Nutritional considerations for vegetarian athletes

Case Report: From disordered eating to an eating disorder-a case study of an orienteering athlete with anorexia nervosa and the shortcomings of the multidisciplinary approach

This case study explores the transition from disordered eating (DE) to an eating disorder (ED) in a 23-year-old female orienteer. Despite her talent as an athlete, her eating habits and training practices led to significant health concerns. After following an ovo-lacto vegetarian diet for 3 years, she exhibited symptoms of DE, including low energy intake (1,200 kcal/day), low body weight (50.1 kg, BMI: 16.9), and amenorrhea. Her condition deteriorated over 2 years, resulting in a diagnosis of anorexia nervosa (AN) by February 2023. During the treatment process, the athlete utilized a multidisciplinary approach that included dietitians, psychologists, and physicians. Despite achieving some initial progress, including a slight increase in body weight and the return of menstruation in July 2022, her health declined after psychological consultations were halted, leading to a further decrease in body fat and persistent low serum iron levels. This case highlights the importance of continuous monitoring, timely intervention, and a coordinated multidisciplinary team in addressing DE and ED in athletes. It also highlights the significance of effective communication among healthcare professionals and the need for comprehensive treatment strategies that include psychological, nutritional, and medical support. This study highlights the significance of early detection, suitable intervention, and the prevention of long-term health complications, such as decreased bone density and cardiovascular issues, in athletes with DE and ED.

Protein and Leucine Requirements for Maximal Muscular Development and Athletic Performance Are Achieved with Completely Plant-Based Diets Modeled to Meet Energy Needs in Adult Male Rugby Players

Rugby athletes consume large amounts of animal protein in accordance with conventional dietary guidance to increase muscle mass and strength. This misaligns with national dietary guidelines, which suggest limiting meat consumption for chronic disease prevention. The ability of completely plant-based diets to satisfy the nutritional needs of rugby players has not been explored. This study scaled nutrient data from a large population consuming completely plant-based diets with limited supplemental protein to meet the calorie requirements of adult male rugby athletes to assess whether protein and leucine recommendations for muscular development and athletic performance would be achieved. Calorie requirements were estimated from research that employed the doubly labeled water method, and dietary data from the Adventist Health Study-2 were scaled to this level. The modeled protein level was 1.68 g/kg/day, which meets recommendations for maximal gains in muscle mass, strength, and athletic performance. The modeled leucine level was 2.9 g/meal for four daily meals, which exceeds the threshold proposed to maximally stimulate muscle protein synthesis in young men. These results indicate that consuming large portions of completely plant-based meals can satisfy protein and leucine requirements for maximal muscular development and athletic performance in adult male rugby athletes while aligning with public health recommendations.

Protein Requirements for Maximal Muscle Mass and Athletic Performance Are Achieved with Completely Plant-Based Diets Scaled to Meet Energy Needs: A Modeling Study in Professional American Football Players

American football players consume large quantities of animal-sourced protein in adherence with traditional recommendations to maximize muscle development and athletic performance. This contrasts with dietary guidelines, which recommend reducing meat intake and increasing consumption of plant-based foods to promote health and reduce the risk of chronic disease. The capacity of completely plant-based diets to meet the nutritional needs of American football players has not been studied. This modeling study scaled dietary data from a large cohort following completely plant-based diets to meet the energy requirements of professional American football players to determine whether protein, leucine, and micronutrient needs for physical performance and health were met. The Cunningham equation was used to estimate calorie requirements. Nutrient intakes from the Adventist Health Study 2 were then scaled to this calorie level. Protein values ranged from 1.6-2.2 g/kg/day and leucine values ranged from 3.8-4.1 g/meal at each of four daily meals, therefore meeting and exceeding levels theorized to maximize muscle mass, muscle strength, and muscle protein synthesis, respectively. Plant-based diets scaled to meet the energy needs of professional American football players satisfied protein, leucine, and micronutrient requirements for muscle development and athletic performance. These findings suggest that completely plant-based diets could bridge the gap between dietary recommendations for chronic disease prevention and athletic performance in American football players.

Nutritional Strategies for Managing Iron Deficiency in Adolescents: Approaches to a Challenging but Common Problem

Iron deficiency (ID) is a common and challenging problem in adolescence. In order to prevent, recognize, and treat ID in this age range, it is critical to understand the recommended daily intake of iron in relation to an adolescent's activity, dietary habits, and basal iron losses. Adolescents following vegetarian or vegan diets exclusively rely on plant-based, nonheme iron, which has decreased bioavailability compared with heme iron and requires increased total iron intake. Individuals with disordered eating habits, excessive menstrual blood loss, and certain chronic health conditions (including inflammatory bowel disease and heart failure) are at high risk of ID and the development of symptomatic iron deficiency anemia (IDA). Adolescent athletes and those with sleep and movement disorders may also be more sensitive to changes in iron status. Iron deficiency is typically treated with oral iron supplementation. To maximize iron absorption, oral iron should be administered no more than once daily, ideally in the morning, while avoiding foods and drinks that inhibit iron absorption. Oral iron therapy should be provided for ≥3 mo in the setting of ID to reach a ferritin of 20 ng/mL before discontinuation. Intravenous iron is being increasingly used in this population and has demonstrated efficacy and safety in adolescents. It should be considered in those with persistent ID despite a course of oral iron, severe and/or symptomatic IDA, and chronic inflammatory conditions characterized by decreased gastrointestinal iron absorption.

The Relationship between Vegetarian Diet and Sports Performance: A Systematic Review

INTRODUCTION

In recent years, the vegetarian diet has increased in popularity among athletes. The aim of this review is to ascertain the differences in variables related to performance, nutritional intake, and health in athletes according to whether they are omnivores or vegetarians.

METHODOLOGY

A literature search was carried out in different databases: PubMed, Web of Science, Dialnet, and Cochrane. The keywords used were "vegetarian diet", "vegan diet", "exercise", "sport", and "performance". After applying different inclusion criteria, six studies were included in the review.

RESULTS

No significant differences were obtained in variables related to physical performance (adherence exercise, Vo2Máx, muscle power, and sprint test) or health (body composition, psychological well-being, and social relationships), but dietary intake was significantly higher in carbohydrates and lower in proteins in vegetarian athletes (p < 0.05).

CONCLUSIONS

It cannot be affirmed that vegetarian subjects have a higher sports performance, for which more research should be carried out.

Alteration in cerebral blood flow, kynurenines with respect to mood profile in freshly recruited armed forces personnel

The present study is conducted to understand the association of mood profile with the kynurenine pathway (KP) metabolites, and cerebral hemodynamics in freshly recruited central armed forces personnel. Profile of Mood States questionnaire was utilized to assess mood profile, and Total Mood Disturbance (TMD) score was calculated. Transcranial Doppler was used to record blood flow velocity bilaterally of the middle cerebral artery. Chromatographic profile of the kynurenine metabolites was obtained in serum. Further, personnel were stratified according to sociodemographic variables (gender, age and diet) to observe the changes in their KP metabolic status. An activation of the kynurenic acid branch of the KP and the reduction in the mean blood flow velocity, and an increase in Gosling pulsatility index (PI) were observed in females having high TMD score. On gender comparative analysis, kynurenine metabolites of quinolinic acid branch and serotonin were significantly high in males. In males, with increase in age, a significant increase in the quinolinic acid branch of the KP was observed. Furthermore, a significant difference in level metabolites of the KP among the vegetarian and non-vegetarian groups was also observed. In conclusion we observed that increased TMD score was associated with cerebral hypoperfusion and higher vascular resistance along with activation of the KP. Our findings highlighted the importance of multi-facet brain function to showcase the close interaction of various dimensionalities and true picture of the assessee.

Efficacy of Popular Diets Applied by Endurance Athletes on Sports Performance: Beneficial or Detrimental? A Narrative Review

Endurance athletes need a regular and well-detailed nutrition program in order to fill their energy stores before training/racing, to provide nutritional support that will allow them to endure the harsh conditions during training/race, and to provide effective recovery after training/racing. Since exercise-related gastrointestinal symptoms can significantly affect performance, they also need to develop strategies to address these issues. All these factors force endurance athletes to constantly seek a better nutritional strategy. Therefore, several new dietary approaches have gained interest among endurance athletes in recent decades. This review provides a current perspective to five popular diet approaches: (a) vegetarian diets, (b) high-fat diets, (c) intermittent fasting diets, (d) gluten-free diet, and (e) low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diets. We reviewed scientific studies published from 1983 to January 2021 investigating the impact of these popular diets on the endurance performance and health aspects of endurance athletes. We also discuss all the beneficial and harmful aspects of these diets, and offer key suggestions for endurance athletes to consider when following these diets.

Dietary Intake of Essential Elements (Na, K, Mg, Ca, Mn, Zn, Fe, Cu, Mo, Co) from Tofu Consumption

Tofu is one of the most consumed soybean products. Currently, tofu is consumed in vegan and vegetarian diets to avoid meat. However, it is necessary to determine the content of essential elements to assess the dietary intake. Essential elements (Na, K, Mg, Ca, Mn, Zn, Fe, Cu, Mo, Co) were determined in 130 samples of tofu by ICP-OES (inductively coupled plasma optical emission spectroscopy). The highest element content was found in flavoured tofu; the most notable were Na (2519 mg/kg wet weight) and Fe (19.5 mg/kg ww). Consumption of 200 g/day of flavoured tofu by adults would mean a high contribution of Cu (46.9% women, 38.1% men), Fe (55.7% women, 65.0% men) and Na (25.2% adults) to its AI (adequate intakes) sets by the EFSA (European Food Safety Authority). Natural tofu would mean a remarkably Mn contribution (50% adults) to the AI. Tofu could be an important source of essential elements such as Mg, Mn, Na, Cu and Fe.

Benefits of Creatine Supplementation for Vegetarians Compared to Omnivorous Athletes: A Systematic Review

Background: Creatine monohydrate is a nutritional supplement often consumed by athletes in anaerobic sports. Creatine is naturally found in most meat products; therefore, vegetarians have reduced creatine stores and may benefit from supplementation. Objective: to determine the effects of creatine supplementation on vegetarians. Data sources: PubMed and SPORTDiscus. Eligibility criteria: Randomized controlled trials (parallel group, cross-over studies) or prospective studies. Participants: Vegetarians. Intervention: Creatine supplementation. Study appraisal and synthesis: A total of 64 records were identified, and eleven full-text articles (covering nine studies) were included in this systematic review. Results: Creatine supplementation in vegetarians increased total creatine, creatine, and phosphocreatine concentrations in vastus lateralis and gastrocnemius muscle, plasma, and red blood cells, often to levels greater than omnivores. Creatine supplementation had no effect on brain levels of phosphocreatine. Creatine supplementation increased lean tissue mass, type II fiber area, insulin-like growth factor-1, muscular strength, muscular endurance, Wingate mean power output, and brain function (memory and intelligence) in vegetarian participants. Studies were mixed on whether creatine supplementation improved exercise performance in vegetarians to a greater extent compared to omnivores. Limitations: Studies that were reviewed had moderate–high risk of bias. Conclusions: Overall, it appears vegetarian athletes are likely to benefit from creatine supplementation.

Background Diet Influences TMAO Concentrations Associated with Red Meat Intake without Influencing Apparent Hepatic TMAO-Related Activity in a Porcine Model

Red meat has been associated with an increased cardiovascular disease (CVD) risk, possibly through gut microbial-derived trimethylamine-N-oxide (TMAO). However, previous reports are conflicting, and influences from the background diet may modulate the impact of meat consumption. This study investigated the effect of red and white meat intake combined with two different background diets on urinary TMAO concentration and its association with the colon microbiome in addition to apparent hepatic TMAO-related activity. For 4 weeks, 32 pigs were fed chicken or red and processed meat combined with a prudent or western background diet. ¹H NMR-based metabolomics analysis was conducted on urine samples and hepatic Mrna expression of TMAO-related genes determined. Lower urinary TMAO concentrations were observed after intake of red and processed meat when consumed with a prudent compared to a western background diet. In addition, correlation analyses between urinary TMAO concentrations and relative abundance of colon bacterial groups suggested an association between TMAO and specific bacterial taxa. Diet did not affect the hepatic Mrna expression of genes related to TMAO formation. The results suggest that meat-induced TMAO formation is regulated by mechanisms other than alterations at the hepatic gene expression level, possibly involving modulations of the gut microbiota.

Biomarkers of meat and seafood intake: an extensive literature review

Meat, including fish and shellfish, represents a valuable constituent of most balanced diets. Consumption of different types of meat and fish has been associated with both beneficial and adverse health effects. While white meats and fish are generally associated with positive health outcomes, red and especially processed meats have been associated with colorectal cancer and other diseases. The contribution of these foods to the development or prevention of chronic diseases is still not fully elucidated. One of the main problems is the difficulty in properly evaluating meat intake, as the existing self-reporting tools for dietary assessment may be imprecise and therefore affected by systematic and random errors. Dietary biomarkers measured in biological fluids have been proposed as possible objective measurements of the actual intake of specific foods and as a support for classical assessment methods. Good biomarkers for meat intake should reflect total dietary intake of meat, independent of source or processing and should be able to differentiate meat consumption from that of other protein-rich foods; alternatively, meat intake biomarkers should be specific to each of the different meat sources (e.g., red vs. white; fish, bird, or mammal) and/or cooking methods. In this paper, we present a systematic investigation of the scientific literature while providing a comprehensive overview of the possible biomarker(s) for the intake of different types of meat, including fish and shellfish, and processed and heated meats according to published guidelines for biomarker reviews (BFIrev). The most promising biomarkers are further validated for their usefulness for dietary assessment by published validation criteria.

Health Status of Female and Male Vegetarian and Vegan Endurance Runners Compared to Omnivores-Results from the NURMI Study (Step 2)

Health effects of vegetarian and vegan diets are well known. However, data is sparse in terms of their appropriateness for the special nutritional demands of endurance runners. Therefore, the aim of this study was to investigate the health status of vegetarian (VER) and vegan endurance runners (VGR) and compare it to omnivorous endurance runners (OR). A total of 245 female and male recreational runners completed an online survey. Health status was assessed by measuring health-related indicators (body weight, mental health, chronic diseases, and hypersensitivity reactions, medication intake) and health-related behavior (smoking habits, supplement intake, food choice, healthcare utilization). Data analysis was performed by using non-parametric ANOVA and MANOVA. There were 109 OR, 45 VER and 91 VGR. Significant differences (p < 0.05) were determined for the following findings: (i) body weight for VER and VGR was less than for OR, (ii) VGR had highest food choice scores, and (iii) VGR reported the lowest prevalences of allergies. There was no association (p > 0.05) between diet and mental health, medication intake, smoking habits, supplement intake, and healthcare utilization. These findings support the notion that adhering to vegetarian kinds of diet, in particular to a vegan diet, is associated with a good health status and, thus, at least an equal alternative to an omnivorous diet for endurance runners.

Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition

BACKGROUND

Interest in vegetarian diets is growing in Italy and elsewhere, as government agencies and health/nutrition organizations are emphasizing that regular consumption of plant foods may provide health benefits and help prevent certain diseases.

METHODS AND RESULTS

We conducted a Pubmed search, up to September, 2015, for studies on key nutrients (proteins, vitamin B12, iron, zinc, calcium, vitamin D, and n-3 fatty acids) in vegetarian diets. From 295 eligible publications the following emerged: Vegetarians should be encouraged to supplement their diets with a reliable source of vitamin B12 (vitamin-fortified foods or supplements). Since the plant protein digestibility is lower than that of animal proteins it may be appropriate for vegetarians to consume more proteins than recommended for the general population. Vegetarians should also be encouraged to habitually consume good sources of calcium, iron and zinc - particularly vegetables that are low in oxalate and phytate (e.g. Brassicaceae), nuts and seeds, and calcium-rich mineral water. Calcium, iron, and zinc bioavailability can be improved by soaking, germination, and sour-dough leavening that lower the phytate content of pulses and cereals. Vegetarians can ensure good n-3 fatty acid status by habitually consuming good sources of a-linolenic acid (walnuts, flaxseeds, chia seeds, and their oils) and limiting linoleic acid intake (corn and sunflower oils).

CONCLUSIONS

Well-planned vegetarian diets that include a wide variety of plant foods, and a reliable source of vitamin B12, provide adequate nutrient intake. Government agencies and health/nutrition organizations should provide more educational resources to help Italians consume nutritionally adequate vegetarian diets.

"Eat as If You Could Save the Planet and Win!" Sustainability Integration into Nutrition for Exercise and Sport

Today's industrial food production contributes significantly to environmental degradation. Meat production accounts for the largest impact, including greenhouse gas emissions, land and water use. While food production and consumption are important aspects when addressing climate change, this article focuses predominantly on dietary change that promotes both health for planet and people with focus on athletes. Healthy, sustainable eating recommendations begin to appear in various governmental guidelines. However, there remains resistance to the suggested reductions in meat consumption. While food citizens are likely to choose what is good for them and the planet, others may not, unless healthy eating initiatives integrate creative food literacy approaches with experiential learning as a potential vehicle for change. This concept paper is organized in three sections: (1) Environmental impact of food; (2) health and sustainability connections; and (3) application in sports and exercise. For active individuals, this article focuses on the quantity of protein, highlighting meat and dairy, and quality of food, with topics such as organic production and biodiversity. Finally, the timing of when to integrate sustainability principles in sport nutrition is discussed, followed by practical applications for education and inclusion in team, institutional, and event operations.

Vegetarian, Gluten-Free, and Energy Restricted Diets in Female Athletes

Female athletes who follow a diet that fails to meet energy and nutrient needs are at risk for musculoskeletal injuries, menstrual disturbances, and poor sports performance. Common nutritional concerns for the female athlete include low energy availability (EA) (i.e., energy intake from food remaining for metabolic processes after accounting for energy expended during exercise) and inadequate dietary intakes (i.e., not meeting sports nutrition guidelines) of carbohydrates, protein, essential fatty acids (EFAs), B-vitamins, calcium, iron, and vitamin D. Low EA and the associated nutrient deficiencies are more common in athletes who compete in weight-sensitive sports (i.e., aesthetic, gravitational, and weight category sports) because low body fat and mass confer a competitive advantage. Other athletes at risk for energy and nutrient deficits include athletes following a vegetarian or gluten-free diet (GFD). Careful dietary planning can help an athlete meet energy and nutrient needs. This review covers the nutrition issues associated with low EA and special diets (i.e., vegetarian and GFD) and describes strategies to help female athletes meet their energy and nutrient needs.

Prevalence in running events and running performance of endurance runners following a vegetarian or vegan diet compared to non-vegetarian endurance runners: the NURMI Study

Background

Beneficial and detrimental effects of various vegetarian and vegan diets on the health status are well known. Considering the growing background numbers of vegetarians and vegans, the number of vegetarian and vegan runners is likely to rise, too. Therefore, the Nutrition and Running High Mileage (NURMI) Study was designed as a comparative study to investigate the prevalence of omnivores, vegetarians, and vegans in running events and to detect potential differences in running performance comparing these three subgroups.

Methods/design

The NURMI Study will be conducted in three steps following a cross-sectional design. Step 1 will determine epidemiological aspects of endurance runners (any distance) using a short standardized questionnaire. Step 2 will investigate dietary habits and running history from eligible participants (capable of running a half-marathon at least) using an extended standardized questionnaire. Step 3 will collect data after a running event on finishing time and final ranking as well as a post-race rating of perceived exertion, mood status, nutrient and fluid intake during the race.

Discussion

Our study will provide a major contribution to overcome the lack of data on the prevalence and running performance of vegetarian and vegan runners in endurance running events. We estimate the prevalence of vegetarians and vegans participating in a running event to be less compared to the respective proportion of vegetarians and vegans to the general population. Furthermore we will validate the subject’s self-assessment of their respective diet. This comparative study may identify possible effects of dietary behavior on running performance und may detect possible differences between the respective subgroups: omnivorous, vegetarian and vegan runners.

Trial registration Current controlled trials, ISRCTN73074080

The Role of Maternal Dietary Proteins in Development of Metabolic Syndrome in Offspring

The prevalence of metabolic syndrome and obesity has been increasing. Pre-natal environment has been suggested as a factor influencing the risk of metabolic syndrome in adulthood. Both observational and experimental studies showed that maternal diet is a major modifier of the development of regulatory systems in the offspring in utero and post-natally. Both protein content and source in maternal diet influence pre- and early post-natal development. High and low protein dams’ diets have detrimental effect on body weight, blood pressure191 and metabolic and intake regulatory systems in the offspring. Moreover, the role of the source of protein in a nutritionally adequate maternal diet in programming of food intake regulatory system, body weight, glucose metabolism and blood pressure in offspring is studied. However, underlying mechanisms are still elusive. The purpose of this review is to examine the current literature related to the role of proteins in maternal diets in development of characteristics of the metabolic syndrome in offspring.

Hair for brain trade-off, a metabolic bypass for encephalization

Hair loss in humans is perplexing and raises many hypothetical explanations. This paper suggests that hair loss in humans is metabolically related to encephalization; and that hair covered hominids would have been unable to evolve large brains because of a dietary restriction of several amino acids which are essential for hair and brain development. We use simulations to imply that hair loss must have preceded increase in brain size & volume. In this respect we see hair loss as a major force in human evolution. We assume that hair reduction required favorable climatic conditions and must have been quick. Using evolutionary and ecological time scales, we pinpoint hair loss to a period around 2.2-2.4 million years ago. The dating is further supported by a rapid selection at that time of the sialic acid deletion mutation which may have protected growing human brains against calcium ion flux. In summary we view encephalization, in part, as a metabolic trade-off between hair and brain. Other biochemical changes may have intervened in the process too; and the deletion mutation of sialic acid hydroxylation may have been involved as well.

Vegan triple-ironman (raw vegetables/fruits)

Endurance sport requires a healthy and balanced diet. In this case report we present the findings of an ultra-triathlete (three times Ironman, means 11.4 km swim, 540 km bike, 125 km run in 41:18 h as a whole) living on a raw vegan diet and having finished the competitions under these nutritional conditions. To this end, the vegan ultra triathlete and a control group of 10 Ironman triathletes of similar age living on a mixed diet were investigated, using echocardiography and spiroergometry. In addition, blood samples were taken from the vegan athlete both in the sporting season and in the off-season. The vegan athlete showed no signs of dietary deficiencies or impaired health. In comparison with the control group, the vegan athlete showed a higher oxygen intake at the respiratory compensation point. This case demonstrates that even top-class sporting performance, like that of a three-time Ironman, is possible on a vegan diet. Whether a vegan diet offers advantages or disadvantages for the performance of endurance athletes remains an open question.

Influence of nutrient intake on antioxidant capacity, muscle damage and white blood cell count in female soccer players

Background

Soccer is a form of exercise that induces inflammatory response, as well as an increase in free radicals potentially leading to muscle injury. Balanced nutritional intake provides important antioxidant vitamins, including vitamins A, C and E, which may assist in preventing exercise-related muscle damage. The purpose of the present study was to determine the effect of macro/micronutrient intake on markers of oxidative stress, muscle damage, inflammatory and immune response in female soccer players.

Methods

Twenty-eight female players belonging to two soccer teams of the same professional soccer club participated in this study after being informed about the aims and procedures and after delivering written consent. Each team completed an 8-day dietary record and played one competition match the same week. Participants were divided into two groups: the REC group (who complied with recommended intakes) and the NO-REC group (who were not compliant). Laboratory blood tests were carried out to determine hematological, electrolytic and hormonal variables, as well as to monitor markers of cell damage and oxidative stress. Blood samples were obtained 24 h before, immediately after and 18 h after official soccer matches. Student t-test or Mann–Whitney U-test was used to compare both groups throughout the match.

Results

At rest, we observed that the REC group had higher levels of total antioxidant status (TAS), glutathione peroxidase (GPx), and lower levels of creatine kinase (CK) and lactate dehydrogenase (LDH) in comparison to the NO-REC group. Immediately after the match, levels of TAS, GPx, superoxide dismutase (SOD), LDH and % lymphocytes were higher and the % of neutrophils were lower in the REC group compared to the NO-REC group. These differences were also maintained 18 h post-match, only for TAS and GPx.

Conclusions

Our data reveal an association between nutritional intake and muscle damage, oxidative stress, immunity and inflammation markers. The benefit of the intake of specific nutrients may contribute to preventing the undesirable physiological effects provoked by soccer matches.

Consumption and biochemical impact of commercially available plant-derived nutritional supplements. An observational pilot-study on recreational athletes

BACKGROUND

A growing consumption of natural (plant-derived) dietary supplements with ergogenic aims, with particular regard for ecdysteroids, phytoestrogens and vegetal sterols, has been registered over the last years among "recreational" athletes. The present study was carried out in order to evaluate the real knowledge of plant-derived nutritional supplements among physically active people as well as their real consumption. Additional aim was to evaluate the effects of these supplements on the health profile of the users.

METHODS

Twenty-three trained subjects who habitually used natural dietary supplements, and 30 matched controls were analyzed for plasma biochemical markers and hormonal profile.

RESULTS

The laboratory tests revealed the absence of any sign of organ toxicity/damage in both athletes and controls. On the contrary, hormone profiles revealed marked alterations in 15 (65%) out of the 23 of investigated athletes. Specifically, 10 males presented increased plasma levels of progesterone, 15 subjects presented abnormal estrogen levels, including 5 (2 F and 3 M) presenting a "dramatic" increased estrogen values and 2 two males with increased estrogen levels, increased testosterone levels and associated suppression of luteinizing hormone and follicle-stimulating hormone.

CONCLUSIONS

The results of the present study highlighted that the habitual consumption of plant-derived nutritional supplements is frequently associated with significant hormonal alterations both in male and female subjects. Although these biochemical alterations were not associated with signs or symptoms of organ toxicity/damage at the moment of the study, it cannot be excluded that, in the mid/long-term, these subjects would suffer of health problems secondary to chronic exposure to heavily altered hormonal levels. Further large scale studies are needed to confirm the results of this pilot study as well as to investigate the biological mechanisms at the base of the observed hormonal alterations.

Could a vegetarian diet reduce exercise-induced oxidative stress? A review of the literature

Oxidative stress is a natural physiological process that describes an imbalance between free radical production and the ability of the antioxidant defence system of the body to neutralize free radicals. Free radicals can be beneficial as they may promote wound healing and contribute to a healthy immune response. However, free radicals can have a detrimental impact when they interfere with the regulation of apoptosis and thus play a role in the promotion of some cancers and conditions such as cardiovascular disease. Antioxidants are molecules that reduce the damage associated with oxidative stress by counteracting free radicals. Regular exercise is a vital component of a healthy lifestyle, although it can increase oxidative stress. As a typical vegetarian diet comprises a wide range of antioxidant-rich foods, it is plausible that the consumption of these foods will result in an enhanced antioxidant system capable of reducing exercise-induced oxidative stress. In addition, a relationship between a vegetarian diet and lower risks of cardiovascular disease and some cancers has been established. This review explores the current available evidence linking exercise, vegetarians, antioxidants, and oxidative stress.

Aspectos gerais da deficiência de ferro no esporte, suas implicações no desempenho e importância do diagnóstico precoce

A ingestão inadequada de ferro pode trazer consequências deletérias ao desempenho atlético. Os aspectos negativos provenientes da deficiência orgânica de ferro estão diretamente relacionados com os níveis de depleção desse mineral, que, em sua última instância, tem como principal agravo o desenvolvimento da anemia ferropriva. O presente artigo esclarece que, além da omissão férrica dietética, existem vários fatores agregados que não estão vinculados apenas à dieta, mas que, no conjunto, podem interferir sobre o balanço negativo do ferro, principalmente em atletas. Dentre os fatores etiológicos associados à prática esportiva, os mais evidentes são as hemorragias gastrintestinais, as hemólises por impacto e por radicais livres e as perdas férricas através da transpiração. Nota-se a suma importância do controle da ingestão de ferro e da manutenção de uma vigilância para a detecção precoce da deficiência desse mineral, evitando alteração na produção normal de hemoglobina e de outros compostos essenciais, o que pode causar redução considerável no desempenho do indivíduo, principalmente aeróbico. Embora seja crucial o papel da suplementação no restabelecimento do indivíduo com deficiência de ferro, a automedicação é contraindicada, devido às consequências negativas associadas às altas doses desse mineral. A abordagem desse tema é de extrema relevância para o meio esportivo, contendo informações sobre a anemia esportiva e o diagnóstico da deficiência de ferro, em uma revisão que visa o esclarecimento dos principais fatores etiológicos envolvidos.

The influence of creatine supplementation on the cognitive functioning of vegetarians and omnivores

Creatine when combined with P forms phosphocreatine that acts as a reserve of high-energy phosphate. Creatine is found mostly in meat, fish and other animal products, and the levels of muscle creatine are known to be lower in vegetarians. Creatine supplementation influences brain functioning as indicated by imaging studies and the measurement of oxygenated Hb. Given the key role played by creatine in the provision of energy, the influence of its supplementation on cognitive functioning was examined, contrasting the effect in omnivores and vegetarians. Young adult females (n 128) were separated into those who were and were not vegetarian. Randomly and under a double-blind procedure, subjects consumed either a placebo or 20 g of creatine supplement for 5 d. Creatine supplementation did not influence measures of verbal fluency and vigilance. However, in vegetarians rather than in those who consume meat, creatine supplementation resulted in better memory. Irrespective of dietary style, the supplementation of creatine decreased the variability in the responses to a choice reaction-time task.

Efeitos da suplementação prolongada de creatina mono-hidratada sobre o desempenho anaeróbio de adultos jovens treinados

O objetivo do presente estudo foi investigar o impacto de oito semanas de suplementação de creatina mono-hidratada (Crm) sobre o desempenho anaeróbio de adultos jovens treinados. Vinte e seis estudantes de educação física, do sexo masculino, saudáveis, foram divididos aleatoriamente em grupo creatina (GCr, n = 13; 22,5 ± 2,7 anos; 74,9 ± 6,8kg, 178,5 ± 4,8cm) e grupo placebo (GPl, n = 13; 22,9 ± 3,2 anos, 71,9 ± 11,3kg, 178,6 ± 4,0cm). Os indivíduos ingeriram em sistema duplo-cego doses de Crm ou placebo-maltodextrina (20 g.d-1 por 5 dias e 3 g.d-1 por 51 dias subsequentes). Ambos os grupos tiveram seus hábitos alimentares e os níveis de aptidão física controlados anteriormente. O teste anaeróbio de Wingate (TW) foi usado para avaliar o desempenho anaeróbio antes e após o período de ingestão de Crm ou placebo. Os índices de desempenho analisados foram: potência pico relativa (PPR), potência média relativa (PMR), trabalho total relativo (TTR) e índice de fadiga (IF). Para tratamento estatístico foi utilizado ANOVA, seguido pelo teste de post hoc Tukey, quando P<0,05. Não foram observadas diferenças significantes nos índices PPR, PMR, TTR e IF após o período de suplementação de Crm (P<0,05). Os resultados do presente estudo sugerem que a suplementação de Crm não parece ser um recurso ergogênico eficiente em esforços físicos de alta intensidade e curta duração que envolve uma única série.

An experimental meat-free diet maintained haematological characteristics in sprint-racing sled dogs

A dog's nutrient requirements can theoretically be met from a properly balanced meat-free diet; however, proof for this is lacking. Exercise places additional demands on the body, and dogs fed a meat-free diet may be at increased risk of developing sports anaemia. We hypothesised that exercising dogs would remain in good health and not develop anaemia when fed a nutritionally balanced meat-free diet. To this end, twelve sprint-racing Siberian huskies were fed either a commercial diet recommended for active dogs (n 6), or a meat-free diet formulated to the same nutrient specifications (n 6). The commercial diet contained 43 % poultry meal, whereas soyabean meal and maize gluten made up 43 % of the meat-free diet, as the main protein ingredients. Dogs were fed these diets as their sole nutrient intake for 16 weeks, including 10 weeks of competitive racing. Blood samples were collected at weeks 0, 3, 8 and 16, and veterinary health checks were conducted at weeks 0, 8 and 16. Haematology results for all dogs, irrespective of diet, were within normal range throughout the study and the consulting veterinarian assessed all dogs to be in excellent physical condition. No dogs in the present study developed anaemia. On the contrary, erythrocyte counts and Hb values increased significantly over time (P < 0.01) in both groups of dogs. The present study is the first to demonstrate that a carefully balanced meat-free diet can maintain normal haematological values in exercising dogs.

Pediatric sports nutrition: an update

PURPOSE OF REVIEW

There is a growing interest in the field of pediatric sports nutrition because of the will to lead the child athlete to high achievements, with minimal impairment of growth and development. In this article, we review some of the new data concerning the possible short-term and long-term effects of nutrition on children's performance, current and future health.

RECENT FINDINGS

Growing children engaged in strenuous exercise have several physiologic and metabolic characteristics that distinguish them from adults and require specific nutritional considerations. There is currently not enough evidence to support either carbohydrate loading or increased protein intake in the diet of the child athlete. Creatine use, although common among youth, is not recommended. Adequate hydration is essential to optimal performance. Consumption of iron-rich foods should be encouraged, as depleted iron stores are common in young athletes. In female athletes, nutritional deficiencies could lead to athletic amenorrhea and bone loss, and the resolution of energy deficits can restore normal bone formation and the return of menses.

SUMMARY

In the highly competitive world of the child athlete, proper nutrition is of essence. Unfortunately, most of the knowledge in this field is based on adult literature. Age-specific research would lead to a better understanding of what constitutes 'a healthy diet' in the context of the growing athlete and may be a first step toward achieving these necessary insights.

Bone density and young athletic women. An update

High-school girls and collegiate women have tremendous opportunities to participate in athletic teams. Young girls are also playing in club and select teams at an early age and often, year-round. There are many benefits for participating in sport and physical activity on both the physical and mental health of girls and women. Decreased risk for heart disease and diabetes mellitus, along with improved self-esteem and body-image, were among the first reported benefits of regular physical activity. In addition, sport participation and physical activity is also associated with bone health. Athletes have a greater bone mineral density compared with non-active and physically active females. The increase in bone mass should reduce the risk of fragility fractures in later life. There appears to be a window of opportunity during the development of peak bone mass in which the bone is especially responsive to weight-bearing physical activity. Impact loading sports such as gymnastics, rugby or volleyball tend to produce a better overall osteogenic response than sports without impact loading such as cycling, rowing and swimming. Relatively little is known about the impact of retiring from athletics on bone density. It appears that former athletes continue to have a higher bone density than non-athletes; however, the rate of bone loss appears to be similar in the femoral neck. The positive impact of sports participation on bone mass can be tempered by nutritional and hormonal status. It is not known whether female athletes need additional calcium compared with the general female population. Due to the increased energy expenditure of exercise and/or the pressure to obtain an optimal training bodyweight, some female athletes may develop low energy availability or an eating disorder and subsequently amenorrhoea and a loss of bone mineral density. The three inter-related clinical disorders are referred to as the 'female athlete triad'. This article presents a review of the relationship between sports training and bone health, specifically bone mineral density, in young athletic women.

An NMR-based metabonomic investigation on effects of milk and meat protein diets given to 8-year-old boys

The objective of the study was to investigate the ability of an NMR-based metabonomic approach, applied to biofluids, to explore and identify overall exogenous and endogenous biochemical effects of a short-time high intake of milk protein or meat protein given to prepubertal children, the aim being to compare relative differences and not an absolute quantification. A total of twenty-four 8-year-old boys were asked to take 53 g protein as milk (n 12) or meat daily (n 12). At baseline and after 7 d, urine and serum samples were collected and high-resolution 1H NMR spectra were acquired on these using a 800 MHz spectrometer. The milk diet reduced the urinary excretion of hippurate, while the meat diet increased the urinary excretion of creatine, histidine and urea. The NMR measurements on serum revealed minor changes in the lipid profile, which most probably should be ascribed to an increase in the content of SCFA in the blood after consumption of the milk diet. The meat diet had no effect on the metabolic profile of serum. The study for the first time demonstrates the capability of proton NMR-based metabonomics to identify the overall biochemical effects of consumption of different animal proteins. The urine metabolite profile is more susceptible to perturbations as a result of short diet interventions than the serum metabolite profile. The milk diet-induced reduction in urinary excretion of hippurate suggests alterations in gut microflora, which may be useful information for further studies elucidating the effects of bioactive components in milk.

Special populations: the female player and the youth player

Females and youth are frequently described as "special" populations in football literature, but together these two populations outnumber male players. What makes females "special" is that they tend to eat less when training and competing than their male counterparts, leading to lower intakes of energy, carbohydrate, and some nutrients. Youth football players are special in regard to energy and nutrient requirements to promote growth and development, as well as to fuel sport. There is limited research on the dietary habits of these two populations, but the available literature suggests that many female and youth players need to increase carbohydrate intake, increase fluid intake, and develop dietary habits to sustain the demands of training and competition.

Dietary supplements for football

Physical training and competition in football markedly increase the need for macro- and micronutrient intake. This requirement can generally be met by dietary management without the need for dietary supplements. In fact, the efficacy of most supplements available on the market is unproven. In addition, players must be cautious of inadequate product labelling and supplement impurities that may cause a positive drug test. Nonetheless, a number of dietary supplements may beneficially affect football performance. A high endurance capacity is a prerequisite for optimal match performance, particularly if extra time is played. In this context, the potential of low-dose caffeine ingestion (2 - 5 mg . kg body mass(-1)) to enhance endurance performance is well established. However, in the case of football, care must be taken not to overdose because visual information processing might be impaired. Scoring and preventing goals as a rule requires production of high power output. Dietary creatine supplementation (loading dose: 15 - 20 g . day(-1), 4 - 5 days; maintenance dose: 2 - 5 g g . day(-1)) has been found to increase muscle power output, especially during intermittent sprint exercises. Furthermore, creatine intake can augment muscle adaptations to resistance training. Team success and performance also depend on player availability, and thus injury prevention and health maintenance. Glucosamine or chondroitin may be useful in the treatment of joint pain and osteoarthritis, but there is no evidence to support the view that the administration of these supplements will be preventative. Ephedra-containing weight-loss cocktails should certainly be avoided due to reported adverse health effects and positive doping outcomes. Finally, the efficacy of antioxidant or vitamin C intake in excess of the normal recommended dietary dose is equivocal. Responses to dietary supplements can vary substantially between individuals, and therefore the ingestion of any supplement must be assessed in training before being used in competition. It is recommended that dietary supplements are only used based on the advice of a qualified sports nutrition professional.

Health effects of vegetarian and vegan diets

Vegetarian diets do not contain meat, poultry or fish; vegan diets further exclude dairy products and eggs. Vegetarian and vegan diets can vary widely, but the empirical evidence largely relates to the nutritional content and health effects of the average diet of well-educated vegetarians living in Western countries, together with some information on vegetarians in non-Western countries. In general, vegetarian diets provide relatively large amounts of cereals, pulses, nuts, fruits and vegetables. In terms of nutrients, vegetarian diets are usually rich in carbohydrates, n-6 fatty acids, dietary fibre, carotenoids, folic acid, vitamin C, vitamin E and Mg, and relatively low in protein, saturated fat, long-chain n-3 fatty acids, retinol, vitamin B(12) and Zn; vegans may have particularly low intakes of vitamin B(12) and low intakes of Ca. Cross-sectional studies of vegetarians and vegans have shown that on average they have a relatively low BMI and a low plasma cholesterol concentration; recent studies have also shown higher plasma homocysteine concentrations than in non-vegetarians. Cohort studies of vegetarians have shown a moderate reduction in mortality from IHD but little difference in other major causes of death or all-cause mortality in comparison with health-conscious non-vegetarians from the same population. Studies of cancer have not shown clear differences in cancer rates between vegetarians and non-vegetarians. More data are needed, particularly on the health of vegans and on the possible impacts on health of low intakes of long-chain n-3 fatty acids and vitamin B(12). Overall, the data suggest that the health of Western vegetarians is good and similar to that of comparable non-vegetarians.

Creatine supplementation affords cytoprotection in oxidatively injured cultured mammalian cells via direct antioxidant activity

A growing body of evidence suggests that creatine (Cr) might exert protective effects in a variety of pathologies where oxidative stress plays a concausal etiologic role; furthermore, it has been recently reported that Cr displays direct antioxidant activity in a cell-free setting. However, at present, no research has been specifically aimed to directly test the antioxidant potential of Cr on oxidatively injured cultured cells. Here, the effects of Cr were studied using cultured human promonocytic (U937) and endothelial (HUVEC) cells, and murine myoblasts (C2C12) exposed to H(2)O(2), tert-butylhydroperoxide (tB-OOH) and, in the case of U937 cells, peroxynitrite. Cr (0.1-10 mM) attenuated the cytotoxic effects caused by the oxidants in all the cell lines; under our conditions, cytoprotection was invariably associated with elevation of the intracellular fraction of Cr but it seemed to be unrelated to the levels of Cr phosphate (CrP); Cr did not affect the activity of catalase (CAT) and glutathione peroxidase (GpX), but it prevented H(2)O(2)- or tB-OOH-induced consumption of the nonprotein sulfhydryl (NPSH) pool in U937 and HUVEC cells; mass spectrometry experiments showed that a 136 MW molecule, which is likely to represent an oxidation by-product of Cr, formed in reaction buffers containing Cr and H(2)O(2) as well as in cellular extracts from H(2)O(2)- or tB-OOH- treated Cr-preloaded U937 cells; finally, Cr cytoprotection appeared to be unrelated to chelation of Fe(2+). In conclusion, it is suggested that Cr exerts a mild, although significant, antioxidant activity in living cells, via a mechanism depending on direct scavenging of reactive oxygen (in particular hydroxyl radical) and nitrogen species.

Dietary Reference Intakes for the micronutrients: considerations for physical activity

The Dietary Reference Intakes (DRIs) are a set of recommendations for healthy persons. For the most part, recommendations are determined experimentally under controlled conditions of light activity. During increased physical activity, it is expected that micronutrient requirements would increase relative to the inactive state. Micronutrients of interest to athletes are those associated with oxygen handling and delivery, such as iron, and vitamin D, a newly emerging function of which is to maintain muscle strength. The DRI report on electrolytes (including water) is the most recent set of recommendations. In addition to recommendations for intakes to meet needs, many micronutrients have an upper level that indicates caution in consuming a large amount. We illustrate the process of setting DRI values for the micronutrients (including electrolytes and water), and provide a summary of instances where physical activity needs were considered when DRI values were derived. Understanding the origin of DRI values for micronutrients will assist in understanding how to use the values in assessment and planning.Key words: iron, vitamin D, electrolytes, physical activity, nutrient reference standards, adverse effects.

Dietary Reference Intakes for the macronutrients and energy: considerations for physical activity

The Dietary Reference Intakes (DRIs) are the North American reference standards for nutrients in the diets of healthy individuals. The macronutrient DRI report includes the standards for energy, fat and fatty acids, carbohydrate and fiber, and protein and amino acids. Equations used to identify the Estimated Energy Requirement (EER) were also developed based on individual characteristics including levels of physical activity. The DRIs for the macronutrients are presented as Recommended Dietary Allowances (RDAs) or Adequate Intakes (AIs), as well as Acceptable Macronutrient Distribution Ranges (AMDRs), and were arrived at by considering both nutrient inadequacies and excesses. In addition, recommendations are made that would reduce the risk of chronic diseases, such as setting intake limits for added sugar; reducing cholesterol, saturated, and trans fatty acids consumption; and increasing levels of physical activity. As healthy individuals include those engaged in various levels of physical activity, the DRIs should apply to the athlete and address their macronutrient and energy needs. This paper summarizes the macronutrient DRI report as applied to the adult, with discussion of the dietary needs of those engaged in various levels of physical activity, including the athlete.Key words: nutrition, requirements, guidelines, performance, human.

Vegetarian Diets

The quality of vegetarian diets to meet nutritional needs and support peak performance among athletes continues to be questioned. Appropriately planned vegetarian diets can provide sufficient energy and an appropriate range of carbohydrate, fat and protein intakes to support performance and health. The acceptable macronutrient distribution ranges for carbohydrate, fat and protein of 45-65%, 20-35% and 10-35%, respectively, are appropriate for vegetarian and non-vegetarian athletes alike, especially those who perform endurance events. Vegetarian athletes can meet their protein needs from predominantly or exclusively plant-based sources when a variety of these foods are consumed daily and energy intake is adequate. Muscle creatine stores are lower in vegetarians than non-vegetarians. Creatine supplementation provides ergogenic responses in both vegetarian and non-vegetarian athletes, with limited data supporting greater ergogenic effects on lean body mass accretion and work performance for vegetarians. The potential adverse effect of a vegetarian diet on iron status is based on the bioavailability of iron from plant foods rather than the amount of total iron present in the diet. Vegetarian and non-vegetarian athletes alike must consume sufficient iron to prevent deficiency, which will adversely affect performance. Other nutrients of concern for vegetarian athletes include zinc, vitamin B12 (cyanocobalamin), vitamin D (cholecalciferol) and calcium. The main sources of these nutrients are animal products; however, they can be found in many food sources suitable for vegetarians, including fortified soy milk and whole grain cereals. Vegetarians have higher antioxidant status for vitamin C (ascorbic acid), vitamin E (tocopherol), and beta-carotene than omnivores, which might help reduce exercise-induced oxidative stress. Research is needed comparing antioxidant defences in vegetarian and non-vegetarian athletes.

Iron and the Athlete

Iron is an important mineral necessary for many biologic pathways. Different levels of deficiency can occur in the athlete, resulting in symptoms that range from none to severe fatigue. Iron deficiency without anemia may adversely affect athletic performance. Causes of iron deficiency include poor intake, menstrual losses, gastrointestinal and genitourinary losses due to exercise-induced ischemia or organ movement, foot strike hemolysis, thermohemolysis, and sweat losses. A higher incidence of deficiency occurs in female athletes compared with males.

Micronutrient requirements of physically active women: what can we learn from iron?

The health benefits of physical activity are well established and there is increasing recognition of the importance of fitness as a key modulator of chronic disease. The impact of physical activity on micronutrient requirements is a topic of tremendous interest to the lay public, but the interest is in sharp contrast to data from well-designed studies. Research in this area is poorly controlled for nutritional status of the participants, standardized exercise protocols, markers and cutoff points for measurement of micronutrient status, and variability in subject characteristics. The micronutrient status of women in the general population is of concern, but it is not clear that physical activity increases the requirement of most micronutrients. When dietary intake is adequate, the results of most studies are either equivocal or show no benefit to performance of supplementation. In the few instances where exercise does appear to increase an individual's requirement, the increase can be obtained within the additional calories required for energy balance. In the absence of consistent data, micronutrient supplementation is often indiscriminate without regard to nutrient status. Because iron is such a key nutrient for physical activity, and the status in women is often compromised, it serves as a useful example of how current research limits the ability to make recommendations regarding the impact of exercise on micronutrients requirements in women. With the recent recognition of the importance of physical activity to the prevention and treatment of chronic diseases through the life span, more attention should be focused on the impact of exercise on micronutrient requirements, especially in the context of weight loss regimens.