Core Concepts in Performance Nutrition Program Design

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By Hector Lopez, MD, MS(c), CSCS and Joseph Jimenez, MD, MBA, CSCS
First published at www.MohrResults.com, August 2007

Athletes at all levels of competition continue to search intently for nutritional strategies, which may confer athletic performance and recovery benefits.  We are operating in an era of unprecedented growth in sports nutrition-related basic, applied, and clinical research exploration.  Staying abreast of the new and evolving knowledge in performance nutrition can be a daunting task, when added to the already overwhelming list of obligations for:  coaches, trainers, fitness professionals, sports medicine clinicians, and athletes alike.  The field of sports nutrition involves a complex interplay amongst multiple disciplines that span frsom applied nutritional biochemistry/integrated metabolism, to exercise physiology, to psychology.  For this reason, a conceptual framework is helpful for managing and organizing the plethora of advances in performance nutrition science into a context that allows for more effective and practical nutritional program design.  The conceptual framework may serve as guidelines for individuals rendering dietary supplement/nutritional advice to athletes. This collection of broad core concepts includes:  Rational Poly-supplementation™, CHRONO-Nutrition™, Restorative Nutrition, and Level System of Evidence for Sports Supplements/Nutritional Strategies.

Rational Poly-supplementation™

This core concept is akin to the idea of “stacking,” yet it is a broader term, which includes integrating nutrients in a coherent fashion so as to amplify the effect of each nutrient on training adaptations.  The theory also involves “polysupplementing” multiple dietary nutrients in a goal-directed manner to yield additive or synergistic ergogenic effects.  Rational Polysupplementation is defined as utilizing 2 or more nutritional components/metabolites with complimentary mechanisms of action to augment the “effect” and desired response beyond what would be expected with separate mono-supplementation.  In this manner, the performance nutrition practitioner avoids redundancy, unnecessary overlap, and antagonism that are exemplified with the “everything-under-the-sun” approach. 

An analogous approach of strategic stacking has been applied in medicine for decades.  Rational “Polypharmacy” is an established model of therapy for various disease states, including:  neuropathic pain, high blood pressure, coronary heart disease, congestive heart failure, diabetes, and cancer [1, 2].  In certain cases, multi-targeted and specific drug therapy (rational polypharmacy) provides optimal disease management, symptom relief, minimized adverse reactions, and improved quality of life outcomes [3].  

Human physiology is full of redundant pathways, which are fighting to bring the system back into homeostasis.  Oftentimes, to enhance training adaptations, exercise performance capacity and body composition, the system must be challenged from multiple angles in an integrated strategy; hence, the term Rational Polysupplementation.

CHRONO-Nutrition™

This is a broad, umbrella concept that may be subdivided further into 3 components, namely: 1) nutrient timing, 2) nutritional periodization, and 3) supplement holidays. 

Nutrient Timing refers to providing strategic nutritional support at specific times relative to exercise training, recovery, rest, adaptational curve, and natural biorhythms in order to harness physiological windows for amplifying the training effect [4].  In other words, “nutrient timing” involves taking certain supplements or nutrients in the right amounts at specific times, to augment body composition, performance, and recovery from exercise and athletic competition [5, 6].

Nutritional Periodization involves the concept of tailoring nutritional needs (supplements, macronutrients, and energy intake) to specific training cycles throughout the year for optimum health and performance.  Adjusting and manipulating macronutrients/ supplementation as an athlete modulates their volume, intensity, and total training workload is an example of nutritional periodization.  Fundamentally, it is the systematic variation in macro/micro nutrient consumption to improve performance and functional outcome over time (i.e., day to day, weekly, monthly, semi-yearly, etc.).  For athletes in season-based sports, this tool may relate to different nutritional strategies for off-season versus, training camp/pre-season, or in-season [7].

Supplement Holidays offer a physiologic “respite” to maintain optimal responsiveness to nutrients over time.  The time off of certain supplements may allow for re-sensitization of the physiologic systems and biochemical pathways involved in nutrient metabolism.  In medicine, drug therapy is often interrupted with a “holiday” to optimize the desired effect, while minimizing risk and adverse effects [8].

Restorative Supplementation™

This technique may be somewhat counter-intuitive to the typical application of CHRONO-NutritionTM, but it seems to be very effective in certain athletes/ trainees with unique clinical or athletic situations.  For example, the overtraining/overreaching athlete and athlete with a musculoskeletal injury seem to benefit from restorative nutrition/ supplementation to halt and reverse maladaptive metabolic momentum.  With restorative nutrition, unique supplementation and/or hypercaloric microcycling could take place during a period of decreased training demand (e.g. recovering from injury or unloading/active rest training block).  Athletes with soft-tissue injuries (sprain/strains) may benefit from chondro-restorative and strategic amino acid and fatty acid supplementation as a useful adjunct to complement more traditional medical modalities [9,10].

Level System for Safety and Efficacy

An evidence-based “level system” for safety and efficacy is a powerful tool for evaluating treatment options, management, prognosis, and diagnoses of disease.  Additionally, a similar model can be applied by exercise physiologists, sports/ performance nutritionists, trainers, strength coaches, etc. to serve as a guideline for recommendations regarding nutrition and exercise.  Four levels may be used to categorize the merit of nutritional practices and sport supplements based on the strength of research-based evidence, scientific rationale, safety and efficacy.  To explain further, Level I would be considered “safe and effective” with strong evidence from prospective clinical trials.  Level II evidence would be considered “possibly effective” with data from observational, cohort studies and based on sound scientific rationale/ principles.  Level III evidence would fall under “equivocal/ preliminary” with good theoretical rationale, data from ‘proof of concept’ or pilot studies, and expert opinions.  Level III evidence may include suboptimal experimental design leading to substantial gaps in the literature.  Finally, Level IV evidence is known as “apparently ineffective” with either poor theoretical basis, or body of research indicating ineffectiveness and/or adverse effects.

In conclusion, the core concepts of Rational Poly-supplementation™, CHRONO-Nutrition™, Restorative Nutrition, and a Level System of Evidence may provide a useful vessel to navigate in the “sea” of performance nutrition science.

References:

1. Gallagher RM. Management of Neuropathic Pain: Translating Mechanistic Advances and Evidence-based Research Into Clinical Practice. Clin J Pain. 2006 Jan;22:S2-8.
2. Vardan S and Pratt CM. Combination Drug Therapy in Patients with Heart Failure: Tenets of Rational Polypharmacy. Cardiol Rev. 1998 Oct;(5):267-271.
3. Fleishman M. Rational and irrational polypharmacy.  Psychiatr Serv. 2002 Feb;53(2):214.
4. Volek JS. Influence of nutrition on responses to resistance training. Med Sci Sports Exerc. 2004 Apr;36(4):689-96.
5. Ivy JL et al. Early postexercise muscle glycogen recovery is enhanced with a carbohydrate protein supplement. J Appl Physiol. 2002, 93:1337-44.
6. Tipton KD et al. Timing of amino acid-carbohydrate ingestion alters anabolic response of muscle to resistance exercise.  Am J Physiol. 2001, 281:197-206.
7. Burke LM and Hawley JA. Effect of short-term fat adaptation on metabolism and performance of prolonged exercise. Med Sci Sports Exerc. 2002, (34)1492-98.
8. Shore JE et al. Drugs take a holiday. Contemp Adam Lng term care. 1983, 6(10):46-52.
9. Cerra FB. Nutrient Modulation of inflammatory and immune function. Am J Surg. 1991, (161)230-236.
10. Karna E et al. The potential mechanism for glutamine-induced collagen biosynthesis in cultures human skin fibroblasts. Comp Biochem Physiol B Biochem Mol Biol. 2001, 130(1):23-32

Joseph Jimenez, MD, MBA, CSCS and Hector Lopez, MD, MS(c),CSCS are physicians training in the specialty of Physical Medicine and Rehabilitation.  They are co-founders of Physicians Pioneering Performance, LLCTM.  PPP is a multi-specialty, interdisciplinary group of like-minded doctors who seek to seamlessly integrate musculoskeletal, spine and sports medicine, optimal aging, and rehabilitation, with medical and performance nutrition, athletic performance, and fitness to accommodate the needs of a diverse population. 

Dr. Lopez is a part of the Mohr Results, Inc Board of Advisors.

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