Can the Right Nutrition Boost Your Immune System and Speed Up Recovery in Sports?

Can the Right Nutrition Boost Your Immune System and Speed Up Recovery in Sports?

Nutritional target

Energy

Identification of metabolic needs

• Total daily energy requirement* = BMR × stress factor × activity level

• Avoid chronic LEA (<30kcal/kg FFM/day)

• 45 kcal/kg FFM/day

Comment

Negative energy balance results in: • Slow wound healing• Increased muscle loss by

decreasing MPS and

facilitating MPB• Increased deconditioning• Prolong the time to return to

playAdjust the macronutrient composition of the diet to prevent body mass and fat gain (2:1 = complex CHO: protein ratio). Avoid alcohol.

Protein

Inadequate protein intake:• increased loss of muscle

mass• decreased tissue repair

and healing; regional distribution of protein

intake during the day (4-6 meals). Start protein consumption within one hour of waking.

Protein

• Increased due to anabolic resistance

• High protein diet 1.6-2.5 g/kg BM/day

• 20-30 g of leucine-rich protein per meal (providing 2.5 – 3.0 g leucine) or 10 g of EAA

• 0.3-0.4 g/kg BM per meal

• 0.4 g/kg BM pre-sleep

Carbohydrates

• 3-5 g/kg BM/day

• The preferred energy source is a high CHO diet as it reduces protein breakdown more than a high-fat diet.

  Complex CHO is rich in micronutrients and fibre. Limit simple CHO.

Fat

• Moderate intake (~ 0.8-1.5 g/kg BM/day, depending on energy requirements)

• Low omega-3 to omega-6 FA ratio in the diet

Omega-6 FA linoleic acid reduces the conversion of α-linolenic acid to EPA and DHA.

Malnutrition is usually linked with low intake of vitamins, iron and zinc. Antioxidant supplementation may impair muscle regeneration.

• No need for specific supplementation in the absence of micronutrient deficiency

Vitamin D: Supplementation required when the serum level of 25-OH vitamin D < 75 nmol/l (suboptimal), < 50 nmol/l (inadequate) or < 30 nmom/l (deficiency)• therapy with oral vitamin D3

(2,000–4,000 IU/day) during the winter months to ensure serum level of 25-OH vitamin D > 75 nmol/l.

Vitamin D deficiency:• increased injury risk• delayed bone and muscle

tissue healing• increased infection risk

Dietary supplement

HMB

Recommendation

• ~3 g/day in the period of extreme immobilisation

• Same benefit with whey protein or leucine

Creatine

• 20 g (4×5 g)/day in immobilisation (or 5 days)

• 5 g/day in rehabilitation phase

Omega-3 FA

• Use of high dosage of omega - 3 FA (3 g/day EPA, 2 g/day DHA) for short period to stimulate the resolution of inflammation

Prolonging intake for more than a few days may be counterproductive in the first stage of injury. Some evidence of benefit for the rehabilitation phase.

No clear benefit

Prebiotics Probiotics

• Positive effect on the gastrointestinal microbiota

• Less bacterial infections after surgery (Lactobacillus acidophilus, Bifidobacterium longum)

• Improvement in protein absorption (Bacillus coagulans)

• > 1010 colony-forming units of either strain; consumed in fermented food (e.g. yoghurt)

Collagen Peptides and Specific gelatin products

• Hydrolysed collagen 10 g/day • 15 g/day gelatin + 500 mg/day

LEA rapid weight loss prolonged LEA (< 30 kcal/kg FFM/day) with moderate insufficiency of micronutrients (e.g. iron, zinc) weight cycling

Estimation of energy expenditure EA > 45 kcal/kg FFM/day Monitor energy intake. Monitor micronutrient intake to reach the population referenced standards. Monitor nutritional status and markers of immune function in athletes during training sessions with LEA or low CHO intake Limit fibre intake in athletes with very high energy requirements When weight loss is mandatory, try an early-season intervention to reach the target body mass Rapid loss of body mass should be avoided

CHO intake: Low daily intake During exercise	• Daily CHO intake must be individualised and periodised to the amount and intensity of training and to the specific training period.

	Intake of 30-60 g CHO per hour of during sustained intensive exercise > 60 g CHO per hour in specific situations (longer duration of training session/competition, high intensity) 1.0-1.2 g CHO/kg within 2 hours after exercise, absolute quantity should be adjusted to the duration and the intensity of the training session/competition and the duration of the recovery period before the next exercise.
Protein/AA intake Low daily protein intake Low quality protein intake Inappropriate timing of protein intake	Recommended daily protein intake: 1.2–1.7 g/kg BM/day. Protein intake should be individualised; mainly depends on the nature of athlete training, the age and training status of athlete and his/her metabolic characteristics. Regular intake ∼20–30 g of protein at ∼3 h intervals throughout the day is recommended for maximising net protein balance. The evidence for further supplementation of protein intake (> 2 g/kg BM/day) or single (glutamine) or multiple amino acids (BCAA) to improve immune function is not clear. Check protein quality in regular food to avoid AA imbalances. e-proof

Vitamin D J	Regular seasonal (summer, winter) check of serum levels of 25-OH vitamin D should be part of routine medical examinations for athletes. Treatment of deficiency of vitamin D (serum 25-OH vitamin D < 30 nmol/L) with 2000-4000 IU/day vitamin D3 is recommended. It seems that in otherwise healthy people 4000 IU/day for 8 weeks will attain adequate vitamin D status for most who are deficient. Supplementation of vitamin D3 in winter months in athletes with suboptimal levels of vitamin D (serum 25-OH vitamin D < 75 nmol/L) with 1000-2000 IU/day and athletes with dark skin tone or training indoors. Excessive intake of vitamin D should be avoided in the absence of deficiency.

Antioxidants	Variety of fresh fruits and vegetables together with other quality food sources are recommended to be consumed during the day to provide sufficient intake of antioxidants. Additional supplementation with antioxidant vitamins is not recommended. It is well recognised that exercise generated free radicals and other oxidants are central to the control of gene expression, cell signalling pathway regulation, and physiological modulation of skeletal muscle functions. Excessive vitamin C + vitamin E intake has been shown to impair training adaptation. Moderate additional intake of vitamin C in dosage 0.25–1.0 g/day may reduce the incidence, duration and severity of theourr common cold in athletes. It may be useful in some athletes when they are exposed to extreme unaccustomed acute physical stress. • Supplementation of omega-3 fatty acids (DHA and EPA at a dose of 250 mg/day) may benefit immune tolerance. DHA and EPA present at the site of inflammation are converted into compounds called resolvins, protectins, and maresins, which promote the resolution of inflammation and support healing, including healing in the respiratory tract.

Zinc (Zn), magnesium (Mg) and iron (Fe)

• The benefit of routine supplementation in absence of deficiency has no evidence.

• Short term Zn supplementation (75 mg/day within 24 hours of onset of illness symptoms) may reduce severity and duration of common cold and may have benefit in periods of high psychological/physiological stress in athletes with history of recurrent URI. Bioavailability of Zn is impaired by simultaneous intake of food rich in phytates (whole-grain breads, cereals, and legumes), and by Fe supplementation.

• In absence of deficiency, magnesium supplementation has no proven benefit.

• Treatment of iron deficiency with high-dose iron supplements must be done under medical supervision.

Zinc (Zn), magnesium (Mg) and iron (Fe)

Glutamine

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• The benefit of routine supplementation in absence of deficiency has no evidence.

• Short term Zn supplementation (75 mg/day within 24 hours of onset of illness symptoms) may reduce severity and duration of common cold and may have benefit in periods of high psychological/physiological stress in athletes with history of recurrent URI. Bioavailability of Zn is impaired by simultaneous intake of food rich in phytates (whole-grain breads, cereals, and legumes), and by Fe supplementation.

• In absence of deficiency, magnesium supplementation has no proven benefit.

• Treatment of iron deficiency with high-dose iron supplements must be done under medical supervision.

Glutamine

• Despite reduced availability of plasma glutamine after prolonged exercise there is no clear benefit of oral glutamine supplementation on respiration infection incidence.

Dehydration

• Maintaining fluid balance is important to ensure optimal performance and health.

• Daily monitoring of body mass may help to maintain fluid balance in training in the heat or at altitude.

• During training in temperature extremes or at altitude monitoring of either urine osmolality or specific gravity can be useful to support the application of a hydration strategy.

• The mouth should be kept moist to maintain the saliva flow as the first line of immune defence.

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Kozjek NR, Tonin G, Gleeson M. Nutrition for Optimising Immune Function and Recovery from Injury in Sports. Clin Nutr ESPEN. 2025 Jan 17:S2405-4577(25)00032-4. doi: 10.1016/j.clnesp.2025.01.031. Epub ahead of print. PMID: 39828217.