It is hard not be impressed at the sheer variety of foods on offer when wandering around a typical supermarket. But are we guilty of ignoring the bigger picture? All around the globe, billions of people consume diets radically different from those followed in the affluent west, containing a wide variety of unfamiliar foods. But this doesn’t seem to be a barrier to superior athletic performance – witness China’s medal haul in the 2004 Athens Olympics! So can western athletes learn anything from their contemporaries? And have western nutritional practices influenced athletes from the east?

Most Chinese people still live on farms in rural villages, where they grow much of their own food and have very limited access to shops and supermarkets, processed foods and refrigeration. Grain, particularly rice, is the major component of the rural diet, and households grow much of it themselves. In 1999, rural Chinese households consumed an average of 247kg of grain per person, of which they purchased only 42kg! Purchases of perishable foods in rural areas are also limited by access to refrigeration; and in 2000 only 12% of rural households had a refrigerator.

The typical Chinese rural diet, therefore, tends to be much higher in carbohydrate and fibre, and lower in fat, than the western diet. In the morning, people often start the day with porridge or millet gruel as the main breakfast food. Soybean milk, salted vegetables, eggs (boiled or fried), deep-fried twisted dough sticks and cakes are also common breakfast choices. Lunch and dinner tend to feature steamed rice and boiled noodles as the major foods, accompanied by vegetables and small amounts of protein, such as eggs, chicken, fish and meat. The dishes are usually prepared by stirfrying with salt, soy sauce or a little sugar.

Effects of urbanisation

However, in the cities things are very different. When people move to cities or towns, they tend to consume more meat, processed foods and restaurant meals, and less grain. Figures compiled in 2000 showed the average Chinese urban dweller consuming 40% more red meat, 300% more fish and 250% more eggs than his rural counterpart, and much more likely to consume processed foods, leading to a far more ‘westernised’ way of eating.

China is currently undergoing a rapid process of urbanisation, which is likely to accelerate this trend towards westernisation of the diet. In 2000, only 36% of the population lived in cities and towns, an urbanisation rate some 10 percentage points below the world average, and lower than the rate in many other countries at similar developmental levels. China’s policymakers, however, are placing a high priority on urbanisation, with analysts projecting a 50% urban population share by 2020 – an increase of 270 million!

Nobody who witnessed the Athens Olympics can be in any doubt that Chinese athletes are a force to be reckoned with. And, with the next games scheduled to take place on home soil in Beijing, there’s a real prospect of China finishing top of the medals table. However, the Chinese authorities are still struggling to overcome a general perception that drugs may be partly responsible for their medal successes.

This perception began to take hold in the early 90s, when Ma Junren’s brilliant group of young female runners, supposedly fuelled by a diet of turtles’ blood, rewrote the world record books. However, when some of the athletes tested positive for the banned blood-boosting drug erythropoietin before the Sydney games, a more likely explanation emerged.

The perception was compounded by China’s once-mighty swimmers, who were also devastated by a series of doping scandals. When the squad reappeared in the Sydney Olympics pool, not only was their performance mediocre but they also looked different – gone were the deep-voiced, square-jawed, muscle-bound women of the 1990s, who had raised eyebrows and suspicions of doping.

More recently, the Chinese authorities have been mounting a concerted effort to clean up Chinese sport, and on the evidence of Athens it looks like they’re winning. But, in a society where Chinese medicine plays a huge role in everyday life, this is no easy battle. In Chinese culture, the line between food and drugs is blurred; many medicinal herbs are used in cooking and many foods have medicinal properties assigned to them.

Traditional medicines, based on secret recipes handed down from generation to generation, are popular with many. For example, some Chinese dried pork products are prepared using clostebol, which is banned as a performance-enhancing drug. And one of the most popular medicines taken by Chinese athletes, ‘Dalishen Oral Liquid’, is a popular panacea based on seals’ penises and testes. Others include sealwort and the lingzhi mushroom.

While most western athletes are now aware that many herbs contain active biological ingredients that may lead to a failed drug test, many Chinese athletes remain poorly informed. Another challenge is the chaotic Chinese marketplace, where drug piracy is rampant and anyone can buy medicine – including steroids – without a prescription. To make matters worse, many drugs, particularly traditional remedies, aren’t labelled properly, making it very easy for unwitting buyers to consume an ingredient on the Olympic list of banned substances.

Getting the message across

However, despite these hurdles, it seems the Chinese sports authorities are getting the message across. Of 150 urine tests carried out on Chinese athletes in Athens, none was positive. David Howman, director general of the World Anti- Doping Agency (WADA), recently said he was convinced the Chinese government had done everything in its power to stop drug use in Chinese sport. And Simon Clegg, chief executive of the British Olympic Association, has agreed, claiming that any suggestion of regime approach to doping in China is completely unfounded.

A few calculations show that the average rural resident in China consumes around 650g of grain per day which, in the case of rice, equates to around 550g of carbohydrates per day: that’s well over 2000kcals from carbohydrate alone! Even allowing for the inclusion of small quantities of meat, fish, eggs etc, the overall composition of the diet is still overwhelmingly carbohydrate in nature (typically accounting for more than 75% of total calories consumed), with perhaps less than 10% of calories coming from protein.

With these very high intakes of complex carbohydrate and fibre, coupled with very low intakes of fat and sugar, it is easy to see why diseases of excess, such as coronary heart disease, are relatively uncommon in rural China. Moreover, the high carbohydrate content is ideally suited to athletes subjecting themselves to high volumes of training.

However, this kind of diet is not without its drawbacks. The very low seafood intake in rural areas, combined with low soil iodine, means that both goitre (enlarged thyroid) and iodine deficiency anaemia (IDA) are common, affecting 7.5 million and 380 million Chinese people respectively. Widespread fortification of salt with iodine has recently been sanctioned by the government as a means of reducing the prevalence of goitre.

The low Chinese intake of protein and dairy produce also increases the risk of iron, zinc and calcium deficiencies. In a study examining the dietary habits of Chinese gymnasts, these deficiencies were earmarked as potential risk areas⁽¹⁾. The researchers recommended that athletes should address these risks by increasing their protein intake to 1.9g per kg of body weight per day and boost their consumption of vegetable, fruit and milk products.

Pitfalls of the western diet

However, according to Jidi Chen, director of the sports nutrition research division at the Institute of Sports Medicine in Beijing, Chinese athletes are generally aware that their nutritional requirements are different from those of the general population. ‘Chinese athletes eat more meat, fruits, and milk products than the general population. This has improved their intake of a number of important nutrients such as calcium, iron and zinc. However, this is also leading to a greater prevalence of excess fat and cholesterol intake, and many of our athletes fail to fully appreciate the importance of carbohydrate, and fluid replacement.’⁽²⁾ It seems, therefore, that, in their efforts to increase protein and nutrient intakes, some Chinese athletes may unwittingly be falling prey to the common pitfalls of western diets!

Although the consumer market is growing rapidly in urban China, sports supplements, such as protein powders, carbohydrate drinks, creatine etc, are not readily available over the counter. Instead, the emphasis is still principally on foods, food extracts and herbal remedies, very much in harmony with the traditional respect for Chinese medicine. So, for example, high-protein foods such as turtle, soft-shelled turtle and the dark meat of chicken are thought of as ergogenic aids.

Many athletes also use herbs, such as ginseng, which are widely considered to have tonic effects, including enhancement of strength and immune function. Another supplement popular with athletes is a fungus known as cordyceps sinensis, which has been used in traditional Chinese medicine as an aphrodisiac and anti-ageing agent for many years, and for which research evidence is starting to emerge; a new study on healthy middle aged and elderly adults indicates that it may improve peak volume of oxygen consumption and decrease diastolic blood pressure⁽³⁾.

However, China’s rising profile on the world’s sports stage and its determination to lay past drug scandals to rest means that the authorities are now taking a growing interest in – and control of – the sports supplement market. The State Administration of Physical Culture and Sports has now decreed that all traditional Chinese medicines must be tested for stimulants before athletes on local and national teams can use them. Furthermore, the State General Administration of Sports recently launched a key scientific project whose aim is to develop a system of dietary nutrients designed to enhance recovery and support the training loads of elite athletes. This system was employed to prepare Chinese athletes for the 2004 Athens Olympic Games – with apparent success.

With the 2008 Beijing Olympic Games looming, great emphasis is also being placed on the training of dieticians. And there is a simultaneous drive by the State Drug and Food Administration to tighten up on supplement manufacturing practices in order to reduce the risk of contamination. Only recently, one major Chinese supplement manufacturer was investigated by the Agricultural Products Quality Supervision Centre at the Ministry of Agriculture for the quality of its calcium supplements, which apparently contained significant amounts of toxic hydrogen peroxide. This case gained notoriety, because in China calcium tablets are a popular gift!

The new regulations and controls on the manufacture, sales and use of sports supplements, combined with growing consumer power in China, will almost certainly mean that its sports supplement market is likely to rely less on traditional Chinese herbal remedies and more on conventional ‘western-type’ supplements in the future.

However, as cultural and commercial links between China and the west continue to grow and deepen, it would not be surprising if more of the exotic traditional Chinese herbal remedies gained scientific credibility here in the west!

Given the nutritional and sports science resources currently being poured into Chinese sports, and a huge population from which to select the genetically gifted, it is only a matter of time before we in the west become familiar with the names of top Chinese athletes as they reach the upper echelons of international sport. But can we learn anything from the Chinese experience?

Well, maybe, because despite the trend towards urbanisation, the Chinese diet is still heavily reliant on carbohydrate, which should, of course, be the fuel of choice for athletes. Many western athletes would consider a 70% carbohydrate diet to be ‘very high’ in carbs, although it is nothing exceptional for our Chinese counterparts.

But protein intake remains important too, and the Chinese way of squaring this circle is by incorporating adequate (but not excessive) amounts of very high-quality and ‘nutrient-rich’ proteins into the diet. By contrast, the western approach tends to rely on larger amounts of less nutrient-rich proteins (eg factory farmed chicken), which not only contains few nutrients and essential fats but sometimes also displaces valuable carbohydrate from the diet.

More generally, the Chinese tend to view food not just as fuel for training but as the vehicle for a range of health-giving and life-sustaining properties. This is not just a more psychologically healthy approach but a motivation to include more nutritional variety in the diet – always a good thing.

Finally, the Chinese drug problems of the past have resulted in a tightly regulated system of supplementation, which removes the onus on individual athletes and coaches to personally check out every supplement they take for possible infringement of drug regulations. Although such a highly structured system might not be compatible with a western democracy, the increasingly sophisticated sports supplement market and confusion over what exactly constitutes a ‘natural’ nutrient makes a strong case for some kind of structured guidance in the west.

Andrew Hamilton

References

1. Asia Pacific J of Clin Nutr 1995; 4, Suppl 1:29-33
2. Nutrition And Health Of Physically Active People: An International Perspective Gatorade Roundtable Discussion 1995; Rt# 22 / Volume 6, Number 4
3. Presentation to Experimental Biology Conference, Washington DC, USA, 17-24 Apr 2004