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To promote safe supplement use, athletes are advised to choose third-party tested (TPT) supplements to minimise doping risk. This study evaluated changes in knowledge on supplements in US high school athletes from a 2-week online supplement education programme. One group of sophomores (ED, n = 48) completed a Canvas course on safe supplement use, based on the Theory of Planned Behaviour, while the other group of freshmen (NOED, n = 38) did not. Participants completed questionnaires pre- and post-intervention to assess practical knowledge of finding and ordering TPT supplements, familiarity with World Anti-Doping Agency (WADA) banned substances and decision-making in supplement purchasing. Chi-Square and McNemar tests were applied with significance set at p ≤ 0.05. Pre-intervention no differences were found between groups (ages 14-17 years, 39.5% female) for any knowledge questions (p = 0.18). Post-intervention, ED participants were more likely to know where to find (58.3% vs. 39.5%, p = 0.041), and order (62.5% vs. 28.9%, p = 0.001) TPT supplements, and more athletes in ED (72.9%) than NOED (40.0%) reported deciding to purchase supplements themselves (p = 0.015). Parents were less influential in ED (75.0% vs. 92.1%, p = 0.019). Importantly, positive changes over time were larger for ED versus NOED in knowing where to find (28% vs. 13%, p = 0.04) and order (28% vs. 7%, p < 0.001) TPT supplements and WADA familiarity (19% vs. 5%, p = 0.01). Within-group changes showed ED improved on all practical knowledge questions (p = <0.001-0.008), whereas NOED only increased in knowing where to find TPT supplements (p = 0.003). These findings suggest an online educational programme may enhance practical knowledge of safe supplement use among high school athletes., (© 2024 British Nutrition Foundation.)

This article provides a recap of the 10 Questions/10 Experts session at the 2024 American College of Sports Medicine Annual Meeting. Each of the speakers considered the validity of common "myths," while providing evidence-based opinions to support, or, bust, myths addressing the following questions: (1) Would 100 g/hr of carbohydrate be advisable for the Olympic Cycling Road race? (2) Is there an advantage in the marathon of ingesting bicarbonate as a hydrogel product? (3) Can genotyping be used to individualize caffeine supplementation in football? (4) Should low fluid consumers drink more to improve 1,500-m track performance? (5) Do urinary markers of dehydration predict poor basketball performance? (6) Do placebo effects influence 10-km track performance? (7) Should combat athletes make weight using glucagon-like peptide-1 receptor agonists? (8) Would crushed ice ingestion help tennis umpires make better decisions in the heat? (9) Are collagen supplements useful to reduce tendon and ligament injuries in volleyball? and (10) Should female athletes plan their training and diet according to their menstrual cycle? This article describes the content of each of the presentations including the most important outcomes and conclusions drawn by the presenters.

Context: The training stress of heat acclimatization optimizing exercise performance in a hot environment can be demanding., Objectives: This study evaluated the efficiency of different single heating protocols to elevate core temperature., Design: Not randomized controlled trial., Setting: Passive heating (PAS), 30-min active heating using a high-intensity bike protocol (HIBP) in a hot environment with 30-min passive heating (EH-PAS), 60-min HIBP in a hot environment (EH), or 60-min HIBP at room temperature (EM)., Participants: Ten male participants (25±3 years) performed four different 60-min heating strategies at least one week apart., Main Outcome Measures: Body core temperature and heart rate., Results: The highest peak gastrointestinal temperature occurred in EH-PAS (39.1±0.4°C), followed by EH (38.9±0.3°C), EM (38.4±0.3°C), and PAS (38.1±0.5°C). The average HR, measured as a control for intensity, was not different between exercise strategies (EH-PAS: 142±12.3, EH: 146±9.7, and EM: 142±13.3, p>0.05), while different from PAS: 98±15.2 bpm, p<0.05., Conclusions: Adding passive heating to a shorter exercise protocol can be just as effective in keeping core temperature elevated as exercise in the heat alone during a 60-minute session. Therefore, a single-bout combination of exercise and passive heating may result in a similar body temperature induction compared to exercise heat stress alone.

Background: Athletes often report gastrointestinal (GI) complaints. Standardized validated tests validated in athletes are lacking., Objective: The objective of the current study was to investigate the test-retest reliability of the gastrointestinal symptoms rating scale (GSRS), a disease-specific instrument of 15 items to quantify the severity of various GI symptoms., Methods: For this purpose, a 3-week repeated measurements design was used. The mean difference (Wilcoxon signed rank test), associations (Spearman correlations), and systematic difference using Bland-Altman calculations for repeated measurements, as well as its internal consistency (Cronbach's alpha) on testing day 1 and day 2 were analyzed, with significance set at p ≤ 0.05. A total of n = 70 well-trained athletes (26.1 ± 5.4 years, of which 40% were female) were included., Results: A high Cronbach's α for GSRS was found on testing day 1 (0.825), and day 2 (0.823), suggesting a good and comparable internal consistency of the questionnaire. When assessing the multilevel temporal stability for total GSRS scores (28.0, IQR 22.0-36.3 vs 26.5, IQR 18.0-35.0), there was a small but significant difference (Z =  - 2.489, and p = 0.013), but a fair correlation between day scores (r = 0.68, p < 0.001), and a Bland-Altman reporting difference between questionnaires within 10% of the total GSRS score, without significant reporting bias (p = 0.38). In most cases, except for hunger, burping, and loose stools, the individual GSRS items were reported in line with total scores and similar for sex., Conclusion: In conclusion, the GSRS is reliable when used with athletes, with good internal consistency for most symptoms independently of sex, except for hunger, burping, and loose stools., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Use of food supplements (FS) by athletes is well characterised but there is little information on 'herbal' or 'botanical' FS beyond 'natural'. This study determined, by questionnaire, whether athletes' main self-reported reason for using FS was reflective of what was written on product labels or, when these claims were unavailable, was in accordance with the scientific literature. In 217 elite (n = 55) and amateur (n = 162) athletes living on the island of Ireland, 71% (n = 153) consumed any kind of FS, with 16% (n = 34) of the entire cohort deemed botanical consumers. 'Protein' (21%, n = 46), 'vitamin D' (17%, n = 37) and 'vitamin C' (15% n = 32) were most consumed with the top reasons for use being 'to support health', 'to prevent illness/for immunity purposes' and 'recovery'. There was generally good agreement between approved nutrition and health claims for such products and athletes' main reported reasons for use. Only the amateur athletes in our pool described using botanical supplements, with reasons for use stated as 'sleep improvement' (21%), 'recovery' (14%), 'supporting health' (12%) and 'energy' (12%), resulting in poor agreement with either approved claims or scientific evidence. Only half of amateur athletes knew if their botanical FS were third-party tested. Athletes and practitioners require guidance to avoid consuming supplements for which there is little scientific evidence, and which may risk being contaminated/fraudulent., (© 2024 The Author(s). Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation.)

Background: Energy expenditure may be difficult to assess when hiking difficult trails. Case presentation: We measured physical activity exercise energy expenditure (PAEE) directly from oxygen uptake using a mobile device (cardiopulmonary exercise testing, CPET), and by using a formula based on heart rate (HR), or metabolic equivalent values from the Compendium of Physical Activity, and other physiological outcomes. Outcomes and implications: Total PAEE (1342 kcal) using CPET showed a two-fold difference between ascending and descending (887 vs. 455 kcal) during a 124-min hike. For HR, PAEE was 1893kcal (+551 kcal overreporting), while compendium-based scenarios ranged from 1179 to 1446 kcal, which was in closer range (-163 to +104 kcal/min) compared to the CPET data. Fluid consumption was 1300 mL/hour, with 1.1% bodyweight loss, peak skin temperature of 35.2°C and core body temperature of 39.2°C. Recommendations: Tables reasonably predict energy expenditure while not precisely reflecting the actual situation., Competing Interests: Declaration of conflicting interestsThe authors report there are no competing interests for this project, but FW received grants from external partners that were not related to this project. FW received grants from: Arizona Parks & Trails, Pac-12 Health and Wellbeing Initiative, the Collegiate and Professional Sports Dietetic Organization, Friesland Campina N.V., Standard Process Inc., Kraft Heinz Company, FEMA, and the Arizona Board of Regents.

Context: Nutritional supplement use in athletes is common, accompanied by potential doping risk., Objective: Determine athletes' nutritional supplement and third-party tested (TPT) supplement use, supplement knowledge as well as factors influencing their behavior., Design: Cross-Sectional Study., Setting: NCAA DI athletic departments., Participants: Student-athletes (n=410, 53% female, age 21.4±1.6 years)., Main Outcome Measures: Survey questions addressed topics including nutritional supplement knowledge and use, TPT supplement knowledge, use and logo recognition and data were 11 stratified for sex differences., Results: Athletes (91%) report the use of supplements, but the total number of supplements used (median and interquartile range, IQR) is lower in females (7, 4-11), than males (9, 4-12), with U=17960, p=0.01. A total of 48% (n=191, out of 402 responses) reported purchasing supplements outside of their athletic department, with significantly fewer females (40%, n=84) than males (56%, n=107) reporting this behavior (χ2=11.20, p<0.001). No association between TPT logo recognition and TPT use was seen (χ2=0.238, p=0.63). Of all athletes using supplements, 38% (n=140) reported "consistent TPT use", while females (36%, n=70) reported this less often than males (41%, n=70, χ2=0.952, p<0.32). No sex differences were seen for receiving nutritional counseling (89%, p=0.37), or the low nutritional supplement knowledge (<50%, p=0.38), however, males had 2.5 times greater odds at recognizing a TPT organization logo than females (OR=2.45, with 95% CI=1.58-3.79)., Conclusions: Most athletes use nutritional supplements. Females report slightly fewer supplements than males, while also less frequently purchasing them outside their athletic department, potentially explaining the lower TPT logo recognition in female athletes.

The current state of the literature lacks a clear characterization of gastrointestinal (GI) symptoms, gut microbiota composition, and general physical and mental wellbeing in well-trained athletes. Therefore, this study aimed to characterize differences in self-reported symptoms, gut microbiota composition, and wellbeing (i.e., sleep quality, mood, and physical (PHQ) and mental wellbeing) between athletes with and without GI symptoms. In addition, we assessed the potential impact of a 3-week multi-ingredient fermented whey supplement in the GI complaints group, without a control group, on the gut microbiota and self-reported GI symptoms and wellbeing. A total of 50 athletes (24.7 ± 4.5 years) with GI issues (GI group at baseline, GI-B) and 21 athletes (25.4 ± 5.3 years) without GI issues (non-GI group, NGI) were included. At baseline, there was a significant difference in the total gastrointestinal symptom rating scale (GSRS) score (24.1 ± 8.48 vs. 30.3 ± 8.82, p = 0.008) and a trend difference in PHQ (33.9 ± 10.7 vs. 30.3 ± 8.82, p = 0.081), but no differences ( p > 0.05) were seen for other outcomes, including gut microbiota metrics, between groups. After 3-week supplementation, the GI group (GI-S) showed increased Bifidobacterium relative abundance ( p < 0.05), reported a lower number of severe GI complaints (from 72% to 54%, p < 0.001), and PHQ declined ( p = 0.010). In conclusion, well-trained athletes with GI complaints reported more severe GI symptoms than an athletic reference group, without showing clear differences in wellbeing or microbiota composition. Future controlled research should further investigate the impact of such multi-ingredient supplements on GI complaints and the associated changes in gut health-related markers.

Introduction: The aim of this cross-sectional study was to develop an algorithm to predict athletes use of third-party tested (TPT) supplements. Therefore, a nutritional supplement questionnaire was used with a section about self-reported TPT supplement use., Methods: Outcomes were randomly assigned to a training dataset to identify predictors using logistic regression models, or a cross-validation dataset. Training data were used to develop an algorithm with a score from 0 to 100 predicting use or non-use of TPT nutritional supplements., Results: A total of n = 410 NCAA Division I student-athletes (age: 21.4 ± 1.6 years, 53% female, from >20 sports) were included. Then n = 320 were randomly selected, of which 34% ( n = 109) of users consistently reported that all supplements they used were TPT. Analyses resulted in a 10-item algorithm associated with use or non-use of TPT. Risk quadrants provided the best fit for classifying low vs. high risk toward inconsistent TPT-use resulting in a cut-off ≥60% (χ 2 (4) = 61.26, P < 0.001), with reasonable AUC 0.78. There was a significant association for TPT use (yes/no) and risk behavior (low vs. high) defined from the algorithm (χ 2 (1)=58.6, P < 0.001). The algorithm had a high sensitivity, classifying 89% of non-TPT users correctly, while having a low specificity, classifying 49% of TPT-users correctly. This was confirmed by cross-validation ( n = 34), reporting a high sensitivity (83%), despite a lower AUC (0.61)., Discussion: The algorithm classifies high-risk inconsistent TPT-users with reasonable accuracy, but lacks the specificity to classify consistent users at low risk. This approach should be useful in identifying athletes that would benefit from additional counseling., Competing Interests: FW and CG received grants from external partners during the last 5 years that were not related to this project. FW received grants from: Arizona Parks & Trails, Pac-12 Health and Wellbeing Initiative, the Collegiate and Professional Sports Dietetic Organization, Friesland Campina N.V., Standard Process Inc., Kraft Heinz Company, FEMA, Unilever Corporation, and the Arizona Board of Regents. CG received grants from the National Institutes of Health and Beyond Meat. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wardenaar, Schott, Seltzer and Gardner.)

The World Cup is traditionally held oppressive thermal conditions. Therefore, teams should follow heat strain mitigation strategies, including optimal fluid ingestion. The objective of this analysis was to assess and visually communicate match-based World Cup player hydration opportunities and behaviors. Broadcast recordings of the 2018 World Cup (June-July) were analyzed. Descriptive data were reported for match duration, the number, type, and duration of breaks, and player-initiated hydration moments, as well as environmental conditions categorized as 'no thermal stress' and 'thermal heat stress.' The median number and interquartile range of total match breaks were 7 [5-8] during official breaks, with a duration of 42 [23-72] seconds. There were 2 [1-3] player-initiated hydration moments per game, with a duration of 77 [55-100] seconds. On top of the 29% (#126) of breaks in which drinking occurred, an additional 26% (#33) of self-initiated drinking was registered with a duration of 7 [4-28] seconds without an official break. There was no significant difference (P = 0.22) in self-initiated hydration between thermal conditions. Relative percentages showed suboptimal use of substitution (14%) and VAR (38%) breaks vs. injury breaks (75%). In conclusion, football players did not sufficiently use available breaks to hydrate.

Purpose: Relationships between body weight, urine color (Uc), and thirst level (WUT) have been proposed as a simple and inexpensive self-assessment method to predict dehydration. This study aimed to determine if this method also allowed us to accurately identify a low vs. high urine concentration in (tactical) athletes., Methods: A total of n = 19 Army Reserve Officer Training Corps cadets and club sports athletes (22.7 ± 3.8 years old, of which 13 male) were included in the analysis, providing morning body weight, thirst sensation, and Uc for five consecutive days. Each item received a score 0 or 1, resulting in a WUT score ranging from 0 (likely hydrated) to 3 (very likely dehydrated). WUT model and individual item outcomes were then compared with a ≥ 1.020 urine specific gravity (USG) cut-off indicating a high urine concentration, using descriptive comparisons, generalized linear mixed models, and logistic regression (to calculate the area under the curve (AUC))., Results: WUT score was not significantly predictive of urine concentration, z = 1.59, p = 0.11. The AUC ranged from 0.54 to 0.77 for test days, suggesting a fair AUC on most days. Only Uc was significantly related to urine concentration, z = 2.49, p = 0.01. The accuracy of the WUT model for correctly classifying urine samples with a high concentration was 68% vs. 51% of samples with a low concentration, resulting in an average accuracy of 61%., Conclusion: This study shows that WUT scores were not predictive of urine concentration, and the method did not substantially outperform the accuracy of Uc scoring alone., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

The use of nutritional supplements can lead to doping risk and no data exist on high school athletes' use of certified third-party tested supplements. A cross-sectional cohort design was developed using an anonymous survey. Descriptive data for supplement use, use of third-party tested supplements, and knowledge in high school athletes were reported. A total of 225 high school athletes, ranging from 14-19 years of age, from a private high school in the western US, were included in the analysis of the results. A total of 94% (n=211) of athletes reported nutritional supplement use within the past year with an average of six (interquartile range: 3-9) individual supplements, ranging from 0-20 supplements per person. Most frequently reported were sports drinks (72%), vitamins (65%), sports bars (60%), protein powder (58%), caffeine (37%, as part of normal beverages, or 13% as a supplement), followed by creatine (23%). A total of 24% claimed to know for sure that all their supplements were third-party tested. In addition, the recognition of third-party testing organization icons was low (46% in supplement users vs. 14% in nonusers). Athletes also scored low in reporting how to find (22%) and how to order (25%) third-party tested supplements. In conclusion, almost all athletes in this study reported the use of multiple nutritional supplements annually. Only one-fourth of the athletes reported consistently using third-party tested supplements. Knowledge of where and how tested supplements could be purchased was limited in this high school athlete population.

Many high school athletes report using nutritional supplements. Due to a lack of education at the high school level, the use of safe for sports third-party tested nutritional supplements may be limited. To determine the impact of a short online nutritional supplement education program on safe dietary supplement behavior a cross-sectional repeated measures design was used. Therefore, a convenience sample of 106 high school athletes (14-19 years old) was recruited to measure pre-post education difference for nutritional supplement use and third-party tested (TPT) supplements. Additionally, it was analyzed if nutritional supplement related Theory of Planned Behavior (TPB) constructs were associated with athlete choices. The most popular supplements included protein powder (65%), caffeine from beverages (45%), and different types of vitamins (ranging from 38-44%). Consistent use of (safe) third-party tested individual supplements was low, ranging from 35-77% for the most frequently reported supplements. The combined TPB determinants explained 26% of the variance of the intention to use safe supplements (F 3, 102 = 13.03, p  < 0.001, Adj R 2 = 0.26). The self-reported intention to use third-party tested supplements increased significantly (+7%-36% per individual supplement) after following the education program ( Z  = -3.288, p  = 0.001) resulting in an intentional use of 54-94% TPT supplements. In conclusion, education resulted in more high school athletes reporting future third-party tested supplements use, and TPB construct scores did not change over time but could explain a substantial part of the variance of safe supplement use intentions.

ObjectiveTo examine funding and college-provided nutritional resources and to assess whether these are associated with diet quality and subsequent dietitian referral among female collegiate athletes of different sports levels. Participants: Female athletes (N = 120) from NCAA, NJCAA, and Club sports. Methods: Differences in questionnaire-based demographics, diet quality, and dietitian referrals were analyzed using Kruskal-Wallis and Chi-Square tests, with p  < 0.05. Factors associated with diet quality and dietitian referral were examined using regression. Results: NCAA reported more funding than Club and NJCAA ( p  < 0.05). NJCAA expressed insufficient funds for purchasing food and reported fewer college-provided nutritional resources ( p  < 0.05) while showing lower diet quality scores and higher subsequent dietitian referrals than NCAA and Club. No significant associations for dietary quality and dietitian referrals were found. Conclusions: Athletes across all sports levels reported insufficient funds for purchasing food and low diet quality, with NJCAA, showing the least funding and fewest nutritional resources.

Gastrointestinal (GI) symptoms may limit performance, but their prevalence and impact among team sports athletes is not well-documented. The objective of this study was to examine the prevalence of GI symptoms in a small sample of collegiate DI American football athletes, using a survey including the Gastrointestinal Symptoms Ratings Scale (GSRS). Forty-six athletes responded to the survey and reported scores for the 15-question GSRS with additional questions about dietary habits and supplement use. A total of 44 athletes were included in the study (45% of the current roster, age: 20.7 ± 1.7 years, 50% Afro-American or black, 39% skill position, 18% NSAIDs use, and 41% reporting protein supplement use); approximately half of the athletes (52%) reported experiencing GI complaints during exercise. Two-thirds of the athletes (61%) reported at least one or more GI symptoms in general, and 50% reported at least four moderate complaints. Seven athletes (16%) reported ≥2 severe GI symptoms with 5-13 moderate complaints. The most reported symptom was stomach pain (39%, n = 17), followed by hunger pain (36%, n = 16). Athletes reporting the use of protein supplements reported a higher GSRS score (22.0 and interquartile range (IQR) 17.0-31.8) vs. athletes not reporting protein use (15.0 and IQR 15.0-19.3), p = 0.001. Most athletes surveyed reported experiencing GI symptoms. A small group of these athletes reported multiple, varied, and severe symptoms that were associated with self-reported protein supplement use. In conclusion, the number of complaints varied among athletes, confirming the value of integrating the GSRS for screening purposes, and the expected need for individual dietary treatment approaches.

Athletes should carefully consider the use of botanical food supplements (BFSs) given the current lack of substantiation for botanical nutrition and health claims under EU and UK food laws. In addition, athletes may be at an increased risk of doping violations and other adverse outcomes potentially associated with BFS use; however, little is known about athletes' intake, knowledge, or perceptions in relation to BFS use. An online cross-sectional survey of n = 217 elite and amateur athletes living on the island of Ireland was conducted using Qualtrics XM to assess intake, knowledge, attitudes, and perceptions. General food supplements (FSs) were reported by approximately 60% of the study cohort, and 16% of the supplements reported were categorized as BFS. The most frequently consumed BFSs were turmeric/curcumin (14%), Ashwagandha (10%), and Beetroot extract (8%). A higher proportion of amateur athletes would source information about BFSs from less credible sources, such as fellow athletes, or from internet sources or their coach, compared to elite athletes. Those who sourced information about botanicals from fellow athletes ( p = 0.03) or the internet ( p = 0.02) reported a lower perceived level of risks associated with BFS use. This study therefore suggests that amateur athletes may be more likely to source information from less credible sources compared to elite athletes who may have more access to nutrition professionals and their knowledge/advice. This may have potential adverse implications for amateur athletes, e.g., Gaelic games players, who are included within the doping testing pool but who may not have access to evidence-based nutrition advice.

Background: Education may improve hiker safety on trails. Aim: To investigate the impact of an educational video on hiker fluid selection and fluid consumption in a hot environment. Methods: Quasi-experimental field study at hiking trails in which the intervention group (INT) viewed a three-minute hydration education video, whereas the control group (CON) did not. Before the hike, all hikers were asked if they wanted to select extra fluid, which was provided by the research team. Results: A total of n  = 97 hikers participated in the study, with n  = 56 in INT (32 male) and n  = 41 in CON (25 male). Despite absolute differences in environmental conditions, the differences fell within the same WBGT category. The total amount of fluid brought to the trails by participants was different between INT: 904 (503-1758) mL and CON: 1509 (880-2176) mL ( P  = 0.006), but participants in the INT group selected extra fluid (41%; n  = 23) significantly more often when compared with participants in the CON group (7%; n  = 3; P  < 0.001). As a result, there was no difference in the amount of fluid brought on the trail between INT: 1047 (611-1936) mL and CON: 1509 (932-2176) mL ( P  = 0.069), nor for fluid consumption between INT: 433 (289-615) mL/h and CON: 489 (374-719) mL/h ( P  = 0.18). Conclusions and Implications: A 3-min educational video may encourage hikers to select additional fluid before the start of their hike but does not appear to increase fluid intake.

Background: No study has evaluated the effect of macronutrient feedings on golf performance. Aim: Determine the effect of feedings during simulated golf game using a randomized cross-over study design. Methods: Male participants (n = 6, USGA handicap index 8.5 ± 6.72) played three standardized nine-hole rounds, consuming 30 g of carbohydrate, 15 g + 15 g protein and carbohydrate, or a zero-calorie control. Measurements of driving, chipping, and putting distance and accuracy were taken, as well as perceived levels of fatigue and alertness. Results: No relevant differences ( P  > 0.05) were seen in golf performance or alertness, but self-reported fatigue differed between conditions ( P   =  0.02), with scores of 2.5 (0.8 to 3.6) for the combination of carbohydrate and protein, 3.0 (1.5 to 4.3) for carbohydrate, and 4.0 (2.9 to 6.5) for the control, with higher levels indicating more fatigue. Conclusion: Macronutrient feedings led to a significantly lower level of self-reported fatigue without affecting golf performance and alertness compared to a control.

Background: Females are prone to urinary tract infections (UTIs) due to estrogen fluctuations affecting vaginal flora. While menstruating, increased fluid consumption to support urination frequency and void volume may be important, as the urethra and urinary tract are more predisposed to bacteria, particularly UTI pathogens. Aim: This study aimed to investigate the impact of hydration on urinary tract health during menstruation among underhydrated premenopausal women. Methods: Thirteen females participated in a 60-day 2 × 2 randomized crossover trial to evaluate the effectiveness of consuming ≥2.2 L of total beverage fluid intake, with 1.9 L being water, (intervention, INT) and maintaining habitual fluid intake (control, CON) on two subsequent menses. Participants completed fluid and urination diaries at days 2 and 5 after the onset of bleeding (day 1) to determine the fluid amount consumed and urination frequency. Urine concentration was assessed in afternoon (days 2 and 5) and uropathogenic bacterial activity in first-morning (days 3 and 6) urinations. General linear models assessed differences in bacterial and hydration outcomes. Results: The intervention led to a 62% mean total fluid increase, INT 3.0 ± 1.1 L and CON 1.9 ± 0.9 L, p  < 0.001, η 2  = 0.459. Urination frequency was greater and urine concentration less in the INT to CON, all p s  < 0.05, η 2 range = 0.023-0.019. Only four cultures detected uropathogenic bacteria, with no patterns between conditions or days, making it difficult to determine the intervention's effectiveness. Conclusion: Fluid intake increased, and hydration status improved. No differences in uropathogenic bacterial activity were seen between the hydration and control conditions.

Background: A wide range of sports health professionals provide nutritional supplement advice. We aimed to better understand the expertise, knowledge, and attitudes of sports health professionals toward nutritional supplements and third-party supplement testing., Methods: A web-based questionnaire was used to ask questions about nutritional supplement knowledge and attitudes toward the Dutch third-party supplement testing system (NZVT), about supplement efficacy, and if professionals advise these supplements, as well as which profession can be deemed the expert on nutritional supplements., Results: A total of n = 320 sports health professionals delivered input, of which 45% worked with Olympic athletes and 18% were sports dietitians. Sports dietitians were ranked as the most knowledgeable professionals about sports nutrition (80%) and nutritional supplements (74%), and a literature-based comparison showed the most favorable knowledge, attitudes, and ergogenic classifications of supplement scores for sports dietitians compared with other sports health professions. Sports health professionals working with Olympic athletes scored similar but slightly lower trends on self-reported knowledge, attitude and third-party supplement testing than sports dietitians but substantially better than professionals not working with Olympic athletes., Conclusion: Sports dietitians are seen as the absolute expert on supplements by other sports health professionals, with professionals working with Olympic athletes reporting similar trends, and other sports health professionals do have lower self-reported knowledge and preferred attitudes toward effective and safe use of dietary supplements.

The purpose of this study was to evaluate nutrition knowledge and diet quality in collegiate athletes to determine if referral to a sports registered dietitian (RD) is warranted. This cross-sectional study analyzed four sections of the Nutrition for Sport Knowledge Questionnaire and the Rapid Eating Assessment for Patients Questionnaire, both validated in athletic populations. The relationship between nutrition knowledge and diet quality was evaluated. Significance was set at P  ≤ 0.05. One hundred and twenty athletes reported a median nutrition score of 52 (45-61), and a dietary quality score of 53 (46-58), with a weak, positive association between both ( r  = 0.28 (95% CI: 0.11-0.44), P  < 0.01). Fifty-four percent were categorized as needing a referral to a sports RD. Diet quality scores differed between dietitian referral group with 49 (43-54) versus 58 (52-62) for the nonreferral group, respectively ( P  < 0.01, V = 0.71), with no difference in nutrition knowledge observed, P  = 0.73. Overall, nutrition knowledge and diet quality in our sample of collegiate athletes was poor. College athletic departments with limited access to sports RD should use these questionnaires to evaluate knowledge and the need of dietitian referral separately.

We aimed to assess the association between gastrointestinal (GI) injury, complaints, and food intake in 60-km ultramarathon runners. Thirty-three ultramarathon runners provided pre- and post-race blood samples for assessment of GI injury by intestinal fatty-acid binding protein (I-FABP), and inflammatory response by interleukin (IL)-6, IL-8, tumour necrosis factor alpha (TNF-α), and C-reactive protein (CRP). GI complaints and nutritional intake were reported by a post-race questionnaire. GI complaints were reported by 73% of the runners, of which 20% reported 1 or 2 severe complaints. IL-6, IL8, TNF-α, and CRP increased significantly from pre- to post-race ( P < 0.001 for all biomarkers), while I-FABP did not (1375 [IQR: 1264-2073] to 1726 [IQR: 985-3287] pg/mL; P = 0.330). The 'GI complaints score', as the integral of the number and severity of GI complaints, did not correlate with ΔI-FABP (rs: -0.050, P = 0.790) or energy intake (rs: 0.211, P = 0.260). However, there was a significant negative correlation between energy intake and ΔI-FABP (rs: -0.388, P = 0.031). In conclusion, GI complaints were neither associated with food intake nor GI injury as assessed by plasma I-FABP response. Energy intake, however, was inversely related to the I-FABP response to exercise. This finding suggests that substantial energy intakes during exercise may prevent exercise-induced GI injury as assessed by the I-FABP response. Novelty: No association between gastrointestinal complaints and gastrointestinal injury (I-FABP response) or food intake was present. There was an inverse correlation between energy intake and plasma I-FABP response, suggesting that higher energy intakes may prevent gastrointestinal injury as assessed by the I-FABP response.

Probiotic supplementation, traditionally used for the prevention or treatment of a variety of disease indications, is now recognized in a variety of population groups including athletes and those physically active for improving general health and performance. However, experimental and clinical trials with probiotics commonly suffer from design flaws and different outcome measures, making comparison and synthesis of conclusions difficult. Here we review current randomized controlled trials (RCTs) using probiotics for performance improvement, prevention of common illnesses, or general health, in a specific target population (athletes and those physically active). Future RCTs should address the key elements of (1) properly defining and characterizing a probiotic intervention, (2) study design factors, (3) study population characteristics, and (4) outcome measures, that will allow valid conclusions to be drawn. Careful evaluation and implementation of these elements should yield improved trials, which will better facilitate the generation of evidence-based probiotic supplementation recommendations for athletes and physically active individuals., Competing Interests: AM is employed by Isagenix International LLC. Isagenix was not involved in any aspect of the review. JP is a consultant for Aliment Nutrition Ltd. JT has previously received grants to evaluate the efficacy of various nutritional supplements including probiotics. FW received research funding from Royal Friesland Campina N.V., Amersfoort, the Netherlands after this review was drafted. NW has been the recipient of research from DuPont, Chr Hanson, Yakult, Probiotics Australia, UAS Laboratories, and Winclove Probiotics. CW serves on scientific advisory boards for the Wheat Foods Council, Ardent Mills, LLC, and the Hass Avocado Board Avocado Nutrition Science Advisory group. LM is on the Scientific Advisory Board for Bio-K+, Canada and on the Microbiome Advisory Board for Biocodex, France and is a paid lecturer for both companies. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mohr, Pugh, O'Sullivan, Black, Townsend, Pyne, Wardenaar, West, Whisner and McFarland.)