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The aim of this booklet is to provide football referees with key advice and helpful suggestions regarding nutritional support. As you are aware, quality training leads to improvements in your fitness. However in order to maximise training, there is a need to ensure that serious attention is given to nutrition. This is because nutrition provides the fuel to train properly, the fluid to prevent dehydration and overheating, the micronutrients for health and well-being, the building blocks for enhancing muscle recovery and size (if you need to), and the supplements to aid these processes. Each of these areas are addressed in this text. CONTENTS
1. Code of conduct for referees
2. Fatigue, nutrition and football
3. The Macronutrients – carbohydrate, fat, and protein
4. The Glycaemic Index (GI)
5. Fluids
6. Breakfast
8. Dinner
9. Supper
10. Snacks
11. Pre-match meal
12. Post-match meal
13. Training days
14. Recovery Days
15. Guidelines for Pres-Season
16. Guidelines for Off-Season
17. How to use supplements
18. How to use caffeine
19. How to use creatine
20. How to use glutamine
Nutrition plays two fundamental roles for referees:- 1. Sound nutritional practices are essential for the good health of
all referees. In order to achieve this referees must:-
• consume a varied diet of foods to ensure adequate amounts of carbohydrates, fat, protein, minerals, and vitamins are eaten. • eat foods in line with the recommendations provided in this • take advice on supplements as provided in this document. Such supplements include those for enhancing immune function, reducing body fat, enhancing recovery, and promoting increases in • undertake regular medical screening to ensure normal liver, kidney and immune functions, a normal blood lipid profile, and normal iron status. Appropriate nutritional interventions could help if any • drink at least 2 litres of water a day in addition to other beverages. • avoid alcohol, or at the very least ingest small quantities when 2. Sound nutritional practices are essential for proper training to be
undertaken and for good match performances. In order to
achieve this, referees must:-
• eat a breakfast containing carbohydrates and some protein before • drink carbohydrate drinks or water during training sessions • drink the carbohydrate and protein drinks for recovery after • eat a sensible carbohydrate-based meal at lunchtime. Drink plenty • eat a sensible dinner containing carbohydrates based on vegetables, salad and fruit as well as good amounts of quality protein meat and • ensure that dinner is not eaten later than 7.30 pm on most nights. • not eat a large supper, although a light supper may be eaten before bed if body fat is within acceptable limits. • attempt to eat snacks based on fruit, yoghurt, and salads rather than • ensure that pre-match meals taken at home are similar to those provided in hotels when playing away i.e. low in fat, high in carbohydrates, and reasonable amounts of protein. This meal must be eaten no later than 3 to 3.5 hours before the match. • ensure that post-match meals are high in carbohydrate (i.e. 2 g for every kg of a referees body weight) and have some protein. This must be consumed within 2 hours after the match. Drinking Precision Carbohydrate and Myoplex (or their alternates) are • make themselves familiar with this ‘Nutrition’ booklet and ask FATIGUE, NUTRITION and FOOTBALL
Fatigue is an inevitable consequence of participating in any sport, and
training and correct nutritional practices can help to ensure that fatigue
occurs later rather than sooner. From a nutritional perspective, the
following are known to result in fatigue:-

1. Depletion of muscle glycogen stores
– it has been known for at
least 30 years that when muscle glycogen stores become depleted the ability to engage in intense bouts of exercise is not possible. This is because muscle glycogen is a fuel necessary for muscles to work at intensities greater than 50% of maximum. Fats on their own cannot be used as energy stores for intense exercise bouts. It is imperative that referees have sufficient muscle glycogen levels at the start of a match, and that they eat and/or drink some carbohydrate during the match/training. 2. Low blood glucose (hypoglycaemia) – it has been known for at
least 70 years that when blood glucose levels are low, the ability to exercise is reduced. More recently, it has become clear that maintenance of blood glucose is essential for the brain to function properly. Since the role of refereeing demands decision making skills, a reduced blood glucose level from low liver glycogen content will invariably lead to slower times for reactions and decisions. It is imperative that referees have sufficient liver glycogen levels at the start of a match/training, and that they eat and/or drink some carbohydrate during the match/training. 3. Dehydration – sweating is a normal response in training and
match play. The inevitable result is that the body loses water and body temperature becomes elevated. Loss of body water causes dehydration, and this leads to impaired physical and mental performance. It is imperative that referees are well hydrated before a match, and continue to drink fluids at opportunities during the match. The Macronutrients

There are several important functions about carbohydrates:-
1. Energy Source – Provides the energy for high intense activity.
Energy comes from the breakdown of glucose from the blood and glycogen in muscle. 2. Protein Sparing – Sufficient carbohydrate intake can help to stop
muscle tissue protein breakdown. The main role of protein in the body is for maintenance, repair and growth of body tissue. When the carbohydrate levels in the body become depleted through prolonged exercise or insufficient carbohydrate in the diet, protein is used as a source of energy. 3. Fuel for the Brain – carbohydrate is essential for the proper
functioning of the brain. Blood glucose is the only fuel used by the brain. So when blood glucose levels are low (hypoglycaemia), the brain does not work as well as it should. Decisions and skill are impaired, and fatigue will happen.

Although the fat intake of a referee should not be high, fats are needed in
the diet and have many essential functions in the body such as: -

1. Energy Source - Fats are the major energy reserve in the body,
and the major source of energy for low intensity activity. 2. Protection and insulation -Fats act as a protective shield against
trauma to vital organs such as the heart, liver, kidneys, spleen, brain and the spinal cord. 3. Cell membranes - Fats are a major part of all cell membranes
4. Vitamin carrier, and fat and cholesterol transporter - Fat serves
as a carrier for the fat soluble vitamins – A, D, E, and K. They also help in the transport of fats and cholesterol in the blood. 5. Hunger depression - Fats in the diet delay the onset of ‘hunger
pangs’ and contribute to feeling of fullness after a meal. This is because fat empties from the stomach slowly. Protein is an essential macronutrient within the body and performs many important roles concerning structure and function. These roles include: - 1. Structure - Building material for bone, ligaments, tendons, and
2. Enzymes - All enzymes are proteins. Enzymes regulate many
energy producing reactions, as well as the building and repair of tissues, especially muscle. 3. Hormones - Hormones such as insulin and adrenaline are proteins
and are important in controlling exercise metabolism. 4. Blood Transport - Protein is required in the body for the synthesis
of the many blood transport proteins such as haemoglobin and albumin. 5. Energy - Proteins can act as an energy source after the depletion of
The Glycaemic Index (GI)

Traditionally carbohydrate-containing foods have been classified as
simple or complex. In this instance, foods which are high in simple
carbohydrates include glucose, sugar, fruit, jams, sweets and
confectionery products, whereas complex carbohydrates include foods
high in starch, such as bread, pasta, potato, and rice. More recently, the
glycaemic index (GI) has been used to categorise foods according to their
ability to raise blood glucose. Since all carbohydrate-containing foods
raise blood glucose levels following digestion and absorption, the GI is a
useful way of ranking composite and simple carbohydrate sources based
on this ability.
Selected foods categorised on their GI values.

When to use foods of varying GI?

1. The pre-training/pre-match meal should be high in carbohydrates with a low-GI IF referees are sensitive to small decreases in blood
glucose in the first 10-15 minutes.
2. Drinks with a moderate to high-GI are of greatest benefit during 3. Drinks or food with a high-GI are essential in the early stages of 4. Drinks or food with a high-GI should normally be avoided at night unless the day before or the day of a game. Prevention of dehydration

1. The loss of body fluids from sweating causes fatigue, and so referees must take on board enough fluids during games and training. 2. The rule of thumb is ‘little and often’. Drinking around 200 mls (a paper cup full) every 15-20 minutes is recommended. 3. Drinking about 500 ml of fluid in the hour before a match/training 4. Drinking fluids during half-time is also strongly advised. 5. Ideally referees should drink 2 litres of water (I suggest Penta
What should the drink contain?
1. In hot conditions just water should be ingested. This is because the addition of carbohydrates tends to slow down the rate at which water gets into the blood. The more concentrated the carbohydrate drink, the slower the rate of delivery of water to the blood. 2. Drink a low carbohydrate drink in the early stages (say 40-45 minutes), followed by a normal carbohydrate sports drink at half-time and in the last 20 minutes.

1. Dehydration from sweat loss is inevitable during strenuous exercise, whether in the heat or not. This is because more fluids is lost through sweating than can be taken by drinking i.e. sweat rates of 1.5-2 litres an hour are not uncommon, whereas drinking more than 1 litre an hour is difficult to achieve. 2. Referees must rehydrate adequately afterwards. 3. A useful guide to see how much body fluid is lost in training or a match is to weigh yourself (nude and dry) before and afterwards. The weight loss in kg is equal to water loss from sweat in litres i.e. 0.5 kg loss = 500 mls water lost. 4. Drink fluid after training/match at least 150% (1.5 times) the body weight loss i.e. if 1 kg of body weight is lost through sweat, drink 1.5 litres of fluid. 5. The drink must contain sodium (normally in the form of salt). The recommendation is around 0.7-1.2 g in a litre. 6. Carbohydrates drinks do not make a difference to rehydration after 7. Food eaten with water helps to rehydrate, because the food 8. Many of the ‘soft’ drinks (e.g. coke) contain no (or too little) salt, 9. Drink as soon as possible after exercise since body fluid recovery takes at least 30 minutes. However because drinking fluids inevitably leads to urine production and elimination, actual rehydration may not be complete for 4-6 hours.
Penta Water

There is evidence that Penta water may help rehydrate players more
quickly than other bottled water, and that Penta also helps hydrate more
effectively when drunk before and during training/games.
Eat breakfast like a King
This means that breakfast MUST be considered as the most
important meal of the day. For referees this is not quite true BUT it
is a very important meal which helps you to repay what the body has
used during sleep and to ‘fuel-up’ before morning training. The
emphasis should be on carbohydrates, protein, and fluid.
You are strongly advised to select from the following menu:-

Breakfast items 1 to 2 hours before training
Poached or Scrambled egg (2-3 whites:1 yolk)
Grilled tomato and grilled/boiled mushrooms
Baked beans
Cereals with skimmed milk
Fresh fruit salad and yoghurt
Fruit juices - orange/apple/pineapple
Toast and preserves
Breakfast items 45 minutes to 1 hour before training
Cereal with skimmed milk
Fresh fruit salad and yoghurt
Fruit juices - orange/apple/pineapple
Toast and preserves
Whey Protein supplement
Eat lunch like a prince
Since this meal is normally after a morning training session, it is
important to re-fuel with carbohydrates, enhance muscle structure
and recovery with protein, and rehydrate with fluids. This meal
MUST be eaten within 1 hour of finishing training and contain quick
release carbohydrates as well as protein. If an afternoon session
follows this meal then eating vegetables or salad is less important,
and eating too much can be a problem.

Starters (If eaten)
Soup + roll
Fresh fruit salad
Main Course
Grilled chicken/turkey/beef strips/fish (medium portion)
Rice/pasta/potatoes (large portion)
Steamed or boiled vegetables or salad (medium –small portion)
Fresh fruit
Water/ fruit juice or squash/ low carb. Sports drink

Eat the above in good-sized amounts when players have finished
training and have NO afternoon session. Drink a high carb. Sports
drink if not hungry and eat less.
Eat the above in smaller portions if there is an afternoon session.

Eat dinner like a pauper
Referees should be careful about what they eat for this meal. This
means not eating too much and not eating TOO LATE AT NIGHT
(no later than 7.30 pm). It is a time to continue to ‘fuel up’, but using
‘slow releasing’ carbohydrates. So, eat more vegetables and salad,
and less potato, rice, bread, and pasta compared with lunch.

Starters (If eaten)
Soup (no roll)
Fresh fruit ( e.g. melon)
Bowl of salad (with pate/grilled chicken pieces/smoked salmon)
Main Course
Fish/chicken/turkey/lean steak/pork fillet (large portion)
Rice/pasta/potatoes (small portion)
Steamed or boiled vegetables or salad (large portion)
Fresh fruit
SMALL amount of fruit pie/ fruit crumble and custard
SMALL piece of cake
Water/ fruit juice or squash/ tea/coffee

What you eat in the evening is usually a key factor in body weight control.
Too much food at night (if there is no training or match) or the wrong
type of food can lead to increases in body fat. This is unacceptable for an
elite referee and so must be addressed. Having supper around 9 or 10pm
is okay if you have eaten your dinner at 6-7pm and start to feel hungry –
or if you are hungry just before bedtime.
Having a bowl of cereal or a couple of slices of toast sometime after
dinner or just before bed is okay on the night before a match or the
night of a match, but not normally okay on other nights.
It is
preferable that on all other occasions referees keep away from quick
release or high GI foods. This means avoiding bread and cereal (and also
potatoes, rice, and sugary drinks – including sports drinks).
As a bedtime drink you should have a cup of warm milk or casein (a type
of protein which is slow release) if in training or recovering from a match.
Snacks to eat for supper or to stop hunger at 9-10pm could include:-
Small bowl of salad – either on its own or with chicken breast or sliced
ham or tuna or a boiled egg.
Couple of slices of Ryvita (multigrain is good) with sliced ham and
Natural yoghurt (low fat) and add fruit slices if you wish.
Fresh fruit (though try and avoid pineapple or ripe bananas).
A few plain nuts (unsalted).
Small bowl of All Bran with skimmed milk.
Small bowl of porridge with skimmed milk.
The foods you must avoid are other cereals, toast or sandwiches, sweets,
chocolates, cakes, fizzy drinks, crisps, and dried fruit such as raisins.
Snacks play an important role in the nutrition of referees, and so careful attention should be given as to what to eat as snacks at varying times during a day. After training, snacks can be useful to fill a gap until a meal is eaten – these snacks should contain high GI carbohydrates and some protein. In the evening, a snack will fill a hunger gap before bed – these snacks should be low GI but have some protein. If there is a need to increase body weight, nutritious snacks can help. Ideas for types of snack are:- Post-training
Fresh fruit (bananas and pineapple are good) Evening snacks
Snacks for weight gain
Breast of chicken/slices of ham or turkey or beef or pork Meat or tuna salad wholemeal/wholegrain sandwiches PRE-MATCH MEAL
The pre-match meal should be eaten approx. 3.5 hours before kick-off. Therefore, if kick-off is 3.00 pm the pre-match meal should be served for 11.30 am. Selecting from the following items will be required for the pre-match meal: - Starters
Main Courses
Chicken slices griddled with a little olive oil Thin beef slices griddled with a little olive oil Poached/scrambled eggs on extra thick toast (3-4 slices) Baked beans on extra thick toast or jacket potato Broccoli/carrots/cauliflower/green beans/peas Variety of mixed salad tossed with olive oil or vinaigrette POST-MATCH NUTRITION
The emphasis for this crucial meal is to add to the supplements you are drinking by eating a high carbohydrate meal with some quality protein, and to get fluids on board. The order of refuelling/restocking is:- Carbohydrate/Water → Protein
The timing of this is Carbohydrate+Water in the 1st 30-60 min with follow up in the next two hours. Protein within 2 hours. These can be eaten or drunk. In the Changing Room
Sandwiches, hot baguettes, pizzas, malt loaf, bananas, dried fruit
Precision Carbohydrate/Sports drink
Whey Protein/Precision Protein/Myoplex
The post-match meal (i.e. after changing) is as follows:- Starters
A soup with wholemeal rolls (no butter)
Main Course
ALL meals to have a selection of steamed vegetables i.e. 4 choices from
broccoli, cauliflower, carrot, green beans, peas, baby corn, mange tout,
sugar snaps, courgettes.

ALL meals to have two types of sauce for the pasta – one being a
tomato based sauce.

Meal 1 – Plain griddled chicken breast strips with pasta and rice.
Spaghetti bolognaise (low fat mince or chicken mince)
Meal 2 – Piri Piri chicken breast strips with pasta and rice.
Roast ham with boiled new potatoes.
Meal 3 - Lemon pepper chicken breast strips with pasta and rice.
Roast turkey with boiled new potatoes.

Meal 4 - Cajun chicken breast strips with pasta and rice.
Roast beef with boiled new potatoes and mashed potato.
Meal 5 – Tandoori chicken breast strips with pasta and rice.
Roast gammon with boiled new potatoes.
Meal 6 - Chicken lasagne made with as low fat content as possible i.e
lots of pasta and chicken.
Oriental honeyed pork with rice.
Meal 7 – Deep pan pizza with no cheese. Topping to include spicy
chicken with mushrooms and peppers.
Tuna pasta bake.

fresh fruit available at all meals;
emphasis on high carbohydrate and low fat;
apple crumble and custard,
meringue nests with fruit and ice cream,
fresh fruit salad,
various types of sponge with custard.
Breakfast 90 minutes before training
Breakfast 90 minutes before training
Include cereal/toast/scrambled
eggs/baked beans/fresh fruit
Protein shake 1 hour before training
10.30am TRAINING
10.30am TRAINING
Can eat larger portions and have fair
portions of vegetables/salad
Take creatine with this meal
Good time to take creatine with this
Mid afternoon snack (see snack list)
Straight after training drink high Carb
Within 1 hour have Protein shake
Drink water and eat snacks
This meal should be large on protein
This meal should be large on protein
portions and vegetables (not potato or
portions and vegetables (not potato or
sweetcorn) and salad but low (or no)
sweetcorn) and salad but low (or no)
Drink water not fruit juice
Drink water not fruit juice
Try not to eat unless need to bulk up
Try not to eat unless need to bulk up
NO high GI carbs – you can eat low fat
NO high GI carbs – you can eat low
yoghurt with fruit (tho’ not banana or
fat yoghurt with fruit (tho’ not banana
pineapple), some unsalted nuts, or even
or pineapple), some unsalted nuts, or
a tuna/chicken salad
even a tuna/chicken salad
Casein protein
Casein protein
For some referees, the day after a game is one in which they feel very tired and not particularly hungry. For others there is a feeling that a recovery day is one in which there is little activity and so little food should be eaten. Please remember that the day after a game is an ideal time to refuel the low levels of muscle carbohydrates by eating (especially in the morning and early afternoon) toast, cereal, pasta, rice, potatoes, and bread. If not hungry then there is a need to drink carbohydrate drinks e.g. take two bottles of Precision Carbohydrate (one at breakfast and one at lunch) with meals. The muscle has been put through a punishing time and needs to physically recover. This requires energy (from carbohydrate) as well as protein to rebuild itself. So Protein intake must not be compromised. Have scrambled eggs and bacon for breakfast. Eat yoghurt and fresh fruit or mixed nuts and dried fruit as snacks. Eat meat and/or fish at lunch and dinner. Drink one whey protein drink in the day. The body may be dehydrated – what does your pee colour suggest. Make sure you drink 2 litres of water in addition to fruit juice, tea, and coffee etc. So, a recovery day is just what it states i.e. an opportunity for your muscle to recover (with protein), your fuel stores to recover (with carbohydrate), and your fluid levels to recover (with water/fluids). GUIDELINES FOR PRE-SEASON
Pre-season training is a crucial period for referees to become ready for the oncoming season. It is a period where fitness is worked on, and so it is vital to be mentally alert and physically ready. Sound nutrition is an absolute requirement to help fuel the brain and the muscles, and this will allow you to maximise your efforts. The following points are just to focus your mind on some important nutritional factors:- 1. Since carbohydrates are the major fuel for muscles and your brain, make sure you 'think carbohydrates'. This means eating
carbohydrates for breakfast, drinking carbohydrate drinks during and
after training, and eating carbohydrates for lunch and for dinner.
2. Your carbohydrate foods should be cereal, toast and fruit for breakfast. Drinking 200 ml of a carbohydrate drink every 20 minutes during training. Drinking up to 500 ml of carbohydrate drink after training. Eating pasta/rice/potatoes/bread as well as salad/vegetables/fruit for lunch and dinner. 3. Your muscles are made up of protein and this will break down during training, so make sure you eat or drink protein before and after
training. Pre-season is a time when extra protein is necessary. Eat
eggs, ham/lean bacon, and/or baked beans for breakfast. Drink milk or
milk shakes or smoothies as snacks. Drink Myoplex 1 hour before and
within 1 hour after training. Eat meat or fish in large amounts for
dinner. Eating red meat (i.e. steak, beef, lamb) is important for
keeping iron levels high in your body - eat this type of meat on 2 or 3
times a week. You might even consider having a drink of skimmed
milk before bedtime.
4. Drink plenty of fluids. You need to take at least 3 litres of fluid a day
above the coffee or tea or fruit juice you normally drink. Check the colour of your urine - if it is very yellow, you are not drinking enough. Your urine colour should be pale yellow or clear. 5. Check your body weight every morning. A decrease in body weight could mean you are dehydrating or not eating enough. An increase in weight could mean you are eating too much or that you are putting on muscle. 6. Variety is the spice of life. Eat a variety of fruit and vegetables for health, good immune function, and to aid recovery. 7. Be wary of alcohol!! This can lead to dehydration and increases in fat GUIDELINES FOR OFF-SEASON

After a hard season all you want to do is go and have a nice restful
holiday – eat, drink, and be merry!! The off-season is an essential part
of recovery, a great time to re-charge the batteries, and important
quality time with family and friends. The only problem is that if a
referee ‘lets himself go’, the consequences are a very tough pre-season
training period to undo all the poor habits you have taken on board in
just a few weeks. So what do you do?
1. Better to have a holiday (with any bad habits!!) in the first 2-3
weeks off so that you get back to some better habits leading up to 2. Where and when possible watch what and how much you eat and drink in the evenings. If possible stick to the high protein and high 3. Be wary about eating high GI carbohydrates too often in the 4. Keep well hydrated. Check your morning urine colour. 6. Check your body weight regularly to make sure you don’t really let HOW TO USE SUPPLEMENTS
The following are some key points about how to take supplements which may be of some specific benefit:- There are two types of protein available – Whey Protein and Casein. Whey Protein has a fast release of amino acids and is the drink to take 1 hour before your morning session and 1 hour before a match. It should also be taken after the second training session in the afternoon. Casein is the bedtime protein because it provides a slow release of amino acids. Precision Carbohydrate (EAS product)

This is a high carbohydrate-providing recovery drink. It has 100g of
carbohydrate and should be taken within 30 minutes after a match and
after any training session where it is not possible to eat or drink enough
carbs i.e. maybe after an afternoon session before going home.
Creatine/HMB/Betagen (EAS product)
Never take Creatine or HMB if you are taking Betagen, since Betagen contains both creatine and HMB. Normal daily intake of creatine should be about 3-5g a day (so Betagen intake must be modified to take that amount of creatine). This must be taken with a high carb drink or high carb meal. So this means either having it at lunch with your pasta/rice meal (preferably) or with Precision Carbohydrate drink (maybe after the afternoon training). If you have been off creatine for a month or more, then loading with creatine can be done over 5 days with four 5g doses a day taken at breakfast, lunch, mid-afternoon, and evening (with carb meals/drinks). When you do this you MUST drink plenty of fluid throughout these days. Caffeine/CLA/Carnitine

These supplements, either singly or in combination, are used for ‘fat
burning’ and as such should be taken 1 hour before an aerobic session.
During the session make sure you only drink water NOT carbohydrates.

If you wish, you may take a multivitamin tablet at breakfast. Do not
exceed the dose because you can overdose on vitamin A if you take too
much (and especially if you are also on antioxidants which may also
contain vitaminA).
When a person exercises, free radicals are formed from the extra oxygen taken in. These free radicals cause damage to cells. Antioxidants help to ‘quench’ free radicals and so may be useful to protect muscle cells during and in recovery from training. The best known nutritional antioxidants are vitamins A, C, and E and the mineral, selenium. Glucosamine and Chondroitin
These tablets are beneficial for joints and should be taken (if needed) as per manufacturers’ instructions. Glutamine
Glutamine is an amino acid of great significance in the body for a number of reasons. It may help muscle to recover from training faster, it may help to boost muscle carb stores after training when taken with carbs, and may enhance immune function during periods of heavy training as well as during winter months when colds, flu etc are prevalent. HOW TO USE CAFFEINE
Caffeine is a natural food substance found in products such as coffee, tea, chocolates, coca cola, and some over the counter diuretics. The IOC lifted the ban on caffeine from 1st January 2004 due to the fact that the ergogenic properties of caffeine arise from ingested amounts of 5-6mg/kg body mass, and these do not result in urine levels being above the limit (and indeed amounts of caffeine above 5-mg/kg body mass fail to enhance performance any further). Research findings have clearly demonstrated over the years that supplementation with caffeine leads to an improvement in endurance and sprint performance. Indeed, studies in the Sports Science laboratories at Liverpool John Moores University have established that caffeine ingestion significantly enhances performance in games lasting 90 minutes or so – both the ability to sustain sprinting and Caffeine stimulates mental alertness, which is an important aspect of refereeing– particularly in the later stages of a game, and also conserves muscle glycogen stores by enhancing fat use. Since muscle glycogen is a key factor concerned with fatigue, the use of caffeine should be considered to spare these limited stores – particularly when there is more The well-known fat burning effects of caffeine may be employed in situations where players need to reduce body fat stores. In this case caffeine ingestion should take place before appropriate training sessions. 1. Concerns have been expressed with regard to the diuretic properties of caffeine and possible dehydration. This is NOT observed in an 2. Caffeine overdose can lead to hospitalisation, so make sure you Caffeine Ingestion
1. 'Pure quality' caffeine MUST be used or products containing caffeine must be vetted. Examples of products include ProPlus, Ripped Fuel, or 2. No more than 5 - 6 mg/kg body mass of caffeine should be ingested in 3. Referees should refrain from caffeine-containing products in the 12-24 hours before caffeine is to be ingested (if possible) for maximal effects. 4. Referees must consult with the sports science and medical staff before 5. The use of caffeine will only be considered in cases where there is (a) a need to spare muscle glycogen due to close proximity of matches, HOW TO USE CREATINE
Creatine is a natural food substance found in meat and fish since it is found in muscle. Consequently it is also found in human muscle and provides an important energy source during high intensity bouts of exercise such as sprinting, jumping, throwing, and diving - all important aspects in a game of rugby. Research findings have clearly demonstrated over the years that supplementation with creatine in combination with carbohydrate leads to an increase in muscle stores of total creatine. Furthermore, most appropriate and well-designed studies have also demonstrated subsequent improvements in muscle strength, power, and the ability to perform multiple sprints. Since the game of football demands strength, power, and the ability to sustain sprinting ability, creatine supplementation may well be of significant benefit at appropriate Creatine supplementation also leads to increases in lean body mass when taken in combination with resistance and power training over a period of weeks. Whereas the initial increase is concerned with elevated intra- muscular water, the later changes are due to greater lean body tissue. Such an increase in muscle mass may be of significance to those referees In the last 12-18 months a number of important research papers have
highlighted the value of taking creatine with carbohydrates after
intense bouts of exercise with a view to more rapidly restoring muscle
glycogen. These studies have clearly demonstrated that 5-10g of
creatine taken with 100-200g of carbohydrate will restore muscle
glycogen 20-30% faster than just carbohydrates in 24 and 48 hours
after exercise. This would be invaluable for referees who have only 2-
4 days of rest between games/training.
Creatine is NOT a substance banned by the IOC because it is a natural nutritional food made from amino acids. However, concerns have been expressed with regard to the dose and kidney function. The following guidelines should ensure no adverse health problems:- 1. A normal liver and kidney function test must be present. 2. The 'loading' phase only lasts for 5-6 days before the 'maintenance' 3. Referees are advised to consume plenty of fluids during the 'loading' phase and adequate intakes thereafter. Creatine Ingestion
1. 'Pure quality' creatine monohydrate MUST be used. 2. Normal liver and kidney function tests MUST be shown by the medical 3. The 'loading' phase results in taking three 6.6 g scoops a day for between 5 and 6 days ONLY. Alternatively four 5 g portions are to 4. A carbohydrate meal or drink MUST precede the ingestion of creatine - preferably 15 to 30 minutes beforehand. 5. At least an extra 1 litre of fluid a day is taken during the 'loading' phase. This may be achieved by mixing the creatine in either 330 mls ( if 3 x 6.6 g/day) or 250 mls (if 4 x 5 g/day) of fruit juice or squash. 6. No more than 3 - 4 g/day of creatine should be ingested in the 'maintenance' phase. This phase can last for weeks or months during 7. If supplementation is for a long period (i.e. longer than 3 months) then medical staff will undertake further liver and kidney function tests. HOW TO USE GLUTAMINE
Glutamine is a naturally occurring amino acid found in all protein- containing foods and drinks. Although not an essential amino acid it nonetheless is reported to play an important role as a nutrient for cells of the immune system. Low levels of glutamine may result in impaired immune function with the consequences of more illnesses and infections such as colds, flu, and upper respiratory tract infections. Furthermore glutamine, in combination with carbohydrates such as glucose, has been reported to promote glycogen storage in muscle after exercise. Research findings have been equivocal in both these respects, although on balance glutamine ingestion should be considered during strenuous periods of training and especially during winter months. There are no real safety issues concerning glutamine ingestion, although Glutamine Ingestion
1. 'Pure quality' glutamine MUST be used. 2. Approximately 5 - 10 g/day of glutamine should be ingested at lunchtime after training and after a match.


In the name of god

Shiraz E-Medical Journal Vol. 12, No. 4, October 2011 Benefits of Metformin Combined with Insulin in Children with Type 1 Diabetes Mellitus. Abdeyazdan Z *, Hashemipour M**, Barekatain R***, Kalantary F±, Amini MΩ. * Associate Professor, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, **

Suggested therapy

Neuroborreliosis (Lyme disease) Lyme disease is an infectious disease contracted through a tick bite. The disease exists worldwide, except in areas with very extremely climates. While many infected patients recover with or without treatment with antibiotics, Neuroborreliosis represents a frequent complication of Lyme disease. The causes of the disease are Borrelia, named after Borrel, the

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