DIETARY ANALYSIS

EDGU1003
Diet and Nutrition for Health and Sports

Date: 3. November 2023

Wordcount: 2496
Diet and Nutrition for Health and Sports 3. November 2023
EDGU1003

Part 1 – Chronic disease analysis (coronary artery disease)

The term cardiovascular disease generally refers to 4 disorders related to the heart and blood vessels
which include coronary artery disease (CAD), cerebrovascular disease, peripheral artery disease, and
aortic atherosclerosis (Olvera Lopez, et al., 2023). According to WHO, coronary artery disease is the
leading contributor to death and morbidity worldwide (WHO, 2020). As agreed with the unit coordi-
nator, the following content focuses on this particular condition and not cardiovascular disease in its
entirety.

Introduction
Coronary artery disease (CAD) is a common heart disease that is characterized by narrowing or block-
age of the coronary arteries. This is caused by atherosclerosis where arteries become narrow and
hardened due to graduate cholesterol plaque build-up (Mahmood 2009, p. 24). Common symptoms
are shortness of breath and angina which is a form of chest pain. Angina is often triggered by increased
physical exertion which is referred to as stable angina where the symptoms are always the same and
away quickly with rest. Unstable angina on the other hand is a medical emergency where symptoms
suddenly can become worse without any change in physical exertion (National Library of Medicine
2013). The disease develops over decades, and symptoms are often not noticed until the lesion be-
comes hemodynamically significant enough, that an insufficient amount of oxygen reaches the myo-
cardium when increased oxygen delivery is demanded (Mahmood 2009). The primary way to diag-
nose CAD is with an electrocardiogram (ECG), where the electrical activity of the heart is tracked,
and any irregularities can be discovered (National Library of Medicine 2013).

What causes the condition?

The risk of developing CAD can be divided into modifiable and unmodifiable risk factors. Unmodi-
fiable risk factors include gender, family history, race, and genetics. For both men and women, the
risk of developing CAD increases after 35 years of age, though men have an increased risk compared
to women. Family history plays a significant role as well. Individuals with a family history of prem-
ature cardiac disease under the age of 50 face a heightened risk of mortality due to CAD (Brown et
al., 2023).
Research indicates that age, sex, and race can explain between 63%-80% of the prog-
nostic performance while modifiable risk factors had less impact while still having a significant role
(Brown et al., 2023). The most significant modifiable risk factors include hypertension,

1
Diet and Nutrition for Health and Sports 3. November 2023
EDGU1003

hyperlipidemia, obesity, smoking, poor diet, stress, and a sedentary lifestyle (Brown et al., 2023).
Hypertension causes both oxidative and mechanical stress on the arterial wall. Hyperlipidemia refers
to high serum levels of cholesterol and triglycerides which can contribute to plaque build-up. Obesity
not only doubles the risk of developing CAD but also increases the likelihood of other discussed risk
factors like hypertension and hyperlipidemia. Smoking damages the blood vessels and accelerates
atherosclerosis. The risk of developing CAD among smokers older than 60 doubles, and even non-
smokers regularly exposed to second-hand smoke have a 25-30% increased risk. A poor diet with a
high intake of saturated fats, refined sugar, red meat, and processed meat are all associated with de-
veloping CAD (Brown et al., 2023). Research indicates that consumption of red meat and processed
meat is related to 15% - 29% higher risk for red meat and 23% - 42% higher risk for processed meat
(Brown et al., 2023). Physical activity and exercise are known to be protective factors in developing
CAD, why physical inactivity increases the risk of developing CAD by 12.2% while also contributing
to obesity, hypertension, and hyperlipidemia. The mechanism for the preventative effects of physical
activity is an increased production of the vasodilator nitrous oxide and improved vasculogenesis,
which is the formation of new blood vessels (Brown et al., 2023).

Dietary and lifestyle choices

Coronary artery disease is a complex condition influenced by various risk factors described above.
Only the modifiable risk factors can be controlled. To prevent the development of the disease and
manage the symptoms, a sufficient heart-healthy diet combined with regular physical activity is nec-
essary.

A reduction in calorie intake as well as an overall improvement in diet composition may reduce the
risk of the further development of CAD. Current guidelines recommend diets high in fruits, vegeta-
bles, whole grains, nuts, and legumes, moderate in low-fat dairy and seafood, and low in processed
meats, sugar-sweetened beverages refined grains, and sodium (Yu, et al., 2018). Supplements such as
fish oil, folic acid, and the vitamins C, D, and E may be beneficial for some patients but need to
undergo clinical trials to prove their efficiency (Raphael & Conaway 2012). Factors that often influ-
ence people to consume an unhealthy diet include lack of knowledge, lack of availability, high cost,
time scarcity, marketing, and social and cultural norms (Yu, et al., 2018). This means that making
healthy foods more accessible might have an impact on CAD development in the public.

2
Diet and Nutrition for Health and Sports 3. November 2023
EDGU1003

Research has shown that following a Mediterranean diet is beneficial for preventing the development
of CAD. This is explained by the many components of the Mediterranean diet. It is high in monoun-
saturated fat, low in saturated fat high in complex carbohydrates from legumes, and high in fiber
mostly from fruit and vegetables (Dontas, et al., 2007).
In addition to diet, physical inactivity and smoking are two significant risk factors that
contribute to the increased formation of plaque in blood vessels. High levels of physical activity are
beneficial because it decrease the myocardial oxygen demand by improving the contractility of the
heart and increasing the diameter of the coronary arteries. Exercise and physical activity are linked
to reduced blood pressure, lower levels of low-density lipoproteins, weight loss, and improved insulin
and glucose tolerance. These factors collectively contribute to the effective management of CAD
(Yadav, 2007).

3
Diet and Nutrition for Health and Sports 3. November 2023
EDGU1003

Part 2a – Sports Nutrition Requirements

Introduction
Running is a versatile and easily accessible sport that can be practiced on varying distances from
100m sprints up to ultra-marathons beyond 50 kilometers. The training and nutrition needs, along
with the energy systems used, vary across the numerous running distances. This paper discusses the
comprehensive requirements for an elite-level marathon runner.
The marathon is an iconic running distance and has become a symbol of human endur-
ance by testing physical as well as mental strength over 42,2 kilometers. The overall average finishing
time is 4 hours and 30 minutes, but this time is much faster for elite athletes. The men’s world record
has recently been broken and is now only 2 hours and 35 seconds (Toccy, 2023). Such a performance
requires supreme mental strength and an incredible aerobic capacity, which can take years of hard
work and dedication to accomplish.

Physical requirements
Long-distance running, including marathon running, requires a well-trained aerobic system. This is
because longer-duration activities rely on oxidative phosphorylation pathways to sustain ATP produc-
tion. These pathways are aerobic glycolysis/β-oxidation, Kreb's Cycle, and the electron transport
chain which requires delivery and the utilization of oxygen (Morrison, et al., 2017). To ensure a suf-
ficient oxygen supply to muscle tissue it is necessary to have a high maximum oxygen uptake
(VO2max). Training adaptations, such as an increased stroke volume and the proliferation of capil-
laries, contribute to an enhanced blood supply to the muscles, leading to an elevated VO2 max (Sjödin
& Svedenhag, 1985). Given the extended working time, type 1 slow twitch muscle fibers are predom-
inant in the active muscles of marathon runners. Type 1 fibers are considered highly aerobic and more
fatigue-resistant than type 2 fibers, why they are beneficial for endurance athletes (Sjödin & Sveden-
hag, 1985). Sufficient recovery from an extreme endurance event such as a marathon requires optimal
nutritional intake and high-quality sleep. Research indicates that a high glycogen intake to restore
glycogen stores after races results in fewer overtraining symptoms and greater training adaptations
(Burke, 2007).
Training sessions for an elite marathon runner during mid-preparation periods typically
consist of around 160-220 km of running each week. 80% of the total running distance is performed
at low intensity to build an aerobic base. Furthermore, are altitude camps commonly used during the

4
Diet and Nutrition for Health and Sports 3. November 2023
EDGU1003

preparation period to increase red blood cell mass. 7-10 days before competition running volume is
reduced during the tapering process (Haugen et al., 2022).

Nutrition requirements
Carbohydrate is the key fuel for training and racing a marathon, as carbohydrate has the advantage of
generating more ATP per volume of oxygen compared to fat (Vitale & Getzin 2019). Traditionally fat
and protein intake among endurance athletes has therefore been underemphasized which research has
shown to be wrong (Vitale & Getzin 2019). Protein in general as well as the timing of the protein
intake is crucial for optimal training adaptations among athletes. In addition, fat is an important nu-
trient for multiple processes in the body such as nerve function and for cell membranes (Vitale &
Getzin 2019).
During a race, hydration is important to maintain fluid and electrolyte balance. The main
electrolytes are sodium, potassium, and chloride which are lost because of sweating. To maintain fluid
and electrolyte balance, athletes therefore consume electrolytes in drinks. Inadequate fluid and elec-
trolyte intake can lead to numerous symptoms that decrease performance, but it is also important not
to overhydrate. Overdrinking can lead to hyponatremia which is a condition characterized by low
sodium concentrations in the blood (Vitale & Getzin 2019). This condition has been seen in athletes
after completing races because prior water intake guidelines primarily emphasized preventing dehy-
dration by encouraging drinking before athletes experience thirst. (Vitale & Getzin 2019). It is sug-
gested that athletes' intake of electrolytes is matched to their sweat rate (Vitale & Getzin 2019). Fur-
thermore, a deficiency in vital minerals such as iron, magnesium, sodium, potassium, and calcium,
can lead to decreased endurance, muscle cramps, weakened bones, and hypotranemia. In general,
elite marathon runners have elevated requirements for both macronutrients and micronutrients. These
increased nutritional needs are necessary to sustain energy expenditure, address losses of hydroelec-
trolytes during exercise, and support the recovery of lean mass, electrolyte balance, and glycogen
stores. (Passos et al., 2019).
Some current hot topic supplements in long-distance running are nitrate, which can be
found in beetroots and antioxidants, which can be found in e.g., dark berries and dark leafy greens
(Vitale & Getzin, 2019). Research has shown that nitrate can decrease the oxygen cost for submaximal
exercise workloads. Furthermore, the consumption of antioxidants 2-3 days after exercise may pro-
mote recovery (Vitale & Getzin 2019).

5
 Diet and Nutrition for Health and Sports 3. November 2023
EDGU1003

The macro and micro-nutrients as well as the fluid intake for an elite marathon runner pre-competi-
tion, during competition, and for recovery are shown in Table 1 below.

Table 1: Nutri&on recommenda&ons for an elite marathon runner. Basis of calcula&ons (Vitale & Getzin 2019)

Nutrition recommendations
Nutrient (macros) Pre-competition During competition Recovery
Energy (kj) 16.000-25.000 2.000-3.000 18.000-27.000
Protein (g) 1,4 g/kg/day 0.3 g/kg (within 0-2 hours or immedi-
0,3 g/kg every 3–5 h ately prior to race)
Carbohydrate (g) 10-12g/kg/day + 1-4g/kg (1-4 hours 60-90 g/h if tolerable 8-10g/kg/day (first 24 hours)
prior to event)
Fat <20 % energy intake in general. Limit fat intake during the carb-loading phase
Nutrient (micros) Pre-race During competition Recovery
Fluids (ml) 400-800ml/h Replace fluid intake with 150% of
(must be adjusted to individual sweat rates, sweat sodium content, exercise loss
intensity, body temperature, ambient temperature, bodyweight, kidney
function)
Sodium (mg) (Depends on intensity of exercise) 300-600mg/h 1380mg/l (for improved water reple-
tion)
Nitrate (mg) up to 10 mg/kg or 0.1 mmol/kg 6
days prior to race + 300–600 mg of
nitrate 90 minutes before race
Antioxidants Eat whole foods containing antioxi-
dants (e.g. dark berries, dark greens)

6
Diet and Nutrition for Health and Sports 3. November 2023
EDGU1003

Part 2b – Supplementations
Caffeine
Caffeine is one of the most widely consumed performance-enhancing supplements. Due to the well-
documented evidence of caffeine’s effects on endurance exercises, it is commonly used in aerobic-
based sports (Wang, et al., 2022). Utilizing caffeine as an elite marathon runner can therefore be
advantageous for enhancing performance.

Effects and use of caffeine for an elite marathon runner

When caffeine is ingested, it is rapidly absorbed and transported via the bloodstream to all body
tissues and organs where it has numerous effects. These effects vary from person to person and can
be both positive and negative responses. The most important effects for increasing performance are
discussed below.
Caffeine is a stimulant in the central nervous system (CNS) and acts as a competitor
for the neurotransmitter adenosine by blocking its receptors. This means inhibiting the effects of
adenosine on neurotransmission excitation and pain perception (Mielgo-Ayuso et al., 2019). In addi-
tion, caffeine can act on the body's use of energy substrates during exercise, as it increases the mo-
bilization of free fatty acids by stimulating adrenalin secretion, which is beneficial for endurance
athletes, who want to save glycogen stores. Furthermore, it has been suggested that caffeine causes
greater activity of the Na+/K+ pump, which enhances excitation contractions coupling (Mielgo-
Ayuso et al., 2019).
There is currently a substantial body of scientific evidence supporting caffeine’s use as
an ergogenic aid for endurance athletes, as well as sports where anaerobic metabolism is prioritized.
Multiple controlled studies support this, which have resulted in dosage recommendations. Current
guidelines recommend ingesting (3-6 mg/kg) 60 minutes before exercise. Higher doses (9-13mg/kg)
do no not result in additional performance improvements (Mielgo-Ayuso et al., 2019). The effects
of ingesting caffeine on physical performance are highly individual. Studies have shown that caf-
feine is primarily metabolized in the liver and that potential effects and side effects are highly re-
lated to an individual's expressed genotype (Pickering & Kiely 2018). It is therefore suggested that
the use of caffeine should be based on the experience of athletes' responsiveness and reactions. A
common side effect is disturbed sleep. Given the half-time of caffeine being approximately 5 hours,
even low doses of caffeine can reduce sleep quality if ingested in the evening (Pickering & Kiely
2018). Furthermore, it is not recommended to ingest caffeine if athletes tend to have pre-

7
Diet and Nutrition for Health and Sports 3. November 2023
EDGU1003

competition anxiety. Caffeine’s stimulating effect on the sympathetic nervous system may worsen
pre-competition symptoms such as gastrointestinal discomfort, nausea, and increased heart rate and
stroke volume (Pickering & Kiely 2018).
Caffeine is found naturally in tea coffee and cocoa, but caffeine is also added to a variety
of sports supplements including drinks and foods. A common way of ingesting caffeine is by what is
advertised as pre-workout supplements. Research has shown that among 15 common Australian sup-
plements, the actual caffeine content varied from the labeling by 59% to 176% (Desbrow et al., 2019).
Marathon runners should therefore consider their source of caffeine to ensure consistent effects of the
supplement and not exceed the guidelines. Ingesting caffeine pills or tablets is a safer way to consume
caffeine as the caffeine content is more accurate. Depending on the influence of genetic variation on
caffeine response, athletes must base their intake on personal experience and develop their own guide-
lines (Pickering & Kiely 2018).
Along with consuming the right dose, hydration after ingestion is also important. Caf-
feine is a diuretic drug, meaning that it promotes urine production and thereby influences the fluid
balance negatively. However, this is mainly important pre-exercise as research has shown that exer-
cise exerts the anti-diuretic effect via the release of catecholamines, which lowers the fluid filtration
rate of the kidneys by constricting the arterioles of the renals (Zhang et al., 2015).

Thanks to research, the performance-enhancing effects of caffeine have been known for more than a
decade making it one of the most popular supplements of choice among endurance athletes today.
During the timeframe spanning 1984 to 2004, the use of more than (12 μg mL−1 ) caffeine in compet-
itive sports was prohibited due to the drug being classified as a banned substance (Diel, 2020). Today
the drug is classified by World Antidoping Agency as a group A supplement along with multiple types
of vitamins and sports supplements. Type A supplements are characterized by being permitted for use
by athletes and by having strong scientific evidence for use in specific situations in sports (Australian
Sports Commission, n.d.).

Caffeine can be a valuable supplement for elite marathon runners based on its well-documented ef-
fects on performance, mental focus, and energy substrate utilization. When used strategically, and in
accordance with individual responses, the effects of caffeine align with the physical requirements of
elite marathon running discussed in part 2a.

8
Diet and Nutrition for Health and Sports 3. November 2023
EDGU1003

References

Australian Sports Commission. (n.d.). Supplements: Benefits and risk of using supplements and
sports foods. Retrieved 3. November from https://www.ais.gov.au/nutrition/supple-
ments/group_a#caffeine

Brown J.C., Gerhardt T.E., Kwon E., (2023) Risk Factors for Coronary Artery
Disease. [Updated 2023 Jan 23]. In: Stat Pearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK554410/

Burke L. M. (2007). Nutrition strategies for the marathon : fuel for training and racing. Sports
medicine (Auckland, N.Z.), 37(4-5), 344–347. https://doi.org/10.2165/00007256-
200737040-00018

Desbrow, B., Hall, S., O'Connor, H., Slater, G., Barnes, K., & Grant, G. (2019). Caffeine content of
pre-workout supplements commonly used by Australian consumers. Drug testing and
analysis, 11(3), 523–529. https://doi.org/10.1002/dta.2501

Diel, P. (2020). Caffeine and Doping—What Have We Learned since

2004. Nutrients, 12(8). https://doi.org/10.3390/nu12082167

Dontas, A. S., Zerefos, N. S., Panagiotakos, D. B., Vlachou, C., & Valis, D. A. (2007).
Mediterranean diet and prevention of coronary heart disease in the elderly. Clinical
interventions in aging, 2(1), 109–115. https://doi.org/10.2147/ciia.2007.2.1.109

Haugen, T., Sandbakk, Ø., Seiler, S. et al., (2022). The Training Characteristics of World-Class
Distance Runners: An Integration of Scientific Literature and Results-Proven Practice.
Sports Med - Open 8, 46 (2022). https://doi.org/10.1186/s40798-022-00438-7

Mahmood, S. (2009). Pathophysiology of Coronary Artery Disease. In: Movahed, A.,

Gnanasegaran, G., Buscombe, J., Hall, M. (eds) Integrating Cardiology for Nuclear
Medicine Physicians. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-
78674-0_2

Mielgo-Ayuso, J., Marques-Jiménez, D., Refoyo, I., Coso, J. D., León-Guereño, P., & Calleja-
González, J. (2019). Effect of Caffeine Supplementation on Sports Performance Based
on Differences Between Sexes: A Systematic
Review. Nutrients, 11(10). https://doi.org/10.3390/nu11102313

Morrison, S., Ward, P., & duManoir, G. R. (2017). ENERGY SYSTEM DEVELOPMENT AND
LOAD MANAGEMENT THROUGH THE REHABILITATION AND RETURN TO
PLAY PROCESS. International journal of sports physical therapy, 12(4), 697–710.

National Library of Medicine. (2013). Coronary artery disease: Overview., Cologne, Germany:
Institute for Quality and Efficiency in Health Care (IQWiG). Retrieved 3. November
2023 from https://www.ncbi.nlm.nih.gov/books/NBK355313/

9
Diet and Nutrition for Health and Sports 3. November 2023
EDGU1003

Olvera Lopez E, Ballard BD, Jan A., (2023). Cardiovascular Disease. [Updated 2023 Aug 7]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan-. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK535419/

Passos, B. N., Lima, M. C., R. Sierra, A. P., Oliveira, R. A., S. Maciel, J. F., Manoel, R., Rogante, J.
I., Pesquero, J. B., & Cury-Boaventura, M. F. (2019). Association of Daily Dietary
Intake and Inflammation Induced by Marathon Race. Mediators of Inflammation,
2019. https://doi.org/10.1155/2019/1537274

Pickering, C., & Kiely, J. (2018). Are the Current Guidelines on Caffeine Use in Sport Optimal for
Everyone? Inter-individual Variation in Caffeine Ergogenicity, and a Move Towards
Personalised Sports Nutrition. Sports Medicine (Auckland, N.z.), 48(1), 7-16.
https://doi.org/10.1007/s40279-017-0776-1

Raphael, C. W., & Conaway, D. G. (2012). Nutritional and vitamin supplements: do they prevent
coronary artery disease?. Missouri medicine, 109(3), 204–209.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179702/

Sjödin, B., & Svedenhag, J. (1985). Applied physiology of marathon running. Sports medicine
(Auckland, N.Z.), 2(2), 83–99. https://doi.org/10.2165/00007256-198502020-00002

Toccy, K. (2023). Marathon Handbook. What is a good marathon time?.

https://marathonhandbook.com/what-is-a-good-marathon-time/

Vitale, K., & Getzin, A. (2019). Nutrition and Supplement Update for the Endurance Athlete:
Review and Recommendations. Nutrients, 11(6), 1289.
https://doi.org/10.3390/nu11061289

Wang, Z., Qiu, B., Gao, J., & Coso, J. D. (2022). Effects of Caffeine Intake on Endurance Running
Performance and Time to Exhaustion: A Systematic Review and Meta-Analysis.
Nutrients, 15(1). https://doi.org/10.3390/nu15010148

World Health Organization (2020). Top 10 causes of death. Retrieved 3. November 2023 from
https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

Yadav, Y. (2007). Exercise in the Management of Coronary Artery Disease. Medical Journal, Armed
Forces India, 63(4), 357-361. https://doi.org/10.1016/S0377-1237(07)80016-5

Yu, E., Malik, V. S., & Hu, F. B. (2018). Cardiovascular Disease Prevention by Diet Modification:
JACC Health Promotion Series. Journal of the American College of Cardiol-
ogy, 72(8), 914–926. https://doi.org/10.1016/j.jacc.2018.02.085

Zhang, Y., Coca, A., Casa, D. J., Antonio, J., Green, J. M., & Bishop, P. A. (2015). Caffeine and
diuresis during rest and exercise: A meta-analysis. Journal of Science and Medicine
in Sport / Sports Medicine
Australia, 18(5), 569. https://doi.org/10.1016/j.jsams.2014.07.017

10