Dietary periodisation for health and performance in world-class endurance athletes

Periodisation – defined as the systematic planning and sequencing of training blocks across macro, meso and micro cycles of training and racing as a means to optimise athletic adaptation and performance – has been implemented by coaches to athletes across most sports for several decades. Similarly to training, nutrition should also be periodised to support training and racing goals. For example, the diets of endurance athletes may move along the spectrum from low to high energy availability (EA) or low to high carbohydrate (CHO) availability (e.g. body composition management with brief periods of low EA or CHO vs optimised adherence to sports nutrition guidelines via high energy and CHO availability). Despite robust evidence behind current guidelines, the literature lacks systematic information on the knowledge and implementation of periodised nutrition strategies across various levels of training and racing by world class endurance athletes. Another popular dietary approach – chronic or long-term ketogenic low-CHO, high fat (LCHF) diet – has become popular among some athletes and scientists as a means to enhance endurance performance and to support health. Notably, current literature does not support the former claim of enhanced performance, and the majority of existing evidence in favour of the latter claim comes from research in clinical populations (such as obesity, cancer, and epilepsy). Since endurance athletes are at an especially high risk for low bone mineral density (BMD) and stress fractures, and as available evidence suggests that both acute low EA and CHO availability may have independent and negative effects on bone modelling process in active individuals, this is an important topic that has been largely unexplored in the literature to-date. Therefore, this thesis will investigate dietary periodisation approaches in elite endurance athletes as well as the effects of low energy and low CHO availability on direct and indirect outcomes of markers of bone modelling and bone health in this population

Six days of low carbohydrate, not energy availability, alters the iron and immune response to exercise in elite athletes

Purpose To quantify the effects of a short-term (6-d) low carbohydrate (CHO) high fat (LCHF), and low energy availability (LEA) diet on immune, inflammatory, and iron-regulatory responses to exercise in endurance athletes. Methods Twenty-eight elite male race walkers completed two 6-d diet/training phases. During phase 1 (Baseline), all athletes consumed a high CHO/energy availability (CON) diet (65% CHO and ~40 kcal·kg−1 fat-free mass (FFM)·d−1). In phase 2 (Adaptation), athletes were allocated to either a CON (n = 10), LCHF (n = 8; <50 g·d−1 CHO and ~40 kcal·kg−1·FFM−1·d−1), or LEA diet (n = 10; 60% CHO and 15 kcal·kg−1·FFM−1·d−1). At the end of each phase, athletes completed a 25-km race walk protocol at ~75% V˙O2max. On each occasion, venous blood was collected before and after exercise for interleukin-6, hepcidin, cortisol, and glucose concentrations, as well as white blood cell counts. Results The LCHF athletes displayed a greater IL-6 (P = 0.019) and hepcidin (P = 0.011) response to exercise after Adaptation, compared with Baseline. Similarly, postexercise increases in total white blood cell counts (P = 0.026) and cortisol levels (P 0.05). No differences between CON and LEA were evident for any of the measured biological markers (all P > 0.05). Conclusions Short-term adherence to a LCHF diet elicited small yet unfavorable iron, immune, and stress responses to exercise. In contrast, no substantial alterations to athlete health were observed when athletes restricted energy availability compared with athletes with adequate energy availability. Therefore, short-term restriction of CHO, rather than energy, may have greater negative impacts on athlete health

Short severe energy restriction with refueling reduces body mass without altering training-associated performance improvement

Purpose We investigated short-term (9 d) exposure to low energy availability (LEA) in elite endurance athletes during a block of intensified training on self-reported well-being, body composition, and performance. Methods Twenty-three highly trained race walkers undertook an ~3-wk research-embedded training camp during which they undertook baseline testing and 6 d of high energy/carbohydrate (HCHO) availability (40 kcal·kg FFM−1·d−1) before being allocated to 9 d continuation of this diet (n = 10 M, 2 F) or a significant decrease in energy availability to 15 kcal·kg FFM−1·d−1 (LEA: n = 10 M, 1 F). A real-world 10,000-m race walking event was undertaken before (baseline) and after (adaptation) these phases, with races being preceded by standardized carbohydrate fueling (8 g·kg body mass [BM]−1 for 24 h and 2 g·kg BM−1 prerace meal). Results Dual-energy x-ray absorptiometry–assessed body composition showed BM loss (2.0 kg, P < 0.001), primarily due to a 1.6-kg fat mass reduction (P < 0.001) in LEA, with smaller losses (BM = 0.9 kg, P = 0.008; fat mass = 0.9 kg, P < 0.001) in HCHO. The 76-item Recovery–Stress Questionnaire for Athletes, undertaken at the end of each dietary phase, showed significant diet–trial effects for overall stress (P = 0.021), overall recovery (P = 0.024), sport-specific stress (P = 0.003), and sport-specific recovery (P = 0.012). However, improvements in race performance were similar: 4.5% ± 4.1% and 3.5% ± 1.8% for HCHO and LEA, respectively (P < 0.001). The relationship between changes in performance and prerace BM was not significant (r = −0.08 [−0.49 to 0.35], P = 0.717). Conclusions A series of strategically timed but brief phases of substantially restricted energy availability might achieve ideal race weight as part of a long-term periodization of physique by high-performance athletes, but the relationship between BM, training quality, and performance in weight-dependent endurance sports is complicated

Short-Term Very High Carbohydrate Diet and Gut-Training Have Minor Effects on Gastrointestinal Status and Performance in Highly Trained Endurance Athletes

We implemented a multi-pronged strategy (MAX) involving chronic (2 weeks high carbohydrate [CHO] diet + gut-training) and acute (CHO loading + 90 g·h(−1) CHO during exercise) strategies to promote endogenous and exogenous CHO availability, compared with strategies reflecting lower ranges of current guidelines (CON) in two groups of athletes. Nineteen elite male race walkers (MAX: 9; CON:10) undertook a 26 km race-walking session before and after the respective interventions to investigate gastrointestinal function (absorption capacity), integrity (epithelial injury), and symptoms (GIS). We observed considerable individual variability in responses, resulting in a statistically significant (p < 0.001) yet likely clinically insignificant increase (Δ 736 pg·mL(−1)) in I-FABP after exercise across all trials, with no significant differences in breath H(2) across exercise (p = 0.970). MAX was associated with increased GIS in the second half of the exercise, especially in upper GIS (p < 0.01). Eighteen highly trained male and female distance runners (MAX: 10; CON: 8) then completed a 35 km run (28 km steady-state + 7 km time-trial) supported by either a slightly modified MAX or CON strategy. Inter-individual variability was observed, without major differences in epithelial cell intestinal fatty acid binding protein (I-FABP) or GIS, due to exercise, trial, or group, despite the 3-fold increase in exercise CHO intake in MAX post-intervention. The tight-junction (claudin-3) response decreased in both groups from pre- to post-intervention. Groups achieved a similar performance improvement from pre- to post-intervention (CON = 39 s [95 CI 15–63 s]; MAX = 36 s [13–59 s]; p = 0.002). Although this suggests that further increases in CHO availability above current guidelines do not confer additional advantages, limitations in our study execution (e.g., confounding loss of BM in several individuals despite a live-in training camp environment and significant increases in aerobic capacity due to intensified training) may have masked small differences. Therefore, athletes should meet the minimum CHO guidelines for training and competition goals, noting that, with practice, increased CHO intake can be tolerated, and may contribute to performance outcomes

Short-term very high carbohydrate diet and gut-training have minor effects on gastrointestinal status and performance in highly trained endurance athletes

We implemented a multi-pronged strategy (MAX) involving chronic (2 weeks high carbohydrate [CHO] diet + gut-training) and acute (CHO loading + 90 g·h−1 CHO during exercise) strategies to promote endogenous and exogenous CHO availability, compared with strategies reflecting lower ranges of current guidelines (CON) in two groups of athletes. Nineteen elite male race walkers (MAX: 9; CON:10) undertook a 26 km race-walking session before and after the respective interventions to investigate gastrointestinal function (absorption capacity), integrity (epithelial injury), and symptoms (GIS). We observed considerable individual variability in responses, resulting in a statistically significant (p < 0.001) yet likely clinically insignificant increase (Δ 736 pg·mL−1) in I-FABP after exercise across all trials, with no significant differences in breath H2 across exercise (p = 0.970). MAX was associated with increased GIS in the second half of the exercise, especially in upper GIS (p < 0.01). Eighteen highly trained male and female distance runners (MAX: 10; CON: 8) then completed a 35 km run (28 km steady-state + 7 km time-trial) supported by either a slightly modified MAX or CON strategy. Inter-individual variability was observed, without major differences in epithelial cell intestinal fatty acid binding protein (I-FABP) or GIS, due to exercise, trial, or group, despite the 3-fold increase in exercise CHO intake in MAX post-intervention. The tight-junction (claudin-3) response decreased in both groups from pre- to post-intervention. Groups achieved a similar performance improvement from pre- to post-intervention (CON = 39 s [95 CI 15–63 s]; MAX = 36 s [13–59 s]; p = 0.002). Although this suggests that further increases in CHO availability above current guidelines do not confer additional advantages, limitations in our study execution (e.g., confounding loss of BM in several individuals despite a live-in training camp environment and significant increases in aerobic capacity due to intensified training) may have masked small differences. Therefore, athletes should meet the minimum CHO guidelines for training and competition goals, noting that, with practice, increased CHO intake can be tolerated, and may contribute to performance outcomes

Energy availability in athletics:Health, performance and physique

The reported prevalence of low energy availability (LEA) in female and male track and field athletes is between 18% and 58% with the highest prevalence among athletes in endurance and jump events. In male athletes, LEA may result in reduced testosterone levels and libido along with impaired training capacity. In female track and field athletes, functional hypothalamic amenorrhea as consequence of LEA has been reported among 60% of elite middle- and long-distance athletes and 23% among elite sprinters. Health concerns with functional hypothalamic amenorrhea include impaired bone health, elevated risk for bone stress injury, and cardiovascular disease. Furthermore, LEA negatively affects recovery, muscle mass, neuromuscular function, and increases the risk of injuries and illness that may affect performance negatively. LEA in track and field athletes may occur due to intentional alterations in body mass or body composition, appetite changes, time constraints, or disordered eating behavior. Long-term LEA causes metabolic and physiological adaptations to prevent further weight loss, and athletes may therefore be weight stable yet have impaired physiological function secondary to LEA. Achieving or maintaining a lower body mass or fat levels through long-term LEA may therefore result in impaired health and performance as proposed in the Relative Energy Deficiency in Sport model. Preventive educational programs and screening to identify athletes with LEA are important for early intervention to prevent long-term secondary health consequences. Treatment for athletes is primarily to increase energy availability and often requires a team approach including a sport physician, sports dietitian, physiologist, and psychologist

A mismatch between athlete practice and current sports nutrition guidelines among elite female and male middle- and long-distance athletes

Contemporary nutrition guidelines promote a variety of periodized and time-sensitive recommendations, but current information regarding the knowledge and practice of these strategies among world-class athletes is limited. The aim of this study was to investigate this theme by implementing a questionnaire on dietary periodization practices in national/international level female (n = 27) and male (n = 21) middle- and long-distance runners/race-walkers. The questionnaire aimed to gain information on between and within-day dietary choices, as well as timing of pre- and posttraining meals and practices of training with low or high carbohydrate (CHO) availability. Data are shown as percentage (%) of all athletes, with differences in responses between subgroups (sex or event) shown as Chi-square x2 when p < .05. Nearly two-thirds of all athletes reported that they aim to eat more food on, or after, hard training days. Most athletes said they focus on adequate fueling (96%) and adequate CHO and protein (PRO) recovery (87%) around key sessions. Twenty-six percent of athletes (11% of middle vs 42% of long-distance athletes [x2 (1, n = 46) = 4.308, p = .038, phi = 0.3])) reported to undertake training in the fasted state, while 11% said they periodically restrict CHO intake, with 30% ingesting CHO during training sessions. Our findings show that elite endurance athletes appear to execute pre- and post-key session nutrition recovery recommendations. However, very few athletes deliberately undertake some contemporary dietary periodization approaches, such as training in the fasted state or periodically restricting CHO intake. This study suggests mismatches between athlete practice and current and developing sports nutrition guidelines

Sustained Exposure to High Carbohydrate Availability Does Not Influence Iron-Regulatory Responses in Elite Endurance Athletes

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Dietary microperiodization in elite female and male runners and race walkers during a block of high intensity precompetition training

We investigated one week of dietary microperiodization in elite female (n = 23) and male (n = 15) runners and race-walkers by examining the frequency of training sessions and recovery periods conducted with recommended carbohydrate (CHO) and protein availability. Food and training diaries were recorded in relation to HARD (intense or > 90min sessions; KEY) versus RECOVERY days (other-than KEY sessions; EASY). The targets for amount and timing of CHO and protein around KEY sessions were based on current nutrition recommendations. Relative daily energy and CHO intake was significantly (p < .05) higher in males (224 ± 26 kJ/kg/d, 7.3 ± 1.4 g/kg/d CHO) than females (204 ± 29 kJ/kg/d, 6.2 ± 1.1 g/kg/d CHO) on HARD days. However, when adjusted for trainingvolume (km), there was no sex-based difference in CHO intake daily (HARD: 0.42 ± 0.14 vs 0.39 ± 0.15 g/kg/km). Females appeared to periodize energy and protein intake with greater intakes on HARD training days (204 ± 29 vs 187 ± 35 kJ/kg/d, p = .004; 2.0 ± 0.3 vs 1.9 ± 0.3 g/ kg/d protein, p = .013), while males did not periodize intakes. Females showed a pattern of periodization of postexercise CHO for KEY vs EASY (0.9 ± 0.4 vs 0.5 ± 0.3 g/kg; p < .05) while males had higher intakes but only modest periodization (1.3 ± 0.9 vs 1.0 ± 0.4; p = .32). There was only modest evidence from femaleathletes of systematic microperiodization of eating patterns to meet contemporary sports nutrition guidelines. While this pattern of periodization was absent in males, in general they consumed more energy and CHO daily and around training sessions compared with females. Elite endurance athletes do not seem to systematically follow the most recent sports nutrition guidelines of periodized nutrition

Alternate-day low energy availability during Spring Classics in professional cyclists

Purpose: To assess energy and carbohydrate (CHO) availability and changes in blood hormones in 6 professional male cyclists over multiple single-day races. Methods: The authors collected weighed-food records, power-meter data, and morning body mass measurements across 8 d. CHO intakes were compared with contemporary guidelines. Energy availability (EA) was calculated as energy intake minus exercise energy expenditure, relative to fat-free mass (FFM). Skinfold thickness and blood metabolic and reproductive hormones were measured prestudy and poststudy. Statistical significance was defined as P ≤ .05. Results: Body mass (P = .11) or skinfold thickness (P = .75) did not change across time, despite alternate-day low EA (14 [9] vs 57 [10] kcal·kg−1 FFM·d−1, race vs rest days, respectively; P 46 kcal·kg−1 FFM·d−1) on days between. CHO intakes were significantly higher on race versus rest days (10.7 [1.3] vs 6.4 [0.8] g·kg−1·d−1, respectively; P < .001). The cyclists reached contemporary prerace fueling targets (3.4 [0.7] g·kg−1·3 h−1 CHO; P = .24), while the execution of CHO guidelines during race (51 [9] g·h−1; P = .048) and within acute (1.6 [0.5] g·kg−1·3 h−1; P = .002) and prolonged (7.4 [1.0] g·kg−1·24 h−1; P = .002) postrace recovery was poor. Conclusions: The authors are the first to report the day-by-day periodization of energy and CHO in a small sample of professional cyclists. They also examined the logistics of conducting a field study under stressful conditions in which major cooperation from the subjects and team management is needed. Their commentary around these challenges and possible solutions is a major novelty of the article