Anni Vanhatalo

This article provides a synopsis of the 10 Questions/10 Experts session at the 2026 American College of Sports Medicine Annual Meeting, which examined whether sports nutrition guidelines are equally applicable from recreational to elite athletes. Each speaker considered the validity of a given common “myth” statement and provided an evidence-based opinion to support, bust, or qualify propositions addressing the following questions: (a) Are sports nutrition guidelines based primarily on studies of elite athletes, and are they too serious for recreational athletes? (b) Do recreational marathon runners need the same in-race carbohydrate recommendations as elite marathon runners? (c) Must recreational athletes consume 1.6 g·kg ⁻¹ ·day ⁻¹ of protein to benefit from exercise training? (d) Does nitrate supplementation benefit elite and recreational athletes equally? (e) Do recreational athletes need a structured fluid intake plan? (f) Is sodium bicarbonate loading relevant only to elite athletes? (g) Do recreational and elite athletes require more micronutrients than suggested by the Recommended Dietary Allowances? (h) Is eating after 8:00 p.m. detrimental to performance or recovery in recreational athletes? (i) Are recreational athletes at greater risk for suboptimal vitamin D status because indoor occupations reduce sunlight exposure? and (j) Should recreational athletes train with low carbohydrate availability to amplify adaptation? This article describes the content of each presentation, including the most important evidence, practical implications, and conclusions identified by the presenters.

One hundred years ago, A.V. Hill authored three manuscripts analysing athletic world records from a physiological perspective. That analysis, grounded in Hill's understanding of contemporary muscle bioenergetics, provides a fascinating sketch of the thoughts and speculations of one of the fathers of exercise physiology. In this review, we reflect on Hill's prose with the benefit of 100 years of hindsight, and illustrate how Hill was able to draw startlingly accurate conclusions from what limited data were available on the physiology of intense exercise. Hill discusses the energetics of running, swimming, rowing and cycling in both males and females, as well as addressing exercise performance in horses and the mechanics of jumping. He also considers sports nutrition, pacing strategy and ultra‐endurance exercise. Perhaps most impactfully, he establishes that the speed–duration relationship has characteristics that reflect the underlying physiological basis of exercise performance. That physiology, in turn, differs depending on the duration of the event itself, providing one of the first descriptions of the task‐dependent nature of mechanisms limiting exercise tolerance. A remarkable feature of Hill's papers is that they were written just a few years before a major revolution in muscle biochemistry, and yet Hill was still able to develop conceptually sound ideas about human performance. His hypotheses require only minor revision to bring them into line with current understanding. In reaching their centenary, therefore, the surprising feature of these papers is not how well they have aged, but how relevant they remain. image

Apolipoprotein E4 (APOE4) genotype and nitric oxide (NO) deficiency are risk factors for age-associated cognitive decline. The oral microbiome plays a critical role in maintaining NO bioavailability during aging. The aim of this study was to assess interactions between the oral microbiome, NO biomarkers, and cognitive function in 60 participants with mild cognitive impairment (MCI) and 60 healthy controls using weighted gene co-occurrence network analysis and to compare the oral microbiomes between APOE4 carriers and noncarriers in a subgroup of 35 MCI participants. Within the MCI group, a high relative abundance of Neisseria was associated with better indices of cognition relating to executive function (Switching Stroop, rs = 0.33, P = 0.03) and visual attention (Trail Making, rs = −0.30, P = 0.05), and in the healthy group, Neisseria correlated with working memory (Digit Span, rs = 0.26, P = 0.04). High abundances of Haemophilus (rs = 0.38, P = 0.01) and Haemophilus parainfluenzae (rs = 0.32, P = 0.03), that co-occurred with Neisseria correlated with better scores on executive function (Switching Stroop) in the MCI group. There were no differences in oral nitrate (P = 0.48) or nitrite concentrations (P = 0.84) between the MCI and healthy groups. Linear discriminant analysis Effect Size identified Porphyromonas as a predictor for MCI and Prevotella intermedia as a predictor of APOE4-carrier status. The principal findings of this study were that a greater prevalence of oral P. intermedia is linked to elevated genetic risk for dementia (APOE4 genotype) in individuals with MCI prior to dementia diagnosis and that interventions that promote the oral Neisseria–Haemophilus and suppress Prevotella-dominated modules have potential for delaying cognitive decline.

A low carbohydrate, high fat (LCHF) diet in athletes increases fat oxidation but impairs sports performance, potentially due to impaired exercise economy. Dietary nitrate supplementation can improve exercise economy via an increase in nitric oxide production, which is initiated by the reduction of nitrate to nitrite within the oral cavity. This reaction is dependent on the presence of nitrate-reducing oral bacteria, which can potentially be altered by dietary changes, including a LCHF diet. This study explored the effect of a LCHF diet on the oral microbiome and subsequent changes to plasma nitrite concentration following nitrate supplementation. Following five days of LCHF or high carbohydrate (HCHO) control dietary intervention, highly trained male race walkers consumed 140 mL beetroot juice containing 8.4 mmol nitrate; they then provided (a) blood samples for plasma nitrate and nitrite analysis and (b) saliva samples for 16S rRNA sequencing of the oral microbiome. The LCHF diet (n = 13) reduced oral bacterial diversity and changed the relative abundance of the genera Neisseria (+10%), Fusobacteria (+3%), Prevotella (−9%), and Veillonella (−4%), with no significant changes observed following the HCHO diet (n = 11). Following beetroot juice ingestion, plasma nitrite concentrations were higher for the LCHF diet compared to the HCHO diet (p = 0.04). However, the absence of an interaction with the trial (pre–post) (p = 0.71) suggests that this difference was not due to the dietary intervention. In summary, we found an increase in plasma nitrate and nitrite concentrations in response to nitrate supplementation independent of diet. This suggests the oral microbiome is adaptive to dietary changes and can maintain a nitrate reduction capacity despite a decrease in bacterial diversity following the LCHF diet.

Aim: Dietary nitrate (NO₃⁻) supplementation increases nitric oxide bioavailability and can enhance exercise performance. We investigated the distribution and metabolic fate of ingested NO₃⁻ at rest and during exercise with a focus on skeletal muscle.Methods: In a randomized, crossover study, 10 healthy volunteers consumed 12.8 mmol ¹⁵N‐labeled potassium nitrate (K¹⁵NO₃; NIT) or potassium chloride placebo (PLA). Muscle biopsies were taken at baseline, at 1‐ and 3‐h post‐supplement ingestion, and immediately following the completion of 60 maximal intermittent contractions of the knee extensors. Muscle, plasma, saliva, and urine samples were analyzed using chemiluminescence to determine absolute [NO₃⁻] and [NO₂⁻], and by mass spectrometry to determine the proportion of NO₃⁻ and NO₂⁻ that was ¹⁵N‐labeled.Results: Neither muscle [NO₃⁻] nor [NO₂⁻] were altered by PLA. Following NIT, muscle [NO₃⁻] (but not [NO₂⁻]) was elevated at 1‐h (from ~35 to 147 nmol/g, p < 0.001) and 3‐h, with almost all of the increase being ¹⁵N‐labeled. There was a significant reduction in ¹⁵N‐labeled muscle [NO₃⁻] from pre‐ to post‐exercise. Relative to PLA, mean muscle torque production was ~7% greater during the first 18 contractions following NIT. This improvement in torque was correlated with the pre‐exercise ¹⁵N‐labeled muscle [NO₃⁻] and the magnitude of decline in ¹⁵N‐labeled muscle [NO₃⁻] during exercise (r = 0.66 and r = 0.62, respectively; p < 0.01).Conclusion: This study shows, for the first time, that skeletal muscle rapidly takes up dietary NO₃⁻, the elevated muscle [NO₃⁻] following NO₃⁻ ingestion declines during exercise, and muscle NO₃⁻ dynamics are associated with enhanced torque production during maximal intermittent muscle contractions.

Purpose: We tested the hypotheses that a highly cushioned running shoe (HCS) would 1) improve incremental exercise performance and reduce the oxygen cost (O_c) of submaximal running, and 2) attenuate the deterioration in O_c elicited by muscle damage consequent to a downhill run. Methods: Thirty-two recreationally active participants completed an incremental treadmill test in an HCS and a control running shoe (CON) for the determination of O_c and maximal performance. Subsequently, participants were pair matched and randomly assigned to one of the two footwear conditions to perform a moderate-intensity running bout before and 48 h after a 30-min downhill run designed to elicit muscle damage. Results: Incremental treadmill test performance was improved (+5.7%; +1:16 min:ss; P < 0.01) in the HCS when assessed in the nondamaged state, relative to CON. This coincided with a significantly lower O_c (−3.2%; −6 mL·kg⁻¹·km⁻¹; P < 0.001) at a range of running speeds and an increase in the speed corresponding to 3 mM blood lactate (+3.2%; +0.4 km·h⁻¹; P < 0.05). As anticipated, the downhill run resulted in significant changes in biochemical, histological, and perceptual markers of muscle damage, and a significant increase in O_c (+5.2%; 10.1 mL·kg⁻¹·km⁻¹) was observed 48 h post. In the presence of muscle damage, O_c was significantly lower in HCS (−4.6%; −10 mL·kg⁻¹·km⁻¹) compared with CON. Conclusions: These results indicate that HCS improved incremental exercise performance and O_c in the absence of muscle damage and show, for the first time, that despite worsening of O_c consequent to muscle damage, improved O_c in HCS is maintained.

Nonenzymatic nitric oxide (NO) generation via the reduction of nitrate and nitrite ions, along with remarkably high levels of nitrate ions in skeletal muscle, have been described recently. Skeletal muscle nitrate storage may be critical for maintenance of NO homeostasis in healthy aging, and nitrate supplementation may be useful for the treatment of specific pathophysiologies and for enhancing normal functions.