PM
Meal replacement or
1/2 cup of cottage cheese

8:00 PM MEAL #5.

Follow 1-2-2 rule.
(Fat/Protein/Carb
ratio)

7:05 PM
BCAAs and
L-glutamine direct- 10:30 AM MEAL #2.
ly after workout Follow 1-2-3 rule.
(Fat/Protein/Carb ratio)
6:15 – 7:00 PM
Workout
11:45 AM
6:00 – 6:15 PM BCAAs and L-glutamine
Warm-up and
flexibility stretching 12:00 – 12:30 PM
Cardio (lunch hour)

5:45 PM
BCAAs and L-glutamine 12:30 PM
before workout BCAAs and L-glutamine

4:30 PM MEAL #4. 1:30 PM MEAL #3.

Low-glycemic Follow 1-2-3 rule.
(Fat/Protein/Carb ratio)

C
6:15 AM
BCAAs and
L-glutamine
6:30 – 7:00 AM
Cardio
7:05 AM
9:30 PM BCAAs and L-glutamine
Meal replacement or
7:30 AM Meal #1.
1/2 cup of cottage cheese
Follow 1-2-3 rule.
(Fat/Protein/Carb ratio)

8:30 PM MEAL #5.

Follow 1-2-2 rule. (Fat/
Protein/Carb ratio)

7:35 PM
BCAAs and
L-glutamine directly
10:30 AM MEAL #2.
after workout
Follow 1-2-3 rule. (Fat/
6:15 – 7:30 PM Protein/Carb ratio)
Workout

6:00 – 6:15 PM
Warm-up and flex-
ibility stretching;
herbal thermogenesis
enhancing formula

5:55 PM
BCAAs and L-glutamine
before workout
1:30 PM MEAL #3.
5:00 PM MEAL #4. Follow 1-2-3 rule. (Fat/
Low-glycemic Protein/Carb ratio)
492 | Unit 17

Sports Nutrition Fine-Tuning Is Ongoing

Based on new ingredients, new sports nutrition be the championship edge an athlete needs to
products, new research discoveries, and new achieve his or her athletic performance goals.
sports nutrition insights, one thing is certain: The “Alkalinity Nutrition Factor” information
fine-tuning an athlete’s sports nutrition program box is a good example of progressive sports
will be an ongoing effort. Even when the point nutrition research that goes beyond conventional
is reached when 99 percent optimization is nutrition thinking.
achieved, it is that extra 1 percent that could

The Alkalinity Nutrition Factor Throughout this course, and in most conventional thinking about
nutrition, the major focus is on achieving daily intake of the essential, semi-essential nutrients, and specialty ergogen-
ic ingredients for optimum health and maximum performance, too. But aside from this essential nutrient focus, an
additional line of thinking concerns how diets affect the acidity or alkalinity of the body. Acid-alkaline diets and food
factors come arise as a topic in general for health purposes and as related to sports and athletic performance. Books
have been and will continue to be written about this subject of growing interest, and research is being conducted as
well.

At a simple level of explanation, the idea is, with pH 7 being neutral, the body (body fluids) could be in a healthier
condition when on the alkaline side of the pH scale for body fluids (7+) versus the acid side (7-). The thought is that
when the body’s pH is alkaline, this could be healthier, and when the body’s pH is acid, this could be unhealthy. Ori-
gins of acid-alkaline balance are thought to be rooted in traditional health approaches dating back thousands of years.

A core point of achieving and maintaining alkalinity is eating the right balance of acid forming foods and alkaline
forming foods to maintain a body that is overall alkaline. There are many facets to this, and modern research is slowly
but surely being conducted to provide additional evidence to the appropriateness of the alkalinity-forming diet
approach. Note that while this is independent of essential nutrients, there is a relationship. For example, body acidity
may disrupt calcium in the bones, possibly causing bone calcium to be released to support the body’s calcium-based
buffering system. Acid body plus inadequate calcium intake is even more of a problem for bone health. Moreover, dis-
ruption of calcium ions in the nervous system may be adversely affected from body acidity, one of the possible factors
leading to exercise-related fatigue, such as with the lowering of pH in the exercising muscles and the rest of the body.

Speculation aside, the point of bringing this topic to your attention is leading up to a 2015 research study by Susan
L. Caciano and coworkers, titled “Effects of Dietary Acid Load on Exercise Metabolism and Anaerobic Exercise Perfor-
mance.” The researchers noted that urine pH relates to dietary acid-base load, and during the study, the alkaline-pro-
moting diet was designed to promote a urine pH greater than or equal to pH of 7.0, and the acid-promoting diet was
designed to promote urine pH less than or equal to 6.0. The alkalinity-promoting diet was high in fruits and vegeta-
bles and low in meats, grains, and cheese, which can promote systemic acidity. Note too that bicarbonates reviewed
in Unit 9 have been proven to promote alkalinity and benefit some types of athletic performance. Furthermore, there
is some research examining the alkalinity-promoting effects of the “greens drinks” being sold in health product stores,
which are becoming more popular with health-minded people (see Anton 2013 reference for an example). It is import-
ant to realize that although this research is interesting, it is considered experimental and evolving, and the research
subjects were under close medical supervision in the Caciano 2015 experiment.

It took several days for subjects to achieve either acid or alkaline urine pH from the respective diets. Subjects then
underwent anaerobic exercise-performance testing. Anaerobic exercise performance testing consisted of running
time-to-exhaustion lasting one to four minutes on a treadmill wherein running speed was constant and the incline
was increased until fatigue was achieved in a graded exercise design. The alkaline-promoting diet subjects experi-
enced improvement in anaerobic exercise performance by 21 percent compared to the acid promoting diet subjects.
 Sports Nutrition Approach Concepts and Examples | 493

Food Lists Note that the actual calorie and nutrient content
for conventional foods can vary up to 20 percent
The foods lists can be used to make food or more, higher or lower; many agricultural
substitutions to the eating plans listed above factors contribute to this variation. Nutrient
based on individual athlete requirements. You content variation of supplement products
should also include healthy favorite foods and tends to be less, due to the high standard of
foods that are readily available. Make additions manufacturing and quality control testing
to these lists to include suitable foods that are the requirements.
athlete’s favorites. Be sure to refer to the Dietary
Guidelines document in the appendix. The food When possible, choose organic foods,
lists begin on the next page. range-fed organic, whole grains, and whole
unprocessed foods.

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High-Protein Foods: Beef, Lamb, Poultry, Fish, Pork.

Food Serving Calories Protein Carbs Fat
Size (Grams) (Grams) (Grams)
Abalone 3 oz 89 14.5 5.1 0.7
Bacon Alternative (Louis Rich) 1 strip 32 2.4 0.3 2.4
Bacon Bits (Hormel) 1 oz 117 12 1 7
Bacon, Canadian-Style 1 slices 86 11.3 0.6 3.9
Bass, Freshwater 1 oz 32 5.3 0 1
Bass, Sea 1 oz 27 5.2 0 0.6
Beef, Flank, untrimmed 1 oz 51 5.6 0 3
Beef, Bottom Round, prime, trimmed 1 oz 45 6.2 0 2.1
Beef, Bottom Round, prime, untrimmed 1 oz 64 5.7 0 4.4
Beef, Sirloin, prime, trimmed 1 oz 44 6 0 2
Beef, Tenderloin, choice, untrimmed 1 oz 82 5 0 6.7
Beef, Corned (Hillshire Farm) 1 oz 31 6 0 0.4
Beef, Roast, sliced (Healthy Deli) 1 oz 30 6.4 0.2 0.4
Buffalo 1 oz 31 6.1 0 0.5
Bluefish 1 oz 35 5.7 0 1.2
Burger, vegetarian, Harvest Burger (Green Giant) 1 burger 140 18 8 4
Chicken, breast, no skin 1 oz 31 6.5 0 0.4
Chicken, breast, with skin 1 oz 49 5.9 0 2.6
Chicken,sliced,(Tysonhickorysmoked) 1 slice 25 4 0.8 1
Cod 1 oz 23 5 0 0.2
Deer 1 oz 34 6.4 0 0.7
Egg (chicken) 1 large 75 6.3 0.6 5
Egg, white (chicken) 1 large 17 3.5 0.3 0
Egg, Alternative (Fleishmann’s) Egg Beaters vegetable omelet 1/2 cup 50 7 5 0
Flounder 3 oz 77 16 0 1
Frankfurter, low fat, (Healthy Choice) 1 frank 70 8 5 2
Halibut 1 oz 31 5.9 0 0.6
Ham, fresh trimmed 1 oz 39 6 0 1.5
Ham, sliced (Kahn’s) 1 slice 30 5 1 1
Pork, Tenderloin, trimmed 1 oz 34 5.9 0 1
Pork Chops (Master Choice) 1 chop 120 22 0 4
Tofu, soybean curd cake 1 oz 22 2.3 0.5 1.4
Tuna, bluefin 1 oz 41 6.6 0 1.4
Tuna, canned in soybean oil, solid, drained (Star-Kist) 2 oz 150 13 0 13
Tuna, canned, white, in water, drained, diet (Star-Kist) 2 oz 70 15 0 1
Turkey, light meat, no skin 1 oz 33 6.7 0 0.4
Turkey, dark meat, no skin 1 oz 35 5.7 0 1.2
Turkey, sliced, (Tyson) 1 slice 20 4 0.3 0.4

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Foods High In Complex Carbohydrates:

Breads, Crackers, Cereals, Grains, Starchy Vegetables, And Starchy Fruits.
Food Serving Calories Protein Carbs Fat
Size (Grams) (Grams) (Grams)
Bagel, Onion 3.5-inch diameter 1 bagel 195 7.5 37.9 1.1
Bagel, Plain 3.5-inch diameter 1 bagel 195 7.5 37.9 1.1
Bagel, Frozen (Lender’s) 1 bagel 150 6 30 1
Bagel Chips (Burns & Ricker) 1 oz 130 4 20 4
Biscuit, commercially baked 1 oz 103 1.8 13.8 4.7
Hamburger bun 1 bun 123 3.7 21.6 2.2
Bread, white 1 slice 70 3 13 1
Bread, whole wheat 1 slice 60 3 11 1
Bread, bran 1 oz 100 4 19 1
Bread, French 1 oz 78 2.5 14.7 0.9
Bread, whole grain 1 slice 85 3.9 17.4 1.6
Bread, rye 1 slice 80 3 16 1
Cake, Free & Light frozen (Sara Lee) 1/8 cake 110 2 26 0
Cake, pound, Free & Light (Sara Lee) 1/10 cake 70 1 17 0
Cereal, All Bran extra fiber (Kellogg’s) 1 oz 50 4 22 0
Cereal, Basic 4 (General Mills) 3/4 cup 130 3 28 2
Cereal, Corn Flakes 1 oz 110 2.3 24.4 0.1
Cereal, Grape-nuts (Post) 1 oz 101 3.3 23.3 0.1
Cereal MultiGrain Cheerios (General Mills) 1 oz 100 2 23 1
Cracker, saltine (Premium) Fat-free 4 crackers 50 1 12 0
English Muffin, plain (Thomas’) 1 muffin 130 4.3 25.4 1.3
Frankfurter bun 1 bun 123 3.7 21.6 2.2
Oatmeal, plain, instant 1 oz 100 5.8 18 2
Roll, Hoagie 1 roll 210 8 34 5
Roll, Kaiser 1 roll 184 7 35.4 2.9
Roll, Sandwich 1 roll 123 4.5 21.6 3.3
Grits, dry (Arrowhead Mills) 2 oz 200 5 43 1
Pancake, buttermilk, (Hungry Jack), prepared, with skim milk, oil, 3 pancakes 200 6 28 7
egg whites
Pancake, extra light, (Hungry Jack), prepared with skim milk, oil, 3 pancakes 170 6 28 4
egg whites
Pasta linguine and spaghetti, dry 2 oz 210 9 41 1
Popcorn, microwave, (Jiffy Pop), Natural, popped. 4 cups 140 3 17 7
Popcorn, microwave, (Jolly Time), light 3 cups 60 2 12 2
Potato, baked in skin 4 oz 124 2.6 28.6 0.1
Potato, boiled, no skin 4 oz 99 2.1 22.8 0.1
Potato, sweet, baked , pulp only 4 oz 117 2 27.5 0.1
Pretzels, most types 1 oz 110 3 23 1
Rice, Brown, dry 1 oz 103 2.3 22 1
Rice, White, dry 1 oz 105 2 23 0.2

International Sports Sciences Association

 Vegetables and Beans
Food Serving Calories Protein Carbs Fat
Size (Grams) (Grams) (Grams)
Adzuki Bean, raw 1 oz 93 5.6 17.8 tr
Arugula 1 leaf 1 0.1 0.1 0
Baked Beans, canned , 8 oz 200 10 43 3
Tomato (Campbell’s)
Baked Beans, canned, 8 oz 260 15 48 6
Barbecue (B&M)
Baked Beans, canned, pea, small (Friends) 8 oz 360 17 62 4
Baked Beans, canned, 8 oz 160 12 38 <1
Showboat (Bush’s Best)
Baked Beans, canned, 8 oz 230 14 50 3
Vegetarian (B&M)
Black Bean, raw 1 oz 97 6.1 17.7 0.4
Broccoli, fresh, raw, trimmed 1 oz 8 0.8 1.5 0.1
Broccoli, frozen, spears (Birds Eye) 4 oz 30 4 6 0
Cabbage, raw 1 oz 5 0.3 0.9 0.1
Carrot, raw 1 oz 12 0.3 2.9 0.1
Cauliflower, raw 1 oz 7 0.6 1.4 0.1
Celery, raw 1 oz 5 0.2 1 0
Corn, frozen (Health Valley) 1/2 cup 76 2 17 0
Garbanzo Bean, raw 1 oz 103 5.5 17.2 1.7
Lettuce, iceberg, trimmed 1 oz 4 0.3 0.6 0.1
Lettuce, romaine, trimmed 1 oz 5 0.5 0.7 0.1
Lima Bean, raw 1 oz 32 2 5.7 0.2
Lima Bean, frozen (Green Giant) 1/2 cup 80 6 18 0
Onion, raw, trimmed 1 oz 11 0.3 2.4 0.1
Spinach, untrimmed 1 oz 6 0.2 1 0.1
Tomato, 2 3/4inch dia, 4.75 oz 1 tomato 26 1 5.7 0.4
Turkey, sliced, (Tyson) 1 slice 20 4 0.3 0.4

Fruit: Whole Fruits and Sauces

Food Serving Calories Protein Carbs Fat
Size (Grams) (Grams) (Grams)
Apple Sauce (Mott’s) Natural 6 oz 80 0 20 0
Apricot pitted 1 oz 14 0.4 3.2 0.1
Apricot Dried (Del Monte) 2 oz 140 2 35 0
Asparagus Frozen (Birds Eye) 3.3 oz 25 3 4 0
Blueberry 1 oz 16 0.2 4 0.1
Fruit Cocktail, canned, in light syrup 4 oz 65 0.5 16.9 0.1
Grapefruit 1/2 fruit 50 1 13 0
Orange 1 med 62 1.2 15.5 0
Pasta Sauce, (Hunt’s) Homestyle 4 oz 60 2 10 2
Pasta Sauce, (Ragu), Mushroom Thick and Hearty 4 oz 100 2 15 3

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Dairy: Cheese, Milk, Yogurt

Food Serving Calories Protein Carbs Fat
Size (Grams) (Grams) (Grams)
Cheese, American 1 oz 110 6 1 9
Cheese, American Cheddar 1 oz 113 7 0.4 9.3
Cheese, parmesan, grated 1 oz 128 11.6 1 8.4
Cheese, Swiss 1 oz 105 8 1 7.7
Cottage Cheese, large curd 4 oz 117 14.1 3 5.1
Cottage Cheese, large curd, 1% 1 oz 20 3.5 0.8 0.3
Cottage Cheese, large curd, 2% 1 oz 25 3.9 1 0.5
Cream Cheese 1 oz 98 2.1 0.7 9.8
Cream Cheese, fat-free 1 oz 30 6 2 0
Butter, Salted 1 tbsp 100 0.1 0 11.4
Milk, Skim 8 oz 86 8.4 11.9 0.4
Milk, 1% 8 oz 102 8 11.7 2.6
Milk, 2% 8 oz 121 8.1 11.7 4.7
Milk, Whole 8 oz 150 8 11 8
Yogurt, Plain (Dannon), low fat 8 oz 140 10 16 4
Yogurt, Plain (Dannon), nonfat 8 oz 110 11 16 0
Yogurt,MixedBerry(Breyers),low fat 8 oz 250 9 48 2

Spreads and Sauces

Food Serving Calories Protein Carbs Fat
Size (Grams) (Grams) (Grams)
Catsup 1 tbsp 16 0.2 4.1 0.1
Margarine (Land O’Lakes) 1 tbsp 35 0 0 4
Mayonnaise 1 tbsp 100 0 0 11
Mustard 1 tbsp 10 1 1 1
Olive oil 1 tbsp 120 0 0 14
Pancake syrup (Hungry Jack), lite 2 tbsp 50 0 14 0
Pancake syrup (Hungry jack), regular 2 tbsp 100 0 26 0
Safflower oil 1 tbsp 120 0 0 14
Salad Dressing, (Kraft), Blue Cheese “Free” 1 tbsp 16 0 4 0
Salad Dressing, (Kraft), French, reduced calorie 1 tbsp 20 0 3 1
Salad Dressing, (Seven Seas), oil & vinegar 1 tbsp 45 0 1 4
Salad Dressing, (Wish-Bone), Blue Cheese, Chunky 1 tbsp 75 0.4 0.7 7.9
Salad Dressing, (Wish-Bone), Italian 1 tbsp 46 0 1.5 4.5
Steak Sauce, (A1) 1 tbsp 18 0 4 0

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498 | Unit 17

Beverages
Food Serving Calories Protein Carbs Fat
Size (Grams) (Grams) (Grams)
Apple Juice,(Knudsen&Sons),natural 8 oz 85 <1 21 0
Apple Juice (Ocean Spray) 6 oz 90 0 23 0
Apple Grape Juice (Red Cheek) 6 oz 109 0.3 27 0
Banana, w/o skin 1 fruit 105 1.2 26.7 0.6
Cranberry Juice 8 oz 125 <1 31 0
Carbohydrate Sports Drink, low calorie 8 oz 50 0 13 0
Carbohydrate Sports Drink, medium calorie 8 oz 100 0 25 0
Carbohydrate Sports Drink, high calorie 16 oz 400 0 100 0
Grape Juice 6 oz 120 0 30 0
Grapefruit Juice 6 oz 60 1 15 0
Orange Juice 6 oz 120 0 30 0
Vegetable Juice (V8) 6 oz 35 1 8 0

Mixed Foods
Food Serving Calories Protein Carbs Fat
Size (Grams) (Grams) (Grams)
Beef, corned hash, canned (Libby’s) 8 oz 420 19 21 28
Chili, canned w/ chicken (Stagg) 7.5 oz 200 14 21 6
Chili, canned vegetarian (HealthValley) 5 oz 90 10 12 0
Food-bar, banana apple walnut, “Bagel Power Bar” (Earth 1 bar 270 12 45 6
Grains)
Food-bar, Pemmician, carob-cocoa (Bear Valley) 1 bar 440 16 68 12
Food-bar, raspberry, fat free (Health Valley) 1 bar 140 3 33 0
Pizza, frozen, Three Cheese (Lean Cuisine) 5.5 oz 330 23 38 10
Protein Drink, low calorie, powder 2 oz 225 30 15 5
Protein Drink, medium calorie 4 oz 470 40 64 6
Protein Drink, high calorie 5 oz 548 30 80 12
Protein Nutrition Bar, low calorie 1 bar 225 30 15 5
Protein Nutrition Bar, medium calorie 1 bar 470 40 64 6
Protein Nutrition Bar, high calorie 1 bar 548 30 80 12
Power Bar 1 bar 230 10 45 2.5

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2017 Advice about Eating Fish Guidelines from the FDA and EPA
Although the advice about eating fish, including shellfish, issued by the FDA
and EPA focuses on avoiding and/or reducing potentially harmful intake of
mercury and is geared toward women of childbearing age, it will be useful
for everybody who wants to reduce mercury in his or her diet. The following
chart categorizes fish and seafood into three main categories: Best Choices,
Good Choices, and Choices to Avoid. Additional information can be found
at the FDA’s website:
http://www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm393070.htm#supporting

Use this chart!

Advice About
For women of childbearing age (about
16-49 years old), especially pregnant and
breastfeeding women, and for parents
Eating Fish
You can use this chart to help you choose
and caregivers of young children. which fish to eat, and how often to eat them,
based on their mercury levels. The “Best
Choices” have the lowest levels of mercury.
What Pregnant Eat 2 to 3 servings of fish a week from
the “Best Choices” list OR 1 serving
Women & Parents from the “Good Choices” list.

Should Know Eat a variety of fish. What

Serve 1 to 2 servings of fish a week to is a
Fish and other protein-rich
children, starting at age 2. serving?
foods have nutrients that can If you eat fish caught by family or
friends, check for fish advisories. To find out,
help your child’s growth and If there is no advisory, eat only one use the palm For an adult
For children,
ages 4 to 7
development. serving and no other fish that week.* of your hand! 4 ounces 2 ounces

Best Choices EAT 2 TO 3 SERVINGS A WEEK OR Good Choices EAT 1 SERVING A WEEK

Anchovy Herring Scallop Bluefish Monkfish Tilefish (Atlantic

Atlantic croaker Lobster, Shad Buffalofish Rockfish Ocean)

Atlantic mackerel American and spiny Shrimp Carp Sablefish Tuna, albacore/
Mullet white tuna, canned
Black sea bass Skate Chilean sea bass/ Sheepshead and fresh/frozen
Butterfish Oyster Smelt Patagonian toothfish Snapper Tuna, yellowfin
Catfish Pacific chub Sole Grouper Spanish mackerel
mackerel Weakfish/seatrout
Clam Squid Halibut Striped bass
Perch, freshwater White croaker/
Cod Tilapia Mahi mahi/ (ocean) Pacific croaker
and ocean dolphinfish
Crab Pickerel Trout, freshwater
Crawfish Plaice Tuna, canned light
Flounder Pollock
(includes skipjack)
Whitefish
Choices to Avoid HIGHEST MERCURY LEVELS
Haddock Salmon
Hake Whiting
Sardine
King mackerel Shark Tilefish
Marlin Swordfish (Gulf of Mexico)

Orange roughy Tuna, bigeye

*Some fish caught by family and friends, such as larger carp, catfish, trout and perch, www.FDA.gov/fishadvice
are more likely to have fish advisories due to mercury or other contaminants. State
advisories will tell you how often you can safely eat those fish. www.EPA.gov/fishadvice

THIS ADVICE REFERS TO FISH AND SHELLFISH COLLECTIVELY AS “FISH.” / ADVICE UPDATED JANUARY 2017

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Conclusion
The Dynamic Nutrition Approach offers a comprehensive scientific
evidence-based approach, which can be used as a starting point when
developing a personalized sports nutrition program, by qualified health
professionals, and under the athlete’s doctor supervision.

Key Word
Hypoglycemia

Sports Nutrition
 Topics Covered In This Unit

Introduction

 thlete body composition change

A
challenges

The weight-loss misnomer

First stop the weight gain

Targeted fat-loss approach

Fat loss off-season and preseason

Jump-starting the fat-loss program

F at loss during the athletic season (not

preferred)

 he gender and age gap when losing

T
weight

Important rules for making perfor-

mance nutrition work for an athlete’s
fat-loss program

The zigzag method of fat loss

Muscle gain approach

 onstructing a custom nutrition plan

C
for fat loss and muscle gain

Conclusion

UNIT 18

FAT LOSS AND MUSCLE GAIN FOR ATHLETES

502 | Unit 18

Uit Outline
I. Introduction g. The gender and age gap when losing
weight
II. Athlete body composition change chal-
lenges h. Important rules for making performance
nutrition work for an athlete’s fat-loss pro-
a. The weight-loss misnomer
gram
b. First stop the weight gain
i. The zigzag method of fat loss
c. Targeted fat-loss approach
III. Muscle gain approach
d. Fat loss off-season and preseason
IV. Constructing a custom nutrition plan
e. Jump-starting the fat-loss program for fat loss and muscle gain
f. Fat loss during the athletic season V. Conclusion
(not preferred)

Learning Objectives
After completing this unit, you will be able to:
• Define and describe related terms.

• Understand the ZIGZAG method developed by Dr. Fredrick Hatfield, PhD.

• Discuss effective fat loss and muscle gain for athletes.

• Determine weight management programs for healthy adult athletes.

Introduction There are thousands of products and services

on the market for fat loss and muscle gain in
In an athlete’s career, there may come a time
the form of books, videos, audio cassettes,
when a modification in body composition is
magazines, nutritional products, exercise
desired, such as weight gain or weight loss.
equipment, pre-packaged meals, support groups,
However, as you have learned throughout this
and seminars. Billions and billions of dollars are
book, for maximum athletic performance
spent each year by people wanting to lose and
and results, body composition changes must
gain weight. In the process, most people lose out
be specifically targeted. This means that for
in some way: in time, money, impaired athletic
weight loss, the primary goal is fat loss. For
performance, or diminished health and energy.
weight gain, increase in muscle mass is the
primary goal. As it turns out, the best way Clearly, a combined loss of body fat and increase
for athletes to accomplish these goals is the in muscle mass will produce the most desirable
same for most healthy athletic adults. results. However, note that for weight-class

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 Fat Loss and Muscle Gain for Athletes | 503

Athletic Significance Fitness Significance

of Fat Loss and Muscle Gain of Fat Loss and Muscle Gain
For the athlete wanting to lose body fat and As it turns out, the method developed for athletes to
maintain or build muscle mass, taking the correct lose body fat is also ideal for everybody—all healthy
approach is critical for performance. The approaches adults. This approach is easy to implement and will be
presented in this unit have been developed and immediately effective in reducing excess body fat.
field tested to confirm that fat loss can be targeted,
i.e., without loss in lean body mass, including with What differentiates this system from the rest is that it
many famous athletes. It presents an approach for targets fat loss, builds lean body mass in the process, and
building lean body mass while losing body fat. requires no special foods, just making adjustments in
when and how much is eaten and cutting down on eating
Extra body fat will reduce performance levels, just as certain fat-forming foods. After a few days, people can
much as not having enough muscle will. And many become efficient fat-burning machines.
athletes find that gaining weight becomes a double-
edged sword because they also gain fat. This integrated Of course, implementing healthy nutrition practices is
approach is a solution for athletic applications. desirable, including implementing the 2015–2020 Dietary
Guidelines for Americans when practical.

sports, such as wrestling, loss of body fat while composition will be required regularly to
maintaining muscle mass/lean body mass may determine changes in lean body mass and body
be the most appropriate goal but may vary with fat mass. The body fat loss rate should be slow,
each individual athlete. This unit therefore treats 0.5 to 1 pound per week, as not to result in loss
these two subjects together, fat loss and muscle/ of lean body mass. By your keeping track of an
lean body mass gain, providing background athlete’s body composition, adjustments to the
information and guidelines that could be used to rate of body fat loss can be made, for example,
achieve athletic body composition goals. slower rate if lean body mass is also being lost.
Over 1 pound of body fat mass loss per week
Athlete Body Composition is sometimes possible while maintaining or
building lean body mass, but it depends on
Change Challenges the body response dynamics of each person to
Changes in an athlete’s body composition determine what rate of fat reduction is best. As a
related to muscle gain or fat loss can bring about rule, as the rate of fat loss increases, the chance
unwanted decrements in athletic performance of loss in lean body increases, and the associated
and, sometimes, even in health. Therefore, negative metabolic adverse effects increase, too.
ideally, intentional changes in an athlete’s body
composition should be planned for during Note that the specialized approach developed
the off-season and early preseason whenever by Dr. Hatfield, referred to as the ZIGZAG
possible. Depending on the amount of muscle Approach solves this problem by cycling the
gain or fat loss an athlete wants during a reduction of calories for a few days, with some
particular year, a few to several months may days of normal caloric intake, versus chronic
be required for optimum changes in body negative caloric intake, which can trigger the
composition to minimize negative effects on metabolism to slow down. More information
an athlete’s anatomy or physiology. Measuring about the ZIGZAG approach is provided in
body weight, circumferences, skinfolds, and following section of this unit.

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504 | Unit 18

The Weight-Loss Misnomer

Losing weight has become something of
a pastime for many people, and we have
discovered a great deal along the way. When
you determine the optimum fat-loss approach
for athletes, reviewing traditional methods will
help shed some light on how to best approach
the task. Surprisingly, when researching the
facts, it became evident that traditional fat-
loss approaches vary and are not intended for
athletes. These methods are primarily developed
for people who need to lose weight fast for health
reasons or for the would-be dieter who wants to
Body composition goal changes can include a trim down to look better.
variety of outcomes, depending on the athlete’s
goals, for example: There are three main ways your body loses
weight: dehydration, lean weight loss (from
• Reduction of body fat, with maintenance of
muscle, bone, organs), and fat loss. Dehydration
lean body mass
is not a recommended type of weight loss.
• Reduction of body fat, with increase of lean However, wrestlers and other athletes who
body mass
need to “make weight” will unavoidably turn
• Increase of lean body mass, with maintenance to this method as a last-minute resort. Losing
of body fat a few pounds during the last few hours prior
• Increase of lean body mass, with an increase in to competition to make it into a specific weight
body fat division may not be harmful, assuming the
athlete is in a good state of hydration to begin
In rare instances, athletes may desire a reduction
with. In most cases, athletes can have time to
of both body fat and lean body mass, sometimes
rehydrate after the weigh-ins. However, do not
encountered in weight-class sports, but it should
rely on dehydration to lose more than a few
be noted that negative effects on health and
pounds (usually less than 2 percent of total body
athletic performance may occur, and this type
weight), and do not stay dehydrated or become
of situation should be avoided. Report severe
dehydrated under circumstances of heat stress
weight-loss attempts to the client’s doctor, coach,
or during training or athletic events. Ideally,
or other appropriate parties when warranted.
dehydration to make weight should be avoided
Note that a reduction in body weight, body fat,
and is not recommended but seems to be an
and/or lean body mass can also be a sign of
unavoidable reality for some athletes.
severe under eating, eating disorders, disordered
eating, dehydration, or disease, which likely Lean body mass/muscle mass weight loss can
require immediate medical attention. result from cutting back on the calories too

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 Fat Loss and Muscle Gain for Athletes | 505

much, losing weight too fast, not eating the (not recommended) below what is required by
proper proportions of macronutrients, and not the body for weight maintenance. When caloric
properly exercising. Lean body mass weight loss intake is less than caloric use from energy
stems primarily from the breakdown of muscle expenditure, the body liberates energy from
tissue, but bone and connective tissue can also be body tissues and stores; fat, glycogen, and muscle
reduced in size. This is a very detrimental type tissue. Although reduction of total calories
of weight loss for the athlete or anybody for that causing a calorie intake deficit can result in
matter. Loss of lean body mass also reduces BMR weight loss, a significant amount of muscle tissue
and jeopardizes body structure and function. If may be lost in the process if proper methods are
athletes are doing more long duration aerobic not implemented to prevent this.
exercise during weight loss, this type of exercise
may also result in reducing lean body mass due Anyone familiar with the popular survival
to changes in muscle fiber composition, more of television shows has seen how fast a person can
the smaller slow-twitch muscle fibers, and less lose weight from food and calorie deprivation
of the larger fast-twitch muscle fibers. Thus, the along with the adverse effects to body function
body composition change balancing act involves and structure, often resulting in bed (hut) rest
nutrition and training. a few days into the survival experience. In
addition, notice that post-show interviews with
For most athletes, increases in lean body mass the survival participants typically demonstrate
percentage can accompany a proper fat-loss rapid weight gain.
program. This is a result of losing fat and keeping
lean body weight the same, which will result in Another type of currently popular weight-loss
a lower percent body fat and higher percent lean television show example is something like The
body mass. Or this is a result of increasing the Big Loser type of show. Scientists have studied
weight of lean body mass, which will result in the before, during, and after effects of some of
a higher increase of lean body mass percentage the contestants and have reported their findings
and lower body fat percentage. An appropriate in scientific journals. One study that gained
resistance-training program is typically needed media attention reported that weigh regain
to increase lean body mass during reduction occurred among most of the show participants,
of body fat mass. The key to adjusting body even when they adhered to an exercise and diet
composition should not be dictated by reaching program to try to maintain the quickly lost and
some arbitrary weight goal; it should be large amount of weight lost during the TV
determined by reaching a body fat goal that is series competition.
realistic, that can be reached within the allotted
An interesting note on powdered meal
time, and that is related to achieving maximum
replacements: meal replacements usually result
athletic performance and good health.
in an initial drop in weight attributed mostly
In its most basic form, untargeted weight loss to loss of water weight and gastrointestinal
can be accomplished by cutting back on food bulk. Additionally, you may find that a meal
(energy) intake or through outright starvation replacement diet causes diarrhea, which

International Sports Sciences Association

506 | Unit 18

will cause dehydration and adversely affect unrealistic to reverse a fat-gaining metabolism
performance. The athlete needs to consider or weight-maintenance metabolism and switch
maintaining adequate performance levels and to a fat-loss metabolism in days or even weeks
maintaining or building muscle mass. to achieve long-term success, which includes
avoiding body fat regain. The higher the excess
When following a “targeted fat-loss” program,
body fat and the lower the physical activating
fitness trainers and their clients will be surprised
of a person, the longer this metabolic switching
how easy losing fat can be in healthy athletic
may take.
adults. Put aside your misconceptions that you
need to starve to lose fat. In fact, when a program
is properly executed, people won’t even realize Targeted Fat-Loss Approach
they are on a fat-loss program because they will Ideally, athletes should plan to make body
be eating about the same amount of food as composition changes during the off-season.
during a weight-maintenance nutrition program. This way, the pre/in-season nutrition and
However, note that if the desired body-fat loss training program can focus on maximizing
is not occurring within two to three weeks, performance. Most championship athletes will
there may be health problem or other issue that follow this approach. Just think of boxers for
requires a medical evaluation to determine why example. When they are in their prime, they
body fat is not being reduced. look in shape. When they get fat, they look out
of shape and perform poorly. Carrying around
extra weight in the form of fat will decrease
First Stop the Weight Gain
performance. Rollercoaster fluctuations in
A short, simple, and important point is athletes your body composition during the season will
and other clients with excess body fat should also adversely affect athletic performance.
“first stop the weight gain” before starting a However, realistically it is common for weight-
fat-loss program. During the pre-fat-loss phase, class athletes such as boxers, weightlifters,
they can focus on achieving weight maintenance powerlifters, and wrestlers to also try to lose
for a few to several weeks; establish their fat-loss weight during the season or up to the day of
eating plan; modify food-related behaviors; start competitions. Avoiding this approach is best, but
an exercise program; and determine whether the next best approach would be to minimize
any weight-loss supplements or even drugs are athlete clients from doing this.
warranted, under physician supervision; and
address any abnormal health issues based on Start by strategically determining body
their physicians’ examinations. composition goals by referring to the table on the
following pages. Plan to reach body composition
This “first-stop-the-weight-gain” step can help goals two months before the season begins. This
make the fat-loss program even more successful will give an athlete’s body a chance to adjust.
and easier. A major reason many people rapidly Depending on the amount of body fat to lose,
regain the excess body fat they lost is from it may take weeks or months. NEVER try to
skipping this first-stop-the-weight-gain.” It is lose excess fat by using crash diets, starvation

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 Fat Loss and Muscle Gain for Athletes | 507

diets, or any of the fad approaches common to calories (-625 calories/ 5 meals = -125 calories
the weight-loss and sports nutrition industries. per meal) in the above example. It is crucial to
For athletes, the fad weight-loss diets can result keep up with the daily meal schedule. Of course,
in losing muscle mass, which means a drop in based on a person’s individual situation, caloric
BMR and athletic performance along with other reduction per day may be less than the 3 to 4
potential adverse health effects. calories per pound of lean body mass range.

However, for some people, even slow, steady

Fat Loss Off-Season and body-fat reduction with a moderate level of
Preseason calorie restriction, along with lean body mass
For losing fat during the off-season, simply maintenance or building, might reduce basal
follow along with the nutrition guidelines for a metabolic rate. Therefore, this is where the
particular sport. For example, reduce total daily ZIGZAG approach fits in. This can be used from
caloric intake by about 3–4 calories per pound of the start of a body fat reduction program, but
lean body mass (or lean body weight). can be phased in after a few weeks, especially if
lean body mass starts to be reduced. Regarding
For example, modifications to caloric intake, caloric intake
• If an athlete weighs 195 pounds with 20% is zigzagged down and up. Thus, in this
body fat, lean body mass is about 156 pounds. example, reduce caloric intake for 4 to 5 days,
then return to normal caloric intake for 2 to 3
• Therefore, 156 pounds of lean body mass ×
4 calories = 624 calories per day. days. Modulating caloric intake may prevent
the body’s response to lower basal metabolic
• Thus, for a weight-maintenance 3,500 calories
rate. However, another important factor of the
per day nutrition plan, subtract 624 calories,
which is about 2,876 calories per day for the fat ZIGZAG approach is to include muscle-building
loss program’s calorie reduction days. resistance (weight) training into the athlete’s
• Be sure to reevaluate the metabolic needs of
training program, especially when wanting to
the athlete regularly to make adjustments to building lean body mass. But it can be useful for
the calorie calculations based on changes in maintaining lean body mass in association with
lean body mass. reducing body fat mass. The resistance-training
program should be compatible with an athlete’s
As a pound of fat contains 3,500 calories, it will
training program goals.
take about six days to lose a pound of fat for the
above example. Losing fat at a faster rate will Furthermore, the calorie reduction should
certainly result in a loss of muscle mass, not what come from excess dietary fats and simple
athletes want. This moderate fat-loss approach carbohydrates and then complex carbohydrates.
will result in about 4 to 5 pounds of fat lost per These three calorie sources are the fat-causing
month. Subtract the calories evenly from each culprits. Cut back on the high-fat foods, spreads,
meal. If the sport-specific nutrition plan has a desserts, pastries, fruit, soda, and other sources
daily menu that consists of five meals/snacks of fat, sugar, and alcohol, too. Follow the fat-loss
per day, then reduce each meal/snack by 125 tips and guidelines to reduce consumption of

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508 | Unit 18

these calorie sources. In addition, consuming Additionally, protein/amino acids are generally
higher proportions of low glycemic index foods the last source of energy the body uses, because
can provide additional benefits to a fat-loss it saves them for building and repairing tissues
program and to health. and compounds. Complex carbohydrates are
very important to maintain blood sugar levels
Calorie reduction should not come from the
and provide a constant dietary source of high
essentially required protein intake, and should
energy. Studies also show that fat burns better
come only minimally from healthy complex
when carbohydrates are present in the diet. Also,
carbohydrates. Protein consumption should stay
maintain supplement intake as required.
at the level recommended level based on sport
and season needs, also the protein chart in Unit Regarding additional exercise. Stick to the
4 can be used to fine-tune protein needs during core strength training and endurance exercise
fat loss/muscle building cycles. Protein has the program as determined by the specific sport
bonus of stimulating the thermogenic effect, requirements. For sport training programs
meaning that it takes the body more calories that do not include daily aerobic activity,
to process protein then it can derive from the incorporation of 40 minutes of aerobic exercise
breakdown of protein, in addition to its other into the exercise schedule, four to five days
essential nutrient benefits. per week during fat-loss cycle, may be needed.

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 Fat Loss and Muscle Gain for Athletes | 509

Remember, aerobic exercise uses a higher Reduction of carbohydrate intake also needs to
proportion of fatty acids as fuel, whereas be done cautiously as not to jeopardize health or
strength training uses mostly muscle glycogen. physical performance.
Maintaining a daily exercise program will also
Some individuals may find it helpful to give their
help keep up your metabolic rate, maintain or
fat-loss program a “jump start” by depleting
increase lean body mass, and keep up your fat-
their glycogen system, thereby encouraging
burning enzyme levels. High-Intensity Interval
greater use of body fat stores. To do this, one
Training can additionally add benefits depending
approach is to reduce carbohydrates, along
on the athlete’s performance training program.
with calorie deficit, during the first day or
Regarding establishing the ultimate percentage two of the fat-loss program. The reduction
body fat reduction, and goal percentage body fat of carbohydrates can be similar to what is
mass, this should be accomplished working with presented Unit 19 about Glycogen Loading,
the athlete’s team and or sport’s organization the depletion phase. Eating plenty of healthy
guidelines and doctor. low-calorie, low-starch vegetables and the daily
protein required amount should be part of the
Jump-Starting the nutrition program. This should help deplete
Fat-Loss Program muscle glycogen stores and cause a loss in water
weight, too, that is stored with glycogen. It will
Rate of fat loss will be determined by individual
also get fat stores liberating fatty acids for energy.
genetics, body type, metabolism, nutrition,
Follow this jump-start diet for one or two days;
and exercise program. Ectomorphs (naturally
then slowly phase in carbohydrates over the
lean people) will have the easiest time losing fat
next two to three days. Following this approach
but find it hard to gain muscle. Mesomorphs
should only be considered during the off-season
will also able to lose fat easily and can put on
by healthy people under physician approval
muscle mass the easiest. Endomorphs, who tend
and supervision. Be aware that depleting
to carry more body fat, can lose fat at a good
glycogen stores will reduce mental and physical
rate, but need to make sure to stick to a low-fat
performance and, depending on the individual,
nutrition program, keep up on strength and
can cause low blood sugar-associated problems,
aerobic exercise, and use the Fat Loss Tips, as
like dizziness. Therefore, this approach may not
they will probably benefit from them the most.
be suitable for everyone, and some mild side
Endomorphs may also find it beneficial to raise
effects are expected to occur.
their protein levels up to 25 to 30 percent of
total daily calories, which is accommodated Make sure that body composition is measured
by reducing carbohydrate and fat intake. The once a week while on a fat loss program
relative proportions of reducing carbohydrate to monitor body composition changes.
and fat intake may vary depending on how much Additionally, make sure athletes are not losing
fat and carbohydrate each athlete is consuming lean body mass, unless, as in some situations,
to start with. It is important to maintain a reduction of lean body mass may be desired
healthy minimum intake of essential fatty acids. along with reduction of body fat mass.

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510 | Unit 18

Fat-Loss Tips
• Never skip meals.
• Exercise daily.
• Maximize the thermogenic effect by keeping protein levels up, increasing activity, and taking
supplement factors.
• Vigorous resistance training will maintain or increase lean body mass (muscle). Muscle burns
calories, which means that, for every pound of muscle gained, you will be burning more calories
and increasing the rate of fat loss.
• Do not drastically reduce total daily caloric intake.
• Reduce fat intake to less than 25% of total daily calories.
• Increase foods high in fiber and low GI complex carbohydrates to help satisfy hunger.
• Avoid foods high in salt and fat, such as all processed foods and snack foods.
• Eat fresh foods, organic when possible.
• Do not fry foods or use oil or fat in the cooking process. Instead, bake, broil, boil, grill, or micro-
wave foods.
• Avoid using heavy sauces on foods.
• Read food nutrition labels. Look for foods that have less than 2 grams of fat per 100 calories.
• Eat fat-free foods.
• Eat low-fat protein foods.
• Use low-fat protein supplements to help meet daily protein requirements.
• Eat egg whites as a snack to help reduce hunger pangs at night.
• Do not eat out daily and avoid eating fast foods. These foods are usually high in fat, salt, and
calories.
• Eat plenty of low-starch vegetables.
• Do not overeat excess calories at any meal because this will promote fat-storing enzymes and
metabolism to store excess food as body fat.

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 Fat Loss and Muscle Gain for Athletes | 511

Fat Loss during the Athletic more easily than women do because of their
hormonal differences, particularly testosterone.
Season (not preferred)
Testosterone is higher in men, which gives men
Fat loss during the athletic season should be the ability to maintain a higher proportion of
undertaken at a much slower rate than in the muscle mass and a higher metabolic rate than
off-season, if required. Do this by reducing total women can.
daily calories by only 2 calories per pound of
lean body mass. This will result in a slower rate A woman’s hormonal system resists changes in
of fat loss but may avoid or minimize adverse body composition as a protective mechanism to
effects on athletic performance that would result conserve energy stores while pregnant. Women
from a higher rate of fat loss. However, ideally therefore may tend to lose fat at a slower rate
athletes should lose body fat during the off- and find it hard to maintain body fat levels
season and early preseason. below 16 percent. As men and women age (get
older), reduction of body fat stores may occur at
a slower rate. This should not discourage anyone
The Gender and
but should rather underscore the importance
Age Gap When Losing Fat of establishing realistic, lifelong goals. These
The above fat-loss approach is intended for include following a balanced nutrition plan and
healthy adult males and females, under doctor keeping up with a daily exercise program that
supervision. Men tend to lose fat and gain muscle best suits the individual athlete’s needs.

Why Most Fat-Loss Diets Fail

Athletes usually do not have a problem losing body fat when they stick to the targeted fat-loss approach
discussed above. The primary problems they may have encountered in the past had to do with the
quality of weight loss. Fat loss, muscle loss, and water-weight loss results from gimmick diet plans that
are unbalanced in essential nutrients and too low in calories. By following the above approach, athletes
should easily start to lose body fat and reach their realistic, new body composition goal.
Most of the population is interested in quick weight-loss gimmicks that are easy to use. Dieters want
a magic pill or food that melts away fat. Although many of these diet programs can reduce weight,
evaluations report that they have less than a 10 percent success rate in keeping the weight off. This
is because these plans do not use realistic menus and do not advocate sensible exercise. They also
result in loss of lean body mass, which means lowering metabolic rate, leading to low calorie dieter’s
syndrome. When you lose lean body mass, even if reducing body fat, the percent body fat may not
change, or even increase if the amount of lean body mass lost is greater than the amount of body fat
lost. Avoid weight-loss gimmicks that are not for athletes. Avoid fad weight loss too!

International Sports Sciences Association

512 | Unit 18

Important Rules for Making This is a general rule to follow. You can also use
the worksheet and food charts to make a more
Performance Nutrition Work for
specific dietary intake plan for specific individual
an Athlete’s Fat-Loss Program needs. The important thing to remember is
Sound athletic nutrition is not always an easy that when following this plan, when reducing
job. But it is something every athlete should calories, do not cut back on protein calories: cut
follow. Although it is not always practical to eat back first on fat, simple carbohydrates, and then
100 percent properly, attempts to do so will make on complex carbohydrates. Keep protein intake
athletes better competitors. Listed below are the same as determined by daily activity. Note
some suggestions for good athletic eating habits, that Athlete-Type Nutrition Plan examples can
whether an athlete is trying to lose fat, gain also be used.
muscle, or simply maintain body composition.
Rule Three
Rule One
When you sit down to eat, ask yourself, “What
Always eat at least five (5) meals a day. Two am I going to be doing for the next three hours
or three meals simply aren’t often enough. If of my life?” Then, if you’re taking a nap, eat less;
muscles don’t get the calories they need, how if you’re planning on a training session, eat more,
are they going to keep going? By cannibalizing and so forth. Remember, when overeating at a
muscle tissue! Space meals accordingly, similar meal, the excess calories get stored as fat. If a
to when following a sports nutrition program. meal is skipped, do not eat to make up for it: eat
Meal spacing may be about every three to four for what is required based on post-meal activity.
hours but could vary depending on each person’s
daily schedule and rate of digestion. Rule Four

Rule Two ZIGZAG caloric intake for reducing body fat

mass or increasing lean body mass. Depending
Remember the 1-2-3 rule. In each of your five or on the main body composition goals, this
more meals, approximately 1 part of the calories approach involves increasing or reducing caloric
should come from fats, 2 parts from protein and intake for four to five days, followed by normal
3 parts from carbohydrates. caloric intake for two to three days. Refer to
the respective sections of this unit for details.
Here’s an example. Let’s say an athlete eats 600
The basic idea to this approach is to avoid
calories five times a day. That’s 3,000 calories. If
reducing basal metabolic rate that is common
he or she is following the 1-2-3 rule, each meal is
with reduced calorie diets that are sustained for
broken down like this:
many weeks or months. When a person stays
100 calories from fat, on a negative caloric diet too long, his or her
200 calories from protein, and body’s BMR will drop in response to it, causing
low calorie dieter’s syndrome. To avoid losing
300 calories from carbs.
lean body mass when reducing body fat mass,

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 Fat Loss and Muscle Gain for Athletes | 513

and to avoid increasing body fat mass when Make use of dietary supplements to fill in
increasing lean body mass, caloric intake should essential nutrient gaps and, when required, under
be zig-zagged. physician supervision, use additional specialty
fat-loss aid supplements. The use of specialty fat-
Rule Five loss supplements will depend on the issues being
experienced by the athlete, such as poor appetite
The final rule of thumb for serious athletes is that control or a sluggish fat-burning metabolism.
no matter how hard they try:
Here are examples of some fat-loss aid
• You can’t always eat perfectly balanced meals;
supplements based on independent research
• You can’t always eat five or six times daily; and natural health products approved in
• There are many instances in which your body Canada for weight reduction purposes.
requires certain nutrients in greater amounts Also, note that meal replacement food
than what can be derived from diet alone; and products, technically not supplements, can
• With today’s advanced nutritional and often play a role in a fat-loss program.
botanical sciences, we now know that there
are many substances (both synthetic and
those provided by nature) that aid in taking
you far beyond the performance limits that are
possible through diet alone.

Supplement Weight-Loss Aid Examples.

Includes clinically researched ingredients that are either approved as Natural Health Products in Canada, or Received
Positive Weight-Loss Benefits reported in “Dietary Supplements for Weight Loss

Fact Sheet for Health Professionals,” Office of Dietary Supplements, National Institutes of Health, and subject to
multiple clinical research studies. Consult products for directions and dosages, under physician supervision.

African Wild Mango – Irvingia gabonensis Glucomannan

Caffeine (alone and in combination with other Green Coffee Bean Extract
ingredients, like green tea extract)
Green Tea and Green Tea Extract
L-carnitine
5-HTP
Chitosan
Pyruvate
Chromium (extra)
White Kidney Bean Extract
Conjugated Linoleic Acid (CLA)

Note: Supplement weight loss aids may be effective along with a weight loss diet and exercise program, to increase
rate of weight loss, in studies that compare ingredients to placebos. Studies are typically short term, a few to several
weeks or months, under doctor and researcher supervision. Supplement weight loss aids typically have a wide range
of effectiveness depending on each person’s metabolism, diet, activity level, and genetics. In other words, the same
supplement weight-loss aid ingredient that may be effective for one person, may not exhibit the same effectiveness
for another person. This is not intended to be an exhaustive list of all the possible supplement weight loss aids, just
examples of some of the ingredients with clinical research evidence, official approvals, and or recognition by authori-
tative bodies.

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514 | Unit 18

The Zigzag Method of Fat Loss bodyweight. After the 48 weeks, the BMRs of
both groups had dipped an average of 9 percent,
“I eat like a BIRD, and I still gain weight!”
and their percentages of body fat had dropped an
“No matter WHAT I do, I get fatter average of 16–19 percent.
and fatter!”
Now, what’s interesting about this study’s
“All I have to do is SMELL food and I findings (other than the relatively predictable
put on weight!” outcome that the crash dieters weren’t any better
off than the moderate dieters were after 48
Anyone who has been around the fitness weeks) is that scientists had previously assumed
world for any length of time has heard these that any reduction in body weight triggered
complaints. Even athletes and bodybuilders a permanent corresponding drop in BMR. A
preparing for competition often have trouble permanently lowered BMR would mean that a
shedding those last couple of pounds of third- dieter would not burn calories as rapidly and
place-rendering, muscle-masking ugliness called might therefore regain the lost pounds or have
adipose. real problems shedding more pounds.
Scientists have long known that stringent Of course, the mechanism responsible for this
dieting causes a corresponding drop in resting highly undesirable turn of events is the loss in
metabolic rate (called “basal” metabolic rate, or lean muscle. It’s simple: bigger muscles burn
“BMR”), making it difficult—often impossible— more calories than little muscles. And if you are
to continue the fat-shedding process. Scientists losing weight from both fat and muscle, your
at the University of Pennsylvania performed ability to continue losing fat—and keep it off—is
a 48-week research study, which explored this literally sacrificed.
phenomenon. They arrived at some intriguing
findings that you – elite athlete or couch Scientists are finally beginning to garner some
potato – can benefit from. The study involved hard data supporting what experts of “Irondom”
18 women weighing an average of 216 pounds have known for a long, long time. That is, there’s
at the beginning of the research period. Half a way to lose fat and maintain a reasonably
received a 1,200-calorie per day diet, and the high BMR so your fat-loss process can continue
other half received 16 weeks of a common meal smoothly. It’s called the “zigzag” method of fat
replacement liquid followed by a conventional loss, and it works better than any fat-loss method
weight-reducing diet. All the women walked to there is. Why? It’s permanent. Permanent, that
increase their caloric burn. is, if you continue to eat five or six smaller meals
per day and exercise regularly. It also allows you
While the BMRs of both groups fell after to maintain (or improve) your lean muscle mass.
five weeks, it fell significantly more for those
taking the meal replacement supplement Refer to the following tables for examples. You’ll
(the more stringent of the two experimental notice that as you reduce your caloric intake and
treatments). Their BMRs quickly returned to a increase caloric burn, body fat percentage drops
level considered normal for their new (lower) correspondingly. But so does your BMR. Then,

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 Fat Loss and Muscle Gain for Athletes | 515

This individual actually lost

Ineffective Bodyfat Reduction Plan 21 pounds of muscle and
200 lbs. 200 pounds & 30% bodyfat only nine pounds of fat!
He’ll yo-yo back up to 200 in
190 lbs. no time (within one to two
years, according to informa-
tion compiled during the
180 lbs.
Congressional investigation
into the fat-loss industry).
170 lbs. 170 pounds & 30% bodyfat
However, in doing so, he will
be 35% body fat instead of
160 lbs.
his original 30%. Why? He
will never regain all of the
150 lbs. lean tissue he lost as a result
of his crash-dieting earlier.
140 lbs. 140 pounds lean bodyweight This same scenario happens
over and over to men and
130 lbs. women alike.

120 lbs. 119 pounds lean bodyweight

110 lbs.

100 lbs.

Week 1 2 3 4 5 6

Effective Bodyfat Reduction Plan By following the five rules of

performance nutrition, this
200 lbs. 200 pounds & 30% bodyfat client gained 14 pounds of
quality muscle (and a greatly
190 lbs. amplified metabolic rate and
immune competence). An ef-
180 lbs. fective nutritional strategy al-
lowed him to lose 44 pounds
170 lbs. 170 pounds & 10% body fat of body fat!

160 lbs. 154 pounds lean bodyweight

150 lbs.

140 lbs. 140 pounds lean bodyweight

130 lbs.

120 lbs.

110 lbs.

100 lbs.

Week 1 4 8 12 16 20

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516 | Unit 18

to force your BMR back to a normal level, begin

eating normally again for a brief period.

What happens is that body fat level again

begins to climb but not as high as it was at the
beginning. Then you lower caloric intake again;
down goes body fat. Eat normal again, and up
the body fat goes -- again, not so high as it was
before. This process continues until body fat
percentage is at healthful levels.

By zigzagging your caloric intake like this, you

fitness. But even for such people, weight training
ultimately allow periodic BMR adjustments
stands out as the single best method there is for
to take place, bringing it back to a level
ensuring that gradually lost weight will come
corresponding to your new (lower) bodyweight.
from fat stores, and not hard-won muscle tissue.
Then it’s easy to begin losing fat again—and
Why? Because aerobic training simply does not
again. If you simply try going down, down, down
build muscle to the extent that weight training
in body fat, your BMR never has a chance to
can. In fact, aerobic training alone will reduce
adjust, and your fat loss efforts become harder
your lean body mass, and drop your BMR.
and harder until, in thorough frustration, you
This means you need to exercise to burn more
binge out and get fat again—forever. This also
calories. On the other hand, if you gain 5 or 10
will help you get over or avoid the phenomenon
pounds of muscle, you are burning more calories
of plateauing, when a person loses several pounds
all the time, even when you are sleeping.
of fat, then stops losing. When most people hit
a plateau, what do they do? They reduce caloric Further, when you couple the zigzag method and
intake, which is wrong. You now know that this weight training with moderate aerobic exercise
just adds to the problem, by further dropping and a careful diet and supplement program, you
BMR. Zigzag calories up, and BMR will be will be amazed at how easy it is to lose fat and
readjusted higher, to burn more calories. how utterly enjoyable it is to keep it off forever.
Your new lifestyle will ensure that!
An important key to the entire process is weight
training. Without the weight training, your lost Finally, for diehard athletes or fitness enthusiasts
weight will be from lean tissue, NOT only fat! who insist on becoming fat between contests
And don’t try to do it too quickly! Even with or during the winter months of inactivity, I
weight training, starvation diets will cause too have only a couple of things to say: 1) change
much muscle loss rather than sheer fat reduction. your slovenly ways, or 2) if not, be prepared to
Walking is OK for those considered “chronically” suffer the indignation associated with being
fat. And for those who are only slightly overweight, always “on a diet,” and stuck in a
overweight, other forms of aerobic exercise are rut wherein you never quite realize your true
excellent for maintaining great cardiovascular potential as an athlete.

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 Fat Loss and Muscle Gain for Athletes | 517

Muscle Gain Approach will vary considerably and depends on your

body type, gender, age, and current training
The muscle building/bodybuilding market status. Mesomorph men tend to be able to pack
continues to grow. Just walk into a health on muscle the fastest. Endurance athletes will
food store and you are faced with hundreds of initially find that due to their previous training,
muscle-building products. They range from and training-induced muscle fiber content, they
powders to sophisticated kits. Gaining muscle will gain muscle more slowly. Can an athlete
is just as scientific as losing fat is and requires a gain 30 pounds of muscle in a year? This is
specific training and nutrition program. When possible, but do not be discouraged if the rate of
athletes want to build muscle mass, they can muscle gain is slower based on each athlete.
follow the nutrition and training guidelines
Here are some tips for a muscle-gaining
given for bodybuilders as a starting point.
program.
This is an effective approach for increasing
• Add 2 calories per pound of body weight to
muscle mass and reducing body fat. As with
the daily caloric intake for 4 to 5 days, and then
fat loss, muscle building should be undertaken reduce caloric intake to normal caloric body-
in the off-season. Preseason and in-season weight maintenance levels for 2 to 3 days.
efforts should focus on strength training
• If body fat levels are increasing too much, try
and maximizing athletic performance for
for a week or longer the previously mentioned
the particular sport; noting that increase in fat-loss approach, which can be cycled into the
muscle mass can occur as a side benefit. muscle gain program. This may slow down the
Many books will mislead you into thinking increase in lean body mass, but some increase
in lean body mass is usually possible with
that gaining muscle weight is a matter of just
targeted fat loss. Then once body fat levels
increasing caloric and protein intake. Not so.
are reduced to the desired levels, return to the
Athletes must primarily be following an effective muscle-gaining program by adding 2 calories
weigh-training/resistance-training program that per pound of body weight, and so on.
is designed for muscle building. That’s right. Not
• Some athletes may be able to add more
all weight-training programs result in optimum than the 2 calories per pound of body
muscle gains. In fact, most of the weight-training weight to the daily caloric intake, which
programs labeled “strength training” will can be experimented with by closely
build muscle but are more focused on building monitoring changes in body composition to
strength and power. These performance factors determine rate of lean body mass increase
are important but can be worked on in the and rate of body fat mass increase.

preseason after gaining desired muscle mass. In • The added calories should be mostly protein
addition, the muscle-building and development and some complex carbohydrates (no added
goals of each athlete must be considered to best fat calories).
result in being compatible with overall athletic • Spread these added calories equally among at
performance training program. least five meals per day.

Set realistic muscle gain goals and focus on the • Evaluate using a bodybuilding/strength
long term. An athlete’s ability to gain muscle athlete nutrition program model during

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518 | Unit 18

off-season, when compatible with • Evaluate performing weight training in two

overall sport specific program or with shorter sessions per day to maximize anabolic
appropriate sport-specific modifications. hormones and optimize nutrient intake.

• Then in the preseason, follow sport-specific • Keep the dietary fat intake low.
strength-training program to maximize
• Eat high-quality, low-fat protein like egg
strength and power and athletic performance
whites, chicken, turkey, tuna, lean meats, low-
for the sport.
fat dairy, and protein supplements.
• Include some of the well-established
• Consume the recommended healthy daily
muscle- and strength-building
intake of fruits and vegetables.
supplements such as creatine in addition
to multivitamin/mineral supplements • Do not overtrain. Overtraining—which is
and other supplements as required. defined as “cumulative microtrauma”—actually
stimulates the release of catabolic hormones,
• Eat a least five meals per day, increasing caloric
like cortisol, which break down muscle.
intake strategically to result in increased lean
Weight train at the appropriate level of fitness,
body mass, not excess body fat.
beginner, intermediate, advanced, or elite.
• Have body composition measured at least Give the body a chance to repair muscle and
weekly to determine where changes in body connective tissue with adequate rest and
composition are occurring: body fat mass or sleep each day and adequate intervals of rest
lean body mass. from day to day based on resistance-training
intensity and an individual’s rate of recovery.
• Consume organic foods when possible.
• Keep adequate body composition and training
• Eat fruits and nuts for energy boost.
records and evaluate regularly
• Eat more complex carbohydrates;
• Make adjustments to an athlete’s caloric
whole grain rice, pasta, potatoes,
intake and nutrition program as determined
whole grain breads, and beans.
by the progress in gaining lean body mass
• Eat whole foods instead of processed foods. and changes in body fat mass and overall
body weight.
• Eat sport nutrition bars that are low fat, high
carbohydrate and high protein. Note that individuals with low body fat levels
• Because most people find it hard to eat should be aware that they might have to increase
all the required food, try eating low- their caloric intake levels higher than the average
fat, high-protein weight-gain drinks guidelines to avoid having too low body fat
as a snack or as part of a meal. mass levels, which can be unhealthy or lead to
• Remember not to overdo the protein at each disqualification in some sports.
meal; the body can only effectively digest and
assimilate about 20 to 40 grams of protein per
meal, but this may vary from person to person.

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 Fat Loss and Muscle Gain for Athletes | 519

Constructing a Custom Nutrition

Plan for Fat Loss and Muscle Gain
If you find that the rate of fat loss or muscle gain is not occurring at the
rate you want, you may have to get more specific with dietary intake
than the general guidelines provide. First determine daily protein intake
and then building carbohydrate intake on top of this. As most protein
sources contain 10 to 50 percent of calories from fat, you want to keep
added fat low during a fat-loss program, especially unhealthy saturated
fats. When you ZIGZAG caloric intake, it is best to keep protein
intake the same and cut back on fat, simple carbohydrates, and then
complex carbohydrate intake if needed. The intake of protein is vital to
maintaining and building lean body mass and adding a thermogenic
effect to the diet. Note that when doing this, the percentages of
protein:carbohydrate:fat will change from the starting values.

The following will provide an example for a more specific nutrition plan
for reducing calories per day.

Example person will be male, 190 pounds, 22% body fat.

Lean Body Mass = 190 × .78 (78%) = 148.2 lbs.

From Units 14/15, add in daily range of caloric requirements for the
different activity levels.

BMR 130% 155% 165% 200% 230%

Calories 2073 2424 2892 3078 3731 4291

Determine Protein Intake from Unit 4: Using 148.2 pounds LBM and a
need factor of .7, for sports participation or moderate training, 3 × per
week, the protein requirement is: 105 grams per day. Protein intake can
also be determined based on the sports-specific nutrition plans, using
percentage of total daily calories needed. As with other nutrient intake
approaches, fine-tuning will be required as the program progresses and
as body composition and other data are collected and evaluated.

Thus, for a typical training day, this person would need 2,892 calories,
containing 105 grams of protein. But remember you will be cutting back
on calories for fat loss, by about 600 to 800 per day.
* Use the chart on the
Divide protein intake by 5, to spread over 5 meals. That is: following page as a
105 grams/5 = 21 grams of protein per meal. worksheet

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520 | Unit 18

Daily Food Intake Worksheet for Fat Loss or Weight Gain.

Calories Per Meal Rest Calories Per Meal Daily Protein Intake Daily Carbohydrate Fat Intake
Day Training Day Intake Intake

Meal 1 Meal 1

Meal 2 Meal 2

Meal 3 Meal 3

Meal 4 Meal 4

Meal 5 Meal 5

Meal 6 Meal 6

Meal 7 Meal 7

Note: This approach is intended for the special conditions of losing body fat or building muscle mass, or both. For
performance nutrition, follow sport-specific guidelines on caloric intake and protein, fat, and carbohydrate percentage
intake.

Daily Food Intake Goal Examples (estimates)

Listed below are food guidelines that range meal. Following these food intake guidelines
between 2,500 calories per day and 3,500 calories results in a 20% Protein, 60% Carbohydrate, 20%
per day and that are designed for a lean reference Fat diet. One of the performance nutrition plans
individual of 175 pounds. The daily caloric can also be used as a guideline to be modified to
intake can be adjusted by adding or subtracting best suit the individual athlete. Refer, too, to the
about 1-2 servings from each food category, Dietary Guidelines and DASH diet for additional
noting that suitable protein intake should be examples and healthy eating considerations.
maintained, along with other essential nutrients.
Choose whole foods, whole grains, and organic
Spread out food intake over five to seven meals
foods when possible.
per day to match caloric demands following the

Sports Nutrition
 Fat Loss and Muscle Gain for Athletes | 521

Daily Food Intake Examples (estimates)

Listed below are food guidelines that range between 2,500 calories per day to 3,500 calories per day and are designed
for a reference individual of 175 pounds, who is lean. If you are lighter or heavier, you can adjust the daily caloric intake
by adding or subtracting about one serving from each food category. Spread out food intake over five to seven meals
per day to match you caloric demands following the meal. Following these food intake guidelines result in a 20 percent
protein, 60 percent carbohydrate, and 20 percent fat diet. You can also use one of the performance nutrition plans
presented in Chapter 17.

Food Group Suggested Servings Per Day Serving Size

Fruits 4 to 6 servings 1 whole fruit (like apple, banana. pear, or-
ange); 1/2 grapefruit; 1/2 melon wedge;
Citrus, melon, berries and Fresh fruit preferred 3/4 cup of juice; 1/2 cup of berries; 1/2 cup
other fruits cooked or canned fruit; 1/4 cup dried fruit

Vegetables 5 to 8 servings 1/2 c cooked vegetables

Dark-green leafy vegeta- Include a diversity of vegetables each 1/2 c chopped raw vegetables
bles and other non-starchy day
vegetables. 1 c leafy raw vegetables like lettuce or spinach

Complex Carbohydrates 11 to 14 servings 1 slice bread. 1/2 hamburger bun or English

muffin. 1 small roll, biscuit or muffin. 4 crack-
Bread, Cereal, Grains, Pasta, Include several servings of whole grain ers. 1/2 cup cooked cereal, rice or pasta. 1
and starchy vegetables. products daily. ounce of breakfast cereal. Maintain intake of
(Whole grains) healthy complex carbohydrates, from whole
grains, and low to medium glycemic index
foods, limit high GI foods.
High Protein Foods 3 to 4 servings Amounts per serving should range 5 to 7
ounces of cooked lean meat, poultry, or fish
Meat, poultry, fish, and Choose lean cuts of meat (trim the a day. Count 1 egg, 1/2 cup cooked beans, or
other seafood. fat), skinless chicken and turkey or fish. 2 tablespoons of peanut butter as 1 ounce of
Avoid over fatty meats. meat.
Also beans, protein
and carbs.
Dairy 2 to 3 servings per day. 1 c milk, 8 oz yogurt, and 1 1/2 oz cheese.

Milk, cheese, and yogurt Choose low fat dairy products when-
ever possible to reduce fat intake

Water/Fluids Drink 8 to 12, 8-ounce glasses of water Plain filtered water, diluted fruit juices, and
each day. Additional guidelines in Unit low-cal beverages.
6.

Fats Minimize consumption of dietary fats, Use food preparation methods that use little or
saturated fats, and cholesterol. no added fats or oils.

Sweets/Sugar Minimize high ingestion of sugar and Simple carbs from mostly fruits, and for special
foods containing high sugar content. sports energetic purposes, sports nutrition
preparations in moderation.

Alcohol Avoid drinking alcoholic beverages. Or Drinks containing 1 to 2 ounces of alcohol per
if you do drink, do so in moderation. day are considered to be moderate consump-
Never do so before athletic events or tion. Low alcohol content beverages like beer
during athletic season or other periods and wine, with health benefits may be a top
banned by sports governing bodies choice based on each individual.

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Conclusion
Weight control: this Weight control. Body composition management for athletes is an
refers to achieving and
important factor for achieving and maintaining peak health and athletic
maintaining a healthy
weight with healthy eating performance. Weight-loss adjustments should ideally be targeted at
and physical activity adjusting body composition levels like body fat mass and lean body mass
(principally skeletal muscle). Adjustments in body composition should
be made off-season/early preseason when possible, especially for losing
excess body fat mass, which requires creating a daily caloric deficient and
can impair athletic performance for many types of athletes, but which
will vary based on individual athlete and type of sport. Note that muscle
mass can be increased concurrent with reduction of body fat mass.
Gaining muscle mass (which is typically accompanied with the increase
in other lean body mass, such as bone, connective tissues, and body
water), depending on the sport, may include off-season, preseason, and
athletic-season periods. Gaining muscle typically involves excess caloric
consumption; therefore, athletic performance from calorie deficits is
avoided. Whatever the weight-control or body composition management
goals are for individual athletes, a top priority is an athlete’s health and
athletic performance goals.

Use of Dr. Hatfield’s ZIGZAG method is proven approach to accomplish

weight control and body composition management goals of healthy
adult athletes, with applications for nonathletic adults, too. Physician
and other applicable health professional supervision will determine an
individual’s state of health and the suitability of weight loss or weight
gain approaches, including any health issues requiring special medical
attention that are common in people with excess body fat.

Key Word
Weight control

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 Topics Covered In This Unit

Introduction

 hy “glycogen” loading
W
(supercompensation) for athletes?

Glycogen-loading science

Glycogen-loading
(supercompensation) origins

 lycogen-loading
G
(supercompensation) approaches
overview

 raditional glycogen loading

T
(carbohydrate loading approach)

Modified glycogen-loading approaches

International Olympic Committee

2000 glycogen-loading approach

ASC glycogen-loading 2009 approach

Military research study

Glycogen-loading considerations

For glycogen-depletion phase

For glycogen-loading phase

Creatine with glycogen loading?

Conclusion

UNIT 19

GLYCOGEN LOADING
(SUPER COMPENSATION)
524 | Unit 19

Unit Outline
I. Introduction c. International Olympic Committee 2000
glycogen-loading approach
II. Why “glycogen” loading (supercom-
pensation) for athletes? d. ASC glycogen-loading 2009 approach
III. Glycogen-loading science e. Military research study
IV. Glycogen-loading (supercompensa- VI. Glycogen-loading considerations
tion) origins
a. For glycogen-depletion phase
V. Glycogen-loading (supercompensa-
b. For glycogen-loading phase
tion) approaches overview
VII. Creatine with glycogen loading?
a. Traditional glycogen loading (carbohy-
drate loading approach) VIII. Conclusion
b. Modified glycogen-loading approaches

Learning Objectives
After completing this unit, you will be able to:
• Define and describe terms related to glycogen loading;

• Discuss how glycogen loading works in the body;

• Understand the glycogen loading methods; and

• Determine which types of sports athletes can benefit from glycogen loading.

Introduction intensity is increased, carbohydrates become

the more dominant source of fuel for muscles.
Skeletal muscles use carbohydrates as a main
At very high training intensities, carbohydrates
source of energy during high-intensity exercise
become utilized at even higher rates of energy
and competition to maintain high-level skeletal
production. This is true for endurance and
muscle contractions. Dietary carbohydrates can
strength sport activities.
be used for energy production and can also be
converted into glycogen and stored in muscles Additionally, glycogen supply is usually
and the liver. When a person is at rest, the much more limited than body fat stores are.
body burns carbohydrates and fats for energy It is therefore paramount to make sure an
production, the rates of which depend on level athlete’s glycogen stores are at their maximum,
of fitness, training (aerobic or anaerobic athlete), replenished daily, and sparing glycogen loss
and the composition of the diet. But as training with dynamic carbohydrate intake. One

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exception to this glycogen status would be Thus, while long-distance endurance athletes
during carbohydrate-loading approaches that have been regarded as utilizing glycogen loading,
first require glycogen depletion, followed by carbohydrate loading may be suitable for other
glycogen replenishment to achieve super-loaded types of athletes, in particular during long
glycogen stores. competitions and those grueling tournaments.
Glycogen loading aside, as reviewed in the
As reviewed in Unit 3, glycogen is a type of Carbohydrate Unit, maintaining adequate
polysaccharide branched molecule made of carbohydrate intake daily is vital for all athletes,
glucose, found in the cytosol/cytoplasm of including before, during, and after training.
cells. The amount of water stored in association
with glycogen is estimated to be about 1 part
glycogen to 3 to 4 parts water; for example, 1 Why “Glycogen” Loading
ounce glycogen with 3 to 4 ounces water, or 1 (Supercompensation)
gram of glycogen with 3 to 4 grams of water. Any
for Athletes?
athlete considering carbohydrate loading should
experiment/practice with it during the months Traditionally, the terms carbohydrate loading
preceding the competition season to see how the and carbohydrate supercompensation have been
body responds and during the off-season, too. used in the research and various publications
regarding sports nutrition, including in previous
The athlete’s body also uses fatty acids for energy editions of this course book. However, from
production; this tends to fuel the body at a conversations I have had with students and
slower rate than carbohydrate does. Note that athletes, and from conducting seminars with
once glycogen stores run low or run out, fatty health professionals over the years, when
acids are used as a dominant source of energy, discussing the ultimate reason of carbohydrate
and physical and even mental performance is loading (supercompensation)—muscle and liver
decreased. Exercise duration can be shortened, glycogen loading (supercompensation)—I have
and exercise intensity level can be reduced found that this shift in focus seemed to better
under low and/or depleted glycogen levels in the connect with the various audiences. Therefore,
muscles and liver. in this updated edition, “Glycogen Loading
(supercompensation)” is utilized, a phrase that
Additionally, when glycogen is depleted, the
also appears in research studies.
body uses a higher amount of amino acids from
muscle tissue for energy and to manufacture The phrase also connotes dynamic aspects,
glucose, which the body thrives on, especially ranging from the traditional method of lowering
to fuel the brain and high-intensity muscle carbohydrate intake to attempt to completely
contractions, along with some of the body’s deplete muscle glycogen and liver glycogen
other functions. The depleted body glycogen stores, followed by increasing and maintaining
means increased muscle tissue catabolism, which high carbohydrate intake to replenish body
is undesirable. Glycogen depletion can occur glycogen stores to a higher level compared with
during long duration training and competition. normal conditions; to the modified methods

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that are more “carbing up” approaches to make increased glycogen synthase activity to rapidly
sure body glycogen levels are filled up, with a restore glycogen. Other enzymes are involved
bonus if they are higher than normal. In other in the biosynthesis of glycogen, but glycogen
words, athletes load up on carbohydrates to synthase is considered to be a rate-limiting
load up their glycogen stores: glycogen loading enzyme, so boosting its activity is a vital part of
(supercompensation). However, with all the achieving glycogen supercompensation potential,
different approaches that have evolved during along with maintaining an adequate supply
the decades, the primary outcome of a glycogen of glycogen molecule substrate. In addition,
loading program is to increase glycogen body adequate hydration, as water is stored along with
stores to above normal levels. But some of the the glycogen molecules.
more recently developed, modified glycogen
loading approaches may be also suited for all
athletes looking to maximize glycogen stores, Glycogen Loading Origins
in addition to the conventional long-distance Decades ago, scientists discovered that when
endurance athletes who were the basis of glycogen is depleted, fatigue sets in and reduces
developing glycogen loading in the first place. work, physical, and athletic performance.
Additionally, it was determined that when
Glycogen glycogen stores are depleted, they can hold more
glycogen when replenished properly, to achieve
Loading Science glycogen supercompensation. Scientist then used
From reviewing the glycogen loading science, this knowledge to devise a method of packing
some insights in to the underlying metabolic greater-than-normal amounts of glycogen inside
aspects can be found. For example, on a athletes’ muscles and liver tissues. This allowed
fundamental basis, during glycogen depletion, long-distance endurance athletes to be able
catabolism is involved during the breakdown to run for longer periods without “hitting the
of the glycogen molecule, and liberation of wall.” When the wall is hit, and high energy-
glucose for energy, which is further catabolized yielding glucose becomes low or absent, when
by the cells to produce energy. During glycogen the body must rely on mostly fatty acids and
loading, anabolism is involved for the synthesis amino acids and various metabolic by products,
of glycogen molecules from glucose. As with the bioenergetics of muscle contractions become
most biochemical reactions, enzymes are reduced, slowing down even slow-twitch
involved. A core enzyme occurring in the body muscle fiber output, in addition to increasing
involved in the biosynthesis of glycogen you the feelings of physical and mental fatigue.
will read about is called glycogen synthase. Therefore, with body glycogen depletion, athletes
Researchers observed that from depleting experience lower energy muscle contraction
glycogen stores via exercise and also low output, becoming fatigued sooner during
glycogen levels in the body, glycogen synthase exercise, and can also experience mental/
activity can be stimulated to replenish glycogen cognitive fatigue. This depleted condition can
supplies. Of course, adequate substrate, such also leave athletes susceptible to injury and
as glucose, is required to take advantage of the potential adverse health events.

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As the story goes, it is reported to be during the 1960s, that

Scandinavian researchers (Bergstrom and Hultman for example) were
experimenting with the different influences of diet manipulation on
glycogen stores and exercise duration. Through their experiments using
normal mixed nutrient diets, carbohydrate-free diets, and carbohydrate-
rich diets, they found some interesting effects on exercise capacity.
Additionally, intervals of heavy work were performed in association
with the different diets. What they discovered was that when individuals
underwent heavy exercise along with diets low in daily carbohydrate
content, their work capacity was shortened. Then when these individuals
consumed carbohydrate-rich diets for a few days directly following
the period after their glycogen stores had been depleted, these people’s
exercise capacity significantly increased.

What was also determined was that muscle glycogen content was much
higher than that attained when just following a normal mixed-nutrient
diet. The traditional approach to carbohydrate loading was thus born—
referred to as the classical approach or method.

This research led to the practice of glycogen loading; however, one

drawback of this traditional approach is that athletes will experience
very low glycogen stores for two or three days, which may interfere
with training and cause some undesirable side effects. As carbohydrate
loading is commonly used before important endurance sport Endurance sport: a sport
competitions, this depletion could ironically hinder an athlete’s that requires the ability to
perform for long periods
performance. Further research conducted in the 1980s by Sherman and at low intensities, such as
Costill shows that similar glycogen loading results can be accomplished marathon running and
cross-country skiing.
using a modified nutrition/exercise regimen. About six days prior to the
important competition, the athlete will gradually taper down exercise.
Researchers found that when athletes use this modified approach,
extremely high levels of muscle glycogen, similar to those reached using
the traditional approach, are attainable.

The roster of glycogen-loading scientists continues to grow as, each

year, research is conducted investigating glycogen loading dynamics
and searching for alternative approaches, new insights, additional sport
applications, gender differences, and so on. The following section will
present examples of some of the glycogen-loading approaches.

Glycogen loading is popular with long-distance athletes such as

triathletes, cross-country skiers, cyclists, and long-distance runners.
Other athletes continue to experiment with carbohydrate loading.

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Athletes find that carbohydrate loading is improved physical performance among athletes
especially beneficial during tournaments in a squash match. These researchers used a
that demand participation in several events 48-hour “Carbohydrate Loading” program and
or matches that only last for a short period. a simulated squash match. The squash match
However, athletes who need to meet weight-class simulation was designed to mimic a five-game
requirements may find it hard to use glycogen match lasting approximately one hour. Improved
loading because of the high-calorie intake physical performance was measured for the
required and the gain in water weight in the carbohydrate-loaded athletes (48-hour high-
days leading up to the day of competition during carbohydrate diet, 11.1 grams per kilogram of
loading, as water is stored with glycogen in the body weight), compared with the athletes on low-
body, hydrated glycogen. carbohydrate diets.

Sport activities that traditionally are expected

to benefit by glycogen loading are generally Glycogen-Loading
sports that are long in duration and continuous, (Supercompensation)
like long-distance running, in which glycogen
depletion body stores may occur: generally,
Approaches Overview
continuous endurance athletic events lasting Experts who supervise athletes using glycogen-
more than 90 minutes, but depending on the loading programs, and the athletes themselves,
intensity of the exercise, and starting body will attest to the reality that mastering
glycogen stores, athletic events over 60 minutes glycogen loading can be just as challenging
may be of concern for the onset of reduced as is mastering their other athletic training,
physical and/or mental athletic performance. nutrition, and performance skills. Similar to
Additional factors involved carbohydrate other sports nutrition examples, the methods
consumption during exercise or sports events. are general and need to be fine-tuned for each
Note that athletes competing in daylong athlete. Mastering glycogen loading may take
tournaments may also benefit from glycogen years to perfect for each athlete. However, as
loading along with ingesting carbohydrate with other sports nutrition approaches, the
drinks during the tournament and a high- payoff (improved athletic performance) can be
carbohydrate diet. And at certain times, all worth the athlete’s painstaking effort and his or
athletes who need to make sure their glycogen her expert support team.
stores are at capacity may experience benefits
following one of the more recently developed There are a few ways to glycogen load. It’s up to
modified approaches and following a sports the heath professional team and coach working
nutrition program that provides adequate together to determine which approach is suitable
carbohydrate intake—in addition to the other for their athletes. Together with integrated
essential nutrients. training, glycogen loading makes it possible
to significantly load up more glycogen than
Regarding the non-traditional types of sports, normal into muscle cells and other body tissues:
Aaron Raman and coworkers (2014) found supranormal glycogen tissue levels.

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Glycogen supercompensation or loading methods can follow two phases:

• Glycogen depletion phase in which the amount of glycogen is depleted
to some degree by dietary manipulation, moderate calorie restriction, or
increased training duration that is sufficient to deplete muscle glycogen
stores. Note that the muscles being used in the athletic event need to
undergo the glycogen storage depletion exercises. In addition, it seems
that based on ongoing recent research, the glycogen depletion phase
may be shortened or even eliminated for some athletes and situations.

• Glycogen replenishment phase in which training intensity and duration

are reduced (exercise taper) and dietary carbohydrate content is greatly
increased. Concerns about the duration of the exercise taper associated
with the different glycogen loading approaches can be an issue with
some athletes and their coaches and need to be personalized to best
meet an athlete’s competition preparation goals, which can also include
exercise taper days and rest day(s) leading up to the competition.

Traditional Glycogen-Loading
(Carbohydrate Loading) Approach
The following presents an overview of the Traditional Glycogen-Loading
Approach, also referred to as classic or original. Note from the start
that although this Traditional Approach can be effective for most long-
distance endurance athletes, there has been a trend by coaches and
athletes to follow less grueling modified or alternative glycogen loading
approaches—ones that are more pre-event schedule friendly and with
fewer or no annoying potential side effects that may arise from the
traditional approach.
• Glycogen-Depletion Phase, typically three days, starting six
to seven days prior to the athletic event day. Diet is very low in
carbohydrate content, as low as 100 grams per day, about 15 to 20
percent of total daily calorie range. The diet should be high protein and
high lipid, in proportions that works best for the individual athlete. Right
from the start, it is apparent how this traditional approach glycogen
depletion diet gained a reputation for being “unpleasant.” Exercise or
training is kept at a high- to moderate-intensity level to further assist
in completely depleting glycogen stores along with maintaining the
very low carbohydrate diet. Note that side effects from the very low
carbohydrates can limit or make exercise or training hazardous (refer
to comment section for details.) Dietary protein and healthy lipids are
increased to higher than normal levels to compensate for the calorie
deficiency from reducing carbohydrate content. You still want to try

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to maintain adequate total daily calorie intake. Including oily fish is an

example of increasing both healthy protein and lipid content. Increasing
consumption of healthy nuts and nut butters can increase lipid content
of the diet. Note that nut butters can be used as spreads and added to
sauces. Choose soft nuts and avoid hard nuts that entail chewing, which
may damage teeth and interrupt athletic training and performance to
repair. Adequate hydration should be maintained.

• Glycogen Loading Phase, typically three days in duration,

starting directly after glycogen depletion phase. High
carbohydrate about 60 to 70 percent of total daily calories; 400 to 700
grams per day. Adequate protein and lipid content, in proportions that
works best for the individual athlete. Taper exercise: exercise or training
intensity and duration is reduced to a low level, with a day of rest (no
training) typically occurring the day before the athletic event. Adequate
hydration should be maintained.

• Comments. Potential unpleasant side effects during the depletion

phase may include ketosis; irritability; fatigue; nausea; hunger;
muscle soreness; dizziness; hypoglycemia; metabolic upset from
the low carbohydrate higher lipid diet; weight loss, primarily
associated with glycogen depletion and glycogen bound water;
and the potential for injury during training due to some these
side effects, such as dizziness causing falling. Potential unpleasant
side effects during loading phase might include weight gain from
glycogen storage and associated glycogen-bound water and
perhaps temporary muscle stiffness. Good to know about, but
considered obsolete by many sports performance experts.

Modified Glycogen-Loading Approaches

With the decades that passed since the development of the Traditional
Approach, many sports scientists have conducted and continue to
conduct research regarding modifying or alternative glycogen loading
procedures. This is in attempt to overcome some of the scheduling
and/or annoying side effect issues sometimes encountered with the
Traditional Approach. The following overviews present a range of
dynamic modified glycogen-loading possibilities, based on the numerous
studies conducted after the original Traditional Approach research
studies were conducted.

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 Glycogen Loading (Supercompensation) | 531

• Glycogen Depletion Phase. Either eliminate or modify the depletion

phase approach, compared with the traditional approach. For example,
afternoon or evening glycogen-depletion training session, followed by
low-carbohydrate meal and evening snack; overnight fast during sleep.
The next morning, start high-carbohydrate loading. Or if energy levels
are adequate, perform another training session for further glycogen
depletion, followed by starting the high-carbohydrate-loading diet.
The low-carbohydrate diet approach can be varied. For example,
following the traditional method’s lead, very low-carbohydrate intake
reduced to about 100 grams per day, while increasing healthy lipids
and protein intake to maintain an athlete’s specific daily caloric needs,
noting that known side effects will occur. A low-carbohydrate range of
about 30 percent to 50 percent of total daily calories is also associated
with reducing glycogen levels. Note that when very low and low-
carbohydrate diets are followed during the glycogen-depletion phase,
three or four days of high-carbohydrate glycogen-loading diet should
be followed for a higher level of body glycogen restoration. Adequate
hydration should be maintained.

• Glycogen-Loading Phase. Although there is some indication that

one or two days of high-carbohydrate diet glycogen loading may be
sufficient to increase body glycogen levels, three to four days is likely
more appropriate and may result in higher body glycogen levels. Keep in
mind that for each athlete, you need to evaluate how much extra body
glycogen storage above normal will benefit each one’s competition
athletic performance the most. Exercise taper (reducing exercise/training
duration and intensity) should occur, leading typically to a day of rest
prior to the day of competition as appropriate to each athlete and the
duration allotted for the loading phase. High-carbohydrate diets may
range from 60 to 70 percent carbohydrates of total daily calories. On a
body weight basis, an example range is 8 to 12 grams of carbohydrate
per kilogram per day. Maintain adequate protein and essential lipid
intake. Adequate hydration should be maintained.

• Comments. When you determine a modified glycogen approach to

follow, remember that long-distance endurance athletes will likely
benefit most from some type of low-carbohydrate glycogen depletion
followed by three to four days of high-carbohydrate glycogen-loading
diet. Middle-distance endurance athletes who might benefit from
glycogen loading could likely benefit from the less stringent high-
carbohydrate glycogen loading diet approach for one to three days,
without the glycogen depletion phase, or from simply trying the
overnight glycogen depletion strategy.

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This overview of modified approaches exemplifies the need for

personalization by experienced health professionals to best suit an
athlete’s specialized performance nutrition needs. Fitness trainers and
other health professionals who are new to glycogen loading and who
want to become experts should team up with an existing glycogen-
loading expert to develop some supervised hands-on experience. How
many times per season an athlete may be able to handle this is also a
consideration. Some of the research reports a few times per year for the
extreme traditional approach, whereas others indicate higher frequency
per season may be possible with a suitable modified glycogen-loading
approach. One thing is certain: adult athletes who are new to glycogen
loading should approach first using this performance-boosting nutrition
approach in the preseason under health expert supervision, well before
the competition season, to determine how their body responds to it and
to establish which modified glycogen loading approach works best.

International Olympic Committee 2000

Glycogen Loading Approach
The IOC 2000 glycogen loading approach is worth mentioning, as it
appears in the 2000 “Nutrition in Sport” publication by the IOC Medical
Commission and International Federation of Sports Medicine and is
relied on by many sports nutrition experts training Olympic athletes.
The approach is located in Chapter 7 Optimization of Glycogen Stores,
written by John L. Ivy. Following a detailed review of the numerous
related scientific studies, some recommendations are made. Some crucial
points of the recommendations for endurance athletes include:
• Hard training bout performed seven days prior to event;

• During the next three days, employ moderate-intensity and -duration

training, a well-balanced mixed diet of 45 to 50 percent carbohydrate
composition; and

• During the next three days, taper training. Increase carbohydrate

content to 70 percent of total daily calories, which should promote
glycogen loading/supercompensation, similar to the traditional/classic
approach, with less stress and fatigue.

• Additional details can be found in the referenced chapter by J. L. Ivy.

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ASC Glycogen Loading 2009 Approach

In 2009, the Australian Sports Commission published a modified
glycogen/carbohydrate-loading approach that is much simplified. As
the ASC and IOC work closely together, it is useful to be aware of the
ACS’s 2009 approach, details of which can be found on its website. Note
that with this approach, there is no glycogen-depletion phase. It reports
that leading up to the competition day, use one to four days of exercise
taper, along with following a high-carbohydrate diet. The guidelines for
a high-carbohydrate diet prescribe daily carbohydrate calculated on a
body weight basis: 7 to 12 grams of carbohydrate per kilogram of body
weight per day to elevate glycogen levels. Therefore, for example, daily
carbohydrate for a 70-kilogram athlete would be 490 grams (about 1,600
kilocalories) to 840 grams (about 3,360 kilocalories).

Military Research Study

From a historical point of view, it is interesting to include information
and a copy of research conducted by the military regarding glycogen
loading. The research study report is titled “Manipulation of Muscle
Glycogen Concentrations Using High and Low Carbohydrate Diets
and Exercise Report No T32-87.” The US Army Research Institute
of Environmental Medicine, Natick, Massachusetts, conducted this
research in August 1987. The research team sought to evaluate the
effectiveness of the classical approach (somewhat) and to establish
exercise and diet examples that could be used for military personnel and
for future studies.

It is important to note that this research did not include physical

performance effects of glycogen loading. It sought to establish a program
to accomplish glycogen loading. This research report is worth reading
and keeping as a resource for those interested in glycogen loading for
a number of reasons. The complete diets for the depletion and loading
phases are included, which could be used as starting point to customize
for athletes. During glycogen depletion, average carbohydrate intake
each day was about 118 grams (16.5% of total daily calories), protein 142
grams (19.9% of total daily calories), and fat 206 grams (64.8% of total
daily calories). During glycogen loading phase, average carbohydrate

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intake each day was about 517 grams (63.7% of total daily calories),
protein 115 grams (14.2% of total daily calories); and fat 86 grams (24%
of total daily calories).

Here is the “somewhat” part of the story. The male subjects were not
competitive endurance athletes. In addition, the discussion section of
the research study explained that the depletion phase and loading phase
were separated by some time, not directly one before the other. It was
also noted that some research subjects did the loading phase part of the
experiment first and then the depletion phase. It was interesting that the
loading phase did result in a significant increase in glycogen store levels,
which the researchers noted supports other research about achieving
adequate muscle glycogen levels without previously depleted glycogen
stores, but reducing physical activity along with employing a high-
carbohydrate diet.

Glycogen Loading and Gender Differences

Though some differences have been reported in the various scientific studies regarding glyco-
gen-loading effects for males and females, Jennifer Wismann and Darryn Willoughby noted in their
2006 review study titled “Gender Differences in Carbohydrate Metabolism and Carbohydrate Load-
ing” that female athletes do have the capacity for glycogen supercompensation at levels comparable
to males when fed comparable amounts of carbohydrates relative to lean body mass. This statement
was based on the results of research conducted by Dr. James and coworkers, 2001. Both males and
females were able to attain supranormal muscle glycogen levels. Here are some interesting points:
• The James study used endurance-trained female and male subjects.
• These subjects ingested 12 grams of carbohydrate per kilogram of lean body mass per day.
• This was in conjunction with the cessation of their daily physical training.
• A three-day exposure to this diet resulted in a marked rise in muscle glycogen levels.
• Comparing female and male athletes on a lean body mass basis did not show any differences.

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Glycogen-Loading Considerations
The following includes some additional information or considerations
for the glycogen-depletion and glycogen-loading phases.

For Glycogen-Depletion Phase

Extra niacin may help speed up glycogen depletion. For example,
two days prior to glycogen depletion and on the first day of the
program, taking extra amounts of niacin and or pyridoxine (1
to 2 mg per pound of lean body mass each day for example) may
increase the rate of glycogen depletion by stimulating greater rate
of release from glycogen body stores. In addition, use of protein
supplements to achieve the higher dietary protein intake required
during the low-carbohydrate diet phase may help increase the
rate of glycogen depletion. Maintain adequate hydration.

For Glycogen-Loading Phase

Some extra vitamins and minerals may help increase the rate of glycogen
loading. For example, taking extra amounts of chromium with each
meal may be beneficial: 1 to 2 micrograms per pound of lean body mass
each day, spread out in two or three divided dosages, is one example, but
needs to be determined on an individual basis. Chromium is an essential
mineral nutrient that is reported to enhance the action of insulin, a
hormone involved in the metabolism and storage of carbohydrate
(including glycogen), fat, and protein in the body.

Primary carbohydrate food sources should be healthy complex

carbohydrates during both phases. Depending on each athlete’s ability
to digest that high-carbohydrate glycogen-loading diet, fiber content
may have to be reduced. For a one-day method, higher amounts of faster
digesting complex carbohydrates, short-chain glucose polymers, and Glucose polymer:
a processed form of
simple carbohydrates may be beneficial.
polysaccharides, or complex
carbohydrates.
Use carbohydrate supplements that are low in fiber and fat and protein
free and that consist mainly of glucose-polymers and maltodextrin in
addition to glucose. In addition, sucrose may be useful as appropriate in
the context of the total glycogen-loading program. High glycemic index
carbohydrate supplement consumption may generally be focused during
and post exercise/training.

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536 | Unit 19

Drink a complex-carbohydrate beverage before bedtime and upon

waking; for example, 400 to 600 calories per serving, noting that more
or less may be needed based on the individual athlete’s requirements.
Protein and micronutrients may also be present depending on each
individual athlete’s digestion receptiveness. Use of a mixed-carbohydrate
and protein supplement drink post-exercise/training may help increase
the rate of glycogen replenishment leading up to the post-exercise meal,
but after the immediate intake of faster digesting water and carbohydrate
beverage that should be ingested right after exercise.

Maintain adequate hydration all day.

Including fructose as part of the daily beverages and food intake, in

moderation, may provide certain glycogen-loading benefits. Fructose has
a low glycemic index rating and is reported to replenish liver glycogen
stores, noting that muscle glycogen has a higher affinity for glucose;
however, glucose can also replenish liver glycogen stores. But do not
overdo fructose intake, as it may cause gastrointestinal upset and,
for some individuals, may contribute to fatty liver condition. Sucrose
contains glucose and fructose, so this can be an option as a supply of
fructose along with glucose, in moderation, for the days of glycogen
loading. Examples of some fructose-containing fruits and fruit products
are presented from the USDA Food Composition Database presented in
the following table.

Creatine with Glycogen Loading?

Various studies have examined the effects of creatine loading along with
high carbohydrate intake during the glycogen-loading phase. Although
mixed results have been reported in the scientific literature, a study
conducted by Paul Roberts and coworkers reported the results in 2016 in
their research journal article titled “Creatine ingestion augments dietary
carbohydrate mediated muscle glycogen supercompensation during the
initial 24 hours of recovery following exhaustive exercise in humans.” In
this study, healthy male volunteers who were recreationally active, not
highly trained, and had an average age of 26 years old participated. An
exercise bout of cycling to exhaustion to help reduce body glycogen levels
was undertaken. This was followed by a daily high-carbohydrate diet and
20 grams of creatine per day taken in divided dosages. Muscle biopsy
sampling was used.

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 Glycogen Loading (Supercompensation) | 537

Some Examples of Fructose-Containing Fruit and Fruit Product Examples from Usda.Gov Food
Composition Database
Fructose(g)Per
Fruit or Fruit Product Weight(g) Measure
Measure

Apples, raw, without skin 110 1.0 cup slices 6.63

Applesauce, canned, sweetened, with-

246 1.0 cup 17.88
out salt (includes USDA commodity)
Blueberries, wild, canned, heavy syrup,
319 1.0 cup 28.77
drained

Cherries, sweet, raw 138 1.0 cup, with pits, yields 7.41

Cranberry sauce, canned, sweetened 277 1.0 cup 27.01

Currants, red and white, raw 112 1.0 cup 3.95

1.0 cup sections, with

Grapefruit, raw, pink and red, all areas 230 4.07
juice

Grapes, 6 1.0 grape 0.24

Kiwifruit, green, raw 180 1.0 cup, sliced 7.83

Lemon juice, raw 244 1.0 cup 2.68

Lime juice, raw 242 1.0 cup 1.48

Mangos, raw 165 1.0 cup pieces 7.72

Orange juice, chilled, includes from

249 1.0 cup 5.55
concentrate, with added calcium
Orange juice, chilled, includes from
concentrate, with added calcium and 249 1.0 cup 5.55
vitamin D
Orange juice, frozen concentrate, un-
262 1.0 cup 19.78
sweetened, undiluted

Papaya, canned, heavy syrup, drained 39 1.0 piece 2.64

Papayas, raw 145 1.0 cup 1” pieces 5.41

Pears, canned, light syrup pack, solids

251 1.0 cup, halves 12.8
and liquids

Pears, raw 140 1.0 cup, slices 8.99

Persimmons, 168 1.0 fruit (2-1/2” 9.34

Pomegranate juice, bottled 249 1.0 cup 15.86

Tamarind nectar, canned 251 1.0 cup 15.24

Tangerines, (mandarin oranges), raw 195 1.0 cup, sections 4.68

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The results indicate that subjects engaged in creatine-loading along

with high-carbohydrate diet experienced faster and higher muscle
glycogen rates, starting on day one, and continuing during the six-
day glycogen loading periods, compared with subjects following the
same high-carbohydrate diet, but without creatine supplementation.
However, note that exercise performance after glycogen loading was not
examined. This approach might have some application with competitive
athletes but needs to be confirmed with athletic performance outcome
studies. Students interested in the details can locate the complete study
using the citation in the reference section. You should be familiar with
these emerging research developments, but also be aware of the study’s
limitations: It did not demonstrate an athletic performance improvement
outcome with the subjects, nor did the research examine effects with
highly trained competitive athletes.

Conclusion
Glycogen loading (supercompensation) is one of the sports nutrition
practice breakthroughs that continues to be useful and that has gained
popularity and acceptance in various sports and among experts. For
best results, athletes should determine the glycogen-loading method
that works best for them months before the actual events for which
competition-phase glycogen loading will be used. “Carbing up” and
following a sports nutrition program that is adequate in carbohydrate
content all the time can benefit athletes by helping them maintain
the highest levels of athletic performance as part of a complete sports
nutrition program of food and dietary supplements.

Key Words
Endurance Sport Glucose polymer

Sports Nutrition
 Topics Covered In This Unit

Introduction

Female athlete triad

Who is at risk?

Menstrual irregularities,
an early warning sign

 easures that can be taken to prevent

M
the female athlete triad

Adequate calcium and vitamin D in-

take and reduction of osteoporosis

From 21 CFR

Adequate folic acid and reduction of

neural tube birth defects

 ational Center on Birth Defects and

N
Developmental Disabilities (NCBDDD)

From 21 CFR

Conclusion

UNIT 20

SPECIAL CONCERNS OF ATHLETIC FEMALES

540 | Unit 20

Unit Outline
I. Introduction IV. Adequate folic acid and reduction of
neural tube birth defects
II. Female athlete triad
a. National Center on Birth Defects and
a. Who is at risk?
Developmental Disabilities (NCBDDD)
b. Menstrual irregularities,
b. From 21 CFR
an early warning sign
V. Conclusion
c. Measures that can be taken to prevent the
female athlete triad
III. Adequate calcium and vitamin D
intake and reduction of osteoporosis
a. From 21 CFR

Learning Objectives
After completing this Unit, you will be able to:
• Define and describe terminology related to the Female Athlete Triad;

• Discuss the symptoms that characterize the Female Athlete Triad;

• Understand which nutrient-related diseases of concern to female athletes can be reduced

from adequate dietary intake from food and dietary supplements.

Introduction
Over the decades, as female participation in sports has increased, some
gender-specific health concerns have become apparent. Medical findings
indicate that while in general female athletes require nutrition similar to
that of male athletes on a pound-for-pound basis, female athletes are at
higher risk for developing certain poor nutrition-related disorders that
can have serious health consequences.

Female Athlete Triad

Among female athletes, a set of symptoms is sometimes encountered,
which has become termed the “Female Athlete Triad” and can have
devastating adverse health effects for individuals who fall victim to it. It is

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 Special Concerns of Femaie Athletes | 541

important to note that although this education course content is relevant

for adults, this health concern can occur in young female athletes as
well. Additionally, the triad can inflict females who are not competitive
athletes, including but not limited to fitness exercising clients.

This ISSA course was one of the first to educate health professionals
about this important female athlete health issue. Subsequently, other
education organizations have joined in the effort and have since
published position papers noted in the reference section, and there is
even a website-based international resource referred to as The Female
Athlete Triad Coalition (www.femaleathletetriad.org) that can be
consulted for the most recent developments for people interested in this
topic, including your clients.

Being aware of this syndrome is critical for all health professionals

and for female athletes under their supervision. This also underscores
the importance of athletes being under the strict supervision of their
physician(s) and other health professionals to create and implement a
training and nutrition program that can prevent the female athlete triad
from occurring in the first place and to provide prompt attention if it
does in fact develop.

The female athlete triad is a disorder that usually occurs with

increased frequency among female athletes and is characterized by
disordered eating and menstrual irregularities, which eventually lead
to osteoporosis and other potential health problems. The female athlete
triad symptoms primarily include:
• Disordered Eating (abnormal/dysfunctional eating behaviors resulting in
inadequate caloric and nutrient intake, with or without eating disorders);
• Amenorrhea (loss of menstruation); and
• Osteoporosis (disease associated with loss of bone tissue, bone fragility,
and increased risk to bone fracture).

[Note that terminology related to the Female athlete triad is evolving,

and there may be differences encountered in publications from
organization to organization.]

Early diagnosis of the symptoms is critical to prevent severe health

risks from developing. It seems that the onset of menstrual cycle
irregularities is among the first clinical warning signs. This is a common
condition among female athletes, which historically has been thought
to be a trivial occurrence due to commonly resolving itself after the

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competition season. Medical researchers

now consider this condition more serious. In
addition, weight loss and low percentage body
fat are other physical symptoms often associated
with the triad and generally precede menstrual
cycle irregularities. Another consideration
is that inadequate nutrition, menstrual cycle
irregularities, and osteoporosis can be health
problems individually, without the presence of
the complete triad symptoms.

Who is at risk?
Poor nutrition combined with strenuous athletic
training is thought to be the root cause of the
triad. Inadequate nutrition practices create
energy and essential nutrient deficiencies. This as demanded by the sport or because of body
then typically leads to a poor state of health, image concerns. But female athletes in any sport
which is typically associated with loss in can be at risk.
body weight. Loss in body weight can include
Disordered eating may or may not include eating
reduction of body fat mass, lean body mass,
disorders, such as anorexia or other psychiatric
and water weight. This condition triggers
eating disorders. Beware that eating disorders
menstrual cycle irregularities, which should be
do occur among female athletes and are another
considered early warning signs of overtraining
serious problem to be aware of and can certainly
and inadequate nutrition. If the condition is
be involved in causing the triad. However,
allowed to persist without corrective treatment,
disordered eating, without an eating disorder, is
osteoporosis can develop, which leads to
generally considered abnormal eating patterns
increased risk of bone fractures; a variety of
and includes poor nutrition habits, inadequate
other health problems related to poor nutrition
energy intake, inadequate essential nutrient
can be present as well.
intake, eating unhealthy foods “junk foods”;
It seems that female athletes who are at highest unneeded or extreme dieting; and use of purging
risk participate in sports in which nutrition and laxatives for unhealthy weight control. This
deficiencies are common; in other words, leads to an energy deficit, decreased metabolic
distance sports and sports in which body weight rate, metabolic abnormalities, hormonal
or appearance are important. These sports imbalances, and reduced structure and function
include long-distance running, cycling, and of the body. Disordered eating, with or without
swimming; gymnastics; diving; figure skating; eating disorders, combined with intense athletic
triathlon; dancing; rowing; martial arts; and training often lead to health problems, including
other sports in which weight control is involved the Female athlete triad.

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 Special Concerns of Femaie Athletes | 543

Menstrual Irregularities, other medical causes of amenorrhea may be

present, which a physician can properly diagnose
an Early Warning Sign.
and treat: Turner Syndrome and hypothalamic
Many factors can cause menstrual irregularities; or pituitary problems are examples of some other
however, the primary cause that characterizes amenorrhea causes.
the triad is triggered by poor nutrition practices
and intensive athletic training, which depletes I thought exercise helps prevent
the body’s nutrient balance, causes calorie intake osteoporosis; can you elaborate on
deficiency, reduces body fat mass, and alters body this point?
function. Eventually ovarian function becomes
Osteoporosis is the term used to describe a
impaired and can even lead to a decrease in the
condition in which there is decreased bone mass,
production of estrogen and other hormones
causing a reduction in bone mineral density and
along with various hormonal imbalances.
a reduction of bone strength, thereby leading
Although amenorrhea is observed in a small to increased risk of bone fracture. Osteoporosis
percentage of nonathletic females, it can occur in has several causes and is primarily thought of as
much higher frequency among athletic females. occurring in older females. In fact, a program of
There are two types of amenorrhea observed in exercise and proper nutrition can prevent and
the Female athlete triad: primary and secondary. treat osteoporosis. However, medical researchers
Primary amenorrhea is when there is an absence have made a connection between secondary
of menstruation by age 15 or 16 in females with amenorrhea and osteoporosis in athletic females.
developed secondary sex characteristics. It is This causes weakened bones and leads to
crucial to prevent the triad from every occurring increased risk of bone fractures. For example,
in teenage female athletes. Any type of menstrual female runners with amenorrhea were reported
irregularities in teenage females should be given to have lower bone density than normally
serious attention and prompt medical treatment. menstruating runners. Researchers believe that if
this condition is allowed to develop, normal bone
Secondary amenorrhea occurs when there formation may not be able to be restored, and
is an absence of three or more consecutive the triad’s osteoporosis may not be completely
menstrual periods after menarche, not caused by irreversible. Males are also at risk of osteoporosis
pregnancy. More than 35-day intervals between due to poor nutrition consisting of inadequate
menstruation may also be considered menstrual energy and inadequate essential nutrient intake,
irregularity. If menstrual irregularity occurs, in particular, calcium and vitamin D.
prompt medical attention is warranted, as it
is with younger female athletes. According to
Measures That Can Be Taken to
the Office on Women’s Health, US Department
of Health and Human Services, you should be Prevent the Female Athlete Triad
aware too that athletic training and associated First and foremost, an adequate sports
health issues are recognized as contributing to nutrition program must be strictly adhered to
female infertility in some instances. Note that under physician supervision and along with

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other health professionals as appropriate— for primary treatment by a physician along with
such as nutritionists and fitness trainers. other health professionals, such as nutritionists
Behavioral therapy may also be required for and fitness trainers. Experts, such as Thein-
some individuals, in particular, those with Nissenbaum in the journal article titled “Long-
eating disorders. This means eating the proper term consequences of the female athlete triad,”
amounts of carbohydrates, protein, and fats, concluded that multidisciplinary management
spread out over five to seven meals per day from is strongly recommended. However, be aware
healthy nutrient-rich foods providing other that Curry and coworkers (2015) in a survey-
essential nutrients like vitamins and minerals. based study of physicians reported, “Our
Maintaining adequate fluid intake is also vital. findings suggest that approximately one-third
of the physicians surveyed have heard of the
As required, taking dietary supplements can
triad. Increased awareness through education
be needed to ensure intake of the essential
to properly identify and manage the triad is
macronutrients and micronutrients, especially
essential for all physicians”; so it is important for
calcium, magnesium, vitamin D, folic
non-physician health professions to confirm that
acid, and iron. In fact, the Food and Drug
a client’s physician is knowledgeable about this
Administration has approved a health claim for
condition. Approximately one half of physicians
foods and supplements high in calcium (over
were comfortable treating or referring a patient
200 milligrams) and vitamin D as being able
with the triad. Regarding athlete awareness, in
to help prevent osteoporosis. A reprint of the
2015, Folscher and coworkers reported based on
corresponding FDA regulation for health product
their survey of ultra-marathon runner female
companies to follow in included under the next
athletes that only about 7.5 percent were aware of
heading. Moreover, some research studies also
the triad, and about 44 percent were at high risk
reported the use of high-calorie meal replacement
for the triad. Thus, confirm your athlete clients
products and weight-gainer-type supplement
are aware of the triad along other female clients
beverages to help add extra calories and essential
who exercise regularly and may also be at risk.
nutrients to the diet, which are also convenient
and typically easier to consume, helping people It is also a useful practice (habit) to keep a
who are under eating due to lack of appetite or training journal that documents athletic life,
who may have poor food and meal choices. These including medical history, medical exams, health
products would be used in addition to other problems, medication, nutrition logs, dietary
required recovery medical therapies. supplement intake, sleep patterns, menstrual
periods, behavior patterns, and training logs.
Corrective treatment may also require reducing
This simple daily task, which only takes minutes
exercise and training volume and frequency,
a day, will prove to be extremely beneficial and
restoring lean body mass, and increasing body
result in improved athletic performance and
fat composition to a healthy level. Drug therapy
optimum health.
may also be warranted, which is another reason

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 Special Concerns of Femaie Athletes | 545

Adequate Calcium and Vitamin D

intake and Reduction of Osteoporosis
The following paragraphs are from the FDA regulations related to calcium
and vitamin D health claims. This helps illustrate a few things, such
as the FDA’s strict regulations for foods and dietary supplements, the
FDA’s involvement in approving ingredients and the claims to be used in
nutrition products, and the significant science that exists to back claims.
Note, however, that other very lengthy documentation not included herein
that was published by the FDA in the Federal Register presented scientific
information, which interested readers can view online at the Federal
Register website. Moreover, the actual amounts of calcium, vitamin D, and
other essential nutrients required for prevention and treatment programs
will depend on individual needs and often may exceed the dietary reference
intake amounts.

From 21 CFR:
Sec. 101.72 Health claims: calcium, vitamin D, and osteoporosis.

(a) Relationship between calcium, vitamin D, and osteoporosis. An inadequate

intake of calcium or calcium and vitamin D contributes to low peak bone mass,
which has been identified as one of many risk factors in the development of
osteoporosis. Peak bone mass is the total quantity of bone present at maturity,
and experts believe that it has the greatest bearing on whether a person will be
at risk of developing osteoporosis and related bone fractures later in life. Another
factor that influences total bone mass and susceptibility to osteoporosis is the rate
of bone loss after skeletal maturity. Vitamin D is required for normal absorption of
calcium and to prevent the occurrence of high serum parathyroid hormone (PTH)
concentration, which stimulates mobilization of calcium from the skeleton and can
lower bone mass. Calcium, along with vitamin D and several other nutrients, is
required for normal bone mineralization. While vitamin D is required for optimal
bone mineralization, it is more effective when calcium intake is adequate. An
adequate intake of calcium and vitamin D is thought to exert a positive effect
during adolescence and early adulthood in optimizing the amount of bone that is
laid down. However, the upper limit of peak bone mass is genetically determined.
The mechanism through which adequate intakes of calcium and vitamin D and
optimal peak bone mass reduce the risk of osteoporosis is thought to be as follows.
All persons lose bone with age. Hence, those with higher bone mass at maturity
take longer to reach the critically reduced mass at which bones can fracture easily.
The rate of bone loss after skeletal maturity also influences the amount of bone

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present at old age and can influence an individual’s risk of developing osteoporosis.
Maintenance of adequate intakes of calcium and vitamin D later in life is thought
to be important in reducing the rate of bone loss particularly in the elderly and in
women during the first decade following menopause, but a significant protective
effect is also seen among men and younger women.

(b) Significance of calcium or calcium and vitamin D. Adequate calcium intake, or

adequate calcium and vitamin D intake, is not the only recognized risk factor in the
development of osteoporosis, which is a multifactorial bone disease. Maintenance
of adequate calcium and vitamin D intakes throughout life is necessary to
achieve optimal peak bone mass and to reduce the risk of osteoporosis in later
life. However, vitamin D is most effective in this regard when calcium intake is
adequate. Increasing intake of calcium has been shown to have beneficial effects on
bone health independent of dietary vitamin D.

(c) Requirements. (1) All requirements set forth in 101.14 shall be met.

(2) Specific requirements --(i) Nature of the claim. A health claim associating
calcium or, when appropriate, calcium and vitamin D with a reduced risk of
osteoporosis may be made on the label or labeling of a food described in
paragraphs (c)(2)(ii) and (d)(1) of this section, provided that:

(A) The claim makes clear the importance of adequate calcium intake, or when
appropriate, adequate calcium and vitamin D intake, throughout life, in a healthful
diet, are essential to reduce osteoporosis risk. The claim does not imply that
adequate calcium intake, or when appropriate, adequate calcium and vitamin D
intake, is the only recognized risk factor for the development of osteoporosis;

(B) The claim does not attribute any degree of reduction in risk of osteoporosis to
maintaining an adequate dietary calcium intake, or when appropriate, an adequate
dietary calcium and vitamin D intake, throughout life.

(ii) Nature of the food. (A) The food shall meet or exceed the requirements for a
“high” level of calcium as defined in 101.54(b);

(B) The calcium content of the product shall be assimilable;

(C) Dietary supplements shall meet the United States Pharmacopeia (USP)
standards for disintegration and dissolution applicable to their component calcium
salts, except that dietary supplements for which no USP standards exist shall exhibit
appropriate assimilability under the conditions of use stated on the product label;

(D) A food or total daily recommended supplement intake shall not contain more
phosphorus than calcium on a weight per weight basis.

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 Special Concerns of Femaie Athletes | 547

(d) Optional information. (1) The claim may include the term “vitamin D” if the
food meets or exceeds the requirements for a “high” level of vitamin D as defined
in 101.54(b);

(2) The claim may include information from paragraphs (a) and (b) of this section.

(3) The claim may make reference to physical activity.

(4) The claim may include information on the number of people in the
United States, including the number of people in certain subpopulations
in the United States, who have osteoporosis or low bone density. The
sources of this information must be identified, and it must be current
information from the National Center for Health Statistics, the National
Institutes of Health, or the National Osteoporosis Foundation.

(5) The claim may state that the role of adequate calcium intake, or when
appropriate, the role of adequate calcium and vitamin D intake, throughout
life is linked to reduced risk of osteoporosis through the mechanism of
optimizing peak bone mass during adolescence and early adulthood. The
phrase “build and maintain good bone health” may be used to convey
the concept of optimizing peak bone mass. The claim may also state that
adequate intake of calcium, or when appropriate, adequate intake of
calcium and vitamin D, is linked to reduced risk of osteoporosis through the
mechanism of slowing the rate of bone loss for persons with a family history
of the disease, post-menopausal women, and elderly men and women.

(e) Model health claims. The following model health claims may be used in food
labeling to describe the relationship between calcium and osteoporosis:

Adequate calcium throughout life, as part of a well-balanced diet, may reduce the
risk of osteoporosis.

Adequate calcium as part of a healthful diet, along with physical activity, may
reduce the risk of osteoporosis in later life.

(f) Model additional health claims for calcium and vitamin D. The following model
health claims may be used in food labeling to describe the relationship between
calcium, vitamin D, and osteoporosis:

Adequate calcium and vitamin D throughout life, as part of a well-balanced diet,

may reduce the risk of osteoporosis.

Adequate calcium and vitamin D as part of a healthful diet, along with physical
activity, may reduce the risk of osteoporosis in later life.

[73 FR 56486, Sept. 29, 2008]

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Adequate Folic Acid Intake and

Reduction of Neural Tube Birth Defects
While we are on the topic of special concerns of the female athlete, it seems
appropriate for this unit to include nutrition-related birth defects referred
to as neural tube defects—even though this is a concern for the general
reproductive-age female general population along with athletic females.

Note that medically supervised folic acid supplementation or higher dosage

prescription folic acid supplements may be effective in reducing the risk
in some females; however, due to the potential multiple causes of these
birth defects, there is a significant but less than 100 percent reduction rate.
Moreover, as reported in the journal article “Epidemiology of Neural Tube
Defects” (Frey 2003), in some high-risk females, the reduction from taking
folic acid may not occur.

National Center on Birth Defects and

Developmental Disabilities (NCBDDD)
The Centers for Disease Control and Prevention NCBDDD reports that
worldwide, more than 300,000 babies are born with neural tube defects
each year, serious birth defects of the brain (anencephaly) and spine (spina
bifida). Neural tube defects are a significant cause of infant death and
lifelong disability, and most are preventable. Research has shown that
taking 400 micrograms daily of folic acid, a B vitamin, before and during
early pregnancy, reduces the risk of neural tube defects (but higher dosages
may be required based on individual requirements). NCBDDD has a global
initiative to significantly reduce infant death and lifelong disability resulting
from neural tube defects that occur worldwide each year. The initiative aims
to increase folic acid intake among women of reproductive age through
fortification and other means. Folic acid dietary supplements can be a viable
and effective means to helping to reduce certain neural tube birth defects.
The scientific evidence is so compelling that it supported the FDA’s approving
a health claim for conventional foods and dietary supplements.

The following is health claim regulatory information reprinted as yet another

example of how the FDA does regulate dietary supplements in addition to
conventional foods and other health products, and the important findings
about folate and reduction of neural tube defects in infants that all females of
reproductive age should be aware of.

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 Special Concerns of Femaie Athletes | 549

From 21 CFR
Sec. 101.79 Health claims: Folate and neural tube defects.

(a) Relationship between folate and neural tube defects — (1) Definition. Neural
tube defects are serious birth defects of the brain or spinal cord that can result
in infant mortality or serious disability. The birth defects anencephaly and spina
bifida are the most common forms of neural tube defects and account for about 90
percent of these defects. These defects result from failure of closure of the covering
of the brain or spinal cord during early embryonic development. Because the
neural tube forms and closes during early pregnancy, the defect may occur before
a woman realizes that she is pregnant.

(2) Relationship. The available data show that diets adequate in folate may reduce
the risk of neural tube defects. The strongest evidence for this relationship comes
from an intervention study by the Medical Research Council of the United Kingdom
that showed that women at risk of recurrence of a neural tube defect pregnancy
who consumed a supplement containing 4 milligrams (mg) (4,000 micrograms
(mcg)) folic acid daily before conception and continuing into early pregnancy had
a reduced risk of having a child with a neural tube defect. (Products containing
this level of folic acid are drugs). In addition, based on its review of a Hungarian
intervention trial that reported periconceptional use of a multivitamin and
multimineral preparation containing 800 mcg (0.8 mg) of folic acid, and its review
of the observational studies that reported periconceptional use of multivitamins
containing 0 to 1,000 mcg of folic acid, the Food and Drug Administration
concluded that most of these studies had results consistent with the conclusion
that folate, at levels attainable in usual diets, may reduce the risk of neural tube
defects.

(b) Significance of folate --(1) Public health concern. Neural tube defects occur in
approximately 0.6 of 1,000 live births in the United States (i.e., approximately 6 of
10,000 live births; about 2,500 cases among 4 million live births annually). Neural
tube defects are believed to be caused by many factors. The single greatest risk
factor for a neural tube defect-affected pregnancy is a personal or family history of
a pregnancy affected with a such a defect. However, about 90 percent of infants
with a neural tube defect are born to women who do not have a family history
of these defects. The available evidence shows that diets adequate in folate may
reduce the risk of neural tube defects but not of other birth defects.

(2) Populations at risk. Prevalence rates for neural tube defects have been reported
to vary with a wide range of factors including genetics, geography, socioeconomic
status, maternal birth cohort, month of conception, race, nutrition, and maternal
health, including maternal age and reproductive history. Women with a close

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relative (i.e., sibling, niece, nephew) with a neural tube defect, those with insulin-
dependent diabetes mellitus, and women with seizure disorders who are being
treated with valproic acid or carbamazepine are at significantly increased risk
compared with women without these characteristics. Rates for neural tube defects
vary within the United States, with lower rates observed on the west coast than on
the east coast.

(3) Those who may benefit. Based on a synthesis of information from several
studies, including those that used multivitamins containing folic acid at a daily
dose level of 400 mcg (0.4 mg), the Public Health Service has inferred that folate
alone at levels of 400 mcg (0.4 mg) per day may reduce the risk of neural tube
defects. The protective effect found in studies of lower dose folate measured by
the reduction in neural tube defect incidence, ranges from none to substantial; a
reasonable estimate of the expected reduction in the United States is 50 percent. It
is expected that consumption of adequate folate will avert some, but not all, neural
tube defects. The underlying causes of neural tube defects are not known. Thus, it
is not known what proportion of neural tube defects will be averted by adequate
folate consumption. From the available evidence, the Public Health Service
estimates that there is the potential for averting 50 percent of cases that now occur
(i.e., about 1,250 cases annually). However, until further research is done, no firm
estimate of this proportion will be available.

(c) Requirements. The label or labeling of food may contain a folate/neural tube
defect health claim provided that:

(1) General requirements. The health claim for a food meets all of the general
requirements of 101.14 for health claims, except that a food may qualify to bear the
health claim if it meets the definition of the term “good source.”

(2) Specific requirements --(i) Nature of the claim --(A) Relationship. A health claim
that women who are capable of becoming pregnant and who consume adequate
amounts of folate daily during their childbearing years may reduce their risk of
having a pregnancy affected by spina bifida or other neural tube defects may be
made on the label or labeling of food provided that:

(B) Specifying the nutrient. In specifying the nutrient, the claim shall use the terms
“folate,” “folic acid,” “folacin,” “folate, a B vitamin,” “folic acid, a B vitamin,” or
“folacin, a B vitamin.”

(C) Specifying the condition. In specifying the health-related condition, the claim
shall identify the birth defects as “neural tube defects,” “birth defects spina bifida
or anencephaly,” “birth defects of the brain or spinal cord anencephaly or spina
bifida,” “spina bifida and anencephaly, birth defects of the brain or spinal cord,”
“birth defects of the brain or spinal cord”; or “brain or spinal cord birth defects.”

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 Special Concerns of Femaie Athletes | 551

(D) Multifactorial nature. The claim shall not imply that folate intake is the only
recognized risk factor for neural tube defects.

(E) Reduction in risk. The claim shall not attribute any specific degree of reduction
in risk of neural tube defects from maintaining an adequate folate intake
throughout the childbearing years. The claim shall state that some women may
reduce their risk of a neural tube defect pregnancy by maintaining adequate intakes
of folate during their childbearing years. Optional statements about population-
based estimates of risk reduction may be made in accordance with paragraph (c)(3)
(vi) of this section.

(F) Safe upper limit of daily intake. Claims on foods that contain more than 100
percent of the Daily Value (DV) (400 mcg) when labeled for use by adults and
children 4 or more years of age, or 800 mcg when labeled for use by pregnant
or lactating women) shall identify the safe upper limit of daily intake with respect
to the DV. The safe upper limit of daily intake value of 1,000 mcg (1 mg) may be
included in parentheses.

(G) The claim shall state that folate needs to be consumed as part of a
healthful diet.

(ii) Nature of the food --(A) Requirements. The food shall meet or exceed the
requirements for a “good source” of folate as defined in 101.54;

(B) Dietary supplements. Dietary supplements shall meet the United States
Pharmacopeia (USP) standards for disintegration and dissolution, except that if
there are no applicable USP standards, the folate in the dietary supplement shall be
shown to be bioavailable under the conditions of use stated on the product label.

(iii) Limitation. The claim shall not be made on foods that contain more than 100
percent of the RDI for vitamin A as retinol or preformed vitamin A or vitamin D per
serving or per unit.

(iv) Nutrition labeling. The nutrition label shall include information about
the amount of folate in the food. This information shall be declared after the
declaration for iron if only the levels of vitamin A, vitamin C, calcium, and iron are
provided, or in accordance with 101.9 (c)(8) and (c)(9) if other optional vitamins or
minerals are declared.

(3) Optional information --(i) Risk factors. The claim may specifically identify risk
factors for neural tube defects. Where such information is provided, it may consist
of statements from 101.79(b)(1) or (b)(2) (e.g., Women at increased risk include
those with a personal history of a neural tube defect-affected pregnancy, those
with a close relative (i.e., sibling, niece, nephew) with a neural tube defect; those

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with insulin-dependent diabetes mellitus; those with seizure disorders who are
being treated with valproic acid or carbamazepine) or from other parts of this
paragraph (c)(3)(i).

(ii) Relationship between folate and neural tube defects. The claim may
include statements from paragraphs (a) and (b) of this section that summarize
the relationship between folate and neural tube defects and the significance of
the relationship except for information specifically prohibited from the claim.

(iii) Personal history of a neural tube defect-affected pregnancy. The claim

may state that women with a history of a neural tube defect pregnancy should
consult their physicians or health care providers before becoming pregnant. If
such a statement is provided, the claim shall also state that all women should
consult a health care provider when planning a pregnancy.

(iv) Daily value. The claim may identify 100 percent of the DV (100% DV; 400
mcg) for folate as the target intake goal.

(v) Prevalence. The claim may provide estimates, expressed on an annual

basis, of the number of neural tube defect-affected births among live births
in the United States. Current estimates are provided in 101.79(b)(1), and
are approximately 6 of 10,000 live births annually (i.e., about 2,500 cases
among 4 million live births annually). Data provided in 101.79(b)(1) shall be
used, unless more current estimates from the U.S. Public Health Service are
available, in which case the latter may be cited.

(vi) Reduction in risk. An estimate of the reduction in the number of neural

tube defect-affected births that might occur in the United States if all
women consumed adequate folate throughout their childbearing years may
be included in the claim. Information contained in paragraph (b)(3) of this
section may be used. If such an estimate (i.e., 50 percent) is provided, the
estimate shall be accompanied by additional information that states that the
estimate is population-based and that it does not reflect risk reduction that
may be experienced by individual women.

(vii) Diets adequate in folate. The claim may identify diets adequate in folate
by using phrases such as “Sources of folate include fruits, vegetables, whole
grain products, fortified cereals, and dietary supplements.” or “Adequate
amounts of folate can be obtained from diets rich in fruits, dark green leafy
vegetables, legumes, whole grain products, fortified cereals, or dietary
supplements.” or “Adequate amounts of folate can be obtained from diets rich
in fruits, including citrus fruits and juices, vegetables, including dark green
leafy vegetables, legumes, whole grain products, including breads, rice, and
pasta, fortified cereals, or a dietary supplement.”

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(d) Model health claims. The following are examples of model health claims
that may be used in food labeling to describe the relationship between folate
and neural tube defects:

(1) Examples 1 and 2. Model health claims appropriate for foods containing
100 percent or less of the DV for folate per serving or per unit (general
population). The examples contain only the required elements:

(i) Healthful diets with adequate folate may reduce a woman’s risk of having a
child with a brain or spinal cord birth defect.

(ii) Adequate folate in healthful diets may reduce a woman’s risk of having a
child with a brain or spinal cord birth defect.

(2) Example 3. Model health claim appropriate for foods containing 100
percent or less of the DV for folate per serving or per unit. The example
contains all required elements plus optional information: Women who
consume healthful diets with adequate folate throughout their childbearing
years may reduce their risk of having a child with a birth defect of the brain or
spinal cord. Sources of folate include fruits, vegetables, whole grain products,
fortified cereals, and dietary supplements.

(3) Example 4. Model health claim appropriate for foods intended for use
by the general population and containing more than 100 percent of the DV
of folate per serving or per unit: Women who consume healthful diets with
adequate folate may reduce their risk of having a child with birth defects of
the brain or spinal cord. Folate intake should not exceed 250% of the DV
(1,000 mcg).

[61 FR 8779, Mar. 5, 1996; 61 FR 48529, Sept. 13, 1996, as amended at 65 FR 58918, Oct. 3, 2000]

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Conclusion
Awareness about the female athlete triad for fitness trainers
and other health professionals involved with athletes, coaches,
parents, and the athletes themselves is of paramount importance
for the prevention, and if the triad occurs, for the early detection
and prompt physician-supervised medical treatment.

Key Words
Disordered eating Osteoporosis

Amenorrhea

Sports Nutrition
 Topics Covered In This Unit

Introduction

Legal aspects and limitations

Nutritional practices and coaching

Dietary supplements

Training program considerations

Warming up and cooling down

Flexibility training

Strength training

 eriodization approach for skill training

P
& conditioning

Psychological techniques

Meditation

Visualization

Anchoring and future pacing

Medical support team

Therapeutic modalities

Avoid banned substances & methods

WADA (World Anti-Doping Agency)

Prohibited list overview

The next step for students

Conclusion

UNIT 21

PUTTING IT ALL TOGETHER:

ATHLETIC PERFORMANCE IMPROVEMENT APPROACH
556 | Unit 21

Unit Outline
I. Introduction VI. Psychological techniques
II. Legal aspects and limitations a. Meditation
III. Nutritional practices and coaching b. Visualization
IV. Dietary supplements c. Anchoring and future pacing
V. Training program considerations VII. Medical support team
a. Warming up and cooling down VIII. Therapeutic modalities
b. Flexibility training IX. Avoid banned substances & methods
c. Strength training a. WADA (World Anti-Doping Agency)
d. Periodization approach for skill training b. Prohibited list overview
& conditioning
X. The next step for students
XI. Conclusion

Learning Objectives
After completing this unit, you will be able to:
• Define and discuss key terms;

• Discuss athletic performance improvement factors;

• Understand periodized training program; and

• Discuss issues related to banned substances and methods.

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 Putting It All Together: Athletic Performance Improvement Approach | 557

Introduction Legal Aspects

Whether an athlete’s goal is to win the Olympics and Limitations
or just improve his or her level of fitness Each student/health professional must verify the
for health reasons, athletes need to address legal requirements of working with healthy adult
several factors in their personal performance- athletes related to the nutrition programs for
improvement programs to succeed. Primary health and athletic performance. The limitations
among those factors are nutritional practices, of the information presented in this book include
dietary supplements, warming up and cooling its being for education purposes and reference
down, strength training, skill training, flexibility guidelines only. Suitability of any guidelines
training, psychological techniques, medical needs to be confirmed on an individual athlete’s
support, therapeutic modalities, periodization, basis. Working with the athlete’s physician
and anti-doping. and other health professionals as required.
ISSA-certified fitness trainers will benefit from Personalization and suitability are crucial factors
their diversified experience and training. The for athletic performance benefits of nutrition and
approach to program development taught in training programs.
their CFT course work, contained in the course
book Fitness: The Complete Guide, is useful Nutritional Practices
for addressing sports nutrition applications for
athletic clients, too, as part of the entire athletic
and Coaching
training and nutrition programs. As this course has stressed from its very first
pages, athletes do not eat solely to stay alive and
Here is a summary of the stages of Program
healthy: they also eat to excel at their sports.
Development, Drawing-in Phase:
Athletes’ diets are designed to assist in achieving
• Stage One: Establish Yourself as a Professional. specific sport performance and training goals.
• Stage Two: Data Collection. Several special nutritional techniques also help
in areas such as endurance and force output,
• Stage Three: Guided Discovery.
the improvement of which further enhances
• Stage Four: Feel the Water Before Jumping In. training and competition efforts. Day to day,
• Stage Five: Establish an Integrated and even within the same day, there can be
Fitness Lifestyle. differences in nutrition intake that must be
recognized and satisfied.
Utilize this ISSA Program Development
approach when working with athlete To put together the nutritional component of an
clients, including with the athlete’s health athlete’s performance-improvement program,
professional, coaching, teammates, and begin with the dietary guidelines presented in
parent support team. All athletes should be the sport-specific plan as a starting guideline
under the supervision of their physicians to personalize and determine suitability when
and/or team physicians as appropriate. working with healthy adult athletes. If there is

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a need to lose fat, build muscle, or carbohydrate protein and carbohydrates, reduce high-
load to improve performance, see the appropriate energy athletic performance, and promote
inflammation in the body.
units for guidelines, noting this education
information is for healthy adult athletes only. • Hydration too low. Measuring body weight
several times a day, including before and
Use Daily Nutrition Logs and other appropriate after training and events, will provide insight
forms and planning tools to your liking. as to whether water intake is not adequately
Keep a record of everything healthy adult replenishing water loss. Note: one approach
athlete clients consume. This will let you for determining a well-hydrated body weight
to serve as a baseline to compare with is after
stay on top of caloric and macronutrient
a period of two or three days of rest, with
intakes and helps fine-tune the diet. Do so
adequate hydration. Look for daily trends and
in conjunction with the athlete’s physician for trends over several days. Body composition
and other appropriate health professionals. measurements will reveal additional details
regarding changes in body fat mass and lean
Examples of some common nutrition body mass (which water is part of).
inadequacies with athletes during the season
may in particular include: • Too low daily intake of essential vitamins
and minerals. Review of athlete’s food
• Too low daily caloric intake. This can diary will detect trend in all foods types
be resolved by determining the athlete’s and possible inadequacies, adequacies, and
daily caloric requirements, providing eating excess of micronutrients and macronutrients.
plan examples to attain the required daily A basic multivitamin/mineral supplement
caloric intake goals. Check body weight, is routinely required as part of an athlete’s
body composition, and other anthropometric nutrition program in addition to any other
measurements to determine whether daily supplements that may be required for essential
caloric intake is maintaining body weight and nutrients that cannot be provided from foods
the desired body composition, such as lean alone—on a consistent basis. Ideally, medical
body mass and body fat mass. testing of nutrient levels will yield high-quality
information to determine more exact nutrient
• Too low daily protein intake. Generally, all deficiency, adequacy, or excess issues.
other nutrition factors being equal, loss of lean
body mass can indicate too low protein intake. An up-to-date eating diary will help keep
an athlete on the right track and provide
• Too low daily carbohydrate intake. If daily a good update on the athlete’s nutrition
carbohydrate is too low, along with total daily
practices and areas to work on when
caloric intake being too low, weight loss can
occur. If daily carbohydrate intake is too low, a
required. Getting an athlete into the habit
decrease in athletic performance is commonly of keeping an eating diary will inherently
observed. help the athlete stick to the physician-
authorized food and supplement programs.
• Too high fat intake. Excessive dietary fat
intake is a common occurrence with many Working with the athlete client’s physician and
athletes, which, for example, can lead to other health professionals is vital to confirm
excessive body fat and displacement of
the athlete’s requirements, to confirm ongoing

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 Putting It All Together: Athletic Performance Improvement Approach | 559

medical monitoring, and to be aware of any • To improve general health and fitness
special nutritional needs. The athlete’s nutrition • To build muscle mass
and training coach can provide valuable support • To lose fat
with winning results. Although surveys have
• To improve anaerobic energy
reported there is a significant need for nutritional
coaching, some teams do a better job than others • To improve aerobic energy
do, and these better nutrition guidance teams • To reduce fatigue
will typically have nutrition reference guides • To improve stamina
published. For the fitness trainer involved with
• To reduce pain and inflammation related
an athlete’s nutrition coaching, it is beneficial to exercise
to obtain copies these team nutrition guidelines
• To improve tissue repair
when working with athletes. Note, however, it is
• To improve recovery
common for team nutrition guides to have some
areas in which they may be deficient in certain • To improve mental focus and arousal
nutrition areas, typically protein and ergogenic • To improve strength
supplements, and over relying on the various • To improve the immune system
simple carbohydrate drinks and gels. Some team
• To improve sleep
nutrition guides are also too high in total fat
intake. There is also a major concern regarding • To maintain adequate essential nutrient intake

the legal use of substances and methods. A Each of these purposes is, in fact, included
following section of this unit will review the among most athletes’ training goals at some
basics of this area. point in their careers. It is therefore logical
to conclude that athletes train, eat, and
Dietary Supplements use supplements to enhance their planned
progression toward their training and
At a minimum, multivitamin/mineral competition goals. Indeed, eating a proper
supplements are part of an athlete’s diet, and diet and taking supplements are seen as part
surveys on the supplement use by athletes reveal and parcel of a scientifically planned athlete
that multivitamin/mineral supplements have performance nutrition and training program.
the highest frequency of use among athletes. A training program that did not include proper
Protein supplements are typically second highest and personalized use of supplements could in
frequency of us. Aside from supplementing the fact be considered inadequate. As with other
diet with macronutrients and micronutrients, factors of a sports nutrition program, use of
athletes use a variety of dietary supplements for supplements will involve fine-tuning, seasonal
a number of purposes. There is also the wide change, and some evaluation for customization—
selection of carbohydrate sports nutrition food even when using well-established and researched
and supplements ranging from carbohydrate/ proven-to-work supplements, all under physician
electrolyte drinks to simple carbohydrate syrups. supervision, and when checking the use’s legal
The supplements’ purposes include the following: status with the team’s governing body.

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Training Program Considerations

The following items will review elements and may therefore be necessary. Inflexibility of a
factors that are part of an athlete’s performance particular joint or muscle group may also be
improvement training program in addition to due to a muscle imbalance, which usually takes
sports nutrition program development. years to develop. Medical attention plus strength
training may be required, and it can take months
Warming Up and Cooling Down or even years to correct the problem.

Warming up generally consists of doing some Simply stretching as part of a warm-up before
calisthenics and stretching, followed by some and after exercising may not be enough. A
training or undertaking a sport event or fitness proper diet, strength training, skill training, and
activity. The main purposes of warming up are to therapeutic modalities are all necessary factors
raise the body temperature, increase circulation, that can contribute to ideal flexibility.
and limber up the muscles and connective tissues.
Some sports and fitness activities require more
Depending on the sport and athlete, warm-up
flexibility training than others do. Martial arts
periods can be several minutes to more than 20
and ballet, for example, require a daily program
minutes. In addition to static slow stretching,
of stretching. Powerlifting, discus throwing, and
athletes can include dynamic active stretching,
marathon running require less. Work closely
too. Cooling down consists simply of reducing
with athlete clients to determine whether their
the intensity physical activity gradually as
flexibility is adequate for their sport activity and
opposed to simply stopping it. The purpose is to
for general health and fitness.
ease breathing and heart rate back to their resting
levels. This generally takes several minutes. In Athletes should also consult an experienced
some sports, skill training can be combined with sports massage therapist to determine whether
the warm-up and cool-down periods. there are problem muscles that are in spasm
and need to be released. Note that if the muscle
Flexibility Training tissues are in a contracted and stiff state, and
flexibility exercises are undertaken to improve
The first rule of flexibility is not to overstretch.
range of motion, the connective tissues can
When joints are stretched beyond their normal
become overstretched and lead to tearing or
range of motion, they may become too loose
rupturing. An experienced sports massage
and may actually become prone to injury. Do
therapist can usually identify the stiff muscles
not compare athletes’ flexibility to anyone else’s.
and work to release them, which can take a
Everyone is different, and trying to be as flexible
few to several or more sessions. Treatment by a
as someone else is can lead to overstretching.
sports medical physician and physical therapist
If a particular joint or muscle group is inflexible, may also be required. Athletes should make
it may indicate that injury has occurred or that complete use of all the medical support team
adhesions have formed. Proper medical attention members they have access to.

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 Putting It All Together: Athletic Performance Improvement Approach | 561

Strength Training To condition the muscles to exert optimum

strength and thereby enhance performance, a
Strength, simply defined, is applied force. When
number of strength-training devices have been
athletes lift a barbell, throw a ball, or even
developed and are available in gyms or for home
run, they are applying force, or using strength.
use. The best known are free weights. Also
Different actions use different kinds of strength.
popular are the variety of systems that apply
For example, some actions use aerobic strength,
resistance to the muscles, such as hydraulic
whereas others use anaerobic strength.
devices, pressurized-air devices, elastic devices,
When most of us think of strength, we think of springs, and the host of machines that apply
anaerobic strength-maximum or near-maximum heavy external resistance. Most of these devices
force output that does not require the use of can be grouped into four major categories of
oxygen. But on the energy continuum, this is strength-training technologies:
just one type of strength. The muscles also exert 1. Constant-resistance devices. These are
force during aerobic activities. Aerobic-strength resistance-training devices in which the
training focuses on performing more muscle amount of weight (resistance) remains the
contractions with less force output. Furthermore, same. Examples are dumbbells, barbells, and
some pulley systems.
there are linear and nonlinear forms of strength.
Linear-strength movements are movements 2. Variable-resistance devices. These are
performed repetitively without interruption, resistance-training devices in which the
amount of weight (resistance) is increased or
such as running strides. Nonlinear-strength
decreased during the exercise movement.
movements come in bursts, such as the explosive Examples are the Nautilus and Cybex exercise
plays of football and the jumping, starting, and machines.
dodging movements of basketball and soccer.
3. Accommodating-resistance devices.
Another component of strength is power. The These variable-resistance devices have
been modified to allow maximum force to
textbook definition of power is “force times
be exerted during the range of motion of
distance divided by time,” or “strength plus the exercise movement, but they keep the
speed.” Sprinters require massive amounts of speed of motion fixed. Examples are the
speed-strength, which demands huge amounts Com II and Com III exercise machines.
of power output per contraction. Even long- 4. Static-resistance devices. These
distance runners, whose primary goal is the are resistance-training devices that are
maintenance of speed, require some strength, immovable or fixed and designed to be
which demands at least a modicum of power pushed or pulled. They cause the muscles
to contract without using motion. They can
output per muscle contraction. Any muscle that
be used to focus strength development at
contracts and relaxes exhibits strength, and every a particular point in the range of motion.
muscle contraction displays some combination of Examples are any of the exercise machines
strength, power, speed, and endurance. that can be locked into one position.

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Another form of strength training includes any should not just go into a gym and start lifting
exercise in which the body alone is the source of weights like a bodybuilder or power lifter.
resistance—for example, running, swimming, Sure, the athlete will gain strength and, in the
calisthenics, and aerobic dance. These exercises beginning, perhaps see some improvement
are called light resistance training. Another in performance, but as anaerobic strength is
category of strength training utilizes machines developed, overall performance will begin to
that apply light external resistance, such as the suffer. This does not mean that these types of
stationary cycle, rowing machine, and stair- athletes should not lift weights at all. Rather, they
climbing machine. should train in a way that is appropriate for the
sport-specific energetic goals.
With all these different training technologies
and devices available, it is vital that athletes
follow a program that is appropriate for the Periodization Approach for Skill
strength requirements of their specific sport and Training & Conditioning
a nutrition program to meet the sports specific Skill training and physical conditioning for
and health requirements. Following an incorrect sports are of paramount importance for peak
strength-training program can actually have athletic performance and typically fall in the
a negative effect on athletic performance. For coach’s domain. Fitness trainers and other
example, if an athlete is a middle-distance or sports health professionals usually follow the
endurance athlete or fitness exerciser, he or she coach’s lead and established training programs.

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 Putting It All Together: Athletic Performance Improvement Approach | 563

However, there are also instances in which final adjustments to body composition
fitness trainers are expert coaches. That said, (preferably early in the macrocycle) and
honing skills. The training intensity should
the common goal of the athlete’s support is to
go from moderate too high, over the course
work cooperatively to achieve what is in the best
of the macrocycle. As the training program
interest of the athletes and their individual and ramps up, so should the nutrition program,
team goals. including use of special sports nutrition
foods and supplements to confirm they
Periodization is a quite sophisticated training are compatible and have no side effects.
concept used by professional and world-class
Macrocycle III. Competition phase, four
athletes, which can also be used by other levels of
months long. The attention to training
athletes. With periodization, the year is divided
and good nutrition pays off during this
into phases called macrocycles, with specific macrocycle. The training focus should be on
training goals set for each period of training. improving skills and physical performance
Four macrocycles are usually used, with each factors that were found to be lacking after the
one lasting one to four months. Often, the first few competitions. The training intensity
macrocycles are further divided into mesocycles, can reach extremely high levels throughout
the macrocycle, with appropriate low- and
which are several weeks long, and microcycles,
moderate-intensity days for recovery. The
which are several days long. The athlete’s
sports nutrition program needs to be adhered
specific sport, skill level, and personal goals will to strictly, athletes must be monitored closely
determine how the year should be divided. Along by their team of health professionals, and
with macrocycle training programs, macrocycle adjustments must be made to the nutrition
nutrition programs will be developed. program (fine-tuning) as required to maintain
peak athlete performance.
In general, a periodized training program
Macrocycle IV. Recovery phase, one-
includes the following:
month long. The goal of this macrocycle is
Macrocycle I. Developmental phase, to maintain fitness and flexibility. The training
four months long. The training focus of focus should be on healing injuries using
this macrocycle should be on developing professionally supervised therapeutic and
skills, defining physical performance nutrition programs. The training intensity
parameters, adjusting body composition, should be low. During this macrocycle, plans
and improving weaknesses and strengths. for the following year’s macrocycle should be
The training intensity should be made with input from the coach, trainer, fitness
moderate. Good health and performance trainer, team physician, and other involved
nutrition goals should be established health professionals. Food and supplement
and followed. Use of special ergogenic nutrition programs should continue to be
sports nutrition foods and supplements monitored to maintain the athlete’s desired
can be evaluated during this period. body composition and health and to address
any special nutrition needs as determined by an
Macrocycle II. Preparation phase, athlete’ physician.
three months long. This macrocycle
immediately precedes the competitive season. Note that if athletes choose to let up on their
The training focus should be on making nutrition program during this macrocycle, in

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addition to gaining excess body fat, this can For athletes, the mind is a powerful piece
cause undesirable metabolic changes that can of “sports equipment,” command central!
take several weeks or longer to reacclimate Knowing how to maximize and control
their bodies to when the athletes return to the internal forces can offer athletes a big
preferred athletic performance improvement advantage in sports and life. Most athletes
nutrition program. Thus, while it is typical practice some kind of mental technique, even
for some athletes to want to slack off and pig if it is just “psyching themselves up” before
out, champions follow their healthy athletic a competition. Among the more popular
performance nutrition programs all year long, techniques practiced by athletes are meditation,
year to year to year. visualization, anchoring, and future pacing.

If a season runs longer or shorter than the

typical four months used in this example, adjust Meditation
schedule by modifying macrocycles I and IV. Do Meditation has been practiced since the
not change macrocycle II, which should always beginning of recorded history. In its most
be three months long for the best results. A fundamental sense, meditation is a technique in
year-round training program will help athletes which you elevate your state of mind above the
make steady progress toward their ultimate conscious to the unconscious. In other words,
performance goals. The top athletes in the world you clear your mind of all conscious thoughts
train year-round to be their best. and enter an altered state of consciousness, a
state of relaxation and mental imagery.
Psychological Techniques In some approaches, practitioners examine the
Self-hypnosis, mental imagery, meditation, anatomical divisions of the brain and ascribe the
visualization, and a number of other “mind power to meditate to the right hemisphere. In
strategies” can help you improve your strength the contemporary model of the brain, the mind’s
and performance in competition and training. logical functions (such as speaking, writing,
They can help athletes develop a mental edge and calculating, and worrying) take place in the left
a winning mind-set. hemisphere, whereas the more creative, visually
orientated operations take place in the right
Until recently, society generally overlooked the hemisphere. Although this simple model of the
powers of the human mind. Other cultures human brain is constantly being updated and
place limitations on individuals and restrict revised, of practical interest to us here is that
their mental potential. The human mind has the even modern science recognizes the function
capacity to store trillions of bits of information, and power of the creative right hemisphere. Put
more than the most powerful computers have. it in more practical terms, sometimes people
In fact, according to one progressive educational tend to function from the left hemisphere,
authority, the human brain has a greater storage preoccupied with jealousy, insecurity, anger,
capacity than the US National Archives have. and other negative thoughts that adversely affect
Sadly, however, most people use only a small their overall state of health and well-being. This
percentage of the mind’s capacity. type of thinking also distracts from athletic

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 Putting It All Together: Athletic Performance Improvement Approach | 565

thing is certain: when you are done meditating,

you will feel relaxed, refreshed, and renewed.
And each time you meditate, the benefits will
accrue. You will eventually find your general state
of mind to be more controlled and less stressful.
Meditation, therefore, is an important stepping-
stone on the path to total empowerment. When
performance focus. By meditating, athletes can you learn to control your thoughts and emotions,
open up and develop the powerful creative mind you will be on your way to mastering your sport
and use techniques such as visualization to help and defeating your opponents. You will be on
improve athletic performance and health. Other your way to success in life.
benefits of meditation include helping to relieve
and manage stress.
Visualization
Athletes and fitness trainers who are interested
Visualization is the technique of using mental
in trying meditation should seek the guidance of
imagery to picture your accomplishing a stated
a trained professional.
purpose. It is something like daydreaming, but
Here are some general meditation guidelines: more intense. Athletes can practice it as part of a
meditation session, including helping them reach
• Plan to meditate at a time of day when you can
relax and when you are not under the influence
the meditative state.
of a stimulant such as alcohol, a medication, or
Before beginning a visualization session, you
a recent meal.
must state your purpose. For example, your
• Find a quiet place away from distractions.
purpose may be to master a certain move or to
Turn off the phone and create a comfortable,
relaxing environment. prepare yourself mentally for a competition.
Once you have stated your purpose, you must
• Turn down the lights and sit in a comfortable
position. If you wish, meditate in the dark while
set your stage—that is, you must establish your
lying down. setting and point of view before you bring on
the “players.” Then, begin the visualization,
• To meditate, first clear your thoughts. If you
have trouble, try repeating the same word to running a picture of yourself accomplishing
yourself or focusing, with your eyes closed, your purpose over and over again in your mind.
on a bright object that you picture in your Visualize everything—all the sights, sounds,
mind. Even beginners will find themselves
smells, and feelings. If you are preparing for a
slipping in and out of the meditative state.
Your goal is the state between consciousness contest, visualize the specific moves you will use
and unconsciousness, the point where the to defeat your opponent. Visualize everything
conscious and unconscious meet. you anticipate happening.
• Work up to meditation sessions lasting 30
Visualization can be a powerful tool. Practice
minutes or longer if needed.
it regularly, for about 30 or more minutes per
Whatever the exact physiological condition isthat session. Increase sessions to once a day during
your body enters into during meditation, one the week before a tournament.

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566 | Unit 21

Anchoring and Future Pacing them feel at home and reducing the intimidation
of being in a strange place. This way, it is possible
Anchoring and future pacing are mental tech-
to recall the sights, smells, and sounds of being
niques related to meditation and visualization.
in a place that feels most comfortable and
Most people have experienced the sensation of
perhaps helping them perform at their best.
having a memory triggered by a sight, sound,
smell, or another stimulus. Perhaps a song on When you compete in a foreign environment, get
the radio makes you remember when you were to the location as early as possible. Find a quiet
a child playing with your best friend, or a sunset corner, meditate for a while, and visualize de-
brings back memories of a romantic moment. feating the opponent. Then work out for a while,
Anchoring is a method in which you deliberately calling up an anchor to help feel as comfortable
associate a stimulus with a particular experience. as possible. With practice as an athlete becomes
Your anchor can be a single stimulus, such as an comfortable with using anchoring as a tech-
internal verbalization, visualization, feeling, or nique, athletes will develop a routine that works
smell, or it can be a combination of stimuli. best for their individual personalities.

For an athlete, anchoring can be especially useful Future pacing is similar to anchoring but
for tournaments and away games. When athletes focuses on future events, such as defeating an
practice in their regular environment, they upcoming opponent. To future pace, visualize
can make a mental note of what it feels like to your anticipated performance and relate it to
perform in home surroundings. When athletes an anchoring stimulus. When the competition
win a competition, they can lock into memory finally begins, use the anchor to stimulate
the song that is playing as they accept the yourself to play as well as you visualized. The
trophy, for example. Then, when they are in an goal is to do in reality what you picture yourself
unfamiliar environment, they can use the anchor doing in your mind.
to recreate these feelings and memories, helping

Sports Nutrition
 Putting It All Together: Athletic Performance Improvement Approach | 567

Medical Support Team from training and events). Athletes should use
all the medical and therapeutic options they
Medical support is a critical performance have, effectively, safely, and promptly. Team
factor, and all athletes should be under the athletic trainers, physicians, and coaches can be
close supervision of their physicians and other consulted to determine what medical support
required health professionals. Only qualified is available from the school and where gaps
sports medicine specialists are allowed to may exist for which additional sports medical
prescribe such support. Sports medicine is a expertise may be required.
highly diversified and complex field, and fitness
trainers should make an effort to know about There is nothing macho about letting injuries
the sports medicine experts in their area, the go unattended. When persistent pain is present,
ones who may be involved with the athletes you in addition to damage and injury from training
are involved with. Preventive medicine is also and sports participation, pain can be a symptom
an important factor. Athletes should keep copies of serious diseases, such as cancer, which does
of their medical records so they can share them inflict some athletes. It is much smarter to
with their team of health professionals. address an injury when it occurs than to suffer
the consequences when it heals incorrectly.
Better yet, athletes should be proactive and
Therapeutic Modalities make preferred therapeutic modalities a part of
Whirlpools, electrical muscle stimulation, their preventive programs. Taking time during
massage, ultrasound, light technologies, and a training for injury prevention might seem
host of other therapeutic modalities can have an bothersome, but doing so will pay off in the
extremely positive effect on an athlete’s training long term in terms by promoting better athletic
efforts, both directly (improve performance) and performance, prolonging an athlete’s career, and
indirectly (how quickly an athlete can recover fostering a healthier post-athletic career.

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568 | Unit 21

Avoiding Banned WADA

Substances & Methods (World Anti-Doping Agency)
The World Anti-Doping Agency (WADA) is
Avoiding the major tragedy of an athlete
an international independent agency, and its
being disqualified because of banned
primary activities include scientific research,
substance use or methods is more than ever
education, development of anti-doping
an important function of fitness trainers and
capacities, and monitoring of the World
others involved with training and supervising
Anti-Doping Code (Code) – the document
athletes. Awareness is a crucial factor, in that
harmonizing anti-doping policies in all sports
athletes must understand this topic, including
and all countries. WADA is active in many areas
confirmation that athletes you are involved
related to anti-doping, including publishing the
with demonstrate proof of checking with their
“prohibited list.” The prohibited list is available
coaches and sports governing organizations.
for download from WADA’s website:
Proof can be in the form of showing the fitness
trainer and other health professionals a printout https://www.wada-ama.org/en/what-we-do/prohibited-list
of the sports organizations’ rules and regulations
regarding banned substances and methods. In
Prohibited List Overview
addition, a fitness trainer’s knowing about these
topics provides valuable information for talking The prohibited list is updated regularly, so fitness
with athlete clients about this vital topic and trainers working with athletes should visit the
knowing what to look for. WADA website a few times a year to determine
whether they have the most current versions.
Today more than ever athletes are challenged The following table will summarize the main
with the temptation of using banned substances content headings included on the prohibited list.
and practices. The Internet fosters even greater Some of the limitations apply for in and out of
ability to purchase banned illegal drugs. competition or in competition, which the official
But another consideration regarding illegal list will specify. Note that an APP for mobile
substances that are available is that they might devices is also available.
contain other substances or drugs—some which
can be hazardous to an athlete’s health. Note that
these illegal drugs commonly contain no drug.
For some sports, readily available substances
such as caffeine and alcohol are banned; as such,
athletes in these sports can more easily violate
the rules, which can lead to disqualification.

In addition to the specific sports governing

organizations that have direct authority
over the athletes, they can present
information from one of the international
organizations, such as WADA.

Sports Nutrition
 Putting It All Together: Athletic Performance Improvement Approach | 569

Prohibited Substances Categories Examples

S0. Non-Approved Substances Generally related to substances not addressed by any of the other sections
of the list and those substances with no current approval for human
therapeutic use, such as drugs.
S1. A
 nabolic Agents Anabolic androgenic steroids, such as bolasterone, clostebol, nandrolone,
testosterone, etc. And other substances with a similar chemical structure
or similar biological effects(s).
S2. Peptide Hormones, Growth Erythropoietin-receptor agonists; hypoxia-inducible factor stabilizers;
Factors, Related Substances, chorionic gonadotrophin and luteinizing hormone; corticotrophin and
and Mimetics, their releasing factors; growth hormone; insulin-like growth factor-1, etc.
S3. Beta-2-Agonists All beta-2-agonists, with some exceptions noted.
S4. Hormone and Aromatase inhibitors; Selective estrogen receptor modulators; other anti-
Metabolic Modulators estrogenic substances; etc.
S5. Diuretics and Masking Agents Desmopressin, acetazolamide, thiazides, etc.
S6. Stimulants Non-specified stimulants such as adrafinil, cocaine, phentermine, etc.;
specified stimulants such as, cathine, ephedrine, octopamine, selegiline,
sibutramine, strychnine, etc.
S7. Narcotics Buprenorphine, diamorphine (heroin), morphine, oxycodone, etc.
S8. Cannabinoids Cannabis, hashish, cannabimimetics, etc.
S9. Glucocorticoids All glucocorticoids.

Prohibited Methods Examples

M1. M
 anipulation of Blood and Administration of red blood cell products; artificially enhancing the
Blood Components uptake, transport or delivery of oxygen; etc.
M2. C
 hemical and Physical Tapering to alter the integrity and validity of samples collected during
Manipulation doping control; intravenous infusions and/or injections; etc.
M3. Gene Doping Transfer of polymers of nucleic acids; use of normal or genetically
modified cells.

Substances Prohibited
Examples
in a Particular Sport
P1. Alcohol Air sports, archery, automobile, etc. Determined by analysis of breath
and/or blood.
P2. Beta-Blockers Beta-blockers are prohibited in competition only in certain sports and
are also prohibited out of competition where indicated. Archery,
automobile, golf, shooting, skiing, etc. Acebutolol, bunolol, esmolol,
nadolol, pindolol, etc.

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570 | Unit 21

The Next Step for Students

Upon completion and certification, fitness trainers and other
health professionals with athlete clients can continue to build on
the foundational information from this course through continuing
education. ISSA provides a variety of continuing education courses and
will be expanding CE courses related to the variety of specialty sports
nutrition topics and new research discoveries along with updates to the
foundational sports nutrition information.

Conclusion
It is apparent to the student taking this course that there are a multiple
opportunities to become part of an athlete’s training and nutrition
program team. Because many athletes are part of understaffed teams
with limited resources for the time-intensive year-round attention
athletes require, fitness trainers can be a dynamic specialized resource
for such athletes. Although the legal ability to develop and prescribe
nutrition programs for athletes may be restricted based on state or local
law requirements, typically licensed health professionals, knowing about
scientific evidence-based sports nutrition is knowledge worth having.
For some athletes, doing only one thing wrong that is corrected or doing
something new that is ergogenic to their athletic performance can mean
the difference between winning and losing.

Sports Nutrition
 Appendix Table of Contents

References, p. 573

Glossary, p. 629

APPENDIX

REFERENCES AND GLOSSARY OF KEY WORDS

This page is intentionally blank.
 References and Glossary of Key Words | 573

REFERENCE SECTION Adams MR, McCredie R, Jessup W, Robinson J, Sullivan

D, Celermajer DS. 1997. Oral L-Arginine improves
endothelium-dependent dilatation and reduces monocyte
This reference section contains examples of adhesion to the endothelial cells in young men with
scientific references and technical reports in coronary artery disease. Atherosclerosis 129: 261-269.
support of the information provided in this
Adiloglu AK, Gönülates N, Isler M, Senol A. The effect of
course book. Note that not all of references are kefir consumption on human immune system: a cytokine
included due to space limitations as the authors study. Mikrobiyoloji Bulteni 2013; 47(2):273-281.
have gathered and reviewed thousands of studies Adlof RO, Duval S, Emken EA. Biosynthesis of conjugated
during the decades of their work. Some of the linoleic acid in humans. Lipids 35:131-135 (2000).
following references are cited in the course Affourtit C, et a. On the mechanism by which dietary
materials, while other referecnces included nitrate improves human skeletal muscle function. Front
represent the general body of related scientific Physiol. 2015 Jul 29;6:211.
knowledge. African Wild Mango - Irvingia gabonensis Carnitine
Monograph, Natural Health Products, Health Canada,
5-HTP Monograph, Health Canada. 2015
Abe S, Takayama K, Kinoshita S. Taxonomic studies on Ahmadova A, Todorov SD, Hadji-Sfaxi I, Choiset Y,
glutamic acid-producing bacteria. Journal of General and Rabesona H, Messaoudi S, Kuliyev A, Franco BD, Chobert
Applied Microbiology 1967; 13(3):279-301. JM, Haertlé T. Antimicrobial and antifungal activities of
Abel T, Knechtle B, Perret C, Eser P, von Arx P, Knecht Lactobacillus curvatus strain isolated from homemade
H. Influence of chronic supplementation of arginine Azerbaijani cheese. Anaerobe. 2013; 20:42-49.
aspartate in endurance athletes on performance and Ahmet U, Abdurrahman K, Sait B, Ahmet E, Salih D,
substrate metabolism – a randomized, double-blind, Mendane S, Ates Y, Fatih B, Necmettin K, Kemal D.
placebo-controlled study. Int J Sports Med. 2005 L-carnitine therapy in non-alcoholic steatohepatitis.
Jun;26(5):344-9. Turkish Journal of Pediatrics 2000;11(3):196-201.
Abumrad, N., and P. Flakoll. The Efficacy and Safety Ahmun RP, Tong RJ, Grimshaw PN. The effects of acute
of CaBHBM (Beta-Hydroxy Beta-Methylbutyrate) in creatine supplementation on multiple sprint cycling and
Humans. Vanderbilt University Medical Center Annual running performance in rugby players. J Strength Cond
Report (1991). Res. 2005 Feb;19(1):92-7.
Academy of Nutrition and Dietetics (AND), Dietitians of Ainsworth BE, Haskell WL, Whitt MC, et al.
Canada (DC), and American College of Sports Medicine Compendium of physical activities: An update of activity
(ACSM). Nutrition and Athletic Performance. Medicine codes and MET intensities. Med Sci Sports Exerc.
& Science in Sports & Exercise: March 2016 - Volume 48 - 2000;32(9 suppl):S498-S504.
Issue 3 - p 543–568
Ainsworth BE, Haskell WL, Whitt MC, et al.
Ackland TR, Lohman TG, Sundgot Borgen J, et al. Compendium of physical activities: An update of activity
Current status of body composition assessment in sport: codes and MET intensities. Med Sci Sports Exerc.
Review and position statement on behalf of the ad hoc 2000;32(9 suppl):S498-S504.
research working group on body composition health and
performance, under the auspices of the I.O.C. Medical Akermark C, Jacobs I, Anderson ME, Bruce CR, Fraser
Commission. Sports Med. 2012;42(3):227-249. SF, Stepto NK, Klein R, Hopkins WG, Hawley JA.
Improved 2000-meter rowing performance in competitive
Ackland TR, Lohman TG, SundgotBorgen J, et al. oarswomen after caffeine ingestion. Int J Sport Nutr Exerc
Current status of body composition assessment in sport: Metab 2000 Dec;10(4):464-75.
Review and position statement on behalf of the ad hoc
research working group on body composition health and
performance, under the auspices of the I.O.C. Medical
Commission. Sports Med. 2012;42(3):227-249.

International Sports Sciences Association

574 | Appendix References and Glossary of Key Words | 574

Almada, A., et al. Effects of B-BHBM Supplementation Antonio Herbert Lancha Junior, Vitor de Salles Painelli,
With and Without Creatine During Training on Strength Bryan Saunders, Guilherme Giannini Artioli. Nutritional
and Sprint Capacity. Federation of American Societies of Strategies to Modulate Intracellular and Extracellular
Experimental Biology Journal, Vol. 11 (1997), pg. A374. Buffering Capacity During High-Intensity Exercise.
Sports Med. 2015; 45: 71–81.
Alpha lipoic acid Monograph, Health Canada.
Antonio J, et al. A high protein diet (3.4 g/kg/d) combined
Altman, R.D. and K.C. Marcussen (2001). Effects with a heavy resistance training program improves body
of a ginger extract on knee pain in patients with composition in healthy trained men and women--a
osteoarthritis. Arthritis Rheum. 44:2531-2538. follow-up investigation. J Int Soc Sports Nutr. 2015 Oct
20;12:39.
American College of Sports Medicine, Armstrong LE,
Casa DJ, MillardStafford M, et al. American College of Antonio J, et al. A High Protein Diet Has No Harmful
Sports Medicine position stand. Exertional heat illness Effects: A One-Year Crossover Study in Resistance-
during training and competition. Med Sci Sports Exerc. Trained Males. J Nutr Metab. 2016;2016:9104792.
2007;39(3):556-572.
Antonio, J., J. Uelmen, R. Rodriguez, and C. Earnest
American College of Sports Medicine, Sawka MN, (2000). The effects of Tribulus terrestris on body
Burke LM, Eichner ER, et al. American College of Sports composition and exercise performance in resistance-
Medicine position stand. Exercise and fluid replacement. trained males. Int.J. Sport Nutr. Exerc. Metab. 10:208-215.
Med Sci Sports Exerc. 2007;39(2):377-390.
Apfelbaum, Marian, Jacques Fricker, and Lawrence
American College of Sports Medicine. Position stand Igoin-Apfelbaum. Low and Very Low Calorie Diets.
on exercise and fluid replacement. Med Sci Sports American Journal of Clinical Nutrition, Vol. 45 (1987), pp.
Med.1996;28:i-vii. 1126-1134.
Amylase Monograph, Health Canada. Applegate EA, Grivetti LE. Search for the competitive
edge: a history of dietary fads and supplements. J Nutr.
Anderson ML. A Double-Blind Clinical Study to
1997;127:869S-873S.
Investigate the Effects of a Fungal Protease Enzyme
System on Metabolic, Hepato-renal, and Cardiovascular Applegate EA. Nutritional considerations for
Parameters Following 30 Days of Supplementation in ultraendurance performance. Int J Sport Nutr. 1991
Active, Healthy Men. Food Dig. 2013 May;4(1):19-25. Jun;1(2):118-26.
Epub 2011 Dec 13.
Application of a Sub-set of Skinfold Sites for Ultrasound
Anderson, Helen L., Mary Belle Heindel, and Hellen Measurement of Subcutaneous Adiposity and Percentage
Linkswiler. Effect on Nitrogen Balance of Adult Man of Body Fat Estimation in Athletes. Int J Sports Med. 2016
Varying Source of Nitrogen and Level of Calorie Intake. May;37(5):359-63.
Journal of Nutrition (1969), pp. 82-90.
Araújo CA, Leon LL. 2001. Abstract: Biological
Anderson, M., et al. Pre-Exercise Meal Affects Ride Time activities of Curcuma longa L. Mem Inst Oswaldo Cruz
to Fatigue in Trained Cyclists. Journal of the American 96(5):723-728
Dietetic Association, Vol. 94 (1994), pp. 1152-1153.
Arciero PJ, Hannibal NS 3rd, Nindl BC, Gentile
Andrade C, Srihari BS, Reddy KP, Chandramma L. CL, Hamed J, Vukovich MD. Comparison of
Melatonin in medically ill patients with insomnia: a creatine ingestion and resistance training on energy
double blind placebo-controlled study. Journal of Clinical expenditure and limb blood flow. Metabolism. 2001
Psychiatry 2001;62(1):41-5 Dec;50(12):1429-34.
Antioxidants Monograph, Health Canada. Arenas J, Huertas R, Campos Y, Diaz AE, Villalon
JM, Vilas E. Effect of L-carnitine on the pyruvate
Anton SD, et al. Effect of a novel dietary supplement on
dehydrogenase complex and carnitine palmitoyl
pH levels of healthy volunteers: a pilot study. J Integr Med.
transferase activities in muscle of endurance athletes.
2013 Nov; 11(6): 384–388.
FEBS Letters 1994;341:91-93.

Sports Nutrition
 References and Glossary of Key Words | 575

Arenas J, Ricoy JR, Encinas AR, Pola P, D’Iddio S, Zeviani Asano K, Takahashi T, Miyashita M, Matsuzaka A,
M, Didonato S, Corsi M. Carnitine in muscle, serum, Muramatsu S, Kuboyama M, Kugo H, Imai J. Effect of
and urine of nonprofessional athletes: Effects of physical Eleuthero senticosus Extract on Human Physical Working
exercise, training, and L-carnitine administration. Capacity. Planta Medica. 1986; 52(3): 175-177.
Journal of Muscle & Nerve 1991;14:598-604.
Ashihara H, Suzuki T. Distribution and biosynthesis
Areta JL, Burke LM, Camera DM, et al. Reduced of caffeine in plants. Frontiers in Bioscience
resting skeletal muscle protein synthesis is rescued 2004;9:1864-1876.
by resistance exercise and protein ingestion following
shortterm energy deficit. Am J Physiol Endocrinol Metab. Ashizawa N., R. Fujimura, K. Tokuyama and M. Suzuki.
2014;306(8):E989-E997. A bout of resistance exercise increases urinary calcium
independently of osteoclastic activation in men. Journal of
Areta JL, Burke LM, Ross ML, et al. Timing and Applied Physiology, Vol. 83 (1998), pp. 1159-1163.
distribution of protein ingestion during prolonged
recovery from resistance exercise alters myofibrillar Assinewe VA. Phytochemical variation and
protein synthesis. J Physiol. 2013;591(pt 9): 2319-2331. immunopharmacology of Panax quinquefolius L.
(American Ginseng) [Doctoral dissertation]. Ottawa
Arginine Monograph, Health Canada. (ON): University of Ottawa;2001

Armstrong, L.E., D.L. Costill, and W.J. Fink (1985). Astorino TA, Roberson DW. Efficacy of acute
Influence of diuretic-induced dehydration on competitive caffeine ingestion for short-term high-intensity
running performance. Med. Sci. Sports Exerc. 17:456-461. exercise performance: A systematic review. J Strength
Conditioning Res. 2010;24(1):257-265.
Armstrong, R. B. Mechanisms of Exercise-Induced
Delayed Onset Muscular Soreness: A Brief Review. Attenburrow ME, Cowen PJ, Sharpley AL. Low dose
Medicine and Science in Sports and Exercise, Vol. 16 melatonin improves sleep in healthy middle-aged subjects.
(1984), No. 6, pp. 529-538. Psychopharmacology (Berlin) 1996;126(2):179-81

Armstrong, R. B. Muscle Damage and Endurance Events. Avery D, Lenz M, Landis C. Guidelines for prescribing
Sports Medicine, Vol. 3 (1986), pp. 370-381. melatonin. Annals of Medicine 1998;30(1):122-30

Armuzzi A, Cremonini F, Bartolozzi F, Canducci Avisar R, Avisar E, Weinberger D. Effect of coffee

F, Candelli M, Ojetti V, Cammarota G, Anti M, De consumption on intraocular pressure. The Annals of
Lorenzo A, Pola P, Gasbarrini G, Gasbarrini A. The Pharmacotherapy 2002;36(6):992-995.
effect of oral administration of Lactobacillus GG on
antibiotic-associated gastrointestinal side-effects during Ayoama R, Hiruma E, Sasaki H. Effects of creatine
Helicobacter pylori eradication therapy. Alimentary loading on muscular strength and endurance of female
Pharmacology & Therapeutics 2001; 15(2):163-169. softball players. J Sports Med Phys Fitness. 2003
Dec;43(4):481-7.
Arnall DA, Nelson AG, Quigley J, Lex S, Dehart T,
Fortune P. Supercompensated glycogen loads persist 5 Azain MJ, Hausman DB, Sisk MB, Flatt WP, Jewell DE.
days in resting trained cyclists. Eur J Appl Physiol. 2007 Dietary conjugated linoleic acid reduces rat adipose tissue
Feb;99(3):251-6. Epub 2006 Nov 22. cell size rather than cell number. J. Nutr. 130:1548-1554
(2000).
Arnaoutis G1, Kavouras SA, Angelopoulou A, Skoulariki
C, Bismpikou S, Mourtakos S, Sidossis LS. Fluid Balance Babraj J, Cuthbertson DJ, Rickhuss P, et al. Sequential
During Training in Elite Young Athletes of Different extracts of human bone show differing collagen synthetic
Sports. J Strength Cond Res. 2015 Dec;29(12):3447-52. rates. Biochem Soc Transact. 2002;30(2):61-65.

Arya LA, Myers DL, Jackson ND. Dietary caffeine intake Bahrke MS, Morgan WP. 1994. Evaluation of the
and the risk for detrusor instability: a case-control study. ergogenic properties of ginseng. Sports Medicine
Obstetrics and Gynecology 2000;96(1):85-89. 18(4):229-248

International Sports Sciences Association

576 | Appendix

Bailey SJ, et al. Inorganic nitrate supplementation Bao H Y, Zhang J, Yeo SJ, Myung CS, Kim HM, Kim JM,
improves muscle oxygenation, O₂ uptake kinetics, and Park JH, Cho J, Kang JS. 2005. Memory enhancing and
exercise tolerance at high but not low pedal rates. J Appl neuroprotective effects of selected ginsenosides. Archives
Physiol (2015) Jun 1;118(11):1396-405. of Pharmacal Research 28(3):335-342.

Bain MA, Faull R, Fornasini G. Accumulcation of Barba, C. et al., 2004. Appropriate body-mass index for
trimethylamine and trimethylamine-N-oxide in end- Asian populations and its implications for policy and
stage renal disease patients undergoing haemodialysis. intervention strategies. Lancet, 363(9403), pp.157–163.
Molecular Genetics and Metabolism 2004;81:263-272.
Barnes MJ. Alcohol: Impact on sports performance and
Baker LB1, Rollo I2, Stein KW3, Jeukendrup AE4. Acute recovery in male athletes. Sports Med. 2014;44(7):909-919.
Effects of Carbohydrate Supplementation on Intermittent
Sports Performance. Nutrients. 2015 Jul 14;7(7):5733-63. Barry M. Popkin, Kristen E. D’Anci, and Irwin H.
Rosenberg. Water, Hydration and Health. Nutr Rev. 2010
Baker, O., et al. Absorption and Excretion of L-Carnitine Aug; 68(8): 439–458.
During Single or Multiple Dosings in Humans.
International Journal of Vitamin and Nutrition Research, Bartlett JD, Hawley JA, Morton JP. Carbohydrate
Vol. 63 (1993), pp. 22-26. availability and exercise training adaptation: Too much of
a good thing? Eur J Sport Sci; 2014:1-10.
Ball, T., et al. Periodic Carbohydrate Replacement
During 50 Minutes of High-Intensity Cycling Improves Beam, W. C. The Effect of Chronic Ascorbic Acid
Subsequent Sprint Performance. International Journal of Supplementation on Strength Following Isotonic Strength
Sport Science (1995), pp. 151-158. Training. Medicine and Science in Sports and Exercise,
Vol. 30 (1998), pg. S219.
Balsom P, Söderlund K, Ekblom B (1994).
Creatine in humans with special reference to creatine Beard J, Tobin B. Iron status and exercise. Am J Clin Nutr.
supplementation. Sports Medicine 18, 268-80. 2000;72(2 suppl):594S597S.

Balsom, P. D., K. Wood, P. Olsson, and B. Ekblom (1999). Beck KL, et al. Role of nutrition in performance
Carbohydrate intake and multiple sprint sports: with enhancement and postexercise recovery. J Sports Med.
special reference to football (soccer). Int. J. Sports Med. 2015; 6: 259–267.
20:48-52.
Beckman, B. and Nystuen L. Comparative effects
Bamman, M. M., et al. Changes in Body Composition, of inhibitors of arachidonic acid metabolism on
Diet, and Strength of Bodybuilders During the 12 Weeks erythropoiesis. Prostaglandins Leukot Essent Fatty Acids.
Prior to Competition. Journal of Sports Medicine and 1988 Jan;31(1):23-26.
Physical Fitness, Vol. 33 (1993), pg. 383.
Beckman, BS, and Seferynska, I. Possible involvement
Bangsbo, J. (1994a). Energy demands in competitive of phospholipase activation in erythroid progenitor cell
soccer. J. Sports Sci. 12(Spec No): S5-S12. proliferation. Exp. Hmeatol. 1989 Mar;17(3):309-312.

Bangsbo, J. (1994b). The physiology of soccer-with special Bednarz B, Wolk R, Chamiec T, Herbaczyriska-Cedro
reference to intense intermittent exercise. Acta Physiol. K, Winek D, Ceremuzynski L. 2000. Effects of oral
Scand. Suppl. 619:1-155. L-arginine supplementation on exercise-induced QT
dispersion and exercise tolerance in stable angina pectoris.
Bangsbo, J., L. Narregaard, and F. Thorsa (1991). Activity International Journal of Cardiology 75(2-3):205-210.
profile of competition soccer. Can. J. Sport Sci., 16:
110-116. Beelen M, Burke LM, Gibala MJ, van Loon LJ. Nutritional
strategies to promote postexercise recovery. Int Sport Nutr
Bangsbo, J., L. Narregaard, and F. Thorsa (1992). The Exerc Metab. 2010;20(6):515-532.
effect of carbohydrate diet on intermittent exercise
performance. Int. J. Sports Med. 13:152-157. Beelen M, Koopman R, Gijsen AP, et al. Protein
coingestion stimulates muscle protein synthesis during
resistance-type exercise. Am J Physiol Endocrinol Metab.
2008;295(1):E70-E77.

Sports Nutrition
 References and Glossary of Key Words | 577

Belanger, A. Y., and A. J. McComas. A Comparison of Berardi J and Andrews Ryan. Specialist in Fitness
Contractile Properties in Human Arm and Leg Muscles. Nutrition. ISSA, First Edition 2013.
European Journal of Applied Physiology, Vol. 54 (1985),
pp. 26-33. Berardi JM, Noreen EE, Lemon PW. Recovery from
a cycling time trial is enhanced with carbohydrate-
Belcaro G et al. Venous ulcers: microcirculatory protein supplementation vs. isoenergetic carbohydrate
improvement and faster healing with local use of supplementation. J Int Soc Sports Nutr. 2008;5:24.
Pycnogenol®. Angiology 56: 699-705, 2005.
Bergeron MF. Exertional heat cramps: Recovery and
Beleslin-Cokic, BB., et al. Erythropoietin and hypoxia return to play. J Sport Rehab. 2007;16(3):190-196.
stimulate erythropoietin, receptor and nitric oxide
production by endothelial cells. Blood 2004 Oct Bergonzelli GE, Granato D, Pridmore RD, Marvin-
1;104(7):2073-80. Guy LF, Donnicola D, Corthésy-Theulaz IE. GroEL of
Lactobacillus johnsonii La1 (NCC 533) Is Cell Surface
Bell, R. D., J. D. MacDougall, R. Billeter, and H. Howald. Associated: Potential Role in Interactions with the Host
Muscle Fiber Types and Morphometric Analysis of and the Gastric Pathogen Helicobacter pylori. Infection
Skeletal Muscle in Six-Year-Old Children. Medicine and and Immunity 2006; 74(1):425-434.
Science in Sports and Exercise, Vol. 12 (1980), No. 1, pp.
28-31. Bergstrom, J., L. Hermansen, E. Hultman, and B. Saltin
(1967). Diet, muscle glycogen and physical performance.
Below PR. Mora-Rodriguez R, Gonzalez-Alonso J, Coyle Acta Physiol. Scand. 71:140-150.
E. Fluid and carbohydrate ingestion independently
improve performance during 1 hr of intense exercise. Med Bergstrom, Jonas, and Eric Hultman. Nutrition for
Sci Sports Exerc. 1995;27:200-210. Maximal Sports Performance. Journal of the American
Medical Association, Vol. 221 (1972), No. 9, pp. 999-1004.
Belury MA, Mahon A, Banni S. The conjugated linoleic
acid (CLA) isomer, t10c12-CLA, is inversely associated Berning, J. R. The Role of Medium-Chain Triglycerides in
with changes in body weight and serum leptin in Exercise. International Journal of Sport Nutrition, Vol. 6
subjects with type 2 diabetes mellitus. J Nutr. 2003 (1996), No. 3, pp. 121-133.
Jan;133(1):257S-260S.
Berven G, Bye A, Hals O, Blankson H, Fagertun H,
Bemben MG, Bemben DA, Loftiss DD, Knehans AW. Thom E, Wadstein J, Gudmundsen O. 2000. Safety of
2001. Creatine supplementation during resistance training conjugated linoleic acid (CLA) in overweight and obese
in college football athletes. Medicine & Science in Sports human volunteers. European Journal of Lipid Science and
& Exercise 33(10):1667-1673. Technology 102(7):455-462.

Beniamini, Y., et al. High-intensity strength training of Berven G, Bye A, Hals O, Blankson H, Fagertun H, Thom
patients enrolled in an outpatient cardiac rehabilitation E, Wadstein J, Gudmundsen O. Safety of conjugated
program. J Cardiopulm Rehabil 1999 Jan-Feb;19(1):8-17. linoleic acid (CLA) in overweight or obese human
volunteers. European J. Lipid Sci. Technol. 102:455-462
Benito P, Nelson GJ, Kelley DS, Bartolini G, Schmidt PC, (2000).
Simon V. The effect of conjugated linoleic acid on plasma
lipoproteins and tissue fatty acid composition in humans. Beta-Carotene Monograph, Health Canada.
Lipids 36:229-236 (2001).
Beta-Glucan Monograph, Health Canada.
Bennett T, Bathalon G, Armstrong D 3rd, Martin B, Coll
Betaine Monograph, Health Canada.
R, Beck R, Barkdull T, O’Brien K, Deuster PA. Effect of
creatine on performance of militarily relevant tasks and Betts JA, Williams C. Short-term recovery from prolonged
soldier health. Mil Med. 2001 Nov;166(11):996-1002. exercise: exploring the potential for protein ingestion
to accentuate the benefits of carbohydrate supplements.
Bentzur KM1, Kravitz L, Lockner DW. Evaluation of the
Sports Med. 2010;40(11): 941-959.
BOD POD for estimating percent body fat in collegiate
track and field female athletes: a comparison of four Bezkorovainy A. Probiotics: determinants of survival and
methods. J Strength Cond Res. 2008 Nov;22(6):1985-91. growth in the gut. American Journal of Clinical Nutrition
2001; 73(2):399S-405S.

International Sports Sciences Association

578 | Appendix

Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Black Pepper - Piper nigrum Monograph, Health Canada.
Leon DA, Smeeth L. Body-mass index and risk of 22
specific cancers: a population-based cohort study of 5•24 Blankson H, Stakkestad JA, Fagertun H, Thom E,
million UK adults. Lancet. 2014 Aug 30;384(9945):755-65. Wadstein J, Gudmundsen O. Conjugated linoleic acid
doi: 10.1016/S0140-6736(14)60892-8. Epub 2014 Aug 13. reduces body fat mass in overweight and obese humans. J.
Nutr. 130:2943-2948 (2000).
British Herbal Pharmacopoeia. Bournemouth (UK):
British Herbal Medical Association; 1996. Blomstrand E, Celsing F, Newshome EA (1988). Changes
in plasma concentrations of aromatic and branch-chain
Biegert, C., I. Wagner, R. Ludtke, I. Kotter, C. Lohmuller, amino acids during sustained exercise in man and their
I. Gunaydin, K. Taxis, and L. Heide (2004). Efficacy possible role in fatigue. Acta Physiologica Scandinavica
and safety of willow bark extract in the treatment of 133, 115-21.
osteoarthritis and rheumatoid arthritis: results of 2
randomized double-blind controlled trials. J. Rheumatol. Bloomer RJ, Farney TM, Trepanowski JF, McCarthy CG,
31:2121-2130. Canale RE, Schilling BK. Comparison of pre-workout
nitric oxide stimulating dietary supplements on skeletal
Bilberry Monograph, Health Canada. muscle oxygen saturation, blood nitrate/nitrite, lipid
peroxidation, and upper body exercise performance in
Bill Campbell, et al. International Society of Sports resistance trained men. J Int Soc Sports Nutr. 2010 May
Nutrition position stand: energy drinks. Journal of the 6;7:16.
International Society of Sports Nutrition 2013, 10:1
Bloomer RJ, Williams SA, Canale RE, Farney TM,
Bill Campbell, et al. International Society of Sports Kabir MM. Acute effect of nitric oxide supplement
Nutrition position stand: protein and exercise. Journal of on blood nitrate/nitrite and hemodynamic variables
the International Society of Sports Nutrition 2007, 4:8 in resistance trained men. J Strength Cond Res. 2010
Oct;24(10):2587-92.
Biondo PD, Goruk S, Ruth MR, O’Connell E, Field
CJ. 2008. Effect of CVT-E002 (COLD-fX) versus a Bloomstrand E, Hassmen P, Ekblom B et al (1991).
ginsenoside extract on systemic and gut-associated Administration of branch-chain amino acids during
immune function. International Immunopharmacology sustained exercise - effects on performance and on plasma
8(8):1134-42. concentration of some amino acids. European Journal of
Applied Physiology 63, 83-8.
Biondo PD, Robbins SJ, Walsh JD, McCargar LJ, Harber
VJ, Field CJ. 2008. A randomized controlled crossover Bloomstrand E, Hassmen P, Newsholme E (1991). Effect
trial of the effect of ginseng consumption on the immune of branch-chain amino acid supplementation on mental
response to moderate exercise in healthy sedentary men. performance. Acta Physiologica Scandinavica 143, 225-6.
Applied Physiology, Nutrition, and Metabolism 33(5):
966-975. Blumenthal M, Busse W, Goldberg A, Gruenwald J, Hall
T, Riggins C, Rister R, editors. The Complete German
Biotin Monograph, Health Canada. Commission E Monographs: Therapeutic Guide to Herbal
Medicines. Austin (TX): American Botanical Council;
Biradar SS, Bahagvati ST, Shegunshi B. Probiotics and
1998.
antibiotics: a brief overview. The Internet Journal of
Nutrition and Wellness 2005; 2(1):1-7. Blumenthal M, Goldberg A, Brinckmann J, editors.
Herbal Medicine: Expanded Commission E Monographs.
Birch R, Nobel D, Greenhaff P (1994). The influence of
Boston (MA): Integrative Medicine Communications;
dietary creatine supplementation on performance during
2000.
repeated bouts of maximal isokinetic cycling in man.
European Journal of Applied Physiology 69, 268-76. Bode-Böger SM, Böger RH, Galland A, Tsikas D, Frölich
JC. L-arginine-induced vasodilation in healthy humans:
Bisby F, Roskov Y, Culham A, Orrell T, Nicolson D,
pharmacokinetic-pharmacodynamic relationship. Br J
Paglinawan L, Bailly N, Appeltans W, Kirk P, Bourgoin T,
Clin Pharmacol. 1998 Nov;46(5):489-97.
Baillargeon G, Ouvrard

Black Cohosh Monograph, Health Canada.

Sports Nutrition
 References and Glossary of Key Words | 579

Bode-Böger SM, Muke J, Surdacki A, Brobant G, Böger Borum, Peggy R. Carnitine. Annual Reviews of Nutrition,
RH, Frölich J. 2003. Oral L-arginine improves endothelial Vol. 3 (1983), pp. 233-259.
function in healthy individuals older than 70 years.
Vascular Medicine 8(2):77-81. Bovine Colostrum Monograph, Health Canada.

Bohmer D, Ambrus P, Szogy A, and G. Haralambie. A Bowman, B, Acetyl-L-carnitine and Alzheimer’s disease
Treatment of chrondropathia patellae in young athletes (review), Nutrition Reviews 50, No. 5 (1990): 142-144.
with glucosamine sulfate. Current Topics in Sports
Boyne, P. S., and H. Medhurst. Oral Anti-inflammatory
Medicine, Vienna, Austria: Urban & Schwarzenberg,
Enzyme Therapy in Injuries in Professional Footballers.
1984:799-803.
The Practitioner, Vol. 198 (April 1967), pp. 543-546.
Bohn B, Nebe CT, Birr C. Flow-cytometric studies
BP 2003: British Pharmacopoeia Commission. British
with Eleutherococcus senticosus extract as an
Pharmacopoeia. London ( UK ): Her Majesty’s Stationary
immunomodulatory agent. Arzneimittelforschung.
Office; 2003.
1987;37(10):1193-1196.
BP 2015: British Pharmacopoeia 2015, Volume II. London
Bolster DR, et al. Regulation of protein synthesis
(GB): The Stationary Office.
associated with skeletal muscle hypertrophy by insulin-,
amino acid- and exercise-induced signaling. Proc Nutr Bradley PR, editor. 1992. British Herbal Compendium: A
Soc. 2004 May;63(2):351-6. Handbook of Scientific Information on Widely Used Plant
Drugs, Volume 1. Bournemouth (GB): British Herbal
Bonde-Petersen, Flemming, Howard G. Knuttgen, and
Medicine Association.
Jan Henriksson. Muscle Metabolism During Exercise
With Concentric and Eccentric Contractions. Journal of Bradley PR, editor. British Herbal Compendium: A
Applied Physiology, Vol. 33 (1972), pp. 792-795. Handbook of Scientific Information on Widely Used Plant
Drugs, Volume 2. Bournemouth (UK): British Herbal
Bondonno CP, et al. Short-term effects of a high nitrate
Medicine Association; 2006.
diet on nitrate metabolism in healthy individuals.
Nutrients. 2015 Mar 12;7(3):1906-15. Braham, R. The effect of glucosamine supplementation on
people experiencing regular knee pain. Br J Sports Med
Bondonno CP. Short-term effects of nitrate-rich green
2003;37:45-49.
leafy vegetables on blood pressure and arterial stiffness in
individuals with high-normal blood pressure. Free Radic Branch, J. D. (2003). Effect of creatine supplementation on
Biol Med. 2014 Dec;77:353-62. body composition and performance: a meta-analysis. Int.
J. Sport Nutr. Exerc. Metab. 13, 198-226.
Bonke, D., and B. Nickel. Improvement of Fine Motoric
Movement Control by Elevated Dosages of Vitamin B1, Brass EP. Supplemental carnitine and exercise.
B6 and B12 in Target Shooting. International Journal of The American Journal of Clinical Nutrition
Vitamin and Nutrition Research, Vol. 30 (1989), pg. 198. 2000;72:618S-623S.
Borage Oil Monograph, Health Canada. Brass, Eric P and William R Hiatt, The role of carnitine
and carnitine supplementation during exercise in man
Borum, Peggy R, Role of carnitine during development,
and in individuals with special needs, Journal of the
Canadian Journal of Physiology and Pharmacology 63
American College of Nutrition Vol. 17, No. 3 (1988):
(1985): 571-576.
207-215.
Borum, Peggy R, The role of carnitine in enhancing
Bray, G.A. et al., 2001. Evaluation of body fat in fatter and
physical performance, in Food Components to Enhance
leaner 10-y-old African American and white children: the
Performance: An Evaluation of Potential Performance-
Baton Rouge Children’s Study. Am. J. Clin. Nutr., 73(4),
Enhancing Food Components for Operational Rations,
pp.687–702.
Bernadette M. Marriott, Editor, Committee on
Military Nutrition Research, National Academy Press, Brevetti, G, et al., Increases in walking distance in
Washington, D.C. (1994): 433-452. patients with peripheral vascular disease treated with
L-carnitine: a double-blind, cross-over study, Circulation
(1988): 767-773.

International Sports Sciences Association

580 | Appendix

Brewer, J. (1994). Nutritional aspects of women’s soccer. J. Bruyee, O. et al. Correlation between radiographic
Sports Sci., 12 (Spec No):S35-S38. severity on knee osteoarthritis and future disease
progression. Results from a 3-year prospective, placebo-
Brian K. McFarlin,a,b,⁎ Adam S. Venable,a,b Andrea L. controlled study evaluating the effect of glucosamine
Henning,a,b Jill N. Best Sampson,a,b Kathryn Pennel,a sulfate. Osteoarthritis Cartilage 2003 jan;11(1):1-5.
Jakob L. Vingren,a,b and David W. Hilla Reduced
inflammatory and muscle damage biomarkers following Brzezinski A, Vangel MG, Wurtman RJ, Norrie G,
oral supplementation with bioavailable curcumin BBA Zhdanova I, Ben-Shushan A, Ford I. Effects of exogenous
Clin. 2016 Jun; 5: 72–78. melatonin on sleep: a meta-analysis. Sleep Medicine
Reviews 2005;9:41-50
Brilla LR, Giroux MS, Taylor A, Knutzen KM.
Magnesium-creatine supplementation effects on body Bucci L, Hickson JF, Pivarnik JM et al (1990). Ornithine
water. Metabolism. 2003 Sep;52(9):1136-40. ingestion and growth hormone release in bodybuilders.
Nutrition Research 10, 239-45.
Brilla, L. R., and T. E. Landerholm. Effect of Fish Oil
Supplementation and Exercise on Serum Lipids and Bucci LR. 2000. Selected herbs and human exercise
Aerobic Fitness. Journal of Sports Medicine and Physical performance. The American Journal of Clinical Nutrition
Fitness, Vol. 30 (1990), No. 2, pp. 173-180. 72(Suppl 2):624S-636S

Brodan, V., E. Kuhn, J. Pechar, Z. Placer, and Z. Bucci, L. Nutrients as Ergogenic Aids for Sports and
Slabochova. Effects of Sodium Glutamate Infusion on Exercise. Boca Raton, FL: CRC Press, 1993.
Ammonia Formation During Intense Physical Exercise in
Man. Nutrition Reports International, Vol. 9 (1974), No. 3, Bucci, L. Nutrition Applied to Injury Rehabilitation and
pp. 223-232. Sports Medicine. Boca Raton, FL: CRC Press, 1995.

Bromelain Monograph, Health Canada. Bucci, L.R. (2000). Selected herbals and human exercise
performance. Am. J. Clin. Nutr. 72:624S-636S.
Brose A, Parise G, Tarnopolsky MA. Creatine
supplementation enhances isometric strength and body Buford TW, Kreider RB, Stout JR, Greenwood M,
composition improvements following strength exercise Campbell B, Spano M, Ziegenfuss T, Lopez H, Landis
training in older adults. J Gerontol A Biol Sci Med Sci. J, Antonio J. International Society of Sports Nutrition
2003 Jan;58(1):11-9. position stand: creatine supplementation and exercise. J
Int Soc Sports Nutr. 2007 Aug 30;4:6.
Brown GM, Pandi-Perumal SR, Trakht I, Cardinali DP.
Melatonin and its relevance to jet lag. Travel Medicine and Buono, Michael J., Thomas R. Clancy, and Jeff R. Cook.
Infectious Disease 2009;7:69-81. Blood Lactate and Ammonium Ion Accumulation During
Graded Exercise in Humans. The American Physiological
Brown, C. Harmon, and Jack H. Wilmore. The Effects of Society (1984), pp. 135-139.
Maximal Resistance Training on the Strength and Body
Composition of Women Athletes. Medicine and Science Burd NA, West DW, Moore DR, et al. Enhanced amino
in Sports, Vol. 6 (1974), No. 3, pp. 174-177. acid sensitivity of myofibrillar protein synthesis persists
for up to 24 h after resistance exercise in young men. J
Brown, GA, et al. Effects of anabolic precursors on serum Nutr. 2011;141(4): 568-573.
testosterone concentrations and adaptations to resistance
training in young men. Int J Sport Nutr Exerc Metab. Burden RJ, Morton K, Richards T, Whyte GP, Pedlar
2000 Sep;10(3):340-359. CR. Is iron treatment beneficial in, iron-deficient but
nonanaemic (IDNA) endurance athletes? A meta-analysis.
Brusco LI, Fainstein I, Marquez M, Cardinali DP. Br J Sports Med. 2015;49(21):1389-1397.
Effect of melatonin in selected populations of sleep-
disturbed patients. Biological Signals and Receptors Burger, Martin et al. Observations of the influence of
1999;8(1-2):126-31 chondroitin sulphate on the rate of bone repair. The
Journal of Bone and Joint Surgery 1962; 44B(3):674-687.

Sports Nutrition
 References and Glossary of Key Words | 581

Burke DG, Chilibeck PD, Parise G, Candow DG, Burke LM, Kiens B, Ivy JL. Carbohydrates and fat for
Mahoney D, Tarnopolsky M. Effect of creatine and training and recovery. J Sports Sci. 2004;22(1):15-30.
weight training on muscle creatine and performance in
vegetarians. Med Sci Sports Exerc. 2003;35(11):1946-1955. Burke LM, Maughan RJ. The Governor has a sweet
tooth—Mouth sensing of nutrients to enhance sports
Burke DG, Chilibeck PD, Parise G, Tarnopolsky MA, performance. Eur J Sport Sci. 2014:1-12.
Candow DG. Effect of alpha-lipoic acid combined with
creatine monohydrate on human skeletal muscle creatine Burke LM, Read RS. A study of dietary patterns of elite
and phosphagen concentration. Int J Sport Nutr Exerc Australian football players. Can J Sport Sci. 1988;13(1):
Metab. 2003 Sep;13(3):294-302. 15-19.

Burke DG, Silver S, Holt LE, Smith Palmer T, Culligan CJ, Burke LM. Fueling strategies to optimize performance:
Chilibeck PD. The effect of continuous low dose creatine Training high or training low? Scan J Med Sci Sports.
supplementation on force, power, and total work. Int J 2010; 20(suppl 2):48-58.
Sport Nutr Exerc Metab 2000 Sep;10(3):235-44.
Burke, D.G. et al. The effect of whey protein
Burke E. Nutrients that accelerate healing. Strength and supplementation with and without creatine monohydrate
Conditioning 1997:19-23. combined with resistance training on lean tissue mass
and muscle strength. Int J Sport Nutr. 2001, 11, 349-364.
Burke L, Pyne LD, Telford R (1996). Effect of oral creatine
supplementation on single-effort sprint performance in Burke, L.M. (1997). Fluid balance during team sports. J.
elite swimmers. International Journal of Sports Nutrition Sports Sci. 15:287-295.
6, 222-33.
Burns J, Dugan, L. Working with professional athletes in
Burke LM et al. (2004). Carbohydrates and fat for training the rink: the evolution of a nutrition program for a NHL
and recovery. J Sports Sci 22:15-30. team. Int J Sport Nutr. 1994;4:132-134.

Burke LM, Claassen A, Hawley JA, Noakes TD. Buscemi N, Vandermeer B, Pandya R, Hooton N, Tjosvold
Carbohydrate intake during prolonged cycling minimizes L, Hartling L, Baker G, Vohra S, Klassen T. Melatonin for
effect of glycemic index of preexercise meal. J Appl treatment of sleep disorders. Evidence Report/Technology
Physiol. 1998;85(6):2220-2226. Assessment No. 108. AHRQ Publication No. 05-E002-2.
Rockville (MD): U.S. Department of Health and Human
Burke LM, Claassen A, Hawley JA, Noakes TD. Services, Agency for Healthcare Research and Quality.
Carbohydrate intake during prolonged cycling minimizes November, 2004
effect of glycemic index of preexercise meal. J Appl
Physiol. 1998;85(6):2220-2226. Buskirk, Elsworth R., and Jose Mendez. Sports Science
and Body Composition Analysis: Emphasis on Cell
Burke LM, Collier GR, Beasley SK, Davis PR, Fricker PA, and Muscle Mass. Medicine and Science in Sports and
Heeley P, Walder K, Hargreaves M. Effect of coingestion Exercise, Vol. 16 (1984), No. 6, pp. 584-593.
of fat and protein with carbohydrate feedings on muscle
glycogen storage. J Appl Physiol. 1995; 78:2187-2192. Butterfield, G. Ergogenic Aids: Evaluating Sport Nutrition
Products. International Journal of Sport Nutrition, Vol. 6
Burke LM, Collier GR, Broad EM, et al. Effect of alcohol (1996), No. 3, pp. 191-197.
intake on muscle glycogen storage after prolonged
exercise. J Appl Physiol. 2003;95(3):983-990. Butterfield, Gail E., and Doris H. Calloway. Physical
Activity Improves Protein Utilization in Young Men.
Burke LM, Deakin V, eds. Clinical Sports Nutrition. British Journal of Nutrition, Vol. 51 (1984), pp. 171-184.
Sydney: McGraw-Hill. 1994. Burke LM, Hawley JA. Fluid
balance in team sports: guidelines for optimal intake. Cabral de Oliveira, A.C., A.C. Perez, G. Merino, J.G.
Sports Med. 1997;24:38-54. Prieto, and A.I. Alvarez (2001). Protective effects of
Panax ginseng on muscle injury and inflammation after
Burke LM, Hawley JA, Wong SH, Jeukendrup AE. eccentric exercise. Comp. Biochen. Physiol. C. Toxicol..
Carbohydrates for training and competition. J Sports Scis. Pharmacol. 130:367-377.
2011;29(suppl 1):S17-S27.

International Sports Sciences Association

582 | Appendix

Caciano SL, et al. Effects of Dietary Acid Load on Exercise Cao Y, Qu HJ, Li P, Wang CB, Wang LX, Han ZW. Single
Metabolism and Anaerobic Exercise Performance. J dose administration of L-carnitine improves antioxidant
Sports Sci Med. 2015 Jun; 14(2): 364–371. activities in healthy subjects. The Tohoku Journal of
Experimental Medicine 2011;224(3):209-213.
Cade JR, Reese RH, Privette RM et al (1992). Dietary
intervention and training in swimmers. European Journal Capel F, Viguerie N, Vega N, Dejean S, Arner P,
of Applied Physiology 63, 210-15. Klimcakova E, Martinez JA, Saris WH, Holst C, Taylor
M, Oppert JM, Sørensen TI, Clément K, Vidal H, Langin
Caffeine Monograph, Health Canada. D. Contribution of energy restriction and macronutrient
composition to changes in adipose tissue gene expression
Calcium Monograph, Health Canada.
during dietary weight-loss programs in obese women. J
Calcium-Potassium Salt of Hydroxycitric Acid Clin Endocrinol Metab. 2008;93(11):4315-22
Monograph, Health Canada.
Capó X, Martorell M, Sureda A, Tur JA, Pons A. Effects of
Calles-Escandon, Jorge, John J. Cunningham, Peter dietary Docosahexaenoic, training and acute exercise on
Snyder, Ralph Jacob, Gabor Huszar, Jacob Loke, and lipid mediators. J Int Soc Sports Nutr. 2016 Apr 5;13:16
Philip Felig. Influence of Exercise on Urea, Creatinine,
Carli G, Bonifazi M, Lodi L et al. (1992). Changes in
and 3-Methylhistidine Excretion in Normal Human
exercise-induced hormone response to branched chain
Subjects. The American Physiological Society (1984), pp.
amino acid administration. European Journal of Applied
E334-E338.
Physiology 64, 272-7.
Campbell B, Roberts M, Kerksick C, Wilborn C, Marcello
Carlson HE, Miglietta JT, Roginsky MS et al. (1989).
B, Taylor L, Nassar E, Leutholtz B, Bowden R, Rasmussen
Stimulation of pituitary hormone secretion by
C, Greenwood M, Kreider R. Pharmacokinetics, safety,
neurotransmitter amino acids in humans. Metabolism 28,
and effects on exercise performance of L-arginine alpha-
1179-82.
ketoglutarate in trained adult men. Nutrition. 2006
Sep;22(9):872-81. Carnitine Monograph, Health Canada.
Campbell, C. J., A. Bonen, R. L. Kirby, and A. N. Carr AJ, Hopkins WG, Gore CJ. Effects of acute alkalosis
Belcastro. Muscle Fiber Composition and Performance and acidosis on performance: A meta-analysis. Sports
Capacities of Women. Medicine and Science in Sports, Med. 2011;41(10):801-814.
Vol. 11 (1979), pp. 260-265.
Carriker CR et al. Effect of Acute Dietary Nitrate
Campbell, M. J., A. J. McComas, and F. Petitio. Consumption on Oxygen Consumption During
Physiological Changes in Aging Muscles. Journal of Submaximal Exercise in Hypobaric Hypoxia.
Neurology, Neurosurgery, and Psychiatry, Vol. 36 (1973), International Journal of Sport Nutrition and Exercise
pp. 174-182. Metabolism, 2015.
Can M, Besirbellioglu BA, Avci IY, Beker CM, Pahsa A. Caruso, T.J., and J.M. Gwaltney, Jr. (2005). Treatment of
Prophylactic Saccharomyces boulardii in the prevention the common cold with echinacea: a structured review.
of antibiotic-associated diarrhea: a prospective study. Clin. Infect. Dis. 40:807-810.
Medical Science Monitor: International Medical
Journal of Experimental and Clinical Research 2006; Casa DJ, Armstrong LE, Hillman SK, et al. National
12(4):PI19-122. Athletic Trainers’ Association position statement: fluid
replacement for athletes. J Athl Train. 2000;35:212–224.
Canani RB, Cirillo P, Terrin G, Cesarano L, Spagnuolo
MI, De Vincenzo A, Albano F, Passariello A, De Marco Casa DJ, et al. American College of Sports Medicine
G, Manguso F, Guarino A. Probiotics for treatment of roundtable on hydration and physical activity: consensus
acute diarrhoea in children: randomised clinical trial of statements. Curr Sports Med Rep. 2005 Jun;4(3):115-27.
five different preparations. British Medical Journal 2007;
335(7615):340. Casa DJ, et al. National Athletic Trainers’ Association
Position Statement: Exertional Heat Illnesses Journal of
Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson Athletic Training 2015;50(9):986–1000
JJ. Athletic performance and vitamin D. Med Sci Sports
Exerc. 2009;41(5):1102-1110.

Sports Nutrition
 References and Glossary of Key Words | 583

Casalta E, Montel MC. Safety assessment of dairy Chamomile Monograph, Health Canada.
microorganisms: the Lactococcus genus. International
Journal of Food Microbiology 2008; 126(3):271-273. Chandler RM, Byrne HK, Patterson JG et al (1994).
Dietary supplements affect the anabolic hormones after
Casanueva, F. F., L. Villanueva, J. A. Cabranes, J. Cabezas- weight-training exercise. Journal of Applied Physiology
Cerrato, and A. Fernandez-Cruz. Cholinergic Mediation 76, 839-45.
of Growth Hormone Secretion Elicited by Arginine,
Clonidine, and Physical Exercise in Man. Journal of Chandrasekaran S, Rochtchina E, Mitchell P. Effects of
Clinical Endocrinology and Metabolism, Vol. 59 (1984), caffeine on intraocular pressure: the Blue Mountains Eye
No. 3, pp. 526-530. Study. Journal of Glaucoma 2005;14(6):504-507.

Casey A, Constantin-Teodosiu D, Howell S et al (1996). Chang Kiu Moon , Kyl Soon Sim, Soo Hwan Lee, Kwang
Creatine ingestion favorably affects performance and Sik Park, Yeo Pyo Yun, Bae-Jin Ha and Chong-Chul
muscle metabolism during maximal exercise in humans. Lee. 1983. Antitumor activity of some phytobased
American Journal of Physiology 271, E31-7. polysaccharides and their effects on the immune function.
Pharmaceutical Society of Korea 6(2):123-131
Caso Marasco A, Vargas Ruiz R, Salas Villagomez
A, Begoña Infante C. 1996. Double-blind study of a Chang, Tse Wen, and Alfred L. Goldberg. The Metabolic
multivitamin complex supplemented with ginseng Fates of Amino Acids and the Formation of Glutamine in
extract. Drugs Under Experimental and Clinical Research Skeletal Muscle. Journal of Biological Chemistry, Vol. 253
22(6):323-329. (1978), No. 10, pp. 3685-3695.

Cayenne - Capsicum annuum Monograph, Health Chaste tree Monograph, Health Canada.
Canada.
Chen Y1, Wong SH, Xu X, Hao X, Wong CK, Lam CW.
Celejowa, I., and M. Homa. Food Intake, Nitrogen and Effect of CHO loading patterns on running performance.
Energy Balance in Polish Weight Lifters, During Training Int J Sports Med. 2008 Jul;29(7):598-606.
Camp. Nutrition and Metabolism, Vol. 12 (1970), pp.
Cheng, W., et al. Beta-Hydroxy Beta-Methylbutyrate
259-274.
Increases Fatty Acid Oxidation by Muscle Cells.
Cellulase Monograph, Health Canada. Federation of American Societies of Experimental Biology
Journal, Vol. 11 (1997): pg. A381.
Ceremuzynski L, Chamiec T, Herbaczynska-Cedro K.
1997. Effect of supplemental oral L-arginine on exercise Cherchi, A, et al., Effects of L-carnitine on exercise
capacity in patients with stable angina pectoris. The tolerance in chronic stable angina: a multicenter, double-
American Journal of Cardiology 80(3):331-333. blind, randomized, placebo controlled crossover study,
International Journal of Clinical Pharmacology, Therapy
Cermak NM1, van Loon LJ. The use of carbohydrates and Toxicology, Vol. 23, No. 10 (1985): 569-672.
during exercise as an ergogenic aid. Sports Med. 2013
Nov;43(11):1139-55. Chiang IY, Worobo RW, Churey JJ, Henick-Kling
T. Growth inhibition of foodborne pathogens by
Cerretellia, P and C Marconi, L-carnitine Oenococcus oeni. Journal of Food Science 2012;
supplementation in humans. The effects on physical 77(1):M15-M19.
performance, International Journal of Sports Medicine
Vol. 11, No. 1 (1990): 1-14. Chida M et al. In vitro testing of antioxidants and
biochemical end-point in bovine retinal tissue.
Cha Y-S, Choi S-K, Suh H, Lee S-N, Cho D, Lim K. Effects Ophthalmic Res 31: 407-415, 1999.
of carnitine coingested caffeine on carnitine metabolism
endurance capacity in athletes. Journal of Nutritional Chin, S., J. Storkron, K. Albright, M. Cook, and M.
Science and Vitaminology 2001;47:378-384. Pariza. Conjugated Linoleic Acid is a Growth Factor for
Rats as Shown by Enhanced Weight Gain and Improved
Chad Kerksick, et al. International Society of Sports Feed Efficiency. Journal of Nutrition, Vol. 124 (1994), pp.
Nutrition position stand: Nutrient timing. Journal of the 2344-2349.
International Society of Sports Nutrition 2008, 5:17 (3
October 2008) Chitosan Monograph, Health Canada.

International Sports Sciences Association

584 | Appendix

Chlorella - Cholrella vulgaris Monograph, Health Chymotrypsin Monograph, Health Canada.

Canada.
Cialdella-Kam L, Guebels CP, Maddalozzo GF, Manore
Choline Monograph, Health Canada. MM. Dietary intervention restored menses in female
athletes with exercise-associated menstrual dysfunction
Chondroitin Sulphate Monograph, Health Canada. with limited impact on bone and muscle health.
Nutrients. 2014 Jul 31;6(8):3018-39.
Christensen, H. Muscle Activity and Fatigue in the
Shoulder Muscles During Repetitive Work. European Cinnamon - Cinnamomum verum Monograph, Health
Journal of Applied Physiology, Vol. 54 (1986), pp. 596-601. Canada.
Christine M. Bonci, MS; Leslie J. Bonci, MPH, RD, LDN, Citrus Bioflavonoids Monograph, Health Canada.
CSSD; Lorita R. Granger, ATC; Craig L. Johnson, PhD;
Robert M. Malina, PhD, FACSM; Leslie W. Milne, MD; Clark JF. Creatine and phosphocreatine: a review of
Randa R. Ryan, PhD; Erin M. Vanderbunt, MS. National their use in exercise and sport. J Athl Train. 1997
Athletic Trainers’ Association Position Statement: Jan;32(1):45-51.
Preventing, Detecting, and Managing Disordered Eating
in Athletes. Journal of Athletic Training 2008;43(1):80–10. Clark, M., D.B. Reed, S.F. Crouse, and R.B. Armstrong
(2003). Pre- and post-season dietary intake, body
Christopher G, Sutherland D, Smith A. Effects of composition, and performance indices of NCAA division
caffeine in non-withdrawn volunteers. Human I female soccer players. Int. J. Sport Nutr. Exerc. Metab.
Psychopharmacology 2005;20(1):47-53. 13:303-319.

Chromium (from Chromium picolinate) Monograph, Clarkson P, Adams MR, Powe AJ, Donald AE, McCredie
Health Canada. R, Robinson J, McCarthy SN, Keech A, Celermajer
DS, Deanfield JE. 1996. Oral L-arginine endothelium-
Chromium (from non-picolinate sources) Monograph, dependent dilation in hypercholesterolemic young adults.
Health Canada. Journal of Clinical Investigation 97(8):1989-1994.
Chrubasik, S., E. Eisenberg, E. Balan, T. Weinberger, Clarkson, P., and E. Haymes. Trace Mineral Requirements
R. Luzzati, and C. Conradt (2000). Treatment of low for Athletes. International Journal of Sports Nutrition,
back pain exacerbations with willow bark extract: a Vol. 4 (1994), p. 104.
randomized double-blind study. Am. J. Med. 109:9-14.
Clarkson, Priscilla M., Walter Kroll, and Thomas C.
Chrusch MJ, Chilibeck PD, Chad KE, Davison KS, Burke McBride. Plantar Flexion Fatigue and Muscle Fiber Type
DG. Creatine supplementation combined with resistance in Power and Endurance Athletes. Medicine and Science
training in older men. Med Sci Sports Exerc. 2001 in Sports and Exercise, Vol. 12 (1980), pp. 262-267.
Dec;33(12):2111-7.
Claustrat B, Brun J, David M, Sassolas G, Chazot
Chung, Y., et al. Control of respiration and bioenergetics G. Melatonin and jet lag: confirmatory result
during muscle contraction. Am J Physiol Cell Physiol. using a simplified protocol. Biological Psychiatry
2005 Mar 288:C730-C738. 1992;32(8):705-11
Churchward-Venne TA, Burd NA, Mitchell Clements WT, et al. Nitrate ingestion: a review of the
CJ, et al. Supplementation of a suboptimal protein health and physical performance effects. Nutrients. 2014
dose with leucine or essential amino acids: Effects on Nov 18;6(11):5224-64.
myofibrillar protein synthesis at rest and following
resistance exercise in men. J Physiol. 2012;590(pt Cod Liver Oil Monograph, Health Canada.
11):2751-2765.
Coenzyme Q10 Monograph, Health Canada.
Chwalbinska-Moneta J. Effect of creatine supplementation
on aerobic performance and anaerobic capacity in elite Cognitive function products Monograph, Health Canada.
rowers in the course of endurance training. Int J Sport
Cole M, Coleman D, Hopker J, Wiles J. Improved gross
Nutr Exerc Metab. 2003 Jun;13(2):173-83.
efficiency during long duration submaximal cycling
following a short-term high carbohydrate diet. Int J Sports
Med. 2014;35(3):265-269.

Sports Nutrition
 References and Glossary of Key Words | 585

Coleman CI, Hebert JH, Reddy P. 2003. The effects of Cooke M, et al. Effects of acute and 14-day coenzyme Q10
Panax ginseng on quality of life. Journal of Clinical supplementation on exercise performance in both trained
Pharmacy and Therapeutics 28(1):5-15 and untrained individuals. Journal of the International
Society of Sports Nutrition20085:8.
Colker, C. M. Immune Status of Elite Athletes: Role of
Whey Protein Concentrate: A Review. Medicine and Coombes J, McNaughton L (1995). The effects of branched
Science in Sports and Exercise, Vol. 30 (1998), pg. S17. chain amino acid supplementation on indicators of muscle
damage after prolonged strenuous exercise. Medicine and
Collins JK, Thornton G, O’Sullivan GO. Selection of Science in Sports and Exercise 27, S149 (abstract).
probiotic strains for human applications. International
Dairy Journal 1998ɖ(5-6):487-490. Copinschi, Georges, Laurence C. Wegienka, Satoshi
Hane, and Peter H. Forsham. Effect of Arginine on Serum
Collins MD, Phillips BA and Zanoni P. Deoxyribonucleic Levels of Insulin and Growth Hormone in Obese Subjects.
acid homology studies of Lactobacillus casei, Lactobacillus Metabolism, Vol. 16 (1967), pp. 485-491.
paracasei sp. nov., subsp. paracasei and subsp. tolerans,
and Lactobacillus rhamnosus sp. nov., comb. nov. Copper Monograph, Health Canada.
International Journal of Systematic Bacteriology 1989;
39(2):105-108. Cornelis MC, El-Sohemy A. Coffee, caffeine, and
coronary heart disease. Current Opinion in Lipidology
Colombani PC, Bitzi R, Frey-Rindova P, Frey W, Arnold 2007;18(1):13-19.
M, Langhans W, Wenk C. Chronic arginine aspartate
supplementation in runners reduces total plasma amino Cossack, Zafrallah T., and Ananda Prasad. Effect of
acid level at rest and during a marathon run. Eur J Nutr. Protein Source on the Bioavailability of Zinc in Human
1999 Dec;38(6):263-70. Subjects. Nutrition Research, Vol. 3 (1983), pp. 23-31.

Conjugated Linoleic Acid Monograph, Health Canada. Costa, M, et al., L-carnitine in idiopathic
asthenozoospermia: a multicenter study, Adrologia Vol.
Conlay, L. A., R. J. Wurtman, J. K. Blusztajn, et al. 26 (1994): 155-159.
Decreased Plasma Choline Concentrations in Marathon
Runners (letter). New England Journal of Medicine, Vol. Costill DL, Miller JM. Nutrition for endurance sport:
175 (1986), pg. 892. carbohydrate and fluid balance. Int J Sports Med.
1980;1:2-14.
Connes, P., et al. Faster oxygen uptake kinetics at the
onset of submaximial cycling exercise following 4 weeks Costill, D. L., A. Barnett, R. Sharp, W. J. Fink, and A.
recombinant human erythropoietin treatment. Pflugers Katz. Leg Muscle pH Following Sprint Running. Medicine
Arch. 2003 Nov;447(2)231-8. and Science in Sports and Exercise, Vol. 15 (1983), pp.
325-329.
Conway PL, Gorbach SL, Goldin BR. Survival of lactic
acid bacteria in the human stomach and adhesion to Costill, D. L., and M. Hargreaves. Carbohydrate Nutrition
intestinal cells. Journal of Dairy Science 1987:70(1):1-12. and Fatigue. Sports Medicine, Vol. 13 (1992), p. 86.

Conzolazio, C. Frank, Herman L. Johnson, Richard A. Costill, D. L., R. Bowers, et al. Muscle Glycogen
Nelson, Joseph G. Dramise, and James H. Skala. Protein Utilization During Prolonged Exercise on Successive
Metabolism During Intensive Physical Training in the Days. Journal of Applied Physiology, Vol. 31 (1971), pp.
Young Adult. American Journal of Clinical Nutrition, Vol. 834-838.
28 (1975), pp. 29-35.
Costill, D. L., W. M. Sherman, et al. The Role of Dietary
Cook, James D., and Elaine R. Monsen. Vitamin C, the Carbohydrate in Muscle Glycogen Synthesis After
Common Cold, and Iron Absorption. American Journal Strenuous Running. American Journal of Clinical
of Clinical Nutrition (1977), pp. 235-241. Nutrition, Vol. 34 (1981), pp. 1831-1836.

Cook, M. Immune Modulation by Altered Nutrient Costill, D., R. Bowers, G. Branam, and K. Sparks (1971).
Metabolism: Nutritional Control of Immune-Induced Muscle glycogen utilization during prolonged exercise on
Growth Depression. Poultry Science, Vol. 72 (1993), pp. successive days. J. Appl. Physiol. 31:834-838.
1301-1305.

International Sports Sciences Association

586 | Appendix

Costill, D.L, W.M. Sherman, W.J. Fink, C. Maresh, Coyle EF. Substrate utilization during exercise in active
M. Witten, and J.M. Miller (1981). The role of dietary people. Am J Clin Nutr. 1995;61 (suppl):968S-79S.
carbohydrates in muscle glycogen resynthesis after
strenuous running. Am. J. Clin. Nutr. 34:1831-1836. Coyle EF. Timing and method of increased carbohydrate
intake to cope with heavy training, competition and
Costill, David L., Michael G. Flynn, John P. Kirwan, recovery. J Sports Sci. 1991;9(summer): 29-51. discussion
Joseph A. Houmard, Joel B. Mitchell, Robert Thomas, 51-22.
and Sung Han Park. Effects of Repeated Days of
Intensified Training on Muscle Glycogen and Swimming Coyle, Edward F., and Andrew R Coggan. Effectiveness of
Performance. Medicine and Science in Sports and Carbohydrate Feeding in Delaying Fatigue During Pro-
Exercise, Vol. 20 (1987), No. 3, pp. 249-254. longed Exercise. Sports Medicine (1984), pp. 446-458.

Cottrell GT, Coast JR, Herb RA. Effect of recovery Craig WJ, Mangels AR; ; American Dietetic Association.
interval on multiple-bout sprint cycling performance after Position of the American Dietetic Association: Vegetarian
acute creatine supplementation. J Strength Cond Res. diets. J Am Diet Assoc. 2009;109(7):1266-1282.
2002 Feb;16(1):109-16.
Craig, B. The Influence of Fructose on Physical
Cousin FJ, Mater DD, Foligné B, Jan G. Dairy Performance. American Journal of Clinical Nutrition,
propionibacteria as human probiotics: A review of recent Vol. 58 (1993), p. S819.
evidence. Dairy Science & Technology 2011; 91(1):1-26.
Cranberry juice, dried Monograph, Health Canada.
Coussement PA. Inulin and Oligofructose: safe
Cranberry Monograph, Health Canada.
intakes and legal status. The Journal of Nutrition
1999;129:1412S-1417S. Crane FL. Biochemical functions of coenzyme
Q10. Journal of the American College of Nutrition
Couto PG1, Bertuzzi R, de Souza CC, Lima HM, Kiss
2001;20(6):591-598.
MA, de-Oliveira FR, Lima-Silva AE. High Carbohydrate
Diet Induces Faster Final Sprint and Overall 10,000- Creatine monohydrate Monograph, Health Canada.
m Times of Young Runners. Pediatr Exerc Sci. 2015
Aug;27(3):355-63. Creighton SM, Stanton SL. Caffeine: does it affect your
bladder? British Journal of Urology 1990;66(6):613-614.
Cowell BS, Rosenbloom CA, Skinner R, Summers SH.
Policies on screening female athletes for iron deficiency Cremonini F, Di Caro S, Covino M, Armuzzi A, Gabrielli
in NCAA division I-A institutions. Int J Sport Nutr Exerc M, Santarelli L, Nista EC, Cammarota G, Gasbarrini G,
Metab. 2003;13(3):277-285. Gasbarrini A. Effect of different probiotic preparations
on anti-Helicobacter pylori therapy-related side effects:
Cox G, Mujika I, Tumilty D, Burke L. Acute creatine a parallel group, triple blind, placebo-controlled study.
supplementation and performance during a field test The American Journal of Gastroenterology 2002;
simulating match play in elite female soccer players. Int J 97(11):2744-2749.
Sport Nutr Exerc Metab. 2002 Mar;12(1):33-46.
Cruchet S, Obregon MC, Salazar G, Diaz E, Gotteland
Cox GR, Clark SA, Cox AJ, et al. Daily training with M. Effect of the ingestion of a dietary product containing
high carbohydrate availability increases exogenous Lactobacillus johnsonii La1 on helicobacter pylori
carbohydrate oxidation during endurance cycling. J Appl colonization in children. Nutrition 2003; 19(9):716-721.
Physiol. 2010;109(1):126-134.
Cukovic-Cavka S, Likic R, Francetic I, Rustemovic N,
Cox MH, Miles DS, Verde TJ, Rhodes EC. Applied Opacic M, Vucelic B. Lactobacillus acidophilus as a cause
physiology of ice hockey. Sports Med. 1995;19:184-201. of liver abscess in a NOD2/CARD15-positive patient with
Crohn’s disease. Digestion 2006; 73(2-3):107-110.
simulating match play in elite female soccer players. Int. J.
Sport Nutr. Exerc. Metab. 12:33-46. Cunningham JJ. A reanalysis of the factors influencing
basal metabolic rate in normal adults. Am J Clin Nutr.
Coyle EF, Coggan AR, Hemmert MK, Ivy JL. Muscle
1980;33(11):2372-2374.
glycogen utilization during prolonged exercise when fed
carbohydrate. J Appl Physiol 1986;61:165-172. Curcumin Monograph, Health Canada.

Sports Nutrition
 References and Glossary of Key Words | 587

Curk MC, Hubert JC and Bringel F. Lactobacillus Davis BA1, Thigpen LK, Hornsby JH, Green JM, Coates
paraplantarum sp. nov., a new species related to TE, O’Neal EK. Hydration kinetics and 10-km outdoor
Lactobacillus plantarum. International Journal of running performance following 75% versus 150% between
Systematic Bacteriology 1996; 46(2): 595-598. bout fluid replacement. Eur J Sport Sci. 2014;14(7):703-10.

Curry EJ, Logan C1, Ackerman K, McInnis KC, Davis JK, Baker LB, Barnes K, Ungaro C, Stofan J.
Matzkin EG. Female Athlete Triad Awareness Among Thermoregulation, Fluid Balance, and Sweat Losses
Multispecialty Physicians. Sports Med Open. 2015;1(1):38. in American Football Players. Sports Med. 2016
Epub 2015 Nov 12. Oct;46(10):1391-405.

Dahlitz M, Alvarez B, Vignau J, English J, Arendt J, Davis JM (1995). Carbohydrates, branched-chain amino
Parkes JD. Delayed sleep phase syndrome response to acids, and endurance, The central fatigue hypothesis.
melatonin. Lancet 1991;337(8750):1121-4 International Journal of Sport Nutrition 5, S29-38.

Dalmacio LM, Angeles AK, Larcia LL, Balolong MP, Davis JM, Baily SP, Woods JA et al (1992). Effects of
Estacio RC. Assessment of bacterial diversity in selected carbohydrate feedings on plasma free tryptophan and
Philippine fermented food products through PCR-DGGE. branched-chain amino acids during prolonged cycling
Beneficial Microbes 2011; 2(4):273-281. European Journal of Applied Physiology 65, 513-19.

D’Ambrosio E. Glucosamine sulphate: a controlled Davis JM, Welsh RS, Alerson NA. Effects of carbohydrate
clinical investigation in arthrosis. Pharmatherapeutica and chromium ingestion during intermittent high-
1981; 2(8):504-508. intensity exercise to fatigue. Int J Sport Nutr Exerc Metab
2000 Dec;10(4):476-85.
Danaher J1, Gerber T, Wellard RM, Stathis CG. The effect
of β-alanine and NaHCO3 co-ingestion on buffering Davis, Teresa A., Irene E. Karl, Elise D. Tegtmeyer, Dale
capacity and exercise performance with high-intensity F. Osborne, Saulo Klahr, and Herschel R. Harter. Muscle
exercise in healthy males. Eur J Appl Physiol. 2014 and Protein Turnover: Effects of Exercise Training and
Aug;114(8):1715-24. Renal Insufficiency. The American Physiological Society
(1985), pp. E337-E345.
Dandelion (Taraxacum Officinale) Monograph, Health
Canada. De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete
Triad Coalition consensus statement on treatment and
Das A Jr, Hammad TA. Efficacy of a combination return to play of the female athlete triad: 1st International
of FCHG49 glucosamine hydrochloride, TRH122 Conference held in San Francisco, California, May 2012
low molecular weight sodium chondroitin sulfate and 2nd International Conference held in Indianapolis,
and manganese ascorbate in the management of Indiana, May 2013. Br J Sports Med. 2014;48(4):289.
knee osteoarthritis. Osteoarthritis Cartilage. 2000
Sep;8(5):343-50. DeBock, K., B.O. Eijnde, M. Ramaekers, and P. Hespel
(2004). Acute Rhodiola rosea intake can improve
Dash AK, Sawhney A. 2002. A simple LC method with endurance exercise performance. Int. J. Sport Nutr. Exerc.
UV detection for the analysis of creatine and creatinine Metab. 14:298-307.
and its application to several creatine formulations.
Journal of Pharmaceutical and Biomedical Analysis Delafuente JC. Glucosamine in the treatment of
29(5):939-945. osteoarthritis. Rheum Dis Clin North Am 2000;26(1):
1-11.
Davidson, M.H., C.E. Weeks, H. Lardy, et al. Safety and
Endocrine Effects of 3-Acetyl-7-Oxo DHEA (7-Keto DeLany JP, West DB. Changes in body composition with
DHEA). Paper presented at the Experimental Biology conjugated linoleic acid. J. Am. Coll. Nutr. 19:487S-493S
National Meetings, 1998. (2000).

Davies, Kelvin J. A., Alexandre T. Quintanilha, George DellaValle DM. Iron supplementation for female athletes:
A. Brooks, and Lester Packer. Free Radicals and Tissue Effects on iron status and performance outcomes. Curr
Damage Produced by Exercise. Biochemical and Sports Med Rep. 2013;12(4):234-239.
Biophysical Research Communications, Vol. 107 (1982),
No. 4, pp. 1198-1205.

International Sports Sciences Association

588 | Appendix

Dempster P, Aitkens S: A new air displacement method Dollins AB, Lynch HJ, Wurtman RJ, Deng MH,
for the determination of human body composition. Med Lieberman HR. Effects of illumination on human
Sci Sports Exerc 1995, 27:1692-1697. nocturnal serum

Deodhar SD, Sethi R, Srimal RC. 1980. Preliminary Dong, LW., et al. Effects of flavones extracted from
studies on antirheumatic activity of curcumin (di-feruloyl Portulaca oleracea on ability of hypoxia tolerance in mice
methane). Indian Journal of Medical Research 71:632-634. and its mechanisms. Zhong Xi Yi Jie He Xue Bao. 2005;
3(6):450-4.
Derave W, Eijnde BO, Verbessem P, Ramaekers M, Van
Leemputte M, Richter EA, Hespel P. Combined creatine Donovan JL, DeVane CL, Chavin KD, Taylor RM,
and protein supplementation in conjunction with Markowitz JS. Siberian Ginseng (Eleutherococcus
resistance training promotes muscle GLUT-4 content senticosus) effects on CYP2D6 and CYP3A4 activity in
and glucose tolerance in humans. J Appl Physiol. 2003 normal volunteers. Drug Metabolism and Disposition: the
May;94(5):1910-6. biological fate of chemicals. 2003;31(5)519-522.

Desplat, V., et al. Effects of lipoxygenase metabolites of Dowling, E.A., D.R. Redondo, J.D. Branch, S. Jones, G.
arachidonic acid on the growth of human blood CD34 McNabb, M.H Williams (1996). Effect of Eleutherococcus
progenitors. Blood Cells, Molecules, and Diseases. senticosus on submaximal and maximal exercise
2000;Oct 26(5):427-436. performance. Med. Sci. Sports. Exerc. 28:482-489.

Despres, J. P., C. Bouchard, A. Tremblay, R. Savard, Draeger CL, Naves A, Marques N, et al. Controversies
and M. Marcotte. Effects of Aerobic Training on Fat of antioxidant vitamins supplementation in exercise:
Distribution in Male Subjects. Medicine and Science in Ergogenic or ergolytic effects in humans? J Int Soc Sports
Sports and Exercise, Vol. 17 (1985), No. 1, pp. 113-118. Nutr. 2014;11(1):4.

Despres, J. P., C. Bouchard, R. Savard, A. Tremblay, M. Driehuis F, Elferink SJ, and Spoelstra SF. Anaerobic lactic
Marcotte, and G. Theriault. Level of Physical Fitness acid degradation during ensilage of whole crop maize
and Adipocyte Lipolysis in Humans. The American inoculated with Lactobacillus buchneri inhibits yeast
Physiological Society (1984), pp.1157-1161. growth and improves aerobic stability. Journal of Applied
Microbiology 1991; 87(4):583-594.
Devaraj S et al. Supplementation with a pine bark extract
rich in polyphenols increases plasma antioxidant capacity DuPont AW, DuPont HL. The Intestinal microbiota
and alters the plasma lipoprotein profile. Lipids 37: 931- and chronic disorders of the gut. Nature Reviews
934, 2002. Gastroenterology & Hepatology 2011; 8(9):523-531.

Dicks LM, Dellaglio F, Collins MD. Proposal to reclassify Earnest C, Snell P, Rodriguez R et al (1995). The effect
Leuconostoc oenos as Oenococcus oeni [corrig.] gen. of creatine monohydrate ingestion on anaerobic power
nov., comb. nov. International Journal of Systematic indices muscular strength and body composition. Acta
Bacteriology 1995; 45(2):395-397. Physiologica Scandinavica 153, 207-9.

Dieli-Conwright CM1, Jensky NE, Battaglia GM, Earnest, C.P., G.M. Morss, F. Wyatt, A.N. Jordan, S.
McCauley SA, Schroeder ET. Validation of the Colson, T.S. Church, Y. Fitzgerald, L. Autrey, R. Jurca,
CardioCoachCO2 for submaximal and maximal and A. Lucia (2004). Effects of a commercial herbal-based
metabolic exercise testing. J Strength Cond Res. 2009 formula on exercise performance in cyclists. Med. Sci.
Jul;23(4):1316-20. Sports Exerc. 36:504-509.

Digestive Enzymes Monograph, Health Canada. Echinacea Angustifolia Monograph, Health Canada.

DiPrampero, P. Enrico. Energetics of Muscular Exercise. Echinacea pallida Monograph, Health Canada.
Biochemical Pharmacology, Vol. 89 (1981), pp. 143-209.
Echinacea purpurea Monograph, Health Canada.
Doherty M, Smith PM. Effects of caffeine ingestion on
rating of perceived exertion during and after exercise: Eckerson JM, Stout JR, Moore GA, Stone NJ, Nishimura
a meta-analysis. Scandinavian Journal of Medicine & K, Tamura K. Effect of two and five days of creatine
Science in Sports 2005;15(2):69-78. loading on anaerobic working capacity in women. J
Strength Cond Res. 2004 Feb;18(1):168-73.

Sports Nutrition
 References and Glossary of Key Words | 589

Economos CD, Bortz SS, Nelson ME. Nutritional Ehn, Lars, Bjorn Carlmark, and Sverker Hoglund. Iron
practices of elite athletes. Practical recommendations. Status in Athletes Involved in Intense Physical Activity.
Sports Med. 1993 Dec;16(6):381-99. Medicine and Science in Sports and Exercise, Vol. 12
(1980), No. 1, pp. 61-64.
European Food Safety Authority (EFSA). (2003). Opinion
of the Scientific Panel on Food Additives, Flavourings, Einzig, S., J. St. Cyr, R. Bianco, J. Schneider, E. Lorenz,
Processing Aids and Materials in Contact with Food and J. Foker. Myocardial ATP Repletion With Ribose
(AFC) on a request from the Commission related to Infusion. Pediatric Research, Vol. 19 (1985), No. 4, pg.
L-Carnitine-L-tartrate for use in foods for particular 127A.
nutritional uses (adopted on 3 November 2003 by written
procedure). European Food Safety Authority (EFSA). Elam JL, Carpenter JS, Shu XO, Boyapati S, Friedmann-
Gilchrist J. 2006. Methodological issues in the
European Food Safety Authority (EFSA). (2012). investigation of ginseng as an intervention for fatigue.
European Food Safety Authority. Scientific Opinion on Clinical nurse specialist CNS 20(4):183-189.
the removal of a maximum dose from the authorisation
of microbial products assessed using the Qualified Eleuthero Monograph, Health Canada.
Presumption of Safety approach. EFSA Journal 2012;
Elli M, Callegari ML, Ferrari S, Bessi E, Cattivelli D, Soldi
10(5):2680.
S, Morelli L, Goupil Feuillerat N, Antoine J. Survival
European Food Safety Authority (EFSA). (2012). of Yogurt Bacteria in the Human Gut. Applied and
SCIENTIFIC OPINION: Scientific Opinion on the safety Environmental Microbiology 2006; 72(7):5113-5117.
and efficacy of L-carnitine and L-carnitine L-tartrate as
Ellis JM, Reddy P. 2002. Effects of Panax ginseng
feed additives for all animal species based on a dossier
on quality of life. The Annals of Pharmacotherapy
submitted by Lonza Benelux BV. European Food Safety
36(3):375-379
Authority (EFSA).
Engelhandt, M., G. Neumann, A. Berbalk, et al. Creatine
European Food Safety Authority (EFSA). (2015).
Supplementation in Endurance Sports. Medicine and
Scientific Opinion on the safety of caffeine. EFSA Journal
Science in Sports and Exercise, Vol. 30 (1998), pp.
13(5):4120.
1123-1129.
European Food Safety Authority (EFSA). (2015). EFSA
Engels HJ, Kolokouri I, Cieslak TJ, Wirth JC. 2001. Effects
explains risk assessment: Caffeine.
of ginseng supplementation on supramaximal exercise
European Food Safety Authority (EFSA). (2011). Scientific performance and short-term recovery. Journal of Strength
Opinion on the substantiation of health claims related and Conditioning Research 15(3):290-295
to caffeine and increase in physical performance during
Engels, H.J., M.M. Fahlman, and J.C. Wirth (2003). Effects
short-term high-intensity exercise (ID 737, 1486, 1489),
of ginseng on secretory IgA, performance, and recovery
increase in endurance performance (ID 737, 1486),
from interval exercise. Med. Sci. Sports Exerc. 35:690-696.
increase in endurance capacity (ID 1488) and reduction in
the rated perceived exertion/effort during exercise. Engstrom G, Hedblad B, Stavenow L, Lind P, Janzon L and
Lingarde F. Inflammation- sensitive plasma proteins are
European Food Safety Authority (EFSA). (2011). Scientific
associated with future weight gain. Diabetes. Aug 2003;
Opinion on the substantiation of health claims related to
52(08): 2097-101.
caffeine and increased fat oxidation leading to a reduction
in body fat mass (ID 735, 1484), increased energy Erbay, E, et al. IGF-II transcription in skeletal myogenesis
expenditure leading to a reduction in body weight (ID is controlled by mTOR and nutrients JCB. 2003 163(5):
1487), increased alertness (ID 736, 1101, 1187, 1485, 1491, 931-936.
2063, 2103) and increased attention.
Eric Trexler, et al. International society of sports nutrition
Egger F1, Meyer T1, Such U1, Hecksteden A1. Effects position stand: Beta-Alanine. Journal of the International
of Sodium Bicarbonate on High-Intensity Endurance Society of Sports Nutrition 2015, 12:30
Performance in Cyclists: A Double-Blind, Randomized
Cross-Over Trial. PLoS One. 2014 Dec 10;9(12):e114729.

International Sports Sciences Association

590 | Appendix

Erica R Goldstein, et al. International society of sports Evening Primrose Oil Monograph, Health Canada.
nutrition position stand: caffeine and performance.
Journal of the International Society of Sports Nutrition Fahey, T.D., and M. Pearl. Hormonal Effects of
2010, 7:5 (27 January 2010) Phosphatidylserine During 2 Weeks of Intense Training.
Abstract presented at the national meeting of the
Erickson, Mark A., Robert J. Schwarzkopf, and Robert American College of Sports Medicine, June 1998.
D. McKenzie. Effects of Caffeine, Fructose, and Glucose
Ingestion on Muscle Glycogen Utilization During Fahey, Thomas D., Lahsen Akka, and Richard Rolph.
Exercise. Medicine and Science in Sports and Exercise, Body Composition and VO2 Max of Exceptional Weight-
Vol. 19 (1987), No. 6, pp. 579-583. Trained Athletes. Journal of Applied Physiology, Vol. 19
(1975), No. 4, pp. 559-561.
Erling, T. A. Pilot Study With the Aim of Studying
the Efficacy and Tolerability of CLA (Tonalin) on the Fahs CA, Heffernan KS, Fernhall B. Hemodynamic and
Body Composition in Humans. Medstat Research Ltd., vascular response to resistance exercise with L-arginine.
Liilestrom, Norway, July 1997. Med Sci Sports Exerc. 2009 Apr;41(4):773-9.

Eschbach P, Webster M, Boyd J, McArthur P, Evetovich Farajian P, Kavouras SA, Yannakoulia M, Sidossis
T. The effect of Siberian Ginseng (Eleutherococcus LS. Dietary intake and nutritional practices of elite
Senticosus) on substrate utilization and performance Greek aquatic athletes. Int J Sport Nutr Exerc Metab.
during prolonged cycling. International Journal of Sport 2004;14(5):574-585.
Nutrition and Exercise Metabolism 2000;10(4):444-451.
Farrow JAE, Facklam RR, Collins MD. Nucleic acid
ESCOP 2003: ESCOP Monographs: The Scientific homologies of some vancomycin-resistant leuconostocs
Foundation for Herbal Medicinal Products, 2nd edition. and description of Leuconostoc citreum sp. nov. and
Exeter (UK): European Scientific Cooperative on Leuconostoc pseudomesenteroides sp. nov. International
Phytotherapy and Thieme; 2003. Journal of Systematic Bacteriology 1989; 39(3):279-283.

Eslami S, et al. Effects of gamma oryzanol FDA 1988: Food and Drug Administration. 21 CFR Part
supplementation on anthropometric measurements & 340. Stimulant drug products for over-the-counter human
muscular strength in healthy males following chronic use; final monograph; final rule. Washington (DC): U.S.
resistance training. Indian J Med Res. 2014 Jun; 139(6): Food and Drug Administration, Department of Health
857–863. and Human Services; 1988.

Essen, B. E., J. Jansson, J. Henriksson, A. W. Taylor, and B. Febbraio MA, Flanagan TR, Snow R et al (1995). Effect
Saltin. Metabolic Characteristics of Fibre Types in Human of creatine supplementation on intramuscular TCr
Skeletal Muscle. Acta Physiolgica Scandinavica, Vol.19 metabolism and performance during intermittent
(1975), pp.153-165. supramaximal exercise in humans. Acta Physiologica
Scandinavica 155, 387-95.
Etheridge T, Philp A, Watt PW. A single protein meal
increases recovery of muscle function following an Felley CP, Corthésy-Theulaz I, Rivero JL, Sipponen P,
acute eccentric exercise bout. Appl Physiol Nutr Metab. Kaufmann M, Bauerfeind P, Wiesel PH, Brassart D,
2008;33(3):483-488. Pfeifer A, Blum AL, Michetti P. Favourable effect of an
acidified milk (LC-1) on Helicobacter pylori gastritis
Evans SM, Griffiths RR. Caffeine withdrawal: a in man. European Journal of Gastroenterology and
parametric analysis of caffeine dosing conditions. The Hepatology 2001; 13(1):25-29.
Journal of Pharmacology and Experimental Therapeutics
1999;289(1):285-294. Ferreira, M., R. Kreider, M. Wilson, and A.
Almada. Effects of Conjugated Linoleic Acid (CLA)
Evans WJ. Muscle damage: nutritional considerations. Int Supplementation During Resistance Training on Body
J Sport Nutr. 1991 Sep;1(3):214-24. Composition and Strength. Journal of Strength and
Conditioning Research, Vol. 11 (1997), pg. 280.
Evans WR, Fernstrom JD, Thompson J, Morris SM
Jr, Kuller LH. 2004. Biochemical responses of healthy Feverfew Monograph, Health Canada.
subjects during dietary supplementation with L-arginine.
Journal of Nutritional Biochemistry 15(9):534-539.

Sports Nutrition
 References and Glossary of Key Words | 591

Fields DA, Goran MI, McCrory MA: Body-composition Freedman, D.S. et al., 2009. Relation of body mass index
assessment via air-displacement plethysmography in and skinfold thicknesses to cardiovascular disease risk
adults and children: a review. Am J Clin Nutr 2002, factors in children: the Bogalusa Heart Study. Am. J. Clin.
75:453-467. Nutr., 90(1), pp.210–216.

Fish Oil Monograph, Health Canada. Freedman, D.S., Horlick, M. & Berenson, G.S., 2013. A
comparison of the Slaughter skinfold-thickness equations
Fisher, JW. Erythropoietin: Physiology and Pharmacology and BMI in predicting body fatness and cardiovascular
Update. Exp Biol Med. 2003 228:1-14. disease risk factor levels in children. Am. J. Clin. Nutr.,
98(6), pp.1417–24.
Fisher, JW., et al. A concept for the control of kidney
production of erythropoietin involving prostagladins and Friedman, J. E., et al. Regulation of Glycogen Resynthesis
cyclic nucleotides. Contrib Nephrol. 1978;13:37-59. Following Exercise. Sports Medicine, Vol. 11 (1991), pg.
232.
Fitzpatrick DF et al. Endothelium-dependent vascular
effects of Pycnogenol®. J Cardiovas Pharmacol 32: 509-515, Frisch S, Zittermann A, Berthold HK, Götting C, Kuhn J,
1998. Kleesiek K, Stehle P, Körtke H. A randomized controlled
trial on the efficacy of carbohydrate-reduced or fat-
Flaxseed Monograph, Health Canada.
reduced diets in patients attending a telemedically guided
Flaxseed oil Monograph, Health Canada. weight loss program. Cardiovasc Diabetol. 2009;18(8):36

Fleck, S. J. Cardiovascular adaptations to resistance Froio de Araujo Dias G1, da Eira Silva V1, de Salles
training. Med Sci Sports Exerc 1988 Oct;20(5 Painelli V1, Sale C2, Giannini Artioli G1, Gualano B1,
Suppl):S146-151. Saunders B1. (In)Consistencies in Responses to Sodium
Bicarbonate Supplementation: A Randomised, Repeated
Flegal, K.M. & Graubard, B.I., 2009. Estimates of excess Measures, Counterbalanced and Double-Blind Study.
deaths associated with body mass index and other PLoS One. 2015 Nov 17;10(11):e0143086.
anthropometric variables. Am. J. Clin. Nutr., 89(4),
pp.1213–1219. Fryar CD, Gu Q, Ogden CL. Anthropometric reference
data for children and adults: United States, 2007–2010.
Flegal, K.M. et al., 2010. High adiposity and high body National Center for Health Statistics. Vital Health Stat
mass index-for-age in US children and adolescents overall 11(252). 2012.
and by race-ethnic group. Am. J. Clin. Nutr., 91(4),
pp.1020–6. Fujisawa T, Adachi S, Toba T, Arihara K, Mitsuoka T.
Lactobacillus kefiranofaciens sp. nov. isolated from kefir
Folate Monograph, Health Canada. grains. International Journal of Systematic Bacteriology
1988; 38(1):12-14.
Foley, JE., The effects of arachidonic acid on
erythropoietin production in exhypoxic polycythemic Fujisawa T, Benno Y, Yaeshima T, Mitsuoka T. Taxonomic
mice and the isolated perfused canine kidney. J study of the Lactobacillus acidophilus group, with
Pharmacol Exp Ther. 1978 Nov;207(2):402-9. recognition of Lactobacillus gallinarum sp. nov. and
Lactobacillus johnsonii sp. nov. and synonymy of
Folscher LL, Grant CC, Fletcher L, Janse van Rensberg Lactobacillus acidophilus group A3 (Johnson 1980) with
DC. Ultra-Marathon Athletes at Risk for the Female the type strain of Lactobacillus amylovorus (Nakamura
Athlete Triad. Sports Med Open. 2015;1(1):29. 1981). International Journal of Systematic Bacteriology
1992; 42(3):487-491.
Forbes, Richard M., and John W. Erdman, Jr.
Bioavailability of Trace Mineral Elements. Annual Fuke C, Krikorian SA, Couris RR. Coenzyme Q10:
Reviews of Nutrition, Vol. 3 (1983), pp. 213-231. a review of essential functions and clinical trials. US
Pharmacist 2000;28-41.
Foster C, Costill DL, Fink WJ. Effects of preexercise
feedings on endurance performance. Med Sci Sports. Funk JL, Oyarzo JN, Frye JB, Chen G, Lantz RC, Jolad
1979;11(1): 1-5. SD, Sólyom AM, Timmermann BN. 2006. Turmeric
extracts containing curcuminoids prevent experimental
Free Plant Sterols Monograph, Health Canada.
rheumatoid arthritis. Journal of Natural Products
69(3):351-355.

International Sports Sciences Association

592 | Appendix

Gaffney B, Hügel H, Rich P. The effects of Eleutherococcus Gastmann UA, Lehmann MJ (1998). Overtraining and the
senticosus and Panax ginseng on steroidal hormone BCAA hypothesis. Medicine and Science in Sports and
indices of stress and lymphocyte subset numbers in Exercise 30, 1173-8.
endurance athletes. Life Sciences. 2001;70(4):431-442.
Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C,
Galactosidase, alpha Monograph, Health Canada. Nurminiemi M, Hassfeld C, Einerhand A, O’Shea M,
Gudmundsen O. 2007. Six months supplementation with
Galton, David J., and George A. Bray. Studies on conjugated linoleic acid induces regional-specific fat mass
Lipolysis in Human Adipose Cells. Journal of Clinical decreases in overweight and obese. British Journal of
Investigation, Vol. 46 (1967), No. 4, pp. 621-629. Nutrition 97(3):550-560.
Gao W, Weng J, Gao Y, Chen X. Comparison of the Gaullier JM, Halse J, Hoye K, Kristiansen K, Fagertun H,
vaginal microbiota diversity of women with and without Vik H, Gudmundsen O. 2004. Conjugated linoleic acid
human papillomavirus infection: a cross-sectional study. supplementation for 1 y reduces body fat mass in healthy
BMC Infectious Diseases 2013; 13(1):271. overweight humans. The American Journal of Clinical
Nutrition 79:1118-1125.
Gao, J. P., D. I. Costill, C. A. Horswill, and S. H. Park.
Sodium Bicarbonate Ingestion Improves Performance Gaullier JM, Halse J, Hoye K, Kristiansen K, Fagertun H,
in Interval Swimming. European Journal of Applied Vik H, Gudmundsen O Supplementation with conjugated
Physiology, Vol. 58 (1988), pp. 171-174. linoleic acid for 24 months is well tolerated by and reduces
body fat mass in healthy, overweight humans. J Nutr. 2005
Garlic Monograph, Health Canada.
Apr;135(4):778-84.
Garlick PJ, Grant I (1988). Amino acid infusion increases
Gay-Crosier F, Schreiber G, Huaser C. Anaphylaxis from
the sensitivity of muscle protein synthesis in vivo to
inulin in vegetables and processed food. The New England
insulin. Biochemistry Journal 254, 579-84.
Journal of Medicine 2000;342(18):1372.
Garrow, J.S. & Webster, J., 1985. Quetelet’s index (W/H2)
Genger, H, et al., Carnitinspiegel wahrend der
as a measure of fatness. Int. J. Obes., 9(2), pp.147–153.
schwangerschaft, Zeitschrift fur Geburtshilfe Und
Garth AK, Burke LM. What do athletes drink Perinatologie Vol. 192 (1998): 134-136.
during competitive sporting activities? Sports Med.
Giacoia GP, Taylor-Zapata P, Mattison D. Eunice Kennedy
2013;43(7):539-564.
Shriver National Institute of Child Health and Human
Garthe I, Raastad T, Refsnes PE, Koivisto A, Sundgot- Development Pediatric Formulation Initiative: selected
Borgen J. Effect of two different weight-loss rates on reports from working groups. Clinical Therapeutics 2008;
body composition and strength and power-related 30(11):2097-2101.
performance in elite athletes. Int J Sport Nutr Exerc
Giamberadino, MA, et al., Effects of prolonged
Metab. 2011;21(2):97-104.
L-carnitine administration on delayed muscle pain and
Garza, C., N. S. Scrimshaw, and V. R. Young. Human CK release after eccentric effort, International Journal of
Protein Requirements: The Effect of Variations in Energy Sports Medicine Vol. 17, No. 5 (1996): 320-324.
Intake Within the Maintenance Range. American Journal
Gibson GR, Beatty ER, Wang X, Cummings JH.
of Clinical Nutrition, Vol. 29 (1976), pp. 280-287.
Selective stimulation of bifidobacteria in the human
Gastelu, D and Hatfield, F. Specialist In Sports Nutrition: colon by oligofructose and inulin. Gastroenterology
The Complete Guide, Third Edition, International Sports 1995;108(4):975-82.
Sciences Association, Santa Barbara, CA 2013
Gill H, Prasad J. Probiotics, immunomodulation, and
Gastelu, D Creatine Science Review CE 2005. health benefits. Advances in Experimental Medicine and
Biology 2008; 606:423-454.
Gastelu, D The Complete Nutritional Supplements Buyer’s
Guide. 2000. Three Rivers Press: New York. Gill ND, Hall RD, Blazevich AJ. Creatine serum is not as
effective as creatine powder for improving cycle sprint
Gastelu, D. L. Developing State-of-the-Art Amino Acids. performance in competitive male team-sport athletes. J
Muscle Magazine International, May 1989, pp. 58-64. Strength Cond Res. 2004 May;18(2):272-5.

Sports Nutrition
 References and Glossary of Key Words | 593

Ginger Monograph, Health Canada. Gollnick, Philip D. Metabolism of Substrates: Energy

Substrate Metabolism During Exercise and as Modified by
Ginkgo Biloba Monograph, Health Canada. Training. Metabolic and Nutritional Aspects of Physical
Exercise: Federation Proceedings, Vol. 44 (1985), No. 2,
Ginseng, American Monograph, Health Canada.
pp. 353-368.
Ginseng, Panax Monograph, Health Canada.
Gontzea, I., P. Sutzescu, and S. Dumitrache. The
Gleeson, M., et al. Effect of Low- and High-Carbohydrate Influence of Muscular Activity on Nitrogen Balance
Diets on the Plasma Glutamine and Circulating and on the Need of Man for Proteins. Nutrition Reports
Leukocyte Responses to Exercise. International Journal of International, Vol.10 (1974), pp. 35-43.
Sports Nutrition, Vol. 8 (1998), pp. 49-59.
Gordon MM, Bopp MJ, Easter L, Miller GD, Lyles
Gliemann L, Nyberg M, Hellsten Y. Nitric oxide and MF, Houston DK, Nicklas BJ, Kritchevsky SB. Effects
reactive oxygen species in limb vascular function: what of dietary protein on the composition of weight loss
is the effect of physical activity? Free Radic Res. 2014 in post-menopausal women. J Nutr Health Aging.
Jan;48(1):71-83. 2008;12(8):505-9

Glucomannan - Capsule Monograph, Health Canada. Gorostaga, EM, et al., Decrease in respiratory quotient
during exercise following L-carnitine supplementation,
Glucomannan - Powder Monograph, Health Canada. International Journal of Sports Medicine Vol. 10, No. 3
(1989): 169-174.
Glucosamine hydrochloride Monograph, Health Canada.
Goss, F., et al. Effect of Potassium Phosphate
Glucosamine sulfate Monograph, Health Canada. Supplementation on Perceptual and Physiological
Responses to Maximal Graded Exercise. International
Glutamine, Monograph, Health Canada.
Journal of Sport Nutrition and Exercise Metabolism, 2001,
Goa, Karen L and Rex N Brogden, L-Carnitine, Drugs 34 11, 53-62.
(1987): 1-24.
Gotshalk LA, Volek JS, Staron RS, Denegar CR,
Goel A, Kunnumakkara AB, Aggarwal BB. 2008. Hagerman FC, Kraemer WJ. Creatine supplementation
Curcumin as Curecumin: From kitchen to clinic. improves muscular performance in older men. Med Sci
Biochemical Pharmacology 75:787-809. Sports Exerc. 2002 Mar;34(3):537-43.

Goforth HW Jr1, Laurent D, Prusaczyk WK, Schneider Gottlieb MS. Conservative management of spinal
KE, Petersen KF, Shulman GI. Effects of depletion exercise osteoarthritis with glucosamine sulfate and chiropractic
and light training on muscle glycogen supercompensation treatment. J Manipulative Ther 1997; 20(6):400-414.
in men.
Goulet ED. Dehydration and endurance performance
Goldspink, David F. The Influence of Activity on Muscle in competitive athletes. Nutr Rev. 2012;70(suppl
Size and Protein Turnover. Journal of Physiology, Vol. 264 2):S132-S136.
(1976), pp. 283-296.
Graef JL, Smith AE, Kendall KL, Fukuda DH, Moon JR,
Goldwasser, E., et al. Studies on erythropoiesis V. The Beck TW, Cramer JT, Stout JR. The effects of four weeks
effect of cobalt on the production of erythropoietin. Blood of creatine supplementation and high-intensity interval
1958; 13:55-60. training on cardiorespiratory fitness: a randomized
controlled trial. J Int Soc Sports Nutr. 2009 Nov 12;6:18.
Gollnick, P. D., R. B. Armstrong, B. Saltin, C. W. Saubert
IV, W. L. Sembrowich, and R. E. Shepherd. Effect of Graham T. Alcohol ingestion and man’s ability to adapt to
Training on Enzyme Activity and Fiber Composition of exercise in a cold environment. Can J Appl Sport Sci.
Human Skeletal Muscle. Journal of Applied Physiology,
Grandjean AC. Diets of elite athletes: has the
Vol. 34 (1973), No. 1, pp. 107-111.
discipline of sports nutrition made an impact? J Nutr.
1997;127:874S-877S.

International Sports Sciences Association

594 | Appendix

Grape Seed Extract Monograph, Health Canada. Greenleaf J.E, C.G. Jackson, G. Geelen, L.C. Keil, H.
Hinghofer-Szalkay, and J.H. Whittam (1988). Plasma
Gray SL, Lackey BR, Tate PL, Riley MB, Camper ND. volume expansion with oral fluids in hypohydrated men
2004. Mycotoxins in root extracts of American and at rest and during exercise. Aviat. Space Environ. Med.
Asian ginseng bind estrogen receptors alpha and beta. 69:837-844.
Experimental Biology and Medicine 229(6):560-568.
Greenwood, M, Kreider, RB, Greenwood, L, and Byars,
Green AL, Hultman E, Macdonald IA et al (1996). A. Cramping and injury incidence in collegiate football
Carbohydrate feeding augments skeletal muscle creatine players are reduced by creatine supplementation. Journal
accumulation during creatine supplementation in of Athletic Training 2003;38(3):216-219.
humans. American Journal of Physiology 271, E821-6.
Greenwood, M., Farris, J., Kreider, R., Greenwood, L. &
Green AL, Hultman E, Macdonald IA, Sewell DA, Byars, A. (2000). Creatine supplementation patterns and
Greenhaff PL. Carbohydrate ingestion augments perceived effects in select division I collegiate athletes.
skeletal muscle creatine accumulation during creatine Clin. J. Sport Med. 10, 191-194.
supplementation in humans. Am J Physiol. 1996
Nov;271(5 Pt 1):E821-6. Greenwood, M., Kreider, R. B., Melton, C., Rasmussen, C.,
Lancaster, S., Cantler, E., Milnor, P. & Almada, A. (2003).
Green AL, Simpson EJ, Littlewood JJ, Macdonald IA, Creatine supplementation during college football training
Greenhaff PL. Carbohydrate ingestion augments creatine does not increase the incidence of cramping or injury.
retention during creatine feeding in humans. Acta Physiol Mol. Cell. Biochem. 244, 83-88.
Scand. 1996 Oct;158(2):195-202.
Grindstaff PD, Kreider R, Bishop R et al (1997). Effects of
Green Coffee Bean Extract Monograph, Health Canada. creatine supplementation on repetitive sprint performance
and body composition in competitive swimmers.
Green Tea Extracts Monograph, Health Canada.
International Journal of Sports Nutrition 7, 330-46.
Green, A. L., Simpson, E. J., Littlewood, J. J., Macdonald,
Groeneveld GJ, Beijer C, Veldink JH, Kalmijn S, Wokke
I. A. & Greenhaff, P. L. (1996). Carbohydrate ingestion
JH, van den Berg LH. Few adverse effects of long-term
augments creatine retention during creatine feeding in
creatine supplementation in a placebo-controlled trial. Int
humans. Acta Physiol. Scand. 158, 195-202.
J Sports Med. 2005 May;26(4):307-13.
Greenhaff PL, Bodin K, Soderlund K, Hultman E.
Gross D, Shenkman Z, Bleiberg B, Dayan M, Gittelson M,
Effect of oral creatine supplementation on skeletal
Efrat R. 2002. Ginseng improves pulmonary functions
muscle phosphocreatine resynthesis. Am J Physiol. 1994
and exercise capacity in patients with COPD. Monaldi
May;266(5 Pt 1):E725-30.
Archives for Chest Disease 57(5-6):242-246
Greenhaff PL, Casey A, Short A et al. (1993). Influence of
Gross, M., R. Kormann, and N. Zollner. Ribose
oral creatine supplementation on muscle torque during
Administration During Exercise: Effects on Substrates
repeated bouts of maximal voluntary exercise in man.
and Products of Energy Metabolism in Healthy Subjects
Clinical Science 84, 565-71.
and a Patient With Myoadenylate Deaminase Deficiency.
Greenhaff PL, Constantin-Teodosiu D, Casey A et al Klinische Wochenschrift, Vol. 69 (1991), pp. 151-155.
(1994). The effect of oral creatine supplementation on
Guebels CP, Kam LC, Maddalozzo GF, Manore MM.
skeletal muscle ATP degradation during repeated bouts of
Active women before/after an intervention designed
maximal voluntary exercise in man. Journal of Physiology
to restore menstrual function: Resting metabolic rate
476, 84P.
and comparison of four methods to quantify energy
Greenhaff, P., et al. Effect of Oral Creatine expenditure and energy availability. Int J Sport Nutr Exerc
Supplementation on Skeletal Muscle Phosphocreatine Metab. 2014;24(1):37-46.
Resynthesis. American Journal of Physiology, Vol. 266
Gyllenhaal C, Merritt SL, Peterson SD, Block KI,
(1994), pp. E725-E730.
Gochenour T. 2000. Efficacy and safety of herbal
Greenhaff, Paul L. The nutritional biochemistry of stimulants and sedatives in sleep disorders. Sleep
creatine. The Journal of Nutritional Biochemistry, Volume Medicine Reviews 4(2):229-251
8, Issue 11 , Pages 610-618, November 1997

Sports Nutrition
 References and Glossary of Key Words | 595

Haff, G. G. Roundtable Discussion: Low Carbohydrate Harris RC, Nevill M, Harris DB, Fallowfield JL, Bogdanis
Diets and Anaerobic Athletes. Strength and Conditioning GC, Wise JA. Absorption of creatine supplied as a drink,
Journal, June 2001, Volume 23, Number 3, pages 42-61. in meat or in solid form.

Haller CA, Benowitz NL, Jacob P. Hemodynamic effects Harris RC, Soderlund K, Hultman E. Elevation of creatine
of ephedra-free weight-loss supplements in humans. The in resting and exercised muscle of normal subjects
American Journal of Medicine 2005;118(9):998-1003. by creatine supplementation. Clin Sci (Lond). 1992
Sep;83(3):367-74.
Halliday TM, Peterson NJ, Thomas JJ, Kleppinger K,
Hollis BW, LarsonMeyer DE. Vitamin D status relative to Hartman JW, Tang JE, Wilkinson SB, et al. Consumption
diet, lifestyle, injury, and illness in college athletes. Med of fat-free fluid milk after resistance exercise promotes
Sci Sports Exerc. 2011;43(2):335-343. greater lean mass accretion than does consumption of soy
or carbohydrate in young, novice, male weightlifters. Am
Hamilton KL, Meyers MC, Skelly WA, Marley RJ. Oral J Clin Nutr. 2007;86(2):373-381.
creatine supplementation and upper extremity anaerobic
response in females. Int J Sport Nutr Exerc Metab 2000 Härtter S, Nordmark A, Rose DM, Bertilsson L,
Sep;10(3):277-89. Tybring G, Laine K. Effects of caffeine intake on the
pharmacokinetics of melatonin, a probe drug for CYP1A2
Han KH, Choe SC, Kim HS, Sohn DW, Nam KY, Oh BH, activity. British Journal of Clinical Pharmacology
Lee MM, Park YB, Choi YsS, Seo JD, Lee YW. Effect of 2003;56(6):679-682.
red ginseng on blood pressure in patients with essential
hypertension and white coat hypertension. The American Hartz A, Bentler S, Noyes R, Hoehns J, Logemann C,
Journal of Chinese Medicine 1998;26(2):199-209. Sinift Y, Butani W, Wang W, Brake K, Ernst M, Kautzman
H. Randomized controlled trial of Siberian Ginseng for
Han, T. S., et al. Quality of life in relation to overweight chronic fatigue. Psychological Medicine. 2004;34(1):51-61.
and body fat distribution. American Journal of Public
Health 88.12 (1998): 1814-1820. Hatcher H, Planalp R, Cho J, Torti FM, Torti SV. 2008.
curcumin: From ancient medicine to current clinical
Hand TM, Howe S, Cialdella-Kam L, Hoffman CP, trials. Cellular and Molecular Life Sciences 65:1631-1652.
Manore M. A Pilot Study: Dietary Energy Density
is Similar between Active Women with and without Hatfield, D. L., et al. (2006). The effects of carbohydrate
Exercise-Associated Menstrual Dysfunction. Nutrients. loading on repetitive jump squat power performance.
2016 Apr 19;8(4). Journal of Strength and Conditioning Research, 20(1),
167-171.
Hargreaves, M., David L. Costill, A. Katz, and W. J. Fink.
Effect of Fructose Ingestion on Muscle Glycogen Usage Hatfield, F. Fitness the Complete Guide. ISSSA, Edition
During Exercise. Medicine and Science in Sports and 8.6.6, 2009.
Exercise, Vol. 17 (1985), pp. 360-363.
Havemann L, West SJ, Goedecke JH, et al. Fat adaptation
Harkey MR, Henderson GL, Gershwin ME, Stern JS, followed by carbohydrate loading compromises
Hackman RM. Variability in commercial ginseng high-intensity sprint performance. J Appl Physiol.
products: an analysis of 25 preparations. American 2006;100(1):194-202.
Journal of Clinical Nutrition 2001;73:1101-1106.
Hawkins, R. D., M. A. Hulse, C. Wilkinson, A. Hodson,
Harmsen, Eef, Peter P. DeTombe, Jan Willem DeJong, and and M. Gibson (2001). The association football medical
Peter W. Achterberg. Enhanced ATP and GTP Synthesis research programme: an audit of injuries in professional
From Hypoxanthine or Inosine After Myocardial football. Brit. J. Sports Med. 35:43-47.
Ischemia. The American Physiological Society (1984), pp.
H37-H43. Hawley JA, Burke LM, Phillips SM, Spriet LL. Nutritional
modulation of training-induced skeletal muscle
Harper P, Elwin CE, Cederblad G. Pharmacokinetics of adaptations. J Appl Physiol. 2011;110(3):834-845.
intravenous and oral bolus doses of L-carnitine in healthy
subjects. European Journal of Clinical Pharmacology Hawley JA, Dennis SC, Lindsay FH, Noakes TD.
1988;35:555-562. Nutritional practices of athletes: are they suboptimal? J
Sport Sci. 1995;13:S75-S87.

International Sports Sciences Association

596 | Appendix

Hawley JA, Shabort EJ, Noakes TD, Dennis SC. Hickson, James F., Jr., and Klaus Hinkelmann. Exercise
Carbohydrate-loading and exercise performance. Sports and Protein Intake Effects on Urinary 3-Methylhistidine
Med. 1997;24:73-81. Excretion. American Journal of Clinical Nutrition, Vol. 41
(1985), pp. 32-45.
Hawrelak JA, Whitten DL, Myers SP. Is Lactobacillus
rhamnosus GG effective in preventing the onset of Higdon JV, Frei B. Coffee and health: a review of recent
antibiotic-associated diarrhoea: a systematic review. human research. Critical Reviews in Food Science and
Digestion 2005; 72(1):51-56. Nutrition 2006;46(2):101-123.

Hefler SK, Wildman L, Gaesser GA et al (1993). Branched- Hinrichs R, Hunzelmann N, Ritzkowsky A, Zollner
chain amino acid (BCAA) supplementation improves TM, Krieg T, Scharffetter-Kochanek K. Caffeine
endurance performance in competitive cyclists. Medicine hypersensitivity. Allergy 2002;57(9):859-60.
and Science in Sports and Exercise 25, S24 (abstract).
Hitchins S, Martin DT, Burke L, Yates K, Fallon K, Hahn
Helie, R., J.-M. Lavoie, and D. Cousineau. Effects of a A, Dobson GP. Glycerol hyperhydration improves cycle
24-Hour Carbohydrate-Poor Diet on Metabolic and time trial performance in hot humid conditions. Eur J
Hormonal Responses During Glucose-Infused Leg Appl Physiol Occup Physiol. 1999 Oct;80(5):494-501.
Exercise. European Journal of Applied Physiology, Vol. 54
(1985), pp. 420-426. Hjortmo S, Patring J, Jastrebova J, Andlid T. Inherent
biodiversity of folate content and composition in
Helms ER, et al. Evidence-based recommendations for yeasts. Trends in Food Science & Technology. 2005;
natural bodybuilding contest preparation: nutrition and 16(6-7):311-316.
supplementation. J Int Soc Sports Nutr. 2014 May 12;11:20.
Hjortmo SB, Hellström AM, Andlid TA.. Production of
Hermansen, Lars, Eric Hultman, and Bengt Saltin. folates by yeasts in Tanzanian fermented togwa. FEMS
Muscle Glycogen During Prolonged Severe Exercise. Acta Yeast Research 2008; 8(5):781-787.
Physiolgica Scandinavica, Vol. 71 (1967), pp. 129-139.
Ho JY, Kraemer WJ, Volek JS, Fragala MS, Thomas GA,
Hershey AD, Powers SW, Vockell AL, Lecates SL, Dunn-Lewis C, Coday M, Hakkinen K, Maresh CM.
Ellinor PL, Segers A, Burdine D, Manning P, Kabbouche L-carnitine L-tartrate supplementation favorably affects
MA. Coenzyme Q10 deficiency and response to biochemical markers of recovery from physical exertion in
supplementation in pediatric and adolescent migraine. middle-aged men and women. Metabolism Clinical and
Headache 2007;47(1):73-80. Experimental Journal 2010;59:1190-1199.

Hespel, P., et al. Opposite actions of caffeine and creatine Hobson RM, Maughan RJ. Hydration status and the
on muscle relaxation time in humans. J Appl Physiol 2002 diuretic action of a small dose of alcohol. Alcohol
92:513-518. Alcoholism. 2010;45(4):366-373.

Hew-Butler T, Rosner MH, FowkesGodek S, et al. Hobson, RM, et al. Effects of b-alanine supplementation
Statement of the Third International Exercise-Associated on exercise performance: a meta-analysis. Amino Acids
Hyponatremia Consensus Development Conference, (2012) 43:25–37.
Carlsbad, California, 2015. Clin J Sports Med.
2015;25(4):303-320. Hoffman JR, Ratamess NA, Tranchina CP, Rashti SL,
Kang J, Faigenbaum AD. Effect of a proprietary protein
Heymsfield, Steven B., Carlos Arteaga, Clifford McManus, supplement on recovery indices following resistance
Janet Smith, and Steven Moffitt. Measurement of Muscle exercise in strength/power athletes. Amino Acids.
Mass in Humans: Validity of the 24-Hour Urinary 2010;38(3): 771-778.
Creatinine Method. American Journal of Clinical
Nutrition, Vol. 37 (1983), pp. 478-494. Hofman, Z., et al. Glucose and Insulin Responses After
Commonly Used Sport Feedings Before and After a
Heyward, VH, et al. Anthropometric, Body Composition 1-Hour Training Session. International Journal of Sport
and Nutritional Profiles of Bodybuilders During Training. Nutrition, Vol. 5 (1995), pp. 194-205.
The J of Strength and Conditioning Research, Vol. 3, No.
2, pp.22-29. Holloszy, John O. Adaptation of Skeletal Muscle to
Endurance Exercise. Medicine and Science in Sports, Vol.
7 (1975), No. 3, pp. 155-164.

Sports Nutrition
 References and Glossary of Key Words | 597

Holt WS Jr. Nutrition and athletes. Am Fam Physician. Hultman, E., Saderlund, K., Timmons, J. A., Cederblad, G.
1993 Jun;47(8):1757-64. & Greenhaff, P. L. (1996). Muscle creatine loading in men.
J. Appl. Physiol. 81, 232-237.
Holt, Henry T. Carica Paypaya as Ancillary Therapy for
Athletic Injuries. Current Therapeutic Research, Vol. 11 Huynh NT, Tayek JA. 2002. Oral arginine reduces
(October 1969), pp. 621-624. systemic blood pressure in type 2 diabetes: Its potential
role in nitric oxide generation. American College of
Hong Y, Yang HS, Li J, Han SK, Chang HC, Kim HY. Nutrition 21(5):422-427.
Identification of lactic acid bacteria in salted Chinese
cabbage by SDS-PAGE and PCR-DGGE. Journal of the Hyde, Parker, Utilization Of B-Mode Ultrasound As A
Science of Food and Agriculture 2013; 94(2):296-300. Body Fat Estimate In Collegiate Football Players (2015).
Electronic Theses & Dissertations. Paper 1282.
Hoon MW, et al. The effect of nitrate supplementation on
exercise performance in healthy individuals: a systematic Hydrolyzed collagenMonograph, Health Canada.
review and meta-analysis. Int J Sport Nutr Exerc Metab.
2013 Oct;23(5):522-32. Hyssop Monograph, Health Canada.

Hops Monograph, Health Canada. Imagawa, S., et al. Does k-11706 enhance performance and
why? Int J Sports Med. 2007 Nov;28(11):928-33.
Horn, M. E. Improved Sprint Cycle Performance
Following Consumption of a Chromium-Carbohydrate Indole-3-carbinol Monograph, Health Canada.
Beverage During Prolonged Exercise. Medicine and
Infante S, Baeza ML, Calvo M, De Barrio M, Rubio
Science in Sports and Exercise, Vol. 30 (1998), pg. S288.
M, Herrero T. Anaphylaxis due to caffeine. Allergy
Horphag Research. Pycnogenol for sports nutrition. 2003;58(7):681-682.
Monograph.
Institute of Medicine (IOM), Food and Nutrition Board.
Horse Chestnut Monograph, Health Canada. Dietary Reference intakes for Energy, Carbohydrate,
Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino
Horton, Edward S. Metabolic Aspects of Exercise and Acids. Washington, DC: The National Academies Press;
Weight Reduction. Medicine and Science in Sports and 2005.
Exercise, Vol. 18 (1986), p. 10.
Inulin Monograph, Health Canada.
Housh, D. J., et al. Effects of leucine and whey protein
supplementation during 8 weeks of dynamic constant IOC Medical Commission Working Group Women
external resistance training on strength and thigh in Sport; Chair: Patricia Sangenis, MD. International
muscle cross-sectional area: a preliminary analysis. Olympic Committee (IOC) Medical Commission Position
National Strength and Conditioning Association annual Stand on the Female Athlete Triad.
conference, July 2004.
IOC MEDICAL COMMISSION, Nutrition In Sport. 2000.
Howey RT, Lock CM, Moore LVH. Subspecies names
Iodine Monograph, Health Canada.
automatically created by Rule 46. International Journal of
Systematic Bacteriology 1990; 40(3):317-319. Institute of Medicine (IOM). 1993. Nutritional Needs in
Hot Environments: Applications for Military Personnel
Hu C, Kitts D. 2001 Free Radical Scavenging Capacity
in Field Operations. Washington, DC: National Academy
as Related to Antioxidant Activity and Ginsenoside
Press.
Composition of Asian and North American Ginseng
Extracts. Journal of the American Oil Chemists’ Society Institute of Medicine (IOM). Committee on Military
78(3):249 Nutrition Research, Food and Nutrition Board, Institute
of Medicine. Caffeine for the Sustainment of Mental Task
Huertas R, Campos Y, Diaz E, Esteban J, Vechietto L,
Performance: Formulations for Military Operations.
Montanari G, D’Iddio S, Corsi M, Arenas J. Respiratory
Washington (DC): National Academy Press; 2001.
chain enzymes in muscle of endurance athletes: Effect
of L-carnitine. Biochemical and biophysical research
communications 1992;188(1):102-107.

International Sports Sciences Association

598 | Appendix

Institute of Medicine (IOM). Institute of Medicine. Panel Isidori A, Lo Monaco A, Cappa M (1981). A study of
on Micronutrients, Subcommittees on Upper Reference growth hormone release in man after oral administration
Levels of Nutrients and Interpretation and Uses of Dietary of amino acids. Current Medical Research Opinion 74,
Reference Intakes, and the Standing Committee on the 75-81.
Scientific Evaluation of Dietary Reference Intakes, Food
and Nutrition Board, Institute of Medicine. 2001. Dietary Ivy JL, Res PT, Sprague RC, Widzer MO. Effect of
Reference Intakes for Vitamin A, Vitamin K, Arsenic, a carbohydrate-protein supplement on endurance
Boron, Chromium, Copper, Iodine, Iron, Manganese, performance during exercise of varying intensity. Int J
Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Sports Nutr Exerc Metab. 2003;13(3): 382-395.
Washington (DC): National Academy Press.
Ivy, J. L., R. T. Withers, P. J. Van Handel, D.L.L. Elger,
Institute of Medicine (IOM). Institute of Medicine. and D. L. Costill. Muscle Respiratory Capacity and Fiber
Committee on Food Chemicals Codex, Food and Type as Determinants of the Lactate Threshold. American
Nutrition Board, Institute of Medicine. 2003. Food Physiological Society (1980), pp. 523-527.
Chemicals Codex, 5th edition. Washington (DC):
Ivy, J.L., A.L. Katz, C.L. Cutler, W.M. Sherman, and E.F.
National Academies Press.
Coyle (1988). Muscle glycogen resynthesis after exercise:
Institute of Medicine (IOM) Institute of Medicine effect of time of carbohydrate ingestion. J. Appl. Physiol.
Committee on the Framework for Evaluating the Safety 64:1480-1485.
of Dietary Supplements. Prototype monograph on
Iwasaki K, Mano K, Ishihara M et al (1987). Effects of
melatonin. Dietary Supplement Ingredient Prototype
ornithine or arginine administration on serum amino
Monographs, Developed as Examples for the Report
acid levels. Biochemistry International 14, 971-6.
Dietary Supplements: A Framework for Evaluating Safety.
Institute of Medicine and the National Research Council Izquierdo M, Ibanez J, Gonzalez-Badillo JJ, Gorostiaga
of the National Academies, Washington (DC): National EM. Effects of creatine supplementation on muscle power,
Academies Press 2004. endurance, and sprint performance. Med Sci Sports Exerc.
2002 Feb;34(2):332-43.
Institute of Medicine (IOM). Institute of Medicine of the
National Academies. Intakes for Energy, Carbohydrate, Jacob M Wilson, et al. International Society of
Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Sports Nutrition Position Stand: beta-hydroxy-beta-
Acids. Food and Nutrition Board. methylbutyrate (HMB). Journal of the International
Society of Sports Nutrition 2013, 10:6 (2 February 2013)
Institute of Medicine (IOM). Panel on Dietary Reference
Intakes for Electrolytes and Water, and the Standing Jacobs I., N. Westlin, J. Karlsson, M. Rasmusson, and B.
Committee on the Scientific Evaluation of Dietary Houghton (1982). Muscle glycogen and diet in elite soccer
Reference Intakes, Food and Nutrition Board, Institute players. Eur. J. Appl. Physiol. Occup. Physiol. 48:297-302.
of Medicine. 2005. Dietary Reference Intakes for Water,
Potassium, Sodium, Chloride, and Sulfate. Washington Jäger R, Harris RC, Purpura M, Francaux M. Comparison
(DC): National Academies Press. of new forms of creatine in raising plasma creatine levels.
J Int Soc Sports Nutr. 2007 Nov 12;4:17.
Institute of Medicine (IOM). Otten JJ, Pitzi Hellwig J,
Meyers LD, editors. 2006. Institute of Medicine Dietary Jäger R, Purpura M, Shao A, Inoue T, Kreider RB.
Reference Intakes: The Essential Guide to Nutrient Analysis of the efficacy, safety, and regulatory status
Requirements. Washington (DC): National Academies of novel forms of creatine. Amino Acids. 2011
Press. May;40(5):1369-83.

Institute of Medicine (IOM). 1994. Fluid Replacement and Jahreis G, Kraft J, Tischendorf F, Schone F, von
Heat Stress. Washington, DC: National Academy Press. Loeffelholz C. Conjugated linoleic acids: Physiological
effects in animal and man with special regard to body
Institute of Medicine (IOM). 2005. Water, Potassium, composition. European J. Lipid Sci. Technol. 102:695-703
Sodium, Chloride, and Sulfate. Washington, DC: The (2000).
National Academies Press.

Iron Monograph, Health Canada.

Sports Nutrition
 References and Glossary of Key Words | 599

Jakeman, P., and S. Maxwell. Effect of Antioxidant Jeukendrup AE. Carbohydrate and exercise performance:
Vitamin Supplementation on Muscle Function After The role of multiple transportable carbohydrates. Curr
Eccentric Exercise. European Journal of Applied Opin Clin Nutr Metab Care. 2010;13(4): 452-457.
Physiology, Vol. 67 (1993), p. 426.
Jeukendrup AE. Carbohydrate intake during exercise and
James AP1, Lorraine M, Cullen D, Goodman C, performance. Nutrition 2004; 20:669-677.
Dawson B, Palmer TN, Fournier PA. Muscle glycogen
supercompensation: absence of a gender-related Jeukendrup AE. Nutrition for endurance sports:
difference. Eur J Appl Physiol. 2001 Oct;85(6):533-8. Marathon, triathlon, and road cycling. J Sports Sci.
2011;29(suppl 1): S91-S99.
James MJ, Zomerdijk JC. Physphtidylinositol 3-kinase
and mTOR signaling pathways regulate RNA polymerase Jin HZ, Fan XB, Hang XM, Li KB, Yang H. Analysis of the
1 transcription in response to IGF-1 and nutrients. J Biol probiotic Bifidobacterium and Lactobacillus community
Chem. 2004 Mar 5;279(10):8911-8. in child intestinal flora. [Article in Chinese; Abstract in
English]. Wei Sheng Wu Xue Bao. 2005; 45(4):567-70.
James SP, Mendelson WB, Sack DA, Rosenthal NE,
Wehr TA. The effect of melatonin on normal sleep. Joan Gandy. Water intake: validity of population
Neuropsychopharmacology 1987;1(1):41-4 assessment and recommendations. Eur J Nutr. 2015;
54(Suppl 2): 11–16.
Javed A1, Tebben PJ, Fischer PR, Lteif AN. Female athlete
triad and its components: toward improved screening and Johnson JL, Phelps CF, Cummins CS, London J and
management. Mayo Clin Proc. 2013 Sep;88(9):996-1009. Gasser F. Taxonomy of the Lactobacillus acidophilus
group. International Journal of Systematic Bacteriology
Jean-Louis G, von Gizycki H, Zizi F. Predictors 1980; 30(1):53-68.
of subjective sleepiness induced by melatonin
administration. Journal of Psychosomatic Research Johnston CS, Tjonn SL, Swan PD, White A, Hutchins
1999;47(4):355-8 H, Sears B. Ketogenic low-carbohydrate diets have no
metabolic advantage over nonketogenic low-carbohydrate
Jee SH, He J, Whelton PK, Suh II, Klag MJ. The effect diets. Am J Clin Nutr. 2006;83(5):1055-61
of chronic coffee drinking on blood pressure: a meta-
analysis of controlled clinical trials. Hypertension Joint Health Products, Multiple Ingredient Monograph,
1999;33(2):647-652. Health Canada.

Jefferson JW. Lithium tremor and caffeine intake: two Jones AM, Atter T, Georg KP. Oral creatine
cases of drinking less and shaking more. Journal of supplementation improves multiple sprint performance in
Clinical Psychiatry 1988;49(2):72-73. elite ice-hockey players. J Sports Med Phys Fitness. 1999
Sep;39(3):189-96.
Jefferson, LS and Kimball, SR. Amino acids as regulators
of gene expression at the level of mRNA translation. J Jones AM. Influence of dietary nitrate on the physiological
Nutr. 2003 133: 2046S-2051S. determinants of exercise performance: A critical review.
Appl Physiol Nutr Metab. 2014;39(9):10191028.
Jelkmann, W. Molecular biology of erythropoietin.
Internal Medicine 2004 Aug 43(8):649-659. Josse AR, Atkinson SA, Tarnopolsky MA, Phillips SM.
Increased consumption of dairy foods and protein during
Jenkins DJ, Wong JM, Kendall CW, Esfahani A, Ng VW, diet- and exercise-induced weight loss promotes fat
Leong TC, Faulkner DA, Vidgen E, Greaves KA, Paul G, mass loss and lean mass gain in overweight and obese
Singer W. The effect of a plant-based low-carbohydrate premenopausal women. J Nutr. 2011;141(9):1626-1634.
(Eco-Atkins) diet on body weight and blood lipid
concentrations in hyperlipidemic subjects. Arch Intern Josse AR, Tang JE, Tarnopolsky MA, Phillips SM. Body
Med. 2009;169(11):1046-54 composition and strength changes in women with
milk and resistance exercise. Med Sci Sports Exerc.
Jennifer Wismann and Darryn Willoughby. Gender 2010;42(6):1122-1130.
Differences in Carbohydrate Metabolism

International Sports Sciences Association

600 | Appendix

Juhn, M. S., O’Kane, J. W. & Vinci, D. M. (1999). Oral Kao, R., et al. Erythropoietin improves skeletal muscle
creatine supplementation in male collegiate athletes: microcirculation and tissue bioenergetics in a mouse
a survey of dosing habits and side effects. J. Am. Diet. sepsis model. Crit Care. 2007;11(3):R58.
Assoc. 99, 593-595.
Karahan M, Coksevim B, Artis S. The effect of
Juliano LM, Griffiths RR. A critical review of caffeine L-carnitine supplementation on 1500 m running
withdrawal: empirical validation of symptoms and performance. Science, Movement and Health Journal
signs, incidence, severity, and associated features. 2010;10(2):504-507.
Psychopharmacology 2004;176(1):1-29.
Karapinar M, Jakobsen M. Identification of lactic
Jurenka JS. 2009. Anti-inflammatory properties of acid bacteria isolated from Tarhana, a traditional
curcumin, a major constituent of Curcuma longa: a review Turkish fermented food. International Journal of Food
of preclinical and clinical research. Alternative Medicine Microbiology 2009; 135(2):105-111.
Review 14(2):141-153.
Kargotich S, Rowbottom DG, Keast D et al (1996). Plasma
Kaats, G. R., D. Blum, D. Pullin, et al. A Randomized, glutamine changes after high intensity exercise in elite
Double Blind, Placebo Controlled Study of the Effects male swimmers. Medicine and Science in Sport and
of Chromium Picolinate Supplementation on Body Exercise 28, S133.
Composition: A Replication and Extension of a Previous
Study. Current Therapy Research, Vol. 59 (1998), pp. Karlsson, HKR., et al. Branched-chain amino acids
379-388. increase p-70S6K phosphorylation in human skeletal
muscle after resistance exercise. Am J Physiol Endocrinol
Kalpravidh RW, Wichit A, Siritanaratkul N, Metab 2004. 287: E1-E7.
Fucharoen S. Effect of coenzyme Q10 as an antioxidant
in beta-thalassemia/Hb E patients. BioFactors Karlsson, Jan, and Bengt Saltin. Diet, Muscle Glycogen,
2005;25(1-4):225-234. and Endurance Performance. Journal of Applied
Physiology, Vol. 31 (1971), no. 2, pp. 203-206.
Kambis KW, Pizzedaz SK. Short-term creatine
supplementation improves maximum quadriceps Karlsson, Jan, and Bengt Saltin. Lactate, ATP, and CP in
contraction in women. Int J Sport Nutr Exerc Metab. 2003 Working Muscles During Exhaustive Exercise in Man.
Mar;13(1):87-96. Journal of Applied Physiology, Vol. 29 (1970), No. 5, pp.
598-602.
Kamikawa, T, et al., Effects of L-carnitine on exercise
tolerance in patients with stable angina pectoris, Japanese Karlsson, Jan, Lars-Olof Nordesjo, and Bengt Saltin.
Heart Journal (1984): 587-597. Muscle Glycogen Utilization During Exercise After
Physical Training. Acta Physiolgica Scandinavica, Vol. 90
Kamimori GH, Penetar DM, Headley DB, Thorne DR, (1974), pp. 210 -217.
Otterstetter R, Belenky G. Effect of three caffeine doses on
plasma catecholamines and alertness during prolonged Kasai, Kikuo, Hitoshi Suzuki, Tsutomu Nakamura,
wakefulness. European Journal of Clinical Pharmacology Hiroaki Shiina, and Shin-Ichi Shimoda. Glycine
2000;56(8):537-544. Stimulates Growth Hormone Release in Man. Acta
Endocronologica, Vol. 90 (1980), pp. 283-286.
Kamphuis MM, Lejeune MP, Saris WH, Westerterp-
Plantenga MS. 2003. The effect of conjugated linoleic Kasai, Kikuo, Masami Kobayashi, and Shin-Ichi Shimoda.
acid supplementation after weight loss on body weight Stimulatory Effect of Glycine on Human Growth
regain, body composition, and resting metabolic rate in Hormone Secretion. Metabolism, Vol. 27 (1978), pp.
overweight subjects. International Journal of Obesity and 201-208.
Related Metabolic Disorders 27(7):840-847.
Kasen, Stephanie, et al. Obesity and psychopathology in
Kanter, M. Free Radicals, Exercise, and Antioxidant women: a three decade prospective study. International
Supplementation. International Journal of Sports Journal of Obesity 32.3 (2008): 558-566.
Nutrition, Vol. 4 (1994), p. 205.
Kasperek, George J., and Rebecca D. Snider. Increased
Protein Degradation After Eccentric Exercise. European
Journal of Applied Physiology, Vol. 54 (1985), pp. 30-34.

Sports Nutrition
 References and Glossary of Key Words | 601

Katch, F. U.S. Government Raises Serious Questions Kennedy DO, Scholey AB, Wesnes KA. 2001. Differential,
About Reliability of U.S. Department of Agriculture’s dose dependent changes in cognitive performance
Food Composition Database. International Journal of following acute administration of a Ginkgo biloba/
Sport Nutrition, Vol. 5 (1995), pp. 62-67. Panax ginseng combination to healthy young volunteers.
Nutritional neuroscience 4(5):399-412
Kato H1,2, Suzuki K1, Bannai M1, Moore DR2. Protein
Requirements Are Elevated in Endurance Athletes after Kennedy DO, Scholey AB, Wesnes KA. 2001. Dose
Exercise as Determined by the Indicator Amino Acid dependent changes in cognitive performance and mood
Oxidation Method. PLoS One. 2016 Jun 20;11(6):e0157406. following acute administration of Ginseng to healthy
young volunteers. Nutritional Neuroscience 4(4):295-310
Kayumov L, Brown G, Jindal R, Buttoo K, Shapiro
CM. A randomized, double-blind, placebo-controlled Kennedy DO, Scholey AB, Wesnes KA. 2002. Modulation
crossover study of the effect of exogenous melatonin on of cognition and mood following administration of single
delayed sleep phase syndrome. Psychosomatic Medicine doses of Ginkgo biloba, ginseng, and a ginkgo/ginseng
2001;63(1):40-8 combination to healthy young adults. Physiology &
Behavior 75(5):739-751
Kellis, J.T., and L. E. Vickery. Inhibition of Estrogen
Synthetase (Aromatase) by Flavones. Science, Vol. 225 Kennedy DO, Scholey AB. 2003. Ginseng: potential for
(1984), pp. 1032-1033. the enhancement of cognitive performance and mood.
Pharmacology, Biochemistry and Behavior 75(3):687-700
Kelly GS. The role of glucosamine sulfate and chondroitin
sulfates in the treatment of degenerative joint disease. Kern M, Lagomarcino ND, Misell LM, Schuster V. The
Altern Med Rev 1998;3(1): 27-39. effect of medium-chain triacylglycerols on the blood lipid
profile of male endurance runners. J Nutr Biochem. 2000
Kelly, G.S. (2001). Rhodiola rosea: A possible plant May;11(5):288-92.
adaptogen. Altern. Med. Rev. 6:293-302.
Ki MR, Ghim SY, Hong IH, Park JK, Hong KS, Ji AR,
Kelly, V. G., and D. G. Jenkins. Effect of Oral Creatine Jeong KS. In vitro inhibition of Helicobacter pylori
Supplementation on Near-Maximal Strength and growth and of adherence of cagA-positive strains to
Repeated Sets of High-Intensity Bench Press Exercise. gastric epithelial cells by Lactobacillus paraplantarum
Journal of Strength and Conditioning Research, Vol. 12 KNUC25 isolated from kimchi. Journal of Medicinal
(1998), pp. 109-115. Food. 2010; 13(3):629-634.
Kelp Products Monograph, Health Canada. Kidd, P. M. Phosphatidylserine (PS): A Remarkable Brain
Cell Nutrient. Decatur, IL: Lucas Meyer, 1995.
Kenefick RW, Cheuvront SN. Hydration for recreational
sport and physical activity. Nutr Rev. 2012;70(suppl Kiefer D, Pantuso T. 2003. Panax ginseng. American
2):S137-S142. Family Physician 68(8):1539-1542
Kennedy D, Scholey A, Wesnes KA. 2000. Dose- Kilduff LP, Georgiades E, James N, Minnion RH, Mitchell
dependent enhancement of cognitive performance M, Kingsmore D, Hadjicharlambous M, Pitsiladis YP. The
in young volunteers by a single doses of ginseng. effects of creatine supplementation on cardiovascular,
International Journal of Neuropsychopharmacology metabolic, and thermoregulatory responses during
3(Suppl 1):S365 exercise in the heat in endurance-trained humans. Int J
Sport Nutr Exerc Metab. 2004 Aug;14(4):443-60.
Kennedy DO, Haskell CF, Wesnes KA, Scholey AB. 2004.
Improved cognitive performance in human volunteers Kilduff LP, Pitsiladis YP, Tasker L, Attwood J, Hyslop P,
following administration of guarana (Paullinia cupana) Dailly A, Dickson I, Grant S. Effects of creatine on body
extract: comparison and interaction with Panax ginseng. composition and strength gains after 4 weeks of resistance
Pharmacology, Biochemistry and Behavior 79(3):401-411. training in previously nonresistance-trained humans. Int
J Sport Nutr Exerc Metab. 2003 Dec;13(4):504-20.
Kennedy DO, Scholey AB, Drewery L, Marsh VR, Moore
B, Ashton H. 2003. Electroencephalograph effects of Killingsworth, R., et al. Hyperthermia and Dehydration-
single doses of Ginkgo biloba and Panax ginseng in Related Deaths Associated With Intentional Rapid
healthy young volunteers. Pharmacology, Biochemistry Weight Loss in Three Collegiate Wrestlers. Morbidity and
and Behavior 75(3):701-709 Mortality Weekly Report, Vol. 47 (1998), pp. 105-108.

International Sports Sciences Association

602 | Appendix

Kim, SW., et al. Direct and indirect effects of androgens Klein DA1, Poth MA. Amenorrhea: an approach to
on survival of hematopoietic progenitor cells in vitro. J diagnosis and management. Am Fam Physician. 2013 Jun
Korean Med Sci. 2005 Jun;20(3):409-16. 1;87(11):781-8.

Kimball SR, Jefferson LS. Molecular mechanisms through Knopf, R. F., J. W. Conn, S. S. Fajans, J. C. Floyd, E. M.
which amino acids mediate signaling through the Guntsche, and J. A. Rull. Plasma Growth Hormone
mammalian target of rapamycin. Curr Opin Clin Nutr Response to Intravenous Administration of Amino Acids.
Metab Care. 2004 Jan;7(1)39-44. Journal of Clinical Endocrinology, Vol. 25 (1965), pp.
1140-1144.
Kimball SR, Jefferson LS. Regulation of global and specific
mRNA translation by oral administration of branched- Knuiman P1, Hopman MT2, Mensink M1 Glycogen
chain amino acids. Biochem Biophys Res Commun. 2004 availability and skeletal muscle adaptations with
Jan 9;313(2):423-7. endurance and resistance exercise. Nutr Metab (Lond).
2015 Dec 21;12:59.
Kimball SR, Jefferson LS. Regulation of protein synthesis
by branched-chain amino acids. Curr Opin Clin Nutr Ko SR, Choi KJ, Uchida K, Suzuki Y. 2003. Enzymatic
Metab Care. 2001 Jan;4(1):39-43. preparation of ginsenosides Rg2, Rh1, and F1 from
protopanaxatriol-type ginseng saponin mixture. Planta
King, N; Leet, A; McDonald, J; Conti, C; Pitkin, Medica 69:285-286
C; Pollard, C; and Witzke, K (2015) Validity of the
cardiocoach metabolic system for the determination Kocak S, Karli U. Effects of high dose oral creatine
of vo2 peak, International Journal of Exercise Science: supplementation on anaerobic capacity of elite wrestlers. J
Conference Proceedings: Vol. 8: Iss. 3, Article 23. Sports Med Phys Fitness. 2003 Dec;43(4):488-92.

Kinoshita S, Nakayama S, Akita S. Taxonomic study Koehle MS, Cheng I, Sporer B. Canadian Academy of
of glutamic acid accumulating bacteria, Micrococcus Sport and Exercise Medicine position statement: Athletes
glutamicus, nov. sp. Bulletin of the Agricultural Chemical at high altitude. Clin J Sports Med. 2014;24(2): 120-127.
Society of Japan 1958; 22:176-185.
Koeslag, J. H. Post-Exercise Ketosis and the Hormone
Kirkendall, D. Effect of Nutrition on Performance in Response to Exercise: A Review. Medicine and Science in
Soccer. Medicine and Science in Sports and Exercise, Vol. Sports and Exercise, Vol. 14 (1982), No. 5, pp. 327-334.
25 (1993), pp. 1370.
Kohama T. Clinical applications of Pycnogenol® in Japan.
Kirkendall, D.T, C. Foster, J.A. Dean, J. Gorgan, and Prog Med 24: 1503-1510, 2004.
N.N. Thompson (1988). Effect of glucose polymer
supplementation on performance of soccer players. In: T. Kohli K, Ali J, Ansari J, Raheman Z. 2005. Curcumin:
Reilly, A. Lees, K. Davids, and W. Murphy (eds.), Science a natural antiinflammatory agent. Indian Journal of
and Football I. London: E&FN Spon Ltd., pp. 33-41. Pharmacology 37(3):141-147.

Kirkendall, D.T. (1993). Effects of nutrition on Kolida S, Gibson GR. 2007. Prebiotic capacity of
performance in soccer. Med. Sci. Sports Exerc. inulin-type fructans. The Journal of Nutrition
25:1370-1374. 2007;137:2503S-2506S.

Kiso Y, Suzuki Y, Watanabe N, Oshima Y, Hikino H. 1983. Kotowska M, Albrecht P, Szajewska H. Saccharomyces
Antihepatotoxic principles of Curcuma longa rhizomes. boulardii in the prevention of antibiotic-associated
Journal of Medicinal Plant Research 49:185-187 diarrhoea in children: a randomized double-blind
placebo-controlled trial. Alimentary Pharmacology &
Kitts DD, Wijewickreme AN, Hu C. 2000. Antioxidant Therapeutics 2005; 21(5):583-590.
properties of a North American ginseng extract.
Molecular and Cellular Biochemistry 203(1-2):1-10 Kraemer WJ, Spiering BA, Volek JS, Ratamess NA,
Sharman MJ, Rubin MR, French DN, Silvestre R, Hatfield
Kleessen B, Sykura B, Zunft H-J, Blaut M. Effects of inulin DL, Van Heest JC, Vingren JL, Judelson DA, Deschenes
and lactose on fecal microflora, microbial activity, and MR, Maresh CM. Androgenic responses to resistance
bowel habit in elderly constipated persons. American exercise: Effects of feeding and L-Carnitine. Official
Journal of Clinical Nutrition 1997;65(5):1397-1402. Journal of the American College of Sports Medicine
2006;1288-1296.

Sports Nutrition
 References and Glossary of Key Words | 603

Kraemer WJ, Volek JS, French DN, Rubin MR, Sharman Kuczmarski, R.J. et al., 2002. 2000 CDC Growth Charts
MJ, Gomez AL, Ratamess NA, Newton RU, Jemiolo for the United States: methods and development. Vital
B, Craig BW, Hakkinen K. The effects of L-carnitine Health Stat. 11., 11(246), pp.1–190.
L-tartrate supplementation on hormonal responses to
resistance exercise and recovery. Journal of Strenght and Kunz D, Mahlberg R, Müller C, Tilmann A, Bes F.
Conditioning Research 2003;17(3):455-462. Melatonin in patients with reduced REM sleep duration:
two randomized controlled trials. Journal of Clinical
Kraemer, W. J. et al. Resistance training combined with Endocrinology & Metabolism 2004;89(1):128-134
bench-step aerobics enhances women’s health profile. Med
Sci Sports Exerc 2001 Feb;33(2):259-269. Kuo J, Chen CY and Lee N. Effects of Eleutherococcus
senticosus (ciwujia) on fat metabolism and endurance
Kreider RB (1999). Dietary supplements and the performance in long distance runners. Medicine &
promotion of muscle growth with resistance training. Science in Sports and Exercise 38(5):S401, 2006.
Sports Medicine 27, 97-110.
Kuo J, Kenny WC, Cheng I, et al. The effect of eight weeks
Kreider RB, Melton C, Rasmussen CJ, Greenwood M, of supplementation with Eleutherococcus senticosus on
Lancaster S, Cantler EC, Milnor P, Almada AL. Long- endurance capacity and metabolism in humans. Chinese
term creatine supplementation does not significantly Journal of Physiology 53(2):105-111, 2010.
affect clinical markers of health in athletes. Mol Cell
Biochem. 2003 Feb;244(1-2):95-104. Kuo J, Su C, Yang H, et al. Supplementation of
Eleutherococcus senticosus (ciwujia) on cardiorespiratory
Kreider RB, Miriel V, Bertun E (1993). Amino acid function and fat metabolism in college students. Annals
supplementation and exercise performance: proposed of Nutrition & Metabolism 51(1):161, 2007.
ergogenic value. Sports Medicine 16, 190-209.
Kurkin, V. A., and G. G. Zapesochnaya. Chemical
Kreider, R. B. (2003). Effects of creatine supplementation Composition and Pharmacological Properties of Rhodiola
on performance and training adaptations. Mol. Cell. Rosea. Chemical-Pharmaceutical Journal, Vol. 20 (1986),
Biochem. 244, 89-94. No. 10, pp. 1231-1244.

Kreider, R. B., et al. Effects of Creatine Supplementation Kurosawa Y, Hamaoka T, Katsumura T, Kuwamori M,
on Body Composition, Strength, and Sprint Performance. Kimura N, Sako T, Chance B. Creatine supplementation
Medicine and Science in Sports and Exercise, Vol. 30 enhances anaerobic ATP synthesis during a single 10
(1998), pp. 73-82. sec maximal handgrip exercise. Mol Cell Biochem. 2003
Feb;244(1-2):105-12.
Kreider, R. B., Melton, C., Rasmussen, C. J., Greenwood,
M., Lancaster, S., Cantler, E. C., Milnor, P. & Almada, A. LaBotz, M. & Smith, B. W. (1999). Creatine supplement
L. (2003). Long-term creatine supplementation does not use in an NCAA Division I athletic program. Clin. J.
significantly affect clinical markers of health in athletes. Sport Med. 9, 167-169.
Mol. Cell. Biochem. 244, 95-104.
Lactase Monograph, Health Canada.
Kreider, R., et al. Effects of B-BHBM Supplemetation
With and Without Creatine During Training on Body Lagowska K, Kapczuk K, Friebe Z, Bajerska J. Effects
Composition Alterations. Federation of American of dietary intervention in young female athletes with
Societies of Experimental Biology Journal, Vol. 11 (1997), menstrual disorders. J Int Soc Sports Nutr. 2014;11:21.
pg. A374.
Lambert, CP, et al. Macronutrient considerations for the
Kreider R, et al. ISSN exercise & sport nutrition review: sport of bodybuilding. Sports Med. 2004;34(5)317-327.
research & recommendations. Journal of the International
Lands, LC, et al. Effect of supplementation with a cysteine
Society of Sports Nutrition 2010, 7:7 (2 February 2010)
donor on muscular performance. J. Appl. Physiol. 1999,
Krill Oil Monograph, Health Canada. 87(4): 1381-1385.

Krustrup P1, Ermidis G2, Mohr M3. Sodium bicarbonate Lang, CH. Alcohol impairs leucine-mediated
intake improves high-intensity intermittent exercise phosphorylation of 4E-BP1, S6K1, eIF4G, and mTOR in
performance in trained young men. J Int Soc Sports Nutr. skeletal muscle. Am J Physiol Endocrinol Metab. 2003
2015 Jun 4;12:25. 285: E1205-1215.

International Sports Sciences Association

604 | Appendix

Langsjoen PH, Folkers K, Lyson K, Muratsu K, Lyson T, Leffler CT, Philippi AF, Leffler SG, Mosure JC, Kim PD.
Langsjoen P. Effective and safe therapy with coenzyme Glucosamine, chondroitin, and manganese ascorbate
Q10 for cardiomyopathy. Klinische Wochenschrift for degenerative joint disease of the knee or low back: a
1988;66(13):583-590. randomized, double-blind, placebo-controlled pilot study.
Mil Med. 1999 Feb;164(2):85-91.
Langsjoen PH, Langsjoen AM. Supplemental ubiquinol in
patients with advanced congestive heart failure. Biofactors Lehmkuhl M, Malone M, Justice B, Trone G, Pistilli
2008;32(1-4):119-28. E, Vinci D, Haff EE, Kilgore JL, Haff GG. The effects
of 8 weeks of creatine monohydrate and glutamine
Lappin, TR., et al. EPO’s alter ego: erythropoietin has supplementation on body composition and performance
multiple actions. Stem Cells 2002;20:485-492. measures. J Strength Cond Res. 2003 Aug;17(3):425-38.
Larsen TM, Toubro S, Gundmensen O, Astrup A. 2006. Leidy HJ, Carnell NS, Mattes RD, Campbell WW.
Conjugated linoleic acid supplementation for 1 y does not Higher protein intake preserves lean mass and satiety
prevent weight or body fat gain. The American Journal of with weight loss in pre-obese and obese women. Obesity.
Clinical Nutrition 83(3):606-612. 2007;15(2):421-9
Larson-Meyer DE, Willis KS. Vitamin D and athletes. Leite AM, Leite DC, Del Aguila EM, Alvares TS, Peixoto
Curr Sports Med Rep. 2010;9(4):220-226. RS, Miguel MA, Silva JT, Paschoalin VM. Microbiological
and chemical characteristics of Brazilian kefir during
Lawlor, D.A. et al., 2010. Association between general and
fermentation and storage processes. Journal of Dairy
central adiposity in childhood, and change in these, with
Science 2013; 96(7):4149-4159.
cardiovascular risk factors in adolescence: prospective
cohort study. BMJ, 341, p.c6224. Lekakis JP, Papathanassiou S, Papaioannou TG,
Papamichael CM, Zakopoulos N, Kotsis V, Dagre AG,
Lawson RE, Moss AR, Givens DI. The role of dairy
Stamatelopoulos K, Protogerou A, Stamatelopoulos SF.
products in supplying conjugated linoleic acid to man’s
2002. Oral L-arginine improves endothelial dysfunction
diet: a review. Nutr. Res. Rev. 14:153-172 (2001).
in patients with essential hypertension. International
Layman, DK. The role of leucine in weight loss diets and Journal of Cardiology 86(2-3):317-323.
glucose homeostasis. J Nutr. 2003 133: 261S-267S.
Lemon PW, Proctor DN. Protein intake and athletic
Leatt, P.B., and I. Jacobs (1989). Effect of glucose polymer performance. Sports Med. 1991 Nov;12(5):313-25.
ingestion on glycogen depletion during a soccer match.
Lemon PW. Effect of exercise on protein requirements. J
Can. J. Sport Sci. 14:112-116.
Sports Sci. 1991 Summer;9 Spec No:53-70.
Leblanc, J.Ch., F. Le Gall, V. Grandjean, and P. Verger
Lemon PW. Is increased dietary protein necessary or
(2002). Nutritional intake of French soccer players at the
beneficial for individuals with a physically active lifestyle?
Clairefontaine training center. Int. J. Sport Nutr. Exerc.
Nutr Rev. 1996 Apr;54(4 Pt 2):S169-75.
Metab. 12:268-280.
Lemon PW. Protein and amino acid needs of the strength
Lecithin Monograph, Health Canada.
athlete. Int J Sport Nutr. 1991 Jun;1(2):127-45.
Ledoux D, Labombardi VJ, Karter D. Lactobacillus
Lemon PWR (1998). Effects of exercise on dietary protein
acidophilus bacteraemia after use of a probiotic in a
requirements. International Journal of Sport Nutrition 8,
patient with AIDS and Hodgkin’s disease. International
426-47.
Journal of STD & AIDS 2006; 17(4):280-282.
Lemon, P. W. R., and F. J. Nagle. Effects of Exercise on
Lee JM, Kim Y, Welk GJ. Validity of consumer-based
Protein and Amino Acid Metabolism. Medicine and
physical activity monitors. Med Sci Sports Exerc.
Science in Sports and Exercise, Vol. 13 (1981), No. 3, pp.
2014;46(9): 1840-1848.
141-149.
Lee JS, et al. Effects of chronic dietary nitrate
Lemon, P. W. R., et al. Protein Requirements and Muscle
supplementation on the hemodynamic response to
Mass/Strength Changes During Intensive Training in
dynamic exercise. Am J Physiol Regul Integr Comp
Novice Bodybuilders. Journal of Applied Physiology, Vol.
Physiol. 2015 Sep;309(5):R459-66.
73 (1992), pp. 767-775.

Sports Nutrition
 References and Glossary of Key Words | 605

Lemon, P.W.R., and D. Proctor. Protein Intake and Lindner P. Schizosaccharomyces pombe n. sp., ein neuer
Athletic Performance. Sports Medicine, Vol. 12 (1991), Gährungserreger, volume 10. 1893. p.1298 (in German).
No. 5, p. 313.
Lipase Monograph, Health Canada.
Lemon, P.W.R., and J. P. Mullin. Effect of Initial Muscle
Glycogen Levels on Protein Catabolism During Exercise. Lippi, G. and Cuidi, CG. Gene manipulation and
The American Physiological Society (1980), pp. 624-629. improvement of athletic performances: new strategies in
blood doping. Br J Sports Med 2004: 38:641.
Lenoir-Wijnkoop I, Sanders ME, Cabana MD, Caglar E,
Corthier G, Rayes N, Sherman PM, Timmerman HM, Lippi, G., et al. Blood doping by cobalt. Should we
Vaneechoutte M, Van Loo J, Wolvers DA. Probiotic and measure cobalt in athletes? Journal of Occupational
prebiotic influence beyond the intestinal tract. Nutrition Medicine and Tox. 2006;1:18.
Reviews 2007; 65(11):469-489.
Lippiello L, Woodward J, Karpman R, Hammad TA.
Lerman A, Burnett JC, Higano ST, McKinley LJ, Holmes In vivo chondroprotection and metabolic synergy of
Jr DR. 1998. Long-term L-arginine supplementation glucosamine and chondroitin sulfate. Clin Orthop. 2000
improves small-vessel coronary endothelial function in Dec;(381):229-40.
humans. Circulation 97(21):2123-2128.
Lippiello L. Glucosamine and chondroitin sulfate:
Levenhagen DK et al. (2002) Postexercise protein intake biological response modifiers of chondrocytes under
enhances whole-body and leg protein accretion in simulated conditions of joint stress. Osteoarthritis
humans. Med Sci Sports Exerc. 34:828-837. Cartilage. 2003 May;11(5):335-42.

Lewis RM, Redzic M, Thomas DT. The effects of Liu SQ, Tsao M. Enhancement of survival of probiotic and
season-long vitamin D supplementation on collegiate non-probiotic lactic acid bacteria by yeasts in fermented
swimmers and divers. Int J Sports Nutr Exerc Metab. milk under non-refrigerated conditions. International
2013;23(5):431-440. Journal of Food Microbiology 2009; 135(1):34-38.

Lewy AJ, Bauer VK, Cutler NL, Sack RL. Melatonin Liu TH, Wu CL, Chiang CW, Lo YW, Tseng HF, Chang
treatment of winter depression: a pilot study. Psychiatry CK. No effect of short-term arginine supplementation on
Research 1998;77(1):57-61 nitric oxide production, metabolism and performance in
intermittent exercise in athletes. J Nutr Biochem. 2009
Lherm T, Monet C, Nougière B, Soulier M, Larbi D, Le Jun;20(6):462-8.
Gall C, Caen D, Malbrunot C. Seven cases of fungemia
with Saccharomyces boulardii in critically ill patients. López MV, Cuadrado MP, Ruiz-Poveda OM, Del Fresno
Intensive Care Medicine 2002; 28(6):797-801. AM, Accame ME. 2007. Neuroprotective effect of
individual ginsenosides on astrocytes primary culture.
Licorice Monograph, Health Canada. Biochimica et Biophysica Acta 1770(9):1308-1316

Lim SD, Mooradian SJ, Goldberg CS, Gomez C, Crowley Lopez RM, Casa DJ, Jensen K, Stearns RL, DeMartini
DC, Rocchini AP, Charpie JR. 2004. Effect of oral JK, Pagnotta KD, Roti MW, Armstrong LE, Maresh CM.
L-arginine on oxidant stress, endothelial dysfunction, Comparison of two fluid replacement protocols during a
and systemic arterial pressure in young cardiac transplant 20-km trail running race in the heat. J Strength Cond Res.
recipients. The American Journal of Cardiology 2016 Jan 29.
94(6):828-831.
Loucks AB. Energy balance and energy availability. In:
Lim, K., M. Yoshioka, S. Kikuzato, A. Kiyonaga, H. Maughan RJ, ed. Sports Nutrition, The Encyclopaedia
Tanaka, M. Shindo, and M. Suzuki (1997). Dietary red of Sports Medicine, an IOC Medical Commission
pepper ingestion increases carbohydrate oxidation at rest Publication. West Sussex, UK: John Wiley & Sons, Ltd;
and during exercise in runners. Med. Sci. Sports Exerc. 2013:72-87.
29:355-361.
Lourenco S, Oliveira A, Lopes C. The effect of current
Linderman, J., and T. D. Fahey. Sodium Bicarbonate and lifetime alcohol consumption on overall and central
Ingestion and Exercise Performance. Sports Medicine, obesity. Eur J Clin Nutr. 2012;66(7):813-818.
Vol. 11, No. 9, p. 71.

International Sports Sciences Association

606 | Appendix

Lucke, Christoph, and Seymour Glick. Experimental Magal M1, Cain RJ1, Long JC1, Thomas KS1. Pre-Practice
Modification of the Sleep-Induced Peak of Growth Hydration Status and the Effects of Hydration Regimen
Hormone Secretion. Journal of Clinical Endocrinology on Collegiate Division III Male Athletes. J Sports Sci Med.
and Metabolism, Vol. 32 (1971), pp. 729-736. 2015 Mar 1;14(1):23-8. eCollection 2015.

Lukaski HC. Vitamin and mineral status: Effects on Magnesium Monograph, Health Canada.
physical performance. Nutrition. 2004;20(7-8):632-644.
Magnusson J, Schnürer J. Lactobacillus coryniformis
Luppino, Floriana S., et al. Overweight, obesity, and subsp. coryniformis strain Si3 produces a broad-spectrum
depression: a systematic review and meta-analysis of proteinaceous antifungal compound. Applied and
longitudinal studies. Archives of general psychiatry 67.3 Environmental Microbiology 2001; 67(1):1-5.
(2010): 220-229.
Malgoire JY, Bertout S, Renaud F, Bastide JM, Mallié M.
Lycopene Monograph, Health Canada. Typing of Saccharomyces cerevisiae clinical strains by
using Microsatellite Sequence Polymorphism. Journal of
Lynch CJ, et al. Potential role of leucine metabolism in the Clinical Microbiology 2005; 43(3):1133-1137.
leucine-signaling pathway involving mTOR. Am J Physiol
endocrinol Met. 2003 285: E854-E863. Mancini, DM., Effect of erythropoietin on exercise
capacity in patients with moderate to severe chronic heart
Lysine Monograph, Health Canada. failure. 2003 Jan 21;107(2):294-9.
MacDonald HB. Conjugated linoleic acid and disease Manore M, Thompson J. Energy requirements of the
prevention: A review of current knowledge. J Am Coll athlete: Assessment and evidence of energy efficiency. In:
Nutr 19(2 Suppl S):111S-118S (2000). Burke L, Deakin V, eds. Clinical Sports Nutrition. 5th ed.
Sydney, Australia: McGraw-Hill; 2015:114-139.
MacDougall, J. D., D. G. Sale, G.C.B. Elder, and J. R.
Sutton. Muscle Ultrastructural Characteristics of Elite Manore, M. Vitamin B6 and Exercise. International
Power-lifters and Bodybuilders. European Journal of Journal of Sports Nutrition, Vol. 4 (1994), p. 89.
Applied Physiology, Vol. 48 (1982), pp. 117-126.
Marconi C, Sassi G, Carpinelli A, Cerretelli P. Effect
MacDougall, J. D., D. G. Sale, J. R. Moroz, G.C.B. Elder, J. of L-carnitine loading on the aerobic and anaerobic
R. Sutton, and H. Howald. Mitochondrial Volume Density performance of endurance athletes. European Journal of
in Human Skeletal Muscle Following Heavy Resistance Applied Physiology 1985;54:131-135.
Training. Medicine and Science in Sports and Exercise,
Vol. 11 (1979), No. 2, pp. 164-166. Maresh, C., et al. Dietary Supplementation and Improved
Anaerobic Performance. International Journal of Sport
MacDougall, J. D., D. G. Sale, S. E. Alway, and J. R. Sutton. Nutrition, Vol. 4 (1994), p. 387.
Muscle Fiber Number in Biceps Brachii in Bodybuilders
and Control Subjects. The American Physiological Society Marigold Extract and Isolates (Lutein and Zeaxanthin)
(1984), p. 1399. Monograph, Health Canada.

Mackova, Eva V., Jan Melichna, Karel Vondra, Toivo Marriott, B. Food Components to Enhance Performance.
Jurimae, Thomas Paul, and Jaroslav Novak. The Washington, DC: National Academy Press, 1994.
Relationship Between Anaerobic Performance and Muscle
Metabolic Capacity and Fibre Distribution. European Marseglia L, Manti S, D’Angelo G, Nicotera A, Parisi E,
Journal of Applied Physiology, Vol. 54 (1985), pp. 413-415. DiRosa G, Gitto E, Arrigo T. Oxidative stress in obesity:
a critical component in human diseases. International
MacLean, William C., Jr., and George G. Graham. The Journal of Molecular Sciences. Dec 2014; 16(1):378-400.
Effect of Level of Protein Intake in Isoenergetic Diets
on Energy Utilization. American Journal of Clinical Marsit, Joseph, et al. Effects of Ascorbic Acid on Serum
Nutrition (1979), pp. 1381-1387. Cortisol and the Testosterone: Cortisol Ratio in Junior
Elite Weightlifters. Journal of Strength and Conditioning
Maffucci DM, McMurray RG. Towards optimizing the Research, Vol. 12 (1998), pp. 179-184.
timing of the pre-exercise meal. Int J Sport Nutr Exerc
Metab. 2000 Jun;10(2):103-13.

Sports Nutrition
 References and Glossary of Key Words | 607

Marteau P, Jacobs H, Cazaubiel M, Signoret C, Prevel J-M, McArdle, et al. Exercise Physiology: Energy, Nutrition, &
Housez B. Effects of chicory inulin in constipated elderly Human Performance, Sixth Edition, 2007.
people: a double-blind controlled trial. International of
Food Sciences and Nutrition 2011;62(2):164-170. McCall, GE, et al. Muscle fiber hypertrophy, hyperplasia,
and capillary density in college men after resistance
Mathur S, Singh R. Antibiotic resistance in food lactic training. J. Appl. Physiol. 81(5):2004-2012, 1996.
acid bacteria - a review. International Journal of Food
Microbiology 2005; 105(3):281-295. McCartney D, Desbrow B, Irwin C. The Effect of Fluid
Intake Following Dehydration on Subsequent Athletic
Mattarelli P, Bonaparte C, Pot B, Biavati B. Proposal to and Cognitive Performance: a Systematic Review and
reclassify the three biotypes of Bifidobacterium longum as Meta-analysis. Sports Med Open. 2017 Dec;3(1):13
three subspecies: Bifidobacterium longum subsp. longum
subsp. nov., Bifidobacterium longum subsp. infantis McCarty M. Glucosamine for wound healing. Med
comb. nov. and Bifidobacterium longum subsp. suis comb. Hypotheses 1996;47:273-5.
nov. International Journal of Systematic and Evolutionary
McClung JP, Karl JP, Cable SJ, et al. Randomized, double-
Microbiology. 2008; 58(4):767-772.
blind, placebo controlled trial of iron supplementation in
Maughan RJ, Leiper JB, Shirreffs SM. Restoration of fluid female soldiers during military training: Effects on iron
balance after exercise-induced dehydration: effects of food status, physical performance, and mood. Am J Clin Nutr.
and fluid intake. Eur J Appl Physiol. 1996;73:317-325. 2009;90(1):124-131.

Maughan RJ, Shirreffs SM, Leiper JB. Rehydration and McCrory MA, Gomez TD, Bernauer EM, Molé PA:
recovery after exercise. Sport Sci Exc. 1996;9(62):1-5. Evaluation of a new air displacement plethysmograph
for measuring human body composition. Med Sci Sports
Maughan, R.J., S.J. Merson, N.P. Broad and S.M. Shirreffs Exerc 1995, 27:1686-1691.
(2004). Fluid and electrolyte intake and loss in elite soccer
players during training. Int. J. Sport Nutr. Exerc. Metab. McCullough MJ, Clemons KV, McCusker JH, Stevens DA.
14:333-346. 1998. Species identification and virulence attributes of
Saccharomyces boulardii (nom. inval.). Journal of Clinical
Maughan, Ronald. Creatine Supplementation and Microbiology 36(9):2613-2617.
Exercise Performance. International Journal of Sport
Nutrition (1995), pp. 94-101. McDaniel, ML., et al. Metabolic and autocrine regulation
of the mammalian target of rapamycin by B-cells.
Maxwell, N.S., F. Gardner, and M.A. Nimmo (1999). Diabetes. 2002 51:2877-2885.
Intermittent running: muscle metabolism in the heat
and effect of hypohydration. Med. Sci. Sports Exerc. McFarland LV, Surawicz CM, Greenberg RN, Elmer GW,
31:675-683. Moyer KA, Melcher SA, Bowen KE, Cox JL. Prevention
of beta-lactam-associated diarrhea by Saccharomyces
Mayer, Jean, Roy Purnima, and Kamakhya Prasad Mitra. boulardii compared with placebo. The American Journal
Relation Between Caloric Intake, Body Weight, and of Gastroenterology 1995; 90(3):439-448.
Physical Work: Studies in an Industrial Male Population
in West Bengal. American Journal of Clinical Nutrition, McFarland LV. Systematic review and meta-analysis of
Vol. 4 (1956), No. 2, pp. 169-175. Saccharomyces boulardii in adult patients. World Journal
of Gastroenterology 2010; 16(18):2202-2222.
Mazieres B et al. Chondroitin sulfate in osteoarthritis of
the knee: A prospective, double blind, placebo controlled McGregor, S.J., C.W. Nicholas, H.K.A. Lakomy, and C.
multicenter clinical study. Journal of Rheumatology Williams (1999). The influence of intermittent high-
2001;28:173-81. intensity shuttle running and fluid ingestion on the
performance of a soccer skill. J. Sports Sci. 17:895-903.
McAlindon TE, MP La Valley, JP Gulin and DT
Felson. Glucosamine and chondroitin for treatment of McGuffin M, Hobbs C, Upton R, Goldberg A, editors.
osteoarthritis: a systematic quality assessment and meta- 1997. American Herbal Products Association’s Botanical
analysis, JAMA 2000; 283(11):1469-1475. Safety Handbook. Boca Raton (FL): CRC Press

International Sports Sciences Association

608 | Appendix

McGuffin M, Kartesz JT, Leung AY, Tucker AO, editors. Mester R, Toren P, Mizrachi I, Wolmer L, Karni N,
2000. Herbs of Commerce, 2nd edition. Austin(TX): Weizman A. Caffeine withdrawal increases lithium blood
American Herbal Products Association. levels. Biological Psychiatry 1995;37(5):348-350.

McGuine, T. A., Sullivan, J. C. & Bernhardt, D. A. (2002). Methionine Monograph, Health Canada.
Creatine supplementation in Wisconsin high school
athletes. Wmj 101, 25-30. Mettler S, Mitchell N, Tipton KD. Increased protein
intake reduces lean body mass loss during weight loss in
McGuine, T. A., Sullivan, J. C. & Bernhardt, D. T. (2001). athletes. Med Sci Sports Exerc. 2010; 42(2):326-337.
Creatine supplementation in high school football players.
Clin. J. Sport Med. 11, 247-253. Meydani, M., et al. Protective Effect of Vitamin E on
Exercise-Induced Oxidative Damage in Young and Older
McLaughlin T, Carter S, Lamendola C, Abbasi F, Yee Adults. American Journal of Physiology, Vol. 264 (1993),
G, Schaaf P, Basina M, Reaven G. Effects of moderate pp. R992-R998.
variations in macronutrient composition on weight loss
and reduction in cardiovascular disease risk in obese, Mihic S, MacDonald JR, McKenzie S, Tarnopolsky MA.
insulin-resistant adults. Am J Clin Nutr. 2006;84(4):813-21 2000. Acute creatine loading increases fat-free mass, but
does not affect blood pressure, plasma creatinine, or CK
McLellan TM1, Pasiakos SM, Lieberman HR. Effects of activity in men and women. Medicine & Science in Sports
protein in combination with carbohydrate supplements and Exercise 32(2):291-296.
on acute or repeat endurance exercise performance: a
systematic review. Sports Med. 2014 Apr;44(4):535-50. doi: Milk Thistle Monograph, Health Canada.
10.1007/s40279-013-0133-y.
Miller BF, Olesen JL, Hansen M, et al. Coordinated
Medina EA, Horn WF, Keim NL, Havel PJ, Benito P, collagen and muscle protein synthesis in human patella
Kelley DS, Nelson GJ, Erickson KL. Conjugated linoleic tendon and quadriceps muscle after exercise. J Physiol.
acid supplementation in humans: Effects on circulating 2005;567(pt 3):1021-1033.
leptin concentrations and appetite. Lipids 35:783-788
Miller, ME., et al. Mechanism of erythropoietin
(2000).
production by cobalt. Blood. 1974 Sept 44(3):339-346.
Melatonin - Oral Monograph, Health Canada.
Mills S, Bone K. 2000. Principles and Practice of
Melatonin - Sublingual Monograph, Health Canada. Phytotherapy. Toronto (ON): Churchill Livingstone.

Menne E, Guggenbuhl, Roberfroid M. Fn-type chicory Mills S, Bone K. 2005. The Essential Guide
inulin hydrolysate has a prebiotic effect in humans. to Herbal Safety. St. Louis (MO): Elsevier Churchill
Journal of Nutrition 2000;130:1197-1199. Livingstone.

Merimee, T. J., D. Rabinowitz, and S. E. Fineberg. Millward DJ. Optimal intakes of protein in the human
Arginine-Initiated Release of Human Growth Hormone. diet. Proc Nutr Soc. 1999 May;58(2):403-13.
New England Journal of Medicine (1969), pp. 1434-1438.
Miner JL, Cederberg CA, Nielsen MK, Chen XL, Baile
Merimee, Thomas J., David Rabinowitz, Lamar Riggs, CA. Conjugated linoleic acid (CLA), body fat, and
John A. Burgess, David L. Rimoin, and Victor A. apoptosis. Obesity Res. 9:129-134 (2001).
McKusick. Plasma Growth Hormone After Arginine
Misic, M. & Kelley, G. A. (2002). The impact of creatine
Infusion. New England Journal of Medicine, Vol. 23
supplementation on anaerobic performance: A meta-
(1967), pp. 434-438.
analysis. Am. J. Med. Sports 4, 116-124.
Mero AA, Keskinen KL, Malvela MT, Sallinen
Mitchell CJ, et al. Supplementation of a suboptimal
JM. Combined creatine and sodium bicarbonate
protein dose with leucine or essential amino acids: Effects
supplementation enhances interval swimming. J Strength
on myofibrillar protein synthesis at rest and following
Cond Res. 2004 May;18(2):306-10.
resistance exercise in men. J Physiol. 2012;590(pt
Mertz, Walter. Assessment of the Trace Element 11):2751-2765.
Nutritional Status. Nutrition Research (1985), pp. 169-174.

Sports Nutrition
 References and Glossary of Key Words | 609

Mitchell, J. B., D. L. Costill, J. A. Houmard, M. G. Flynn, Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC
W. J. Fink, and J. D. Beltz. Effects of Carbohydrate consensus statement: Beyond the female athlete triad—
Ingestion on Gastric Emptying and Exercise Performance. Relative Energy Deficiency in Sport (RED-S). Br J Sports
Medicine and Science in Sports and Exercise, Vol. 20 Med. 2014;48(7):491-497.
(1988), No. 2, pp. 110-115.
MSM Monograph, Health Canada.
Mittleman, K. D., M. R. Ricci, and S. P. Bailey. Branched-
Chain Amino Acids Prolong Exercise During Heat Stress Muckle, D. (1973). Glucose syrup ingestion and team
in Men and Women. Medicine and Science in Sports and performance in soccer. Brit. J. Sports Med. 7:340-343.
Exercise, Vol. 30 (1998), pp. 83-91.
Müeller DM, Seim H, Kiess W, Löster H, Richter T. Effects
Monteleone, P., L. Beinat, C. Tanzillo, M. Maj, and of oral L-carnitine supplementation on in vivo long-
D. Kemali. Effects of Phosphatidylserine on the chain fatty acid oxidation in healthy adults. Journal of
Neuroendocrine Response to Physical Response in Metabolism 2002;51(11):1389-1391.
Humans. Neuroendocrinology, Vol. 52 (1990), pp.
Mujika, I., S. Padilla, J. Ibañez, M. Izquierdo, and E.
243-248.
Gorostiaga (2000). Creatine supplementation and sprint
Monteleone, P., M. Maj, L. Beinat, M. Natale, and performance in soccer players. Med. Sci Sports Exerc.
D. Kemali. Blunting by Chronic Phosphatidylserine 32:518-522.
Administration of the Stress-Induced Activation of the
Multi-Vitamin/Mineral Supplements Monograph, Health
Hypothalamo-Pituitary-Adrenal Axis in Healthy Men.
Canada.
European Journal of Clinical Pharmacology, Vol. 43
(1992), pp. 385-388. Murad H. and Tabibian M. P., The effect of an oral
supplement containing glucosamine, amino acids,
Montner P, Stark DM, Riedesel ML, Murata G, Robergs
minerals, and antioxidants on cutaneous aging:
R, Timms M, Chick TW. Pre-exercise glycerol hydration
a preliminary study. J Dermatolog Treat 2001
improves cycling endurance time. Int J Sports Med.
Mar;12(1)47-51.
1996;17(1):27–33.
Murphy LL, Lee TJ. 2002. Ginseng, sex behavior, and
Moore DR, Robinson MJ, Fry JL, et al. Ingested protein
nitric oxide. Annals of the New York Academy of Sciences
dose response of muscle and albumin protein synthesis
962:372-377
after resistance exercise in young men. Am J Clin Nutr.
2009;89(1):161-168. Murphy, T., et al. Performance Enhancing Ration
Components Project: U.S. Army. Abstract presented at the
Moran DS, McClung JP, Kohen T, Lieberman HR.
11th Annual Symposium of Sports and Cardiovascular
Vitamin D and physical performance. Sports Med.
Nutritionists, Atlanta, Georgia, 22-24 April 1994.
2013;43(7): 601-611.
Murray, Robert; Dennis E. Eddy, Tami W. Murray,
Morelli L. In vitro selection of probiotic lactobacilli:
John G. Seifert, Gregory L. Paul, and George A. Halaby.
a critical appraisal. Current Issues in Intestinal
The Effect of Fluid and Carbohydrate Feedings During
Microbiology 2000; 1(2):59-67.
Intermittent Cycling Exercise. Medicine and Science in
Morrissey, S., R. Wang, and E. R. Burke. Evaluation of Sports and Exercise, Vol.19 (1987), No. 6, pp. 597-604.
the Effects of a Complex Herbal Formulation on Lactate
Mustafa, K. Y., and N. E. Mahmoud (1979). Evaporative
Metabolism. Paper presented at the national meeting
water loss in African soccer players. J. Sports Med. Phys.
of the American College of Sports Medicine, Orlando,
Fit. 19:181-183.
Florida, June 6, 1998.
Mutch, B.J.C., and E. W. Banister. Ammonia Metabolism
Moss M. The effect of chondroitin sulfate on bone
in Exercise and Fatigue: A Review. Medicine and Science
healing. Georgetown University School of Dentistry 1965;
in Sports and Exercise, Vol.15 (1983), No.1, pp 41-50.
20(6):795-801.
N-Acetyl-L-Cysteine Monograph, Health Canada.
Mountjoy M, Alonso JM, Bergeron MF, et al.
Hyperthermic-related challenges in aquatics, athletics,
football, tennis and triathlon. Br J Sports Med.
2012;46(11): 800-804.

International Sports Sciences Association

610 | Appendix

Nagaya N, Uematsu M, Oya H, Sato N, Sakamaki F, Niacinamide Monograph, Health Canada.

Kyotani S, Ueno K, Nakanishi N, Yamagishi M, Miyatake
K. 2001. Short-term oral administration of L-arginine Nicholas, C.W., C. Williams, H.K.A. Lakomy, G.
improves hemodynamics and exercise capacity in patients Phillips, and A. Nowitz (1995). Influence of ingesting a
with precapillary pulmonary hypertension. American carbohydrate-electrolyte solution on endurance capacity
Journal of Respiratory and Critical Care Medicine during intermittent high-intensity shuttle running. J.
163(4):887-891. Sports Sci. 13:283-290.

Nair KS, Schwartz RG, Welle S (1992). Leucine as a Nicholas, C.W., P.A. Green, R.D. Hawkins, and C.
regulator of whole body and skeletal muscle protein Willliams (1997). Carbohydrate intake and recovery
metabolism in humans. American Journal of Physiology of intermittent running capacity. Int. J. Sport Nutr.
263, E928-34. 7:251-260.

Nakamura LK. Lactobacillus amylovorus, a new starch- Nickols-Richardson SM, Beiseigel JM, Gwazdauskas FC.
hydrolyzing species from cattle waste-corn fermentations. Eating restraint is negatively associated with biomarkers
International Journal of Systematic Bacteriology 1981; of bone turnover but not measurements of bone mineral
31(1):56-63. density in young women. J Am Diet Assoc. 2006;106(7):
1095-1101.
Nakamura Y, Fukuhara H, Sano K. Secreted phytase
activities of yeasts. Bioscience Biotechnology and Nicol LM1, Rowlands DS, Fazakerly R, Kellett J.
Biochemistry 2000; 64(4):841-844. Curcumin supplementation likely attenuates delayed
onset muscle soreness (DOMS). Eur J Appl Physiol. 2015
Nam SH. Genome sequence of Lactobacillus Aug;115(8):1769-77.
farciminis KCTC 3681. Journal of Bacteriology 2011;
193(7):1790-1791. Nieman DC. Physical fitness and vegetarian diets:
is there a relation? Am J Clin Nutr. 1999 Sep;70(3
Nattiv A, Loucks AB, Manore MM, et al. American Suppl):570S-575S.
College of Sports Medicine position stand. The female
athlete triad. Med Sci Sports Exerc. 2007;39(10):18671882. Nishioka K, Hidaka T, Takemoto H, Nakamura S,
Umemura T, Jitsuiki D, Soga J, Goto C, Chayama K,
Navarro, JF., et al. Randomized prospective comparison Yoshizumi M, Higashi Y. Pycnogenol®, French maritime
between erythropoietin and androgens in CAPD patients. pine bark extract, augments endothelium-dependent
Kidney Int. 2002 Apr;61(4):1537-44. vasodilation in humans. Hypertens Res 30: 775-780, 2007.

Nawrot P, Jordan S, Eastwood J, Rotstein J, Hugenholtz Nishizawa, N., M. Shimbo, S. Hareyama, and R. Funabiki.
A, Feeley M. Effects of caffeine on human health. Food Fractional Catabolic Rates of Myosin and Actin Estimated
Additives and Contaminants 2003;20(1):1-30. by Urinary Excretion of N-Methylhistidine: The Effect
of Dietary Protein Level on Catabolic Rates Under
Neuhäuser-Berthold M, Beine S, Verwied SC, Conditions of Restricted Food Intake. British Journal of
Lührmann PM. Coffee consumption and total body Nutrition, Vol. 37 (1976), pp. 345-421.
water homeostasis as measured by fluid balance and
bioelectrical impedance analysis. Annals of Nutrition and Nissen S, Sharp R, Ray M et al (1996). Effect of leucine
Metabolism 1997;41(1):29-36. metabolite beta-hydroxy-beta-methylbutyrate on muscle
metabolism during resistance-exercise training. Journal
Newsholme EA, Calder PC (1997). The proposed role of Applied Physiology 81, 2095-104.
of glutamine in some cells of the immune system and
speculative consequences for the whole animal. Nutrition Nissen, S. L. & Sharp, R. L. (2003). Effect of dietary
13, 728-30 supplements on lean mass and strength gains with
resistance exercise: a meta-analysis. J. Appl. Physiol. 94,
NHLBI. 2013. Managing Overweight and Obesity in 651-659.
Adults: Systematic Evidence Review from the Obesity
Expert Panel. Nissen, S., et al. Effect of Leucine Metabolite Beta-
Hydroxy Beta-Methylbutyrate on Muscle Metabolism
Niacin Monograph, Health Canada. During Resistance Training. Journal of Applied
Physiology, Vol. 81 (1996), pp. 2095-2104.

Sports Nutrition
 References and Glossary of Key Words | 611

Nissen, S., et al. Effects of Feeding Beta-Hydroxy Okano, Goroh, Hidekatsu Takeda, Isao Morita, Mitsuru
Beta-Methylbutyrate (BHBM) on Body Composition Katoh, Zuien Mu, and Shosuke Miyake. Effect of Pre-
in Women. Federation of American Societies of Exercise Fructose Ingestion on Endurance Performance
Experimental Biology Journal, Vol. 11 (1997), pg. A290. in Fed Men. Medicine and Science in Sports and Exercise,
Vol. 20 (1987), No. 7, pp. 105-109.
Noakes M, Foster PR, Keogh JB, James AP, Mamo
JC, Clifton PM. Comparison of isocaloric very low Okudan N, Gökbel H. 2005. The effects of creatine
carbohydrate/high saturated fat and high carbohydrate/ supplementation on performance during the repeated
low saturated fat diets on body composition and bouts of supramaximal exercise. Journal of Sports
cardiovascular risk. Nutr Metab. 2006;11;3:7 Medicine and Physical Fitness 45(4):507-512.

Noakes TD. The dehydration myth and carbohydrate Oliff, H.S. eta al. Scientific And Clinical M O N O G R
replacement during prolonged exercise. Cycling Sci 1990; A P H For Proprietary Botanical Ingredient Pycnogenol
1:23-29. (French Maritime Pine Bark Extract). American Botanical
Council.
Noordzij M, Uiterwaal CS, Arends LR, Kok FJ, Grobbee
DE, Geleijnse JM. Blood pressure response to chronic O’Neill DC, Cronin O, O’Neill SB, Woods T, Keohane
intake of coffee and caffeine: a meta-analysis of DM, Molloy MG, Falvey EC.
randomized controlled trials. Journal of Hypertension
2005;23(5):921-928. Oopik V, Paasuke M, Timpmann S, Medijainen L, Ereline
J, Gapejeva J. Effects of creatine supplementation during
Nosaka N, Suzuki Y, Nagatoishi A, Kasai M, Wu recovery from rapid body mass reduction on metabolism
J, Taguchi M. Effect of ingestion of medium-chain and muscle performance capacity in well-trained
triacylglycerols on moderate- and high-intensity exercise wrestlers. J Sports Med Phys Fitness. 2002 Sep;42(3):330-9.
in recreational athletes. J Nutr Sci Vitaminol (Tokyo).
2009 Apr;55(2):120-5. Ormsbee MJ, Bach CW, Baur DA. Preexercise nutrition:
The role of macronutrients, modified starches and
Nuviala Mateo RJ, Lapieza Lainez MG. The intake of supplements on metabolism and endurance performance.
proteins and essential amino acids in top-competing Nutrients. 2014;6(5):1782-1808.
women athletes. Nutr Hosp. 1997 Mar-Apr;12(2):85-91.
Oscai, Lawrence B., and John O. Holloszy. Effects of
Nyakayiru J, et al. Beetroot Juice Supplementation Weight Changes Produced by Exercise, Food Restriction,
Improves High-Intensity Intermittent Type Exercise or Overeating on Body Composition. Journal of Clinical
Performance in Trained Soccer Players. Nutrients. 2017 Investigation, Vol. 48 (1969), pp. 2124-2128.
Mar; 9(3): 314.
Ostojic SM. Creatine supplementation in young
O’Connor H, Slater G. Losing, gaining and making weight soccer players. Int J Sport Nutr Exerc Metab. 2004
for athletes. In: LanhamNew S, Stear S, Sherriffs M, Feb;14(1):95-103.
Collins A, eds. Sport and Exercise Nutrition. West Sussex,
UK: Wiley-Blackwell; 2011:210-232. Ostojic, S., and S. Mazic (2002). Effects of a carbohydrate-
electrolyte drink on specific soccer tests and performance.
Oben J, Kothari SC, Anderson ML. An open label study to J. Sports Sci. Med. 2:47-53.
determine the effects of an oral proteolytic enzyme system
on whey protein concentrate metabolism in healthy males. Paddon-Jones, D. J., and D. Pearson. Cost-Effectiveness
Journal of the International Society of Sports Nutrition of Pre-Exercise Carbohydrate Meals and Their Impact on
2008, 5:10. Performance. Journal of Conditioning Research, Vol. 12
(1998), pp. 90-94.
Office Of Dietary Supplements, NIH, Dietary Supplement
Professional Fact Sheets, 2017. Pallafacchina, G, et al. A protein kinase B-dependent and
rapamycin-sensitive pathway controls skeletal muscle
Oil Products, Multiple Ingredient Fixed Monograph, growth but not fiber type specification. PNAS. 2002
Health Canada. 99(14): 9213-9218.

International Sports Sciences Association

612 | Appendix

Pallarés JG, Martínez-Abellán A, López-Gullón JM, Parkhouse, W. S., and D. C. McKenzie. Possible
Morán-Navarro R, De la Cruz-Sánchez E, Mora- Contribution of Skeletal Muscle Buffers to Enhanced
Rodríguez R. Muscle contraction velocity, strength and Anaerobic Performance: A Brief Review. Medicine and
power output changes following different degrees of Science in Sports and Exercise, Vol. 16 (1984), No. 4, pp.
hypohydration in competitive olympic combat sports. J 328-338.
Int Soc Sports Nutr. 2016 Mar 8;13:10.
Parr EB, Camera DM, Areta JL, et al. Alcohol ingestion
Palmer, Warren K. Introduction to Symposium: Cyclic impairs maximal postexercise rates of myofibrillar protein
AMP Regulation of Fuel Metabolism During Exercise. synthesis following a single bout of concurrent training.
Medicine and Science in Sports and Exercise, Vol. 20 PloS ONE. 2014;9(2):e88384.
(1988), No. 6, pp. 523-524.
Parry-Billings M, Blomstrand E, Leighton B et al (1990).
Pancreatic Enzymes Monograph, Health Canada. Does endurance exercise impair glutamine metabolism?
Canadian Journal of Sport Science 13, 13P.
Pantoflickova D, Corthésy-Theulaz I, Dorta G, Stolte M,
Isler P, Rochat F, Enslen M, and Blum AL. Favourable Parry-Billings M, Budgett R, Koutedakis K et al (1992).
effect of regular intake of fermented milk containing Plasma amino acid concentrations in the overtraining
Lactobacillus johnsonii on Helicobacter pylori associated syndrome: Possible effects on the immune system.
gastritis. Alimentary Pharmacology and Therapeutics Medicine and Science in Sports and Exercise 24, 1353-8.
2003; 18(8):805-813.
Pascoe DD, Gladden LB. Muscle glycogen resynthesis
Pantothenic Acid Monograph, Health Canada. after short term, high intensity exercise and resistence
exercise. Sports Med. 1996;21:98-118.
Papain Monograph, Health Canada.
Passe, D.H., M. Horn, J. Stofan, and R. Murray (2004).
Para Aminobenzoic Acid Monograph, Health Canada. Palatability and voluntary intake of sports beverages,
diluted orange juice, and water during exercise. Int. J.
Pariza MW, Park Y, Cook ME. Mechanisms of action of
Sport Nutr. Exerc. Metab. 14:272-284.
conjugated linoleic acid: evidence and speculation. Proc
Soc Exp Biol Med 2000 Jan;223(1):8-13. Patlar S, Yalçin H, Boyali E. The effect of glycerol
supplements on aerobic and anaerobic performance
Pariza MW, Park Y, Cook ME. The biologically active
of athletes and sedentary subjects. J Hum Kinet. 2012
isomers of conjugated linoleic acid. Prog. Lipid Res.
Oct;34:69-79.
40:283-298 (2001).
Paul M La Bounty, et al. International Society of Sports
Pariza MW. 2004. Perspective on the safety and
Nutrition position stand: meal frequency. Journal of the
effectiveness of conjugated linoleic acid. The American
International Society of Sports Nutrition 2011, 8:4 (16
Journal of Clinical Nutrition 79(Supplement
March 2011)
6):1132S-1136S.
Pavlovic P. Improved endurance by use of antioxidants.
Pariza, M. Mechanism of Body Fat Reduction by
Eur Bull Drug Res 7(2): 26-29, 1999.
Conjugated Linoleic Acid. Federation of American
Societies of Experimental Biology Journal, Vol. 11 (1997), Peeling P, Sim M, Badenhorst CE, et al. Iron status and
pg. A139. the acute post-exercise hepcidin response in athletes. PloS
ONE. 2014;9(3):e93002.
Parker JO, Parker JD, Caldwell RW, Farrell B, Kaesemeyer
WH. 2002. The effect of supplemental L-arginine on Peeling P, Dawson B, Goodman C, Landers G, Trinder
tolerance development during continuous transdermal D. Athletic induced iron deficiency: New insights into the
nitroglycerin therapy. Journal of the American College of role of inflammation, cytokines and hormones. Eur J Appl
Cardiology 39(7):1199-1203 Physiol. 2008;103(4):381-391.

Pennings B, Boirie Y, Senden JM, Gijsen AP, Kuipers

H, van Loon LJ. Whey protein stimulates postprandial
muscle protein accretion more effectively than do casein
and casein hydrolysate in older men. Am J Clin Nutr.
2011;93(5): 997-1005.

Sports Nutrition
 References and Glossary of Key Words | 613

Peppermint Monograph, Health Canada. Phillips SM, Van Loon LJ. Dietary protein for athletes:
From requirements to optimum adaptation. J Sports Sci.
Périard JD, Racinais S, Knez WL, Herrera CP, Christian 2011;29(suppl 1):S29-S38.
RJ, Girard O. Coping with heat stress during match-play
tennis: does an individualised hydration regimen enhance Phillips SM. A brief review of critical processes in
performance and recovery? Br J Sports Med. 2014 Apr;48 exercise-induced muscular hypertrophy. Sports Med.
Suppl 1:i64-70. 2014;44(suppl 1): S71-S77.

Péteri Z, Teren J, Vagvolgyi C, Varga J. Ochratoxin Phillips SM. Dietary protein requirements and adaptive
degradation and adsorption caused by astaxanthin- advantages in athletes. Br J Nutr. 2012;108(suppl
producing yeasts. Food Microbiology 2007; 24(3):205-210. 2):S158-S167.

Peternelj TT, Coombes JS. Antioxidant supplementation Philp A, Hargreaves M, Baar K. More than a store:
during exercise training: Beneficial or detrimental? Sports Regulatory roles for glycogen in skeletal muscle
Med. 2011;41(12):1043-1069. adaptation to exercise. Am J Physiol Endocrinol Metab.
2012;302(11):E1343-E1351.
Petrie K, Conaglen JV, Thompson L, Chamberlain K.
Effect of melatonin on jet lag after long haul flights. Phinney SD, Bistrian BR, Evans WJ, Gervino E,
British Medical Journal 1989;298(6675):705-7 Blackburn GL. The human metabolic response to
chronic ketosis without caloric restriction: Preservation
Petrie K, Dawson AG, Thompson L, Brook R. A double- of submaximal exercise capability with reduced
blind trial of melatonin as a treatment for jet lag in carbohydrate oxidation. Metab Clin Experiment.
international cabin crew. Biological Psychiatry 1993;33(7): 1983;32(8): 769-776.
526-30
Phosphatidylserine Monograph, Health Canada.
Peyrebrune MC, Nevill ME, Donaldson FJ et al
(1998). The effects of oral creatine supplementation on Picard C, Fioramonti J, Francois A, Robinson T, Neant
performance in single and repeated sprint swimming. F, Matuchansky C. Review article: bifidobacteria as
Journal of Sports Sciences 16, 271-9. probiotic agents -- physiological effects and clinical
benefits. Alimentary Pharmacology & Therapeutics 2005;
Peyrollier K, et al. L-leucine availability regulates 22(6):495-512.
phosphatidylinositol 3-kinase, p70 kinase and glycogen
synthase-3 activity in L6 muscle cells: evidence for the Piehl, Karin. Time Course for Refilling of Glycogen Stores
involvement of the mammalian target of rapamycin in Human Muscle Fibres Following Exercise-Induced
(mTOR) pathway in the L-leucine-induced up-regulation Glycogen Depletion. Acta Physiologica Scandinavica, Vol.
of system A amino acid transport. Biochem J. 2000 Sep 90 (1974), pp. 297-302.
1;350 Pt2:361-8.
Pinkoski C, Chilibeck PD, Candow DG, Esliger D,
Pfeuffer M, Schrezenmeir J. Bioactive substances in milk Ewaschuk JB, Facci M, Farthing JP, Zello GA. 2006. The
with properties decreasing risk of cardiovascular diseases. effects of conjugated linoleic acid supplementation during
Brit. J. Nutr. 84: S155-S159 (Suppl. 1) (2000). resistance training. Medicine and Science in Sports and
Exercise 38(2):339-348.
Philip P, Taillard J, Moore N, Delord S, Valtat C, Sagaspe
P, Bioulac B. The effects of coffee and napping on night Pizza, F., et al. A Carbohydrate Loading Regimen
time highway driving: a randomized trial. Annals of Improves High Intensity, Short Duration Exercise
Internal Medicine 2006;144(11):785-791. Performance. International Journal of Sport Science
(1995), pp. 110-116.
Phillips SM, Chevalier S, Leidy HJ. Protein requirements
beyond the RDA: implications for optimizing health. Appl Plant Stanol Esters Monograph, Health Canada.
Physiol Nutr Metab. 2016 May;41(5):565-72.
Plant Sterol Esters Monograph, Health Canada.
Phillips SM, Moore DR, Tang JE. A critical examination
of dietary protein requirements, benefits, and excesses Pline KA, Smith CL. 2005. The effect of creatine intake
in athletes. Int J Sport Nutr Exerc Metab. 2007;17(suppl on renal function. The Annals of Pharmacotherapy
17):S58-S76. 39(6):1093-1096.

International Sports Sciences Association

614 | Appendix

Plioplys, Audrius V and Sigita Plioplys, Amantadine Pridmore RD, Berger B, Desiere F, Vilanova D, Barretto
and L-carnitine treatment of chronic fatigue syndrome, C, Pittet AC, Zwahlen MC, Rouvet M, Altermann E,
Neuropsychobiology Vol. 35 (1997): 16-23. Barrangou R, Mollet B, Mercenier A, Klaenhammer
T, Arigoni F, Schell MA. The genome sequence of the
Plioplys, AV and S Plioplys, Serum levels of carnitine probiotic intestinal bacterium Lactobacillus johnsonii
in chronic fatigue syndrome: clinical correlates, NCC 533. Proceedings of the National Academy
Neuropsychobiology Vol. 32 (1995): 132-139. of Sciences of the United States of America 2004;
101(8):2512-2517.
Pöchmüller M, Schwingshackl L, Colombani PC,
Hoffmann G. A systematic review and meta-analysis Pringle, JS., et al. Oxygen uptake kinetics during
of carbohydrate benefits associated with randomized moderate, heavy and severe submaximal exercise humans:
controlled competition-based performance trials.J Int Soc the influence of muscle fiber type and capillarisation. Eur
Sports Nutr. 2016 Jul 11;13:27. J Appl Physiol. 2003 May;89(3-4):289-300.
Pojednic RM, Ceglia L. The emerging biomolecular role Pritchard NR, Kalra PA. 1998. Renal dysfunction
of vitamin D in skeletal muscle. Exerc Sport Sci Rev. accompanying oral creatine supplements. The Lancet
2014;42(2):76-81. 351(9111):1252-1253.
Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, Probart CK, Bird PJ, Parker KA. Diet and athletic
and health. Nutr Rev. 2010 Aug;68(8):439-58. performance. Med Clin North Am. 1993 Jul;77(4):757-72.
Prasad, Ananda S. Role of Trace Elements in Growth and Probiotics Monograph, Health Canada.
Development. Nutrition Research (1985), pp. 295-299.
Protease, Fungal Monograph, Health Canada.
Predy GN, Goel V, Lovlin RE, Basu TK. 2006. Immune
Modulating Effects of Daily Supplementation of COLD- Prud’homme, D. C. Bouchard, C. Leblanc, F. Landry,
fX (a Proprietary Extract of North American Ginseng) and E. Fontaine. Sensitivity of Maximal Aerobic Power to
in Healthy Adults. Journal of Clinical Biochemistry and Training Is Genotype-Dependent. Medicine and Science
Nutrition 39:162-167 in Sports and Exercise, Vol. 16 (1984), No. 5, pp. 489-493.

Predy GN, Goel V, Lovlin RE, Donner A, Stitt L, Basu Psyllium - Plantago afra Monograph, Health Canada.
TK. 2005. Efficacy of an extract of North American
ginseng containing poly-furanosyl-pyranosyl-saccharides Psyllium - Plantago arenaria Monograph, Health Canada.
for preventing upper respiratory tract infections:
Psyllium - Plantago ovata Monograph, Health Canada.
a randomized controlled trial. Canadian Medical
Association 173(9):1043-1048 Pujalte J et al. Double-blind clinical evaluation of
oral glucosamine sulphate in the basic treatment of
Preen D, Dawson B, Goodman C, Beilby J, Ching S.
osteoarthrosis. Curr. Med. Res. Opin 1980; 7(2):110-114.
Creatine supplementation: a comparison of loading and
maintenance protocols on creatine uptake by human Pycnogenol®, French maritime pine bark extract,
skeletal muscle. Int J Sport Nutr Exerc Metab. 2003 augments endothelium-dependent vasodilation in
Mar;13(1):97-111. humans. Hypertens Res 30: 775-780, 2007.
Prentice, A.M. & Jebb, S.A., 2001. Beyond body mass Qiu, G. X., et al. Efficacy and safety of glucosamine sulfate
index. Obes. Rev., 2(3), pp.141–7. versus ibuprofen in patients with knee osteoarthritis.
Arzneimittelforschung 1998 May;48(5):469-474.
Prevost MC, Nelson AG, Morris GS (1997). Creatine
supplementation enhances intermittent work Quercetin Monograph, Health Canada.
performance. Research Quarterly for Exercise and Sport
68, 233-40. Quesnele JJ, Laframboise MA, Wong JJ, Kim P, Wells
GD. The effects of beta-alanine supplementation on
performance: A systematic review of the literature. Int J
Sport Nutr Exerc Metab. 2014;24(1):14-27.

Sports Nutrition
 References and Glossary of Key Words | 615

Raff M, Tholstrup T, Toubro S, Bruun JM, Lund P, Reay JL, Kennedy DO, Scholey AB. 2006. The glycaemic
Straarup EM, Christensen R, Sandberg MB, Mandrup effects of single doses of Panax ginseng in young healthy
S. 2009. Conjugated linoleic acids reduce body fat in volunteers. British Journal of Nutrition 96(4):639-642
healthy postmenopausal women. The Journal of Nutrition
39(7):1347-1352 Redondo, D.R., E.A. Dowling, B.L. Graham, A.L. Almada,
and M.H. Williams (1996). The effect of oral creatine
Rafii M1, Chapman K1, Elango R2, Campbell WW3, monohydrate supplementation on running velocity. Int. J.
Ball RO4, Pencharz PB5, Courtney-Martin G6. Dietary Sport Nutr. 6:213-221.
Protein Requirement of Men >65 Years Old Determined
by the Indicator Amino Acid Oxidation Technique Is Reess M. Botanische Untersuchungen über die
Higher than the Current Estimated Average Requirement. Alkoholgährungspilze; 1870. p.83. (in German)
J Nutr. 2016 Mar 9.
Reginster J. Effects of glucosamine sulphate on
Raman A1, Macdermid PW, Mündel T, Mann M, osteoarthritis progression: a randomized, placebo-
Stannard SR. The effects of carbohydrate loading 48 hours controlled clinical trial. Lancet 2001; 357(9252):251-256.
before a simulated squash match. Int J Sport Nutr Exerc
Rehrer NJ, van Kemenade M, Meester W, Brouns F, Saris
Metab. 2014 Apr;24(2):157-65.
WH. Gastrointestinal complaints in relation to dietary
Ramnani P, Gaudier E, Bingham M, van Bruggen P, intake in triathletes. Int J Sports Nutr. 1992;2(1):48-59.
Tuohy KM, Gibson GR. Prebiotic effect of fruit and
Reichelt A, Forster K, Fisher M, et al. Efficacy and safety
vegetable shots containing Jerusalem artichoke inulin: a
of intramuscular glucosamine sulfate in osteoarthritis of
human intervention study. British Journal of Nutrition
the knee. A randomised, placebo-controlled, double-blind
2010;104(2):233-240.
study. Arzneimittelforschung 1994;44:75-80.
Rankin JW. Glycemic index and exercise metabolism.
Reid G, Jass J, Sebulsky MT, McCormick JK. Potential
Sport Sci Exch.1997;10(1):1-8.
uses of probiotics in clinical practice. Clinical
Rasmusen M, Karlson J. Diet and muscle glycogen Microbiology Reviews 2003; 16(4):658-672.
concentration in relation to physical performance
Reid G. Minireview- The scientific basis for probiotic
in Swedish elite ice hockey players. Int J Sport Nutr.
strains of Lactobacillus. Applied and Environmental
1996;6:272-284.
Microbiology 1999; 65(9):3763-3766.
Rasmussen RB, Phillips SM. (2003). Contractile and
Rennie MJ (1996). Glutamine metabolism and transport
nutritional regulation of human muscle growth. Exerc.
in skeletal muscle and heart and their clinical relevance.
Sport Sci. Rev. 31:127-131.
Journal of Nutrition 126(4), 1142S-9S.
Rawson ES, Clarkson PM, Price TB, Miles MP.
Rennie MJ, Tadros L, Khogali S et al (1994). Glutamine
Differential response of muscle phosphocreatine to
transport and its metabolic effects. Journal of Nutrirtion
creatine supplementation in young and old subjects. Acta
124, 1503S-8S.
Physiol Scand. 2002 Jan;174(1):57-65.
Rhodiola Monograph, Health Canada.
Rawson, E. S. & Volek, J. S. (2003). The effects of creatine
supplementation and resistance training on muscle Riboflavin Monograph, Health Canada.
strength and weight-lifting performance. J. Strength
Cond. Res. 17, 822-831. Rico-Sanz, J, W.R. Frontera, M.A. Rivera, A. Rivera-
Brown, P.A. Mole, and C.N. Meredith (1996). Effects
Rawson, E. S., Gunn, B. & Clarkson, P. M. (2001). The of hyperhydration on total body water, temperature
effects of creatine supplementation on exercise-induced regulation and performance of elite young soccer players
muscle damage. J. Strength Cond. Res. 15, 178-184. in a warm climate. Int J Sports Med. 17:85-91.
Reay JL, Kennedy DO, Scholey AB. 2006. Effects of Rico-Sanz, J., W.R. Frontera, P.A. Mole, M.A. Rivera, A.
Panax ginseng, consumed with and without glucose, Rivera-Brown, and C.N. Meredith (1998). Dietary and
on blood glucose levels and cognitive performance performance assessment of elite soccer players during a
during sustained ‘mentally demanding’ tasks. Journal of period of intense training. Int. J. Sport Nutr. 8:230-240.
Psychopharmacology 20(6):771-781

International Sports Sciences Association

616 | Appendix

Rindone J, Hiller D, Collacott E, et al. Randomized, Rohdewald P. A review of the French maritime pine bark
controlled trials of glucosamine for treating osteoarthritis extract (Pycnogenol®), a herbal medication with a diverse
of the knee. West J Med 2000;172:91-4. pharmacology. Int J Clin Pharmacol Ther 40: 158-168,
2002.
Rivera-Espinoza Y, Muriel P. 2009. Pharmacological
actions of curcumin in liver diseases or damage. Liver Rolfe RD. The role of probiotic cultures in the control
International 29(10):1457-1466. of gastrointestinal health. Journal of Nutrition 2000;
130(Supplement 2S):396S-402S.
Roberfroid M. Prebiotics: The Concept Revisited. The
Journal of Nutrition 2007b;137:830S-837S. Romer LM, Barrington JP, Jeukendrup AE. Effects of oral
creatine supplementation on high intensity, intermittent
Roberfroid MB. Inulin-type fructans: functional exercise performance in competitive squash players. Int J
food ingredients. The Journal of Nutrition Sports Med. 2001 Nov;22(8):546-52.
2007a;137:2493S-2502S.
Romieu, Isabelle, Walter C. Willett, Meir J. Stampfer,
Roberts PA1, Fox J1, Peirce N1, Jones SW1, Casey Graham A. Colditz, Laura Sampson, Bernard Rosner,
A2, Greenhaff PL3,4. Creatine ingestion augments Charles Hennekens, and Frank E. Speizer. Energy Intake
dietary carbohydrate mediated muscle glycogen and Other Determinants of Relative Weight. American
supercompensation during the initial 24 h of recovery Journal of Clinical Nutrition, Vol. 47 (1988), pp. 406-412.
following prolonged exhaustive exercise in humans.
Amino Acids. 2016 May 19. Ronca, L., et al. Anti-inflammatory activity of chondroitin
sulfate. Osteoarthritis and Cartilage 1998; 6 Supp:14-21.
Roberts, MD., et al. Effects of arachidonic acid
supplementation on training adaptations in resistance- Roos S, Karner F, Axelsson L, Jonsson H. Lactobacillus
trained males. Journal of the International Society of mucosae sp. nov., a new species with in vitro mucus-
Sports Nutrition 2007, 4:21. binding activity isolated from pig intestine. International
Journal of Systematic and Evolutionary Microbiology
Robertson, R. J., R. T. Stanko, F. L. Goss, et al. Blood 2000; 50(Part 1):251-258.
Glucose Extraction as a Mediator of Perceived Exertion
During Prolonged Exercise. European Journal of Applied Rosenfeldt FL, Haas SJ, Krum H, Hadj A, Ng K, Leong
Physiology, Vol. 61 (1990), pp. 100-105. JY, Watts GF. Coenzyme Q10 in the treatment of
hypertension: a meta-analysis of the clinical trials. Journal
Robles Alonso V, Guarner F. Linking the gut microiota of Human Hypertension 2007;21(4):297-306.
to human health. British Journal of Nutrition 2013;
109(Supplement 2):S21-26. Roy BD, Tarnopolsky MA (1998). Influence of differing
macronutrient intakes on muscle glycogen resynthesis
Roche HM, Noone E, Nugent A, Gibney MJ. Conjugated after resistance exercise. Journal of Applied Physiology 84,
linoleic acid: a novel therapeutic nutrient Nutr. Res. Rev. 890-96.
14:173-187 (2001).
Roy BD, Tarnopolsky MA, MacDougall JD et al (1997).
Rodriguez NR, Vislocky LM, Gaine PC. Dietary Effect of glucose supplementation timing on protein
protein, endurance exercise, and human skeletal-muscle metabolism after resistance training. Journal of Applied
protein turnover. Curr Opin Clin Nutr Metab Care. Physiology 82, 1882-88.
2007;10(1):40-45.
Roza AM, Shizgal HM. The Harris Benedict equation
Roedde S, MacDougall JD, Sutton JR, Green HJ. reevaluated: Resting energy requirements and the body
Supercompensation of muscle glycogen in trained cell mass. Am J Clin Nutr. 1984;40(1):168-182.
and untrained subjects. Can J Appl Sport Sci. 1986
Mar;11(1):42-6. Rozen TD, Oshinsky ML, Gebeline CA, Bradley KC,
Young WB, Shechter AL, Silberstein SD. Open label trial
Rohde T, Asp S, MacLean DA et al (1998). Competitive of coenzyme Q10 as a migraine preventative. Cephalgia
sustained exercise in humans, lymphokine activated 2002;22(2):137-141.
killer cell activity, and glutamine--an intervention study.
European Journal of Applied Physiology 78, 448-53.

Sports Nutrition
 References and Glossary of Key Words | 617

Rubin, M. A., et al. Acute and Chronic Resistive Exercise Santos DA, Dawson JA, Matias CN, et al. Reference values
Increase Urinary Chromium Excretion in Men as for body composition and anthropometric measurements
Measured With an Enriched Chromium Stable Isotope. in athletes. PloS ONE. 2014;9(5):e97846.
Journal of Nutrition, Vol. 128 (1998), pp. 73-78.
Satabin, Pascale, Pierre Portero, Gilles Defer, Jacques
Rudakewich M, Ba F, Benishin CG. 2001. Neurotrophic Bricout, and Charles-Yannick Guezennec. Metabolic and
and neuroprotective actions of ginsenosides Rb(1) and Hormonal Responses to Lipid and Carbohydrate Diets
Rg(1). Planta Medica 67(6):533-537 During Exercise in Man. Medicine and Science in Sports
and Exercise, Vol. 19 (1987), No. 3, pp. 218-223. Saudek,
Ruohola JP, Laaksi I, Ylikomi T, et al. Association Christopher D. The Metabolic Events of Starvation.
between serum 25(OH)D concentrations and bone stress American Journal of Medicine, Vol. 60 (1976), pp. 117-126.
fractures in Finnish young men. J Bone Mineral Res. Saunders MJ et al. (2004). Effects of a carbohydrate-
2006;21(9):1483-1488. protein beverage on cycling endurance and muscle
damage. Med Sci Sports Exerc. 36:1233-1238.
Rutin Monograph, Health Canada.
Satoskar RR, Shah SJ, Shenoy SG. 1986. Evaluation of
Sack RL, Brandes RW, Kendall AR, Lewy AJ. Entrainment
anti-inflammatory property of curcumin (diferuloyl
of free-running circadian rhythms by melatonin in blind
methane) in patients with postoperative inflammation.
people. New England Journal of Medicine 2000;343
International Journal of Clinical Pharmacology, Therapy
(15):1070-7
and Toxicology 24(12):651-654.
Sack RL, Lewy AJ, Blood ML, Stevenson J, Keith LD.
Saw Palmetto Monograph, Health Canada.
Melatonin administration to blind people: phase advances
and entrainment. Journal of Biological Rhythms Saw palmetto, liposterolic extract Monograph, Health
1991;6(3):249-61 Canada.
Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain
SD, McManus K, Champagne CM, Bishop LM, Laranjo N, SJ, Stachenfeld NS. American College of Sports Medicine
Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, position stand. Exercise and fluid replacement. Med Sci
Obarzanek E, Williamson DA. Comparison of weight- Sports Exerc. 2007 Feb;39(2):377-90.
loss diets with different compositions of fat, protein, and
carbohydrates. N Engl J Med. 2009;360(9):859-73 Sawka, M.N., Burke, L.M., Eichner, E.R. et al, American
College of Sports Medicine position stand. Exercise and
Saitoh, Shin-ichi, Yutaka Yoshitake, and Masahige fluid replacement. Med Sci Sports Exerc. 2007;39:377–390.
Suzuki. Enhanced Glycogen Repletion in Liver and
Skeletal Muscle With Citrate Orally Fed After Exhaustive Sawynok J. Pharmacological rationale for the clinical use
Treadmill Running and Swimming. Journal of Nutritional of caffeine. Drugs 1995;49(1):37-50.
Science and Vitaminology, Vol. 29 (1983), pp. 45-52.
Scaglione F, Cattaneo G, Alessandria M, Cogo R. 1996.
Salleo, Alberto, Guiseppe Anastasi, Guiseppa LaSpada, Efficacy and safety of the standardized ginseng extract
Guiseppina Falzea, and Maria G. Denaro. New Muscle G115 for potentiating vaccination against common cold
Fiber Production During Compensatory Hypertrophy. and/or influenza syndrome. Drugs Under Experimental
Medicine and Science in Sports and Exercise, Vol. 12 and Clinical Research 22(2):65-72
(1980), No. 4, pp. 268-273.
Schalch, Don S. The Influence of Physical Stress and
Sandage, B. W., L. A. Sabounjian, R. White, et al. Choline Exercise on Growth Hormone and Insulin Secretion in
Citrate May Enhance Athletic Performance. Physiologist, Man. Journal of Laboratory and Clinical Medicine, Vol.
Vol. 35 (1992), pg. 236a. 69 (1967), No. 2, pp. 256-267.

Sandor PS, Di Clemente L, Coppola G, Saenger U, Fumal Scheett, T. P., et al. Effectiveness of Glycerol As a
A, Magis D, Seidel L, Agosti RM, Schoenen J. Efficacy of Rehydrating Agent. International Journal of Sport
coenzyme Q10 in migraine prophylaxis: a randomized Nutrition and Exercise Metabolism, 2001, 11, 63-71.
controlled trial. Neurology 2005;64(4):713-715.

International Sports Sciences Association

618 | Appendix

Schillinger U. Isolation and identification of lactobacilli Seida JK, Durec T, Kuhle S. North American (Panax
from novel-type probiotic and mild yoghurts and their quinquefolius) and Asian Ginseng (Panax ginseng)
stability during refrigerated storage. International Journal Preparations for Prevention of the Common Cold in
of Food Microbiology 1999; 47(1-2):79-87. Healthy Adults: A Systematic Review. Evidence-based
complementary and alternative medicine 2011.
Schleifer KH, Kilpper-Bälz R. Transfer of streptococcus
faecalis and streptococcus faecium to the genus Selenium Monograph, Health Canada.
enterococcus nom. rev. as enterococcus faecalis comb.
nov. and enterococcus faecium comb. nov. International Selsby JT, Beckett KD, Kern M, Devor ST. Swim
Journal of Systematic Bacteriology 1984; 34(1):31-34. performance following creatine supplementation in
Division III athletes. J Strength Cond Res. 2003 Aug;
Schmid, B., R. Ludtke, H.K. Selbmann, I. Kotter, B. 17(3):421-4.
Tschirdewahn, W. Schaffner, and L. Heide (2001). Efficacy
and tolerability of a standardized willow bark extract Selsby JT, DiSilvestro RA, Devor ST. Mg2+-creatine
in patients with osteoarthritis: randomized, placebo- chelate and a low-dose creatine supplementation regimen
controlled, double-blind clinical trial. Phytother. Res. improve exercise performance. J Strength Cond Res. 2004
15:344-350. May;18(2):311-5.

Schoenfeld BJ, Ratamess NA, Peterson MD, Contreras B, Sen, C., et al. Oxidative Stress After Human Exercise:
Sonmez GT, Alvar BA. Effects of different volumeequated Effect of N-Acetylcysteine Supplementation. Journal of
resistance training loading strategies on muscular Applied Physiology, Vol. 76 (1994), pp. 2570-2577.
adaptations in well-trained men. J Strength Condition
Sengun IY, Nielsen DS, Karapinar M, Jakobsen M.
Res. 2014;28(10):2909-2918.
Identification of lactic acid bacteria isolated from tarhana,
Scholey AB, Kennedy DO. 2002. Acute, dose-dependent a traditional turkish fermented food. International
cognitive effects of Ginkgo biloba, Panax ginseng Journal of Food Microbiology 2009; 135(2):105-111.
and their combination in healthy young volunteers:
Senna Monograph, Health Canada.
differential interactions with cognitive demand. Human
Psychopharmacology 17(1):35-44 Setnikar I et al. Antiarthritic effects of glucosamine
sulfate studied in animal models, Arzmelm-Forch/Drug
Schulten, B., M. Bulitta, B. Ballering-Bruhl, U.
Res 1991; 41(5):541-545.
Koster, and M. Schafer (2001). Efficacy of Echinacea
purpurea in patients with a common cold. A placebo- Shao A, Hathcock JN. Risk assessment for the amino
controlled, randomized, double-blind clinical trial. acids taurine, L-glutamine and L-arginine. Regul Toxicol
Arzneimittelforschung 51:563-568. Pharmacol. 2008 Apr;50(3):376-99. Epub 2008 Jan 26
Sciberras JN1, Galloway SD2, Fenech A3, Grech Sharp, R. Less Pain, More Gain for Distance Runners on
G4, Farrugia C5, Duca D5, Mifsud J3. The effect of HMB. Presented at the national meeting of Experimental
turmeric (Curcumin) supplementation on cytokine Biology, San Francisco, CA, 1998.
and inflammatory marker responses following 2 hours
of endurance cycling. J Int Soc Sports Nutr. 2015 Jan Shaw, P. C. The Use of a Trypsin-Chymotrypsin
21;12(1):5. Formulation in Fractures of the Hand. The British Journal
of Clinical Practice, Vol. 23 (January 1969), pp. 25-26.
Scimeca JA, Miller GD. Potential health benefits of
conjugated linoleic acid. J. Am. Coll. Nutr. 19:470S-471S Sheikh, MM, et al. The effect of Permixon on androgen
(2000). receptors. Acta Obstet. Gynecol. Scand. 1988; 67(5):
397-399.
Scott, C. Misconceptions about Aerobic and Anaerobic
Energy Expenditure. J. International Society of Sports Shephard RJ, Shek PN. Immunological hazards from
Nutrition. 2(2):32-37, 2005. nutritional imbalance in athletes. Exerc Immunol
Rev. 1998;4:22-48. Tarnopolsky MA, Atkinson SA,
Sedlock DA. The latest on carbohydrate loading: MacDougall JD, Chesley A, Phillips S, Schwarcz HP.
a practical approach. Curr Sports Med Rep. 2008 Evaluation of protein requirements for trained strength
Jul-Aug;7(4):209-13. athletes. J Appl Physiol. 1992 Nov;73(5):1986-95.

Sports Nutrition
 References and Glossary of Key Words | 619

Shephard RJ, Shek PN. Immunological hazards from Siani A, Pagano E, Iacone R, Iacoviello L, Scopacasa F,
nutritional imbalance in athletes. Exerc Immunol Rev. Strazzullo P. 2000. Blood pressure and metabolic changes
1998;4:22-48. during dietary L-arginine supplementation in humans.
American Journal of Hypertension 13(5):547-551
Sheppard, H. L., Raichada, S. M., Kouri, K. M., Stenson-
Bar-Maor, L. & Branch, J. D. (2000). Use of creatine and Sim M, Dawson B, Landers G, Trinder D, Peeling P.
other supplements by members of civilian and military Iron regulation in athletes: Exploring the menstrual
health clubs: a cross-sectional survey. Int. J. Sport Nutr. cycle and effects of different exercise modalities on
Exerc. Metab. 10, 245-259. hepcidin production. Int J Sport Nutr Exerc Metab.
2014;24(2):177-187.
Sherman, W.M., and D.L. Costill (1984). The marathon:
dietary manipulation to optimize performance. Am. J. Simard C. Tremblay A, Jobin M. Effects of carbohydrate
Sports Med. 12:44-51. intake before and during an ice hockey game on
blood and muscle energy substrates. Research Qtly.
Shi, X., R.W. Summers, H.P. Schedl, S.W. Flanagan, R. 1988;59:144-147.
Chang, and C.V. Gisolfi (1995). Effects of carbohydrate
type and concentration and solution osmolality on water Simoneau, J.-A., G. Lortie, M. R. Boulay, M. Marcotte,
absorption. Med. Sci. Sports Exerc. 27:1607-1615. M.-C. Thibault, and C. Bouchard. Human Skeletal Muscle
Fiber Type Alteration With High-Intensity Intermittent
Shick, Siao Mei, et al., Persons successful at long-term Training. European Journal of Applied Physiology, Vol. 54
weight loss and maintenance continue to consume a (1985), pp. 250-253.
low-energy, low-fat diet, Journal of the American Dietetic
Association Vol. 98, No. 4 (April 1998): 408-413. Simon-Schnass, I., and H. Pabst. Influence of Vitamin
E on Physical Performance. International Journal of
Shigenaga, Mark K, Tory M Hagen, and Bruce N Ames, Vitamin Nutrition Research (1987), pp. 49-54.
Oxidative damage and mitochondrial decay in aging,
Proceedings of the National Academy of Sciences in the Singh RB, Niaz MA, Rastogi SS, Shukla PK, Thakur AS.
USA Vol. 91 (1994): 10771-10778. Effect of hydrosoluble coenzyme Q10 on blood pressures
and insulin resistance in hypertensive patients with
Shirley DG, Walter SJ, Noormohamed FH. coronary artery disease. Journal of Human Hypertension
Natriuretic effect of caffeine: assessment of segmental 1999;13(3):203-208.
sodium reabsorption in humans. Clinical Science
2002;103(5):461-466. Singh, RB, et al., A randomized, double-blind, placebo-
controlled trial of L-carnitine in suspected acute
Shirreffs SM, Sawka MN. Fluid and electrolyte needs myocardial infarction, Postgraduate Medical Journal 72:
for training, competition, and recovery. J Sports Sci. (1996): 45-50.
2011;29(suppl 1):S39-S46.
Sinha A, Hollingsworth KG, Ball S, Cheetham T.
Shirreffs, S.M., A.J. Taylor, J.B. Leiper, and R.J. Maughan Improving the vitamin D status of vitamin D deficient
(1996). Postexercise rehydration in man: effects of volume adults is associated with improved mitochondrial
consumed and drink sodium content. Med. Sci. Sports oxidative function in skeletal muscle. J Clin Endocrinol
Exerc. 28:1260-1271. Metab. 2013;98(3): E509-E513.
Shulman SP, Becker LC, Kass DA, Champion HC, Terrin Sivonova M et al. The effect of Pycnogenol® on the
ML, Forman S, Ernst KV, Kelemen MD, Townsend SN, erythrocyte membrane fluidity. Gen Physiol Biophys 23:
Capriotti A, Hare JM, Gerstenblith G. 2006. L-Arginine 39-51, 2004.
therapy in acute myocardial infarction: the vascular
interaction with age in myocardial infarction (VINTAGE Skare OC, Skadberg, Wisnes AR. Creatine
MI) randomised clinical trial. Journal of American supplementation improves sprint performance in male
Medical Association 295(1): 58-64. sprinters. Scand J Med Sci Sports. 2001 Apr;11(2):96-102.

Shytle, RD. Oxidative stress of neural, hematopoietic, Skene DJ, Lockley SW, Arendt J. Melatonin in circadian
and stem cells: protection by natural compounds. sleep disorders in the blind. Biological Signals and
Rejuvenation Research 2007, 10(2):173-178. Receptors 1999;8(1-2):90-5

International Sports Sciences Association

620 | Appendix

Skerman VBD, McGowan V, Sneath PHA. Approved lists Spiering BA, Kraemer WJ, Vingren JL, Hatfield DL,
of bacterial names. International Journal of Systematic Fragala MS, Ho J-Y, Maresh CM, Anderson JM, Volek JS.
Bacteriology 1980; 30(1):225-420. Responses of criterion variables to different supplemental
doses of L-carnitine L-tartrate. Journal of Strength and
Slater G, Rice A, Jenkins D, Hahn A. Body mass Conditioning Research 2007;21:259-264.
management of lightweight rowers: Nutritional strategies
and performance implications. Br J Sports Med. Spiller, G. A., C. D. Jensen, T. S. Pattison, C. S. Chuck,
2014;48(21):1529-1533. J. H. Whittam, and J. Scala. Effect of Protein Dose on
Serum Glucose and Insulin Response to Sugars. American
Smedman A, Basu S, Jovinge S, Fredrikson GN, Vessby Journal of Clinical Nutrition, Vol. 46 (1987), pp. 474-480.
B. 2005. Conjugated linoleic acid increased C-reactive
protein in human subjects. British Journal of Nutrition Spirulina Monograph, Health Canada.
94(5):791-795.
Spriet LL. New insights into the interaction of
Smith A, Sutherland D, Christopher G. Effects of repeated carbohydrate and fat metabolism during exercise. Sports
doses of caffeine on mood and performance of alert and Med. 2014;44(suppl 1):S87-S96.
fatigued volunteers. Journal of Psychopharmacology
2005;19(6):620-626 Srimal R, Dhawan B. 1973. Pharmacology of diferuloyl
methane (curcumin), a non-sterodal anti-inflammatory
Smith SA, Montain SJ, Matott RP et al (1998). Creatine agent. Journal of Pharmacy and Pharmacology
supplementation and age influence muscle metabolism 25:447-452.
during exercise. Journal of Applied Physiology 85,
1349-56. St. John’s Wort - Oral - Hydroalcoholic Extract
Monograph, Health Canada.
Snyder, DS and Desforges JF. Lipoxygenase metabolites
of arachidonic acid modulate hematopoiesis. Blood. 1986 St. John’s Wort – Oral Monograph, Health Canada.
Jun;67(6):1675-1679.
Stanko, R. T., A. Mitrakou, et al. Effect of
Soares, M. J., et al. The Effect of Exercise on Riboflavin Dihydroxyacetone and Pyruvate on Plasma Glucose
Status of Adult Men. British Journal of Nutrition, Vol. 69 Concentration and Turnover in Noninsulin-Dependent
(1993), pp. 541-551. Diabetes Mellitus. Clinical Physiology and Biochemistry
(1990), pp. 283-288.
Sommerfield LM1, McAnulty SR, McBride JM, Zwetsloot
JJ, Austin MD, Mehlhorn JD, Calhoun MC, Young JO, Stanko, R. T., H. Reiss Reynolds, et al. Pyruvate
Haines TL, Utter AC. Validity of Urine Specific Gravity Supplementation of a Low-Cholesterol, Low-Fat Diet:
When Compared With Plasma Osmolality as a Measure Effects on Plasma Lipid Concentrations and Body
of Hydration Status in Male and Female NCAA Collegiate Composition in Hyperlipidemic Patients. American
Athletes. J Strength Cond Res. 2016 Aug;30(8):2219-25. Journal of Clinical Nutrition, Vol. 59 (1994), pp. 423-427.

Soy Flour Monograph, Health Canada. Stanko, R. T., R. J. Robertson, R. J. Spina, et al.
Enhancement of Arm Exercise Endurance Capacity With
Soybean Extracts and Isolates Monograph, Health Dihydroxyacetone and pyruvate. Journal of Applied
Canada. Physiology, Vol. 68 (1990), pp. 119-124.

Spector, S. A., M. R. Jackman, L. A. Sabounjian, et al. Stanko, R. T., R. J. Robertson, R. W. Galbreath, et

Effects of Choline Supplementation on Fatigue in Training al. Enhanced Leg Exercise Endurance With a High
Cyclists. Medicine and Science in Sports and Exercise, Carbohydrate Diet and Dihydroxyacetone and Pyruvate.
Vol. 27 (1995), pp. 669-673. Journal of Applied Physiology, Vol. 69 (1990), pp.
1651-1656.
Spiering BA, Kraemer WJ, Hatfield DL, Vingren JL,
Fragala MS, Ho J-Y, Thomas GA, Hakkinen K, Volek Stanton, R. & Abt, G. A. (2000). Creatine monohydrate
JS. Effects of L-carnitine L-tartrate supplementation on use among elite Australian Power lifters. J. Strength Cond.
muscle oxygenation responses to resistance exercise. Res. 14, 322-327.
Journal of Strength and Conditioning Research
2008;22(4):1130-1135.

Sports Nutrition
 References and Glossary of Key Words | 621

Steck SE, Chalecki AM, Miller P, Conway J, Austin GL, St-Onge MP1, Bosarge A. Weight-loss diet that includes
Hardin JW, Albright CD, Thuillier P. 2007. Conjugated consumption of medium-chain triacylglycerol oil leads to
linoleic acid supplementation for twelve weeks increases a greater rate of weight and fat mass loss than does olive
lean body mass in obese humans. The Journal of Nutrition oil. Am J Clin Nutr. 2008 Mar;87(3):621-6.
137(5):1188-1193.
St-Onge MP1, Jones PJ. Physiological effects of medium-
Steenge, G. R., Lambourne, J., Casey, A., Macdonald, I. A. chain triglycerides: potential agents in the prevention of
& Greenhaff, P. L. (1998). Stimulatory effect of insulin on obesity. J Nutr. 2002 Mar;132(3):329-32.
creatine accumulation in human skeletal muscle. Am. J.
Physiol. 275, E974-979. Stout JR, Echerson J, Noonan D et al (1999). The effects
of a supplement designed to augment creatine uptake on
Steenge, G. R., Simpson, E. J. & Greenhaff, P. L. (2000). exercise performance and fat free mass in football players.
Protein- and carbohydrate-induced augmentation of Nutrition Research 19, 217-25.
whole body creatine retention in humans. J. Appl. Physiol.
89, 1165-1171. Suhner A, Schlagenhauf P, Johnson R, Tschopp A, Steffen
R. Comparative study to determine the optimal melatonin
Steffes GD, Megura AE, Adams J, et al. Prevalence of dosage form for the alleviation of jet lag. Chronobiology
metabolic syndrome risk factors in high school and International 1998a;15(6):655-6
NCAA division I football players. J Strength Conditiong
Res. 2013;27(7):1749-1757. Suhner A, Schlagenhauf P, Tschopp A, Hauri-Bionda
R, Friedrich-Koch A, Steffen R. Impact of melatonin
Steinberger, J. et al., 2005. Comparison of body fatness on driving performance. Journal of Travel Medicine
measurements by BMI and skinfolds vs dual energy X-ray 1998b;5(1):7-13
absorptiometry and their relation to cardiovascular risk
factors in adolescents. Int. J. Obes., 29(11), pp.1346–1352. Sun FH1, Wong SH2, Chen SH3, Poon TC4. Carbohydrate
electrolyte solutions enhance endurance capacity in active
Stellingwerff T, Cox GR. Systematic review: Carbohydrate females. Nutrients. 2015 May 15;7(5):3739-50.
supplementation on exercise performance or capacity
of varying durations. Appl Physiol Nutr Metab. Sun, Q. et al., 2010. Comparison of dual-energy x-ray
2014;39(9):998-1011. absorptiometric and anthropometric measures of
adiposity in relation to adiposity-related biologic factors.
Stellingwerff T, Maughan RJ, Burke LM. Nutrition for Am. J. Epidemiol., 172(12), pp.1442–1454.
power sports: Middledistance running, track cycling,
rowing, canoeing/kayaking, and swimming. J Sport Sci. Sundgot-Borgen J, Garthe I. Elite athletes in aesthetic and
2011;29(suppl 1):S79-S89. Olympic weight-class sports and the challenge of body
weight and body compositions. J Sport Sci. 2011;29(suppl
Stellingwerff T, Spriet LL, Watt MJ, et al. Decreased PDH 1):S101-S114.
activation and glycogenolysis during exercise following fat
adaptation with carbohydrate restoration. Am J Physiol Sünram-Lea SI, Birchall RJ, Wesnes KA, Petrini O. 2005.
Endocrinol Metab. 2006;290(2):E380-E388. The effect of acute administration of 400 mg of Panax
ginseng on cognitive performance and mood in healthy
Stellingwerff T. Contemporary nutrition approaches to young volunteers. Current Topics in Nutraceutical
optimize elite marathon performance. Int J Sports Physiol Research 3(1):65-74
Perform. 2013;8(5):573-578.
Surawicz CM, Elmer GW, Speelman P, McFarland LV,
Stephens FB, Constantin-Teodosiu D, Greenhaff PL. Chinn J, van Belle G. Prevention of antibiotic-associated
New insights concerning the role of carnitine in the diarrhea by Saccharomyces boulardii: a prospective study.
regulation of fuel metabolism in skeletal muscle. Journal Gastroenterology 1989; 96(4):981-988.
of Physiology 2007;581.2:431-444.
Sydow K, Schwedhelm E, Arakawa N, Bode-Böger SM,
Stickler L, Hoogenboom BJ, Smith L. THE FEMALE Tsikas D, Hornig B, Frölich, Böger RH. 2002. ADMA
ATHLETE TRIAD-WHAT EVERY PHYSICAL and oxidative stress are responsible for endothelial
THERAPIST SHOULD KNOW. Int J Sports Phys Ther. dysfunction in hyperhomocyst(e)inemia: effects of
2015 Aug;10(4):563-71. L-arginine and B vitamins. Cardiovascular Research
57:244-252.

International Sports Sciences Association

622 | Appendix

Syrotuik, D. G., Bell, G. J., Burnham, R., Sim, L. L., Tay J, Brinkworth GD, Noakes M, Keogh J, Clifton
Calvert, R. A. & MacLean, I. M. (2000). Absolute PM. Metabolic effects of weight loss on a very-low-
and relative strength performance following creatine carbohydrate diet compared with an isocaloric high-
monohydrate supplementation combined with periodized carbohydrate diet in abdominally obese subjects. J Am
resistance training. J. Strength Cond. Res. 14, 182-190. Coll Cardiol. 2008;51(1):59-67

Szolomicki S, Samochowiec L, Wójcicki J, Drozdzik M. Taylor JS, Williams SR, Rhys R, James P, Frenneaux
The influence of active components of Eleutherococcus MP. 2006. Conjugated linoleic acid impairs endothelial
senticosus on Cellular Defence and Physical Fitness in function. Arteriosclerosis, Thrombosis, and Vascular
Man. Phytotherapy Research. 2000;14(1)30-35. Biology 26(2):307-312.

Tang JE, Lysecki PJ, Manolakos JJ, MacDonald Terrillion KA, Kolkhorst FW, Dolgener FA et al (1997).
MJ, Tarnopolsky MA, Phillips SM. Bolus arginine The effect of creatine supplementation on two 700-m
supplementation affects neither muscle blood flow nor maximal running bouts. International Journal of Sports
muscle protein synthesis in young men at rest or after Nutrition 7, 138-43.
resistance exercise. J Nutr. 2011 Feb;141(2):195-200. doi:
10.3945/jn.110.130138. Epub 2010 Dec 29. Teruel, JL., et al. Androgen therapy for anaemia of chronic
renal failure. Indications in the erythropoietin era. Scan J
Tangphao O, Chalon S, Moreno HJr, Hoffman BB, Urol Nephrol. 1996 Oct;30(5):403-8.
Blaschke TF. 1999. Pharmacokinetics of L-arginine
during chronic administration to patients with Tesch, Per, et al. Skeletal Muscle Glycogen Loss Evoked by
hypercholesterolaemia. Clinical Science 96:199-207. Resistance Exercise. Journal of Strength and Conditioning
Research, Vol. 12 (1998), pp. 67-73.
Tarnopolsky MA, Atkinson SA, MacDougall JD, Chesley
A, Phillips S, Schwarcz HP. Evaluation of protein Theanine Monograph, Health Canada.
requirements for trained strength athletes. J Appl Physiol.
Thein-Nissenbaum J1. Long term consequences of the
1992 Nov;73(5):1986-95.
female athlete triad. Maturitas. 2013 Jun;75(2):107-12.
Tarnopolsky MA, Atkinson SA, Phillips SM, MacDougall
Thiamine Monograph, Health Canada.
JD. Carbohydrate loading and metabolism during exercise
in men and women. J Appl Physiol. 1995;78:1360-1368. Tholstrup T, Raff M, Straarup EM, Lund P, Basu S, Bruun
JM. 2008. An oil mixture with trans-10, cis-12 conjugated
Tarnopolsky MA, Bosman M, Macdonald JR, Vandeputte
linoleic acid increases markers of inflammation and in
D, Martin J, Roy BD. Postexercise protein-carbohydrate
vivo lipid peroxidation compared with cis-9, trans-11
and carbohydrate supplements increase muscle
conjugated linoleic acid in postmenopausal women. The
glycogen in men and women. J Appl Physiol. 1997
Journal of Nutrition 138(8):1445-1451.
Dec;83(6):1877-83.
Thomas DE, Brotherhood JR, Brand JC. Carbohydrate
Tarnopolsky MA, MacLennan DP. Creatine monohydrate
feeding before exercise: Effect of glycemic index. Int J
supplementation enhances high-intensity exercise
Sports Med. 1991;12(2):180-186.
performance in males and females. Int J Sport Nutr Exerc
Metab 2000 Dec;10(4):452-63. Thomas DM, Martin CK, Lettieri S, et al. Can a weight
loss of one pound a week be achieved with a 3500-kcal
Tarnopolsky MA. Caffeine and creatine use in sport. Ann
deficit? Commentary on a commonly accepted rule. Int J
Nutr Metab. 2010;57(suppl 2):1-8.
Obes (Lond). 2013;37(12): 1611-1613.
Tarnopolsky MA. Creatine as a therapeutic strategy for
Thomas DT, et al. Position of the Academy of Nutrition
myopathies. Amino Acids. 2011 May;40(5):1397-407. doi:
and Dietetics, Dietitians of Canada, and the American
10.1007/s00726-011-0876-4. Epub 2011 Mar 12.
College of Sports Medicine: Nutrition and Athletic
Taurine Monograph, Health Canada. Performance. J Acad Nutr Diet. 2016 Mar;116(3):501-28.

Taverniti V, Guglielmetti S. Health-promoting properties Thomas W Buford, et al. International Society of Sports
of lactobacillus helveticus. Frontiers in Microbiology 2012; Nutrition position stand: creatine supplementation and
3:392. exercise. Journal of the International Society of Sports
Nutrition 2007, 4:6 (30 August 2007)

Sports Nutrition
 References and Glossary of Key Words | 623

Thomas, D., et al. Plasma Glucose Levels After Torun, B., N. S. Scrimshaw, and V. R. Young. Effect of
Prolonged Strenuous Exercise Correlate Inversely With Isometric Exercises on Body Potassium and Dietary
Glycemic Response to Food Consumed Before Exercise. Protein Requirements of Young Men. American Journal
International Journal of Sport Nutrition, Vol. 4 (1994), p. of Clinical Nutrition, Vol. 30 (1977), pp. 1983-1993.
361.
Tribulus - Tribulus terrestris Monograph, Health Canada.
Thompson C, et al. Dietary nitrate improves sprint
performance and cognitive function during prolonged Tric, I., and E. Haymes. Effects of Caffeine Ingestion
intermittent exercise. Eur J Appl Physiol. 2015 on Exercise-Induced Changes During High-Intensity,
Sep;115(9):1825-34. Intermittent Exercise. International Journal of Sport
Nutrition, Vol. 5 (1995), pp. 37-44.
Thompson, Deborah A., Larry A. Wolfe, and Roelof
Eikelboom. Acute Effects of Exercise Intensity on Appetite Trickett, P. Proteolytic Enzymes in Treatment of Athletic
in Young Men. Medicine and Science in Sports and Injuries. Applied Therapeutics (August 1964), pp. 647-652.
Exercise, Vol. 20 (1988), No. 3, pp. 222-227.
Trommelen J, et al. Fructose and Sucrose Intake Increase
Thorland, William G., Glen O. Johnson, Thomas G. Exogenous Carbohydrate Oxidation during Exercise.
Fagot, Gerald D. Tharp, and Richard W. Hammer. Body Nutrients. 2017 Feb; 9(2): 167.
Composition and Somatotype Characteristics of Junior
Trommelen J, et al. Pre-Sleep Protein Ingestion to
Olympic Athletes. Medicine and Science in Sports and
Improve the Skeletal Muscle Adaptive Response to
Exercise, Vol. 13 (1981), No. 5, pp. 332-338.
Exercise Training. Nutrients. 2016 Dec; 8(12): 763.
Tipton KD, Elliott TA, Cree MG, Aarsland AA, Sanford
Trypsin Monograph, Health Canada.
AP, Wolfe RR. Stimulation of net muscle protein synthesis
by whey protein ingestion before and after exercise. Am J Tsai PH, Tang TK, Juang CL, Chen KW, Chi CA, Hsu
Physiol Endocrinol Metab. 2007;292(1):E71-E76. MC. Effects of arginine supplementation on post-
exercise metabolic responses. Chin J Physiol. 2009 Jun
Tipton KD, Ferrando AA, Phillips SM, Doyle D Jr, Wolfe
30;52(3):136-42.
RR. (1999). Postexercise net protein synthesis in human
muscle from orally administered amino acids. Am J Tsintzas K. and C. Williams. Human muscle glycogen
Physiol Endocrinol Metab 276:E628-E634. metabolism during exercise. Effect of carbohydrate
supplementation. Sports Medicine, Vol. 25 (1998), pp.
Tipton KD, Rasmussen BB, Miller SL, et al. Timing
7-23.
of amino acid-carbohydrate ingestion alters anabolic
response of muscle to resistance exercise. Am J Physiol Tsomides, J., et al. Controlled Evaluation of Oral
Endocrinol Metab. 2001;281(2): E197-E206. Chymotrypsin-Trypsin Treatment of Injuires to the Head
and Face. Clinical Medicine (November 1996), pp. 40-45.
Tipton KD, Witard OC. Protein requirements and
recommendations for athletes: Relevance of ivory tower Tullson, P., and R. Terjung. Adenine Nucleotide Synthesis
arguments for practical recommendations. Clin Sports in Exercising and Endurance-Trained Skeletal Muscle.
Medicine. 2007;26(1):17-36. American Journal of Physiology, Vol. 261 (1991), pp.
C342-C347.
Tipton KD, Wolfe RR. (2004). Protein and amino acids for
athletes. J Sports Sci. 22:65-79. Tullson, P., D. Whitlock, and R. Terjung. Adenine
Nucleotide Degradation in Slow-Twitch Red Muscle.
Tipton, K. D. and Wolfe, R. R. Exercise, Protein
American Journal of Physiology, Vol. 258 (1990), pp.
Metabolism, and Muscle Growth. International Journal
C258-C265.
of Sport Nutrition and Exercise Metabolism, 2001, 11,
109-132. Tullson, P., J. Bangsbo, Y. Hellsten, and E. Richter. IMP
Metabolism in Human Skeletal Muscle After Exhaustive
Todd, Karen S., Gail E. Butterfield, and Doris Howes
Exercise. Journal of Applied Physiology, Vol. 78(1995), No.
Calloway. Nitrogen Balance in Men With Adequate and
1, pp. 146-152.
Deficient Energy Intake at Three Levels of Work. Journal
of Nutrition, Vol. 114 (1984), pp. 2107-2118.

International Sports Sciences Association

624 | Appendix

Turmeric - Oral Monograph, Health Canada. van Geijlswijk IM, Korzilius HP, Smits MG. The use of
exogenous melatonin in delayed sleep phase disorder: a
Turocy PS, DePalma BF, Horswill CA, et al. National meta-analysis. Sleep 2010;33(12)1605-1614.
Athletic Trainers’ Association position statement: Safe
weight loss and maintenance practices in sport and van Loon LJ, Oosterlaar AM, Hartgens F, Hesselink MK,
exercise. J Athletic Train. 2011;46(3): 322-336. Snow RJ, Wagenmakers AJ. Effects of creatine loading and
prolonged creatine supplementation on body composition,
Tyrosine Monograph, Health Canada. fuel selection, sprint and endurance performance in
humans. Clin Sci (Lond). 2003 Feb;104(2):153-62.
U.S. Department of Health and Human Services and
U.S. Department of Agriculture. 2015–2020 Dietary van Loon, LJC. Is There a Need for Protein Ingestion
Guidelines for Americans. 8th Edition. December 2015. During Exercise? Sports Med. 2014; 44(Suppl 1): 105–111.
Ubiquinol Monograph, Health Canada. Van Schuylenbergh R, Van Leemputte M, Hespel P. Effects
of oral creatine-pyruvate supplementation in cycling
Udischev, S. N., and K. V. Yaremenko. The Use of the
performance. Int J Sports Med. 2003 Feb;24(2):144-50.
Characteristic of the Rhodiola Rosea Extract to Stimulate
Regenerative Processes for an Increase in the Selectivity Vanakoski J, Kosunen V, Meririnne E et al (1998).
of the Cyclophoshamide Anti-Tumor Action. In New Creatine and caffeine in anaerobic and aerobic exercise,
Medicinal Preparations From Plants of Siberia and the Far effects on physical performance and pharmacokinetic
East. Tomsk, Russia: Tomsk University Publishers, 1968, considerations. International Journal of Clinical
pp. 151-152. Pharmacology and Therapeutics 36, 258-62.
Uebelhard, D., et al. Effects of oral chondroitin sulfate Vandebuerie, F., Vanden Eynde, B., Vandenberghe, K. &
on the progression of knee osteoarthritis: a pilot study. Hespel, P. (1998). Effect of creatine loading on endurance
Osteoarthritis Cartilage 1998 May;6 Suppl A:39-46. capacity and sprint power in cyclists. Int. J. Sports Med.
19, 490-495.
Valerian Monograph, Health Canada.
Vandenberghe K, Gillis N, Van Leemputte M, Van
Valeriani, A. The Need for Carbohydrate Intake During
Hecke P, Vanstapel F, Hespel P. Caffeine counteracts
Endurance Exercise. Sports Medicine, Vol. 12 (1991), No.
the ergogenic action of muscle creatine loading. J Appl
6, pg. 349.
Physiol. 1996 Feb;80(2):452-7.
van Blitterswijk WJ, van de Nes JC, Wuisman PI.
Vandenberghe K, Goris M, Van Hecke P et al (1997).
Glucosamine and chondroitin sulfate supplementation
Long-term creatine intake is beneficial to muscle
to treat symptomatic disc degeneration: biochemical
performance during resistance training. Journal of
rationale and case report. BMC Complement Altern Med.
Applied Physiology 83, 2055-63.
2003 Jun 10;3(1):2.
Vanderhoof JA, Whitney DB, Antonson DL, Hanner TL,
Van der Berg, J., N. Cook, and D. Tribble. Reinvestigation
Lupo JV, Young RJ. Lactobacillus GG in the prevention of
of the Antioxidant Properties of Conjugated Linoleic
antibiotic-associated diarrhea in children. The Journal of
Acid. Lipids, Vol. 73 (1995), pp. 595-598.
Pediatrics 1999; 135(5):564-568.
Van Erp-Baart, A. M., J., W.H.M. Saris, R. A. Binkhorst,
Vardjan T, Mohar Lorbeg P, Rogelj I, Canzek Majhenic
J. A. Vos, and J.W.H. Elvers. Nationwide Survey on the
A. Characterization and stability of lactobacilli and yeast
Nutritional Habits of Elite Athletes, part 1: Energy,
microbiota in kefir grains. Journal of Dairy Science 2013;
Carbohydrate, Protein, and Fat Intake. International
96(5):2729-2736.
Journal of Sports Medicine, Vol. 10 (1989), supplement,
pp. S3-S10. Varnier M, Leese GP, Thompson J et al (1995). Stimulatory
effect of glutamine on glycogen accumulation in human
van Essen M, Gibala MJ. Failure of protein to improve
skeletal muscle. American Journal of Physiology 269,
time trial performance when added to a sports drink. Med
E309-15.
Sci Sports Exerc. 2006;38(8):1476-1483.

Sports Nutrition
 References and Glossary of Key Words | 625

Vaz AL. Double-blind clinical evaluation of the relative supplementation and heavy resistance training. Medicine
efficacy of ibuprofen and glucosamine sulphate in the and Science in Sports Exercise 31(8):1147-1156.
management of osteoarthrosis of the knee in out-patients.
Curr. Med. Res. Opin 1982; 8(3):145-149. Volek JS, Kraemer WJ, Rubin MR, Gomez AL, Ratamess
NA, Gaynor P. L-carnitine L-tartrate supplementation
Vecchiet, L, et al., Influence of L-carnitine administration favorably affects markers of recovery from exercise stress.
on maximal physical exercise, European Journal of American Journal of Physiology-Endocrinology and
Applied Physiology 61 (1990): 486-490. Metabolism 2002;282:E474-E482.

Velmurugan, et al. Dietary nitrate improves vascular Volek JS, Rawson ES. 2004. Scientific basis and practical
function in patients with hypercholesterolemia: a aspects of creatine supplementation for athletes. Nutrition
randomized, double-blind, placebo-controlled study. Am 20(7-8):609-614.
J Clin Nutr. 2016 Jan;103(1):25-38.
Volek, J. S., Duncan, N. D., Mazzetti, S. A., Staron, R.
Verrill, D. E. and Ribisl, P. M. Resistive exercise training S., Putukian, M., Gomez, A. L., Pearson, D. R., Fink,
in cardiac rehabilitation. An update. Sports Med 1996 W. J. & Kraemer, W. J. (1999). Performance and muscle
May; 21(5): 347-383. fiber adaptations to creatine supplementation and heavy
resistance training. Med. Sci. Sports Exerc. 31, 1147-1156.
Vinciguerra G et al. Cramps and muscular pain:
prevention with Pycnogenol® in normal subjects, Volek, J. S., Kraemer, W. J., Bush, J. A., Boetes, M.,
venous patients, athletes, claudicants and in diabetic Incledon, T., Clark, K. L. & Lynch, J. M. (1997). Creatine
microangiopathy. Angiology 57: 331-339, 2006. supplementation enhances muscular performance during
high-intensity resistance exercise. J. Am. Diet. Assoc. 97,
Vinciguerra, G., G. Belcaro, E. Bonanni, M. R. Cesarone, 765-770.
V. Rotondi, A. Ledda, M. Hosoi, M. Dugall, M. Cacchio
and U. Cornelli (2013). Evaluation of the effects of Volek, J. S., Mazzetti, S. A., Farquhar, W. B., Barnes, B.
supplementation with Pycnogenol® on fitness in normal R., Gomez, A. L. & Kraemer, W. J. (2001). Physiological
subjects with the Army Physical Fitness Test and in responses to short-term exercise in the heat after creatine
performances of athletes in the 100-minute triathlon. J loading. Med. Sci. Sports Exerc. 33, 1101-1108.
Sports Med Phys Fitness 53(6): 644-654.
Volpe SL, Bland E. Vitamins, minerals, and exercise. In:
Vitali, G, et al., Carnitine supplementation in human Rosenbloom CA, Coleman EJ, eds. Sports Nutrition: A
idiopathic asthenospermia: clinical results, Drugs Under Practice Manual for Professionals. 5th ed. Chicago, IL:
Experimental and Clinical Research Vol. XXI, No. 4 Academy of Nutrition and Dietetics; 2012:75-105.
(1995): 157-159.
Von Allworden, H. N., S. Horn, J. Kahl, et al. The
Vitamin A Monograph, Health Canada. Influence of Lecithin on Plasma Choline Concentrations
in Triathletes and Adolescent Runners During Exercise.
Vitamin B12 Monograph, Health Canada. European Journal of Applied Physiology, Vol. 67 (1983),
pp. 87-91.
Vitamin B6 Monograph, Health Canada.
Vukovich MD, Stubbs NB, Bohlken RM et al (1997). The
Vitamin C Monograph, Health Canada.
effect of dietary hydroxyl -methylbutyrate (HMB) on
Vitamin D Monograph, Health Canada. strength gains and body composition changes in older
adults. FASEB Journal 11, A376.
Vitamin E (from rac-alpha-tocopherol and esters)
Monograph, Health Canada. Vuksan V, Stavro MP, Sievenpiper JL, Koo VY, Wong
E, Beljan-Zdravkovic U, Francis T, Jenkins AL, Leiter
Vitamin E (from RRR-alpha-tocopherol and esters) LA, Josse RG, Xu Z. 2000c. American ginseng improves
Monograph, Health Canada. glycemia in individuals with normal glucose tolerance:
effect of dose and time escalation. Journal of the
Volek JS, Duncan ND, Mazzeti SA, Staron RS, Putukian American College of Nutrition 19(6):738-744.
M, Gomez AL , Pearson DR, Fink WJ, Kraemer WJ. 1999.
Performance and muscle fiber adaptations to creatine

International Sports Sciences Association

626 | Appendix

Vuksan V, Xu Z, Jenkins AL, Belgan U, Sievenpiper Ward, P. S., and D.C.L. Savage. Growth Hormone
JL, Leiter LA, Josse RG, Stavro MP. 2000a. American Responses to Sleep, Insulin Hypoglycemia and Arginine
ginseng (Panax quinquefolium L.) improves long-term Infusion. Hormone Research, Vol. 22 (1985), pp. 7-11.
glycemic control in type 2 diabetes: double-blind placebo
controlled crossover trial. Diabetes 49 (Suppl.1):A95. Watanabe, Shigeyuki, et al., Effects of L- and DL-carnitine
on patients with impaired exercise tolerance, Japanese
Wagner DR. Hyperhydrating with glycerol: implications Heart Journal Vol. 36 (1995): 319-331.
for athletic performance. J Am Diet Assoc. 1999
Feb;99(2):207-12. Watras AC, Buchholz AC, Close RN, Zhang Z, Schoeller
DA. 2007. The role of conjugated linoleic acid in reducing
Wagner, D.R. & Heyward, V.H., 2000. Measures of body body fat and preventing holiday weight gain. International
composition in blacks and whites: a comparative review. Journal of Obesity 31(3):481-487.
Am. J. Clin. Nutr., 71(6), pp.1392–1402.
Watsford ML, Murphy AJ, Spinks WL, Walshe
Wal JS, McBurney MI, Moellering N, Marth J, AD. Creatine supplementation and its effect on
Dhurandhar NV. Moderate-carbohydrate low-fat versus musculotendinous stiffness and performance. J Strength
low-carbohydrate high-fat meal replacements for weight Cond Res. 2003 Feb;17(1):26-33.
loss. Int J Food Sci Nutr. 2007;58(4):321-9
Watson TA, MacDonald-Wicks LK, Garg ML. Oxidative
Walberg, Janet L., V. Karina Ruiz, Sandra L. Tarlton, stress and antioxidants in athletes undertaking regular
Dennis E. Hinkle, and Forrest W. Thye. Exercise Capacity exercise training. Int J Sports Nutr Exerc Metab.
and Nitrogen Loss During a High or Low Carbohydrate 2005;15(2):131-146.
Diet. Medicine and Science in Sports and Exercise, Vol. 20
(1986), pp. 34-43. Weatherwax-Fall D. Different Nutrition Plans For
Different Athletes. NSCA’s Performance Training Journal
Walker, J. B. (1979). Creatine: biosynthesis, regulation, Vol. 5 No. 6 , 2006.
and function. Adv. Enzymol. Relat. Areas Mol. Med. 50,
177-242. Webb MC1, Salandy ST1, Beckford SE1. Monitoring
hydration status pre- and post-training among university
Wall BT, Morton JP, van Loon LJ. Strategies to maintain athletes using urine color and weight loss indicators. J Am
skeletal muscle mass in the injured athlete: Nutritional Coll Health. 2016 Aug-Sep;64(6):448-55.
considerations and exercise mimetics. Eur J Sport Sci.
2015;15(1):53-62. Weir, Jane, Timothy D. Noakes, Kathryn Myburgh, and
Brett Adams. A High Carbohydrate Diet Negates the
Wall BT, Stephens FB, Constantin-Teodosiu D, Metabolic Effects of Caffeine During Exercise. Medicine
Marimuthu K, Macdonald IA, Greenhaff PL. Chronic and Science in Sports and Exercise, Vol. 19 (1986), pp.
oral ingestion of L-carnitine and carbohydrate increases 100-105.
muscle carnitine content and alters muscle fuel
metabolism during exercise in humans. The Journal of Welsh, R.S., J.M. Davis, J.R. Burke, and H.G. Williams
Physiology 2011;589.4:963-973. (2002). Carbohydrates and physical/mental performance
during intermittent exercise to fatigue. Med. Sci. Sports
Wang S et al. The effect of Pycnogenol® on the Exerc. 34:723-731.
microcirculation, platelet function and ischemic
myocardium in patients with coronary artery diseases. Weltman, Arthur, Sharleen Matter, and Bryant A.
Eur Bull Drug Res 7(2): 19-25, 1999. Stamford. Caloric Restriction and/or Mild Exercise:
Effects on Serum Lipids and Body Composition.
Warber JP, Tharion WJ, Patton JF, Champagne CM, American Journal of Clinical Nutrition, Vol. 33 (1980), pp.
Mitotti P, Lieberman HR. The effect of creatine 1002-1009.
monohydrate supplementation on obstacle course and
multiple bench press performance. J Strength Cond Res. Wentz L, Liu PY, Ilich JZ, Haymes EM. Dietary and
2002 Nov;16(4):500-8. training predictors of stress fractures in female runners.
Int J Sport Nutr Exerc Metab. 2012;22(5):374-382.

Sports Nutrition
 References and Glossary of Key Words | 627

West DB, Blohm FY, Truettt AA, DeLany JP. Wingo JE, Casa DJ, Berger EM, Dellis WO, Knight
Conjugated linoleic acid persistently increases total JC, McClung JM. Influence of a Pre-Exercise Glycerol
energy expenditure in AKR/J mice without increasing Hydration Beverage on Performance and Physiologic
uncoupling protein gene expression. J. Nutr. 130(10):2471- Function During Mountain-Bike Races in the Heat. J Athl
2477 (2000). Train. 2004 Jun;39(2):169-175.

White Kidney bean extract Monograph, Health Canada. Wismann J1, Willoughby D. Gender differences in
carbohydrate metabolism and carbohydrate loading. J Int
White willow - Salix alba Monograph, Health Canada. Soc Sports Nutr. 2006 Jun 5;3:28-34.
Whitehead MT., et al. The effect of 4 wk of oral Echinacea Wohlfahrt-Veje, C. et al., 2014. Body fat throughout
supplementation on serum erythropoietin and indices of childhood in 2647 healthy Danish children: agreement
erythropoietic status. Int J Sport Nutr Exerc Metab. 2007 of BMI, waist circumference, skinfolds with dual X-ray
Aug;17(4):378-90. absorptiometry. Eur. J. Clin. Nutr., 68(6), pp.664–70.
WHO 1999: World Health Organization. WHO Wojchowski, DM and He, TC., Signal transduction in the
Monographs on Selected Medicinal Plants, Volume 1. erythropoietin receptor system. Stem Cells. 1993 Vol 11,
Geneva (CH): World Health Organization; 1999. 381-392.
WHO 2007: World Health Organization (WHO) Wolfrum C, Spener F. Fatty acids as regulators of lipid
Monographs on Selected Medicinal Plants, Volume 3. metabolism. Eur. J. Lipid Sci. Technol. 102(12):746-762
Geneva (CHE): World Health Organization. (2000).
Wilcox, Anthony R. The Effects of Caffeine and Exercise Woolf K, Manore MM. B-vitamins and exercise: Does
on Body Weight, Fat-Pad Weight, and Fat-Cell Size. exercise alter requirements? Int J Sport Nutr Exerc Metab.
Medicine and Science in Sports and Exercise, Vol. 14 2006;16(5):453-484.
(1981), pp. 317-321.
Workout Supplements Monograph, Health Canada.
Willett, K. et al., 2006. Comparison of bioelectrical
impedance and BMI in predicting obesity-related medical World Health Organization and Food and Agriculture
conditions. Obes. (Silver Spring), 14(3), pp.480–490. Organization of the United Nations, United Nations
University. Joint WHOFAOUNUEC. Protein and
Williams, M. H. Vitamin Supplementation and Athletic amino acid requirements in human nutrition. World
Performance. International Journal of Vitamin and Health Organization Technical Report Series. Geneva,
Nutrition Research, Vol. 30 (1989), pg. 163. Switzerland: World Health Organization; 2007(935):1-265.
Willoughby DS, Boucher T, Reid J, Skelton G, Clark Wu Y, Wang X, Li M, Compbell TC. Effect of Ciwujia
M. Effects of 7 days of arginine-alpha-ketoglutarate (Radix Acanthopanax senticosus) preparation on exercise
supplementation on blood flow, plasma L-arginine, nitric performance under constant endurance load for the
oxide metabolites, and asymmetric dimethyl arginine elderly. Journal of Hygiene research. 1999;27(6)421-444.
after resistance exercise. Int J Sport Nutr Exerc Metab.
2011 Aug;21(4):291-9. Wu YN, Wang X, Zhao Y. Effect of ciwujia (Radix
acanthopanacis senticosus) preparation on human
Willoughby DS, Rosene J. Effects of oral creatine and stamina. Journal of Hygiene Research 25(1):57-61, 1996.
resistance training on myosin heavy chain expression.
Med Sci Sports Exerc. 2001 Oct;33(10):1674-81. Wutzke KD, Lorenz H. The effect of L-carnitine on fat
oxidation, protein turnover; and body composition
Wilson G, Drust B, Morton JP, Close GL. Weight-making in slightly overweight subjects. Metabolism
strategies in professional jockeys: Implications for 2004;53(8):1002-1006.
physical and mental health and well-being. Sports Med.
2014;44(6):785-796. Wylie, et al. Influence of beetroot juice supplementation
on intermittent exercise performance. Eur J Appl Physiol.
2016 Feb;116(2):415-25.

International Sports Sciences Association

628 | Appendix

Yale, S.H. and K. Liu (2004). Echinacea purpurea therapy Zhang WY. A benefit-risk assessment of caffeine as an
for the treatment of the common cold. Arch. Intern. Med. analgesic adjuvant. Drug Safety 2001;24(15):1127-1142.
164:1237-1241.
Zhenqi, L and Barrett, EJ. Human protein metabolism: its
Yan, W., et al. Steroidal saponins from fruits of Tribulus measurement and regulation. Am J Physiol Endocrinol
terrestris. Phytochemistry, Vol. 42 (1996), No. 5, pp. Metb. 2002 283: E1105-E1112.
1417-22.
Zhenqi, L, et al. Amino acids stimulate translation
Yoshizawa F. Regulation of protein synthesis by branched- initiation and protein synthesis through an Akt-
chain amino acids in vivo. Biochem Biophys Res independent pathway in human skeletal muscle. J Clin
Commun. 2004 Jan 9;313(2):417-22. Endocrinol Metab. 2002 87: 5553-5558.

Young, K., and C.T.M. Davies. Effect of Diet on Human Zhou Sufeng, et al., L-carnitine’s effect on comprehensive
Muscle Weakness Following Prolonged Exercise. weight loss program in obese adolescents, Acti
European Journal of Applied Physiology, Vol. 53 (1984), Nutrimenta Sinica Vol. 19, No. 2 (June 1997): 146-151.
pp. 81-85.
Ziegenfuss TN, Rogers M, Lowery L, Mullins N, Mendel
Young, Vernon R., and Peter L. Pellett. Protein Intake R, Antonio J, Lemon P. Effect of creatine loading on
and Requirements With Reference to Diet and Health. anaerobic performance and skeletal muscle volume
American Journal of Clinical Nutrition, Vol. 45 (1987), pp. in NCAA Division I athletes. Nutrition. 2002 May;
1323-1343. 18(5):397-402.

Zambell KL, Keim NL, Van Loan MD, Gale B, Benito Ziemba AW, Chmura J, Kaciuba-Uscilko H, Nazar
P, Kelley DS, Nelson GJ. Conjugated linoleic acid K, Wisnik P, Gawronski W. 1999. Ginseng treatment
supplementation in humans: Effects on body composition improves psychomotor performance at rest and during
and energy expenditure. Lipids 35:777-782 (2000). graded exercise in young athletes. International Journal of
Sport Nutrition 9(4):371-377
Zawadzki, K. M., B. B. Yaspelkis, and J. L. Ivy.
Carbohydrate-Protein Complex Increases the Rate of Zinc (from non-picolinate sources) Monograph, Health
Muscle Glycogen Storage After Exercise. Journal of Canada.
Applied Physiology, Vol. 72 (1992), pp. 1854-1859.
Zinc (from Zinc picolinate) Monograph, Health Canada.
Zeederberg C., L. Leach, E.V. Lambert, T.D. Noakes, S.C.
Dennis, and J.A. Hawley (1996). The effect of carbohydrate Zwyghuizen-Doorenbos A, Roehrs TA, Lipschutz
ingestion on the motor skill proficiency of soccer players. L, Timms V, Roth T. Effects of caffeine on alertness.
Int. J. Sport Nutr. 6:348-55. Psychopharmacology 1990;100(1):36-39.

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 References and Glossary of Key Words | 629

Glossary of Key Words B

Bile—a substance secreted by the liver that is
A essential for the digestion and absorption of fats.
Acetylcholine—a neurotransmitter that is critical Bioavailability—the ability of an ingested
for optimum nervous system functioning. nutrient to cross from the digestive tract into the
Adipose tissue—fat tissue in the body. bloodstream and then from the bloodstream into
the cells in which it will be utilized.
Aerobic—With oxygen.
Blood plasma—the liquid part of the blood; the
Alpha-linolenic acid (ALA)—an n-3 fatty acid substance in the blood that carries the red blood
that is essential in the diet because it cannot be cells.
synthesized by humans. Primary sources include
soybean oil, canola oil, walnuts, and flaxseed. Blood Pressure—the pressure of the blood
against the walls of the arteries.
Amenorrhea—loss of menstruation.
Blood-brain barrier—a semipermeable
Ammonia—A toxic metabolic waste product. membrane that keeps the blood that is
circulating in the brain away from the tissue
Anabolism—the biochemical process in which
fluids surrounding the brain cells.
different molecules combine to form larger, more
complex molecules. Body mass index (BMI)—BMI is a measure of
body weight relative to height. The BMI tool
Anaerobic—Without oxygen.
uses a formula that produces a score often used
Anemia—a condition in which the oxygen- to determine if a person is underweight, at a
carrying capacity of the blood is reduced. It is normal weight, overweight, or obese. For adults,
the most common symptom of iron deficiency. a BMI of 18.5 to 24.9 is considered healthy (or
“normal”). A person with a BMI of 25 to 29.9 is
Anti-catabolic—describing a substance that
considered overweight, and a person with a BMI
prevents catabolism.
of 30 or more is considered obese.
Antioxidant—a nutrient that has been found
C
to seek out and neutralize free radicals in the
body and to stimulate the body to recover more Calorie—a unit of measurement used to express
quickly from free-radical damage. the energy value of food. Carbohydrates, fats,
protein, and alcohol in the foods and drinks
Assimilation—conversion of food into living
we eat provide food energy or “calories.”
tissue.
Carbohydrates and proteins provide 4 calories
per gram, fat has 9 calories per gram, and
alcohol has 7 calories per gram.

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Cannibalization—the breakdown of muscle Creatine (also, phosphocreatine)—a compound

tissue by the body for the purpose of obtaining produced in the body, stored in the muscle
amino acids for other metabolic purposes and fibers, and broken down by enzymes to quickly
may also include other body tissues. replenish the adenosine-triphosphate stores. Also
a supplement ingredient.
Capillary—a tiny blood vessel through which
nutrients and waste products travel between the Creatinine—a waste product of creatine
bloodstream and the body’s cells. metabolism.

Carbohydrate drink—a sports beverage designed

to provide energy substrate and to replenish the
D
glycogen (energy) stores. Deoxyribonucleic acid (DNA)—the substance in
the cell nucleus that contains the cell’s genetic
Carbon dioxide—a metabolic waste product.
blueprint and determines the type of life form
Catabolism—the chemical reactions that break into which the cell will develop.
down complex biomolecules into simpler ones
Di-peptide—two amino acids linked together.
for energy production.
Dietary Reference Intakes (DRIs)—DRIs
Cell membrane—the outer boundary of a cell.
are dietary reference values for the intake of
Also called the plasma membrane.
nutrients and food components by Americans
Cellular uptake—absorption by the cells. and Canadians.

Coenzyme—an enzyme cofactor. Dietary sodium—also called “salt,” sodium helps

your nerves and muscles work properly. Table
Cofactor—a substance that must be present for
salt is composed of sodium and chloride. Your
another substance to be able to perform a certain
kidneys control how much sodium is in your
function.
blood, releasing it when needed and flushing out
Collagen—a simple protein that is the chief any excess. Too much sodium building up in
component of connective tissue. the blood may raise blood pressure. High blood
pressure is linked to serious health problems.
Complete protein—a protein that contains
the essential amino acids in amounts that are Digestive enzyme—an enzyme that acts as
sufficient for the maintenance of normal growth catalysts for the breakdown of food components.
rate and body weight.
Disaccharide—a simple carbohydrate composed
Connective tissue—tissue that either supports of two sugar molecules.
other tissue or joins tissue to tissue, muscle to
Disordered Eating—abnormal/dysfunctional
bone, or bone to bone. It includes cartilage,
eating behaviors resulting in inadequate caloric
bone, tendons, ligaments, reticular tissue, areolar
and nutrient intake, with or without eating
tissue, adipose tissue, blood, bone marrow, and
disorders.
lymph.
Diuretic—a substance that increases urination.

Sports Nutrition
 References and Glossary of Key Words | 631

E the nutrients that occur during processing.

Enrichment of refined grains is not mandatory;
Eating pattern (also called “dietary pattern”)— however, those that are labeled as enriched
the combination of foods and beverages that (e.g., enriched flour) must meet the standard
constitutes an individual’s complete dietary of identity for enrichment set by the FDA.
intake over time. This may be a description When cereal grains are labeled enriched, it is
of a customary way of eating or a description mandatory that they be fortified with folic acid.
of a combination of foods recommended for (The addition of specific nutrients to whole-
consumption. Specific examples include USDA grain products is referred to as fortification; see
Food Patterns and the Dietary Approaches to Fortification.)
Stop Hypertension (DASH) Eating Plan. (See
USDA Food Patterns and DASH Eating Plan.) Enteric coating—a coating on tablets that delays
digestion of the tablets until they pass from the
Electrolyte Balance—the ratio of chloride, stomach into the intestines.
potassium, sodium, and the other electrolytes in
the body. Ergogenic Aids—a catchall term that describes
anything that can be used to enhance athletic
Emulsifier—a substance that, during digestion, performance. Ergogenic aids can be dietary or
helps disperse fats in water mediums. non-dietary and include dietary supplements,
Endurance sport—a sport that requires the special training techniques, and mental
ability to perform for long periods at low strategies.
intensities, such as marathon running and cross- Essential Nutrient—a nutrient that the body
country skiing. cannot produce itself or that it cannot produce in
Energy Drink—a beverage that contains caffeine sufficient amounts to maintain good health.
as an ingredient, along with other ingredients, Euhydration—a term used to indicate a state of
such as taurine, herbal supplements, vitamins, adequate hydration.
and added sugars or other carbohydrates. It is
usually marketed as a product that can improve Extracellular—outside the cell.
perceived energy, stamina, athletic performance,
or concentration. F
Energy Expenditure—The amount of energy that Fat—a major source of energy in the diet, fat
you use measured in calories. You use calories to helps the body absorb fat-soluble vitamins, such
breathe, send blood through your blood vessels, as vitamins A, D, E, and K. Some kinds of fats,
digest food, maintain posture, and be physically especially saturated fats and trans fatty acids,
active. may raise blood cholesterol and increase the risk
for heart disease. Other fats, such as unsaturated
Enrichment—the addition of specific nutrients
fats, do not raise blood cholesterol. Fats that are
(i.e., iron, thiamin, riboflavin, and niacin)
in foods are combinations of monounsaturated,
to refined grain products to replace losses of
polyunsaturated, and saturated fatty acids.

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Food Groups—a method of grouping similar comparable traditional food. When cereal grains
foods for descriptive and guidance purposes. are labeled as enriched, it is mandatory that they
Food groups in the USDA Food Patterns are be fortified with folic acid.
defined as vegetables, fruits, grains, dairy, and
Free-form amino acids—amino acids that are in
protein foods. Some of these groups are divided
their free state, or single.
into subgroups, such as dark-green vegetables
or whole grains, which may have intake goals
or limits. Foods are grouped within food G
groups based on their similarity in nutritional Gluconeogenesis—the metabolic process
composition and other dietary benefits. For in which glucose is synthesized from
assignment to food groups, mixed dishes are noncarbohydrate sources.
disaggregated into their major component parts.
Glucose polymer—a processed form of
Food pattern modeling—(Pg. 79) the process of polysaccharides, or complex carbohydrates.
developing and adjusting daily intake amounts
from food categories or groups to meet specific Glucose—a simple carbohydrate that is a
criteria, such as meeting nutrient intake goals, monosaccharide. Also called dextrose or grape
limiting nutrients or other food components, sugar.
or varying proportions or amounts of specific
Glycogen Depletion—the draining of the body’s
food categories or groups. This methodology
glycogen stores.
includes using current food consumption data
to determine the mix and proportions of foods Glycogen depletion—the draining of the body’s
to include in each group, using current food glycogen stores.
composition data to select a nutrient-dense
Glycogen replenishment—the refilling of the
representative for each food, calculating nutrient
body’s glycogen stores.
profiles for each food group using these nutrient-
dense representative foods, and modeling Glycogen sparing—the saving of glycogen by the
various combinations of foods and amounts to body for other functions.
meet specific criteria.
Glycogen-bound water—the water that is stored
Fortification—as defined by the US Food and in the muscles along with glycogen.
Drug Administration (FDA), the deliberate
addition of one or more essential nutrients to a Glycogen—a complex carbohydrate that occurs
food, whether or not it is normally contained in only in animals; the form in which glucose is
the food. Fortification may be used to prevent stored in the body.
or correct a demonstrated deficiency in the Glycogenolysis—the metabolic process in which
population or specific population groups; glycogen is broken down.
restore naturally occurring nutrients lost
during processing, storage, or handling; or to Glycolysis—the metabolic process in which
add a nutrient to a food at the level found in a glucose is converted to lactic acid.

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 References and Glossary of Key Words | 633

H High-intensity sweeteners—ingredients
commonly used as sugar substitutes or sugar
Heart rate—the rate at which the heart pumps alternatives to sweeten and enhance the flavor of
the blood through the body. foods and beverages. People may choose these
Hemoglobin—the oxygen carrier in red blood sweeteners in place of sugar for a number of
cells. reasons, including that they contribute few or
no calories to the diet. Because high-intensity
Hemolytic anemia—a condition in which the sweeteners are many times sweeter than table
hemoglobin becomes separated from the red sugar (sucrose), smaller amounts of high-
blood cells. intensity sweeteners are needed to achieve the
Hemorrhage—bleed excessively. same level of sweetness as sugar in food and
beverages. (Other terms commonly used to refer
High blood pressure—your blood pressure to sugar substitutes or alternatives include non-
rises and falls throughout the day. An optimal caloric, low-calorie, no-calorie, and artificial
blood pressure is less than 120/80 mmHg. sweeteners, which may have different definitions
When blood pressure stays high; greater than or and applications. A high-intensity sweetener
equal to 140/90 mmHg—you have high blood may or may not be non-caloric, low-calorie, no-
pressure, also called hypertension. With high calorie, or artificial.)
blood pressure, the heart works harder, your
arteries take a beating, and your chances of a Homeostasis—the tendency of the body to
stroke, heart attack, and kidney problems are maintain an internal equilibrium.
greater. Uncontrolled high blood pressure may Hormone—one of the numerous substances
lead to blindness, heart attacks, heart failure, produced by the endocrine glands that regulate
kidney disease, and stroke. Prehypertension is bodily functions.
blood pressure between 120 and 139 for the top
number, or between 80 and 89 for the bottom Hyaluronic acid—a polysaccharide molecule
number. which is one of the chief components of
connective tissue, forming a gelatinous matrix
High-density lipoprotein (HDL)—HDL is a that surrounds cells.
compound made up of fat and protein that
carries cholesterol in the blood to the liver, where Hydrochloric acid—a stomach secretion that
it is broken down and excreted. Commonly functions in protein metabolism, helps keep the
called “good” cholesterol, high levels of HDL stomach relatively bacteria-free, and assists in the
cholesterol are linked to a lower risk of heart maintenance of a low pH balance in the stomach.
disease. Men should aim for an HDL of 40 mg/ Hydrogenation—a chemical process that turns
DL or higher. Women should aim for an HDL of liquid fats (oils) into solid fats, hydrogenation
50 mg/DL or higher. creates a fat called trans fatty acid (also
known as “trans fat”). Trans fats are found in
frostings, shortening, some margarines, and

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some commercial baked foods, like cakes, Intracellular—inside the cell.

cookies, muffins, and pastries. Eating trans fats
Ionic form—in the form of ions, which are atoms
may raise heart disease risk. Federal dietary
or groups of atoms that have either a positive or
guidelines [found at http://www.health.gov/
a negative charge from having lost or gained one
dietaryguidelines/External Link Disclaimer]
or more electrons.
recommend keeping trans fat intakes as low as
possible.
L
Hydrolyzed protein—a protein that has already
been broken down, usually by enzymes, and is a Lean body mass—all of a body’s tissues apart
mixture of free-form, di-peptide, and tri-peptide from the body fat—the bones, muscles, organs,
amino acids. blood, and water. Also called fat-free mass.

Hydrostatic weighing—a method for Limiting nutrient—a nutrient that has the ability,
determining body composition that involves through its absence or presence, to restrict the
weighing the body underwater. utilization of other nutrients or the functioning
of the body.
Hyperhydration—excess body water.
Linoleic acid (LA)—one of the n-6 fatty acids,
Hypoglycemia—low blood sugar. is essential in the diet because it cannot be
synthesized by humans. Primary sources are
Hypohydration—occurs when water intake does
nuts and liquid vegetable oils, including soybean
not meet the body’s hydration requirements
oil, corn oil, and safflower oil. Also called
omega-6 fatty acids.
I
Lipoprotein—a compound made up of fat and
Incomplete protein—a protein that is usually
protein that carries fats and fat-like substances,
deficient in one or more of the essential amino
such as cholesterol, in the blood.
acids.
Lipotropic—a substance that prevents fatty
Insulin—a hormone made by the pancreas,
buildup in the liver and helps the body
insulin helps move glucose (sugar) from the
metabolize fat more efficiently.
blood to muscles and other tissues. Insulin
controls blood sugar levels. Low-density lipoprotein (LDL)—LDL is a
compound made up of fat and protein that
International unit (IU)—a measure of potency
carries cholesterol in the blood from the liver
based on an accepted international standard. It
to other parts of the body. High levels of LDL
is usually used with beta-carotene and vitamins
cholesterol, commonly called “bad” cholesterol,
A, D, and E. Because this unit is a measure of
cause a buildup of cholesterol in the arteries and
potency, not weight or volume, the number of
increase the risk of heart disease. An LDL level of
milligrams in an IU varies, depending on the
less than 100 mg/dL is considered optimal, 100 to
substance being measured.

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 References and Glossary of Key Words | 635

129 mg/dL is considered near or above optimal, sugars, refined starches, and sodium. Ideally,
130 to 159 mg/dL is considered borderline high, these foods and beverages also are in forms that
160 to 189 mg/dL is considered high, and 190 retain naturally occurring components, such as
mg/dL or greater is considered very high. dietary fiber. All vegetables, fruits, whole grains,
seafood, eggs, beans and peas, unsalted nuts
M and seeds, fat-free and low-fat dairy products,
and lean meats and poultry—when prepared
Macronutrient Modulation—the practice of with little or no added solid fats, sugars, refined
varying the ratio of the macronutrients in starches, and sodium—are nutrient-dense foods.
the diet to meet specific metabolic needs to These foods contribute to meeting food group
enhance performance. Also called macronutrient recommendations within calorie and sodium
manipulation. limits. The term “nutrient dense” indicates the
Macronutrient—a macronutrient is any nutrient nutrients and other beneficial substances in a
that the body uses in relatively large amounts. food have not been “diluted” by the addition of
Macronutrients include carbohydrates, fat, and calories from added solid fats, sugars, or refined
proteins. Macronutrients are different from starches or by the solid fats naturally present in
micronutrients, such as vitamins and minerals, the food.
which the body needs in smaller amounts. Nutrition—the process of the body using food to
Malabsorption—incorrect absorption. sustain life.

Metabolic pathway—a sequence of metabolic O

reactions.
Oils—lipids that are liquid at room temperature,
Metabolic Rate—the body’s total daily caloric oils come from many different plants and from
expenditure. seafood. Some common oils include canola,
Metabolic water—the water that is produced in corn, olive, peanut, safflower, soybean, and
the body as a result of energy production. sunflower oils. A number of foods are naturally
high in oils, such as avocados, olives, nuts, and
Metalloenzyme—a mineral-containing enzyme. some fish.
Micronutrients—nutrients present in the diet Osteoporosis—disease associated with loss of
and body in small amounts bone tissue, bone fragility, and increased risk to
bone fracture.
N
Oxidative pathways—the systems that supply
Nutrient Dense—a characteristic of foods and
energy for low-intensity, high-duration activities
beverages that provide vitamins, minerals, and
lasting more than approximately three or four
other substances that contribute to adequate
minutes, such as marathon running and aerobic
nutrient intakes or may have positive health
dance. They include oxidative glycolysis and beta
effects, with little or no solid fats and added
oxidation.

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P S
Polypeptide—four or more amino acids linked Saturated fatty acids—fatty acids that have no
together. double bonds. Fats high in saturated fatty acids
are usually solid at room temperature. Major
Polysaccharide—a complex carbohydrate.
sources include animal products such as meats
Polyunsaturated fatty acids (PUFAs)—fatty and dairy products, and tropical oils such as
acids that have two or more double bonds and coconut or palm oils.
are usually liquid at room temperature. Primary
Seafood—marine animals that live in the sea and
sources are vegetable oils and some nuts and
in freshwater lakes and rivers. Seafood includes
seeds. PUFAs provide essential fats such as n-3
fish (e.g., salmon, tuna, trout, and tilapia) and
and n-6 fatty acids.
shellfish (e.g., shrimp, crab, and oysters).
Precursor—an intermediate substance in the
Skinfold calipers—the specialized calipers used
body’s production of another substance.
to measure the thickness of skinfolds.
Protein—one of the nutrients that provides
Skinfold measurement—a method for
calories to the body. Protein is an essential
determining body composition that involves
nutrient that helps build many parts of the body,
measuring the thickness of selected folds of skin
including blood, bone, muscle, and skin. Protein
using special calipers.
provides 4 calories per gram and is found in
foods like beans, dairy products, eggs, fish, meat, Solid fats—fats that are usually not liquid at
nuts, poultry, and tofu. Proteins are composed room temperature. Solid fats are found in animal
of amino acids, nine of which are indispensable foods, except for seafood, and can be made from
(essential), meaning they cannot be synthesized vegetable oils through hydrogenation. Some
by humans and therefore must be obtained tropical oil plants, such as coconut and palm,
from the diet. The quality of dietary protein is are considered as solid fats due to their fatty
determined by its amino acid profile relative acid composition. The fat component of milk
to human requirements as determined by the and cream (butter) is solid at room temperature.
body’s requirements for growth, maintenance, Solid fats contain more saturated fats and/
and repair. Protein quality is determined by or trans fats than liquid oils (e.g., soybean,
two factors—digestibility and amino acid canola, and corn oils), with lower amounts of
composition. monounsaturated or polyunsaturated fatty
acids. Common fats considered to be solid fats
R include—butter, beef fat (tallow), chicken fat,
pork fat (lard), shortening, coconut oil, palm
Ribonucleic acid (RNA)—the substance that oil and palm kernel oil. Foods high in solid fats
carries the coded genetic information from the include—full-fat (regular) cheeses, creams, whole
deoxyribonucleic acid (DNA), in the cell nucleus, milk, ice cream, marbled cuts of meats, regular
to the ribosomes, where the instructions are ground beef, bacon, sausages, poultry skin, and
translated into the form of protein molecules.

Sports Nutrition
 References and Glossary of Key Words | 637

many baked goods made with solid fats (such Triiodothyronine—a thyroid hormone that
as cookies, crackers, doughnuts, pastries, and affects almost every physiological process in
croissants). the body, including growth and development,
metabolism, body temperature, and heart rate
Starch—a complex carbohydrate that occurs only
in plants.
U
T Unsaturated fat—unsaturated fats are liquid
at room temperature. Vegetable oils are a
Thermogenesis—the process by which the body
major source of unsaturated fat in the diet.
generates heat, or energy, by increasing the
Unsaturated fats include polyunsaturated fats
metabolic rate above normal.
and monounsaturated fats. Other foods, such as
Thermogenic Response—the rise in the avocados, fatty fish like salmon and tuna, most
metabolic rate. Also known as the thermogenic nuts, and olives are good sources of unsaturated
effect or specific dynamic action (sda). fat.

Trans fatty acids—a type of fat produced when Urea cycle—the metabolic process in which
liquid fats (oils) are turned into solid fats through ammonia is converted to the waste product urea,
a chemical process called hydrogenation. Eating which is then excreted from the body.
a large amount of trans fatty acid, or “trans fats,”
Uric acid—toxic metabolic waste product.
also raises blood cholesterol and risk of heart
disease. USDA Food Patterns—a set of eating patterns
that exemplify healthy eating, which all include
Transamination reaction—the process in which
recommended intakes for the five food groups
an amino group is transferred from an amino
(vegetables, fruits, grains, dairy, and protein
acid to a molecule, usually to produce another
foods) and for subgroups within the vegetables,
amino acid.
grains, and protein foods groups. They also
Transmethylation—the metabolic process in recommend an allowance for intake of oils.
which an amino acid donates a methyl group to Patterns are provided at 12 calorie levels from
another compound. 1,000 to 3,200 calories to meet varied calorie
needs. The Healthy U.S.-Style Pattern is the base
Tri-peptide—three amino acids linked together. USDA Food Pattern. See—Healthy U.S.-Style
Triglycerides—a type of fat in your blood, Eating Pattern, Healthy Mediterranean-Style
triglycerides can contribute to the hardening and Eating Pattern, and Healthy Vegetarian Eating
narrowing of your arteries if levels are too high. Pattern.
This puts you at risk of having a heart attack
or stroke. Triglycerides are measured along
with cholesterol as part of a blood test. Normal
triglyceride levels are below 150 mg/dL. Levels
above 200 mg/dL are high.

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V Whole fruits—(Pg. 79) all fresh, frozen, canned,

and dried fruit but not fruit juice.
Vascularization—the creation of new blood
vessels in the tissues. Whole grains—grains and grain products
made from the entire grain seed, usually
Vitamin toxicity—vitamin poisoning. called the kernel, which consists of the bran,
• germ, and endosperm. If the kernel has been
VO2 max—the maximum rate at which oxygen
can be consumed. cracked, crushed, or flaked, it must retain the
same relative proportions of bran, germ, and
W endosperm as the original grain to be called
whole grain. Many but not all whole grains are
Weight control—this refers to achieving and also sources of dietary fiber.
maintaining a healthy weight with healthy eating
and physical activity

Whole food—food that is in its natural, complete

state; unprocessed food.

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Libro de Trabajo y Guía de Estudio
Novena Edicion

Guía de Estudio de ENTRENADOR DE FITNES CERTIFICADO

Guía de Estudio de ENTRENADOR DE FITNES CERTIFICADO

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