Michelle Rockwell MS, RD, CSSD

1
Hot Topics in Sports Nutrition
...and YES, this applies to YOU!

• Michelle Rockwell MS, RD, CSSD
• Sports Dietitian Durham, NC
• michellerock1_at_aol.com

2
Define athlete

• Anyone who is physically active or exercises on a
  regular basis
• We should all be working with athletes!
• EXERCISE GUIDELINES
• 6 days/week (30-60 min)
• US Surgeon General
• American Heart Association
• All RDs can apply Sports Nutrition strategies to
  their clients

3
We have a new board certification!

• CSSD Board Certified as a
• Specialist in Sports Dietetics
• 159 CSSDs in U.S.
• Sports Dietetics Practitioner
• experienced RDs who apply evidence-based
  nutrition knowledge in exercise and sports. They
  assess, educate, and counsel athletes and active
  individuals. They design, implement, and manage
  safe and effective nutrition strategies that
  enhance lifelong health, fitness, and optimal
  performance. 

4
Become a CSSD!

• Current Registered Dietitian (RD) status.
• Maintenance of RD status for a minimum of 2 years
  by the date of the CSSD exam.
• Documentation of 1,500 hours of specialty
  experience as an RD within the past 5 years (by
  the date the application is due).
• Deadline for Summer, 2008 CSSD exam is MAY 7!
• Education can count toward up to 1200 hours until
  May, 2009.
• Successful completion of CSSD exam.
• Visit www.cdrnet.org for more information!

5
My Philosophy

• Performance
• Health
• through
• Good Taste

6
Sports NutritionRecommendation Considerations

• Population of athlete
• i.e. child, Masters, college/elite,
  non-competitive
• Background
• Exercise intensity
• Exercise duration
• Exercise frequency

7
Calorie Needs for Athletes
10-30
5-10
TEF
55-75
8
Energy Expenditure Varies Widely!

• Examples
• Female Olympic Gymnasts
• 1900 kcals/day
• McNickols MSSE 55187-91, 1996
• High School Soccer Players (females)
• 3300 kcals/day
• Burke et al J Sports Sci 24675-85, 2006
• Tour de France Cyclists
• 7069 kcals/day
• Saris et al Int J Sports Med 1026-31,
  1999

9
Energy needs

• Basic caloric requirements

15-30 kcal/pound
Sample 160-pound marathon runner 160 X 25-30
4,000 4,800
10
Energy Needs
Estimated Daily Energy (Calorie) Needs for
Training Training/workouts Calories/
120 160 280 Low
(sedentary) 13 to 15 1,560 1,800 2,080
2,400 3,640 4,200 Active (30 to 60min/d ) 16
to 18 1,920 2,160 2,560 2,880 4,480
5,040 Moderate (1 to 1 ½ hr/d) 19 to 21 2,280
2,520 3,040 3,360 5,320 5,880 High (1 ½ to
2 hr/d) 22 to 24 2,640 2,880 3,520
3,840 6,160 6,720 Very High (2 to 3
hours/d) 25 to 30 or more 3,000 3,600 4,000
4,800 7,000 8,400

11
RMR Measurements in Real Athletes

• Football player 67, 230
• Estimated 2300, Measured 3450
• Female Gymnast 51, 130
• predicted 1320, actual 1160
• Male Runner 60, 155
• predicted 1620, actual 1400
• Male Rower 64, 210
• predicted 2100, actual 1750

Note RMR estimation equations are not specific
for athletes!
12
Calorie Considerations

• When working with athletes, consider potentially
  huge fluctuation in calorie needs based on
  training periods, off-season, injury, growth,
  etc.
• Teach concept of Nutrition Periodization

13
Injury and energy needs

• Female collegiate swimmer - 12,000yards/day
  (6/week) weights 3 days/week
• 3800 calories/day
• Shoulder injury -
• no swimming
• 2200 calories/day
• Shoulder surgery w/ complications
• 4000 calories/day

14
Meal Timing Frequency
15
Guideline Eat multiple times/day

• Regardless of WEIGHT goals
• Problem Bottom Heavy Diets
• Time, schedule, avoiding eating before exercise
• Importance
• Energy availability
• Protein synthesis
• BODY COMPOSITION

16
Inter-Day Energy Balance

• Those with wide deviations in energy balance
  during the day have highest body fat regardless
  of whether the energy deviations are surpluses or
  deficits
• Muscle protein may be broken down to maintain
  blood glucose

17
Breakfast

• Provide practical examples
• Sleep and time are precious to athletes
• Educate that people who eat breakfast have
• Better weight control
• More appropriate caloric intake
• Greater academic performance
• Greater energy availability
• Improved hydration status
• Better intake of fiber, calcium, iron, zinc,
  fruit, and whole grains

18
Satiety Index of Breakfast Foods
Croissant
Yogurt Strawberry
White Bread
Granola Oats, Fruits, Nuts
Special K
Corn Flakes
Bananas
Eggs Poached
Wheat Bran Cereal (14g Fiber)
Oatmeal
Source Holt et al. European Journal Clinical
Nutrition 1995, 49675-690.
19
Macronutrient Basics
20
Macronutrient Needs
20-25

• Carbohydrate protein needs may be better
  expressed as absolute grams rather than as of
  kcals.

15-20
55-65
21
CarbohydratesFUEL

• Carbohydrate Needs

30 min 1 hr moderate exercise 4-6g/kg
1 hr intense training/day 7g/kg
1-2 hrs intense training/day 8-9g/kg
2-4 hrs intense training/day 9-10g/kg
Ultraendurance athletes gt12g/kg
150-lb Mom who does aerobics classes 300g
Carbs/day
150-lb Lance Armstrong 800g Carbs/day
22
Carbohydrates Practical Issues

• Carbohydrate-loading really works
• Glycogen Supercompensation
• 3 days out100-150 extra grams CHO ?exercise
• Athletes benefit from carbohydrates during
  intense exercise (?physical mental, ?fatigue)
• 30-60grams/hour recommended
• Consider half-time and during-event carbohydrate
  options

23
ProteinGrowth, Strength, Repair

• Protein needs
• 1.2-1.7g/kg
• Some research supports up to 2g/kg
• so, more than the average person, but not as
  much as many athletes regularly eat!

24
Protein Scorecard for Athletes

• 10 grams protein in
• 1 ounce meat, tofu, or equivalent
• 2 eggs
• 1 cup milk/yogurt or 1 ounce cheese
• 2/3 cup beans
• 1/3 cup nuts or 2T peanut butter

Animals Plants
25
Protein Is more better?



Food
Supplements
26
How much is too much?

• Research has shown a CEILING above which no
  further benefits occur

200-lb athlete
80g protein
130g protein
220g protein
Tarnopolsky et al. JAP, 1992
27
Individuals with higher protein needs

• New training program
• Energy restriction
• Intentional (diet)
• Non-intentional (extreme expenditure)
• Vegetarians
• Disease/disuse
• Injury rehab
• Young or old athletes

These arent the people typically using protein
supplements!
28
Whats the big deal about getting too much
protein?

• Dont you just excrete it?
• Potential impact on
• kidney, bone, hydration status, etc. ?
• intake of other nutrients
• Fat (can be excessive)
• Carbohydrates (can be inadequate)
• Vitamins minerals (can be inadequate)
• Fiber (can be inadequate)
• hormonal regulation of muscle growth

29
If the athlete insists on following a high
protein diet

• Focus on lean protein sources
• Emphasize ample carbohydrates
• Encourage whole grains, fruits, veggies
• Consider micronutrient supplement

30
Why should athletes follow a low-fat diet?

• Allow for adequate CHO and protein intake
• Minimize gastrointestinal upset
• Control body weight
• Prevent chronic disease

31
Keep athletes backgrounds in mind

• Many genetically gifted in terms of body
  compositionnever worried about nutritional
  intake before
• ExampleUS Soccer National Team Member diet
  analysis 62 kcals from fat
• Teach sources of HEALTHY fats and their value
  flax, fish, oils, avocado, nuts, seeds, etc.

32
Fast Food Education

• Popular, realistic, only option for some budgets
  (especially teams)
• Small changes, big difference
• Egg and cheese on
• English Muffin 10 grams of fat
• Biscuit 25 grams of fat
• Croissant 32 grams of fat

33
Sports RDs Food Service

• Use meal planning opportunities for EDUCATION!

34
Micronutrients

• Do athletes have enhanced vitamin mineral
  needs?
• Consequences of micronutrient deficiencies may be
  greater to athletes than sedentary people

Use message of communication most influential to
each athlete EX Calcium
35
General Vitamin Mineral Needs

• Recommend DRI, but ltUL
• Perhaps higher needs for
• Sodium and electrolytes
• Iron
• Antioxidants
• Vitamin C respiratory infections, muscle
  damage?
• B-vitamins

36
Stress Fractures

• What is a stress fracture?
• A skeletal defect that results from repeated
  application of stress that is less than that
  required to fracture a bone in a single loading,
  but greater than the bones ability to recover
  fully.
• Stress Fracture Commonalities
• 15 of female athletes in 5 year period at one DI
  university
• 95 of all stress fractures occur in the lower
  extremities
• A study of 5900 college athletes revealed no
  significant difference between male and female
  susceptibility to stress factors. However, when
  looking specifically at track and field athletes,
  womens incidence for stress fractures was
  nearly doubled.

Feingold et al. Female athlete triad and stress
fractures. Orthop Clin North Am. 2006
Oct37(4)575-83.
37
Female Athlete Triad
Disordered Eating
Amenorrhea most often due to energy drain not
very low body fat!
Menstrual Abnormalities
Poor Bone Health
Remember that disordered eating exists on a
continuum!
38
Female Athlete Triads effects on Stress Fractures

• Osteoporosis, a BMD standard deviation of 2.5
  below the normal level, characterizes the third
  component of the female athlete triad.
• Can result from depleted estrogen levels
• OR inadequate energy, protein, calcium, and/or
  Vit. D intake associated with restrictive eating
• Always screen for TRIAD with menstrual
  abnormalities, stress fractures, or restrictive
  eating

39
Calcium Needs for Athletes
Age (years) Calcium DRI (mg)
14-18 1300
19-30 1000
31-50 1200
gt50 1200

• Recommend 1500mg-2000mg/day especially for
  females, amenorrheic, high sweat loss (some
  calcium is lost in sweat)
• Be prepared to recommend non-dairy sources and
  supplements

40
Keeping Athletes On the Field

• What athletes eat on a consistent basis can have
  a significant impact on their overall health and
  immunity.
• By enhancing an athletes diet with more
  anti-inflammatory foods, athletes may recover
  faster and manage chronic inflammation better.

41
Antioxidants

• Antioxidants help protect the body from harmful
  free radicals.
• Free radicals can damage tissues, cells, and
  genes. They occur in the environment and are
  naturally produced by the body.
• A natural type of rusting
• Antioxidants neutralize free radicals before
  damage to cells and tissue occurs.

42
Colors Fruits and Veggies
Green Broccoli, Brussels Sprouts, Bok Choy, Cauliflower, Cabbage, Kale, Collards, Mustard Greens, Green Peppers, Kiwi, Spinach, Limes, Leeks, Avocados
Orange/Yellow Oranges, Tangerines, Yellow Grapefruit, Peaches, Lemons, Papaya, Pineapple, Nectarines
Red/Purple Red Grapes, Purple Grape Juice, Cherries, Berries, Plums, Prunes, Raisins
White Onions, Chives, Garlic

• Adapted from Heber D., Bowerman S. What Color is
  Your Diet? (2001)

43
Immunity Nutrients

• Carbohydrates
• Fluids
• Vitamin A
• Vitamin E
• Vitamin C
• higher levels may help reduce incidence of
  respiratory infections, overtraining syndrome,
  and muscle damage
• Zinc
• Omega-3 fatty acids
• also important for joint health and decreasing
  inflammation
• omega-3 fatty acids in fish oils (1-3 g/day with
  mixed DHA and EPA) have also been found to reduce
  inflammation in and around the joints
• flax seeds/oil, borage oil, and evening primrose
  oil may also benefit

44
I have NO ENERGY

• Common reason to consult with Sports RD
• Distinguish type of tired and causes
• Tired all the time
• Wake up tired in the morning, sleepy during day
• Fatigue upon exertion
• Could be ?calories, ?carbs, overtraining
  syndrome, ?quality overall, dehydration, mental
  health issues, iron deficiency
• Note that iron deficient athletes typically
  report fatigue during exercise

45
Iron Deficiency Anemia in Athletes

• Iron deficiency without anemia may have
  performance detriment
• Female athletes with Hgb gt 12 g/dL, but low
  ferritin levels were given iron or placebo for 6
  weeks. Those on iron grew fitter and cycled
  faster. Thus, even women with ferritin greater
  than 12 g/dL can be functionally anemic.
• What is appropriate ferritin goal for various
  athletes?
• Consider relative anemia
• Value of baseline and routine screening

Reference GSSI Sports Science Exchange
Anemia and Blood Boosting, Randy Eichner, 2001.
www.gssiweb.com.
46
Incidence of Iron Deficiency Anemia

• Typically thought to be higher in females and
  endurance athletes
• BUT in a recent study of 100 high-level
  basketball players,
• Low ferritin was found in 37 of females and
  14 of males.
• Full iron deficiency anemia was noted in 14 of
  females and 3 of males.

Dubnov and Constantini, Int. J. Sport Nutr. Exerc
Metab. 1430-37, 2004.
47
Iron Deficiency and Anemia

• Identify High Risk Populations
• Screen Properly Hgb Ferritin
• Educate on dietary iron content and absorption
  considerations
• Blockers - tea, coffee, calcium, antacids (ex.
  Tums), H2 blockers (ex. Zantac), Proton Pump
  Inhibitors (ex. Prilosec)
• Enhancers - 100mg vit C/30mg elemental iron,
  pots
• Food combinations - animal and vegetable sources
• Supplement if necessary
• Monitor Side Effects
• Reassess Status

48
Therapy for Deficiency and Anemia

• Typically FeSO4 325 mg (65 mg of elemental iron)
  2-3x/day
• may be absorbed better between meals
• Hemoglobin should rise about 1 g/dL each week,
  and half way to normal in 3 wks, and to WNL in 2
  months.

49
Hydration

• General fluid guidelines
• At rest Is it really 8 glasses a day?
• A recent study indicates that nearly half of all
  active people begin their workout inadequately
  hydrated.
• Stover et al. Can J Appl Phys, 28s105, 2003
• Drink 2or3 cups 1-2 hours BEFORE exercise
• At least 2 cups per hour of exercise
• Studies have repeatedly shown that people do not
  do a good job replacing fluids lost through sweat
• 3 cups for every pound lost during exercise

50
Inadequate fluids result in

• ? performance (strength, speed, stamina)
• ? mental sharpness and willpower
• ? recovery
• ? metabolic rate
• ? perceived effort of exertion
• ? core body temperature
• ? risk of injury

51
Dehydration Impairs Attentiveness in Basketball
Players

• 11 male players
• Dehydrated to 1, 2, 3, or 4
• As dehydration progressed, the players exhibited
  slowed response time and inattentiveness to cues
  (computer-based testing)
• The authors determined these differences in
  response would likely lead to costly errors in a
  basketball game
• Med. Sci. Sports Exerc. 2007 39976-983

52
Heat Illness

• DEHYDRATION allows the body to heat up faster!
• Heat cramps
• Heat exhaustion
• Heat stroke
• Can be fatal
• Several cases of high school, college, and NFL
  tragedies

53
How can athletes tell if they are drinking enough?

• Clear urine, frequent bathroom trips
• Absence of thirst

54
HydrationPractical Issues

• Remember
• Should be a focus in cold weather too!
• Drink on a schedule!
• Gulps over sips
• Swallow instead of spit
• In, not on
• Cool, not ice cold
• Taste preferences change during exercise

55
Sodium loss

• Can be as high as 3000-7000mg per hour in the
  heat.
• Note that athletes have different sweat rates,
  electrolyte sweat content, and these may change
  with training

56
Pass the salt!

• Restricted sodium diets can actually be
  detrimental to athletes!
• Athletes exercising in the heat should eat salty
  foods, add salt to meals, and use a sports drink
  containing sodium!

Confusion!
57
When to use which drink?

• Water
• Vs.
• Propel
• Vs.
• Gatorade Thirst Quencher
• Vs.
• G2 (New)
• How about Vitamin Water? Accelerade?

• Long exercise (gt 45 min to 1 hour)
• Intense exercise
• HOT, sweaty exercise
• When performance matters

58
Stop and Go Simulation

• One week apart, 9 male players completed 75
  minutes of shuttle runs followed by intermittent
  running to fatigue (performance trial).
• These intermittent, high-intensity shuttle runs
  were designed to replicate activity patterns of
  stop and go sports. They consisted of
  intermittent running, including maximal sprinting
  interspersed with less intense periods of running
  and walking.
• The athletes drank either a 6.9
  carbohydrate-electrolyte drink or placebo
  immediately prior to exercise (5 ml per kg) and
  every 15 minutes thereafter (2 ml/kg).
• Nicholas et al., J Sports Sci. 1995
  13(4)283-290

59
RESULTS Shuttle Run Test
8.9 min.
CHO trial
6.7 min.
Placebo
Time of Exercise to Fatigue

• Conclusion A carbohydrate-electrolyte drink
  improved performance during intermittent,
  high-intensity exercise.
• Nicholas et al. J Sports
  Sci. 1995 13(4)283-290

60
Other important sports nutrition issues
61
Dietary Strategies for Weight Gain
62
Gaining Lean Body Mass
Hormonal flux
Macronutrient ingredients
Stimulus via exercise
63
Strategies for Increasing Lean Body Mass

• Increase caloric intake by 1000 to 1500/day
• Consider restrictive mindset in those trying to
  lose body fat as well
• Emphasize BALANCE of nutrients
• Carbs are needed for muscle gainnot just protein
• Get adequate protein

64
Strategies for Increasing Lean Body Mass

• Increase meal frequency (every 2-3 hours)
• Particularly important to split protein intake
• Maximize fueling opportunities
• Use liquid calories!
• Eat before strength training
• 10g essential amino acids carbs
• Practice good recovery nutrition
• Consistency
• Weekdays AND weekends, on AND off days
• Nutrition AND training

65
Diet Affects Hormones

• Insulin
• anabolic impact on muscle, prevents breakdown
• Athletes need carbs!
• Growth Hormone
• anabolic impact on muscle, prevents breakdown
• levels reduced by chronic high protein diet
• secretion inhibited by high levels of circulating
  fatty acids
• Insulin-like Growth Factor-1 (IGF-1)
• initiates protein synthesis
• act of eating induces IGF-1 synthesis in muscle
• Testosterone
• stimulates muscle growth
• testosterone levels are significantly reduced
  after a high fat meal or an episode of binge
  drinking (gt 4 drinks)
• Cortisol
• stress hormone that interferes with
  muscle-building

66
Meet Chris

• 20 year-old gym rat
• 510, 170 pounds
• Goal increase LBMFAST!
• CANT gain weight and Ive tried everything
• Claims to eat all the time
• Self-restricts carbohydrates because I dont do
  cardio and Im trying to cut body fat
• Spends 180/month on sports foods/drinks
• Bars, shakes, energy drinks
• Complains that healthy foods cost too much

67
Chris Current Diet

• Breakfast protein shake
• Lunch 2 cans tuna, 2 slices cheese, low-carb
  pita,
• nuts, unsweet ice tea
• 3pm 2 energy drinks, protein bar
• 5-8 practice workouts, recovery shake post
  workout
• 900 2 chicken breasts, sweet potato, cottage
  cheese, 1/3 carton sugar-free ice cream
  (oops! Hungry and craving sweets)
• 1100 protein shake

68
Nutritional Analysis for Chris

Energy Actual 3700 cals (includes ice cream) Needs 4700 cals (22 cals/lb 1000)
CHO Actual 175 grams Needs 575 grams (50 cals)
Pro Actual 350 grams Needs lt170 grams (1 gram/pound)
Main recommendations Larger breakfast Lots more carbs, especially throughout day Replace protein with safe carbs such as oatmeal, fruits, veggies, brown rice, dairy, beans Change bars or shakes to carb-containing products or REAL food Add 100 juices Add multivitamin Eat foods just for TASTE occasionally

69
Weight LossPractical Issues

• They want it fast and easy
• Fad diets can have risky consequences
• But do reduce carbs slightly, increase protein
  slightly
• Should be during off-season
• Rate should be 1-3 pounds/week
• Cut typical calories by 500-800
• Do not jeopardize energy level for training
• Eat smaller portions more frequently
• Fill up on veggies, fruits, soups, lean proteins
• Increase fibers
• Reduce sugars and fats
• Watch liquid calories
• Hydrate especially well (athletes may mistake
  thirst for hunger)

70
Pre-competition meal

• GOAL Restoring liver glycogen, raising BS,
  preventing hunger, settling stomach
• Ideally high carb (3-5g/kg), moderate protein,
  low fat, with fluids and salt and PALATABLE 3-4
  hours before game
• Then use 1 hour top off CHO snack or drink
• Pre-comp meal CAN be closer to event if tolerated
  (example of early morning
  events)
• What to do with the athlete who says
  If I eat anything
  before I play Ill throw up!
• THINK LIQUIDS!
• Also produces lower stool residue for weight
  class sports or athletes sensitive to bulky
  feeling

71
Recovery Nutrition

• Defined helping athletes bounce back for future
  exercise bouts
• Considerations
• Intensity and duration of exercise
• When will athlete exercise again?
• Nutritional Recovery Goals
• Glycogen restoration
• Fluid/electrolyte replacement
• Muscle repair and adaptation

72
Recovery Nutrition

• General daily diet hydration status
• Pre-competition meal, fuel/fluids during exercise
• Training status
• Post-Exercise Recovery Period

WINDOW OF OPPORTUNITY for important gains
73
Recovery Nutrition(for intense, dehydrating
exercise)

• Ingredients Timing
• Fluids
• 24 ounces for every pound lost during exercise
  within 2 hours
• Need 150 of fluid loss to compensate for urine
  production
• Achieve body weight within 1 of start weight
  before next session
• Including sodium beneficial
• Carbohydrates
• .5 grams/kg body weight within 30 minutes
• TOTAL of 1.5 grams/kg body weight within 2 hours
• High glycemic index preferred
• Protein
• 10-20 grams protein within 30 minutes
• Does protein source matter?

ASAP
74
Barriers Benefits to Recovery
Nutrition

• Barriers
• Suppressed appetite
• Food/fluid availability
• Habits, sport routine
• Perceived impact on weight
• Benefits
• Enhanced performance in future exercise
• Lowered injury risk in future exercise
• Better compliance to training program
• Promotion of positive energy balance for weight
  gain
• Appetite control for meals

75
Personalize Recommendations

• What recovery nutrition recommendations might you
  give these individuals?

76
Recovery Options

• Regular foods drinks
• /OR
• Sports foods drinks
• Readily available
• Easily transported and stored
• Inexpensive (?)
• Do-able DAILY
• What does the research say about
  post-exercise protein source?

77
Sports MNT
78
Cardiovascular Risk Factors

• Age
• Sex
• Heredity
• High cholesterol and blood pressure
• Diabetes
• Obesity and overweight
• Physical inactivity
• Stress
• Tobacco, alcohol
• Increased incidence of high cholesterol, HTN,
  pre-diabetes, and obesity among YOUNG athletes in
  some sports
• Ethical challenge for Sports RDs!

79
19 Year Old Male Shot-Putter

• Weight 295lbs. Height 64
• TC 325mg/dL LDL 185mg/dL
• Advice he practices
• Eat high volume of food 6 times per day
• Eat low fat diet
• Increase cardiovascular exercise
• But resistance from coach
• Food treatment strategies
• Help athletes recognize that food can work FOR
  them
• Added beans legumes, nuts, margarines with
  plant sterols, oatmeal, whole grain cereals,
  fresh fruits, avocado, oil-based salad dressings
• TASTE WOW!, TC down to 240 in 6 months

80
50 Year Old Male Runner

• Runs about 6 miles/day, now training for marathon
  (his 5th)
• Family history of HTN, recently diagnosed with
  HTN
• Advice he practices
• Eat a low sodium diet
• Problem consistent muscle cramping in longer
  runs
• Food treatment strategies
• Increase dairy (currently 1 serving/day)
• Increase veggies to 4-5 servings of each/day
• Determine if hes SALT SENSITIVE
• Many individuals ARE NOT
• Experiment with Na content of diet and timing of
  Na intake (before/during/after exercise only?)

81
Muscle Cramping Inventory

• Adequate fluids?
• Adequate sodium?
• Sodium loss via sweat VARIES individually
• Can be 3000mg/hour case studies of 7000mg/hour
• Adequate other electrolytes?
• Adequate glycogen stores?
• Not a nutritional issue at all?

82
Gastrointestinal Issues

• Some are more frequent with athletes
• Some are exacerbated by physical activity
• Meal timing, dehydration, high calorie needs,
  hormonal effect on digestion, sports foods,
  jostling of stomach, shift of blood flow from GI
  tract to skeletal muscle, competition issues
• Issues GERD, IBS, runners diarrhea,
  constipation, gastritis, Celiac

83
Issues to Address with GI Problems

• Timing/spacing
• Anti-inflammatory meds
• Hydration issues
• Low fiber
• Excessive sports foods
• Excessive sugar alcohols
• Excessive fruit juices or highly concentrated
  drinks
• Caffeine/alcohol
• Food allergy or intolerance
• Lactose intolerance?
• Fructose intolerance?
• Dietary supplements

84
Athlete-Friendly/ GI-Friendly Foods

• Probiotics
• Probiotics are live microbial foods and food
  supplements that can be beneficial by improving
  microbial balance
• The most widely studied and utilized probiotics
  are the lactic acid bacteria (Lactobacillus and
  Bifidobacterium species)
• Just 1 yogurt/day with active cultures enhances
  the bodys ability to enhance digestion.
• Dried fruits or fruit bars (Fig bars, cereal
  bars)
• Oatmeal, nuts, beans
• Value of liquid calories before/during activity

85
Current Sports Nutrition Topics on the Horizon

• Macro micronutrients during exercise
• Nutrition periodization
• Inflammation
• Recovery and healing
• Food allergies intolerances
• Sickle cell trait
• Heat illness/heat stroke
• Nutrition and genetics
• Fitness vs. Fatness and mortality/health
• What happens after competition ends
• Changes in weight and nutritional needs, mental
  health status, results of concussion, long term
  effects of supplementation, orthopedic issues

86
Dietary Supplements

• Most commonly used in sports
• Anabolics or muscle builders
• Weight loss or fat loss supplements
• Energy boosters
• Herbs
• Vitamin-mineral supplements

87
Evaluate dietary supplements for

• Legality
• Check ncaa.org and other sport-specific
  guidelines
• Safety
• Purity
• Effectiveness

88
Questions to ask

• 1. Are claims backed in solid age-specific
  research?
• 2. What are the possible side effects?
• 3. Is the supplement legal, necessary and
  appropriate?
• 4. Is the company reputable?
• 5. Is it worth the risk? For athletes, the risk
  can be very great.
• 6. Is the athlete doing everything possible with
  his or her diet FIRST before relying on a
  supplement?
• NEW CONCERN athletes and staff being so careful
  that they are missing out on potentially valuable
  supplements

89
Dietary SupplementsMislabeled?

• Extensive results of over 100 common nutrition
  supplements by Advance Supplement Testing Systems
  found
• Pyruvate Label says 500 mg per tablet
• Tested at 106 mg per tablet
• Bulk Label says 50 g protein 0 g carbohydrate
• Builder Tested at 4 g protein 53 g
  carbohydrate

In many reviews 20 of supplements contained a
banned substance (not on the label)
90
Online tools for dietary supplement assessment

1. www.consumerlab.com Obtain a listing of all
   categories of supplements that have passed their
   tests for quality and purity. Good overview of
   supplement categories, reasons for use, and
   safety. Yearly fee 30.00

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Online tools for dietary supplement assessment

1. www.naturaldatabase.com Determine exact
   ingredients, potential benefits, potential side
   effects and drug/supplement interactions. Updated
   frequently by pharmacists. USP check. Yearly fee
   92.00

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Online tools for dietary supplement assessment

• http//www.nsf.org/Certified/Dietary/ NSF
  Certified Dietary Supplements Program.
• Verify the identity and quantity of dietary
  ingredients declared on product label.
• Ensure the product does not contain undeclared
  ingredients or unacceptable levels of
  contaminants.
• Demonstrate conformance to currently recommended
  industry GMPs for dietary supplements.

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Growth Hormone (HGH)

• Obviously banned. Side effects can include
  swelling, joint pain, diabetes symptoms,
  increased risk of some cancers.
• Adequate sleep can increase levels.
• High fat, excessive protein, high stress hormones
  can decrease levels.

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Invasion of the Energy Drink

• Energy drinks are different from sports drinks
• Contain caffeine, other stimulants, sometimes
  sugar, herbs, vitamins, etc.
• Some safety concerns for athletes
• Use nutrition, hydration, and lifestyle changes
  to improve energy level

• Energy drinks do not provide REAL energythey
  just help athletes feel energized.

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Caffeine Common Forms

• Common Form Average Amount of Caffeine
• Fixx Energy Drink (20 ounces) 500 mg
• Coffee, Drip (16 ounces) 170 mg
• Rockstar Energy Soda (16 ounces) 150 mg
• Sky Rocket Caffeinated Syrup (1 oz.) 100 mg
• Diet Pepsi Max (16 ounces) 92 mg
• Red Bull Energy Drink (8 ounces) 80 mg
• Mountain Dew soft drink (16 ounces) 75 mg
• Most soft drinks (16 ounces) 50 mg
• Espresso, 1 ounce shot 40 mg
• Brewed tea (8 ounces) 40 mg
• Jolt gum (1 piece) 40 mg
• Typical caffeine tabs 200 mg/each
• Vivarin tablet 200 mg/each

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Energy Drinks

• Some caffeine may enhance performance (dose for
  many athletes 2mg/pound 1 hour before exercise)
• Individual tolerance variessome experience
  nervousness, jitters, headaches, tachycardia, GI
  symptoms
• Its difficult to determine how much caffeine (or
  other stimulants) is in energy drinks. 100 to
  650mg have been reported.
• Concerns with alcoholputting one foot on the gas
  and the other on the brakes.

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Combine with Caution!

• Many manufacturers of ephedra-free products
  also commonly combine stimulants with
  aspirin-like substances in an attempt to mimic
  the ECA Stack with ephedrine, caffeine, and
  aspirin.
• Many caffeine-containing herbs and supplements
  interact with grapefruit juice (enhanced CNS
  effect).
• Watch for combinations like (1) Willow bark,
  green tea, and bitter orange (2) Green tea,
  mate, and kitjitsu (3) Caffeine, green tea,
  mate, guarana, and willow bark

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NO2 (arginine) based supplements

• Amino acid necessary for protein synthesis. Found
  naturally in meat, fish, poultry, and dairy.
• Arginine is the substrate for NOS enzyme,
  increasing NO (nitric oxide), causing
  vasodilation.
• No long-term studies on safety. Several
  anecdotal reports of concerning symptoms (severe
  headaches, rapid changes in blood flow, syncope,
  blood pressure changes).
• May pose high risk for athletes who have known or
  unknown vascular problems.

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NO2 supplements
Warning ON LABEL  For men only and not intended
for use by persons under 18. Do not use if you
have a myocardial infarction (heart attack). May
cause flushing and itching. Consult a medical
doctor before use if you have been treated for,
or diagnosed with, or have a family history of,
any medical condition including (but not limited
to) cardiovascular, central nervous system, or
genito-urinary problems, cold sores, or if you
are using any prescription or over the counter
medication(s). Inhalation may amplify the
inflammatory airway response in people with
asthma. One scoop of this product contains about
as much caffeine as between one and one and a
half cups of coffee. Do not consume with other
arginine products or other sources of caffeine
(e.g., tea, coffee, or cola beverages). Do not
take within 4 hours of exercising. Discontinue
use and call a medical doctor immediately if you
experience irregular heart beat, chest pain,
dizziness, headache, nausea, or other similar
symptoms.
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Creatine

• Creatine is synthesized in the liver, kidney, and
  pancreas and supplied through the diet
• Primary food sources are meat and fish usual
  diet in the U.S. provides 1-2g/day
• Recommended dose 3-5g/day
• NO LOADING period necessary unless need for rapid
  reach of maximal phosphocreatine stores!
• Most studies of repetitive, short-duration (lt30
  sec.), high-intensity tasks (strength training in
  particular) suggest modest improvement in
  performance

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Maximize creatine in foods

• Food Grams Creatine
• 8 ounces pork 1.1
• 8 ounces salmon 1.0
• 8 ounces beef 1.0
• 8 ounces cod 0.7

Supplemental Creatine Dose 3-5 grams/day
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Beta-Alanine

• A non-essential amino acid found both in the body
  and in food (i.e. chicken)
• Rate-limiting substance to carnosine production
  in the muscle cell
• Carnosine buffers hydrogen ions in the muscle
  (delaying the burn)
• Typical doses 3-6 grams/day

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Beta-Alanine Proposed Benefits

• Boosts explosive muscular strength power
  output.
• Increases muscle mass
• Boosts muscular anaerobic endurance
• Increases aerobic endurance
• Increase exercise capacity to train harder and
  longer

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Beta-Alanine

• In one recent study in 15 trained male
  sprinters, beta-alanine supplementation
  (4.8g/day)
• Increased muscle carnosine levels
• Attenuated muscle fatigue in repeated bouts of
  exhaustive contractions
• Did not improve isometric endurance or 400m race
  times.
• Derave et al. J Appl. Physiology August 2007
• 10.1152/japplphysiol.00397.2007

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One Last Thought

• Whenever possible, if you recommend against using
  a supplement, have a plan for helping your
  athlete meet the goal he felt the supplement was
  helping with.
• For example, if amino acids are not recommended,
  provide a plan for the athlete to maximize amino
  acids in protein on a daily basis.
• If stimulants are not recommended, show how to
  provide more modest boosts of caffeine in safe
  forms.

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Important teaching concept

• Fitness is more important than fatness!
• Dont let your recreational exercisers forget it!
• In a survey of women health club members,
  subjects said they would rather have a car
  accident, lose a job, go through a divorce, and
  even get cancer than gain 50 pounds.
• GLAMOUR Magazine, 2005
• LOSS OF PERSPECTIVE!!

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For further information

• Gatorade Sports Science Institute
• www.gssiweb.com
• SCAN
• www.scandpg.org
• Nutrition and athletic performance position of
  the American Dietetics Association, Dietitians of
  Canada, and the American College of Sports
  Medicine. JADA 2000 1543-56 (revision due 2007)
  available on www.eatright.org

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For further information

• American Council on Exercise
• www.acefitness.org
• American College of Sports Medicine
• www.acsm.org
• The Physician and Sports Medicine
• www.physsportsmed.com

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Michelle Rockwell MS, RD, CSSD michellerock1_at_aol.c
om Susan Kundrat MS, RD, CSSD kundrat_at_nutritionon
themove.net