Integrating Traditional Chinese Medicine Phytotherapy and Diet Therapy with Contemporary Endurance Nutrition: Mechanisms, Evidence, and Practical Applications

Background: Traditional Chinese Medicine (TCM) is a holistic medical system emphasising en-ergetic balance and personalised therapies, including diet therapy and phytotherapy. Its poten-tial relevance in high-performance sport is increasingly recognised, as elite athletes face high physical and psychological demands, fatigue, injury risk, and metabolic or gastrointestinal dis-turbances. Contemporary endurance nutrition highlights carbohydrate periodisation, optimised protein intake, micronutrient adequacy, gut microbiota stability, and individualised dietary strategies to support performance and recovery.
Objective: To review evidence on the use of TCM diet therapy and phytotherapy in endurance sports, exploring physiological mechanisms, recovery effects, and the integration of TCM with modern nutritional strategies.
Methods: A narrative synthesis of experimental, clinical, and sports nutrition literature was conducted, including studies on macronutrient requirements, dietary periodisation, gut micro-biota, and herbal interventions in athletes.
Results: Carbohydrates remain the key determinant of endurance performance, influencing time-to-exhaustion, metabolic efficiency, and gut microbial stability. Ketogenic or low-carbohydrate strategies often impair high-intensity performance. Many endurance athletes fail to meet energy and micronutrient needs, increasing the risk of deficiencies and Relative En-ergy Deficiency in Sport (RED-S).
TCM diet therapy focuses on strengthening Spleen Qi, nourishing Kidney Essence, and correct-ing imbalances, conceptually supporting metabolism, recovery, and gastrointestinal function. Constitution-based approaches (ti zhi) align with modern personalised nutrition. Experimental studies suggest that herbs such as ginseng and Astragalus may improve mitochondrial function, reduce oxidative stress, and enhance fatigue resistance, although human trials show limited and inconsistent performance effects. Tribulus terrestris, Rhodiola, and Cordyceps demonstrate minimal ergogenic benefits.
Conclusions: TCM diet therapy and phytotherapy may complement endurance nutrition through personalised, systemic, and recovery-focused strategies. Current evidence does not support most herbal supplements as primary ergogenic aids. Integration is most effective when TCM principles are applied alongside established nutritional practices, including adequate car-bohydrate and protein intake, micronutrient sufficiency, and tailored fuelling. Further con-trolled human studies are required to determine efficacy and mechanisms.