They are most common in children up to the age of four, but some allergies continue into adulthood. Diagnosis occurs by a skin prick test or blood test by a GP or immunologist. Food intolerances are more prevalent in adults than in children and unlike an allergen, cause a non-immune response.

It is normally dose related, meaning the more you eat the worse the reaction. There may also be a threshold amount required to be consumed before experiencing any symptoms which can makes it difficult to determine the specific cause.

Depending on the type of symptom there is a number of ways to approach the dietary treatment of food intolerances. For some food intolerances with gastrointestinal symptoms it may be beneficial to consider a low-FODMAP diet approach.

For more information see the FODMAP factsheet. Treatment of food allergies requires that all allergens must be removed completely from the diet. Due to altered conditions e. The intake of probiotics two weeks before and during a trip appears to have a marginal protective role in reducing the incidence and severity of travel-specific problems [23].

Nutritional support is key to ensure that junior players can meet the requirements for their daily school routine, training, games, growth, maturity, health and recovery.

Mostly, energy demands are higher compared to adults due to growth and changes in body composition. A severe chronic energy deficit may impair growth and maturity, develop menstrual irregularities and enhance injury and illness risk [7,25].

Players should be monitored periodically to examine changes in height-for-weight, weight-for-age, BMI-for-age and body composition [7]. Therefore, daily CHO recommendations by body mass are similar to adult players [25].

Additional CHO intake during trainings and games may be beneficial [7]. Regarding protein consumption, a daily intake of up to 1. Compared to adults, youth athletes are less effective in regulating body temperature and have lower heat tolerance [25].

Due to the greater surface area-to-body mass ratio than adults and a lower sweating capacity, junior players have an increased risk of hypohydration [25]. With their daily training schedules and school commitments, hydration is not a priority.

Many youth athletes arrive for trainings and games hypohydrated [28]. They should be encouraged to ensure euhydration before commencing exercise [25]. Furthermore, a food-first approach is essential when educating junior players [29]. Generally, adolescent athletes would benefit from sports nutrition education that enhances food selection skills for their daily schedule, general health and sport performance [29].

In the past few years, the term relative energy deficiency in sports RED-S has emerged and describes the risk of an inadequate EI in athletes [30]. Energy availability is calculated from the daily EI minus exercise energy expenditure related per kg fat-free mass []. A state of low energy availability is defined as an intake below 30 kcal per kg fat-free mass per day.

Such a low intake further increases the risk for secondary health consequences like low bone mineral density, menstrual and hormonal dysfunction, depression, gastrointestinal disturbances and cardiovascular disease.

Furthermore, physical and cognitive performance reduce whereas injury and illness risk increase. The risk for low energy availability is increased in endurance, body weight sensitive and esthetic sports as well as in female athletes in general [].

Female soccer players displayed this issue of inadequate nutritional support [7,37,38]. Therefore, it seems highly important to educate female team sport athletes properly in terms of risks and consequences of RED-S [35], even though they are not part of a weight-sensitive, esthetics or endurance sport.

Moreover, the risk for micronutrient deficiencies such as iron [39], vitamin D and calcium might be increased in female athletes [27,34]. Also, numerous female athletes often stick to a vegan, vegetarian or low-CHO diet, which represents an additional risk for low energy availability and deficiencies [3].

Therefore, it is important to educate female athletes properly in terms of risks and consequences of RED-S [35] and to provide nutritional support to those athletes Figure 2 to verify an adequate macro- and micronutrient intake as well as to optimize training adaptation and performance [40].

Due to the scarce scientific literature on the special requirements of female athletes, to date, no differentiated recommendations regarding CHO intake before, during or after exercise can be given for the female athletes [34].

Adequate EI should be the first nutritional consideration as negative energy balance accelerates muscle loss especially in immobility period [41]. In conditions of sudden inactivity as a result of surgery or injury, elevating protein intakes to 1.

Including leucine-rich protein and pre-sleep protein to the diet helps to achieve the protein target values [7]. anti- inflammatory, collagen, etc. They might play a role in the management and rehabilitation of different injuries, but the different phases of stage and duration of injury provide a continuum of varied nutritional needs [3].

Literature is scarce and further studies are needed to establish nutritional guidelines. By providing an adequate energy and protein intake, the first step for a successful rehabilitation is made [41].

The further intake of micronutrients through vegetables and fruits might support the healing process. The authors thank Dr. Anneke Hertig-Godeschalk for her valuable feedback. The authors declare no financial, institutional or any other conflict of interest.

No funding has been received. Joëlle Flück Guido A. flueck sportmedizin-nottwil. Subscribe now to keep reading and get access to the full archive. Type your email…. Continue reading. Team Coverage - Nutrition. published online on Flueck Joelle Leonie 1,2 , Kyburz Sarina Annik 2 1 Swiss Sports Nutrition Society, Luzern, Switzerland 2 Institute for Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland Abstract Team sports performance is highly demanding in terms of physiological and psychological aspects.

Zusammenfassung Die sportlichen Belastungen im Teamsport sind aus physiologischer und psychologischer Sicht sehr anspruchsvoll. Physiological aspects in team sports Team sports performance is very complex, as a player needs to present different physiological and non-physiological skills to perform at its best.

Figure 1: Classification of different team sports Energy requirements The activity level between players varies depending on the type of sport, training quantity and quality, body mass as well as playing position.

Fluid loss and hydration The risk for hypohydration is the greatest in soccer and rugby [15]. Travelling Domestic and international travel for games and training camps is happening on a regular basis in elite teams.

Young athletes Nutritional support is key to ensure that junior players can meet the requirements for their daily school routine, training, games, growth, maturity, health and recovery. Female athletes In the past few years, the term relative energy deficiency in sports RED-S has emerged and describes the risk of an inadequate EI in athletes [30].

Recovery from injury Adequate EI should be the first nutritional consideration as negative energy balance accelerates muscle loss especially in immobility period [41]. Practical implications The key nutritional considerations Table 4 : Use different techniques Figure 2 to induce a long-term change in nutritional practices on an individual, gender- and age-specific level.

Nutrition should be tailored to individual needs e. load, intensity, sweat rate, environmental conditions Education e. general healthy eating, RED-S, nutritional needs for youth or female athletes, risk and benefit of supplement use is important in the development and should be implemented in the early stages of the career.

Acknowledgments, conflict of interest and ­funding The authors thank Dr. Corresponding author Dr. A comparison of the physiological profiles of elite ­Gaelic footballers, hurlers, and soccer players.

Br J Sports Med. Bangsbo J, Mohr M, Krustrup P. Physical and metabolic demands of training and match-play in the elite football player. J Sports Sci. Smith MR, Coutts AJ, Merlini M, Deprez D, Lenoir M, Marcora SM. Mental Fatigue Impairs Soccer-Specific Physical and Technical Performance. Med Sci Sports Exerc.

Fuller CW. Injury Risk Burden , Risk Matrices and Risk Contours in Team Sports: A Review of Principles, Practices and Problems. Sports Med. Anderson L, Naughton RJ, Close GL, Di Michele R, Morgans R, Drust B, et al. Daily Distribution of Macronutrient Intakes of Professional Soccer Players From the English Premier League.

Int J Sport Nutr Exerc Metab. Holway FE, Spriet LL. Sport-specific nutrition: practical strategies for team sports. Collins J, Maughan RJ, Gleeson M, Bilsborough J, Jeukendrup A, Morton JP, et al. UEFA expert group statement on nutrition in elite football.

Current evidence to inform practical recommendations and guide future research. Baker LB, Rollo I, Stein KW, Jeukendrup AE. Acute Effects of Carbohydrate Supplementation on Intermittent Sports Performance.

Carbohydrate Mouth Rinse Improves Relative Mean Power During Multiple Sprint Performance. International journal of exercise science. Maughan RJ, Burke LM, Dvorak J, Larson-Meyer DE, Peeling P, Phillips SM, et al.

IOC Consensus Statement: Dietary Supplements and the High-Performance Athlete. Geyer H, Parr MK, Koehler K, Mareck U, Schanzer W, Thevis M. Nutritional supplements cross-contaminated and faked with doping substances. J Mass Spectrom. Zürcher SJ, Quadri A, Huber A, Thomas L, Close GL, Brunner S, et al.

Predictive Factors for Vitamin D Concentrations in Swiss Athletes: A Cross-sectional Study. Gluten is a naturally occurring storage protein found in wheat, barley, and rye, as well as hybrids of these grains. It helps provide structure, texture, and elasticity to food products 1.

Gluten is heat stable and may be added into processed foods to help the product retain moisture, enhance texture, and maintain form.

Based on these properties, items such as processed meats, vegetarian meat substitutes, thickeners, seasonings, stuffings, marinades, and dressings may contain added gluten 1.

There are specific medical conditions which necessitate that individuals follow a gluten-free diet, such as athletes with celiac disease or non-celiac gluten sensitivity, as well as athletes with wheat allergies 2.

Celiac disease is an autoimmune disease in which individuals develop an intolerance to gluten. When individuals with celiac disease ingest gluten, it causes an immune response that damages the lining of the small intestine 3.

Athletes that have celiac disease must follow a strict gluten-free diet. In addition to celiac disease, athletes with other gluten-related disorders, such as non-celiac gluten sensitivity, are advised to follow a gluten-free diet to help alleviate symptoms. Athletes with an allergy to wheat must avoid consuming wheat and wheat containing products to prevent an allergic reaction from occurring 2.

Athletes should visit with a physician if they have concerns regarding the consumption of gluten or feel they may have a gluten or wheat-related disorder. It is not necessary for athletes to eliminate gluten or wheat from their diets if they do not have celiac disease, a wheat allergy, or other gluten-related disorders.

Following a gluten-free diet will not result in improved performance in athletes who do not have celiac disease or other gluten or wheat-related disorders 4 , 5 , 6. Carbohydrates provide athletes with the energy needed to perform at their best during training and competition.

Similar to gas used to fuel a car, carbohydrates provide fuel for the body to run on during activity. Carbohydrate recommendations for athletes are typically based upon the intensity and duration of the exercise session. Athletes participating in higher intensity or longer duration sessions require more carbohydrates to support performance 7.

Although athletes following a gluten-free diet must avoid gluten containing grains, there are numerous other ways athletes can add carbohydrates to their diet. Athletes following a gluten-free diet can get carbohydrates from a variety of food groups, including:.

Athletes following a gluten-free diet need to avoid wheat, barley, rye, and crossbreeds of these grains. There are a variety of other grain options that are naturally gluten-free, including 8 :.

Even when products are made with gluten-free grains, it is important for athletes to read the food label carefully. It is possible gluten containing ingredients were added to the product.

In addition, cross-contamination with grains containing gluten may occur during harvest and production 8. Oats are also naturally gluten-free.

Further, inflammatory symptom scores did differ between the athlete 8. However, if an athlete has a sensitivity to whey protein this supplement may be causing more harm than good.

Moving forward these athletes will receive 4 weeks of whey protein versus 4 weeks of plant protein daily after practice to assess changes in performance, recovery, and inflammatory symptoms.

Clarkson, Eve M. Miss; Lockard, Brittanie L. Health and Physical Education Commons , Medical Education Commons , Sports Sciences Commons. To view the content in your browser, please download Adobe Reader or, alternately, you may Download the file to your hard drive. NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern Intel Mac, there is no official plugin for viewing PDF files within the browser window.

Advanced Search. Home About FAQ My Account Accessibility Statement. Privacy Copyright. Skip to main content Home About FAQ My Account. Food Sensitives in Athletes: Whey More Common Than You May Expect? Authors Eve M. Abstract Food sensitives, which differ from food allergies, are caused by digestive problems to foods that may lead to symptoms such as bloating, diarrhea, constipation, fatigue, headache, joint pain, and sleep disturbances, among other issues.

The incidence was calculated as the number of athletes responding to each symptom in each group, and the severity was calculated as the average response to each symptom. Descriptive statistics were used to define continuous variables means, standard deviations, and percentages , and for non-parametric data, medians and interquartile ranges IQR were applied.

Chi-squared tests were used to determine associations between categorical data, i. For any significant group differences, Bonferroni post hoc tests were used. For Ex-GIS incidence and severity, the data were checked for normality by applying the Shapiro—Wilk test. The Friedman test was used to determine differences within each symptom group, and a post hoc Wilcoxon test to determine differences within repeated measures.

A Bonferroni correction factor was applied if significant. Data analysis was performed using IBM SPSS Statistics One hundred and thirty-seven endurance athletes with Ex-GIS completed the questionnaire. The mean age was Participant characteristics are described in Table 1 , and Ex-GIS incidence in Table 2.

There were no differences in Ex-GIS incidence by main sport, participation level, or biological sex. Table 1. Table 2. Figure 1 highlights the combined incidence for each Ex-GIS and the median severity of all symptoms across all independent groups.

Lower-GIS was more commonly reported compared to upper-GIS in all groups, i. Figure 1. Combined incidence and median severity rating of gastrointestinal symptoms before, during, and after exercise. Symptoms are listed in upper, lower, and other symptom categories and descending order of incidence.

A Ex-GIS around training only, B Ex-GIS around competitions only, C Ex-GIS equally around training and competitions training responses.

D Ex-GIS equally around training and competitions competition responses. B, Belching; BL, Bloating; D, Dizziness; DB, Defecation Bloody Stools; DD, Defecation Diarrhea ; DL, Defecation Loose Stools; F, Flatulence; Ex-GIS, exercise-associated gastrointestinal symptoms; HB, Heartburn; LA, Lower Abdominal Bloating; LI, Left Intestinal Pain; N, Nausea; PV, Projectile Vomiting; R, Regurgitate; S, Stitch; SP, Stomach Pain; UD, Urge to Defecate; UR, Urge to Regurgitate.

The incidence and severity of symptoms were not normally distributed; therefore, median and IQR were used to describe the data with non-parametric tests applied. Using the Wilcoxon test for non-parametric data the incidence of reported symptoms was significantly greater during exercise than before and after exercise e.

Table 3. A total of strategies were reported by athletes, an average of 3. A qualitative content review of the strategies used including the five most common dietary strategies to reduce Ex-GIS, specific high FODMAP food groups exclusion, and the non-dietary strategies used to reduce Ex-GIS, are shown in Figure 2.

The most popular dietary strategies were dietary fiber reduction Avoiding disaccharides lactose and sucrose 6. Figure 2. FODMAP, fermentable oligosaccharide disaccharide monosaccharide and polyols; GOS, galacto-oligosaccharides; FOS, fructo-oligosaccharide.

Endurance athletes rated the overall success of specific dietary components Table 4 or attempted dietary strategies Table 5 and when they tended to implement them.

Table 4. Dietary components self-selected to eat more or less of to reduce the development of exercise-associated gastrointestinal symptoms. Table 5. Specific dietary strategies trialed, and supplements used to reduce the development of exercise-associated gastrointestinal symptoms listed in order of success at reducing symptoms.

The most common sources of dietary information for Ex-GIS management are shown in Figure 3. After chi-squared analysis and post hoc testing, no significant associations were found between the most important nutrition information sources for managing Ex-GIS, categorized by main sports, participation levels, event characteristics, or biological sex.

Figure 3. APD, Accredited Practicing Dietitian. This is the first exploratory study to review the specific self-reported strategies used to manage symptomology amongst endurance athletes who experience Ex-GIS.

The most commonly reported successful dietary strategies to manage Ex-GIS, typically before and during exercise, were dietary fiber reduction, a low FODMAP diet, a dairy-free diet, and increasing carbohydrates. Endurance athletes primarily sought accredited practicing dietitians in the management of Ex-GIS.

Reducing dietary fiber, particularly before exercise, was the most common dietary strategy endurance athletes have implemented. Current sports nutrition guidelines recommend endurance athletes reduce dietary fiber around key training sessions and competitions to mitigate the incidence of Ex-GIS 3 , 29 , This is due to the ability of dietary fiber to increase the luminal contents in the large colon due to an osmotic effect and fermentation, which may promote greater gastrointestinal discomfort and reduced orocaecal transit times 5 , 7.

However, due to variable gastrointestinal tract transit times, a low-fiber diet may require implementation 1—3 days before exercise 41 , which may not be practical habitually. Therefore, if athletes restrict dietary fiber to reduce Ex-GIS, a short-term low-fiber diet around specific competitions is likely to be practical without compromising the beneficial effects of consuming adequate dietary fiber daily.

Ex-GIS reported by athletes in this investigation was similar to individuals diagnosed with IBS, including abdominal pain, bloating, and diarrhea An effective treatment strategy for those with IBS is implementing a low FODMAP diet 43 , Similarly, athletes commonly reported using a low FODMAP diet to manage Ex-GIS successfully in the current study.

A low FODMAP diet has also reportedly been used to manage Ex-GIS in other investigations with athletes 25 , However, the time frame for implementation in previous studies, including the current study, has not been investigated. It has been shown that a short-term h low FODMAP diet before endurance exercise can reduce Ex-GIS and malabsorption 10 , and the impact of this short-term dietary restriction on overall nutritional status is unlikely to be significant.

However, a low FODMAP diet is not designed to be followed long-term due to possible nutritional deficiencies if chronically administered 43 , However, if a low FODMAP diet is necessary over more extended time frames i.

Dairy avoidance around exercise was an exclusive dietary strategy employed by athletes to reduce Ex-GIS, i. In this study, dairy products were avoided before, during, and after exercise.

Endurance athletes may have been avoiding dairy products due to the lactose component, which is typically moderated on a low FODMAP diet It is possible that endurance athletes avoid dairy as they have lactose intolerance.

Lactose intolerance is one of the most commonly reported food intolerances, with many symptoms overlapping with IBS, e. In the current study, implementing a lactose-free diet was also reported as a successful dietary strategy to manage Ex-GIS; however, slightly lower implementation rates before, during, and after exercise were reported compared to a dairy-free diet.

Future research could also investigate if athletes have food allergies or intolerances, hence the need for a dairy or lactose-free diet.

Many endurance athletes also reported successfully increasing carbohydrate around endurance exercise to mitigate Ex-GIS development.

Increasing carbohydrate intake around exercise is a well-advocated dietary method to facilitate carbohydrate availability, particularly for endurance and ultra-endurance athletes 3 , 29 , However, research has also shown that carbohydrate consumed during exercise facilitates splanchnic region blood flow It is possible this also promotes intestinal epithelial blood flow, reducing epithelium damage.

Indeed, carbohydrate or whey protein hydrolysate WPH ingestion before and during exercise ameliorates intestinal epithelial injury and reduces small intestine permeability 24 , which may also indicate maintenance of splanchnic blood flow.

However, given Ex-GIS severity is greater following WPH ingestion, carbohydrate is likely the preferential macronutrient due to protective mechanisms at the intestinal epithelium, fewer Ex-GIS, and a valuable exogenous fuel source for skeletal muscle A further consideration when increasing carbohydrate intakes is that athletes may inadvertently increase FODMAP loads due to many carbohydrate foods being associated with a higher FODMAP content, e.

Therefore, understanding which foods are rich in carbohydrates but lower in FODMAP content is a dietary strategy some athletes who experience Ex-GIS may have to learn how to apply. It is acknowledged that some athletes used a combination of dietary and non-dietary strategies to manage Ex-GIS and a smaller proportion used non-dietary strategies exclusively.

Relaxation and psychological interventions such as cognitive behavior therapy, hypnotherapy, or psychological therapy are recommended strategies for people with IBS These non-dietary interventions have the potential to reduce Ex-GIS in endurance athletes, but further research is required to confirm efficacy.

Observational studies indicate that there may be a link between anxiety or stress and GIS development in athletes 50 , but the effect on both functional e. Further research using randomized controlled cross-over or parallel trials into the use of non-dietary approaches as a strategy to manage Ex-GIS is required, in addition to applying recommended methodological approaches Given the subtleties of negotiating the most popular dietary strategies for managing Ex-GIS against current sports nutrition guidelines for endurance athletes, it is perhaps not surprising to learn that athletes mainly source support from accredited practicing dietitians.

Accredited practicing dietitians are uniquely skilled in addressing health and performance-related dietary requirements. It is suggested that an accredited practicing dietitian experienced in sports nutrition and the administration of acute dietary strategies for managing Ex-GIS be sought Specific nutritional guidance should be provided to individuals who experience Ex-GIS, especially regarding carbohydrate loading and acute carbohydrate intakes before and during exercise.

During training, dietary strategies should be trialed to establish individual tolerance and self-perceived efficacy before considering implementation during competition, e.

One of the limitations of the current study is that convenience sampling was applied, i. As all researchers were registered dietitians, it is possible that athletes had a better appreciation of the importance of receiving therapeutic dietary advice through a registered health professional.

It is also possible that athletes were from countries with greater access to a registered dietitian, e. non-western countries 47 , which may over-represent accredited practicing dietitians as the most common source of nutrition information for managing Ex-GIS.

Endurance athletes try different dietary methods to manage Ex-GIS, e. All of these dietary strategies tried were rated as successful. This is especially applicable for accredited practicing dietitians whom athletes often seek for nutrition information to manage Ex-GIS.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The studies involving human participants were reviewed and approved by the Human Research Ethics Committee—University of the Sunshine Coast, Australia ethics approval number: S RS and GS: conceptualization and writing—original draft.

RS, GS, RC, FP, and DL: methodology and writing—review and editing. RS: statistical analysis and project administration. GS: supervision. All authors contributed to the article and approved the submitted version. It is acknowledged that RS has received an Australian Government Research Training Program Scholarship for her research studies.

The support from the University of the Sunshine Coast and the Australian Government is gratefully received. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.

Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Deutsche Ultramarathon-Vereinigung. Ultra Marathon Statistics. org accessed April 9, Google Scholar.

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