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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 Objectives • 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 Children’s Healthcare of Atlanta Reality • 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 Children’s Healthcare of Atlanta 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 Children’s Healthcare of Atlanta 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 Children’s Healthcare of Atlanta 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. Children’s Healthcare of Atlanta Why Athletes Need Carbohydrates • 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 Children’s Healthcare of Atlanta Strategies for Estimating Daily Carbohydrate Intake Type of Athlete Daily Estimate Training Time grams/ kg Strength 5 - 7 g/kg 1 – 2 hours, Stop-n-Go Endurance 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 tournaments 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? Children’s Healthcare of Atlanta Sources of Carbohydrates in Foods Food __ 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 12g 20-25g 42g 43g 24g 17g 30g 37g 20g Children’s Healthcare of Atlanta 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 120g 22g 30g Poptart, Frosted, 1 Skim Milk, 2 cups 38g 24g Pizza, 2 servings Apple Juice, 2 cups 46g 60g Chocolate Milkshake, large 110g TOTAL 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. Children’s Healthcare of Atlanta 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 muscle. Http://www.athlonsports.com/overtime/most-ridiculous-bodybuilding-photos Children’s Healthcare of Atlanta 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. Children’s Healthcare of Atlanta Strategies for Estimating Daily Protein Intake Type of Athlete Daily Estimate Training Time grams/ kg Strength 1.6 – 2.2 g/kg 1 – 2 hours, Stop-n-Go Endurance 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 Food 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 8g 7g 7g Children’s Healthcare of Atlanta 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 Children’s Healthcare of Atlanta Pre-Practice Snack Ideas • SNACKS TO THROW IN YOUR BACKPACK OR GYM BAG OR VENDING MACHINES - Grab n’ Go Food Bagel 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 Pretzels Dried Fruits Peanut Butter Crackers Nuts Muffins Shakes Children’s Healthcare of Atlanta 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 • • Examples: • 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 Children’s Healthcare of Atlanta 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 Children’s Healthcare of Atlanta 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 Children’s Healthcare of Atlanta Recovery 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 Children’s Healthcare of Atlanta 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 Children’s Healthcare of Atlanta 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. GERD • If you have calculated the appropriate number of daily calories, how they are distributed is of less consequence. • Night time calories are needed and used for repair and recovery. Children’s Healthcare of Atlanta 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 replaced • 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 Children’s Healthcare of Atlanta Recovery Fluids • • • • • Sports Drinks, like Gatorade – CHO only Sports Drinks – CHO/ Pro combo Chocolate Milk Fruit Smoothies Fruit Juice • NOT ENERGY DRINKS • NOT DILUTED FRUIT JUICES • NOT SODA Children’s Healthcare of Atlanta Are You Sure You Are Hydrated? • Your athlete will say “but I drank water all day”. • Pale Like Lemonade, Not Dark Like Apple Juice Children’s Healthcare of Atlanta Recommended Intakes For Athletes • Timing 2 hours before Amount 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 lost Children’s Healthcare of Atlanta 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 Children’s Healthcare of Atlanta 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 Children’s Healthcare of Atlanta 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. Children’s Healthcare of Atlanta 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 Children’s Healthcare of Atlanta 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. Children’s Healthcare of Atlanta 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) Children’s Healthcare of Atlanta 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 RDA 3 in amounts > 1000% US RDA 18 other substances Children’s Healthcare of Atlanta 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 nutrients. • Consider Calcium fortified choices Children’s Healthcare of Atlanta Antioxidants Help Immune Function? • • • • • • • • Vitamin A Vitamin C Vitamin E Vitamin B6 Vitamin B12 Zinc Selenium Glutamine Children’s Healthcare of Atlanta 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. Children’s Healthcare of Atlanta 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 present. Children’s Healthcare of Atlanta Supplements Used by Athletes • Potentially Safe & Beneficial Supplements – Creatine – Whey and Casein Proteins – Carb/Protein Shakes (recovery, weight gain, meal replacement) – 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.) Children’s Healthcare of Atlanta 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 coach) Children’s Healthcare of Atlanta Signs A Supplement May Be Harmful Natural testosterone booster Aromatase inhibitor Increased testosterone Testosterone booster Third Party Certification Programs US Pharmacopia– dietary supplement verification program http://www.usp.org/USPVerified/dietarySupplements/ ConsumerLab.com approved quality product seal: http://www.ConsumerLab.com/seal.asp NSF Certified for Sporthttp://nsf.org/business/athletic_banned_substances/inde x.asp?program=AthleticBanSub NSF NFL/ NFL Players Association Certification http://nsf.org/business/nfl_nflpa/index.asp?program=NFLPA Informed Sport - http://www.informed-sport.com/ Informed Choice - http://www.informed-choice.org/ HFL Sports Science Supplement Resources • Need help? • www.usantidoping.org • www.usada.org • www.drugfreesport.com • http://www.fda.gov/medwatch • www.consumerlab.com Children’s Healthcare of Atlanta HFL 2007 • 58 supplements were purchased from popular retail stores and internet sites in the United States. • 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. Children’s Healthcare of Atlanta 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 Children’s Healthcare of Atlanta Jane’s Meal Plan Initial Food Log Breakfast Bagel 16 oz water Lunch 2 c Iceberg Lettuce With Tomato/Cucumber 3 T Fat‐Free French Dressing Snack 1 c Honey Nut Cheerios (pre‐workout) ½ c Skim Milk 195 0 Revised Food Log Breakfast Bagel 1 T Peanut Butter 1 cup orange juice 15 25 70 Lunch 125 45 16 oz Water 0 (post workout) Dinner Snack 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 15 With Tomato/Cucumber 25 Green Pepper/ ½ c Mushrooms 25 3 T Fat‐Free French Dressing 70 Turkey Sandwich, 3 oz meat 230 1 c skim milk 90 Snack ½ c Kashi Go Lean Crunch 100 (pre‐workout) 1/2 c Low Fat Yogurt 95 WORKOUT 2 HOURS Snack 195 95 110 160 210 66 90 WORKOUT 2 HOURS Snack 20 oz Sports Drink 150 (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 160 210 125 90 Snack 1 c strawberries 50 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 ‐ 226 Children’s Healthcare of Atlanta Andre’s Meal Plan Breakfast 2 Fried Eggs 1 Slice Toast 1 tsp Butter 16 fl oz Water 180 80 35 0 Morning Workout 1.0 hours of Weight Training Class Mid Morning Snack Water Lunch 0 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 Sandwich 1 c Lowfat Milk 120 Dinner 8 oz Hamburger Patty 560 Hamburger Bun 120 1 c Baked Beans 320 1 c Corn 120 16 fl oz Water 0 Evening Snack Frosted Flakes, 1 c ½ c Milk 147 60 3305 Calories, 395 g carbohydrate, 155 g protein, 126 g fat Breakfast 1 large Blueberry Muffins 2 cups Cran‐Apple Juice 420 335 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 90 140 160 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 375 220 240 45 180 Evening Snack 2 Peanut Butter / Jelly Sandwiches 2 c Lowfat Milk 800 240 5400 calories, 762 g carbohydrate, 257 g protein, 168 g fat Food is Fuel Summary • Strategies to help athletes maintain their “fuel tanks” – Encourage athletes to eat breakfast even if it is small – Liquid meal supplements may be useful when in a hurry – Focus on “grab & go” foods – Focus on foods with carbohydrate and protein Children’s Healthcare of Atlanta 360 Conclusion Food is the primary tool for safe and effective training and performance Teach athletes to make good choices and stay healthy for a lifetime Diane King, MS, RD, CSSD, ATC Certified Specialist in Sports Dietetics [email protected] 404‐354‐0008 Children’s Healthcare of Atlanta
