Thesis of Masters Degree On A Critical e

“A critical evaluation of the nutritional supplements that enhance
the performance of athlete’s.”
By
PANAGIOTIS BASOURAKOS
(Student No. 2401935)
2007
A dissertation submitted to the Faculty of Engineering, Science and the

Built Environment, Department of Applied Sciences – Academy of Sport,
2401935
Physical Activity and Well-being of the London South Bank University, in

partial-fulfilment of the degree of M. Sc. in Nutrition, Health and Lifestyle.
Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

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ACKNOWLEDGEMENTS
I would sincerely like to thank everyone that helped me with this project. I
would like to say a special thank you to my parents for helping me in the best
way possible. Finally I must sincerely thank my supervisor Professor John
Seeley for all his invaluable help and advice during the period of this project.
Basourakos Panagiotis 3 M. Sc. in Nutrition, Health and Lifestyle

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TABLE OF CONTENTS
TABLE OF CONTENTS......................................................................................................3
1. INTRODUCTION.............................................................................................................4
2. DEFINITIONS OF PRE-EXERCISE AND POST-EXERCISE PERIODS....................6
3. THE EFFECT OF MEAL FREQUENCY AND TIMING ON PHYSICAL

PERFORMANCE...........................................................................................................7
4. TIMING OF CARBOHYDRATE ADMINISTRATION AND ITS EFFECT ON

PHYSICAL PERFORMANCE.....................................................................................10
4.1. Carbohydrate in the days before an athletic event.................................................12
4.2. Carbohydrate in the 3-4 hours before an athletic event.........................................13
4.3. Carbohydrate in the 30-60 min before an athletic event........................................14
4.4. Carbohydrate during an athletic event...................................................................17
4.5. Carbohydrate after an athletic event......................................................................18
5. TIMING OF PROTEIN ADMINISTRATION AND ITS EFFECT ON PHYSICAL

PERFORMANCE.........................................................................................................21
6. TIMING OF FAT ADMINISTRATION AND ITS EFFECT ON PHYSICAL

PERFORMANCE.........................................................................................................29
7. TIMING OF WATER AND ELECTROLYTES ADMINISTRATION AND THEIR

EFFECT ON PHYSICAL PERFORMANCE..............................................................33
7.1. Fluid intake before an athletic event......................................................................34
7.2. Fluid intake during an athletic event......................................................................35
7.3. Fluid intake after an athletic event.........................................................................36
8. TIMING OF OTHER SUPPLEMENTS ADMINISTRATION AND THEIR

EFFECT ON PHYSICAL PERFORMANCE..............................................................38
9. CONCLUSIONS.............................................................................................................42

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REFERENCES....................................................................................................................44
1. INTRODUCTION
For those who get exercise regularly, there are various strategies that can be followed in order
to improve their performance. Examples include increasing their training time or their training
load, finding a good professional to coach them, investment in good professional sports
equipment, or join a good team of known reputation. However, at the highest levels of athletic
competition, there are fewer options available. All the competitors are usually training to their
maximal levels and so the margin between losing or winning is often extremely small
(Maughan, 2002). Therefore, it seems logical that athletes and their coaches are looking for
other ways to improve their performance. One of these ways is to exploit the power of sports
nutrition by maximising the potential it offers, by seeking professional nutritional advice.
This nutritional advice will include the type and quality of their meals but also the
supplements that can be taken along with or between their basic meals. The latter can range
from the daily multivitamin tablet to the long list of “cure-all miracles” found in health food
stores. The most sought-after supplements are those that claim to be ergogenic, i.e.
performance enhancing or work producing. In general, ergogenic aids are those that can
improve athletic performance by increasing work capacity. Nevertheless, supplements aiming
to maintain well-being, and increase resilience, for example to infections, also have a
beneficial effect on an athlete and could be helpful. The problem is, however, that although
the use of supplements is so common among athletes, only few of them have been
comprehensively evaluated and most are poorly researched. Although the scientific value of
dietary manipulation for athletic performance has been studied extensively, the popularity and
use of ergogenic aids have preceded scientific substantiation of claims (Slavin, 2003).
Therefore to give nutritional advice to a highly competitive sportsman is definitely not a
simple task. More to this point, a discussion on the nutritional needs of athletes is complicated
further by the wide range of sports and the corresponding athletic types these sports require.
Athletic pursuits include a range of activities from short bursts of speed to high endurance
events that include days of uninterrupted exercise. Adding to the complexity are differences
in nutrient needs related to age, gender and environmental conditions (Slavin, 2003).

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The field of nutrition, and especially sports nutrition, is a dynamic one. As already mentioned,
both the recreational athlete as well as the professional athlete will seek nutritional advice
from a sports dietician or an exercise physiologist, a coach or a doctor, for example, in order to
maximise his/ her potential, achieve higher goals or excel in his/ her preferred sport.
Nowadays the competition among athletes has obviously grown bigger than in the past
because a minute difference in athletic performance, for example, a difference of even
fractions of seconds in distance runners, can be crucial in winning a medal or breaking a
record. Even if someone is just exercising in their spare time, it is to their own benefit to stay
as well informed as possible about the latest discoveries in sports nutrition and science so that
they maximise their performance. Therefore there is constantly a growing interest in applied
sports nutrition.
Sports nutrition is a multi-disciplinary field, requiring knowledge of several different sciences,

such as Biochemistry, Medicine, Exercise Physiology and Psychology. It is also relatively
new, in the sense that it is evolving rapidly from the classic nutritional approaches of the past.
That’s why it can be controversial at times, since not everyone is equally well informed about
the latest publications and findings (Kalman & Campbell, 2004).
One such controversial issue regarding sports nutrition that has gained much interest is the
timing of administration of the various meals, supplements or drinks. A large number of
scientific studies have examined the effects of supplements used by athletes, however
comparatively little attention has been given to the patterns of supplement or meals
consumption. The answers depend on the nutrient content of foods under question and most
times they are not straightforward. They also depend on the type and nature of the physical
exercise required for a particular sport, for example resistance training versus endurance
training. It is important to note that since the answers to these questions are crucial as far as
athletic performance is concerned, there is extensive ongoing research about these issues. The
current thesis will attempt to critically review these issues.
It has been shown that the quantity and frequency of dietary supplementation is higher among
elite than non-elite athletes, making the former vulnerable to the uncontrolled use of dietary
supplements, including some that have dubious effects on physical performance. Since these

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athletes are also role models, the excessive use of dietary supplements could be considered a
serious health concern (Schroder et al., 2002).
At all times, and no matter what the different findings and approaches are, it should be
remembered that sports nutrition must aim to optimise the personal abilities of each athlete as
well as to maximise their potential, whilst safeguarding and maintaining their good health. It is
true that, in order for someone to become a champion, extreme practices often have to be
followed. Sports nutrition, however, should always aim to keep the balance by promoting
healthy choices as far as eating habits and preferences are concerned.
2. DEFINITIONS OF PRE-EXERCISE AND POST-EXERCISE PERIODS
When one talks about nutritional timing with respect to an athletic event or training session,
normally the pre-exercise time periods are divided into these important metabolical stages:
firstly in the period of days before the exercise event, secondly in the 2-4 h period before the
event, and thirdly in the 30-60 min before exercise (Hawley & Burke, 1997). Then there is a
period during the athletic event that, as it will be shown later, can also be exploited for
nutritional refuelling, and finally there is the period of recovery, which follows the event itself.
The period of recovery can also be broken down into the first couple of hours that are the most
crucial, and the hours following these. All these periods are important for different reasons
and they all have a major or minor potential in affecting athletic performance depending on
other circumstances as well.
Obviously, these stages are somewhat less clearly defined if there is another exercise session
shortly after or before the first, because then the period of recovery from one event may
coincide for example with the 2-4 h pre-exercise period, where different recommendations
exist. That’s why these time divisions should only be used as general guidelines and should
be modified accordingly, depending on the nutritional needs of each specific sportsman/
sportswoman and his/ her training needs.

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3. THE EFFECT OF MEAL FREQUENCY AND TIMING ON PHYSICAL

PERFORMANCE
The caloric needs of athletes vary considerably depending on the type of sport undertaken.
Whereas sports such as gymnastics require calorie restriction, ultra-endurance sports may
require up to 10,000 kcal d-1 (Slavin, 2003). A survey of elite American female gymnasts
showed that they were undertaking heavy training loads, whilst consuming too few calories
and inadequate levels of vital nutrients (Howells and Thompson 2002) while another survey
with elite Swiss gymnasts, reported a calorie deficiency of 725 kcal d -1 (Zaggelidis et al.
2005). Therefore, athletes undergoing strenuous physical training have energy requirements
double or even triple that of the sedentary population and certainly well above the estimated
average requirements for energy. Estimated average requirements (EARs) for energy are
calculated based on the physical activity level and the basal metabolic rate for the average
population (Thomas & Nelson, 2001).
Athletes with increased physical activity levels have also increased energy expenditure, which
in turn depends on the type, intensity and duration of the exercise undertaken. The intensity of
exercise affects fuel use. Low-intensity exercise, such as walking, stimulates lipolysis,
whereas high-intensity exercise maximises carbohydrate (CHO) breakdown. Training
intensity can be measured as a percentage of the maximum oxygen uptake (VO 2max). For
example, a value of 75% VO2max, is a typical training intensity in many endurance sports
(Maughan, 2002). Research done by Romijn et al. (1993) studied five trained subjects during
exercise intensities of 25, 65, and 85% of maximal oxygen consumption (VO 2max). They found
that plasma glucose tissue uptake and muscle glycogen oxidation increased in relation to
exercise intensity whereas peripheral lipolysis was stimulated maximally at the lowest
exercise intensity, and fatty acid release into plasma decreased with increasing exercise
intensity. Muscle triglyceride lipolysis was stimulated only at higher intensities. During two
hours of exercise at 65% VO2max plasma-derived substrate oxidation progressively increased
over time, whereas muscle glycogen and triglyceride oxidation decreased. In recovery from
high-intensity exercise, although the rate of lipolysis immediately decreased, the rate of
release of fatty acids into plasma increased, indicating release of fatty acids from previously
hydrolysed triglycerides. The authors concluded that, whereas carbohydrate availability is

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regulated directly in relation to exercise intensity, the regulation of lipid metabolism seemed to
be more complex. (Romijn et al. 1993)
At all intensities, a combination of protein, fat and carbohydrate is used to fuel exercise. As
exercise continues, body stores of carbohydrates are depleted and it is crucial for the athlete to
consume energy sources in order to fuel exercise, if the exercise is prolonged (Slavin, 2003).
Therefore athletes under strenuous training regimes have increased energy requirements and,
with the exception of some endurance sportsmen, normally they also do because of their larger
body size and muscular development. Consequently, one of the most evident concerns when
providing nutritional advice to an athlete is how to ensure that their total energy requirements
are met.
The glycaemic index of a food is the incremental effect of carbohydrate in a food on blood
glucose, as a percentage of the effect of an equal weight of glucose. It is usually based on the
glycaemic effect of enough food to provide a 50 g dose of carbohydrate, compared with the
effect that an equivalent amount of pure glucose has (Monro, 2002). For example, corn flakes
have a glycaemic index of 80, whereas new potatoes have a glycaemic index of 70 (Jenkins et
al., 1981). Obviously the most common sense solution to ensure that an athlete’s total energy
requirements are met is to increase the total caloric intake, but this is not always easy since the
most energy-dense-nutrients (for example fat, or alcohol) are usually not recommended in
high doses since they can influence performance negatively. Total energy intake can be
achieved by increasing carbohydrate intake, and especially the refined, high glycaemic index
forms of it, which are less bulky and can therefore be consumed more easily in high quantities
(Hawley & Burke, 1997).
A simpler way of achieving this goal may be to consume a series of small meals and snacks
throughout the day rather than less frequent bigger meals. This is because frequent meal
consumption, and especially with high carbohydrate content that is recommended for athletes,
usually results in a higher total energy intake. The definition of a diet with “high carbohydrate
content” depends on the level of activity of the individual. For athletes, a high carbohydrate
diet is one that supplies 400-800 g of CHO d -1, or 7-12 g of CHO kg-1 BW d-1 (Burke et al.,
2004; Coyle, 2004). Another benefit of snacking regularly is that the gastric discomfort of
infrequent large meals is greatly reduced (Hawley & Burke, 1997).

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Even so, some athletes still don’t manage to meet their daily energy requirements, so it has
been suggested by various researchers to consume energy-rich snacks (for example bars,
cakes, sweets) or drinks whilst exercising, in an attempt to explore all opportunities available
to refuel (Maughan, 2002; Kalman & Campbell, 2004). Indeed this practice has been proven
crucial to maintain energy balance during a cycling competition which lasted twenty days
(Saris et al., 1993). Nevertheless, the fear of gastrointestinal discomfort (for example
vomiting, diarrhoea) and the limited access to food and drinks during training may limit the
energy intake both during as well as shortly after a training session or an athletic event.
It is true that many people report diminished appetite for the first two or three hours after
exercise and these may require additional nutritional advice in order to identify their personal
opportunities to refuel with their preferred options (Hawley & Burke, 1997). Besides, meal
timing is crucial because it has been shown to have an effect on muscle protein synthesis,
which is an important parameter in determining the percentage of lean body mass of an
athlete. Recent data indicate that consuming a small meal of mixed macronutrient composition
(for example proteins plus carbohydrates and minerals) immediately before or following
strength exercise bouts can alter significantly net protein balance, thus resulting in greater
gains in both muscle strength and mass than those observed with training alone (Kalman &
Campbell, 2004).
The universal strategy here is to try to ensure that meals do not cause gastrointestinal
discomfort during exercise because excessive stomach fullness could result in an impairment
of exercise. Gastrointestinal symptoms greatly vary among individuals but may include
dizziness, nausea, stomach or intestinal cramps, vomiting and diarrhoea. High energy levels
are the result of good eating and exercise habits but the benefits of a high-energy status should
always be balanced with the possibility of gastrointestinal discomfort and of course this can
vary from one individual to the other.

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4. TIMING OF CARBOHYDRATE ADMINISTRATION AND ITS EFFECT ON

PHYSICAL PERFORMANCE
In addition to their high energy requirements, athletes, and especially those undertaking
endurance exercise, have increased carbohydrate needs. Sugars, such as sucrose and glucose,
together with polysaccharides, such as starch and cellulose, are the principal components of
the class of substances called carbohydrates. The empirical formulae of most carbohydrates
one encounters in foodstuffs approximate to (CH2O)n, hence the name. Polysaccharides are
polymers made up from monosaccharides, such as glucose or fructose connected together. The
common table sugar is a disaccharide (two monosaccharides joined together) of fructose and
glucose (Collins & Ferrier, 1995; Voet & Voet, 1995).
Carbohydrate is the main source of energy for muscle metabolism. Carbohydrates can be
divided into two categories based on their origin as endogenous or exogenous/ ingested.
Endogenous carbohydrates like glycogen are synthesised by the body and during the actual
exercise session, they provide much of the fuel used for muscle contraction assuming the
activity is of moderate-to-high intensity. Exogenous carbohydrates on the other hand are
ingested as part of the food consumed and subsequently broken down into their constituent
monosaccharides through the action of enzymes found in the saliva and the intestine.
Monosaccharides are then subjected to glycolysis, which is the first series of reactions to
produce energy in the form of ATP. The excess carbohydrates obtained from diet are stored in
the muscle and in the liver as glycogen. The concentration of glycogen is higher in the liver
than in muscle, but more glycogen is stored in skeletal muscle overall because of its greater
mass. Glycogen can then be converted back to glucose when energy is needed (Collins &
Ferrier, 1995; Voet & Voet, 1995). At this point it is important to provide a comparison of
glycogen levels in liver and muscles for male and female athletes. The normal body stores of
carbohydrate in a 70kg male athlete are 90g of liver glycogen and 400g of muscle glycogen,
while for a 60kg female athlete are 70g of liver glycogen and 300g of muscle glycogen.
The presence of glycogen increases significantly the amount of glucose that is immediately
available between meals and during muscular activity. The glucose in the body fluids of an
average 70 kg man has an energy content of around 40 kcal, whereas the total body glycogen
has an energy content of around 600 kcal. As soon as more energy is required, glycogen is

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broken down into glucose and the latter is oxidised to yield the energy required. Therefore
mainly the muscle but also the liver serve as carbohydrate reserves for the body but also as
regulators of a constant glucose concentration in the blood, with the help of the hormone
insulin (Stryer, 1995a).
A high-carbohydrate diet (for a definition, see section 3) is important in training to maximise

the intensity of the total training load and also to reduce the risk of illness and injury, but it is
even more critical during competition (Coyle, 2004). High-carbohydrate diets will cause
increased levels of glycogen stored in the muscle (Sherman et al., 1981; Hargreaves & Briggs,
1988; Hawley & Burke, 1997; Hawley et al., 1997a; Hawley et al., 1997b; Maughan, 2002;
Hargreaves et al., 2004). An increased level of glycogen in the working muscles has been
shown to enhance performance in various exercise models, such as prolonged constant
intensity effort, simulated race performance, multiple sprint events and short-duration high
intensity exercise (Maughan, 2002). On the contrary, a low-carbohydrate diet in athletes
impairs their exercise tolerance and their ability to adapt to long-term physical training (Coyle,
2004). At this point it is important to compare trained and untrained individuals with respect
to glycogen levels. For an untrained individual consuming a high carbohydrate (75%) diet,
glycogen stores may increase up to 130g and 360g for liver and muscle respectively for a total
storage of 490g. For an athlete training on a daily basis consuming a normal diet (45%
carbohydrate), glycogen levels approximate 55g and 280g for liver and muscle respectively
yielding a total of 330g. However, should this same well-conditioned athlete consume a high
diet (75% carbohydrate), their total carbohydrate reserves may soar up to 880g with
approximately 160g stored in the liver and 720g in the muscle (Peterson 2000).
However, the mode of exercise is important in determining the effect of carbohydrate, if any.
For example, it has been proposed that carbohydrate ingestion before and during running
results in lower glycogen utilisation (therefore higher glycogen levels in muscle) but has no
effect on muscle glycogen levels during cycling (Tsintzas & Williams, 1995; Arkinstall et al.,
2001). Similarly, it has been proposed that carbohydrate ingestion results in more marked
elevations in blood glucose and insulin concentrations during cycling compared with running,
at the same relative exercise intensity (Tsintzas & Williams, 1995; Arkinstall et al., 2001). So
the precise mechanism underlying the ergogenic effect of carbohydrate is not fully understood.

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Nevertheless, the total reserves of endogenous carbohydrate are limited and they are often
substantially less than the fuel requirements of most athletic events. Consequently, it is an
important concern for the athlete to match carbohydrate availability to the training or the
competition requirements. The extra carbohydrate obtained from food is crucial for fuel
availability between and during training sessions and also to promote glycogen re-synthesis
after exercise. Also, the ingestion of carbohydrate-containing foods and drinks before, during
and in combination can delay the onset of fatigue at the course of prolonged exercise
(Arkinstall et al., 2001; Slavin, 2003). However it is unclear exactly how the ingested
carbohydrate causes an ergogenic effect.
4.1. Carbohydrate in the days before an athletic event
The way ingested carbohydrate can help most likely depends on the time of administration
with respect to an athletic event. In the days before this athletic event, it has been proven that
“carbohydrate supercompensation” (a week of high carbohydrate diet with no taper in
training) elevates muscle glycogen, and most experimenters report similar findings based on
muscle biopsies (Hawley et al., 1997a; Hawley et al., 1997b; Arkinstall et al., 2001). The
elevated glycogen levels should help an athlete to achieve better results, at least in theory
(Sherman et al., 1981; Hargreaves & Briggs, 1988; Hawley et al., 1997b; Hargreaves et al.,
2004).
Before products were available to help athletes reload muscle glycogen stores quickly, some
old-fashioned and extreme practices were used instead, in order to raise glycogen levels as
much as possible. More specifically, before an important athletic event, athletes were put on a
few days of intense training without any carbohydrate in their diet, forcing their muscle
glycogen stores to a very low level. For the next few days that would follow, up to the day of
the event itself, the athletes would rest and would eat a carbohydrate-reach diet, in order to
double their muscle glycogen stores and give themselves plenty of energy to compete
(Karinch, 2002a). A period of relative carbohydrate deprivation, followed by the ingestion of
a high-carbohydrate diet, results in an marked increase in muscle glycogen, well above that
seen in the fed state. This phenomenon is known as “carbohydrate loading” and has been
linked with improved performance (Lamb et al., 1969; Costill et al., 1981). This practice is
indeed quite efficient in raising glycogen stores (Sherman et al., 1981; Chryssanthopoulos et

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al., 2004). However it had to be abandoned because during the intense training/no
carbohydrates period the athletes would suffer from hypoglycaemia and ketosis (increased
blood acids) and consequently they would experience symptoms such as nausea, dizziness,
bad temper and fatigue (Karinch, 2002a). Besides, more recent studies failed to find any
correlation between carbohydrate loading and increased performance (Madsen et al., 1990).
Nowadays, present strategies in sports nutrition still involve attempts to raise glycogen stores,
yet it remains controversial whether this effect can or cannot affect positively athletic
performance. The controversy may arise because the studies available may not be directly
comparable, because of the different nature of the athletic event used to monitor performance,
the different degree of professionalism among the athletes participating, and other factors that
complicate the picture further, making analogies and comparisons scientifically not viable.
The effects of gender on carbohydrate utilisation also remain unclear. Most studies of
glycogen storage have been conducted with males, assuming that the findings will be
applicable to females too (Burke et al., 2004). More to this point, it has also been suggested
by Tarnopolsky and colleagues (1995), that females may not be able to increase their muscle
glycogen levels as much as males can, by consuming high-carbohydrate diets in the days
before an event (Tarnopolsky et al., 1995). However, this can be explained by the lower total
caloric intake of females when compared to the diets of males (Tarnopolsky et al., 2001). A
psychological explanation to this tendency is that females are typically restrained eaters when
compared to males, being more concerned with their weight. They are therefore more
reluctant to consume the increased carbohydrate portions suggested to fully recover muscle
glycogen (Coyle, 2004). So, most likely, female and male athletes would benefit equally from
carbohydrate loading, provided energy and carbohydrate intake are adequate (Tarnopolsky et
al., 2001; Coyle, 2004).
4.2. Carbohydrate in the 3-4 hours before an athletic event
In the 3-4 h period before an athletic event, the consumption of carbohydrate-rich meals
elevates both muscle and liver glycogen, along with increasing the concentration of blood
glucose (Hawley et al., 1997a; Jeukendrup et al., 2005). However, current research still
remains controversial about whether these effects could indeed affect performance. Surely, if
access to carbohydrate-containing snacks and drinks during the event is restricted, ingestion of

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200-300 g carbohydrate 3-4 hours before may be a beneficial practice (Jeukendrup et al.,
2005). Of course that will depend on whether there is a recovery period before the next or the
previous event, otherwise the periods mentioned above are less clearly defined or they overlap
(Hawley & Burke, 1997).
There are various reasons regarding the controversial findings reported, which cannot always
be eliminated. For example, the protocol used to measure performance might not be fully
reliable to elucidate the differences in performance that, although minor, could be of
significance to an elite athlete. Besides, it is difficult to conduct long-term studies comparing
athletic performance improvements in athletes training under a specific nutritional regime.
More than often athletes do not wish to participate after a certain time period or they keep
travelling and therefore the environmental conditions vary a lot, further hampering direct
comparisons among available studies.
4.3. Carbohydrate in the 30-60 min before an athletic event
The period appearing to have more importance in affecting performance, as far as

carbohydrate consumption is concerned, seems to be the 30-60 min before the athletic event.
Past practices of coaches imposed to athletes included avoiding carbohydrates in the hour
preceding exercise, a notion mainly existing because of some research findings reported in the
1970’s (Foster et al., 1979). The Foster et al. (1979) study involved eight male and female
students who were studied during exercise to exhaustion on a bicycle ergometer at 80 and
100% of Vo2max following the ingestion of water, 75 g of glucose or a liquid meal (10 g
protein, 12.5 g fat, 15 g CHO). When compared to the endurance ride (80% Vo 2max) in the
water treatment, endurance performance time was reduced by 19%as a result of the pre-
exercise glucose feeding. No difference in performance at 80% Vo 2max was found between the
water and mineral trials. The pre-exercise feedings had no effect on exercise time to
exhaustion at 100% Vo2max. During the glucose and metal trials at 80% Vo2max, most of the
subjects demonstrated a transient decline in serum glucose (less than 3.5 mM). After 30-40
minutes of exercise, however, serum glucose returned to normal and was seldom low at the
time of exhaustion. Serum free fatty acids were depressed throughout the glucose trial. The
results of these experiments indicated impaired lipid mobilisation following carbohydrate
ingestion and demonstrated that glucose feedings 30-45 minutes before endurance exercise

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increased the rate of carbohydrate oxidation and impeded the mobilisation of free fatty acids,
thereby reducing exercise time to exhaustion. Unfortunately the results of this study have
been so widely reported and publicised that warnings to avoid carbohydrate intake during the
hour before endurance exercise have become part of sports nutrition dogma (Wilmore &
Costill, 1994; Inge & Brukner, 1986). However, a review of the literature reveals that this is
the only study to find reductions in performance capacity after the ingestion of CHO in the
hour before exercise.
A lot has changed since this study was conducted and the research community’ knowledge
about carbohydrates has progressed much further. Studies since the Foster et al. (1979) have
found either no detrimental effect or improvements in performance ranging from 7 to 20 %. A
summary of these studies investigating the effect of carbohydrate feedings during the hour
before exercise on exercise performance (cycling) can be seen in Table 1 presented below.
Time of pre-
Study Subjects (n) exercise CHO feeding Effect on performance
feed (min)
5 trained males
(Chryssanthopoulo 4 trained females
30 75 g glucose No effect
s et al., 1994) 8 untrained
males
(Devlin et al., 8 untrained
30 43 g glucose No effect
1986) males
(Febbraio and 1g CHO/kg BM as high or
6 trained males 45 No effect
Stewart, 1996) low GI
(Foster et al., 8 trained males Reduced performance
30 70 g glucose
1979) 8trained females by 19%
(Gleeson et al., 6 untrained Improved
45 70 g glucose
1986) males performance by 13%
(Hargreaves and 75 g glucose or 75 g
6 trained males 45 No effect
Briggs, 1988) fructose
(Okano et al., Improved
12 trained males 60 60-85 g fructose
1988) performance by 7%
(Sherman et al., 75 g or 150 g glucose Improved
9 trained males 60
1981) polymer performance by 13%
Increased
(Thomas et al., performance by 20%
8 trained males 60 70 g CHO as low or high GI
1991) with low GI, no effect
with high GI
Table 1 – Effect of carbohydrate feedings during the hour before exercise on exercise performance
(cycling) (Source: Hawley and Burke, 1997)
It has been reported that the ingestion of carbohydrate in the hour before exercise results in a
large increase in plasma glucose and insulin concentrations. Both glucose availability and

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insulin concentration determine the rate of glucose uptake in skeletal muscle. Insulin is further
responsible for glucose utilisation by muscle cells through the activation of some
transmembrane proteins (glucose transporters) and other intracellular enzymes which regulate
pathways for oxidative and nonoxidative glucose metabolism (Van Loon et al., 2000).
Under normal circumstances, the level of plasma glucose decreases once exercise commences,
presumably because of the combination of hyperinsulinaemia and contractile muscle activity
(Hawley & Burke, 1997; Hargreaves et al., 2004). However, in susceptible individuals, an
exaggerated increase in plasma insulin may cause rebound- hypoglycaemia, which is a
condition with unknown aetiology and must be determined by personal experience (Hawley
and Burke, 1997; Hargreaves et al., 2004). Therefore, unless the athlete suffers from crises of
rebound-hypoglycaemia, carbohydrate ingestion during exercise provides a pool of glucose
that becomes available for use during the later stages of exercise (Hargreaves et al., 2004).
Studies have reported that carbohydrate-rich sources with a low-glycaemic index could have
been an alternative at this stage (for example fructose-containing foods), because they produce
a minimal glycaemic-insulinaemic response (Hawley & Burke, 1997) and in essence, the
ingestion of low glycaemic index foods during the 30-60 min before exercise provides a more
stable metabolic response (Febbraio et al., 2000). However, their potential usefulness is
limited due to the fact that these carbohydrate-rich sources with a low-glycaemic index take
longer to be absorbed by the system, as they need to be metabolised by the liver.
Nowadays it has been widely accepted that the metabolic alterations associated with ingestion
of carbohydrate in this crucial period of 30-60 min before an athletic event, have the greatest
potential to influence performance. There are researchers like Febbraio et al. (2000) who
claim the opposite. In their research Febbraio et al. (2000) examined the effect of pre-exercise
carbohydrate ingestion on muscle carbohydrate metabolism and performance during
prolonged exercise. The study involved six endurance-trained men who performed three
exercise trials on a cycle ergometer after ingesting either a high glycaemic index (HGI), low
glycemic index (LGI), or placebo (Con) meal 45 min before exercise. During each trial,
subjects cycled at a workload corresponding to 70% peak oxygen uptake for 120 min,
followed by a 15-min performance cycle where total work (kJ) was measured. Ingestion of
HGI resulted in an elevated (P < 0.01) blood glucose concentration 15 min after ingestion,
compared with LGI and Con, but there were no differences in the glycemic responses to the

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meals thereafter, despite plasma insulin concentration being higher (P < 0.01) throughout the
rest period after ingestion of HGI compared with LGI and Con. Plasma free fatty acid
concentrations were lower (P < 0.05) throughout exercise in HGI compared with LGI and
Con. In addition, concentrations of this metabolite were lower (P < 0.05) during the first hour
of exercise in LGI compared with Con. Despite these results, no differences were observed in
either the rate of muscle glycogen utilisation during submaximal exercise or work output
during the performance cycle when the three trials were compared. These results
demonstrated that pre-exercise carbohydrate ingestion has no effect on muscle glycogen
utilisation or exercise performance, irrespective of the glycaemic or insulinaemic responses to
the ingested meals.
Contrary to the findings of this study, there appears to be little evidence to support the practise
of avoiding carbohydrates ingestion in the hours before exercise (Hawley & Burke, 1997;
Hargreaves et al., 2004). The Okano et al. (1988) that studied 12 trained males with a
carbohydrate feeding of 60-85 g fructose, 60 min before exercise found that it improved
performance by 7%. The Sherman et al. (1981) that studied 9 trained males with a
carbohydrate feeding of 75 g or 150 g glucose polymer, 60 min before exercise found that it
improved performance by 13%. The Thomas et al. (1991) that studied 8 trained males with a
carbohydrate feeding of 70 g carbohydrate, 60 min before exercise found that it improved
performance by 20%. This information is important and there is evidence to suggest that
carbohydrate ingestion 60 min prior to exercise may be beneficial unless of course the
nutritional advice is directed at individuals who are susceptible to rebound hypoglycaemia.
(Hargreaves et al., 2004)
4.4. Carbohydrate during an athletic event
On the other hand, there is now strong evidence that increasing the availability of
carbohydrate during prolonged exercise can improve work capacity. The most possible reason
for this is the preservation of plasma glucose concentration, the continuation of high rates of
carbohydrate oxidation and the sparing effect of liver glycogen (Hawley & Burke, 1997). The
availability of carbohydrate as a substrate for the central nervous system is also a critical
factor in athletic performance (Burke, 2001) and recent studies have shown that even with

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exercise as short as one hour, carbohydrate intake may have an advantage (Jeukendrup et al.,
2005). During exercise, high-glycaemic index food are recommended (Slavin, 2003).
Certainly, practical considerations may dictate the timing and the frequency of carbohydrate
feedings that athletes can follow during exercise. For example, during endurance athletic
competitions, energy replacement stops are every few kilometres in the course of the itinerary.
Hence, considerations such as: the time lost to grab something, the fear of discomfort felt in
order to digest it, and other practicalities, may prevent an athlete from attempting to refuel
during the event. Therefore, the practical problem of ingesting sufficient carbohydrate to
maximise muscle glycogen storage, when competition is either continuous or comprises of
multiple events, means that athletes must have a strategy to ensure the availability of suitable
carbohydrate sources at the right times and in the right amounts. Unfortunately, nutrition
might be perceived as important by athletes but often lags behind the importance of other
parameters, such as equipment (Maughan, 2002).

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4.5. Carbohydrate after an athletic event
Finally, the period of recovery for muscle and liver glycogen restoration is important
especially if subsequent athletic events follow. Previously it was believed that restoration of
muscle and liver glycogen stores to normal levels could take up to 48 hours after the end of
exercise (Piehl et al., 1974). However, now it is commonly accepted that glycogen repletion
can be completed within 24 hours, provided that the amount and the timing of carbohydrate
are optimal (Hawley & Burke, 1997; Burke et al., 2004). For example, complete restoration
of depleted carbohydrate stores can occur within 24 hours if at least 8g of carbohydrate per kg -
1
BW d-1 is consumed (Jeukendrup et al., 2005). In general, the rate of recovery of glycogen
stores depend on the amount and type of carbohydrate consumed, as well as on the timing of
carbohydrate intake and the presence of muscle damage.
When there is only a few hours of recovery, the current literature suggests that it is better not
to delay the post-exercise intake of carbohydrate because early rates of glycogen re-synthesis
become important (Hawley & Burke, 1997). The highest rates of muscle glycogen storage
occur during the first hour after exercise (Ivy et al., 1988). After a glycogen-depleting
stimulus like exercise, the rise in plasma insulin induced by a carbohydrate-rich meal directs a
substantial part of the glucose towards repletion of the glycogen stores. This process occurs
by insulin-dependent and insulin-independent increases in both glucose uptake and glycogen
synthesis. A key enzyme in glycogen synthesis is glycogen synthase, which catalyses the
incorporation of UDP-glucose into glycogen. Exercise is a potent regulator of glycogen
synthase activity, leading to activation of glycogen synthase immediately after exercise
promoting glycogen repletion by mechanisms independent of insulin. The incorporation of
UDP-glucose is energy demanding, and during intense exercise glycogen synthase is
deactivated, diminishing energy utilisation but also increasing the potential for glycogen
breakdown. An apparent activation of glycogen synthase is observed during moderate
exercise, which could be considered as a potential waste of energy, although the cellular
capacity for glycogen breakdown is considerably higher than that for glycogen synthesis.
(Nielsen & Wojtaszewski 2004)
The interactive effect of exercise and supplement ingestion may be due to the increased
muscle blood flow, and thus substrate delivery, immediately after exercise (Borsheim et al.,

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2002). Other researchers conclude that carbohydrate supplementation following resistance

training can decrease myofibrillar protein degradation and urea nitrogen excretion, favouring a
positive nitrogen balance (Roy et al., 1997). In all cases, it seems that early carbohydrate
intake is crucial for replenishing depleted glycogen stores.
During the period of recovery, it is recommended to consume carbohydrate foods with a

moderate to high glycaemic index because this might result in higher glycogen synthesis rates
and greater insulin responses than the ingestion of carbohydrates foods with low glycaemic
index (Slavin, 2003; Burke et al., 2004). For example, fructose (low glycaemic index) is more
slowly absorbed than sucrose or glucose (high glycaemic index). Two studies have directly
monitored muscle glycogen storage after 24 h of recovery from glycogen-depleting exercise
by feeding different amounts of carbohydrate to trained individuals over a 24-h recovery
period. The results of these studies show an increase in glycogen storage with increasing
carbohydrate intake and a glycogen storage threshold at a daily carbohydrate intake of around
7–10 g CHO·kg-1 BW d-1 (Costill et al., 1981; Burke et al., 1995). Although these figures have
evolved into the recommended carbohydrate intakes for optimal muscle glycogen recovery, it
is worth noting that they are derived from studies of glycogen storage during a passive
recovery period. As a result, requirements for total daily carbohydrate intake may be lower for
athletes whose training programmes do not challenge daily glycogen stores, but may also be
higher for some individuals or some situations. For example, athletes who undertake
strenuous training or competition programmes may also need to meet the daily fuel
requirements of their continued exercise in addition to post-exercise recovery. For example,
well-trained cyclists undertaking 2 h of training each day were found to have higher muscle
glycogen stores after a week of a daily carbohydrate intake of 12 g CHO·kg -1 BW d-1ay, than
when consuming the ‘recommended’ carbohydrate intake of 10 g CHO·kg-1 BW d-1 (Coyle et
al., 2001).
Whether the carbohydrate supplement is in solid or liquid form does not seem to affect muscle
glycogen synthesis rate, although there might be a preference for drinking fluids rather than
eating solid foods immediately after exercise, when appetite is suppressed (Keizer et al. 1987;
Reed et al. 1989; Jeukendrup et al., 2005). The amount of carbohydrate ingested is debatable,
with some researchers claiming that there is no benefit seen above certain quantities (Wong &
Williams, 2000). A general rule is that athletes should ingest approximately 1g CHO·kg-1

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BW· h after exercise until they eat their next large meal (Coyle, 2004). Other guidelines state
that carbohydrate intake after exhaustive exercise should average 50g·2h of moderate to high
glycaemic index foods, aiming to ingest a total of 600 g/ 24 h (Burke et al., 2004).
A final point regarding the recovery period and ingested carbohydrate is the latest popular
press literature about the pentose ribose, a carbohydrate component in our body’s energy
production, used by most living cells. The manufacturers controlling and marketing ribose
continuously claim that energy recovery in muscle cells during and after strenuous exercise
(high intensity exercise) is enhanced with ribose supplementation. Despite the current popular
beliefs though, this suggestion still remains to be proven (Kalman & Campbell, 2004; Kreider
et al., 2004).

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5. TIMING OF PROTEIN ADMINISTRATION AND ITS EFFECT ON PHYSICAL

PERFORMANCE
The maintenance of skeletal muscle throughout our lifespan is of utmost importance. Skeletal
muscle comprises around 40% of our total body weight and 50-75% of the total protein mass
(Kerksick & Leutholtz, 2005). It provides mechanical support, maintenance of body posture
but it also holds a primary role in the transport of amino acids throughout the body. The
balance of body protein is maintained by regulating a tight balance between protein synthesis
and breakdown and is controlled by various cellular mechanisms. Overall protein anabolism
(or growth) occurs when the rate of protein synthesis is greater than the rate of breakdown.
This is of particular interest to resistance training athletes who need to increase their muscle
mass in order to remain strong and competent, as well as to endurance athletes who need to
ensure that they remain in positive nitrogen balance so that they do not lose a significant
percentage of skeletal muscle with training. So, protein balance is strongly related with
athletic performance.
There has been considerable debate as far as protein needs of athletes are concerned. In the
past, scientists believed that athletes did not need to ingest more than the recommended
dietary allowance (RDA) for protein (i.e. 0.8-1.0 g·kg-1·d-1). This was probably because it was
known that, at least for resistance athletes, an acute bout of resistance exercise increases
muscle protein synthesis more than breakdown so that the net muscle protein balance is
increased (Tipton et al., 2001). While resistance training by itself can increase protein
synthesis, recent research has indicated that the administration of exogenous nutrients is
needed to make the overall balance of protein positive. Over the last decade, it has been
shown that athletes participating in intense training programmes need to ingest almost double
the RDA in order to maintain protein balance. (Lemon et al., 1992; Tarnopolsky et al., 1988;
1992; 1999; Kreider, 1999) If the amount of protein obtained from food is not sufficient, an
athlete will be on negative nitrogen balance, which can increase protein catabolism and slow
recovery. In the long term, this may result in lean muscle wastage and training intolerance
(Kreider et al., 2004). Thus exercise and amino acids from proteins seem to have
complementary effects on muscle protein synthesis (Tipton et al., 2001).

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For people involved in a general fitness programme, protein needs can generally be met by
ingesting 0.8-1.0 g·kg-1·d-1 of protein. It is generally recommended that athletes involved in
moderate amounts of intense training consume 1–1.5 g·kg -1·d-1of protein (50 – 225 g··d-1for a
50–150 kg athlete) while athletes involved in high volume intense training consume 1.5 – 2.0
g·kg-1·d-1 of protein (75 – 300 g··d-1for a 50 – 150 kg athlete). This protein need would be
equivalent to ingesting 3 – 11 servings of chicken or fish per day for a 50 – 150 kg athlete.
Although smaller athletes typically can ingest this amount of protein in their normal diet,
larger athletes often have difficulty consuming this much dietary protein. Additionally, a
number of athletic populations have been reported to be susceptible to protein malnutrition
(e.g. runners, cyclists, swimmers, triathletes, gymnasts, dancers, skaters, wrestlers, boxers,
etc.). Therefore, care should be taken to ensure that athletes consume a sufficient amount of
quality protein in their diet in order to maintain nitrogen balance (e.g., 1.5 - 2 g·kg -1·d-1).
(Kreider & Klein 2000; Kreider et al., 2004)
The first step in determining the potential benefit of protein supplementation of the diet for
subjects involved in strenuous exercise is to define the goal of supplementation. For example,
an endurance athlete may look to a supplement that will speed recovery from workouts
without adding muscle mass, whereas a power-lifter will seek a supplement specifically to
increase muscle mass and power. The components, and amounts of each component, that
would optimally achieve the desired goal should then be predicted on the basis of results from
metabolic studies in which the responses of muscle protein synthesis and breakdown are
quantified. Factors yet to be determined are the optimal composition of a supplement (e.g.
type of protein, composition of amino acid mixture, nature of non-protein energy), the optimal
timing of ingestion in relation to exercise, and the amount of protein or amino acids per
serving. When a theoretically optimal supplement is designed, then a long-term (e.g. 6-mo)
outcome study should be performed in which pertinent outcome variables (e.g. muscle
strength) are measured. Outcome studies should include both individuals who are habitual
exercisers and untrained individuals who start training as part of the study. Only when an
optimal supplement is evaluated under controlled conditions (i.e., comparable levels of
exercise intensity, training duration, and other nutritional intake) can the question of protein
requirements during exercise be definitively answered. (Wolfe, 2000: 556S)

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The human body requires nitrogen. Nitrogen requirements include what is needed for both
tissue protein synthesis and the production of several nitrogenous compounds involved in a
range of functions (hormones, neurotransmitters, immune competence and peroxidative
defences). Under specific physiological and dietary conditions, the dietary requirements for
protein, amino acid and nitrogen are determined by the nature of the metabolic demand that
must be satisfied. An evaluation of protein quality must therefore take into account the
different processes involved in amino acid and nitrogen homeostasis. The achievement of
nitrogen homeostasis involves a complex series of changes in rates of whole body protein
turnover, amino acid oxidation, urea production and nitrogen excretion during the fasting, fed,
postprandial and postabsorptive periods of the day. Human nitrogen requirements are usually
determined from the nitrogen balance. The usual procedure is to regress nitrogen balance on
intake and to define the requirement as the intake level that would produce a zero balance, i.e.,
equality of dietary N intake and N losses. (Tome & Bos 2000: 1868S) Table 2 presents some
published results of nitrogen balance in humans on high protein diets. These studies show that
high protein intakes result in a continuous, positive nitrogen balance of 1–3 g N d -1. (Cheng et
al., 1978, Fisher et al., 1967, Forslund et al., 1999, Oddoye & Margen, 1979, Price et al.,
1994) However, it is not clear whether this apparent retention is real or originates from
intrinsic errors in calculation of the nitrogen balance.
Reference Protein intake Time period Nitrogen balance

-1 -1
g·kg ·d d g of N d-1
Oddoye & Margen 1978 3.0 50 +1.6
Fisher et al. 1967 2.8 21 +3.1
Forslund et al. 1999 2.5 7 +1.8 (NS)
Price et al. 1994 2.3 12 +3.0
Cheng et al. 1978 2.3 11 +3.0
Table 2 - Some published results of nitrogen balance in humans on high protein diets
Protein supplements offer a convenient way to ensure that athletes consume quality protein in
their diet and meet their protein needs. However, ingesting additional protein beyond that

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necessary to meet protein needs does not seem to promote further any gains in muscle mass or
strength. On the contrary, the type of protein ingested, the timing of administration and the
combination of protein with other nutrients, for example with carbohydrate, seem to be the
most important parameters. Therefore, the effectiveness of protein or amino acid intake
depends not only on the form in which the substrate is ingested, but also on the pattern of
ingestion and the interaction with other factors, such as exercise and non-protein caloric intake
(Wolfe, 2002).
Despite the fact that research on timing of protein administration is rich, current literature is
contradictory as to whether protein intake following resistance exercise is more important in
promoting muscle protein synthesis than the same intake before exercise. Theoretically,
increased availability of amino acids in the body before an exercise bout (in the form of a
proteinaceous meal or snack ingested shortly beforehand) may enhance gains in muscle mass
during training (Kreider et al., 2004). On the other hand, increased availability of amino acids
after exercise (again by ingesting a protein-rich meal or snack shortly afterwards) may speed
up recovery and the natural muscle re-built processes occurring in our body. This is because
protein helps the body repair damaged muscles after exercise and provides the building blocks
needed for muscles to grow stronger to handle the stress of future workouts (Karinch, 2002a).
Whether protein intake is before or after exercise, though, the proportional contributions of
individual amino acids to the ingested mixture seem to have an important role. It appears that
essential amino acids (i.e. those that the body cannot synthesise and must therefore be supplied
by the diet) produce a dose-dependent effect on muscle protein synthesis, whereas non-
essential amino acids (i.e. those that the body can synthesise on its own) do not appear to
contribute in that respect. In other words, essential amino acids are the primary stimulators of
muscle protein synthesis, but non-essential amino acids are not a necessary component. The
mechanism through which essential amino acids play this role is unknown, although
regulation of translation via initiation factors has been suggested (Rasmussen et al., 2000).
Another interesting point to make is that essential amino acids, even at an experimental dose
as low as 6 g, continue to cause the same effect (it is unknown to what extent, though) whether
or not carbohydrate is added to the formula (Borsheim et al., 2002). This is an important
finding because it means that essential amino acids can be easily combined, for example in the

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form of a drink, with the beneficial effects of carbohydrate supplementation before or after
exercise (Tipton et al., 2001). Indeed it has been shown that a mixture of wheat hydrolysate,
free leucine and free phenylalanine leads to a substantial increase in plasma insulin levels in
healthy subjects after a short fasting period, and that the addition of carbohydrate to this
insulinotropic protein-free amino acid mixture can accelerate post-exercise muscle protein
synthesis up to 88% than carbohydrate alone (Van Loon et al., 2000). Other researchers report
that a mixture of carbohydrate and essential amino acids result in up to 400% increase in
muscle protein synthesis after resistance exercise (Biolo et al., 1995; Biolo et al., 1997), when
compared to resting values, without determining the specific effect of the added carbohydrate,
though. In another study, the authors report their findings which indicate that the combined
effect on net muscle protein synthesis of carbohydrate and amino acids given together after
resistance exercise is roughly equivalent to the sum of the independent effects of either given
alone (Miller et al., 2003), but care should always be taken before attempting to compare
results from different research groups and experimental conditions. Besides, other parameters,
such as hormonal influence, disease, exhaustion, internal and external temperature, can affect
the stimulation of protein synthesis (Kerksick & Leutholtz, 2005).
In summary, many studies have provided support for the powerful effect of combining protein
with carbohydrate, and evidence gathers towards the belief that eating protein with
carbohydrate post-workout increases the amount of carbohydrate converted and stored in the
muscles as glycogen. Adding carbohydrates to a protein delivery system actually increases the
insulin release. The insulin helps deliver the nutrients by shuttling them in an accelerated rate
for growth and recovery (Karinch, 2002a). Nevertheless, the only one to date to determine
quantitatively any changes in protein synthesis when considering the timing of ingestion
before or after the exercise bout, is the work of Tipton (Tipton et al., 2001). Tipton et al.
(2001) studied six healthy volunteers (3 females, 3 males) in two trials (test and placebo) of
pre-resistance exercise (PRE). Each subject consumed two 500-ml bolus drinks during each
trial. The order of the trials was randomly selected. During the PRE trial, the essential amino
acid-carbohydrate supplement (EAC) drink was consumed immediately before initiation of the
exercise bout, and the placebo was consumed immediately upon cessation of the exercise bout.
For the POST trial, the order was reversed. The EAC consisted of 6 g of essential amino acids,
in amounts designed to increase muscle free intracellular amino acid levels in proportion to

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their respective requirements for protein synthesis, and 35 g of sucrose in 500 ml of deionised-
distilled water. The amounts of essential amino acids in a 500-ml bolus EAC solution were
(mg and mmol, respectively) histidine 0.65, 4.2; isoleucine 0.60, 4.6; leucine 1.12, 8.5; lysine
0.93, 6.4; methionine 0.19, 1.3; phenylalanine 0.93, 5.6; threonine 0.88, 7.4; and valine 0.7,
6.0. Additionally, 0.0605 g of L-[ring-2H5]phenylalanine was added to the solution to
maintain isotopic steady state. A small amount of artificial sweetener, containing aspartame,
was added to the EAC to improve palatability. The placebo solution was composed of
deionised-distilled water and an artificial sweetener containing aspartame. The placebo
contained 200 mg of phenylalanine.
According to the findings of this research group, consuming a small dose of essential amino
acids with some carbohydrate immediately before an acute resistance training session was
more effective at stimulating protein synthesis and improving protein balance when compared
to ingesting the nutrients immediately after the workout. The doses used were absolute (6 g of
essential amino acids with 35 g of carbohydrate) and the total number of subjects was only six
so it still remains under question whether these findings can be extrapolated with confidence
to the general athletic society. Moreover, although there is sound theoretical rationale, it is
currently unclear whether following this strategy would lead to greater training adaptations
and whether essential amino acid supplementation would be better than simply ingesting
carbohydrate and a quality protein following exercise (Kreider et al., 2004).
Age can also affect the extent of muscle protein synthesis. Actually aging is associated with a
progressive reduction of skeletal muscle volume with a concomitant reduction in strength.
However, resistance training has been shown to counteract the atrophy and loss of strength in
the elderly, so an interesting study to examine the beneficial effect of protein intake timing on
top of resistance training for the elderly has been conducted (Esmarck et al., 2001). Esmarck
et al. (2001: 1) investigated the importance of immediate (P0) or delayed (P2) intake of an oral
protein supplement upon muscle hypertrophy and strength over a period of resistance training
in elderly males. 3. Thirteen men (age, 74 ± 1 years; body mass index (BMI), 25 ± 1 kg m _2)
completed a 12 week resistance training programme (3 times per week) receiving oral protein
in liquid form (10 g protein, 7 g carbohydrate, 3 g fat) immediately after (P0) or 2 h after (P2)
each training session. Muscle hypertrophy was evaluated by magnetic resonance imaging
(MRI) and from muscle biopsies and muscle strength was determined using dynamic and

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isokinetic strength measurements. Body composition was determined from dual-energy X-ray
absorptiometry (DEXA) and food records were obtained over 4 days. The plasma insulin
response to protein supplementation was also determined. In response to training, the cross-
sectional area of m. quadriceps femoris (54.6 ± 0.5 to 58.3 ± 0.5 cm 2) and mean fibre area
(4047 ± 320 to 5019 ± 615 μm2) increased in the P0 group, whereas no significant increase
was observed in P2. For P0 both dynamic and isokinetic strength increased, by 46 and 15 %,
respectively (P < 0.05), whereas P2 only improved in dynamic strength, by 36 % (P < 0.05).
No differences in glucose or insulin response were observed between protein intake at 0 and 2
h post-exercise. Based on the findings of this study, it appears that the first two hours after
resistance exercise are important for the net protein synthesis and hypertrophy of skeletal
muscle in elderly individuals. Additionally, this does not appear to be related to the
hyperinsulinaemia in response to the intake of a protein-carbohydrate supplement.
An interesting point to make here is that the majority of the studies already mentioned have
employed infusions of free amino acids or ingestion of free amino acid solutions as opposed to
only the intact protein supplements which are commonly ingested. The constituents of both
forms may be similar, however it is possible that the intact proteins may not respond in the
same manner (Kerksick & Leutholtz, 2005). Fortunately, recent research with whey and
casein protein has proven that the results on amino acid uptake by the muscle were similar to
those observed with free amino acids (Tipton et al., 2004).
Supplements of branched-chain amino acids also appear in literature, since theoretically they
are supposed to help minimise protein degradation (Kreider, 1999), possibly because, unlike
other amino acids, these are metabolised in the muscle rather than in the liver (Karinch,
2002a). Branched chain amino acids are also believed to decrease the psychological
perception of fatigue (Kreider et al., 2004), when ingested with glucose/ electrolyte solution
(GES) sports drinks during exercise. Maughan (2002) suggest that this is because “fatigue
may be partly mediated by the actions of serotonin in the brain, which in turn can be
modulated by diet. More specifically, the synthesis of serotonin is limited depending on the
availability of its precursor tryptophan, and tryptophan shares the same transporter across the
blood-brain barrier as branched chain amino acids. Therefore an increase in the concentration
of the latter may “occupy” some of the common transporter, thereby delaying the onset of
fatigue.” Branched-chain amino acid supplementation is generally targeted toward strength-

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power athletes, however much of the research has been done on endurance athletes (Antonio
& Stout, 2002). Still, additional research is necessary to determine whether branched-chain
amino acid supplementation prior to and/or following resistance exercise promotes any muscle
growth or has a beneficial effect in exercise performance in any other respect.
A final point that is raised is the matter of the non-essential amino acid glutamine, which is
widely used as a supplement for enhancing performance, especially by resistance training
athletes. Glutamine is used as an energy source by the cells of the immune system and hard
exercise causes a fall in the plasma glutamine level (Maughan, 2002), therefore from here it is
only a short step to propose that glutamine supplementation may strengthen the immune
system. Some researchers claim that the available evidence does not support this suggestion
(Pedersen et al., 1999), whereas other gather promising findings (Walsh et al., 1998) towards
the muscle growth effect of glutamine supplementation (because it affects protein synthesis) as
well as its ability to prevent upper respiratory tract infections among athletes (Kreider, 1999;
Kreider et al., 2004). Glutamine supplementation of about 17.5 g is indeed common among
elite athletes and it is actually suggested to take place before and after workouts, although
taking it afterwards is more effective, presumably because it helps to replenish glycogen levels
too (Karinch, 2002a). However, long-term studies investigating the effects of glutamine
supplementation on protein synthesis, body composition and immune system function during
training have yet to be conducted. Basic research is promising so far but additional and in
depth research is required so that conclusive remarks can be drawn.

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6. TIMING OF FAT ADMINISTRATION AND ITS EFFECT ON PHYSICAL

PERFORMANCE
If carbohydrate is not available, or if it is available in limited amounts, the intensity of the

exercise will inevitably be reduced to a level where fat oxidation will provide a substantial
part of the energy requirements. Once the requirements for protein and carbohydrate are met,
the balance of energy intake can be in the form of fat (Maughan, 2002).
The dietary recommendations of fat intake for athletes are similar to, or slightly greater than
those recommended for the sedentary individuals, so it is suggested that fats should make up
10-20% of the total caloric intake (Karinch, 2002b) or even 30% according to other sources
(Kreider et al., 2004). Fat donates the backbone to steroid hormones, supports healthy joints
and brain function and mobilises the fat-soluble vitamins (namely vitamins A, D, E, and K) in
the body. Thus, an increased intake of fat, and especially essential fatty acids, is explained in
the case of athletes and allows for these high percentages of caloric intake. For example, it
has been demonstrated that higher-fat diets maintain circulating testosterone concentrations
better than low-fat diets (Kreider et al., 2004).
Of course, it all depends on the personal needs and specific goals of the individual athlete.
Maintaining circulating testosterone may be crucial for resistance athletes but may have little
effect on endurance performance. Conversely, some athletes may need to restrict their caloric
intake in order to lose weight, for example in weight-restricted sports; so increased fat intake
may not be a good practice in this case. Instead, weight loss supplements that help athletes
manage body weight and fat mass may posses some ergogenic benefit for this category of
athletes.
What appears to be a potential strategy to enhance endurance exercise performance is to

acutely increase fat availability, with a view to reducing carbohydrate utilisation during
exercise. Increasing the total fat intake in the days preceding the athletic event can do this.
Such a practice is thought to delay the onset of carbohydrate depletion and fatigue (Burke et
al., 2004). Indeed, ingestion of high fat meals is effective in raising plasma fatty acid
concentration and this has been associated with reduced muscle glycogen utilisation and
carbohydrate oxidation (Hargreaves et al., 2004). However, although such a strategy may

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have a pronounced effect on exercise metabolism, research so far has not proven that it has a
beneficial effect on exercise performance (Burke et al., 2004).

32
Study Subjects (n) Fat adaptation protocol Performance protocol Performance advantage with HFAT
5 male well-trained No. No difference in time to fatigue between

cyclists 28 days; CHO (57% carbohydrate), Cycling time to fatigue at 80% VO2max trials (151 vs. 147 min for HFAT vs. CHO).
Phinney et al. (1983) then 28 days HFAT (fat=85% E, Overnight-fasted + no carbohydrate intake during However, group data skewed by performance
Crossover design carbohydrate <20 g· d-1) exercise of one participant who increased time to
with order effect fatigue by 156% on the fat trial
(control diet first)
7 female moderately
trained cyclists No. In fact, performance deterioration with
7 days; HFAT (fat =59% E, Cycling time to fatigue at 80% VO2max
HFAT.
O’Keefe et al. (1989) Carbohydrate = 1.2 g kg-1 BM); 3–4 h post-meal, no carbohydrate intake during
Time to fatigue reduced by 47% on HFAT
CHO (carbohydrate = 6.4 g kg-1BM) exercise
Crossover design trial
5 males well-trained
cyclists 14 days; HFAT (fat = 67% E, Cycling time to fatigue at 60% VO2max (preceded by Yes. Time to fatigue increased by 87% on
carbohydrate = 17% g kg-1 BM); Wingate test and time to fatigue at 90% VO2max) HFAT trial. No significant differences in
Lambert et al. (1994)
CHO (carbohydrate = 74% g kg-1 Overnight-fasted + no carbohydrate intake during performance between trials on preceding high-
Crossover design BM exercise intensity cycle tests
268 male well-trained 150 min cycling at 70% VO2max+~60-min time-trial

No. Time-trial performance improved over
cyclists (time to complete 40 km)
15 days; HFAT (fat = 69% E, time in both groups as a result of training
Goedecke et al. MCT intake 1.5 h pre-event (~14 g); MCT (0.3 g
carbohydrate = 2.2 g kg-1 BM); CHO protocol. Significant improvements seen in
(1999) kg-1 h-1) and carbohydrate (0.8 g kg-1 h-1) during
(carbohydrate = 5.5 g kg-1 BM) both groups by day 10, but no difference in
Parallel group design exercise
mean improvement between groups
Performance measured at 0, 5, 10 and 15 days
Yes. Submaximal intensity exercise

7 male well-trained No: Higher intensity exercise
cyclists 5-h cycling protocol, including 15-min time-trial +
14 days; HFAT (fat = 66% E, Relative to baseline testing: HCHO showed
incremental test +100-km time-trial
Rowlands & Hopkins carbohydrate ~ 2.4 g kg-1 BM); small non-significant decreases in both 15-min
HFAT= high fat pre-event meal; HCHO=high
(2002) HCHO (carbohydrate ~ 8.6 g kg-1 time-trial and 100-km time-trial. HFAT
carbohydrate pre-event meal; both 0.8 g kg-1 h-
Crossover design BM,70% carbohydrate) 1 showed larger but non-significant decrease in
carbohydrate during ride
15-min time-trial but small non-significant
improvement in 100-km time-trial
Table 3 - Effect of high fat/low carbohydrate (HFAT) intakes and moderate to high carbohydrate intakes (CHO) on endurance performance in well-
trained individuals (cycling) (Source: Burke et al., 2004)

Studies in which trained individuals have been exposed to a high fat diet (460–65% of dietary
energy [E]) for 5–28 days show markedly higher rates of fat oxidation and reduced rates of
muscle glycogen use during submaximal exercise compared with consumption of an
isoenergetic high carbohydrate diet, despite the already enhanced capacity for fat oxidation
expected in the trained individual (Phinney et al., 1983; Lambert et al., 1994; Goedecke et al.,
1999). Table 3 presents the studies that have researched the effect of high fat/ low
carbohydrate (HFAT) intakes and moderate to high carbohydrate intakes (CHO) on endurance
performance in well-trained individuals (cycling). However, examination of the performance
outcomes from these studies shows either a lack of a performance benefit or methodological/
design flaws that require a conservative and cautious interpretation of the results (Burke and
Hawley, 2002). For example, while the study of Phinney et al. (1983), in which five well-
trained cyclists were tested before and after 4 weeks of adaptation to a high fat (85% E)/low
carbohydrate (520 g-1 d-1) diet, is frequently cited in support of performance enhancement after
fat-loading, the participants actually achieved similar endurance times under both
experimental conditions. Furthermore, the group results were skewed by an abnormally large
improvement in the performance of one cyclist: the remaining four cyclists showed little
change or, indeed, an impairment of exercise capacity after the high fat treatment.
An important finding of Goedecke et al. (1999), who showed that matched groups showed
similar training effects after 2 weeks of a high fat diet or an isoenergetic high carbohydrate
diet, was that the adaptations to the high fat diet (65% of dietary energy) were achieved in as
little as 5 days. If fat adaptation can be demonstrated as an effective strategy for performance
enhancement for athletes, by itself or as part of a ‘dietary periodisation’ protocol that
subsequently replaces muscle glycogen stores (Burke & Hawley, 2002), then brief exposure is
more practical and better tolerated by most individuals than more prolonged periods of
intervention. Therefore, it is best considered as a pre-competition strategy (Hargreaves et al.,
2004) rather than a long-term training practice. Indeed, studies in which previously sedentary
individuals undertook training while following a high fat or high carbohydrate diet indicate
that prolonged exposure of more than 4 weeks to a high fat diet causes an impairment of
training adaptations and subsequent performance (Helge et al., 1996; 1998).

2401935
Glycerol has also been suggested as a possible ergogenic aid. Glycerol is a component of
triglycerol, which is mainly found inside the fat cells of the adipose tissue. Fat cells are
specialised for the synthesis and storage of triglycerols and for their mobilisation into fuel
molecules that are transported to other tissues by the blood. Therefore glycerol is a metabolic
intermediate both in the breakdown of fats for energy as well as in their synthesis (Stryer,
1995b). As a supplement, glycerol ingested with water has been reported to increase fluid
retention. In theory, this should prevent dehydration during prolonged exercise and could
therefore improve performance if ingested before or during exercise, since performance is
greatly affected by hydration levels (see Figure 1). Although studies indicate that such an
effect is possible, current research is inconclusive whether performance is affected positively
this way (Kreider et al., 2004). Also, athletes wishing to experiment with glycerol
supplementation should be aware of the potential adverse effects that may be associated with
it, such as headaches and gastrointestinal discomfort (Jeukendrup et al., 2005).

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7. TIMING OF WATER AND ELECTROLYTES ADMINISTRATION AND THEIR

EFFECT ON PHYSICAL PERFORMANCE
The most important and common sense nutritional ergogenic aid for athletes is water (Kreider
et al., 2004). Water is lost from the body by a number of routes; major losses occur through
urine and sweat but losses can also occur from the lungs and through the skin, especially at
altitude or in air-conditioned environments (Maughan, 2002). Sweat rates will increase with
increased metabolic rate (i.e. increased exercise intensity) and impaired dissipation (i.e. hot,
humid, lack of wind) but can also be variable between individuals (Jeukendrup et al., 2005).
Athletes who travel extensively may also suffer from infectious diarrhoea, a condition
resulting in substantial losses of body water and electrolytes.
It is well known that both a pre-existing fluid deficit as well as dehydration occurring during
an athletic event can impair performance in prolonged exercise (Karinch, 2002a; Maughan,
2002). This is because the loss of body water will result in reduced plasma volume and blood
flow, which may lead to an inability to maintain thermal homeostasis and can thus be the
primal cause of reduced performance (Figure 1). Performance impairments can be detected
when fluid deficits are as low as 1.8% of body mass (Burke, 2001), however the effects are
progressive throughout all levels of dehydration. As can be seen from Figure 1 severe loss of
thermoregulation can occur with 6% dehydration which can even result in losses of cognitive
functioning with important consequences on athlete’s health (Burke, 2001). It is therefore a
top priority for athletes to maintain high levels of body water at all times.
100% 1%: thirst; heat regulation is altered and performance

begins to decline
Performance (%)
75%
4%: performance is cut by 20-30%
50%
6%: feeling of weakness, headaches, fatigue, irritability,

25% severe loss of thermoregulation
1 2 3 4 5 6 7
Dehydration (%)

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Figure 1 – Diagram demonstrating how performance diminishes with dehydration (Source: Karinch,
2002a)
An athlete with normal total body water is said to be in a state of “euhydration”, while having
total body water below normal is defined as being in a state of “hypohydration” and is
achieved by the process of “dehydration”. Having a greater than normal total body water
constitutes the condition called “hyperhydration” (Burke, 2001).
The effects of hypohydration on physiological function and exercise performance are also
much greater when exercise is performed in the heat than when the same level of
hypohydration is imposed in the cold (Coyle, 2004). Although most athletes prefer to train
and compete in warm climates, it is widely recognised that endurance performance is impaired
in the heat. Even at modest environmental temperatures, some reduction in exercise capacity
is apparent and the performance decrement becomes progressively greater as the
environmental heat stress increases (Galloway & Maughan, 1997; Parkin et al., 1999). The
optimum temperature for endurance performance – at least in the laboratory – may be about
108C, so this raises the question of whether special strategies are needed when the ambient
temperature exceeds this value. The reduction in performance in the heat is in part due to the
progressive dehydration that results from sweat losses, with negative consequences for
cardiovascular capacity and thermoregulatory function (Gonzalez Alonso et al., 1999). Thus,
one can posit that the levels of hypohydration that may be tolerable when the athlete exercises
in cool or temperate environments may impair his/ her performance in the heat. (Maughan &
Shirreffs 2004)
Particularly in hot environments (above room temperature of 25 oC), significant hypohydration

is inevitable during many exercise activities and poses a challenge to the health and the
performance of the athlete at the same time. Hypohydration may occur because an athlete’s
sweat rate is unusually high, because there is little or no opportunity to drink before or during
the event, or because these factors are combined. Therefore strategies to minimise the degree
of hypohydration should be undertaken pre-, during and in the recovery period from exercise
activities.
7.1. Fluid intake before an athletic event

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First of all, it is important to start exercise in a euhydrated state. Advice given to athletes
normally suggests increasing their fluid intake over the days leading up to the event, but more
so in the hours preceding it. For example triathletes, it is recommended to drink about 400-
600 ml of fluid two hours before the start of exercise (Jeukendrup et al. 2005). The
consumption of this amount of fluid promotes adequate hydration and allows time for the
excretion of excess ingested water. Hyperhydration may also be a beneficial practice,
particularly for those who lose body water at high rates or those who exercise at hot
conditions. Hyperhydration is induced by over-drinking water with or without electrolytes,
although the former is thought to be a more effective strategy. The latter may only produce a
transient expansion of body water because most of the fluid overload is rapidly excreted by the
kidneys (Jeukendrup et al., 2005). This can have a detrimental effect on performance instead,
because of the significant interruptions caused by having to urinate and by the gastric
discomfort felt from the large fluid volumes. On rare occasions and if taken at extreme levels,
some susceptible individuals may suffer from “hyponatremia” (low plasma sodium), also
known as “water intoxication” (Burke, 2001; Jeukendrup et al., 2005).
The impact of any gain in body mass as a result of increased fluid retention from any fluid
overloading strategies should be taken into account in sports that are weight restricted (for
example wrestling, weight lifting) or weight-sensitive (for example running). There are many
sports where an increase in body mass may increase the energy cost of the activity and so the
benefits of hyperhydration should be carefully balanced with the potential costs (Burke, 2001).
7.2. Fluid intake during an athletic event
Preventing dehydration during exercise is one of the most effective ways to maintain exercise
capacity. For this reason, it is critical that athletes consume a sufficient amount of water and
sports drinks during exercise in order to maintain hydration status. This is a worldwide
common practice now, but it is interesting to look back and see how many years it has taken
before it is adopted by for example the International Association of Athletics Federations
(IAAF) and before it is implemented properly during athletic events, such as for example long
distance running. Figure 2 shows how the IAAF rules were changed through the years, as
research started indicating that refuelling in water and carbohydrate is crucial for athletic
performance and health.

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Taking into account that the normal sweat rate for athletes ranges from 0.5 to 2l·h -1, depending
on the discipline, climate, temperature, intensity of the exercise, age and sex of athlete,
athletes need to ingest the same amount of fluids per hour so that they offset weight losses and
avoid dehydration. A good practice is to drink a cup of cold water or glucose/ electrolyte
solution (GES) sports drinks every 10-15 min during exercise. It is better not to depend on
thirst as an indicator for initiating drinking, because people do not typically get thirsty until
they have lost a significant amount of fluid through sweat (Kreider et al., 2004).
Figure 2 – The historical evolution of the IAAF rules governing the intake of food and fluids during long-
distance running. It is evident that since 1953 the timing and frequency for the availability of
fluids has markedly increased. (Source: Hawley and Burke, 1997)
Although it may be uncomfortable or impractical to consume fluids at rates that exactly match
the sweat loss process, it is possible for most athletes to increase fluid intake by following
current practices. Helpful strategies include the recognition of specific opportunities for fluid
intake in a sport or an event, the provision of cool and palatable beverages to be available, the
use of creative tactics to make drinks available and handy to consume, and finally the use of
pre- and post-exercise weighing to monitor fluid deficits (Burke, 2001).
7.3. Fluid intake after an athletic event
Despite a carefully planned fluid intake plan during exercise, most athletes can expect to finish
the session with a moderate fluid deficit. The restoration of fluid balance after exercise is,
therefore, an important part of the recovery process itself, which becomes even more
important following exercise in hot and humid conditions. After exercise, people fail to drink
sufficient volumes of fluid in order to restore fluid balance, even when drinks are made freely
available. The factors affecting self-chosen drinking patterns are complicated and include

39
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behavioural issues, such as social customs of drinking, but may also depend on a genetic
predisposition, for example to be a heavy drinker or to develop a feeling of satiety earlier than
usual. Optimal rehydration requires a scheduled plan of fluid intake, in order to overcome
physiological challenges (for example limited thirst) as well as practical problems (for
example poor access to fluids). An additional challenge is the continuation of fluid loss during
the recovery period, particularly due to urination. Actually, the balance between fluid intake
and urine losses will ultimately determine the success of post-exercise rehydration.
For this reason, water alone is not the most effective rehydration beverage after workout or
competition. Manipulation of fluid and electrolyte balance and the ingestion of a variety of
osmotically active substances, or even their precursors, offers potential for optimising the
effectiveness of a training regimen. More fluid is retained when beverages are ingested with a
moderate to high sodium content (i.e. more than 50 mmol/ lt) and there seems to be an inverse
relationship between sodium content of the ingested fluid and urine production. Sodium
containing drinks may also enhance post-exercise fluid balance compared with water alone by
increasing the sensation of thirst, thereby increasing voluntary fluid intake. It is therefore clear
that sodium is an important ingredient in rehydration drinks (Jeukendrup et al., 2005).
Apart from sodium, athletes may need several other added electrolytes in a recovery drink
because they may become deficient of these important electrolytes as a direct result of
exercise. There are two reasons for this. Firstly because intense activity increases the
metabolic need for electrolytes and secondly because athletes tend to excrete excessive
amounts of electrolytes, particularly with sweat, so exercise in a hot climate can make the
problem considerably worse. Such important electrolytes, other than sodium, that should be
contained in a rehydration drink are chloride and the minerals potassium, calcium and
magnesium (Karinch, 2002a). Although important, all these electrolytes are not as crucial as
sodium is as a component of recovery drinks.
An important issue on effective rehydration is the palatability of drinks, especially when large
volumes of fluid need to be consumed. The disadvantage of the post-exercise sports drinks
containing sodium is that these drinks are not very palatable and this may discourage athletes
from drinking them. It is for this reason that commercially available sports drinks have
included some carbohydrate in their formula and have also reduced their sodium content

40
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(Burke, 2001; Jeukendrup et al., 2005). Therefore commercial sports drinks may confer some
rehydration advantages compared to water alone, both in terms of palatability and fluid
retention.
Finally, one important point to make is that not all fluids are suitable for rehydration. For
example, caffeinated, alcoholic and carbonated drinks are all interfering with different
recovery processes and should be avoided (Karinch, 2002a). This is despite recent findings
claiming that caffeine can spare carbohydrate use during exercise, thereby increasing
performance (Kreider et al., 2004), because the diuretic effect of caffeine and the fact that it is
considered a prohibited substance if detected above certain levels, limit the usefulness of such
a hypothetic beneficial effect.
8. TIMING OF OTHER SUPPLEMENTS ADMINISTRATION AND THEIR EFFECT

ON PHYSICAL PERFORMANCE
In previous sections, various supplements that fall in the categories described already have
been discussed in their appropriate section. Still, there are other supplements that do not fall
in any of the above categories and are therefore discussed here. In competitive events, where
the difference between winning and losing is minute, many athletes seek ergogenic aids with
no side effects and which are not banned. Multi-vitamin tablets are one example. Schroder et
al. (2002) performed research on the type, frequency and amount of dietary supplement
consumption among a group of professional basketball players. 55 professional basketball
players from seven different teams of the First Spanish Basketball League recorded the type,
amount and specific timing of supplement used. Most participants (58%) consumed dietary
supplements. Multivitamins and vitamins were the most frequently used supplements among
the athletes (50.9%), followed by sport drinks (21.8%), miscellaneous supplements (21.8%),
amino acids (14.5%), proteins (12.7%) and carbohydrates (12.7%). The average daily dietary
supplement was one capsule of multivitamins, one capsule of antioxidant vitamins, 0.2–1.0 g
vitamin C, 10.3 g protein, 1.9 g amino acids, 16.2 g carbohydrates and 377 ml of a commercial
sport drink. Although the proportion of participants who consumed dietary supplements
before, during and immediately after exercise was 25.4%, 16.3% and 7.3% respectively, only
a few consumed a potentially ergogenic supplement at these times. The authors concluded that
it would appear unlikely that the type or amount of dietary supplements consumed had a

41
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beneficial effect on the physical performance of these professional basketball players, with the
possible exception of antioxidant vitamins and the commercial sport drinks. (Schroder et al.,
2002) From the data it is evident that multivitamins are the most common supplement used. It
is important to note, however, that they cannot be termed as being ergogenic as they have
mostly been proven that they do not influence performance.
As already explained in the introduction, any supplements enhancing performance must also
safeguard the athlete’s health in order to be considered ethical according to the sports
nutritional ethical considerations. Some sports nutrition specialists only consider a
supplement ergogenic if studies show that this supplement significantly enhances exercise
performance. On the other hand, some are of the opinion that if a supplement helps prepare an
athlete to perform or if it enhances recovery, then this supplement has the potential to improve
training adaptations, so it too should be considered ergogenic (Kreider et al., 2004).
Multivitamins, containing vitamins, minerals and antioxidants fall exactly in this category.
Vitamins function in the human body as metabolic regulators, by influencing various

physiological processes crucial to exercise and sports performance. For instance, many of the
vitamins of the complex B participate in the conversion of fats and carbohydrates to energy.
Many B-complex vitamins are also essential to help form haemoglobin in red blood cells,
thereby playing a major role in the extent of oxygen delivery to the muscles during aerobic
exercise. Therefore vitamin deficiencies can certainly impair exercise performance. The point
though is that most athletes consume high-calories diets containing the RDA of all nutrients
and rarely suffer from vitamin or mineral deficiencies. An exception is perhaps athletes
participating in weight-controlled sports and those who do not eat a well-balanced diet for
whatever the reasons might be. In general though, taking vitamin supplements is a prudent
behaviour for athletes and has not been found to have a detrimental effect to performance or
health (Williams, 2004). Timing of intake does not seem to play an important role and current
recommendations simply suggest supplementation during periods of intense training without
any further specification (Kreider et al., 2004; Williams, 2004).
Elite athletes train hard, therefore they are prone to tissue damage caused by an increased level
of free radical generation during and after exercise. (Kreider et al., 2004) There is also
preliminary evidence that exercise in the heat increases protein oxidation and cellular damage

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due to the generation of free oxygen radicals (Burke, 2001). Besides, oxidative stress is also
associated with a wide range of chronic and acute disease processes. Thus it has been
suggested that increased dietary intake of antioxidants (for example vitamins C and E,
macronutrients such as flavanols in green tea, anthocyanins in berries, lycopene in tomatoes)
may confer some protection (Coultate, 1996). Indeed, supplementation with antioxidants could
reduce some of the markers of free radical-mediated muscle damage, but this factor alone is
not enough to justify a recommendation of using dietary supplements and there is no evidence
gathered that it might have any performance benefits for athletes (Maughan, 2002).
Somewhat in contrast to vitamins, there appears to be several minerals that may enhance
exercise capacity and/ or training adaptations for athletes under certain conditions. Minerals
are essential inorganic elements necessary for a large number of metabolic processes. Some
minerals have been found to be deficient in athletes or become deficient in response to training
and prolonged exercise. When mineral status is inadequate, exercise capacity may be affected.
Dietary supplementation of minerals in deficient athletes has generally been found to improve
exercise capacity (Kreider et al., 2004). For example some athletes may experience post-
workout haematuria (blood in urine) and therefore these athletes may present symptoms of
iron deficiency. The symptoms of this condition are normally easily detected: athletes fatigue
easily or do not perform up to expectations. Additionally, long distance runners may
experience more haemolysis due to foot impact. In these cases, supplementation with iron is
strongly recommended because correcting an iron-deficiency anaemia will improve athletic
performance (Williams, 2005). Iron is better absorbed when taken with vitamin C and, as far
as timing is concerned, when it is taken between meals or before going to bed and together
with fluids apart from milk and/or tea.
It is interesting to mention here that supplementation of minerals has been reported to affect
performance even in non-deficient athletes. For example, supplementation with calcium in
athletes who are susceptible to premature osteoporosis could indeed aid in bone mass
maintenance. Besides, iron and calcium are the two macronutrients, which are most likely to
be low in the diet, particularly in young athletes, or females who exercise regularly.
Therefore, as previously stressed for other supplements, individual needs must always be
taken into account before a sports nutritionist can suggest a supplement. Again, current

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literature does not support any evidence that timing of administration may have any effect on
performance, although perhaps this parameter has not been extensively investigated so far.
However, timing is important when supplementing athletes with sodium bicarbonate (baking
soda) for example. Ingestion of sodium bicarbonate before exercise (0.3 g/kg body weight,
taken 60-90 min before exercise) induces metabolic alkalosis that is an antidote to the
metabolic acidosis accompanying glycolysis, which accumulates acid and carbon dioxide in
the muscle and in the blood. The latter can inhibit key glycolytic enzymes and interfere with
actin-myosin interactions, ultimately resulting affecting negatively performance. Although
bicarbonate can improve exercise, some people have difficulty tolerating it, and therefore
bloating and other gastrointestinal problems could be caused as a consequence (Maughan,
2002; Kreider et al., 2004).
Apart from multivitamins, convenience supplements are widespread too. These are meal
replacement powders, ready to drink supplements, energy bars and energy gels. At present,
they form a large segment o f nutrition industry, representing as high as 70% of most
companies’ sales (Kreider et al., 2004). They vary a lot in the relative percentage of nutrients,
like proteins or carbohydrates, and usually they are accompanied by various eye-catching
claims, such as that they enhance weight loss, they promote gain in strength or muscle built or
even that they improve performance. Although most of them are fortified with vitamins and
minerals, some contain nutrients which are not beneficial at all, for example hydrogenated oils
with large percentages of trans-fatty acids or unnecessary flavour enhancing agents and
preservatives. Moreover, they are also accompanied by misleading adverts that can affect
public opinion to think that they are indeed very healthy options. The truth is that these
supplements could indeed be useful if they were used as such that they are named:
convenience supplements. That is, they could be helpful indeed if they would help an athlete
eat something on the go to top up his energy needs, when food is not immediately available or
until a better and fuller meal is prepared. However, they should never be seen as substitutes of
standard meals for athletes, neither as replacements of a good balanced diet. Taking into
account all the above, a recommended timing for convenience supplements is shortly before or
during exercise, to top up energy and nutrient needs.

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9. CONCLUSIONS
In this review, we have examined the importance of timing of nutrients and the administration
of meals with regards to athletic performance. It has been shown that the correct timing in
sports nutrition is yet another key parameter in determining performance and it should be
regarded as equally crucial as for example equipment, training tactics or psychology of the
athlete. Meal timing to maximise the effects of exercise is actually one of the areas of
nutrition where most growth is currently occurring and still there are a lot of issues that need
to be researched.
The research so far has shown that the consumption of snacks, the supplementation with
liquids during exercise, and a combination of carbohydrates with proteins before and after
exercise aids in the improvement of athletic performance and are the recommended practices
to follow. They have been found to work in a number of cases, although the exact effects may
be somewhat varied between resistance and endurance sports and further research is needed in
both categories of sports. A number of commercial products consisting of various
carbohydrate/ protein combinations and a long list of sports drinks brands are now widely
available, but there is no evidence that these formulas are more effective than normal food
combinations. For instance, a sandwich made with ham, cheese, tuna, or jam and margarine,
might be as good in providing a good balance of nutrients, in order to replenish glycogen
stores and amino acids to stimulate protein synthesis (Maughan, 2002). Similarly, bananas and
other fruits could work equally well as energy bars to top up an athlete’s needs when the
athlete is on the go or between exercise and competition sets.
Given that complete muscle glycogen restoration takes at least 20-24 hours, athletes should
not waste time (Coyle, 2004). As already mentioned, athletes should ingest at least 1 g of
CHO per kg BW per h for immediate recovery after exercise, preferably in combination with
protein. Co-ingesting carbohydrates with proteins is the practice receiving most attention
currently, because it is perhaps one where most controversial findings are reported. Many of
the conflicting results though may be explained because of differences in experimental design,
such as the amounts of carbohydrate and protein involved and the frequency of
supplementation. At all times, guidelines for carbohydrates and other macronutrients should

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not be provided in terms of percentage contributions to total dietary intake, but rather as
grams/ day, because the former vary greatly (Burke et al., 2004; Coyle, 2004).
A long list of other timing issues to be researched exists too, where preliminary evidence is
present but facts have not been systematically studied yet. Examples include the potential
ergogenic effect of supplements such as caffeine, carnitine, boron, hydroxyl-methyl butarate
and glutamine. Supplements are so widespread among athletes that they are perceived as
irreplaceable aids; therefore, since they will be used anyway, at least they should be
extensively researched for safety and efficacy but also for finding the ideal time of their
administration, in order to avoid harmful interactions with other substances.
The balance of good health model (also known as the “plate model”) remains the best and the
most appropriate starting point when advising athletes too. Nutritional choices are more
scientifically sound and easily followed when they include personal choices, religious issues
and geographic considerations. Athletes are no different to other people in the sense that they
too need to gain satisfaction from their food. They also need to be given the correct advice in
order to make by themselves healthy choices, without a feeling of deprivation or constraint.
Nutritional experts giving advice should therefore similarly consider ergogenic aids as nothing
works equally well for everyone. Promoting, maintaining and safeguarding athlete’s health
remains a top priority so the emphasis should always be given on those supplements aiming to
promote health and well being in the first place, whilst improving performance in the second.
It is in the experience and the professionalism of the coach (or the sports nutritionist, or any
expert advising an athlete) not to be manipulated by unsubstantiated claims and to be
responsibly and actively informed about the latest findings in sports nutrition.

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REFERENCES
Zaggelidis S., Martinidis K., Zaggelidis G., Mitropoulou T. (2005) “Nutritional Supplements
use in Elite Gymnasts”, Physical Training (Available at: http://ejmas.com/pt/2005pt/ptart_zaggelidis_0305.html
- Viewed 08.05.2007)

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“A critical evaluation of the nutritional supplements that enhance

the performance of athlete’s.”

(Student No. 2401935)

A dissertation submitted to the Faculty of Engineering, Science and the

Physical Activity and Well-being of the London South Bank University, in

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

Basourakos Panagiotis 3 M. Sc. in Nutrition, Health and Lifestyle

2. DEFINITIONS OF PRE-EXERCISE AND POST-EXERCISE PERIODS....................6

3. THE EFFECT OF MEAL FREQUENCY AND TIMING ON PHYSICAL

4. TIMING OF CARBOHYDRATE ADMINISTRATION AND ITS EFFECT ON

4.1. Carbohydrate in the days before an athletic event.................................................12

4.2. Carbohydrate in the 3-4 hours before an athletic event.........................................13

4.3. Carbohydrate in the 30-60 min before an athletic event........................................14

4.4. Carbohydrate during an athletic event...................................................................17

4.5. Carbohydrate after an athletic event......................................................................18

5. TIMING OF PROTEIN ADMINISTRATION AND ITS EFFECT ON PHYSICAL

6. TIMING OF FAT ADMINISTRATION AND ITS EFFECT ON PHYSICAL

7. TIMING OF WATER AND ELECTROLYTES ADMINISTRATION AND THEIR

7.1. Fluid intake before an athletic event......................................................................34

7.2. Fluid intake during an athletic event......................................................................35

7.3. Fluid intake after an athletic event.........................................................................36

8. TIMING OF OTHER SUPPLEMENTS ADMINISTRATION AND THEIR

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

Sports nutrition is a multi-disciplinary field, requiring knowledge of several different sciences,

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

2. DEFINITIONS OF PRE-EXERCISE AND POST-EXERCISE PERIODS

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

3. THE EFFECT OF MEAL FREQUENCY AND TIMING ON PHYSICAL

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

4. TIMING OF CARBOHYDRATE ADMINISTRATION AND ITS EFFECT ON

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

A high-carbohydrate diet (for a definition, see section 3) is important in training to maximise

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

4.1. Carbohydrate in the days before an athletic event

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

4.2. Carbohydrate in the 3-4 hours before an athletic event

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

4.3. Carbohydrate in the 30-60 min before an athletic event

The period appearing to have more importance in affecting performance, as far as

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

4.4. Carbohydrate during an athletic event

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

4.5. Carbohydrate after an athletic event

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

2002). Other researchers conclude that carbohydrate supplementation following resistance

During the period of recovery, it is recommended to consume carbohydrate foods with a

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

5. TIMING OF PROTEIN ADMINISTRATION AND ITS EFFECT ON PHYSICAL

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle

Basourakos Panagiotis M. Sc. in Nutrition, Health and Lifestyle