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Nutritional Recommendations for Divers

Article in International Journal of Sport Nutrition and Exercise Metabolism · June 2014
DOI: 10.1123/ijsnem.2014-0012 · Source: PubMed

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International Journal of Sport Nutrition and Exercise Metabolism, 2014, 24, 392  -403
http://dx.doi.org/10.1123/ijsnem.2014-0012
© 2014 Human Kinetics, Inc.
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Consensus Statement

Nutritional Recommendations for Divers

Dan Benardot, Wes Zimmermann, Gregory R. Cox, and Saul Marks

Competitive diving involves grace, power, balance, and flexibility, which all require satisfying daily energy
and nutrient needs. Divers are short, well-muscled, and lean, giving them a distinct biomechanical advantage.
Although little diving-specific nutrition research on performance and health outcomes exists, there is concern
that divers are excessively focused on body weight and composition, which may result in reduced dietary
intake to achieve desired physique goals. This will result in low energy availability, which may have a negative
impact on their power-to-weight ratio and health risks. Evidence is increasing that restrictive dietary practices
leading to low energy availability also result in micronutrient deficiencies, premature fatigue, frequent injuries,
and poor athletic performance. On the basis of daily training demands, estimated energy requirements for
male and female divers are 3,500 kcal and 2,650 kcal, respectively. Divers should consume a diet that provides
3–8 g/kg/day of carbohydrate, with the higher values accommodating growth and development. Total daily
protein intake (1.2–1.7 g/kg) should be spread evenly throughout the day in 20 to 30 g amounts and timed
appropriately after training sessions. Divers should consume nutrient-dense foods and fluids and, with medi-
cal supervision, certain dietary supplements (i.e., calcium and iron) may be advisable. Although sweat loss
during indoor training is relatively low, divers should follow appropriate fluid-intake strategies to accommodate
anticipated sweat losses in hot and humid outdoor settings. A multidisciplinary sports medicine team should
be integral to the daily training environment, and suitable foods and fluids should be made available during
prolonged practices and competitions.

Keywords: swimming, diving, nutrition, aesthetic sport, energy balance

History of Diving Since the first FINA Diving World Championships

in 1973, the number of international senior diving com-
Men’s diving was first introduced as an Olympic sport petitions has steadily increased to a year-round diving
in the 1904 St. Louis Olympic Games, with women’s circuit. Currently, FINA is responsible for supervising the
diving added in the 1912 Stockholm Olympic Games. World Aquatic Championships, the Diving World Cup,
Diving has been continuously included in the summer the Diving World Series, and the Diving Grand Prix and
Olympic Games since that time. The 1908 Olympics in the Olympic Games diving events. There are additional
London included a full competition in “fancy diving” diving events at club, regional, national, and continental
from both platform and “elastic board.” Women’s “plain levels. At the FINA World Aquatic Championships, two
diving,” without acrobatic feats, was added in the 1912 events are contested that are not in the Olympics, includ-
Olympics, and springboard was added in 1920 (Baird, ing 1-m diving (since 1991) and high diving (since 2013),
1994). Founded in 1908, the Fédération Internationale de consisting of 27 m for men and 20 m for women (Heller,
Natation (FINA), the international aquatic sports federa- 2013). Since the 1980s, there has been, in addition to the
tion, now governs all five aquatic sports, including diving. senior circuit, an increasingly available year-round pro-
gram of international diving competitions for juniors (age
groups 13–18) and for masters (age groups ranging from
25 and older to 90 and older). Top-level junior divers may
be entered into senior competition in the year in which
Benardot is with the Department of Nutrition, Georgia State
they reach age 14 (FINA, 2009–2013).
University, Atlanta, GA. Zimmermann is with the Dept. of
Sports Medicine, Royal Dutch Army, Utrecht, The Nether-
lands. Cox is with the Sports Nutrition, Australian Institute of Diving at the Olympic Games
Sport, Gold Coast, Queensland, Australia. Marks is with the
Dept. of Psychiatry, University of Toronto, Toronto, Ontario, The Olympic diving events currently consist of four
Canada. Address author correspondence to Dan Benardot at events for men and four events for women, with four
[email protected]. synchronized diving events being added to the summer

392
 Nutritional Recommendations for Divers   393

Olympic games in Sydney, New South Wales, Australia, A typical training day for competitive divers consists
in 2000 (see Table 1). of two training sessions, with both sessions involving 1
The springboard and platform diving events require hr of dry-land training, followed by 1.5 hr of diving in
competitors to complete five different dive types—for- the pool (Minganti et al., 2011). Springboard divers aver-
ward, back, reverse, inward, and twisting. Male spring- age 100–150 dives per day, and platform divers average
board divers have one more dive than female divers and, 50–100 dives per day. During dry-land training, 50–100
therefore, repeat one of the dive categories for their sixth somersaults are practiced as part of various tumbling
dive. The platform diving event includes all five types skills, with full-time training typically running to 40 hr
of dives included in the springboard event, with a sixth per week. Young aspiring international-level divers often
category, the arm stand, which may combine somersaults have six to nine diving training sessions per week by
and twists. In the individual events, divers compete with age 12 (Foley et al., 2005). The International Olympic
optional dives only, which emphasize acrobatic skills. In Committee consensus statement on training the elite child
the synchronized diving events, the first two dives of each athlete emphasizes that training programs for children
pair are relatively easy, with a prescribed degree of dif- should be age appropriate, pleasurable, and fulfilling
ficulty of 2.0. Points for the judges to consider include the (Mountjoy et al., 2008). There is concern, however, that
technique and grace of the starting position, the approach, these guidelines are not universally followed within
the takeoff, the flight, and the entry (FINA, 2009–2013). diving (Zimmermann, 2013). Competitive diving often
The degree of difficulty of the dives performed and the begins during the prepubertal years because 14-year-old
degree of performance perfection are rising with every divers may compete at senior international-level events,
Olympic Games (Geissbühler, 2012). This may be attrib- including the Olympic Games. There have been warnings
uted to increased training time, better talent identification from experienced researchers that accelerated training
(Zimmermann, 2009), improved sport-specific condition- diving programs during adolescence may result in higher
ing (McNeal, 2013), and closer cooperation between rates of physical and psychological injury (Raspopova,
diving coaches and scientists (Naundorf et al., 2006). The 2005).
ever-increasing difficulty of dives has increased physical
and mental demands, forcing divers and their coaches to
explore new and novel strategies, including nutrition, that Physical Characteristics of Divers
have the potential of ethically enhancing performance.
Data on the physical characteristics of male and female
divers for the London 2012 Olympic Games were
Components of Diving published in The Guardian (Rogers, 2012). These data
Training Programs indicate that the median age for divers was 22 years and
23 years for male and female divers, respectively (Table
Although an aquatic sport, diving closely mirrors the 3). The median reported heights were 172 cm (67.7
skills set of gymnastics and acrobatics, with training in.) and 160 cm (64.0 in.) for male and female divers,
focusing heavily on tumbling and water entry (Table 2). respectively; and the median reported weights were 67 kg
Diving coaches supervise many training activities, and (147.4 lb) and 53 kg (116.6 lb) for male and female divers,
strength and conditioning and other specialty coaches respectively. Researchers investigating the physical char-
direct other activities. National teams often train and acteristics of elite divers (N = 82) competing in the 1991
live in centralized training environments that include a FINA World Aquatic Championships reported similar
swimming pool, dry-land fitness area, and supporting values (Carter & Ackland, 1998). Male divers were taller
sports science and medicine facilities. and heavier and had lower skinfold measurements than

Table 1 Current Olympic Diving Events

Men
10-m platform
3-m springboard
synchronized 10-m platform
synchronized 3-m springboard
Women
10-m platform
3-m springboard
synchronized 10-m platform
synchronized 3-m springboard
 Table 2 Components of Diving Training
Supervised by the Diving Coach
Pool training Dry-land area training Team meetings
basic diving skills conditioning, body weight goal setting
line-ups conditioning, free weights goal evaluation
jumps tumbling on the floor video replay
preparatory dives tumbling on mini-trampoline imagery training
competition dives trampoline parent meetings
dry-land board public appearances
overhead mounted belt
Supervised by Other Coaches
tumbling gymnastics coach
dance dance teacher
ballet ballet teacher
weights strength and conditioning coach
plyometrics track and field coach
running track and field coach
Other Professionals for Periodic Consultation
primary care sports medicine physician
sport physical therapist
sport psychologist
sport psychiatrist
sport nutritionist
sport biomechanic or scientist
media coach or communication coach
manager or commercial advisor

Table 3 Age, Height, and Weight of Olympic Divers Competing

in the 2012 London Olympic Games
Characteristic Men Women
Age (years)
Median 22 23
Youngest 16 14
Oldest 32. 33
Lower quartile 20 20
Upper quartile 26 26
Height (cm [in.])
median 172 (67.7) 160 (62.9)
shortest 155 (61.0) 147 (57.9)
tallest 183 (72.0) 170 (66.9)
lower quartile 166 (65.4) 157 (61.8)
upper quartile 175 (68.9) 164 (64.6)
weight (kg [lb])
median 67 (147.4) 53 (116.6)
lowest 42 (92.4) 36 (79.2)
highest 79 (173.8) 64 (140.8)
lower 62 (124.0) 50 (110.0)
upper 72 (158.4) 59 (129.8)
Note. From Rogers (2012).

394
 Nutritional Recommendations for Divers   395

female divers (Carter & Ackland, 1998). In comparison training regimen (Lindholm et al., 1994). Heavy train-
with generally active children, elite adolescent divers are ing may have an impact on the anabolic-to-catabolic
typically shorter, lighter, and more heavily muscled and (insulin-like growth factor 1-to-cortisol) ratio, indicating
have broader shoulders and narrower hips (Sovak et al., a catabolic state from energy intake inadequacy (Daly et
1992). A small, well-muscled physique coupled with high al., 1998). Studies of gymnasts have found that a delay
explosive power and good flexibility are characteristics in achieving each stage of pubertal development was
that have distinct biomechanical advantages in diving. closely associated with the amount of energy expended,
with more advanced gymnasts (i.e., those with greater
training times and greater energy expenditures) having
Nutrition Issues in Divers lower height velocity curves (Theodoropoulou et al.,
Pressure is placed on divers to achieve, through manipula- 2005). There is also concern that restrained eating may
tion of weight and body composition, a physique that is increase the risk of eventually developing eating disor-
consistent with competitive expectations. Consequently, ders, with associated amenorrhea and low bone mineral
divers may resort to energy restriction to achieve the density (Barr et al. 1994).
desired physical characteristics. This emphasis on weight, Diving-specific training and competition are primar-
performance, and appearance is engrained from a young ily anaerobic with a high reliance on phosphocreatine
age as athletes strive to attain a high lean-to-fat ratio, and glycogen. During preparatory phases after an annual
with the goal of achieving a highly toned and contoured break or injury, general nonspecific conditioning work
physique. Although this body type is desirable for almost may be included in daily training. Lower intensity con-
every sport, the ideal physique for diving is more difficult ditioning or cross-training work is regularly included,
to maintain after puberty (Sundgot-Borgen & Torstveit, which may further stress muscle glycogen stores, particu-
2010). Consequently, after puberty some divers find larly in athletes following a restricted dietary intake. The
more difficult dives impossible to perform even though recommendations of major nutrition and sports medicine
they were capable of performing these dives when they organizations provide a general framework to which
were younger with smaller physiques (Raspopova et al., sports nutrition practitioners can refer when consulting
2005). This psychological pressure to stay small lingers with athletes (Rodriguez et al., 2009). These recommen-
with aesthetic sport athletes, including divers, from the dations are useful for avoiding a mismatch between sport
beginning through to the elite-level stages of training. and growth-related energy and nutrient requirements and
Dietary restriction may form the prominent strategy the consumption of energy and nutrients.
for reducing energy availability to modify body size,
weight, and composition (Loucks et al., 2011). A failure Energy and Nutrient Intakes
to adequately satisfy energy requirements has health and Although the data on energy and nutrient intakes of divers
performance implications for divers: Low energy avail- are limited, the eating behavior of divers is believed to be
ability is associated with impaired immunocompetence similar to that of athletes in other aesthetic sports, includ-
(Nova et al., 2001); dizziness, weakness, and shortness ing figure skating and gymnastics, in which appearance
of breath (Ersoy, 1991); higher body fat percentages is viewed as an integral component of high-level perfor-
(Deutz et al., 2000); increased risk of low bone density mance. In a combined study reporting dietary intakes of
(Deutz et al., 2000); greater risk of amenorrhea (Loucks collegiate swimmers (n = 18) and divers (n = 6), mean
et al., 2011); and lower resting metabolic rate (Loucks, reported energy intake (± standard deviation) was 10,061
2003; Sundgot-Borgen, 1994). It is notable that rhythmic ± 3,617 kJ/day (2,405 ± 864 kcal/day), with carbohydrate
gymnasts, who may restrict energy consumption more and protein intakes of 5.7 g/kg and 1.2 g/kg, respectively
than artistic gymnasts, have higher body fat percentages (Petersen et al., 2006). A study investigating dietary
than artistic gymnasts at comparable ages (Deutz et al. intake and eating patterns of Olympic athletes reported
2000). As with other aesthetic sports, the hours young that athletes in weight-important sports (including four
competitive divers spend on training is extremely high. divers) consumed less energy than athletes in other groups
Coupled with increased energy and nutrient requirements (Burke et al., 2003). Furthermore, athletes in weight-
to support growth and development, young divers may aesthetic sports had fewer occasions to eat during the day
be at high risk of nutritional inadequacy. than other athlete groups (Burke et al., 2003).
As documented in wrestlers and artistic gymnasts, Using the median heights and weights of the divers
restrained eating by younger divers may result in a failure competing at the London Olympic games and typical
to achieve the predicted adult height (Georgopoulos et al., exercise intensities at practices and competitions, we
2010). Athletes with training schedules that exceed 18 hr/ predicted energy requirements for male and female
week before and during puberty have marked stunting of divers. For this procedure, we used the Harris-Benedict
growth, which could permanently affect achievement of equation to predict resting energy expenditure and a
predicted adult height (Theintz et al., 1993). The reduced metabolic equivalent value table (Food and Nutrition
growth may be due to a diet-related inhibition of the Board, 1989) to predict the energy requirement of specific
hypothalamic–pituitary–gonadal axis from inadequate exercise intensities. The estimated energy requirement
energy and nutrient intake or from the combination of for male divers during a typical practice day was 3,500
inadequate energy and nutrients coupled with a heavy kcal; for female divers, the estimated requirement was
396  Benardot et al.

Table 4 Predicted Energy Requirements for Male and Female

Divers During Practice and Competition
Predicted
Weight (kg Height (cm kcal Predicted KJ
Diver [lb]) [in.]) Required Required
Competition
male 67 (147.4) 172 (68) 3,200 13,389
female 53 (116.6) 160 (63) 2,400 10,042
Practice
male 67 (147.4) 172 (68) 3,500 14,644
female 53 (116.6) 160 (63) 2,650 11,088
Note. Resting energy expenditure predicted using Harris-Benedict equations, and total energy require-
ments predicted from metabolic equivalent values derived from Food and Nutrition Board, Recom-
mended Dietary Allowances, Table 3.2. Calculations are based on hourly predicted exercise intensities.
Male and female weights and heights represent the medians for divers competing at the 2012 London
Olympic Games

2,650 kcal. As expected, estimated energy requirements exercise carbohydrate consumption and carbohydrate
during a competition day were lower for male (3,200 kcal) immediately after exercise, nutrient-dense carbohydrates
and female (2,400 kcal) divers because of a decrease in rather than low nutrient-density carbohydrates (i.e.,
overall exercise on those days. refined sugary foods and fluids) are preferred (Benardot,
Although energy requirements are reduced during 2007).
competition, divers need to maintain an adequate intake
Protein. Total daily protein intake to optimize the
of fuel foods on these days. It typically takes 1 min to
adaptation from daily training and promote recovery
complete the procedure for a single competition dive, so
after exercise is approximately 1.2–1.7 g/kg body mass,
in a preliminary competition with 40 contestants each
depending on protein quality and eating frequency
diver must wait 40 min between dives. The duration of a
(Phillips & Van Loon, 2011; Rodriguez et al., 2009).
typical competition suggests that it is important for divers
The timing of protein intake is as crucial as the amount
to develop food and fluid strategies for sustaining normal
consumed. Recommended protein intake can generally be
blood sugar and energy status.
met through diet alone, although the use of protein drinks
(i.e., whey protein isolate) and related packaged foods
Energy Substrate Intakes may assist in the timely intake of protein immediately
after training or competition. Slightly higher protein
Carbohydrate . New information has changed
intake may be required for athletes striving to lose
the understanding of the needs of athletes and the (fat) weight so as to better maintain lean muscle mass
advice provided to them regarding their daily training (Mettler et al., 2010). Adequate energy intake sufficient
carbohydrate intake and competition carbohydrate to maintain body weight is necessary for optimal protein
strategies (Burke et al., 2011). Interpretation of use and performance (Rodriguez et al., 2009). Ideally, the
these guidelines with respect to an athlete’s dietary diver should maintain energy balance and a regular meal
plan should consider the diver’s total daily energy pattern, providing 20–30 g/meal of high-quality protein
requirements, specific training volume and intensity, to maintain or increase muscle mass and bone density
gender, environmental conditions, and requirements for and to satisfy creatine synthesis (Koenig et al., 2008;
growth and development (for children and adolescent Paddon-Jones & Rasmussen, 2009). The consumption of
athletes; Rodriguez et al., 2009). Although divers
a carbohydrate- and protein-rich snack immediately after
typically train for at least 5 hr each day, an inherent
exercise is also useful for reducing exercise-associated
knowledge of the training and competition demands
muscle soreness, improving postexercise muscle recovery,
is essential to interpret current carbohydrate intake
and enhancing muscle protein synthesis (Koopman et al.,
guidelines. Although we have no definitive assessment
2007; Moore et al., 2010; Tang et al., 2009).
of carbohydrate usage during diving training, it is likely
that daily requirements are within 3–8 g/kg body mass/ Fat. Fat is a source of energy, fat-soluble vitamins,
day, with the higher values accommodating growth and and essential fatty acids. Although high-fat diets are not
development in younger divers. Divers should avoid recommended for athletes, they should be consumed at
carbohydrate-loading strategies that maximize glycogen a level of 20%–25% of total energy intake to help ensure
stores because they could compromise flexibility that total energy requirements are met (Rodriguez et al.,
(Maughan & Poole, 1981). With the exception of during- 2009).
 Nutritional Recommendations for Divers   397

Micronutrient Intakes This food concentration level of iron would require that
divers have an average minimum energy consumption
To ensure sufficient intake of micronutrients (i.e., vita- of approximately 2,500 kcal/day to satisfy the dietary
mins and minerals), divers are encouraged to consume intake of iron.
nutrient-dense foods (International Olympic Committee
Consensus Statement on Sports Nutrition, 2010). Divers Calcium. No calcium studies have been done on divers,
who restrict energy intake or use severe weight-loss but a low intake of calcium, coupled with low vitamin D
practices; eliminate one or more food groups from their exposure or intake, has been found to predispose athletes
diet; or consume high- or low- carbohydrate diets of low to stress fractures (Lovell, 2008). Adequate calcium
micronutrient density are at greatest risk of micronutri- intake (1,000–1,500 mg/day) may impart some degree
ent deficiencies. Divers should strive to consume diets of safety in helping to reduce stress fracture risk, and
that provide at least the Dietary Reference Intakes for all if it is not possible to obtain sufficient calcium through
micronutrients (Rodriguez et al., 2009). food consumption, calcium supplementation has been
Studies assessing the diets of adolescent female aes- effective in increasing bone mineral density in children
thetic sport athletes have suggested that they are at high (Johnston et al., 1992).
risk of consuming inadequate amounts of macro- and Vitamin D. Vitamin D is known to promote the
micronutrients in an attempt to achieve or maintain the mineralization of bones and teeth by enhancing calcium
ideal body size and thinness that is perceived to be associ- and phosphorus absorption, but vitamin D also has
ated with success (Ziegler et al., 2005). This inadequate multiple other functions that influence the athletic
nutrient intake may be influenced by negative environ- endeavor. These functions include enhancing muscle
mental factors, such as a demanding training schedule, contraction, muscle protein anabolism, improved
lack of time to consume nourishing meals, and increased immune function, and enhanced anti-inflammatory
emphasis on physical features, such as leanness and body action (Cannell et al., 2009; Hamilton, 2010; Schubert &
image (Ziegler et al., 2002). Prolonged energy restriction DeLuca, 2010; Williams, 2004). A significant proportion
combined with inadequate micronutrient intake can result of athletes training indoors have below-optimal levels
in amenorrhea, eating disorders, osteoporosis, injuries, of serum vitamin D (Lovell, 2008). However, a study
and delayed growth (Ziegler et al., 2005). In an interview investigating vitamin D status and supplementation in
with two elite male divers (D. Benardot, personal com- collegiate swimmers and divers training indoors found
munication, September 2013), it was apparent that they a relatively low prevalence of vitamin D insufficiency
binge-consumed alcohol and had high caffeine intakes. (25-hydroxy vitamin D < 32 ng/ml) and an absence of
Neither male diver felt pressure to restrict food intake. vitamin D deficiency (25-hydroxy vitamin D < 20 ng/
However, they felt that many female divers were exces- ml; Lewis et al., 2013).
sively weight conscious and consistently restricted food
intake. These statements from divers are consistent with
studies of athletes in other sports, suggesting that female Vitamin and Mineral Supplementation
divers are at greater risk for inadequate micronutrient and Ergogenic Aids
intakes than male divers because of restrained eating
Athletes may consume high-dose dietary supplements
patterns.
as part of their regular training or competition routine
Athletes should rely on food rather than vitamin and
(Maughan et al., 2007). Although heavy training is
mineral supplements for obtaining needed nutrients but,
associated with depressed immune cell function, there
with proper medical supervision, the intake of certain
is no evidence that high doses of “immune-boosting”
mineral supplements (calcium and iron in particular)
supplements, including antioxidant vitamins, prevent
may be advisable. Vegetarianism may increase nutrient
exercise-induced immune impairment (Gleeson et al.,
risks for iron, zinc, and calcium, but proper dietary plan-
2004; Nieman, 2007). Some dietary supplements that
ning can overcome these challenges. It is recommended
appear legitimate are contaminated with undeclared
that vegetarian athletes consult with a qualified sports
substances prohibited by the World Anti-Doping Agency
nutrition professional to avoid these nutrition concerns
(Maughan, 2005; Maughan et al., 2007). As a result
(Rodriguez et al., 2009).
of these findings, divers should pursue a “food-first”
Iron. A study assessing iron status of collegiate approach to obtaining required nutrients and carefully
swimmers and divers reported a median serum ferritin consider the potential problems of taking supplements
of 12.7 µg/L (range = 1.6–113.5 μg/L), suggesting a when there is no diagnosed reason to take them.
marginal iron status (Petersen et al., 2006). Athletes in
similar aesthetic sports have reported inadequate dietary Fluid and Hydration Strategies
iron intake below the recommended level (15 mg/day in
female athletes between ages 11 and 24 years), which has Divers should consume sufficient fluids before, during,
implications for resistance to disease, growth, strength, and after exercise to sustain health and performance.
and ability to concentrate (Loosli, 1993). It is estimated Dehydration, defined as a body water deficit in excess
that the typical diet in industrialized nations provides of 2%–3% body mass, decreases exercise performance
about 6 mg of iron per 4.2 MJ (1,000 kcal) of energy. in laboratory settings. During exercise, divers should
398  Benardot et al.

c­ onsume sufficient fluids to avoid a more than 2% body hr; Ranchordas & Rogerson, 2013). This study reported
mass loss. It is also advisable for athletes to avoid con- a tendency for divers to overhydrate. A 145-min training
suming fluids in excess of their sweat rate, which could session consisting of 65 min of training on dry land and
predispose them to hyponatremia. In addition, a small 80 min of training in the pool resulted in divers losing an
amount of carbohydrate (~6% solution) in the hydration average of 0.52 L of fluid but ingesting 0.60 L of fluids.
fluid may serve to sustain normal blood sugar. After
exercise, it is recommended that approximately 16–24 oz.
(450–675 mL) of fluid for every pound (0.5 kg) of body Nutritional Strategies
weight lost during exercise be consumed (Rodriguez et for Competition and Training
al., 2009). Recovery rehydration beverages should replace
water and sodium losses (International Olympic Com- A multidisciplinary sports medicine support team should
mittee Consensus Statement on Sports Nutrition, 2010). be engaged within the daily training environment and
Data from Olympic divers during training in an indoor competition arena to ensure nutrition-related issues are
pool indicated an average sweat rate of 0.22 (SD = 0.3 L/ managed appropriately. Table 5 outlines key members

Table 5 Roles of Sports Medicine Team Members to Support Health and Performance for Divers
Professional Role
Physiotherapist or physical • Annual musculoskeletal screening with follow-up
therapist • Regular communication with soft tissue therapist to keep updated on any potential injury
concerns
• Direct communication with sport physician and coach regarding injury status and manage-
ment
• Direct communication with strength and conditioning coach to devise return to sport reha-
bilitation and maintenance programs
Soft tissue therapist • Provision of regular soft tissue support to athletes, preferably on a weekly basis
• Regular communication with physiotherapist on areas of concern for early identification of
potential injuries
Sport dietitian • Periodic dietary intake and anthropometric screening with follow-up
• Individual dietary counseling to assist daily training performance, recovery, and body com-
position management
• Direct communication with sport physician for management of iron status and bone health
• Regular communication with coach, sport psychologist, and sport physician regarding body
image concerns
Sports physician • Annual medical screen including relevant pathology for divers including iron and vitamin D
status with follow-up
• Primary care provider at the first sign of injury or illness
• Direct communication with the coach to assist in the management of training loads on the
onset and return to training after injury and illness
• Regular communication with the physiotherapist to manage return to training after injury
• Regular communication with the sport dietitian and psychologist regarding athlete health
and well-being
• Menstrual history (female divers)
Sport psychologist and sport • Annual psychology screening with follow-up
psychiatrist • Individual psychological counseling and intervention strategies to assist competition perfor-
mance
• Management of psychological stresses that relate to daily sport and lifestyle and communi-
cation with coach
• Regular communication with coach, sport dietitian, and sports physician regarding body
image concerns
Strength and conditioning • Regular strength and power assessments of athletes
coach • Coordinated approach with physiotherapist regarding return to sport after injury
• Direct communication with coach and physiotherapist to develop physical qualities of the
athletes
 Nutritional Recommendations for Divers   399

of a multidisciplinary support team and their nutrition- Travel Considerations

related roles.
Competitive divers inevitably find themselves compet-
Precompetition and Training ing away from home, often in locations with unfamiliar
foods and food safety issues. Regardless of the distance
The goal of the precompetition or training meal is to traveled, planning ahead is essential to ensure the final
promote carbohydrate availability and ensure the diver performance matches the athlete’s trained capabilities.
is well hydrated at the onset of exercise. Before training This is particularly important for divers and their sup-
or competition, a meal or snack scheduled 1–4 hr before port staff when traveling to underdeveloped countries in
exercise should provide adequate fluid, be relatively low which the risks of food- or water-borne gastrointestinal
in fat and fiber to facilitate gastric emptying and mini- infections are highest. Travel and the final precompeti-
mize gastrointestinal distress, contain carbohydrate, be tion period offer considerable downtime for incidental
moderate in protein, be composed of familiar foods, and eating because of boredom. A common mistake athletes
be well tolerated by the athlete (Rodriguez et al., 2009). make when traveling is to assume their typical dietary
Because blood sugar fluxes in 3-hr units, the precom- choices are available at their new destination. When
petition or training meal should be followed with foods traveling, preferred foods and fluids should be arranged
and beverages that can sustain normal blood sugar when before departure (Benardot, 2012). Athletes with special
the competition or practice is more than 3 hr later than dietary needs, allergies, or food sensitivities should have
the meal (Benardot, 2007; Deutz et al., 2000). During a information cards prepared in the local language to avoid
precompetition taper period and during prolonged com- misinterpretation.
petitions such as the Olympic Games, divers reduce the
number of dives and the intensity of dry-land training.
Their food intake must be adjusted accordingly. Relative Energy Deficiency in Sport,
Disordered Eating, and Eating
During Competition and Training Disorders
Exercise demands for dry-land and pool diving sessions The spectrum of low energy availability, amenorrhea,
far exceed those of diving competition. Hence, nutritional and osteoporosis, either alone or in combination, are
support should be adjusted to reflect this obvious differ- regarded as significant health risks for female athletes and
ence in energy requirements. Diving training is explosive are medically referred to as the female triad or exercise-
and intermittent, requiring athletes to complete high rep- induced menstrual dysfunction (Arasheben et al., 2011).
etition of dives or related skills. As such, divers should be More recently, relative energy deficiency in sport has
encouraged to consume small amounts of carbohydrate been used in place of the female athlete triad to describe a
during training and competition to maintain blood sugar broader range of problems, including greater bone health
levels and promote carbohydrate availability (Burke et al., and eating disorder risks, which occur in both male and
2011). Athletes are reminded to drink to minimize weight female athletes who exercise in an energy-deficient state
loss to less than 2% body weight, particularly in outdoor (Melin et al., 2014). The prevalence of amenorrhea is
or humid indoor facilities (Rodriguez et al., 2009). elevated in women who restrict their diets and who are
intensely physically active, including divers (Hecht &
Postcompetition and Training Nattiv, 2007). The associated hypoestrogenism causes
skeletal demineralization that increases the risk of stress
The primary postexercise dietary goals are to provide fractures in the near term and of osteoporosis later in life
adequate fluids, electrolytes, energy, carbohydrates, and (Loucks et al., 2011). Women who exercise and maintain
protein to recover muscle glycogen and fluid stores as normal menstrual cycles appear to have higher bone
well as facilitate maximal protein synthesis. General mineral density than amenorrheic women, and low bone
recommendations are to consume a carbohydrate intake mineral density has been reported for adult athletes with
of approximately 1.0–1.5 g/kg body mass (0.5–0.7 g/lb) amenorrhea (Arasheben et al., 2011). Delayed menarche,
during the first 30 min and again every 2 hr for 4–6 hr to menstrual irregularities, and low body fat are frequently
replace glycogen stores (Rodriguez et al., 2009). Given seen in aesthetic athletes (Georgopoulos et al., 2001) but,
the nature of daily training sessions and the importance contrary to the commonly held belief that the low body fat
of maintaining a lean physique, these recommendations is principally responsible for the menstrual dysfunction, it
should be adapted to the needs of individual divers. The appears that low energy availability is the primary cause
posttraining or competition intake should be planned to (Loucks, 2003). According to Loucks (2003), dysfunc-
reduce time between the end of exercise and the availabil- tion of reproductive hormones occurs below 20–30 kcal/
ity of food and beverages. Alcohol consumption should be kg lean body mass/day of energy availability (energy
avoided because it interferes with optimal performance on consumed minus exercise energy expended in training).
subsequent days (Shirreffs & Maughan, 2006). Although If left untreated, disordered eating can progress
the prevalence of alcohol consumption in divers has not to a diagnosis of an eating disorder (American Psy-
been assessed, studies of athletes in other sports suggest chiatric Association 2013), which can result in all of
its use is widespread (Yusko et al., 2008). the disordered eating complications. Regardless of the
400  Benardot et al.

specific eating disorder (i.e., anorexia nervosa, bulimia trained sports medicine professionals to ensure that their
nervosa, binge eating disorder, and otherwise specified nutritional needs are satisfied. Ideally, a multidisciplinary
or unspecified), eating disorders should be considered sports medicine team should be available to competitive
serious conditions (American Psychiatric Association, divers to lower health risks and safely improve diving-
2013). See Table 6 for information on how to approach specific fitness. Although some evidence has suggested
the diver with disordered eating behavior. that the daily intake of divers is similar to that of other
Fortes et al. (2013) reported that body dissatisfaction aesthetic sport athletes, research is needed in this area.
and the commitment to exercise were explanatory risk Furthermore, there are no studies assessing the degree to
factors for risky eating behaviors in adolescent aesthetic which male and female divers satisfy the energy needs
sport Brazilian athletes, which included divers. Athletes of their sport-specific training regimens or competition.
with elevated dietary restraint were found to be as much
as 7 times more likely to have musculoskeletal injuries Acknowledgments
(Rauh et al., 2010).
We acknowledge the contributions of Ashley Catherine Delk, an
MS student studying dietetics and sports nutrition in the Depart-
Summary ment of Nutrition at Georgia State University. Ms. Delk assisted
in the writing and referencing of this consensus statement. We
Diving is an Olympic sport requiring a combination of also thank Jennifer Gibson, sport dietitian for acrobatic and
explosive power, flexibility, strength, artistry, grace, and combat sports, U.S. Olympic Committee, for her generous time
courage. There is a paucity of diving-specific nutrition in providing selected diving resources and for introducing to
research investigating performance and health-related us to several Olympic-level divers who volunteered to provide
outcomes. Divers are focused on maximizing the us with important insights on their dietary and activity habits.
strength-to-weight ratio, which requires an eating strategy We also thank these divers, who wish to stay anonymous. The
that enables a maintenance or increase in muscle mass authors have no conflicts of interest to declare.
and a decrease in fat mass. Divers who follow restrained
eating patterns with the goal of weight maintenance
or loss may develop multiple risk factors that could References
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Table 6 How to Approach the Diver With Disordered Eating Behavior

1. Direct and empathic approach—Discuss in a private and quiet place without interruption. Tell the person you are worried
about him or her (i.e., if teammates have seen the person vomiting after meals).
2. Avoid threats of manipulation—Tell the person her or she has a problem, and it is his or her problem, not your problem. Tell
the person that you will help him or her get assistance if he or she needs it. Stand your ground firmly and compassionately.
3. If the athlete refuses help—If there are enough reasons to be concerned, a coach or parent should consider removing the ath-
lete from diving until he or she seeks help. This could be a lifesaving intervention.
Note. FINA Aquatic World Magazine—“Aquatic Sports and Diet”—2004
 Nutritional Recommendations for Divers   401

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