nutrition in sport || alcohol in sport

Introduction

Ancient civilizations dating back to thousands ofyears bc recorded the intake of drinks containingalcohol (or, more correctly, ethanol) as part ofsocial rituals. One practice which has persisted,even throughout the last decades, is the intake ofalcohol before or during sport in the belief that it might improve performance (for review, see Williams 1991). Today, the major strong linkbetween sport and alcohol is through spon-sorship and advertising, with many sportingorganizations, leagues, teams and events beingfinanced by beer and liquor brewing companies.While a small number of athletes may stillconsume alcohol specifically to attempt toimprove their sports performance, the overwhelming majority of athletes who drinkalcohol, do so for social reasons. However, this isoften in the context of rituals that are part of theculture of their sport. The aim of this chapter is tooverview the effect of alcohol on sports per-formance, particularly related to the typical pat-terns of consumption by athletes, and to providesome guidelines for sensible use of alcohol bysports people.

Alcohol use by athletes

Typically, alcohol intake provides less than 5% ofthe total energy intake of adults, although recentUK data suggest that alcohol accounted onaverage for 6.9% of the total energy intake of menaged between 18 and 64 years (Gregory et al.

1990); the corresponding value for women was2.8%. Since the contribution to total energyintake is regarded as minor, it is often excludedfrom the results of dietary surveys of athletes.Furthermore, while the general limitations ofdietary survey methodology are acknowledged,it is likely that self-reported data on alcoholintake are particularly flawed. For example,people are unlikely to report accurately and reli-ably about their consumption of a nutrient orfood that is regarded so emotively; there is poten-tial for both significant under-reporting andover-reporting. These factors help to explain thelack of reliable data on the alcohol intakes anddrinking practices of athletes. It is also importantto note that, because many people abstain com-pletely from alcohol, the data are skewed, andmean values may be misleading: in the survey ofGregory et al. (1990) quoted above, for example,men and women who were alcohol drinkersobtained an average of 8.7% and 4.3%, respec-tively, of total energy from alcohol.

There are clearly gender-related differences inconsumption patterns, but age, socio-economicbackground, and geographical location alsoinfluence drinking habits. It is not clear whetherthe consumption patterns of athletes are greatlydifferent from those of the non-athletic popula-tion. In general, though, dietary surveys of athletes which include alcohol suggest that itcontributes 0–5% of total energy intake in theeveryday diet. However, there is evidence thatthis provides a misleading view of the alcoholintakes of athletes. For example, in a dietary

Chapter 30

Alcohol in Sport

LOUISE M. BURKE AND RONALD J. MAUGHAN

405

survey of 45 professional football players fromthe leading team in the national Australian RulesFootball League, mean daily alcohol intake wasestimated to be 20g, accounting for 3.5% of totalenergy intake (Burke & Read 1988). However,these players rarely drank alcohol during thetraining week, in accordance with the club policy,and instead confined their intake to weekends,particularly after the weekly football match.Closer examination of the football data revealedthat the mean intake of alcohol immediately afterthe match was 120g (range, 27–368g), withalcohol providing a mean contribution of 19% oftotal energy intake on match day (range, 3–43%of total energy intake).

Such ‘binge’ drinking practices were con-firmed in a separate study in these same subjects.Blood samples were taken from 41 players who attended a 9.00 a.m. training session on themorning following a weekend match. Fourteenof these players still registered a positive blood alcohol content (BAC) from their previousevening’s intake, with levels ranging from 0.001to 0.113 g · 100ml–1. Blood alcohol content in fourplayers exceeded the legal limit for driving amotor vehicle (0.05g · 100ml–1). The lay pressprovides ample anecdotal evidence of bingedrinking patterns of some athletes, particularlyin the immediate celebration or commiserationof their competition performances, or in the off-season. In some cases these episodes are romanti-cized and the drinking prowess of the athletes isadmired.

Whether total alcohol intake, or the prevalenceof episodes of heavy alcohol intake, by athletes is different from that of the general populationremains unclear. Surveys which have examinedthis issue report conflicting results. Varioushypotheses have been proposed to explain likelyassociations between sport and alcohol use. Ithas been suggested that athletes might have alower intake due to increased self-esteem, a morerigid lifestyle and greater interest in their healthand performance. Equally, alcohol has been asso-ciated with the rituals of relaxation and celebra-tion in sport, and it has been suggested thatathletes might be socialized into certain behav-

406 nutrition and exercise

iours and attitudes to drinking as a result of theirsports participation.

Several dietary surveys comparing differentgroups of athletes have reported that the meandaily alcohol intakes of team sport athletes are significantly greater than those of athletesinvolved in endurance and strength sports (vanErp-Baart et al. 1989; Burke et al. 1991). Whilethese studies were not specifically designed tocollect data on alcohol intake, the findings aresupported by data collected in some populationsurveys on alcohol use. Watten (1995), in anational survey of Norwegian adults, reportedthat men and women involved in team sportsreported a higher intake of alcohol, particularlybeer and liquor, than those involved in individ-ual sports or those with no sports involvement.However, some of these differences wereexplained by the age and educational back-grounds of subjects. O’Brien (1993) reported dif-ference between sports in alcohol use by eliteIrish athletes, but the overall intake of this groupwas exceptionally low, at an average of 0.5% oftotal energy intake.

Clearly, while there is anecdotal evidence tosuggest that some athletes may consume alcoholin excessive amounts, on at least some occasions,further studies are needed to fully determine thealcohol intake and patterns of use by athletes.Information on the attitudes and beliefs of athletes about alcohol is also desirable, since it would allow education about current drink-ing practices which are detrimental to theathlete’s performance or health to be specificallytargeted.

Metabolism of alcohol

The metabolism of ethanol occurs primarily inthe liver, where it is oxidized, first to acetalde-hyde, and then to acetate. The first step is catalysed by a number of hepatic enzymes, themost important of which is the nicotinamideadenine dinucleotide (NAD)-dependent alcoholdehydrogenase:

CH3CH2OH + NAD+ Æ CH3CHO + NADH + H+

Aldehyde dehydrogenase catalyses the furtheroxidation of acetaldehyde to acetate:

CH3CHO + NADH+ +H2O Æ CH3COO–

+ NADH +2H+

The NADH which is formed in these reactionsmust be reoxidized within the mitochondria, buttransfer of the hydrogen atoms into the mito-chondria might be a limiting process leading toan alteration in the redox potential of the cell.This can interfere with the conversion of lactateto pyruvate, and explains the increased bloodlactate concentration that may be observed afterhigh alcohol intakes.

Acetaldehyde is metabolized within the liver,and the acetaldehyde concentration in the blood remains low, but it is acetaldehyde that is thought to be responsible for many of theadverse effects of ethanol. The rate of hepaticgluconeogenesis is markedly suppressed by themetabolism of ethanol as a result of the alteredNAD/NADH ratio and the reduced availabilityof pyruvate (Krebs et al. 1969). If the liver glyco-gen stores are low because of a combination ofexercise and a low carbohydrate intake, the liverwill be unable to maintain the circulating glucoseconcentration, leading to hypoglycaemia. Therate at which ethanol is cleared by the liver varieswidely between individuals, and the response of the individual will depend on the amount ofethanol consumed in relation to the habitualintake. It is not altogether clear whether the rateof metabolism of alcohol is increased by exercise,and there are conflicting data in the literature(Januszewski & Klimek 1974). Table 30.1 indi-cates the amount of alcohol contained in somestandard measures.

Effects of acute alcohol ingestion on exercise

The variety of effects of alcohol on different bodytissues, and the variability of subject responses to alcohol, make it difficult to study the directeffects on sports performance. Generally, theergogenic benefits of alcohol intake immediatelybefore and during exercise are psychologically

driven. Alcohol has been used to decrease sen-sitivity to pain, improve confidence, and toremove other psychological barriers to perfor-mance. However, it may also be used to stimulatethe cardiovascular system, or to lessen the tremorand stress-induced emotional arousal in finemotor control sports. Although it is no longer onthe general doping list of the IOC, it is still con-sidered a banned substance in some sports, suchas shooting and fencing. In some sports, such asdarts and billiards, it is still popularly used as a(proposed) performance aid, but it remains to beseen whether this simply reflects the culture ofsports that are widely played in a hotel environ-ment (for review, see Williams 1991).

Exercise metabolism and performance

The American College of Sports Medicine (1982),and a more recent review by Williams (1991),have summarized the acute effects of alcoholingestion on metabolism and performance ofexercise. Alcohol does not contribute signifi-cantly to energy stores used for exercise, but insituations of prolonged exercise it may increasethe risk of hypoglycaemia due to a suppressionof hepatic gluconeogenesis. Increased heat lossmay be associated with this hypoglycaemia aswell as the cutaneous vasodilation caused byexercise, causing an impairment of temperatureregulation in cold environments. Studies of theeffects of alcohol on cardiovascular, respiratoryand muscular function have provided conflictingresults, but ingestion of small amounts of alcohol

alcohol in sport 407

Table 30.1 A standard drink contains approximately10g of alcohol.

Drink Amount (ml)

Standard beer (4% alcohol) 250Low alcohol beer (2% alcohol) 500Cider, wine coolers, alcoholic soft 250

drinksWine 100Champagne 100Fortified wines, sherry, port 60Spirits 30

has been reported not to significantly alter thecardiorespiratory and metabolic responses tosubmaximal exercise (Bond et al. 1983; Mangumet al. 1986). Dose–response relationships, inter-and intrasubject variability, and difficulty withproviding a suitable placebo may all help toexplain the difficulty of conducting and inter-preting alcohol studies. In general it has beenconcluded that the acute ingestion of alcohol hasno beneficial effects on aspects of muscle func-tion and performance tasks: because it may actually produce detrimental responses, it is bestavoided.

The few studies of acute alcohol ingestion andactual sports performance show variability inresults and responses. For example, Houmardand others (1987) reported that the ingestion ofsmall amounts of alcohol (keeping BAC below0.05g · 100ml–1) did not have a significant effecton the performance of a 8-km treadmill time trial, although there was a trend towards perfor-mance deterioration at higher blood alcohollevels. Meanwhile, McNaughton and Preece(1986) tested the performance of runners overvarious distances ranging from 100 to 1500 m, at four different levels of alcohol consumption(BAC estimated at 0–0.1g ·100 ml–1). Alcoholintake did not affect performance of 100-m timesin sprinters, but reduced performance over 200and 400 m as alcohol intake increased. Middle-distance runners showed impaired performancein 800 and 1500m run times, with these effectsalso being dose-related. An earlier study byHebbelinck (1963) showed no effect of alcohol(0.6 ml of 94% ethanol ·kg–1 body mass) on iso-metric strength, but a 6% reduction in verticaljump height and a 10% decrease in performancein an 80-m sprint.

Motor control and skill performance

There is a limited amount of information avail-able on the effects of acute ingestion of alcohol on motor control and the performance of skilledtasks. It is, however, clear from the controlledstudies that have been conducted that alcoholhas an adverse effect on tasks where concen-


tration, visual perception, reaction time, and co-ordination are involved (Williams 1995). In manyof the earlier studies that showed a detrimentaleffect of even small doses of alcohol on compo-nents of athletic performance, the performancemeasures were not well standardized and the results are difficult to interpret. Hebbelinck(1963), however, showed that posture controldeteriorated after alcohol ingestion, with boththe extent and frequency of sway beingmarkedly increased: this represents a mildversion of the unsteadiness and ataxia that isapparent after higher levels of alcohol intake.

In 1982, the American College of Sports Medi-cine published a Position Statement on the use ofalcohol in sports, and this included a review ofthe research to date on the effects of alcohol onperformance: this literature was also reviewedby Williams (1985). The available evidenceshowed a detrimental effect of small to moderateamounts of alcohol on reaction time, hand–eyeco-ordination, accuracy, balance and complexskilled tasks, with no evidence cited to supportthe purported beneficial effects of reducedtremor. It has, however, been proposed that theingestion of small amounts of alcohol may resultin a greater feeling of self-confidence in athletes(Shephard 1972), and this may, in turn, improveperformance in some situations. The interferenceof alcohol with the judgement and skill involvedin the fine motor skills required for drivingaccounts for the legislation to prevent indivi-duals who have been drinking from drivingautomobiles.

Effects of acute alcohol ingestion onpostexercise recovery

There is evidence that the postcompetition situa-tion is often associated with alcohol intake andbinge drinking, and it is likely that social ritualsafter training or practice sessions in some sports(particularly in lower level competitions) mayalso involve moderate to heavy intake of alcohol.Given that athletes may be dehydrated and have eaten little on the day of competition, it islikely that alcohol consumed after exercise is

more quickly absorbed and has increased effects.Therefore it is important to examine the effects of alcohol on processes that are important in the recovery from prolonged exercise, and on the performance of subsequent exercise bouts.Unfortunately, postexercise drinking is subject tomany rationalizations and justifications by ath-letes, including ‘everyone is doing it’, ‘I onlydrink once a week’ and ‘I can run/sauna it off thenext morning’.

Rehydration

The restoration of the body fluid deficit incurredduring exercise is a balance between the amountof fluid that athletes can be induced to drink after exercise, and their ongoing fluid losses. Thepalatability of postexercise fluids is an importantfactor in determining total fluid intake, whilereplacement of sodium losses is a major determi-nant of the success in retaining this fluid (seeChapter 19). It has been suggested that beer is a valuable postexercise beverage since largevolumes can be voluntarily consumed by someathletes! However, the absence of an appreciablesodium content (unless it is accompanied by theintake of salty foods), and the diuretic action of alcohol are factors that are likely to pro-mote increased urine losses. A recent study(Shirreffs & Maughan 1997) examined the effect

of alcohol on postexercise rehydration from anexercise task which dehydrated subjects by 2% ofbody mass. Subjects replaced 150% of the volumeof their fluid deficits with drinks containing 0%,1%, 2% or 4% alcohol within 90 min of finishingthe exercise. The total volume of urine producedduring the 6h of recovery was positively relatedto the alcohol content of the fluid. However, onlyin the 4% alcohol drink trial did the difference intotal urine approach significance, with a netretention of 40% of ingested fluid compared with59% in the no-alcohol trial, equating to a differ-ence of about 500 ml in urine losses. Subjectswere still dehydrated at the end of the recoveryperiod with the 4% alcohol drink, despite havingconsumed 1.5 times the volume of their fluiddeficit (Fig. 30.1). Although individual variabil-ity must be taken into account, this study sug-gests that the intake of significant amounts ofalcohol will impede rehydration. It also indi-cated that beer is not a suitable rehydrationdrink, even in the low alcohol forms that areavailable, because of the low content of elec-trolytes, particularly sodium (Maughan &Shirreffs 1997).

In practical terms, low alcohol beers (< 2%alcohol) or beer ‘shandies’ (beer mixed in equalproportions with lemonade, thus diluting thealcohol content and providing some carbohy-drate) may not be detrimental to rehydration.


1000

500

0

–500

–1000

–1500

–2000Pre-

exercisePost-

exercise0 1 2 3 4 5 6

Time after rehydration (h)

Net

flu

id b

alan

ce (

ml)

Fig. 30.1 Whole-body waterbalance after exercise- induceddehydration followed byingestion of a volume equal to 1.5times the sweat loss of fluidscontaining alcohol atconcentrations of 0% (�), 1% (�),2% (�) and 4% (�). There isclearly an increasing urine outputin the postingestion period as thealcohol concentration increases.Adapted from Shirreffs andMaughan (1997).

Furthermore, notwithstanding other effects ofsmall to moderate amounts of alcohol, thesedrinks might be useful in encouraging large fluidintakes in dehydrated athletes. However, drinkswith more a concentrated alcohol content are notadvised, since the combination of a smaller fluidvolume and a greater alcohol intake will reducethe rate of effective fluid replacement. Neverthe-less, when aggressive rehydration is required,the planned intake of fluids containing sodium,or fluid intake in conjunction with sodium-rich foods, provides a more reliable strategy toreplace fluid losses (see Chapter 19).

Glycogen storage

Since alcohol has a number of effects on the inter-mediary metabolism of carbohydrate, it is possi-ble that postexercise intake might impair therestoration of depleted glycogen stores. In theabsence of carbohydrate intake, alcohol intake isknown to impair the carbohydrate status of theliver by inhibiting hepatic gluconeogenesis andincreasing liver glycogenolysis. Alcohol intakehas been reported to impair muscle glycogenstorage in rats following depletion by fasting orexercise (for review, see Palmer et al. 1991). Theeffect of alcohol intake on muscle glycogenstorage in humans was recently studied by Burkeand co-workers (in press), who undertook twoseparate studies to examine refuelling over 8 hand 24 h of recovery from a prolonged cyclingbout.

In these studies, athletes undertook three dif-ferent diets following their glycogen-deletingexercise: a control (high carbohydrate) diet, analcohol displacement diet (kept isoenergetic withthe control diet by reducing the carbohydrateintake) and an alcohol+ carbohydrate diet(alcohol added to the control diet). In the twodiets containing alcohol, the athletes wererequired to consume 1.5 g alcohol · kg–1 bodymass of alcohol in the 3h immediately after exer-cise (e.g. ª 100g alcohol or 10 standard drinks).Muscle glycogen storage was significantlyreduced on the alcohol displacement diets inboth the 8h and 24h study compared with the


high carbohydrate diets. There was a trendtowards a reduction in glycogen storage over 8hof recovery with alcohol +carbohydrate diet;however, glycogen storage on the alcohol+ car-bohydrate diet on the 24-h study was identical tothe control diet. Therefore, there was no clear evi-dence of a direct impairment of muscle glycogenstorage by alcohol when adequate substrate wasprovided to the muscle; however, this may havebeen masked by intersubject variability.

The results of these studies suggest that themajor effect of alcohol intake on postexerciserefuelling is indirect, that high intakes of alcoholare likely to prevent the athlete from consum-ing adequate carbohydrate intake to optimizemuscle glycogen storage. In general, athleteswho participate in alcoholic binges are unlikelyto eat adequate food or make suitable high-carbohydrate food choices. Furthermore, foodintake over the next day may also be affected asthe athletes ‘sleep off their hangover’. Furtherstudies are needed to determine the direct effectof alcohol on muscle glycogen storage.

Other effects

Alcohol is known to exert other effects whichmay impede postexercise recovery. Many sport-ing activities are associated with muscle damageand soft tissue injuries, either as a direct conse-quence of the exercise, as a result of accidents, ordue to the tackling and collisions involved incontact sports. Standard medical practice is totreat soft tissue injuries with vasoconstrictivetechniques (e.g. rest, ice, compression, elevation).Since alcohol is a potent vasodilator of cutaneousblood vessels, it has been suggested that theintake of large amounts of alcohol might cause or increase undesirable swelling around dam-aged sites, and might impede repair processes.Although this effect has not been systematicallystudied, there are case histories that report thesefindings. Until such studies are undertaken, itseems prudent that players who have sufferedconsiderable muscle damage and soft tissueinjuries should avoid alcohol in the immediaterecovery phase (e.g. for 24 h after the event).

Another likely effect of cutaneous vasodilationfollowing alcohol intake is an increase in heatloss from the skin. This may be exacerbated byhypoglycaemia, which results from the com-bined effects of carbohydrate depletion andimpaired liver gluconeogenesis. Therefore, ath-letes who consume large quantities of alcohol in cold environments may incur problems with thermoregulation. An increased risk ofhypothermia may be found in sports or rec-reational activities undertaken in cold weather,particularly hiking or skiing, where alcoholintake is an integral part of après-ski activities.

As in the case of postexercise refuelling, it islikely that the major effect of excessive alcoholintake comes from the athlete’s failure to followguidelines for optimal recovery. The intoxicatedathlete may fail to undertake sensible injurymanagement practices or to report for treatment;they may fail to seek suitable clothing or shelterin cold conditions or to notice early signs ofhypothermia. While studies which measure thedirect effect of alcohol on thermoregulation andsoft tissue damage are encouraged, these effectsare likely to be minor or at least additive to thefailure to undertake recommended recoverypractices.

Accidents and high-risk behaviour

The most important effect of alcohol is theimpairment of judgement. Coupled with areduced inhibition, it is easy to see how intoxi-cated athletes might undertake high-risk behav-iour and suffer an increased risk of accidents.Alcohol consumption is highly correlated withaccidents of drowning, spinal injury and otherproblems in recreational water activities (seeO’Brien 1993), and is a major factor in road acci-dents. The lay press frequently contains reportsof well-known athletes being caught drivingwhile severely intoxicated, or being involved inbrawls or other situations of domestic or publicviolence. There have been a disturbing numberof deaths of elite athletes in motor car accidentsfollowing excess alcohol intake. Clearly, athletesare not immune to the social and behavioural

problems following excess alcohol intake; thereis some discussion that certain athletes may bemore predisposed (see O’Brien 1993). Furtherstudies are required before it can be determinedwhether athletes, or some groups of athletes, are more likely to drink excessively or suffer agreater risk of alcohol-related problems. How-ever, it appears that athletes should at least beincluded in population education programmesrelated to drink-driving and other high-riskbehaviour.

Effect of previous day’s intake (i.e. ‘hangover’)on performance

Some athletes will be required to train (or evencompete again) on the day after a competitionand its postevent drinking binge. In some cases,athletes may choose to drink heavily the nightbefore a competition, as a general part of theirsocial activities, or in the belief that this will helpto ‘relax’ them prior to the event. The effect of an‘alcohol hangover’ on performance is widely dis-cussed by athletes, but has not been well studied.Karvinen and coworkers (1962) used a crossoverdesign to examine ‘next day’ performance fol-lowing the consumption of large amounts ofalcohol (approximately eight standard drinks),and reported that a hangover did not impairpower or strength, but impaired the ability to undertake a bout of high-intensity cycling.O’Brien (1993) undertook ‘aerobic’ and ‘anaero-bic’ testing of a team of Rugby Union players on aFriday night, and then requested them to returnfor repeat testing the next day after consumingtheir ‘typical Friday night’s alcohol intake’. Astandardized sleep time and breakfast were fol-lowed. He reported that V

.O2max. was significantly

reduced the following day, and that any level ofalcohol intake appeared to impair this measureof aerobic capacity. However, since no controltrial was undertaken, it is hard to dissociate theeffects of alcohol from the effects and variabilityof repeated testing. Meanwhile it is interesting tonote that the mean alcohol intake reported byplayers as typical of their prematch activities wasapproximately 130g (range, 1–38 units).


Research in other areas of industrial work (e.g.machine handling and flying) suggests thatimpairment of psychomotor skills may continueduring the hangover phase. Clearly this will be ofdetriment in team sports and court sports whichdemand tactical play and a high skill level.

Effects of chronic alcohol intake onissues of sports performance

Athletes who chronically consume largeamounts of alcohol are liable to the large num-ber of health and social problems associated with problem drinking. Early problems to haveimpact on sports performance include inade-quate nutrition and generally poor lifestyle (e.g.inadequate rest). Since alcohol is an energy-dense nutrient (providing 27 kJ ·g–1), frequentepisodes of heavy alcohol intake are generallyaccompanied by weight gain. Weekend bingedrinkers tend to maintain their food consump-tion, since alcohol does not seem to regulate totalenergy intake in the short term. However, erraticeating patterns and choice of high fat foods canlead to excess energy consumption. A commonissue, particularly in team sports, is the signifi-cant gain in body fat during the off-season due to increased alcohol intake coupled with reduced exercise expenditure. Many playersneed to devote a significant part of their pre-season (and even early season) conditioning toreversing the effects of their off-season activities.Clearly this is a disadvantage to performanceand to the longevity of a sports career.

Guidelines for sensible use of alcoholby athletes

The following guidelines are suggested topromote sensible use of alcohol by athletes.1 Alcohol is not an essential component of a

diet. It is a personal choice of the athlete whetherto consume alcohol at all. However, there is noevidence of impairments to health and perfor-mance when alcohol is used sensibly.2 The athlete should be guided by community

guidelines which suggest general intakes of


alcohol that are ‘safe and healthy’. This variesfrom country to country, but in general, it is sug-gested that mean daily alcohol intake should be less than 40–50g (perhaps 20–30g ·day–1 forfemales), and that ‘binge’ drinking is discour-aged. Since individual tolerance to alcohol isvariable, it is difficult to set a precise definition of‘heavy’ intake or an alcohol ‘binge’. However,intakes of about 80–100 g at a single sitting arelikely to constitute a heavy intake for mostpeople.3 Alcohol is a high-energy (and nutrient-poor)

food and should be restricted when the athlete isattempting to reduce body fat.4 The athlete should avoid heavy intake of

alcohol on the night before competition. Itappears unlikely that the intake of one or twostandard drinks will have negative effects inmost people.5 The intake of alcohol immediately before or

during exercise does not enhance performanceand in fact may impair performance in manypeople. Psychomotor performance and judge-ment are most affected. Therefore the athleteshould not consume alcohol deliberately to aidperformance, and should be wary of exercise thatis conducted in conjunction with the social intakeof alcohol.6 Heavy alcohol intake is likely to have a

major impact on postexercise recovery. It mayhave direct physiological effects on rehydration,glycogen recovery and repair of soft tissuedamage. More importantly, the athlete isunlikely to remember or undertake strategies foroptimal recovery when they are intoxicated.Therefore, the athlete should attend to thesestrategies first before any alcohol is consumed.No alcohol should be consumed for 24h in thecase of an athlete who has suffered a major soft-tissue injury.7 The athlete should rehydrate with appropri-

ate fluids in volumes that are greater than theirexisting fluid deficit. Suitable fluid choicesinclude sports drinks, fruit juices, soft drinks (allcontaining carbohydrate) and water (when refu-elling is not a major issue). However, sodiumreplacement via sports drinks, oral rehydration

solutions or salt-containing foods is also impor-tant to encourage the retention of these rehydra-tion fluids. Low alcohol beers and beer–softdrink mixes may be suitable and seem to encour-age large volume intakes. However, drinks containing greater than 2% alcohol are not rec-ommended as ideal rehydration drinks.8 Before consuming any alcohol after exercise,

the athlete should consume a high carbohydratemeal or snack to aid muscle glycogen recovery.Food intake will also help to reduce the rate ofalcohol absorption and thus reduce the rate ofintoxication.9 Once postexercise recovery priorities have

been addressed, the athlete who chooses to drinkis encouraged to do so ‘in moderation’. Drink-driving education messages in various countriesmay provide a guide to sensible and well-paceddrinking.10 Athletes who drink heavily after competition,or at other times, should take care to avoiddriving and other hazardous activities.11 It appears likely that it will be difficult tochange the attitudes and behaviours of athleteswith regard to alcohol. However, coaches, man-agers and sports medicine staff can encourageguidelines such as these, and specifically targetthe old wives tales and rationalizations thatsupport binge drinking practices. Importantly,they should reinforce these guidelines with aninfrastructure which promotes sensible drinkingpractices. For example, alcohol might be bannedfrom locker rooms and fluids and foods appro-priate to postexercise recovery provided instead.In many cases, athletes drink in a peer-group situation and it may be easier to change the envi-ronment in which this occurs than the immediateattitudes of the athletes.

Conclusion

Alcohol is strongly linked with modern sport.The alcohol intakes and drinking patterns of ath-letes are not well studied; however, it appearsthat some athletes undertake binge drinkingpractices, often associated with postcompetitionsocializing. There is no evidence that alcohol

improves sports performance; in fact there is evi-dence that intake during or immediately beforeexercise, or that large amounts consumed thenight before exercise may actually impair perfor-mance. There are considerable differences in theindividual responses to alcohol intake. It is likelythat recovery after exercise is also impaired; but particularly by the failure of the intoxicatedathlete to follow guidelines for optimum recov-ery. Athletes are not immune to alcohol-relatedproblems, including the greatly increased risk ofmotor vehicle accidents following excess alcoholintake. Not only should athletes be targeted foreducation about sensible drinking practices, butthey might be used as spokespeople for commu-nity education messages. Athletes are admired inthe community and may be effective educators inthis area. Alcohol is consumed by the vast major-ity of adults around the world, and merits edu-cation messages about how it might be used toenhance lifestyle rather than detract from healthand performance.

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nutrition in sport || alcohol in sport

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