Med Clin (Barc).
2019;153(7):281–283
www.elsevier.es/medicinaclinica
Editorial article
Nutrition and Sport. New conceptual approaches today夽
Nutrición y deporte. Nuevos enfoques conceptuales en la actualidad
Ricard Pruna ∗ , Antonia Lizarraga
Servicios Médicos, FC Barcelona, Barcelona, Spain
Since ancient times, there are references to nutritional strategies
employed by Olympic athletes in order to improve performance,
eating meat and animal protein instead of cereals, fruit and cheese,
so as to improve strength and muscle. This is shown in the engrav-
ings and sculptures of Milo of Croton, famous athlete, 5 times
Olympic wrestling champion, who lived in the VI century BCE and
became famous for being a precursor to progressive training: he
carried the weight of an animal on his shoulders every day and
ended up eating it, making an important contribution of kilocalories
and animal protein to his diet.
Current views on what an athlete’s nutrition should be have
experienced changes from what was thought a few years ago,
based on nutrition guidelines. The concept of energy in the form
of available kilocalories that athletes need for their activity and the
distribution of the different macronutrients in percentage, grams
and equal amounts for every day of the week has given way to a
much more functional, individualized and integrative concept for
the athlete: periodization.
The concept of “eating depending on how you train”, according
to training loads (external load), adapting the intake to the macro-
cycles, microcycles and physiological needs of the athlete, looking
for ways to help each athlete to train at the highest level, providing
what they really need at all times and emphasizing the optimiza-
tion of recovery in a correct and fast way, allowing to compete and
train at peak performance.1 And not only that, with respect to the
improvement of body composition, strategies that a few years ago
began in medium and long-distance sports modalities are now also
applied to team sports. It is not the same to do one training session, a
double session, have the day off or eating during the day of the com-
petition, be in pre-season or in the competitive phase. Therefore,
the nutritional recommendations should not be the same.
You train differently, eat differently and supplement differently,
since all this can induce the ability to adapt to situations of variable
demand.
夽 Please cite this article as: Pruna R, Lizarraga A. Nutrición y deporte. Nuevos
enfoques conceptuales en la actualidad. Med Clin (Barc). 2019;153:281–283.
∗ Corresponding author.
E-mail address: ricard.pruna@fcbarcelona.cat (R. Pruna).
2387-0206/© 2019 Elsevier España, S.L.U. All rights reserved.
New specialties such as nutrigenetics and nutrigenomics or
metabolomics show us to what extent we can modify metabolic
signals with nutrition.2
Adequate energy availability tries to avoid the energy deficit that
leads to fatigue and overtraining. However, other trainable aspects
are increasingly considered by the athlete such as “metabolic
flexibility”3 (ability to effectively alternate carbohydrate or fat as
fuel). The digestive system can also be trained to eat and drink
during the effort so as to delay physical and mental fatigue. The
combination of nutrients chosen more and more qualitatively,
together with the importance of the moment in which they are
taken and the possibility of varying or periodizing what is eaten,
aims to help an optimal and lasting “adaptation”. It includes mul-
tiple signals and metabolic pathways and a range of nutritional
strategies of an anti-inflammatory and recuperative nature that try
to achieve an optimal and rapid return of the athlete to his previous
status.4,5
The fact of periodizing the diet seeks, through training in dif-
ferent conditions, to express different metabolic pathways that
are usable in an effective and alternative way in a “metabolically
flexible” athlete and that allow to optimize the different types of
energy available in those situations that could make a difference,
such as the final minutes of a race or a match, or the ability to
compete at the same level at different times of the season, even
after months of physical and mental wear. An example could be the
“fasted training” strategies or with low reserves of muscle glycogen
to drastically change to the loads of the previous day and the day of
the competition and greatly increase the intake of carbohydrates,
which are what will allow to achieve the best results: training low,
compete high, strategies that can bring benefits depending on the
sport modality.
With nutrition we help the athlete to adapt and to stay adapted
to avoid overtraining and injuries at a time when the load pro-
gressively increases both physically and mentally. The search for
improvement and rapid daily recovery in the face of adversity high-
lights the concept of “resilient athlete”, which goes far beyond the
psychological aspect and includes aspects of physical and mental
recovery such as nutrition, rest, stress control and supplementa-
tion.
With nutrition, we have the perception that today we can inter-
vene in relevant aspects such as inflammation, detected through
cytokines such as IL-6 or TNF-alpha, changes associated with stress
282 R. Pruna, A. Lizarraga / Med Clin (Barc). 2019;153(7):281–283
and immunity, such as cortisol or NK levels or even the athlete’s
intestinal and microbiota health.
In all of them, nutrition can play a very important role, and nutri-
ents such as omega-3, vitamin D, turmeric, cherry concentrate and
probiotics are incorporated into the athlete’s diet and supplemen-
tation more and more frequently.6
On the other hand, nutrition and supplementation for the brain
are becoming increasingly important in order to optimize its func-
tion and the management of brain fatigue, which could be the
cause of a decrease in performance.7 Magnesium, zinc, creatine,
vitamin B complex and melatonin supplements can help. Surpris-
ingly, a certain parallelism between muscle cell and neuron seems
to become increasingly evident, which means that, in matters
of nutrition and supplementation, both can benefit from com-
mon strategies such as the intake of creatine, turmeric or vitamin
B.
We are really in a new era, that of “ergogenic functionality”, in
which ergogenic supplements, with scientific evidence since the
last decade (whey protein, buffers, creatine etc.), merge with func-
tional foods; foods with phytonutrients, which are proving to have a
preventive role in the immune and cognitive system and could even
enhance the ability to recover and alleviate late muscle damage8,9 ;
the polyphenols of aromatic plants and spices such as rosemary,
cloves, in addition to ginger and turmeric. The flavonoids family
include the anthocyanidins of pomegranate and berries: blueber-
ries, blackberries, rose hips, acai, etc., or flavanols of pure cocoa
and green tea. If we want to continue improving their performance,
these foods need to be taken into account in the diets of our ath-
letes, especially in the seasonal peaks, when the highest level is
demanded of them, when there is little time to recover and the
tournaments, semi-finals and finals accumulate; with two or three
games in a week.
On these occasions, just as higher contributions of carbohy-
drates are needed, strengthening and establishing guidelines for
increases in the aforementioned phytonutrients on the day before
the competition, the day of the competition and the day after
the competition could be beneficial for preparation, execution and
recovery optimization. Therefore, it is not surprising that sports
nutrition specialists design recovery formulations with food or con-
centrates in anthocyanidins, or with natural anti-inflammatories
such as turmeric, and that, in collaboration with sports chefs, cre-
ate more specific sports recipes before, during or after the sporting
event.
The nutritional quality, and not only the energetic quantity of
macronutrients, differentiates the diet of an athlete from that of
a good athlete as an essential part of the day-to-day care. We are
seeing the great importance of nutritional synergy and we must see
food in an integral way and its power of action as such, not only
as separate ingredients or as megadoses of a micronutrient. Hence,
the great importance of nutritional variety, with seasonal and min-
imally processed foods, the basic concepts of eating a varied diet,
with colourful plant-origin foods being essential, but considering
what and when to enhance them at all times.
It is very important that the athletes know which foods will be
more appropriate for their day to day, and which on the day of the
competition, when everything must be rehearsed, tested and toler-
ated, without surprises or last-minute experiments that involve the
dreaded digestive and intestinal discomfort.10 There must be a rou-
tine, a “competitive type protocol-diet” that respects each athlete’s
sensations.
Since gastrointestinal problems have an important effect on the
athlete’s performance and health,11,12 we must take into account
the redistribution of blood flow and ischaemia of the lower diges-
tive tract generated by high intensity exercise, which are the
main causes of changes in motility, intestinal barrier function
and absorption, which can be the trigger for increased intestinal
permeability13 and lead to nausea, vomiting, abdominal pain and
diarrhoea.
To avoid these feared symptoms in the athlete, often low
fibre/fat easy-digestion diets are not enough during the day of
the match, besides respecting the postprandial time. There are
even diets that were previously recommended for specific clinical
situations, which are also used today for some athletes, espe-
cially in competitive phases. For example, diets low in fermentable
residues, poor in oligosaccharides, disaccharides and fermentable
monosaccharides and polyols (FODMAP, fermentable oligo-, di-
and monosaccharides and polyols).14 This type of carbohydrates
(fructose, fructans, lactose, sorbitol and xylitol) has been shown
to increase the osmotic load in the small intestine and its high
consumption could worsen gastrointestinal symptoms in some
athletes.15
Perhaps, for this reason, sports nutrition, a key element of the
popular invisible training, together with rest and sleep quality,
is increasingly becoming a “a slightly more visible training” and
essential for athletes: this regenerative rest, nutritionally speak-
ing, amounts to “pampering” the immune and digestive system, an
improvement of the inflammatory and anabolic response, which
makes it possible to enhance cognitive ability, avoid and control
fatigue and even prevent injuries, accelerating the return to sports
activity (return to play).
Of course, training and nutrition can help the athlete to achieve
success, but not with a set pattern for everyone: they must be
individualized. It is increasingly evident that athletes of the same
specialty reach great accomplishments even if they do not follow
the same nutritional strategies.
A sport-dependent specification, periodization and personaliza-
tion are the pillars on which today’s nutritional advice is based,
with the type of dietary orientation (vegetarian, paleo, flexitarian,
vegan, omnivorous, etc.) and sports vision, which allows designing
strategies tailored to the athlete who, within a team, may have spe-
cific and different needs from the rest in order to achieve his best
performance.
But is the athlete born or made? (nature or nurture?), In what
percentage can we modify him? These are difficult questions to
solve; surely, we are still in the conception phase of this great sci-
ence. In addition, it can be a difficult issue to analyze as the athlete
who competes at high level is not usually a participating subject in
clinical trials, rather, these studies are conducted with a different
athlete population profile.
The truth is that this field evolves at high speed and forces us
to modify the recommendations to our athletes, so we have to be
prepared to adapt to new trends and scientific evidence. Of course,
sports nutrition will always have as its main objective to help the
athlete to remain healthy without being injured, to seek maxi-
mum performance and to combat the factors that induce fatigue
and make achieving success difficult, far from the simple and old-
fashion concept of contributing energy in form of kilocalories.
References
1. Jeukendrup AE. Periodized nutrition for athletes. Sports Med. 2017;47 Suppl.
1:S51–63.
2. Burke LM, Hawley JA. Swifter, higher, stronger: what’s on the menu? Science.
2018;362:781–7.
3. Goodpaster BH, Lauren M, Sparks LM. Metabolic flexibility in health and disease.
Cell Metab. 2017;25:1027–36.
4. Burd NA, Beals JW, Martinez IG, Salvador AF, Skinner SK. Food-first approach to
enhance the regulation of post-exercise skeletal muscle protein synthesis and
remodelling. Sports Med. 2019;49 Suppl. 1:59–68.
5. Owens DJ, Twist C, Cobley JN, Howatson G, Close GL. Exercise-induced muscle
damage: what is it, what causes it and what are the nutritional solutions? Eur J
Sport Sci. 2019;19:71–85.
6. Maughan RJ, Burke LM, Dvorak J, Larson-Meyer DE, Peeling P, Phillips SM, et al.
IOC consensus statement: dietary supplements and the high-performance ath-
lete. Br J Sports Med. 2018;52:439–55.
 R. Pruna, A. Lizarraga / Med Clin (Barc). 2019;153(7):281–283
7. Camandola S, Mattson MP. Brain metabolism in health, aging, and neurodegen-
eration. EMBO J. 2017;36:1474–92.
8. Kennedy DO. Phytochemicals for improving aspects of cognitive function and
psychological state potentially relevant to sports performance. Sports Med.
2019;49 Suppl. 1:39–58.
9. Bowtel J, Kelly V. Fruit-derived polyphenol supplementation for athlete recovery
and performance. Sports Med. 2019;49 Suppl. 1:3–23.
10. Jeukendrup AE. Training the gut for athletes. Sports Med. 2017;47 Suppl.
1:s101–10.
11. Moses FM. The effect of exercise on the gastrointestinal tract. Sports Med.
1990;9:72–159.
283
12. Waterman JJ, Kapur R. Upper gastrointestinal issues in athletes. Curr Sports Med
Rep. 2012;11:99–104.
13. Pals KL, Chang RT. Effect of running intensity on intestinal permeability. J Appl
Physiol. 1997;82:6–571.
14. Lis DM. Exit gluten-free and enter FODMAPs: a novel dietary strategy to reduce
gastrointestinal symptoms in athletes. Sports Med. 2018.
15. Pfeiffer B, Stellingwerff T, Hodgson AB, Randell R, Pottgen K, Res P, et al.
Nutritional intake and gastrointestinal problems during competitive endurance
events. Med Sci Sports Exerc. 2012;44:344–51.