Perhaps more alarming is a report by the Centers for Disease Control suggesting 2,, emergency room visits were due to prescription drug-related events which dwarfs the emergency room visits due to dietary supplements adjusted from 23, visits after excluding cases of older adults choking on pills, allergic reactions, unsupervised children consuming too many vitamins, and persons consuming ingredients not defined by DSHEA as a dietary supplement [ 5 ].

Furthermore, a recent Healthcare Cost and Utilization Project Statistical Brief by Lucado et al. Notwithstanding, there have been case reports of liver and kidney toxicity potentially caused by supplements containing herbal extracts [ 7 ] as well as overdoses associated with pure caffeine anhydrous ingestion [ 8 ].

Collectively, the aforementioned statistics and case reports demonstrate that while generally safe, as with food or prescription drug consumption, dietary supplement consumption can lead to adverse events in spite of DSHEA and current FDA regulations described below.

Recognizing that new and untested dietary supplement products may pose unknown health issues, DSHEA distinguishes between products containing dietary ingredients that were already on the market and products containing new dietary ingredients that were not marketed prior to the enactment of the law.

DSHEA grants the FDA greater control over supplements containing NDIs. The first criterion is silent as to how and by whom presence in the food supply as food articles without chemical alteration is to be established. The second criterion—applicable only to new dietary ingredients that have not been present in the food supply—requires manufacturers and distributors of the product to take certain actions.

The guidance prompted great controversy, and FDA agreed to issue a revised draft guidance to address some of the issues raised by industry. In August , FDA released a revised Draft Guidance that replaced the Draft Guidance. The purpose of the Draft Guidance was to help manufacturers and distributors decide whether to submit a premarket safety notification to FDA, help prepare NDI notifications in a manner that allows FDA to review and respond more efficiently and quickly, and to improve the quality of NDI notifications.

The Draft Guidance has been criticized by industry and trade associations for its lack of clarity and other problems. Some of these issues include the lack of clarity regarding Pre-DSHEA, Grandfathered , ingredients and FDA requiring an NDI notification even if another manufacturer has submitted a notification.

Self-Affirmed GRAS is when a company has a team of scientific experts evaluate the safety of their ingredient. There is no requirement that the safety dossier be submitted to FDA but is used by the company as an internal document that may be relied upon if the ingredient is challenged by the FDA.

FDA has expressed its concern with this practice and does not encourage dietary supplement manufacturers to use Self-Affirmed GRAS to avoid submitting NDI notifications. In any event, the likelihood of another revised Draft Guidance from FDA becoming available in the future is high, and possibly more enforcement actions taken against companies that market an NDI without submitting a notification.

In response to growing criticism of the dietary supplement industry, the th Congress passed the first mandatory Adverse Event Reporting AER legislation for the dietary supplement industry. In December , President Bush signed into law the Dietary Supplement and Nonprescription Drug Consumer Protection Act, which took effect on December 22, After much debate in Congress and input from the FDA, the American Medical Association AMA , many of the major supplement trade associations, and a host of others all agreed that the legislation was necessary and the final version was approved by all.

The law strengthens the regulatory structure for dietary supplements and builds greater consumer confidence, as consumers have a right to expect that if they report a serious adverse event to a dietary supplement marketer the FDA will be advised about it.

An adverse event is any health-related event associated with the use of a dietary supplement that is adverse. A serious adverse event is an adverse event that A results in i death, ii a life-threatening experience, iii inpatient hospitalization, iv a persistent or significant disability or incapacity, or v a congenital anomaly or birth defect; or B requires, based on reasonable medical judgment, a medical or surgical intervention to prevent an outcome described under subparagraph A.

Once it is determined that a serious adverse event has occurred, the manufacturer, packer, or distributor responsible person of a dietary supplement whose name appears on the label of the supplement shall submit to the Secretary of Health and Human Services any report received of the serious adverse event accompanied by a copy of the label on or within the retail packaging of the dietary supplement.

The responsible person has 15 business days to submit the report to FDA after being notified of the serious adverse event. Following the initial report, the responsible person must submit follow-up reports of new medical information that they receive for one-year.

The FDA has various options to protect consumers from unsafe supplements. The FDA also has the authority to protect consumers from dietary supplements that do not present an imminent hazard to the public but do present certain risks of illness or injury to consumers. The law prohibits introducing adulterated products into interstate commerce.

The standard does not require proof that consumers have actually been harmed or even that a product will harm anyone. It was under this provision that the FDA concluded that dietary supplements containing ephedra, androstenedione, and DMAA presented an unreasonable risk.

Most recently, FDA imposed an importation ban on the botanical Mitragyna speciose, better known as Kratom. In , FDA issued Import Alert 54—15, which allows for detention without physical examination of dietary supplements and bulk dietary ingredients that are, or contain, Kratom.

Criminal penalties are present for a conviction of introducing adulterated supplement products into interstate commerce. While the harms associated with dietary supplements may pale in comparison to those linked to prescription drugs, recent pronouncements from the U.

Department of Justice confirm that the supplement industry is being watched vigilantly to protect the health and safety of the American public. When DSHEA was passed in , it contained a provision requiring that the FDA establish and enforce current Good Manufacturing Practices cGMPs for dietary supplements.

However, it was not until that the cGMPs were finally approved, and not until that the cGMPs applied across the industry, to large and small companies alike.

The adherence to cGMPs has helped protect against contamination issues and should serve to improve consumer confidence in dietary supplements. The market improved as companies became compliant with cGMPs, as these regulations imposed more stringent requirements such as Vendor Certification, Document Control Procedures, and Identity Testing.

These compliance criteria addressed the problems that had damaged the reputation of the industry with a focus on quality control, record keeping, and documentation. However, it does appear that some within the industry continue to struggle with compliance.

In Fiscal Year , it was reported that approximately Further, Undoubtedly, relying on certificates of analysis from the raw materials supplier without further testing, or failing to conduct identity testing of a finished product, can result in the creation of a product that contains something it should not contain such as synthetic chemicals or even pharmaceutical drugs.

All members of the industry need to ensure compliance with cGMPs. According to the Nutrition Labeling and Education Act NLEA , the FDA can review and approve health claims claims describing the relationship between a food substance and a reduced risk of a disease or health-related condition for dietary ingredients and foods.

However, since the law was passed it has only approved a few claims. The delay in reviewing health claims of dietary supplement ingredients resulted in a lawsuit, Pearson v.

Shalala , filed in After years of litigation, in the U. Court of Appeals for the District of Columbia Circuit ruled that qualified health claims may be made about dietary supplements with approval by FDA, as long as the statements are truthful and based on adequate science.

Supplement or food companies wishing to make health claims or qualified health claims about supplements can submit research evidence to the FDA for review. The FTC also regulates the supplement industry. Further, before marketing products, they must have evidence that their supplements are generally safe to meet all the requirements of DSHEA and FDA regulations.

This has increased job opportunities for sports nutrition specialists as well as enhanced external funding opportunities for research groups interested in exercise and nutrition research.

While the push for more research is due in part to greater scrutiny from the FDA and FTC, it is also in response to an increasingly competitive marketplace where established safety and efficacy attracts more consumer loyalty and helps ensure a longer lifespan for the product in commerce.

Companies that adhere to these ethical standards tend to prosper while those that do not will typically struggle to comply with FDA and FTC guidelines resulting in a loss of consumer confidence and an early demise for the product.

A common question posed by athletes, parents, and professionals surrounding dietary supplements relates to how they are manufactured and perceived supplement quality. In several cases, established companies who develop dietary supplements have research teams who scour the medical and scientific literature looking for potentially effective nutrients.

These research teams often attend scientific meetings and review the latest patents, research abstracts presented at scientific meetings, and research publications.

Leading companies invest in basic research on nutrients before developing their supplement formulations and often consult with leading researchers to discuss ideas about dietary supplements and their potential for commercialization.

Other companies wait until research has been presented in patents, research abstracts, or publications before developing nutritional formulations featuring the nutrient.

Upon identification of new nutrients or potential formulations, the next step is to contact raw ingredient suppliers to see if the nutrient is available, if it is affordable, how much of it can be sourced and what is the available purity. Sometimes, companies develop and pursue patents involving new processing and purification processes because the nutrient has not yet been extracted in a pure form or is not available in large quantities.

Reputable raw material manufacturers conduct extensive tests to examine purity of their raw ingredients. When working on a new ingredient, companies often conduct series of toxicity studies on the new nutrient once a purified source has been identified.

The company would then compile a safety dossier and communicate it to the FDA as a New Dietary Ingredient submission, with the hopes of it being allowed for lawful sale. When a powdered formulation is designed, the list of ingredients and raw materials are typically sent to a flavoring house and packaging company to identify the best way to flavor and package the supplement.

In the nutrition industry, several main flavoring houses and packaging companies exist who make many dietary supplements for supplement companies. Most reputable dietary supplement manufacturers submit their production facilities to inspection from the FDA and adhere to GMP, which represent industry standards for good manufacturing of dietary supplements.

Some companies also submit their products for independent testing by third-party companies to certify that their products meet label claims and that the product is free of various banned ingredients. For example, the certification service offered by NSF International includes product testing, GMP inspections, ongoing monitoring and use of the NSF Mark indicating products comply with inspection standards, and screening for contaminants.

More recently, companies have subjected their products for testing by third party companies to inspect for banned or unwanted substances. These types of tests help ensure that the dietary supplement made available to athletes do not contained substances banned by the International Olympic Committee or other athletic governing bodies e.

While third-party testing does not guarantee that a supplement is void of banned substances, the likelihood is reduced e.

Moreover, consumers can request copies of results of these tests and each product that has gone through testing and earned certification can be researched online to help athletes, coaches and support staff understand which products should be considered.

In many situations, companies who are not willing to provide copies of test results or certificates of analysis should be viewed with caution, particularly for individuals whose eligibility to participate might be compromised if a tainted product is consumed. The ISSN recommends that potential consumers undertake a systematic process of evaluating the validity and scientific merit of claims made when assessing the ergogenic value of a dietary supplement [ 1 , 4 ].

This can be accomplished by examining the theoretical rationale behind the supplement and determining whether there is any well-controlled data showing the supplement is effective. Supplements based on sound scientific rationale with direct, supportive research showing effectiveness may be worth trying or recommending.

Sports nutrition specialists should be a resource to help their clients interpret the scientific and medical research that may impact their welfare and help them train more effectively.

The following are recommended questions to ask when evaluating the potential ergogenic value of a supplement. Most supplements that have been marketed to improve health or exercise performance are based on theoretical applications derived from basic science or clinical research studies.

Based on these preliminary studies, a dietary approach or supplement is often marketed to people proclaiming the benefits observed in these basic research studies.

Although the theory may appear relevant, critical analysis of this process often reveals flaws in the scientific logic or that the claims made do not quite match up with the cited literature.

By evaluating the literature one can discern whether or not a dietary approach or supplement has been based on sound scientific evidence. To do so, one is recommended to first read reviews about the training method, nutrient, or supplement from researchers who have been intimately involved in the available research and consult reliable references about nutritional and herbal supplements [ 1 , 9 ].

To aid in this endeavour, the ISSN has published position statement on topics related to creatine [ 10 ], protein [ 11 ], beta-alanine [ 12 ], nutrient timing [ 13 ], caffeine [ 14 ], HMB [ 15 ], meal frequency [ 16 ], energy drinks [ 17 ], and diets and body composition [ 18 ].

Each of these documents would be excellent resources for any of these topics. In addition, other review articles and consensus statements have been published by other researchers and research groups that evaluate dietary supplements, offer recommendations on interpreting the literature, and discuss the available findings for several ingredients that are discussed in this document [ 19 , 20 , 21 ].

A quick look at these references will often help determine if the theoretical impetus for supplementing with an ingredient is plausible or not. Proponents of ergogenic aids often overstate claims made about training devices and dietary supplements while opponents of ergogenic aids and dietary supplements are often either unaware or are ignorant of research supporting their use.

Sports nutrition specialists have the responsibility to know the literature and search available databases to evaluate the level of merit surrounding a proposed ergogenic aid. Some athletic associations have banned the use of various nutritional supplements e.

and many professional sports organization have now written language into their collective bargaining agreements that products made available by the team must be NSF certified as safe for sport. Obviously, if the supplement is banned, the sports nutrition specialist should discourage its use.

In addition, many supplements lack appropriate long-term safety data. People who consider taking nutritional supplements should be well aware of the potential side effects so they can make an informed decision whether to use a supplement. Additionally, they should consult with a knowledgeable physician to see if any underlying medical problems exist that may contraindicate its use.

When evaluating the safety of a supplement, it is suggested to determine if any side effects have been reported in the scientific or medical literature.

In particular, we suggest determining how long a particular supplement has been studied, the dosages evaluated, and whether any side effects were observed.

Unfortunately, many available supplements have not had basic safety studies completed that replicate the length of time and dosages being used. The next question to ask is whether any well-controlled data are available showing effectiveness of the proposed ergogenic aid in athletic populations or people regularly involved in exercise training.

The first place to look is the list of references cited in marketing material supporting their claims. Are the abstracts or articles cited just general references or specific studies that have evaluated the efficacy of the nutrients included in the formulation or of the actual supplement?

From there, one can critically evaluate the cited abstracts and articles by asking a series of questions:. For perspective, studies reporting improved performance in rats or an individual diagnosed with type 2 diabetes may be insightful, but research conducted on non-diabetic athletes is much more practical and relevant.

Were the studies well controlled? For ergogenic aid research, the gold standard study design is a randomized, double-blind, placebo controlled clinical trial.

This means that neither the researcher nor the subject is aware which group received the supplement or the placebo during the study and that the subjects were randomly assigned into the placebo or supplement group.

At times, supplement claims have been based on poorly designed studies i. or testimonials which make interpretation more difficult. Well-controlled clinical trials provide stronger evidence as to the potential ergogenic value and importantly how the findings can best be used. Do the studies report statistically significant results or are claims being made on non-significant means or trends?

Appropriate statistical analysis of research results allows for an unbiased interpretation of data. Although studies reporting statistical trends may be of interest and lead researchers to conduct additional research, studies reporting statistically significant results are obviously more convincing.

With this said, it is important for people to understand that oftentimes the potential effect a dietary supplement or diet regimen may have above and beyond the effect seen from the exercise bout or an accepted dietary approach is quite small.

In addition, many studies examining a biochemical or molecular biology mechanism can require invasive sampling techniques or the study population being recruited is unique very highly trained resulting in a small number of study participants.

When viewed together, the combination of these two considerations can result in statistical outcomes that do not reach statistical significance even though large mean changes were observed. In all such cases, additional research is warranted to further examine the potential ergogenic aid before conclusions can be made.

Do the results of the cited studies match the claims made about the supplement or do they accurately portray the response of the supplement against an appropriate placebo or control group?

It is not unusual for marketing claims to greatly exaggerate the results found in the actual studies and do so by focusing upon just the outcomes within the supplement treatment group as opposed to how the supplement group changed in comparison to how a placebo group changed.

Similarly, it is not uncommon for ostensibly compelling results, that may indeed be statistically significant, to be amplified while other relevant findings of significant consumer interest are obscured or omitted e.

a dietary supplement showing statistically significant increases in circulating testosterone yet changes in body composition or muscular performance were not superior to a placebo. Reputable companies accurately and completely report results of studies so that consumers can make informed decisions about using a product.

At times, claims are based on research that has either never been published or only published in an obscure journal.

If you see only a few other journals this is a suggestion that the journal is not a reputable journal. Additionally, one can also look up how many articles have been published by the journal in the last 6—12 months and how many of these articles are well-conducted studies.

Impact factors are determined and published by Thomson Reuters under Journal Citation Reports® a subscription service available at most university libraries. Most journals list their impact factor on the journal home page. Historically, those articles that are read and cited the most are the most impactful scientifically.

Have the research findings been replicated? If so, have the results only been replicated at the same laboratory? The best way to know an ergogenic aid works is to see that results have been replicated in several studies preferably by several separate, distinct research groups.

The most reliable ergogenic aids are those in which multiple studies, conducted at different labs, have reported similar results of safety and efficacy.

Additionally, replication of results by different, unaffiliated labs with completely different authors also removes or reduces the potentially confounding element of publication bias publication of studies showing only positive results and conflicts of interest.

A notable number of studies on ergogenic aids are conducted in collaboration with one or more research scientists or co-authors that have a real or perceived economic interest in the outcome of the study.

This could range from being a co-inventor on a patent application that is the subject of the ergogenic aid, being paid or receiving royalties from the creation of a dietary supplement formulation, providing consulting services for the company or having stock options or shares in a company that owns or markets the ergogenic aid described in the study.

An increasing number of journals require disclosures by all authors of scientific articles, and including such disclosures in published articles. This is driven by the aim of providing greater transparency and research integrity.

It is important to emphasize that disclosure of a conflict of interest does not alone discredit or dilute the merits of a research study.

The primary thrust behind public disclosures of potential conflicts of interest is first and foremost transparency to the reader and second to prevent a later revelation of some form of confounding interest that has the potential of discrediting the study in question, the findings of the study, the authors, and even the research center or institution where the study was conducted.

Dietary supplements may contain carbohydrate, protein, fat, minerals, vitamins, herbs, enzymes, metabolic intermediates i. Supplements can generally be classified as convenience supplements e.

As discussed previously, evaluating the available scientific literature is an important step in determining the efficacy of any diet, diet program or dietary supplement. In considering this, nutritional supplements can be categorized in the following manner:.

Strong Evidence to Support Efficacy and Apparently Safe: Supplements that have a sound theoretical rationale with the majority of available research in relevant populations using appropriate dosing regimens demonstrating both its efficacy and safety. Limited or Mixed Evidence to Support Efficacy: Supplements within this category are characterized as having a sound scientific rationale for its use, but the available research has failed to produce consistent outcomes supporting its efficacy.

Routinely, these supplements require more research to be completed before researchers can begin to understand their impact. Importantly, these supplements have no available evidence to suggest they lack safety or should be viewed as harmful.

Several factors are evaluated when beginning to counsel individuals who regularly complete exercise training. To accomplish this, one should make sure the athlete is eating an energy balanced, nutrient dense diet that meets their estimated daily energy needs and that they are training intelligently.

Far too many athletes or coaches focus too heavily upon supplementation or applications of supplementation and neglect these key fundamental aspects. Following this, we suggest that they generally only recommend supplements in category I i.

If an athlete is interested in trying supplements in category II i. Obviously, the ISSN does not support athletes taking supplements in category III i.

We believe this approach is scientifically substantiated and offers a balanced view as opposed to simply dismissing the use of all dietary supplements. A well-designed diet that meets energy intake needs and incorporates proper timing of nutrients is the foundation upon which a good training program can be developed [ 22 , 23 ].

Incorporating good dietary practices as part of a training program is one way to help optimize training adaptations and prevent overtraining. The following is an overview of energy intake recommendations and major nutrient needs for active individuals.

The primary component to optimize training and performance through nutrition is to ensure the athlete is consuming enough calories to offset energy expenditure [ 22 , 23 , 24 , 25 , 26 ]. People who participate in a general fitness program e.

However, athletes involved in moderate levels of intense training e. For elite athletes, energy expenditure during heavy training or competition will further exceed these levels [ 27 , 28 ]. Additionally, caloric needs for large athletes i.

This point was clearly highlighted in a review by Burke who demonstrated that carbohydrate needs are largely unmet by high-level athletes [ 22 ].

Additionally it is difficult to consume enough food and maintain gastrointestinal comfort to train or race at peak levels [ 35 ]. Maintaining an energy deficient diet during training often leads to a number of physical i.

and psychological i. It is still a question whether there may be specific individualized occasions when negative energy balance may enhance performance in the days prior to running performance [ 36 ]. Populations susceptible to negative energy balance include runners, cyclists, swimmers, triathletes, gymnasts, skaters, dancers, wrestlers, boxers, and athletes attempting to lose weight too quickly [ 37 ].

Additionally, female athletes are at particular risk of under fueling due to both competitive and aesthetic demands of their sport and their surrounding culture. Female athletes have been reported to have a high incidence of eating disorders [ 38 ].

This makes LEA a major nutritional concern for female athletes [ 39 ]. Consequently, it is important for the sports nutrition specialist working with athletes to assess athletes individually to ensure that athletes are well fed according to the goals of their sport and their health, and consume enough calories to offset the increased energy demands of training, and maintain body weight.

Further, travel and training schedules may limit food availability or the types of food athletes are accustomed to eating. This means that care should be taken to plan meal times in concert with training, as well as to make sure athletes have sufficient availability of nutrient dense foods throughout the day for snacking between meals e.

Beyond optimal energy intake, consuming adequate amounts of carbohydrate, protein, and fat is important for athletes to optimize their training and performance.

In particular and as it relates to exercise performance, the need for optimal carbohydrates before, during and after intense and high-volume bouts of training and competition is evident [ 41 ].

Excellent reviews [ 42 , 43 ] and original investigations [ 44 , 45 , 46 , 47 , 48 , 49 ] continue to highlight the known dependence on carbohydrates that exists for athletes competing to win various endurance and team sport activities. A complete discussion of the needs of carbohydrates and strategies to deliver optimal carbohydrate and replenish lost muscle and liver glycogen extend beyond the scope of this paper, but the reader is referred to several informative reviews on the topic [ 23 , 41 , 50 , 51 , 52 , 53 ].

As such, individuals engaged in a general fitness program and are not necessarily training to meet any type of performance goal can typically meet daily carbohydrate needs by consuming a normal diet i.

However, athletes involved in moderate and high-volume training need greater amounts of carbohydrate and protein discussed later in their diet to meet macronutrient needs [ 50 ].

In terms of carbohydrate needs, athletes involved in moderate amounts of intense training e. Research has also shown that athletes involved in high volume intense training e. Preferably, the majority of dietary carbohydrate should come from whole grains, vegetables, fruits, etc.

while foods that empty quickly from the stomach such as refined sugars, starches and engineered sports nutrition products should be reserved for situations in which glycogen resynthesis needs to occur at accelerated rates [ 53 ].

When considering the carbohydrate needs throughout an exercise session, several key factors should be considered. Previous research has indicated athletes undergoing prolonged bouts 2—3 h of exercise training can oxidize carbohydrates at a rate of 1—1.

Several reviews advocate the ingestion of 0. It is now well established that different types of carbohydrates can be oxidized at different rates in skeletal muscle due to the involvement of different transporter proteins that result in carbohydrate uptake [ 55 , 56 , 57 , 58 , 59 ].

Interestingly, combinations of glucose and sucrose or maltodextrin and fructose have been reported to promote greater exogenous rates of carbohydrate oxidation when compared to situations when single sources of carbohydrate are ingested [ 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ].

These studies generally indicate a ratio of 1—1. In addition to oxidation rates and carbohydrate types, the fasting status and duration of the exercise bout also function as key variables for athletes and coaches to consider. When considering duration, associated reviews have documented that bouts of moderate to intense exercise need to reach exercise durations that extend well into 90th minute of exercise before carbohydrate is shown to consistently yield an ergogenic outcome [ 41 , 68 , 69 ].

Of interest, however, not all studies indicate that shorter 60—75 min bouts of higher intensity work may benefit from carbohydrate delivery. Currently the mechanisms surrounding these findings are, respectively, thought to be replacement of depleted carbohydrate stores during longer duration of moderate intensity while benefits seen during shorter, more intense exercise bouts are thought to operate in a central fashion.

Moreover, these reviews have also pointed to the impact of fasting status on documentation of ergogenic outcomes [ 41 , 68 , 69 ]. In this respect, when studies require study participants to commence exercise in a fasted state, ergogenic outcomes are more consistently reported, yet other authors have questioned the ecological validity of this approach for competing athletes [ 43 ].

As it stands, the need for optimal carbohydrates in the diet for those athletes seeking maximal physical performance is unquestioned. Daily consumption of appropriate amounts of carbohydrate is the first and most important step for any competing athlete.

As durations extend into 2 h, the need to deliver carbohydrate goes up, particularly when commencing exercise in a state of fasting or incomplete recovery.

Once exercise ceases, several dietary strategies can be considered to maximally replace lost muscle and liver glycogen, particularly if a limited window of recovery exists. In these situations, the first priority should lie with achieving aggressive intakes of carbohydrate while strategies such as ingesting protein with lower carbohydrate amounts, carbohydrate and caffeine co-ingestion or certain forms of carbohydrate may also help to facilitate rapid assimilation of lost glycogen.

Initially, it was recommended that athletes do not need to ingest more than the RDA for protein i. However, research spanning the past 30 years has indicated that athletes engaged in intense training may benefit from ingesting about two times the RDA of protein in their diet 1.

If an insufficient amount of protein is consumed, an athlete will develop and maintain a negative nitrogen balance, indicating protein catabolism and slow recovery. Over time, this may lead to muscle wasting, injuries, illness, and training intolerance [ 76 , 77 , 81 ].

For people involved in a general fitness program or simply interested in optimizing their health, recent research suggests protein needs may also be above the RDA. Phillips and colleagues [ 76 ], Witard et al.

In this respect, Morton and investigators [ 83 ] performed a meta-review and meta-regression involving 49 studies and participants and concluded that a daily protein intake of 1. In addition and in comparison to the RDA, non-exercising, older individuals 53—71 years may also benefit from a higher daily protein intake e.

Recent reports suggest that older muscle may be slower to respond and less sensitive to protein ingestion, typically requiring 40 g doses to robustly stimulate muscle protein synthesis [ 84 , 85 , 86 ]. Studies in younger individuals, however, have indicated that in the absence of exercise, a 20 g dose can maximize muscle protein synthesis [ 87 , 88 ] and if consumed after a multiple set workout consisting of several exercises that target large muscle groups a 40 g dose might be needed [ 89 ].

Consequently, it is recommended that athletes involved in moderate amounts of intense training consume 1. This protein need would be equivalent to ingesting 3—15 three-ounce servings of chicken or fish per day for a 50— kg athlete [ 78 ]. Although smaller athletes typically can ingest this amount of protein, on a daily basis, in their normal diet, larger athletes often have difficulty consuming this much dietary protein.

Additionally, a number of athletic populations are known to be susceptible to protein malnutrition e. DOI: Houtkooper, L. Nutrition for Throwers, Jumpers, and Combined Events Athletes.

How to Maximize Performance Hydration. Sport Science Institute. Jeukendrup, A. Periodized Nutrition for Athletes. Karpinski, Christine.

Sports, Cardiovascular, and Wellness Nutrition Dietetic Practice Group. Sports Nutrition: A Handbook for Professionals. Purcell, L. Sport Nutrition for Young Athletes. Shriver, L. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional.

The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website.

All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances.

The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website. Skip to main content. Healthy eating.

Home Healthy eating. Sporting performance and food. Actions for this page Listen Print. Summary Read the full fact sheet. On this page. Nutrition and exercise The link between good health and good nutrition is well established.

Daily training diet requirements The basic training diet should be sufficient to: provide enough energy and nutrients to meet the demands of training and exercise enhance adaptation and recovery between training sessions include a wide variety of foods like wholegrain breads and cereals , vegetables particularly leafy green varieties , fruit , lean meat and low-fat dairy products to enhance long term nutrition habits and behaviours enable the athlete to achieve optimal body weight and body fat levels for performance provide adequate fluids to ensure maximum hydration before, during and after exercise promote the short and long-term health of athletes.

Carbohydrates are essential for fuel and recovery Current recommendations for carbohydrate requirements vary depending on the duration, frequency and intensity of exercise.

Eating during exercise During exercise lasting more than 60 minutes, an intake of carbohydrate is required to top up blood glucose levels and delay fatigue. Eating after exercise Rapid replacement of glycogen is important following exercise.

Protein and sporting performance Protein is an important part of a training diet and plays a key role in post-exercise recovery and repair.

For example: General public and active people — the daily recommended amount of protein is 0. Sports people involved in non-endurance events — people who exercise daily for 45 to 60 minutes should consume between 1.

Sports people involved in endurance events and strength events — people who exercise for longer periods more than one hour or who are involved in strength exercise, such as weight lifting, should consume between 1.

Athletes trying to lose weight on a reduced energy diet — increased protein intakes up to 2. While more research is required, other concerns associated with very high-protein diets include: increased cost potential negative impacts on bones and kidney function increased body weight if protein choices are also high in fat increased cancer risk particularly with high red or processed meat intakes displacement of other nutritious foods in the diet, such as bread, cereal, fruit and vegetables.

Using nutritional supplements to improve sporting performance A well-planned diet will meet your vitamin and mineral needs. Nutritional supplements can be found in pill, tablet, capsule, powder or liquid form, and cover a broad range of products including: vitamins minerals herbs meal supplements sports nutrition products natural food supplements.

Water and sporting performance Dehydration can impair athletic performance and, in extreme cases, may lead to collapse and even death. Where to get help Your GP doctor Dietitians Australia External Link Tel.

Burke L, Deakin V, Mineham M , Clinical sports nutrition External Link , McGraw-Hill, Sydney. Jäger R, Kerksick CM, Campbell BI, et al.

Nutrition External Link , Australian Institute of Sport, Australian Government. Nutrition and healthy eating resources External Link , Nutrition Australia.

Give feedback about this page. Was this page helpful? Yes No. View all healthy eating. Related information. From other websites External Link Australian Institute of Sport.

Sports drinks can be expensive compared to other drinks; however it is easy to make them yourself! To make your own isotonic sports drink, mix ml fruit squash containing sugar rather than sweeteners , ml water and a pinch of salt.

Supplements are one of the most discussed aspects of nutrition for those who are physically active. However, whilst many athletes do supplement their diet, supplements are only a small part of a nutrition programme for training.

For most people who are active, a balanced diet can provide all the energy and nutrients the body needs without the need for supplements. Sports supplements can include micronutrients, macronutrients or other substances that may have been associated with a performance benefit, such as creatine, sodium bicarbonate or nitrate.

The main reasons people take supplements are to correct or prevent nutrient deficiencies that may impair health or performance; for convenient energy and nutrient intake around an exercise session; or to achieve a direct performance benefit.

Whilst adequate amounts of protein and carbohydrate are both essential in maximising performance and promoting recovery, most people should be able to get all the nutrients they need by eating a healthy, varied diet and, therefore, supplements are generally unnecessary.

For athletes, supplementing the diet may be beneficial, possibly on performance, on general health or for reducing injury and illness risk. However, there is not much research on many of the commonly used supplements, and there are only a small number of supplements where there is good evidence for a direct benefit on performance, including caffeine, creatine in the form of creatine monohydrate , nitrate and sodium bicarbonate.

Even in these cases, the benefits on performance vary greatly depending on the individual and there is only evidence for a benefit in specific scenarios.

This means that any athletes considering supplementation will need to weigh the potential benefits with the possible negative impacts, such as negative effects on general health or performance, risk of accidental doping or risks of consuming toxic levels of substances such as caffeine.

The advice to consider supplementation for a performance benefit is for high performance athletes and should be carried out alongside expert advice from qualified sports nutritionists or dietitians. It is a common myth that consuming lots of excess protein gives people bigger muscles.

Quite often, people taking part in exercise focus on eating lots of protein, and consequently may not get enough carbohydrate, which is the most important source of energy for exercise. The main role of protein in the body is for growth, repair and maintenance of body cells and tissues, such as muscle.

Fifteen to 25g of high-quality protein has been shown to be enough for optimum muscle protein synthesis following any exercise or training session, for most people, and any excess protein that is ingested will be used for energy.

The recommendations for daily protein intake are set equally for both endurance training and resistance training athletes, so higher intakes are not recommended even for those exclusively trying to build muscle.

Any more protein than this will not be used for muscle building and just used as energy. Therefore, whilst among recreational gym-goers protein supplementation has become increasingly popular for muscle building, it is generally unnecessary.

However, after competition or an intense training session, high quality protein powders can be a more convenient and transportable recovery method when there is limited access to food or if an individual does not feel hungry around exercise, and may be effective for maintenance, growth and repair of muscle.

If you have a more general query, please contact us. Please note that advice provided on our website about nutrition and health is general in nature. We do not provide any personal advice on prevention, treatment and management for patients or their family members.

If you would like a response, please contact us. We do not provide any individualised advice on prevention, treatment and management for patients or their family members. Forgot your password? Contact us Press office. Our work Healthy sustainable diets Life stages Health conditions Putting it into practice Training and events Healthy Eating Week News.

Back Our work Who we are What we do Who we work with Why trust us? Impact and reach Support what we do Press office Contact us. Back Healthy sustainable diets Healthy and sustainable diets Starchy foods, sugar and fibre Protein Fat Vitamins and minerals Hydration Nutrient requirements.

Back Life stages Pregnancy Baby Toddlers and pre-school Children Teenagers Students Women Men Older people. Back Health conditions COVID, nutrition and immunity Heart disease and stroke Overweight, obesity and weight loss Cancer risk Type 2 diabetes Bone and joint health.

Back Putting it into practice Some tips to save money on food Make healthier choices Balancing the diet Food labelling Plant-based diets Keeping active Planning Food, seasons and celebrations.

Back Training and events On-demand webinars Conference recordings and Annual Lectures Learning activities. Putting it into practice Keeping active Nutrition for sports and exercise.

Enlarge Text A A. Nutrition for sports and exercise. The article looks at: Foods for fuel and exercise How to stay well hydrated Supplements. Eating well for physical activity and sport can have many benefits including: allowing you to perform well in your chosen sport or activity reducing the risk of injury and illness ensuring the best recovery after exercise or a training programme However, the dietary patterns that will best suit an individual will depend on the amount and intensity of activity.

Physical activity when losing weight Doing physical activity will increase your energy expenditure the calories you use , as energy is required during exercise to fuel the contracting muscles, increased breathing and heart rate and metabolism. Foods for fuel and exercise Carbohydrates Protein Vegetarian and vegan diets for athletes Fat Carbohydrates The main role of carbohydrates in physical activity is to provide energy.

The table below shows the carbohydrate content of some common foods: Food source Serving size Carbohydrate content g per serving size Wholewheat pasta boiled g Protein Protein is important in sports performance as it can boost glycogen storage, reduce muscle soreness and promote muscle repair.

The table below shows the protein content of some common foods: Food source Serving size Protein content g per serving size Chicken breast grilled g Fat Fat is essential for the body in small amounts, but it is also high in calories.

How to stay well hydrated Water is essential for life and hydration is important for health, especially in athletes and those who are physically active, who will likely have higher requirements.

The amount an individual sweats varies from person to person and depends on: intensity and duration of exercise — longer and higher intensity exercise can cause greater sweat loss. environmental temperature — in hot, humid conditions sweat loss can increase.

clothing — the more clothing that is worn, the quicker you are likely to heat up which may cause greater sweat loss. genetics — some people sweat more than others. Sports drinks: sports drinks contain carbohydrates in the form of glucose, as well as electrolytes such as sodium.

Sodium will replace any lost from sweating and enhance rehydration, and glucose will replenish carbohydrate stores. Sports drinks have been shown to help endurance performance and recovery for active individuals performing endurance exercise over a longer duration 60 minutes or more e.

The law prohibits introducing adulterated products into interstate commerce. The standard does not require proof that consumers have actually been harmed or even that a product will harm anyone. It was under this provision that the FDA concluded that dietary supplements containing ephedra, androstenedione, and DMAA presented an unreasonable risk.

Most recently, FDA imposed an importation ban on the botanical Mitragyna speciose, better known as Kratom. In , FDA issued Import Alert 54—15, which allows for detention without physical examination of dietary supplements and bulk dietary ingredients that are, or contain, Kratom.

Criminal penalties are present for a conviction of introducing adulterated supplement products into interstate commerce. While the harms associated with dietary supplements may pale in comparison to those linked to prescription drugs, recent pronouncements from the U.

Department of Justice confirm that the supplement industry is being watched vigilantly to protect the health and safety of the American public. When DSHEA was passed in , it contained a provision requiring that the FDA establish and enforce current Good Manufacturing Practices cGMPs for dietary supplements.

However, it was not until that the cGMPs were finally approved, and not until that the cGMPs applied across the industry, to large and small companies alike. The adherence to cGMPs has helped protect against contamination issues and should serve to improve consumer confidence in dietary supplements.

The market improved as companies became compliant with cGMPs, as these regulations imposed more stringent requirements such as Vendor Certification, Document Control Procedures, and Identity Testing.

These compliance criteria addressed the problems that had damaged the reputation of the industry with a focus on quality control, record keeping, and documentation. However, it does appear that some within the industry continue to struggle with compliance.

In Fiscal Year , it was reported that approximately Further, Undoubtedly, relying on certificates of analysis from the raw materials supplier without further testing, or failing to conduct identity testing of a finished product, can result in the creation of a product that contains something it should not contain such as synthetic chemicals or even pharmaceutical drugs.

All members of the industry need to ensure compliance with cGMPs. According to the Nutrition Labeling and Education Act NLEA , the FDA can review and approve health claims claims describing the relationship between a food substance and a reduced risk of a disease or health-related condition for dietary ingredients and foods.

However, since the law was passed it has only approved a few claims. The delay in reviewing health claims of dietary supplement ingredients resulted in a lawsuit, Pearson v. Shalala , filed in After years of litigation, in the U. Court of Appeals for the District of Columbia Circuit ruled that qualified health claims may be made about dietary supplements with approval by FDA, as long as the statements are truthful and based on adequate science.

Supplement or food companies wishing to make health claims or qualified health claims about supplements can submit research evidence to the FDA for review. The FTC also regulates the supplement industry. Further, before marketing products, they must have evidence that their supplements are generally safe to meet all the requirements of DSHEA and FDA regulations.

This has increased job opportunities for sports nutrition specialists as well as enhanced external funding opportunities for research groups interested in exercise and nutrition research. While the push for more research is due in part to greater scrutiny from the FDA and FTC, it is also in response to an increasingly competitive marketplace where established safety and efficacy attracts more consumer loyalty and helps ensure a longer lifespan for the product in commerce.

Companies that adhere to these ethical standards tend to prosper while those that do not will typically struggle to comply with FDA and FTC guidelines resulting in a loss of consumer confidence and an early demise for the product.

A common question posed by athletes, parents, and professionals surrounding dietary supplements relates to how they are manufactured and perceived supplement quality. In several cases, established companies who develop dietary supplements have research teams who scour the medical and scientific literature looking for potentially effective nutrients.

These research teams often attend scientific meetings and review the latest patents, research abstracts presented at scientific meetings, and research publications. Leading companies invest in basic research on nutrients before developing their supplement formulations and often consult with leading researchers to discuss ideas about dietary supplements and their potential for commercialization.

Other companies wait until research has been presented in patents, research abstracts, or publications before developing nutritional formulations featuring the nutrient. Upon identification of new nutrients or potential formulations, the next step is to contact raw ingredient suppliers to see if the nutrient is available, if it is affordable, how much of it can be sourced and what is the available purity.

Sometimes, companies develop and pursue patents involving new processing and purification processes because the nutrient has not yet been extracted in a pure form or is not available in large quantities. Reputable raw material manufacturers conduct extensive tests to examine purity of their raw ingredients.

When working on a new ingredient, companies often conduct series of toxicity studies on the new nutrient once a purified source has been identified. The company would then compile a safety dossier and communicate it to the FDA as a New Dietary Ingredient submission, with the hopes of it being allowed for lawful sale.

When a powdered formulation is designed, the list of ingredients and raw materials are typically sent to a flavoring house and packaging company to identify the best way to flavor and package the supplement. In the nutrition industry, several main flavoring houses and packaging companies exist who make many dietary supplements for supplement companies.

Most reputable dietary supplement manufacturers submit their production facilities to inspection from the FDA and adhere to GMP, which represent industry standards for good manufacturing of dietary supplements. Some companies also submit their products for independent testing by third-party companies to certify that their products meet label claims and that the product is free of various banned ingredients.

For example, the certification service offered by NSF International includes product testing, GMP inspections, ongoing monitoring and use of the NSF Mark indicating products comply with inspection standards, and screening for contaminants. More recently, companies have subjected their products for testing by third party companies to inspect for banned or unwanted substances.

These types of tests help ensure that the dietary supplement made available to athletes do not contained substances banned by the International Olympic Committee or other athletic governing bodies e. While third-party testing does not guarantee that a supplement is void of banned substances, the likelihood is reduced e.

Moreover, consumers can request copies of results of these tests and each product that has gone through testing and earned certification can be researched online to help athletes, coaches and support staff understand which products should be considered.

In many situations, companies who are not willing to provide copies of test results or certificates of analysis should be viewed with caution, particularly for individuals whose eligibility to participate might be compromised if a tainted product is consumed. The ISSN recommends that potential consumers undertake a systematic process of evaluating the validity and scientific merit of claims made when assessing the ergogenic value of a dietary supplement [ 1 , 4 ].

This can be accomplished by examining the theoretical rationale behind the supplement and determining whether there is any well-controlled data showing the supplement is effective. Supplements based on sound scientific rationale with direct, supportive research showing effectiveness may be worth trying or recommending.

Sports nutrition specialists should be a resource to help their clients interpret the scientific and medical research that may impact their welfare and help them train more effectively. The following are recommended questions to ask when evaluating the potential ergogenic value of a supplement.

Most supplements that have been marketed to improve health or exercise performance are based on theoretical applications derived from basic science or clinical research studies. Based on these preliminary studies, a dietary approach or supplement is often marketed to people proclaiming the benefits observed in these basic research studies.

Although the theory may appear relevant, critical analysis of this process often reveals flaws in the scientific logic or that the claims made do not quite match up with the cited literature.

By evaluating the literature one can discern whether or not a dietary approach or supplement has been based on sound scientific evidence.

To do so, one is recommended to first read reviews about the training method, nutrient, or supplement from researchers who have been intimately involved in the available research and consult reliable references about nutritional and herbal supplements [ 1 , 9 ].

To aid in this endeavour, the ISSN has published position statement on topics related to creatine [ 10 ], protein [ 11 ], beta-alanine [ 12 ], nutrient timing [ 13 ], caffeine [ 14 ], HMB [ 15 ], meal frequency [ 16 ], energy drinks [ 17 ], and diets and body composition [ 18 ]. Each of these documents would be excellent resources for any of these topics.

In addition, other review articles and consensus statements have been published by other researchers and research groups that evaluate dietary supplements, offer recommendations on interpreting the literature, and discuss the available findings for several ingredients that are discussed in this document [ 19 , 20 , 21 ].

A quick look at these references will often help determine if the theoretical impetus for supplementing with an ingredient is plausible or not. Proponents of ergogenic aids often overstate claims made about training devices and dietary supplements while opponents of ergogenic aids and dietary supplements are often either unaware or are ignorant of research supporting their use.

Sports nutrition specialists have the responsibility to know the literature and search available databases to evaluate the level of merit surrounding a proposed ergogenic aid. Some athletic associations have banned the use of various nutritional supplements e.

and many professional sports organization have now written language into their collective bargaining agreements that products made available by the team must be NSF certified as safe for sport. Obviously, if the supplement is banned, the sports nutrition specialist should discourage its use.

In addition, many supplements lack appropriate long-term safety data. People who consider taking nutritional supplements should be well aware of the potential side effects so they can make an informed decision whether to use a supplement.

Additionally, they should consult with a knowledgeable physician to see if any underlying medical problems exist that may contraindicate its use. When evaluating the safety of a supplement, it is suggested to determine if any side effects have been reported in the scientific or medical literature.

In particular, we suggest determining how long a particular supplement has been studied, the dosages evaluated, and whether any side effects were observed. Unfortunately, many available supplements have not had basic safety studies completed that replicate the length of time and dosages being used.

The next question to ask is whether any well-controlled data are available showing effectiveness of the proposed ergogenic aid in athletic populations or people regularly involved in exercise training. The first place to look is the list of references cited in marketing material supporting their claims.

Are the abstracts or articles cited just general references or specific studies that have evaluated the efficacy of the nutrients included in the formulation or of the actual supplement? From there, one can critically evaluate the cited abstracts and articles by asking a series of questions:.

For perspective, studies reporting improved performance in rats or an individual diagnosed with type 2 diabetes may be insightful, but research conducted on non-diabetic athletes is much more practical and relevant.

Were the studies well controlled? For ergogenic aid research, the gold standard study design is a randomized, double-blind, placebo controlled clinical trial.

This means that neither the researcher nor the subject is aware which group received the supplement or the placebo during the study and that the subjects were randomly assigned into the placebo or supplement group. At times, supplement claims have been based on poorly designed studies i.

or testimonials which make interpretation more difficult. Well-controlled clinical trials provide stronger evidence as to the potential ergogenic value and importantly how the findings can best be used. Do the studies report statistically significant results or are claims being made on non-significant means or trends?

Appropriate statistical analysis of research results allows for an unbiased interpretation of data. Although studies reporting statistical trends may be of interest and lead researchers to conduct additional research, studies reporting statistically significant results are obviously more convincing.

With this said, it is important for people to understand that oftentimes the potential effect a dietary supplement or diet regimen may have above and beyond the effect seen from the exercise bout or an accepted dietary approach is quite small. In addition, many studies examining a biochemical or molecular biology mechanism can require invasive sampling techniques or the study population being recruited is unique very highly trained resulting in a small number of study participants.

When viewed together, the combination of these two considerations can result in statistical outcomes that do not reach statistical significance even though large mean changes were observed. In all such cases, additional research is warranted to further examine the potential ergogenic aid before conclusions can be made.

Do the results of the cited studies match the claims made about the supplement or do they accurately portray the response of the supplement against an appropriate placebo or control group? It is not unusual for marketing claims to greatly exaggerate the results found in the actual studies and do so by focusing upon just the outcomes within the supplement treatment group as opposed to how the supplement group changed in comparison to how a placebo group changed.

Similarly, it is not uncommon for ostensibly compelling results, that may indeed be statistically significant, to be amplified while other relevant findings of significant consumer interest are obscured or omitted e. a dietary supplement showing statistically significant increases in circulating testosterone yet changes in body composition or muscular performance were not superior to a placebo.

Reputable companies accurately and completely report results of studies so that consumers can make informed decisions about using a product. At times, claims are based on research that has either never been published or only published in an obscure journal.

If you see only a few other journals this is a suggestion that the journal is not a reputable journal. Additionally, one can also look up how many articles have been published by the journal in the last 6—12 months and how many of these articles are well-conducted studies.

Impact factors are determined and published by Thomson Reuters under Journal Citation Reports® a subscription service available at most university libraries. Most journals list their impact factor on the journal home page. Historically, those articles that are read and cited the most are the most impactful scientifically.

Have the research findings been replicated? If so, have the results only been replicated at the same laboratory? The best way to know an ergogenic aid works is to see that results have been replicated in several studies preferably by several separate, distinct research groups. The most reliable ergogenic aids are those in which multiple studies, conducted at different labs, have reported similar results of safety and efficacy.

Additionally, replication of results by different, unaffiliated labs with completely different authors also removes or reduces the potentially confounding element of publication bias publication of studies showing only positive results and conflicts of interest. A notable number of studies on ergogenic aids are conducted in collaboration with one or more research scientists or co-authors that have a real or perceived economic interest in the outcome of the study.

This could range from being a co-inventor on a patent application that is the subject of the ergogenic aid, being paid or receiving royalties from the creation of a dietary supplement formulation, providing consulting services for the company or having stock options or shares in a company that owns or markets the ergogenic aid described in the study.

An increasing number of journals require disclosures by all authors of scientific articles, and including such disclosures in published articles.

This is driven by the aim of providing greater transparency and research integrity. It is important to emphasize that disclosure of a conflict of interest does not alone discredit or dilute the merits of a research study.

The primary thrust behind public disclosures of potential conflicts of interest is first and foremost transparency to the reader and second to prevent a later revelation of some form of confounding interest that has the potential of discrediting the study in question, the findings of the study, the authors, and even the research center or institution where the study was conducted.

Dietary supplements may contain carbohydrate, protein, fat, minerals, vitamins, herbs, enzymes, metabolic intermediates i. Supplements can generally be classified as convenience supplements e. As discussed previously, evaluating the available scientific literature is an important step in determining the efficacy of any diet, diet program or dietary supplement.

In considering this, nutritional supplements can be categorized in the following manner:. Strong Evidence to Support Efficacy and Apparently Safe: Supplements that have a sound theoretical rationale with the majority of available research in relevant populations using appropriate dosing regimens demonstrating both its efficacy and safety.

Limited or Mixed Evidence to Support Efficacy: Supplements within this category are characterized as having a sound scientific rationale for its use, but the available research has failed to produce consistent outcomes supporting its efficacy.

Routinely, these supplements require more research to be completed before researchers can begin to understand their impact. Importantly, these supplements have no available evidence to suggest they lack safety or should be viewed as harmful.

Several factors are evaluated when beginning to counsel individuals who regularly complete exercise training. To accomplish this, one should make sure the athlete is eating an energy balanced, nutrient dense diet that meets their estimated daily energy needs and that they are training intelligently.

Far too many athletes or coaches focus too heavily upon supplementation or applications of supplementation and neglect these key fundamental aspects. Following this, we suggest that they generally only recommend supplements in category I i.

If an athlete is interested in trying supplements in category II i. Obviously, the ISSN does not support athletes taking supplements in category III i. We believe this approach is scientifically substantiated and offers a balanced view as opposed to simply dismissing the use of all dietary supplements.

A well-designed diet that meets energy intake needs and incorporates proper timing of nutrients is the foundation upon which a good training program can be developed [ 22 , 23 ].

Incorporating good dietary practices as part of a training program is one way to help optimize training adaptations and prevent overtraining. The following is an overview of energy intake recommendations and major nutrient needs for active individuals. The primary component to optimize training and performance through nutrition is to ensure the athlete is consuming enough calories to offset energy expenditure [ 22 , 23 , 24 , 25 , 26 ].

People who participate in a general fitness program e. However, athletes involved in moderate levels of intense training e. For elite athletes, energy expenditure during heavy training or competition will further exceed these levels [ 27 , 28 ].

Additionally, caloric needs for large athletes i. This point was clearly highlighted in a review by Burke who demonstrated that carbohydrate needs are largely unmet by high-level athletes [ 22 ].

Additionally it is difficult to consume enough food and maintain gastrointestinal comfort to train or race at peak levels [ 35 ]. Maintaining an energy deficient diet during training often leads to a number of physical i.

and psychological i. It is still a question whether there may be specific individualized occasions when negative energy balance may enhance performance in the days prior to running performance [ 36 ].

Populations susceptible to negative energy balance include runners, cyclists, swimmers, triathletes, gymnasts, skaters, dancers, wrestlers, boxers, and athletes attempting to lose weight too quickly [ 37 ]. Additionally, female athletes are at particular risk of under fueling due to both competitive and aesthetic demands of their sport and their surrounding culture.

Female athletes have been reported to have a high incidence of eating disorders [ 38 ]. This makes LEA a major nutritional concern for female athletes [ 39 ]. Consequently, it is important for the sports nutrition specialist working with athletes to assess athletes individually to ensure that athletes are well fed according to the goals of their sport and their health, and consume enough calories to offset the increased energy demands of training, and maintain body weight.

Further, travel and training schedules may limit food availability or the types of food athletes are accustomed to eating. This means that care should be taken to plan meal times in concert with training, as well as to make sure athletes have sufficient availability of nutrient dense foods throughout the day for snacking between meals e.

Beyond optimal energy intake, consuming adequate amounts of carbohydrate, protein, and fat is important for athletes to optimize their training and performance. In particular and as it relates to exercise performance, the need for optimal carbohydrates before, during and after intense and high-volume bouts of training and competition is evident [ 41 ].

Excellent reviews [ 42 , 43 ] and original investigations [ 44 , 45 , 46 , 47 , 48 , 49 ] continue to highlight the known dependence on carbohydrates that exists for athletes competing to win various endurance and team sport activities.

A complete discussion of the needs of carbohydrates and strategies to deliver optimal carbohydrate and replenish lost muscle and liver glycogen extend beyond the scope of this paper, but the reader is referred to several informative reviews on the topic [ 23 , 41 , 50 , 51 , 52 , 53 ].

As such, individuals engaged in a general fitness program and are not necessarily training to meet any type of performance goal can typically meet daily carbohydrate needs by consuming a normal diet i. However, athletes involved in moderate and high-volume training need greater amounts of carbohydrate and protein discussed later in their diet to meet macronutrient needs [ 50 ].

In terms of carbohydrate needs, athletes involved in moderate amounts of intense training e. Research has also shown that athletes involved in high volume intense training e.

Preferably, the majority of dietary carbohydrate should come from whole grains, vegetables, fruits, etc. while foods that empty quickly from the stomach such as refined sugars, starches and engineered sports nutrition products should be reserved for situations in which glycogen resynthesis needs to occur at accelerated rates [ 53 ].

When considering the carbohydrate needs throughout an exercise session, several key factors should be considered. Previous research has indicated athletes undergoing prolonged bouts 2—3 h of exercise training can oxidize carbohydrates at a rate of 1—1. Several reviews advocate the ingestion of 0.

It is now well established that different types of carbohydrates can be oxidized at different rates in skeletal muscle due to the involvement of different transporter proteins that result in carbohydrate uptake [ 55 , 56 , 57 , 58 , 59 ].

Interestingly, combinations of glucose and sucrose or maltodextrin and fructose have been reported to promote greater exogenous rates of carbohydrate oxidation when compared to situations when single sources of carbohydrate are ingested [ 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ].

These studies generally indicate a ratio of 1—1. In addition to oxidation rates and carbohydrate types, the fasting status and duration of the exercise bout also function as key variables for athletes and coaches to consider.

When considering duration, associated reviews have documented that bouts of moderate to intense exercise need to reach exercise durations that extend well into 90th minute of exercise before carbohydrate is shown to consistently yield an ergogenic outcome [ 41 , 68 , 69 ].

Of interest, however, not all studies indicate that shorter 60—75 min bouts of higher intensity work may benefit from carbohydrate delivery.

Currently the mechanisms surrounding these findings are, respectively, thought to be replacement of depleted carbohydrate stores during longer duration of moderate intensity while benefits seen during shorter, more intense exercise bouts are thought to operate in a central fashion.

Moreover, these reviews have also pointed to the impact of fasting status on documentation of ergogenic outcomes [ 41 , 68 , 69 ]. In this respect, when studies require study participants to commence exercise in a fasted state, ergogenic outcomes are more consistently reported, yet other authors have questioned the ecological validity of this approach for competing athletes [ 43 ].

As it stands, the need for optimal carbohydrates in the diet for those athletes seeking maximal physical performance is unquestioned.

Daily consumption of appropriate amounts of carbohydrate is the first and most important step for any competing athlete. As durations extend into 2 h, the need to deliver carbohydrate goes up, particularly when commencing exercise in a state of fasting or incomplete recovery.

Once exercise ceases, several dietary strategies can be considered to maximally replace lost muscle and liver glycogen, particularly if a limited window of recovery exists.

In these situations, the first priority should lie with achieving aggressive intakes of carbohydrate while strategies such as ingesting protein with lower carbohydrate amounts, carbohydrate and caffeine co-ingestion or certain forms of carbohydrate may also help to facilitate rapid assimilation of lost glycogen.

Initially, it was recommended that athletes do not need to ingest more than the RDA for protein i. However, research spanning the past 30 years has indicated that athletes engaged in intense training may benefit from ingesting about two times the RDA of protein in their diet 1.

If an insufficient amount of protein is consumed, an athlete will develop and maintain a negative nitrogen balance, indicating protein catabolism and slow recovery.

Over time, this may lead to muscle wasting, injuries, illness, and training intolerance [ 76 , 77 , 81 ]. For people involved in a general fitness program or simply interested in optimizing their health, recent research suggests protein needs may also be above the RDA.

Phillips and colleagues [ 76 ], Witard et al. In this respect, Morton and investigators [ 83 ] performed a meta-review and meta-regression involving 49 studies and participants and concluded that a daily protein intake of 1.

In addition and in comparison to the RDA, non-exercising, older individuals 53—71 years may also benefit from a higher daily protein intake e. Recent reports suggest that older muscle may be slower to respond and less sensitive to protein ingestion, typically requiring 40 g doses to robustly stimulate muscle protein synthesis [ 84 , 85 , 86 ].

Studies in younger individuals, however, have indicated that in the absence of exercise, a 20 g dose can maximize muscle protein synthesis [ 87 , 88 ] and if consumed after a multiple set workout consisting of several exercises that target large muscle groups a 40 g dose might be needed [ 89 ].

Consequently, it is recommended that athletes involved in moderate amounts of intense training consume 1. This protein need would be equivalent to ingesting 3—15 three-ounce servings of chicken or fish per day for a 50— kg athlete [ 78 ]. Although smaller athletes typically can ingest this amount of protein, on a daily basis, in their normal diet, larger athletes often have difficulty consuming this much dietary protein.

Additionally, a number of athletic populations are known to be susceptible to protein malnutrition e. and consequently, additional counseling and education may be needed to help these athletes meet their daily protein needs.

Overall, it goes without saying that care should be taken to ensure that athletes consume a sufficient amount of quality protein in their diet to maintain nitrogen balance. Proteins differ based on their source, amino acid profile, and the methods of processing or isolating the protein undergoes [ 11 ].

These differences influence the availability of amino acids and peptides, which may possess biological activity e. For example, different types of proteins e. Therefore, care should be taken not only to make sure the athlete consumes enough protein in their diet but also that the protein is high quality.

The best dietary sources of low fat, high quality protein are light skinless chicken, fish, egg whites, very lean cuts of beef and skim milk casein and whey while protein supplements routinely contain whey, casein, milk and egg protein.

In what is still an emerging area of research, various plant sources of protein have been examined for their ability to stimulate increases in muscle protein synthesis [ 77 , 97 ] and promote exercise training adaptations [ 98 ].

While amino acid absorption from plant proteins is generally slower, leucine from rice protein has been found to be absorbed even faster than from whey [ 99 ], while digestive enzymes [ ], probiotics [ ] and HMB [ ] can be used to overcome differences in protein quality.

Preliminary findings suggest that rice [ 98 ] and pea protein [ ] may be able to stimulate similar changes in fat-free mass and strength as whey protein, although the reader should understand that many other factors dose provided, training status of participants, duration of training and supplementation, etc.

will ultimately impact these outcomes and consequently more research is needed. While many reasons and scenarios exist for why an athlete may choose to supplement their diet with protein powders or other forms of protein supplements, this practice is not considered to be an absolute requirement for increased performance and adaptations.

Due to nutritional, societal, emotional and psychological reasons, it is preferable for the majority of daily protein consumed by athletes to occur as part of a food or meal. However, we recognize and embrace the reality that situations commonly arise where efficiently delivering a high-quality source of protein takes precedence.

Jager and colleagues [ 11 ] published an updated position statement of the International Society of Sports Nutrition that is summarized by the following points:. An acute exercise stimulus, particularly resistance exercise and protein ingestion both stimulate muscle protein synthesis MPS and are synergistic when protein consumption occurs before or after resistance exercise.

For building and maintaining muscle mass, an overall daily protein intake of 1. Higher protein intakes 2. Optimal doses for athletes to maximize MPS are mixed and are dependent upon age and recent resistance exercise stimuli.

General recommendations are 0. The optimal time period during which to ingest protein is likely a matter of individual tolerance; however, the anabolic effect of exercise is long-lasting at least 24 h , but likely diminishes with increasing time post-exercise.

Rapidly digested proteins that contain high proportions of EAAs and adequate leucine, are most effective in stimulating MPS. Different types and quality of protein can affect amino acid bioavailability following protein supplementation; complete protein sources deliver all required EAAs.

The dietary recommendations of fat intake for athletes are similar to or slightly greater than dietary recommendations made to non-athletes to promote health.

Maintenance of energy balance, replenishment of intramuscular triacylglycerol stores and adequate consumption of essential fatty acids are important for athletes, and all serve as reasons for an increased intake of dietary fat [ ]. For example, higher-fat diets appear to maintain circulating testosterone concentrations better than low-fat diets [ , , ].

Additionally, higher fat intakes may provide valuable translational evidence to the documented testosterone suppression which can occur during volume-type overtraining [ ]. In situations where an athlete may be interested in reducing their body fat, dietary fat intakes ranging from 0.

Well-known author Dan Benardot draws on his vast experience as an instructor, scientist, and practitioner to craft an engaging and factual resource that makes the nutrition of exercise science accessible.

Written at a level appropriate for both exercise science majors and non-majors, this practical book is packed with helpful in-text learning aids and stunning visuals that bring sports nutrition concepts to life. Learn More. This comprehensive toolkit provides sports nutritionists with introductory materials covering fundamental sports nutrition topics, including athlete consultations and dietary analysis, nutrition monitoring, nutrition interventions and individualized meal planning.

Practitioners will find checklists, decision trees, assessment worksheets and questionnaires, templates, nutritional breakdowns and a wealth of supporting research to help modify and adapt each tool to meet the unique needs of their athletes.

The content was authored by GSSI Scientists Liam Brown, M. and Ian Rollo, Ph. Download the Free Toolkit. Historical nutrition strategies were based on beliefs and sport-specific traditions that had little to do with any consideration of human biology and physiology.