AD VAN C E D S PO R T S

NUTRITION
 OPTIMAL NUTRITION FOR ATHLETES
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How can we determine if an athlete follows a correct diet or not?
• looking at the person and deciding if he/she is over weight or underweight
• monitoring changes in body weight over time, body composition
• calculating BMI
• measure and monitor performance
• intervew the athlete to determine habits and preferences
• food diary (or food preferences)
• monitoring overall health and injuries
• determine the energy requirement

The problem is to find scientific references of what is good and what is not for a specific sport, but is hard (we can
find them only on elite data athletes), if we are dealing with different level of a sport we need different datas. The
most sports that are tested are tested on males athletes. Another difficulty is the effect of growing.

What is an optimal body composition for a given sport?

• we need to find reference in the literature
• it has to be specific for sex, age and competitive level
• if no data is available from literature, one possibility is to focus on the performance model of the sport
• training requirements (this can inform us on the body type of the athlete, if he/she needs more or less muscle
mass and the overall energy requirement of the sport, fat mass)

Z-SCORE
The only reference that we can always have is calculating the Z - score (way of expression how far is an athlete
from the model reference):
Z - score = (athlete value - average) / standard deviation

Difference between athletes value and average value (15%) by the standard deviation.
The minus is the value, the more a person is skinner.

WHY DO WE EAT?
Food provides:
• energy: food is the fuel of the body
• nutritional elements: essential elements for the building (bricks), mantainance and functioning of the body

A healthy diet must adequately cover both the energy requirements and the nutritional requirements of the body.

ENERGY REQUIREMENT
The human body requires energy to live and move. This energy is derived from the splitting of the chemical
elements contained in food. The total amount of energy consumed daily is named daily energy requirement and is
derived from:
• resting metabolic rate (60-75%): the lowest energy requirement to maintain life in awake, resting conditions.
Its determinants are age, sex and mass. And less importantly are genetics, lean mass, health.
• physical activity (15-30%) 1
• induced thermogenesis (10%)

BASAL METABOLIC RATE

Basal metabolic rate (BMR) is the rate of energy expenditure per time unit at rest:
Estimate by formulas:
2-1 -1
energy expenditure (Kcal * m * h )

2 0.425 0.725
body surface (m ) = weight * stature * 71.84 / 10000

Harris Benedict equation for estimating basal metabolic rate:

• male: BMR = 66,473 + (13,7516 body mass in kg) + (5,0033 height in cm) – (age 6,755)
• female: BMR = 655,095 + (9,563 body mass in kg) + (1,8496 height in cm) – (age 4,6756)

ENERGY REQUIREMENT OF ACTIVITIES

The energy expenditure necessary for muscle activity varies in relation to:
• type of activity
• intensity
• duration
• body mass

MEASURING METABOLIC RATE

First we need to determine the resting metabolic rate:

Resting VO2 = 250 ml/kg/min

How to translate VO2 into Kcal? We need to know the equivalent energy of oxygen, that is 4,842 Kcal/1L of VO2
at rest, when the body is burning predominantly fats. It raises to % Kcal/1L of VO2 when we are burning
carbohydrates at the higher intensities of exercise.

PRIORITY IN ENDURANCE SPORTS

________________________________________________________________
Main goals:
• obtain or mantain optimal body composition (determination of caloric intake)
• avid or delay fatigue
• fully recover
• coverage of energy requirement
• adequate charbohydrates intake
• adequate water intake
• quality and timing meals (24h, around the field)

ADEQUATE AMOUNT OF CHARBOHYDRATES

Simple molecules composed by carbon (C) and water (H2O).
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Dietary of CHO:
• glucose
• fructose
• galactose

They are metabolized at the level of the liver by glycogenolysis and gluconeogenesys. Here charbohydrates are
polimerized into a bigger molecule called glycogen. Glycogen is stored in the muscles. The difference between
liver glycogen and muscle glycogen is that the first one can be split (phosphates are removed in order to pass
through the manmbrane) and introduced in the circulation system in order to maintaine the correct level of glucose
omeostasys (same amount of glucose in the blood), muscle glycogen can be only used inside the muscle (cannot
exit the muscle) because here there are not the enzymes that can remove phospahtes from glucose.

GLYCOGENOLYSIS
After a meal, when the levels of glucose in the blood are high, the glucose is transfered inside the liver and
synthesized into glycogen. Award from the meal, when the levels of glucose decrease, the liver provide the extra
amount in order to maintane the correct level.

GLUCONEOGENESYS
The liver is able to produced glucose starting from none sugar skeletons through transamination.
At the end of the process of glicolysis piruvate is obtained.

CHO UTILISATION
The destiny of piruvate is to be transformed into acetil-CoA or lactate.

The diagram illustrates what kind of substrates are used inside the muscle in order to produced ATP:

The contribution of these different sources to ATP turnover is a function

of relative (%) exercise intensity. At low intensities (rest) the major
contribution to ATP turnover is thanks to fat oxidation. As the intensity
of the exercise increases the larger the contribution of CHO is. CHO are
the main fuel used for heavy exercise intensities.

The exercise intensity is identified by the respiratory exchange ratio R (the quotient between CO2 and VO2, the
amount of CO2 produced per L of oxygen consumed):

R = VCO2 / VO2

It gives information of what kind of substrate is used. If the substrate used is anaerobic the amount of CO2 will be
higher than O2.

The next scheme indicates the amount of fats and CHO rates used in functional relative exercise intensity:
The fats (•) values in g/L are higher at low exercise intensity and become
progressily near to 0 as the intensity increases. The opposite occurs with
charbohydrates (⑥). By the measurement of gas exchange we can calculate
the amount of grams of CHO and fats used during exercise.

> maximal fat

oxidation

In this case the relative intensity increases causing the fat oxidation to reduced. At the
same time the overall metabolic rate is rising. The addition of the two factors causes an
higher improvement of VO2 than the reduction of fats oxidation. However, after a
certain intensity, the oxidation decreases so much that even if the metabolic rate
continues to raise it will be anyway impossible for it to increase.
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So, after the maximal point, the fat oxidation begins to decrease. Fitness is an important determinant of the amount
of exercise it can be done. By increasing the fitness level we will have an higher point of maximal fat oxidation (a
higher ability of the body to burn fats). So, even the activities are very light intensity, the body will be burning more
fats. The more the body is trained, the more it will burn fats (because the maximal point of oxidation is increased).

For subjects who meant to loose weight is recomended to practice aerobic training instead of HIIT (for example) in
order to decrease the sense of hunger. Trainings like HIIT burn glucose substrate contained in muscle supporting the
sense of hunger.

There is a proportion between the VO2 max and the thresholds, on average the second threshold is found around
80% of the VO2 max and the first around 60%. On the other hand, it will not be the same for all people (especially
for non-normotypes). There are variables that modify the attitude to the consumption of carbohydrates and fats, such
as food intake and fasting (working in fasting condition with a low level of sugar in the blood, the attitude in the
consumption of fats will increase). On the other hand, the stimulus is reduced (it is not possible to work at the same
intensities).
The nature of exercise plays a very important role, during any intermittent
exercise many metabolic transition occurs (situations in which the
workroad changes forma given value to a higher or lower one, square
function). During the initial time in which the oxidation metabolism
cannot provide the ATP required for muscle contraction other sources must
be use such as phosphocreatine ad lactate. The power available at a given
moment depends on the interaction between the three metabolic pathways
(PCr hydrolysis, anaerobic glycolysis, oxidative phosphorylation). In the
very first seconds of exercise PCr is required, as time goes on the power
available depends one the glycolysis and later on by the phosphorilation.

The speed is directly proportional to the available power output and inversely proportional to the costs.
Anything that has a duration below 30" is tipically related to energy coming from anaerobic ways.
As the intensity of exercise increases muscle become the main source of energy thanks to muscle glycogen.

In order to be able to mantain a high power output we need to have

glycogen stores, long exercise in heavy intensity is limited by
glycogen stores. A progressive reduction in muscle glycogen content
occurs as the duration of exercise progresses. We reach the 0 value
after 88' ca. The more glycogen you have before starting the exercise,
the longer you will last. People who have a high protein-factor diet
will have a low glycogen content before the beginning of exercise.
Only when the diet is clearly switched to more carbs it will be a
higher carbs content in muscle.

However, no matter what diet is consumed, there is still a linear relationship between how much glycogen is stored
and the duration. The physiological concentration of glycogen contained in tissues is about 14g / Kg of tissue
(50-100 mmol / Kg). Glycogen is not stored in excess because is a very hydrophilic molecule (bulky).

In order to increase the exercise duration is necessary to maximize glycogen stores in order to avoid or postpone
fatigue. For exercise intensities < 60% of VO2 max, muscle glycogen concentration does not affect fatigue onset.
For intensities 60-90% of VO2 max, time to exhaustion is a function of muscle's glycogen concentration prior to
exercise onset.

CHO AND EIMD

Exercise Induced Muscole Damaged (what results after an intensity muscle activity, the muscle is damaged
causing an inflammatory state). EIMD is categorized into two different categories:
• Mechanical damaged: mechanical rupture of muscle cell membrane, tipically occurs during strength activity, has
a peak of symptoms at 24-48h after the training session, characterized by a high level of inflammation (pain,
swelling, redness), can be avoid by abituation or by assuming vitamine C
• Metabolic damaged: intracellular energetic imbalance, associated with prolonged exercise (aerobic), has a peak
of symptoms at 24h (immediately after the training), has a lower level of inflammation, can be attenuated by
adeguate stores and the assumption of glucose during the training

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ENERGETIC AVAILABILITY
In endurance athletes in order to avoid or postpone fatigue a different possible strategies can be followed:
• maximize storage
• maintain the continuous intake of carbs (even during the activity): for activities that last 30-60 mins the intake is
not necessary (mouth rising can be help), for activities > 1-2h take a max of 30-60g / h, for activities > 3h take
a mixture of transportable carbs (maltodestrins/fructose, glucose/fructose, allows to bypass the limitations of
intestinal glucose absorption) in drink, gel or bar, assume a max of 250cc of water every 15 mins
• eating a sufficient amount of carbs
• increase reserves right before starting the training: 1g / Kg / h before the training starts in a maximum of 3g (3h),
choose products with a low glycemic index and highly digestible, reduce the amount of lipid (will slow the
stomach emptying), drink 500cc of water

CARBS REQUIREMENT IN 24H

Depending on the type of activity the athlete is involved in, there are different ranges:
• moderate duration and light intensity training: 5-7g / Kg / day
• from moderate to intense training: 7-12g / Kg / day
• extreme training regimes (4-6h / day): 10-12g / Kg / day

REFUELING "IN FLIGHT"

PROBLEMS
Solid foods and very concentrated solutions of carbs reduce intestinal absorption of water (is preferable to use
liquids supplementation in order to avoid disidratation). Assume a maximum of 1L of water per hour (the maximum
empty rate of the stomach is limited, it empties at most 1L / h).

PROTIDES AND PROTEINS

Raccomanded daily amount: 0.8-2g / Kg (10-15% of the total amount intake).
In a vegetarian diet more proteins intake is needed because the animal derived food have a high biological value than
plants derived food. A lower biological value requires more proteins because are more rich in fibers that decrease the
overall absorption capacity. Injures need an higher amount of protein because in these situations it is necessary to
contrast catabolism (muscle weisting) and repair any damaged occured.

Destiny of aminoacids derived from proteins:

• synthesis of different aminoacids (transamination)
• glucose synthesis (gluconeogenesys)
• energy production

Energy production: deamination, use of the carbonaceous skeleton and synthesis of urea starting from amino groups
(urea cycle, H20 for disposal).

Carbonaceous skeleton:
• intermediates of the Krebs cycle 5
• chetonic bodies (lipids synthesis)
• intermediates for gluconeogenesis
• pyruvate-alanine cycle

RDA
Quantity needed to prevent the risk of malnutrition in the population. Individual assessments require specific
measures (nitrogen balance).

Nitrogen Balance: Nt - (Nu + Nf + Ns) = 0

• t = total (taken with the diet)

• u= urinary (lost with urine)
• f = fecal (lost with feces)
• s = sweat (lost in sweat)

+ balance: t > losses, indicator of protein synthesis

- balance: t < losses, indicator of catabolism

There are no stocks of proteins, but there are "expendable" proteins for energy purposes (muscle and blood).

PROTEINS REQUIREMENT
Why athletes need more proteins? During an activity part of the protein is used ad fuel. The more the person is
training in conditions of fasting, carbs deficit or insufficient amount of glucose in diet the more proteins are
required. The catabolism during activity is proportional to intensity and to the deficiency of carbs. Protein
catabolism is favored by high concentrations of cortisol (stress hormone) and sleep deprivation.

Muscle proteins can contribute to a body deficit. Inside the muscle glucose stored can exit the muscle by lactate or
the transformation from pyruvate to alanine (alanine can exit the muscle). This cycle can be used to maintaine
omeostasys.

A further increase in synthesis can lead to a demand for a higher protein requirement. After 4 to 24h an exercise an
increase in protein synthesis (from 10 to 80%) is recorded. It depends on the type of exercise and its intensity,
protein anabolism is increase by strength exercise (can cause muscle damaged), GH effect, glycemic effect, insuline
effect, aminoacids availability and leucine availability.

This occurs thanks to regulation of mTOR (transcriptional factor). Any activity that is intens, repeated and traumatic
will increase proteins need. Proteins intake depends on the amount of activity any person does.

The protein content in food is higher in seasoned cheese and seasoned meats (are more concentrated). The most
protein dense food are accompanied by a big amount of fats.

SKELETAL MUSCLE PROTEIN TURNOVER

The overall amount of muscle mass contained in body depends on the relation between protein synthesis and protein
breakdown. It tells us if the body has a more hypertophy or atrophy. Athletes seek to:
• maximize hypertrophic respose to training
• offset of atrophy

ADAPTIVE RESPONSE TO TRAINING

One aspect that can be modulate from diet is the amplification of adaptive response to training in order to improve
protein balance and in order to maintain muscle mass recover must be improved.

FEEDING RESPONSE
Fenomenal that follow food ingestion. Happens after 1h after food ingestion, is mediated by two many changes,
food ingestion causes an increase in the content of aminoacids (hyper aminoacidemia, will improve protein synthesis
and decrease protein breakdown) and an increase of blood glucose (hyperinsulinemia, will decrease protein
breakdown).

FASTING RESPONSE
The opposite of feeding response. When the content of aminoacids decrease it will cause a reduction of protein
synthesis and an increase in protein breakdown.When insuline is reduced it causes an increase in protein breakdown.
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WINDOW OF ANABOLIC POTENTIAL

There is a synergy between exercise and food that amplified the feeding
response or exercise related response. The feeding effect is maximize at around
3h post exercise. The synergy is called window of anabolic potential, time
frame after exercise in which the addition of food will amplified the feeding
response.
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nessunissima morosa
The synthetic response that follows protein ingestion can be modulated by a
number of factors. Exercise will cause a reduction of the leucine trigger (the
amount of leucine that is required to produced a certain effects). On the
contrary aging, inactivity and diseases will improve leucine trigger (more
leucine is necessary in order to trigger protein).

DIGESTIBILITY SCORE
The effect of protein depend on biological value and digestibility (how fast the protein is digested). The highest
score is 1.0 for milk derived proteins. More so for whey (fast protein) than casein (slow protein). Milk-derived
proteins also have the highest leucine content.

POST EXERCISE
The adequate post-exercise amount of proteins correspond to 0.25-0.5g / Kg within 2h. In these fase occurs a
recovery of substrate stores, a muscle repair and an amplification of adaptive response. The relation between carbs
and protein must be 3:1.

STRATEGIES TO INCREASE MUSCLE MASS IN ATHLETE

• adequate training
• provide sufficient recovery time
• normal-low calorie diet (+500 - 1000 Kcal/day)
• adequate amount of CHO and proteins
• high frequency of meals

GASTROINTESTINAL HEALTH IN ENDURANCE ATHLETES

The gut is considered as an athletic organ, the gastrointestinal tract is a key in performance, its main function is the
delivery of water and nutrients through the body during exercise. Gastrointestinal problems have a prevalence of
30-90% in long distance athletes. In these prevalence the 93% are long-distance triathletes, 70% elite endurance
athletes. This large variability in prevalence is caused by:
• variable definition of GI complaints
• affected by population type (sex, training status, age, individual susceptibility)
• exercise type, intensity and duration
• ambient conditions

Impact on:
• performance
• drop out (non finishers)
• long-term health

SYMPTOMS
Main synthoms are:
• nausea
• abdominal cramps
• diarrea
• vomiting
• fecal blood loss
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Classified by:
• site: upper tract or lower tract
• severity: severe (affects performance), mild (don't affects performance)
• type: nausea, vomiting abdominal cramps, flatulence, diarrea, blood diarrea

They can be caused by an intensity dependent reduction in gastrointestinal blood. At rest the stork volume is about
70ml, the hearth rate is about 70 bpm so the total cardiac output is about 5 liters / min. Organs don't all get the same
blood amount, the total 100% blood that pass trough lungs is distributed in:
• 20-25% gastrointestinal tract
• 20% kidneys
• 15-20% muscle
• 15% brain
• 5% tissues
• 4-5% heart
• 3-5% bones

During exercise a shift to muscle occurs, decreasing the amount of blood to the other organs. Occurs a 80% reduction
in flow to the intestine when the activity is at 70% to the VO2 max. This reduction can be increased by:
• extreme heat conditions
• dehydration

So, intensity-dependent gastrointestinal hypoperfusion causes:

• mucosal erosions
• chemical colitis (necrosis and bacteria invasion)
• intestinal infarction
• blood loss
• changes in motility (esophageal reflux, reduced gastric emptying)
• altered gut permeability (leaky gut syndrome)
• symptoms such as pain, nausea, vomiting, diarrea

MECHANICAL CAUSES
There are also mechanical causes that can contribute to gastrointestinal problems:
• effects of mechanical impact
• effects of posture (abdominal pressure)
• effects of air swallowing

These causes can be all attenuated by training.

NUTRITIONAL CAUSES
Other causes can be nutritional:
• effect of nutrients on gastric emptying
• effect of nutrients on intestinal peristalsis
• effect of nutrients on gastrointestinal blood flow

PHARMACOLOGICAL CAUSES
• effect of NSAIDSs (aspirin, ibuprofen)
• protective effect of nitrates

RACCOMANDATIONS
• avoid high-fibers food in the day or the day before
• avoid NSAIDSs
• avoid high fructose food (drinks)
• preference multiple transportable CHO, avoid excessive osmolarity
• avoid dehydration (>4% during or after exercise)
• train gut

Particularly important if:

• positive history
• female
• young age
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• vertical impact sport
• medicine use

THERMOREGULATION AND EXERCISE

EXERCISE IS MEDICINE
Facilities weight loss, prevents weight regain.

Moderate intensity (3,0 - 5,9 METs):

• 5-7 days per week
• 150-250 mins per week

MET
MET means metabolic equivalent, is used for expressing energy costs for physical activities as a multiple of resting
metabolic rate, 1 MET corresponds to the rest metabolic rate of an individual, how many time above the rest metabolic
rate an activity is.

Quantification and monitoring of dose in METs allows:

• individualized exercise prescription
• diet modulation
• interpretation of results
• definition of population-specific dose-response relationship

HEART RATE INDEX

The gold standard for the quantification of intensity is the oxygen consumption. However this type of measure is not
very easy to calculate because is an overall cost. An australian doctor developed an alternative method called heart
rate index, is the METs heart rate, heart rate index expresses the heart rate as a multiplus of the resting heart rate.

The doctor also found that there is a very strong relationship between
HR index and METs of an individual.
In the graphic is shown the metabolic rate expressed in METs as a
function of HR index in a very large group of individuals. The data
are expressed in a linear relationship. METs can be calculated or
predicted based on the value of HR index multiplied by 6 and minus
5. This equation is valid for all subjects, individual HR/VO2
relationship si not necessary.

Test the performance of HR index in estimating the metabolic intensity of exercise during cycling in obese
individuals:
• step incremental test
• VO2 and HR determination
• HR index = HR / HR rest
• eMETs = (HR index * 6) - 5