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Chapter

Sports Nutrition and Performance

Raúl Arcusa Saura, María Pilar Zafrilla Rentero
and Javier Marhuenda Hernández

Abstract

Nutrition plays an essential role on sports performance. Following an adequate

nutrition pattern determines winning the gold medal or failing in the attempt. That
is why it is commonly referred to as “invisible training.” However, regarding food
and performance, it is not only referred to professional athletes. Nowadays, a large
number of amateur athletes perform daily physical activity both recreationally and
semiprofessionally. That population also seeks to achieve an improvement in their per-
sonal brands, which can be reached following proper nutritional guidelines. In athlete
population, nutrient requirements are incremented compared with non-
athlete population. Therefore, it is essential to carry out a nutritional approach
adapted to the athlete and training sessions. In addition, other advantages of adequate
food intake in sports are related to changes in body composition, reduction of injuries,
and prolongation of professional career length. The objective of this chapter is to
determine the nutritional requirements of athlete population that allow to achieve
their sporting goals. Nutritional strategies will be addressed in terms of macronutri-
ents consumption, hydration, and timing depending on type and intensity of exercise.

Keywords: nutrition, sports performance, intake, nutrients, hydration

1. Introduction

Nutrition is strongly linked to health, especially when sports are concerned, due
to the increase in energy and nutrient demands. It is necessary to know the physiol-
ogy of the exercise in order to know the different metabolic pathways that coexist
during sports practice. In this way, you can predict the changes that occur in the
organism during physical effort, in order to achieve some dietary recommendations.
The nutritional practices of athletes are multifactorial and depend on the habits,
culture, or nutritional knowledge of the athlete. So the work of a sports nutritionist
is to advise the athlete and his environment to make the necessary changes in his
intake and thereby improve sports performance (SP).
Nutrition is determinant in achieving an adequate SP, which is defined by
three variables: training, rest, and feeding. However, the main objective of sports
nutrition must be preserving the health of the athlete, which can be achieved with
an adequate intake adapted to the type of training performed. Optimal nutrition
provides the energy necessary to perform physical exercise while reducing injury
rate, a factor that together makes the SP increase by itself.
Two of the aspects that can limit the SP are the state of hydration and the energy
contribution. Hypohydration states produce alterations in homeostasis, decreased
blood volume, increased heart rate, lower rate of sweating, increased organism

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temperature, and greater perception of effort which translates into SP deterioration.

Likewise, a low energy consumption accentuates fatigue, immunosuppression, and
predisposition for injuries, which can interfere in the development of SP.
Nowadays, an exponential increase in the population that performs physical
activity has been reported. In the USA, the total number of runners endorsed in
marathon events is 541,000 in 2013, which represents 27% more participants than
observed in 2008 in the same trend observed in many countries. For example, in
Spain the number of participants increased from 28,000 (2008) to 57,931 (2013),
which represented an increase of 101%. These increases far from ceasing have con-
tinued growing in the last 5 years. Specifically, marathons of Sevilla and Valencia
have reached 14,500 and 20,000 runners in 2018, which contrast with the previous
participation observed in 2013 (5963 and 9653 participants, respectively).
Unfortunately, sports nutrition is often referenced to sports supplements or
“magical” strange diets. In fact 40–70% of athletes use sports supplements without
even analyzing if their use is really necessary.

2. Body composition

The body composition (BC) of the athletes is related to the SP, as it can be
modified throughout the season. There is no single BC for each group of athletes;
however, it can serve as a guide for athletes and coaches [1].
The season of the athlete will be divided into different phases throughout the
competitive period. Competitive season can be divided in preseason, competitive
period, transition period, and in the worst case injury period. Due to different
intensities, timing, and types of training, the BC is normally different in the
competitive season. Therefore, it is vital to know the BC of the athletes in order to
determine the adequacy of the current season stage [2].
Apart from a higher body mass index (BMI), there are several methods for the
evaluation of BC [2]. Dual-energy X-ray absorptiometry (DEXA) is considered the
gold standard for the assessment of body fat, mainly due to its high reproducibility
and accuracy. However, DEXA has high economic cost, is not portable, and also
emits a small radiation, so its use is not very common [3].
Among the most used methods are bioelectrical impedance analysis (BIA)
and anthropometry. Impedance is defined as the opposition shown by biological
materials to the passage of an electric flow. Tissues with high impedance offer
greater resistance (adipose tissue, bone, air in the lungs) and contain less amount of
water [4]. The greater the amount of water, the better this electrical flow, will pass
through. Therefore, the hydration sate of the individual is the determinant for the
BC measurement by BIA. In addition, in order to standardize previous conditions
and dismiss errors, certain protocols must be followed prior to the measurement of
BC by BIA. That fact makes BIA a rather imprecise method [5].
Anthropometry allows the evaluation of different body dimensions and the
overall composition of the body. It consists of the measurement of skinfolds,
perimeters of the muscles, and bone diameters. This technique must be carried
out by experts qualified by the International Society for the Advancement of
Kinanthropometry (ISAK) [4]. It is the most widely used method in the sports field,
from which the percentages of fat, muscle mass, and bone mass can be obtained by
means of mathematic formulas [5]. The most effective way to monitor an athlete
using this technique is performing a sum of six bodyfolds (triceps, subscapular,
supraspinal, abdominal, thigh, and medial leg) that gives an absolute value [6].
In summary mode, the values for said summation of folds are estimated in physi-
cally active people (75 mm men and 100 mm in women), footballers (<50 mm men

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Population Men (∑six skinfolds) Women (∑six skinfolds)

Physically active people 75 10

Footballers <50 <65

Runners <35 50

Minimum value 25 42

Table 1.
Summary of summation folds of the athletes.

and <65 mm women), and endurance athletes (<35 mm men and 50 mm women).
The minimum values seen in the healthy sports population were 25 mm for men and
42 mm for women (Table 1).
However, it must be taken into account that BC is not the only thing that will
measure sports performance, but it is one more parameter of the measurements
that must be made in the athlete.

3. Metabolic pathways and exercise

Prior to establishing requirements regarding quantity and timing of mac-

ronutrients, a brief approach about different metabolic pathways that provides
energy during exercise is necessary. The energy systems are integrated by a set
of metabolic pathways that come into operation during exercise, depending on
the intensity and duration. In summary, they can be divided into non-oxidative
pathways (phosphogenic and glycolytic pathways) and aerobic pathways (nutri-
ent oxidation) [1].
Both pathways aim to generate ATP that will be consumed during the exercise.
The non-oxidative pathways occur in the cellular cytosol, do not require oxygen,
and are activated during short-time periods (seconds). Phosphagen route uses ATP
and phosphocreatine, lasting between 1 and 10 s, and is a route that does not need
oxygen and does not generate lactate. Glycolytic pathways metabolize glucose,
muscle, and liver glycogen through glycolysis and occur in high-intensity exercises
up to 3 min. These glycolytic pathways generate lactate and hydrogen bonds, gener-
ating an acidity in the muscle cell—this acidity being one of its limitations [7].
The aerobic pathway occurs inside the mitochondria, so it requires the presence
of oxygen to metabolize fuels. It is typical of resistance exercises with medium-low
intensity and long duration. It includes the oxidation of CHOs, fats, and to a lesser
extent proteins. This route generates much more ATP than the anaerobic path but
more slowly, speed being the limitation of this path [7].

4. Energy needs

The key to success for any athlete will be to adapt energy intake to energy
expenditure, which allows the correct functioning of the organism while improving
BC [1]. However, it can be complicated due to multiple changes in periodization of
training and competitions.
The energy demands of athletes differ widely depending on the type of sport,
duration, intensity, competitive level, and individual variability of each athlete. The
more demanding the competitive levels of the athlete are, the greatest increase in
the intensity of both training and competition occurs, which will result in a signifi-
cant reduction energy reserves that must be replaced by an adequate diet [8].

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Nutrition in Health and Disease

The objectives of the athletes’ diet are the following: provide the necessary
energy for exercise, regulate body metabolism, and provide nutrients to maintain
and repair tissues [9]. Due to variation among athletes, different available food
options, and individual food patterns, there is no single feeding pattern for athletes,
so there are a large number of strategies and options to assess [2].
Caloric intakes below the basal metabolic rate (BMR) are not recommended
because it can compromise organism functions. Depending on the type of train-
ing energy requirement, the following recommendations for athletes can be
approached: moderate training 1.7 × BMR, intense training 2.1 × BMR, extreme
training 3 × BMR, and with the maximum recommended limit being 4 × BMR.
Athletes should bear in mind that it is not enough to pay attention to food
only on the day of competition, but daily. Appropriate nutritional guidelines will
optimize SP, improve recovery, and reduce the risk of injury and illness [2]. For
example, in women daily intake below 30 kcal/kg body mass/day can induce dam-
age to metabolic and hormonal functions that affect SP, growth, and health [10].
A varied diet is recommended, covering energetic requirements, and is based
on foods as fruits, vegetables, legumes, cereals, dairy products, eggs, fish, and lean
meat, in order to provide vitamins and minerals. A poor choice of foods cannot be
compensated by the use of supplements [2].

5. Macronutrients

In order to establish recommendations for macronutrients, it is preferable taking

into account the body weight (BW) of the athlete, instead of giving the typical
percentages based on the total caloric intake of the diet [2]. For this purpose the
recommendations will be provided by grams of nutrient/kg of BW.
Main energy substrates used for physical exercise are carbohydrates (CHO)
and lipids, while proteins as energy substrate are reserved for extreme condi-
tions. The use of energy substrate varies depending on the intensity and duration
of the exercise, level of training of the athlete, and the state of pre-workout CHO
stores. The use of CHO as energy substrate is produced mainly during high-
intensity and short-duration exercises. Meanwhile, less intense and long-term
exercises use fats’ main energy substrate [11]. However the use of CHO will also
have a great impact on exercises of less intensity and longer duration such as
resistance test, showing that depletion of CHO together with dehydration is a
major limitation of the SP [12].
One of the big differences between CHO and lipids is their storage in the body.
While CHOs have a limited reserve which leads to around 1600–2000 kcal, fats
suppose a practically unlimited energy reserve close to 70,000 kcal (depending on
fat mass) [7, 11].

5.1 Carbohydrate

Currently, there are a large number of myths related to nutrition, which causes
great confusion in general population. One of the most widespread errors is the
demonization suffered by the CHO, which has generated some carbophobia in soci-
ety, including the athlete population [13]. This is a mistake, due to the importance of
CHO as energy substrate for the brain and central nervous system. Moreover, they
can also be used at different intensities both by anaerobic and aerobic pathways [1].
CHO are an energy fuel that provides 4 kcal/g of dry weight. They are stores
in liver and muscle in the form of glycogen. Although, these deposits are limited
to around 400-500 g, providing 1600- 2000 kcal, they can be depleted if the diet

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does not contain enough CHO. Glycogen stores in the organism are divided into
350–400 g in the muscle, 75–100 g in the liver, and around 5 g in the plasma [14].
In addition to size differences, the liver is really a store of glycogen, responsible for
maintaining blood glucose. Meanwhile, the muscle can be considered a “false” store
since it only uses glucose for its own needs. In other words, the liver can contribute
to the replacement of muscle glycogen in the event of depletion, something that
does not happen in reverse, which can lead to hypoglycemia and considerably affect
SP due to fatigue [15].
It is vitally important to maintain high levels of glycogen so as not to compro-
mise the physical demands of physical activity, since low availability can be associ-
ated with loss of abilities and impaired decision-making and increases risk of injury
and decreases SP. Therefore, it is essential to provide CHO before exercise, as well as
during, in order to improve the SP and delay the onset of fatigue [14, 16].
A good strategy in order to optimize increased glycogen reserves for a competi-
tion is the “CHO overload” in the hours or even days before. In athletes with good
training status, it is not necessary to deplete these deposits previously, as was
believed decades ago. In fact an intake or around 10 g CHO/kg/day during the previ-
ous 36–48 h would be enough [17]. Athletes are advised to test how many CHOs are
able to inatek without gastric problems. On the other hand, it is also advisable not to
try new things on competition days [14].
In general, the CHO recommendations based on the intensity and duration of
physical activity can be summarized as follows [1, 18]:

• 3–5 g/kg/d of low-intensity training such as recovery days or tactical skills

• 5–7 g/kg/d for moderate intensity training of 1 h duration

• 6–10 g/kg/d for moderate–high intensity exercises between 1 and 3 h

• 8–12 g/kg/d for workouts of more than 4–5 h of moderate-high intensity

During competition as well as during high-intensity training, a high intake of

CHO between 3 and 4 h before the beginning of the exercise is convenient, in order
to complete glycogen levels [14]. In case of CHO overload, the recommendation
ranges from 200 g CHO to 300 g CHO of moderate glycemic index. The intake
should be light, easily digestible, and low in fat, protein, and fiber, in order not to
decrease glycemia. Also, an intake of 1–4 g/kg of CHO between the previous 1 and
4 h would be recommended. However, some athletes should be careful with the
intake of simple CHOs in the hour before the competition, which can cause a reac-
tive hypoglycemia that affects the SP [18].
The type of exercise, length, and provisioning are determinant factors for the
physical exercise. Depending on all the variables, the nutritional strategies will be
adapted to the athlete as personalized as possible. To summarize, the recommenda-
tions of CHO during the exercise are [19, 20]:

• In an exercise of less than 30 min, CHO intake is not necessary.

• In exercise lasting 45–75 min, it seems that the intake of CHOs is not neces-
sary and it would be enough to perform mouth rinses. However, ingesting this
liquid can promote hydration.

• In exercises lasting 1–2 h, the intake of 30 g/h seems to be sufficient, increasing

CHO intake up to 60 g/h in case of more delayed sports.

5
Nutrition in Health and Disease

• In exercises lasting more than 2.5 h, the intake of CHO should be 90 g/h. High
CHO amounts can cause digestive problems; therefore, a previous intestine
training is determinant to tolerate such CHO intake.

The rate of glucose oxidation is estimated at 60 g/h. Therefore, the CHO com-
position must be formed by a combination of CHOs that use different transporters
and increase the oxidation rate, such as maltodextrin or sucrose, among others [20].
Consuming 90 g CHOs/h can cause gastrointestinal problems in sports such as
continuous running. These gastrointestinal problems may be due to the redistribution
of blood flow to the muscles during exercise. Therefore, strategies for bowel training
have been proposed to increase the rate of gastric emptying as well as reduce possible
discomfort [21]. When it is proposed to reach recommendations, it seems beneficial to
alternate different types of drinks, gels, or bars, so that the taste is not monotonous.
The reposition of CHO is determinant in approaching the following training or
competitive sessions. After the completion of physical activity, it is vitally important
to replenish CHO stores after the training and competition sessions. These replace-
ments of CHO levels can be approached by different methods, depending on the
closeness and intensity of the next sporting event. It will be necessary to rehydrate
and to ensure glycogen recovery as well as muscle tissue. The optimum approach is
a recovery of 150% of BW lost and a CHO intake between 1 and 2 g/kg/h during the
following 6 h after exercise. Moreover, it is advisable to take advantage of the first
2 h afterward where the glycogen resynthesis rate is maximum [14, 22].
The contribution of 1 g/kg BW of CHO after the first hour post-exercise has
anticatabolic effect, increases insulin secretion, and increases muscle protein syn-
thesis. Moreover, the addition of protein may also increase the glycogen resynthesis,
so a less aggressive pattern can be reached by combining a consumption of 0.8 g kg
BW/h of CHO together with protein intake of 0.2–0.4 g/kg BW/h [19].
The appropriate intake of CHO before, during and, after exercise ensures a satis-
factory energy intake to face both training and competitions. Most CHOs are found
in cereals, fruits, legumes, and vegetables and can be found in smaller quantities in
dairy products, unless they could have added sugars. Given the importance of CHO,
it is considered essential that athletes ingest enough CHO complexes during the
course of the day, leaving simple CHOs during and after exercise [2].
However, in some circumstances in which physiological adaptations to training
are the target, different strategies can be handled to those previously mentioned.
For example, training with low availability of glycogen induces mitochondrial
biogenesis (increase in the number of mitochondria) and thereby enhances lipid
oxidation [23]. This strategy can make the athlete more profitable metabolically,
allowing a saving of glycogen reserves during exercise and thereby delaying the
onset of fatigue. Another purpose of this strategy can be to accustom the athlete to
know the feeling of emptiness that can have at the end of a competition and know
in advance how to deal with it [24].
Because a reduction in the availability of CHO will affect the quality of the
training, these strategies should be carried out with extreme caution and under
the supervision of nutritionist and coach. The performance of training under low
availability of CHO will be done during low-intensity sessions due to the perception
of effort is greater, the immune system can be affected, and the athlete is at greater
risk of injury [24].

5.2 Proteins

The proteins are composed of amino acid (AA) chains. There are 20 types
of AA, divide into nonessential AAs (can be synthetized by the organism) and

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essential AAs (must be contributed by the diet) [2]. Within the essential AAs, there
are three types of AAs called branched (leucine, valine, and isoleucine). Among
them, leucine stands out as a stimulator of the mammalian target of rapamycin
(mTOR) pathway, which is related to protein synthesis and hypertrophy [25].
Although proteins can contribute between 5 and 10% to the total energy used
during physical activity, they are not considered as energy source. Proteins consti-
tute the base of muscle tissue and of the immune system and are the major compo-
nent of muscle enzymes and play a large role in SP [14].
Regarding sedentary population, the estimated consumption rate is 0.8 g/
kg BW/day. In the athlete population, these requirements are increased to repair
muscle damage caused by exercise, enhance metabolic adaptations to training,
and avoid possible muscle catabolism [2]. The focus of protein consumption is on
estimating an adequate protein intake for each given moment [1].
The current recommendations for athlete population range between 1.2 and
2.0 g/kg BW/day depending on the type of sports performed [1]. Moreover, higher
amounts may be reached at exceptional times such as injurious period, high-
intensity training, or weight loss plans with caloric restriction. The purpose of this
increase is to maintain maximum muscle mass integrity [26].
Although the most important factor in terms of protein consumption is the
overall consumption throughout the day, it may be advisable to divide the protein
intake into several intakes. For example, four doses of 0.4 g/kg BW ensuring a
total of 1.6 g/kg BW a day [25]. Likewise, it is recommended to ensure a contribu-
tion of 3 g of leucine every meal [27]. The optimal timing seems to adjust the
intake depending on the moment, type of training, as well as availability of the
rest of nutrients and energy. It is important to have an adequate energy and CHO
consumption, so that dietary amino acid are used for protein synthesis and not
oxidized to obtain energy [28].
Protein-rich diets are associated with increased risk of dehydration due to elimi-
nation of nitrogenous waste products, an increased cardiovascular disease risk due
to the association of fat with protein products, or a shift of CHO [2]. However, even
at high doses, no negative effects on renal function have been reported in healthy
subjects.
Regarding timing of protein intake along with exercise, it seems that the most
optimal time is the period after exercise. Better doses ranged between 0.25 and
0.3 g/protein/kg BW (approximately 15–25 g protein) [1]. However, high protein
intake is discouraged close to physical exercise, due to possible digestive problems as
a result of its long time of gastric emptying. However, in very long duration exer-
cise, there is not such limitation.
In order to stimulate muscle protein synthesis, the intake of 30–40 g of casein
is beneficial prior to going to bed, promoting nocturnal recovery due to its slow
digestion [29].
To choose protein sources, it is important that animal proteins may be of greater
interest. In fact, animal proteins are considered as a complete protein due to the
presence of all essential AAs [30].
The main protein sources are lean meat products, fish, eggs, dairy products, and
legumes that provide vegetable protein and reduce animal consumption.
The use of protein supplements does not seem to be necessary because protein
requirements are usually reached with diet in Western population. However,
population that may find it difficult to reach such recommendations should be
monitored. These groups includes: vegetarian athletes, young athletes in the growth
phase, and athletes who restrict their diet due to religious or cultural reason. can be
included [2]. If protein supplementation is chosen, the best option is whey protein
for its high content on AAs and leucine content.

7
Nutrition in Health and Disease

5.3 Lipids

Along with the CHO, lipids are major energy substrates during exercise [27].
The difference is that fats are not as profitable per unit of time as CHO and high fat
consumption is not associated with improvements in SP [31].
Lipid consumption is important for both energy intake and essential nutrients
such as fat-soluble vitamins A, D, E, and K. Both quantity and quality of fats are
determinant in the diet. The quality is often referred by its content on inflammatory
fatty acids [2].
The recommendation regarding fat consumption in athletes is similar to that of the
general population. It is advisable not to make restrictive consumption of fat, as it can
lead to deficit of nutrients such as fat-soluble vitamins and omega-3 fatty acids [1].
Fatty acid requirements, according to the American College of Sports Medicine
(ACSM), are 20–35% of the total kcal of the diet, where 7–10% should correspond
to saturated fatty acids, 10% to polyunsaturated fatty acids, and 10–15% to mono-
unsaturated fatty acids [32].
Adequate intake of omega-3 fatty acids should be ensured due to its anti-
inflammatory effects, improvements in the organism’s coagulation, or increase in
omega-3/omega-6 ratio [33].
In particular, food as avocado or olive oil is recommended, due to their high
content on monounsaturated fatty acids, which have less susceptible to oxidation.
It is recommended to reduce the consumption of fatty meats, substituting them
for lean meats, fish, and legumes. It is also advisable to eliminate the consumption
of processed products such as sausages [2].
An excess of polyunsaturated fatty acids carries a risk of lipid peroxidation, so
a joint intake with vitamin E is recommend. Moreover, the ratio omega-3/omega-6
series should be greater as possible, because of the greater pro-inflammatory
character of omega-6. The recommendations regarding the omega-6/omega-3 range
oscillate between 2 and 4/1 in favor of the omega-6, something that is far from the
inflammatory level that this entails [33]. In order to reduce the omega-6/omega-3
ratio, it is advisable to reduce consumption of meats and increase consumption of
blue fish such as sardines, salmon, tuna, anchovy, and mackerel.

6. Hydration

During exercise, increments of energy requirements are associated to larger pro-

duction of metabolic heat [34]. Human organism dissipates that extra heat mainly
by the mechanism of evaporation, which ultimately induces dehydration [35, 36].
One of the greatest limitations of SP is dehydration. It is estimated that each kg
of BW lost during exercise corresponds to 1 L of sweat [35]. The sensitivity to dehy-
dration is personal, but generally no losses greater than 2% of the BW are recom-
mended in order not to compromise the SP [37]. In fact, 1% of BW lost leads to SP
decrease by 10%. Some authors have raised the possibility of training dehydration,
but there is some controversy about it [38, 39].
The consumption of water is the only method to prevent dehydration and will
be essential before, during, and after exercise. However, a large number of athletes
usually begin the exercise in a state of hypohydration [40]. Therefore, it is necessary
to instruct the athlete to acquire correct hydration habits according to the type of
sports, so that the SP is affected as little as possible [12].
Losses of electrolytes, especially sodium, occur along with water losses. It has
been seen that well-trained athletes “sweat more but swear better,” that is, they

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Figure 1.
How to calculate sweat rate? [43].

sweat more water, but the loss of electrolytes is lower [41]. Recent studies have com-
pared both the rate of sweating and the concentration of sodium in tattooed people
versus non-tattooed people, concluding that the most tattooed skin presented lower
sweating rate and higher sodium concentration [42].
It seems interesting to perform a sweat test to athletes, in order to know their
rate of sweating (liters/hour). To accomplish it, weighing the athlete before and
after the exercise session is enough. This data reveals the amount of sweat that is
lost at the time, so it can serve to adjust the athlete’s water intake (Figure 1). [43].
In general, the rate of sweating is usually greater than that of gastric emptying.
However athletes can be trained to increase gastric emptying during workouts and
thereby reduce dehydration as possible [21]. In conditions of higher temperature
and humidity, this rate of sweating will rise higher. Another simpler way to deter-
mine the state of hydration in athletes is controlling the color of urine (darker colors
are associated with enhanced dehydration states) [2].
Wherein some cases, athletes must acclimatize to different temperatures they
accustomed. It has been reported that among all factors, the most important factor
is the previous state of hydration.
In healthy non-athlete population, the sensation of thirst is an ancestral
mechanism that informs of the need to ingest liquid. However, in children, elderly
people, and athletes, this mechanism is altered and liquid should be ingested
before presenting thirst sensation. In the case of athletes, thirst appears when
there is a deficit of 2% dehydration [27]. However, special care should be taken
to amateur athletes, who increase their water intake above their needs, which
can suffer dilutional hyponatremia “leading to serious problems and even lead to
death” [44].
Regarding the drink to be used for sports, it is advisable to use replacement
drinks instead of water, due to the CHO and sodium content. Both salts and CHO
improve intestinal transport, which facilitates the arrival of fluid in the blood.
Prepositional beverages should present an isotonic composition, with the following
characteristics [12]:

9
Nutrition in Health and Disease

• 80–35 kcal

• At least 75% of the kcal should be high glycemic index CHO

• No more than 90 g CHO/liter

• 460–1150 mg sodium/liter

• Osmolality 200–330 mOsm/kg of water

As commented before, it is advisable to use drink with different CHOs as

glucose, sucrose, and maltodextrinas, in order to facilitate the absorption of liquid
due to the use of different intestinal transporters. Moreover, the fructose content
should not be very high, due to quantities between 20 and 30% can cause intestinal
problems [22].
The hydration guidelines indicated for performing physical exercise are [12, 14]:

• Ingest between 400 and 600 ml of water along the 4 h before the start of the
exercise.

• Just at the beginning of the activity, ingest 200–400 ml of water with CHO (5–8%).

• During the exercise, ingest 100–200 ml of water every 15–20 min.

• After physical activity consume 150% of the BW lost in the 6 h after.

• In low-intensity training and short-duration, the intake of water alone is

sufficient

• The ideal temperature of drinks oscillates between 15 and 21°C

• The taste should be pleasant to the palate of the athlete.

In a situation where the environment is very hot and has high humidity, the
recommendations of intake of liquid and sodium will be higher [22]. A good
strategy can be to make salted snacks in the hours before the exercise or add more
salt content to the meals before and after the exercise. Such increase of sodium has a
double purpose, on the one hand to increase the intake of liquid through thirst and
on the other to favor the retention of that liquid in the organism.
Finally, alcohol consumption is discouraged in both athletes and non-athletes.
However, there seems to be a high consumption of this substance in team sports and
greater consumption in men than women [45]. Among the harmful effects of alco-
hol consumption, the following can be highlighted: reduction of SP due to decrease
in strength, power, speed, and resistance; diuretic effect that affects hydration [46];
diminution of sleep quality, mood, and immune system [47]; elevation of cortisol
concentration; and reduction of muscle synthesis up to 24% even when consumed
right at the end of the exercise [48].

7. Diabetes in sports

First, the effect of exercise between insulin-dependent (type 1) and insulin-

dependent (type 2) diabetes should be differentiated. In type 2, you do the exercise

10
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DOI: [Link]

to improve insulin resistance, while in type 1, you should adjust and modify the
amount of insulin administered, along with the CHO intake.
Physical exercise is one of the most difficult activities to adapt to diabetes, due to
the increase in the frequency of hypoglycemia. People with diabetes who perform
physical activity on a regular basis have less need for insulin, but this does not
ensure adequate glycemic control. The blood glucose value is of multifactorial ori-
gin, and one should take into account the CHO intake and type of sports performed
as well as adjust the dose of insulin used [49].
In order to avoid hypoglycemia, during the exercise the dose of insulin will be
reduced but in no case will be completely eliminated, because the lack of insulin
prevents the entry of a sufficient amount of glucose into the cells for obtaining
energy. A greater use of fats as fuel can generate an accumulation of ketone bodies
and cause ketoacidosis. In the presence of glucose values (>250 mg/dL), ketone
levels should be checked, and if elevated (>0.5 mmol/l), postpone the activity [49].
The type of exercise performed by the athlete should be taken into account,
since aerobic exercise increases the risk of hypoglycemia during and after exercise,
while anaerobes cause hyperglycemia due to counterregulatory hormones (gluca-
gon, cortisol, and catecholamines) [49].
Physical exercise has some ability to introduce glucose into the muscle cell without
the need for insulin action. This effect can occur during the 48 h after exercise, so
there is a certain risk of suffering hypoglycemia in that period depending on the
sports performed. This is due to the fact that during the physical exercise, the reserves
of the muscle and liver glycogen have been emptied. Once the exercise is finished and
after the intake of CHO, the glucose will be destined to replace the glycogen reserves
instead of the blood, which can cause hypoglycemia, so that the high blood glucose
value after a type of anaerobic exercise can be deceptive. Therefore, higher consump-
tion of CHO or decreased insulin dose can prevent such hypoglycemia [49].

8. Supplements

An ergonomic aid is a product that contains a nutrient or a group of nutrients

that improve the SP without taking into account the harmful effects in athletes,
while a supplement is a nutritional aid to complete the diet associated with the prac-
tice of physical exercise [50].
When an athlete seeks to improve in the SP, his ability to tolerate intense work-
outs and hard competitions is crucial to avoid falling into injury or chronic fatigue.
To achieve this purpose, an adequate supply of nutrients is essential. However, many
times this does not happen, and the use of dietary supplements is resorted to [50].
These supplements must be prescribed individually according to the needs of
each person (sex, age, fitness, intensity and duration of the exercise, season, etc.),
in order to maintain both the state of health and the improvement of the SP. Dietary
supplements must offer maximum possible safety and have a degree of scientific
evidence to support their effect [50].
Currently between 40 and 70% of athletes make use of supplements without
previously analyzing if necessary. In addition, a large number of sports supple-
ments have not shown empirical evidence to improve SP. Likewise, there is a certain
legal vacuum with the labeling of these substances, where 80% of these products
do not contain the quantities declared on the label. In addition, 10–15% of these
contain prohibited substances, and this can generate a high risk of committing an
offense involuntarily by the athlete [51].
According to the Australian Institute of Sport, supplements are classified into
four groups, based on effectiveness and safety [52]:

11
Nutrition in Health and Disease

• Group A: based on the evidence. Recommended for athletes.

○ Useful and timely source of energy or nutrients in the diet of athlete

○ Scientifically proven their evidence for the improvement of the SP, when
they are used with a protocol and specific situation

In this group we can find:

• Food for athletes (gels, bars, electrolytes, isotonic drinks, maltodextrins, whey
protein)

• Medical supplements (vitamin D, probiotics, iron/calcium supplements)

• Substances to improve SP (creatine monohydrate, caffeine, beta-alanine, bicar-

bonate, beet juice)

• Group B: more research deserved and advised under research or monitoring

protocol.

○ Some benefit in non-athlete population or have data that suggest possible

benefit of SP.
○ Of particular interest to athletes and coaches.

In this group we can find (quercetin, HMB, glutamine, BCCA, CLA, carnitine).

• Group C: few tests of beneficial effect are not provided to athletes.

○ Not proven improvement RD despite its widespread use.

○ Very little or no benefit, and sometimes they even affect the RD in a negative
way.

In this group supplements of group A and B may be included when used without
an individualized protocol and without a basis in scientific evidence.

• Group D: should not be used by athletes.

○ Are prohibited or have risk of contamination with doping or positive sub-

stance by drug

In this group we can find glycerol, ephedrine, sibutramine, and tribulus

terrestris.
Despite all this information, many athletes believe that supplements are the
basis of the athlete’s diet and believe that without that supplement, they will not
reach their maximum level. This belief is one of the biggest mistakes in the world of
sports nutrition, where the basic diet that is the true pillar on which sports nutrition
is based is neglected.

9. Conclusions

The basis of sports nutrition is a varied diet and individually tailored to the
requirements and appetency of each athlete. The athlete should be instructed about

12
Sports Nutrition and Performance
DOI: [Link]

the importance of diet, called “invisible training,” which is not only important on
competition day. Prior to establishing nutritional guidelines, it is necessary to know
and adapt the BC of the athlete in the different periods of the season and make
revisions through the sum of six skinfolds.
It is necessary to know some physiology to know the different metabolic path-
ways that interact during the exercise. In this way depending on the type of sports
performed, duration and intensity adapt dietary intake at expense. Macronutrient
requirements will be established based on g/kg/BW. With respect to CHOs, recom-
mendations vary between 3 and 12 g/kg/BW to avoid compromising the SP, and
protein consumption can vary between 1.2 and 2.0 g/kg/BW, with the total daily
intake being more important than the number of intakes. Regarding to fatty acids,
quality will prevail, improving the inflammatory profile with an increase in the
consumption of omega-3 compared to omega-6.
It is essential to maintain a state of hydration before, during, and after exercise
to avoid compromising SP, so it is necessary to instruct the athlete with proper
hydration guidelines. It is advisable to train the digestive system during workouts,
both for hydration and testing different CHOs doses. It is important not to try new
patterns on the day of competition.

Acronyms and abbreviations

SP sports performance
BC body composition
BMI body mass index
DEXA dual-energy X-ray absorptiometry
BIA bioelectrical impedance analysis
ISAK International Society for the Advancement of Kinanthropometry
CHOs carbohydrates
BMR basal metabolic rate
BW body weight
AA amino acid
mTOR mammalian target of rapamycin
ACSM American College of Sports Medicine

Author details

Raúl Arcusa Saura, María Pilar Zafrilla Rentero

and Javier Marhuenda Hernández*
Faculty of Health Sciences, Universidad Católica San Antonio de Murcia (UCAM),
Spain

*Address all correspondence to: jmarhuenda@[Link]

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms
of the Creative Commons Attribution License ([Link]
by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

13
Nutrition in Health and Disease

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