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The popularity of natural bodybuilding is increasing; however, evidence-based recommendations for it are lacking. This paper reviewed the scientific literature relevant to competition preparation on nutrition and supplementation, resulting in the following recommendations. Caloric intake should be set at a level that results in bodyweight losses of approximately 0.5 to 1%/wk to maximize muscle retention. Within this caloric intake, most but not all bodybuilders will respond best to consuming 2.3-3.1 g/kg of lean body mass per day of protein, 15-30% of calories from fat, and the reminder of calories from carbohydrate. Eating three to six meals per day with a meal containing 0.4-0.5 g/kg bodyweight of protein prior and subsequent to resistance training likely maximizes any theoretical benefits of nutrient timing and frequency. However, alterations in nutrient timing and frequency appear to have little effect on fat loss or lean mass retention. Among popular supplements, creatine monohydrate, caffeine and beta-alanine appear to have beneficial effects relevant to contest preparation, however others do not or warrant further study. The practice of dehydration and electrolyte manipulation in the final days and hours prior to competition can be dangerous, and may not improve appearance. Increasing carbohydrate intake at the end of preparation has a theoretical rationale to improve appearance, however it is understudied. Thus, if carbohydrate loading is pursued it should be practiced prior to competition and its benefit assessed individually. Finally, competitors should be aware of the increased risk of developing eating and body image disorders in aesthetic sport and therefore should have access to the appropriate mental health professionals.
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R E V I E W Open Access
Evidence-based recommendations for natural
bodybuilding contest preparation: nutrition and
Eric R Helms
, Alan A Aragon
and Peter J Fitschen
The popularity of natural bodybuilding is increasing; however, evidence-based recommendations for it are lacking.
This paper reviewed the scientific literature relevant to competition preparation on nutrition and supplementation,
resulting in the following recommendations. Caloric intake should be set at a level that results in bodyweight
losses of approximately 0.5 to 1%/wk to maximize muscle retention. Within this caloric intake, most but not all
bodybuilders will respond best to consuming 2.3-3.1 g/kg of lean body mass per day of protein, 15-30% of calories
from fat, and the reminder of calories from carbohydrate. Eating three to six meals per day with a meal containing
0.4-0.5 g/kg bodyweight of protein prior and subsequent to resistance training likely maximizes any theoretical
benefits of nutrient timing and frequency. However, alterations in nutrient timing and frequency appear to have
little effect on fat loss or lean mass retention. Among popular supplements, creatine monohydrate, caffeine and
beta-alanine appear to have beneficial effects relevant to contest preparation, however others do not or warrant
further study. The practice of dehydration and electrolyte manipulation in the final days and hours prior to
competition can be dangerous, and may not improve appearance. Increasing carbohydrate intake at the end of
preparation has a theoretical rationale to improve appearance, however it is understudied. Thus, if carbohydrate
loading is pursued it should be practiced prior to competition and its benefit assessed individually. Finally,
competitors should be aware of the increased risk of developing eating and body image disorders in aesthetic
sport and therefore should have access to the appropriate mental health professionals.
Keywords: Hypertrophy, Calories, Frequency, Nutrient, Body fat, Resistance training, Competition
The popularity of natural bodybuilding is increasing rap-
idly. In the United States, over 200 amateur natural
(drug tested) bodybuilding contests occurred during
2013 and the number of contests is expected to increase
in 2014 [1]. Preparation for bodybuilding competition
involves drastic reductions in body fat while maintaining
muscle mass. This is typically achieved through a de-
creased caloric intake, intense strength training, and in-
creased cardiovascular exercise. Competitors partake in
numerous dietary and supplementation strategies to pre-
pare for a contest. Some have a strong scientific basis;
however, many do not. Therefore, the purpose of this
article is to review the scientific literature on topics rele-
vant to nutrition and supplementation for bodybuilding
competition preparation. Dietary modifications during
the last week to enhance muscle definition and fullness
(peaking) and psychosocial issues will also be covered.
Ultimately, evidence-based recommendations will be
made for nutrition, supplementation, and peak week
strategies for natural bodybuilders. As a final note, this
paper does not cover training recommendations for nat-
ural bodybuilding and the training methodology used
will interact with and modify the effects of any nutri-
tional approach.
PubMed, MEDLINE, SPORTDiscus and CINAHL elec-
tronic databases were searched online. Each author was
* Correspondence:
Sport Performance Research in New Zealand (SPRINZ) at AUT Millennium
Institute, AUT University, 17 Antares Place, Mairangi Bay, Auckland 0632,
New Zealand
Full list of author information is available at the end of the article
© 2014 Helms et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited.
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20
assigned a portion of the manuscript to write specific to
their area(s) of expertise. Authors performed searches
for key words associated with their portion(s) of the
manuscript; calories and macronutrients, nutrient timing
and meal frequency, dietary supplementation, psycho-
social issues and peak weekwere the selected topics.
The publications obtained were carefully screened for
studies that included healthy humans or humans in a
caloric deficit. Long-term human studies focusing on
hypertrophy and body fat loss were preferentially se-
lected; however, acute studies and/or studies using ani-
mal models were selected in the absence of adequate
long-term human studies. In addition, author names and
reference lists were used for further search of the se-
lected papers for related references. As this review is
intended to be an evidence-based guide and the available
data relevant to natural bodybuilding is extremely lim-
ited, a narrative review style was chosen.
Calories and macronutrients
Competitive bodybuilders traditionally follow two to
four month diets in which calories are decreased and en-
ergy expenditure is increased to become as lean as pos-
sible [2-6]. In addition to fat loss, muscle maintenance is
of primary concern during this period. To this end, opti-
mal caloric intakes, deficits and macronutrient combina-
tions should be followed while matching the changing
needs that occur during competition preparation.
Caloric intake for competition
To create weight loss, more energy must be expended
than consumed. This can be accomplished by increasing
caloric expenditure while reducing caloric intake. The
size of this caloric deficit and the length of time it is
maintained will determine how much weight is lost.
Every pound of pure body fat that is metabolized yields
approximately 3500 kcals, thus a daily caloric deficit of
500 kcals theoretically results in fat loss of approxi-
mately one pound per week if the weight loss comes en-
tirely from body fat [7]. However, a static mathematical
model does not represent the dynamic physiological ad-
aptations that occur in response to an imposed energy
deficit [8]. Metabolic adaptation to dieting has been
studied in overweight populations and when observed,
reductions in energy expenditure amount to as little as
79 kcal/d [9], to as much as 504 kcal/d beyond what is
predicted from weight loss [10]. Metabolic adaptations
to bodybuilding contest preparation have not been stud-
ied however; non-overweight men who consumed 50%
of their maintenance caloric intake for 24 weeks and lost
one fourth of their body mass experienced a 40% reduc-
tion in their baseline energy expenditure. Of that 40%
reduction 25% was due to weight loss, while metabolic
adaptation accounted for the remaining 15% [11]. There-
fore, it should be expected that the caloric intake at
which one begins their preparation will likely need to be
adjusted over time as body mass decreases and meta-
bolic adaptation occurs. A complete review of metabolic
adaptation to dieting in athletes is beyond the scope of
this review. However, coaches and competitors are en-
couraged to read the recent review on this topic by
Trexler et al. [12] which covers not only the physiology
of metabolic adaptation, but also potential methods to
mitigate its negative effects.
In determining an appropriate caloric intake, it should
be noted that the tissue lost during the course of an en-
ergy deficit is influenced by the size of the energy deficit.
While greater deficits yield faster weight loss, the per-
centage of weight loss coming from lean body mass
(LBM) tends to increase as the size of the deficit in-
creases [7,13-15]. In studies of weight loss rates, weekly
losses of 1 kg compared to 0.5 kg over 4 weeks resulted
in a 5% decrease in bench press strength and a 30%
greater reduction in testosterone levels in strength train-
ing women [16]. Weekly weight loss rates of 1.4% of
bodyweight compared to 0.7% in athletes during caloric
restriction lasting four to eleven weeks resulted in re-
ductions of fat mass of 21% in the faster weight loss
group and 31% in the slower loss group. In addition,
LBM increased on average by 2.1% in the slower loss
group while remaining unchanged in the faster loss
group. Worthy of note, small amounts of LBM were lost
among leaner subjects in the faster loss group [13].
Therefore, weight loss rates that are more gradual may
be superior for LBM retention. At a loss rate of 0.5 kg per
week (assuming a majority of weight lost is fat mass), a
70 kg athlete at 13% body fat would need to be no more
than 6 kg to 7 kg over their contest weight in order to
achieve the lowest body fat percentages recorded in com-
petitive bodybuilders following a traditional three month
preparation [4,6,17-20]. If a competitor is not this lean at
the start of the preparation, faster weight loss will be re-
quired which may carry a greater risk for LBM loss.
In a study of bodybuilders during the twelve weeks be-
fore competition, male competitors reduced their caloric
intake significantly during the latter half and subse-
quently lost the greatest amount of LBM in the final
three weeks [21]. Therefore, diets longer than two to
four months yielding weight loss of approximately 0.5 to
1% of bodyweight weekly may be superior for LBM re-
tention compared to shorter or more aggressive diets.
Ample time should be allotted to lose body fat to avoid an
aggressive deficit and the length of preparation should be
tailored to the competitor; those leaner dieting for shorter
periods than those with higher body fat percentages. It
must also be taken into consideration that the leaner the
competitor becomes the greater the risk for LBM loss
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 2 of 20
[14,15]. As the availability of adipose tissue declines the
likelihood of muscle loss increases, thus it may be best to
pursue a more gradual approach to weight loss towards
the end of the preparation diet compared to the beginning
to avoid LBM loss.
Determining macronutrient intake
Protein Adequate protein consumption during contest
preparation is required to support maintenance of LBM.
Athletes require higher protein intakes to support in-
creased activity and strength athletes benefit from higher
intakes to support growth of LBM [5,22-28]. Some re-
searchers suggest these requirements increase further
when athletes undergo energy restriction [13,16,22,28-33].
Furthermore, there is evidence that protein requirements
are higher for leaner individuals in comparison to those
with higher body fat percentages [7,33,34].
The collective agreement among reviewers is that a pro-
tein intake of 1.2-2.2 g/kg is sufficient to allow adaptation
to training for athletes whom are at or above their energy
needs [23-28,35-38]. However, bodybuilders during their
contest preparation period typically perform resistance and
cardiovascular training, restrict calories and achieve very
lean conditions [2-6,17-21]. Each of these factors increases
protein requirements and when compounded may further
increase protein needs [33]. Therefore, optimal protein in-
takes for bodybuilders during contest preparation may be
significantly higher than existing recommendations.
In support of this notion, Butterfield et al. [22] found
that male athletes running five to 10 miles per day dur-
ing a slight caloric deficit were in a significant negative
nitrogen balance despite consuming 2 g/kg of protein
daily. Celejowa et al. [39] showed that five out of 10
competitive weight lifters achieved a negative nitrogen
balance over the course of a training camp while con-
suming an average protein intake of 2 g/kg. Out of these
five, as many as three were in a caloric deficit. The au-
thors concluded that a protein intake of 22.2 g/kg
under these conditions only allows for a small margin of
error before nitrogen losses occur.
Walberg et al. [32] examined the effects of two energy
restricted isocaloric diets of differing protein intakes in
19 lean (9.1-16.7% body fat), male, non-competitive
body builders. One group consumed a protein intake of
0.8 g/kg and higher carbohydrates, while the other con-
sumed 1.6 g/kg of protein with lower carbohydrates. The
length of the intervention was only one week, but none-
theless nitrogen losses occurred only in the lower pro-
tein group and LBM decreased by a mean of 2.7 kg in
the 0.8 g/kg protein group and by a mean of 1.4 kg in
the 1.6 g/kg protein group. While the high protein group
mitigated LBM losses compared to the low protein
group, they were not eliminated.
A recent study by Mettler et al. [29] employed the same
basic methodology as Walberg et al. [32]. However, one
group consumed a protein intake of 1 g/kg, while the
other consumed 2.3 g/kg. The high-protein group lost sig-
nificantly less LBM (0.3 kg) over the course of the two
week intervention compared to the low-protein group
(1.6 kg). Unlike Walberg et al. [32] calorie balance be-
tween diets was maintained by reducing dietary fat as op-
posed to carbohydrate to allow for the increase in protein.
While it appears that the 2.3 g/kg protein intervention
in Mettler et al. [29] was superior for maintaining LBM
compared to 1.6 g/kg in Walberg et al. [32] a recent
study by Pasiakos et al. [40] found a trend towards the
opposite. In this study, a non-significant trend of greater
LBM retention occurred when subjects consumed 1.6
g/kg of protein compared to 2.4 g/kg of protein. How-
ever, the participants were intentionally prescribed low
volume, low intensity resistance training "to minimize
the potential of an unaccustomed, anabolic stimulus
influencing study outcome measures". Thus, the non-
anabolic nature of the training may not have increased
the participantsprotein requirements to the same de-
gree as the participants in Mettler et al. [29] or to what
would be expected among competitive bodybuilders.
Maestu et al. [6] did not observe a significant loss of
LBM in a group of drug free bodybuilders consuming
2.5-2.6 g/kg of protein during the 11 weeks prior to
competition. These results when considered alongside
the works by Walberg et al. [32] and Mettler et al. [29]
imply that the higher the protein intake, the lower the
chance for LBM loss. However, it should be noted that
this study did not include a low protein control and not
all studies show a linear increase in LBM preservation
with increases in protein [40]. Furthermore, two subjects
did lose significant amounts of LBM (1.5 kg and 1.8 kg),
and the authors noted that these specific bodybuilders
were among the leanest of the subjects. These two sub-
jects lost the majority of their LBM (approximately 1 kg)
during the latter half of the intervention as their per-
centage of calories from protein increased from 28% to
32-33% by the end of the study. The group as a whole
progressively decreased their calories by reducing all
three macronutrients throughout the investigation.
Thus, the two subjects uniquely increased their propor-
tion of protein, possibly reducing fat and carbohydrate
to the point of detriment [6]. That said it is also plaus-
ible that the lost LBM seen by these two subjects was
necessary in order to achieve their low levels of body fat.
It is unknown whether or not the lost LBM influenced
their competitive outcome and it is possible that had the
competitors not been as lean, they may have retained
more LBM but also not have placed as well.
In a review by Phillips and Van Loon [28], it is sug-
gested that a protein intake of 1.8-2.7 g/kg for athletes
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 3 of 20
training in hypocaloric conditions may be optimal.
While this is one of the only recommendations existing
that targets athletes during caloric restriction, this rec-
ommendation is not given with consideration to body-
builders performing concurrent endurance and resistance
training at very low levels of body fat. However, the re-
cently published systematic review by Helms et al. [33] on
protein intakes in resistance-trained, lean athletes during
caloric restriction suggests a range of 2.3-3.1 g/kg of LBM,
which may be more appropriate for bodybuilding. More-
over, the authors suggest that the lower the body fat of the
individual, the greater the imposed caloric deficit and
when the primary goal is to retain LBM, the higher the
protein intake (within the range of 2.3-3.1 g/kg of LBM)
should be.
Carbohydrate High carbohydrate diets are typically
thought to be the athletic performance standard. How-
ever, like protein, carbohydrate intake needs to be cus-
tomized to the individual. Inadequate carbohydrate can
impair strength training [41] and consuming adequate
carbohydrate prior to training can reduce glycogen de-
pletion [42] and may therefore enhance performance.
While it is true that resistance training utilizes glyco-
gen as its main fuel source [43], total caloric expenditure
of strength athletes is less than that of mixed sport and
endurance athletes. Thus, authors of a recent review rec-
ommend that carbohydrate intakes for strength sports,
including bodybuilding, be between 47 g/kg depending
on the phase of training [26]. However, in the specific
case of a bodybuilder in contest preparation, achieving
the necessary caloric deficit while consuming adequate
protein and fat would likely not allow consumption at
the higher end of this recommendation.
Satiety and fat loss generally improve with lower carbo-
hydrate diets; specifically with higher protein to carbohy-
drate ratios [44-49]. In terms of performance and health,
low carbohydrate diets are not necessarily as detrimental
as typically espoused [50]. In a recent review, it was rec-
ommended for strength athletes training in a calorically
restricted state to reduce carbohydrate content while in-
creasing protein to maximize fat oxidation and preserve
LBM [28]. However, the optimal reduction of carbohy-
drate and point at which carbohydrate reduction becomes
detrimental likely needs to be determined individually.
One comparison of two isocaloric, energy restricted
diets in bodybuilders showed that a diet that provided
adequate carbohydrate at the expense of protein (1 g/kg)
resulted in greater LBM losses compared to a diet that
increased protein (1.6 g/kg) through a reduction of
carbohydrate [32]. However, muscular endurance was
degraded in the lower carbohydrate group. In a study of
athletes taking in the same amount of protein (1.6 g/kg)
during weight loss, performance decrements and LBM
losses were avoided when adequate carbohydrate was
maintained and dietary fat was lowered [13]. Mettler,
et al. [29] also found that a caloric reduction coming
from dietary fat while maintaining adequate carbohy-
drate intake and increasing protein to 2.3 g/kg main-
tained performance and almost completely eliminated
LBM losses in resistance trained subjects. Finally, in
Pasiakos et al. [40] participants undergoing an equal cal-
orie deficit and consuming the same amount of protein
as those observed in Mettler et al. [29] lost three times
the amount of LBM over the same time period (0.9 kg in
the first two weeks of energy restriction observed by
Pasiakos versus 0.3 kg observed by Mettler). One key
difference between these studies was the highest protein
group in Mettler et al. [29] consumed a 51% carbohy-
drate diet while the comparable group in Pasiakos et al.
[40] consumed a 27% carbohydrate diet. While perform-
ance was not measured, the participants in Pasiakos
et al. [40] performing sets exclusively of 15 repetitions
very likely would have experienced decrements in per-
formance due to this carbohydrate intake level [32]. The
difference in training protocols or a nutritionally medi-
ated decrement in training performance could have
either or both been components that lead to the greater
losses of LBM observed by Pasiakos et al. [40].
While it appears low carbohydrate, high protein diets
can be effective for weight loss, a practical carbohydrate
threshold appears to exist where further reductions
negatively impact performance and put one at risk for
LBM losses. In support of this notion, researchers study-
ing bodybuilders during the final 11 weeks of contest
preparation concluded that had they increased carbohy-
drate during the final weeks of their diet they may have
mitigated metabolic and hormonal adaptations that were
associated with reductions in LBM [6].
Therefore, once a competitor has reached or has
nearly reached the desired level of leanness, it may be a
viable strategy to reduce the caloric deficit by an in-
crease in carbohydrate. For example, if a competitor has
reached competition body fat levels (lacking any visible
subcutaneous fat) and is losing half a kilogram per week
(approximately a 500 kcals caloric deficit), carbohydrate
could be increased by 25-50 g, thereby reducing the cal-
oric deficit by 100-200 kcals in an effort to maintain per-
formance and LBM. However, it should be noted that
like losses of LBM, decrements in performance may not
affect the competitive outcome for a bodybuilder. It is
possible that competitors who reach the leanest condi-
tion may experience unavoidable drops in performance.
Fat The importance of carbohydrate and protein in sports
nutrition is often emphasized over that of dietary fat. Sub-
sequently, recommendations typically focus on maintain-
ing adequate fat intake while emphasizing carbohydrate to
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 4 of 20
fuel performance and protein to build and repair LBM.
However, there is evidence that dietary fat influences ana-
bolic hormone concentrations which may be of interest
to bodybuilders attempting to maintain LBM while diet-
ing [5,26,51,52].
Reductions in the percentage of dietary fat in isocalo-
ric diets from approximately 40% to 20% has resulted in
modest, but significant, reductions in testosterone levels
[53,54]. However, distinguishing the effects of reducing
total dietary fat on hormonal levels from changes in cal-
oric intake and percentages of saturated and unsaturated
fatty acids in the diet is difficult [51,52,55]. In a study by
Volek et al. [51], correlations were found between testos-
terone levels, macronutrient ratios, types of lipids, and
total dietary fat, illustrating a complex interaction of var-
iables. In a similar study of resistance trained males, cor-
relations were found between testosterone, protein, fat
and saturated fat which lead the researchers to conclude
that diets too low in fat or too high in protein might im-
pair the hormonal response to training [52].
Competing bodybuilders must make an obligatory cal-
oric reduction. If a reduction in fat is utilized, it may be
possible to attenuate a drop in testosterone by maintain-
ing adequate consumption of saturated fat [5]. However, a
drop in testosterone does not equate to a reduction in
LBM. In direct studies of resistance trained athletes
undergoing calorically restricted high protein diets, low fat
interventions that maintain carbohydrate levels [13,29] ap-
pear to be more effective at preventing LBM loses than
lower carbohydrate, higher fat approaches [32,40]. These
results might indicate that attempting to maintain resist-
ance training performance with higher carbohydrate in-
takes is more effective for LBM retention than attempting
to maintain testosterone levels with higher fat intakes.
Body composition and caloric restriction may play
greater roles in influencing testosterone levels that fat
intake. During starvation, a reduction in testosterone oc-
curs in normal weight, but not obese, males [56]. In
addition, rate of weight loss may influence testosterone
levels. Weekly target weight loss rates of 1 kg resulted in
a 30% reduction in testosterone compared to target
weight loss rates of 0.5 kg per week in resistance trained
women of normal weight [16]. Additionally, an initial
drop in testosterone occurred in the first six weeks of
contest preparation in a group of drug free bodybuilders
despite various macronutrient percentages [6]. Finally, in
a one year case study of a natural competitive body-
builder, testosterone levels fell to one fourth their base-
line values three months into the six month preparation
period. Levels then fully recovered three months into
the six month recovery period. Testosterone did not de-
cline further after the initial drop at the three month
mark despite a slight decrease in fat intake from 27% to
25% of calories at the six month mark. Furthermore, the
quadrupling of testosterone during the recovery period
from its suppressed state back to baseline was accom-
panied by a 10 kg increase in body mass and a 1000 kcal
increase in caloric intake. However, there was only a
minor increase in calories from fat (percentage of calo-
ries from fat during recovery was between (30 and 35%)
[57]. Finally, these testosterone changes in men appear
mostly related to energy availability (body fat content
and energy balance), and not surprisingly low-levels of
sustained energy availability are also the proposed cause
of the hormonal disturbance athletic amenorrheain
women [58]. Thus, the collective data indicates that
when extremely lean body compositions are attained
through extended, relatively aggressive dieting, the cal-
oric deficit and loss of body fat itself may have a greater
impact on testosterone than the percentage of calories
coming from dietary fat.
While cogent arguments for fat intakes between 20 to
30% of calories have been made to optimize testosterone
levels in strength athletes [59], in some cases this intake
may be unrealistic in the context of caloric restriction
without compromising sufficient protein or carbohydrate
intakes. While dieting, low carbohydrate diets may de-
grade performance [32] and lead to lowered insulin and
IGF-1 which appear to be more closely correlated to
LBM preservation than testosterone [6]. Thus, a lower
end fat intake between 15-20% of calories, which has
been previously recommended for bodybuilders [5], can
be deemed appropriate if higher percentages would re-
duce carbohydrate or protein below ideal ranges.
Ketogenic diets and individual variability
Some bodybuilders do use very-low carbohydrate, "keto-
genic diets" for contest preparation [60,61]. While these
diets have not been sufficiently studied in bodybuilders,
some study of ketogenic diets has occurred in resistance
trained populations. In an examination of the effects of a
1 week ketogenic diet (5.4% of calories from carbohy-
drate) in subjects with at least 2 years of resistance train-
ing experience, Sawyer et al. [62] observed slight
decreases in body fat among female participants and
maintenance or slight increases in measures of strength
and power among both male and female participants.
However, it is difficult to draw conclusions due to the
very short term nature of this study and due to an ad
libitum implementation of the ketogenic diet. As imple-
mented in this study, besides a reduction in carbohy-
drate and an increase in dietary fat, the ketogenic diet
resulted in an average reduction of 381 calories per day
and an increase of 56 g of protein per day compared to
the participantshabitual diets. Thus, it is unclear
whether the improvements in body composition and
performance can be attributed to the low-carbohydrate
and high-fat nature of the diets or rather a decrease in
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 5 of 20
calories and an increase in protein. At least with regards
to weight loss, previous research indicates that the often
concomitant increase in protein observed in very low
carbohydrate diets may actually be the key to their suc-
cess [63].
The only research on strength athletes following keto-
genic diets for longer periods is a study of gymnasts in
which they were observed to maintain strength perform-
ance and lose more body fat after 30 days on a ketogenic
diet in comparison to 30 days on a traditional western
diet [64]. However, this study's sample size was limited
(n = 8) and it was not a controlled study of an intentional
fat-loss phase such as seen among bodybuilders during
competition preparation. Therefore, more study is needed
in resistance trained populations and bodybuilders before
definitive recommendations can be made to support keto-
genic diets.
However, the research that does exist challenges trad-
itional views on carbohydrate and anaerobic perform-
ance. Despite the common belief that carbohydrate is
the sole fuel source for weight training, intramuscular
triglyceride is used during short term heavy resistance
training [65] and likely becomes an increasingly viable fuel
source for those adapted to high-fat low-carbohydrate di-
ets. While some might suggest that this implies a keto-
genic diet could be a viable option for contest preparation,
a trend of decreased performance and impaired mainten-
ance of FFM is associated with lower carbohydrate intakes
in the majority of studies included in this review.
While it is our contention that the majority of the evi-
dence indicates that very-low carbohydrate diets should
be avoided for contest preparation (at least until more re-
search is performed), it must be noted that there is a high
degree of variability in the way that individuals respond to
diets. Carbohydrate and fat utilization as a percentage of
energy expenditure at rest and various intensities has as
much as a four-fold difference between individual athletes;
which is influenced by muscle fiber-composition, diet, age,
training, glycogen levels and genetics [66]. Additionally,
individuals that are more insulin sensitive may lose more
weight with higher-carbohydrate low-fat diets while those
more insulin resistant may lose more weight with lower-
carbohydrate higher-fat diets [67].
Due to this individual variability, some popular com-
mercial bodybuilding literature suggests that somato-
type and/or body fat distribution should be individually
assessed as a way of determining macronutrient ratios.
However, there is no evidence of any relationships with
bone structure or regional subcutaneous fat distribution
with any response to specific macronutrient ratios in
bodybuilders or athletic populations. Bodybuilders, like
others athletes, most likely operate best on balanced
macronutrient intakes tailored to the energy demands
of their sport [68].
In conclusion, while the majority of competitors will
respond best to the fat and carbohydrate guidelines we
propose, the occasional competitor will undoubtedly re-
spond better to a diet that falls outside of these sug-
gested ranges. Careful monitoring over the course of a
competitive career is required to determine the optimal
macronutrient ratio for pre-contest dieting.
Macronutrient recommendations summary
After caloric intake is established based on the time
frame before competition [69], body composition of the
athlete [14,15,34], and keeping the deficit modest to
avoid LBM losses [13,16], macronutrients can be deter-
mined within this caloric allotment. Table 1 provides an
overview of these recommendations.
If training performance degrades it may prove beneficial
to decrease the percentage of calories from dietary fat
within these ranges in favor of a greater proportion of
carbohydrate. Finally, while outside of the norm, some
competitors may find that they respond better to diets
that are higher in fat and lower in carbohydrate than rec-
ommended in this review. Therefore, monitoring of indi-
vidual response over a competitive career is suggested.
Nutrient timing
Traditional nutrient timing guidelines are typically based
on the needs of endurance athletes. For example, it is
common lore that post-exercise carbohydrate must elicit a
substantial glycemic and insulinemic response in order to
optimize recovery. The origin of this recommendation can
be traced back to 1988, when Ivy et al. [70] put fasted
subjects through a glycogen-depleting cycling bout and
compared the rate of glycogen resynthesis from a carbo-
hydrate solution (2 g/kg) consumed either immediately
after, or two hours after the bout. Glycogen storage was
23 times faster in the immediate condition during four
hours post-exercise resulting in greater glycogen storage
at four hours.
These findings initiated the faster-is-better post-
exercise guideline for carbohydrate. However, complete
glycogen resynthesis to pre-trained levels can occur well
within 24 hours given sufficient total carbohydrate intake.
Jentjens and Jeukendrup [71] suggest that a between-bout
period of eight hours or less is grounds for maximally
Table 1 Dietary recommendations for bodybuilding
contest preparation
Diet component Recommendation
Protein (g/kg of LBM) 2.3-3.1 [33]
Fat (% of total calories) 15-30% [5,59]
Carbohydrate (% of total calories) remaining
Weekly weight loss (% of body weight) 0.5-1% [13,16]
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 6 of 20
expediting glycogen resynthesis. Therefore, the urgency of
glycogen resynthesis is almost an exclusive concern of en-
durance athletes with multiple glycogen-depleting events
separated by only a few hours. Bodybuilders in contest
preparation may exceed a single training bout per day
(e.g., weight-training in the morning, cardio in the evening).
However, bodybuilders do not have the same performance
objectives as multi-stage endurance competition, where the
same muscle groups are trained to exhaustion in a repeated
manner within the same day. Furthermore, resistance
training bouts are typically not glycogen-depleting. High-
intensity (70-80% of 1 RM), moderate-volume (69 sets per
muscle group) bouts have been seen to reduce glycogen
stores by roughly 36-39% [72,73].
A more relevant question to bodybuilding may be
whether protein and/or amino acid timing affect LBM
maintenance. With little exception [74], acute studies
have consistently shown that ingesting protein/essential
amino acids and carbohydrate near or during the train-
ing bout can increase muscle protein synthesis (MPS)
and suppress muscle protein breakdown [75-79]. How-
ever, there is a disparity between short- and long-term
outcomes in studies examining the effect of nutrient
timing on resistance training adaptations.
To-date, only a minority of chronic studies have shown
that specific timing of nutrients relative to the resistance
training bout can affect gains in muscular size and/or
strength. Cribb and Hayes [80] found that timing a sup-
plement consisting of 40 g protein, 43 g carbohydrate, and
7 g creatine immediately pre- and post-exercise resulted
in greater size and strength gains than positioning the
supplement doses away from the training bout. Addition-
ally, Esmarck et al. [81] observed greater hypertrophy in
subjects who ingested a supplement (10 g protein, 8 g
carbohydrate, 3 g fat) immediately post-exercise than sub-
jects who delayed the supplement 2 hours post-exercise.
In contrast, the majority of chronic studies have not
supported the effectiveness of timing nutrients (protein
in particular) closely around the training bout. Burk
et al. [82], found that a time-divided regimen (two 35 g
protein doses consumed at far-off points in the morning
and evening away from the afternoon training bout)
caused slightly better gains in squat strength and fat-free
mass than the time-focused regimen, where the protein
supplement doses were consumed in the morning, and
then again immediately prior to the resistance training
bout. Hoffman et al. [83] found no significant differences
in strength gains or body composition when comparing
an immediate pre- and post-exercise supplement inges-
tion (each dose provided 42 g protein) with the supple-
ment ingested distantly separate from each side of the
training bout. This lack of effect was attributed to the
subjectssufficient daily protein consumption combined
with their advanced lifting status. Wycherley et al. [84]
examined the effects of varying nutrient timing on over-
weight and obese diabetics. A meal containing 21 g pro-
tein consumed immediately before resistance training
was compared with its consumption at least two hours
after training. No significant differences in weight loss,
strength gain, or cardio metabolic risk factor reductions
were seen. Most recently, Weisgarber et al. [85] ob-
served no significant effect on muscle mass and strength
from consuming whey protein immediately before or
throughout resistance training.
Its important to note that other chronic studies are re-
ferred to as nutrient timing studies, but have not matched
total protein intake between conditions. These studies ex-
amined the effect of additional nutrient content, rather
than examining the effect of different temporal placement
of nutrients relative to the training bout. Thus, they can-
not be considered true timing comparisons. Nevertheless,
these studies have yielded inconsistent results. Willoughby
et al. [86] found that 10 weeks of resistance training sup-
plemented with 20 g protein and amino acids 1 hour pre-
and post-exercise increased strength performance and
MPS compared to an energy-matched carbohydrate pla-
cebo. Hulmi et al. [87] found that 21 weeks of supple-
menting 15 g of whey before and after resistance training
increased size and altered gene expression favorably to-
wards muscle anabolism in the vastus lateralis. In contrast
to the previous 2 studies, Verdijk et al. [88] found no sig-
nificant effect of 10 g protein timed immediately before
and after resistance training over a 12-week period. The
authors attributed this lack of effect to an adequate total
daily protein intake. Recently, a 12-week trial by Erksine
et al. [89] reported a lack of effect of 20 g protein taken
pre- and post-exercise compared to placebo.
The disparity of outcomes between the acute and
chronic studies could also potentially be due to a longer
anabolic windowthan traditionally thought. Burd and
colleagues [90] found that resistance training to failure
can cause an increased anabolic response to protein
feedings that can last up to 24 hours. Demonstrating the
body's drive toward equilibrium, Deldicque et al. [91]
observed a greater intramyocellular anabolic response in
fasted compared to fed subjects given a post-exercise
carbohydrate/protein/leucine mixture. This result sug-
gests that the body is capable of anabolic supercompen-
sation despite the inherently catabolic nature of fasted
resistance training. These data, in addition to the previ-
ously discussed chronic studies, further support the idea
that macronutrient totals by the end of the day may be
more important than their temporal placement relative
to the training bout.
There are additional factors that might explain the
lack of consistent effectiveness of nutrient timing in
chronic studies. Training status of the subjects could in-
fluence outcomes since novice trainees tend to respond
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 7 of 20
similarly to a wider variety of stimuli. Another possible
explanation for the lack of timing effects is the protein
dose used, 1020 g, which may not be sufficient to elicit a
maximal anabolic response. MPS rates have been shown
to plateau with a post-exercise dose of roughly 20 g of
high-quality protein [92]. However, in subsequent research
on older subjects, Yang et al. [93] observed that an even
higher post-exercise protein dose (40 g) stimulated MPS
to a greater extent than 10 g or 20 g.
In addition to the paucity of studies using ample protein
doses, there is a lack of investigation of protein-
carbohydrate combinations. Only Cribb and Hayes [80]
have compared substantial doses of both protein (40 g)
and carbohydrate (43 g) taken immediately surrounding,
versus far apart from both sides of the training bout.
Nearly double the lean mass gains were seen in the prox-
imally timed compared to the distally timed condition.
However, acute studies examining the post-exercise ana-
bolic response elicited by co-ingesting carbohydrate with
protein have thus far failed to show significant effects
given a sufficient protein dose of approximately 2025 g
[94,95]. These results concur with previous data indicat-
ing that only moderate insulin elevations (1530 mU/L)
are required to maximize net muscle protein balance in the
presence of elevated plasma amino acids [96]. Koopman
et al. [97] observed a similar lack of carbohydrate-
mediated anabolic effect when protein was administered
at 0.3 g/kg/hr in the post-exercise recovery period.
Questions remain about the utility of consuming pro-
tein and/or carbohydrate during bodybuilding-oriented
training bouts. Since these bouts typically do not resem-
ble endurance bouts lasting 2 hours or more, nutrient
consumption during training is not likely to yield any
additional performance-enhancing or muscle -sparing
benefits if proper pre-workout nutrition is in place. In
the exceptional case of resistance training sessions that
approach or exceed two hours of exhaustive, continuous
work, it might be prudent to employ tactics that maximize
endurance capacity while minimizing muscle damage.
This would involve approximately 815 g protein co-
ingested with 3060 g carbohydrate in a 6-8% solution per
hour of training [98]. Nutrient timing is an intriguing area
of study that focuses on what might clinch the competitive
edge. In terms of practical application to resistance train-
ing bouts of typical length, Aragon and Schoenfeld [99]
recently suggested a protein dose corresponding with 0.4-
0.5 g/kg bodyweight consumed at both the pre- and post-
exercise periods. However, for objectives relevant to body-
building, the current evidence indicates that the global
macronutrient composition of the diet is likely the most
important nutritional variable related to chronic training
adaptations. Figure 1 below provides a continuum of im-
portance with bodybuilding-specific context for nutrient
Meal frequency
Previous optimal meal frequency studies have lacked
structured resistance training protocols. Moreover, there
are no studies that specifically examined meal frequency
in bodybuilders, let alone during contest preparation
conditions. Despite this limitation, the available research
has consistently refuted the popular belief that a grazing
pattern (smaller, more frequent meals) raises energy ex-
penditure compared to a gorging pattern (larger, less fre-
quent meals). Disparate feeding patterns ranging from
two to seven meals per day have been compared in
tightly controlled studies using metabolic chambers, and
no significant differences in 24-hour thermogenesis have
been detected [100,101]. It should be noted that irregu-
lar feeding patterns across the week, as opposed to
maintaining a stable daily frequency, has been shown to
decrease post-prandial thermogenesis [102] and ad-
versely affect insulin sensitivity and blood lipid profile
[103]. However, relevance of the latter findings might be
limited to sedentary populations, since regular exercise
is well-established in its ability to improve insulin sensi-
tivity and blood lipids.
Bodybuilders typically employ a higher meal frequency
in an attempt to optimize fat loss and muscle preserva-
tion. However, the majority of chronic experimental
studies have failed to show that different meal frequen-
cies have different influences on bodyweight or body
composition [104-108]. Of particular interest is the re-
search examining the latter, since the preservation of
muscle mass during fat loss is a paramount concern in
the pre-contest phase. A recent review by Varady [109]
examined 11 daily caloric restriction (CR) studies and 7
intermittent calorie restriction (ICR) studies. CR in-
volved a linear consumption of 15-60% of baseline needs
every day, while ICR alternated ad libitum feeddays
with fastdays involving partial or total food intake re-
striction. It was concluded that although both types have
similar effects on total bodyweight reduction, ICR has
thus far been more effective for retaining lean mass.
Three of the ICR studies showed no significant decrease
in LBM, while all of the CR studies showed decreased
LBM. However, the majority of the ICR trials used bio-
electrical impedance analysis (BIA) to measure body
composition, while the majority of CR studies used dual
X-ray absorptiometry (DXA) or magnetic resonance im-
aging (MRI). These methods have been shown to have
greater accuracy than BIA [110-112], so the results of
Varadys [109] analysis should be interpreted with cau-
tion. Along these lines, Stote et al. [113] found that com-
pared to three meals per day, one meal per day caused
slightly more weight and fat loss. Curiously, the one
meal per day group also showed a slight gain in lean
mass, but this could have been due to the inherent error
in BIA for body composition assessment.
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 8 of 20
To-date, only two experimental studies have used
trained, athletic subjects. Iwao et al. [114] found that
boxers consuming six meals a day lost less LBM and
showed lower molecular measures of muscle catabolism
than the same diet consumed in two meals per day.
However, limitations to this study included short trial
duration, subpar assessment methods, a small sample
size, and a 1200 kcal diet which was artificially low com-
pared to what this population would typically carry out
in the long-term. It is also important to note that protein
intake, at 20% of total kcal, amounted to 60 g/day which
translates to slightly under 1.0 g/kg. To illustrate the in-
adequacy of this dose, Mettler et al. [29] showed that
protein as high as 2.3 g/kg and energy intake averaging
2022 kcal was still not enough to completely prevent
LBM loss in athletes under hypocaloric conditions. The
other experimental study using athletic subjects was
by Benardot et al. [115], who compared the effects of
adding three 250 kcal between-meal snacks with the
addition of a noncaloric placebo. A significant increase
in anaerobic power and lean mass was seen in the snack-
ing group, with no such improvements seen in the pla-
cebo group. However, it is not possible to determine if
the superior results were the result of an increased meal
frequency or increased caloric intake.
A relatively recent concept with potential application
to meal frequency is that a certain minimum dose of
leucine is required in order to stimulate muscle protein
synthesis. Norton and Wilson [116] suggested that this
threshold dose is approximately 0.05 g/kg, or roughly
3 g leucine per meal to saturate the mTOR signaling
pathway and trigger MPS. A related concept is that MPS
can diminish, or become 'refractory' if amino acids are
held at a constant elevation. Evidence of the refractory
phenomenon was shown by Bohé et al. [117], who ele-
vated plasma amino acid levels in humans and observed
that MPS peaked at the 2-hour mark, and rapidly de-
clined thereafter despite continually elevated blood
amino acid levels. For the goal of maximizing the ana-
bolic response, the potential application of these data
would be to avoid spacing meals too closely together. In
addition, an attempt would be made to reach the leucine
threshold with each meal, which in practical terms
would be to consume at least 3040 g high-quality pro-
tein per meal. In relative agreement, a recent review by
Phillips and Van Loon [28] recommends consuming
one's daily protein requirement over the course of three
to four isonitrogenous meals per day in order to maximize
the acute anabolic response per meal, and thus the rate of
muscle gain.
It is important to note that the leucine threshold and
the refractory nature of MPS are not based on human
feeding studies that measure concrete outcomes over the
long-term. These ideas are largely based on mechanistic
studies whose data was derived via steady intravenous in-
fusion of amino acids [117,118]. Long-term studies are
needed to determine if the refractory nature of MPS seen
in acute infusion data would have any real impact on the
gain or preservation of LBM at various meal frequencies.
Munster and Saris [119] recently shed further light on
what might be optimal in the context of pre-contest
dieting. Lean, healthy subjects underwent 36-hour pe-
riods in a respiration chamber. Interestingly, three meals
per day resulted in higher protein oxidation and RMR,
Figure 1 Continuum of nutrient & supplement timing importance.
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 9 of 20
along with lower overall blood glucose concentrations
than an isoenergetic diet composed of 14 meals per day.
The lower glucose AUC observed in this study is in agree-
ment with previous research by Holmstrup et al. [120],
who reported lower 12-hour glucose concentrations as a
result of consuming three high-carbohydrate meals com-
pared to the equivalent distributed over the course of six
meals. Another interesting finding by Munster and Saris
[119] was lower hunger and higher satiety ratings in the
lower meal frequency condition. This finding concurred
with previous work by Leidy et al. [121], who compared
varying protein levels consumed across either three or six
meals per day. Predictably, the higher-protein level (25%
vs. 14%) promoted greater satiety. Interestingly, the higher
meal frequency led to lower daily fullness ratings regard-
less of protein level. Meal frequency had no significant im-
pact on ghrelin levels, regardless of protein intake. PYY, a
gut peptide associated with satiety, was 9% lower in the
higher meal frequency condition. However, Arciero et al.
[122] recently found that six meals per day in a high-
protein condition (35% of total energy) were superior to
three meals with a high-protein or traditional protein in-
take (15% of total energy) for improving body composition
in overweight subjects. The discrepancy between Leidy et
als short-term effects and Arcieros chronic effects war-
rants further study, preferably in subjects undergoing pro-
gressive resistance training.
Other common meal frequencies (i.e., 4 or 5 meals per
day) have eluded scientific investigation until very re-
cently. Adechian et al. [123] compared whey versus ca-
sein consumed in either a 'pulse' meal pattern (8/80/4/8%)
or a 'spread' pattern (25/25/25/25%) over a six week
hypocaloric period. No significant changes were seen in
body composition between conditions. These outcomes
challenge Phillips and Van Loon's recommendation for
protein-rich meals throughout the day to be isonitro-
genous (40). Moore et al. [124] compared evenly spaced
distributions of two, four, and eight meals consumed
after a fasted, acute bout of bilateral knee extension. A
trend toward a small and moderate increase in net pro-
tein balance was seen in the four meal and eight meal
conditions, respectively, compared to the two meal con-
dition. Subsequent work by Areta et al. [125] using the
same dosing comparison found that the four meal treat-
ment (20 g protein per meal) caused the greatest in-
crease in myofibrillar protein synthesis. A limitation of
both of the previous studies was the absence of other
macronutrients (aside from protein in whey) consumed
during the 12-hour postexercise period. This leaves
open questions about how a real-world scenario with
mixed meals might have altered the outcomes. Further-
more, these short-term responses lack corroboration in
chronic trials measuring body composition and/or exer-
cise performance outcomes.
The evidence collectively suggests that extreme lows
or highs in meal frequency have the potential to threaten
lean mass preservation and hunger control during body-
building contest preparation. However, the functional
impact of differences in meal frequency at moderate
ranges (e.g., 36 meals per day containing a minimum of
20 g protein each) are likely to be negligible in the con-
text of a sound training program and properly targeted
total daily macronutrition.
Nutritional supplementation
When preparing for a bodybuilding contest, a competi-
tor primarily focuses on resistance training, nutrition,
and cardiovascular training; however, supplements may
be used to further augment preparation. This section
will discuss the scientific evidence behind several of the
most commonly used supplements by bodybuilders.
However, natural bodybuilding federations have exten-
sive banned substance lists [126]; therefore, banned sub-
stances will be omitted from this discussion. It should be
noted that there are considerably more supplements that
are used by bodybuilders and sold on the market. How-
ever, an exhaustive review of all of the supplements
commonly used by bodybuilders that often lack support-
ing data is beyond the scope of this paper. In addition, we
have omitted discussion of protein supplements because
they are predominantly used in the same way that whole
food protein sources are used to reach macronutrient
targets; however, interested readers are encouraged to
reference the ISSN position stand on protein and exer-
cise [127].
Creatine monohydrate (CM) has been called the most
ergogenic and safe supplement that is legally available
[128]. Supplementation of healthy adults has not re-
sulted in any reported adverse effects or changes in liver
or kidney function [129]. Numerous studies have found
significantly increased muscle size and strength when CM
was added to a strength training program [130-134]. In
many of these studies, 1-2 kg increases in total body mass
were observed after CM loading of 20 g/day for 428 days
[135]. However, the loading phase may not be necessary.
Loading 20 g CM per day has been shown to increase
muscle total creatine by approximately 20 percent and this
level of muscle creatine was maintained with 2 g CM daily
for 30 days [136]. However, the same study also observed
a 20 percent increase in muscle creatine when 3 g CM
was supplemented daily for 28 days, indicating the loading
phase may not be necessary to increase muscle creatine
Recently, alternative forms of creatine, such as creatine
ethyl ester (CEE) and Kre Alkalyn (KA) have been mar-
keted as superior forms of creatine to CM; however, as
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 10 of 20
of this time these claims have not been supported by sci-
entific studies. Tallon and Child [137,138] found that a
greater portion of CEE and KA are degraded in the
stomach than CM. Additionally, recent investigations
have shown that 2842 days of CEE or KA supplemen-
tation did not increase muscle creatine concentrations
more than CM [139,140]. Thus, it appears that CM may
be the most effective form of creatine.
Beta-alanine (BA) is becoming an increasingly popular
supplement among bodybuilders. Once consumed, BA en-
ters the circulation and is up-taken by skeletal muscle
where it is used to synthesize carnosine, a pH buffer in
muscle that is particularly important during anaerobic ex-
ercise such as sprinting or weightlifting [141]. Indeed, con-
sumption of 6.4 g BA daily for four weeks has been shown
to increase muscle carnosine levels by 64.2% [142]. More-
over, supplementation with BA for 410 weeks has been
shown to increase knee extension torque by up to 6%
[143], improve workload and time to fatigue during high
intensity cardio [144-148], improve muscle resistance to
fatigue during strength training [149], increase lean mass
by approximately 1 kg [147] and significantly reduce per-
ceptions of fatigue [150]. Additionally, the combination of
BA and CM may increase performance of high intensity
endurance exercise [151] and has been shown to increase
lean mass and decrease body fat percentage more than
CM alone [152]. However, not all studies have shown
improvements in performance with BA supplementation
[143,153,154]. To clarify these discrepancies, Hobson et al.
[155] conducted a meta-analysis of 15 studies on BA
supplementation and concluded that BA significantly
increased exercise capacity and improved exercise per-
formance on 60-240 s (ES = 0.665) and >240 s (ES = 0.368)
exercise bouts.
Although BA appears to improve exercise perform-
ance, the long-term safety of BA has only been partially
explored. Currently, the only known side effect of BA is
unpleasant symptoms of parasthesia reported after con-
sumption of large dosages; however, this can be minimized
through consumption of smaller dosages throughout the
day [142]. While BA appears to be relatively safe in the
short-term, the long-term safety is unknown. In cats, an
addition of 5 percent BA to drinking water for 20 weeks
has been shown to deplete taurine and result in damage to
the brain; however, taurine is an essential amino acid for
cats but not for humans and it is unknown if the smaller
dosages consumed by humans could result in similar ef-
fects [156]. BA may increase exercise performance and in-
crease lean mass in bodybuilders and currently appears to
be safe; however, studies are needed to determine the
long-term safety of BA consumption.
Beta-hydroxy-beta-methylbutyrate (HMB) is a metabol-
ite of the amino acid leucine that has been shown to de-
crease muscle protein catabolism and increase muscle
protein synthesis [157,158]. The safety of HMB supple-
mentation has been widely studied and no adverse effects
on liver enzymes, kidney function, cholesterol, white blood
cells, hemoglobin, or blood glucose have been observed
[159-161]. Furthermore, two meta-analyses on HMB sup-
plementation have concluded that HMB is safe and does
not result in any major side effects [159,160]. HMB may
actually decrease blood pressure, total and LDL choles-
terol, especially in hypercholesterolemic individuals.
HMB is particularly effective in catabolic populations
such as the elderly and patients with chronic disease [162].
However, studies on the effectiveness of HMB in trained,
non-calorically restricted populations have been mixed.
Reasons for discrepancies in the results of HMB supple-
mentation studies in healthy populations may be due to
many factors including clustering of data in these meta-
analysis to include many studies from similar groups, poorly
designed, non-periodized training protocols, small sample
sizes, and lack of specificity between training and testing
conditions [163]. However, as a whole HMB appears to be
effective in a majority of studies with longer-duration, more
intense, periodized training protocols and may be beneficial
to bodybuilders, particularly during planned over-reaching
phases of training [164]. While the authors hypothesize that
HMB may be effective in periods of increased catabolism,
such as during contest preparation, the efficacy of HMB on
maintenance of lean mass in dieting athletes has not been
investigated in a long-term study. Therefore, future studies
are needed to determine the effectiveness of HMB during
caloric restriction in healthy, lean, trained athletes.
Branched chain amino acids
Branched chain amino acids (BCAAs) make up 14-18%
of amino acids in skeletal muscle proteins and are quite
possibly the most widely used supplements among nat-
ural bodybuilders [165]. Of the BCAAs, leucine is of
particular interest because it has been shown to stimu-
late protein synthesis to an equal extent as a mixture
of all amino acids [166]. However, ingestion of leucine
alone can lead to depletion of plasma valine and isoleu-
cine; therefore, all three amino acids need to be con-
sumed to prevent plasma depletion of any one of the
BCAAs [167]. Recently, the safe upper limit of leucine
was set at 550 mg/kg bodyweight/day in adult men;
however, future studies are needed to determine the safe
upper limit for both other populations and a mixture of
all 3 BCAAs [168].
Numerous acute studies in animals and humans have
shown that consumption of either essential amino acids,
BCAAs, or leucine either at rest or following exercise
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 11 of 20
increases skeletal muscle protein synthesis, decreases
muscle protein degradation, or both [27,169-172]; how-
ever, there are few long-term studies of BCAA supple-
mentation in resistance-trained athletes. Stoppani et al.
[173] supplemented trained subjects with either 14 g
BCAAs, whey protein, or a carbohydrate placebo for eight
weeks during a periodized strength training routine. After
training the BCAA group had a 4 kg increase in lean mass,
2% decrease in body fat percentage, and 6 kg increase in
bench press 10 repetition maximum. All changes were sig-
nificant compared to the other groups. However, it should
be noted that this data is only available as an abstract and
has yet to undergo the rigors of peer-review.
The use of BCAAs between meals may also be beneficial
to keep protein synthesis elevated. Recent data from ani-
mal models suggest that consumption of BCAAsbetween
meals can overcome the refractory response in protein
synthesis that occurs when plasma amino acids are ele-
vated, yet protein synthesis is reduced [174]. However,
long-term human studies examining the effects of a diet
in which BCAAs are consumed between meals on lean
mass and strength have not been done to date. It should
also be noted that BCAA metabolism in humans and ro-
dents differ and the results from rodent studies with
BCAAs may not translate in human models [175]. There-
fore, long-term studies are needed in humans to deter-
mine the effectiveness of this practice.
Based on the current evidence, it is clear BCAAsstimu-
late protein synthesis acutely and one study [173] has indi-
cated that BCAAs may be able to increase lean mass and
strength when added to a strength training routine; how-
ever, additional long-term studies are needed to determine
the effects of BCAAs on lean mass and strength in trained
athletes. In addition, studies are needed on the effective-
ness of BCAA supplementation in individuals following a
vegetarian diet in which consumption of high-quality pro-
teins are low as this may be population that may benefit
from BCAA consumption. Furthermore, the effects of
BCAA ingestion between meals needs to be further inves-
tigated in a long-term human study.
NO supplementscontaining arginine are consumed by
bodybuilders pre-workout in an attempt to increase
blood flow to the muscle during exercise, increase pro-
tein synthesis, and improve exercise performance. How-
ever, there is little scientific evidence to back these
claims. Fahs et al. [176] supplemented healthy young
men with 7 g arginine or a placebo prior to exercise and
observed no significant change in blood flow following
exercise. Additionally, Tang et al. [177] supplemented ei-
ther 10 g arginine or a placebo prior to exercise and
found no significant increase in blood flow or protein
synthesis following exercise. Moreover, arginine is a non
essential amino acid and prior work has established that
essential amino acids alone stimulate protein synthesis
[178]. Based on these findings, it appears that arginine
does not significantly increase blood flow or enhance
protein synthesis following exercise.
The effects of arginine supplementation on performance
are controversial. Approximately one-half of acute and
chronic studies on arginine and exercise performance have
found significant benefits with arginine supplementation,
while the other one-half has found no significant benefits
[179]. Moreover, Greer et al. [180] found that arginine
supplementation significantly reduced muscular endur-
ance by 24 repetitions on chin up and push up endur-
ance tests. Based on these results, the authors of a recent
review concluded that arginine supplementation had little
impact on exercise performance in healthy individuals
[181]. Although the effects of arginine on blood flow, pro-
tein synthesis, and exercise performance require further
investigation, dosages commonly consumed by athletes
are well below the observed safe level of 20 g/d and do
not appear to be harmful [182].
Citrulline malate
Citrulline malate (CitM) has recently become a popular
supplement among bodybuilders; however, there has
been little scientific research in healthy humans with this
compound. CitM is hypothesized to improve performance
through three mechanisms: 1) citrulline is important part
of the urea cycle and may participate in ammonia clear-
ance, 2) malate is a tricarboxylic acid cycle intermediate
that may reduce lactic acid accumulation, and 3) citrulline
can be converted to arginine; however, as discussed previ-
ously, arginine does not appear to have an ergogenic effect
in young healthy athletes so it is unlikely CitM exerts an
ergogenic effect through this mechanism [179,183].
Supplementation with CitM for 15 days has been
shown to increase ATP production by 34% during exer-
cise, increase the rate of phosphocreatine recovery after
exercise by 20%, and reduce perceptions of fatigue [184].
Moreover, ingestion of 8 g CitM prior to a chest work-
out significantly increased repetitions performed by ap-
proximately 53% and decreased soreness by 40% at 24
and 48 hours post-workout [183]. Furthermore, Stoppani
et al. [173] in an abstract reported a 4 kg increase in lean
mass, 2 kg decrease in body fat percentage, and a 6 kg
increase in 10 repetition maximum bench press after
consumption of a drink containing 14 g BCAA, glutamine,
and CitM during workouts for eight weeks; although, it is
not clear to what degree CitM contributed to the out-
comes observed. However, not all studies have supported
ergogenic effects of CitM. Sureda et al. [185] found no
significant difference in race time when either 6 g CitM
or a placebo were consumed prior to a 137 km cycling
stage. Hickner et al. [186] found that treadmill time to
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 12 of 20
exhaustion was significantly impaired, with the time taken
to reach exhaustion occurring on average seven seconds
earlier following CitM consumption.
Additionally, the long-term safety of CitM is unknown.
Therefore, based on the current literature a decision on
the efficacy of CitM cannot be made. Future studies are
needed to conclusively determine if CitM is ergogenic
and to determine its long term safety.
Glutamine is the most abundant non-essential amino
acid in muscle and is commonly consumed as a nutri-
tional supplement. Glutamine supplementation in quan-
tities below 14 g/d appear to be safe in healthy adults
[182]; however, at present there is little scientific evi-
dence to support the use of glutamine in healthy athletes
[187]. Acutely, glutamine supplementation has not been
shown to significantly improve exercise performance
[188,189], improve buffering capacity [189], help to main-
tain immune function or reduce muscle soreness after ex-
ercise [187]. Long-term supplementation studies including
glutamine in cocktails along with CM, whey protein,
BCAAs, and/or CitM have shown 1.5 2 kg increases in
lean mass and 6 kg increase in 10RM bench press strength
[173,190]. However, the role of glutamine in these changes
is unclear. Only one study [191] has investigated the ef-
fects of glutamine supplementation alone in conjunction
with a six week strength training program. No significant
differences in muscle size, strength, or muscle protein
degradation were observed between groups. Although the
previous studies do not support the use of glutamine in
bodybuilders during contest preparation, it should be
noted that glutamine may be beneficial for gastrointestinal
health and peptide uptake in stressed populations [192];
therefore, it may be beneficial in dieting bodybuilders who
represent a stressed population. As a whole, the results of
previous studies do not support use of glutamine as an er-
gogenic supplement; however, future studies are needed to
determine the role of glutamine on gastrointestinal health
and peptide transport in dieting bodybuilders.
Caffeine is perhaps the most common pre-workout
stimulant consumed by bodybuilders. Numerous studies
support the use of caffeine to improve performance dur-
ing endurance training [193,194], sprinting [195,196],
and strength training [197-199]. However, not all studies
support use of caffeine to improve performance in
strength training [200,201]. It should be noted that many
of the studies that found increases in strength training
performance supplemented with larger (56 mg/kg) dos-
ages of caffeine. However, this dosage of caffeine is at the
end of dosages that are considered safe (6 mg/kg/day)
[202]. Additionally, it appears that regular consumption of
caffeine may result in a reduction of ergogenic effects
[203]. Therefore, it appears that 56 mg/kg caffeine
taken prior to exercise is effective in improving exercise
performance; however, caffeine use may need to be cy-
cled in order for athletes to obtain the maximum ergo-
genic effect.
Several previous studies have observed deficiencies in
intakes of micronutrients, such as vitamin D, calcium,
[3,17,18,204,205]. However, it should be noted that
these studies were all published nearly 2 decades ago
and that micronutrient deficiencies likely occurred due
to elimination of foods or food groups and monotony of
food selection [3,205]. Therefore, future studies are
needed to determine if these deficiencies would present
while eating a variety of foods and using the contest
preparation approach described herein. Although the
current prevalence of micronutrient deficiencies in
competitive bodybuilders is unknown, based on the pre-
vious literature, a low-dose micronutrient supplement
may be beneficial for natural bodybuilders during con-
test preparation; however, future studies are needed to
verify this recommendation.
Peak week
In an attempt to enhance muscle size and definition by re-
ducing extracellular water content, many bodybuilders en-
gage in fluid, electrolyte, and carbohydrate manipulation
in the final days and hours before competing [2,60,206].
The effect of electrolyte manipulation and dehydration
on visual appearance has not been studied, however it
may be a dangerous practice [207]. Furthermore, dehy-
dration could plausibly degrade appearance considering
that extracellular water is not only present in the sub-
cutaneous layer. A significant amount is located in the
vascular system. Thus, the common practice of "pump-
ing up" to increase muscle size and definition by in-
creasing blood flow to the muscle with light, repetitive
weight lifting prior to stepping on stage [208] could be
compromised by dehydration or electrolyte imbalance.
Furthermore, dehydration reduces total body hydration.
A large percentage of muscle tissue mass is water and
dehydration results in decreases in muscle water con-
tent [209] and therefore muscle size, which may nega-
tively impact the appearance of muscularity.
In the final days before competing, bodybuilders com-
monly practice carbohydrate loading similar to endur-
ance athletes in an attempt to raise muscle-glycogen
levels and increase muscle size [4,18,60,208]. In the only
direct study of this practice, no significant quantitative
change in muscle girth was found to occur [208]. How-
ever, an isocaloric diet was used, with only a change in
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 13 of 20
the percentage of carbohydrate contributing to the diet.
If total calories had also been increased, greater levels of
glycogen might have been stored which could have
changed the outcome of this study. Additionally, unlike
the subjects in this study bodybuilders prior to carbohy-
drate loading have reduced glycogen levels from a long
calorically restricted diet and it is possible in this state
that carbohydrate loading might effect a visual change.
Furthermore, bodybuilding performance is measured
subjectively, thus analysis of girth alone may not discern
subtle visual changes which impact competitive success.
Lastly, some bodybuilders alter the amount of carbohy-
drate loaded based on the visual outcome, increasing the
amount if the desired visual change does not occur [60].
Thus, an analysis of a static carbohydrate load may not
accurately represent the dynamic nature of actual carbo-
hydrate loading practices.
In fact, in an observational study of competitive body-
builders in the days before competition who loaded car-
bohydrates, subjects showed a 4.9% increase in biceps
thickness the final day before competition compared to
six weeks prior [4]. Although it is unknown if this was
caused by increased muscle glycogen, it is unlikely it was
due to muscle mass accrual since the final weeks of
preparation are often marked by decreases not increases
in LBM [6]. Future studies of this practice should in-
clude a qualitative analysis of visual changes and analyze
the effects of concurrent increases in percentage of car-
bohydrates as well as total calories.
At this time it is unknown whether dehydration or elec-
trolyte manipulation improves physique appearance. What
is known is that these practices are dangerous and have
the potential to worsen it. It is unclear if carbohydrate
loading has an impact on appearance and if so, how sig-
nificant the effect is. However, the recommended muscle-
sparing practice by some researchers to increase the
carbohydrate content of the diet in the final weeks of
preparation [6] might achieve any proposed theoretical
benefits of carbohydrate loading. If carbohydrate loading
is utilized, a trial run before competition once the com-
petitor has reached or nearly reached competition lean-
ness should be attempted to develop an individualized
strategy. However, a week spent on a trial run consuming
increased carbohydrates and calories may slow fat loss,
thus ample time in the diet would be required.
Psychosocial issues
Competitive bodybuilding requires cyclical periods of
weight gain and weight loss for competition. In a study by
Anderson et al. [207], it was found that 46% of a group of
male drug free bodybuilders reported episodes of binge
eating after competitions. One third to half reported anx-
iety, short tempers or anger when preparing for competi-
tion and most (81.5%) reported preoccupation with food.
Competitive male bodybuilders exhibit high rates of
weight and shape preoccupation, binge eating and bu-
limia nervosa. However, they exhibit less eating-related
and general psychopathology compared to men already
diagnosed with bulimia nervosa [210]. Often they are
more focused on muscle gain versus fat loss when com-
pared to males with eating disorders [211]. That being
said, this may change during preparation for competition
when body builders need to reduce body fat levels.
Muscle dysmorphia is higher in male competitive nat-
ural bodybuilders than in collegiate football players and
non-competitive weight trainers for physique [212]. How-
ever, the psychosocial profile of competitive bodybuilders
is rather complex. Despite exhibiting greater risk for eat-
ing disturbances and a greater psychological investment in
their physical appearance, they may have greater levels of
physique satisfaction compared to non-competitive weight
lifters and athletically active men [213]. Also, male body-
builders are not a body-image homogenous group when
experience is taken into account. Novice bodybuilders
show greater levels of dissatisfaction with their muscle size
and greater tendencies towards unhealthy and obsessive
behavior [214]. Furthermore, the physical effects of semi-
starvation in men can approximate the signs and symp-
toms of eating disorders such as anorexia nervosa and bu-
limia nervosa [11]. Thus, many of the psychosocial effects
and behaviors seen in competitive bodybuilders may be at
least partially the result of a prolonged diet and becoming
very lean. When these factors are all considered it may
indicate that at least in men, competitive bodybuilding
drives certain psychosocial behaviors, in addition to those
with prior existing behaviors being drawn to the sport.
However this may not be as much the case with female
bodybuilders. Walberg [215] when comparing competitive
bodybuilders to non-competitive female weight lifters,
found that among bodybuilders 42% used to be anorexic,
67% were terrified of becoming fat, and 50% experienced
uncontrollable urges to eat. All of these markers were sig-
nificantly higher in bodybuilders than in non-competitors.
Furthermore, it was found that menstrual dysfunction was
more common among the bodybuilders. In agreement
with this finding, Kleiner et al. [2] reported that 25% of fe-
male bodybuilding competitors reported abnormal men-
strual cycles.
Competitive bodybuilders are not alone in their risk and
disposition towards behaviors that carry health concerns.
Elite athletes in aesthetic and weight-class sports as a
whole share these risks [216]. In some sports, minimum
body fat percentages can be established and minimum hy-
dration levels for weighing in can be set. However, because
bodybuilding performance is directly impacted by body fat
percentage and not by weight per se, these regulatory
changes to the sport are unlikely. Therefore, competitors
and trainers should be aware of the potential psychosocial
Helms et al. Journal of the International Society of Sports Nutrition 2014, 11:20 Page 14 of 20
risks involved with competition. Open and frequent com-
munication on these topics should be practiced and com-
petitors and trainers should be aware of the signs and
symptoms of unhealthy behaviors. Early therapeutic inter-
vention by specialists with experience in competitive
bodybuilding and eating disorders should occur if disor-
dered eating patterns or psychological distress occurs.
The primary limitation of this review is the lack of large-
scale long-term studies on competitive natural body-
builders. To circumvent this, long-term studies on skeletal
muscle hypertrophy and body fat loss in athletic dieting
human populations were preferentially selected. In the ab-
sence of such studies, acute studies and/or animal studies
were selected.
Competing interests
The authors declare that they have no competing interests.
ERH developed the concept for this manuscript and wrote the sections on
caloric intake, macronutrients, psychosocial issues and peak week. AAA
wrote the sections on nutrient timing and meal frequency. PJF wrote the
abstract, methods, limitations, and the section on dietary supplementation.
All authors read and approved the final manuscript.
Author details
Sport Performance Research in New Zealand (SPRINZ) at AUT Millennium
Institute, AUT University, 17 Antares Place, Mairangi Bay, Auckland 0632,
New Zealand.
California State University, Northridge, CA, USA.
Division of
Nutritional Sciences, University of Illinois, Urbana, IL, USA.
Received: 24 August 2013 Accepted: 29 April 2014
Published: 12 May 2014
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