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2014 Pediatric Orthopaedic & Sports Medicine Seminar
Saturday, November 8, 2014
Sports Nutrition
Diane King, R.D., C.S.S.D., A.T.C./L.
♦ All handouts are the property of the presenters and are not to be reproduced without permission. If
handouts are not included for the session, they were not provided by the presenter.
A Practical Approach to Sports
Nutrition: Helping Athletes
Make Better Choices
Diane King, MS, RD, CSSD, ATC
Children’s Healthcare of Atlanta
Certified Specialist in Sports Dietetics
Athletic Trainer, South Forsyth High School
• Identify healthy eating and hydration strategies
that help athletes optimize their performance
• Identify meal timing strategies
• Develop a supplement
education process for
athletes and their parents
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• Athletes want a fix
and they want it fast
• Athletic Trainers and
Sports Dietitians
must educate the
athlete on the
appropriate way to
make choices
regarding a healthy
eating plan
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Performance Nutrition Means…
• Fueling to boost activity
performance on a daily basis
• Fueling to decrease the risk of injury
and recover fully after workouts to stay healthy
• Fueling with foods that taste
good, foods that can be
prepared easily, and foods the
athlete feels confident eating
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Consequences of Poor Nutrition
• Weight loss
• Strength loss
• Lethargy
• Chronic Fatigue
• Soreness, joint pain
• Micronutrient Deficit
• Respiratory Infections
• Diminished Performance
• “Overtraining Syndrome”Children’s Healthcare of Atlanta
Challenges to an Athlete’s Diet
• Good nutrition may be common sense, but it is not
common practice
• Hectic schedules
• Little knowledge about:
Basic nutrition
Eating for Growth and Development
Meal Timing
Eating for Performance
Eating Out or Eating on the Run
• Optimal nutrition isn’t always a priority
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Myth: Athletes Should Not Eat
White Foods – Bread, Potatoes,
Rice, Etc
MYTH: Carbs always turn into fat.
FACT: In a balanced diet, carbohydrates fuel
your muscles.
Athletes need carbs to function properly.
Remember, any foods eaten that
exceed your energy needs will
contribute to fat storage.
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Why Athletes Need
• Muscle glycogen is the primary fuel of choice for
exercise. Repeated strenuous bouts of exercise
deplete these stores.
• The body does not have a large storage
capacity, so carbohydrates should be eaten at
meals and snacks on a consistent basis.
• Fruits, vegetables, whole
grain breads/cereals, dairy
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Strategies for Estimating Daily
Carbohydrate Intake
Type of Athlete
Daily Estimate Training Time
grams/ kg
5 - 7 g/kg
1 – 2 hours,
Ultra Endurance
7 - 10 g/kg
> 10 g/kg
Up to 2 hrs, cont.
3 – 4 hours
Team Sports
6 - 8 g/kg
1 – 2 hours
Higher during
Sample Athlete
Male soccer player
Trains 2-3 hr/day
165 lbs = 75kg
8gm CHO/kg =
600 gm CHO
That means little to nothing to most athletes.
So how much can I have?
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Sources of Carbohydrates in Foods
Bread Slice/ Tortilla, 1
Piece of Fruit
Quaker Oat Squares, 1 c
Yogurt, strawberry, 1 c
Pancakes, (3) 4” round
Chewy Granola Bar
Instant Oatmeal, 1 package
Noodles, egg, 1 c
Milk/ Chocolate Milk, 1c
Carbohydrate grams
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How Much is
Quaker Oat Squares, 2 cups
Vanilla Greek Yogurt, 1 cup
600gm of CHO?Dried Cranberries, 1/3 cup
Pasta, 3 cups
Spaghetti Sauce, 1 cup
Garlic Bread, 2 slices
84 g
43 g
32 g
Poptart, Frosted, 1
Skim Milk, 2 cups
Pizza, 2 servings
Apple Juice, 2 cups
Chocolate Milkshake, large
609 g
Protein Is Essential
• Protein promotes normal growth and
development in a young athlete.
• A younger athlete needs a slightly higher intake
than a teenager or adult.
• Female athletes may need
more protein for energy
availability if treating an
eating disorder.
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Myth Buster
• Athletes need extra protein because they need
to build muscle.
• Boys need protein
more than girls.
• There’s no such
thing as too much
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Protein Is Essential
• Protein is used to build, repair and maintain
tissue. It promotes normal growth and
development in a young athlete.
• A male athlete can utilize approximately 14-30
grams every 3-4 hours.
• A female athlete can
utilize 7-21 grams in
the same time period.
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Strategies for Estimating Daily
Protein Intake
Type of Athlete
Daily Estimate Training Time
grams/ kg
1.6 – 2.2 g/kg
1 – 2 hours,
Ultra Endurance
1.2 – 2.0 g/kg
1.6 – 2.0 g/kg
Up to 2 hrs, cont.
3 – 4 hours
Team Sports
1.2 – 1.6 g/kg
1 – 2 hours
130 lb (59 kg) x 1.4 – 1.6 g/kg = 83 – 95 grams protein
175 lb (79.5 kg) x 1.4 - 1.6 g/kg = 111 - 127 grams protein
Sources Of Protein In Foods
Protein grams
5 oz. chicken breast (one half)
4 oz. lean sirloin steak
4 oz. turkey slices
1 cup mixed nuts
1 large hamburger
2 cups milk
2 eggs
2 Tbsp. peanut butter
1 oz. cheese
1 slice cheese pizza
42 g
34 g
25 g
23 g
22 g
16 g
12 g
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Pre-Exercise Fuel
• Provide energy to working muscles
• Maximize blood sugar and glycogen stores
• Provide a psychological edge
• Minimize hunger during play
• Maximize hydration
• Be individualized
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Pre-Practice Snack Ideas
Trail Mix
Rice cakes
100% Juices
Cheese Crackers
Chocolate Milk
Dry Cereal
Dried Fruit
Graham Crackers
Sports Bars
Fresh Fruit
Fig Bars / Low-fat Cookies
Granola Bar
Raisin Bread
Dried Fruits
Peanut Butter Crackers
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Pre-Exercise Meal
• Purpose: Hydrate, provide glucose for fuel, satisfy hunger, delay
fatigue during exercise
• Timing: 3-4 hours pre-exercise or game, sometimes less
• Meal Combination: 50-70% carbohydrate, moderate protein, low fat,
low fiber
• Hydration: approximately 2 cups of fluid 2 hours before
• Grilled chicken breast, 2 cups pasta, marinara sauce & fruit salad
• 3 oz lean steak, 2 cup potatoes w/skin, green beans, 1 cup pasta
salad & roll
• Wheat bagel sandwich w/3-5 oz turkey or ham, lettuce, tomato,
mustard, 1 cup pasta salad or fruit & ½ a sports bar
Finicky Stomach:
• Meal replacement shake or smoothie (w/protein)
• Sports drink and sports bar
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Game Day Nutrition
• 1 or less hours between games – fruit, sports drinks, fruit
based smoothie, dried cereal and juice
• 2 or less hours between games – same as above, may also
tolerate meal replacement such as Ensure or other milk
based product; sports bars – PowerBar, Luna, Balance Gold
• 3 or less hours – waffles/ pancakes; chicken or turkey
sandwich, fruit; pasta with tomato sauce, bread; baked
potato with low fat cheese, thick crust cheese or veggie
pizza; juice or milk
• 4 or more hours between games – eggs, breakfast meat,
pancakes, beverage; grits with cheese, toast, yogurt; chicken
breast with rice or pasta, fruit juice or milk; 6 inch sub
sandwich with baked chips, beverage
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During Exercise
• Very individualized to athlete’s sweat rate, but a
general rule is 5-10 oz water or sports drink every
15-20 minutes
• After one hour of exercise, make sure you are
consuming some carbohydrate, sports drink or other
• When extremely hot and humid, rely more on a
sports drink to ensure adequate carbohydrate and
electrolytes (sodium, chloride, potassium); you may
also need to drink a greater quantity
• Consumption 40-65 g/hr or .5-1.0 g/kg/hr
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Nutrition Recovery Goals:
Fluid & electrolyte replacement
• Muscle repair and adaptation
Glycogen restoration
Muscles replace glycogen @ 5% /hour
20-24 hrs post exercise to maximally
replenish glycogen stores
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Immediately Post-Exercise
• Purpose: Enhance the rate of carbohydrate repletion in muscles &
restore fluids and electrolytes
• Composition: Consume foods with 1.0-1.5g carbohydrate per kg body
wt ( ~50-70g) plus ~10-20 g protein. May include moderate-high glycemic
index foods
• Timing: Within 30 minutes of ending exercise
• Hydration: Consume 20-24 oz of fluid (water or sports drink) for every
pound lost during exercise
• Examples: • 12-16 oz smoothie with 1 scoop whey protein powder
• 1 sports bar plus 16 oz sports drink
• Bagel with peanut butter plus 1 cup low-fat chocolate milk
• 2 cups cereal plus low-fat milk
• 1 oz string cheese, 1 medium apple
• Commercial recovery beverage
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Myth: Athletes Should Not Eat After 6pm
• It might be uncomfortable to go to bed on a full
stomach, and you could have trouble with reflux.
• If you have calculated the appropriate number of
daily calories, how they are distributed is of less
• Night time calories are needed and used for
repair and recovery.
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Post-Exercise Meal
• Purpose: Accelerate recovery. Provide carbohydrate to resynthesize
muscle glycogen; provide protein to aid muscle repair; replace fluid and
electrolytes lost in exercise
• Timing: Within 2 hours post-exercise or game
• Composition: 1.0–1.5 g carbohydrate per kg body wt & ~10-20 g protein
• Hydration: 16-20 oz water/sports drink and continue until fluid losses are
• Examples:
• 2 cups macaroni & cheese, 1 cup green beans & 1 cup low-fat milk
• Spaghetti with meat sauce, green salad & wheat roll
• 3 oz lean steak, 2 cups potatoes w/skin, 1 cup broccoli, 1 cup
pasta salad & wheat roll
• Whole wheat pita sandwich with 3-5 oz turkey or ham, lettuce, tomato,
mustard, 1 cup pasta salad & 2 tangerines
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Recovery Fluids
Sports Drinks, like Gatorade – CHO only
Sports Drinks – CHO/ Pro combo
Chocolate Milk
Fruit Smoothies
Fruit Juice
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Are You Sure You Are Hydrated?
• Your athlete will say “but I drank water all day”.
• Pale Like Lemonade, Not Dark Like Apple Juice
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Recommended Intakes For Athletes
• Timing
2 hours before
2 cups
10-15 minutes before
2 – 2 ½ cups
Every 15-20 minutes during
After Activity
½ - 1 cup
2 - 3 cups for
every pound
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Energy Drinks
• Rock Star, Full Throttle, Red Bull, Cocaine,
Bawls, Spark
• Significant increase in athletes using it as
a food substitute, especially girls.
• May provide a quick boost of energy, followed by
a rapid drop in blood sugar.
• Will increase core temperature.
• May increase rate of dehydration
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Caffeine Contents
Starbucks, Grande (16 oz) – 400 mg
Redline Power Rush, 2.5 oz – 350 mg
NOS High Performance, 8 0z – 343 mg
Cocaine Energy Drink, 8.4 oz - 280 mg
NOS, 16 oz – 260 mg
No Doze, 1 tablet – 200 mg
Crunk, 16 oz – 150 - 200 mg
Coffee, avg. 12 oz – 150 mg
Red Bull, 8 oz – 80 mg
Iced Tea or Soda, 12 oz – 25 - 35mg
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Caffeine Toxicity
• In Consumer Reports recent tests
of 27 top-selling energy drinks,
11 did not list caffeine amounts.
• Emergency room visits from energy
drink consumption now tops 13,000 annually.
This is a 10-fold rise between the years 2005
and 2009.
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Myth: Sports Drinks And Energy
Drinks Are The Same, Right?
• Energy drinks are not meant for hydration.
– Most athletes don’t need the “special”
ingredients (read the label)
– They’re expensive
– They often contain caffeine which
can increase fluid loss
– They may contain too much carbohydrate
which can upset the stomach
• Sports drinks replace fluid, carbohydrates and
electrolytes lost in sweat
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Help or Hype
• Many of these products contain caffeine or other
stimulants. The body’s reaction to these
stimulants can be unpredictable, especially
since these act synergistically in the body.
• Drinking energy drinks before
a practice or competition can
throw off your mental game and
hamper your concentration.
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What About Supplementation?
• To supplement the body with nutrients it may not
receive from food (ex. Multivitamin)
• To regenerate disrupted/damaged muscle tissue
after exercise training
• To ensure sufficient calorie intake
• To enhance recovery or refill your gas tank
• This is a day-to-day process (ex. Tour De France, or repeated 2-a day
football practices)
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Vitamins for Athletes
• Look for no more than 100% USRDA of any one vitamin
or mineral
• Take only one each day
“Mega Men”
 20 vitamins & Minerals listed
 11 in amounts > 100% US
 3 in amounts > 1000% US
 18 other substances
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Calcium in the Diet
• Only 13.5% of girls and 36% of boys age 12-19
meet their recommended intake of Calcium.
• Nearly 90% of adult bone mass is established in
this age period – 1300mg
• Milk does contain saturated fat, but also other
• Consider Calcium fortified choices
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Antioxidants Help Immune
Vitamin A
Vitamin C
Vitamin E
Vitamin B6
Vitamin B12
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Illness and Immune Function
• Carbohydrate foods, more than individual
antioxidants, act to decrease the suppression in
the immune function from strenuous exercise.
• Studies done regarding upper respiratory
infections during heavy periods of exercise
indicate they are most likely due to stress
hormone shifts: cortisol and adrenaline. Vitamin
C won’t likely prevent this illness.
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Eating For An Injury
• Certain nutrients are needed
for wound healing.
• Vitamin C – helps with collagen formation.
• Vitamin A (carotenes)– assists with cell growth
and development, bone development and
immune function.
• Zinc – plays a role in wound healing.
• Protein – more may be needed if infection is
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Supplements Used by Athletes
• Potentially Safe & Beneficial Supplements
– Creatine
– Whey and Casein Proteins
– Carb/Protein Shakes (recovery, weight gain, meal
– Glutamine (Amino Acid) and Branched Chain Amino Acids
– Vitamins E & C
– Omega 3 Fatty Acids – Flax and Fish Oil
– Chocolate Milk – effective and inexpensive
• Potentially Hazardous Supplements
– NO2 – NO Explode or Arginine Alpha Keto-Glutarate
– Weight loss products/Stimulants (even Ephedra Free)
– Energy Drinks (Red Bull, etc.)
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What’s The Problem with Use in Youth?
• Dangers of athletes purchasing supplements
– Don’t understand ingredient list
• Most supplements have multiple ingredients
(especially Weight loss pills)
– Side effects caused by supplement
– Appropriate dosage for safe supplements
• “More is better”
– Exact reason why they are taking them
– Sold by someone who has less knowledge than they do
(supplement store employee, gym employee, or even a
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Signs A Supplement May Be
Third Party Certification Programs
US Pharmacopia– dietary supplement verification
program approved quality product seal:
NSF Certified for Sport
NSF NFL/ NFL Players Association Certification
Informed Sport -
Informed Choice -
HFL Sports Science
Supplement Resources
• Need help?
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HFL 2007
• 58 supplements were purchased from popular
retail stores and internet sites in the United
• The screen used detects the presence of low
levels of steroids and stimulant contaminants
that are considered prohibited by World AntiDoping Agency (WADA).
• One-fourth of the samples had contaminates not
listed on the label.
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Case Study
• It’s two weeks before Jane’s sectional gymnastics meet and she cuts down on her calories since she is training less. After eating this way a week, she is feeling irritable and tired. Her legs are sore and it takes a long time to get warmed up when she goes to practice. Mom panics and calls the doctor, the PT and the health food store. You need to convince Jane that cutting out more calories is not the best way to train even when the workouts are starting to taper off. Food is fuel and she’s running on empty. Her weight is 130 lbs (or 59 kg). She is 5’4” and she is 16 years old.
• Basic calorie needs: (12.2 x weight in Kg) + 749 ‐> (12.2 x 59) +749 = 1470 calories for minimal metabolism
• Multiply this number by activity factor = 1470 x (1.6 – 1.8) = 2350 ‐ 2646 calories
• Carbohydrate grams = BW in Kg x 5 to 8 (since it is a lighter training period. During heavier training, she may need 7‐10g/kg) = 295 ‐ 472 • Protein Grams = BW in kg x 1.2 – 1.6 since she is in a taper season = 71 ‐94
Source: World Health Organization. Energy and Protein Requirements. Report of a Joint FAO/WHO/UNU Expert Consultation. Technical Report Series 724. Geneva Switzerland: World Health Organiztion; 1985
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Jane’s Meal Plan
Initial Food Log
16 oz water
2 c Iceberg Lettuce
With Tomato/Cucumber
3 T Fat‐Free French Dressing
1 c Honey Nut Cheerios
(pre‐workout) ½ c Skim Milk
Revised Food Log
1 T Peanut Butter
1 cup orange juice 15
16 oz Water
(post workout) Dinner
4 oz Baked Chicken
1 Baked Potato
1 ½ c Broccoli
1 c Skim Milk
1 c Fat‐Free, Sugar‐Free 25
White Chocolate Pudding
1122 calories, 213 g carbohydrate, 58 g protein
2 c Iceberg Lettuce
With Tomato/Cucumber
Green Pepper/ ½ c Mushrooms 25
3 T Fat‐Free French Dressing
Turkey Sandwich, 3 oz meat 230
1 c skim milk
½ c Kashi Go Lean Crunch 100
(pre‐workout) 1/2 c Low Fat Yogurt
95 110 160
20 oz Sports Drink
(post workout) 1 Nutrigrain bar 100 Dinner
4 oz Baked Chicken
1 Baked Potato
1 ½ c Broccoli in olive oil 1 c Skim Milk
1 c strawberries
2010 calories, 361 g carbohydrate, 87 g protein
Case Study
• Andre is a 10th grade defensive tackle. He is training for the high school combine because he wants to play college football. His playing weight has been about 240‐
245. He just had a growth spurt of 2” in the past 6 months. His coach tells him he wants him to be 265 by March for colleges to look at him. The first day he checks in with you after his playoff game in December, he weighs 241. He tells you he is eating as much as he can but just doesn’t feel hungry. What’s next?
• Basic calorie needs: (15.3 x BW in Kg) + 679 ‐> (15.3 x 113.6) + 679 = 2417 • Multiply this number by activity factor = 2417 x (2.0 – 2.2) = 4835 ‐5852 calories
• Carbohydrate grams = BW in Kg x 6 to 8 grams per kg = 678 ‐ 904 • Protein Grams = BW in kg x 1.8 – 2.0 since he is in a strength building cycle = 203 ‐
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Andre’s Meal Plan
2 Fried Eggs
1 Slice Toast
1 tsp Butter
16 fl oz Water
80 35
Morning Workout 1.0 hours of Weight Training Class Mid Morning Snack Water
Pepperoni Pizza, 2 slices 625
Side Salad with Dressing 260
Apple, 1 95
Sports Drink, 20 fl oz. 160
Afternoon Workout 2.5 Hours of Running and Football Drills Afternoon Snack 1 Peanut Butter/ Jelly 410
1 c Lowfat Milk 120
Dinner 8 oz Hamburger Patty
Hamburger Bun 120
1 c Baked Beans
1 c Corn
120 16 fl oz Water
Evening Snack Frosted Flakes, 1 c
½ c Milk 147
3305 Calories, 395 g carbohydrate, 155 g protein, 126 g fat
Breakfast 1 large Blueberry Muffins
2 cups Cran‐Apple Juice
Morning Workout 1.5 hours of Weight Lifting
Morning Snack 12 Fl oz Recovery shake 360 Mid Morning Snack 3” bagel
2 Tbsp. Cream cheese
Snack cup mandarin oranges 290
100 65
Lunch 2 Chicken Pot Pies 1 c. Mixed Vegetables 2 nectarines
Sports Drink, 20 fl oz 620
Afternoon Workout 2.5 Hours of Running and Football Drills Afternoon Snack .5 c trail mix with salted nuts and chocolate pieces
12 Fl oz Recovery Shake
(Boost Plus) 350
Dinner 8 oz Grilled Chicken Breast
2 dinner rolls with margarine
1 c brown rice
1 c steamed broccoli
2 svg fresh fruit salad
240 45
Evening Snack
2 Peanut Butter / Jelly Sandwiches 2 c Lowfat Milk
240 5400 calories, 762 g carbohydrate, 257 g protein, 168 g fat
Food is Fuel Summary
• Strategies to help athletes maintain their “fuel
– Encourage athletes to eat breakfast even if it is small
– Liquid meal supplements may be useful when in a
– Focus on “grab & go” foods
– Focus on foods with
carbohydrate and protein
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Food is the primary tool for safe and
effective training and performance
Teach athletes to make good
choices and stay healthy for a
Diane King, MS, RD, CSSD, ATC
Certified Specialist in Sports Dietetics
[email protected]
Children’s Healthcare of Atlanta