Lecture: 17° Corso Nazionale PROGRESS IN NUTRIZIONE CLINICA (Ancona 21-22-23 Maggio 2018)

1. AMINOACIDS INTEGRATION AND
ADAPTIVE ADVANTAGES IN
SPECIAL POPULATION OF
ATHLETES
Fabio Piccini MD PhD

2. WELCOME EVERYONE!
• Doctor in Medicine
• MS: Sport & Exercise Nutrition
• PhD: Food Nutrition & Health
• Co-founder & Director: Progetto
Microbioma Italiano
• Consultant: FISI National Ski
Jumping Team
f.piccini@univpm.it

3. FACT
• There is likely no other dietary component that inspires as much debate, insofar as
athletes are concerned, as protein
• How much protein is required, optimal or excessive?
• According to US and Canadian dietary reference intakes «in view of the lack of
compelling evidence of the contrary, no additional dietary protein is suggested for
healthy adults undertaking resistance or endurance exercise»
• Nevertheless, no group or groups of scientists involved in establishing dietary guidelines
see a need for any statement that athletes require more protein than ordinary people

4. EVIDENCE
• The divide between those setting dietary protein requirements and those who might be
making practical recommendations for athletes appears substantial, but ultimately, most
athletes indicate that they consume proteins at levels beyond even the highest
recommendations (up to 7gr./kg./die)
• One may conclude that any debate on «protein requirements» for athletes is
unconsequential
• Of relevance to athletes and those in charge of setting their nutrition is the fact that
higher protein diets have quite consistently been shown to result in grater weight loss,
grater fat loss, and preservation of lean mass as compared with lower protein diets

5. ABOUT SPECIAL POPULATION OF
ATHLETES
• There are some populations of athletes that may be more restricrive in their dietary
intake than usual
• Some athletes are at higher risk for disordered eating than others
• Some sports requires an obsessive control of the athletes weight
• Despite the health-conscious nature of athletes, their dietary intake of essential nutrients
may be inadequate
• Special population of athletes may need nutritional integration to ensure adequate
energy and nutrient intake for optimal performance and health

6. AN UNUSUAL SPORT

7. WITH BIZARRE STANDARDS

8. EXTRAORDINARY PERFORMANCE
REQUIRES ORDINARY MEASURES

9. BUT…WHAT ABOUT THEIR NUTRITION?
• In ski jumping, athletes with low body weight have a distinct advantage over their
opponents; however, this advantage can easily turn into a noticeable disadvantage
because low body weight may also be associated with health problems
• Athletes often restrict calories and/or over-exercise to achieve, or maintain, low body
and fat masses
• There is a growing body of evidence that several metabolic and endocrine disturbances
are the result of prolonged energy restriction
• However, the long-term outcome of such sport-related disordered eating has not been
thoroughly studied

10. HOW MANY CALORIES A SKI JUMPER EATS

11. THE FIS FIGHTS BACK…

12. PYEONGCHANG 2018: THE DINNER OF A
SKI JUMPER

13. BACK TO THE BASICS
• In sport nutrition we set protein to support the growth and maintenance of lean muscle
mass
• We set a baseline level of fats to account for essential fatty acids needs and to optimize
steroid hormone production
• We account for micronutrients and phytonutrients with a variety of vegetables and whole
fruit
• Beyond that, all other food / supplements intake is just a source of energy

14. FUELLING PHYSICAL ACTIVITY
• Adapting to physical activity means consuming more compared to when one is at rest
• Adapting to physical activity has many advantages but it also has some very specific
costs
• Building and maintaining muscles is in itself costly
• The more prolonged the workload, the higher the consumption of energy substrates
• What happens when we are forced to limit the athletes caloric intake?

15. THE SKI JUMPER DILEMMA
• Ski jumpers need to be very lean and even if they train very hard, they have to take in
very small amounts of calories in order not to gain weight
• Humans have very low-power engines (less than 0,75 CV) that are extremely modest
when compared to internal combustion engines
• In this scenario even a 10% extra weight can have devastating effects on the athletic
performance (2 kgs of bodyweight may impact for a loss of 3-5 meters on a 130 mt
ramp)
• Consequently it is difficult to follow a balanced diet with the right amounts of carbs and
lipids and yet take in sufficient amounts of aminoacids through food proteins

16. FUELLING A SKI JUMPER PERFORMANCE
• Contrary to what is often said, body lipids consumption in order to produce energy is
unfavourable in terms of the amount of energy produced if compared to the efficency of
the maximum use of glucose in the citric acid cycle
• Since ski jumpers have very low body fat percentages we must take into account
alternative power sources
• Question: how can we give them muscles that are efficient to produce energy as
well as a liver that is able to maintain constant level of glucose to allow peak
muscles contraction and the best use of the available oxygen?

17. THE ANSWER: EAA
After trying various supplements (whey proteins and BCAA) we developed a two step
process to answer that question by:
• Step 1. Supplementing athletes with EAA (0,5 to 1,5 gr / 10 kg of lean body mass)
• Step 2. Instructing them to train without eating first (Intermittent Fasting) two times a
week, to control bodyweight and to train the liver to convert amino acids into glucose,
thus increasing the production of the enzymes which activates and maintain this
metabolic pathway

18. THE AMINO ACIDS SYLLABUS

19. WHAT TO EXPECT FROM EAA
Supplementation with essential amino acids (EAA) is a good choice because it’s easy to take in and because of
their very low calorie content and it guarantees:
• Increased mioglobin synthesis
• Increased hemoglobin synthesis
• Increased albumin synthesis
• Better glucose tolerance
• Better mithocondrial efficiency
• Less hunger
• Faster recovery
All these effects were confirmed in our study

20. IN THEIR OWN WORDS…

21. ARE THERE ANY RISKS OR DISAVANTAGES
TO USING EAA?
• EAA are indispensable for the maintenance of life under normal and pathological conditions.
Genetic expression modifications induced by increasing supply of EAA suggest beneficial
effects of chronically modifying the ratio with non-essential AAs
• Few data are available on amino acids toxicity
• Only one EAA may be considered to have relevant toxicity: methionine, which is transformed
in a toxic intermediate (homocysteine) when cysteine is required by metabolic needs
• Matching of stechiometric ratios between methionine and cysteine in the supplementation
formula may solve the problem of supplying sufficient amounts of sulphur to the body
• Our athletes didn’t report any significant side effect

22. OTHER TRICKS OF THE TRADE
• Add Omega-3 fats to sustain
performance and prevent sarcopenia
• Optimize nutrition and training loads
for optimal SNA activation
• Optimize athlete’s microbiota with
individually tailored prebiotic and
probiotic supplements

23. FOOD FOR THOUGHTS
• While the requirements for proteins is
reasonably well accepted - even if not
exactly assessed - the (relatively low)
requirements for EAA estimated for healty
adults have been confirmed since 1985
• On the other hand the precise
requirement for EAA in athletes is far from
being established and requires further
investigation thus it needs to be
challenged on methodologic and
theoretical grounds

24. A VERY SPECIAL THANK TO OUR EAGLES

25. AND THANK YOU FOR ATTENTION