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SPORTS NUTRITIONEvidence-based Guidelines and

Practical Applications

Presented By:Jennifer M. Doane, MS, RD, CSSD, LDN, ATC

Advantage Nutrition & Wellness, LLC

Allied Health Education, LLC

Provider Disclaimer

• Allied Health Education and the presenter of this webinar do not have any financial or other associations with the manufacturers of any products or suppliers of commercial services that may be discussed or displayed in this presentation.

• There was no commercial support for this presentation.

• The views expressed in this presentation are the views and opinions of the presenter.

• Participants must use discretion when using the information contained in this presentation.

Webinar Learning Objectives

Each participant will be able to:

• Identify the six essential nutrients and their respective roles in health and performance

• Identify the red flags for which a referral to a nutrition specialist is warranted

• Explain the most optimal time frames for nutrient consumption prior to sport

• Identify current best-practices for fluid replacement

• Explain to their athletes the optimal content and portions of both carbohydrates and protein for optimal recovery fuel after sport

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Sports Nutrition “Team”• Athlete

Parents

Coach and Institution

• Doctors

Primary Care Physician

Specialists, Orthopedic Physician

• Allied Healthcare Providers

Certified Athletic Trainer

Registered Dietitian

Strength and Conditioning Specialist

The Two “T’s” To Being An Athlete

Train Your Body Right

• Endurance

• Power

• Speed

• Flexibility

Treat Your Body Right

• Nutrition

Nutritional Supplements

• Rest / Recovery

• Injuries / Illness

• Risk Taking Behaviors

Performance Enhancing Drugs

Alcohol

Nutrition Topics Will Be The Focus Area For This Webinar

• In this day and age, there are not too many more advantages to be gained from various training techniques

• Larger focus being placed on how an athlete is “treating” their body for optimal performance

• The “winner” could likely be the one who is hydrated, better rested, and/or more properly fueled for the timing of their event

• So, when do you bring in a nutrition professional…

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Looking For An “RD”• Registered Dietitian Nutritionist (RDN)

is a …• Legally protected title

• RDs are credentialed by the Commission of Dietetic Registration (CDR) of the Academy of Nutrition and Dietetics (AND)

• All RD’s hold at least a bachelor’s degree, have completed required hours of supervised practice, have passed the national registration exam, as well as completed continuing professional education requirements

http://www.eatright.org/HealthProfessionals/content.aspx?id=6857

American Dietetic Association Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty,

Advanced) in Sports Dietetics. J Am Diet Assoc. 2009;109(3):544-552.e30

Looking For A “Nutritionist”

• Sometimes you hear the term “Nutritionist” Some dietitians call themselves

nutritionists, however not all nutritionists are “RD’s” (registered dietitians)

Some states have licensure laws that protect the term however in other states virtually anyone can use the term “nutritionist”

http://www.cdrnet.org/certifications/

Specialty Board Certifications

• Board Certified Specialist in Sports Dietetics (CSSD)

Just as many other medical professions have specialty areas, RD’s are now being held to practice standards through national board certifications

An RD which completes a minimum of practice hours in the realm of sports nutrition and successfully completes the board certification exam (5 year certification) can use the credentials “CSSD”

This represents the ideal credential for a practicing sports dietitian

http://www.cdrnet.org/certifications/

http://www.eatright.org/HealthProfessionals/content.aspx?id=6857

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Rationale For A Nutrition Consult

• Nutritional guidance to enhance the following:

Exercise / Sport training capacity

Athletic performance

Recovery from illness and/or injury

Overall health of athletes and physically active adults

Criteria To Assign Risk

• There are certain “red flags” to watch out for which determine nutrition risk

• Understanding these signs and/or symptoms will be the cornerstone for an positive referral to a registered dietitian for evidence-based nutrition intervention

Consultation With An RD…Red Flags for Referral to Medical Nutrition Therapy (MNT)

• Iron deficiency anemia

• Poorly controlled diabetes

• Hypoglycemia

• Cardiovascular conditions

• Food allergies

• Vitamin/Mineral deficiencies

http://www.nutritioncaremanual.org/content.cfm?ncm_content_id=92163

• Bone mineral disturbances

• Eating Disorders

• Female Athlete Triad

• Food intolerances

• Gastrointestinal disorders

• Hydration Issues / Hyponatremia

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One of the Largest Complaints

• When an athlete is looking for nutrition intervention, fatigue us largely one of their complaints

• Complaints could surface as:

“I am just tired all the time and fall asleep very early”

“Coach says my times are slipping” or “I don’t feel “sharp” with my skills”

“Half way through practice I am just dead”

• They may think:

Am I eating too much of the wrong things?

Am I not eating enough?

Loucks, AB Energy balance and body composition in sports and exercise. J Sports Sci 2004;22:1-14.

Nutrition Related Fatigue

• Fatigue is characterized by an inability to continue exercise at a desired pace or intensity

• Nutritional factors that lead to fatigue… Iron deficiency anemia

Depleting muscle glycogen stores

Hypoglycemia

Dehydration

http://www.nutritioncaremanual.org/content.cfm?ncm_content_id=92165&highlight=fatigue

Welsh RS, et al. Carbohydrates and physical/mental performance during intermittent exercise to fatigue. Med Sci Sports Exer. 2002;34:723-731.

Help Your Athletes Delay Fatigue By…

• Maintaining adequate carbohydrate availability

• Maintain adequate fluid intakes

• Adhering to appropriate aerobic exercise training

• Wearing appropriate clothing for environmental conditions

Or else they may suffer the consequences…

http://www.nutritioncaremanual.org/content.cfm?ncm_content_id=92165&highlight=fatigue

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Complications To The Athlete With An Energy Deficit

Performance

• Loss of muscular strength

• Loss of endurance

• Decreased oxygen

utilization

• Decreased aerobic power

• Decreased speed

• Loss of coordination

• Impaired judgment

Health

• Reduced blood volume

• Decreased blood flow to kidneys

• Loss of all muscle glycogen

• Inability to regulate body temperature

• Dehydration

• Electrolyte imbalance (cardiac complications)


Role of Nutrition for Athletes

• Once we understand the athlete’s nutrition risk, it is the provider’s job to provide sound, evidence-based interventions & education

• “Paycheck”• Improve performance

Strength Power Endurance

• Every sport and every athlete has their own unique nutrient and energy demands

GOAL = Delay Fatigue & Improve Performance!

Nutrition Comes From 6 Essential Nutrients

All Calories Are Not Created Equal!

Carbohydrates

Proteins

Fats

Vitamins

Minerals

Water

Quick Energy

Structure (Reserve Energy)

Long Term Energy

Functional

Functional

All Body Processes and

Structures

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Overview of Energy

• Movement requires energy to fuel muscle contraction

• Varies greatly among sports

• ATP, our ultimate source of energy

• Chemical energy stored in the phosphate bond of ATP is converted to mechanical work in skeletal muscle by hydrolysis of ATP

• ATP is stored in limited quantities

• However, can be rapidly synthesized by input of energy to join inorganic phosphate with ADP

Where Does ATP Come From

• Three energy systems replenish ATP to meet energy needs for all body functions:

Phosphocreatine (PCr) provides immediate anaerobic energy



Anaerobic Glycolysis provides short-term energy anaerobically

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Oxidative Phosphorylation provides longer term energy via aerobic glycolysis and aerobic lipolysis

Energy Use Summary

• Carbohydrates and Fatty acids are the main fuel for energy production during exercise

• Using protein for energy breakdown is NOT performance enhancing and is very inefficient

• Amino acids from protein breakdown are used as fuel sources to a limited degree when… In endurance activity when glycogen stores are

low about 90 minutes into an activity

When carbohydrate stores are limited with insufficient calorie intakes


Calculating Energy Needs

• How many calories will I need? Age Gender Height Weight Body Composition Exercise TimeADL

Don’t get caught “copying”!

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Estimated Energy Requirement

• EER is a prediction to maintain energy balance in a healthy adult of a defined age, gender, weight, height, and physical activity level consistent with good health

• In order to complete this calculation you need to understand a couple conversions:

Weight in pounds to kg wt#/2.2 = kg

Height in inches = meters ht inches x .0254 = m

Age = years

Energy Formulas

EER, kcal

Boys, age 9-18y 88.5 - 6.19 x Age + [PA x (26.7 x Wt) + (903xHt)] + 25

Girls, age 9-18y 135.3 – 30.8 x Age + [PA x 10.0 x Wt) + (934 x Ht)] + 25

Men, age >19y 662 – 9.53 X Age + [PA x 15.91 x Wt) + (539.6 x Ht)]

Women, >19y 354 – 6.91 x Age + [PA x (9.361 x Wt) + (726 x Ht)]


PAL Category Men, Age >19y Women, Age >19y Boys, Age 8-19y Girls, Age 8-19y

Sedentary 1.00 1.00 1.00 1.00

Low Active 1.11 1.12 1.13 1.16

Active 1.25 1.27 1.26 1.31

Very active 1.48 1.45 1.42 1.56

Physical Activity Coefficient (PA)

Estimated Energy Requirement Formulas

Or, Use The Quick Version (Adults)

• Weight kg x 30 = maintenance

• Weight kg x 25 = weight loss

• Weight kg x 20 = basal metabolic requirement

Activity calories must be added to the above baseline

equations, or… • Weight kg x 45 = energy

sufficiency for most athletes

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Females require approx. 30 calories / kg body weight /day

for health promotion

This is generally equivalent to

1700-1800 calories per day

For a 150-pound woman

Female athletes need approx.

40 - 50 calories per kg body weight / day

This is equivalent to

2,700 to 3,400 calories a day

for a 150-pound woman


Males require approx. 30 calories / kg body weight /day

for health promotion

This is generally equivalent to

2300-2400 calories per day

For a 175-pound man

Male athletes need approx.

50 - 80 calories per kg body weight / day

This is equivalent to

4,000 to 6,300 calories a day

for a 175-pound man

Activity Calories

• The final factor to determining accurate daily caloric needs is to estimate one’s calories expended during activity or sport

• This is one of the many specific areas in which a Certified Specialist in Sports Dietetics (CSSD’s) is most helpful

• Reference tables or Wearable technology

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Periodization

Energy intakes need to be adjusted!

A “one-size fits all” approach will not work &

each training season needs to be approached

with a specific plan

• Off-season

• Heavier conditioning phases

• Two-A-Days

• Extended breaks

Jeukendrup, A.E. Sports Med (2017) 47(Suppl 1): 51. https://doi.org/10.1007/s40279-017-0694-2

So, How Do We Advise Athletes To Eat?

• Now we will start to look at our essential nutrients and determine the proper amounts to advise for fueling sport

• As you will find, “how” an athlete eats is just as important (if not more sometimes) verses “what” they eat How Much = Portions

How Often = Frequency

Carbohydrates

• Types of Carbohydrates (Food): Simple Carbohydrates Complex Carbohydrates

• Storage Forms of Carbohydrates (Body): Glycogen (muscle and liver) Blood glucose

• Energy for… Brain Muscles

• Food Sources… Breads, Grains & Legumes

Vegetables Dairy Products Fruits

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How Much?

• 3-12 g/kg/day average For every 100# = 136 - 545g carbohydrates

o Light training 5.0 - 7.0 g/kg/day

o Moderate or Heavy Training 7.0 – 12.0 g/kg/day

o Pre-event Loading (24 – 48 hrs prior) 10.0 – 15.0 g/kg/day

Recovery Fuel ( immed & 2 hr post) 1.5g/kg

Variable depending upon sport, intensity and actual minutes of activity


Recommended CHO Intake Prior To Exercise

1 Hour Prior = approx. 40-50g / 100#Bagel, Nature Valley Bar, Sports Drink, Fruit, Yogurt, Pretzels, Fruit newtons, PowerBarLow-fat, Low-protein, low-fiber options

2 Hours Prior = approx. 90-95g / 100#Can allow enough time for digestion of more protein options; Turkey sandwich, Clif Bar, Yogurt

3 Hours Prior = approx. 135-140g / 100#Some athletes may fit a meal of mixed content; If stomach “sensitive” then consider tapering fat, protein, and fiber content

4 Hours Prior = approx. 180 – 185g / 100#Last optimal time for a meal of mixed CHO, FATS, PROCarbohydrates should remain the focus


Carbohydrate Loading

• Glycogen (CHO) energy storage occurs relatively slowly

Usually takes 2-6 days to achieve optimal levels

• Athletes can consume high (10-15g/kg) level of carbohydrates in their diet to super-saturate one’s glycogen energy stores for competition

• Can also beneficial to taper down activity levels

http://www.ausport.gov.au/ais/nutrition/factsheets/competition_and_training2/carbohydrate_loading

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CHO Loading Prior To Exercise

• Supersaturation Old (7day) vs. New (24-48 hours)

• Goal = 10-15g/CHO per kg body weight

• 12 hour fasting (sleep) depletes the body’s glycogen stores

For every 100#...450 – 700g CHO the 24 hours prior to activity

Carbs Too Low?• Muscles:

Inadequate carbohydrate intake is the largest factor for the onset of fatigue

Most injuries occur late game/practice when fatigue increases

• Mind:

Concentration

Skill level and performance

Best Type of Carbohydrate For Muscle Energy

• Glucose:

Complex carbohydrates and starches

• Sucrose:

Table sugar

• Glucose and sucrose are twice as effective as fructose in restoring muscle glycogen after exercise

Fructose = liver glycogen

Glucose/Sucrose = muscle glycogen

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What does 100g Carbs Look Like?

100g Carbs

• 2 slices bread 30g

• Yogurt 25g

• Banana 30g

• 2c vegetables 20g

100g Carbs

• Kaiser roll 45g

• 8oz milk 12g

• 1c grapes 15g

• 16oz Gatorade 28g

100g Carbs

• 1.5c Cheerios 30g

• 16oz milk 24g

• 1c berries 15g

• Mini –bagel 30g

100g Carbs

• Powerbar 42g

• FOB yogurt 37g

• 3T dried fruit 22g

Fats

• Types of Fats (Food):Saturated Fats• Trans Fats

Unsaturated Fats• Poly-• Mono-

• Food Sources

Meat/Proteins

Added Fats

Whole Grains

Dairy Products

(Body) FAT Burns Within A Carbohydrate Flame!!

~ Nancy Clark, RD

Benefits of Fats

• All cellular structure

• Absorption and storage of fat soluble vitamins

• Blood pressure & Blood flow regulation

• Hormone Balance

Estrogen imbalance = poor bone health & increased risk of stress fractures

Poor testosterone levels

• Blood clotting

• Inflammation

• Bronchiole air flow

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Consequences of a Low Fat Diet to Athletes

• Low-fat = 20-30% of calories coming from dietary fat

• Consuming less than 20% of your calories from fat (less than 45g fat per day for 2000 kcal)

Develop EFA deficiency

Develop deficiency of fat

soluble vitamins

Menstrual Irregularities

How Much?

• Low-fat = 20-30% of calories coming from dietary fat.8 - 1.0g/kg or 40 - 45g every 100#

• Consuming less than 20% of your calories from fat ( < 22g / 1000 kcal)

Develop EFA deficiencyo Cell Structure, Nerve Integrity o Immune Functiono Sufficient energy for endurance

performance


Fuel Comparison

For every 100#... 1,200 kcal stored carbohydrates40,000 to 70,000 kcal stored fat

Athletes need to understand that their primary muscle fuel is carbohydrates…

Carbs are function, not (body) “fat”!

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The Next Slide…• The following slide will show…

With increased intensity of exercise, as shown by the increasing VO2max, one’s body will exponentially burn more carbohydrate sources

This increased intensity of exercise will thus require a significant increase to exogenous CHO to fuel the exercise being performed

If one does not fuel high intensity exercise, the subsequent reaction may be a slowed physiological response to the exercise demands (or decreased metabolic rate)

J.A. Romijn et al., Regulation of Endogenous Fat and Carbohydrate Metabolism in Relation to Exercise Intensity, American Journal of Physiology, Vol. 265,

E380-E391, 1993.

Substrate Utilization At Different Exercise Intensities

0

100

200

300

25 65 85

ca

l/k

g/m

in

% of VO2 Max

Muscle Glycogen

Muscle Triglycerides

Plasma FFA

Plasma Glucose

J.A. Romijn et al., Regulation of Endogenous Fat and Carbohydrate Metabolism in Relation to Exercise Intensity, American Journal of Physiology, Vol. 265, E380-E391, 1993.

Protein

• Primary Function Structure Not an efficient energy

source

• 9 Essential Amino Acids Complete proteins Animal vs. plant

proteins

• Food Sources: Dairy Meat, Poultry Fish Eggs Beans Grains Nuts/Seeds

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Muscle Building

• Adequate protein intake with inadequate caloric intake prohibitspositive protein balance

• When building…You need enough energy to make the substrates build structure!

Carbohydrates = energy

Protein = structure

Usually takes at least adding 500 – 1000 calories/day to create increases

Betts, James A. et. Al. Endocrine Responses During Overnight Recovery From Exercise: Impact of Nutrition and Relationship With Muscle Protein Synthesis. IJSNEM

2011;21(5): 398-409.

Protein Requirements Per 100# Body Weight

• Sedentary

• Athletes

• 0.8 g/kg 36 g day

• 1.2 – 2.0 g/kg 55 - 90 g day

• Endurance athletes vs. Strength athletes no longer a focus Variations to exogenous protein intakes is more related to… Exercise intensity Injury or healing Type of exercise

Too Much??• Many athletes consume protein far in excess

of requirements

• Extra calories = Extra energy storage = Body fat

• Trained athletes only require 1.12 times more protein than sedentary counterparts

Need for increased protein is greatest during the first phases of training (3-6 months) when muscle hypertrophy gains are the greatest

• Greater than 2.5g/kg shown to increase risks for dehydration, calcium losses, and weight gain

Equals decreased performance


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Energy Use Summary

• Carbohydrates and Fatty acids are the main fuel during sport

• Amino acids from protein breakdown are used as fuel sources to a limited degree… In endurance activity when glycogen stores

are low about 90 minutes into an activity When carbohydrate stores are limited with

insufficient calorie intakes

Underfueling for your athletes will cause their body to break itself down in order to fuel their

performance!

Last But Not Least….Water

• Water is one of our six essential nutrients

• Water is just as important as the energy nutrients of carbohydrates, fats, and protein that we achieve in our diet through a variety of foods

• Essential to every body process and cell structure, achieving adequate hydration is going to be vital to the overall success of every athletes

Fluid Replacement Guidelines

• Adequate fluid intake = optimal performance

• We know that even a 1-2% loss of body weight can decrease performance by 2-5%

• Adolescents require greater diligence with hydration practices because: Surface area to mass ratio is much greater in children

than adults thus they absorb heat more easily

Children lack adequately functioning sweat glands until well into puberty

Children/adolescents experience greater heat accumulation and heat stress

• Sports drinks can be beneficial if one’s activity is greater than 60-90 minutes• New low-calorie sports drinks to consider

Jequier E, Constant F. Water as an essential nutrient: the physiological basis of hydration. Euro J Clin Nutr 2010;64:115-123.

Casa, D. et al. Fluid Replacement for Athletes. Jour Ath Tr 2000;35(2):212-224.

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Fluid Replacement Guidelines

• Depletion of body water beyond 2% of body weight can cause significant impairment to performance

2# body weight = 1L sweat loss

• Sweat loses of 1.5L/hr common in endurance with 2.5L possible in hot/humid conditions with accelerated sweat rates

• Urine should be pale but not clear• Drinking to thirst has been shown to be

adequate • Sports drinks beneficial if activity

> 60-90 minutes• Do not gain weight during activity


Electrolyte Losses

• Concentrations in mmol/L of the major electrolytes present in sweat

Sodium 40-80 mmol/L

Potassium 4-8 mmol/L

Calcium 3-4 mmol/L

Magnesium 1-4 mmol/L

Chloride 30-70 mmol/L

Most sports drinks contain 10-30 mmol/L sodium

Hydration Guidelines

• Before exercise: 16 - 24oz water 2-3 hours before exercise 8oz water 10-20 minutes before exercise

• During Exercise: 6 – 8oz every 20 minutes Can be very individualized

• After exercise: Drink 16-24 oz for every # lost

during exercise

Have athletes “practice” pre & post weights in different environments, training conditions,& temperatures to be able to rehydrate properly

Athletes need to include sodium and potassium.Athletes without medical risk can liberally use table salt.


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Hydration Do’s and Don’ts• DO start exercise well-hydrated

o weigh yourself before/after

o drink during exercise

o ingest sodium freely*

o follow your own plan

o drink plenty during meals

• DON’T rely solely on water

o over drink

o gain weight during exercise

o restrict salt in your diet

o use dehydration to lose weight

o delay drinking during exercise

Koslo, Jennifer et al. Water, Hydration, and Health: What Dietetics Practitioners Need To Know. SCAN’s Pulse 2012; 31(1):5-8.

Is It Possible To Drink Too Much Water?

Hyponatremia

• Electrolyte imbalance when water is consumed without electrolyte balance = water-intoxicated

• More common when athlete drinks too much and gains weight during activity

• When water intake exceeds water loses and causes an abnormally low plasma Na+ concentration

• S/S = diarrheaexhaustionmental confusionsyncopeconvulsions


Hyponatremia

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Working Performance Nutrition Around Their

SportWhen Athletes Eat Is Just As Important As What They Eat…

Nutrition Before Exercise• Used to increase fuel stores, consider CHO loading

• Provide adequate hydration

• Prevent both hunger and GI distress during activity

• Consumption of 1.0-4.0g/kg of CHO 1-4 hours before exercise has potential to improve endurance performance as much as 14%

• Focus on complex CHO (high fiber, low sugar, increased protein) and shift towards higher sugar more refined carbohydrates when closer to exercise

• High fiber, higher protein CHO foods (starchy vegetables, whole grains) may prolong endurance by maintaining higher blood glucose levels longer than simple sugars

• 8oz every hour within 2-3 hours before exercise

• 6 – 8oz during the 15 min before exercise

Nutrition During Exercise

• CHO ingestion between 30 and 60g/hour has positive effects Prolonged, moderate-intensity exercise (more

than 2 hours) as well as stop & go exercise of shorter duration

High glycemic carbohydrateso Sports Drink, Pretzels, Fruit newtons, PowerBar

Eating foods containing higher levels of protein or fat during activity = cramping and/or GI distress

• Both fluid and CHO are shown to have a cumulative effect on performance About 14g CHO in every 8oz sports drink Recommend 8oz every 20 min during

exercise

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Nutrition After Exercise

• Consume a mixed meal of CHO, PRO, and FATS within 30-minutes after strenuous exercise

• CHO intake of 1.5 g/kg immediately after as well as additional 1.5g/kg 2 hours later

Recovery Fuel; About 60-70g CHO for every 100#

• Use moderate to high index CHO and include small amounts of PRO (approx. 1g protein : 4g carbs)

Chocolate Milk

• Fats consumed after recovery are important to replace lipid stores after high volume endurance training

• Consume 16-24 fl oz./# lost during sport

• Need to include adequate electrolytes

Salting foods/plate is recommended for athletes

Athlete’s Plate

https://www.google.com/search?q=performance+enhancing+plate&rlz=1C1CHFX_enUS607US607&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjT4bSOscvVAhVk5IMKHYTXD7sQ_AUICygC&biw=1366&bih=638#imgrc=3SHb1Z5jF3-O6M:

Athletes Should Always Be Prepared… With Snacks

• Newtons

• Cereal bars

• Pretzels

• Mini Bagels w/ PB

• Trail mix

• Nuts, seeds

• Cheese sticks

• Raisin bread

• PB, banana sandwich

• Animal crackers

• Wheat thins

• PB crackers

• Sports bars

• Dry cereal

• Yogurt

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Packing Their Cooler

• Fluids: water, sports drink, fruit juices

• Turkey sandwiches

• Fresh and dried fruit

• Low-fat yogurt

• Vegetables

• Part-skim cheese

• Energy Bars

• Ginger snaps

• Ready to Eat cereal

• Bagels, breads, rolls

• Rice cakes

• Breadsticks

• Pretzels

• Graham Crackers

• Animal Crackers

• Fig newtons, Nutrigrain bars

• Vanilla wafers

Are there any foods athletes should just stay away from?

• Overall key is moderation

• Pre-sport

High total fat

High protein

• After Sport

Preferably Carbohydrates

Best time for almost anything!

• During Sport

High total fat

High protein

Low glycemic carb

o Fruit sugar

o High fiber

2,200 Calories

• Breakfast 2sl. Toast, 2t margarine, 2 scrambled eggs,

8oz milk, 1c fresh fruit• Snack

8oz yogurt with 1/4c granola• Lunch

12” wrap, 3oz turkey; L/T, 1t mayo; 1c fresh fruit and salad with 1T dressing

• Snack 2oz pretzels

• Dinner 1c rice with vegetables – stir fry, 3oz

chicken, 1c frozen yogurt with 1T cookie crumbles, 8oz milk

• Snack 3c butter lite popcorn 6oz yogurt

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2,500 Calories (3000 Calories)

• Breakfast yogur1.5c whole grain cereal, 8oz skim milk,

banana, t with1/2c granola (2T nuts)• Lunch

2sl whole grain bread, 2oz (3oz) turkey, 1oz cheese , 1t mayo, 4oz (8oz) chicken/rice soup, side salad w/ 1T dressing

• Pre-Px. Snack 1c seedless grapes and 2oz (3oz) pretzels

• Post Px. Snack 8oz. (16 oz) Chocolate Milk, 2 newtons, apple

• Dinner 1c (1.5c) prepared macaroni and cheese, 3oz

grilled chicken, olive oil, cooked vegetables, 8oz milk

• Snack 1/2c (1c) frozen yogurt, 2T chopped nuts

Taking A Look At…Case Study Examples

Case Study #1

How many calories should I consume for moderate to heavy training? (WSoc)

• Age 22 years, Weight = 182.0#, Height = 5 ft8 in

• Carbs: 8g/kg body weight x 4 g/kcal

(182 / 2.2) x 8g x 4 =

• PRO: 1.2 g/kg body weight x 4 g/kcal

(182 / 2.2) x 1.2g x 4 =

• FAT: 1g/kg body weight x 9 g/kcal

(182 / 2.2) x 1g x 9 =

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Case Study #1




(182 / 2.2) x 8g x 4 = 2647 kcal CHO


(182 / 2.2) x 1.2g x 4 =


(182 / 2.2) x 1g x 9 =

Case Study #1




(182 / 2.2) x 8g x 4 = 2647 kcal CHO


(182 / 2.2) x 1.2g x 4 = 397 kcal PRO


(182 / 2.2) x 1g x 9 =

Case Study #1




(182 / 2.2) x 8g x 4 = 2647 kcal CHO


(182 / 2.2) x 1.2g x 4 = 397 kcal PRO


(182 / 2.2) x 1g x 9 = 745 kcal day

Total = 3789 kcal/day

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Case Study #1

Or, 40-50 kcal x kg body weight

(182 / 2.2) x 40-50 kcal/kg =

3309 - 4136 kcal/day

Previous method = 3789 kcal/day

Case Study #2

What should I eat before and after my practice? (M bball)

• 19 yo male, Weight 185#, Height 5ft 10 in

• Before Practice:

Last meal of mixed content (preference to CHOs) @ ______ hours

Slide towards preference of _________ starches verses _____________ starches

Finally, move towards all ___________ starches pre-event

Case Study #2




Last meal of mixed content (preference to CHOs) @ 4 hours

Slide towards preference of _________ starches verses _____________ starches


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Case Study #2





Slide towards preference of simple starches verses complex starches


Case Study #2





Slide towards preference of simple starches verses complex starches

Finally, move towards all simple starches pre-event, esp. glucose and sucrose options

Case Study #2

• Examples:

@ 3-4 hours = Brown rice/fruit/dairy

@ 2 hours = yogurt, fruit, cereal

@ 1 hour = Gatorade, cinnamon/sugar graham crackers or fruit newtons

• CHO focus: 4 hours (4g x kg) = _______ CHO

3 hours (3g x kg) = _______ CHO

2 hours (2g x kg) = _______ CHO

1 hour (1g x kg) = ________ CHO

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Case Study #2

• Examples:




• CHO focus: 4 hours (4g x kg) = 336g CHOs

3 hours (3g x kg) = _______ CHO

2 hours (2g x kg) = _______ CHO

1 hour (1g x kg) = ________ CHO

Case Study #2

• Examples:





3 hours (3g x kg) = 252g CHOs

2 hours (2g x kg) = _______ CHO

1 hour (1g x kg) = ________ CHO

Case Study #2

• Examples:







1 hour (1g x kg) = ________ CHO

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Case Study #2

• Examples:







1 hour (1g x kg) = 84g CHOs

Case Study #2

After Practice:

• Use a _______ CHO:PRO ratio for recovery fuel

• Base from carbs

185# / 2.2 = 84.1 kg x 1.5g/kg = 126g Carbs Post-WO

CHO:

o Bagel 45g, Banana 30g, Yogurt 25g, Gatorade 16oz 28g = 128g CHO

PRO:

o Bagel 9g, Yogurt 8g, Turkey 2oz (14g PRO) = 31g PRO

Case Study #2

After Practice:

• Use a 4 : 1 CHO:PRO ratio for recovery fuel

• Base from carbs

185# / 2.2 = 84.1 kg x 1.5g/kg = 126g Carbs Post-WO

CHO:

o Bagel 45g, Banana 30g, Yogurt 25g, Gatorade 16oz 28g = 128g CHO

PRO:

o Bagel 9g, Yogurt 8g, Turkey 2oz (14g PRO) = 31g PRO

30

Case Study #3: Eating After An Injury

• 6’2”, 170# athlete• Post-ACL surgery and wants to know

if vitamins will help healing move faster

• Food diary has shown 2,500 calories, 228g CHO, 117g PRO, and 105g FAT


• 6’2”, 170# athlete• Post-ACL surgery and wants to know

if vitamins will help healing move faster

• Food diary has shown 2,500 calories, 228g CHO, 117g PRO, and 105g FAT

• Diet changed to, 3,500 calories to include 558g CHO, 112g PRO, and 95g FAT


• 170# / 2.2 x 30 kcal/kg = 2318 kcal/day maintenance

• 2318 x 1.5 very active = 3477 kcal/day total requirement

• Vitamin C aids collagen formation

• Vitamin A is needed for cell growth and development, bone development, and aids immune function

• Zinc is involved in wound healing

31

Case Study #3: Eating After An Injury - Vitamin C

Baked potatoes CabbageTomatoes Broccoli Oranges / orange juice Red bell peppersStrawberries GrapefruitPapaya Cantaloupe

Recommended Dietary Allowance (RDA) is 90 milligrams per day for men and 75 milligrams per day for women.

Do not take more than 2,000 milligrams per day

Case Study #3: Eating After An Injury - Vitamin A

Liver Sweet potatoes

Carrots Mango

Turnip greens Spinach

Papaya Red bell peppers

Recommended Dietary Allowance (RDA) is 900 retinal activity equivalents per day for

men and 700 RAE per day for women.

Do not take more than 3,000 RAE (10,000 IU) per day

Case Study #3: Eating After An Injury - Zinc

Meat Seafood

Sunflower seeds Almonds

The Recommended Dietary Allowance is 11 milligrams per day for men and 8

milligrams per day for women

Do not take more than 40 milligrams per day

32


Sample Meal Plan For Rehab & Recovery

• Breakfast

Banana, 8oz 1% milk, 8oz OJ, 1c instant oatmeal (cooked)

• Snack

12oz sports drink, 1c fruit salad, 4 graham crackers, 1T PB

• Lunch

Roast beef sandwich w/ mustard, small French fries, 1/2c coleslaw, water

• Snack

(1) Orange, 1oz pretzels or crackers, 1oz cheese stick

• Dinner

3c cooked spaghetti, 2c marinara sauce, 2oz lean ground beef, tossed green salad, veggies for salad, 1T Italian dressing, 2 T sunflower seeds, 2 slices Italian bread, water

• Snack

1c vanilla frozen yogurt, topped with 1c fresh berries

Taking Responsibility

• Athletes are responsible for follow-through with their coach…the nutrition care team should not be an exception!!

• Everyone is different – all nutrition plans will be different & cookie cutter approaches or comparative nutrition goals should be avoided.

• Balanced nutrition for athletes will often involve schedules and diligence rather than “feeling”

• Athletes should be responsible for their individual fueling plan

Nutrition On The Go

Meal Substitutes

Trying new foods

Packing appropriate snacks

Water bottle / fluids

In Summary

• Eat approx. 40-50 / 50-80 calories per kg per day with at least 5-10g of carbohydrates per kg per day for + energy balance

• Eat 1.2 – 2.0g of protein per kg per day with lean protein foods spaced fairly evenly at every meal

• Eat some good fats with every meal

• Pre-fuel with carbohydrates 1-2 hours before activity and consume recovery fuel of carbohydrates and protein within 30-60 minutes after sport

• Be diligent with your eating schedule! It’s not always based on “hunger”.

• Eat plenty of vegetables, but their calories will not be a significant contribution to your overall intakes. They provide a wealth of micronutrients but are too low in calories to make a difference in performance.

33

Thank You!!

Jennifer M. Doane, MS, RD, CSSD, LDN, ATC

Advantage Nutrition & Wellness, LLC

2005 City Line Road, Suite 104

Bethlehem, PA 18017

610-443-1885

www.ANWnutrition.com

[email protected]

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