International Journal of Sport Nutrition and Exercise Metabolism, 2019, 29, 198-209

https://doi.org/10.1123/ijsnem.2018-0271
© 2019 Human Kinetics, Inc. SCHOLARLY REVIEW

Sports Foods and Dietary Supplements for Optimal Function and

Performance Enhancement in Track-and-Field Athletes
Peter Peeling
The University of Western Australia and Western Australian Institute of Sport

Linda M. Castell University of Oxford Ghent University Louise M. Burke Olivier de Hon
Wim Derave Anti-Doping Authority Netherlands

Australian Institute of Sport and Australian Catholic University

Athletes are exposed to numerous nutritional products, attractively marketed with claims of optimizing health,
function, and performance. However, there is limited evidence to support many of these claims, and the efficacy
and safety of many products is questionable. The variety of nutritional aids considered for use by track-and-field
athletes includes sports foods, performance supplements, and therapeutic nutritional aids. Support for sports
foods and five evidence-based performance supplements (caffeine, creatine, nitrate/beetroot juice, β-alanine, and
bicarbonate) varies according to the event, the specific scenario of use, and the individual athlete’s goals and
responsiveness. Specific challenges include developing protocols to manage repeated use of performance
supplements in multievent or heat-final competitions or the interaction between several products which are used
concurrently. Potential disadvantages of supplement use include expense, false expectancy, and the risk of
ingesting banned substances sometimes present as contaminants. However, a pragmatic approach to the
decision-making process for supplement use is recommended. The authors conclude that it is pertinent for sports
foods and nutritional supplements to be considered only where a strong evidence base supports their use as safe,
legal, and effective and that such supplements are trialed thoroughly by the individual before committing to use in
a competition setting.

Keywords: ergogenic aids, performance nutrition, high performance, athletics

Numerous nutritional products are marketed with supplements in an athlete’s training and competition
claims of optimizing athlete health and function and/or routine, particu larly within elite sport where marginal
enhancing performance. Products that fall under the performance gains are pursued. The following review
banner of “Sports Foods” or “Dietary Supplements,” may presents general considerations for track-and field athletes
be used to support performance during training and using sports foods and dietary supplements to enhance
competition or for enhancing aspects of training adaptation, performance, in addition to exploring the potential
recovery, immune function, and/or overall athlete health. therapeutic/ prophylactic use of these nutritional aids.
Effective marketing campaigns and athlete endorsements
may convince us that certain sports foods and supplements
are fundamental in allowing athletes to reach their sporting Definition of a Dietary Supplement Maughan et
goals. However, this approach is naive in understanding al. (2018a) recently defined a dietary supplement as:
the true foundations of athlete success, such as the
inherent genetic predisposition for athletic characteristics, A food, food component, nutrient, or non-food
the many hours of well-structured/periodized training, compound that is purposefully ingested in addition to
appropriate underlying nutrition, adequate sleep and the habitually consumed diet with the aim of achieving
recovery, and of course, good overall physical and mental a specific health and/or perfor mance benefit.
health. Nevertheless, if these variables are all accounted
for, there may be a role for sports foods and dietary
Prevalence
Peeling is with School of Human Sciences (Exercise and Sport Science), The A recent systematic review and meta-analysis of 159
University of Western Australia, Crawley, Western Australia, Australia; and the unique studies in athlete populations (Knapik et al., 2016)
Western Austra lian Institute of Sport, Mt Claremont, Western Australia, investigated the prevalence of dietary supplement use
Australia. Castell is with Green Templeton College, University of Oxford, (defined using the Federal Drug Administration’s Dietary
Oxford, United Kingdom. Derave is with the Dept. of Movement and Sports
Sciences, Ghent University, Ghent, Belgium. de Hon is with the Anti-Doping
Supplement Health and Education Act of 1994; e.g., sports
Authority Netherlands, Capelle aan den IJssel, The Netherlands. Burke is with foods, iron, vitamins, etc.) by sport, sex, and athlete status
the Australian Institute of Sport, Bruce, Australian Capital Territory, Australia; (i.e., elite vs. nonelite). High variability in supplement use
and the Mary MacKillop Institute for Health Research, Australian Catholic among various sporting groups was reported,
University, Melbourne, Victoria, Australia. Address author correspondence to
Peter Peeling at [email protected].
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198
with the combined group summary prevalence estimate (SPE) particularly in situations before, during, or after/between
ranging from 4 to 62% across various supplement types. When competi tion events and training sessions. However,
differentiated by athlete status, results showed that elite athletealthough some sports foods resemble “everyday food,” they
cohorts (SPE male: ∼69% and SPE female: ∼71%) presented also differ in that they may consist of only a few nutrients
with greater rates of supplement use than their nonelite compared with the many hundreds of nutrients and
counterparts (SPE male: ∼48% and SPE female: ∼42%). phytochemicals found in the former. For that reason, sports
Furthermore, sex differences were apparent, with greater use of foods should not be used as a dietary replacement for
supplemental iron reported by female athletes, whereas males used athletes, but rather as a supplementary strategy on
products such as protein, creatine, and vitamin E more often. occasions where a specific combination of key nutrients is
Although specific supplement use among athlete groups is hard to required.
quantify, these outcomes suggest that service providers (i.e., The ergogenic properties of sports foods, in general,
dietitians, physiol ogists, sports physicians) working with athletecan be ascribed to four main physiological goals, which they
cohorts should be aware of differences in the incidence and type help to support:
of supplement use within a given group of athletes, with caliber a. Hydration: Fluid ingestion for maintaining or restoring
and sex being discriminating characteristics. For further insights hydra tion status.
into the prev alence and rationale for use of supplements and
sports foods, the reader is directed to recent comprehensive review b. Fuelling: Carbohydrate provision before, during, and
of the topic (Garthe & Maughan, 2018). following/ between exercise.
c. Anabolism: Protein ingestion to promote amino acid
delivery for optimal training adaptation and event recovery.
Sports Foods d. Osmolality: Electrolyte ingestion to replenish loss in
sweat. These goals are generally accepted by the broad
The term “Sports Foods” generally refers to specifically sport nutrition scientific community as being determinants of
formulated food products that are commercially developed
sports performance and training response. Of note, the risk
for use by athletes. The various categories of such foods
are outlined in Table 1, with a specific function to target of dehydration and fuel/ electrolyte depletion is
nutritional goals that underpin training adaptation, recovery, predominately an issue during longer athletic events, such
and competition performance (Burke & Cato, 2015). as distance running and race walking; furthermore, there is
Although they often contain nutrients in similar amounts to ample evidence of the benefits of hydration, carbohydrate
those found in whole foods and manufactured products in fueling, and electrolyte replacements during these events
the general food supply (hereafter, called “everyday foods”), (Burke, 2010; Hoffman et al., 2018). Alternatively, athletic
sports foods may offer the practical advantage of combining sprint events require a high level of muscle power, and their
all the nutrients needed for a specific goal in a single training-induced muscle hypertrophy relies on adequate
source. In addition, the use of novel food and packaging protein and amino acids provision around training sessions
technology can make sports foods easy to transport, store (Reidy & Rasmussen, 2016). Each sports foods category
hygienically, prepare, and consume, will contribute to one or more of these physiological goals,
Sports Foods and Supplements for Athletics 199 yet each in a variable degree. The link between the sports
foods categories and their respective goals is summarized
in Table 1.

Table 1 Summary of the Roles and Ingredients in Sports Foods

Active ingredient Water Carbohydrates Protein Electrolytes Product Physiological goal Hydration Fueling Anabolism
Osmolality Isotonic sports drink ✓✓ ✓ ✓ High-energy sports drink ✓ ✓✓ ✓ Electrolyte supplement (drink form) ✓ ✓✓ Sports gel ✓✓
Protein supplement (drink form) ✓ ✓ ✓✓ ✓ Sports bars ✓ ✓✓ Sports confectionary ✓✓
Liquid meal supplements ✓ ✓✓ ✓ ✓ Advantages of sports foods • Sports foods can contain only those ingredients that are actually
needed during exercise. Foods in the general food supply, particularly whole foods, will usually contain other
nutrients, such as fat and fibers, which are not needed during a race, and may cause
gastrointestinal discomfort.
• Sports foods may be manufactured to optimize serving size, convenience, digestibility,
storage, and transport.
Concerns about sports foods • Sports foods are more expensive than “everyday foods” and may drain an unnecessarily large share of
the athlete’s budget. It should be noted that many sports nutrition goals can
easily be met with the use of everyday foods. A typical example is the protein-rich recovery
drinks that can be adequately replaced by the much cheaper dairy products (e.g., skim milk or
yogurt).
• An overreliance on sports foods as energy sources may lead to poor nutrient intake and
limited dietary variety.
✓ Can contribute to this goal. ✓✓ Is an important contributor to this goal.

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200 Peeling et al. manufacturers add performance supple ments or other
ingredients to sports foods. For instance, protein shakes can
contain creatine, sport drinks or sports bars can contain
Of course, manufacturers want to claim additional caffeine, and vitamins can be found in the most unexpected
benefits of their specific products and proprietary blends, places (e.g., in the so-called “sports/fitness waters” that
which usually lack any scientific substantiation, beyond the provide a pleasant tasting drink rather than addressing any
benefits of each compound in isolation. Of note, some unique athlete need). This makes the distinction between
sports foods and sports supplements more diffuse, and it “social” use of caffeine, confirming the need for athletes both to
also greatly complicates the work of sport nutritionists to trial their intended performance uses of caffeine prior to
keep track of the total daily doses of supplements and implementation in competition and to take into account their
micronutrients to which athletes are exposed. To track the personal history of reactions to caffeine intake in “everyday life”
total ingestion of such ingredients and to reduce concerns (e.g., effects on heart rate, jitteriness, or sleep quality).
around product contamination via raw ingredients that may Interestingly, larger caffeine doses (≥9 mg/kg BM) do not appear
be considered at higher risk of this problem, athletes are to increase the performance effect (Bruce et al., 2000), and are
guided to choose brands of sports foods with the simplest more likely to increase the risk of negative side effects such
formulations to meet the specific goals for which they are as nausea, anxiousness, insomnia, and restlessness
designed; in general, they should focus their use of (Burke, 2008). Caffeine habituation seems to have limited
performance supplements to separate protocols, using impact on the performance effects of this stimulant
separate products, which have preferably been third-party (Goldstein et al., 2010); high-habitual daily caffeine users
batch tested or are manufactured by large (reputable) food tend to encounter similar performance benefits as those with
companies. The exception to this might be caffeine, which low and moderate intakes (Gonçalves et al., 2017).
already has a crossover to the food industry, as it is found in Furthermore, studies have shown that athletes need not
the athlete’s diet via their intake of “everyday-consumer” undertake “caffeine withdrawal” over the days prior to
products, such as coffee, tea, iced coffee beverages, and competition use to achieve a performance improvement
“energy drinks.”. (Irwin et al., 2011). Earlier studies that suggested a larger
In summary, sports foods may provide a valuable performance improvement when caffeine supplementation
contribution to an athlete’s nutrition plan, providing nutrients was preceded by a dehabituation period may have been
that support training adaptation (e.g., protein) and promote measuring the reversal of the negative effects of caffeine
performance (e.g., carbohydrate and fluid/electrolytes). withdrawal (i.e., headache, fatigue, demotivation; Irwin et al.,
However, their role should not be overestimated, as many of 2011) on top of the normal performance effect rather than a
those goals can, to a large extent, be also obtained by unique benefit.
carefully selected “everyday” foods. The caffeine supplementation literature shows strong
evidence of improved performance when it is consumed
before events varying in duration from 5 to 150 min (Ganio
Performance Supplements et al., 2009). Furthermore, low–moderate doses of caffeine
Although countless supplements are marketed with the (100–300 mg) con sumed during endurance exercise (after
claims of directly enhancing athletic performance, only a 15–80 min of activity) have also been shown to enhance
handful are sup ported by an evidence base that warrants endurance performance by a range of 3–7% (Paton et al.,
consideration for trial use by athletes (see Figure 1 relevant 2015; Talanian & Spriet, 2016). When considering short-
to the decision-making process). A recent review of this area term, supramaximal tasks, the ingestion of 3–6 mg/kg BM of
categorizes the commonly encountered performance caffeine taken 50–60 min preexercise relates to
supplements in terms of their research support and level of performance gains of >3% for anaerobic activities of 1–2
efficacy (Peeling et al., 2018). In addition, the recent min in duration (Wiles et al., 2006). Therefore, there is
International Olympic Committee consensus statement on support for high performance track-and-field athletes in the
supple ment use by high-performance athletes (Maughan et longer sprints, middle distance, and
al., 2018a) proposes that only five performance endurance/ultraendurance events to consider compe tition
supplements have an adequate level of evidence to suggest use of caffeine. Furthermore, shifting the “social” intake of
marginal performance gains may be possible for elite caffeine to target its effects to training sessions may help to
athletes (a population where such gains are generally improve the quality of some workouts, particularly if
harder to obtain) when added to a bespoke and periodized rehearsing competition practices or undertaking sessions in
training and nutrition plan. These supplements are a fuel-depleted state (Lane et al., 2013).
summarized with the mechanism of action and the potential
application to track and-field athletics presented in Tables 2 Creatine Monohydrate
and 3, respectively.
Creatine monohydrate (CM) supplementation increases
muscle creatine and phosphocreatine stores, sustaining
Caffeine exercise that is otherwise limited by the inability of
Caffeine shows well-established benefits for enhancing athletic phosphocreatine resynthesis to keep pace with exercise fuel
performance across both endurance-based events and short-term, demands, for example, single and repeated bouts of high-
supramaximal tasks. Caffeine dosages of 3–6 mg/kg of body mass intensity exercise (<150 s duration), with the most
(BM), consumed ∼60 min prior to exercise in the form of anhy pronounced effects evident during tasks <30 s (Branch,
drous caffeine (i.e., pill or powder form), are commonly shown to 2003; Lanhers et al., 2017). Indeed, creatine
result in performance gains (Ganio et al., 2009). However, lower supplementation received widespread attention in 1992
caffeine doses (<3 mg/kg BM, ∼200 mg), provided both before when the first report on successful loading protocols (Harris
and during exercise, have also resulted in an ergogenic benefit et al., 1992) was published at the same time as anecdotes
(Spriet, 2014). Of note, recent research has suggested that emerged from the Barcelona Olympic Games regarding its
the ergogenic use by gold-medal winning British track-and-field sprinters.
In addition, chronic training adaptations, such as lean mass
gains and improvements to muscular strength and power,
have also been noted with both direct and indirect
effects of caffeine are influenced by the athlete’s variant of a mechanisms proposed (Table 2). Less commonly,
number of genes, including the CYP1A2 gene involved in performance advantages for endurance athletes have also
the liver metabolism of caffeine (Guest et al., 2018). This been suggested, including such
explains the well-known variability in individual responses to the
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Figure 1 — A pragmatic approach to making decisions about supplement use to optimize function and performance in athletes.
Adapted from “IOC consensus statement: Dietary supplements and the high-performance athlete,” by R. J. Maughan, L. M. Burke, J.
Dvorak, D. E. Larson-Meyer, P. Peeling, S. M. Phillips, ::: L. Engebretsen, 2018a, International Journal of Sport Nutrition and Exercise
Metabolism, 28(2), pp. 104–125.

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202 Peeling et al.
Table 2 Roles and Challenges of Evidence-Based Performance Supplements
Challenges around use in track-and-field events
Supplement Mechanism of action heptathlon and decathlon) requires careful planning of the
timing and amount of doses, including whether a top up dose
Caffeine Caffeine acts as an adenosine receptor antagonist, with
is even needed.
many effects on different organs and systems. Actions include
increases in epinephrine release, improvements in neuromuscular • Use on successive days (e.g., heats and finals of many
function, vigilance and alertness, and a masking of pain and events in major meets) requires consideration of the effect
perception of effort during exercise (Burke, 2008; Spriet, 2014). on sleep and overall recovery, especially when the first event
has a late-night schedule.
(Burke, 2017)
• Interactions with the efficacy or side effects of other
• High degree of individual variability includes potential for supplements used concurrently needs careful consideration
negative response, minimal response, positive response, and and experimentation; this is a likely scenario in many events
super response; thorough practice is needed. (see Table 3).
• Repeated use for events within the same day (e.g.,
Creatine harder) as well as the direct benefits of the CM “loading phase” may avoid such
monohydrate upregulation of cellular signaling and protein issues (Rawson et al., 2011).
Supplementation with creatine monohydrate synthesis due to changes in cellular • Interactions with the efficacy or side effects
increases muscle creatine stores and osmolality (Safdar et al., 2008). Benefits of of other supplements used concurrently
augments the rate of PCr resynthesis, additional muscle storage of glycogen and needs careful consideration and
thereby enhancing short-term, high-intensity water might be of interest to endurance experimentation (see Table 3). Indeed, there
exercise capacity (Buford et al., 2007) and events (Twycross-Lewis et al., 2016). has been lengthy but unclear speculation that
the ability to perform repeat high intensity • Weight gain of 1–2 kg associated with the independently achieved performance
bouts. Chronic effects of increased muscle creatine supplementation (Buford et al., 2007) benefits of creatine supplementation might be
size and strength might be explained by may be counterproductive for weight-sensitive negated by caffeine supplementation (Trexler
indirect benefits (allowing the athlete to train events, such as jumps and distance races. & Smith-Ryan, 2015).
However, a low-dose approach that avoids
Nitrate Nitrate enhances NO bioavailability via the NO3−–nitrite–NO individual, and protocols for repeated use within the same
pathway, which plays an important role in the modulation of skeletal day need planning. Furthermore, various research suggests a
muscle function (Jones, 2014). This pathway augments exercise lack of response for athletes with a well-developed aerobic
performance via an enhanced function of Type II muscle fibers capacity (i.e., VO2max >60 ml/kg; Jones, 2014).
(Jones et al., 2016a), a reduced ATP cost of muscle force • Interactions with the concurrent use of other performance
production, an increased efficiency of mitochondrial respiration, supplements require consideration; at present, this has been
increased blood flow to the muscle, and a decrease in blood flow to investigated in relation to use with caffeine with unclear
VO2 heterogeneities (Bailey et al., 2010). results (Burke, 2017).
β-Alanine β-Alanine is a rate-limiting precursor to carnosine, an • Concurrent use of β-alanine and sodium bicarbonate
endogenous intracellular (muscle) pH buffer during exercise (Lancha supplementation is logical when maximal buffering capacity
Junior et al., 2015). Chronic, daily supplementation increases is needed; however, literature support for combined
skeletal muscle carnosine content (Saunders et al., 2017). benefits is premature.
• As for caffeine, responsiveness to nitrate supplementation is
Sodium H+ and La− from the exercising muscle (Katz day or successive days need planning.
bicarbonate et al., 1984; Mainwood & Worsley-Brown, • Interactions with the concurrent use of other
Sodium bicarbonate acts as an extracellular 1975). performance supplements require
(blood) buffer, aiding intracellular pH • Potential for gut disturbances is high risk in consideration; concurrent use with caffeine
regulation by raising the extracellular pH and running-based events, likely due to the supplementation has been investigated in
HCO3− concentrations (Katz et al., 1984; increased sodium content and large fluid other sports and often seen to counteract the
Lancha Junior et al., 2015). The resultant pH intake required to consume the supplement. benefits of the former due to gastrointestinal
gradient between the intracellular and • Protocols for repeated use within the same side effects (Burke, 2017).
extracellular environments leads to efflux of
Note. PCr = phosphocreatine; CM = creatine monohydrate; NO = nitric oxide; ATP = adenosine triphosphate.

benefits as enhanced glycogen storage and that low doses of CM provided over an adequate time period
thermoregulation sec ondary to the changes in the cellular can increase muscle creatine levels (Hultman et al., 1996).
environment associated with the additional storage of Of note, consuming CM concurrently with a mixed
creatine and water (Cooper et al., 2012; Kreider et al., protein/carbohydrate source (∼50 g of protein and carbohydrate)
2017); however, the potential negative influence of minor may enhance muscle creatine uptake via insulin stimulation
weight gain from such mechanisms should be considered in (Steenge et al., 2000), while it takes ∼4–6 weeks following the
the context of event-specific performance requirements (see cessation of supplementation for muscle stores to return to
Table 2). baseline levels.
Effective supplementation protocols generally encompass a No negative health effects have been noted with the
“loading phase” of ∼20 g/day (divided into 4 equal 5 g long-term use of CM (up to 4 years) when appropriate
doses/day), for 5–7 days, followed by a “maintenance phase,” loading protocols are followed (Schilling et al., 2001), and in
typically involving a single daily CM dose of 3–5 g for the some instances, potential anti-inflammatory effects are
duration of the supplementation period (Hultman et al., 1996). proposed (Deminice et al., 2013). Therefore, creatine
Alternative approaches propose lower doses of CM (2–5 supplementation consumed according to the previously
g/day), consumed for approximately 4 weeks (Rawson et al., mentioned protocols shows strong efficacy for both
2011), based on the concept
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Sports Foods and Supplements for Athletics 203

Table 3 Performance Supplements That May Achieve a Marginal Performance Gain in Track-and-Field Events as Part
of a Bespoke and Periodized Training and Nutrition Plan
Event Caffeine Creatine Nitrate β-Alanine Bicarbonate Sprints: 100 m, 100-m hurdles, 110-m hurdles, and 200 m ✓ ✓
Sustained sprints: 400 m and 400-m hurdles ✓✓ ✓ ✓ Middle distance: 800 m, 1,500 m, 3,000 m, and steeple chase ✓ ✓✓ ✓
Long distance: 5,000 m, 10,000 m, cross-country, 20-km race walk, vault, discus throw, hammer throw, javelin throw, and shot put
half marathon, marathon, 50-km race walk, and mountain/ultra ✓✓✓✓
running Jumps and throws: high jump, long jump, triple jump, pole

Multievents: heptathlon and decathlon ✓ ✓✓ ✓ ✓ Readers are referred to Burke et al. (2019), da Costa et al. (2019), Slater et al. (2019);
Stellingwerff et al. (2019), and Sygo et al. (2019).

acute and chronic performance gains, where power, β-Alanine dosing strategies typically involve the
strength, and short-repeated bouts of high-intensity exercise consumption of 3.2–6.4 g/day, ingested via a split-dose
are encountered. regimen (i.e., 0.8–1.6 g every 3–4 hr) over an extended
supplement time frame of 4–12 weeks (Saunders et al.,
2017). Regardless, a positive correlation between the
Nitrate magnitude of muscle carnosine change and performance
Nitrate supplementation has been shown to promote benefit remains to be established (Saunders et al., 2017). Of
improvements in exercise tasks that predominately stress note, the effectiveness of this supplement has also been
the aerobic energy system, such as time to exhaustion (4– shown in well-trained athletes (Bex et al., 2014; Saunders et
25% increased performance) and sport-specific events (1– al., 2017), although the performance margins for
3% increased performance) lasting <40 min (Jones, 2014; improvement are evidently smaller (Bellinger, 2014). A
McMahon et al., 2017). In addition, nitrate supplementation possible negative side effect of skin paresthesia should be
is proposed to enhance Type II muscle fiber function (Bailey considered, although sustained release tablets are noted to
et al., 2015) resulting in the improvement (3–5%) of high- prevent this outcome and are reported to result in lower
intensity exercise efforts (Thompson et al., 2015; Wylie et urinary loss of the supplement, possibly resulting in
al., 2016). Current evidence is equivocal for such benefit to improved whole-body β-alanine retention (Decombaz et al.,
exercise tasks lasting <12 min (Reynolds et al., 2016; 2012). Finally, large interindividual variations in muscle
Thompson et al., 2016), although more work is needed in carnosine synthesis have been reported with the use of β-
this area. alanine (Stautemas et al., 2018), and therefore, an
Nitrate-rich foods include leafy green and root individualized approach to supplementation must be
vegetables (i.e., spinach, rocket, celery, beetroot, etc.), considered.
although beetroot juice is the more popular supplement
choice for exercise settings (McMahon et al., 2017). Acute
performance benefits are generally seen within 2–3 hr Sodium Bicarbonate
following a NO3− bolus of 5–9 mmol (310– 560 mg) (Hoon et Sodium bicarbonate (NaHCO3) supplementation is proposed to
al., 2014; Peeling et al., 2015); however, chronic periods of enhance the performance (∼2%) of short-term, high-intensity
intake (>3 days) also appear beneficial to perfor sprints lasting ∼60 s in duration, with a reduced efficacy as the
NO3− mance
(Thompson et al., 2015, 2016). effort duration exceeds 10 min (Carr et al., 2011a). In contrast
There appears to be few side effects or limitations to to β-alanine supplementation, which achieves a chronic
nitrate supplementation other than the potential for minor elevation in intracellular buffering capacity, NaHCO 3
gastrointestinal upset in some gut-sensitive athletes. In ingestion (consumed at a dose of 0.2–0.4 g/kg BM)
addition, an upper limit to the benefits of NO 3− consumption achieves an acute increase in extracellular/ blood buffering
has been shown (i.e., no greater benefit from 16.8 mmol (Carr et al., 2011a) with peak blood bicarbonate levels
[1,041 mg] vs. 8.4 mmol [521 mg]; Wylie et al., 2013), and it occurring after 75–180 min (when consuming 0.3 g/kg BM
might also be considered that performance gains appear NaHCO3), which appear to decrease by 3-hr
harder to obtain in elite athletes, with limited to no benefits postsupplementation (Jones et al., 2016b). However, split
generally seen in athletes with a maximal oxygen uptake doses (i.e., several smaller doses) taken over a 30- to 60-
(VO2max) > 60 ml/kg (Jones, 2014). Therefore, individual min time period (Krustrup et al., 2015) or serial loading with
trials of this supplement prior to use in competition are three to four smaller doses per day for two to four
recommended to ensure its use is effective. consecutive days prior to an event (Burke, 2013) has been
proposed as methods to overcome the well-established
gastroin testinal distress associated with this supplement.
β-Alanine Further strategies used to minimize gastrointestinal distress
β-Alanine supplementation is associated with the improved include the coingestion of NaHCO3 with a small carbohydrate-
toler ance for maximal exercise in the range of 30 s to 10 rich meal (∼1.5 g/kg BM CHO; Carr et al., 2011b) or the use
min (Saunders et al., 2017), with small but potentially of the less effective but more gut-friendly sodium citrate as
meaningful performance benefits (∼0.2–3%) shown during both an alternative (Requena et al., 2005).
continuous and intermittent exercise tasks of this duration In summary, despite the relatively robust evidence base
(Baguet et al., 2010; Chung et al., 2012). β-Alanine to support the consideration for use of these five
supplementation increases the muscle content of carnosine, supplements by well trained athlete populations, the
an intracellular dipeptide with buffering, antioxidant, and potential side effects and negative individual tolerance must
anti-inflammatory properties. Of these effects, enhanced be considered, and therefore, any sup plement use should
buff ering is believed to explain the main performance be thoroughly trialed in training before com petition.
benefit. Notwithstanding, as can be seen in Table 2, there are
potential challenges for the use of these supplements within
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204 Peeling et al. track-and-field events, including issues of repeated use and
the potential for interaction when several potentially useful (Dimitriou et al., 2015; Howatson et al., 2010), or
supplements are used together (Burke, 2017). The current consecutive days of intermittent high-intensity activity (Bell
literature relevant to such use is not well understood and et al., 2014). This may be particularly relevant to the heavy
requires more research. training loads of many high-performance athletes, as well as
the competition recovery in multievents in track-and-field
athletics or the programs of middle distance runners with
Therapeutic Nutritional Supplements heats and finals across several events at major competition.
Other anti-inflammatory nutrients include flavonoids such as
and Prophylactic Aids quercetin and green tea extract, plus fish oil, each of which
may have a beneficial effect on delayed onset muscle
In the context of this review, “therapeutic/prophylactic supple soreness (Ranchordas et al., 2018). Consumption of highly
ments” are considered as nutritional aids that can be used colored vege tables/fruit is often advised; this advice is
either to (a) correct a deficiency, (b) assist in the possible appropriate for elite athletes (previously mentioned), as
prevention of illness and/or injury, or (c) help in the recovery these flavonoids (including blueberries, blackcurrants, and
from the stress of physical workloads via an anti- cherries) have a beneficial effect on exercise-induced
inflammatory effect. For instance, it is well known that iron inflammation, muscle damage, and illness (Bermon et al.,
deficiency can impair hematologic adapta tion, which left 2017). In addition, it is proposed that some of these foods
untreated can negatively impact on athletic perfor mance may also have the ability to reduce exercise-induced
(Garvican et al., 2011). However, nutritional correction of oxidative stress; however, there is currently some
this issue via various intervention strategies has been controversy about whether high-dose antioxidant
regularly shown to have a positive impact on correcting the supplementation (in the form of pills, powders, and tablets)
underlying deficiency and enhancing athlete performance is advisable to alleviate exercise-induced generation of
(Dawson et al., 2006; Garvican et al., 2011; Woods et al., reactive oxygen/nitrogen species. Emerging evidence
2014). suggests that antioxidant supplementation mitigates
Regarding illness, there is strong evidence to suggest important exercise-induced adaptations, which may also
that immunodepression can occur as a result of strenuous extend to the immune system (Bermon et al., 2017).
exercise (Castell et al., 2019; Peake et al., 2017), and a In summary, there are various roles for nutritional
high incidence of upper respiratory tract illness is frequently supplements for what may be considered “therapeutic
reported (Drew et al., 2018; Nieman, 1994), before and applications”; however, much more work is needed in this
particularly after endurance events. Low-energy availability area to assess the efficacy of these supplements and to
has been identified as a key nutritional factor in such illness determine their true effect on athletic performance.
(Drew et al., 2018; Heikura et al., 2018); however, the
provision of nutritional supplements to alleviate exercise-
induced immunodepression and to aid more rapid recovery Disadvantages of Sports Foods
in athletes has also been well studied. Sometimes certain and Dietary Supplements
supplements initially appear promising, but further inten sive
investigation fails to provide sufficient evidence of consistent The decision to take a supplement will always involve an
beneficial effects on some aspects of exercise-induced attempt to gain a functional advantage, in most cases being
immuno depression. As different nutritional supplements health protection/ improvement, physique management or
become unfash ionable, whether targeting enhanced recovery, or a direct performance enhancement.
immunodepression or performance, others take their place; Contrary to these potential benefits, is the consideration that
however, the pros and cons of these need to be carefully the supplement inherently possesses certain risks against
studied. For instance, probiotic supplementa tion has been its use; such risks can be divided into three categories.
investigated in recent years (as have prebiotics), with
preliminary evidence of positive effects on immune function
(Cox et al., 2010) that might support the consistency of Risks of Labeled Content
training and competition. However, the effects of such All supplements worldwide are legally bound to be sold in
supplementation are dependent on appropriate doses of live packages that contain a listing of the ingredients. Some
bacteria of specific strains (e.g., Lactobacillus, national legislations may be stricter than others in setting
Bifidobacterium), and larger studies are still needed to and enforcing the list of permitted ingredients in
provide definitive evidence that probiotics benefit the supplements, but any consumer, and certainly, athletes who
immune function of athletes. Glutamine and branched chain consider taking supplements to support their athletic
amino acids, which are often marketed to support performance should not consume a product with ingredients
bodybuilding and postexercise recovery, also have an that cannot be recognized in a basic Internet search. A so-
unclear role in supporting immune function in athletes called “proprietary-blend” listing exotic names and claiming
(Bermon et al., 2017). Clearly, im munonutrition is an commercial Intellectual property cannot be considered a
emerging and important area for consideration in the use of transpar ent listing of ingredients.
dietary supplements for athlete populations, and as such, Even when supplement contents are clearly listed, they
the reader is directed to recent reviews in this area (Bermon cannot necessarily all be considered safe. In many
et al., 2017; Castell et al., 2019), in addition to the countries, the regulations covering supplements do not
comprehensive paper on feeding the immune system require specific testing before going to market but rely on
(Calder, 2013). notification of adverse events to remove unsafe products
With respect to the inflammatory response, there is a from sale. This has led to the inclusion of toxic substances
growing body of work that is investigating anti-inflammatory in highly popular products, for example, the bodybuilding
and antioxi dant aspects of various foods and supplements. and weight loss supplement OxyELITE Pro (USPlabs,
For instance, food polyphenols possess strong antioxidant Hermosa Beach, CA) was found to be associated with at
and anti-inflammatory properties (Tsao, 2010) that may be least one death and a cluster of serious liver complications,
beneficial to exercise recovery. Specifically, the high- attributed to the ingredient 1,3-dimethylhexanamine (also
anthocyanin content of tart Montmorency cherries is known as DMAA; Johnston et al., 2016). This was
proposed to reduce the inflammatory and oxidative stress subsequently removed from the list of ingredients
responses to strenuous exercise, such as a marathon
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that may be included in supplements across many supplementation is bound to be small. Expecting too much
countries. Even where some ingredients might have been of an intervention that addresses only the top end of one
considered to be “safe use,” basic toxicology laws dictate aspect of athletic performance may lead to disappoint ments
that any substance has the potential to lead to health- and distract from other, more powerful, aspects of elite
deteriorating effects when used by some individuals in athletic training. Second, expense must also be considered,
specific scenarios or doses. For athletes, this is often Sports Foods and Supplements for Athletics 205
preceded by decreased performance.

Risks of Undeclared or Unlabeled Content especially when finite resources could have been used in
other areas of the preparation of an elite athlete’s life.
Despite existing legislations, some supplements have been Finally, concerns have been raised that supplement use
found to contain contaminants or health hazards, such as may be a stepping stone to taking other substances,
molds, glass, or animal feces (Benedict et al., 2016; Katz, including those prohibited by antidoping regulations
2013). A specific risk for competitive athletes is the (Backhouse et al., 2013). With this in mind, attention should
undeclared presence of substances that are banned under be directed toward the ethical challenges of athlete product
the World Anti-Doping Agency (WADA) anti doping code. Of marketing and the influence of such approaches on
course, these substances are sometimes identified on encouraging undue supplement use, especially on
product labels, but athletes are either unaware that they are young/developing athletes.
banned or are confused by technical/chemical names. For In summary, the very real risks of taking supplements
example, DMAA is a banned substance and has been should be carefully considered by competitive athletes. Of
included in supple ments under a variety of other names note, Castell et al. (2015) published an A–Z Guide on 140
including geranium oil/ extract or geranamine; this no doubt nutritional supplements in exercise and health; this includes
contributed to many publi cized and less well-known cases efficacy tables ranging from those supplements shown to be
of anti-doping rule violations. ergogenically effective to those banned by WADA as being
This risk of inadvertent doping from supplement use has harmful or illegal. Readers might find it useful to consult this
been known for at least 30 years but is still very much book prior to embarking on a course of supplements.
present (de Hon & Coumans, 2007; Geyer et al., 2004;
Martinez-Sanz et al., 2017). Indeed, the list of prohibited
substances that have been detected in supplements Conclusion: A Pragmatic Approach to
includes stimulants, anabolic agents, selective andro gen Making Decisions about Supplements
receptor modulators, diuretics, anorectics, and β2 agonists
(Martinez-Sanz et al., 2017). When the amounts of banned In the past, athletes and coaches often worked in a parallel
sub stances in supplements are large enough to generate a universe to their expert groups (e.g., governing bodies of
direct effect (e.g., stimulant symptoms), this is an obvious sport) and service teams (e.g., sports scientists, dietitian,
sign of potential contamination to a consumer and and physicians) with regard to performance supplements,
sometimes an indicator of inten tional but undeclared with the former favoring supplement use based on their
manufacturing practices (Geyer et al., 2008; Parr et al., interest in performance gains and the latter being risk
2007, 2008). But the risks of unintentional contamination averse and dismissive of such products. The modern
from adulterated raw ingredients or cross-contamination of landscape, at least for high-performance athletes, has seen
machin ery, even by the most careful manufacturers, should a unification of effort and intent, with many parties now
not be under estimated and will never be zero (Judkins et working together to take a pragmatic approach to managing
al., 2010; Maughan et al., 2018b). Because of the ever- a risk:benefit audit around the use of sports foods,
improving analytical capabilities in antidoping laboratories, therapeutic/prophylactic supplements, and perfor mance
trace amounts of prohibited substances can be found in supplements. This has been led by organizations such as
biological samples taken at doping control. As a result, it the International Olympic Committee and the Australian
cannot be stressed enough that athletes need to be aware Institute of Sport, that have produced expert statements
that the WADA rules of strict liability mean that the detection (Maughan et al., 2018a) and education resources (Burke &
of a prohibited substance in an athlete’s specimen will be Cato, 2015) to guide a proactive but evidence-based
treated as an anti-doping rule violations, irrespective of the consideration of the use of these products. In the case of
intentions behind it (Abbott, 2004; Hughes, 2015). sports foods, track-and-field athletes are guided to seek the
Furthermore, it should also be understood that coaches, expertise of an appropriately qualified sports nutrition
support personnel, parents, friends, and anyone else professional who can help them balance the expense of
involved in the life of an athlete can also be implicated in an using these specialized products with the scenarios in which
anti-doping rule violations, with WADA imposed sanctions they offer genuine performance benefits.
(i.e., suspensions from sport) applicable. Using only Therapeutic/prophylactic supplements should involve the
products that have been audited by a third-party testing expertise of a sports physician, especially when a diagnosis
program and found to be free of banned substances will of medical issues and nutrient defi ciencies is needed. A
help to lower, but not completely eliminate, this risk. decision-tree approach to the use of perfor mance
However, the general avoidance of the high-risk multi- supplements (Figure 1), especially in collaboration with
ingredient supplements promoted as preworkouts or weight sports science/nutrition experts, will help to ensure that any
loss and bodybuilding products is recommended. products that are used are appropriate to the athlete’s age
and maturation in their event, integrated into the athlete’s
plan accord ing to evidence-based protocols and
Noncontent-Related Risks appropriate scenarios, and chosen on the basis of being at
Some final concerns or issues regarding use of low risk of contamination with banned or harmful
supplements and sports foods need to be considered. First, ingredients. Ultimately, it is pertinent that sports foods and
athletes should realize that any benefit of legal nutritional supplements should only be considered where a
 strong evidence base supports their use as safe, legal and Abbott, A. (2004). Dutch set the pace in bid to clean up diet
effective and that such supplements are trialed thoroughly supplements. Nature, 429(6993), 689. PubMed ID: 15201875
by the individual before committing to use in a competition doi:10.1038/429689a Backhouse, S.H., Whitaker, L., & Petroczi, A.
setting. (2013). Gateway to doping? Supplement use in the context of
preferred competitive situations, doping attitude, beliefs, and
norms. Scandinavian Journal of
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