Nutrition in Ultra-Endurance: State of the Art

Nikolaidis, Pantelis T.; Veniamakis, Eleftherios; Rosemann, Thomas; Knechtle, Beat

doi:10.3390/nu10121995

Cited by 70Muscle metabolism and nutritionThermoregulation and physiological responsesSports Performance and Training

Nutrition in Ultra-Endurance: State of the Art

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Nikolaidis, Pantelis T., Veniamakis, Eleftherios, Rosemann, Thomas, Knechtle, Beat·2018·Nutrients

DOI 10.3390/nu10121995PMC PMC6315825

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Abstract

Athletes competing in ultra-endurance sports should manage nutritional issues, especially with regards to energy and fluid balance. An ultra-endurance race, considered a duration of at least 6 h, might induce the energy balance (i.e., energy deficit) in levels that could reach up to ~7000 kcal per day. Such a negative energy balance is a major health and performance concern as it leads to a decrease of both fat and skeletal muscle mass in events such as 24-h swimming, 6-day cycling or 17-day running. Sport anemia caused by heavy exercise and gastrointestinal discomfort, under hot or cold environmental conditions also needs to be considered as a major factor for health and performance in ultra-endurance sports. In addition, fluid losses from sweat can reach up to 2 L/h due to increased metabolic work during prolonged exercise and exercise under hot environments that might result in hypohydration. Athletes are at an increased risk for exercise-associated hyponatremia (EAH) and limb swelling when intake of fluids is greater than the volume lost. Optimal pre-race nutritional strategies should aim to increase fat utilization during exercise, and the consumption of fat-rich foods may be considered during the race, as well as carbohydrates, electrolytes, and fluid. Moreover, to reduce the risk of EAH, fluid intake should include sodium in the amounts of 10–25 mmol to reduce the risk of EAH and should be limited to 300–600 mL per hour of the race.

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The foremost nutritional challenge facing the ultra-marathon runner is meeting the daily caloric demands necessary to optimize recovery and permit prolonged and repeated training sessions.
“The foremost nutritional challenge facing the ultra-marathon runner is meeting the daily caloric demands necessary to optimize recovery and permit prolonged and repeated training sessions [24].”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [24]

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BackgroundInfluential
Running 338 Kilometres within Five Days has no Effect on Body Mass and Body Fat But Reduces Skeletal Muscle Mass - the Isarrun 2006.
Knechtle, B., & Kohler, G. (2007) · Europe PMC (PubMed Central) · Cited by 54 · see citing works
Self-citation
Higher prevalence of exercise-associated hyponatremia in female than in male open-water ultra-endurance swimmers: the ‘Marathon-Swim’ in Lake Zurich
Wagner, S., Knechtle, B., Knechtle, P., Rüst, C. A., & Rosemann, T. J. (2011) · European Journal of Applied Physiology · doi:10.1007/s00421-011-2070-5 · Cited by 53 · cited 3× · see citing works
“a = [77], b = [89], c = [90], d = [87], e = [64], f = [86], g = [83], h = [91], i = [82], j = [92], k = [73], l = [63], m = [79], n = [93], o = [94], p = [95], q = [88], r = [96], s = [97], t = [98].”
BackgroundSelf-citation
Nutritional aspects in ultra-endurance exercise
Peters, E. M. (2003) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/01.mco.0000078986.18774.90 · Cited by 53 · cited 2× · see citing works
“a = [23], b = [24], c = [25], d = [26], e = [27], f = [28], g = [29], h = [30], i = [31], j = [24], k = [32], l = [11], m = [33], n = [34], o = [35], p = [36], q = [37], r = [38], s = [39], t = [40], u = [41], v = [42].”
Nutritional implications for ultra-endurance walking and running events
Williamson, E. (2016) · Extreme Physiology & Medicine · doi:10.1186/s13728-016-0054-0 · Cited by 53 · see citing works
Similarities and differences in anthropometry and training between recreational male 100-km ultra-marathoners and marathoners
Rüst, C. A., Knechtle, B., Knechtle, P., & Rosemann, T. J. (2012) · Journal of Sports Sciences · doi:10.1080/02640414.2012.697182 · Cited by 52 · cited 1× · see citing works
“Also, 100-km ultra-marathon runners reported ~8 h running weekly [58].”
BackgroundSelf-citation
Maintained total body water content and serum sodium concentrations despite body mass loss in female ultra-runners drinking ad libitum during a 100 km race
Knechtle, B., Senn, O., Imoberdorf, R., Joleska, I., Wirth, A., Knechtle, P., & Rosemann, T. J. (2010) · PubMed · doi:10.5167/uzh-33190 · Cited by 51 · see citing works
Self-citation
Nutritional and Plasmatic Antioxidant Vitamins Status of Ultra Endurance Athletes
Machefer, G., Groussard, C., Zouhal, H., Vincent, S., Youssef, H. A., Faure, H., Malardé, L., & Gratas‐Delamarche, A. (2007) · Journal of the American College of Nutrition · doi:10.1080/07315724.2007.10719616 · Cited by 49 · see citing works
Nutritional, Physiological, and Perceptual Responses During a Summer Ultraendurance Cycling Event
Armstrong, L. E., Casa, D. J., Emmanuel, H., Ganio, M. S., Klau, J. F., Lee, E. C., Maresh, C. M., McDermott, B. P., Stearns, R. L., Vingren, J. L., et al. (2011) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0b013e318240f677 · Cited by 49 · cited 2× · see citing works
“So far, research has concluded that endurance and ultra-endurance athletes do not consume sufficient food and drinks resulting in a negative energy and fluid balance during the race, as shown by their reduced post-race body mass and body fat percentage [15,16].”
Background
Fluid replacement during and after exercise in the heat
Carter, J. E., & GISOLFI, C. V. (1989) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-198910000-00007 · Cited by 49 · cited 1× · see citing works
“In another example (Triple Iron ultra-triathlon), a comparison between athletes with and without regular pre-race consumption of vitamins and minerals found no difference in race time, too [130].”
Background
A multi-stage ultra-endurance run over 1,200 km leads to a continuous accumulation of total body water
Knechtle, B., Duff, B., Schulze, I., & Kohler, G. (2008) · Europe PMC (PubMed Central) · doi:10.5167/uzh-12702 · Cited by 49 · see citing works
Self-citation
Association Between Energy Balance and Metabolic Hormone Suppression During Ultraendurance Exercise
Geesmann, B., Gibbs, J. C., Mester, J., & Koehler, K. (2016) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.2016-0061 · Cited by 49 · see citing works
Maintained Serum Sodium in Male Ultra-Marathoners – The Role of Fluid Intake, Vasopressin, and Aldosterone in Fluid and Electrolyte Regulation
Bürge, J., Knechtle, B., Knechtle, P., Gnädinger, M. P., Rüst, A., & Rosemann, T. J. (2011) · Hormone and Metabolic Research · doi:10.1055/s-0031-1284352 · Cited by 48 · cited 1× · see citing works
“a = [77], b = [89], c = [90], d = [87], e = [64], f = [86], g = [83], h = [91], i = [82], j = [92], k = [73], l = [63], m = [79], n = [93], o = [94], p = [95], q = [88], r = [96], s = [97], t = [98].”
Self-citation
Male ironman triathletes lose skeletal muscle mass
Knechtle, B., Baumann, B., Wirth, A., Knechtle, P., & Rosemann, T. J. (2010) · PubMed · doi:10.5167/uzh-33316 · Cited by 48 · see citing works
Self-citation
Prevalence of exercise-associated hyponatremia in male ultraendurance athletes
Knechtle, B., Gnädinger, M., Knechtle, P., Imoberdorf, R., Kohler, G., Ballmer, P., Rosemann, T., & Senn, O. (2011) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0b013e31820cb021 · Cited by 48 · cited 1× · see citing works
“Nonetheless, the occurrence of EAH in ultra-marathoners [84] is similar as in marathoners [85].”
BackgroundSelf-citation
Energy turnover during 24 hours and 6 days of adventure racing
Enqvist, J. K., Mattsson, C. M., Johansson, P. H., Brink-Elfegoun, T., Bakkman, L., & Ekblom, B. T. (2010) · Journal of Sports Sciences · doi:10.1080/02640411003734069 · Cited by 45 · cited 3× · see citing works
“A comparison between athletes that were administered vitamins and minerals for a four-week pre-race period and those that were not provided with supplements did not find any difference in race time in a 200-km multi-stage ultra-marathon (“Deutschlanlauf 2006”) [12].”
BackgroundMethod
Body composition and hydration status changes in male and female open-water swimmers during an ultra-endurance event
Weitkunat, T., Knechtle, B., Knechtle, P., Rüst, C. A., & Rosemann, T. J. (2012) · Journal of Sports Sciences · doi:10.1080/02640414.2012.682083 · Cited by 43 · cited 2× · see citing works
“For swimmers participating in a 12-h indoor pool, no change in body mass, fat mass or skeletal muscle mass was shown [49], whereas for male open-water ultra-swimmers, a loss in skeletal muscle mass was reported [50].”
BackgroundSelf-citation
Nutritional Intake during an Ultraendurance Running Race
Eden, B. D., & Abernethy, P. J. (1994) · International Journal of Sport Nutrition · doi:10.1123/ijsn.4.2.166 · Cited by 42 · cited 1× · see citing works
“To finish an ultra-endurance race, optimal energy and fluid intake is necessary [103].”
Background
The Prevalence of Vitamin Supplementation in Ultraendurance Triathletes
Knez, W. L., & Peake, J. M. (2010) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.20.6.507 · Cited by 41 · cited 2× · see citing works
“Thus, it is no surprise that the effect of vitamins, minerals, and other ergogenic supplements has been studied in ultra-endurance athletes [127].”
Background
Energy Balance of Triathletes during an Ultra-Endurance Event
Barrero, A., Erola, P., & Bescós, R. (2014) · Nutrients · doi:10.3390/nu7010209 · Cited by 41 · cited 2× · see citing works
“In turn, the energy expenditure is assessed using triaxial accelerometry [10], indirect calorimetry [12] or the energy equivalent of oxygen that can be calculated from heart rate recordings during the race [9,11].”
BackgroundMethod
Increase of Total Body Water With Decrease of Body Mass While Running 100 km Nonstop—Formation of Edema?
Knechtle, B., Wirth, A., Knechtle, P., & Rosemann, T. J. (2009) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2009.10599598 · Cited by 41 · cited 4× · see citing works
“Whether the loss of body mass reflects to a fat mass, skeletal muscle mass or a combination of them as well as fluid loss depends on the duration of race [46].”
BackgroundInfluentialSelf-citation
Fluid intake and changes in limb volumes in male ultra-marathoners: does fluid overload lead to peripheral oedema?
Bracher, A., Knechtle, B., Gnädinger, M. P., Bürge, J., Rüst, C. A., Knechtle, P., & Rosemann, T. J. (2011) · European Journal of Applied Physiology · doi:10.1007/s00421-011-2056-3 · Cited by 41 · cited 1× · see citing works
“A relationship between changes in limb volumes and fluid intake has been documented recently [70].”
BackgroundSelf-citation
An Ultra-cycling Race Leads to no Decrease in Skeletal Muscle Mass
Knechtle, B., Wirth, A., Knechtle, P., & Rosemann, T. J. (2009) · International Journal of Sports Medicine · doi:10.1055/s-0028-1104585 · Cited by 40 · cited 3× · see citing works
“It might be assumed that a concentric exercise (cycling) rather induces a loss of fat mass [47], whereas an eccentric exercise (running) rather causes a loss of skeletal muscle mass [48].”
BackgroundSelf-citation
Effects of a Deca Iron Triathlon on Body Composition - A Case Study
Knechtle, B., Knechtle, P., Schück, R., Andonie, J. L., & Köhler, G. (2008) · International Journal of Sports Medicine · doi:10.1055/s-2007-965354 · Cited by 40 · cited 7× · see citing works
“a = [25], b = [24], c = [26], d = [28], e = [32], f = [33], g = [11], h = [51], i = [34], j = [35], k = [37], l = [46], m = [48], n = [52], o = [39], p = [40], q = [53], r = [13], s = [42], t = [54], u = [55], v = [56].”
BackgroundInfluentialSelf-citation
The Interconnectedness of Diet Choice and Distance Running: Results of the Research Understanding the Nutrition of Endurance Runners (RUNNER) Study
Turner‐McGrievy, G. M., Moore, W. J., & Barr‐Anderson, D. J. (2015) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2015-0085 · Cited by 38 · cited 2× · see citing works
“For instance, a higher prevalence of vegan/vegetarian diets have been observed in ultra-marathon than in marathon runners [4].”
Background
No Fluid Overload in Male Ultra-Runners During a 100 km Ultra-Run
Knechtle, B., Senn, O., Imoberdorf, R., Joleska, I., Wirth, A., Knechtle, P., & Rosemann, T. J. (2010) · Research in Sports Medicine · doi:10.1080/15438627.2010.510039 · Cited by 38 · cited 2× · see citing works
“a = [23], b = [24], c = [25], d = [26], e = [27], f = [28], g = [29], h = [30], i = [31], j = [24], k = [32], l = [11], m = [33], n = [34], o = [35], p = [36], q = [37], r = [38], s = [39], t = [40], u = [41], v = [42].”
Self-citation
Ad Libitum Fluid Replacement in Military Personnel during a 4-h Route March
Nolte, H. W., Noakes, T. D., & Vuuren, B. J. V. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181d6f9d0 · Cited by 37 · cited 2× · see citing works
“In all situations, the volume of fluid consumption depends from the individual’s level f thirst, the gastrointestinal comfort, and the source and the type of fluid and the temperature of the drink [100,101].”
Background
Hyponatraemic encephalopathy despite a modest rate of fluid intake during a 109 km cycle race
Dugas, J. P., & Noakes, T. D. (2005) · British Journal of Sports Medicine · doi:10.1136/bjsm.2005.018820 · Cited by 36 · cited 1× · see citing works
“a = [77], b = [89], c = [90], d = [87], e = [64], f = [86], g = [83], h = [91], i = [82], j = [92], k = [73], l = [63], m = [79], n = [93], o = [94], p = [95], q = [88], r = [96], s = [97], t = [98].”
Nutrient Intake of an Ultraendurance Cyclist
Lindeman, A. K. (1991) · International Journal of Sport Nutrition · doi:10.1123/ijsn.1.1.79 · Cited by 35 · cited 2× · see citing works
“Carbohydrates are the main energy source in ultra-endurance athletes like in the general population [14].”
Background
Bike Transalp 2008: Liquid Intake and Its Effect on the Body's Fluid Homeostasis in the Course of a Multistage, Cross-Country, MTB Marathon Race in the Central Alps
Schenk, K., Gatterer, H., Ferrari, M., Ferrari, P., Cascio, V. L., & Burtscher, M. (2010) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0b013e3181c9673f · Cited by 34 · cited 1× · see citing works
“a = [77], b = [89], c = [90], d = [87], e = [64], f = [86], g = [83], h = [91], i = [82], j = [92], k = [73], l = [63], m = [79], n = [93], o = [94], p = [95], q = [88], r = [96], s = [97], t = [98].”
A Triple Iron Triathlon Leads to a Decrease in Total Body Mass But Not to Dehydration
Knechtle, B., Knechtle, P., Rosemann, T. J., & Oliver, S. (2010) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2010.10599680 · Cited by 34 · cited 1× · see citing works
“a = [25], b = [24], c = [26], d = [28], e = [32], f = [33], g = [11], h = [51], i = [34], j = [35], k = [37], l = [46], m = [48], n = [52], o = [39], p = [40], q = [53], r = [13], s = [42], t = [54], u = [55], v = [56].”
Self-citation
Energy Intakes of Ultraendurance Cyclists During Competition, an Observational Study
Black, K. E., Skidmore, P. M. L., & Brown, R. C. (2012) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.22.1.19 · Cited by 34 · cited 1× · see citing works
“, the more the intake of calories from nutrition, the faster the race time) has been shown in a 384-km cycling race [21].”
Background
An increased fluid intake leads to feet swelling in 100-km ultra-marathoners - an observational field study
Cejka, C., Knechtle, B., Knechtle, P., Rüst, C. A., & Rosemann, T. J. (2012) · Journal of the International Society of Sports Nutrition · doi:10.1186/1550-2783-9-11 · Cited by 33 · cited 1× · see citing works
“An association between an increased fluid intake and swelling of the feet in ultra-marathoners has been observed, too [71].”
BackgroundSelf-citation
Ergogenic demands of a 24 hour cycling event.
White, J. A., Ward, C., & Nelson, H. (1984) · British Journal of Sports Medicine · doi:10.1136/bjsm.18.3.165 · Cited by 31 · cited 2× · see citing works
“a = [23], b = [24], c = [25], d = [26], e = [27], f = [28], g = [29], h = [30], i = [31], j = [24], k = [32], l = [11], m = [33], n = [34], o = [35], p = [36], q = [37], r = [38], s = [39], t = [40], u = [41], v = [42].”
Higher prevalence of exercise-associated hyponatremia in triple iron ultra-triathletes than reported for ironman triathletes
(2012) · Chinese Journal of Physiology · doi:10.4077/cjp.2012.baa010 · Cited by 31 · cited 1× · see citing works
“a = [77], b = [89], c = [90], d = [87], e = [64], f = [86], g = [83], h = [91], i = [82], j = [92], k = [73], l = [63], m = [79], n = [93], o = [94], p = [95], q = [88], r = [96], s = [97], t = [98].”
Self-citation
No Exercise-Associated Hyponatremia Found in an Observational Field Study of Male Ultra-Marathoners Participating in a 24-Hour Ultra-Run
Knechtle, B., Knechtle, P., & Rosemann, T. J. (2010) · The Physician and Sportsmedicine · doi:10.3810/psm.2010.12.1831 · Cited by 30 · cited 1× · see citing works
“a = [77], b = [89], c = [90], d = [87], e = [64], f = [86], g = [83], h = [91], i = [82], j = [92], k = [73], l = [63], m = [79], n = [93], o = [94], p = [95], q = [88], r = [96], s = [97], t = [98].”
Self-citation
Exercise-Associated Hyponatremia
Rosner, M. H. (2008) · The Physician and Sportsmedicine · doi:10.3810/psm.2008.12.12 · Cited by 30 · cited 1× · see citing works
“Exercise-associated hyponatremia is the most commonly occurring health condition of ultra-distance exercise and is typically from excessive intake of hypotonic fluids [78].”
Background
No case of exercise-associated hyponatraemia in top male ultra-endurance cyclists: the ‘Swiss Cycling Marathon’
Rüst, C. A., Knechtle, B., Knechtle, P., & Rosemann, T. J. (2011) · European Journal of Applied Physiology · doi:10.1007/s00421-011-2024-y · Cited by 29 · cited 2× · see citing works
“a = [77], b = [89], c = [90], d = [87], e = [64], f = [86], g = [83], h = [91], i = [82], j = [92], k = [73], l = [63], m = [79], n = [93], o = [94], p = [95], q = [88], r = [96], s = [97], t = [98].”
BackgroundSelf-citation
Finishers and Nonfinishers in the ‘Swiss Cycling Marathon ’ to Qualify for the ‘Race across America ’
Knechtle, B., Knechtle, P., Rüst, C. A., Rosemann, T. J., & Lepers, R. (2011) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0b013e31821606b3 · Cited by 29 · see citing works
Self-citation
Veränderung der Körperzusammensetzung bei einem Ultralauf
Knechtle, & Bircher (2005) · Praxis · doi:10.1024/0369-8394.94.10.371 · Cited by 28 · see citing works
Biochemical changes in a 100 km run: Carbohydrates, lipids, and hormones in serum
Keul, J., Kohler, B., von Glutz, G., Lüthi, U., Berg, A., & HOWALD, H. (1981) · European Journal of Applied Physiology · doi:10.1007/bf00421670 · Cited by 27 · cited 1× · see citing works
“An increase in plasma volume is related to an increase in the potassium-to-sodium ratio in urine that suggests that an augmented activity of aldosterone may induce retention in both sodium and fluid during an ultra-endurance race [68].”
Background
Human Albumin Synthesis Is Increased by an Ultra-Endurance Trial
Mischler, I., Boirie‌, Y., Gachon, P., Pialoux, V., Mounier, R., Rousset, P., COUDERT, J., & Fellmann, N. (2003) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200301000-00013 · Cited by 27 · cited 1× · see citing works
“An increase in total body water in ultra-endurance athletes has been shown in several studies [42,66].”
Background
No effect of short-term amino acid supplementation on variables related to skeletal muscle damage in 100 km ultra-runners - a randomized controlled trial
Knechtle, B., Knechtle, P., Mrazek, C., Senn, O., Rosemann, T., Imoberdorf, R., & Ballmer, P. (2011) · Journal of the International Society of Sports Nutrition · doi:10.1186/1550-2783-8-6 · Cited by 27 · cited 1× · see citing works
“However, the effectiveness of amino acids has not been documented yet; for instance, the consumption of amino acids did not influence skeletal muscle damage [125].”
BackgroundSelf-citation
Redox status and antioxidant response in professional cyclists during training
Leonardo-Mendonça, R. C., Concepción‐Huertas, M., Guerra-Hernández, E. J., Zabala, M., Escames, G., & Acuña-Castroviejo, D. (2014) · European Journal of Sport Science · doi:10.1080/17461391.2014.915345 · Cited by 26 · cited 2× · see citing works
“In all situations, the volume of fluid consumption depends from the individual’s level f thirst, the gastrointestinal comfort, and the source and the type of fluid and the temperature of the drink [100,101].”
Background
Chronic probiotic supplementation with or without glutamine does not influence the eHsp72 response to a multi-day ultra-endurance exercise event
Marshall, H., Chrismas, B. C. R., Suckling, C. A., Roberts, J. D., Foster, J., & Taylor, L. (2017) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2017-0131 · Cited by 26 · see citing works
Mitochondrial actaptations to chronic muscle use: Effect of iron deficiency
Hood, D. A., Kelton, R., & Nismo, M. L. (1992) · Comparative Biochemistry and Physiology Part A Physiology · doi:10.1016/0300-9629(92)90514-q · Cited by 25 · cited 1× · see citing works
“An iron status deficiency is most likely to occur among the micronutrients as inadequate iron status can impair exercise performance through suboptimal levels of hemoglobin and also through changes in the muscle including reduced myoglobin and iron-related enzymes [132].”
Background
A case study evaluation of competitors undertaking an antarctic ultra-endurance event: nutrition, hydration and body composition variables
Paulin, S., Roberts, J., Roberts, M. G., & Davis, I. D. (2015) · Extreme Physiology & Medicine · doi:10.1186/s13728-015-0022-0 · Cited by 25 · cited 1× · see citing works
“7% protein in an 800-km ultra-endurance Antarctic race [45].”
Background
Case Study: Nutrition Planning and Intake for Marathon des Sables—A Series of Five Runners
McCubbin, A. J., Cox, G. R., & Broad, E. M. (2016) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2016-0016 · Cited by 25 · cited 3× · see citing works
“The CHO intake has been reported 31 g·h−1 in an ultra-marathon race [108], 42 g·h−1 in the Marathon des Sables [109], 56 g·h−1 in 4254 km ultra-marathon over 78 days [110], and 83 g·h−1 participating in seven open water swimming races of 15–88 km distance and 3–12 h duration [111].”
Background
Case Study: Nutrition and Hydration Status during 4,254 km of Running Over 78 Consecutive Days
Dempster, S., Britton, R., Murray, A. M., & Costa, R. J. S. (2013) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.23.5.533 · Cited by 23 · cited 4× · see citing works
“The CHO intake has been reported 31 g·h−1 in an ultra-marathon race [108], 42 g·h−1 in the Marathon des Sables [109], 56 g·h−1 in 4254 km ultra-marathon over 78 days [110], and 83 g·h−1 participating in seven open water swimming races of 15–88 km distance and 3–12 h duration [111].”
BackgroundInfluential
Saccharide Composition of Carbohydrates Consumed during an Ultra-endurance Triathlon
Wilson, P. B., Rhodes, G. S., & Ingraham, S. J. (2015) · Journal of the American College of Nutrition · doi:10.1080/07315724.2014.996830 · Cited by 22 · cited 2× · see citing works
“, an optimal glucose-to-fructose ratio during exercise might increase the exogenous C -oxidation and prevent gastrointestinal distress [112].”
Background
Body Composition, Energy, and Fluid Turnover in a Five-Day Multistage Ultratriathlon: A Case Study
Knechtle, B., Knechtle, P., Andonie, J. L., & Kohler, G. (2009) · Research in Sports Medicine · doi:10.1080/15438620902900260 · Cited by 22 · cited 2× · see citing works
“The long duration of an ultra-endurance race implies increased exercise-induced energy expenditure [13].”
BackgroundSelf-citation
No Change of Body Mass, Fat Mass, and Skeletal Muscle Mass in Ultraendurance Swimmers After 12 Hours of Swimming
Knechtle, B., Knechtle, P., Kaul, R., & Kohler, G. (2009) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2009.10599530 · Cited by 20 · cited 4× · see citing works
“studies [46,47,49] should be attributed to race specific characteristics (e.”
BackgroundInfluentialSelf-citation
High Energy Deficit in an Ultraendurance Athlete in a 24-Hour Ultracycling Race
Bescós, R., Rodríguez, F. A., Iglesias, X., Benítez, A., Marina, M., Padullés, J. M., Torrado, P., Vázquez, J., & Knechtle, B. (2012) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2012.11928806 · Cited by 20 · cited 2× · see citing works
“a = [23], b = [24], c = [25], d = [26], e = [27], f = [28], g = [29], h = [30], i = [31], j = [24], k = [32], l = [11], m = [33], n = [34], o = [35], p = [36], q = [37], r = [38], s = [39], t = [40], u = [41], v = [42].”
Self-citation
Do Male 100-km Ultra-Marathoners Overdrink?
Knechtle, B., Knechtle, P., & Rosemann, T. J. (2011) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.6.2.195 · Cited by 20 · cited 2× · see citing works
“a = [77], b = [89], c = [90], d = [87], e = [64], f = [86], g = [83], h = [91], i = [82], j = [92], k = [73], l = [63], m = [79], n = [93], o = [94], p = [95], q = [88], r = [96], s = [97], t = [98].”
BackgroundSelf-citation
The Recovery Phase Following a Triple Iron Triathlon
Knechtle, B., Vinzent, T., Kirby, S., Knechtle, P., & Rosemann, T. J. (2009) · Journal of Human Kinetics · doi:10.2478/v10078-09-0008-3 · Cited by 19 · cited 6× · see citing works
“a = [25], b = [24], c = [26], d = [28], e = [32], f = [33], g = [11], h = [51], i = [34], j = [35], k = [37], l = [46], m = [48], n = [52], o = [39], p = [40], q = [53], r = [13], s = [42], t = [54], u = [55], v = [56].”
BackgroundResultInfluentialSelf-citation
Short-Term High-Fat Diet Alters Substrate Utilization during Exercise but Not Glucose Tolerance in Highly Trained Athletes
Staudacher, H. M., Carey, A. L., Cummings, N. K., Hawley, J. A., & Burke, L. M. (2001) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.11.3.273 · Cited by 19 · cited 1× · see citing works
“6 g·kg−1·day−1 fat [120] or 70% fat [121], whereas a 5-day fat-adapt diet includs 2.”
LaTulippe--a case study of a one hundred and sixty kilometre runner.
O'Hara, W. J., Allen, C., Shephard, R. J., & Gill, J. W. (1977) · British Journal of Sports Medicine · doi:10.1136/bjsm.11.2.83 · Cited by 19 · cited 3× · see citing works
“a = [25], b = [24], c = [26], d = [28], e = [32], f = [33], g = [11], h = [51], i = [34], j = [35], k = [37], l = [46], m = [48], n = [52], o = [39], p = [40], q = [53], r = [13], s = [42], t = [54], u = [55], v = [56].”
Energy balance during two days of continuous stationary cycling
Stewart, I. B., & Stewart, K. L. (2007) · Journal of the International Society of Sports Nutrition · doi:10.1186/1550-2783-4-15 · Cited by 19 · cited 1× · see citing works
“An ultra-endurance race induces an energy deficit [22].”
Background
Innovative Operations Measures and Nutritional Support for Mass Endurance Events
Chiampas, G., & Goyal, A. V. (2015) · Sports Medicine · doi:10.1007/s40279-015-0396-6 · Cited by 18 · see citing works
Physical exercise as a modulator of adaptation to low and high carbohydrate and low and high fat intakes
Miller, S. L., & Wolfe, R. R. (1999) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1600751 · Cited by 17 · cited 2× · see citing works
““Fat-adapt” has been developed as a pre-race nutritional strategy to increase fatty acid oxidation, attenuate the depletion of glycogen, and ameliorate performance [118,119].”
Background
Effect of a Multistage Ultraendurance Triathlon on Aldosterone, Vasopressin, Extracellular Water and Urine Electrolytes
Knechtle, B., Morales, N. P. H., Gonzalez, E., Gutierrez, A. A. A., Sevilla, J. N., Gómez, R., Robledo, A. R. E., Rodríguez, A. L. M., Fraire, O. S., Andonie, J. L., et al. (2012) · Scottish Medical Journal · doi:10.1258/smj.2011.011287 · Cited by 17 · cited 1× · see citing works
“Likely, the increase in body mass, skin-fold thicknesses, and limb circumferences might be due to an increase in body water [65].”
BackgroundSelf-citation
State of the Science—Ultraendurance Sports
Hoffman, M. D. (2016) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.2016-0472 · Cited by 17 · cited 2× · see citing works
“Despite the increasing participation in ultra-endurance sports during the last years, the scientific interest in these sports remains relatively small with regards to other sports [5,6].”
Background
Case Study: Simulated and Real-Life Energy Expenditure During a 3-Week Expedition
Koehler, K., Hülsemann, F., de Marées, M., Braunstein, B., Braun, H., & Schaenzer, W. (2011) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.21.6.520 · Cited by 16 · cited 3× · see citing works
“It has been shown that the decrease of body mass is located mostly in the lower trunk [36].”
Background
The Effect of 1,000 Km Nonstop Cycling on Fat Mass and Skeletal Muscle Mass
Knechtle, B., Knechtle, P., & Kohler, G. (2011) · Research in Sports Medicine · doi:10.1080/15438627.2011.582827 · Cited by 13 · cited 2× · see citing works
“a = [23], b = [24], c = [25], d = [26], e = [27], f = [28], g = [29], h = [30], i = [31], j = [24], k = [32], l = [11], m = [33], n = [34], o = [35], p = [36], q = [37], r = [38], s = [39], t = [40], u = [41], v = [42].”
Self-citation
Case Study: Competition Nutrition Intakes During the Open Water Swimming Grand Prix Races in Elite Female Swimmer
Kumstát, M., Rybářová, S., Thomas, A., & Novotný, J. (2015) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2015-0168 · Cited by 12 · cited 2× · see citing works
“The CHO intake has been reported 31 g·h−1 in an ultra-marathon race [108], 42 g·h−1 in the Marathon des Sables [109], 56 g·h−1 in 4254 km ultra-marathon over 78 days [110], and 83 g·h−1 participating in seven open water swimming races of 15–88 km distance and 3–12 h duration [111].”
Background
The Effect of Nutritional Manipulation on Ultra-Endurance Performance: A Case Study
Robins, A., Davies, D. M., & Jones, G. E. (2005) · Research in Sports Medicine · doi:10.1080/15438620500222505 · Cited by 11 · cited 2× · see citing works
“The role of fat consumption has been studied during training [115,123] and race [110,124], where a nutritional strategy in its intake was to increase fatty acid oxidation for a given exercise intensity and meet the increased caloric demands, respectively.”
Background
Einfluss von einem Langstreckenschwimmen auf die Körperzusammensetzung – das Marathonschwimmen 2006 von Rapperswil nach Zürich
Knechtle, Baumann, & Knechtle (2007) · Praxis · doi:10.1024/1661-8157.96.15.585 · Cited by 10 · see citing works
Does a 24-hour ultra-swim lead to dehydration?
Knechtle, B., Knechtle, P., Kohler, G., & Rosemann, T. J. (2011) · Journal of Human Sport and Exercise · doi:10.4100/jhse.2011.61.08 · Cited by 10 · see citing works
Self-citation
Energiebilanz bei Langzeitbelastung: eine Fallstudie
Knechtle, Bisig, Schläpfer, & Zwyssig (2003) · Praxis · doi:10.1024/0369-8394.92.18.859 · Cited by 9 · see citing works
Nutritional Practices of Extreme Endurance Swimmers the Marathon-Swim in the Lake of Zurich 2006
Beat, K., Knechtle, P., & Kaul, R. (2007) · Pakistan Journal of Nutrition · doi:10.3923/pjn.2007.188.193 · Cited by 9 · cited 1× · see citing works
“a = [28], b = [32], c = [11], d = [104], e = [35], f = [105], g = [106], h = [41], i = [40].”
Training for a 78-km solo open water swim
Piacentini, M. F., Ioannon, G. D., Cibelli, G., Mignardi, S., Antonelli, A., & Capranica, L. (2017) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.16.06309-x · Cited by 7 · cited 1× · see citing works
“For instance, a master swimmer trained 3 h per day (15–70 km weekly) prior to a 78-km open water swim [57].”
Method
Energieumsatz bei Langstreckenschwimmen - eine Fallbeschreibung
Knechtle, B., Knechtle, P., & Heusser, D. (2004) · Cited by 7 · see citing works
Self-citation
Exercise‐associated hyponatraemia on the Kokoda Trail
Rothwell, S., Rosengren, D., Rojek, A. M., Williams, J. M., Lukin, B., & Greenslade, J. H. (2011) · Emergency Medicine Australasia · doi:10.1111/j.1742-6723.2011.01470.x · Cited by 6 · cited 1× · see citing works
“Athletes suffering by EAH consume the double quantity of fluids during a race compared to athletes without EAH [80].”
Background
Zwölf Stunden Laufen führt zu einem nachweisbaren Abbau des subkutanen Fettgewebes
Knechtle, Zimmermann, Wirth, Knechtle, & Kohler (2007) · Praxis · doi:10.1024/1661-8157.96.38.1423 · Cited by 6 · see citing works
In einem Lauf vom Bodensee an den Genfersee – Effekt auf Fett- und Muskelmasse
Knechtle, & Knechtle (2007) · Praxis · doi:10.1024/1661-8157.96.8.281 · Cited by 6 · see citing works
Ernährungsverhalten bei Ultraläufern - Deutschlandlauf 2006
Knechtle, B., & Schulze, I. (2008) · Praxis · doi:10.1024/1661-8157.97.5.243 · Cited by 5 · see citing works
Self-citation
Ein 12-Stunden-Indoor-Cycling-Marathon führt zu einem messbaren Abbau des subkutanen Fettgewebes
Knechtle, Früh, Knechtle, Schück, & Kohler (2007) · Praxis · doi:10.1024/1661-8157.96.27.1071 · Cited by 4 · see citing works

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Sorted by citations

Nutrition and Supplement Update for the Endurance Athlete: Review and Recommendations
Vitale, K., & Getzin, A. R. (2019) · Nutrients · doi:10.3390/nu11061289 · Cited by 290 · see citing works
“Ultra-endurance activities are typically defined as events lasting at least 4 [4] to 6 h [5] duration.”
Background
International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing
Tiller, N. B., Roberts, J. D., Beasley, L., Chapman, S., Pinto, J. M., Smith, L., Wiffin, M., Russell, M., Sparks, S. A., Duckworth, L., et al. (2019) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-019-0312-9 · Cited by 164 · see citing works
Advances in Understanding the Interplay between Dietary Practices, Body Composition, and Sports Performance in Athletes
Martín-Rodríguez, A., Belinchón-deMiguel, P., Rubio-Zarapuz, A., Tornero-Aguilera, J. F., Martínez‐Guardado, I., Villanueva-Tobaldo, C. V., & Clemente‐Suárez, V. J. (2024) · Nutrients · doi:10.3390/nu16040571 · Cited by 120 · see citing works
“However, carbohydrate intake is higher in ultra-endurance athletes, with the quality of these carbohydrates being crucial as it relates to higher exogenous carbohydrate oxidation and mitigating common gastrointestinal discomforts in ultra-endurance events [99].”
BackgroundInfluential
Efficacy of Popular Diets Applied by Endurance Athletes on Sports Performance: Beneficial or Detrimental? A Narrative Review
Devrim-Lanpir, A., Hill, L., & Knechtle, B. (2021) · Nutrients · doi:10.3390/nu13020491 · Cited by 57 · see citing works
“As it is well known that depleting glycogen stores is one of the major causes of fatigue during endurance exercise [2], HFD also aims to reduce muscle glycogen utilization to ensure CHO availability for longer periods of time during endurance training.”
BackgroundInfluentialSelf-citation
Mapping the complexities of Relative Energy Deficiency in Sport (REDs): development of a physiological model by a subgroup of the International Olympic Committee (IOC) Consensus on REDs
Burke, L. M., Ackerman, K. E., Heikura, I. A., Hackney, A. C., & Stellingwerff, T. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107335 · Cited by 59 · see citing works
Analysis of food and fluid intake in elite ultra-endurance runners during a 24-h world championship
Lavoué, C., Siracusa, J., Chalchat, É., Bourrilhon, C., & Charlot, K. (2020) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-020-00364-7 · Cited by 39 · see citing works
Effects of Sodium Intake on Health and Performance in Endurance and Ultra-Endurance Sports
Veniamakis, E., Kaplanis, G., Voulgaris, P., & Nikolaidis, P. Τ. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063651 · Cited by 36 · see citing works
Self-citation
Effect of Iron Supplementation on the Modulation of Iron Metabolism, Muscle Damage Biomarkers and Cortisol in Professional Cyclists
Córdova, A., Mielgo‐Ayuso, J., Fernandez-Lazaro, C. I., Caballero-García, A., Roche, E., & Fernández‐Lázaro, D. (2019) · Nutrients · doi:10.3390/nu11030500 · Cited by 34 · see citing works
A Review of Carbohydrate Supplementation Approaches and Strategies for Optimizing Performance in Elite Long-Distance Endurance
Cao, W., He, Y., Fu, R. G., Chen, Y., Yu, J., & He, Z. (2025) · Nutrients · doi:10.3390/nu17050918 · Cited by 36 · see citing works
“Glycogen restoration is initiated through gluconeogenesis at a rate of 1–2 mmol · kg − 1 · h − 1 .”
Ultra-Endurance Participation and Acute Kidney Injury: A Narrative Review
Tidmas, V., Brazier, J., Bottoms, L. M., Muniz‐Pumares, D., Desai, T., Hawkins, J., Sridharan, S., & Farrington, K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192416887 · Cited by 33 · see citing works
“Conventionally, ultraathletes do not prioritise protein [28] where nutrition and fuelling mainly focuses on carbohydrates [28,29].”
Background
Genotype scores in energy and iron-metabolising genes are higher in elite endurance athletes than in nonathlete controls
Varillas‐Delgado, D., Orriols, J. J. T., Martín, D. M., & Coso, J. D. (2020) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2020-0174 · Cited by 29 · see citing works
Supplement Intake in Recreational Vegan, Vegetarian, and Omnivorous Endurance Runners—Results from the NURMI Study (Step 2)
Wirnitzer, K., Motevalli, M. S., Tanous, D., Gregori, M., Wirnitzer, G., Leitzmann, C., Hill, L., Rosemann, T. J., & Knechtle, B. (2021) · Nutrients · doi:10.3390/nu13082741 · Cited by 29 · see citing works
“The primary nutritional challenge that marathoners face is to meet the high exerciseinduced requirements of daily energy and macronutrients necessary to optimize performance and recovery of prolonged training sessions [54,59].”
BackgroundSelf-citation
Ultra-Marathon-Induced Increase in Serum Levels of Vitamin D Metabolites: A Double-Blind Randomized Controlled Trial
Mieszkowski, J., Stankiewicz, B., Kochanowicz, A., Niespodziński, B., Kowalik, T., Zmijewski, M. A., Kowalski, K., Rola, R., Bieńkowski, T., & Antosiewicz, J. (2020) · Nutrients · doi:10.3390/nu12123629 · Cited by 28 · see citing works
“The consumption of vitamins during an ultra-marathon is a common nutritional habit and, along with the growing interest in this type of physical activity, has been studied [44,45].”
Background
Current Trends in Ultramarathon Running
Spittler, J., & Oberle, L. (2019) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000654 · Cited by 26 · see citing works
Exercise-Induced Muscle Damage and Cardiac Stress During a Marathon Could be Associated with Dietary Intake During the Week Before the Race
Mielgo‐Ayuso, J., Calleja-González, J., Refoyo, I., León-Guereño, P., Córdova, A., & Coso, J. D. (2020) · Nutrients · doi:10.3390/nu12020316 · Cited by 26 · see citing works
Relationship of Carbohydrate Intake during a Single-Stage One-Day Ultra-Trail Race with Fatigue Outcomes and Gastrointestinal Problems: A Systematic Review
Arribalzaga, S., Viribay, A., Calleja-González, J., Fernández‐Lázaro, D., Castañeda-Babarro, A., & Mielgo‐Ayuso, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18115737 · Cited by 24 · see citing works
“Ultra-endurance physical exertion causes physical and psychological stress [11,81], which could lead to changes in the intestinal tract and consequently affect athletic performance [37].”
Background
Could middle- and long-distance running performance of well-trained athletes be best predicted by the same aerobic parameters?
Denadai, B. S., & Greco, C. C. (2022) · Current Research in Physiology · doi:10.1016/j.crphys.2022.06.006 · Cited by 24 · see citing works
Sex Differences in Supplement Intake in Recreational Endurance Runners—Results from the NURMI Study (Step 2)
Wirnitzer, K., Motevalli, M. S., Tanous, D., Gregori, M., Wirnitzer, G., Leitzmann, C., Rosemann, T. J., & Knechtle, B. (2021) · Nutrients · doi:10.3390/nu13082776 · Cited by 22 · see citing works
“foods to support their athletic requirements [26,33,34], and this concern might be more critical for endurance athletes who follow specific kinds of diets and/or inappropriately planned regimes [35,36].”
BackgroundSelf-citation
Intestinal Microbiota Interventions to Enhance Athletic Performance—A Review
Patel, B. K., Patel, K. H., Lee, C. N., & Moochhala, S. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms251810076 · Cited by 25 · see citing works
“Endurance athletes encounter challenging circumstances during their physical activity regimens, prompting them to explore alternate dietary approaches aimed at enhancing both their endurance performance and metabolic well-being [75].”
Background
Female Endurance Runners Have a Healthier Diet than Males—Results from the NURMI Study (Step 2)
Motevalli, M. S., Wagner, K., Leitzmann, C., Tanous, D., Wirnitzer, G., Knechtle, B., & Wirnitzer, K. (2022) · Nutrients · doi:10.3390/nu14132590 · Cited by 19 · see citing works
“Nutritional concerns, particularly energy deficiency, are more critical in both male and female long-distance runners compared to those who run in shorter races [18,22].”
BackgroundSelf-citation
Do Spanish Triathletes Consume Sports Supplements According to Scientific Evidence? An Analysis of the Consumption Pattern According to Sex and Level of Competition
Jiménez-Alfageme, R., Sanz, J. M. M., Romero-García, D., Giménez-Monzó, D., Aparicio, S. H., Sánchez-Oliver, A. J., & Sospedra, I. (2023) · Nutrients · doi:10.3390/nu15061330 · Cited by 17 · see citing works
“In fact, sports bars, sports drinks, sports gels, and caffeine were the most-consumed supplements by triathletes, as these SS are very important when it comes to providing energy in the form of carbohydrates, preventing dehydration and hyponatremia during training or competitions, and for recovery after these sessions…”
Background
The Epidemiology, Risk Factors, and Nonsurgical Treatment of Injuries Related to Endurance Running
Raghunandan, A., Charnoff, J. N., & Matsuwaka, S. T. (2021) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000852 · Cited by 16 · see citing works
Optimizing athletic performance through advanced nutrition strategies: can AI and digital platforms have a role in ultraendurance sports?
Puce, L., Ceylan, H. İ., Trompetto, C., Cotellessa, F., Schenone, C., Marinelli, L., Żmijewski, P., Bragazzi, N. L., & Mori, L. (2024) · Biology of Sport · doi:10.5114/biolsport.2024.141063 · Cited by 15 · see citing works
Running for Your Life: Metabolic Effects of a 160.9/230 km Non-Stop Ultramarathon Race on Body Composition, Inflammation, Heart Function, and Nutritional Parameters
Bizjak, D. A., Schulz, S. V. W., John, L., Schellenberg, J., Bizjak, R., Witzel, J., Valder, S., Kostov, T., Schalla, J., Steinacker, J. M., et al. (2022) · Metabolites · doi:10.3390/metabo12111138 · Cited by 14 · see citing works
“9 km) to 9000 kcal (230 km), with the results thus comparable to other ultramarathon studies [18,19].”
BackgroundResultInfluential
Supplement intake in half-marathon, (ultra-)marathon and 10-km runners – results from the NURMI study (Step 2)
Wirnitzer, K., Motevalli, M. S., Tanous, D., Gregori, M., Wirnitzer, G., Leitzmann, C., Hill, L., Rosemann, T. J., & Beat, K. (2021) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-021-00460-2 · Cited by 14 · see citing works
Self-citation
Clinical presentation of exercise‐associated hyponatremia in male and female IRONMAN ® triathletes over three decades
Johnson, K. B., Connolly, C. P., Cho, S. P., Miller, T. K., Sallis, R. E., & Hiller, W. D. B. (2023) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14401 · Cited by 13 · see citing works
“Do probiotics mitigate GI-induced inflammation and perceived fatigue in athletes? A systematic review”
Kearns, R., Dooley, J. S. G., Matthews, M., & McNeilly, A. M. (2024) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2024.2388085 · Cited by 12 · see citing works
“However, during extended physical exertion, the equilibrium of these systems can be disrupted, detrimentally influencing performance due to factors such as oxidative stress [9], compromised intestinal permeability [10], muscle damage [11], systemic inflammation [12] and immune responses [13].”
Background
Changes in Sex Difference in Time-Limited Ultra-Cycling Races from 6 Hours to 24 Hours
Scholz, H., Sousa, C. V., Baumgartner, S., Rosemann, T. J., & Knechtle, B. (2021) · Medicina · doi:10.3390/medicina57090923 · Cited by 12 · see citing works
“The long duration and the high intensity of an ultraendurance race create physiological challenges [51].”
BackgroundSelf-citation
Eating habits and nutritional knowledge among amateur ultrarunners
Kosendiak, A. A., Król, M., Ligocka, M., & Kepinská, M. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1137412 · Cited by 12 · see citing works
Exploring the Nutrition Strategies Employed by Ultra-Endurance Athletes to Alleviate Exercise-Induced Gastrointestinal Symptoms—A Systematic Review
Ryan, T., Daly, E., & Ryan, L. (2023) · Nutrients · doi:10.3390/nu15204330 · Cited by 11 · see citing works
A comparative observational study of carbohydrate intake and continuous blood glucose levels in relation to performance in ultramarathon
Inamura, N., Taniguchi, H., Yoshida, S., Nishioka, M., & Ishihara, K. (2024) · Scientific Reports · doi:10.1038/s41598-023-51048-6 · Cited by 11 · see citing works
Exploring the Evolutionary Disparities: A Case Study on the Psychophysiological Response to Recreating the Hunter–Gatherer Lifestyle through Physical Activity and Caloric Restriction
Belinchón-deMiguel, P., Ramos‐Campo, D. J., & Clemente‐Suárez, V. J. (2023) · Applied Sciences · doi:10.3390/app132011140 · Cited by 10 · see citing works
Sports Nutrition and Performance
Arcusa, R., Rentero, M. P. Z., & Hernández, J. M. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.84467 · Cited by 9 · see citing works
Endurance in Long-Distance Swimming and the Use of Nutritional Aids
Miguel‐Ortega, Á., Calleja-González, J., & Mielgo‐Ayuso, J. (2024) · Nutrients · doi:10.3390/nu16223949 · Cited by 12 · see citing works
“In terms of the use of performance-enhancing aids in swimming, there has been [24] particular interest for open water swimmers in products that can improve central drive and help buffer acidic environments and translate this into increased performance, with substances such as those listed below.”
Cortical and Subcortical Brain Volume Alterations Following Endurance Running at 38.6 km and 119.2 km in Male Athletes
Sıngın, R. H. Ö., Düz, S., & Kiraz, M. (2021) · Medical Science Monitor · doi:10.12659/msm.926060 · Cited by 8 · see citing works
“Most recreational ultramarathon runners reach their peak performance in their 40s and are willing to push their limits in extreme conditions that make them prone to diverse medical complications that vary from mild blisters and stress fractures to severe cardiac arrest or stroke [18-21].”
Background
Ultra-Cycling– Past, Present, Future: A Narrative Review
Tiemeier, L., Nikolaidis, P. Τ., Chlíbková, D., Wilhelm, M., Thuany, M., Weiss, K., & Knechtle, B. (2024) · Sports Medicine - Open · doi:10.1186/s40798-024-00715-7 · Cited by 7 · see citing works
Self-citation
Physical Exercise or Activity and Energy Balance or Metabolism in the Context of Health and Diseases
Messonnier, L. A. (2023) · Nutrients · doi:10.3390/nu15234909 · Cited by 6 · see citing works
“While this may be beneﬁcial in cases of overweight and obesity for example [3–5], this may be more detrimental in the case of military missions [6] or long-lasting exercises (e.g., ultra-endurance events [7]).”
Background
A comparison of economy between two different backpack designs for runners
Scheer, V., Vieluf, S., Schröder, M., Lappe, P., & Heitkamp, H. (2020) · Applied Ergonomics · doi:10.1016/j.apergo.2019.103038 · Cited by 6 · see citing works
Performance demands in the endurance rider
Williams, J. M., Douglas, J. L., Davies, E., Bloom, F., & Castejón‐Riber, C. (2020) · Comparative Exercise Physiology · doi:10.3920/cep200033 · Cited by 5 · see citing works
Are the Dietary–Nutritional Recommendations Met? Analysis of Intake in Endurance Competitions
Jiménez-Alfageme, R., Álvarez, J., Garbisu-Hualde, A., Romero-García, D., Giménez-Monzó, D., Sospedra, I., Ausó, E., & Sanz, J. M. M. (2024) · Nutrients · doi:10.3390/nu16020189 · Cited by 4 · see citing works
“For endurance events, lasting more than 2.5–3 h and with a competitive-level intensity, the amount should be 90 g per hour [8–10].”
BackgroundInfluential
Kidney Function and Extreme Endurance Races: Risks, Mechanisms, and Preventing Strategies
Kulbacka, J., Dziedzic, K., Arczewski, F., Wójcikiewicz, M., Chuncia-Ileczko, M., Kacperczyk, J., Czyż, W., Zys, D., Pasek, P., & Ryniecka, J. (2025) · Quality in Sport · doi:10.12775/qs.2025.37.57434 · Cited by 4 · see citing works
Common Health Issues Encountered by Ultraendurance Ocean Rowers
Galsworthy, W. J. H., Carr, J. A. J., & Hearn, R. (2022) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2021.11.008 · Cited by 4 · see citing works
Endurance Sporting Events
Golubjatnikov, M., & WALKER, A. E. (2024) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2024.02.017 · Cited by 4 · see citing works
The Optimal Weight Carriage System for Runners: Comparison Between Handheld Water Bottles, Waist Belts, and Backpacks
Scheer, V., Vieluf, S., Bitter, N., Christ, L., & Heitkamp, H. (2020) · Frontiers in Physiology · doi:10.3389/fphys.2020.571221 · Cited by 4 · see citing works
“Maintaining appropriate fluid and nutritional intake is important to avoid decrements in performance and medical complications (Costa et al., 2016; Knechtle and Nikolaidis, 2018; Nikolaidis et al., 2018).”
Background
Exertional sodium loss does not increase immediate salt appetite or dietary sodium intake in athletes
Manevitz, Z., Leshem, M., Heled, Y., Epstein, Y., Gershon, B., & Kodesh, E. (2021) · Appetite · doi:10.1016/j.appet.2021.105181 · Cited by 4 · see citing works
Running on the edge: hematological responses to a non-stop ultramarathon with a focus on nitric oxide–mediated red blood cell deformability
Grau, M., Bruns, J., Stücher, M., John, L., Munk, M., Siebers, M., Siebers, C., Bloch, W., & Bizjak, D. A. (2025) · Frontiers in Physiology · doi:10.3389/fphys.2025.1715513 · Cited by 3 · see citing works
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Authors: Nikolaidis, P. T., Veniamakis, E., Rosemann, T., & Knechtle, B.
Affiliations: Laboratory of Exercise Testing, Hellenic Air Force Academy, 13671 Dekelia, Greece
Department of Nutrition and Dietetics, Technological Educational Institute, 72300 Sitia, Greece
University of Zurich (CH)
Corresponding author: Knechtle, Beat
ORCID: Nikolaidis, Pantelis T.
Rosemann, Thomas
Knechtle, Beat
Venue: Nutrients
Publisher: MDPI AG
Published: 2018-12-16
Volume: 10
Issue: 12
Pages: 1995
ISSN: 2072-6643 (ISSN-L)
DOI: 10.3390/nu10121995
PMC: PMC6315825
OpenAlex: W2904539705
Cited by: 70
References: 137
Citations by year: 2026: 6 · 2025: 11 · 2024: 11 · 2023: 8 · 2022: 7 · 2021: 11 · 2020: 9 · 2019: 7
FWCI: 0.76
Type: journal article
Language: en
Open access: gold
dx.doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Nutrients (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
Zurich Open Repository and Archive (University of Zurich)
Topics: Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
Keywords: ultra-endurance sports, sports nutrition, energy balance, negative energy balance, fluid balance, exercise-associated hyponatremia, hypohydration, gastrointestinal discomfort, fat utilization, carbohydrate intake, electrolyte consumption, muscle mass loss, fat loss
MeSH terms: Humans, Physical Endurance, Sports, Athletes, Sports Nutritional Physiological Phenomena

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