Exam 3

Youth and adolescent athletes

-Difference between child and adolescent athletes -Growth and development -Carbohydrate intake -Protein intake -Fat intake -Fluid intake -Micronutrient intake -General nutrition recommendations

Androstenedione

▪Anabolic steroid used to increase blood testosterone ▪Andostenedione, androstenediol & DHEA are often referred to as prohormones (meaning human body converts them to testosterone) ▪Bottom Line: Not safe, not effective, a banned substance

Protein intake

▪Dietary recommendation is 0.8-1.0 gm/kg BW for non-active adolescents ▪Upper limit for protein intake for adolescent athletes in training is 1.7 gm/kg BW

dietary supplements

▪"A dietary supplement is a vitamin, mineral, herb, botanical, amino acid, metabolite, constituent, extract, or a combination of these ingredients."- United States Food and Drug Administration

Certifying dietary supplements

▪"Legal Supplements" can test an athlete positive on a drug test from being "laced" or contaminated ▪Consumer Lab - www.consumerlab.com ▪United States Pharmacopeia - www.usp.org?USPVerified ▪NSF - www.nsf.org?consumer/dietart_supplements ▪NSF Certified for Sport - www.nsfsport.com ▪App: NSF Sport

Review of protein needs

▪0.8 gm/kg BW per day for sedentary individuals ▪1.0 gm/kg BW per day for recreational exercise ▪1.2-1.4 gm/kg BW per day for those who regularly engage in endurance activities (1.5-1.75 times the current adult RDA) ▪1.6-1.7 gm/kg BW per day for those who regularly engage in resistance training (2.0-2.1 times the current adult RDA) ▪2.0 gm/kg BW per day for those engaging in extreme exercise & heavy weight lifting

Pregnant athletes and weight gain

▪1st Trimester - no extra calories needed ▪2nd Trimester - additional 340 calories needed ▪Example: Nature Valley Granola Bar & 10 oz 2% milk ▪3rd Trimester - Additional 450 calories needed ▪Not in addition to the 340 calories, but 450 calories total from pre-pregnancy ▪110 calories in addition to 2nd trimester ▪Example: ½ cup oatmeal (measured dry), 2 Tbs. peanut butter & 8 oz 1% milk

Nutrient timing for recovery

▪2-Hour Window of Recovery ▪Most important time to consume plenty of carbohydrate, protein, & fluids to replenish & refuel ▪Greater capacity to take up nutrients (why?) ▪Blood flow to muscles is greater ▪Muscle cell is more sensitive to insulin ▪0-45 minutes ▪Optimal time...the body is incredibly sensitive to nutrient absorption! ▪45 minutes - 2 hours - try to get a nice-size meal or larger snack Essential if participating in twice a day training

Review of fat (1/3)

▪20-30% of total calories ▪Anything less does not show performance enhancement ▪Essential Fatty Acids ▪Consume at least 3-5% of dietary fat from food sources such as fish and plant oils ▪Consequences of low-fat diets in athletes ▪May not meet energy demands for growth & development in young athletes ▪Could cause deficiencies in fat-soluble vitamins & essential fatty acids over time ▪In females, low-fat diets can contribute to menstrual dysfunction

Vitamin D

▪Activated by the sun, but many athletes may train indoors, in the cold with lots of clothes or wear sunscreen ▪IOM recommended dose is 600 IU/d, but up to 2000 IU/day ▪Bottom Line: Safe, may have performance benefits if supplementing when there is a deficiency

Vegetarian athletes

▪Additional groups that can be considered vegetarian include: ▪Macrobiotic vegetarian - Avoids most animal-derived foods and emphasizes unprocessed organic foods ▪Pesco vegetarian - Does NOT eat red meat or fowl ▪Eats dairy and egg products with fish occasionally ▪Pollo vegetarian - Does NOT eat red meat or fish ▪Eats dairy and egg products with fowl occasionally ▪Semivegetarian - tries to limit meat consumption ▪"Meatless Monday"

Nutrient timing: during workouts (2/4)

▪All simple sugars, such as glucose, sucrose, and maltodextrin (e.g., Polycose, glucose polymers), are absorbed rapidly from the gut ▪Appears to be no physiological advantage of one type of simple sugar over the other, but is more of a personal preference ▪Most sports drinks use a combination of sugars with glucose, sucrose, fructose and maltodextrin ▪Different pathways

Physiological aids

▪Altitude training ▪Blood doping ▪Nasal strips ▪Hypoxic tents

Pregnant athletes and exercise

▪American College of Obstetrics & Gynecologists (ACOG) suggest all women in low-risk pregnancies should be exercising most days of the week ▪150 minutes of moderate-intense activity over week ▪Women that are medically pre-screened with no contraindications can exercise at 60-80% VO2Max ▪New guidelines use maternal age & fitness level ▪Starting a low-intensity exercise program, while pregnant, 3 days a week may limit fatigue from pregnancy ▪The best time to increase duration of exercise is in 2nd trimester when many pregnancy-induced discomforts are minimal ▪Strength training exercise should be lower weight, high repetitions for most women ▪Exercise pre-cautions in pregnant women: ▪Avoid exercise in the supine position past 16 weeks ▪Avoid exercise with rapid direction changes and jarring of joints because of potential relaxation of ligaments and joint instability ▪Avoid abdominal exercises as pregnancy progresses if diastatis recti is present (tearing of connective tissue line around abdomen) ▪Avoid exercise in the heat and humidity due to increased maternal temperature ▪Focus on correct posture which is neutral pelvic alignment to help prevent injury

NSF stamp

▪At the request of the National Football League (NFL) and the National Football League Players Association (NFLPA), NSF has developed stringent criteria for product certification under the NFL/NFLPA Supplement Certification Program. ▪In addition to requiring NSF Certification to dietary supplements or functional foods criteria, the program requires each product lot to undergo analytical testing to ensure the absence of any substances banned by the NFL/NFLPA ▪In addition to the strict NSF Dietary Supplements and Functional Foods Program requirements, products certified under the Official NFL/NFLPA Supplement Certification Program must meet the following stringent criteria

Fueling after injury

▪Athletes should eat often over the course of the day averaging 5-8 meals and snacks ▪Carbohydrates (whole grains & fruit) based on training levels ▪Quality protein at each meal and snacks ▪Sprinkling in healthy fats throughout the day ▪Eating plenty of vegetables ▪Decrease intake of saturated fat, processed and high sugar foods ▪Consume post-workout carbohydrate-protein snack within 45 minutes to promote recovery from training ▪Continue to try to eat anti-oxidant rich, anti-inflammatory foods when available

Nutrient timing: morning training

▪Athletes that train early cannot always eat 2-4 h prior workout ▪Recommend quick CHO snack ▪Moderate to high GI goods ▪Food or drink with ~50 g CHO ▪Fruit (if tolerant) ▪Energy bar (Luna, Zone, Clif, Power Bar) ▪Sports drink ▪Low-fat granola ▪Plain bagel or dry cereal ▪Shake with carbohydrate and protein Whey protein mixed with water or skim milk, fruit

Review of Glycemic index (1/2)

▪Based on the blood glucose response compared to a reference food ▪Reflects the rate of digestion and absorption ▪High GI Foods ▪Glucose, bread, potatoes, breakfast cereal, sports drinks ▪Medium GI Foods ▪Sucrose, soft drinks, oats, tropical fruits ▪Low GI Foods ▪Fructose, milk, yogurt, lentils, pasta, nuts, apples, oranges

Recovery nutrition- sample eating day

▪Breakfast ▪½ oats (measure dry) with 2 Tbs. chopped walnuts, ¾ cup blueberries, 1 egg & 2 egg whites and 8 oz low-fat milk ▪Snack ▪¼ cup homemade trail mix (1/8 cup nuts & 1/8 cup dried tart cherries, blueberries, acai berries) and 6 oz low-fat Greek yogurt ▪Lunch ▪Smoothie with 1 scoop whey protein, 1 ½ cups spinach, 1 banana, 1 cup strawberries, water and ice with 15 almonds and whole grain granola bar ▪Snack ▪1 apple with 1 Tbs. natural peanut butter and 1 cup baby carrots ▪Dinner ▪4 oz salmon, large sweet potato, 2 cups spinach salad with 1 Tbs. pine nuts, ½ cup raspberries and olive-oil based balsamic dressing ▪Snack ▪Low-fat string cheese, 15 grapes and 2 small 70% dark chocolate bites ▪Contains: 11.5 vegetable/fruit servings and 115-120 grams protein

Review of protein

▪Build/repair muscles, hair/nail growth, boosts immunity, RBC production ▪Lean meat ▪Chicken, turkey, lean ham, lean red meat, fish, tuna, turkey bacon and turkey sausage ▪Take the skin off of meat - high in fat ▪Eggs and egg whites ▪Low-fat dairy products ▪Milk, cheese, yogurt, cottage cheese ▪Whey protein powders and smoothies/shakes made with it...whey protein absorbs very quickly ▪Nuts, seeds, peanut butter have some protein

Pharmacological aids

▪Caffeine ▪Creatine ▪Anabolic steroids ▪Protein supplements

Review of glycemic index (2/2)

▪Can be used to help "fine tune" athlete's food choices ▪Should not be the main indicator ▪Pre-exercise - low GI foods to sustain energy ▪During exercise - medium-high GI foods for "quick" energy ▪Post-exercise - higher GI foods to promote quick recovery ▪Glycemic Load ▪Combination of macronutrients alters the Glycemic Index response of a given meal

Nutrient timing: Post exercise goals

▪Carbohydrate - Replenish ▪Body NEEDS lots of carbohydrate post-exercise to replace energy stores ▪Nearly 90% of the dietary CHO consumed post-exercise is deposited in muscle glycogen ▪Simple carbs are best: milk, sports drink, fruit, juice ▪Protein - Rebuild ▪Body needs some protein to start repairing tiny muscle tears ▪Ideally 20 gm protein immediately post-workout ▪10 gm seems to show benefit to athletes who need less calories post-workout ▪Whey protein is the highest in BCAAs, specifically leucine which has been shown to re-synthesize muscle the fastest after a workout ▪The three R's to post-workout recovery: ▪Replenish carbohydrate burned during exercise ▪Repair damage done to lean muscle mass ▪Rehydrate the body to euhydration

Nutritional aids

▪Carbohydrate loading ▪Sports drinks ▪Beetroot juice ▪Nitrates ▪Improves recovery

Carbohydrate

▪Carbohydrate recommendations range from 3 - 12 g/kg/day for athletes ▪College, elite, and other competitive athletes participating in heavy training may benefit from higher carbohydrate consumption ▪Aim to consume closer to the upper range of 7 - 12 g/kg/day ▪Smaller female athletes, athletes that are trying to decrease body weight or fat stores, and athletes partaking at a level that demands less training (such as off season training or a recreational athlete) may only need 3 - 5 g/kg/day

Nutrient timing: During workouts (1/4)

▪Carbohydrate-rich foods/drinks ▪Carbohydrates digest the quickest & thus provide energy faster! ▪Avoid fat, protein, & fiber when exercising... slows digestion & increases time in which energy is available to be used ▪After the first hour of exercise ▪30-60 grams of carbohydrate per hour ▪1 gram carbohydrate/kg body weight/per hour ▪Fluid losses - match sweat losses ▪Consume 5-10 oz fluid every 15-20 minutes

Macronutrient intake of masters athletes

▪Carbohydrates should make up 45-65% total energy intake as there is no ideal level for masters athletes ▪Guidelines for younger athletes should be used: ▪3-5 gm/kg BW for light, low-intensity, skill exercise ▪5-7 gm/kg BW for moderate to high intensity exercise ▪7-12 gm/kg BW for endurance athletes ▪Protein guidelines have not been set for masters athletes, but studies suggest the range should be similar to that of young athletes: ▪1.2-1.7 gm/kg BW ▪Athletes who ingest low-calorie diets, less than recommended carbohydrate intakes, or who are in the beginning stages of endurance or strength training programs need more protein than others ▪Fat recommendations are the same as young athletes: ▪1 gm/kg BW ▪DRI suggests a diet of 20-35% of calorie coming from fat with 35% the maximum

Nutrient timing: During workouts (4/4)

▪Carbohydrates, some protein, little fat ▪Energy bars ▪Granola bars ▪Plain bagels ▪Peanut butter crackers ▪Dry cereal/trail mix with minimal nuts ▪High calorie shake (Ex: Muscle Milk Collegiate) ▪Sports drink with snack ▪Athletes losing weight ▪Need to eat snack(s) during practice ▪Constantly drink sports drink Calories in vs calories out OVER TIME

Physiological adaptations during pregnancy

▪Cardiac Output increases substantially in 1st trimester to adapt for increased blood volume ▪Increased stroke volume to accommodate increased blood volume, ~50% more by late pregnancy ▪Pregnancy-induced hormones cause a remodeling of the thoracic cage so that the diaphragm is in a higher position ▪Increase in respiratory sensitivity to carbon dioxide with little or no change in respiratory frequency ▪Many women complain of shortness of breath or breathing discomfort ▪Thermoregulation improves with pregnancy allowing for a woman to sweat/release heat at a lower body temperature ▪Fetal metabolism produces heat and fetal temperature is dependent on maternal temperature, fetal metabolism and uterine blood flow ▪Maternal blood glucose is primary energy source for growth for fetus and placenta ▪Host of pregnancy hormones result in increase in maternal blood glucose production from the liver, an increase in pancreatic insulin production, an increase in insulin resistance at the skeletal muscle level and a decrease in the use of blood glucose by maternal skeletal muscles ▪Maternal body fat is stored early in pregnancy to ensure that fat reserves can be used in lipolysis late in pregnancy as an alternate fuel source for the mother to conserve maternal glucose for fetus

Masters athletes

▪Centers for Disease Control and Prevention recommend all adults over 65 years of age get 150 minutes of moderate physical activity a week and perform muscle strengthening exercise that works major muscle groups at least twice per week ▪Maximum oxygen consumption decreases 5mL/kg/min each decade beginning at 25 years ▪Muscle strength peaks at approximately age 25, plateaus through ages 35-40 and then decreases with a loss of about 25% by age 65 ▪Linked to decrease in muscle mass with age ▪Typically Resting Metabolic Rate (RMR) decreases 2-3% per decade with age ▪Studies suggest that older individuals that exercise regularly may attenuate the age-related decrease in RMR

Foods that fight inflammation (spices)

▪Certain dietary herbs can be beneficial in the first stage of injury recovery ▪Turmeric is a flowering plant in the ginger family & common ingredient in curry powder ▪Been used for anti-inflammatory & wound healing ▪Turmeric extract supplement will have greater effect ▪Garlic has been shown to inhibit the activity of two inflammatory enzymes, cyclooxygenases & lipoxygenases, & affects the function of the function of macrophage cells which help clear dead tissue from inflammation sites ▪Recommend 2-4 gm of whole garlic clove ▪Bromelain is an anti-inflammatory plant extract & has analgesic compounds ▪Found in pineapple ▪Recommend 500-1000mg/day to manage inflammation

Difference between child and adolescent athletes

▪Children have an immature anaerobic system and their substrate utilization may vary based on pubertal status ▪Data suggests that children rely more on fat oxidation for energy during exercise than adults ▪Glycolytic activity tends to increase with age ▪Children have increased free fatty acid mobilization, glycerol release and growth hormone levels during exercise ▪Period of adolescent development is characterized by a faster rate of growth resulting in an increase requirement for energy and nutrients

Important tips to remember

▪Choose a variety of foods ▪If dairy products are not part of the athlete's diet, choose 8 or more servings of calcium-rich foods per day ▪Consume adequate energy for performance and to meet additional nutrient needs ▪Consume small, frequent meals and snacks ▪Incorporate healthy fats ▪Limit saturated and trans fats ▪Aim to consume a variety of protein-rich foods each day ▪Obtain adequate vitamin D from regular sun exposure, fortified foods or supplements ▪Include foods that are high in omega-3 fatty acids ▪Walnuts, flax seeds, and canola, flaxseed, hemp, and walnut oils) ▪Consume a variety of iron-rich foods and legumes each day ▪Use iodized salt for cooking and when adding to foods ▪Sodium needs of athletes are often higher due to sodium loss through sweat ▪Include sources of vitamin B12 each day ▪Include a serving or two of nuts daily ▪Provide energy, healthy fats, protein, iron, zinc, magnesium, and some calcium

Review of fat (2/3)

▪Consuming large quantities of fat is not recommended during intense exercise lasting less than 4 hours ▪Slows gastric emptying/stays in the gastrointestinal tract longer ▪Enter the blood more slowly than other sources of energy ▪Ultra-endurance events - some fat is recommended to help possibly spare muscle glycogen, satisfy hunger and provide calories ▪May not be tolerated well by gastrointestinal tract so athlete needs to practice

Nitric Oxide

▪Contain arginine alpha-ketoglutarate; arginine is precursor to nitric oxide and nitric oxide is a vasodilator ▪Theory is vasodilation will take more oxygen and nutrients to the working muscle to get a "pump" during resistance training ▪Bottom Line: Safety is questionable, may increase muscle strength but not size

Citrus Aurantium (Bitter Orange)

▪Contains synepherine, octopamine and other stimulatory compounds ▪Marketed as weight loss supplement ▪Bottom Line: Safety concerns, not effective for weight loss, effective central nervous stimulant

Micronutrient intake of masters athletes

▪DRI recommends increases for those over 50 years of age for the following vitamins and minerals: ▪Vitamins: D, B-6, and B-12 ▪Minerals: Calcium is higher and iron is lower for older women ▪Often thought that higher calorie intakes of masters athletes might contribute to improved vitamin and mineral intakes as well

Iodine

▪Deficiency may occur as a result of: ▪Consuming plant foods grown in soil with low iodine levels ▪Limited cow's milk intake ▪No fish or sea products consumption ▪Decreased use of iodized salt ▪Some plant foods (including soy beans, cruciferous vegetables, and sweet potatoes) naturally contain goitrogens ▪Suppresses thyroid gland function by interfering with iodine uptake

Energy intake

▪Dependent on training regimen, nontraining physical activity patterns, body size, body composition, and gender ▪Inadequate energy consumption relative to energy expenditure negatively effects training benefits and jeopardizes performance ▪Vegetarian athletes that struggle with consuming adequate energy, may benefit from eating ⅓ to ½ of grains and fruit in whole, unprocessed form ▪Encourages enhanced energy consumption, decreases intake of too much fiber, and reduces early onset of satiety

Pregnant athletes and gestational diabetes

▪Diabetes developed during pregnancy ▪Gestational Diabetes Risk Factors ▪Overweight ▪Family history of diabetes ▪Ethnic predisposition (Native American, Hispanic, South Asian, Asian or African American) ▪35 years or older at time of pregnancy ▪The high concentration of blood glucose is used for the fetus' growth and development increasing baby size and weight and leading to difficult labor and birth

Carbohydrate intake

▪Due to the lack of research, it is unclear whether young athletes need the same carbohydrate intake as adult athletes due to a decrease in functioning of the glycolytic pathway ▪General recommendations is 50% of total energy intake from quality carbohydrates ▪Young athletes should limit processed sugars and snack foods as an energy source throughout the day ▪During exercise, research supports that refined carbohydrate can still be helpful ▪Sports drinks, energy bars, goos, etc.

Food supplements

▪Energy Bars ▪Clif Bar, Power Bar, Muscle Milk ▪Protein Drinks ▪Muscle Milk, EAS Myoplex, Rockin Refuel ▪Carbohydrate Boosters ▪Cherry Pharm Juice, gels, chocolate milk ▪Sports Drinks Gatorade, Powerade

Growth and development

▪Energy intake should be adequate to maintain growth, development, health and performance ▪Periods of rapid growth may lead to unexpected periods of lethargy, poor coordination and movement efficiency and result in considerable fluctuations in energy needs ▪Should elevated energy requirements be consistently unmet, it may result in short stature, delayed puberty, menstrual irregularities, poor bone health and increased risk of injuries ▪Because energy requirements vary so greatly during growth and development, accompanied with exercise, the best evaluation of young athlete's energy needs is careful monitoring of growth, body mass and other anthropometric values

Chromium (chromium picolinate)

▪Enhances insulin sensitivity by increasing the number of insulin receptors, thus improving glucose utilization ▪Found in beef, poultry, eggs, nuts, whole grains, wheat germ ▪Picolinate makes it more stable and helps with GI absorption ▪Bottom Line: Safe, issues with doses over 200 mcg

Ergogenic aids

▪Ergo = work ▪Genic = to generate ▪Substance or techniques other than training that are thought to improve athletic performance ▪Mechanical aids ▪Pharmacological aids ▪Physiological aids ▪Nutritional aids ▪Psychological aids

Caffeine

▪Ergogenic aid by stimulating central nervous system and delaying fatigue ▪Studies show effectiveness in endurance exercise and high-intensity exercise lasting 1-20 minutes ▪Recommended dose is 5-6 mg/kg body weight ▪In NCAA, urinary caffeine levels cannot exceed 15 mcg/mL or they will be disqualified from competition Bottom Line: Safe at recommended doses, effective for endurance athletes and high intensity activities lasting under 20 minutes

Regulation of dietary supplements (1/2)

▪Established legal definitions and label guidelines ▪DSHEA was the first time herbs and botanicals were classified as supplements in the US ▪Other countries consider herbs and botanicals as medicines ▪DSHEA Act established "Supplement Facts" labels similar to "Nutrition Facts" labels ▪Supplement Facts Labels ▪Suggested serving size, type and quantity of ingredients ▪Term "Proprietary Blend" can be used ▪Does not state how much of a product is in supplement, just what type is in it ▪Health claims, but not therapeutic claims may be found on labels ▪Food and Drug Administration (FDA) requires the following statement to appear on the label: ▪"This product is not intended to diagnose, treat, cure or prevent any disease." ▪Under DSHEA, the FDA does not have the authority to require that supplements be approved for safety before they are marketed ▪Dietary supplements that appear on the market are "presumed" to be safe until it is proven otherwise ▪Cannot be removed from market until proven unsafe

Dietary factors of inflammation

▪Excessive calorie intake ▪Can cause weight or fat gain ▪Sugars or white floured foods ▪Processed foods ▪Frozen, Pre-Packaged Convenient Meals ▪Excessive Saturated fat intake ▪Fried foods, white/thick/creamy foods, pastries ▪Trans fats ▪Nitrites (Sodium Nitrite - cured meats) ▪Gluten ▪For those with food sensitivities ▪Excessive alcohol ▪More than one a day for women ▪More than two drinks a day for men

Growth Hormone (GH) Releasers

▪Exercise is a potent stimulator of GH ▪Arginine, ornithine and lysine stimulate GH release ▪5-9g arginine at rest shows increases in GH; more may cause GI distress ▪Consuming arginine pre-workout attenuates exercise's normal effect on GH so should not be taken pre-workout ▪Bottom Line: GH Releasers are safe, effective at rest, not effective for increasing muscle mass or growth

Quercetin

▪Flavanoid, phytochemical, and is an antioxidant 5x as powerful as Vitamin C ▪Can help reduce inflammation in trained athletes/reduce oxidative damage ▪Dose is 1000 mg/d ▪Bottom Line: Safe, effective for reducing oxidative stress especially in endurance athletes and may have anti-inflammatory effects

Foods that fight inflammation

▪Fresh Fruits and Vegetables ▪Flavonoids, Anthocyanins, Zeaxanthin, Lycopene, Beta Carotene ▪Flavonoids can also help manage inflammation through their well-know anti-oxidant properties ▪Have added bonus in cell growth & the development of new capillaries, both important for tissue regeneration ▪Can be taken in supplement form via blueberry extracts, green tea extracts, and biflavonoid supplements ▪Anthocyanin-rich foods like cherries & acai berries ▪Extra-dark chocolate ▪At least 70% cocoa content ▪Nuts ▪High in Arginine and Omega 3 Fatty Acids ▪Almonds, Walnuts, Brazil Nuts, Pecans, and Cashews ▪Allium Family of Foods ▪High in Flavonoids ▪Garlic, onions, leeks, scallions, shallots, and chives ▪Barley ▪High in soluble and insoluble fiber, low glycemic ▪Herbs & Spices ▪Capsaicin: red pepper ▪Ginger: cancer fighting ▪Turmeric: yellow spice in curry ▪Green tea

Nutrient timing: during workouts (3/4)

▪Fructose is absorbed more slowly from the gut because it is absorbed through facilitated diffusion instead of active absorption ▪Large doses of fructose can overload the absorption capabilities of the gut and cause gastrointestinal distress (cramping / diarrhea) ▪When fructose is consumed in moderate amounts, absorption from the gut is rapid and without adverse effects ▪Feeding small amounts of fructose in combination with other sugars may be beneficial both before and during exercise

Basics of nutrient timing

▪Fuel frequently ▪Goal is to eat smaller, more frequent meals to keep energy levels up ▪Example: Breakfast-Snack-Lunch-Post Workout Snack-Dinner-Snack ▪80/20 Rule ▪80% of the time focus on quality food choices or "eating for health" ▪20% of the time you can splurge on less nutritious foods and "eat for pleasure" ▪Three nutrients give your body energy ▪Carbohydrates ▪Protein ▪Fat

Nutrient timing: pre-exercise (1/2)

▪How much time should I allow for digestion of food? ▪3-4 hours for large meal ▪Meat, pasta, vegetables, salad, roll ▪2-3 hours for smaller meal ▪Sandwich, crackers/baked chips, fruit ▪1-2 hours for a blenderized meal ▪Smoothie, protein drink/shake ▪Carbohydrate snack 30 minutes before exercise provides "energy burst" for performance ▪50-70% carbohydrate, low-moderate protein

Psychological aids

▪Hypnosis ▪Imagery ▪meditation music

Informed choice stamp

▪INFORMED-CHOICE tests supplements and their ingredients for inadvertent contamination with substances prohibited by WADA (the World Anti Doping Agency) ▪Only supplement testing program that uses a WADA-experienced lab and ISO 17025 accredited analytical methods to analyze for banned substances within top level sports ▪WADA (the World Anti-Doping Agency) has prohibited ANY of their current labs from undertaking ANY testing of supplements for quality assurance purposes ▪INFORMED-CHOICE is working with HFL, a WADA-experienced lab in the UK that is committed to the long term provision of testing services to the supplement industry ▪World's largest sports regulatory and research lab, and the world's most experienced provider of commercial supplement testing services

Zinc

▪Important for immune function, protein synthesis, and blood formation ▪In vegetarians, decreased zinc levels is likely related to decreased zinc bioavailability from plant foods compared with animal foods ▪May also be related to choosing poor dietary sources of zinc ▪Lower bioavailability is primarily from the higher phytic acid content of several plant foods (includes phytate-rich unrefined grains and legumes) ▪May increase zinc requirement by 50%

Example of the regulation of dietary supplements

▪In 2007 a study of 52 supplements, bought at a supplement store or on-line, showed that 25% contained a small amount of steroids (1) ▪This would likely test any athlete positive on a drug test ▪Athletes should be cautious in taking anything that is described as a "testosterone booster" as it could contain steroids

Micronutrients

▪In all stages of recovery, vitamins A, B, C, & D as well as calcium, copper, iron, magnesium, manganese & zinc all play a vital supporting roles ▪Vitamin E has been shown to delay healing & thus should not be provided during injury recovery ▪Vitamin A supports early inflammation after injury, helps reverse post-injury immune system suppression & assists in collagen formation ▪Recommend 25,000 IU during short periods after surgery and 10,000 IU for 1-2 weeks post-injury ▪Green leafy vegetables, carrots, sweet potatoes, butternut squash and mango ▪Vitamin C enhances neutrophil & lymphocyte activity during the inflammation phase & plays a role in collagen synthesis ▪Vitamin C deficiency can cause abnormal collagen fiber formation & thus week tissue with poor adhesion ▪Recommend 1-2 gm/day for limited time spans ▪Citrus fruits, strawberries, red & green peppers, green leafy vegetables ▪Copper is a mineral that assists in the formation of red blood cells & acts in concert with vitamin C to strengthen connective tissue ▪Recommend 2-4mg/day during first few weeks post-injury ▪Seeds & beans ▪Zinc is required for over 300 enzymes in the body & plays a roll in DNA synthesis, cell division & protein synthesis...all which are necessary for tissue regeneration & repair ▪Recommend 15-20mg/day, especially during initial stages post-injury ▪Oysters, beef, liver (beef, veal, chicken and turkey), the dark meat of turkey, pumpkin seeds, almonds, pecans, brazil nuts and clams ▪Iron ▪Iron deficiency impairs proliferation of all cells involved in wound debridement and healing ▪Pumpkin seeds, tofu, meat, sweet potato, pinto beans, macadamia nuts, walnuts, artichoke, spinach and tomato juice, meat ▪Stress Fractures and Bone Health ▪Seems to be more common in female athletes ▪Calcium & Vitamin D needed for bone health ▪~1300mg/day ▪3-4 servings of dairy ▪1 serving of calcium = ▪1 cup milk, 6 oz yogurt, ¼ cup grated cheese, 1.5 oz cheese, ½ cup cottage cheese ▪Supplements ▪Calcium Citrate w/Vitamin D (500-600mg) which is typically 2 tablets ▪2 Viactiv chews

Conjugated Linoleic Acid (CLA)

▪Isomer of the essential fatty acid linoleic acid ▪In animals, has been shown reduce deposition of fat in adipose tissue ▪Bottom Line: Safe, but not effective for weight loss in humans

Pregnant athletes and nutrients

▪Kcals ▪Not pregnant - ~2400 ▪Pregnant - ~2750 2nd trimester, ~2850 3rd trimester ▪Lactating women, 0-6 months post-delivery - ~2700 ▪CHO ▪Not pregnant - 130 g ▪Pregnant - 175 g ▪Lactating women, 0-6 months post-delivery - 210 g ▪Vitamin C ▪Not pregnant - 75 mg ▪Pregnant - 85 mg ▪Lactating women, 0-6 months post-delivery - 120 mg ▪Vitamin B6 ▪Not pregnant - 1.3 mg ▪Pregnant - 1.9 mg ▪Lactating women, 0-6 months post-delivery - 2.0 mg ▪Folate ▪Not pregnant - 400 mcg ▪Pregnant - 600 mcg ▪Lactating women, 0-6 months post-delivery - 500 mcg ▪Iodine ▪Not pregnant - 150 mcg ▪Pregnant - 220 mcg ▪Lactating women, 0-6 months post-delivery - 290 mcg

Micronutrient intake

▪Like adults, there appears to be no increased need of vitamins and minerals in young athletes ▪Likely due to increased calorie consumption ▪Two minerals, iron and calcium, deserve attention because they are frequently identified as being deficient and can affect overall health and performance ▪Puberty increases the requirements for iron due to increase in hemoglobin mass, tissue deposition, growth spurts and onset on menstruation in females ▪Inadequate intake of calcium coupled with heavy intense training can have detrimental effect on bone health in maturing children

HMB (Beta-hydroxy-beta-methylbutyrate)

▪Metabolite of amino acid leucine ▪Has anti-catabolic properties; promoted to enhance lean muscle mass and increase strength gains ▪Dose is 3g/day ideally in three 1g-doses ▪Bottom Line: Safe, may contribute to small muscle gains

Iron

▪Most iron consumed in a vegetarian diet is the non-heme iron which has a relatively low absorption rate (2-20%) compared to heme iron (15-35%) ▪Non-heme iron is sensitive to both inhibitors and enhancers of iron absorption ▪Inhibitors: calcium, phytates, and the polyphenolics (includes tannins) in tea, herb teas, coffee, and cocoa ▪Enhancers: Vitamin C and other organic acids (lactic, citric, malic, and tartaric acids) - can also decrease the inhibitory effects of phytates and tannins ▪Supplements should only be recommended for athletes with compromised iron stores ▪Indicated by elevated serum transferrin receptor, increased total iron binding capacity, and low serum ferritin

Complementary proteins

▪Most non-animal protein sources (excluding soybeans) are deficient in one or more of the essential amino acids ▪Research suggests that complementary proteins do not need to be consumed at each meal, but instead, should be consumed in adequate amounts throughout the day to meet needs ▪Lacto-ovo vegetarians can also consume the complete proteins including eggs or dairy ▪Complementary Proteins - combinations available to vegetarians and vegans ▪Dairy and seeds ▪Dairy and legumes ▪Dairy and grains ▪Grains and seeds ▪Grains and legumes ▪Legumes and seeds ▪Better complementary relationship based on arrow thickness

NCAA rules nutrition supplements

▪NCAA By-law 16.5.2 ▪Nutritional Supplements. An institution may provide only nonmuscle-building permissible nutritional supplements to a student-athlete at any time for the purpose of providing additional calories and electrolytes lost through athletics activity, provided the supplements do not contain any NCAA banned substances. ▪Nutritional supplement products shall contain no more than 500 calories per product or drink, contain no more than 30 percent of calories from protein, and not exceed the Tolerable Upper Level Intake (UL) for any vitamin and mineral element, as identified by the Food and Nutrition Board, Institutes of Medicine, National Academy of Sciences, 2004. ▪ Permissible nonmuscle-building nutritional supplements are identified according to the following four classes: ▪Carbohydrate/electrolyte replacement drinks, energy bars ▪Calorie replacement products ▪Carbohydrate boosters Vitamin and mineral supplements

Beet Juice

▪Naturally high in nitrate ▪Preliminary research suggests that consumption of a large dose of nitrate may have an effect on skeletal muscle efficiency by reducing the ATP cost of the muscle force production and the ability to tolerate high-intensity exercise for a longer period of time ▪Bottom Line: Studies show that it can cause a lower oxygen demand thus increasing skeletal muscle efficiency, safety concerns so further research is needed

Beta-alanine

▪Non-essential amino acid and is the rate-limiting precursor for carnosine, which buffers lactic acid ▪Studies show beta-alanine supplementation can greatly increase carnosine levels in the muscle ▪Doses are typically 3.2-6.4 g/day initially followed by a lower maintenance dose ▪Bottom Line: Safe, shows promise as a way to buffer muscle pH in athletes performing high intensity exercise

Nutrition for healing

▪Nutritional Strategies ▪Healing Fuel: Macronutrients ▪Anti-Inflammatory Foods & Antioxidants ▪Micronutrients as Supplements to Aid in Recovery ▪Food provides the building blocks for cells and influences messages sent throughout the body to regulate blood flow, tissue replacement and healing ▪Basal/Resting Metabolic Rate may increase 15-50% after injury, depending on the severity of the trauma, injury or surgery ▪Most common after surgery is 15-20% ▪Energy becomes top priority as the proliferation & remodeling process begins ▪Energy needs are actually higher when the body is repairing itself due to post-injury hormonal changes & the physical requirements of new tissue formation ▪Challenge is that many athletes attempt to reduce caloric intake to maintain weight or due to less expenditure ▪Female Soccer Player Recovering from ACL Surgery ▪Ht: 5'2" or 157.48 cm / Wt: 120 lb or 54.5 kg / Age: 20 ▪Female: (10 x wt in kg) + (6.25 x ht in cm) - (5 x age) - 161 ▪RMR: 545 + 984 - 100 - 161 = 1268 calories ▪Calorie needs with daily activity only: 1268 x 1.2 = 1522 cal ▪Typically works out 6d/wk: 1268 x 1.725 = 2187 calories ▪Injury/surgery increases RMR 15-20%: 1458 - 1521 calories ▪Use new RMR for range of daily activity calorie needs ▪1458 x 1.2 = 1794 calories and 1522 x 1.2 = 1826 calories ▪More than normal, less than when exercising ▪Challenges? ▪Appetite may not adapt to decrease in caloric need as quickly ▪Athletes trying not to gain weight

Fluid intake of masters athletes

▪Older adults have less body water ▪60-70% versus a high of 80% in infancy ▪Thirst sensation decreases with age ▪After age 40, renal mass declines with a subsequent decrease in renal blood flow ▪Ability of older kidney to concentrate urine decreases requiring more water to remove wastes ▪Sweat glands change as the skin ages ▪Less sweat produced per gland with aging

Mechanical aids

▪Parachutes ▪Elastic cords ▪Downhill/uphill running ▪Weighted vests

Vitamin C and E

▪Powerful antioxidants that work with glutathione to reduce oxidative stress ▪Aerobic exercise increases production of free radicals ▪Bottom Line: Safe, effective for reducing oxidative stress, large doses are not beneficial

Nutrient timing: pre exercise (2/2)

▪Pre-exercise meal - 2-4 hours before exercise ▪Restores liver glycogen and raises blood glucose after overnight fast ▪Improves performance by up to 15% compared to fasted state ▪High carbohydrate ▪Moderate protein ▪Low in fat & fiber ▪These slow down digestion ▪Plenty of fluids (16-20 oz) ▪Immediate Pre-exercise Snack ▪30 minutes before workout/game ▪High carbohydrate, small amount of protein to provide you with a boost of energy 5-10 oz water or sports drink

Dehydroepiandrosterone (DHEA)

▪Precursor to testosterone, but weak androgen ▪Natural DHEA diminishes with age so many Masters Athletes want to take it ▪Studies do not suggest it is anabolic or increase strength ▪Before DSHEA, it was a prescription drug ▪Bottom Line: Not safe or effective

Review of Carbohydrates

▪Primary source of energy ▪Simple vs complex ▪Provide the substrate necessary for glycogen replenishment ▪Help maintain blood glucose levels and prevent premature fatigue when used during exercise ▪Need is dictated by frequency, intensity, and duration of activity ▪CHO used during exercise ▪Substrate sources? ▪3 g/kg for athletes in off-season ▪5-7 g/kg for general training needs ▪7-10 g/kg for endurance athletes ▪11+ g for ultra-endurance athletes

Macronutrients of nutrition for healing

▪Protein is most important ▪Rehabbing an injury requires 2 gm/kg BW of protein ▪Compared to 1.2-1.4gm/kg for endurance athletes & 1.6-1.7gm/kg for strength athletes ▪Carbohydrate ▪Glucose is needed for injury repair & for stabilization of insulin concentration in the blood stream ▪No specific recommendations at this point ▪Ideally getting in more complex, high fiber carbohydrates ▪Fat is a key component ▪30% of total calorie needs ▪10% (1/3) of each fat ▪Saturated, mono-unsaturated, poly-unsaturated ▪Increase intake of omega-3 fatty acids ▪3-9 grams/day ▪Salmon, salmon oil, sardine oil, trout, tuna, flaxseed, walnuts, hemp seeds, nuts, seeds, soy foods ▪Decrease intake of omega-6 fatty acids ▪Vegetable oil like corn, safflower, sunflower, & soybean ▪Fruits and vegetables ▪Low in calories, but packed with nutrients ▪Can help athletes feel full faster at meals ▪Provide the vitamins and minerals needed to promote healing, recovery, collagen and tissue re-synthesis ▪Eating a variety of colors is important as each color has its own set of vitamins and minerals

Protein

▪Protein needs vary based on type of activity/level and training frequency ▪Active vegetarians who participate in light to moderate intensity exercise several times each week are likely met by the RDA of 0.8 g/kg/day ▪Conversely, athletes who train more intensely (5 or more times per week) are likely to require significantly higher than the RDA ▪Protein recommendations for athletes vary from 1.2 - 1.7 g/kg/day ▪Extra protein and essential amino acids are needed during endurance exercise and strength training to cover: ▪Enhanced protein utilization as an supplementary fuel during exercise ▪Increased protein needs throughout muscle development ▪Protein requirements may be slightly increased in athletes whose dietary protein sources are almost entirely from less-well digested plant sources (such as legumes and some cereal grains) ▪Well digested sources include soy foods ▪Recommend consumption of a variety of plant foods throughout the day ▪Will provide all essential amino acids ▪Maintains adequate nitrogen retention and utilization in healthy adults ▪Most vegetarian athletes meet endurance training requirements without special meal planning ▪Conversely, strength training athletes (i.e. wrestlers, football players or weightlifters), those with low energy intake or high training volumes may need to consume more protein rich foods

Omega-3 Fatty Acid Supplements

▪Provide essential fatty acids ▪May contribute to reducing inflammation at the cellular level ▪Dose is 3 g/day ▪Bottom Line: Safe, effective for raising HDL, may reduce inflammation

Glucosamine/Chondroitin Sulfate

▪Reduce joint pain and improve function and range of motion ▪Glucosamine is an amino acid that may help and repair cartilage ▪Chondroitin is part of a protein that aids in elasticity of cartilage ▪Together may stimulate cartilage synthesis or inhibit breakdown ▪Dose is 1500 mg glucosamine and 1200 mg chondroitin Bottom Line: Safe, maybe helpful for knee pain

Drug free sport

▪Resource for supplements ▪www.drugfreesport.rec

Review of fat (3/3)

▪Saturated Fats: "Bad Fats" ▪Fried foods, pastries/baked goods, creamy foods ▪Unsaturated Fats: "Good Fats" ▪Peanut butter, almond butter, nuts, seeds ▪Olive oil and Canola Oil ▪Avocado ▪Flaxseed or flaxseed oil ▪Can buy milled, as oil, or in breads and cereals ▪Fats in fish like salmon ▪Remember that you get some fat in dairy products, meats, whole eggs, and energy bars/shakes

Fat

▪Should compose the remainder of energy intake after both carbohydrate and protein needs are achieved ▪Recommendations: 20 - 35% of total energy intake ▪Consuming < 20% from fat is not recommended because of the potential to negatively effect endurance performance, impede the normal menstrual function in female athletes, and unfavorably change lipid profile ▪Provides energy, essential fatty acids, and other important elements for cell membranes ▪Needed for fat-soluble vitamin absorption (vitamins A, D, E and K) ▪Proportion of fatty acids should follow national guidelines ▪Polyunsaturated fat - about 10% ▪Monounsaturated fat - about 10% ▪Saturated fat - < 7 to 10% ▪Little to no trans fat ▪DRI of alpha linolenic acid (omega-3's): 1.6 g for men and 1.1 g for women ▪Vegetarian diets tend to be rich in omega-6 polyunsaturated fatty acids and may be low in omega-3 polyunsaturated fatty acids

Glutamate

▪Stores are fuel source during long periods of exercise ▪Decreases exercise-induced stress and susceptibility to illness ▪Dose 5-10 g/day, usually split in two doses ▪Bottom Line: Safe and can be effective

Ephedra (Ephedra-containing supplements)

▪Strong stimulant ▪Sales were banned in 2004 ▪Bottom Line: Safety is a concern over 10 mg, effective for enhanced energy, but not for muscle strength/growth

Creatine

▪Supplementation increases creatine stores by 10-30% and phosphocreatine stores by 10-40% ▪Weight gain and used for increasing strength ▪Dose: 5 g/day; loading does not appear to have added benefit ▪Bottom Line: Safe at recommended doses, effective for increasing strength in short bouts of high intense activity and for weight gain

Herbal supplements

▪The active ingredient in herbal dietary supplements can vary tremendously ▪A study on ephedrine-containing supplements, before banned by the FDA, found that half of the 20 supplements tested varied 20% in the actual amount of the ephedrine alkaloid in the product (2) ▪Toxicity with herbal dietary supplements ▪Might be from contamination with a pharmaceutical agent ▪Might be contaminated with a heavy metal ▪Most toxicity problems can be avoided with Good Manufacturing Practices (GMP)

Pharmaceutical grade

▪The highest quality of supplement for purity ▪Typically at least double in price ▪Can't usually purchase "over-the-counter" ▪Hard to get, but worth it! ▪Example: Beneprotein

Food and drug interactions of masters athletes

▪Thiazide Diuretics ▪Increase urinary losses of sodium, potassium, and magnesium ▪Use of salicylates and nonsteroidal anti-inflammatory drugs may cause iron losses ▪Attention should also be paid to those taking cholesterol-lowering medications and hypertension drugs such as angiotensin-converting enzyme inhibitors ▪Beta blockers

Fat intake

▪Though young athletes use more fat as fuel during exercise, there appears to be no greater need for higher fat intake ▪Dietary recommendation is the same as adults, 20-35% of total daily energy intake ▪High fat intake before exercise tends to reduce the magnitude of growth hormone secretion naturally produced in young athletes during exercise

Regulation of dietary supplements (2/2)

▪Three critical questions to ask ▪Is the supplement safe? ▪Is the supplement effective? ▪Is the supplement contaminated? ▪Many consumers mistakenly believe that the safety, efficacy and purity of supplements are tightly regulated ▪The purity of dietary supplements is NOT comparable to over-the-counter medications or prescription drugs ▪The purity of supplements is of question for athletes who are drug tested ▪Issues with purity could be due to poor manufacturing practices and/or the use of tainted substances ▪Weight loss and muscle building supplements rank high on the list of those that are likely to be contaminated

Recovery nutrition

▪Tips for eating less, but getting more ▪Eat small frequent meals throughout the day to prevent getting too hungry, overeating & even bingeing ▪Each meal/snack should contain a whole grain carbohydrate and a lean protein ▪Limit sugary, processed carbohydrates ▪Limit high-fat proteins ▪Garnish each meal with omega 3-rich fat ▪Eat 5-10 fruit and vegetable servings a day ▪Include anti-inflammatory foods as much as you can over the course of the day

Athletes with disabilities

▪Types of physical disabilities ▪Paraplegic ▪Quadriplegic ▪Amputees ▪Energy needs in athletes with disabilities ▪BMR anywhere from 5-30% lower ▪Energy needs for any given sport depend on ▪Injury level ▪Energy demands of specific sport ▪Nutritional considerations ▪Literature is lacking ▪Use able-bodied recommendations and adjust as necessary ▪Be mindful of level of disability ▪Some athletes are on specific bowel/bladder programs ▪Rates of metabolic diseases and obesity significantly higher in this population ▪Weight management may need to be a priority ▪Medical considerations ▪Many medications can exacerbate ill effects of exercise in certain sub-populations of athletes with disabilities ▪Inability to sweat, etc.

Branch chain amino acids

▪Used for energy during prolonged exercise when glycogen levels are low ▪Competes with tryptophan, an amino acid associated with mental fatigue ▪Leucine has been shown to resynthesize muscle the fastest after a workout ▪Doses of 5-20 g/day seem safe ▪Bottom Line: Safe, not effective for improving performance in research, positive effects on immune response and reduction of post-exercise muscle fatigue

Multivitamin/Mineral Supplements

▪Usually only beneficial when deficiencies are present ▪Many athletes consume lots of vitamins and minerals in fortified supplements like shakes and bars ▪Bottom Line: Safe, but not be needed, mega-doses can be harmful

B vitamins

▪Vitamin B12 ▪Cobalamin (active form of B12) is located solely in animal products ▪Vegan athletes may require regular consumption of B12-fortified foods or a B12-containing multivitamin ▪Markers of vitamin B12 status include homocysteine, methylmalonic acid, and holotranscobalamin ▪Typical manifestation of B12 deficiency is macrocytic anemia, but can be hidden by high folate consumption

Demand evidence and think critically

▪Was any research actually performed? ▪If so, where and when was it published? ▪Have the results been replicated by other researchers? ▪Was it a double-blind, placebo-controlled study? ▪How many and what kind of participants were involved? ▪Have safety, ethical and legal consequences of taking the product been determined?

inflammation

▪When/why is it harmful? ▪The natural balance of immune system can be disrupted, shifting into a state of chronic inflammation ▪Can occur when lifestyle or environment exposes the body to substances perceived as irritants - sedentary lifestyle, low-grade infections, toxins, food allergens, inflammatory foods ▪Chronic, uncontrolled inflammation is destructive, linked to a multitude of health problems

protein supplements

▪Whey, casein, soy, egg, etc; whey is highest in BCAAs ▪Athletes need more protein than sedentary individuals ▪Dose is 1.2-2.0 g/kg body weight ▪Bottom Line: Safe, effective for protein needs and whey may help with increasing muscle size as a post-workout supplement

Fluid intake

▪Young athletes have a greater ratio of surface area to body mass and absorb environmental heat more readily than adults ▪Greater risk for experiencing heat stress when exercising in hot environments ▪Children have a lower sweating capacity reducing their ability to dissipate body heat by evaporation ▪As children grow, body surface grows, increasing their need for fluid and electrolytes ▪Research shows that when given water, young athletes do not replace fluid losses as completely as when provided a flavored sports drink ▪Like adults, a 2% dehydration level will begin to compromise performance in young athletes ▪However with children, the negative side effects of fluid loss begin at 1% dehydration level ▪Fluid recommendations during exercise are vague for young athletes ▪Pre-exercise young athletes should be encouraged to drink water and/or sports drink consistently throughout the day ▪During exercise young athletes should consume electrolyte rich fluids ▪Giving water breaks is essential in young athlete practices and sports because they may not choose to do it on their own ▪Post-exercise athletes should monitor urine color to replace fluids lost during exercise

General nutrition recommendations

▪Young athletes should be eating small, frequent meals to keep their bodies fueled ▪A breakfast rich in complex carbohydrate and protein is essential to start a young athlete's day ▪If practicing in the morning, a "to-go breakfast" should be sent with athlete or they should eat in school cafeteria before class starts ▪Nutrient-rich snacks should be sent to school for in-between meals ▪Pre-workout snacks and sports drinks should be sent to school and practice so the athlete stays hydrated and fueled throughout practice and athletics class/PE ▪Half-time snacks and beverages should be provided during team sports and tournament play