Nutrition Behavior & Performance
Fueling Athletes
Facts Versus Fiction on Feeding Athletes
for Peak Performance
Christine Rosenbloom, PhD, RD
Downloaded from http://journals.lww.com/nutritiontodayonline by DcFa2XmjTMD9LZlJhGyTmutR8IAQGBvWYY8SyEPy0+3Dm3i0iLzbCMBixBaHu/E4XLARDwiDo9sl4x29rlSA0cj+qYenSi5YeikluzFY91U= on 05/11/2018
Athletes are more interested in nutrition to fuel peak
performance than ever before. Unfortunately, too often, they
get the wrong message about what to eat and when to
eat and seek information from unqualified practitioners.
Sports nutrition research has elucidated the need for
macronutrients during various phases of training and
competition, but there is still a long way to go in
understanding the nuances of fueling athletes. This article
reviews the most current guidelines for carbohydrate,
protein, and fat needs for athletes—from the elite to the
recreational. Nutr Today. 2006;41(5):227-232
F rom soccer moms feeding their future Ronaldinhos
or Brandi Chastains to the chief executive officer
who runs 10K road races on the weekend,
everyone wants to know what to eat and when to eat
to fuel peak performance. Finding reliable nutrition
information can be challenging. Type the words ‘‘sports
nutrition’’ in any common search engine and more
than 90 million hits offering advice on supplements,
diets, and energy-boosters from reputable and
not-so-reputable marketers will appear. To assist
consumers in locating reliable sources, the Commission
on Dietetic Registration, the credentialing agency for
the American Dietetic Association, recently decided to
certify sports nutrition experts. The Commission on
Dietetic Registration has established a Board Certification
as a Specialist in Sports Dietetics to differentiate qualified
sports dietitians from those who are less qualified to
provide nutrition counseling to athletes. Credentials
for eligibility for the Board Certification as a Specialist
in Sports Dietetics include status as a registered dietitian,
sports dietetics practice experience, and passage of a
specialty exam. For more information, visit the
Commission on Dietetic Registration’s Web site: http://
www.cdrnet.org.
Nutrition Today, Volume 41
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September/October, 2006
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The research literature contains hundreds of studies
elucidating the energy and macronutrient needs of
athletes; indeed, entire journals have been devoted to
publishing research on sports nutrition. The American
Dietetic Association, the American College of Sports
Medicine, and the Dietitians of Canada collaborated
on a joint position statement on the nutritional needs
of athletes,1 and the International Olympic Committee
published a consensus statement on sports nutrition in
2003.2 Despite this information, confusion exists, and
many athletes are still searching for the magic pill or
potion that will improve their performance and give
them the edge in competition. This article reviews the
most recent information on macronutrient needs for
sports performance and debunks some misinformation.
In a Carbohydrate-conscious World,
What Role Does Carbohydrate Play
in Fueling Athletes?
Athletes, like many nonathletes, fear carbohydrate.
Thanks to a national fixation on low-carbohydrate,
high-protein diets, many athletes have gotten the
message that carbohydrate is the fattening enemy.
The truth is that carbohydrate fuels anaerobic activity;
it is the only macronutrient that can be used without
oxygen. Athletes rely on carbohydrate metabolism
for a slam dunk in basketball, a sprint to the finish
line, to hurl a discus, or to score the power play goal
in ice hockey. Carbohydrate also fuels aerobic exercise,
with protein and fat contributing to the fuel mix.
Muscle glycogen and blood glucose both contribute
fuel to working muscles, but the body has limited
supplies of glucose. Approximately 300 to 500 g of
glycogen is stored in muscles (or approximately 1,200
to 2,000 calories), another 60 to 100 g is stored in the
liver (240 to 400 calories), and blood glucose can
supply 15 to 20 g of glucose (60 to 80 calories), for a
total of 1,520 to 2,480 calories. This would not be
227
Nutrition Behavior & Performance Feeding Athletes for Peak Performance

enough to fuel a 26-mile marathon if carbohydrate
was the only fuel available.3 Fortunately, carbohydrate
may be the preferred fuel, but it is not the only fuel. At
low exercise intensities (approximately 40% of maximum
oxygen consumption), fat utilization from plasma free
fatty acids becomes the major fuel, and exercise can be
performed for many hours by drawing upon the body’s
fat reserves.3
Carbohydrate is the primary fuel
for working muscles.
Studies on carbohydrate use during exercise are
typically conducted on athletes who train and compete at
high intensity (965% of maximum oxygen consumption),
and recommendations for carbohydrate consumption
are made with the serious athlete in mind. The typical
US diet contains approximately 4 to 5 g of carbohydrate
per kilogram of body weight, which is at the low end
of recommendations even for recreational athletes.
Endurance athletes need even higher carbohydrate
intake than recreational athletes do, and here is where
the confusion lies. Research is usually conducted on
trained, elite athletes; but most of the active people
who seek nutrition advice are not at the elite level.
Many are exercising to lose or maintain weight and fear
that eating carbohydrate will undermine the benefits of
exercise. However, without adequate carbohydrate,
exercise will be more difficult, so a vicious cycle of
underfueling can begin. Athletes, whether elite,
recreational, or somewhere in between, can tailor their
intake of carbohydrate fueling for pre-exercise, during
exercise, or recovery. Not all athletes need to be vigilant
about all 3 phases. Table 1 illustrates carbohydrate
recommendations for athletes in selected situations.
Pre-exercise Carbohydrate
All active people should eat a carbohydrate-rich diet,
focusing on whole grains, fruits, and vegetables for
nutrient-dense carbohydrates. In certain circumstances,
eating a carbohydrate-rich meal or snack before
exercise can improve performance.4 Athletes who
began exercise with low glycogen stores can benefit
from pre-exercise carbohydrate. Low glycogen stores
can be the result of hard training, with inadequate
time to replenish liver and muscle stores or from
inadequate carbohydrate consumption in the usual diet,
especially when paired with overnight fasting. Liver
glycogen can be depleted by a 15-hour fast, and an
overnight fast can reduce stores significantly.5 Athletes
who need to compete at high intensities may find
that their performance is limited if carbohydrate intake
is not optimal. A pre-exercise feeding can help to restore
glycogen if consumed 2 to 4 hours before the activity
and is most helpful in endurance events that last more
than 1 hour at high intensities. Recommendations
on carbohydrate intake should be based on the total
amount of carbohydrate and the timing relative to
exercise. If an athlete has only an hour to eat before
an early morning event, then 1 g/kg carbohydrate
is recommended; if more time is available, more
carbohydrate can be consumed.
Athletes are encouraged to try food or fluids during
training to make sure no gastrointestinal upset occurs
during competition. Many athletes tell horror stories
about eating a new or unfamiliar food in the hours
before a competition, with negative results. Runners

Table 1. Carbohydrate Intake Recommendations for Selected Situations

Situation Recommendations Example for a 70-kg (154-lb) Athlete
y
1Y4 h before event* 1.0Y4.0 g/kg 70Y135 g
General training for endurance events 6.0Y7.0 g kgj1 dj1 420Y490 g
Endurance training and competition 7.0Y10.0 g kgj1 dj1 490Y700 g
During endurance events lasting 960 min 30Y60 g/h 30Y60 g/h
High-intensity events 5.0Y8.0 g kgj1 dj1 350Y560 g
Recovery for athletes who train or 1.5 g/kg immediately after exercise 350Y420 g
compete hard for 990 min/d Additional 1.5 g/kg 2 h after exercise
Adapted from Christine A. Rosenbloom, ed. Sports Nutrition: Client Education Handouts. Chicago, Ill: American Dietetic Association; 2006. Reprinted with
permission from the American Dietetic Association.
*An athlete who eats 4 hours before an event may need to eat again 1 hour before the event.
y
The carbohydrate recommendation will vary depending on the number of hours that passes between the time the athlete eats and the activity. Athletes who
eat 4 hours before an event should eat more carbohydrate; athletes who eat 1 hour before an activity should eat less carbohydrate.

228 Nutrition Today, Volume 41
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 Feeding Athletes for Peak Performance
are urged to use caution at the running expo when
they go to pick up their race number. Here, they can
find themselves surrounded by marketers giving samples
of energy bars, gels, and drinks. If an athlete has never
used a gel and tries it the morning of the event, he or
she is flirting with an upset stomach or diarrhea during
the race. When in doubt, leave it out, and go for the
tried and true foods and fluids that worked in training.
Athletes often believe that energy bars are the best
pre-event food, but Paddeon-Jones and Pearson6
debunked that myth when they gave athletes 4 different
types of carbohydrate feedings (460 calories, with
approximately 70% carbohydrate) 2 hours before a
60-minute endurance cycling bout. They found that
all of the feedings offered a benefit to performance
with no advantage to one type of feeding over another.
The feedings ranged from an expensive energy bar
at a cost of $2.60 to oat or wheat cereal at a cost of
approximately $0.50.
Carbohydrate During Exercise
The purpose a carbohydrate feeding during exercise
is to maintain blood glucose levels to fuel long bouts
of exercise, especially those activities that require a
‘‘kick’’ or sprint at the end of exercise. Researchers
have also studied carbohydrate use during intermittent
sports, such as basketball and soccer, and found that
the ability to perform activities for a longer period are
achieved with carbohydrate compared with placebo.7
Based on observations by Nicholas et al7 and Coyle
et al,8 athletes are advised to consume small amounts
of carbohydrate (30 to 60 g) every hour during
high-intensity endurance or intermittent activity. The
key is intensity; recreational athletes who play baseball
for several hours at low intensity will not benefit from
additional carbohydrate.
Athletes who choose to include carbohydrate feedings
during exercise can achieve the recommendations
through solid food or through consumption of sports
drinks. A typical sports drink contains approximately
15 g of carbohydrate per 8 fl oz; thus, consuming 16 oz
of sports drink every hour will aid both carbohydrate
and fluid intake.
Recovery Carbohydrate
Carbohydrate in the hours after exercise is important for
athletes who train every day. Elite-level athletes frequently
train hard several times a day, and these athletes have
to work hard to replace glycogen used during training.
The best strategy to aid in glycogen resynthesis is to
consume 1.5 g/kg of carbohydrate in the first hour after
exercise and an additional 1.5 g/kg 2 hours later.3 Many
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Nutrition Behavior & Performance
athletes rely on carbohydrate plus protein to aid
recovery, but research is equivocal. Carbohydrate plus
protein will not improve muscle glycogen resynthesis,
but protein may provide an anabolic stimulus to muscle.9
Athletes who do not train hard every day do not need to
be concerned with recovery strategies. Eating a
carbohydrate-rich meal after exercise will be sufficient to
begin the glycogen replacement process.
Other Benefits of Carbohydrates
Recently, other benefits of carbohydrates have been
observed. Nieman10 has shown that carbohydrate
consumption may be beneficial to the immune system
to ward off upper respiratory infections after strenuous
exercise. It appears to reduce the level of stress hormones
(catecholamines, growth hormone, cortisol, and
adrenocorticotropic hormone) and cytokines secreted
after exercise. Carbohydrate also helps prevent a
decrease in neutrophils that is commonly seen after
strenuous exercise. The effects of immunosuppression
during exercise are exacerbated when exercising in a
carbohydrate-depleted state.11
Another benefit of carbohydrate intake appears to
be an improved mood state. Achten et al12 fed trained
runners diets containing 5.4 g of carbohydrate per
kilogram of body weight (41% of total energy) or 8.5 g
of carbohydrate per kilogram of body weight (65% of
total energy) and trained them intensively for 11 days.
The crossover, randomized trial had performance
measures of 8-km all-out run indoors on a treadmill
and an 11-km all-out run outdoors. Athletes consuming
the higher level of carbohydrate performed better in
the running trials and reported less fatigue and better
mood, using the Profile of Mood States. The authors
speculate that adequate carbohydrate consumption
improved the runner’s mood and physical performance
by allowing them to train and compete without fatigue.
Carbohydrate offers additional
benefits to athletes; it aids in the
elevation of mood states and
improves immune function.
Are Protein Needs Significantly Higher
for Athletes Than for Nonathletes?
Protein has always been the most favored macronutrient
in the sports world. Open any muscle and fitness
229
Nutrition Behavior & Performance
magazine and gaze at the muscle-bound men who
swear by amino acids in various combinations, as well as
protein isolates from casein to whey. The understanding
of the role of protein in sports performance has come
a long way from the days when an athlete’s training
diet consisted of steak. Jack London wrote a short
story on an aging boxer, Tom King, who ‘‘remembered
back into the fight to the moment when he had Sandel
swaying and tottering on the hairline balance of defeat.
Ah, that piece of steak would have done it. He had lacked
just that for the decisive blow, and he had lost. It was
all because of the piece of steak.’’13 Today, an athlete
is more likely to say, ‘‘Ah, I lost the fight/match/game
because I didn’t have a creatine-fortified, branched
chain amino acidYsupplemented, whey protein shake.’’
Protein for Endurance Athletes
Although the protein needs of athletes is still an area of
emerging science, and experts do not all agree, protein
needs may be higher for athletes, but the quantity of
protein can be easily obtained in the diet. Lemon14 was
among the first to observe that the recommended daily
allowance for protein of 0.8 g/kg of body weight was
established using sedentary subjects, and athletes might
have greater requirements. In the 1970s, researchers
began to study protein balance in athletes and observed
that 2 amino acids, alanine and glutamine, were released
from muscles during exercise. These early studies led
researchers to believe that protein had a role as fuel in
exercise, not just as a building block for muscle growth
and strength.14 In endurance athletes, the need for
increased protein is related to the need for increases
in hemoglobin to transport oxygen and enzymes for
synthesis and repair of muscle during training and
competition.15 Protein is used as a fuel in aerobic
exercise, but only approximately 3% to 6% of total
energy expenditure is from amino acid oxidation.16
Protein recommendations for endurance athletes are
suggested to be 1.2 to 1.4 g/kg of body weight.16
Protein maybe needed in amounts
greater than the recommended daily
allowance of 0.8 g/kg of body weight,
but it is easy to get the recommended
amount of protein from food
instead of supplements.
230 Nutrition Today, Volume 41
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Feeding Athletes for Peak Performance
Protein for Strength/Power Athletes
Athletes who strength-train to increase muscle mass
and strength need increased protein intake, along with
progressive resistance exercise. Protein is needed for
muscle synthesis; when protein balance is positive, net
protein synthesis occurs when muscle is stimulated. If
insufficient protein and energy are consumed, a catabolic
state occurs and muscle gains are limited. Protein needs
seem to be higher in the early phases of strength training
(ie, 3 to 6 months) and are less when individuals are
trained, as protein efficiency improves with training. The
recommendation for strength training is 1.6 to 1.7 g/kg
of body weight.
However, it is important to consider that current
methods for studying protein turnover in muscle are not
ideal. Early studies relied on nitrogen balance, which
is not a very sensitive measure for pinpointing protein
needs in the fed state or fasted state during activity. It
generally leads to an overestimation of requirements.
Current research uses more sophisticated methods to
study protein utilization and turnover (whole-body
protein turnover using isotope tracers), but there are still
limitations to the research. Many things affect protein
needs: energy intake, protein intake, amino acid pool
availability during and after exercise, and fed or fasting
state. Given the limitations, it is generally accepted in the
scientific community that protein intakes above 2 g/kg
of body weight offer no additional anabolic benefit.16,17
It is worth mentioning that sufficient energy intake is
critical for protein to be used for anabolism. Laboratory
studies on the assessment of protein needs for athletes
control for energy intake, but in the real world, athletes
are frequently dieting to lose or make weight, and protein
needs may be higher than 1.7 g/kg of body weight in
those individuals. Athletes would be well advised to seek
the consultation of a sports dietitian to more accurately
assess their protein needs. Table 2 summarizes protein
recommendations for athletes.
Timing of Protein Intake
Although it is fairly well established that protein needs
are higher for athletes, recently, there is interest in the
timing of protein intake to maximize muscle mass gains.
Rasmussen et al18 studied the effect of an oral amino
acidYcarbohydrate supplement on protein anabolism
after a bout of strength training. Subjects were given a
bolus of 6 g of essential amino acids and 35 g of sucrose
1 or 3 hours after an intense bout of weight training.
Compared with placebo, muscle protein synthesis was
increased (as measured using a 3-compartment model
of leg muscle protein kinetics) when subjects ingested
the beverage at 1 or 3 hours. Earlier studies showed

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 Feeding Athletes for Peak Performance
Table 2. Protein Recommendations for Endurance and Strength-training Athletes
Protein Recommendations for Endurance Athletes
Situation Recommendations
Daily intake 1.2Y1.4 g/kg
Protein Recommendations for Strength-training Athletes
Situation Recommendations
Daily intake 1.6Y1.7 g/kg
Initial phase of training (first 3Y6 mo) 1.7 g/kg
Immediately before strength training* 0.1 g/kg
Immediately after strength training* 0.1 g/kg
and every 1Y2 h in recovery
Adapted from Christine A. Rosenbloom, ed. Sports Nutrition: Client Education Handouts. Chicago, Ill: American Dietetic Association; 2006. Reprinted with
permission from the American Dietetic Association.
*These recommendations are based on the most current research but are not conclusive.
y
High-quality protein contains all essential amino acids.
that amino acid infusion increases protein synthesis in
muscle, but Rasmussen et al showed that oral intake
of essential amino acids could have a similar effect. The
amount of amino acids used in this study is small, but it
could be that a protein-rich snack containing essential
amino acids and carbohydrate could have a positive effect
on muscle accretion in athletes. More research is needed.
The timing of protein intake on
muscle anabolism may play a
more important role than the
quantity of protein.
Increased Dietary Protein and Kidney Function
An important consideration in any discussion on protein
intake in athletes is how much is too much. Will excess
protein increase glomerular filtration, setting the stage
for kidney disease? Poortmans and Dellalieux19 studied
body builders and other trained athletes and measured
protein intake through 7-day dietary records and
renal clearance values to assess the effect of protein
on renal function. The investigators found that
consumption of up to 2.8 g/kg of body weight of protein
did not cause any harmful effect on clinical measures
of renal function in healthy, well-trained athletes.
Other research suggests that in people without kidney
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Nutrition Behavior & Performance
Example for a 70-kg (154-lb) Endurance Athlete
84Y98 g
Example for a 91-kg (200-lb) Football Player
146Y155 g
155 g
9 g high-quality proteiny
9 g high-quality proteiny
disease, protein intakes within reasonable limits have
no effects on glomerular filtration.20
Is Fat Loading the New Magic Bullet?
Stored fat is in great supply in the human body, and
athletes have sought ways to tap into fat reserves to spare
limited carbohydrate stores. During endurance exercise,
lipolysis of stored fat increases after approximately
20 minutes of exercise (this is where the popular idea
that when one hits the magic mark of 20 minutes of
activity, fat is burned as a fuel and weight loss begins
comes from). However, although stores of fat may be
plentiful, getting fatty acids to working muscles is not
an easy task. Fatty acids must be transported to muscle
mitochondria for oxidation, and this is believed to
be the rate-limiting step in providing adequate fats to
working muscles.21 Aerobic or endurance training has
been shown to provide a carbohydrate-sparing effect,
and a trained individual will burn more fat and less
carbohydrate at the same workload intensity.22
Researchers and endurance athletes have tried to
manipulate the diet to enhance fat oxidation and spare
performance. In a meta-analysis of the ability of high-fat
or high-carbohydrate diets to increase endurance
performance, Erlenbusch et al23 concluded that
high-fat diets have not been consistent in their ability
to prolong exercise in untrained individuals, but the
studies on trained individuals are more difficult to assess.
Currently, it is advisable for athletes to consume
20% to 35% of total energy as fat, with an emphasis
on heart-healthy fats and reduced consumption of
saturated fats.
231
Nutrition Behavior & Performance
Fat is an essential nutrient, and
athletes should consume no less
than 15% of total energy as
fat, but no more than 35%.
Athletes should be discouraged from consuming a diet
too low in fat (less than 15% of total energy) because of
the important role of essential fatty acids in eicosanoid
production, which influences blood flow dynamics,
inflammatory responses, and airflow through the lungs.24
Conclusion
Athletes should be encouraged to seek evidence-based
nutrition recommendations from a qualified sports
dietitian. Athletes have unique needs for training and
competition, and active individuals may have different goals
than simply success in sport. By tailoring macronutrient
needs to individual effort, athletes can achieve their goals
for training, competition, and weight management.
Christine Rosenbloom, PhD, RD, is an associate dean at the College of
Health and Human Sciences and is a professor at the Division of Nutrition at
Georgia State University. She conducts research on sports nutrition and on
nutrition and aging. She served as a chair of the dietetic practice group of the
American Dietetic Association, Sports, Cardiovascular, and Wellness Nutritionists
(SCAN). She edited the third edition of SCAN’s Sports Nutrition Manual and
recently edited a CD-ROM for the American Dietetic Association, entitled ‘‘Sports
Nutrition: Client Education Handouts.’’ We welcome her as our newest columnist.
Correspondence: Christine Rosenbloom, PhD, RD, College of Health and
Human Sciences, Georgia State University, PO Box 3995, Atlanta, GA
30302-3995 (e-mail: crosenbloom@gsu.edu).
Suggested References
Marie Dunford, ed. Sports Nutrition: A Practice Manual for
Professionals. 4th ed. Chicago: The American Dietetic
Association; 2006.
www.scandpg.org: This Web site of the Sports, Cardiovascular,
and Wellness Nutritionist Dietetic Practice Group contains
information on sports nutrition and includes a list of
books published by its members.
REFERENCES
1. American Dietetic Association. Position of The American
Dietetic Association, Dietitians of Canada, and the
American College of Sports Medicine: Nutrition and
Athletic Performance. J Am Diet Assoc. 1999;100:1543Y1556.
2. International Olympic Committee. IOC consensus
statement of sports nutrition 2003. Int J Sport Nutr Exerc
Metab. 1003;13:552.
3. Ivy JL. Role of carbohydrate in physical activity. Clin
Sports Med. 1999;18:469Y484.
232 Nutrition Today, Volume 41
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Feeding Athletes for Peak Performance
4. Sherman W, Costill D, Fink W, Miller J. Effect of exercise-
diet manipulation on muscle glycogen and its subsequent
utilization during performance. Int J Sports Med. 1981;1:114Y118.
5. Coleman EJ. Carbohydrate and exercise. In: Dunford M, ed.
Sports Nutrition: A Practice Manual for Professionals. 4th ed.
Chicago: American Dietetic Association, 2006:14Y32.
6. Paddeon-Jones DJ, Pearson DR. Cost-effectiveness of
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7. Nicholas CE, Tsintzas K, Boobis L, Williams C. Carbohydrate-
electrolyte ingestion during intermittent high-intensity
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8. Coyle EF, Coggan AR, Hemmert WK, Ivy JL. Muscle
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9. Tipton K, Wolfe R. Exercise, protein metabolism, and muscle
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11. Gleeson M. Can nutrition limit exercise-induced
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