While chatting to Shelly Meltzer, 
head of the dietary practice at 
the Sports Science Institute of 
South Africa, I learnt about a new 
concept: the empty-basket or full-
basket approach to managing ath-
letes.  Shelly used this term in de-
scribing the approach she is using 
when she consults with athletes 
about nutritional supplements.  
It is well known from a variety 
of studies around the world that 
about 60% of elite athletes ingest 
supplements

1
 and most of these 

athletes work on the assumption that all supplements are effective 
and adopt a ‘more-the-merrier’ approach to what supplements they 
choose to ingest.  The full-basket approach is in accordance with this 
way of thinking. It follows that if you train hard your body needs extra 
nutrition, which can only be obtained by ingesting supplements.  By 
flooding the body with nutrients, those nutrients that are required are 
absorbed, and those that are deemed unnecessary, or in excess, 
are excreted – the net result, according to this approach, is that all 
the nutritional demands are met. This approach provides comforting 
insurance, satisfying a ‘just in case  …’  way of thinking.  

The athletes who adopt this approach have mindsets which are 
wired to ensure that they have an abundance of nutrients, in the 
event that their bodies need something that is not covered in their 
habitual nutrition. This is analogous to a caterer preparing for a meal, 
not knowing the likes and dislikes of the people who will be eating 
the meal. As a safeguard the caterer provides an excessive variety 
of food, incurring large amounts of waste and expense. Athletes 
who subscribe to the full-basket approach also do so at excessive 
monetary cost, while producing nutritious urine which is flushed 
down the toilet.  These athletes also increase their risk of ingesting 
a contaminated supplement resulting in the failure of a drug test.

2
 

Such athletes are difficult to counsel because this way of thinking is 
resistant to change. A pragmatic strategy for a dietitian dealing with 
this type of athlete is to offer advice on what they can remove from 
their full basket, rather than advising on what they should put in. In 
other words, their full basket needs to be systematically emptied. 

In contrast, the empty-basket approach describes a bottom-up 
approach in which the first step is to examine what an athlete is 
currently eating. The next step is to make recommendations that 
accommodate the specific demands of the athlete (i.e. age, gender, 
training load, level of performance, type of sport, phase of season). 
Once the athlete’s eating habits have been optimised the dietitian 
carefully considers whether nutritional supplements should be 
prescribed. Recommendations are then made about the dose and 
brand of supplement and the timing of the ingestion. This is done 
in accordance with the risk associated with contaminated products. 
With this approach athletes are monitored and adjustments are 
made, if necessary, to the supplements. Younger, less experienced 
athletes are more likely to be amenable to this approach. 

There is no doubt that the empty-basket approach is logical and 
appealling to anyone who believes in an evidence-based approach 
to managing athletes. It requires an understanding of the principles 
of nutrition and the demands of exercise and then matching the two.  
The reality, however, is that the full-basket approach is more common, 
particularly among experienced high-performance athletes. The 
full-basket approach  follows the path of least resistance, a quick-
fix mentality inculcated by peers, and promoted by manufacturers,  
eager to get a slice of the multibillion dollar international industry. The 
manufacturers of supplements take advantage of this mentality and 
flood the market with new products with wonderful claims about their 
efficacy, cunningly supported by pseudoscience. It is an enormous 
challenge for health care providers working with athletes, but the 
only way to change the current prevailing pattern is to consistently 
promote the empty-basket approach so that this becomes the norm 
around which recommendations are made. 

Mike Lambert
Editor-in-Chief

1.    Maughan R. Contamination of dietary supplements and positive drug tests 
in sport. J Sports Sci 2005;23(9):883-889.

2.    Van der Merwe PJ, Grobbelaar E. Unintentional doping through the use of 
contaminated nutritional supplements. S Afr Med J 2005;95(7):510-511.

Empty-basket philosophy

EditoriaL

2                                                                                                                    SaJSM  voL 23  No. 1  2011