This season has been a difficult one for Real Madrid, not least because of the club’s many injury setbacks. The injury crisis is hardly a new problem for the Spanish giants. As far back as 2024, in an effort to address it, Real brought in clinical nutritionist and physiogenomics creator Itziar González de Arriba.
The partnership, however, ended in dismissal and in a very public and legal dispute. González accused the club’s medical staff of fostering a “hostile” environment that made it impossible for her to work.
Recently, new alleged details have emerged about the inner workings of Real Madrid’s medical department. Reports in leading sports media claimed that the club’s doctors mistakenly examined Kylian Mbappé’s healthy knee instead of the injured one. González reacted to those reports by saying that club employees use ChatGPT to make decisions about supplement prescriptions for players. She also added that Real Madrid has incompetent specialists with good connections.
Although Mbappé denied the misdiagnosis claim, the media later reported that another Real Madrid player, Eduardo Camavinga, had allegedly been affected by a similar medical error.
The global popularity of the Spanish powerhouse is well known. Anything involving the Madrid side is discussed in every corner of the world, where Los Blancos have millions of fans. Azerbaijan is no exception. Given Real Madrid’s popularity in our country, İdman.Biz contacted Itziar González and spoke to her about working at the Madrid club and about proper sports nutrition.
In an exclusive interview with our publication, she said that artificial intelligence, including platforms such as ChatGPT, can be useful in sports medicine and nutrition if it is used as a support tool rather than as the primary instrument for diagnosis or treatment decisions.
According to her, AI can be used to process large volumes of scientific literature, prepare basic nutrition plans and diet templates, which are then adapted by a specialist to the individual patient on the basis of clinical data.
In addition, such systems can be used to create accessible information materials for patients, as well as to assist with administrative and documentation work.
"AI should complement, not replace, expert clinical decision-making. AI tools operate on population-level data and cannot integrate individual genomic, metabolomic, and physiological complexity," the specialist said.
View this post on Instagram"This is not only about England; it reflects a broader trend in elite football worldwide," she said. "The consequences of inadequate interdisciplinary integration – especially the lack of collaboration between coaching, medical and dietary staff – have been directly linked in peer-reviewed literature to significantly higher rates of recurrent muscle injuries in professional football."
"Mbappé’s case is not an exception," she stressed. In her view, such situations are signs of a system that "permits and perpetuates poor medical practice, including resistance to bringing in outside specialists."
Itziar González de Arriba said that the presence of insufficiently qualified staff in professional football clubs is a documented structural problem. The nutritionist pointed to research from English clubs that confirms gaps in the recruitment of medical personnel.
González believes the following reforms are needed: standardized, competency-based recruitment that should apply across major leagues and federations for all medical specialties, including dietetics; dietetics, physiotherapy and sports medicine should have a clear reporting structure and protected clinical autonomy, rather than functioning as subdivisions of a single medical body; daily exchange of data on training, medication, supplements and injuries among all specialists, with fixed accountability as a standard club procedure; reliable, anonymous mechanisms allowing medical staff to report concerns about practice standards without fear of retaliation that could end their careers; and investment in academic and continuing education.
"The core problem at elite clubs is the tolerance – and at times the active cultivation – of institutional conservatism, which treats outside innovation as a threat rather than an advantage," the specialist argues. "Until that changes, Mbappé’s case will remain illustrative rather than exceptional."
Itziar González has an impressive and wide-ranging academic background, years of clinical experience and an active research profile. So it should come as no surprise that she developed her own approach to working with athletes: physiogenomics.
Physiogenomics is the integration of physiology and genomics into a single, personalized system of nutrition and supplementation. As González explained, the method emerged from practical observation. Its central idea is that one and the same plan does not work for every athlete.
"When athletes who had been told their injuries or conditions were untreatable began recovering thanks to individually tailored genomic-nutritional protocols, it became clear that the standard one-size-fits-all approach was not merely ineffective — it was limiting performance," González said.
According to her, the new concept has fundamentally changed the way athletes are managed. Physiogenomics takes into account genetic characteristics, regular blood and urine tests, real-time training-load data and precise supplement dosing based on each athlete’s condition and metabolic profile.
"The goal is not simply to optimize performance, but to enable athletes to reach their genetic ceiling – something that is impossible under standard protocols," she said.
González argues that nutrigenomics, and the related physiogenomic approach, challenge many conventional principles of sports nutrition.
For example, traditional methods prescribe a standard ratio of protein, fats and carbohydrates. Her approach starts from the premise that genetic factors influence how the body absorbs and processes these elements, which means that everyone has a different "ideal" nutritional model. The same applies to caffeine, vitamin D, omega-3 and other supplements.
Special attention is also paid to foods commonly regarded as "neutral", such as dairy products and gluten. According to González, for genetically predisposed athletes they can trigger inflammatory processes, slow recovery and increase the risk of injury.
The specialist adds that adherence is not just a matter of an athlete’s willpower. When a player understands that recommendations are based on data from his own body, following the diet becomes easier and more effective.
"Despite the serious institutional obstacles encountered – including systematic blocking by medical departments, denial of access to player analytics and the deliberate undermining of nutritional recommendations – physiogenomics produced observable results in players who were able to follow the proposed protocols," González says.
She notes that the first clear effect was visible at the very first stage of the team’s buffet analysis. It was suggested that processed foods, refined sugar, pastries, dairy and fried foods, processed meats, soft drinks and juices be removed from the menu. According to her, such products can intensify inflammation in the body, interfere with energy replenishment, slow muscle recovery and increase injury risk in professional athletes.
"The players’ positive response to these dietary changes was direct, despite the institutional resistance that prevented their full implementation," she says.
González also recalls another case from her private practice before joining Real Madrid: "A professional La Liga footballer was publicly declared by the club’s medical staff to have an untreatable injury. Thanks to a personalized physiogenomic protocol, the player recovered and returned to competition, which the footballer himself later confirmed publicly. That led to threats from the club doctor, but it also confirmed the effectiveness of the approach both clinically and publicly."
Itziar González says physiogenomics has transformative potential for regions where sports science still relies on standardized methods. She identifies several advantages for Azerbaijani sport if the concept is adopted.
First, she says, personalized nutrition and supplementation can significantly reduce inflammatory load, lower injury frequency, shorten recovery times and extend an athlete’s competitive career.
"Athletes in these regions, regardless of training level, are currently limited by standard dietary protocols that may not suit their genetic profile – especially with regard to caffeine, omega-3, vitamin D and iron absorption," she explains.
The specialist stresses that any transition to such a model must be gradual, because without basic infrastructure the new approach will fail.
She recommends the following sequence for integrating the system. The first stage involves constant monitoring of key health markers: ferritin, 25-OH vitamin D, CRP, lipid profile and metabolic markers. Even this, she says, would already represent a major step forward compared with routine player monitoring.
The next stage is reforming the team dining room or buffet. Foods that may promote inflammation are removed from the menu, and the diet is built on an evidence-based foundation.
This is followed by nutrigenetic testing of key genetic markers linked to physical performance in order to select individual supplements. Only then comes full implementation of the physiogenomic model described above.
"Critically, the education of already employed medical and sports-science staff is not optional; it is the key factor that determines the pace of change," she warns. "Resistance from entrenched specialists is the main obstacle, as is evident across elite European clubs."
As an example of a gradual transition, she points to educational programs in team sports medicine, including initiatives such as Barça Innovation Hub.
