Aside from training, nutrition may be
the most important influence on athletic performance.1 However, in seeking a
competitive edge, athletes are often susceptible to fad diets or supplements that have not
been scientifically validated. Nevertheless, there is much useful research to guide the
exerciser toward optimum health and performance.
-
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- Lifestyle changes that may be
helpful
|
- Many athletes use exercise and weight-modifying diets
as tools to change their body composition, assuming that a lower
percent body fat and/or higher lean body mass is desirable in any sport. There is no
single standard for body weight and body composition that applies to all types of athletic
activities. Different sports, even different roles in the same sport (e.g., running vs.
blocking in football), require different body types. These body types are largely
determined by genetics. However, within each athletes genetic predisposition,
variations occur due to diet and exercise that may impact performance. In general, excess
weight is a disadvantage in activities that require quickness and speed. However, brief,
intense bursts of power depend partly on muscle size, so this type of activity may favor
athletes with higher body weights due to increased lean body mass. On the other hand,
participants in endurance sports, which require larger energy reserves, should not attempt
to lower their body fat so much as to compromise long-term performance.2
|
|
-
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- Dietary changes that
may be helpful
|
- Calorie requirements for athletes depend on the
intensity of their training and performance. The athlete who trains to exhaustion on a daily basis needs more fuel than one who performs a milder regimen two or
three times per week. Calorie requirements can be as much as 2339 kcal per pound of
body weight per day for the training athlete who exercises vigorously for many hours per
day.3 4 Many athletes compete in sports having weight categories
(such as wrestling and boxing), sports that favor small body size (such as gymnastics and
horse racing), or sports that may require a specific socially-accepted body shape (such as
figure skating). These athletes may feel pressured to restrict calories to extreme degrees
to gain a competitive edge.5 Excessive calorie restriction can result in
chronic fatigue, sleep disturbances, reduced performance, impaired ability for intensive
training, and increased vulnerability to injury.6
Carbohydrate is the most efficient fuel for energy
production and can also be stored as glycogen in muscle and liver, functioning as a
readily available energy source for prolonged, strenuous exercise. For these reasons,
carbohydrate may be the most important nutrient for sports performance.7
Depending on training intensity and duration, athletes require up to 4.5 grams per day of
carbohydrate per pound of body weight or 6070% of total dietary calories from
carbohydrate, whichever is greater.8 9 Emphasizing grains, starchy
vegetables, fruits, low-fat dairy products, and carbohydrate-replacement beverages and
reducing intake of fatty foods results in a relatively high carbohydrate diet.
Carbohydrate beverages should be consumed during
endurance training or competition (3070 grams of carbohydrate per hour) to help
prevent carbohydrate depletion that might otherwise occur near the end of the exercise
period. At the end of endurance exercise, body carbohydrate stores must be replaced to
prepare for the next session. This replacement can be achieved most rapidly if 4060
grams of carbohydrate are consumed right after exercise, repeating this intake every hour
for at least five hours after the event.10 Standard sport drinks containing
68% carbohydrate can be used during exercise, while high-density carbohydrate
beverages containing 2025% carbohydrate are useful for immediate post-exercise
repletion. Addition of protein or a blend of essential amino acids to these products may
increase their effectiveness for carbohydrate repletion,11 may help athletes
recover from anaerobic (short-term and intense) exercise,12 and, according to
preliminary research,13 14 may facilitate muscle growth during
weight-training.
Carbohydrate-loading, or supercompensation, is a
pre-event strategy that improves performance for some endurance athletes.15 16
Carbohydrate-loading can be achieved by consuming a 70% carbohydrate diet (or 4.5 grams
per pound of body weight) for three to five days before competition, while gradually
reducing training time, and ending with a day of no training while continuing the diet
just before the event date.
Protein requirements are often higher for both strength
and endurance athletes than for people who are not exercising vigorously; however, the
increased food intake needed to supply necessary calories and carbohydrate also supplies
extra protein. As long as the diet contains at least the typical 1215% of calories
as protein, or up to 0.75 grams per day per pound of body weight, protein supplements are
neither necessary nor likely to be of benefit.17 18
Some athletes have speculated that consuming a
high-fat diet for two or more weeks prior to endurance competition might cause the body to
shift its fuel utilization toward more abundant fat stores (fat adaptation).
In general, high-fat diets have not been found to consistently improve performance, and
may even be detrimental;19 20 21 however, one study did
report that a high-fat diet supported endurance training and performance as effectively as
a high carbohydrate diet after two to four weeks of adaptation to the diets.22
Water is the most abundant substance in the human body and
is essential for normal physiological function. Water loss due to sweating during exercise
can result in decreased performance and other problems. The athlete should not wait until
thirst occurs before drinking water but should instead drink before the need is felt.
Fluids should be ingested prior to, during, and after exercise, especially when extreme
conditions of climate, exercise intensity, and exercise duration exist.23
Approximately two glasses of fluid should be consumed two hours before exercise and at
regular intervals during exercise; fluid should be cool, not cold, (5972 degrees F).
Flavored sports drinks containing electrolytes are not necessary for fluid replacement
during brief periods of exercise, but they may be more effective in encouraging the
athlete to drink frequently in larger amounts.24 water
 | Nutritional supplements
that may be helpful |
|
Ask
the Expert about Sport Supplments (click) |

|
- Many athletes do not eat an optimal diet, especially
when they are trying to control their weight while training strenuously.25
These athletes may experience micronutrient deficiencies that, even if marginal, could
affect performance or cause health problems.26 27 28 29
However, athletes who receive recommended daily allowances of vitamins
and minerals from their diet do not appear to benefit from additional multivitamin/mineral
supplements with increased performance.30 31 32 The
importance of individual vitamins and minerals is discussed below.
Electrolyte replacement is not as important
as water intake in most athletic endeavors. It usually takes several hours of exercise in
warm climates before sodium depletion becomes significant, and even longer for potassium,
chloride, and magnesium.33 However, the presence of sodium in
fluids will often make it easier to drink as well as retain more fluid.34
Most research has demonstrated that strenuous
exercise increases production of harmful substances called free radicals,
which can damage muscle tissue and result in inflammation and muscle soreness. Exercising
in cities or smoggy areas also increases exposure to free radicals. Antioxidants,
including vitamin C and
vitamin E, neutralize free radicals before
they can damage the body, so antioxidants may aid in exercise recovery. Regular exercise
increases the efficiency of the antioxidant defense system, potentially reducing the
increased intake otherwise needed for protection.
However, supplements of antioxidant vitamins
may be at least theoretically beneficial in older or untrained individuals or athletes who
are undertaking an especially vigorous training protocol or athletic event, although
research focusing on recovery from exercise is lacking.35 36
Placebo-controlled research, some of it double blind, has shown that taking 4003,000
mg of vitamin C per day may reduce pain and speed up muscle strength recovery after
intense exercise.37 38 Reductions in blood indicators of muscle
damage and free radical activity have also been reported for supplementation with
4001,200 IU per day of vitamin E in most studies,39 40 41
but no measurable benefits in exercise recovery have been reported.42 A
combination of 90 mg per day of coenzyme Q10 and a very small amount of
vitamin
E did not produce any protective effects in one double blind study,43 while
in another double blind study, a combination of 50 mg per day of zinc and 3 mg per day of
copper significantly reduced evidence of post-exercise free radical activity.44
| In most
well-controlled studies, exercise performance has not been shown to benefit from
supplementation of vitamin C, unless a deficiency exists.45 46
Similarly, vitamin E has not benefited exercise performance,47
except possibly at high altitudes.48 49 |
| The
B-complex
vitamins are important for athletes, because they are needed to produce energy from
carbohydrates. Exercisers may have slightly increased requirements for some of the B
vitamins, including vitamin B2, vitamin B6, and
pantothenic acid;50 athletic
performance can suffer if these slightly increased needs are not met.51
However, most athletes obtain enough B vitamins from their diet without supplementation,52
and supplementation studies have found no effect on performance measures for vitamin B2,53
54 niacin,55 or vitamin B6.56 |
| Chromium,
primarily in a form called chromium picolinate, has been studied for its potential role in
altering body composition. Preliminary research in animals57 and humans58
59 suggested that chromium picolinate increases fat loss and lean muscle tissue gain
when used with a weight-training program. However, several recent studies have found
little to no effect of chromium on body composition or strength,60 61
62 though one group of researchers has reported significant reductions in body
fat measured with precise techniques in double blind trials using 200400 mcg per day
of chromium for six to twelve weeks in middle aged adults.63 64 |
| Iron is
important for the athlete because it transports oxygen to and within muscle cells. Some
athletes, especially women, do not get enough of this mineral, and endurance athletes,
such as marathon runners, frequently have low body iron levels for reasons that are
unclear.65 66 67 A severe deficiency of iron can impair
performance, but mild deficiency appears harmless; as a result, supplementing non-anemic
athletes does not usually improve performance.68 Anemia in athletes is often
not due to iron deficiency and may be a normal adaptation to the stress of exercise.69
Therefore, it is unwise to supplement with iron unless a significant deficiency has been
diagnosed. Athletes who experience undue fatigue (an early warning sign of iron
deficiency) should have their iron status evaluated by a nutritionally oriented physician.
|
| Magnesium
deficiency can reduce exercise performance and contribute to muscle cramps, but it is not
clear whether the occasional suboptimal intake found in some athletes is particularly
important.70 One recent study found no effect of supplementation with 500 mg
per day of magnesium on performance or muscle symptoms in athletes with blood levels of
magnesium in the low end of the normal range.71 However, two double blind
studies have reported intriguing results. One suggested that magnesium at 3.6 mg per pound
body weight per day (including both diet and supplements) may benefit strength training,72
and the other trial used 390 mg per day of magnesium in triathletes and demonstrated
reduced swimming, cycling, and running times.73 |
| Very little research
has been done to evaluate the ergogenic effects of other vitamins or minerals.
Supplementation with selenium had no effect on the results of endurance training in one
double blind study.74 Vanadyl sulfate, a form of vanadium
that may have an insulin-like action, was given to weight-training athletes in a double
blind study using 225 mcg per pound of body weight per day, but no effect on body
composition was seen after twelve weeks, and effects on strength were inconsistent.75
|
| Certain
amino acids, the
building blocks for protein, might be ergogenic aids as discussed below. However,
while athletes have an increased need for protein compared with non-exercising adults, the
maximum amount of protein suggested by many researchers0.75 grams per pound of body
weightis already in the diet of most athletes as long as they are not restricting
calories. Supplements of amino acids are therefore not needed to fulfill protein
requirements for either strength or endurance exercise.76 |
| Some research has
shown that supplemental branched-chain amino acids
(BCAA) (typically 1020
grams per day) do not result in meaningful changes in body composition,77 nor
do they improve exercise performance78 79 80 81
or enhance the effects of physical training.82 83 However, BCAA
supplementation may be useful in special situations, such as the prevention of muscle loss
at high altitudes84 and prolonging endurance performance in the heat.85
Studies by one group of researchers suggest that BCAA supplementation may also improve
exercise-induced declines in some aspects of mental functioning.86 87
88 |
| L-carnitine,
which is normally manufactured by the human body, has been popular as a potential
ergogenic aid because of its role in the conversion of fat to energy.89
However, while some studies have found that L-carnitine improves certain measures of
muscle physiology, research on the effects of 24 grams of carnitine per day on
performance have produced inconsistent results.90 L-carnitine
may be effective in certain intense exercise activities leading to exhaustion,91
but recent studies have reported that L-carnitine
supplementation does not
benefit non-exhaustive or even marathon-level endurance exercise,92 93
anaerobic performance,94 or lean body mass in weight-lifters.95 |
| At very high intakes
(approximately 250 mg per 2.2 pounds of body weight) the amino acid arginine has
increased growth hormone levels,96 an effect that has interested body
builders. Large quantities (170 mg per 2.2 pounds of body weight per day) of a related
amino acid, ornithine,
has also raised growth hormone levels in some athletes.97 High amounts of
arginine
98
or ornithine99
do not appear to raise levels of insulin, another anabolic hormone. More reasonable
amounts of a combination of these amino acids have not had measurable effects on any
anabolic hormone levels during exercise.100 101 Nonetheless, double
blind trials combining weight training with either arginine/ornithine (500 mg of each,
twice per day, five times per week) or placebo, found that the amino acid combination
produced decreases in body fat,102 higher total strength and lean body mass,
and reduced evidence of tissue breakdown after only five weeks.103 These
remarkable results need independent confirmation before gaining acceptance among
healthcare professionals who work with athletes. |
| Strenuous physical
activity lowers blood levels of coenzyme Q10 (CoQ10).112 However, the effects
of CoQ10 on how the healthy body responds to exercise have been inconsistent, with several
studies finding no improvement.113 114 A few studies using at least
four weeks of CoQ10 supplementation at 60100 mg per day, have reported improvements
in measures of work capacity ranging from 3% to 29% in sedentary people and from 4% to 32%
in trained athletes.115 However, recent double blind and/or placebo-controlled
trials in trained athletes, using performance measures such as time to exhaustion and
total performance, have found either no significant improvement116 or
significantly poorer results in those taking CoQ10.117 118 |
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- Daily supplements of 30 to 100 mg. daily
have been known to restore health by re-establishing steady and efficient energy
production to heart tissue. CoQ10 is also used for Health, Immunity, Aging, and Athletic
Performance. CoQ10 can possess up to a five times greater antioxidant effect in certain
tissues, specifically heart tissue.
|
|
| The amino acid glutamine
appears to play a role in muscle function and and in the immune system.104
Intense exercise lowers blood levels of glutamine, which can remain indefinitely low with
overtraining.105 Glutamine supplementation raises levels of growth hormone at
an intake of 2 grams per day,106 and intravenous glutamine is better than other
amino acids at helping replenish muscle glycogen after exercise.107 However,
glutamine supplementation (30 mg per 2.2 pounds body weight) has not improved performance
of short-term, high-intensity exercise by trained athletes,108 and no studies
on endurance performance have been done. Although the effects of glutamine supplementation
on immune function after exercise have been inconsistent,109 110 a
double blind study giving athletes glutamine
(2.5 grams after exercise and again two hours
later) reported 81% without subsequent infection compared with 49% in the placebo group.111
|
| One group of researchers has reported
on two small placebo-controlled trials showing that 100 grams of a combination of
dihydroxyacetone and pyruvate enhanced the endurance of certain muscles.119
120 No follow-up research has appeared in the last decade to confirm these
preliminary results. |
| Aspartic acid is a non-essential amino
acid that participates in many biochemical reactions relating to energy and protein.
Preliminary, though conflicting, animal and human research suggested a role for aspartic
acid (in the form of potassium and magnesium aspartate) in reducing fatigue
during exercise.121 However, most studies have found aspartic acid useless in
improving either athletic performance or the bodys response to exercise.122
123 124 125 126 |
| Whey protein is a dairy-based source of amino acids. While
whey is a high quality source of protein, there is no evidence that currently supports its
use for strength-training or body-building. |
| Creatine (creatine monohydrate) is used in
muscle tissue for the production of phosphocreatine, a factor in the formation of ATP, the source of
energy for muscle contraction and many other functions in the body.129 130
Creatine
supplementation increases phosphocreatine levels in muscle, especially when accompanied by
exercise or carbohydrate intake.131 132 It may also increase
exercise-related gains in lean body mass, though it is unclear whether this represents
more muscle or simply water retention.133 Most controlled studies have shown
that 20 grams per day of creatine monohydrate taken for five or six days in sedentary or
moderately active people have improved performance and delayed muscle fatigue during
short-duration, high-intensity exercise such as sprinting and weight lifting.134
135 However, performance does not appear to be improved for trained
athletes supplementing with Creatine
in competitive situations, according to most,136
though not all,137 138 studies. Creatine supplementation does not
appear to increase endurance performance and may impair it by contributing to weight gain.139
Only one controlled study lasting over one month has been done to evaluate the effects of
creatine monohydrate supplementation.140 More long-term research is needed to
evaluate creatines positive effects on athletic performance, particularly in trained
athletes. |
| Gamma
oryzanol is a mixture of sterols and ferulic acid esters. Despite claims that gamma
oryzanol or its components increase testosterone levels, the release of endorphins, and
the growth of lean muscle tissue, research has provided little support and has also
shown gamma-oryzanol to be poorly absorbed.141 A recent nine-week double blind
trial of 500 mg per day of gamma-oryzanol in weightlifters found no benefit compared with
placebo in strength performance gains or circulating anabolic hormones;142
however, a small, double blind study using 30 mg per day of ferulic acid for eight weeks
in trained weightlifters did find significantly more weight gain (though lean body mass
was not measured) and increased strength in one of three measures compared with placebo.143
|
| HMB
(beta hydroxy-beta-methylbutyrate) is a metabolite of leucine, one of the essential
branched-chain amino
acids. As with other amino acid-related substances, HMB appears to play a role in the
synthesis of protein, including the protein that builds new muscle tissue. Animal research
suggests that HMB may improve the growth of lean muscle tissue,151 but only
preliminary and limited research in humans supports the potential link between HMB
and enhanced muscle building in athletes.152 One study of twenty-eight
individuals involved in a weight-lifting program reported that supplements of 3 grams of
HMB, compared with no supplementation, contributed to greater gains of muscle in seven
weeks.153 The use of alkalinizing
agents, such as bicarbonate, citrate, and phosphate, to enhance athletic performance is
designed to neutralize the acids produced during exercise that may interfere with energy
production or muscle contraction.154 Placebo-controlled studies have found that
sodium bicarbonate typically improves exercise performance for events lasting one to seven
minutes when at least 135 mg per pound of body weight is used.155 This amount
is taken either as a single ingestion at least one hour before exercise or divided into
smaller amounts taken over several hours before exercise. Similar results have been
reported for sodium citrate ingestion at 225 mg per pound of body weight in
placebo-controlled studies demonstrating improved performance of exercise of short to
intermediate duration.156 157 158 159 However,
performance during periods less than one minute160 161 162
or greater than seven minutes is not improved by taking alkalinizing agents.163
164 Sodium citrate may be preferable to sodium bicarbonate because it causes
less gastrointestinal upset.165 Another alkalinizing agent, phosphate, has been
investigated primarily as an endurance performance enhancer, with very inconsistent
results.166 167 |
| Inosine is a purine-like substance that appears in
exercising muscle tissue. Its role in various cellular reactions has led to suggestions
that it may have ergogenic effects.168 However, two placebo-controlled studies
demonstrated no beneficial effects on performance and suggested that inosine may impair
some aspects of exercise performance.169 170 Therefore, use of
inosine is discouraged. |
| Caffeine
is present in many popular beverages and appears to have an effect on fat utilization.171
Caffeine does not benefit short-term, high-intensity exercise, according to most,172
173 but not all, studies.174 175 However,
placebo-controlled research, much of it double blind, has shown that endurance performance
does appear to be enhanced by caffeine in many athletes.176 177 178
179 Inconsistency in reported effectiveness of caffeine in some trials can been
explained by differences in caffeine sensitivity among athletes, variable effect of
caffeine on different forms of exercise and under different environmental conditions, and
effects of other dietary components on the response to caffeine.180 181
Effective amounts of caffeine appear to be about 2.5 mg per pound of body weight, which
would require 23 cups brewed coffee or the equivalent taken one hour before
exercise. However, most research has used caffeine supplements in capsules, and a recent
study found caffeine was not effective when taken as coffee.182 Caffeine
consumption is banned by the International Olympic Committee at levels that produce
urinary concentrations of 12 mg/ml or more. These levels would require ingestion of
considerably more than 2.5 mg per pound of body weight, or several cups of coffee over a
short period of time.183 |
| Androstenedione is an androgen hormone. It
is produced in the adrenal glands and gonads from dehyroepiandrosterone (DHEA) or
17 alpha-hydroxyprogesterone and is converted to testosterone by several tissues,
including muscle. One study reported that 100 mg of androstenedione raised testosterone
levels in women to six times the normal range and was significantly more effective in this
than a similar amount of DHEA.184 A German patent claims that oral
androstenedione briefly raises blood levels of testosterone in men,185 but no
published data are available to corroborate this. Despite interest by some athletes, no
studies have investigated the effects of androstenedione on body composition or athletic
performance. |
Are there any side effects
or interactions? Refer to the individual supplement for information about any
side effects or interactions.
-
 |
- Herbs that may be helpful
|
- Extensive but often poorly executed studies have been
conducted on the use of Asian ginseng (Panax ginseng) to improve athletic
performance.186 Some of these studies have reported that Asian ginseng is beneficial187 while others have not.188
One study also found that an extract of the related plant, Asian
ginseng (Panax quinquefolium), was not effective at improving exercise
performance in untrained people after one weeks supplementation.189
Despite a lack of consistent evidence, some doctors of natural medicine recommend taking
extracts containing 5% ginsenosides at a level of 150200 mg three times per day for
at least several weeks.
Siberian ginseng or eleuthero (Eleutherococcus
senticosus) has also been investigated as an herb that may improve athletic
performance. Research from Russia indicates it may be effective for this purpose.190
Other studies have been inconclusive191 or have shown no beneficial effect.192
Although many doctors of natural medicine suggest taking 14 ml (1/41/2 tsp) of
fluid extract of eleuthero three times per day, supportive evidence remains weak.
Some athletes take guaraná
during their training; however, there is no scientific research to support this use.
Guaraná contains caffeine, which is discussed above.
Yohimbe Bark is another herbal that helps
Athletic Perfomance. In Weight Lifting - 90 percent of those who
have try Yohimbe are happy with the results. Incredible gains in lean hard muscle mass
with less body fat have been reported. Yohimbe is very effective in increasing the natural
production of testosterone (male hormone). High levels of testosterone can make the
difference between strong, well-developed muscles and/or a flabby, smooth appearance. Not
only does yohimbe help build muscle and strength, but recent research shows it may elevate
your mood, slow down the aging process and boost your sex drive.
Are there any side effects
or interactions? Refer to the individual herb for information about any side
effects or interactions.
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References:
1. American Dietetic Association: Position of the American Dietetic
Association and the Canadian Dietetic Association: Nutrition for physical fitness and
athletic performance for adults. J Am Diet Assoc 1993;93:69196.
2. McArdle WD, Katch FI, Katch VL. Sports & exercise nutrition. Chapter 12,
Body composition assessment and sport-specific observations. Philadelphia, PA: Lippincott,
Williams & Wilkins, 1999.
3. Wilmore JH, Costill DL. Physiology of sport and exercise. Champaign, IL: Human
Kinetics, 1994, 11014.
4. Grandjean AC. Sports nutrition. In: Mellion MB, Walsh WM, Shelton GL, eds. The
team physicians handbook. Philadelphia, PA: Hanley & Belfus, 1990,7891.
5. Thornton JS. Feast or famine: eating disorders in athletes. Phys Sportsmed
1990;18:11622 [review].
6. Thornton JS. How can you tell when an athlete is too thin? Phys Sportsmed
1990;18:12433 [review].
7. Walberg-Rankin J. Dietary carbohydrate as an ergogenic aid for prolonged and brief
competitions in sport. Int J Sport Nutr 1995;5:S1338 [review].
8. Jacobs KA, Sherman WM. The efficacy of carbohydrate supplementation and chronic high-
carbohydrate diets for improving endurance performance. Int J Sport Nutr 1999;9:92115
[review].
9. Costill DL. Carbohydrates for exercise: dietary demands for optimal performance. Int
J Sports Med 1988;9:118 [review].
10. Walberg-Rankin J. Dietary carbohydrate as an ergogenic aid for prolonged and brief
competitions in sport. Int J Sport Nutr 1995;5:S1328 [review].
11. Ivy JL Glycogen resynthesis after exercise: effect of carbohydrate intake. Int J
Sports Med 1998;19:S14245 [review].
12. Cade JR, Reese RH, Privette RM, et al. Dietary intervention and training in swimmers. Eur
J Appl Physiol 1991;63:21015.
13. Kraemer WJ, Volek JS, Bush JA, et al. Hormonal responses to consecutive days of
heavy-resistance exercise with or without nutritional supplementation. J Appl Physiol 1998;85:154455.
14. Chandler RM, Byrne HK, Patterson JG, et al. Dietary supplements affect the anabolic
hormones after weight-training exercise. J Appl Physiol 1994;76:83945.
15. Hawley JA, Schabort EJ, Noakes TD, et al. Carbohydrate-loading and exercise
performance. An update. Sports Med 1997;24:7381 [review].
16. Costill DL. Carbohydrates for exercise: dietary demands for optimal performance. Int
J Sports Med 1988;9:118 [review].
17. Lemon PW. Effects of exercise on dietary protein requirements. Int J Sport Nutr 1998;8:42647
[review].
18. Lemon PW. Is increased dietary protein necessary or beneficial for individuals with a
physically active lifestyle? Nutr Rev 1996;54:S16975 [review].
19. Hawley JA, Brouns F, Jeukendrup A. Strategies to enhance fat utilisation during
exercise. Sports Med 1998;25:24157 [review].
20. Jeukendrup AE, Saris WH, Wagenmakers AJ. Fat metabolism during exercise: a
reviewpart III: effects of nutritional interventions. Int J Sports Med 1998
Aug;19(6):37179 [review].
21. Whitley HA, Humphreys SM, Campbell IT, et al. Metabolic and performance responses
during endurance exercise after high-fat and high-carbohydrate meals. J Appl Physiol
1998;85:41824.
22. Helge JW, Wulff B, Kiens B. Impact of a fat-rich diet on endurance in man: role of the
dietary period. Med Sci Sports Exerc 1998;30:45661.
23. Pivarnik JM, Palmer JM. Water and electrolyte balance during rest and exercise. In:
Wolinsky I, Hickson JF, eds. Nutrition in exercise and sport, 2nd ed. Boca Raton: CRC
Press, 1994, 24563 [review].
24. Convertino VA, Armstrong LE, Coyle EF, et al. American College of Sports Medicine
position stand. Exercise and fluid replacement. Med Sci Sports Exerc
1996;28(1):ivii [review].
25. Short SH. Surveys of dietary intake and nutrition knowledge of athletes and their
coaches. In: Wolinsky I, Hickson JF, eds. Nutrition in exercise and sport, 2nd ed. Boca
Raton, FL: CRC Press, 1994, 367416.
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