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Nutrition and Hydration Issues for Combat

Sport Athletes
Impact Factor: 0.77 DOI: 10.1519/SSC.0b013e318237247e






Jay R Hoffman

Carl M Maresh

University of Central Florida

University of Connecticut





Available from: Jay R Hoffman

Retrieved on: 25 June 2015

Nutrition and Hydration

Issues for Combat Sport
Jay R. Hoffman, PhD, CSCS*D, FNSCA1 and Carl M. Maresh, PhD2
Sport and Exercise Science Program, University of Central Florida, Orlando, Florida; and 2Department of Kinesiology,
University of Connecticut, Storrs, Connecticut


or competitive athletes to maintain a high level of training and

perform optimally during competition, their energy intake will need to
equal their high-energy expenditures.
The nutritional requirements for athletes are much greater than that needed
for the average population (4,33). Depending on the needs of the athlete (i.e.,
size, gender, requirements of the sport),


their energy intake may be 3- to 4-fold

higher than that recommended for the
average person (33). The nutritional
needs of the athlete have been the
focus of much research concerning
questions on what to eat, when to eat,
and which nutritional supplements to
take to maximize athletic performance. For example, for most people,
a recommended balance of 5560%
carbohydrates, 30% fat, and 1015%
protein appears to provide a sufficient
dietary composition (33). However,
for many athletes, this may not meet
their specific nutritional needs and
may require them to alter both protein
and carbohydrate intake.
To optimize the athletes potential for
training and competition, it is also
imperative that the athlete stays well
hydrated. In combat sports, this can
sometimes be a challenge because
many athletes withhold water as part
of a strategy to reduce weight and
compete in a desired weight class.
Unfortunately, this habit can have dire
consequences on the athletes health.
Water is second only to oxygen in the
necessity for maintaining life. Although
the body can withstand a 40% loss in
body mass due to starvation, a 912%
loss of body mass due to fluid loss can
be fatal. Clearly, if proper precautions
are not taken and an appreciation for
the physiological adjustments that
surround inappropriate nutritional
intake and/or rehydration strategies
is not observed, undesirable outcomes
may be the result. In consideration of


these issues, this article will focus on

nutrition and hydration strategies and
how they specifically relate to combat
sports in relation to training and

There are 6 classes of nutrients that are

required for the energy and health
needs of the individual. These nutrients
include carbohydrates, fats, proteins,
vitamins, minerals, and water. Carbohydrates, fats, and proteins are the principle compounds that comprise our food
and provide the energy needs for our
body. They are referred to as macronutrients. Vitamins and minerals play an
important role in energy production but
provide no direct source of energy. As
such, they are deemed micronutrients.
Water may be the most important
nutrient available. It is involved in
most physiological reactions in the
body, including nutrient transport,
waste removal, and body cooling.

Carbohydrates play a critical role in

fueling exercise, either by being the
primary energy source to fuel anaerobic
exercise via glycolysis or as a gateway
to oxidative phosphorylation. The
body can only store a limited amount
of carbohydrates in both the skeletal

sport nutrition; protein; hydration;


Copyright National Strength and Conditioning Association

muscle and the liver. Thus, during highintensity training (similar to what is
typically performed by combat sport
athletes), carbohydrates can provide
energy for only a relatively short
duration of time. This places a large
emphasis on maximizing carbohydrate
storage before training and competition
and replenishing them after exercise
and competition (41,60). There are
several types of carbohydrates available,
all of which are metabolized differently
by the body. Differences between
simple (composed of 1 or 2 sugar molecules) and complex carbohydrates
(chain of sugar molecules) are related
to their ability to be absorbed and to be
used either as a source of quick energy
or as a source of providing a more
gradual increase in energy availability.
Fats are a highly concentrated fuel that
has limited water solubility. The basic
unit of the fat molecule is the fatty acid,
which is also the part of fat that is used
for energy production. In contrast to
carbohydrates, fats have unlimited availability. During light to moderate exercise, the energy needs of the muscle are
met by free fatty acids released from
adipose sites around the body, which
bind to the protein albumin in the blood
for transport to the active muscle, and
triglycerides from within the muscle
itself. During exercise, energy will be
used from carbohydrate and fat sources.
However, as duration of exercise is
prolonged, a greater reliance on fat
utilization is seen. As exercise duration
exceeds more than an hour, the carbohydrate reserves become quite limited
until they are eventually depleted. The
utilization of stored fat as the primary
source of energy increases further, and
as long as the intensity of exercise is of
moderate intensity, it will supply the
vast majority of total energy required by
the end of the exercise session (33).
Proteins are composed of amino acids
and serve as the major structural
component of muscle and other tissues
in the body. In addition, they are used to
produce hormones, enzymes, and hemoglobin. Although protein can be
used as a source of energy, it is not
desirable as it likely means that the body

is metabolizing lean tissue to compensate for an energy deficit. The primary

role of dietary protein is to enhance and
stimulate various anabolic processes in
the body. In studies examining resistance-trained individuals, high protein intakes have generally been shown
to have a positive effect on muscle
protein synthesis, lean tissue gains and
increases in strength (35,45,54,68).
Tarnopolsky et al. (63) have shown that
for strength-trained individuals to maintain a positive nitrogen balance, they
need to consume a protein intake
equivalent to 1.8 gkg21day21. This is
consistent with other studies showing
that protein intakes between 1.4 and
2.4 gkg21day21 will maintain a positive
nitrogen balance in resistance-trained
athletes (36,45). As a result, daily protein intake for combat sport athletes,
who are classified as strength/power
athletes, should range between 1.4 and
2.0 gkg21day21 (4,16). Recent research
has suggested that protein intakes
exceeding 2.0 gkg21day21 may provide an even greater advantage for these
athletes by enhancing strength performance (34).
Another aspect of protein intake that
may take on greater importance to the
combat sports athlete is the issue with
protein intake and caloric restriction.
Recent research has demonstrated that
during prolonged situations of inadequate energy intake, greater protein
consumption appears to defend lean
body mass and prevent or minimize the
catabolic consequence of low caloric
diets (55). Thus, athletes who are
reducing their energy intake to achieve
a desired body weight should maintain
a high protein intake to minimize and
prevent lean tissue degradation.


To optimally prepare for training and

competition, the athlete needs to ensure
appropriate energy and protein intakes.
However, there are a number of strategies that can be used to maximize the
benefit of these nutrients: controlling
the timing of ingestion in relation to

the athletes workout or competition

and selecting the appropriate type of
nutrient or combination of nutrients
that are consumed at those times.

One of the more interesting areas of

research within sport nutrition has been
in nutrient timing. In regards to protein,
the time of ingestion appears to have
a significant impact on maximizing
skeletal muscle adaptation during resistance training programs (24,30) and
may also be beneficial in enhancing
muscular recovery in trained athletes
after an acute exercise session (37).
These effects appear to be related to an
enhanced delivery of amino acids to
exercising muscle that provides an
immediate availability of nutrients at
the end of workouts. This is thought to
stimulate greater muscle protein synthesis and adaptation resulting from
heightened muscle sensitivity from the
exercise stimulus. In support of this
hypothesis, several studies have demonstrated that, when essential amino
acids are consumed immediately before
a workout, the rate of delivery and
uptake of these amino acids to skeletal
muscle is significantly greater than
when these nutrients are consumed
after the workout (66,67). Although
protein consumption within an hour
after the training session can enhance
protein synthesis within skeletal tissue
to a greater degree than later feedings
(56), there does appear to be a greater
benefit in a pre-exercise ingestion.
The prevailing evidence is quite convincing regarding the importance of
ingesting protein immediately before
and/or after a training session. Although
pre-exercise ingestion enhances delivery
of these nutrients, most studies have
actually compared feedings surrounding
the workout to morning and evening
ingestion times (24,30,37). The evidence
provided by these studies indicate that
skeletal muscle may be more sensitive
after an acute resistance exercise session
than at other times of the day. Adding
further support, Hulmi et al. (40)
showed that protein consumption before and immediately after a resistance
exercise session can increase messenger

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Nutrition and Hydration Strategies in Combat Sports

RNA (mRNA) expression, suggesting

higher cell activation, and prevent a postexercise decrease in myogenin mRNA

Ingestion of both amino acids and

whole proteins such as whey and casein
can increase muscle protein synthesis.
The question often asked is whether
one type stimulates muscle protein
synthesis to a greater degree than the
other. Most studies investigating the
acute effect of nutrient timing focused
on amino acid ingestion, whereas most
training studies used whole protein
(method of protein that is more commonly used among athletes). Although
the benefit of pre-exercise protein
ingestion using an amino acid supplement has been well documented, a similar effect is not always observed with
whole proteins. These differences are
not well understood, but it has been
speculated that differences in the
delivery of essential amino acids to
the exercising muscle may be responsible (65). Increases in arterial amino acid
concentrations are approximately 100%
higher than resting levels after ingestion
of essential amino acids but only 30%
after whey protein ingestion (65). In
addition, the delivery of amino acids to
active muscle during exercise increases
approximately 7.5-fold after essential
amino acid ingestion but only 4.4-fold
higher for whey protein (65). It is
possible that the combination of carbohydrates with the amino acids (no
carbohydrates were generally included
with whey protein ingestion) stimulated
a greater insulin response resulting in
a greater amino acid uptake by muscle.
When carbohydrates are added to both
a whey protein and an amino acid in
combination, the anabolic response, as
assessed by muscle protein net balance,
appears to be extended (14).
Another question that is often raised is
whether the benefits seen with protein
supplement ingestion can be achieved
from protein from a food source.
Interestingly, this does appear to be


the case. Evidence has been published

that reports that milk consumption can
stimulate amino acid uptake by skeletal
muscle and result in an increase in net
muscle protein synthesis (27). Whole
milk appears to be more beneficial than
fat-free milk, unless the quantity of fatfree milk consumed is similar in caloric
value as whole milk. Whole milk and
isocaloric fat-free milk ingested 1-hour
after a resistance exercise session stimulated significant elevations in amino
acid uptake that was 80 and 85%,
respectively, greater than fat-free milk.
These results demonstrate that a food
source, such as milk, appears to be
suitable for ingestion during recovery
from resistance exercise and may be
a cheaper and effective alternative to
protein supplements. The primary benefit from taking a supplement as a postworkout drink is the ease of preparation
and the ability to provide a large intake
of protein that is quickly absorbed
within the time frame that the exercising tissue is at a heightened sensitivity.

A major emphasis in the nutritional

strategy of combat sport athletes is in
maintaining and replenishing carbohydrate stores. Carbohydrates are the
primary fuel used by these athletes
during training and competition. Considering that these athletes may be
competing in several competitions per
day, the ability to maintain sufficient
energy stores can often be the difference in their success or failure. Thus,
a strategy focusing on maximizing
carbohydrate storage and consuming
sufficient quantity of carbohydrates
between competitions and training
sessions needs to be used. In addition,
the type of carbohydrate consumed
also has an important effect on the rate
of absorption. Thus, careful selection of
food in relation to time of exercise or
competition becomes critical for maximizing energy availability and avoiding a hypoglycemic response that can
impede performance.
To help determine the appropriate
carbohydrate to consume, a glycemic
index was developed to help classify


food on their acute glycemic impact

(42). Foods with a high glycemic index
will be digested quickly and raise blood
glucose levels fairly rapidly. Examples of
foods with a high glycemic index are
baked potato, rice cakes, waffles, and
instant rice. Foods with a lower glycemic index will take longer to be digested.
Examples of such foods include nuts,
fruits, dairy products, and pasta.
Pre-exercise or precompetition. Preexercise or precompetition feedings
should occur approximately 34 hours
before the workout or event. Some
recommendations suggest that the meal
should contain 12 g/kg body mass of
carbohydrate (64), whereas others have
suggested that 200300 g of carbohydrate be consumed (58,59). More often
than not, it is generally the athletes
personal perception of how they
respond to a particular meal that
will determine its content. Interesting
to note is that the meal before competition contributes very little to the
glycogen content of the muscle. However, it will help to ensure blood glucose
levels and prevent feelings of hunger.
As the athlete gets closer to practice or
competition, any snack should comprise a low glycemic carbohydrate to
prevent the occurrence of a premature
fatigue due to a hypoglycemic response.
Despite this, a number of studies have
suggested that higher glycemic feedings
close to competition may not be as
detrimental as once thought (2,38).
Exercise feedings. During exercise or
competition, the use of a highglycemic carbohydrate will not pose
the same risk as that seen before
exercise. During exercise, the elevation in catecholamines will inhibit the
insulin response and maintain normal
blood glucose concentrations. Several
studies have shown that providing
carbohydrates during exercise will
maintain blood glucose levels and
improve exercise performance (11,25,
43). Liquid ingestion may be the best
route of delivery in these situations. A
68% solution in 816 ounces of water
is often recommended for exercise
feedings (44). This may become quite

important especially on days with

multiple bouts of competition.
feedings. It is generally recommended
that after a workout or competition,
carbohydrates with a high glycemic
index be consumed. Considering the
anaerobic nature of combat sports, it is
likely that the glycogen reserves after
the competition or workout will be
reduced. A postexercise carbohydrate
feeding with a high glycemic index
will result in a greater muscle glycogen replenishment in comparison
with a similar amount of carbohydrate
provided with a lower glycemic index
(15). A delay in carbohydrate ingestion after the workout or competition
may reduce glycogen resynthesis by
approximately 50% (41).

The human bodys level of hydration is

constantly challenged by water lost
through respiration, sweating, and
excretion. Replacement of this fluid
mostly depends on drinking behavior,
but it has been known for decades that
a persons desire to drink does not
normally occur until water loss reaches
12% of body mass (1). As a result,
athletes commonly train and compete
in an unrecognized state of mild to
moderate hypohydration (5). Even this
mild degree of dehydration will impair
both exercise (22,51) and cognitive
performance (26,69), while increasing
the physiological strain (i.e., heart rate
and core body temperature) (46) associated with a given intensity of exercise.
Hypohydration also impairs and delays
the thermoregulatory benefits that characterize heat acclimatization and physical fitness (19). It is not uncommon for
combat athletes to withhold fluid as
part of a strategy to further reduce body
weight for competition in lower weight
classes. This practice imposes greater
levels of dehydration and thermal strain
that may lead to the least desirable of
outcomes, more dramatic performance
Both the American College of Sports
Medicine (3) and the National Athletic
Trainers Association (NATA) (18)

have prepared position statements that

identify the negative effects of dehydration on health and performance.
These documents also provide important guidelines regarding the rate at
which fluids should be consumed and
methods to evaluate hydration state. A
measurement of urine specific gravity
(sometimes called urine density) is
most commonly used to evaluate the
bodys water balance or hydration
state. It is easily obtained and is
a measure of the number of chemical
particles in the urine. The National
Collegiate Athletic Association (49)
and the National Federation of High
School Associations (50) use measurements of urine specific gravity greater
than 1.0201.025 to indicate dehydration. In this regard, for example,
wrestlers are not allowed to have their
minimal weight determined for competition unless an appropriate urine
specific gravity is verified. This guideline is required to deter the potential
health risks associated with acute
dehydrationrelated weight loss and
to promote competitive equity among
athletes (52). Similarly, the NATA
supports that a urine specific gravity
greater than 0.020, a body mass loss
greater than 3%, and a urine color
greater than 4 indicate dehydration
(18). Obviously, the assessment of an
athletes state of hydration can have
several implications. However, given
the absence of a sufficient number of
studies on human hydration indices,
the recommendations of some sports
medicine and sport governing groups
may not be fully supported at this time
by normative values from adequate
samples of athletes or by research
describing the day-to-day variability
in these measures (10). That is not to
say that these guidelines have not been
extremely helpful in promoting athlete
and sporting safety.

Before designing hydration strategies

for training and competition, the following environmental and host factors
(9), as summarized below, should be
considered as possibly influencing the

fluid intake of a combat sport athlete

before, during, and after exercise.
1. Environmental stressors, such as
temperature and humidity, cause
physiological changes that tend to
increase or decrease fluid consumption (13,32).
2. Individual differences in learned
behaviors may influence fluid
replacement, such that people can
be instructed to drink in the
absence of thirst (39) or may learn
through experience that physical
and mental performance are enhanced by drinking (8).
3. Societal customs and mores may
influence fluid consumption, as evidenced by the differences in beer
American and British citizens (13,32).
4. Fluid palpability affects consumption (62) and consists of beverage
characteristics, such as saltiness, temperature, sweetness, flavor, color,
viscosity, and carbonation (29,31,62).
5. Personal opinions regarding the effect
of a fluid on ones health, body
weight (13), cost (32), or exercise
performance (7) affect beverage
choice and the amount consumed.
6. Thirst increases during eating. Generally, between 69 and 78% of fluid
replacement during normal daily
activities occurs at meals (28).
7. Fluid restriction for 24 hours increases subjective ratings of thirst,
mouth dryness, and the unpleasantness of the taste in the mouth (53),
suggesting that specific sensations
are associated with dehydration and
may enhance fluid replacement.
8. Gastrointestinal distension inhibits
fluid consumption, before tissue
repletion of lost fluid occurs (13).
Reduced sensations of mouth dryness have a similar effect (57).
9. Humans tend to drink less when
they are preoccupied or are performing physical or mental tasks (1).
Therefore, frequent rest periods in
the midst of training or competition
will likely increase fluid intake.
Similarly, if a fluid is readily available, it is more likely to be consumed (1).

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Nutrition and Hydration Strategies in Combat Sports

10. People consume a greater quantity

of fluid when they are calm than
when they are excited (32).

Proper pre-exercise hydration is necessary for safe and effective training

and competition. The following strategies should be considered for optimal
hydration before exercise.
 Before exercise, the athlete should be
well hydrated, with replenished
muscle glycogen stores.
 Chronic dehydration may occur in
athletes who perform repeated bouts
of intense training or competition on
the same day or on consecutive days
(12). Remember that athletes
will often need assistance in recognizing this problem, and a prescribed,
mandatory pre-exercise hydration
regime may be useful.
 If possible, athletes should eat regular
meals and a nutritionally balanced
diet during the 24 hours before
exercise because a large portion of
rehydration occurs during meals. In
most cases, water is an appropriate
pre-exercise beverage because sufficient carbohydrate and electrolytes
are provided in a normal U.S. diet.
 Electrolytes will help the athlete
regain and retain fluid-electrolyte
balance after exercise-induced dehydration via sweating.
 The athlete should drink 500600 mL
of fluid 23 hours before exercise,
providing ample time to urinate excess
fluid. Then, 1020 minutes before
exercise, an additional 200300 mL
of fluids should be consumed (18).
 Changes in body weight, urine
color (5,6), and urine specific gravity
are each valid indicators of hydration status, and athletes, coaches,
and trainers should routinely use
these methods to assess pre-exercise
hydration status.

Proper hydration during exercise reduces cardiovascular strain, optimizes

heat dissipation, and helps to maintain
plasma volume and cardiac output,
thus the ability to maintain exercise


intensity. Therefore, athletes are

advised to carefully consider the following hydration strategies during
training and competition.
 If possible, fluid should be readily
available, and athletes should consume as much as is comfortable,
stopping regularly to drink. Understandably, this may not be easy to
accomplish in some events that lack
frequent breaks, but this is generally
not the case with combat sports.
 Athletes should attempt to optimize,
not maximize, fluid intake without
overhydrating. Athletes who know
their rate of sweat production can
then match intake during training
and competition with sweat losses.
This can be challenging to measure,
but with practice, athletes can learn
to consume the correct amount of
fluid (23).
 To optimize gastric emptying, 400
600 mL of fluid should be in the
stomach at all times (23). If the fluid
contains carbohydrates, the carbohydrate concentration should be
between 4 and 8%. The rates of
gastric emptying and intestinal
absorption are similar for water
and dilute carbohydrate solutions,
but carbohydrates assist in fluid
replacement and concurrently provide energy replenishment (48).

The period after exercise provides the

opportunity to rest and replenish
nutrients, including fluids that have
been depleted during training or competition. A rehydration strategy after
exercise is critical and should be
addressed independently of hydration
before and during exercise (17). If the
athlete was adequately hydrated at the
start of exercise, reductions in body
weight can be assumed to reflect body
water loss during exercise. Also, the
importance of proper rest after intense
training or competition cannot be
overemphasized. The body recuperates best if provided with adequate rest
and sleep. The following strategies will
help the athlete prepare for upcoming
training sessions or competition.


 Body water can be replenished after

exercise by drinking fluids with or
without carbohydrates and electrolytes. However, water alone
may not be the optimal rehydration
beverage at this time because it
decreases osmolality (a measure of
solute concentration), limits the
drive to drink, and may increase
urine output. Salt (sodium or sodium
chloride) in a rehydration beverage
or food will better conserve fluid
volume and increase the drive to
drink (9). For the athlete who must
rehydrate between training of competitive sessions without meal consumption, choosing a rehydration
beverage with electrolytes is an
important consideration.
 The volume of fluid consumed
during recovery should exceed the
volume of sweat that was lost
during exercise. Otherwise, the
athlete will remain somewhat
dehydrated because of urinary fluid
losses. Consumption of fluid equal
to 150% of weight loss, and using
fluid that contains sodium, will
optimize the bodys retention of
fluid (61).
 Because replacement of expended
glycogen stores is also a postexercise goal, the rehydration solution should contain carbohydrates.
Carbohydrates may also help to
improve the intestinal absorption
of sodium and water (47). However,
the amount of carbohydrate in
a sports drink supplies only a small
portion of the total carbohydrate
content of a 2,000-kcal diet. Therefore, athletes should incorporate the
needed carbohydrate in their eating
 Some athletes use intravenous fluid
infusion for rehydration between
exercise sessions in the absence of
clinical indications to do so. However, scientific studies (20,21) that
have assessed the efficacy of this
practice reported no performance
differences between this practice and
oral rehydration techniques when
the rehydration and rest periods
ranged from 20 to 75 minutes between exercise sessions.


To optimally prepare for exercise or

competition, the athlete should consume a meal with 12 g/kg body
weight of carbohydrate 34 hours
before. In addition, a preworkout supplement consisting of low-glycemic
carbohydrate with essential amino
acids would benefit from maintaining
blood glucose concentrations and
enhance delivery of amino acids to
exercising muscle. Postexercise feedings should occur as soon after the
conclusion of exercise as possible
(perhaps a liquid meal) consisting of
both protein (whey) and carbohydrates. Chocolate milk can serve as
a good postrecovery drink.
The primary postexercise nutritional
strategy for combat sport athletes is to
focus on maximizing muscle glycogen
content and enhance muscle protein
synthesis. Combining carbohydrate and
protein feedings immediately after
exercise may not only enhance glycogen replenishment but also increase
protein synthesis. Greater protein accretion appears to enhance muscle
recovery, quite relevant for a contact
sport athlete. Dietary strategies should
also provide appropriate levels of hydration at the start of, and during,
intense training or competitive sessions
and recovery approaches to replenish
fluid losses and other depleted nutrients.
Jay R. Hoffman
is full professor
and coordinator of
the Sport and Exercise Science program at the
University of Central Florida.

Carl M. Maresh
is Department
Head of Kinesiology and Director of
the Human Performance Laboratory at the
University of

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