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Eat Well, Play Hard, Make The Food
Count Franca B. Alphin, MPH, RD, CSSD, CEDRD, LDN
Associate Professor, Sports Dietitian
Director, Student Health Nutrition Services
What Determines How Well They Play?
• Genetics
• Opportunity: Facilities, trainers, coaches
• State of mind- mental edge
• Body composition – mechanical edge – Higher muscle to fat ratio
• Nutrition (food) –
– What you eat /drink – When you eat/drink – Type of sport/activity: fuel utilization – Pre and post nourishment
Where Are The Athletes In
Training? (Periodization)
– How much they eat depends on how much they need – more
training, higher intensity, more food– bigger appetite!
– Very few athletes adjust their calorie intake/dietary needs based on
where they are in training (very few coaches make this suggestion)
– Preseason is different from In season which is different from Post
season, which is different from Recovery, which is different from
injury etc. etc…..
Energy Excess or Deficit
• Weight is one indicator of nutritional status i.e.
performance.
• Over and/or underweight
• Weigh once per week same time/same place
• Do not use BMI as a gauge for optimal weight– should not
be used for anyone under 19 or athletes.
• Calories fuel the body, in turn supporting healthy weight.
• Weight does not differentiate between lean and fat weight.
• Loss of muscle mass/power
• Dehydration- poor performance
• anemia- fatigue
• Loss of endurance- glycogen
depletion
• Slowed metabolic rate
• Overall POOR PERFORMANCE
• Likely to get sick more often
• Lack of concentration
• Impaired coordination
• Increased risk of injury
• Delayed recovery from injury
Not Eating Enough May Lead to...
Weight Management – less is not more!
• Imagine a range with four burners representing your metabolism.
• The less you eat the more your metabolism slows down to preserve energy.
• The more you exercise and not change your eating the same effect happens- in women this results in lack of menses, which increases risk of stress fractures and bone related issues.
Dietary Recommendations for
Athletes
Carbohydrates ◦ Fruits, vegetables and
starches (phytochemicals)
Protein ◦ Meats or meat substitutes
(lean meats)
Fat ◦ Mono- and Polyunsaturated
fats
high carbohydrate
availability (based on grams/kg/body weight– 3-10 gms/kg or higher)
• RDA ranges from 1.2-1.7
gms/kg/body weight (18-25% of total calories) Teen athletes 1.4-1.8 or even 2 grams.
20%- 25% of total calories
or often what is remaing after above calculations.
Optimal Balance
• Kind Bar (s)
• Hummus and baked chips
• Greek yogurt/cereal/fruit
• Mixed nuts with some dried
fruit
• Wraps
• Sandwich on whole wheat
bread/lean lunch
meat/veggies/dressing
and dessert.
• Soup and sandwich
• Why add dessert at all?
• Pizza but not with
pepperoni rather
vegetables or ham and
pineapple
• Banana nut muffin and milk
• Bran muffin and milk
• Eggs/whole wheat
bread/ham/cheese
• Bran/whole grain
cereal/fruit/milk/nuts
• Peanut butter and Jelly/Whole
wheat
• Maintain blood sugar levels– keep you alert
• Spare protein (muscle and tissue) from being used as energy
• Allow for greater % of maximum workload maintained
• Improve endurance and intensity
• Optimize recovery and immune system
• Help prevent mental fatigue!
Even if the muscle has adequate food, if an athlete is mentally tired, the
body will decrease work load, as if it were tired.
Do you know when the last time was that your athletes ate?
Carbohydrates
What Does That Look Like?
Fuel Utilization
Rate of Nutrient Absorption
70
90
110
130
150
170
190
210
230
250
Baseline 1/2 Hour 1-2 Hours 2-3 Hours 4 Hours
Simple
Carbohydrates
Complex
Carbohydrates
Protein
Fat
Blood
glucose
Time
Key Points: Carbohydrates Grains, Vegetables, Fruit
• Most of the diet should be long acting carbohydrates– not
sugars.
• Approx. 1 gram of carbohydrate per kilogram/body/wt. within 30 minutes post workout, along with 20 grams of whey protein. (Milk or chocolate milk is fine – just as good as any supplement)
• Use sports drinks that have carbohydrate in them after working out/playing for over 60 minutes to help replenish glycogen (stored carbohydrate).
• Remember, too much of anything can be stored as fat, so try not to overdo– watch the junk food and sugar.
Key Points: Carbohydrates
• If the diet is low in carbohydrate one may experience any or all of the following symptoms:
– Legs feel heavy – difficult to move – Tired – Inability to regain stamina, energy-- dragging for days on end – Hard time staying focused – Muscle soreness that lasts much longer than usual – More susceptible to upper respiratory illness – Run out of energy quickly – Dizziness
• A diet that is low in carbohydrates forces the body to use protein to as an energy source. This can take away from the primary functions of protein and increase protein need.
• Notice that some of these symptoms are similar to dehydration. If you are aware of how
much fluid you take in daily, to feel fine, then you can rule out dehydration fairly quickly.
Say “No” to High Fructose Corn
Syrup
• This type of sweetener, which is added to everything,
affects the body differently than regular sugar. Because
of this, often, one feels less full and is more likely to
overeat. (Ask your athletes to begin to read labels. They do not need to eat high
fructose corn syrup, regardless of buget.)
• Although it may not be harmful, it’s also not healthy and
there is no need for it in the diet.
Anti-inflammatory Pyramid- these
elements should be contained in the healthy/athletic diet.
Some Fiber is Good --
• Adequate Intake For Fiber
• 25 g per day for women
• 38 g per day for men
or 14 g for every 1000 calories
– Navy/kidney beans = ½ cup = 8 g
– Corn = ½ cup = 6 g
– Broccoli cooked = 1 cup = 5 g
– Pear 1 = 5 g
– Whole Wheat Bread = 3-4 gms
Too Much Fiber – is not
• Intestinal gas
• Bloating
• Constipation
• Diarrhea
• Reduced caloric intake due to too much volume
• Binds vitamins and minerals; iron, zinc and calcium
Protein
• Important for muscle growth and repair
• 0.5-0.9 grams protein per pound body weight
– (1.2 – 1.9+ grams/kg/body wt.)
EXAMPLES
– 3 ounces of chicken, beef, tuna 21 grams of protein
– A veggie burger 18 grams of protein
– 12 ounce glass of milk 12 grams protein
– 2 eggs 14 grams of protein
– 8 ounce yogurt 11 grams of protein
– 2 TBSP peanut butter 10 grams of protein
Adequate Protein Intake
Grams/pound
Moderate Exercise: 0.5 - 0.65 grams
(1.1 - 1.5 per kg)
Heavy Exercise: 0.65 – 1.0 grams
Ultra Exercise/growth: 0.8 - 1.0+ grams
*Athletes restricting calories, in a growth spurt, building muscle, or
in very intense training need the most protein
Whey Protein (Dairy protein)
• High biological value
• Digests quickly
• Safe unless one is allergic to milk
• If lactose intolerant can use soy, but won’t have
casein.
• Can increase work capacity
• Think milk or chocolate milk – it’s cheaper and tastier
than protein supplements.
Key Points: Protein
• There are no specific symptoms to watch for if your diet is low in protein, because our bodies can break down our own body protein.
• If you are trying to increase lean body mass through weight lifting and you
are not seeing any progress over a few weeks then consider two options:
– Either you are not taking in enough calories, which is usually the cause
– Or, you may not be taking in enough protein, but that is usually not the case.
Fat
Provides a dense source of calories – allows for lower volume of food while still getting caloric needs met.
Provides essential fatty acids
Great source of antioxidants – Vit. E, essential fatty acids
Adds wonderful flavor to food
Many athletes see fat in their diet as fat on their bodies – which can make eating fat a challenge.
Fats
Monounsaturated such as olive oil and canola oil, the oil you find in nuts and seeds, peanut butter, nut butters.
Fish oils, flax seed
Polyunsaturated fat
Saturated fat – least healthy – but some is fine such as in cheeses or dairy products – good source of calcium for healthy bones.
Ideally some fat at every meal CAUTION: FAT SLOWS STOMACH EMPTYING
Trans Fats
• These fats are very unhealthy
and can increase your risk of
heart disease. Avoid trans
fats in commercially prepared
foods.
Key Points: Fat
• Although many athletes do eat enough fat for a healthy diet, diets low in fat can cause the following symptoms:
– Lack of energy, fatigue – due to inadequate caloric intake
– Decrease in serum testosterone – male hormone
– Never feeling full or satisfied with your meal choices
– Always thinking about food or your next meal, even while eating your current one.
Timing is Everything
• Eating throughout the day is ideal for weight management, energy and performance. (You’ll be lucky if your athlete has had 2 meals by practice time)
• Sticking only to three larger meals can make you feel overly full and uncomfortable
• High intensity workouts slow digestion, so keep the meals small and easy to digest when planning an intense workout or on race day.
• Fat takes longer to digest so keep fat intake “simple” prior to workout.
• Every meal should have some protein in it.
Post-Exercise
• Within 30 minutes:
– Fluid to replace what the body has lost
– 1 to 1.2 gms of carbohydrate/kg/ per hour (50-80 grams+)for first 4 hours- glucose and sucrose are twice as effective as fructose.
– 20 grams of protein to expedite recovery
• Trail mix
• A turkey, cheese sandwich
• Yogurt with granola and fruit
• A bar, or a shake, but ½ the scoop with milk or sports drink
• Chocolate milk
Spectra of the Female Athlete Triad
De Souza M J et al. Br J Sports Med 2014;48:289
Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.
Origins of Energy Deficiency in Athletes
• ACSM identified three distinct causes of energy deficiency
– Obsessive eating disorders along with their clinical mental
illnesses: anxiety, depression, OCD, etc.
– Intentional and rational but mismanaged attempts to reduce weight
or body fat in the hopes of improving performance
– Inadvertent failure to increase energy intake to compensate for the
energy expended in exercise.
• Education, education, education about periodization in training
Important Risk Factors To Screen For….
• History of menstrual irregularities and
amenorrhea
• History of stress fractures
• History of critical comments about eating
or weight from parent, coach or
teammate
• History of depression
• History of dieting
• Vegan or newly converted vegetarian
• Pressure to lose weight and/or frequent
weight cycling
• Early start of sport specific training
• Overtraining
• Recurrent and non-healing injuries
• Inappropriate coaching behavior
• Personality factors
– Anxiety, depression, OCD
tendencies, perfectionism
• Newly diagnosed medical condition:
Celiac disease, food allergies, diabetes
Comments about eating and weight
Ongoing food conversations and body comments
– How many calories are in this or that
– How much should I eat, can I eat this
– What supplements should I be taking, or I’m taking this and that,
what do you think.
– I eat “healthy”
– Everyone in my family is really thin
– Constant desire to lose weight and doesn’t need to
– Expresses fear of gaining weight – typical of people who have been heavier
in the past
– Feeling fat and would feel better if they lost weight
BMI- Under 19 years of Age/Growth
Charts
In a study done by Gibson, Mitchell, Harries & Reeves, 2004,
who looked at elite athletes (50 British national or higher
standard middle-and long distance runners), found that a low
body mass index (BMI) below 18.5 failed to account for 67%
of the cases with amenorrhea and 67% of the cases with
oligomenorrhea.
Energy Availability
• The amount of dietary energy (calories) remaining after exercise,
training, for all other physiological functions.
• Equations used to calculate energy expenditure contain no information
about whether physiological systems are functioning in a healthy
manner.
• Because physiological systems are suppressed by severely low energy
availability, measurements of REE or total energy expenditure will
underestimate an athlete’s energy requirements.
.
ATHLETE’S PLATE
The Athlete’s Plates are a collaboration between the United States Olympic Committee Sport Dietitians and the University of Colorado
(UCCS) Sport Nutrition Graduate Program.
For educational use only. Print and use front and back as 1 handout.
Fluids
• Temperature regulation – body cooling
• Solvent
• Transport of nutrients
• Lubricant
Signs of Dehydration
Thirst– dry mouth
Headache
Fatigue
Hard time concentrating – brain seems a bit fuzzy
Heart racing
Cold/goose bumps -- when it’s hot out
Having not had to pee in hours
Urine is dark colored and/or very small amount
Not All Fluids Are Created Equal
Fluid sources:
• Beverages – non alcoholic
Although alcohol is technically a fluid, it dehydrates and so has the opposite effect.
• Caffeinate is fine (and has been shown to have some benefits for athletes)– within limits – no more than 3 cups (8 oz. each) per day of caffeinated beverages
Best options
• Milk of any kind/Chocolate milk (whey protein)
• Water
• 100% fruit juice
• Sports drinks
• Fruits and Vegetables
How Much Fluid?
Everyone has different fluid requirements
Begin hydrating when you first get up
Drink 10-20 oz 1 hour BEFORE Exercise
14-40 oz per hour of exercise (depends on sweat rate and
environment)
24 oz ( 3 cups) for every pound lost during exercise
Gulps over sips
Swallow instead of spit
Cool, not ice cold
Salty Sweaters
If you have muscle cramps (usually fluid), cake salt or sweat
that stings your eyes, or sweat that tastes salty, you need to:
– Increase your use of salt or salty condiments
– Drink sports drinks instead of water
– Eat salty snacks such as crackers, Chex mix, pretzels, pickles,
soup
– You may need to try consider other products such as The Right
Stuff™ or Pedialyte which offer different amounts of sodium.
Key Points: Hydration
Not drinking enough is the first thing that will limit your performance. Symptoms of dehydration may be any and/or all of the following:
– Dry mouth – Fatigue – Light headedness/headache – Difficulty concentrating – Nausea* – Limited need to urinate – Muscle cramping – Feeling cold or having goose bumps when it’s hot out – Difficulty breathing
*Nausea is also a symptom when diets are too low in salt. Although this is rarely the case, it is possible if drinking a lot of fluid and not eating foods that are high in sodium.
Vitamins/Supplements
• Vitamin C – antioxidant – but does not help prevent the common
cold (range of 100 – 200 mgs)
– Citrus fruit, bell peppers, strawberries, broccoli
• Omega 3 fatty acids – have anti-inflammatory properties (2-3
grams of distilled fish oils)
– Fatty fish, walnuts
• Calcium, Vit.D and magnesium – crucial for healthy bone
development – Calcium -1000 mgs, Vit. D up to 2000 IU’s. (Not
unusual to see 25,000 to 50,000 units once per week.) – Margarine
– Fatty fish
– Milk and eggs
Iron Depletion
Female and adolescent athletes have the highest rate of iron depletion.
National average of IDA – 3-5%
NHANES II - Adolescent girls – 9-10%, boys 1%
• Suggested that 20-50% of female athletes and 4 to 50% of male athletes have depleted stores.
• Highest frequency is seen in athletes participating in running, triathlon, swimming, rowing, soccer and basketball.
• Ferritin should be above 35 ug/L for W and above 40 ug/L for male athletes.
Educate on dietary iron content and absorption considerations Blockers: tea, coffee, calcium, antacids (ex. Tums),H2 blockers (ex. Zantac), Proton Pump Inhibitors (ex. Prilosec)
Enhancers: 100mg vit C/~30mg elemental iron, pots
Food combinations: animal and vegetable sources Supplement if necessary: Consider alternate days* Monitor Side Effects: Constipation, nausea, upset stomach Reassess Status
Iron Deficiency and Anemia
