Nutrition and Athlete Immune Health: New Perspectives on an Old Paradigm
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REVIEW ARTICLE
Nutrition and Athlete Immune Health: New Perspectives on an Old Paradigm Neil P. Walsh1
© The Author(s) 2019
Abstract Respiratory and gastrointestinal infections limit an athlete’s availability to train and compete. To better understand how sick an athlete will become when they have an infection, a paradigm recently adopted from ecological immunology is presented that includes the concepts of immune resistance (the ability to destroy microbes) and immune tolerance (the ability to dampen defence yet control infection at a non-damaging level). This affords a new theoretical perspective on how nutrition may influence athlete immune health; paving the way for focused research efforts on tolerogenic nutritional supplements to reduce the infection burden in athletes. Looking through this new lens clarifies why nutritional supplements targeted at improving immune resistance in athletes show limited benefits: evidence supporting the old paradigm of immune suppression in athletes is lacking. Indeed, there is limited evidence that the dietary practices of athletes suppress immunity, e.g. low-energy availability and train- or sleep-low carbohydrate. It goes without saying, irrespective of the dietary preference (omnivorous, vegetarian), that athletes are recommended to follow a balanced diet to avoid a frank deficiency of a nutrient required for proper immune function. The new theoretical perspective provided sharpens the focus on tolerogenic nutritional supplements shown to reduce the infection burden in athletes, e.g. probiotics, vitamin C and vitamin D. Further research should demonstrate the benefits of candidate tolerogenic supplements to reduce infection in athletes; without blunting training adaptations and without side effects. Key Points A new paradigm for exercise immunology is presented that considers ‘resistance’ (the strength of the immune weaponry) and ‘tolerance’ (the ability to endure microbes and dampen defence activity). A contemporary view is that immune ‘resistance’ is not suppressed in athletes under heavy training; as such, it is not surprising that nutritional supplements targeted towards improving immune ‘resistance’ show limited benefits to reduce the infection burden in athletes—‘if it ain’t broke, don’t fix it!’ This paradigm of ‘resistance’ and ‘tolerance’ helps to explain why nutritional supplements with tolerogenic effects (e.g. probiotics, vitamin C and vitamin D) are the new targets—tolerogenic supplements may reduce the infection burden in athletes. * Neil P. Walsh [email protected] 1
College of Human Sciences, Bangor University, Bangor LL57 2PZ, UK
1 Introduction “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” Hippocrates c. 460—377 B.C. It has long been known that an individual’s nutritional status influences both their susceptibility to infection and their response to infection in terms of clinical outcome [1, 2]. Leyton’s seminal work in British and Rus
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