Dietary Patterns in Runners with Gastrointestinal Disorders.

Individuals with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and reflux frequently experience gastrointestinal symptoms (GIS), potentially enhanced by high-intensity running. Food avoidances, food choices, and GIS in runners with IBS/IBD (n = 53) and reflux (n = 37) were evaluated using a reliability and validity tested questionnaire. Comparisons to a control group of runners (n = 375) were made using a Fisher's Exact test. Runners with IBS/IBD experienced the greatest amount of exercise-induced GIS followed by those with reflux. Commonly reported GIS were stomach pain/cramps (77%; 53%), bloating (52%; 50%), intestinal pain/cramps (58%; 33%), and diarrhea (58%; 39%) in IBS/IBD and reflux groups respectively. In the pre-race meal, those with IBS/IBD frequently avoided milk products (53%), legumes (37%), and meat (31%); whereas, runners with reflux avoided milk (38%), meat (36%), and high-fibre foods (33%). When considering food choices pre-race, runners with IBS/IBD chose grains containing gluten (40%), high fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) fruits (38%), and water (38%). Runners with reflux chose water (51%), grains containing gluten (37%), and eggs (31%). In conclusion, while many runners with IBS/IBD and reflux are avoiding trigger foods in their pre-race meals, they are also consuming potentially aggravating foods, suggesting nutrition advice may be warranted.

Dietary restrictions in endurance runners to mitigate exercise-induced gastrointestinal symptoms.

BACKGROUND: Endurance runners frequently experience exercise-induced gastrointestinal (GI) symptoms, negatively impacting their performance. Food choices pre-exercise have a significant impact on the gut's tolerance to running, yet little information is available as to which foods runners restrict prior to exercise. METHODS: A questionnaire designed to assess dietary restrictions pre-racing and gastrointestinal symptoms was administered to 388 runners. Fisher's exact tests determined differences in gender, age, performance level, and distance with follow-up multivariable logistic regression modeling. RESULTS: Runners regularly avoided meat (32%), milk products (31%), fish/seafood (28%), poultry (24%), and high-fiber foods (23%). Caffeinated beverages were commonly avoided in events 10 km or less (p < .001); whereas in females, increased running distance was a predictor of avoiding high-fiber foods (OR = 6.7; 95% CI = 1.6-28.5). Rates of food avoidance were elevated in younger and more competitive runners. Common GI symptoms included stomach pain/cramps (42%), intestinal pain/discomfort (23%), side ache/stitch (22%), urge to defecate (22%), and bloating (20%). The prevalence of GI symptoms was higher in younger athletes, especially females, which may explain their propensity to avoid foods. Lower recreational athletes were the least likely to report GI symptoms. Diarrhea incidence increased with running distance. CONCLUSIONS: Identification of voluntary food restrictions in the pre-running meal highlights trends that can direct further research.

Development of a questionnaire to assess dietary restrictions runners use to mitigate gastrointestinal symptoms.

BACKGROUND: Exercise induced gastrointestinal (GI) symptoms can plague athletes, especially runners. Sport nutrition recommendations are nutrient rather than foods focused and do not adequately address strategies to reduce GI symptoms. The objective was to develop a valid and reliable questionnaire to evaluate pre-training and pre-racing voluntary food restrictions/choices, reasons for avoiding foods, and gastrointestinal symptoms in endurance runners. METHODS: Validity testing occurred through four Registered Dietitians, three of whom possess Master's degrees, and a dietetic trainee who provided initial feedback. Additionally, one Registered Dietitian is a Board Certified Specialist in Sports Dietetics (CSSD), and another has an International Olympic Committee Diploma in Sports Nutrition. The second version was sent out to nine different experts who rated each question using a Likert scale and provided additional comments. For reliability testing, the questionnaire was administered to 39 participants in a test re-test format. Kappa statistics and the prevalence-adjusted bias-adjusted kappa (PABAK) were used to assess the reliability. RESULTS: All questions had an average Likert scale rating of 4/5 or greater. All test re-test results falling under basic information exhibited substantial agreement (kappa ≥0.61). All medical questions including food allergies and intolerances had moderate (kappa ≥0.41) or higher agreement. Responses were less consistent for food avoidances while training (5/28 outcomes) versus racing (0/28 outcomes) with a kappa below 0.41. All reasons for avoiding foods were deemed reliable. Regarding symptoms, side stitch while training and gas while racing were the only flagged categories. CONCLUSIONS: Overall, the questionnaire is a valid and reliable tool to evaluate voluntary dietary restrictions among endurance runners. Future studies can use the questionnaire to assess dietary strategies runners employ to reduce GI distress and optimize performance.

Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance.

It is the position of the Academy of Nutrition and Dietetics (Academy), Dietitians of Canada (DC), and the American College of Sports Medicine (ACSM) that the performance of, and recovery from, sporting activities are enhanced by well-chosen nutrition strategies. These organizations provide guidelines for the appropriate type, amount, and timing of intake of food, fluids, and supplements to promote optimal health and performance across different scenarios of training and competitive sport. This position paper was prepared for members of the Academy, DC, and ACSM, other professional associations, government agencies, industry, and the public. It outlines the Academy's, DC's, and ACSM's stance on nutrition factors that have been determined to influence athletic performance and emerging trends in the field of sports nutrition. Athletes should be referred to a registered dietitian nutritionist for a personalized nutrition plan. In the United States and in Canada, the Certified Specialist in Sports Dietetics is a registered dietitian nutritionist and a credentialed sports nutrition expert.

American College of Sports Medicine Joint Position Statement. Nutrition and Athletic Performance.

It is the position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine that the performance of, and recovery from, sporting activities are enhanced by well-chosen nutrition strategies. These organizations provide guidelines for the appropriate type, amount, and timing of intake of food, fluids, and supplements to promote optimal health and performance across different scenarios of training and competitive sport. This position paper was prepared for members of the Academy of Nutrition and Dietetics, Dietitians of Canada (DC), and American College of Sports Medicine (ACSM), other professional associations, government agencies, industry, and the public. It outlines the Academy's, DC's and ACSM's stance on nutrition factors that have been determined to influence athletic performance and emerging trends in the field of sports nutrition. Athletes should be referred to a registered dietitian/nutritionist for a personalized nutrition plan. In the United States and in Canada, the Certified Specialist in Sports Dietetics (CSSD) is a registered dietitian/nutritionist and a credentialed sports nutrition expert.

Evaluation of congruence among dietary supplement use and motivation for supplementation in young, Canadian athletes.

BACKGROUND: Dietary supplement use is endemic in young athletes; however, it is unclear if their choices are congruent with their motivation for supplementation and the established benefits of the dietary supplements. The aim of this study was to evaluate the relationships between dietary supplement use and self-reported rationale in young athletes. METHODS: Canadian athletes (n = 567; 11-25 years; 76% club or provincial level, 24% national or higher) completed a questionnaire designed to assess supplementation patterns and motivation for supplementation. Chi square tests examined associations between dietary supplements and self-reported rationale for use. RESULTS: Vitamin and mineral supplements, including vitamin-enriched water, were associated with several health- and performance- related reasons (p < 0.001). Branched chain amino acids (BCAA) and glutamine were linked to improving diet and immune function (p < 0.01), but were more strongly associated with performance reasons, as were performance foods (protein powder, sport bars, sport gels, etc.). Plant extracts and fatty acids were primarily associated with health reasons, particularly immune support (p < 0.001). CONCLUSIONS: Congruencies exist between performance rationales and supplementation for common ergogenic aids, however, less so for vitamin and mineral supplements, vitamin-enriched water, and plant extracts. Incongruences were found between fatty acids, protein supplements, vitamin and mineral supplements, vitamin-enriched water, and plant extracts and health motivators for supplementation. Educational interventions are essential to ensure young athletes are using dietary supplements safely and effectively.

A Lifetime Pursuit of a Sports Nutrition Practice.

Sports nutrition in Canada has significantly evolved over the years from providing fundamental training dietary advice to applied precise assessment of nutritional status in a variety of settings, especially with the establishment of Canadian Sport Institutes and Centres across Canada. This progression has enhanced the level of dietary support to manage athletes' nutrition in a holistic perspective. Athletes are now educated about food fundamentals (acquiring foods, menu planning, preparing, food safety), personal accountability of hydration and energy monitoring (urinary and body weight assessments), individualized supplementation protocols, and customized nutrition for variable daily training environments according to their Yearly Training Plan. Sport dietitians are an important member of Integrated Sport Teams where collaboration exists amongst professionals who coordinate the athletes' personalized training and performance programming. Dietitians in sport are encouraged to continue to lobby for nutrition programming at the elite, varsity, provincial, and club levels to ensure that athletes receive accurate guidance from nutrition experts.

Dietary supplement usage, motivation, and education in young, Canadian athletes.

PURPOSE: To evaluate dietary supplement use in young Canadian athletes, their motivation for consuming supplements, and their sources of information. METHODS: A questionnaire tested for content validity and reliability was administered to 567 athletes between the ages of 11 and 25 years from the Canadian athletic community in face-to-face meetings. Demographics and sport variables were analyzed using descriptive statistics. Fisher's exact tests were used to examine dietary supplementation patterns and sources of information regarding dietary supplement use between categories of gender, age, sport type, and competition level. RESULTS: Ninety-eight percent of athletes were taking at least one dietary supplement. Males were more likely to consume protein powder, energy drinks, recovery drinks, branched chain amino acids, beta-alanine, and glutamine (p < .01); supplements typically associated with increased muscle mass. Athletes 11-17 years old focused on vitamin and mineral supplements; whereas, athletes 18-25 years old focused on purported ergogenic supplements. Strength training athletes were more likely to consume creatine, glutamine, and protein powders (p < .02). Reasons for supplement use included to stay healthy, increase energy, immune system, recovery, and overall performance. Primary sources of information were family and friends, coaches, and athletic trainers; with 48% of athletes having met with a dietitian. Preferred means of education included individual consultations, presentations, and the internet. CONCLUSIONS: The majority of young athletes are using dietary supplements with the belief they will improve performance and health; however, may not always have reliable information. Educational programs using individual consultations and electronic media are recommended for this demographic.

Eating patterns and composition of meals and snacks in elite Canadian athletes.

The purpose of this study was to determine the meal- and snack-eating frequency and the nutritional composition of each eating occasion of Canadian high-performance athletes during training. Athletes from 8 Canadian Sport Centres prospectively completed 3-d dietary records including all food, fluid, and supplements consumed. The time of consumption and whether the consumption was a meal or snack were also identified. The dietary records were analyzed for energy (kcal) and macronutrient intake (carbohydrate, protein, and fat) and compared based on gender, age, meal vs. snack, and training vs. rest days. Three hundred twenty-four athletic subjects (64% female and 36% male) completed the study. On average, the athletes ate 4.8 ± 0.8 times daily. Nearly all athletes consumed 3 daily meals of breakfast (98.9%), lunch (97.9%), and dinner (98.7%), with few having snacks: 57%, 71.6%, and 58.1% of athletes consumed an a.m., p.m., and evening snack, respectively. Training-day meal frequency did not differ from that during rest days; however, fewer snacks were consumed on rest days. A.m. and p.m. snacks were consumed significantly more often on training days than rest days. Overall, snacks contributed 24.3% of total daily energy intake. Few dietary variations were discovered between genders, while the youngest athletes (<18 yr) ate less often, especially their morning snack, than the older athletes. In conclusion, Canadian high-performance athletes self-adjusted their energy intakes on training vs. rest days primarily by snacking less and reducing their carbohydrate and protein intakes on rest days, yet they consistently ate regular meals.

Evaluation of nutritional intake in Canadian high-performance athletes.

OBJECTIVE: To determine the nutritional intake of Canadian high-performance athletes. DESIGN: Prospective survey study. SETTING: Canadian sport center athletes. PARTICIPANTS: Three hundred twenty-four high-performance athletes (114 males and 201 females; mean age 21.3 +/- 13 years) from 8 Canadian sport centers participated in the study. INTERVENTION: Subjects prospectively completed 3-day dietary records, reporting all food, fluid, and supplement consumption. MAIN OUTCOME MEASURES: Dietary records were analyzed for total calories, macronutrients, and micronutrients for food alone and food plus supplements for all subjects collectively and according to gender and competitive event. RESULTS: Average daily energy intake was 2533 +/- 843 Kcal/day with males consuming more calories than females (2918 +/- 927 and 2304 +/- 713 Kcal/day, respectively; P < 0.05). Both genders consumed below recommended levels. Carbohydrate, protein, and fat accounted for 53%, 19%, and 28% of daily calorie intake, respectively. Average daily carbohydrate and protein intake was 5.1 +/- 1.8 and 1.8 +/- 0.6 g/kg body weight, respectively. Protein intake, but not carbohydrate intake, met recommendations. Supplementation significantly increased athletes' energy, total carbohydrate, protein, and fat intake. Of 17 micronutrients assessed, intake ranged between 120% and 366% of recommended daily intake with food alone and between 134% to 680% of recommended daily intake with supplements. CONCLUSIONS: Canadian high-performance athletes do not consume adequate energy or carbohydrates. However, their intake of micronutrients exceed current recommended daily intakes, even when supplements are not considered, indicating that athletes make high-quality food choices. Supplementation significantly increased energy, macronutrient, and micronutrient intake.

Consumption of dietary caffeine and coffee in physically active populations: physiological interactions.

Caffeine is a proven ergogenic aid, increasing athletic performance, endurance, and mental chronometry at doses as low as 1-3 mg.kg-1. As coffee is a readily available and commonly ingested form of caffeine, the two are often equated. However, coffee also contains hundreds of other biologically active compounds, many of which are metabolically distinct from caffeine. The purpose of this review was to examine the prevalence of coffee and (or) caffeine consumption among elite Canadian athletes, and to delineate the effects of coffee and caffeine on physical activity, weight maintenance, performance, and metabolism. A total of 270 self-reported 3-day food records were examined for caffeine intake from athletes registered with Canadian Sport Centres in 2005 and 2006. Athletes ranged in age from 16-45 years, and competed in 38 different sports. Results showed that 30% of athletes ingested >1 mg.kg-1.day-1 from a variety of sources. Average daily intake was 0.85 +/- 13 mg.kg-1. Caffeine intake was not correlated with any 1 sport; the 10 highest caffeine users were athletes from 9 different sports, including skill, endurance, and power sports. No differences were noted for average caffeine ingestion between summer and winter sports. High caffeine intakes corresponded to coffee ingestion, with the 25 highest individual intakes (193-895 mg.day-1) from coffee drinkers. In summary, it can be concluded that the majority of high-level Canadian athletes consume dietary caffeine primarily in the form of coffee. However, levels consumed are insufficient to elicit performance enhancement. Potential detrimental effects of caffeine consumption on exercise performance include gastric upset, withdrawal, sleep disturbance, and interactions with other dietary supplements.

Dietary supplementation of high-performance Canadian athletes by age and gender.

OBJECTIVE: To determine dietary supplementation practices and opinions, preferred means for dietary supplement (DS) education, and antidoping opinions among elite Canadian athletes varying in age and gender. DESIGN: A descriptive, cross-sectional survey. SETTING: Elite athlete training centers in Calgary, Canada and surrounding area. PARTICIPANTS: A total of 582 high-performance athletes (314 male, 268 female). MAIN OUTCOME MEASURES: High-performance athletes representing 27 sports with a mean age of 19.96+/-3.91 years completed a validated questionnaire assessing DS practices and opinions by recall. Sport categories included varsity, Canadian Sport Centre Calgary (CSCC), and National Sport School (NSS). RESULTS: There was extensive DS use, with 88.4% of participants taking>or=1 DS (mean of 3.08+/-1.87 DS per user) during the previous 6 months. Overall, sport drinks (22.4%), sport bars (14.0%), multivitamins and minerals (13.5%), protein supplements (9.0%), and vitamin C (6.4%) were most frequently reported. Older athletes were significantly more likely to report greater DS usage; to be advised by teammates, health food store retailers, and magazines; to prefer supplementation education via individual interviews; to claim awareness of anti-doping rules; and to perceive anti-doping compliance. Relative to gender, significant differences were observed for the types of DS reported; supplementation advisors; justifications for DS use; and awareness of anti-doping regulations. CONCLUSIONS: Utilization of this validated and reliable questionnaire has the potential for broad use and provides insight into the factors that influence DS use in elite athletes.

Influence of performance level on dietary supplementation in elite Canadian athletes.

INTRODUCTION: It is well documented that athletes report greater dietary supplement (DS) usage than nonathletes; however, limited data exist for Canadian athletes, especially relative to competitive performance levels. PURPOSE: This descriptive and analytical, cross-sectional research investigated DS practices and opinions, preferred means for DS education, and antidoping opinions among elite Canadian athletes competing at various performance levels. METHODS: Subjects completed a validated questionnaire by recall. Combined, 582 high-performance athletes (314 M, 268 F) between the ages of 11 and 42 yr (mean 19.96 +/- 3.91 yr) and representing 27 sports activities participated. Respondents were categorized into five competitive performance levels: provincial (68), national (101), North America (61), international or professional (89), and varsity (263). RESULTS: Overall, most (88.4%) reported taking one or more DS during the previous 6 months (mean 3.08 +/- 1.87 DS per user). From a total of 1555 DS declared, sport drinks (22.4%), sport bars (14.0%), multivitamins and minerals (13.5%), protein supplements (9.0%), and vitamin C (6.4%) were most frequently reported. Athletes at the highest performance level were significantly more likely to use protein supplements, to be advised by strength trainers regarding DS usage, to have a higher self-rating of their diet, to prefer individual interviews for DS educational purposes, to perceive greater awareness of antidoping legislation, and train more h.wk(-1). Furthermore, differences were observed for the types of DS reported and justifications for use. CONCLUSION: This dataset, the first of its kind in Canada, was generated with a validated and reliable questionnaire and has the potential to be extended nationally and internationally to provide greater insight into the patterns and opinions of elite athletes regarding supplementation and antidoping.