Download “athlete”… - eatrightsc

Michelle Rockwell MS, RD, CSSD
Sports Dietitian – Durham, NC
[email protected]
Define “athlete”…

Anyone who is physically active or
exercises on a regular basis

We should all be working with athletes!
EXERCISE GUIDELINES
6 days/week (30-60 min)
 US Surgeon General
 American Heart Association

All RD’s can apply Sports Nutrition
strategies to their clients
We have a new board certification!

CSSD= Board Certified as a
Specialist in Sports Dietetics

159 CSSDs in U.S.

Sports Dietetics Practitioner:
experienced RD’s who apply evidence-based nutrition
knowledge in exercise and sports. They assess, educate, and
counsel athletes and active individuals. They design,
implement, and manage safe and effective nutrition strategies
that enhance lifelong health, fitness, and optimal performance.
Become a CSSD!

Current Registered Dietitian (RD) status.

Maintenance of RD status for a minimum of 2 years by
the date of the CSSD exam.

Documentation of 1,500 hours of specialty experience as
an RD within the past 5 years (by the date the
application is due).
o
o

Deadline for Summer, 2008 CSSD exam is MAY 7!
Education can count toward up to 1200 hours until May, 2009.
Successful completion of CSSD exam.
Visit www.cdrnet.org for more information!
My Philosophy

Performance
&

Health
through

Good Taste
Sports Nutrition:
Recommendation Considerations

Population of athlete

i.e.: child, Master’s, college/elite, non-competitive

Background

Exercise intensity

Exercise duration

Exercise frequency
Calorie Needs for Athletes
10-30%
TEF
5-10%
55-75%
Energy Expenditure Varies Widely!
Examples:

Female Olympic Gymnasts
1900 kcals/day
McNickols MSSE 55:187-91, 1996

High School Soccer Players (females)
3300 kcals/day
Burke et al J Sports Sci 24:675-85, 2006

Tour de France Cyclists
7069 kcals/day
Saris et al Int J Sports Med 10:26-31, 1999
Energy needs
Basic caloric requirements:
15-30 kcal/pound
Sample:
160-pound marathon runner
160 X 25-30 = 4,000 – 4,800
Energy Needs
Estimated Daily Energy (Calorie) Needs for Training
Training/workouts
Calories/#
120#
160#
280#
Low (sedentary)
13 to 15
1,560 – 1,800
2,080 – 2,400
3,640 – 4,200
Active
(30 to 60min/d )
16 to 18
1,920 – 2,160
2,560 – 2,880
4,480 – 5,040
Moderate
(1 to 1 ½ hr/d)
19 to 21
2,280 – 2,520
3,040 – 3,360
5,320 – 5,880
High
(1 ½ to 2 hr/d)
22 to 24
2,640 – 2,880
3,520 – 3,840
6,160 – 6,720
Very High
(2 to 3 hours/d)
25 to 30 or more
3,000 – 3,600
4,000 – 4,800
7,000 – 8,400
RMR Measurements in Real Athletes

Football player – 6’7”, 230#
o

Female Gymnast – 5’1”, 130#
o

predicted: 1320, actual: 1160
Male Runner – 6’0”, 155#
o

Estimated: 2300, Measured: 3450
predicted: 1620, actual: 1400
Male Rower – 6’4”, 210#
o
predicted: 2100, actual: 1750
Note: RMR estimation equations are not specific for
athletes!
Calorie Considerations

When working with athletes, consider potentially
huge fluctuation in calorie needs based on
training periods, off-season, injury, growth, etc.

Teach concept of “Nutrition Periodization”
Injury and energy needs
• Female collegiate swimmer -
12,000yards/day (6/week) +
weights 3 days/week
= 3800 calories/day
• Shoulder injury no swimming
= 2200 calories/day
• Shoulder surgery w/ complications
= 4000 calories/day
Meal Timing & Frequency
Guideline: Eat multiple times/day
Regardless of WEIGHT goals
 Problem: “Bottom Heavy” Diets



Time, schedule, avoiding eating before exercise
Importance



Energy availability
Protein synthesis
BODY COMPOSITION
Inter-Day Energy Balance

Those with wide deviations in energy balance during the
day have highest body fat – regardless of whether the
energy deviations are surpluses or deficits

Muscle protein may be broken down to maintain blood
glucose
Breakfast
Provide practical examples
 Sleep and time are precious to athletes
 Educate that people who eat breakfast have:







Better weight control
More appropriate caloric intake
Greater academic performance
Greater energy availability
Improved hydration status
Better intake of fiber, calcium, iron, zinc, fruit, and
whole grains
Satiety Index of Breakfast Foods
210.0
180.0
150.0
120.0
90.0
60.0
30.0
0.0
Croissant
Yogurt –
Strawberry
White
Bread
Granola – Special K
Oats,
Fruits,
Nuts
Corn
Flakes
Source: Holt et al. European Journal Clinical Nutrition 1995, 49:675-690.
Bananas
Eggs –
Poached
Wheat
Oatmeal
Bran
Cereal
(14g Fiber)
Macronutrient Basics
Macronutrient Needs
2025%
1520%
5565%
CHO
Protein
Fat
Carbohydrate & protein
needs may be better
expressed as absolute
grams rather than as % of
kcals.
Carbohydrates…FUEL

Carbohydrate Needs:
30 min – 1 hr moderate exercise: 4-6g/kg
1 hr intense training/day: 7g/kg
1-2 hrs intense training/day: 8-9g/kg
2-4 hrs intense training/day: 9-10g/kg
**Ultraendurance athletes: >12g/kg
150-lb Mom who does
aerobics classes:
300g Carbs/day
150-lb Lance Armstrong:
800g Carbs/day
Carbohydrates: Practical Issues

Carbohydrate-loading really works



3 days out…100-150 extra grams CHO + ↓exercise
Athletes benefit from carbohydrates during intense
exercise (↑physical & mental, ↓fatigue)


“Glycogen Supercompensation”
30-60grams/hour recommended
Consider half-time and during-event carbohydrate
options
Protein…Growth, Strength, Repair

Protein needs:



1.2-1.7g/kg
Some research supports up to 2g/kg
…so, more than the average person, but not as
much as many athletes regularly eat!
Protein Scorecard for Athletes

~10 grams protein in:





1 ounce meat, tofu, or equivalent
2 eggs
1 cup milk/yogurt or 1 ounce cheese
2/3 cup beans
1/3 cup nuts or 2T peanut butter
Animals
&
Plants
Protein: Is more better?
+
+
Food
=
Supplements
How much is too much?
Research has shown a CEILING above which no
further benefits occur
Protein synthesis

200-lb
athlete
No exercise
Strength trained
.9g/kg
80g
protein
1.4g/kg
130g
protein
2.4g/kg
220g
protein
Tarnopolsky et al. JAP, 1992
Individuals with higher protein needs:

New training program

Energy restriction
o
Intentional (diet)
o
Non-intentional (extreme expenditure)

Vegetarians

Disease/disuse

Injury rehab

Young or old athletes
These aren’t the
people typically
using protein
supplements!
What’s the big deal about getting
too much protein?

“Don’t you just excrete it?”

Potential impact on:

kidney, bone, hydration status, etc. ?

intake of other nutrients
o
o
o
o

Fat (can be excessive)
Carbohydrates (can be inadequate)
Vitamins & minerals (can be inadequate)
Fiber (can be inadequate)
hormonal regulation of muscle growth
If the athlete insists on following a
high protein diet:
 Focus
on lean protein sources
 Emphasize

ample carbohydrates
Encourage whole grains, fruits, veggies
 Consider
micronutrient supplement
Why should athletes follow a
low-fat diet?

Allow for adequate CHO and protein intake

Minimize gastrointestinal upset

Control body weight

Prevent chronic disease
Keep athletes’ backgrounds in mind

Many genetically gifted in terms of body
composition…never “worried” about nutritional
intake before

Example…US Soccer National Team Member diet
analysis: 62% kcals from fat

Teach sources of HEALTHY fats and their value:
flax, fish, oils, avocado, nuts, seeds, etc.
Fast Food Education

Popular, realistic, only option for some budgets
(especially teams)

Small changes, big difference:

Egg and cheese on…
o
o
o
…English Muffin = 10 grams of fat
…Biscuit = 25 grams of fat
…Croissant = 32 grams of fat
Sports RDs & Food Service

Use meal planning opportunities for
EDUCATION!
Micronutrients

Do athletes have enhanced vitamin
& mineral needs?

Consequences of micronutrient
deficiencies may be greater to
athletes than sedentary people
Use message of
communication most
influential to each athlete
EX: Calcium
General Vitamin & Mineral Needs

Recommend DRI, but <UL

Perhaps higher needs for:



Sodium and electrolytes
Iron
Antioxidants
o

Vitamin C & respiratory infections, muscle damage?
B-vitamins
Stress Fractures

What is a stress fracture?


A skeletal defect that results from repeated application of stress
that is less than that required to fracture a bone in a single
loading, but greater than the bone’s ability to recover fully.
Stress Fracture Commonalities:



15% of female athletes in 5 year period at one DI university
95% of all stress fractures occur in the lower extremities
A study of 5900 college athletes revealed no significant
difference between male and female susceptibility to stress
factors. However, when looking specifically at track and field
athletes, women’s incidence for stress fracture’s was nearly
doubled.
Feingold et al. Female athlete triad and stress fractures.
Orthop Clin North Am. 2006 Oct;37(4):575-83.
Female Athlete Triad
Disordered Eating
Amenorrhea
most often due
to energy drain
– not very low
body fat!
Poor Bone
Health
Menstrual
Abnormalities
Remember that disordered eating exists on a continuum!
Female Athlete Triad’s effects on
Stress Fractures

Osteoporosis, a BMD standard deviation of 2.5 below the
normal level, characterizes the third component of the
female athlete triad.



Can result from depleted estrogen levels
OR inadequate energy, protein, calcium, and/or Vit. D intake
associated with restrictive eating
Always screen for TRIAD with menstrual abnormalities, stress
fractures, or restrictive eating
Calcium Needs for Athletes
Age
(years)
14-18
Calcium
DRI
(mg)
1300
19-30
1000
31-50
1200
>50
1200

Recommend 1500mg2000mg/day especially
for females, amenorrheic,
high sweat loss (some
calcium is lost in sweat)

Be prepared to
recommend non-dairy
sources and supplements
Keeping Athletes On the Field

What athletes eat on a consistent basis can have a
significant impact on their overall health and
immunity.

By enhancing an athlete’s diet with more antiinflammatory foods, athletes may recover faster and
manage chronic inflammation better.
Antioxidants

Antioxidants help protect the body from harmful
free radicals.

Free radicals can damage tissues, cells, and
genes. They occur in the environment and are
naturally produced by the body.


A natural type of “rusting”
Antioxidants neutralize free radicals before
damage to cells and tissue occurs.
Colors
Fruits and Veggies
Green
Broccoli, Brussels Sprouts, Bok Choy,
Cauliflower, Cabbage, Kale, Collards,
Mustard Greens, Green Peppers, Kiwi,
Spinach, Limes, Leeks, Avocados
Orange/Yellow
Oranges, Tangerines, Yellow Grapefruit,
Peaches, Lemons, Papaya, Pineapple,
Nectarines
Red/Purple
Red Grapes, Purple Grape Juice, Cherries,
Berries, Plums, Prunes, Raisins
White
Onions, Chives, Garlic
Adapted from: Heber D., Bowerman S. What Color is Your Diet? (2001)
Immunity Nutrients





Carbohydrates
Fluids
Vitamin A
Vitamin E
Vitamin C
o


higher levels may help reduce incidence of respiratory infections,
overtraining syndrome, and muscle damage
Zinc
Omega-3 fatty acids
o
o
o
also important for joint health and decreasing inflammation
omega-3 fatty acids in fish oils (1-3 g/day with mixed DHA and EPA)
have also been found to reduce inflammation in and around the
joints
flax seeds/oil, borage oil, and evening primrose oil may also benefit
“I have NO ENERGY”

Common reason to consult with Sports RD

Distinguish type of “tired” and causes:



Tired all the time
Wake up tired in the morning, sleepy during day
Fatigue upon exertion
o
o
Could be: ↓calories, ↓carbs, “overtraining syndrome”, ↓quality
overall, dehydration, mental health issues, iron deficiency
Note that iron deficient athletes typically report fatigue during
exercise
Iron Deficiency & Anemia in Athletes

Iron deficiency without anemia may have
performance detriment



Female athletes with Hgb > 12 g/dL, but low ferritin levels were
given iron or placebo for 6 weeks. Those on iron grew fitter and
cycled faster. Thus, even women with ferritin greater than 12
g/dL can be “functionally anemic.”
What is appropriate ferritin goal for various athletes?
Consider relative anemia

Value of baseline and routine screening
***Reference: GSSI Sports Science Exchange: Anemia and Blood
Boosting, Randy Eichner, 2001. www.gssiweb.com.
Incidence of Iron Deficiency & Anemia

Typically thought to be higher in females
and endurance athletes

BUT in a recent study of 100 high-level
basketball players,

Low ferritin was found in 37% of females and
14% of males.

Full iron deficiency anemia was noted in 14% of
females and 3% of males.
Dubnov and Constantini, Int. J. Sport Nutr. Exerc Metab.
14:30-37, 2004.
Iron Deficiency and Anemia



Identify High Risk Populations
Screen Properly – Hgb & Ferritin
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
Monitor Side Effects
Reassess Status
Therapy for Deficiency and Anemia

Typically FeSO4 325 mg (65 mg of elemental iron)
2-3x/day


may be absorbed better between meals
Hemoglobin should rise about 1 g/dL each week,
and half way to normal in 3 wks, and to WNL in
2 months.
Hydration

General fluid guidelines:

At rest: Is it really 8 glasses a day?
• A recent study indicates that nearly half of all active
people begin their workout inadequately hydrated.
Stover et al. Can J Appl Phys, 28:s105, 2003

Drink 2or3 cups 1-2 hours BEFORE exercise

At least 2 cups per hour of exercise
o

Studies have repeatedly shown that people do not do
a good job replacing fluids lost through sweat
3 cups for every pound lost during exercise
Inadequate fluids result in:














performance (strength, speed, stamina)
mental sharpness and willpower
recovery
metabolic rate
perceived effort of exertion
core body temperature
risk of injury
Dehydration Impairs Attentiveness
in Basketball Players

11 male players

Dehydrated to 1%, 2%, 3%, or 4%

As dehydration progressed, the players
exhibited slowed response time and
inattentiveness to cues (computer-based
testing)

The authors determined these differences in
response would likely lead to costly errors in
a basketball game
Med. Sci. Sports Exerc. 2007 39:976-983
Heat Illness

DEHYDRATION allows the body to heat up faster!

Heat cramps

Heat exhaustion

Heat stroke


Can be fatal
Several cases of high school, college, and NFL tragedies
How can athletes tell if they are
drinking enough?

Clear urine, frequent bathroom trips

Absence of thirst
Hydration…Practical Issues

Remember:







Should be a focus in cold weather too!
Drink on a schedule!
Gulps over sips
Swallow instead of spit
In, not on
Cool, not ice cold
Taste preferences change during exercise
Sodium loss

Can be as high as 3000-7000mg per hour in the
heat.

Note that athletes have different sweat rates,
electrolyte sweat content, and these may
change with training
Pass the salt!

Restricted sodium diets can actually be detrimental to
athletes!

Athletes exercising in the heat should eat salty foods,
add salt to meals, and use a sports drink containing
sodium!
When to use which drink?
Water
Vs.
 Propel
Vs.
 Gatorade Thirst Quencher
Vs.
 G2 (New)

 Long exercise (> 45 min to 1 hour)
 Intense exercise
 HOT, sweaty exercise
 When performance matters
How about Vitamin Water? Accelerade?
Stop and Go Simulation

One week apart, 9 male players completed 75 minutes of
shuttle runs followed by intermittent running to fatigue
(performance trial).

These intermittent, high-intensity shuttle runs were designed
to replicate activity patterns of stop and go sports. They
consisted of intermittent running, including maximal sprinting
interspersed with less intense periods of running and walking.

The athletes drank either a 6.9% carbohydrate-electrolyte
drink or placebo immediately prior to exercise (5 ml per kg)
and every 15 minutes thereafter (2 ml/kg).
Nicholas et al., J Sports Sci. 1995; 13(4):283-290
RESULTS: Shuttle Run Test
8.9 min.
6.7 min.
0
2
4
CHO trial
Placebo
6
8
10
Time of Exercise to Fatigue

Conclusion: A carbohydrate-electrolyte drink improved
performance during intermittent, high-intensity exercise.
Nicholas et al. J Sports Sci. 1995; 13(4):283-290
Other important sports
nutrition issues
Dietary Strategies for
Weight Gain
Gaining Lean Body Mass
Hormonal
flux
Macronutrient
ingredients
Stimulus via
exercise
Strategies for Increasing
Lean Body Mass

Increase caloric intake by 1000 to 1500/day


Emphasize BALANCE of nutrients


Consider restrictive mindset in those trying to lose body fat as well
Carbs are needed for muscle gain…not just protein
Get adequate protein
Strategies for Increasing
Lean Body Mass

Increase meal frequency (every 2-3 hours)




Particularly important to split protein intake
Maximize “fueling opportunities”
Use liquid calories!
Eat before strength training

10g essential amino acids + carbs
Practice good recovery nutrition
 Consistency



Weekdays AND weekends, on AND off days
Nutrition AND training
Diet Affects Hormones

Insulin



Growth Hormone





levels reduced by chronic high protein diet
secretion inhibited by high levels of circulating fatty acids
initiates protein synthesis
act of eating induces IGF-1 synthesis in muscle
Testosterone



anabolic impact on muscle, prevents breakdown
Insulin-like Growth Factor-1 (IGF-1)


anabolic impact on muscle, prevents breakdown
Athletes need carbs!
stimulates muscle growth
testosterone levels are significantly reduced after a high fat meal or an episode of “binge”
drinking (> 4 drinks)
Cortisol


stress hormone that interferes with muscle-building
carbohydrate intakes may help blunt cortisol release
Meet Chris
20 year-old “gym rat”
5’10”, 170 pounds
Goal: increase LBM…FAST!
CAN’T gain weight and “I’ve tried everything”
Claims to “eat all the time”
Self-restricts carbohydrates because “I don’t do
cardio and I’m trying to cut body fat”
 Spends $180/month on sports foods/drinks






• Bars, shakes, energy drinks
• Complains that healthy foods “cost too much”
Chris’ Current Diet
Breakfast: protein shake
Lunch: 2 cans tuna, 2 slices cheese, low-carb pita,
nuts, unsweet ice tea
3pm: 2 energy drinks, protein bar
5-8: practice & workouts, recovery shake post workout
9:00: 2 chicken breasts, sweet potato, cottage cheese,
1/3 carton sugar-free ice cream (oops! Hungry and craving
sweets)
11:00: protein shake
Nutritional Analysis for Chris
Energy
Actual: 3700 cals (includes ice cream)
Needs: 4700 cals (22 cals/lb + 1000)
CHO
Actual: 175 grams
Needs: 575 grams (50% cals)
Pro
Actual: 350 grams
Needs: <170 grams (1 gram/pound)
Main
recommendations
Larger
breakfast
Lots more carbs, especially throughout day
Replace protein with “safe” carbs such as oatmeal,
fruits, veggies, brown rice, dairy, beans
Change bars or shakes to carb-containing products or
REAL food
Add 100% juices
Add multivitamin
Eat foods just for TASTE occasionally
Weight Loss…Practical Issues


They want it fast and easy
Fad diets can have risky consequences











But do reduce carbs slightly, increase protein slightly
Should be during off-season
Rate should be 1-3 pounds/week
Cut typical calories by 500-800
Do not jeopardize energy level for training
Eat smaller portions more frequently
Fill up on veggies, fruits, soups, lean proteins
Increase fibers
Reduce sugars and fats
Watch liquid calories
Hydrate especially well (athletes may mistake thirst for hunger)
Pre-competition meal

GOAL: Restoring liver glycogen, raising BS, preventing hunger,
“settling stomach”

Ideally high carb (3-5g/kg), moderate protein, low fat, with fluids
and salt and PALATABLE 3-4 hours before game


Then use 1 hour “top off” CHO snack or drink

Pre-comp meal CAN be closer to event if tolerated
(example of early morning events)
What to do with the athlete who says:
“If I eat anything before I play I’ll throw up!”
THINK LIQUIDS!
o
Also produces lower stool residue for weight class sports or athletes sensitive
to “bulky” feeling
Recovery Nutrition

Defined: helping athletes bounce back for
future exercise bouts

Considerations:
o
o

Intensity and duration of exercise
When will athlete exercise again?
Nutritional Recovery Goals:
1. Glycogen restoration
2. Fluid/electrolyte replacement
3. Muscle repair and adaptation
Recovery Nutrition

General daily diet & hydration status
Pre-competition meal, fuel/fluids during exercise
Training status

Post-Exercise Recovery Period


WINDOW OF
OPPORTUNITY for
important gains
Recovery Nutrition
(for intense, dehydrating exercise)

Ingredients & Timing

Fluids
o
o
o
o

Carbohydrates
o
o
o

24 ounces for every pound lost during exercise within 2 hours
Need 150% of fluid loss to compensate for urine production
Achieve body weight within 1% of “start weight” before next session
Including sodium beneficial
.5 grams/kg body weight within 30 minutes
TOTAL of 1.5 grams/kg body weight within 2 hours
High glycemic index preferred
Protein
o
o
10-20 grams protein within 30 minutes
Does protein source matter?
Barriers & Benefits to
Recovery Nutrition

Barriers





Suppressed appetite
Food/fluid availability
Habits, sport routine
Perceived impact on weight
Benefits





Enhanced performance in future exercise
Lowered injury risk in future exercise
Better compliance to training program
Promotion of positive energy balance for weight gain
Appetite control for meals
Personalize Recommendations

What recovery nutrition recommendations might
you give these individuals?
Recovery Options

Regular foods & drinks
&/OR


Sports foods & drinks

Readily available

Easily transported and stored

Inexpensive (?)

Do-able DAILY
What does the research say about
post-exercise protein source?
Sports MNT
Cardiovascular Risk Factors
1.
2.
3.
4.
5.
6.
7.
8.
9.
Age
Sex
Heredity
High cholesterol and blood pressure
Diabetes
Obesity and overweight
Physical inactivity
Stress
Tobacco, alcohol

Increased incidence of high cholesterol, HTN, pre-diabetes, and
obesity among YOUNG athletes in some sports

Ethical challenge for Sports RD’s!
19 Year Old Male Shot-Putter



Weight = 295lbs.; Height 6’4”
TC = 325mg/dL; LDL 185mg/dL
Advice he practices:



Eat high volume of food 6 times per day
Eat low fat diet
Increase cardiovascular exercise
o

But resistance from coach
Food treatment strategies

Help athletes recognize that food can work FOR them
Added: beans & legumes, nuts, margarines with plant sterols, oatmeal,
whole grain cereals, fresh fruits, avocado, oil-based salad dressings

TASTE= WOW!, TC down to 240 in 6 months

50 Year Old Male Runner



Runs about 6 miles/day, now training for marathon (his 5th)
Family history of HTN, recently diagnosed with HTN
Advice he practices:



Eat a low sodium diet
Problem = consistent muscle cramping in longer runs
Food treatment strategies



Increase dairy (currently 1 serving/day)
Increase veggies to 4-5 servings of each/day
Determine if he’s SALT SENSITIVE
o
o
Many individuals ARE NOT
Experiment with Na content of diet and timing of Na intake
(before/during/after exercise only?)
Muscle Cramping Inventory
Adequate fluids?
 Adequate sodium?



Sodium loss via sweat VARIES individually
Can be 3000mg/hour; case studies of 7000mg/hour
Adequate other electrolytes?
 Adequate glycogen stores?
 Not a nutritional issue at all?

Gastrointestinal Issues
Some are more frequent with athletes
 Some are exacerbated by physical activity



Meal timing, dehydration, high calorie needs,
hormonal effect on digestion, sports foods, jostling of
stomach, shift of blood flow from GI tract to skeletal
muscle, competition issues
Issues: GERD, IBS, “runner’s diarrhea,
constipation, gastritis, Celiac
Issues to Address with GI Problems












Timing/spacing
Anti-inflammatory meds
Hydration issues
Low fiber
Excessive sports foods
Excessive sugar alcohols
Excessive fruit juices or highly concentrated drinks
Caffeine/alcohol
Food allergy or intolerance
Lactose intolerance?
Fructose intolerance?
Dietary supplements
Athlete-Friendly/ GI-Friendly Foods

Probiotics
o
o
o
Probiotics are live microbial foods and food supplements that
can be beneficial by improving microbial balance
The most widely studied and utilized probiotics are the lactic
acid bacteria (Lactobacillus and Bifidobacterium species)
Just 1 yogurt/day with active cultures enhances the body’s
ability to enhance digestion.
Dried fruits or fruit bars (Fig bars, cereal bars)
 Oatmeal, nuts, beans
 Value of liquid calories before/during activity

Current Sports Nutrition Topics on
the Horizon






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
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Macro & micronutrients during exercise
Nutrition periodization
Inflammation
Recovery and healing
Food allergies & intolerances
Sickle cell trait
Heat illness/heat stroke
Nutrition and genetics
Fitness vs. Fatness and mortality/health
What happens after competition ends

Changes in weight and nutritional needs, mental health status,
results of concussion, long term effects of supplementation,
orthopedic issues
Dietary Supplements
Most commonly used in sports:
Anabolics or muscle builders
 Weight loss or fat loss supplements
 Energy boosters
 Herbs
 Vitamin-mineral supplements

Evaluate dietary supplements for:
1. Legality
Check ncaa.org and other sport-specific
guidelines
2. Safety
3. Purity
4. Effectiveness
Questions to ask…
1. Are claims backed in solid age-specific research?
2. What are the possible side effects?
3. Is the supplement legal, necessary and appropriate?
4. Is the company reputable?
5. Is it worth the risk? For athletes, the risk can be very great.
6. Is the athlete doing everything possible with his or her diet
FIRST before relying on a supplement?

NEW CONCERN: athletes and staff being so careful that they are
missing out on potentially valuable supplements
Dietary Supplements…Mislabeled?
Extensive results of over 100 common nutrition supplements by
Advance Supplement Testing Systems found:
Pyruvate:
Label says: 500 mg per tablet
Tested at: 106 mg per tablet
Bulk
Builder:
Label says: 50 g protein; 0 g carbohydrate
Tested at: 4 g protein; 53 g carbohydrate
In many reviews: 20% of supplements contained a
banned substance (not on the label)
Online tools for dietary
supplement assessment
1.
www.consumerlab.com: Obtain a
listing of all categories of
supplements that have passed
their tests for quality and purity.
Good overview of supplement
categories, reasons for use, and
safety. Yearly fee: $30.00
Online tools for dietary
supplement assessment
2.
www.naturaldatabase.com:
Determine exact ingredients,
potential benefits, potential side
effects and drug/supplement
interactions. Updated frequently
by pharmacists. USP check.
Yearly fee: $92.00
Online tools for dietary
supplement assessment
3.
http://www.nsf.org/Certified/Dietary/ :
NSF Certified Dietary Supplements
Program.



Verify the identity and quantity of dietary ingredients
declared on product label.
Ensure the product does not contain undeclared
ingredients or unacceptable levels of contaminants.
Demonstrate conformance to currently
recommended industry GMPs for dietary
supplements.
Growth Hormone (HGH)

Obviously banned. Side effects can include
swelling, joint pain, diabetes symptoms,
increased risk of some cancers.

Adequate sleep can increase levels.

High fat, excessive protein, high stress
hormones can decrease levels.
Invasion of the Energy Drink

Energy drinks do not
provide REAL
energy…they just
help athletes feel
energized.

Energy drinks are
different from sports
drinks

Contain caffeine, other
stimulants, sometimes
sugar, herbs, vitamins,
etc.

Some safety concerns
for athletes

Use nutrition, hydration,
and lifestyle changes to
improve energy level
Caffeine Common Forms
Common Form
Average Amount of Caffeine
Fixx Energy Drink (20 ounces)
500 mg
Coffee, Drip (16 ounces)
170 mg
Rockstar Energy Soda (16 ounces)
150 mg
Sky Rocket Caffeinated Syrup (1 oz.)
100 mg
Diet Pepsi Max (16 ounces)
92 mg
Red Bull Energy Drink (8 ounces)
80 mg
Mountain Dew soft drink (16 ounces)
75 mg
Most soft drinks (16 ounces)
50 mg
Espresso, 1 ounce shot
40 mg
Brewed tea (8 ounces)
40 mg
Jolt gum (1 piece)
40 mg
Typical
caffeine tabs: 200 mg/each
Vivarin tablet: 200 mg/each
Energy Drinks




Some caffeine may enhance performance (dose for
many athletes = 2mg/pound 1 hour before exercise)
Individual tolerance varies…some experience
nervousness, jitters, headaches, tachycardia, GI
symptoms
It’s difficult to determine how much caffeine (or other
stimulants) is in energy drinks. 100 to 650mg have been
reported.
Concerns with alcohol…putting one foot on the gas and
the other on the brakes.
Combine with Caution!
•Many manufacturers of “ephedra-free” products also
commonly combine stimulants with aspirin-like
substances in an attempt to mimic the “ECA Stack”
with ephedrine, caffeine, and aspirin.
•Many caffeine-containing herbs and supplements
interact with grapefruit juice (enhanced CNS effect).
•Watch for combinations like: (1) Willow bark, green
tea, and bitter orange; (2) Green tea, mate, and kitjitsu;
(3) Caffeine, green tea, mate, guarana, and willow bark
NO2 (arginine) based supplements




Amino acid necessary for protein synthesis. Found
naturally in meat, fish, poultry, and dairy.
Arginine is the substrate for NOS enzyme, increasing
NO (nitric oxide), causing vasodilation.
No long-term studies on safety. Several anecdotal
reports of concerning symptoms (severe headaches,
rapid changes in blood flow, syncope, blood
pressure changes).
May pose high risk for athletes who have known or
unknown vascular problems.
NO2 supplements
Warning ON LABEL: For men only and not intended for use by persons under
18. Do not use if you have a myocardial infarction (heart attack). May cause
flushing and itching. Consult a medical doctor before use if you have been
treated for, or diagnosed with, or have a family history of, any medical
condition including (but not limited to) cardiovascular, central nervous system,
or genito-urinary problems, cold sores, or if you are using any prescription or
over the counter medication(s). Inhalation may amplify the inflammatory
airway response in people with asthma. One scoop of this product contains
about as much caffeine as between one and one and a half cups of coffee. Do
not consume with other arginine products or other sources of caffeine (e.g.,
tea, coffee, or cola beverages). Do not take within 4 hours of exercising.
Discontinue use and call a medical doctor immediately if you experience
irregular heart beat, chest pain, dizziness, headache, nausea, or other similar
symptoms.
Creatine



Creatine is synthesized in the liver, kidney, and
pancreas and supplied through the diet
Primary food sources are meat and fish; usual diet in
the U.S. provides 1-2g/day
Recommended dose: 3-5g/day


NO LOADING period necessary unless need for rapid reach of
maximal phosphocreatine stores!
Most studies of repetitive, short-duration (<30 sec.),
high-intensity tasks (strength training in particular)
suggest modest improvement in performance
Maximize creatine in foods
Food
 8 ounces pork:
 8 ounces salmon:
 8 ounces beef:
 8 ounces cod:
Grams Creatine
1.1
1.0
1.0
0.7
Supplemental Creatine Dose:
3-5 grams/day
Beta-Alanine
A non-essential amino acid found both in the
body and in food (i.e. chicken)
 Rate-limiting substance to carnosine
production in the muscle cell
 Carnosine buffers hydrogen ions in the
muscle (delaying the “burn”)
 Typical doses: 3-6 grams/day

Beta-Alanine Proposed Benefits:
Boosts explosive muscular strength &
power output.
 Increases muscle mass
 Boosts muscular anaerobic endurance
 Increases aerobic endurance
 Increase exercise capacity to train harder
and longer

Beta-Alanine
In one recent study in 15 trained male sprinters, betaalanine supplementation (4.8g/day)



Increased muscle carnosine levels
Attenuated muscle fatigue in repeated bouts of
exhaustive contractions
Did not improve isometric endurance or 400m race
times.
Derave et al. J Appl. Physiology August 2007
10.1152/japplphysiol.00397.2007
One Last Thought…
Whenever possible, if you recommend against using a
supplement, have a plan for helping your athlete
meet the goal he felt the supplement was helping
with.
For example, if amino acids are not recommended,
provide a plan for the athlete to maximize amino
acids in protein on a daily basis.
If stimulants are not recommended, show how to
provide more modest boosts of caffeine in safe
forms.
Important teaching concept

Fitness is more important than fatness!

Don’t let your recreational exercisers forget it!

In a survey of women health club members, subjects said they
would rather have a car accident, lose a job, go through a
divorce, and even get cancer than gain 50 pounds.
o

GLAMOUR Magazine, 2005
LOSS OF PERSPECTIVE!!
For further information:

Gatorade Sports Science Institute


www.gssiweb.com
SCAN

www.scandpg.org
• Nutrition and athletic performance: position of the American
Dietetics Association, Dietitians of Canada, and the American
College of Sports Medicine. JADA 2000: 1543-56 (revision due 2007)
…available on www.eatright.org
For further information:

American Council on Exercise


American College of Sports Medicine


www.acefitness.org
www.acsm.org
The Physician and Sports Medicine

www.physsportsmed.com
Michelle Rockwell MS, RD, CSSD
[email protected]
Susan Kundrat MS, RD, CSSD
[email protected]