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Update on vegetarian and vegan athletes: a review


Abstract and Figures

Interest in vegetarian and vegan diets continues to grow, not only in the general population, but in the high-performing athlete. Vegetarian diets may lower risk of chronic diseases and have proposed ergogenic benefits to the athlete regarding exercise performance and enhanced recovery. However, controversy and confusion exist in the literature regarding vegetarianism. Traditionally, a vegetarian or vegan diet was considered low in certain micronutrients (iron, zinc, calcium, iodine, vitamin A, B2, B12, D), as well as protein, omega-3 fatty acids, and total energy needs. However, a vegetarian diet typically contains higher complex carbohydrates, dietary fiber, magnesium, nitrates, folic acid, vitamin C and E, carotenoids and other phytochemicals which may offer certain performance benefits to the athlete. This review summarizes the current literature on the benefits of a vegetarian diet specific to the athlete, clarifies nutritional requirements, and provides insight on the potential performance benefits. With proper meal planning, an athlete can meet all their nutritional needs with foods derived from plants without any loss in physical performance.
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J Phys Fitness Sports Med, 10 (1): 1-11 (2021)
DOI: 10.7600/jpfsm.10.1
JPFSM: Review Article
Update on vegetarian and vegan athletes: a review
Kenneth Vitale1* and Shawn Hueglin2
Received: April 20, 2020 / Accepted: July 14, 2020
Abstract Interest in vegetarian and vegan diets continues to grow, not only in the general
population, but in the high-performing athlete. Vegetarian diets may lower risk of chronic
diseases and have proposed ergogenic benefits to the athlete regarding exercise performance
and enhanced recovery. However, controversy and confusion exist in the literature regarding
vegetarianism. Traditionally, a vegetarian or vegan diet was considered low in certain micro-
nutrients (iron, zinc, calcium, iodine, vitamin A, B2, B12, D), as well as protein, omega-3 fatty
acids, and total energy needs. However, a vegetarian diet typically contains higher complex
carbohydrates, dietary fiber, magnesium, nitrates, folic acid, vitamin C and E, carotenoids and
other phytochemicals which may offer certain performance benefits to the athlete. This review
summarizes the current literature on the benefits of a vegetarian diet specific to the athlete,
clarifies nutritional requirements, and provides insight on the potential performance benefits.
With proper meal planning, an athlete can meet all their nutritional needs with foods derived
from plants without any loss in physical performance.
Keywords : vegetarian, vegan, diet, athlete, nutritional requirements
In recent years, there has been growing interest in veg-
etarian and vegan diets, not only in the general public, but
the athlete population as well. About 3.3% of Americans
report being vegetarian, and 46% of these individuals are
vegan1,2); however, the overall prevalence of vegetarian
athletes is largely unknown3). In a survey of athletes in the
2010 Commonwealth Games, 8% of the athletes followed
vegetarian diets, and 1% of them reported being vegan4).
Furthermore, vegetarianism is also growing in the young
adult population, as 5% of high school students (grades
9-12) and 6% of young adults (18-34 years) report being
vegetarian or vegan. In addition, there is a growing shift
in recommendations for people to switch to more plant-
based, whole food diets5), increased awareness regarding
animal welfare6) and concern for environmental repercus-
sions7,8) if high animal protein consumption countries
such as America do not change their farming practices.
Last year, the documentary film “Game Changers”9)
received wide media attention on the potential benefits
of “plant-based” (vegetarian) diets for athletes, but also
received criticism for possible sensationalism and pseu-
doscience7,10). Unfortunately, because of the variability in
vegetarian diets (e.g., vegetarian, vegan, lacto-ovo, whole
foods diets, raw foods diet) there are no high-quality stud-
ies on the effects of the vegetarian diet overall in athletes.
Most studies in athletes examine specific plant foods or
single-dose plant food supplementation, not the effects of
a vegetarian diet as a whole. With the recent popularity
and increased media visibility of vegetarian and vegan di-
ets, however, clinicians treating athletes need to be aware
of the latest science and recommendations. This review
summarizes current available literature on vegetarian and
vegan diets specific to the athlete. A background on these
“plant-based” (vegetarian) diets is presented, along with a
summary of key macro- and micronutrients important to
athletes considering a change to a vegetarian or vegan diet.
A literature search utilizing PubMed/Medline was per-
formed in April 2020 including the past 10 years prior.
No data restrictions were employed for language, date,
subject age, or article type. Keywords included vegan,
vegetarian, plant-based, athlete, exercise, nutritional re-
quirements, and performance.
An initial search including vegan/vegetarian and athlete/
exercise produced 78 potential articles. Studies that did
not include relevance to exercise or athletes, and studies
that involved patients or medical diseases were excluded.
Abstracts of conference proceedings, as well as in-vitro
and animal studies were also excluded. Additionally,
manual searching of references of the above retrieved ar-
1Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego, 9300 Campus Point Drive,
#7894, La Jolla, CA 92037, USA
2Senior Sports Dietitian, United States Olympic Committee, 2800 Olympic Parkway, Chula Vista, CA 91915, USA
2JPFSM : Vitale K and Hueglin S
ticles and additional expanded search of NCBI databases,
including NLM Catalog, PubMed Central (PMC), and
Google Scholar yielded 25 additional articles; duplicates
were removed. Fig. 1 represents the PRISMA search
A total of 50 studies met eligibility criteria. Due to sig-
nificant methodological heterogeneity, pooling of data
and a systematic review was impossible; therefore, a nar-
rative review was performed.
Vegetarian and vegan diets for athletes
A vegetarian diet is defined as a diet that does not in-
clude any animal meats, including red meat, poultry and
seafood11). Variations include lacto-, ovo-, lacto-ovo, or
pesco-vegetarian which are diets that include dairy, eggs,
both dairy and eggs, or fish, respectively. Vegan diets ex-
clude all animal-derived products and byproducts includ-
ing meat, fish, seafood, dairy, eggs, and honey11 ). While
there are minor differences in lacto-, ovo-, and lacto-ovo
vegetarian diets, vegetarians in general tend to consume
slightly more calcium, phosphorous, vitamin D and vi-
tamin B12 than vegans due to the consumption of dairy
products3,5,11). Vegans are traditionally considered to be
at risk for low protein, creatine and carnitine3,11) and risk
low EPA and DHA omega-3 fatty acid intake6) due to lack
of eggs and seafood. All vegetarian diets (vegan and the
above vegetarian variations)3,5,11) need to ensure adequate
intakes in protein, iron, zinc, calcium, vitamin A, vita-
min B12, omega-3 fatty acids EPA and DHA intake and
iodine, as well as vitamin D and overall caloric intake6).
Table 1 outlines key differences in these diet variations in
terms of potential nutrient deficiencies.
Vegetarian diets may lower risk of chronic diseases such
as cardiovascular disease, diabetes, obesity, hypertension,
and even cancer mortality11,12). Although chronic disease
prevention may not be the primary concern of an elite ath-
lete, it is proposed that these same diets may enhance an
athlete’s performance and/or speed recovery from intense
or strenuous exercise bouts3,13,14).
This is due to several potential reasons. Some authors
feel the higher intake of complex carbohydrates, dietary
Fig. 1 PRISMA flow diagragm search strategy
3JPFSM : Update on Vegetarian Athletes
fiber, magnesium, folic acid, vitamin C and E, carotenoids
and other phytochemicals consumed by vegetarians15,16)
may improve performance3). The increased carbohydrate
intake may promote better glycogen storage14,17). The
overall increased antioxidant and other phytochemical in-
take from foods derived from plant sources may enhance
the antioxidant system to offset the increased exercise-
induced oxidative stress in elite athletes and potential en-
vironmental oxidative stresses, including altitude and pro-
longed sun exposure18,19). Another advantage of vegetarian
diets is that the antioxidants derived from whole foods are
generally favored over antioxidant supplements in terms
of effectiveness20).
It is also suggested that plant-based diets reduce inflam-
mation and blood viscosity, improve arterial flexibility
and endothelial function14). This may improve vascular
flow, tissue oxygenation, and cardioprotection14,17) for the
endurance athlete that may be at higher-than-average risk
for atherosclerosis and myocardial damage21-24). There are
even studies suggesting that, due to the slight alkalinizing
effect on serum during exercise25), foods derived from
plants may induce an ergogenic effect by improved buff-
ering of acid production from intense exercise26).
Another ergogenic benefit includes the high nitrate
content in plants. Since a landmark study in 2007 show-
ing decreased oxygen cost during submaximal exercise27),
several studies have demonstrated how nitrate-rich plant
foods (such as beets and nitrate-rich greens [e.g. spinach
and arugula]) can improve performance27,29-31). Dietary
nitrate gets converted in the body to nitric oxide, which
exerts pleotropic effects pertinent to athletes, including
improved vasodilation, blood flow and oxygen regulation
in muscle, mitochondrial function, and overall muscle
contraction/relaxation28-30). Cumulatively, these effects
can improve muscle economy during exercise, improve
efficiency and mitigate fatigue, decrease cardiorespiratory
effort at submaximal workloads, and improve exercise
(e.g. cycling time trial) performance29-33).
Lastly, single dose supplementation with plant-based
products may also improve performance15,34,35). In a recent
novel study, a single dose of fermented soy during a 20-
km time trial cycling race improved cyclists’ times to race
completion, lowered average heart rates, and had sig-
nificantly improved power outputs34). It is believed these
performance benefits were due to the isoflavones found
in soy, improving vascular endothelial relaxation, increas-
ing limb blood flow, and decreasing cardiac demand.
These isoflavone-induced effects would not be seen in
animal-based protein sources. Another study has shown
soy supplementation also improves time to exhaustion
in prolonged endurance exercise35), due, it is believed, to
soy’s high antioxidant capacity. This study was the first
of its kind to show improved race performance times and
reduced heart rates.
Conversely, there have been conflicts in research and
an overall misunderstanding in the literature concerning
vegetarianism15), especially regarding nutritional deficien-
cies. Traditionally, vegetarians were considered to have
inadequate intakes in protein, iron, zinc, calcium, vitamin
A, vitamin B12, omega-3 fatty acids EPA and DHA, and
iodine15), as well as vitamin D and overall caloric intake6).
However, several studies demonstrate these deficiencies
are typically due to poor meal planning15) rather than in-
adequate nutrient content in a vegetarian diet. In the fol-
lowing sections, select macronutrients and micronutrients
(including a special section on protein) are reviewed with
recommendations specific to the plant-based athlete. Also,
performance considerations are provided for the elite or
professional athlete interested in following a vegetarian
or vegan diet.
Carbohydrate. Carbohydrates can be an important com-
ponent to an endurance athlete’s diet as they are necessary
for glycogen repletion if the athlete undergoes exhaustive
exercise. Due to the inherent nature of carbohydrate-rich
foods in a vegetarian diet, a vegetarian athlete is likely
able to meet typical carbohydrate needs36). Although some
sports such as power or skill-based sports require less car-
bohydrate intake (3-5 g/kg/day) and not a concern, even
endurance and ultra-endurance athletes following a veg-
etarian diet can easily meet carbohydrate loading (“carbo
loading”) and overall high carbohydrate needs (up to 8-12
g/kg/day) with a plant-based diet36).
One precaution if an athlete switches to a vegetarian
Table 1. Vegetarian vs. Vegan Diet Considerations
Pesco-ovo vegetarian Lacto-ovo vegetarian Vegan All vegetarian diets
Adequate omega-3
fay acids EPA and
DHA from fish
May have adequate B12
intake compared to vegans;
Beer omega-3 fay acid EPA
and DHA intake from eggs
compared to vegans; Higher
calcium, phosphorous,
vitamin D and B12 from dairy
products than vegans
At risk for low protein,
creane and carnine;
risk low omega-3 fay
acids EPA and DHA
intake due to lack of
eggs or seafood; Lower
B12 and may need
All vegetarian diets
(including vegan) at risk
for low protein, iron, zinc,
calcium, iodine, vitamin A,
vitamin B2, B12, D,
omega-3 fay acids EPA
and DHA intake, and
overall caloric intake
4JPFSM : Vitale K and Hueglin S
diet is the potential risk of consuming too much carbohy-
drate compared to their previous intake– this can have a
negative impact on body composition, and therefore per-
formance, in some sports. For example, when athletes ex-
change an animal source of protein for a plant source (e.g.
chicken for black beans) there is an associated change in
nutrient profile resulting in higher carbohydrate per gram
of beans compared to chicken. Weight class athletes and
athletes in which excess body fat negatively impacts per-
formance and competition results (e.g. running, jumping,
diving, gymnastics, aesthetic sports) need to be aware that
plant-based protein sources tend to increase carbohydrate
and fat to their total intake. Appropriate planning and edu-
cation on the differences in plant vs. animal-based protein
sources is recommended to ensure an optimal range of
carbohydrate intake.
Fat. Dietary fat can provide energy during prolonged
exercise, if glycogen stores are depleted, and aids in fat-
soluble vitamin absorption. Athletes should follow current
public health guidelines to ensure adequate fat intake36,37),
since athletes who restrict fat intake to <20% of total en-
ergy can be low in fat-soluble vitamins and essential fatty
acids36). Lacto-ovo vegetarians and pesco-vegetarians (fish
consumption with vegetarian diet, also called pescetari-
anism) typically consume adequate essential fatty acids;
however strict vegans may be low in the omega-3 fatty
acid eicosapentaenoic acid (EPA). Even though conver-
sion of alpha-linolenic acid (ALA) to EPA and docohexae-
noic acid (DHA) in humans is inefficient, current research
suggests vegan athletes can meet EPA/DHA requirements
by adequate intake of ALA12). Vegetarian athletes may
also opt for DHA-rich microalgae supplements38).
Overall, adequate energy intake is important for any
athlete, regardless of whether they eat foods derived from
animal and/or plants. Athletes not meeting total energy
requirements may suffer impaired performance, recovery,
and may experience health consequences such as weight
loss, sarcopenia, low bone mass, chronic fatigue and ill-
ness3,36). Plant-based athletes may risk inadequate caloric
intake due to the high-fiber and low caloric density foods
contained in a plant-based diet. However, frequent meals,
selecting energy-dense foods, and limiting excessive
high-fiber foods should help meet energy needs in a veg-
etarian and vegan athlete.
Protein. Protein intake is often the most controversial
aspect of vegetarian and vegan diets for athletes. In addi-
tion, protein supplements are a multi-billion-dollar market
with widespread use in sports39), and many athletes fol-
low a high-protein diet39). Traditional recommendations
indicate high-performance athletes require 1.2-2.0 g/kg/
day of protein according to sport category36), however
newer recommendations suggest 1.6 g/kg and up to 2.2g/
kg depending on type of sport and goals40). Additionally,
protein timing may favorably impact athletes. Intake of
a 0.25-0.3 g/kg dose within the 0-2 hour post-exercise
window can stimulate muscle protein synthesis (MPS)36,41).
Alternatively, 0.4 g/kg 4 times a day40) may be a simpler
way to achieve protein needs. This latter approach may
be more practical to high-level athletes who usually train
multiple times a day - the window after exercise may be
less important compared to steady intake throughout the
day to cover the times after each training session. Regard-
less of protein source, this dose should have a high con-
centration of not only branched-chain amino acids, such
as leucine to stimulate MPS, but approximately 10g of the
essential amino acids (EAA) to maximize MPS36,41,42).
There is little evidence that protein requirements in
vegetarian athletes are any different than omnivorous
athletes3). However, athletes who consume plant-based
protein sources need adequate EAA and leucine intake to
ensure appropriate MPS. Leucine (at least 2.5g doses) has
been shown in multiple studies to be a powerful activa-
tor of mTORC and other signaling proteins involved in
MPS36,41,42). While animal-based whey protein is high in
leucine and classically considered a preferential source
for omnivorous athletes, soy, pea, brown rice, potato, and
corn all can provide leucine requirements43). However,
individual plant leucine amounts vary. Due to the greater
leucine content of corn, 20 g of corn protein would need
to be ingested to provide 2.7 g leucine. The dose of other
individual plant-based proteins would need to be in-
creased [e.g. 33 g (potato), 37 g (brown rice), 38 g (pea),
40 g (soy)] to achieve a similar leucine content as corn43).
Therefore, athletes should incorporate varied plant-based
sources of protein to obtain appropriate leucine and
Individual plant-based protein sources may lack ade-
quate amounts of certain amino acids such as leucine, me-
thionine, and lysine. The relative shortage of these amino
acids may contribute to potential lower anabolic capacity
of plant-based proteins compared to animal sources43).
Other possible reasons for lower anabolism may be due to
the lower digestibility and absorption (about 10-15% low-
er) of plant-based proteins, greater splanchnic extraction
and subsequent urea synthesis44) and shuttling of plant
protein towards oxidation rather than MPS45), which may
be related to lower concentration of certain EAA in plant-
based proteins44). However common food combinations
e.g. rice and beans, beans and nuts/seeds [hummus], nut
butter sandwiches typically are complementary and can
provide a complete profile of all EAA (e.g. grains are low
in lysine but high in methionine, legumes are low in me-
thionine but high in lysine, and corn and potatoes are high
in leucine)43). This is further supported by a recent review
pointing out that protein-rich plant foods are sufficient for
human requirements, and the question of amino acid de-
ficiency in plant foods has been substantially overstated5).
Furthermore, the once-popular recommendation that one
needs to combine protein sources in the same meal to
achieve a complete EAA profile at each feeding no lon-
5JPFSM : Update on Vegetarian Athletes
ger appears necessary, as long as the daily total intake
is adequate8,12,43,46). This allows more flexibility in meal-
planning for an athlete that consumes only plant protein
There are numerous studies and reviews suggesting
cardiovascular disease risk and metabolic syndrome risk
may be reduced by incorporating more plant-based pro-
tein sources47,48), as well as all-cause and cardiovascular
mortality49). However, to date there are limited high-
quality studies specifically examining animal vs. plant-
based protein regarding athletic performance. A recent
study investigated 25g of either pea or whey protein
supplementation twice a day in a double-blind random-
ized placebo-controlled trial and showed no difference in
muscle strength or thickness50). Another study compared
24g of whey vs. pea protein supplementation taken before
and after exercise on training days and in-between meals
on non-training days during an 8-week high-intensity
functional training program51). There were no differences
in body composition, muscle thickness, strength (thigh
muscle peak force or rate of force development), or per-
formance (benchmark workouts of the day)51). However,
these preliminary studies have limitations, since they
were not conducted on elite, professional, or Olympic/
Paralympic athletes; and in some cases, the sample size is
quite small. While preliminary, they do suggest there are
no significant differences for athletes in terms of muscle
size, muscle strength, or performance when consuming
whey vs. pea protein supplements, although more studies
are needed.
Vegetarian athletes should emphasize the adequate in-
take of certain micronutrients, as several of these have
been shown to be either less abundant or less efficiently
absorbed compared to animal sources3). These include
iron, zinc, calcium, vitamin A (according to one study15)),
vitamin B2, vitamin B12, iodine and vitamin D6,15). In
contrast, vegetarian diets typically have higher concen-
trations of folic acid (vitamin B9), vitamin A, C, E, and
K, and carotenoids12,16), as well as potassium and mag-
nesium12,15,16). The following sections explain important
vitamin and mineral issues faced by vegetarian athletes;
Table 2 provides a summary of the important differences
in vegetarian diets compared to omnivorous diets.
Vitamins. An advantage of a vegetarian diet is the re-
ported higher intake of folic acid (vitamin B9), vitamin
C and E, and carotenoids16); this higher intake has been
proposed to improve performance3). Plant-based diets also
typically have plentiful sources of the vitamins A and K
as well12). A vegetarian athlete typically contains adequate
amounts of these micronutrients and supplementation
therefore is generally not needed52).
Furthermore, as mentioned above, the overall increased
antioxidant effect from the higher intake of these vitamins
may offset the increased exercise-induced oxidative stress
in elite athletes, and potential environmental oxidative
stresses such as altitude and prolonged sun exposure ex-
perienced by athletes18,19). Another advantage is that the
antioxidant vitamins derived from whole foods are gener-
ally favored over antioxidant supplements in terms of ef-
However, there are a few concerns regarding micronu-
trient vitamin intake. Traditionally, vegetarians are con-
sidered to have potential inadequate intakes of vitamin A
(according to one study15)), B2 and B12, as well as vita-
min D6,15). Vitamin D supplementation may be required
if an athlete lives in an area (or follows a lifestyle) with
limited natural sunlight exposure (e.g., athletes who use
sunscreen regularly when training outdoors, practice in-
doors, have darker skin color). Strict vegan athletes may
not consume adequate vitamin B12, found in animal-
derived foods12). Fortified foods or B12 supplementation
is recommended for vegans12), whereas lacto-ovo vegetar-
ians generally obtain sufficient amounts.
However, studies demonstrate these deficiencies are
usually due to poor meal planning15) rather than inad-
equate nutrient content in a vegetarian diet. Careful
meal planning can avoid these pitfalls in the plant-based
athlete’s meal plan. Obtaining these micronutrients via
natural or fortified foods is recommended; however,
plant-based athletes may opt for supplementation due to
Minerals. In contrast to vegetarians often showing a
higher intake of multiple vitamins, the only minerals
reported to be higher in vegetarians is potassium and
magnesium12,15,16). A vegetarian athletic diet typically
contains adequate amounts of these micronutrients and
supplementation is generally not needed52). Furthermore,
these are critical minerals to athletes and higher intakes
are purported to improve performance3).
Traditionally, vegetarians are considered to have in-
adequate intakes of iron, zinc, calcium, and iodine15).
However, as with vitamins, studies show these mineral
deficiencies are often due to poor meal planning15) rather
than inadequate nutrient content in a vegetarian diet.
Although, a few considerations are worth mentioning.
Non-heme iron and zinc are better absorbed with vita-
min C and should be taken together, and single high-
dose mineral supplementation should be avoided, as high
doses of one mineral may compete for absorption with
another12). Certain food preparation techniques such as
soaking, sprouting, and fermenting/leavening also reduce
the phytate content, which binds minerals and can prevent
absorption12). High oxalate content in certain greens (e.g.
spinach, chard) may also bind and limit availability of
calcium52). Lastly, iodine may be adequate according to
geographic region, but supplementation is recommended
if an athlete lives in a region with iodine-poor soil, or
6JPFSM : Vitale K and Hueglin S
consumed by vegetarians15,16) may improve performance3).
The overall increased phytochemical intake from plant
sources may enhance the antioxidant system and offset
the increased exercise-induced oxidative stress experi-
enced by elite athletes18,19).
Another ergogenic benefit mentioned above is derived
from the high nitrate content in plants. Several stud-
ies have demonstrated how nitrate-rich plant foods can
improve performance in athletes27,29-31). Nitric oxide can
improve blood flow and oxygen regulation in muscle and
improve mitochondrial function28-30); cumulatively, these
uses only iodine-free salts12,52). These nutrients can eas-
ily be obtained with a simple well-balanced diet, and as
mentioned above, these deficiencies typically occur more
commonly due to poor meal planning6) rather than poor
food sources.
Other micronutrients such as nitrates, antioxidants,
polyphenols, isoflavones, and other phytochemicals.
Plant-based diets typically have plentiful sources of
nitrates, antioxidants, polyphenols, isoflavones, and other
phytochemicals12). The increased levels of phytochemicals
Table 2. Macronutrient and micronutrient differences of vegetarian diets
Potenally low in vegetarian diets Considered high in vegetarian diets
Carbohydrate Higher; may promote glycogen storage
Fat Lower, especially omega-3 fay acids
EPA and DHA if vegan
Protein Lower; especially leucine and other EAA
Micronutrients: Vitamins
Vitamin A
Lower in one study Higher in several studies
Vitamin B2 Lower
Vitamin B9 (folate) Higher
Vitamin B12 Lower; vegans may need
Lacto-ovo vegetarians may have adequate
Vitamin C Higher
Vitamin D Lower; supplementaon may be
needed if low sunlight exposure,
training indoors, darker skin color
Vitamin E Higher
Vitamin K Higher
Micronutrients: Minerals
Magnesium Higher; may improve performance
Potassium Higher; may improve performance
Iron Lower; Non-heme iron beer absorbed
with vitamin C
Zinc Lower; beer absorbed with vitamin C
Calcium Lower; High oxalate content in certain
greens may limit calcium absorpon
Iodine Lower; supplementaon may be
needed if iodine-poor soil, or athletes
uses iodine-free salts
Fiber Higher
Anoxidants Higher; may offset increased oxidave
Phytochemicals Higher; may offset inflammaon
Nitrates Higher; may improve performance
Isoflavones (in soy) Higher; may improve performance
Creane Lower; may affect high-intensity
exercise, supplementaon considered
β-alanine Lower; supplementaon may be
consider if power sport
Carnosine Lower; supplementaon may be
consider if power sport
Total Calories Lower; due to the high-fiber and low
caloric density foods contained in a
plant-based diet
7JPFSM : Update on Vegetarian Athletes
mentation. Further studies are needed.
The overall exercise capacity of vegan, lacto-ovo-veg-
etarian and omnivorous recreational runners was exam-
ined in a recent study58). Vegan and lacto-ovo-vegetarian
runners were compared to omnivorous runners and per-
formed a maximal exercise stress test to exhaustion. All
three groups had comparable training frequency, training
time, and running distance. There were no differences in
terms of maximal power output or lactate levels, and the
authors concluded that any of the vegetarian diets might
be suitable alternatives for recreational athletes compared
to omnivorous diets.
However, this previous study presumes that the athletes
all had similar energy availability. As mentioned in the
carbohydrate section, vegetarian athletes usually can meet
carbohydrate needs due to the inherent carbohydrate-rich
nature of plant-based foods. Some may assume there-
fore they are able to meet overall energy needs as well.
However, on the contrary, some athletes who primarily
eat plant-based foods may struggle to maintain an appro-
priate energy balance due to more restrictive eating pat-
terns. Although energy balance is considered important
(comparing energy intake to energy expenditure), energy
availability is most important to athletes. Energy avail-
ability is the amount of dietary energy remaining after
exercise, available for other physiological functions such
as growth, muscle recovery, and homeostasis59). Athletes
who eat primarily plant-derived foods may be at risk of
low energy availability if their total daily intake is insuf-
ficient. For example, one of the key concerns of vegetar-
ian diets is the high fiber content, which may lead to early
satiety and appetite blunting60) resulting in potentially
too few calories consumed to support energy expendi-
ture from training. Also, besides consuming more high-
fiber foods, vegetarian athletes may choose less energy-
dense foods resulting in undereating61). Another challenge
when transitioning to plant-based foods is an athlete may
exclude certain foods (i.e. animal-based foods) without
replacing the nutrients from another source. These factors
can lead to a decrease in total daily calories, low energy
availability, energy imbalance, and poor performance in
the vegetarian athlete59).
Furthermore, low energy availability underlies the fe-
male athlete triad, male athlete triad, and relative energy
deficiency in sport (RED-S) syndromes59). The health
concerns associated with these low energy availability
syndromes (e.g. menstrual and cardiovascular dysfunc-
tion, compromised bone health) can also contribute to
impaired sports performance59). Therefore, it is paramount
for athletes to achieve proper energy balance and energy
availability. A detailed meal plan designed to support the
athlete’s training volume, intensity, and duration is key to
avoiding an unwanted energy imbalance.
Lastly, in regard to performance considerations, Table 3
summarizes key recommendations for athletes including
macronutrient breakdown32). While specific macronutrient
effects can improve muscle economy and efficiency, re-
duce fatigue and cardiorespiratory effort at submaximal
workloads, and improve performance29-33).
Finally, the isoflavones found specifically in soy can
improve vascular endothelial relaxation, increase limb
blood flow, and decrease cardiac demand15,34,35). While
this would be specific to the athlete who eats soy as part
of their diet, studies have shown these isoflavone-induced
effects can improve power outputs and cyclists’ times to
race completion, as well as lower average heart rates34).
Performance Considerations
Specific to the athlete, there has been skepticism regard-
ing vegetarian diets and performance compared to tradi-
tional omnivorous diets. However, vegetarian-based diets
compared to omnivorous mixed diets (when matched for
total energy, micro- and macronutrient intake appropriate
to support the needs of the athlete) have shown no distin-
guishable differences in physical performance in several
randomized trials and reviews53-55) in terms of strength/
power, aerobic exercise and anaerobic exercise perfor-
mance. In addition, specifically animal vs. plant protein
supplementation has shown no strength, muscle size, or
performance differences50,51).
However, there are a few legitimate concerns. Female
and male athletes following vegetarian and vegan diets
may be at increased risk of (non-anemic) iron deficiency
that may limit endurance performance17,56), and needs to
be carefully accounted for in an athlete’s dietary choices
and monitored with bloodwork as clinically indicated.
Male and female athletes who rely primarily on plant-
based proteins may also have lower mean muscle creatine
concentrations compared to their omnivore counter-
parts, which may affect supramaximal (repeated high-
intensity bouts, high intensity interval training) exercise
performance56). Some research suggests that creatine and
β-alanine supplementation may be beneficial to vegan
athletes who engage in power sports, since they may
have lower creatine and muscle carnosine levels6). One
study has suggested vegetarians were likely to experience
greater performance increments, after creatine loading, in
short high-intensity sports that mainly rely on the adenos-
ine triphosphate/phosphocreatine (ATP/CP) system for
energy56). It is important to note that the majority of elite
athletes perform some type of strength training which
relies on this energy system; even endurance athletes
regularly utilize the ATP/CP system and may benefit from
elevated levels of muscle creatine. And, in a very recent
study in soccer players, creatine supplementation seems
to have shown some improvement in cognitive perfor-
mance57), warranting further investigation into the brain
phosphocreatine’s effects on mental fatigue. While there
have been no studies specifically in vegetarian or vegan
athletes regarding brain creatine levels, this finding is of
importance to athletes who may consider creatine supple-
8JPFSM : Vitale K and Hueglin S
zinc, calcium, vitamin A, vitamin B2 and B12, iodine,
vitamin D, and overall energy intake. Protein require-
ments are no different in a vegetarian athlete compared
to an omnivorous athlete, as long as a plant-based athlete
can meet EAA (including leucine) requirements and total
protein intake throughout the day. While more studies are
needed, plant-based diets may even provide certain health
and performance benefits compared to omnivorous diets.
With the right meal planning an athlete can not only meet
all nutritional requirements with plant-based foods, but
also enjoy similar strength/power, aerobic and anaerobic
exercise performance.
amount and timing recommendations based on duration
of exercise are outside the scope of this manuscript, this
table concisely summarizes carbohydrate, protein and fat
requirements, and additionally provides key information
regarding other nutrients relevant to athletes such as so-
dium, water, nitrates, caffeine, and whether or not a veg-
etarian athlete chooses probiotic supplementation.
With proper planning, athletes can achieve all their nu-
tritional needs via a vegetarian or vegan diet. There are
certain considerations in terms of macro- and micronu-
trient intake specific to a plant-based diet, such as iron,
Table 3. Key recommendations for macronutrients, hydration, and supplements for athletes (exercise duration is
listed in italics within parentheses). Adapted from: “Nutrition and supplement update for the endurance athlete:
review and recommendations” by Vitale, K. and Getzin, A., 2019, Nutrients, 11(6), p.1289. Copyright 2019 by
Kenneth Vitale. Reprinted with permission by author.
Nutrient Daily Requirements Pre-Exercise During Exercise Post-Exercise
5–7 g/kg/day (1
6–10 g/kg/day (1–3
8–12 g/kg/day
6 g/kg/day (<90 min)
10–12 g/kg/day (> 90
1–4 g/kg (1–4 h prior
to event)
30–60 g/h (<2.5 h)
60–70 g/h (>2.5 h)
90 g/h (>2.5 h, if
8–10 g/kg/day (first 24
h) 1.0–1.2 g/kg/h (first
3–5 h) or
0.8 g/kg/h + protein (0.3
mg/kg/h) or caffeine (3
Protein 1.4 g/kg/day
0.3 g/kg every 3–5 h
0.3 g/kg immediately
prior (or post
0.25 g/kg/h (if high
0.3 g/kg within 0–2 h
(or pre-exercise)
Do not restrict to <20% total caloric energy
Unclear role of CLA, omega-3, MCT supplements
Consider limiting fat intake only during carbohydrate loading, or pre-race if GI comfort concerns
Try initial hydration plan at ~400–800 mL/h;
Adjust according to individual athlete variations (sweat rates, sweat
sodium content, exercise intensity, body temperature, ambient
temperature, bodyweight, kidney function)
Follow thirst mechanism, monitor parameters (bodyweight, urine
Replace fluid with 150%
of fluid lost
Try initial sodium plan at 300–600 mg/h if high sweat rate (>1.2 L/h),
subjective “salty sweater,” or prolonged exercise >2 h
Adjust intake according to individual athlete variations (sweat rates,
sweat sodium content, exercise intensity, body temperature, ambient
temperature, bodyweight, kidney function)
Improved water
repletion observed with
>60 mmol/L sodium
content (~1380 mg/L)
300–600 mg of nitrate (up to 10 mg/kg or 0.1 mmol/kg) or 500 mL beetroot juice or 3–6 whole beets
within 90 min of exercise onset
Consider multi-day dosing e.g., 6 days of a high-nitrate diet prior to event
Avoid prior to exercise to maximize training adaptation
Take prior to exercise only if recovery needed within 24 h
Many options: whole foods, dark berries, dark greens, green tea
e.g., 8–12oz tart cherry juice twice a day (1oz if concentrate) 4–5 days prior and 2–3 days after event
e.g., green tea extract (270–1200 mg/d)
3–6 mg/kg taken 30–90 min prior to exercise
Consider “topping-up” every 1–2 h as needed
≥9 mg/kg does not further enhance performance, may have undesirable
side effects, + drug test
≤3 mg/kg can also be ergogenic without side effects
3 mg/kg with
carbohydrate enhances
glycogen repletion
Lactobacillus and Bifidobacteria may help with upper respiratory and/or GI symptoms
9JPFSM : Update on Vegetarian Athletes
Conflict of Interests
The authors declare that there is no conflict of interests regard-
ing the publication of this article.
Author Contributions
KV conceptualized, designed, developed the theory of the
manuscript, performed literature review and background data
collection, and wrote the manuscript. SH revised the manuscript,
provided critical feedback, direction and planning of the manu-
script, and made critical contributions. Both authors read and
approved the final manuscript.
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... Diets restricting animal products (i.e., vegan/vegetarian) may be limiting in some essential amino acids [11] and essential micronutrients that support athlete health and performance, such as iron, zinc, calcium, and vitamin D. While these micronutrients (i.e., calcium and iron) can be consumed through plant-based foods, nutrients may be less bioavailable. This could be a major consideration for those transitioning to a diet avoiding animal products. ...
... This could be a major consideration for those transitioning to a diet avoiding animal products. Leucine can be provided by soy, corn, pea, brown rice or potato, though higher quantities of these foods are needed to provide an equivalent leucine content [11]. Other considerations include the level of ultra-processed foods (UFPs), which may be higher among individuals following a vegetarian or vegan diet, and linked to adverse health outcomes [12,13]. ...
... Adequate nutrition is critical to a sport such as female gymnastics, which includes long hours of training, starting at a young age, with high metabolic demands for growth. A study investigating adolescent gymnasts age [11][12][13][14][15][16][17][18] showed that those with a higher KIDMED score, a pediatric-adapted Mediterranean Diet Quality Index that measures adherence to the MedDiet, had a healthier body mass index compared to those that had lower adherence [25]. While on the MedDiet, it is crucial that all athletes, especially those at risk for malnutrition, especially gymnasts, runners, and dancers, where pressures exist to maintain a low body weight, consume the calories that they need to maintain a healthy weight. ...
Full-text available
Background: Nutrition fuels optimal performance for athletes. With increased research developments, numerous diets available, and publicity from professional athletes, a review of dietary patterns impact on athletic performance is warranted. Results: The Mediterranean diet is a low inflammatory diet linked to improved power and muscle endurance and body composition. Ketogenic diets are restrictive of carbohydrates and proteins. Though both show no decrements in weight loss, ketogenic diets, which is a more restrictive form of low-carbohydrate diets, can be more difficult to follow. High-protein and protein-paced versions of low-carbohydrate diets have also shown to benefit athletic performance. Plant-based diets have many variations. Vegans are at risk of micronutrient deficiencies and decreased leucine content, and therefore, decreased muscle protein synthesis. However, the literature has not shown decreases in performance compared to omnivores. Intermittent fasting has many different versions, which may not suit those with comorbidities or specific needs as well as lead to decreases in sprint speed and worsening time to exhaustion. Conclusions: This paper critically evaluates the research on diets in relation to athletic performance and details some of the potential risks that should be monitored. No one diet is universally recommend for athletes; however, this article provides the information for athletes to analyze, in conjunction with medical professional counsel, their own diet and consider sustainable changes that can help achieve performance and body habitus goals.
... Growing studies have explored sports performance across a range of sports in vegetarian and nonvegetarian athletes [12][13][14][15][16]; however, two recent review studies investigating physical performance reported some controversial results from vegetarian and nonvegetarian athletes [15,17]. On the other hand, evidence specifically targeting vegetarians from community-dwelling general populations for insights into physical activity levels and physical performance is relatively scarce and inconclusive [18]. ...
... Growing studies have explored sports performance across a range of sports in vegetarian and nonvegetarian athletes [12][13][14][15][16]; however, two recent review studies investigating physical performance reported some controversial results from vegetarian and nonvegetarian athletes [15,17]. On the other hand, evidence specifically targeting vegetarians from community-dwelling general populations for insights into physical activity levels and physical performance is relatively scarce and inconclusive [18]. ...
... Although growing evidence suggests vegetarian athletes are less likely to experience poor physical performance or exercise capacity [12][13][14][15], some studies reported controversial results [16,17]. Therefore, a representative survey of general German adults has indicated that approximately 21% of vegetarians and 74% of omnivores are concerned about being less productive (poor physical performance) following a vegetarian diet [1]. ...
Full-text available
Religious vegetarianism has become more popular with women and increases with age. However, concerns have been raised that vegetarians are less productive than nonvegetarians. Thus, we aimed to compare the characteristics of physical activity and physical performance in properly matched religious vegetarian and nonvegetarian women aged ≥ 45 years. Participants (n = 160) were recruited via convenience sampling in the community of Hualien, Taiwan, and matched by demographic and cognitive characteristics. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Physical performance was assessed with handgrip strength, five-times-sit-to-stand, gait speed, timed up-and-go, and functional reach tests (FRT). Overall, 90% of religious vegetarians practiced lacto-ovo-vegetarianism. The proportions of those with low physical activity levels and poor physical performance did not significantly differ between religious vegetarians and nonvegetarians. Additionally, there were no significant between-group differences in IPAQ-SF scores and physical performance, except for FRT performance (mean 24.5 cm vs. 19.7 cm, p < 0.001). Exhaustion after work, busyness, and a lack of interest were three main reasons for low physical activity levels, and none of these had significant between-group differences (p = 0.936). Our results show a similar profile of physical activity and physical performance in religious vegetarian and nonvegetarian women.
... Moreover, vitamin A is a potent antioxidant that helps in neutralizing free radicals generated by oxidative stress during advanced physical training. The sufficient consumption of vitamin A may help alleviate the reactive oxygen species and avoid the onset of illnesses such as heart failure and muscle damage [244], as mentioned in many studies in Table 2. ...
... B-complex vitamins also contribute to maintaining optimal health and performance in athletes, supporting improved brain functioning, concentration, sleep quality, and energy levels [19]. Thus, athletes need to ensure that they are receiving enough vitamin B through their diet or supplements [244]. ...
Full-text available
The aim of this systematic review is twofold: (i) to examine the effects of micronutrient intake on athletic performance and (ii) to determine the specific micronutrients, such as vitamins, minerals, and antioxidants, that offer the most significant enhancements in terms of athletic performance , with the goal of providing guidance to athletes and coaches in optimizing their nutritional strategies. The study conducted a systematic search of electronic databases (i.e., PubMed, Web of Science, Scopus) using keywords pertaining to micronutrients, athletic performance, and exercise. The search involved particular criteria of studies published in English between 1950 and 2023. The findings suggest that vitamins and minerals are crucial for an athlete's health and physical performance , and no single micronutrient is more important than others. Micronutrients are necessary for optimal metabolic body's functions such as energy production, muscle growth, and recovery, which are all important for sport performance. Meeting the daily intake requirement of micronutrients is essential for athletes, and while a balanced diet that includes healthy lean protein sources, whole grains, fruits, and vegetables is generally sufficient, athletes who are unable to meet their micronu-trient needs due to malabsorption or specific deficiencies may benefit from taking multivitamin supplements. However, athletes should only take micronutrient supplements with the consultation of a specialized physician or nutritionist and avoid taking them without confirming a deficiency.
... In addition, the two groups differed in their answers as to whether vegetarianism diminishes physical performance: Although more responders answered "no" than "yes" in both groups, the percentage of vegetarians (67%) was double that of omnivores (34%), among whom more (41%) did not know. Indeed, vegetarianism is not considered an obstacle to sport performance and athletic achievement, although vegetarians need to be more vigilant about their diet, as compared to omnivores [23][24][25][26]. ...
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Recent studies have shown that the prevalence of vegetarianism among the general population in western societies ranges between 2% and 9%. Information regarding the prevalence of vegetarianism among exercisers is lacking. The aim of the present pilot study was to determine the prevalence of vegetarianism among regular exercisers in Greek gyms, as well as assess their dietary habits, exercise habits, and attitudes toward health and environmental issues. 291 regular gym clients completed an anonymous descriptive online questionnaire containing 65 questions divided into five sections (demographic characteristics, dietary habits, physical activity, dietary supplements, environment). Thirty responders (10.3%) identified themselves as vegetarians, spanning the entire spectrum of vegetarianism, from raw vegan to semi-vegetarian. Compared to omnivores, vegetarians had lower body weight, were more concerned about their health and convinced about the health benefits of their dietary choices, were surrounded by more vegetarians socially, consumed fast food and ate out less often, used more dietary supplements, and were better informed about what a sustainable diet is (all p < 0.05). Vegetarians did not differ significantly from omnivores in demographic characteristics, alcohol consumption, smoking habits, prevalence of psychogenic eating disorders, or exercise practices (except for practicing more yoga/Pilates). In conclusion, we report, for the first time, a considerable prevalence of vegetarianism among regular exercisers in gyms. Our findings demonstrate important similarities and differences between exercising vegetarians and omnivores (partly at odds with those seen in the general population) and highlight nutritional and environmental issues on which both groups should be better educated.
... Nowadays, numerous athletes compete at a high level without consuming animal products, guided by ethical and health reasons [1,2]. A well-planned vegan diet that considers the management of critical nutrients could be appropriate for all stages of the life cycle, as well as for athletes [3], as there seem to be no differences between plant-based and omnivorous diets when comparing physical performance [4]. ...
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Numerous athletes compete at a high level without consuming animal products; although a well-planned vegan diet might be appropriate for all stages of the life cycle, a few elements need to be addressed to build a balanced plant-based diet for an athlete, particularly in bodybuilding, in which muscle growth should be maximised, as athletes are judged on their aesthetics. In this observational study, nutritional intakes were compared in a cohort of natural omnivorous and vegan bodybuilders, during two different phases of preparation. To this end, 18 male and female bodybuilders (8 vegans and 10 omnivores) completed a food diary for 5 days during the bulking and cutting phases of their preparation. A mixed-model analysis was used to compare macro-and micronutrient intakes between the groups in the two phases. Both vegans and omnivores behaved similarly regarding energy, carbohydrate, and fat intakes, but vegans decreased their protein intake during the cutting phase. Our results suggest that vegan bodybuilders may find difficulties in reaching protein needs while undergoing a caloric deficit, and they might benefit from nutritional professionals' assistance to bridge the gap between the assumed proteins and those needed to maintain muscle mass through better nutrition and supplementation planning.
... These results suggest a changing pattern of motivators for following vegetarian-based diets, with greater emphasis on environmental concerns and, increasingly, improved performance. Documentaries such as 'The Game Changers' which promoted the potential benefits of a vegetarian-based diet for athletes and attracted extensive media attention (Vitale & Hueglin, 2021) may be driving this shift. Similarly, popular documentaries such as 'Cowspiracy' outlining the environmental impact of meat production can have a substantial influence on consumer behaviour which may shape changes in vegetarian-based dietary motives in both athletes and non-athletes (Pabian et al., 2020). ...
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The adoption of vegetarian‐based dietary patterns among athletes has been gaining popularity. However, limited research examines the dietary behaviours within this group. Therefore, the aim of this study was to examine self‐reported dietary behaviours in a cohort of physically active individuals following vegetarian‐based dietary patterns, recruited via social media. A 52‐item online survey was created with questions related to demographics, physical activity, eating patterns and supplementation use. An external link to the Australian Automated Self‐Administered 24‐h (ASA24‐AU) recall was included to examine nutrient intakes. Dietary quality was assessed using the Alternate Healthy Eating Index‐2010 (AHEI‐2010) and the Dietary Phytochemical Index (DPI) tools. A total of 781 (84.8%) respondents completed the survey in 2018. Principal motives for adhering to a vegetarian‐based dietary pattern included animal rights (86.5%), environmental concerns (75.4%), health reasons (69.6%) and improving physical performance (24.1%). Vitamin B12 was the most commonly reported supplement (58.1%) followed by protein powder (36.3%) and vitamin D (35.9%). A total of 133 respondents completed the ASA24‐AU dietary recall with generally adequate nutrient intakes and a high‐quality diet as assessed by the AHEI‐2010 and DPI. A significant minority of physically active individuals following vegetarian‐based diets do so with the aspiration of improving their exercise performance. Dietary quality was considered high in this group for recreational physical activity, although intakes of vitamin B12 and LC n‐3 PUFA were low.
... Increasingly, athletes or exercisers decide to eat a plant-based diet, which may be associated with deepening deficiencies; moreover, researchers and nutritionists suggest that with proper meal planning, an athlete can meet all of his nutritional needs with plantbased foods without sacrificing physical performance [12,13]. Edible freeze-dried flowers can help to supplement protein or dietary fibre, in addition, they can be easily added to a meal, e.g., a cocktail or yoghurt consumed after training. ...
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Edible flowers have been gaining popularity among researchers, nutritionists and chefs all around the world. Nowadays, flowers are used to make food look and/or taste better; however, they are also a very good source of valuable nutrients (antioxidants, vitamins, proteins, fats, carbohydrates, macro and microelements). The aim of our study was to determine the content of dietary fibre and total protein in selected edible flowers; we also compared the nutritional content of petals, differentiating between the representatives of the Oleaceae and Asteraceae families, as well as herbaceous vs. woody plants. The study material consisted of petals of 12 edible flower species (Magnolia × soulangeana, Sambucus nigra L., Syringa vulgaris L. (white and violet flowers), Robinia pseudoacacia, Forsythia × intermedia, Cichorium intybus L., Bellis perennis, Tussilago farfara L., Taraxacum officinale F.H. Wiggers coll., Centaurea cyanus L., Calendula officinalis). Dietary fibre content was determined by the enzymatic-gravimetric method and ranged from 13.22 (Magnolia × soulangeana) to 62.33 (Calendula officinalis L.) g/100 g. For insoluble dietary fibre (IDF), the values ranged from 8.69 (Magnolia × soulangeana) to 57.54 (Calendula officinalis L.) g/100 g, and the content of soluble dietary fibre (SDF) was between 1.35 (Syringa vulgaris L.-white flowers) and 7.46 (Centaurea cyanus L) g/100 g. Flowers were also shown to be a good, though underappreciated, source of plant protein, with content ranging from 8.70 (Calendula officinalis L.) to 21.61 (Magnolia × soulangeana) g/100 g dry matter (Kjeldahl method). Considerable amounts of protein were found in the flowers of the olive family (Oleaceae) and woody plants, which can enrich the daily diet, especially vegan and vegetarian. Edible flowers of the Asteraceae family, especially the herbaceous representatives, contained high levels of both total dietary fibre and its insoluble fraction; therefore, they can be a rich source of these nutrients in the daily diet of athletes, which would perform a prebiotic function for gut bacteria.
... This may be due to the high fibre content of plant-based foods causing increased levels of satiety, leading to a decreased energy intake [110]. A properly planned vegetarian or vegan diet can provide adequate levels of energy and essential nutrients such as iron; however, in poorly planned and or energy-restricted vegetarian/vegan diets, nutrient deficiencies may arise [112]. In short, it is the combination of the reduced bioavailability of non-haem iron and the adoption of an improperly planned or energy restricted diet which may contribute to the increased risk of ID among dancers adopting vegetarian or vegan diets. ...
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Dancers are an athlete population at high risk of developing iron deficiency (ID). The aesthetic nature of the discipline means dancers potentially utilise dietary restriction to meet physique goals. In combination with high training demands, this means dancers are susceptible to problems related to low energy availability (LEA), which impacts nutrient intake. In the presence of LEA, ID is common because of a reduced mineral content within the low energy diet. Left untreated, ID becomes an issue that results in fatigue, reduced aerobic work capacity, and ultimately, iron deficient anaemia (IDA). Such progression can be detrimental to a dancer’s capacity given the physically demanding nature of training, rehearsal, and performances. Previous literature has focused on the manifestation and treatment of ID primarily in the context of endurance athletes; however, a dance-specific context addressing the interplay between dance training and performance, LEA and ID is essential for practitioners working in this space. By consolidating findings from identified studies of dancers and other relevant athlete groups, this review explores causal factors of ID and potential treatment strategies for dancers to optimise absorption from an oral iron supplementation regime to adequately support health and performance.
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Introdução: Atualmente as dietas a base de vegetais têm ganhado cada vez mais adeptos a esse estilo de vida, tendo como objetivo uma alimentação mais saudável. No meio esportivo, muitos atletas estão adotando essa prática alimentar e assim acabam gerando vários debates se esse tipo de alimentação oferece todos os nutrientes que um atleta necessita. Objetivo: Debater suas principais carencias nutricionais, necessidades energeticas e impacto na performance em atletas que seguem um padrão vegetariano. Metodologia: Para a realização desse estudo optou-se por modalidade de revisão bibliografica, para o levantamento da literatura foi incluído monografias e artigos retirados de sites como Google Acadêmico, Scielo e PubMed. Este trabalho reune evidencias cientificas de 2012 até 2022 que abordam sobre alimentação e necessidades nutricionais em atletas vegetarianos. Resultados e Discussões: Os nutrientes a ter em atenção para evitar deficiências nutricionais em atletas vegetarianos incluem as proteínas, ácidos gordos n-3, ferro, zinco, cálcio, iodo vitamina D e vitamina B12. Conclusão: Com base nesses estudos o padrao de alimentação vegetariano não afeta de forma negativa a perfomance dos atletas e suas necessidades nutricionais são facilmente supridas quando planejadas de forma adequada.
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Low energy availability (EA) underpins the female and male athlete triad and relative energy deficiency in sport (RED-S). The condition arises when insufficient calories are consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities in active females. The health concerns associated with longstanding low EA include menstrual/libido, gastrointestinal and cardiovascular dysfunction and compromised bone health, all of which can contribute to impaired sporting performance. This narrative review provides an update of our previous review on the prevalence and risk of low EA, within-day energy deficiency, and the potential impact of low EA on performance. The methods to assess EA remain a challenge and contribute to the methodological difficulties in identifying “true” low EA. Screening female athletic groups using a validated screening tool such as the Low Energy Availability in Females Questionnaire (LEAF-Q) has shown promise in identifying endurance athletes at risk of low EA. Knowledge of RED-S and its potential implications for performance is low among coaches and athletes alike. Development of sport and gender-specific screening tools to identify adolescent and senior athletes in different sports at risk of RED-S is warranted. Education initiatives are required to raise awareness among coaches and athletes of the importance of appropriate dietary strategies to ensure that sufficient calories are consumed to support training.
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Background: Endurance events have experienced a significant increase in growth in the new millennium and are popular activities for participation globally. Sports nutrition recommendations for endurance exercise however remains a complex issue with often opposing views and advice by various health care professionals. Methods: A PubMed/Medline search on the topics of endurance, athletes, nutrition, and performance was undertaken and a review performed summarizing the current evidence concerning macronutrients, hydration, and supplements as it pertains to endurance athletes. Results: Carbohydrate and hydration recommendations have not drastically changed in years, while protein and fat intake have been traditionally underemphasized in endurance athletes. Several supplements are commercially available to athletes, of which, few may be of benefit for endurance activities, including nitrates, antioxidants, caffeine, and probiotics, and are reviewed here. The topic of "train low," training in a low carbohydrate state is also discussed, and the post-exercise nutritional "recovery window" remains an important point to emphasize to endurance competitors. Conclusions: This review summarizes the key recommendations for macronutrients, hydration, and supplements for endurance athletes, and helps clinicians treating endurance athletes clear up misconceptions in sports nutrition research when counseling the endurance athlete.
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Purpose of Review The purpose of this review is to provide background on the present literature regarding the utility and effectiveness of protein supplements, including protein source and nutrient timing. Recent Findings In the setting of adequate dietary protein consumption, research suggests some benefit particularly in sport or exercise activities. Summary Protein supplements command a multi-billion-dollar market with prevalent use in sports. Many individuals, including athletes, do not consume optimal dietary protein on a daily basis. High-protein diets are remarkably safe in healthy subjects, especially in the short term. Some objective outcomes are physiologic and may not translate to clinically relevant outcomes. Athletes should, however, consider long-term implications when consuming high quantities of protein in dietary or supplement form.
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While animal products are rich in protein, the adequacy of dietary protein intake from vegetarian/vegan diets has long been controversial. In this review, we examine the protein and amino acid intakes from vegetarian diets followed by adults in western countries and gather information in terms of adequacy for protein and amino acids requirements, using indirect and direct data to estimate nutritional status. We point out that protein-rich foods, such as traditional legumes, nuts and seeds, are sufficient to achieve full protein adequacy in adults consuming vegetarian/vegan diets, while the question of any amino acid deficiency has been substantially overstated. Our review addresses the adequacy in changes to protein patterns in people newly transitioning to vegetarian diets. We also specifically address this in older adults, where the issues linked to the protein adequacy of vegetarian diets are more complex. This contrasts with the situation in children where there are no specific concerns regarding protein adequacy because of their very high energy requirements compared to those of protein. Given the growing shifts in recommendations from nutrition health professionals for people to transition to more plant-based, whole-food diets, additional scientific evidence-based communications confirming the protein adequacy of vegetarian and vegan diets is warranted.
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Plant-sourced proteins offer environmental and health benefits, and research increasingly includes them in study formulas. However, plant-based proteins have less of an anabolic effect than animal proteins due to their lower digestibility, lower essential amino acid content (especially leucine), and deficiency in other essential amino acids, such as sulfur amino acids or lysine. Thus, plant amino acids are directed toward oxidation rather than used for muscle protein synthesis. In this review, we evaluate the ability of plant- versus animal-based proteins to help maintain skeletal muscle mass in healthy and especially older people and examine different nutritional strategies for improving the anabolic properties of plant-based proteins. Among these strategies, increasing protein intake has led to a positive acute postprandial muscle protein synthesis response and even positive long-term improvement in lean mass. Increasing the quality of protein intake by improving amino acid composition could also compensate for the lower anabolic potential of plant-based proteins. We evaluated and discussed four nutritional strategies for improving the amino acid composition of plant-based proteins: fortifying plant-based proteins with specific essential amino acids, selective breeding, blending several plant protein sources, and blending plant with animal-based protein sources. These nutritional approaches need to be profoundly examined in older individuals in order to optimize protein intake for this population who require a high-quality food protein intake to mitigate age-related muscle loss.
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Introduction: Isoflavones, a chemical class of phytoestrogens found in soybeans and soy products, may have biological functions similar to estradiol. After binding with ERβ or perhaps independently of estrogen receptors, isoflavones may augment vascular endothelial relaxation, contributing to improved limb blood flow. Purpose: To determine if acute fermented soy extract supplementation influences 20-km time trial cycling performance and cardiac hemodynamics compared to a placebo. Methods: Subjects included twenty-five cyclists and triathletes (31 ± 8 y, VO2peak: 55.1 ± 8.4 mL·kg·min). Each subject completed a VO2peak assessment, familiarization, and two 20-km time trials in randomized order following ingestion of a fermented soy extract supplement or placebo. The fermented soy extract consisted of 30 g powdered supplement in 16 fl. ounces of water. The placebo contained the same quantities of organic cocoa powder and water. Each trial consisted of 60 min of rest, 30 min at 55% Wpeak, and a self-paced 20-km time trial. Results: Soy supplementation elicited a faster time to 20km completion (-0.22 ± 0.10 min; -37 s), lower average heart rate (-5 ± 1 bpm), and significantly greater power (7 ± 3 W) and speed (0.42 ± 0.16 km•h) during the last 5 km of the time trial compared to placebo. Analysis of the results by relative fitness level (< 57 vs. ≥ 57 mL⋅kg⋅min) indicated that those with a higher level of fitness reaped the largest performance improvement alongside a reduced heart rate (-5 ± 7 bpm). Conclusion: Ingestion of a fermented soy extract supplement improved sprint-distance performance through improvements in both power and speed. For those with great aerobic fitness, soy supplementation may help to decrease cardiac demand alongside performance improvement.
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Background In search of the right nutrition for the athlete, numerous nutritional strategies and diets were discussed over time. However, the influence of plant-based diets, especially veganism, on exercise capacity has not been clarified. Methods We conducted a cross-sectional study to compare the exercise capacity of vegan (VEG, n = 24), lacto-ovo-vegetarian (LOV, n = 26) and omnivorous (OMN, n = 26) recreational runners. To determine maximal exercise capacity, participants performed an incremental exercise test on a bicycle ergometer until voluntary exhaustion. During the test capillary blood samples were taken at several time points for the measurement of arterial lactate [lac] and glucose [glc] concentrations. To determine nutrient intake, a 24 h dietary recall was conducted. Results The groups showed comparable training habits in terms of training frequency (mean 3.08 ± 0.90 time/wk., p = 0.735), time (mean 2.93 ± 1.34 h/wk., p = 0.079) and running distance (mean 29.5 ± 14.3 km/wk., p = 0.054). Moreover, similar maximum power output (PmaxBW) was observed in all three groups (OMN: 4.15 ± 0.48 W/kg, LOV: 4.20 ± 0.47 W/kg, VEG: 4.16 ± 0.55 W/kg; p = 0.917) and no differences regarding [lac] throughout the exercise test and maximum lactate could be observed between the groups (OMN: 11.3 ± 2.19 mmol/l, LOV: 11.0 ± 2.59 mmol/l, VEG: 11.9 ± 1.98 mmol/l; p = 0.648). Conclusion The data indicate that each examined diet has neither advantages nor disadvantages with regard to exercise capacity. These results suggest that a vegan diet can be a suitable alternative for ambitious recreational runners. Trial registration German Clinical Trials Register (DRKS00012377). Registered on 28 April 2017
Importance Epidemiological evidence regarding the long-term effects of higher dietary protein intake on mortality outcomes in the general population is not clear. Objective To evaluate the associations between animal and plant protein intake and all-cause and cause-specific mortality. Design, Setting, and Participants This prospective cohort study included 70 696 participants in the Japan Public Health Center–based Prospective Cohort who were aged 45 to 74 years and had no history of cancer, cerebrovascular disease, or ischemic heart disease at study baseline. Data were collected from January 1, 1995, through December 31, 1999, with follow-up completed December 31, 2016, during which 12 381 total deaths were documented. Dietary intake information was collected through a validated food frequency questionnaire and used to estimate protein intake in all participants. Participants were grouped into quintile categories based on their protein intake, expressed as a percentage of total energy. Data were analyzed from July 18, 2017, through April 10, 2019. Main Outcomes and Measures Hazard ratios (HRs) and 95% CIs for all-cause and cause-specific mortality were estimated using Cox proportional hazards regression models with adjustment for potential confounding factors. Results Among the 70 696 participants, 32 201 (45.5%) were men (mean [SD] age, 55.6 [7.6] years) and 38 495 (54.5%) were women (mean [SD] age, 55.8 [7.7] years). Intake of animal protein showed no clear association with total or cause-specific mortality. In contrast, intake of plant protein was associated with lower total mortality, with multivariable-adjusted HRs of 0.89 (95% CI, 0.83-0.95) for quintile 2; 0.88 (95% CI, 0.82-0.95) for quintile 3; 0.84 (95% CI, 0.77-0.92) for quintile 4; and 0.87 (95% CI, 0.78-0.96) for quintile 5, with quintile 1 as the reference category (P = .01 for trend). For cause-specific mortality, this association with plant protein intake was evident for cardiovascular disease (CVD)–related mortality (HRs, 0.84 [95% CI, 0.73-0.96] to 0.70 [95% CI, 0.59-0.83]; P = .002 for trend). Isocaloric substitution of 3% energy from plant protein for red meat protein was associated with lower total (HR, 0.66; 95% CI, 0.55-0.80), cancer-related (HR, 0.61; 95% CI, 0.45-0.82), and CVD-related (HR, 0.58; 95% CI, 0.39-0.86) mortality; substitution for processed meat protein was associated with lower total (HR, 0.54; 95% CI, 0.38-0.75) and cancer-related (HR, 0.50; 95% CI, 0.30-0.85) mortality. Conclusions and Relevance In this large prospective study, higher plant protein intake was associated with lower total and CVD-related mortality. Although animal protein intake was not associated with mortality outcomes, replacement of red meat protein or processed meat protein with plant protein was associated with lower total, cancer-related, and CVD-related mortality.
Purpose: The importance of the brain in sports was recently confirmed by the negative effect of mental fatigue (MF) on sport-specific psychomotor skills. Creatine supplementation improves strength, but can also improve cognitive functioning. To explore the role of creatine in combatting MF, we evaluated whether creatine supplementation counteracts the MF-associated impairment in sport-specific psychomotor skills. Methods: In 23°C, 14 healthy participants (4F 10M; mean ± SD; age:24 ± 3 y; mass:74 ± 13 kg; height:179 ± 9 cm) performed -counterbalanced, crossover and double blinded- a 90-min mentally fatiguing task (i.e. Stroop task) in two different conditions: after a 7-day creatine supplementation (CR; 20 g/day) and after a 7-day calcium lactate supplementation (PLAC; placebo), separated by a 5-week washout. In both conditions, a 7-min sport-specific visuomotor task, a dynamic handgrip strength endurance task and a 3-min Flanker task was performed before and after the mentally fatiguing task. Physiological and perceptual responses were measured throughout the protocol. Results: Handgrip strength endurance was higher in CR compared to PLAC (p=0.022). MF impaired visuomotor response time (+4.4%; p=0.022) and Flanker accuracy (-5.0%; p=0.009) in both conditions. Accuracy on the Stroop task was higher in CR compared to PLAC (+4.9%; p=0.026). Within the perceptual and physiological parameters, only motivation and vigor (p≤0.027) were lower in CR compared to PLAC. Conclusion: Creatine supplementation improved physical (strength endurance) and prolonged cognitive (Stroop accuracy) performance, yet it did not combat mental fatigue-induced impairments in short sport-specific psychomotor or cognitive (Flanker) performance. These results warrant further investigation in the potential role of creatine in combatting the MF-associated decrements in prolonged (e.g. 90-min soccer game) sport performance, and suggest a role of brain-phosphocreatine in MF.
Some track-and-field athletes implement special diets aiming to improve health and/or performance. An evidence-based approach to any diet is recommended to minimize the risks associated with unnecessary dietary restriction, which may potentially do more harm than good. Four prevalent diets are reviewed in this study: (a) gluten-free; (b) low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP); (c) vegetarian; and (d) fasting diets. Recently, gluten-free diets and low FODMAP diets have emerged as novel regimes thought to improve gastrointestinal health and reduce the risk of exercise-associated gastrointestinal symptoms. No direct beneficial outcomes have been associated with avoiding gluten for clinically healthy athletes. Indirectly, a gluten-free diet is associated with other dietary changes, particularly FODMAP reduction, which may improve adverse gastrointestinal symptoms. Vegetarian diets can optimally support athletic demands. However, attention is required to ensure adequate energy and intake of specific nutrients that are less abundant or less well absorbed from plant sources. Finally, fasting is a long-standing concept that is undertaken on a voluntary and obligatory basis. Despite limited supporting research, voluntary fasting is a popular alternative to conventional diets perceptually offering health and body composition benefits. Strict obligatory fasting guidelines likely require the implementation of tailored nutrition strategies to help athletes cope with athletic demands. Overall, a multitude of factors influence adherence to special diets. Even when adherence to a special diet is a necessity, education and advice from an accredited dietitian/nutritionist are recommended for track-and-field athletes to optimize nutrition for health and performance.