• Simone do Carmo // MSc Physiology

Quality Control: How Good is the Food Athletes eat?

I was trained to use calorie and macronutrient calculations to determine requirements and optimal intakes for an athlete’s performance and goals. During my studies, there was never a big focus on food quality, i.e. the types of foods and their sourcing. It was always more about food as fuel and for maintaining performance. While that is obviously important for an athlete, I believe that food for health is paramount.

I first came across the phrase “quality before quantity” in the context of sports nutrition during a conference speech given by my mentor Ian Craig, an exercise physiologist and nutritional therapist based in Johannesburg. He was also educated within the traditional model of sports nutrition but soon realised that he was missing the larger picture of food quality.

Now, I am not saying that counting calories and macronutrients is not useful. In fact, I do this regularly with clients to obtain objective data, especially in cases where athletes are undereating or overeating, or trying to make weight for a competition. One should note that calorie and macronutrient counting can really only be used as an estimate since dietary analysis software is not flawless and the quantity of a particular food is highly subjective, unless the individual measures it accurately with a scale. However, I always emphasise the importance of food quality and ask clients to keep a simple food diary. This is an important tool for them to reflect on and so I can also see the type of foods they are consuming and make recommendations.

The main reason I do this is because an athlete’s health, body composition, performance and recovery is not just about simple equations based on height, body mass, gender, and physical activity levels. Each athlete is biochemically unique and needs to be treated as such. There are also huge variations in how individuals respond to diet and providing athletes with standardised nutrition advice is not necessarily going to give them the result they want. The standardised sports nutrition guidelines are useful as a starting point for an athlete but adjustments will almost certainly have to be made as each athlete will have their own preferences and tolerances, as recognised recently by a new position stand for athletic performance[1]. For example, the standard advice for an elite athlete who engages in high volume and high intensity exercise is to consume 8-12g/kg body weight of carbohydrates[2]. However, this particular athlete may actually thrive on a lower carbohydrate diet or a periodised approach. And just like each athlete is biochemically unique, the same applies to food: each food is its own entity and not just a calorie or macronutrient number. A fitting example used by Ian is that “a medium sized apple and four teaspoons of table sugar both have approximately 25 grams of carbs in them. The low-carb fraternity [and I would also add a lot of people following a flexible dieting approach] would lump them into the same nutritional basket, whereas I see one as a fruit with high pectin levels for good digestive health and the other as a nutrient-sapping usurper of health”[3].

Although there are no clear, standardised micronutrient (or micronutrient supplementation) guidelines for athletes, the existing guidelines do suggest a healthy, balanced diet to provide enough micronutrients[2]. They do mention vitamin D supplementation and that vegetarian athletes or athletes on severe energy-restricting diets may need to supplement with vitamins and minerals, such as vitamin B, iron, riboflavin, zinc and calcium[2]. However, the micronutrient guidelines are not as well-defined as the macronutrient guidelines and so the focus is often on the latter and overlooks the larger picture of food quality.

I also question the specificity of a “healthy, balanced” diet since this can have different meanings to different people. One might argue that an athlete who is meeting their macronutrient requirements is most likely meeting their micronutrient requirements (assuming they are not on an energy-restricting diet). Yet it is uncommon to see an athlete who does not have any micronutrient insufficiencies or deficiencies when analysing their food diary. This is often reflected in common symptoms, such as “not recovering properly”, “getting tired too quickly”, “not feeling as strong”, “my performance is not improving”, etc. Micronutrients are vital as they are enzymatic cofactors to many of the biological processes that occur in the body, such as the energy pathways. For example, if an athlete is not consuming enough B vitamins and magnesium, it is likely that their glycolysis and Krebs cycle will be compromised. Exactly why I advocate assessing an athlete’s food quality first and advising them to make better changes. Once they have that in place and are making the effort to change, then I focus on individual calorie and macronutrient requirements. If their symptoms persist, I would then advise them to do further testing and obtain biochemical measures of their nutritional status. I am currently learning more myself about functional testing, which is widely used by integrative health practitioners and can provide a wealth of information. The functional model of thinking is that all our bodily systems are interconnected and if one fails, it will affect the others. Taking this into account, if I simply focus on getting the right micronutrients to support an athlete’s energy pathways, I will not necessarily cover the needs of other systems that may have more immediate needs for these same micronutrients. I also consider an athlete’s stress levels and their sleeping habits as these are often common culprits.

To conclude, we are moving towards an era in which we can prescribe for the individual. This evolving science of nutrigenomics enables us to assess (and then prescribe) based on an individual’s genetic profile. It helps us understand what to eat and which (if any) supplements to use. For example, nutrigenomics explains how people store and metabolise fat. In particular, it explains why some people can eat a diet that is high in fat and have no problem with their cholesterol levels while others experience the exact opposite. Hopefully, this exciting area will become standard sport nutrition practice someday and routinely used to help athletes succeed.

  1. Thomas D, Erdman, K, Burke, L. American College of Sports Medicine Joint Statement. Nutrition and Athletic Performance. Med Sci Sport Exerc 2016; 48(3):543-568.

  2. Potgieter S. Sport Nutrition: A review of the latest guidelines for exercise and sport nutrition from the American College of Sport Nutrition, the International Olympic Committee and the International Society for Sports Nutrition. S Afr J Clin Nutr 2013; 26(1)6-16.

  3. Craig I (2017). Calories are cr**p [Blog post]. Retrieved from: https://www.thenutritionalinstitute.com/resources/blog/228-calories-are-c-p



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