Lorna Doyle

Since the introduction of relative energy deficiency in sport (REDs) in 2014, research has primarily focused on athletes’ experiences of REDs symptomatology and consequences, limiting understanding beyond athletes’ perspective. This study assessed the relationship between athletes’ expectations of coaching and support staff in relation to REDs, and staff members’ perceptions of athletes’ REDs experiences. Two interrelated questionnaires were implemented in a mixed-methods cross-sectional study: the Athlete- and Coach-Centric Questionnaires. 101 respondents participated, comprising 56 athletes and 45 coaching and support staff. Awareness of REDs was reported by 31 (55%) athletes and 33 (73%) coaching and support staff. Among athletes, 31 (55%) expected coaches to be aware of REDs symptoms, while 35 (62%) expected awareness of REDs consequences. Only 8 (18%) staff members reported the presence of a REDs assessment, and 10 (22%) a REDs treatment responsibility in their sporting organisation. Qualitative analysis highlighted the importance of the coach-athlete relationship in delivering individualised REDs care. Athletes reported negative coaching practices, and expected to receive limited support, while coaching and support staff highlighted that REDs symptoms were often unreported by athletes. Staff also felt that REDs was under-supported by national governing bodies (NGBs), limiting their potential to positively influence REDs experiences. Further exploration of REDs-specific education for coaching and support staff, athletes, and NGBs is warranted.

Relative energy deficiency in sport (REDs) is a syndrome that negatively impacts the health and performance of athletes, due to low energy availability (LEA), resulting in metabolic, cardiovascular, and endocrine function impairments, and an increased risk of injury. An increased emphasis on the coach-athlete relationship may facilitate the knowledge transfer of LEA's negative effects, mitigating the potential of an athlete developing REDs. Yet building on the International Olympic Committee's 2023 REDs statement of articles published between 2018–2022, to also include articles from 2023–2024, it is noted 38,424 participants were recruited to 246 REDs-related studies, with coaching staff only represented ∼3% of the total cohort. This review aims to assess coaches’ and athletes’ perceptions of their respective, as well as each other's roles and experiences in the presence of LEA and REDs. A summary of athlete and coach first-person experiences of REDs-related issues is provided. However first-person REDs experiences are often that of the athlete, while the coach will more often ‘ experience ’ REDs from a second-person perspective, thereby highlighting the need for the development and provision of REDs education targeted to coaching staff which maybe sports-specific, taking into account topics such as appropriate language to use and how/when to discuss an athlete's body, health and/or performance. A better understanding of how athletes experience REDs-related issues may facilitate individual coaching staffs’ evaluation of their role in preventing and/or addressing a potential REDs diagnosis.

Introduction: Sports nutrition is a rapidly growing sector with increasing demand for evidence-based nutritional products to support competitive and healthy lifestyles. The product development process for novel foods should rely heavily on end-user engagement to facilitate future success, however there is a dearth of published information available. An understanding of the practices and self-reported nutritional priorities of athletes and active individuals is required for the development of new food products, facilitating evidence-based product formulation.Methods: Participants were at least 18 years of age, actively participating in competitive sport or structured physical activity on at least two occasions per week. Participants were asked to undertake a comprehensive online survey assessing their nutritional practice, perceived nutritional priorities and preferences for product characteristics. Questions were developed on the basis of critical evaluation of the current scientific literature and the hosting of two scoping focus group sessions with prospective end-users.Results: 405 individuals (29 ± 9 years) completed this questionnaire. 295 participants reported active participation in competitive sport while the remaining 110 participants undertook structured physical activity exclusively. When asked to rank their top three most sought-after product claims in sports nutrition, “enhanced muscular recovery” was the most prioritised receiving 101 first choice preferences (25%) and 295 top 3 preferences. Fifty-eight percent of participants reported taking nutritional supplements. Caffeine containing functional foods (excluding caffeine supplements) were the most commonly used functional food group. A very low incidence of functional food usage was reported otherwise. When asked to rank the importance of various food product attributes, “nutritional profile” was ranked as the most important with rating of 3.37 ± 0.7 out of 4 followed by “taste” and “accessibility”. Whole food nutritional products received the most first preference selections and most top 3 selections when presented with a number of popular performance and recovery products on the market.Conclusions: The transition towards a food first approach in sports nutrition is vital for athletes and active individuals to achieve their goals; with the development of evidence-based functional foods, particularly with a focus on muscle recovery, endurance, and strength enhancement at the forefront for new food product design and innovation.

Title: Analysis of the Nutritional Priorities, Practices and Preferences of Athletes and Active Individuals to Inform New Food Product Development in Sports Nutrition Authors: Conor C. Carey1, Lorna Doyle2, Alice Lucey1 1. Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland 2. Department of Sport and

Background Flavonoid polyphenols are bioactive phytochemicals found in fruits and teas among other sources. It has been postulated that foods and supplements containing flavonoid polyphenols may enhance recovery from exercise-induced muscle damage (EIMD) through upregulation of cell signalling stress response pathways, particularly the nuclear factor erythroid 2–related factor 2 (NRF2) pathway. Objectives This study aims to investigate the ability of polyphenol treatments containing flavonoids to enhance recovery of skeletal muscle strength, soreness and creatine kinase post EIMD. Methods Medline (Pubmed), Embase and SPORTdiscus were searched from inception to August 2020 for randomised placebo-controlled trials which assessed the impact of 6 or more days of flavonoid containing polyphenol ingestion on skeletal muscle recovery in the 96-h period following a single bout of EIMD. A total of 2983 studies were screened in duplicate resulting in 26 studies included for analysis. All meta-analyses were undertaken using a random-effects model. Results The pooled results of these meta-analyses show flavonoid polyphenol treatments can enhance recovery of muscle strength by 7.14% (95% CI [5.50–8.78], P < 0.00001) and reduce muscle soreness by 4.12% (95% CI [− 5.82 to − 2.41] P = 0.00001), no change in the recovery of creatine kinase concentrations was observed. Conclusion These results indicate that ingestion of polyphenol treatments which contain flavonoids has significant potential to improve recovery of muscular strength and reduce muscle soreness in the 4-day period post EIMD. However, the characterisation of polyphenol dosage and composition of study treatments should be prioritised in future research to facilitate the development of specific guidelines for the inclusion of flavonoid-rich foods in the diet of athletes and active individuals.

The Female Athlete Triad has recently been suggested to be a threat to male athletes. This review aims to examine the evidence, and associated effects, of low energy availability (LEA) in male athletes. A comprehensive search of PubMed and SportsDiscus was performed. Three RCT and seven CS studies were included that measured energy availability and included well trained males. Clinical LEA (<30 kcal/kg LBM/ day) or subclinical LEA (36 ± 6 kcal/kg LBM/day) was evident within all CS studies, documenting 25% of middle and long distance runners and race walkers and 70% of cyclists with LEA. Two out of three RCTs and three out of seven CS studies reported disrupted endocrine functioning, particularly reduced testosterone levels, in association with LEA. One CS study reported that up to 40% of cyclists with LEA had low BMD. One CS study assessed metabolic health, reporting those with suppressed levels spent more time in a severe energy deficit. This review highlights that LEA appears prevalent across male athletic populations, in particular endurance and weight class athletes, and is a potentially serious threat to bone, endocrine and metabolic health. Future larger scale longitudinal studies, using appropriate study designs, should be undertaken to confirm these threats.

The impact of a ketogenic diet (KD) (75% fat) on athletic performance has sparked much interest and self-experimentation in the past 3–4 years. Evidence shows 3–4-week adaptations to a KD in endurance-trained athletes were associated with maintenance of moderate (46–63% VO_2max) and vigorous intensity (64–90% VO_2max) endurance exercise, while at intensities >70% VO_2max, increases in fat oxidation were associated with decreased economy (increased oxygen consumption), and in some cases, increased ratings of perceived exertion and heart rate. Two investigations in recreationally active endurance athletes noted no vigorous intensity exercise decrement following 3- and 12-week adaptations. Moderate (70–85% one repetition maximum) and near-maximal to maximal intensity (>85% 1RM) strength performance experienced no decrement following a 3-12-week KD adaptation. Beneficial effects were noted for 2000 m sprint and critical power test completed for short duration at vigorous intensity, while two additional tests noted no decrement. For sprint, near-maximal exercise (>91% VO_2max), benefit of the KD was observed for six-second sprint, while no decrement in performance was noted for two additional maximal tests. When protein is equated (grams per kilogram), one investigation noted no decrement in muscle hypertrophy, while one noted a decrement. One investigation with matched protein noted the KD group lost more body fat. In conclusion, moderate-to-vigorous intensity exercise experiences no decrement following adaptation to a KD. Decreases in exercise economy are observed >70% VO_2max in trained endurance athletes which may negate performance within field settings. Beneficial effects of the KD during short duration vigorous, and sprint bouts of exercises are often confounded by greater weight loss in the KD group. With more athletes pursuing carbohydrate-restricted diets (moderate and strict (KD)) for their proposed health benefits, more work is needed in the area to address both performance and health outcomes.

High-carbohydrate (HC) diets and low-carbohydrate ketogenic diets (LCKD) are consumed by athletes for body composition and performance benefits. Little research has examined nutrient density of self-selected HC or LCKDs and consequent effect on blood haematology in an athlete population. Using a non-randomised control intervention trial, nutrient density over 3 days, total blood count and serum ferritin, within endurance athletes following a self-selected HC (n = 11) or LCKD (n = 9) over 12 weeks, was examined. At week 12, HC diet participants had greater intakes of carbohydrate, fibre, sugar, sodium, chloride, magnesium, iron, copper, manganese and thiamine, with higher glycaemic load (GL), compared to LCKD participants (P < 0.05). LCKD participants had greater intakes of saturated fat, protein, a higher omega 3:6 ratio, selenium, vitamins A, D, E, K₁, B₁₂, B₂, pantothenic acid and biotin. Mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) decreased in LCKD participants after 12 weeks but remained unchanged in HC participants, with no change in serum ferritin in either group. This analysis cannot examine nutrient deficiency, but athletes should be made aware of the importance of changes in dietary type on micronutrient intakes and blood haematology, especially where performance is to be considered.